1
|
Alexopoulos P, Canty A, Dasgupta J, Furlano JA, Nogueira Haas A. Brain health and value diversity: A new implementation field for values-based practice? Psychiatriki 2024. [PMID: 38252899 DOI: 10.22365/jpsych.2024.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
Abstract
Brain health has recently emerged as an overarching concept encompassing cognitive, sensory, social-emotional, behavioural and motor aspects of brain functioning, enabling individuals to achieve their potential for both health and wellbeing over their life course, independent of the presence or absence of disease.1 It is contingent on a continuous, complex interplay between interconnected determinants related to physical health, healthy environments, safety and security, learning and social connection, and access to quality services. Even though responsibility for optimizing brain health can be taken at an individual level, brain health is in fact heavily influenced by determinants far beyond the control of individuals and their families. For instance, protection from abuse and maltreatment or equitable access to health services depend on interacting social, financial, and political factors that can often only be minimally influenced by individual or small group initiatives.2,3 In addition, the voice of many people, including the very young, the very old, the sick, the disadvantaged, and those who live in poverty, may not be sufficiently influential, even though the decision-making process crucially affects the brain health and quality of life for these individuals. The breadth of determinants of brain health makes brain health a terrain that is justifiably shaped by a plethora of stakeholders with highly diverse values and hence potentially conflicting interests and albeit different degrees of power. Consequently, decision-making in such contexts embodies a thorny process that may render the negligence of the values, viewpoints, and perspectives of those directly involved in a given decision, particularly when the individual capacity to advocate for oneself and the willingness of society and governments to act on behalf of their citizens, are low. Values-based practice (VBP) is a toolkit for balancing interests, wishes, and values in contexts characterized by diverse values, which may be valuable in decision-making related to brain health.4 The implementation of this toolkit in different fields of healthcare (e.g., occupational therapy, orthopedics, primary care, psychiatry, psychology, radiotherapy) has been proposed, and training materials for healthcare professionals have been developed.5 VBP aims to include the differences in values, viewpoints, and perspectives of those directly concerned with a given decision so that communication and shared decision-making are facilitated. Based on the legacy of the Popperian open society,5 VBP treats values in the same way that democracy treats ideas and human voices. Hence, this decision-making toolkit is neither restricted to ethical codes nor prioritizes one value over others. It also does not endorse certain values while excluding others, provided that the values in play are compatible with legal, regulatory, and bioethical frameworks. The emphasis of VBP is on good process rather than predetermined 'correct' outcomes.6,7 Respect for differences between stakeholders results in the creation of a culture of mutual responsibility and in building up a positive relationship between all those concerned, so that everyone feels a sense of ownership of the decision made.4,6 Of note, according to VBP, the perspective of the health service user or of the individuals or community seeking to protect their brain health is the ideal starting point for any decision. This approach minimizes the negligence of the views, needs, values, competencies, resources, and aspirations of those trying to optimize their brain health in contexts where powerful socioeconomic and further interests may be at stake. The 'good process' of VBP is safeguarded by ten principles.4 Four of them pertain to clinical skills and practice - awareness raising regarding the involvement of values in a given decision-making process; use of a clear reasoning strategy to explore value diversity; knowledge about the values and facts that may be relevant to different contexts; and good communication skills. Two further principles underscore the importance of person-centred and multidisciplinary health service delivery. Other principles focus on the fact that all decisions are based on both values and facts, where the former become noticeable particularly when they are diverse or conflicting, especially in environments where variable choices are at the disposal of service users. The last principle of VBP is based on partnership in decision-making, including both service users and providers. In conclusion, VBP may become a valuable tool for making balanced decisions in the broad terrain of brain health. Its protective focus on the perspectives of service users and its democratic character may pave the way towards achieving equity in and optimization of brain health.
