Tracey Weiland - Academia.edu (original) (raw)
Papers by Tracey Weiland
BMC neurology, 2015
A growing evidence base implicates vitamin D, sun exposure and latitude in the aetiology of multi... more A growing evidence base implicates vitamin D, sun exposure and latitude in the aetiology of multiple sclerosis (MS), however there are less data on the associations of these variables with disease outcomes. We undertook a cross-sectional survey of over 2000 people with MS recruited through internet platforms, seeking self-reported data on geographical location, intentional sun exposure for health, and supplementation with vitamin D, among other lifestyle variables. We also requested data on health-related quality of life (MSQOL-54), self-reported doctor-diagnosed relapse rate, and disability (Patient Determined Disease Steps). Bivariate and multivariate analyses were used for comparisons, including multiple linear regression modeling. Of 2301 participants, 82.3 % were female, median age was 45 years (IQR 38-53 years), with a median time since diagnosis of 6 years (IQR 3-12 years), the majority (61.6 %) having relapsing-remitting MS. Nearly two-thirds (64.6 %) lived in the Northern h...
International Journal of Emergency Medicine, 2015
Background: Delivery of care to people with advanced cancer in the emergency department (ED) is c... more Background: Delivery of care to people with advanced cancer in the emergency department (ED) is complicated by competing service demands, workloads and physical design constraints. We explored emergency clinicians' attitudes to the ED environment when caring for patients who present with advanced cancer, and how these attitudes are affected by access to palliative care services, palliative care education, staff type, ED experience and patient demographic, hospital type and region. Methods: We electronically surveyed clinicians from the College of Emergency Nursing Australasia, Australian College of Emergency Nursing and Australasian College for Emergency Medicine working in an Australian ED. Results: Respondents were 444 doctors and 237 nurses. They reported overcrowding, noise, lack of time and privacy as barriers to care. Most (93.3%) agreed/strongly agreed that the dying patient should be allocated private space in ED. 73.6% (451) felt unable to provide a desired level of care to advanced cancer patients in ED. Clinician attitudes were affected by staff type, experience, ED demographic and hospital type, but not education in palliative care. Conclusions: ED environments place pressure on clinicians delivering care to people with advanced cancer. Integrating palliative care services in ED and redesigning EDs to better match its multifaceted functions should be considered.
The Australasian journal of dermatology, 2015
Emergency medicine international, 2015
Background. We aimed to determine Australasian Specialist Emergency Physicians' and Emergency... more Background. We aimed to determine Australasian Specialist Emergency Physicians' and Emergency Physicians in Training (Trainees') level of knowledge of common dental emergencies. We also explored confidence in managing dental emergencies; predictors of confidence and knowledge; and preferences for further dental education. Methods. A questionnaire was distributed electronically (September 2011) and directly (November 2011) to Fellows and Trainees of the Australasian College for Emergency Medicine. It explored demographics, confidence, knowledge of dental emergencies, and educational preferences. Results. Response rate was 13.6% (464/3405) and college members were proportionally represented by region. Fewer than half (186/446; 42%) had received dental training. Sixty-two percent (244/391, 95% CI 57.5-67.1) passed (>50%) a knowledge test. More than 60% incorrectly answered questions on dental fracture, periodontal abscess, tooth eruption dates, and ulcerative gingivitis. For...
Australian health review : a publication of the Australian Hospital Association, 2014
To identify medical, social and demographic factors associated with increased risk of 30-day re-p... more To identify medical, social and demographic factors associated with increased risk of 30-day re-presentation to the emergency department (ED) in elderly people presenting with pain. We undertook a single site, prospective observational study of all patients aged >65 years discharged from the ED with pain. Data were collected on possible medical, social and demographic predictors of ED readmission. Participants were a subset of all elderly patients presenting to the ED with pain, and received follow-up case management as part of the hospital's rapid response, assessment and care planning program for elderly people. Over 8 months, 356 people were eligible for inclusion in the study; of these, 189 consented to case management and to participate in the study. Three factors statistically increased odds of re-presentation to ED within 30 days: (1) prescription of opioids (P=0.003); (2) the presence of Home and Community Care Services (P=0.03); and (3) the absence of a gait aid (P=0...
International journal of emergency medicine, 2010
The Australian Medical Association is strongly opposed to the nurse practitioner (NP) role with c... more The Australian Medical Association is strongly opposed to the nurse practitioner (NP) role with concerns that NPs may become doctor substitutes without the requisite training and education that the medical role demands. Despite this, NPs have been heralded by some as a potential solution to the access block, workforce shortage and increased demand affecting emergency departments (EDs). The purpose of this study was to determine the perception of NPs by medical staff working in Australian EDs. Semi-structured telephone interviews were conducted with closed and open-ended questions. Participants were drawn from a representative stratified sample of two city, two metropolitan and two provincial hospitals of each State/Territory. A total of 95 doctors from 35 EDs participated in this study including 36 Departmental Directors; 36% of participating Directors indicated having an NP on staff. Doctors were strongly opposed to the statement that NPs could replace either nurses or other prevoc...
