ORCID Profile
0000-0001-7084-2359
Current Organisations
Flinders University
,
Flinders Medical Centre
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Publisher: Wiley
Date: 03-2015
DOI: 10.1002/JPPR.1058
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 06-2015
Publisher: Elsevier BV
Date: 06-2018
Publisher: BMJ
Date: 03-2019
DOI: 10.1136/BMJOPEN-2018-025822
Abstract: patient-reported outcome measures (PROMs) are instruments used to measure outcomes and experiences of healthcare from the patient perspective. The specific methodology used to develop a PROM should be communicated to establish the quality of the instrument. This mixed methods protocol describes the development of a cross-cultural, internationally applicable PROM for hand conditions, the HAND-Q. The multiphase approach used for this study has been previously used with the development of other PROMs by our team (eg, BODY-Q, BREAST-Q, CLEFT-Q, FACE-Q). In Phase I, we establish what important concepts matter to patients with hand conditions. A conceptual framework is developed from a systematic review of existing PROMs in the field and an extensive international qualitative study. Interpretive description is the qualitative approach used. Item generation is based on the qualitative data. The preliminary scales will be created for each theme identified in the conceptual framework. These scales will be refined by cognitive debriefing interviews with participants and expert input. Phase II involves a large international s le of patients with varied hand conditions completing the field-test version of the HAND-Q. The scales will be refined using the modern psychometric approach of Rasch Measurement Theory. Analysis will result in a shortened set of clinically meaningful and scientifically robust HAND-Q scales. This study is coordinated at Flinders University (Adelaide, Australia) where it has ethics board approval for phase I and phase II. Findings will be published in peer-reviewed journals and presented at local, national and international conferences.
Publisher: BMJ
Date: 02-2020
DOI: 10.1136/BMJOPEN-2019-031804
Abstract: To assess the health burden of breast hypertrophy and the comparative effectiveness of breast reduction surgery in improving health-related quality of life. Prospective cohort study. A major public tertiary care hospital in Australia. Women with symptomatic breast hypertrophy who underwent breast reduction surgery were followed for 12 months. A comparison control cohort comprised women with breast hypertrophy who did not undergo surgery. Bilateral breast reduction surgery for women in the surgical cohort. The primary outcome measure was health-related quality of life measured preoperatively and at 3, 6 and 12 months postoperatively using the Short Form-36 (SF-36) questionnaire. Secondary outcome measures included post-surgical complications. 209 patients in the surgical cohort completed questionnaires before and after surgery. 124 patients in the control hypertrophy cohort completed baseline and 12-month follow-up questionnaires. At baseline, both groups had significantly lower scores compared with population norms across all scales (p .001). In the surgical cohort significant improvements were seen across all eight SF-36 scales (p .001) following surgery. Within 3 months of surgery scores were equivalent to those of the normal population and this improvement was sustained at 12 months. SF-36 physical and mental component scores both significantly improved following surgery, with a mean change of 10.2 and 9.2 points, respectively (p .001). In contrast, SF-36 scores for breast hypertrophy controls remained at baseline across 12 months. The improvement in quality of life was independent of breast resection weight and body mass index. Breast reduction significantly improved quality of life in women with breast hypertrophy. This increase was most pronounced within 3 months of surgery and sustained at 12-month follow-up. This improvement in quality of life is comparable to other widely accepted surgical procedures. Furthermore, women benefit from surgery regardless of factors including body mass index and resection weight.
Publisher: Elsevier BV
Date: 06-1994
DOI: 10.1016/0277-9536(94)90119-8
Abstract: Kenya is well known for its high fertility rate and West Pokot District has the highest population growth rate in Kenya. This study was designed to examine the community's perceptions of fertility dynamics. It looks at traditional methods of family planning and the recent changes in child spacing, fertility and contraception and the attitudes behind them. This study also examines what the community (particularly women), want in the way of family planning services. The study used randomly selected groups throughout the district and employed a quasi-anthropological group discussion method.
Publisher: Wiley
Date: 22-11-2013
DOI: 10.1111/ANS.12008
Abstract: The authors present a technique for mastectomy with greater versatility for reconstruction. The areola is marked and a vertical line is dropped medial to the breast axis, down towards the inframammary fold and laterally to the anterior axillary line. In large ptotic breasts, the markings are modified to reduce the skin envelope. The rotation flap is raised over the lateral half of the breast, and the remainder of the skin envelope is then separated from the breast tissue as per any other mastectomy. Skin closure is by rotation of the flap and incremental gathering of skin. An audit of 37 cases of rotation flap approach (RoFA) mastectomy has been performed, evaluating complications and post-reconstruction outcome using the BREAST Q. RoFA has been found to offer good access for mastectomy and lymphadenectomy. A total of 7 of 37 patients had delay in healing, and 2 patients developed haematoma. Post-reconstruction outcome was scored as comparable with other published series. The RoFA mastectomy has the potential to facilitate reconstructive results equivalent to skin-sparing mastectomy and immediate reconstruction.
