Digital Commons Network^™

'Death Is Difficult In Any Language': A Qualitative Study Of Palliative Care Professionals' Experiences When Providing End-Of-Life Care To Patients From Culturally And Linguistically Diverse Backgrounds, Anna Green, Natalia Jerzmanowska, Marguerite Green, Elizabeth Lobb

Medical Papers and Journal Articles

Background: Ethnic minority patients have unique challenges in accessing health services. These include language difficulties, unfamiliarity with the health system, lower rates of cancer screening and survival, higher rates of reported side effects from cancer treatment and poorer quality of life. Little is known about this patient group when transitioning to palliative care.

Aim: To elicit the experiences of palliative care health professionals when providing care for patients from culturally and linguistically diverse backgrounds which differ from mainstream Australian language and culture.

Design: An emergent qualitative design, informed by theoretical and procedural direction from grounded theory research.

Setting/participants: Four focus …

Identifying Systems Barriers That May Prevent Bereavement Service Access To Bereaved Carers: A Report From An Australian Specialist Palliative Care Service, Jane Phillips, Elizabeth A. Lobb, Paula Mohacsi, Nicole Heneka, David Currow

Medical Papers and Journal Articles

Background: Bereavement follow up is an integral element of palliative care. However, little is known about the systems that link bereavement services with bereaved carers.

Aim: To map how effectively a specialist palliative care service linked bereavement service to bereaved carers.

Methodology: A retrospective medical audit, using process mapping was undertaken within one Australian specialist palliative care service to identify the systems that linked bereavement services to a consecutive cohort of palliative care decedents (n=60) next of kin.

Results: Bereavement records were located for 80% of decedents. Nearly all (98%) had a nominated next of kin, with just over half …

Help-Seeking Experiences Of Bereaved Adolescents: A Qualitative Study, Karl Andriessen, Elizabeth Lobb, Jane Mowll, Michael Dudley, Brian Draper, Philip Mitchell

Medical Papers and Journal Articles

Despite the potentially devastating effects of a death on the lives of adolescents, little is known about their help-seeking experiences. We interviewed by telephone 39 bereaved adolescents on their help-seeking experiences. Thematic analysis resulted in three themes: Formal support, Informal support and School-related support. Participants provided a critical appraisal of positive and negative experiences, and noted barriers and facilitators for help-seeking. As adolescents bereaved through suicide may receive less social support, professional help is a much needed auxiliary. Parental encouragement is important in accessing adequate professional help.

Rheumatoid Leptomeningitis Presenting With An Acute Neuropsychiatric Disorder, Michal Lubomski, Joanne Sy, Michael Buckland, Andie S. Lee, Bethan Richards, Elizabeth Thompson, Michael Fulham, Nora Breen, Kirsty Morris, G Michael Halmagyi

Medical Papers and Journal Articles

Leptomeningitis is a rare central nervous system manifestation of rheumatoid arthritis, generally in patients with established chronic rheumatoid disease. We report a 41-year-old man without previous rheumatoid arthritis or psychiatric disorder who presented with an acute neuropsychiatric disturbance and polyarthralgia. His MR scan of brain showed asymmetric bifrontal leptomeningitis, confirmed on (18F)-fluoro-D-glucose-positron emission tomography. Other investigations showed highly positive serum and cerebrospinal fluid anti-cyclic citrullinated peptide. A leptomeningeal biopsy showed necrotising leptomeningeal inflammation with ill-defined granulomas and lymphoplasmacytic infiltrate without organisms. Prolonged high-dose corticosteroids and then rituximab resulted in recovery. Chronic leptomeningitis can present with an acute neuropsychiatric disorder. We …

Culturally And Linguistically Diverse Palliative Care Patients' Journeys At The End-Of-Life, Anna Green, Natalia Jerzmanowska, Marguerite Green, Elizabeth Lobb

Medical Papers and Journal Articles

Objective: To understand the clinical and psychosocial journey of culturally and linguistically diverse (CALD) palliative care patients.

