Port N.,Hunter New England Training |
Weiss A.,Hunter New England ECT Services |
Maudsley I.,Hunter New England Area Health Service
Australasian Psychiatry | Year: 2012
Objectives: This paper gives an overview of the teaching and assessment process in electroconvulsive therapy (ECT) provided in the Hunter Region to see if it can be used as a successful example of competency assessment and training. We describe the process and practice of training and credentialing in ECT in the Hunter Region, and compare these with the requirements of an Entrustable Professional Activity (EPA) in particular and competency based training and assessment in general. Conclusion: The intensely supervised 'hands on' training and assessment in this program, and the entrusting of successful graduates to perform ECT and related activities with sufficient independence, demonstrate an 'Entrustable Professional Activity' as proposed for introduction in the Royal Australian and New Zealand College of Psychiatrists Competency Based Fellowship Program. © 2012 The Royal Australian and New Zealand College of Psychiatrists.
Kannu P.,Murdoch Childrens Research Institute |
Kannu P.,Queen's University |
Bateman J.F.,Murdoch Childrens Research Institute |
Randle S.,Glenroy Specialist Center |
And 5 more authors.
Arthritis and Rheumatism | Year: 2010
Mutations in the gene encoding type II collagen (COL2A1) give rise to a spectrum of phenotypes predominantly affecting cartilage and bone. These chondrodysplasias are typically characterized by disproportionately short stature, eye abnormalities, cleft palate, and hearing loss. It is less recognized that mutations in COL2A1 can also present as degenerative joint disease in the absence of any other phenotypic clues. We report 2 Australian families presenting with an isolated arthritis phenotype, segregating as a dominant trait affecting both large and small joints, prior to age 30 years. Sequencing of COL2A1 in the propositi revealed 2 sequence changes resulting in glycine substitutions in the triple-helical domain of type II collagen. We review the increasing evidence implicating COL2A1 mutations in individuals presenting with isolated degenerative joint disease, aiming to alert physicians who assess these patients to this possibility. The importance of finding a COL2A1 mutation in such patients lies in the subsequent ability to accurately assess recurrence risks, offer early (including prenatal) diagnosis, and provide information regarding the natural history of the condition. Most importantly, it enables at-risk individuals to be identified for implementation of preventative strategies (i.e., weight loss, joint-friendly exercise programs) and early ameliorative management of their condition. © 2010, American College of Rheumatology.
White J.H.,Hunter New England Area Health Service |
Magin P.,University of Newcastle |
Attia J.,University of Newcastle |
Sturm J.,Gosford Hospital |
And 3 more authors.
Annals of Family Medicine | Year: 2012
PURPOSE There has been little exploration of the distinct trajectories of psychological distress after stroke and the factors that predict recovery from distress. These trajectories may assist primary care physicians by providing insight into disease onset, progression, and resolution and may be a useful way to conceptualize and understand the pattern of psychological morbidity in stroke over time. We undertook a longitudinal qualitative study to explore poststroke psychological trajectories METHODS The primary data collection method was semistructured interviews with community-dwelling stroke survivors in metropolitan Newcastle, New South Wales, Australia. Our sample included 23 participants (12 men, 10 women; age range 37 to 94 years) discharged from a tertiary referral hospital after a stroke; these participants subsequently participated in a total of 106 interviews over 12 months. Qualitative outcomes were participants' perceptions at baseline, 3, 6, 9, and 12 months. Thematic saturation was achieved. RESULTS Most participants were male (54%) and had a partial anterior circulation infarction stroke subtype (57%). Four different longitudinal trajectories were identified: resilience (n = 5); ongoing crisis (n = 5), emergent mood disturbance (n = 3), and recovery from mood disturbance (n = 10). Recovery from mood disturbance was facilitated by gains in independence and self-esteem and by having an internal health locus of control. CONCLUSIONS Stroke survivors experienced a variety of psychological trajectories. Identifying distinct trajectories of psychological morbidity may help primary care physicians develop appropriately timed interventions to promote better mental health. Interventions require implementation over a longer duration than the current outpatient services that, in Australia, are typically provided in the first few months after stroke.
Spratt N.J.,Hunter Medical Research Institute |
Spratt N.J.,Hunter New England Area Health Service |
Spratt N.J.,University of Melbourne |
Donnan G.A.,University of Melbourne |
And 2 more authors.
