Digital Commons Network^™

Complex Structural Rearrangements Are Present In High-Grade Dysplastic Barrett's Oesophagus Samples, Felicity Newell, Kalpana Patel, Michael Gartside, Lutz Krause, Sandra Brosda, Lauren G. Aoude, Kelly A. Loffler, Vanessa F. Bonazzi, Ann-Marie Patch, Stephen H. Kazakoff, Oliver Holmes, Qinying Xu, Scott Wood, Conrad Leonard, Guy Lampe, Reginald V. Lord, David C. Whiteman, John V. Pearson, Katia Nones, Nicola Waddell, Andrew P. Barbour

Medical Papers and Journal Articles

Background: Oesophageal adenocarcinoma (EAC) incidence is increasing and has a poor survival rate. Barrett’s oesophagus (BE) is a precursor condition that is associated with EAC and often occurs in conjunction with chronic gastro-oesophageal reflux, however many individuals diagnosed with BE never progress to cancer. An understanding of the genomic features of BE and EAC may help with the early identification of at-risk individuals.

Methods: In this study, we assessed the genomic features of 16 BE samples using whole-genome sequencing. These included non-dysplastic samples collected at two time-points from two BE patients who had not progressed to EAC over several years. …

Metastatic Breast Cancer Incidence, Site And Survival In Australia, 2001-2016: A Population-Based Health Record Linkage Study Protocol, Sarah J. Lord, Belinda E. Kiely, Sally-Anne Pearson, Benjamin Daniels, Dianne L. O'Connell, Jane Beith, Max Bulsara, Nehmat Houssami

Medical Papers and Journal Articles

Introduction: Advances in systemic therapy for early and metastatic breast cancer (BC) over the last two decades have improved patients’ survival, but their impact on metastatic disease outcomes at a population level is not well described. The aim of this study is to investigate changes in the incidence, site and survival of metastatic disease for women with a first diagnosis of BC in 2001– 2002 vs 2006–2007.

Methods and analysis: Population-based retrospective cohort study of women with first primary invasive BC registered in the New South Wales (NSW) Cancer Registry in 2001–2002 and 2006–2007. We will use linked records from …

Microsimulation Model For The Health Economic Evaluation Of Osteoporosis Interventions: Study Protocol, Lei Si, John A. Eisman, Tania Winzenberg, Kerrie M. Sanders, Jacqueline R. Center, Tuan V. Nguyen, Andrew J. Palmer

Medical Papers and Journal Articles

Introduction: Osteoporosis is a systemic skeletal disease that is characterised by reduced bone strength and increased fracture risk. Osteoporosis-related fractures impose enormous disease and economic burden to the society. Although many treatments and health interventions are proven effective to prevent fractures, health economic evaluation adds evidence to their economic merits. Computer simulation modelling is a useful approach to extrapolate clinical and economic outcomes from clinical trials and it is increasingly used in health economic evaluation. Many osteoporosis health economic models have been developed in the past decades; however, they are limited to academic use and there are no publicly accessible …

Disability Patterns Over The First Year After A Diagnosis Of Epilepsy, Ying Xu, Dennis R. Neuen, Nick Glozier, Armin Nikpour, Ernest Somerville, Andrew Bleasel, Carol Ireland, Craig S. Anderson, Maree L. Hackett

Medical Papers and Journal Articles

Objective: To determine the patterns and predictors of disability over the first 12 months after a diagnosis of epilepsy.

Patients and methods: The Sydney Epilepsy Incidence Study to Measure Illness Consequences (SEISMIC) was a prospective, multicenter, community-based study of people with newly diagnosed epilepsy in Sydney, Australia. Disability was assessed using the World Health Organization’s, Disability Assessment Schedule (WHODAS) 2.0 12-item version, at baseline (i.e. within 28 days of diagnosis) and 12 months post-diagnosis. Demographic, socioeconomic, clinical and epilepsy-related data, obtained through structured interviews, were entered into multivariable linear regression and shift analysis to determine predictors of greater disability.

