Katelaris C.H.,Campbelltown Hospital
Immunology and Allergy Clinics of North America | Year: 2017
Several treatment modalities have become available for management of acute hereditary angioedema (HAE) attacks in the last 15 years. Most are now available to patients in North America, Europe, United Kingdom, and Australia, but few options exist in developing countries. Preferred contemporary use of the treatments to be discussed is "on demand," because control remains with the patient and delays in treatment access avoided. Four treatments-plasma-derived C1 inhibitor concentrate, recombinant C1 inhibitor concentrate, ecallantide, and icatibant-are reviewed in this article. All have been shown to be superior to placebo and effective in the management of all HAE attacks. © 2017 Elsevier Inc.
El-Haddad C.,Campbelltown Hospital |
El-Haddad C.,University of Western Sydney
Academic Medicine | Year: 2017
PURPOSE: The medical education community is rapidly accepting the use of entrustable professional activities (EPAs) as a means of assessing residents. Stakeholder engagement is advised in developing EPAs, but no studies have investigated the role of patient input. In this qualitative study, the authors investigated what patient input may add to designing a patient-centered EPA. METHOD: The authors chose “management of acute low back pain (LBP)” as a common, important clinical task on which to base the patient-centered EPA. In 2015, 14 patients who presented to a teaching hospital with acute LBP participated in semistructured interviews exploring their illness experience and expectations of doctors. Clinicians representing multiple disciplines participated in a focus group. The authors used the Framework Method to analyze data, identifying and developing themes, similarities, and differences between patient and clinician input. They used the findings to develop the EPA. Through an iterative procedure of data review and tracking data sources, they determined how patient and clinician input informed each EPA descriptor. RESULTS: Drawing from their firsthand experience of LBP, patients described unique expectations of trainees which directly informed EPA descriptors. For example, the authors primarily used patients’ detailed descriptions of desirable and observable trainee behaviors to inform the required attitudes descriptor. CONCLUSIONS: Patients can provide unique contributions, complementary to those of clinicians, to EPAs. Consultations with patients led to the development of a patient-centered EPA, which aligned best clinical practice with patient expectations. Educators seeking to apply patient-centered care to EPA development could adopt a similar approach. © 2017 by the Association of American Medical Colleges
Fok K.C.,Campbelltown Hospital |
Fok K.C.,University of Western Sydney |
Ng W.W.S.,Liverpool Hospital |
Henderson C.J.A.,Liverpool Hospital |
Connor S.J.,Liverpool Hospital
Journal of Crohn's and Colitis | Year: 2012
The advance of anti-tumour necrosis factor (TNF) therapy had dramatically changed the treatment algorithm of inflammatory bowel disease (IBD). This had significantly improved the quality of life for patients with Crohn's disease (CD) and ulcerative colitis (UC).1 However, side-effects of anti-TNF treatment were unavoidable with paradoxical inflammation (for example leucocytoclastic vasculitis and psoriasis) being well-known phenomena of anti-TNF therapy.2 We report a case of infliximab induced cutaneous sarcoidosis in a patient with ulcerative colitis and review the literature. © 2012 .
Milne S.,Campbelltown Hospital |
McDonald J.,Campbelltown Hospital |
Comino E.J.,University of New South Wales
Physical and Occupational Therapy in Pediatrics | Year: 2012
In response to concerns that the Bayley Scales of Infant and Toddler Development III (BSIDIII) underestimate delay in clinical populations, this study explores developmental quotient scores as an alternative to composite scores for these children. One hundred and twenty-two children aged ≤42 months, referred for diagnosis of developmental disability from January 2007 to May 2010, were assessed, and their composite and developmental quotient scores on each scale were compared. Composite scores identified only 22% (cognitive), 27% (motor), and 47.5% (language) of children as having a developmental disability. Developmental quotient scores were significantly lower than composite scores, giving rates of developmental disability of 56.6% (cognitive), 48.4% (motor), and 74.6% (language) and more closely matching both clinical impressions of delay and the proportions of those children who were also delayed on standardized tests of adaptive function. © 2012 Informa Healthcare USA, Inc.
