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Chou R, Tran D, Descallar J, Jalaludin B, Soon PS. Outcomes of atypical (B3) core biopsy lesions diagnosed across BreastScreen NSW, Australia. Breast 2024; 75:103720. [PMID: 38564975 PMCID: PMC10993176 DOI: 10.1016/j.breast.2024.103720] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Revised: 03/15/2024] [Accepted: 03/23/2024] [Indexed: 04/04/2024] Open
Abstract
INTRODUCTION Atypical or B3 lesions comprise a heterogeneous group of uncertain malignant potential. B3 lesions diagnosed on core biopsy are usually recommended for diagnostic open biopsy. Identifying factors which could allow conservative management of B3 lesions would be helpful in avoiding unnecessary surgery. The aim of this study was to identify the upgrade rate to malignancy for B3 core biopsy lesions and to compare characteristics of lesions which were malignant and benign at excision. METHOD This retrospective study used data from BreastScreen New South Wales (NSW), Australia, of women who were diagnosed with B3 lesions on needle biopsy from 2011 to 2019. RESULTS During the study period, 1927 B3 lesions were included. The upgrade rate to malignancy was 26.4%. Of the malignant lesions on excision, 29.6% were invasive and 69.2% were in situ. The rates of upgrade to invasive cancer and DCIS varied substantially with the core biopsy lesion type. Lesions with atypia on core biopsy had significantly higher upgrade rates to malignancy at 34.7% compared to 13.6% for lesions without atypia (p < 0.0001). Lesions with malignant pathology were significantly larger than those with benign pathology (difference = 5.1 mm (95% CI 2.7-7.5 mm), p < 0.001). CONCLUSIONS The overall upgrade rate of B3 lesions to malignancy was 26.4%. The majority of the lesions were upgraded to DCIS instead of invasive cancer. Upgrade rates varied by lesion type. Lesions with atypia had significantly higher upgrade rates to cancer compared to lesions without atypia. Malignant lesions were significantly larger than benign lesions.
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Affiliation(s)
- Richard Chou
- Department of Surgery, Bankstown Hospital, Bankstown, NSW, Australia; South Western Sydney Clinical School, University of New South Wales, Liverpool, NSW, Australia
| | - Diana Tran
- BreastScreen South Western Sydney Local Health District, Liverpool, NSW, Australia; Department of Radiology, Bankstown Hospital, Bankstown, NSW, Australia
| | - Joseph Descallar
- South Western Sydney Clinical School, University of New South Wales, Liverpool, NSW, Australia; Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia
| | - Bin Jalaludin
- Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia; School of Population Health, University of New South Wales, NSW, Australia
| | - Patsy S Soon
- Department of Surgery, Bankstown Hospital, Bankstown, NSW, Australia; South Western Sydney Clinical School, University of New South Wales, Liverpool, NSW, Australia; BreastScreen South Western Sydney Local Health District, Liverpool, NSW, Australia; Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia.
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Christie LJ, Rendell R, Fearn N, Descallar J, McCluskey A, Pearce A, Wong L, Lovarini M. Increasing the delivery of upper limb constraint-induced movement therapy programs for stroke and brain injury survivors: evaluation of the ACTIveARM project. Disabil Rehabil 2023:1-13. [PMID: 38131331 DOI: 10.1080/09638288.2023.2290687] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 11/28/2023] [Indexed: 12/23/2023]
Abstract
PURPOSE To increase the number of constraint-induced movement therapy (CIMT) programs provided by rehabilitation services. METHODS A before-and-after implementation study involving nine rehabilitation services. The implementation package to help change practice included file audit-feedback cycles, 2-day workshops, poster reminders, a community-of-practice and drop-in support. File audits were conducted at baseline, every three months for 1.5 years, and once after support ceased to evaluate maintenance of change. CIMT participant outcomes were collected to evaluate CIMT effectiveness and maintenance (Action Research Arm Test and Motor Activity Log). Staff focus groups explored factors influencing CIMT delivery. RESULTS CIMT adoption improved from baseline where only 2% of eligible people were offered and/or received CIMT (n = 408 files) to more than 50% over 1.5 years post-implementation (n = 792 files, 52% to 73% offered CIMT, 27%-46% received CIMT). Changes were maintained at 6-month follow-up (n = 172 files, 56% offered CIMT, 40% received CIMT). CIMT participants (n = 74) demonstrated clinically significant improvements in arm function and occupational performance. Factors influencing adoption included interdisciplinary collaboration, patient support needs, intervention adaptations, a need for continued training, and clinician support. CONCLUSIONS The implementation package helped therapists overcome an evidence-practice gap and deliver CIMT more routinely.
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Affiliation(s)
- Lauren J Christie
- Brain Injury Rehabilitation Research Group, Ingham Institute for Applied Medical Research, Sydney, Australia
- Discipline of Occupational Therapy, Faculty of Medicine and Health, Sydney School of Health Sciences, The University of Sydney, Sydney, Australia
- Allied Health Research Unit, St Vincent's Health Network Sydney, Sydney, Australia
| | - Reem Rendell
- Brain Injury Rehabilitation Research Group, Ingham Institute for Applied Medical Research, Sydney, Australia
- School of Health Sciences, Western Sydney University, Campbelltown, Australia
- Discipline of Physiotherapy, Faculty of Medicine and Health, Sydney School of Health Sciences, The University of Sydney, Sydney, Australia
| | - Nicola Fearn
- Allied Health Research Unit, St Vincent's Health Network Sydney, Sydney, Australia
| | - Joseph Descallar
- Ingham Institute for Applied Medical Research, Sydney, Australia
- South Western Sydney Clinical School, UNSW Sydney, Sydney, Australia
| | - Annie McCluskey
- Discipline of Occupational Therapy, Faculty of Medicine and Health, Sydney School of Health Sciences, The University of Sydney, Sydney, Australia
- The StrokeEd Collaboration, Sydney, Australia
| | - Alison Pearce
- Faculty of Medicine and Health, Sydney School of Public Health, The University of Sydney, Sydney, Australia
- The Daffodil Centre, a Joint Venture with Cancer Council NSW, The University of Sydney, Sydney, Australia
| | | | - Meryl Lovarini
- Discipline of Occupational Therapy, Faculty of Medicine and Health, Sydney School of Health Sciences, The University of Sydney, Sydney, Australia
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Wu VS, Sabud T, Smith A‘B, Lambert SD, Descallar J, Lebel S, Bamgboje-Ayodele A. The Evaluation of the Suitability, Quality, and Readability of Publicly Available Online Resources for the Self-Management of Fear of Cancer Recurrence. Curr Oncol 2023; 31:66-83. [PMID: 38248090 PMCID: PMC10814354 DOI: 10.3390/curroncol31010005] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 12/12/2023] [Accepted: 12/20/2023] [Indexed: 01/23/2024] Open
Abstract
Cancer survivors often rely on the internet for health information, which has varying levels of readability, suitability, and quality. There is a need for high-quality online self-management resources for cancer survivors with fear of cancer recurrence (FCR). This study evaluated the readability, suitability, and quality of publicly available online FCR self-management resources. A Google search using FCR-related keywords identified freely available FCR self-management resources for cancer survivors in English. Resource readability (reading grade level), suitability, and quality were evaluated using relevant assessment tools. Descriptive statistics and cluster analysis identified resources with higher suitability and quality scores. Mean resource (n = 23) readability score was grade 11 (SD = 1.6, Range = 9-14). The mean suitability score was 56.0% (SD = 11.4%, Range = 31.0-76.3%), indicating average suitability and the mean quality score was 53% (SD = 11.7%, Range = 27-80%), indicating fair quality. A cluster of 15 (65%) resources with higher suitability and quality scores was identified. There were no significant associations between suitability or quality scores and the type of organisation that published the resources. Online FCR self-management resources varied in readability, suitability and quality. Resources with higher quality and suitability scores relative to other resources are identified for use by healthcare professionals and cancer survivors. Resources that are more culturally appropriate, with lower reading grade levels and detailed self-management strategies are needed.
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Affiliation(s)
- Verena Shuwen Wu
- Faculty of Medicine and Health, South West Sydney Clinical Campuses, University of New South Wales (UNSW Sydney), Liverpool, NSW 2170, Australia
- Ingham Institute for Applied Medical Research, Liverpool, NSW 2170, Australia
| | - Tiyasha Sabud
- Faculty of Medicine and Health, South West Sydney Clinical Campuses, University of New South Wales (UNSW Sydney), Liverpool, NSW 2170, Australia
- Ingham Institute for Applied Medical Research, Liverpool, NSW 2170, Australia
| | - Allan ‘Ben’ Smith
- Faculty of Medicine and Health, South West Sydney Clinical Campuses, University of New South Wales (UNSW Sydney), Liverpool, NSW 2170, Australia
- Ingham Institute for Applied Medical Research, Liverpool, NSW 2170, Australia
- The Daffodil Centre, The University of Sydney, A Joint Venture with Cancer Council NSW, Sydney, NSW 2006, Australia
| | - Sylvie D. Lambert
- Ingram School of Nursing, McGill University, Montreal, QC H3A 2M7, Canada;
- St. Mary’s Research Centre, Montreal, QC H3T 1M5, Canada
| | - Joseph Descallar
- Faculty of Medicine and Health, South West Sydney Clinical Campuses, University of New South Wales (UNSW Sydney), Liverpool, NSW 2170, Australia
- Ingham Institute for Applied Medical Research, Liverpool, NSW 2170, Australia
| | - Sophie Lebel
- School of Psychology, University of Ottawa, Ottawa, ON K1N 6N5, Canada
| | - Adeola Bamgboje-Ayodele
- Faculty of Medicine and Health, South West Sydney Clinical Campuses, University of New South Wales (UNSW Sydney), Liverpool, NSW 2170, Australia
- Ingham Institute for Applied Medical Research, Liverpool, NSW 2170, Australia
- Biomedical Informatics and Digital Health, School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia
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Habashy P, Lea V, Wilkinson K, Wang B, Wu XJ, Roberts TL, Ng W, Rutland T, Po JW, Becker T, Descallar J, Lee M, Mackenzie S, Gupta R, Cooper W, Lim S, Chua W, Lee CS. KRAS and BRAF Mutation Rates and Survival Outcomes in Colorectal Cancer in an Ethnically Diverse Patient Cohort. Int J Mol Sci 2023; 24:17509. [PMID: 38139338 PMCID: PMC10743527 DOI: 10.3390/ijms242417509] [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: 11/18/2023] [Revised: 12/13/2023] [Accepted: 12/14/2023] [Indexed: 12/24/2023] Open
Abstract
KRAS and BRAF mutation rates in colorectal cancer (CRC) reported from various mono-ethnic studies vary amongst different ethnic groups. However, these differences in mutation rates may not be statistically significant or may be due to differences in environmental and/or laboratory factors across countries rather than racial genetic differences. Here, we compare the KRAS/BRAF mutation rates and survival outcomes in CRC between ethnic groups at a single institution. We also investigate the contributions of genetic, environmental, and laboratory factors to the variations in KRAS/BRAF mutation rates reported from different countries. Clinicopathological data from 453 ethnically diverse patients with CRC were retrospectively analyzed at Liverpool Hospital, NSW Australia (2014-2016). KRAS/BRAF mutations were detected using real-time PCR (Therascreen kits from Qiagen). Mismatch repair (MMR) status was determined using immunohistochemical staining. Four ethnic groups were analyzed: Caucasian, Middle Eastern, Asian, and South American. Overall survival data were available for 406 patients. There was no significant difference in KRAS mutation rates between Caucasians (41.1%), Middle Easterners (47.9%), Asians (44.8%), and South Americans (25%) (p = 0.34). BRAF mutation rates differed significantly between races (p = 0.025), with Caucasians having the highest rates (13.5%) and Middle Easterners the lowest (0%). A secondary analysis in which Caucasians were divided into three subgroups showed that ethnic grouping correlated significantly with KRAS mutation rate (p = 0.009), with central and eastern Europeans having the highest rates (58.3%). There were no significant differences in overall survival (OS) or disease-free survival (DFS) between the four races. The similarity in KRAS mutation rates across races raises the possibility that the differences in KRAS mutation rates reported from various countries may either not be statistically significant or may be due to environmental and/or laboratory factors rather than underlying racial genetic differences. In contrast, we verified that BRAF mutation rates differ significantly between races, suggesting racial genetic differences may be responsible for the discrepant BRAF mutation rates reported from different countries.
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Affiliation(s)
- Paul Habashy
- Discipline of Pathology, School of Medicine, Western Sydney University, Sydney, NSW 2560, Australia; (P.H.); (T.R.)
- Liverpool Clinical School, Western Sydney University, Sydney, NSW 2170, Australia; (T.L.R.); (T.B.)
| | - Vivienne Lea
- Discipline of Pathology, School of Medicine, Western Sydney University, Sydney, NSW 2560, Australia; (P.H.); (T.R.)
- Department of Anatomical Pathology, Liverpool Hospital, Sydney, NSW 2170, Australia
| | - Kate Wilkinson
- Department of Medical Oncology, Liverpool Hospital, Sydney, NSW 2170, Australia
| | - Bin Wang
- Discipline of Pathology, School of Medicine, Western Sydney University, Sydney, NSW 2560, Australia; (P.H.); (T.R.)
- Ingham Institute for Applied Medical Research, Liverpool Hospital, Sydney, NSW 2170, Australia
| | - Xiao-Juan Wu
- Department of Anatomical Pathology, Liverpool Hospital, Sydney, NSW 2170, Australia
| | - Tara Laurine Roberts
- Liverpool Clinical School, Western Sydney University, Sydney, NSW 2170, Australia; (T.L.R.); (T.B.)
- Ingham Institute for Applied Medical Research, Liverpool Hospital, Sydney, NSW 2170, Australia
- South Western Sydney Clinical School, University of New South Wales, Sydney, NSW 2170, Australia
| | - Weng Ng
- Liverpool Clinical School, Western Sydney University, Sydney, NSW 2170, Australia; (T.L.R.); (T.B.)
- Department of Medical Oncology, Liverpool Hospital, Sydney, NSW 2170, Australia
- Ingham Institute for Applied Medical Research, Liverpool Hospital, Sydney, NSW 2170, Australia
- South Western Sydney Clinical School, University of New South Wales, Sydney, NSW 2170, Australia
| | - Tristan Rutland
- Discipline of Pathology, School of Medicine, Western Sydney University, Sydney, NSW 2560, Australia; (P.H.); (T.R.)
- Liverpool Clinical School, Western Sydney University, Sydney, NSW 2170, Australia; (T.L.R.); (T.B.)
- Department of Anatomical Pathology, Liverpool Hospital, Sydney, NSW 2170, Australia
| | - Joseph William Po
- Ingham Institute for Applied Medical Research, Liverpool Hospital, Sydney, NSW 2170, Australia
- Surgical Innovations Unit, Department of Surgery, Westmead Hospital, Sydney, NSW 2140, Australia
| | - Therese Becker
- Liverpool Clinical School, Western Sydney University, Sydney, NSW 2170, Australia; (T.L.R.); (T.B.)
- Ingham Institute for Applied Medical Research, Liverpool Hospital, Sydney, NSW 2170, Australia
- South Western Sydney Clinical School, University of New South Wales, Sydney, NSW 2170, Australia
| | - Joseph Descallar
- Ingham Institute for Applied Medical Research, Liverpool Hospital, Sydney, NSW 2170, Australia
- South Western Sydney Clinical School, University of New South Wales, Sydney, NSW 2170, Australia
| | - Mark Lee
- Department of Radiation Oncology, Liverpool Hospital, Sydney, NSW 2170, Australia
| | - Scott Mackenzie
- Liverpool Clinical School, Western Sydney University, Sydney, NSW 2170, Australia; (T.L.R.); (T.B.)
- Department of Surgery, Liverpool Hospital, Sydney, NSW 2170, Australia
| | - Ruta Gupta
- Department of Tissue Pathology and Diagnostic Oncology, NSW Health Pathology, Royal Prince Alfred Hospital, Sydney, NSW 2050, Australia
| | - Wendy Cooper
- Discipline of Pathology, School of Medicine, Western Sydney University, Sydney, NSW 2560, Australia; (P.H.); (T.R.)
- Department of Tissue Pathology and Diagnostic Oncology, NSW Health Pathology, Royal Prince Alfred Hospital, Sydney, NSW 2050, Australia
- Sydney Medical School, University of Sydney, Sydney, NSW 2050, Australia
| | - Stephanie Lim
- Liverpool Clinical School, Western Sydney University, Sydney, NSW 2170, Australia; (T.L.R.); (T.B.)
- Ingham Institute for Applied Medical Research, Liverpool Hospital, Sydney, NSW 2170, Australia
- Department of Medical Oncology, Campbelltown Hospital, Sydney, NSW 2560, Australia
| | - Wei Chua
- Liverpool Clinical School, Western Sydney University, Sydney, NSW 2170, Australia; (T.L.R.); (T.B.)
- Department of Medical Oncology, Liverpool Hospital, Sydney, NSW 2170, Australia
- Ingham Institute for Applied Medical Research, Liverpool Hospital, Sydney, NSW 2170, Australia
| | - Cheok Soon Lee
- Discipline of Pathology, School of Medicine, Western Sydney University, Sydney, NSW 2560, Australia; (P.H.); (T.R.)
- Liverpool Clinical School, Western Sydney University, Sydney, NSW 2170, Australia; (T.L.R.); (T.B.)
- Department of Anatomical Pathology, Liverpool Hospital, Sydney, NSW 2170, Australia
- Ingham Institute for Applied Medical Research, Liverpool Hospital, Sydney, NSW 2170, Australia
- South Western Sydney Clinical School, University of New South Wales, Sydney, NSW 2170, Australia
- Department of Tissue Pathology and Diagnostic Oncology, NSW Health Pathology, Royal Prince Alfred Hospital, Sydney, NSW 2050, Australia
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Naylor JM, Bhandari P, Descallar J, Yang OO, Rider M, Mayland EC, Tang C, Brady B, Lim D, Santalucia Y, Gabbe BJ, Hassett G, Baker E. Comparison of short-term outcomes between people with and without a pre-morbid mental health diagnosis following surgery for traumatic hand injury: a prospective longitudinal study of a multicultural cohort. BMC Musculoskelet Disord 2023; 24:805. [PMID: 37821871 PMCID: PMC10568865 DOI: 10.1186/s12891-023-06931-8] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 09/29/2023] [Indexed: 10/13/2023] Open
Abstract
BACKGROUND Following traumatic hand injury, few studies have compared outcomes between people with and without a pre-morbid mental health diagnosis. This study aimed to compare sub-acute outcomes in a multicultural patient cohort with surgically managed traumatic hand injury with and without a pre-morbid mental health diagnosis. METHODS A prospective, observational cohort study of people with traumatic hand injury presenting pre- surgically to a high-volume hand injury centre in a region of cultural and language diversity was conducted. Participants were assessed face-to-face (baseline) then via telephone (3-months post-surgery) and categorized according to a pre-morbid medically diagnosed mental health diagnosis. Baseline and follow-up assessments included global mental health, and the EuroQol (EQ) 'Health Today' analogue scale (0-100) and health domains. Return-to-work status, complications/symptomatic complaints, and hand function (QuickDASH) were also collected at follow-up. Adjusted analyses-accounting for covariates including cultural identity-were conducted to determine whether 3-month outcomes were associated with a pre-morbid mental health diagnosis. RESULTS From 405 eligible patients, 386 were enrolled (76% male, mean age 38.9 (standard deviation 15.6)); 57% self-identified as Australian and 22% had a pre-morbid mental health diagnosis. Common injuries regardless of pre-morbid mental health diagnosis were skin (40%), tendon (17%) and bone (17%) injuries. None were complex mutilating injuries. Seventy-eight per cent of the cohort was followed-up. In adjusted analyses, a pre-morbid mental health diagnosis was associated with lower odds for reporting 'good or better' global mental health (Odds Ratio (OR) 0.23 (95% Confidence Interval (CI) 0.18, 0.47), p < 0.001), 'no' anxiety or depression (OR 0.21 (0.11, 0.40), p < 0.001) and no pain (OR 0.56 (0.31, 0.98), p = 0.04)(EQ domains), and worse EQ 'Health Today' (10 points on average (95%CI -14.9, -5.1, p < 0.001). QuickDASH scores, rates of complications/symptomatic complaints and return-to-work profiles were similar. CONCLUSIONS Despite reporting worse mental and health-related quality-of-life outcomes post-surgery, people with a pre-morbid mental health diagnosis regardless of cultural identity experienced similar clinical and return-to-work outcomes. Future research assessing the value of screening for pre-morbid mental health conditions on post-surgical outcomes is required and should include people with more complex hand injuries.
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Affiliation(s)
- Justine M Naylor
- Orthopaedic Department, Liverpool Hospital, Locked Bag 7103, Liverpool BC, NSW, 1871, Australia.
- Ingham Institute of Applied Medical Research, 1 Campbell St, Liverpool, NSW, 2170, Australia.
| | - Pratibha Bhandari
- South Western Sydney Hand Centre at Fairfield Hospital, Cnr Polding St. & Prairievale Road, Prairiewood, NSW, 2176, Australia
| | - Joseph Descallar
- Ingham Institute of Applied Medical Research, 1 Campbell St, Liverpool, NSW, 2170, Australia
| | - Owen Ou Yang
- South Western Sydney Hand Centre at Fairfield Hospital, Cnr Polding St. & Prairievale Road, Prairiewood, NSW, 2176, Australia
| | - Mark Rider
- South Western Sydney Hand Centre at Fairfield Hospital, Cnr Polding St. & Prairievale Road, Prairiewood, NSW, 2176, Australia
| | - Elizabeth C Mayland
- School of Health Sciences, Western Sydney University, Locked Bag 1797, Penrith, NSW, 2751, Australia
| | - Clarice Tang
- School of Health Sciences, Western Sydney University, Locked Bag 1797, Penrith, NSW, 2751, Australia
| | - Bernadette Brady
- Department of Pain Medicine, Liverpool Hospital, Locked Bag 7103, Liverpool BC, NSW, 1871, Australia
| | - David Lim
- School of Health Sciences, Western Sydney University, Locked Bag 1797, Penrith, NSW, 2751, Australia
| | - Yvonne Santalucia
- Multicultural Health Service, South West Sydney Local Health District, Locked Bag 7103, Liverpool BC, NSW, 1871, Australia
| | - Belinda J Gabbe
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne, Victoria, 3004, Australia
| | - Geraldine Hassett
- Rheumatology, Liverpool Hospital, Locked Bag 7103, Liverpool BC, NSW, 1871, Australia
- South Western Sydney Clinical School, Faculty of Medicine, UNSW, Liverpool, BC 1871, NSW, Australia
| | - Elise Baker
- Ingham Institute of Applied Medical Research, 1 Campbell St, Liverpool, NSW, 2170, Australia
- School of Health Sciences, Western Sydney University, Locked Bag 1797, Penrith, NSW, 2751, Australia
- South Western Sydney Local Health District, Liverpool, Locked Bag 7279, Liverpool BC, 1871, Australia
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Islam ST, Descallar J, Martens D, Hassett G, Gibson KA. Screening for Anxiety in Patients With Inflammatory Arthritis Using the Multidimensional Health Assessment Questionnaire. J Rheumatol 2023; 50:1273-1278. [PMID: 37399467 DOI: 10.3899/jrheum.2022-1261] [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] [Accepted: 06/06/2023] [Indexed: 07/05/2023]
Abstract
OBJECTIVE To analyze the Multidimensional Health Assessment Questionnaire (MDHAQ) in screening for anxiety in patients with rheumatoid arthritis (RA) and psoriatic arthritis (PsA), compared to the Hospital Anxiety and Depression Scale (HADS) as the reference standard. METHODS Patients with a physician diagnosis of RA or PsA were invited to complete the MDHAQ and HADS at their routine rheumatology clinic visit. Sensitivity, specificity, percent agreement, and [Formula: see text] statistics were used to evaluate agreement between 2 MDHAQ items for anxiety and HADS subscale for Anxiety (HADS-A) score of ≥ 8. The first item is a question asked on a 4-point scale (0-3.3), and the second is a yes or no (blank) question asked within a 60-item review of symptoms (ROS) checklist. RESULTS The study included 183 participants, of whom 126 (68.9%) had RA and 57 (31.1%) had PsA. The mean age was 57.3 years and 66.7% were female. Positive screening for anxiety according to a HADS-A score of ≥ 8 was seen in 39.3% of patients. Compared to those with a HADS-A score of ≥ 8, patients with an MDHAQ score of ≥ 2.2 or a positive on ROS had a sensitivity of 69.9%, specificity of 73.6% and substantial agreement (agreement 80.9%, [Formula: see text] 0.59). CONCLUSION The MDHAQ provides information similar to the HADS in screening for anxiety in patients with RA and PsA. The use of this single questionnaire, which can also be used to monitor clinical status and to screen for fibromyalgia and depression without requiring multiple questionnaires, may prove a valuable tool in routine clinical practice.
