Medical Education - Research Publications
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ItemContinuing Professional Development programmes through the lens of Habermas’ Knowledge-Constitutive Interests: a novel approach to evaluating and (re)designing CPD(AMEE, 2024)Background: Clinician-educators are usually experienced clinicians seeking information and strategies to improve their teaching. Continuing Professional Development (CPD) programmes can address a range of learning requirements for clinician-educators if they can respond to the particular educational and contextual needs of participants. A critical review of a one-day postgraduate course was conducted. It focused on how the course was tailored to the learning needs and interests of participants and drew on the early work of Jürgen Habermas and his Knowledge-Constitutive Interests schema in its analysis. Habermas describes technical, practical and emancipatory interests. For clinician-educator CPD, ‘teaching tips that work’ align with the technical interest, while learning why certain teaching techniques suit specific situations or learners is a practical interest. Understanding the material so attendees can flexibly apply it in their context aligns with the emancipatory interest in autonomy. Summary of Work: Examination of the course through the lens of Habermas' interests was conducted by asking: What type of interest does each session target? How does it do this? How could the teaching method shift from fostering technical or practical knowledge towards meeting the participants' emancipatory interests?
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ItemMeeting Halfway: Engaging Clinician-Educators(ANZAHPE, 2024)Introduction/Background: Clinician-educators form a significant component of the health professional education workforce and deliver a substantial amount of teaching and supervision, especially in placement sites. There are many challenges clinician-educators face in contributing to educational activities such as programme development, evaluation and educational research and scholarship, yet experience in these areas can be critical to their professional development. Are health professional education programmes doing enough to encourage the contribution of their clinician-educator workforce? Methods: In this PeArLS, I will briefly introduce the issue outlined in the Introduction and then engage the participants in a discussion across several questions listed below in ‘Issues or questions for exploration’. These questions will explore the experience of participants in working with clinician-educators outside of their usual teaching or supervisory activity and the ways in which those educators might best be utilised to enhance the programmes into which they teach. Strategies for engaging clinician-educators will form an important part of this discussion and will focus on ways in which participants have successfully overcome barriers to clinician-educator contribution. Results/Evaluation: This session will be a success if both the presenters and participants identify ways to engage their clinician-educator staff in broader participation in their educational programmes. These could be in areas such as programme design, evaluation, faculty development or scholarship. Insights from participants who have successfully developed professional development programmes or scholarly collaborations with their clinician-educator workforce will be particularly valuable. Discussion: Opportunities for shared understanding and problem-solving are critical to the ongoing development of health professional education programmes and practitioners. Greater involvement of clinician-educators in the academic programmes to which they contribute will be of benefit to all health professional education practitioners.
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ItemNo Preview AvailableMalignant pleural effusion management: An audit of current practice(Wiley, 2024)Introduction/Aim: Malignant pleural effusion (MPE) is a complication of advanced cancer that can result in limited life expectancy and significant morbidity. Recurrence of MPE is common and definitive management with either pleurodesis or indwelling pleural catheter (IPC) insertion is often required. This study aimed to review the management of MPE at two tertiary hospitals to identify potential areas for improvement with an emphasis on the hospital length of stay, frequency of non-definitive pleural procedures and frequency of unplanned pleural related admissions. Methods: Retrospective audit of all patients diagnosed with MPE at Western Health over a 3-year period. Results: Of 79 patients with MPE were identified during the time period (mean age 66.1 years, 59% female). 25 patients (13.1%) had a non-definitive pleural procedure following diagnosis, including 16 (38.1%) of the 42 patients who subsequently went on to have a definitive procedure. The median hospital length of stay for pleural effusion related hospitalisations was 9 days. 22 of the 42 pleural effusion-related admissions occurred after a presentation via the emergency department (ED). When compared with planned admissions, those who presented via ED had a higher rate of non-definitive procedures (77% vs 25%) and a longer length of stay (12 vs 7 days). Conclusion: The pleural effusion-related hospital length of stay was in line with previously published Australasian data. Despite this, our data suggests that there might still be scope for improvement. In particular, our data has suggested that interventions to reduce the number of unplanned admissions via ED might result in a reduced rate of non-definitive procedures and a reduced hospital length of stay. Future research could assess the impact of interventions such as the introduction of dedicated pleural clinic or a streamlined admissions pathway on these measures.
