ORCID Profile
0000-0002-6109-9134
Current Organisations
Feng Chia University
,
University of Sydney
,
Health Research Group
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Publisher: Mary Ann Liebert Inc
Date: 03-2021
Publisher: Mary Ann Liebert Inc
Date: 2023
Publisher: Oxford University Press (OUP)
Date: 06-1996
DOI: 10.1093/OXFORDJOURNALS.PUBMED.A024480
Abstract: Outcome measurement is an important component of health care service evaluation. The aim of this paper is to review child and adolescent mental health outcome measures and identify outcome measurement tools for use in routine clinical practice. A systematic literature review was undertaken, using Medline and Psych Info and supplemented by correspondence with relevant institutions and authorities in the field. The review identifies potential specific outcome measurement tools. These tools are evaluated using the scientific criteria of validity and reliability, responsiveness to change, and appropriateness of each tool's format for use in routine clinical practice. Three broad categories of outcome are identified: population outcomes, specific outcome and performance indicators. Nineteen specific outcome measurement tools are short-listed and compared in detail. No single tool is suitable for use as a comprehensive outcome measurement tool in routine clinical practice. A combination of some of the tools short-listed will cover all the necessary outcome items. However, the increase in assessment time will reduce clinical usefulness. Further research is needed to modify or created appropriate outcome measurement tools for use in routine clinical practice.
Publisher: Springer Science and Business Media LLC
Date: 09-05-2018
Publisher: SAGE Publications
Date: 2021
DOI: 10.1177/21649561211014107
Abstract: Culturally appropriate communication between healthcare professionals and with patients is widely recognised as a cornerstone of high quality, patient-centred care. The widespread use of traditional, complementary, and integrative medicine (TCIM) necessitates that patient-centre communication and cultural competency in healthcare extends beyond race, ethnicity, and languages spoken to also include an awareness of, and respect for the erse range of healthcare practices, paradigms, and lexicons that patients and practitioners use. Education can equip practitioners with the necessary communication skills and expand their knowledge about the therapies and practices that patients are accessing. In this viewpoint essay, we aim to 1) emphasise the importance of respectful, culturally competent interprofessional communication and collaboration that mutually supports patients’ care needs 2) note the impact of a political agenda that perpetuates medical hegemony and has discriminated against, and marginalised TCIM practitioners and the people who use these services and 3) highlight the importance of educational initiatives that support inclusive, culturally competent, interprofessional communication and collaboration between conventional and TCIM healthcare practitioners.
Publisher: BMJ
Date: 10-2021
DOI: 10.1136/BMJOPEN-2020-047474
Abstract: To evaluate the benefits and risks of zinc formulations compared with controls for prevention or treatment of acute viral respiratory tract infections (RTIs) in adults. Seventeen English and Chinese databases were searched in April/May 2020 for randomised controlled trials (RCTs), and from April/May 2020 to August 2020 for SARS-CoV-2 RCTs. Cochrane rapid review methods were applied. Quality appraisals used the Risk of Bias 2.0 and Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. Twenty-eight RCTs with 5446 participants were identified. None were specific to SARS-CoV-2. Compared with placebo, oral or intranasal zinc prevented 5 RTIs per 100 person-months (95% CI 1 to 8, numbers needed to treat (NNT)=20, moderate-certainty/quality). Sublingual zinc did not prevent clinical colds following human rhinovirus inoculations (relative risk, RR 0.96, 95% CI 0.77 to 1.21, moderate-certainty/quality). On average, symptoms resolved 2 days earlier with sublingual or intranasal zinc compared with placebo (95% CI 0.61 to 3.50, very low-certainty/quality) and 19 more adults per 100 were likely to remain symptomatic on day 7 without zinc (95% CI 2 to 38, NNT=5, low-certainty/quality). There were clinically significant reductions in day 3 symptom severity scores (mean difference, MD −1.20 points, 95% CI −0.66 to −1.74, low-certainty/quality), but not average daily symptom severity scores (standardised MD −0.15, 95% CI −0.43 to 0.13, low-certainty/quality). Non-serious adverse events (AEs) (eg, nausea, mouth/nasal irritation) were higher (RR 1.41, 95% CI 1.17 to 1.69, NNHarm=7, moderate-certainty/quality). Compared with active controls, there were no differences in illness duration or AEs (low-certainty/quality). No serious AEs were reported in the 25 RCTs that monitored them (low-certainty/quality). In adult populations unlikely to be zinc deficient, there was some evidence suggesting zinc might prevent RTIs symptoms and shorten duration. Non-serious AEs may limit tolerability for some. The comparative efficacy/effectiveness of different zinc formulations and doses were unclear. The GRADE-certainty/quality of the evidence was limited by a high risk of bias, small s le sizes and/or heterogeneity. Further research, including SARS-CoV-2 clinical trials is warranted. CRD42020182044.
