Other
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LanguagesMandarin, Hakka, Cantonese, Malay
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Scientific MembershipsASCIA, TSANZ, ATS,
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Journal RefereesClinical and Experimental Allergy, Respirology, Thorax, The Medical journal of Australia
Publications (100) View all
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Article: Implementation Of A Clinical Prediction Tool For Pulmonary Embolism Diagnosis In A Tertiary Teaching Hospital Reduces The Number Of Ct Pulmonary Angiograms Performed.
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ABSTRACT: OBJECTIVE: To evaluate the effect of implementing the Wells score clinical prediction tool (CPT) on rationalising the use of computed tomography pulmonary angiography (CTPA) for diagnosing pulmonary embolism (PE). DESIGN AND SETTING: Within a tertiary teaching hospital, a retrospective study was conducted applying Wells score to all CTPAs ordered in the first quarter of 2007. Subsequently an algorithm including Wells score and D-dimer assay was developed to assist clinicians in rationalising their ordering of CTPAs. A prospective study was performed from February to August 2009 to assess the impact of this algorithm. CTPA results, D-dimer levels, referral sources and dates were recorded. MAIN OUTCOME MEASURES: The number of CTPAs performed over a 7 month period following implementation of the algorithm was compared to the same period during the previous year. PE prevalence within each risk category was compared to the published literature. RESULTS: 333 patients were investigated with CTPA in the prospective study period. 268 patients (80.4% of cases) had complete data. The prevalence of PE in our study was 13.8% with 57 (21.2%) patients stratified to low risk, 169 (63.0%) to intermediate risk and 42 (15.6%) to high risk. Subgroup prevalence was 8.8%, 11.8% and 23.8% respectively. Compared to the same period in 2008, 121 (26.6%) less CTPAs were performed. CONCLUSION: Institutional implementation of a clinical prediction tool into the decision making process is feasible and significantly reduces the number of CTPAs being performed, with substantial cost savings and patient benefits.Internal Medicine Journal 08/2012; · 1.54 Impact Factor -
Article: Accuracy of asthma and COPD diagnosis in Australian general practice: a mixed methods study.
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ABSTRACT: Spirometry is the 'gold standard' for diagnosing asthma and chronic obstructive pulmonary disease (COPD) but is rarely used in general practice. To compare doctor diagnoses with patient reports/spirometry and to determine doctors' perceptions of spirometry. Patients prescribed inhaled medication were recruited from 31 practices. Doctor diagnoses were extracted from practice records. Patients completed a questionnaire and spirometry before and after bronchodilator. In-depth interviews were conducted with a sample of doctors. Doctor diagnoses were available for 278 patients: asthma 192 (69%), COPD 38 (14%), asthma/COPD 40 (14%), and eight patients (3%) with other conditions. The diagnosis of asthma was correctly reported by 93% of patients, but only by 61% of those with COPD alone. Among those with both diagnoses, 83% reported asthma and 48% reported COPD. Of those with a diagnosis of COPD, 65% had fixed airflow limitation. Conversely, only 14% of those had been diagnosed with COPD alone. There was no significant difference in reversibility in forced expiratory volume in 1 second between diagnoses. While recognising the value of spirometry in differentiating between asthma and COPD, most general practices only used spirometry in diagnostically difficult cases. Doctor-diagnosed asthma is accurately reported by patients. However, COPD remains substantially under-diagnosed. Spirometry needs to be more widely used to improve the accuracy of respiratory diagnoses in general practice.Primary care respiratory journal: journal of the General Practice Airways Group 01/2012; 21(2):167-73. -
Article: Ear-acupressure for allergic rhinitis: a systematic review.