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Affiliation(s)
- Sadia Tasnim Islam
- S.T. Islam, MD, Department of Rheumatology, Liverpool Hospital, Liverpool;
| | - Joseph Descallar
- J. Descallar, MBiostat, Ingham Institute for Applied Medical Research, Liverpool, and South West Sydney Clinical Campuses, School of Clinical Medicine, University of New South Wales (UNSW Sydney), Liverpool
| | - David Martens
- D. Martens, MBBS, Department of Rheumatology, Liverpool Hospital, Liverpool, and South West Sydney Clinical Campuses, School of Clinical Medicine, UNSW Sydney, Liverpool
| | - Geraldine Hassett
- G. Hassett, PhD, K.A. Gibson, PhD, Department of Rheumatology, Liverpool Hospital, Liverpool, Ingham Institute for Applied Medical Research, Liverpool, and South West Sydney Clinical Campuses, School of Clinical Medicine, UNSW Sydney, Liverpool, Australia
| | - Kathryn Alleyne Gibson
- G. Hassett, PhD, K.A. Gibson, PhD, Department of Rheumatology, Liverpool Hospital, Liverpool, Ingham Institute for Applied Medical Research, Liverpool, and South West Sydney Clinical Campuses, School of Clinical Medicine, UNSW Sydney, Liverpool, Australia
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Rodwell N, Hassett G, Bird P, Pincus T, Descallar J, Gibson KA. RheuMetric Quantitative 0 to 10 Physician Estimates of Inflammation, Damage, and Distress in Rheumatoid Arthritis: Validation Against Reference Measures. ACR Open Rheumatol 2023; 5:511-521. [PMID: 37608509 PMCID: PMC10570671 DOI: 10.1002/acr2.11574] [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] [Received: 12/06/2022] [Revised: 04/23/2023] [Accepted: 04/26/2023] [Indexed: 08/24/2023] Open
Abstract
OBJECTIVE To analyze a RheuMetric checklist, which includes four feasible physician 0 to 10 scores for DOCGL, inflammation (DOCINF), damage (DOCDAM), and distress (DOCSTR) for criterion and discriminant validity against standard reference measures. METHODS A prospective, cross-sectional assessment was performed at one routine care visit at Liverpool Hospital, Sydney, Australia. Rheumatologists recorded DOCGL, DOCINF, DOCDAM, DOCSTR, and 28 joint counts for swelling (SJC), tenderness (TJC), and limited motion/deformity (DJC). Patients completed a multidimensional health assessment questionnaire (MDHAQ), which includes routine assessment of patient index data (RAPID3), fibromyalgia assessment screening tool (FAST4), and MDHAQ depression screen (MDS2). Laboratory tests and radiographic scores were recorded. RheuMetric estimates of inflammation, damage, and distress were compared with reference and other measures using correlations and linear regressions. RESULTS In 173 patients with RA, variation in RheuMetric DOCINF was explained significantly by SJC and inversely by disease duration; variation in DOCDAM was explained significantly by DJC, radiographic scores, and physical function; and variation in DOCSTR was explained significantly by fibromyalgia and depression. CONCLUSION RheuMetric DOCINF, DOCDAM, and DOCSTR estimates were correlated significantly and specifically with reference measures of inflammation, damage, and distress, documenting criterion and discriminant validity.
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Affiliation(s)
- Nicholas Rodwell
- Liverpool Hospital and Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia, and University of New South WalesMedicine and HealthSydneyNew South WalesAustralia
| | - Geraldine Hassett
- Liverpool Hospital and Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia, and University of New South WalesMedicine and HealthSydneyNew South WalesAustralia
| | - Paul Bird
- University of New South Wales, Medicine and HealthKensingtonSydneyNew South WalesAustralia
| | | | - Joseph Descallar
- Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia, and University of New South WalesMedicine and HealthSydneyNew South WalesAustralia
| | - Kathryn A. Gibson
- Liverpool Hospital and Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia, and University of New South WalesMedicine and HealthSydneyNew South WalesAustralia
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Mills K, Bowden JL, Boland R, Pardey M, Descallar J, Naylor JM. Taking the first step: protocol for a cluster randomised implementation trial comparing strategies on access to exercise programmes for people with knee osteoarthritis. BMJ Open 2023; 13:e071045. [PMID: 37567743 PMCID: PMC10423770 DOI: 10.1136/bmjopen-2022-071045] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 06/29/2023] [Indexed: 08/13/2023] Open
Abstract
INTRODUCTION This cluster randomised implementation trial will assess the effect of two behavioural change interventions on the proportion of people with structural knee osteoarthritis (OA) referred and attending exercise-based professionals (physiotherapists and exercise physiologists). The interventions are designed to increase awareness of guidelines, benefits and access pathways for exercise therapy. We hypothesise either strategy will result in more people with knee OA being referred and attending physiotherapy/exercise physiology than current standard of care. METHODS AND ANALYSIS We will recruit 30 radiology clinics. 10 clinics will be randomly assigned to each trial arm with 1020 people with knee OA consecutively recruited (102 people per practice) into each arm. Intervention arm 1 is an educational reminder message targeted at primary care practitioners with a hyperlink to national guidelines regarding knee OA clinical management. It will be included in the reporting template of a plain knee X-ray. Intervention arm 2 is the reminder message and a patient-facing infographic explaining the benefits and access pathways for exercise. Both interventions will be delivered once, by the radiology clinics, when a person undergoes plain X-ray for non-traumatic knee pain/dysfunction. The primary outcome is referral to physiotherapist/exercise physiology. The secondary outcome is attendance to that appointment. Both outcomes are self-reported via an online survey administered 4 weeks after the X-ray. Additional survey questions explore facilitators and barriers to appointment attendance and acceptability of the interventions. A subsample of the intervention groups will be recruited for semistructured telephone-based interviews to further explore these latter outcomes. ETHICS AND DISSEMINATION The study protocol was approved by Macquarie University Human Research Ethics Committee (#520221190343842) and prospectively registered with the Australian New Zealand Clinical Trials Registry. The findings of the trial will be disseminated through peer-reviewed scientific journals and conferences. We will engage with Australian physician colleges and main-stream media to distribute findings. TRIAL REGISTRATION NUMBER ACTRN12622001414707p.
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Affiliation(s)
- Kathryn Mills
- Department of Health Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Jocelyn L Bowden
- Institute of Bone and Joint Research, The University of Sydney, St Leonards, New South Wales, Australia
| | - Robert Boland
- Discipline of Physiotherapy, The University of Sydney, Camperdown, New South Wales, Australia
| | - Margery Pardey
- Department of Health Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Joseph Descallar
- South Western Sydney Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - Justine M Naylor
- South Western Sydney Clinical School, University of New South Wales, Sydney, New South Wales, Australia
- Whitlam Orthopaedic Research Centre, Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
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9
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Barbaro J, Winata T, Gilbert M, Nair R, Khan F, Lucien A, Islam R, Masi A, Diaz AM, Dissanayake C, Karlov L, Descallar J, Eastwood J, Hasan I, Jalaludin B, Kohlhoff J, Liaw ST, Lingam R, Ong N, Tam CWM, Woolfenden S, Eapen V. General practitioners' perspectives regarding early developmental surveillance for autism within the australian primary healthcare setting: a qualitative study. BMC Prim Care 2023; 24:159. [PMID: 37563549 PMCID: PMC10416397 DOI: 10.1186/s12875-023-02121-6] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 08/01/2023] [Indexed: 08/12/2023]
Abstract
BACKGROUND Significant challenges remain in the early identification of child developmental disabilities in the community. Implementing supports and services early in the life course has been shown to promote positive developmental outcomes for children at high likelihood of developmental disabilities, including autism. As part of a cluster randomised controlled trial, this study seeks to examine and compare the perspectives and experiences of Australian general practitioners (GPs) in relation to a digital developmental surveillance program for autism and usual care pathway, in general practice clinics. METHODS A qualitative research methodology with semi-structured interviews and thematic inductive analysis underpinned by grounded theory was utilised. All GPs from South Western Sydney (NSW) and Melbourne (Victoria) who participated in the main program ("GP Surveillance for Autism") were invited to the interview. GPs who provided consent were interviewed either over online or in-person meeting. Interviews were audio-recorded, transcribed, and coded using NVivo12 software. Inductive interpretive approach was adopted and data were analysed thematically. RESULTS Twenty-three GPs across the two sites (NSW: n = 11; Victoria: n = 12) agreed to be interviewed; data saturation had reached following this number of participants. Inductive thematic coding and analysis yielded eight major themes and highlighted common enablers such as the role of GPs in early identification and subsequent supports, enhanced communication between clinicians/professionals, relationship-building with patients, and having standardised screening tools. Specific facilitators to the feasibility and acceptability of a digital screening program for the early identification of developmental disabilities, including the early signs of autism, and encouraging research and education for GPs. However, several practical and socioeconomic barriers were identified, in addition to limited knowledge and uptake of child developmental screening tools as well as COVID-19 lockdown impacts. Common and specific recommendations involve supporting GPs in developmental/paediatrics training, streamlined screening process, and funding and resources in the primary healthcare services. CONCLUSIONS The study highlighted the need for practice and policy changes, including further training of GPs alongside sufficient time to complete developmental checks and appropriate financial remuneration through a Medicare billing item. Further research is needed on implementation and scale up of a national surveillance program for early identification of developmental disabilities, including autism.
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Affiliation(s)
- Josephine Barbaro
- Olga Tennison Autism Research Centre, School of Psychology and Public Health, La Trobe University, Bundoora, VIC, Australia
- Cooperative Research Centre for Living with Autism (Autism CRC), The University of Queensland, Indooroopilly, QLD, Australia
| | - Teresa Winata
- Discipline of Psychiatry and Mental Health, School of Clinical Medicine, University of New South Wales, Sydney, NSW, Australia
- Academic Unit of Infant, Child and Adolescent Psychiatry, South Western Sydney Local Health District, Sydney, NSW, Australia
- Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia
| | - Melissa Gilbert
- Olga Tennison Autism Research Centre, School of Psychology and Public Health, La Trobe University, Bundoora, VIC, Australia
- Cooperative Research Centre for Living with Autism (Autism CRC), The University of Queensland, Indooroopilly, QLD, Australia
| | - Radhika Nair
- Olga Tennison Autism Research Centre, School of Psychology and Public Health, La Trobe University, Bundoora, VIC, Australia
- Cooperative Research Centre for Living with Autism (Autism CRC), The University of Queensland, Indooroopilly, QLD, Australia
| | - Feroza Khan
- Discipline of Psychiatry and Mental Health, School of Clinical Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Abbie Lucien
- Discipline of Psychiatry and Mental Health, School of Clinical Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Raisa Islam
- Discipline of Psychiatry and Mental Health, School of Clinical Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Anne Masi
- Cooperative Research Centre for Living with Autism (Autism CRC), The University of Queensland, Indooroopilly, QLD, Australia
- Discipline of Psychiatry and Mental Health, School of Clinical Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Antonio Mendoza Diaz
- Discipline of Psychiatry and Mental Health, School of Clinical Medicine, University of New South Wales, Sydney, NSW, Australia
- Academic Unit of Infant, Child and Adolescent Psychiatry, South Western Sydney Local Health District, Sydney, NSW, Australia
- Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia
| | - Cheryl Dissanayake
- Olga Tennison Autism Research Centre, School of Psychology and Public Health, La Trobe University, Bundoora, VIC, Australia
- Cooperative Research Centre for Living with Autism (Autism CRC), The University of Queensland, Indooroopilly, QLD, Australia
| | - Lisa Karlov
- Discipline of Psychiatry and Mental Health, School of Clinical Medicine, University of New South Wales, Sydney, NSW, Australia
- Academic Unit of Infant, Child and Adolescent Psychiatry, South Western Sydney Local Health District, Sydney, NSW, Australia
| | - Joseph Descallar
- Academic Unit of Infant, Child and Adolescent Psychiatry, South Western Sydney Local Health District, Sydney, NSW, Australia
- Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia
| | - John Eastwood
- Faculty of Medicine and Health, School of Medicine, University of Sydney, Sydney, NSW, Australia
- Faculty of Medicine, School of Women and Children's Health, University of New South Wales, Sydney, NSW, Australia
| | - Iqbal Hasan
- Discipline of Psychiatry and Mental Health, School of Clinical Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Bin Jalaludin
- Faculty of Medicine, School of Population Health, University of New South Wales, Sydney, NSW, Australia
| | - Jane Kohlhoff
- Discipline of Psychiatry and Mental Health, School of Clinical Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Siaw-Teng Liaw
- Faculty of Medicine, School of Population Health, University of New South Wales, Sydney, NSW, Australia
| | - Raghu Lingam
- Population Child Health Research Group, Faculty of Medicine, School of Women's and Children's Health, University of New South Wales, Sydney, NSW, Australia
| | - Natalie Ong
- Children's Hospital Westmead Clinical School, University of Sydney, Sydney, NSW, Australia
| | - Chun Wah Michael Tam
- Faculty of Medicine, School of Population Health, University of New South Wales, Sydney, NSW, Australia
- Primary and Integrated Care Unit, South Western Sydney Local Health District, Liverpool, NSW, Australia
| | - Sue Woolfenden
- Faculty of Medicine, School of Women and Children's Health, University of New South Wales, Sydney, NSW, Australia
- Population Child Health Research Group, Faculty of Medicine, School of Women's and Children's Health, University of New South Wales, Sydney, NSW, Australia
| | - Valsamma Eapen
- Cooperative Research Centre for Living with Autism (Autism CRC), The University of Queensland, Indooroopilly, QLD, Australia.
- Discipline of Psychiatry and Mental Health, School of Clinical Medicine, University of New South Wales, Sydney, NSW, Australia.
- Academic Unit of Infant, Child and Adolescent Psychiatry, South Western Sydney Local Health District, Sydney, NSW, Australia.
- Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia.
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10
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Zulkifli S, Short K, Kleiman C, Kidd JC, Earley J, Beckett S, Descallar J, McCabe P. Evaluating the dose-response relationship of the number of sessions of "It Takes Two to Talk®" in young children with language delay. Int J Speech Lang Pathol 2023; 25:566-576. [PMID: 35689394 DOI: 10.1080/17549507.2022.2080270] [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] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
PURPOSE To evaluate the dose-response relationship between the number of It Takes Two to Talk® (ITTT) sessions attended and the language outcomes of young children with language delay and their parent's responsivity in a multicultural clinical population. METHOD A clinical caseload of 273 early language delayed children (mean age 29.2 months, SD 7.8) and their families participated in parent group workshops and individual coaching sessions of the parent responsivity program ITTT. The children's vocabulary and early syntax, collected using the MacArthur-Bates Communicative Development Inventories and mean length of the three longest utterances respectively, were collated from pre- and post-intervention from pre-existing clinical data. Parental responsivity was evaluated utilising the Parent-Child Interaction checklist at three time points. Multilevel regression was used to determine the relationship between the number of sessions attended and outcomes, while accounting for covariates such as age and language spoken. RESULT ITTT dosage did not predict child language outcomes. Rather, vocabulary and early syntax outcomes were predicted by age, pre-scores and parent responsivity at the beginning of treatment. A higher dosage of ITTT did however positively predict parent responsivity, as did speaking only English at home. Socioeconomic status, gender and presence of receptive language difficulties did not contribute significantly to either child or parent outcomes. CONCLUSION A lower dosage of the intervention may be considered for parents and children with fewer known risk factors without significant implications.
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Affiliation(s)
| | - Kate Short
- Liverpool Hospital, South Western Sydney Local Health District, Ingham Institute, South West Sydney Local Health District, The University of Sydney, Sydney, Australia
| | - Carissa Kleiman
- Sydney Local Health District; Ingham Institute, South Western Sydney Local Health District; Sydney Institute for Women, Children and their Families, Camperdown, Australia
| | - Joanna C Kidd
- Campbeltown Hospital, South Western Sydney Local Health District, Campbelltown, Australia
| | | | - Sara Beckett
- South Western Sydney Local Health District, Liverpool, Australia
| | - Joseph Descallar
- Ingham Institute, South Western Sydney Local Health District, South Western Sydney Clinical School, The University of New South Wales, Liverpool, Australia
| | - Patricia McCabe
- The University of Sydney, Sydney, Australia; Liverpool Hospital, South Western Sydney Local Health District, The University of Sydney, Sydney, Australia
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11
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Albayati S, Bhai D, Descallar J, Turner CE, Berney C, Morgan MJ. Pelvic floor training improves faecal incontinence and obstructed defaecation despite the presence of rectal intussusception. ANZ J Surg 2023; 93:1253-1256. [PMID: 36484354 DOI: 10.1111/ans.18200] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 08/27/2022] [Revised: 11/06/2022] [Accepted: 11/29/2022] [Indexed: 11/30/2023]
Abstract
BACKGROUND Rectal intussusception is often observed in patients with faecal incontinence and obstructed defaecation. The aim of this study is to assess if pelvic floor training improves faecal incontinence and obstructed defaecation in patients with rectal intussusception. METHODS Case notes of all patients referred to Bankstown Hospital Pelvic Floor Clinic between 2013 and 2018 for the management of faecal incontinence and obstructed defaecation and rectal intussusception were retrospectively reviewed using a prospectively maintained database. St Mark's faecal incontinence and Cleveland clinic constipation scores were obtained from patients before and after they underwent pelvic floor training. RESULTS One hundred and thirty-one patients underwent pelvic floor training at Bankstown Hospital Pelvic Floor Clinic between 2013 and 2018. Sixty-one patients had rectal intussusception (22 low-grade and 39 high-grade). Median St Marks score improved following pelvic floor training from 8 to 1 (P < 0.001). Median Cleveland Clinic constipation score improved from 8 to 5 (P < 0.001). In patients with low grade rectal intussusception, pelvic floor training improved median St Mark's score from 3 to 0 (P = 0.003), whereas Cleveland Clinic constipation score improved from 9 to 7 (P < 0.001). In patients with high-grade rectal intussusception, pelvic floor training improved median St Mark's score from 9 to 2 (P < 0.001), whereas median Cleveland Clinic constipation score improved from 8 to 4 (P < 0.001). CONCLUSION Pelvic floor training without biofeedback therapy improves faecal incontinence and obstructed defaecation. Improvement in symptoms is unrelated to rectal intussusception observed on proctography or at examination under anaesthesia in these patients.
