Medicine and Health Sciences Commons^™

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 …

Dental Bacterial Dna Are Present In The Amniotic Cavity Of Healthy Pregnant Women At Term, S Vytla, George Mendz, J Quinlivan

Medical Papers and Journal Articles

Aims: To determine if dental bacterial DNA are present in the amniotic cavity of healthy pregnant women undergoing an elective caesarean section at term utilising culture independent techniques.

Methods: Pregnant Australian women undergoing an elective caesarean section were recruited. Women completed questionnaires addressing demographics, past and current pregnancies and medical history. One high vaginal swab and three amniotic cavity swabs (amniotic fluid, newborn axilla and placental) were collected under sterile conditions. Samples were analysed using culture-independent techniques to detect the presence of predefined pathogenic bacterial taxa of the oral microbiome. Taxa isolated from the amniotic cavity swabs were compared to …

Survey Of Australian Father's Attitudes Towards Infant Vaccination: Findings From The Australian Father's Study, N Prosser, R Petersen, J Quinlivan

Medical Papers and Journal Articles

Objective: To investigate the attitudes of expectant Australian fathers towards vaccination, and to identify factors which may influence these attitudes.

Methods: A cross-sectional survey study of 407 Australian men with expectant partners, mean age 30.4 (SD 6.7). Self reported attitude, level of knowledge and information resources accessed regarding pregnancy related issues. Participant demographics collected included: Age, number of children, relationship status, level of education, employment information and smoking status.

Results: Majority (89%) of participants had a positive attitude towards infant vaccination, 9% felt neutral and 2% had negative attitudes. Positive attitudes towards vaccination were associated with lower self-reported knowledge …

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 …

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 …

Circadian Rhythmicity In Emerging Mood Disorders: State Or Trait Marker?, A Grierson, I Hickie, S Naismith, D Hermans, E Scott, J Scott

Medical Papers and Journal Articles

Background: Circadian rhythm disturbances overlap with the symptoms of mood episodes and may trigger or prolong mood symptoms. There is limited research on the role of circadian disturbances in mood disorders in young people and/or first episode cases of unipolar and bipolar disorders.

Methods: Actigraphy was undertaken for about 14 days in 63 post-pubertal individuals aged 13–25 years with a recent onset of a mood disorder meeting recognised diagnostic criteria. We examined associations between three easily interpretable markers of circadian rhythm activity (amplitude, acrophase and rhythmicity index) and demography and clinical characteristics. Then, circadian markers were compared between diagnostic groups, …

An Integrated General Practice And Pharmacy-Based Intervention To Promote The Use Of Appropriate Preventive Medications Among Individuals At High Cardiovascular Disease Risk: Protocol For A Cluster Randomized Controlled Trial, A Hayek, R Joshi, T Usherwood, R Webster, B Kaur, B Saini, C Armour, I Krass, T Laba, C Reid, L Shiel, C Hespe, F Hersch, S Jan, S Lo, D Peiris, A Rodgers, A Patel

Medical Papers and Journal Articles

Background: Cardiovascular diseases (CVD) are responsible for significant morbidity, premature mortality, and economic burden. Despite established evidence that supports the use of preventive medications among patients at high CVD risk, treatment gaps remain. Building on prior evidence and a theoretical framework, a complex intervention has been designed to address these gaps among high-risk, under-treated patients in the Australian primary care setting. This intervention comprises a general practice quality improvement tool incorporating clinical decision support and audit/feedback capabilities; availability of a range of CVD polypills (fixed-dose combinations of two blood pressure lowering agents, a statin ± aspirin) for prescription when appropriate; …

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: …

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 …

Are Primetime Diets Congruent With Dietary Recommendations? Content Analyses Of Food Advertisements In The United States, China, And Singapore, Su Lin Yeo, Wonsun Shin, May O. Lwin, Jerome Williams, Ying-Yi Hong

Research Collection Lee Kong Chian School Of Business

Despite public programs to promote healthy eating among populations in developed and developing countries, the increase in obesity as a result of poor dietary patterns continues to persist. As food advertising has been implicated for contributing to this global health challenge, this study aims to provide empirical evidence on food advertising in a broader global context, across economically and culturally different nations. We conducted a large scale content analysis of the types of food advertised on primetime television in the United States, China, and Singapore, which resulted in the collection of 1,008 television hours. Using the dietary blue2376s proposed by …

