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Timing Of Palliative Care Referral And Aggressive Cancer Care Toward The End-Of-Life In Pancreatic Cancer: A Retrospective, Single-Center Observational Study, Natasha Michael, Greta Beale, Clare O'Callaghan, Adelaide Melia, William Desilva, Daniel Costa, David Kissane, Jeremy Shapiro, Richard Hiscock

Medical Papers and Journal Articles

Background: Pancreatic cancer is noted for its late presentation at diagnosis, limited prognosis and physical and psychosocial symptom burden. This study examined associations between timing of palliative care referral (PCR) and aggressive cancer care received by pancreatic cancer patients in the last 30 days of life through a single health service.

Method: A retrospective cohort analysis of end-of-life (EOL) care outcomes of patients with pancreatic cancer who died between 2012 and 2016. Key indicators of aggressive cancer care in the last 30 days of life used were: ≥1 emergency department (ED) presentations, acute inpatient/intensive care unit (ICU) admission, and chemotherapy …

Developing A Practice-Based Research Agenda For Grief And Bereavement Care, Ashton Hay, Christopher W. Hall, Margaret Sealey, Elizabeth Lobb, Lauren J. Breen

Medical Papers and Journal Articles

We aimed to identify practitioners’ perspectives on current research priorities in grief and bereavement care. Grief and bereavement care providers were invited to participate in a three-phase Delphi study to create expert consensus on the top priorities for grief and bereavement research. A total of 140 participants completed Phase 1, 84 completed Phase 2, and 70 completed Phase 3. These top 10 research priorities form the basis of a practice-based research agenda for grief and bereavement care to enable researchers to respond to key issues in grief and bereavement care that will ultimately improve the lives of bereaved people.

Reducing Stroke Risk In Atrial Fibrillation: Adherence To Guidelines Has Improved, But Patient Persistence With Anticoagulant Therapy Remains Suboptimal., Nicole Lowres, Katrina Giskes, Charlotte Hespe, Ben Freedman

Medical Papers and Journal Articles

Atrial fibrillation (AF) is a significant risk factor for avoidable stroke. Among high-risk patients with AF, stroke risk can be mitigated using oral anticoagulants (OACs), however reduction is largely contingent on physician prescription and patient persistence with OAC therapy. Over the past decade significant advances have occurred, with revisions to clinical practice guidelines relating to management of stroke risk in AF in several countries, and the introduction of non-vitamin K antagonist OACs (NOACs). This paper summarises the evolving body of research examining guideline-based clinician prescription over the past decade, and patient-level factors associated with OAC persistence. The review shows clinicians' …

Prevalence Of Sexual Harassment Of Nurses And Nursing Students In China: A Meta-Analysis Of Observational Studies, Liang-Nan Zeng, Qian-Qian Zong, Ji-Wen Zhang, Li Lu, Feng-Rong An, Chee H. Ng, Gabor S. Ungvari, Fang-Yu Yang, Teris Cheung, Ligang Chen, Yu-Tao Xiang

Medical Papers and Journal Articles

Sexual harassment experienced by nurses and nursing students is common and significantly associated with negative consequences. This study is a meta-analysis of the pooled prevalence of sexual harassment of nurses and nursing students in China. Electronic databases (PubMed, EMBASE, PsycINFO, Web of Science and Ovid, China National Knowledge Internet, WanFang, SinoMed and Chinese VIP Information) were independently and systematically searched by two reviewers from their commencement date to 12 March 2018. Forty-one studies that reported the prevalence of sexual harassment were analyzed using the random-effects model. The pooled prevalence of sexual harassment was 7.5% (95% CI: 5.5%-10.1%), with 7.5% (5.5%-10.2%) …

Social Network Analysis Of Rural Medical School Immersion In A Rural Clinical School, Denese E. Playford, Tessa Burkitt, David Atkinson

Medical Papers and Journal Articles

Background: The impact of new medical graduates on the social dimensions of the rural medical workforce is yet to be examined. Social Network Analysis (SNA) is able to visualize and measure these dimensions. We apply this method to examine the workforce characteristics of graduates from a representative Australian Rural Clinical School.

