ORCID Profile
0000-0002-0919-2235
Current Organisations
University of Sydney
,
World Health Organization
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Publisher: Elsevier BV
Date: 04-2021
DOI: 10.1016/J.EUO.2019.04.006
Abstract: Conservative management, specifically with active surveillance (AS), has emerged as the preferred approach for low-risk prostate cancer (LRPC). We evaluated the trend for conservative management (ie, no active treatment within 12mo of diagnosis) for LRPC in an Australian population-based cohort of men captured in the Prostate Cancer Outcomes Registry Victoria (PCOR-Vic). Of the 3201 men diagnosed with LRPC between January 2009 and December 2016, 60% (1928/3201) had conservative management, and 52% (1664/3201) were documented to be on AS. There was an increase in conservative management from 52% in 2009 to 73% in 2016 (p<0.001), largely attributable to an increase in AS from 33% in 2009 to 67% in 2016 (p<0.001). When stratified by age group, the increase in conservative management was more pronounced among younger patients: from 37% to 66% for men aged <60yr versus from 72% to 86% for men aged ≥70yr. In multivariable analyses, increasing age, lower prostate-specific antigen and clinical category, lower socioeconomic status, and being diagnosed in public metropolitan institutions were all independently associated with a greater likelihood of conservative management. Identification of sociodemographic and institutional variations in practice allows for targeted strategies to improve management for men with LRPC. PATIENT SUMMARY: We looked at the uptake of conservative management (no active treatment within 12 mo of diagnosis) over time in an Australian population-based cohort of men with low-risk prostate cancer. The proportion of men with low-risk prostate cancer managed conservatively increased from 52% in 2009 to 73% in 2016. The increase in the uptake of conservative management for low-risk prostate cancer in Australia is concordant with international guidelines and other international population-based studies.
Publisher: Elsevier BV
Date: 04-2022
Publisher: Springer Science and Business Media LLC
Date: 16-11-2010
Publisher: Elsevier BV
Date: 06-2020
DOI: 10.1016/J.PEC.2019.12.014
Abstract: To refine communication strategies to assist clinician conversations with vaccine hesitant and declining parents as part of the Sharing Knowledge About Immunisation (SKAI) package. We recorded and analysed consultations held in two Specialist Immunisation Clinics in tertiary hospitals in Australia between consenting clinicians and parents. We undertook content analysis that was both iterative and informed by the Calgary Cambridge Model of health communication and motivational interviewing. We found common strengths and opportunities in clinician's communication styles. Strengths included: rapport building communicating care for both the parent and child exhibiting depth of vaccination-specific communication skill and content knowledge. Opportunities for strengthening communication practices included: eliciting parents' concerns to saturation early in the consultation structuring the consultation to prioritise and address parents' concerns recognising and responding to parents' motivation to vaccinate effectively closing consultations. This study has synthesised clinical communication strategies from expert vaccination communicators using well-established communication frameworks to advance a unique approach to the challenging task of addressing vaccine hesitancy and refusal. The clinic observations helped us to create a structured consultation guide that can enhance and provide greater structure to a clinician's existing communication skills.
Publisher: Springer Science and Business Media LLC
Date: 13-07-2016
Publisher: Wiley
Date: 19-09-2005
DOI: 10.1002/AIC.10662
Publisher: Elsevier BV
Date: 10-2018
DOI: 10.1016/J.VACCINE.2017.10.077
Abstract: The SKAI (Sharing Knowledge About Immunisation) project aims to develop effective communication tools to support primary health care providers' consultations with parents who may be hesitant about vaccinating their children. This study explored parents' communication needs using a qualitative design. Parents of at least one child less than five years old were recruited from two major cities and a regional town known for high prevalence of vaccine objection. Focus groups of parents who held similar vaccination attitudes and intentions were convened to discuss experiences of vaccination consultations and explore their communication needs, including preferences. Draft written communication support tools were used to stimulate discussion and gauge acceptability of the tools. Important differences in communication needs between group types emerged. The least hesitant parent groups reported feeling reassured upon reading resources designed to address commonly observed concerns about vaccination. As hesitancy of the group members increased, so did their accounts of the volume and detail of information they required. Trust appeared to be related to apparent or perceived transparency. More hesitant groups displayed increased sensitivity and resistance to persuasive language forms.
