Medicine (RMH) - Research Publications
Permanent URI for this collection
Search Results
1 - 10 of 43
-
ItemNo Preview AvailableLet's CHAT (Community Health Approaches to) Dementia in Aboriginal and Torres Strait Islander Community Controlled Primary Care: Baseline audit results of a stepped-wedge cluster randomised controlled trial(WILEY, 1/05/2021)Aim: This study describes baseline audit results documenting cognitive impairment not dementia (CIND) and dementia and associated risk factors in Aboriginal and Torres Strait Islander peoples aged ≥50 years attending Aboriginal Community Controlled Health Services (ACCHSs). Method: A specialised chart audit tool was designed to identify documented dementia and CIND, and relevant risk factor profiles in patient health records. The audits were conducted as part of a stepped-wedge cluster randomised controlled trial. Twelve Aboriginal Controlled Community Health Services (ACCHSs) in four states across Australia were recruited and medical records of 1,662 patients aged >50 years were audited. The primary outcome measure is documentation of CIND and dementia along with the associated risk factors. Results: The mean age was 60.2 +/-8.2 years and 56% were female. The overall prevalence of documented CIND or dementia was low, reported for only 57 (3.4%) patients audited. The prevalence of risk factors was high, with nearly two-thirds (64.1%,) having ≥4 risk factors. These included high rates of hypertension (52.5%), diabetes (44.3%), dyslipidemia (42.3%), obesity (35.3%) and current smoking (35.3%). Conclusion: Our previous work demonstrated the true prevalence of dementia was 10% and CIND was 10% in Indigenous communities. The low detection of these conditions in the primary care setting, accompanied by high prevalence of associated risk factors for cognitive impairment, demonstrates the need for dementia specific culturally responsive primary care interventions that optimise brain health and support identification of cognitive impairment and dementia, using a community wide and holistic approach across the lifespan.
-
ItemValidation of the Good Spirit, Good Life quality-of-life tool for older Aboriginal Australians(WILEY, 2022-09-09)OBJECTIVE: Improving the quality of life (QoL) of older people is a key priority for governments, clinicians, researchers and service providers worldwide. However, the lack of culturally appropriate QoL tools for First Nations people is a major barrier to such efforts. The purpose of this study was to evaluate the psychometric properties of the Good Spirit, Good Life (GSGL) QoL tool for older Aboriginal Australians. METHODS: One hundred and twenty older Aboriginal people living in Perth and Melbourne, Australia, were administered the GSGL tool, along with several other instruments assessing cognition (KICA-Cog), depression (KICA-Dep), anxiety (GAI-SF), health and well-being (EQ-5D-5L and ICECAP-O) and resilience (ARRQ-25). Associations between these instruments and the GSGL tool were explored to determine concurrent and known-groups validity. Internal consistency was assessed with split-half reliability and Cronbach's alpha. Exploratory factor analysis was performed to investigate construct validity. RESULTS: GSGL scores were positively correlated with ICECAP-O and ARRQ-25 scores, and negatively correlated with EQ-5D-5L score. GSGL scores differed significantly between participants with a probable anxiety disorder or depression, but not those with cognitive impairment. The Spearman-Brown prophecy estimate was 0.83 and Cronbach's alpha was 0.75. Principal component analysis identified two factors, which were labelled foundation and external. CONCLUSIONS: The GSGL tool is a valid tool to assess quality of life in older Aboriginal Australians. The tool demonstrates acceptable convergent, concurrent and known-groups validity. It was co-designed at all stages with older Aboriginal people contributing to its strong face and content validity.
-
ItemDiagnosis, differential diagnosis and misdiagnosis of Susac syndrome(WILEY, 2022-03-25)BACKGROUND AND PURPOSE: Susac syndrome (SuS) is an inflammatory condition of the brain, eye and ear. Diagnosis can be challenging, and misdiagnosis is common. METHODS: This is a retrospective review of the medical records of 32 adult patients from an Australasian cohort of SuS patients. RESULTS: An alternative diagnosis prior to SuS was made in 30 patients (94%) with seven patients receiving two or more diagnoses. The median time to diagnosis of SuS was 3 months (range 0.5-100 months). The commonest misdiagnoses were migraine in 10 patients (31%), cerebral vasculitis in six (19%), multiple sclerosis in five (16%) and stroke in five (16%). Twenty-two patients were treated for alternative diagnoses, 10 of whom had further clinical manifestations prior to SuS diagnosis. At presentation seven patients (22%) met criteria for definite SuS, 19 (59%) for probable SuS and six (19%) for possible SuS. Six patients (19%) presented with brain-eye-ear involvement, 14 with brain-ear (44%), six with brain-eye (19%) and six (19%) with only brain involvement. In patients with the complete triad of symptoms the median delay to diagnosis was 3 months (range 1-9 months) compared to 5.25 months (range 0.5-100 months) for patients with encephalopathy and ocular symptoms at presentation. CONCLUSIONS: Susac syndrome patients are frequently misdiagnosed at initial presentation, despite many having symptoms or radiological features that are red flags for the diagnosis. Delayed diagnosis can lead to patient morbidity. The varied ways in which SuS can present, and clinician failure to consider or recognize SuS, appear to be the main factors leading to misdiagnosis.
-
ItemNo Preview AvailableEndoscopic features of buried Barrett's mucosa: visible to the trained eye?(Wiley, 2019-12-01)
-
Item
-
Item
-
Item
-
ItemA case of actinic granuloma responding to oral retinoids(WILEY, 2019-05-01)
-
Item
-
Item
- 1 (current)
- 2
- 3
- 4
- 5