Raphael Hau - Academia.edu (original) (raw)

Papers by Raphael Hau

Acupuncture in Medicine, May 17, 2022

Purpose: Level 1 evidence supports the use of acupuncture/acupressure (A/A) to manage post-operat... more Purpose: Level 1 evidence supports the use of acupuncture/acupressure (A/A) to manage post-operative nausea and vomiting (PONV). This study aimed to survey healthcare professionals’ attitudes towards A/A, influencing factors and barriers to implementing this effective non-drug intervention into peri-operative care. Methods: A validated, anonymous survey with 43 questions was emailed or distributed as a hard copy at meetings to anaesthetists, midwives, nurses, obstetricians, gynaecologists and surgeons at a public hospital in Australia. Descriptive data were presented. Influencing factors were explored using chi-square analysis. Multinomial logistical regression was used to identify the influences of confounding factors. Results: A total of 155 completed surveys were returned, reflecting a response rate of 32%. The majority of participants were female (69%), nurses/midwives (61%) and aged between 20 and 50 years old (76%). Eighty-three percent of respondents considered A/A ‘clearly alternative’ medicine or ‘neither mainstream nor alternative’. Eighty-one percent would encourage patients to use acupressure for PONV if it was offered at the hospital. Previous personal use of A/A was the key factor influencing attitudes and openness to clinical use. The key barriers to implementation were perceived lack of evidence and lack of qualified providers and time. Conclusion: Hospital-based healthcare professionals strongly supported the evidence-based use of A/A for PONV despite considering the therapy to be non-mainstream and having limited A/A education or history of personal use, providing a positive context for an acupressure implementation study. Significant gaps in training and a desire to learn were identified.

International Journal of Evidence-Based Healthcare, 2019

BACKGROUND AND AIMS Postoperative nausea and vomiting (PONV) is a common surgical complication, a... more BACKGROUND AND AIMS Postoperative nausea and vomiting (PONV) is a common surgical complication, affecting 30-50% of patients and 80% in high risk populations. Successful prevention and management of PONV relies on accurately assessing individual risk prior to surgery. A valid and reliable Apfel score is commonly used to assess patients' risk. It is however challenging to translate this evidence into clinical practice. This evidence-based project aimed to identify the current practice of assessing and documenting the risk factors of PONV prior to surgery, and to develop strategies to improve the practice. METHODS The project had three phrases, including forming a team and conducting the baseline audit; identifying problems and developing strategies; and conducting a follow-up tool to assess the impact on compliance with best practice. A research team was formed. A baseline audit was conducted at a public hospital in Victoria in June 2016 to examine PONV risk assessment practice t...

Acupuncture in Medicine

Additional file 1. Nonstandard outcome measures.

$Research paper thumbnail of The use of virtual clinics in the management of fractures: a narrative review$

Virtual fracture clinics (VFC) involve the management and follow-up of appropriate patients throu... more Virtual fracture clinics (VFC) involve the management and follow-up of appropriate patients through virtual interaction, namely telephone or teleconference consultation and review of imaging. VFCs appear safe for the management of several minor orthopaedic injuries in adults and children. In adults, there is evidence for using a VFC to manage patients with clavicular isolated radial head (Mason 1 and 2), radial neck, and radial styloid fractures, and closed soft-tissue and bony injuries of the hand (excluding carpal and wrist fractures). Stable ankle fractures and fifth metatarsal fractures also can be managed effectively according to VFC protocols. In children, home-based management with VFC review appears effective in management of stable metacarpal, phalangeal, and wrist fractures (undisplaced or torus) and elbow fractures (for children aged over 5 yr). Pediatric metatarsal and lateral malleolar fractures (in patients over 5 yr of age) also can be managed through a VFC.

$Research paper thumbnail of Motivational interviewing with community-dwelling older adults after hip fracture (MIHip): protocol for a randomised controlled trial$

BMJ Open

IntroductionCommunity-dwelling people recovering from hip fracture have the physical capacity to ... more IntroductionCommunity-dwelling people recovering from hip fracture have the physical capacity to walk in their community but lack the confidence to do so. The primary aim of this trial is to determine whether motivational interviewing increases time spent walking at 12 months in community-dwelling people after hip fracture compared with an attention placebo control group. Secondary aims are to evaluate cost effectiveness, patient and health service outcomes and to complete a process evaluation.Methods and analysisAn assessor-blinded parallel group randomised controlled design with embedded health economic evaluation and process evaluation will compare the effects of n=270 participants randomly allocated to an experimental group (motivational interviewing) or a control group (dietary advice). For inclusion, participants are aged ≥65 years, living at home independently within 6 months of discharge from hospital after hip fracture and able to walk independently and communicate with con...

