Digital Commons Network^™

Improving Allied Health Professionals' Research Implementation Behaviours For Children With Cerebral Palsy: Protocol For A Before-After Study, Christine Imms, Iona Novak, Claire Kerr, Nora Shields, Melinda Randall, Adrienne Harvey, H Kerr Graham, Dinah Reddihough

Medical Papers and Journal Articles

Background: Cerebral palsy is a permanent disorder of posture and movement caused by disturbances in the developing brain. It affects approximately 1 in every 500 children in developed countries and is the most common form of childhood physical disability. People with cerebral palsy may also have problems with speech, vision and hearing, intellectual difficulties and epilepsy. Health and therapy services are frequently required throughout life, and this care should be effective and evidence informed; however, accessing and adopting new research findings into day-to-day clinical practice is often delayed.

Methods/Design: This 3-year study employs a before and after design to evaluate …

De Novo Identification Of Differentially Methylated Regions In The Human Genome, Timothy J. Peters, Michael J. Buckley, Aaron L. Statham, Ruth Pidsley, Katherine Samaras, Reginald V. Lord, Susan J. Clark, Peter L. Molloy

Medical Papers and Journal Articles

Background: The identification and characterisation of differentially methylated regions (DMRs) between phenotypes in the human genome is of prime interest in epigenetics. We present a novel method, DMRcate, that fits replicated methylation measurements from the Illumina HM450K BeadChip (or 450K array) spatially across the genome using a Gaussian kernel. DMRcate identifies and ranks the most differentially methylated regions across the genome based on tunable kernel smoothing of the differential methylation (DM) signal. The method is agnostic to both genomic annotation and local change in the direction of the DM signal, removes the bias incurred from irregularly spaced methylation sites, and …

A Comparison Of The Predictive Accuracy Of Three Screening Models For Pulmonary Arterial Hypertension In Systemic Sclerosis, Yanjie Hao, Vivek Thakkar, Wendy Stevens, Kathleen Morrisroe, David Prior, Candice Rabusa, Peter Youssef, Eli Gabbay, Janet Roddy, Jennifer Walker, Jane Zochling, Joanne Sahhar, Peter Nash, Susan Lester, Maureen Rischmueller, Susanna M. Proudman, Mandana Nikpour

Medical Papers and Journal Articles

Introduction: There is evidence that early screening for pulmonary arterial hypertension (PAH) in systemic sclerosis (SSc) improves outcomes. We compared the predictive accuracy of two recently published screening algorithms (DETECT 2013 and Australian Scleroderma Interest Group (ASIG) 2012) for SSc-associated PAH (SSc-PAH) with the commonly used European Society of Cardiology/European Respiratory Society (ESC/ERS 2009) guidelines.

Methods: We included 73 consecutive SSc patients with suspected PAH undergoing right heart catheterization (RHC). The three screening models were applied to each patient. For each model, contingency table analysis was used to determine sensitivity, specificity, and positive (PPV) and negative (NPV) predictive values for …

Relationship Between Serum Testosterone And Fracture Risk In Men: A Comparison Of Ria And Lc-Ms/Ms, Thach S. Tran, Jacqueline R. Center, Markus J. Seibel, John A. Eisman, Mark M. Kushnir, Alan L. Rockwood, Tuan V. Nguyen

Medical Papers and Journal Articles

BACKGROUND: Serum testosterone can be measured byLC-MS/MS and RIA. We investigated whether the testosterone–fracture relationship was affected by the method of measurement.

METHODS: We measured total testosterone (TT) by LCMS/MS (TTLC-MS/MS) and RIA (TTRIA) in serum samples collected from 602 men whose incident fractures had been continuously ascertained by x-ray reports from 1989 to 2010. We measured bone mineral density (BMD) by dual-energy x-ray absorptiometry. The association between TT and fracture risk was assessed by the Cox proportional hazards model, taking into account the effect of age and BMD.