The Medical journal of Australia, Jan 19, 2006
To evaluate the effects of multidisciplinary case management (CM) on emergency department (ED) ut... more To evaluate the effects of multidisciplinary case management (CM) on emergency department (ED) utilisation and psychosocial variables for frequent attenders at the ED. Retrospective cohort analysis, with the study population as historical controls and data analysed 12 months before and after CM intervention in the period 1 January 2000 - 31 December 2004. Subgroup analyses were performed according to primary problem categories: general medical, drug and alcohol, and psychosocial. Inner urban tertiary hospital ED. Frequent ED attenders who received CM. ED attendances: length of stay, triage category, ambulance transport, disposition, attendances at the only two EDs nearby. Psychosocial factors: housing status, drug and alcohol use, and primary and community care engagement. 60 CM patients attended the ED on 1387 occasions. Total attendances increased after CM for the whole group (610 v 777, P = 0.055). Mean average length of stay (minutes) of the total study population and each subgr...
PLOS ONE, 2015
Fatigue contributes a significant burden of disease for people with multiple sclerosis (PwMS). Mo... more Fatigue contributes a significant burden of disease for people with multiple sclerosis (PwMS). Modifiable lifestyle factors have been recognized as having a role in a range of morbidity outcomes in PwMS. There is significant potential to prevent and treat fatigue in PwMS by addressing modifiable risk factors.
Neurology Research International, 2014
Background. Multiple sclerosis (MS) disease course is known to be adversely affected by several f... more Background. Multiple sclerosis (MS) disease course is known to be adversely affected by several factors including stress. A proposed mechanism for decreasing stress and therefore decreasing MS morbidity and improving quality of life is meditation. This review aims to critically analyse the current literature regarding meditation and MS. Methods. Four major databases were used to search for English language papers published before March 2014 with the terms MS, multiple sclerosis, meditation, and mindfulness. Results. 12 pieces of primary literature fitting the selection criteria were selected: two were randomised controlled studies, four were cohort studies, and six were surveys. The current literature varies in quality; however common positive effects of meditation include improved quality of life (QOL) and improved coping skills. Conclusion. All studies suggest possible benefit to the use of meditation as an adjunct to the management of multiple sclerosis. Additional rigorous clinical trials are required to validate the existing findings and determine if meditation has an impact on disease course over time.
BMC psychiatry, Jan 3, 2014
BackgroundDepression is the most common co-morbidity for people with Multiple Sclerosis (MS); irr... more BackgroundDepression is the most common co-morbidity for people with Multiple Sclerosis (MS); irrespective of disease severity, depression has the greatest impact on quality of life. An emerging paradigm in the treatment of depression is lifestyle medicine. There is significant potential to prevent and treat depression through modification of lifestyle risk factors for people with MS. This study sought to understand the association between lifestyle risk factors, medication and depression risk through the analysis of self-reported data from a large international sample of people with MS.MethodsThis cross-sectional analysis recruited a total of 2459 participants via Web 2.0 platforms. Survey data included socio-demographics; a range of lifestyle risk factors; medication; disease variables and depression risk using the Patient Health Questionnaire-2 (PHQ-2).ResultsIn total approximately one fifth (19.3%) of our sample screened positive for depression (PHQ-2 score ¿3). Several demograp...
Behavioural Neurology, 2014
To explore the association between meditation and health related quality of life (HRQOL), depress... more To explore the association between meditation and health related quality of life (HRQOL), depression, fatigue, disability level, relapse rates, and disease activity in a large international sample of people with multiple sclerosis (MS). Participants were invited to take part in an online survey and answer questions relating to HRQOL, depression, fatigue, disability, relapse rates, and their involvement in meditation practices. Statistically and potentially clinically significant differences between those who meditated once a week or more and participants who never meditated were present for mean mental health composite (MHC) scores, cognitive function scale, and health perception scale. The MHC results remained statistically significant on multivariate regression modelling when covariates were accounted for. Physical health composite (PHC) scores were higher in those that meditated; however, the differences were probably not clinically significant. Among those who meditated, fewer screened positive for depression, but there was no relationship with fatigue or relapse rate. Those with worsened disability levels were more likely to meditate. The study reveals a significant association between meditation, lower risk of depression, and improved HRQOL in people with MS.
Emergency Medicine International, 2014
Background/Objectives. There is minimal data available on the types of dermatological conditions ... more Background/Objectives. There is minimal data available on the types of dermatological conditions which present to tertiary emergency departments (ED). We analysed demographic and clinical features of dermatological presentations to an Australian adult ED. Methods. The St. Vincent's Hospital Melbourne (SVHM) ED database was searched for dermatological presentations between 1 January 2009 and 31 December 2011 by keywords and ICD-10 diagnosis codes. The lists were merged, and the ICD-10 codes were grouped into 55 categories for analysis. Demographic and clinical data for these presentations were then analysed. Results. 123 345 people presented to SVHM ED during the 3-year period. 4817 (3.9%) presented for a primarily dermatological complaint. The most common conditions by ICD-10 diagnosis code were cellulitis (n = 1741, 36.1%), allergy with skin involvement (n = 939, 19.5%), boils/furuncles/pilonidal sinuses (n = 526, 11.1%), eczema/dermatitis (n = 274, 5.7%), and varicella zoster infection (n = 161, 3.3%). Conclusion. The burden of dermatological disease presenting to ED is small but not insignificant. This information may assist in designing dermatological curricula for hospital clinicians and specialty training organisations as well as informing the allocation of dermatological resources to ED.
