ORCID Profile
0000-0001-9404-0035
Current Organisations
Macquarie University
,
Edith Cowan University
,
Prince of Wales Hospital
,
University of New South Wales
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Publisher: Elsevier BV
Date: 02-2017
DOI: 10.1016/J.PHRS.2016.12.011
Abstract: Eight percent of Australians aged 65 years and over receive residential aged care each year. Residents are increasingly older, frailer and have complex care needs on entry to residential aged care. Up to 63% of Australian residents of aged care facilities take nine or more medications regularly. Together, these factors place residents at high risk of adverse drug events. This paper reviews medication-related policies, practices and research in Australian residential aged care. Complex processes underpin prescribing, supply and administration of medications in aged care facilities. A broad range of policies and resources are available to assist health professionals, aged care facilities and residents to optimise medication management. These include national guiding principles, a standardised national medication chart, clinical medication reviews and facility accreditation standards. Recent Australian interventions have improved medication use in residential aged care facilities. Generating evidence for prescribing and deprescribing that is specific to residential aged care, health workforce reform, medication-related quality indicators and inter-professional education in aged care are important steps toward optimising medication use in this setting.
Publisher: Elsevier BV
Date: 10-2021
Publisher: Wiley
Date: 28-06-2004
DOI: 10.1002/MRM.20105
Abstract: The interventricular septum (IVS) occupies a unique position within the heart, lying between the left (LV) and right (RV) ventricular cavities. Changes in its normal geometry may signify not only abnormalities of the septal myocardium, but also abnormal pressure differences between the LV and RV. Flattening of the IVS has been noted with cross-sectional imaging in association with pulmonary hypertension, but the septal curvature and shape have not previously been measured in three dimensions. This paper describes a method to model the RV surface of the IVS from spatially registered cross-sectional images for measurements of curvature. A smoothing 2D spline surface is constructed through the RV septal surface at regular times during the cardiac cycle, and the principal curvatures, as well as the Gaussian and mean curvatures, shape index, and curvedness, are calculated. Vector and color surface maps and graphs of average curvature and shape indices are constructed. Consistent curvature patterns were observed in four normal subjects. This method of measuring septal geometry can provide potentially useful new information on the effects of RV disease. We examine the problem of describing septal motion, and describe a simple measure of septal curvature that may be of clinical value.
Publisher: CSIRO Publishing
Date: 2020
DOI: 10.1071/AH19069
Abstract: ObjectiveThis study assessed the effect of the frequency of general practitioner (GP) visitation in the 12 months before a 21% consumer copayment increase in the Pharmaceutical Benefits Scheme (PBS January 2005) on the reduction or discontinuation of statin dispensing for tertiary prevention. MethodsThe study used routinely collected, whole-population linked PBS, Medicare, mortality and hospital data from Western Australia. From 2004 to 2005, in iduals were classified as having discontinued, reduced or continued their use of statins in the first six months of 2005 following the 21% consumer copayment increase on 1 January 2005. The frequency of GP visits was calculated in 2004 from Medicare data. Multivariate logistic regression models were used to determine the association between GP visits and statin use following the copayment increase. ResultsIn December 2004, there were 22495 stable statin users for tertiary prevention of prior coronary heart disease, prior stroke or prior coronary artery revascularisation procedure. Following the copayment increase, patients either discontinued (3%), reduced (12%) or continued (85%) their statins. In iduals who visited a GP three or more times in 2004 were 47% less likely to discontinue their statins in 2005 than people attending only once. Subgroup analysis showed the effect was apparent in men, and long-term or new statin users. The frequency of GP visits did not affect the proportion of patients reducing their statin therapy. ConclusionsPatients who visited their GP at least three times per year had a lower risk of ceasing their statins in the year following the copayment increase. GPs can help patients maintain treatment following rises in medicines costs. What is known about the topic?Following the 21% increase in medication copayment in 2005, in iduals discontinued or reduced their statin usage, including for tertiary prevention. What does this paper add?Patients who visited their GP at least three times per year were less likely to discontinue their statin therapy for tertiary prevention following a large copayment increase. What are the implications for practitioners?This paper identifies the important role that GPs have in maintaining the continued use of important medications following rises in medicines costs.
Publisher: Informa UK Limited
Date: 1995
Publisher: Springer Science and Business Media LLC
Date: 28-04-2023
DOI: 10.1186/S12877-023-03954-7
Abstract: Older populations in residential aged care facilities (RACFs) in many immigrant-receiving countries are now being increasingly culturally and linguistically erse (CALD). CALD populations require tailored social and health services to support their needs and improve health outcomes. Falls among the elderly are common and can have significant health and psychosocial consequences. There is some evidence to suggest that country of birth may influence risk of falls among older people, but such evidence has been scarce. This study aimed to determine the association between place of birth and the incidence of falls in RACFs. Routinely collected incident data relating to 5,628 residents aged ≥ 65 years in 25 RACFs in Sydney, New South Wales, Australia were used. RACF residents were classified into two groups, Australia-born (N = 4,086) and overseas-born (N = 1,542). Overseas-born RACF residents were further categorised into two subgroups: overseas-English-speaking-country (N = 743) and overseas-non-English-speaking-country (N = 799). Outcomes measures were rate of all falls, injurious falls and falls requiring hospitalisation. Multilevel binary negative regression was used to examine the relationship between fall risk and place of birth. Incidence rates of all falls, injurious falls and falls requiring hospitalisation were 8.62, 3.72 and 1.07 incidents per 1,000 resident days, respectively, among the Australia-born RACF residents, but were higher at 11.02, 4.13 and 1.65, respectively, among the overseas-born RACF residents. Within those born overseas, fall rates were higher among the overseas-non-English-speaking-country-born residents (11.32, 4.29 and 2.22, respectively) than those overseas-English-speaking-country-born (10.70, 3.96 and 1.05, respectively). After controlling for confounders, the overseas-born RACF residents overall experienced a higher risk of all three types of falls (incidence rate ratios: [IRR] = 1.278, 95% confidence interval [CI] = 1.131, 1.443 injurious falls: IRR = 1.164 [95% CI = 1.013, 1.338] falls requiring hospitalisation: IRR = 1.460 [95% CI = 1.199, 1.777]) than the Australia-born RACF residents. Among the overseas-born RACF residents, males, respite residents and those overseas-non-English-speaking-country-born experienced higher rates of falls. Fall incidence in RACFs varies significantly by place of birth. With increasingly erse RACF populations, fall intervention and prevention programs should consider cultural and linguistical backgrounds of RACF residents. Greater attention to understand the mechanisms for the differences by place of birth in risk profiles is warranted.
