ORCID Profile
0000-0002-5041-2666
Current Organisations
Seoul National University Hospital
,
James Cook University
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Publisher: Springer Science and Business Media LLC
Date: 14-04-2012
Publisher: Elsevier BV
Date: 12-2022
Abstract: To evaluate the secondary prevention of acute rheumatic fever (ARF) and rheumatic heart disease (RHD) in the Townsville region, Australia. Adherence to benzathine benzylpenicillin G (BPG) was determined for 196 children and young adults aged under 22 years between January 2009 and December 2019, and factors associated with BPG adherence were analysed. Secondary outcomes included attendance at specialist reviews and echocardiograms. Adequate adherence (80%) to regular BPG injections was met by 51.1% of the cohort. Adequate BPG adherence more likely occurred for those that attended the Paediatric Outreach Clinic (OR4.15, 95%CI:2.13-8.05) or a school delivery program (OR1.87, 95%CI:1.11-3.45). People with moderate/severe RHD had greater BPG adherence (OR1.76,95%CI:1.00-3.10). People in rural/remote areas were less likely to have adequate BPG adherence compared to urban counterparts (OR0.31, 95%CI:0.15-0.65). Adherence to echocardiography was 66% and specialist review attendance was 12.5-50%. Half of the cohort in the Townsville region received adequate BPG prophylaxis to prevent ARF/RHD. Although rates were relatively higher than those reported in other Australian regions, health delivery goals should be close to 100%. Low attendance at specialist services was reported. Implication for public health: Delivery models with dedicated services, case management and family support could improve BPG adherence in in iduals with ARF/RHD. Further resources in rural and remote areas are needed.
Publisher: Elsevier BV
Date: 08-2008
DOI: 10.1111/J.1753-6405.2008.00256.X
Abstract: Most diagnoses of genital chlamydia infection in Queensland are made by general practitioners (GPs). This study aimed to assess GP attitudes to and knowledge of contact tracing in rural North Queensland. A single page questionnaire mailed to a database of 65 GPs in May 2007. Nearly all respondents (42/43, 97.7%) 'always' or 'mostly' told patients to advise their contacts to seek medical treatment. More than half (24/44, 54.5%) felt that contact tracing was 'sometimes' or 'never' the responsibility of GPs. Around half of respondents (19/39, 48.7%) thought that the local public health unit staff were conducting contact tracing, which is not actually the case. There is lack of clarity surrounding the respective roles and responsibilities of sexual health units, public health units and GPs regarding contact tracing for chlamydia infection. GPs would benefit from education clarifying current contact tracing procedures, methods and resources.
Publisher: The Royal Australian College of General Practitioners
Date: 12-2020
Publisher: The Royal Australian College of General Practitioners
Date: 02-2021
Publisher: The Royal Australian College of General Practitioners
Date: 08-2022
Publisher: BMJ
Date: 04-2018
Publisher: Oxford University Press (OUP)
Date: 06-2008
DOI: 10.1111/J.1365-2133.2008.08715.X
Abstract: Skin cancer is an increasing problem in fair-skinned populations worldwide. It is important that doctors are able to diagnose skin lesions accurately. To compare the clinical with the histological diagnosis of excised skin lesions from a set of epidemiological data. We analysed diagnostic accuracy stratified by histological subtype and body site and examined the histological nature of misclassified diagnosis. All excised and histologically confirmed skin cancers in Townsville/Thuringowa, Australia from December 1996 to October 1999 were recorded. Positive predictive values (PPVs) and sensitivities were calculated for the clinical diagnoses and stratified by histological subtype and body site. Skin excisions in 8694 patients were examined. PPVs for the clinical diagnoses were: basal cell carcinoma (BCC) 72.7% squamous cell carcinoma (SCC) 49.4% cutaneous melanoma (CM) 33.3%. Sensitivities for the clinical diagnosis were: BCC 63.9% SCC 41.1% CM 33.8%. For BCC, PPVs and sensitivities were higher for the trunk, the shoulders and the face and lower for the extremities. The reverse pattern was seen for SCCs. Diagnostic accuracy was highest for BCC, the most prevalent lesion. Most excisions were correctly diagnosed or resulted in the removal of malignant lesions. With nonmelanocytic lesions, doctors tended to misclassify benign lesions as malignant, but were less likely to do the reverse. Although a small number of clinically diagnosed common naevi subsequently proved to be melanoma (6.3%), a higher proportion of all melanomas had been classified as common naevi (20.9%). Accuracy of diagnosis was dependent on body site.
Publisher: Baishideng Publishing Group Inc.
Date: 2016
Publisher: The Royal Australian College of General Practitioners
Date: 03-2018
Publisher: Wiley
Date: 19-03-2019
DOI: 10.1111/AJO.12966
Abstract: Some women with diabetes in pregnancy express and store colostrum in the antenatal period for the purposes of preventing and treating neonatal hypoglycaemia. Our primary aim was to compare rates of neonatal hypoglycaemia in babies born to mothers who express and store antenatal colostrum to babies born to mothers who do not. Retrospective cohort study involving 357 women with diabetes in pregnancy, who had live, singleton births delivered after 36 weeks gestation, in a regional hospital in North Queensland (2014–2015). Multivariable binary logistic regression modelling identified independent characteristics associated with primary outcomes. Eighty women (23%) expressed antenatal colostrum and 223 (62%) did not. One hundred and thirty‐one babies (37%) were diagnosed with hypoglycaemia. Aboriginal and Torres Strait Islander women were less likely to express than Caucasian women (odds ratio ( OR ) 0.10, 95% confidence interval ( CI ) 0.01–0.77). There were no significant differences in the rates of hypoglycaemia, or median blood glucose levels in babies born to mothers who expressed antenatal colostrum compared to babies born to mothers who did not express. Babies born to mothers who expressed were significantly less likely to receive formula in hospital compared to babies born to mothers who did not ( OR 0.12, 95% CI 0.05–0.32). We found no independent association of expressing antenatal colostrum on rates of neonatal hypoglycaemia or median blood glucose levels. Expressing antenatal colostrum may have some benefits to the newborn such as reduced formula consumption in hospital. Further research into other methods of reducing neonatal hypoglycaemia appears warranted.
Publisher: Elsevier BV
Date: 03-2021
Publisher: Wiley
Date: 07-08-2019
DOI: 10.1002/HPJA.280
Abstract: Australia has recently introduced a new screening program for cervical cancer. There has also been a decline in participation rates for cervical screening. To complete a systematic literature review of the factors that prevent Australian women from participating in cervical screening. Authors searched CINAHL, Medline, SCOPUS and the Cochrane Library to obtain articles discussing Australian women's self-identified barriers to cervical screening. Quantitative studies published in peer-reviewed journals after 1991 were considered. PROSPERO Registration Number: CRD42018105028. The final search produced 1749 studies, with 13 quantitative papers included in the narrative synthesis after screening by two independent reviewers. No articles were excluded due to bias. Self-identified barriers to screening were categorised into personal, practitioner, test-related and logistical factors. The most commonly stated barriers included lack of time, embarrassment, fear of results, irrelevance and male health professionals. The use of HPV triage in cervical screening was not a barrier to screening, however, some women regarded self-collected HPV testing as a barrier. Barriers to self-collection included desire for the general practitioner to complete the test, fear of doing the test incorrectly, wishing to include it in a general check-up and concerns about the test itself. A variety of personal, practitioner, test-related and logistical barriers negatively impact the screening participation of Australian women. Further research into barriers in the Australian population, and women's attitudes towards HPV testing and self-collection is required to create effective health interventions to improve participation in cervical screening.
