Medicine and Health Sciences Commons^™

Case Series Of Elective Instrumented Posterior Lumbar Spinal Fusions Demonstrating A Low Incidence Of Venous Thromboembolism, Benjamin Weber, Alexa Seal, Joseph Mcgirr, Kerin Fielding

Medical Papers and Journal Articles

Introduction: Venous thromboembolism (VTE) is a significant cause of morbidity and mortality in orthopaedic surgery. While specific guidelines exist for hip and knee arthroplasty, there is wide variation in VTE prophylaxis in complex spinal surgery. This study sought to determine the incidence of VTE, and risk factors associated with VTE, in patients undergoing elective instrumented posterior lumbar spinal fusion.

Methods: In a single-centre case series study, 107 consecutive patients undergoing elective lumbar spinal fusion were evaluated for VTE by lower limb duplex ultrasonography and/or clinical observation, and where indicated, computed tomography pulmonary angiogram (CTPA). The Caprini model for thrombosis risk …

Domestic Violence Is A Leading Risk Factor In Default From Colposcopy Services, Rachael R. Collier, Julie Quinlivan

Medical Papers and Journal Articles

Aim: Domestic violence is common in women and is associated with poorer healthcare outcomes. However, no causal pathway has been identified to explain this observation. We have followed a cohort of women to determine whether poorer outcomes can be explained by high rates of default and lost to follow up.

Methods: A prospective cohort study was performed. Institutional ethics approval was obtained. Participants were consecutive patients attending colposcopy clinics at a major metropolitan hospital in Australia. Following ascertainment of domestic violence status, appointment outcomes for colposcopy services were tracked for a three-year period. Multivariate analysis was undertaken to determine demographic …

Evaluating The Guideline Enhancement Tool (Get): An Innovative Clinical Training Tool To Enhance The Use Of Hypertension Guidelines In General Practice, Chinthaka Balasooriya, Joel Rhee, Boaz Shulruf, Rosa Canalese, Nicholas Zwar

Medical Papers and Journal Articles

Background: This project aims to evaluate the effectiveness of an innovative educational intervention in enhancing clinical decision making related to the management of hypertension in general practice. The relatively low level of uptake of clinical practice guidelines by clinicians is widely recognised as a problem that impacts on clinical outcomes. This project addresses this problem with a focus on hypertension guidelines. Hypertension is the most frequently managed problem in general practice but evidence suggests that management of Hypertension in general practice is sub-optimal.

Methods/design: This study will explore the effectiveness of an educational intervention named the ‘Guideline Enhancement Tool (GET)’. …

Unmet Needs Of Patients With Chronic Obstructive Pulmonary Disease (Copd): A Qualitative Study On Patients And Doctors, S Wong, N Abdullah, A Abdullah, S Liew, S Ching, E Khoo, M Jiwa, Y Chia

Medical Papers and Journal Articles

Background: Chronic Obstructive Pulmonary Disease (COPD) is a chronic disease with repeated exacerbations resulting in gradual debilitation. The quality of life has been shown to be poor in patients with COPD despite efforts to improve self-management. However, the evidence on the benefit of self-management in COPD is conflicting. Whether this could be due to other unmet needs of patients have not been investigated. Therefore, we aimed to explore unmet needs of patients from both patients and doctors managing COPD.

Methods: We conducted a qualitative study with doctors and patients in Malaysia. We used convenience sampling to recruit patients until data …

Management Of Behavioural Change In Patients Presenting With A Diagnosis Of Dementia: A Video Vignette Study With Australian General Practitioners, M Jiwa, P Nichols, P Magin, G Pagey, X Meng, R Parsons, V Pillai

Medical Papers and Journal Articles

Objective: To test the impact of feedback on the proposed management of standardised patients presenting with behavioural change with a diagnosis of dementia in Australian primary care.

