Eastern Health

Melbourne, Australia

Eastern Health

Melbourne, Australia
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Yeoh S.W.,Eastern Health
Clinical Journal of Gastroenterology | Year: 2017

Esophageal obstruction from soluble fiber laxatives, such as karaya gum, has been rarely reported in the literature. However, as such preparations are widely commercially available, it is important for gastroenterologists to be aware of their potential to form a bezoar in the esophagus due to swelling on contact with liquid. This report highlights such a case and discusses its challenging management. © 2017 Japanese Society of Gastroenterology

Yao W.,Eastern Health
Medical Physics | Year: 2013

Purpose: To ensure dose coverage at shallow depth and to reduce breathing effect during adjuvant radiotherapy for breast cancer patients, by using optimal treatment planning. Methods: When treating the breast or chest wall with tangential fields, low energy beams should be used as much as possible to ensure dose coverage to the target volume at shallow depth close to the skin, provided that the dose variation within the target volume is clinically acceptable. When using a hybrid plan, namely a plan that consists of open beams and IMRT segments, the weightings of open beams should be set as high as possible to minimize breathing effect in the skin region during IMRT delivery. Based on these two considerations, a treatment planning scheme is proposed to assign optimal weightings to low and high energy open beams as well as to IMRT segments. Delivery of the IMRT segments in the hybrid plans was verified by using a MapCheck device attached to a motion simulation table. Results: Compared with 3DCRT plans and non‐optimal hybrid plans, i.e. plans with non‐optimized weightings, the optimal hybrid plans demonstrated better dose uniformity, conformity and coverage of the target, especially at shallow depth close to the skin. As to the verification of the delivery of the IMRT segments in the hybrid plans, when breathing was shallow, the pass rate of gamma‐test (3%/3mm and 10% threshold) was greater than 95% for both optimal and non‐optimal plans; however, when breathing was deep, the pass rate was about 95% for optimal plans and 91% for non‐optimal plans. Conclusion: Our optimal hybrid planning can effectively improve the quality of treatment plans in terms of improving dose uniformity (including adequate dose coverage at shallow depth close to the skin and avoidance of cold/hot spots at beam junction) and minimizing breathing effect. © 2013, American Association of Physicists in Medicine. All rights reserved.

Gururajan A.,Monash Institute of Pharmaceutical Sciences | Taylor D.A.,Eastern Health | Malone D.T.,Monash Institute of Pharmaceutical Sciences
Behavioural Brain Research | Year: 2011

Cannabidiol is a non-psychoactive phytocannabinoid which, based on several previous preclinical and clinical reports, is purported to have antipsychotic potential. The purpose of this investigation was to further investigate if these effects would be seen using an MK-801-induced rat model of aspects of schizophrenia. MK-801 is an NMDA receptor-antagonist known to produce hyperactivity, deficits in prepulse inhibition and social withdrawal, behaviours which correlate well with some of the positive, cognitive and negative symptoms of schizophrenia. Following a 4-day acclimatisation to the holding room, rats were acclimatised to startle chambers on day 5 and their prepulse inhibition (PPI) determined on day 6 following treatment with cannabidiol or vehicle and MK-801 or vehicle. On day 9, rats were acclimatised to the social interaction testing arena and on day 10, were tested for social interaction and locomotor activity following the same treatments. Cannabidiol treatment alone disrupted PPI and produced hyperactivity but had no effect on social behaviour. Cannabidiol had no effect on MK-801-induced disruption of PPI or hyperactivity but showed potential towards inhibiting MK-801-induced social withdrawal. As a comparator, we also tested the effect of the atypical antipsychotic clozapine which only partially reversed MK-801-induced disruption of PPI but was able to reverse MK-801-induced hyperactivity and social withdrawal. In conclusion, cannabidiol showed both propsychotic activity and partial antipsychotic activity in an MK-801-induced model of aspects of schizophrenia. Further behavioural studies would be required using a range of species, strains, animal models and testing paradigms to conclusively establish the antipsychotic potential of cannabidiol. © 2011.