Publisher: MDPI AG
Date: 09-11-2021
DOI: 10.3390/TROPICALMED6040197
Abstract: Impetigo affects millions of children worldwide. Most guidelines recommend antibiotics as first-line treatment however, topical antiseptics present a potentially valuable, understudied, antibiotic-sparing treatment for mild impetigo. We aimed to determine the feasibility of a randomised controlled trial (RCT) comparing efficacy of soft white paraffin (SWP), hydrogen peroxide (H2O2) and mupirocin for mild impetigo. Participants were recruited from general practices and randomly assigned one of three treatments. Size and number of lesions were measured at the initial consultation and day six. Post-recruitment, interviews with general practitioners were transcribed and themes identified to determine protocol acceptability, recruitment barriers and avenues to improve delivery. Two participants received SWP (n = 1) and mupirocin (n = 1). Both commenced oral antibiotics following failure of assigned topical treatment in which lesions increased in size or number. Recruitment barriers included reduced presentation of impetigo due to COVID-19, pre-treatment with existing at-home medications and moderate/severe infection. Childcare centers and pharmacies were identified as alternative venues to improve the recruitment rate. Valuable insight was gained into the practicality of conducting a RCT of impetigo treatments in general practice. Future trials should consider recruiting outside of general practice clinics to capture patients at earlier, more mild stages of infection. Further investigation into the prevalence and impact of use of at-home expired antibiotics may be beneficial.
Publisher: Wiley
Date: 11-01-2018
DOI: 10.1111/JOG.13544
Abstract: In January 2015, the diagnostic and therapeutic criteria for gestational diabetes changed, with the goal of increasing the sensitivity of diagnosis and improving overall glycemic control, and thus reducing adverse pregnancy outcomes. Our primary aim was to evaluate the effect of the new guidelines on the incidence of diagnosis of gestational diabetes and the incidence of therapeutic interventions. Our secondary aim was to look at the incidence of adverse pregnancy outcomes. A retrospective clinical audit was conducted at a regional hospital to compare the incidence of gestational diabetes, and the specific maternal and neonatal outcomes before and after the change in guidelines was implemented. Data were collected via chart review for a 6-month period before and after the change in guidelines in January 2015. Data collected included demographics, neonatal and maternal outcomes, and the treatment type used for patients diagnosed with gestational diabetes. There was a significant increase in the incidence of diagnosis of gestational diabetes (9.8-19.6% P < 0.001), and an overall increase in the use of pharmacological treatments for gestational diabetes. There was no significant difference in the incidence of the adverse outcomes measured, including cesarean delivery and macrosomia. There was no significant change in mean fetal weight. Despite a doubling of the incidence of diagnosis of gestational diabetes, and a consequent increase in pharmacological interventions, the change in diagnostic and therapeutic criteria did not significantly reduce the neonatal or maternal adverse outcomes measured.
Publisher: Hindawi Limited
Date: 24-01-2016
DOI: 10.1155/2016/6043427
Abstract: Background. Central venous catheters and peripherally inserted central catheters are well established risk factors for upper limb deep vein thrombosis. There is limited literature on the thrombosis rates in patients with peripheral catheters. A prospective observational study was conducted to determine the incidence of peripheral catheter-related thrombosis in surgical patients. Methods. Patients deemed high risk for venous thrombosis with a peripheral catheter were considered eligible for the study. An ultrasound was performed on enrolment into the study and at discharge from hospital. Participants were reviewed twice a day for clinical features of upper limb deep vein thrombosis during their admission and followed up at 30 days. Results. 54 patients were included in the study. The incidence of deep vein thrombosis and superficial venous thrombosis was 1.8% and 9.2%, respectively. All cases of venous thrombosis were asymptomatic. Risk factor analysis was limited by the low incidence of thrombosis. Conclusion. This study revealed a low incidence of deep vein thrombosis in surgical patients with peripheral catheters (1.8%). The study was underpowered therefore the association between peripheral catheters and thrombosis is unable to be established. Future studies with larger s le sizes are required to determine the association between peripheral catheters and thrombosis.
Publisher: Public Library of Science (PLoS)
Date: 21-06-2018
Publisher: CMA Joule Inc.
Date: 07-08-2017
DOI: 10.1503/CMAJ.161460
Publisher: Informa UK Limited
Date: 27-09-2019
Publisher: Elsevier BV
Date: 12-2016
Publisher: The Royal Australian College of General Practitioners
Date: 02-2022
Publisher: John Wiley & Sons, Ltd
Date: 14-12-2014
Publisher: BMJ
Date: 2019
DOI: 10.1136/BMJOPEN-2018-021513
Abstract: To explore and describe the experiences and perspectives of collecting and storing colostrum in the antenatal period in women who have had diabetes in pregnancy. Face-to-face, semistructured interviews analysed with purposive s ling and thematic analysis. A regional hospital in North Queensland with a high prevalence of diabetes in pregnancy. Six women with a previous pregnancy complicated by diabetes who were advised to collect and store colostrum in pregnancy. Six themes were identified: wariness of medicalisation (adjusting to an ‘abnormal’ pregnancy, seeking continuity of care, determination to reduce formula, fear of invasive intervention) underlying altruism (providing the best for baby, preparing for complications, eager for milk donation) internal pressure to succeed (coping with confronting information, disheartened by failures, constant fear of insufficient supply, overwhelming guilt, concern for future breastfeeding success) self-management and ownership (adapting to awkwardness, developing strategies for success, actively seeking education, gaining confidence to request help, accepting personal limitations) frustrated by waste (encroaching on time, squandering a precious resource, ambiguous about necessity) and building fortitude for motherhood (physically preparing for breast feeding, symbolic of the imminent infant, establishing early relationships with supports, approaching challenges with realistic optimism). Women with diabetes in pregnancy experience guilt and stress about the added risk of hypoglycaemia to their babies and strive to provide the best for their babies by collecting and storing colostrum, even if this leads to distress to themselves. It is crucial that these women be provided accurate, realistic advice about the benefits and disadvantages of collecting colostrum in the antenatal period.
