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Informing the management of the post-COVID condition: Insights from the Western Australian experience comparing those who tested positive and negative to early COVID-19 strains
No full textObjective: This study aimed to compare the relative physical recovery and symptoms after SARS-CoV-2 infection between groups confirmed positive or negative to early strains of COVID-19.
Methods: A prospective, longitudinal cohort study compared outcomes of metropolitan adults polymerase chain reaction-tested for COVID-19 between March and November 2020 in Western Australia. Control matching was attempted: inpatients (gender, age) and ambulatory clinic (gender, age, asthma, chronic pulmonary disease). One-year follow-up involved three repeated measures: physical function (grip strength and 1-min sit-to-stand) and patient reported outcomes (Fatigue Severity Scale, modified Medical Research Council dyspnoea scale and Euroqol-5D-5L).
Results: Three hundred and forty-four participants were recruited (154 COVID+, age 54 ± 18 years, 75 females [49%]); 190 COVID−, age 52 ± 16 years, 67 females [35%]) prior to national vaccination roll-out. No between-group differences in physical function measures were evident at any time point. Fatigue (OR 6.62, 95% CI 2.74–15.97) and dyspnoea (OR 2.21, 95% CI 1.14–4.30) were higher in the COVID+ group at second assessment (T2). On Euroqol-5D-5L, no between-group differences were evident in the physical function domains of self-care, mobility or usual activities at any time point. However, COVID+ participants were less likely to report an absence of anxiety or depression symptoms at T2 (OR 0.41, 95% CI 0.19–0.89).
Conclusions: Neither statistical nor clinically meaningful differences in physical function were evident between COVID+ and COVID− participants to 12-months after acute illness. Symptoms of fatigue, dyspnoea, anxiety or depression were more prevalent in the COVID+ group til ~8 months after illness with between-group differences no longer evident at 1 year
The education and implementation of clinical reasoning education in post graduate emergency medicine training: An integrative review
No full textThe ability to clinically reason is a necessity for doctors to reduce the possibility of diagnostic error in patients. Emergency medicine doctors work in a highly active, challenging and, at times, cognitively formidable setting that can affect clinical reasoning. This review aims to study the literature on post-graduate training programs and how clinical reasoning education is incorporated. Methods: CINAHL, Embase and Medline were used to obtain relevant literature from 2010 to 2023. A review was undertaken of clinical reasoning curriculums and resources in medical and surgical specialties in Australia, New Zealand, USA, UK, Ireland and Canada. Results: 23 articles were included in the review. Educational themes to teach clinical reasoning were a) simulation b) technological and innovative methods, c) morning report, d) peer teaching, and e) curriculum related. Surgery, General practice, and Internal Medicine colleges appear to have embedded clinical reasoning courses and resources within their curriculum and training. Conclusion: Specialty colleges are recognising the importance of clinical reasoning and have incorporated formal curricula into their training. Teaching can occur at a college, hospital and departmental level using a variety of educational modalities that vary in the resources required and is a possible option for Emergency Medicine training
First Nations Children: Investigating Elements for a Successful Education Model
Get PDFThis study was undertaken at the request of and in collaboration with Aboriginal and Torres Strait Islander Elders, community members and families, and educators. These First Nations participants allowed the study to explore what might contribute to the creation of a successful model of education for First Nations children to lead them to be successful contributing members of the community.
The cultural interface theory is the theoretical framework used in the design of this research project. Through the implementation of the phenomenographic methodology, knowledge was gathered through semi-structured interviews with participants. By listening and questioning, a picture of the educational experiences of the First Nations participants was formed. This backdrop was the foundation from which participants provided their thoughts, beliefs and philosophies beyond the classroom and how they saw it as pivotal that these elements be included within classrooms in a model of successful education for First Nations children. A strength of this study is the inclusion of the voices of First Nations children living the education experience. Interviews with educators who have experience working with First Nations children provided a measure of triangulation.
Data analysis, following phenomenographic principles, resulted in there being four conceptions with 11 related themes that provided the basis for a model of education that would likely lead to success for First Nations children. While this study is limited to participants from Sydney, Australia, the model may prove helpful for others grappling with the best way to meet the educational needs of First Nations children.
