Philip J Schluter

University of Canterbury, Christchurch, Canterbury, New Zealand

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Publications (128)252.5 Total impact

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    ABSTRACT: Dry mouth is a common and troublesome symptom in palliative care. Pilocarpine is a cholinergic agent that promotes salivation. This study aimed to test the feasibility of using n-of-1 trials to test pilocarpine drops compared to placebo, for patients of palliative care units with advanced cancer, who experienced dry mouth. This was an N-of-1 study, in which each participant was offered three cycles of pilocarpine drops 4% (6 mg tds) (3 days) and placebo drops (3 days) in random order. Participants were patients of specialist palliative care services with advanced cancer assessed as having a dry mouth, defined as having a score of ⩾3 on an 11-point self-rated xerostomia numerical rating scale, from any cause. Patients self-completed a diary using validated symptom and quality-of-life scores. The randomisation order was unmasked at the end of each person's trial by a clinician independent of the trial to allow a treatment decisions for individual patients to be made. Nine patients completed at least 1 cycle; 33 cycles of data were completed in total, comprising 438 doses of pilocarpine. Four patients completed the trial: two responded and two did not. Most withdrawals related to deteriorating condition, unacceptable toxicity, non-compliance with study procedures or withdrawal of consent. Many issues contributed to slow recruitment and high withdrawal rate. The formulation of pilocarpine drops proved unacceptable to most participants. More work is required to determine an appropriate formulation, dose and method of delivery and then a retest of pilocarpine drops for this symptom. © The Author(s) 2015.
    Full-text · Article · May 2015 · Palliative Medicine
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    ABSTRACT: Fatigue is common in life-limiting cancer. Methylphenidate (MPH), a psychostimulant, may be a useful therapy. Gathering evidence in patients with advanced cancer can be challenging. To determine if MPH improves cancer-related fatigue in people with advanced cancer. N-of-1 trials are multi-cycle, double-blind, randomized, controlled crossover trials using standardized measures of effect in individuals. They are normally used to assess treatment effects in individuals. Aggregated N-of-1 trials from participants with end-stage cancer suffering fatigue were used to assess the group effect of MPH, producing an estimate of equivalent power to a parallel group randomized controlled trial (RCT) but requiring less than half of the sample size. Up to three cycles of MPH 5mg twice daily (three days) versus identical placebo (three days) capsules were offered to participants. Primary outcome was improvement in fatigue as measured by the Functional Assessment of Chronic Illness Therapy-Fatigue Scale and the Wu Cancer Fatigue Scale. Analysis employed Bayesian statistical methods using intention-to-treat principles. Forty-three participants completed 84 cycles of MPH and placebo in random order - exceeding sample size estimates. Overall, MPH did not improve fatigue (mean difference 3.2; 95% credible interval: -2.0, 9.0; posterior probability of favorable effect 0.890). Eight participants showed important improvement and one showed important worsening of fatigue on MPH. There were no features that distinguished participants whose fatigue responded to MPH compared with those who did not. MPH does not improve fatigue in the population of patients with end-stage cancer. Aggregated N-of-1 trial methodology is feasible and produces population-based sample estimates with less than half the sample size required for the equivalent parallel group RCT. It also identified individuals who did and did not respond to MPH, which is a feature difficult to achieve in a standard RCT. The study was registered with the Australian Clinical Trials Registry (ACTRN 12609000794202). Copyright © 2015 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.