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Affiliation(s)
- Sinan Albayati
- Department of Surgery, Nepean Hospital, Sydney, New South Wales, Australia
- South Western Sydney Clinical School, UNSW, Sydney, New South Wales, Australia
| | - Doleen Bhai
- Department of Surgery, Bankstown-Lidcombe Hospital, Sydney, New South Wales, Australia
| | - Joseph Descallar
- South Western Sydney Clinical School, UNSW, Sydney, New South Wales, Australia
- Ingham Institute for Applied Medical Research, Sydney, New South Wales, Australia
| | - Catherine E Turner
- Department of Surgery, Bankstown-Lidcombe Hospital, Sydney, New South Wales, Australia
| | - Christophe Berney
- South Western Sydney Clinical School, UNSW, Sydney, New South Wales, Australia
- Department of Surgery, Bankstown-Lidcombe Hospital, Sydney, New South Wales, Australia
| | - Matthew J Morgan
- South Western Sydney Clinical School, UNSW, Sydney, New South Wales, Australia
- Department of Surgery, Bankstown-Lidcombe Hospital, Sydney, New South Wales, Australia
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12
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Rachakonda KS, Bhonagiri S, Maley MW, Descallar J, Lombardo L. Rational Clinical Pathology Assessment in Intensive Care Unit (RCPA-ICU): Follow-up study. Anaesth Intensive Care 2023; 51:149-151. [PMID: 36524289 DOI: 10.1177/0310057x221106488] [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: 12/23/2022]
Affiliation(s)
- Kanaka S Rachakonda
- Intensive Care Unit, Liverpool Hospital, South Western Sydney Local Health District, Liverpool, New South Wales (NSW), Australia.,Faculty of Medicine, Southwest Sydney Clinical School, University of New South Wales, Liverpool, NSW, Australia.,Faculty of medicine, Macquarie Clinical School (MQ health), Macquarie University, Macquarie Park, NSW, Australia
| | - Satyadeepak Bhonagiri
- Intensive Care Unit, Liverpool Hospital, South Western Sydney Local Health District, Liverpool, New South Wales (NSW), Australia.,Faculty of Medicine, Southwest Sydney Clinical School, University of New South Wales, Liverpool, NSW, Australia.,Faculty of medicine, Macquarie Clinical School (MQ health), Macquarie University, Macquarie Park, NSW, Australia.,Intensive Care Unit, Campbelltown Hospital, South Western Sydney Local Health District, Campbelltown, NSW, Australia.,School of Medicine, Western Sydney University, Campbelltown, NSW, Australia
| | - Michael W Maley
- South Western Sydney Local Health District, Liverpool, NSW, Australia.,Department of Microbiology and Infectious Diseases, NSW Health Pathology, Liverpool, NSW, Australia
| | - Joseph Descallar
- Faculty of Medicine, Southwest Sydney Clinical School, University of New South Wales, Liverpool, NSW, Australia.,Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia
| | - Lien Lombardo
- South Western Sydney Local Health District, Liverpool, NSW, Australia.,Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia.,Nepean Blue Mountains Local Health District, Penrith, NSW, Australia
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13
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Brady B, Sidhu B, Jennings M, Saberi G, Tang C, Hassett G, Boland R, Dennis S, Ashton-James C, Refshauge K, Descallar J, Lim D, Said CM, Williams G, Sayed S, Naylor JM. The Natural Helper approach to culturally responsive disease management: protocol for a type 1 effectiveness-implementation cluster randomised controlled trial of a cultural mentor programme. BMJ Open 2023; 13:e069120. [PMID: 36697054 PMCID: PMC9884889 DOI: 10.1136/bmjopen-2022-069120] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
INTRODUCTION Chronic disease is a leading cause of death and disability that disproportionately burdens culturally and linguistically diverse (CALD) communities. Self-management is a cornerstone of effective chronic disease management. However, research suggests that patients from CALD communities may be less likely to engage with self-management approaches. The Natural Helper Programme aims to facilitate patient engagement with self-management approaches (ie, 'activation') by embedding cultural mentors with lived experience of chronic disease into chronic disease clinics/programmes. The Natural Helper Trial will explore the effect of cultural mentors on patient activation, health self-efficacy, coping efforts and health-related quality of life (HRQoL) while also evaluating the implementation strategy. METHODS AND ANALYSIS A hybrid type-1 effectiveness-implementation cluster-randomised controlled trial (phase one) and a mixed-method controlled before-and-after cohort extension of the trial (phase 2). Hospital clinics in highly multicultural regions in Australia that provide healthcare for patients with chronic and/or complex conditions, will participate. A minimum of 16 chronic disease clinics (clusters) will be randomised to immediate (active arm) or delayed implementation (control arm). In phase 1, the active arm will receive a multifaceted strategy supporting them to embed cultural mentors in their services while the control arm continues with usual care. Each cluster will recruit an average of 15 patients, assessed at baseline and 6 months (n=240). In phase 2, clusters in the control arm will receive the implementation strategy and evaluate the intervention on an additional 15 patients per cluster, while sustainability in active arm clusters will be assessed qualitatively. Change in activation over 6 months, measured using the Patient Activation Measure will be the primary effectiveness outcome, while secondary effectiveness outcomes will explore changes in chronic disease self-efficacy, coping strategies and HRQoL. Secondary implementation outcomes will be collected from patient-participants, mentors and healthcare providers using validated questionnaires, customised surveys and interviews aligning with the Reach, Effectiveness, Adoption, Implementation, Maintenance framework to evaluate acceptability, reach, dose delivered, sustainability, cost-utility and healthcare provider determinants. ETHICS AND DISSEMINATION This trial has full ethical approval (2021/ETH12279). The results from this hybrid trial will be presented at scientific meetings and published in peer-reviewed journals. TRIAL REGISTRATION NUMBER ACTRN12622000697785.
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Affiliation(s)
- Bernadette Brady
- Allied Health, South Western Sydney Local Health District, Liverpool, New South Wales, Australia
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- School of Health Sciences, Western Sydney University, Campbelltown, New South Wales, Australia
| | - Balwinder Sidhu
- Multicultural Health Service, South Western Sydney Local Health District, Bankstown, NSW, Australia
| | - Matthew Jennings
- Allied Health, South Western Sydney Local Health District, Liverpool, New South Wales, Australia
- School of Health Sciences, Western Sydney University, Campbelltown, New South Wales, Australia
| | - Golsa Saberi
- Multicultural Health Service, South Western Sydney Local Health District, Bankstown, NSW, Australia
| | - Clarice Tang
- Allied Health, South Western Sydney Local Health District, Liverpool, New South Wales, Australia
- School of Health Sciences, Western Sydney University, Campbelltown, New South Wales, Australia
- Translational Health Research Institute, Western Sydney University, Campbelltown, New South Wales, Australia
| | - Geraldine Hassett
- Rheumatology, Liverpool Hospital, South Western Sydney Local Health District, Liverpool, NSW, Australia
| | - Robert Boland
- Allied Health, South Western Sydney Local Health District, Liverpool, New South Wales, Australia
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Sarah Dennis
- Allied Health, South Western Sydney Local Health District, Liverpool, New South Wales, Australia
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
| | - Claire Ashton-James
- Sydney Medical School, Kolling Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Kathryn Refshauge
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Joseph Descallar
- Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
- School of Clinical Medicine, UNSW Medicine and Health, University of New South Wales, Randwick, New South Wales, Australia
| | - David Lim
- School of Health Sciences, Western Sydney University, Campbelltown, New South Wales, Australia
- Translational Health Research Institute, Western Sydney University, Campbelltown, New South Wales, Australia
| | - Catherine M Said
- Physiotherapy Department, Western Health, St Albans, Victoria, Australia
- Melbourne School of Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
- Australian Institute for Musculoskeletal Science (AIMSS), Sunshine Hospital, St Albans, VIC, Australia
| | - Gavin Williams
- Melbourne School of Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
- Physiotherapy Department, Epworth HealthCare, Richmond, Victoria, Australia
| | - Samia Sayed
- Multicultural Health Service, South Western Sydney Local Health District, Bankstown, NSW, Australia
| | - Justine M Naylor
- Allied Health, South Western Sydney Local Health District, Liverpool, New South Wales, Australia
- Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
- School of Clinical Medicine, UNSW Medicine and Health, University of New South Wales, Randwick, New South Wales, Australia
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Girgis A, Bamgboje-Ayodele A, Rincones O, Vinod SK, Avery S, Descallar J, Smith A‘B, Arnold B, Arnold A, Bray V, Durcinoska I, Rankin NM, Chang CF, Eifler B, Elliott S, Hardy C, Ivimey B, Jansens W, Kaadan N, Koh ES, Livio N, Lozenkovski S, McErlean G, Nasser E, Ryan N, Smeal T, Thomas T, Tran T, Wiltshire J, Delaney GP. Stepping into the real world: a mixed-methods evaluation of the implementation of electronic patient reported outcomes in routine lung cancer care. J Patient Rep Outcomes 2022; 6:70. [PMID: 35723827 PMCID: PMC9207870 DOI: 10.1186/s41687-022-00475-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Accepted: 06/03/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
To realize the broader benefits of electronic patient-reported outcome measures (ePROMs) in routine care, we used the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework to inform the translation of a clinically effective ePROM system (hereafter referred to as the PRM system) into practice. The study aimed to evaluate the processes and success of implementing the PRM system in the routine care of patients diagnosed with lung cancer.
Method
A controlled before-and-after mixed-methods study was undertaken. Data sources included a self-report questionnaire and interviews with healthcare providers, electronic health record data for PRMs patients and historical controls, and field notes. Descriptive statistics, logistic regression modelling, negative binomial models, generalized estimating equations and repeated measures ANOVA were used to analyze quantitative data. Qualitative data was thematically analyzed.
Results
A total of 48/79 eligible people diagnosed with lung cancer completed 90 assessments during the 5-month implementation period (RE-AIM reach). Every assessment breached the pre-defined threshold and care coordinators reviewed and actioned 95.6% of breaches, resulting in 146 referrals to allied health services, most frequently for social work (25.3%), dietetics (18.5%), physiotherapy (18.5%) and occupational therapy (17.1%). PRMs patients had significantly fewer visits to the cancer assessment unit for problematic symptoms (M = 0.23 vs. M = 0.43; p = 0.035), and were significantly more likely to be offered referrals (71% vs. 29%, p < 0.0001) than historical controls (RE-AIM effect). The levels of ‘organizational readiness for implementing change’ (ORIC) did not show much differences between baseline and follow-up, though this was already high at baseline; but significantly more staff reported improved confidence when asking patients to complete assessments (64.7% at baseline vs. 88.2% at follow-up, p = 0.0046), and when describing the assessment tool to patients (64.7% at baseline vs. 76.47% at follow-up, p = 0.0018) (RE-AIM adoption). A total of 78 staff received PRM system training, and 95.6% of the PRM system alerts were actioned (RE-AIM implementation); and all lung cancer care coordinators were engaged with the PRM system beyond the end of the study period (RE-AIM maintenance).
Conclusion
This study demonstrates the potential of the PRM system in enhancing the routine care of lung cancer patients, through leveraging the capabilities of automated web-based care options.
Plain English summary
Research has shown the clear benefits of using electronically collected patient-reported outcome measures (ePROMs) for cancer patients and health services. However, we need to better understand how to implement ePROMs as part of routine care. This study evaluated the processes and outcomes of implementing an ePROMs system in the routine care of patients diagnosed with lung cancer. Key findings included: (a) a majority of eligible patients completed the scheduled assessments; (b) patient concerns were identified in every assessment, and care coordinators reviewed and actioned almost all of these, including making significantly more referrals to allied health services; (c) patients completing assessments regularly were less likely to present to the cancer assessment unit with problematic symptoms, suggesting that ePROMs identified patient concerns early and this led to a timely response to concerns; (d) staff training and engagement was high, and staff reporting increased confidence when asking patients to complete assessments and when describing the assessment tool to patients at the end of the implementation period. This study shows that implementing ePROMs in routine care is feasible and can lead to improvements in patient care.
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15
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Eapen V, Winata T, Gilbert M, Nair R, Khan F, Lucien A, Islam R, Masi A, Lam-Cassettari C, Mendoza Diaz A, Dissanayake C, Karlov L, Descallar J, Eastwood J, Hasan I, Jalaludin B, Kohlhoff J, Liaw ST, Lingam R, Ong N, Tam CWM, Woolfenden S, Barbaro J. Parental experience of an early developmental surveillance programme for autism within Australian general practice: a qualitative study. BMJ Open 2022; 12:e064375. [PMID: 36442896 PMCID: PMC9710335 DOI: 10.1136/bmjopen-2022-064375] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES Implementing support and services early in the life course has been shown to promote positive developmental outcomes for children at high likelihood of developmental conditions including autism. This study examined parents'/caregivers' experiences and perceptions about a digital developmental surveillance pathway for autism, the autism surveillance pathway (ASP), and usual care, the surveillance as usual (SaU) pathway, in the primary healthcare general practice setting. DESIGN This qualitative study involves using a convenience selection process of the full sample of parents/caregivers that participated in the main programme, 'General Practice Surveillance for Autism', a cluster-randomised controlled trial study. All interviews were audio-recorded, transcribed and coded using NVivo V.12 software. An inductive thematic interpretive approach was adopted and data were analysed thematically. PARTICIPANTS Twelve parents/caregivers of children with or without a developmental condition/autism (who participated in the main programme) in South Western Sydney and Melbourne were interviewed. SETTINGS All interviews were completed over the phone. RESULTS There were seven major themes and 20 subthemes that included positive experiences, such as pre-existing patient-doctor relationships and their perceptions on the importance of knowing and accessing early support/services. Barriers or challenges experienced while using the SaU pathway included long waiting periods, poor communication and lack of action plans, complexity associated with navigating the healthcare system and lack of understanding by general practitioners (GPs). Common suggestions for improvement included greater awareness/education for parents/carers and the availability of accessible resources on child development for parents/caregivers. CONCLUSION The findings support the use of digital screening tools for developmental surveillance, including for autism, using opportunistic contacts in the general practice setting. TRIAL REGISTRATION NUMBER ANZCTR (ACTRN12619001200178).
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Affiliation(s)
- Valsamma Eapen
- Faculty of Medicine, Discipline of Psychiatry and Mental Health, UNSW, Sydney, New South Wales, Australia
- Academic Unit of Infant, Child and Adolescent Psychiatry, South Western Sydney Local Health District, Liverpool, New South Wales, Australia
- Olga Tennison Autism Research Centre, School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia
- Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
| | - Teresa Winata
- Faculty of Medicine, Discipline of Psychiatry and Mental Health, UNSW, Sydney, New South Wales, Australia
- Academic Unit of Infant, Child and Adolescent Psychiatry, South Western Sydney Local Health District, Liverpool, New South Wales, Australia
- Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
| | - Melissa Gilbert
- Olga Tennison Autism Research Centre, School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia
- Cooperative Research Centre for Living with Autism, The University of Queensland, Saint Lucia, Queensland, Australia
| | - Radhika Nair
- Olga Tennison Autism Research Centre, School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia
- Cooperative Research Centre for Living with Autism, The University of Queensland, Saint Lucia, Queensland, Australia
| | - Feroza Khan
- Faculty of Medicine, Discipline of Psychiatry and Mental Health, UNSW, Sydney, New South Wales, Australia
| | - Abbie Lucien
- Faculty of Medicine, Discipline of Psychiatry and Mental Health, UNSW, Sydney, New South Wales, Australia
| | - Raisa Islam
- Faculty of Medicine, Discipline of Psychiatry and Mental Health, UNSW, Sydney, New South Wales, Australia
| | - Anne Masi
- Faculty of Medicine, Discipline of Psychiatry and Mental Health, UNSW, Sydney, New South Wales, Australia
- Olga Tennison Autism Research Centre, School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia
| | - Christa Lam-Cassettari
- Faculty of Medicine, Discipline of Psychiatry and Mental Health, UNSW, Sydney, New South Wales, Australia
- Academic Unit of Infant, Child and Adolescent Psychiatry, South Western Sydney Local Health District, Liverpool, New South Wales, Australia
| | - Antonio Mendoza Diaz
- Faculty of Medicine, Discipline of Psychiatry and Mental Health, UNSW, Sydney, New South Wales, Australia
- Academic Unit of Infant, Child and Adolescent Psychiatry, South Western Sydney Local Health District, Liverpool, New South Wales, Australia
- Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
| | - Cheryl Dissanayake
- Olga Tennison Autism Research Centre, School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia
- Cooperative Research Centre for Living with Autism (Autism CRC), The University of Queensland, Saint Lucia, Queensland, Australia
| | - Lisa Karlov
- Faculty of Medicine, Discipline of Psychiatry and Mental Health, UNSW, Sydney, New South Wales, Australia
- Academic Unit of Infant, Child and Adolescent Psychiatry, South Western Sydney Local Health District, Liverpool, New South Wales, Australia
| | - Joseph Descallar
- Academic Unit of Infant, Child and Adolescent Psychiatry, South Western Sydney Local Health District, Liverpool, New South Wales, Australia
- Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
| | - John Eastwood
- Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
- Faculty of Medicine and Health, School of Medicine, The University of Sydney, Sydney, New South Wales, Australia
| | - Iqbal Hasan
- Faculty of Medicine, Discipline of Psychiatry and Mental Health, UNSW, Sydney, New South Wales, Australia
| | - Bin Jalaludin
- Centre for Research, Evidence Management and Surveillance, South Western Sydney Local Health District, Liverpool, New South Wales, Australia
- Faculty of Medicine, School of Population Health, UNSW, Sydney, New South Wales, Australia
| | - Jane Kohlhoff
- Faculty of Medicine, Discipline of Psychiatry and Mental Health, UNSW, Sydney, New South Wales, Australia
| | - Siaw-Teng Liaw
- School of Public Health and Community Medicine, UNSW, Sydney, New South Wales, Australia
| | - Raghu Lingam
- Population Child Health Research Group, Faculty of Medicine, School of Women's and Children's Health, UNSW, Sydney, New South Wales, Australia
| | - Natalie Ong
- Children's Hospital Westmead Clinical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Chun Wah Michael Tam
- Faculty of Medicine, School of Population Health, UNSW, Sydney, New South Wales, Australia
- Primary and Integrated Care Unit, South Western Sydney Local Health District, Liverpool, New South Wales, Australia
| | - Susan Woolfenden
- Population Child Health Research Group, Faculty of Medicine, School of Women's and Children's Health, UNSW, Sydney, New South Wales, Australia
| | - Josephine Barbaro
- Olga Tennison Autism Research Centre, School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia
- Cooperative Research Centre for Living with Autism, The University of Queensland, Saint Lucia, Queensland, Australia
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16
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Batumalai V, Descallar J, Gabriel G, Delaney GP, Oar A, Barton MB, Vinod SK. Response from Batumalai V et al. Asia Pac J Clin Oncol 2022; 19:415. [DOI: 10.1111/ajco.13891] [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] [Received: 09/27/2022] [Accepted: 10/10/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Vikneswary Batumalai
- Collaboration for Cancer Outcomes, Research and Evaluation, Ingham Institute for Applied Medical Research, South Western Clinical School University of New South Wales New South Wales Australia
- GenesisCare, Alexandria New South Wales Australia
| | - Joseph Descallar
- Collaboration for Cancer Outcomes, Research and Evaluation, Ingham Institute for Applied Medical Research, South Western Clinical School University of New South Wales New South Wales Australia
| | - Gabriel Gabriel
- Collaboration for Cancer Outcomes, Research and Evaluation, Ingham Institute for Applied Medical Research, South Western Clinical School University of New South Wales New South Wales Australia
| | - Geoff P. Delaney
- Collaboration for Cancer Outcomes, Research and Evaluation, Ingham Institute for Applied Medical Research, South Western Clinical School University of New South Wales New South Wales Australia
- Department of Radiation Oncology South Western Sydney Local Health District New South Wales Australia
| | - Andrew Oar
- Icon Cancer Centre Gold Coast University Hospital Gold Coast Australia
| | - Michael B. Barton
- Collaboration for Cancer Outcomes, Research and Evaluation, Ingham Institute for Applied Medical Research, South Western Clinical School University of New South Wales New South Wales Australia
- Department of Radiation Oncology South Western Sydney Local Health District New South Wales Australia
| | - Shalini K. Vinod
- Collaboration for Cancer Outcomes, Research and Evaluation, Ingham Institute for Applied Medical Research, South Western Clinical School University of New South Wales New South Wales Australia
- Department of Radiation Oncology South Western Sydney Local Health District New South Wales Australia
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17
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Girgis A, Bamgboje-Ayodele A, Rincones O, Vinod S, Avery S, Descallar J, Arnold B, Arnold A, Bray V, Durcinoska I, Rankin N, Delaney G. EP04.01-025 Implementation of Electronic Patient Reported Outcomes in Routine Cancer Care. J Thorac Oncol 2022. [DOI: 10.1016/j.jtho.2022.07.437] [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: 10/14/2022]
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18
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Eapen V, Liaw ST, Lingam R, Woolfenden S, Jalaludin B, Page A, Kohlhoff J, Scott JG, Lawson KD, Lam-Cassettari C, Heussler H, Descallar J, Karlov L, Ong N, Colditz PB, Littlewood R, Murphy E, Deering A, Short K, Garg P, Blight V, Rodgers K, Chalmers L, Webb KL, Atkins H, Newcomb D, Beswick R, Thomas C, Marron C, Chambers A, Scheinpflug S, Statham M, Samaranayake D, Chay P, Tam CWM, Khan F, Mendoza Diaz A, Cibralic S, Winata T, Pritchard M. Watch me grow integrated (WMG-I): protocol for a cluster randomised controlled trial of a web-based surveillance approach for developmental screening in primary care settings. BMJ Open 2022; 12:e065823. [PMID: 35977775 PMCID: PMC9389092 DOI: 10.1136/bmjopen-2022-065823] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION The increasing prevalence of developmental disorders in early childhood poses a significant global health burden. Early detection of developmental problems is vital to ensure timely access to early intervention, and universal developmental surveillance is recommended best practice for identifying issues. Despite this, there is currently considerable variation in developmental surveillance and screening between Australian states and territories and low rates of developmental screening uptake by parents. This study aims to evaluate an innovative web-based developmental surveillance programme and a sustainable approach to referral and care pathways, linking primary care general practice (GP) services that fall under federal policy responsibility and state government-funded child health services. METHODS AND ANALYSIS The proposed study describes a longitudinal cluster randomised controlled trial (c-RCT) comparing a 'Watch Me Grow Integrated' (WMG-I) approach for developmental screening, to Surveillance as Usual (SaU) in GPs. Forty practices will be recruited across New South Wales and Queensland, and randomly allocated into either the (1) WMG-I or (2) SaU group. A cohort of 2000 children will be recruited during their 18-month vaccination visit or opportunistic visit to GP. At the end of the c-RCT, a qualitative study using focus groups/interviews will evaluate parent and practitioner views of the WMG-I programme and inform national and state policy recommendations. ETHICS AND DISSEMINATION The South Western Sydney Local Health District (2020/ETH01625), UNSW Sydney (2020/ETH01625) and University of Queensland (2021/HE000667) Human Research Ethics Committees independently reviewed and approved this study. Findings will be reported to the funding bodies, study institutes and partners; families and peer-reviewed conferences/publications. TRIAL REGISTRATION NUMBER ANZCTR12621000680864.