Publisher: Elsevier BV
Date: 09-2023
Publisher: Springer Science and Business Media LLC
Date: 21-11-2022
DOI: 10.1186/S12875-022-01896-4
Abstract: The rising prevalence of prediabetes increases the population risk of type 2 diabetes mellitus (T2DM), metabolic syndrome and cardiovascular disease. Early identification by General Practitioners (GPs) provides opportunities for lifestyle modifications that can lower these risks. This study examined 16 years of hyperglycaemia-related testing for patients in Australia aged 13 years or older with, or at risk of a diagnosis of T2DM. The Bettering the Evaluation and Care of Health (BEACH) study is a national cross-sectional survey, with a single-stage, cluster s ling design. Approximately 1,000 GPs were randomly selected annually (2000/01–20,015/16) from across Australia, who each recorded details of 100 consecutive clinical encounters with consenting patients. Point estimates were adjusted for intracluster correlation and GP characteristics. Fifteen thousand six hundred seventy nine GPs recorded details of 1,387,190 clinical encounters with patients aged 13 + years. Prediabetes and T2DM were managed at 0.25% (95% CI: 0.24–0.27%) and 3.68% (95% CI: 3.62–3.73%) of encounters respectively. By the end of the study, the proportion of encounters where prediabetes was managed was 2.3 times higher and for T2DM, 1.5 times higher. The proportion of prediabetes (55.9%, 95% CI: 53.9–57.8%) and T2DM (27.3%, 95% CI: 26.7–27.9%) management occasions where one or more hyperglycaemia-related tests were requested were relatively stable. However, differences in the types of tests were observed. For prediabetes, glucose tolerance tests were most common but from 2014/15, requests for HbA1c tests began to increase. For T2DM, HbA1c tests were most common, and requests for one or more glucose tests gradually declined. The observed 16-year annual trends align with the rising incidence of prediabetes and T2DM. GPs appeared to be strongly influenced by changes to the national insurance scheme and clinical guidelines for hyperglycaemia-related pathology testing. However, some GPs may have been pre-empting policy changes as there was also evidence of ‘unendorsed’ testing, notably for prediabetes, that warrants further investigation. The increasing proportion of encounters for prediabetes, coupled with a high proportion of management occasions where pathology was requested have substantial resource implications. Calls to lower the risk threshold for prediabetes screening therefore warrant an economic analysis. Ongoing, reliable, up-to-date data is needed to inform clinical practice guidelines and policy in Australia.
Publisher: AMPCo
Date: 12-08-2020
DOI: 10.5694/MJA2.50731
Publisher: The Royal Australian College of General Practitioners
Date: 10-2021
Publisher: SAGE Publications
Date: 2021
DOI: 10.1177/21649561211037594
Abstract: Globally, a substantial proportion of general practitioners (GPs) incorporate integrative medicine (IM) into their clinical practice. This study aimed to map the IM education and training pathways and needs of a cohort of Australian GPs who are members of the Royal Australian College of General Practitioners’ IM Specific Interest Network, which is a group of GPs with interest in IM. We conducted a mixed-methods study comprising of an online, cross-sectional survey supplemented with in-depth semi-structured interviews. Data from the survey and interviews were initially analysed separately and then combined. Eighty-three (83) of 505 eligible GPs/GPs in training (16.4%) participated in the survey, and 15 GPs were interviewed. Results from the two datasets either converged or were complementary. Almost half (47%) of survey respondents had undertaken formal undergraduate or postgraduate IM education, a short course (63%), informal education (71%) or self-education (54%), in at least one of 20 IM modalities listed. Interviewees affirmed there was no single education pathway in IM. Survey respondents who identified as practicing IM were significantly more likely to have IM education, positive attitudes towards IM, particularly natural products, and higher self-rated IM knowledge and competencies. However, knowledge gaps were identified in professional skills domains of population health and context, and organisational and legal dimensions of applied IM practice. Interviewees also highlighted a range of professional and systemic barriers to the practice of IM, education, and training. There was broad support for recognition of IM as a sub-specialty through formalised post-graduate training and accreditation. Most survey respondents (62%) expressed interest in post-fellowship recognition of GPs with advanced skills in IM. Our findings demonstrate that it is important to define best practice in IM for GPs in Australia and provide a standardised pathway towards recognition of advanced skills in IM.