Collapse
Affiliation(s)
- Panagiotis Alexopoulos
- Mental Health Services, Patras University Hospital, Department of Medicine, School of Health Sciences, University of Patras Global Brain Health Institute, Trinity College Dublin Department of Psychiatry and Psychotherapy, Klinikum rechts der Isar, Faculty of Medicine, Technical University of Munich
| | - Alison Canty
- Wicking Dementia Research and Education Centre, University of Tasmania; Global Brain Health Institute, Medical School, Trinity College Dublin
| | - Jayashree Dasgupta
- Samvedna Senior Care; Global Brain Health Institute, Trinity College Dublin
| | - Joyla A Furlano
- Faculty of Health Sciences, McMaster University; Global Brain Health Institute, Trinity College Dublin
| | - Aline Nogueira Haas
- School of Physical Education, Physiotherapy and Dance, Universidade Federal do Rio Grande do Sul, Brazil; Global Brain Health Institute, Medical School, Trinity College Dublin
| |
Collapse
|
2
|
Clerke T, Margetts J, Donovan H, Shepherd HL, Makris A, Canty A, Ruhotas A, Catling C, Henry A. Piloting a shared decision-making clinician training intervention in maternity care in Australia: A mixed methods study. Midwifery 2023; 126:103828. [PMID: 37717344 DOI: 10.1016/j.midw.2023.103828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 08/28/2023] [Accepted: 09/11/2023] [Indexed: 09/19/2023]
Abstract
PROBLEM Implementation of woman-centred care in evidence-based maternity practice requires clinicians to be skilled in shared decision-making, yet there is limited training or research into such interventions. BACKGROUND Shared decision-making enables women to make informed decisions in partnership with clinicians where there are varied clinical options in relation to indications for and timing of planned birth. AIM We aimed to develop a shared decision-making training intervention and evaluate its feasibility and acceptability to midwives and obstetricians. METHODS The intervention was co-designed by midwifery and medical clinician-researchers, and a consumer representative. Online training and demonstration videos were distributed to midwives and obstetricians in three Sydney hospitals, followed by two online workshops in 2021 and 2022 where participants practised shared decision-making in roleplaying scenarios tailored to timing of birth. Training was evaluated using post-workshop and post-training surveys and semi-structured qualitative interviews. FINDINGS The training workshop format, duration and content were well received. Barriers to the uptake of shared decision-making were time, paternalistic practices and fear of repercussions of centring women in the decision-making process. DISCUSSION The intervention enabled midwifery and medical colleagues to learn communication repertoires from each other in woman-centred discussions around timing of birth. Roleplay scenarios enabled participants to observe and provide feedback on their colleagues' shared decision-making practices, while providing a space for collective reflection on ways to promote, and mitigate barriers to, its implementation in practice. CONCLUSION Shared decision-making training supports maternity clinicians in developing skills that implement woman-centred care in the timing of planned birth.
Collapse
Affiliation(s)
- Teena Clerke
- Maridulu Budyari Gumal, Sydney Partnership for Health, Education, Research and Enterprise (SPHERE), Australia; University of Technology Sydney, Faculty of Health, Australia.
