Medicine and Health Sciences Commons^™

Quality Improvement Initiatives In The Care And Prevention Of Fragility Fractures In The Asia Pacific Region, Paul J. Mitchell, Seng Bin Ang, Leilani Basa Mercado-Asis, Reynaldo Rey-Matias, Wen-Shiang Chen, Leon Flicker, Edward Leung, David Choon, Sankara Kumar Chandrasekaran, Jacqueline Clare Therese Close, Hannah Seymour, Cyrus Cooper, Philippe Halbout, Robert Daniel Blank, Yanling Zhao, Jae-Young Lim, Irewin Tabu, Maoyi Tian, Aasis Unnanuntana, Ronald Man Yeung Wong, Noriaki Yamamoto, Ding-Cheng Chan, Joon Kiong Lee, On Behalf Of The Asia Pacific Fragility Fracture Alliance

Medical Papers and Journal Articles

Summary: This narrative review summarises ongoing challenges and progress in the care and prevention of fragility fractures across the Asia Pacific region since mid-2019. The approaches taken could inform development of national bone health improvement Road Maps to be implemented at scale during the United Nations ‘Decade of Healthy Ageing’.

Purpose: This narrative review summarises recent studies that characterise the burden of fragility fractures, current care gaps and quality improvement initiatives intended to improve the care and prevention of fragility fractures across the Asia Pacific region.

Methods: The review focuses on published studies, reports and quality improvement …

Repeat Anterior Cruciate Ligament Injury And Return To Sport In Australian Soccer Players After Anterior Cruciate Ligament Reconstruction With Hamstring Tendon Autograft, Jonathan R. Manara, Lucy J. Salmon, Faisal M. Kilani, Gerardo Zelaya De Camino, Claire Monk, Keran Sundaraj, Leo A. Pinczewski, Justin P. Roe

Medical Papers and Journal Articles

Background: Soccer is the most commonly played team sport in the world and a high-risk sport for anterior cruciate ligament (ACL) injury and subsequent ACL reconstruction (ACLR).

Purpose: To assess the rate of further ACL injury in patients who have undergone ACLR with hamstring tendon autograft after soccer injuries in Australia and to determine factors associated with repeat ACL injury and return to soccer.

Study Design: Case-control study; Level of evidence, 3.

Methods: From a prospectively collected database, a series of 1000 consecutive ACLRs using hamstring autografts performed in soccer players were identified. Patients were surveyed at a minimum 5 …

Multichannel Mixture Models For Time-Series Analysis And Classification Of Engagement With Multiple Health Services: An Application To Psychology And Physiotherapy Utilization Patterns After Traffic Accidents, Nazanin Esmaili, Quinlan D. Buchlak, Massimo Piccardi, Bernie Kruger, Federico Girosi

Medical Papers and Journal Articles

Background: Motor vehicle accidents (MVA) represent a significant burden on health systems globally. Tens of thousands of people are injured in Australia every year and may experience significant disability. Associated economic costs are substantial. There is little literature on the health service utilization patterns of MVA patients. To fill this gap, this study has been designed to investigate temporal patterns of psychology and physiotherapy service utilization following transport-related injuries.

Method: De-identified compensation data was provided by the Australian Transport Accident Commission. Utilization of physiotherapy and psychology services was analysed. The datasets contained 788 psychology and 3115 physiotherapy claimants and 22,522 …

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 …

Who Cares For The Bereaved? A National Survey Of Family Caregivers Of People With Motor Neurone Disease, Samar M. Aoun, Paul A. Cafarella, Bruce Rumbold, Geoff Thomas, Anne Hogden, Leanne Jiang, Sonia Gregory, David W. Kissane

Medical Papers and Journal Articles

Background: Although Motor Neurone Disease (MND) caregivers are most challenged physically and psychologically, there is a paucity of population-based research to investigate the impact of bereavement, unmet needs, range of supports, and their helpfulness as perceived by bereaved MND caregivers.

Methods: An anonymous national population-based cross-sectional postal and online survey of bereavement experiences of family caregivers who lost a relative/friend to MND in 2016, 2017, and 2018. Recruitment was through all MND Associations in Australia.

