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ABSTRACT: Background/Aims:Timely access to appropriate cardiac care is critical for optimizing positive outcomes after a cardiac event. Attendance at cardiac rehabilitation (CR) remains less than optimal (10%-30%). Our aim was to derive an objective, comparable, geographic measure reflecting access to cardiac services after a cardiac event in Australia.Methods:An expert panel defined a single patient care pathway and a hierarchy of the minimum health services for CR and secondary prevention. Using geographic information systems a numeric/alpha index was modelled to describe access before and after a cardiac event. The aftercare phase was modelled into five alphabetical categories: from category A (access to medical service, pharmacy, CR, pathology within 1 h) to category E (no services available within 1 h).Results:Approximately 96% or 19 million people lived within 1 h of the four basic services to support CR and secondary prevention, including 96% of older Australians and 75% of the indigenous population. Conversely, 14% (64,000) indigenous people resided in population locations that had poor access to health services that support CR after a cardiac event.Conclusion:Results demonstrated that the majority of Australians had excellent 'geographic' access to services to support CR and secondary prevention. Therefore, it appears that it is not the distance to services that affects attendance. Our 'geographic' lens has identified that more research on socioeconomic, sociological or psychological aspects to attendance is needed.
European journal of cardiovascular nursing: journal of the Working Group on Cardiovascular Nursing of the European Society of Cardiology 04/2013;
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Academic medicine: journal of the Association of American Medical Colleges 10/2012; 87(10):1310. · 2.34 Impact Factor
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ABSTRACT: Skin cancer is a major cause of mortality and morbidity in Australia, and primary care doctors can, and should, treat most cases.
In this article we outline one method for the effective use of dermatoscopy in diagnosing melanoma and other skin malignancies in general practice.
The use of a dermatoscope in clinical practice has been shown to increase diagnostic accuracy and is considered the standard of care in assessing patients with pigmented skin lesions. Its use is also being increasingly applied to the diagnosis of nonpigmented skin lesions. Like any clinical tool, training is required for effective use. 'Chaos and clues' is a straightforward method of rapidly assessing suspicious pigmented skin lesions using a dermatoscope; its use can lead to improved diagnosis of melanoma and other skin malignancies.
Australian family physician 07/2012; 41(7):482-7. · 0.73 Impact Factor
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ABSTRACT: In small groups, medical students were involved in generating questions to contribute to an online item bank. This study sought to support collaborative question‐writing and enhance students’ metacognitive abilities, in particular, their ability to self‐regulate learning and moderate understanding of subject material. The study focused on supporting students to write questions requiring higher order cognitive processes. End‐of‐year formal examinations comprised 25% student‐generated questions (SGQs), while mid‐year examination items were completely unseen. Data were gathered from repeated administration of a questionnaire and from examination results. No statistically significant changes were identified in self‐rated monitoring of understanding and regulation of learning. The activity of generating questions supported students to work collaboratively in developing questions and answers. The bank of questions was appreciated by students as a source of revision material, even though it was not strongly focused on higher order processes. Based on scores, it would appear that many students chose to memorise the question bank as a ‘high‐yield’ strategy for mark inflation, paradoxically favouring surface rather than deep learning. The study has not identified directly improvements in metacognitive capacity and this is an area for further investigation. Continual refinement of the study method will be undertaken, with an emphasis on education of students in developing questions addressing higher order cognitive processes. Although students may have memorised the questions and answers, there is no evidence that they do not understand the information.
Assessment & Evaluation in Higher Education 06/2012; 37(4):439-452. · 0.84 Impact Factor
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ABSTRACT: This study aimed to describe the prevalence of perceived workplace bullying in the Australian medical workforce, and investigate the relationship between workplace bullying and job satisfaction, health status, and current and planned medical workforce participation.
An electronic cross-sectional survey of doctors currently in the paid workforce, conducted between April 2008 and October 2009, was nested within a longitudinal cohort study investigating factors affecting the recruitment and retention of the Australian medical workforce. To address the specific aims of this study, a subset of questions in the survey investigated the prevalence of self-reported bullying; physical and mental health; workforce participation patterns; job satisfaction; and job stressors.
