Roy Rasalam - Academia.edu (original) (raw)

Papers by Roy Rasalam

[Extract] Clinical use of computers in general practice has not been widespread due to lack of: s... more [Extract] Clinical use of computers in general practice has not been widespread due to lack of: skilled support, training programs focused on general practitioners (GPs), familiarity with computer systems. The concept of a Computer Petting Zoo is to provide a hands-on computer laboratory where GPs can become familiar with available clinical software in a neutral, non-threatening environment; much like children at a petting zoo. The purpose of the zoo is to increase awareness of and comfort with information technology and thereby assist GPs to make informed choices about computer applications and adopt computer based information management practices.

PLOS ONE

Background Indigenous peoples in high income countries are disproportionately affected by Type 2 ... more Background Indigenous peoples in high income countries are disproportionately affected by Type 2 Diabetes. Socioeconomic disadvantages and inadequate access to appropriate healthcare are important contributors. Objectives This systematic review investigates effective designs of primary care management of Type 2 Diabetes for Indigenous adults in Australia, Canada, New Zealand, and the United States. Primary outcome was change in mean glycated haemoglobin. Secondary outcomes were diabetes-related hospital admission rates, treatment compliance, and change in weight or Body Mass Index. Methods Included studies were critically appraised using Joanna Briggs Institute appraisal checklists. A mixed-method systematic review was undertaken. Quantitative findings were compared by narrative synthesis, meta-aggregation of qualitative factors was performed. Results Seven studies were included. Three reported statistically significant reductions in means HbA1c following their intervention. Seven c...

Australian & New Zealand Association for Health Professional Educators, 2020

Over 65% of all James Cook University (JCU) medical graduates practise outside of major cities (c... more Over 65% of all James Cook University (JCU) medical graduates practise outside of major cities (compared to 20% of all Australian clinicians), including 5% who choose to practice in remote northern Australian towns such as Mount Isa, Darwin, and Palm and Thursday Islands. Many remote towns have high proportional Aboriginal and Torres Strait Islander populations. Little is known about the challenges and pressures for Australian doctors practising in remote locations; including community expectations around advocacy and leadership roles for graduates from Aboriginal or Torres Strait Islander cultures.

Diabetes is a common, progressive condition with multiple long-term complications. The importance... more Diabetes is a common, progressive condition with multiple long-term complications. The importance of a holistic, person-centred approach to management and involving the person with diabetes in treatment decisions can help with adherence to therapy. Good communication between health professionals and people living with diabetes is essential for optimising health outcomes, particularly in individuals with an intellectual disability disorder

Australian Diabetes Educators Association, 2020

National Diabetes Services Scheme, Oct 1, 2020

The purpose of this document is to provide practice recommendations to health professionals to be... more The purpose of this document is to provide practice recommendations to health professionals to better support people living with an IDD and diabetes, as well as their families, carers and support workers. This document provides information for health professionals to improve their understanding of the health care challenges and needs of individuals with an IDD and diabetes, particularly with respect to the communication of health care information. It also encourages all health professionals and their health service management to advocate for health organisations to consider and accommodate the needs of people with an IDD and diabetes, along with their families, carers and support workers

Diabetes affects over 1.2 million people in Australia. Saxagliptin (SAXA) is a potent, selective ... more Diabetes affects over 1.2 million people in Australia. Saxagliptin (SAXA) is a potent, selective dipeptidyl peptidase-4 (DPP-4) inhibitor. Three 24-week phase 3 studies assessed efficacy and safety of SAXA as add-on to Metformin (MET), as initial combination therapy with MET, or as add-on to the sulfonylurea (SU) glyburide (GLY) in patients (pts) with type 2 diabetes (T2D) and inadequate glycaemic control. In the add-on to MET study, 743 pts inadequately controlled on MET alone (HbA1c 7.0%–10.0%; mean baseline (BL) HbA1c 8.0%; mean T2D duration 6.5 yrs) were randomised to SAXA or placebo (PBO) with ongoing dose of MET. In the initial combination study, 1306 drug naive pts (HbA1c8.0%–12.0%; mean BL HbA1c 9.5%; mean T2D duration 1.7 yrs) were randomised to SAXA + MET, SAXA + PBO, or MET + PBO. In the add-on to SU study, 768 pts inadequately controlled on SU alone (HbA 1c7.5%–10.0%; mean BL HbA1c 8.4%; mean T2D duration 6.9 yrs) were randomised to SAXA or uptitrated GLY + PBO in additi...

