Background Commonly used sedatives/analgesics can increase the risk of postoperative complications, including delirium. This double-blinded study assessed the neurobehavioral, hemodynamic, and sedative characteristics of dexmedetomidine... more
Background Commonly used sedatives/analgesics can increase the risk of postoperative complications, including delirium. This double-blinded study assessed the neurobehavioral, hemodynamic, and sedative characteristics of dexmedetomidine compared with morphine-based regimen after cardiac surgery at equivalent levels of sedation and analgesia. Methods A total of 306 patients at least 60 yr old were randomized to receive dexmedetomidine (0.1-0.7 microg x kg(-1) x h(-1)) or morphine (10-70 microg x kg(-1) x h(-1)) with open-label propofol titrated to a target Motor Activity Assessment Scale of 2-4. Primary outcome was the prevalence of delirium measured daily via Confusion Assessment Method for intensive care. Secondary outcomes included ventilation time, additional sedation/analgesia, and hemodynamic and adverse effects. Results Of all sedation assessments, 75.2% of dexmedetomidine and 79.6% (P = 0.516) of morphine treatment were in the target range. Delirium incidence was comparable b...
Research Interests: Anesthesiology, Medicine, Cardiac Surgery, Delirium, Humans, and 15 moreINTENSIVE CARE, Female, Male, Anesthesia, Morphine, Clinical Sciences, Postoperative pain, Aged, Dexmedetomidine, Postoperative Complication, Intensive Care Units, Confidence Interval, Postoperative care, Motor activity, and Adverse effect
Research Interests: Health Care, Health Education, Life Sciences, Physical Activity, Health, and 15 moreMedicine, Physical Therapy, Psychological Intervention, Care, Social and Behavioral Sciences, Physical, Arts and Humanities, CAN, Activity, Facility, Curriculum and Pedagogy, Australian, Signs, Medicine and Health Sciences, and Motivational
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Research Interests: Australia, Medicine, Applied Economics, Humans, Female, and 14 moreMale, Public Policy and Administration, Infant, Ethnic Groups, Parents, Questionnaires, Longitudinal Studies, Public health systems and services research, Communication barriers, Logistic Models, Child Health Services, Socioeconomic Factors, Health Services Accessibility, and healthcare disparities
... ity findings may have been influenced by unmeasured confounding.1 The one point that we clearly agree with Hillman and col-leagues ... Author Affiliations: Department of Internal Medicine, Mid-America Heart Institute at St... more
... ity findings may have been influenced by unmeasured confounding.1 The one point that we clearly agree with Hillman and col-leagues ... Author Affiliations: Department of Internal Medicine, Mid-America Heart Institute at St Luke's Hospital, Uni-versity of MissouriKansas City (Dr ...
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Background The most effective and efficient model for providing organized stroke care remains uncertain. This study aimed to compare the effect of two models in a randomized controlled trial. Methods Patients with acute stroke were... more
Background The most effective and efficient model for providing organized stroke care remains uncertain. This study aimed to compare the effect of two models in a randomized controlled trial. Methods Patients with acute stroke were randomized on day one of admission to combined, co-located acute/rehabilitation stroke care or traditionally separated acute/rehabilitation stroke care. Outcomes measured at baseline and 90 days post-discharge included functional independence measure, length of hospital stay, and functional independence measure efficiency (change in functional independence measure score ÷ total length of hospital stay). Results Among 41 patients randomized, 20 were allocated co-located acute/rehabilitation stroke care and 21 traditionally separated acute/rehabilitation stroke care. Baseline measurements showed no significant difference. There was no significant difference in functional independence measure scores between the two groups at discharge and again at 90 days po...
Research Interests: Nursing, Medicine, Stroke, Humans, Health service management, and 15 moreFemale, Male, Follow-up studies, Length of Stay, Clinical Sciences, Aged, Middle Aged, Time Factors, Randomized Controlled Trial, Retrospective Studies, Rehabilitation Centers, Neurosciences, Disability Evaluation, Delivery of Health Care, and Outcome assessment (Health care)
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OBJECTIVE: To examine NFR orders in relation to adverse events and emergency team calls in hospitals with or without a Medical Emergency Team (MET) system during the MERIT study. METHOD: Within a cluster randomized controlled trial (the... more
OBJECTIVE: To examine NFR orders in relation to adverse events and emergency team calls in hospitals with or without a Medical Emergency Team (MET) system during the MERIT study. METHOD: Within a cluster randomized controlled trial (the MERIT study), ...