| | - Jayne Margetts
- Maridulu Budyari Gumal, Sydney Partnership for Health, Education, Research and Enterprise (SPHERE), Australia; University of Technology Sydney, Faculty of Health, Australia
| | - Helen Donovan
- Maridulu Budyari Gumal, Sydney Partnership for Health, Education, Research and Enterprise (SPHERE), Australia; University of Technology Sydney, Faculty of Health, Australia
| | - Heather L Shepherd
- The University of Sydney, Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, Australia
| | - Angela Makris
- Maridulu Budyari Gumal, Sydney Partnership for Health, Education, Research and Enterprise (SPHERE), Australia; University of New South Wales, Australia; Liverpool Hospital, South West Sydney Local Health District, Australia; Western Sydney University, Women's Health Initiative Translation Unit (WHITU), Australia
| | - Alison Canty
- Maridulu Budyari Gumal, Sydney Partnership for Health, Education, Research and Enterprise (SPHERE), Australia; Liverpool Hospital, South West Sydney Local Health District, Australia; Western Sydney University, Women's Health Initiative Translation Unit (WHITU), Australia
| | - Annette Ruhotas
- Maridulu Budyari Gumal, Sydney Partnership for Health, Education, Research and Enterprise (SPHERE), Australia
| | - Christine Catling
- Maridulu Budyari Gumal, Sydney Partnership for Health, Education, Research and Enterprise (SPHERE), Australia; University of Technology Sydney, Faculty of Health, Australia
| | - Amanda Henry
- Maridulu Budyari Gumal, Sydney Partnership for Health, Education, Research and Enterprise (SPHERE), Australia; University of New South Wales, Australia; St George Hospital, South East Sydney Local Health District, Australia
| |
Collapse
|
3
|
Gow ML, Rossiter C, Roberts L, Henderson MJ, Yang L, Roche J, Hayes E, Canty A, Denney-Wilson E, Henry A. COVID-19, lifestyle behaviors and mental health: A mixed methods study of women 6 months following a hypertensive pregnancy. Front Public Health 2022; 10:1000371. [PMID: 36330103 PMCID: PMC9623114 DOI: 10.3389/fpubh.2022.1000371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 10/04/2022] [Indexed: 01/26/2023] Open
Abstract
Introduction The COVID-19 pandemic introduced unprecedented challenges to both the physical and psychological health of postpartum women. The aim of this study was to determine how the COVID-19 pandemic affected the diet, physical activity and mental health of women 6 months following a hypertensive disorder of pregnancy. Methods Mixed methods sub-study of the Blood Pressure Postpartum trial, which recruited women following a hypertensive disorder of pregnancy from six Sydney metropolitan hospitals. Cross sectional analysis of baseline quantitative data, collected at 6-months postpartum from March 2019-February 2022, and qualitative data analysis from semi-structured telephone interviews, was performed. Dates of COVID-19 lockdowns for Sydney, Australia were collected from government websites. Diet (vegetable, fruit, alcohol, take away intake) and physical activity (walking, vigorous activity, strength training frequency and duration) were assessed using the self-report NSW Population Health Survey. Depression and anxiety were assessed using the Edinburgh Depression Scale and GAD-7 scale, respectively. Outcome data were compared between women who completed surveys "In Lockdown" vs. "Not in Lockdown" as well as "Prior to any Lockdown" vs. "During or Following any Lockdown". Results Of 506 participants, 84 women completed the study surveys "In Lockdown," and 149 completed the surveys "Prior to any Lockdown." Thirty-four participants were interviewed. There were no statistically significant differences in diet, physical activity, depression and anxiety among women who completed the survey "In Lockdown" vs. "Not in Lockdown." "Prior to any Lockdown," participants were more likely to do any walking (95% vs. 89%, p = 0.017), any vigorous activity (43% vs. 30%, p = 0.006) or any strength training (44% vs. 33%, p = 0.024), spent more time doing vigorous activity (p = 0.003) and strength training (p = 0.047) and were more likely to drink alcohol at least monthly (54% vs. 38%, p < 0.001) compared with "During or Following any Lockdown." Conclusions Our findings suggest that the confinements of lockdown did not markedly influence the mental health, diet and physical activity behaviors of women 6 months following hypertensive pregnancy. However, physical activity levels were reduced following the emergence of COVID-19, suggesting targeted efforts may be necessary to re-engage postpartum women with exercise. Trial registration https://anzctr.org.au/Trial/Registration/TrialReview.aspx?id=376286&isReview=true, identifier: ACTRN12618002004246.
