Medicine and Health Sciences Commons^™

Adherence To Prescribing Restrictions For Her2-Positive Metastatic Breast Cancer In Australia: A National Population-Based Observational Study (2001-2016), Benjamin Daniels, Federico Girosi, Hanna Tervonen, Belinda E. Kiely, Sarah J. Lord, Nehmat Houssami, Sally-Anne Pearson

Medical Papers and Journal Articles

Background: Targeted cancer therapy is often complex, involving multiple agents and chemotherapeutic partners. In Australia, prescribing restrictions are put in place to reflect existing evidence of cost-effectiveness of these medicines. As therapeutic options continue to expand, these restrictions may not be perceived to align with best practice and it is not known if their use in the real-world clinic adheres to these restrictions. We examined the treatment of women receiving trastuzumab for HER2-positive metastatic breast cancer (HER2+MBC) to determine the extent to which treatment adhered to national prescribing restrictions.

Patients and methods: Our population-based, retrospective cohort study used dispensing records …

Changing Medical Student Attitudes To Patient Safety: A Multicentre Study, Kim Oates, Ian Wilson, Wendy Hu, Ben Walker, Amanda Nagle, Janice Wiley

Medical Papers and Journal Articles

Background: Although patient safety is becoming widely taught in medical schools, its effect has been less rigorously evaluated. We describe a multicentre study to evaluate student changes in patient safety attitudes using a standardized instrument, the Attitudes to Patient Safety Questionnaire3 (APSQ3).

Methods: A patient safety training package designed for medical students was delivered in the first year and second year in four Australian medical schools. It comprises eight face-to-face modules, each of two hours. Seminars start with an interactive introduction using questions, video and role play, followed by small group break-outs to discuss a relevant case study. Groups are …

Nonstandard Lumbar Region In Predicting Fracture Risk, Dima Alajlouni, Dana Bliuc, Thach Tran, Nicholas Pocock, Tuan Nguyen, John A. Eisman, Jacqueline Center

Medical Papers and Journal Articles

Background: Femoral neck BMD is the most commonly used skeletal site to estimate fracture risk. The role of lumbar spine BMD in fracture risk prediction is less clear due to osteophytes that spuriously increase LS BMD, particularly at lower levels. The aim of this study was to compare fracture predictive ability of upper L1-L2 BMD compared to standard L2-L4 BMD and assess whether the addition of either lumbar spine site could improve fracture prediction over FN BMD.

Methodology: A prospective cohort of 3016 women and men 60+ years from the Dubbo Osteoporosis Epidemiology Study followed for occurrence of minimal trauma …

Actinomyces Cavernous Sinus Infection: A Case And Systematic Literature Review, Michal Lubomski, James Dalgliesh, Kenneth Lee, Omprakash Damodaran, Genevieve Mckew, Stephen Reddel

Medical Papers and Journal Articles

A 63-year-old man presented with a 2-month history of progressive right-sided exophthalmos, painful ophthalmoplegia and fevers. As more features developed, he was diagnosed with giant cell arteritis then Tolosa-Hunt syndrome and transiently responded to corticosteroids. A bland cerebrospinal fluid and highly metabolically active brain (18F)-fluoro-D-glucose-positron emission tomography suggested lymphoma. Biopsy of the mass showed sulphur granules with Gram-positive filamentous bacteria with Actinomyces-like colonies. Actinomyces cavernous sinus infections are rare and indolent. They often mimic non-infective causes including other inflammatory and infiltrative conditions, vascular and neoplastic causes, particularly lymphoma. Clinicians should consider infective cavernous sinus syndromes in people with a …

The Association Between Urinary Alzheimer-Associated Neuronal Thread Protein And Cognitive Impairment In Late-Life Depression: A Controlled Pilot Study, Qing-E Zhang, Sihai Ling, Peng Li, Saina Zhang, Chee H. Ng, Gabor S. Ungvari, Liang-Jen Wang, Sheng-Yu Lee, Gang Wang, Yu-Tao Xiang