Publisher: Springer Science and Business Media LLC
Date: 09-2017
DOI: 10.1007/S00520-017-3851-0
Abstract: There is an obvious mismatch between the high reported rates of use of traditional and complementary medicines (T&CM) by Australian cancer patients and cancer survivors and the low numbers of Australian cancer services integrating T&CM. An estimated 65% of Australian cancer patients use at least one form of T&CM. Over half use T&CM in conjunction with conventional cancer therapy. Yet, less than 20% of Australian hospital cancer care facilities provide access to T&CM. This compares to around 70% of UK cancer care facilities offering at least one T&CM therapy. Barriers to developing integrative oncology services include determining an appropriate service model and revenue structure concerns with ethical and legal issues such as regulations and credentialing and inadequate high-quality scientific evidence demonstrating safety and effectiveness, including concerns about the possibility of adversely affecting chemotherapy or radiotherapy treatment. This paper aims to provide general guidance and practical strategies for those seeking to develop integrative oncology services in Australian cancer care facilities.
Publisher: Elsevier BV
Date: 12-2023
Publisher: SAGE Publications
Date: 07-2012
Abstract: This pilot study sought to identify motivators and barriers to participating in a longitudinal survey we interviewed patients and practitioners at a multidisciplinary primary care clinic where the proposed project would be based. While altruism motivates participation in medical research, we found that for many potential participants, the opportunity to benefit directly was the primary, and sometimes the only motive to participate or encourage participation in the research project. Patients often wanted direct feedback from their in idual results, and they expected to provide consent before the results were forwarded to other parties such as their practitioners. Similarly, some practitioners were more likely to support the project if participation benefited patients directly. Other factors were also identified that influenced the acceptability and perceived risks and benefits of participating. More work is needed to understand these motivators and how patients might benefit directly from participating in health services research, especially when direct medical benefit is not possible.
Publisher: Cold Spring Harbor Laboratory
Date: 04-11-2020
DOI: 10.1101/2020.11.02.20220038
Abstract: To evaluate the benefits and risks of any type of zinc intervention to prevent or treat SARS-CoV-2. A living, systematic review and meta-analysis, incorporating rapid review methods. 17 English and Chinese databases and clinical trial registries were searched in April/May 2020, with additional covid-19 focused searches in June and August 2020. Randomized control trials (RCTs) published in any language comparing zinc to a control to prevent or treat SARS-CoV-2. Other viral respiratory tract infections (RTIs) were included, but the certainty of evidence downgraded twice for indirectness. Screening, data extraction, risk of bias appraisal (RoB-2 tool) and verification was performed by calibrated, single reviewers. RCTs with adult populations were prioritised for analysis. 123 RCTs were identified. None were specific to SARS-CoV-2 nor other coronaviruses. 28 RCTs evaluated oral (15-45mg daily), sublingual (45-300mg daily), or topical nasal (0.09-2.6 mg daily) zinc to prevent or treat nonspecific viral RTIs in 3,597 adults without zinc deficiency. Compared to placebo, zinc prevented 5 mild to moderate RTIs per 100 person-months, including in older adults (95% confidence interval 1 to 9) (number needed to treat (NTT)=20). There was no significant difference in the rates of non-serious adverse events (AE). For RTI treatment, a clinically important reduction in peak symptom severity scores was found for zinc compared to placebo (mean difference 1.2 points, 0.7 to 1.7), but not average daily symptom severity (standardised mean difference 0.2, 0.1 to 0.4). 19 fewer per 100 adults were at risk of remaining symptomatic over the first 7 days (2 to 38, NNT=5) and the mean duration of symptoms was 2 days shorter (0.2 to 3.5), however, there was substantial heterogeneity (I 2 = 82% and 97%). 14 more per 100 experienced a non-serious AE (4 to 16, NNT=7) such as nausea, or mouth or nasal irritation. No differences in illness duration nor AE were found when zinc was compared to active controls. No serious AE, including copper deficiency, were reported by any RCT. Quality of life outcomes were not assessed. Confidence in these findings for SARS-CoV-2 is very low due to serious indirectness and some concerns about bias for most outcomes. Zinc is a potential therapeutic candidate for preventing and treating SARS-CoV-2, including older adults and adults without zinc deficiency (very low certainty). Zinc may also help to prevent other viral RTIs during the pandemic (moderate certainty) and reduce the severity and duration of symptoms (very low certainty). The pending results from seven RCTs evaluating zinc for SARS-CoV-2 will be tracked. PROSPERO CRD42020182044
Publisher: Springer Science and Business Media LLC
Date: 11-06-2019
Publisher: Elsevier BV
Date: 08-2021
Publisher: Mary Ann Liebert Inc
Date: 07-2020
Publisher: Elsevier BV
Date: 12-2018
Publisher: Elsevier BV
Date: 04-2022
DOI: 10.1016/J.DSX.2022.102445
Abstract: Present screening methods for Type 2 diabetes (T2DM) fall short of detecting prediabetes. This paper summarises the literature on the utility of insulin measurements (hyperinsulinemia) in detecting prediabetes in adolescents. A systematic literature review was conducted using EMBASE and Medline. Relevant data on hyperinsulinemia in the adolescent population is narrated. The database search identified 174 potential articles 106 underwent a full-paper review, and 36 were included. Elevated fasting insulin is a marker of impaired insulin resistance and pending beta-cell dysfunction in at-risk adolescents and can be an early indicator of prediabetes.
