Medicine and Health Sciences Commons^™

Optimising Motor Learning Of Infants At High Risk Of Cerebral Palsy Using Goal-Oriented And Environmental Interventions, Catherine Morgan

Theses

Background and aims: Cerebral palsy (CP) is the most common physical disability of childhood occurring in 1 in 500 live births in developed countries. Although CP starts in infancy because of a lesion in the developing brain, it is usually not diagnosed until about 19 months. The problem with late detection has meant that early neurorehabilitation is not accessed until motor impairment is evident. Consequently the dose of active intervention during the critical period for brain plasticity is often inadequate. Little evidence exists for the effectiveness of early intervention (EI) protocols for infants with CP. In particular, interventions that take …

Traumatic Facet Joint Dislocations In Western Australia, Vivek Eranki

Theses

Background: Early enlocation of dislocated cervical facets is important to minimize long term neurological deficit.

Aims: To assess impact of delay in enlocation on clinical outcome in patients with facet dislocations and propose a scheme for enlocation for rural patients who usually have longer enlocation times.

Methods: A retrospective analysis of consecutive cervical spine facet joint dislocations presenting to Royal Perth Hospital from January 2009 to November 2012 was carried out to assess factors affecting final neurological outcome (ASIA score) at discharge.

Results: A total of 51 patients were included in the study. More patients in the urban group had …

Evaluating Web-Based Pelvic Floor Muscle Education For Pregnant Women, Judith Wilson

Theses

Background: Guidelines recommend that when pregnant women attend antenatal education they gain adequate knowledge about pregnancy-related topics, including the function of pelvic floor muscles and how to undertake a pelvic floor muscle exercise programme. Evidence is limited about how this information can be optimally delivered to pregnant women such that they gain knowledge, confidence and motivation to engage in a pelvic floor muscle exercise programme during the antenatal period. The primary objectives of the research were to evaluate the effect of delivering a web-based pelvic floor muscle education intervention in addition to usual antenatal care on primiparae women’s awareness; knowledge; …

Framing Overdiagnosis In Breast Screening: A Qualitative Study With Australian Experts, Lisa M. Parker, Lucie Rychetnik, Stacy Carter

Medical Papers and Journal Articles

Background: The purpose of this study was to identify how the topic of overdiagnosis in breast cancer screening is framed by experts and to clarify differences and similarities within these frames in terms of problems, causes, values and solutions.

Methods: We used a qualitative methodology using interviews with breast screening experts across Australia and applying framing theory to map and analyse their views about overdiagnosis. We interviewed 33 breast screening experts who influence the public and/or policy makers via one or more of: public or academic commentary; senior service management; government advisory bodies; professional committees; non-government/consumer organisations. Experts were currently …

Neuropsychological And Functional Outcomes In Recent-Onset Major Depression, Bipolar Disorder And Schizophrenia-Spectrum Disorders: A Longitudinal Cohort Study, R Lee, D Hermens, S Naismith, J Lagopoulos, A Jones, J Scott, K Chitty, D White, R Robillard, E Scott, I Hickie

Medical Papers and Journal Articles

Functional disability is the lead contributor to burden of mental illness. Cognitive deficits frequently limit functional recovery, although whether changes in cognition and disability are longitudinally associated in recent-onset individuals remains unclear. Using a prospective, cohort design, 311 patients were recruited and assessed at baseline. One hundred and sixty-seven patients met eligibility criteria (M = 21.5 years old, s.d. = 4.8) and returned for follow-up (M = 20.6 months later, s.d. = 7.8). Two-hundred and thirty participants were included in the final analysis, comprising clinically stable patients with major depression (n = 71), bipolar disorder (BD; n = 61), schizophrenia-spectrum …

Conversion Of A Gastric Band Into An Intraperitoneal Port In A Patient With Optimally Debulked Stage 3c Serous Ovarian Carcinoma, P Tucker, P Cohen, J Tan, J Tan

Medical Papers and Journal Articles

Intraperitoneal (IP) chemotherapy in women with optimally debulked stage 3 ovarian cancer improves overall survival and progression-free survival, and its use has been encouraged in the adjuvant treatment of appropriately selected patients (Armstrong et al., 2006; Jaaback and Johnson, 2006). We describe a case in which a previously inserted adjustable gastric band was converted to an IP chemotherapy port during a laparotomy for advanced ovarian cancer.

