Medicine (Western Health) - Research Publications

Permanent URI for this collection

Search Results

Now showing 1 - 10 of 934
  • Item
    No Preview Available
    The practicality of using bone impact microindentation in a population-based study of women: A Geelong-Osteoporosis Study.
    Rufus-Membere, P ; Anderson, KB ; Holloway-Kew, KL ; Harland, JW ; Diez-Perez, A ; Kotowicz, MA ; Pasco, JA (Elsevier BV, 2024-03)
    Impact microindentation (IMI) is a minimally invasive technique that allows the assessment of bone material strength index (BMSi) in vivo, by measuring the depth of a micron-sized, spherical tip into cortical bone that is then indexed to the depth of the tip into a reference material. In this study, we aimed to assess the practicality of its application in 99 women aged 42-84 yr from the Geelong Osteoporosis Study. Impact microindentation was performed in the mid-shaft of the right tibia using the OsteoProbe. Immediately following measurement, each participant was requested to rate on a Visual Analogue Scale [0-10] the level of discomfort anticipated and experienced, any initial reluctance towards the measurement and whether they were willing to repeat the measurement. Of 99 potential participants who attended this assessment phase, 55 underwent IMI measurement. Reasons for non-measurement in 44 women were existing skin conditions (n = 8, 18.2 %) and excessive soft tissue around mid-tibial region (n = 32, 72.2 %). An additional four (9.1 %) participants did not provide any reasons for declining. For 55 participants who had underwent IMI, the expectation for pain when briefed about the procedure was low (2.28 ± 2.39), as was pain experienced during the measurement (0.72 ± 1.58). Participants were not reluctant to undergo the measurement (0.83 ± 1.67), and all indicated a willingness to repeat the measurement. Results of this study showed that the IMI technique is well tolerated and accepted by women participating in the Geelong Osteoporosis Study, suggesting that the technique shows promise in a research or clinical setting.
  • Item
    No Preview Available
  • Item
    Thumbnail Image
    Additional Insights on the Osteoporosis Care Gap
    Talevski, J ; Daly, RM (Wiley, 2023-04-01)
  • Item
    Thumbnail Image
    Outcome of reduction of paediatric forearm fracture by emergency department clinicians
    Gursanscky, J ; Kelly, A-M ; Hamad, A ; Tagg, A ; Klim, S ; Ritchie, P ; Law, I ; Krieser, D (Wiley, 2023-04)
    OBJECTIVES: Paediatric forearm fractures are common. Anecdotally, there is a trend towards ED reduction of selected fractures under procedural sedation. We aimed to determine the rate of subsequent operative intervention for fracture re-displacement. METHODS: Retrospective observational study of children with a forearm/wrist fracture undergoing fracture reduction in ED. Outcome of interest was operative intervention for fracture re-displacement within 6 weeks. RESULTS: Among 176 patients studied, operative intervention occurred in nine patients (5.1%, 95% confidence interval 2.7-9.4%). CONCLUSION: Reduction of paediatric forearm fractures under procedural sedation by ED clinicians is increasingly common and results in a low rate of subsequent operative intervention.
  • Item
  • Item
    No Preview Available
    The Women’s Healthy Ageing Project: A pattern of cognitive decline after brain injury
    Bird, S ; Faux, NG ; Szoeke, C (Wiley, 2021-12)
    Abstract Background It is well recognised that damage sustained by traumatic brain injury (TBI) initiate injury mechanisms that continue to develop long after insult. Increasing evidence suggests TBI may lead to chronic cognitive decline and the development of dementia later in life. However, due to the low rate of TBI in the general community, there is a paucity of data on the impact of cognitive decline in community TBI. We examined longitudinal cognitive changes over a 12‐year period to determine if there was any relationship with community reported TBI. Method The Women’s Healthy Aging Project is an ongoing longitudinal cohort study of community‐dwelling Australian women. Assessments included an extensive range of measures, including neuropsychological testing of multiple cognitive domains and questions relating to head injury. In total, 110 women had complete neuropsychological testing at all three time points; from 2002, 2012 and 2014. Of these women, nine (aged 56‐65 in 2002) had a history of moderate to severe TBI. Composite cognitive scores were compared to 18 healthy controls randomly selected from the complete dataset individually matched for age, education, and APO4‐genotype. Analyses were conducted in five datasets drawn from the complete dataset and results were averaged. Result Median scores for executive function were similar for both the TBI group and healthy controls in 2002, lower in the TBI group by 2012 and this difference increased further in 2014. Median scores for verbal episodic memory were slightly lower in the TBI group than controls in 2002 and 2012, and this difference increased in 2014. Although this initial pilot study with small samples in mid‐aged healthy women did not show statistically significant results, the observed relationships were constant over the five datasets, warranting further exploration. Conclusion In our small pilot study, we observed greater rate of decline of both executive function and verbal episodic memory in women with a history of TBI. Findings warrant a need for larger studies to explore this relationship as it indicates that community‐based reported TBI may impact cognitive performance even in early ageing. Further work will continue to explore cognitive trajectories in women with a mean age 80 at next follow‐up.
