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Melbourne, Australia

Rose M.,Cabrini Medical Center | Pan H.,Caulfield General Medical Center | Levinson M.R.,Cabrini Institute | Staples M.,Cabrini Institute
Internal Medicine Journal | Year: 2014

The Reported Edmonton Frail Scale was used to describe the prevalence of frailty in an acute general medical unit. The relationship between frailty, discharge destination, mortality and length of hospital stay was explored. We found that age was associated with frailty, and frailty correlated to an increasing length of hospital stay. © 2014 Royal Australasian College of Physicians.

Ward S.A.,Monash University | Ward S.A.,Western University of Health Sciences | Parikh S.,Monash University | Parikh S.,Caulfield General Medical Center | Workman B.,Monash University
Best Practice and Research: Clinical Anaesthesiology | Year: 2011

Populations globally are ageing, in part due to dramatic increases in life expectancies, forcing a reconsideration of what constitutes being "elderly" and "old." The proportion of older adults living with disability may be decreasing, yet older individuals are living with a significant burden of chronic disease, geriatric impairments in cognition, vision and hearing and reduced physiological reserve (frailty). Caring for a growing number of medically complex individuals has implications for medical workforce size and composition, health programmes and expenditure. Future responses to an ageing population will require further innovation in health-care delivery models, and increasing representation of older adults in clinical trials. © 2011 Elsevier Ltd. All rights reserved.

Frossard L.,Queensland University of Technology | Frossard L.,University of Queensland | Gow D.L.,Caulfield General Medical Center | Hagberg K.,Sahlgrenska University Hospital | And 5 more authors.
Gait and Posture | Year: 2010

The purpose of this proof-of-concept study was to determine the relevance of direct measurements to monitor the load applied on the osseointegrated fixation of transfemoral amputees during static load bearing exercises. The objectives were (A) to introduce an apparatus using a three-dimensional load transducer, (B) to present a range of derived information relevant to clinicians, (C) to report on the outcomes of a pilot study and (D) to compare the measurements from the transducer with those from the current method using a weighing scale. One transfemoral amputee fitted with an osseointegrated implant was asked to apply 10 kg, 20 kg, 40 kg and 80 kg on the fixation, using self-monitoring with the weighing scale. The loading was directly measured with a portable kinetic system including a six-channel transducer, external interface circuitry and a laptop. As the load prescribed increased from 10 kg to 80 kg, the forces and moments applied on and around the antero-posterior axis increased by four-fold anteriorly and 14-fold medially, respectively. The forces and moments applied on and around the medio-lateral axis increased by nine-fold laterally and 16-fold from anterior to posterior, respectively. The long axis of the fixation was overloaded and underloaded in 17% and 83% of the trials, respectively, by up to ±10%. This proof-of-concept study presents an apparatus that can be used by clinicians facing the challenge of improving basic knowledge on osseointegration, for the design of equipment for load bearing exercises and for rehabilitation programs. © 2009 Elsevier B.V.

Baguley I.J.,University of Sydney | Nott M.T.,University of Sydney | Turner-Stokes L.,Kings College London | Graaff S.D.,Caulfield General Medical Center | And 3 more authors.
Journal of Rehabilitation Medicine | Year: 2011

Background: Limited empirical information exists regarding botulinum toxin-A injector decision-making practices for adult upper limb post-stroke spasticity. The design of most studies prevents such an assessment, as injection sites and dosage are mandated by researcher protocols. This contrasts to usual injector practices, where individualized decisionmaking is the standard of care. Design: Secondary data analysis from an Australian randomized controlled trial of 90 adults with upper limb poststroke spasticity where experienced clinicians followed their standard clinical injecting practice rather than a mandated injection regimen. Methods: Clinicians were hypothesized to tailor their injection practices according to the subject's degree of spasticity and/or the type of functional gain desired. Hypothesis testing was conducted using non-parametric analysis. Results: Muscle selection and botulinum toxin-A dosage were not significantly associated with spasticity severity or with patient-identified goals. Between-site differences in injection practices suggested that injector beliefs, rather than patient characteristics, were the dominant feature driving botulinum toxin-A injection strategy for post-stroke upper limb spasticity. Conclusion: This result looks into the "black box" of rehabilitation, revealing significant variation in injector beliefs. Findings suggest that further scientific work is required to maximize the efficacy of botulinum toxin-A injections in post-stroke upper limb spasticity management. © 2011 Foundation of Rehabilitation Information.

O'Connor D.W.,Monash University | Gardner B.,Monash University | Presnell I.,Monash University | Singh D.,Monash University | And 2 more authors.
Journal of Affective Disorders | Year: 2010

Background: We report on the outcomes in aged patients with severe, treatment-resistant depression or psychosis who were given ongoing outpatient continuation-maintenance ECT of varying duration to prevent remission and relapse following a successful course of acute ECT. Methods: A retrospective chart review of 58 consecutive patients of three Australian aged psychiatry services comparing the number and length of psychiatric admissions before and after the start of continuation-maintenance ECT. Results: Four patients had only one treatment and two received over 50 (mean 14.7). Five were still enrolled in a maintenance program two years later. In the two years after continuation-maintenance ECT started, admissions fell by 53% in number and 79% in duration compared with the previous two years. Within the actual treatment period which varied from one patient to another, admissions fell by 90% in number and 97% in duration compared with the same period beforehand. Conclusion: A treatment effect cannot be proven but the severity and chronicity of patients' conditions make placebo effects and spontaneous remission unlikely. Randomised, controlled trials are almost impossible in this setting and so carefully conducted reviews and case-control studies are still of value. Our findings suggest that continuation-maintenance ECT is effective in carefully selected patients at high risk of relapse. © 2009 Elsevier B.V. All rights reserved.

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