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Wang Z, Raistrick T, Street A, Reynolds M, Liu Y, Gleeson HF. Direct Observation of Biaxial Nematic Order in Auxetic Liquid Crystal Elastomers. Materials (Basel) 2022; 16:ma16010393. [PMID: 36614732 PMCID: PMC9822019 DOI: 10.3390/ma16010393] [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] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 12/22/2022] [Indexed: 05/31/2023]
Abstract
Auxetic materials exhibit a negative Poisson's ratio, i.e., they become thicker rather than thinner in at least one dimension when strained. Recently, a nematic liquid crystal elastomer (LCE) was shown to be the first synthetic auxetic material at a molecular level. Understanding the mechanism of the auxetic response in LCEs is clearly important, and it has been suggested through detailed Raman scattering studies that it is related to the reduction of uniaxial order and emergence of biaxial order on strain. In this paper, we demonstrate direct observation of the biaxial order in an auxetic LCE under strain. We fabricated ~100 μm thick LCE strips with complementary geometries, exhibiting either planar or homeotropic alignment, in which the auxetic response is seen in the thickness or width of the sample, respectively. Polarized Raman scattering measurements on the planar sample show directly the reduction in the uniaxial order parameters on strain and suggest the emergence of biaxial order to mediate the auxetic response in the sample thickness. The homeotropic sample is studied via conoscopy, allowing direct observation of both the auxetic response in the width of the sample and increasing biaxiality in the LCE as it is strained. We verified that the mechanism of the auxetic response in auxetic LCEs is due to the emergence of the biaxial order and conclude such materials can be added to the small number of biaxial nematic systems that have been observed. Importantly, we also show that the mechanical Frèedericksz transition seen in some LCEs is consistent with a strain-induced transition from an optically positive to an optically negative biaxial system under strain, rather than a director rotation in a uniaxial system.
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Affiliation(s)
- Zhenming Wang
- School of Physics and Astronomy, University of Leeds, Leeds LS2 9JT, UK
- Department of Electrical and Electronic Engineering, Southern University of Science and Technology, Shenzhen 518055, China
| | - Thomas Raistrick
- School of Physics and Astronomy, University of Leeds, Leeds LS2 9JT, UK
| | - Aidan Street
- School of Physics and Astronomy, University of Leeds, Leeds LS2 9JT, UK
| | - Matthew Reynolds
- School of Physics and Astronomy, University of Leeds, Leeds LS2 9JT, UK
| | - Yanjun Liu
- Department of Electrical and Electronic Engineering, Southern University of Science and Technology, Shenzhen 518055, China
| | - Helen F. Gleeson
- School of Physics and Astronomy, University of Leeds, Leeds LS2 9JT, UK
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Giles ML, MacPhail A, Bell C, Bradshaw CS, Furner V, Gunathilake M, John M, Krishnaswamy S, Martin SJ, Ooi C, Owen L, Russell D, Street A, Post JJ. The barriers to linkage and retention in care for women living with HIV in an high income setting where they comprise a minority group. AIDS Care 2019; 31:730-736. [PMID: 30754996 DOI: 10.1080/09540121.2019.1576843] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Women comprise a minority population of individuals living with HIV in Australia, and are often poorly represented in research and clinical trials so their needs remain largely unknown. Data suggests that they are diagnosed later than men and start antiretroviral therapy at a lower CD4 cell count. This raises the question whether there are sex specific barriers to linkage and retention in care. This study analyzed 484 surveys received from clinicians collecting demographic, virological, and reproductive health data along with perceived barriers to linkage and retention in care. Most women (67%) were estimated to have been linked into care within 28 days of diagnosis. For women who were not linked into care for more than 28 days, the most commonly reason cited was fear of disclosure to others, followed by fear of disclosure to their partner. The main reasons given for non-retention in care were related to transport, carer responsibilities, financial pressure, health beliefs and concern about stigma or disclosure.
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Affiliation(s)
- M L Giles
- a Department of Infectious Diseases , Alfred Health , Melbourne , Australia.,b Department of Obstetrics and Gynecology , Monash University , Melbourne , Australia
| | - A MacPhail
- a Department of Infectious Diseases , Alfred Health , Melbourne , Australia
| | - C Bell
- c Royal Adelaide Hospital , Adelaide , Australia
| | - C S Bradshaw
- d Melbourne Sexual Health Centre , Melbourne , Australia.,e Central Clinical School , Monash University , Melbourne , Australia
| | - V Furner
- f The Albion Centre , Sydney , Australia
| | - M Gunathilake
- g Sexual Health and Blood Borne Virus Unit, Centre for Disease Control , Northern Territory , Darwin , Australia.,h Kirby Institute , University of New South Wales , Sydney , Australia
| | - M John
- i Department of Immunology , Royal Perth Hospital , Perth , Australia
| | - S Krishnaswamy
- j Alice Springs Hospital , Alice Springs , Australia.,k Monash Infectious Diseases , Monash Health , Melbourne , Australia
| | - S J Martin
- l Canberra Sexual Health Service , Canberra Hospital , Canberra , Australia.,m Australian National University , Canberra , Australia
| | - C Ooi
- n Western Sydney Sexual Health Centre , Sydney , Australia
| | - L Owen
- o Statewide Sexual Health Service , Tasmania , Australia
| | - D Russell
- p Cairns Sexual Health Service , Cairns , Australia
| | - A Street
- q Victorian Infectious Diseases Service , Royal Melbourne Hospital , Melbourne , Australia
| | - J J Post
- f The Albion Centre , Sydney , Australia.,r Department of Infectious Diseases, Prince of Wales Hospital , Sydney , Australia.,s Prince of Wales Clinical School , University of New South Wales , Sydney , Australia
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Buising KL, Thursky KA, Bak N, Skull S, Street A, Presneill JJ, Cades JF, Brown GV. Antibiotic Prescribing in Response to Bacterial Isolates in the Intensive Care Unit. Anaesth Intensive Care 2019; 33:571-7. [PMID: 16235473 DOI: 10.1177/0310057x0503300504] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This study aimed to identify potential knowledge-performance gaps in antibiotic prescribing for bacterial isolates in the Intensive Care Unit (ICU) in order to guide the development of interventions such as antibiotic policies, decision support, and improved systems for communication between the laboratory and the bedside. A prospective observational cohort study of all patients admitted to a mixed medical/surgical ICU was undertaken over a six-month period in an Australian adult tertiary hospital. From a cohort of 524 patients, 108 had 303 isolates that were eligible for inclusion. Overall, 14.3% and 30.8% of sterile and non-sterile isolates respectively were associated with inadequate initial antibiotic therapy after identification of the bacteria. After sensitivity results were available inadequate directed therapy was observed in 4.0% and 21.3% of sterile and non-sterile isolates respectively. Problems were most commonly associated with isolates of Pseudomonas spp., Stenotrophomonas spp., Acinetobacter spp., S. aureus, enterococci and group III Enterobacteriaceae. Inadequate antibiotic therapy was found to be independently associated with prolonged length of ICU stay. Narrower spectrum antibiotic therapy was potentially available for 30% of isolates after sensitivity results were known. We conclude that there is scope to improve antibiotic prescribing in the ICU by providing clinicians with access to information regarding local susceptibility patterns and intrinsic resistance of bacteria, and spectra of antibiotic cover. Timely notification of laboratory results at the point of care may also facilitate improved prescribing performance.