CONCLUSIONS: The concordance between LC-MS/MS and RIA in the measurement of …

Twenty-Year Outcomes Of A Longitudinal Prospective Evaluation Of Isolated Endoscopic Anterior Cruciate Ligament Reconstruction With Patellar Tendon Autografts, Simon Thompson, Lucy Salmon, Alison Waller, James Linklater, Justin Roe, Leo Pinczewski

Medical Papers and Journal Articles

Background: Long term prospective follow up studies of single-incision endoscopic anterior cruciate ligament reconstruction are limited and may include confounding factors.

Objectives: This longitudinal prospective study reports the outcome of isolated anterior cruciate ligament (ACL) reconstruction using middle-third patellar tendon autograft in 90 patients over 20 years.

Study design: Case series; Level of evidence, 4.

Methods: Between January 1993 and April 1994, 90 patients met study inclusion criteria, evaluation 1,2,3,4,5,7,10,15 and 20 years post-surgery. Exclusion criteria: associated ligamentous injury requiring surgery, previous meniscectomy; meniscal injury meniscectomy more than 1/3; chondral injury; and an abnormal contralateral knee.

Results: At 20 years, …

Bioabsorbable Versus Titanium Screws In Anterior Cruciate Ligament Reconstruction Using Hamstring Autograft: A Prospective, Blinded, Randomized Controlled Trial With 5-Year Follow-Up, Yuval Arama, Lucy J. Salmon, Kesavan Sri-Ram, James Linklater, Justin P. Roe, Leo Pinczewski

Medical Papers and Journal Articles

Background: Longer term studies of bioabsorbable screws for ACL reconstruction are reported, but results are specific to the exact screw material and design. Titanium and PLLA-HA screw outcomes have been compared only to 2 years.

Purpose: The aim of this study was to compare the clinical and radiological outcomes of PLLAHA screw (BS) versus a titanium screw (TS), for hamstring tendon anterior cruciate ligament reconstruction over 5 years. We hypothesized that there are no differences in clinical scores, and tunnel widening, between the BS and the TS groups, and that the PLLA-HA screw as seen on MRI should show high …

Familial Hypercholesterolaemia: Challenges In Primary Care, Tom Brett, Gerald F. Watts, Jacquie Garton-Smith, Damon A. Bell, Alistair W. Vickery, Jing Pang, Diane Arnold-Reed

Medical Papers and Journal Articles

Familial hypercholesterolaemia remains largely unrecognised and undertreated in Australian primary care. A new approach involving increased awareness, early detection, lifelong treatment and cascade testing of relatives is essential to improve outcomes of patients with this disorder.

Key Points

• Familial hypercholesterolaemia (FH) is a relatively common inherited disorder of high cholesterol levels.
• FH can lead to atherosclerosis, premature coronary artery disease and early death if left untreated.
• Cascade testing of relatives of patients with FH is cost- effective and necessary as one in two will have the condition.
• Innovations in primary care can improve FH detection in the community.
• An integrated …

Tracking Funded Health Intervention Research, Lesley A. King, Robyn S. Newson, Gillian E. Cohen, Jacqueline Schroeder, Selina Redman, Lucie Rychetnik, Andrew J. Milat, Adrian Bauman, Simon Chapman

Medical Papers and Journal Articles

Objective: To describe the research publication outputs from intervention research funded by Australia’s National Health and Medical Research Council (NHMRC).

Design and setting: Analysis of descriptive data and data on publication outputs collected between 23 July 2012 and 10 December 2013 relating to health intervention research project grants funded between 1 January 2003 and 31 December 2007.

Main outcome measures: Stages of development of intervention studies (efficacy, effectiveness, replication, adaptation or dissemination of intervention); types of interventions studied; publication output per NHMRC grant; and whether interventions produced statistically significant changes in primary outcome variables.

Results: Most of the identified studies …

Abdominal Compliance: A Bench-To-Bedside Review, Annika R. Blaser, Martin Bjorck, Bart De Keulenaer, Adrian Regli

Medical Papers and Journal Articles

Abdominal compliance is an important determinant and predictor of available workspace during laparoscopic surgery. Furthermore, critically ill patients with a reduced abdominal compliance are at an increased risk of developing intra-abdominal hypertension and abdominal compartment syndrome both of which are associated with high morbidity and mortality. Despite of this, abdominal compliance is a concept, which has been neglected in the past.

