ORCID Profile
0000-0003-1814-3416
Current Organisation
Royal Melbourne Hospital
Does something not look right? The information on this page has been harvested from data sources that may not be up to date. We continue to work with information providers to improve coverage and quality. To report an issue, use the Feedback Form.
Publisher: Elsevier BV
Date: 09-2021
DOI: 10.1016/J.AUCC.2021.08.010
Abstract: Oral care is a fundamental nurse-led intervention in the critical care setting that provides patient comfort and prevents adverse outcomes in critically ill patients. To date, there has been minimal focus on nurse-focused interventions to improve adherence to oral care regimens in the adult intensive care unit setting. The objectives of this study were to (i) identify types and characteristics of interventions to improve oral care adherence amongst critical care nurses and intervention core components, (ii) evaluate the effectiveness of interventions to improve adherence of oral care regimens, and (iii) identify the types of outcome measures used to assess oral care regimen adherence. This is a systematic review in alignment with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Key bibliographic databases and platforms, including Scopus, Cochrane, MEDLINE, CINAHL, Embase, PsycINFO, ProQuest, and Web of Science, were searched for studies published before July 2020. The Joanna Briggs Institute's quality appraisal tool was used to assess risk of bias in included studies. A total of 21 original research studies were identified, of which 18 studies used multifaceted interventions. In accordance with the Joanna Briggs Institute's quality appraisal tools, four of the 20 quasi-experimental studies were rated as high quality. The one randomised control trial was of moderate quality. Outcome measures included oral care adherence behaviours, oral care knowledge, self-reported adherence, and documentation. Improved effectiveness in oral care adherence was reported in 20 studies. Review findings confirm interventions to change behaviours improve oral care adherence. The most effective interventional approach could not be determined owing to heterogeneity in intervention design and outcome measures. Oral care in the intensive care unit is a vital, nurse-led activity that reduces the risk of hospital-acquired infection. It is recommended that future research adopt implementation science methods to ensure stakeholder engagement and feasibility. This review was submitted and subsequently registered on PROSPERO, the International Perspective Register of Systematic Reviews PROSPERO 2019 CRD42019123142.
Publisher: Elsevier BV
Date: 2007
DOI: 10.1016/J.HRTLNG.2006.05.006
Abstract: Little evidence exists to describe expected volumes of chest tube (CT) drainage after coronary artery bypass grafting (CABG). The study objective was to map the trajectory of CT drainage volumes from insertion to removal after CABG. This was a retrospective, descriptive study. The study included 239 patients who underwent CABG at a single metropolitan hospital in Melbourne, Australia. The s le (N = 234), aged 68.7 years (standard deviation [SD] 9.9), was predominantly male (N = 185, 79.1%). The mean duration of CT insertion was 45.2 hours (SD 26.7), and total drainage volume was 1300.6 mL (SD 763.8). Drainage volumes plateau to 31 mL per hour, 8 hours after surgery. From 24 to 48 hours, the mean drainage was 21 mL per hour. Drainage volumes varied between genders. Evidence of similar drainage patterns in other populations is difficult to locate. If the pattern of drainage shown in this study is consistent, experimental intervention studies comparing standard removal time and earlier removal are recommended. If not, prospective collection of relevant preoperative, intraoperative, and postoperative factors across multiple sites is necessary to determine which patient or practice variations influence CT drainage patterns after CABG.
Publisher: Elsevier BV
Date: 2019
Publisher: Oxford University Press (OUP)
Date: 21-02-2023
Abstract: A cardiac surgery international nursing and allied professional research network titled CONNECT was created to strengthen collaborative cardiac surgery research through shared initiatives including supervision, mentorship, workplace exchange programs, and multi-site clinical research. As with any new initiative, there is a need to build brand awareness to enhance user familiarity, grow membership, and promote various opportunities offered. Social media has been used across various surgical disciplines however, their effectiveness in promoting scholarly and academic-based initiatives has not been examined. The aim of this scoping review was to examine the different types of social media platforms and strategies used to promote cardiac research initiatives for CONNECT. A scoping review was undertaken in which a comprehensive and thorough review of the literature was performed. Fifteen articles were included in the review. Twitter appeared to be the most common form of social media used to promote cardiac initiatives, with daily posts being the most frequent type of engagement. Frequency of views, number of impressions and engagement, link clicks, and content analysis were the most common types of evaluation metrics that were identified. Findings from this review will inform the design and evaluation of a targeted Twitter c aign aimed at increasing brand awareness of CONNECT, which will include the use of @CONNECTcardiac Twitter handle, hashtags, and CONNECT-driven journal clubs. In addition, the use of Twitter to disseminate information and brand initiatives related to CONNECT will be evaluated using the Twitter Analytics function. Open Science Framework: osf.io/q54es
Publisher: Elsevier BV
Date: 2022
Publisher: Wiley
Date: 05-2005
Publisher: Elsevier BV
Date: 06-2005
Publisher: Oxford University Press (OUP)
Date: 18-06-2009
DOI: 10.1510/ICVTS.2009.204735
Abstract: The aim of this case series is to review the effect of recombinant activated factor VIIa (rFVIIa) on refractory haemorrhage, despite aggressive treatment with conventional blood products and medications at our institution. All patients undergoing cardiac surgery who received rFVIIa as rescue therapy for persistent uncontrollable haemorrhage were studied. We examined coagulation immediately before and after rFVIIa was given international normalized ratio (INR), activated partial thromboplastin (APTT) fibrinogen and platelet levels, in addition to the use of red cell and non-red cell blood products, morbidity and mortality. Thirty patients (0.6%) received 31 doses of rFVIIa for bleeding refractory to conventional treatment. Twenty received rFVIIa in theatre after primary surgery, three after re-exploration and eight in the intensive care unit (ICU). Hospital mortality was 6.5% (2/30) and there were no documented thromboembolic phenomena. There was significant reduction in red blood cell and product transfusion before and after rFVIIa administration (P<0.001). There was significant correction in coagulation parameters after rFVIIa. Recombinant FVIIa appears to be safe, and is effective in reducing red blood cell and product transfusion requirements and may impact on early and late outcomes in this small complex subgroup of patients.