    Full-text · Article · Apr 2015 · Journal of pain and symptom management
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    ABSTRACT: Objective The aim of this study is to assess the feasibility and utility of retrospective frontomaxillary facial angle measurement on two-dimensional (2D) images from confirmed trisomy 21 fetuses.Materials and methodsOver a 27-month period, stored 2D fetal profile images taken during routine first-trimester screening were assessed. A single experienced operator utilising an offline digital measurement tool measured the frontomaxillary facial angle of 55 karyotypically proven trisomy 21 fetuses. The resultant measurements were compared with 2D prospectively collected frontomaxillary facial angle measurements in both trisomy 21 and euploid fetuses, which were also performed by the same operator.ResultsThe mean maternal age of both trisomy 21 cohorts [37 years old (prospective) and 37.7 years old (retrospective)] was similar (p = 0.72), and both were greater than those of the euploid group (32.2 years old) (p < 0.001). The median frontomaxillary facial angle measurement of the retrospective trisomy 21 cohort (90.5°) was greater than that of the euploid fetus group (87.1°) (p < 0.001) but has no difference to the median of the measurements collected prospectively from trisomy 21 fetuses (91.1°) (p = 0.86).Conclusion Overall, trisomy 21 fetuses have a larger frontomaxillary facial angle than euploid fetuses. Frontomaxillary facial angle measurements performed retrospectively in 2D were not different to prospective 2D frontomaxillary facial angle measurements.
    No preview · Article · Mar 2015
  • Gus Ridding · Philip J Schluter · Jon A Hyett · Andrew C McLennan
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    ABSTRACT: Introduction: Uterine artery pulsatility index (PI) is a key variable in the first trimester screening for pre-eclampsia. The aims of the study were to examine the effect of sampling the uterine arteries at a site distal to the level of the internal os, and to determine a lower limit of peak systolic velocity (PSV) to establish an auditable standard. Material and methods: PI and PSV measurements were performed at 11-13(+6) weeks' gestation at two sites: at the level of the internal os and 3 cm distal to the internal os. Comparative analyses utilised the Student's paired t-test. A 90% reference interval of transformed PSV measurements at the internal os was generated by polynomial regression. Results: There was a significant reduction in both the PI (14.9%) and the PSV (17.4%) when measured at the distal site compared to the level of the internal os (both p < 0.001). The best estimated 5th centile for uterine artery PSV at 11-13(+6) weeks was 60.9 cm/s. Conclusion: PI measurements performed distal to the internal os are significantly lower and will result in inaccurate pre-eclampsia risk assessment. PSV measurements below 60 cm/s are likely to indicate an incorrect sampling site. Development of auditable measurement standards is important to ensure accuracy of prospective pre-eclampsia screening.
    No preview · Article · Feb 2015 · Fetal Diagnosis and Therapy
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    El-Shadan Tautolo · Philip J. Schluter · Janis Paterson
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    ABSTRACT: This paper examines the relationship between father involvement and their child’s behaviour outcomes amongst a birth cohort of Pacific children and fathers in New Zealand. A birth cohort was established in 2000 from births at Middlemore Hospital in South Auckland where at least one parent was identified as being of Pacific ethnicity and a New Zealand permanent resident. This included 1,376 mothers, 825 fathers, and 1,398 children at baseline. At the 6-years measurement wave, father involvement was measured using the Inventory of Father Involvement, and child behaviour measured using the Child Behaviour Check-list. Internalising and externalising behaviour was related to father involvement in crude and adjusted logistic regression and generalised estimating equation models. 571 Pacific fathers participated at the 6-years measurement wave; most of Samoan (42.9 %) or Tongan (33.5 %) ethnic identification. Overall, 190 (32.1 %) children exhibited clinical or border-line internalising and externalising behaviour. Self-reported father involvement was generally high, but lower involvement was significantly related to increased odds of internalising [adjusted odds ratio (aOR) approximately 1.9, p < 0.001] and externalising (aOR approximately 4.0, p < 0.001) behaviour. Father involvement was significantly associated with child behaviour in Pacific families within New Zealand. Strategies that promote and enable increased father involvement may reduce negative child outcomes amongst Pacific families.