Abdominal compliance is defined as a measure of the ease of abdominal expansion, expressed as a change in intra-abdominal volume per change in intra-abdominal pressure:

abdominal compliance = delta intra-abdominal volume / delta intra-abdominal pressure.

AC is a dynamic …

Meningitis Or Septicaemia In A Backpacker?, Sascha Fulde, Gordian Fulde

Medical Papers and Journal Articles

Negative blood test results for meningitis but positive for Staphylococcus aureus in a young patient with suspected meningitis and a recent joint injury led to a diagnosis of staphylococcal septicaemia with septic arthritis as the source of the infection.

The Thalamus As A Putative Biomarker In Neurodegenerative Disorders, Brian D. Power, Jeffrey C.L Looi

Medical Papers and Journal Articles

Objective: This review provides a brief account of the clinically relevant functional neuroanatomy of the thalamus, before considering the utility of various modalities utilised to image the thalamus and technical challenges therein, and going on to provide an overview of studies utilising structural imaging techniques to map thalamic morphology in the spectrum of neurodegenerative disorders.

Methods: A systematic search was conducted for peer-reviewed studies involving structural neuroimaging modalities investigating the morphology (shape and/ or size) of the thalamus in the spectrum of neurodegenerative disorders.

Results: Whilst the precise role of the thalamus in the healthy brain remains unclear, there is …

Recurrent Nocturnal Hypoglycaemia As A Cause Of Morning Fatigue In Treated Addison’S Disease – Favourable Response To Dietary Management: A Case Report, Kristina S. Petersen, R Louise Rushworth, Peter M. Clifton, David J. Torphy

Medical Papers and Journal Articles

Background: Addison’s disease, or primary adrenal insufficiency, is often associated with reduced well-being and fatigue despite use of currently recommended adrenal hormone replacement. Hypoglycaemia is a known manifestation of glucocorticoid deficiency, but is generally considered rare in adults and not relevant to troubling ongoing symptoms in patients with Addison’s disease.

Case presentation: A 43 year old woman with a three year history of Addison’s disease complained of severe morning fatigue and headaches, despite standard glucocorticoid replacement therapy in the form of thrice daily hydrocortisone and mineralocorticoid replacement with fludrocortisone. Alternative glucocorticoid replacement regimens and the addition of dehydroepiandrosterone replacement therapy …

The Role Of Communication In Breast Cancer Screening: A Qualitative Study With Australian Experts, Lisa M. Parker, Lucie Rychetnik, Stacy M. Carter

Medical Papers and Journal Articles

Background: One well-accepted strategy for optimising outcomes in mammographic breast cancer screening is to improve communication with women about screening. It is not always clear, however, what it is that communication should be expected to achieve, and why or how this is so. We investigated Australian experts’ opinions on breast screening communication. Our research questions were: 1 What are the views of Australian experts about communicating with consumers on breast screening? 2 How do experts reason about this topic?

Methods: We used a qualitative methodology, interviewing 33 breast screening experts across Australia with recognisable influence in the Australian mammographic breast …

Paramedics' Perceptions And Educational Needs With Respect To Palliative Care, Ian R. Rogers, Freya M. Shearer, Jeremy R. Rogers, Gail Ross-Adjie, Leanne Monterosso, Judith C. Finn

Medical Papers and Journal Articles

Introduction: In recent years the scope of palliative care has been redefined to include patients earlier in the course of their illness, and those suffering from life-limiting conditions. Paramedics may be involved in the care of these patients, especially in situations of carer distress, sudden deterioration and imminent death, as well as in non-emergent situations such as inter-facility transfers. In these scenarios, clinical decisions regarding patient care initiated by paramedics may set the trajectory for subsequent care.