Publisher: Wiley
Date: 31-05-2022
DOI: 10.1111/IMJ.15288
Abstract: Docetaxel has emerged as a standard‐of‐care for metastatic hormone‐sensitive prostate cancer (mHSPC). Uptake of docetaxel for mHSPC in Australia has not previously been reported. To investigate the real‐world uptake of docetaxel in mHSPC and to identify predictors of utilisation of docetaxel in mHSPC. Men diagnosed from June 2014 to December 2018 and enrolled in the Prostate Cancer Outcomes Registry‐Victoria (PCOR‐Vic) were included. Data collected include demographics, diagnosis method and institution, staging investigations and treatments within 12 months of diagnosis. Wilcoxon rank‐sum, Chi‐squared and trend tests were used to identify predictors of docetaxel utilisation. All predictors were entered as covariates simultaneously into a multivariable logistic regression model. Statistical significance was set at 0.05 (two sided). In all, 1014 men with mHSPC were analysed, 25% of whom received docetaxel with androgen deprivation therapy. Uptake of docetaxel increased from 20% in 2014 to 33% in 2018. Predictors of higher usage of docetaxel were younger age and treatment in a private hospital, with both remaining significant on multivariable analysis. Notably, the proportion of men aged years receiving docetaxel increased from 54% in 2014–2015 to 64% in 2016–2018, while in men aged ≥70 years the comparative figures were 15% and 22% respectively. Although docetaxel was not used in the majority of cases, there was a clear increase in docetaxel uptake, especially in younger men following publication of the CHAARTED and STAMPEDE trials. Identifying barriers to real‐world implementation of pivotal clinical trial data is critical to improving outcomes in mHSPC.
Publisher: BMJ
Date: 10-2018
DOI: 10.1136/BMJOPEN-2018-023044
Abstract: Very-low birthweight (VLBW, g) infants comprise about 1%–1.4% of all births in high-income countries. Every year, about 3000 VLBW babies in Australia and New Zealand receive intensive care. Many die or else survive with severe brain injury, retinopathy, late-onset sepsis or necrotising enterocolitis (NEC), each of which carries substantial risk of disability. This trial tests whether adding bovine lactoferrin (bLF) to feeds in VLBW infants improves (1) survival to hospital discharge free from brain injury, late-onset sepsis, NEC and treated retinopathy of prematurity (primary composite end point) (2) each component of the primary composite end point and (3) time to reach full enteral feeds, number of blood transfusions, chronic lung disease and length of hospital stay. It includes a cost-effectiveness analysis of bLF in improving survival free from major morbidity, and evaluates the effect of bLF on survival and developmental outcomes at 24 to 36 months corrected gestational age. This is a multicentre, two-arm, randomised trial comparing the treatment group receiving bLF added to breast milk or formula milk daily (up to 250 mg/kg/day bLF) versus the control group receiving no bLF supplementation. The intervention is administered until 34 completed weeks corrected gestation or for 2 weeks, whichever is longer, or until discharge home, if earlier. The target s le size of 1500 participants yields 85% power, at the two-sided 5% level significance, to detect a difference in proportions meeting the primary outcome assuming the true probability is 74% in controls and 80.5% in the bLF group. This protocol was approved by Northern Sydney Local Human Research Ethics Committee in January 2017 (Version 2.0, Reference 1003-118M) and other relevant ethics committees. The findings of the trial will be disseminated through peer-reviewed journals and conference presentations. ACTRN12611000247976 Pre-results.