Results: …

Exploring Assessment Of Medical Students' Competencies In Pain Medicine - A Review, Elspeth Shipton, Carole Steketee, Frank Bate, Eric J. Visser

Medical Papers and Journal Articles

Introduction: Considering the continuing high prevalence and public health burden of pain, it is critical that medical students are equipped with competencies in the field of pain medicine. Robust assessment of student expertise is integral for effective implementation of competency-based medical education.

Objective: The aim of this review was to describe the literature regarding methods for assessing pain medicine competencies in medical students.

Method: PubMed, Medline, EMBASE, ERIC, and Google Scholar, and BEME data bases were searched for empirical studies primarily focusing on assessment of any domain of pain medicine competencies in medical students published between January 1997 and December …

The Art Of Clinical Supervision: Strategies To Assist With The Delivery Of Student Feedback, Kylie P. Russell

Medical Papers and Journal Articles

Objective: The Art of Clinical Supervision (ACS) seminar was developed to provide health professionals with the essential knowledge, skill and attitude to support student clinical learning. This paper provides an outline of the strategies provided to participants to support the delivery of feedback to students on clinical placement.

Setting: Western Australian health services

Primary argument: The provision of timely and descriptive feedback to students on clinical placement is essential for learning and achievement of competence. Health professionals working with students in the delivery of patient care, termed clinical supervisors, require effective strategies to support this communication technique.

Conclusion: ACS participant …

James Annesley Of Madras Medical Service (1800-1838) On Cholera In Madras Presidency In 1825, Ramya Raman, Anantanarayanan Raman

Medical Papers and Journal Articles

James Annesley from Ireland spent nearly four decades in Madras, first as an assistant and later as a senior surgeon attached to the Madras Medical Establishment. During this span of service he published the book in 1825 on the most prevalent diseases of India comprising a treatise on the epidemic cholera of the East. This paper recounts the epidemiology of cholera and the efforts made to manage it in the Madras Presidency in the 1820s, keeping in view the life of Annesley and the contents of his book.

Student Exposure To Cancer Patients: An Analysis Of Clinical Logbooks And Focus Groups In Clinical Year Medical Students, Darren L. Starmer, Caris L. House, Kristyn M. Langworthy

Medical Papers and Journal Articles

Despite cancer being the leading cause of mortality, cancer education and patient exposure are lacking in many medical schools. The aim of this study was to evaluate the nature of cancer patient exposure, relative to the clinical setting for medical students on placement and to explore their experiences. Participants were asked to maintain a logbook of cancer patient encounters and were invited to attend a structured focus group upon completion of the academic year. Eleven students submitted logbooks (rr = 6.15%) and eight participated in the focus groups (4.47%). A total of 247 cancer patient encounters were recorded. Third-year students …

Presumed Choroidal Metastasis From Soft Tissue Myoepithelial Carcinoma, Michelle M. Hui, Rohan Merani, Fiona Bonar, Angela M. Hong, Adrian T. Fung

Medical Papers and Journal Articles

Purpose: To report a case of presumed choroidal metastasis from soft tissue myoepithelial carcinoma and highlight challenges in its diagnosis.

Observations: A 52-year-old man was referred with a two-week history of photopsia in his left eye. His background medical history included known soft tissue myoepithelial carcinoma metastatic to his bone, lung, liver and chest wall. A large, raised, yellow choroidal lesion was identified nasal to and abutting the optic disc. This lesion demonstrated growth 1 month after presentation. The patient died with widespread metastatic disease 5 months after initial presentation.

Conclusion and importance: Soft tissue myoepithelial carcinoma can rarely metastasise …

Bioethics In The News: The Values At Stake. Why Are Conservative Values So Difficult To Communicate In The Public Square And Progressive Values So Easy?, Margaret Somerville

Medical Papers and Journal Articles

Bioethical issues are complex, often involve factual uncertainty, and have broad and long-term potential consequences for individuals, institutions and society. Simplification is a strategy used by so-called ‘progressive’ values advocates to promote acceptance of their values. It results from excluding consideration of complexity, uncertainty and potentiality in the values disputes around bio-ethical issues. In order to engage effectively in public debates of bioethics issues, it is necessary to understand the current societal values zeitgeist and how it differs from a traditional societal values zeitgeist. Since words are weapons in the values battles, it is necessary to identify how they are …

