Radiology - Research Publications
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ItemHybrid imaging is the future of molecular imaging.(Department of Biomedical Imaging, University of Malaya, Malaysia, 2007-07)Correlative imaging has long been used in clinical practice and particularly for the interpretation of nuclear medicine studies wherein detailed anatomical information is often lacking. Previously, side-by-side comparison or software co-registration techniques were applied but suffered from technical limitations related to the differing geometries of the imaging equipment, differences in the positioning of patients and displacement of mobile structures between studies. The development of the first hybrid PET and CT device struck a chord with the medical imaging community that is still ringing loudly throughout the world. So successful has been the concept of PET-CT that none of the major medical imaging manufacturers now offers stand-alone PET scanners. Following close behind this success, SPECT-CT devices have recently been adopted by the nuclear medicine community, already compelled by the benefits of hybrid imaging through their experience with PET-CT. Recent reports of adaptation of PET detectors to operate within the strong magnetic field of MRI scanners have generated further enthusiasm. Prototype PET-MRI devices are now in development. The complementary anatomical, functional and molecular information provided by these techniques can now be presented in an intuitive and aesthetically-pleasing format. This has made end-users more comfortable with the results of functional imaging techniques than when the same information is presented independently. Despite the primacy of anatomical imaging for locoregional disease definition, the molecular characterisation available from PET and SPECT offers unique complementary information for cancer evaluation. A new era of cancer imaging, when hybrid imaging will be the primary diagnostic tool, is approaching.
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ItemPrevention of type 2 diabetes by lifestyle intervention in an Australian primary health care setting: Greater green triangle (GGT) diabetes prevention project(BMC, 2007-09-19)BACKGROUND: Randomised controlled trials demonstrate a 60% reduction in type 2 diabetes incidence through lifestyle modification programmes. The aim of this study is to determine whether such programmes are feasible in primary health care. METHODS: An intervention study including 237 individuals 40-75 years of age with moderate or high risk of developing type 2 diabetes. A structured group programme with six 90 minute sessions delivered during an eight month period by trained nurses in Australian primary health care in 2004-2006. Main outcome measures taken at baseline, three, and 12 months included weight, height, waist circumference, fasting plasma glucose and lipids, plasma glucose two hours after oral glucose challenge, blood pressure, measures of psychological distress and general health outcomes. To test differences between baseline and follow-up, paired t-tests and Wilcoxon rank sum tests were performed. RESULTS: At twelve months participants' mean weight reduced by 2.52 kg (95% confidence interval 1.85 to 3.19) and waist circumference by 4.17 cm (3.48 to 4.87). Mean fasting glucose reduced by 0.14 mmol/l (0.07 to 0.20), plasma glucose two hours after oral glucose challenge by 0.58 mmol/l (0.36 to 0.79), total cholesterol by 0.29 mmol/l (0.18 to 0.40), low density lipoprotein cholesterol by 0.25 mmol/l (0.16 to 0.34), triglycerides by 0.15 mmol/l (0.05 to 0.24) and diastolic blood pressure by 2.14 mmHg (0.94 to 3.33). Significant improvements were also found in most psychological measures. CONCLUSION: This study provides evidence that a type 2 diabetes prevention programme using lifestyle intervention is feasible in primary health care settings, with reductions in risk factors approaching those observed in clinical trials.
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ItemPatient Engagement and Coaching for Health: The PEACH study a cluster randomised controlled trial using the telephone to coach people with type 2 diabetes to engage with their GPs to improve diabetes care: a study protocol(BMC, 2007-04-11)BACKGROUND: The PEACH study is based on an innovative 'telephone coaching' program that has been used effectively in a post cardiac event trial. This intervention will be tested in a General Practice setting in a pragmatic trial using existing Practice Nurses (PN) as coaches for people with type 2 diabetes (T2D). Actual clinical care often fails to achieve standards, that are based on evidence that self-management interventions (educational and psychological) and intensive pharmacotherapy improve diabetes control. Telephone coaching in our study focuses on both. This paper describes our study protocol, which aims to test whether goal focused telephone coaching in T2D can improve diabetes control and reduce the treatment gap between guideline based standards and actual clinical practice. METHODS/DESIGN: In a cluster randomised controlled trial, general practices employing Practice Nurses (PNs) are randomly allocated to an intervention or control group. We aim to recruit 546 patients with poorly controlled T2D (HbA1c >7.5%) from 42 General Practices that employ PNs in Melbourne, Australia. PNs from General Practices allocated to the intervention group will be trained in diabetes telephone coaching focusing on biochemical targets addressing both patient self-management and engaging patients to work with their General Practitioners (GPs) to intensify pharmacological treatment according to the study clinical protocol. Patients of intervention group practices will receive 8 telephone coaching sessions and one face-to-face coaching session from existing PNs over 18 months plus usual care and outcomes will be compared to the control group, who will only receive only usual care from their GPs. The primary outcome is HbA1c levels and secondary outcomes include cardiovascular disease risk factors, behavioral risk factors and process of care measures. DISCUSSION: Understanding how to achieve comprehensive treatment of T2D in a General Practice setting is the focus of the PEACH study. This study explores the potential role for PNs to help reduce the treatment and outcomes gap in people with T2D by using telephone coaching. The intervention, if found to be effective, has potential to be sustained and embedded within real world General Practice.
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ItemEarly therapeutic response assessment by 18FDG-positron emissiontomography during chemotherapy in patients with diffuse large B-celllymphoma: isolated residual positivity involving bone is not usually a predictor of subsequent treatment failure(Taylor & Francis, 2007-03)Residual 2-fluoro-2-deoxyglucose (FDG) – positron emission tomography (PET) positivity during treatment of patients withdiffuse large B-cell lymphoma (DLBLC) prospectively identifies a subgroup at high likelihood of subsequent treatmentfailure. A single institution clinical audit of FDG-PET performance for this indication was undertaken for patients withDLBCL treated with anthracycline-based chemotherapy+radiotherapy. Of 45 eligible patients, 14 (31%) were PETpositiveafter a median of three chemotherapy cycles (range 1 – 5), of which 10 (71%) progressed at a median of 6.5 months.An interim positive PET was a statistically significant adverse prognostic factor for treatment failure (P=0.0001, log-rankanalysis) with a hazard ratio for a positive interim-treatment PET of 9 (95% confidence interval 4 – 55) and positivepredictive value of 71% and negative predictive value of 90%. Notably, four patients with low-grade FDG-avidity limited tosites previously involved by biopsy-proven osseous lymphoma, remain progression-free (median follow-up 62 months). LowgradeFDG-avidity on interim restaging at sites of bone involvement by DLBCL at diagnosis, appears to be less predictive ofdisease progression than residual nodal or extra-nodal soft tissue abnormality by PET.