Medical Papers and Journal Articles

Accumulation of tau protein is associated with both Alzheimer’s disease (AD) and late-life depression (LLD). Alzheimer-associated neuronal thread protein (AD7c-NTP), which is closely linked with the tau protein, is elevated in the cerebrospinal fluid and urine of AD patients. This study examined the association between urinary AD7c-NTP and late-life depression with cognitive impairment. One hundred and thirty-eight subjects were recruited into late-life depression with cognitive impairment (LLD-CI, n=52), late-life depression without cognitive impairment (LLD-NCI, n=29), AD (n=27), and healthy control (HC, n=30) groups. The level of urinary AD7c-NTP was measured using the enzyme-linked immunosorbent assay method. The Montreal Cognitive Assessment …

Long-Term Impact Of Childhood Hepatitis B Vaccination Programs On Prevalence Among Aboriginal And Non-Aboriginal Women Giving Birth In Western Australia, Joanne Reekie, John M. Kaldor, Donna B. Mak, James Ward, Basil Donovan, Jane S. Hocking, David Preen, Bette Liu

Medical Papers and Journal Articles

Background/Aims: To evaluate the long-term effect of infant and childhood hepatitis B (HBV) vaccination programs among birthing women in Western Australia.

Methods: A cohort of Western Australian women born from 1974 to 1995 was created using Birth Registrations and Electoral Roll records. They were linked to a perinatal register and notifiable diseases register to identify women having respectively their first births between 2000 and 2012 and diagnoses of HBV infections. HBV prevalence was estimated in Aboriginal and non-Aboriginal women, and according to maternal birth year cohorts.

Results: Of 66,073 women, 155 (0.23%) had a linked non-acute HBV notification. HBV prevalence …

The Prevalence Of Autism Spectrum Disorders In China: A Comprehensive Meta-Analysis, Fei Wang, Li Lu, Shi-Bin Wang, Ling Zhang, Chee H. Ng, Gabor S. Ungvari, Xiao-Lan Cao, Jian-Ping Lu, Cai-Lan Hou, Fu-Jun Jia, Yu-Tao Xiang

Medical Papers and Journal Articles

There are conflicting prevalence estimates of autism spectrum disorders (ASDs) in mainland China (China thereafter). This study is a comprehensive meta-analysis of the pooled prevalence of ASDs in the general population in China. Study investigators independently conducted a systematic literature search of the following databases: PubMed, EMBASE, PsycINFO, China National Knowledge Infrastructure, Chinese biomedical literature service system, and Wan Fang. Studies reporting prevalence of ASDs and autism in Chinese population were identified and analysed using the Comprehensive Meta-Analysis program with the random effects model. Forty-four studies were included in the meta-analysis comprising 2,337,321 subjects of whom 46.66 % were females. …

Help-Seeking Experiences Of Bereaved Adolescents: A Qualitative Study, Karl Andriessen, Elizabeth Lobb, Jane Mowll, Michael Dudley, Brian Draper, Philip Mitchell

Medical Papers and Journal Articles

Despite the potentially devastating effects of a death on the lives of adolescents, little is known about their help-seeking experiences. We interviewed by telephone 39 bereaved adolescents on their help-seeking experiences. Thematic analysis resulted in three themes: Formal support, Informal support and School-related support. Participants provided a critical appraisal of positive and negative experiences, and noted barriers and facilitators for help-seeking. As adolescents bereaved through suicide may receive less social support, professional help is a much needed auxiliary. Parental encouragement is important in accessing adequate professional help.

The Importance Of Left Atrial Volume Assessment In Identifying The Cause Of Ischemic Stroke, David Playford, Sarah Bowler, Max Bulsara, David J. Blacker, Timothy R. Bates, James P. Codde

Medical Papers and Journal Articles

Separating cardioembolic from large artery stroke has important treatment implications. We investigated whether echocardiography could improve Cardioembolic Stroke (CES) prediction compared with traditional measures and cholesterol biomarkers.