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Affiliation(s)
- Valsamma Eapen
- ICAMHS, South Western Sydney Local Health District, Liverpool, New South Wales, Australia
- Discipline of Psychiatry and Mental Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Siaw-Teng Liaw
- University of New South Wales, Sydney, New South Wales, Australia
| | - Raghu Lingam
- University of New South Wales, Sydney, New South Wales, Australia
| | - Susan Woolfenden
- University of New South Wales, Sydney, New South Wales, Australia
- Sydney Institute for Women, Children and their Families, Sydney Local Health District, Camperdown, New South Wales, Australia
| | - Bin Jalaludin
- South Western Sydney Local Health District, Liverpool, New South Wales, Australia
- Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
| | - Andrew Page
- Translational Health Research Institute, Western Sydney University, Penrith South, New South Wales, Australia
| | - Jane Kohlhoff
- University of New South Wales, Sydney, New South Wales, Australia
- Karitane, Villawood, New South Wales, Australia
| | - James G Scott
- The University of Queensland Centre for Clinical Research, Herston, Queensland, Australia
- QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia
| | - K D Lawson
- Translational Health Research Institute, Western Sydney University, Penrith South, New South Wales, Australia
| | - Christa Lam-Cassettari
- Discipline of Psychiatry and Mental Health, University of New South Wales, Sydney, New South Wales, Australia
- Academic Unit of Infant, Child and Adolescent Psychiatry, University of New South Wales, Sydney, New South Wales, Australia
| | - Helen Heussler
- Children's Health Queensland Hospital and Health Service, Herston, Queensland, Australia
- Centre for Children's Health Research, The University of Queensland, South Brisbane, Queensland, Australia
| | - Joseph Descallar
- Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
- Academic Unit of Infant, Child and Adolescent Psychiatry, University of New South Wales, Sydney, New South Wales, Australia
| | - Lisa Karlov
- University of New South Wales, Sydney, New South Wales, Australia
- South Western Sydney Local Health District, Liverpool, New South Wales, Australia
| | - Natalie Ong
- University of New South Wales, Sydney, New South Wales, Australia
- Sydney Institute for Women, Children and their Families, Sydney Local Health District, Sydney, New South Wales, Australia
| | - Paul B Colditz
- The University of Queensland Centre for Clinical Research, Herston, Queensland, Australia
| | - Robyn Littlewood
- Children's Health Queensland Hospital and Health Service, Herston, Queensland, Australia
- Health and Wellbeing, Milton, Queensland, Australia
| | - Elisabeth Murphy
- New South Wales Ministry of Health, St Leonards, New South Wales, Australia
| | - April Deering
- New South Wales Ministry of Health, St Leonards, New South Wales, Australia
| | - Kate Short
- South Western Sydney Local Health District, Liverpool, New South Wales, Australia
| | - Pankaj Garg
- University of New South Wales, Sydney, New South Wales, Australia
- South Western Sydney Local Health District, Liverpool, New South Wales, Australia
| | - Victoria Blight
- South Western Sydney Local Health District, Liverpool, New South Wales, Australia
| | - Kim Rodgers
- South Western Sydney Local Health District, Liverpool, New South Wales, Australia
| | | | - Kerri-Lyn Webb
- Developmental Paediatrics, Children's Health Queensland Hospital and Health Service, South Brisbane, Queensland, Australia
| | - Heidi Atkins
- Queensland Child & Youth Clinical Network, Queensland Health, Brisbane, Queensland, Australia
| | - Dana Newcomb
- Integrated Care, Children's Health Queensland Hospital and Health Service, South Brisbane, Queensland, Australia
- The University of Queensland Primary Care Clinical Unit, Herston, Queensland, Australia
| | - Rachael Beswick
- Queensland Child & Youth Clinical Network, Queensland Health, Brisbane, Queensland, Australia
| | - Clare Thomas
- Queensland Child & Youth Clinical Network, Queensland Health, Brisbane, Queensland, Australia
| | - Catherine Marron
- Queensland Child & Youth Clinical Network, Queensland Health, Brisbane, Queensland, Australia
| | - Aaron Chambers
- Integrated Care, Children's Health Queensland Hospital and Health Service, South Brisbane, Queensland, Australia
| | - Sue Scheinpflug
- Brisbane South PHN, Upper Mount Gravatt, Queensland, Australia
| | - Matt Statham
- Brisbane South PHN, Upper Mount Gravatt, Queensland, Australia
| | - Dimuthu Samaranayake
- School of Medicine, Western Sydney University, Penrith South, New South Wales, Australia
| | - Paul Chay
- University of New South Wales, Sydney, New South Wales, Australia
- South Western Sydney Local Health District, Liverpool, New South Wales, Australia
| | - Chun Wah Michael Tam
- University of New South Wales, Sydney, New South Wales, Australia
- South Western Sydney Local Health District, Liverpool, New South Wales, Australia
| | - Feroza Khan
- Academic Unit of Infant, Child and Adolescent Psychiatry, University of New South Wales, Sydney, New South Wales, Australia
| | - Antonio Mendoza Diaz
- Academic Unit of Infant, Child and Adolescent Psychiatry, University of New South Wales, Sydney, New South Wales, Australia
| | - Sara Cibralic
- Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
| | - Teresa Winata
- ICAMHS, South Western Sydney Local Health District, Liverpool, New South Wales, Australia
- Academic Unit of Infant, Child and Adolescent Psychiatry, UNSW, Sydney, New South Wales, Australia
| | - Margo Pritchard
- Centre for Clinical Research, The University of Queensland, Herston, Queensland, Australia
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19
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Batumalai V, Descallar J, Gabriel G, Delaney GP, Oar A, Barton MB, Vinod SK. Patterns of curative treatment for non-small cell lung cancer in New South Wales, Australia. Asia Pac J Clin Oncol 2022; 19:e149-e159. [PMID: 35844037 DOI: 10.1111/ajco.13811] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 06/02/2022] [Accepted: 06/13/2022] [Indexed: 01/16/2023]
Abstract
INTRODUCTION There is a lack of large population-based studies examining patterns of curative treatment for non-small cell lung cancer (NSCLC) in Australia. This study aimed to evaluate the utilization of curative treatment for NCSLC at a population level and identify factors associated with its use in New South Wales (NSW), Australia. METHODS Patients diagnosed with localized or locoregional NSCLC between 2009 and 2014 were identified from the NSW Central Cancer Registry. Curative treatment was defined as surgery or radiotherapy with a 45 Gy minimum dose. Univariate and multivariable analyses were performed to investigate factors associated with the receipt of curative treatment. A Cox proportional-hazards regression model was used to analyze the factors associated with 2-year overall survival (OS). RESULTS Of the 5722 patients diagnosed with NSCLC in the study period, 3355 (59%) patients received curative treatment and 2367 (41%) patients did not receive curative treatment. The receipt of curative treatment was significantly associated with younger patients, female gender, localized disease, and Charlson Comorbidity Index (CCI) = 0. The use of curative treatment increased significantly over time from 2009 (55%) to 2014 (63%) and varied significantly from 24% to 70% between local health districts (LHDs) of residence. Younger age, female gender, localized disease, CCI = 0, and overseas country of birth were significantly associated with 2-year OS. The 2-year OS significantly improved from 70% in 2009 to 77% in 2014 for patients who received curative treatment. CONCLUSION The use of curative treatment for patients with potentially curable NSCLC was low at 59%. However, the use of curative treatment and survival have increased over time. Significant variation was noted in the use of curative treatment between LHDs.
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Affiliation(s)
- Vikneswary Batumalai
- Collaboration for Cancer Outcomes, Research and Evaluation, Ingham Institute for Applied Medical Research, South Western Clinical School, University of New South Wales, New South Wales, Australia.,GenesisCare, Alexandria, New South Wales, Australia
| | - Joseph Descallar
- Collaboration for Cancer Outcomes, Research and Evaluation, Ingham Institute for Applied Medical Research, South Western Clinical School, University of New South Wales, New South Wales, Australia
| | - Gabriel Gabriel
- Collaboration for Cancer Outcomes, Research and Evaluation, Ingham Institute for Applied Medical Research, South Western Clinical School, University of New South Wales, New South Wales, Australia
| | - Geoff P Delaney
- Collaboration for Cancer Outcomes, Research and Evaluation, Ingham Institute for Applied Medical Research, South Western Clinical School, University of New South Wales, New South Wales, Australia.,Department of Radiation Oncology, South Western Sydney Local Health District, New South Wales, Australia
| | - Andrew Oar
- Icon Cancer Centre, Gold Coast University Hospital, Gold Coast, Australia
| | - Michael B Barton
- Collaboration for Cancer Outcomes, Research and Evaluation, Ingham Institute for Applied Medical Research, South Western Clinical School, University of New South Wales, New South Wales, Australia.,Department of Radiation Oncology, South Western Sydney Local Health District, New South Wales, Australia
| | - Shalini K Vinod
- Collaboration for Cancer Outcomes, Research and Evaluation, Ingham Institute for Applied Medical Research, South Western Clinical School, University of New South Wales, New South Wales, Australia.,Department of Radiation Oncology, South Western Sydney Local Health District, New South Wales, Australia
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Bamgboje-Ayodele A, Arnold B, Durcinoska I, Avery S, Vinod S, Rincones O, Thomas T, Descallar J, Smith B, Delaney GP, Girgis A. Implementing patient-reported outcomes into routine care: an audit of cancer patients from two local health districts in New South Wales to understand their capabilities and preferences. AUST HEALTH REV 2022; 46:331-337. [PMID: 35545809 DOI: 10.1071/ah21270] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 03/03/2022] [Indexed: 11/23/2022]
Abstract
ObjectiveIt has been established that the implementation of patient-reported outcome measures (PROMs) in routine care provides significant benefits to patients, providers and health services. However, there are patient-level barriers that must be identified and addressed for the successful implementation of PROMs. This study aimed to understand the capabilities and preferences of our cancer patient population prior to implementation of electronically collected PROMs (ePROMs). Specifically, we conducted a clinic audit to determine the proportion of patients in clinics with access to out-of-clinic internet; those preferring to complete PROMs on paper or via an electronic device; those capable of completing PROMs in English; and those anticipating requiring assistance to complete PROMs.MethodsPatients receiving cancer treatment or follow-up care at two Local Health Districts (LHDs) in New South Wales, Australia, completed a questionnaire (audit form) with items about internet and mobile access, communication preferences and assistance needed to complete PROMs. Participant demographic and treatment information were extracted from their electronic medical records.ResultsAcross both LHDs, 637 of 1668 participants (38%) completed the audit forms. Mean participant age was 65 years (range = 23-98), 53% were female, and 92% were outpatients. Patients in the two LHDs differed in their levels of internet and email access, and ability to complete PROMs independently in English, suggesting that some LHD-specific tailoring of implementation strategies is necessary to optimise ePROMs uptake.ConclusionThis study highlights the importance of understanding the specific local contexts and patient populations, including potential technology and language barriers, which can influence patient ability to complete ePROMs.
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Affiliation(s)
- Adeola Bamgboje-Ayodele
- Ingham Institute for Applied Medical Research, Liverpool, NSW 1871, Australia; and South Western Sydney Clinical School, UNSW Medicine and Health, UNSW Sydney, Kensington, NSW 2052, Australia; and Present address: Faculty of Medicine and Health, School of Medical Sciences, Biomedical Informatics and Digital Health, The University of Sydney, Camperdown, NSW 2006, Australia
| | - Belinda Arnold
- Wollongong Hospital, Illawarra Shoalhaven Local Health District, Wollongong, NSW 2500, Australia
| | - Ivana Durcinoska
- Ingham Institute for Applied Medical Research, Liverpool, NSW 1871, Australia
| | - Sandra Avery
- Ingham Institute for Applied Medical Research, Liverpool, NSW 1871, Australia; and South Western Sydney Clinical School, UNSW Medicine and Health, UNSW Sydney, Kensington, NSW 2052, Australia; and Liverpool Cancer Therapy Centre, Liverpool Hospital, South Western Sydney Local Health District, Liverpool, NSW 1871, Australia
| | - Shalini Vinod
- Ingham Institute for Applied Medical Research, Liverpool, NSW 1871, Australia; and South Western Sydney Clinical School, UNSW Medicine and Health, UNSW Sydney, Kensington, NSW 2052, Australia; and Liverpool Cancer Therapy Centre, Liverpool Hospital, South Western Sydney Local Health District, Liverpool, NSW 1871, Australia
| | - Orlando Rincones
- Ingham Institute for Applied Medical Research, Liverpool, NSW 1871, Australia
| | - Tien Thomas
- Liverpool Cancer Therapy Centre, Liverpool Hospital, South Western Sydney Local Health District, Liverpool, NSW 1871, Australia
| | - Joseph Descallar
- Ingham Institute for Applied Medical Research, Liverpool, NSW 1871, Australia; and South Western Sydney Clinical School, UNSW Medicine and Health, UNSW Sydney, Kensington, NSW 2052, Australia
| | - Ben Smith
- Ingham Institute for Applied Medical Research, Liverpool, NSW 1871, Australia; and South Western Sydney Clinical School, UNSW Medicine and Health, UNSW Sydney, Kensington, NSW 2052, Australia
| | - Geoff P Delaney
- Ingham Institute for Applied Medical Research, Liverpool, NSW 1871, Australia; and South Western Sydney Clinical School, UNSW Medicine and Health, UNSW Sydney, Kensington, NSW 2052, Australia; and Liverpool Cancer Therapy Centre, Liverpool Hospital, South Western Sydney Local Health District, Liverpool, NSW 1871, Australia
| | - Afaf Girgis
- Ingham Institute for Applied Medical Research, Liverpool, NSW 1871, Australia; and South Western Sydney Clinical School, UNSW Medicine and Health, UNSW Sydney, Kensington, NSW 2052, Australia
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Chow JSF, D'Souza A, Lane B, Descallar J, Ford M, Marshall S, Pennings S. Health workers' Perceptions and REsponses in implementing COVID-19 Immunisation StratEgy in South Western Sydney (PRECISE): an observational study. BMJ Open 2022; 12:e055034. [PMID: 35428626 PMCID: PMC9013787 DOI: 10.1136/bmjopen-2021-055034] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVES To understand the views and motivations of healthcare workers at a vaccination hub who received a COVID-19 vaccination in March-May 2021. STUDY DESIGN This is an observational study via an anonymous electronic survey of seven questions focus on where survey recipients received information about the vaccine roll-out, their motivations for receiving the vaccine and their level of comfort in receiving the vaccine. SETTING The Liverpool Vaccination Hub is located in South Western Sydney. PARTICIPANTS Participants were healthcare workers who received the first dose of a COVID-19 vaccine in the Australian Government's Phase 1a and 1b priority categories. The majority of survey respondents (70%) were female (median aged between 35 and 44 years). The majority of survey respondents were clinical workers, such as nurse, paramedics and doctors. OUTCOME MEASURES χ2 analysis was used for analysis of survey responses in univariate analysis. Logistic regression was used to analyse survey responses, adjusting for week, type of health worker and age. RESULTS 4746 healthcare workers responded to the survey after receiving their first vaccine dose, a response rate of 23%. Over 90% of respondents said that COVID-19 vaccination information from their organisation was easily available. Most of them reported that they were comfortable receiving a COVID-19 vaccine. The majority of respondents were motivated to receive the vaccine due to concern about contracting COVID-19 themselves (75%), or concerns about transmitting it to other people such as patients (52%), family members (65%) or other community members (54%). Younger respondents were more likely to have preferred more information on vaccine safety (p<0.0001) and the effectiveness of the vaccine (p<0.0001). CONCLUSION The majority of healthcare workers who received a COVID-19 vaccine reported that it was easy to find useful information about the vaccination roll-out and they had a positive experience being vaccinated.
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Affiliation(s)
- Josephine Sau Fan Chow
- Clinical Innovation & Business Unit, South Western Sydney Local Health District, Liverpool, New South Wales, Australia
| | - Annamarie D'Souza
- Clinical Innovation & Business Unit, South Western Sydney Local Health District, Liverpool, New South Wales, Australia
| | - Brian Lane
- Clinical Innovation & Business Unit, South Western Sydney Local Health District, Liverpool, New South Wales, Australia
| | - Joseph Descallar
- Clinical Trial Support Unit, Ingham Institute, Liverpool, New South Wales, Australia
| | - Megan Ford
- Clinical Trial Support Unit, Ingham Institute, Liverpool, New South Wales, Australia
| | - Sonia Marshall
- Clinical Innovation & Business Unit, South Western Sydney Local Health District, Liverpool, New South Wales, Australia
| | - Susan Pennings
- Clinical Innovation & Business Unit, South Western Sydney Local Health District, Liverpool, New South Wales, Australia
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Khan T, Becker TM, Scott KF, Descallar J, de Souza P, Chua W, Ma Y. Prognostic and Predictive Value of Liquid Biopsy-Derived Androgen Receptor Variant 7 (AR-V7) in Prostate Cancer: A Systematic Review and Meta-Analysis. Front Oncol 2022; 12:868031. [PMID: 35372002 PMCID: PMC8971301 DOI: 10.3389/fonc.2022.868031] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 02/21/2022] [Indexed: 12/21/2022] Open
Abstract
In advanced prostate cancer, access to recent diagnostic tissue samples is restricted and this affects the analysis of the association of evolving biomarkers such as AR-V7 with metastatic castrate resistance. Liquid biopsies are emerging as alternative analytes. To clarify clinical value of AR-V7 detection from liquid biopsies, here we performed a meta-analysis on the prognostic and predictive value of androgen receptor variant 7 (AR-V7) detected from liquid biopsy for patients with prostate cancer (PC), three databases, the Embase, Medline, and Scopus were searched up to September 2021. A total of 37 studies were included. The effects of liquid biopsy AR-V7 status on overall survival (OS), radiographic progression-free survival (PFS), and prostate-specific antigen (PSA)-PFS were calculated with RevMan 5.3 software. AR-V7 positivity detected in liquid biopsy significantly associates with worse OS, PFS, and PSA-PFS (P <0.00001). A subgroup analysis of patients treated with androgen receptor signaling inhibitors (ARSi such as abiraterone and enzalutamide) showed a significant association of AR-V7 positivity with poorer OS, PFS, and PSA-PFS. A statistically significant association with OS was also found in taxane-treated patients (P = 0.04), but not for PFS (P = 0.21) or PSA-PFS (P = 0.93). For AR-V7 positive patients, taxane treatment has better OS outcomes than ARSi (P = 0.01). Study quality, publication bias and sensitivity analysis were integrated in the assessment. Our data show that liquid biopsy AR-V7 is a clinically useful biomarker that is associated with poor outcomes of ARSi-treated castrate resistant PC (CRPC) patients and thus has the potential to guide patient management and also to stratify patients for clinical trials. More studies on chemotherapy-treated patients are warranted.
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Affiliation(s)
- Tanzila Khan
- School of Medicine, Western Sydney University, Campbelltown, NSW, Australia
- Medical Oncology, Ingham Institute of Applied Medical Research, Liverpool, NSW, Australia
- Centre of Circulating Tumour Cell Diagnostics & Research, Ingham Institute of Applied Medical Research, Liverpool, NSW, Australia
| | - Therese M. Becker
- Medical Oncology, Ingham Institute of Applied Medical Research, Liverpool, NSW, Australia
- Centre of Circulating Tumour Cell Diagnostics & Research, Ingham Institute of Applied Medical Research, Liverpool, NSW, Australia
- South West Sydney Clinical School, University of New South Wales, Liverpool Hospital, Liverpool, NSW, Australia
| | - Kieran F. Scott
- School of Medicine, Western Sydney University, Campbelltown, NSW, Australia
- Medical Oncology, Ingham Institute of Applied Medical Research, Liverpool, NSW, Australia
| | - Joseph Descallar
- South West Sydney Clinical School, University of New South Wales, Liverpool Hospital, Liverpool, NSW, Australia
- Ingham Institute of Applied Medical Research, Liverpool, NSW, Australia
| | - Paul de Souza
- School of Medicine, Western Sydney University, Campbelltown, NSW, Australia
- Medical Oncology, Ingham Institute of Applied Medical Research, Liverpool, NSW, Australia
- School of Medicine, University of New South Wales, Kensington, NSW, Australia
| | - Wei Chua
- School of Medicine, Western Sydney University, Campbelltown, NSW, Australia
- Medical Oncology, Ingham Institute of Applied Medical Research, Liverpool, NSW, Australia
- South West Sydney Clinical School, University of New South Wales, Liverpool Hospital, Liverpool, NSW, Australia
- Medical Oncology, Liverpool Hospital, Liverpool, NSW, Australia
| | - Yafeng Ma
- Medical Oncology, Ingham Institute of Applied Medical Research, Liverpool, NSW, Australia
- Centre of Circulating Tumour Cell Diagnostics & Research, Ingham Institute of Applied Medical Research, Liverpool, NSW, Australia
- South West Sydney Clinical School, University of New South Wales, Liverpool Hospital, Liverpool, NSW, Australia
- *Correspondence: Yafeng Ma,
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23
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Habiba U, Ozawa M, Chambers JK, Uchida K, Descallar J, Nakayama H, Summers BA, Morley JW, Tayebi M. Neuronal Deposition of Amyloid-β Oligomers and Hyperphosphorylated Tau Is Closely Connected with Cognitive Dysfunction in Aged Dogs. J Alzheimers Dis Rep 2021; 5:749-760. [PMID: 34870101 PMCID: PMC8609497 DOI: 10.3233/adr-210035] [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] [Accepted: 08/30/2021] [Indexed: 11/15/2022] Open
Abstract
Background Canine cognitive dysfunction (CCD) is a progressive syndrome recognized in mature to aged dogs with a variety of neuropathological changes similar to human Alzheimer's disease (AD), for which it is thought to be a good natural model. However, the presence of hyperphosphorylated tau protein (p-Tau) in dogs with CCD has only been demonstrated infrequently. Objective The aim of the present study was to investigate the presence of p-Tau and amyloid-β oligomer (Aβo) in cerebral cortex and hippocampus of dogs with CCD, with focus on an epitope retrieval protocol to unmask p-Tau. Methods Immunohistochemical and immunofluorescence analysis of the cortical and hippocampal regions of five CCD-affected and two nondemented aged dogs using 4G8 anti-Aβp, anti-Aβ1 - 42 nanobody (PrioAD13) and AT8 anti-p-Tau (Ser202, Thr205) antibody were used to demonstrate the presence of Aβ plaques (Aβp) and Aβ1 - 42 oligomers and p-Tau deposits, respectively. Results The extracellular Aβ senile plaques were of the diffuse type which lack the dense core normally seen in human AD. While p-Tau deposits displayed a widespread pattern and closely resembled the typical human neuropathology, they did not co-localize with the Aβp. Of considerable interest, however, widespread intraneuronal deposition of Aβ1 - 42 oligomers were exhibited in the frontal cortex and hippocampal region that co-localized with p-Tau. Conclusion Taken together, these findings reveal further shared neuropathologic features of AD and CCD, supporting the case that aged dogs afflicted with CCD offer a relevant model for investigating human AD.
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Affiliation(s)
- Umma Habiba
- School of Medicine, Western Sydney University, Campbelltown, NSW, Australia
| | - Makiko Ozawa
- Department of Veterinary Pathology, the University of Tokyo, Japan
| | - James K Chambers
- Department of Veterinary Pathology, the University of Tokyo, Japan
| | - Kazuyuki Uchida
- Department of Veterinary Pathology, the University of Tokyo, Japan
| | - Joseph Descallar
- Ingham Institute of Applied Medical Research, Liverpool, NSW, Australia
| | | | - Brian A Summers
- School of Veterinary Medicine, Melbourne University, Werribee, Victoria, Australia
| | - John W Morley
- School of Medicine, Western Sydney University, Campbelltown, NSW, Australia
| | - Mourad Tayebi
- School of Medicine, Western Sydney University, Campbelltown, NSW, Australia
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24
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Batumalai V, Descallar J, Wong K, Gabriel G, Delaney GP, Shafiq J, Vinod SK, Barton MB. Trends in the use of short-course radiation therapy for rectal cancer in New South Wales, Australia. J Med Imaging Radiat Oncol 2021; 66:436-441. [PMID: 34862736 DOI: 10.1111/1754-9485.13364] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 11/18/2021] [Indexed: 12/29/2022]
Abstract
INTRODUCTION Trends in the use of short-course radiation therapy (RT) for rectal cancer in Australia are unknown. The purpose of this study was to compare short-course RT and long-course chemoradiation (CRT) utilisation in the neoadjuvant treatment of rectal cancer in New South Wales (NSW). METHODS Patients who received neoadjuvant RT (2009-2014) for rectal cancer were identified from the NSW Central Cancer Registry. Univariate and multivariable analyses were performed to investigate factors associated with receipt of short-course RT. RESULTS A total of 1196 (81%) patients received long-course CRT, and 274 (19%) patients received short-course RT. Receipt of short-course RT was associated with older age: 54% in patients ≥80 years, and 11% in patients <50 years (P < 0.0001). Patients with T2 disease (30%) were more likely to receive short-course RT, compared with T3 (19%) or T4 (8%) disease (P = 0.002). Patients with N0 (23%) disease were more likely to be treated with short-course RT, compared with N+ (16%) (P = 0.03). The proportion of short-course RT delivered to patients with Charlson Comorbidity Index (CCI) ≥ 2 (28%) was higher than patients with CCI = 0 (17%) (P = 0.002). There was wide variation in the proportion of short-course RT used across residence local health districts (5-29%) (P < 0.0001). CONCLUSION In rectal cancer patients treated with neoadjuvant RT in NSW, 19% received short-course RT. The use of short-course RT was associated with older age, comorbidities and less advanced disease. Wide variation across NSW was identified and future research investigating factors for the variation will be useful.
