Medicine and Health Sciences Commons^™

The Coaches’ Eye: Exploring Coach Decision-Making During Talent Identification, Alexandra Hannah Roberts

Theses: Doctorates and Masters

For decades, researchers and practitioners interested in talent identification have discussed the coaches’ eye: the elusive ability that allows some coaches to ‘see’ qualities in an athlete that point to their talent or future potential. While there is significant anecdotal evidence of coaches who possess this ability, there is little empirical research supporting the validity or reliability of the coaches’ eye. Guided by ecological dynamics, this thesis employs mixed methodologies to explore the decision-making that underpins how high-level coaches identify talent in Olympic combat sports. These four studies captured the processes of thirty- four coaches during the talent identification process, …

An Exploration Of The Relationship Between Aphasia Therapy, Depression And Quality Of Life In Post-Stroke Patients After Rehabilitation At 12 And 26 Weeks After Stroke: A Verse Sub-Study, Alia Rashid Khan

Theses: Doctorates and Masters

Background: Depression is a common consequence of stroke, and people with aphasia (PWA) post-stroke have a higher risk of developing depression compared to stroke survivors without aphasia. However, current stroke interventions featuring aphasia therapy tend to neglect the effect of the treatment on mood. There is also a lack of evidence on the impact of stroke education and counselling on PWA in early stroke recovery. Additionally, the research on post-stroke depression often excludes or insufficiently describes PWA in study populations. The influence of direct aphasia therapy on depression in PWA is undetermined. This sub-study investigated: i) the effect of …

Cost-Effectiveness Of Exercise Medicine For Prostate Cancer, Kim Edmunds

Theses: Doctorates and Masters

Background

Androgen deprivation therapy (ADT) is associated with numerous adverse effects that impact on quality of life and contribute further to the cost burden of prostate cancer (PCa) via treatment and supportive care. Exercise medicine is effective in slowing PCa progression, reversing treatment adverse effects and improving quality of life and survival of patients, however, no economic analyses have been conducted to determine whether exercise is cost-effective in this population.

Objectives

Firstly, to examine the adverse effects of ADT for PCa and the evidence supporting the use of exercise medicine in their management. Secondly, to conduct the first economic evaluations …

Assessment Of The Clinical Validity Of Ctdna Analysis For Melanoma Management, Anda-Gabriela Marsavela

Theses: Doctorates and Masters

Metastatic melanoma is responsible for almost 80% of all skin cancer-related deaths and the incidence of people affected continues to rise worldwide. The emergence of targeted therapy and immune-checkpoint inhibitors has improved the clinical management of melanoma, but durable survival benefit is only seen in a minority of patients. The use of these very expensive systemic therapies on all appropriate patients also poses a high economic burden on health systems across numerous countries. Currently, surveillance for treatment failure is not optimal. Thus, reliable and accurate biomarkers of patient disease status are urgently required.

Circulating tumour DNA (ctDNA) analysis has emerged …

Drumbeat© For Arthritis “ A Shared Purpose” Rather Than A “Lonely Struggle”, Jannette Warhurst

Theses: Doctorates and Masters

Australia is regarded as a healthy nation, with life expectancy one of the highest in the world. Yet the latest National Health Survey tells a very different story. Almost 50% of Australians are now living with one or more chronic conditions, with arthritis and other musculoskeletal (MSK) conditions representing the most expensive chronic disease group in Australia. As the leading cause of chronic pain and second most common cause of disability and early retirement due to ill health in Australia, Arthritis is costing the economy over $7 billion a year, in addition to over $1.1 billion in extra welfare costs …

Does Accurate Data, Identifying Obese Patients Impact Nurse Safety And Hospital Finances?, Kim Mcclean

Theses: Doctorates and Masters

Healthcare staff who manage obese patients are at increased risk of sustaining patient handling injuries, and this risk is anticipated to intensify as projected Australian obesity rates increase to 42% by the year 2035 and obese patients admitted to hospitals also increase. High cost burdens to healthcare organisations will result due to increased funding requirements for bariatric risk management solutions and growing costs of workers’ compensation claims of injured staff. Five (5) studies explored if identification of obese patients impacts the safety of nurses and other healthcare staff who manage obese patients and investigated the accuracy of obesity data recorded …

Breeching The System: An Exploration Of Women’S Experiences In Western Australia And Breech Birth Recommendations, Sara Elizabeth Morris

Theses: Doctorates and Masters

Breech presentation creates division in the consumer and healthcare communities. A number of studies report the use of scare tactics and bullying from clinicians, when women express a preference for vaginal birth after the diagnosis of a breech presenting fetus. Despite evidence showing that vaginal birth of a breech presenting fetus is safe in the presence of an appropriately skilled and experienced clinician, Caesarean Section is the primary mode of birth for breech presenting fetuses, which has resulted in a global lack of accessibility to breech birth experienced practitioners and birth mode options for women. Women planning a vaginal breech …

Delegation Practices Between The Registered Nurse And The Assistant In Nursing In The Acute Care Setting In Western Australia, Carol Crevacore

Theses: Doctorates and Masters

Background:

Delegation is an essential skill that allows the Registered Nurse (RN) to allocate aspects of patient care to other team members including the unregulated Assistant in Nursing (AIN). Concerns have been raised about the activities delegated to AINs in the acute care environment.