Objective: To identify and measure paramedics’ perspectives and educational needs regarding palliative care provision, as well as their understanding of the common causes …

Target Definition For Shipwreck Hunting, Kim Kirsner

Medical Papers and Journal Articles

The research described in the present article was implemented to define the locations of two World War II shipwrecks, the German raider Kormoran, and the Australian light cruiser HMAS Sydney. The paper describes the long and complex trail that led through inefficient oceanographic prediction to ambiguous historical prediction involving a single report and on to precise cognitive prediction based on nine reports from more than 70 survivors, a process that yielded a single target position or “mean” just 2.7NM (nautical miles) from the wreck of Kormoran. Prediction for the position of the wreck of Sydney opened with wishful thinking that …

International Dissemination Of Evidence‑Based Practice, Open Access And The Iacapap Textbook Of Child And Adolescent Mental Health, Joseph Rey

Medical Papers and Journal Articles

Dramatic changes have occurred in both publishing and teaching in the last 20 years stemming from the digital and Internet revolutions. Such changes are likely to grow exponentially in the near future aided by the trend to open access publishing. This revolution has challenged traditional publishing and teaching methods that—largely but not exclusively due to cost—are particularly relevant to professionals in low and middle income countries. The digital medium and the Internet offer boundless opportunities for teaching and training to people in disadvantaged regions. This article describes the development of the IACAPAP eTextbook of child and adolescent mental health, its …

Building Social Capital With Interprofessional Student Teams In Rural Settings: A Service-Learning Model, Pippa L. Craig, Christine Phillips, Sally Hall

Medical Papers and Journal Articles

Objective: To describe outcomes of a model of service learning in interprofessional learning (IPL) aimed at developing a sustainable model of training that also contributed to service strengthening.

Design: A total of 57 semi-structured interviews with key informants and document review exploring the impacts of interprofessional student teams engaged in locally relevant IPL activities.

Setting: Six rural towns in South East New South Wales.

Participants: Local facilitators, staff of local health and other services, health professionals who supervised the 89 students in 37 IPL teams, and academic and administrative staff.

Main outcome measures: Perceived benefits as a consequence of interprofessional, …

Protocol For The Care-Is Trial: A Randomised Controlled Trial Of A Supportive Educational Intervention For Carers Of Patients With High-Grade Glioma (Hgg), G K B Halkett, Elizabeth A. Lobb, L Miller, J L. Phillips, T Shaw, R Moorin, A Long, A King, J Clarke, S Fewster, P Hudson, M Agar, A K. Nowak

Medical Papers and Journal Articles

Introduction: High-grade glioma (HGG) is a rapidly progressive and debilitating disease. Primary carers experience significant levels of distress which impacts on their experience of caregiving, the quality of care received and the community in terms of the increased reliance on healthcare due to the potential development of complicated grief. This paper describes the protocol for testing the efficacy and feasibility of an intervention for primary carers of patients with HGG in order to improve preparedness to care and reduce carer distress.

Methods: Randomised controlled trial. The target population is carers of patients with HGG who are undergoing combined chemoradiotherapy. The …

Surveillance Of Antenatal Influenza Vaccination: Validity Of Current Systems And Recommendations For Improvement, Annette Regan, Donna Mak, Hannah C. Moore, Lauren Tracey, Richard Saker, Catherine Jones, Paul Effler

Medical Papers and Journal Articles

Abstract

Background: Although influenza vaccination is recommended during pregnancy as standard of care, limited surveillance data are available for monitoring uptake. Our aim was to evaluate the validity of existing surveillance in Western Australia for measuring antenatal influenza immunisations.

Methods: The self-reported vaccination status of 563 women who delivered between April and October 2013 was compared against three passive data collection sources: a state-wide antenatal influenza vaccination database maintained by the Department of Health, a public maternity hospital database, and a private health service database. Sensitivity, specificity, and positive and negative predictive values were calculated for each system using self-report …

Impact Of Geography On The Control Of Type 2 Diabetes Mellitus: A Review Of Geocoded Clinical Data From General Practice, Moyez Jiwa, Ori Gudes, Richard Varhol, Narelle Mullan

Medical Papers and Journal Articles

Objective: To review the clinical data for people with diabetes mellitus with reference to their location and clinical care in a general practice in Australia.