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Affiliation(s)
- Vikneswary Batumalai
- Collaboration for Cancer Outcomes, Research and Evaluation, Ingham Institute for Applied Medical Research, South Western Clinical School, University of New South Wales, Sydney, New South Wales, Australia.,GenesisCare, Sydney, New South Wales, Australia
| | - Joseph Descallar
- Collaboration for Cancer Outcomes, Research and Evaluation, Ingham Institute for Applied Medical Research, South Western Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - Karen Wong
- Collaboration for Cancer Outcomes, Research and Evaluation, Ingham Institute for Applied Medical Research, South Western Clinical School, University of New South Wales, Sydney, New South Wales, Australia.,Department of Radiation Oncology, South Western Sydney Local Health District, Sydney, New South Wales, Australia
| | - Gabriel Gabriel
- Collaboration for Cancer Outcomes, Research and Evaluation, Ingham Institute for Applied Medical Research, South Western Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - Geoff P Delaney
- Collaboration for Cancer Outcomes, Research and Evaluation, Ingham Institute for Applied Medical Research, South Western Clinical School, University of New South Wales, Sydney, New South Wales, Australia.,Department of Radiation Oncology, South Western Sydney Local Health District, Sydney, New South Wales, Australia
| | - Jesmin Shafiq
- Collaboration for Cancer Outcomes, Research and Evaluation, Ingham Institute for Applied Medical Research, South Western Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - Shalini K Vinod
- Collaboration for Cancer Outcomes, Research and Evaluation, Ingham Institute for Applied Medical Research, South Western Clinical School, University of New South Wales, Sydney, New South Wales, Australia.,Department of Radiation Oncology, South Western Sydney Local Health District, Sydney, New South Wales, Australia
| | - Michael B Barton
- Collaboration for Cancer Outcomes, Research and Evaluation, Ingham Institute for Applied Medical Research, South Western Clinical School, University of New South Wales, Sydney, New South Wales, Australia.,Department of Radiation Oncology, South Western Sydney Local Health District, Sydney, New South Wales, Australia
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25
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Eapen V, Woolfenden S, Schmied V, Jalaludin B, Lawson K, Liaw ST, Lingam R, Page A, Cibralic S, Winata T, Mendoza Diaz A, Lam-Cassettari C, Burley J, Boydell K, Lin P, Masi A, Katz I, Dadich A, Preddy J, Bruce J, Raman S, Kohlhoff J, Descallar J, Karlov L, Kaplun C, Arora A, Di Mento B, Smead M, Doyle K, Grace R, McClean T, Blight V, Wood A, Raine KH. "Watch Me Grow- Electronic (WMG-E)" surveillance approach to identify and address child development, parental mental health, and psychosocial needs: study protocol. BMC Health Serv Res 2021; 21:1240. [PMID: 34789234 PMCID: PMC8596348 DOI: 10.1186/s12913-021-07243-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 08/13/2021] [Accepted: 10/29/2021] [Indexed: 11/11/2022] Open
Abstract
Background The COVID-19 pandemic and the associated economic recession has increased parental psychosocial stress and mental health challenges. This has adversely impacted child development and wellbeing, particularly for children from priority populations (culturally and linguistically diverse (CALD) and rural/regional communities) who are at an already increased risk of health inequality. The increased mental health and psychosocial needs were compounded by the closure of in-person preventive and health promotion programs resulting in health organisations embracing technology and online services. Watch Me Grow- Electronic (WMG-E) – developmental surveillance platform- exemplifies one such service. WMG-E was developed to monitor child development and guide parents towards more detailed assessments when risk is identified. This Randomised Controlled Trial (RCT) aims to expand WMG-E as a digital navigation tool by also incorporating parents’ mental health and psychosocial needs. Children and families needing additional assessments and supports will be electronically directed to relevant resources in the ‘care-as-usual’ group. In contrast, the intervention group will receive continuity of care, with additional in-person assessment and ‘warm hand over’ by a ‘service navigator’ to ensure their needs are met. Methods Using an RCT we will determine: (1) parental engagement with developmental surveillance; (2) access to services for those with mental health and social care needs; and (3) uptake of service recommendations. Three hundred parents/carers of children aged 6 months to 3 years (recruited from a culturally diverse, or rural/regional site) will be randomly allocated to the ‘care-as-usual’ or ‘intervention’ group. A mixed methods implementation evaluation will be completed, with semi-structured interviews to ascertain the acceptability, feasibility and impact of the WMG-E platform and service navigator. Conclusions Using WMG-E is expected to: normalise and de-stigmatise mental health and psychosocial screening; increase parental engagement and service use; and result in the early identification and management of child developmental needs, parental mental health, and family psychosocial needs. If effective, digital solutions such as WMG-E to engage and empower parents alongside a service navigator for vulnerable families needing additional support, will have significant practice and policy implications in the pandemic/post pandemic period. Trial registration The trial (Protocol No. 1.0, Version 3.1) was registered with ANZCTR (registration number: ACTRN12621000766819) on July 21st, 2021 and reporting of the trial results will be according to recommendations in the CONSORT Statement.
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Affiliation(s)
- V Eapen
- School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, Australia. .,South Western Sydney Local Health District, Liverpool, Australia.
| | - S Woolfenden
- Sydney Children's Hospital Randwick, Randwick, Australia
| | - V Schmied
- School of Nursing and Midwifery, Western Sydney University, Sydney, Australia
| | - B Jalaludin
- South Western Sydney Local Health District, Liverpool, Australia.,Ingham Institute for Applied Medical Research, Liverpool, Australia
| | - K Lawson
- School of Business, Western Sydney University, Sydney, Australia
| | - S T Liaw
- Population Child Health Research Group, School of Women's and Children's Health, Faculty of Medicine, University of New South Wales, Sydney, Australia.,WHO Collaborating Centre for eHealth, University of New South Wales, Sydney, Australia
| | - R Lingam
- Population Child Health Research Group, School of Women's and Children's Health, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - A Page
- School of Medicine, Western Sydney University, Campbelltown, Australia
| | - S Cibralic
- Ingham Institute for Applied Medical Research, Liverpool, Australia
| | - T Winata
- South Western Sydney Local Health District, Liverpool, Australia
| | - A Mendoza Diaz
- School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - C Lam-Cassettari
- School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - J Burley
- Population Child Health Research Group, School of Women's and Children's Health, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - K Boydell
- Black Dog Institute, Sydney, Australia
| | - P Lin
- School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, Australia.,South Western Sydney Local Health District, Liverpool, Australia
| | - A Masi
- School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - I Katz
- Social Policy Research Centre, Faculty of Arts, Design, & Architecture, University of New South Wales, Sydney, Australia
| | - A Dadich
- School of Business, Western Sydney University, Sydney, Australia
| | - J Preddy
- Murrumbidgee Local Health District, Wagga Wagga, Australia
| | - J Bruce
- Murrumbidgee Local Health District, Wagga Wagga, Australia
| | - S Raman
- South Western Sydney Local Health District, Liverpool, Australia
| | - J Kohlhoff
- School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, Australia.,Karitane, Carramar, Australia
| | - J Descallar
- Ingham Institute for Applied Medical Research, Liverpool, Australia
| | - L Karlov
- South Western Sydney Local Health District, Liverpool, Australia
| | - C Kaplun
- Ingham Institute for Applied Medical Research, Liverpool, Australia.,TeEACH -Transforming early Education and Child Health Research Centre, Western Sydney University, Sydney, Australia
| | - A Arora
- School of Health Sciences, Western Sydney University, Sydney, Australia.,Sydney Local Health District, Camperdown, Australia
| | - B Di Mento
- School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - M Smead
- Murrumbidgee Local Health District, Wagga Wagga, Australia
| | - K Doyle
- School of Medicine, Western Sydney University, Campbelltown, Australia
| | - R Grace
- TeEACH -Transforming early Education and Child Health Research Centre, Western Sydney University, Sydney, Australia
| | | | - V Blight
- South Western Sydney Local Health District, Liverpool, Australia
| | - A Wood
- Karitane, Carramar, Australia
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26
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Gray A, Bawazeer O, Arumugam S, Vial P, Descallar J, Thwaites D, Holloway L. Evaluation of the ability of three commercially available dosimeters to detect systematic delivery errors in step-and-shoot IMRT plans. Rep Pract Oncol Radiother 2021; 26:793-803. [PMID: 34760314 DOI: 10.5603/rpor.a2021.0093] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Accepted: 07/03/2021] [Indexed: 11/25/2022] Open
Abstract
Background There is limited data on error detectability for step-and-shoot intensity modulated radiotherapy (sIMRT) plans, despite significant work on dynamic methods. However, sIMRT treatments have an ongoing role in clinical practice. This study aimed to evaluate variations in the sensitivity of three patient-specific quality assurance (QA) devices to systematic delivery errors in sIMRT plans. Materials and methods Four clinical sIMRT plans (prostate and head and neck) were edited to introduce errors in: Multi-Leaf Collimator (MLC) position (increasing field size, leaf pairs offset (1-3 mm) in opposite directions; and field shift, all leaves offset (1-3 mm) in one direction); collimator rotation (1-3 degrees) and gantry rotation (0.5-2 degrees). The total dose for each plan was measured using an ArcCHECK diode array. Each field, excluding those with gantry offsets, was also measured using an Electronic Portal Imager and a MatriXX Evolution 2D ionisation chamber array. 132 plans (858 fields) were delivered, producing 572 measured dose distributions. Measured doses were compared to calculated doses for the no-error plan using Gamma analysis with 3%/3 mm, 3%/2 mm, and 2%/2 mm criteria (1716 analyses). Results Generally, pass rates decreased with increasing errors and/or stricter gamma criteria. Pass rate variations with detector and plan type were also observed. For a 3%/3 mm gamma criteria, none of the devices could reliably detect 1 mm MLC position errors or 1 degree collimator rotation errors. Conclusions This work has highlighted the need to adapt QA based on treatment plan type and the need for detector specific assessment criteria to detect clinically significant errors.
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Affiliation(s)
- Alison Gray
- Liverpool and Macarthur Cancer Therapy Centres, South Western Sydney Local Health District, Sydney, NSW, Australia.,Ingham Institute for Applied Medical Research, Sydney, NSW, Australia.,South Western Sydney Clinical School, School of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Omemh Bawazeer
- Physics Department, Umm Al-Qura University, Mecca, Saudi Arabia
| | - Sankar Arumugam
- Liverpool and Macarthur Cancer Therapy Centres, South Western Sydney Local Health District, Sydney, NSW, Australia.,Ingham Institute for Applied Medical Research, Sydney, NSW, Australia.,South Western Sydney Clinical School, School of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Philip Vial
- Liverpool and Macarthur Cancer Therapy Centres, South Western Sydney Local Health District, Sydney, NSW, Australia.,Ingham Institute for Applied Medical Research, Sydney, NSW, Australia.,South Western Sydney Clinical School, School of Medicine, University of New South Wales, Sydney, NSW, Australia.,Institute of Medical Physics, School of Physics, University of Sydney, Sydney, NSW, Australia
| | - Joseph Descallar
- Ingham Institute for Applied Medical Research, Sydney, NSW, Australia.,South Western Sydney Clinical School, School of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - David Thwaites
- Institute of Medical Physics, School of Physics, University of Sydney, Sydney, NSW, Australia
| | - Lois Holloway
- Liverpool and Macarthur Cancer Therapy Centres, South Western Sydney Local Health District, Sydney, NSW, Australia.,Ingham Institute for Applied Medical Research, Sydney, NSW, Australia.,South Western Sydney Clinical School, School of Medicine, University of New South Wales, Sydney, NSW, Australia.,Institute of Medical Physics, School of Physics, University of Sydney, Sydney, NSW, Australia.,Centre for Medical Radiation Physics, University of Wollongong, Wollongong, NSW, Australia
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27
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Jenkin DE, Naylor JM, Descallar J, Harris IA. Effectiveness of Oxycodone Hydrochloride (Strong Opioid) vs Combination Acetaminophen and Codeine (Mild Opioid) for Subacute Pain After Fractures Managed Surgically: A Randomized Clinical Trial. JAMA Netw Open 2021; 4:e2134988. [PMID: 34787656 PMCID: PMC8600392 DOI: 10.1001/jamanetworkopen.2021.34988] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Patients with a surgically managed fracture are commonly discharged from the hospital with a strong opioid prescription, but limited evidence exists to support this practice. OBJECTIVE To test the hypothesis that strong opioids provide greater analgesia than mild opioids over the first week postdischarge from hospital after fracture surgical treatment. DESIGN, SETTING, AND PARTICIPANTS This double-blind, superiority, randomized clinical trial was conducted at a single-center, major trauma hospital in Sydney, Australia. Participants were inpatients who had sustained an acute nonpathological facture of a long bone or the pelvis, patella, calcaneus, or talus who were treated with surgical fixation and enrolled from July 27, 2016, to August 22, 2017. Data were analyzed from June through October 2018. INTERVENTIONS Initiation at discharge of oxycodone hydrochloride 5 mg of 10 mg (ie, 1 or 2 tablets) or combination acetaminophen and codeine 500 mg and 8 mg or 1000 mg and 16 mg (ie, 1 or 2 tablets) 4 times daily for a maximum duration of 3 weeks. MAIN OUTCOMES AND MEASURES The primary outcome was the mean of daily pain scores collected during week 1 of treatment measured using the Numerical Pain Rating Scale (NRS). Participants were asked to rate their mean pain over the previous 24 hours daily using an NRS score from 0 to 10, with 0 representing no pain and 10 representing the worst pain imaginable. The key secondary outcomes were EuroQol 5-Dimension 5-Level Questionnaire (EQ-5D-5L) responses, worst pain, medication adverse events, global perceived effect, and return to work. RESULTS A total of 120 patients with 1 or more acute orthopedic fractures requiring surgical fixation were randomized, including 59 patients in the strong-opioid group (43 [72.9%] men; mean [SD] age, 36.0 [14.1] years; mean oral morphine equivalent for days 1-7 of 32.9 mg) and 61 patients in the mild opioid group (47 [77.1%] men; mean [SD] age, 38.2 [13.5] years; mean oral morphine equivalent for days 1-7 of 5.5 mg). From days 1 to 7 postdischarge, the mean daily NRS mean pain score was 4.04 (95% Cl, 3.67 to 4.41) in the strong opioid group and 4.54 (95% Cl, 4.17 to 4.90) in the mild opioid group. The between-group difference of the primary outcome was not statistically significant (-0.50 [95% Cl, -1.11 to 0.12]; P = .11) despite a 6-fold increased dose of opioids being delivered in the strong opioid group. CONCLUSIONS AND RELEVANCE This study found that treatment with strong opioid medication subacutely was not superior to treatment with milder medication for treatment of pain among patients with surgically managed orthopedic fractures. These findings suggest that ongoing first-line strong opioid use after discharge from the hospital should not be supported. TRIAL REGISTRATION Australia New Zealand Clinical Trial Registry No.: ACTRN12616000941460.
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Affiliation(s)
- Deanne E. Jenkin
- University of New South Wales, South Western Sydney Clinical School, Sydney, Australia
- Whitlam Orthopaedic Research Centre, Liverpool, New South Wales, Australia
- Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
- Presently with Daffodil Centre, University of Sydney, a joint venture with Cancer Council New South Wales, Kings Cross, New South Wales, Australia
| | - Justine M. Naylor
- University of New South Wales, South Western Sydney Clinical School, Sydney, Australia
- Whitlam Orthopaedic Research Centre, Liverpool, New South Wales, Australia
- Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
- Liverpool Hospital, South Western Sydney Local Health District, Sydney, New South Wales, Australia
| | - Joseph Descallar
- University of New South Wales, South Western Sydney Clinical School, Sydney, Australia
- Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
| | - Ian A. Harris
- University of New South Wales, South Western Sydney Clinical School, Sydney, Australia
- Whitlam Orthopaedic Research Centre, Liverpool, New South Wales, Australia
- Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
- Liverpool Hospital, South Western Sydney Local Health District, Sydney, New South Wales, Australia
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28
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Yu H, Shek KL, Gillor M, Descallar J, Dietz HP. Is the Visual Analogue Scale inferior to the Pelvic Organ Prolapse Distress Inventory for assessing symptom bother of pelvic organ prolapse? Aust N Z J Obstet Gynaecol 2021; 61:918-921. [PMID: 34318480 DOI: 10.1111/ajo.13412] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 06/04/2021] [Accepted: 07/13/2021] [Indexed: 11/27/2022]
Abstract
AIMS Disease-specific validated questionnaires are used to quantify symptom severity, but they are time consuming to complete and evaluate. A Visual Analogue Scale (VAS) assessment of bother is simpler and faster. The aim of this study is to compare VAS with individual and composite pelvic floor disability index-short form 20 items in predicting significant pelvic organ prolapse (POP). METHODS A retrospective analysis of data was obtained at a tertiary urogynaecological clinic between February 2017 and August 2018. All women filled out the PFDI-20 and underwent a standardised physician-directed interview, POP-Q and translabial ultrasound. Women with symptoms of POP were asked to indicate the degree of bother using a VAS. Receiver operating characteristic curves were used to evaluate the performance of individual Pelvic Organ Prolapse Distress Inventory (POPDI)-6 items, the six-item composite POPDI-6 score, and VAS in predicting significant POP on clinical and ultrasound examination. RESULTS The complete data sets of 231 women were analysed. Median VAS for POP was 2.9 (range 0-10). Median POPDI-6 individual and composite scores for items one to six were 2, 2, 2, 1, 2, 0 (all range 0-4) and 9 (range 0-22), respectively. The majority had significant prolapse on clinical examination (n = 195, 84%) and on ultrasound (n = 192, 83%). The composite POPDI-6 prolapse score provided areas under the curve of 0.68 and 0.64 for the prediction of clinical and sonographic POP, compared to 0.74 and 0.69, respectively, for VAS. The difference was not significant (P = 0.3 and 0.8, respectively). CONCLUSIONS The VAS score was not inferior to the POPDI-6 in predicting significant POP. It has the potential to simplify the assessment of symptom severity.
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Affiliation(s)
- Hongxia Yu
- Department of Ultrasound, The Second Affiliated Hospital of Zhengzhou University, Henan, China
| | - Ka Lai Shek
- Department of Obstetrics and Gynaecology, Liverpool Clinical School, Western Sydney University, Sydney, NSW, Australia.,Sydney Medical School Nepean, Department of O&G, University of Sydney, Penrith, NSW, Australia
| | - Moshe Gillor
- Department of O&G, affiliated to the Hebrew University and Hadassah Medical School in Jerusalem, Kaplan Medical Center, Rehovot, Israel
| | - Joseph Descallar
- Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia.,South Western Sydney Clinical School, UNSW, Sydney, NSW, Australia
| | - Hans Peter Dietz
- Sydney Medical School Nepean, Department of O&G, University of Sydney, Penrith, NSW, Australia
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Arnold BL, Girgis PA, Dhillon AH, Descallar J, Halkett AG. Does a communication skills program enable symptom and distress screening?: The impact of training on radiation therapists' confidence, knowledge, and use of distress screening. J Med Imaging Radiat Sci 2021; 52:399-408. [PMID: 34183301 DOI: 10.1016/j.jmir.2021.05.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Revised: 05/16/2021] [Accepted: 05/19/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Due to the prevalence of distress following a cancer diagnosis, routine symptom and distress screening is recommended as best practice. RTs perceive psychosocial support and screening to be part of their role, however feel they lack the education and skills to perform this confidently. The study aimed to evaluate the impact of providing communication skills training (RT Prepare CST) on the perceived barriers, knowledge, attitude, role, and confidence of radiation therapists (RTs) in using routine symptom and distress screening. METHODS A single-arm, pre-post intervention design was implemented. All RTs at one regional and one rural centre participated in RT Prepare CST. RTs completed a questionnaire: pre-intervention (T1); immediately post-intervention (T2); and, three months post-intervention (T3). Cochran's Q and McNemar's tests for non-parametric data were conducted to compare outcomes over time. RESULTS Of 39 RTs approached, 37 (95%) consented to participate with 36 (92%) completing questionnaires at all three time points. Significant and sustained improvements post-intervention were noted from T1-T3 including: confidence in describing the PROMPT-Care tool to patients (p=0.002), discussing psychosocial issues (p=0.014); recognising signs of anxiety/depression (p<0.001); dealing with signs of anxiety (p=0.002), depression (p=0.015) and distress (p=0.008) as well as agreeing 'the tool is useful in identifying psychosocial problems' (p=0.029). CONCLUSIONS RT Prepare CST was effective in increasing confidence, knowledge and attitudes of RTs in the psychosocial care of patients with a change in RT behaviour noted by a significant increase in the number of patients screened following the intervention. Providing routine CST and emotional cues training to RTs enhances their ability to care for patients holistically, equipping them with skills to be included within a psychosocial model of care. Engaged leadership and role models are essential to sustain the learnings from education programs and provide an environment to discuss and define roles within radiation therapy departments.
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Affiliation(s)
- Belinda L Arnold
- Illawarra Shoalhaven Local Health District, New South Wales, Australia; Centre for Oncology Education and Research Translation (CONCERT), Ingham Institute for Applied Medical Research, South Western Sydney Clinical School, University of New South Wales, Liverpool, New South Wales, Australia.
| | - Prof Afaf Girgis
- Centre for Oncology Education and Research Translation (CONCERT), Ingham Institute for Applied Medical Research, South Western Sydney Clinical School, University of New South Wales, Liverpool, New South Wales, Australia
| | - A/Prof Haryana Dhillon
- Centre for Medical Psychology & Evidence-based Decision-making School of Psychology, Faculty of Science. The University of Sydney, Sydney, New South Wales, Australia
| | - Joseph Descallar
- Centre for Oncology Education and Research Translation (CONCERT), Ingham Institute for Applied Medical Research, South Western Sydney Clinical School, University of New South Wales, Liverpool, New South Wales, Australia
| | - A/Prof Georgia Halkett
- Curtin School of Nursing, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
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Habiba U, Descallar J, Kreilaus F, Adhikari UK, Kumar S, Morley JW, Bui BV, Hamaoui MK, Tayebi M. Detection of retinal and blood Aβ oligomers with nanobodies. Alzheimers Dement (Amst) 2021; 13:e12193. [PMID: 33977118 PMCID: PMC8101010 DOI: 10.1002/dad2.12193] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 04/13/2021] [Accepted: 04/13/2021] [Indexed: 12/11/2022]
Abstract
Introduction Abnormal retinal changes are increasingly recognized as an early pathological change in Alzheimer's disease (AD). Although amyloid beta oligomers (Aβo) have been shown to accumulate in the blood and retina of AD patients and animals, it is not known whether the early Aβo deposition precedes their accumulation in brain. Methods and results Using nanobodies targeting Aβ1‐40 and Aβ1‐42 oligomers we were able to detect Aβ oligomers in the retina and blood but not in the brain of 3‐month‐old APP/PS1 mice. Furthermore, Aβ plaques were detected in the brain but not the retina of 3‐month‐old APP/PS1 mice. Conclusion These results suggest that retinal accumulation of Aβo originates from peripheral blood and precedes cognitive decline and Aβo deposition in the brain. This provides a very strong basis to develop and implement an “eye test” for early detection of AD using nanobodies targeting retinal Aβ.