Publisher: Elsevier BV
Date: 12-2021
Publisher: Elsevier BV
Date: 03-2023
DOI: 10.1016/J.AUCC.2021.12.004
Abstract: Mucosal pressure injuries (PIs) are usually caused by pressure from essential medical devices. There is no universally accepted criterion for assessment, monitoring, or reporting mucosal PI. Reliable descriptors are vital to benchmark the frequency and severity of this hospital-acquired complication. The objective of this study was to determine whether modified Reaper Oral Mucosa Pressure Injury Scale (ROMPIS) descriptors improved the reliability of mucosal PI assessment. Secondary aims were to explore nurses' knowledge of and attitudes toward mucosal PI. A prospective cross-sectional survey was distributed to nurses from two tertiary affiliated intensive care units via REDCap® to capture demographic data, knowledge, attitudes, and inter-rater reliability (IRR) measures. Nurses were randomised at a 1:1 ratio to original or modified ROMPIS descriptors and classified 12 images of mucosal PI. IRR was assessed using percentage agreement, Fleiss' kappa, and intraclass correlation coefficients. The survey response rate was 20.9% (n = 98/468), with 73.5% (n = 72/98) completing IRR measures. Agreement was higher with modified (75%) than original ROMPIS descriptors (69.4%). IRR was fair for the original (κ = 0.30, 95% confidence interval [CI] [0.28, 0.33], z 26.5, p < 0.001) and modified ROMPIS (κ = 0.29, 95% CI [0.26, 0.31], z 25.0, p < 0.001). Intraclass correlation coefficient findings indicated ratings were inconsistent for the original (0.33, 95% CI [0.18, 0.59], F 18.8 (11 df), p < 0.001) and modified ROMPIS (0.31, 95% CI [0.17, 0.57], F 17.6 (11 df), p < 0.001). PI-specific education and risk factor recognition were common. Modified descriptors had marginally better agreement. Participants understand management and prevention but need to strengthen their perceived capacity for mucosal PI risk assessment. This work provides a foundation for future benchmarking and a platform from which further research to refine and test descriptors specific to mucosal PI can be generated.
Publisher: Wiley
Date: 04-01-2021
DOI: 10.1111/JOCN.15619
Publisher: Elsevier BV
Date: 08-2017
DOI: 10.1016/J.PMN.2017.03.003
Abstract: Evidence to support the argument that general anesthesia (GA) with paravertebral block (PVB) provides better pain relief for mastectomy patients than GA alone is contradictory. The aim of this study was to explore pain and analgesia after mastectomy with or without PVB during acute inpatient recovery. A retrospective study was conducted in a single hospital providing specialist cancer services in metropolitan Melbourne, Australia. We explored pain and concomitant analgesic administration in 80 consecutive women recovering from mastectomy who underwent GA with (n = 40) or without (n = 40) PVB. A pain management index (PMI) was derived to illustrate the efficacy of management from day of surgery (DOS) to postoperative day (POD) 3. Patients who reported no pain progressively increased from DOS (n = 12, 15%) to POD 3 (n = 54, 67.5%). Most patients were administered analgesics as a combination of acetaminophen and a strong opioid on DOS (n = 53, 66.2%), POD 1 (n = 45, 56.2%), POD 2 (n = 33, 41.2%), and POD 3 (n = 21, 26.2%). Less than 6% of patients on any POD were administered multimodal anlagesics. PMI scores indicate some pain in the context of receiving weak and strong opioids for GA patients and more frequent use of nonopioid analgesics in PVB patients during recovery. These findings highlight the need for data describing patterns of analgesic administration in addition to reports of postoperative pain to determine the most effective means of avoiding postoperative pain in patients who require mastectomy.
Publisher: Springer Science and Business Media LLC
Date: 23-03-2022
DOI: 10.1186/S13643-022-01926-3
Abstract: Although simulation-based education (SBE) has become increasingly popular as a mode of teaching in undergraduate nursing courses, its effect on associated student learning outcomes remains ambiguous. Educational outcomes are influenced by SBE quality that is governed by technology, training, resources and SBE design elements. This paper reports the protocol for a systematic review to identify, appraise and synthesise the best available evidence regarding the impact of SBE on undergraduate nurses’ learning outcomes. Databases to be searched from 1 January 1990 include the Cumulative Index to Nursing and Allied Health Literature (CINAHL), the Medical Literature Analysis and Retrieval System Online (MEDLINE), American Psychological Association (APA) PsycInfo and the Education Resources Information Centre (ERIC) via the EBSCO host platform. The Excerpta Medica database (EMBASE) will be searched via the OVID platform. We will review the reference lists of relevant articles for additional citations. A combination of search terms including ‘nursing students’, ‘simulation training, ‘patient simulation’ and ‘immersive simulation’ with common Boolean operators will be used. Specific search terms will be combined with either MeSH or Emtree terms and appropriate permutations for each database. Search findings will be imported into the reference management software (Endnote© Version.X9) then uploaded into Covidence where two reviewers will independently screen the titles, abstracts and retrieved full text. A third reviewer will be available to resolve conflicts and moderate consensus discussions. Quantitative primary research studies evaluating the effect of SBE on undergraduate nursing students’ educational outcomes will be included. The Mixed Methods Appraisal Tool (MMAT) will be used for the quality assessment of the core criteria, in addition to the Cochrane RoB 2 and ROBINS-I to assess the risk of bias for randomised and non-randomised studies, respectively. Primary outcomes are any measure of knowledge, skills or attitude. SBE has been widely adopted by healthcare disciplines in tertiary teaching settings. This systematic review will reveal (i) the effect of SBE on learning outcomes, (ii) SBE element variability and (iii) interplay between SBE elements and learning outcome. Findings will specify SBE design elements to inform the design and implementation of future strategies for simulation-based undergraduate nursing education. PROSPERO CRD42021244530
Publisher: Elsevier BV
Date: 03-2017
DOI: 10.1016/J.HRTLNG.2017.01.002
Abstract: Evidence describing the characteristics of urinary incontinence (UI) in patients with chronic heart failure (CHF), and the impact of this combination of conditions on functional status and quality of life, is limited. The primary aim of this study was to determine the prevalence and characteristics of UI in a cohort of CHF patients. A prospective survey of 100 outpatients with CHF was undertaken. There were 43 (65.1%) patients with UI secondary to mixed incontinence (n = 16, 37.2%), urge incontinence (n = 19, 44.2%), stress incontinence (3, 6.9%) or post micturition dribble (n = 5, 1.6%) and 23 (34.9%) cited urgency with the potential for urge incontinence as their primary continence problem. UI was bothersome and managed by patients to minimize interference in daily living. Strategies for the measurement and management of UI in disease specific cohorts such as CHF requires further exploration.