Materials and methods: A video vignette study was performed with Australian general practitioners (GPs) in 2013. Participants viewed six pairs of matched videos depicting people presenting changed behavior in the context of a dementia diagnosis in two phases. In both phases GPs indicated their diagnosis and management. After phase 1, GPs were offered feedback on management strategies for the patients depicted. Analyses focused on identification of change in management between the two phases …

Rating General Practitioner Consultation Performance In Cancer Care: Does The Specialty Of Assessors Matter? A Simulated Patient Study, M Jiwa, G Halkett, X Meng, M Berg

Medical Papers and Journal Articles

Background: Patients treated for prostate cancer may present to general practitioners (GPs) for treatment follow up, but may be reticent to have their consultations recorded. Therefore the use of simulated patients allows practitioner consultations to be rated. The aim of this study was to determine whether the speciality of the assessor has an impact on how GP consultation performance is rated.

Methods: Six pairs of scenarios were developed for professional actors in two series of consultations by GPs. The scenarios included: chronic radiation proctitis, Prostate Specific Antigen (PSA) ‘bounce’, recurrence of cancer, urethral stricture, erectile dysfunction and depression or anxiety. …

A Randomised Trial Deploying A Simulation To Investigate The Impact Of Hospital Discharge Letters On Patient Care In General Practice, M Jiwa, X Meng, C O'Shea, P Magin, A Dadich, V Pillai

Medical Papers and Journal Articles

Objective: To determine how the timing and length of hospital discharge letters impact on the number of ongoing patient problems identified by general practitioners (GPs).

Trial design: GPs were randomised into four groups. Each viewed a video monologue of an actor-patient as he might present to his GP following a hospital admission with 10 problems. GPs were provided with a medical record as well as a long or short discharge letter, which was available when the video was viewed or 1 week later. GPs indicated if they would prescribe, refer or order tests for the patient’s problems.

Methods: Setting Primary …

Genomic Catastrophes Frequently Arise In Esophageal Adenocarcinoma And Drive Tumorigenesis, K Nones, N Waddell, N Wayte, A Patch, P Bailey, F Newell, O Holmes, J Fink, M Quinn, Y Tang, G Lampe, K Quek, K Loffler, S Manning, S Idrisoglu, D Miller, Q Xu, N Waddell, P Wilson, T Bruxner, A Christ, I Harliwong, C Nourse, E Nourbakhsh, M Anderson, S Kazakoff, C Leonard, S Wood, P Simpson, L Reid, L Krause, D Hussey, D Watson, R Lord, D Nancarrow, W Phillips, D Gotley, B Smithers, D Whiteman, N Hayward, P Campbell, J Pearson, S Grimmond, A Barbour

Medical Papers and Journal Articles

Oesophageal adenocarcinoma (EAC) incidence is rapidly increasing in Western countries. A better understanding of EAC underpins efforts to improve early detection and treatment outcomes. While large EAC exome sequencing efforts to date have found recurrent loss-offunction mutations, oncogenic driving events have been underrepresented. Here we use a combination of whole-genome sequencing (WGS) and single-nucleotide polymorphism-array profiling to show that genomic catastrophes are frequent in EAC, with almost a third (32%, n¼40/123) undergoing chromothriptic events. WGS of 22 EAC cases show that catastrophes may lead to oncogene amplification through chromothripsis-derived double-minute chromosome formation (MYC and MDM2) or breakage-fusion-bridge (KRAS, MDM2 and …

Health Inequalities And Development Plans In Iran: An Analysis Of The Past Three Decades (1984–2010), H Zare, A Trujillo, J Driessen, M Ghasemi, G Gallego

Medical Papers and Journal Articles

Introduction: Reducing inequalities in health care is one of the main challenges in all countries. In Iran as in other oil-exporting upper middle income countries, we expected to witness fewer inequalities especially in the health sector with the increase in governmental revenues.

Methods: This study presents an inequalities assessment of health care expenditures in Iran. We used data from the Household Income and Expenditure Survey (HIES) in Iran from 1984–2010. The analysis included 308,735 urban and 342,532 rural households.

Results: The results suggest heightened inequality in health care expenditures in Iran over the past three decades, including an increase in …

Robot-Assisted Gastrectomy And Oesophagectomy For Cancer, Dan Falkenback, Christopher W. Lehane, Reginald V.N Lord

Medical Papers and Journal Articles

Background: Robot-assisted surgery is a technically feasible alternative to open and laparoscopic surgery, which is being more frequently used in general surgery. We undertook this review to investigate whether robotic assistance provides a significant benefit for oesophagogastric cancer surgery.

