Medicine and Health Sciences Commons^™

"[It's] More Than Just Medicine": The Value And Sustainability Of Mandatory, Non-Clinical, Short-Term Rural Placements In A Western Australian Medical School, Daniel Vujcich, Sandy Toussaint, Donna B. Mak

Medical Papers and Journal Articles

Introduction: In 2005, the University of Notre Dame School of Medicine (Western Australia) established a mandatory, non-clinical rural and remote (hereafter termed rural) health placement program delivered in 2 weeks over 2 years, largely resourced by voluntary human capital. Our study investigated whether the program: (1) encouraged medical graduates to seek rural employment; (2) enhanced their ability to meet rural people’s health needs; and (3) was sustainable.

Methods: A qualitative descriptive study collected data using semi-structured, in-depth interviews with graduates and placement hosts. Data were transcribed, coded and analysed using Framework Analysis to identify key themes.

Results: Twenty-eight medical graduates …

Exploring The Efficacy Of The Expiratory Muscle Strength Trainer To Improve Swallowing In Inclusion Body Myositis: A Pilot Study, Nika Mohannak, Gemma Pattison, Bronwyn Radich, Kathryn Hird, Erin Godecke, Frank L. Mastaglia, Merrilee Needham

Medical Papers and Journal Articles

Inclusion Body Myositis (IBM) is the most common acquired myopathy in older individuals with more than two thirds of patients experiencing impaired swallowing. There are currently no standardized exercise therapies to improve or sustain swallowing despite good evidence for exercise therapy in limb muscles. Reduced upper esophageal sphincter (UES) opening is a common abnormality associated with dysphagia in IBM. This pilot study recruited IBM patients with abnormal UES function and dysphagia into an exercise program. It was hypothesised that regular practice using the Expiratory Muscle Strength Trainer (EMST) device would improve hyolaryngeal movement by strengthening suprahyoid musculature and facilitate opening …

Utility Of Preoperative Blood Screening Before Hip And Knee Arthroplasty, Sarah Shumborski, Benjamin Gooden, Lucy J. Salmon, Michael O'Sullivan, Leo Pinczewski, Justin P. Roe, Kaka Martina, Sarthak Chopra, Colin Maclean, Matthew C. Lyons

Medical Papers and Journal Articles

Background: It is engrained in medical training that routine blood screening prior to arthroplasty is necessary for optimal patient care. There is little evidence to support their utility and the aggregate cost to the health system. The purpose of this study was to evaluate preoperative blood screening by identifying the frequency of an abnormal result and to examine the influence of age, gender and body mass index on the frequency of abnormal blood pathology.

Methods: This is a retrospective review of 1000 patients from a single centre who underwent elective primary hip or knee arthroplasty from 2015 to 2017. Abnormal …

Transphyseal Anterior Cruciate Ligament Reconstruction Using Living Parental Donor Hamstring Graft: Excellent Clinical Results At 2 Years In A Cohort Of 100 Patients, Koushik Ghosh, Lucy J. Salmon, Emma Heath, Leo Pinczewski, Justin P. Roe

Medical Papers and Journal Articles

Methods: One hundred consecutive juveniles undergoing ACL reconstruction with a living parental hamstring allograft were recruited prospectively and reviewed 2 years after ACL reconstruction with IKDC Knee Ligament Evaluation, and KT1000 instrumented laxity testing. Skeletally immature participants obtained annual radiographs until skeletal maturity, and long leg alignment radiographs at 2 years. Radiographic Posterior tibial slope was recorded.

Results: Of 100 juveniles, the median age was 14 years (range 8-16) and 68% male. At surgery, 30 juveniles were graded Tanner 1 or 2, 21 were Tanner 3 and 49 were Tanner 4 or 5. There were no cases of iatrogenic physeal …

Cognitive Behavioural Therapy Monotherapy For Insomnia: A Meta-Analysis Of Randomized Controlled Trials, Yuan-Yuan Wang, Yuan Yang, Wen-Wang Rao, Shu-Fang Zhang, Liang-Nan Zeng, Wei Zheng, Chee H. Ng, Gabor S. Ungvari, Ling Zhang, Yu-Tao Xiang