Putting theory into practice, the thesis concludes with a description of the development of a ‘learning place’ for young First Nations children based on the model from the study. And this is just the beginning
‘Navigating tax and business challenges: Understanding the relationships and roles of business advisors and accountants in supporting Indigenous entrepreneurs\u27
Get PDFA research project is underway which focuses on how accountants and business advisors support Indigenous entrepreneurs with tax requirements as well as more broadly how accountants, business advisors and Indigenous entrepreneurs perceive the current tax system. As a result, the project team are investigating beyond tax-specific support, we are also interested in understanding how indigenous entrepreneurs engage with other business-related knowledge/skills, such as business planning, financing, marketing, etc. This seminar will provide an overview and preliminary results of field work undertaken among business advisors, accountants and their clients, some of which are operating in the Kimberly region. Data was collected in June-July 2024. With early findings indicating that Indigenous entrepreneurs are largely supported by non-Indigenous accountants who may not fully understand the cultural specificities of Indigenous people and the impact it has on their business choices. Ensuring that accountants are culturally sensitive could positively impact the overall accountant-client relationship. We aim at providing insights that are of relevance for a variety of stakeholders, including 1) Indigenous entrepreneurs understand how their perceptions and understanding of wealth accumulation and distribution of income impact on business decisions related to fiscal matters; 2) the ATO, improve policy and incentives that are more aligned with Indigenous entrepreneurs values and business practices and the development of a more culturally relevant and sensitive communication that better resonate with the Indigenous culture; 3) Our project will provide the accounting profession and its associations e.g. CPA and CA ANZ, with insights that could help tweaking the current accreditation system. For example, looking at the CA Program and even how the Mentored Practical Experience is delivered to integrate learning opportunities about challenges professionals encounter within Indigenous context. This research project was borne after an extensive consultation with colleagues, accountants and entrepreneurs (both Indigenous and non-Indigenous), and members of CPA, who highlighted a clear gap in knowledge and ability to support clients. The study involves myself in collaboration with Dr Mattia Anesa, Lecturer at the discipline of Strategy, Innovation and Entrepreneurship, The University of Sydney Business School and Dr Tarunna Sebastian, Lecturer at the Faculty of Arts and Social Sciences, The University of Sydney
“A qualitative study of multiple sclerosis specialists’ experiences and perspectives in managing family planning in people with multiple sclerosis”
No full textBackground: Managing multiple sclerosis (MS) in people of reproductive age can be challenging as treatment decisions often need to balance efficacy, safety to reproductive health and an understanding of reproductive intentions. There has been limited examination of how family planning (FP) is approached in people with MS (pwMS) in Australia. This study aimed to explore the experiences and perspectives of Australian MS clinical specialists on managing FP in the context of MS.
Methods: We conducted one-on-one semi-structured interviews with nine neurologists and ten MS nurses across Australia who regularly provide care to pwMS of reproductive age. Interview topics examined current approaches to managing FP, availability of FP resources, and opportunities for improvement. Interview recordings were transcribed verbatim and analysed thematically.
Results: Two main themes emerged. First, ‘inconsistent approaches in providing family planning’, where neurologists and MS nurses recognised FP provision as essential but revealed differences in the content, timing and extent of FP discussions; conflicts between reproductive considerations and DMT prescriptions according to teratogenic risk; and variable implementation of interdisciplinary approaches. Second, ‘barriers in providing family planning’ emerged which included a lack of local information resources on FP, lack of contemporary data on safety of DMTs, and a range of patient and professional factors, including time constraints.
