Smith E.,University of Sydney |
Hoy D.,University of Queensland |
Cross M.,University of Sydney |
Merriman T.R.,University of Otago |
And 6 more authors.
Annals of the Rheumatic Diseases | Year: 2014
Objective: Gout is the most common cause of inflammatory arthritis in men, but has not previously been included in Global Burden of Disease (GBD) studies. As part of the GBD 2010 Study, the Musculoskeletal Disorders and Risk Factors Expert Group estimated the global burden of gout. Methods: The American Rheumatism Association 1977 case definition of primary gout was used in the study. A series of systematic reviews were conducted to gather the age-specific and sex-specific epidemiological data for gout prevalence, incidence, mortality risk and duration. Two main disabling sequelae of gout were identified; acute episode gout and chronic polyarticular gout, and used in the surveys to collect data to derive disability weights. The epidemiological data together with disability weights were then used to calculate years of life lived with disability (YLDs) for gout, for 1990 and 2010. No evidence of cause-specific mortality associated with gout was found. Gout disability-adjusted life years (DALYs), therefore, have the same value as YLDs. Results: Global prevalence of gout was 0.08% (95% uncertainty interval (UI) 0.07 to 0.08). DALYs increased from 76 000 (95% UI 48 to 112) in 1990 to 114 000 (95% UI 72 to 167) in 2010. Out of all 291 conditions studied in the GBD 2010 Study, gout ranked 138th in terms of disability as measured by YLDs, and 173rd in terms of overall burden (DALYs). Conclusions: The burden of gout is rising. With increasing ageing populations globally, this evidence is a significant prompt to optimise treatment and management of gout at individual, community and national levels.
Buchbinder R.,Cabrini Hospital |
Buchbinder R.,Monash University |
Blyth F.M.,University of Sydney |
March L.M.,University of Sydney |
And 3 more authors.
Best Practice and Research: Clinical Rheumatology | Year: 2013
The latest Global Burden of Disease Study, published at the end of 2012, has highlighted the enormous global burden of low back pain. In contrast to the previous study, when it was ranked 105 out of 136 conditions, low back pain is now the leading cause of disability globally, ahead of 290 other conditions. It was estimated to be responsible for 58.2 million years lived with disability in 1990, increasing to 83 million in 2010. This chapter illustrates the ways that the Global Burden of Disease data can be displayed using the data visualisation tools specifically designed for this purpose. It also considers how best to increase the precision of future global burden of low back pain estimates by identifying limitations in the available data and priorities for further research. Finally, it discusses what should be done at a policy level to militate against the rising burden of this condition. © 2013 Elsevier Ltd. All rights reserved.
Krogh T.P.,Silkeborg Regional Hospital |
Bartels E.M.,Copenhagen University |
Ellingsen T.,Silkeborg Regional Hospital |
Stengaard-Pedersen K.,Aarhus University Hospital |
And 7 more authors.