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ItemNo Preview AvailableRecommendations from The Medical Education Editor(WILEY, 2024-04)
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ItemNo Preview AvailableInsulin icodec use in hospital settings: Considerations for once-weekly basal insulin therapy in hospital glycaemic management practice(Elsevier, 2024-05)Diabetes management has benefitted greatly from novel insulin analogues with action profiles that better match individual’s requirements. However, the increased complexity of hospital insulin administration involving multiple practitioners, rapidly changing clinical situations, and therapies causing hyperglycaemia, demands specific consideration for their use. Insulin icodec has an extended duration of action and is beginning to be used in the ambulatory setting. A reassuring early trial experience observed no substantial dysglycaemia in 135 hospitalised participants [ 1 ]. However, the limited glucose measurements informing this observation under intensive clinical trial conditions warrants further consideration of insulin icodec’s implications for real-world hospital settings.
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ItemNon-SARS-CoV-2 respiratory viral detection and whole genome sequencing from COVID-19 rapid antigen test devices: a laboratory evaluation study.(Elsevier BV, 2024-04)BACKGROUND: There has been high uptake of rapid antigen test device use for point-of-care COVID-19 diagnosis. Individuals who are symptomatic but test negative on COVID-19 rapid antigen test devices might have a different respiratory viral infection. We aimed to detect and sequence non-SARS-CoV-2 respiratory viruses from rapid antigen test devices, which could assist in the characterisation and surveillance of circulating respiratory viruses in the community. METHODS: We applied archival clinical nose and throat swabs collected between Jan 1, 2015, and Dec 31, 2022, that previously tested positive for a common respiratory virus (adenovirus, influenza, metapneumovirus, parainfluenza, rhinovirus, respiratory syncytial virus [RSV], or seasonal coronavirus; 132 swabs and 140 viral targets) on PCR to two commercially available COVID-19 rapid antigen test devices, the Panbio COVID-19 Ag Rapid Test Device and Roche SARS-CoV-2 Antigen Self-Test. In addition, we collected 31 COVID-19 rapid antigen test devices used to test patients who were symptomatic at The Royal Melbourne Hospital emergency department in Melbourne, Australia. We extracted total nucleic acid from the device paper test strips and assessed viral recovery using multiplex real-time PCR (rtPCR) and capture-based whole genome sequencing. Sequence and genome data were analysed through custom computational pipelines, including subtyping. FINDINGS: Of the 140 respiratory viral targets from archival samples, 89 (64%) and 88 (63%) were positive on rtPCR for the relevant taxa following extraction from Panbio or Roche rapid antigen test devices, respectively. Recovery was variable across taxa: we detected influenza A in nine of 18 samples from Panbio and seven of 18 from Roche devices; parainfluenza in 11 of 20 samples from Panbio and 12 of 20 from Roche devices; human metapneumovirus in 11 of 16 from Panbio and 14 of 16 from Roche devices; seasonal coronavirus in eight of 19 from Panbio and two of 19 from Roche devices; rhinovirus in 24 of 28 from Panbio and 27 of 28 from Roche devices; influenza B in four of 15 in both devices; and RSV in 16 of 18 in both devices. Of the 31 COVID-19 devices collected from The Royal Melbourne Hospital emergency department, 11 tested positive for a respiratory virus on rtPCR, including one device positive for influenza A virus, one positive for RSV, four positive for rhinovirus, and five positive for SARS-CoV-2. Sequences of target respiratory viruses from archival samples were detected in 55 (98·2%) of 56 samples from Panbio and 48 (85·7%) of 56 from Roche rapid antigen test devices. 98 (87·5%) of 112 viral genomes were completely assembled from these data, enabling subtyping for RSV and influenza viruses. All 11 samples collected from the emergency department had viral sequences detected, with near-complete genomes assembled for influenza A and RSV. INTERPRETATION: Non-SARS-CoV-2 respiratory viruses can be detected and sequenced from COVID-19 rapid antigen devices. Recovery of near full-length viral sequences from these devices provides a valuable opportunity to expand genomic surveillance programmes for public health monitoring of circulating respiratory viruses. FUNDING: Australian Government Medical Research Future Fund and Australian National Health and Medical Research Council.
