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Extending ICPC-2 PLUS terminology to develop a classification system specific for the study of chiropractic encounters

- Charity, Melanie, French, Simon, Forsdike, Kirsty, Britt, Helena, Polus, Bolus, Gunn, Jane

  • Authors: Charity, Melanie , French, Simon , Forsdike, Kirsty , Britt, Helena , Polus, Bolus , Gunn, Jane
  • Date: 2013
  • Type: Text , Journal article
  • Relation: Chiropractic and Manual Therapies Vol. 21, no. 1 (2013), p.1-10
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  • Description: Background: Typically a large amount of information is collected during healthcare research and this information needs to be organised in a way that will make it manageable and to facilitate clear reporting. The Chiropractic Observation and Analysis STudy (COAST) was a cross sectional observational study that described the clinical practices of chiropractors in Victoria, Australia. To code chiropractic encounters COAST used the International Classification of Primary Care (ICPC-2) with the PLUS general practice clinical terminology to code chiropractic encounters. This paper describes the process by which a chiropractic-profession specific terminology was developed for use in research by expanding the current ICPC-2 PLUS system.Methods: The coder referred to the ICPC-2 PLUS system when coding chiropractor recorded encounter details (reasons for encounter, diagnoses/problems and processes of care). The coder used rules and conventions supplied by the Family Medicine Research Unit at the University of Sydney, the developers of the PLUS system. New chiropractic specific terms and codes were created when a relevant term was not available in ICPC-2 PLUS.Results: Information was collected from 52 chiropractors who documented 4,464 chiropractor-patient encounters. During the study, 6,225 reasons for encounter and 6,491 diagnoses/problems were documented, coded and analysed; 169 new chiropractic specific terms were added to the ICPC-2 PLUS terminology list. Most new terms were allocated to diagnoses/problems, with reasons for encounter generally well covered in the original ICPC 2 PLUS terminology: 3,074 of the 6,491 (47%) diagnoses/problems and 274 of the 6,225 (4%) reasons for encounter recorded during encounters were coded to a new term. Twenty nine new terms (17%) represented chiropractic processes of care.Conclusion: While existing ICPC-2 PLUS terminology could not fully represent chiropractic practice, adding terms specific to chiropractic enabled coding of a large number of chiropractic encounters at the desired level. Further, the new system attempted to record the diversity among chiropractic encounters while enabling generalisation for reporting where required. COAST is ongoing, and as such, any further encounters received from chiropractors will enable addition and refinement of ICPC-2 PLUS (Chiro). More research is needed into the diagnosis/problem descriptions used by chiropractors. © 2013 Charity et al.; licensee BioMed Central Ltd.

Testing the NKT cell hypothesis in lenalidomide-treated myelodysplastic syndrome patients

- Chan, Angela, Neeson, Paul, Leeansyah, Edwin, Tainton, K., Quach, Hang, Prince, Henry, Godfrey, Dale, Ritchie, David, Berzins, Stuart

  • Authors: Chan, Angela , Neeson, Paul , Leeansyah, Edwin , Tainton, K. , Quach, Hang , Prince, Henry , Godfrey, Dale , Ritchie, David , Berzins, Stuart
  • Date: 2010
  • Type: Text , Journal article
  • Relation: Leukemia Vol. 24, no. 3 (2010), p. 592-600
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  • Description: Myelodysplastic syndrome (MDS) comprises a group of clonal bone marrow disorders characterized by ineffective hematopoiesis and increased predisposition to acute myeloid leukemia. The causes of MDS remain poorly defined, but several studies have reported the NKT cell compartment of patients with MDS is deficient in number and functionally defective. In support of a central role for NKT cells, a pilot clinical study reported that lenalidomide (an approved treatment for MDS) increased NKT cell numbers in patients with MDS, and several in vitro studies showed lenalidomide specifically promoted NKT cell proliferation and cytokine production. We tested this in a much larger study and confirm a moderate in vitro augmentation of some NKT cell functions by lenalidomide, but find no impact on the NKT cell compartment of patients treated with lenalidomide, despite a consistently positive clinical response. We further show that the frequency and cytokine production of NKT cells is normal in patients with MDS before treatment and remains stable throughout 10 months of lenalidomide therapy. Collectively, our data challenge the concept that NKT cell defects contribute to the development of MDS, and show that a clinical response to lenalidomide is not dependent on modulation of NKT cell frequency or function. © 2010 Macmillan Publishers Limited All rights reserved.