Seven hundred and forty-seven participants responded to the bullying question and were included in this analysis. Twenty-five percent of participants reported being bullied in the last 12 months. There were no differences in the reported rates of bullying across age groups, sex and country of medical qualification. Bullied doctors were least satisfied with their jobs (P<0.001), had taken more sick leave in the last 12 months (P<0.001), and were more likely to be planning to decrease the number of hours worked in medicine in the next 12 months (P=0.01) or ceasing direct patient care in the next 5 years (independent of their age or the number of hours currently worked in patient care) (P=0.006).
Our findings suggest that Australian doctors, independent of age or sex, have experienced workplace bullying, and although no conclusions can be made about causal pathways, there were strong associations between this exposure and poorer health and wellbeing, and on remaining in the medical workforce.
Australian health review: a publication of the Australian Hospital Association 05/2012; 36(2):197-204. · 0.55 Impact Factor
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ABSTRACT: Access to cardiac services is essential for appropriate implementation of evidence-based therapies to improve outcomes. The Cardiac Accessibility and Remoteness Index for Australia (Cardiac ARIA) aimed to derive an objective, geographic measure reflecting access to cardiac services.
An expert panel defined an evidence-based clinical pathway. Using Geographic Information Systems (GIS), the team developed a numeric/alphabetic index at 2 points along the continuum of care. The acute category (numeric) measured the time from the emergency call to arrival at an appropriate medical facility via road ambulance. The aftercare category (alphabetic) measured access to 4 basic services (family doctor, pharmacy, cardiac rehabilitation, and pathology services) when a patient returned to his or her community. The numeric index ranged from 1 (access to principal referral center with cardiac catheterization service ≤1 hour) to 8 (no ambulance service, >3 hours to medical facility, air transport required). The alphabetic index ranged from A (all 4 services available within a 1-hour drive-time) to E (no services available within 1 hour). The panel found that 13.9 million Australians (71%) resided within Cardiac ARIA 1A locations (hospital with cardiac catheterization laboratory and all aftercare within 1 hour). Those outside Cardiac 1A were overrepresented by people >65 years of age (32%) and indigenous people (60%).
The Cardiac ARIA index demonstrated substantial inequity in access to cardiac services in Australia. This methodology can be used to inform cardiology health service planning and could be applied to other common disease states within other regions of the world.
Circulation 03/2012; 125(16):2006-14. · 14.74 Impact Factor
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ABSTRACT: To determine the predictive validity of the Undergraduate Medicine and Health Sciences Admission Test (UMAT) for academic performance at university.
We studied all 339 students who entered medical study at the School of Medicine, University of Queensland, directly from high school, between 2005 and 2009.
UMAT scores before entry compared with grade point averages (GPAs) during university study.
Mean overall UMAT score at entry was 60/100 and mean GPA during university study was 6.1 (range, 1-7), with a correlation coefficient of 0.15 (P = 0.005). This relationship existed only in the first year of university study. For UMAT Section 1 score, the correlation coefficient was 0.14 (P = 0.01); for UMAT Section 2, the correlation coefficient was 0.06 (P = 0.29); and for UMAT Section 3, the correlation coefficient was 0.09 (P = 0.11). UMAT overall score for men (60.2) and women (59.8), and GPA for men (6.1) and women (6.2) were similar. However, men performed better in Section 1 (mean score 61.6 v 61; P = 0.05) and Section 3 (63.2 v 60.7; P < 0.001), whereas women performed better in Section 2 (58.5 v 55.8; P = 0.009). In multivariate analysis, only correlation between GPA and UMAT Section 1 score remained significant but was weak and lasted for 1 year of university study.
Our findings suggest that UMAT has limited predictive validity for academic performance.
