ResearchOnline@ND (University of Notre Dame)
Not a member yet
7734 research outputs found
Sort by
Comparison of contralateral ACL rupture versus ACL graft rupture in Australian netballers after ACL reconstruction
No full textBackground: Netball is a popular sport worldwide, particularly for women. However, its nature puts players at high risk for anterior cruciate ligament (ACL) injury.
Purpose: To determine (1) the prevalence of ACL graft rupture and contralateral ACL (CACL) rupture in Australian female netballers after ACL reconstruction (ACLR) and (2) the rate of return to sports (RTS) and psychological readiness.
Study Design: Cohort study; Level of evidence, 3.
Methods: A patient database identified 332 consecutive female netball players who underwent ACLR with hamstring tendon autografts performed by 2 surgeons between 2007 and 2015. Patients were retrospectively surveyed at a minimum of 7 years postoperatively—including details of a second ACL injury to either knee, RTS, and psychological readiness per the ACL–Return to Sport After Injury (ACL-RSI) score. Multivariate regression assessed the association between selected variables and repeat ACL injury.
Results: A total of 267 patients (80%) were included with a mean follow-up of 8.4 years (range, 7-15 years). ACL graft rupture and CACL rupture occurred in 11 (4%) and 27 (10%) patients, respectively, at 7 years postoperatively. The ACL graft had a survival rate of 99%, 97%, 97%, and 96% at 1, 2, 5, and 7 years after surgery, respectively. The native CACL had a survival rate of 100%, 99%, 94%, and 90% at 1, 2, 5, and 7 years, respectively. Adolescents had a 4.5 times greater hazard for ACL graft rupture (95% CI, 1.4-14.6; P = .014) and a 2.5 times greater hazard for CACL rupture (95% CI, 1.2-5.5; P = .021) compared with adults. CACL injury was also associated with a return to level 1—including jumping, hard pivoting, and cutting—sports (hazard ratio, 10.3 [95% CI, 1.4-77.1]; P = .023). Most (62%) participants returned to netball, with those with higher ACLRSI scores more likely to RTS.
Conclusion: The prevalence of repeat ACL injury was higher in the contralateral knee (10%) than the ACL-reconstructed knee (4%) at 7 years postoperatively. ACLR was a suitable option for female netballers who sustained an ACL rupture with low long-term rates of graft rupture. Repeat ACL injuries to either knee were more common in adolescents and those who returned to cutting and pivoting sports
Implementation of home-schooling: Parents\u27 practices and processes
No full textWith increasing numbers of parents choosing to home-school their child, currently there is very limited information about how this is implemented. Utilizing the recently developed Parents’ Perceptions of Home-Schooling scale (PPHS), a survey of 93 home-schooling parents in Western Australia was undertaken. Data were collected using five Likert scales to obtain information concerned with a range of implementation aspects. Key findings were related to the process for registering and providing an appropriate learning program, the role of the home-educator moderator, the type of study and support utilized, and whether the student had a disability or ALNs. The discussion considers links to inclusion and how the heightened uptake of home-schooling can be monitored effectively
The psychophysiology of music-based interventions and the experience of pain
No full textIn modern times there is increasing acceptance that music-based interventions are useful aids in the clinical treatment of a range of neurological and psychiatric conditions, including helping to reduce the perception of pain. Indeed, the belief that music, whether listening or performing, can alter human pain experiences has a long history, dating back to the ancient Greeks, and its potential healing properties have long been appreciated by indigenous cultures around the world. The subjective experience of acute or chronic pain is complex, influenced by many intersecting physiological and psychological factors, and it is therefore to be expected that the impact of music therapy on the pain experience may vary from one situation to another, and from one person to another. Where pain persists and becomes chronic, aberrant central processing is a key feature associated with the ongoing pain experience. Nonetheless, beneficial effects of exposure to music on pain relief have been reported across a wide range of acute and chronic conditions, and it has been shown to be effective in neonates, children and adults. In this comprehensive review we examine the various neurochemical, physiological and psychological factors that underpin the impact of music on the pain experience, factors that potentially operate at many levels – the periphery, spinal cord, brainstem, limbic system and multiple areas of cerebral cortex. We discuss the extent to which these factors, individually or in combination, influence how music affects both the quality and intensity of pain, noting that there remains controversy about the respective roles that diverse central and peripheral processes play in this experience. Better understanding of the mechanisms that underlie music’s impact on pain perception together with insights into central processing of pain should aid in developing more effective synergistic approaches when music therapy is combined with clinical treatments. The ubiquitous nature of music also facilitates application from the therapeutic environment into daily life, for ongoing individual and social benefit
Mahmud
No full textSummary: The efect of deprivation on total bone health status has not been well defned. We examined the relationship between socioeconomic deprivation and poor bone health and falls and we found a significant association. The finding could be beneficial for current public health strategies to minimise disparities in bone health.