Chiropractic Observation and Analysis Study (COAST): Providing an understanding of current chiropractic practice

- French, Simon, Charity, Melanie, Forsdike, Kirsty, Gunn, Jane, Polus, Barbara, Walker, Bruce, Chondros, Patty, Britt, Helena

  • Authors: French, Simon , Charity, Melanie , Forsdike, Kirsty , Gunn, Jane , Polus, Barbara , Walker, Bruce , Chondros, Patty , Britt, Helena
  • Date: 2013
  • Type: Text , Journal article
  • Relation: Medical Journal of Australia Vol. 199, no. 10 (2013), p. 687-691
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  • Description: Objectives: COAST (Chiropractic Observation and Analysis Study) aimed to describe the clinical practices of chiropractors in Victoria, Australia. Design: Cross-sectional study using the BEACH (Bettering the Evaluation and Care of Health) methods for general practice. Setting and participants: 180 chiropractors in active clinical practice in Victoria were randomly selected from the list of 1298 chiropractors registered on Chiropractors Registration Board of Victoria. Twenty-four chiropractors were ineligible, 72 agreed to participate, and 52 completed the study. Main outcome measures: Each participating chiropractor documented encounters with up to 100 consecutive patients. For each chiropractor-patient encounter, information collected included patient health profile, patient reasons for encounter, problems and diagnoses, and chiropractic care. Results: Data were collected on 4464 chiropractor-patient encounters from 52 chiropractors between 11 December 2010 and 28 September 2012. In most (71%) encounters, patients were aged 25-64 years; 1% of encounters were with infants (age < 1 year; 95% CI, 0.3%-3.2%). Musculoskeletal reasons for encounter were described by patients at a rate of 60 per 100 encounters (95% CI, 54-67 encounters) and maintenance and wellness or check-up reasons were described at a rate of 39 per 100 encounters (95% CI, 33-47 encounters). Back problems were managed at a rate of 62 per 100 encounters (95% CI, 55-71 encounters). The most frequent care provided by the chiropractors was spinal manipulative therapy and massage. Conclusions: A range of conditions are managed by chiropractors in Victoria, Australia, but most commonly these conditions are musculoskeletal-related. These results can be used by stakeholders of the chiropractic profession in workforce development, education and health care policy.

A therapist-assisted cognitive behavior therapy internet intervention for posttraumatic stress disorder: Pre-, post- and 3-month follow-up results from an open trial

- Klein, Britt, Mitchell, Joanna, Abbott, Jo-Anne, Shandley, Kerrie, Austin, David, Gilson, Kathryn, Kiropoulos, Litza, Cannard, Gwenda, Redman, Tomi

  • Authors: Klein, Britt , Mitchell, Joanna , Abbott, Jo-Anne , Shandley, Kerrie , Austin, David , Gilson, Kathryn , Kiropoulos, Litza , Cannard, Gwenda , Redman, Tomi
  • Date: 2010
  • Type: Text , Journal article
  • Relation: Journal of Anxiety Disorders Vol. 24, no. 6 (2010), p. 635-644
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  • Description: This study was an open trial evaluation of a 10-week therapist-assisted cognitive behavior therapy (CBT) internet intervention (PTSD Online) undertaken with people with a primary clinical diagnosis of posttraumatic stress disorder (PTSD) (n= 22) at pre-assessment. Participants were re-assessed at post-assessment and 3-month follow-up. Significant improvements on PTSD severity ratings and related PTSD symptomatology were observed at post-assessment and maintained at 3-month follow-up. At post-assessment, 69.2% of the sample showed clinically significant improvement and 77% of the sample at follow-up assessment. Non-significant, yet improved, change was observed on all other general psychological measures. Overall, treatment satisfaction was good (69%), participant therapeutic alliance ratings were high (87.5%), and the average total therapist time required was 194.5. min. PTSD Online appears to be an efficacious treatment option for people with PTSD that can be provided entirely remotely, with far less therapist time than traditional face-to-face treatment, and without compromising therapeutic alliance. © 2010 Elsevier Ltd.