Medical Papers and Journal Articles

This was a meta-analysis of randomized controlled trials (RCTs) comparing the effects of cognitive behavioural therapy for insomnia (CBTI) as a monotherapy and active control treatments in persons with insomnia who have no major medical conditions or psychiatric comorbidities. PubMed, PsycINFO, EMBASE, Cochrane Library databases, WanFang and CNKI were systematically and independently searched. Standardized mean differences (SMDs) and risk ratio (RR) with their 95% confidence intervals (CIs) were calculated. Nine RCTs with 12 treatment arms comparing CBTI (n = 479) and active control (n = 510) groups were analyzed. Compared to the active control group, the CBTI group showed significantly …

Patterns Of Sickness Absence From A Secondary Hospital In Melbourne: A 10-Year Longitudinal Study, Catherine Krejany, Lee Gaedtke, Epi Kanjo, Moyez Jiwa

Medical Papers and Journal Articles

Background/aims: There has been significant concern in recent years regarding increases in absenteeism in the healthcare sector, leading to lost productivity and projected workforce shortages. This study aimed to identify patterns of sickness absence over a 10-year period in a single-site secondary hospital in Melbourne, Australia.

Methods: Data regarding sickness absences were extracted from anonymised payroll records from 2007 to 2016. The patterns of sickness absence analysed included seasonality, amount of leave and category of leave. These were explored both for individuals and in the aggregate.

Results: Compared to the Australian average of 9.7 days, this cohort of employees took …

Contralateral Prophylactic Mastectomy For Unilateral Breast Cancer In Women At Average Risk: Systematic Review Of Patient Reported Outcomes, Amilee Srethbhakdi, Meagan E. Brennan, Geaty Hamid, Kathy Flitcroft

Medical Papers and Journal Articles

Objective: The rate of contralateral prophylactic mastectomy (CPM) in women with early, unilateral cancer is relatively high and is increasing around the world a previous study. Women choose this option for many reasons other than reducing their risk of future cancer, including symmetry, reasons related to breast reconstruction and attempting to manage fear of recurrence. This systematic review evaluated patient‐reported quality of life outcomes following CPM.

Methods: A literature search of MEDLINE, PubMed and PsycINFO was performed to February 2019. Abstracts and full‐text articles were assessed for eligibility according to pre‐determined criteria. Data were extracted into evidence tables for analysis. …

Marked Increase In Community-Associated Methicillin-Resistant Staphylococcus Aureus Infections, Western Australia, 2004–2018, Lauren E. Bloomfield, G W. Coombs, S Tempone, P K. Armstrong

Medical Papers and Journal Articles

This study presents enhanced surveillance data from 2004 – 2018 for all community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) specimens collected in Western Australia (WA), and describes the changing epidemiology over this period. A total of 57,557 cases were reviewed. Annual incidence rates increased from 86.2 cases per 100,000 population to 245.6 per 100,000 population (IRR = 2.9, CI95 2.7 – 3.0). The proportion of isolates carrying Panton-Valentine leukocidin (PVL)-associated genes increased from 3.4% to 59.8% (χ2 test for trend 7021.9, p<0.001). The emergence of PVL-positive, “Queensland CA-MRSA” (ST93- IV) and “WA 121” (ST5-IV) accounted for the majority of increases in CA-MRSA across the study period. It is unclear why some clones are more prolific in certain regions. In WA, CA-MRSA rates increase as indices of temperature and humidity increase after controlling for socioeconomic disadvantage. We suggest climatic conditions may contribute to transmission, along with other socio-behavioural factors. A better understanding of the ability for certain clones to form ecological niches and cause outbreaks is required.

'Take 10 To Talk About It': Use Of A Scripted, Post-Event Debriefing Tool In A Neonatal Intensive Care Unit, Anastasi Gougoulis, Rory Trawber, Kathryn Hird, Greg Sweetman

Medical Papers and Journal Articles

Aim: This study assessed the impact of a scripted, post-event debriefing tool in identifying logistical, procedural, personnel and performance obstacles and successes in a clinical setting. It was predicted that the debriefing tool would highlight the importance of routine debriefing following challenging clinical events.