Purpose: Socioeconomic deprivation is associated with many illnesses including increased fracture incidence in older people. However, the efect of deprivation on total bone health status has not been well defned. To examine the relationship between socioeconomic deprivation and poor bone health and falls, we conducted a cross-sectional study using baseline measures from the United Kingdom (UK) Biobank cohort comprising 502,682 participants aged 40–69 years at recruitment during 2006–2010.
Method: We examined four outcomes: 1) low bone mineral density/osteopenia, 2) fall in last year, 3) fracture in the last five years, and 4) fracture from a simple fall in the last five years. To measure socioeconomic deprivation, we used the Townsend index of the participant’s residential postcode.
Results: At baseline, 29% of participants had low bone density (T-score of heel\u3c-1 standard deviation), 20% reported a fall in the previous year, and 10% reported a fracture in the previous five years. Among participants experiencing a fracture, 60% reported the cause as a simple fall. In the multivariable logistic regression model after controlling for other covariates, the odds of a fall, fracture in the last fve years, fractures from simple fall, and osteopenia were respectively 1.46 times (95% confidence interval [CI] 1.42–1.49), 1.26 times (95% CI 1.22–1.30), 1.31 times (95% CI 1.26–1.36) and 1.16 times (95% CI 1.13–1.19) higher for the most deprived compared with the least deprived quantile.
Conclusion: Socioeconomic deprivation was significantly associated with poor bone health and falls. This research could be beneficial to minimise social disparities in bone health
Serum and tissue metallome of pancreatic ductal adenocarcinoma
No full textPancreatic ductal adenocarcinoma (PDAC) patients have late presentation at the time of diagnosis and a poor prognosis. Metal dyshomeostasis is known to play a role in cancer progression. However, the blood and tissue metallome of PDAC patients has not been assessed. This study aimed to determine the levels of essential and toxic metals in the serum and pancreatic tissue from PDAC patients. Serum samples were obtained from PDAC patients before surgical resection. Tissue (tumor and adjacent normal pancreas) were obtained from the surgically resected specimen. Inductively coupled plasma–mass spectrometry (ICP-MS) analysis was performed to quantify the levels of 10 essential and 3 toxic metals in these samples. Statistical analysis was performed to identify dysregulated metals in PDAC and their role as potential diagnostic and prognostic biomarkers. Significantly decreased serum levels of magnesium, potassium, calcium, iron, zinc, selenium, arsenic, and mercury and increased levels of molybdenum were shown to be associated with PDAC. There were significantly decreased levels of zinc, manganese and molybdenum, and increased levels of calcium and selenium in the pancreatic tumor tissue compared with the adjacent normal pancreas. Notably, lower serum levels of calcium, iron, and selenium, and higher levels of manganese, were significantly associated with a poor prognosis (i.e., overall survival) in PDAC patients. In conclusion, this is the first study to comprehensively assess the serum and tissue metallome of PDAC patients. It identified the association of metals with PDAC diagnosis and prognosis
Methadone versus other opioids for refractory malignant bone pain: A pilot randomised controlled study
No full textPurpose: Refractory cancer-induced bone pain (CIBP) affects a patient’s functional capacity and quality of life, but there is limited evidence to guide opioid choice. We assessed the feasibility, tolerability and possible efcacy of methadone rotation (MR) compared to other opioid rotations (OOR) in this cohort.