Publisher: Oxford University Press (OUP)
Date: 2021
Publisher: Elsevier BV
Date: 05-2017
DOI: 10.1016/J.AENJ.2017.01.004
Abstract: Mechanical ventilation (MV) is commonly used in emergency departments (EDs). Protective lung strategies (PLS), comprising of low tidal volume (6mL/kg), control of oxygen and plateau pressures, and administration of positive end expiratory pressure (PEEP) has been shown to reduces the risks associated with MV but there is little evidence exists about nurses' knowledge or application of PLS. Our aim was to explore nurses knowledge and application of PLS in Australian EDs. Descriptive, exploratory design utilising an online questionnaire. A convenience s le was recruited via the College of Emergency Nursing Australasia mailing list and secondary snowball s ling was used to optimise response rate. There were 157 participants. PLS are being used in most EDs (n=104, 75%) and clinical practice guidelines (CPG) are often available (n=86, 62%). Most ED ventilators are capable of implementing PLS, but measurement of plateau pressures was infrequent (n=46%). Participants demonstrate appropriate knowledge, but reported varying levels of confidence and perceived autonomy when implementing PLS in the ED. PLS are being used in Australian EDs, aligning with best available evidence. Nursing staff have good levels of PLS knowledge. Development of an evidence-based CPG may improve confidence when implementing PLS and may pave the way for ED nurses to expand their scope of practice.
Publisher: Informa UK Limited
Date: 03-07-2020
Publisher: Elsevier BV
Date: 2004
Abstract: To compare three dressing types in terms of their ability to protect against infection and promote healing, patient comfort, and cost-effectiveness. Prospective, randomized controlled trial. Major metropolitan, academically affiliated, tertiary referral center. Seven hundred thirty-seven patients were randomized to receive a dry absorbent dressing (n = 243) [Primapore Smith & Nephew Sydney, NSW, Australia], a hydrocolloid dressing (n = 267) [Duoderm Thin ConvaTec Mulgrave, VIC, Australia], or a hydroactive dressing (n = 227) [Opsite Smith & Nephew] in the operating theater on skin closure. There was no difference in the rate of wound infection or wound healing between treatment groups. The Primapore dressing was the most comfortable and cost-effective dressing option for the sternotomy wound. Duoderm Thin dressings were associated with increased wound exudate (p < 0.001), poor dressing integrity (p < 0.001), more frequent dressing changes (p < 0.001), more discomfort with removal (p < 0.05), and increased cost (p < 0.001). In the context of no additional benefit for the prevention of wound infection or the rate of wound healing for any of the three dressing products examined, dry absorbent dressings are the most comfortable and cost-effective products for sternotomy wounds following cardiac surgery.
Publisher: Wiley
Date: 09-2022
DOI: 10.1111/JAN.15035
Publisher: SAGE Publications
Date: 27-12-2021
Publisher: Elsevier BV
Date: 08-2002
DOI: 10.1016/S1036-7314(02)80049-2
Abstract: Current legislation does not permit the administration of first line resuscitation medications by suitably qualified Division 1 registered nurses (RNs) in the absence of a medical officer. This omission by the Drugs, Poisons and Controlled Substances Act 1981 (Vic) and the Drugs, Poisons and The Controlled Substances Regulations 1995 (Vic) leaves many critical care nurses in a vulnerable legal position. The primary aim of this study was to gauge the view of critical care nurses with respect to lobbying for change to the current legislation. In addition, the study aimed to explore and describe the educational preparation, practice perceptions and experiences of RNs working in critical care regarding cardiopulmonary resuscitation and the administration of first line advanced life support (ALS) medications in the absence of a medical officer. It was anticipated that data collected would demonstrate some of the dilemmas associated with the initiation and administration of ALS medications for practising critical care nurses and could be used to inform controlling bodies in order for them to gain an appreciation of the issues facing critical care nurses during resuscitation. A mailout survey was sent to all members of the Victorian Branch of the Australian College of Critical Care Nurses (ACCCN). The results showed that the majority of nurses underwent an annual ALS assessment and had current ALS accreditation. Nurses indicated that they felt educationally prepared and were confident to manage cardiopulmonary resuscitation without a medical officer indeed, the majority had done so. The differences in practice issues for metropolitan, regional and rural nurses were highlighted. There is therefore clear evidence to suggest that legislative amendments are appropriate and necessary, given the time critical nature of cardiopulmonary arrest. There was overwhelming support for ACCCN Vic. Ltd to lobby the Victorian government for changes to the law.
