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Biomedical subjects

N Donnelly

Publications and source records attributed to N Donnelly.

At least 19 recordsLinked to original sources
PubMed2005

The role of parental presence in the context of children's medical procedures: a systematic review.

BACKGROUND: There are conflicting views and practices regarding whether or not parents should be present at the time of their child's medical procedure. A systematic review was conducted to assess the effects of parental presence in the paediatric treatment room on child, parent and health professional outcomes and to synthesize this body of literature. METHODS: Based on a comprehensive literature search, studies investigating parental presence in the paediatric treatment room were included in the review if they had a concurrent control group (i.e. a parent-absent group). RESULTS: A total of 28 studies met inclusion criteria, which included 1256 children with a parent present and 1025 children without a parent present. There were mixed findings regarding the effect of parental presence on measures of child distress and affect, however, studies of lower levels of evidence were more likely to report significant results. Parents who were present during their child's medical intervention were either better off or no different from parents who were absent with regard to their levels of distress and satisfaction. There was no evidence of increased technical complications nor elevated staff anxiety for health professionals attending to children with a parent present as compared to attending to children without their parents. DISCUSSION: Although parental presence may not have a clear, direct influence on child distress and behavioural outcomes, there are potential advantages for parents. It seems appropriate that clinicians provide parents with the opportunity to be present during their child's painful procedure.

Adolescent↗
PubMed2004

Impact of national guidelines about the management of colorectal cancer on Australian surgeons' awareness of evidence: a pre/post survey.

OBJECTIVE: To evaluate the immediate impact of national evidence-based guidelines about colorectal cancer on Australian surgeons' self-reported practice and their deficits in awareness of scientific evidence underpinning clinical management practices. DESIGN: Pre/post evaluation, comprising preguidelines survey (November 1998) and postguidelines survey (February 2001). METHODS: One hundred and fourteen Australian surgeons returned postguidelines surveys, of whom 103 (90%) agreed to matching of their pre- and postguidelines responses. National distribution of the CRC guidelines occurred in November 1999. Over the ensuing year, dissemination strategies included seminars, presentations at conferences and journal articles. The main outcome measures used were changes in awareness of evidence for each of 23 clinical recommendations, changes in overall awareness score (maximum possible 23), changes in subscore for nine items for which evidence was compelling and predictors of change. RESULTS: Of those surgeons followed up, 95% were aware of the guidelines and 32% had read them in detail. Only 47% recalled the consumer version. The three most highly rated topics in the guidelines were: high-risk familial syndromes (45%); screening based on family history of colorectal cancer (40%); population screening for colorectal cancer (25%). Compared with baseline, there was a modest improvement in the mean overall awareness score (P = 0.02). Paired analyses of awareness of the evidence for each of 23 individual topics revealed significant improvement only in five. For two, awareness significantly decreased. CONCLUSIONS: Our pre/post findings are not inconsistent with the expectation that dissemination of the CRC guidelines has had some short-term impact. However, definitive evidence acquired through more rigorously designed controlled trials will be needed to determine first, whether surgical practice has changed and, second, whether implementation of the CRC guidelines or some other secular event caused such change.

Adult↗
PubMed2003

Preventive dentistry: what do Australian patients endorse and recall of smoking cessation advice by their dentists?

OBJECTIVE: To investigate patients' views regarding dentists' smoking cessation advice. DESIGN: Survey questionnaire. SETTING: One hundred and thirty five dental practices in Sydney Australia. Subjects Two thousand, four hundred and fifty one dental patients. RESULTS: One thousand, one hundred and sixty pre-consultation questionnaires were obtained (RR=80%), 302 (26%) were self-reported smokers. From these, 623 post-consultation questionnaires were returned (RR = 54%). Most patients expected dentists to be interested in their smoking status (n = 847/1160, 73%, 95% CI: 70% to 76%) and to discuss smoking with them (n = 713/1160, 61%, 95% CI: 59% to 64%), however, smokers were significantly less likely to respond as such compared with non-smokers (P < 0.001). Smokers and non-smokers equally would not change dentist even if asked about their smoking status opportunistically (59% versus 62%) (OR = 0.91, 95% CI: 0.67 to 1.22). Less than one third of all smokers would try to quit if their dentist suggested they do so (n = 90/302, 30%, 95% CI: 25% to 35%). Smokers' recall of quit advice from their recent consultation was low (n = 22/124, 18%). CONCLUSIONS: Smoking cessation advice by dentists is not self-evidently effective. These findings behove interventional research to ascertain efficacy of smoking cessation advice delivered by dentists before admonishing changes in routine clinical practice.

