Digital Commons Network^™

Informing Implementation Of Quality Improvement In Australian Primary Care, Charlotte Hespe, Lucie Rychetnik, David Peiris, Mark Harris

Medical Papers and Journal Articles

Background: Quality Improvement (QI) initiatives in primary care are effective at improving uptake of evidence based guidelines, but are difficult to implement and sustain. In Australia meso-level health organisations such as Primary health care Organisations (PHCO) offer new opportunities to implement area-wide QI programs. This study sought to identify enablers and barriers to implementation of an existing Australian QI program and to identify strategic directions that PHCOs can use in the ongoing development of QI in this environment.

Methods: Semi-structured telephone interviews were conducted with 15 purposively selected program staff and participants from the Australian Primary Care Collaborative (APCC) QI …

Risk Of Pelvic Inflammatory Disease In Relation To Chlamydia And Gonorrhea Testing, Repeat Testing, And Positivity: A Population-Based Cohort Study, Joanne Reekie, Basil Donovan, Rebecca Guy, Jane S. Hocking, John M. Kaldor, Donna B. Mak, Sallie Pearson, David Preen, Louise Stewart, James W.B Liu

Medical Papers and Journal Articles

Background: There is uncertainty around whether the risks of pelvic inflammatory disease (PID) differ following Chlamydia trachomatis (chlamydia) and Neisseria gonorrhoeae (gonorrhea) infection. We quantified the risk of PID associated with chlamydia and gonorrhea infection and subsequent repeat infections in a whole-population cohort.

Methods: A cohort of 315123 Western Australian women, born during 1974–1995, was probabilistically linked to chlamydia and gonorrhea testing records and to hospitalizations and emergency department presentations for PID from 2002 to 2013. Time-updated survival analysis was used to investigate the association between chlamydia and gonorrhea testing, and positivity, and risk of PID.

Results: Over 3199135 person-years, …

Midwives' Knowledge, Attitudes And Learning Needs Regarding Antenatal Vaccination, Annette Regan, Yvonne Hauck, Lisa Nicolaou, Danielle Engelbrecht, Janice Butt, Donna B. Mak, Rikki Priest, Ronit Cukierman, Paul Effler

Medical Papers and Journal Articles

Objective: To determine the knowledge, attitudes and learning needs of midwives regarding antenatal vaccination.

Design & Setting: A cross-sectional, paper-based survey of midwives employed at the only public tertiary maternity hospital in the Australian state of XX between November 2015 and July 2016.

Participants: 252 midwives providing care in antepartum, intrapartum, and/or postpartum settings.

Measurements: Self-reported responses to a 41-item survey.

Findings: The vast majority of midwives supported influenza and pertussis vaccination for pregnant women, with 90.0% and 71.7% reporting they would recommend pertussis and influenza vaccine, respectively, to a pregnant friend or family member, and almost all stating that …

Chlamydia Trachomatis And The Risk Of Spontaneous Preterm Birth, Babies Who Are Born Small For Gestational Age, And Stillbirth: A Population-Based Cohort Study, Joanne Reekie, Christine Roberts, David Preen, Jane S. Hocking, Basil Donovan, James Ward, Donna B. Mak, Bette Liu

Medical Papers and Journal Articles

Background: Chlamydia trachomatis is one of the most commonly diagnosed sexually transmitted infections worldwide, but reports in the medical literature of an association between genital chlamydia infection and adverse obstetric outcomes are inconsistent.

Methods: The Western Australia Data Linkage Branch created a cohort of women of reproductive age by linking records of birth registrations with the electoral roll for women in Western Australia who were born from 1974 to 1995. The cohort was then linked to both chlamydia testing records and the state perinatal registry for data on preterm births and other adverse obstetric outcomes. We determined associations between chlamydia …

Meta-Analysis Of The Efficacy And Safety Of Adjunctive Rosuvastatin For Dyslipidemia In Patients With Schizophrenia, Wei Zheng, Wei Yang, Qing-E Zhang, Xin-Hu Yang, Dong-Bin Cai, Jin-Qing Hu, Gabor S. Ungvari, Chee H. Ng, Marc De Hert, Yu-Ping Ning, Yu-Tao Xiang

Medical Papers and Journal Articles

Background: Metabolic syndrome in patients with schizophrenia is a major health concern. The efficacy and safety of adjunctive rosuvastatin in treating dyslipidemia were controversial.

