ORCID Profile
0000-0002-2890-527X
Current Organisation
University of Sydney
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Publisher: American Physical Society (APS)
Date: 21-09-2016
Publisher: Elsevier BV
Date: 08-2018
DOI: 10.1016/J.JPAINSYMMAN.2018.03.022
Abstract: Increasing emphases are being placed on early integration of palliative care for patients with advanced cancers, yet barriers to implementation in clinical practice remain. Criteria to standardize referral have been endorsed, but their application is yet to be tested at the population level. This study sought to establish the need for standardized referral by examining current end-of-life care outcomes of decedents with cancer and define transition points within a cancer illness course, which are associated with poor prognosis, whereby palliative care should be routinely introduced to augment clinician-based decision making. Population cohort study of admitted patients with advanced cancer diagnosed with non-small cell lung cancer (NSCLC), small cell lung cancer (SCLC), prostate or breast cancer between 2000 and 2010 in Victoria, Australia, identified from routinely collected, linked, hospital discharge, emergency department, and death registration data. Descriptive statistics described quality indicators for end-of-life care outcomes for decedents. Kaplan-Meier analyses were used to test the predefined transition point that mostly accurately predicted survival of six months or lesser. About 46,700 cases (56% females) were admitted with metastatic NSCLC (n = 14,759 31.6%), SCLC (n = 2932 6%), prostate (n = 9445 20.2%), and breast cancer (n = 19,564 41.9%). Of the 29,680 decedents, most (80%) died in hospital, had suboptimal end-of-life care outcomes (83%), and 59% received a palliative approach to care, a median of 27 days before death. Transition points in the cancer illness course of all cases were identified as first admission with any metastatic disease (NSCLC: 3.8 months [interquartile range {IQR} 1.1, 16.0] n = 14,666 and SCLC: 4.2 months [IQR 1.0, 10.6] n = 2914) first multiday admission with any metastatic disease (prostate: 6.0 months [IQR 1.3, 26.4] n = 7174) and first multiday admission with at least one visceral metastatic site (breast: 6.0 months [IQR 1.2, 29.8] n = 7120). Despite calls for integrated palliative care, this occurs late or not at all for many patients with cancer. Our findings demonstrate the application of targeted cancer-specific transition points to trigger integration of palliative care as a standard part of quality oncological care and augment clinician-based referral in routine clinical practice.
Publisher: IOP Publishing
Date: 24-07-2014
Publisher: Wiley
Date: 06-2021
DOI: 10.1111/IMJ.15361
Abstract: Regulatory changes now permit the availability and prescribing of medicinal cannabis in Australia. Public awareness and patient interest are high. Using a co‐design approach involving cancer patients, carers and oncology and palliative care clinicians, two information resources were developed to provide readily available sources of important information for cancer patients and clinicians who are considering the use of medicinal cannabis. Focus groups and evaluation interviews revealed some areas of dissonance between consumers and clinicians concerning aspects of medicinal cannabis.
Publisher: SAGE Publications
Date: 24-08-2022
DOI: 10.1177/02692163221118205
Abstract: Mature evidence exists supporting the integration of palliative care in cancer care, but translation of evidence into practice is less well understood. We sought to understand current access to palliative care and its timing for people with cancer and to compare practices over time. We conducted a retrospective population cohort study using routinely collected administrative health data sets in Victoria, Australia. All adult cancer decedents in 2018 were identified and clinical, demographic, palliative care access and quality of end of life care indices collected. Comparisons between a historic cohort of lung, breast and prostate cancer patients who died between the years 2005 and 2009 and those with these diagnoses in the current cohort. In 2018 there were 10,245 Victorian decedents with a cancer-coded cause of death, of these 3689 had lung, prostate or breast cancer. In 2018, access to palliative care increased (66% vs 54%) and greater numbers accessed palliative care more than 3 months before death (18% vs 10%) than in 2005–2009. Indices of end of life quality improved across most domains. However the median time between first palliative care and death was shorter in 2018 (22 vs 25 days) and more people first accessed palliative care in the hospitalisation during which they died (43% vs 33%). Despite established benefits of early palliative care, the important task of translation of this evidence into practice remains.
