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Enhancing epistaxis blood loss estimation with an online visual aid
No full textBackground: A common presentation to otolaryngologists and primary care providers is epistaxis (“nosebleed”) and can range from mild to severe blood loss, representing a careful need to balance intervention and resuscitation. Our previous paper found that the accuracy of blood loss estimation improved with participants greater years of experience; this paper sought to investigate whether this experience could be taught in the form of a visual aid that was delivered online in a survey for participants to view.
Methods: A pre- and post-education online survey was distributed to clinical staff via email. The two surveys were separated by exposure to a visual aid of two common items (T-shirt and tissues) with varying amounts of blood spilt on them. Participants were asked to estimate the blood loss on the item by choosing a volume on a range slider, with a total of 87 participants completing the survey. Demographic data included duration of practice and specialisation. Pre- and post-estimated means, pre-post changes and differences from actual volume were calculated for each object with marginal means and 95% confidence intervals used.
Results: Several items had improved accuracy post-education including rayteks and blueys; the amount of blood spilt on the rayteks, was better estimated at an equivalent volume post-education when compared to the actual volume (actual volume: 30 mL, pre-education: 40 mL, post-education: 32.11 ML).
Conclusions: Education in the digital age has been shown to have higher rates of information retention. This study demonstrates that blood loss in epistaxis is more reliably estimated in medical products with brief online visual aid. This has implications for use in varied health settings, including emergency departments and points of care with limited resourc
Predicting the risk of pancreatic cancer in women with new-onset diabetes mellitus
No full textBackground and Aim
People with new-onset diabetes mellitus (diabetes) could be a possible target population for pancreatic cancer surveillance. However, distinguishing diabetes caused by pancreatic cancer from type 2 diabetes remains challenging. We aimed to develop and validate a model to predict pancreatic cancer among women with new-onset diabetes. Methods
We conducted a retrospective cohort study among Australian women newly diagnosed with diabetes, using first prescription of anti-diabetic medications, sourced from administrative data, as a surrogate for the diagnosis of diabetes. The outcome was a diagnosis of pancreatic cancer within 3 years of diabetes diagnosis. We used prescription medications, severity of diabetes (i.e., change/addition of medication within 2 months after first medication), and age at diabetes diagnosis as potential predictors of pancreatic cancer. Results
Among 99 687 women aged ≥ 50 years with new-onset diabetes, 602 (0.6%) were diagnosed with pancreatic cancer within 3 years. The area under the receiver operating curve for the risk prediction model was 0.73. Age and diabetes severity were the two most influential predictors followed by beta-blockers, acid disorder drugs, and lipid-modifying agents. Using a risk threshold of 50%, sensitivity and specificity were 69% and the positive predictive value (PPV) was 1.3%. Conclusions
Our model doubled the PPV of pancreatic cancer in women with new-onset diabetes from 0.6% to 1.3%. Age and rapid progression of diabetes were important risk factors, and pancreatic cancer occurred more commonly in women without typical risk factors for type 2 diabetes. This model could prove valuable as an initial screening tool, especially as new biomarkers emerge. Introduction
Pancreatic cancer is the seventh leading cause of cancer-related fatalities globally.1 In more developed regions, it is predicted to advance from the fourth to the second most common cause of cancer-related deaths by the year 2030.1, 2 Survival from pancreatic cancer is strongly related to stage at diagnosis, with 5-year survival for localized and metastatic disease being 44% and 3%, respectively.3, 4 Screening to detect disease earlier may improve outcomes, but due to the low lifetime risk of pancreatic cancer (1.7%),3 population-based screening is not recommended.5 Surveillance in people with a high inherited risk of pancreatic cancer can lead to earlier stage at diagnosis,6, 7 but approximately 90% of pancreatic cancers arise sporadically,8, 9 and there is currently no established surveillance strategy in this context. It has been estimated that screening may be appropriate in population groups with a lifetime risk of 5% or greater,10 so there is considerable interest in identifying these high-risk groups.