Methods: Participants were medical graduates of the Rural Clinical School of Western Australia (RCSWA) from the 2001–2014 cohorts, identified as being in rural work in 2017 by the Australian Health Practitioner Regulation Agency. SNA was used to examine the relationships between site of origin and of work destination. Data …

Bioethics In The News: The Values At Stake. Why Are Conservative Values So Difficult To Communicate In The Public Square And Progressive Values So Easy?, Margaret Somerville

Medical Papers and Journal Articles

Bioethical issues are complex, often involve factual uncertainty, and have broad and long-term potential consequences for individuals, institutions and society. Simplification is a strategy used by so-called ‘progressive’ values advocates to promote acceptance of their values. It results from excluding consideration of complexity, uncertainty and potentiality in the values disputes around bio-ethical issues. In order to engage effectively in public debates of bioethics issues, it is necessary to understand the current societal values zeitgeist and how it differs from a traditional societal values zeitgeist. Since words are weapons in the values battles, it is necessary to identify how they are …

Characteristics Of Gay, Bisexual And Other Men Who Have Sex With Men With Multiple Diagnoses Of Infectious Syphilis In British Columbia, Canada, 2005-2014, Stephanie Konrad, Donna B. Mak, Troy Grennan, Bernadette Zakher, Bobbi Brownrigg, Gina Ogilvie, Muhammad Morshed, Mark Tyndall, Mark Gilbert, Mel Krajden, Jason Wong

Medical Papers and Journal Articles

Background: Infectious syphilis has increased substantially over the past decade. Targeting limited public health resources toward subpopulations with multiple reinfections may have a large impact in reducing onward transmission within a community.

Methods: A chart review was conducted for individuals with 4 or more infectious syphilis diagnoses between 2005 and 2014 (the top 1% of all syphilis diagnoses in British Columbia, Canada). We characterized the sociodemographics, partner notification outcomes and social network.

Results: Between 2005 and 2014, there were 30 individuals with 4 or more syphilis diagnoses, accounting for 139 diagnoses. All were men who have sex with men and …

Student Exposure To Cancer Patients: An Analysis Of Clinical Logbooks And Focus Groups In Clinical Year Medical Students, Darren L. Starmer, Caris L. House, Kristyn M. Langworthy

Medical Papers and Journal Articles

Despite cancer being the leading cause of mortality, cancer education and patient exposure are lacking in many medical schools. The aim of this study was to evaluate the nature of cancer patient exposure, relative to the clinical setting for medical students on placement and to explore their experiences. Participants were asked to maintain a logbook of cancer patient encounters and were invited to attend a structured focus group upon completion of the academic year. Eleven students submitted logbooks (rr = 6.15%) and eight participated in the focus groups (4.47%). A total of 247 cancer patient encounters were recorded. Third-year students …

Familial Hypercholesterolaemia In 2020: A Leading Tier 1 Genomic Application, Jing Pang, David R. Sullivan, Tom Brett, Karam M. Kostner, David L. Hare, Gerald F. Watts

Medical Papers and Journal Articles

Familial hypercholesterolemia (FH) is caused by a major genetic defect in the low-density lipoprotein (LDL) clearance pathway. Characterised by LDL-cholesterol elevation from birth, FH confers a significant risk for premature coronary artery disease (CAD) if overlooked and untreated. With risk exposure beginning at birth, early detection and intervention is crucial for the prevention of CAD. Lowering LDL-cholesterol with lifestyle and statin therapy can reduce the risk of CAD. However, most individuals with FH will not reach guideline recommended LDL-cholesterol targets. FH has an estimated prevalence of approximately 1:250 in the community. Multiple strategies are required for screening, diagnosing and treating …

How Does The Duration Of Consults Vary For Upper Respiratory Tract Infections In General Practice Where An Antibiotic Has Been Prescribed?, Phoebe R. Darlison Shepherd, Catherine J. Krejany, Moyez Jiwa

Medical Papers and Journal Articles

Background: There is limited data on the duration of consults resulting in the prescription of antibiotics for upper respiratory tract infections (URTIs) in general practice.

Objective: To explore how demographic factors influence consult duration where antibiotics have been prescribed for URTI in Australian general practice.

Methods: 2985 URTI-specific presentations were identified from a national study of patients who were prescribed an antibiotic after presenting to general practice between June and September 2017. Consult duration was analysed to assess for any variation in visit length based on demographic factors.