Collapse
Affiliation(s)
- Megan L. Gow
- The University of Sydney Children's Hospital Westmead Clinical School, Westmead, NSW, Australia,Discipline of Paediatrics and Child Health, School of Clinical Medicine, University of New South Wales, Sydney, NSW, Australia,Women's and Children's Health, St George Hospital, Kogarah, NSW, Australia,*Correspondence: Megan L. Gow
| | - Chris Rossiter
- Susan Wakil School of Nursing and Midwifery, The University of Sydney, Sydney, NSW, Australia
| | - Lynne Roberts
- Women's and Children's Health, St George Hospital, Kogarah, NSW, Australia,St George and Sutherland Clinical Campus, School of Clinical Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Maddison J. Henderson
- The University of Sydney Children's Hospital Westmead Clinical School, Westmead, NSW, Australia
| | - Lin Yang
- Women's and Children's Health, St George Hospital, Kogarah, NSW, Australia,Office of Medical Education, University of New South Wales, Sydney, NSW, Australia
| | - Judith Roche
- Royal Hospital for Women, Randwick, NSW, Australia
| | - Erin Hayes
- Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Alison Canty
- Women's Health Initiative Translational Unit, South Western Sydney Local Health District, Liverpool, NSW, Australia
| | - Elizabeth Denney-Wilson
- Susan Wakil School of Nursing and Midwifery, The University of Sydney, Sydney, NSW, Australia,Sydney Local Health District, Sydney, NSW, Australia
| | - Amanda Henry
- Women's and Children's Health, St George Hospital, Kogarah, NSW, Australia,Discipline of Women's Health, School of Clinical Medicine, University of New South Wales, Sydney, NSW, Australia
| |
Collapse
|
4
|
Scott H, Whitelaw A, Canty A, Lovato N, Lack L. 1192 The Accuracy of a Novel Sleep Ring Device for Estimating Sleep Onset with Good and Poor Sleepers. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.1186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
THIM is a new ring-like sleep device that, if found to accurately measure sleep onset, could be used for a variety of clinical purposes. These include administering a brief but effective treatment for insomnia called Intensive Sleep Retraining, facilitating the optimal 10-minute power nap, and administering Multiple Sleep Latency Tests (MSLTs) outside of the sleep laboratory. This study assessed the accuracy of THIM for measuring sleep onset latency compared to polysomnography (PSG).
Methods
Twenty healthy individuals aged 23.6 years (SD = 4.89) underwent overnight PSG recording whilst using THIM on two nights in the sleep laboratory, one week apart. On each night, participants completed sleep onset trials for four hours whilst monitored via PSG. In these trials, participants attempted to fall asleep whilst responding to vibrations emitted from THIM. Once they failed to respond to two consecutive stimuli, THIM woke them with an intense vibration. Participants had a short break before attempting the next trial.
Results
On average, THIM overestimated sleep onset on the first night by 0.24 minutes (SD = 0.90). On the second night, THIM overestimated sleep onset by 0.82 minutes (SD = 1.31) and this discrepancy was not significantly different to that obtained on the first night, p = .08. The accuracy of THIM did not differ between good sleepers (Insomnia Severity Index (ISI) score < 7) or poor sleepers (ISI score 8-15), p = .98.
Conclusion
The findings suggest that THIM is accurate at estimating sleep onset latency for both good and poor sleepers. The next step is to test THIM outside of the laboratory environment. The goal is to develop an accurate yet practical device that can translate laboratory-based procedures to the home environment, to the benefit of patients and clinicians wanting to improve sleep.
Support
The project was funded in-part by the manufacturers of THIM, Re-Time Pty. Ltd., with additional funding provided by Flinders University.