Publisher: Oxford University Press (OUP)
Date: 29-06-2021
Abstract: Impetigo is a common superficial skin infection that affects people worldwide and is usually treated with antibiotics therefore, its management has implications for global antibiotic stewardship. This systematic review and narrative synthesis compares and contrasts international impetigo management guidelines. Guidelines for treatment of impetigo that were produced by a national authority available to primary care physicians and published since 2008 were included. Following a comprehensive search strategy, data extraction from eligible studies was performed independently in duplicate. Details of antiseptic and antibiotic treatment methicillin-resistant Staphylococcus aureus treatment and conservative management and preventative measures were tabulated and analysed descriptively. Fifty-one guidelines were included from 42 different countries. All guidelines recommended systemic antibiotics, 78% of these only for widespread lesions or failure of topical antibiotic treatment. The first-line systemic antibiotic treatment was restricted to narrow-spectrum options in 21 (41%) whilst 7 (14%) recommended only broad-spectrum antibiotics first-line. Thirty-four (67%) guidelines included recommendations for topical antibiotic use. Twenty guidelines (39%) did not mention antiseptic treatment for impetigo. Guidelines did not always provide clear indications for different treatment options. Despite potentially equal efficacy to systemic antibiotics, only two-thirds of guidelines include topical antibiotic options. Many fail to include recommendations for non-antibiotic treatments such as antiseptics, preventative measures and conservative management, despite potential for antibiotic-sparing. Provision of clear definitions of disease severity and indications for treatment would enhance the ability of clinicians to adhere to recommendations. PROSPERO CRD42018117770
Publisher: Wiley
Date: 05-09-2012
DOI: 10.1111/J.1754-9485.2012.02430.X
Abstract: Cervical spine radiography may be over-utilised in an emergency department setting. The Canadian C-Spine Rule has been developed to reduce unnecessary radiography. Our aim was to retrospectively determine the proportion of cervical spine radiographs requested through the emergency department for trauma patients that were clinically indicated, according to the Canadian C-Spine Rule. This was a cross-sectional survey conducted at a regional centre in Northern Queensland, Australia. All cervical spine radiographs for trauma, performed at the Mackay Base Hospital from 1 January 2009 to the 31 December 2009, were reviewed. The relevant patient charts were audited for evidence of indications for radiography. Of 406 patients in the study, 155 patients (38%) (95% confidence interval 33.3%, 42.7%) had cervical spine imaging performed that was not indicated according to the Canadian C-Spine Rule. None of these patients had a significant cervical spine injury on radiography. Applying the Canadian C-Spine Rule would have safely reduced the incidence of cervical spine radiography by 38%. This would also reduce costs, patient morbidity and radiation exposure.
Publisher: BMJ
Date: 07-2016
Publisher: MDPI AG
Date: 23-05-2018
Publisher: Wiley
Date: 18-06-2020
DOI: 10.1002/HPJA.365
Abstract: The new National Cervical Screening Program (NCSP) has recently been implemented. Little research is available on women's attitudes towards the program. This study aims to quantitatively assess Australian women's understanding and attitudes towards the new guidelines and their barriers to screening. Authors designed a cross‐sectional survey which was piloted and distributed as a waiting room survey to eligible women who attended a private general practice in North Queensland. Of the respondents, 53.8% had accurate knowledge of the new NCSP. Most participants (75.8%) believed they were not provided sufficient information about the NCSP and 60.2% wished to receive this information from their general practitioner. The screening test itself remains an issue, with embarrassment and discomfort listed as the most common barriers to screening. Many women do not have accurate knowledge of the new NCSP. Further health promotion in this area is warranted, where the general practitioner may play a key role. While the new NCSP will lead to further reduction in cervical cancer mortality, it appears from the data that women did not fully understand cervical cancer and its screening. This suggests the need for further health education to women about updated screening guidelines.
Publisher: Elsevier BV
Date: 04-2013
DOI: 10.1016/J.INJURY.2012.10.012
Abstract: Currently available volar locking plates for the treatment of distal radius fractures incorporate at least two distal screw rows for fixation of the metaphyseal fragment and have a variable-angle locking mechanism which allows placement of the screws in various directions There is, however no evidence that these plates translate into better outcomes or have superior biomechanical properties to first generation plates, which had a single distal screw row and fixed-angle locking. The aim of our biomechanical study was to compare fixed-angle single-row plates with variable-angle multi-row plates to clarify the optimal number of locking screws. Five different plate-screw combinations of three different manufacturers were tested, each group consisting of five synthetic fourth generation distal radius bones. An AO type C2 fracture was created and the fractures were plated according to each manufacturer's recommendations. The specimens then underwent cyclic and load-to-failure testing. An optical motion analysis system was used to detect displacement of fragments. No significant differences were detected after cyclic loading as well as after load-to-failure testing, neither in regard to axial deformation, implant rigidity or maximum displacement. The fixed-angle single-row plate showed the highest pre-test rigidity, least increase in post-testing rigidity and highest load-to-failure rigidity and least radial shortening. The radial shortening of plates with two distal screw rows was 3.1 and 4.3 times higher, respectively, than that of the fixed-angle single-row plate. The results of our study indicate that two distal screw rows do not add to construct rigidity and resistance against loss of reduction. Well conducted clinical studies based on the findings of biomechanical studies are necessary to determine the optimal number of screws necessary to achieve reproducibly good results in the treatment of distal radius fractures.
Publisher: Springer Science and Business Media LLC
Date: 14-02-2015
DOI: 10.1007/S11239-015-1175-9
Abstract: To identify patient-related risk factors for venous thrombosis in patients with central venous catheters (CVC) or peripherally inserted central catheters (PICC). We performed a systematic review of the literature assessing patient-related risk factors for thrombosis related to CVC or PICC. The databases PubMed, Ovid and the Cochrane library were searched for observational studies pertaining to patient-related risk factors for CVC and PICC-related thrombosis. The initial search through PubMed, Ovid and the Cochrane library yielded 516 results. After 71 duplicates were removed, 445 articles were assessed for eligibility based on title and abstract. Four hundred and eleven articles were then excluded and 33 full text articles were manually assessed for eligibility. Eight articles were eliminated as they did not contain content relevant to the review. Twenty-five studies were then selected to assess 20 risk factors. There were no consistent significant associations for catheter-related thrombosis across the twenty-five studies. Multiple studies identified age, malignancy, diabetes, obesity, chemotherapy, thrombophilia and a history of thrombosis as significant risk factors for catheter-related thrombosis. Inconsistent findings among studies make it difficult to establish which patient-related risk factors are associated with catheter-related thrombosis. Future studies could include larger s le sizes and more cases of catheter-related thrombosis to produce more significant results. Identification of patient-related risk factors could lead to early recognition of upper limb deep vein thrombosis in patients with catheters, thereby preventing complications.
Publisher: Wiley
Date: 16-09-2010
DOI: 10.1111/J.1445-2197.2010.05479.X
Abstract: Background: The current options for plate–screw combinations in volar locking distal radius plates used for the treatment of distal radius fractures are either plates with a single distal screw row or plates with multiple distal screw rows. Additionally, the screws themselves may have either fixed angle locking or polyaxial locking mechanisms. To date, there is no evidence or consensus regarding the optimal plate–screw combination. The aim of this study was to assess the biomechanical behaviour of different plate–screw combinations with respect to total distal screw number, number of distal screw rows and screw projection surface area of the most distal row. Methods: Biomechanical study to assess six different plating configurations in five different volar locking plate models in a Sawbone distal radius fracture model. The specimens were loaded with 800 Newton loads for 2.000 cycles at 1 Hz. After cyclic loading, load‐to‐failure testing was performed. Results: With cyclical testing, there was a significant and positive correlation between rigidity and a greater projection area of the most distal screws. Dorsal tilting was significantly more pronounced in plate models with a lesser projection area of the most distal screws and a smaller number of distal screws. With load‐to‐failure testing, there was a significant increase in rigidity with increasing screw projection area of the most distal row and total number of distal screws. Conclusions: Additional distal screw rows in volar locking distal radius plates might not add substantially to resistance against loss of reduction in the post‐operative period.
Publisher: Baishideng Publishing Group Inc.
Date: 2014
Publisher: Mattioli1885
Date: 31-01-2019
DOI: 10.5826/DPC.0901A08
Abstract: Background: Surgical site infection (SSI) rates for below-knee dermatological surgery are unacceptably high, particularly following complex flap and graft closures. The role of antibiotic prophylaxis for these surgical cases is uncertain. Objective: To determine whether SSI following complex dermatological closures on the leg could be reduced by antibiotic prophylaxis administered as a single oral preoperative dose. Methods: A total of 115 participants were randomized to 2 g of oral cephalexin or placebo 40-60 minutes prior to surgical incision in a prospective, randomized, double-blind, placebo-controlled trial at a primary care skin cancer clinic in North Queensland, Australia. Results: Overall 17/55 (30.9%) controls and 14/55 (25.5%) intervention participants developed infection (P = 0.525). There was no difference between the study groups in adverse symptoms that could be attributed to high-dose antibiotic administration (P = 1).