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Affiliation(s)
- K L Buising
- Victorian Infectious Diseases Service, The Royal Melbourne Hospital, Melbourne, Parkville, Victoria
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4
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Dunkley S, Lam JCM, John MJ, Wong RSM, Tran H, Yang R, Nair SC, Shima M, Street A, Srivastava A. Principles of haemophilia care: The asia pacific perspective. Response. Haemophilia 2018; 24:e243-e244. [PMID: 29901827 DOI: 10.1111/hae.13522] [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] [Accepted: 04/28/2018] [Indexed: 12/01/2022]
Affiliation(s)
- S Dunkley
- Haemophilia Treatment Centre, Royal Prince Alfred Hospital, Sydney, Australia
| | - J C M Lam
- Department of Paediatric Subspecialties, KK Women's and Children's Hospital, Singapore, Singapore
| | - M J John
- Department of Clinical Haematology, Christian Medical College, Ludhiana, India
| | - R S M Wong
- Department of Medicine & Therapeutics and Sir Y.K. Pao Centre for Cancer, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - H Tran
- Ronald Sawers Haemophilia Centre, The Alfred Hospital Melbourne, Melbourne, VIC, Australia
| | - R Yang
- State Key Laboratory of Experimental Hematology, Institute of Hematology and Hospital of Blood Disease, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, China
| | - S C Nair
- Department of Immunohematology & Transfusion Medicine, Christian Medical College, Vellore, India
| | - M Shima
- Department of Paediatrics, Nara Medical University, Kashihara, Nara, Japan
| | - A Street
- Department of Immunology and Pathology, Monash University, Melbourne, VIC, Australia
| | - A Srivastava
- Department of Hematology, Christian Medical College, Vellore, India
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Dunkley S, Lam JCM, John MJ, Wong RSM, Tran H, Yang R, Nair SC, Shima M, Street A, Srivastava A. Principles of haemophilia care: The Asia-Pacific perspective. Haemophilia 2018; 24:366-375. [DOI: 10.1111/hae.13425] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/16/2017] [Indexed: 01/08/2023]
Affiliation(s)
- S. Dunkley
- Haemophilia Treatment Centre; Royal Prince Alfred Hospital; Sydney NSW Australia
| | - J. C. M. Lam
- Department of Paediatric Subspecialties; KK Women's and Children's Hospital; Singapore Singapore
| | - M. J. John
- Department of Clinical Haematology; Christian Medical College; Ludhiana Punjab India
| | - R. S. M. Wong
- Department of Medicine & Therapeutics; Sir Y.K. Pao Centre for Cancer; Prince of Wales Hospital; The Chinese University of Hong Kong; Hong Kong Hong Kong
| | - H. Tran
- Ronald Sawers Haemophilia Centre; The Alfred Hospital Melbourne; Melbourne Vic Australia
| | - R. Yang
- State Key Laboratory of Experimental Hematology; Institute of Hematology and Hospital of Blood Disease; Chinese Academy of Medical Sciences & Peking Union Medical College; Tianjin China
| | - S. C. Nair
- Department of Immunohematology & Transfusion Medicine; Christian Medical College; Vellore Tamil Nadu India
| | - M. Shima
- Department of Paediatrics; Nara Medical University; Kashihara Japan
| | - A. Street
- Department of Immunology and Pathology; Monash University; Melbourne Vic Australia
| | - A. Srivastava
- Department of Hematology; Christian Medical College; Vellore Tamil Nadu India
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Rodgers M, Thomas S, Harden M, Parker G, Street A, Eastwood A. P30 Developing a methodological framework for organisational case studies: a rapid review and consensus development process. J Epidemiol Community Health 2016. [DOI: 10.1136/jech-2016-208064.129] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Heriot G, Yeoh J, Street A, Ratnam I. Echocardiography has minimal yield and may not be warranted in Staphylococcus aureus bacteremia without clinical risk factors for endocarditis. Eur J Clin Microbiol Infect Dis 2015; 34:1231-6. [PMID: 25717023 DOI: 10.1007/s10096-015-2352-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Accepted: 02/11/2015] [Indexed: 11/28/2022]
Abstract
Current guidelines recommend performing echocardiography in all patients with Staphylococcus aureus bacteremia (SAB), but patients at very low risk of endocarditis may not benefit from this investigation. This study seeks to identify patients at very low risk of endocarditis. A retrospective single-center consecutive case series of patients with SAB was examined. Microbiological and echocardiographic data were used to identify patients with community onset, prolonged bacteremia, and intracardiac prosthetic devices. The diagnostic performance of these criteria for endocarditis as measured against transesophageal echocardiography (TEE) was calculated. 593 episodes of SAB were examined over a period of 6 years. 10 % were excluded from analysis due to death or discharge less than 48 h after the first positive blood culture or no admission to hospital, leaving 532 episodes for analysis. 64 % of the included episodes were investigated with echocardiography: 39 % with TEE and 26 % with transthoracic echocardiography (TTE) only. 16 % of the episodes investigated with echocardiography were demonstrated to have endocarditis. The rate of endocarditis was higher for episodes undergoing TEE (24 %) than TTE only (5 %). There were no instances of endocarditis amongst the 23 episodes investigated with TEE where none of the three risk factors were present. This group represented 57 % of the nosocomial (non-community-onset) episodes investigated with TEE. Patients with none of the three criteria examined in this study have a very low rate of endocarditis and may fall below the test threshold for echocardiography.
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Affiliation(s)
- G Heriot
- Victorian Infectious Diseases Service, Royal Melbourne Hospital, Grattan Street, Parkville, VIC, 3050, Australia,
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Abstract
All-oral treatments of hepatitis C (HCV) have been trialled in patients with hereditary bleeding disorders and found to be effective. Further refinements of dosing and duration are being established. Importantly for patient acceptability these regimens are interferon-free. Cohort studies in older patients with haemophilia direct the need for attention to weight control, exercice, assessment of cardiovascular risk, especially hypertension and detection of osteoporosis. Where patients live a long way from a comprehensive care centre, telemedicine connections can engage centre experts with the patient and his/her local practitioners in devising and monitoring care plans.