Publisher: Elsevier BV
Date: 03-2014
DOI: 10.1071/HI13031
Publisher: Oxford University Press (OUP)
Date: 12-05-2022
Abstract: Reports of sex-specific differences in mortality after coronary artery bypass graft surgery (CABGS) are contradictory. The review aim was to determine whether CABGS is differentially efficacious than alternative procedures by sex, on short- and longer-term mortality. EMBASE, CINAHL, Medline, and the Cochrane Library were searched. Inclusion criteria: English language, randomized controlled trials from 2010, comparing isolated CABGS to alternative revascularization. Analyses were included Mantel–Haenszel fixed-effects modelling, risk of bias (Cochrane RoB2), and quality assessment (CONSORT). PROSPERO Registration ID: CRD42020181673. The search yielded 4459 citations, and full-text review of 29 articles revealed nine studies for inclusion with variable time to follow-up. Risk of mortality for women was similar in pooled analyses [risk ratio (RR) 0.94, 95% confidence interval (CI) 0.84–1.05, P = 0.26] but higher in sensitivity analyses excluding ‘high risk’ patients (RR 1.22, 95% CI 1.01–1.48, P = 0.04). At 30 days and 10 years, in contrast to men, women had an 18% (RR 0.82, 95% CI 0.66–1.02, P = 0.08) and 19% (RR 0.81, 95% CI 0.69–0.95, P = 0.01) mortality risk reduction. At 1–2 years women had a 7% (RR 1.07, 95% CI 0.69–1.64, P = 0.77), and at 2–5 years a 25% increase in risk of mortality compared with men (RR 1.25, 95% CI 1.03–1.53, P = 0.03). Women were increasingly under-represented over time comprising 41% (30 days) to 16.7% (10 years) of the pooled population. Meta-analysis revealed inconsistent sex-specific differences in mortality after CABGS. Trials with sex-specific stratification are required to ensure appropriate sex-differentiated treatments for revascularization.
Publisher: Informa UK Limited
Date: 04-03-2021
Publisher: Elsevier BV
Date: 04-2013
Publisher: Oxford University Press (OUP)
Date: 04-2004
Publisher: Public Library of Science (PLoS)
Date: 31-07-2014
Publisher: Wiley
Date: 28-11-2022
DOI: 10.1111/JAN.15104
Abstract: To describe a protocol for the pilot phase of a trial designed to test the effect of an mHealth intervention on representation and readmission after adult cardiac surgery. A multisite, parallel group, pilot randomized controlled trial (ethics approval: HREC2020.331‐RMH69278). Adult patients scheduled to undergo elective cardiac surgery (coronary artery bypass grafting, valve surgery, or a combination of bypass grafting and valve surgery or aortic surgery) will be recruited from three metropolitan tertiary teaching hospitals. Patients allocated to the control group with receive usual care that is comprised of in‐patient discharge education and local paper‐based written discharge materials. Patients in the intervention group will be provided access to tailored ‘GoShare’ mHealth bundles preoperatively, in a week of hospital discharge and 30 days after surgery. The mHealth bundles are comprised of patient narrative videos, animations and links to reputable resources. Bundles can be accessed via a smartphone, tablet or computer. Bundles are evidence‐based and designed to improve patient self‐efficacy and self‐management behaviours, and to empower people to have a more active role in their healthcare. Computer‐generated permuted block randomization with an allocation ratio of 1:1 will be generated for each site. At the time of consent, and 30, 60 and 90 days after surgery quality of life and level of patient activation will be measured. In addition, rates of representation and readmission to hospital will be tracked and verified via data linkage 1 year after the date of surgery. Interventions using mHealth technologies have proven effectiveness for a range of cardiovascular conditions with limited testing in cardiac surgical populations. This study provides an opportunity to improve patient outcome and experience for adults undergoing cardiac surgery by empowering patients as end‐users with strategies for self‐help. Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12621000082808.
Publisher: Oxford University Press (OUP)
Date: 12-03-2018
DOI: 10.1093/EJCTS/EZY073
Abstract: The Ross procedure has demonstrated excellent results when performed in patients with aortic stenosis or mixed aortic valve disease [aortic stenosis and aortic regurgitation (AR)]. However, due to its reported risk of late reoperation, it is not recommended under current guidelines for patients presenting with bicuspid aortic valve and pure AR. We have analysed our own results in light of this recommendation. Between 1993 and 2016, 129 consecutive patients with a mean age of 34.7 ± 10.6 years (range 16-64 years) presented with bicuspid aortic valve and pure AR and underwent the Ross procedure. Patients were reviewed annually and had 2nd yearly transthoracic echocardiograms during follow-up. The unit had a liberal reoperation policy where reoperation was performed if patients developed recurrent moderate or greater AR during follow-up. There was 1 inpatient death, and 3 late deaths over a mean follow-up duration of 9.6 ± 6.8 years. Late survival at 10 and 20 years post-surgery were 99% [95% confidence interval (CI) 94-100] and 95% (95% CI 85-99), respectively. Eleven patients underwent redo aortic valve replacement (AVR) and 4 patients had redo pulmonary valve replacement. Freedom from reoperation for AVR and more-than-mild AR at 10 and 20 years post-surgery were 89% (95% CI 81-94) and 85% (95% CI 74-92), respectively. Having longer aortic cross-cl (hazard ratio 1.03, 95% CI 1.00-1.06 P = 0.05) and cardiopulmonary bypass times (hazard ratio 1.02, 95% CI 1.00-1.05 P = 0.05), and having a larger preoperative sinotubular junction diameter (hazard ratio 1.15, 95% CI 1.03-1.30 P = 0.02) were significant predictors of having redo AVR or significant AR at follow-up. With a 20-year freedom from redo AVR and greater-than-mild residual AR of 85%, the utilization of the Ross procedure in bicuspid aortic valve patients with pure AR should be considered.
