Medicine and Health Sciences Commons^™

Caring For Individuals Who Have Used Methamphetamine: A Study Exploring The Experiences Of West Australian Nurses Working In An Authorised Mental Health Institute, John Kriticos

Theses

Background: Methamphetamine (MA) use in Australia has stabilized over the last 22 years, however changing routes of administration and increased purity of the drug has led to greater rates of physical dependency and higher rates of cardiovascular, neurological, and mental health complications. Challenges managing MA related presentations have been reported in Australian Emergency Departments (ED’s), with limited research considering nurses’ experience treating individual(s) who use MA (IWUM) and require prolonged mental health care. Purpose: The aim of this study was to understand nurses’ experiences who care for IWUM in a West Australian hospital’s inpatient mental health service. Methods: Interpretive phenomenological …

Cancer Education Framework For Australian Medical Schools, Darren Starmer

Theses

The incidence, mortality, survival, and impact of cancer on the Australian health system and community highlight the need for Australian medical schools to adequately prepare medical student to care for patients with cancer. Several studies have shown that Australian medical students are ill-prepared to care for cancer patients upon graduation. At a national level, oncology and palliative care curricula have been developed. However, it is unclear as to the level of uptake of either curricula within Australian medical schools. There remains a lack of consensus on what content to include in a cancer curriculum and how best to deliver such …

Equitable Expanded Carrier Screening Needs Indigenous Clinical And Population Genomic Data, Simon Easteal, Ruth M. Arkell, Renzo F. Balboa, Shayne A. Bellingham, Alex D. Brown, Tom Calma, Matthew C. Cook, Megan Davis, Hugh J.S Dawkins, Marcel E. Dinger, Michael S. Dobbie, Ashley Farlow, Kylie G. Gwynne, Azure Hermes, Wendy E. Hoy, Misty R. Jenkins, Simon H. Jiang, Warren Kaplan, Stephen Leslie, Bastien Llamas, Graham J. Mann, Brendan J. Mcmorran, Rebekah E. Mcwhirter, Cliff J. Meldrum, Shivashankar H. Nagaraj, Saul J. Newman, Jack S. Nunn, Lyndon Ormond-Parker, Neil J. Orr, Devashi Paliwal, Hardip R. Patel, Glenn Pearson, Greg R. Pratt, Boe Rambaldini, Lynette W. Russell, Ravi Savarirayan, Matthew Silcocks, John C. Skinner, Yassine Souilmi, Carola G. Vinuesa, Gareth Baynam

Medical Papers and Journal Articles

Expanded carrier screening (ECS) for recessive monogenic diseases requires prior knowledge of genomic variation including DNA variants that cause disease. The composition of pathogenic variants differs greatly among human populations, but historically research about monogenic diseases has focused mainly on people with European ancestry. By comparison, less is known about pathogenic DNA variants in people from other parts of the world. Consequently, inclusion of currently under-represented Indigenous and other minority population groups in genomic research is essential to enable equitable outcomes in ECS and other areas of genomic medicine. Here we discuss this issue in relation to the implementation of …

Enhancing Access To Parenting Services Using Digital Technology Supported Practices, Elaine Bennett, Wendy Simpson, Cathrine Fowler, Ailsa Munns, Jane Kohlhoff

Nursing Papers and Journal Articles

Background: Early parenting services (EPS) in Australia provide a range of expanding and rapidly changing services, including innovative digital technologies to improve service access for metropolitan and rural families.

Aim: This research aims to provide comprehensive information required for the planning, implementation and evaluation of the use of digital technologies for service delivery with parenting/child and family services in Australia and New Zealand in metropolitan and rural settings.

Methods: An interpretive descriptive approach was applied using semi-structured interviews from 23 EPS practitioners and managers in five sites.

Findings: These are presented as five main themes – preparing the way, practitioner …

How Well Do Australian Government Urban Planning Policies Respond To The Social Determinants Of Health And Health Equity?, Michael Mcgrevy, Patrick Harris, Toni Delaney-Crowe, Matt Fisher, Peter Sainsbury, Emily Riley, Fran Baum

Medical Papers and Journal Articles

There is now wide recognition and evidence that the built environment affects population health and health equity. This research provides a thematic analysis of 108 urban planning policy documents from Australian state, territory, and federal governments to address the question: How well do Australian government urban planning policies respond to the social determinants of health and health equity? Health and health equity were discussed explicitly in several policies, most often as a secondary or co-benefit to environmental, social, and economic concerns. The most significant themes in the documents associated with health were visions for urban development that is compact, mixed …

Parents' Ability To Access Community Health Occupational Therapy Services In A Disadvantaged Area: A Proof Of Concept Study, Rachel Smith, Gisselle Gallego

Medical Papers and Journal Articles

Introduction: In New South Wales children from disadvantaged backgrounds have poorer health outcomes and reduced access to health services than their more advantaged counterparts. This study aimed to identify barriers and enablers to accessing child and family occupational therapy services in a disadvantaged area.