Adolescent↗
PubMed2000

Impact of increasing the re-supply interval on the seasonality of subsidised prescription use in Australia.

OBJECTIVE: To evaluate the impact of increasing the minimum re-supply period for prescriptions on the Pharmaceutical Benefits Scheme (PBS) in November 1994. The intervention was designed to reduce the stockpiling of medicines used for chronic medical conditions under the PBS safety net. METHODS: Interrupted times series regression analyses were performed on 114 months of PBS drug utilisation data from January 1991 to June 2000. These analyses assessed whether there had been a significant interaction between the onset of the intervention in November 1994 and the extreme levels of drug utilisation in the months of December (peak utilisation) and January (lowest utilisation) respectively. Both serial and 12-month lag autocorrelations were controlled for. RESULTS: The onset of the intervention was associated with a significant reduction in the December peak in drug utilisation; after the introduction of the policy there were 1,150,196 fewer prescriptions on average for that month (95% CI 708,333-1,592,059). There was, however, no significant change in the low level of utilisation in January. The effect of the policy appears to be decreasing across successive post-intervention years, though the odds of a prescription being dispensed in December remained significantly lower in 1999 compared to each of the pre-intervention years (11% vs. 14%). CONCLUSION: Analysis of the impact of increasing the re-supply period for PBS prescriptions showed that the magnitude of peak utilisation in December had been markedly reduced by the policy, though this effect appears to be decreasing over time. Continued monitoring and policy review is warranted in order to ensure that the initial effect of the intervention be maintained.

Australia↗
PubMed2000

Computer recording of standard tests of visual neglect in stroke patients.

OBJECTIVE: To determine whether a computer-based method for recording standardized assessment of neglect identifies abnormalities in the 'process' as well as in the 'outcome' of such tasks. DESIGN: Prospective sequential assessment of patients admitted to a stroke rehabilitation unit. SUBJECTS: All consecutive patients with right-sided cerebrovascular accident confirmed on computerized tomography (CT) scan including 30 patients with neglect, 57 patients without neglect. An age-matched control group of 13 subjects. INTERVENTION: All patients were tested using the standard Rivermead Behavioural Inattention Test (BIT) and by computer recording of two standard tests for assessing neglect (line bisection and Albert's test). Age-matched controls were tested using computer recording of the two standard tests. MAIN OUTCOME MEASURES: Neglect was defined using the BIT with a cut-off score of 129. Computer recording measured the 'outcome' of tasks, i.e. the deviation from midline and omissions in cancellation, as well as the 'process' of tasks, i.e. time between cancellations, components of cancellation time including premovement, movement and drawing time, and the starting point for cancellation. RESULTS: The computer recording identified significant differences in 'outcome' and 'process' which distinguished neglect from non-neglect patients. There were significant differences between non-neglect patients and age-matched controls with regard to 'process' measures but not with regard to 'outcome' measures. CONCLUSIONS: Computer recording of standard tests for assessing neglect identifies novel impairments with regard to the process of carrying out tasks. These impairments may be used to investigate changes in neglect with time, the response of neglect to treatment and to explore further the neuropsychological changes associated with neglect in stroke patients.

Aged↗
PubMed2000

3-D constraints on spatially parallel shape perception.