Data from 40 consecutive patients presenting with acute ischemic stroke which included brain and carotid imaging, ECG, echo, serum cholesterol and apolipoproteins were independently reviewed. Patients were classified into two groups: a) CES, defined by sustained or paroxysmal atrial fibrillation and <50% stenosis of a perfusing cerebral artery; b) Large artery stroke (LAS) defined as > 50% stenosis of an ipsilateral perfusing cerebral artery, with no evidence of AF on monitoring or evidence of small artery disease on neuroimaging and confirmed by an independent neurologist.

Other than the …

Existential Distress In Cancer: Alleviating Suffering From Fundamental Loss And Change, Sigrun Vehling, David Kissane

Medical Papers and Journal Articles

A severe life threatening illness can challenge fundamental expectations about security, interrelatedness with others, justness, controllability, certainty, and hope for a long and fruitful life. That distress and suffering but also growth and mastery may arise from confrontation with an existentially threatening stressor is a long‐standing idea. But only recently have researchers studied existential distress more rigorously and begun to identify its distinct impact on health care outcomes. Operationalizations of existential distress have included fear of cancer recurrence, death anxiety, demoralization, hopelessness, dignity‐related distress, and the desire for hastened death. These focus in varying emphasis on fear of death, concern …

Does Implementation Matter If Comprehension Is Lacking? A Qualitative Investigation Into Perceptions Of Advance Care Planning In People With Cancer, Anna Ugalde, Clare O'Callaghan, Clem Byard, Samantha Brean, Jenelle Mackay, Anna Boltong, Sondra Davoren, Deborah Lawson, Phillip Parente, N Michael, Patricia Livingstone

Medical Papers and Journal Articles

Purpose: While advance care planning holds promise, uptake is variable and it is unclear how well people engage with or comprehend advance care planning. The objective of this study was to explore how people with cancer comprehended Advance Care Plans and examine how accurately advance care planning documentation represented patient wishes.

Methods: This study used a qualitative descriptive design. Data collection comprised interviews and an examination of participants’ existing advance care planning documentation. Participants included those who had any diagnosis of cancer with an advance care plan recorded: Refusal of Treatment Certificate; Statement of Choices; and/or Enduring Power of Attorney …

Indigenous Youth Peer-Led Health Promotion In Canada, New Zealand, Australia, And The United States: A Systematic Review Of The Approaches, Study Designs, And Effectiveness, Daniel Vujcich, Jessica Thomas, Katy Crawford, James Ward

Medical Papers and Journal Articles

Background: Youth peer-led interventions have become a popular way of sharing health information with young people and appear well suited to Indigenous community contexts. However, no systematic reviews focusing on Indigenous youth have been published. We conducted a systematic review to understand the range and characteristics of Indigenous youth-led health promotion projects implemented and their effectiveness.

Methods: A systematic search of Medline, Embase, and ProQuest Social Sciences databases was conducted, supplemented by gray literature searches. Included studies focused on interventions where young Indigenous people delivered health information to age-matched peers.

Results: Twenty-four studies were identified for inclusion, based on 20 …

Comorbidities Only Account For A Small Proportion Of Excess Mortality After Fracture: A Record Linkage Study Of Individual Fracture Types, Chen Weiwen, Judy Simpson, Lynette March, Fiona Blyth, Dana Bliuc, Thach Tran, Tuan Nguyen, John A. Eisman, Jacqueline Center

Medical Papers and Journal Articles

Background: Non-hip non-vertebral fractures (NHNV) constitute the majority of osteoporotic fractures but few studies have examined the association between these fractures, co-morbidity and mortality.

Objective: To examine the relationship between individual non-hip non-vertebral fractures, co-morbidities and mortality.