Journal of Cerebral Blood Flow and Metabolism | Year: 2011
The degree of cellular injury within the stroke ischaemic penumbra is controversial. Clinical and experimental studies using the hypoxia tracer fluoromisonidazole (FMISO) have shown retention of this tracer in the penumbra, but cellular outcome has not been well characterised. We hypothesised that macroscopically intact FMISO-retaining penumbral tissues would show evidence of microscopic injury, and that no FMISO retention would be seen in the infarct core. To determine the distribution of FMISO retention, a tritium-labelled tracer (hydrogen-3 FMISO (3HFMISO)) was administered 5 minutes after induction of 2-hour temporary middle cerebral artery occlusion. Coregistered brain histology and autoradiography at 24 hours revealed marked retention of FMISO within the infarct. However, 48% of the FMISO-retaining tissue was not infarcted. Within this noninfarcted tissue, only 27% (17 of 64) of sampled regions showed no evidence of neuronal loss, whereas 44% (28 of 64) showed injury to >50% of neurons within the sample. To determine whether FMISO retention occurred after the tissue was already committed to infarction, FMISO was administered 4 to 6 hours after the onset of permanent vessel occlusion. Intense FMISO retention was consistently seen throughout the infarct core. In conclusion, FMISO retention occurs both within the ischaemic penumbra and within the early infarct core. Most penumbral tissues show evidence of selective cellular injury. © 2011 ISCBFM All rights reserved.
Mitchell R.,University of Newcastle |
Parker V.,Hunter New England Area Health Service |
Giles M.,Hunter New England Area Health Service |
White N.,Hunter New England Area Health Service
Medical Care Research and Review | Year: 2010
Interprofessional approaches to health and social care have been linked to improved planning and policy development, more clinically effective services, and enhanced problem solving; however, there is evidence that professionals tend to operate in uniprofessional silos and that attempts to share knowledge across professional borders are often unsuccessful.
Beesley K.,Hunter New England Local Health Network |
White J.H.,Hunter Region Mail Center |
Alston M.K.,Hunter New England Area Health Service |
Sweetapple A.L.,Hunter New England Area Health Service |
Pollack M.,Hunter New England Local Health Network
Disability and Rehabilitation | Year: 2011
Purpose This study aimed to qualitatively explore the experience of community dwelling stroke survivors participation in an arts health group programme and possible health benefits to quality of life (QOL) and wellbeing. Method.Sixteen participants were conveniently sampled to participate in two group art programmes, both held weekly over a period of 8 weeks. Qualitative data were collected through two focus groups (n = 9) and individual interviews (n = 11). Qualitative analysis of the data was undertaken, using a grounded theory approach incorporating constant comparison. Results.Age ranged from 43 to 81 years. Four themes emerged including: experience of stroke, benefit of art, benefit for self and benefit of group experience. Participants experienced improved confidence, self-efficacy, QOL and community participation through involvement in an arts health programme. Conclusions.The implementation of an arts health programme after stroke made a substantial impact on well-being and QOL. Results from this study are promising and this is a model that warrants rigorous investigation regarding the impact of art on QOL and wellbeing. This study also highlighted the need for community resources to address community re-integration and service provision in the form of age appropriate, activity-based groups for stroke survivors. © 2011 Informa UK, Ltd.
Hardy L.L.,University of Sydney |
Grunseit A.,University of Sydney |
Khambalia A.,University of Sydney |
Bell C.,University of Newcastle |
And 3 more authors.
Journal of Adolescent Health | Year: 2012
The purpose of this study was to determine the prevalence, sociodemographic distribution, and co-occurrence of five potentially obesogenic behavioral risk factors (low physical activity, high screen time, low fruit and vegetable intake, high soft drink consumption, and high snack intake) among adolescents. Cross-sectional representative population survey (n = 1,568) of grade 6, 8, and 10 students (49% male) randomly selected from 70 primary and secondary schools in New South Wales, Australia, between February and May 2007. Co-occurrence was assessed using an observed-to-expected ratio (O/E) method. Only 5% of boys and 9% of girls had none of the five obesogenic behavioral risk factors studied. Overall, 51.4% of boys and 42.9% of girls had three or more risk factors. Prevalence of multiple risk factors (3+) was higher among boys and girls from lower income households and among girls whose mothers had less than grade 12 education. For both boys and girls, the occurrence of all five risk factors was 160% greater than expected (O/E ratio: 2.6). There was clear evidence of a co-occurrence of obesogenic risk factors among adolescents, especially among those from lower socioeconomic backgrounds, indicating this group would benefit from targeted prevention strategies.