Method: This study was conducted at a subacute hospital with a specialist palliative care unit and a community palliative care service in a metropolitan region of New South Wales, Australia. Medical records of 100 deceased patients from CALD backgrounds over a 12-month period from 2014 to 2015 were recorded on a data mining tool. The cohort had transitioned to either community or inpatient palliative care services with a life-limiting illness. We used descriptive statistical analyses to identify the patients’ end-of-life journeys in the …

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 …

Depressive Symptoms In Patients With Irritable Bowel Syndrome: A Meta-Analysis Of Comparative Studies, Qing-E Zhang, Fei Wang, Geng Qin, Wei Zheng, Chee H. Ng, Gabor S. Ungvari, Zhen Yuan, Songli Mei, Gang Wang, Yu-Tao Xiang

Medical Papers and Journal Articles

Depression is common in patients with irritable bowel syndrome (IBS), but the reported prevalence across different studies is inconsistent. This meta-analysis systematically examined the presence and severity of depressive symptoms in patients with IBS. Two investigators independently performed a literature search. The pooled depressive symptom severity was calculated using a random effects model. Subgroup, sensitivity and meta-regression analyses were conducted to examine the moderating factors of the development of depressive symptoms. Twenty four studies (n=2,837) comparing depressive symptoms between IBS patients (n=1,775) and healthy controls (n=1,062) were identified; 14 (58.3%) studies were rated as high quality. Compared to healthy controls, …

The Association Between Urinary Alzheimer-Associated Neuronal Thread Protein And Cognitive Impairment In Late-Life Depression: A Controlled Pilot Study, Qing-E Zhang, Sihai Ling, Peng Li, Saina Zhang, Chee H. Ng, Gabor S. Ungvari, Liang-Jen Wang, Sheng-Yu Lee, Gang Wang, Yu-Tao Xiang

Medical Papers and Journal Articles

Accumulation of tau protein is associated with both Alzheimer’s disease (AD) and late-life depression (LLD). Alzheimer-associated neuronal thread protein (AD7c-NTP), which is closely linked with the tau protein, is elevated in the cerebrospinal fluid and urine of AD patients. This study examined the association between urinary AD7c-NTP and late-life depression with cognitive impairment. One hundred and thirty-eight subjects were recruited into late-life depression with cognitive impairment (LLD-CI, n=52), late-life depression without cognitive impairment (LLD-NCI, n=29), AD (n=27), and healthy control (HC, n=30) groups. The level of urinary AD7c-NTP was measured using the enzyme-linked immunosorbent assay method. The Montreal Cognitive Assessment …

Protocol To Develop Sustainable Day Care For Children Aged 1-4 Years In Disadvantaged Urban Communities In Dhaka, Bangladesh, Mahua Das, Helen Elsey, Riffat A. Shawon, Joseph Hicks, J Ferdoush, Rumana Huque, Fariza Fieroze, Shammi Nasreen, Hilary Wallace, Saidur R. Mushreky

Medical Papers and Journal Articles

Introduction: Lack of safe, stimulating and health promoting environments for children under-5 hinders their physical, social and cognitive development, known as early childhood development (ECD). Improving ECD impacts on children, and can improve educational attainment for girls, who often care for younger siblings, and employment prospects for mothers. Developing and evaluating the impacts of ECD programmes within childcare needs to assess a range of social, health, educational and economic impacts, including women’s empowerment. Children living in slums are at high risk of poor early development and holistic, sustainable interventions are needed to address ECD in these contexts. This study will …

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 …

Cortical Aav-Cntf Gene Therapy Combined With Intraspinal Mesenchymal Precursor Cell Transplantation Promotes Functional And Morphological Outcomes After Spinal Cord Injury In Adult Rats, Stuart I. Hodgetts, Jun Han Yoon, Alysia Fogliani, Emmanuel A. Akinpelu, Danii Baron-Heeris, Imke G.J Houwers, Lachlan P.G Wheeler, Bernadette T. Majda, Sreya Santhakumar, Sarah J. Lovett, Emma Duce, Margaret A. Pollett, Tylie M. Wiseman, Brooke Fehily, Alan R. Harvey