Methods: Prospective population-based cohort of 267,043 subjects (45 and Up Study, Australia) had baseline questionnaires linked to hospital administrative and all-cause mortality data from 2006 - 2013. Associations between fracture and mortality examined using multivariate, time dependent Cox models, adjusted for age, prior fracture, body mass index, smoking and co-morbidities (cardiovascular disease, diabetes, stroke, thrombosis and cancer) and survival function curves. Population attributable …

Protocol To Develop Sustainable Day Care For Children Aged 1-4 Years In Disadvantaged Urban Communities In Dhaka, Bangladesh, Mahua Das, Helen Elsey, Riffat A. Shawon, Joseph Hicks, J Ferdoush, Rumana Huque, Fariza Fieroze, Shammi Nasreen, Hilary Wallace, Saidur R. Mushreky

Medical Papers and Journal Articles

Introduction: Lack of safe, stimulating and health promoting environments for children under-5 hinders their physical, social and cognitive development, known as early childhood development (ECD). Improving ECD impacts on children, and can improve educational attainment for girls, who often care for younger siblings, and employment prospects for mothers. Developing and evaluating the impacts of ECD programmes within childcare needs to assess a range of social, health, educational and economic impacts, including women’s empowerment. Children living in slums are at high risk of poor early development and holistic, sustainable interventions are needed to address ECD in these contexts. This study will …

Antenatal Influenza And Pertussis Vaccination In Western Australia: A Cross-Sectional Survey Of Vaccine Uptake And Influencing Factors, Donna Mak, Annette K. Regan, Dieu T. Vo, Paul V. Effler

Medical Papers and Journal Articles

Background: Influenza and pertussis vaccines have been recommended in Australia for women during each pregnancy since 2010 and 2015, respectively. Estimating vaccination coverage and identifying factors affecting uptake are important for improving antenatal immunisation services.

Methods: A random sample of 800 Western Australian women ≥18 years of age who gave birth between 4th April and 4th October 2015 were selected. Of the 454 (57%) who were contactable by telephone, 424 (93%) completed a survey. Data were weighted by maternal age and area of residence to ensure representativeness. The proportion immunised against influenza and pertussis was the main outcome measure; multivariate …

How Are Junior Doctors Managing Patients With Self-Limiting Illnesses At Their First Presentation? A Video Vignette Study, Eugene D'Souza, Catherine Krejany, Rosie Meng, Moyez Jiwa

Medical Papers and Journal Articles

Purpose: To conduct a video vignette survey of medical students and doctors investigating test ordering for patients presenting with self-limiting or minor illness.

Methods: Participants were shown six video vignettes of common self-limiting illnesses and invited to devise investigation and management plans for the patients’ current presentation. The number of tests ordered was compared with those recommended by an expert panel. A Theory of Planned Behaviour Questionnaire explored participants’ beliefs and attitudes about ordering tests in the context of self-limiting illness.

Results: Participants (n=61) were recruited from across Australia. All participants ordered at least one test that was not recommended …

Informing Implementation Of Quality Improvement In Australian Primary Care, Charlotte Hespe, Lucie Rychetnik, David Peiris, Mark Harris

Medical Papers and Journal Articles

Background: Quality Improvement (QI) initiatives in primary care are effective at improving uptake of evidence based guidelines, but are difficult to implement and sustain. In Australia meso-level health organisations such as Primary health care Organisations (PHCO) offer new opportunities to implement area-wide QI programs. This study sought to identify enablers and barriers to implementation of an existing Australian QI program and to identify strategic directions that PHCOs can use in the ongoing development of QI in this environment.