American Journal of Sports Medicine | Year: 2013
Background: Injection therapy with glucocorticoids has been used since the 1950s as a treatment strategy for lateral epicondylitis (tennis elbow). Lately, several novel injection therapies have become available. Purpose: To assess the comparative effectiveness and safety of injection therapies in patients with lateral epicondylitis. Study Design: Systematic review and meta-analysis. Methods: Randomized controlled trials comparing different injection therapies for lateral epicondylitis were included provided they contained data for change in pain intensity (primary outcome). Trials were assessed using the Cochrane risk of bias tool. Network (random effects) meta-analysis was applied to combine direct and indirect evidence within and across trial data using the final end point reported in the trials, and results for the arm-based network analyses are reported as standardized mean differences (SMDs). Results: Seventeen trials (1381 participants; 3 [18%] at low risk of bias) assessing injection with 8 different treatments-glucocorticoid (10 trials), botulinum toxin (4 trials), autologous blood (3 trials), platelet-rich plasma (2 trials), and polidocanol, glycosaminoglycan, prolotherapy, and hyaluronic acid (1 trial each)-were included. Pooled results (SMD [95% confidence interval]) showed that beyond 8 weeks, glucocorticoid injection was no more effective than placebo (20.04 [-0.45 to 0.35]), but only 1 trial (which did not include a placebo arm) was at low risk of bias. Although botulinum toxin showed marginal benefit (-0.50 [-0.91 to 20.08]), it caused temporary paresis of finger extension, and all trials were at high risk of bias. Both autologous blood (-1.43 [-2.15 to 20.71]) and platelet-rich plasma (-1.13 [-1.77 to 20.49]) were also statistically superior to placebo, but only 1 trial was at low risk of bias. Prolotherapy (-2.71 [-4.60 to 20.82]) and hyaluronic acid (-5.58 [-6.35 to 24.82]) were both more efficacious than placebo, whereas polidocanol (0.39 [-0.42 to 1.20]) and glycosaminoglycan (-0.32 [-1.02 to 0.38]) showed no effect compared with placebo. The criteria for low risk of bias were only met by the prolotherapy and polidocanol trials. Conclusion: This systematic review and network meta-analysis of randomized controlled trials found a paucity of evidence from unbiased trials on which to base treatment recommendations regarding injection therapies for lateral epicondylitis. © 2013 The Author(s).
McCrory P.,University of Melbourne |
McCrory P.,Monash University |
Davis G.,Cabrini Hospital |
Makdissi M.,University of Melbourne
Current Sports Medicine Reports | Year: 2012
Second impact syndrome is believed to be the catastrophic consequence of repeated head injury in sport. The scientific evidence to support this concept is nonexistent, and belief in the syndrome is based upon the interpretation of anecdotal cases more often than not, lacking sufficient clinical detail to make definitive statements. The fear of this condition has driven many of the current return-to-play guidelines following concussion. Diffuse cerebral swelling (DCS) following a head injury is a wellrecognized condition, more common in children than in adults, and usually has a poor outcome. © 2012 Paul McCrory, The University of Melbourne.
Ciciriello S.,Royal Melbourne Hospital |
Buchbinder R.,Cabrini Hospital |
Buchbinder R.,Monash University |
Osborne R.H.,Monash University |
Wicks I.P.,Deakin University
Seminars in Arthritis and Rheumatism | Year: 2014
Objectives: To develop and test an evidence-based, multimedia patient education program (MPEP) about methotrexate (MTX) treatment for rheumatoid arthritis (RA) and a new measure of patient knowledge [Methotrexate in Rheumatoid Arthritis Knowledge test (MiRAK)]. Methods: The content of the MPEP and MiRAK was guided by concept-mapping workshops with patients (N = 24), literature review, health professional, and expert linguistic input. The MPEP and MiRAK underwent multiple stages of testing and revision with patients and health professionals. The MiRAK was administered to RA patients (N = 169) and its properties examined using the Rasch analyses. A subset of respondents (N = 131) repeated the MiRAK to determine test-retest reliability. A before-after pilot study with patients who had recently started MTX (N = 31) tested responsiveness of the MiRAK and feasibility and acceptability of the MPEP. Results: A DVD of 24-minutes duration was produced that presents detailed, evidence-based information about MTX. The Rasch analyses of the 60 MiRAK items revealed that these could be summated into a single score. The MiRAK had good model fit, supporting internal construct validity, good internal consistency (person separation index; 0.84), test-retest reliability (ICC; 0.89), and ability to detect change (ES; 2.38). The before-after study suggested that patients could self-administer the MPEP, with the majority finding it informative and easy to use. Conclusions: We developed a MPEP about MTX treatment for RA, which was found to be user-friendly and easily implementable. The MiRAK is a new scale, testing a broad spectrum of MTX knowledge. Analyses revealed strong evidence for its validity and reliability. © 2014 Elsevier Inc.