In Australia, pancreatic cancer ranked as the third most common cause of cancer-related mortality,11 and it occurs slightly more frequently in men compared with women.11 The burden of diabetes mellitus (diabetes) has been increasing, with the number of individuals in Australia affected by diabetes surging by 2.8 times in the last two decades.12 The incidence of diabetes rises with age and is slightly higher in men than women.12 These patterns underscore the significance of gaining a deeper understanding of the connection between these two conditions. Diabetes and pancreatic cancer appears to have a bidirectional association,13 with long-standing diabetes being a risk factor for pancreatic cancer and new-onset diabetes being a manifestation of pancreatic cancer.14-16 Pancreatic cancer-associated diabetes is thought to be a paraneoplastic phenomenon, where one or more factors induced by the malignancy interfere with β-cell function, leading to diabetes.15, 17 People with new-onset diabetes may be a possible target population for pancreatic cancer surveillance. However, there is currently no clear way of distinguishing diabetes caused by pancreatic cancer from typical type 2 diabetes.
A small number of studies have found that the absolute risk of developing pancreatic cancer within 3 years of being diagnosed with diabetes ranged from 0.25% to 1%.18-21 Although this is considerably higher than in people without new-onset diabetes, this absolute risk may still be too low for routine surveillance. Using risk-prediction models to stratify this population according to the risk of pancreatic cancer may help identify a subgroup of people among whom investigations of the pancreas may be appropriate. Several pancreatic cancer risk prediction models have been reported.19, 20, 22-25 However, they were limited in that they used a small number of pancreatic cancer cases or included prediction variables that are challenging to capture in real-world settings or may be indicative of advanced disease. An alternative to this is to use medication data which can serve as proxy for other underlying risk factors or that may directly influence risk of pancreatic cancer and is easily available at the point of care. Thus, it may help to identify people who should undergo surveillance for pancreatic cancer.
The aim of this study was to estimate the absolute risk of developing pancreatic cancer, and to develop and validate a model to predict the risk of pancreatic cancer within 3 years after a new diagnosis of diabetes, within a national cohort of Australian women
Lutetium-177 Labelled Anti-PSMA Monoclonal Antibody (Lu-TLX591) therapy for metastatic prostate cancer: Treatment toxicity and outcomes
No full textIntroduction: Whilst prostate cancer is the fourth most common cancer globally, effective therapies for patients with advanced disease are lacking. In recent years, interest in using theranostic agents to treat castrate-resistant prostate cancer (CRPC) and metastatic prostate cancer has emerged. Lu-TLX591 monoclonal antibody is a potential agent of significance; however, to date, reports on its toxicity and efficacy have been limited to small clinical trials in heavily pretreated patients. This retrospective study describes the real-world toxicity and efficacy profile of Lu-TLX591.
Methods: Eighteen patients received Lu-TLX591 at two private oncology centres in Australia. Patients were eligible if they had CRPC or metastatic prostate cancer and prostate-specific membrane antigen (PSMA)-avid disease confirmed by PSMA-positron emission tomography (PET). Patients received two cycles of Lu-TLX591 monoclonal antibody (177 Lu-DOTA-rosopatamab) each dosed from 1.01-2.85 GBq, 14 days apart. Patient side effects, blood test results and radiology reports were recorded on the patient\u27s electronic medical record (eMR).
Results: Prominent side effects included fatigue (55.6%), anorexia (16.7%), nausea (11.1%), and transfusion reactions (11.1%). All-grade haematological toxicities included lymphopenia (61.1%), anaemia (22.2%), leukopenia (27.8%), neutropenia (27.8%), and thrombocytopenia (27.8%). Grade 4 toxicity included lymphopenia (6.7%) and thrombocytopenia (6.7%). Patients\u27 prostate-specific antigen (PSA) responses were as follows; ≥ 30% PSA decline (27.8%), ≥ 50% PSA decline (11.4%) and any PSA decline (38.9%). Follow-up radiology revealed 54.5% stable disease, 45.4% disease progression and 9.1% disease regression.
