ORCID Profile
0000-0001-9375-3762
Current Organisations
Alfred Health
,
Monash Alfred Psychiatry Research Centre
,
Royal Melbourne Hospital
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Publications
Comparing survival and mortality in patients with late-onset and young-onset vascular dementia
Publisher: Cambridge University Press (CUP)
Date: 13-04-2023
DOI: 10.1017/S1041610223000248
Abstract: Vascular dementia (VD) is one of the more common types of dementia. Much is known about VD in older adults in terms of survival and associated risk factors, but comparatively less is known about VD in a younger population. This study aimed to investigate survival in people with young-onset VD (YO-VD) compared to those with late-onset VD (LO-VD) and to investigate predictors of mortality. Retrospective file review from 1992 to 2014. The inpatient unit of a tertiary neuropsychiatry service in Victoria, Australia. Inpatients with a diagnosis of VD. Mortality information was obtained from the Australian Institute of Health and Welfare. Clinical variables included age of onset, sex, vascular risk factors, structural neuroimaging, and Hachinksi scores. Statistical analyses used were Kaplan–Meier curves for median survival and Cox regression for predictors of mortality. Eighty-four participants were included with few clinical differences between the LO-VD and YO-VD groups. Sixty-eight (81%) had died. Median survival was 9.9 years (95% confidence interval 7.9, 11.7), with those with LO-VD having significantly shorter survival compared to those with YO-VD (6.1 years and 12.8 years, respectively) and proportionally more with LO-VD had died (94.6%) compared to those with YO-VD (67.5%), χ2(1) = 9.16, p = 0.002. The only significant predictor of mortality was increasing age ( p = 0.001). While there were few clinical differences, and older age was the only factor associated with survival, further research into the effects of managing cardiovascular risk factors and their impact on survival are recommended.
Improving healthcare team harmony through collaborative team reflection and mindfulness
Publisher: Cold Spring Harbor Laboratory
Date: 26-07-2023
DOI: 10.1101/2023.07.25.23293060
Abstract: Hospital wards, staffed by the multidisciplinary team, are complex environments where teamwork, communication and psychological safety is essential for coordinated care delivery, yet are faced with challenges such as staffing changes and complex care needs. However, there is little literature on interventions to assist staff connect as a team. We evaluated a brief daily group based on team reflection and mindfulness aimed at a multidisciplinary general medicine team, using measures of team functioning (effectiveness, communication, and psychological safety). We found that participants reported significant improvement in the meeting’s effectiveness ( U= 184, p=0.013), team morale ( U= 123, p .001), and focus ( U= 183, p .001) after the program’s commencement. Furthermore, participants who attended the program for at least a week reported they felt more psychologically safe ( U= 116, p=0.032). We also found significant positive correlation between measures of team functioning and the number of sessions they attended the program (effectiveness of the interdisciplinary meeting r=0.509, p .001 team’s communication and functioning (r=0.509, p .001). The post-intervention focus group highlighted the program helped build relationships within the team, improve psychological safety, and subsequently shifted the team’s behaviour to be more supportive of the overall team. Our program improved the functioning of a multidisciplinary healthcare team, with the overall aim to deliver better patient care.
Cerebrospinal fluid neurofilament light predicts longitudinal diagnostic change in patients with psychiatric and neurodegenerative disorders
Publisher: Cambridge University Press (CUP)
Date: 28-04-2023
DOI: 10.1017/NEU.2023.25
Abstract: People with neuropsychiatric symptoms often experience delay in accurate diagnosis. Although cerebrospinal fluid neurofilament light (CSF NfL) shows promise in distinguishing neurodegenerative disorders (ND) from psychiatric disorders (PSY), its accuracy in a diagnostically challenging cohort longitudinally is unknown. We collected longitudinal diagnostic information (mean = 36 months) from patients assessed at a neuropsychiatry service, categorising diagnoses as ND/mild cognitive impairment/other neurological disorders (ND/MCI/other) and PSY. We pre-specified NfL 582 pg/mL as indicative of ND/MCI/other. Diagnostic category changed from initial to final diagnosis for 23% (49/212) of patients. NfL predicted the final diagnostic category for 92% (22/24) of these and predicted final diagnostic category overall (ND/MCI/other vs. PSY) in 88% (187/212), compared to 77% (163/212) with clinical assessment alone. CSF NfL improved diagnostic accuracy, with potential to have led to earlier, accurate diagnosis in a real-world setting using a pre-specified cut-off, adding weight to translation of NfL into clinical practice.