Publisher: Elsevier BV
Date: 12-2016
DOI: 10.1016/J.ATHORACSUR.2016.05.062
Abstract: Recent large randomized trials and metaanalyses have shown that, for patients with diabetes mellitus and advanced coronary artery disease, coronary artery bypass graft surgery (CABG) was superior to percutaneous intervention. We investigated whether total arterial revascularization (TAR) conferred an additional survival advantage for diabetic patients having CABG. We reviewed 63,592 cases from an audited, collaborative Australian cardiac surgical database. A total of 34,181 patients undergoing first time isolated CABG from 2001 to 2012 were identified. Of the 34,181, 11,642 (34.1%) were diabetic patients, and TAR was performed in 12,271 of 34,181 (35.9%). Of the 11,642 diabetic patients, TAR was performed in 3,795 (32.6%) and non-TAR in 7,847 (67.4%). Propensity matching resulted in 6,232 matched pairs of patients who did and patients who did not have TAR. Data were linked to the National Death Index. In the propensity matched s le, of 6,232 diabetic patients, 2,017 (32.4%) underwent TAR and 1,967 (31.6%) did not (p = 0.337). Mean follow-up was 4.9 years. Perioperative mortality, including 30-day mortality, was similar: 1.2% (24 of 2,017) for TAR and 1.4% (28 of 1,967) for non-TAR (p = 0.506). Late mortality was less among diabetic patients who underwent TAR, 10.2% (205 of 2,017), than no TAR, 12.2% (240 of 1,967 p = 0.041). Kaplan-Meier survival for the diabetic TAR group at 1, 5, and 10 years was 96.2%, 88.9%, and 82.2%, respectively, versus 95.4%, 87.5%, and 78.3% for the diabetic non-TAR group (log rank, p = 0.036). In a large propensity matched cohort of patients having CABG, TAR demonstrated further long-term prognostic benefit for diabetic patients, in the context of equivalent perioperative mortality.
Publisher: Oxford University Press (OUP)
Date: 25-08-2021
Publisher: Elsevier BV
Date: 07-2009
DOI: 10.1016/J.ATHORACSUR.2009.03.086
Abstract: To avoid late vein graft atheroma and failure, we have used arterial grafts extensively in coronary operations. The radial artery (RA) is the conduit of second choice. This study determined the long-term patency of the RA as a coronary graft. Two independent observers evaluated 1108 consecutive postoperative RA conduit angiograms performed between January 1997 and June 2007 for cardiac symptoms. Mean time to postoperative angiography was 48.3 months (range, 1 to 132 months). An RA graft was considered failed (nonpatent) if there was stenosis exceeding 60%, string sign, or occlusion. Patency was determined over time, by coronary territory grafted and by the degree of native coronary artery stenosis (NCAS). At a mean of 48.3 months, 982 of the 1108 RA grafts (89%) were patent. RA patencies for the left anterior descending were 96% (24 of 25), diagonal/intermediate, 90% (121 of 135) circumflex marginal, 89% (499 of 561) right coronary, 83% (38 of 46) posterior descending, 89% (253 of 286) and left ventricular branch osterolateral, 86% (47 of 55). Patency was 87.5% (56 of 64) for NCAS of less than 60% compared with 89% (926 of 1044 p = 0.89) for NCAS exceeding 60%. Of 318 RAs in place more than 5 years, 294 (92.5%) were patent, and for 107 RAs in place for more than 7 years, 99 were patent (92.5%). Patency was consistent through each year of the decade. Mechanisms of failure did not involve development of atherosclerosis. Patent RA grafts were smooth, with no angiographic evidence of atheroma. Late patencies of RA grafts are excellent and justify continuing use of the RA in coronary operations.
Publisher: American Medical Association (AMA)
Date: 05-2021
Publisher: Oxford University Press (OUP)
Date: 18-05-2023
Abstract: Women are underrepresented in cardiovascular trials. We sought to explore the proportional representation of women in contemporary cardiovascular research and the factors (barriers and enablers) that affect their participation in cardiovascular studies. Multiple electronic databases were searched between January 2011 and September 2021 to identify papers that defined underrepresentation of women in cardiovascular research and/or reported sex-based differences in participating in cardiovascular research and/or barriers for women to participate in cardiovascular research. Data extraction was undertaken independently by two authors using a standardised data collection form. Results were summarised using descriptive statistics and narrative synthesis as appropriate. From 548 identified papers, 10 papers were included. Of those, four were conducted prospectively and six were retrospective studies. Five of the retrospective studies involved secondary analysis of trial data including over 780 trials in over 1.1 million participants. Overall, women were reported to be underrepresented in heart failure, coronary disease, myocardial infarction, and arrhythmia trials, compared to men. Barriers to participation included lack of information and understanding of the research, trial-related procedures, the perceived health status of the participant, and patient-specific factors including travel, childcare availability, and cost. A significantly higher likelihood of research participation was reported by women following a patient educational intervention. This review has highlighted the underrepresentation of women in a range of cardiovascular trials. Several barriers to women’s participation in cardiovascular studies were identified. Researchers could mitigate against these in future trial planning and delivery to increase women’s participation in cardiovascular research. The protocol was published on the public Open Science Framework platform on 13th August 2021 (no registration reference provided) and can be accessed at osf.io/ny4fd/.
