Anne Tonkin

Anne Tonkin
University of Adelaide · School of Medicine

BMBS, MEd, PhD, FRACP

About

96
Publications
15,285
Reads
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2,436
Citations
Citations since 2017
0 Research Items
629 Citations
2017201820192020202120222023020406080100120
2017201820192020202120222023020406080100120
2017201820192020202120222023020406080100120
2017201820192020202120222023020406080100120
Introduction
Anne Tonkin previously worked at the Adelaide Medical School, University of Adelaide. Anne did research in clinical autonomic disorders, educational assessment and medical education. Their most recent publication is 'Clinical approach to autonomic dysfunction”. She is currently Chair of the Medical Board of Australia.
Additional affiliations
January 2015 - present
University of Adelaide
Position
  • Professor Emeritus
January 2005 - December 2014
University of Adelaide
Position
  • Director, Medicine Learning and Teaching Unit
Description
  • Academic interest in medical education, and implementation of MBBS program
January 2003 - present
Royal Adelaide Hospital
Description
  • Clinical responsibilities for inpatients in general medicine, and outpatients in clinical pharmacology, hypertension and autonomic disorders

Publications

Publications (96)
Article
Patients with autonomic dysfunction may present with a variety of seemingly unrelated symptoms, both generalised and involving specific systems, including fatigue, difficulty concentrating, orthostatic intolerance, palpitations, constipation or diarrhoea, early satiety, urinary retention or incontinence and erectile dysfunction. Failure to connect...
Article
Collins and Oliver make the point that students’ performance in Objective Structured Clinical Examinations is not altered by prior knowledge of the stations,1 2 a point also illustrated by the incident reported by Professor …
Article
A recent case in Australia highlights that cheating is a real challenge for academic medical educators. Anne Tonkin finds both a sketchy literature and a culture that perpetuates cheating—both research and action are needed A case of exam cheating was reported at an Australian medical school in November 2013. Local and international media coverage...
Article
Full-text available
Transition Pedagogy provided a framework for a case-study of the first year experience of students entering Medicine at the University of Adelaide. The first three dedicated areas of the Transition Pedagogy Model were investigated for the 2011 first year cohort. A mixed-methods research design was used with students, academic and administrative sta...
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Background: Problem-based curricula have provoked controversy amongst educators and students regarding outcome in medical graduates, supporting the need for longitudinal evaluation of curriculum change. As part of a longitudinal evaluation program at the University of Adelaide, a mixed method approach was used to compare the graduate outcomes of t...
Article
Polypharmacy, defined as the concomitant use of two or more psychotropic drugs, has become increasingly common in the paediatric and adolescent population over the past two decades. Combining psychotropic drugs leads to possible increases in benefits, but also in risks, particularly given the potential for psychotropic drug interactions. Despite th...
Article
Background: Standard setting in assessment seeks to apply meaning of achievement to an assessment score. Appropriate standard setting for script concordance tests (SCTs) remains a challenge, with existing methods representing norm-referenced approaches. Aims: To develop a criterion-referenced standard setting approach for sct using an adapted ne...
Article
Background: The University of Adelaide offers a six-year undergraduate medical degree with a focus on small group learning. Senior medical students had previously received limited formal training in education skills, and were identified as an underutilised teaching resource. Aims: To devise a programme in which senior students are exposed to the...
Article
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Objectives: The aim of the study was to assess the acceptance and usefulness to students of a student-developed portfolio of Guidelines (GLs) in clinical skills, as a tool for competency development in the early years of the undergraduate medical program. Methods: A mixed-method design was employed to explore students' perceptions of the general us...
Article
Full-text available
The process of clinical reasoning is undertaken by all clinicians, often automatically, and is the cognitive process that underlies diagnosis and management of a patient's presenting problem. The teaching of clinical reasoning can pose a challenge to the clinical teacher. This article reviews the process of clinical reasoning and provides the teach...