  • Item
    No Preview Available
    Real-world clinical outcomes and cost estimates of metastatic castration-resistant prostate cancer treatment: does sequencing of taxanes and androgen receptor-targeted agents matter?
    Pereira-Salgado, A ; Anton, A ; Franchini, F ; Mahar, RK ; Kwan, EM ; Wong, S ; Shapiro, J ; Weickhardt, A ; Azad, AA ; Spain, L ; Gunjur, A ; Torres, J ; Parente, P ; Parnis, F ; Goh, J ; Steer, C ; Brown, S ; Gibbs, P ; Tran, B ; IJzerman, M (TAYLOR & FRANCIS LTD, 2023-02-07)
    INTRODUCTION: Health economic outcomes of real-world treatment sequencing of androgen receptor-targeted agents (ARTA) and docetaxel (DOC) remain unclear. MATERIAL AND METHODS: Data from the electronic Castration-resistant Prostate cancer Australian Database (ePAD) were analyzed including median overall survival (mOS) and median time-to-treatment failure (mTTF). Mean total costs (mTC) and incremental cost-effectiveness ratios (ICER) of treatment sequences were estimated using the average sample method and Zhao and Tian estimator. RESULTS: Of 752 men, 441 received ARTA, 194 DOC, and 175 both sequentially. Of participants treated with both, first-line DOC followed by ARTA was the more common sequence (n = 125, 71%). mOS for first-line ARTA was 8.38 years (95% CI: 3.48, not-estimated) vs. 3.29 years (95% CI: 2.92, 4.02) for DOC. mTTF was 15.7 months (95% CI: 14.2, 23.7) for the ARTA-DOC sequence and 18.2 months (95% CI: 16.2, 23.2) for DOC-ARTA. In first-line, ARTA cost an additional $13,244 per mTTF month compared to DOC. In second-line, ARTA cost $6726 per mTTF month. The DOC-ARTA sequence saved $2139 per mTTF compared to ARTA-DOC, though not statistically significant. CONCLUSION: ICERs show ARTA had improved clinical benefit compared to DOC but at higher cost. There were no significant cost differences between combined sequences.
  • Item
    No Preview Available
    The experiences and support needs of students with diabetes at university: An integrative literature review
    Hagger, V ; Lake, AJ ; Singh, T ; Hamblin, PS ; Rasmussen, B (WILEY, 2023-01)
    AIMS: Commencing university presents particular challenges for young adults with diabetes. This integrative literature review aimed to synthesise the research exploring the experiences and support needs of university students with diabetes. METHODS: Medline, CINAHL, PsychInfo and EMBASE databases were searched for quantitative and qualitative studies, among undergraduate and postgraduate students with type 1 or type 2 diabetes conducted in the university setting. Two reviewers independently screened titles, abstracts and full-text articles. Data were analysed thematically and synthesised narratively utilising the ecological model as a framework for interpreting findings and making recommendations. RESULTS: We identified 25 eligible papers (20 studies) utilising various methods: individual interview, focus group, survey, online forum. Four themes were identified: barriers to self-care (e.g. lack of structure and routine); living with diabetes as a student; identity, stigma and disclosure; and strategies for managing diabetes at university. Students in the early years at university, recently diagnosed or moved away from home, reported more self-care difficulties, yet few accessed university support services. Risky alcohol-related behaviours, perceived stigma and reluctance to disclose diabetes inhibited optimal diabetes management. CONCLUSION: Despite the heterogeneity of studies, consistent themes related to diabetes self-care difficulties and risky behaviours were reported by young adults with diabetes transitioning to university life. No effective interventions to support students with diabetes were identified in this setting. Multilevel approaches to support students to balance the competing demands of study and diabetes self-care are needed, particularly in the early years of university life.