Publisher: Oxford University Press (OUP)
Date: 14-04-2021
Publisher: Elsevier BV
Date: 02-2015
DOI: 10.1016/J.JTCVS.2014.08.068
Abstract: It is hypothesized that by performing radical aortic root manipulation and then autologous support for the pulmonary autograft in the Ross procedure, this will maintain aortic root size and should, in turn, lead to the demonstrated low incidence of late aortic regurgitation and need for reoperation on the aortic root and valve. Aortic root size was measured echocardiographically both preoperatively and then at second yearly intervals in 322 consecutive patients who underwent a Ross operation between October 1992 and June 2013 with autologous support of the pulmonary autograft root using the patient's own aorta. This technique, a variant of the inclusion cylinder method, has been developed with the aim of minimizing prosthetic materials in the aortic root. Measures to reduce aortic root size included annulus reduction in 201 patients (62.4%) and reduction in aortic sinus or sinotubular junction in 159 patients (49.4%). Maximal aortic root diameter postoperatively at 5, 10, and 15 years was 34.0, 34.6, and 34.7 mm, respectively. Eleven reoperations were required during the study period for progressive aortic regurgitation (none for aortic root enlargement), with freedom from reoperation being 96% at both 15 years and 18 years. Preoperative pure aortic regurgitation, aortic annulus, and sinotubular junction enlargement were risk factors for reoperation. This inclusion method of pulmonary autograft implantation leads to minimal increases in aortic root size over time, with no reoperations for aortic root dilatation and a low requirement for aortic valve reoperation. The Ross procedure deserves to remain on the surgical menu for aortic valve replacement.
Publisher: Elsevier BV
Date: 02-2004
DOI: 10.1016/S1036-7314(05)80046-3
Abstract: The Australian healthcare system underwent radical reform in the 1990s as economic rationalist policies were embraced. As a result, there was significant organisational restructuring within hospitals. Traditional indicators, such as nursing absenteeism and attrition, increase during times of organisational change. Despite this, nurses' views of healthcare reform are under-represented in the literature and little is known about the impact of organisational restructuring on perceived performance. This study investigated the perceived impact of organisational restructuring on a group of intensive care unit (ICU) nurses' workplace performance. It employed a qualitative approach to collect data from a purposive s le of clinical nurses. The primary method of data collection was semi-structured interviews. Content analysis generated three categories of data. Participants identified constant pressure, inadequate communication and organisational components of restructuring within the hospital as issues that had a significant impact on their workplace performance. They perceived organisational restructuring was poorly communicated, and this resulted in an environment of constant pressure. Organisational components of restructuring included the subcategories of specialised service provision and an alternative administrative structure that had both positive and negative ramifications for performance. To date, there has been little investigation of nurses' perceptions of organisational restructure or the impact this type of change has in the clinical domain. Participants in this study believed reorganisation was detrimental to quality care delivery in intensive care, as a result of fiscal constraint, inadequate communication and pressure that influenced their workplace performance.
Publisher: Oxford University Press (OUP)
Date: 10-01-2019
DOI: 10.1093/EJCTS/EZY461
Publisher: Elsevier BV
Date: 10-2015
DOI: 10.1016/J.ATHORACSUR.2015.03.107
Abstract: Total arterial revascularization (TAR) is adopted to overcome late vein graft atherosclerosis, and occlusion. Uptake of TAR remains low despite reports suggesting superior survival. Previous studies primarily involved single sites and short-term follow-up. We report the influence of TAR on long-term survival in a large multicenter patient cohort. We reviewed 63,592 cases from an audited collaborative multicenter database. Of those, 34,181 consecutive patients undergoing first-time isolated coronary artery bypass (CABG) from 2001 to 2012 were studied. The data were linked to the National Death Index. We compared outcomes in patients who underwent TAR (n = 12,271) with outcomes in those who did not (n = 21,910). The influence of TAR on 10-year all-cause late mortality was assessed by propensity score analyses in 6,232 matched pairs. The 30-day mortality was 0.8% (96/12,271) for TAR patients and 1.8% (398/21,910) for non-TAR patients (p < 0.001). Late mortality was 7.5% (918/12,271) for TAR patients and 8.9% (1,952/21,910) for non-TAR patients (p < 0.001). The mean follow-up time was 4.9 years. In the propensity-matched cohort, the perioperative mortality was 0.9% (53/6,232) for TAR patients versus 1.2% (76/6,232) for non-TAR patients (p < 0.001). Kaplan-Meier survival in the matched cohort at 1, 5, and 10 years was 97.2%, 91.3%, and 85.4% for TAR patients and 96.5%, 90.1%, and 81.2% for non-TAR patients (p < 0.001). Late mortality was 8.0% (n = 500) for TAR patients and 10.0% (n = 622) for non-TAR patients (p < 0.001). Stratified Cox proportional hazards models showed lower risk for all-cause late mortality in the TAR group (TAR:HR 0.80, 95% confidence interval 0.71 to 0.90, p < 0.001). TAR is associated with low perioperative mortality and, importantly, improved long-term survival and could be used more liberally.
Publisher: Elsevier BV
Date: 07-2023
DOI: 10.1016/J.AUCC.2022.08.007
Abstract: Lower life expectancy, higher rates of chronic disease, and poorer uptake of health services are common in remote patient populations. Patients with poor health literacy (HL) are less likely to attend appointments, adhere to medications, and have higher rates of chronic illness. Evidence underpinning the relationship between HL and inequity in remote critical care populations is sparse. The primary study aim was to explore a multidimensional HL profile of patients requiring critical care in a remote area health service. Secondary aims were to explore HL in subgroups of the s le and to explore associations between HL and emergency department representation and discharge against medical advice. This was a cross-sectional study of consecutive eligible patients admitted to the Mount Isa Base Hospital intensive care unit. The Health Literacy Questionnaire was administered in a semistructured interview. In a 5-month period, there were 141 patient admissions to the five-bed intensive care unit, 67 patients (47.5%) met inclusion criteria and were not discharged prior to recruitment, and 37 (26.2%) agreed to participate. Participants felt understood and supported by healthcare providers, had sufficient information to manage their health, proactively engaged with healthcare providers, and had strong social supports. More challenging was their capacity to advocate on their own behalf, to explore and appraise information and to navigate healthcare systems. Patients who represented to the emergency department (n = 8, 21.6%) felt more empowered to seek healthcare advice. Of the 11 patients that discharged against medical advice, only one participated in the study. Trends in the data showed that Aboriginal and Torres Strait Islander participants were marginally less likely to be information explorers and to understand all written information. Findings provide guidance for the development of interventions to progress a reduction in health disparities experienced by this population.