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Affiliation(s)
- R Kulkarni
- Professor and Director Pediatric Hematology/Oncology, Michigan State University, East Lansing, MI, USA
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Northcott MJ, Ong WL, Walsh M, McCarthy P, Belleli D, Tran H, Street A, Kemp W, Davis AK. Prevalence of transfusion-acquired hepatitis C in an Australian bleeding disorders population. Haemophilia 2013; 19:847-52. [DOI: 10.1111/hae.12204] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/09/2013] [Indexed: 12/30/2022]
Affiliation(s)
- M. J. Northcott
- Ronald Sawers Haemophilia Centre; The Alfred Hospital; Melbourne Australia
| | - W. L. Ong
- Ronald Sawers Haemophilia Centre; The Alfred Hospital; Melbourne Australia
| | - M. Walsh
- Ronald Sawers Haemophilia Centre; The Alfred Hospital; Melbourne Australia
| | - P. McCarthy
- Ronald Sawers Haemophilia Centre; The Alfred Hospital; Melbourne Australia
| | - D. Belleli
- Ronald Sawers Haemophilia Centre; The Alfred Hospital; Melbourne Australia
| | - H. Tran
- Ronald Sawers Haemophilia Centre; The Alfred Hospital; Melbourne Australia
| | - A. Street
- Ronald Sawers Haemophilia Centre; The Alfred Hospital; Melbourne Australia
| | - W. Kemp
- Gastroenterology Department; The Alfred Hospital; Melbourne Australia
| | - A. K. Davis
- Ronald Sawers Haemophilia Centre; The Alfred Hospital; Melbourne Australia
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10
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Street A, Threlkeld G, Blackford J, Bidstrup B, Downing J. ACP FOR HEALTHY OLDER ADULTS: STRATEGIES AND TOOLS FOR A PUBLIC HEALTH APPROACH. BMJ Support Palliat Care 2013. [DOI: 10.1136/bmjspcare-2013-000491.117] [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: 11/03/2022]
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11
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Davis A, Walsh M, McCarthy P, Brown G, Roberts S, Tran H, Street A, Fong CY, Kemp W. Tranexamic acid without prophylactic factor replacement for prevention of bleeding in hereditary bleeding disorder patients undergoing endoscopy: a pilot study. Haemophilia 2013; 19:583-9. [DOI: 10.1111/hae.12146] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2013] [Indexed: 11/30/2022]
Affiliation(s)
- A. Davis
- Ronald Sawers Haemophilia Centre; The Alfred; Melbourne; Vic.; Australia
| | - M. Walsh
- Ronald Sawers Haemophilia Centre; The Alfred; Melbourne; Vic.; Australia
| | - P. McCarthy
- Ronald Sawers Haemophilia Centre; The Alfred; Melbourne; Vic.; Australia
| | - G. Brown
- Department of Gastroenterology; The Alfred; Melbourne; Vic.; Australia
| | - S. Roberts
- Department of Gastroenterology; The Alfred; Melbourne; Vic.; Australia
| | - H. Tran
- Ronald Sawers Haemophilia Centre; The Alfred; Melbourne; Vic.; Australia
| | - A. Street
- Ronald Sawers Haemophilia Centre; The Alfred; Melbourne; Vic.; Australia
| | - C. Y. Fong
- Ronald Sawers Haemophilia Centre; The Alfred; Melbourne; Vic.; Australia
| | - W. Kemp
- Department of Gastroenterology; The Alfred; Melbourne; Vic.; Australia
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Srivastava A, Brewer AK, Mauser-Bunschoten EP, Key NS, Kitchen S, Llinas A, Ludlam CA, Mahlangu JN, Mulder K, Poon MC, Street A. Guidelines for the management of hemophilia. Haemophilia 2012; 19:e1-47. [PMID: 22776238 DOI: 10.1111/j.1365-2516.2012.02909.x] [Citation(s) in RCA: 1251] [Impact Index Per Article: 104.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/06/2012] [Indexed: 01/23/2023]
Affiliation(s)
- A. Srivastava
- Department of Hematology; Christian Medical College; Vellore; India
| | - A. K. Brewer
- Department of Oral Surgery; The Royal Infirmary; Glasgow; Scotland
| | - E. P. Mauser-Bunschoten
- Van Creveldkliniek and Department of Hematology; University Medical Center Utrecht; Utrecht; The Netherlands
| | - N. S. Key
- Department of Medicine; University of North Carolina; Chapel Hill; NC; USA
| | - S. Kitchen
- Sheffield Haemophilia and Thrombosis Centre; Royal Hallamshire Hospital; Sheffield; UK
| | - A. Llinas
- Department of Orthopaedics and Traumatology; Fundación Santa Fe University Hospital Fundación Cosme y Damián and Universidad de los Andes and Universidad del Rosario; Bogotá; Colombia
| | - C. A. Ludlam
- Comprehensive Care Haemophilia and Thrombosis Centre; Royal Infirmary; Edinburgh; UK
| | - J. N. Mahlangu
- Haemophilia Comprehensive Care Centre; Johannesburg Hospital and Department of Molecular Medicine and Haematology; Faculty of Health Sciences; National Health Laboratory Services and University of the Witwatersrand; Johannesburg; South Africa
| | - K. Mulder
- Bleeding Disorders Clinic; Health Sciences Center; Winnipeg; Canada
| | - M. C. Poon
- Departments of Medicine; Pediatrics and Oncology, and Southern Alberta Rare Blood and Bleeding Disorders Comprehensive Care Program; University of Calgary, Foothills Hospital and Calgary Health Region; Calgary; Canada
| | - A. Street
- Haematology; Alfred Hospital; Melbourne; Victoria; Australia
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Affiliation(s)
- A. Gringeri
- Department of Medicine; University of Milan, and Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico; Milan; Italy
| | - T. Lambert
- Centre de Traitement des Hémophiles; Hôpital de Bicêtre AP-HP; Le Kremlin Bicêtre; France
| | - A. Street
- Ronald Sawers Haemophilia Centre; Alfred Health; Melbourne; Australia
| | - L. Aledort
- The Mary Weinfeld Professor of Clinical Research in Hemophilia; Mount Sinai School of Medicine; New York; NY; USA
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Soares LP, Dias KRHC, de Vasconcellos AB, Sampaio EM, Street A. Effects of different pretreatments on the bond strength of a dual-cure resin core material to various fiber-reinforced composite posts. Eur J Prosthodont Restor Dent 2012; 20:41-47. [PMID: 22474936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
The aim of this study was to evaluate the effects of different pretreatments on the bond strength of a dual-cure resin core to 3 types of fiber posts. Bond strength was measured using a push-out design. One-sided t-Test of Hypothesis with unknown variance was performed (p-values < 5%). Sandblasting abrasion with 50 micro alumina particles at a specific distance, pressure and time was the only surface treatment in DT Light Post and Transluma Post that increased the bond strength to dual cure resin composite cores. FRC Postec Plus post did not shown an increase in bond strength in any group.