Publisher: IOP Publishing
Date: 29-11-2011
Publisher: American Physical Society (APS)
Date: 06-10-2017
Publisher: Informa UK Limited
Date: 27-09-2022
DOI: 10.1080/00140139.2021.1980115
Abstract: Prolonged periods of stationary behaviour, a common occurrence in many office workplaces, are linked with a range of physical disorders. Investigating the physical context of this behaviour may be a key to developing effective interventions. This study aimed to estimate and locate the stationary and movement behaviours of office workers (
Publisher: IOP Publishing
Date: 28-06-2011
Publisher: Mary Ann Liebert Inc
Date: 03-2023
Publisher: American Physical Society (APS)
Date: 28-01-2013
Publisher: MyJove Corporation
Date: 24-04-2014
DOI: 10.3791/51184
Publisher: American Physical Society (APS)
Date: 02-07-2014
Publisher: The Optical Society
Date: 02-04-2012
DOI: 10.1364/OE.20.008915
Publisher: IOP Publishing
Date: 06-02-2013
Publisher: MDPI AG
Date: 12-04-2019
Abstract: Background: Patients who discharge against medical advice (DAMA) from hospital carry a significant risk of readmission and have increased rates of morbidity and mortality. We sought to identify the demographic and clinical characteristics of DAMA patients from a tertiary paediatric hospital. Methods: Data were extracted retrospectively from electronic medical records for all inpatient admissions over a 5-year period. Demographic characteristics (age, sex, Aboriginality, socioeconomic status and remoteness of residence) and clinical characteristics (admitting hospital site, level of urgency on admission, diagnosis and previous DAMA) were extracted and logistic regression models were used to identify predictors of DAMA with 95% confidence intervals. Results: There were 246,359 admissions for 124,757 patients, of which 1871 (0.8%) admissions and 1730 patients (1.4%) DAMA. Predictors of DAMA in a given admission were hospital site (OR 4.8, CI 4.2–5.7, p 0.01), a mental health/behavioural diagnosis (OR 3.3, CI 2.2–4.8, p 0.01), Aboriginality (OR 1.6, CI 1.3–2.1, p 0.01), emergency rather than elective admissions (OR 0.7ha, CI 0.6–0.8, p 0.01), a gastrointestinal diagnosis (OR 1.5, CI 1.1–2.0, p = 0.04) and a history of previous DAMA (OR 2.0, CI 1.2–3.2, p = 0.05). Conclusions: There are clear predictors of DAMA in this tertiary hospital admission cohort and identification of these provides opportunities for intervention at a practice and policy level in order to prevent adverse outcomes.
Publisher: Oxford University Press (OUP)
Date: 27-07-2017
Publisher: Wiley
Date: 07-08-2020
DOI: 10.1111/CDOE.12567
Abstract: To evaluate the effectiveness of health promotion interventions on oral health knowledge, behaviour and status of healthy adolescents. This review included randomized controlled trials (RCTs) of oral health promotion interventions targeting adolescents. Primary clinical outcomes (gingival health, plaque scores, caries) and secondary proxy outcomes were evaluated. Meta-analysis of primary outcomes was conducted where possible, with subgroup analysis based on intervention (comprehensive health promotion and education-only). Thirty-seven eligible publications reporting on 28 unique RCTs of oral health promotion interventions were included. Quality appraisal of studies ranged from 48% to 96%. Interventions reported ranged from single-session interventions to community-wide programmes, including clinical preventive procedures and take-home products. Half used a health behaviour change theory to inform their intervention. The meta-analysis pooling of results favoured the intervention over control for all clinical outcomes, except DMFS in the education-only subgroup. Stronger intervention effects were seen in the comprehensive intervention subgroup than the education-only subgroup for DMFS (P = .02). This effect was slight, but not as clear in all other clinical categories. The majority of studies reported improvements in oral health knowledge, attitudes and behaviours. More positive outcomes were found with longer programmes, especially for dental caries outcomes. Oral health promotion programmes targeting adolescents have the ability to improve clinical oral health outcomes in the short and long term. Programmes should use more behavioural theory-based interactive and strategic methods, including self-awareness and the use of the wider community and peers for oral health promotion activities over a longer intervention duration.