Materials and methods: Patient data were extracted from a general practice in Western Australia. Iterative data-cleansing steps were taken. Data were grouped into Statistical Area level 1 (SA1), designated as the smallest geographical area associated with the Census of Population and Housing. The data were analysed to identify if SA1s with people aged 70 years and older, and with relatively high glycosylated haemoglobin (HbA1c) were significantly clustered, and whether this was associated with their medical …

Comparison Of Text-Messaging To Voice Telephone Interviews For Active Surveillance Of Adverse Events Following Immunisation, A Regan, C Blyth, L Tracey, D Mak, P Richmond, P Efflier

Medical Papers and Journal Articles

Objectives: In 2013, the Follow-up and Active Surveillance of Trivalent Influenza Vaccine in Mums (FASTMum) program began using short message service (SMS) to collect adverse event information in pregnant women who recently received trivalent influenza vaccine (TIV). This study was designed to compare data collected via SMS and telephone for the purposes of monitoring vaccine safety.

Methods: A number of 344 women who received TIV were randomly assigned to a telephone interview group. They were telephoned seven days post-vaccination and administered a standard survey soliciting any adverse events following immunisation (AEFI) they experienced. They were matched by brand of vaccine, …

Do Patients With Long-Term Side Effects Of Cancer Treatment Benefit From General Practitioner Support? A Literature Review, I Ngune, M Jiwa, A Mcmanus, J Hughes

Medical Papers and Journal Articles

Background: Alongside specialist cancer clinics, general practitioners have an important role in cancer patients’ follow-up care, yet no literature summarises the nature, extent and impact of their involvement. This paper addresses this issue through a review of the literature.

Methods: Studies were sourced from six academic databases - AustHealth (n = 202), CINAHL (n = 500), the Cochrane Library (reviews and trials; n = 200), Embase (n = 368), PHCRIS (n = 132) and PubMed/Medline (n = 410). Studies that focused on interventions designed for patients receiving follow-up care and reported cancer care provided by a general practitioner delivered alongside …

Discrepancy Of Target Sites Between Clinician And Cytopathological Reports In Head Neck Fine Needle Aspiration: Did I Miss The Target Or Did The Clinician Mistake The Organ Site?, M Khanlari, Y Daneshbod, H Yazdi, S Shirian, S Negahban, A Aledavood, A Oryan, B Khademi, K Daneshbod, A Field

Medical Papers and Journal Articles

The diagnostic accuracy of fine needle aspiration cytology (FNAC) of head and neck lesions is relatively high, but cytologic interpretation might be confusing if the sample is lacking typical cytologic features according to labeled site by physician. These errors may have an impact on pathology search engines, healthcare costs or even adverse outcomes. The cytology archive database of multiple institutions in southern Iran and Australia covering the period 2001–2011, were searched using keywords: salivary gland, head, neck, FNAC, and cytology. All the extracted reports were reviewed. The reports which showed discordance between the clinician’s impression of the organ involved and …

Twenty-Year Outcome Of A Longitudinal Prospective Evaluation Of Isolated Endoscopic Anterior Cruciate Ligament Reconstruction With Patellar Tendon Or Hamstring Autograft, S Thompson, L Salmon, A Waller, J Linklater, J Roe, L Pinczewski

Medical Papers and Journal Articles

Background: Long-term prospective follow-up studies of single-incision endoscopic anterior cruciate ligament (ACL) reconstruction are limited and may include confounding factors.

Purpose: This longitudinal prospective study reports the outcomes of isolated ACL reconstruction using middle-third patellar tendon autografts in 90 patients over 20 years.

Study Design: Case series; Level of evidence, 4.

Methods: Between January 1993 and April 1994, a total of 90 patients met study inclusion criteria: evaluation at 1, 2, 3, 4, 5, 7, 10, 15, and 20 years after surgery. Exclusion criteria were associated ligamentous injuries requiring surgery, previous meniscectomy or meniscal injuries requiring more than one-third meniscectomy, …

Trans-Arterial Embolisation Therapies For Unresectable Intrahepatic Cholangiocarcinoma: A Systematic Review, L. Yang, J Shan, L Shan, A Saxena, L Bester, D Morris

Medical Papers and Journal Articles

Background: Unresectable intrahepatic cholangiocarcinoma (ICC) portends a poor prognosis despite standard systemic treatments which confer minimal survival benefits and significant adverse effects. This study aimed to assess clinical outcomes, complications and prognostic factors of TAE therapies using chemotherapeutic agents or radiation.

