The Colorectal cancer RISk Prediction (CRISP) trial: a randomised controlled trial of a decision support tool for risk-stratified colorectal cancer screening.

Background: A risk-stratified approach to colorectal cancer (CRC) screening could result in a more acceptable balance of benefits and harms, and be more cost-effective.

Aim: To determine the effect of a consultation in general practice using a computerised risk assessment and decision support tool (Colorectal cancer RISk Prediction, CRISP) on risk-appropriate CRC screening.

Design And Setting: Randomised controlled trial in 10 general practices in Melbourne, Australia, from May 2017 to May 2018.

Exploring a novel method for optimising the implementation of a colorectal cancer risk prediction tool into primary care: a qualitative study.

Background: We developed a colorectal cancer risk prediction tool ('CRISP') to provide individualised risk-based advice for colorectal cancer screening. Using known environmental, behavioural, and familial risk factors, CRISP was designed to facilitate tailored screening advice to patients aged 50 to 74 years in general practice. In parallel to a randomised controlled trial of the CRISP tool, we developed and evaluated an evidence-based implementation strategy.

Ten-year prediction model for post-bronchodilator airflow obstruction and early detection of COPD: development and validation in two middle-aged population-based cohorts.

Background: Classifying individuals at high chronic obstructive pulmonary disease (COPD)-risk creates opportunities for early COPD detection and active intervention.

Objective: To develop and validate a statistical model to predict 10-year probabilities of COPD defined by post-bronchodilator airflow obstruction (post-BD-AO; forced expiratory volume in 1 s/forced vital capacity<5th percentile).

Setting: General Caucasian populations from Australia and Europe, 10 and 27 centres, respectively.

'That might be a bit sexy for somebody your age': Older adult sexual health conversations in primary care.

Background: Many older adults are sexually active, and STIs are rising amongst this cohort. In primary care, sexual health discussions are limited as health-care practitioners commonly assume older patients aged 60+ are not sexually active or are unwilling to discuss sex. Studies have either examined patient or clinician views, but not both.

Accuracy of Risk Estimates from the iPrevent Breast Cancer Risk Assessment and Management Tool.

Background: iPrevent is an online breast cancer (BC) risk management decision support tool. It uses an internal switching algorithm, based on a woman's risk factor data, to estimate her absolute BC risk using either the International Breast Cancer Intervention Study (IBIS) version 7.02, or Breast and Ovarian Analysis of Disease Incidence and Carrier Estimation Algorithm version 3 models, and then provides tailored risk management information.

Benefits and harms of aspirin to reduce colorectal cancer risk: a cross-sectional study of methods to communicate risk in primary care.

Background: New Australian guidelines recommend that GPs actively consider prescribing low-dose aspirin to patients aged 50-70 years to reduce their risk of developing colorectal cancer (CRC). Patients and GPs need to understand the relative benefits and harms to support informed decision making.

Aim: To develop and examine different methods to communicate the benefits and harms of taking aspirin for CRC prevention.

Benefits and harms of selective oestrogen receptor modulators (SERMs) to reduce breast cancer risk: a cross-sectional study of methods to communicate risk in primary care.

Background: In Australia, evidence-based guidelines recommend that women consider taking selective oestrogen receptor modulators (SERMs) to reduce their risk of breast cancer. In practice, this requires effective methods for communicating the harms and benefits of taking SERMs so women can make an informed choice.

Aim: To evaluate how different risk presentations influence women's decisions to consider taking SERMs.

The CRISP-P study: feasibility of a self-completed colorectal cancer risk prediction tool in primary care.

Objective: Australia and New Zealand have the highest incidence of colorectal cancer (CRC) globally. Our research team has developed a CRC risk prediction tool for use in primary care to increase targeted screening. This study, Colorectal cancer RISk Prediction tool - patient ('CRISP-P'), aimed to determine the following to inform a future trial design: (i) the feasibility of self-reporting; (ii) the feasibility of recruitment methods; and (iii) the prevalence of CRC risk.

Could an online or digital aid facilitate discussions about sexual health with older Australians in general practice?