Publisher: Public Library of Science (PLoS)
Date: 29-06-2021
DOI: 10.1371/JOURNAL.PONE.0253581
Abstract: Associations between rheumatic heart disease (RHD) in pregnancy and fetal outcomes are relatively unknown. This study aimed to review rates and predictors of major adverse fetal outcomes of RHD in pregnancy. Medline (Ovid), Pubmed, EMcare, Scopus, CINAHL, Informit, and WHOICTRP databases were searched for studies that reported rates of adverse perinatal events in women with RHD during pregnancy. Outcomes included preterm birth, intra-uterine growth restriction (IUGR), low-birth weight (LBW), perinatal death and percutaneous balloon mitral valvuloplasty intervention. Meta-analysis of fetal events by the New-York Heart Association (NYHA) heart failure classification, and the Mitral-valve Area (MVA) severity score was performed with unadjusted random effects models and heterogeneity of risk ratios (RR) was assessed with the I 2 statistic. Quality of evidence was evaluated using the GRADE approach. The study was registered in PROSPERO (CRD42020161529). The search identified 5949 non-duplicate records of which 136 full-text articles were assessed for eligibility and 22 studies included, 11 studies were eligible for meta-analyses. In 3928 pregnancies, high rates of preterm birth (9.35%-42.97%), LBW (12.98%-39.70%), IUGR (6.76%-22.40%) and perinatal death (0.00%-9.41%) were reported. NYHA III/IV pre-pregnancy was associated with higher rates of preterm birth (5 studies, RR 2.86, 95%CI 1.54–5.33), and perinatal death (6 studies, RR 3.23, 1.92–5.44). Moderate /severe mitral stenosis (MS) was associated with higher rates of preterm birth (3 studies, RR 2.05, 95%CI 1.02–4.11) and IUGR (3 studies, RR 2.46, 95%CI 1.02–5.95). RHD during pregnancy is associated with adverse fetal outcomes. Maternal NYHA III/IV and moderate/severe MS in particular may predict poor prognosis.
Publisher: BMJ
Date: 10-03-2012
DOI: 10.1136/SEXTRANS-2011-050422
Abstract: Chlamydia reinfection is common and increases the risk of reproductive complications. Guidelines for Australian general practitioners recommend retesting 3-12 months after a positive result but not before 6 weeks. The authors describe retesting rates among 16-29-year-old patients diagnosed as having chlamydia at 25 general practice clinics participating in the Australian Collaboration for Chlamydia Enhanced Sentinel Surveillance system. The authors calculated annual testing and positivity rates for 16-29-year-olds attending in 2008-2009, re-attendance and retesting rates within <6 weeks, 1.5-4 months and 1.5-12 months of a positive test in 2008-2009 and positivity at retest (where results were available). Results There were 50,408 in iduals (60.4% women) who attended in 2008-2009. Annually, 7.4% and 7.3% were tested for chlamydia, of whom 9.1% and 8.0% tested positive, respectively. Within 1.5-4 months of a positive test, 24.6% re-attended and were retested (19% tested positive), 31.6% re-attended and were not retested and 43.9% did not re-attend. Within 1.5-12 months, 40% re-attended and were retested (16% tested positive), 40% re-attended and were not retested and 20% did not re-attend. Of in iduals re-attending in 1.5-12 months but not retested, 50% had re-attended three or more times in the period. Within 6 weeks of a positive test, 25% were retested. A high proportion of 16-29-year-olds re-attended general practices in the recommended retest periods, but retesting rates were low and multiple missed opportunities were common. The findings highlight the need for strategies such as electronic clinician prompts, patient recall systems and promotion of retesting guidelines.
Publisher: Oxford University Press (OUP)
Date: 28-06-2017
DOI: 10.1002/BJS.10588
Abstract: Surgical-site infections (SSIs) increase patient morbidity and costs. The aim was to identify and synthesize all RCTs evaluating the effect of topical antibiotics on SSI in wounds healing by primary intention. The search included Ovid MEDLINE, Ovid Embase, the Cochrane Wounds Specialized Register, Central Register of Controlled Trials and EBSCO CINAHL from inception to May 2016. There was no restriction of language, date or setting. Two authors independently selected studies, extracted data and assessed risk of bias. When sufficient numbers of comparable trials were available, data were pooled in meta-analysis. Fourteen RCTs with 6466 participants met the inclusion criteria. Pooling of eight trials (5427 participants) showed that topical antibiotics probably reduced the risk of SSI compared with no topical antibiotic (risk ratio (RR) 0·61, 95 per cent c.i. 0·42 to 0·87 moderate-quality evidence), equating to 20 fewer SSIs per 1000 patients treated. Pooling of three trials (3012 participants) for risk of allergic contact dermatitis found no clear difference between antibiotics and no antibiotic (RR 3·94, 0·46 to 34·00 very low-quality evidence). Pooling of five trials (1299 participants) indicated that topical antibiotics probably reduce the risk of SSI compared with topical antiseptics (RR 0·49, 0·30 to 0·80 moderate-quality evidence) 43 fewer SSIs per 1000 patients treated. Pooling of two trials (541 participants) showed no clear difference in the risk of allergic contact dermatitis with antibiotics or antiseptic agents (RR 0·97, 0·52 to 1·82 very low-quality evidence). Topical antibiotics probably prevent SSI compared with no topical antibiotic or antiseptic. No conclusion can be drawn regarding whether they cause allergic contact dermatitis.
Publisher: Informa UK Limited
Date: 02-10-2018
Publisher: AMPCo
Date: 2015
DOI: 10.5694/MJA14.00314
Abstract: To compare the incidence of infection after minor surgery conducted using non-sterile clean boxed gloves with surgery conducted using sterile gloves. Prospective randomised controlled single-centre trial testing for non-inferiority in infection rates. Primary care regional centre, Queensland, Australia. Consecutive patients presenting to participating general practitioners for a minor skin excision, between 30 June 2012 and 28 March 2013, were eligible to participate. The use of non-sterile clean boxed gloves was compared with normal treatment using sterile gloves in the control group. Wound infection, assessed at the time of removal of sutures, and other adverse events. Four hundred and ninety-three consecutive patients presenting for minor skin excisions were randomly allocated to the two treatment groups: non-sterile clean boxed gloves (n = 250) or sterile gloves (n = 243). Four hundred and seventy-eight patients contributed data for analysis (241 non-sterile, 237 sterile gloves). The incidence of infection in the non-sterile gloves group (8.7% 95% CI, 4.9%-12.6%) was significantly non-inferior compared with the incidence in the control group (9.3% 95% CI, 7.4%-11.1%). The two-sided 95% CI for the difference in infection rate (- 0.6%) was - 4.0% to 2.9%, and did not reach the predetermined margin of 7% which had been assumed as the non-inferiority limit. RESULTS of the intention-to-treat analysis were confirmed by per-protocol and sensitivity analyses. There were no important adverse effects. Our study suggests that in regard to wound infection, non-sterile clean boxed gloves are not inferior to sterile gloves for minor skin excisions in general practice. ACTRN12612000698875.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 05-2019
Publisher: Massachusetts Medical Society
Date: 05-11-2020
Publisher: BMJ
Date: 04-2022
DOI: 10.1136/BMJOPEN-2021-059069
Abstract: Identifying optimal strategies for managing patients of any age with varying risk of acute rheumatic fever (ARF) attending for an apparently uncomplicated acute sore throat, also clarifying the role of point-of-care testing (POCT) for presence of group A beta-haemolytic Streptococcus (GABHS) in these settings. We compared outcomes of adhering to nine different strategies for managing these patients in primary healthcare. The nine strategies, similar to guidelines from several countries, were tested against two validation data sets being constructs from seven prior studies. The proportion of patients requiring a POCT, prescribed antibiotics, prescribed antibiotics having GABHS and finally having GABHS not prescribed antibiotics, if different strategies had been adhered to. In a scenario with high risk of ARF, adhering to existing guidelines would risk many patients ill from GABHS left without antibiotics. Hence, using a POCT on all of these patients minimised their risk. For low-risk patients, it is reasonable to only consider antibiotics if the patient has more than low pain levels despite adequate analgesia, 3–4 Centor scores (or 2–3 FeverPAIN scores or 3–4 McIsaac scores) and a POCT confirming the presence of GABHS. This would require testing only 10%–15% of patients and prescribing antibiotics to only 3.5%–6.6%. Patients with high or low risk for ARF needs to be managed very differently. POCT can play an important role in safely targeting the use of antibiotics for patients with an apparently uncomplicated acute sore throat.