Publisher: JMIR Publications Inc.
Date: 17-01-2019
DOI: 10.2196/10935
Publisher: Elsevier BV
Date: 12-2022
Publisher: JMIR Publications Inc.
Date: 02-08-2020
Abstract: he role of eHealth programs to support patients through surgical pathways, including total hip arthroplasty (THA), is rapidly growing and offers the potential to improve patient engagement, self-care, and outcomes. he aim of this study is to compare the effects of an eHealth program (intervention) versus standard care for pre- and postoperative education on patient outcomes for primary THA. prospective parallel randomized controlled trial with two arms (standard care and standard care plus access to the eHealth education program) was conducted. Participants included those who underwent THA. Outcome measures were collected preadmission, at 6 weeks, and at 3 and 6 months after surgery. The primary outcome was the Hip Dysfunction and Osteoarthritis Outcome Score. Secondary outcomes were a 5-level 5-dimension quality of life measure and the self-efficacy for managing chronic disease scale. Demographic and clinical characteristics were also collected. A satisfaction survey was completed by all participants 6 weeks after surgery, and those in the intervention arm completed an additional survey specific to the eHealth program. total of 99 patients were recruited: 50 in the eHealth program (intervention) and 49 in standard care (control). Clinical improvements were demonstrated in both groups across all time points. Per-protocol analysis demonstrated no differences between the groups for all outcome measures across all time points. Participants in the eHealth program reported that the program was accessible, that they felt comfortable using it, and that the information was helpful. his study demonstrated that the eHealth program, in addition to standard care, had no additional benefit to THA recovery compared with standard care alone. The study found that the eHealth program was highly valued by participants, and it supported the preoperative preparation, recovery, and postoperative rehabilitation of participants. ustralian New Zealand Clinical Trial Registry ACTRN12617001433392 www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=373657
Publisher: SAGE Publications
Date: 08-11-2020
Abstract: This study examined the association between statin usage (discontinued, reduced or continued) and two-year death following a 21% increase in the Pharmaceutical Benefits Scheme (PBS) consumer co-payment in Western Australia. A retrospective observational study in Western Australia using linked administrative Commonwealth PBS data and State hospital inpatient and death data (n = 207,066) was undertaken. We explored the two-year all-cause and ischemic heart disease(IHD)/stroke-specific-death in in iduals who discontinued, reduced or continued statin medication following the January 2005 PBS co-payment increase, overall, by beneficiary status (general population vs. social security recipients) and by a history of admission for ischemic heart disease or stroke. Non-cardiovascular (CVD)-related death was also considered. In the first six months of 2005, 3.3% discontinued, 12.5% reduced and 84.2% continued statin therapy. We found those who discontinued statins were also likely to discontinue at least two other medicines compared to those who continued therapy. There were 4,607 all-cause deaths. For IHD/stroke-specific death, there were 1,317. For all non-CVD-related death, there were 2,808 deaths during the 2-year follow-up period. Cox regression models, adjusted for demographic and clinical characteristics, showed a 39%-61% increase in the risk of all-cause death for in iduals who reduced or discontinued statin medication compared to those who continued their statin medication (Discontinued: Adj HR = 1.61, 95% CI 1.40–1.85 Reduced: Adj HR = 1.39, 95% CI 1.28–1.51). For IHD/stroke-specific death, there was an increased risk of death by 28–76% (Discontinued: Adj sHR = 1.76, 95% CI 1.37–2.27 Reduced: Adj sHR = 1.28, 95% CI 1.10–1.49), and for non-CVD-related death, there was an increased risk of death by 44–57% (Discontinued: Adj sHR = 1.57, 95% CI 1.31–1.88 Reduced: Adj sHR = 1.44, 95% CI 1.30–1.60), for in iduals who discontinued or reduced their statin medication compared to those who continued. Patients who discontinued their statin therapy had a significantly increased risk of IHD and stroke death. Health professionals should be aware that large co-payment changes may be associated with patients discontinuing or reducing medicines to their health detriment. Factors that lead to such changes in patient medication-taking behaviour need to be considered and addressed at the clinical and policy levels.