Medical Papers and Journal Articles

Ciliary neurotrophic factor (CNTF) promotes survival and enhances long-distance regeneration of injured axons in parts of the adult CNS. Here we tested whether CNTF gene therapy targeting corticospinal neurons (CSN) in motor-related regions of the cerebral cortex promotes plasticity and regrowth of axons projecting into the female adult F344 rat spinal cord after moderate thoracic (T10) contusion injury (SCI). Cortical neurons were transduced with a bicistronic adeno-associated viral vector (AAV1) expressing a secretory form of CNTF coupled to mCHERRY (AAV-CNTF^mCherry) or with control AAV only (AAV-GFP) two weeks prior to SCI. In some animals, viable or …

Educating For Indigenous Health Equity: An International Consensus Statement, Rhys Jones, Lynden Crowshoe, Papaarangi Reid, Betty Calam, Elana Curtis, Michael Green, Tania Huria, Kristen Jacklin, Martina Kamaka, Cameron Lacey, Jill Milroy, David Paul, Suzanne Pitama, Leah Walker, Gillian Webb, Shaun Ewen

Medical Papers and Journal Articles

The determinants of health inequities between Indigenous and non-Indigenous populations include factors amenable to medical education’s influence, for example, the competence of the medical workforce to provide effective and equitable care to Indigenous populations. Medical education institutions have an important role to play in eliminating these inequities. However, there is evidence that medical education is not adequately fulfilling this role, and in fact may be complicit in perpetuating inequities.

This article seeks to examine the factors underpinning medical education’s role in Indigenous health inequity, in order to inform interventions to address these factors. The authors developed a consensus statement that …

Screening For Familial Hypercholesterolaemia In Primary Care: Time For General Practice To Play Its Part, Tom Brett, Nadeem Qureshi, Samuel Gidding, Gerald F. Watts

Medical Papers and Journal Articles

Fifty per cent of first-degree relatives of index cases with familial hypercholesterolemia (FH) inherit the disorder. Despite cascade screening being the most cost-effective method for detecting new cases, only a minority of individuals with FH are currently identified. Primary care is a key target area to increase identification of new index cases and initiate cascade screening, thereby finding close relatives of all probands. Increasing public and health professional awareness about FH is essential.

In the United Kingdom and in Australia, most of the population are reviewed by a General Practitioner (GP) at least once over a three-year period, offering opportunities …

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 …

Cardiac Steatosis In Hiv-A Marker Or Mediator Of Disease?, Morgan Jacob, Cameron J. Holloway

Medical Papers and Journal Articles

Although people living with HIV (PLHIV) are approaching normal life expectancy, a limitation to achieving this goal is managing the higher prevalence of co-morbidities, including cardiovascular disease. Whilst ischaemic heart disease likely contributes to a large proportion of cardiac disease in the modern era of treatment, cardio-metabolic disease, including cardiac steatosis, akin to obesity-related heart disease, is also a possible mechanism of increased cardiac morbidity and mortality. HIV and other metabolic and inflammatory diseases affecting the heart, including obesity, share many cardio-metabolic abnormalities, with increased pericardial and myocardial fat content, in association with chronic systemic inflammatory changes and alterations in …

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 …

Antenatal Influenza And Pertussis Vaccination In Western Australia: A Cross-Sectional Survey Of Vaccine Uptake And Influencing Factors, Donna Mak, Annette K. Regan, Dieu T. Vo, Paul V. Effler

Medical Papers and Journal Articles

Background: Influenza and pertussis vaccines have been recommended in Australia for women during each pregnancy since 2010 and 2015, respectively. Estimating vaccination coverage and identifying factors affecting uptake are important for improving antenatal immunisation services.

Methods: A random sample of 800 Western Australian women ≥18 years of age who gave birth between 4th April and 4th October 2015 were selected. Of the 454 (57%) who were contactable by telephone, 424 (93%) completed a survey. Data were weighted by maternal age and area of residence to ensure representativeness. The proportion immunised against influenza and pertussis was the main outcome measure; multivariate …

Accuracy Of Multiparametric Magnetic Resonance Imaging To Detect Significant Prostate Cancer And Index Lesion Location, Hariette Goldman, Neha Singh, Catherine Harding, Joe Mcgirr, Alexa Seal, Ian Duncan, Steven Sowter

Medical Papers and Journal Articles

Background: Multiparametric magnetic resonance imaging (mpMRI) of the prostate appears to improve prostate cancer detection, but studies comparing mpMRI to histopathology at the time of radical prostatectomy (RP) are lacking. This retrospective study determined the accuracy of mpMRI predicting Gleason score and index lesion location at the time of RP, the current gold standard for diagnosis.

