Graduate School of Medicine - Papers (Archive)

Antipsychotics and sexual dysfunction: Sexual dysfunction: Part III

Anil Kumar Mysore Nagaraj — Mon, 18 Mar 2013 16:56:22 PDT

Satisfying sexual experience is an essential part of a healthy and enjoyable life for most people. Antipsychotic drugs are among the various factors that affect optimal sexual functioning. Both conventional and novel antipsychotics are associated with significant sexual side effects. This review has presented various studies comparing different antipsychotic drugs. Dopamine antagonism, increased serum prolactin, serotonergic, adrenergic and cholinergic mechanisms are all proposed to be the mechanisms for sexual dysfunction. Drug treatment for this has not given satisfactory long-term results. Knowledge of the receptor pharmacology of an individual antipsychotic will help to determine whether it is more or less likely to cause sexual side effects and its management.

A phase II clinical trial of a dental health education program delivered by aboriginal health workers to prevent early childhood caries

Fiona Blinkhorn — Mon, 14 Jan 2013 20:05:10 PST

Background: Early Childhood Caries (ECC) is a widespread problem in Australian Aboriginal communities causing severe pain and sepsis. In addition dental services are difficult to access for many Aboriginal children and trying to obtain care can be stressful for the parents. The control of dental caries has been identified as a key indictor in the reduction of Indigenous disadvantage. Thus, there is a need for new approaches to prevent ECC, which reflect the cultural norms of Aboriginal communities. Methods/Design. This is a Phase II single arm trial designed to gather information on the effectiveness of a dental health education program for Aboriginal children aged 6months, followed over 2years. The program will deliver advice from Aboriginal Health Workers on tooth brushing, diet and the use of fluoride toothpaste to Aboriginal families. Six waves of data collection will be conducted to enable estimates of change in parental knowledge and their views on the acceptability of the program. The Aboriginal Health Workers will also be interviewed to record their views on the acceptability and program feasibility. Clinical data on the child participants will be recorded when they are 30months old and compared with a reference population of similar children when the study began. Latent variable modeling will be used to interpret the intervention effects on disease outcome. Discussion. The research project will identify barriers to the implementation of a family centered Aboriginal oral health strategy, as well as the development of evidence to assist in the planning of a Phase III cluster randomized study. Trial registration. ACTRN12612000712808.

Clinical skills team modelling interprofessional collaboration

Susan I. Vella — Wed, 19 Dec 2012 20:35:10 PST

Background: The Graduate School of Medicine at the University of Wollongong began with its first cohort of 80 graduate-entry students in January 2007. A diverse group of tutors was recruited from the region to deliver the clinical skills program. Tutor expertise included clinical and academic education from generalist and specialist fields of nursing and medicine.

A variety of health and medical schools are investigating how to improve professional relationships within the health care industry by fostering interprofessional collaboration in the curriculum. One problem fostering interprofessional collaboration in the early years of training is lack of student awareness of the boundaries or expectations of their particular discipline.

Aims: To investigate the formation of the interprofessional team of clinical skills tutors within the school and explore this as a model for teaching interprofessional practice.

Methods: Semi-structured interviews of the clinical skills team were conducted by an independent interviewer. Those involved in analysis of the transcripts, while part of the team were not interviewed.

Results: Analysis of the narrative of those interviewed will be explored. The themes which stand out include, ‘factors contributing to a collaborative team’ (e.g. mutual respect and lack of hierarchy) and ‘striving for excellence together’ which illustrates Allports’ contact hypothesis of conflict reduction.

Conclusion: The interprofessional team in clinical skills demonstrating professional attitudes in ethical and professional behaviour is potentially a model for health care students that may be extended into the workplace.

Establishing a mental health rehabilitation unit in a regional area - What have we learnt one year on?