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ItemEfficacy and safety of oral immunotherapy for peanut, cow's milk, and hen's egg allergy: A systematic review of randomized controlled trials(WILEY, 2023-07)BACKGROUND: Oral immunotherapy (OIT) is a promising treatment for food allergies; however, safety is a concern. We synthesized evidence from the best randomized controlled trials (RCTs) on efficacy/safety of OIT for desensitization (DS) and remission (sustained unresponsiveness (SU)) in IgE mediated allergy to peanut, hen's eggs, and cow's milk. BODY: We searched Pubmed, EMBASE, and Cochrane databases (Until Oct 22) identifying 16 eligible RCTs published in English measuring food allergy by food challenge at the beginning and at the end of the study. The Cochrane Risk of Bias tool was used to assess study quality. We found 18 eligible studies. There was evidence of efficacy for DS for all allergens: peanut (RR 11.32; 95% CI 5.93, 21.60, I2 49%, 8 studies); hen's egg (RR 4.67; 2.66, 8.21, I2 0%, 5 studies); cow's milk (RR 13.98; 3.51, 55.65, I2 0%, 4 studies) and evidence for SU for peanut (RR 7.74; 2.90, 20.69, I2 0%, 3 studies) and hen's egg (RR 6.91; 1.67, 28.57, I2 0%, 2 studies). Allergic events were increased with intervention, and risk of adrenaline use increased for peanut RR 2.96; 1.63, 5.35, I2 0%, 8 studies; egg RR 1.71; 0.42, 6.92, I2 0%, 6 studies; and milk RR 8.45; 2.02, 35.27, I2 0%, 4 studies. CONCLUSION: We found strong evidence that peanut, hen's egg, and cow's milk OIT can induce DS and some evidence for remission. There was a high risk of allergic reactions. Generalizability to the entire food allergic population is not known.
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ItemSystematic reviews of osteopathic care: protocol for an umbrella review(Taylor and Francis Group, 2024)Background: The practice of osteopathy differs around the world. However, the dominant practice is that of manual therapy interventions guided by assessment of the neuromusculoskeletal system. Patient populations treated by osteopaths vary across the lifespan and include groups with more-nuanced care requirements such as those who are pregnant. The volume of evidence for osteopathy care is increasing. Objectives: This umbrella review seeks to identify systematic reviews of osteopathic care with the purpose of highlighting current knowledge about the high-level evidence underpinning the profession. Methods: The umbrella review will be conducted consistent with the Joanna Briggs Institute umbrella review methodology. Articles will be limited to those describing osteopathic care. An initial search did not identify a similar study and nor is one registered. A search of MEDLINE and CINAHL informed the search syntax. A full search will be performed across MEDLINE (PubMed), CINAHL (EBSCO), Scopus, Web of Science, PEDro, Osteopathic Research Web, AMED, Index to Chiropractic Literature, Cochrane Database of Systematic Reviews, and the Osteopathic Medicine Digital Repository (OSTMED.DR). The reference lists of included articles will be reviewed to identify potentially relevant systematic reviews. Data will be extracted from each systematic review and presented in tabular format. Conclusion: The umbrella review will synthesise what is known about osteopathic care as described in systematic reviews. The review will inform stakeholders about the role of osteopathic care in the health system and provide recommendations for future research. The findings will be submitted for peer-review publication.
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ItemNo Preview AvailablePrescribing oxygen: An audit of prescribing and delivery practices at two tertiary hospitals in Melbourne, Australia(Wiley Online Library, 2021)Background and Aims: Over-oxygenation in COPD patients can result in adverse outcomes. The use of specific oxygen saturation targets in COPD has been associated with less acidosis, a lower requirement for assisted ventilation, and reduced mortality. Our study reviews current practices of both oxygen prescription and delivery for patients admitted at two tertiary hospitals with an exacerbation of COPD. Methods: This retrospective audit included all admissions at two tertiary hospitals with a primary diagnosis of exacerbation of COPD over 6 months (April to September 2020). Medical records were reviewed to determine how many had documented target SpO2 ranges and how concordant these were with the Thoracic Society of Australia and New Zealand guidelines (SpO2 range 88% to 92% in COPD). For those with documented SpO2 ranges, we determined the percentage of recorded SpO2 levels that were below, above and within the target range. Results: 312 admissions for exacerbation of COPD were reviewed. Target SpO2 goals were documented for 57% of admissions (N=178), of which 77% (N=137) were consistent with current guidelines. Of those with a documented SpO2 range, only 75.4% of recorded SpO2 readings were within range, with 2.3% falling below and 22.3% above range. Conclusions: Our results highlight underutilisation of SpO2 targets in patients with COPD, as well as frequent over-oxygenation despite documented targets.