    Full-text · Article · Feb 2015 · Journal of Child and Family Studies
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    ABSTRACT: Background: Health is an important aspect of individuals' lives as they age. The aim of this study was to examine the relationship of sociodemographic factors, diagnosed chronic health conditions, and current depression with attitudes to aging in midlife. Methods: A cross-sectional baseline analysis was conducted on the first 300 participants from the Canterbury Health, Ageing and Life Course study in New Zealand, a stratified randomized community longitudinal study of adults recruited between 49 and 51 years. Attitudes were measured using the Attitudes to Aging Questionnaire (AAQ) and analyzed with a range of prevalent diagnosed chronic conditions, current depression, and sociodemographic variables. Results: Individuals perceived their physical aging more negatively after a diagnosis of hypertension, arthritis or asthma. Diagnosed lifetime depression and anxiety, and current depression, showed strong relationships with attitudes to aging across domains. After controlling for sociodemographic factors and current depression, individuals with diagnosed hypertension, arthritis, asthma, lifetime depression or anxiety continued to report significantly more negative attitudes to aging. Current depression showed the strongest associations with attitudes to aging and mediated relationships of health on attitudes to aging. Conclusions: Physical and mental health are related to attitudes to aging. Most chronic conditions examined are significantly associated with attitudes toward aging in the physical change domain. Diagnosed lifetime depression and anxiety, and current depression, are negatively related across attitudinal domains. Individuals can feel positive about aging while experiencing poorer health, but this is more difficult in the presence of low mood.
    No preview · Article · Aug 2014 · International Psychogeriatrics
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    ABSTRACT: Objective: To assess 2D and 3D frontomaxillary facial angle (FMFA) measurements in euploid and trisomy 21 fetuses. Materials and methods: Over a 2-year period, women with singleton pregnancies attending a private prenatal screening and diagnosis practice in Sydney, Australia, were invited to participate in this study where 2D images and 3D volumes of the fetal face were collected during routine first trimester screening. In pregnancies where trisomy 21 was confirmed, FMFA measurements were performed in 2D and 3D and compared with those from a euploid cohort. Results: Overall, 250 women carrying euploid and 22 women carrying trisomy 21 fetuses participated. Trisomy 21 fetuses had significantly larger FMFA measurements than euploid fetuses in both 2D and 3D assessments. 95% of 3D and 100% of 2D FMFA measurements for the trisomy 21 fetuses were above the mean FMFA measurement of the euploid fetuses. There was no relationship between increasing crown-rump length and FMFA measurement. Conclusion: 2D and 3D FMFA measurements in trisomy 21 fetuses are statistically greater (p < 0.001) than those in euploid fetuses. This supports FMFA as a possible additional marker for trisomy 21 for first trimester screening.
    Full-text · Article · Aug 2014 · Fetal Diagnosis and Therapy
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    Gus Ridding · Philip J Schluter · Jon A Hyett · Andrew C McLennan
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    ABSTRACT: Introduction: First-trimester uterine artery pulsatility index (PI) measurements form part of an algorithm used to assess the risk of developing pre-eclampsia. The objective of this study was to construct a population-specific reference range for both the lower and mean maternal uterine artery PI at 11-13(+6) weeks' gestation and to assess measurement agreement. Materials and methods: Reference ranges for mean and lower PI measurements were developed using polynomial regression models following prospective collection of maternal uterine artery PI measurements at 11-13(+6) weeks' gestation. Measurement agreement studies were performed by two experienced operators. Results: Measurements from 298 women were included in the primary study. Polynomial regression indicated no change over gestational age for the lower PI (mean 1.44). There was an inverse relationship between the average PI and gestational age (mean [0.8960 + (2.9771 × CRL(-1/2))]2). PI measurement agreement was good-strong (intraclass correlation (ICC) 0.50-0.79) between operators, and within-operator agreement was almost perfect (ICC 0.88-0.93). Conclusions: Reference ranges for both the average and lowest PI of the maternal uterine arteries were derived at 11-13(+6) weeks' gestation. This will provide a basis for development of auditable standards for first-trimester uterine artery Doppler measurements. The PI measurements are reproducible and reliable.