Publisher: IEEE
Date: 11-2015
Publisher: Springer Science and Business Media LLC
Date: 13-12-2022
DOI: 10.1038/S41746-022-00739-X
Abstract: Electronic medication management (eMM) systems are designed to improve safety, but there is little evidence of their effectiveness in paediatrics. This study assesses the short-term (first 70 days of eMM use) and long-term (one-year) effectiveness of an eMM system to reduce prescribing errors, and their potential and actual harm. We use a stepped-wedge cluster randomised controlled trial (SWCRCT) at a paediatric referral hospital, with eight clusters randomised for eMM implementation. We assess long-term effects from an additional random s le of medication orders one-year post-eMM. In the SWCRCT, errors that are potential adverse drug events (ADEs) are assessed for actual harm. The study comprises 35,260 medication orders for 4821 patients. Results show no significant change in overall prescribing error rates in the first 70 days of eMM use (incident rate ratio [IRR] 1.05 [95%CI 0.92–1.21], but a 62% increase (IRR 1.62 [95%CI 1.28–2.04]) in potential ADEs suggesting immediate risks to safety. One-year post-eMM, errors decline by 36% (IRR 0.64 [95%CI 0.56–0.72]) and high-risk medication errors decrease by 33% (IRR 0.67 [95%CI 0.51–0.88]) compared to pre-eMM. In all periods, dose error rates are more than double that of other error types. Few errors are associated with actual harm, but 71% [95%CI 50–86%] of patients with harm experienced a dose error. In the short-term, eMM implementation shows no improvement in error rates, and an increase in some errors. A year after eMM error rates significantly decline suggesting long-term benefits. eMM optimisation should focus on reducing dose errors due to their high frequency and capacity to cause harm.
Publisher: Springer Science and Business Media LLC
Date: 27-02-2023
DOI: 10.1038/S41598-023-29933-X
Abstract: Frailty and pain in hospitalised patients are associated with adverse clinical outcomes. However, there is limited data on the associations between frailty and pain in this group of patients. Understanding the prevalence, distribution and interaction of frailty and pain in hospitals will help to determine the magnitude of this association and assist health care professionals to target interventions and develop resources to improve patient outcomes. This study reports the point prevalence concurrence of frailty and pain in adult patients in an acute hospital. A point prevalence, observational study of frailty and pain was conducted. All adult inpatients (excluding high dependency units) at an acute, private, 860-bed metropolitan hospital were eligible to participate. Frailty was assessed using the self-report modified Reported Edmonton Frail Scale. Current pain and worst pain in the last 24 h were self-reported using the standard 0–10 numeric rating scale. Pain scores were categorised by severity (none, mild, moderate, severe). Demographic and clinical information including admitting services (medical, mental health, rehabilitation, surgical) were collected. The STROBE checklist was followed. Data were collected from 251 participants (54.9% of eligible). The prevalence of frailty was 26.7%, prevalence of current pain was 68.1% and prevalence of pain in the last 24 h was 81.3%. After adjusting for age, sex, admitting service and pain severity, admitting services medical (AOR: 13.5 95% CI 5.7–32.8), mental health (AOR: 6.3, 95% CI 1. 9–20.9) and rehabilitation (AOR: 8.1, 95% CI 2.4–37.1) and moderate pain (AOR: 3.9, 95% CI 1. 6–9.8) were associated with increased frailty. The number of older patients identified in this study who were frail has implications for managing this group in a hospital setting. This indicates a need to focus on developing strategies including frailty assessment on admission, and the development of interventions to meet the care needs of these patients. The findings also highlight the need for increased pain assessment, particularly in those who are frail, for more effective pain management. Trial registration: The study was prospectively registered (ACTRN12620000904976 14th September 2020).
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 07-2014
DOI: 10.1016/J.JURO.2014.01.014
Abstract: Multiparametric magnetic resonance imaging appears to improve prostate cancer detection but prospective studies are lacking. We determined the accuracy of multiparametric magnetic resonance imaging for detecting significant prostate cancer before diagnostic biopsy in men with abnormal prostate specific antigen/digital rectal examination. In this single center, prospective study men older than 40 years with abnormal prostate specific antigen/digital rectal examination and no previous multiparametric magnetic resonance imaging underwent T2-weighted, diffusion-weighted and dynamic contrast enhanced imaging without an endorectal coil. Imaging was allocated alternately to 1.5/3.0 Tesla. Imaging was double reported independently using PI-RADS (Prostate Imaging Reporting and Data System) by specialist radiologists. Transperineal grid directed 30-core biopsy was performed with additional magnetic resonance imaging directed cores for regions of interest outside template locations. Four significant cancer definitions were tested. Chi-square and logistic regression analysis was done. Men undergoing prostatectomy were analyzed. Of the 165 men who enrolled in the study 150 were analyzed. Median age was 62.4 years, median prostate specific antigen was 5.6 ng/ml, 29% of patients had an abnormal digital rectal examination and 88% underwent initial biopsy. Multiparametric magnetic resonance imaging was positive (PI-RADS 3 to 5) in 66% of patients, 61% had prostate cancer and 30% to 41% had significant prostate cancer (definitions 1 to 4). For significant cancer sensitivity was 93% to 96%, specificity was 47% to 53%, and negative and positive predictive values were 92% to 96% and 43% to 57%, respectively (definitions 1 to 4). Radical prostatectomy results in 48 men were similar. Aggregate PI-RADS (4 to 20) performed similarly to overall PI-RADS (1 to 5). Negative and positive predictive values (100% and 71%, respectively) were similar in men at higher risk, defined as prostate specific antigen greater than 10 ng/ml with abnormal digital rectal examination. On multivariate analysis PI-RADS score was associated with significant prostate cancer (p <0.001) but magnet strength was not. Adding PI-RADS to the multivariate model improved the AUC from 0.810 to 0.913 (95% CI 0.038-0.166, p = 0.002). Radiologist agreement was substantial (weighted κ = 0.626). Multiparametric magnetic resonance imaging reported by expert radiologists achieved an excellent negative predictive value and a moderate positive predictive value for significant prostate cancer at 1.5 and 3.0 Tesla.
