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Oqueli E.,Ballarat Health Services
Internal medicine journal | Year: 2012

Before the routine use of coronary stents, potential complications of percutaneous coronary interventions required the presence of backup cardiac surgery on-site. Advances in pharmacotherapy and interventional techniques, particularly in the last decade, have significantly decreased the rates of complications requiring emergency cardiac surgery, from approximately 4% to 6% in the balloon angioplasty era to as low as 0.3% to 0.6% in the contemporary era of routine intracoronary stent implantation. An early invasive approach has been shown to improve outcomes among patients with non-ST elevation acute coronary syndromes (NSTEACS), particularly in those at the highest risk, emphasising the importance of early access to revascularisation premises in such patients. Patients with ST-segment elevation myocardial infarction require immediate and sustained recanalisation of the culprit vessel to obtain rapid reperfusion of the threatened myocardium, in order to reduce infarct size and improve outcomes. Primary percutaneous coronary intervention at hospitals without on-site cardiac surgery improves clinical outcomes and reduces length of stay when compared with fibrinolytic therapy. It also significantly reduces door-to-balloon times when compared with transfer for percutaneous coronary interventions at hospitals with on-site surgery. It has been published that risk-adjusted mortality rates for patients undergoing percutaneous coronary interventions in centres without on-site surgical backup are comparable with those of percutaneous coronary intervention facilities that have cardiac surgery on-site, regardless of whether percutaneous coronary intervention was performed as primary therapy for ST-segment elevation myocardial infarction or in a non-primary setting. To achieve these results however, an adequate percutaneous coronary intervention programme is required, including proper hospital infrastructure and appropriately trained interventional cardiologists. © 2012 The Author; Internal Medicine Journal © 2012 Royal Australasian College of Physicians. Source

Dawson M.,Podiatry | Phillips B.,Ballarat Health Services | Phillips B.,La Trobe University | Leggat S.,La Trobe University
Journal of Allied Health | Year: 2013

BACKGROUND: It is recommended that allied health professionals (AHPs) participate in regular clinical supervision (CS). However, AHP understanding of CS processes and outcomes is unclear. This systematic review reports the evidence for CS for AHPs and other health professionals. METHODS: Five databases and reference lists of included articles were searched. Papers included described CS definitions, processes and outcomes of CS. Due to the paucity of CS research for AHPs, nursing and medical disciplines were included. Two reviewers critically appraised the 33 included papers. RESULTS: The majority of papers were exploratory. Definitions and processes for CS were not clearly identified. Outcomes of CS included the relationships between CS and job satisfaction and workplace stress. Proctor's model and the Manchester Clinical Supervision Scale were the most common framework and evaluation approach. Contradictory positions of which components of Proctor's model should be included in CS were reported. Methodological flaws and a lack of comparative studies were common. DISCUSSION: Although not extensively supported by evidence, CS was generally held to be a positive experience and tends to be provided without a clear definition or model, using new or untested tools. Further research to evaluate CS for AHPs, is needed. © 2013 Association of Schools of Allied Health Professions, Wash., DC. Source

Jones R.L.,Fred Hutchinson Cancer Research Center | Kim E.S.,Levine Cancer Institute | Nava-Parada P.,Celgene | Alam S.,Drug Development Unit | And 8 more authors.
Clinical Cancer Research | Year: 2015

Purpose: We determined the maximum tolerated dose (MTD), safety, pharmacokinetics, pharmacodynamics, and preliminary activity of OSI-906, a potent, oral, dual inhibitor of insulin-like growth factor-1 receptor (IGF1R) and insulin receptor (IR), in patients with advanced solid tumors. Experimental Design: This was a multicenter, open-label, dose escalation phase I study evaluating three intermittent dosing schedules of once-daily OSI-906 [schedule (S) 1, days 1-3 every 14 days; S2, days 1-5 every 14 days; S3, days 1-7 every 14 days]. A fed-fasting expansion cohort was included in the study. Results: Seventy-nine patients were enrolled: 62 in S1, 4 in S2, and 13 in S3. S2 was discontinued. Dose-limiting toxicity comprised grade 3-4 hyperglycemia, vomiting, fatigue, and prolonged QTc interval. The MTD and recommended phase II dose of OSI-906 was 600 mg for both S1 and S3 schedules. Other common adverse events were grade 1-2 nausea, vomiting, fatigue, and diarrhea. The pharmacokinetics of OSI-906 was dose linear, and the terminal half-life ranged between 2 and 6 hours. High-fat meals had a moderate effect on the pharmacokinetics of OSI-906. At the MTD, inhibition of IGF1R and IR was observed in peripheral blood mononuclear cells. An increase in plasma IGF1 concentrations, an indirectmeasure of IGF1R signaling inhibition, was seen at doses ≥ 450 mg. Two patients with adrenocortical carcinoma achieved partial responses. Conclusion: The MTD of 600 mg was well tolerated and associated with preliminary antitumor activity. These data support further evaluation of OSI-906 in solid tumors. ©2014 American Association for Cancer Research. Source

Scott I.A.,Princess | Brand C.A.,Monash University | Phelps G.E.,Ballarat Health Services | Barker A.L.,Monash University | Cameron P.A.,Monash University
Medical Journal of Australia | Year: 2011

Australian Health Ministers have endorsed the hospital standardised mortality ratio (HSMR) as a key indicator of quality and safety, and efforts are currently underway towards its national implementation. In the United Kingdom, Canada, the Netherlands and the United States, the HSMR has been used for several years within organisations to monitor performance and response to various quality and safety programs. In the UK and Canada, the HSMR is also publicly reported and used to compare performance between hospitals. The validity and reliability of the HSMR as a screening tool for distinguishing low-quality from high-quality hospitals remain in doubt, and it has not yet been proven that HSMR reporting necessarily leads to worthwhile improvement in quality of care and patient outcomes. Institutions may respond to an unfavourable HSMR by "gaming" administrative data and risk-adjustment models or implementing inappropriate changes to care. Despite its apparent low cost and ease of measurement, the HSMR is currently not "fit for purpose" as a screening tool for detecting low-quality hospitals and should not be used in making interhospital comparisons. It may be better suited to monitoring changes in outcomes over time within individual institutions. Source

Ibrahim J.E.,Monash University | MacPhail A.,Ballarat Health Services | Winbolt M.,La Trobe University | Grano P.,Office of the Public Advocate
Resuscitation | Year: 2016

The prevalence of dementia is growing with an ageing population. Most persons with dementia die of acute illness and many are hospitalised at the end of life.In the acute hospital setting, limitation of care orders (LCOs) such as Do Not Attempt CPR and Physician Orders For Life Sustaining Treatment (POLST), appear to be underused in patients with dementia. These patients receive the same aggressive life-prolonging therapies as any other patient, despite drastically higher mortality.However, limitation of care orders in patients with dementia is not addressed by current guidelines or policies. Systems and processes for obtaining and documenting LCO need improvement at the individual, organisational and societal level. The issue is controversial amongst the public and poorly understood by clinicians.Balanced and empathetic decision-making requires an individualised approach and recognition of the complexities (legal, ethical and clinical) of this issue. We examine the domains of: (a) treatment effectiveness, (b) burden of care and quality of life and (c) patient autonomy and capacity. © 2015 Published by Elsevier Ireland Ltd. Source

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