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Do some levator avulsions improve over time? ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2024. [PMID: 38764178 DOI: 10.1002/uog.27702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Revised: 05/07/2024] [Accepted: 05/11/2024] [Indexed: 05/21/2024]
Abstract
OBJECTIVE To determine whether the sonographic appearance of levator avulsion after vaginal childbirth can improve significantly over the first few years postpartum. METHODS Retrospective study of women seen in the context of two prospective perinatal imaging studies. All subjects had undergone an interview, clinical examination and 4D translabial ultrasound (TLUS) on average 4.3 months and 3.1 years post-partum. Volume data sets were analysed at a later date blinded against all other data. The number of abnormal slices at both time points was compared using Mann- Whitney U Test. Patients in whom findings had changed over time were reviewed separately in parallel in order to reduce the impact of differences in slice location and imaging settings. The symmetry test was used to analyse changes between the two postnatal visits. RESULTS Of 1148 women originally recruited, 315 had had at least two postnatal visits. 42 were excluded, leaving 273 women for analysis. They were first seen on average 4.3 (2.6-9.8) months after childbirth and the last time 3.1 (1.4-8) years postpartum. Cohen's kappa for the two assessments was 0.89, with agreement in 97% (264/273) of cases. At the first visit, complete avulsion was diagnosed in 20, partial avulsion in 32, and no avulsion in 221. While seven partial avulsions appeared sonographically normal at the second visit, there were no statistically significant changes in avulsion category between visits (P=0.4). CONCLUSION Tomographic pelvic floor imaging obtained 2.5-10 months after childbirth may be used as a proxy for long- term outcomes. Findings at a mean of 3.1 years showed 97% agreement with imaging obtained at an average of 4.3 months. There was a non-significant reduction in abnormal slices affecting at most 3/12 slices. This may be explained by compensatory hypertrophy of remaining intact muscle. Sonographic normalisation of complete avulsion was not observed. This article is protected by copyright. All rights reserved.
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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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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"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] [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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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] [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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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] [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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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] [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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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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Prevalence and factors associated with physical activity after total hip or knee arthroplasty. J Sci Med Sport 2018. [DOI: 10.1016/j.jsams.2018.09.124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Longitudinal vocabulary development in Australian urban Aboriginal children: Protective and risk factors. Child Care Health Dev 2017; 43:906-917. [PMID: 28776756 DOI: 10.1111/cch.12492] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Revised: 06/22/2017] [Accepted: 06/22/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND Vocabulary is a key component of language that can impact on children's future literacy and communication. The gap between Australian Aboriginal and non-Aboriginal children's reading and academic outcomes is well reported and similar to Indigenous/non-Indigenous gaps in other nations. Determining factors that influence vocabulary acquisition over time and may be responsive to treatment is important for improving Aboriginal children's communication and academic outcomes. AIM To determine what factors influence Australian urban Aboriginal children's receptive vocabulary acquisition and whether any of these are risks or protective for vocabulary development. METHOD One hundred thirteen Aboriginal children in South Western Sydney from the longitudinal birth cohort Gudaga study were assessed on The Peabody Picture Vocabulary Test multiple times: 3 years, just prior to school entry, at the end of the first and second years of formal schooling. Multilevel models were used to determine the effects of 13 fixed and manipulable maternal, child, and family variables drawn from previous research. RESULTS Higher maternal education was found to be protective at 3 years and over time. The number of children in urban Australian Aboriginal households made an impact on vocabulary development and this varied over time. From 3 to 6 years, those with early poor non-verbal cognitive skills had vocabulary skills that remained below those with stronger non-verbal skills at 3 years. Girls exhibit an earlier advantage in vocabulary acquisition, but this difference is not sustained after 4 years of age. CONCLUSIONS The risk and protective factors for vocabulary development in Australian Aboriginal children are similar to those identified in other studies with some variation related to the number of children in the home. In this limited set of predictors, maternal education, gender, non-verbal cognitive skills, and the number of children in households were all shown to impact on the acquisition of vocabulary to 3 years and or the developmental trajectory over time.
