Surgery (St Vincent's) - Research Publications

Permanent URI for this collection

Search Results

Now showing 1 - 10 of 22
  • Item
    Thumbnail Image
    Flexible mechanical metamaterials enabling soft tactile sensors with multiple sensitivities at multiple force sensing ranges
    Mohammadi, A ; Tan, Y ; Choong, P ; Oetomo, D (NATURE PORTFOLIO, 2021-12-16)
    The majority of existing tactile sensors are designed to measure a particular range of force with a fixed sensitivity. However, some applications require tactile sensors with multiple task-relevant sensitivities at multiple ranges of force sensing. Inspired by the human tactile sensing capability, this paper proposes a novel soft tactile sensor based on mechanical metamaterials which exhibits multiple sensitivity regimes due to the step-by-step locking behaviour of its heterogenous multi-layered structure. By tuning the geometrical design parameters of the collapsible layers, each layer experiences locking behaviour under different ranges of force which provides different sensitivity of the sensor at different force magnitude. The integration of a magnetic-based transduction method with the proposed structure results in high design degrees of freedom for realising the desired contact force sensitivities and corresponding force sensing ranges. A systematic design procedure is proposed to select appropriate design parameters to produce the desired characteristics. Two example designs of the sensor structure were fabricated using widely available benchtop 3D printers and tested for their performance. The results showed the capability of the sensor in providing the desired characteristics in terms of sensitivity and force range and being realised in different shapes, sizes and number of layers in a single structure. The proposed multi-sensitivity soft tactile sensor has a great potential to be used in a wide variety of applications where different sensitivities of force measurement is required at different ranges of force magnitudes, from robotic manipulation and human-machine interaction to biomedical engineering and health-monitoring.
  • Item
    Thumbnail Image
    Systems-Level Change to Alleviate Barriers to Cancer Clinical Trial Access for Adolescents and Young Adults in Australia
    Ellis, JA ; Malalasekera, VS ; Allan, C ; Choong, PF ; Hansford, JR ; Hehir, R ; Morello, N ; O'Callaghan, S ; Orme, L ; Phillipson, N ; Rosenthal, MA ; Sawyer, S ; Strong, R ; Super, L ; Watt, A ; Williams, C ; Woollett, A ; Robertson, A ; Lewin, J (MARY ANN LIEBERT, INC, 2021-07-22)
    Purpose: International data demonstrate association between clinical trial participation and reduced cancer mortality. Adolescents and young adults (AYA) have low clinical trial enrollment rates. We established a program to understand local barriers and develop targeted solutions that lead to greater AYA clinical trial participation. Methods: A steering committee (SC) with expertise in adult and pediatric oncology, research ethics, and consumer representation was formed. The SC mapped barriers related to AYA trial access and established working groups (WGs) around three themes. Results: The Regulatory Awareness WG identified a lack of understanding of processes that support protocol approval for clinical trials across the AYA age range. A guideline to raise awareness was developed. The Access WG identified challenges for young adults (18-25 years) to access a pediatric hospital to enroll in a pediatric trial. A procedure was developed to streamline applications for access. The first six applications using this procedure have been successful. The Availability WG identified lack of pediatric-adult oncology reciprocal relationships as a barrier to awareness of open trials, and future collaboration. An AYA Craft Group Framework was established to grow relationships within tumor streams across institutions; two craft groups are now operating locally. An additional achievement was a successful request to the Therapeutic Goods Administration for Australian adoption of the Food and Drug Administration Guidance on Considerations for the Inclusion of Adolescent Patients in Adult Oncology Clinical Trials. Conclusion: This multipronged approach to improving AYA clinical trial access has relevance for other health environments. Our knowledge products are available as an online toolkit.
  • Item
    Thumbnail Image
    The Impact of Enhanced Recovery After Surgery on Total Joint Arthroplasty: Protocol for a Systematic Review and Meta-analysis
    Rele, S ; Shadbolt, C ; Schilling, C ; Taylor, NF ; Dowsey, MM ; Choong, PFM (JMIR PUBLICATIONS, INC, 2021-03-01)
    BACKGROUND: The number of total joint arthroplasties (TJAs) being performed is increasing worldwide. To match this increasing demand, there has been focus on hastening patients' recovery of function. This effort has culminated in the formulation of enhanced recovery after surgery (ERAS) strategies. However, with evolving ERAS programs and new recommendations, a review of current evidence is required to provide clinicians with up-to-date information about its effect on outcomes for TJA. OBJECTIVE: The objective of this study is to assess the utility of ERAS programs on patient, health service, and economic outcomes for primary, elective total hip arthroplasty (THA) and total knee arthroplasty (TKA). METHODS: A systematic search will be conducted in Medline (Ovid), EMCARE (Ovid), EMBASE (Ovid), Web of Science, CINAHL, National Health Service Economic Evaluations Database, and the Cochrane Library. Analytical, observational, and experimental designs will be included in this systematic review. Only studies including patients undergoing primary TKA and THA comparing ERAS programs with conventional surgery and postoperative care will be included. Data related to patient outcomes, health service outcomes, safety, and economic evaluation will be extracted. RESULTS: The search terms and primary database searches have been finalized. Findings will be reported in narrative and tabular form. Where appropriate, random effects meta-analyses will be conducted for each outcome, and heterogeneity quantified with Cochran Q test and I2 statistic. Measures of effect or mean differences will be reported with 95% confidence intervals. The results of this systematic review will be disseminated in a peer-reviewed journal. CONCLUSIONS: This protocol will guide a systematic review assessing outcomes associated with ERAS surgery in primary THA and TKA. TRIAL REGISTRATION: Open Science Framework osf.io/y4bhs; https://osf.io/y4bhs. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/25581.
