Medicine and Health Sciences Commons^™

Changing The Antibiotic Prescribing Of General Practice Registrars: The Chap Study Protocol For A Prospective Controlled Study Of A Multimodal Educational Intervention, Mieke L. Van Driel, Simon Morgan, Amanda Tapley, Lawrie Mcarthur, Patrick Mcelduff, Lucy Yardley, Anthea Dallas, Laura Deckx, Katie Mulquiney, Joshua S. Davis, Andrew Davey, Kim Henderson, Paul Little, Parker J. Magin

Medical Papers and Journal Articles

Background: Australian General Practitioners (GPs) are generous prescribers of antibiotics, prompting concerns including increasing antimicrobial resistance in the community. Recent data show that GPs in vocational training have prescribing patterns comparable with the high prescribing rate of their established GP supervisors. Evidence-based guidelines consistently advise that antibiotics are not indicated for uncomplicated upper respiratory tract infections (URTI) and are rarely indicated for acute bronchitis. A number of interventions have been trialled to promote rational antibiotic prescribing by established GPs (with variable effectiveness), but the impact of such interventions in a training setting is unclear. We hypothesise that intervening while early-career …

Can My Mechanic Fix Blue Cars? A Discussion Of Health Clinician's Interactions With Aboriginal Australian Clients, S Hill, S Ewen, D Paul, A Wilkin

Medical Papers and Journal Articles

We expect our professional mechanics to ‘diagnose’ and 'treat' our cars irrespective of colour, but are we expecting less from our health professionals? There is an increasing focus in the literature on health practitioner decision-making and its influence on the nature and quality of health care. In this article we explore how the basic diagnostic and therapeutic skills that health care practitioners have should be utilised equitably for all clients and propose ways this might be realised. Could the development of Indigenous specific curricula be teaching our medical students to think that Aboriginal patients are different from the norm? We …

The Western Australian Clinical Senate As A Model For State-Wide Clinical Engagement, J Quinlivan, T Basile, K Gibson, D Xu, N Croker

Medical Papers and Journal Articles

International reforms in healthcare have established the principal that embracing clinical engagement can drive healthcare reform and improved safety and quality outcomes. Most attention has focussed on how clinicians might be engaged at a local or hospital level. However, healthcare reforms are usually initiated at a state or national level. Less attention has gone into exploring the key elements of a model to achieve clinical engagement at state or national level. This paper explores the key elements of a successful state-wide clinical engagement model including culture and leadership, membership, decision-making processes and accountability and discusses how the current model of …

A Patient Preference Study That Evaluated Fluticasone Furoate And Mometasone Furoate Nasal Sprays For Allergic Rhinitis, A Yanez, A Dimitroff, P Bremner, C Rhee, G Luscombe, B Prillaman, N Johnson

Medical Papers and Journal Articles

Background: Corticosteroid nasal sprays are the mainstay of treatment for allergic rhinitis. These sprays have sensory attributes such as scent and/or odor, taste and aftertaste, and run down the throat and/or the nose, which, when unpleasant, can affect patient preference for, and compliance with, treatment.

Objective: This study examined patient preference for fluticasone furoate nasal spray (FFNS) or mometasone furoate nasal spray (MFNS) based on their sensory attributes after administration in patients with allergic rhinitis.

Methods: This was a multicenter, randomized, double-blind, cross-over study. Patient preferences were determined by using three questionnaires (Overall Preference, Immediate Attributes, and Delayed Attributes).

