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Hoy D.G.,University of Queensland | Smith E.,Royal North Shore Hospital | Cross M.,Royal North Shore Hospital | Sanchez-Riera L.,University of Barcelona | And 17 more authors.
Annals of the Rheumatic Diseases | Year: 2014

The objective of this paper is to provide an overview of methods used for estimating the burden from musculoskeletal (MSK) conditions in the Global Burden of Diseases 2010 study. It should be read in conjunction with the disease-specific MSK papers published in Annals of Rheumatic Diseases. Burden estimates (disability-adjusted life years (DALYs)) were made for five specific MSK conditions: hip and/or knee osteoarthritis (OA), low back pain (LBP), rheumatoid arthritis (RA), gout and neck pain, and an 'other MSK conditions' category. For each condition, the main disabling sequelae were identified and disability weights (DW) were derived based on short lay descriptions. Mortality (years of life lost (YLLs)) was estimated for RA and the rest category of 'other MSK', which includes a wide range of conditions such as systemic lupus erythematosus, other autoimmune diseases and osteomyelitis. A series of systematic reviews were conducted to determine the prevalence, incidence, remission, duration and mortality risk of each condition. A Bayesian meta-regression method was used to pool available data and to predict prevalence values for regions with no or scarce data. The DWs were applied to prevalence values for 1990, 2005 and 2010 to derive years lived with disability. These were added to YLLs to quantify overall burden (DALYs) for each condition. To estimate the burden of MSK disease arising from risk factors, population attributable fractions were determined for bone mineral density as a risk factor for fractures, the occupational risk of LBP and elevated body mass index as a risk factor for LBP and OA. Burden of Disease studies provide pivotal guidance for governments when determining health priority areas and allocating resources. Rigorous methods were used to derive the increasing global burden of MSK conditions.

PubMed | BGI Shenzhen, Alfred Center and King's College London
Type: Journal Article | Journal: Cancer letters | Year: 2016

Oral squamous cell carcinoma (OSCC) is genetically highly heterogeneous, which contributes to the challenges of treatment. To create an invitro model that accurately reflects this heterogeneity, we generated a panel of HPV-negative OSCC cell lines. By whole exome sequencing of the lines and matched patient blood samples, we demonstrate that the mutational spectrum of the lines is representative of primary OSCC in The Cancer Genome Atlas. We show that loss of function mutations in FAT1 (an atypical cadherin) and CASP8 (Caspase 8) frequently occur in the same tumour. OSCC cells with inactivating FAT1 mutations exhibited reduced intercellular adhesion. Knockdown of FAT1 and CASP8 individually or in combination in OSCC cells led to increased cell migration and clonal growth, resistance to Staurosporine-induced apoptosis and, in some cases, increased terminal differentiation. The OSCC lines thus represent a valuable resource for elucidating the impact of different mutations on tumour behaviour.

Ilic D.,Alfred Center | Nordin R.B.,Monash University | Glasziou P.,Bond University | Tilson J.K.,University of Southern California | Villanueva E.,Monash University
BMC Medical Education | Year: 2015