McDonald J.L.,Campbelltown Hospital |
Milne S.,Campbelltown Hospital |
Knight J.,University of New South Wales |
Webster V.,University of New South Wales
Journal of Paediatrics and Child Health | Year: 2013
Aim The study aims to describe the developmental and behavioural difficulties in pre-school children who have experienced maltreatment and/or neglect Methods A retrospective medical file audit of all children assessed at the Cottage Family Care Centre, a child protection pre-school, between April 2004 and June 2010. Demographic characteristics, parent and teacher reports, and clinical and developmental assessment results were collated and analysed. Results The average age of the 55 children assessed was 36.3 months (ranging from 14 to 55.3 months). Fifty-five per cent were male and 65% were from disadvantaged families. A significant developmental delay in at least one domain and or a significant behavioural problem was identified in 91% of assessments. Overall (or global) delay was found in 38% and this was significantly more likely in girls (P = 0.03). Emotional and/or behavioural difficulties were reported in 85% of children. Internalising problem behaviours were more common than externalising problems. A diagnosis of an autism spectrum disorder was made in four children. In the six review assessments, regression was identified in three children. Conclusions Children who have experienced maltreatment and/or neglect may present with developmental delays and behavioural problems. Language delays and internalising problems are characteristic. There are many features in common with primary developmental disorders. The presence of fearfulness and hypervigilance may provide a clue to diagnosis. © 2012 Paediatrics and Child Health Division (Royal Australasian College of Physicians).
Thientosapol E.S.,Campbelltown Hospital
Internal medicine journal | Year: 2013
Survival times of women starting first-line chemotherapy for metastatic breast cancer (MBC) in routine clinical practice were determined and compared with those from a systematic review of randomised clinical trials. We identified women with MBC starting first-line chemotherapy from June 2003 to February 2011 and recorded their demographics, tumour and treatment characteristics, and survival times from the start of chemotherapy. Their survival distribution was summarised by the following percentiles (represented scenarios for survival): 90th (worst-case), 75th (lower-typical), 25th (upper-typical) and 10th (best-case), which were compared with the same percentiles from our systematic review of first-line chemotherapy trials. The 273 women had a median age of 56 years, and a median time from diagnosis of MBC of 3 months. Eastern Cooperative Oncology Group performance status was 0-1 in 80%. Tumours were hormone receptor positive in 69%, human epidermal growth factor receptor 2 (HER2)-positive in 27% and triple negative in 13%. Survival times in months in routine clinical practice (vs the systematic review) were: 90th percentile 4 (6); 75th percentile 9 (12); median 20 (22); 25th percentile 36 (36) and 10th percentile 61 (56). Independent predictors of overall survival included HER2-positive disease (hazard ratio (HR) 0.49, P = 0.0002), hormone receptor positive disease (HR 0.51, P = 0.0004), Eastern Cooperative Oncology Group performance status 0-1 (HR 0.36, P < 0.0001) and adjuvant chemotherapy (HR 1.86, P = 0.0002). Median and better survival times in routine practice were similar to those from randomised clinical trials; however, survival times worse than the median were shorter, likely reflecting patient selection in trials. Oncologists should adjust trial-based survival estimates for patients not meeting typical trial eligibility criteria. © 2013 The Authors; Internal Medicine Journal © 2013 Royal Australasian College of Physicians.
Arnold S.,Campbelltown Hospital |
Elder M.,Campbelltown Hospital
Care Management Journals | Year: 2013
Case management is a service frequently provided to clients following a traumatic brain injury (TBI); however, the time required for this service is uncertain. To identify factors that influence case management for clients with TBI, a descriptive analysis of 64 client files were provided with case management services of a rehabilitation provider based in Sydney, Australia. These files were then further examined by using qualitative measures to determine the relationship among case management factors, time required, and the severity of the injury. This information was statistically analyzed to identify what factors predicted the greatest use of case management time. The analysis identified inappropriate behavior, family dynamics, accommodation, and formal relationships as primary affectors on case management time. Other issues identified as less demanding of case management time were sustaining employment and provision of equipment. In terms of case management hours, the mean was 2.5 hr/month. Where there was a combination of three factors, the time for case management increased to a mean of 3.97 hr, and up to 4.34 hr/month (range: 1.5-14.0 hr) of case management time where 4 factors were identified. A positive relationship between severity of posttraumatic amnesia (PTA) and care and needs score was also noted to impact on amount of case management time and duration of service. © 2013 Springer Publishing Company.
