Medicine and Health Sciences Commons^™

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 …

Assessing The Feasibility Of A Web-Based Registry For Multiple Orphan Lung Diseases: The Australasian Registry Network For Orphan Lung Disease (Arnold) Experience, K Casamento, A Laverty, M Wilsher, J Twiss, E Gabbay, I Glaspole, A Jaffe

Medical Papers and Journal Articles

Background: We investigated the feasibility of using an online registry to provide prevalence data for multiple orphan lung diseases in Australia and New Zealand.

Methods: A web-based registry, The Australasian Registry Network of Orphan Lung Diseases (ARNOLD) was developed based on the existing British Paediatric Orphan Lung Disease Registry. All adult and paediatric respiratory physicians who were members of the Thoracic Society of Australia and New Zealand in Australia and New Zealand were sent regular emails between July 2009 and June 2014 requesting information on patients they had seen with any of 30 rare lung diseases. Prevalence rates were calculated …

Simulation Modelling As A Tool For Knowledge Mobilisation In Health Policy Settings: A Case Study Protocol, Louise Freebairn, Jo-An Atkinson, P. Kelly, Geoff Mcdonnell, Lucie Rychetnik

Medical Papers and Journal Articles

Background: Evidence-informed decision-making is essential to ensure that health programs and services are effective and offer value for money; however, barriers to the use of evidence persist. Emerging systems science approaches and advances in technology are providing new methods and tools to facilitate evidence-based decision-making. Simulation modelling offers a unique tool for synthesising and leveraging existing evidence, data and expert local knowledge to examine, in a robust, low risk and low cost way, the likely impact of alternative policy and service provision scenarios. This case study will evaluate participatory simulation modelling to inform the prevention and management of gestational diabetes …

Abnormal Plasma Dna Profiles In Early Ovarian Cancer Using A Non-Invasive Prenatal Testing Platform: Implications For Cancer Screening, P Cohen, N Flowers, S Tong, N Hannan, M Pertile, L Hui

Medical Papers and Journal Articles

Background: Non-invasive prenatal testing (NIPT) identifies fetal aneuploidy by sequencing cell-free DNA in the maternal plasma. Pre-symptomatic maternal malignancies have been incidentally detected during NIPT based on abnormal genomic profiles. This low coverage sequencing approach could have potential for ovarian cancer screening in the non-pregnant population. Our objective was to investigate whether plasma DNA sequencing with a clinical whole genome NIPT platform can detect early- and late-stage high-grade serous ovarian carcinomas (HGSOC).

Methods: This is a case control study of prospectively-collected biobank samples comprising preoperative plasma from 32 women with HGSOC (16 ‘early cancer’ (FIGO I–II) and 16 ‘advanced cancer’ …

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 …

Self-Sampling Hpv Testing Versus Mainstream Cervical Screening And Hpv Testing, A Farnsworth

Medical Papers and Journal Articles

No abstract provided.

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 …

The Bipolar Ii Depression Questionnaire: A Self-Report Tool For Detecting Bipolar Ii Depression, C Leung, C Yim, C Yan, C Chan, Y Xiang, D Mak, M Fok, G Ungvari

Medical Papers and Journal Articles

Bipolar II (BP-II) depression is often misdiagnosed as unipolar (UP) depression, resulting in suboptimal treatment. Tools for differentiating between these two types of depression are lacking. This study aimed to develop a simple, self-report screening instrument to help distinguish BP-II depression from UP depressive disorder. A prototype BP-II depression questionnaire (BPIIDQ-P) was constructed following a literature review, panel discussions and a field trial. Consecutively assessed patients with a diagnosis of depressive disorder or BP with depressive episodes completed the BPIIDQ-P at a psychiatric outpatient clinic in Hong Kong between October and December 2013. Data were analyzed using discriminant analysis and …

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 …

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 …

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: …

Therapists' Experiences Of Alliance Formation In Short-Term Counselling, Mark Pearson, Caroline Bulsara

Medical Papers and Journal Articles

While therapeutic alliance formation has been widely researched over many sessions of psychotherapy, the question of alliance formation in short-term counselling has been less explored. Given the increasing evidence in the literature for the positive impact of alliances on therapy outcomes, providing counsellors - who may work with clients for a limited number of sessions - with enhanced insight into alliance formation will be of value. This qualitative study investigated the experiences of eight counsellors forming alliances with clients over short periods. Semi-structured interviews were analysed using interpretive phenomenological analysis. Five major themes emerged, that while congruent with the alliance …