Background And Objectives: Older patients want to discuss sexual health with general practitioners (GPs) but feel uncomfortable doing so, as do their GPs. Online and digital aids (ODAs) are used in other clinical contexts and could provide an effective tool to overcome this discomfort. The aim of this study was to explore health practitioners’ views on the type of ODA that could be used to facilitate sexual health discussions between older patients (aged ≥60 years) and health practitioners.

Do you talk to your older patients about sexual health? Health practitioners’ knowledge of, and attitudes towards, management of sexual health among older Australians.

Background And Objectives: Research suggests that older patients want to talk about sexual health, but are reluctant to initiate these discussions with health practitioners. Little is known of the practitioners’ perspectives. The objective of this study was to explore health practitioners’ knowledge of and attitudes towards management of sexual health among older patients.

Mortality after breast cancer as a function of time since diagnosis by estrogen receptor status and age at diagnosis.

Our aim was to estimate how long-term mortality following breast cancer diagnosis depends on age at diagnosis, tumor estrogen receptor (ER) status, and the time already survived. We used the population-based Australian Breast Cancer Family Study which followed-up 1,196 women enrolled during 1992-1999 when aged <60 years at diagnosis with a first primary invasive breast cancer, over-sampled for younger ages at diagnosis, for whom tumor pathology features and ER status were measured. There were 375 deaths (median follow-up = 15.

The iPrevent Online Breast Cancer Risk Assessment and Risk Management Tool: Usability and Acceptability Testing.

Background: iPrevent estimates breast cancer (BC) risk and provides tailored risk management information.

Objective: The objective of this study was to assess the usability and acceptability of the iPrevent prototype.

Methods: Clinicians were eligible for participation in the study if they worked in primary care, breast surgery, or genetics clinics.

Consumer and clinician perspectives on personalising breast cancer prevention information.

Background: Personalised prevention of breast cancer has focused on women at very high risk, yet most breast cancers occur in women at average, or moderately increased risk (≤moderate risk).

Objectives: To determine; 1) interest of women at ≤ moderate risk (consumers) in personalised information about breast cancer risk; 2) familial cancer clinicians' (FCCs) perspective on managing women at ≤ moderate risk, and; 3) both consumers' and FCCs reactions to iPrevent, a personalised breast cancer risk assessment and risk management decision support tool.

Methods: Seven focus groups on breast cancer risk were conducted with 49 participants; 27 consumers and 22 FCCs.

The use of a risk assessment and decision support tool (CRISP) compared with usual care in general practice to increase risk-stratified colorectal cancer screening: study protocol for a randomised controlled trial.

Background: Australia and New Zealand have the highest incidence rates of colorectal cancer worldwide. In Australia there is significant unwarranted variation in colorectal cancer screening due to low uptake of the immunochemical faecal occult blood test, poor identification of individuals at increased risk of colorectal cancer, and over-referral of individuals at average risk for colonoscopy. Our pre-trial research has developed a novel Colorectal cancer RISk Prediction (CRISP) tool, which could be used to implement precision screening in primary care.

An open-source, integrated pedigree data management and visualization tool for genetic epidemiology.

With advances in genetic epidemiology, increasingly large amounts of pedigree-related information are being collected by family studies, including twin studies. To date, biomedical data management systems that cater for family data have usually done so as part of their standard (non-family-centric) data model. Consequently, data managers with computing expertise are needed to extract family datasets and perform family-centric operations.

The CRISP-Q study: Communicating the risks and benefits of colorectal cancer screening.

Background And Objectives: Many Australians at average risk of colorectal cancer (CRC) are undergoing unnecessary colonoscopic screening, while many at increased risk are getting inadequate screening. The aim of this study was to test different ways of communicating the risks and benefits of CRC screening, as part of the development of a CRC risk prediction (CRISP) tool.

Method: General practice patients were shown five different risk presentations for hypothetical ‘average’ and ‘increased’ risk cases and were asked to choose the screening method they would undergo.

Testing for Gene-Environment Interactions Using a Prospective Family Cohort Design: Body Mass Index in Early and Later Adulthood and Risk of Breast Cancer.