Aims: To assess the efficacy and safety of adjunctive rosuvastatin for dyslipidemia in patients with schizophrenia.

Methods: We systematically searched for relevant controlled clinical trials from the following databases: PubMed, PsycINFO, Cochrane Library, China Knowledge Network, WanFang Database and Chinese Biomedical Database up to September 28, 2017. Standardized mean difference (SMD) and risk ratio (RR) along with their 95% confidence intervals (CIs) were calculated. The quality of the included studies was assessed using the Cochrane risk …

International Medical Electives In Selected African Countries: A Phenomenological Study On Host Experience, Elspeth Fotheringham, Pippa Craig, Elina Tor

Medical Papers and Journal Articles

Objectives: To explore the host experience on international medical electives at a selection of hospitals in low- and middle-income countries in Africa. Outcomes of the study may inform and improve the preparation of global health curriculum, pre-elective training and debriefing for international medical electives.

Methods: A descriptive phenomenological study was undertaken, involving semi-structured interviews with ten elective hosts at seven study sites in three African countries. Purposive convenience sampling augmented by snowballing was utilised to recruit study participants. The data were thematically analysed and interpreted with reflexivity to generate an accurate aggregate of the experience of participants in hosting international …

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 …

A Research And Evaluation Capacity Building Model In Western Australia, Roanna Lobo, Gemma Crawford, Jonathan Hallett, Sue Laing, Donna B. Mak, Jonine Jancey, Sally Rowell, Kahlia Mccausland, Lisa Bastian, Anne Sorenson, P.J. Matt Tilley, Simon Yam, Jude Comfort, Sean Brennan, Maryanne Doherty

Medical Papers and Journal Articles

Evaluation of public health programs, services and policies is increasingly required to demonstrate effectiveness. Funding constraints necessitate that existing programs, services and policies be evaluated and their findings disseminated. Evidence-informed practice and policy is also desirable to maximise investments in public health. Partnerships between public health researchers, service providers and policymakers can help address evaluation knowledge and skills gaps. The Western Australian Sexual Health and Blood-borne Virus Applied Research and Evaluation Network (SiREN) aims to build research and evaluation capacity in the sexual health and blood-borne virus sector in Western Australia (WA). Partners’ perspectives of the SiREN model after 2 …

Systematic Review Of Pain Medicine Content, Teaching, And Assessment In Medical School Curricula Internationally, Elspeth E. Shipton, Frank Bate, Raymond Garrick, Carole Steketee, Edward A. Shipton, Eric J. Visser

Medical Papers and Journal Articles

Introduction: Pain management is a major health care challenge in terms of the significant prevalence of pain and the negative consequences of poor management. Consequently, there have been international calls to improve pain medicine education for medical students. This systematic review examines the literature on pain medicine education at medical schools internationally, with a particular interest in studies that make reference to: a defined pain medicine curriculum, specific pain medicine learning objectives, dedicated pain education modules, core pain topics, medical specialties that teach pain medicine, elective study opportunities, hours allocated to teaching pain medicine during the curriculum, the status of …

The Effect Of Self-Selected Complementary Therapies On Cancer Patients' Quality Of Life And Symptom Distress: A Prospective Cohort Study In An Integrative Oncology Setting, N J. Stomski, A Petterson, L J. Kristjanson, Elizabeth Lobb, M B. Phillips, A Williams, P Morrison, D Joske

Medical Papers and Journal Articles

Objective: To examine the effectiveness of a multifaceted complementary therapies intervention, delivered in a systematic manner within an Australian public hospital setting, on quality of life and symptom distress outcomes for cancer patients.

Methods: Adults receiving treatment for any form of cancer were eligible to participate in this study. Self-referred participants were offered a course of six complementary therapy sessions. Measures were administered at baseline, and at the third and sixth visit. The primary outcomes were quality of life and symptom distress. Linear mixed models were used to assess change in the primary outcomes.