  • Item
    Thumbnail Image
    Addressing surgical inequity for Aboriginal and Torres Strait Islander people in Australia's universal health care system: a call to action
    O'Brien, P ; Bunzli, S ; Lin, I ; Bessarab, D ; Coffin, J ; Dowsey, MM ; Choong, PFM (WILEY, 2021-01-28)
    Aboriginal and Torres Strait Islander people continue to experience health inequity within the Australian health care system. Little research has examined how disparities in surgical care access and outcomes contribute to Aboriginal health. In this narrative review and call to action, we discuss five care points along the journey to high-quality surgical care: health care seeking, primary health care services, specialist services, surgery and surgical outcomes. We highlight barriers and disparities that exist along this journey, drawing examples from the field of joint replacement surgery. Finally, we present opportunities for change at the health system, health service and clinician level, calling upon researchers, clinicians and policy makers to confront the surgical disparities experienced by Aboriginal and Torres Strait Islander people.
  • Item
    Thumbnail Image
    How Do People Communicate About Knee Osteoarthritis? A Discourse Analysis
    Bunzli, S ; Taylor, N ; O'Brien, P ; Dowsey, M ; Wallis, J ; Choong, P ; Shields, N (OXFORD UNIV PRESS, 2021-01-27)
    OBJECTIVE: To explore the ways in which people talk about knee osteoarthritis and how this may influence engagement in physical activity and activity-based interventions as recommended by clinical practice guidelines. DESIGN: A qualitative synthesis using discourse analysis methods. METHODS: Systematic review methods were used to identify qualitative studies exploring the perceptions of people with knee osteoarthritis, their carers, and/or clinicians. Methodological quality was evaluated through the use of the Critical Appraisal Skills Programme. Raw quotes extracted from each study were analyzed with inductive discourse analysis. RESULTS: A search of five electronic databases from inception until August 2019 yielded 778 articles. Sixty-two articles from 56 studies were included, reporting data (1,673 direct quotes) from people with knee osteoarthritis, carers, and clinicians in 16 countries. Two overarching discourses were identified-impairment and participation. The overarching impairment discourse prevailed in all participant groups and study settings. In this discourse, knee osteoarthritis was likened to a machine that inevitably wore down over time and required a doctor to repair. The overarching participatory discourse almost always coexisted alongside an impairment discourse. According to this discourse, a "busy body" was perceived as "healthy," and people could remain active despite knee osteoarthritis. CONCLUSION: The prevailing impairment discourse may potentially discourage people from using knees that have passed their "use-by date" and increase reliance on doctors to repair joint damage. Consistent with recommendations in clinical practice guidelines, a participatory discourse may provide an alternative way of communicating that may encourage people with knee osteoarthritis to continue to engage in physical activity by focusing on what they can do, rather than what they cannot do.
  • Item
    Thumbnail Image
    Placebo Surgery Controlled Trials Do They Achieve What They Set Out To Do? A Systematic Review
    Bunzli, S ; Choong, E ; Shadbolt, C ; Wall, L ; Nelson, E ; Schilling, C ; Wilding, H ; Lohmander, LS ; Balogh, ZJ ; Paolucci, F ; Clarke, P ; Choong, PFM ; Dowsey, MM (LIPPINCOTT WILLIAMS & WILKINS, 2021-06-01)
    OBJECTIVE: To explore whether placebo surgery controlled trials achieve what they set out to do by investigating discrepancy between projected and actual design aspects of trials identified through systematic review methods. SUMMARY BACKGROUND: Interest in placebo surgery controlled trials is growing in response to concerns regarding unnecessary surgery and the societal cost of low-value healthcare. As questions about the justifiability of using placebo controls in surgery have been addressed, attention is now being paid to more practical concerns. METHODS: Six databases were searched from inception - May 2020 (MEDLINE, Embase, Emcare, APA PsycInfo, CINAHL, Cochrane Library). Placebo surgery controlled trials with a published protocol were included. Three authors extracted "projected" design aspects from protocols and "actual" design aspects from main findings papers. Absolute and relative difference between projected and actual design aspects were presented for each trial. Trials were grouped according to whether they met their target sample size ("completed") and were concluded in a timely fashion. Pairs of authors assessed risk of bias. RESULTS: Of 24 trials with data available to analyse; 3 were completed and concluded within target timeframe; 10 were completed and concluded outside the target timeline; 4 were completed without clear target timeframes; 2 were incomplete and concluded within the target framework; 5 were incomplete and concluded outside the target timeline. Trials which reached the recruitment target underestimated trial duration by 88% and number of recruitment sites by 87%. CONCLUSIONS: Trialists need to factor additional time and sites into future placebo surgery controlled trials. A robust reporting framework of projected and actual trial design is imperative for trialists to learn from their predecessors. REVIEW REGISTRATION: PROSPERO (CRD42019133296).