Hawkes E.A.,Austin Hospital | Hawkes E.A.,Eastern Health | Hawkes E.A.,Monash University | Grigg A.,Austin Hospital | And 4 more authors.
The Lancet Oncology | Year: 2015

Cancers can evade the host immune system by inducing upregulation of immune inhibitory signals. Anti-programmed cell death-1 (PD-1) monoclonal antibodies block these inhibitory signals allowing the host to mount an immune response against malignant cells. This class of drugs is active in solid tumours, where upregulation of cell-surface PD-1 ligand proteins is nearly uniform. Because lymphoma is a malignancy of immune system cells, the role of the PD-1 pathway in these neoplasms is more complex. However, early clinical trials using PD-1 inhibitors have shown significant clinical activity in various subtypes of relapsed lymphoma. In this Review, we assess the scientific literature on the role of the PD-1 pathway in lymphoma, the relevant clinical data for PD-1 inhibition, and future strategies for this next generation of anticancer agents. © 2015 Elsevier Ltd.

Ogeil R.P.,Monash University | Ogeil R.P.,Eastern Health | Phillips J.G.,Auckland University of Technology
Drug and Alcohol Dependence | Year: 2015

Background: Caffeine and nicotine are commonly used stimulants that enhance alertness and mood. Discontinuation of both stimulants is associated with withdrawal symptoms including sleep and mood disturbances, which may differ in males and females. The present study examines changes in sleep quality, daytime sleepiness and psychological distress associated with use and dependence on caffeine and nicotine. Methods: An online survey comprising validated tools to assess sleep quality, excessive daytime sleepiness and psychological distress was completed by 166 participants (74 males, 96 females) with a mean age of 28 years. Participants completed the study in their own time, and were not offered any inducements to participate. Results: Sleep quality was poorer in those dependent upon caffeine or nicotine, and there were also significant interaction effects with gender whereby females reported poorer sleep despite males reporting higher use of both stimulants. Caffeine dependence was associated with poorer sleep quality, increased daytime dysfunction, and increased levels of night time disturbance, while nicotine dependence was associated with poorer sleep quality and increased use of sleep medication and sleep disturbances. There were strong links between poor sleep and diminished affect, with psychological distress found to co-occur in the context of disturbed sleep. Conclusions: Stimulants are widely used to promote vigilance and mood; however, dependence on commonly used drugs including caffeine and nicotine is associated with decrements in sleep quality and increased psychological distress, which may be compounded in female dependent users. © 2015 Elsevier Ireland Ltd.

Gururajan A.,Monash Institute of Pharmaceutical Sciences | Taylor D.A.,Eastern Health | Malone D.T.,Monash Institute of Pharmaceutical Sciences
Journal of Psychopharmacology | Year: 2012

Recently, a novel paradigm has been designed to assess social investigative behaviour in pairs of Sprague-Dawley rats, which involves physical separation whilst ensuring they are able to maintain contact through other social cues. We have modified this set-up in order to assess not just social behaviour but also locomotor activity of the rats. Results showed that the MK-801- (0.3 mg/kg) treated rats displayed reduced social investigative behaviour, hyperactivity as well as reduced attention span. Pretreatment with the phytocannabinoid cannabidiol (3 mg/kg) not only normalised social investigative behaviour but increased it beyond control levels. Pretreatment with clozapine (1, 3 mg/kg) also normalised social investigative behaviour. Both cannabidiol and clozapine inhibited MK-801-induced hyperactivity. However, there were no effects of pretreatment on impairments to attention span. Our findings reinforce several aspects of the validity of the MK-801-induced model of social withdrawal and hyperactivity and also support the use of this novel set-up for further investigations to assess the antipsychotic potential of novel compounds. © The Author(s) 2012.

McGrice M.A.,Eastern Health | Porter J.A.,Eastern Health
Obesity Surgery | Year: 2012

Background: There is a paucity of evidence-based dietary management guidelines for patients post-laparoscopic adjustable gastric banding, including no consensus recommendations for macronutrient intake. We examined the macronutrient intake across a multi-centre cohort of post-bariatric surgery patients and compared these intakes to post-bariatric surgery and population-based dietary guidelines. Methods: Two hundred and fifteen patients from three bariatric surgery centres in Melbourne, Australia were invited to complete a validated Food Frequency Questionnaire 12 months post-operatively. Results: Energy intakes of the 52 participants ranged from 1,140 to 13,200 kJ/day, with an average of 4,890 kJ/day (±2,360 kJ/day). Many patients did not meet minimum population recommendations for macronutrients. The average fibre intake was only 14 g/day (compared to the recommendations of 25 g for women and 30 g for men). The average diet 1 year post-operatively was 36 % total fat compared to the recommendations of 20-25 %, with 14 % of intake from saturated fat. Conclusions: Patients' dietary intakes vary significantly 1 year post-laparoscopic adjustable band surgery, with many patients not meeting recommendations. These results suggest that patients decrease their total energy intake; however, eating habits may not improve as they consume a diet high in saturated fat. It is recommended that all patients receive dietary education about diet quality post-laparoscopic adjustable gastric band surgery to assist them in improving their diet quality as well as quantity for optimal health and weight loss. Specific international guidelines for nutrient intakes for people undergoing bariatric surgery are needed. © 2012 Springer Science + Business Media, LLC.

