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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 …

Where's My What? A Survey Of Anatomical Knowledge In A Community In Western Melbourne, Morgan Jones, Catherine Krejany, Moyez Jiwa

Medical Papers and Journal Articles

Background and Aims: This study aimed to explore if members of the public could identify the location of major body organs as well as pain associated with major organ pathologies.

Method: A survey of 100 participants was conducted in Melbourne, Australia. Participants were invited to mark the location of two internal organs and the site of pain for two pathologies on a manikin. Five anatomical questions and four clinical scenario questions were randomised prior to data collection. Photographs of participant responses were compared to responses of a doctor, and if a site within the same area was identified the participant …

Developing A Practice-Based Research Agenda For Grief And Bereavement Care, Ashton Hay, Christopher W. Hall, Margaret Sealey, Elizabeth Lobb, Lauren J. Breen

Medical Papers and Journal Articles

We aimed to identify practitioners’ perspectives on current research priorities in grief and bereavement care. Grief and bereavement care providers were invited to participate in a three-phase Delphi study to create expert consensus on the top priorities for grief and bereavement research. A total of 140 participants completed Phase 1, 84 completed Phase 2, and 70 completed Phase 3. These top 10 research priorities form the basis of a practice-based research agenda for grief and bereavement care to enable researchers to respond to key issues in grief and bereavement care that will ultimately improve the lives of bereaved people.

Turning Conceptual Systems Maps Into Dynamic Simulation Models: An Australian Case Study For Diabetes In Pregnancy, Louise Freebairn, Jo-An Atkinson, Nathaniel D. Osgood, Paul M. Kelly, Geoff Mcdonnell, Lucie Rychetnik

Medical Papers and Journal Articles

Background: System science approaches are increasingly used to explore complex public health problems. Quantitative methods, such as participatory dynamic simulation modelling, can mobilise knowledge to inform health policy decisions. However, the analytic and practical steps required to turn collaboratively developed, qualitative system maps into rigorous and policy relevant quantified dynamic simulation models are not well described. This paper reports on the processes, interactions and decisions that occurred at the interface between modellers and end-user participants in an applied health sector case study focusing on diabetes in pregnancy.

Methods: An analysis was conducted using qualitative data from a participatory dynamic simulation …

Characteristics Of Gay, Bisexual And Other Men Who Have Sex With Men With Multiple Diagnoses Of Infectious Syphilis In British Columbia, Canada, 2005-2014, Stephanie Konrad, Donna B. Mak, Troy Grennan, Bernadette Zakher, Bobbi Brownrigg, Gina Ogilvie, Muhammad Morshed, Mark Tyndall, Mark Gilbert, Mel Krajden, Jason Wong

Medical Papers and Journal Articles

Background: Infectious syphilis has increased substantially over the past decade. Targeting limited public health resources toward subpopulations with multiple reinfections may have a large impact in reducing onward transmission within a community.

Methods: A chart review was conducted for individuals with 4 or more infectious syphilis diagnoses between 2005 and 2014 (the top 1% of all syphilis diagnoses in British Columbia, Canada). We characterized the sociodemographics, partner notification outcomes and social network.

Results: Between 2005 and 2014, there were 30 individuals with 4 or more syphilis diagnoses, accounting for 139 diagnoses. All were men who have sex with men and …

Obesity Prevention And The Role Of Hospital And Community-Based Health Services: A Scoping Review, Claire Pearce, Lucie Rychetnik, Sonia Wutzke, Andrew Wilson

Medical Papers and Journal Articles

Background: Control of obesity is an important priority to reduce the burden of chronic disease. Clinical guidelines focus on the role of primary healthcare in obesity prevention. The purpose of this scoping review is to examine what the published literature indicates about the role of hospital and community based health services in adult obesity prevention in order to map the evidence and identify gaps in existing research.