Sequence Variants In The Ptch1 Gene Associate With Spine Bone Mineral Density And Osteoporotic Fractures, U Styrkarsdottir, G Thorleifsson, S Gudjonsson, A Sigurdsson, J Center, S Lee, T Nguyen, T Kwok, J Lee, S Ho, J Woo, P Leung, B Kim, T Rafnar, L Kiemeney, T Ingvarsson, J Koh, N Tang, J Eisman, C Christiansen, G Sigurdsson, U Thorsteinsdottir, K Stefansson

Medical Papers and Journal Articles

Bone mineral density (BMD) is a measure of osteoporosis and is useful in evaluating the risk of fracture. In a genome-wide association study of BMD among 20,100 Icelanders, with follow-up in 10,091 subjects of European and East-Asian descent, we found a new BMD locus that harbours the PTCH1 gene, represented by rs28377268 (freq. 11.4–22.6%) that associates with reduced spine BMD (P=1.0 × 10⁻¹¹, β=−0.09). We also identified a new spine BMD signal in RSPO3, rs577721086 (freq. 6.8%), that associates with increased spine BMD (P=6.6 × 10⁻¹⁰, β=0.14). Importantly, both …

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 …

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

Medical Papers and Journal Articles

No abstract provided.

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 …

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 …

Doctors' Perspectives On Psa Testing Illuminate Established Differences In Prostate Cancer Screening Rates Between Australia And The Uk: A Qualitative Study, K Pickles, S Carter, L Rychetnik, V Entwistle

Medical Papers and Journal Articles

Objectives: To examine how general practitioners (GPs) in the UK and GPs in Australia explain their prostate-specific antigen (PSA) testing practices and to illuminate how these explanations are similar and how they are different.

Design: A grounded theory study.

Setting: Primary care practices in Australia and the UK.

Participants: 69 GPs in Australia (n=40) and the UK (n=29). We included GPs of varying ages, sex, clinical experience and patient populations. All GPs interested in participating in the study were included.

Results: GPs’ accounts revealed fundamental differences in whether and how prostate cancer screening occurred in their practice and in the …

Predicting Low-Risk Prostate Cancer From Transperineal Saturation Biopsies, P Van Leeuwen, A Siriwardana, M Roobol, F Ting, D Nieboer, J Thompson, Warick Delprado, A Haynes, P Brenner, P Stricker

Medical Papers and Journal Articles

Introduction: To assess the performance of five previously described clinicopathological definitions of low-risk prostate cancer (PC).

Materials and Methods: Men who underwent radical prostatectomy (RP) for clinical stage ≤T2, PSA <10 ng/mL, Gleason score <8 PC, diagnosed by transperineal template-guided saturation biopsy were included. The performance of five previously described criteria (i.e., criteria 1–5, criterion 1 stringent (Gleason score 6 + ≤5mm total max core length PC + ≤3mm max per core length PC) up to criterion 5 less stringent (Gleason score 6-7 with ≤5% Gleason grade 4) was analysed to assess ability of each to predict insignificant disease in RP specimens (defined as Gleason score ≤6 and total tumour volume <2.5mL, or Gleason score 7 with ≤5% grade 4 and total tumour volume <0.7 mL).

Results: 994 men who underwent RP were included. Criterion 4 (Gleason score 6) performed best with area under the curve of receiver operating characteristics 0.792. At decision curve analysis, criterion 4 was deemed clinically the best performing transperineal saturation biopsy-based definition for low-risk PC.

Conclusions: Gleason score 6 disease demonstrated a superior trade-off between sensitivity and specificity for clarifying low-risk PC that can guide treatment and be used as reference …

The Pivotal Position Of 'Liaison People': Facilitating A Research Utilisation Intervention In Policy Agencies, A Haynes, P Butow, S Brennan, A Williamson, S Redman, S Carter, G Gallego, S Rudge

Medical Papers and Journal Articles

Externally designed and implemented organisational change interventions are thought to have a greater chance of success when they are supported by one or more internal staff members acting as facilitators (Greenhalgh, Robert, Macfarlane, Bate, & Kyriakidou, 2004). Such facilitators often manage the administrative tasks associated with an intervention and may be involved in recruitment, consent processes and/or data collection. More importantly, they are social mediators of the ideas and processes central to the intervention. This may involve formal activities such as presentations at staff meetings, but is likely to include ad hoc negotiation and interpretive communication with diverse colleagues and …

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 …

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?