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Wang K, Street A, Dowrick A, Liew S. Clinical outcomes and patient satisfaction following total joint replacement in haemophilia - 23-year experience in knees, hips and elbows. Haemophilia 2011; 18:86-93. [PMID: 21649799 DOI: 10.1111/j.1365-2516.2011.02579.x] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- K Wang
- Orthopaedic SurgeryHaematology, Alfred Hospital, Melbourne, Vic, Australia.
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Blackford J, Street A. A self-evaluation tool for advance care planning programs. BMJ Support Palliat Care 2011. [DOI: 10.1136/bmjspcare-2011-000053.82] [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: 11/03/2022]
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Blackford J, Street A. Transferability of an ACP model across Australian community palliative care. BMJ Support Palliat Care 2011. [DOI: 10.1136/bmjspcare-2011-000053.126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Ray R, Street A, Blackford J. Hear the right story and finish up in country: learning lessons from Aboriginal Australians implementing Advance Care Planning. BMJ Support Palliat Care 2011. [DOI: 10.1136/bmjspcare-2011-000053.83] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Abstract
AIMS We analysed the in-hospital costs of diabetic patients admitted to English hospitals and aimed to assess what proportions of cost variation are explained by patient and hospital characteristics. METHODS We used Hospital Episode Statistics and reference costs for all patients admitted to diabetes care for all English hospitals for the financial year 2005/2006. Our sample included 31 371 patients admitted to 148 hospitals. We applied a multi-level approach. We analysed the relationship between patient costs and patient characteristics. We estimated the average cost of being treated in each hospital after controlling for patient characteristics. In addition, we explored why these average costs vary across hospitals. RESULTS Much of the variation in the costs of controlling diabetes was driven by the Healthcare Resource Group to which the patient was allocated, but costs were also higher for patients who were transferred between hospitals, suffered infections and other complications, or for those who died in hospital. Even so, approximately 8-9% of the variation in costs was related to the hospital in which the patient was treated, with geographical variation in factor prices being the prime reason for this variation. The volume of patients, and the number and diversity of specialties involved in caring for diabetic patients did not explain the variation in the cost of treating diabetic patients across hospitals. CONCLUSIONS Healthcare Resource Groups and diagnostic markers are significant patient-related cost drivers in diabetes care. Costs are not lower in hospitals with a high volume of patients and where diabetes care is concentrated in few specialties.
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Affiliation(s)
- T Kristensen
- Department of Health Economics, Faculty of Social Sciences, Institute of Public Health, University of Southern Denmark, Odense, Denmark.
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Dunkley S, Baker RI, Pidcock M, Price J, Seldon M, Smith M, Street A, Maher D, Barrese G, Stone C, Lloyd J. Clinical efficacy and safety of the factor VIII/von Willebrand factor concentrate BIOSTATE in patients with von Willebrand's disease: a prospective multi-centre study. Haemophilia 2010; 16:615-24. [PMID: 20331755 DOI: 10.1111/j.1365-2516.2010.02206.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
von Willebrand's disease (VWD) is an inherited bleeding disorder characterized by deficient levels of or dysfunctional von Willebrand factor (VWF). This phase II/III open-label, multicentre study evaluated the efficacy and safety of BIOSTATE, a high purity plasma-derived double-virus inactivated FVIII/VWF concentrate, when used in non-surgical bleeds, surgical procedures and prophylactic therapy in VWD patients for whom desmopressin treatment was deemed ineffective, inadequate or contraindicated. Twenty three patients (7 type 1, 9 type 2 and 7 type 3; 12 male, 11 female), who received FVIII/VWF concentrate as part of their VWD management, were recruited prospectively between December 2004 and May 2007 from eight centres in Australia and New Zealand. BIOSTATE dosing was based on pre-treatment FVIII:C and/or VWF:RCo plasma levels and a predetermined dosing guide. Haemostatic efficacy of BIOSTATE was rated as excellent or good for all major and minor surgery events, long-term prophylaxis, and for four of the six assessable non-surgical bleeding events. Blood transfusions were required by two major surgery patients as well as one patient with a non-surgical bleed. The median overall exposure to BIOSTATE across all groups was 8 days, greater in the prophylactic group (range 53-197) compared with major surgery (3-24), minor surgery (1-8) and non-surgical bleeds (1-10). BIOSTATE was shown to be efficacious and well tolerated when treating patients with VWD. This study also provides important insights into dosing regimens with BIOSTATE and the role of monitoring therapy with FVIII:C and VWF:RCo.
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Affiliation(s)
- S Dunkley
- Haematology Dept, Royal Prince Alfred Hospital, Sydney, Newcastle, NSW, Australia.
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Abstract
The main focus of lower limb physical performance assessment in people with haemophilia (PWH) has usually been on function, muscle strength and joint flexibility. The impact of haemophilic arthropathy on balance and falls risk is relatively under-explored. The aim of this study was to evaluate balance and related performance in PWH compared with age and gender matched healthy controls. It involved a comprehensive suite of clinical and laboratory measures of static and dynamic balance, mobility, strength, physical activity and falls efficacy completed in 20 PWH (mean age 39.4, 100% male) and 20 controls. Fifty percent of PWH reported falls in the past 12 months. Moderate impairment of balance and related measures were identified in PWH compared with the controls, with an average 35% difference between groups. Significant differences were evident between groups on both clinical and laboratory measures, including measures of dynamic bilateral stance balance [limits of stability measures on the laboratory test, functional reach; (P < 0.001); dynamic single leg balance (Step Test, P < 0.001)], gait and mobility (gait speed, step width and turning measures on the laboratory test, timed up and go test; P < 0.001); muscle strength (timed sit to stand, P = 0.002; quadriceps strength, P < 0.001); and activity level and falls efficacy, (P < 0.004). The dynamic clinical and laboratory measures testing similar domains of balance, gait and mobility had moderate correlations (0.310 < r < 0.531, P < 0.01). Moderate impairments in balance, mobility and related measures were identified in PWH, compared with the control group. Clinicians should include assessments of balance and related measures when reviewing adults with haemophilia.
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Affiliation(s)
- M Fearn
- Preventive and Public Health Division, National Ageing Research Institute, Parkville, Vic., Australia.