Progress in Transplantation, 2013
To determine Australian emergency department clinicians&a... more To determine Australian emergency department clinicians' cultural and religious barriers to organ and tissue donation (OTD). A national cross-sectional survey of physicians and nurses working in Australian emergency departments. An online questionnaire of 133 items was delivered via e-mail. Responses were received from 599 of 2969 (20%) physicians and 212 of 1026 (21%) nurses. Respondents were generally representative of the colleges. Participants were from 26 cultures and 9 religious groups. Self-rated competence in OTD tasks was low for some minority groups: South American, Caribbean, and Pacific Islanders reported little competence in identifying, referring, and caring for potential donors, introducing OTD to families, and approaching distressed families. Those of Arabic, Jewish, North African, and Middle Eastern background reported low competence in referring and caring for potential donors and comforting distressed families. They reported low support for OTD after cardiac death, low familiarity with OTD processes after cardiac death, and poor familiarity with the coroner's process. Those of Southern Asian background reported low comfort in undertaking OTD processes, poor familiarity with the coroner's process, and low competence in caring for potential donors. Those of Islamic faith reported low competence in identifying potential donors, low support for OTD after cardiac death, and thought that the emergency department was an inappropriate location to identify potential donors. Those of Buddhist and Hindu faiths reported low competence in identifying potential donors. Respondent numbers for members of minority groups were low, thereby limiting the statistical accuracy of results. Among clinicians working in Australian emergency departments, religion and culture may be barriers to facilitating OTD in emergency departments because of the perceptions and attitudes held by particular religious and cultural groups. Improving access to education may address these differences.
Physiology & Behavior, 2004
The present study explored the contribution of type 2 cholecystokinin (CCK) receptors in energy r... more The present study explored the contribution of type 2 cholecystokinin (CCK) receptors in energy regulation. A total of 78 CCK 2 receptordeficient mice and 80 wild-type controls were acclimated to a 12:12 light -dark cycle at 30 F 1 jC. Using a computer-monitored biotelemetry system, circadian patterns of body temperature, food intake, and activity were monitored for 4 days. Body weight and water consumption were manually recorded during this period. Results indicate that CCK 2 receptor invalidation produces elevated body temperature during both the photophase and scotophase (by 0.38 and 0.12 jC, respectively), increased body weight (29.3 F 0.2 vs. 26.8 F 0.2 g) and water consumption (4.1 F 0.1 vs. 3.2 F 0.1 ml), and decreased scotophase locomotor activity (WT: 7.0 F 0.2 vs. KO: 6.1 F 0.2 counts/min). These findings suggest an important role for CCK 2 receptors in processes underlying energy regulation during basal and possibly pathological states.
Peptides, 2005
Several mechanisms have been proposed for neuroimmune communication supporting sickness behavior ... more Several mechanisms have been proposed for neuroimmune communication supporting sickness behavior (fever, anorexia, inactivity, and cachexia) following infection. We examined the role of cholecystokinin as a neurochemical intermediary of sickness behavior by determining plasma, duodenum, hypothalamus, and brainstem cholecystokinin concentrations 30 and 60 min and 12 h following intraperitoneal lipopolysaccharide (LPS) (0.25 and 2.5 mg/kg). Hypothalamic cholecystokinin was significantly lower in LPS-versus saline-treated mice 30 min (0.25 and 2.5 mg/kg) and 12 h (2.5 mg/kg) post-injection. Plasma cholecystokinin of LPS-treated mice was significantly lower than that of controls 1 and 12 h post-injection, a finding consistent with a non-endocrine action of peripheral cholecystokinin.
Injury, 2009
reduced phonemic VF in left frontal patients. However, a recent meta-analysis of VF performance i... more reduced phonemic VF in left frontal patients. However, a recent meta-analysis of VF performance in young adult TBI patients demonstrated that both phonemic and semantic VF measures were comparably impaired [1]. In this study, we examined phonemic and semantic SV performances in 25 TBI patients over the age of 65 years compared to 25 demographically matched community older adults. The TBI patients were of mild to moderate severity, and were seen at 3-and 6-month post-injury. Analyses revealed that, at both time-points, the TBI group produced significantly fewer words than the control group on the phonemic VF task, but performed similarly on the semantic VF task. We further examined the phonemic VF performance by controlling for the role of executive attention set-shifting ability (Trails Making Test B-A duration), and found that the group difference in phonemic VF total words no longer remained. That is, the ability to shift to new mental sets played a significant role in reduced phonemic VF performance. Overall, the findings indicate that the ability to access and retrieve from the semantic system was broadly preserved at 3 months post-injury. However, when cognitive demands are increased requiring executive processing (i.e., generating new strategies), the older TBI group showed a slowed impaired performance even at 6 months TBI. The findings illustrate the need to focus on targeted cognitive strategies that optimise coping with novel situations.