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There is some evidence that adult separation anxiety disorder (ASAD) symptoms are closely associated with posttraumatic stress disorder (PTSD) amongst refugees exposed to traumatic events (TEs), but the pathways involved remain to be... more
There is some evidence that adult separation anxiety disorder (ASAD) symptoms are closely associated with posttraumatic stress disorder (PTSD) amongst refugees exposed to traumatic events (TEs), but the pathways involved remain to be elucidated. A recent study suggests that separation anxiety disorder precedes and predicts onset of PTSD. We examined a path model testing whether ASAD symptoms and worry about family mediated the path from traumatic losses to PTSD symptoms amongst 230 refugees from West Papua. Culturally adapted measures were applied to assess TE exposure and symptoms of ASAD and PTSD. A structural equation model indicated that ASAD symptoms played an important role in mediating the effects of traumatic losses and worry about family in the pathway to PTSD symptoms. Although based on cross-sectional data, our findings suggest that ASAD symptoms may play a role in the path from traumatic losses to PTSD amongst refugees. We propose an evolutionary model in which the ASAD and PTSD reactions represent complementary survival responses designed to protect the individual and close attachments from external threats.
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Documentation is limited in relation to the mental health of the people of West Papua, a territory that has been exposed to decades-long political persecution. We examined associations of traumatic events (TEs) and current stressors with... more
Documentation is limited in relation to the mental health of the people of West Papua, a territory that has been exposed to decades-long political persecution. We examined associations of traumatic events (TEs) and current stressors with mental disorder and functioning, amongst 230 West Papuan refugees residing in six settlements in Port Morseby, Papua New Guinea (PNG). We used culturally adapted modules to assess exposure to TEs and mental disorders. Current stressors and functioning were assessed using modifications of measures developed by the World Health Organization (WHO). 129 of 230 respondents (56%) reported exposure to at least one traumatic event (TE), including: political upheaval (36.5%), witnessing or hearing about family members tortured and murdered (33.9%), and not being able to access medical care for family members (33%). One fifth of respondents (47, 20.4%) experienced exposure to high levels of TEs (16 to 23). 211 (91.7%) endorsed at least one or more ongoing str...
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The validity of applying the construct of post-traumatic stress disorder (PTSD) across cultures has been the subject of contention. Although PTSD symptoms have been identified across multiple cultures, questions remain whether the... more
The validity of applying the construct of post-traumatic stress disorder (PTSD) across cultures has been the subject of contention. Although PTSD symptoms have been identified across multiple cultures, questions remain whether the constellation represents a coherent construct with an interpretable factor structure across diverse populations, especially those naïve to western notions of mental disorder. An important additional question is whether a constellation of Complex-PTSD (C-PTSD) can be identified and if so, whether there are distinctions between that disorder and core PTSD in patterns of antecedent traumatic events. Our study amongst West Papuan refugees in Papua New Guinea (PNG) aimed to examine the factorial structure of PTSD based on the DSM-IV, DSM-5, ICD-10 and ICD-11 definitions, and C-PTSD according to proposed ICD-11 criteria. We also investigated domains of traumatic events (TEs) and broader psychosocial effects of conflict (sense of safety and injustice) associated ...
