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Launceston, Australia

Keung C.,Launceston General HospitalTAS | Hebbard G.,Royal Melbourne Hospital
Australian Prescriber | Year: 2016

If there are no features of serious disease, suspected gastro-oesophageal reflux disease can be initially managed with a trial of a proton pump inhibitor for 4–8 weeks. This should be taken 30–60 minutes before food for optimal effect. Once symptoms are controlled, attempt to withdraw acid suppression therapy. If symptoms recur, use the minimum dose that controls symptoms. Patients who have severe erosive oesophagitis, scleroderma oesophagus or Barrett’s oesophagus require long-term treatment with a proton pump inhibitor. Lifestyle modification strategies can help gastro-oesophageal reflux disease. Weight loss has the strongest evidence for efficacy. Further investigation and a specialist referral are required if there is no response to proton pump inhibitor therapy. Atypical symptoms or signs of serious disease also need investigation. © 2016, Australian Government Publishing Service. All rights reserved. Source

Chandran S.,Austin Health | Chandran S.,University of Melbourne | Parker F.,Austin Health | Vaughan R.,Austin Health | And 6 more authors.
Gastrointestinal Endoscopy | Year: 2015

Background: Colonoscopy and polypectomy can prevent up to 80% of colon cancer; however, a significant adenoma miss rate still exists, particularly in the right side of the colon. Objective: To assess whether retroflexion in the right side of the colon significantly improves theadenoma detection rate (ADR) over forward-view assessment. Design: Multicenter prospective cohort study. Setting: Three tertiary care public and 2 private hospitals. Patients: A total of 1351 consecutive adult patients undergoing elective colonoscopy. Intervention: Withdrawal from the cecum was performed in the forward view initially and identified polyps removed. Once the hepatic flexure was reached, the cecum was reintubated and the right side of the colon was assessed in the retroflexed view to the hepatic flexure. Main Outcome Measurements: ADR in the retroflexed view when compared with forward-view examination of the right side of the colon. Results: Retroflexion was successful in 95.9% of patients, with looping the predominant (69.6%) reason for failure. Forward-view assessment of the right side of the colon identified 642 polyps, of which 531 were adenomas yielding a polyp and ADR of 28.57% and 24.64%, respectively. Limitations: Observational study. Conclusion: Right-sided retroflexion was successful in most of our cohort with a statistically signi ficant but small increase in ADR. Right-sided retroflexion is safe when performed by experienced endoscopists with no adverse events observed in this cohort. (Clinical trial registration: Australian New Zealand Clinical Trials Registry, ACTRN12613000424707.) Copyright © 2015 by the American Society for Gastrointestinal Endoscopy. Source

El-Ansary D.,University of Melbourne | Aitken J.,Launceston General HospitalTAS | Zalucki N.,Launceston General HospitalTAS | Hardikar A.,Launceston General Hospital and Royal Hobart HospitalTAS
International Journal of Therapy and Rehabilitation | Year: 2015

Background: Postoperative sternal complications after cardiac surgery remain a significant problem that increases hospital length of stay and cost of care, delays recovery, and impairs function. While the majority of patients with sternal instability can be successfully treated with sternal debridement and rewiring, this may not be an option for all patients who present with acute or persistent instability. Methods: This clinical case reports an interdisciplinary approach to the clinical assessment and conservative management of a complex patient with multiple co-morbidities and persistent sternal instability following three open-heart procedures for coronary revascularisation. It presents new and innovative diagnosis of sternal instability and monitoring of sternal healing using real-time ultrasound, as well as clinical management, with a sternal brace (QualiBreath, Chiaverano, 10010-Torino, Italy). Results: With the QualiBreath in situ, the patient reported a significant reduction in pain with activity (2/10), uninterrupted sleep and improved confidence in completing everyday tasks. On physical examination, there was minimal sternal motion on palpation (Sternal Instability Scale grade 1). Conclusions: A conservative interdisciplinary team approach to the management of patients who present with persistent sternal instability is recommended. © MA Healthcare Limited 2014. Source

Field K.M.,Royal Melbourne Hospital | Simes J.,University of Sydney | Nowak A.K.,Sir Charles Gairdner Hospital | Nowak A.K.,University of Western Australia | And 48 more authors.
Neuro-Oncology | Year: 2015

Background. The optimal use of bevacizumab in recurrent glioblastoma (GBM), including the choice of monotherapy or combination therapy, remains uncertain. The purpose of this study was to compare combination therapy with bevacizumab monotherapy. Methods. This was a 2-part randomized phase 2 study. Eligibility criteria included recurrent GBM after radiotherapy and temozolomide, no other chemotherapy for GBM, and Eastern Cooperative Oncology Group performance status 0-2. The primary objective (Part 1) was to determine the effect of bevacizumab plus carboplatin versus bevacizumab monotherapy on progression-free survival (PFS) using modified Response Assessment in Neuro-Oncology criteria. Bevacizumab was given every 2 weeks, 10 mg/kg; and carboplatin every 4 weeks, (AUC 5). On progression, patients able to continue were randomized to continue or cease bevacizumab (Part 2). Secondary endpoints included objective radiological response rate (ORR), quality of life, toxicity, and overall survival (OS). Results. One hundred twenty-two patients (median age, 55y) were enrolled to Part 1 from 18 Australian sites. Median follow-up was 32 months, and median on-treatment time was 3.3 months. Median PFS was 3.5 months for each arm (hazard ratio [HR]: 0.92, 95% CI: 0.64-1.33, P =. 66). ORR was 14% (combination) versus 6% (monotherapy) (P =. 18). Median OS was 6.9 (combination) versus 7.5 months (monotherapy) (HR: 1.18, 95% CI: 0.82-1.69, P =. 38). The incidence of bevacizumab-related adverse events was similar to prior literature, with no new toxicity signals. Toxicities were higher in the combination arm. Part 2 data (n = 48) will be reported separately. Conclusions. Adding carboplatin resulted in more toxicity without additional clinical benefit. Clinical outcomes in patients with recurrent GBM treated with bevacizumab were inferior to those in previously reported studies. © 2015 The Author(s) 2015. Source

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