Heart, Lung and Circulation, 2008
Background: Acute shortness of breath (SOB) is a common symptom and a potentially significant mar... more Background: Acute shortness of breath (SOB) is a common symptom and a potentially significant marker of cardiorespiratory disease. The subjective and unmeasurable nature of breathlessness can make its clinical evaluation difficult. This study aimed to investigate the convergent validity of a verbal 0-10 rating scale for SOB.
Emergency Medicine Australasia, 2010
As a reaction to the medical workforce shortage in Australia, a large expansion of undergraduate ... more As a reaction to the medical workforce shortage in Australia, a large expansion of undergraduate medical education has occurred through the provision of funding of additional medical student places. As a consequence, the number of medical graduates is anticipated to increase by as much as 90% with a peak in numbers anticipated in 2012. With ED already under pressure, this increase has serious implications for ED, particularly the delivery of intern and student teaching. This integrated review describes potential challenges that might arise from the predicted increase in intern numbers working in ED. A structured literature search was conducted from which 44 directly relevant articles were identified. We discuss the possible impact of an increased number of medical graduates on emergency medical staff, education, supervision and feedback to interns, and given the potential impacts on the education of junior doctors; we review the purpose and implementation of the Australian Curriculum framework for Junior Doctors in relation to their learning requirements. Although there is consensus by most postgraduate bodies that the core emergency term in emergency medicine should be retained, the impact of increased intern numbers might dramatically affect the clinical experiences, supervision and educational resources in the ED. This might necessitate cultural changes in medical education and ED function.
Emergency Medicine Australasia, 2010
To identify emergency medicine (EM) staff perceptions of EM intern rotation, the capacity of ED t... more To identify emergency medicine (EM) staff perceptions of EM intern rotation, the capacity of ED to accept an increase in intern numbers of 70%, attitudes of staff towards the increase, and its anticipated impact on management of ED, patient care and learning opportunities. A semistructured telephone interview was conducted with ED Directors, Directors of Emergency Medicine Training (DEMT), advanced trainees and interns in EM from a stratified sample of city, metropolitan and rural/provincial public hospitals in Australia. Ninety-five interviews were completed with 100% participation from ED Directors. Most participants agreed that the ED rotation should remain compulsory for full medical registration, 67% disagreed that they would like 70% more interns in their ED; most ED Directors and DEMT indicated this could not occur without problems. Most felt it would be difficult for existing numbers of consultants and registrars to supervise 70% more interns, and more interns would not improve patient wait times and ED length of stay. Almost two-thirds felt the increase in interns would decrease their exposure to procedures; most Directors and DEMT felt that an increase in medical students would affect their ability to take medical elective students (78%) and Australian Medical Council observers (70%). The increase in interns peaking in 2012 represents a significant change to the health system that will challenge the capacity of ED. Although ED internship is perceived as an indispensable learning opportunity, maintaining the ED experience with a rapid influx of interns will not occur without problems.
Emergency Medicine Australasia, 2010
We examined whether a previously validated verbal dyspnoea rating scale, and/or other demographic... more We examined whether a previously validated verbal dyspnoea rating scale, and/or other demographic and clinical parameters, could predict ED departure status, among ED patients presenting with shortness of breath. In this prospective observational study, a convenience sample of patients presenting to an inner urban adult tertiary hospital ED with shortness of breath were assessed at triage using objective and subjective breathlessness parameters. These included respiratory rate, oxygen saturation, heart rate, systolic blood pressure and verbal dyspnoea scores. A verbal dyspnoea score for worst dyspnoea during the current episode and basic demographic and presentation characteristics were also collected. These variables were assessed as predictors of ED departure status (inpatient admission or ED discharge) using logistic regression. From a sample of 253 participants, verbal dyspnoea scores > or =8 predicted inpatient admission 89% specificity (95% confidence interval [CI] 82.1-93.4), and scores < or =3 predicted discharge with 95% specificity (95% CI 89.5-98.0). For patients with shortness of breath as the primary complaint, the combination of verbal dyspnoea score > or =6, heart rate > or =94 bpm at triage and ambulance arrival predicted admission with 90% sensitivity (95% CI 82-95%) and 84% specificity (95% CI 73-92%). These same variables predicted admission for all patients with 84% sensitivity (95% CI 75.8-89.2) and 79% specificity (95% CI 71.5-85.5). Verbal dyspnoea score, alone and in combination with heart rate and arrival transport, can accurately predict admission. Once validated they might be useful in assessing, prioritizing and making rapid site of care decisions for breathless patients presenting to the ED.