Results: The overall median consult duration was 11.42 minutes [interquartile range (IQR) …

Disability Patterns Over The First Year After A Diagnosis Of Epilepsy, Ying Xu, Dennis R. Neuen, Nick Glozier, Armin Nikpour, Ernest Somerville, Andrew Bleasel, Carol Ireland, Craig S. Anderson, Maree L. Hackett

Medical Papers and Journal Articles

Objective: To determine the patterns and predictors of disability over the first 12 months after a diagnosis of epilepsy.

Patients and methods: The Sydney Epilepsy Incidence Study to Measure Illness Consequences (SEISMIC) was a prospective, multicenter, community-based study of people with newly diagnosed epilepsy in Sydney, Australia. Disability was assessed using the World Health Organization’s, Disability Assessment Schedule (WHODAS) 2.0 12-item version, at baseline (i.e. within 28 days of diagnosis) and 12 months post-diagnosis. Demographic, socioeconomic, clinical and epilepsy-related data, obtained through structured interviews, were entered into multivariable linear regression and shift analysis to determine predictors of greater disability.

Results: …

Transnational Parent-Child Separation And Reunion During Early Childhood In Chinese Migrant Families: An Australian Snapshot, Yat Man Louise Hui, Julie Stevenson, Gisselle Gallego

Medical Papers and Journal Articles

Limited international research exists on reasons for transnational child care, or developmental consequences of separations and reunions on young Chinese children. This descriptive study portrays a sample of children from Chinese migrant families residing in western Sydney, New South Wales, Australia, whose parents temporarily relinquished their care to grandparents in China. Data were collected via retrospective health record audits. The majority of parents were first-time parents and the majority of children were first-borns sent back to China during infancy. The average duration of transnational parent–child separation was 20 months. Results showed that male child subjects who experienced multiple transnational separations …

An Education Intervention To Improve Decision Making And Health Literacy Among Older Australians: A Randomised Controlled Trial, Caroline A. Smith, Esther Chang, Gisselle Gallego, Afshan Khan, Mike Armour, Lynda G. Balneaves

Medical Papers and Journal Articles

Background: National policies seek to involve older Australian’s in decisions regarding their care; however, research has found varying levels of decision self-efficacy and health literacy skills. An increasing number of older Australians use complementary medicine (CM). We examined the effectiveness of a CM educational intervention delivered using a web or DVD plus booklet format to increase older adults’ decision self-efficacy and health literacy.

Methods: A randomised controlled trial was conducted. We recruited individuals aged over 65years living in retirement villages or participating in community groups, in Sydney Australia. Participants were randomly allocated to receive a CM education intervention delivered using …

What Is The Prevalence, And What Are The Clinical Correlates, Of Insulin Resistance In Young People Presenting For Mental Health Care? A Cross-Sectional Study, Elizabeth M. Scott, Joanne S. Carpenter, Frank Iorfino, Shane P.M Cross, Daniel F. Hermens, Jeanne Gehue, Chloe Wilson, Django White, Sharon L. Naismith, Adam J. Guastella, Ian B. Hickie

Medical Papers and Journal Articles

Objectives: To report the distribution and predictors of insulin resistance (IR) in young people presenting to primary care-based mental health services.

Design: Cross-sectional.

Setting: Headspace-linked clinics operated by the Brain and Mind Centre of the University of Sydney.

Participants: 768 young people (66% female, mean age 19.7±3.5, range 12–30 years).

Main outcome measures: IR was estimated using the updated homeostatic model assessment (HOMA2-IR). Height and weight were collected from direct measurement or self-report for body mass index (BMI).

Results: For BMI, 20.6% of the cohort were overweight and 10.2% were obese. However,6.9 mmol/L). By contrast, 9.9% had a HOMA2-IR score …

Exposure To Second Hand Smoke And 10-Year (2002–2012) Incidence Of Cardiovascular Disease In Never Smokers: The Attica Cohort Study, Elena Critselis, Demosthenes B. Panagiotakos, Ekavi N. Georgousopoulou, Paraskevi Katsaounou, Christina Chrysohoou, Christos Pitsavos

Medical Papers and Journal Articles

Background: Despite WHO Framework Convention of Tobacco Control (FCTC) adoption, effective implementation of national smoking bans remains pending in several countries. This study quantified the association of second hand smoke (SHS) exposure and 10-year cardiovascular disease (CVD) among never smokers in such settings.