Publisher: Wiley
Date: 19-03-2020
DOI: 10.1002/JMRI.27135
Publisher: Wiley
Date: 11-05-2023
DOI: 10.1002/JMRI.28742
Abstract: Local staging of prostate cancer (PCa) is important for treatment planning. Radiologist interpretation using qualitative criteria is variable with high specificity but low sensitivity. Quantitative methods may be useful in the diagnosis of extracapsular extension (ECE). To assess the performance of quantitative MRI markers for detecting ECE. Systematic review and meta‐analysis. 4800 patients from 28 studies with histopathologically confirmed PCa on radical prostatectomy were pooled for meta‐analysis. Patients from 46 studies were included for systematic review. Diffusion‐weighted, T2‐weighted, and dynamic contrast‐enhanced MRI at 1.5 T or 3 T. PubMed, Embase, Web of Science, Scopus, and Cochrane databases were searched to identify studies on diagnostic test accuracy or association of any quantitative MRI markers with ECE. Results extracted by two independent reviewers for tumor contact length (TCL) and mean apparent diffusion coefficient (ADC‐mean) were pooled for meta‐analysis, but not for other quantitative markers including radiomics due to low number of studies available. Hierarchical summary receiver operating characteristic (HSROC) curves were computed for both TCL and ADC‐mean, but summary operating points were computed for TCL only. Heterogeneity was investigated by meta‐regression. Results were significant if P ≤ 0.05. At the 10 mm threshold for TCL, summary sensitivity and specificity were 0.76 [95% confidence interval (CI) 0.71–0.81] and 0.68 [95% CI 0.63–0.73], respectively. At the 15 mm threshold, summary sensitivity and specificity were 0.70 [95% CI 0.53–0.83] and 0.74 [95% CI 0.60–0.84] respectively. The area under the HSROC curves for TCL and ADC‐mean were 0.79 and 0.78, respectively. Significant sources of heterogeneity for TCL included timing of MRI relative to biopsy. Both 10 mm and 15 mm thresholds for TCL may be reasonable for clinical use. From comparison of the HSROC curves, ADC‐mean may be superior to TCL at higher sensitivities. 3 2
Publisher: Radiological Society of North America (RSNA)
Date: 05-2006
DOI: 10.1148/RADIOL.2392050324
Abstract: To retrospectively and quantitatively analyze the acromial undersurface in three dimensions and to determine its association with impingement syndrome and rotator cuff tears. Institutional review board approval was received with exemption of informed consent for this retrospective HIPAA-compliant study. Magnetic resonance images were evaluated in 84 patients (63 males, 21 females mean age, 42.6 years age range, 15-74 years). On the basis of surgical results, patients were separated into three groups: those without shoulder impingement or rotator cuff tears (31 patients), those with shoulder impingement (22 patients), and those with rotator cuff tears (31 patients). To quantitate the acromial undersurface, the structure was manually plotted, and a mathematic model was created by using splines. The undersurface was ided into a 20 x 20 grid. For each patient, a shape index (SI) data set and local undersurface angulation (LUA) data set were determined. Regression analyses were used to identify differences between groups, and prediction models were constructed on the basis of correspondent areas. Analysis of both data sets yielded no apparent progression between groups and demonstrated a lack of similarity between the impingement and rotator cuff tear groups. Discrimination between groups could be demonstrated by iding the lateral portion of the acromial undersurface into contiguous blocks. The highest overall diagnostic accuracy of our prediction models was 58.3% (49 of 84) by using 10 blocks of the SI data set and 73.8% (62 of 84) by using five blocks of the LUA data set. Three-dimensional modeling yields objective data about the acromial undersurface. On the basis of this method, osseous impingement by the acromion is not a primary cause of shoulder impingement syndrome or rotator cuff tears.
Publisher: JMIR Publications Inc.
Date: 03-03-2021
DOI: 10.2196/22944
Abstract: The role of eHealth programs to support patients through surgical pathways, including total hip arthroplasty (THA), is rapidly growing and offers the potential to improve patient engagement, self-care, and outcomes. The aim of this study is to compare the effects of an eHealth program (intervention) versus standard care for pre- and postoperative education on patient outcomes for primary THA. A prospective parallel randomized controlled trial with two arms (standard care and standard care plus access to the eHealth education program) was conducted. Participants included those who underwent THA. Outcome measures were collected preadmission, at 6 weeks, and at 3 and 6 months after surgery. The primary outcome was the Hip Dysfunction and Osteoarthritis Outcome Score. Secondary outcomes were a 5-level 5-dimension quality of life measure and the self-efficacy for managing chronic disease scale. Demographic and clinical characteristics were also collected. A satisfaction survey was completed by all participants 6 weeks after surgery, and those in the intervention arm completed an additional survey specific to the eHealth program. A total of 99 patients were recruited: 50 in the eHealth program (intervention) and 49 in standard care (control). Clinical improvements were demonstrated in both groups across all time points. Per-protocol analysis demonstrated no differences between the groups for all outcome measures across all time points. Participants in the eHealth program reported that the program was accessible, that they felt comfortable using it, and that the information was helpful. This study demonstrated that the eHealth program, in addition to standard care, had no additional benefit to THA recovery compared with standard care alone. The study found that the eHealth program was highly valued by participants, and it supported the preoperative preparation, recovery, and postoperative rehabilitation of participants. Australian New Zealand Clinical Trial Registry ACTRN12617001433392 www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=373657
Publisher: Springer Science and Business Media LLC
Date: 26-09-2016
DOI: 10.1007/S11548-015-1265-3
Abstract: To describe an algorithm for the accurate segmentation of the main pulmonary artery (MPA) and determining its length, mid-cross-sectional area and mid-circumferential perimeter. This will help with accurate, rapid and reproducible MPA measurements which can be used to detect diseases that cause raised pulmonary arterial pressure, and allow standardized serial measurements to assess progression or response to treatment. We perform MPA segmentation using a novel approach based on erosion and dilation. A centerline is then determined by skeletonization, graph construction and spline fitting. MPA cross sections perpendicular to the centerline are analyzed in order to determine MPA length, and mid-cross-sectional area and perimeter. The technique was developed using four normal chest CT data sets and then tested on twenty normal post-contrast chest CT studies. Results are compared to manual segmentation and measurement by a thoracic radiologist. The mean MPA length, mid-cross-sectional area and mid-circumferential perimeter of the twenty test data sets, calculated by our algorithm, are 43.6 [Formula: see text] 9.2 mm, 552.9 [Formula: see text] 132.4[Formula: see text] and [Formula: see text], respectively, compared with [Formula: see text] and [Formula: see text] obtained manually by the radiologist. Our technique shows high correlation with the manually determined parameters for both mid- cross-sectional area ([Formula: see text]) and length ([Formula: see text]), and good correlation for mid-circumferential perimeter ([Formula: see text]). Our algorithm is a robust accurate automated method for obtaining measurements of the MPA. This allows a more standardized method for determining length, and mid- cross-sectional area erimeter and therefore allows more accurate comparison of MPA measurements.