Methods: This was a mixed methods study that included: 1) a retrospective analysis of de-identified routinely collected Community Health service utilisation data from 2016-2017, and a 2) face to face interview guided survey with parents and carers.

Results: The retrospective data analysis showed outreach at the targeted suburbs’ Early Childhood Health Centres (ECHC) improved attendance for …

A Western Australian Story: A Mixed Method Study Exploring Nutrition Knowledge, Food Intake, Influences On Food Choice, Body Image And Eating Attitudes Of University Students, Michelle Lambert

Theses

Emerging adults are fast gaining recognition as an important target group for health promotion as previous research indicates very few are meeting dietary guidelines, often consuming foods that have increased saturated fats, sugar and sodium. These eating patterns place this group at higher risk of developing chronic illnesses such as obesity, diabetes, cardiovascular disease and cancer. Understanding how and why these eating patterns develop is important to help establish healthy eating behaviours and greater compliance to Australian Dietary Guidelines – Recommended Daily Serves (ADG-RDS) for emerging adults. International research has focused on eating habits, weight gain patterns and possible influences …

An Examination Of Pain Education Of Medical Students In Australia And New Zealand, Elspeth Shipton

Theses

Background: Unrelieved pain is a significant public health challenge in Australia and New Zealand. Medical practitioners play an essential role in the management of acute, cancer and chronic non-cancer pain.

Aim: This thesis aimed to examine the delivery of pain education at medical schools in Australia and New Zealand, and to determine how effectively it equips medical students with pain medicine competencies required for internship.

Methods: An explanatory sequential mixed methods approach was used. Quantitative studies focused on gathering information regarding the pain-related content of medical curricula of all medical schools; and on testing pain medicine competencies of final-year medical …

Eliminating Hepatitis C: Part 2. Assessing Your Patient For Antiviral Treatment, Chloe Layton, Jacqui Richmond, David Baker, Louise Owen, Gail Matthews, Erin Oliver-Landry, Jessica Howell, Joseph Doyle

Medical Papers and Journal Articles

With the introduction of direct-acting antivirals (DAAs) in Australia in 2016, most people with chronic hepatitis C can be cured of this infection. GPs and suitably qualified nurse practitioners working in all areas of primary care have a key role in identifying, testing and treating their patients with hepatitis C. The previous article in this series discussed how to identify your patients with hepatitis C. This article provides practical advice on assessing a patient after diagnosis in preparation for DAA therapy. This includes determining whether they can be safely treated in general practice or require specialist referral.

Complementary Medicine Use And Health Literacy In Older Australians, Caroline A. Smith, Esther Chang, Gisselle Gallego

Medical Papers and Journal Articles

Objectives: To investigate whether complementary medicine (CAM) use is associated with health literacy levels and decision self-efficacy.

Design: A cross-sectional survey was distributed to men and women aged 65 years and older who participated in a randomised control trial (N = 153) in Sydney, Australia.

Results: One hundred and fifty-three people completed the survey of those 66% were females and the mean age was 76 years. Most participants used or were currently using CAM in the past 12 months (75%). The most common source of CAM information were GPs. Participants with higher levels of social support were found more likely …

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 …

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 …

The Effect Of Individual Radiographers On Rates Of Attendance To Breast Screening: A 7-Year Retrospective Study, S. Savaridas, J. Brook, J. Codde, M Bulsara, W. Wylie

Health Sciences Papers and Journal Articles

AIM: To establish whether individual radiographers had significantly different rescreening rates whilst controlling for other known confounding factors.

MATERIALS AND METHODS: Women aged 50e69 years were identified from a state-wide screening database at their first screening attendance during the study period (2007e2013). The radiographer performing this index screen and potential confounding factors were recorded and subsequent screening behaviour was assessed. Clients with abnormal screens and those known to have died during the time period were excluded. A univariate analysis of the data from 160,028 women was assessed using the chi-square test to compare those women who attended their next mammography …

Mortality In A Cohort Of Remote-Living Aboriginal Australians And Associated Factors, Zoe Hyde, Kate Smith, Leon Flicker, David Atkinson, Osvaldo P. Almeida, Nicola T. Lautenschlager, Anna Dwyer, Dina Logiudice

Health Sciences Papers and Journal Articles

Objectives: We aimed to describe mortality in a cohort of remote-living Aboriginal Australians using electronic record linkage.