    Full-text · Article · Aug 2014 · Fetal Diagnosis and Therapy
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    ABSTRACT: Background Active transport (e.g., walking, cycling) to school (ATS) can contribute to children’s physical activity and health. The built environment is acknowledged as an important factor in understanding children’s ATS, alongside parental factors and seasonality. Inconsistencies in methodological approaches exist, and a clear understanding of factors related to ATS remains equivocal. The purpose of this study was to gain a better understanding of associates of children’s ATS, by considering the effects of daily weather patterns and neighbourhood walk ability and neighbourhood preferences (i.e., for living in a high or low walkable neighbourhood) on this behaviour. Methods Data were drawn from the Understanding Relationships between Activity and Neighbourhoods study, a cross-sectional study of physical activity and the built environment in adults and children in four New Zealand cities. Parents of participating children completed an interview and daily trip diary that assessed their child’s mode of travel to school, household and individual demographic information, and parental neighbourhood preference. Daily weather data were downloaded from New Zealand’s national climate database. Geographic information systems-derived variables were calculated for distance to school and neighbourhood walkability. Bivariate analyses were conducted with ATS and potential associates; factors related to ATS at p < 0.20 were considered simultaneously in generalized estimation equation models, and backwards elimination of non-significant factors was conducted; city was treated as a fixed effect in all models. Results A total of 217 children aged 6.5-15 years participated in this study. Female sex, age, city, household income, limited/no car access, residing in zone of school, shorter distance to school, neighbourhood self selection, rainfall, and sunlight hours were simultaneously considered in multivariate generalised estimation equation modelling (all p < 0.20 in bivariate analyses). After elimination of non-significant factors, age (p = 0.005), shorter distance to school (p < 0.001), city (p = 0.03), and neighbourhood self selection (p = 0.04) remained significantly associated with ATS in the multivariate analysis. Conclusion Distance to school is the prevailing environmental influencing factor on children’s ATS. This study, in conjunction with previous research, suggests that school siting is likely an important associate of children’s ATS.
    Full-text · Article · Jun 2014 · International Journal of Behavioral Nutrition and Physical Activity
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    Philip J Schluter · Paul Bridgford · Lynley Cook · Greg Hamilton
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    ABSTRACT: Objective: Despite many reforms and initiatives, inequities in access to primary health care remain. However, the concept of ‘access’ and its measurement is complex. This paper aims to provide estimates of general practice visit frequencies for ‘attenders’ (those who seek consultation) and the proportion of ‘non-attenders’ (those who never seek consultation) of primary health care services. Methods: A panel study of people enrolled within a large primary health care organisation of affiliated general practices. Standard and zero-inflated regression models were assessed. Results: 980,918 visits were made by 388,424 people, averaging 2.64 visits/person/year. The zero-inflated negative binomial model was superior, and significant age, gender and ethnic differences were observed in attender and non-attender profiles. More Asian (21.0%), Pacific (19.6%) and Māori (17.1%) people were non-attenders than European/Other (9.0%) people. Among attenders, males, Asian and Pacific people, and young to middle-aged adults, generally had relatively lower visit rates. Conclusions: Interpretation of utilisation data must be made with caution because of two distinct characteristics: the differential rates of non-attenders and the highly dispersed distribution of attenders. Implications: Improved understanding of differential non-attender rates and attender visit distributions by demographic factors needs to be considered when addressing improved access to general practice services.
    Full-text · Article · Apr 2014 · Australian and New Zealand Journal of Public Health
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    ABSTRACT: Objective: In September 2010 Christchurch, New Zealand, was struck by a 7.1 magnitude earthquake, followed by a prolonged sequence of significant aftershocks including a fatal aftershock in February 2011. Christchurch City has experienced widespread damage, ongoing disruption and building demolitions resulting in many difficulties for the residents of the Christchurch area. We explore what impact the earthquakes have had on the mental and physical health of a random sample of 50-year-olds who live in the Christchurch area. Methods: The 295 participants were selected from the electoral rolls for participation in the CHALICE study, a longitudinal study of ageing. Self-reported health status was assessed using the standardised Short Form 36 version 2 health survey (SF-36v2), a 36-item questionnaire, and results from the eight subscales compared to a national health survey. Mood disorders were assessed and the results were compared to other local and national studies. Results: Since the onset of the earthquakes and throughout the study period, participating middle-aged Christchurch residents have mean SF-36v2 scores significantly lower than population norms in the mental health, vitality, social functioning and role-emotional subscales (Cohen's d ranged from -0.270 to -0.357, all p < 0.001), while there was no evidence of reduced physical health. Rates of current major depressive disorder were 7.5% in the earthquake survivors compared to 5.1% and 3.7% in other historical, local and national surveys. Similarly, bipolar disorder prevalence was 2.8% in the earthquake survivors compared to 2.2% and 1.4% in other studies. Conclusion: Eighteen months after the first earthquake the significant adverse impact on mental health clearly continues. The ongoing provision of additional mental health services and consideration of these adverse mental health effects in relation to other social policies remains necessary and fundamental.