Methods: Electronic databases were searched for original English-language publications for robotic-assisted gastrectomy and oesophagectomy between January 1990 and October 2013.

Results: Sixty-one publications were included. Thirty-five included gastrectomy, 31 included oesophagectomy and five included both operations. Several publications suggest that robot-assisted subtotal gastrectomy can be as safe and effective as an open or laparoscopic procedure, with equal outcomes with regard to …

Palliative Care Nurses' Recognition And Assessment Of Delirium Symptoms: A Qualitative Study Using Critical Incident Technique, Annmarie Hosie, Meera Agar, Elizabeth Lobb, Patricia M. Davidson, Jane Phillips

Health Sciences Papers and Journal Articles

Delirium is prevalent in palliative care inpatient settings and management is often challenging. Despite nurses’ integral patient care role, little is known about palliative care nurses’ capacity to recognise, assess and respond to patients’ delirium symptoms. Objective: To explore the experiences, views and practices of inpatient palliative care nurses in delirium recognition and assessment. Settings and participants: 30 nurses from nine Australian specialist palliative care inpatient services. Design and methods: Critical incident technique (CIT) guided a series of semi-structured interviews. Prior to interviews participants were given a vignette of a palliative care inpatient with an unrecognised hypoactive delirium, to prompt …

'Workshops In Healing' For Senior Medical Students: 5 Year Overview And Appraisal, John Kearsley, Elizabeth Lobb

Health Sciences Papers and Journal Articles

We report upon the design, content and feedback from an interactive, experiential series of Workshops in Healing for senior medical students. Fifty-six final year medical students enrolled in 2×3 h workshops designed around the core themes of ‘physician know thyself’ (Workshop 1) and ‘confronting suffering’ (Workshop 2). Of the 56 students who initially enrolled, 48 students completed both workshops and provided a written openended reflection of their learning experience. The study, undertaken over a consecutive 5-year period (2008–2012), employed an emergent, qualitative design using thematic analysis of the reflective comments. We found that the design and content of both workshops …

The Importance Of Translating Evidence Into Practice In Counseling Individuals With Life-Threatening Illness, Elizabeth Lobb

Health Sciences Papers and Journal Articles

A review of Counseling Individuals with Life-Threatening Illness (2nd Edition) by Kenneth J Doka. New York: Springer Publishing Company, 2013. 324 pp. (ISBN: 978-0826195814).

Early Infant Feeding And Adiposity Risk: From Infancy To Adulthood, W H. Oddy, T A. Mori, R C Huang, J A. Marsh, C E. Pennell, Paola Chivers, Beth Hands, P Jacoby, P Rzehak, B V. Koletzko, L J. Beilin

Health Sciences Papers and Journal Articles

Introduction: Systematic reviews suggest that a longer duration of breast-feeding is associated with a reduction in the risk of later overweight and obesity. Most studies examining breast-feeding in relation to adiposity have not used longitudinal analysis. In our study, we aimed to examine early infant feeding and adiposity risk in a longitudinal cohort from birth to young adulthood using new as well as published data.

Methods: Data from the Western Australian Pregnancy Cohort (Raine) Study in Perth, W.A., Australia, were used to examine associations between breast-feeding and measures of adiposity at 1, 2, 3, 6, 8, 10, 14, 17, and …

The Challenge To Deliver Cost Effective Care For Patients With Gestational Diabetes Mellitus, Julie Quinlivan

Health Sciences Papers and Journal Articles

The global rise in obesity and gestational weight gain, along with recent trials demonstrating improved pregnancy and neonatal outcomes associated with the treatment of mild hyperglycaemia, have resulted in a clinical challenge to deliver cost effective healthcare to manage the epidemic of Gestational Diabetes Mellitus (GDM). Whilst clinicians now have clear criteria by which to diagnose GDM, and the glycaemic targets to achieve, less clear are the pathways to achieve these outcomes in a cost effective manner. The value of using allied health providers such as dieticians compared to less trained patient educators, the effectiveness of individualised versus group dietician …