BMC neurology, 2015
A growing evidence base implicates vitamin D, sun exposure and latitude in the aetiology of multi... more A growing evidence base implicates vitamin D, sun exposure and latitude in the aetiology of multiple sclerosis (MS), however there are less data on the associations of these variables with disease outcomes. We undertook a cross-sectional survey of over 2000 people with MS recruited through internet platforms, seeking self-reported data on geographical location, intentional sun exposure for health, and supplementation with vitamin D, among other lifestyle variables. We also requested data on health-related quality of life (MSQOL-54), self-reported doctor-diagnosed relapse rate, and disability (Patient Determined Disease Steps). Bivariate and multivariate analyses were used for comparisons, including multiple linear regression modeling. Of 2301 participants, 82.3 % were female, median age was 45 years (IQR 38-53 years), with a median time since diagnosis of 6 years (IQR 3-12 years), the majority (61.6 %) having relapsing-remitting MS. Nearly two-thirds (64.6 %) lived in the Northern h...
International Journal of Emergency Medicine, 2015
Background: Delivery of care to people with advanced cancer in the emergency department (ED) is c... more Background: Delivery of care to people with advanced cancer in the emergency department (ED) is complicated by competing service demands, workloads and physical design constraints. We explored emergency clinicians' attitudes to the ED environment when caring for patients who present with advanced cancer, and how these attitudes are affected by access to palliative care services, palliative care education, staff type, ED experience and patient demographic, hospital type and region. Methods: We electronically surveyed clinicians from the College of Emergency Nursing Australasia, Australian College of Emergency Nursing and Australasian College for Emergency Medicine working in an Australian ED. Results: Respondents were 444 doctors and 237 nurses. They reported overcrowding, noise, lack of time and privacy as barriers to care. Most (93.3%) agreed/strongly agreed that the dying patient should be allocated private space in ED. 73.6% (451) felt unable to provide a desired level of care to advanced cancer patients in ED. Clinician attitudes were affected by staff type, experience, ED demographic and hospital type, but not education in palliative care. Conclusions: ED environments place pressure on clinicians delivering care to people with advanced cancer. Integrating palliative care services in ED and redesigning EDs to better match its multifaceted functions should be considered.
The Australasian journal of dermatology, 2015
Emergency medicine international, 2015
Background. We aimed to determine Australasian Specialist Emergency Physicians' and Emergency... more Background. We aimed to determine Australasian Specialist Emergency Physicians' and Emergency Physicians in Training (Trainees') level of knowledge of common dental emergencies. We also explored confidence in managing dental emergencies; predictors of confidence and knowledge; and preferences for further dental education. Methods. A questionnaire was distributed electronically (September 2011) and directly (November 2011) to Fellows and Trainees of the Australasian College for Emergency Medicine. It explored demographics, confidence, knowledge of dental emergencies, and educational preferences. Results. Response rate was 13.6% (464/3405) and college members were proportionally represented by region. Fewer than half (186/446; 42%) had received dental training. Sixty-two percent (244/391, 95% CI 57.5-67.1) passed (>50%) a knowledge test. More than 60% incorrectly answered questions on dental fracture, periodontal abscess, tooth eruption dates, and ulcerative gingivitis. For...
Australian health review : a publication of the Australian Hospital Association, 2014
To identify medical, social and demographic factors associated with increased risk of 30-day re-p... more To identify medical, social and demographic factors associated with increased risk of 30-day re-presentation to the emergency department (ED) in elderly people presenting with pain. We undertook a single site, prospective observational study of all patients aged >65 years discharged from the ED with pain. Data were collected on possible medical, social and demographic predictors of ED readmission. Participants were a subset of all elderly patients presenting to the ED with pain, and received follow-up case management as part of the hospital's rapid response, assessment and care planning program for elderly people. Over 8 months, 356 people were eligible for inclusion in the study; of these, 189 consented to case management and to participate in the study. Three factors statistically increased odds of re-presentation to ED within 30 days: (1) prescription of opioids (P=0.003); (2) the presence of Home and Community Care Services (P=0.03); and (3) the absence of a gait aid (P=0...
International journal of emergency medicine, 2010
The Australian Medical Association is strongly opposed to the nurse practitioner (NP) role with c... more The Australian Medical Association is strongly opposed to the nurse practitioner (NP) role with concerns that NPs may become doctor substitutes without the requisite training and education that the medical role demands. Despite this, NPs have been heralded by some as a potential solution to the access block, workforce shortage and increased demand affecting emergency departments (EDs). The purpose of this study was to determine the perception of NPs by medical staff working in Australian EDs. Semi-structured telephone interviews were conducted with closed and open-ended questions. Participants were drawn from a representative stratified sample of two city, two metropolitan and two provincial hospitals of each State/Territory. A total of 95 doctors from 35 EDs participated in this study including 36 Departmental Directors; 36% of participating Directors indicated having an NP on staff. Doctors were strongly opposed to the statement that NPs could replace either nurses or other prevoc...