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Affiliation(s)
- Umma Habiba
- School of Medicine Western Sydney University Campbelltown New South Wales Australia
| | - Joseph Descallar
- South Western Sydney Clinical School, Faculty of Medicine UNSW, Liverpool Hospital Liverpool New South Wales Australia.,Ingham Institute of Applied Medical Research Liverpool New South Wales Australia
| | - Fabian Kreilaus
- School of Medicine Western Sydney University Campbelltown New South Wales Australia
| | - Utpal K Adhikari
- School of Medicine Western Sydney University Campbelltown New South Wales Australia
| | - Sachin Kumar
- School of Medicine Western Sydney University Campbelltown New South Wales Australia
| | - John W Morley
- School of Medicine Western Sydney University Campbelltown New South Wales Australia
| | - Bang V Bui
- Department of Optometry and Vision Sciences University of Melbourne Melbourne Victoria Australia
| | - Maya K Hamaoui
- Department of Neurosurgery Maxine Dunitz Neurosurgical Research Institute and Department of Biomedical Sciences Cedars-Sinai Medical Center Los Angeles California USA
| | - Mourad Tayebi
- School of Medicine Western Sydney University Campbelltown New South Wales Australia
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Kanazaki R, Smith B, Girgis A, Descallar J, Connor S. Survey of barriers to adherence to international inflammatory bowel disease guidelines: Does gastroenterologists' confidence translate to high adherence? Intern Med J 2021; 52:1330-1338. [PMID: 33755298 DOI: 10.1111/imj.15299] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 03/02/2021] [Accepted: 03/11/2021] [Indexed: 12/07/2022]
Abstract
BACKGROUND & AIMS Despite the availability of evidence-based inflammatory bowel disease (IBD) guidelines, suboptimal care persists. There is little published research assessing barriers to IBD guideline adherence. This study aimed to identify barriers to IBD guideline adherence including gastroenterologists' knowledge and attitudes towards guidelines. METHODS An online cross-sectional survey of 824 Australian gastroenterologists was conducted from April to August 2018, with 198 (24%) responses. A novel survey was developed which was informed by the theoretical domain's framework. RESULTS Confidence in guideline recommendations was high, however referral to them was low. The European Crohn's and Colitis Organisation (ECCO) guidelines were the most commonly referred to (43.6%). In multivariate analysis, significant predictors of frequent versus infrequent guideline referral were: high confidence in the guideline (OR 7.70, 95% CI: 2.43-24.39, p = 0.001), and low (≤10 years) clinical experience (OR 3.62, 95% CI: 1.11-11.79, p = 0.03). The most common barriers to guideline adherence were not having time (62%) followed by guideline specifics being difficult to remember (61%). Low confidence was reported in managing pregnancy and IBD (34%) and loss of response to therapy (29%). High confidence was reported in managing immunomodulators, however only 43% answered the associated knowledge question correctly. CONCLUSION Although gastroenterologists' have high confidence in guidelines, they use them infrequently, primarily due to specifics being difficult to remember and lack of time. Self-reported confidence in an area of IBD management does not always reflect knowledge. An intervention targeting these barriers, for example computer-based clinical decision support tools, may improve adherence and standardise care. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Ria Kanazaki
- South Western Sydney Clinical School, University of New South Wales, Australia
| | - Ben Smith
- South Western Sydney Clinical School, University of New South Wales, Australia.,Ingham Institute for Applied Medical Research, Sydney, Australia
| | - Afaf Girgis
- South Western Sydney Clinical School, University of New South Wales, Australia.,Ingham Institute for Applied Medical Research, Sydney, Australia
| | - Joseph Descallar
- South Western Sydney Clinical School, University of New South Wales, Australia.,Ingham Institute for Applied Medical Research, Sydney, Australia
| | - Susan Connor
- South Western Sydney Clinical School, University of New South Wales, Australia.,Ingham Institute for Applied Medical Research, Sydney, Australia.,Department of Gastroenterology and Hepatology, Liverpool Hospital, Sydney, Australia
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Wang G, Karimi N, Descallar J, O’Connor K, Pipicella J, Willmann L, Williams A, Huang VW. A170 A NOVEL DECISION AID IMPROVES KNOWLEDGE AND QUALITY OF PREGNANCY-RELATED DECISION-MAKING IN IBD. J Can Assoc Gastroenterol 2021. [DOI: 10.1093/jcag/gwab002.168] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Women with inflammatory bowel disease (IBD) with poor IBD-specific reproductive knowledge experience more voluntary childlessness. Poor knowledge is associated with fear of IBD medications in pregnancy; this must be addressed as active IBD at preconception (PC) correlates with worse intrapartum disease and poor fetal outcomes. The Pregnancy IBD Decision Aid (PIDA), developed by an international multidisciplinary team following International Patient Decision Aids Standards, is an interactive online tool that offers personalised decision support on fertility, pregnancy, and medications in IBD (Fig).
Aims
To assess PIDA’s impact on knowledge and quality of decision-making among PC and pregnant patients with IBD, and to evaluate its feasibility as a tool for patients and clinicians.
Methods
PC and pregnant women aged 18–45 with IBD, recruited in Canada and Australia, completed questionnaires pre and post PIDA to assess quality of decision-making (Decisional Conflict Scale, DCS; Self-Efficacy Score, SES) and IBD in pregnancy knowledge (Crohn’s and Colitis Pregnancy Knowledge Score, CCPKnow). DCS assesses if a decision is informed, aligned with personal values, and would be implemented. SES measures belief in one’s ability to make informed decisions. Patients and clinicians (gastroenterology, obstetrics, primary care) also completed feasibility surveys. Paired t-test assessed for differences pre and post PIDA.
Results
DCS and SES were completed by 74 patients (42 Crohn’s disease, 32 ulcerative colitis); 41 PC and 33 pregnant. DCS improved significantly post PIDA (effect size 0.44, p<0.0001); this was observed in PC patients regarding pregnancy planning with IBD, and in pregnant patients regarding peripartum IBD medication management. SES of PC but not pregnant patients improved significantly post PIDA (effect size 0.32 vs 0.24, p=0.0001 vs 0.0525). In both cohorts, CCPKnow improved significantly post PIDA (n=76, effect size 0.66, p<0.0001).
Patients (n=73) assessed PIDA feasibility. Mean scores for length (3.05±0.44), readability (3.09±0.5), and content amount (2.91±0.81) were perceived as appropriate (1=limited, 5=excessive). Perceived usefulness of PIDA was high among all patients (4.09±0.93; 5=most useful). Clinicians (n=14) believed PIDA had appropriate length, readability, and content amount, and deemed PIDA useful to patients (4.6±0.8) and themselves (4.8±0.8) for clinical practice.
Conclusions
PIDA improved knowledge and quality of decision-making in PC and pregnant patients with IBD. Patients developed a strengthened belief in their ability to make informed, effective decisions, and both patients and clinicians found PIDA feasible. PIDA is an accessible tool that can empower women with IBD to make evidence-based decisions about pregnancy and may ultimately reduce voluntary childlessness.
Funding Agencies
Mount Sinai Hospital Resident Research Grant; Gastroenterological Society of Australia Rose Amarant Grant; Women and Children’s Health Research Institute (WCHRI); Clinical/Community Research Integration Support Program (CRISP); Merck Better Care, Healthy Communities Funding Program
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Affiliation(s)
- G Wang
- University of Toronto, Toronto, ON, Canada
| | - N Karimi
- University of New South Wales, Sydney, New South Wales, Australia
| | - J Descallar
- Ingham Institute, Liverpool, New South Wales, Australia
| | - K O’Connor
- Mount Sinai Hospital Department of Gastroenterology, Toronto, ON, Canada
| | - J Pipicella
- Ingham Institute, Liverpool, New South Wales, Australia
| | - L Willmann
- Liverpool Hospital Department of Gastroenterology, Liverpool, New South Wales, Australia
| | - A Williams
- Liverpool Hospital Department of Gastroenterology, Liverpool, New South Wales, Australia
| | - V W Huang
- Mount Sinai Hospital Department of Gastroenterology, Toronto, ON, Canada
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Barbaro J, Masi A, Gilbert M, Nair R, Abdullahi I, Descallar J, Dissanayake C, Eastwood J, Hasan I, Jalaludin B, Karlov L, Khan F, Kohlhoff J, Liaw ST, Lingam R, Mendoza Diaz A, Ong N, Tam CWM, Unwin K, Woolfenden S, Eapen V. A Multistate Trial of an Early Surveillance Program for Autism Within General Practices in Australia. Front Pediatr 2021; 9:640359. [PMID: 33968847 PMCID: PMC8102783 DOI: 10.3389/fped.2021.640359] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 03/12/2021] [Indexed: 11/13/2022] Open
Abstract
Background: The early detection of developmental conditions such as autism is vital to ensure children can access appropriate and timely evidence-based supports, services, and interventions. Children who have undetected developmental conditions early in life are more likely to develop later health, developmental, learning, and behavioral issues, which in turn can have a cumulative effect over the life course. Methods: The current protocol describes a multi-site, cluster randomized control trial comparing a developmental surveillance pathway for autism to usual care, using opportunistic visits to general practitioners (GPs). Units of randomization are GP clinics across two Australian states (New South Wales and Victoria), with thirty clinics within each state, each of which will aim to recruit approximately forty children aged between ~18- and 24-months, for a total of ~2,400 participants. Children will be randomized to two clusters; namely, an autism surveillance pathway (ASP) or surveillance as usual (SaU). The screening process for the ASP arm involves primary and secondary screenings for developmental concerns for autism, using both parent and GP reports and observations. Children in both arms who show signs of developmental concerns for autism will be offered a full developmental assessment by the research team at 24 months of age to determine the efficacy of developmental surveillance in successfully identifying children with autism. Trial Registration: The trial is registered with ANZCTR (ACTRN12619001200178) and reporting of the trial results will be according to recommendations in the CONSORT Statement.
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Affiliation(s)
- Josephine Barbaro
- Olga Tennison Autism Research Centre, School of Psychology and Public Health, College of Science, Health & Engineering, La Trobe University, Bundoora, VIC, Australia.,Cooperative Research Centre for Living With Autism (Autism CRC), The University of Queensland, Indooroopilly, QLD, Australia
| | - Anne Masi
- Cooperative Research Centre for Living With Autism (Autism CRC), The University of Queensland, Indooroopilly, QLD, Australia.,Faculty of Medicine, School of Psychiatry, University of New South Wales, Sydney, NSW, Australia
| | - Melissa Gilbert
- Olga Tennison Autism Research Centre, School of Psychology and Public Health, College of Science, Health & Engineering, La Trobe University, Bundoora, VIC, Australia
| | - Radhika Nair
- Olga Tennison Autism Research Centre, School of Psychology and Public Health, College of Science, Health & Engineering, La Trobe University, Bundoora, VIC, Australia
| | - Ifrah Abdullahi
- Olga Tennison Autism Research Centre, School of Psychology and Public Health, College of Science, Health & Engineering, La Trobe University, Bundoora, VIC, Australia
| | - Joseph Descallar
- Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia.,South Western Sydney Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - Cheryl Dissanayake
- Olga Tennison Autism Research Centre, School of Psychology and Public Health, College of Science, Health & Engineering, La Trobe University, Bundoora, VIC, Australia.,Cooperative Research Centre for Living With Autism (Autism CRC), The University of Queensland, Indooroopilly, QLD, Australia
| | - John Eastwood
- Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia.,Faculty of Medicine and Health, School of Medicine, University of Sydney, Sydney, NSW, Australia.,Faculty of Medicine, School of Women and Children's Health, University of New South Wales, Sydney, NSW, Australia
| | - Iqbal Hasan
- Faculty of Medicine, School of Psychiatry, University of New South Wales, Sydney, NSW, Australia
| | - Bin Jalaludin
- Faculty of Medicine, School of Population Health, University of New South Wales, Sydney, NSW, Australia
| | - Lisa Karlov
- Faculty of Medicine, School of Psychiatry, University of New South Wales, Sydney, NSW, Australia.,Academic Unit of Psychiatry, Infant Child and Adolescent Mental Health Services, South Western Sydney Local Health District, Sydney, NSW, Australia
| | - Feroza Khan
- Faculty of Medicine, School of Psychiatry, University of New South Wales, Sydney, NSW, Australia
| | - Jane Kohlhoff
- Faculty of Medicine, School of Psychiatry, University of New South Wales, Sydney, NSW, Australia
| | - S T Liaw
- Faculty of Medicine, School of Population Health, University of New South Wales, Sydney, NSW, Australia
| | - Raghu Lingam
- Population Child Health Research Group, Faculty of Medicine, School of Women's and Children's Health, University of New South Wales, Sydney, NSW, Australia
| | - Antonio Mendoza Diaz
- Faculty of Medicine, School of Psychiatry, University of New South Wales, Sydney, NSW, Australia.,Academic Unit of Psychiatry, Infant Child and Adolescent Mental Health Services, South Western Sydney Local Health District, Sydney, NSW, Australia
| | - Natalie Ong
- Children's Hospital Westmead Clinical School, University of Sydney, Sydney, NSW, Australia
| | - Chun Wah Michael Tam
- Faculty of Medicine, School of Population Health, University of New South Wales, Sydney, NSW, Australia.,Primary and Integrated Care Unit, South Western Sydney Local Health District, Liverpool, NSW, Australia
| | - Katy Unwin
- Olga Tennison Autism Research Centre, School of Psychology and Public Health, College of Science, Health & Engineering, La Trobe University, Bundoora, VIC, Australia
| | - Sue Woolfenden
- Population Child Health Research Group, Faculty of Medicine, School of Women's and Children's Health, University of New South Wales, Sydney, NSW, Australia
| | - Valsamma Eapen
- Cooperative Research Centre for Living With Autism (Autism CRC), The University of Queensland, Indooroopilly, QLD, Australia.,Faculty of Medicine, School of Psychiatry, University of New South Wales, Sydney, NSW, Australia.,Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia.,Academic Unit of Psychiatry, Infant Child and Adolescent Mental Health Services, South Western Sydney Local Health District, Sydney, NSW, Australia
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Batumalai V, Descallar J, Delaney G, Gabriel G, Wong K, Shafiq J, Vinod S, Barton M. Patterns of use of palliative radiotherapy fractionation for bone metastases and 30-day mortality. Radiother Oncol 2021; 154:299-305. [DOI: 10.1016/j.radonc.2020.11.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 10/30/2020] [Accepted: 11/08/2020] [Indexed: 12/18/2022]
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Batumalai V, Descallar J, Delaney GP, Gabriel G, Wong K, Shafiq J, Vinod SK, Barton MB. Patterns of palliative radiotherapy fractionation for brain metastases patients in New South Wales, Australia. Radiother Oncol 2020; 156:174-180. [PMID: 33359268 DOI: 10.1016/j.radonc.2020.12.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 12/10/2020] [Accepted: 12/12/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND AND PURPOSE There is a paucity of studies examining variation in the use of palliative radiation therapy (RT) fractionation for brain metastases. The aim of this study is to assess variation in palliative RT fractionation given for brain metastases in New South Wales (NSW), Australia, and identify factors associated with variation. MATERIALS AND METHODS This is a population-based cohort of patients who received whole brain RT (WBRT) for brain metastases (2009-2014), as captured in the NSW Central Cancer Registry. A logistic regression model was used to identify factors associated with fractionation type. RESULTS Of the 2,698 patients that received WBRT, 1,389 courses (51%) were < 6 fractions, 1,050 courses (39%) were 6-10 fractions, and 259 courses (10%) were > 10 fractions. Older patients were more likely to be treated with shorter courses (P < 0.0001). Patients with primary lung cancers were more likely to receive shorter courses compared with other primary cancers (P < 0.0001). Patients without surgical excision were more likely to receive < 6 fractions compared to those who underwent surgical excision. Shorter courses were more likely to be delivered to patients with the most disadvantaged socioeconomic status (SES) compared with patients with the least disadvantaged SES (P < 0.0001). There were significant fluctuations in the proportion of courses using lower number of fractions over time from 2009 to 2014, but no apparent trend (P = 0.02). There was wide variation in the proportion of shorter courses across residence local health districts, ranging from 24% to 69% for < 6 fractions, 21% to 72% for 6-10 fractions, and 4% to 20% for > 10 fractions (P < 0.0001). CONCLUSION This study has identified significant unwarranted variations in fractionation for WBRT in NSW. Accelerating the uptake of shorter fractionation regimens, if warranted through evidence, should be prioritised to enhance evidence-based care.
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Affiliation(s)
- V Batumalai
- Collaboration for Cancer Outcomes, Research and Evaluation, Ingham Institute for Applied Medical Research, South Western Clinical School, University of New South Wales, Australia; Department of Radiation Oncology, South Western Sydney Local Health District, New South Wales, Australia.
| | - J Descallar
- Collaboration for Cancer Outcomes, Research and Evaluation, Ingham Institute for Applied Medical Research, South Western Clinical School, University of New South Wales, Australia
| | - G P Delaney
- Collaboration for Cancer Outcomes, Research and Evaluation, Ingham Institute for Applied Medical Research, South Western Clinical School, University of New South Wales, Australia; Department of Radiation Oncology, South Western Sydney Local Health District, New South Wales, Australia
| | - G Gabriel
- Collaboration for Cancer Outcomes, Research and Evaluation, Ingham Institute for Applied Medical Research, South Western Clinical School, University of New South Wales, Australia
| | - K Wong
- Collaboration for Cancer Outcomes, Research and Evaluation, Ingham Institute for Applied Medical Research, South Western Clinical School, University of New South Wales, Australia; Department of Radiation Oncology, South Western Sydney Local Health District, New South Wales, Australia
| | - J Shafiq
- Collaboration for Cancer Outcomes, Research and Evaluation, Ingham Institute for Applied Medical Research, South Western Clinical School, University of New South Wales, Australia
| | - S K Vinod
- Collaboration for Cancer Outcomes, Research and Evaluation, Ingham Institute for Applied Medical Research, South Western Clinical School, University of New South Wales, Australia; Department of Radiation Oncology, South Western Sydney Local Health District, New South Wales, Australia
| | - M B Barton
- Collaboration for Cancer Outcomes, Research and Evaluation, Ingham Institute for Applied Medical Research, South Western Clinical School, University of New South Wales, Australia; Department of Radiation Oncology, South Western Sydney Local Health District, New South Wales, Australia
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Jones KF, Pryor J, Care-Unger C, Descallar J, Simpson GK. Effectiveness of spiritual care training for rehabilitation professionals: An exploratory controlled trial. NeuroRehabilitation 2020; 47:393-403. [DOI: 10.3233/nre-203221] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND: Spirituality may play an important role in neurorehabilitation, however research findings indicate that rehabilitation professionals do not feel well equipped to deliver spiritual care. OBJECTIVE: To evaluate a spiritual care training program for rehabilitation professionals. METHODS: An exploratory controlled trial was conducted. Participants enrolled in a two-module spiritual care training program. Spiritual care competency was measured with the Spiritual Care Competency Scale. Confidence and comfort levels were measured using the Spiritual Care Competency Scale domains. The Spirituality and Spiritual Care Rating Scale assessed participant attitudes and knowledge. Measures were administered three times: pre-program, post-program and six weeks follow-up. RESULTS: The training (n = 41) and control (n = 32) groups comprised rehabilitation professionals working in spinal cord or traumatic brain injury units. No between-group differences were observed on the study variables at the pre-program time point. Multilevel models found that levels of spiritual care competency, confidence, comfort, and ratings on existential spirituality increased significantly for the training group (versus control) post-program (p < 0.05) and these significant differences were maintained at follow-up. CONCLUSIONS: A brief spiritual care training program can be effective in increasing levels of self-reported competency, confidence and comfort in delivery of spiritual care for rehabilitation professionals.
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Affiliation(s)
- Kate Fiona Jones
- Royal Rehab, PO Box 6, Ryde, Sydney, NSW, Australia
- Institute for Ethics and Society, University of Notre Dame, Sydney, Australia
| | - Julie Pryor
- Royal Rehab, PO Box 6, Ryde, Sydney, NSW, Australia
- Susan Wakil School of Nursing & Midwifery, University of Sydney, Sydney, NSW, Australia
| | | | - Joseph Descallar
- Biostatistics Unit, Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia
- South Western Sydney Clinical School, University of New South Wales, Liverpool, Australia
| | - Grahame Kenneth Simpson
- Brain Injury Rehabilitation Research Group, Ingham Institute for Applied Medical Research, Sydney, NSW, Australia
- School of Human Services and Social Work, Griffith University, Brisbane, QLD, Australia
- John Walsh Centre for Rehabilitation Research, Sydney School of Medicine, University of Sydney, Sydney, NSW, Australia
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Haider S, Descallar J, Moylan E, Chua W. Polypharmacy and the use of low or limited value medications in advanced cancer. Intern Med J 2020; 51:1891-1896. [PMID: 33305887 DOI: 10.1111/imj.14964] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 06/10/2020] [Accepted: 06/15/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Patients with advanced malignancy are often on medications for co-morbidities, including those for primary or secondary prevention. The benefit from these medications can be limited and may result in adverse effects, interact with medications used for the malignancy or associated symptoms, increase pill burden and reduce quality of life. AIMS To evaluate the proportion of patients with advanced malignancy that were continued on low or limited value medications and identify the factors associated with this. We also sought to determine how prevalent polypharmacy was within this group of patients and the factors associated with this. METHODS A retrospective chart review was conducted of patients with incurable malignancy admitted under medical oncology at Liverpool Hospital over a 90-day period. Demographic variables, co-morbidities, disease related parameters and medications were reviewed. Criteria were established to identify low or limited value medications. RESULTS Seventy-eight patients were identified between September and December 2018. Thirty-day mortality was 33%. Sixty-five percent of the cohort was on five or more medications and 24% on 10 or more. One low or limited value medication was reported in 36% and 20% were on two or more. Age ≤60 years was associated with a risk of being on at least one unnecessary medication. Patients with fewer co-morbidities and those in their last 3 months of life were significantly less likely to have polypharmacy. Nine percent of the cohort was on three or more antihypertensives and 6% of patients were on three or more oral hypoglycaemics. CONCLUSION Polypharmacy and continued prescribing of low or limited value medications was identified in a high proportion of patients. Further studies are needed to assess the impact of continuing these medications, as well as investigation of patient and physician attitudes towards de-escalation.
