Medicine and Health Sciences Commons^™

Recurrent Nocturnal Hypoglycaemia As A Cause Of Morning Fatigue In Treated Addison’S Disease – Favourable Response To Dietary Management: A Case Report, Kristina S. Petersen, R Louise Rushworth, Peter M. Clifton, David J. Torphy

Medical Papers and Journal Articles

Background: Addison’s disease, or primary adrenal insufficiency, is often associated with reduced well-being and fatigue despite use of currently recommended adrenal hormone replacement. Hypoglycaemia is a known manifestation of glucocorticoid deficiency, but is generally considered rare in adults and not relevant to troubling ongoing symptoms in patients with Addison’s disease.

Case presentation: A 43 year old woman with a three year history of Addison’s disease complained of severe morning fatigue and headaches, despite standard glucocorticoid replacement therapy in the form of thrice daily hydrocortisone and mineralocorticoid replacement with fludrocortisone. Alternative glucocorticoid replacement regimens and the addition of dehydroepiandrosterone replacement therapy …

Experience Of A Tutor Centric Model For Sonography Training Of Emergency Department Registrars In An Australian Urban Emergency Department 2009–2012, Greg Sweetman, Mark Fear, Kathryn Hird

Medical Papers and Journal Articles

Purpose: To assess the impact of a regular sonographer proctored training program for emergency medicine trainees in the use of Emergency Department bedside ultrasound

Methods: Emergency Department (ED) Registrars in the Swan District Hospital ED were provided with proctored instruction in bedside ultrasound in performance of extended focused assessment sonography in trauma (eFAST) and abdominal aortic aneurysm (AAA) detection. Training was conducted by credentialed sonographers for individual trainees in a 1:1 or 1:2 setting for 1 hour on a weekly basis. Registrars who trained in the Department between Jan 2009 to Dec 2012 were invited to participate in a survey …

Acute Ankle And Knee Injuries: To X-Ray Or Not?, G Fulde

Medical Papers and Journal Articles

The Ottawa ankle and knee rules are validated clinical decision tools that guide clinicians in targeting radiology to those patients who are likely to have an ankle or knee fracture, thus minimizing x-ray exposure of patients and reducing costs.

Abdominal Compliance: A Bench-To-Bedside Review, Annika R. Blaser, Martin Bjorck, Bart De Keulenaer, Adrian Regli

Medical Papers and Journal Articles

Abdominal compliance is an important determinant and predictor of available workspace during laparoscopic surgery. Furthermore, critically ill patients with a reduced abdominal compliance are at an increased risk of developing intra-abdominal hypertension and abdominal compartment syndrome both of which are associated with high morbidity and mortality. Despite of this, abdominal compliance is a concept, which has been neglected in the past.

Abdominal compliance is defined as a measure of the ease of abdominal expansion, expressed as a change in intra-abdominal volume per change in intra-abdominal pressure:

abdominal compliance = delta intra-abdominal volume / delta intra-abdominal pressure.

AC is a dynamic …

International Dissemination Of Evidence‑Based Practice, Open Access And The Iacapap Textbook Of Child And Adolescent Mental Health, Joseph Rey

Medical Papers and Journal Articles

Dramatic changes have occurred in both publishing and teaching in the last 20 years stemming from the digital and Internet revolutions. Such changes are likely to grow exponentially in the near future aided by the trend to open access publishing. This revolution has challenged traditional publishing and teaching methods that—largely but not exclusively due to cost—are particularly relevant to professionals in low and middle income countries. The digital medium and the Internet offer boundless opportunities for teaching and training to people in disadvantaged regions. This article describes the development of the IACAPAP eTextbook of child and adolescent mental health, its …

Using The Script Concordance Test To Assess Clinical Reasoning Skills In Undergraduate And Postgraduate Medicine, Michael Wan

Medical Papers and Journal Articles

The script concordance test is a relatively new format of written assessment that is used to assess higher order clinical reasoning and data interpretation skills in medicine. Candidates are presented with a clinical scenario, followed by the reveal of a new piece of information. The candidates are then asked to assess whether this additional information increases or decreases the probability or likelihood of a particular diagnostic, investigative, or management decision. To score these questions, the candidate’s decision in each question is compared with that of a reference panel of expert clinicians. This review focuses on the development of quality script …