What Influences Chronic Pain Management? A Best–Worst Scaling Experiment With Final Year Medical Students And General Practitioners, Linda Rankin, Christopher J. Fowler, Britt-Marie Stålnacke, Gisselle Gallego

Medical Papers and Journal Articles

Background: Chronic pain education is an essential determinant for optimal chronic pain management. Given that attitudes and preferences are involved in making treatment decisions, identifying which factors are most influential to final year medical students’ and general practitioners’ (GPs) chronic pain management choices is of importance. This study investigates Swedish and Australian students’ preferences with respect to a chronic pain condition, using a best–worst scaling (BWS) experiment, which is designed to rank alternatives.

Methods: BWS, a stated-preference method grounded in random utility theory, was used to explore the importance of factors influencing chronic pain management.

Results: All three cohorts considered …

Kbg Syndrome Presenting With Brachydactyly Type E, Renata Libianto, Kathy H.C Wu, Sophie Devery, John A. Eisman, Jackie R. Center

Medical Papers and Journal Articles

We report the case of a young woman who presented at age 10 years with height on the tenth centile, brachydactyly type E and mild developmental delay. Biochemistry and hormonal profiles were normal. Differential diagnoses considered included Albright hereditary osteodystrophy without hormone resistance (a.k.a pseudopseudohypoparathyroidism), 2q37 microdeletion syndrome and acrodysostosis. She had a normal karyotype and normal FISH of 2q37. Whole genome sequencing (WGS) identified a mutation in the ANKRD11 gene associated with KBG syndrome. We review the clinical features of the genetic syndromes considered, and suggest KBG syndrome be considered in patients presenting with syndromic brachydactyly type E, especially …

Exploring Physicians, Nurses And Ward-Based Pharmacists Working Relationships In A Swedish Inpatient Setting: A Mixed Methods Study, Marcia H. Lindqvist, Maria Gustafsson, Gisselle Gallego

Medical Papers and Journal Articles

Background: In Sweden there has been limited work investigating the integration and nature of collaborative relationships between pharmacists and other healthcare practitioners.

Objective: To explore the working relationships of physicians, nurses and ward-based pharmacists in a rural hospital after the introduction of a clinical pharmacy service. Setting General medical ward in a rural hospital in northern Sweden.

Method: Mixed methods involving face-to-face semi-structured interviews with nurses, physicians and pharmacists, and a physician survey using the Physician-Pharmacist Collaboration Index to measure the extent of physician-reported collaborative working relationships.

Main outcome measure: Perceptions about collaborative working relationships between …

The Role Of Trauma And Partner Support In Perinatal Depression And Parenting Stress: An Australian Pregnancy Cohort Study, Megan Galbally, Stuart J. Watson, Phillip Boyce, Andrew J. Lewis

Medical Papers and Journal Articles

Background: Improving our understanding of the relationship between maternal depression and parenting stress is likely to lie in the range of additional factors that are associated with vulnerability to depression and also to parenting stress.

Objectives: To examine the role of trauma and partner support, in understanding the relationship between perinatal depression and parenting stress.

Methods: This study utilises data from 246 women in a pregnancy cohort study that followed women from early pregnancy until their infant was 12 months. Included were both women with a diagnosis of depression and those without depression. The measures included Structured Clinical Interview for …

Commentary: Expert Responses In Script Concordance Tests: A Response Process Validity Investigation, Siu Hong Wan, Elina Tor, Judith N. Hudson

Medical Papers and Journal Articles

No abstract available.

