Medicine and Health Sciences Commons^™

External Validation Of The Garvan Nomograms For Predicting Absolute Fracture Risk: The Tromso Study, Luai A. Ahmed, Nguyen D. Nguyen, Ashild Bjornerem, Ragnar M. Joakimsen, Lone Jorgensen, Jan Stormer, Dana Bliuc, Jacqueline R. Center, John A. Eisman, Tuan V. Nguyen, Nina Emaus

Medical Papers and Journal Articles

Background: Absolute risk estimation is a preferred approach for assessing fracture risk and treatment decision making. This study aimed to evaluate and validate the predictive performance of the Garvan Fracture Risk Calculator in a Norwegian cohort.

Methods: The analysis included 1637 women and 1355 aged 60+ years from the Tromsø study. All incident fragility fractures between 2001 and 2009 were registered. The predicted probabilities of non-vertebral osteoporotic and hip fractures were determined using models with and without BMD. The discrimination and calibration of the models were assessed.Reclassification analysis was used to compare the models performance.

Results: The incidence of osteoporotic …

High Expression Of Cathepsin E In Tissues But Not Blood Of Patients With Barrett’S Esophagus And Adenocarcinoma, Oliver M. Fisher, Angelique J. Levert-Mignon, Sarah J. Lord, Natalie K. Botelho, Araluen K. Freeman, Melissa L. Thomas, Dan Falkenback, Antony Wettstein, David C. Whiteman, Yuri V. Bobryshev, Reginald V. Lord

Medical Papers and Journal Articles

Background Cathepsin E (CTSE), an aspartic proteinase, is differentially expressed in the metaplasia–dysplasia–neoplasia sequence of gastric and colon cancer. We evaluated CTSE in Barrett’s esophagus (BE) and cancer because increased CTSE levels are linked to improved survival in several cancers, and other cathepsins are up-regulated in BE and esophageal adenocarcinoma (EAC). Methods A total of 273 pretreatment tissues from 199 patients were analyzed [31 normal squamous esophagus (NE), 29 BE intestinal metaplasia, 31 BE with dysplasia (BE/D), 108 EAC]. CTSE relative mRNA expression was measured by real-time polymerase chain reaction, and protein expression was measured by immunohistochemistry. CTSE serum levels …

Health Inequalities And Development Plans In Iran: An Analysis Of The Past Three Decades (1984–2010), H Zare, A Trujillo, J Driessen, M Ghasemi, G Gallego

Medical Papers and Journal Articles

Introduction: Reducing inequalities in health care is one of the main challenges in all countries. In Iran as in other oil-exporting upper middle income countries, we expected to witness fewer inequalities especially in the health sector with the increase in governmental revenues.

Methods: This study presents an inequalities assessment of health care expenditures in Iran. We used data from the Household Income and Expenditure Survey (HIES) in Iran from 1984–2010. The analysis included 308,735 urban and 342,532 rural households.

Results: The results suggest heightened inequality in health care expenditures in Iran over the past three decades, including an increase in …

Evaluating The Guideline Enhancement Tool (Get): An Innovative Clinical Training Tool To Enhance The Use Of Hypertension Guidelines In General Practice, Chinthaka Balasooriya, Joel Rhee, Boaz Shulruf, Rosa Canalese, Nicholas Zwar

Medical Papers and Journal Articles

Background: This project aims to evaluate the effectiveness of an innovative educational intervention in enhancing clinical decision making related to the management of hypertension in general practice. The relatively low level of uptake of clinical practice guidelines by clinicians is widely recognised as a problem that impacts on clinical outcomes. This project addresses this problem with a focus on hypertension guidelines. Hypertension is the most frequently managed problem in general practice but evidence suggests that management of Hypertension in general practice is sub-optimal.

Methods/design: This study will explore the effectiveness of an educational intervention named the ‘Guideline Enhancement Tool (GET)’. …

Unmet Needs Of Patients With Chronic Obstructive Pulmonary Disease (Copd): A Qualitative Study On Patients And Doctors, S Wong, N Abdullah, A Abdullah, S Liew, S Ching, E Khoo, M Jiwa, Y Chia

Medical Papers and Journal Articles

Background: Chronic Obstructive Pulmonary Disease (COPD) is a chronic disease with repeated exacerbations resulting in gradual debilitation. The quality of life has been shown to be poor in patients with COPD despite efforts to improve self-management. However, the evidence on the benefit of self-management in COPD is conflicting. Whether this could be due to other unmet needs of patients have not been investigated. Therefore, we aimed to explore unmet needs of patients from both patients and doctors managing COPD.