The Medical journal of Australia 04/2011; 194(7):341-4. · 2.81 Impact Factor
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Cliff Rosendahl,
Craig Hansen,
Alan Cameron,
Peter Bourne,
Tobias Wilson,
Ben Cook,
Martin Baker,
Jeff Keir,
Tony Dicker,
Mike Reid,
Richard Williamson,
David Weedon,
H Peter Soyer,
Philippa H Youl, David Wilkinson
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ABSTRACT: The Skin Cancer College of Australia and New Zealand (SCCANZ) has developed a unique project named SCARD - the Skin Cancer Audit and Research Database. Designed initially as a self-audit tool for primary care skin cancer practitioners, SCARD acts as a tracking tool to enhance practice safety, and it also creates practice performance reports. Pooling of de-identified data enables participating practitioners to confidentially compare their own practice to that of their peers. Additionally, this creates a large database with significant research potential, as SCARD records for every lesion de-identified practitioner and patient data, and extensive details of location, provisional and histological diagnosis, and the procedure(s) performed in its treatment.
Preliminary data collected in the database have been presented in this study.
An initial pool of data from 177 practitioners contains 77,553 specimens from 41,006 individual patients.
The data presented are being analyzed for further studies, and additional data continues to be collected from this ongoing project. SCARD is a useful tool at practice level, and substantial uptake by Australian primary care skin cancer practitioners has provided a unique opportunity for research into skin cancer and its management. SCCANZ, a professional college of predominantly primary care medical practitioners, with a commitment to the management of skin cancer in Australia and New Zealand, has formed a partnership with the School of Medicine at the University of Queensland to ensure that these data are managed and analyzed appropriately.
International journal of dermatology 01/2011; 50(1):44-51. · 1.18 Impact Factor
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ABSTRACT: The GP Super Clinics Program is a highly topical and controversial initiative with varying levels of support within the policy, consumer and health care communities. Here, we describe the GP super clinic initiative of the University of Queensland (UQ), and how it aims to enhance primary-care capacity in the regions where clinics are based. The UQ GP super clinic model has considered the concerns of general practitioners, patients and other stakeholders, and addresses the needs of these groups while providing an excellent opportunity for the university to be involved in innovative service delivery, community-based education, primary-care service design and evaluation.
The Medical journal of Australia 07/2010; 193(2):86-9. · 2.81 Impact Factor
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ABSTRACT: In the context of the impending national registration of health practitioners in Australia including doctors, this column describes the types and patterns of complaints to a State Medical Board across an extended period, about graduates from one medical school. De-identified data concerning complaints about medical practitioners who had graduated from the University of Queensland, made to the Medical Board of Queensland between 1968 and 2006, were analysed. The main outcome measures were category of complaint, total complaint rate per doctor-year, frequency of complaints per practitioner and outcomes of complaints. There were 12 categories of complaints, encompassing different aspects of clinical management, impairment and unethical conduct. Outcomes included "no further action", a hierarchy of recommendations and conditions on registration, suspension, deregistration, health assessment, or referral to alternative bodies. Complaints predominantly related to clinical standards, and this also applied to those who attracted multiple complaints. Most cases were managed without resort to sanctions of any kind. Sanctions may be underutilised, particularly in cases of apparent recalcitrance. Improved tracking and appropriate reeducation and disciplinary measures will assist in better protecting the public under the new national registration arrangements.
Journal of law and medicine 02/2010; 17(4):493-501.
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ABSTRACT: To study rates of incomplete excision of basal (BCC) and squamous (SCC) cell cancer by Australian general practitioners with a special interest.
Records review.
A network of 15 primary care skin cancer clinics across Australia.
Fifty-seven physicians performing excisions of 9417 BCCs and SCCs in a single network of 15 primary care skin cancer clinics across Australia between 2005 and 2007.
Rates of incomplete excision according to physician, clinic, anatomic location of the lesion, and whether a previous biopsy had been performed.