Results: 393 valid responses were received (31% response rate). Bereaved caregiver deterioration in physical (31%) and mental health (42%) were common. Approximately 40% did not …

Depression In Parkinson's Disease: Perspectives From An Australian Cohort, Michal Lubomski, Ryan L. Davis, Carolyn M. Sue

Medical Papers and Journal Articles

Introduction: Depression is often an under-recognised feature of Parkinson's disease (PD). It is detrimental to physical and interpersonal functioning, negatively impacting a patient's clinical management, quality of life and well-being. We aimed to identify clinical predictors and management implications of depression in Australian PD patients.

Methods: 103 PD and 81 Healthy Control (HC) subjects were evaluated using the Beck Depression Inventory (BDI) and other validated PD motor and non-motor symptom (NMS) tools.

Results: Nearly twice as many PD patients were depressed, (38.9% vs 20.1%, p = 0.009), with a corresponding increase in depression severity on the BDI (11.9; standard deviation …

Parents' Ability To Access Community Health Occupational Therapy Services In A Disadvantaged Area: A Proof Of Concept Study, Rachel Smith, Gisselle Gallego

Medical Papers and Journal Articles

Introduction: In New South Wales children from disadvantaged backgrounds have poorer health outcomes and reduced access to health services than their more advantaged counterparts. This study aimed to identify barriers and enablers to accessing child and family occupational therapy services in a disadvantaged area.

Methods: This was a mixed methods study that included: 1) a retrospective analysis of de-identified routinely collected Community Health service utilisation data from 2016-2017, and a 2) face to face interview guided survey with parents and carers.

Results: The retrospective data analysis showed outreach at the targeted suburbs’ Early Childhood Health Centres (ECHC) improved attendance for …

A Randomized Controlled Trial Of Peek Versus Titanium Interference Screws For Anterior Cruciate Ligament Reconstruction With 2-Year Follow-Up, Sarah Shumborski, Emma Heath, Lucy J. Salmon, Justin P. Roe, James P. Linklater, Michael Facek, Leo Pinczewski

Medical Papers and Journal Articles

Purpose: To compare the clinical performance of ACL reconstruction with PEEK and titanium interference screws at 2 years and to evaluate a novel method of measuring tunnel volume.

Study Design: Randomized controlled trial; Level of evidence, 1.

Methods: A total of 133 patients underwent arthroscopic ACL reconstruction with 4-strand hamstring autografts and were randomized to have titanium or PEEK interference screws for femoral and tibial tunnel fixation. At 2 years, subjective Lysholm and International Knee Documentation Committee scores were assessed and clinical examination performed. At 12 months, MRI was performed to assess graft incorporation and cyst formation, and a novel …

Exploring Assessment Of Medical Students' Competencies In Pain Medicine - A Review, Elspeth Shipton, Carole Steketee, Frank Bate, Eric J. Visser

Medical Papers and Journal Articles

Introduction: Considering the continuing high prevalence and public health burden of pain, it is critical that medical students are equipped with competencies in the field of pain medicine. Robust assessment of student expertise is integral for effective implementation of competency-based medical education.

Objective: The aim of this review was to describe the literature regarding methods for assessing pain medicine competencies in medical students.

Method: PubMed, Medline, EMBASE, ERIC, and Google Scholar, and BEME data bases were searched for empirical studies primarily focusing on assessment of any domain of pain medicine competencies in medical students published between January 1997 and December …

Primary Open Abductor Reconstruction - A 5-10 Year Study, Olivia J.K Fox, Graeme Wertheimer, Michael Walsh

Medical Papers and Journal Articles

Background: Gluteal tears are recognised as the source of pain over the greater trochanter. We investigated the outcome of primary open abductor tendon reconstruction with a 5 year follow-up.

Methods: 165 consecutive hips underwent an open abductor tendon reconstruction, with all tears confirmed pre-operatively by MRI. Oxford hip scores (OHS) were assessed at the initial visit, and at 5 to 10 years.

Results: The average pre-operative OHS was 22 (r: 7y – 34y) and average post-operative OHS was 40 a difference of 18 (p<0.0001).