Lundine K.M.,Dandenong Hospital |
Davis G.,Austin Hospital and Cabrini Hospital |
Rogers M.,Austin Hospital and Cabrini Hospital |
Staples M.,Cabrini Hospital |
Quan G.,Austin Hospital
Journal of Clinical Neuroscience | Year: 2014
Anterior cervical discectomy and fusion (ACDF) is a widely accepted surgical treatment for symptomatic cervical spondylosis. Some patients develop symptomatic adjacent segment degeneration, occasionally requiring further treatment. The cause and prevalence of adjacent segment degeneration and disease is unclear at present. Proponents for motion preserving surgery such as disc arthroplasty argue that this technique may decrease the "strain" on adjacent discs and thus decrease the incidence of symptomatic adjacent segment degeneration. The purpose of this study was to assess the pre-operative prevalence of adjacent segment degeneration in patients undergoing ACDF. A database review of three surgeons' practice was carried out to identify patients who had undergone a one- or two-level ACDF for degenerative disc disease. Patients were excluded if they were operated on for recent trauma, had an inflammatory arthropathy (for example, rheumatoid arthritis), or had previous spine surgery. The pre-operative MRI of each patient was reviewed and graded using a standardised methodology. One hundred and six patient MRI studies were reviewed. All patients showed some evidence of intervertebral disc degeneration adjacent to the planned operative segment(s). Increased severity of disc degeneration was associated with increased age and operative level, but was not associated with sagittal alignment. Disc degeneration was more common at levels adjacent to the surgical level than at non-adjacent segments, and was more severe at the superior adjacent level compared with the inferior adjacent level. These findings support the theory that adjacent segment degeneration following ACDF is due in part to the natural history of cervical spondylosis. © 2013 Elsevier Ltd. All rights reserved.
Osborne R.H.,Deakin University |
Batterham R.W.,Deakin University |
Elsworth G.R.,Deakin University |
Hawkins M.,Deakin University |
Buchbinder R.,Cabrini Hospital
BMC Public Health | Year: 2013
Background: Health literacy has become an increasingly important concept in public health. We sought to develop a comprehensive measure of health literacy capable of diagnosing health literacy needs across individuals and organisations by utilizing perspectives from the general population, patients, practitioners and policymakers. Methods. Using a validity-driven approach we undertook grounded consultations (workshops and interviews) to identify broad conceptually distinct domains. Questionnaire items were developed directly from the consultation data following a strict process aiming to capture the full range of experiences of people currently engaged in healthcare through to people in the general population. Psychometric analyses included confirmatory factor analysis (CFA) and item response theory. Cognitive interviews were used to ensure questions were understood as intended. Items were initially tested in a calibration sample from community health, home care and hospital settings (N=634) and then in a replication sample (N=405) comprising recent emergency department attendees. Results: Initially 91 items were generated across 6 scales with agree/disagree response options and 5 scales with difficulty in undertaking tasks response options. Cognitive testing revealed that most items were well understood and only some minor re-wording was required. Psychometric testing of the calibration sample identified 34 poorly performing or conceptually redundant items and they were removed resulting in 10 scales. These were then tested in a replication sample and refined to yield 9 final scales comprising 44 items. A 9-factor CFA model was fitted to these items with no cross-loadings or correlated residuals allowed. Given the very restricted nature of the model, the fit was quite satisfactory: χ §ssup§2§ esup§ §ssub§WLSMV§esub§(866 d.f.) = 2927, p<0.000, CFI = 0.936, TLI = 0.930, RMSEA = 0.076, and WRMR = 1.698. Final scales included: Feeling understood and supported by healthcare providers; Having sufficient information to manage my health; Actively managing my health; Social support for health; Appraisal of health information; Ability to actively engage with healthcare providers; Navigating the healthcare system; Ability to find good health information; and Understand health information well enough to know what to do. Conclusions: The HLQ covers 9 conceptually distinct areas of health literacy to assess the needs and challenges of a wide range of people and organisations. Given the validity-driven approach, the HLQ is likely to be useful in surveys, intervention evaluation, and studies of the needs and capabilities of individuals. © 2013 Osborne et al.; licensee BioMed Central Ltd.