When A Patient's Ethnicity Is Declared, Medical Students' Decision-Making Processes Are Affected, S C. Ewen, J Barrett, David Paul, D Askew, G Webb, A Wilkin

Medical Papers and Journal Articles

Background: Disparity in health status and healthcare outcomes is widespread and well known. This holds true for Indigenous peoples in many settings including Australia and Hawaii. While multi-factorial, there is increasing evidence of health practitioner contribution to this disparity. This research explored senior medical students’ clinical decision-making processes.

Methods: A qualitative study was conducted in 2014 with 30 final year medical students from The University of Melbourne, Australia, and The John Burns Medical School, Hawaii, USA. Each student responded to questions about a paper-based case, first in writing and elaborated further in an interview. Half the students were given a …

Should I Stay Or Should I Go? Exploring The Job Preferences Of Allied Health Professionals Working With People With Disability In Rural Australia, G Gallego, A Dew, M Lincoln, A Bundy, R Chedid, K Bulkeley, J Brentnall, C Veitch

Medical Papers and Journal Articles

Introduction: The uneven distribution of allied health professionals (AHPs) in rural and remote Australia and other countries is well documented. In Australia, like elsewhere, service delivery to rural and remote communities is complicated because relatively small numbers of clients are dispersed over large geographic areas. This uneven distribution of AHPs impacts significantly on the provision of services particularly in areas of special need such as mental health, aged care and disability services.

Objective: This study aimed to determine the relative importance that AHPs (physiotherapists, occupational therapists, speech pathologists and psychologists – “therapists”) living in a rural area of Australia and …

Values In Breast Cancer Screening: An Empirical Study With Australian Experts, Lisa Parker, Lucie Rychetnik, Stacy Carter

Medical Papers and Journal Articles

Objective:

To explore what Australian experts value in breast screening, how these values are conceptualised and prioritised, and how they inform experts’ reasoning and judgement about the Australian breast-screening programme.

Design:

Qualitative study based on interviews with experts.

Participants:

33 experts, including clinicians, programme managers, policymakers, advocates and researchers selected for their recognisable influence in the Australian breast-screening setting.

Setting:

Australian breast-screening policy, practice and research settings.

Results:

Experts expressed 2 types of values: ethical values (about what was good, important or right) and epistemological values (about how evidence should be created and used). Ethical values included delivering benefit, avoiding …

Early Primary Care Physician Contact And Health Service Utilisation In A Large Sample Of Recently Released Ex-Prisoners In Australia: Prospective Cohort Study, Jesse T. Young, Diane Arnold-Reed, David Preen, Max Bulsara, Nick Lennox, Stuart A. Kinner

Medical Papers and Journal Articles

Objective To describe the association between ex-prisoner primary care physician contact within 1 month of prison release and health service utilisation in the 6 months following release.

Design A cohort from the Passports study with a mean follow-up of 219 (±44) days post release. Associations were assessed using a multivariate Andersen-Gill model, controlling for a range of other factors.

Setting Face-to-face, baseline interviews were conducted in a sample of prisoners within 6 weeks of expected release from seven prisons in Queensland, Australia, from 2008 to 2010, with telephone follow-up interviews 1, 3 and 6 months post release.

Participants From an …

Apathy And Suicide-Related Ideation 3 Months After Stroke: A Cross-Sectional Study, Wai Kwong Tang, Lara Caeiro, Chieh Grace Lau, Huajun Liang, Vincent Mok, Gabor S. Ungvari, Ka Sing Wong

Medical Papers and Journal Articles

Background: Both apathy and suicide are common in poststroke patients. However, the association between poststroke apathy and suicide-related ideation (SI) in Chinese stroke patients is not clear and poorly understood. The aim of this study was to examine the association between apathy and SI in stroke.

Methods: A cross-sectional study was conducted to investigate the association in 518 stroke survivors from Acute Stroke Unit of the Prince of Wales Hospital in Hong Kong. Geriatric Mental State Examination-Version A (GMS) and Neuropsychiatric Inventory-apathy subscale (NPI-apathy) were employed to assess poststroke SI and apathy, respectively. Patients’ clinical characteristics were obtained with the …

Challenges In The Care Of Familial Hypercholesterolemia: A Community Care Perspective, Tom Brett, Gerald F. Watts, Diane Arnold-Reed, Damon Bell, Jacquie Garton-Smith, Alistair W. Vickery, Jacqueline D. Ryan, Jing Pang

Medical Papers and Journal Articles

Familial hyperchoelsterolaemia (FH) remains under-diagnosed and under-treated in the community setting. Earlier evidence suggested prevalence of 1:500 worldwide but newer evidence suggests it is more common. Less than 15% of FH patients are ever diagnosed with children and young adults rarely tested despite having most to gain given their lifetime exposure.