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Predictors of developmental surveillance completion at six months of age in south western Sydney. Child Care Health Dev 2017; 43:307-315. [PMID: 27910128 PMCID: PMC5396131 DOI: 10.1111/cch.12425] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2016] [Revised: 09/22/2016] [Accepted: 10/09/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND While developmental surveillance programs promote early identification of child developmental problems, evidence has indicated suboptimal uptake. This study aimed to identify predictors of developmental surveillance completion at 6 months postpartum. METHODS Questionnaires were administered to the parents of 510 infants who were born in south western Sydney, Australia over a 22-month period. Attendance for developmental screening and completion of the Parents' Evaluation of Developmental Status (PEDS) at 6 months postpartum were modelled separately using multivariable logistic regression. RESULTS Developmental surveillance attendance was predicted by higher levels of maternal education, annual income and being informed about checks. PEDS completion at 6 months of age was predicted by higher income and being informed, as well as being married, employed, speaking English at home, full-term birth and the professional status of the practitioner completing the check. CONCLUSIONS Barriers to developmental surveillance included low socioeconomic status, linguistic diversity and possible gaps in parental knowledge and professional education. Developmental surveillance rates may be increased by the addition of targeted parental and professional support within current universal frameworks.
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An equivalence study: Are patient-completed and telephone interview equivalent modes of administration for the EuroQol survey? Health Qual Life Outcomes 2017; 15:18. [PMID: 28114993 PMCID: PMC5259885 DOI: 10.1186/s12955-017-0596-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Accepted: 01/17/2017] [Indexed: 11/13/2022] Open
Abstract
Background To determine if the EuroQol Health Related Quality of Life survey produces equivalent results when administered by phone interview or patient-completed forms. Methods People awaiting hip or knee arthroplasty at a major metropolitan hospital participated. They were randomly assigned to receive the EuroQol Health Related Quality of Life survey via telephone, followed by a patient completed form 1 week later, or vice versa. Equivalence was determined using two one-sided tests (TOST) based on minimal clinically-important differences for the visual analogue scale (VAS) and the summary Utility Index. Cohen’s Kappa scores were computed to determine agreement for the individual EuroQoL Likert scale items. Results Seventy-six from 90 (84%) participants completed the survey twice. Based on limits set at ±7 and ±0.11 for the VAS and Utility Index, respectively, equivalence was established between the two methods of administration for both the VAS (mean difference 0.05 [90% CI −3.76–3.67]) and the Utility Index (mean difference 0.06 [90% CI 0.02–0.11]). Varying levels of agreement, ranging from slight to substantial (κ = 0.17–0.67), were demonstrated for the individual health domains. The order of telephone and patient-completed survey administration had no significant effect on results. Conclusions Equivalent results are obtained between telephone and patient-completed administration for the VAS and Utility Index of the EuroQol Survey in people with advanced hip or knee osteoarthritis. The limits of agreement for the individual health domains vary which prevents the accurate interpretation of real change in these items across modes.
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Application of Guideline Recommended Treatment in Routine Clinical Practice: A Population-based Study of Stage I–IIIB Non-small Cell Lung Cancer. Clin Oncol (R Coll Radiol) 2016; 28:639-47. [DOI: 10.1016/j.clon.2016.04.045] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Revised: 03/14/2016] [Accepted: 03/17/2016] [Indexed: 11/25/2022]
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ENsCOPE: Scoping the Practice of Enrolled Nurses in an Australian Community Health Setting. Int Nurs Rev 2016; 64:59-68. [PMID: 27652574 DOI: 10.1111/inr.12305] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
INTRODUCTION A continuing shift of healthcare delivery from hospital to the community has increased the acuity and complexity of care provided in the home. Global financial crises and nursing shortages have prompted policies supporting two tiers of nursing and expansion of the licensed practical nurse, second level or enrolled nurse role and evoked debate surrounding roles traditionally undertaken by registered nurses. Community nursing offers unique challenges for enrolled nurses wanting to enact their full scope of practice. AIM To compare and describe registered and enrolled nurse opinions of their current and potential enrolled nurse scope of practice in the community health setting. METHODS A cross-sectional survey of 136 nurses (115 registered and 21 enrolled nurses) was undertaken within a large community nursing team in Australia. Participants reported their opinions of enrolled nurse scope of practice based on 27 core community nursing skills. RESULTS Although substantial agreement was evident, there were statistically significant differences between registered nurse and enrolled nurse opinions in core skill areas; 'Patient Education' and 'Clinical Observation'. Registered nurses identified some specialized skills-catheter and gastrostomy care-that could be undertaken by enrolled nurses with further education. CONCLUSION We confirm that registered nurses do agree with extending the skills of enrolled nurses. Education approaches that build shared confidence in enrolled nurse advanced skills are recommended. IMPLICATIONS FOR NURSING AND HEALTH POLICY The future supply of nurses is at risk. There are limited resources and increasing demand for quality health care where people live and work. While there may be opportunities internationally to improve productivity through advanced nursing roles, these policies should prioritize efficiency by firstly promoting the full enactment of nursing skills in these settings.