Publisher: BMJ
Date: 03-2020
DOI: 10.1136/BMJOPEN-2019-034483
Abstract: To investigate women’s understanding and attitudes towards the National Cervical Screening Program (NCSP) and to explore methods to improve screening participation. Semi-structured face-to-face interviews were conducted through convenience and snowball s ling. Thematic analysis occurred using the interpretivist framework. A private general practice in North Queensland. Women between the ages of 18 and 74 who attended the general practice were eligible to participate. Fourteen women between 20 and 58 years old were interviewed. Participants were concerned that the new NCSP would miss cancer due to longer screening intervals and reliance on primary human papilloma virus (HPV) testing. They believed that young women are at increased risk of cervical cancer, due to perceived HPV vaccine ineffectiveness and parent objection to vaccination. Most participants were not agreeable to self-s ling and preferred their doctor to perform screening. Personal and practitioner beliefs influenced a woman’s screening participation. Personal factors include being healthy for themselves and their family, previous abnormal smears and family history of cancer. Emphasis was placed on feeling ‘comfortable’ with their practitioner which included patient rapport and gender preference. Proposed methods to improve cervical screening included education programmes, advertising c aigns, general practitioner interventions and improving accessibility. It is apparent that women are hesitant about the new NCSP. However, when provided with additional information they were more amenable to the changes. This highlights the need to improve awareness of cervical screening and the new NCSP.
Publisher: The Royal Australian College of General Practitioners
Date: 09-2021
Publisher: Elsevier BV
Date: 2011
DOI: 10.1093/BJA/AEQ297
Abstract: Opinions about satisfaction with care are rarely obtained from children and few studies of this type exist in the area of paediatric anaesthesia. In this study, we developed a comprehensive self-administered questionnaire to measure the level of paediatric and, as a substitute in younger children, parental satisfaction with anaesthesia. In addition, we aimed to identify factors influencing satisfaction and compare results between hospitals. We followed a rigorous protocol including construction of a pilot questionnaire and qualitative and quantitative analysis. The questionnaire was adapted for confounding variables. We analysed satisfied and dissatisfied groups and compared satisfaction scores between participating hospitals. A questionnaire was developed which comprised 37 questions assessed on a five-point Likert scale. With a response rate of 71%, a total of 1052 patients completed the questionnaire. In the final analysis, 760 questionnaires (72%) were included. Most questionnaires were answered by the parents [705 (92.8%)]. The mean age of children was 6.7 (4.97) yr. Multivariate analysis found a history of previous anaesthetic problems and the identity of the person answering the questionnaire as influencing factors on the sum score. The most important differences between satisfied and dissatisfied children were found for the dimensions 'privacy and waiting', 'information giving', and 'discomfort'. Scores differed between hospitals. Our psychometric questionnaire provides a novel approach to paediatric patient satisfaction with anaesthesia care and covers areas deemed important by children, parents, and carers. Significant differences between satisfied and dissatisfied groups and between participating hospitals were found.
Publisher: Wiley
Date: 07-11-2016
Publisher: Wiley
Date: 27-12-2022
DOI: 10.1111/EMR.12541
Abstract: The role of recreational fishers forming paths (routes of concentrated passage characterised by short vegetation or ground indentation) as they gain access to wilderness waterbodies has not been well documented in Australia. Recreational use for trout and tournament fly fishing has increased in the Central Plateau of Tasmania therefore, it is important to determine the human contribution to path formation and its potential consequences for bio ersity conservation in this area of high conservation value. We predicted that paths parallel to waterbodies experienced more human traffic than orthogonal paths. Across 36 sites at different distances from roads, a parallel and orthogonal path to lakeshore were s led using eight, 1 × 1 m quadrats randomly located along each path within a 10 × 10‐m plot. Recorded for each quadrat were the path widths, height difference between centre of paths and adjacent vegetation (path depth), vegetation types on and adjacent to paths, Bennetts Wallaby ( Notamacropus rufogriseus ) and Wombat ( Vombatus ursinus ) faecal numbers. General linear models indicated that path width was greater on parallel than orthogonal paths and declined with distance from roads. Path depth, however, was not affected by distance from roads but was shallower than orthogonal paths. Separate models used to test the potential effects of edge vegetation type, or the covariates Wallaby and Wombat scats did not have significant effects on‐path variables. Paths encircling or orthogonal to Central Plateau lakes appear different floristically to adjacent vegetation communities, nonetheless. Heath and tussock grassland were largely absent from paths, whereas grassland and herbfield communities were infrequently observed off paths. Herbfield and grassland are rarer communities than heath and tussock grassland, which, in the context of a lack of exposure to erosion, suggests a conservation benefit of paths at present usage levels. The human contribution to parallel path conditions is likely to be high, given the results from the study, so monitoring of change is desirable, especially if predicted increasing human activity eventuates in this area.
Publisher: Wiley
Date: 05-2021
DOI: 10.1111/IMJ.15327
Abstract: Familial hypercholesterolaemia (FH) is a common, heritable and preventable cause of premature coronary artery disease. New clinical practice recommendations are presented to assist practitioners in enhancing the care of all patients with FH. Core recommendations are made on the detection, diagnosis, assessment and management of adults, children and adolescents with FH. Management is under‐pinned by the precepts of risk stratification, adherence to healthy lifestyles, treatment of non‐cholesterol risk factors and appropriate use of low‐density lipoprotein (LDL)‐cholesterol‐lowering therapies including statins, ezetimibe and proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors. The recommendations need to be utilised using judicious clinical judgement and shared decision‐making with patients and families. New government‐funded schemes for genetic testing and use of PCSK9 inhibitors, as well as the National Health Genomics Policy Framework, will enable adoption of the recommendations. However, a comprehensive implementation science and practice strategy is required to ensure that the guidance translates into benefit for all families with FH.