The World Health Organization has estimated that more than 600 million adults worldwide are now c... more The World Health Organization has estimated that more than 600 million adults worldwide are now classified as obese, which is defined as a BMI of ≥30 kg/m2. The rising prevalence of obesity has led to a simultaneous increase in the prevalence of type 2 diabetes, and the term “diabesity” has been coined to describe those with type 2 diabetes and obesity. The aim of this review is to describe the prevalence of obesity and type 2 diabetes in Australia and summarise practical aspects of weight management. It will also explore the role of healthcare professionals in weight management and the prevention of the complications of diabesity.

Amidst the contemporary debate on the existing practices of physicians and the increasing commerc... more Amidst the contemporary debate on the existing practices of physicians and the increasing commercialisation of medicine, the question of professionalism and how medical professionalism is taught at Higher Education Institutions is highly relevant. This study reviews the current practices of teaching and learning medical professionalism in Work Integrated Learning (WIL). The authors view the problem of professionalism as a complex adaptive challenge requiring new learning to adapt to medical professionalism of the future. The objective of the study is to determine the effectiveness in teaching medical professionalism to future physicians. The approach is a case study of best practice in teaching medical professionalism at an Australian university and its conformance to Australian Medical Association guidelines. The study concludes that all medical curricula should integrate medical professionalism and make it an explicit part of WIL assessment and curriculum.

Performing high quality cardiopulmonary resuscitation (CPR) is paramount to patient survival, and... more Performing high quality cardiopulmonary resuscitation (CPR) is paramount to patient survival, and the successful application of CPR knowledge and skills largely depends on the education and training the rescuers have received. Medical students are expected to be proficient in basic CPR skills upon graduation, and as such may be required to demonstrate the ability to deliver CPR to patients at any point during their medical degree. Similar to other Australian Medical Schools, James Cook University (JCU) requires all first year medical students to submit a certificate of completion of an Australian Credited First Aid and CPR course, from a Registered Training Organisation (RTO). Currently, no additional training or assessment of students’ competence in basic CPR knowledge and skills are included in Years1-3 of the medical curriculum, even though further activities in Years4-6 of the course build on fundamental CPR knowledge and skills.

The objective of the AHCD was to facilitate the successful transition of an allied health profess... more The objective of the AHCD was to facilitate the successful transition of an allied health professional from novice to advanced practitioner while focussing on key competencies and levels of autonomy through reflective practice and emotional and social sensitivity to the workplace. The AHCD facilitates this transition via self-directed learning and reflective practice. The philosophy presented in the framework may be applicable to all health care professionals.

Diabetes is Australia's fastest growing chronic disease with approximately 890,000 patients c... more Diabetes is Australia's fastest growing chronic disease with approximately 890,000 patients currently diagnosed with diabetes. 1 By 2031 it is predicted that 3.3 million Australians will have type 2 diabetes mellitus, 2 thus increasing the demand for treatment. However, several diabetes, obesity, and lipid drug trials have had unexpected and unfavourable cardiovascular (CV) results. The saxagliptin (SAXA) phase 2b/3 program enrolled a range of patients with diabetes and included a controlled, long-term safety extension phase. SAXA is a potent, selective dipeptidyl peptidase-4 (DPP-4) inhibitor. In the SAXA clinical data, the primary endpoint, major adverse cardiovascular events (MACE; stroke, myocardial infarction or CV death, analysed post hoc) and acute cardiovascular events (ACE; acute, clinically significant events, including cardiac revascularisation procedures) were identified using selected MedDRA Preferred Terms. CV events were analysed in a comprehensive dataset: 8 rand...

