ORCID Profile
0000-0003-0876-5676
Current Organisations
University of Hong Kong
,
Monash University
,
University of Melbourne
,
University of Melbourne Academic Unit for Psychiatry of Old Age
,
St John of God Mt Lawley Hospital
,
Curtin University
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Publications
A randomised controlled trial of feedback to improve patient satisfaction and consultation skills in medical students
Publisher: Springer Science and Business Media LLC
Date: 20-08-2020
DOI: 10.1186/S12909-020-02171-9
Abstract: The use of feedback has been integral to medical student learning, but rigorous evidence to evaluate its education effect is limited, especially in the role of patient feedback in clinical teaching and practice improvement. The aim of the Patient Teaching Associate (PTA) Feedback Study was to evaluate whether additional written consumer feedback on patient satisfaction improved consultation skills among medical students and whether multisource feedback (MSF) improved student performance. In this single site, double-blinded randomised controlled trial, 71 eligible medical students from two universities in their first clinical year were allocated to intervention or control and followed up for one semester. They participated in five simulated student-led consultations in a teaching clinic with patient volunteers living with chronic illness. Students in the intervention group received additional written feedback on patient satisfaction combined with guided self-reflection. The control group received usual immediate formative multisource feedback from tutors, patients and peers. Student characteristics, baseline patient-rated satisfaction scores and tutor-rated consultation skills were measured. Follow-up assessments were complete in 70 students attending the MSF program. At the final consultation episodes, both groups improved patient-rated rapport ( P = 0.002), tutor-rated patient-centeredness and tutor-rated overall consultation skills ( P = 0.01). The intervention group showed significantly better tutor-rated patient-centeredness ( P = 0.003) comparing with the control group. Distress relief, communication comfort, rapport reported by patients and tutor-rated clinical skills did not differ significantly between the two groups. The innovative multisource feedback program effectively improved consultation skills in medical students. Structured written consumer feedback combined with guided student reflection further improved patient-centred practice and effectively enhanced the benefit of an MSF model. This strategy might provide a valuable adjunct to communication skills education for medical students. Australian New Zealand Clinical Trials Registry Number ACTRN12613001055796 .
Alterations in dorsal and ventral posterior cingulate connectivity in APOE ε4 carriers at risk of Alzheimer's disease
Publisher: Royal College of Psychiatrists
Date: 10-2015
DOI: 10.1192/BJPO.BP.115.001339
Abstract: Recent evidence suggests that exercise plays a role in cognition and that the posterior cingulate cortex (PCC) can be ided into dorsal and ventral subregions based on distinct connectivity patterns. To examine the effect of physical activity and ision of the PCC on brain functional connectivity measures in subjective memory complainers (SMC) carrying the epsilon 4 allele of apolipoprotein E (APOE 4) allele. Participants were 22 SMC carrying the APOE ɛ4 allele (ɛ4+ mean age 72.18 years) and 58 SMC non-carriers (ɛ4– mean age 72.79 years). Connectivity of four dorsal and ventral seeds was examined. Relationships between PCC connectivity and physical activity measures were explored. ɛ4+ in iduals showed increased connectivity between the dorsal PCC and dorsolateral prefrontal cortex, and the ventral PCC and supplementary motor area (SMA). Greater levels of physical activity correlated with the magnitude of ventral PCC–SMA connectivity. The results provide the first evidence that ɛ4+ in iduals at increased risk of cognitive decline show distinct alterations in dorsal and ventral PCC functional connectivity.
Association Between Cognitive Function and Clustered Cardiovascular Risk of Metabolic Syndrome in Older Adults at Risk of Cognitive Decline
Publisher: Springer Science and Business Media LLC
Date: 11-02-2020
Semi-automated hippocampal segmentation in people with cognitive impairment using an age appropriate template for registration
Publisher: Wiley
Date: 03-07-2015
DOI: 10.1002/JMRI.24966
Abstract: To evaluate a new semi-automated segmentation method for calculating hippoc al volumes and to compare results with standard software tools in a cohort of people with subjective memory complaints (SMC) and mild cognitive impairment (MCI). Data from 58 participants, 39 with SMC (17 male, 22 female, mean age 72.6) and 19 with MCI (6 male, 13 female, mean age 74.3), were analyzed. For each participant, T1-weighted images were acquired using an MPRAGE sequence on a 3 Tesla MRI system. Hippoc al volumes (left, right, and total) were calculated with a new, age appropriate registration template, based on older people and using the advanced software tool ANTs (Advanced Normalization Tools). The results were compared with manual tracing (seen as the reference standard) and two widely accepted automated software tools (FSL, FreeSurfer). The hippoc al volumes, calculated by using the age appropriate registration template were significantly (P < 0.05) more accurate (mean volume accuracy more than 90%) than those obtained with FreeSurfer and FSL (both less than 70%). Dice coefficients for the hippoc al segmentations with the new template method (75.3%) were slightly, but significantly (P < 0.05) higher than those from FreeSurfer (72.4%). These results suggest that an age appropriate registration template might be a more accurate alternative to calculate hippoc al volumes when manual segmentation is not feasible.