    No preview · Article · Mar 2014 · Australian and New Zealand Journal of Psychiatry
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    Philip J Schluter · Anna P Dawson · Catherine Turner
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    ABSTRACT: Sick leave due to neck pain (NP-SL) is costly and negatively impacts the productivity of the nursing and midwifery workforce. Identification of modifiable risk indicators is necessary to inform preventive efforts. This study aimed to investigate the role of pain-related psychological features (pain catastrophizing, fear of movement, and pain coping) in NP-SL alongside other potential risk indicators. A cross-sectional analysis of a large cohort study of Australian and New Zealand nurses and midwives, established between 1st April 2006 to 30th March 2008, was undertaken. Recruitment procedures adopted within each Nursing Council jurisdiction were governed by the individual regulatory authorities and their willingness to engage with the study. Invitations directed potential participants to a purpose-built internet-based survey, where study information was provided and consent requested. Once consent was obtained, a range of standardized tools combined into one comprehensive electronic questionnaire was elicited. Exposure variables assessed included pain characteristics and a broad range of psychological, psychosocial, occupational, general health and demographic factors. Two-way interactions between age and gender and candidate exposures were also assessed. Binary logistic regression was performed using manual backward stepwise elimination of non-significant terms. The cohort included 4,903 currently working nurses or midwives aged 18-65 years. Of these, 2,481 (50.6%) reported neck pain in the preceding 12 months. Our sample comprised of 1,854 working nurses and midwives with neck pain in the preceding year who supplied sick leave data. Of these, 343 (18.5%) reported taking sick leave in the preceding year due to their neck pain. The final most parsimonious multivariable model demonstrated neck pain severity (adjusted odds ratio, [aOR] = 1.59), passive pain coping (aOR = 1.08) and fear of movement (aOR = 1.06) increased the likelihood of NP-SL in the previous year. Interactions between demographic and general health factors exhibited both protective and risk relationships with NP-SL, and there was no association between pain catastrophizing and NP-SL. Findings demonstrate that sick leave due to neck pain was associated with pain severity, fear of movement and passive pain coping. In addition, there were complex interactions found between demographic and general health factors. These features represent potentially modifiable targets for preventive programs.