  • Item
    Thumbnail Image
    Factors Underlying Patient and Surgeon Willingness to Participate in a Placebo Surgery Controlled trial
    Bunzli, S ; Nelson, E ; Wall, L ; Schilling, C ; Lohmander, LS ; Balogh, ZJ ; Tran, P ; Paolucci, F ; Clarke, P ; Choong, PFM ; Dowsey, MM (Ovid Technologies (Wolters Kluwer Health), 2021)
  • Item
    Thumbnail Image
    Staying moving, staying strong: Protocol for developing culturally appropriate information for Aboriginal people with osteoarthritis, rheumatoid arthritis, lupus and gout
    O'Brien, P ; Conley, B ; Bunzli, S ; Bullen, J ; Coffin, J ; Persaud, J ; Gunatillake, T ; Dowsey, MM ; Choong, PF ; Lin, I ; Suppiah, V (PUBLIC LIBRARY SCIENCE, 2021-12-23)
    INTRODUCTION: Addressing disparities in arthritis care is an important yet unmet health need for Aboriginal and Torres Strait Islander people in Australia (respectfully Aboriginal people herewith). Despite the significant prevalence and burden of arthritis within Aboriginal communities, access to care for arthritis is low. One means to reduce existing disparities in health care is to address current challenges relating to the appropriateness and acceptability of health care information resources for Aboriginal people. Health information sources can help to empower patients and their families to have greater involvement in their care and to engage in self-management of their condition. Despite an extensive range of arthritis information resources being available, currently no resources have been culturally adapted and developed in collaboration with Aboriginal consumers with arthritis. This paper outlines the processes that will be undertaken within the Staying Moving, Staying Strong project. This project aims to develop culturally secure arthritis information for Aboriginal people with osteoarthritis, rheumatoid arthritis, lupus and gout. METHODS AND ANALYSIS: The overarching principle guiding this project is cultural security, referring to the incorporation of processes such that the research will not compromise the cultural rights, values and expectations of Aboriginal people. This project will prioritise partnerships, community engagement, community benefit, sustainability, transferability, and capacity building and therefore uphold the cultural rights and values of Aboriginal people. In this six-phase project we will; 1) Establish a community reference group and advisory committee; 2) Explore the health information needs and preferences of Aboriginal people with arthritis; 3) Synthesise the existing key recommendations in high quality clinical practice guidelines on arthritis care; 4) Culturally adapt key clinical recommendations; 5) Develop culturally appropriate arthritis resources and; 6) Qualitatively evaluate the developed resources.
  • Item
    No Preview Available
    Arthroplasty information on the internet: quality or quantity?
    Davaris, MT ; Dowsey, MM ; Bunzli, S ; Choong, PF (Elsevier, 2021-04-01)
  • Item
    Thumbnail Image
    Assessing the suitability of general practice electronic health records for clinical prediction model development: a data quality assessment
    Thuraisingam, S ; Chondros, P ; Dowsey, MM ; Spelman, T ; Garies, S ; Choong, PF ; Gunn, J ; Manski-Nankervis, J-A (BMC, 2021-10-30)
    BACKGROUND: The use of general practice electronic health records (EHRs) for research purposes is in its infancy in Australia. Given these data were collected for clinical purposes, questions remain around data quality and whether these data are suitable for use in prediction model development. In this study we assess the quality of data recorded in 201,462 patient EHRs from 483 Australian general practices to determine its usefulness in the development of a clinical prediction model for total knee replacement (TKR) surgery in patients with osteoarthritis (OA). METHODS: Variables to be used in model development were assessed for completeness and plausibility. Accuracy for the outcome and competing risk were assessed through record level linkage with two gold standard national registries, Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR) and National Death Index (NDI). The validity of the EHR data was tested using participant characteristics from the 2014-15 Australian National Health Survey (NHS). RESULTS: There were substantial missing data for body mass index and weight gain between early adulthood and middle age. TKR and death were recorded with good accuracy, however, year of TKR, year of death and side of TKR were poorly recorded. Patient characteristics recorded in the EHR were comparable to participant characteristics from the NHS, except for OA medication and metastatic solid tumour. CONCLUSIONS: In this study, data relating to the outcome, competing risk and two predictors were unfit for prediction model development. This study highlights the need for more accurate and complete recording of patient data within EHRs if these data are to be used to develop clinical prediction models. Data linkage with other gold standard data sets/registries may in the meantime help overcome some of the current data quality challenges in general practice EHRs when developing prediction models.