Publisher: Wiley
Date: 28-06-2021
DOI: 10.1111/JOCN.15916
Abstract: To highlight the need for the development of effective and realistic workforce strategies for critical care nurses, in both a steady state and pandemic. In acute care settings, there is an inverse relationship between nurse staffing and iatrogenesis, including mortality. Despite this, there remains a lack of consensus on how to determine safe staffing levels. Intensive care units (ICU) provide highly specialised complex healthcare treatments. In developed countries, mortality rates in the ICU setting are high and significantly varied after adjustment for diagnosis. The variability has been attributed to systems, patient and provider issues including the workload of critical care nurses. Discursive paper. Nursing workforce is the single most influential mediating variable on ICU patient outcomes. Numerous systematic reviews have been undertaken in an effort to quantify the effect of critical care nurses on mortality and morbidity, invariably leading to the conclusion that the association is similar to that reported in acute care studies. This is a consequence of methodological limitations, inconsistent operational definitions and variability in endpoint measures. We evaluated the impact inadequate measurement has had on capturing relevant critical care data, and we argue for the need to develop effective and realistic ICU workforce measures. COVID‐19 has placed an unprecedented demand on providing health care in the ICU. Mortality associated with ICU admission has been startling during the pandemic. While ICU systems have largely remained static, the context in which care is provided is profoundly dynamic and the role and impact of the critical care nurse needs to be measured accordingly. Often, nurses are passive recipients of unplanned and under‐resourced changes to workload, and this has been brought into stark visibility with the current COVID‐19 situation. Unless critical care nurses are engaged in systems management, achieving consistently optimal ICU patient outcomes will remain elusive. Objective measures commonly fail to capture the complexity of the critical care nurses’ role despite evidence to indicate that as workload increases so does risk of patient mortality, job stress and attrition. Critical care nurses must lead system change to develop and evaluate valid and reliable workforce measures.
Publisher: Elsevier BV
Date: 05-2009
DOI: 10.1016/J.ATHORACSUR.2009.02.069
Abstract: The purpose of this study was to analyze our institutional results with pulmonary resection in neutropenic patients with hematologic malignancies and suspected invasive pulmonary fungal infections. We performed a retrospective medical record review of 25 immunocompromised patients with hematologic malignancies who underwent pulmonary resection between 2000 and 2007. We analyzed preoperative diagnostic technique, degree of pulmonary resection, and postoperative morbidity and mortality to determine whether surgery is a viable treatment option in this subset of patients. Twenty-three of 25 patients had a minithoracotomy compared with 2 who had video-assisted thorascopic surgery resection only. Thirteen had wedge resections, 9 had lobectomies, and 3 had segmentectomies. Early surgical morbidity was 2 of 25, involving 1 pneumothorax and 1 empyema. In-hospital mortality was 2, with 1 death primarily related to surgery. Median survival was 342 days, and survival was significantly better in patients with only one lesion. No patient experienced late recurrence of invasive pulmonary fungal infection. Resected pulmonary tissue also provided the best chance for a proven diagnosis in 19 of 25 (76%). This study confirms that pulmonary resection in high-risk immunocompromised patients with suspected invasive fungal infection can be carried out with excellent operative morbidity and mortality.
Publisher: Elsevier BV
Date: 03-2023
Publisher: Frontiers Media SA
Date: 08-10-2021
Abstract: Background: Atrial Fibrillation (AF) is the most common sustained cardiac arrhythmia. Obesity is an independent risk factor for AF. Anticoagulants have been strongly recommended by all international guidelines to prevent stroke. However, altered pathophysiology in obese adults may influence anticoagulant pharmacology. Direct oral anticoagulants (DOACs) in the context of obesity and AF have been examined in recent systematic reviews. Despite the similarities in included studies, their results and conclusions do not agree. Methods and Results: The protocol for this review was registered with PROSPERO (CRD42020181510). Seven key electronic databases were searched using search terms such as “atrial fibrillation,” “obese, * ” “overweight,” “novel oral anticoagulant,” “direct oral anticoagulant,” “DOAC,” “NOAC,” “apixaban,” dabigatran,” “rivaroxaban,” and “edoxaban” to locate published and unpublished studies. Only systematic reviews with meta-analyses that examined the effect of DOACs in overweight or obese adults with AF, published in the English language, were included. A total of 9,547 articles were initially retrieved. After removing the duplicates, title and abstract review and full-text review, five articles were included in the systematic review. From these only RCTs were included in the meta-analyses. There was disagreement within the published systematic reviews on DOACs in obesity. The results from our meta-analysis did not show any significant difference between all body mass index (BMI) groups for all outcomes at both 12 months and for the entire trial duration. Non-significant differences were seen among the different types of DOACs. Conclusion: There was no difference between the BMI classes in any of the outcomes assessed. This may be due to the limited number of people in the trial that were in the obese class, especially obese class III. There is a need for large prospective trials to confirm which DOACs are safe and efficacious in the obese class III adults and at which dose.