Publisher: BMJ
Date: 06-2017
Publisher: Wiley
Date: 06-07-2021
Abstract: Deep learning (DL) has shown rapid advancement and considerable promise when applied to the automatic detection of diseases using CXRs. This is important given the widespread use of CXRs across the world in diagnosing significant pathologies, and the lack of trained radiologists to report them. This review article introduces the basic concepts of DL as applied to CXR image analysis including basic deep neural network (DNN) structure, the use of transfer learning and the application of data augmentation. It then reviews the current literature on how DNN models have been applied to the detection of common CXR abnormalities (e.g. lung nodules, pneumonia, tuberculosis and pneumothorax) over the last few years. This includes DL approaches employed for the classification of multiple different diseases (multi‐class classification). Performance of different techniques and models and their comparison with human observers are presented. Some of the challenges facing DNN models, including their future implementation and relationships to radiologists, are also discussed.
Publisher: Wiley
Date: 30-10-2006
DOI: 10.1002/JMRI.20763
Abstract: To quantify acromial slope (the scapuloacromial [SA] angle). We used shoulder MR studies in 64 subjects who were stratified surgically into impingement (with and without tear) and nonimpingement (shoulder instability) groups. We measure, in three dimensions, the angle between unit normal vectors to planes of best fit to the undersurface of the acromion and the medial surface of the blade of the scapula. We examine the projection of this SA angle onto the transverse, coronal, and sagittal planes to gauge some measure of rotation, lateral tilt, and anterior tilt with respect to the patient. Orientation of the acromion and scapular blade in relation to the MR scanner and therefore to the patient was also calculated. We found no significant differences between these two groups when examining age and side of pathology. A statistically significant difference was seen between males and females. Our study does not support the idea that a flatter acromial slope causes impingement and is an etiological basis for rotator cuff tears. We believe that acromial slope, regardless of imaging plane, is not useful in classifying patients who present with shoulder pain and should not be considered as a source of pathologic changes.
Publisher: Wiley
Date: 08-2021
Publisher: JMIR Publications Inc.
Date: 14-12-2017
Abstract: otal hip arthroplasty is an effective surgical procedure commonly used worldwide for patients suffering the disabling effects of osteoarthritis when medical therapy is unsuccessful. Traditionally pre- and postoperative information for patients undergoing a hip arthroplasty has been provided by paper-based methods. Electronic health (eHealth) programs to support in idualized patient education on preoperative preparation, in-patient care, and home rehabilitation have the potential to increase patient engagement, enhance patient recovery, and reduce potential postoperative complications. he aim of this study is to compare the addition of an eHealth program versus standard care for pre- and postoperative education on patient outcomes for primary total hip arthroplasty. ne hundred patients undergoing a primary elective total hip arthroplasty will be recruited from a metropolitan hospital in Western Australia to participate in a 6-month parallel randomized control trial. Participants will be randomized to either the standard care group (n=50) and will be given the education booklet and enrolled to attend a 1-hour education session, or the intervention group (n=50), and will receive the same as the standard care plus access to an eHealth program titled “My Hip Journey.” The eHealth program encourages the patient to log in daily, from 2 weeks prior to surgery to 30 days postsurgery. The information on the platform will be aligned with the patient's in idual surgical journey and will include exercises to be completed each day for the duration of the program. The primary outcome measure is the Hip Dysfunction and Osteoarthritis Outcome Score, version LK 2.0. Secondary outcome measures include the EuroQoL EQ-5D-5L, a 5-level 5-dimension quality of life measure, and the Self-Efficacy for Managing Chronic Disease Scale. Data will be collected at pre-admission (presurgery) and at 6 weeks, 3 months, and 6 months postsurgery. A patient satisfaction survey will be completed 6 weeks postsurgery and Web-based analytics will be collected 6 months postsurgery. A cost-effectiveness analysis, using the intention-to-treat principle, will be conducted from the hospital’s perspective. nrollment in the study commenced in January 2018 with recruitment due for completion towards the end of the year. The first results are expected to be submitted for publication in 2019. he outcomes and cost of using an eHealth program to support a patient’s recovery from a hip arthroplasty will be compared with standard care in this study. If the eHealth program is found to be effective, further implementation across clinical practice could lead to improvement in patient outcomes and other surgical areas could be incorporated. ustralian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12617001433392 www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=373657& isReview=true (Archived by WebCite at yzoTuggx). R1-10.2196/9654
