The Woolcock Institute of Medical Research

Sydney, Australia

The Woolcock Institute of Medical Research

Sydney, Australia
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King G.G.,The Woolcock Institute of Medical Research | King G.G.,University of Sydney | King G.G.,Cooperative Research Center for Asthma and Airways | King G.G.,Royal North Shore Hospital
Pulmonary Pharmacology and Therapeutics | Year: 2011

Medical imaging has been increasingly used in respiratory research due to the rapid and ongoing development of medical technology. Current imaging is almost entirely 3-dimensional and allows the measurement of structure and function, often both simultaneously. The information complements other measurement methods in airway research because imaging's greatest contributions are those of topographical information, direct visualisation of functional or structural change, sampling of the whole organ (in contrast to for example bronchoscopy) and potential for in vivo imaging in a repeated, prospective nature. Medical imaging modalities of high-resolution computed tomography (HRCT), magnetic resonance imaging (MRI), ultra-high resolution imaging, positron emission computed tomography (PET) and single photon emission computed tomography (SPECT) are reviewed in relation to research in airways disease. © 2011 Elsevier Ltd.


Bajorek B.,University of Technology, Sydney | Lemay K.,The Woolcock Institute of Medical Research | Gunn K.,Balance Healthcare | Armour C.,The Woolcock Institute of Medical Research
Australasian Medical Journal | Year: 2015

Background The Australian government’s General Practitioner (GP) super clinics programme aims to provide well-integrated, multidisciplinary, patient-centred care for people with chronic disease. However, there is no research into the current role of pharmacists in this setting. Aims To explore the perspectives of GP super clinic staff on current and potential (future) pharmacist-led services provided in this setting. Methods Individual interviews (facilitated using a semi-structured interview guide and thematically analysed) were conducted with purposively sampled staff of a GP super clinic in a semirural location in the state of New South Wales, until theme saturation. Participating staff included (n=9): three GPs, one pharmacist, one nurse, one business manager, and three reception staff. Results Three themes emerged conveying perspectives on: working relationships between staff; a pharmacist’s current role; and potential future roles for a pharmacist. All clinic staff actively engaged the pharmacist in their “team approach”. Currently established roles for home medicines reviews (HMRs) and drug information were well supported, but needed to be expanded, for example, with formalised case conferences between GPs, pharmacists, and other staff. New roles needed be explored in auditing medication use, optimising medication records, specialised drug information, dispensing, and prescribing. Although GPs had differing views about opportunities for pharmacists’ prescribing in this setting, they saw several benefits to this service, such as reducing the time pressure on GPs to enable more effective consultations. Conclusion Results suggest a pharmacist’s services can potentially be better used within the multidisciplinary super clinic model of care to address current gaps within the semi-rural practice setting. Any future role for the pharmacist could be addressed as part of a formalised, strategic approach to creating an integrated healthcare team, with attention to funding and government legislation. © 2015, AMJ. All rights reserved.


PubMed | Balance Healthcare, University of Technology, Sydney and The Woolcock Institute of Medical Research
Type: Journal Article | Journal: The Australasian medical journal | Year: 2015

The Australian governments General Practitioner (GP) super clinics programme aims to provide well-integrated, multidisciplinary, patient-centred care for people with chronic disease. However, there is no research into the current role of pharmacists in this setting.To explore the perspectives of GP super clinic staff on current and potential (future) pharmacist-led services provided in this setting.Individual interviews (facilitated using a semi-structured interview guide and thematically analysed) were conducted with purposively sampled staff of a GP super clinic in a semirural location in the state of New South Wales, until theme saturation. Participating staff included (n=9): three GPs, one pharmacist, one nurse, one business manager, and three reception staff.Three themes emerged conveying perspectives on: working relationships between staff; a pharmacists current role; and potential future roles for a pharmacist. All clinic staff actively engaged the pharmacist in their team approach. Currently established roles for home medicines reviews (HMRs) and drug information were well supported, but needed to be expanded, for example, with formalised case conferences between GPs, pharmacists, and other staff. New roles needed be explored in auditing medication use, optimising medication records, specialised drug information, dispensing, and prescribing. Although GPs had differing views about opportunities for pharmacists prescribing in this setting, they saw several benefits to this service, such as reducing the time pressure on GPs to enable more effective consultations.Results suggest a pharmacists services can potentially be better used within the multidisciplinary super clinic model of care to address current gaps within the semi-rural practice setting. Any future role for the pharmacist could be addressed as part of a formalised, strategic approach to creating an integrated healthcare team, with attention to funding and government legislation.


