Digital Commons Network^™

Evaluating The Effectiveness Of 'Mcq Development Workshop Using Cognitive Model Framework: A Pre-Post Study, Rahila Ali, Amber Shahmim Sultan, Nida Zahid

Department for Educational Development

A workshop on MCQ development using cognitive model framework was conducted for health educators from Aga Khan University (AKU) and other academic institutions. The aim was to develop the skill of preparing MCQs for assessing higher cognitive levels. A pre-post study was conducted, participant satisfaction was evaluated and pre-post test scores were used to assess learning capability of the workshop participants. Out of the 19 who attended the workshop, 16 participated in the pre- and post-tests and were included in the study through convenience sampling. The total duration of the study was six months. There was a significant difference in …

Graduate Nurse Transition Programs Pivotal Point Of Participants’ Practice Readiness Questioned During The Covid-19 Pandemic Crisis: A Scoping Review, Kylie Russell, Dianne Juliff

Nursing Papers and Journal Articles

Background: The COVID-19 pandemic requires an accessible, practice-ready nursing workforce to assist with the increase in health service delivery. Graduate nurse transition programs are the entry point for most graduates into professional practice, and this review focused on both empirical studies and gray literature to identify at what point practice readiness occurs and what can assist graduate nurses’ transition to become practice ready.

Method: A scoping review was conducted using the Joanna Briggs Institute scoping review framework.

Results: Consensus purports supportive environments, ideally in formal structured graduate transition to practice programs, to enhance graduate nurses’ clinical skills and confidence development. …

Multichannel Mixture Models For Time-Series Analysis And Classification Of Engagement With Multiple Health Services: An Application To Psychology And Physiotherapy Utilization Patterns After Traffic Accidents, Nazanin Esmaili, Quinlan D. Buchlak, Massimo Piccardi, Bernie Kruger, Federico Girosi

Medical Papers and Journal Articles

Background: Motor vehicle accidents (MVA) represent a significant burden on health systems globally. Tens of thousands of people are injured in Australia every year and may experience significant disability. Associated economic costs are substantial. There is little literature on the health service utilization patterns of MVA patients. To fill this gap, this study has been designed to investigate temporal patterns of psychology and physiotherapy service utilization following transport-related injuries.

Method: De-identified compensation data was provided by the Australian Transport Accident Commission. Utilization of physiotherapy and psychology services was analysed. The datasets contained 788 psychology and 3115 physiotherapy claimants and 22,522 …

Coronary 18f-Sodium Fluoride Pet Detects High-Risk Plaque Features On Optical Coherence Tomography And Ct-Angiography In Patients With Acute Coronary Syndrome, Kamran Majeed, Jamie W. Bellinge, Steele C. Butcher, Richard Alcock, Jon Spiro, David Playford, Graham S. Hillis, David E. Newby, Trevor A. Mori, Roslyn Francis, Carl J. Schultz

Medical Papers and Journal Articles

Background and aims: ¹⁸F-Sodium Fluoride Positron Emission Tomography (¹⁸F–NaF PET) non-invasively detects micro-calcification activity, the earliest stage of atherosclerotic arterial calcification. We studied the association between coronary ¹⁸F–NaF uptake and high-risk plaque features on intra-coronary optical coherence tomography (OCT) and CT-angiography (CTCA) and the potential application to patient-level risk stratification.

Methods: Sixty-two prospectively recruited patients with acute coronary syndrome (ACS) underwent multi-vessel OCT, ¹⁸F–NaF PET and CTCA. The maximum tissue to background ratio (TBRmax = standardised uptake value (SUV)max/SUVbloodpool) was measured in each coronary segment on ¹⁸F–NaF PET scans. High-risk plaque features on OCT …

Could "The Wonder Equation" Help Us To Be More Ethical? A Personal Reflection, Margaret Somerville

Medical Papers and Journal Articles

This is a personal reflection on what I have learnt as an academic, researching, teaching and participating in the public square in Bioethics for over four decades. I describe a helix metaphor for understanding the evolution of values and the current “culture wars” between “progressive” and “conservative” values adherents, the uncertainty people’s “mixed values packages” engender, and disagreement in prioritizing individual rights and the “common good”. I propose, as a way forward, that individual and collective experiences of “amazement, wonder and awe” have the power to enrich our lives, help us to find meaning and sometimes to bridge the secular/ …