The Malarial Exported Pfa0660w Is An Hsp40 Co-Chaperone Of Pfhsp70-X, M Daniyan, A Boshoff, E Prinsloo, E Pesce, G Blatch

Medical Papers and Journal Articles

Plasmodium falciparum, the human pathogen responsible for the most dangerous malaria infection, survives and develops in mature erythrocytes through the export of proteins needed for remodelling of the host cell. Molecular chaperones of the heat shock protein (Hsp) family are prominent members of the exportome, including a number of Hsp40s and a Hsp70. PFA0660w, a type II Hsp40, has been shown to be exported and possibly form a complex with PfHsp70-x in the infected erythrocyte cytosol. However, the chaperone properties of PFA0660w and its interaction with human and parasite Hsp70s are yet to be investigated. Recombinant PFA0660w was found to …

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 …

Fifteen-Year Survival Of Endoscopic Anterior Cruciate Ligament Reconstruction In Patients Aged 18 Years And Younger, Morgan Matthew, Lucy Salmon, Alison Waller, Justin Roe, Leo Pinczewski

Medical Papers and Journal Articles

Background: The current body of literature surrounding anterior cruciate ligament (ACL) survival and the variables contributing to further ACL injuries after primary ACL reconstruction in children and adolescents is limited, with no long-term evidence examining the incidence and contributing factors of further ACL injuries in this younger patient population.

Purpose: To determine the long-term survival of the ACL graft and the contralateral ACL (CACL) after primary reconstruction in patients aged 18 years and to identify the factors that increase the odds of subsequent ACL injuries.

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

Methods: Patients having undergone primary ACL reconstruction …

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 …

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 …

Effect Of Medical Student Preference On Rural Clinical School Experience And Rural Career Intentions, L Walters, A Seal, J Mcgirr, R Stewart, D Dewitt, D Playford

Medical Papers and Journal Articles

Introduction: The key parameter for rural clinical schools (RCSs) is to provide at least 1 year of clinical training in rural areas for 25% of Australian Commonwealth supported medical students with the intent to influence future rural medical workforce outcomes. The objective of this study was to describe the association between a medical student’s selection preference and their RCS experience and rural career intent.

Methods: Medical students completing an RCS placement in 2012 and 2013 were encouraged to complete a survey regarding their experience and future career intent. Data were analysed to compare medical students for whom the RCS was …

Complementary Therapies For Labour And Birth: A Randomized Controlled Trial Of Antenatal Integrative Medicine For Pain Management In Labour, K Levett, C Smith, A Bensoussan, H Dahlen

Medical Papers and Journal Articles

Objective: To evaluate the effect of an antenatal integrative medicine education programme in addition to usual care for nulliparous women on intrapartum epidural use.

Design: Open-label, assessor blind, randomized controlled trial.

Setting: 2 public hospitals in Sydney, Australia.

Population: 176 nulliparous women with low-risk pregnancies, attending hospital-based antenatal clinics.

Methods and intervention: The Complementary Therapies for Labour and Birth protocol, based on the She Births and acupressure for labour and birth courses, incorporated 6 evidence-based complementary medicine techniques: acupressure, visualisation and relaxation, breathing, massage, yoga techniques, and facilitated partner support. Randomisation occurred at 24–36 weeks’ gestation, and participants attended a …

Clinical Audit Project In Undergraduate Medical Education Curriculum: An Assessment Validation Study, E Tor, C Steketee, D Mak

Medical Papers and Journal Articles

Objectives: To evaluate the merit of the Clinical Audit Project (CAP) in an assessment program for undergraduate medical education using a systematic assessment validation framework.

Methods: A cross-sectional assessment validation study at one medical school in Western Australia, with retrospective qualitative analysis of the design, development, implementation and outcomes of the CAP, and quantitative analysis of assessment data from four cohorts of medical students (2011-2014).

Results: The CAP is fit for purpose with clear external and internal alignment to expected medical graduate outcomes. Substantive validity in students’ and examiners’ response processes is ensured through relevant methodological and cognitive processes. Multiple …