Results: …

All Care, But Whose Responsibility? Community Juries Reason About Expert And Patient Responsibilities In Prostate-Specific Antigen Screening For Prostate Cancer, C Degeling, S Carter, L Rychetnik

Medical Papers and Journal Articles

General practitioners have implicitly been given responsibility for guiding men’s decisions about prostate-specific antigen–based screening for prostate cancer, but patients’ expectations of the bounds of this responsibility remain unclear. We sought to explore how well-informed members of the public allocate responsibilities in prostate-specific antigen screening decision-making. In 2014, we convened two Community juries in Sydney, Australia, to address questions related to the content and timing of information provision and respective roles of patients and general practitioners in screening decisions. Participants in the first jury were of mixed gender and of all ages (n = 15); the participants in the second …

Development Of A Video-Based Education And Process Change Intervention To Improve Advance Cardiopulmonary Resuscitation Decision-Making, Nicholas Waldron, Clare V. Johnson, P Saul, Waldron Heidi, Jeffrey C. Chong, Anne-Marie Hill, Barbara Hayes

Medical Papers and Journal Articles

Background: Advance cardiopulmonary resuscitation (CPR) decision-making and escalation of care discussions are variable in routine clinical practice. We aimed to explore physician barriers to advance CPR decision-making in an inpatient hospital setting and develop a pragmatic intervention to support clinicians to undertake and document routine advance care planning discussions.

Methods: Two focus groups, which involved eight consultants and ten junior doctors, were conducted following a review of the current literature. A subsequent iterative consensus process developed two intervention elements: (i) an updated ‘Goals of Patient Care’ (GOPC) form and process; (ii) an education video and resources for teaching advance CPR …

A Middle-Aged Man With Cellulitis, R Sullivan, G Fulde

Medical Papers and Journal Articles

A middle-aged man presents with an extremely painful swollen red leg and signs of sepsis. He has a history of chronic venous insufficiency, obesity, diabetes, hypertension and obstructive sleep apnoea. What are your differential diagnoses and how should he be managed?

Employment May Protect Fathers In The Setting Of Maternal Teenage Pregnancy From Anxiety And Depression: Findings From The Australian Father's Study, A Atkinson, R Petersen, J Quinlivan

Medical Papers and Journal Articles

Objective: There is limited research on fathers in the setting of maternal teenage pregnancy. Most studies report data from regions of social disadvantage and low education. We report on the levels of anxiety, depression and quality of life of fathers in the setting of maternal teenage pregnancy in an area where the unemployment rate is low.

Methods: Observational study of 50 fathers in the setting of maternal teenage pregnancy and 100 fathers whose partners were not teenagers (control), living within the same metropolitan healthcare region with high employment rates. Fathers were enrolled within the larger Australian Father’s Study and were …

Poly-Arginine Peptides Reduce Infarct Volume In A Permanent Middle Cerebral Artery Rat Stroke Model, D Milani, V Clark, J Cross, R Anderton, N Knuckey, B Meloni

Medical Papers and Journal Articles

Background: We recently reported that poly-arginine peptides have neuroprotective properties both in vitro and in vivo. In cultured cortical neurons exposed to glutamic acid excitotoxicity, we demonstrated that neuroprotective potency increases with polymer length plateauing at R15 to R18 (R = arginine resides). In an in vivo study in rats, we also demonstrated that R9D (R9 peptide synthesised with D-isoform amino acids) administered intravenously at a dose of 1000 nmol/kg 30 min after permanent middle cerebral artery occlusion (MCAO) reduces infarct volume. Based on these positive in vitro and in vivo findings, we decided to examine the neuroprotective efficacy of …

Huperzine A For Treatment Of Cognitive Impairment In Major Depressive Disorder: A Systematic Review Of Randomized Controlled Trials, Wei Zheng, Ying-Qiang Xiang, Gabor S. Ungvari, Helen Chiu, Chee H. Ng, Ying Wang, Yu-Tao Xiang

Medical Papers and Journal Articles

Background: Acetylcholinesterase (AChE) inhibitors have been shown to be effective in treating cognitive impairment in animal models and in human subjects with major depressive disorder (MDD). Huperzine A (HupA), a Traditional Chinese Medicine derived from a genus of clubmosses known as Huperzineserrata, is a powerful AChE inhibitor that has been used as an adjunctive treatment for MDD, but no meta-analysis on HupA augmentation for MDD has yet been reported.

Aim: Conduct a systematic review and meta-analysis of randomized controlled trials (RCTS) about HupA augmentation in the treatment of MDD to evaluate its efficacy and safety.