    Preview · Article · Feb 2014 · BMC Nursing
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    ABSTRACT: In 2006 there were 432,700 people in Australia who had acquired brain injury (ABI) with some limitation of activities; 90% of these were traumatic brain injuries (TBIs) and nearly a third sustained injury below age 15 years. One to four years post injury, 20% to 46% of children with traumatic brain injury (TBI) have clinically significant disorders of attention. There is controversy as to whether central nervous system (CNS) stimulants can be an effective method of treating these.Objectives were to determine the efficacy of CNS stimulants for children with TBI, and to calculate the sample size for a larger trial using the Conners' Long Forms Parent Rating Scales Score as the primary endpoint. Pilot series of aggregated prospective randomised, double-blind, n-of-1 trials of stimulant versus placebo within individual patients. Setting: tertiary children's public hospital. Participants: ten children aged 6 to 16 years more than 12 months post TBIwith attention, concentration and behavioral difficulties on stimulants. Interventions: Three cycles of methylphenidate or dexamphetamine orally at doses titrated by physician compared to placebo. Main Outcome Measures: Conners 3 Parent (Conners 3-P) and Teacher (Conners 3-T) Rating Scales (Global Index), Behaviour Rating Inventory of Executive Function (BRIEF) and Eyberg Child Behaviour Inventory (ECBI). Five of ten patients completed the study. Data from 18 completed cycles from seven patients were analysed. The posterior mean difference between stimulant and placebo scores for the Conners 3-PS (Global Index) was 2.3 (SD 6.2; 95% credible region -1.0 to 6.1; posterior probability that this mean difference was greater than zero was 0.92), and for the Conners 3-T (Global Index) the posterior mean difference was 5.9 (SD 4.5; 95% credible region -3.1 to 14.9; posterior probability 0.93). Posterior mean differences suggest improvement in behaviour and executive function and a decrease in number and intensity of child behaviour problems when taking stimulants compared to placebo. Taken together these data are suggestive of a small benefit at group level. In this pilot study, there was sufficient evidence that stimulants may be useful in management of behavioral and cognitive sequelae following TBI, to warrant a larger trial.Trial registration: The trial was registered with the Australian and New Zealand Clinical Trials Registry: registration number ACTRN12609000873224.
    Full-text · Article · Feb 2014 · Trials
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    ABSTRACT: Background: Breaks in sedentary behavior are associated with reduced body size in general populations. This study is the first to consider the relationship between objectively assessed sedentary breaks and body size in Pacific children and their mothers. Methods: Pacific children aged 6 years (n = 393) and their mothers (n = 386) residing in New Zealand were invited to participate in 2006. Sedentary time was assessed via accelerometry. Average frequency, duration, and intensity of breaks in sedentary time per hour were calculated. Waist circumference was assessed and demographic factors collected via questionnaire. Relationships between waist circumference and potential associated factors for participants were assessed using linear regression analyses. Results: Accelerometer data were obtained from 126 children (52 boys) and 108 mothers. Mean (standard deviation) waist circumference values for mothers and children were 114 cm (20.1 cm) and 59.4 cm (7.8 cm), respectively. For mothers, time spent sedentary and being an ex/nonsmoker were positively related to waist circumference. For children, watching television every day and having a mother with a high waist circumference was associated with a greater waist circumference. Conclusion: Strategies that focus on reducing sedentary time in Pacific mothers and on encouraging television free days in young Pacific children are recommended.
    Full-text · Article · Nov 2013 · Journal of Physical Activity and Health
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    ABSTRACT: It is estimated that 39,000 Australians die from malignant disease yearly. Of these, 60% to 88% of advanced cancer patients suffer xerostomia, the subjective feeling of mouth dryness. Xerostomia has significant physical, social and psychological consequences which compromise function and quality of life. Pilocarpine is one treatment for xerostomia. Most studies have shown some variation in individual response to pilocarpine, in terms of dose used, and timing and extent of response.We will determine a population estimate of the efficacy of pilocarpine drops (6 mg) three times daily compared to placebo in relieving dry mouth in palliative care (PC) patients. A secondary aim is to assess individual patients' response to pilocarpine and provide reports detailing individual response to patients and their treating clinician. Aggregated n-of-1 trials (3 cycle, double blind, placebo-controlled crossover trials using standardized measures of effect). Individual trials will identify which patients respond to the medication. To produce a population estimate of a treatment effect, the results of all cycles will be aggregated. Managing dry mouth with treatment supported by the best possible evidence will improve functional status of patients, and improve quality of life for patients and carers. Using n-of-1 trials will accelerate the rate of accumulation of high-grade evidence to support clinical therapies used in PC.Trial registration: Australia and New Zealand Clinical Trial Registry Number: 12610000840088.