Narinder Panesar — Wed, 19 Dec 2012 20:30:25 PST

Pathogenesis of NIDDM in Pima Indians

Clitton Bogardus — Wed, 19 Dec 2012 20:30:25 PST

The Pima Indians of Arizona have the highest reported prevalence and incidence of non-insulin-dependent diabetes mellitus (NIDDM) of any population in the world. A cross-sectional and longitudinal study was begun in 1982 to determine the metabolic characteristic(s) that is (are) predictive of the development of NIDDM and to document the sequence of metabolic events that occur with the transition from normal to impaired glucose tolerance and then to diabetes. Preliminary analyses suggest that insulin resistance is a primary abnormality predisposing Pima Indians to develop impaired glucose tolerance, and that the development of diabetes occurs with subsequent pancreatic failure.

Australian sentinel practice research network.

Ian G. Wilson — Wed, 19 Dec 2012 20:25:11 PST

During the 1970s and 1980s the state-based Research Committees of the Royal Australian College of General Practitioners (RACGP) in South Australia and New South Wales developed independent networks of sentinel general practices. The networks monitored a number of conditions, but did not work cooperatively. In the late 1980s Dr Ian Steven, as the head of the RACGP research secretariat, brought the networks together and expanded the project into other states, leading to the establishment in 1990 of the Australian Sentinel Practice Network (ASPREN), a national group recording infectious and other diseases. Each year since then a small, dedicated group of general practitioners record basic epidemiological data on up to 14 conditions.

Medications are more heavily promoted than psychotherapies

Ian G. Wilson — Wed, 19 Dec 2012 20:25:11 PST

Audit on myocardial infarction in a district general hospital: Is there room for improvement in diagnostic accuracy?

Wilson Wong — Wed, 19 Dec 2012 20:25:11 PST

The proportion of patients with an acute myocardial infarction (MI) whose diagnosis was missed on admission was accessed. The admitting consultants were then tested to see if they could diagnose the patients correctly when they were shown the admission histories and electrocardiograms (ECGs). Twenty-six per cent of patients with a final diagnosis of MI were not correctly diagnosed on admission. Fifty-one per cent of all patients did not receive thrombolytic therapy (TT) mainly because the diagnosis was not made on admission. A smaller proportion of these patients were admitted to the coronary care unit (CCU). The consultants only correctly diagnosed an average of 7.3 of the 20 patients who were mis-diagnosed on admission and would have prescribed TT to an average of 4.3 of these 20 patients. A significant proportion of patients had a diagnosis of MI missed on admission and therefore did not receive TT. Therefore, another aid to diagnosis such as serum creatinine phosphokinase (CPK) measurement should be available as an emergency test.

Does doctors' knowledge of inflammatory bowel disease patients' psychological status affect patients' clinical outcomes: A pilot randomized controlled trial

Antonina A. Mikocka-Walus — Wed, 19 Dec 2012 20:20:10 PST

Evidence into practice: The mental health hurdle is high

Phillip Mitchell — Wed, 19 Dec 2012 20:20:10 PST

To the Editor: We are delighted at the attention which the editorial by Hickie and Blashki1 has drawn to our clinical update on the management of bipolar disorder in general practice.2 However, we are bemused by a number of the sentiments, criticisms and statements of fact included in that robustly expressed editorial.

What's your poison?

Alison L. Jones — Wed, 19 Dec 2012 20:20:10 PST

TOXBASE is the database provided by the National Poisons Information Service of the United Kingdom for use by CPs, hospital pharmacists and hospital doctors to provide information on the toxicity, clinical features and up to date management of acute poisoning. The database provides in/ormation on industrial chemicals, pharmaceuticals, pesticides, houselwld products, plants and 'uenomous animals or insects. The foUoUJing article discusses the database's design and development and some of the information technology involved.