Surveillance Of Antenatal Influenza Vaccination: Validity Of Current Systems And Recommendations For Improvement, Annette Regan, Donna Mak, Hannah C. Moore, Lauren Tracey, Richard Saker, Catherine Jones, Paul Effler

Medical Papers and Journal Articles

Abstract

Background: Although influenza vaccination is recommended during pregnancy as standard of care, limited surveillance data are available for monitoring uptake. Our aim was to evaluate the validity of existing surveillance in Western Australia for measuring antenatal influenza immunisations.

Methods: The self-reported vaccination status of 563 women who delivered between April and October 2013 was compared against three passive data collection sources: a state-wide antenatal influenza vaccination database maintained by the Department of Health, a public maternity hospital database, and a private health service database. Sensitivity, specificity, and positive and negative predictive values were calculated for each system using self-report …

Relationship Between Serum Testosterone And Fracture Risk In Men: A Comparison Of Ria And Lc-Ms/Ms, Thach S. Tran, Jacqueline R. Center, Markus J. Seibel, John A. Eisman, Mark M. Kushnir, Alan L. Rockwood, Tuan V. Nguyen

Medical Papers and Journal Articles

BACKGROUND: Serum testosterone can be measured byLC-MS/MS and RIA. We investigated whether the testosterone–fracture relationship was affected by the method of measurement.

METHODS: We measured total testosterone (TT) by LCMS/MS (TTLC-MS/MS) and RIA (TTRIA) in serum samples collected from 602 men whose incident fractures had been continuously ascertained by x-ray reports from 1989 to 2010. We measured bone mineral density (BMD) by dual-energy x-ray absorptiometry. The association between TT and fracture risk was assessed by the Cox proportional hazards model, taking into account the effect of age and BMD.

CONCLUSIONS: The concordance between LC-MS/MS and RIA in the measurement of …

Why Hitnet Kiosks Didn't Hit The Mark For Sexual Health Education Of Western Australian Aboriginal Youth, D Vujcich, N Hadland, B A. Sullivan, S Clews, K Kerry, D Mak

Medical Papers and Journal Articles

Objective: To assess the use, appropriateness of, and staff feedback on specific sexual health modules, which were installed on Heuristic Interactive Technology (HITnet) kiosks at Aboriginal Community Controlled Health Services (ACCHS). The HITnet kiosks were aimed at Aboriginal youth visiting these sites.

Methods: Modules on the HITnet kiosks were assessed for (1) cultural appropriateness using Yunkaporta’s Aboriginal pedagogy framework and (2) compliance with the World Health Organization’s (WHO) advice on key elements for comprehensive sexual health education for young people. Data measuring kiosk use were obtained through HITnet kiosk activity reports. An online survey of ACCHS staff was …

Optimising Motor Learning In Infants At High Risk Of Cerebral Palsy: A Pilot Study, Catherine Morgan, Iona Novak, Russell Dale, Nadia Badawi

Medical Papers and Journal Articles

Background: The average age for the diagnosis of cerebral palsy (CP) is 19 months. Recent neuroplasticity literature suggests that intensive, task-specific intervention ought to commence as early as possible and in an enriched environment, during the critical period of neural development. Active motor interventions are effective in some populations, however the effects of active motor interventions on the motor outcomes of infants with CP have not been researched thoroughly, but pilot work is promising. The aim of this study was to determine the short- term effects of “GAME”; a new and novel goal-oriented activity-based, environmental enrichment therapy programme on the …

Do Patients With Long-Term Side Effects Of Cancer Treatment Benefit From General Practitioner Support? A Literature Review, I Ngune, M Jiwa, A Mcmanus, J Hughes

Medical Papers and Journal Articles

Background: Alongside specialist cancer clinics, general practitioners have an important role in cancer patients’ follow-up care, yet no literature summarises the nature, extent and impact of their involvement. This paper addresses this issue through a review of the literature.