Methods: Between April 2013 and April 2016, a database of all men aged more than 40 years who underwent RP after positive transrectal ultrasound biopsy by an experienced urological surgeon was collated at a single regional centre. This was cross‐referenced with a database of …

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 …

20-Year Outcomes Of Anterior Cruciate Ligament Reconstruction With Hamstring Tendon Autograft: The Catastrophic Effect Of Age And Posterior Tibial Slope, Lucy J. Salmon, Emma Heath, Hawar Akrawi, Justin P. Roe, James Linklater, Leo Pinczewski

Medical Papers and Journal Articles

Background: No well-controlled studies have compared the long-term outcome of anterior cruciate ligament (ACL) reconstruction with hamstring tendon autograft between adolescents and adults. Increased posterior tibial slopes (PTSs) have been reported in the ACL-injured versus controls, but the effect of PTS on the outcome after reconstruction is relatively unexplored.

Purpose: To compare the prospective longitudinal outcome of ‘‘isolated’’ ACL ruptures treated with anatomic endoscopic ACL reconstruction using hamstring tendon autograft over 20 years in adolescent and adult cohorts and to examine factors for repeat ACL injury.

Study Design: Case-control study; Level of evidence, 3.

Methods: A single-surgeon series of 200 …

Evaluation Of Serum Glycoprotein Biomarker Candidates For Detection Of Esophageal Adenocarcinoma And Surveillance Of Barrett’S Esophagus, Alok K. Shah, Gunter Hartel, Ian Brown, Clay Winterford, Renhua Na, Kim-Anh Le Cao, Bradley A. Spicer, Michelle Dunstone, Wayne A. Phillips, Reginald V. Lord, Andrew P. Barbour, David I. Watson, Virendra Joshi, David C. Whiteman, Michelle M. Hill

Medical Papers and Journal Articles

Esophageal adenocarcinoma (EAC) is thought to develop from asymptomatic Barrett’s esophagus (BE) with a low annual rate of conversion. Current endoscopy surveillance for BE patients is probably not cost-effective. Previously, we discovered serum glycoprotein biomarker candidates which could discriminate BE patients from EAC. Here, we aimed to validate candidate serum glycoprotein biomarkers in independent cohorts, and to develop a biomarker candidate panel for BE surveillance. Serum glycoprotein biomarker candidates were measured in 301 serum samples collected from Australia (4 states) and USA (1 clinic) using previously established lectin magnetic bead array (LeMBA) coupled multiple reaction monitoring mass spectrometry (MRM-MS) tier …

Atrial Fibrillation Screen, Management And Guideline Recommended Therapy (Af Smart Ii) In The Rural Primary Care Setting: An Implementation Study Protocol, Jessica J. Orchard, Lis Neubeck, Ben Freedman, Ruth Webster, Anushka Patel, Robyn Gallagher, Jialin Li, Charlotte Hespe, Caleb Ferguson, Nicholas Zwar, Nicole Lowres

Medical Papers and Journal Articles

Introduction: Screening for atrial fibrillation (AF) in people ≥65 years is now recommended by guidelines and expert consensus. While AF is often asymptomatic, it is the most common heart arrhythmia and is associated with increased risk of stroke. Early identification and treatment with oral anticoagulants can substantially reduce stroke risk. The general practice setting is ideal for opportunistic screening and provides a natural pathway for treatment for those identified. This study aims to investigate the feasibility of implementing screening for AF in rural general practice using novel electronic tools. It will assess whether screening will fit within an existing workflow …

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 …

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 …

Dermal Nerve Fibre And Mast Cell Density, And Proximity Of Mast Cells To Nerve Fibres In The Skin Of Patients With Complex Regional Pain Syndrome, Natalie Morellini, Philip M. Finch, Andreas Goebel, Peter D. Drummond