Collapse
Affiliation(s)
- H Scott
- Flinders University, Adelaide, AUSTRALIA
| | - A Whitelaw
- Flinders University, Adelaide, AUSTRALIA
| | - A Canty
- Flinders University, Adelaide, AUSTRALIA
| | - N Lovato
- Flinders University, Adelaide, AUSTRALIA
| | - L Lack
- Flinders University, Adelaide, AUSTRALIA
| |
Collapse
|
5
|
Robinson A, Vickers J, Goldberg L, Canty A, McInerney F. THE SUCCESSFUL AND INNOVATIVE UNDERSTANDING DEMENTIA MASSIVE OPEN ONLINE COURSE (UD MOOC). Innov Aging 2017. [DOI: 10.1093/geroni/igx004.3666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- A.L. Robinson
- Wicking Dementia Research and Education Centre, University of Tasmania, Hobart, Tasmania, Australia
| | - J. Vickers
- Wicking Dementia Research and Education Centre, University of Tasmania, Hobart, Tasmania, Australia
| | - L. Goldberg
- Wicking Dementia Research and Education Centre, University of Tasmania, Hobart, Tasmania, Australia
| | - A. Canty
- Wicking Dementia Research and Education Centre, University of Tasmania, Hobart, Tasmania, Australia
| | - F. McInerney
- Wicking Dementia Research and Education Centre, University of Tasmania, Hobart, Tasmania, Australia
| |
Collapse
|
6
|
Goldberg L, Canty A, King A, Price A, Carr A, Ziebell J, Westbury J, Elliott K. CAN MATURE-AGE NONTRADITIONAL STUDENTS SUCCEED IN AN ONLINE BACHELOR OF DEMENTIA CARE PROGRAM? Innov Aging 2017. [DOI: 10.1093/geroni/igx004.1399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- L. Goldberg
- Wicking Dementia Research and Education Centre, University of Tasmania, Hobart, Tasmania, Australia
| | - A. Canty
- Wicking Dementia Research and Education Centre, University of Tasmania, Hobart, Tasmania, Australia
| | - A. King
- Wicking Dementia Research and Education Centre, University of Tasmania, Hobart, Tasmania, Australia
| | - A. Price
- Wicking Dementia Research and Education Centre, University of Tasmania, Hobart, Tasmania, Australia
| | - A. Carr
- Wicking Dementia Research and Education Centre, University of Tasmania, Hobart, Tasmania, Australia
| | - J. Ziebell
- Wicking Dementia Research and Education Centre, University of Tasmania, Hobart, Tasmania, Australia
| | - J. Westbury
- Wicking Dementia Research and Education Centre, University of Tasmania, Hobart, Tasmania, Australia
| | - K. Elliott
- Wicking Dementia Research and Education Centre, University of Tasmania, Hobart, Tasmania, Australia
| |
Collapse
|
7
|
King A, Canty A. Axon pathology and repair. J Chem Neuroanat 2016; 76:1. [PMID: 27589929 DOI: 10.1016/j.jchemneu.2016.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Anna King
- Wicking Dementia Research and Education Centre, University of Tasmania, Australia
| | - Alison Canty
- Wicking Dementia Research and Education Centre, University of Tasmania, Australia
| |
Collapse
|
8
|
Tang A, Bennett B, Puri R, Garry M, Hinder M, Summers J, Rodger J, Canty A. Investigating the mechanisms of repetitive transcranial magnetic stimulation using motor learning paradigms and in vivo 2 photon imaging. Brain Stimul 2015. [DOI: 10.1016/j.brs.2015.01.126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
|
9
|
Tang A, Garrett A, Woodward R, Bennett B, Hadrill C, Canty A, Garry M, Hinder M, Gersner R, Rotenberg A, Summers J, Thickbroom G, Rodger J. Construction and evaluation of rodent-specific TMS coils. Brain Stimul 2015. [DOI: 10.1016/j.brs.2015.01.093] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
|
10
|
Berghuis P, Rajnicek AM, Morozov YM, Ross RA, Mulder J, Urbán GM, Monory K, Marsicano G, Matteoli M, Canty A, Irving AJ, Katona I, Yanagawa Y, Rakic P, Lutz B, Mackie K, Harkany T. Hardwiring the brain: endocannabinoids shape neuronal connectivity. Science 2007; 316:1212-6. [PMID: 17525344 DOI: 10.1126/science.1137406] [Citation(s) in RCA: 378] [Impact Index Per Article: 22.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
The roles of endocannabinoid signaling during central nervous system development are unknown. We report that CB(1) cannabinoid receptors (CB(1)Rs) are enriched in the axonal growth cones of gamma-aminobutyric acid-containing (GABAergic) interneurons in the rodent cortex during late gestation. Endocannabinoids trigger CB(1)R internalization and elimination from filopodia and induce chemorepulsion and collapse of axonal growth cones of these GABAergic interneurons by activating RhoA. Similarly, endocannabinoids diminish the galvanotropism of Xenopus laevis spinal neurons. These findings, together with the impaired target selection of cortical GABAergic interneurons lacking CB(1)Rs, identify endocannabinoids as axon guidance cues and demonstrate that endocannabinoid signaling regulates synaptogenesis and target selection in vivo.