    Full-text · Article · Oct 2013 · BMC Palliative Care
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    ABSTRACT: Paper-based Aboriginal and Torres Strait Islander health checks have promoted a preventive approach to primary care and provided data to support research at the Inala Indigenous Health Service, south-west Brisbane, Australia. Concerns about the limitations of paper-based health checks prompted us to change to a computerised system to realise potential benefits for clinical services and research capability. We describe the rationale, implementation and anticipated benefits of computerised Aboriginal and Torres Strait Islander health checks in one primary health care setting. In May 2010, the Inala Indigenous Health Service commenced a project to computerise Aboriginal and Torres Strait Islander child, adult, diabetic, and antenatal health checks. The computerised health checks were launched in September 2010 and then evaluated for staff satisfaction, research consent rate and uptake. Ethical approval for health check data to be used for research purposes was granted in December 2010. Three months after the September 2010 launch date, all but two health checks (378 out of 380, 99.5%) had been completed using the computerised system. Staff gave the system a median mark of 8 out of 10 (range 5-9), where 10 represented the highest level of overall satisfaction. By September 2011, 1099 child and adult health checks, 138 annual diabetic checks and 52 of the newly introduced antenatal checks had been completed. These numbers of computerised health checks are greater than for the previous year (2010) of paper-based health checks with a risk difference of 0.07 (95% confidence interval 0.05, 0.10). Additionally, two research projects based on computerised health check data were underway. The Inala Indigenous Health Service has demonstrated that moving from paper-based Aboriginal and Torres Strait Islander health checks to a system using computerised health checks is feasible and can facilitate research. We expect computerised health checks will improve clinical care and continue to enable research projects using validated data, reflecting the local Aboriginal and Torres Strait Islander community's priorities.
    Full-text · Article · Sep 2013 · BMC Medical Informatics and Decision Making
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    ABSTRACT: To determine the frequency and types of stressful events experienced by urban Aboriginal and Torres Strait Islander children, and to explore the relationship between these experiences and the children's physical health and parental concerns about their behaviour and learning ability. Cross-sectional study of Aboriginal and Torres Strait Islander children aged ≤ 14 2013s presenting to an urban Indigenous primary health care service in Brisbane for annual child health checks between March 2007 and March 2010. Parental or carer report of stressful events ever occurring in the family that may have affected the child. Of 344 participating children, 175 (51%) had experienced at least one stressful event. Reported events included the death of a family member or close friend (40; 23%), parental divorce or separation (28; 16%), witness to violence or abuse (20; 11%), or incarceration of a family member (7; 4%). These children were more likely to have parents or carers concerned about their behaviour (P < 0.001) and to have a history of ear (P < 0.001) or skin (P = 0.003) infections. Children who had experienced stressful events had poorer physical health and more parental concern about behavioural 1s than those who had not. Parental disclosure in the primary health care setting of stressful events that have affected the child necessitates appropriate medical, psychological or social interventions to ameliorate both the immediate and potential lifelong negative impact. However, treating the impact of stressful events is insufficient without dealing with the broader political and societal 1s that result in a clustering of stressful events in the Aboriginal and Torres Strait Islander population.
    Full-text · Article · Jul 2013 · The Medical journal of Australia
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    ABSTRACT: New Zealand's ageing population threatens the financial sustainability of our current model of health service delivery. The Canterbury Health, Ageing and Life Course (CHALICE) study aims to develop a comprehensive and flexible database of important determinants of health to inform new models. This paper describes the design, methodology, and first 300 participants of CHALICE. Commencing August 2010, CHALICE is a multidisciplinary prospective random cohort study and biobank of 1,000 Canterbury adults aged 49-51 years at inception, stratified by self-identified Maori (n=200) and non-Maori (n=800) ethnicity. Assessment covers sociodemographic, physical, cognition, mental health, clinical history, family and social, cardiovascular, and lifestyle domains. Detailed follow-up assessment occurs every 5 years, with a brief postal follow-up assessment undertaken annually. For the first 300 participants (44 Maori, 256 non-Maori), the participation rate is 63.7%. Overall, 53.3% of participants are female, 75.3% are living in married or de facto relationships, and 19.0% have university degrees. These sociodemographic profiles are comparable with the 2006 Census, Canterbury region, 50-54 years age group percentages (50.7%, 77.2%, and 14.3%, respectively). CHALICE has been designed to provide quality data that will inform policy development and programme implementation across a broad spectrum of health indicators.