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Visuospatial ability and novice brachial plexus sonography performance. Acta Anaesthesiol Scand 2016; 60:1161-9. [PMID: 27324187 DOI: 10.1111/aas.12757] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Revised: 05/17/2016] [Accepted: 05/21/2016] [Indexed: 01/03/2023]
Abstract
BACKGROUND The knowledge on the type and influence of visuospatial ability on sonography performance relevant for ultrasound-guided regional anaesthesia remains incomplete. The aim of this study was to determine whether four different factors of visuospatial ability are important in determining proficiency and procedure time of novices performing brachial plexus sonography. These factors were spatial visualisation, flexibility of closure, spatial relations and speed of closure. METHODS Thirty-three ultrasound novices were recruited in this prospective, observational trial. Five cognitive tests, from a standardised battery that assesses all four visuospatial factors, were administered to each participant at the start of the study. Each novice then performed brachial plexus sonography on a human model at baseline and final exams, separated by a discovery learning session. Novices were examined in their sonography performance by blinded assessors who scored proficiency, technique, image quality, and time taken to perform at both baseline and final scans. RESULTS Novices with intermediate and high visuospatial ability in spatial visualisation, spatial relations and speed of closure were significantly more proficient and efficient compared with their peers stratified into low-ability cohorts (P < 0.02). The Matrix Reasoning and the Mental Rotations Test-A were both correlated with sonography final exam scores (Spearman rank correlation ρ = 0.38 and 0.36, P = 0.03 and 0.04, respectively). CONCLUSIONS Spatial visualisation, spatial relations and speed of closure, but not flexibility of closure, influence sonography performance. Visuospatial ability testing can identify novices who will require extra assistance in learning ultrasound relevant for regional anaesthesia. ( TRIAL REGISTRATION Australian and New Zealand Clinical Trials Registry 12614000819628).
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Correlation of Gross Tumour Volume and metabolic Tumour Volume for non-small cell lung cancer patients. Radiother Oncol 2016. [DOI: 10.1016/s0167-8140(16)30107-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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369O Timing of palliative care referral and its impact on receiving aggressive end of life care in patients with metastatic non-small cell lung cancer (NSCLC) in Southwest Sydney. Ann Oncol 2015. [DOI: 10.1093/annonc/mdv531.02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Circulating Tumor Cells in Locally Advanced Rectal Cancer Treated With Neoadjuvant Chemoradiation. Int J Radiat Oncol Biol Phys 2015. [DOI: 10.1016/j.ijrobp.2015.07.1883] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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2172 Presence of circulating tumour cells and correlation with inflammatory markers in non-metastatic rectal cancer. Eur J Cancer 2015. [DOI: 10.1016/s0959-8049(16)31092-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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1558 Quality of life and circulating tumour cells in patients treated with neoadjuvant chemoradiation for rectal cancer - is there a link? Eur J Cancer 2015. [DOI: 10.1016/s0959-8049(16)30648-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Upregulated Polo-Like Kinase 1 Expression Correlates with Inferior Survival Outcomes in Rectal Cancer. PLoS One 2015; 10:e0129313. [PMID: 26047016 PMCID: PMC4457812 DOI: 10.1371/journal.pone.0129313] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2014] [Accepted: 05/08/2015] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Human polo-like kinase 1 (PLK1) expression has been associated with inferior outcomes in colorectal cancer. Our aims were to analyse PLK1 in rectal cancer, and its association with clinicopathological variables, overall survival as well as tumour regression to neoadjuvant treatment. METHODS PLK1 expression was quantified with immunohistochemistry in the centre and periphery (invasive front) of rectal cancers, as well as in the involved regional lymph nodes from 286 patients. Scores were based on staining intensity and percentage of positive cells, multiplied to give weighted scores from 1-12, dichotomised into low (0-5) or high (6-12). RESULTS PLK1 scores in the tumour periphery were significantly different to adjacent normal mucosa. Survival analysis revealed that low PLK1 score in the tumour periphery had a hazard ratio of death of 0.59 in multivariate analysis. Other predictors of survival included age, tumour depth, metastatic status, vascular and perineural invasion and adjuvant chemotherapy. There was no statistically significant correlation between PLK1 score and histological tumour regression in the neoadjuvant cohort. CONCLUSION Low PLK1 score was an independent predictor of superior overall survival, adjusting for multiple clinicopathological variables including treatment.