Methods: In 2001–2002, a sample of 1514 males and 1528 females (range: 18–89 years old) were randomly selected in Greece. Frequency and duration of SHS exposure (i.e. exposure extending >30 min/day) within the home and/or workplace were assessed by interview. Following a 10-year follow-up period (2002–2012), incidence of non-fatal and fatal CVD (ICD-10) was evaluated among n …

Symptom Profile Of Patients Receiving Antibiotics For Upper Respiratory Tract Infections In General Practice: An Observational Study Using Smartphone Technology, Moyez Jiwa, Catherine Krejany, Epi Kanjo, Alan Leeb, Ian J. Peters

Medical Papers and Journal Articles

Background: Upper respiratory tract infections (URTIs) are a common presentation in general practice and are linked to high rates of inappropriate antibiotic prescription. There is limited information about the trajectory of patients with this condition who have been prescribed antibiotics.

Objective: To document the symptom profile of patients receiving antibiotics for URTIs in Australian general practice using smartphone technology and online surveys.

Methods: In total, 8218 patients received antibiotics after attending one of the 32 general practice clinics in Australia from June to October 2017: 4089 were identified as URTI presentations and were the cohort studied. Patients completed the Wisconsin …

Long-Term Prevalence And Predictors Of Prolonged Grief Disorder Amongst Bereaved Cancer Caregivers: A Cohort Study, Rachel D. Zordan, Melanie L. Bell, Melanie Price, Cheryl Remedios, Elizabeth Lobb, Christopher Hall, Peter Hudson

Medical Papers and Journal Articles

Context: The short-term impact of prolonged grief disorder (PGD) following bereavement is well documented. The longer term sequelae of PGD however are poorly understood, possibly unrecognized, and may be incorrectly attributed to other mental health disorders and hence undertreated.

Objectives: The aims of this study were to prospectively evaluate the prevalence of PGD three years post bereavement and to examine the predictors of long-term PGD in a population-based cohort of bereaved cancer caregivers.

Methods: A cohort of primary family caregivers of patients admitted to one of three palliative care services in Melbourne, Australia, participated in the study (n = …

Attitudes And Factors Involved In Decision-Making Around Complementary And Alternative Medicines (Cams) By Older Australians: A Qualitative Study, Gisselle Gallego, Saira Gugnani, Mike Armour, Caroline A. Smith, Esther Chang

Medical Papers and Journal Articles

Introduction: Recent evidence has indicated that older Australians are increasingly turning to complementary and alternative medicines (CAMs) to address a variety of health issues. This qualitative study aimed to explore the attitudes and factors involved in decision-making around CAMs by older Australians upon the completion of a CAM educational intervention.

Methods: Men and women aged over 65 years living in New South Wales, Australia were invited to participate in semi-structured interviews after taking part in a randomised control trial. Interviews were analysed using the framework approach.

Results: A total of 20 participants aged over 65 years were interviewed. Themes captured …

Where's My What? A Survey Of Anatomical Knowledge In A Community In Western Melbourne, Morgan Jones, Catherine Krejany, Moyez Jiwa

Medical Papers and Journal Articles

Background and Aims: This study aimed to explore if members of the public could identify the location of major body organs as well as pain associated with major organ pathologies.

Method: A survey of 100 participants was conducted in Melbourne, Australia. Participants were invited to mark the location of two internal organs and the site of pain for two pathologies on a manikin. Five anatomical questions and four clinical scenario questions were randomised prior to data collection. Photographs of participant responses were compared to responses of a doctor, and if a site within the same area was identified the participant …

Mortality Risk Reduction Differs According To Bisphosphonate Class: A 15-Year Observational Study, D Bliuc, T Tran, T Van Geel, J D. Adachi, C Berger, J Van Den Bergh, John A. Eisman, P Geusens, D Golzman, D A. Hanley, R G. Josse, S Kaiser, C S. Kovacs, L Langsetmo, J C. Prior, T V. Nguyen, J R. Center

Medical Papers and Journal Articles

Summary: In this prospective cohort of 6120 participants aged 50+, nitrogen-bisphosphonates but not non-nitrogen bisphosphonates were associated with a significant 34% mortality risk reduction compared to non-treated propensity score matched controls. These findings open new avenues for research into mechanistic pathways.