Methods: Two evaluators independently searched …

An International Randomised Controlled Trial To Compare Targeted Intraoperative Radiotherapy (Targit) With Conventional Postoperative Radiotherapy After Breast-Conserving Surgery For Women With Early-Stage Breast Cancer (The Targit-A Trial), J Vaidya, F Wenz, M Bulsara, J Tobias, D Joseph, C Saunders, C Brew-Graves, I Potyka, S Morris, H Vaidya, N Williams, M Baum

Medical Papers and Journal Articles

Background: Based on our laboratory work and clinical trials we hypothesised that radiotherapy after lumpectomy for breast cancer could be restricted to the tumour bed. In collaboration with the industry we developed a new radiotherapy device and a new surgical operation for delivering single-dose radiation to the tumour bed – the tissues at highest risk of local recurrence. We named it TARGeted Intraoperative radioTherapy (TARGIT). From 1998 we confirmed its feasibility and safety in pilot studies.

Objective: To compare TARGIT within a risk-adapted approach with whole-breast external beam radiotherapy (EBRT) over several weeks.

Design: The TARGeted Intraoperative radioTherapy Alone (TARGIT-A) …

Perinatal Maternal Depression And Cortisol Function In Pregnancy And The Postpartum Period: A Systematic Literature Review, Sunaina Seth, Andrew J. Lewis, Megan Galbally

Medical Papers and Journal Articles

Background:

Perinatal depression has a significant impact on both mother and child. However, the influence of hormonal changes during pregnancy and the postpartum period remains unclear. This article provides a systematic review of studies examining the effects of maternal cortisol function on perinatal depression.

Method:

A systematic search was conducted of six electronic databases for published research on the relationship between cortisol and perinatal depression. The databases included; MEDLINE complete, PsychINFO, SCOPUS, Psychology and Behavioural Sciences, Science Direct and EBSCO, for the years 1960 to May 2015. Risk of bias was assessed and data extraction verified by two investigators

Results: …

Effectiveness Of A Service Learning Model With Allied Health Assistant Students In Aged Care, D Zulch, R Saunders, J Peters, J Quinlivan

Medical Papers and Journal Articles

This mixed methods audit explores the impact of a student learning activity involving service learning. As part of a vocational course in the Academy of Health Sciences at the West Coast Institute, Allied Health Assistant (AHA) students participated in a service learning program focused on work-based learning in residential aged care. Students delivered a therapy program for residents at the facility. Students completed validated evaluation questionnaires on conclusion of study. Of 121 students completing the audit, 91% thought the experience challenged their way of thinking. Only 2% disagreed with this concept. A majority of students (93%) reported the experience interesting …

Relationship Between Community Drug Administration Strategy And Changes In Trachoma Prevalence, 2007 To 2013, Bette Liu, Carleigh Cowling, Andrew Hayen, Gabrielle Watts, Donna Mak, Stephen Lambert, Hugh Taylor, John M. Kaldor

Medical Papers and Journal Articles

Australia is the only high income country with persisting endemic trachoma and a national control program has been in place since 2006. The program involves annual screening of children for trachoma in communities designated to be at high risk of disease and treatment of those affected with the antibiotic azithromycin. Depending on the level of trachoma detected in children, antibiotic treatment is also given to households and other community members. We used data collected annually from 2007 to 2013 to examine what effect the extent of azithromycin treatment had on subsequent levels of trachoma in children aged 5–9 years. We …

Health Care Homes: Lessons From The Diabetes Care Project, T Fountaine, C Bennett

Medical Papers and Journal Articles

No abstract provided.

The Presence And Predictors Of Complicated Grief Symptoms In Perinatally-Bereaved Mothers From A Bereavement Support Organization, Margaret Mcspedden Mcouns, Barbara Mullan, Louise Sharpe, Lauren J. Breen, Elizabeth Lobb

Medical Papers and Journal Articles

The present study investigated the presence and possible predictors of complicated grief symptoms in perinatally-bereaved mothers (N = 121) up to 5 years post-bereavement. The presence of complicated grief scores in the clinical range was 12.4%, which is higher than in many other bereaved populations, and the presence of other living children may protect against the development of complicated grief symptoms. The majority of the women were able to negotiate a perinatal loss without developing complicated grief; however, there remains an important group of women who up to 5 years later score in the clinical range for complicated grief symptoms.