Publisher: Elsevier BV
Date: 09-2016
DOI: 10.1016/J.BJPS.2016.06.004
Abstract: Patient-reported outcomes and quality of life following mastectomy are not well understood. This study evaluates the quality of life following surgery for breast cancer and compares outcomes following breast-conserving surgery versus total mastectomy with or without reconstruction. A case-controlled cross-sectional study was conducted using the validated BREAST-Q™ questionnaire and a study-specific questionnaire to determine patient's views about surgical outcomes. Questionnaires were completed by patients following breast-conserving surgery and total mastectomy with or without reconstruction and by controls without breast cancer. A one-way ANOVA was used to compare mean BREAST-Q™ scores between groups and post hoc analysis using Tukey's and Kruskal-Wallis tests. BREAST-Q™ questionnaires were completed by 400 women (123 controls, 97 breast conservations, 93 mastectomies without reconstruction, 87 mastectomies with reconstruction). Women who had undergone mastectomy and reconstruction had higher scores in satisfaction with breast and sexual well-being domains compared with women who had breast-conserving surgery, and women who had total mastectomy without reconstruction had the lowest scores in these two domains. There was no difference in psychosocial well-being between the groups. Women who had undergone breast-conserving surgery scored the lowest in the physical well-being chest domain and the majority reported breast asymmetry. Our study suggests that women who undergo total mastectomy and breast reconstruction for cancer achieve a quality-of-life outcome that is at least as good as that following breast-conserving surgery. Furthermore, breast conservation has been found to be associated with lower physical well-being (i.e., more pain and discomfort) in the chest area and poorer sexual well-being outcomes.
Publisher: Elsevier BV
Date: 10-2002
Abstract: Fading of nipple-areolar reconstructions is commonly reported, but there are few formal studies of this phenomenon. The purpose of this study was to determine whether deficiencies in nipple-areolar reconstruction and pigmentation were perceived by patients, their partners and independent observers, and whether a technique could be developed to measure nipple-areolar colour reliably. A total of 57 patients, 32 partners and four independent observers completed questionnaires about the appearance of the patients' breast reconstructions in general and specifically about their nipple-areolar reconstructions. Scores for the general attributes of the breast reconstruction were used as internal controls for the scores of the nipple-areolar reconstruction. A computer software package was developed to analyse colour in photographs of the reconstructions. Independent observers thought that nipple-areolar reconstruction improved the appearance of a breast reconstruction 81% of the time. Considerably fewer patients were happy with their nipple-areolar colour than were happy with the more general attributes of the breast reconstruction (P < 0.005). Colour analysis objectively demonstrated measurable mismatch between normal and reconstructed nipple-areolar skin, which was positively correlated with time since surgery due to fading of the nipple-areolar reconstruction. In our patients, the quality of nipple-areolar reconstruction, in particular its pigmentation, is seen as inferior to that of the rest of the breast reconstruction in the eyes of patients, their partners and independent observers. The poor colour match and fading of reconstructed nipple-areolar skin are phenomena that can be measured using colour analysis.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 05-2016
DOI: 10.1097/GOX.0000000000000699
Abstract: Late periprosthetic seroma has lately been concerning for breast implant-associated anaplastic large cell lymphoma. The authors present an uncommon presentation of breast implant rupture with a seroma and skin rash forming 2 years after insertion of the implant.