Methods: Between 2004 and 2006, 363 Aboriginal people living in remote Western Australia (WA) completed a questionnaire assessing medical history and behavioural risk factors. We obtained mortality records for the cohort from the WA Data Linkage System and compared them to data for the general population. We used Cox proportional hazards regression to identify predictors of mortality over a 9-year follow-up period.

Results: The leading causes of mortality were diabetes, renal failure, and ischaemic heart disease. Diabetes and renal failure accounted for 28% …

Factors Contributing To Australian Adolescents’ Self-Report Of Their Motor Skill Competence, Amanda Timler, Fleur Mcintyre, Beth Hands

Health Sciences Papers and Journal Articles

An adolescents motor skill competence can affect areas such as sports participation, social activities and future academic or employment decisions. The Adolescent Motor Competence Questionnaire (AMCQ) is a 26-item questionnaire that uses a four point Likert response (never, sometimes, frequently, always) to assess motor-related activities during adolescence. This study aims to provide evidence of the construct validity using Principle Component Analysis (PCA) and to identify factors that contributed to Australian adolescent self-reported motor competence. A final aim was to determine whether individual item responses differed between males and females. The AMCQ was completed by 160 adolescents (M_age = 14.45 …

Adherence To Prescribing Restrictions For Her2-Positive Metastatic Breast Cancer In Australia: A National Population-Based Observational Study (2001-2016), Benjamin Daniels, Federico Girosi, Hanna Tervonen, Belinda E. Kiely, Sarah J. Lord, Nehmat Houssami, Sally-Anne Pearson

Medical Papers and Journal Articles

Background: Targeted cancer therapy is often complex, involving multiple agents and chemotherapeutic partners. In Australia, prescribing restrictions are put in place to reflect existing evidence of cost-effectiveness of these medicines. As therapeutic options continue to expand, these restrictions may not be perceived to align with best practice and it is not known if their use in the real-world clinic adheres to these restrictions. We examined the treatment of women receiving trastuzumab for HER2-positive metastatic breast cancer (HER2+MBC) to determine the extent to which treatment adhered to national prescribing restrictions.

Patients and methods: Our population-based, retrospective cohort study used dispensing records …

How Are Junior Doctors Managing Patients With Self-Limiting Illnesses At Their First Presentation? A Video Vignette Study, Eugene D'Souza, Catherine Krejany, Rosie Meng, Moyez Jiwa

Medical Papers and Journal Articles

Purpose: To conduct a video vignette survey of medical students and doctors investigating test ordering for patients presenting with self-limiting or minor illness.

Methods: Participants were shown six video vignettes of common self-limiting illnesses and invited to devise investigation and management plans for the patients’ current presentation. The number of tests ordered was compared with those recommended by an expert panel. A Theory of Planned Behaviour Questionnaire explored participants’ beliefs and attitudes about ordering tests in the context of self-limiting illness.

Results: Participants (n=61) were recruited from across Australia. All participants ordered at least one test that was not recommended …

Carers' Preferences For The Delivery Of Therapy Services For People With Disability In Rural Australia: Evidence From A Discrete Choice Experiment, G Gallego, A Dew, M Lincoln, K Bulkeley, J Brentnall, C Vietch

Medical Papers and Journal Articles

Background: The implementation of the Australian National Disability Insurance Scheme (NDIS) is expected to generate a responsive, person-centred system that will empower people with disability to choose the services and support they receive. However little attention has been paid to examine how users of the NDIS will choose and spend their individual budgets. This study aimed to determine quantitatively the relative importance that carers of people with a disability living in rural Australia place on different therapy service delivery characteristics.

Methods: A stated preference discrete choice experiment (DCE) was incorporated into a survey of carers of people with disability living …

Vitamin D Deficiency And Segregation Status In Prisoners, Zelda Doyle, John Dearin, Joe Mcgirr

Medical Papers and Journal Articles

Purpose: The purpose of this paper is to investigate if any exposure to segregation minimal association in a single male prison population had any association with an increased risk of vitamin D deficiency.

Design/methodology/approach: A retrospective case study was undertaken with all inmates who had a 25-hyrdoxy-vitamin D test taken during the study period deemed eligible. Hand searching of the medical records by an independent party identified eligible participants whose data were recorded for analysis.