Publisher: Elsevier BV
Date: 09-2020
Publisher: MDPI AG
Date: 27-09-2019
Abstract: Background and Objectives: People have multi-faceted health care needs and consult a erse range of health care practitioners (HCP) from both the conventional and complementary medicine healthcare sectors. The effective communication between HCP and with patients are obvious requisites to coordinating multidisciplinary care and shared decision making. Further, miscommunication is a leading cause of patient harm and is associated with reduced patient satisfaction, health literacy, treatment compliance and quality of life. In conventional healthcare settings, the differences in professional hierarchy, training, communication styles and culture are recognised communication barriers. Less is known about interprofessional communication (IPC) that includes traditional and complementary medicine (TCM) HCP. This review aims to summarise the experiences and perceptions of conventional and complementary HCP and identify factors that influence IPC. Methods: A qualitative rapid literature review was conducted. Six databases were searched to identify original research and systematic reviews published since 2009 and in English. Excluded were articles reporting original research outside of Australia that did not include TCM-HCP, already cited in a systematic review, or of low quality with a score of less than three on a critical appraisal skills programme (CASP) checklist. A thematic analysis of included studies was used to identify and explore important and recurring themes. Results: From the conducted searches, 18 articles were included, 11 of which reported data on complementary HCP and seven were literature reviews. Four key themes were identified that impact IPC: medical dominance, clarity of HCP roles, a shared vision, and education and training. Conclusion: IPC within and between conventional and complementary HCP is impacted by interrelated factors. A erse range of initiatives that facilitate interprofessional learning and collaboration are required to facilitate IPC and help overcome medical dominance and interprofessional cultural ides.
Publisher: SAGE Publications
Date: 2019
Abstract: This commentary discusses the concept of value-based or value-focused health care as a rationale for researchers to incorporate mixed methods study designs a priori into clinical trials evaluating traditional, complementary, alternative, and integrative medicine (TCAIM). Along with assessing patient outcomes, information about patients’ experiences and preferences are needed to determine the value of an intervention. Incorporating a mixed-methods approach can improve the quality of clinical trials and provide important information about the potential value of the intervention.
Publisher: Elsevier BV
Date: 05-2018
DOI: 10.1016/J.CTCP.2018.01.011
Abstract: To develop a policy, practice, education and research agenda for evidence-based practice (EBP) in traditional and complementary medicine (T&CM). The study was a secondary analysis of qualitative data, using the method of roundtable discussion. The s le comprised seventeen experts in EBP and T&CM. The discussion was audio-recorded, and the transcript analysed using thematic analysis. Four central themes emerged from the data understanding evidence and EBP, drivers of change, interpersonal interaction, and moving forward. Captured within these themes were fifteen sub-themes. These themes/sub-themes translated into three broad calls to action: (1) defining terminology, (2) defining the EBP approach, and (3) fostering social movement. These calls to action formed the framework of the agenda. This analysis presents a potential framework for an agenda to improve EBP implementation in T&CM. The fundamental elements of this action plan seek clarification, leadership and unification on the issue of EBP in T&CM.
Publisher: Elsevier BV
Date: 04-2018
DOI: 10.1016/J.HEALTHPOL.2018.02.004
Abstract: High demand for traditional Korean medicine led to a policy change in 2010 allowing hospitals to provide Integrative medicine care that combines Western medicine and Korean medicine. This study evaluated the effects of Integrative medicine compared to Western medicine-only for managing acute stroke in South Korean hospitals. A retrospective matched case-control observational study was conducted for acute stroke patients admitted nationwide in 2012 and 2013. Propensity score matching was used to adjust for the likelihood of selecting Integrative medicine. Hierarchical generalized linear models were used to control for patient characteristics at the episode of care (level 1) and cluster effects from the hospitals (level 2). A total of 1182 patients and 65 hospitals were matched and analyzed. Receiving Integrative medicine significantly increased the average length of stay (OR 1.27 95% CI 1.13-1.42), total cost of inpatient care (OR 1.93 95% CI 1.62-2.31), and per-day cost (OR 1.34 95% CI 1.21-1.47). Receiving Integrative medicine did not affect all-cause 3-month emergency readmissions (OR 1.36 95% CI 0.92-2.02). However, Integrative medicine was associated with a reduced risk of all-cause mortality at 3 months (OR 0.36 90% CI 0.13-0.99) and 12 months (OR 0.34 95% CI 0.15-0.75) after admission. Receiving Integrative medicine was associated with improved 3-month and 12-month survival, greater healthcare utilization and higher costs. Further economic evaluations are needed to guide policy for efficient integration of Korean medicine and Western medicine.