PubMed | University of Sydney, e The George Institute for Global Health and The Woolcock Institute of Medical Research
Type: | Journal: Behavioral sleep medicine | Year: 2016

Treatment preferences play a key role in dictating sleep health outcomes. However, patients treatment beliefs, attitudes, and experiences that inform preference conceptualization remain an unknown phenomenon. Therefore, this study aims to explore patient perceptions toward pharmacotherapy and the nonpharmacological management of insomnia. Fifty-one patients with insomnia were recruited from specialist clinics and general community settings. Participants completed a brief questionnaire followed by an in-depth semistructured interview that was digitally recorded, transcribed verbatim, and subjected to Framework Analysis to identify emergent themes. Three key themes were identified: Resolving Insomnia, Self-Imposed Treatment Boundaries, and Treatment Uptake. Patients illness, treatment, and psychosocial beliefs and experiences are closely linked to treatment choice. Being attuned to these influences during the clinical encounter can facilitate treatment selection that is meaningful for the patient.


Byrne A.L.,University of Sydney | Byrne A.L.,Partners In Health | Byrne A.L.,Center for Research Excellence in Tuberculosis | Marais B.J.,University of Sydney | And 7 more authors.
International Journal of Infectious Diseases | Year: 2015

Background: Chronic respiratory disease causes substantial global morbidity and mortality. The contribution of pulmonary tuberculosis to the aetiology of chronic respiratory disease is rarely considered, but may be important in tuberculosis-endemic areas. Methods: We performed a systematic literature review to assess the association between a history of tuberculosis and the presence of chronic obstructive pulmonary disease (COPD) or chronic suppurative lung disease (bronchiectasis). Study quality was evaluated using the National Heart Lung and Blood Institute quality assessment tool. Meta-analysis was performed using the DerSimonian and Laird random effects model. Results: We identified 9 eligible studies for COPD and 2 for bronchiectasis. Overall, there was a significant association between a history of tuberculosis and the presence of COPD in adults aged over 40 years (pooled odds ratio 3.05 (95% confidence interval 2.42, 3.85). Among individual COPD studies the strongest associations were found in countries with a high incidence of tuberculosis, as well as among never smokers and younger people. Conclusion: In tuberculosis endemic areas, tuberculosis is strongly associated with the presence of chronic respiratory disease in adults. Efforts to improve long-term lung health should be part of tuberculosis care. © 2014 The Authors.


PubMed | University of Sydney, Northumbria University and The Woolcock Institute of Medical Research
Type: Journal Article | Journal: Health expectations : an international journal of public participation in health care and health policy | Year: 2016

Sedative hypnotics form an important part of managing insomnia and are recommended for short-term use. It is standard practice for clinicians to inform the patient to use medications only when required, but the use of these medications is often chronic. Little is known about the impact of standard labelling/instructions on promoting appropriate medication use for managing insomnia.To explore patient medication-taking beliefs, experiences and behavioural practices relating to the use of pharmacological/complementary sleep aids for insomnia.Specialist sleep/psychology clinics and the general community in Sydney, Australia.Semi-structured interviews were conducted with 51 people with insomnia using a schedule of questions to gauge their experiences, beliefs and current practices relating to insomnia medication use. Interviews were audio-recorded, transcribed verbatim and subjected to Framework Analysis to identify emergent themes.Participants held distinctive views about the safety and efficacy of complementary and pharmacological agents but do not intuitively turn to medications to resolve their sleep complaint. Medication use was affirmed through tangible medication-taking cues due to the ambivalence in current instructions and labelling. Practices such as dosage modification, medication substitution and delaying medication use might be important drivers for psychological dependence.Current labelling and instructions do not necessarily promote the quality use of sedative hypnotics due to the variability in patient interpretations. Clarifying the timing, quantity and frequency of medication administration as well as insomnia symptom recognition would play a significant role in optimizing the role of pharmacotherapy in the management of insomnia.