Recent advances and key challenges in investigations of the flow inside human oro-pharyngeal-laryngeal airway

A Pollard — Wed, 19 Dec 2012 20:15:10 PST

The oro-pharyngeal-laryngeal human airway is a complex geometry; the flow physics within are subjected to and influenced by a variety of different factors that produce jet-like flow, re-circulating flows that are enhanced by curvature, detached and secondary flows. Simulation and experiment are the tools available to the fluid dynamics researcher. Simulation results obtained from direct and large-eddy simulation, and Reynolds-averaged Navier-Stokes and associated models of turbulence are reviewed. Experimental data obtained through the use of flow visualisation, hot-wire anemometry and particle image velocimetry are also reviewed. A comparison of data obtained from the application of these tools reveals many inconsistencies that are explored in this article. While much progress has been made to understand some of the physics of the flow in the human airway, we continue to uncover new and significant fluid dynamic behaviour. Finally, future research directions are suggested. © 2012 Copyright Taylor and Francis Group, LLC.

Progres recents dans le traitment des intoxications au paracetamol

Alison L. Jones — Wed, 19 Dec 2012 20:15:10 PST

Au Royaume-Uill et aux EtatsUills, Ie parac~tamol est utilise depuis plus de 40 ans comme antalgique de premiere ligne en raison de sa securite d'emploi a dose tMrapeutique. Au RoyaumeUni, il figure parmi les substances les plus sou vent impliquees dans les tentatives de suicide, seul dans la majorite des cas ou en association avec l' alcoo!. En moyenne, six patients intoxiques par cet antalgique sont admis chaque jour a la Poisons Unit de la Royal Infirmary d'Ectimbourg (incidence annuelle 400/100 000 habitants). Parmi eux, 0,02 % vont developper une Mpatite fulminante. Le parac~tamol en est la cause la plus frequente dans les unites de transplantation Mpatique d'outre-Manche. II rend compte de 10 % de tous les appels telephoniques arrivant aux National Poisons Information Service Centers de l' ensemble du pays. Le paracetamol est probablement responsable d'environ 200 a 300 deces par an, bien que certains cas puissent etre lies l'arret respiratoire ou a la cardiotoxicite induits par Ie dextropropoxyphene contenu dans des m~dications combinees

The study design and methodology for the ARCHER study - adolescent rural cohort study of hormones, health, education, environments and relationships

Katharine Steinbeck — Wed, 19 Dec 2012 20:10:14 PST

Background: Adolescence is characterized by marked psychosocial, behavioural and biological changes and represents a critical life transition through which adult health and well-being are established. Substantial research confirms the role of psycho-social and environmental influences on this transition, but objective research examining the role of puberty hormones, testosterone in males and oestradiol in females (as biomarkers of puberty) on adolescent events is lacking. Neither has the tempo of puberty, the time from onset to completion of puberty within an individual been studied, nor the interaction between age of onset and tempo. This study has been designed to provide evidence on the relationship between reproductive hormones and the tempo of their rise to adult levels, and adolescent behaviour, health and wellbeing.

Methods/Design The ARCHER study is a multidisciplinary, prospective, longitudinal cohort study in 400 adolescents to be conducted in two centres in regional Australia in the State of New South Wales. The overall aim is to determine how changes over time in puberty hormones independently affect the study endpoints which describe universal and risk behaviours, mental health and physical status in adolescents. Recruitment will commence in school grades 5, 6 and 7 (10–12 years of age). Data collection includes participant and parent questionnaires, anthropometry, blood and urine collection and geocoding. Data analysis will include testing the reliability and validity of the chosen measures of puberty for subsequent statistical modeling to assess the impact over time of tempo and onset of puberty (and their interaction) and mean-level repeated measures analyses to explore for significant upward and downward shifts on target outcomes as a function of main effects.

Discussion The strengths of this study include enrollment starting in the earliest stages of puberty, the use of frequent urine samples in addition to annual blood samples to measure puberty hormones, and the simultaneous use of parental questionnaires.

Is there room for general practice in penitentiary institutions: screening and vaccinating high-risk groups against hepatitis

Marios Chatziarsenis — Sun, 16 Dec 2012 16:10:11 PST

OBJECTIVE: The purpose of this study was to determine the prevalence of hepatitis markers in inmates and staff of the Penitentiary of Neapolis on Crete and discuss the role of GPs in identifying and vaccinating susceptible subjects.