Conclusion: Surgical reconstruction of degenerate abductor tendons should be considered in the presence of an MRI …

Microsimulation Model For The Health Economic Evaluation Of Osteoporosis Interventions: Study Protocol, Lei Si, John A. Eisman, Tania Winzenberg, Kerrie M. Sanders, Jacqueline R. Center, Tuan V. Nguyen, Andrew J. Palmer

Medical Papers and Journal Articles

Introduction: Osteoporosis is a systemic skeletal disease that is characterised by reduced bone strength and increased fracture risk. Osteoporosis-related fractures impose enormous disease and economic burden to the society. Although many treatments and health interventions are proven effective to prevent fractures, health economic evaluation adds evidence to their economic merits. Computer simulation modelling is a useful approach to extrapolate clinical and economic outcomes from clinical trials and it is increasingly used in health economic evaluation. Many osteoporosis health economic models have been developed in the past decades; however, they are limited to academic use and there are no publicly accessible …

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 …

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 …

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; …

Culturally And Linguistically Diverse Palliative Care Patients' Journeys At The End-Of-Life, Anna Green, Natalia Jerzmanowska, Marguerite Green, Elizabeth Lobb

Medical Papers and Journal Articles

Objective: To understand the clinical and psychosocial journey of culturally and linguistically diverse (CALD) palliative care patients.

Method: This study was conducted at a subacute hospital with a specialist palliative care unit and a community palliative care service in a metropolitan region of New South Wales, Australia. Medical records of 100 deceased patients from CALD backgrounds over a 12-month period from 2014 to 2015 were recorded on a data mining tool. The cohort had transitioned to either community or inpatient palliative care services with a life-limiting illness. We used descriptive statistical analyses to identify the patients’ end-of-life journeys in the …

Pain Medicine Content, Teaching And Assessment In Medical School Curricula In Australia And New Zealand, Elspeth E. Shipton, Frank Bate, Raymond Garrick, Carole Steketee, Eric J. Visser

Medical Papers and Journal Articles

Background: The objective of pain medicine education is to provide medical students with opportunities to develop their knowledge, skills and professional attitudes that will lead to their becoming safe, capable, and compassionate medical practitioners who are able to meet the healthcare needs of persons in pain. This study was undertaken to identify and describe the delivery of pain medicine education at medical schools in Australia and New Zealand.

Method: All 23 medical schools in Australia and New Zealand in 2016 were included in this study. A structured curriculum audit tool was used to obtain information on pain medicine curricula including …

Differences In Swedish And Australian Medical Student Attitudes And Beliefs About Chronic Pain, Its Management, And The Way It Is Taught, Linda Rankin, Britt-Marie Stalnacke, Christopher J. Fowler, Gisselle Gallego

Medical Papers and Journal Articles

Background and aims: Medical students receive training in the management of chronic pain, but the training is often suboptimal. Considering that the basis for physician’s knowledge is their medical education, it is important to explore the attitudes and beliefs of medical students with respect both to chronic pain management and to their views on current pain education. Therefore, the aim of this study was to compare Swedish and Australian medical student’s attitudes and beliefs about patients with chronic pain, and their perceptions regarding their chronic pain management education.

Methods: An online survey was conducted with final year Australian and Swedish …

Feedback From Activity Trackers Improves Daily Step Count After Knee And Hip Arthroplasty: A Randomized Controlled Trial, Neill Van Der Walt, Lucy J. Salmon, Benjamin Gooden, Matthew C. Lyons, Michael O'Sullivan, Kaka Martina, Leo A. Pinczewski, Justin P. Roe

Medical Papers and Journal Articles

Background: Commercial wrist-worn activity monitors have the potential to accurately assess activity levels and are being increasingly adopted in the general population. The aim of this study was to determine if feedback from a commercial activity monitor improves activity levels over the first 6 weeks after total hip arthroplasty (THA) or total knee arthroplasty (TKA).

Methods: One hundred sixty-three consecutive subjects undergoing primary TKA or THAwere randomized into 2 groups. Subjects received an activity tracker with the step display obscured 2 weeks before surgery and completed patient-reported outcome measures (PROMs). On day 1 after surgery, participants were randomized to either …

Inpatient Rehabilitation Did Not Positively Affect 6-Month Patient-Reported Outcomes After Hip Or Knee Arthroplasty, Adam G. Hutchinson, Benjamin Gooden, Matthew C. Lyons, Justin P. Roe, Michael D. O'Sullivan, Lucy J. Salmon, Kaka Martina, Leo Pinczewski

Medical Papers and Journal Articles

Background: The aim of this study was to compare patient-reported outcomes 6 months after hip or knee arthroplasty in subjects who were discharged to home compared to those who attended inpatient rehabilitation.