Publisher: Elsevier BV
Date: 06-2021
Publisher: BMJ
Date: 08-2019
DOI: 10.1136/BMJOPEN-2018-028714
Abstract: The objectives of this study were threefold: to estimate people’s interest in health-related research, to understand to what extent people appreciate being actively informed about current local health-related research and to investigate whether their interest can be influenced by advertising local current health-related research using large TV monitors. Randomised controlled trial using a stepped wedge design. The emergency department waiting room at two public hospitals in northern Queensland, Australia. Waiting patients and their accompanying friends and relatives in the emergency department waiting room not requiring immediate medical attention. A TV monitor advertising local current health-related research. OR for the effect of intervention on changing the interest in health-related research compared with a control group while adjusting for gender, age and socioeconomic standard. The intervention significantly increased the short-term interest in health-related research with an OR of 1.3 (1.1–1.7, p=0.0063). We also noted that being female and being older was correlated to a higher interest in health-related research This study found that proactive information significantly increased the general populations’ interest in health-related research. There are reasonable set up costs involved but the costs for maintaining the system were very low. Hence, it seems reasonable that research-active organisations should give much higher priority to this type of activity. ACTRN12617001085369
Publisher: BMJ
Date: 30-07-2014
Publisher: BMJ
Date: 10-2019
DOI: 10.1136/BMJOPEN-2019-031527
Abstract: To establish the prevalence and associations of systemic antibiotic prescription for impetigo by early-career general practitioners (GPs) (GP registrars in their first 18 months in general practice). A cross-sectional analysis of data from the Registrar Clinical Encounters in Training (ReCEnT) study. ReCEnT is an ongoing multisite cohort study of Australian registrars’ in-consultation clinical practice across five Australian states. Registrars participating in ReCEnT from 2010 to 2017. Management of impetigo with systemic antibiotics. 1741 registrars (response rate 96%) provided data from 384 731 problems identified in 246 434 consultations. Impetigo, on first presentation or follow-up, was managed in 930 (0.38%, 95% CI 0.35 to 0.40) consultations and comprised 0.24% (95% CI 0.23 to 0.26) of problems. 683 patients presented with a new diagnosis of impetigo of which 38/683 (5.6%) were not prescribed antibiotics 239/683 (35.0%) were prescribed solely topical antibiotics 306/683 (44.8%) solely systemic antibiotics and 100/683 (14.6%) both systemic and topical antibiotics. The most common systemic antibiotic prescribed was cephalexin (53.5%). Variables independently associated with prescription of systemic antibiotics were an inner regional (compared with major city) location (OR 1.82, 95% CI 1.06 to 3.13 p=0.028), seeking in-consultation information or advice (OR 2.17, 95% CI 1.47 to 3.23 p .001) and ordering pathology (OR 2.13, 95% CI 1.37 to 3.33 p=0.01). Australian early-career GPs prescribe systemic antibiotics (the majority broad-spectrum) for a high proportion of initial impetigo presentations. Impetigo guidelines should clearly specify criteria for systemic antibiotic prescription and in idual antibiotic choice. The role of non-antibiotic management and topical antiseptics needs to be explored further.
Publisher: Wiley
Date: 20-06-2012
DOI: 10.1111/J.1365-4632.2011.05189.X
Abstract: Surgical site infection (SSI) following minor surgery contributes to patient morbidity and compromises cosmetic outcomes. The purpose of this study was to determine the incidence of and risk factors for SSI after dermatological surgery in general practice. A prospective, observational study which assessed infection among 972 patients was conducted in regional north Queensland, Australia. Consecutive patients presenting for minor skin excisions were invited to participate. Wounds were assessed for SSI at the time of removal of sutures. Infection occurred in 85 of the 972 excisions thus, the overall incidence of infection was 8.7% (95% confidence interval 6.5-11.0). Excisions in the upper (P<0.001) or lower (P<0.001) extremities, excisions of basal cell carcinoma (BCC) (P=0.001) or squamous cell carcinoma (SCC) (P=0.001), and re-excision of skin cancer were found to be independent risk factors for wound infection. The length of the excision (P<0.001) and the patient's status as an ex-smoker (P=0.019) were additional independent risk factors for infection. Diabetes was not found to be an independent risk factor for infection (P=0.891). Prophylactic antibiotics are probably prescribed excessively or inappropriately for dermatological surgery, and overall we wish to discourage their use. The results of this study may encourage the more judicial use of prophylactic antibiotics by defining high-risk procedures, such as excisions from the extremities, excision of BCC or SCC, and larger excisions, and patients who are at high risk for infection, such as ex-smokers.
Publisher: The Royal Australian College of General Practitioners
Date: 10-2019
Publisher: BMJ
Date: 24-04-2006
Publisher: Elsevier BV
Date: 03-2021
Publisher: BMJ
Date: 11-2022
DOI: 10.1136/BMJOPEN-2022-064431
Abstract: Skin cancer is a common disease in the tropics, and oncological resection typically requires reconstruction with skin grafts. Fibrin glue, initially established as a haemostatic agent, has been studied extensively as an adhesive for skin grafts in burns. This study aims to investigate the use of fibrin as an adhesive for split skin grafts in skin cancers. The study design is a prospective randomised controlled trial with the aim of investigating the impact of two different methods of split skin graft fixation. The intervention of fibrin glue will be compared with the control of staples or sutures. The trial will be conducted at two sites, a public hospital and a private hospital in Townsville, Australia, over a 24-month period with 334 participants to be recruited. Consecutive patients presenting for skin excisions and grafting will be eligible to participate in this study. Randomisation will be on the level of the patient. The primary outcome is graft take based on wound healing at 1 month. Secondary outcomes will be pain on dressing changes and operative time. The study has been approved by The Townsville University Hospital Human Research Ethics Committee. Findings will be disseminated in conference presentations and journals and through online electronic media. ACTRN12618000484246.
Publisher: CSIRO Publishing
Date: 2010
DOI: 10.1071/PY09078
Abstract: The Enhanced Primary Care (EPC) program funds GPs to provide preventative health assessments through a specific set of Medicare item numbers. The study aimed to show whether patients completing these health assessments had better recorded screening rates than those receiving usual care. A retrospective clinical record audit was undertaken in north Queensland general practices by practice nurses from the North Queensland Practice Based Research Network. Comparisons were made between the recorded screening test rates for patients who completed an over-75-years health assessment with those who did not. A questionnaire was also completed by practice nurses and practice principals. Screening tests were recorded more frequently in patients with a completed health assessment: notably urinalysis, visual acuity and faecal occult blood test/colonoscopy. Blood pressure was the most frequently recorded test with or without a health assessment. The questionnaires provided useful information on how health assessments are implemented and whether GPs believe they are useful.
Publisher: Informa UK Limited
Date: 22-09-2017
Publisher: Informa UK Limited
Date: 13-12-2020
DOI: 10.1080/00140139.2019.1699952
Abstract: Solar ultraviolet radiation (UVR) is the main environmental risk-factor for cancer of the skin. Sun-protective clothing provides a physical barrier that reduces the UVR dose reaching the skin and European and Australian standards for sun-protective clothing set minimum clothing coverage requirements. Body Surface Area Coverage by clothing (BSAC) is calculated by means of indirect or direct methods, which are laborious and do not support computer-based apparel design. To support the sun-safe specification and design of garments, parametric digital human models and protective clothing mesh covering the minimum Body Surface Area specified in AS/NZS 4399:2017, were created making use of MakeHuman v1.1.1 and Blender software. The Whole Body Surface Area (WBSA) and the BSAC were calculated employing code developed in Blender. Thus, different groups of subjects were analysed to explore BSAC. The method assists in the evaluation of exposed body areas in a wider spectrum of different occupations.