Methods: A literature search and article acquisition was conducted on PubMed (MEDLINE), OVID (MEDLINE) and EBSCOhost (EMBASE). Original articles published after January 2000 on trans-arterial therapies for unresectable ICC were selected using strict eligibility criteria. Radiological response, overall survival, progression-free survival, safety profile, and prognostic factors for overall survival were assessed. Quality appraisal and data tabulation were performed using …

Should I Stay Or Should I Go? Exploring The Job Preferences Of Allied Health Professionals Working With People With Disability In Rural Australia, G Gallego, A Dew, M Lincoln, A Bundy, R Chedid, K Bulkeley, J Brentnall, C Veitch

Medical Papers and Journal Articles

Introduction: The uneven distribution of allied health professionals (AHPs) in rural and remote Australia and other countries is well documented. In Australia, like elsewhere, service delivery to rural and remote communities is complicated because relatively small numbers of clients are dispersed over large geographic areas. This uneven distribution of AHPs impacts significantly on the provision of services particularly in areas of special need such as mental health, aged care and disability services.

Objective: This study aimed to determine the relative importance that AHPs (physiotherapists, occupational therapists, speech pathologists and psychologists – “therapists”) living in a rural area of Australia and …

Factors Affecting Retention Of Allied Health Professionals Working With People With Disability In Rural New South Wales, Australia: Discrete Choice Experiment Questionnaire Development, G Gallego, A Dew, K Bulkeley, C Veitch, M Lincoln, A Bundy, J Brentnall

Medical Papers and Journal Articles

Objective: This paper describes the development of a discrete choice experiment (DCE) questionnaire to identify the factors (attributes) that allied health professionals (AHPs) working with people with disability identify as important to encouraging them to remain practising in rural areas.

Methods: Focus groups and semi-structured interviews were conducted with 97 purposively selected service providers working with people with disability in rural New South Wales, Australia. Focus groups and interviews were digitally recorded, transcribed, and analysed using a modified grounded theory approach involving thematic analysis and constant comparison.

Results: Six attributes that may influence AHPs working with people with disability in …

General Practice Registrars’ Intentions For Future Practice: Implications For Rural Medical Workforce Planning, C Harding, A Seal, J Mcgirr, T Caton

Medical Papers and Journal Articles

The models of practice that general practice registrars (GPRs) envisage undertaking will affect workforce supply. The aim of this research was to determine practice intentions of current GPRs in a regional general practice training program (Coast City Country General Practice Training). Questionnaires were circulated to 220 GPRs undertaking general practice placements to determine characteristics of ideal practice models and intentions for future practice. Responses were received for 99 participants (45%). Current GPRs intend to work an average of less than eight half-day sessions/week, with male participants intending to work more hours (t(91) = 3.528, P = 0.001). More than one-third …

Implementation Of The International Association Of Diabetes And Pregnancy Study Groups Criteria: Not Always A Cause For Concern, P Sibartie, J Quinlivan

Medical Papers and Journal Articles

Background: Controversy surrounds the decision to adopt the International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria for the diagnosis of gestational diabetes mellitus (GDM) as fears that disease prevalence rates will soar have been raised.

Aims: To investigate the prevalence of pregnancy complicated with GDM before and after the introduction of the IADPSG 2010 diagnostic criteria.

Materials and Methods: A prospective audit of all women who delivered from July 1, 2010, to June 30, 2014, in a predefined geographic region within the North Metropolitan Health Service of Western Australia. Women were diagnosed with GDM according to Australian Diabetes …

Conversion Of A Gastric Band Into An Intraperitoneal Port In A Patient With Optimally Debulked Stage 3c Serous Ovarian Carcinoma, P Tucker, P Cohen, J Tan, J Tan

Medical Papers and Journal Articles

Intraperitoneal (IP) chemotherapy in women with optimally debulked stage 3 ovarian cancer improves overall survival and progression-free survival, and its use has been encouraged in the adjuvant treatment of appropriately selected patients (Armstrong et al., 2006; Jaaback and Johnson, 2006). We describe a case in which a previously inserted adjustable gastric band was converted to an IP chemotherapy port during a laparotomy for advanced ovarian cancer.