Methods: Studies were sourced from six academic databases - AustHealth (n = 202), CINAHL (n = 500), the Cochrane Library (reviews and trials; n = 200), Embase (n = 368), PHCRIS (n = 132) and PubMed/Medline (n = 410). Studies that focused on interventions designed for patients receiving follow-up care and reported cancer care provided by a general practitioner delivered alongside …

Australian Fathers' Study: What Influences Paternal Engagement With Antenatal Care?, T Jeffrey, K Luo, B Kueh, R Petersen, J Quinlivan

Medical Papers and Journal Articles

This mixed-methods study explores factors associated with and levels of engagement of fathers in antenatal care. One hundred expectant fathers were recruited from antenatal clinics and community settings in Western Australia. They completed validated questionnaires. Eighty-three percent of expectant fathers reported a lack of engagement with antenatal care. Factors significantly associated with lack of engagement in multivariate analysis were working more than 40 hours a week and lack of adequate consultation by antenatal care staff. In qualitative analysis, 6 themes emerged in association with a lack of engagement. They were role in decision making, time pressures, the observer effect, lack …

Trans-Arterial Embolisation Therapies For Unresectable Intrahepatic Cholangiocarcinoma: A Systematic Review, L. Yang, J Shan, L Shan, A Saxena, L Bester, D Morris

Medical Papers and Journal Articles

Background: Unresectable intrahepatic cholangiocarcinoma (ICC) portends a poor prognosis despite standard systemic treatments which confer minimal survival benefits and significant adverse effects. This study aimed to assess clinical outcomes, complications and prognostic factors of TAE therapies using chemotherapeutic agents or radiation.

Methods: A literature search and article acquisition was conducted on PubMed (MEDLINE), OVID (MEDLINE) and EBSCOhost (EMBASE). Original articles published after January 2000 on trans-arterial therapies for unresectable ICC were selected using strict eligibility criteria. Radiological response, overall survival, progression-free survival, safety profile, and prognostic factors for overall survival were assessed. Quality appraisal and data tabulation were performed using …

Impact Of Geography On The Control Of Type 2 Diabetes Mellitus: A Review Of Geocoded Clinical Data From General Practice, Moyez Jiwa, Ori Gudes, Richard Varhol, Narelle Mullan

Medical Papers and Journal Articles

Objective: To review the clinical data for people with diabetes mellitus with reference to their location and clinical care in a general practice in Australia.

Materials and methods: Patient data were extracted from a general practice in Western Australia. Iterative data-cleansing steps were taken. Data were grouped into Statistical Area level 1 (SA1), designated as the smallest geographical area associated with the Census of Population and Housing. The data were analysed to identify if SA1s with people aged 70 years and older, and with relatively high glycosylated haemoglobin (HbA1c) were significantly clustered, and whether this was associated with their medical …

A Prospective Cohort Study Comparing The Reactogenicity Of Trivalent Influenza Vaccine In Pregnant And Non-Pregnant Women, A Regan, L Tracey, C Blyth, D Mak, P Richmond, G Shellam, C Talbot, P Effler

Medical Papers and Journal Articles

Background: Influenza vaccination during pregnancy can prevent serious illness in expectant mothers and provide protection to newborns; however, historically uptake has been limited due to a number of factors, including safety concerns. Symptomatic complaints are common during pregnancy and may be mistakenly associated with reactions to trivalent influenza vaccine (TIV). To investigate this, we compared post-vaccination events self-reported by pregnant women to events reported by non-pregnant women receiving TIV.

Methods: A prospective cohort of 1,086 pregnant women and 314 non-pregnant female healthcare workers (HCWs) who received TIV between March-May 2014 were followed-up seven days post-vaccination to assess local and systemic …

Osseointegrated Total Knee Replacement Connected To A Lower Limb Prosthesis: 4 Cases, Aditya Khemka, Laurent Frossard, Sarah J. Lord, Belinda Bosley, Munjed Al Muderis

Medical Papers and Journal Articles

Background and purpose

Osseointegrated implants are an alternative for prosthetic attachment in individuals with amputation who are unable to wear a socket. However, the load transmitted through the osseointegrated fixation to the residual tibia and knee joint can be unbearable for those with transtibial amputation and knee arthritis. We report on the feasibility of combining total knee replacement (TKR) with an osseointegrated implant for prosthetic attachment.