Four hundred forty-three of 6881 BCCs (6.4%) and 159 of 2536 SCCs (6.3%) were excised incompletely. Incomplete BCC and SCC excisions were more frequent on the head and neck (282 of 2872 excisions [9.8%] and 97 of 861 [11.3%], respectively) than elsewhere. Ears (74 of 388 excisions [19.1%]) and nose (78 of 546 [14.3%]) had the highest rates of incompletely excised BCCs, and ears (26 of 144 excisions [18.1%]) and forehead (20 of 157 [12.7%]) had the highest rates of incompletely excised SCCs. Of all BCC excisions, 67.3% were once-off excisions with no previous biopsy, and these excisions were more likely to be incomplete (odds ratio, 1.73; 95% confidence interval, 1.36-2.20) than those with a previous biopsy. There was, however, substantial variation in frequency of incomplete excision between clinics for BCC (ranging from 3.3% to 24.7%) and SCC (ranging from 0% to 17.2%) and between physicians within clinics (BCC ranging from 0% to 31.1%, and SCC ranging from 0% to 23.5%).
Overall frequency of incomplete excision is low and similar to that in other reports. However, high frequency in high-risk sites, low rates of previous biopsy, and substantial variation in performance between physicians and clinics suggests there is significant opportunity to further improve health outcomes.
Archives of dermatology 11/2009; 145(11):1253-60. · 4.76 Impact Factor
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ABSTRACT: Assessment partnerships between staff and students are considered a vital component of the student-centred educational process. To enhance the development of this partnership in a problem-based learning curriculum, all first-year students were involved in generating a bank of formative assessment questions with answers, some of which were included in their final written examination. Important principles to guide development of a sound methodology for such an assessment partnership have been described. These include organisational issues as well as matters pertaining to participation, education and motivation of students and teaching staff.
Advances in Health Sciences Education 09/2009; 16(5):703-10. · 2.09 Impact Factor
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ABSTRACT: The number needed to treat (NNT) is a key measure of the quality of melanoma diagnosis. There are few data on this measure from primary care skin cancer clinics in Australia.
We sought to report the NNT from a large pathology database and examine several patient characteristics.
We calculated NNT by doctor and clinic among 10,612 lesions, 6796 patients, 57 doctors, and 15 clinics from a pathology database. NNT was calculated with and without seborrheic keratoses.
Overall NNT was 30 (with seborrheic keratoses) and 23 (without seborrheic keratoses). Excluding the 4 doctors with NNT greater than 60, total NNT decreased from 30 to 21 and from 23 to 15, respectively (with and without seborrheic keratoses). NNT was higher for female patients and younger patients (<30 years). NNT varied by doctor from 0 to 192 and 117, respectively (with and without seborrheic keratoses).
Given the retrospective design, we were unable to examine doctor characteristics such as age, sex, medical training, and patient pressure to excise.
Substantial variability in individual doctor NNT produced an overall NNT similar to that reported from mainstream general practice, and higher than specialist practice.
Journal of the American Academy of Dermatology 09/2009; 61(4):599-604. · 3.99 Impact Factor
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ABSTRACT: The doctor shortage in Australia generally, and the rural shortage in particular, has led to an increase in medical schools, medical places and rural training. If effective, these strategies will first impact on the intern workforce. We studied the source of interns in Queensland.
Analysis of number, source and location of interns by Rural, Remote and Metropolitan Area (RRMA) classification (an index of remoteness) from university and health department records (2003-2008). Odds ratios compared the likelihood of intern supply from Queensland universities and rural clinical schools.
Most interns in Queensland graduated from Queensland universities in 2007 (287 [72%]) and 2008 (344 [84%]). Proportions increased across all three RRMA groups from: 82% to 93% in RRMA1; 56% to 68% in RRMA2 and 67% to 79% in RRMA3. The University of Queensland (UQ) provides most interns in all RRMA locations including RRMA3, and this increased from 2007 (n = 33 [35%]) to 2008 (n = 57 [58%]). Interns from interstate decreased from 61 (15%) in 2007 to 40 (10%) in 2008. Interns from overseas fell from 53 (13%) in 2007 to 27 (7%) in 2008. Rural clinical schools compared with traditional urban-based schools were more likely to supply interns to RRMA3 than RRMA1 hospitals in 2007 (OR, 8.8; 95% CI, 4.6-16.7; P < 0.0001) and 2008 (OR, 6.5; 95% CI, 3.5-12.2; P < 0.0001).