Methods: Adults with CIBP and worst pain intensity≥4/10 and/or opioid toxicity graded≥2 on the Common Terminology Criteria for Adverse Events were randomised 1:1 to methadone or another opioid rotation. Standardised assessment tools were used at pre-defined study time points up to 14 days.
Results: Of 51 eligible participants, 38 (74.5%) consented, and 29 (76.3%, MR: 14, OOR: 15) completed the fourteen days follow-up post-opioid rotation. Both groups displayed signifcant reduction in average (MR: d= −1.2, p=0.003, OOR: d= −0.8, p=0.015) and worst pain (MR: d= −0.9, p=0.042, OOR: d= −0.6, p=0.048) and total pain interference score (MR: d= −1.1, p=0.042, OOR: d= −0.7, p=0.007). Oral morphine equivalent daily dose was reduced signifcantly in MR compared to the OOR group (d= −0.8, p=0.05). The incidence of opioid-related adverse events following MR was unchanged but lower in the OOR group (d=0.9, 95% CI 0.1,1.7, p=0.022). There were no within-group or between-group differences in satisfaction with analgesia at the end of the study.
Conclusion: This pilot study demonstrated that MR and OOR in patients with refractory CIBP are feasible, safe and acceptable to patients. Appropriately powered multi-centre randomised controlled studies are needed to confirm the efficacy of MR and OOR in this cohort.
Trial registration: ACTRN12621000141842 registered 11 February 2021
Does a peer review group consensus process for MR-Linac patients affect clinical care? Evaluation of impact and feasibility
No full textBackground and purpose: Peer review is an important component of quality assurance in radiotherapy. To our knowledge, there are no studies reporting on the feasibility and outcomes of the peer review process for magnetic resonance (MR) guided radiotherapy (MRgRT) on the MR linear accelerator (MR-Linac) despite the planning complexity involved and its evolving clinical indications. This study aimed to quantify the rate of change in treatment plans post-peer review and the time and resources required.
Materials and methods: Fifty-five cases presented at weekly MR-Linac peer review meetings across two centres from 8 June to 21 September 2023 were prospectively collected. Cases were analysed to determine the rate and extent of plan changes based on the Peer Review Audit Tool for radiation oncology (PRAT) developed by the Royal Australian and New Zealand College of Radiologists (RANZCR).
Results: Peer review resulted in changes to 36.4 % of treatment plans (n = 20), with 3.6 % (n = 2) having major changes requiring deferment of treatment. The most frequent changes were to organs at risk (OAR) volumes involving both delineation and increased OAR sparing (16.4 %, n = 9), total dose and fractionation (10.9 %, n = 6) and target volume dose coverage (5.5 %, n = 3). Patients with SBRT plans (39.1 % cf 22.2 %), oligometastatic/ oligoprogressive sites (38.1 % cf 30.7 %) and reirradiation cases (41.2 % cf 34.2 %) had higher rates of change. Cases took a mean of 7 min (range 2–15 minutes) to discuss.
Conclusion: The high rates of plan changes support the value of peer review in MRgRT. We recommend, where possible that all MRgRT cases, particularly those involving SBRT plans, oligometastatic/oligoprogressive sites, and/or reirradiation, be subject to peer revie
Gender diversity in radiology: Shedding light on the 256 shades of grey
No full textIntroduction: Despite medical school cohorts being composed of approximately 50% men and women, trainee positions in Clinical Radiology remain predominantly occupied by men. This study aims to identify reasons behind the gender gap, explore why more women are not pursuing a career in Clinical Radiology and to assess if there are gender differences in these reasons.