Rhodes J.,Willesden Mental Health Resources Center |
Jakes S.,Campbelltown Hospital
Clinical Psychology and Psychotherapy | Year: 2010
There are many descriptions in the research literature of the onset of delusions in psychosis: it is still not clear however whether there is one specific pathway to delusions or in fact several, and the role of social difficulties remains controversial. In this research we wished to explore the first person perspective of participants who had developed delusions. Interpretative phenomenological analysis was used to interview and analyse themes from 28 participants. An additional matrix analysis of themes was used to examine the importance of social difficulties in relation to types of onset and diagnoses. Our results suggest 3 types of onset: an eruptive sudden transformation of self or world; a slow progressive onset characterised by interconnected changes in meaning and experience; and onset beginning in childhood experience. Social difficulties were mentioned spontaneously by 17 participants in describing onset and a further 9 discussed social difficulties when explicitly asked. One feature that appears to be present both in the progressive and childhood onset is negative emotion about, and preoccupation with, a difficult interpersonal topic over long periods of time. The descriptions given suggest that certain ideas or images could take hold of a person and become interwoven in his or her thinking and perhaps even begin to influence the way the person experienced the world or self. We suggest that it may be important for therapeutic work with delusions to articulate a narrative of onset. Key Practitioner Message: • Exploring the onset of delusions can lead to useful information about social and emotional difficulties. • Most patients are able to give detailed accounts of onset, though some might only describe social and emotional difficulties if prompted. • Reported changes in experience and/or social difficulties may have occurred for some patients over many years and may even begin in childhood. • There may be a process of mutual influence between extreme negative ideas and experience over years for some patients. Copyright © 2010 John Wiley & Sons, Ltd.
Atlantis E.,University of Western Sydney |
Fahey P.,University of Western Sydney |
Cochrane B.,University of Western Sydney |
Cochrane B.,Campbelltown Hospital |
And 2 more authors.
Chest | Year: 2013
Background: The longitudinal associations between depression or anxiety and COPD, and their comorbid effect on prognosis, have not been adequately addressed by previous reviews. We aimed to systematically assess these associations to inform guidelines and practice. Methods: We searched electronic databases for articles published before May 2012. Longitudinal studies in adult populations that reported an association between clinically relevant depression or anxiety and COPD, or that reported their comorbid effect on exacerbation and/or mortality, were eligible. Risk ratios (RRs) were pooled across studies using random-effects models and were verifi ed using fi xed-effects models. Heterogeneity was explored with subgroup and metaregression analyses. Results: Twenty-two citations yielded 16 studies on depression or anxiety as predictors of COPD outcomes (incident COPD/chronic lung disease or exacerbation) and/or mortality, in 28,759 participants followed for 1 to 8 years, and six studies on COPD as a predictor of depression in 7,439,159 participants followed for 1 to 35 years. Depression or anxiety consistently increased the risk of COPD outcomes (RR, 1.43; 95% CI, 1.22-1.68), particularly in higher-quality studies and in people aged ≤ 66 years. Comorbid depression increased the risk of mortality (RR, 1.83; 95% CI, 1.00-3.36), particularly in men. Anxiety (or psychologic distress) increased the risk of COPD outcomes/mortality in most studies (RR, 1.27; 95% CI, 1.02-1.58). Finally, COPD consistently increased the risk of depression (RR, 1.69; 95% CI, 1.45-1.96). Conclusions: Depression and anxiety adversely affect prognosis in COPD, conferring an increased risk of exacerbation and possibly death. Conversely, COPD increases the risk of developing depression. These bidirectional associations suggest potential usefulness of screening for these disease combinations to direct timely therapeutic intervention.
Katelaris C.H.,University of Western Sydney |
Katelaris C.H.,Campbelltown Hospital
Current Opinion in Allergy and Clinical Immunology | Year: 2016
Purpose of review The review outlines recent insights into our understanding of the complex relationships between pollen and plant food sensitization patterns resulting in the pollen fruit syndrome and the possible risk, upon ingestion, of generalized symptoms rather than localized oropharyngeal reactions. Appreciation of this risk will inform management strategies, which include epinephrine prescription. Recent findings In recent times, the ability to examine molecular components of foods and pollen has allowed further delineation of reactivity patterns. These reveal complex patterns of IgE reactivity and sensitization pathways. More precise definition of these patterns will allow a more accurate analysis of risk of severe food reactions following ingestion. Summary Despite improvement in diagnostic tests, there remains no completely reliable way to determine whether an individual with pollen fruit syndrome is at risk of a systemic reaction. The decision to prescribe an epinephrine autoinjector must be based on a risk assessment for the individual patient. © 2016 Wolters Kluwer Health, Inc. All rights reserved.