Methods: Databases were searched for articles published in English between 2006 and 2016 and screened against inclusion and exclusion criteria. Further papers were highlighted through a manual search of the reference lists. Included …

Genetic Influence On Scar Height And Pliability After Burn Injury In Individuals Of European Ancestry: A Prospective Cohort Study, Hilary J. Wallace, Gemma Cadby, Phillip E. Melton, Fiona M. Wood, Sian Falder, Margaret M. Crowe, Lisa J. Martin, Karen Marlow, Sarah V. Ward, Mark W. Fear

Medical Papers and Journal Articles

After similar extent of injury there is considerable variability in scarring between individuals, in part due to genetic factors. This study aimed to identify genetic variants associated with scar height and pliability after burn injury. An exome-wide array association study and gene pathway analysis were performed on a prospective cohort of 665 patients treated for burn injury. Outcomes were scar height (SH) and scar pliability (SP) sub-scores of the modified Vancouver Scar Scale (mVSS). DNA was genotyped using the Infinium^® HumanCoreExome-24 BeadChip. Associations between genetic variants (single nucleotide polymorphisms) and SH and SP were estimated using an additive genetic …

Trans-Generational Stress Regulation: Mother-Infant Cortisol And Maternal Mental Health Across The Perinatal Period, Megan Galbally, Elisabeth F.C Van Rossum, Stuart J. Watson, Edo Ronald De Kloet, Andrew J. Lewis

Medical Papers and Journal Articles

Understanding maternal mental health and cortisol regulation across pregnancy and the relationship to the development of the offspring’s stress regulation is critical to a range of health outcomes. The aim of this study was to investigate infant and maternal cortisol in women with depression. Data were obtained from 241 pregnant women within the Mercy Pregnancy and Emotional Wellbeing Study (MPEWS), a selected pregnancy cohort study. Depression was measured using the Structured Clinical Interview for DSM-IV (SCID-IV) and repeat Edinburgh Postnatal Depression Scale (EPDS). Repeated measures of antidepressant use, stressful events, anxiety symptoms and maternal hair cortisol concentrations (HCC) and infant …

Adrenal Crisis, R Louise Rushworth, David J. Torpy, Henrik Falhammar

Medical Papers and Journal Articles

Glucocorticoid replacement therapy, available since the 1950s, has prolonged the survival of patients with adrenal insufficiency. However, adrenal crises, which are life-threatening medical emergencies, still develop in many affected patients. Adrenal crisis appears to be increasing in frequency, despite the availability of effective preventive strategies. This review examines the definitions, pathophysiology, epidemiology, and treatment of adrenal crises.

Reducing Stroke Risk In Atrial Fibrillation: Adherence To Guidelines Has Improved, But Patient Persistence With Anticoagulant Therapy Remains Suboptimal., Nicole Lowres, Katrina Giskes, Charlotte Hespe, Ben Freedman

Medical Papers and Journal Articles

Atrial fibrillation (AF) is a significant risk factor for avoidable stroke. Among high-risk patients with AF, stroke risk can be mitigated using oral anticoagulants (OACs), however reduction is largely contingent on physician prescription and patient persistence with OAC therapy. Over the past decade significant advances have occurred, with revisions to clinical practice guidelines relating to management of stroke risk in AF in several countries, and the introduction of non-vitamin K antagonist OACs (NOACs). This paper summarises the evolving body of research examining guideline-based clinician prescription over the past decade, and patient-level factors associated with OAC persistence. The review shows clinicians' …

Machine Learning Classification Of Human Joint Tissue From Diffuse Reflectance Spectroscopy Data, Rajitha Gunaratne, Issac Monteath, Joshua Goncalves, Raymond Sheh, Charles N. Ironside, Michael Kapfer, Richard Chipper, Brett Robertson, Riaz Khan, Daniel Fick

Medical Papers and Journal Articles

Objective: To assess if incorporation of DRS sensing into real-time robotic surgery systems has merit. DRS as a technology is relatively simple, cost-effective and provides a non-contact approach to tissue differentiation.

Methods: Supervised machine learning analysis of diffuse reflectance spectra was performed to classify human joint tissue that was collected from surgical procedures.

Results: We have used supervised machine learning in the classification of a DRS human joint tissue data set and achieved classification accuracy in excess of 99%. Sensitivity for the various classes were; cartilage 99.7%, subchondral 99.2%, meniscus 100% and cancellous 100%. Full wavelength range is required for …