Diagnosing Death 50 Years After The Harvard Brain Death Report, Francis J. O'Keeffe, George L. Mendz

Medical Papers and Journal Articles

More than 50 years after the publication of the Harvard Committee Report that sought to define death according to whole-brain function criteria, this document continues to generate a diversity of opinions regarding how death should be defined. The various perspectives show that doubts linger regarding when brain death should be diagnosed, the criteria to pinpoint the occurrence of death, and the alignment of medical practices seeking to establish human death with these criteria. This study reviews and assesses three perspectives that have made significant contributions to the debate. Attention is also given to definitions of death that depart from the …

Ejection Fraction And Mortality: A Nationwide Register-Based Cohort Study Of 499 153 Women And Men, Simon Stewart, David Playford, Gregory M. Scalia, Philip Currie, David S. Celermajer, David Prior, Jim Codde, Geoff Strange

Medical Papers and Journal Articles

Aims: We investigated the sex-based risk of mortality across the spectrum of left ventricular ejection fraction (LVEF) in a large cohort of patients in Australia.

Methods and results: Quantified levels of LVEF from 237 046 women (48.1%) and 256 109 men undergoing first-time, routine echocardiography (2000–2019) were linked to 119 232 deaths (median 5.6 years of follow-up). Overall, 17.6% of men vs. 8.3% of women had an LVEF P< 0.001] in women and 1.21 (95% CI 1.05–1.39; P = 0.008) in men. In women, an LVEF of 60.0–64.9% was also associated with a HR 1.33 (95% CI 1.16–1.52; P< 0.001) for cardiovascular-related mortality. These associations were most striking in women and men aged

Conclusions: Among patients investigated for suspected or established cardiovascular …

Essentials Of A New Clinical Practice Guidance On Familial Hypercholesterolaemia For Physicians, Gerald F. Watts, David R. Sullivan, David L. Hare, Karam M. Kostner, Ari E. Horton, Damon A. Bell, Tom Brett, Ronald J. Trent, Nicola K. Poplawski, Andrew Martin, Shubha Srinivasan, Robert N. Justo, Clara K. Chow, Jing Pang

Medical Papers and Journal Articles

Familial hypercholesterolaemia (FH) is a common, heritable and preventable cause of premature coronary artery disease. New clinical practice recommendations are presented to assist practitioners in enhancing the care of all patients with FH. Core recommendations are made on the detection, diagnosis, assessment and management of adults, children and adolescents with FH. Management is under-pinned by the precepts of risk stratification, adherence to healthy lifestyles, treatment of non-cholesterol risk factors and appropriate use of low-density lipoprotein (LDL)-cholesterol-lowering therapies including statins, ezetimibe and proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors. The recommendations need to be utilised using judicious clinical judgement and shared …

Exported Plasmodial J Domain Protein, Pfe0055c, And Pfhsp70-X Form A Specific Co-Chaperone-Chaperone Partnership, Tanima Dutta, Harpreet Singh, Jason E. Gestwicki, Gregory L. Blatch

Medical Papers and Journal Articles

Plasmodium falciparum is a unicellular protozoan parasite and causative agent of a severe form of malaria in humans, accounting for very high worldwide fatality rates. At the molecular level, survival of the parasite within the human host is mediated by P. falciparum heat shock proteins (PfHsps) that provide protection during febrile episodes. The ATP-dependent chaperone activity of Hsp70 relies on the co-chaperone J domain protein (JDP), with which it forms a chaperone-co-chaperone complex. The exported P. falciparum JDP (PfJDP), PFA0660w, has been shown to stimulate the ATPase activity of the exported chaperone, PfHsp70-x. Furthermore, PFA0660w has been shown to associate …

Transfer Learning Artificial Intelligence For Automated Detection Of Atrial Fibrillation In Patients Undergoing Evaluation For Suspected Obstructive Sleep Apnoea: A Feasibility Study, Nestor Gahungu, Afsin Shariar, David Playford, Christopher Judkins, Eli Gabbay

Medical Papers and Journal Articles

Background: Individuals with obstructive sleep apnoea (OSA) experience a higher burden of atrial fibrillation (AF) than the general population, and many cases of AF remain undetected. We tested the feasibility of an artificial intelligence (AI) approach to opportunistic detection of AF from single-lead electrocardiograms (ECGs) which are routinely recorded during in-laboratory polysomnographic sleep studies.