Hip arthroscopy in the setting of hip osteoarthritis : Systematic review of outcomes and progression to hip arthroplasty

- Kemp, Joanne, MacDonald, David, Collins, Natalie, Hatton, Anna, Crossley, Kay

  • Authors: Kemp, Joanne , MacDonald, David , Collins, Natalie , Hatton, Anna , Crossley, Kay
  • Date: 2015
  • Type: Text , Journal article
  • Relation: Clinical Orthopaedics and Related Research Vol. 473, no. (2015), p. 1055-1073
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  • Description: Background: Hip arthroscopy is now commonly used to treat hip pain and pathology, including osteoarthritis (OA). Despite this, little is known about the effect of hip arthroscopy on outcomes of pain and function and progression to total hip arthroplasty (THA) in hip OA. Questions/purposes: This systematic review aimed to (1) determine pain and function outcomes after hip arthroscopy in people with hip OA; (2) compare the outcome after hip arthroscopy between people with and without hip OA; and (3) report the likelihood of progression to THA in patients with hip OA after hip arthroscopy. Methods: This review was conducted in accordance with the PRISMA statement. The Downs and Black checklist was used for quality appraisal. Studies scoring positively on at least 50% of items were included in final analyses. Standardized mean differences (SMDs) were calculated where possible or study conclusions are presented. Results: Twenty-two studies were included in the final analyses. Methodological quality and followup time varied widely. Moderate to large SMDs were reported for people with and without hip OA; however, the positive effects of the intervention were smaller for people with hip OA. Greater severity of hip OA and older age each predicted more rapid progression to THA. Conclusions: Patients with hip OA report positive outcomes from hip arthroscopy, although observed positive effects may be inflated as a result of methodological limitations of the included studies. Patients with hip OA had inferior results compared with those who did not. Chondropathy severity and patient age were associated with a higher risk and more rapid progression to THA. High-quality comparative studies are required to confirm the effects of hip arthroscopy on symptoms and structural change in people with hip OA.

A multi-omics glimpse into the biology of arterial stiffness

- Eales, James, Romaine, Simon, Charchar, Fadi, Tomaszewski, Maciej

  • Authors: Eales, James , Romaine, Simon , Charchar, Fadi , Tomaszewski, Maciej
  • Date: 2015
  • Type: Text , Journal article
  • Relation: Journal of Hypertension Vol. 34, no. 1 (2015), p. 32-35
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  • Description: It has long been recognized that the structure of arteries throughout the vascular tree is not uniform. Notably, the media of large proximal (central) vessels contains relatively much greater amounts of elastin and elastic lamellae than smaller, more distal (peripheral) arteries; the converse is true of vascular smooth muscle cells. Under physiological conditions, the greater elasticity of central arteries compared with more muscular peripheral arteries allows conversion of the pulsatile nature of ventricular ejection into a relatively steady flow of blood at the distal end of the arterial system, conferring protection from pulsatile energy [1,2]. Furthermore, these differences in impedance can generate partial wave reflections, which arrive in the aorta during diastole, boosting diastolic blood pressure and augmenting coronary perfusion pressure [3].

Report of the 3rd annual International Society of Hypertension New Investigator Symposium.