Article
This article presents the results of a 6-month prospective cohort study of methadone maintenance treatment (MMT) in Indonesia. The study aimed to investigate the predictor variables of retention in MMT in Indonesia. The duration of treatment (in days) was the main outcome of the study. For the study, program, client, social network, and accessibili...
Article
Transfer of knowledge is the cornerstone of any educational organisation, with senior staff expected to participate in the training of less experienced colleagues and students. Teaching in the field is, however, slightly different, and a less theoretical approach is usually recommended. In terms of Disaster Victim Identification (DVI) activities, p...
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The aim of this research was to assess tertiary student distress levels with regards to (i) comparisons with normative population data, and (ii) the effects of discipline, year level, and student characteristics. Self-reported treatment rates and level of concern regarding perceived distress were also collected. Students from all six years of an un...
Article
Transthyretin amyloid polyneuropathy, caused by mutations in the transthyretin gene, is a progressive condition for which liver transplantation is an established treatment. Favorable outcomes have been described in patients with the most common transthyretin mutation, Val30Met, but outcomes have been variable in patients with other mutations. We de...
Article
We report a 54-year-old man who developed bilateral bulbar palsy and severe postural hypotension following resection of a fourth ventricle subependymoma. It is proposed that interruption of the function of the nucleus of the tractus solitarius (in which the baroreflex is integrated) may have been responsible for the postural hypotension.
Article
Peer-assisted learning (PAL) has been reported to have educational benefits in cross-year, small-group teaching in other contexts. Accordingly, we explored whether senior medical students are effective tutors for their junior peers in clinical skills education, and how the participants in the learning triad (tutors, learners and simulated patients...
Article
Full-text available
Doctors' clinical reasoning ability significantly impacts upon their level of clinical competence. Throughout medical training students are given the opportunity to develop their reasoning ability in order to become appropriately clinically competent by graduation. To develop an instrument to assess students' reasoning ability on a written case-bas...
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Full-text available
The aim of this study was to compare cardiovascular autonomic nervous system function in patients with primary Sjögren's syndrome (pSS) with that in control individuals, and to correlate the findings with autonomic symptoms and the presence of exocrine secretory dysfunction. Twenty-seven female patients with pSS and 25 control individuals completed...
Chapter
Full-text available
IntroductionThe Nature of DrugsMechanisms of Drug ActionDrug PotencyPharmacodynamics and PharmacokineticsThe Role of Pharmacodynamics in Determining Variability of Drug ResponseThe Role of Pharmacokinetics in Determining Variability of Drug ResponseThe Importance of the Human Factor: Prescriber and Consumer BehaviorConclusions References
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Objectives: To evaluate the effectiveness of small group tutorials in teaching senior medical students the requirements of prescription writing. Design: Random allocation to interactive tutorial or didactic lecture with blinded evaluation. Subjects: All 1999 6th year medical students, the University of Adelaide. Results: The Tutorial Attende...
Article
AimTo develop guidelines for clopidogrel prescribing and survey its use to ascertain the need for changes in prescribing patterns.Method Guidelines were developed after a literature review. Prescribing patterns were assessed by a cross-sectional survey which investigated the therapy of inpatients identified taking clopidogrel at a teaching hospital...
Article
The problem of under-diagnosis and under-treatment of depression has been identified as a major public health issue and measures have been taken to increase the recognition of depression and its treatment with antidepressants. The possibility of harm from the overuse of antidepressants has attracted far less attention. This review sets out evidence...
Article
Objectives: We aimed to assess the feasibility of implementing, within Australian general practice, an innovative disease management program for hypertension. The central platform of this program is an information communication technology package for risk assessment and management, access to a dietitian commissioned by the program and a tailored se...
Article
Full-text available
The use of selective serotonin reuptake inhibitors (SSRIs) in children under 18 years old increased ten-fold (from 0.5 to 4.6 per 1000) in the UK from 1992 to 2001 ([Murray et al , 2004][1]). Usage rates are even higher in the USA, at 16.6 per 1000 ([Delate et al , 2004][2]), despite the existence
Article
Full-text available
Postprandial hypotension occurs frequently in older people and may result in syncope and falls. It has recently been established that the magnitude of the fall in blood pressure is related to the rate at which glucose enters the small intestine. We addressed the hypothesis that the fall in blood pressure induced by an intraduodenal glucose infusion...