Conclusion: MS clinical specialists saw FP as an essential part of the care of their patients and expressed a need for information and service provision consistency in order to improve FP and reproductive care to pwMS
The outcomes for women planning a VBAC at a private hospital in Australia
No full textBackground
Rates of cesarean birth (CBs) are steadily increasing and account for 36.7% of all births in New South Wales (NSW), with primary cesareans driving the increase. NSW Health guidelines recommend women attempt a vaginal birth after a previous CB (VBAC); however, rates of VBAC are decreasing, particularly within the private hospital setting. This study aimed to determine the rates of adverse outcomes for women who planned a VBAC (pVBAC) compared with women who planned an elective repeat CB (pERCB) at one private hospital in Sydney, Australia. Method
This retrospective data review evaluated patient records over a 10-year period (2010–2019). Records (n = 2039) were divided into four groups: pVBAC, pVBAC + EMCB, labor + ERCB (lab + ERCB), and pERCB. The incidence of adverse maternal and neonatal outcomes is reported as counts and percentages. Regression and chi-squared tests were used to compare groups. Significance was determined at a p-value of \u3c0.05. Results
Overall, very low rates (N = 148, 7.3%) of women had a VBAC compared with a repeat CB at this private hospital over the 10-year period. The incidence of adverse outcomes was low regardless of study group. Outcomes differed significantly between groups for postpartum hemorrhage (pERCB seven times less likely than VBAC group) and special care nursery admission (pVBAC + EMCB is 4.6 times more likely than in the VBAC group). Conclusion
Overall, it is safe to attempt a VBAC at this private hospital, and labor after a cesarean should be recommended, yet very few women had a VBAC at the study site. The incidence of adverse outcomes was low compared with other published research
Transoral robotic surgery-based therapy for HPV-related oropharyngeal squamous cell carcinoma
No full textBackground: Transoral robotic surgery (TORS) for the treatment of early human papillomavirus- related oropharyngeal squamous cell carcinoma (HPVOPSCC) is a well-established treatment modality. It requires a distinctive skill set from the head and neck surgeon to achieve optimal oncological and functional outcomes. The aim of this study is to demonstrate oncological outcomes of HPVOPSCC treated with TORS and guideline indicated adjuvant therapy.
Methods: A consecutive case series of adult patients with HPVOPSCC undergoing primary surgical treatment by a single fellowship trained robotic head and neck surgeon in Australia was performed. Adjuvant therapy (radiotherapy with or without chemotherapy) was delivered based on current guidelines. The primary outcomes were to determine complete resection of the primary tumour, locoregional recurrence, disease specific survival, and overall survival. The secondary outcomes were to determine complications; post-operative haemorrhage, salivary leak, and need for percutaneous gastrostomy (PEG) insertion.
Results: A total of 41 patients were assessed. Adjuvant therapy was indicated in 15 (36.6%) patients (radiotherapy: 14; chemoradiotherapy: 1). The follow-up was 51 [interquartile range (IQR) 24] months. The positive margin rate on histopathology analysis was 4.9% (n=2). The locoregional recurrence rate was4.9% (n=2). The disease-specific survival and overall survival rate was 100% at 3 years, and 95.1% at 5 years. TORS-related complications occurred in 5 patients (12.1%), of which 2 patients (4.9%) had a secondary haemorrhage, 1 patient (2.4%) had a salivary leak, and 2 patients (4.9%) required short-term PEG insertion.
Conclusions: TORS for the treatment of early stage HPVOPSCC can result in complete resection, low rates of recurrence, and acceptable complication profile
Protocol for the development and initial validation of the cog-impact tool: A purpose-built unmet needs assessment for cancer-related cognitive impairment
No full text(1) Background: A significant proportion of cancer survivors report experiencing a cognitive ‘fog’ that affects their ability to think coherently and quickly, and reason with clarity. This has been referred to as cancer-related cognitive impairment (CRCI). CRCI has extensive impacts on the daily lives of people living with or beyond cancer, including occupational, social, and psychological functioning. Oncology health professionals report feeling under-resourced to effectively assess the needs of an individual with CRCI and then provide optimal care and referral.
(2) Methods: The objective of this project is to develop and provide an initial validation of the first purpose-built unmet needs assessment for CRCI: the Unmet Needs Assessment of Cancer-Related Cognitive Impairment Impact (COG-IMPACT). We will use a multiple-stage, co-design, mixed-methods approach to develop and provide an initial validation of the COGIMPACT.
(3) Results: The primary anticipated result of this research is the production of the COG-IMPACT, the first purpose-built unmet needs assessment for CRCI. The assessment could be used by health professionals to understand the unmet needs and facilitate optimal care and referral for cancer survivors, by survivors to elucidate their supportive needs and advocate for their care, and by researchers to examine the correlates of unmet needs relating to CRCI, as well as how best to support people with CRCI