From Qasc To Qascip: Successful Australian Translational Scale-Up And Spread Of A Proven Intervention In Acute Stroke Using A Prospective Pre-Test/Post-Test Study Design, S Middleton, A Lydtin, D Comerford, D Cadilhac, P Mcelduff, S Dale, K Hill, M Longworth, J Ward, N Cheung, C D'Este

Health Sciences Papers and Journal Articles

Objectives: To embed an evidence-based intervention to manage FEver, hyperglycaemia (Sugar) and Swallowing (the FeSS protocols) in stroke, previously demonstrated in the Quality in Acute Stroke Care (QASC) trial to decrease 90-day death and dependency, into all stroke services in New South Wales (NSW), Australia’s most populous state.

Design: Pre-test/post-test prospective study.

Setting: 36 NSW stroke services.

Methods: Our clinical translational initiative, the QASC Implementation Project (QASCIP), targeted stroke services to embed 3 nurse-led clinical protocols (the FeSS protocols) into routine practice. Clinical champions attended a 1-day multidisciplinary training workshop and received standardised educational resources and ongoing support. Using the …

An Examination Of The Correlation Amongst Trunk Flexibility, X-Factor And Clubhead Speed In Skilled Golfers, Christopher Joyce

Health Sciences Papers and Journal Articles

Skilled golfers are reported to be more flexible than lesser able golfers, which may assist in increased x-factor (shoulder – pelvis separation) at the top of the backswing. However, it is unknown if increased flexibility produces faster clubhead speed. The aim of this study was to investigate the correlations amongst trunk flexibility and x-factor, as well as the association between flexibility and clubhead speed in low handicap golfers. Fifteen low handicap male golfers who displayed a modern swing, had their trunk static anatomical end-range of motion (ROM) (flexibility) and driver swing kinematics were measured. Although Pearson correlations revealed trunk extension …

Relationship Between Pre-Season Testing Performance And Playing Time Among Ncaa Dii Basketball Players, Jay J. Dawes, Marshall M, Tania Spiteri

Health Sciences Papers and Journal Articles

Purpose: The purpose of this study was to investigate the relationships between pre-season testing performance and playing time within a men’s Division II basketball team.

Methods: Archival data from pre-season athletic performance testing for ten (n=10) male NCAA Division II basketball players was collected and analyzed to determine if there was a relationship between anthropometric data (height, weight, wingspan), physical performance tests (vertical jump height, lane agility test, 5 and 20 m sprint time, National Basketball League (NBA) line drill and 20 m multi-stage fitness test (MSFT)), and playing time in the subsequent collegiate season.

Results: Pearson’s product …

Predicting Academic Success Of Health Science Students For First Year Anatomy And Physiology, R Anderton, P Chivers

Health Sciences Papers and Journal Articles

Students commencing tertiary education enter through a number of traditional and alternative academic pathways. As a result, tertiary institutions encounter a broad range of students, varying in demographic, previous education, characteristics and academic achievement. In recent years, the relatively constant increase in tertiary applications in Australia has not translated to an increase in student retention or graduate numbers. The Health Sciences discipline typically falls within this paradigm, prompting various approaches to promote academic success and overall student retention. In this study, the demographic and previous education of health science students at an Australian University, were analysed along with first year …

Triage, Treatment And Transfer Of Patients With Stroke In Emergency Department Trial (The T3 Trial): A Cluster Randomised Trial Protocol, Sandy Middleton, Chris Levi, Simeon Dale, N. Wah Cheung, Elizabeth Mcinnes, Julie Considine, Catherine D'Este, Dominique A. Cadilhac, Jeremy Grimshaw, Richard Gerraty, Louise E. Craig, Verena Schadewaldt, Patrick Mcelduff, Mark Fitzgerald, Clare Quinn, Greg Cadigan, Sonia Denisenko, Mark Longworth, Jeanette Ward, T3 Trialist Collaborators

Health Sciences Papers and Journal Articles

Background: Internationally recognised evidence-based guidelines recommend appropriate triage of patients with stroke in emergency departments (EDs), administration of tissue plasminogen activator (tPA), and proactive management of fever, hyperglycaemia and swallowing before prompt transfer to a stroke unit to maximise outcomes. We aim to evaluate the effectiveness in EDs of a theory-informed, nurse-initiated, intervention to improve multidisciplinary triage, treatment and transfer (T3) of patients with acute stroke to improve 90-day death and dependency. Organisational and contextual factors associated with intervention uptake also will be evaluated.