Article
Full-text available
Postprandial hypotension (PPH) occurs frequently in the elderly; the magnitude of the fall in blood pressure (BP) is related to the rate of glucose entry into the duodenum during intraduodenal glucose infusion and spontaneous gastric emptying (GE). It is unclear if glucose concentration affects the hypotensive response. Gastric distension may atten...
Article
In a multicultural and diverse society with vast health disparities, facing rapid socio-economic and demographic change both in the community and within the medical profession, it is imperative that our medical education system addresses appropriately issues arising from this diversity. The educational task is not only to encourage the development...
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The primary aims of this study were to evaluate the effects of the nitric oxide (NO) synthase inhibitor N(G)-nitro-l-arginine methyl ester (l-NAME) on gastric emptying (GE) of, and the blood pressure (BP), glycemic, insulin, and incretin responses to, oral glucose in older subjects. Eight healthy subjects (4 males and 4 females, aged 70.9 +/- 1.3 y...
Article
The move from discipline-based to problem-based learning (PBL) at Adelaide University in 2000 offered exciting opportunities to integrate the teaching and learning of the basic and clinical sciences for medical undergraduates. However, several cohorts of students still needed to progress through the first 3 years of the more traditional curriculum....
Article
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How safe and effective are antidepressants in children and adolescents? The authors of this review have found disturbing shortcomings in the methods and reporting of trials of newer antidepressants in this patient group Introduction Antidepressants introduced since 1990, especially selective serotonin reuptake inhibitors and venlafaxine, have been...
Article
Most new drugs are marketed as single enantiomers but many older agents are still available in racemic form. As these drugs reach the end of their patent life manufacturers become interested in marketing single enantiomer equivalents. This is called ‘chiral switching’ and it has been claimed that it will bring clinical benefits in terms of improved...
Article
Full-text available
Most new drugs are marketed as single enantiomers but many older agents are still available in racemic form. As these drugs reach the end of their patent life manufacturers become interested in marketing single enantiomer equivalents. This is called 'chiral switching' and it has been claimed that it will bring clinical benefits in terms of improved...
Article
1. Cardiovascular responses to the stress of orthostasis, forearm (FA) ischaemia (reactive hyperaemia) and FA exercise (postexercise hyperaemia) are well described. Although sex differences in responses to orthostatic stress have been reported, few studies have examined the impact of sex on reactive hyperaemia and none has commented with regard to...
Article
Thirteen syncopal subjects and thirteen asymptomatic controls were examined by head-up tilt (HUT) with and without sublingual GTN. Adding GTN to HUT improved the sensitivity of the test (8 % to 46%) but decreased specificity (100 % to 54 %).
Article
Postprandial hypotension occurs frequently in diabetes; the fall in blood pressure is greatest after ingestion of carbohydrate, particularly glucose and, in type 2 diabetes, is related to the rate of gastric emptying. The aim of this study was to determine whether slowing of gastric emptying by guar gum reduces the fall in blood pressure after oral...
Article
Full-text available
Gastric emptying is a determinant of the postprandial glycemic and cardiovascular responses to oral carbohydrate. We evaluated the effects of a solid meal on gastric emptying and the glycemic and cardiovascular responses to oral glucose in healthy older subjects. Ten subjects aged 72.1 +/- 1.9 yr were studied. Each subject had measurements of gastr...
Article
Objective: The aim of this research was to develop an empirically derived methodological model for the development of disease management programs in general practice. The model was developed applying the example of hypertension. Methods: Using a rapid appraisal framework, empirical investigations, which included structured panel discussions, face-t...