Carer burden and psychological distress in young‐onset dementia: An Australian perspective
Publisher: Wiley
Date: 16-06-2022
DOI: 10.1002/GPS.5765
Abstract: Carer burden in dementia is associated with poor outcomes, including early nursing home placement for people with dementia and psychological distress for their carers. Carers of people with young‐onset dementia (YOD) are particularly vulnerable to carer burden. Yet they are often overlooked by clinicians as dementia services are generally designed for older people. We sought to estimate the rate of burden and psychological distress in carers of YOD at a state‐wide tertiary service based in Australia. We conducted a cross‐sectional study examining 71 dyads from a Neuropsychiatry service. We collected patient demographic and clinical data including the Neuropsychiatry Unit Cognitive Assessment tool (NUCOG) and Mini‐Mental State Examination (MMSE). Carer data, such as demographics and psychological distress, were obtained using Depression Anxiety Stress Scale 21 (DASS‐21). Carer burden was rated using the Zarit Burden Inventory‐short version (ZBI). Higher carer burden, measured using ZBI, was associated with longer duration of dementia and greater severity of overall cognitive impairment. Carers who felt burdened reported higher levels of stress, depression, and anxiety measured using DASS‐21. Multiple linear regression analysis found carer burden was independently predicted by duration of dementia, total cognition score and carers experiencing psychological stress. We found that patient variables of dementia duration and cognitive impairment and carer variable of carer stress to be associated with carer burden. Poor executive function was associated with carer stress. Early identification and management of carer burden and psychological distress is important for outcomes. Ideally, this should be provided by a specialist YOD service.
Carer burden and behavioral disturbance is similar between younger-onset Alzheimer’s disease and behavioral variant frontotemporal dementia
Publisher: Cambridge University Press (CUP)
Date: 09-02-2023
DOI: 10.1017/S1041610222001259
Abstract: Carer burden is common in younger-onset dementia (YOD), often due to the difficulty of navigating services often designed for older people with dementia. Compared to Alzheimer’s disease (AD), the burden is reported to be higher in behavioral variant frontotemporal dementia (bvFTD). However, there is little literature comparing carer burden specifically in YOD. This study hypothesized that carer burden in bvFTD would be higher than in AD. Retrospective cross-sectional study. Tertiary neuropsychiatry service in Victoria, Australia. Patient-carer dyads with YOD. We collected patient data, including behaviors using the Cambridge Behavioral Inventory-Revised (CBI-R). Carer burden was rated using the Zarit Burden Inventory-short version (ZBI-12). Descriptive statistics and Mann-Whitney U tests were used to analyze the data. Carers reported high burden (ZBI-12 mean score = 17.2, SD = 10.5), with no significant difference in burden between younger-onset AD and bvFTD. CBI-R stereotypic and motor behaviors, CBI-R everyday skills, and total NUCOG scores differed between the two groups. There was no significant difference in the rest of the CBI-R subcategories, including the behavior-related domains. Carers of YOD face high burden and are managing significant challenging behaviors. We found no difference in carer burden between younger-onset AD and bvFTD. This could be due to similarities in the two subtypes in terms of abnormal behavior, motivation, and self-care as measured on CBI-R, contrary to previous literature. Clinicians should screen for carer burden and associated factors including behavioral symptoms in YOD syndromes, as they may contribute to carer burden regardless of the type.