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ABSTRACT: Allergic rhinitis affects 10-40% of the population globally with a substantial health and economic impact on the community. To assess the effectiveness and safety of ear-acupuncture or ear-acupressure for the treatment of allergic rhinitis by reviewing randomised controlled trials and quasi-randomised controlled trials. This review followed the methods specified in the Cochrane Handbook for Systematic Reviews of Interventions. A total of 21 electronic English and Chinese databases were searched from their respective inceptions to April 2008. Key words used in the search included the combination of ear, auricular, acupuncture, acupressure, acupoint, allergic, allergy, rhinitis, hayfever, randomised clinical trial and their synonyms. The methodological quality was assessed using Jadad's scale. The effect size analysis was performed to explore the difference between interventional groups. Ninety-two research papers were identified and seven of them referring to five studies met the inclusion criteria. All included studies involved ear-acupressure treatment. These studies mentioned randomisation, but no details were given. None of the five studies used blinding or intention-to-treat analysis. Ear-acupressure was more effective than herbal medicine, as effective as body acupuncture or antihistamine for short-term effect, but it was more effective than anti-histamine for long-term effect. The benefit of ear-acupressure for symptomatic relief of allergic rhinitis is unknown due to the poor quality of included studies.Clinical otolaryngology: official journal of ENT-UK; official journal of Netherlands Society for Oto-Rhino-Laryngology & Cervico-Facial Surgery 02/2010; 35(1):6-12. · 2.39 Impact Factor -
Article: Do spirometry and regular follow-up improve health outcomes in general practice patients with asthma or COPD? A cluster randomised controlled trial.
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ABSTRACT: To determine whether spirometry with regular medical review improves the quality of life or other health outcomes among patients with asthma or chronic obstructive pulmonary disease (COPD) managed in general practice. Cluster randomised controlled trial conducted in 31 general practices in Melbourne during 2007-2008. Practices recruited 305 adult patients who had been prescribed inhaled medication in the preceding 6 months. Practices were randomly assigned to one of three groups: Group A patients received 3-monthly spirometry performed by a respiratory scientist with results returned to the practice and regular medical review; Group B patients received spirometry only before and after the trial; and Group C patients received usual care. Quality of life, assessed with the 36-item Short Form (SF-36) Australian (English) Version 2 questionnaire at baseline and 3, 6, 9 and 12 months. Secondary outcomes were assessed with the European Community Respiratory Health Survey at baseline and 12 months. The trial was completed by 253 participants: 79 in Group A, 104 in Group B, and 70 in Group C. Median age was 58 years (range, 18-70 years), and 167 participants (66%) were women. There were no significant changes in SF-36 Physical and Mental Component Summary scores from baseline to 12 months, or significant differences between groups on either scale or any subscale of the SF-36. There were also no significant differences in respiratory symptoms, asthma attacks, written asthma action plans, days lost from usual activities or health care utilisation. Three-monthly spirometry and regular medical reviews by general practitioners are not associated with any significant improvement in quality of life or other health outcomes for patients with asthma and/or COPD. Australian New Zealand Clinical Trials Registry ACTRN12606000378527.The Medical journal of Australia 07/2010; 193(2):104-9. · 2.81 Impact Factor -
Article: Systematic review of the effectiveness of breathing retraining in asthma management.
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ABSTRACT: In asthma management, complementary and alternative medicine is enjoying a growing popularity worldwide. This review synthesizes the literature on complementary and alternative medicine techniques that utilize breathing retraining as their primary component and compares evidence from controlled trials with before-and-after trials. Medline, PubMed, Cumulative Index to Nursing and Allied Health Literature and the Cochrane Library electronic databases were searched. Reference lists of all publications were manually checked to identify studies not found through electronic searching. The selection criteria were met by 41 articles. Most randomized controlled trials (RCTs) of the Buteyko breathing technique demonstrated a significant decrease in β(2)-agonist use while several found improvement in quality of life or decrease in inhaled corticosteroid use. Although few in number, RCTs of respiratory muscle training found a significant reduction in bronchodilator medication use. Where meta-analyses could be done, they provided evidence of benefit from yoga, Buteyko breathing technique and physiotherapist-led breathing training in improving asthma-related quality of life. However, considerable heterogeneity was noted in some RCTs of yoga. It is reasonable for clinicians to offer qualified support to patients with asthma undertaking these breathing retraining techniques.Expert Review of Respiratory Medicine 12/2011; 5(6):789-807.