Patient-Specific Instrumentation Does Not Improve Radiographic Alignment Or Clinical Outcomes After Total Knee Arthroplasty: A Meta-Analysis, H Huijbregts, R Khan, E Sorensen, D Fick, S Haebich

Medical Papers and Journal Articles

Background and purpose: Patient-specific instrumentation (PSI) for total knee arthroplasty (TKA) has been introduced to improve alignment and reduce outliers, increase efficiency, and reduce operation time. In order to improve our understanding of the outcomes of patient-specific instrumentation, we conducted a meta-analysis.

Patients and methods: We identified randomized and quasi-randomized controlled trials (RCTs) comparing patient-specific and conventional instrumentation in TKA. Weighted mean differences and risk ratios were determined for radiographic accuracy, operation time, hospital stay, blood loss, number of surgical trays required, and patient-reported outcome measures.

Results: 21 RCTs involving 1,587 TKAs were included. Patient-specific instrumentation resulted …

New Techniques To Characterise The Vaginal Microbiome In Pregnancy, G Mendz, N Kaakoush, J Quinlivan

Medical Papers and Journal Articles

Understanding of the vaginal microbiome in health and disease is essential to screen, detect and manage complications in pregnancy. One of the major complications of pregnancy is preterm birth, which is the leading world-wide cause of death and disability in children under five years of age. The aetiology of preterm birth is multifactorial, but a causal link has been established with infection. Despite the importance of understanding the vaginal microbiome in pregnancy in order to evaluate strategies to prevent and manage PTB, currently used culture based techniques provide limited information as not all pathogens are able to be cultured.

The …

Efficacy Of Infant Simulator Programmes To Prevent Teenage Pregnancy: A School-Based Cluster Randomised Trial In Western Australia, Sally A. Brinkman, Sarah E. Johnson, James Codde, Michael B. Hart, Judith Straton, Murthy N. Mittinty, Sven R. Silburn

Medical Papers and Journal Articles

Background: Infant simulator-based programmes seek to prevent teenage pregnancy. They are utilised in western and developing countries but, despite growing popularity, there is no published evidence of their long-term impact. The aim of this trial was to investigate the effect of such a programme, the Virtual Infant Parenting (VIP) Programme, on the pregnancy outcomes of birth and induced abortion.

Methods: Fifty-seven of 66 eligible schools (86%) in Perth, Western Australia enrolled in the pragmatic clustered (by school) randomised trial (ISRCTN24952438) with even randomisation to the intervention and control groups. Between 2003 and 2006, the VIP programme was administered to 1,267 …

Does Cardiotocography Have A Role In The Antenatal Management Of Pregnancy Complicated By Gestational Diabetes Mellitus?, T Jeffery, R Petersen, J Quinlivan

Medical Papers and Journal Articles

Background: Controversy surrounds the role of fetal cardiotocography (CTG) in the antenatal management of pregnancy complicated with gestational diabetes mellitus (GDM).

Aim: The aim was to investigate whether antenatal CTG aids the management in pregnancy complicated by GDM. Materials and Methods: A prospective audit of 1404 consecutive antenatal CTGs in women diagnosed with GDM. Outcomes for all CTGs were audited to determine if the CTGs altered pregnancy management.

Results: In women requiring combination therapy (diet and medication), 43 CTGs were required to change management of a pregnancy. In women managed by diet alone with a secondary pregnancy complication, 161 CTGs …

Osseointegrated Total Hip Replacement Connected To A Lower Limb Prosthesis: A Proof-Of-Concept Study With Three Cases, Sarah J. Lord

Medical Papers and Journal Articles

Background

Osseointegrated implants are a suitable alternative for prosthetic attachment in individuals with a transfemoral amputation, who are unable to wear a socket. However, the small bone-implant contact area, reduced muscular leverage, and osteoporosis contraindicate osseointegrated implant use in transfemoral amputees with osteoporosis and a short residuum. We report on the feasibility of combining total hip replacement (THR) with an osseointegrated implant for prosthetic attachment.