Milne S.,The Woolcock Institute of Medical Research | Milne S.,University of Sydney | King G.G.,The Woolcock Institute of Medical Research | King G.G.,University of Sydney | King G.G.,Royal North Shore Hospital
Journal of Thoracic Disease | Year: 2014

Chronic obstructive pulmonary disease (COPD) involves a complex interaction of structural and functional abnormalities. The two have long been studied in isolation. However, advanced imaging techniques allow us to simultaneously assess pathological processes and their physiological consequences. This review gives a comprehensive account of the various advanced imaging modalities used to study COPD, including computed tomography (CT), magnetic resonance imaging (MRI), and the nuclear medicine techniques positron emission tomography (PET) and single-photon emission computed tomography (SPECT). Some more recent developments in imaging technology, including micro-CT, synchrotron imaging, optical coherence tomography (OCT) and electrical impedance tomography (EIT), are also described. The authors identify the pathophysiological insights gained from these techniques, and speculate on the future role of advanced imaging in both clinical and research settings. © 2011 - 2014 Journal of Thoracic Disease.


PubMed | University of Sydney and The Woolcock Institute of Medical Research
Type: Journal Article | Journal: Behavioral sleep medicine | Year: 2016

Patient views about their treatment for insomnia often dictate outcome. This review explores the literature relating to the patients global perceptions toward treatment for insomnia. A strategic literature search was conducted using five databases (PubMed, CINAHL, Medline, PsycINFO, and Embase). The 57 research articles included for this review were mapped out chronologically across three key stages of treatment-seeking (pretreatment appraisal, actual treatment experiences, and posttreatment evaluation). Patient perceptions played an important role across these three key stages and influenced subsequent health behaviors such as the initiation of help-seeking, treatment uptake, treatment adherence, and treatment adjustment. Patients perceptions toward treatment were heavily grounded by their psychosocial contexts. Clinical implications and future directions for including patient-centered metrics in mainstream practice and research are discussed.


Zhong J.,University of Basel | Lardinois D.,University of Basel | Szilard J.,The Woolcock Institute of Medical Research | Tamm M.,University of Basel | Roth M.,University of Basel
Lung Cancer | Year: 2011

Pleural malignant mesothelioma is a rare but deadly tumour mainly induced by asbestos inhalation. Despite the ban of asbestos in 1990 in 52 countries, mesothelioma cases still increase worldwide. In pleural mesothelioma, p38 mitogen activated protein kinases (MAPK) have been suggested to play a major role in carcinogenesis and aggressiveness of tumours. The aim of this study was to determine the role of the different four p38 MAPK isoforms and their effect on proliferation together with the underlying signalling pathways in a rat pleural mesothelioma cell line. Rat pleural mesothelioma cells were stimulated with platelet-derived growth factor (PDGF)-BB and/or transforming growth factor beta (TGF)-β MAPK and transcription factor expression and activation was monitored in the cytosol and nucleus by immuno-blotting. Proliferation was determined by manual cell count and siRNAs were used to control MAPK and transcription factor expression and action. Only PDGF-BB, but not TGF-β1 induced proliferation via activated Erk1/2 and p38 MAPK. The p38α and δ isoforms were expressed in the cytosol, and upon activation p38δ translocated into the nucleus, while p38α remained in the cytosol. No other p38 isoform was expressed by rat mesothelioma cells. C/EBP-α was found in both the cytosol and the nucleus, while C/EBP-β was not expressed at all. PDGF-BB induced proliferation was suppressed by down-regulation of either Erk1/2, or p38δ MAPK, or C/EBP-α Furthermore, TGF-β inhibited PDGF-BB induced proliferation by interruption of p38 MAPK signalling. From this rat model, we conclude that in pleural mesothelioma, p38δ in C/EBP-α mediate proliferation and thus may represent new targets in mesothelioma therapy. © 2010 Elsevier Ireland Ltd.


PubMed | The Woolcock Institute of Medical Research
Type: Journal Article | Journal: Pharmaceutical research | Year: 2014

The purpose of this study was to present a modified Andersen cascade impactor (ACI) as a platform to evaluate the deposition and subsequent transport of aerosol micropaticles across airway epithelial cells.The impaction plate of an ACI was modified to accommodate up to eight Snapwells. Aerodynamic particle size distribution of the modified ACI was investigated with two commercially available formulations of Ventolin (salbutamol sulphate) and QVAR (beclomethasone dipropionate). Deposition and transport of these drug microparticles across sub-bronchial epithelial Calu-3 cells were also studied.The modified ACI demonstrated reproducible deposition patterns of the commercially available pressurised metered dose inhalers compared to the standard ACI. Furthermore, the Calu-3 cells could be placed in different stages of the modified ACI. No significant effect was observed among the transport rate of different particle sizes deposited on Calu-3 cells within the range of 3.3 to 0.4 m.The use of the cell compatible ACI to assess the fate of microparticles after deposition on the respiratory epithelia may allow for better understanding of deposited microparticles in vivo.

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