Publisher: The Royal Society
Date: 22-05-2019
Abstract: In the wild, prey species often live in the vicinity of predators, rendering the ability to assess risk on a moment-to-moment basis crucial to survival. Visual cues are important as they allow prey to assess predator species, size, proximity and behaviour. However, few studies have explicitly examined prey's ability to assess risk based on predator behaviour and orientation. Using mosquitofish, Gambusia holbrooki , and their predator, jade perch, Scortum barcoo , under controlled conditions, we provide some of the first fine-scale characterization of how prey adapt their behaviour according to their continuous assessment of risk based on both predator behaviour and angular distance to the predator's mouth. When these predators were inactive and posed less of an immediate threat, prey within the attack cone of the predator showed reductions in speed and acceleration characteristic of predator-inspection behaviour. However, when predators became active, prey swam faster with greater acceleration and were closer together within the attack cone of predators. Most importantly, this study provides evidence that prey do not adopt a uniform response to the presence of a predator. Instead, we demonstrate that prey are capable of rapidly and dynamically updating their assessment of risk and showing fine-scale adjustments to their behaviour.
Publisher: American Physical Society (APS)
Date: 20-02-2014
Publisher: American Physical Society (APS)
Date: 26-05-2017
Publisher: Cambridge University Press (CUP)
Date: 08-2023
DOI: 10.1017/S1478951523001153
Abstract: To explore the perceptions of parents caring for a child with a life-limiting condition on approaches to communication used by clinicians engaging in routine serious illness communication. An exploratory qualitative design was used, employing a thematic analysis of data derived through semi-structured interviews which presented hypothetical vignettes of serious illness conversations to elicit parental perspectives. Adult parents of children with a life-limiting condition, in a stable phase of care, known to the Neurodevelopment and Disability Department of a tertiary Children’s Hospital in Melbourne, Australia, were purposively s led to achieve a broad representation of relevant clinical and sociodemographic factors. Eleven parents (72% female) of children aged 7 months to 18 years participated. Two major themes characterized parental perspectives on serious illness communication: “Approaches clinicians can use to lay the foundation for quality communication” including checking in, validation, aligning with hopes and a commitment to listening and being present and “Approaches clinicians can use to aid the delivery of information” including honesty and compassion, presenting possibilities, providing a plan, and conveying the clinician’s experience. This study provides novel insights into the perspectives of parents of children with life-limiting conditions that inform how clinicians may best approach serious illness communication. The findings highlight the need for clinicians working in pediatric health care to be cognizant of parents’ needs before and during conversations. Laying the foundation for quality communication is important alongside the approaches outlined that aid in the delivery of information.
Publisher: The Optical Society
Date: 25-04-2014
DOI: 10.1364/OE.22.010642
Publisher: American Physical Society (APS)
Date: 27-04-2010
Publisher: American Physical Society (APS)
Date: 18-11-2013
Publisher: Elsevier BV
Date: 07-2023
Publisher: IOP Publishing
Date: 03-2014
Publisher: Springer Science and Business Media LLC
Date: 16-05-2016
DOI: 10.1038/SREP25890
Abstract: We apply an online optimization process based on machine learning to the production of Bose-Einstein condensates (BEC). BEC is typically created with an exponential evaporation r that is optimal for ergodic dynamics with two-body s-wave interactions and no other loss rates, but likely sub-optimal for real experiments. Through repeated machine-controlled scientific experimentation and observations our ‘learner’ discovers an optimal evaporation r for BEC production. In contrast to previous work, our learner uses a Gaussian process to develop a statistical model of the relationship between the parameters it controls and the quality of the BEC produced. We demonstrate that the Gaussian process machine learner is able to discover a r that produces high quality BECs in 10 times fewer iterations than a previously used online optimization technique. Furthermore, we show the internal model developed can be used to determine which parameters are essential in BEC creation and which are unimportant, providing insight into the optimization process of the system.