Aim:

The aim of this research was to explore the practice of delegation between the RN and the AIN in the acute care environment. This delegation practice was examined through the lens of both the RN and the AIN.

Methodology:

This study used a mixed method explanatory sequential design. The participants were RNs and AINs working …

Investigation Of A Communication Enhanced Environment Model After Stroke: A Mixed Methods Before-And-After Pilot Study, Sarah D’Souza

Theses: Doctorates and Masters

Background: Aphasia is an acquired communication disorder that affects approximately 30% of first ever stroke survivors and persists one-year post-stroke in up to 61% of survivors. Aphasia impacts on all communication modalities with significant negative consequences for social participation, interpersonal relationships, autonomy, capacity to work and quality of life. It is recognised that the environment can influence neural remapping during early stroke recovery. However, patients with aphasia (PWA) following stroke have been observed to spend less than 30% of their day communicating and 44% of their day alone during their first weeks of in-patient rehabilitation. Inadequate opportunities for communication places …

Unravelling The Potential Applications Of Extracellular Vesicles For The Clinical Management Of Melanoma Patients, Michael Edward Clark

Theses: Doctorates and Masters

Metastatic melanoma is the third most common cancer in Australia with global incidence increasing. After decades without effective systemic treatments for advanced melanoma, the advent of targeted and immune therapies has substantially improved patient survival. While this is encouraging, further research is needed as the majority of patients treated with targeted therapy ultimately develop drug resistance. Immunotherapy can achieve durable responses in many patients however, not all patients respond to current single or a combination of immune checkpoint inhibitors. Considering the cost and potential toxicities to patients being treated with these therapies, there is an urgent need to develop biomarkers …

Clinicopathologic Implications Of Complement Genetic Variants In Kidney Transplantation, Zhen Ren, Stephen J Perkins, Latisha Love-Gregory, John P Atkinson, Anuja Java

2020-Current year OA Pubs

Genetic testing has uncovered rare variants in complement proteins associated with thrombotic microangiopathy (TMA) and C3 glomerulopathy (C3G). Approximately 50% are classified as variants of uncertain significance (VUS). Clinical risk assessment of patients carrying a VUS remains challenging primarily due to a lack of functional information, especially in the context of multiple confounding factors in the setting of kidney transplantation. Our objective was to evaluate the clinicopathologic significance of genetic variants in TMA and C3G in a kidney transplant cohort. We used whole exome next-generation sequencing to analyze complement genes in 76 patients, comprising 60 patients with a TMA and …

Gene Therapy Potential For Genetic Disorders Of Surfactant Dysfunction, Ashley L Cooney, Jennifer A Wambach, Patrick L Sinn, Paul B Mccray

2020-Current year OA Pubs

Pulmonary surfactant is critically important to prevent atelectasis by lowering the surface tension of the alveolar lining liquid. While respiratory distress syndrome (RDS) is common in premature infants, severe RDS in term and late preterm infants suggests an underlying genetic etiology. Pathogenic variants in the genes encoding key components of pulmonary surfactant including surfactant protein B (SP-B,

A Modified Delphi Approach To Develop A Trial Protocol For Antibiotic De-Escalation In Patients With Suspected Sepsis, Michael E Yarrington, Rebekah W Moehring, Michael Z David, Keith W Hamilton, Michael Klompas, Chanu Rhee, Kevin Hsueh, Elizabeth Dodds Ashley, Ronda L Sinkowitz-Cochran, Matthew Ryan, Deverick J Anderson, Detours Expert Panel Of The Cdc Prevention Epicenters Program

2020-Current year OA Pubs

Background: Early administration of antibiotics in sepsis is associated with improved patient outcomes, but safe and generalizable approaches to de-escalate or discontinue antibiotics after suspected sepsis events are unknown.