Conclusion: Lu-TLX591 was safely administered at acceptable toxicity and its efficacy reflects previous clinical trials. Larger studies are required and are underway (NCT04786847; NCT05146973; NCT04876651) to determine Lu-TLX591 effectiveness amongst different prostate cancer populations and compare its efficacy against peptide-based radiopharmaceutical agents
A feasibility, randomised controlled trial of Club Connect: a group-based healthy brain ageing cognitive training program for older adults with major depression within an older people\u27s mental health service
No full textBackground: Using the RE-AIM (reach, effectiveness, adoption, implementation, maintenance) framework, we outline steps taken to implement an evidence-based cognitive training program, Club Connect, in older adults with major depressive disorder in an Older People’s Mental Health Service in Sydney, Australia. The primary aim was to explore feasibility (or ‘reach’), tolerability (or ‘implementation’), and acceptability (or ‘adoption’). The secondary aim was to explore the most sensitive clinical outcomes and measurement tools (i.e. ‘effectiveness’) to inform a formal randomised controlled trial, and to explore the healthcare resources used (i.e. costs) to assist decision-making by health care managers and policy-makers in relation to future resource allocation.
Methods: Using a single blinded feasibility design, 40 participants (mean age: 76.13 years, SD: 7.45, range: 65–95 years) were randomised to either (a) Club Connect, a 10-week group-based multifaceted program, comprising psychoeducation and computer-based cognitive training, or (b) a waitlist control group.
Results: Implementing group-based cognitive training within a clinical setting was feasible, well tolerated and accepted by participants. Further, cognitive training, in comparison to the waiting list control, was associated with moderate to very large effect size improvements in depression, stress and inhibition (ηp2=0.115–0.209). We also found moderate effect size improvements on measures of daily functioning, wellbeing and cognitive flexibility. Small effect size improvements for other cognitive and psychosocial outcomes were also observed. The average cost per person participating in in the intervention was AU$607.50.
Conclusions: Our findings support the feasibility of implementing group-based cognitive training into a specialised clinical (public health) setting. This trial was registered on the Australian and New Zealand Clinical Trial Registry (ACTRN12619000195156, 12/02/2019)
Interpretative phenomenological analysis: Learnings from employing IPA as a qualitative methodology in educational research
No full textInterpretative Phenomenological Analysis (IPA) is an established qualitative methodology widely adopted within health-based research. However, one gap in the literature is that little has been written about IPA’s employability within educationally situated research. Our paper aims to demonstrate that IPA is a suitable methodology for education research. This paper has two parts. In the first part, the authors utilise the method of exegesis and theoretical analysis to explicate and provide clarity concerning the often misunderstood philosophical and theoretical background of IPA. In the second part, we advocate for IPA as a suitable option for qualitative research in educational contexts. To execute this advocacy, the authors present a specific example of qualitative research that successfully employed IPA as its methodological approach and system for analysis. We present the details of a research project that utilised IPA to explore spirituality in early childhood education contexts, and in doing so the authors illustrate how the theories and methods of IPA can be actualised, thus introducing IPA into education contexts in a coherent fashion. The overall aim of the paper is to affirm IPA as a viable qualitative approach for education researchers
TENDINopathy Severity assessment-Achilles (TENDINS-A): Evaluation of reliability and validity in accordance with COSMIN recommendations
No full textObjective: To evaluate the construct validity (structural validity and hypothesis testing), reliability (test–retest reliability, measurement error and internal consistency) and minimal important change (MIC) of the 13- item TENDINopathy Severity assessment–Achilles (TENDINS-A).
Methods: Participants with Achilles pain completed an online survey including: demographics, TENDINS-A, Foot and Ankle Outcome Score (FAOS) and Victorian Institute of Sport Assessment–Achilles (VISA-A). Exploratory factor analysis (EFA) assessed dimensionality. Confirmatory factor analysis (CFA) assessed structural validity (root mean square error of approximation (RMSEA); Comparative Fit Index (CFI); Tucker-Lewis Index (TLI); standardised root measure square (SRMS)). Correlations between TENDINS-A and the FAOS or VISA-A assessed hypothesis testing. Intraclass correlation (ICC) assessed test–retest reliability. Cronbach’s alpha assessed internal consistency. SE of the measurement (SEM) assessed measurement error. A distribution-based approach assessed MIC.
Results: 79 participants (51% female) with a mean (SD) age=42.6 (13.0) years, height=175.0 (11.7) cm and body mass=82.0 (19.1) kg were included. EFA identified three meaningful factors, proposed as pain, symptoms and function. The best model identified using CFA for TENDINS-A had structural validity (RMSEA=0.101, CFI=0.959, TLI=0.947, SRMS=0.068), which included three factors (pain, symptoms and function), but excluded three items from the original TENDINS-A. TENDINS-A exhibited moderate positive correlation with FAOS (r=0.598, p\u3c0.001) and a moderate negative correlation with VISA-A (r=−0.639, p\u3c0.001). Reliability of the TENDINS-A was excellent (ICC=0.930; Cronbach’s α=0.808; SEM=6.54 units), with an MIC of 12 units.