Methods:

Seven hundred and forty-eight consecutive total hip or knee replacement patients were identified from a prospective database. Preoperative and 6-month post-operative patient-reported outcome measures were recorded. Forty-four patients discharged directly to home were cohort matched by age, gender, procedure and surgeon to 44 patients from the cohort who received inpatient care. Patient outcomes were compared using SPSS version 24 software.

Results: Both cohorts saw significant improvements from …

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 …

Single-Stage Osseointegrated Reconstruction And Rehabilitation Of Lower Limb Amputees: The Osseointegration Group Of Australia Accelerated Protocol-2 (Ogaap-2) For A Prospective Cohort Study, Munjed Al Muderis, William Lu, Kevin Tetsworth, Belinda Bosley, Jiao Jiao Li

Medical Papers and Journal Articles

Introduction: Lower limb amputations have detrimental influences on the quality of life, function and body image of the affected patients. Following amputation, prolonged rehabilitation is required for patients to be fitted with traditional socket prostheses, and many patients experience symptomatic socket–residuum interface problems which lead to reduced prosthetic use and quality of life. Osseointegration has recently emerged as a novel approach for the reconstruction of amputated limbs, which overcomes many of the socket-related problems by directly attaching the prosthesis to the skeletal residuum. To date, the vast majority of osseointegration procedures worldwide have been performed in 2 stages, which require …

Improving The Management And Care Of Refugees In Australian Hospitals: A Descriptive Study, Lindsey Ross, Catherine Harding, Alexa Seal, Geraldine Duncan

Medical Papers and Journal Articles

Objectives: The aim of the study was to investigate healthcare provider perceptions of the impact of refugee patients at two public hospitals, one rural and one urban, in designated refugee resettlement areas. Healthcare professionals’ views regarding improvements that could be made in this area were also sought.

Methods: Two page anonymous questionnaires containing demographic, quantitative and open-ended questions were distributed to 150 healthcare providers at each research site.

Results: Response rates were 50% and 49% at the rural and urban sites respectively. Refugees were seen at least monthly by 40% of the respondents. Additional support was requested …

Student-Centered Interventions The Key To Student Health Care Worker Influenza Vaccination, M Nyandoro, D Kelly, D Macey, D Mak

Medical Papers and Journal Articles

Objectives: To investigate influenza vaccination uptake rates, attitudes and motivations towards influenza vaccination among student health care workers (HCWs).

Methods: Self-reported influenza vaccination uptake among student HCWs at The University of Notre Dame Australia, Fremantle, Western Australia (UNDAF) was surveyed before and after implementation of a peer-led, student-centered campaign to raise awareness of, and improve access to, influenza vaccination. Data were weighted and analysed using logistic regression.

Results: Pre-campaign influenza vaccination uptake was 36.3% (95% CI=31.8%-40.8%), with students identifying lack of awareness of both the Australian Government’s recommendations and university policy, cost, and inconvenience of vaccine access …

Development Of A Video-Based Education And Process Change Intervention To Improve Advance Cardiopulmonary Resuscitation Decision-Making, Nicholas Waldron, Clare V. Johnson, P Saul, Waldron Heidi, Jeffrey C. Chong, Anne-Marie Hill, Barbara Hayes

Medical Papers and Journal Articles

Background: Advance cardiopulmonary resuscitation (CPR) decision-making and escalation of care discussions are variable in routine clinical practice. We aimed to explore physician barriers to advance CPR decision-making in an inpatient hospital setting and develop a pragmatic intervention to support clinicians to undertake and document routine advance care planning discussions.

Methods: Two focus groups, which involved eight consultants and ten junior doctors, were conducted following a review of the current literature. A subsequent iterative consensus process developed two intervention elements: (i) an updated ‘Goals of Patient Care’ (GOPC) form and process; (ii) an education video and resources for teaching advance CPR …

Acute Ankle And Knee Injuries: To X-Ray Or Not?, G Fulde

Medical Papers and Journal Articles

The Ottawa ankle and knee rules are validated clinical decision tools that guide clinicians in targeting radiology to those patients who are likely to have an ankle or knee fracture, thus minimizing x-ray exposure of patients and reducing costs.