Patients and methods

We retrospectively reviewed all 4 cases (aged 38–77 years) of transtibial amputations managed with osseointegration and TKR in 2012–2014. The below-the-knee prosthesis was connected to the tibial base plate of a …

Target Definition For Shipwreck Hunting, Kim Kirsner

Medical Papers and Journal Articles

The research described in the present article was implemented to define the locations of two World War II shipwrecks, the German raider Kormoran, and the Australian light cruiser HMAS Sydney. The paper describes the long and complex trail that led through inefficient oceanographic prediction to ambiguous historical prediction involving a single report and on to precise cognitive prediction based on nine reports from more than 70 survivors, a process that yielded a single target position or “mean” just 2.7NM (nautical miles) from the wreck of Kormoran. Prediction for the position of the wreck of Sydney opened with wishful thinking that …

Diagnosis And Management Of Respiratory Adverse Events In The Operating Room, Adrian Regli, Britta S. Von Ungern-Sternberg

Medical Papers and Journal Articles

Perioperative respiratory adverse events cause more than three-quarters of all perioperative critical incidents in pediatric anesthesia and approximately half of anesthesia-related cardiac arrests. We can define seven main clinical types of perioperative respiratory adverse events: upper airway obstruction, laryngospasm, bronchospasm, severe persistent cough, apnea, stridor, and oxygen desaturation. Depending on the definitions used for preoperative respiratory adverse events and the cohort of children examined, the incidence varies between 8 and 21 %. This review discusses the recognition and treatment of perioperative respiratory adverse events. Furthermore, it provides guidance on how to identify children who are at increased risk for developing …

A Mixed Methods Study Of The Factors That Influence Whether Intervention Research Has Policy And Practice Impacts: Perceptions Of Australian Researchers, Robyn Newson, Lesley King, Lucie Rychetnik, Adrian E. Bauman, Sally Redman, Andrew J. Milat, Jacqueline Schroeder, Gillian Cohen, Simon Chapman

Medical Papers and Journal Articles

Objectives: To investigate researchers’ perceptions about the factors that influenced the policy and practice impacts (or lack of impact) of one of their own funded intervention research studies.

Design: Mixed method, cross-sectional study.

Setting: Intervention research conducted in Australia and funded by Australia’s National Health and Medical Research Council between 2003 and 2007.

Participants: The chief investigators from 50 funded intervention research studies were interviewed to determine if their study had achieved policy and practice impacts, how and why these impacts had (or had not) occurred and the approach to dissemination they had employed.

Results: We found that statistically significant …

Improving Allied Health Professionals' Research Implementation Behaviours For Children With Cerebral Palsy: Protocol For A Before-After Study, Christine Imms, Iona Novak, Claire Kerr, Nora Shields, Melinda Randall, Adrienne Harvey, H Kerr Graham, Dinah Reddihough

Medical Papers and Journal Articles

Background: Cerebral palsy is a permanent disorder of posture and movement caused by disturbances in the developing brain. It affects approximately 1 in every 500 children in developed countries and is the most common form of childhood physical disability. People with cerebral palsy may also have problems with speech, vision and hearing, intellectual difficulties and epilepsy. Health and therapy services are frequently required throughout life, and this care should be effective and evidence informed; however, accessing and adopting new research findings into day-to-day clinical practice is often delayed.

Methods/Design: This 3-year study employs a before and after design to evaluate …

De Novo Identification Of Differentially Methylated Regions In The Human Genome, Timothy J. Peters, Michael J. Buckley, Aaron L. Statham, Ruth Pidsley, Katherine Samaras, Reginald V. Lord, Susan J. Clark, Peter L. Molloy

Medical Papers and Journal Articles

Background: The identification and characterisation of differentially methylated regions (DMRs) between phenotypes in the human genome is of prime interest in epigenetics. We present a novel method, DMRcate, that fits replicated methylation measurements from the Illumina HM450K BeadChip (or 450K array) spatially across the genome using a Gaussian kernel. DMRcate identifies and ranks the most differentially methylated regions across the genome based on tunable kernel smoothing of the differential methylation (DM) signal. The method is agnostic to both genomic annotation and local change in the direction of the DM signal, removes the bias incurred from irregularly spaced methylation sites, and …