Publisher: Wiley
Date: 29-05-2013
DOI: 10.1111/J.1365-2753.2012.01864.X
Abstract: A multidisciplinary primary care clinic in Sydney, Australia, was planning to use electronic questionnaires to measure patient-reported outcomes. Semi-structured interviews with 20 patients were undertaken to explore, among other things, practical issues regarding different questionnaire formats. The response rates and costs of email versus postal invitations were also evaluated. Compared with postal invitations, email invitations offered a cost-effective and practical alternative, with a greater proportion of patients volunteering for an interview. Assuming the interface is well-designed and user-friendly, many patients were happy to use the Internet to answer questionnaires. Most patients thought alternate formats should also be offered. Patients discussed advantages and disadvantages of the Internet format. Although more younger patients and females had given the clinic an email address both sexes, and young and old patients, expressed strong preferences for either wanting or not wanting to use the Internet. Researchers should consider using email invitations as a cost-effective first-line strategy to recruit patients to participate in health services research. Internet questionnaires are potentially cheaper than paper questionnaires, and the format is acceptable to many patients. However, for the time being, concurrent alternate formats need to be offered to ensure wider acceptability and to maximize response rates.
Publisher: Elsevier BV
Date: 09-2020
Publisher: Springer Science and Business Media LLC
Date: 29-10-2018
Publisher: SAGE Publications
Date: 2019
Abstract: Interest in integrative oncology (IO) is growing globally. Patients with cancer are actively using traditional complementary and integrative medicine (TCIM) as part of their cancer and survivorship care. Published studies from around the world report increasing use of TCIM by people living with cancer. This article summarizes the presentations that took place during a symposium titled, “Integrative Oncology: International Perspectives” at the International Research Congress on Integrative Medicine and Health in Baltimore, 2018. The purpose of the presentations was to examine whether cancer services across a variety of geographical regions, including Australia, Canada, the United States, and the European Union, were actively responding to cancer survivors’ demand for TCIM. The presenters highlighted utilization rates and both facilitators and barriers to the provision of IO services in their respective countries and regions. The audience discussion following the presentations drew out many noteworthy perspectives.
Publisher: Mary Ann Liebert Inc
Date: 04-2020
Publisher: Institute of Electrical and Electronics Engineers (IEEE)
Date: 09-2019
Publisher: Mary Ann Liebert Inc
Date: 11-2012
Abstract: In May 2006, a multidisciplinary community-based integrative medicine (IM) clinic was established in Sydney, Australia. It was designed to offer a wide range of IM services, for primary care and to serve as a referral center. The aim of this study was to determine which factors were successful and which ones posed challenges for establishing this kind of clinic. A study of the first 4 years of this primary care integrative medicine clinic was undertaken, using mixed methods--both qualitative and quantitative. Consistent with success factors identified in the literature, the clinic had an open-minded culture, credible supporters, suitable facilities, and clinically competent practitioners. Throughout the 4 years of its existence, the clinic strove to create an economically sustainable environment and to develop the service. As time progressed, it became evident that at least half of the practitioners needed to be biomedical doctors for the practice to remain viable. The challenges encountered were creating an economically sustainable clinic, managing high staff and practitioner turnover, finding the right balance between practitioners and services offered, developing an integrative medicine team, and building research capacity to evaluate the clinic and patient outcomes. Although many integrative medicine clinics fail to survive the first few years, after 4 years, this multidisciplinary primary care clinic had succeeded in establishing a viable health care service offering both integrative medicine and conventional, traditional, complementary, and alternative medicine. Finding the right mix of staff members and following up with evaluations to track progress are important.
