Medicine (Austin & Northern Health) - Research Publications
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ItemCerebrovascular disease, Alzheimer's disease biomarkers and longitudinal cognitive decline(WILEY-BLACKWELL, 2016-06)
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ItemIMPLEMENTATION OF "GOALS OF PATIENT CARE" MEDICAL TREATMENT ORDERS IN RESIDENTIAL AGED CARE FACILITIES: A RANDOMISED CONTROLLED TRIAL(OXFORD UNIV PRESS, 2016-09)INTRODUCTION: Systematic reviews demonstrate that advance care planning (ACP) has many positive effects for residents of aged care facilities, including decreased hospitalisation. The proposed Residential Aged Care Facility (RACF) 'Goals of Patient Care' (GOPC) form incorporates a resident's prior advance care plan into medical treatment orders. Where none exists, it captures residents' preferences. This documentation helps guide healthcare decisions made at times of acute clinical deterioration. METHODS AND ANALYSIS: This is a mixed methods study. An unblinded cluster randomised controlled trial is proposed in three pairs of RACFs. In the intervention arm, GOPC forms will be completed by a doctor incorporating advance care plans or wishes. In the control arm, residents will have usual care which may include an advance care plan. The primary hypothesis is that the GOPC form is superior to standard ACP alone and will lead to decreased hospitalisation due to clearer documentation of residents' medical treatment plans. The primary outcome will be an analysis of the effect of the GOPC medical treatment orders on emergency department attendances and hospital admissions at 6 months. Secondary outcome measurements will include change in hospitalisation rates at 3 and 12 months, length of stay and external mortality rates among others. Qualitative interviews, 12 months post GOPC implementation, will be used for process evaluation of the GOPC and to evaluate staff perceptions of the form's usefulness for improving communication and medical decision-making at a time of deterioration. DISSEMINATION: The results will be disseminated in peer review journals and research conferences. This robust randomised controlled trial will provide high-quality data about the influence of medical treatment orders that incorporate ACP or preferences adding to the current gap in knowledge and evidence in this area. TRIAL REGISTRATION NUMBER: ACTRN12615000298516, Results.
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ItemNo Preview AvailableAcoustic monitoring of speech impairment in motor neuron disease associated with frontotemporal dementia: a case series(European Journal of Neurology, 2016)Frontotemporal dementia is the second most common form of younger onset dementia. A subset of people with this disorder develop motor neuron disease (MND) with associated speech impairment (dysarthria). Here, we aim to measure the progression of dysarthria in a case of FTD-MND with acoustic analysis. Four individuals with FTD (one developing concomitant MND) were longitudinally assessed over two years. Two acoustic measures demonstrated capacity to objectively monitor dysarthria in FTD-MND. These preliminary data highlight potential for the clinical use of these methods to identify the initial signs of bulbar onset motor neuron disease. Index terms: acoustics, disease monitoring, dysarthria, frontotemporal dementia, motor neuron disease.
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ItemNo Preview AvailableQuantification of motor speech in primary progressive aphasia and frontotemporal dementia(WILEY-BLACKWELL, 2016-08-01)Frontotemporal dementia (FTD) and primary progressive aphasia (PPA) are two groups of related disorders which are classified into the behavioural (bvFTD), semantic (svPPA), nonfluent/agrammatic (nfvPPA) and logopaenic (lvPPA) variants. Each variant presents with characteristic impairments of communication or behaviour, and the defining features of the syndromes are under ongoing debate in the literature. Researchers and clinicians usually assess speech with listener-based rating scales, which pose a challenge for identifying subtle changes to speech. Objective measures of speech may therefore improve characterisation of speech impairments in the literature and assist in clinical diagnosis and management. In this study, speech samples were taken from 43 people with PPA or FTD (8 svPPA, 4 nfvPPA, 9 lvPPA, 22 bvFTD) and 24 healthy controls. Speech was analysed perceptually using a 5-point rating scale across all speech subsystems. Speech was objectively quantified with measures of lexical stress (the pairwise variability index, PVI), vowel production, timing, voice quality and diadochokinetic (DDK) speech rate. The ability of speech measures to predict regions of neurodegeneration was assessed by comparison of speech to calculations of cortical thickness and subcortical volume derived from participants’ clinical magnetic resonance imaging (MRI) scans. Longitudinal speech investigations were conducted for a subgroup of participants to investigate the capacity of the measures to track disease progression. Group comparisons indicated that several speech measures differentiate pathological groups from controls, including measures of speech timing, DDK rate, and PVI. PVI and DDK also differentiated the nfvPPA group from other subtypes. Case studies of longitudinal data highlight measures which reflect motor speech changes in a case of bvFTD progressing to motor neurone disease (MND), and in two cases of nfvPPA. Findings add to the documentation of speech production in PPA and FTD by establishing acoustic correlates which differ from the healthy population. Longitudinal case studies demonstrate the potential for these measures to be used clinically to improve monitoring of disease progression.