Methods: Using transfer learning, an existing ECG AI model was applied to 1839 single-lead ECG traces recorded during in-laboratory sleep studies without any training of the algorithm. Manual review of all traces was performed by two trained clinicians who were blinded to each other's review. Discrepancies …

Examining The Potential For Coronary Artery Calcium (Cac) Scoring For Individuals At Low Cardiovascular Risk., David Playford, Christian Hamilton-Craig, Girish Dwivedi, Gemma Figtree

Medical Papers and Journal Articles

Atherosclerosis is the commonest cause of death in Australia. Cardiovascular (CV) risk calculators have an important role in preventative cardiology, although they are are strongly age-dependent and designed to identify individuals at high risk of an imminent event. The imprecision around “intermediate” or “low” risk generates therapeutic uncertainty, and a significant proportion of patients presenting with myocardial infarction come from these groups, often with no warning. This highlights a conundrum: “Low” risk does not mean “no” risk.

A fresh approach may be required to address the clinical conundrum around CV preventative approaches in non-high-risk individuals. While probabilistic calculators do not …

Birthing In Regional Australia: Women's Decision Making Surrounding Birthplace, Alexa Seal, Emma Hoban, Annette Panzera, Joseph Mcgirr

Medical Papers and Journal Articles

Objective

Although there is some research on women’s choice of birthplace, most of this research has been conducted overseas. This study explored factors influencing the decision to use public or private maternity services within regional Australia.

Methods

This cross-sectional study consisted of a community-based, anonymous, online questionnaire focused on factors influencing a woman’s choice of birth location and included adult females who had given birth in the past 2 years within two regional areas. Descriptive statistics were used to analyse demographic characteristics and factors influencing decisions regarding birthplace. Pearson’s Chi-squared test was used to compare public and private births for …

Cardiac Damage Staging Classification Predicts Prognosis In All The Major Subtypes Of Severe Aortic Stenosis: Insights From The National Echo Database Australia, Afik Snir, Martin Ng, Geoffrey A. Strange, David Playford, Simon Stewart, David S. Celermajer

Medical Papers and Journal Articles

Background

There are currently no established prognostic models for “low-gradient” severe aortic stenosis (AS), including those with low-flow, low-gradient (LFLG) or normal-flow, low-gradient (NFLG) severe AS. The “cardiac damage staging classification” has been validated as a clinically useful prognostic tool for high-gradient severe AS but not yet for these other common subtypes of severe AS, LFLG and NFLG.

Methods

The authors analyzed data from the National Echo Database of Australia, a large national, multicenter registry with individual data linkage to mortality. Of 192,060 adults (mean age, 62.8 ± 17.8 years) with comprehensive ultrasound profiling of the native aortic valve studied …

Markers Of Elevated Left Ventricular Filling Pressure Are Associated With Increased Mortality In Nonsevere Aortic Stenosis, Lauren C. Giudicatti, Sally Burrows, David Playford, Geoff Strange, Graham Hillis

Medical Papers and Journal Articles

Background: Echocardiographic measures of elevated left ventricular filling pressures are associated with an adverse prognosis. The aim of this study was to determine the relationship between acute (ratio of early transmitral flow to mitral annular velocities; E/e’) and chronic (indexed left atrial volume; LAVI) markers of left ventricular filling pressure (LVFP) and mortality in patients with non-severe aortic stenosis (AS), within the National Echo Database of Australia cohort. We hypothesised that they would reflect the early haemodynamic consequences of AS and be associated with increased mortality in this setting.