Background: Few studies have been performed to inform how best to teach evidence-based medicine (EBM) to medical trainees. Current evidence can only conclude that any form of teaching increases EBM competency, but cannot distinguish which form of teaching is most effective at increasing student competency in EBM. This study compared the effectiveness of a blended learning (BL) versus didactic learning (DL) approach of teaching EBM to medical students with respect to competency, self-efficacy, attitudes and behaviour toward EBM. Methods: A mixed methods study consisting of a randomised controlled trial (RCT) and qualitative case study was performed with medical students undertaking their first clinical year of training in EBM. Students were randomly assigned to receive EBM teaching via either a BL approach or the incumbent DL approach. Competency in EBM was assessed using the Berlin questionnaire and the 'Assessing Competency in EBM' (ACE) tool. Students' self-efficacy, attitudes and behaviour was also assessed. A series of focus groups was also performed to contextualise the quantitative results. Results: A total of 147 students completed the RCT, and a further 29 students participated in six focus group discussions. Students who received the BL approach to teaching EBM had significantly higher scores in 5 out of 6 behaviour domains, 3 out of 4 attitude domains and 10 out of 14 self-efficacy domains. Competency in EBM did not differ significantly between students receiving the BL approach versus those receiving the DL approach [Mean Difference (MD)=-0.68, (95% CI-1.71, 0.34), p=0.19]. No significant difference was observed between sites (p=0.89) or by student type (p=0.58). Focus group discussions suggested a strong student preference for teaching using a BL approach, which integrates lectures, online learning and small group activities. Conclusions: BL is no more effective than DL at increasing medical students' knowledge and skills in EBM, but was significantly more effective at increasing student attitudes toward EBM and self-reported use of EBM in clinical practice. Given the various learning styles preferred by students, a multifaceted approach (incorporating BL) may be best suited when teaching EBM to medical students. Further research on the cost-effectiveness of EBM teaching modalities is required. © 2015 Ilic et al.; licensee BioMed Central.

Gartoulla P.,Monash University | Gartoulla P.,Alfred Center | Han M.M.,Monash University | Han M.M.,Alfred Center
Maturitas | Year: 2014

The safety and efficacy of red clover for alleviating menopausal hot flushes are yet to be established. The aim of this meta-analysis was to generate evidence from published literature regarding red clover as a treatment option for menopausal hot flushes. The results showed that red clover when compared to placebo was effective in reducing menopausal hot flushes when administered for 3-4 months (MD = -1.34, 95% CI = -1.90 to -0.77, p < 0.00001), but their effect did not persist at 12 months (MD = 0.89, 95% CI = -0.07 to 1.85, p = 0.07). © 2014 Elsevier Ireland Ltd.

Suzuki S.,Austin Hospital | Suzuki S.,Okayama University | Eastwood G.M.,Austin Hospital | Bailey M.,Alfred Center | And 6 more authors.
Critical Care | Year: 2015

Introduction: In this study, we aimed to examine the association between paracetamol administration in the intensive care unit (ICU) and mortality in critically ill patients. Methods: We conducted a multicenter retrospective observational study in four ICUs. We obtained information on paracetamol use, body temperature, demographic, clinical and outcome data from each hospital's clinical information system and admissions and discharges database. We performed statistical analysis to assess the association between paracetamol administration and hospital mortality. Results: We studied 15,818 patients with 691,348 temperature measurements at 4 ICUs. Of these patients, 10,046 (64%) received at least 1g of paracetamol. Patients who received paracetamol had lower in-hospital mortality (10% vs. 20%, P <0.001), and survivors were more likely to have received paracetamol (66% vs. 46%; P <0.001). However, patients treated with paracetamol were also more likely to be admitted to the ICU after surgery (70% vs. 51%; P <0.001) and/or after elective surgery (55% vs. 37%; P <0.001). In multivariate logistic regression analysis including a propensity score for paracetamol treatment, we found a significant and independent association between the use of paracetamol and reduced in-hospital mortality (adjusted odds ratio =0.60 (95% confidence interval (CI), 0.53 to 0.68), P <0.001). Cox proportional hazards analysis showed that patients who received paracetamol also had a significantly longer time to death (adjusted hazard ratio =0.51 (95% CI, 0.46 to 0.56), P <0.001). The association between paracetamol and decreased mortality and/or time to death was broadly consistent across surgical and medical patients. It remained present after adjusting for paracetamol administration as a time-dependent variable. However, when such time-dependent analysis was performed, the association of paracetamol with outcome lost statistical significance in the presence of fever and suspected infection and in patients in the lower tertiles of Acute Physiology and Chronic Health Evaluation II scores. Conclusions: Paracetamol administration is common in the ICU and appears to be independently associated with reduced in-hospital mortality and time to death after adjustment for multiple potential confounders and propensity score. This association, however, was modified by the presence of fever, suspected infection and lesser illness severity and may represent the effect of indication bias. © Suzuki et al.; licensee BioMed Central.