  • Item
    No Preview Available
    Retrospective Window of Interest Annotation Provides New Insights Into Functional Channels in Ventricular Tachycardia Substrate
    Hawson, J ; Al-kaisey, A ; Anderson, RD ; Chieng, D ; Segan, L ; Watts, T ; Campbell, T ; Morton, J ; McLellan, A ; Sparks, P ; Lee, A ; Gerstenfeld, EP ; Hsia, HH ; Voskoboinik, A ; Prabhu, S ; Pathik, B ; Kumar, S ; Kistler, P ; Kalman, J ; Lee, G (ELSEVIER, 2023-01)
    BACKGROUND: Accurate annotation of local activation time is crucial in the functional assessment of ventricular tachycardia (VT) substrate. A major limitation of modern mapping systems is the standard prospective window of interest (sWOI) is limited to 490 to 500 milliseconds, preventing annotation of very late potentials (LPs). A novel retrospective window of interest (rWOI), which allows annotation of all diastolic potentials, was used to assess the functional VT substrate. OBJECTIVES: This study sought to investigate the utility of a novel rWOI, which allows accurate visualization and annotation of all LPs during VT substrate mapping. METHODS: Patients with high-density VT substrate maps and a defined isthmus were included. All electrograms were manually annotated to latest activation using a novel rWOI. Reannotated substrate maps were correlated to critical sites, with areas of late activation examined. Propagation patterns were examined to assess the functional aspects of the VT substrate. RESULTS: Forty-eight cases were identified with 1,820 ± 826 points per map. Using the novel rWOI, 31 maps (65%) demonstrated LPs beyond the sWOI limit. Two distinct patterns of channel activation were seen during substrate mapping: 1) functional block with unidirectional conduction into the channel (76%); and 2) wave front collision within the channel (24%). In addition, a novel marker termed the zone of early and late crowding was studied in the rWOI substrate maps and found to have a higher positive predictive value (85%) than traditional deceleration zones (69%) for detecting critical sites of re-entry. CONCLUSIONS: The standard WOI of contemporary mapping systems is arbitrarily limited and results in important very late potentials being excluded from annotation. Future versions of electroanatomical mapping systems should provide longer WOIs for accurate local activation time annotation.
  • Item
    Thumbnail Image
    Chronic disease IMPACT (chronic disease early detection and improved management in primary care project): An Australian stepped wedge cluster randomised trial
    Jones, JL ; Simons, K ; Manski-Nankervis, J-A ; Lumsden, NG ; Fernando, S ; de Courten, MP ; Cox, N ; Hamblin, PS ; Janus, ED ; Nelson, CL (SAGE PUBLICATIONS LTD, 2023)
    BACKGROUND: Interrelated chronic vascular diseases (chronic kidney disease (CKD), type 2 diabetes (T2D) and cardiovascular disease (CVD)) are common with high morbidity and mortality. This study aimed to assess if an electronic-technology-based quality improvement intervention in primary care could improve detection and management of people with and at risk of these diseases. METHODS: Stepped-wedge trial with practices randomised to commence intervention in one of five 16-week periods. Intervention included (1) electronic-technology tool extracting data from general practice electronic medical records and generating graphs and lists for audit; (2) education regarding chronic disease and the electronic-technology tool; (3) assistance with quality improvement audit plan development, benchmarking, monitoring and support. De-identified data analysis using R 3.5.1 conducted using Bayesian generalised linear mixed model with practice and time-specific random intercepts. RESULTS: At baseline, eight included practices had 37,946 active patients (attending practice ≥3 times within 2 years) aged ≥18 years. Intervention was associated with increased OR (95% CI) for: kidney health checks (estimated glomerular filtration rate, urine albumin:creatinine ratio (uACR) and blood pressure) in those at risk 1.34 (1.26-1.42); coded diagnosis of CKD 1.18 (1.09-1.27); T2D diagnostic testing (fasting glucose or HbA1c) in those at risk 1.15 (1.08-1.23); uACR in patients with T2D 1.78 (1.56-2.05). Documented eye checks within recommended frequency in patients with T2D decreased 0.85 (0.77-0.96). There were no significant changes in other assessed variables. CONCLUSIONS: This electronic-technology-based intervention in primary care has potential to help translate guidelines into practice but requires further refining to achieve widespread improvements across the interrelated chronic vascular diseases.