Buchbinder R.,Cabrini Hospital |
Kallmes D.F.,Mayo Medical School
Spine Journal | Year: 2010
COMMENTARY ON: Bono C, Heggeness M, Mick C, et al. North American Spine Society: Newly released vertebroplasty randomized controlled trials: a tale of two trials. Spine J 2010;10:238-240 (in this issue). © 2010 Elsevier Inc. All rights reserved.
Davis G.A.,Cabrini Hospital |
Cox I.H.,Cabrini Hospital
Journal of Neurosurgery | Year: 2011
Object. The etiology of intraneural ganglia has been debated for centuries, and only recently a unifying theory has been proposed. The incidence of tibial nerve intraneural ganglia is restricted to the occasional case report, and there are no reported cases of these lesions in children. While evidence of the unifying theory for intraneural ganglia of the common peroneal nerve is strong, there are only a few reports describing the application of the theory in the tibial nerve. In this report the authors examine tibial nerve intraneural ganglia at the ankle and knee in an adult and a child, respectively, and describe the clinical utility of incorporating the unifying (articular) theory in the management of tibial intraneural ganglia in adults and children. Methods. Cases of tibial intraneural ganglion cysts were examined clinically, radiologically, operatively, and histologically to demonstrate the application of the unified (articular) theory for the development of these cysts in adults and children. Results. Two patients with intraneural ganglion cysts of the tibial nerve were identified: an adult with an intraneural ganglion cyst of the tibial nerve at the tarsal tunnel and a child with an intraneural ganglion cyst of the tibial nerve at the knee. In each case, preoperative MR imaging demonstrated the intraneural cyst and its connection to the adjacent joint via the articular branch to the subtalar joint and superior tibiofibular joint. At surgery the articular branch was identified and resected, thus disconnecting the tibial nerve intraneural cyst from the joint of origin. Conclusions. These cases detail the important features of intraneural ganglion cysts of the tibial nerve and document the clinical utility of incorporating the unifying (articular) theory for the surgical management of tibial intraneural ganglia in adults and children.
News Article | December 21, 2016
Interior walls can be a bit on the boring side, but Australia's ENESS has developed a new light-emitting wall panel that aims to change that. Until activated by motion, the Lumes wall panel looks pretty standard. But once brought to life, an integrated LED array can display images and relatively complex animations. The first real-world application of the Lumes panel is at the entrance of Cabrini Hospital's Pediatrics Ward in Malvern, Victoria. Completed a couple of weeks ago, ENESS worked with architects DesignInc to create a motion-activated wall installation that would help put kids' minds at ease. As someone walks past, Lumes triggers animations including animals peeking their heads out of grass, raindrops falling, rockets launching, and runners following human movements. The system can even discern when people approach closer to the wall and respond with larger animations. While Lumes is a really nice fit for a children's ward, an ENESS representative told us that it's also aiming to use it in other areas too, with hospitality and retail applications being pursued. One example we suggested was directional arrows to help navigate a large building, which the rep said would indeed work, but the firm also aims to try and integrate data visualization somehow. The hospital installation consists of 12 wood veneer-covered LED panels and three acrylic panels, each measuring 175 x 50 cm (68 x 19.6 in), though the panels can be made to customer dimensions. Future installations will also make the animations respond to sound, and the firm also hopes to integrate touch and heat-sensing too. Once the panels are in place, the animations can be tweaked or changed remotely with the firm's own custom software. The LEDs can also be integrated into other surfaces in addition to wood veneer paneling. Lumes is available to purchase now for architects, interior designers, and the like, though we've no word on cost. The wall panel isn't the only way to bring a wall to life, other options include e-ink wall panels, LED wallpaper, and a motion-sensing wall installation. Check out the video below to see the Lumes panels in use.