Increasing awareness among primary care teams is critical to improve detection profile for FH. Cascade testing in the community setting needs a sustainable approach to be developed to facilitate family tracing of index cases. The use of the Dutch Lipid Clinic Network Criteria score to facilitate a phenotypic diagnosis …

Evaluation Of The Regional Nurse-Supported Hepatitis C Shared Care Program In Western Australia: A Mixed Methods Study, Roanna Lobo, Lester Mascarenhas, David Worthington, Judith Bevan, Donna B. Mak

Medical Papers and Journal Articles

Background: Nurse-supported shared care services for patients living with hepatitis C have been implemented in some regional areas of Western Australia to provide access to local treatment and care services for patients and to improve currently low levels of treatment uptake. This study collected data from health professionals involved in managing the care of patients living with hepatitis C and from patients engaged in regional nurse-supported hepatitis C shared care services in Western Australia.

Methods: Key informant qualitative interviews were conducted with health professionals in regions operating a nurse-supported shared care service and in regions without this service. Patients engaged …

The Impact Of The Carer Support Needs Assessment Tool (Csnat) In Community Palliative Care Using A Stepped Wedge Cluster Trial, Samar Aoun, Gunn Grande, Denise Howting, Kathleen Deas, Chris Toye, Lakkhina Troeung, Kelli Stajduhar, Gail Ewing

Medical Papers and Journal Articles

Family caregiving towards the end-of-life entails considerable emotional, social, financial and physical costs for caregivers. Evidence suggests that good support can improve caregiver psychological outcomes. The primary aim of this study was to investigate the impact of using the carer support needs assessment tool (CSNAT), as an intervention to identify and address support needs in end of life home care, on family caregiver outcomes. A stepped wedge design was used to trial the CSNAT intervention in three bases of Silver Chain Hospice Care in Western Australia, 2012-14. The intervention consisted of at least two visits from nurses (2-3 weeks apart) …

Tracking Funded Health Intervention Research, Lesley A. King, Robyn S. Newson, Gillian E. Cohen, Jacqueline Schroeder, Selina Redman, Lucie Rychetnik, Andrew J. Milat, Adrian Bauman, Simon Chapman

Medical Papers and Journal Articles

Objective: To describe the research publication outputs from intervention research funded by Australia’s National Health and Medical Research Council (NHMRC).

Design and setting: Analysis of descriptive data and data on publication outputs collected between 23 July 2012 and 10 December 2013 relating to health intervention research project grants funded between 1 January 2003 and 31 December 2007.

Main outcome measures: Stages of development of intervention studies (efficacy, effectiveness, replication, adaptation or dissemination of intervention); types of interventions studied; publication output per NHMRC grant; and whether interventions produced statistically significant changes in primary outcome variables.

Results: Most of the identified studies …

Meningitis Or Septicaemia In A Backpacker?, Sascha Fulde, Gordian Fulde

Medical Papers and Journal Articles

Negative blood test results for meningitis but positive for Staphylococcus aureus in a young patient with suspected meningitis and a recent joint injury led to a diagnosis of staphylococcal septicaemia with septic arthritis as the source of the infection.

The Thalamus As A Putative Biomarker In Neurodegenerative Disorders, Brian D. Power, Jeffrey C.L Looi

Medical Papers and Journal Articles

Objective: This review provides a brief account of the clinically relevant functional neuroanatomy of the thalamus, before considering the utility of various modalities utilised to image the thalamus and technical challenges therein, and going on to provide an overview of studies utilising structural imaging techniques to map thalamic morphology in the spectrum of neurodegenerative disorders.

Methods: A systematic search was conducted for peer-reviewed studies involving structural neuroimaging modalities investigating the morphology (shape and/ or size) of the thalamus in the spectrum of neurodegenerative disorders.

Results: Whilst the precise role of the thalamus in the healthy brain remains unclear, there is …

The Role Of Communication In Breast Cancer Screening: A Qualitative Study With Australian Experts, Lisa M. Parker, Lucie Rychetnik, Stacy M. Carter

Medical Papers and Journal Articles

Background: One well-accepted strategy for optimising outcomes in mammographic breast cancer screening is to improve communication with women about screening. It is not always clear, however, what it is that communication should be expected to achieve, and why or how this is so. We investigated Australian experts’ opinions on breast screening communication. Our research questions were: 1 What are the views of Australian experts about communicating with consumers on breast screening? 2 How do experts reason about this topic?