Publisher: Wiley
Date: 14-10-2017
DOI: 10.1111/MCN.12383
Publisher: Wiley
Date: 25-07-2018
DOI: 10.1111/ANS.14722
Abstract: To update patterns of care for men diagnosed with prostate cancer in Victoria, Australia between 2008 and 2015. From August 2008 to December 2015, 14 025 men diagnosed with prostate cancer were included. These data were obtained from the Prostate Cancer Outcome Registry - Victoria (PCOR-Vic). Frequencies were used to describe hospital and patient characteristics and treatment types. Comparisons were made between previous period of analysis (2008-2011) to the most recent period (2011-2015). Survival analysis using a stepwise Cox proportional hazards regression model was performed. Mean age of diagnosis was 66.5 years and 44% of patients were diagnosed with Gleason 7 prostate cancer. Majority of notifications (63.6%) were received from a private institution and 70.2% of patients were diagnosed at a metropolitan institution. Most patients (95.3%) were diagnosed with clinically localized disease. Within 12 months of diagnosis, 55.9% of patients with low-risk disease received no active treatment. Radical prostatectomy was the most common primary treatment with curative intent (47%). When comparing of patterns of care between 2008-2011 and 2011-2015, the proportion of patients diagnosed with Gleason 9-10 disease increased, as has the proportion of patients diagnosed with metastatic disease. With the PCOR-Vic, we were able to identify that increasing number of patients were diagnosed with high-risk and metastatic disease. There has been an overall decrease in radical treatment rates, likely due to active surveillance playing a significant role especially in patients with low-risk prostate cancer.
Publisher: Wiley
Date: 10-2022
DOI: 10.14814/PHY2.15477
Publisher: Wiley
Date: 13-12-2008
Publisher: Wiley
Date: 11-10-2017
DOI: 10.1111/MCN.12388
Publisher: Wiley
Date: 24-05-2012
DOI: 10.1111/J.1465-3362.2011.00319.X
Abstract: Alcohol energy drinks (AEDs) are a recent entry to the ready-to-drink market, but there is an absence of research into the reasons young people consume these products and their consumption-related experiences. The aim of the current study was to investigate university students' perceptions of, and experiences with, pre-mixed AEDs. Four focus groups with undergraduate university students in a large regional city in New South Wales with transcripts coded for key themes. Participants reported a number of benefits of AED consumption, many of which were similar to other ready-to-drinks, such as taste and image. However, the primary benefits of AEDs related to their capacity to wake the drinker up at the beginning of the evening and facilitate partying and drinking over a longer period. Many of the participants reported experiencing or observing negative effects from drinking AEDs, some quite severe, but this did not appear to act as a deterrent to their consumption. Given the popularity and perceived benefits of AEDs-and evidence from previous research that their consumption is associated with increases in intoxication levels, risky behaviours and harmful alcohol-related consequences-there is a need to consider a range of strategies to reduce harmful consumption of AEDs. While educational interventions may be of benefit, there is also a role for regulation of the packaging and marketing of a product that is associated with substantial harms.
Publisher: Springer Science and Business Media LLC
Date: 13-01-2017
Publisher: Cambridge University Press (CUP)
Date: 16-06-2020
DOI: 10.1017/S1368980020000555
Abstract: This review collates the published reports that focus on microbial and viral illnesses that can be transmitted by breast milk, donor milk and powdered infant formula (PIF). In this context, we attempt to define a risk framework encompassing those hazards, exposure scenarios, vulnerability and protective factors. A literature search was performed for reported cases of morbidity and mortality associated with different infant feeding modes. Exclusive breast-feeding is the recommended for infant feeding under 6 months, or failing that, provision of donated human milk. However, the use of PIF remains high despite its intrinsic and extrinsic risk of microbial contamination, as well as the potential for adverse physiological effects, including infant gut dysbiosis. Viable pathogen transmission via breast-feeding or donor milk (pasteurised and unpasteurised) is rare. However, transmission of HIV and human T-cell lymphotropic virus-1 is a concern for breast-feeding mothers, particularly for mothers undertaking a mixed feeding mode (PIF and breast-feeding). In PIF, intrinsic and extrinsic microbial contamination, such as Cronobacter and Salmonella , remain significant identifiable causes of infant morbidity and mortality. Disease transmission through breast-feeding or donor human milk is rare, most likely owing to its complex intrinsically protective composition of human milk and protection of the infant gut lining. Contamination of PIF and the morbidity associated with this is likely underappreciated in terms of community risk. A better system of safe donor milk sharing that also establishes security of supply for non-hospitalised healthy infants in need of breast milk would reduce the reliance on PIF.