Publisher: British Institute of Radiology
Date: 05-2015
DOI: 10.1259/BJR.20150034
Publisher: British Institute of Radiology
Date: 04-2016
DOI: 10.1259/BJR.20150431
Publisher: Elsevier BV
Date: 2023
Publisher: SPIE
Date: 29-04-2005
DOI: 10.1117/12.595872
Publisher: Springer Science and Business Media LLC
Date: 10-2015
DOI: 10.1007/S11548-015-1298-7
Abstract: The thoracic diaphragm separates the thorax and abdomen cavity and also performs an important function in respiration. An automatic algorithm to model the human full diaphragm from multi-detector computed tomography (MDCT) images has been developed and tested. The modelling algorithm comprises these steps: (i) diaphragm top boundary estimation (ii) diaphragm side boundary estimation and (iii) full diaphragm modelling in 3D. Diaphragm top boundary is estimated based on lungs' diaphragmatic surfaces with three different methods including: linear interpolation and fitting fourth and fifth degree polynomial surfaces. Diaphragm side boundary is assumed as the inner surfaces of the lower ribs, spinal column and costal cartilages, estimated via interpolation. As the last step, the full diaphragm is modelled by employing 3D active contours that are initiated from a predefined mesh and expand towards the estimated boundaries of the diaphragm. The proposed algorithm was tested on MDCT datasets from 15 patients, and the result were compared to reference masks provided by an experienced radiologist. Based on quantitative evaluations, the accuracy of the algorithm highly depends on the diaphragm top surface estimation, e.g., the proposed algorithm failed on two datasets, both with enlarged pericardial fat pad that cuts off the left lung from the diaphragm. The proposed algorithm was tested on the remaining 13 datasets in which lungs' lower surfaces have normal contact with the diaphragm. To perform quantitative evaluations, four slices per dataset including an axial, mid-coronal and one-fourth of the sagittal planes from left and right, were compared to the ground truth. Hausdorff distance and mean distance to the closest point were measured to be 11.61 and 3.46 mm respectively, when the diaphragm top surface is modelled by a fourth degree polynomial surface. Human full diaphragm can be automatically modelled with 3D active contours bounded by the lower surfaces of the lungs and inner surfaces of the lower ribs, spinal column and costal cartilages.
Publisher: Informa UK Limited
Date: 10-2018
DOI: 10.2147/RRU.S169017
Publisher: Springer Science and Business Media LLC
Date: 16-07-2015
DOI: 10.1007/S11548-014-1086-9
Abstract: The costal cartilage is a prominent feature of the anterior chest wall that is subject to developmental and acquired abnormalities. A fully automatic algorithm to reconstruct the human costal cartilage from multidetector computed tomography (MDCT) images was developed and tested. The reconstruction algorithm includes three steps: (1) estimation of length, curvature and end points for each costal cartilage centre-line, (2) costal cartilage cross-section area approximation, and (3) transformation of the estimated cross-section to the centre-line into a cylindrical coordinate system. Four different models were as follows: circle, vertical ellipse, horizontal ellipse and a non-geometric shape have been assumed for the cross-section. Shape estimates were based on each patient's dataset, so the algorithm is patient-specific and anatomically faithful. MDCT datasets from 15 patients were evaluated with the automated algorithm and the results compared with reference masks provided by an experienced radiologist. The costal cartilage reconstruction result and the reference mask were visually consistent. Based on evaluation results, the circular model cross-section with area of twice M (mean area of all rib cross-sections in the mid-coronal plane) had the highest Dice similarity coefficient (DSC = 77.5%) with only 2.12 mm registration distance. Costal cartilage 3D morphology can be extracted from MDCT scans with an automated method, using a circular cross-section with area equal to twice M.
Publisher: Wiley
Date: 11-05-2015
DOI: 10.1111/BJU.13090
Abstract: To evaluate the accuracy of combined multiparametric magnetic resonance imaging (mpMRI) and transperineal template-guided mapping biopsy (TTMB) for identifying lobes with significant prostate cancer (PCa) for the application of hemi-ablative focal therapy (FT). From January 2012 to January 2014, 89 consecutive patients, aged ≥40 years, with a PSA level ≤15 ng/mL, underwent in sequential order: mpMRI, TTMB and radical prostatectomy (RP) at a single centre. Analysis was performed on 50 patients who met consensus guidelines for FT. Lobes were stratified into lobes with significant cancer (LSC), lobes with insignificant cancer and lobes with no cancer. Using histopathology at RP, the predictive performance of combined mpMRI + TTMB in identifying LSC was evaluated. The sensitivity, specificity and positive predictive value for mpMRI + TTMB for LSC were 97, 61 and 83%, respectively. The negative predictive value (NPV), the primary variable of interest, for mpMRI + TTMB for LSC was 91%. Of the 50 patients, 21 had significant unilateral disease on mpMRI + TTMB. Two of these 21 patients had significant bilateral disease on RP not identified on mpMRI + TTMB. In the selection of candidates for FT, a combination of mpMRI and TTMB provides a high NPV in the detection of LSC.
