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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 …

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 …

Allograft Donor Characteristics Significantly Influence Graft Rupture After Anterior Cruciate Ligament Reconstruction In A Young Active Population, Sarah Shumborski, Lucy J. Salmon, Claire Monk, Emma Heath, Justin P. Roe, Leo A. Pinczewski

Medical Papers and Journal Articles

Background: Graft selection in anterior cruciate ligament (ACL) surgery can be difficult in a young active population given their high rates of reinjury. Allografts allow for control over graft size and reduce morbidity of autograft harvest. There are mixed results about the use of allograft in the literature; however, the influence of the properties of the allograft on outcomes has not been considered.

Hypothesis: ACL reconstruction with allografts from older donors will have a higher rate of graft rupture when compared with allograft from young donors.

Study Design: Cohort study; Level of evidence, 3.

Methods: Patients (N = 211) aged …

How Well Do Australian Government Urban Planning Policies Respond To The Social Determinants Of Health And Health Equity?, Michael Mcgrevy, Patrick Harris, Toni Delaney-Crowe, Matt Fisher, Peter Sainsbury, Emily Riley, Fran Baum

Medical Papers and Journal Articles

There is now wide recognition and evidence that the built environment affects population health and health equity. This research provides a thematic analysis of 108 urban planning policy documents from Australian state, territory, and federal governments to address the question: How well do Australian government urban planning policies respond to the social determinants of health and health equity? Health and health equity were discussed explicitly in several policies, most often as a secondary or co-benefit to environmental, social, and economic concerns. The most significant themes in the documents associated with health were visions for urban development that is compact, mixed …

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 …

The Challenge Of An Expanded Therapeutic Window In Pulmonary Hypertension, Simon Stewart, Geoffrey A. Strange, David Playford

Medical Papers and Journal Articles

Our understanding of the causes and consequences of pulmonary hypertension is limited. Consequently, its most distinctive forms with the worst prognosis have been the focus for diagnosis and treatment. We highlight the emerging challenge of reframing the prevalence and prognostic implications of pulmonary hypertension, focusing on the optimal therapeutic window to address the high mortality linked to this condition.

Antidepressant Exposure In Pregnancy And Child Sensorimotor And Visuospatial Development, Megan Galbally, Stuart J. Watson, Olav Spigset, Philip Boyce, Tim F. Oberlander, Andrew J. Lewis

Medical Papers and Journal Articles

Motor development underlies many aspects of education and learning. There has been uncertainty about the impact of exposure of antidepressant medication in pregnancy on child motor outcomes. This paper examines whether exposure to antidepressants in utero increases the risk of poorer motor development in two areas: sensorimotor and visuospatial processing. Data were obtained from 195 women and children across 3 groups: women with untreated depression in pregnancy, women treated with antidepressants and control women. Data were collected across pregnancy, postpartum and until 4 years for mother and child. Maternal depression was established at baseline with the Structured Clinical Interview for …

How Do Advisory Groups Contribute To Healthy Public Policy Research?, Helen Van Eyk, Sharon Friel, Peter Sainsbury, Tessa Boyd-Caine, Patrick Harris, Colin Macdougall, Toni Delany-Crowe, Connie Musolino, Fran Baum

Medical Papers and Journal Articles

Objectives: This paper reflects on experiences of Australian public health researchers and members of research policy advisory groups (PAGs) in working with PAGs. It considers their benefits and challenges for building researcher and policy actor collaboration and ensuring policy relevance of research.

Methods: Four research projects conducted between 2015 and 2020 were selected for analysis. 68 PAG members from Australian federal, state and local governments, NGOs and academics participated in providing feedback. Thematic analysis of participant feedback and researchers’ critical reflections on the effectiveness and capacity of PAGs to support research translation was undertaken.