Publisher: Wiley
Date: 27-06-2012
DOI: 10.1111/J.1460-9592.2012.03886.X
Abstract: Opinions about satisfaction with care are rarely obtained from disabled children and their carers, and few studies of this type exist in the area of pediatric anesthesia. We specifically aimed to assess groups of children with disabilities and Down syndrome and aimed to identify factors influencing satisfaction in these groups. We assessed two groups of children using the Paediatric Perianesthesia Questionnaire (PPQ). Families with Down syndrome children (Down syndrome group, DSG) were approached via a Down syndrome family support magazine, and families with disabled children were enrolled in hospitals. Two hundred and fifteen disabled children (125 from the journal, 90 from the hospitals) were compared to matching controls without disabilities. Controls were drawn randomly using computer-generated tables of random numbers using data from the PPQ validation, to match cases for confounding variables. Satisfaction was lower in both groups with disabilities (P < 0.05) (lowest in the DSG), fewer would choose the hospital or anesthetic department again. In both of the disabled groups, negative comments were related to the anesthetists' behavior during the consultation, the content of the consultation, and how anxiety was dealt with. Ninety five percent in the DSG reported that the anesthetist had not mentioned or enquired about atlantoaxial instability. Satisfaction was lower than the rest of the respective group if memories of the disclosure of the disabling condition were negative (P = 0.006) or if potential offensive terms had been used during the consultation (P < 0.001). This is the first study to assess families with disabled children for satisfaction with anesthesia. Our findings suggest that parents of children with disabilities are less satisfied with their anesthetic care than parents of children without disabilities. Potential bias comes from the self-selection of the DSG and the recall period in this group.
Publisher: The Royal Australian College of General Practitioners
Date: 08-2019
Publisher: Mattioli1885
Date: 31-07-2017
DOI: 10.5826/DPC.0703A03
Publisher: F1000 Research Ltd
Date: 08-02-2023
DOI: 10.12688/MEP.19478.1
Abstract: Background: The coronavirus disease 2019 (COVID-19) pandemic significantly impacted medical education. This study aimed to determine how COVID-19 affected students’ opportunity to practice core clinical skills across specialty rotations and their self-perceived proficiency at performing these. Methods: Routinely administered surveys of fifth year medical student’ experiences and perceptions of medical training from 2016 to 2021 were analysed. Number of times core clinical skills were performed and self-perceived proficiency of each skill were compared pre- (years 2016-2019) and during-COVID (years 2020-2021). Results: Data from 219 surveys showed a reduction in the opportunity to perform “a cervical screen test” (p .001), “a mental health assessment” (p=0.006), “assess the risk of suicide” (p=0.004) and “bladder catheterisation” (p=0.007) during-COVID. Self-reported skill proficiency was also less during-COVID for performance of: “a mental health assessment” (p=0.026) and “an ECG” (p=0.035). Conclusions: The impact of COVID-19 on mental health skills was greatest, potentially due to a shift toward telehealth services and consequent reduced ability for students to engage in consultations. In a time of potential long-term change in the healthcare landscape, it is imperative to ensure adequate opportunity to practice all core clinical skills during medical training. Inclusion of telehealth earlier into the curriculum may benefit student confidence.
Publisher: MDPI AG
Date: 28-08-2021
DOI: 10.3390/TROPICALMED6030158
Abstract: Background and objectives: vaccine injections are a common cause of iatrogenic pain and anxiety, contributing to non-compliance with scheduled vaccinations. With injection-related pain being recognised as a barrier to vaccination uptake in both adults and children, it is important to investigate strategies to effectively reduce immunisation pain. This prospective randomised controlled trial investigated the effects of applying an ice pack on vaccine-related pain in adults. Methods: medical students receiving the flu vaccination were randomised to receive an ice pack (intervention) or placebo cold pack (control) at the injection site for 30 s prior to needle insertion. Immediate post-vaccination pain (VAS) and adverse reactions in the proceeding 24 h were recorded. Results: pain scores between the intervention (n = 19) and control groups (n = 16) were not statistically significant (intervention: median pain VAS = 7.00, IQR = 18 control: median pain VAS = 11, IQR = 14 (p = 0.26). There were no significant differences in the number of adverse events between the two groups (site pain p = 0.18 localised swelling (p = 0.67) bruising p = 0.09 erythema p = 0.46). Discussion: ice did not reduce vaccination-related pain compared to cold packs. COVID-19 related restrictions impacted participant recruitment, rendering the study insufficiently powered to draw conclusions about the results.
Publisher: F1000 Research Ltd
Date: 26-04-2023
DOI: 10.12688/MEP.19478.2
Abstract: Background: The coronavirus disease 2019 (COVID-19) pandemic significantly impacted medical education. This study aimed to determine how COVID-19 affected students’ opportunity to practice core clinical skills across specialty rotations and their self-perceived proficiency at performing these. Methods: Routinely administered surveys of fifth year medical student’ experiences and perceptions of medical training from 2016 to 2021 were analysed. Number of times core clinical skills were performed and self-perceived proficiency of each skill were compared pre- (years 2016-2019) and during-COVID (years 2020-2021). Results: Data from 219 surveys showed a reduction in the opportunity to perform “a cervical screen test” (p .001), “a mental health assessment” (p=0.006), “assess the risk of suicide” (p=0.004) and “bladder catheterisation” (p=0.007) during-COVID. Self-reported skill proficiency was also less during-COVID for performance of: “a mental health assessment” (p=0.026) and “an ECG” (p=0.035). Conclusions: The impact of COVID-19 on mental health skills was greatest, potentially due to a shift toward telehealth services and consequent reduced ability for students to engage in consultations. In a time of potential long-term change in the healthcare landscape, it is imperative to ensure adequate opportunity to practice all core clinical skills during medical training. Inclusion of telehealth earlier into the curriculum may benefit student confidence.
Publisher: Elsevier BV
Date: 12-2020
Publisher: The Royal Australian College of General Practitioners
Date: 09-2022
Publisher: Informa UK Limited
Date: 18-03-2016
Publisher: Informa UK Limited
Date: 11-11-2021
Publisher: Wiley
Date: 23-02-2020
DOI: 10.1111/HEX.13036
Publisher: BMJ
Date: 20-05-2021
DOI: 10.1136/HEARTJNL-2020-318813
Abstract: Familial hypercholesterolaemia (FH) is characterised by elevated low-density lipoprotein (LDL)-cholesterol and increased risk of cardiovascular disease. However, FH remains substantially underdiagnosed and undertreated. We employed a two-stage pragmatic approach to identify and manage patients with FH in primary healthcare. Medical records for 232 139 patients who attended 15 general practices at least once in the previous 2 years across five Australian States were first screened for potential risk of FH using an electronic tool (TARB-Ex) and confirmed by general practitioner (GP) clinical assessment based on phenotypic Dutch Lipid Clinic Network Criteria (DLCNC) score. Follow-up GP consultation and management was provided for patients with phenotypic FH. A total of 1843 patients were identified by TARB-Ex as at potential risk of FH (DLCNC score ≥5). After GP medical record review, 900 of these patients (49%) were confirmed with DLCNC score ≥5 and classified as high-risk of FH. From 556 patients subsequently clinically assessed by GPs, 147 (26%) were diagnosed with phenotypic FH (DLCNC score 6). Follow-up GP consultation and management for 77 patients resulted in a significant reduction in LDL-cholesterol (−16%, p .01). A higher proportion of these patients attained the treatment target of 50% reduction in LDL-cholesterol (74% vs 62%, p .001) and absolute levels of LDL-cholesterol goals compared with baseline (26% vs 12%, p .05). A pragmatic approach integrating electronic medical record tools and clinical GP follow-up consultation is a feasible method to identify and better manage patients with FH in the primary healthcare setting. 12616000630415.