Parkinson's Disease And The Gastrointestinal Microbiome, Michal Lubomski, Ai Huey Tan, Shen-Yang Lim, Andrew J. Holmes, Ryan L. Davis, Carolyn M. Sue

Medical Papers and Journal Articles

Recently, there has been a surge in awareness of the gastrointestinal microbiome (GM) and its role in health and disease. Of particular note is an association between the GM and Parkinson’s disease (PD) and the realisation that the GM can act via a complex bidirectional communication between the gut and the brain. Compelling evidence suggests that a shift in GM composition may play an important role in the pathogenesis of PD by facilitating the characteristic ascending neurodegenerative spread of α-synuclein aggregates from the enteric nervous system to the brain. Here, we review evidence linking GM changes with PD, highlighting mechanisms …

Advances In Screening For Undiagnosed Atrial Fibrillation For Stroke Prevention And Implications For Patients With Obstructive Sleep Apnoea: A Literature Review And Research Agenda, Nestor Gahungu, Christopher Judkins, Eli Gabbay, David Playford

Medical Papers and Journal Articles

Atrial fibrillation (AF) is the most common type of sustained cardiac arrhythmia encountered in clinical practice, and its burden is expected to increase in most developed countries over the next few decades. Because AF can be silent, it is often not diagnosed until an AF-related complication occurs, such as stroke. AF is also associated with increased risk of heart failure, lower quality of life, and death. Anticoagulation has been shown to dramatically decrease embolic risk in the setting of atrial fibrillation, resulting in growing interest in early detection of previously undiagnosed AF. Newly developed monitoring devices have improved the detection …

Undetectable Mannose Binding Lectin Is Associated With Hrct Proven Bronchiectasis In Rheumatoid Arthritis (Ra), Krista Makin, Tracie Easter, Monica Kemp, Peter Kendall, Max Bulsara, Sophie Coleman, Graeme J. Carroll

Medical Papers and Journal Articles

Aim: The aim of this study was to ascertain whether mannose binding lectin deficiency is implicated in coexistent rheumatoid arthritis and bronchiectasis and to determine whether undetectable mannose binding lectin confers poorer long-term survival in coexistent rheumatoid arthritis and bronchiectasis or in rheumatoid arthritis in general.

Materials and methods: A retrospective audit was conducted in a rheumatoid arthritis cohort in which mannose binding lectin had been measured by enzyme linked immunosorbent assay from 2007–11. Rheumatoid arthritis patients with physician diagnosed HRCT proven bronchiectasis were recruited during this time and compared to those with uncomplicated rheumatoid arthritis. Survival from disease onset …

An Education Intervention To Improve Decision Making And Health Literacy Among Older Australians: A Randomised Controlled Trial, Caroline A. Smith, Esther Chang, Gisselle Gallego, Afshan Khan, Mike Armour, Lynda G. Balneaves

Medical Papers and Journal Articles

Background: National policies seek to involve older Australian’s in decisions regarding their care; however, research has found varying levels of decision self-efficacy and health literacy skills. An increasing number of older Australians use complementary medicine (CM). We examined the effectiveness of a CM educational intervention delivered using a web or DVD plus booklet format to increase older adults’ decision self-efficacy and health literacy.

Methods: A randomised controlled trial was conducted. We recruited individuals aged over 65years living in retirement villages or participating in community groups, in Sydney Australia. Participants were randomly allocated to receive a CM education intervention delivered using …

Midterm Outcomes Of Arthroscopic Reduction And Internal Fixation Of Anterior Cruciate Ligament Tibial Eminence Avulsion Fractures With K-Wire Fixation, Murilo Leie, Emma Heath, Sarah Shumborski, Lucy Salmon, Justin Roe, Leo Pinczewski

Medical Papers and Journal Articles

Purpose: To determine the clinical and radiological outcomes of patients who underwent arthroscopic reduction and internal fixation of a tibial eminence avulsion fracture with Kirshner wires (K-wires) at a mean of 8 years following surgery.

Methods: This was a retrospective study with prospectively collected data. Inclusion criteria consisted of patients who underwent arthroscopic reduction and internal fixation of tibial eminence fracture with K-wires between 1989 and 2015 at a minimum of 18 months follow-up. Assessment included the International Knee Documentation Committee Ligament Evaluation, Lysholm Knee Score, and clinical outcomes. Magnetic resonance imaging (MRI) was performed to evaluate the anterior cruciate …