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Affiliation(s)
- Sana Haider
- Liverpool Cancer Therapy Centre, New South Wales, Australia.,UNSW Sydney, Sydney, New South Wales, Australia
| | - Joseph Descallar
- Ingham Institute for Applied Medical Research, New South Wales, Australia.,UNSW Sydney, Sydney, New South Wales, Australia
| | - Eugene Moylan
- Liverpool Cancer Therapy Centre, New South Wales, Australia
| | - Wei Chua
- Liverpool Cancer Therapy Centre, New South Wales, Australia.,Ingham Institute for Applied Medical Research, New South Wales, Australia.,UNSW Sydney, Sydney, New South Wales, Australia
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Li Z, Satchithanandha A, Hopkins A, Otton J, Descallar J, Adams D, Tang S, Field M, Batumalai V, Holloway L, Delaney G, Koh E. PH-0595: Cardiovascular sequelae after adjuvant therapy in a 10-year cohort of breast cancer patients. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)00617-4] [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]
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Girgis A, Durcinoska I, Arnold A, Descallar J, Kaadan N, Koh ES, Miller A, Ng W, Carolan M, Della-Fiorentina SA, Avery S, Delaney GP. Web-Based Patient-Reported Outcome Measures for Personalized Treatment and Care (PROMPT-Care): Multicenter Pragmatic Nonrandomized Trial. J Med Internet Res 2020; 22:e19685. [PMID: 33118954 PMCID: PMC7661255 DOI: 10.2196/19685] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 08/04/2020] [Accepted: 08/18/2020] [Indexed: 12/16/2022] Open
Abstract
Background Despite the acceptability and efficacy of e–patient-reported outcome (ePRO) systems, implementation in routine clinical care remains challenging. Objective This pragmatic trial implemented the PROMPT-Care (Patient Reported Outcome Measures for Personalized Treatment and Care) web-based system into existing clinical workflows and evaluated its effectiveness among a diverse population of patients with cancer. Methods Adult patients with solid tumors receiving active treatment or follow-up care in four cancer centers were enrolled. The PROMPT-Care intervention supported patient management through (1) monthly off-site electronic PRO physical symptom and psychosocial well-being assessments, (2) automated electronic clinical alerts notifying the care team of unresolved clinical issues following two consecutive assessments, and (3) tailored online patient self-management resources. Propensity score matching was used to match controls with intervention patients in a 4:1 ratio for patient age, sex, and treatment status. The primary outcome was a reduction in emergency department presentations. Secondary outcomes were time spent on chemotherapy and the number of allied health service referrals. Results From April 2016 to October 2018, 328 patients from four public hospitals received the intervention. Matched controls (n=1312) comprised the general population of patients with cancer, seen at the participating hospitals during the study period. Emergency department visits were significantly reduced by 33% (P=.02) among patients receiving the intervention compared with patients in the matched controls. No significant associations were found in allied health referrals or time to end of chemotherapy. At baseline, the most common patient reported outcomes (above-threshold) were fatigue (39%), tiredness (38.4%), worry (32.9%), general wellbeing (32.9%), and sleep (24.1%), aligning with the most frequently accessed self-management domain pages of physical well-being (36%) and emotional well-being (23%). The majority of clinical feedback reports were reviewed by nursing staff (729/893, 82%), largely in response to the automated clinical alerts (n=877). Conclusions Algorithm-supported web-based systems utilizing patient reported outcomes in clinical practice reduced emergency department presentations among a diverse population of patients with cancer. This study also highlighted the importance of (1) automated triggers for reviewing above-threshold results in patient reports, rather than passive manual review of patient records; (2) the instrumental role nurses play in managing alerts; and (3) providing patients with resources to support guided self-management, where appropriate. Together, these factors will inform the integration of web-based PRO systems into future models of routine cancer care. Trial Registration Australian New Zealand Clinical Trials Registry ACTRN12616000615482; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=370633 International Registered Report Identifier (IRRID) RR2-10.1186/s12885-018-4729-3
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Affiliation(s)
- Afaf Girgis
- Centre for Oncology Education and Research Translation, Ingham Institute for Applied Medical Research, Sydney, Australia.,Faculty of Medicine, The University of New South Wales, Sydney, Australia
| | - Ivana Durcinoska
- Centre for Oncology Education and Research Translation, Ingham Institute for Applied Medical Research, Sydney, Australia.,Faculty of Medicine, The University of New South Wales, Sydney, Australia
| | - Anthony Arnold
- Centre for Oncology Education and Research Translation, Ingham Institute for Applied Medical Research, Sydney, Australia.,Illawarra Cancer Care Centre, Wollongong Hospital, Wollongong, Australia
| | - Joseph Descallar
- Centre for Oncology Education and Research Translation, Ingham Institute for Applied Medical Research, Sydney, Australia.,Faculty of Medicine, The University of New South Wales, Sydney, Australia
| | - Nasreen Kaadan
- Centre for Oncology Education and Research Translation, Ingham Institute for Applied Medical Research, Sydney, Australia.,Liverpool Cancer Therapy Centre, Liverpool Hospital, Sydney, Australia
| | - Eng-Siew Koh
- Centre for Oncology Education and Research Translation, Ingham Institute for Applied Medical Research, Sydney, Australia.,Liverpool Cancer Therapy Centre, Liverpool Hospital, Sydney, Australia
| | - Andrew Miller
- Centre for Oncology Education and Research Translation, Ingham Institute for Applied Medical Research, Sydney, Australia.,Illawarra Cancer Care Centre, Wollongong Hospital, Wollongong, Australia.,Centre for Oncology Informatics, University of Wollongong, Wollongong, Australia
| | - Weng Ng
- Centre for Oncology Education and Research Translation, Ingham Institute for Applied Medical Research, Sydney, Australia.,Liverpool Cancer Therapy Centre, Liverpool Hospital, Sydney, Australia.,School of Medicine, Western Sydney University, Sydney, Australia
| | - Martin Carolan
- Centre for Oncology Education and Research Translation, Ingham Institute for Applied Medical Research, Sydney, Australia.,Illawarra Cancer Care Centre, Wollongong Hospital, Wollongong, Australia
| | - Stephen A Della-Fiorentina
- Centre for Oncology Education and Research Translation, Ingham Institute for Applied Medical Research, Sydney, Australia.,School of Medicine, Western Sydney University, Sydney, Australia.,Macarthur Cancer Therapy Centre, Campbelltown Hospital, Sydney, Australia
| | - Sandra Avery
- Centre for Oncology Education and Research Translation, Ingham Institute for Applied Medical Research, Sydney, Australia.,Liverpool Cancer Therapy Centre, Liverpool Hospital, Sydney, Australia
| | - Geoff P Delaney
- Centre for Oncology Education and Research Translation, Ingham Institute for Applied Medical Research, Sydney, Australia.,Faculty of Medicine, The University of New South Wales, Sydney, Australia.,Liverpool Cancer Therapy Centre, Liverpool Hospital, Sydney, Australia
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Kelly G, Brown S, Gillett L, Descallar J, Simpson GK. Can behaviour support interventions successfully treat inappropriate sexual behaviour after acquired brain injury in community settings? A case series ( N = 24). Neuropsychol Rehabil 2020; 32:407-428. [PMID: 33081575 DOI: 10.1080/09602011.2020.1830807] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Inappropriate sexual behaviours (ISX) are challenging clinical sequelae of acquired brain injury (ABI). Limited evidence exists about treatment approaches, with few case studies published to date. This study reports an exploratory clinical trial of community-based behaviour support interventions as a treatment approach to ISX after ABI. From routine referrals to a state-wide service specializing in challenging behaviours after ABI, a cohort (n = 24) displaying ISXs were selected. The interventions addressed multiple behavioural domains, and used a variety of approaches including environmental change, psychoeducation, and specific behavioural techniques. These approaches targetted change in the person with ABI, support personnel, or other environmental domains. Behaviour data were collected using the Overt Behaviour Scale (OBS) at baseline, closure and follow-up. Visual inspection and multilevel models were used to analyse the data. For the sample as a whole, there was a significant decline in ISXs from baseline to closure that was maintained at follow-up. Results at an individual level are also presented. Specificity of the intervention was demonstrated by comparison with concurrent challenging behaviours (aggression, perseveration, absconding) which showed no significant change over the same three time points. The results demonstrate the potential efficacy of community-based behaviour support interventions in treating ISXs after ABI.
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Affiliation(s)
| | | | - Lauren Gillett
- Department of Neurology, Liverpool Hospital, Sydney, Australia
| | - Joseph Descallar
- Ingham Institute for Applied Medical Research, Sydney, Australia.,South Western Sydney Clinical School, UNSW Australia, Liverpool, Australia
| | - Grahame K Simpson
- Ingham Institute for Applied Medical Research, Sydney, Australia.,John Walsh Centre for Rehabilitation Research, University of Sydney, Sydney, Australia
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Karimi N, Descallar J, Girgis A, Soon PS. Breast reconstruction in South Western Sydney. ANZ J Surg 2020; 90:2340-2345. [PMID: 33021080 DOI: 10.1111/ans.16298] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 08/23/2020] [Accepted: 08/25/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND The rates of breast reconstruction in Australian patients of culturally and linguistically diverse (CALD) backgrounds are currently unknown. This retrospective study determined the rate of breast reconstruction in women who had mastectomy as treatment for breast cancer at public hospitals in South Western Sydney Local Health District (SWSLHD) - a culturally diverse health district in New South Wales, Australia - and compared the rate of reconstruction in the CALD and non-CALD populations. METHODS The demographic and clinical data of all female patients who had mastectomy with or without reconstruction for treatment of breast cancer at the five public hospitals in SWSLHD between January 2006 and December 2015 were obtained from the clinical information department of each hospital and from electronic medical records. RESULTS The average rate of reconstruction in SWSLHD was 9.4% for 2006-2015. Although the reconstruction rate was higher among English-speaking women (9.9%) compared to women from a CALD background (8.6%), the difference was not statistically significant (P = 0.57). The type (autologous versus implant) and timing (immediate versus delayed) of reconstruction did not differ between groups (P = 0.19 and P = 0.22, respectively). The Index of Relative Socio-Economic Disadvantage was not significantly associated with reconstruction (P = 0.74). However, younger patients were more likely to have reconstruction (P < 0.0001) and patients with adjuvant therapy were more likely to have a delayed reconstruction (P = 0.01). CONCLUSION This study found a low breast reconstruction rate in public hospitals in SWSLHD. The reconstruction rate did not differ between CALD or English-speaking patients, or between patients from diverse socio-economic backgrounds.
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Affiliation(s)
- Neda Karimi
- Centre for Oncology Education and Research Translation, Ingham Institute for Applied Medical Research, Sydney, New South Wales, Australia.,South Western Sydney Clinical School, The University of New South Wales, Sydney, New South Wales, Australia
| | - Joseph Descallar
- Centre for Oncology Education and Research Translation, Ingham Institute for Applied Medical Research, Sydney, New South Wales, Australia.,South Western Sydney Clinical School, The University of New South Wales, Sydney, New South Wales, Australia
| | - Afaf Girgis
- Centre for Oncology Education and Research Translation, Ingham Institute for Applied Medical Research, Sydney, New South Wales, Australia.,South Western Sydney Clinical School, The University of New South Wales, Sydney, New South Wales, Australia
| | - Patsy S Soon
- Centre for Oncology Education and Research Translation, Ingham Institute for Applied Medical Research, Sydney, New South Wales, Australia.,South Western Sydney Clinical School, The University of New South Wales, Sydney, New South Wales, Australia.,Department of Surgery, Bankstown Hospital, Sydney, New South Wales, Australia
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Jeon MS, Dhillon HM, Koh ES, Nowak AK, Hovey E, Descallar J, Miller L, Marshall NS, Agar MR. Exploring sleep disturbance among adults with primary or secondary malignant brain tumors and their caregivers. Neurooncol Pract 2020; 8:48-59. [PMID: 33664969 DOI: 10.1093/nop/npaa057] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Background Emerging evidence supports the clinical impact of sleep disturbance (SD) on cancer patients. This study aimed to determine the prevalence and predictors of SD in people with malignant brain tumors and caregivers, and explore any relationship between the patient-caregiver dyad's sleep. Methods Eighty-one adults with primary malignant (91%) or metastatic (9%) brain tumors and their family caregivers (n = 44) completed a series of self-report questionnaires, including the Pittsburgh Sleep Quality Index (PSQI), the Insomnia Severity Index, and the drowsiness item of The MD Anderson Symptom Inventory-Brain Tumor in an Australian ambulatory neuro-oncology setting. Participants were grouped by the PSQI cutoff (SD > 5), and binary logistic regression analyses were performed to identify risk factors. Results Of patients, 53% reported SD and 15% of those clinically significant insomnia, and 27% reported moderate to severe daytime drowsiness. Whereas anxiety, depression, fatigue, pain, neurocognitive symptoms, and antiemetic use were higher in patients with SD, fatigue and KPS were strong predictors of SD. In caregivers, 55% reported poor sleep and 13% clinical insomnia. Anxiety, caregiver burden, and comorbid illness were significantly associated with caregivers' SD. The individual's SD did not affect the chance of the other member of the patient-caregiver dyad experiencing SD. Conclusions More than half the sample had sleep disturbance, which was linked to many concomitant symptoms, such as fatigue in patients and anxiety in caregivers, potentially contributing to distress and functional impairment. Understanding underlying mechanisms of SD, the potential use of these clinical predictors in care settings, and options for management is warranted.
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Affiliation(s)
- Megan S Jeon
- South Western Sydney Clinical School, University of New South Wales, Sydney, Australia
| | - Haryana M Dhillon
- Centre for Medical Psychology & Evidence-based Decision-making, University of Sydney, Sydney, Australia
| | - Eng-Siew Koh
- South Western Sydney Clinical School, University of New South Wales, Sydney, Australia.,Ingham Institute for Applied Medical Research, Liverpool, Australia.,Department of Radiation Oncology, Liverpool Hospital, Liverpool, NSW, Australia
| | - Anna K Nowak
- Medical School, QEII Medical Centre Unit, University of Western Australia, Crawley, Australia.,Department of Medical Oncology, Sir Charles Gairdner Hospital, Nedlands WA, Australia
| | - Elizabeth Hovey
- Nelune Comprehensive Cancer Centre, Prince of Wales Hospital, Randwick, Australia.,University of New South Wales, Sydney, Australia
| | - Joseph Descallar
- South Western Sydney Clinical School, University of New South Wales, Sydney, Australia.,Ingham Institute for Applied Medical Research, Liverpool, Australia
| | - Lisa Miller
- Sir Charles Gairdner Hospital, Perth, Australia
| | - Nathaniel S Marshall
- Woolcock Institute for Medical Research & Sydney Nursing School, University of Sydney, Sydney, Australia
| | - Meera R Agar
- South Western Sydney Clinical School, University of New South Wales, Sydney, Australia.,Ingham Institute for Applied Medical Research, Liverpool, Australia.,IMPACCT (Improving Palliative, Aged and Chronic Care through Clinical Research and Translation), Faculty of Health, University of Technology Sydney, Sydney, Australia
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Smith AB, Niu AY, Descallar J, Delaney GP, Wu VS, Agar MR, Girgis A. Clinical trials knowledge and attitudes of Vietnamese- and Anglo-Australian cancer patients: A cross-sectional study. Asia Pac J Clin Oncol 2020; 16:e242-e251. [PMID: 32779349 DOI: 10.1111/ajco.13388] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 05/13/2020] [Indexed: 11/27/2022]
Abstract
AIM Low participation in cancer clinical trials by culturally and linguistically diverse (CALD) patients limits access to cutting-edge treatments and generalizability of results. This is the first study exploring trials knowledge/attitudes and their association with trial participation in Vietnamese- and Anglo-Australian cancer patients. METHODS Eligible patients diagnosed with cancer in the past 10 years were invited to complete a self-report questionnaire comprising validated measures of: trials knowledge and attitudes, preferred information amount, preferred decision-making involvement, health literacy, and past and future (i.e. hypothetical) trial participation. Multivariable linear regression evaluated correlates of trials knowledge/attitudes. Multinomial logistic regression estimated the relationship between trials knowledge/attitudes and possible future trial participation. RESULTS Vietnamese-Australian participants (n = 50) had more negative attitudes regarding trials than Anglo-Australians (n = 100; B = -9.28; 95% confidence interval [CI], -17.60 to -0.97; P = 0.029), but similar knowledge (B = -0.91; 95% CI, -2.27 to 0.44; P = 0.18). Future trial participation was associated with positive attitudes (odds ratio [OR] = 1.08; 95% CI, 1.04-1.12; P < 0.001) and greater knowledge (OR = 1.30; 95% CI, 1.04-1.62; P = 0.02), but not Vietnamese background (OR = 0.95; 95% CI, 0.27-3.32; P = 0.93). CONCLUSION Despite poorer attitudes regarding trials in Vietnamese-Australians, Vietnamese background was not associated with less likely future trial participation, suggesting low trial participation by CALD patients may be more due to opportunity barriers. Improving knowledge and attitudes may increase trial participation generally.
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Affiliation(s)
- Allan B Smith
- Centre for Oncology Education and Research Translation (CONCERT), Ingham Institute for Applied Medical Research, South Western Sydney Clinical School, UNSW Sydney, Liverpool, NSW, Australia
| | - Anita Y Niu
- Centre for Oncology Education and Research Translation (CONCERT), Ingham Institute for Applied Medical Research, South Western Sydney Clinical School, UNSW Sydney, Liverpool, NSW, Australia
| | - Joseph Descallar
- Centre for Oncology Education and Research Translation (CONCERT), Ingham Institute for Applied Medical Research, South Western Sydney Clinical School, UNSW Sydney, Liverpool, NSW, Australia
| | - Geoff P Delaney
- Centre for Oncology Education and Research Translation (CONCERT), Ingham Institute for Applied Medical Research, South Western Sydney Clinical School, UNSW Sydney, Liverpool, NSW, Australia.,Liverpool Cancer Therapy Centre, Liverpool Hospital, South Western Sydney Local Health District, Liverpool, NSW, Australia
| | - Verena S Wu
- Centre for Oncology Education and Research Translation (CONCERT), Ingham Institute for Applied Medical Research, South Western Sydney Clinical School, UNSW Sydney, Liverpool, NSW, Australia
| | - Meera R Agar
- Centre for Oncology Education and Research Translation (CONCERT), Ingham Institute for Applied Medical Research, South Western Sydney Clinical School, UNSW Sydney, Liverpool, NSW, Australia.,Liverpool Cancer Therapy Centre, Liverpool Hospital, South Western Sydney Local Health District, Liverpool, NSW, Australia.,Clinical Trials Unit, Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia
| | - Afaf Girgis
- Centre for Oncology Education and Research Translation (CONCERT), Ingham Institute for Applied Medical Research, South Western Sydney Clinical School, UNSW Sydney, Liverpool, NSW, Australia
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Ayer C, Eapen V, Overs B, Descallar J, Jalaludin B, Eastwood JG, Dissanayake C, Williams K, Murphy E, Woolfenden S. Risk factors for non-participation in a universal developmental surveillance program in a population in Australia. AUST HEALTH REV 2020; 44:512-520. [PMID: 32731919 DOI: 10.1071/ah18236] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Accepted: 05/09/2019] [Indexed: 11/23/2022]
Abstract
Objectives This study examined the risk factors for non-participation in a developmental surveillance program in a population in south-west Sydney with a high proportion of culturally diverse and socioeconomically disadvantaged people. Methods Data from 850 and 625 12- and 18-month-old children respectively from the Watch Me Grow (WMG) birth cohort were used for this study. Logistic regression models were used to assess risk factors for 12- and 18-month non-attendance at Well Child Visits, as well as non-completion of the developmental surveillance questionnaire Parents' Evaluation of Developmental Status (PEDS) in the child's personal health record (PHR). Results Independent risk factors for non-attendance at Well Child Visits were female sex of the child (odds ratio (OR) 12 months 1.5; 95% confidence interval (CI) 1.0-2.3), mother's country of birth Australia (OR 18 months 1.8; 95% CI 1.2-2.7), annual household income less than A$25001 (OR 12 months 1.8; 95% CI 1.0-3.2) and residing in a socioeconomically disadvantaged neighbourhood (OR 12 months 1.7; 95% CI 1.1-2.5). Independent risk factors for non-completion of PEDS in those who did not attend the Well Child Visit compared with those who did attend and did complete PEDS were household annual income at birth less than A$25001 (OR 12 months 3.9; 95% CI 1.9-8.1) and residing in a socioeconomically disadvantaged neighbourhood (OR 12 months 2.1 (95% CI 1.2-3.7) and OR 18 months 2.0 (95% CI 1.2-3.6)). Conclusions In this population, children exposed to socioeconomic disadvantage are less likely to have attended a Well Child Visit and to have a completed PEDS in their PHR at 12 and/or 18 months of age. What is known about the topic? Developmental problems are common in early childhood, and children from socioeconomically disadvantaged households are at higher risk. Universal developmental surveillance programs may be effective at early identification of children at risk of developmental problems. Early childhood interventions, when accessed, can lessen the effects of developmental problems in later years. What does this paper add? This paper highlights that children exposed to socioeconomic disadvantage in early childhood who are at higher risk of having developmental problems are also at higher risk of missing out on early identification by non-participation in universal developmental surveillance. What are the implications for practitioners? A more equitable model of developmental surveillance should include a framework of proportionate universalism to ensure optimal engagement of high-risk population groups.