Publisher: Mary Ann Liebert Inc
Date: 12-2012
Abstract: As traditional, complementary, and alternative medicines (TCAM) continue to find their way into mainstream medical practice, questions arise about the future of integrative medicine (IM). Concern has been voiced that the biomedical profession will dominate IM and many of the core principles and philosophies governing the practice of TCAM will be lost. Using mixed methods, an IM primary care clinic in Sydney, Australia, was compared to the IM models discussed in the literature. Commercial concerns greatly influenced the team's development and the services provided by the practice under study. Questions arose as to whether the clinic was simply incorporating TCAM or truly integrating it. Further analysis of the data revealed evidence of biomedical dominance. Given the current health care system in Australia, it seems likely that the biomedical doctor will continue to occupy a central logistical and leadership role in this clinic's IM team.
Publisher: Elsevier BV
Date: 11-2013
DOI: 10.1016/J.CTCP.2013.07.001
Abstract: Using the phenomenography method, interviews with patients and practitioners were undertaken to explore their understanding of 'health that is more than the absence of disease'. The question was challenging and stimulating for all interviewees. A few were unable to conceptualise this positive definition of health, some perceived it as an optimum end-state, whereas others saw it as an ongoing process. Many positive attributes of health and its influencers were identified. The more advanced understandings of this concept were of a holistic, multidimensional, expansive state where the all dimensions of health are interdependent and positively reinforcing. The results affirmed that wellness is more than psychological wellbeing, 'happiness' and life satisfaction. Optimum physical and cognitive capacities along with spiritual, social and occupational wellness were equally as important. 'Energy and vitality' were sufficiently emphasised by patients and some practitioners to support the inclusion of the principles of vitalism in any discussion about health.
Publisher: Elsevier BV
Date: 2014
Publisher: AMPCo
Date: 05-1988
DOI: 10.5694/J.1326-5377.1988.TB139567.X
Abstract: The performance of the Hudson Multi-Vent oxygen mask was assessed by attaching it to a model of a head and generating varying inspiratory flows of oxygen through the mouth and nasal orifices. The oxygen concentration that was delivered by the mask varied with the inspiratory flow rate at all oxygen concentrations. This effect was proportionately similar at all levels of set oxygen concentration: about 50% of the increment of inspired oxygen was lost as the inspiratory flow rate increased from 20 L/min to 100 L/min. The performance of the mask was not affected by the route (oral or nasal) of inspiratory flow. Rotation of the mask in the coronal plane produced marked changes in delivered oxygen concentration with the oxygen concentration set at 50%, and the inspiratory flow rate at 40 L/min, the delivered oxygen concentration was 45% when the mask was parallel to the coronal plane of the model, was 41% when it was angled 10 degrees towards the face, and was 27% when it was angled 10 degrees away from the face. The measurement of oxygen concentrations at different points inside the mask confirmed that the oxygen-enriched gas is directed in a localized stream in the centre of the mask, and that air is entrained through the large ports that are sited at the sides of the mask to satisfy inspiratory flow. The measurement of inspired oxygen concentrations in 12 hospital inpatients confirmed that the model reflected accurately the performance of the mask when used in a routine way. We conclude that, in clinical use, the Hudson Multi-Vent mask is unlikely to deliver the set oxygen concentration, and that the delivered oxygen concentration is not predictable.
Publisher: Springer Science and Business Media LLC
Date: 12-2019
DOI: 10.1186/S13002-019-0348-6
Abstract: Customary medicine of Australia’s Indigenous peoples draws upon knowledge developed through millennia of interaction with Australia’s unique flora and fauna. Many Indigenous Australians are interested in developing modern medicinal and commercial translations of traditional knowledge however, barriers of trust and benefit sharing often thwart progress. Using a participatory action research framework, university researchers collaborated with members of two Australian Indigenous communities to investigate selected medicinal plants and locally made bush products. A trusted community liaison facilitated the collaboration that was fostered through bilateral site visits. Material transfer and confidentiality agreements ensured that the plant materials were only used for the agreed purpose. Plain language written reports of the laboratory results were provided to the communities with follow up discussions. In case study 1, only some of the traditional uses for the raw plants were shared with the researchers. Deidentified plants were assessed for antioxidant and antimicrobial properties. In case study 2, the plant names, traditional uses, and preparation methods were shared with the aim of learning more about their plants, potential uses, and optimising their bush products. Literature reviews were conducted that also helped guide in vitro testing of the crude and solvent partitioned extracts. These differences reflected the community’s reasons for conducting the research and intellectual property considerations. In both cases, observed benefits included building trust and strengthening working relationships for ongoing collaboration, fostering enthusiasm for linking traditional and scientific knowledge, promoting cross-cultural learning about scientific methods and traditional medicine, maintaining the relevance of traditional knowledge in the modern world, and initiating community discussions around their bush medicine product development. Community-driven scientific investigation of traditional medicinal knowledge can facilitate culturally meaningful outcomes, with potentially wide-reaching direct and indirect benefits. Community liaisons were invaluable for establishment of strong relationships and ensured that the research was culturally and locally appropriate. The need for clearer guidelines and regulation around community-driven biomedical research of their plants was identified. Australia would benefit from a user-friendly, open-source toolkit that promotes use of local traditional medicines, contains information about processes and protocols that communities and scientists could use to develop collaborative projects, and guides regulation and ethical commercialisation. Close consultation and collaboration with communities and researchers will be needed to ensure that such a toolkit is culturally appropriate and fit-for-purpose.