Methods: This prospective, multicentre, parallel group, cluster randomised trial with blinded outcome assessment will be conducted …

Cme/Cne Article: A Framework Of Care In Multiple Sclerosis, Part 1, Scott D Newsome, Philip J Aliotta, Jacquelyn Bainbridge, Susan E Bennett, Gary Cutter, Kaylan Fenton, Fred Lublin, Dorothy Northrop, David Rintell, Bryan D Walker, Megan Weigel, Kathleen Zackowski, David E Jones

Faculty, Staff and Student Publications

Activity Available Online: To access the article, post-test, and evaluation online, go to http://www.cmscscholar.org.

TARGET AUDIENCE: The target audience for this activity is physicians, physician assistants, nursing professionals, and other health-care providers involved in the management of patients with multiple sclerosis (MS).

LEARNING OBJECTIVES: Apply new information about MS to a comprehensive individualized treatment plan for patients with MSIntegrate the team approach into long-term planning in order to optimize rehabilitation care of patients with MSAccreditation Statement: This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) …

Phylogenetic Analysis Of Bunyamwera And Ngari Viruses (Family Bunyaviridae, Genus Orthobunyavirus) Isolated In Kenya, C. Odhiambo, M. Venter, O. Lwande, R. Swanepoel, R. Sang

All Peer-Reviewed Publications

Orthobunyaviruses, tri-segmented, negative-sense RNA viruses, have long been associated with mild to severe human disease in Africa, but not haemorrhagic fever. However, during a Rift Valley fever outbreak in East Africa in 1997-1998, Ngari virus was isolated from two patients and antibody detected in several others with haemorrhagic fever. The isolates were used to identify Ngari virus as a natural Orthobunyavirus reassortant. Despite their potential to reassort and cause severe human disease, characterization of orthobunyaviruses is hampered by paucity of genetic sequences. Our objective was to obtain complete gene sequences of two Bunyamwera virus and three Ngari virus isolates from …

A "Clarion" Call For Embracing Ipe As The Status Quo For Preparing Health Professionals To Engage In Interprofessional Health Research, Kimberly Adams Tufts

Ellmer School of Nursing Faculty Publications

Complex health conditions and the social-economic determinants that contribute to disease and injury incidence, prevalence, and health inequalities require multifaceted evidence-based interventions that only interprofessional research teams who collaborate across traditional disciplinary lines can generate. Interprofessionally driven and derived research evidence is the method of du jour. Nonetheless as a whole, health professionals who are often members of interprofessional health research teams are products of educational systems wherein they were educated in disciplinary silos. Health professionals that learn about, with, from, each other during their foundational education will be better prepared to function as interprofessional research team members. With the …

The Effectiveness Of An Anesthesia Handoff Tool: An Electronic Health Record Application To Enhance Patient Safety, Karen Gillikin, Nathaniel Apatov

Ellmer School of Nursing Faculty Publications

Perioperative patient care handoffs are complex and multidimensional and require accurate attention to detail. Communication failures among healthcare providers increase the risk of morbidity and mortality. Utilizing a standardized handoff tool located within the electronic anesthesia record formalizes the handoff process and improves patient safety. Prior to the introduction of the Electronic Anesthesia Handoff Tool, 82 patient care transfer observations were conducted; subsequent to the launch of the tool, 75 patient care transfer observations were conducted, and then before and after comparisons were made. Descriptive statistics, a two-tailed t-test, and Spearman’s correlations were conducted. Alpha level was set at p < 0.05. There were significantly (p< .05) fewer errors made in all categories of patient information following the introduction of the Electronic Anesthesia Handoff Tool. Though there were trends towards more omissions occurring after 3:00 p.m., the difference in most patient information categories was not significant (p< .05). In addition, there were no differences in omissions related to the severity of patient co-morbidities based on patients’ American Society of Anesthesiologists physical status classification. This study provided information regarding the incidence of patient information inaccuracies and omissions during patient care transfer before and after implementation of an electronic patient care transfer tool.