Publisher: Elsevier BV
Date: 04-2005
Publisher: Elsevier BV
Date: 10-2015
DOI: 10.1016/J.AHJ.2015.06.022
Abstract: Late gadolinium enhancement cardiac magnetic resonance imaging (CMRI) is the current standard for evaluation of myocardial infarct scar size and characteristics. Because post-ST-segment elevation myocardial infarction (STEMI) troponin levels correlate with clinical outcomes, we sought to determine the s ling period for high-sensitivity troponin T (hs-TnT) that would best predict CMRI-measured infarct scar characteristics and left ventricular (LV) function. Among 201 patients with first presentation with STEMI who were prospectively recruited, we measured serial hs-TnT levels at admission, peak, 24 hours, 48 hours, and 72 hours after STEMI. Indexed LV volumes, LV ejection fraction (LVEF) and infarct scar characteristics (scar size, scar heterogeneity, myocardial salvage index, and microvascular obstruction) were evaluated by CMRI at a median of 4 days post-STEMI. Peak and serial hs-TnT levels correlated positively with early indexed LV volumes and infarct scar characteristics, and negatively correlated with myocardial salvage index and LVEF. Both 48- and 72-hour hs-TnT levels similarly predicted "large" total infarct scar size (odds ratios [ORs] 3.08 and 3.53, both P < .001), myocardial salvage index (ORs 1.68 and 2.30, both P < .001), and LVEF <40% (ORs 2.16 and 2.17, both P < .001) on univariate analyses. On multivariate analyses, 48- and 72-hour hs-TnT levels independently predicted large infarct scar size (ORs 2.05 and 2.31, both P < .001), reduced myocardial salvage index (OR 1.39 [P = .031] and OR 1.55 [P = .009]), and LVEF <40% (OR 1.47 [P = .018] and OR 1.43 [P = .026]). All measured hs-TnT levels had a modest association and similar capacity to predict microvascular obstruction. Levels of hs-TnT at 48 and 72 hours, measured during the "plateau phase" post-STEMI, predicted infarct scar size, poor myocardial salvage, and LVEF. These levels also correlated with scar heterogeneity and microvascular obstruction post-STEMI. Since ascertaining peak levels after STEMI is challenging in routine practice, based on the biphasic kinetics of hs-TnT, a measurement at 48 to 72 hours (during the plateau phase) provides a useful and simple method for early evaluation of LV function and infarct scar characteristics.
Publisher: Springer Science and Business Media LLC
Date: 13-06-2018
DOI: 10.1007/S11548-018-1805-8
Abstract: To automatically identify small- to medium-diameter bronchial segments distributed throughout the lungs. We segment the peripheral pulmonary vascular tree and construct cross-sectional images perpendicular to the lung vasculature. The bronchi running with pulmonary arteries appear as concentric rings, and potential center points that lie within the bronchi are identified by looking for circles (using the circular Hough transform) and rings (using a novel variable ring filter). The number of candidate bronchial center points are further reduced by using agglomerative hierarchical clustering applied to the points represented with 18 features pertaining to their 3D position, orientation and appearance of the surrounding cross-sectional image. Resulting clusters corresponded to bronchial segments. Parameters of the algorithm are varied and applied to two experimental data sets to find the best values for bronchial identification. The optimized algorithm was then applied to a further 21 CT studies obtained using two different CT vendors. The parameters that result in the most number of true positive bronchial center points with > 95% precision are a tolerance of 0.15 for the hierarchical clustering algorithm and a threshold of 75 HU with 10 spokes for the ring filter. Overall, the performance on all 21 test data sets from CT scans from both vendors demonstrates a mean number of 563 bronchial points detected per CT study, with a mean precision of 96%. The detected points across this group of test data sets are relatively uniformly distributed spatially with respect to spherical coordinates with the origin at the center of the test imaging data sets. We have constructed a robust algorithm for automatic detection of small- to medium-diameter bronchial segments throughout the lungs using a combination of knowledge-based approaches and unsupervised machine learning. It appears robust over two different CT vendors with similar acquisition parameters.
Publisher: JMIR Publications Inc.
Date: 12-06-2018
DOI: 10.2196/RESPROT.9654
Publisher: BMJ
Date: 03-2021
DOI: 10.1136/BMJOPEN-2020-046138
Abstract: Frailty and pain are associated with adverse patient clinical outcomes and healthcare system costs. Frailty and pain can interact, such that symptoms of frailty can make pain assessment difficult and pain can exacerbate the progression of frailty. The prevalence of frailty and pain and their concurrence in hospital settings are not well understood, and patients with cognitive impairment are often excluded from pain prevalence studies due to difficulties assessing their pain. The aim of this study is to determine the prevalence of frailty and pain in adult inpatients, including those with cognitive impairment, in an acute care private metropolitan hospital in Western Australia. A prospective, observational, single-day point prevalence, cross-sectional study of frailty and pain intensity of all inpatients (excluding day surgery and critical care units) will be undertaken. Frailty will be assessed using the modified Reported Edmonton Frail Scale. Current pain intensity will be assessed using the PainChek smart-device application enabling pain assessment in people unable to report pain due to cognitive impairment. Participants will also provide a numerical rating of the intensity of current pain and the worst pain experienced in the previous 24 hours. Demographic and clinical information will be collected from patient files. The overall response rate of the survey will be reported, as well as the percentage prevalence of frailty and of pain in the s le (separately for PainChek scores and numerical ratings). Additional statistical modelling will be conducted comparing frailty scores with pain scores, adjusting for covariates including age, gender, ward type and reason for admission. Ethical approval has been granted by Ramsay Health Care Human Research Ethics Committee WA/SA (reference: 2038) and Edith Cowan University Human Research Ethics Committee (reference: 2020–02008-SAUNDERS). Findings will be widely disseminated through conference presentations, peer-reviewed publications and social media. ACTRN12620000904976.
Publisher: BMJ
Date: 08-2021
DOI: 10.1136/BMJOPEN-2021-048657
Abstract: There is a clear need for improved care quality and quality monitoring in aged care. Aged care providers collect an abundance of data, yet rarely are these data integrated and transformed in real-time into actionable information to support evidence-based care, nor are they shared with older people and informal caregivers. This protocol describes the co-design and testing of a dashboard in residential aged care facilities (nursing or care homes) and community-based aged care settings (formal care provided at home or in the community). The dashboard will comprise integrated data to provide an ‘at-a-glance’ overview of aged care clients, indicators to identify clients at risk of fall-related hospitalisations and poor quality of life, and evidence-based decision support to minimise these risks. Longer term plans for dashboard implementation and evaluation are also outlined. This mixed-method study will involve (1) co-designing dashboard features with aged care staff, clients, informal caregivers and general practitioners (GPs), (2) integrating aged care data silos and developing risk models, and (3) testing dashboard prototypes with users. The dashboard features will be informed by direct observations of routine work, interviews, focus groups and co-design groups with users, and a community forum. Multivariable discrete time survival models will be used to develop risk indicators, using predictors from linked historical aged care and hospital data. Dashboard prototype testing will comprise interviews, focus groups and walk-through scenarios using a think-aloud approach with staff members, clients and informal caregivers, and a GP workshop. This study has received ethical approval from the New South Wales (NSW) Population & Health Services Research Ethics Committee and Macquarie University’s Human Research Ethics Committee. The research findings will be presented to the aged care provider who will share results with staff members, clients, residents and informal caregivers. Findings will be disseminated as peer-reviewed journal articles, policy briefs and conference presentations.