    No preview · Article · Jul 2013 · The New Zealand medical journal
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    ABSTRACT: Introduction: The primary aim of this study was to assess the interobserver and intraobserver reproducibility of the first-trimester frontomaxillary facial angle (FMFA) measurement using both 2D and 3D ultrasound. Assessment of the relationship between crown-to-rump length (CRL) and FMFA measurement was also reviewed. Materials and methods: Two experienced operators imaged the same 30 patients over a 1-month period collecting both 2D static images and 3D volumes during nuchal translucency assessment at 11-14 weeks' gestation. The operators were blinded to each other's images and results. Results: The mean 2D FMFA measurement was 88.0° and 88.4° for observer 1 and 2, respectively; while the mean 3D FMFA measurement was 87.8° and 88.0°, respectively. Intraclass correlation suggests good intraobserver and interobserver agreement with no statistically significant difference between operators in either 2D (p = 0.14) or 3D (p = 0.11) measurements. The FMFA was unchanged with increasing CRL. Discussion: Both 2D and 3D FMFA measurements have been demonstrated to be equivalent and reliable. Strict image acquisition criteria must be followed for accurate and reproducible FMFA measurements. There was no change demonstrated in FMFA measurement with increasing CRL.
    No preview · Article · Jun 2013 · Fetal Diagnosis and Therapy
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    Kara Seers · Lynley Cook · Gillian Abel · Philip Schluter · Paul Bridgford
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    ABSTRACT: Effective communication is fundamental to successful health care service delivery, and has a positive impact on access, quality of care, health outcomes, and patient satisfaction. Although there are a growing number of New Zealanders who do not speak English proficiently, underutilisation of trained interpreter services appears to be common in primary health care settings. To describe the pattern of interpreter service need and utilisation by general practice services, and to identify key barriers and enabling factors to the use of trained interpreters. A mixed methods study was employed. Census and Partnership Health Canterbury Te Kei o Te Waka (PHC) databases were combined, and quantitative analysis used to derive interpreter service need and utilisation patterns. Transcripts of focus groups and interviews from general practitioners, practice nurses and practice administration staff within the PHC were analysed, using qualitative methods to identify barriers and enablers to interpreter service use. For the years 2008-2010, approximately 10 742 consultations per year involved a non-Englishspeaking patient, yet in only approximately 74.8 (0.7%) consultations per year were interpreter services utilised. Analysis of focus groups and interviews identified four global themes that represented barriers for interpreter service utilisation; namely, practicalities, expectations, knowledge of service, and systems. The current use of interpreter services in PHC general practice appears to be significantly less than the need. In order to maximise health outcomes and reduce risk, strategies must be initiated to counter the barriers currently inhibiting interpreter service use, including adopting best practice policies.
    Full-text · Article · Jun 2013 · Journal of primary health care

Publication Stats

2k Citations
252.50 Total Impact Points

Institutions

  • 2013-2015
    • University of Canterbury
      • School of Health Sciences
      Christchurch, Canterbury, New Zealand
  • 2001-2015
    • University of Queensland
      • • School of Nursing and Midwifery
      • • School of Population Health
      Brisbane, Queensland, Australia
  • 2011-2013
    • University of Otago
      • Department of General Practice & Rural Health
      Taieri, Otago Region, New Zealand
  • 2006-2013
    • Auckland University of Technology
      • • Centre for Physical Activity and Nutrition Research
      • • Department of Public Health and Psychosocial Studies
      • • Faculty of Health and Environmental Sciences
      Окленд, Auckland, New Zealand
    • Griffith University
      • School of Medicine
      Southport, Queensland, Australia
  • 2006-2008
    • University of Auckland
      Окленд, Auckland, New Zealand
  • 2004
    • Royal Brisbane Hospital
      • Department of Neurology
      Brisbane, Queensland, Australia