- Burger, Dylan, Veerabhadrappa, Praveen, Charchar, Fadi, Schutte, Aletta, Tomaszewski, Maciej

The impact of prostate cancer on partners: A qualitative exploration

- Wootten, Addie, Abbott, Jo-Anne, Osborne, Dawn, Austin, David, Klein, Britt, Costello, Anthony, Murphy, Declan

  • Authors: Wootten, Addie , Abbott, Jo-Anne , Osborne, Dawn , Austin, David , Klein, Britt , Costello, Anthony , Murphy, Declan
  • Date: 2014
  • Type: Text , Journal article
  • Relation: Psycho-Oncology Vol. 23, no. 11 (2014), p. 1252-1258
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  • Description: Objective: Prostate cancer and its treatment can result in numerous physical and psychological morbidities for the patient as well as his partner. This qualitative study aimed to explore the experiences of intimate spouses or partners of men diagnosed and/or treated for prostate cancer to better understand the personal impact of prostate cancer on the partner. Methods: Twenty-seven partners participated in this study. Six focus groups were convened, and one in-depth interview was undertaken to explore the practical impact of prostate cancer on the intimate spouse/partner. All discussions were audio-recorded and transcribed and then coded using a thematic approach. Results: Six themes emerged: (a) The influence of the man's response to prostate cancer on the partner, (b) The need to be involved in treatment and medical decision making, (c) Supporting a man who is experiencing a loss of masculinity, (d) Degree of congruence between each partner's coping responses, (e) Constrained communication, and (f) Changed roles and increased practical management. Conclusions: It is clear that prostate cancer impacts substantially on many areas of partner well-being. An effective intervention provided to this population seems warranted and may lead to improvements in partner well-being, assist the couple in lessening the impact of prostate cancer and its treatment on their relationship, and assist in the man's recovery. © 2014 John Wiley & Sons, Ltd.

Can the severity of dependence scale be usefully applied to 'ecstasy'?

- Bruno, Raimondo, Matthews, Allison, Topp, Libby, Degenhardt, Louisa, Gomez, Rapson, Dunn, Matthew

  • Authors: Bruno, Raimondo , Matthews, Allison , Topp, Libby , Degenhardt, Louisa , Gomez, Rapson , Dunn, Matthew
  • Date: 2009
  • Type: Text , Journal article
  • Relation: Neuropsychobiology Vol. 60, no. 3-4 (2009), p. 137-147
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  • Description: Background/Aims: Although use of 'ecstasy' (drugs sold as containing 3,4-methylenedioxymethamphetamine) is prevalent, it is typically infrequent, and treatment presentations involving ecstasy as a principal problem drug are relatively rare. Human case reports and animal literature suggest dependence potential, although there may be some unique aspects to this syndrome for ecstasy in comparison to other substances. The Severity of Dependence Scale (SDS) was examined to determine whether this could usefully identify 'dependent' ecstasy consumers. Methods: We conducted a cross-sectional survey of 1,658 frequent (at least monthly) ecstasy consumers across Australia, assessing drug use, associated harms and risk behaviours. Dependence was evaluated with the SDS, using a cut-off of ≥4 to identify potential 'dependence'. Results: One fifth of the participants were screened as potentially dependent. These individuals used ecstasy more frequently, in greater amounts, engaged more extensively in risk behaviours and reported greater role interference than other participants. These findings were independent of methamphetamine use or dependence. The underlying structure of the ecstasy SDS was bifactorial. Conclusions: The SDS has demonstrated construct validity as a screening tool to identify ecstasy users at elevated risk of experiencing adverse consequences, including features of dependence. The underlying structure of dependence symptoms differs for ecstasy compared to other drug classes, and some dependent consumers use the drug infrequently. The unique neurotoxic potential and entactogenic effects of ecstasy may require a distinct nosological classification for the experience of dependence associated with the drug. Copyright © 2009 S. Karger AG, Basel.

Pathway analysis shows association between FGFBP1 and hypertension

- Tomaszewski, Maciej, Charchar, Fadi, Nelson, Christopher, Barnes, Timothy, Denniff, Matthew, Kaiser, Michael, Debiec, Radoslaw, Christofidou, Paraskevi, Rafelt, Suzanne, Van Harst, Pim Der, Wang, William, Maric, Christine, Zukowska-Szczechowska, Ewa, Samani, Nilesh