The use of simulation as an educational tool is becoming increasingly popular in healthcare train... more The use of simulation as an educational tool is becoming increasingly popular in healthcare training as increasing student numbers and concerns with patient safety challenge opportunities for traditional bedside teaching. Healthcare training centres face many challenges when implementing a simulation training program. Available guidance for successful program implementation is limited, and adaptation for each institution’s unique setting is often required. This study describes the approach taken by James Cook University’s (JCU) Division of Tropical health and Medicine’s (Townsville campus) approach for developing a multi-disciplinary, simulation-based training program with shared resources and centralised asset management.

Diabetes affects the skin in many different ways at a microcirculatory level, making it more pron... more Diabetes affects the skin in many different ways at a microcirculatory level, making it more prone to injury and ulceration. These changes not only have an impact on healing but also on the resulting scar tissue, which is not as strong as the skin was prior to injury. Eight-five percent of amputations are preceded by ulceration, with re-ulceration rates reported to be as high as 70% after 5 years. This article looks at the changes that occur in the skin of people with diabetes and the importance of skin care before and after ulceration

In the current context of COVID-19 restrictions, the perceived infection risk in healthcare facil... more In the current context of COVID-19 restrictions, the perceived infection risk in healthcare facilities has resulted in limited opportunities for clinical placements. This paper aims to demonstrate how virtual WIL clinics (virtual simulated general practice clinics), provide an authentic clinical experience and to ascertain whether these virtual clinics allow the practice of generic WIL competencies. The clinics provide students with WIL experience without the face-to-face contact of a physical clinic via telehealth. The practice of WIL through virtual WIL clinics at James Cook University, Australia, is assessed using the Work Skill Development (WSD) framework via GoSoapBox surveys. Students surveyed (N=66) expressed a high level of motivation to engage, reflect and learn through this medium. The survey also highlighted some possible areas of improvement in time management and communication. Virtual WIL clinics are a suitable substitution for WIL clinical activity and ideally suited ...

Diabetic foot infections (DFIs) are a frequent and costly complication associated with diabetes m... more Diabetic foot infections (DFIs) are a frequent and costly complication associated with diabetes mellitus. Osteomyelitis is present in 44–68% of patients admitted to hospital and DFIs account for 60% of lower extremity amputations in developed countries. Diagnosis of DFIs should be based upon the presence of local and systemic signs and symptoms, and the management and outcomes of DFIs are superior through the involvement of a multidisciplinary team. This article presents an overview of the current evidence for diagnosis and management of DFIs in practice.

People with diabetes have an increased risk of cardiovascular complications, including acute coro... more People with diabetes have an increased risk of cardiovascular complications, including acute coronary syndrome, stroke, heart failure and arrhythmias. The background to this risk for the development of cardiovascular complications is multifactorial and our understanding of the nature of atherosclerotic disease has progressed considerably. This article explores the latest thinking on the link between the various facets of dyslipidaemia and cardiovascular risk, and reviews current evidence for lipid management in people with diabetes.

SMBG has the potential to reduce hypoglycaemia and improve glycaemic control, as well as to empow... more SMBG has the potential to reduce hypoglycaemia and improve glycaemic control, as well as to empower patients in the self-management of their diabetes. SMBG should be performed several times daily by patients with type 1 diabetes, gestational diabetes, type 2 diabetes who are on insulin, or preparing to commence insulin, and possibly those who are on sulphonylureas. It should also be performed several times daily in patients who are acutely unwell or on high dose steroids for the duration of the illness or therapy. SMBG could be used intermittently in a structured manner in all other patients with type 2 diabetes on oral hypoglycaemic agents. Implementation of an effective SMBG schedule also requires comprehensive diabetes education.

Since 2008, the Gait, Arms, Legs and Spine (GALS) Screening Tool is taught to Year one undergradu... more Since 2008, the Gait, Arms, Legs and Spine (GALS) Screening Tool is taught to Year one undergraduate medical students at James Cook University (JCU), as part of the clinical skills Musculoskeletal (MSK) examinatin. 'GALS' is a sequence of concise movement that asseses the range of motion of the major joints of the body. The strategies of small group teaching, instructional video, practical demonstration and simulatedvolunteer patients are utilised to teach 'GALS' in the two hour workshop. Written and audio visual resources are available to the students on JCU's online learning platform. Post workshop, students are assessed in an OSCE style assessment. With the dual intention to enhance student learning, and improve short and long term recall, educators created a 'GALS music and dance' video.