Medical Papers and Journal Articles

An interaction between cutaneous nerves and mast cells may contribute to pain in complex regional pain syndrome (CRPS). To explore this, we investigated the density of dermal nerve fibres, and the density and proximity of mast cells to nerve fibres, in skin biopsies obtained from the affected and unaffected limbs of 57 patients with CRPS and 28 site-matched healthy controls. The percentage of the dermis stained by the pan-neuronal marker protein gene-product 9.5 was lower in the affected limb of patients than in controls (0.12 ± 0.01% versus 0.22 ± 0.04%, P < 0.05), indicating a reduction in dermal nerve fibre density. This parameter did not correlate with CRPS duration. However, it was lower in the affected than unaffected limb of patients with warm CRPS. Dermal mast cell numbers were similar in patients and controls, but the percentage of mast cells less than 5 μm from nerve fibres was significantly lower in the affected and unaffected limbs of patients than in controls (16.8 ±1.7%, 16.5 ± 1.7% and 31.4 ± 2.3% respectively, P < 0.05). We confirm previous findings of a mild neuropathy in CRPS. Our findings suggest that this either develops very early after injury or precedes CRPS onset. Loss of dermal nerve fibres in CRPS might result in loss of chemotactic signals, thus halting mast cell migration towards surviving nerve fibres. Failure of normal nerve fibre-mast cell interactions could contribute to the pathophysiology of CRPS.

Decision Makers' Experience Of Participatory Dynamic Simulation Modelling: Methods For Public Health Policy, Louise Freebairn, Jo-An Atkinson, Paul M. Kelly, Geoff Mcdonnell, Lucie Rychetnik

Medical Papers and Journal Articles

Background: Systems science methods such as dynamic simulation modelling are well suited to address questions about public health policy as they consider the complexity, context and dynamic nature of system-wide behaviours. Advances in technology have led to increased accessibility and interest in systems methods to address complex health policy issues. However, the involvement of policy decision makers in health-related simulation model development has been lacking. Where end-users have been included, there has been limited examination of their experience of the participatory modelling process and their views about the utility of the findings. This paper reports the experience of end-user decision …

Patient Attitudes Towards Analgesia And Their Openness To Non-Pharmacological Methods Such As Acupuncture In The Emergency Department, Andrew L. Jan, Emogene S. Aldridge, Ian R. Rogers, Eric J. Visser, Max K. Bulsara, Dana A. Hince

Medical Papers and Journal Articles

Aims: To investigate patient attitudes to analgesia, opioids and non-pharmacological analgesia including acupuncture, in the ED.

Methods: ED patients with pain were surveyed regarding: pain scores, satisfaction, addiction concern, non-pharmacological methods of pain relief, and acupuncture. Data were analysed using logistic regression.

Results: Of 196 adult patients, 52.8% were ‘very satisfied’ with analgesia. Most patients (84.7%) would accept non-pharmacological methods including acupuncture (68.9%) and 78.6% were not concerned about addiction. Satisfaction was associated with male gender, and ‘adequate analgesia’ but not with opioids.

Conclusion: Most patients were generally satisfied with ED analgesia and were open to non-pharmacologic analgesia including …

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 …

5-Year Survival Of Pediatric Anterior Cruciate Ligament Reconstruction With Living Donor Hamstring Tendon Grafts, Emma L. Heath, Lucy J. Salmon, Robert Cooper, Evangelos Pappas, Justin P. Roe, Leo Pinczewski

Medical Papers and Journal Articles

Background: It is well accepted that there is a higher incidence of repeat anterior cruciate ligament (ACL) injuries in the pediatric population after ACL reconstruction (ACLR) with autograft tissue compared with adults. Hamstring autograft harvest may contribute to the risk for repeat ACL injuries in this high functional demand group. A novel method is the use of a living donor hamstring tendon (LDHT) graft from a parent; however, there is currently limited research on the outcomes of this technique, particularly beyond the short term.

Purpose/Hypothesis: The purpose was to determine the medium-term survival of the ACL graft and the contralateral …