Background: Access to healthcare significantly influences health outcomes, and rural, regional and remote populations face greater challenges in accessing healthcare than urban populations. Digital health tools, such as remote patient monitoring (RPM), have significant potential to address these healthcare challenges, yet there is little research on the facilitators and barriers of RPM in these regions.
Aim: This study aims to identify and understand the facilitators and barriers healthcare staff face implementing RPM in rural and regional Australia, with focus on challenges that arose after the onset of the COVID-19 pandemic.
Implementation of evidence-informed rehabilitation of the upper limb is variable, and outcomes for stroke survivors are often suboptimal. We established a national partnership of clinicians, survivors of stroke, researchers, healthcare organizations, and policy makers to facilitate change. The objectives of this study are to increase access to best-evidence rehabilitation of the upper limb and improve outcomes for stroke survivors.
View Article and Find Full Text PDFRationale: Delivering optimal patient health care requires interdisciplinary clinician communication. A single communication tool across multiple pre-hospital and hospital settings, and between hospital departments is a novel solution to current systems. Fit-for-purpose, secure smartphone applications allow clinical information to be shared quickly between health providers.
View Article and Find Full Text PDFPurpose: Diabetic plexopathy is among the most unusual and disabling complication type 2 diabetic mellitus (T2DM) causing major suffering among affected individuals. The clinical presentation includes asymmetric muscle atrophy, weakness, and pain, typically associated with sudden weight loss. In part due to its rarity, this condition can be easily missed with serious consequences including potentially fatal complications.
View Article and Find Full Text PDFObjectives: To determine if a digital communication app improves care timelines for patients with suspected acute stroke/ST-elevation myocardial infarction (STEMI).
Design: Real-world feasibility study, quasi-experimental design.
Setting: Prehospital (25 Ambulance Victoria branches) and within-hospital (2 hospitals) in regional Victoria, Australia.
Background: News of the impact of COVID-19 around the world delivered a brief opportunity for Australian health services to plan new ways of delivering care to large numbers of people while maintaining staff safety through greater physical separation. The rapid pivot to telemedicine and virtual care provided immediate and longer term benefits; however, such rapid-cycle development also created risks.
Objective: The aim of this study was to understand the sociotechnical aspects of the rapid-cycle development of seven different COVID-19 virtual care tools, and to identify enablers, barriers, and risks at three health services in Victoria, Australia.
Telehealth can effectively increase access to specialist care and reduce the need for travel. The Geri-Connect service was established in 2017 to support people living in residential aged care facilities in regional Victoria, Australia. Using the Model for the Assessment of Telemedicine, an evaluation of the Geri-Connect service identified service activity patterns and factors associated with uptake.
View Article and Find Full Text PDFBackground: This paper describes the rationale and design of the ENVIS-ion Study, which aims to determine whether low-dose aspirin reduces the development of white matter hyper-intense (WMH) lesions and silent brain infarction (SBI). Additional aims include determining whether a) changes in retinal vascular imaging (RVI) parameters parallel changes in brain magnetic resonance imaging (MRI); b) changes in RVI parameters are observed with aspirin therapy; c) baseline cognitive function correlates with MRI and RVI parameters; d) changes in cognitive function correlate with changes in brain MRI and RVI and e) whether factors such as age, gender or blood pressure influence the above associations.
Methods/design: Double-blind, placebo-controlled trial of three years duration set in two Australian academic medical centre outpatient clinics.
Background: Ideally putative disease-modifying therapies for Alzheimer's disease (AD) should be tested in patients who have minimal morbidity. Current barriers to such trials in early disease include the lack of disease-specific early biomarkers, insensitivity of quantitative cognitive outcome measures, and expensive trial designs requiring large sample sizes and long duration. This paper describes principles and progress towards a novel trial design that overcomes these problems, utilizing wide-scale cognitive performance screening to define pre-trial cognitive decline trajectories which can serve as trial outcome measures to assess AD disease-modifying efficacy.
View Article and Find Full Text PDFWhile hippocampal volumes have been extensively examined in neuropsychiatric disorders and ageing, small areas of signal variation within the hippocampus commonly observed on MRI, described as hippocampal sulcal cavities (HSCs), have received less attention. We review the published literature on HSCs to examine their prevalence, putative aetiological factors such as hypertension, and possible cognitive correlates. HSCs were reported in 77% (66% weighted mean) of patients with memory disorders and 48% (47% weighted mean) of controls, and the prevalence increased with age in healthy subjects (r=0.
View Article and Find Full Text PDFIntroduction: the sensitive detection of mild cognitive impairment (MCI) in older adults is an important problem that requires objective assessment. We evaluated whether the computerised cognitive test battery, CogState, was as sensitive to MCI as two well-validated 'paper-and-pencil' tests, the Hopkins Verbal Learning Test (HVLT) and the Mini-Mental Status Examination (MMSE).
Methods: these tests were administered with a subjective memory questionnaire and an 'Activities of Daily Living' scale to 21 individuals with MCI and 98 cognitively healthy controls matched for sex, education and IQ levels.
Childhood obesity is increasingly prevalent in the community and is related to adverse cardiovascular outcomes during adulthood. In this study of healthy children, we evaluated the influence of adiposity and physical activity on carotid-femoral pulse wave velocity (PWV), an index of arterial stiffness and a marker of cardiovascular risk in adults. In 573 community-based children (mean age: 10.
View Article and Find Full Text PDFWe hypothesized that carotid-femoral pulse wave velocity (PWV), a marker of arterial stiffness, interacts with age such that the magnitude of associations between PWV and cognitive performance are greater with increasing age and that this interaction is observed despite adjustments for demographic variables, mean arterial pressure, and cardiovascular risk factors. PWV was estimated using applanation tonometry in 409 dementia- and stroke-free participants of the Maine-Syracuse Longitudinal Study (24 to 92 years of age; 62.3% women).