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P-300 Circulating tumour cell release in the peri-operative setting during curative colorectal cancer surgery. Ann Oncol 2015. [DOI: 10.1093/annonc/mdv233.297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Emergence of Klebsiella pneumoniae liver abscesses in South-western Sydney. Infection 2014; 42:595-6. [PMID: 24664960 DOI: 10.1007/s15010-014-0617-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2013] [Accepted: 03/18/2014] [Indexed: 10/25/2022]
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Mail versus telephone administration of the Oxford Knee and Hip Scores. J Arthroplasty 2014; 29:491-4. [PMID: 24290739 DOI: 10.1016/j.arth.2013.07.047] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2013] [Revised: 07/30/2013] [Accepted: 07/30/2013] [Indexed: 02/01/2023] Open
Abstract
Telephone and postal methods of administration of the Oxford Knee Score (OKS) and the Oxford Hip Score (OHS) were compared on 85 and 61 patients undergoing total knee arthroplasty (TKA) and total hip arthroplasty (THA), respectively. The test for equivalence was significant for both the knee (P<0.001) and hip participants (P<0.001) indicating that the modes of administration yielded similar results. The ICCs of the OKS and OHS were 0.79 (95% Confidence Interval (CI) 0.70, 0.86) and 0.87 (0.79, 0.92) respectively. The 95% limits of agreement were wide for both scores (OKS LOA, -8.6, 8.2; OHS LOA, -7.7, 5.3). The two modes of administration of the OKS and OHS produce equivalent survey responses at a group level but the same method of administration should be constant for individual monitoring in a clinical setting.
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Pedal osteomyelitis in patients with diabetes: a retrospective audit from Saudi Arabia. J Wound Care 2013; 22:318-20, 322-3. [PMID: 24049816 DOI: 10.12968/jowc.2013.22.6.318] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To examine the characteristics of patients presenting to the emergency room and the specialist diabetes foot clinic with pedal osteomyelitis (PO). METHOD A retrospective study was conducted at a regional hospital. The charts of patients with suspected PO who presented during the period 1 January to 31 December 2011 were analysed. Demographics, biochemistry and microbiological data were obtained. Bone biopsies were performed by the attending clinician either during surgical removal of infected bone, or percutaneously under guided fluoroscopy through non-infected tissue. RESULTS Sixty-six cases of osteomyelitis affecting 102 joints were noted. The study population consisted of 44 men, mean age 62.9 +/- 1.3 years, and 22 women, mean age of 57.6 +/- 10.6 years. Gram-positive bacteria were the predominating pathogens (p < 0.05). Staphylococcus aureus was cultured in 36% of all bone biopsy cases. A predictive trend in HbA1c was observed,where every increase of 1% from the recommended level of 7% was associated with a 10% increase in the likelihood of receiving surgical intervention. CONCLUSION S. aureus infection is a major cause of osteomyelitis in interphalangeal joints of the feet of diabetic patients.There is an apparent association with patients who present with diabetic foot osteomyelitis and sub-optimal glycaemic control, requiring surgical intervention.
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Decontamination of ultrasound equipment used for peripheral ultrasound-guided regional anaesthesia. Anaesth Intensive Care 2013; 41:529-34. [PMID: 23808514 DOI: 10.1177/0310057x1304100415] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Portable ultrasound machines are frequently used in operating theatres for peripheral single-shot nerve block procedures. This equipment must be decontaminated by reducing the microbial load to a sufficient level to reduce the risk of nosocomial infection. In our institution we use a simple three-step decontamination protocol utilising 70% isopropyl alcohol as chemical disinfectant. We performed a prospective, quality assurance study to assess the efficacy of this protocol, as it is unclear if this is suitable for disinfecting semi-critical equipment. The primary endpoint was presence of microbial contamination prior to re-use of equipment. Over a four-week period, 120 swabs were taken from multiple sites on our ultrasound machines and linear array transducers for microbial culture. Swabs were taken after decontamination and immediately prior to patient contact. Any pathogenic and environmental bacterial organisms were isolated and identified. No pathogenic organisms were grown from any of the collected swabs. In 85% (n=102) of cultures, no growth was detected. Of the remaining 15% (n=18), commensal organisms commonly found on skin, oral and environmental surfaces were isolated. Our results suggest that our decontamination protocol may be an effective, rapid and cost-effective method of cleaning ultrasound equipment used for peripheral invasive single-shot nerve blocks. Further guidance from national bodies is required to define appropriate cleaning protocols for these machines.
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Left Atrial Volume and Left Ventricular Mass: Prognostic Value and Risk Stratification in Chronic Kidney Disease. Heart Lung Circ 2013. [DOI: 10.1016/j.hlc.2013.05.442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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