Queensland is close to self-sufficiency in intern supply and will achieve this in the next few years. Rural clinical schools are playing an important role in producing interns for RRMA3 hospitals. Due to its large cohort, UQ remains the major provider across all RRMA groups.
Australian health review: a publication of the Australian Hospital Association 08/2009; 33(3):472-7. · 0.55 Impact Factor
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International journal of dermatology 06/2009; 48(5):453-63. · 1.18 Impact Factor
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ABSTRACT: There is a paucity of data to describe advanced forms of cardiovascular disease (CVD) in urban black Africans with hypertension (HT).
Chris Hani Baragwanath Hospital services the black African community of 1.1 million people in Soweto, South Africa. We prospectively collected detailed demographic and clinical data from all de novo presentations to the hospital's Cardiology Unit in 2006.
Overall, 761 black African patients (56% of de novo cases) presented with a diagnosis of HT with more women (63%, aged 58.5±14.9 years) than men (aged 58.0±15.6 years). On presentation, 396 women (82%) versus 187 men (67%) had dizziness, palpitations and/or chest pain (OR 1.23, 95% 1.12-1.34: p<0.0001). HT was the primary diagnosis in 266 cases (35%). In the rest (n=495), non-ischaemic forms of heart failure were common (54% of total) while only 6.2% had coronary artery disease. Concurrent left ventricular hypertrophy, renal dysfunction and anaemia were present in 39%, 24% and 11% of cases, respectively, with a similar age-adjusted pattern of co-morbidity according to sex. However, men were more likely to present with impaired systolic function (OR 2.13, 95% CI 1.50 to 3.00; p<0.0001).
In the absence of effective primary and secondary prevention strategies, these unique data highlight the potentially devastating impact of advanced forms of hypertensive heart disease in urban black African communities with more women than men affected.
International journal of cardiology 06/2009; 146(1):22-7. · 7.08 Impact Factor
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ABSTRACT: There is a paucity of data to describe the clinical characteristics of heart failure (HF) in urban African communities in epidemiological transition.
Chris Hani Baragwanath Hospital services the 1.1 million black African community of Soweto, South Africa. Of 1,960 cases of HF and related cardiomyopathies in 2006, we prospectively collected detailed demographic and clinical data from all 844 de novo presentations (43%). Mean age was 55 +/- 16 years, and women (479 [57%]) and black Africans (739 [88%]) predominated. Most (761 [90%]) had > or =1 cardiovascular risk. Mean left ventricular ejection fraction was 45 +/- 18%. Overall, 180 patients (23%) had isolated diastolic dysfunction, 234 (28%) tricuspid regurgitation, 121 (14%) isolated right HF, and 100 (12%) mitral regurgitation. The most common diagnoses were hypertensive HF (281 [33%]), idiopathic dilated cardiomyopathy (237 [28%]), and, surprisingly, right HF (225 [27%]). Black Africans had less ischemic cardiomyopathy (adjusted odds ratio, 0.12; 95% CI, 0.07 to 0.20) but more idiopathic and other causes of cardiomyopathy (adjusted odds ratio, 4.80; 95% CI, 2.57 to 8.93). Concurrent renal dysfunction, anemia, and atrial fibrillation were found in 172 (25%), 72 (10%), and 53 (6.3%) cases, respectively.
These contemporary data highlight the multiple challenges of preventing and managing an increasing and complex burden of HF in urban Africa. In addition to tackling antecedent hypertension, a predominance of young women and a large component of right HF predicate the development of tailored therapeutic strategies.
Circulation 01/2009; 118(23):2360-7. · 14.74 Impact Factor
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ABSTRACT: The critical shortage of the rural medical workforce in Australia continues. There is pressure on medical schools to produce not only more doctors, but to supply them in geographical areas of need. The latest policy to tackle these problems will increase medical student numbers while the supply of clinical teachers and patients for teaching remains static. This challenges the traditional apprenticeship model for learning medicine. Coupled with this is the requirement of medical schools to provide compulsory rural clinical placements for all students. The success of rural clinical schools and University Departments of Rural Health (UDRH) is increasingly apparent, but they must find new strategies to maintain a quality clinical experience and exposure to rural lifestyle for all medical students. The dilemma is providing this quality rural experience to all medical students in the immediate future. We suggest approaches to meet this challenge at a policy, organisational, student and teaching level.