Setting Clinical Performance Specifications To Develop And Evaluate Biomarkers For Clinical Use, Sarah J. Lord, Andrew St John, Patrick M.M. Bossuyt, Sverre Sandberg, Phillip J. Monaghan, Maurice O'Kane, Christa M. Cobbaert, Ralf Roddiger, Lieselotte Lennartz, Cecilia Gelfi, Andrea R. Horvath, Test Evaluation Working Group Of The European Federation Of Clinical Chemistry And Laboratory Medicine

Medical Papers and Journal Articles

Background: Biomarker discovery studies often claim ‘promising’ findings, motivating further studies and marketing as medical tests. Unfortunately, the patient benefits promised are often inadequately explained to guide further evaluation, and few biomarkers have translated to improved patient care. We present a practical guide for setting minimum clinical performance specifications to strengthen clinical performance study design and interpretation.

Methods: We developed a step-by-step approach using test evaluation and decision-analytic frameworks and present with illustrative examples.

Results: We define clinical performance specifications as a set of criteria that quantify the clinical performance a new test must attain to allow better health outcomes …

Long-Term Prevalence And Predictors Of Prolonged Grief Disorder Amongst Bereaved Cancer Caregivers: A Cohort Study, Rachel D. Zordan, Melanie L. Bell, Melanie Price, Cheryl Remedios, Elizabeth Lobb, Christopher Hall, Peter Hudson

Medical Papers and Journal Articles

Context: The short-term impact of prolonged grief disorder (PGD) following bereavement is well documented. The longer term sequelae of PGD however are poorly understood, possibly unrecognized, and may be incorrectly attributed to other mental health disorders and hence undertreated.

Objectives: The aims of this study were to prospectively evaluate the prevalence of PGD three years post bereavement and to examine the predictors of long-term PGD in a population-based cohort of bereaved cancer caregivers.

Methods: A cohort of primary family caregivers of patients admitted to one of three palliative care services in Melbourne, Australia, participated in the study (n = …

Adrenal Insufficiency Due To Bilateral Adrenal Metastases - A Systematic Review And Meta-Analysis, Philippa H. Tallis, R Louise Rushworth, David J. Torpy, Henrik Falhammar

Medical Papers and Journal Articles

Objective: Bilateral adrenal metastases may cause adrenal insufficiency (AI) but it is unclear if screening for AI in patients with bilateral adrenal metastases is justified, despite the potential for adrenal crises.

Method: A search using PubMed/Medline, ScienceDirect and Cochrane Reviews was performed to collect all original research articles and all case reports from the past 50 years that describe AI in bilateral adrenal metastases.

Results: Twenty studies were included with 6 original research articles, 13 case reports and one case series. The quality was generally poor. The prevalence of AI was 3–8%. Of all cases of AI (n ¼ 25) …

Social Network Analysis Of Rural Medical School Immersion In A Rural Clinical School, Denese E. Playford, Tessa Burkitt, David Atkinson

Medical Papers and Journal Articles

Background: The impact of new medical graduates on the social dimensions of the rural medical workforce is yet to be examined. Social Network Analysis (SNA) is able to visualize and measure these dimensions. We apply this method to examine the workforce characteristics of graduates from a representative Australian Rural Clinical School.

Methods: Participants were medical graduates of the Rural Clinical School of Western Australia (RCSWA) from the 2001–2014 cohorts, identified as being in rural work in 2017 by the Australian Health Practitioner Regulation Agency. SNA was used to examine the relationships between site of origin and of work destination. Data …

Pulmonary Arterial Hypertension Outcomes Upon Endothelin-1 Receptor Antagonist Switch To Macitentan, Timothy Tynan, Kathryn Hird, Tara Hannon, Eli Gabbay

Medical Papers and Journal Articles

Objectives: To assess whether switching patients with suboptimally controlled pulmonary arterial hypertension from bosentan or ambrisentan to macitentan would improve six-minute walk test (6MWT) distance and World Health Organization functional class.