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Eschbach L, Magal M, Street A, Woessner M. Accuracy Of The American College Of Sports Medicine Metabolic Equation For Predicting Oxygen Cost During Leg Ergometry. Med Sci Sports Exerc 2009. [DOI: 10.1249/01.mss.0000354674.29650.a2] [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: 11/21/2022]
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Denholm J, Wright E, Street A, Sasadeusz J. HCV Treatment with Pegylated Interferon and Ribavirin in Patients with Haemophilia and HIV/HCV Coinfection: A Retrospective Review. Int J Infect Dis 2008. [DOI: 10.1016/j.ijid.2008.05.1348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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26
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Spelman D, Buttery J, Daley A, Isaacs D, Jennens I, Kakakios A, Lawrence R, Roberts S, Torda A, Watson DAR, Woolley I, Anderson T, Street A. Guidelines for the prevention of sepsis in asplenic and hyposplenic patients. Intern Med J 2008; 38:349-56. [DOI: 10.1111/j.1445-5994.2007.01579.x] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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27
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Thomas S, Herbert D, Street A, Barnes C, Boal J, Komesaroff P. Attitudes towards and beliefs about genetic testing in the haemophilia community: a qualitative study. Haemophilia 2007; 13:633-41. [PMID: 17880455 DOI: 10.1111/j.1365-2516.2007.01454.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Widespread genetic testing for haemophilia has recently been introduced in Victoria, Australia. While attitudes towards predictive testing have been studied in other conditions, such as cancer, there is limited knowledge about the attitudes of members of the haemophilia community towards predictive testing. This study aimed at exploring attitudes towards, and beliefs about, genetic testing amongst members of the haemophilia community in Victoria prior to the widespread introduction of testing. The study was qualitative and descriptive. In-depth face to face interviews were held with a sample of 39 individuals, including men with haemophilia, female carriers and family members. Data were analysed thematically using cross-case analysis techniques. There was considerable knowledge about the proposed introduction of widespread genetic testing. However, not everyone thought that testing was accessible or user friendly, and there was confusion about who needed to be tested. Most thought that testing was necessary for adolescent girls to determine carrier status to help prepare families for a child with haemophilia, rather than leading them to choose to terminate a pregnancy or not to have children. A minority of women stated that if there was a history of inhibitors in a family then a termination might be considered. The study revealed strong religious beliefs among those studied, which may have influenced attitudes and approaches towards testing. Further investigation is needed into how people with a possible haemophilia genotype negotiate decisions about their further identification, and how this knowledge is placed within cultural, religious and family contexts.
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Affiliation(s)
- S Thomas
- Centre for Ethics in Medicine and Society, Faculty of Medicine, Nursing and Health Sciences, Monash Medical School, Monash University, Melbourne, Victoria, Australia.
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28
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Favaloro E, Bonar R, Street A, Marsden K. 2B OR NOT 2B? DISPARATE DISCRIMINATION OF FUNCTIONAL VWF DISCORDANCE USING DIFFERENT ASSAYS OR METHODOLOGIES FOR VWF LEADS TO SUCCESS OR FAILURE IN THE EARLY IDENTIFICATION OF TYPE 2B VWD. J Thromb Haemost 2007. [DOI: 10.1111/j.1538-7836.2007.tb01942.x] [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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Shortt J, Dunkley S, Rickard K, Baker R, Street A. Efficacy and safety of a high purity, double virus inactivated factor VIII/von Willebrand factor concentrate (Biostate�) in patients with von Willebrand disorder requiring invasive or surgical procedures. Haemophilia 2007; 13:144-8. [PMID: 17286766 DOI: 10.1111/j.1365-2516.2006.01430.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Biostate is a double virally inactivated, plasma derived coagulation factor VIII (FVIII)/von Willebrand factor (VWF) concentrate registered and used in Australia, New Zealand and Asia for the treatment of patients with haemophilia A. Although Biostate has been well characterized for FVIII and VWF (ratio 1:2 respectively) and shows a similar VWF multimeric pattern to normal plasma, limited published data is available on its clinical efficacy and safety in patients with von Willebrand disorder (VWD) who require surgical procedures. We retrospectively assessed the efficacy and safety of Biostate in all VWD patients treated at three Australian haemophilia treatment centres undergoing invasive procedures or surgery over a 29-month period between April 2003 and September 2005. A chart review of 43 VWD patients (26 VWD type 1, 12 VWD type 2, 5 VWD type 3; 21 male, 22 female; mean age 52 years, range 19-80 years) undergoing 58 surgical procedures (24 major, 34 minor) was performed. For each procedure, data were collected on Biostate dosage and administration, adverse reactions, haemostatic efficacy and bleeding events. Haemostatic efficacy of Biostate was assessed as excellent in 78% or good in 22% of procedures. There were no bleeding events attributable to lack of efficacy in any patients. No adverse reactions related to the administration of Biostate were observed. These results suggest that Biostate is both safe and efficacious for the prevention of excessive bleeding in VWD patients undergoing surgery or invasive procedures.
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Affiliation(s)
- J Shortt
- Alfred Hospital, Melbourne, Vic., Australia.
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30
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Mijch A, Burgess P, Judd F, Grech P, Komiti A, Hoy J, Lloyd JH, Gibbie T, Street A. Increased health care utilization and increased antiretroviral use in HIV-infected individuals with mental health disorders. HIV Med 2006; 7:205-12. [PMID: 16630032 DOI: 10.1111/j.1468-1293.2006.00359.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The aims of the study were to describe the prevalence and associations of mental health disorder (MHD) among a cohort of HIV-infected patients attending the Victorian HIV/AIDS Service between 1984 and 2000, and to examine whether antiretroviral therapy use or mortality was influenced by MHD (defined as a record of service provision by psychiatric services on the Victorian Psychiatric Case Register). It was hypothesized that HIV-positive individuals with MHD would have poorer treatment outcomes, reduced responses to highly active antiretroviral therapy (HAART) and increased mortality compared with those without MHD. METHODS This is a retrospective cohort of 2981 individuals (73% of the Victorian population diagnosed with HIV infection) captured on an HIV database which was electronically matched with the public Victorian Psychiatric Case Register (VPCR) (accounting for 95% of public system psychiatry service provision). The prevalence, dates and recorded specifics of mental health disorders at the time of the electronic match on 1 June 2000 are described. The association with recorded MHD, gender, age, AIDS illness, HIV exposure category, duration and type of antiviral therapy, treatment era (prior to 1986, post-1987 and pre-HAART, and post-HAART) on hospitalization and mortality at 1 September 2001 was assessed. RESULTS Five hundred and twenty-five individuals (17.6% of the Victorian HIV-positive population) were recorded with MHD, most frequently coded as attributable to substance dependence/abuse or affective disorder. MHD was diagnosed prior to HIV in 33% and, of those diagnosed after HIV, 93.8% were recorded more than 1 year after the HIV diagnosis. Schizophrenia was recorded in 6% of the population with MHD. Hospitalizations for both psychiatric and nonpsychiatric illness were more frequent in those with MHD (relative risk 5.4; 95% confidence interval 3.7, 8.2). The total number of antiretrovirals used (median 6.4 agents vs 5.5 agents) was greater in those with MHD. When adjusted for antiretroviral treatment era, HIV exposure category, CD4 cell count and antiretroviral therapy, survival was not affected by MHD. CONCLUSIONS MHD is frequent in this population with HIV infection and is associated with increased healthcare utilization but not with reduced survival.