Tracking Funded Health Intervention Research, Lesley A. King, Robyn S. Newson, Gillian E. Cohen, Jacqueline Schroeder, Selina Redman, Lucie Rychetnik, Andrew J. Milat, Adrian Bauman, Simon Chapman

Medical Papers and Journal Articles

Objective: To describe the research publication outputs from intervention research funded by Australia’s National Health and Medical Research Council (NHMRC).

Design and setting: Analysis of descriptive data and data on publication outputs collected between 23 July 2012 and 10 December 2013 relating to health intervention research project grants funded between 1 January 2003 and 31 December 2007.

Main outcome measures: Stages of development of intervention studies (efficacy, effectiveness, replication, adaptation or dissemination of intervention); types of interventions studied; publication output per NHMRC grant; and whether interventions produced statistically significant changes in primary outcome variables.

Results: Most of the identified studies …

Should I Stay Or Should I Go? Exploring The Job Preferences Of Allied Health Professionals Working With People With Disability In Rural Australia, G Gallego, A Dew, M Lincoln, A Bundy, R Chedid, K Bulkeley, J Brentnall, C Veitch

Medical Papers and Journal Articles

Introduction: The uneven distribution of allied health professionals (AHPs) in rural and remote Australia and other countries is well documented. In Australia, like elsewhere, service delivery to rural and remote communities is complicated because relatively small numbers of clients are dispersed over large geographic areas. This uneven distribution of AHPs impacts significantly on the provision of services particularly in areas of special need such as mental health, aged care and disability services.

Objective: This study aimed to determine the relative importance that AHPs (physiotherapists, occupational therapists, speech pathologists and psychologists – “therapists”) living in a rural area of Australia and …

Australian Fathers' Study: What Influences Paternal Engagement With Antenatal Care?, T Jeffrey, K Luo, B Kueh, R Petersen, J Quinlivan

Medical Papers and Journal Articles

This mixed-methods study explores factors associated with and levels of engagement of fathers in antenatal care. One hundred expectant fathers were recruited from antenatal clinics and community settings in Western Australia. They completed validated questionnaires. Eighty-three percent of expectant fathers reported a lack of engagement with antenatal care. Factors significantly associated with lack of engagement in multivariate analysis were working more than 40 hours a week and lack of adequate consultation by antenatal care staff. In qualitative analysis, 6 themes emerged in association with a lack of engagement. They were role in decision making, time pressures, the observer effect, lack …

A Mixed Methods Study Of The Factors That Influence Whether Intervention Research Has Policy And Practice Impacts: Perceptions Of Australian Researchers, Robyn Newson, Lesley King, Lucie Rychetnik, Adrian E. Bauman, Sally Redman, Andrew J. Milat, Jacqueline Schroeder, Gillian Cohen, Simon Chapman

Medical Papers and Journal Articles

Objectives: To investigate researchers’ perceptions about the factors that influenced the policy and practice impacts (or lack of impact) of one of their own funded intervention research studies.

Design: Mixed method, cross-sectional study.

Setting: Intervention research conducted in Australia and funded by Australia’s National Health and Medical Research Council between 2003 and 2007.

Participants: The chief investigators from 50 funded intervention research studies were interviewed to determine if their study had achieved policy and practice impacts, how and why these impacts had (or had not) occurred and the approach to dissemination they had employed.

Results: We found that statistically significant …

Improving Allied Health Professionals' Research Implementation Behaviours For Children With Cerebral Palsy: Protocol For A Before-After Study, Christine Imms, Iona Novak, Claire Kerr, Nora Shields, Melinda Randall, Adrienne Harvey, H Kerr Graham, Dinah Reddihough

Medical Papers and Journal Articles

Background: Cerebral palsy is a permanent disorder of posture and movement caused by disturbances in the developing brain. It affects approximately 1 in every 500 children in developed countries and is the most common form of childhood physical disability. People with cerebral palsy may also have problems with speech, vision and hearing, intellectual difficulties and epilepsy. Health and therapy services are frequently required throughout life, and this care should be effective and evidence informed; however, accessing and adopting new research findings into day-to-day clinical practice is often delayed.

Methods/Design: This 3-year study employs a before and after design to evaluate …