Methods: We used a qualitative methodology, interviewing 33 breast screening experts across Australia with recognisable influence in the Australian mammographic breast …

Protocol For The Care-Is Trial: A Randomised Controlled Trial Of A Supportive Educational Intervention For Carers Of Patients With High-Grade Glioma (Hgg), G K B Halkett, Elizabeth A. Lobb, L Miller, J L. Phillips, T Shaw, R Moorin, A Long, A King, J Clarke, S Fewster, P Hudson, M Agar, A K. Nowak

Medical Papers and Journal Articles

Introduction: High-grade glioma (HGG) is a rapidly progressive and debilitating disease. Primary carers experience significant levels of distress which impacts on their experience of caregiving, the quality of care received and the community in terms of the increased reliance on healthcare due to the potential development of complicated grief. This paper describes the protocol for testing the efficacy and feasibility of an intervention for primary carers of patients with HGG in order to improve preparedness to care and reduce carer distress.

Methods: Randomised controlled trial. The target population is carers of patients with HGG who are undergoing combined chemoradiotherapy. The …

General Practice Registrars’ Intentions For Future Practice: Implications For Rural Medical Workforce Planning, C Harding, A Seal, J Mcgirr, T Caton

Medical Papers and Journal Articles

The models of practice that general practice registrars (GPRs) envisage undertaking will affect workforce supply. The aim of this research was to determine practice intentions of current GPRs in a regional general practice training program (Coast City Country General Practice Training). Questionnaires were circulated to 220 GPRs undertaking general practice placements to determine characteristics of ideal practice models and intentions for future practice. Responses were received for 99 participants (45%). Current GPRs intend to work an average of less than eight half-day sessions/week, with male participants intending to work more hours (t(91) = 3.528, P = 0.001). More than one-third …

Adverse Events Following Influenza Immunization Reported By Healthcare Personnel Using Active Surveillance Based On Text Messages, L Tracey, A Regan, D Mak, P Effler

Medical Papers and Journal Articles

Studies have demonstrated that healthcare personnel (HCP) have concerns about the potential side effects of trivalent inactivate influenza vaccine (IIV3).1-3 A recent metaanalysis of reasons HCP refuse IIV3 indicates the strongest predictors of vaccine acceptance are belief that the vaccine is safe and belief the vaccine does not cause the disease it is meant to prevent.1

Can We Identify Women Who Initiate And Then Prematurely Cease Breastfeeding? An Australian Multicentre Cohort Study, Julie Quinlivan, Sonia Kua, Robert A. Gibson, Andrew Mcphee, Maria M. Makrides

Medical Papers and Journal Articles

Background: Health authorities recommend 6 months of fully breastfeeding and continuation of breastfeeding for at least a year. Many women initiate breastfeeding in hospital but discontinue before the six-month period, and therefore do not optimise the public health benefits. The aim of this study was to determine whether these women could be identified at hospital discharge, to enable targeted interventions.

Methods: A secondary analysis of women who intended to breastfeed and were enrolled in a large randomized trial was undertaken. Women were enrolled in the antenatal period and antenatal, delivery and six month postnatal questionnaires were completed. Univariate and multivariate …

Apoe Ε4 Moderates Abnormal Csf-Abeta-42 Levels, While Neurocognitive Impairment Is Associated With Abnormal Csf Tau Levels In Hiv+ Individuals – A Cross-Sectional Observational Study, Lucette A. Cysique, Timothy Hewitt, Juliana Croitoru-Lamoury, Kevin Taddei, Ralph N. Martins, Constance S. Chew, Nicholas N. Davies, Patricia Price, Bruce J. Brew

Medical Papers and Journal Articles

Background: Cerebrospinal fluid (CSF) biomarkers Aβ1-42, t-tau and p-tau have a characteristic pattern in Alzheimer’s Disease (AD). Their roles in HIV-associated neurocognitive disorder (HAND) remains unclear.

Methods: Adults with chronic treated HIV disease were recruited (n = 43, aged 56.7 ± 7.9; 32% aged 60+; median HIV duration 20 years, >95% plasma and CSF HIV RNA <50 cp/mL, on cART for a median 24 months). All underwent standard neuropsychological testing (61% had HAND), APOE genotyping (30.9% carried APOE ε4 and 7.1% were ε4 homozygotes) and a lumbar puncture. Concentrations of Aβ1-42, t-tau and p-tau were assessed in the CSF using commercial ELISAs. Current neurocognitive status was defined using the continuous Global Deficit Score, which grades impairment in clinically relevant categories. History of HAND was recorded. Univariate correlations informed multivariate models, which were corrected for nadir CD4-T cell counts and HIV duration.