Serological Surveillance Development For Tropical Infectious Diseases Using Simultaneous Microsphere-Based Multiplex Assays And Finite Mixture Models, Yoshito Fujii, Satoshi Kaneko, Samson Muuo Nzou, Matilu Mwau, Sammy M. Njenga, Chihiro Tanigawa, James Kimotho, Anne Wanjiru Mwangi, Ibrahim Kiche, Sohkichi Matsumoto, Mamiko Niki, Mayuko Osada-Oka, Yoshio Ichinose, Manabu Inoue, Makoto Itoh, Hiroshi Tachibana, Kazunari Ishii, Takafumi Tsuboi, Lay Myint Yoshida, Dinesh Mondal, Rashidul Haque, Shinjiro Hamano, Mwatasa Changoma, Tomonori Hoshi, Ken Ichi Kamo, Mohamed Karama, Masashi Miura, Kenji Hirayama

All Peer-Reviewed Publications

Background:A strategy to combat infectious diseases, including neglected tropical diseases (NTDs), will depend on the development of reliable epidemiological surveillance methods. To establish a simple and practical seroprevalence detection system, we developed a microsphere-based multiplex immunoassay system and evaluated utility using samples obtained in Kenya.Methods:We developed a microsphere-based immuno-assay system to simultaneously measure the individual levels of plasma antibody (IgG) against 8 antigens derived from 6 pathogens: Entamoeba histolytica (C-IgL), Leishmania donovani (KRP42), Toxoplasma gondii (SAG1), Wuchereria bancrofti (SXP1), HIV (gag, gp120 and gp41), and Vibrio cholerae (cholera toxin). The assay system was validated using appropriate control samples. The assay …

Adverse Health Effects Of Spousal Violence Among Women Attending Saudi Arabian Primary Health-Care Clinics, H. M. Eldoseri, K. A. Tufts, Q. Zhang, J. N. Fish

Ellmer School of Nursing Faculty Publications

This study aimed to investigate the frequency of spousal violence among Saudi women and document the related health effects and injuries, as well as their attitudes to gender and violence. Structured interviews were conducted with 200 ever-married women recruited from primary-care centres in Jeddah. Nearly half of the surveyed women (44.5%) reported ever experiencing physical violence from their spouse. Although 37 women (18.5%) had received violence-related injuries, only 6.5% had reported these injuries to a health-care provider. Victims of spousal violence had poor perceptions of their overall health, and reported pain or discomfort, antidepressant use and suicidal thoughts. Women mostly …

Telehealth: Preparing Advanced Practice Nurses To Address Healthcare Needs In Rural And Underserved Populations, Carolyn M. Rutledge, Tina Haney, Michele Bordelon, Michelle Renaud, Christianne Fowler

Ellmer School of Nursing Faculty Publications

Healthcare is being confronted with questions on how to deliver quality, affordable, and timely care to patients, especially those in rural areas, in systems already burdened by the lack of providers. Advanced Practice Registered Nurses (APRNs) have been challenged to lead this movement in providing care to these populations through the use of technologies, specifically telehealth. Unfortunately, APRNs have limited exposure to telehealth during their educational experience, thereby limiting their understanding and comfort with telehealth. To address this problem, a telehealth program was developed at a large university that prepares Doctor of Nursing Practice (DNP) APRN students. The telehealth program, …

Predicting Post-Deployment Family Adaptation In U.S. Navy Families, Micah A. Scott, Esther H. Condon, Arlene J. Montgomery, Spencer R. Baker

Ellmer School of Nursing Faculty Publications

Background: Although military families worldwide face changes that include adapting to peace and wartime deployments, few studies have explored how military families adapt to the post-deployment return of a service member.

Objectives: To identify variables that predicted post-deployment adaptation of U.S. Navy families.