METHOD: Forty-five prisoners and 20 house workers were invited to participate in the study. Hepatitis B (HBV) markers (HBsAg and anti-HBc) and hepatitis C antibodies (anti-HCV) were tested. Vaccination against hepatitis B was administered to all susceptible subjects.

RESULTS: Hepatitis B carriage was found in 10 people, six of whom were prisoners. Fifteen of the subjects tested were found to be positive for anti-HBc, six of whom were house workers. Anti-HCV were found to be positive in seven prisoners and one worker. A vaccination programme against hepatitis B was introduced in 27 susceptible subjects (58.7% of unexposed subjects) and was completed in 22.

CONCLUSION: Prisoners and staff at Neapolis Prison constitute a high-risk group for hepatitis B and C. Compliance rate in screening was high and GPs were successful in having a desirable response rate in the administration of vaccines.

The Von Hippel-Lindau (VHL) tumor-suppressor gene is not mutated in sporadic human colon adenocarcinomas

Spyridon Miyakis — Sun, 16 Dec 2012 16:10:10 PST

Von Hippel-Lindau (VHL) disease is a hereditary cancer syndrome, where the affected kindreds manifest multiple tumors, mainly of the central nervous system, renal and pancreatic tissue (Maher and Kaelin, 1997). The gene responsible for the disorder is a tumor-suppressor gene (Latif et al., 1993). Numerous germline mutations of VHL gene have been identified among families with various patterns of disease phenotypes (Zbar et al., 1996). Mutations of VHL, as well as allelic loss at the gene locus 3p25-26, have been repeatedly described in series from sporadic cases of the tumor types involved in VHL disease (Bailly et al., 1995; Lee et al., 1998). Frequent detection of somatic mutations of the gene in renal clear cell carcinoma (Gnarra et al., 1994; Foster et al., 1994; Shuin et al., 1994) and central nervous system hemangioblastomas (Kanno et al., 1994) provides evidence that these events are critical to the pathogenesis of such tumor types. This was further enhanced by the recent association of carcinogen exposure with specific VHL mutations in renal cell carcinoma (Brauch et al., 1999).

Expression of the solute carriers, SLC5A8 and SLC2A1, and metalloproteinases, MMP-2, MMP-7, MMP-9, MMP-12 and the MMP inhibitor, RECK, in colorectal cancer

Caroline A. Kerr — Sun, 16 Dec 2012 16:05:10 PST

Differential expression and mutation of the ras family genes in human breast cancer

Spyridon Miyakis — Sun, 16 Dec 2012 16:05:10 PST

The expression of ras mRNA levels in 27 human sporadic breast cancer specimens was examined, and compared to the corresponding adjacent normal tissue using the RT-PCR technique. Eighteen out of the 27 specimens (67%) exhibited two- to four-fold increased expression of ras mRNA levels, compared to corresponding normal tissue. The rates of augmented mRNA expression were similar among the three ras genes. A statistically significant correlation of overexpression of ras genes in specimens classified as Stage I disease was observed, compared to tumors in a more advanced stage (II or III). The incidence of codon 12 point mutations of the K-ras gene in fresh tissue samples was also assessed in 61 human sporadic breast cancer cases. Point mutations were detected in four (6.5%) out of the 61 cases examined; no correlation was found with any clinicopathological parameter. This is the first report to our knowledge of the differential expression of the ras family genes in breast carcinoma. Our findings indicate that the aberrant expression of ras genes may be an initial event in breast cancer oncogenesis and that K-ras point mutations are rarely involved in the development of mammary neoplasias.

DNA damage and repair signatures in rats fed 'Western' Diets

Caroline A. Kerr — Sun, 16 Dec 2012 16:00:17 PST

Expression pathways in the colonic epithelium of normal and azoxymethane-treated rats

Caroline A. Kerr — Sun, 16 Dec 2012 16:00:17 PST