Yao W.,Eastern Health
Journal of applied clinical medical physics / American College of Medical Physics | Year: 2013

We propose an approach to determining optimal beam weights in breast/chest wall IMRT treatment plans. The goal is to decrease breathing effect and to maximize skin dose if the skin is included in the target or, otherwise, to minimize the skin dose. Two points in the target are utilized to calculate the optimal weights. The optimal plan (i.e., the plan with optimal beam weights) consists of high energy unblocked beams, low energy unblocked beams, and IMRT beams. Six breast and five chest wall cases were retrospectively planned with this scheme in Eclipse, including one breast case where CTV was contoured by the physician. Compared with 3D CRT plans composed of unblocked and field-in-field beams, the optimal plans demonstrated comparable or better dose uniformity, homogeneity, and conformity to the target, especially at beam junction when supraclavicular nodes are involved. Compared with nonoptimal plans (i.e., plans with nonoptimized weights), the optimal plans had better dose distributions at shallow depths close to the skin, especially in cases where breathing effect was taken into account. This was verified with experiments using a MapCHECK device attached to a motion simulation table (to mimic motion caused by breathing).

Croagh C.M.N.,Eastern Health | Lubel J.S.,Eastern Health | Lubel J.S.,Monash University
World Journal of Gastroenterology | Year: 2014

Chronic hepatitis B (CHB) is a condition of global prevalence and its sequelae include cirrhosis and hepatocellular carcinoma. The natural history of CHB is a complex interplay of virological, environmental and host factors. The dynamic relationship between the virus and host evolves over the duration of the infection and different phases of the disease have been observed and described. These have been conceptualized in terms of the state of balance between the host immune system and the hepatitis B virus and have been given the labels immune tolerant, immune clearance, immune control and immune escape although other nomenclature is also used. Host factors, such as age at infection, determine progression to chronicity. Virological factors including hepatitis B viral load, mutations and genotype also have an impact on the adverse outcomes of the infection, as do hepatotoxic cofactors such as alcohol. Our understanding of the natural history of CHB has evolved significantly over the past few decades and characterizing the phase of disease of CHB remains an integral part of managing this virus in the clinic. © 2014 Baishideng Publishing Group Inc. All rights reserved.

Wallis J.A.,Eastern Health | Taylor N.F.,Allied Health Clinical Research Office | Taylor N.F.,La Trobe University
Osteoarthritis and Cartilage | Year: 2011

Objective: To determine if pre-operative interventions for hip and knee osteoarthritis provide benefit before and after joint replacement. Method: Systematic review with meta-analysis of randomised controlled trials (RCTs) of pre-operative interventions for people with hip or knee osteoarthritis awaiting joint replacement surgery. Standardised mean differences (SMD) were calculated for pain, musculoskeletal impairment, activity limitation, quality of life, and health service utilisation (length of stay and discharge destination). The GRADE approach was used to determine the quality of the evidence. Results: Twenty-three RCTs involving 1461 participants awaiting hip or knee replacement surgery were identified. Meta-analysis provided moderate quality evidence that pre-operative exercise interventions for knee osteoarthritis reduced pain prior to knee replacement surgery (SMD (95% CI) = 0.43 [0.13, 0.73]). None of the other meta-analyses investigating pre-operative interventions for knee osteoarthritis demonstrated any effect. Meta-analyses provided low to moderate quality evidence that exercise interventions for hip osteoarthritis reduced pain (SMD (95% CI) = 0.52 [0.04, 1.01]) and improved activity (SMD (95% CI) = 0.47 [0.11, 0.83]) prior to hip replacement surgery. Meta-analyses provided low quality evidence that exercise with education programs improved activity after hip replacement with reduced time to reach functional milestones during hospital stay (e.g., SMD (95% CI) = 0.50 [0.10, 0.90] for first day walking). Conclusion: Low to moderate evidence from mostly small RCTs demonstrated that pre-operative interventions, particularly exercise, reduce pain for patients with hip and knee osteoarthritis prior to joint replacement, and exercise with education programs may improve activity after hip replacement. © 2011 Osteoarthritis Research Society International.

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