Methods: A mixed method study guided by the Roy Adaptation Model included a convenience sample of 142 spouses of service members recently returned from deployment. The degree to which length of deployment, prior deployments, and years married, number of children, participation in religious and family support groups, communication, race, and interdependence predicted post-deployment family adaptation was tested. …

A Systems Biology Approach To Detect Eqtls Associated With Mirna And Mrna Co-Expression Networks In The Nucleus Accumbens Of Chronic Alcoholic Patients, Mohammed Mamdani

Theses and Dissertations

Alcohol Dependence (AD) is a chronic substance use disorder with moderate heritability (60%). Linkage and genome-wide association studies (GWAS) have implicated a number of loci; however, the molecular mechanisms underlying AD are unclear. Advances in systems biology allow genome-wide expression data to be integrated with genetic data to detect expression quantitative trait loci (eQTL), polymorphisms that regulate gene expression levels, influence phenotypes and are significantly enriched among validated genetic signals for many commonly studied traits including AD.

We integrated genome-wide mRNA and miRNA expression data with genotypic data from the nucleus accumbens (NAc), a major addiction-related brain region, of 36 …

Symptoms, Cytokines, And Quality Of Life Of Patients With Chronic Graft-Versus-Host Disease Following Allogeneic Hematopoietic Stem Cell Transplantation, Debra Kelly

Theses and Dissertations

Introduction: Chronic graft-versus-host disease (cGVHD) is a serious complication following allo-HSCT characterized by immune dysregulation, organ dysfunction, risk for infection, and distressing symptoms. Complications may include scleroderma, hepatic dysfunction and bronchiolitis obliterans. Advances in allo-HSCT for many hematologic dyscrasias (e.g. acute and chronic leukemias, aplastic anemia, and myelodysplastic syndrome) have improved survival which has generated a renewed focus on survivorship issues. Distressing symptoms are noted as negatively impacting quality of life (QoL). The relationship between inflammation and behavioral responses may impact symptoms. Examining patterns and levels of inflammation with symptoms is relevant. Objective: The aims of this study were to …

An Analysis Of Fatty Acid Metabolism’S Role In The Development Of Acute Functional Tolerance To Ethanol In Caenorhabditis Elegans, Richard Raabe

Theses and Dissertations

An individual’s naïve level of response (LR) to ethanol is predictive of their lifetime likelihood to abuse alcohol. LR is heavily genetically influenced, suggesting that the genes responsible for LR may also be central to the development of abuse disorders. Our laboratory uses the model organism C. elegans to investigate the genetic influences on responses to acute ethanol exposure. We recently found that changes in TAG levels can alter LR. From this result we investigated the role of long-chain polyunsaturated fatty acids (LC-PUFAs) as well enzymes involved in lipid modifications of proteins. We found that LC-PUFAs are necessary for acute …

The Cytotoxic Effect Of The Bcl-2 Family Of Proteins In Breast Cancer Cells, Yamileth Chin

Theses and Dissertations

Breast cancer is the second leading cause of death amongst women ages 20 to 59. Despite advancements in cancer therapies, more research is necessary to improve the diagnoses and treatment of several types of breast cancer. Paclitaxel (Taxol) is a commonly utilized anti-cancer drug for various types of solid tumors. However, the molecular mechanism utilized by paclitaxel to induce cell death is still elusive. Previous studies in our laboratory have shown that the pro-apoptotic BCL-2 family protein, BAK (BCL-2 homologous antagonist/killer) plays an important role in paclitaxel-induced cell death. In untreated breast cancer cells, BAK is associated with the anti-apoptotic …

Characterization Of Complement Evasion Of The Periopathogen, Treponema Denticola, Daniel Patrick Miller

Theses and Dissertations

Periodontitis is a polymicrobially-induced, chronic inflammatory disease of the tissues that support and surround the tooth. While greater than 500 organisms are found in dental plaque, Treponema denticola is one of only a few species associated with disease. It has been hypothesized that oral bacteria disrupt host homeostasis through manipulation of the innate immune system. In this study, we examine the impact of binding and subsequent cleavage of factor H, a complement regulator, by T. denticola in the evasion and subversion of complement. The molecular interaction between the sole FH-binding protein, FhbB, and FH was detailed by x-ray crystallography, site-directed …

Hiv And Opiates-Mediated Neurotoxicity: Gsk3Β Is A Potential Therapeutic Target, Ruturaj Masvekar