Publisher: Elsevier BV
Date: 09-2020
Publisher: SAGE Publications
Date: 2021
Abstract: The Australasian Integrative Medicine Association (AIMA) established a working group to develop the AIMA Guiding Principles for Letter Writing and Letter Writing Templates. The guiding principles were developed to promote effective communication between the erse range of healthcare practitioners (HCPs) that patients choose to consult. Following the development of the Interprofessional Communication (IPC) resources, AIMA undertook a public consultation as part of a quality assurance process to evaluate the relevance and utility of the resource. This study reports stakeholder feedback on AIMA’s draft guiding principles document. It explores stakeholder attitudes towards IPC and HCPs letter-writing, and interest in ongoing continuing professional development (CPD). A cross-sectional survey involving 1) an online public consultation survey and 2) a paper survey collected following IPC CPD activities. Quantitative data were analysed using Chi square and Fisher-Freeman-Halton Test. Responses to open ended questions were coded and subject to a thematic analysis. The 64 survey participants and 55 CPD participants represented the Australian healthcare sectors and lay community. Most thought IPC is important (n = 112/117 96%) and the resources were informative (n = 112/119 94%), understandable (n = 111/119 93%), and clinically relevant (n = 105/117 90%). HCP reported wide variations in their frequency of correspondence with other practitioner types, with rates often concerningly low. Key IPC themes identified were the importance of continuity of care, clarity of communication, and professional practice. CPD participants were most interested in further IPC training (p = 0.001). The IPC resources affirm the role of formal communication pathways, such as letters of correspondence to support coordinated, patient-centred and multidisciplinary care. Challenges with letter writing and IPC signal the need for more student and professional education on the subject to promote continuity of patient care and the delivery of high quality, integrative medicine and health care services.
Publisher: Springer Science and Business Media LLC
Date: 17-02-2017
Publisher: Elsevier BV
Date: 2021
Publisher: Springer Science and Business Media LLC
Date: 18-02-2020
DOI: 10.1186/S12906-019-2801-4
Abstract: In response to high demand and the growing body of evidence for traditional and complementary therapies, the practice of integrative medicine and integrative healthcare has emerged where these therapies are blended with conventional healthcare. While there are a number of academic integrative healthcare centres worldwide, there are none in Australia. Western Sydney University will soon establish an academic integrative healthcare centre offering evidence-informed traditional and complementary therapies integrated with conventional healthcare in a research-based culture. The aim of this study was to explore healthcare consumers’ views about the perceived need, advantages, and disadvantages of the proposed centre and its relevance to community-defined problems and health and service needs. Qualitative methods, informed by community-based participatory research, were used during 2017. Focus groups supplemented with semi-structured interviews were conducted with healthcare consumers. Participants were recruited through paid advertisements on Facebook. Thematic coding, informed by an integrative healthcare continuum, was used to analyse and organise the data. Analysis was augmented with descriptive statistics of participant demographic details. Three main themes emerged: (i) the integrative approach, (i) person-centred care, and (iii) safety and quality. Participants proposed a coordinated healthcare model, with perspectives falling along a continuum from parallel and consultative to fully integrative models of healthcare. The importance of multidisciplinary collaboration and culturally appropriate, team-based care within a supportive healing environment was emphasised. A priority of providing broad and holistic healthcare that was person centred and treated the whole person was valued. It was proposed that safety and quality standards be met by medical oversight, evidence-informed practice, practitioner competency, and interprofessional communication. Our findings demonstrate that participants desired greater integration of conventional healthcare with traditional and complementary therapies within a team-based, person-centred environment with assurances of safety and quality. Findings will be used to refine the model of care for an academic integrative healthcare centre in Western Sydney.