Gibney K.,Alfred Center | Sinclair M.,Alfred Center | O'Toole J.,Alfred Center | Leder K.,Alfred Center
Journal of Public Health Policy | Year: 2013

Following the 1990 Global Burden of Disease (GBD) study, Disability-Adjusted Life Years (DALYs) have been used widely to quantify the population health burden of diseases and to prioritise and evaluate the impact of specific public health interventions. In the context of the recent release of the 2010 GBD study, we explore the novel use of DALYS to determine health-based targets (HBTs). As with the more traditional use of DALYs, the main advantage of using DALYs as HBTs is the ability to account for differential disease severity, identify the most appropriate public health interventions, and measure the positive and negative outcomes of these interventions. Australia is currently considering adopting DALYs for setting HBTs for drinking water quality, as recommended by the WHO. Adoption of DALY HBTs could be relevant in other areas, including air quality, food safety, health care-associated infections, and surgical complications. © 2013 Macmillan Publishers Ltd.

Carey R.N.,University of Western Australia | Reid A.,University of Western Australia | Driscoll T.R.,University of Sydney | Glass D.C.,Alfred Center | And 2 more authors.
Journal of Clinical Epidemiology | Year: 2013

Objective: To test the impact of an advance letter on response and cooperation rates in a nationwide telephone survey, given previous inconsistent results. Study Design and Setting: Within the context of a larger telephone survey, 1,000 Australian households were randomly selected to take part in this trial. Half were randomly allocated to receive an advance letter, whereas the remainder did not receive any advance communication. Response and cooperation rates were compared between the two groups. Results: A total of 244 interviews were completed, 134 of which were with households that had been sent an advance letter. Intention-to-treat analysis revealed no significant difference in response between those who had received a letter and those who had not (26.8% vs. 22.0%, respectively). In addition, there was no significant difference between the groups in terms of either cooperation (78.4% vs. 79.7%) or response rate (56.3% vs. 57.9%), and no clear differences emerged in terms of the demographic characteristics of the two groups. Conclusion: An advance letter was not seen to be effective in increasing response or cooperation rates in a nationwide telephone survey. Researchers should consider alternative methods of increasing participation in telephone surveys. © 2013 Elsevier Inc. All rights reserved.

Hills D.J.,Alfred Center | Joyce C.M.,Alfred Center | Humphreys J.S.,Monash University
Australian Health Review | Year: 2013

Introduction This report describes the extent to which 12 workplace aggression prevention and minimisation actions have been implemented in Australian clinical medical practice settings. Methods Using a cross-sectional, self-report survey conducted as part of a national longitudinal study of the Australian medical workforce, differences in the proportions of medical clinicians reporting the implementation of 12 aggression prevention and minimisation actions in their main workplace were determined. Results Only one-third of aggression prevention and minimisation actions achieved point-prevalence rates of greater than 60%, including aggression policies and protocols (65.7%) and incident reporting systems (68.2%). Overall, lower point-prevalence rates were detected for general practitioners and specialists compared with hospital non-specialists and specialists in training, largely reflecting those for doctors mainly working in private rooms compared with public hospitals. Key environmental interventions had relatively low point-prevalence overall, including duress alarms and optimised clinician escape in consulting and treatment areas, and after-hours and off-site safety strategies. Conclusions More widespread adoption of aggression prevention and minimisation measures in medical practice settings is required. Specific legislative and accreditation provisions and funding support may provide the necessary impetus for reform. Further studies can enhance the evidence base on the most effective approaches to the prevention and minimisation of workplace aggression in medical practice settings. What is known about the topic With the exception of a small number of qualitative studies in general practice, there is a lack of research reporting on the implementation of workplace aggression prevention and minimisation interventions across clinical medical practice settings in Australia. What does this paper add Baseline evidence is provided on the point-prevalence of 12 workplace aggression prevention and minimisation interventions in diverse medical practice settings in Australia, which suggests that key approaches recommended by leading international organisations and researchers are not widely implemented in many clinical medical workplaces. What are the implications for practitioners More concerted efforts need to be undertaken to achieve the widespread implementation of aggression prevention and minimisation interventions in clinical medical practice settings. © AHHA 2013.

