Medicine and Health Sciences Commons^™

Traumatic Heterotopic Ossification: Pathophysiological Mechanisms, Epidemiological Characteristics, And Risk Factors, Nicola Kate Foster

Theses

Traumatic heterotopic ossification (tHO) refers to the complication of pathological formation of ectopic bone in soft tissues, which follows tissue insult secondary to burn, neurological and orthopaedic injury [2]. Common to these diagnoses is the involvement of central and or peripheral nervous system trauma. Although known risk factors are associated with developing tHO, the underlying cellular and molecular mechanisms are not fully understood. Research to date, primarily in single injury cohorts, has provided minimal translatable results [2]. Thus, clinical guidelines for early screening and prophylactic drug therapy are lacking, and treatment options are limited. To move the body of knowledge …

Contralateral Acl Rupture Is More Common Than Acl Graft Rupture In Australian Netballers After Acl Reconstruction, Conor Honeywill

Theses

Background: Netball is a popular sport worldwide, particularly in females. The nature of the sport makes it high-risk for anterior cruciate ligament (ACL) injury.

Purpose: The primary outcome was to determine the prevalence of ACL graft rupture and contralateral ACL (CACL) rupture in Australian female netballers following ACL Reconstruction (ACLR). Additionally, this study aimed to determine the rate of return to sport and psychological readiness.

Study Design: Cross-Sectional Study

Methods: From a prospective database, 332 consecutive ACLR with hamstring autograft conducted between the years 2007-2015 performed by 2 surgeons in female netball players were identified. Patients were retrospectively surveyed at …

Charting And Navigating The "Scylla And Charybdis" Conundrum Of Our Ageing Hearts - Heart Failure & Atrial Fibrillation, Simon Stewart

Theses

Residing on opposite sides of the Strait of Messina between Sicily and Calabria, Scylla and Charybdis were mythical sea monsters (one a fearsome creature, the other a deadly whirlpool) described by Homer. For anyone seeking to navigate that narrow and treacherous passage, avoid one of these lethal threats and you would be devoured by the other. For many populations around the world, the conundrum of successfully preventing and/or treating heart failure (HF) to increase longevity, only to increase the probability that it will increase the number of people living with and dying from atrial fibrillation (AF), represents a conundrum of …

Exploration Of The Effects Of Developmental Coordination Disorder On Skeletal Development From Childhood Through To Early Adulthood, Jocelyn Tan

Theses

This thesis examined bone development from childhood into early adulthood in individuals with developmental coordination disorder (DCD) using a life course health development framework. One systematic review was conducted, and four original research studies produced with retrospective data from four unique cohorts in childhood, adolescence, and adulthood. Physical activity was assessed via accelerometry in Finnish child and adult populations and via self-reporting in an Australian population at 17 and 20 years. Bone was assessed via peripheral quantitative computed tomography in adolescents and dual energy x-ray absorptiometry in adults at age 20 years in two Australian cohorts. Bone was assessed cross-sectionally …

Early Movement Matters: Examining The Influence Of Early Postnatal Caregiving Experiences Of Term Infants On Motor And Head Shape Outcomes Across Infancy, Helen E. Beaton

Theses

The nurturing, handling and positioning exposures infants experience during daily caregiving contribute to their physical, motor, cognitive and social–emotional development. A relationship exists between infant sleep and wake-time positioning, the emergence of motor skills and the development of head shape deformities diagnosed as non-synostotic plagiocephaly (NSP). However, the underlying causal mechanism of the specific caregiving behaviours that may play a role remains unclear.

The purpose of the study was to investigate the association between maternal caregiving behaviours and the developmental outcomes of ‘low-risk’ term infants in the first 10 months of life. The first phase of the research involved the …

Advances In Upper Gastrointestinal Surgery: Management And Diagnostic Techniques, Gregory L. Falk

Theses

Upper gastrointestinal surgery has progressively moved from the surgically open abdomen to minimally invasive surgery, largely due to technological improvements in instrumentation. A direct result of this Gestalt has been improved patient comfort, rapid recovery and significantly less length of stay in the hospital and therefore significant cost-savings. This was the key impetus to my development of many of the skills in minimally invasive surgery and the subsequent dissemination to other surgeons in an organized and well-recognized teaching system. Many of the novel techniques of this type of surgery led to several publications both in the English and French oncological …