Publisher: Elsevier BV
Date: 2021
Publisher: BMJ
Date: 29-06-2012
Abstract: This study compares the formula milk advertisements that appeared in parenting magazines published in two countries that have enacted measures to restrict the advertising of infant formula products in response to the international code with two that have not. Content analysis was used to compare the type and frequency of formula milk advertisements that appeared in parenting magazines collected from the USA, Canada, the UK and Australia during 2007, and to examine whether there was a relationship between these frequencies and advertising regulations. Advertisements that promoted formula products or brands occurred in all of the magazines s led but the type of product advertised differed. Follow-on formula advertisements occurred more frequently in titles from the UK, where infant formula advertising is prohibited (RR 3.82, 95% CI 2.65 to 5.50, p<0.0001) than they did in titles from the USA/Canada where infant and/or follow-on formula advertising is permitted. Toddler milk advertisements appeared more frequently in titles from Australia, where infant and follow-on formula advertising is prohibited, than they did in titles from countries where direct-to-consumer infant and/or follow-on formula advertising is permitted. Rate ratios were as follows: UK only 0.03 (95% CI 0.01 to 0.11, p<0.0001) USA/Canada only 0.02 (95% CI 0.01 to 0.06, p<0.0001). Bans on the advertising of infant formula products do not prevent companies from advertising (follow-on or toddler formula). These products are presented in ways that encourage consumers to associate the claims made in them with a group of products (a product line) that includes infant formula.
Publisher: Springer Science and Business Media LLC
Date: 11-09-2020
DOI: 10.1186/S12913-020-05713-5
Abstract: Benchmarking outcomes across settings commonly requires risk-adjustment for co-morbidities that must be derived from extant sources that were designed for other purposes. A question arises as to the extent to which differing available sources for health data will be concordant when inferring the type and severity of co-morbidities, how close are these to the “truth”. We studied the level of concordance for same-patient comorbidity data extracted from administrative data (coded from International Classification of Diseases, Australian modification,10th edition [ICD-10 AM]), from the medical chart audit, and data self-reported by men with prostate cancer who had undergone a radical prostatectomy. We included six hospitals (5 public and 1 private) contributing to the Prostate Cancer Outcomes Registry-Victoria (PCOR-Vic) in the study. Eligible patients from the PCOR-Vic underwent a radical prostatectomy between January 2017 and April 2018.Health Information Manager’s in each hospital, provided each patient’s associated administrative ICD-10 AM comorbidity codes. Medical charts were reviewed to extract comorbidity data. The self-reported comorbidity questionnaire (SCQ) was distributed through PCOR-Vic to eligible men. The percentage agreement between the administrative data, medical charts and self-reports ranged from 92 to 99% in the 122 patients from the 217 eligible participants who responded to the questionnaire. The presence of comorbidities showed a poor level of agreement between data sources. Relying on a single data source to generate comorbidity indices for risk-modelling purposes may fail to capture the reality of a patient’s disease profile. There does not appear to be a ‘gold-standard’ data source for the collection of data on comorbidities.
Publisher: Oxford University Press (OUP)
Date: 06-11-2013
DOI: 10.1007/S12160-012-9424-Z
Abstract: There is limited evidence for effective obesity treatment programs that engage men. This study evaluated the efficacy of two gender-tailored weight loss interventions for men, which required no face-to-face contact. This was a three-arm, randomized controlled trial: (1) Resources (n = 54), gender-tailored weight loss materials (DVD, handbooks, pedometer, tape measure) (2) Online (n = 53), Resources materials plus study website and e-feedback and (3) Wait-list control (n = 52). The interventions lasted 3 months and were grounded in Social Cognitive Theory. At 6 months, significantly greater weight loss was observed for the Online (-4.7 kg 95 % CI -6.1, -3.2) and Resources (-3.7 kg 95 % CI -4.9, -2.5) groups compared to the control (-0.5 kg 95 % CI -1.4, 0.4). Additionally, both intervention groups significantly improved body mass index, percent body fat, waist circumference, blood pressure, physical activity, quality of life, alcohol risk, and portion size, compared to controls. Men achieved significant weight loss after receiving novel, minimal-contact, gender-tailored programs, which were designed for widespread dissemination.