Methods: The first record for patients 18 years or over showing …

Machine Learning Applications To Neuroimaging For Glioma Detection And Classification: An Artificial Intelligence Augmented Systematic Review, Quinlan D. Buchlak, Nazanin Esmaili, Jean-Christophe Leveque, Christine Bennett, Farrokh Farrokhi, Massimo Piccardi

Medical Papers and Journal Articles

Glioma is the most common primary intraparenchymal tumor of the brain and the 5-year survival rate of high-grade glioma is poor. Magnetic resonance imaging (MRI) is essential for detecting, characterizing and monitoring brain tumors but definitive diagnosis still relies on surgical pathology. Machine learning has been applied to the analysis of MRI data in glioma research and has the potential to change clinical practice and improve patient outcomes. This systematic review synthesizes and analyzes the current state of machine learning applications to glioma MRI data and explores the use of machine learning for systematic review automation. Various datapoints were extracted …

Clinical Outcomes Associated With Robotic And Computer-Navigated Total Knee Arthroplasty: A Machine Learning-Augmented Systematic Review, Quinlan D. Buchlak, Joe Clair, Nazanin Esmaili, Arshad Barmare, Siva Chandrasekaran

Medical Papers and Journal Articles

Background

Robotic (RTKA) and computer-navigated total knee arthroplasty (CNTKA) are increasingly replacing manual techniques in orthopaedic surgery. This systematic review compared clinical outcomes associated with RTKA and CNTKA and investigated the utility of natural language processing (NLP) for the literature synthesis.

Methods

A comprehensive search strategy was implemented. Results of included studies were combined and analysed. A transfer learning approach was applied to train deep NLP classifiers (BERT, RoBERTa and XLNet), with cross-validation, to partially automate the systematic review process.

Results

52 studies were included, comprising 5,067 RTKA and 2,108 CNTKA. Complication rates were 0–22% and 0–16% and surgical time …

Relative Incidence And Predictors Of Pulmonary Arterial Hypertension Complicating Type 2 Diabetes: The Fremantle Diabetes Study Phase I, Nishant Nundlall, David Playford, Timothy M E Davis, Wendy A. Davis

Medical Papers and Journal Articles

Aims: To determine the relative incidence and predictors of pulmonary arterial hypertension (PAH) in type 2 diabetes.

Methods: Hospitalizations for/with and death from/with PAH, and all-cause mortality, were ascertained from validated databases for participants from the longitudinal, community-based Fremantle Diabetes Study Phase I (FDS1; n = 1287) and age-, sex- and zip code-matched people without diabetes (n = 5153) between entry (1993–1996) and end-2017. Incidence rates (IRs) and IR ratios (IRRs) were calculated. Cox proportional hazards and competing risk models generated cause-specific (cs) and subdistribution (sd) hazard ratios (HRs) for incident PAH.

Results: In the pooled cohort (mean age …

Supporting Families Of Patients With Dementia At End-Of-Life In Hospital, Felicity Moon, Fiona Mcdermott, David Kissane

Medical Papers and Journal Articles

Introduction: There are barriers to implementing person-and family-centred end-of-life care for people with dementia in hospitals. Nursing care for people with dementia is enhanced through family involvement. However, families report unmet needs during admissions contributing to distress and dissatisfaction. Furthermore, little is known about families’ needs during end-of-life care for people with dementia in hospital.

Aim: This study examined perceptions of interpersonal care during end-of-life for patients with dementia.

Methods: This research used a qualitative approach framed through a social constructionist and complex systems theoretical frameworks. Hospital clinicians (n = 20) and bereaved family members (n = 12) of deceased …

The Impact Of Mandatory Mammographic Breast Density Notification On Supplemental Screening Practice In The United States: A Systematic Review, Shuangqin Huang, Nehmat Houssami, Meagan Brennan, Brooke Nickel

Medical Papers and Journal Articles

Purpose: Dense breast tissue is an independent risk factor for breast cancer and lowers the sensitivity of screening mammography. Supplemental screening with ultrasound or MRI improves breast cancer detection rate but has potential harms. Breast density notifcation (BDN) legislation has been introduced in the United States (US) and its impact on supplemental screening practice is unclear. This study systematically reviewed current evidence to explore the impact of BDN on supplemental screening practice in the US.