Method: The study was conducted in a 22 bed Neonatal Intensive Care Unit at a tertiary hospital and involved all staff members in the perinatal service. The debriefing tool, a two-page form providing a structured, scripted approach, was used at the earliest opportunity after acute clinical deteriorations, emergency caesarean sections and any other critical events as …

Screening For Atrial Fibrillation: The Essential Role Of Gps, Katrina Giskes, Charlotte Hespe, Ben Freedman

Medical Papers and Journal Articles

Asymptomatic atrial fibrillation (AF) is associated with similar stroke risk as symptomatic AF, yet is often detected only after the patient presents with a devastating stroke. The first Australian guidelines for the screening and management of AF were released in 2018 by the National Heart Foundation of Australia and the Cardiac Society of Australia and New Zealand. This brief, practical summary of the guidelines focuses on screening in general practice.

Systemic Vasculitides. Part 1: Large, Medium And Variable Vessel Diseases, Sean M. Conte, Peter R. Vale

Medical Papers and Journal Articles

Vasculitis, or inflammation of vessel walls, is common and consists of a diverse array of disease entities encompassing virtually all organ systems. As onset is typically subacute and nonspecific, affected patients usually first seek attention from primary care providers. Size and distribution of the affected vasculature dictate end-organ manifestations and preliminary screening tests. Complications may carry high morbidity and mortality; therefore, prompt recognition, specialist referral and institution of immunosuppressive therapy are crucial to obviate potentially poor outcomes.

Systemic Vasculitides. Part 2: Small Vessel Diseases, Sean M. Conte, Peter R. Vale

Medical Papers and Journal Articles

Small vessel vasculitides often manifest as neurological, renal, pulmonary and dermatological symptoms. Clinical features of systemic vasculitides are often nonspecific; therefore, it is important that GPs be aware of the range of symptoms that can help in the differential diagnosis, treatment and management of this diverse group of conditions.

Three Tools For Managing Vertigo In The Frontline, Vincent A. Van Vugt, Allison S. Young, Andrew P. Bradshaw, Benjamin Nham, Margot Woods, Miriam S. Welgampola

Medical Papers and Journal Articles

Vertigo is a challenging symptom in general practice. With access to three tools – a focused history, eye examination and a management algorithm – a large proportion of vertiginous patients could be managed effectively by GPs. This practical guide seeks to increase the skills and confidence of frontline practitioners when managing vertigo.

The Power Of Collaborative Planning: How A Health And Planning Collaboration Facilitated Integration Of Health Goals In The 30-Year Plan For Greater Adelaide, Michael Mcgreevy, Patrick Harris, Toni Delaney-Crowe, Matt Fisher, Peter Sainsbury, Fran Baum

Medical Papers and Journal Articles

This article examines the relationship between theories of urban governance, strategic planning and collaborative planning and the preparation of a strategic spatial plan for the greater Adelaide region. In particular, it analyses the extent to which health professionals involved in the collaborative processes used to formulate the plan were able to advocate for health-related objectives. The analysis was undertaken using data collected in interviews with actors directly involved in the collaborative processes that produced the plan. Interview responses were analysed to understand how factors that can derail or conversely facilitate successful collaborative planning processes were dealt with.

The Relationship Between Demoralization And Depressive Symptoms Among Patients From The General Hospital: Network And Exploratory Graph Analysis, Martino Belvederi Murri, Rosangela Caruso, Heifa Ounalli, Luigi Zerbinati, Eleonora Berretti, Silvia Costa, Elisabetta Recla, Federica Folesani, David Kissane, Maria Giulia Nanni, Luigi Grassi

Medical Papers and Journal Articles

Introduction: Depression and demoralization are highly prevalent among individuals with physical illnesses but their relationship is still unclear.

Objective: To examine the relationship between clinical features of depression and demoralization with the network approach to psychopathology.

Methods: Participants were recruited from the medical wards of a University Hospital in Italy. The Demoralization Scale (DS) was used to assess demoralization, while the Patient Health Questionnaire-9 (PHQ-9) to assess depressive symptoms. The structure of the depression-demoralization symptom network was examined and complemented by the analysis of topological overlap and Exploratory Graph Analysis (EGA) to identify the most relevant groupings (communities) of symptoms …

Ethical Thinking Machines In Surgery And The Requirement For Clinical Leadership, Quinlan D. Buchlak, Nazanin Esmaili, Jean-Christophe Leveque, Christine Bennett, Massimo Piccardi, Farrokh Farrokhi

Medical Papers and Journal Articles

No abstract available.