Publisher: The Royal Australian College of General Practitioners
Date: 11-2019
Publisher: CSIRO Publishing
Date: 2014
DOI: 10.1071/SH14079
Abstract: Background Clinical guidelines commonly recommend annual chlamydia (Chlamydia trachomatis) testing in young people. General practice (GP) clinics can play an important role in annual testing, as a high proportion of young people attend these clinics annually however, little is known about the timing of attendance and testing in this setting. Methods: The Australian Collaboration for Coordinated Enhanced Sentinel Surveillance of Sexually Transmitted Infections and Blood-Borne Viruses system extracted consultation and pathology data on 16–29-year-olds attending 25 GP clinics in 2007–10. We calculated the proportion of in iduals with an initial negative test that reattended at 12 months (±3 months) and retested at 12 months (±3 months). In iduals with an initial positive test were excluded, as guidelines recommend retesting at 3 months. Results: Among 3852 in iduals who had an initial negative test, 2201 (57.1%) reattended at ~12 months reattendance was higher among females (60.8%) than males (44.1% P 0.001) and higher among 16–19-year-olds (64.2%) than 25–29-year-olds (50.8% P 0.001). Of 2201 in iduals who reattended at 12 months, 377 had a chlamydia test (retesting rate of 9.8%) retesting was higher among females (10.8%) than males (6.1% P 0.01) and higher among 16–19-year-olds (13.3%) than 25–29-year-olds (7.5% P 0.001). Conclusion: Although over half of young people reattended their GP clinic ~1 year after a negative chlamydia baseline test, only 9.8% were retested at this visit. Strategies are needed to promote regular attendance and testing to both patients and clinicians.
Publisher: Elsevier BV
Date: 11-2017
DOI: 10.1016/J.HLC.2017.02.031
Abstract: It is unclear whether it is beneficial to perform angiography and/or percutaneous coronary intervention (PCI) as an early or delayed invasive strategy amongst high-risk non-ST elevation acute coronary syndrome (NSTEACS) patients. To determine whether an early invasive strategy could further reduce recurrent myocardial infarction (MI) and early mortality compared to a delayed invasive strategy. We searched MEDLINE, CINAHL and SCOPUS and performed a meta-analysis of nine RCTs with a total of 5274 patients. No statistically significant difference in recurrent MI (RR=0.56, 95% CI 0.17-1.87, p=0.35), early mortality (RR=0.81, 95% CI 0.62-1.05, p=0.11) and major bleeding (RR=0.85, 95% CI 0.66-1.09, p=0.21) was found between groups. A statistically significant reduction in recurrent ischaemia was found amongst patients treated with an early invasive strategy (RR 0.45, 95% CI 0.26-0.78, p=0.004). Subgroup analysis for recurrent MI showed a statistically significant reduction in risk amongst patients treated <24hours compared to≥24hours (RR=0.31, 95% CI 0.11-0.89, p=0.03). This study suggests that an early invasive strategy may not further reduce recurrent MI and early mortality, but may significantly reduce recurrent ischaemia. However, the recurrent MI endpoint was associated with heterogeneity due to inconsistent MI definitions and strategy timings amongst the included trials. Furthermore, subgroup analysis demonstrated a significant reduction in recurrent MI amongst patients treated <24hours. Therefore, large clinical trials with consistent inclusion criteria are required to confirm whether intervention within 24hours reduces the rate of spontaneous and post-discharge recurrent MI. Future studies with long-term follow-up data are required to detect relevant differences in early mortality. Currently, it appears that stabilised high-risk NSTEACS patients may be safely delayed up to 24hours before undergoing an early invasive strategy.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 2021
Publisher: Informa UK Limited
Date: 16-08-2019
Publisher: Baishideng Publishing Group Inc.
Date: 18-10-2018
Publisher: Wiley
Date: 17-11-2009
DOI: 10.1111/J.1365-4632.2009.04185.X
Abstract: Skin cancer is an increasing problem in fair-skinned populations worldwide. It is important that doctors are able to diagnose skin lesions accurately, and this is supported by accurate histological diagnosis. To compare agreement for histological diagnosis between local histopathologists with a dermato-histopathologist from a stratified random s le of excised skin lesions derived from a set of epidemiological data. All excised and histologically confirmed skin cancers in Townsville/Thuringowa, Australia from December 1996 to October 1999 were recorded. A stratified s le of 407 of 8694 skin excisions slides was analyzed. Results Positive predictive values (PPVs) for the primary histological diagnosis were above 90% for basal cell carcinoma, cutaneous melanoma, and common naevus. For squamous cell carcinoma (SCC), the PPV was 72.6% [95% CI = (65.5, 79.0)]. Lack of agreement between histopathologists regarding the diagnosis of SCC and actinic keratosis has been previously recognized in the literature and this is again reflected in our study. The result also illustrates the difficulty involved for doctors in accurately clinically diagnosing lesions for which a consensus is hard to reach histologically.
Publisher: BMJ
Date: 15-01-2009
DOI: 10.1136/BMJ.A2812
Publisher: The Royal Australian College of General Practitioners
Date: 09-2021
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 08-2020
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 06-2023
DOI: 10.1161/CIRCGEN.122.003842
Abstract: Heterozygous familial hypercholesterolemia (HeFH) is under-detected and undertreated. A general practitioner-led screening and care program for HeFH effectively identified and managed patients with HeFH. We evaluated the cost-effectiveness and the return on investment of an enhanced-care strategy for HeFH in primary care in Australia. We developed a multistate Markov model to estimate the outcomes and costs of a general practitioner-led detection and management strategy for HeFH in primary care compared with the standard of care in Australia. The population comprised in iduals aged 50 to 80 years, of which 44% had prior cardiovascular disease. Cardiovascular risk, HeFH prevalence, treatment effects, and acute and chronic health care costs were derived from published sources. The study involved screening for HeFH using a validated data-extraction tool (TARB-Ex), followed by a consultation to improve care. The detection rate of HeFH was 16%, and 74% of the patients achieved target LDL-C (low-density lipoprotein cholesterol). Quality-adjusted life years, health care costs, productivity losses, incremental cost-effectiveness ratio, and return on investment ratio were evaluated, outcomes discounted by 5% annually, adopting a health care and a societal perspective. Over the lifetime horizon, the model estimated a gain of 870 years of life lived and 1033 quality-adjusted life years when the general practitioner-led program was employed compared with standard of care. This resulted in an incremental cost-effectiveness ratio of AU$14 664/quality-adjusted life year gained from a health care perspective. From a societal perspective, this strategy, compared with standard of care was cost-saving, with a return on investment of AU$5.64 per dollar invested. An enhanced general practitioner-led model of care for HeFH is likely to be cost-effective.
Publisher: Elsevier BV
Date: 02-2020
Publisher: The Royal Australian College of General Practitioners
Date: 03-2022
Location: Korea, Republic of
Location: No location found
Location: United Kingdom of Great Britain and Northern Ireland
Location: Australia
Location: Australia
Start Date: 2018
End Date: 2021
Funder: National Health and Medical Research Council
View Funded Activity