Results: PAGs benefit the …

What Influences Trainee Decisions To Practise In Rural And Regional Australia?, Alexa Seal, Catherine Harding, Joe Mcgirr

Medical Papers and Journal Articles

Although international medical graduates (IMGs) make up a substantial part of the Australian rural general practice workforce, most research on factors associated with rural practice has focused on Australian medical graduates (AMGs). This study aimed to determine whether there were differences between IMGs and AMGs in terms of these factors. Registrars in training and recent fellows (Fellowship of the Royal Australian College of General Practitioners/ Fellowship of the Australian College of Rural and Remote Medicine) who participated in training in rural and regional Australia were surveyed about practice models and rural practice. Almost two-thirds of participants were practicing or intending …

Agency, Autonomy And Euthanasia, George Mendz, David Kissane

Medical Papers and Journal Articles

Agency is the human capacity to freely choose one’s thoughts, motivations and actions without undue internal or external influences; it is distinguished from decisional capacity. Four well-known conditions that can deeply affect agency are depression, demoralization, existential distress, and family dysfunction. The study reviews how they may diminish agency in persons whose circumstances may lead them to consider or request euthanasia or assisted suicide. Since agency has been a relatively neglected dimension of autonomous choice at the end of life, it is argued that to respect the autonomy of individuals, it is essential to establish their agency.

Education And Assessment Of Psycho-Existential Symptoms To Prevent Suicidality In Cancer Care, David W. Kissane

Medical Papers and Journal Articles

Clinicians acknowledge awkwardness and lack of skills in assessing suicidal symptoms. This requires increased education, screening for psycho-existential symptoms, and the therapeutic targeting of key symptoms. Assessment of hopelessness, pointlessness, low morale, entrapment, anhedonia, loss of control, loss of roles, and the wish to die prove extremely helpful in recognising a suicidal patient. Use of a screening tool for psycho-existential symptoms aids this recognition and empowers referral for treatment. Communication skills training increases each clinician’s skill and provides a strategic sequence to explore symptoms that mediate suicidal thinking. Network analysis research to identify core symptoms suggests that hopelessness, pointlessness, and …

A Preliminary Report On The Awareness And Knowledge Of Seafood-Borne Parasitic Diseases Among Medical Doctors In Australia, Alexa Seal, Catherine Harding, Shokoofeh Shamsi

Medical Papers and Journal Articles

Despite the increasing popularity of seafood in Australia and various reports of infection with transmissible parasites in Australian edible aquatic animals such as fish, the number of reported cases of human infections in the country is low. This raised the question that Australian medical doctors may not be fully aware of the presence of these parasites in Australia, which in turn can lead to misdiagnosis of infections. This also may lead to an underestimation of the risk seafood-borne parasites may pose to public health. This preliminary study was conducted to determine the awareness and level of knowledge among Australian medical …

Gastrointestinal Dysfunction In Parkinson's Disease, Michal Lubomski, Ryan L. Davis, Carolyn M. Sue

Medical Papers and Journal Articles

Background: Gastrointestinal (GI) dysfunction is prevalent in Parkinson’s disease (PD). Symptoms are evident throughout the disease course, affect the length of the GI tract and impact on patient quality of life and management. We clarify real-life differences in the frequency and severity of GI symptoms in a cohort of PD and healthy control (HC) subjects.

Methods: 103 PD patients were compared to 81 HC subjects. Outcome measures collected from validated questionnaires included constipation severity, upper and lower GI symptoms and physical activity.

Results: PD patients were three-times more likely to experience constipation than HC subjects, (78.6% vs …

Is Intimate Partner Violence More Common In Pregnant Women With Severe Mental Illness? A Retrospective Study, Liana Suparare, Stuart J. Watson, Ray Binns, Jacqueline Frayne, Megan Galbally

Medical Papers and Journal Articles

Objective: To examine the risk of past and current experiences of intimate partner violence (IPV) in women with severe mental illness (SMI) in pregnancy.

Methods: We examined past and current experiences of IPV in women with SMI in pregnancy. The data of 304 women with SMI including schizophrenia and related psychotic disorders and Bipolar Disorder meeting International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Australian Modification (ICD-10-AM) criteria were extracted from hospital records at King Edward Memorial Hospital, Western Australia. Comparisons were made between our study data and the Australian population data reported by the Australian Bureau …

"[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.