Salamonsen M.,Royal Brisbane and Womens Hospital | Ellis S.,Alfred Hospital | Paul E.,Alfred Center | Steinke K.,Royal Brisbane and Womens Hospital | Fielding D.,Royal Brisbane and Womens Hospital
Respiration | Year: 2012

Background: Ultrasound (US) guidance is advocated to reduce complications from thoracocentesis or intercostal catheter (ICC) insertion. Although imaging of the intercostal artery (ICA) with Doppler US has been reported, current thoracic guidelines do not advocate this, and bleeding from a lacerated ICA continues to be a rare but serious complication of thoracocentesis or ICC insertion. Objectives: It was the aim of this study to describe a method to visualise the ICA at routine US-guided thoracocentesis and map its course across the posterior chest wall. Method: The ICA was imaged in 22 patients undergoing US-guided thoracocentesis, at 4 positions across the back to the axilla. Its location, relative to the overlying rib, was calculated as the fraction of the intercostal space (ICS) below the inferior border of that rib. Results: An ICA was identified in 74 of 88 positions examined. The ICA migrated from a central 'vulnerable' location within the ICS near the spine (0.28, range 0.21-0.38; p < 0.001) towards the overlying rib (0.08, range 0.05-0.11; p < 0.001) in the axilla. Conclusions: The ICA can be visualised with US and is more exposed centrally within the ICS in more posterior positions; however, there is a marked variation between individuals, such that the ICA may lie exposed in the ICS even as far lateral as the axilla. Future studies need to identify which patients are at risk for a 'low-lying' ICA to further define the role of US imaging of the ICA during thoracocentesis or ICC insertion. Copyright © 2012 S. Karger AG.

PubMed | Monash University and Alfred Center
Type: Journal Article | Journal: The patient | Year: 2016

The growing focus on patient-centred care has encouraged the inclusion of patient and public input into payer drug reimbursement decisions. Yet, little is known about patient/public priorities for funding high-cost medicines, and how they compare to payer priorities applied in public funding decisions for new cancer drugs.The aim was to identify and compare the funding preferences of cancer patients and the general public against the criteria used by payers making cancer drug funding decisions.A thorough review of the empirical, peer-reviewed English literature was conducted. Information sources were PubMed, EMBASE, MEDLINE, Web of Science, Business Source Complete, and EconLit. Eligible studies (1) assessed the cancer drug funding preferences of patients, the general public or payers, (2) had pre-defined measures of funding preference, and (3) had outcomes with attributes or measures of value. The quality of included studies was evaluated using a health technology assessment-based assessment tool, followed by extraction of general study characteristics and funding preferences, which were categorized using an established WHO-based framework.Twenty-five preference studies were retrieved (11 quantitative, seven qualitative, seven mixed-methods). Most studies were published from 2005 onward, with the oldest dating back to 1997. Two studies evaluated both patient and public perspectives, giving 27 total funding perspectives (41% payer, 33% public, 26% patients). Of 41 identified funding criteria, payers consider the most (35), the general public considers fewer (23), and patients consider the fewest (12). We identify four unique patient criteria: financial protection, access to medical information, autonomy in treatment decision making, and the value of hope. Sixteen countries/jurisdictions were represented.Our results suggest that (1) payers prioritize efficiency (health gains per dollar), while citizens (patients and the general public) prioritize equity (equal access to cancer medicines independent of cost or effectiveness), (2) citizens prioritize few criteria relevant to payers, and (3) citizens prioritize several criteria not considered by payers. This can explain why payer and citizen priorities clash when new cancer medicines are denied public funding.

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