Methods: Prospective multi-centre study using a voluntary, anonymous questionnaire aimed at senior Medical Students and Junior Doctors.
Results: A total of 318 participants responded to the questionnaire - 197 women (61.9%), 114 men (35.8%), 4 non-binary (1.3%), 2 preferred not to answer gender (0.6%), 1 I/they (0.3%). The most common reasons for not considering Clinical Radiology as a specialty include \u27perceived limited patient contact\u27 (62%), \u27never/rarely exposed to it\u27 (59%) and \u27too lonely\u27 (49%). Reasons with the largest gender discrepancies were \u27too technology heavy\u27 and \u27limited patient contact\u27, both cited more frequently by women. Most respondents indicated that their opinions of Clinical Radiology may change with more exposure during medical school, more patient contact and more mentorship.
Conclusion: This study has revealed multiple reasons why women may not pursue specialty training in Clinical Radiology. Notable differences were found in the reasonings provided by men and women. Limited Clinical Radiology exposure and mentorship in medical school result in a lack of interest in this specialty as a career option. A proposed solution is to offer more medical school lectures and more junior doctor rotations to debunk stereotypes that may be negatively impacting opinions on Clinical Radiology. More mentorship of Medical Students and Junior Doctors, particularly from women, may also help decrease the gender gap
The Australian Traumatic Brain Injury Initiative: Systematic review and consensus process to determine the predictive value of demographic, injury event, and social characteristics on outcomes for people with moderate-severe traumatic brain injury
No full textThe objective of the Australian Traumatic Brain Injury (AUS-TBI) Initiative is to develop a data dictionary to inform data collection and facilitate prediction of outcomes of people who experience moderate-severe TBI in Australia. The aim of this systematic review was to summarize the evidence of the association between demographic, injury event, and social characteristics with outcomes, in people with moderate-severe TBI, to identify potentially predictive indicators. Standardized searches were implemented across bibliographic databases to March 31, 2022. English-language reports, excluding case series, which evaluated the association between demographic, injury event, and social characteristics, and any clinical outcome in at least 10 patients with moderate-severe TBI were included. Abstracts and full text records were independently screened by at least two reviewers in Covidence. A pre-defined algorithm was used to assign a judgement of predictive value to each observed association. The review findings were discussed with an expert panel to determine the feasibility of incorporation of routine measurement into standard care. The search strategy retrieved 16,685 records; 867 full-length records were screened, and 111 studies included. Twenty-two predictors of 32 different outcomes were identified; 7 were classified as high-level (age, sex, ethnicity, employment, insurance, education, and living situation at the time of injury). After discussion with an expert consensus group, 15 were recommended for inclusion in the data dictionary. This review identified numerous predictors capable of enabling early identification of those at risk for poor outcomes and improved personalization of care through inclusion in routine data collection
The Australian Traumatic Brain Injury Initiative: Single data dictionary to predict outcome for people with moderate-severe traumatic brain injury
No full textIn this series of eight articles, the Australian Traumatic Brain Injury Initiative (AUS-TBI) consortium describes the Australian approach used to select the common data elements collected acutely that have been shown to predict outcome following moderate-severe traumatic brain injury (TBI) across the lifespan. This article presents the unified single data dictionary, together with additional measures chosen to facilitate comparative effectiveness research and data linkage. Consultations with the AUS-TBI Lived Experience Expert Group provided insights on the merits and considerations regarding data elements for some of the study areas, as well as more general principles to guide the collection of data and the selection of meaningful measures. These are presented as a series of guiding principles and themes. The AUS-TBI Aboriginal and Torres Strait Islander Advisory Group identified a number of key points and considerations for the project approach specific to Aboriginal and Torres Strait Islander peoples, including key issues of data sovereignty and community involvement. These are outlined in the form of principles to guide selection of appropriate methodologies, data management, and governance. Implementation of the AUS-TBI approach aims to maximize ongoing data collection and linkage, to facilitate personalization of care and improved outcomes for people who experience moderate-severe TBI