Time to onset of efficacy in fracture reduction with current anti-osteoporosis treatments
Publisher: Springer Science and Business Media LLC
Date: 29-05-2012
DOI: 10.1007/S00774-012-0349-1
Abstract: Early prevention of future fracture is an important goal in those at risk. A similar 3-year fracture efficacy is reported for most osteoporosis agents. Onset of fracture efficacy may be useful to help tailor treatment based on risk. We reviewed the peer-reviewed literature for onset of fracture efficacy data on the commonly prescribed osteoporosis treatments. All papers were reviewed independently by at least two reviewers for onset of efficacy for morphometric vertebral fracture (MVF), clinical vertebral fracture (CVF), nonvertebral fracture (NVF), hip fracture, and any clinical fracture (ACF). Alendronate is reported to reduce multiple CVF by 6 months all CVF, NVF, and multiple ACF by 12 months and all ACF and hip fracture by 18 months. Ibandronate is reported to reduce MVF by 12 months and NVF by 36 months. Raloxifene is reported to reduce CVF by 3-6 months and NVF by 36 months. Risedronate is reported to reduce CVF and NVF by 6 months, and hip fracture by 12 months. Strontium ranelate is reported to reduce MVF, CVF, NVF, and ACF by 12 months, and hip fracture by 36 months. Zoledronic acid is reported to reduce MVF, CVF, and ACF by 12 months, NVF by 24 months, and hip fracture by 36 months. Although direct comparisons are limited, based on the available literature, risedronate, followed by alendronate, have the earliest onset of benefit across the range of fracture types. Onset of efficacy may be an important consideration in the selection of treatment for some patients.
Hip fractures among indigenous western Australians from 1999 to 2009
Publisher: Wiley
Date: 12-2013
DOI: 10.1111/IMJ.12040
Abstract: Minimal trauma hip fractures are prevalent in Australia. The incidence rate and trend of hip fractures in Indigenous Western Australians have not been formally reported. To evaluate incidence rates and trend of minimal trauma hip fractures in Indigenous and other Western Australians aged 40 years and over in 1999-2009 METHODS: Hip fracture data were obtained from an administrative database for all hospitalisations in Western Australia. Age-standardised incidence rates were calculated using direct standardisation, and standardised rate ratios were calculated using the indirect method. Trend in incidence rates were calculated using Poisson regression. In 1999-2009, 11,844 admissions for minimal trauma hip fractures were reported among Western Australians aged 40 years and over, of which 201 were recorded as indigenous. The age-standardised hip fracture rate was 273.0 (95% confidence interval (CI) 230.7-315.4) per 100,000 person-years for indigenous adults and 148.8 (95% CI 146.1-151.5) per 100,000 person-years for non-indigenous adults. The standardised morbidity ratio was 2.2 (95% CI 1.9-2.5). Over this period, age-standardised rates increased by an average of 7.2% per year among indigenous adults (P = 0.006), whereas non-indigenous rates fell by an average of 3.4% per year (P < 0.001). The relatively higher rates among indigenous adults were more evident in the younger age groups. There is a widening gap in minimal trauma hip fracture rates between indigenous and other Western Australians. This study demonstrates a need for public health review and management strategies to reduce falls and hip fracture in the indigenous community.
Intracranial cause of delirium: computed tomography yield and predictive factors
Publisher: Wiley
Date: 04-2012
DOI: 10.1111/J.1445-5994.2010.02400.X
Abstract: Computed tomography (CT) of the brain in delirium investigation has a low yield of identifiable causes. We sought to identify the best clinical predictors of an intracranial cause of delirium. We performed a case-control study of patients admitted to a delirium unit. Clinical factors of patients with positive findings on scans were compared with those without demonstrated causes. The main outcome measure was intracranial abnormalities accountable for the cause of delirium. During 18 months, there were 300 admissions to the unit. Mean age of patients was 86.6 years. Among 200 patients who proceeded to CT scanning, only 29 demonstrated intracranial pathology accountable for the cause of delirium, with a yield of 14.5%. There were 13 patients with ischaemic stroke, seven with subdural haemorrhage and nine with intracerebral haemorrhage. In multivariate analysis, new neurological deficits (adjusted odds ratio (OR) 18.17, 95% confidence interval (CI) 5.99-55.15), recent falls history (adjusted OR 5.58, 95% CI 1.90-16.42) and decline in conscious level (adjusted OR 4.58, 95% CI 1.33-15.79) were predictors of clinically meaningful radiological findings. Twenty-six of the 29 patients with scans had these three predictors with a sensitivity of 89.7% (95% CI 78.6-100%). We identified a history of recent fall as a new independent predictor for clinically relevant intracranial pathology in delirious patients, besides new neurological deficits and decline in conscious state. A flow chart incorporating CT head scanning as part of delirium investigation is proposed.