Publisher: Elsevier BV
Date: 09-2018
DOI: 10.1016/J.BJPS.2018.05.011
Abstract: Breast reconstruction using a latissimus dorsi flap impacts one of the principal muscles of the shoulder. There is therefore concern that this procedure could impair shoulder function. The primary objective of this study was to study the effect of breast reconstruction using the latissimus dorsi flap on patient reported shoulder function and quality of life, compared to women who underwent total mastectomy without reconstruction. A case-controlled cross-sectional study was conducted using the validated Breast-Q questionnaire and a functional back and shoulder questionnaire. Questionnaires were mailed to women who had undergone latissimus dorsi flap breast reconstruction (n = 100) and women who had undergone total mastectomy without reconstruction (n = 121). The responses from the 2 groups were compared, and results were analysed with t-test and Pearson's Correlation. Responses were received from 119 patients (60 latissimus dorsi patients and 59 mastectomy alone patients). Latissimus dorsi flap patients had significantly higher Breast-Q scores for all quality of life domains when compared to mastectomy alone patients. There was, however, no significant difference in functional back and shoulder scores between the two groups. Latissimus dorsi flap patients also scored highly for satisfaction with outcome and satisfaction for the 'back'. Patients report high levels of satisfaction following Latissimus dorsi flap breast reconstruction. This type of reconstruction did not adversely impact back and shoulder function.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 2016
Publisher: Elsevier BV
Date: 09-2023
Publisher: Wiley
Date: 16-11-2011
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 10-2010
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 09-2002
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 12-2017
DOI: 10.1097/GOX.0000000000001580
Abstract: Breast asymmetry has a wide spectrum of presentations with several employable strategies for surgical correction. Historically, the external oblique muscle has proven to be a versatile flap option for the reconstruction of both local and distant defects. It has also been described for use in breast reconstruction for coverage of the lower pole of implant prostheses. The external oblique muscle flap can be harvested in several ways to capture overlying fat and skin. In this study, we describe the use of a superiorly based partial rectus and external oblique flap for surgical correction of lower pole breast hypoplasia. This flap provides vascularized autologous volume to the lower pole of the breast with minimal donor morbidity. Other advantages of this flap are that it can increase the nipple to inframammary fold distance and lower the inframammary fold. This technique represents an evolution of an under-utilized flap and is the first study describing the use of the external oblique flap in the management of breast asymmetry.
Publisher: Wiley
Date: 21-06-2021
DOI: 10.1111/ANS.17030
Abstract: Non‐melanoma skin cancers (NMSC) are the most common skin cancers worldwide with research establishing that ultraviolet (UV) radiation influences occurrence. However, recent studies about NMSC tumour frequencies suggested high NMSC predilections in low UV‐exposed skin regions. The ‘Human Surface Anatomy Labeling System’ was used to define 100 skin regions to map NMSC locations excised at Flinders Medical Centre (FMC) between 1 January 2012 and 31 December 2017. Data were retrieved from the FMC histopathology database. A customised phrase algorithm was used to run a systematic word search on the dataset to quantify NMSC locations. A total of 22 303 NMSC excisions were identified 80% were head and neck excisions. Scalp, periocular and nasal regions showed a significantly greater predilection for basal cell carcinomas (BCC). Squamous cell carcinomas (SCC) had significantly more excisions in lip, neck and scalp regions. Regarding gender‐related variations, more males had BCC excisions in ear regions and more females had nasal, lip, and ankle excisions. In SCC excisions, more males had scalp excisions and more females had leg and lip excisions. Considering age‐related variation, significantly higher proportions of BCC were found with forehead excisions compared to scalp, neck and lower limb regions for SCC, all being highest for 60–79‐year age groups. The relationship between NMSC type and anatomical distribution may be partially explained by gender and age affecting NMSC predilections particularly in the head and neck. However, other skin regions could not be explained solely by these factors.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 03-2014
Publisher: Wiley
Date: 06-10-2022
DOI: 10.1111/ANS.18088
Abstract: Carpal tunnel syndrome is a common compressive neuropathy. There is a lack of comprehensive studies evaluating carpal tunnel release (CTR) complications in Australia. This study aimed to evaluate complication rates associated with open and endoscopic CTR in an Australian population, and to identify associated risk factors. Retrospective cohort study of 1287 CTR from 2015 to 2020. Methods of release were endoscopic, open and surgery concomitant with synovectomy or other. Outcomes included wound infection, dehiscence, nerve injury, complex regional pain syndrome, incomplete release, and re‐operation. Statistical analysis included Chi‐squared test, Fisher's exact test, Odds ratio and logistic regression. There were 71 total complications (5.5%), including 35 Clavien–Dindo IIIb complications. There was no difference in complication rates for endoscopic (3.3%) versus open (8.3%) CTR ( P = 0.18). The overall rate of complications was higher in CTR with concomitant surgery (8.5%) compared to CTR alone (5.2%), though this was not statistically significant ( P = 0.058). There was no association between rates of complications and immune suppression (p = 0.55), rheumatoid disease ( P = 0.61), or smoking status ( P = 0.72). Diabetes mellitus was associated with an increased risk of Clavien‐Dindo IIIb complications ( P = 0.028, OR 2.15, 95% CI 1.07–4.32). There was no association between surgical experience and complication rate ( P = 0.55). Open and endoscopic CTR surgeries have similar rates of complications. Diabetes is associated with higher rates of Clavien‐Dindo IIIb complications. Identification of high‐risk patients allows for the application of risk‐mitigation strategies in the perioperative setting.