Article
Postprandial hypotension occurs frequently in older people and may lead to syncope and falls. Some recent studies suggest that the magnitude of the postprandial fall in blood pressure (BP) is influenced by the rate of gastric emptying. The aim of this study was, therefore, to determine whether the fall in blood pressure induced by intraduodenal glu...
Article
To determine whether slowing of gastric emptying and glucose absorption with guar gum would reduce the fall in blood pressure after an oral glucose load in older subjects. A randomized, experimental, cross-over study. Department of Nuclear Medicine, Royal Adelaide Hospital, Adelaide, SA, Australia. Ten healthy subjects, age 67 to 78. Simultaneous m...
Article
To determine the factors influencing general practitioners' prescribing for patients with moderate hypertension, and to investigate their ability to assess patients' absolute risk of cardiovascular disease. Decision-making was assessed by a postal questionnaire involving five standardised example patients, send to all general practitioners in the C...
Article
1. The aim of the present study was to compare the efficacy of nifedipine Oros® and felodipine extended release (ER) in controlling 24 h ambulatory blood pressures (ABP) in hypertensive patients. 2. The study was a randomized cross-over design with a 2 week open placebo run-in phase and two observer-blind treatment periods. 3. Subjects were males a...
Article
To evaluate the dose-response relationship of increasing doses of oxymetazoline compared with placebo in normal subjects, and to determine the sensitivities of rhinomanometry, acoustic rhinometry and symptoms in discriminating between differing doses of oxymetazoline in normal subjects. The study had a randomized, double-blind, placebo-controlled,...
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Full-text available
Although the preoperative use of alpha-receptor antagonist drugs is generally accepted for patients with phaeochromocytoma, evidence on the most appropriate treatment and its timing is scarce. In this retrospective study, the effectiveness of the preoperative preparation of fourteen patients who required surgical excision of a phaeochromocytoma was...
Article
1. Postprandial hypotension is now recognized as an important clinical problem, particularly in the elderly and in patients with autonomic dysfunction. The mechanisms responsible are poorly understood; however, impaired regulation of splanchnic blood flow and the release of gastrointestinal hormones appear to be important The effect of gastric empt...
Article
Consumption of soy products has been linked to a reduced mortality and morbidity from a number of cancers. Genistein, one of the principal soy isoflavones, has been shown to inhibit the growth of a number of tumour cell lines in vitro; however, a role of genistein in retarding tumour growth in vivo is less well documented. In this study, in additio...
Article
Reflex haemodynamic responses to orthostatic stress are attenuated with ageing, the extent of attenuation increasing with advancing age. In 15-20% of individuals aged > 65 years, the attenuation may be so marked that there is an excessive fall of blood pressure (BP) on assumption of the upright posture, sufficient on occasions to cause symptomatic...
Article
Isolated systolic hypertension (ISH), the most common form of hypertension in the elderly, is associated with a significantly increased risk of cardiovascular and cerebrovascular morbidity and mortality. However, lowering systolic blood pressure (SBP) in patients with this condition results in a significant reduction in cardiovascular events. This...
Article
1. Normal subjects (n = 5; age 20-42 years; mean resting blood pressure (± 1 s.d.) 116±21/61±11 mmHg) underwent cardiovascular reflex testing five times each. On every occasion systolic blood pressure (SBP) responses to sustained handgrip (GRIP) and cold pressure (COLD) tests were measured and continuous non-invasive SBP and heart period (RRINT) da...
Article
Isolated systolic hypertension (ISH) [systolic blood pressure (SBP) ≥ 160mm Hg with diastolic blood pressure (DBP) <90mm Hg] is the commonest form of hypertension in the elderly, and accounts for about 60% of all hypertensive conditions in the population aged over 65 years. It is associated with a significantly increased risk of cardiovascular and...
Article
We have demonstrated an enhanced constriction of blood vessels in the mesenteric vascular bed of the Spontaneously Hypertensive Rat (SHR) (Smid et al. J Vase Res 1995;32:247). The mechanism underpinning the enhanced contraction is not known. We have shown the phenomenon occurs with a variety of vaso-active agents and that pretreatment of SHR with a...