Methods: We conducted a qualitative study with doctors and patients in Malaysia. We used convenience sampling to recruit patients until data …

Domestic Violence Is A Leading Risk Factor In Default From Colposcopy Services, Rachael R. Collier, Julie Quinlivan

Medical Papers and Journal Articles

Aim: Domestic violence is common in women and is associated with poorer healthcare outcomes. However, no causal pathway has been identified to explain this observation. We have followed a cohort of women to determine whether poorer outcomes can be explained by high rates of default and lost to follow up.

Methods: A prospective cohort study was performed. Institutional ethics approval was obtained. Participants were consecutive patients attending colposcopy clinics at a major metropolitan hospital in Australia. Following ascertainment of domestic violence status, appointment outcomes for colposcopy services were tracked for a three-year period. Multivariate analysis was undertaken to determine demographic …

Robot-Assisted Gastrectomy And Oesophagectomy For Cancer, Dan Falkenback, Christopher W. Lehane, Reginald V.N Lord

Medical Papers and Journal Articles

Background: Robot-assisted surgery is a technically feasible alternative to open and laparoscopic surgery, which is being more frequently used in general surgery. We undertook this review to investigate whether robotic assistance provides a significant benefit for oesophagogastric cancer surgery.

Methods: Electronic databases were searched for original English-language publications for robotic-assisted gastrectomy and oesophagectomy between January 1990 and October 2013.

Results: Sixty-one publications were included. Thirty-five included gastrectomy, 31 included oesophagectomy and five included both operations. Several publications suggest that robot-assisted subtotal gastrectomy can be as safe and effective as an open or laparoscopic procedure, with equal outcomes with regard to …

Rating General Practitioner Consultation Performance In Cancer Care: Does The Specialty Of Assessors Matter? A Simulated Patient Study, M Jiwa, G Halkett, X Meng, M Berg

Medical Papers and Journal Articles

Background: Patients treated for prostate cancer may present to general practitioners (GPs) for treatment follow up, but may be reticent to have their consultations recorded. Therefore the use of simulated patients allows practitioner consultations to be rated. The aim of this study was to determine whether the speciality of the assessor has an impact on how GP consultation performance is rated.

Methods: Six pairs of scenarios were developed for professional actors in two series of consultations by GPs. The scenarios included: chronic radiation proctitis, Prostate Specific Antigen (PSA) ‘bounce’, recurrence of cancer, urethral stricture, erectile dysfunction and depression or anxiety. …

Early Discontinuation Of Endocrine Therapy For Breast Cancer: Who Is At Risk In Clinical Practice?, Anna Kemp, David Preen, Christobel Saunders, Francis Boyle, Max Bulsara, Eva Malacova, Elizabeth E. Roughead

Medical Papers and Journal Articles

Purpose: Despite evidence supporting at least five years of endocrine therapy for early breast cancer, many women discontinue therapy early. We investigated the impact of initial therapy type and specific comorbidities on discontinuation of endocrine therapy in clinical practice.

Methods

We identified women in a population-based cohort with a diagnosis of early breast cancer and an incident dispensing of anastrozole, letrozole or tamoxifen from 2003-2008 (N = 1531). Pharmacy and health service data were used to determine therapy duration, treatment for pre-existing and post-initiation comorbidities (anxiety, depression, hot flashes, musculoskeletal pain, osteoporosis, vaginal atrophy), demographic and other clinical characteristics. Time …

Multimorbidity In A Marginalised, Street-Health Australian Population: A Retrospective Cohort Study, Tom Brett, Diane Arnold-Reed, Lakkina Troeung, Max Bulsara, Annalise Williams, Robert G. Moorhead

Medical Papers and Journal Articles

OBJECTIVES:

Demographic and presentation profile of patients using an innovative mobile outreach clinic compared with mainstream practice.

DESIGN:

Retrospective cohort study.

SETTING:

Primary care mobile street health clinic and mainstream practice in Western Australia.

PARTICIPANTS:

2587 street health and 4583 mainstream patients.

MAIN OUTCOME MEASURES:

Prevalence and patterns of chronic diseases in anatomical domains across the entire age spectrum of patients and disease severity burden using Cumulative Illness Rating Scale (CIRS).

RESULTS:

Multimorbidity (2+ CIRS domains) prevalence was significantly higher in the street health cohort (46.3%, 1199/2587) than age-sex-adjusted mainstream estimate (43.1%, 2000/4583), p=0.011. Multimorbidity prevalence was significantly higher in …

Eye Trauma Epidemiology In Regional Australia, Luke C. Northey, Gaurav Bhardwaj, Shane Curran, Joseph Mcgirr

Medical Papers and Journal Articles

Purpose: To describe the epidemiology of eye trauma presenting to a regional referral health service in New South Wales, Australia.