Findings: In total, 124 prisoners were deemed eligible for inclusion; 67 were vitamin D sufficient and 57 were vitamin D deficient by Australian standards. Time …

An Education Intervention To Improve Health Literacy And Decision Making About Supporting Self-Care Among Older Australians: A Study Protocol For A Randomised Controlled Trial, C Smith, E Chang, G Gallego, L Balneaves

Medical Papers and Journal Articles

Background: Older Australians are high consumers of complementary and alternative medicines (CM). To help older people to take an active role in their health, we will develop and evaluate a novel educational intervention to support decision self-efficacy, and improve health literacy skills.

Methods: The primary hypothesis is that participants receiving a web/DVD plus booklet intervention compared with a booklet-only group will demonstrate an increase in decision self-efficacy. This study is a randomized controlled trial. One hundred and sixty-eight people aged 65 years and older will be recruited from community settings comprising retirement villages and community groups, based in Sydney, Australia. …

The Effect Of Continuing Professional Development From The Perspective Of Nurses And Midwives Who Participated In Continuing Education Programs Offered By Global Health Alliance Western Australia: A Mixed-Method Study, Yan Ing (Jenni) Ng

Theses

Continuing professional development (CPD) opportunities for nurses and midwives are central to improving knowledge, broadening skills and maintaining competencies to provide best practice and clinical care. This is gained through participating in continuing education (CE). CPD is readily accessible and a mandatory requirement for nurses and midwives in developed nations, such as Australia. However, in developing countries, such as Tanzania, while CPD is promoted, it has limited availability. As such, the Global Health Alliance Western Australia (GHAWA), an international health development program, seeks to provide further sustainable CPD opportunities for nurses and midwives in Tanzania.

The purpose of this research …

From Qasc To Qascip: Successful Australian Translational Scale-Up And Spread Of A Proven Intervention In Acute Stroke Using A Prospective Pre-Test/Post-Test Study Design, S Middleton, A Lydtin, D Comerford, D Cadilhac, P Mcelduff, S Dale, K Hill, M Longworth, J Ward, N Cheung, C D'Este

Health Sciences Papers and Journal Articles

Objectives: To embed an evidence-based intervention to manage FEver, hyperglycaemia (Sugar) and Swallowing (the FeSS protocols) in stroke, previously demonstrated in the Quality in Acute Stroke Care (QASC) trial to decrease 90-day death and dependency, into all stroke services in New South Wales (NSW), Australia’s most populous state.

Design: Pre-test/post-test prospective study.

Setting: 36 NSW stroke services.

Methods: Our clinical translational initiative, the QASC Implementation Project (QASCIP), targeted stroke services to embed 3 nurse-led clinical protocols (the FeSS protocols) into routine practice. Clinical champions attended a 1-day multidisciplinary training workshop and received standardised educational resources and ongoing support. Using the …

Complementary Therapies For Labour And Birth: A Randomized Controlled Trial Of Antenatal Integrative Medicine For Pain Management In Labour, K Levett, C Smith, A Bensoussan, H Dahlen

Medical Papers and Journal Articles

Objective: To evaluate the effect of an antenatal integrative medicine education programme in addition to usual care for nulliparous women on intrapartum epidural use.

Design: Open-label, assessor blind, randomized controlled trial.

Setting: 2 public hospitals in Sydney, Australia.

Population: 176 nulliparous women with low-risk pregnancies, attending hospital-based antenatal clinics.

Methods and intervention: The Complementary Therapies for Labour and Birth protocol, based on the She Births and acupressure for labour and birth courses, incorporated 6 evidence-based complementary medicine techniques: acupressure, visualisation and relaxation, breathing, massage, yoga techniques, and facilitated partner support. Randomisation occurred at 24–36 weeks’ gestation, and participants attended a …

Preferred Practice Location At Medical School Commencement Strongly Determines Graduates’ Rural Preferences And Work Locations, Marie S. Herd, Max Bulsara, Michael P. Jones, Donna Mak

Physiotherapy Papers and Journal Articles

Abstract:

Objective: To identify factors influencing whether Australian medical graduates prefer to, or actually, work rurally

Design: Secondary analysis of longitudinal data from the Medical Schools Outcomes Database (MSOD) using univariate and multivariate logistic regression.

Setting: Twenty Australian medical schools.

Participants: Australian or New Zealand citizens and Australian permanent residents who completed MSOD questionnaires between 2006 and 2013.

Main outcome measures: Preferred and actual work locations one (PGY1) and three (PGY3) years post-graduation.

Results: Of 20,784 participants, 4028 completed a PGY1 and/or PGY3 questionnaire. Self-reported preference for rural practice location at medical school commencement was the most consistent independent predictor …

Effect Of Medical Student Preference On Rural Clinical School Experience And Rural Career Intentions, L Walters, A Seal, J Mcgirr, R Stewart, D Dewitt, D Playford

Medical Papers and Journal Articles

Introduction: The key parameter for rural clinical schools (RCSs) is to provide at least 1 year of clinical training in rural areas for 25% of Australian Commonwealth supported medical students with the intent to influence future rural medical workforce outcomes. The objective of this study was to describe the association between a medical student’s selection preference and their RCS experience and rural career intent.