Article
The effects of gender and oral contraceptive steroids on the pharmacokinetics of (R)-ibuprofen were studied in groups of healthy adult males, females and oral contraceptive steroid (OCS) using females. The values of AUC, CLpo, t1/2 and Vss, app did not differ significantly between the groups. Similarly, the percentage unbound of (R)-ibuprofen in po...
Article
This study tested the hypothesis that treatment with a nonsteroidal anti-inflammatory drug will not alter the hypotensive effect of a dihydropyridine calcium channel antagonist. Fifteen essential hypertensives (ages 58-80 years) had a supine diastolic blood pressure (DBP) < 100 mmHg after 4 weeks monotherapy with nitrendipine 5-20 mg twice daily. T...
Article
Postural hypotension is a common and important problem in elderly patients and necessitates a careful review of medication and lifestyle factors which may precipitate it. Drugs to be avoided if possible include diuretics, alpha-adrenoceptor blocking agents and nitrates. Drugs which may be useful in general practice include low-dose fludrocortisone,...
Article
Postural hypotension is a common and important problem in elderly patients and necessitates a careful review of medication and lifestyle factors which may precipitate it. Drugs to be avoided if possible include diuretics, α‐adrenoceptor blocking agents and nitrates. Drugs which may be useful in general practice include low‐dose fludrocortisone, eph...
Article
Given the reported relationship between systolic hypertension and orthostatic hypotension in the elderly, to test the hypothesis that systolic hypertension causes impairment of the cardiovascular reflex function additional to the effects of age alone. Responses were compared in normotensive healthy young (n = 12) and elderly (n = 15) participants a...
Article
The aim of this study was to assess the relationship between changes in plasma catecholamine concentrations and intra-arterial blood pressure (BP) measured simultaneously during resection of phaeochromocytoma (n = 14). Arterial plasma concentrations of noradrenaline (NA), adrenaline (A) and dopamine (DA) were measured by a radio-enzymatic method. A...
Article
Full-text available
This study compared with placebo the efficacy and tolerability of optimised doses of felodipine 5-20 mg daily, metoprolol 50-200 mg daily and their combination in subjects 60 years or over with isolated systolic hypertension. The study employed a randomised double-blind crossover design with allocation of treatment order within subjects by Latin sq...
Article
Using a randomised double-blind crossover design with Latin square allocation of treatments in 20 subjects (7 male, 13 female-ages: 61-87 years) with systolic hypertension, we investigated the efficacy and tolerability of once daily felodipine (extended release) 5-20 mg, enalapril 5-20 mg and their combination compared with placebo in four treatmen...
Article
The pharmacokinetics and blood pressure response of the phenylpropanolamine enantiomers (i.e., d- and l-phenylpropanolamine) were determined after the separate oral administration of racemic dl-phenylpropanolamine (75 mg), l-phenylpropanolamine (37.5 mg), and d-phenylpropanolamine (37.5 mg) to six healthy volunteers. No significant differences were...
Article
Over the past decade the calcium antagonist drugs, also known as calcium channel blockers, have become established for use in a variety of cardiovascular diseases. A bewildering (and ever-growing) number of drugs in this class now becoming available. This article summarises the important characteristics of the calcium antagonists and discusses thei...
Article
The effects of high and low urine flow rates on the urinary metabolic ratios for paracetamol glucuronidation, sulphation and oxidation were determined at steady-state in seven healthy young adult volunteers. Metabolic partial clearances were unaffected by urine flow rate, but individual paracetamol metabolic ratios varied 2.5- to 3.2-fold over a 7....
Article
Full-text available
To test the hypothesis that the short-term effect of transbuccal nitroglycerin (glyceryl trinitrate, 0.0625 to 1.5 mg) on orthostatic cardiovascular responses would predict the effect of a diuretic (5 mg bendroflumethiazide daily for 1 week), particularly in elderly subjects who may be at higher risk for orthostatic hypotension. This was a randomiz...