The Medical journal of Australia, Jan 19, 2006
To evaluate the effects of multidisciplinary case management (CM) on emergency department (ED) ut... more To evaluate the effects of multidisciplinary case management (CM) on emergency department (ED) utilisation and psychosocial variables for frequent attenders at the ED. Retrospective cohort analysis, with the study population as historical controls and data analysed 12 months before and after CM intervention in the period 1 January 2000 - 31 December 2004. Subgroup analyses were performed according to primary problem categories: general medical, drug and alcohol, and psychosocial. Inner urban tertiary hospital ED. Frequent ED attenders who received CM. ED attendances: length of stay, triage category, ambulance transport, disposition, attendances at the only two EDs nearby. Psychosocial factors: housing status, drug and alcohol use, and primary and community care engagement. 60 CM patients attended the ED on 1387 occasions. Total attendances increased after CM for the whole group (610 v 777, P = 0.055). Mean average length of stay (minutes) of the total study population and each subgr...
PLOS ONE, 2015
Fatigue contributes a significant burden of disease for people with multiple sclerosis (PwMS). Mo... more Fatigue contributes a significant burden of disease for people with multiple sclerosis (PwMS). Modifiable lifestyle factors have been recognized as having a role in a range of morbidity outcomes in PwMS. There is significant potential to prevent and treat fatigue in PwMS by addressing modifiable risk factors.
Neurology Research International, 2014
Background. Multiple sclerosis (MS) disease course is known to be adversely affected by several f... more Background. Multiple sclerosis (MS) disease course is known to be adversely affected by several factors including stress. A proposed mechanism for decreasing stress and therefore decreasing MS morbidity and improving quality of life is meditation. This review aims to critically analyse the current literature regarding meditation and MS. Methods. Four major databases were used to search for English language papers published before March 2014 with the terms MS, multiple sclerosis, meditation, and mindfulness. Results. 12 pieces of primary literature fitting the selection criteria were selected: two were randomised controlled studies, four were cohort studies, and six were surveys. The current literature varies in quality; however common positive effects of meditation include improved quality of life (QOL) and improved coping skills. Conclusion. All studies suggest possible benefit to the use of meditation as an adjunct to the management of multiple sclerosis. Additional rigorous clinical trials are required to validate the existing findings and determine if meditation has an impact on disease course over time.
BMC psychiatry, Jan 3, 2014
BackgroundDepression is the most common co-morbidity for people with Multiple Sclerosis (MS); irr... more BackgroundDepression is the most common co-morbidity for people with Multiple Sclerosis (MS); irrespective of disease severity, depression has the greatest impact on quality of life. An emerging paradigm in the treatment of depression is lifestyle medicine. There is significant potential to prevent and treat depression through modification of lifestyle risk factors for people with MS. This study sought to understand the association between lifestyle risk factors, medication and depression risk through the analysis of self-reported data from a large international sample of people with MS.MethodsThis cross-sectional analysis recruited a total of 2459 participants via Web 2.0 platforms. Survey data included socio-demographics; a range of lifestyle risk factors; medication; disease variables and depression risk using the Patient Health Questionnaire-2 (PHQ-2).ResultsIn total approximately one fifth (19.3%) of our sample screened positive for depression (PHQ-2 score ¿3). Several demograp...
Behavioural Neurology, 2014
To explore the association between meditation and health related quality of life (HRQOL), depress... more To explore the association between meditation and health related quality of life (HRQOL), depression, fatigue, disability level, relapse rates, and disease activity in a large international sample of people with multiple sclerosis (MS). Participants were invited to take part in an online survey and answer questions relating to HRQOL, depression, fatigue, disability, relapse rates, and their involvement in meditation practices. Statistically and potentially clinically significant differences between those who meditated once a week or more and participants who never meditated were present for mean mental health composite (MHC) scores, cognitive function scale, and health perception scale. The MHC results remained statistically significant on multivariate regression modelling when covariates were accounted for. Physical health composite (PHC) scores were higher in those that meditated; however, the differences were probably not clinically significant. Among those who meditated, fewer screened positive for depression, but there was no relationship with fatigue or relapse rate. Those with worsened disability levels were more likely to meditate. The study reveals a significant association between meditation, lower risk of depression, and improved HRQOL in people with MS.
Emergency Medicine International, 2014
Background/Objectives. There is minimal data available on the types of dermatological conditions ... more Background/Objectives. There is minimal data available on the types of dermatological conditions which present to tertiary emergency departments (ED). We analysed demographic and clinical features of dermatological presentations to an Australian adult ED. Methods. The St. Vincent's Hospital Melbourne (SVHM) ED database was searched for dermatological presentations between 1 January 2009 and 31 December 2011 by keywords and ICD-10 diagnosis codes. The lists were merged, and the ICD-10 codes were grouped into 55 categories for analysis. Demographic and clinical data for these presentations were then analysed. Results. 123 345 people presented to SVHM ED during the 3-year period. 4817 (3.9%) presented for a primarily dermatological complaint. The most common conditions by ICD-10 diagnosis code were cellulitis (n = 1741, 36.1%), allergy with skin involvement (n = 939, 19.5%), boils/furuncles/pilonidal sinuses (n = 526, 11.1%), eczema/dermatitis (n = 274, 5.7%), and varicella zoster infection (n = 161, 3.3%). Conclusion. The burden of dermatological disease presenting to ED is small but not insignificant. This information may assist in designing dermatological curricula for hospital clinicians and specialty training organisations as well as informing the allocation of dermatological resources to ED.