Methods: Semi-structured telephone interviews were conducted with 15 purposively selected program staff and participants from the Australian Primary Care Collaborative (APCC) QI …

Healing Conversations: Developing A Practical Framework For Clinical Communication Between Aboriginal Communities And Healthcare Practitioners, Andrea Mckivett, David Paul, Nicky Hudson

Medical Papers and Journal Articles

In recognition of the ongoing health disparities experienced by Aboriginal and Torres Strait Islander peoples (hereafter Aboriginal), this scoping review explores the role and impact of the clinical communication process on Aboriginal healthcare provision. A medical education lens is applied, looking at the utility of a tailored clinical communication framework to assist health practitioners work more effectively with Aboriginal peoples and communities. The initial framework, building on existing communication guides, proposes four domains: content, process, relational and environmental. It places emphasis on critical self-reflection of the health practitioner’s own cultural identity and will be guided by collective Aboriginal world-views in …

Variations In The Management Of Acute Illness In Children With Congenital Adrenal Hyperplasia: An Audit Of Three Paediatric Hospitals, Georgina L. Chrisp, Ann M. Maguire, Maria Quartararo, Henrik Falhammar, Bruce R. King, Craig F. Munns, David J. Torpy, Shihab Hameed, R Louise Rushworth

Medical Papers and Journal Articles

Objective: Episodes of acute adrenal insufficiency (AI)/adrenal crises (AC) are a serious consequence of congenital adrenal hyperplasia (CAH). This study aimed to assess morbidity from acute illness in CAH and identify factors associated with use of IV hydrocortisone, admission and diagnosis of an AC.

Method: An audit of acute illness presentations among children with CAH to paediatric hospitals in New South Wales, Australia, between 2000 and 2015.

Results: There were 321 acute presentations among 74 children with CAH. Two thirds (66.7%, n=214) of these resulted in admission and 49.2% (n=158) of the patients received intravenous (IV) hydrocortisone. An AC was …

Educating For Indigenous Health Equity: An International Consensus Statement, Rhys Jones, Lynden Crowshoe, Papaarangi Reid, Betty Calam, Elana Curtis, Michael Green, Tania Huria, Kristen Jacklin, Martina Kamaka, Cameron Lacey, Jill Milroy, David Paul, Suzanne Pitama, Leah Walker, Gillian Webb, Shaun Ewen

Medical Papers and Journal Articles

The determinants of health inequities between Indigenous and non-Indigenous populations include factors amenable to medical education’s influence, for example, the competence of the medical workforce to provide effective and equitable care to Indigenous populations. Medical education institutions have an important role to play in eliminating these inequities. However, there is evidence that medical education is not adequately fulfilling this role, and in fact may be complicit in perpetuating inequities.

This article seeks to examine the factors underpinning medical education’s role in Indigenous health inequity, in order to inform interventions to address these factors. The authors developed a consensus statement that …

Improving Household Surveys And Use Of Data To Address Health Inequities In Three Asian Cities: Protocol For The Surveys For Urban Equity (Sue) Mixed Methods And Feasibility Study, Helen Elsey, Ak Narayan Poudel, Tim Ensor, Tolib Mirzoev, James Nicholas Newell, Joseph Paul Hicks, Christopher Cartwright, David Wong, Caroline Tait, Sushil Baral, Radheshyam Bhattarai, Sudeepa Khanal, Rajeev Dhungel, Subash Gajurel, Shraddha Manandhar, Saidur Mashreky, Junnatul Ferdoush, Rumana Huque, Tarana Ferdous, Shammi Nasreen, Hoang Van Minh, Duong Minh Duc, Bao Ngoc, Dana Thomson, Hilary Wallace

Medical Papers and Journal Articles

Introduction: As rapid urbanisation transforms the sociodemographic structures within cities, standard survey methods, which have remained unchanged for many years, under-represent the urban poorest. This leads to an overly positive picture of urban health, distorting appropriate allocation of resources between rural and urban and within urban areas. Here, we present a protocol for our study which (i) tests novel methods to improve representation of urban populations in household surveys and measure mental health and injuries, (ii) explores urban poverty and compares measures of poverty and ‘slumness’ and (iii) works with city authorities to understand, and potentially improve, utilisation of …

