Medicine and Health Sciences Commons^™

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, …

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.

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 …

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 …

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 …

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.

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 …

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 …

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 …

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 …

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