Publisher: Wiley
Date: 20-11-2023
DOI: 10.1111/ANS.18167
Abstract: The rotation flap approach (RoFA) mastectomy is a skin‐sparing technique that actively imports skin to the centre of the skin envelope and therefore aids in achieving natural ptosis to the reconstructed breast. The objective of this study was to compare clinical outcomes, aesthetics, patient satisfaction and health‐related quality of life between the ROFA mastectomy and standard mastectomy approach. This study is a prospective randomised controlled trial of participants undergoing mastectomy using either the RoFA technique or standard technique with breast reconstruction. The BREAST‐Q was administered pre‐operatively and at 3‐, 6‐, 9‐ and 12‐months following mastectomy. A panel assessment of clinical photographs was conducted to score aesthetics and outcomes of reconstruction. A total of 100 participants were enrolled in the study of these, 51 underwent RoFA incision, 47 underwent standard incision and 2 were lost to follow up. There were no statistically significant differences in BREAST‐Q scores or panellist assessment between the mastectomy groups following breast reconstruction. The post‐operative incidence of mastectomy skin flap tip necrosis was high in the RoFA incision group, with rates of other complications such as seroma being similar. The RoFA skin‐sparing mastectomy incision showed no significant difference in results across patient‐reported outcomes or aesthetics when compared to the standard approach, however, did rate higher for skin flap tip necrosis.
Publisher: Wiley
Date: 17-05-2020
DOI: 10.1111/ANS.15990
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 02-2009
Publisher: Elsevier BV
Date: 05-2015
DOI: 10.1016/J.BJPS.2014.12.038
Abstract: Breast reconstruction has established psychosocial benefit compared to mastectomy alone. Evaluation of determinants of breast reconstruction outcome has previously been limited by lack of high quality, condition-specific, patient-reported outcomes measures. The BREAST-Q is such a measure and is well suited to comparison against objective measurements of reconstructed breasts such as volume and volume symmetry. A cohort of patients who had undergone breast reconstruction over a 14 year period underwent assessment of their breast reconstructions using a 3D laser scanning technique and at the same time completed the BREAST-Q patient reported outcomes measure. The objective data derived from the 3D laser scans were then compared to the quantitative data from the patient-reported outcomes measure. Internal comparisons between domains of the BREAST-Q were also examined. 119 patients completed the study. No correlation was found between objectively measured post-operative volume symmetry and patient reported satisfaction with breasts. Examination of a specific question of the BREAST-Q established that patients did notice if they had breast asymmetry but that this did not translate into dissatisfaction with the breasts overall. Patients who had second stage surgery to correct asymmetry, however, did have a statistically significant increase in satisfaction with breasts between pre and post-symmetrization measures. The strongest correlation for a high level of satisfaction with the reconstructed breast(s) was high level of satisfaction with pre-operative information given. Although symmetrization procedures are valuable for increasing satisfaction with breasts, breast volume symmetry is not a major determinant of outcome in breast reconstruction. The breast reconstruction 'process' is more important in determining patients' post-operative well-being and satisfaction with their overall outcome than the actual final 'product' of their reconstruction.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 02-2012
Publisher: Wiley
Date: 06-2020
DOI: 10.1111/ANS.15910
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 09-2016
Publisher: Elsevier BV
Date: 04-1995
DOI: 10.1016/0165-0327(94)00105-I
Abstract: The current study compares the current and lifetime prevalence of affective disorder in women who have adopted and have natural children (n = 110) with women who only have adopted children (n = 176). There was no difference in lifetime prevalence of psychiatric disorder between the two groups and a nonsignificant trend for women who had born children to have had a major depressive episode during their lifetime 48 (44%) cf 62 (35%). The increased prevalence of psychiatric illness in married women with children cannot be explained by the biological fact of bearing children. None of the social variables related to child-rearing which were examined influenced the lifetime prevalence of psychiatric disorder.
Publisher: No publisher found
Date: 2016
Publisher: Springer Science and Business Media LLC
Date: 11-03-2010
DOI: 10.1007/S10029-010-0645-4
Abstract: We discuss the management of an otherwise healthy obese patient who presented with a massive paraumbilical hernia extending into a large lymphoedematous abdominal apron. After anaesthetic assessment and abdominal computed tomography (CT), the patient underwent an elective operation. The hernia was dissected free of the heavy lymphoedematous apron with the aid of orthopaedic pins and a motorised patient lifter. Despite the size of the hernia, the primary defect was found to be relatively small and easy to reduce. The defect was repaired with a sublay Proceed(®) mesh and skin closure was achieved primarily. The patient had an uneventful post-operative course and gained significant improvement in her mobility.