Decision Makers' Experience Of Participatory Dynamic Simulation Modelling: Methods For Public Health Policy, Louise Freebairn, Jo-An Atkinson, Paul M. Kelly, Geoff Mcdonnell, Lucie Rychetnik

Medical Papers and Journal Articles

Background: Systems science methods such as dynamic simulation modelling are well suited to address questions about public health policy as they consider the complexity, context and dynamic nature of system-wide behaviours. Advances in technology have led to increased accessibility and interest in systems methods to address complex health policy issues. However, the involvement of policy decision makers in health-related simulation model development has been lacking. Where end-users have been included, there has been limited examination of their experience of the participatory modelling process and their views about the utility of the findings. This paper reports the experience of end-user decision …

Patient Reported Outcomes Of Pastoral Care In A Hospital Setting, Elizabeth A. Lobb, Susanne Schmidt, Natalia Jerzmanowska, Ashley M. Swing, Safrina Thristiawati

Medical Papers and Journal Articles

This study aimed to establish whether Pastoral Care (PC) visits were an effective component of a hospitalized patient’s overall health experience. Outcomes of PC visits were reported by 369 patients in 7 sites across Australia. The patient reported outcomes of PC visits included: the patients felt they could be honest with themselves, with a sense of peace, a better perspective of their illness, less anxiety, and felt more in control. Five factors of the PC visit significantly related to higher patient’s overall outcomes: (a) having more Pastoral Care visits (p < 0.5 0 R 0.778, CI 0.17–1.38); (b) the patient was able to talk about what was on their mind (p < 0.01, OR1.48, CI 0.58–2.37); (c) they had something to be hopeful about (p < 0.01 OR1.18, CI 0.51–1.85); 4); the visit focused on decisions about the patient’s health care (p < 0.05, OR0.70, CI 0.05–1.35); and (d) a belief in God/Higher Being (p < 0.01, OR 1.01, CI 0.43–1.71).

Management Of Amiodarone-Induced Thyrotoxicosis At A Cardiac Transplantation Centre, Michelle Isaacs, Monique Costin, Ron Bova, Helen L. Barrett, Drew Heffernan, Katherine Samaras, Jerry R. Greenfield

Medical Papers and Journal Articles

Background: Amiodarone-induced thyrotoxicosis (AIT) is associated with significant morbidity and mortality, particularly in patients with cardiac failure. The aim of the study was to evaluate the management of AIT at a tertiary hospital specialising in cardiac failure and transplantation.

Methods: Retrospective audit of 66 patients treated for AIT by Endocrinology (2007–2016), classified as type 1 (T1) or type 2 (T2) based on radiological criteria. Main outcome measurements were response rate to initial treatment, time to euthyroidism, and frequency/safety of thyroidectomy.

Results: Mean age was 60 ± 2 years; 80% were male. Sixty-four patients commenced medical treatment: thionamides (THIO) in 23, …

Impact Of Aging On The Auditory System And Related Cognitive Functions: A Narrative Review, Dona M.P Jayakody, Peter L. Friedland, Ralph N. Martins, Hamid R. Sohrabi

Medical Papers and Journal Articles

Age-related hearing loss (ARHL), presbycusis, is a chronic health condition that affects approximately one-third of the world’s population. The peripheral and central hearing alterations associated with age-related hearing loss have a profound impact on perception of verbal and non-verbal auditory stimuli. The high prevalence of hearing loss in the older adults corresponds to the increased frequency of dementia in this population. Therefore, researchers have focused their attention on age-related central effects that occur independent of the peripheral hearing loss as well as central effects of peripheral hearing loss and its association with cognitive decline and dementia. Here we review the …

Standard Setting In Australian Medical Schools, Helena Ward, Neville Chiavaroli, James Fraser, Kylie Mansfield, Darren Starmer, Laura Surmon, Martin Veysey, Deborah O'Mara

Medical Papers and Journal Articles

Background: Standard setting of assessment is critical in quality assurance of medical programs. The aims of this study were to identify and compare the impact of methods used to establish the passing standard by the 13 medical schools who participated in the 2014 Australian Medical Schools Assessment Collaboration (AMSAC).