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Affiliation(s)
- Chandra Ayer
- Royal Far West, PO Box 52, Manly, NSW 1655, Australia; and Kogarah Diagnostic Assessment Service, St George Hospital, 90 Railway Parade, Kogarah, NSW 2217, Australia; and Corresponding author.
| | - Valsamma Eapen
- Psychiatry Research and Teaching Unit, School of Psychiatry, UNSW, Level 1, Mental Health Centre, Liverpool Hospital, corner Forbes and Campbell Streets, Liverpool, NSW 2170, Australia. ; and Academic Unit of Child Psychiatry, Ingham Institute of Applied Medical Research, PO Box 3151 (Westfields), Liverpool, NSW 2170, Australia; and South Western Sydney Clinical School, Faculty of Medicine, UNSW, Liverpool Hospital, Liverpool, NSW 2170, Australia
| | | | - Joseph Descallar
- South Western Sydney Clinical School, Faculty of Medicine, UNSW, Liverpool Hospital, Liverpool, NSW 2170, Australia; and Ingham Institute of Applied Medical Research, PO Box 3151 (Westfields), Liverpool, NSW 2170, Australia. ;
| | - Bin Jalaludin
- Ingham Institute of Applied Medical Research, PO Box 3151 (Westfields), Liverpool, NSW 2170, Australia. ; ; and School of Public Health and Community Medicine, UNSW, Sydney, NSW 2052, Australia
| | - John Graeme Eastwood
- Ingham Institute of Applied Medical Research, PO Box 3151 (Westfields), Liverpool, NSW 2170, Australia. ; ; and Community Paediatrics, Sydney Local Health District, Level 11 KGV Building, Missenden Road, Camperdown, NSW 2050, Australia. ; and School of Public Health, Menzies Centre for Health Policy, University of Sydney, Edward Ford Building, A27 Fisher Road, Sydney, NSW 2006, Australia; and School of Medicine, Griffith University, Parklands Drive, Southport, Gold Coast, Qld 4222, Australia; and School of Women's and Children's Health, UNSW, Sydney, NSW 2052, Australia
| | - Cheryl Dissanayake
- Olga Tennison Autism Research Centre, La Trobe University, Kingsbury Drive, Bundoora, Vic. 3083, Australia.
| | - Katrina Williams
- Department of Paediatrics, Melbourne Medical School, The University of Melbourne, Melbourne, Vic. 3010, Australia; and Present address: Department of Paediatrics, Monash University, School of Clinical Sciences, Level 5, Monash Children's Hospital, 246 Clayton Road, Clayton, Vic. 3168, Australia.
| | - Elisabeth Murphy
- NSW Ministry of Health, Child, Youth and Family Health Services, PO Box 4007, Royal North Shore LPO, St Leonards, NSW 2065, Australia.
| | - Susan Woolfenden
- School of Women's and Children's Health, UNSW, Sydney, NSW 2052, Australia; and Department of Community Paediatrics, Sydney Children's Hospital Network, High Street, Randwick, NSW 2031, Australia.
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Batumalai V, Delaney GP, Descallar J, Gabriel G, Wong K, Shafiq J, Barton M. Variation in the use of radiotherapy fractionation for breast cancer: Survival outcome and cost implications. Radiother Oncol 2020; 152:70-77. [PMID: 32721419 PMCID: PMC7382346 DOI: 10.1016/j.radonc.2020.07.038] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [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: 05/25/2020] [Revised: 07/20/2020] [Accepted: 07/23/2020] [Indexed: 11/30/2022]
Abstract
We evaluated the use of hypofractionation in breast radiotherapy in an Australian population-based cohort. Hypofractionation appears underused for breast radiotherapy in Australia over time. Variation in practice were observed by patient, tumour, sociodemographic and geographical factors. This study highlights that evidence-based practice will translate to reduced health care treatment costs.
Background and purpose Substantial variation in the adoption of hypofractionation for breast radiation therapy has been observed, despite the availability of consensus guidelines. This study aimed to investigate the variation in radiation therapy fractionation in breast cancer patients in New South Wales (NSW), Australia, and to estimate survival outcome and cost implications. Materials and methods This is a population-based cohort of patients who received radiation therapy for breast cancer (2009–2013), as captured in the NSW Central Cancer Registry. A logistic regression model was used to identify factors associated with fractionation type. Survival outcome was estimated using multivariable Cox proportional hazards model. Cost per treatment and potential cost saving associated with evidence-based fractionation was estimated. Results A total of 10,482 patients were available for analysis, divided into 3 cohorts (breast alone: N = 7000; breast + nodes: N = 1119; all chestwall: N = 2363). In multivariable analysis, increasing age, laterality (right), year of treatment (2013), early stage, lower socioeconomic status, and regional area of residence were independent predictors of hypofractionation for breast alone radiation therapy. For the breast + nodes and chest wall cohorts, common factors that predicted the use of hypofractionation were increasing age. In multivariable survival analysis, there was no difference between the fractionation regimens at 5 years. Estimated radiation therapy cost of this cohort approximated $52.1 million, compared with $38.5 million had these patients been treated with evidence-based fractionation. This demonstrated a potential saving of $13.6 million. Conclusion Hypofractionation appears underused for breast radiation therapy in NSW over time. This study highlights that evidence-based practice will translate to reduced health care treatment costs.
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Affiliation(s)
- Vikneswary Batumalai
- Ingham Institute for Applied Medical Research, South Western Clinical School, University of New South Wales, Australia; Department of Radiation Oncology, South Western Sydney Local Health District, New South Wales, Australia.
| | - Geoff P Delaney
- Ingham Institute for Applied Medical Research, South Western Clinical School, University of New South Wales, Australia; Department of Radiation Oncology, South Western Sydney Local Health District, New South Wales, Australia
| | - Joseph Descallar
- Ingham Institute for Applied Medical Research, South Western Clinical School, University of New South Wales, Australia
| | - Gabriel Gabriel
- Ingham Institute for Applied Medical Research, South Western Clinical School, University of New South Wales, Australia
| | - Karen Wong
- Ingham Institute for Applied Medical Research, South Western Clinical School, University of New South Wales, Australia
| | - Jesmin Shafiq
- Ingham Institute for Applied Medical Research, South Western Clinical School, University of New South Wales, Australia
| | - Michael Barton
- Ingham Institute for Applied Medical Research, South Western Clinical School, University of New South Wales, Australia; Department of Radiation Oncology, South Western Sydney Local Health District, New South Wales, Australia
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Kim AH, Girgis A, Karimi N, Sechi AJ, Descallar J, Andrews JM, Siegel CA, Connor SJ. A Web-Based Decision Aid (myAID) to Enhance Quality of Life, Empowerment, Decision Making, and Disease Control for Patients With Ulcerative Colitis: Protocol for a Cluster Randomized Controlled Trial. JMIR Res Protoc 2020; 9:e15994. [PMID: 32673257 PMCID: PMC7382012 DOI: 10.2196/15994] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Revised: 12/10/2019] [Accepted: 12/11/2019] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Patients with ulcerative colitis (UC) often face complex treatment decisions. Although shared decision making (SDM) is considered important, tools to facilitate this are currently lacking for UC. A recent pilot study of a novel Web-based decision aid (DA), my Actively Informed Decision (myAID), has suggested its acceptability and feasibility for informing treatment decisions and facilitating SDM in clinical practice. OBJECTIVE This paper describes the study protocol of the myAID study to assess the clinical impact of systematic implementation of myAID in routine UC management. METHODS The myAID study is a multicenter, cluster randomized controlled trial (CRCT) involving 22 Australian sites that will assess the clinical efficacy of routine use of myAID (intervention) against usual care without access to myAID (control) for UC patients. Participating sites (clusters) will be randomly allocated in a 1:1 ratio between the 2 arms. Patients making a new treatment decision beyond 5-aminosalicylate agents will be eligible to participate. Patients allocated to the intervention arm will view myAID at the time of recruitment and have free access to it throughout the study period. The effect of the myAID intervention will be assessed using the results of serial Web-based questionnaires and fecal calprotectin at baseline, 2 months, 6 months, and 12 months. A Web-based questionnaire within 2-4 weeks of referral will determine early change in quality of decision making and anxiety (both arms) and intervention acceptability (intervention arm only). RESULTS Study recruitment and funding began in October 2016, and recruitment will continue through 2020, for a minimum of 300 study participants at baseline at the current projection. The primary outcome will be health-related quality of life (Assessment of Quality of Life-8D), and secondary outcomes will include patient empowerment, quality of decision making, anxiety, work productivity and activity impairment, and disease activity. In addition, we aim to determine the predictors of UC treatment decisions and outcomes and the cost-effectiveness of implementing myAID in routine practice. Feedback obtained about myAID will be used to determine areas for improvement and barriers to its implementation. Completion of data collection and publication of study results are anticipated in 2021. CONCLUSIONS myAID is a novel Web-based DA designed to facilitate SDM in UC management. The results of this CRCT will contribute new evidence to the literature in comparing outcomes between patients who routinely access such decision support intervention versus those who do not, across multiple large inflammatory bowel disease centers as well as community-based private practices in Australia. TRIAL REGISTRATION Australian New Zealand Clinical Trial Registry ACTRN12617001246370 http://anzctr.org.au/Trial/ Registration/TrialReview.aspx?ACTRN=12617001246370. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/15994.
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Affiliation(s)
- Andrew H Kim
- Ingham Institute for Applied Medical Research, South Western Sydney Clinical School, The University of New South Wales, Sydney, Australia.,Department of Gastroenterology, Liverpool Hospital, Sydney, Australia
| | - Afaf Girgis
- Ingham Institute for Applied Medical Research, South Western Sydney Clinical School, The University of New South Wales, Sydney, Australia
| | - Neda Karimi
- Ingham Institute for Applied Medical Research, South Western Sydney Clinical School, The University of New South Wales, Sydney, Australia
| | - Alexandra J Sechi
- Department of Gastroenterology, Liverpool Hospital, Sydney, Australia
| | - Joseph Descallar
- Ingham Institute for Applied Medical Research, South Western Sydney Clinical School, The University of New South Wales, Sydney, Australia
| | - Jane M Andrews
- IBD Service, Department of Gastroenterology & Hepatology, Royal Adelaide Hospital, Adelaide, Australia.,Faculty of Medicine, University of Adelaide, Adelaide, Australia
| | - Corey A Siegel
- Section of Gastroenterology and Hepatology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States
| | - Susan J Connor
- Ingham Institute for Applied Medical Research, South Western Sydney Clinical School, The University of New South Wales, Sydney, Australia
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Gibson KA, Castrejon I, Descallar J, Pincus T. Fibromyalgia Assessment Screening Tool: Clues to Fibromyalgia on a Multidimensional Health Assessment Questionnaire for Routine Care. J Rheumatol 2019; 47:761-769. [PMID: 31474596 DOI: 10.3899/jrheum.190277] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/06/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To develop feasible indices as clues to comorbid fibromyalgia (FM) in routine care of patients with various rheumatic diseases based only on self-report multidimensional Health Assessment Questionnaire (MDHAQ) scores, which are informative in all rheumatic diagnoses studied. METHODS All patients with all diagnoses complete an MDHAQ at each visit; the 2011 FM criteria questionnaire was added to the standard MDHAQ between February 2013 and August 2016. The proportion of patients who met 2011 FM criteria or had a clinical diagnosis of FM was calculated. Individual candidate MDHAQ measures were compared to 2011 FM criteria using receiver-operating characteristic (ROC) curves; cutpoints to recognize FM were selected from the area under the curve (AUC) for optimal tradeoff between sensitivity and specificity. Cumulative indices of 3 or 4 MDHAQ measures were analyzed as fibromyalgia assessment screening tools (FAST). RESULTS In 148 patients, the highest AUC in ROC analyses versus 2011 FM criteria were seen for MDHAQ symptom checklist, self-report painful joint count, pain visual analog scale (VAS), and fatigue VAS. The optimal cutpoints were ≥ 16/60 for symptom checklist, ≥ 16/48 for self-report painful joint count, and ≥ 6/10 for both pain and fatigue VAS. Cumulative FAST indices of 2/3 or 3/4 MDHAQ measures correctly classified 89.4-91.7% of patients who met 2011 FM criteria. CONCLUSION FAST3 and FAST4 cumulative indices from only MDHAQ scores correctly identify most patients who meet 2011 FM criteria. FAST indices can assist clinicians in routine care as clues to FM with a general rheumatology rather than FM-specific questionnaire.
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Affiliation(s)
- Kathryn A Gibson
- From the Department of Rheumatology, Liverpool Hospital, Liverpool, Sydney, New South Wales, Australia; University of New South Wales, Sydney, Australia; Division of Rheumatology, Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois, USA; Ingham Institute for Applied Medical Research, Liverpool, Sydney, New South Wales, Australia. .,K.A. Gibson, MD, PhD, Department of Rheumatology, Liverpool Hospital, and University of New South Wales; I. Castrejon, MD, PhD, Division of Rheumatology, Department of Internal Medicine, Rush University Medical Center; J. Descallar, BSc, Mbiostat, University of New South Wales, and Ingham Institute for Applied Medical Research; T. Pincus, MD, Division of Rheumatology, Department of Internal Medicine, Rush University Medical Center.
| | - Isabel Castrejon
- From the Department of Rheumatology, Liverpool Hospital, Liverpool, Sydney, New South Wales, Australia; University of New South Wales, Sydney, Australia; Division of Rheumatology, Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois, USA; Ingham Institute for Applied Medical Research, Liverpool, Sydney, New South Wales, Australia.,K.A. Gibson, MD, PhD, Department of Rheumatology, Liverpool Hospital, and University of New South Wales; I. Castrejon, MD, PhD, Division of Rheumatology, Department of Internal Medicine, Rush University Medical Center; J. Descallar, BSc, Mbiostat, University of New South Wales, and Ingham Institute for Applied Medical Research; T. Pincus, MD, Division of Rheumatology, Department of Internal Medicine, Rush University Medical Center
| | - Joseph Descallar
- From the Department of Rheumatology, Liverpool Hospital, Liverpool, Sydney, New South Wales, Australia; University of New South Wales, Sydney, Australia; Division of Rheumatology, Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois, USA; Ingham Institute for Applied Medical Research, Liverpool, Sydney, New South Wales, Australia.,K.A. Gibson, MD, PhD, Department of Rheumatology, Liverpool Hospital, and University of New South Wales; I. Castrejon, MD, PhD, Division of Rheumatology, Department of Internal Medicine, Rush University Medical Center; J. Descallar, BSc, Mbiostat, University of New South Wales, and Ingham Institute for Applied Medical Research; T. Pincus, MD, Division of Rheumatology, Department of Internal Medicine, Rush University Medical Center
| | - Theodore Pincus
- From the Department of Rheumatology, Liverpool Hospital, Liverpool, Sydney, New South Wales, Australia; University of New South Wales, Sydney, Australia; Division of Rheumatology, Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois, USA; Ingham Institute for Applied Medical Research, Liverpool, Sydney, New South Wales, Australia.,K.A. Gibson, MD, PhD, Department of Rheumatology, Liverpool Hospital, and University of New South Wales; I. Castrejon, MD, PhD, Division of Rheumatology, Department of Internal Medicine, Rush University Medical Center; J. Descallar, BSc, Mbiostat, University of New South Wales, and Ingham Institute for Applied Medical Research; T. Pincus, MD, Division of Rheumatology, Department of Internal Medicine, Rush University Medical Center
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48
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Smith SMS, Jan S, Descallar J, Marks GB. An investigation of methods to improve recall for the patient-reported outcome measurement in COPD patients: a pilot randomised control trial and feasibility study protocol. Pilot Feasibility Stud 2019; 5:92. [PMID: 31360536 PMCID: PMC6637538 DOI: 10.1186/s40814-019-0475-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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: 01/07/2019] [Accepted: 07/04/2019] [Indexed: 11/13/2022] Open
Abstract
Background Patient-reported outcomes (PRO) are used to measure the effectiveness of interventions for management of chronic conditions such as chronic obstructive pulmonary disease. Many of these instruments require respondents to describe the change in their health status from baseline to a follow-up assessment and poor recall of previous health status often limits the usefulness and validity of these PRO measures. The use of technology has recently increased in PRO measurement. This study aims to mitigate the problems of poor recall by evaluating different strategies as a way to improve the validity of recall of health status among adults with COPD. Methods A pilot randomised controlled trial of three strategies to improve patient recall will be tested in an acute care clinical environment. The first strategy is the use of tablet computer technology’s audio-visual facility, the second strategy is the provision of base line PRO responses prior to patients completing their follow-up questionnaires and third is standard practice of completing a questionnaire independently of previous responses. The feasibility of conducting this study in a busy clinical environment will be ascertained using the NIHR criteria for assessing feasibility. Discussion There is variability in a person’s ability to recall past events. With studies utilising patient-reported outcome measurement, it has become critically important to develop strategies and ways of supporting the patient to be more accurate recalling their health status. The adaptation of various technological features within mobile devices may provide an opportunity in clinical research studies to improve patient recall of their health status. Trial registration ANZCTR12618001605280. Electronic supplementary material The online version of this article (10.1186/s40814-019-0475-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sheree M S Smith
- 1School of Nursing and Midwifery, Western Sydney University, Penrith, Sydney, 2751 Australia.,4Woolcock Institute of Medical Research, Glebe, Sydney, Australia
| | - Stephen Jan
- 2George Institute for Global Health, University of New South Wales, Randwick, Sydney, Australia
| | - Joseph Descallar
- Ingham Applied Medical Research Institute, Liverpool, Sydney, Australia.,5South Western Sydney Clinical School, University of New South Wales, Sydney, Australia
| | - Guy B Marks
- 4Woolcock Institute of Medical Research, Glebe, Sydney, Australia.,5South Western Sydney Clinical School, University of New South Wales, Sydney, Australia
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Girgis A, Durcinoska I, Arnold A, Kaadan N, Miller AA, Descallar J, Delaney G. Phase III non-randomized controlled trial of PROMPT-Care, an eHealth intervention utilizing patient reported outcomes in routine clinical care: Impact on emergency department presentations. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.6510] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
6510 Background: The significant impact of routine assessment and clinical utilization of patient-reported outcomes (PRO) on patient and survival outcomes and reduced emergency department (ED) presentations has been demonstrated in specific patient populations (e.g. advanced cancer). This controlled trial evaluated the impact of an eHealth system, PROMPT-Care, on ED presentations in a diverse population of cancer patients from four oncology treatments centers. Methods: All adult patients receiving cancer care (including adjuvant therapy and follow-up) were eligible, excepting those with a diagnosis of a hematological malignancy, insufficient English literacy or no internet access outside of the clinic. Intervention (PROMPT-Care) patients completed monthly online assessments comprising 61 items of distress, common symptoms and unmet needs, with PRO results electronically transferred into the electronic medical record (EMR). In “real-time”, the care team accessed patients’ PRO summary reports to guide their care, an email alert notified nurses of ongoing unresolved issues between visits, and patients received links to support self-management. Control group patients (n = 2,288) comprised the general cancer patient population receiving usual care at the participating cancer therapy centers. Multivariable negative binomial regression was used to compare between-group differences. Results: From April 2016 to March 2018, 345 eligible patients (mean age 62, 58% female, 27% stage IV) participated and were sent at least four assessments within the first six months on trial. On average, control patients had 30 ED presentations and PROMPT-Care patients had 21 ED presentations per 10,000 patient days. After adjusting for age, sex and stage of disease, PROMPT-Care patients had 26% (95% CI 0.2%, 57%) fewer ED presentations compared to the control group (p = 0.0483). Conclusions: The PROMPT-Care intervention resulted in significantly fewer ED presentations in a broad population of cancer patients, including those currently undergoing cancer treatment or are in follow-up, and patients with a wide range of tumor types. The results support its utility as an improved model for ongoing supportive care for a diverse population, with potential healthcare cost savings. Clinical trial information: ACTRN12616000615482.
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Affiliation(s)
- Afaf Girgis
- Centre for Oncology Education and Research Translation (CONCERT), Ingham Institute for Applied Medical Research and University of New South Wales, Sydney, Australia
| | - Ivana Durcinoska
- Centre for Oncology Education and Research Translation (CONCERT), Ingham Institute for Applied Medical Research and University of New South Wales, Sydney, Australia
| | - Anthony Arnold
- Illawarra Cancer Care Centre, Wollongong Hospital, Wollongong, Australia
| | - Nasreen Kaadan
- Liverpool Cancer Therapy Centre, Liverpool Hospital, Sydney, Australia
| | | | - Joseph Descallar
- Centre for Oncology Education and Research Translation (CONCERT), Ingham Institute for Applied Medical Research and University of New South Wales, Sydney, Australia
| | - Geoff Delaney
- Liverpool Cancer Therapy Centre, Liverpool Hospital, Sydney, Australia
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Naher S, Padinharakam S, Balakrishnar B, Chua W, Descallar J, Adams D, de Souza P, Harrison M, Lim S. Patterns of Presentation and Treatment Outcomes of Non-clear-cell Renal Cell Carcinoma and Sarcomatoid Renal Cell Carcinoma Patients in 2 Tertiary Referral Centers in Sydney, Australia. Clin Genitourin Cancer 2019; 17:e565-e569. [PMID: 30935815 DOI: 10.1016/j.clgc.2019.02.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2018] [Revised: 02/15/2019] [Accepted: 02/15/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Non-clear-cell renal cell carcinoma (nccRCC) and renal cell carcinoma with sarcomatoid features (scRCC) are rare, and represent subtypes with less defined treatment strategies. The aim of this study is to describe the patterns of care and outcomes of these patients in 2 tertiary referral centers in South Western Sydney Local Health District over a 10-year period. PATIENTS AND METHODS Patients with RCC seen at South Western Sydney Local Health District from January 1, 2005 to December 31, 2015 were identified from electronic medical records. For each patient, we extracted details regarding demographics, tumor characteristics, treatment, recurrences, and survival, which was analyzed using the Kaplan-Meier method. RESULTS Of 178 patients with RCC identified between 2005 and 2015, 23% (n = 41) had nccRCC and 8% (n = 15) had scRCC. Twenty-five patients in total had de novo metastatic disease or disease recurrence. The median follow-up was 46 and 16 months for nccRCC and scRCC, respectively. The median overall survival for nccRCC with metastatic disease was 34 months (range, 14 months to not reached). Seventy percent of these patients received systemic therapy. By contrast, the median overall survival for scRCC with metastatic disease was 10 months (range, 1.6-89 months). Less than one-half of the patients with scRCC received systemic therapy in our cohort, with only 34% receiving no more than 1 line of treatment. CONCLUSIONS Our data confirm the rapid and aggressive course of scRCC, highlighting the need for more effective therapeutic strategies in this rare patient population.
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Affiliation(s)
- Sayeda Naher
- Liverpool Cancer Therapy Centre, Liverpool, New South Wales, Australia; School of Medicine, University of New South Wales, Kensington, New South Wales, Australia; Macarthur Cancer Therapy Centre, Campbelltown, New South Wales, Australia.
| | - Shamsudheen Padinharakam
- School of Medicine, University of New South Wales, Kensington, New South Wales, Australia; School of Health Sciences, University of Tasmania, Tasmania, Australia; Launceston General Hospital, Launceston, Tasmania, Australia
| | | | - Wei Chua
- Liverpool Cancer Therapy Centre, Liverpool, New South Wales, Australia; School of Medicine, University of New South Wales, Kensington, New South Wales, Australia
| | - Joseph Descallar
- School of Medicine, University of New South Wales, Kensington, New South Wales, Australia
| | - Diana Adams
- Macarthur Cancer Therapy Centre, Campbelltown, New South Wales, Australia
| | - Paul de Souza
- Liverpool Cancer Therapy Centre, Liverpool, New South Wales, Australia; School of Medicine, University of New South Wales, Kensington, New South Wales, Australia; Western Sydney University, Liverpool, New South Wales, Australia
| | - Michelle Harrison
- Liverpool Cancer Therapy Centre, Liverpool, New South Wales, Australia
| | - Stephanie Lim
- School of Medicine, University of New South Wales, Kensington, New South Wales, Australia; Macarthur Cancer Therapy Centre, Campbelltown, New South Wales, Australia; Western Sydney University, Liverpool, New South Wales, Australia
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