Methods: A two-stage retrospective and prospective case series study was conducted. Patients who presented with eye trauma to Wagga Wagga Base Hospital (WWBH) emergency department (ED) during a one year review period formed the retrospective case series (RCS). Patient inclusion was determined using SNOMED CT and ICD-10 codes applied to medical records. Patients presenting with eye trauma to the WWBH ED or its ophthalmology service over a prospective 80 day study period formed the prospective case series (PCS). The …

Management Of Behavioural Change In Patients Presenting With A Diagnosis Of Dementia: A Video Vignette Study With Australian General Practitioners, M Jiwa, P Nichols, P Magin, G Pagey, X Meng, R Parsons, V Pillai

Medical Papers and Journal Articles

Objective: To test the impact of feedback on the proposed management of standardised patients presenting with behavioural change with a diagnosis of dementia in Australian primary care.

Materials and methods: A video vignette study was performed with Australian general practitioners (GPs) in 2013. Participants viewed six pairs of matched videos depicting people presenting changed behavior in the context of a dementia diagnosis in two phases. In both phases GPs indicated their diagnosis and management. After phase 1, GPs were offered feedback on management strategies for the patients depicted. Analyses focused on identification of change in management between the two phases …

A Randomised Trial Deploying A Simulation To Investigate The Impact Of Hospital Discharge Letters On Patient Care In General Practice, M Jiwa, X Meng, C O'Shea, P Magin, A Dadich, V Pillai

Medical Papers and Journal Articles

Objective: To determine how the timing and length of hospital discharge letters impact on the number of ongoing patient problems identified by general practitioners (GPs).

Trial design: GPs were randomised into four groups. Each viewed a video monologue of an actor-patient as he might present to his GP following a hospital admission with 10 problems. GPs were provided with a medical record as well as a long or short discharge letter, which was available when the video was viewed or 1 week later. GPs indicated if they would prescribe, refer or order tests for the patient’s problems.

Methods: Setting Primary …

Genomic Catastrophes Frequently Arise In Esophageal Adenocarcinoma And Drive Tumorigenesis, K Nones, N Waddell, N Wayte, A Patch, P Bailey, F Newell, O Holmes, J Fink, M Quinn, Y Tang, G Lampe, K Quek, K Loffler, S Manning, S Idrisoglu, D Miller, Q Xu, N Waddell, P Wilson, T Bruxner, A Christ, I Harliwong, C Nourse, E Nourbakhsh, M Anderson, S Kazakoff, C Leonard, S Wood, P Simpson, L Reid, L Krause, D Hussey, D Watson, R Lord, D Nancarrow, W Phillips, D Gotley, B Smithers, D Whiteman, N Hayward, P Campbell, J Pearson, S Grimmond, A Barbour

Medical Papers and Journal Articles

Oesophageal adenocarcinoma (EAC) incidence is rapidly increasing in Western countries. A better understanding of EAC underpins efforts to improve early detection and treatment outcomes. While large EAC exome sequencing efforts to date have found recurrent loss-offunction mutations, oncogenic driving events have been underrepresented. Here we use a combination of whole-genome sequencing (WGS) and single-nucleotide polymorphism-array profiling to show that genomic catastrophes are frequent in EAC, with almost a third (32%, n¼40/123) undergoing chromothriptic events. WGS of 22 EAC cases show that catastrophes may lead to oncogene amplification through chromothripsis-derived double-minute chromosome formation (MYC and MDM2) or breakage-fusion-bridge (KRAS, MDM2 and …

Case Series Of Elective Instrumented Posterior Lumbar Spinal Fusions Demonstrating A Low Incidence Of Venous Thromboembolism, Benjamin Weber, Alexa Seal, Joseph Mcgirr, Kerin Fielding

Medical Papers and Journal Articles

Introduction: Venous thromboembolism (VTE) is a significant cause of morbidity and mortality in orthopaedic surgery. While specific guidelines exist for hip and knee arthroplasty, there is wide variation in VTE prophylaxis in complex spinal surgery. This study sought to determine the incidence of VTE, and risk factors associated with VTE, in patients undergoing elective instrumented posterior lumbar spinal fusion.

Methods: In a single-centre case series study, 107 consecutive patients undergoing elective lumbar spinal fusion were evaluated for VTE by lower limb duplex ultrasonography and/or clinical observation, and where indicated, computed tomography pulmonary angiogram (CTPA). The Caprini model for thrombosis risk …