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Affiliation(s)
- A Mijch
- Victorian HIV Psychiatry Consortium, Melbourne, Australia.
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31
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Abstract
Men with haemophilia have not only the challenges of living with HIV and/or HCV infection and premature arthritis as complications of their disorder, but they also confront the other ails of ageing. These include genitourinary problems such as prostatic hypertrophy, prostatic cancer and renal stone disease, and arterial disease for which haemophilia is not protective. Progressive arthritis and declining fitness may lead to loss of independence which causes great concern. Associated with the physical aspects of ageing, many patients also suffer from psychological symptoms which may be precipitated by changes in work such as early retirement and altered family dynamics. Many older men with haemophilia may never have consulted primary care physicians because of the rarity and complexity of their disorder. Haemophilia centre staff often assume responsibility for the identification and management of all health problems of their patients. Even when other clinicians are involved, patients require their centre's involvement in the investigation and support of many procedures such as coronary artery surgery and urological surgery. This paper addresses falls in the older man with haemophilia, their causes and consequences and cardiovascular problems in particular. Very little literature has been published about these common problems. We need to be aware of the ageing issues in haemophilia and develop 'wellness' programs which are directed to the early identification of disease as well as preventative strategies to reduce the physical and psychological impacts of ageing.
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Affiliation(s)
- A Street
- Ronald Sawers Haemophilia Centre, Melbourne, Australia.
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32
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Leong CL, Buising K, Richards M, Robertson M, Street A. Providing guidelines and education is not enough: an audit of gentamicin use at The Royal Melbourne Hospital. Intern Med J 2006; 36:37-42. [PMID: 16409311 DOI: 10.1111/j.1445-5994.2006.01002.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Aminoglycoside antibiotics are commonly prescribed for the treatment of Gram-negative infections. Appropriate dosing and therapeutic monitoring of aminoglycosides are important because these agents have a narrow therapeutic index. AIM To audit gentamicin use at our hospital, focusing on selection of the initial dose and therapeutic monitoring practices, and to compare the results against recommendations in the existing hospital aminoglycoside guidelines, which had recently been promoted to doctors. METHODS This audit included all inpatients receiving gentamicin at The Royal Melbourne Hospital from 1 February to 12 March 2004. The principal researcher checked the drug charts of all inpatients to identify those receiving gentamicin and collected data from the medical records and the pathology database. Doses were considered 'concordant' if the dose given was within the recommended dosing range +/-20 mg. RESULTS A total of 132 courses of gentamicin was included in the study. Gentamicin was prescribed for prophylaxis in 31.1% of courses. Thirty-six per cent of patients prescribed gentamicin were more than 65 years of age. Eighty-two per cent of the gentamicin used therapeutically was given as a single daily dose. Sixty-six per cent of gentamicin initial dosing was not in accordance with existing hospital guidelines. Seventy-seven per cent of gentamicin courses requiring therapeutic drug monitoring received such monitoring; however, in only 8.8% of these was the monitoring conducted according to guidelines. CONCLUSION Aminoglycoside prescribing practices at our hospital are suboptimal, despite ready access to prescribing guidelines. Provision of a guideline and education sessions with doctors do not necessarily lead to widespread adoption of recommended practices. We suggest that changes to hospital systems related to prescribing and monitoring of aminoglycosides are required.
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Affiliation(s)
- C L Leong
- Infectious Diseases Department, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia
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33
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Abstract
Comprehensive haemophilia care has been defined as the continuing supervision of all medical and psychosocial factors affecting the person with haemophilia family. Services offered by haemophilia treatment centres (HTCs) adopting the comprehensive care model include establishing prophylaxis and other treatment protocols, development of psychosocial, education and research programme, maintenance of a patient registry, genetic and reference diagnostic services and orchestration and management of a wide variety of multidisciplinary interventions. Most centres practising this model of care are based in developed countries and can meet costs for plentiful treatment products through government or insurance-company funding. Not all the programmes are dependent on the level of product supply, however, and many have been supported in countries with emerging economies as part of national healthcare systems, particularly in relation to blood management. In this paper we present perspectives from different areas of the world on how to adopt, adapt and achieve economically appropriate models of comprehensive care.
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Affiliation(s)
- B L Evatt
- Division of Hereditary Blood Disorders, National Center for Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, USA
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34
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Hodson T, Borosak M, Choo S, Street A. Warfarin: balancing the benefits and harms. Aust Prescr 2004. [DOI: 10.18773/austprescr.2004.115] [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: 11/03/2022] Open
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35
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Dunkley S, Street A. Is there a high thrombosis rate associated with recombinant factor VIIa use in intractable hemorrhage in Australia? J Thromb Haemost 2004; 2:1852-3. [PMID: 15456504 DOI: 10.1111/j.1538-7836.2004.00846.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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36
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Favaloro EJ, Bonar R, Kershaw G, Sioufi J, Hertzberg M, Street A, Lloyd J, Marsden K. Laboratory diagnosis of von Willebrand's disorder: quality and diagnostic improvements driven by peer review in a multilaboratory test process. Haemophilia 2004; 10:232-42. [PMID: 15086320 DOI: 10.1111/j.1365-2516.2004.00897.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Regular multilaboratory surveys of laboratories derived primarily from Australia, New Zealand and Southeast Asia have been conducted over the past 7 years to evaluate testing proficiency in the diagnosis of von Willebrand's disorder (VWD) and to assess changes to test practice. Participating laboratories (currently 45) are asked to perform their usual panel of tests for VWD, and then to self-interpret test results as to the likelihood (or not) of VWD, as well as to the potential subtype identified. Samples provided in the past two survey distributions (both conducted in 2003) were as follows. Survey part A/distribution 1: Normal donor plasma, plasma with borderline normal/reduced levels of VWF (x2) and plasma from an individual with type 2 A VWD. Survey part B/distribution 2 (family VWD study): Plasma from a father, mother and son with borderline normal/reduced von Willebrand factor (VWF), and a daughter with type 3 VWD. In line with previously published survey results, the interassay and within method coefficients of variation (CV) were similar for all assays (around 15-25%), although tending to be slightly higher for VWF:RCo and VWF:CB than VWF:Ag and FVIII:C. Most laboratories reported test values consistent with expected findings, and made correct interpretations or predictions regarding the nature of the samples, although discrepant assay results or interpretations are still seen in approximately 5-10% of responses (typically from laboratories using a more limited test panel or not performing the VWF:CB). Overall, problems with the non-identification of functional VWF discordance in type 2 VWD, the misidentification of functional VWF discordance in type 1 VWD, and difficulties in discriminating types 1 and 3 VWD appear to predominate. In comparison with previous surveys, performance of electro-immuno diffusion (EID) (or Laurel gel) procedures has now ceased, and a reduction in VWF:RCo and VWF:Multimer testing and an increase in latex immunoassay (LIA) testing is sustained. We conclude that laboratories are generally proficient in tests for VWD, and that diagnostic error rates are reduced when test panels are more comprehensive and include the VWF:CB.