Results: Carriage of APOE ε4 predicted markedly lower levels of CSF Aβ1-42 in univariate (r = -.50; p = .001) and multivariate analyses (R2 = .25; p < .0003). Greater levels of neurocognitive impairment were associated with higher CSF levels of p-tau in univariate analyses (r = .32; p = .03) and multivariate analyses (R2 = .10; p = .03). AD risk prediction cut-offs incorporating all three CSF biomarkers suggested that 12.5% of participants had a high risk for AD. Having a CSF-AD like profile was more frequent in those with current (p = .05) and past HIV-associated dementia (p = .03).

Conclusions: Similarly to larger studies, APOE ε4 genotype was not directly associated with HAND, but moderated CSF …

Familial Hypercholesterolaemia: Challenges In Primary Care, Tom Brett, Gerald F. Watts, Jacquie Garton-Smith, Damon A. Bell, Alistair W. Vickery, Jing Pang, Diane Arnold-Reed

Medical Papers and Journal Articles

Familial hypercholesterolaemia remains largely unrecognised and undertreated in Australian primary care. A new approach involving increased awareness, early detection, lifelong treatment and cascade testing of relatives is essential to improve outcomes of patients with this disorder.

Key Points

• Familial hypercholesterolaemia (FH) is a relatively common inherited disorder of high cholesterol levels.
• FH can lead to atherosclerosis, premature coronary artery disease and early death if left untreated.
• Cascade testing of relatives of patients with FH is cost- effective and necessary as one in two will have the condition.
• Innovations in primary care can improve FH detection in the community.
• An integrated …

Twenty-Year Outcome Of A Longitudinal Prospective Evaluation Of Isolated Endoscopic Anterior Cruciate Ligament Reconstruction With Patellar Tendon Or Hamstring Autograft, S Thompson, L Salmon, A Waller, J Linklater, J Roe, L Pinczewski

Medical Papers and Journal Articles

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

Purpose: This longitudinal prospective study reports the outcomes of isolated ACL reconstruction using middle-third patellar tendon autografts in 90 patients over 20 years.

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

Methods: Between January 1993 and April 1994, a total of 90 patients met study inclusion criteria: evaluation at 1, 2, 3, 4, 5, 7, 10, 15, and 20 years after surgery. Exclusion criteria were associated ligamentous injuries requiring surgery, previous meniscectomy or meniscal injuries requiring more than one-third meniscectomy, …

The Telehealth Skills, Training, And Implementation Project: An Evaluation Protocol, Andrew Bonney, Patricia Knight-Billing, Judy Mullan, Michelle Moscova, Stephen Barnett, Don Iverson, Daniel Saffioti, Elisabeth Eastland, Michelle Guppy, Kathryn Weston, Ian Wilson, Judith Nicky Hudson, Dimity Pond, Gerard Gill, Charlotte Hespe

Medical Papers and Journal Articles

External stabilization is reported to improve reliability of hand held dynamometry, yet this has not been tested in burns. We aimed to assess the reliability of dynamometry using an external system of stabilization in people with moderate burn injury and explore construct validity of strength assessment using dynamometry.

Participants were assessed on muscle and grip strength three times on each side. Assessment occurred three times per week for up to four weeks. Within session reliability was assessed using intraclass correlations calculated for within session data grouped prior to surgery, immediately after surgery and in the sub-acute phase of injury. Minimum …

Implementation Of The International Association Of Diabetes And Pregnancy Study Groups Criteria: Not Always A Cause For Concern, P Sibartie, J Quinlivan

Medical Papers and Journal Articles

Background: Controversy surrounds the decision to adopt the International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria for the diagnosis of gestational diabetes mellitus (GDM) as fears that disease prevalence rates will soar have been raised.

Aims: To investigate the prevalence of pregnancy complicated with GDM before and after the introduction of the IADPSG 2010 diagnostic criteria.

Materials and Methods: A prospective audit of all women who delivered from July 1, 2010, to June 30, 2014, in a predefined geographic region within the North Metropolitan Health Service of Western Australia. Women were diagnosed with GDM according to Australian Diabetes …