Publisher: Elsevier BV
Date: 09-2023
Publisher: Wiley
Date: 02-03-2007
DOI: 10.1002/JMRI.20878
Abstract: To investigate whether the loss of corticomedullary differentiation (CMD) on T1-weighted MR images due to renal insufficiency can be attributed to changes in T1 values of the cortex, medulla, or both. Study subjects included 10 patients (serum creatinine range 0.6-3.0 mg/dL) referred for suspected renovascular disease who underwent 99mTc-diethylene triamine pentaacetic acid (DTPA) renography to determine single kidney glomerular filtration rate (SKGFR) and same-day MRI, which included T1 measurements and unenhanced T1-weighted gradient echo imaging. Corticomedullary differentiation on T1-weighted images was assessed qualitatively and quantitatively. SKGFR values ranged from 3.5 to 89.4 mL/minute based on radionuclide studies. T1 relaxation times of the medulla exceeded those of renal cortex by 147.9+/-176.0 msec (mean+/-standard deviation [SD]). Regression analysis showed a negative correlation between cortex T1 and SKGFR (r=-0.5 P=0.03), whereas there was no significant correlation between medullary T1 and SKGFR. The difference between medullary and cortical T1s correlated significantly with SKGFR (r=0.58 P<0.01). In all five kidneys with a corticomedullary contrast-to-noise ratio (CNR)<5.0 on T1-weighted images, SKGFR was less than 20 mL/minute. In our subject population, loss of CMD with decreasing SKGFR can be attributed primarily to an increased T1 relaxation time of the cortex. Medullary T1 values vary but do not appear to correlate with degree of renal insufficiency.
Publisher: The Sax Institute
Date: 2020
Publisher: JMIR Publications Inc.
Date: 02-05-2018
Abstract: hose who experience a critical illness or condition requiring admission to an intensive care unit (ICU) frequently experience physical and psychological complications as a direct result of their critical illness or condition and ICU experience. Complications, if left untreated, can affect the quality of life of survivors and impact health care resources. Explorations of potential interventions to reduce the negative impact of an ICU experience have failed to establish an evidence-based intervention. he aim of this study is to evaluate the impact of a Web-based intensive care recovery program on the mental well-being of intensive care survivors and to determine if it is a cost-effective approach. n total, 162 patients that survived an ICU experience will be recruited and randomized into 1 of 2 groups. The intervention group will receive access to the Web-based intensive care recovery program, ICUTogether, 2 weeks after discharge (n=81), and the control group will receive usual care (n=81). Mental well-being will be measured using the Hospital Anxiety and Depression Scale, The Impact of Events Scale-Revised and the 5-level 5-dimension EuroQoL at 3 time points (2 weeks, 6 months, and 12 months post discharge). Family support will be measured using the Multidimensional Scale of Perceived Social Support at 3 time points. Analysis will be conducted on an intention-to-treat basis using regression modeling. Covariates will include baseline outcome measures, study allocation (intervention or control), age, gender, length of ICU stay, APACHE III score, level of family support, and hospital readmissions. Participants’ evaluation of the mobile website will be sought at 12 months postdischarge. A cost utility analysis conducted at 12 months from a societal perspective will consider costs incurred by in iduals as well as health care providers. articipant recruitment is currently underway. Recruitment is anticipated to be completed by December 2020. his study will evaluate a novel intervention in a group of ICU survivors. The findings from this study will inform a larger study and wider debate about an appropriate intervention in this population.
Publisher: Wiley
Date: 22-02-2018
DOI: 10.1002/JMRI.25983
Publisher: BMJ
Date: 06-2022
DOI: 10.1136/BMJOPEN-2021-059388
Abstract: Hospitalised older adults are prone to functional deterioration, which is more evident in frail older patients and can be further exacerbated by pain. Two interventions that have the potential to prevent progression of frailty and improve patient outcomes in hospitalised older adults but have yet to be subject to clinical trials are nurse-led volunteer support and technology-driven assessment of pain. This single-centre, prospective, non-blinded, cluster randomised controlled trial will compare the efficacy of nurse-led volunteer support, technology-driven pain assessment and the combination of the two interventions to usual care for hospitalised older adults. Prior to commencing recruitment, the intervention and control conditions will be randomised across four wards. Recruitment will continue for 12 months. Data will be collected on admission, at discharge and at 30 days post discharge, with additional data collected during hospitalisation comprising records of pain assessment and volunteer support activity. The primary outcome of this study will be the change in frailty between both admission and discharge, and admission and 30 days, and secondary outcomes include length of stay, adverse events, discharge destination, quality of life, depression, cognitive function, functional independence, pain scores, pain management intervention (type and frequency) and unplanned 30-day readmissions. Stakeholder evaluation and an economic analysis of the interventions will also be conducted. Ethical approval has been granted by Human Research Ethics Committees at Ramsay Health Care WA|SA (number: 2057) and Edith Cowan University (number: 2021-02210-SAUNDERS). The findings will be disseminated through conference presentations, peer-reviewed publications and social media. ACTRN12620001173987.
Publisher: Wiley
Date: 10-02-2015
DOI: 10.1118/1.4905104
No related grants have been discovered for Daniel Moses.