Examiners' Decision‐Making Processes In Observation-Based Clinical Examinations, Bunmi S. Malau-Aduli, Richard B. Hays, Karen D'Souza, Amy M. Smith, Karina Jones, Richard Turner, Lizzi Shires, Jane Smith, Shannon Saad, Cassandra Richmond, Antonio Celenza, Tarun Sen Gupta

Medical Papers and Journal Articles

Background: Objective structured clinical examinations (OSCEs) are commonly used to assess the clinical skills of health professional students. Examiner judgement is one acknowledged source of variation in candidate marks. This paper reports an exploration of examiner decision making to better characterise the cognitive processes and workload associated with making judgements of clinical performance in exit‐level OSCEs.

Methods: Fifty‐five examiners for exit‐level OSCEs at five Australian medical schools completed a NASA Task Load Index (TLX) measure of cognitive load and participated in focus group interviews immediately after the OSCE session. Discussions focused on how decisions were made for borderline and clear …

Epidemiology Of Soccer‐Related Head Injury In Children 5–14 Years In Victoria, Australia, Amy E. Smith, Catherine Krejany, Moyez Jiwa

Medical Papers and Journal Articles

Aim: Our aim was to use epidemiological data to determine the incidence of soccer‐related head injuries in children aged 5–14 years who presented at emergency departments (EDs) or were admitted in hospitals in Victoria, Australia.

Methods: ED presentation and hospital admission de‐identified aggregate data were from the Victorian Injury Surveillance Unit. Soccer participation data were compared with the soccer‐related head injury data to determine the incidence of this injury among these children.

Results: The incidence of ED presentations was 0.17% of children participating in soccer during the study period (financial years 2011–2012 to 2015–2016). The 10–14‐years age group presented with …

Equitable Expanded Carrier Screening Needs Indigenous Clinical And Population Genomic Data, Simon Easteal, Ruth M. Arkell, Renzo F. Balboa, Shayne A. Bellingham, Alex D. Brown, Tom Calma, Matthew C. Cook, Megan Davis, Hugh J.S Dawkins, Marcel E. Dinger, Michael S. Dobbie, Ashley Farlow, Kylie G. Gwynne, Azure Hermes, Wendy E. Hoy, Misty R. Jenkins, Simon H. Jiang, Warren Kaplan, Stephen Leslie, Bastien Llamas, Graham J. Mann, Brendan J. Mcmorran, Rebekah E. Mcwhirter, Cliff J. Meldrum, Shivashankar H. Nagaraj, Saul J. Newman, Jack S. Nunn, Lyndon Ormond-Parker, Neil J. Orr, Devashi Paliwal, Hardip R. Patel, Glenn Pearson, Greg R. Pratt, Boe Rambaldini, Lynette W. Russell, Ravi Savarirayan, Matthew Silcocks, John C. Skinner, Yassine Souilmi, Carola G. Vinuesa, Gareth Baynam

Medical Papers and Journal Articles

Expanded carrier screening (ECS) for recessive monogenic diseases requires prior knowledge of genomic variation including DNA variants that cause disease. The composition of pathogenic variants differs greatly among human populations, but historically research about monogenic diseases has focused mainly on people with European ancestry. By comparison, less is known about pathogenic DNA variants in people from other parts of the world. Consequently, inclusion of currently under-represented Indigenous and other minority population groups in genomic research is essential to enable equitable outcomes in ECS and other areas of genomic medicine. Here we discuss this issue in relation to the implementation of …

Foot Burns: A Comparative Analysis Of Diabetic And Non-Diabetic Patients, Jason Diab, Justine O'Hara, Miranda Pye, Christine Parker, Peter K.M Maitz, Andrea Issler-Fisher

Medical Papers and Journal Articles

Introduction: Foot burns represent a small part of the body with many challenges. The impact of diabetes on clinical outcomes adds further issues in management that clinicians must consider in their management. These factors have serious implications on morbidity and long term sequelae. Our aim is to analyse epidemiological trends of foot burns and examine the differences between diabetic and non-diabetics at Concord hospital from 2014 to 2019.