Results: In total, 1376 cancer patients …

Using New And Innovative Technologies To Assess Clinical Stage In Early Intervention Youth Mental Health Services: Evaluation Study, Laura Ospina-Pinillos, Tracey A. Davenport, Frank Iorfino, Ashleigh Tickell, Shane Cross, Elizabeth M. Scott, Ian B. Hickie

Medical Papers and Journal Articles

Background: Globally there is increasing recognition that new strategies are required to reduce disability due to common mental health problems. As 75% of mental health and substance use disorders emerge during the teenage or early adulthood years, these strategies need to be readily accessible to young people. When considering how to provide such services at scale, new and innovative technologies show promise in augmenting traditional clinic-based services.

Objective: The aim of this study was to test new and innovative technologies to assess clinical stage in early intervention youth mental health services using a prototypic online system known as the Mental …

Predicting Sequential Bilateral Cochlear Implantation Performance In Postlingually Deafened Adults: A Retrospective Cohort Study, Yvette E. Smulders, Thomas Hendriks, Inge Stegeman, Robert H. Eikelboom, Cathy Sucher, Gemma Upson, Ronel Chester Browne, Dona Jayakody, Peter L. Santa Maria, Marcus D. Atlas, Peter L. Friedland

Medical Papers and Journal Articles

Objective: To identify which preoperative patient characteristics influence sequential bilateral cochlear implantation performance and to create a statistical model that predicts benefit.

Design: Multicentre retrospective cohort study.

Setting: All patients were operated in four academic teaching hospitals in Perth, Australia, and followed up by audiologists of the Ear Science Institute Australia.

Participants: A total of 92 postlingually deafened adult patients who had undergone sequential cochlear implantations between 19 June 1990 and 14 March 2016 were included. Patients were excluded if the 12-month follow-up consonant-nucleus-consonant (CNC) phoneme score was missing.

Main outcome measure: The effect of 18 preoperative factors on the …

Prevalence Of Internet Addiction Disorder In Chinese University Students: A Comprehensive Meta-Analysis Of Observational Studies, Lu Li, Dan-Dan Xu, Jing-Xin Chai, Di Wang, Lin Li, Ling Zhang, Li Lu, Chee H. Ng, Gabor S. Ungvari, Song-Li Mei, Yu-Tao Xiang

Medical Papers and Journal Articles

Background and aims: Internet addiction disorder (IAD) is common in university students. A number of studies have examined the prevalence of IAD in Chinese university students, but the results have been inconsistent. This is a meta-analysis of the prevalence of IAD and its associated factors in Chinese university students.

Methods: Both English (PubMed, PsycINFO, and Embase) and Chinese (Wan Fang Database and Chinese National Knowledge Infrastructure) databases were systematically and independently searched from their inception until January 16, 2017.

Results: Altogether 70 studies covering 122,454 university students were included in the meta-analysis. Using the random-effects model, the pooled overall prevalence …

Inpatient Rehabilitation Did Not Positively Affect 6-Month Patient-Reported Outcomes After Hip Or Knee Arthroplasty, Adam G. Hutchinson, Benjamin Gooden, Matthew C. Lyons, Justin P. Roe, Michael D. O'Sullivan, Lucy J. Salmon, Kaka Martina, Leo Pinczewski

Medical Papers and Journal Articles

Background: The aim of this study was to compare patient-reported outcomes 6 months after hip or knee arthroplasty in subjects who were discharged to home compared to those who attended inpatient rehabilitation.

Methods:

Seven hundred and forty-eight consecutive total hip or knee replacement patients were identified from a prospective database. Preoperative and 6-month post-operative patient-reported outcome measures were recorded. Forty-four patients discharged directly to home were cohort matched by age, gender, procedure and surgeon to 44 patients from the cohort who received inpatient care. Patient outcomes were compared using SPSS version 24 software.