$Research paper thumbnail of Improved functional outcome and tuberosity healing in patients treated with fracture stems than nonfracture stems during shoulder arthroplasty for proximal humeral fracture: a meta-analysis and systematic review$

Journal of Shoulder and Elbow Surgery

European Spine Journal

There is a known correlation between the procedures of lumbar spinal fusion (LSF), total hip arth... more There is a known correlation between the procedures of lumbar spinal fusion (LSF), total hip arthroplasty (THA) and the complication of hip dislocation and revision occurring in patients. However there is no consensus as to whether the risk of this complication is higher if THA is performed before or after LSF. This meta-analysis aims to determine the influence of surgical sequence of lumbar spinal fusion and total hip arthroplasty on the rates of hip dislocation and revisions. A meta-analysis was conducted with a multi-database search (PubMed, OVID, EMBASE, Medline) according to PRISMA guidelines on 27th May 2020. Data from all published literature meeting inclusion criteria were extracted and analyzed with an inverse variance statistical model. A total of 25,558 subsequent LSF and 43,880 prior LSF THA patients were included in this study. There was no statistically significant difference in all-cause revisions (OR = 0.86, 95%CI: 0.48–1.54, p = 0.61), dislocation (OR = 0.82, 95%CI: 0.25–2.72, p = 0.75) or aseptic loosening (OR = 1.14, 95%CI: 0.94–1.38, p = 0.17) when comparing patients receiving LSF subsequent versus prior to THA. Lumbar spinal fusion remains a risk factor for dislocation and revision of total hip arthroplasties regardless of whether it is performed prior to or after THA. Further preoperative assessment and altered surgical technique may be required in patients having THA who have previously undergone or are likely to undergo LSF in the future. Level II, Meta-analysis of homogeneous studies.

$Research paper thumbnail of Intraoperative fluoroscopy alone versus routine post‐operative X‐rays in identifying return to theatre after fracture fixation$

ANZ Journal of Surgery

Post‐operative imaging aims to assess fracture reduction and fixation with better resolution than... more Post‐operative imaging aims to assess fracture reduction and fixation with better resolution than intraoperative fluoroscopy (IF). However, this routine practice may increase costs and delay the discharge of patients. The aim of this study is to assess the role of post‐operative imaging in identifying patients that require a return to theatre following the use of IF.

Journal of Science and Medicine in Sport

$Research paper thumbnail of Nails or plates for fracture of the distal femur?: data from the Victoria Orthopaedic Trauma Outcomes Registry$

The Bone & Joint Journal

Aims Fractures of the distal femur are an important cause of morbidity. Their optimal management ... more Aims Fractures of the distal femur are an important cause of morbidity. Their optimal management remains controversial. Contemporary implants include angular-stable anatomical locking plates and locked intramedullary nails (IMNs). We compared the long-term patient-reported functional outcome of fixation of fractures of the distal femur using these two methods of treatment. Patients and Methods A total of 297 patients were retrospectively identified from a State-wide trauma registry in Australia: 195 had been treated with a locking plate and 102 with an IMN. Baseline characteristics of the patients and their fractures were recorded. Health-related quality-of-life, functional and radiographic outcomes were compared using mixed effects regression models at six months and one year. Results There was a clinically relevant and significant difference in quality-of-life at six months in favour of fixation with an IMN (mean difference in EuroQol-5 Dimensions Score (EQ-5D) = 0.12; 95% CI 0.02...

Injury

INTRODUCTION Incidence of Achilles tendon rupture (ATR) has increased over recent years, and deba... more INTRODUCTION Incidence of Achilles tendon rupture (ATR) has increased over recent years, and debate regarding optimal management has been widely documented. Most papers have focused on surgical success, complications and short term region-specific outcomes. Inconsistent use of standardised outcome measures following surgical ATR repair has made it difficult to evaluate the impact of ATR on a patient's health status post-surgery, and to compare this to other injury types. This study aimed to report the frequency of surgical repairs of the Achilles tendon over a five-year period within an orthopaedic trauma registry, and to investigate return to work (RTW) status, health status and functional outcomes at 12 months post-surgical repair of the Achilles tendon. METHODS Two hundred and four adults registered by the Victorian Orthopaedic Trauma Outcomes Registry (VOTOR) who underwent surgical repair of the Achilles tendon between July 2009 and June 2014 were included in this prospective cohort study. The Extended Glasgow Outcome Scale (GOS-E), 3-level European Quality of Life 5 Dimension measure (EQ-5D-3L), and RTW status 12 months following surgical ATR repair were collected through structured telephone interviews conducted by trained interviewers. RESULTS At 12 months, 92% of patients were successfully followed up. Of those working prior to injury, 95% had returned to work. 42% of patients reported a full recovery on the GOS-E scale. The prevalence of problems on the EQ-5D-3L at 12 months was 0.5% for self-care, 11% for anxiety, 13% for mobility, 16% for activity, and 22% for pain. 16% of patients reported problems with more than one domain. The number of surgical repairs of the Achilles tendon within the VOTOR registry decreased by 68% over the five-year study period. CONCLUSIONS Overall, patients recover well following surgical repair of the Achilles tendon. However, in this study, deficits in function persisted for over half of patients at 12 months post-injury. The decreased incidence of surgical Achilles tendon repair may reflect a change in practice at VOTOR hospitals whereby surgery may be becoming less favoured for initial ATR management.