Methods: A retrospective audit from 2014–19 at Concord General Repatriation Hospital Burns Unit summarised patient demographics, burn injury, diabetic status, operations and length of stay. All foot burn injuries from 2014–19 of …

Evaluating A Low-Fidelity Inguinal Canal Model, Jake Hindmarch, Khalil Bazzi, John Lahoud, Ali Malik, Sankar Sinha

Medical Papers and Journal Articles

Purpose: The inguinal canal anatomy is of paramount clinical significance due to the common occurrence of direct and indirect inguinal hernias. However, the inguinal canal is often an area of great difficulty for medical students to understand. The aim of this study was to evaluate the use of a low-cost, low-fidelity inguinal canal model as a teaching and learning aid.

Methods: A low-fidelity inguinal canal model was introduced as a learning aid in an anatomy tutorial on the inguinal region. Students were randomised into intervention (n=66) and control (n=40) groups. Following the tutorial, all students completed a multiple-choice question quiz …

Managing Clinic Variability With Same-Day Scheduling, Intervention For No-Shows, And Seasonal Capacity Adjustments, Kum Khiong Yang, Tugba Cayirli

Research Collection Lee Kong Chian School Of Business

This study investigates demand and capacity strategiesfor managing clinic variability. These include (i) same-day scheduling tocontrol random walk-ins, (ii) no-show intervention, where the clinic callsadvance-booked patients a day before to identify and release canceled slots tosame-day patients, and (iii) adjustments to daily number of appointments foradvance-booked patients to match seasonal variations in same-day demand. Thesestrategies are tested over the individual-block/fixed-interval (IBFI) and theDome appointment rules. The resulting appointment systems are tested underscenarios with different levels of same-day demand, demand seasonality,no-shows and cost ratios. The goal is to minimize the weighted sum of patients’wait time and physician’s idle-time and overtime. Our …

Detection Of Low-Level Egfr C.2369 C>T (P.Thr790met) Resistance Mutation In Pre-Treatment Non-Small Cell Lung Carcinomas Harboring Activating Egfr Mutations And Correlation With Clinical Outcomes, Linda Ye, Nima Mesbah Ardakani, Carla Thomas, Katrina Spilsbury, Connull Leslie, Benhur Amanuel, Michael Millward

IHR Papers and Journal Articles

Increasing evidence points to the presence of low-level de novo T790M mutations in patients with non-small cell lung carcinoma (NSCLC) harboring activating EGFR mutations. We utilized digital PCR (dPCR), a highly sensitive gene mutation detection method, to detect pre-treatment T790M mutations in NSCLC tumor samples and correlated the T790M status with clinical features and patient outcomes. DNA extracted from pre-treatment NSCLC tumor tissue with known activating EGFR mutations, diagnosed between October 2010 and May 2017 at PathWest laboratory, was used to perform targeted dPCR for quantitative detection of T790M mutations. T790M was detected in 42 of 109 pre-treatment samples (38.5%). …

Defining The Border Of The Subthalamic Nucleus For Deep Brain Stimulation: A Proposed Model Using The Symmetrical Sigmoid Curve Function, Anthony M.T Chau, Angela Jacques, Christopher R. Lind

IHR Papers and Journal Articles

Background: The subthalamic nucleus (STN) is an important target during deep brain stimulation (DBS). Accurate lead placement is integral to achieving satisfactory clinical outcomes; however, the STN remains a structure whose visualization is highly variable with borders often difficult to define. We aimed to develop an objective method of evaluating the visibility of the STN on preoperative magnetic resonance imaging (MRI) to standardize future comparative assessments between imaging protocols and patient-specific parameters.

Methods: An imaging study of 64 prospectively collected patients undergoing bilateral DBS of the STN for various movement disorders was performed with institutional approval. MRI scans were acquired …

Do Peers Increase Older Adults' Participation In Strength Training? Pilot Randomized Trial, Elissa Burton, Karen Levit, Jim Codde, Keith D. Hill, Anne-Marie Hill

IHR Papers and Journal Articles

Fewer than 20% of older adults participate in strength training (ST). Barriers to ST participation include not knowing where to go or not having someone to go with. To address these barriers, the authors provided older adults with a peer (older person already participating in ST) to support their engagement. The aim of this pilot randomized controlled trial was to determine whether older adults who were provided with a peer when participating in ST were more likely to be participating in ST 4 weeks postintervention, compared with those receiving ST alone. Fifty-one ST participants were recruited; 40 completed the intervention …

Fatherhood Too Soon. Anxiety, Depression And Quality Of Life In Fathers Of Preterm And Term Babies: A Longitudinal Study, Ingrid Beatrice Petersen, Julie Anne Quinlivan

IHR Papers and Journal Articles

Introduction: Fathers are increasingly recognized as playing a critical role in the family unit and emotional development of children. The birth of a preterm baby can be confronting, yet there is limited research that explores how preterm birth might impact on father’s emotional wellbeing and quality of life. The aim of the study was to monitor quality of life and psychological wellbeing in a group of fathers to explore if a preterm birth altered outcomes in these two domains.