The Medical journal of Australia 07/2008; 188(11):669-71. · 2.81 Impact Factor
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ABSTRACT: There are minimal reports of seasonal variations in chronic heart failure (CHF)-related morbidity and mortality beyond the northern hemisphere.
We examined potential seasonal variations with respect to morbidity and all-cause mortality over more than a decade in a cohort of 2961 patients with CHF from a tertiary referral hospital in South Australia subject to mild winters and hot summers.
Seasonal variation across all event-types was observed. CHF-related morbidity peaked in winter (July) and was lowest in summer (February): 70 (95% CI: 65 to 76) vs. 33 (95% CI: 30 to 37) admissions/1000 at risk (p<0.005). All-cause admissions (113 (95% CI: 107 to 120) vs. 73 (95% CI 68 to 79) admissions/1000 at risk, p<0.001) and concurrent respiratory disease (21% vs. 12%, p<0.001) were consistently higher in winter. 2010 patients died, mortality was highest in August relative to February: 23 (95% CI: 20 to 27) vs. 12 (95% CI: 10 to 15) deaths per 1000 at risk, p<0.001. Those aged 75 years or older were most at risk of seasonal variations in morbidity and mortality.
Seasonal variations in CHF-related morbidity and mortality occur in the hot climate of South Australia, suggesting that relative (rather than absolute) changes in temperature drive this global phenomenon.
European Journal of Heart Failure 06/2008; 10(6):540-9. · 4.90 Impact Factor
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ABSTRACT: The Heart of Soweto Study aims to increase our understanding of the characteristics and burden imposed by heart disease in an urban African community in probable epidemiological transition. We aimed to investigate the clinical range of disorders related to cardiovascular disease in patients presenting for the first time to a tertiary-care centre.
From Jan 1 to Dec 31, 2006, we recorded data for 4162 patients with confirmed cases of cardiovascular disease (1593 newly diagnosed and 2569 previously diagnosed and under treatment) who attended the cardiology unit at the Chris Hani Baragwanath Hospital in Soweto, South Africa. We developed a prospectively designed registry and gathered detailed clinical data relating to the presentation, investigations, and treatment of all 1593 patients with newly diagnosed cardiovascular disease.
Most patients were black Africans (n=1359 [85%]), and the study population contained more women (n=939 [59%]) than men. Women were slightly younger than were men (mean 53 [SD 16] years vs 55 [15] years; p=0.031), with 399 (25%) patients younger than 40 years. Heart failure was the most common primary diagnosis (704 cases, 44% of total). Moderate to severe systolic dysfunction was evident in 415 (53%) of 844 identified cases of heart failure, 577 (68%) of which were attributable to dilated cardiomyopathy or hypertensive heart disease, or both. Black Africans were more likely to be diagnosed with heart failure than were the rest of the cohort (739 [54%] vs 105 [45%]; odds ratio [OR] 1.46, 95% CI 1.11-1.94; p=0.009) but were less likely to be diagnosed with coronary artery disease (77 [6%] vs 88 [38%]; OR 0.10, 0.07-0.14; p<0.0001). Prevalence of cardiovascular risk factors was very high, with 897 (56%) patients diagnosed with hypertension (190 [44%] of whom were also obese). Only 209 (13%) patients had no identifiable risk factors, whereas 933 (59%) had several risk factors.
We noted many threats to the present and future cardiac health of Soweto, including a high prevalence of modifiable risk factors for atherosclerotic disease and a combination of infectious and non-communicable forms of heart disease, with late clinical presentations. Overall, our findings provide strong evidence that epidemiological transition in Soweto, South Africa has broadened the complexity and spectrum of heart disease in this community. This registry will enable continued monitoring of the range of heart disease.
The Lancet 03/2008; 371(9616):915-22. · 38.28 Impact Factor