Progress in Transplantation, 2013
To determine Australian emergency department clinicians&a... more To determine Australian emergency department clinicians' cultural and religious barriers to organ and tissue donation (OTD). A national cross-sectional survey of physicians and nurses working in Australian emergency departments. An online questionnaire of 133 items was delivered via e-mail. Responses were received from 599 of 2969 (20%) physicians and 212 of 1026 (21%) nurses. Respondents were generally representative of the colleges. Participants were from 26 cultures and 9 religious groups. Self-rated competence in OTD tasks was low for some minority groups: South American, Caribbean, and Pacific Islanders reported little competence in identifying, referring, and caring for potential donors, introducing OTD to families, and approaching distressed families. Those of Arabic, Jewish, North African, and Middle Eastern background reported low competence in referring and caring for potential donors and comforting distressed families. They reported low support for OTD after cardiac death, low familiarity with OTD processes after cardiac death, and poor familiarity with the coroner's process. Those of Southern Asian background reported low comfort in undertaking OTD processes, poor familiarity with the coroner's process, and low competence in caring for potential donors. Those of Islamic faith reported low competence in identifying potential donors, low support for OTD after cardiac death, and thought that the emergency department was an inappropriate location to identify potential donors. Those of Buddhist and Hindu faiths reported low competence in identifying potential donors. Respondent numbers for members of minority groups were low, thereby limiting the statistical accuracy of results. Among clinicians working in Australian emergency departments, religion and culture may be barriers to facilitating OTD in emergency departments because of the perceptions and attitudes held by particular religious and cultural groups. Improving access to education may address these differences.
Physiology & Behavior, 2004
The present study explored the contribution of type 2 cholecystokinin (CCK) receptors in energy r... more The present study explored the contribution of type 2 cholecystokinin (CCK) receptors in energy regulation. A total of 78 CCK 2 receptordeficient mice and 80 wild-type controls were acclimated to a 12:12 light -dark cycle at 30 F 1 jC. Using a computer-monitored biotelemetry system, circadian patterns of body temperature, food intake, and activity were monitored for 4 days. Body weight and water consumption were manually recorded during this period. Results indicate that CCK 2 receptor invalidation produces elevated body temperature during both the photophase and scotophase (by 0.38 and 0.12 jC, respectively), increased body weight (29.3 F 0.2 vs. 26.8 F 0.2 g) and water consumption (4.1 F 0.1 vs. 3.2 F 0.1 ml), and decreased scotophase locomotor activity (WT: 7.0 F 0.2 vs. KO: 6.1 F 0.2 counts/min). These findings suggest an important role for CCK 2 receptors in processes underlying energy regulation during basal and possibly pathological states.
Peptides, 2005
Several mechanisms have been proposed for neuroimmune communication supporting sickness behavior ... more Several mechanisms have been proposed for neuroimmune communication supporting sickness behavior (fever, anorexia, inactivity, and cachexia) following infection. We examined the role of cholecystokinin as a neurochemical intermediary of sickness behavior by determining plasma, duodenum, hypothalamus, and brainstem cholecystokinin concentrations 30 and 60 min and 12 h following intraperitoneal lipopolysaccharide (LPS) (0.25 and 2.5 mg/kg). Hypothalamic cholecystokinin was significantly lower in LPS-versus saline-treated mice 30 min (0.25 and 2.5 mg/kg) and 12 h (2.5 mg/kg) post-injection. Plasma cholecystokinin of LPS-treated mice was significantly lower than that of controls 1 and 12 h post-injection, a finding consistent with a non-endocrine action of peripheral cholecystokinin.
Injury, 2009
reduced phonemic VF in left frontal patients. However, a recent meta-analysis of VF performance i... more reduced phonemic VF in left frontal patients. However, a recent meta-analysis of VF performance in young adult TBI patients demonstrated that both phonemic and semantic VF measures were comparably impaired [1]. In this study, we examined phonemic and semantic SV performances in 25 TBI patients over the age of 65 years compared to 25 demographically matched community older adults. The TBI patients were of mild to moderate severity, and were seen at 3-and 6-month post-injury. Analyses revealed that, at both time-points, the TBI group produced significantly fewer words than the control group on the phonemic VF task, but performed similarly on the semantic VF task. We further examined the phonemic VF performance by controlling for the role of executive attention set-shifting ability (Trails Making Test B-A duration), and found that the group difference in phonemic VF total words no longer remained. That is, the ability to shift to new mental sets played a significant role in reduced phonemic VF performance. Overall, the findings indicate that the ability to access and retrieve from the semantic system was broadly preserved at 3 months post-injury. However, when cognitive demands are increased requiring executive processing (i.e., generating new strategies), the older TBI group showed a slowed impaired performance even at 6 months TBI. The findings illustrate the need to focus on targeted cognitive strategies that optimise coping with novel situations.