Mindfulness-based intervention to reduce burnout and psychological distress, and improve wellbeing in psychiatry trainees: a pilot study
Publisher: SAGE Publications
Date: 13-05-2019
Abstract: Healthcare professionals including psychiatry trainees experience high amounts of occupational stress. This pilot study aims to assess the impacts and feasibility of a mindfulness-based intervention program as an occupational intervention in a metropolitan hospital. Psychiatry trainees participated in an mindfulness-based intervention training program consisting of 1-h weekly sessions over 8 weeks. Levels of psychological distress and mindfulness were measured pre and post-intervention. Qualitative data through an open-ended feedback survey were also collected. There was an improved level of mindfulness and a decreased level of burnout among trainees post-intervention. Advantages of the program included having a compassionate facilitator and the program being tailored to healthcare staff. Limiting factors included time restraints and clinical responsibilities. Psychiatry trainees can benefit from an occupational MBI program. This can positively impact their health as well as improve their work performance. A number of factors important for implementation of a mindfulness-based intervention program were also identified.
Exploring behaviours of concern including aggression, self-harm, sexual harm and absconding within an Australian inpatient mental health service
Publisher: SAGE Publications
Date: 02-06-2020
Abstract: Patients admitted to mental health services may exhibit behaviours of concern (BOCs) such as aggression, self-harm, absconding and sexual harm. BOCs can lead to restrictive interventions, which have adverse effects on patients, carers and staff. This paper aims to explore the nature and outcome of BOCs within an adult inpatient mental health setting. A retrospective audit was conducted at a metropolitan inpatient service between 1 August 2016 and 31 July 2017. The frequency, nature and outcomes of BOC episodes were described and thematic analysis was used to summarise BOC antecedents. A BOC was documented for 179 (18.2%) patients who also showed high rates of drug abuse, homelessness and longer admission. Most self-harm and sexual harm events occurred outside of normal business hours. Medications and verbal de-escalation were commonly used interventions. Episodes of deliberate self-harm were likely to result in patient and staff injury or mechanical restraint, whereas aggression was associated with seclusion. Mental state, care engagement, physiological stress and situational stressor were identified as BOC antecedents. Multiple forms of BOCs were experienced with mental state, physical and interpersonal contributors identified. Improving multidisciplinary input into early assessment and treatment of BOC causes is needed to improve safety.
A case of an incidental primary adrenal lymphoma in a patient with newly diagnosed human immunodeficiency virus
Publisher: Wiley
Date: 23-06-2017
DOI: 10.1111/ANS.14078
Collective pause: improving staff performance in acute medicine through a brief mindfulness‐based group programme
Publisher: Wiley
Date: 31-05-2022
DOI: 10.1111/IMJ.15351
Abstract: Hospital wards are a complex and dynamic environment that rely on optimal staff performance. However, there is little research evaluating group interventions to improve staff attention and teamwork. To evaluate whether a regular, short and guided group mindfulness practice for staff in an acute general medicine team improves attention and teamwork. A 10‐min programme comprising mindfulness exercises and techniques was delivered daily to a multidisciplinary general medicine team based in a tertiary hospital for 4 weeks. This was undertaken immediately prior to the team's interdisciplinary ward round. We used a mixed‐method design, with self‐rated surveys to measure mindfulness and staff perception of hospital safety culture, and a focus group to understand participants' experiences. We estimated mean differences using Kruskal–Wallis tests across 10 time‐points and thematically analysed recorded transcripts. There was an increase in staff attention to the team meeting as measured by the decentering domain across time ( P 0.001). There was a trend to greater staff openness with a non‐significant increase in curiosity ( P = 0.14). We identified two overarching qualitative themes: feasibility of the programme and impact on staff and workplace. The programme was a calming circuit breaker to staff's day, which aided in feeling more connected to the group and subjectively better ward round experience. The logistics of the programme, including timing, and the facilitator developing trust with the participants, appear important in implementation. A brief mindfulness‐based intervention delivered to a general medical team improves staff attention at a multidisciplinary team meeting and team functioning.