Results: Both cohorts saw significant improvements from …

The Importance Of Left Atrial Volume Assessment In Identifying The Cause Of Ischemic Stroke, David Playford, Sarah Bowler, Max Bulsara, David J. Blacker, Timothy R. Bates, James P. Codde

Medical Papers and Journal Articles

Separating cardioembolic from large artery stroke has important treatment implications. We investigated whether echocardiography could improve Cardioembolic Stroke (CES) prediction compared with traditional measures and cholesterol biomarkers.

Data from 40 consecutive patients presenting with acute ischemic stroke which included brain and carotid imaging, ECG, echo, serum cholesterol and apolipoproteins were independently reviewed. Patients were classified into two groups: a) CES, defined by sustained or paroxysmal atrial fibrillation and <50% stenosis of a perfusing cerebral artery; b) Large artery stroke (LAS) defined as > 50% stenosis of an ipsilateral perfusing cerebral artery, with no evidence of AF on monitoring or evidence of small artery disease on neuroimaging and confirmed by an independent neurologist.

Other than the …

Improving Household Surveys And Use Of Data To Address Health Inequities In Three Asian Cities: Protocol For The Surveys For Urban Equity (Sue) Mixed Methods And Feasibility Study, Helen Elsey, Ak Narayan Poudel, Tim Ensor, Tolib Mirzoev, James Nicholas Newell, Joseph Paul Hicks, Christopher Cartwright, David Wong, Caroline Tait, Sushil Baral, Radheshyam Bhattarai, Sudeepa Khanal, Rajeev Dhungel, Subash Gajurel, Shraddha Manandhar, Saidur Mashreky, Junnatul Ferdoush, Rumana Huque, Tarana Ferdous, Shammi Nasreen, Hoang Van Minh, Duong Minh Duc, Bao Ngoc, Dana Thomson, Hilary Wallace

Medical Papers and Journal Articles

Introduction: As rapid urbanisation transforms the sociodemographic structures within cities, standard survey methods, which have remained unchanged for many years, under-represent the urban poorest. This leads to an overly positive picture of urban health, distorting appropriate allocation of resources between rural and urban and within urban areas. Here, we present a protocol for our study which (i) tests novel methods to improve representation of urban populations in household surveys and measure mental health and injuries, (ii) explores urban poverty and compares measures of poverty and ‘slumness’ and (iii) works with city authorities to understand, and potentially improve, utilisation of …

Buprenorphine Versus Morphine In Paediatric Acute Pain: A Systematic Review And Meta-Analysis, Nathan Murray, Utsav Malla, Ruan Vlok, Alice Scott, Olivia Chua, Thomas Melhuish, Leigh White

Medical Papers and Journal Articles

Introduction: In lab-based studies, buprenorphine appears to have a ceiling effect on respiratory depression but not on analgesia. There is increasing evidence in adult patients that buprenorphine has no ceiling effect on analgesia or side effects. The aim of this study was to investigate the efficacy and adverse effects of buprenorphine versus morphine in paediatric acute pain.

Methods: A systematic review of five databases was performed until May 2018. Only randomised controlled trials were eligible for inclusion. The outcomes of interest included pain, respiratory depression, nausea, sedation, dizziness, and pruritus.

Results: Four randomized controlled trials (n = 195) were …

Study Of Route Optimization Considering Bottlenecks And Fairness Among Partial Paths, Toshihiro Matsui, Marius Silaghi, Katsutoshi Hirayama, Makoto Yokoo, Hiroshi Matsuo

Electrical Engineering and Computer Science Faculty Publications

Route optimization is an important problem for single agents and multi-agent systems. In route optimization tasks, the considered challenges generally belong to the family of shortest path problems. Such problems are solved using optimization algorithms, such as the A∗algorithm, which is based on tree search and dynamic programming. In several practical cases, cost values should be as evenly minimized for individual parts of paths as possible. These situations are also considered as multi-objective problems for partial paths. Since dynamic programming approaches are employed for the shortest path problems, different types of criteria which can be decomposed with dynamic programming might …

A New Approach To Multiplanar, Real-Time Simulation Of Physiological Knee Loads And Synthetic Knee Components Augmented By Local Composition Control In Fused Filament Fabrication, Joshua Taylor Green