Methods: Institutional ethics committee approval was obtained. Australian men (N = 1000) were recruited in the antenatal period via their …

Paediatric Nurses' Satisfaction With Organisational Communication, Job Satisfaction, And Intention To Stay: A Structural Equation Modelling Analysis, Gemma Doleman, Di Twigg, Sara Bayes, Paola T. Chivers

IHR Papers and Journal Articles

Aims: To examine the effect of paediatric nurses’ organisational communication satisfaction on job satisfaction and intention to stay in their role.

Background: Nurses’ satisfaction with organisational communication has not been studied in-depth in recent years and specifically, there is a paucity of evidence in relation to paediatric nurses’ job satisfaction and intention to stay in their current job.

Methods: A cross-sectional quantitative research design using questionnaires was used. Descriptive statistics were used to analyse demographic data and structural equation modelling was used to analyse the hypothesised models.

Findings: The constructs of supervisor relationships, communication climate and media quality had a …

Mesothelial Cells Regulate Immune Responses In Health And Disease: Role For Immunotherapy In Malignant Mesothelioma, Steven E. Mutsaers, Fiona J. Pixley, Cecilia M. PrêLe, Gerard F. Hoyne

Health Sciences Papers and Journal Articles

Highlights:

• Mesothelial and immune cell interactions play a crucial role in tissue homeostasis in the serosal cavities such as the pleura.

• Mesothelin is viewed as an attractive target for solid tumors, including malignant mesothelioma.

• Checkpoint inhibitor therapy has shown variable efficacy against malignant mesothelioma.

• CAR T cell therapies are being evaluated for malignant mesothelioma.

• Treatment of malignant mesothelioma will require multimodality approaches with immunotherapy central to future therapeutic approaches.

The mesothelium when first described was thought to function purely as a non-adhesive surface to facilitate intracoelomic movement of organs. However, the mesothelium is now recognized as a dynamic cellular membrane …

Physical And Energy Demand Of Soccer: A Brief Review, Filippo Dolci, Nicolas H. Hart, Andrew E. Kilding, Paola Chivers, Benjamin Piggott, Tania Spiteri

Health Sciences Papers and Journal Articles

Soccer is a complex and exhaustive team-sport requiring a high level of tactical, technical, and physical ability to succeed. During a competitive match, a random combination of explosive and powerful activities, together with technical and tactical gestures, is performed in an intermittent manner over a 90-minute game. This review presents a detailed analysis and up-to-date synthesis of the literature describing activities and energy system contribution during soccer to provide to strength and conditioning coaches a clear understanding of soccer players’ physical needs during competition.

Clinically Significant Depressive Symptoms Are Prevalent In People With Extremely Short Prognoses - A Systematic Review, Wei Lee, Marley Pulbrook, Caitlin Sheehan, Slavica Kochovska, Sungwon Chang, Annmarie Hosie, Elizabeth Lobb, Deborah Parker, Brian Draper, Meera R. Agar, David Currow

Nursing Papers and Journal Articles

Context: Currently, systematic evidence of prevalence of clinically significant depressive symptoms in people with extremely short prognoses is not available to inform its global burden, assessment, and management.

Objectives: To determine the prevalence of clinically significant depressive symptoms in people with advanced life-limiting illnesses and extremely short prognoses (range of days to weeks).

Methods: A systematic review and meta-analysis (random effects model) were performed (PROSPERO: CRD42019125119). MEDLINE, Embase, PsycINFO, CINAHL, and CareSearch were searched for studies (1994-2019). Data were screened for prevalence of clinically significant depressive symptoms (assessed using validated depression-specific screening tools or diagnostic criteria) of adults with advanced …