Article
Paracetamol disposition following a single oral 1 g dose of the drug was compared in groups (n = 12) of healthy young adult male Caucasians and Chinese. There was no difference between the groups in terms of paracetamol oral clearance, elimination half-life, or partial metabolic (glucuronidation, sulphation, oxidation) and renal clearances. The res...
Article
1. To test the hypothesis that in apparently healthy elderly subjects with orthostatic hypotension there is afferent baroreflex dysfunction, cardiovascular and neurohumoral responses were measured after separate stimuli which activated baroreceptor (head-up tilt) and non-baroreceptor (cold stress, isometric exercise) afferent pathways. 2. In 15 hea...
Article
In 15 patients with mild to moderate essential hypertension, the effects of diltiazem (120 mg twice daily) were compared with those of atenolol (50 mg once daily), the two drugs in combination, and placebo in a randomized double-blind cross-over study with treatment phases of 4 weeks duration. Blood pressure was reduced in the active treatment phas...
Article
Fish and fish oils have been reported to reduce blood pressure in normotensives and untreated hypertensives. The present study examined the effect of dietary supplementation with fish oil on blood pressure in 20 treated hypertensives with controlled blood pressures who continued their usual antihypertensive drug treatment throughout. A double-blind...
Article
Roxithromycin is a semisynthetic macrolide antibiotic having similar in vitro antibacterial profile and potency to erythromycin but possibly greater in vivo potency. The single and multiple oral dose pharmacokinetics of roxithromycin and erythromycin were studied in 12 healthy volunteers. Plasma concentrations of the two compounds were measured by...
Article
1. The accuracy of blood pressure measurement with the Takeda TM-2420 ambulatory blood pressure monitor and the TM-2020 data recorder have been assessed by comparison with simultaneous measurements taken using auscultation and direct femoral artery measurements. 2. Systolic blood pressure was underestimated by the TM-2420 by a mean of 10 mmHg (s.d....
Article
1. The accuracy of blood pressure measurement with the Takeda TM-2420 ambulatory blood pressure monitor and the TM-2020 data recorder have been assessed by comparison with simultaneous measurements taken using auscultation and direct femoral artery measurements. 2. Systolic blood pressure was underestimated by the TM-2420 by a mean of 10 mmHg (s.d....
Article
111 untreated subjects (mean [SEM] age 58.4 [1.0] years; 93 male, 18 female) with diastolic blood pressure between 90 and 100 mmHg were seen fortnightly, and after four pre-diet visits they were randomised into a low sodium intake group (53 subjects; diet containing less than 80 mmol sodium/day plus 8 placebo tablets daily) or a normal sodium intak...
Article
As NSAIDs are commonly used in patients receiving concomitant drug therapy, there is a risk of clinically significant drug interactions. Important interactions with NSAIDs involve one or both of two major mechanisms: pharmacokinetic (e.g. lithium, phenytoin and barbiturates) and pharmacodynamic (e.g. antihypertensive agents, diuretics). Prescriptio...
Article
One hundred and thirty consecutive patients with anterior myocardial infarction complicated by bundle branch block were retrospectively analyzed. Sixty died within 1 week of infarction. Of the remaining 70 patients, 36 had electrophysiology study with programmed stimulation 8-90 (mean 20) days after infarction. Of these, nine patients (35%) who cli...
Article
1.1. Heart rate, arterial pressure and blood lactate levels were measured in turkeys over a range of running speeds on a treadmill.2.2. Heart rates showed a hyperbolic increase with speed to a level approximately twice that recorded at rest. Arterial pressures were found to be lower than those previously reported for the turkey. During severe exerc...
Article
1. Male Notomys alexis were treated with aspirin (acetylsalicylic acid) and a derivative, salicylic acid.2. The circulating half-life of salicylates was found to be much longer than in laboratory mice.3. Salicylate metabolites in N. alexis are similar to those reported for other rodents.4. The concentration of salicylate in the renal papilla is abo...

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