The Experiences Of Parents Diagnosed With Cancer Whilst Parenting Minor-Aged Children, George Prince

Theses

The incidence of cancer in Australia for people in the parenting age range is significant, and as the fertility rate of women aged 35 years and over continues to rise, many cancer patients may be parenting minor-aged children. The aim of this research was therefore to explore the lived experience of parents diagnosed with cancer whilst parenting minor-aged children, and to gain knowledge and understanding as to how parents and their families respond to a parent’s cancer illness. Utilising a qualitative research design, eight participants, receiving treatment for cancer in a private hospital cancer treatment service, and parenting at least …

Advance Care Planning In Cancer Patient - Caregiver Dyads, Natasha Michael

Theses

For many, a cancer diagnosis signals death's inevitability and elicits much existential concern. In the quest for life prolongation, many are offered or seek life-sustaining treatments, fail to appreciate a declining trajectory and lack the opportunity to seek information or plan meaningfully for their future.

Advance care planning (ACP) provides an avenue for patients and their caregivers to plan for future care. ACP is defined ‘as a process that supports adults at any age or stage of health in understanding and sharing their personal values, life goals and preferences regarding future medical care’ and is a key quality indicator in …

Caring For Individuals Who Have Used Methamphetamine: A Study Exploring The Experiences Of West Australian Nurses Working In An Authorised Mental Health Institute, John Kriticos

Theses

Background: Methamphetamine (MA) use in Australia has stabilized over the last 22 years, however changing routes of administration and increased purity of the drug has led to greater rates of physical dependency and higher rates of cardiovascular, neurological, and mental health complications. Challenges managing MA related presentations have been reported in Australian Emergency Departments (ED’s), with limited research considering nurses’ experience treating individual(s) who use MA (IWUM) and require prolonged mental health care. Purpose: The aim of this study was to understand nurses’ experiences who care for IWUM in a West Australian hospital’s inpatient mental health service. Methods: Interpretive phenomenological …

Wellbeing In The Outdoors: Exploring The Impact Of An Outdoor Adventure Education Program For The Social And Emotional Wellbeing Of Western Australian Adolescents From Selected Independent Schools, Michael Down

Theses

Outdoor adventure education (OAE) programs encompass practical outdoor activities, such as hiking or canoeing, and activities promoting interpersonal and intrapersonal development. Participants are challenged in a manner that appeals to typical risk-taking behaviours common in adolescents, resulting in benefits such as resilience development, personal growth, individual empowerment, and self-efficacy. OAE is commonly used to support positive physical, emotional, and psychological changes among adolescents.

This research aimed to determine the most impactful OAE activities for adolescent wellbeing. A sequential mixed-methods research design using a pragmatic approach was undertaken to identify the most impactful OAE elements for participant wellbeing. This research involved …

An Investigation Of Registered Nurses’ Knowledge And Decision-Making Processes In Relation To The Management Of Adults With Diabetic Ketoacidosis, Megan Alice Westphalen

Theses

Introduction: Diabetic ketoacidosis (DKA) is an acute complication of diabetes. Registered nurses (RNs) knowledge with regard to DKA has never been investigated in any depth, nor has their decision making ever been examined in this specific context.

Research Significance: Nursing research literature acknowledges that nurses have an important role in the management of patient with DKA. However, there is very little empirical evidence available to support this claim. The purpose of this study is to provide evidence of the level of knowledge, the decision-making processes and the factors that influence nurses’ decision making whilst managing patients with DKA.

Methodology: A …

‘Burnt Out Lamps’: Exploring The Impact Of Occupational Stress And Burnout On The Wellbeing Of Intensive Care Nurses In A Tertiary Hospital, Swapna Mathew

Theses

Occupational stress and burnout are commonly experienced by nurses in the intensive care unit and contribute to poor nursing practice. A study in the United Kingdom revealed that approximately one-third of the intensive care unit team members were at a ‘high risk’ for burnout syndrome. Research suggests that multiple factors contribute to occupational stress and burnout, including nursing shortages, staff turnover, high workloads, workplace conflicts, and bullying. Research suggests that the wellbeing of nurses is imperative in ensuring the best delivery of care to patients, which further results in positive health outcomes for patients.