View Article and Find Full Text PDFWith the rapid ageing of the Australian population, dementia has emerged as a major health and economic challenge. Consensus exists that the number of people with dementia will grow significantly because the prevalence is strongly correlated with age. However, there are substantial gaps in our understanding of the impacts on the dementia "epidemic" of changes in non-demographic risk factors and of our knowledge of the economic implications.
View Article and Find Full Text PDFBackground: Previous studies have demonstrated a relationship between central adiposity and cognitive function. However, only some of these studies have adjusted for cardiovascular risk factors and cardiovascular disease, and none have also adjusted for physical activity level.
Purpose: The purpose of the study was to examine the association between anthropometric measures of central adiposity (waist circumference and waist/hip ratio) and cognitive functioning with adjustment for cardiovascular disease risk factors and physical activity.
Background: Various charts based on body mass index (BMI) and per cent body fat (%BF) are used to classify childhood body composition but outcomes may vary.
Aim: The study investigated variation in incidences of childhood obesity as depicted by four classification charts.
Subjects And Methods: BMI and DXA-derived %BF were assessed in 741 children.
Objective: An age-dependent relationship between aortic and left ventricular (LV) stiffening has been observed in community-based adults. Our aim was to compare the performances of wave reflection-dependent (pulse pressure) and independent [carotid-femoral pulse wave velocity (PWV)] indexes of aortic stiffness to detect preclinical LV diastolic dysfunction.
Methods: In this case-control study, a stratified subsample of participants of a population-based echocardiographic survey with LV ejection fraction higher than 45% and without overt heart failure was randomly selected to undergo assessment of brachial blood pressure, LV diastolic function by Doppler echocardiography, and estimation of central aortic pressures and PWV by applanation tonometry.
We hypothesized that the magnitude of the association between plasma homocysteine concentration and cognitive performance is larger for ApoE-epsilon4 carriers than for non-carriers. Nine hundred eleven dementia-free and stroke-free subjects (59% women) from the Maine-Syracuse study (26-98 years old) were stratified into no-ApoE-epsilon4 (n=667) and ApoE-epsilon4 carrier (n=244) cohorts. Employing a cross-sectional design and multiple regression analyses, plasma homocysteine was related to multiple domains of cognitive performance within these cohorts.
View Article and Find Full Text PDFAnnu Int Conf IEEE Eng Med Biol Soc
March 2008
We describe a distributed falls management system capable of real-time falls detection in an unsupervised living context and remote longitudinal tracking of falls risk parameters using a waist-mounted triaxial accelerometer. A self-administrable falls risk assessment is used to facilitate falls prevention. A web-interface allows clinicians to monitor the status of individuals and track their compliance with exercise interventions.
View Article and Find Full Text PDFConf Proc IEEE Eng Med Biol Soc
March 2008
In response to an extended user needs analysis, a home telecare system designed for the management of patients with chronic disease was adapted for use in residential aged care facilities (RACFs). The system architecture and hardware and software components are described for both the client- and server-side. The client-side includes medication dispensing, scheduled clinical measurements and questionnaire delivery.
View Article and Find Full Text PDFThis methods paper outlines the overall design of a community-based multidisciplinary longitudinal study with the intent to stimulate interest and communication from scientists and practitioners studying the role of physical activity in preventive medicine. In adults, lack of regular exercise is a major risk factor in the development of chronic degenerative diseases and is a major contributor to obesity, and now we have evidence that many of our children are not sufficiently active to prevent early symptoms of chronic disease. The lifestyle of our kids (LOOK) study investigates how early physical activity contributes to health and development, utilizing a longitudinal design and a cohort of eight hundred and thirty 7-8-year-old (grade 2) school children followed to age 11-12 years (grade 6), their average family income being very close to that of Australia.
View Article and Find Full Text PDFBackground: Inter-professional learning (IPL) and inter-professional practice (IPP) are thought to be critical determinants of effective care, improved quality and safety and enhanced provider morale, yet few empirical studies have demonstrated this. Whole-of-system research is even less prevalent. We aim to provide a four year, multi-method, multi-collaborator action research program of IPL and IPP in defined, bounded health and education systems located in the Australian Capital Territory (ACT).
View Article and Find Full Text PDFMed Image Comput Comput Assist Interv
April 2007
In model-based segmentation, automated region identification is achieved via registration of novel data to a pre-determined model. The desired structure is typically generated via manual tracing within this model. When model-based segmentation is applied to human cortical data, problems arise if left-right comparisons are desired.
View Article and Find Full Text PDFAim: To investigate doctors' response to and understanding of the legal status of advance directives.
Methods: A vignette-based study administered at palliative medicine, oncology, general practice, and geriatric medicine specialist registrar meetings (United Kingdom). Respondents determined the treatment to provide for a patient presenting with a myocardial infarction with or without an advance directive requesting maximum therapy.
Objective: Our objective was to examine associations among plasma homocysteine concentrations (tHcy), the tHcy-cofactors (folate, vitamins B6 and B12), and multiple domains of cognitive performance, with statistical adjustment for possible confounds, including cardiovascular disease risk factors (CVD-RF) and cardiovascular disease (CVD).
Methods: Subjects were 812 participants (58% women) of the Maine-Syracuse study who were free of dementia and stroke. Employing a cross-sectional design and multiple regression analyses, fasting concentrations of tHcy and its vitamin cofactors (folate, B6, and B12) were related to multiple domains of cognitive performance.