[Extract] Clinical use of computers in general practice has not been widespread due to lack of: s... more [Extract] Clinical use of computers in general practice has not been widespread due to lack of: skilled support, training programs focused on general practitioners (GPs), familiarity with computer systems. The concept of a Computer Petting Zoo is to provide a hands-on computer laboratory where GPs can become familiar with available clinical software in a neutral, non-threatening environment; much like children at a petting zoo. The purpose of the zoo is to increase awareness of and comfort with information technology and thereby assist GPs to make informed choices about computer applications and adopt computer based information management practices.

PLOS ONE

Background Indigenous peoples in high income countries are disproportionately affected by Type 2 ... more Background Indigenous peoples in high income countries are disproportionately affected by Type 2 Diabetes. Socioeconomic disadvantages and inadequate access to appropriate healthcare are important contributors. Objectives This systematic review investigates effective designs of primary care management of Type 2 Diabetes for Indigenous adults in Australia, Canada, New Zealand, and the United States. Primary outcome was change in mean glycated haemoglobin. Secondary outcomes were diabetes-related hospital admission rates, treatment compliance, and change in weight or Body Mass Index. Methods Included studies were critically appraised using Joanna Briggs Institute appraisal checklists. A mixed-method systematic review was undertaken. Quantitative findings were compared by narrative synthesis, meta-aggregation of qualitative factors was performed. Results Seven studies were included. Three reported statistically significant reductions in means HbA1c following their intervention. Seven c...

Australian & New Zealand Association for Health Professional Educators, 2020

Over 65% of all James Cook University (JCU) medical graduates practise outside of major cities (c... more Over 65% of all James Cook University (JCU) medical graduates practise outside of major cities (compared to 20% of all Australian clinicians), including 5% who choose to practice in remote northern Australian towns such as Mount Isa, Darwin, and Palm and Thursday Islands. Many remote towns have high proportional Aboriginal and Torres Strait Islander populations. Little is known about the challenges and pressures for Australian doctors practising in remote locations; including community expectations around advocacy and leadership roles for graduates from Aboriginal or Torres Strait Islander cultures.

Diabetes is a common, progressive condition with multiple long-term complications. The importance... more Diabetes is a common, progressive condition with multiple long-term complications. The importance of a holistic, person-centred approach to management and involving the person with diabetes in treatment decisions can help with adherence to therapy. Good communication between health professionals and people living with diabetes is essential for optimising health outcomes, particularly in individuals with an intellectual disability disorder

Australian Diabetes Educators Association, 2020

National Diabetes Services Scheme, Oct 1, 2020

The purpose of this document is to provide practice recommendations to health professionals to be... more The purpose of this document is to provide practice recommendations to health professionals to better support people living with an IDD and diabetes, as well as their families, carers and support workers. This document provides information for health professionals to improve their understanding of the health care challenges and needs of individuals with an IDD and diabetes, particularly with respect to the communication of health care information. It also encourages all health professionals and their health service management to advocate for health organisations to consider and accommodate the needs of people with an IDD and diabetes, along with their families, carers and support workers

Diabetes affects over 1.2 million people in Australia. Saxagliptin (SAXA) is a potent, selective ... more Diabetes affects over 1.2 million people in Australia. Saxagliptin (SAXA) is a potent, selective dipeptidyl peptidase-4 (DPP-4) inhibitor. Three 24-week phase 3 studies assessed efficacy and safety of SAXA as add-on to Metformin (MET), as initial combination therapy with MET, or as add-on to the sulfonylurea (SU) glyburide (GLY) in patients (pts) with type 2 diabetes (T2D) and inadequate glycaemic control. In the add-on to MET study, 743 pts inadequately controlled on MET alone (HbA1c 7.0%–10.0%; mean baseline (BL) HbA1c 8.0%; mean T2D duration 6.5 yrs) were randomised to SAXA or placebo (PBO) with ongoing dose of MET. In the initial combination study, 1306 drug naive pts (HbA1c8.0%–12.0%; mean BL HbA1c 9.5%; mean T2D duration 1.7 yrs) were randomised to SAXA + MET, SAXA + PBO, or MET + PBO. In the add-on to SU study, 768 pts inadequately controlled on SU alone (HbA 1c7.5%–10.0%; mean BL HbA1c 8.4%; mean T2D duration 6.9 yrs) were randomised to SAXA or uptitrated GLY + PBO in additi...