Assent Described: Exploring Perspectives From The Inside, Rebecca D. Poston

Ellmer School of Nursing Faculty Publications

Purpose- The purpose of this study was to describe the informed consent and assent experience for oncology research from the perspective of the participants: adolescents, their parents, and their physician providers.

Design & Methods- This descriptive mixed-methods study included the pilot use of the Quality of Informed Consent Questionnaire (QuIC) with an adolescent population and semi-structured interviews with adolescents, their parents, and their physician providers within 48-72 hours of the informed consent and assent discussion for a pediatric oncology clinical trial and again 6-9 weeks later. Results: Adolescents and their parents scored considerably lower on part A of the QuIC …

Radioprotective Cerium Oxide Nanoparticles: Molecular Imaging Investigations Of Conps’ Pharmacokinetics, Efficacy, And Mechanisms Of Action, Philip R. Mcdonagh Iii

Theses and Dissertations

Cerium oxide nanoparticles (CONPs) are being investigated for several anti-oxidant applications in medicine. One of their most promising applications is as a radioprotective drug, an area of research in need due to the severe side effects from radiation therapy. In this work, the potential of CONPs as a radioprotective drug is examined using four criteria: favorable biodistribution/pharmacokinetics, low toxicity, ability to protect normal tissue from radiation damage, and lack of protection of tumor. The mechanisms of action of CONPs are also studied. Biodistribution was determined in radiolabeled CONPs with surface coatings including citrate, dextran T10-amine (DT10-NH₂), dextran T10-polyethylene …

“I Just Need To Get Myself Supervised:” Exploring Transformative Learning In The Development Of Professionalism Among Physicians In The First Year Of Graduate Medical Education, Elizabeth P. Marlowe

Theses and Dissertations

The study explored the learning experiences of first-year resident physicians during the first year of graduate medical education. The experiences of four intern physicians in the first year of residency training at an urban academic health system provided the site for the research. An exploratory case study research design was employed to examine the learning experiences of these new physicians. A qualitative approach was used to analyze data from interviews and ethnographic observations. The findings of this research study provide evidence surrounding how and what these physician trainees learned regarding professionalism during the first year of residency training.

The findings …

Irreversible Zinc Block Of The Swelling-Activated Chloride Current In Di Tnc1 Astrocytes, Noah Belkhayat

Theses and Dissertations

The swelling-activated chloride current, commonly referred to as ICl,swell, is an outwardly-rectifying anion current that plays an important role in cell volume regulation, among other capacities. Despite several decades of research, the molecular identity of the channel responsible for this chloride current remains controversial. Recent indications that key endogenous sulfhydryl groups are capable of modifying the current led us to assess the effects of several divalent cations, including zinc, on ICl,swell. Zinc is known to tightly associate with sulfhydryl groups such as in zinc finger proteins. We found that extracellular zinc irreversibly inhibited ICl,swell at a site downstream in the …

Probing Allosteric, Partial Inhibition Of Thrombin Using Novel Anticoagulants, Stephen S. Verespy Iii

Theses and Dissertations

Thrombin is the key protease that regulates hemostasis; the delicate balance between procoagulation and anticoagulation of blood. In clotting disorders, like deep vein thrombosis or pulmonary embolism, procoagulation is up-regulated, but propagation of clotting can be inhibited with drugs targeting the proteases involved, like thrombin. Such drugs however, have serious side effects (e.g., excessive bleeding) and some require monitoring during the course of treatment. The reason for these side effects is the mechanism by which the drugs’ act. The two major mechanisms are direct orthosteric and indirect allosteric inhibition, which will completely abolish the protease’s activity. Herein we sought an …

Provision Of Hospital-Based Palliative Care And The Impact On Organizational And Patient Outcomes, Marisa L. Roczen