A Comparison Of The Predictive Accuracy Of Three Screening Models For Pulmonary Arterial Hypertension In Systemic Sclerosis, Yanjie Hao, Vivek Thakkar, Wendy Stevens, Kathleen Morrisroe, David Prior, Candice Rabusa, Peter Youssef, Eli Gabbay, Janet Roddy, Jennifer Walker, Jane Zochling, Joanne Sahhar, Peter Nash, Susan Lester, Maureen Rischmueller, Susanna M. Proudman, Mandana Nikpour

Medical Papers and Journal Articles

Introduction: There is evidence that early screening for pulmonary arterial hypertension (PAH) in systemic sclerosis (SSc) improves outcomes. We compared the predictive accuracy of two recently published screening algorithms (DETECT 2013 and Australian Scleroderma Interest Group (ASIG) 2012) for SSc-associated PAH (SSc-PAH) with the commonly used European Society of Cardiology/European Respiratory Society (ESC/ERS 2009) guidelines.

Methods: We included 73 consecutive SSc patients with suspected PAH undergoing right heart catheterization (RHC). The three screening models were applied to each patient. For each model, contingency table analysis was used to determine sensitivity, specificity, and positive (PPV) and negative (NPV) predictive values for …

Twenty-Year Outcomes Of A Longitudinal Prospective Evaluation Of Isolated Endoscopic Anterior Cruciate Ligament Reconstruction With Patellar Tendon Autografts, Simon Thompson, Lucy Salmon, Alison Waller, James Linklater, Justin Roe, Leo Pinczewski

Medical Papers and Journal Articles

Background: Long term prospective follow up studies of single-incision endoscopic anterior cruciate ligament reconstruction are limited and may include confounding factors.

Objectives: This longitudinal prospective study reports the outcome of isolated anterior cruciate ligament (ACL) reconstruction using middle-third patellar tendon autograft in 90 patients over 20 years.

Study design: Case series; Level of evidence, 4.

Methods: Between January 1993 and April 1994, 90 patients met study inclusion criteria, evaluation 1,2,3,4,5,7,10,15 and 20 years post-surgery. Exclusion criteria: associated ligamentous injury requiring surgery, previous meniscectomy; meniscal injury meniscectomy more than 1/3; chondral injury; and an abnormal contralateral knee.

Results: At 20 years, …

Bioabsorbable Versus Titanium Screws In Anterior Cruciate Ligament Reconstruction Using Hamstring Autograft: A Prospective, Blinded, Randomized Controlled Trial With 5-Year Follow-Up, Yuval Arama, Lucy J. Salmon, Kesavan Sri-Ram, James Linklater, Justin P. Roe, Leo Pinczewski

Medical Papers and Journal Articles

Background: Longer term studies of bioabsorbable screws for ACL reconstruction are reported, but results are specific to the exact screw material and design. Titanium and PLLA-HA screw outcomes have been compared only to 2 years.

Purpose: The aim of this study was to compare the clinical and radiological outcomes of PLLAHA screw (BS) versus a titanium screw (TS), for hamstring tendon anterior cruciate ligament reconstruction over 5 years. We hypothesized that there are no differences in clinical scores, and tunnel widening, between the BS and the TS groups, and that the PLLA-HA screw as seen on MRI should show high …

Paramedics' Perceptions And Educational Needs With Respect To Palliative Care, Ian R. Rogers, Freya M. Shearer, Jeremy R. Rogers, Gail Ross-Adjie, Leanne Monterosso, Judith C. Finn

Medical Papers and Journal Articles

Introduction: In recent years the scope of palliative care has been redefined to include patients earlier in the course of their illness, and those suffering from life-limiting conditions. Paramedics may be involved in the care of these patients, especially in situations of carer distress, sudden deterioration and imminent death, as well as in non-emergent situations such as inter-facility transfers. In these scenarios, clinical decisions regarding patient care initiated by paramedics may set the trajectory for subsequent care.