Open Access Theses & Dissertations

Despite numerous advances in biomedical engineering, few developments in surgical simulation have been made outside of computational models. Cadavers remain the primary media on which surgical research and simulation is conducted. Most attempts to quantify the effects of orthopedic surgical methods fail to achieve statistical significance due to limited quantities of cadaver specimen, large variations among the cadaver population, and a lack of repeatability among measurement techniques. The general purpose of the research covered in this dissertation is to develop repeatable simulation of physiological loads and develop techniques to fabricate a synthetic-based replacement of cadaver specimens. Future work applying this …

Development And Validation Of A Measure Assessing Blind Patients' Perceptions Of Their Healthcare Providers' Stereotype Content, Nazanin Mina Heydarian

Open Access Theses & Dissertations

People with disabilities (PWDs) constitute about 15-20% of the total population. Health disparities among PWD's are due, in part, to stereotypes about PWDs as incompetent. These stereotypes may lead some healthcare providers (HCP) to patronize PWDs, over-focus on the PWDs' impairments and potentially neglect their presenting problem. Moreover, if the PWD violates stereotypical assumptions, the HCP may actively interfere with the PWD's goals. This Dissertation focused on the blind population because this is a large, stigmatized and understudied subpopulation of PWDs. In Study 1, the content of stereotypes about blind patients in the clinical setting were examined from the patient …

Fight The Dead, Fear Reality: A Fantasy Theme Analysis Of The Walking Dead, Katherine Elizabeth Alanis Ramirez

Open Access Theses & Dissertations

The aim of this study is to use the television show The Walking Dead and fantasy theme analysis in order to assess its significance in contemporary culture. This analysis is a means to discover the importance of fantasy theme analysis and how it could be used in the future to analyze other forms of entertainment media. The analysis spotlights inequalities that can be seen in the real world in terms of issues like race, gender, and sexuality that are likewise found in themes within the television series. Through fantasy theme analysis, it is possible to determine that topics like rape, …

Comparison Of Stride Length And Stride Frequency Patterns Of Sprint Performance In Overground Vs Motorized Treadmill Sprinting., Fayon Kamieka Gonzales

Open Access Theses & Dissertations

The purpose of this study was to investigate the relationship between different kinematic parameters when maximal effort sprints are performed overground and on a motorized treadmill by recreationally trained and collegiate level sprinters. To accomplish the goals of this study, we measured stride length, stride frequency, contact time, and flight time overground and on a motorized treadmill to determine what differences or similarities can be identified. Anthropometric measurements such as the height, body weight, lower limb length, and lower limb circumference were also recorded. Subjects' performance of a 60 meter sprint (50 meter acceleration, 10 meter maximal velocity) was measured …

"Ok Girls, The Fbi Is Here- Look Your Best!": The Defining Of Postfeminism In Keeping Up With The Kardashians, Jennifer Lynn Handrop

Open Access Theses & Dissertations

This is a qualitative study on E! Entertainment's Keeping Up with the Kardashians. This study explores if and how KUWTK contributes to the definition of postfeminist theory in popular culture and the media. Additionally, this study explores any potential class issues that intersect with postfeminism in KUWTK.

Spherical Minimum Description Length, Trevor Herntier, Koffi Eddy Ihou, Anthony Smith, Anand Rangarajan, Adrian Peter

Electrical Engineering and Computer Science Faculty Publications

We consider the problem of model selection using the Minimum Description Length (MDL) criterion for distributions with parameters on the hypersphere. Model selection algorithms aim to find a compromise between goodness of fit and model complexity. Variables often considered for complexity penalties involve number of parameters, sample size and shape of the parameter space, with the penalty term often referred to as stochastic complexity. Current model selection criteria either ignore the shape of the parameter space or incorrectly penalize the complexity of the model, largely because typical Laplace approximation techniques yield inaccurate results for curved spaces. We demonstrate how the …

Opioids Delay Healing Of Spinal Fusion: A Rabbit Posterolateral Lumbar Fusion Model, Nikhil Jain, Khaled Himed, Jeffrey M. Toth, Karen C. Briley, Frank M. Phillips, Safdar N. Khan