Cerebrospinal fluid neurofilament light improves accurate distinction between neurodegenerative and psychiatric disorders at a cognitive neuropsychiatry service
Publisher: Cold Spring Harbor Laboratory
Date: 09-09-2022
DOI: 10.1101/2022.09.08.22279663
Abstract: People with neuropsychiatric symptoms often experience delay in accurate diagnosis. Although cerebrospinal fluid neurofilament light (CSF NfL) shows promise in distinguishing neurodegenerative disorders (ND) from psychiatric disorders (PSY), its accuracy in a diagnostically challenging cohort longitudinally is unknown. We collected longitudinal diagnostic information (mean=36 months) from patients assessed at a neuropsychiatry service, categorising diagnoses as ND/mild cognitive impairment/other neurological disorders (ND/MCI/other), and PSY. We pre-specified NfL pg/mL as indicative of ND/MCI/other. Diagnostic category changed from initial to final diagnosis for 23% (49/212) of patients. NfL predicted the final diagnostic category for 92% (22/24) of these and predicted final diagnostic category overall (ND/MCI/other vs. PSY) in 88% (187/212), compared to 77% (163/212) with clinical assessment alone. CSF NfL improved diagnostic accuracy, with potential to have led to earlier, accurate diagnosis in a real-world setting using a pre-specified cut-off, adding weight to translation of NfL into clinical practice.
Implementing a psychiatric behaviours of concern team can reduce restrictive intervention use and improve safety in inpatient psychiatry
Publisher: SAGE Publications
Date: 11-05-2020
Cerebrospinal fluid neurofilament light chain differentiates behavioural variant frontotemporal dementia progressors from ‘phenocopy’ non-progressors
Publisher: Cold Spring Harbor Laboratory
Date: 15-01-2022
DOI: 10.1101/2022.01.14.22269323
Abstract: Distinguishing behavioural variant frontotemporal dementia (bvFTD) from non-neurodegenerative ‘non-progressor’, ‘phenocopy’ mimics of frontal lobe dysfunction, can be one of the most challenging clinical dilemmas. A biomarker of neuronal injury, neurofilament light chain (NfL), could reduce misdiagnosis and delay. Cerebrospinal fluid (CSF) NfL, amyloid beta 1-42 (AB42), total and phosphorylated tau (T-tau, P-tau) levels were examined in patients with an initial diagnosis of bvFTD. Based on follow up information, patients were categorised as Progressors. Non-Progressors were subtyped in to Phenocopy Non-Progressors (non-neurological/neurodegenerative final diagnosis), and Static Non-Progressors (static deficits, not fully explained by non-neurological/neurodegenerative causes). Forty-three patients were included: 20 Progressors, 23 Non-Progressors (15 Phenocopy, 8 Static), 20 controls. NfL concentrations were lower in Non-Progressors (Non-Progressors Mean, M=554pg/mL, 95%CI:[461, 675], Phenocopy Non-Progressors M=459pg/mL, 95%CI:[385, 539], Static Non-Progressors M=730pg/mL, 95%CI:[516, 940]), compared to bvFTD Progressors (M=2397pg/mL, 95%CI:[1607, 3332]). NfL distinguished Progressors from Non-Progressors with the highest accuracy (area under the curve 0.92, 90%/87% sensitivity/specificity, 86%/91% positive/negative predictive value, 88% accuracy). Static Non-Progressors tended to have higher T-tau and P-tau levels compared to Phenocopy Non-Progressors. This study demonstrated strong diagnostic utility of CSF NfL to distinguish bvFTD from phenocopy non-progressor variants, at baseline, with high accuracy, in a real-world clinical setting. This has important clinical implications, to improve outcomes for patients and clinicians facing this challenging clinical dilemma, as well as for healthcare services, and clinical trials. Further research is required to investigate heterogeneity within the non-progressor group and potential diagnostic algorithms, and prospective studies are underway assessing plasma NfL
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Related Funding Activities
No related grants have been discovered for Matthew Jee Yun Kang.