Methods

We retrospectively reviewed the cases of three transfemoral amputees who underwent osseointegration with THR between 2013 and 2014. In a two-stage procedure, a custom-made femoral prosthesis was connected to a THR with a modular …

Seasonal Trivalent Influenza Vaccination During Pregnancy And The Incidence Of Stillbirth: Population-Based Retrospective Cohort Study, Annette Regan, Hannah C. Moore, Nicholas De Klerk, Saad B. Omer, Geoffrey Shellam, Donna Mak, Paul Effler

Medical Papers and Journal Articles

Concern for the safety to the fetus is a commonly cited reason for vaccine refusal during pregnancy. Results from this investigation support the safety of seasonal influenza vaccination during pregnancy and suggest seasonal influenza vaccination may be protective against stillbirth.

Overexpression And Knock-Down Studies Highlight That A Disintegrin And Metalloproteinase 28 Controls Proliferation And Migration In Human Prostate Cancer, C Rudnicka, S Mochizuki, Y Okada, C Mclaughlin, P Leedman, L Stuart, M Epis, G Hoyne, S Boulos, L Johnson, M Schlaich, V Matthews

Medical Papers and Journal Articles

Prostate cancer is one of the most prevalent cancers inmen. It is critical to identify and characterize oncogenes that drive the pathogenesis of human prostate cancer. The current study builds upon previous research showing that a disintegrin and metalloproteinase (ADAM)28 is involved in the pathogenesis of numerous cancers. Our novel study used overexpression, pharmacological, and molecular approaches to investigate the biological function of ADAM28 in human prostate cancer cells,with a focus on cell proliferation andmigration. The results of this study provide important insights into the role of metalloproteinases in human prostate cancer.

The expression of ADAM28 protein levels was assessed …

Hospital Admission Patterns In Children With Cah: Admission Rates And Adrenal Crises Decline With Age, R Louise Rushworth, Henrik Falhammar, Craig F. Munns, Ann M. Maguire, David J. Torpy

Medical Papers and Journal Articles

Objective: To examine patterns of hospitalisation for acute medical conditions in children with congenital adrenal hyperplasia (CAH).

Design: A retrospective study of hospitalisation using administrative data. Setting. All hospitals in NSW, Australia.

Patients: All patients admitted with CAH and a random sample of admissions in patients aged 0 to 18 years without adrenal insufficiency (AI).

Main Outcome Measures: Admissions and comorbidities by age and sex.

Results: Of 573 admissions for medical problems in CAH children, 286 (49.9%) were in males, and 236 (41.2%) had a principal diagnosis of CAH or had an adrenal crisis (AC). 37 (6.5%) ACs were recorded. …

Empathy And Affect: What Can Empathied Bodies Do?, George Marshall Dr.

Medical Papers and Journal Articles

While there has been much interest in the apparent benefits of empathy in improving outcomes of medical care, there is continuing concern over the philosophical nature of empathy. We suggest that part of the difficulty in coming-to-terms with empathy is due to the modernist dichotomies that have structured Western medical discourse, such that doctor and patient, knower and known, cognitive and emotional, subject and object, are situated in oppositional terms, with the result that such accounts cannot coherently encompass an emotional doctor, or a patient as knower, or empathy as other than a possession or a trait. This paper explores …

The Performance Of Risk Prediction Models For Pre-Eclampsia Using Routinely Collected Maternal Characteristics And Comparison With Models That Include Specialised Tests And With Clinical Guideline Decision Rules: A Systematic Review, Z Al-Rubaie, L Askie, J Ray, H Hudson, S Lord

Medical Papers and Journal Articles

Background: Risk prediction models may be valuable to identify women at risk of pre-eclampsia to guide aspirin prophylaxis in early pregnancy.