Methods: We used a modified Delphi approach to identify safety criteria for an opt-out protocol to guide de-escalation or discontinuation of antibiotic therapy after 72 hours in non-ICU patients with suspected sepsis. An expert panel with expertise in antimicrobial stewardship and hospital epidemiology rated 48 unique criteria across 3 electronic survey rating tools. Criteria were rated primarily based on their impact on patient safety and feasibility for extraction from electronic health …

Evaluation Of A Hybrid Antimicrobial Restriction Process At A Large Academic Medical Center, Jesse D Smith, Linh H Nguyen, Tamara Krekel, Jerrica Waggoner, David J Ritchie, Michael J Durkin, Kevin Hsueh, Elizabeth A Neuner

2020-Current year OA Pubs

We conducted a retrospective review of a hybrid antimicrobial restriction process demonstrating adherence to appropriate use criteria in 72% of provisional-only orders, in 100% of provisional orders followed by ID orders, and in 97% of ID-initiated orders. Therapy interruptions occurred in 24% of provisional orders followed by ID orders.

Transmission Dynamics: Data Sharing In The Covid-19 Era, Randi E Foraker, Albert M Lai, Thomas G Kannampallil, Keith F Woeltje, Anne M Trolard, Philip R O Payne

2020-Current year OA Pubs

Problem: The current coronavirus disease 2019 (COVID-19) pandemic underscores the need for building and sustaining public health data infrastructure to support a rapid local, regional, national, and international response. Despite a historical context of public health crises, data sharing agreements and transactional standards do not uniformly exist between institutions which hamper a foundational infrastructure to meet data sharing and integration needs for the advancement of public health.

Approach: There is a growing need to apply population health knowledge with technological solutions to data transfer, integration, and reasoning, to improve health in a broader learning health system ecosystem. To achieve this, …

Unfriendly Fire: How The Tobacco Industry Is Destroying The Future Of Our Children, Andrew Bush, Thomas Ferkol, Et Al.

2020-Current year OA Pubs

Tobacco has long been known to be one of the greatest causes of morbidity and mortality in the adults, but the effects on the foetus and young children, which are lifelong, have been less well appreciated. Developing from this are electronic nicotine delivery systems or vapes, promulgated as being less harmful than tobacco. Nicotine itself is toxic to the foetus, with permanent effects on lung structure and function. Most vapes contain nicotine, but they also contain many other compounds which are inhaled and for which there are no toxicity studies. They also contain known toxic substances, whose use is banned …

Just Culture For Medical Students: Understanding Response To Providers In Adverse Events, Brijen J Shah, Bonnie Portnoy, Dennis Chang, Marc Napp

2020-Current year OA Pubs

INTRODUCTION: Individual and organizational response to an adverse event is a key part of the life cycle of a patient safety event. Just culture is a safety concept that emphasizes system drivers of human behavior. We developed a learning activity for medical students to teach and discuss just culture as part of a patient safety curriculum.

METHODS: This small-group, discussion-based learning activity was aimed at third-year medical students. Over 5 years, 628 students participated in it. The session had three components: a presession case-based survey, a didactic lecture, and a facilitated small-group discussion. Participants evaluated the session using our institution's …

The Free And Cued Selective Reminding Test Predicts Braak Stage, Ellen Grober, Qi Qi, Lynn Kuo, Jason Hassenstab, Richard J Perrin, Richard B Lipton

2020-Current year OA Pubs

BACKGROUND: The ultimate validation of a clinical marker for Alzheimer's disease (AD) is its association with AD neuropathology.

OBJECTIVE: To identify clinical measures that predict pathology, we evaluated the relationships of the picture version of the Free and Cued Selective Reminding Test (pFCSRT + IR), the Mini-Mental State Exam (MMSE), and the Clinical Dementia Rating scale Sum of Boxes (CDR-SB) to Braak stage.

METHODS: 315 cases from the clinicopathologic series at the Knight Alzheimer's Disease Research Center were classified according to Braak stage. Boxplots of each predictor were compared to identify the earliest stage at which decline was observed and …

Stages Of Objective Memory Impairment Predict Alzheimer's Disease Neuropathology: Comparison With The Clinical Dementia Rating Scale-Sum Of Boxes, Ellen Grober, Qi Qi, Lynn Kuo, Jason Hassenstab, Richard J Perrin, Richard B Lipton

2020-Current year OA Pubs

BACKGROUND: The ultimate validation of a clinical marker for Alzheimer's disease (AD) is its association with AD neuropathology.

OBJECTIVE: To examine how well the Stages of Objective Memory Impairment (SOMI) system predicts intermediate/high AD neuropathologic change and extent of neurofibrillary tangle (NFT) pathology defined by Braak stage, in comparison to the Clinical Dementia Rating (CDR) Scale sum of boxes (CDR-SB).

METHODS: 251 well-characterized participants from the Knight ADRC clinicopathologic series were classified into SOMI stage at their last assessment prior to death using the free recall and total recall scores from the picture version of the Free and Cued Selective …