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Affiliation(s)
- E J Favaloro
- Department of Haematology, Institute of Clinical Pathology and Medical Research, Westmead Hospital, NSW, Australia.
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37
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Street A, Kissane DW. Dispensing death, desiring death: an exploration of medical roles and patient motivation during the period of legalized euthanasia in Australia. Omega (Westport) 2003; 40:231-48. [PMID: 12578011 DOI: 10.2190/jb07-5gcr-bh81-j2qn] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.2] [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] [Indexed: 11/22/2022]
Abstract
A qualitative case study was conducted to explore the clinical decision making processes that underpinned the practice of euthanasia under the Rights of the Terminally Ill (ROTI) Act. The key informant for this research was Philip Nitschke, the general practitioner responsible for the legal cases of euthanasia. His information was supported by extensive document analysis based on the public texts created by patients in the form of letters and documentaries. Further collaborating sources were those texts generated by the media, rights groups, politicians, the coroner's cort, and the literature on euthanasia and assisted suicide. A key study finding was that the ROTI legislation did not adequately provide for the specific medical situation in the Northern Territory, Australia. The medical roles, as proscribed by the legislation, carried many inherent assumptions about the health care context and the availability of appropriately qualified medical staff committed to providing euthanasia. These assumptions translated into difficulties in establishing clinical practices for the provision of euthanasia. A further finding concerned the motivations of those who requested euthanasia. This article addresses the medical roles and the motivations of those seeking euthanasia.
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Affiliation(s)
- A Street
- School of Nursing, La Trobe University, Bundoora, Victoria, Australia 3083
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38
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Skull SA, Ngeow JYY, Biggs BA, Street A, Ebeling PR. Vitamin D deficiency is common and unrecognized among recently arrived adult immigrants from The Horn of Africa. Intern Med J 2003; 33:47-51. [PMID: 12534878 DOI: 10.1046/j.1445-5994.2003.00344.x] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The prevalence of and risk factors for vitamin D deficiency were examined for recent adult immigrants from East Africa living in Melbourne. Demographic data were collected via a face-to-face questionnaire and risk factors predicting deficiency were examined. Suboptimal levels <25 nmol/L were found in 61 patients (53%; 74% of women; 20% of men). Lower levels were more likely in: (i) patients with a longer duration of residence in Australia, (ii) patients who were mostly covered when outdoors and (iii) women. Routine assessment for vitamin D deficiency should be considered for male and female immigrants from East Africa.
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Affiliation(s)
- S A Skull
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.
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39
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Abstract
MonoFIX-VF, a monocomponent factor IX concentrate, has replaced the use of Prothrombinex-HT as the treatment of choice for patients with factor IX deficiency in Australia. The haemostatic effect of MonoFIX-VF, administered by continuous infusion, was assessed in four subjects being treated for 10 bleeding episodes including five surgical procedures. MonoFIX-VF was found to be a safe and effective treatment for patients with haemophilia B.
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Affiliation(s)
- G Evans
- Haemophilia Centre, Kent and Canterbury Hospital, Canterbury, Kent, UK.
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40
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Abstract
Development of an English measure of hospital casemix can be traced back to the early 1980s and has resulted in the creation of healthcare resource groups (HRGs). Despite the availability of this casemix classification system, less use has been made of HRG costs than might be expected, primarily because hospitals are not funded on the basis of their casemix adjusted activity. Instead, the main use of casemix information has been in benchmarking exercises, such as the recent example of the government's use of HRG costs to set hospital efficiency targets. This paper outlines the historical context in which HRGs were developed, the data used for classification purposes and the calculation of HRG costs. The responses of hospitals to efficiency targets based on HRG costs are considered, including the options of improving data quality, reducing costs, and ignoring the targets. It is argued that the latter strategy is most evident in England.
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Affiliation(s)
- A Street
- Centre for Health Economics, University of York, UK.
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41
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Abstract
OBJECTIVE To review the existing literature on suicidal behaviour in people with HIV/AIDS infection. METHOD A search on the Index Medicus/MEDLINE database was performed, for articles that investigated and/or reviewed suicidal behaviour in people with HIV at any stage of the illness. Only articles written in English were used in this review. RESULTS Most studies have been done on homosexual/bisexual groups, with little data available for heterosexual populations or women. Studies show an increased rate of suicidal ideation, suicide attempts and completed suicide in individuals with HIV/AIDS. Of note, there is a high prevalence of psychiatric illness and substance abuse in those with suicidal behaviour. CONCLUSIONS The increased rate of suicidal behaviour in HIV-infected persons is consistent with findings in other medically ill groups with chronic, life-threatening disorders. However, assessment of any possible direct effect of HIV/AIDS on suicidal behaviour is confounded by methodological limitations of many of the studies. More longitudinal studies encompassing other affected groups including heterosexual populations and women are needed to elucidate the relationship between suicidal behaviour and HIV/AIDS.
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Affiliation(s)
- A Komiti
- Department of Psychiatry, University of Melbourne, Parkville, Victoria, Australia.
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42
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Abstract
OBJECTIVES Both the World Health Organization (WHO) and the Fédération Internationale de Football Association (FIFA) have developed sophisticated ways of defining and aggregating performance to produce overall, single-number indices. These are used to illustrate some of the problems of measuring, comparing and improving health system performance. METHODS Possible associations between FIFA football rankings for international 'A' sides for 176 countries and rankings on the WHO overall health system performance index were explored using econometric techniques. RESULTS There is a significant relationship between a country's FIFA ranking and its ranking by the WHO. Taken at face value, the statistical analysis suggests that, if the national football team does well, the WHO score improves. CONCLUSIONS The relationship between FIFA and WHO ranks is entirely spurious. However, comparison of the two indices illustrates problems with the WHO exercise, including measurement difficulties, how policy-makers may use the information to improve health system performance, what the public are to make of the data and how different dimensions of overall performance may be subject to trade-offs.