Methods: Medical students completing an RCS placement in 2012 and 2013 were encouraged to complete a survey regarding their experience and future career intent. Data were analysed to compare medical students for whom the RCS was …

A Binational Multicenter Pilot Feasibility Randomized Controlled Trial Of Early Goal-Directed Mobilization In The Icu, C Hodgson, M Bailey, R Bellomo, S Berney, H Buhr, L Denehy, B Gabbe, M Harrold, A Higgins, T Iwashyna, R Papworth, R Parke, S Patman, J Presneill, M Saxena, E Skinner, C Tipping, P Young, S Webb

Physiotherapy Papers and Journal Articles

Objectives: The primary objective was to determine if the early goal-directed mobilization (EGDM) intervention could be delivered to patients receiving mechanical ventilation with increased maximal levels of activity compared to standard care.

Design: A pilot, randomized controlled trial

Setting: Five intensive care units (ICUs) in Australia and New Zealand

Participants: Fifty critically ill adults, mechanically ventilated for greater than 24 hours.

Intervention: Patients were randomly assigned to either EGDM (intervention) or to standard care (control). EGDM comprised functional rehabilitation treatment conducted at the highest level of activity possible for that patient assessed by the ICU mobility scale …

Assessing The Feasibility Of A Web-Based Registry For Multiple Orphan Lung Diseases: The Australasian Registry Network For Orphan Lung Disease (Arnold) Experience, K Casamento, A Laverty, M Wilsher, J Twiss, E Gabbay, I Glaspole, A Jaffe

Medical Papers and Journal Articles

Background: We investigated the feasibility of using an online registry to provide prevalence data for multiple orphan lung diseases in Australia and New Zealand.

Methods: A web-based registry, The Australasian Registry Network of Orphan Lung Diseases (ARNOLD) was developed based on the existing British Paediatric Orphan Lung Disease Registry. All adult and paediatric respiratory physicians who were members of the Thoracic Society of Australia and New Zealand in Australia and New Zealand were sent regular emails between July 2009 and June 2014 requesting information on patients they had seen with any of 30 rare lung diseases. Prevalence rates were calculated …

Doctors' Perspectives On Psa Testing Illuminate Established Differences In Prostate Cancer Screening Rates Between Australia And The Uk: A Qualitative Study, K Pickles, S Carter, L Rychetnik, V Entwistle

Medical Papers and Journal Articles

Objectives: To examine how general practitioners (GPs) in the UK and GPs in Australia explain their prostate-specific antigen (PSA) testing practices and to illuminate how these explanations are similar and how they are different.

Design: A grounded theory study.

Setting: Primary care practices in Australia and the UK.

Participants: 69 GPs in Australia (n=40) and the UK (n=29). We included GPs of varying ages, sex, clinical experience and patient populations. All GPs interested in participating in the study were included.

Results: GPs’ accounts revealed fundamental differences in whether and how prostate cancer screening occurred in their practice and in the …

Early Life Events And Motor Development: A Longitudinal Study, Tegan Grace

Theses

Longitudinal studies are important to fully understand the processes of neurological development during gestation and how risk factors present during this time impact motor development outcomes, yet few to date have focused on this critical time period.

The purpose of this study was to identify modifiable risk factors influencing motor development during the prenatal period. Of particular interest was finding out whether these risk factors differed between the sexes.

Participants (N=2900) were from the Western Australian Pregnancy Cohort (Raine) Study. The Raine Study began in May 1989 and women were recruited between 16-20 weeks gestation (m = 18 weeks) from …

Experience Of A Tutor Centric Model For Sonography Training Of Emergency Department Registrars In An Australian Urban Emergency Department 2009–2012, Greg Sweetman, Mark Fear, Kathryn Hird

Medical Papers and Journal Articles

Purpose: To assess the impact of a regular sonographer proctored training program for emergency medicine trainees in the use of Emergency Department bedside ultrasound

Methods: Emergency Department (ED) Registrars in the Swan District Hospital ED were provided with proctored instruction in bedside ultrasound in performance of extended focused assessment sonography in trauma (eFAST) and abdominal aortic aneurysm (AAA) detection. Training was conducted by credentialed sonographers for individual trainees in a 1:1 or 1:2 setting for 1 hour on a weekly basis. Registrars who trained in the Department between Jan 2009 to Dec 2012 were invited to participate in a survey …