Effect of a 24-month physical activity program on brain changes in older adults at risk of Alzheimer's disease: the AIBL active trial
Publisher: Elsevier BV
Date: 05-2020
DOI: 10.1016/J.NEUROBIOLAGING.2019.02.030
Abstract: White matter hyperintensities (WMHs) are a risk factor for cognitive decline. Physical activity (PA) is associated with lower WMH. Whether long-term exposure to PA programs has beneficial effects on WMH progression in older adults with memory complaints and comorbid conditions has had limited exploration. This study explored whether a 24-month moderate-intensity PA intervention can delay the progression of WMH and hippoc us loss in older adults at risk for cognitive decline. Data acquired on magnetic resonance imaging were used to measure the progression of WMH and hippoc us loss. The results of this study showed no effect of intervention on either the primary outcome measure "WMH" or the secondary outcome measure "hippoc al volume." In addition, neither beta amyloid status nor the adherence to the intervention had any effect on the outcome. In this cohort of subjective memory complaints and mild cognitive impairment participants with vascular risk factors, there was no effect of long-term moderate-intensity PA on WMH or hippoc al loss.
Baseline White Matter Is Associated With Physical Fitness Change in Preclinical Alzheimer’s Disease
Publisher: Frontiers Media SA
Date: 29-04-2020
Undertreatment of osteoporosis in regional Western Australia
Publisher: Wiley
Date: 05-07-2011
DOI: 10.1111/J.1741-6612.2011.00544.X
Abstract: To identify the geographic differences in osteoporosis management. In this cross-sectional study, osteoporosis treatments in older patients presented to a hip fracture unit from mid 2005-2009 were analysed. Logistic regression was used to examine the association of rural residency with osteoporosis treatments. Among 1130 patients (20% rural, mean age 81.1 years), there was a low prescription rate for osteoporosis among rural patients. Rural patients were 65% less likely to use vitamin D, 60% less likely to use calcium and 46% less likely to use bisphosphonates before a hip fracture than their urban counterparts. Their compliance with vitamin D and calcium was also lower at 1 year but improved significantly over the study period, whereas compliance with bisphosphonate decreased in both regions. Undertreatment of osteoporosis was common in rural patients. These findings need to be confirmed by larger population-based studies.
Effectiveness of patient feedback as an educational intervention to improve medical student consultation (PTA Feedback Study): study protocol for a randomized controlled trial
Publisher: Springer Science and Business Media LLC
Date: 17-09-2014
Efficacy and safety of pharmacological agents in managing osteoporosis in the old old: Review of the evidence
Publisher: Elsevier BV
Date: 05-2009
DOI: 10.1016/J.BONE.2008.12.003
Abstract: Osteoporosis and fracture risk increase exponentially in postmenopausal females. This places a significant burden in terms of morbidity, mortality and costs that are likely to increase with an ageing population. Despite this there is very limited data on pharmacological management of osteoporosis in this high risk group. OBJECTIVES OF THIS REVIEW: To review the published literature on the clinical efficacy and safety of specific anti osteoporosis treatments in the reduction in fracture risk in females >or=75 years of age. The following major endpoints were used in this review: SEARCH METHODS FOR IDENTIFICATION OF STUDIES: We performed an electronic search of Medline (1970 to June 2007) and the Cochrane Library (1996 to June 2007). Our search strategy included MeSH terms for osteoporosis and treatments. We reviewed the reference list of identified articles for additional relevant published trials. Two hundred and fifty-two potentially relevant abstracts were identified. Only six publications were deemed to meet full eligibility criteria and one met most criteria. There is evidence for significant vertebral fracture relative risk reduction(RR) at 1 year for Risedronate (RR 81% p<0.001), Teriparatide (RR 65% p<0.05) and Strontium Ranelate (RR 59% p=0.002) and 3 years for Risedronate (RR 44% p=0.003), Alendronate (RR 38% p<0.05) and Strontium Ranelate (RR 32% p=0.013). There is evidence for significant non-vertebral fracture relative risk reduction at 1 year for Strontium Ranelate (RR 41% p=0.027) but not Teriparatide (p=0.66) and 3 years for Strontium Ranelate (RR 31% p=0.011) but not Risedronate (p=0.66). The only study to report a reduction in hip fracture at 3 years is the TROPOS study with Strontium Ranelate (RR 36% p=0.046). This review reinforces the irony that the least evidence is available for fragility fracture reduction in the group at greatest risk the old old and those with non vertebral and hip fracture. Although there is good evidence for the benefit of the bisphosphonates (Alendronate and Risedronate), Teriparatide and Strontium Ranelate in vertebral fracture reduction, there are very limited data for non vertebral and hip fracture reduction. Strontium Ranelate is the only agent to date that has demonstrated a reduction in non vertebral and hip fracture events in this high risk elderly female population. Perhaps we need to adopt different strategies in managing older patients with osteoporosis as their fracture risks and treatment strategies may be quite different from younger populations.
Improving ambulatory patient-centred practice with a patient teaching associate programme
Publisher: Wiley
Date: 28-07-2015
DOI: 10.1111/IMJ.12813
Awake bruxism in a patient with Alzheimer's dementia
Publisher: Wiley
Date: 10-2013
DOI: 10.1111/GGI.12086
Related Organisations
University Of Melbourne Academic Unit For Psychiatry Of Old Age
Location: Australia
Related Funding Activities
No related grants have been discovered for Michelle Lai.