Publisher: Proceedings of the National Academy of Sciences
Date: 16-04-2018
Abstract: Different combinations and permutations of transcription factors work together to regulate the expression of target genes. These proteins often contain high levels of intrinsically disordered regions, which are important mediators of protein–protein interactions. We show that unusual binding kinetics associated with an intrinsically disordered region in a transcriptional coregulator can regulate the formation of transcriptional complexes that lead to the specification of neuronal cell subtypes. Notably, a single intrinsically disordered region shows selective differences in binding kinetics for proteins of the same family, which have implications for how intrinsic disorder contributes to regulatory processes and complexity in higher organisms.
Publisher: BMJ
Date: 31-12-2021
DOI: 10.1136/BMJSPCARE-2021-003087
Abstract: It is essential that the physical environments in which inpatient palliative care is provided support the needs of patients and the facilitate the multidimensional delivery of palliative care. This review aims to identify the features and characteristics of inpatient palliative care environments that enhance or detract from the patient experience and identify opportunities for progress within this field. Three databases were searched: MEDLINE (1946–2020), PsycINFO (1806–2020) and CINAHL (1937–2020). Articles were screened by title and abstract with included studies read in full for data extraction. Data synthesis involved thematic analysis informed by the findings of the included literature. Inclusion criteria were studies with empirical methodology examining adult palliative care in the hospital, hospice or nursing home environment. Studies that examined palliative care delivered within the emergency department, ICU or within the home were excluded, as were those related to paediatric palliative care. Four main themes were identified: the provision of privacy, facilitating interactions with family, facilitating comfort through homeliness and connections to nature. The board acceptance of single rooms as the preeminent design solution for supporting privacy, dignity and family interaction, alongside current conceptions of homeliness that typically focus on matters of interior design, are limiting possibilities for further design innovation within palliative care settings. Research that investigates a broader set of design strategies through which the built environment can support care, alongside enhanced interdisciplinary collaboration, could positively contribute to patient and family experiences of inpatient palliative care.
Publisher: Springer Science and Business Media LLC
Date: 12-07-2016
DOI: 10.1007/S11060-016-2194-X
Abstract: Over half of glioblastoma (GBM) cases are diagnosed in patients older than 65 years. Their median overall survival (OS) is 4-5 months, compared with 12-14 months in patients younger than 70 years. This retrospective audit aims to identify patterns of care and survival of patients diagnosed with GBM at a single institution in Melbourne, Australia. Consecutive histological diagnoses of adult primary GBM from January 2010 to December 2012 were retrospectively identified from medical records. Demographic, treatment and survival characteristics were recorded until death, with follow-up to January 1st 2015. Survival was estimated by Kaplan-Meier method. Planned, sub-group analyses were conducted using multivariate Cox proportional hazards model to identify differences between elderly and younger cohorts, as well as ECOG. 165 patients were identified (36 % aged ≥70 years). Those ≥70 years had a poorer performance status (ECOG 3-4: 27 vs 10 %, p = .005) poorer median OS (2.6 vs 11.5 months, p < .001) and were less likely to receive adjuvant treatment (no treatment: 40 vs 16 %, p < .001) compared with patients .05), after adjusting for other clinical factors. Significant predictors of poorer os were poor performance status (p = .001), bilateral tumours (p = .04), biopsy only (p = .001), and no adjuvant treatment (p < .001). In patients diagnosed with GBM, those older than 70 years often present with poor performance status, are less likely to receive adjuvant treatment and have inferior os compared with younger patients. Treatment recommendations should be based on performance status/fitness, not age alone.
No related grants have been discovered for Gordon McDonald.