Depczynski J.,University of Sydney |
Challinor K.,Hunter New England Area Health Service |
Fragar L.,University of Sydney
Journal of Agromedicine | Year: 2011
This study compares the hearing status and behaviors of Australian farmers from 1994-2001 with those from 2002-2008. Over this period the authors found (1) there was a 12.5% overall improvement in the proportion of farmers with normal hearing in left ears, with the likelihood of a screening participant having normal hearing improving by almost 9% each year; (2) significant improvements in the mean hearing threshold of both ears from 1 to 6 kHz; (3) significantly higher mean hearing thresholds for 35- to 44-year-old farmers exposed to firearms, chainsaws, workshop tools, heavy machinery, and tractors with cabins compared to nonexposed groups; (4) nonuse of hearing protection devices by young farmers (15 to 24 years old), was associated with hearing loss for those using uncabined tractors. Despite a reduction in noise injury, further adoption of noise reduction strategies for specific agricultural work practices is required.
Marquez J.,University of Newcastle |
van Vliet P.,University of Newcastle |
Mcelduff P.,University of Newcastle |
Lagopoulos J.,University of Sydney |
Parsons M.,Hunter New England Area Health Service
International Journal of Stroke | Year: 2015
Transcranial direct current stimulation has been gaining increasing interest as a potential therapeutic treatment in stroke recovery. We performed a systematic review with meta-analysis of randomized controlled trials to collate the available evidence in adults with residual motor impairments as a result of stroke. The primary outcome was change in motor function or impairment as a result of transcranial direct current stimulation, using any reported electrode montage, with or without adjunct physical therapy. The search yielded 15 relevant studies comprising 315 subjects. Compared with sham, cortical stimulation did not produce statistically significant improvements in motor performance when measured immediately after the intervention (anodal stimulation: facilitation of the affected cortex: standardized mean difference=0·05, P=0·71; cathodal stimulation: inhibition of the nonaffected cortex: standardized mean difference=0·39, P=0·08; bihemispheric stimulation: standardized mean difference=0·24, P=0·39). When the data were analyzed according to stroke characteristics, statistically significant improvements were evident for those with chronic stroke (standardized mean difference=0·45, P=0·01) and subjects with mild-to-moderate stroke impairments (standardized mean difference=0·37, P=0·02). Transcranial direct current stimulation is likely to be effective in enhancing motor performance in the short term when applied selectively to patients with stroke. Given the range of stimulation variables and heterogeneous nature of stroke, this modality is still experimental and further research is required to determine its clinical merit in stroke rehabilitation. © 2013 World Stroke Organization.
James D.J.,University of Newcastle |
Cardew P.,University of Newcastle |
Cardew P.,Hunter New England Area Health Service |
Warren-Forward H.M.,University of Newcastle
Journal of Nuclear Medicine Technology | Year: 2011
Ionizing radiation used in diagnostic nuclear medicine procedures has the potential to have biologic effects on a fetus. Nuclear medicine technologists (NMTs) therefore have a responsibility to ensure that they question all patients of childbearing age about their pregnancy status before starting any procedure, to avoid unnecessary fetal irradiation. In Australia, there are no clearly defined practice guidelines to assist NMTs in determining whom to question or how to question their patients. Methods: Semistructured interviews were conducted with chief NMTs and staff NMTs in 8 nuclear medicine departments in Australia. Questions were based around 5 areas: regulations and policy, fetal radiation exposure, questioning of the patient, difficulties in determining pregnancy status, and the impact of the use of hybrid imaging. Audio files of the interviews were transcribed and coded. Results: Topics were coded into 5 themes: policy and awareness of guidelines, questioning the patient, radiation knowledge, decisions and assumptions made by NMTs, and the use of pregnancy testing. There was a wide variation in practice between and within departments. NMTs demonstrated a lack of knowledge and awareness of the possible biologic effects of radiation. Conclusion: This study identified a need in Australia for nuclear medicine to arrive at a consensus approach to verifying a patient's pregnancy status so that NMTs can successfully question patients about their pregnancy status. Continuing education programs are also required to keep NMTs up to date in their knowledge. © 2011 by the Society of Nuclear Medicine, Inc.