Methods: A survey was conducted to identify the standard setting procedures used by participating schools. Schools standard setting data was collated for the 49 multiple choice items used for benchmarking by AMSAC in 2014. Analyses were conducted for nine schools by their method of standard setting and key characteristics of 28 …

Does Citation Matter? Research Citation In Policy Documents As An Indicator Of Research Impact – An Australian Obesity Policy Case-Study, Robyn Newson, Lucie Rychetnik, Lesley King, Andrew Milat, Adrian Bauman

Medical Papers and Journal Articles

Background: Citation of research in policy documents has been suggested as an indicator of the potential longer-term impacts of research. We investigated the use of research citations in childhood obesity prevention policy documents from New South Wales (NSW), Australia, considering the feasibility and value of using research citation as a proxy measure of research impact.

Methods: We examined childhood obesity policy documents produced between 2000 and 2015, extracting childhood obesity-related references and coding these according to reference type, geographical origin and type of research. A content analysis of the policy documents examined where and how research was cited in the …

Patient Attitudes Towards Analgesia And Their Openness To Non-Pharmacological Methods Such As Acupuncture In The Emergency Department, Andrew L. Jan, Emogene S. Aldridge, Ian R. Rogers, Eric J. Visser, Max K. Bulsara, Dana A. Hince

Medical Papers and Journal Articles

Aims: To investigate patient attitudes to analgesia, opioids and non-pharmacological analgesia including acupuncture, in the ED.

Methods: ED patients with pain were surveyed regarding: pain scores, satisfaction, addiction concern, non-pharmacological methods of pain relief, and acupuncture. Data were analysed using logistic regression.

Results: Of 196 adult patients, 52.8% were ‘very satisfied’ with analgesia. Most patients (84.7%) would accept non-pharmacological methods including acupuncture (68.9%) and 78.6% were not concerned about addiction. Satisfaction was associated with male gender, and ‘adequate analgesia’ but not with opioids.

Conclusion: Most patients were generally satisfied with ED analgesia and were open to non-pharmacologic analgesia including …

What’S Old Is New Again: The Sacroiliac Joint As A Cause Of Lateralizing Low Back Pain, Jennifer Saunders, Manuel Cusi, Hans Van Der Wall

Medical Papers and Journal Articles

It has not been easy to identify mechanical failure of the sacroiliac joint (SIJ) with traditional imaging. The integrated model of function (Lee and Vleeming, 1998) suggests that under normal circumstances, form and force closure combined contribute to sacral nutation and “locking” the SIJ for optimal load transfer. This model is supported by clinical evidence and scintigraphic findings that contribute to successful therapy in 80% of cases. Single-photon emission computed tomography and x-ray computed tomography (SPECT-CT), a hybrid device, was used in a study of 1200 patients (64% female and 36% male patients with an average age of 42 years; …

Improving The Validity Of Script Concordance Testing By Optimising And Balancing Items, Michael Wan, Elina Tor, Judith Nicky Hudson

Medical Papers and Journal Articles

Background: A script concordance test (SCT) is a modality for assessing clinical reasoning. Concerns had been raised about the plausible validity threat to SCT scores if students deliberately avoided the extreme answer options to obtain higher scores. The aims of the study were firstly to investigate whether students’ avoidance of the extreme answer options could result in higher scores, and secondly to determine whether a ‘balanced approach’ by careful construction of SCT items (to include extreme as well as median options as model responses) would improve the validity of an SCT.

Methods: Using the paired sample t-test, the actual average …