Methods: This was a retrospective cohort analysis of 37 patients from a single center. Patients were separated into three heterogeneous treatment groups and followed for 18 months: switch group (n¼14): patients switched to macitentan from bosentan/ambrisentan; added group (n¼11): patients who began macitentan as de novo therapy (n¼5) or who added macitentan to an existing sildenafil regimen (n¼6); and control group (n¼12): patients for whom sildenafil and/or bosentan/ambrisentan therapy …

What Is The Prevalence, And What Are The Clinical Correlates, Of Insulin Resistance In Young People Presenting For Mental Health Care? A Cross-Sectional Study, Elizabeth M. Scott, Joanne S. Carpenter, Frank Iorfino, Shane P.M Cross, Daniel F. Hermens, Jeanne Gehue, Chloe Wilson, Django White, Sharon L. Naismith, Adam J. Guastella, Ian B. Hickie

Medical Papers and Journal Articles

Objectives: To report the distribution and predictors of insulin resistance (IR) in young people presenting to primary care-based mental health services.

Design: Cross-sectional.

Setting: Headspace-linked clinics operated by the Brain and Mind Centre of the University of Sydney.

Participants: 768 young people (66% female, mean age 19.7±3.5, range 12–30 years).

Main outcome measures: IR was estimated using the updated homeostatic model assessment (HOMA2-IR). Height and weight were collected from direct measurement or self-report for body mass index (BMI).

Results: For BMI, 20.6% of the cohort were overweight and 10.2% were obese. However,6.9 mmol/L). By contrast, 9.9% had a HOMA2-IR score …

Attitudes And Factors Involved In Decision-Making Around Complementary And Alternative Medicines (Cams) By Older Australians: A Qualitative Study, Gisselle Gallego, Saira Gugnani, Mike Armour, Caroline A. Smith, Esther Chang

Medical Papers and Journal Articles

Introduction: Recent evidence has indicated that older Australians are increasingly turning to complementary and alternative medicines (CAMs) to address a variety of health issues. This qualitative study aimed to explore the attitudes and factors involved in decision-making around CAMs by older Australians upon the completion of a CAM educational intervention.

Methods: Men and women aged over 65 years living in New South Wales, Australia were invited to participate in semi-structured interviews after taking part in a randomised control trial. Interviews were analysed using the framework approach.

Results: A total of 20 participants aged over 65 years were interviewed. Themes captured …

Reviewing The Preclinical Curriculum In A Problem Based Learning Driven Medical Program: Challenges And Strategies, Manori Amarasekera, Paul S. Noakes, Brian D. Power

Medical Papers and Journal Articles

In order for medical curricula to remain progressive and contemporary, continuous review is critical to ensure that the learners are directed to achieve the intended goals and become workforce ready. We developed a framework for continuous curriculum review at the School of Medicine Fremantle (The University of Notre Dame Australia), taking the key aspects of a curriculum review process into consideration. In planning and implementing the review process we identified several challenges, including management of metadata, work load on staff members, and evaluation. These challenges were addressed successfully by applying necessary strategies using limited resources. The framework we have developed …

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 …

'Links2healthierbubs' Cohort Study: Protocol For A Record Linkage Study On The Safety, Uptake And Effectiveness Of Influenza And Pertussis Vaccines Among Pregnant Australian Women, Mohinder Sarna, Ross M. Andrews, Hannah C. Moore, Michael J. Binks, Lisa Mchugh, Gavin F. Pereira, Christopher C. Blyth, Paul Van Buynder, Karin Lust, Paul Effler, Stephen B. Lambert, Saad B. Omer, Donna Mak, Thomas Snelling, Heather A. D'Antoine, Peter Mcintyre, Nicholas De Klerk, Damien Foo, Annette K. Regan

Medical Papers and Journal Articles

Introduction: Pregnant women and infants are at risk of severe influenza and pertussis infection. Inactivated influenza vaccine (IIV) and diphtheria-tetanus-acellular pertussis vaccine (dTpa) are recommended during pregnancy to protect both mothers and infants. In Australia, uptake is not routinely monitored but coverage appears sub-optimal. Evidence on the safety of combined antenatal IIV and dTpa is fragmented or deficient, and there remain knowledge gaps of population-level vaccine effectiveness. We aim to establish a large, population-based, multi-jurisdictional cohort of mother-infant pairs to measure the uptake, safety and effectiveness of antenatal IIV and dTpa vaccines in three Australian jurisdictions. This is a first …