Objective: To assess the performance of ‘simple’ risk models for pre-eclampsia that use routinely collected maternal characteristics; compare with ‘specialised’ models that include specialised tests; and to guideline recommended decision rules.

Search strategy: MEDLINE, Embase and PubMed were searched to June 2014.

Selection criteria: We included studies that developed or validated pre-eclampsia risk models using maternal characteristics with or without specialised tests and reported model performance.

Data collection and analysis: We extracted data on study characteristics; model predictors, validation …

Student-Centered Interventions The Key To Student Health Care Worker Influenza Vaccination, M Nyandoro, D Kelly, D Macey, D Mak

Medical Papers and Journal Articles

Objectives: To investigate influenza vaccination uptake rates, attitudes and motivations towards influenza vaccination among student health care workers (HCWs).

Methods: Self-reported influenza vaccination uptake among student HCWs at The University of Notre Dame Australia, Fremantle, Western Australia (UNDAF) was surveyed before and after implementation of a peer-led, student-centered campaign to raise awareness of, and improve access to, influenza vaccination. Data were weighted and analysed using logistic regression.

Results: Pre-campaign influenza vaccination uptake was 36.3% (95% CI=31.8%-40.8%), with students identifying lack of awareness of both the Australian Government’s recommendations and university policy, cost, and inconvenience of vaccine access …

Electroconvulsive Therapy Added To Non-Clozapine Antipsychotic Medication For Treatment Resistant Schizophrenia: Meta-Analysis Of Randomized Controlled Trials, W Zheng, X Cao, G Ungvari, Y Xiang, T Guo, Z Liu, Y Wang, B Forester, S Seiner, Y Xiang

Medical Papers and Journal Articles

This meta-analysis of randomized controlled trials (RCTs) examined the efficacy and safety of the combination of electroconvulsive therapy (ECT) and antipsychotic medication (except for clozapine) versus the same antipsychotic monotherapy for treatment-resistant schizophrenia (TRS). Two independent investigators extracted data for a random effects meta-analysis and pre-specified subgroup and meta-regression analyses. Weighted and standard mean difference (WMD/SMD), risk ratio (RR) ±95% confidence intervals (CIs), number needed to treat (NNT), and number needed to harm (NNH) were calculated. Eleven studies (n = 818, duration = 10.2±5.5 weeks) were identified for meta-analysis. Adjunctive ECT was superior to antipsychotic monotherapy regarding (1) symptomatic improvement …

The Disability Rate Of 5-Year Post-Stroke And Its Correlation Factors: A National Survey In China, Y Yang, Y-Z Shi, N Zhang, S Wang, G Ungvari, C Ng, Y-L Wang, X-Q Zhao, Y-J Wang, C-X Wang, Y-T Xiang

Medical Papers and Journal Articles

Few studies on long-term functional outcome have been conducted in post-stroke patients in China. The objective of this study was to conduct a nationwide survey in China to investigate the 5-year prevalence of post-stroke disability and its correlation factors. A total of 893 patients with ischemic stroke were included. Demographic, clinical and neuro-imaging information were collected with standardized instruments that assessed stroke severity, depression, cognitive impairment, stroke recurrence and physical disability. Disability was assessed with the modified Ranking Score (mRS), of which a cutoff score _2 indicates disability. Statistical analysis included chi-square tests, two independent samples t-tests, Mann-Whitney U test …

The Cart Before The Horse? Exploring The Potential Of Eportfolios In A Western Australian Medical School, F Bate, J Macnish, C Skinner

Medical Papers and Journal Articles

In 2014, the School of Medicine Fremantle of the University of Notre Dame Australia initiated a study to explore the curriculum underpinning portfolios used by first-year medical students. The School had used portfolios since 2005 and judged it timely to consider digital technologies as a mechanism to enhance student learning and improve efficiencies. A qualitative approach was adopted that investigated how the curriculum intersected with two ePortfolio platforms: Blackboard and Mahara. Data pertaining to the way in which Blackboard and Mahara ePortfolio platforms supported existing curriculum were collected from students through focus groups and tutors via interviews. As a measure …