Publisher: Elsevier BV
Date: 12-2020
Publisher: Wiley
Date: 09-2017
DOI: 10.1111/IMJ.13534
Abstract: Many patients use complementary medicine (CM) products, such as vitamins, minerals and herbs as part of self-care without professional advice or disclosure to their doctors. While use of CM products is gaining awareness by the medical community and there is mounting evidence for their safety, efficacy and cost-effectiveness, there is also the potential for adverse events from inappropriate use and/or withdrawal, as well as interactions with other medicines. Due to the unique and complex properties of many CM products, research evidence is specific to in idual preparations and this can lead to confusion when assessing label claims and interpreting the results of clinical trials and systematic reviews. While the Australian regulatory environment for CM products is the same as for prescription medicines and is based on risk, there is a great need for consumers and clinicians to have access to easily understood, evidence-based information to facilitate informed decision-making.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 06-2018
DOI: 10.11124/JBISRIR-2017-003468
Abstract: This scoping review aims to explore the following questions: What types of Indigenous healing practices have been integrated with western biomedicine in Australia, Canada, New Zealand and the USA, and for what conditions or purpose have they been used? How has this integration been achieved, i.e. what are the key features of the service models implemented?
Publisher: Elsevier BV
Date: 2018
DOI: 10.2139/SSRN.3215565
Publisher: Elsevier BV
Date: 06-2013
Publisher: Elsevier BV
Date: 12-2020
Publisher: Springer Science and Business Media LLC
Date: 03-12-2022
DOI: 10.1186/S13643-022-02100-5
Abstract: This overview summarizes the best available systematic review (SR) evidence on the health effects of Tai Chi. Nine databases (PubMed, Cochrane Library, EMBASE, Medline, Web of Science, China National Knowledge Infrastructure (CNKI), Chinese Scientific Journal Database (VIP), Sino-Med, and Wanfang Database) were searched for SRs of controlled clinical trials of Tai Chi interventions published between Jan 2010 and Dec 2020 in any language. Effect estimates were extracted from the most recent, comprehensive, highest-quality SR for each population, condition, and outcome. SR quality was appraised with AMSTAR 2 and overall certainty of effect estimates with the GRADE method. Of the 210 included SRs, 193 only included randomized controlled trials, one only included non-randomized studies of interventions, and 16 included both. Common conditions were neurological (18.6%), falls/balance (14.7%), cardiovascular (14.7%), musculoskeletal (11.0%), cancer (7.1%), and diabetes mellitus (6.7%). Except for stroke, no evidence for disease prevention was found however, multiple proxy-outcomes/risks factors were evaluated. One hundred and fourteen effect estimates were extracted from 37 SRs (2 high, 6 moderate, 18 low, and 11 critically low quality), representing 59,306 adults. Compared to active and/or inactive controls, 66 of the 114 effect estimates reported clinically important benefits from Tai Chi, 53 reported an equivalent or marginal benefit, and 6 an equivalent risk of adverse events. Eight of the 114 effect estimates (7.0%) were rated as high, 43 (37.7%) moderate, 36 (31.6%) low, and 27 (23.7%) very low certainty evidence due to concerns with risk of bias (92/114, 80.7%), imprecision (43/114, 37.7%), inconsistency (37/114, 32.5%), and publication bias (3/114, 2.6%). SR quality was often limited by the search strategies, language bias, inadequate consideration of clinical, methodological, and statistical heterogeneity, poor reporting standards, and/or no registered SR protocol. The findings suggest Tai Chi has multidimensional effects, including physical, psychological and quality of life benefits for a wide range of conditions, as well as multimorbidity. Clinically important benefits were most consistently reported for Parkinson’s disease, falls risk, knee osteoarthritis, low back pain, cerebrovascular, and cardiovascular diseases including hypertension. For most conditions, higher-quality SRs with rigorous primary studies are required. PROSPERO CRD42021225708.
Publisher: Elsevier BV
Date: 02-2013
DOI: 10.1016/J.CTCP.2012.10.002
Abstract: The outcomes of Integrative medicine (IM) that combine biomedicine with traditional, complementary and alternative medicine (TCAM) are broad, reflecting the integration. IM is concerned with acute and chronic diseases, holistic approaches, and health promotion and wellness. Before commencing a research program in a primary care IM clinic, stakeholders were interviewed about IM outcomes. Everyone thought Physical Health and Mental Health were important. Those with a more holistic view of health thought a broader range of topics should be measured. Less important topics were lifestyle health-related aspects of life satisfaction and quality of life and healthcare evaluation. However, no one thought these should be excluded. Spirituality was the most contentious. Some commended its inclusion. For others, once religiousness and God were removed, the remaining elements should be relocated to the domains of mental health and life satisfaction. The results highlight the importance of consulting stakeholders before measuring outcomes.
Publisher: Elsevier BV
Date: 09-2020
Publisher: Elsevier BV
Date: 05-2020
Location: United States of America
Location: Taiwan, Province of China
Location: United Kingdom of Great Britain and Northern Ireland
No related grants have been discovered for Jennifer Hunter.