Publisher: Elsevier BV
Date: 04-2020
DOI: 10.1016/J.ATHORACSUR.2019.07.060
Abstract: Limited data exist on long-term pulmonary valve function after the Ross procedure. This study sought to determine the long-term function of the pulmonary valve in 443 consecutive adult patients who underwent a Ross procedure. All 443 patients who underwent a Ross procedure between November 1992 and March 2018 were reviewed retrospectively. All underwent pulmonary valve replacement using a cryopreserved pulmonary allograft. Freedom from the study's outcomes were calculated using Kaplan Meier survival. Risk factors for valve failure were analyzed using Cox regression. Mean age at time of operation was 39 years (range: 15-66 years). There was 1 (0.2%, 1 of 443) operative mortality. Nine patients required reintervention on the pulmonary allograft at a mean 6.1 years (range: 1-12 years) after Ross procedure. Patients required pulmonary allograft reintervention for infective endocarditis (n = 4), severe pulmonary stenosis (n = 4), or severe pulmonary regurgitation (n = 1). Freedom from pulmonary allograft reintervention was 98.9% (95% confidence interval [CI] 97.1%-99.6%), 97.7% (95% CI 95.1%-98.9%), 96.6% (95% CI 93.3%-98.3%), and 96.6% (95% CI 93.3%-98.3%) at 5, 10, 15, and 20 years, respectively. Freedom from pulmonary allograft dysfunction (at least moderate pulmonary regurgitation and/or mean systolic gradient ≥ 25 mm Hg and/or reintervention) was 94.5% (95% CI 91.6%-96.4%), 88.1% (95% CI 83.6%-91.4%), 84.9% (95% CI 79.6%-88.9%), and 78.3% (95% CI 69.5%-84.9%) at 5, 10, 15, and 20 years, respectively. No risk factors were identified to influence pulmonary valve durability. The pulmonary valve allograft gives excellent long-term function when used in adults undergoing the Ross procedure. Reintervention on the pulmonary valve is rare and significant pulmonary allograft dysfunction is uncommon.
Publisher: Hindawi Limited
Date: 03-2003
DOI: 10.1046/J.1365-2834.2002.00367.X
Abstract: Clinical nurses at the crux of health care service delivery experienced radical organizational restructuring during the 1990s in Australia. Despite the implications organizational restructuring has for patient care delivery, clinical nurses continue to lack presence in policy decision-making processes. The aim of this paper is to provide an explanation for clinicians' undisputed acceptance of change. This will be performed by examining the process of organizational restructuring across three analytical levels -- the macro, meso and micro identifying the consequences of restructuring for clinical nurses' performance and evaluating organizational restructuring using a micro-political theoretical framework. Utilizing Hoyle's (1988) micro-political theory, it would appear that clinical nurses are functioning within a paradigm of maintenance. In order to provide quality patient care, effective resource use and preservation of the status quo are prioritized. Successful change outcomes are dependent on clinical nurses' performance. Whether nurses are politically inactive as a result of poor communication, as a consequence of the structural change environment or because their energy is devoted to achieving a balance between organizational imperatives and their personal commitment to patient care requires further investigation.
Publisher: Elsevier BV
Date: 09-2020
Publisher: Elsevier BV
Date: 03-2018
DOI: 10.1016/J.JACC.2018.01.048
Abstract: It is unclear whether the Ross procedure offers superior survival compared with mechanical aortic valve replacement (AVR). This study evaluated experience and compared long-term survival between the Ross procedure and mechanical AVR. Between 1992 and 2016, a total of 392 Ross procedures were performed. These were compared with 1,928 isolated mechanical AVRs performed during the same time period as identified using the University of Melbourne and Australia and New Zealand Society of Cardiac and Thoracic Surgeons' Cardiac Surgery Databases. Only patients between 18 and 65 years of age were included. Propensity-score matching was performed for risk adjustment. Ross procedure patients were younger, and had fewer cardiovascular risk factors. The Ross procedure was associated with longer cardiopulmonary bypass and aortic cross-cl times. Thirty-day mortality was similar (Ross, 0.3% mechanical, 0.8% p = 0.5). Ross procedure patients experienced superior unadjusted long-term survival at 20 years (Ross, 95% mechanical, 68% p < 0.001). Multivariable analysis showed the Ross procedure to be associated with a reduced risk of late mortality (hazard ratio: 0.34 95% confidence internal: 0.17 to 0.67 p < 0.001). Among 275 propensity-score matched pairs, Ross procedure patients had superior survival at 20 years (Ross, 94% mechanical, 84% p = 0.018). In this Australian, propensity-score matched study, the Ross procedure was associated with better long-term survival compared with mechanical AVR. In younger patients, with a long life expectancy, the Ross procedure should be considered in centers with sufficient expertise.
Publisher: Wiley
Date: 26-03-2021
DOI: 10.1111/JAN.14837
Publisher: Springer Science and Business Media LLC
Date: 30-05-2023
DOI: 10.1007/S11096-023-01583-Z
Abstract: Atrial fibrillation (AF) and obesity affect over 60 and 650 million people, respectively. This study aimed to explore clinician practices, beliefs, and attitudes towards the use of direct oral anticoagulants (DOACs) in obese adults (BMI ≥ 30 kg/m 2 ) with AF. Semi-structured interviews via video conference were conducted with multidisciplinary clinicians from across Australia, with expertise in DOAC use in adults with AF. Clinicians were invited to participate using purposive and snowball s ling techniques. Data were analysed in NVIVO using thematic analysis. Fifteen clinicians including cardiologists (n = 5), hospital and academic pharmacists (n = 5), general practitioners (n = 2), a haematologist, a neurologist and a clinical pharmacologist participated. Interviews were on average 31 ± 9 min. Key themes identified were: Health system factors in decision-making Disparities between rural and metropolitan geographic areas, availability of health services, and time limitations for in-patient decision-making, were described Condition-related factors in decision-making Clinicians questioned the significance of obesity as part of decision-making due to the practical limitations of dose modification, and the rarity of the extremely obese cohort Decision-making in the context of uncertainty Clinicians reported limited availability, reliability and awareness of primary evidence including limited guidance from clinical guidelines for DOAC use in obesity. This study highlights the complexity of decision-making for clinicians, due to the limited availability, reliability and awareness of evidence, the intrinsic complexity of the obese cohort and limited guidance from clinical guidelines. This highlights the urgent need for contemporary research to improve the quality of evidence to guide informed shared decision-making.
Location: Australia
No related grants have been discovered for ROCHELLE WYNNE.