Publisher: Elsevier BV
Date: 03-2005
DOI: 10.1016/J.BJPS.2004.10.027
Abstract: The makeup of nipple-areolar skin, in terms of its melanin and melanocyte content has not previously been established. This histological information is required if pigmentation of the reconstructed nipple-areola is to be successful in post-mastectomy breast reconstruction. We describe examination of 200 parallel sections of nipple-areolar skin of 20 women using histochemical (Masson-Fontana) and immunohistochemical (Mel-5) techniques, evaluated using quantitative image analysis. The amount of melanin present per length of basement membrane was 2.14 times higher in areolar skin than breast skin. The ratio of melanocytes to keratinocytes was 1:9.7 in areolar skin vs. 1:14.7 in breast skin. We also describe a cell culture and skin construct method using autologous human serum without toxic growth promoting additives, which could be used in the clinical setting of nipple-areolar reconstruction.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 05-2016
DOI: 10.1097/GOX.0000000000000687
Abstract: Tumoral calcinosis is a rare clinical and histopathological syndrome whose exact etiology is unknown. We present a case of a 57-year-old woman who presents with a painful lump in her right chest after bilateral breast reconstructions for bilateral asynchronous breast cancers. It is important to be aware of all possible differential diagnoses in a patient presenting with a chest mass after mastectomy and reconstruction for breast cancer as not all lesions of this type represent recurrent cancer.
Publisher: Australian Society of Plastic Surgeons
Date: 31-03-2022
Abstract: Introduction: This study was designed to improve understanding of the experiences of women un-dergoing abdominoplasty in a public hospital setting, including their experience of processes of care, surgical treatment and outcomes of surgery. Methods: This was a prospective, qualitative study, with one-to-one interviews with women, tran-scription of interviews and development of themes. Results: Twenty interviews were carried out with 16 women, with four women being interviewed before and after surgery and the remaining 12 being interviewed one time only. Messages emerging from the interviews included gratitude for treatment in the public sector, uncertainty associated with waiting times and surgeon allocation, and varied satisfaction with outcomes. This article also explores the evidence for the association between physical symptoms and rectus diastasis (separa-tion of the rectus abdominis muscles) as well as mental health improvement. Conclusion: Women undergoing abdominoplasty in the public sector are not a homogenous group, either in their motivations for surgery or their reported outcomes. This qualitative study found evidence for improvement in physical symptoms and psychological wellbeing in women undergoing abdominoplasty, which supports existing quantitative studies, but also highlights a need for clear information for public sector patients, especially relating to scars, and for liaison psy-chiatry. Criteria-based assessment contributes an additional burden for these patients.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 04-2017
Publisher: Australian Society of Plastic Surgeons
Date: 29-09-2021
Abstract: Objectives: Dissatisfaction with body image is common in patients seeking corrective plastic surgery. However, surgery may not be suitable for every patient. Surgery can enhance quality of life in mentally healthy patients but those with psychopathology such as body dysmorphic disorder (BDD) tend to have poorer outcomes. For these patients, surgery is not always recommended and psychiatric care can have a useful role. This paper aimed to estimate the rates of psychopathology in a select group of elective plastic surgery candidates and discuss the role of preoperative psychoplastic referral in triaging these candidates. Method: A retrospective cohort study of patients considering elective surgery at Flinders Medical Centre in South Australia referred by their surgeon for psychoplastic evaluation from 2010 to 2016. Medical records were reviewed to determine compliance with psychiatric referral, the number and types of psychiatric diagnosis and rates of subsequent surgery. Results: We found 83 per cent (54/65) of surgical candidates assessed by our psychiatrist had a mental illness. Post-traumatic stress disorder (n=19, 34.5%) and major depressive disorder (n=19, 34.5%) were most common. Nine patients (13.6%) were diagnosed with BDD. A total of 57 (87.7%) patients were considered to need some kind of psychiatric care to improve potential surgery outcomes. Conclusions: In our study, the rate of psychopathology in patients referred for psychiatric evaluation suggests that careful screening is important for clinical decision making. A combined surgical sychiatric approach is effective in ensuring vulnerable patients are identified and managed appropriately.
No related grants have been discovered for Nicola Ruth Dean.