This study was conducted in a …

A Study On Post-Burn Healing: Optimising Scar Outcome Through The Use Of A Silicone-Based Film-Forming Wound Dressing, Fiona Poelchow

Theses

Introduction

The development of scarring is a normal physiological response during burn wound healing for any except the most trivial of injuries. Burn scarring can cause considerable functional and psychological anguish in burn survivors. Prolonged wound healing has been shown to affect scarring outcomes. Superficial cutaneous wound injuries carry a risk of scarring and altered pigmentation after the wound has healed. The primary aim of this study was to explore the effects of topical silicone on the rate of wound healing in superficial wounds. Secondary aims included investigation of scar and pain outcomes.

Methods

This thesis presents two studies which …

Implementing Quality Improvement Strategies In Real-World General Practice- A Study Focused On Cardiovascular Disease, Charlotte Hespe

Theses

Introduction

General practitioners (GPs) are central to cardiovascular disease (CVD) prevention and management. However, multiple studies show they have sub-optimal assessment and management of CVD risk. The central question addressed in this thesis was: How do we translate preventive care guidelines into the real world of Australian general practice through Quality Improvement Collaboration (QIC)?

Methods

The research comprised of four studies. The first examined the experiences of stakeholders participating in a quality improvement collaboration (QIC) intervention undertaken in Australian primary care [the Australian Primary Care Collaboratives [APCC] program], and the second assessed implementation of the 2012 CVD risk management guidelines …

Intraperitoneal Instillation Of Local Anaesthetic (Ipila) In Bariatric Surgery And The Effect On Post-Operative Pain Scores: A Randomised Control Trial, Ramandeep Kaur

Theses

Background
Effective analgesia during bariatric procedures may be vital as it could reduce post-operative opioid use. This can lead to less nausea which may be associated with shorter post- operative length of stay (LOS). Understanding analgesic requirements in patients with obesity is important due to the varied physiology and increased number of comorbidities.

Objectives
The aim of this study was to evaluate the efficacy of IntraPeritoneal Instillation of Local Anaesthetic (IPILA) to reduce opioid requirements in patients undergoing laparoscopic bariatric surgery.

Methods
A double-blinded randomised control trial was conducted to compare intraperitoneal instillation of ropivacaine to normal saline in 104 …

Participation Of Tanzanian Nurses And Midwives In The Implementation Of Millennium Development Goals 4 (Reduction Of Child Mortality) And 5 (Improvement Of Maternal Health): A Case Study, Peter Taratara

Theses

In 2000, the United Nations (UN) developed the Millennium Development Goals (MDGs) as an international framework to address poverty, promote sustainable development, and improve global health. The framework was translated into 8 goals with goals 4 and 5 targeting the reduction of child mortality and the improvement of maternal health. The UN and the World Health Organization (WHO) encouraged nurses and midwives to participate in the implementation process of the MDGs, and each country had the responsibility of formulating its own implementation policies and plans. The encouragement to participate was from the understanding that nurses and midwives are the backbone …

The Accuracy And Validity Of Self-Reported Throwing Loads And The Characteristics Of Throws By Elite Cricket Players In Australia, Zachariah G. Hoyne

Theses

Objectives: To determine the relationship between elite cricket player’s self-reported and independently observed throwing volume. Examine whether sex, playing position, or time to upload self-reported data post training influences the accuracy of self-reported throwing loads. Describe the type and number of throws performed during elite cricket training, and identify characteristics such as type, distance and accuracy of throws.

Design: Cross-sectional study.

Methods: A total of eight female and 18 male professional cricket players participated in the study. Overarm throws from 12 training sessions during the 2020-21 cricket year were observed. Player self-reported throwing volume data were retrieved …

Personalised Antimicrobial Dosing In Paediatric Cystic Fibrosis, Sahand Imani

Theses

Children with cystic fibrosis (CF) are predisposed to recurrent pulmonary exacerbations throughout their lifetime. This is characterised by an acute worsening of respiratory symptoms in the setting of bacterial infection and results in significant morbidity and mortality. Appropriate antimicrobial therapy is fundamental to management, in particular aminoglycoside antibiotics. Tobramycin is the preferred aminoglycoside of choice, usually administered intravenously for 7 to 14 days.