Objective: To identify and measure paramedics’ perspectives and educational needs regarding palliative care provision, as well as their understanding of the common causes …

Comparison Of Text-Messaging To Voice Telephone Interviews For Active Surveillance Of Adverse Events Following Immunisation, A Regan, C Blyth, L Tracey, D Mak, P Richmond, P Efflier

Medical Papers and Journal Articles

Objectives: In 2013, the Follow-up and Active Surveillance of Trivalent Influenza Vaccine in Mums (FASTMum) program began using short message service (SMS) to collect adverse event information in pregnant women who recently received trivalent influenza vaccine (TIV). This study was designed to compare data collected via SMS and telephone for the purposes of monitoring vaccine safety.

Methods: A number of 344 women who received TIV were randomly assigned to a telephone interview group. They were telephoned seven days post-vaccination and administered a standard survey soliciting any adverse events following immunisation (AEFI) they experienced. They were matched by brand of vaccine, …

Discrepancy Of Target Sites Between Clinician And Cytopathological Reports In Head Neck Fine Needle Aspiration: Did I Miss The Target Or Did The Clinician Mistake The Organ Site?, M Khanlari, Y Daneshbod, H Yazdi, S Shirian, S Negahban, A Aledavood, A Oryan, B Khademi, K Daneshbod, A Field

Medical Papers and Journal Articles

The diagnostic accuracy of fine needle aspiration cytology (FNAC) of head and neck lesions is relatively high, but cytologic interpretation might be confusing if the sample is lacking typical cytologic features according to labeled site by physician. These errors may have an impact on pathology search engines, healthcare costs or even adverse outcomes. The cytology archive database of multiple institutions in southern Iran and Australia covering the period 2001–2011, were searched using keywords: salivary gland, head, neck, FNAC, and cytology. All the extracted reports were reviewed. The reports which showed discordance between the clinician’s impression of the organ involved and …

Factors Affecting Retention Of Allied Health Professionals Working With People With Disability In Rural New South Wales, Australia: Discrete Choice Experiment Questionnaire Development, G Gallego, A Dew, K Bulkeley, C Veitch, M Lincoln, A Bundy, J Brentnall

Medical Papers and Journal Articles

Objective: This paper describes the development of a discrete choice experiment (DCE) questionnaire to identify the factors (attributes) that allied health professionals (AHPs) working with people with disability identify as important to encouraging them to remain practising in rural areas.

Methods: Focus groups and semi-structured interviews were conducted with 97 purposively selected service providers working with people with disability in rural New South Wales, Australia. Focus groups and interviews were digitally recorded, transcribed, and analysed using a modified grounded theory approach involving thematic analysis and constant comparison.

Results: Six attributes that may influence AHPs working with people with disability in …

How Do General Practitioners Manage Patients With Cancer Symptoms? A Video-Vignette Study, Moyez Jiwa, Xingqiong Meng, Carolyn O'Shea, Parker Magin, Ann Dadich, Vinita Pillai

Medical Papers and Journal Articles

Objectives: Determine how general practitioners (GPs) manage patients with cancer symptoms.

Design: GPs reviewed 24 video-vignettes and case notes on patients with cancer symptoms and indicated whether they would refer the patient and/or prescribe medication, and/or undertake further investigation. According to available guidelines, all cases warranted a referral to a specialist or further investigations.

Setting: Australian primary care sector.

Participants: 102 practising GPs participated in this study, including trainees.

Interventions: The research was part of a larger randomised controlled trial testing a referral pro forma; however, this paper reports on management decisions made throughout the study.

Primary and secondary outcome …

Building Social Capital With Interprofessional Student Teams In Rural Settings: A Service-Learning Model, Pippa L. Craig, Christine Phillips, Sally Hall

Medical Papers and Journal Articles

Objective: To describe outcomes of a model of service learning in interprofessional learning (IPL) aimed at developing a sustainable model of training that also contributed to service strengthening.

Design: A total of 57 semi-structured interviews with key informants and document review exploring the impacts of interprofessional student teams engaged in locally relevant IPL activities.

Setting: Six rural towns in South East New South Wales.

Participants: Local facilitators, staff of local health and other services, health professionals who supervised the 89 students in 37 IPL teams, and academic and administrative staff.

Main outcome measures: Perceived benefits as a consequence of interprofessional, …