Publisher: AMPCo
Date: 28-05-2018
DOI: 10.5694/MJA17.00559
Abstract: To characterise the practice of active surveillance (AS) for men with low risk prostate cancer by examining the characteristics of those who commence AS, the rate of adherence to accepted AS follow-up protocols over 2 years, and factors associated with good adherence. Design, setting: Retrospective cohort study analysis of data collected from 38 sites participating in the Prostate Cancer Outcomes Registry-Victoria. Men diagnosed with prostate cancer between August 2008 and December 2014 aged 75 years or less at diagnosis, managed by AS for at least 2 years, and with an ISUP grade group of 3 or less (Gleason score no worse than 4 + 3 = 7). Adherence to an AS schedule consisting of at least three PSA measurements and at least one biopsy in the 2 years following diagnosis. Of 1635 men eligible for inclusion in the analysis, 433 (26.5%) adhered to the AS protocol. The significant predictor of adherence in the multivariate model was being diagnosed in a private hospital (v public hospital: adjusted odds ratio [aOR], 1.83 95% CI, 1.42-2.37 P < 0.001). Significant predictors of non-adherence included being diagnosed by transurethral resection of the prostate (v transrectal ultrasound biopsy [TRUS]: OR, 0.54 95% CI, 0.39-0.77 P < 0.001) or transperineal biopsy (v TRUS: OR, 0.32 95% CI, 0.19-0.52 P < 0.001), and being 66 years of age or more at diagnosis (v < 55 years: OR, 0.65 95% CI, 0.45-0.92 P = 0.015). Almost three-quarters of men who had prostate cancer with low risk of disease progression did not have follow-up investigations consistent with standard AS protocols. The clinical consequences of this shortcoming are unknown.
Publisher: Springer Science and Business Media LLC
Date: 04-05-2022
DOI: 10.1007/S13668-022-00414-3
Abstract: Globally, too few children are breastfed as recommended. Commercial promotion of breast-milk substitutes (BMS) is one factor undermining breastfeeding globally. Although the International Code of Marketing of BMS prohibits all forms of marketing, promotion has been observed in digital environments. We aimed to understand the scope and impact of digital marketing for the promotion of BMS. BMS are promoted strategically and in an integrated fashion across multiple digital channels (social media, manufacturer websites, online retailers, blogs, mobile apps and digital streaming services). Traditional marketing strategies like gifts, discounts and coupons are also disseminated digitally. Data mining, real-time direct-to-consumer advertising and partnering with peer-group social media influencers are additional avenues. Exposure to digital marketing is common. Research on the impact of digital marketing is scarce, but its negative impact on breastfeeding intention and initiation has been documented. Case reports from marketing industry press corroborate academic evidence by highlighting the benefits of digital marketing to BMS companies in recruiting new users and increasing sales. To protect and promote breastfeeding, coordinated global action and strengthened national measures will be needed to implement, monitor and enforce the International Code in a digital context. Further action could include voluntary restrictions on BMS marketing by social media platforms and greater use of government-led data and health privacy regulation.
Publisher: Elsevier BV
Date: 03-2023
Publisher: Springer Science and Business Media LLC
Date: 2011
Publisher: Elsevier BV
Date: 08-2006
Publisher: Springer Science and Business Media LLC
Date: 26-11-2018
DOI: 10.1007/S11136-018-2061-7
Abstract: The purpose of the study was to compare completeness, timeliness and cost of patient-reported outcome measures (PROMs) collection using telephone, email and post in men with prostate cancer. A parallel, three-arm randomised controlled equivalence trial. 1168 patients were randomised to telephone (n = 295), postal (n = 388) and email (n = 385) arms. Participants were asked to provide self-reported responses for 26 items of Expanded Prostate Cancer Index Composite. Cost and resource data were collected from a provider perspective. Equivalence tests showed no difference in completeness in the three arms within a 10% equivalence margin. Men diagnosed in public hospitals were less likely to complete the survey compared to those in private hospitals, OR = 0.19 (95% CI 0.04-0.89) (p = 0.035). The email survey required significantly less time to complete than telephone and postal methods [median time of 2 min (IQR 1,8) vs. 7 min (IQR 6,9) vs. 10 min (IQR 9,12), respectively (p < 0.001)]. The incremental cost effectiveness ratio for email compared to telephone was AUD$1.90, cost-effective if users valued an additional 1% improvement in survey completion greater than AUD$1.90. Email method took less time and cost and should be used as the primary PROMs collection, with telephone if men without email or do not respond to email.