Tobramycin dosing can be challenging in patients with CF. This is due to the underlying pharmacokinetic derangements (e.g., volume of distribution, organ function) frequently observed in this population. Accordingly, the use of standard dosing (based on age …

From Isolation To Inclusion: Embracing Local Perspectives In Examining The Treatment Model Of Care For Aboriginal Persons Affected By Tuberculosis Or Leprosy In The Kimberley Region, North Western Australia, Stefanie Jane Oliver

Theses

In the remote Kimberley region of North Western Australia, tuberculosis (TB) and leprosy continue to affect a small number of Aboriginal people, despite historical efforts to eliminate either disease. Treatment, predominantly antibiotic therapy, is a principal therapeutic intervention used to cure TB and leprosy and halt infection transmission. Decisions made around treatment therefore impact not only the individual person affected, but also their families and communities. The well-worn models of Directly Observed Therapy (DOT) and case management are used nationally to assist treatment continuity and completion. Neither model has been substantiated for cultural appropriateness nor for meeting the specific needs …

Does Acupuncture/Dry Needling Improve Pain And Itch In Abnormal Hypertrophic Scars, Catherine Tuckey

Theses

This research program investigated the use of acupuncture intervention as an adjunct for hypertrophic scar (HTS) management. Mechanistic evidence from ex vivo and animal studies suggests that acupuncture has the potential to modulate neurogenic inflammation to influence pain and itch associated with HTS. Further, acupuncture may mediate non-neuronal cells involved in the proliferation and remodelling stage of healing to promote scar maturation. Previous studies using acupuncture for scar management demonstrated positive outcomes, however low-quality clinical trials and case studies provide limited evidence for treatment benefit.

A treatment protocol was designed to investigate the effects of locally applied acupuncture compared to …

Implementation Of Patient Involvement In The Development Of A Health-Related Quality Of Life Patient-Reported Outcome Measure For Ovarian Cancer, Sharolin Boban

Theses

Ovarian cancer is the second most common gynaecological cancer and the eighth-most common cause of death in Australian women with a five-year relative survival of 46%. Using a ‘ground-up approach’ and patient involvement, this research project implemented a sequential mixed methods approach to develop a health-related quality of life outcome measure across the disease trajectory.

The six key themes identified from initial qualitative data highlighted treatment-related and psychosocial challenges alongside financial issues, relationships with health professionals, and patient coping strategies. This informed the generation of items necessary to develop a draft health-related quality of life tool. A cognitive interviewing technique …

Does Acupuncture Have A Role As An Analgesic In The Emergency Setting?, Andrew Jan

Theses

Background: Pain is a feature of most emergency department (ED) presentations. Exacerbation of chronic pain comprises 40% of pain presentations, with the remainder being a mix of recurrent or one-off painful conditions. Opioids are the mainstay treatment for moderate to severe pain but have both short- and long-term adverse effects, including recurrent use, abuse and death. Nonsteroidal anti-inflammatory drugs (NSAIDs) are also a concern, especially in older patients with comorbidities. Thus, emergency physicians are highly motivated to seek alternatives for pain management. Acupuncture is frequently used in outpatient settings that offer nonpharmacological treatments and has gained acceptance in postoperative analgesia; …

Computed Tomography Coronary Angiography (Ctca) For The Risk Assessment Of Acute Coronary Syndrome Patients, Steele Butcher

Theses

Coronary heart disease is the single most frequent cause of mortality in Western countries. Up to 30% of patients surviving an acute coronary syndrome (ACS) will experience a recurrent event within 5 years. Yet precisely defining which of these patients will go on to experience a recurrent event remains difficult despite the use of contemporary risk scores, such as the SYNTAX (Synergy between Percutaneous Coronary Intervention with TAXUS and Cardiac Surgery) and GRACE (Global Registry of Acute Coronary Events) scores. Given the important role of computed tomography coronary angiography (CTCA) in defining risk in the low to intermediate risk coronary …

Osseointegration For Amputees: Past, Present And Future: Basic Science, Innovations In Surgical Technique, Implant Design And Rehabilitation Strategies, Munjed Al Muderis

Theses

Loss of a leg or arm is a tremendous disability. Immediate and obvious impairments are decreased mobility or diminished functional capacity. Not quite as obvious are the difficulties associated with activities of daily living, quality of life impairments, sometimes loss of independence or employment, and the mental health issues which often accompany limb loss. The interface between native tissue and the prosthetic limb presents the greatest challenge to amputee rehabilitation. Computer-controlled robotic limbs have been widely available since the 1990s. However, the weight of prosthetic limbs, coupled with the difficulty of where to locate the components, requires substantial loads to …