Theses and Dissertations

HIV-1 enters the CNS soon after initial systemic infection. HIV-1 can induce a wide range of neurological deficits, collectively known as HIV-1-associated neurocognitive disorders (HAND). Mature neurons are not infected by HIV-1; instead, infected and/or activated glial cells release various viral and cellular factors that induce direct and/or indirect neuronal toxicity, leading to HAND. Injection drug abuse is a significant risk factor for HIV-infection, and opiate drug abusers show increased HIV-neuropathology, even with anti-retroviral treatments. Our previous work has largely modeled HIV-neuropathology using the individual viral proteins Tat or gp120, with murine striatal neurons as targets. To model disease processes …

Evaluating The Antibody Response Against Ospa, Ospc, And Ospe Recombinant Proteins Over Time In Borrelia Burgdorferi Positive Serum Samples, Bridget Dillon

Theses and Dissertations

Lyme disease is the most common tick-borne illness in North America. It can be hard to detect using blood tests, especially in the early stage. Due to the number of significant complications from untreated or undertreated Lyme disease, better methods need to be found to detect the disease. Some surface lipoproteins may be used to detect early disease due to their early expression. Others are maintained for the duration of the infection and can be used to detect chronic Lyme disease. Antibody responses to OspA, OspC and OspE were measured in sera from experimentally infected dogs. The response to OspA …

Characterization Of Tonb-Dependent Metal Transporters Within Neisseria Gonorrhoeae, Mary Kathryne Dickinson

Theses and Dissertations

Neisseria gonorrhoeae, the etiologic agent of gonorrhea, utilizes TonB-dependent transporters to import essential nutrients such as iron. Study of TonB-dependent transporters is extremely important due to the fact that they make excellent vaccine targets. In order to learn more about the structure, function, expression, and regulation of selected TonB-dependent transporters, three goals were established for this study. The first goal was to examine the role of two highly conserved regions of TbpB in lipidation. One of the conserved regions of TbpB, the LSAC motif, was shown to be critical for lipidation. The second goal was to determine whether MisR/MisS regulates …

Characterization Of A Putative Tonb Deficient Porphyromonas Gingivalis Mutant, Soheil Rostami

Theses and Dissertations

Porphorymonas gingivalis is one of the major bacterial pathogens responsible for the initiation and progression of periodontal disease. The bacterium requires hemin uptake for its growth and has developed sophisticated mechanisms to extract hemin from hemin containing proteins in the oral cavity. Hemin first binds to receptors on the surface of P. gingivalis and is then taken up in an energy dependent manner. TonB is an inner membrane bound protein that spans the periplasm and is believed to be involved in the passage of hemin through the double membrane of P. gingivalis. However, the TonB protein in P. gingivalis is …

Android-Based Smartphone Application Simulation And Systematic Design To Reduce Medication Administration Error In Prehospital Emergency Care., Natalie Vazquez

Theses and Dissertations

Since 1999 when the report To Err is Human: Building a Safer Health System was released, medical errors have come into focus (Kohn, 2000). In an effort to reduce medication administration errors in prehospital emergency care, an android-based smartphone application simulation was created. The app has components including QR barcode scanning, text to speech for medication cross-checking, weight-based medication dose calculations, and time stamped medication data wirelessly transferring to a database in real-time. Color standard identification was implemented, aiding to a designed systematic process for patient treatment to reduce medication errors. Direct observation was performed of emergency patient calls with …

Identifying Functional Variation In Schizophrenia Gwas Loci By Pooled Sequencing, Erik Loken

Theses and Dissertations

Schizophrenia demonstrates high heritability in part accounted for by common simple nucleotide variants (SNV), rare copy number variants (CNV) and, most recently, rare SNVs Although heritability explained by rare SNVs and CNVs is small compared to that explained by common SNVs, rare SNVs in functional sequences may identify specific disease mechanisms. However, current exome methods do not capture a large proportion of potentially functional bases where rare variation may impact disease risk: as much as two-thirds of conserved sequences lie outside the exome in non-coding regions of cross-species evolutionary constraint. We reasoned that the candidate loci from the Psychiatric Genomics …