Publisher: SAGE Publications
Date: 02-2012
DOI: 10.1016/J.AUSMJ.2011.10.011
Abstract: The Marketing in Australia of Infant Formula: Manufacturers’ and Importers’ Agreement prevents manufacturers and importers from advertising infant formula. However, toddler milks, which share brand identities with infant formula, are advertised freely and recent research suggests consumers fail to distinguish between advertising for infant formula and for toddler milk. This study examined whether Australian parents recalled having seen advertisements for ‘formula’. Most respondents (66.8%) reported seeing an advertisement for infant formula, with those who had only seen non-retail advertising more than twice as likely to believe that they had seen such an advertisement as those who had only seen retail advertising. This suggests that toddler milk advertisements are functioning as defacto infant formula advertisements in Australia.
Publisher: Wiley
Date: 08-10-2021
DOI: 10.1002/PON.5833
Abstract: Feeling depressed and lethargic are common side effects of prostate cancer (PCa) and its treatments. We examined the incidence and severity of feeling depressed and lack of energy in patients in a population based PCa registry. We included men diagnosed with PCa between 2015 and 2019 in Victoria, Australia, and enrolled in the Prostate Cancer Outcomes Registry. The primary outcome measures were responses to two questions on the Expanded Prostate Cancer Index Composite (EPIC‐26) patient reported instrument: problems with feeling depressed and problems with lack of energy 12 months following treatment. We evaluated associations between these and age, cancer risk category, treatment type, and urinary, bowel, and sexual function. Both outcome questions were answered by 9712 out of 12,628 (77%) men. 981 patients (10%) reported at least moderate problems with feeling depressed 1563 (16%) had at least moderate problems with lack of energy and 586 (6.0%) with both. Younger men reported feeling depressed more frequently than older men. Lack of energy was more common for treatments that included androgen deprivation therapy than not (moderate/big problems: 31% vs. 13%), irrespective of disease risk category. Both outcomes were associated with poorer urinary, bowel, and sexual functional domain scores. Self‐reported depressive feelings and lack of energy were frequent in this population‐based registry. Problems with feeling depressed were more common in younger men and lack of energy more common in men having hormonal treatment. Clinicians should be aware of the incidence of these symptoms in these at‐risk groups and be able to screen for them.
Publisher: Wiley
Date: 05-03-2021
Abstract: There has been a growing body of evidence highlighting the improved sensitivity and specificity for prostate specific membrane antigen (PSMA) positron emission tomography (PET) in advanced prostate cancer imaging. We aimed to assess prostate cancer staging practice patterns in Australia using population‐based data. We extracted data on men diagnosed with prostate cancer between October 2016 and December 2018 from the Prostate Cancer Outcomes Registry‐Victoria (PCOR‐Vic). We evaluated trends and comparisons between patients receiving PET/CT (with or without conventional imaging (CImg)), and CImg alone, and analysed imaging modality as predictor of clinical regional node positive disease (cN1 vs cN0/X), metastatic disease (cM1 vs cM0/X), and treatment received. In total, 6139 patients in the registry had either a staging PET scan ( n = 889, 14%), CImg without PET scan ( n = 2464, 40%), or no recorded PET or CImg ( n = 2786, 45%). The proportion of allimaged patients who received staging PET increased from 19% to 36% from the first to last three‐month period, and in the high‐risk category the increase was 23–43%. After adjustment for grade group, PET vs CImg‐only patients were observed to have a higher proportion of cN1 disease (OR = 2.46, 95% CI: 1.90–3.20) but not cM1 disease (OR = 1.10, 95% CI: 0.84–1.44). Our registry data highlights the rapid uptake of PET imaging, particularly in high‐risk disease. Based on this data, we highlight the increased diagnosis of nodal disease, thus potentially optimizing patient selection prior to definitive treatment for prostate cancer.
Location: Australia
Start Date: 2016
End Date: 2017
Funder: University of Sydney
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