Collapse
Affiliation(s)
- Paul Berghuis
- Division of Molecular Neurobiology, Department of Medical Biochemistry and Biophysics, Karolinska Institutet, S-17177 Stockholm, Sweden
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
11
|
Haylock DN, Canty A, Thorp D, Dyson PG, Juttner CA, To LB. A discrepancy between the instantaneous and the overall collection efficiency of the fenwal CS3000 for peripheral blood stem cell apheresis. J Clin Apher 1992; 7:6-11. [PMID: 1350588 DOI: 10.1002/jca.2920070104] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The collection efficiency (CE) of the Fenwall CS3000 continuous flow blood cell separator in the apheresis of peripheral blood stem cells during haemopoietic recovery following myelosuppressive chemotherapy was analysed. Ninety-three apheresis were performed in 19 patients using procedure 3 on the Fenwal CS3000. The overall CE was calculated from the pre-apheresis cell counts and the stated blood volume processed. Instantaneous CE was calculated from cell counts in the inlet and return lines. The overall mononuclear cell and granulocyte-macrophage colony forming unit CE were 64.0% and 55.8%, respectively, significantly lower than the instantaneous CEs of 94.5% and 95.4%, respectively (P = 0.0001, t test, for both comparisons). Three factors unrelated to machine performance contributed to the lower overall CE despite a high instantaneous CE: (1) A fall in the patient's mononuclear cell counts during apheresis leading to an overestimation of the cells available for collection, (2) dilution of blood by anti-coagulant, and (3) the operational dead space of the Fenwal CS3000. The overall CE corrected for these 3 factors approximated the instantaneous CE closely. Thus there is little room for further enhancement of machine performance because the Fenwal CS3000 is already operating with a very high instantaneous CE. To achieve major improvement in the yield of peripheral blood stem cell harvests, more effective mobilization protocols and better timing of apheresis are required.
Collapse
Affiliation(s)
- D N Haylock
- Leukaemia Research Unit, Institute of Medical and Veterinary Science, Adelaide, Australia
| | | | | | | | | | | |
Collapse
|
12
|
Abstract
One hundred and sixty-three Australian Aboriginals, who were aged from four months to 60 years, were examined clinically and otologically. Audiometric tests were completed on 110 of these subjects. On the assumptions that the aural health of these people has remained stable for many years, the cross-sectional data which were obtained have been used to infer the natural history of ear disease. Seromucinous otitis media is manifest as a disease of early childhood, which recovers spontaneously in most cases and has no obvious sequelae. Perforated tympanic membranes likewise seem to heal spontaneously in the majority of cases. The evidence suggests that hearing loss is the main problem and treatment should be directed towards the level of hearing loss and its effects.
Collapse
|
13
|
Abstract
We introduce the concept of open-ended, successive-day, tympanometric screening. In impedance screening of children for middle ear disorders, there is a serious risk of over-referral if decisions are made on the basis of a single tympanogram. Serial tympanometric studies of Australian aboriginal children show that, whereas the type B tympanogram is usually stable, type A and type C patterns are prone to vary from day to day, inviting inappropriate referral decisions unless the classifications are confirmed by tests on successive days.
Collapse
|