$Research paper thumbnail of Twelve-month mortality and functional outcomes in hip fracture patients under 65 years of age$

Injury, 2016

INTRODUCTION There has been a recent call for improved functional outcome reporting in younger hi... more INTRODUCTION There has been a recent call for improved functional outcome reporting in younger hip fracture patients. Younger hip fracture patients represent a different population with different functional goals to their older counterparts. Therefore, previous research on mortality and functional outcomes in hip fracture patients may not be generalisable to the younger population. The aims of this study were to report 12-month survival and functional outcomes in hip fracture patients aged <65 years and predictors of functional outcome. METHODS Hip fracture patients aged <65years (range 17-64) registered by the Victorian Orthopaedic Trauma Outcomes Registry over four years were included and their 12-month survival and functional outcomes (Extended Glasgow Outcome Scale) reported. Ordered multivariable logistic regression was used to identify predictors of higher function. RESULTS There were 507 patients enrolled in the study and of the 447 patients (88%) with 12-month outcomes, 24 (5%) had died. The majority of patients had no comorbidities or pre-injury disability and were injured via road trauma or low falls. 40% of patients sustained additional injuries to their hip fracture. 23% of patients had fully recovered at 12 months and 39% reported ongoing moderate disability. After adjusting for all key variables, odds of better function 12-months post-fracture were reduced for patients with co-morbidities, previous disability or additional injuries, those receiving compensation or injured via low falls. CONCLUSIONS While 12-month survival rates were satisfactory in hip fracture patients aged under 65 years, their functional outcomes were poor, with less than one quarter having fully recovered 12 months following injury. This study provides new information about which patients may have difficulty returning to their pre-injury level of function. These patients may require additional or more intensive post-discharge care in order to fulfil their functional goals and continue to contribute productively to society.

Journal of Science and Medicine in Sport, 2014

Internal Medicine Journal

CJ. How is it best to deliver care in acute medical units? A systematic review, QJM. 2018;111(8):... more CJ. How is it best to deliver care in acute medical units? A systematic review, QJM. 2018;111(8):515–523. 3. Ahmad A, Purewal T, Sharma D, Weston P. The impact of twice-daily consultant ward rounds on the length of stay in two general medical wards. Clin Med. 2011;11 (524-8). 4. Fielding R, Kause J, Arnell-Cullen V, Sandeman D. The impact of consultant-delivered multidisciplinary inpatient medical care on patient outcomes. Clin Med (London, England). 2013;13(4):344-348.

$Research paper thumbnail of Sarcopenia in women with hip fracture: A comparison of hormonal biomarkers and their relationship to skeletal muscle mass and function$

Osteoporosis and Sarcopenia

$Research paper thumbnail of Predicting fracture outcomes from clinical registry data using artificial intelligence supplemented models for evidence-informed treatment (PRAISE) study protocol$

PLOS ONE

Background Distal radius (wrist) fractures are the second most common fracture admitted to hospit... more Background Distal radius (wrist) fractures are the second most common fracture admitted to hospital. The anatomical pattern of these types of injuries is diverse, with variation in clinical management, guidelines for management remain inconclusive, and the uptake of findings from clinical trials into routine practice limited. Robust predictive modelling, which considers both the characteristics of the fracture and patient, provides the best opportunity to reduce variation in care and improve patient outcomes. This type of data is housed in unstructured data sources with no particular format or schema. The “Predicting fracture outcomes from clinical Registry data using Artificial Intelligence (AI) Supplemented models for Evidence-informed treatment (PRAISE)” study aims to use AI methods on unstructured data to describe the fracture characteristics and test if using this information improves identification of key fracture characteristics and prediction of patient-reported outcome meas...

Archives of Orthopaedic and Trauma Surgery

$Research paper thumbnail of Association between physical activity and short‐term physical function changes after hip fracture: An observational study$

Physiotherapy Research International