  • Authors: Tomaszewski, Maciej , Charchar, Fadi , Nelson, Christopher , Barnes, Timothy , Denniff, Matthew , Kaiser, Michael , Debiec, Radoslaw , Christofidou, Paraskevi , Rafelt, Suzanne , Van Harst, Pim Der , Wang, William , Maric, Christine , Zukowska-Szczechowska, Ewa , Samani, Nilesh
  • Date: 2011
  • Type: Text , Journal article
  • Relation: Journal of the American Society of Nephrology Vol. 22, no. 5 (2011), p. 947-955
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  • Description: Variants in the gene encoding fibroblast growth factor 1 (FGF1) co-segregate with familial susceptibility to hypertension, and glomerular upregulation of FGF1 associates with hypertension. To investigate whether variants in other members of the FGF signaling pathway may also associate with hypertension, we genotyped 629 subjects from 207 Polish families with hypertension for 79 single nucleotide polymorphisms in eight genes of this network. Family-based analysis showed that parents transmitted the major allele of the rs16892645 polymorphism in the gene encoding FGF binding protein 1 (FGFBP1) to hypertensive offspring more frequently than expected by chance (P = 0.005). An independent cohort of 807 unrelated Polish subjects validated this association. Furthermore, compared with normotensive subjects, hypertensive subjects had approximately 1.5- and 1.4-fold higher expression of renal FGFBP1 mRNA and protein (P = 0.04 and P = 0.001), respectively. By immunohistochemistry, hypertensionrelated upregulation of FGFBP1 was most apparent in the glomerulus and juxtaglomerular space. Taken together, these data suggest that FGFBP1 associates with hypertension and that systematic analysis of signaling pathways can identify previously undescribed genetic associations. Copyright © 2011 by the American Society of Nephrology.

Cognitive behaviour therapy for older adults experiencing insomnia and depression in a community mental health setting: Study protocol for a randomised controlled trial

- Sadler, Paul, McLaren, Suzanne, Klein, Britt, Jenkins, Megan, Harvey, Jack

  • Authors: Sadler, Paul , McLaren, Suzanne , Klein, Britt , Jenkins, Megan , Harvey, Jack
  • Date: 2015
  • Type: Text , Journal article
  • Relation: Trials Vol. 16, no. 1 (2015), p.1-12
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  • Description: Background: Cognitive behaviour therapy for insomnia (CBT-I) is a well-established treatment; however, the evidence is largely limited to homogenous samples. Although emerging research has indicated that CBT-I is also effective for comorbid insomnia, CBT-I has not been tested among a complex sample of older adults with comorbid insomnia and depression. Furthermore, no study has explored whether modifying CBT-I to target associated depressive symptoms could potentially enhance sleep and mood outcomes. Therefore, this study aims to report a protocol designed to test whether an advanced form of CBT for insomnia and depression (CBT-I-D) is more effective at reducing insomnia and depressive symptoms compared to a standard CBT-I and psychoeducation control group (PCG) for older adults in a community mental health setting. Methods/Design: We aim to recruit 150 older adults with comorbid insomnia who have presented to community mental health services for depression. Eligible participants will be randomly allocated via block/cluster randomisation to one of three group therapy conditions: CBT-I, CBT-I-D, or PCG. Participants who receive CBT-I will only practice strategies designed to improve their sleep, whereas participants who receive CBT-I-D will practice additional strategies designed to also improve their mood. This trial will implement a mixed-methods design involving quantitative outcome measures and qualitative focus groups. The primary outcome measures are insomnia and depression severity, and secondary outcomes are anxiety, hopelessness, beliefs about sleep, comorbid sleep conditions, and health. Outcomes will be assessed at pre-intervention (week 0), post-intervention (week 8), and 3-month follow-up (week 20). Discussion: This CBT study protocol has been designed to address comorbid insomnia and depression for older adults receiving community mental health services. The proposed trial will determine whether CBT-I is more effective for older adults with comorbid insomnia and depression compared to a PCG. It will also establish whether an advanced form of CBT-I-D generates greater reductions in insomnia and depression severity compared to standard CBT-I. The results from the proposed trial are anticipated to have important clinical implications for older adults, researchers, therapists, and community mental health services. Trial registration: Australian and New Zealand Clinical Trials Registry (ANZCTR): ACTRN: 12615000067572 , Date Registered 12 December 2014. © 2015 Sadler et al.
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