Introduction: Emerging evidence suggests that bisphosphonates (BP), first-line treatment of osteoporosis, are associated with reduced risks for all-cause mortality. This study aimed to determine the association between different BP types and mortality risk in participants with or without a fracture.

Methods: A prospective cohort study of users of different BPs matched to non-users by propensity score (age, gender, co-morbidities, …

'Through The Eyes Of The Dying' - Identifying Who May Benefit From Bereavement Follow-Up: A Qualitative Study, Jane L. Phillips, Elizabeth A. Lobb, Francis Bellemore, Terrence Hays, David C. Currow

Medical Papers and Journal Articles

Introduction: Bereavement support is an integral element of palliative care. Emerging evidence stipulates that bereavement support should be reserved for those most at risk of poor outcomes. While this evidence makes identifying those at risk of experiencing a complex bereavement a necessary first step, it has been difficult to arrive at a consensus as to whom that should be.

Aim: To explore whether palliative care in-patients with advanced disease are concerned about the bereavement needs of others and, if so, is it their next-of-kin.

Design: A qualitative study using semi-structured interviews, and thematic analysis using a constant comparative method.

Setting/participants: …

Exploring Physicians, Nurses And Ward-Based Pharmacists Working Relationships In A Swedish Inpatient Setting: A Mixed Methods Study, Marcia H. Lindqvist, Maria Gustafsson, Gisselle Gallego

Medical Papers and Journal Articles

Background: In Sweden there has been limited work investigating the integration and nature of collaborative relationships between pharmacists and other healthcare practitioners.

Objective: To explore the working relationships of physicians, nurses and ward-based pharmacists in a rural hospital after the introduction of a clinical pharmacy service. Setting General medical ward in a rural hospital in northern Sweden.

Method: Mixed methods involving face-to-face semi-structured interviews with nurses, physicians and pharmacists, and a physician survey using the Physician-Pharmacist Collaboration Index to measure the extent of physician-reported collaborative working relationships.

Main outcome measure: Perceptions about collaborative working relationships between …

A Sex-Specific Evaluation Of Predicted Lean And Fat Mass Composition And Cardiovascular Disease Onset And Progression: A Combined Analysis Of The Attica And Greecs Prospective Epidemiological Studies, Matina Kouvari, Demosthenes B. Panagiotakos, Christina Chrysohoou, Venetia Notara, Ekavi N. Georgousopoulou, Mary Yannakoulia, Dimitrios Tousoulis, Christos Pitsavos

Medical Papers and Journal Articles

Objectives: To evaluate the association of predicted lean and fat mass on 10-year first and recurrent CVD incidence separately for men and women.

Methods: Two prospective studies, ATTICA (2002-2012, n = 3042 subjects free-of-CVD, n = 1514 men (46 ± 13 years) and n = 1528 women (45 ± 14 years)) and GREECS (2004-2014, n = 2172 subjects with acute coronary syndrome (ACS), n = 1649 men (65 ± 13 years) and n = 523 women (62 ± 11 years)) were used. Lean mass index (LMI) and fat mass index (FMI) were created through total body lean and fat mass …

The Impact Of Mandatory Iodine Fortification And Supplementation On Pregnant And Lactating Women In Australia, Stephen Hurley, Creswell J. Eastman, Gisselle Gallego

Medical Papers and Journal Articles

Background and Objectives: In Australia, two public health measures were introduced between 2009 and 2010 to reduce iodine deficiency. However there has been a shortage of information regarding their effectiveness and the ongoing prevalence of iodine deficiency in Australia. The primary aim of this study was to assess the extent to which these public health measures have reduced rates of iodine deficiency among pregnant and lactating women.

Methods and Study Design: A review was conducted to identify all studies published since January 2010 that quantitatively measured the iodine status of pregnant and/or lactating women in Australia.