Biomedical Engineering Faculty Research and Publications

Background Context

Opioid use is prevalent in the management of pre- and postoperative pain in patients undergoing spinal fusion. There is evidence that opioids downregulate osteoblasts in vitro, and a previous study found that morphine delays the maturation and remodeling of callus in a rat femur fracture model. However, the effect of opioids on healing of spinal fusion has not been investigated before. Isolating the effect of opioid exposure in humans would be limited by the numerous confounding factors that affect fusion healing. Therefore, we have used a well-established rabbit model to study the process of spinal fusion healing that …

Crawler Inspection Robot With Machine Vision (Lifelong Endevour), Francisco Martinez

Open Access Theses & Dissertations

The presence of foreign objects (FO) in an aircraft can mean failure to achieve a mission's objective, loss of aircraft, or a catastrophic failure such as loss of life. Currently, Lockheed Martin inspection methods for foreign objects include a person accessing very tight areas that have the potential for FO to be present. There is a need that has been identified to remove the person from this very tight/potentially hazardous area that is being inspected and placing them behind the control center of a remote inspection system that can identify, objectively, whether or not FO is present or not. The …

Prevalence Of Methicillin-Resistant Staphylococcus Aureus (Mrsa) Colonization In Medical Students At The El Paso/Cd. Juarez Border Region, Samantha Michelle Meza

Open Access Theses & Dissertations

Background: Due to the constant use, misuse, and over-prescription of antibiotics, antibiotic resistance has become a global public health threat. Methicillin-Resistant Staphylococcus aureus (MRSA) continues to prevail in healthcare settings and is the cause of many nosocomial infections worldwide. A risk factor for developing an active MRSA infection is the colonization of the pathogen in the anterior nares. Over the past two decades, MRSA infections have increased in both the hospital and the community setting, often infecting healthy individuals lacking common risk factors. Healthcare workers with constant exposure to MRSA are more likely to be colonized and can potentially serve …

The Role Of Circulating Mirnas As Clinical Biomarkers Of Insulin Sensitivity And Exercise Adaptation In Young Offpsring Of Type 2 Diabetes Patients, Cesar Arturo Meza

Open Access Theses & Dissertations

Background: A family history of Type 2 Diabetes (FH) is considered a risk factor for development of type 2 diabetes (T2D). Exercise training is an effective strategy to improve insulin resistance. Recently, micro-RNAs (miRNAs) have emerged as mediators of various intracellular processes, including insulin signaling, and may act as signaling molecules when released into circulation. The miRNAs -29a, -133a and -155 have been implicated in the regulation of insulin sensitivity, however their roles in exercise training-induced improvements in insulin sensitivity are yet to be elucidated. The purpose of this study was to determine whether circulating miRNA-29a, miRNA-29b, miRNA-29c, miRNA-133a, miRNA-133b …

Economic And Environmentally Efficient Energy Management System For Optimal Microgrid Operation, Olayinka Samuel Obafemi

Open Access Theses & Dissertations

The aim of this Thesis is to study and understand the economic analysis of integrating renewable energy resources for the purpose of improving the system grid, identifying and monetizing benefits and cost. This Thesis discusses the approach taken and solution created to tackle the current problems facing the production and consumption of electricity and how the microgrid has become a platform for improvement in power system operation. A microgrid in islanded and connected mode are simulated using Homer Pro for optimization and its results help gain an insight into analyzing and monetizing cost and benefits with one common goal in …

Arthropod Diets In Chihuahuan Desert Snakes, Victor Manuel Parga

Open Access Theses & Dissertations

Over the past century, studies in herpetology regarding snake diets have been commonly focused on those species that feed or specialize in vertebrate prey items. For those that feed primarily on invertebrates however, little work has been done in determining diet specializations and comparing diets within a community of species. This Thesis focuses on small species of snakes that feed primarily on arthropods in a Chihuahuan Desert community, and will investigate if these are diet generalists or specialists. To this end, stomach contents were examined from preserved specimens of the following species: Rena humilis and Rena dissecta (Leptotyphlopidae), Gyalopion canum …