Conclusions: Our evaluation of the revised 10-item TENDINS-A determined it has construct validity and excellent reliability, compared with the VISA-A and FAOS which lack content and construct validity. The TENDINS-A is recommended as the preferred patient-reported outcome measure to assess disability in people with Achilles tendinopath
The effect of different motocross circuit typologies on internal load and external load responses in riders
No full textBackground: Several physical and physiological changes occur during a motocross race, mainly due to the type of circuits, and therefore the impact of different types of circuits on training load responses continues to need to be fully clarified.
Objective: The main aim of the present study was to compare the internal load and external load responses of motocross riders from different classes and on circuits of different types.
Method: A quasi experimental design research was used in the study.The sample consisted of 10 motocross riders (28.10 ± 7.53 years; 74.60 ± 9.70 kg; 176.50 ± 7.18 cm; 23.88 ± 2.18 BMI), male., distributed by the Mx Elite and Mx Hobby categories. The pilots were evaluated before and after the race in relation to indicators of external load (accelerations and decelerations, maximum speed and average speed and impacts) and internal load (Heart rate, blood lactate and rating of perceived exertion) on two circuits of different types.
Results: There was a trend towards higher internal load responses in the Mx Hobby class compared to the Mx Elite class (p ≤ 0.05), regardless of the circuit. Regarding external load responses, the Mx Hobby class has a tendency towards higher maximum and average speeds, while the Mx Elite class presents the same tendency for accelerations and decelerations. Conclusions: Different circuit types appear to influence pilots’ internal load and external load responses
Jesus, Nazareth and the Identity of Catholic Schools
Get PDFThe identity of Jesus of Nazareth is the foundation of the identity of Catholic schools. Often, assertions about the identity of Jesus in relation to Catholics schools are presented without reference to the biblical record. This article seeks to provide biblical context to discussions about the identity of Jesus of Nazareth. These contextual discussions about Jesus are designed to aid considerations of Catholic school identity. The specific focus of this article is a survey of contemporary literature on Jesus’ hometown—Nazareth. A focus on Nazareth does not reveal the whole story of Jesus; it offers one piece of the jigsaw revealing Jesus’ identity. The current surge in studies of biblical Nazareth and Galilee provides insights into key questions: Who was Jesus of Nazareth? What can be learned about his time and place? How do these new discoveries help us to re-create his life and teachings? Themes and issues are drawn from this survey of biblical literature on Nazareth. These themes are discussed in relation to reflections on Catholic school identity
Adrenal washout CT in patients with no history of cancer: a waste of time?
No full textPurpose: To validate the diagnostic performance of adrenal washout CT in patients without known malignancy in a Western Australian population.
Methods: A radiology information system (RIS) search for CT reports containing “adrenal” and “washout” across six networked metropolitan public hospitals between January 2005 and November 2021. Homogenous nodules≥1 cm,≥10 HU without a suspected functional component in patients without a history of malignancy were included. Reported absolute and relative washout percentages were recorded and re-measured from unenhanced, 60-s portal venous and 15-min delayed phase imaging and compared to either histopathological or CT follow up for growth (≥12 months) reference standards.
Results: 2653 studies were screened with 191 meeting inclusion criteria. 105 nodules underwent washout CT and then had either histopathological (12 patients) or CT follow up (93 patients) reference standards available. Reported absolute washout (aWO) estimated sensitivity and specifcity for malignant/indeterminate nodules was low at 33% (95% CI 25–43%) and 77% (95% CI 68–84%) respectively. Reported relative washout (rWO) sensitivity and specifcity were 56% (95% CI 46–65%) and 69% (95% CI 60–77%) respectively. Negative predictive values for both aWO and rWO were reassuring at 92% (95% CI 86–96%) and 94% (95%CI 88–97%).
Conclusion: Our study validates a recent report suggesting that adrenal washout has poor sensitivity for and consequent limited utility to exclude malignancy in patients with no cancer history. However, patients with incidental adrenal nodulesgrowt