Results: We found 25 …

Lipoprotein (A) And 10-Year Cardiovascular Disease Incidence In Apparently Healthy Individuals: A Sex-Based Sensitivity Analysis From Attica Cohort Study, Matina Kouvari, Demosthenes B. Panagiotakos, Christina Chrysohoou, Ekavi N. Georgousopoulou, Mary Yannakoulia, Dimitrios Tousoulis, Christos Pitsavos

Medical Papers and Journal Articles

The association between lipoprotein (a) (Lp(a)) and 10-year first fatal/nonfatal cardiovascular disease (CVD) risk in apparently healthy men and women was evaluated. The ATTICA prospective study was conducted during 2001-2012 and included n = 1514 men and n = 1528 women (age >18 years) from the greater Athens area, Greece. Follow-up CVD assessment (2011-2012) was achieved in n = 2020 participants (n = 317 cases); baseline Lp(a) was measured in n = 1890 participants. The recommended threshold of 50 mg/dL was used to define abnormal Lp(a) status. Ten-year CVD-event rate was 14% and 24% in participants with Lp(a)Lp(a) ≥50 mg/dL, …

Undetectable Mannose Binding Lectin Is Associated With Hrct Proven Bronchiectasis In Rheumatoid Arthritis (Ra), Krista Makin, Tracie Easter, Monica Kemp, Peter Kendall, Max Bulsara, Sophie Coleman, Graeme J. Carroll

Medical Papers and Journal Articles

Aim: The aim of this study was to ascertain whether mannose binding lectin deficiency is implicated in coexistent rheumatoid arthritis and bronchiectasis and to determine whether undetectable mannose binding lectin confers poorer long-term survival in coexistent rheumatoid arthritis and bronchiectasis or in rheumatoid arthritis in general.

Materials and methods: A retrospective audit was conducted in a rheumatoid arthritis cohort in which mannose binding lectin had been measured by enzyme linked immunosorbent assay from 2007–11. Rheumatoid arthritis patients with physician diagnosed HRCT proven bronchiectasis were recruited during this time and compared to those with uncomplicated rheumatoid arthritis. Survival from disease onset …

Investigating Risk Factors And Predicting Complications In Deep Brain Stimulation Surgery With Machine Learning Algorithms, Farrokh Farrokhi, Quinlan D. Buchlak, Matt Sikora, Nazanin Esmaili, Maria Marsans, Pamela Mcleod, Jamie Mark, Emily Cox, Christine Bennett, Jonathan Carlson

Medical Papers and Journal Articles

Background: Deep brain stimulation (DBS) surgery is an option for patients experiencing medically resistant neurological symptoms. DBS complications are rare; finding significant predictors requires a large number of surgeries. Machine learning algorithms may be used to effectively predict these outcomes. The aims of this study were to (1) investigate preoperative clinical risk factors, and (2) build machine learning models to predict adverse outcomes.

Methods: This multicenter registry collected clinical and demographic characteristics of patients undergoing DBS surgery (n=501) and tabulated occurrence of complications. Logistic regression was used to evaluate risk factors. Supervised learning algorithms were trained and validated on 70% …

Impulse Control Disorders In Dopamine Agonist-Treated Hyperprolactinemia: Prevalence And Risk Factors, Sunita M.C De Sousa, John Baranoff, R Louise Rushworth, Jessica Butler, Jane Sorbello, Juanita Vorster, Tanya Thompson, Ann I. Mccormack, Warrick J. Inder, David J. Torpy

Medical Papers and Journal Articles

Context: There are growing reports of dopamine agonist (DA)-induced impulse control disorders (ICDs) in hyperprolactinemic patients. However, the magnitude of this risk and predictive factors remain uncertain.

Objective: To determine ICD prevalence and risk factors in DA-treated hyperprolactinemic patients compared to community controls.

Design, Setting and Participants: Multicenter cross-sectional analysis of 113 patients and 99 healthy controls.

Main Outcome Measures: Participants completed a neuropsychological questionnaire consisting of the Depression Anxiety Stress Scale (DASS21), Questionnaire for Impulsive-Compulsive Disorders in Parkinson’s disease (QUIP-S), Hypersexual Behavior Inventory (HBI), Hypersexual Behavior Consequences Scale and Social Desirability Response Set Scale. Demographic and clinical data were …