Heart, Lung and Circulation, 2008
Background: Acute shortness of breath (SOB) is a common symptom and a potentially significant mar... more Background: Acute shortness of breath (SOB) is a common symptom and a potentially significant marker of cardiorespiratory disease. The subjective and unmeasurable nature of breathlessness can make its clinical evaluation difficult. This study aimed to investigate the convergent validity of a verbal 0-10 rating scale for SOB.
Emergency Medicine Australasia, 2010
As a reaction to the medical workforce shortage in Australia, a large expansion of undergraduate ... more As a reaction to the medical workforce shortage in Australia, a large expansion of undergraduate medical education has occurred through the provision of funding of additional medical student places. As a consequence, the number of medical graduates is anticipated to increase by as much as 90% with a peak in numbers anticipated in 2012. With ED already under pressure, this increase has serious implications for ED, particularly the delivery of intern and student teaching. This integrated review describes potential challenges that might arise from the predicted increase in intern numbers working in ED. A structured literature search was conducted from which 44 directly relevant articles were identified. We discuss the possible impact of an increased number of medical graduates on emergency medical staff, education, supervision and feedback to interns, and given the potential impacts on the education of junior doctors; we review the purpose and implementation of the Australian Curriculum framework for Junior Doctors in relation to their learning requirements. Although there is consensus by most postgraduate bodies that the core emergency term in emergency medicine should be retained, the impact of increased intern numbers might dramatically affect the clinical experiences, supervision and educational resources in the ED. This might necessitate cultural changes in medical education and ED function.
Emergency Medicine Australasia, 2010
To identify emergency medicine (EM) staff perceptions of EM intern rotation, the capacity of ED t... more To identify emergency medicine (EM) staff perceptions of EM intern rotation, the capacity of ED to accept an increase in intern numbers of 70%, attitudes of staff towards the increase, and its anticipated impact on management of ED, patient care and learning opportunities. A semistructured telephone interview was conducted with ED Directors, Directors of Emergency Medicine Training (DEMT), advanced trainees and interns in EM from a stratified sample of city, metropolitan and rural/provincial public hospitals in Australia. Ninety-five interviews were completed with 100% participation from ED Directors. Most participants agreed that the ED rotation should remain compulsory for full medical registration, 67% disagreed that they would like 70% more interns in their ED; most ED Directors and DEMT indicated this could not occur without problems. Most felt it would be difficult for existing numbers of consultants and registrars to supervise 70% more interns, and more interns would not improve patient wait times and ED length of stay. Almost two-thirds felt the increase in interns would decrease their exposure to procedures; most Directors and DEMT felt that an increase in medical students would affect their ability to take medical elective students (78%) and Australian Medical Council observers (70%). The increase in interns peaking in 2012 represents a significant change to the health system that will challenge the capacity of ED. Although ED internship is perceived as an indispensable learning opportunity, maintaining the ED experience with a rapid influx of interns will not occur without problems.
Emergency Medicine Australasia, 2010
We examined whether a previously validated verbal dyspnoea rating scale, and/or other demographic... more We examined whether a previously validated verbal dyspnoea rating scale, and/or other demographic and clinical parameters, could predict ED departure status, among ED patients presenting with shortness of breath. In this prospective observational study, a convenience sample of patients presenting to an inner urban adult tertiary hospital ED with shortness of breath were assessed at triage using objective and subjective breathlessness parameters. These included respiratory rate, oxygen saturation, heart rate, systolic blood pressure and verbal dyspnoea scores. A verbal dyspnoea score for worst dyspnoea during the current episode and basic demographic and presentation characteristics were also collected. These variables were assessed as predictors of ED departure status (inpatient admission or ED discharge) using logistic regression. From a sample of 253 participants, verbal dyspnoea scores > or =8 predicted inpatient admission 89% specificity (95% confidence interval [CI] 82.1-93.4), and scores < or =3 predicted discharge with 95% specificity (95% CI 89.5-98.0). For patients with shortness of breath as the primary complaint, the combination of verbal dyspnoea score > or =6, heart rate > or =94 bpm at triage and ambulance arrival predicted admission with 90% sensitivity (95% CI 82-95%) and 84% specificity (95% CI 73-92%). These same variables predicted admission for all patients with 84% sensitivity (95% CI 75.8-89.2) and 79% specificity (95% CI 71.5-85.5). Verbal dyspnoea score, alone and in combination with heart rate and arrival transport, can accurately predict admission. Once validated they might be useful in assessing, prioritizing and making rapid site of care decisions for breathless patients presenting to the ED.