Theses and Dissertations

Hospital-based palliative care services aim to streamline medical care for patients with chronic and potentially life-limiting illnesses by focusing on individual patient needs, efficient use of hospital resources, and providing guidance for patients, patients’ families and clinical providers toward making optimal decisions concerning a patient’s care. This study examined the nature of palliative care provision in U.S. hospitals and its impact on selected organizational and patient outcomes, including hospital costs, length of stay, in-hospital mortality, and transfer to hospice. Hospital costs and length of stay are viewed as important economic indicators. Specifically, lower hospital costs may increase a hospital’s profit …

Markerless Lung Tumor Trajectory Estimation From Rotating Cone Beam Computed Tomography Projections, Shufei Chen

Theses and Dissertations

Respiration introduces large tumor motion in the thoracic region which influences treatment outcome for lung cancer patients. Tumor motion management techniques require characterization of temporal tumor motions because tumor motion varies patient to patient, day to day and cycle to cycle. This work develops a markerless algorithm to estimate 3 dimensional (3D) lung-tumor trajectories on free breathing cone beam computed tomography (CBCT) projections, which are 2 dimensional (2D) sequential images rotating about an axis and are used to reconstruct 3D CBCT images.

A gold standard tumor trajectory is required to guide the algorithm development and estimate the tumor detection accuracy …

Involvement Of Signal Peptidase I In Streptococcus Sanguinis Biofilm Formation, Jessica Aynapudi

Theses and Dissertations

Biofilm accounts for 65%-80% of microbial infections in humans. Considerable evidence links biofilm formation to oral disease and consequently systemic infections. Eradication of biofilm-associated infections is important. Streptococcus sanguinis, a Gram-positive bacterium, is one of the most abundant species in oral biofilm. It contributes to biofilm development in oral cavities and is one of the recognized causes of infective endocarditis. To study and identify biofilm genes in S. sanguinis, biofilm formation of 51 mutants was compared with the wild type SK36 strain using crystal violet (CV) staining in a microtiter plate. Confocal laser scanning microscopy (CLSM) and image analysis was …

Introducing Novel Combinatorial Targeted Therapies In Multiple Types Of Cancer, Mehrad Tavallai

Theses and Dissertations

The cancers of liver, colon and breast are amongst the top five most prevalent and most fatal worldwide. As the Raf/MEK/ERK pathway is frequently deregulated in hepatocellular carcinoma (HCC), sorafenib, a Raf kinase inhibitor, became the first systemic therapy approved for the treatment of patients with HCC. However, sorafenib only produced modest effects with low response rates in the clinic. Similarly, regorafenib, which was approved for the treatment of metastatic colorectal cancer (CRC), has had a poor response rate in the clinic. Since phosphodiesterase type 5 has been reported to be overexpressed in HCC and CRC, we hypothesized that sildenafil, …

Drug And Vaccine Development For Neisseria Gonorrhoeaea, Devin R. Cash

Theses and Dissertations

Neisseria gonorrhoeae, the causative agent of the STI gonorrhea, is not preventable by vaccination and is rapidly developing resistance to antibiotics. One important strategy for gonococcal survival in the host is iron acquisition in the face of nutritional immunity. To overcome iron limitation, the gonococcus expresses TonB dependent transporters (TdTs), outer membrane proteins that facilitate nutrient acquisition. Of the TdTs, the transferrin (Tf), lactoferrin (Lf), and hemoglobin (Hb) receptors hijack iron directly from host proteins, and studies have already shown that the Tf receptor is essential for the initiation of human infection. Given that the TdTs are virulence factors, …

Vital Pulp Therapy Survivability Based On Radiographic Depth Of Caries, Aaron T. Schmick

Theses and Dissertations

Purpose: The purpose of this retrospective chart review was to determine if the survival of two methods of vital pulp therapy (VPT) were influenced by the pre-operative radiographic depth and location of caries. Methods: Electronic patient records (axiUm®) that contained the procedure codes D3120, Indirect Pulp Therapy (IPT), or D3220, Therapeutic Pulpotomy (TP), were queried. Qualifying charts’ pre-operative and post-operative radiographs were viewed in MiPACS® by two raters. Visit records were queried again to identify any other treatment failures. Results: A total of 568 primary molars met the eligibility criteria. There was a difference in survival depending upon the treatment …