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Affiliation(s)
- J Appleby
- Health Systems Programme, King's Fund, 11-13 Cavendish Square, London W1G 0AN, UK
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43
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Poon MC, d'Oiron R, Hann I, Négrier C, de Lumley L, Thomas A, Karafoulidou A, Demers C, Street A, Huth-Kühne A, Petrini P, Fressinaud E, Morfini M, Tengborn L, Marquès-Verdier A, Musso R, Devecioglu O, Houston DS, Lethagen S, Van Geet C, von Depka M, Berger C, Beurrier P, Britton HA, Gerrits W, Guthner C, Kuhle S, Lorenzo JJ, Makris PE, Nohe N, Paugy P, Pautard B, Torchet MF, Trillot N, Vicariot M, Wilde J, Winter M, Chambost H, Ingerslev J, Peters M, Strauss G. Use of recombinant factor VIIa (NovoSeven) in patients with Glanzmann thrombasthenia. Semin Hematol 2001; 38:21-5. [PMID: 11735106 DOI: 10.1016/s0037-1963(01)90143-x] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Recombinant factor VIIa (rFVIIa; NovoSeven, Novo Nordisk, Bagsvaerd, Denmark) appears effective and relatively safe for the treatment of bleeding and for surgical prophylaxis in patients with Glanzmann thrombasthenia as reported to the International Registry on rFVIIa and Congenital Platelet Disorders. One of the shortcomings of the Registry data is the heterogeneity of treatment protocol, including dosage, number of doses used, duration of treatment before declaration of failure, and mode of rFVIIa administration (bolus v continuous infusion). The data are not yet sufficient to define optimal regimens for various indications such as the type of bleeding or the type of procedures. The place of this drug compared to platelet transfusion in the overall management of patients with Glanzmann thrombasthenia will need to be determined in relationship to a number of challenges and unresolved issues in the clinical care of these patients. These issues include: how to improve local measures for patients with mucosal bleeds, optimal management of young women during menarche, optimal platelet transfusion regimens for various indications, the relationship between antiplatelet antibodies detected by monoclonal antibody-specific immobilization of platelet antigens (MAIPA) and effectiveness of platelet transfusion, whether there are other biological tests that may correlate with effectiveness of platelet transfusion, and management of pregnancy and delivery regarding antiplatelet immunization.
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Affiliation(s)
- M C Poon
- Hemophilia/Hemostasis Centres in Canada.
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44
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Abstract
In order to encourage performance improvements, the English government has set targets for acute hospitals to reduce their unit costs. Targets are based on analysis of costs across all acute hospitals. This policy has parallels with that of 'yardstick competition', advocated as a means to encourage efficiency in industries that lack competitive pressures. However, the prospect of cost improvements may not be realised in England. Firstly, there are insufficient incentives to respond appropriately to the provision of comparative cost information. Secondly, there is more than one index purporting to measure relative hospital costs. As comparison of unit costs is highly dependent on the measurement technique adopted, caution should be exercised when setting performance targets.
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Affiliation(s)
- D Dawson
- Centre for Health Economics, University of York, York YO10 5DD, UK
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45
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46
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Abstract
This paper discusses the findings of a critical study that examined the communication patterns between nurses and general practitioners (GPs) providing palliative care in Australia. Interviews and focus groups involved 40 palliative care nurses who worked in the three settings of care: community, hospice and hospital. Issues that impeded effective communication strategies between palliative care nurses and GPs were networking, case management, multiple service providers, lack of standardized documentation and formal tracking of clients, along with difficulties in transmission of relevant practice knowledge. Supporting strategies for effective formal modes of communicating and reporting are described.
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Affiliation(s)
- A Street
- School of Nursing, La Trobe University, Bundoora, Victoria, Australia.
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47
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Affiliation(s)
- J J Tjandra
- Department of Colorectal Surgery, Royal Melbourne Hospital, Parkville, Victoria, Australia.
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48
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Abstract
This paper describes the participation of critical care nurses in ward rounds, and explores the power relations associated with the ways in which nurses interact with doctors during this oral forum of communication. The study comprised a critical ethnographic study of six registered nurses working in a critical care unit. Data collection methods involved professional journalling, participant observation, and individual and focus group interviews with the six participating nurses. Findings demonstrated that doctors used nurses to supplement information and provide extra detail about patient assessment during ward rounds. Nurses experienced enormous barriers to participating in decision-making activities during ward round discussions. By challenging the different points of view that doctors and nurses might hold about the ward round process, the opportunity exists for enhanced participation by nurses.
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Affiliation(s)
- E Manias
- School of Postgraduate Nursing, The University of Melbourne, Carlton, Victoria, Australia.
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49
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Street A, Strong J, Karp S. Improving patient recruitment to multicentre clinical trials: the case for employing a data manager in a district general hospital-based oncology centre. Clin Oncol (R Coll Radiol) 2001; 13:38-43. [PMID: 11292134 DOI: 10.1053/clon.2001.9212] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
One of the most frequently cited reasons for poor recruitment to multicentre randomized clinical trials is the additional workload placed on clinical staff. We report the effect on patient recruitment of employing a data manager to support clinical staff in an English district general hospital (DGH). In addition, we explore the effect data managers have on the quality of data collected, proxied by the number of queries arising with the trial organizers. We estimate that the cost of employing a data manager on a full-time basis is 502 per patient recruited but may amount to 326 if the appointment is part-time. Data quality is high when full responsibility lies with a data manager but falls when responsibility is shared. Whether the costs of employing a data manager to recruit patients from a DGH are worth incurring depends on the value placed on the speed at which multicentre trials can be completed, how important it is to broaden the research base beyond the traditional setting of teaching hospitals, and the amount of evaluative data required.
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Affiliation(s)
- A Street
- Centre for Health Economics, University of York, UK.
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Abstract
The provision of end-of-life care through a multidisciplinary integrated palliative-care approach is dependent on effective communication between professional groups and services. We did a qualitative study, using semi-structured individual and focus group interviews, in Melbourne, Australia. The research aim was to explore the experiences and strategies used by palliative care nurses to communicate with general practitioners. We found that palliative care nurse consultants in acute hospitals not only provided inpatient consultation, but also played an important part in facilitating continuity of care across healthcare services by improving existing communication strategies and establishing further communication networks. However, there were several issues that had the potential to disrupt communication, and this article reports on the role of the palliative care nurse consultant in addressing these issues.
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Affiliation(s)
- J Blackford
- School of Nursing, La Trobe University, Bundoora, Victoria, Australia
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