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We compared the Health Utility Index (HUI), EuroQol (EQ-5D) and time trade-off methods to identify the most suitable technique for collecting preference data in a clinical trial of patients with benign prostatic hyperplasia (BPH). A total... more
We compared the Health Utility Index (HUI), EuroQol (EQ-5D) and time trade-off methods to identify the most suitable technique for collecting preference data in a clinical trial of patients with benign prostatic hyperplasia (BPH). A total of 29 men with symptomatic BPH were interviewed by a single trained interviewer who collected demographic data and administered EQ-5D and time trade-off questionnaires. Participants self-administered the HUI and a symptom severity index, the International Prostate Symptom Score (I-PSS) questionnaire. Utility values for current patient health states obtained from the HUI, EQ-5D and time trade-off questionnaires were compared and their relationship with I-PSS data was examined using Spearman's correlation coefficients. Administration time and patient assessments of the relevance of the questions were also compared for the 3 methods. Although mean utility values for HUI, EQ-5D and 1-year time trade-off were similar, only utility values elicited using time trade-off with a 1-year time frame significantly correlated with symptom scores. The 1 and 10-year time trade-off derived values were reasonable predictors of the I-PSS with multiple correlation coefficient values of 0.379 and 0.265, respectively. All participants indicated that the HUI and EQ-5D were appropriate for assessing BPH, while approximately 10% considered time trade-off questions irrelevant. Average completion time for the HUI, time trade-off and EQ-5D questionnaires was 31, 25 and 10 minutes, respectively. Because only time trade-off resulted in utility values that significantly correlated with symptom scores, we recommend its use for estimating utility in clinical trials of BPH.
Research Interests: Quality of life, Treatment, Treatment Outcome, Comparative Study, Humans, and 15 moreQuestionnaire, Male, Patient Satisfaction, The, Patient Preference, Clinical Sciences, Aged, Middle Aged, Questionnaires, Adult, Patient Participation, Benign Prostate Hyperplasia, Postoperative Complications, Clinical Trials as Topic, and Sickness Impact Profile
Cooling of recently amputated digits is recommended to preserve tissue pending reimplantation. Although many methods are describe for cooling digits, it is unknown which method is optimal. Six methods were compared in which fresh chicken... more
Cooling of recently amputated digits is recommended to preserve tissue pending reimplantation. Although many methods are describe for cooling digits, it is unknown which method is optimal. Six methods were compared in which fresh chicken feet were wrapped in saline-soaked gauze, placed in a plastic bag or a specimen jar, and then placed in a fixed quantity of ice and water in one of a plastic bag, kidney dish, or sealed plastic container. Serial measurements were made of the (1) tissue temperature and (2) point at which ice in the solution was no longer visible. Each method was repeated 12 times, resulting in 72 sets of measurements. There was a significant variation in the time each method took to reach the target tissue temperature (p < 0.001) and the duration that the tissue was kept within the target temperature range (p < 0.001). Of the six methods tested, placing the chicken foot into a specimen jar and subsequently placing this into a specimen bag containing ice and water kept the tissue within the target temperature range (4 degrees C +/- 2 degrees C) for the longest duration [225.8 minutes, 95% confidence intervals (CI), 201.5-250.1]. The Bag-in-kidney dish method performed worst, with the slowest time to reach target temperature (58.0 minutes, 95%CI, 46.0-70.0) and the shortest duration at this temperature (62.0 minutes, 95%CI, 46.3-77.7). Of the six methods examined, the best method for achieving a target temperature of 4 degrees C +/- 2 degrees C is by wrapping the tissue in saline-soaked gauze, placing it in a specimen jar and placing this into a specimen bag that contains ice and water.
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OBJECTIVE: The potential of the medical emergency team (MET) system to reduce adverse events may depend on the effectiveness of its implementation. We aimed to evaluate the effectiveness of the implementation of the MET system during the... more
OBJECTIVE: The potential of the medical emergency team (MET) system to reduce adverse events may depend on the effectiveness of its implementation. We aimed to evaluate the effectiveness of the implementation of the MET system during the MERIT (Medical Early ...
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This review outlines the way the specialty of intensive care has expanded over the last decade in response to the changing population of hospital patients, being older with more comorbidities and having more complex interventions. The... more
This review outlines the way the specialty of intensive care has expanded over the last decade in response to the changing population of hospital patients, being older with more comorbidities and having more complex interventions. The previous disjointed professional and geographical silos, providing patient care, are being challenged and a more patient focussed continuum of care is replacing it. There have been many reports over the last few years, describing patient centred systems, constructed around the needs of the seriously ill, at-risk patient, including trauma systems and Medical Emergency Team-type systems. There is now general agreement that in most settings these systems are responsible for a significant reduction in mortality and serious adverse events such as cardiac arrest rates. The implications for the move towards systems to improve patient outcome and decrease mortality in hospitals are having a significant impact on the way we practise medicine, resulting in an em...