The World Health Organization has estimated that more than 600 million adults worldwide are now c... more The World Health Organization has estimated that more than 600 million adults worldwide are now classified as obese, which is defined as a BMI of ≥30 kg/m2. The rising prevalence of obesity has led to a simultaneous increase in the prevalence of type 2 diabetes, and the term “diabesity” has been coined to describe those with type 2 diabetes and obesity. The aim of this review is to describe the prevalence of obesity and type 2 diabetes in Australia and summarise practical aspects of weight management. It will also explore the role of healthcare professionals in weight management and the prevention of the complications of diabesity.

Amidst the contemporary debate on the existing practices of physicians and the increasing commerc... more Amidst the contemporary debate on the existing practices of physicians and the increasing commercialisation of medicine, the question of professionalism and how medical professionalism is taught at Higher Education Institutions is highly relevant. This study reviews the current practices of teaching and learning medical professionalism in Work Integrated Learning (WIL). The authors view the problem of professionalism as a complex adaptive challenge requiring new learning to adapt to medical professionalism of the future. The objective of the study is to determine the effectiveness in teaching medical professionalism to future physicians. The approach is a case study of best practice in teaching medical professionalism at an Australian university and its conformance to Australian Medical Association guidelines. The study concludes that all medical curricula should integrate medical professionalism and make it an explicit part of WIL assessment and curriculum.

Performing high quality cardiopulmonary resuscitation (CPR) is paramount to patient survival, and... more Performing high quality cardiopulmonary resuscitation (CPR) is paramount to patient survival, and the successful application of CPR knowledge and skills largely depends on the education and training the rescuers have received. Medical students are expected to be proficient in basic CPR skills upon graduation, and as such may be required to demonstrate the ability to deliver CPR to patients at any point during their medical degree. Similar to other Australian Medical Schools, James Cook University (JCU) requires all first year medical students to submit a certificate of completion of an Australian Credited First Aid and CPR course, from a Registered Training Organisation (RTO). Currently, no additional training or assessment of students’ competence in basic CPR knowledge and skills are included in Years1-3 of the medical curriculum, even though further activities in Years4-6 of the course build on fundamental CPR knowledge and skills.

The objective of the AHCD was to facilitate the successful transition of an allied health profess... more The objective of the AHCD was to facilitate the successful transition of an allied health professional from novice to advanced practitioner while focussing on key competencies and levels of autonomy through reflective practice and emotional and social sensitivity to the workplace. The AHCD facilitates this transition via self-directed learning and reflective practice. The philosophy presented in the framework may be applicable to all health care professionals.

Diabetes is Australia's fastest growing chronic disease with approximately 890,000 patients c... more Diabetes is Australia's fastest growing chronic disease with approximately 890,000 patients currently diagnosed with diabetes. 1 By 2031 it is predicted that 3.3 million Australians will have type 2 diabetes mellitus, 2 thus increasing the demand for treatment. However, several diabetes, obesity, and lipid drug trials have had unexpected and unfavourable cardiovascular (CV) results. The saxagliptin (SAXA) phase 2b/3 program enrolled a range of patients with diabetes and included a controlled, long-term safety extension phase. SAXA is a potent, selective dipeptidyl peptidase-4 (DPP-4) inhibitor. In the SAXA clinical data, the primary endpoint, major adverse cardiovascular events (MACE; stroke, myocardial infarction or CV death, analysed post hoc) and acute cardiovascular events (ACE; acute, clinically significant events, including cardiac revascularisation procedures) were identified using selected MedDRA Preferred Terms. CV events were analysed in a comprehensive dataset: 8 rand...

The use of simulation as an educational tool is becoming increasingly popular in healthcare train... more The use of simulation as an educational tool is becoming increasingly popular in healthcare training as increasing student numbers and concerns with patient safety challenge opportunities for traditional bedside teaching. Healthcare training centres face many challenges when implementing a simulation training program. Available guidance for successful program implementation is limited, and adaptation for each institution’s unique setting is often required. This study describes the approach taken by James Cook University’s (JCU) Division of Tropical health and Medicine’s (Townsville campus) approach for developing a multi-disciplinary, simulation-based training program with shared resources and centralised asset management.