Methods: Medline, PubMed, Embase, Cochrane and the Cinhal Library databases were searched (2009-August 2020). Studies were assessed for eligibility, data were extracted and …

The Impact Of Device-Assisted Therapies On The Gut Microbiome In Parkinson's Disease, Michal Lubomski, Xiangnan Xu, Andrew J. Holmes, Jean Y.H. Yang, Carolyn M. Sue, Ryan L. Davis

Medical Papers and Journal Articles

Background: Microbiome feedbacks are proposed to influence Parkinson’s disease (PD) pathophysiology. A number of studies have evaluated the impact of oral medication on the gut microbiome (GM) in PD. However, the influence of PD device-assisted therapies (DATs) on the GM remains to be investigated.

Objectives: To profile acute gut microbial community alterations in response to PD DAT initiation.

Methods: Clinical data and stool samples were collected from 21 PD patients initiating either deep brain stimulation (DBS) or levodopa–carbidopa intestinal gel (LCIG) and ten spousal healthy control (HC) subjects. 16S amplicon sequencing of stool DNA enabled comparison of …

Transhumanist Genetic Enhancement: Creation Of A 'New Man' Through Technological Innovation, George Mendz, Michael Cook

Medical Papers and Journal Articles

The transhumanist project of reshaping human beings by promoting their improvement through technological innovations has a broad agenda. This study focuses on the enhancement of the human organism through genetic modification techniques. Transhumanism values and a discussion of their philosophical background provide a framework to understand its ideals. Genetics and ethics are employed to assess the claims of the transhumanist program of human enhancement. A succinct description of central concepts in genetics and an explanation of current techniques to edit the human genome serve to assess the capabilities and limitations of editing techniques. Potential benefits and liabilities of human enhancement …

Behavioural Phenotyping Of Thunder Mice With A Hypomorphic Mutation Of Heterogeneous Nuclear Ribonuclear Protein L-Like (Hnrnpll) And Reduced T Cell Function, Maarten Van Den Buuse, Paul Halley, Gerard Hoyne

Medical Papers and Journal Articles

Heterogeneous nuclear ribonuclear protein l-like (hnRNPLL) is an RNA binding protein that regulates alternative splicing of mRNA and is abundantly expressed in memory T lymphocytes of the immune system and in the brain. A hypomorphic allele of the gene encoding hnRNPLL (Hnrpllthunder) selectively reduces T cell accumulation in lymphoid tissues, but little is known about its effects in the brain. Therefore, we exposed Hnrpllthunder mice to a test battery with relevance for a range of psychiatric illnesses. Thunder mice showed enhanced immobility in the tail-suspension test for depression-related behaviours, impaired short-term spatial memory in the Y-maze and reduced …

Mild Pulmonary Hypertension And Premature Mortality Among 154 956 Men And Women Undergoing Routine Echocardiography, Simon Stewart, Yih-Kai Chan, David Playford, Geoffrey A. Strange, On Behalf Of The Neda Investigators

Medical Papers and Journal Articles

Although mild pulmonary hypertension (PHT) is known to be associated with increased mortality, its impact on premature mortality is largely unknown.

We studied the distribution of estimated right ventricular systolic pressures (eRVSP) among 154 956 adults with no evidence of left heart disease investigated with echocardiography. We then examined individually linked mortality, premature mortality and associated life-years lost (LYL) according to eRVSP levels.

The cohort comprised 70 826 men (61.3±17.7 years) and 84 130 women (61.4±18.4 years). Overall, 85 173 (55.0%), 49 276 (31.8%), 13 060 (8.4%) and 7447 (4.8%) cases had an eRVSP level indicative of no (<30.0 mmHg), mild (30.0–39.9 mmHg), moderate (40.0–49.9 mmHg), or severe (≥50.0 mmHg) PHT, respectively. During median 5.7 (interquartile range 3.2–8.9) years follow-up, 38 456/154 986 (24.8%) individuals died. Compared to an eRVSP <30.0 mmHg, age and sex-adjusted hazard ratios for all-cause and cardiovascular-related mortality were 1.90 (95% CI 1.84–1.96) and 1.85 (95% CI 1.74–1.97) respectively, for an eRVSP of 35.0–39.9 mmHg. Overall, 6,256 (54%) men and 7524 (55%) women died prematurely. As a proportion of all deaths, premature mortality rose from 46.7% to 79.2% among those with an eRVSP <30.0 mmHg versus …