Nurse Escorts’ Perceptions Of Their Ability To Manage Patient Clinical Deterioration During Nurse-Led Inter-Hospital Ambulance Transfer In The Wheatbelt Region Of Western Australia: A Mixed Methods Study, Sinqobizitha Mndebele

Theses

The Western Australia (WA) Country Health Service (WACHS) requires a ward or emergency department registered nurse (RN) to assume the responsibility of conducting inter-hospital nurse-led patient ambulance transfers. In WACHS, these nurses are usually generalist nurses with no specialised training. WACHS has various escalation policies, guidelines and support systems for nurses when they are located within the hospital and wards. However, despite these escalation protocols being clear in this setting, their relevance and practicality during patient transport is uncertain. This research explores how well equipped WACHS RNs in the Wheatbelt region of WA are in managing clinical deterioration of patients …

Martuwarra First Law Multi-Species Justice Declaration Of Interdependence: Wellbeing Of Land, Living Waters, And Indigenous Australian People, Anne Poelina

Theses

The thesis is comprised of experiential research, poetry, film and peer reviewed publications, and book chapters culminating in twelve chapters and two appendices. The study is in the Kimberley region of northern Western Australia. The study used an Indigenous decolonising research paradigm. It calls for a powerful policy and investment approach to the planning and development of regional governance. The author engaged ‘cooperative participative inquiry’ with leaders from six independent Indigenous Nations. These Nations are connected through Warloongarriy, the First Law for Martuwarra, the Fitzroy River.

First law is the spirit that connects all things and promotes multispecies justice through …

Cancer Education Framework For Australian Medical Schools, Darren Starmer

Theses

The incidence, mortality, survival, and impact of cancer on the Australian health system and community highlight the need for Australian medical schools to adequately prepare medical student to care for patients with cancer. Several studies have shown that Australian medical students are ill-prepared to care for cancer patients upon graduation. At a national level, oncology and palliative care curricula have been developed. However, it is unclear as to the level of uptake of either curricula within Australian medical schools. There remains a lack of consensus on what content to include in a cancer curriculum and how best to deliver such …

A Cross-Sectional Comparison Study Of The Frequency Of Terminal Care Medication Prescriptions During The Final 48 Hours Of Life In Inpatients Of A Tertiary Acute Hospital With An End Of Life Care Pathway Compared To A Tertiary Acute Hospital Without An End Of Life Care Pathway And A Hospice, Shawna Koh

Theses

The care towards the end of life is an important aspect of patient management. There is a recognised need to support healthcare providers in caring for dying patients in the acute hospital.(1-5) The Liverpool Care Pathway was originally designed to provide guidance in the delivery of comprehensive palliative care in the last days of life. However, there are no robust clinical data supporting the use of the Liverpool Care Pathway despite its widespread implementation worldwide.(6, 7)

This study investigated whether implementation of an end of life care pathway, adapted from the Liverpool Care Pathway, increases the frequency of prescriptions of …

Proactive Management Of Acute Oedema Following Hand And Minor Burn Injury, Dale O. Edwick

Theses

Burn injury is a unique trauma. The inflammatory process initiated with burn injury adversely influences all of the Starling equation variables, resulting in increased transvascular fluid filtration, so that oedema as a product of burn injury is more readily formed than in other forms of trauma. Localised wound oedema forms due to minor burn injury, with increasing systemic oedema associated with increased size of burn. It is now recognised that a marked inflammatory and immune response is created with non-severe burn injury, indicating a systemic component with all burns. The effect of oedema formation on the course of the burn …

Journeying Through Uncharted Territory: The Role Of Humour In Adaption Of Undergraduate Nursing Students In Their First Year Of Study, Marie-Josée Boulianne

Theses

Newly graduated nurses adapting to their professional role have been studied, mainly in their first year of practice. The development of coping strategies, acculturation and other adaptations to the nursing world begin at the onset of the educational journey. Understanding how these manifest early in the formative years can enable educators to tailor nursing programs to assist the future nurse to develop positive coping mechanisms and help pave the way to a successful transition into practice. This research aimed to identify elements conducive to positive adaptation and wellbeing of nursing students during their first year of nursing studies, including the …