Diabetes affects the skin in many different ways at a microcirculatory level, making it more pron... more Diabetes affects the skin in many different ways at a microcirculatory level, making it more prone to injury and ulceration. These changes not only have an impact on healing but also on the resulting scar tissue, which is not as strong as the skin was prior to injury. Eight-five percent of amputations are preceded by ulceration, with re-ulceration rates reported to be as high as 70% after 5 years. This article looks at the changes that occur in the skin of people with diabetes and the importance of skin care before and after ulceration

In the current context of COVID-19 restrictions, the perceived infection risk in healthcare facil... more In the current context of COVID-19 restrictions, the perceived infection risk in healthcare facilities has resulted in limited opportunities for clinical placements. This paper aims to demonstrate how virtual WIL clinics (virtual simulated general practice clinics), provide an authentic clinical experience and to ascertain whether these virtual clinics allow the practice of generic WIL competencies. The clinics provide students with WIL experience without the face-to-face contact of a physical clinic via telehealth. The practice of WIL through virtual WIL clinics at James Cook University, Australia, is assessed using the Work Skill Development (WSD) framework via GoSoapBox surveys. Students surveyed (N=66) expressed a high level of motivation to engage, reflect and learn through this medium. The survey also highlighted some possible areas of improvement in time management and communication. Virtual WIL clinics are a suitable substitution for WIL clinical activity and ideally suited ...

Diabetic foot infections (DFIs) are a frequent and costly complication associated with diabetes m... more Diabetic foot infections (DFIs) are a frequent and costly complication associated with diabetes mellitus. Osteomyelitis is present in 44–68% of patients admitted to hospital and DFIs account for 60% of lower extremity amputations in developed countries. Diagnosis of DFIs should be based upon the presence of local and systemic signs and symptoms, and the management and outcomes of DFIs are superior through the involvement of a multidisciplinary team. This article presents an overview of the current evidence for diagnosis and management of DFIs in practice.

People with diabetes have an increased risk of cardiovascular complications, including acute coro... more People with diabetes have an increased risk of cardiovascular complications, including acute coronary syndrome, stroke, heart failure and arrhythmias. The background to this risk for the development of cardiovascular complications is multifactorial and our understanding of the nature of atherosclerotic disease has progressed considerably. This article explores the latest thinking on the link between the various facets of dyslipidaemia and cardiovascular risk, and reviews current evidence for lipid management in people with diabetes.

SMBG has the potential to reduce hypoglycaemia and improve glycaemic control, as well as to empow... more SMBG has the potential to reduce hypoglycaemia and improve glycaemic control, as well as to empower patients in the self-management of their diabetes. SMBG should be performed several times daily by patients with type 1 diabetes, gestational diabetes, type 2 diabetes who are on insulin, or preparing to commence insulin, and possibly those who are on sulphonylureas. It should also be performed several times daily in patients who are acutely unwell or on high dose steroids for the duration of the illness or therapy. SMBG could be used intermittently in a structured manner in all other patients with type 2 diabetes on oral hypoglycaemic agents. Implementation of an effective SMBG schedule also requires comprehensive diabetes education.

Since 2008, the Gait, Arms, Legs and Spine (GALS) Screening Tool is taught to Year one undergradu... more Since 2008, the Gait, Arms, Legs and Spine (GALS) Screening Tool is taught to Year one undergraduate medical students at James Cook University (JCU), as part of the clinical skills Musculoskeletal (MSK) examinatin. 'GALS' is a sequence of concise movement that asseses the range of motion of the major joints of the body. The strategies of small group teaching, instructional video, practical demonstration and simulatedvolunteer patients are utilised to teach 'GALS' in the two hour workshop. Written and audio visual resources are available to the students on JCU's online learning platform. Post workshop, students are assessed in an OSCE style assessment. With the dual intention to enhance student learning, and improve short and long term recall, educators created a 'GALS music and dance' video.