The ability to classify people according to their underlying genetic susceptibility to a disease is increasing with new knowledge, better family data, and more sophisticated risk prediction models, allowing for more effective prevention and screening. To do so, however, we need to know whether risk associations are the same for people with different genetic susceptibilities. To illustrate one way to estimate such gene-environment interactions, we used prospective data from 3 Australian family cancer cohort studies, 2 enriched for familial risk of breast cancer.

The CRISP colorectal cancer risk prediction tool: an exploratory study using simulated consultations in Australian primary care.

Background: In Australia, screening for colorectal cancer (CRC) with colonoscopy is meant to be reserved for people at increased risk, however, currently there is a mismatch between individuals' risk of CRC and the type of CRC screening they receive. This paper describes the development and optimisation of a Colorectal cancer RISk Prediction tool ('CRISP') for use in primary care. The aim of the CRISP tool is to increase risk-appropriate CRC screening.

The Ark: a customizable web-based data management tool for health and medical research.

Summary: The Ark is an open-source web-based tool that allows researchers to manage health and medical research data for humans and animals without specialized database skills or programming expertise. The system provides data management for core research information including demographic, phenotype, biospecimen and pedigree data, in addition to supporting typical investigator requirements such as tracking participant consent and correspondence, whilst also being able to generate custom data exports and reports. The Ark is 'study generic' by design and highly configurable via its web interface, allowing researchers to tailor the system to the specific data management requirements of their study.

iPrevent®: a tailored, web-based, decision support tool for breast cancer risk assessment and management.

We aimed to develop a user-centered, web-based, decision support tool for breast cancer risk assessment and personalized risk management. Using a novel model choice algorithm, iPrevent(®) selects one of two validated breast cancer risk estimation models (IBIS or BOADICEA), based on risk factor data entered by the user. Resulting risk estimates are presented in simple language and graphic formats for easy comprehension.

Mammographic density defined by higher than conventional brightness thresholds better predicts breast cancer risk.

Background: Mammographic density defined by the conventional pixel brightness threshold, and adjusted for age and body mass index (BMI), is a well-established risk factor for breast cancer. We asked if higher thresholds better separate women with and without breast cancer.

Methods: We studied Australian women, 354 with breast cancer over-sampled for early-onset and family history, and 944 unaffected controls frequency-matched for age at mammogram.

Breast Cancer Risk Prediction Using Clinical Models and 77 Independent Risk-Associated SNPs for Women Aged Under 50 Years: Australian Breast Cancer Family Registry.

Background: The extent to which clinical breast cancer risk prediction models can be improved by including information on known susceptibility SNPs is not known.

Methods: Using 750 cases and 405 controls from the population-based Australian Breast Cancer Family Registry who were younger than 50 years at diagnosis and recruitment, respectively, Caucasian and not BRCA1 or BRCA2 mutation carriers, we derived absolute 5-year risks of breast cancer using the BOADICEA, BRCAPRO, BCRAT, and IBIS risk prediction models and combined these with a risk score based on 77 independent risk-associated SNPs. We used logistic regression to estimate the OR per adjusted SD for log-transformed age-adjusted 5-year risks.

Elevated plasma inflammatory mediators in post-polio syndrome: No association with long-term functional decline.

A key feature of post-polio syndrome (PPS) is progressive loss of muscle strength. In other chronic diseases systemic inflammation has been linked to muscle wasting. In this study plasma TNF-α, IL-6, IL-8, and leptin levels were significantly increased in PPS-patients compared to healthy controls.

Change in physical mobility over 10 years in post-polio syndrome.

Post-polio syndrome is characterised by progressive muscle weakness and other symptoms which can limit physical mobility. We assessed the rate of decline in mobility over 10 years in relation to strength decline; and investigated potential predictors for the rate of decline of walking capacity, a measure of mobility, in 48 patients with post-polio syndrome and proven quadriceps dysfunction at baseline. Average walking capacity and self-reported physical mobility declined over 10 years, by 6 and 14%, respectively.