We report evidence from three sets of experiments dealing with spatially parallel grouping of parts in single objects. A first set of experiments demonstrates that parts can be encoded in a spatially parallel manner in three-dimensional (3-D) objects, while there is a serial selection of parts across objects. A second set of experiments further shows that grouping in 3-D is less affected by eliminating collinearity between the parts of objects than grouping in two dimensions, suggesting that 3-D constraints operate directly on visual grouping. A final pair of experiments demonstrates that rotating the elements in the plane, to make a physically unstable 3-D object, disrupts the benefit found with 3-D stimuli when collinearity is eliminated. The evidence indicates that there is rapid and spatially parallel encoding of 3-D object descriptions in vision.

Attention↗
PubMed1999

Prostate cancer testing: behaviour, motivation and attitudes among Western Australian men.

OBJECTIVE: To estimate the proportion of Western Australian men aged 40-80 years who had been tested for prostate cancer, their experiences of screening and perception of its benefit. DESIGN AND SETTING: Cross-sectional survey (random telephone survey) of Western Australian men conducted in February 1998. PARTICIPANTS: 400 men aged 40-80 years from 670 eligible households (60% response rate from contactable households with eligible men). MAIN OUTCOME MEASURES: Proportion of respondents tested for prostate cancer (by prostate-specific antigen [PSA] test or digital rectal examination); reasons for having been tested; information provided by the doctor before testing; reasons given for and beliefs about the benefits of testing. RESULTS: Of 391 asymptomatic men, 220 (56%) recalled having been tested for prostate cancer and 167 (43%) had had a PSA test. Of those tested, 86% had their first test in the previous five years. The two most common reasons for testing were media publicity and general practitioner recommendation. Thirty-eight per cent of men tested during the previous five years reported that the doctor did not discuss the "pros and cons" of the test; 39% reported a discussion of less than five minutes' duration; 17% were given printed information before undergoing the test for the first time. Half were "very convinced" of the benefits of testing for prostate cancer. CONCLUSIONS: Men are being tested for prostate cancer with minimal pretest counselling or written information.

Adult↗
PubMed1999

The role of stimulus factors in making categorical and coordinate spatial judgments.

We report three experiments which investigate the lateralization of categorical and coordinate processing. In all experiments, participants judged the position of a dot relative to a line. We manipulated display luminance (controlling for contrast), polarity (black-on-white versus white-on-black displays), and exposure duration (100, 150, and 200 ms). The results showed a left visual field-right hemisphere advantage for coordinate judgments, but only under highly prescribed conditions. We argue that stimulus and procedural factors are critical in determining the hemisphere by task interaction.

Brain↗
PubMed1999

Health behaviour and the school environment in New South Wales, Australia.

The relationship between the school environment and health has infrequently been examined. This study sought to examine the association between school students' perceptions of their school environment, teachers' and peers' support and their health behaviours. A cross sectional descriptive survey by supervised self-administration was conducted in 1996 based on the international WHO collaborative survey of school children's health and lifestyle (the HBSC Study) and extended in an Australian setting. Randomly sampled primary and secondary schools from Catholic, Independent and Government education sectors throughout New South Wales (NSW), Australia, were invited to participate. The final sample included 3918 school students attending Year 6 (primary school), Year 8 and Year 10 (high school) from 115 schools. The main outcome measures were self-reported health status and 7 health behaviours (tobacco use, alcohol use, physical activity, dental hygiene, nutritional intake, seat belt and bicycle helmet use). Independent variables included student perceptions of the school environment, perceptions of teachers' and peers' support. Girls, Year 6 students and students who have less than $19 a week to spend were significantly more likely to have positive perceptions towards their school environment, teacher(s) and peers. Students who had positive perceptions regarding their school environment and perceived their teachers as supportive were significantly more likely to engage in health promoting behaviours adjusting for age, sex and average weekly pocket money. A supportive peer environment was not associated with positive health behaviour. Health promotion practitioners need to consider the impact of the school environment on health behaviours of school students. In particular, practitioners should consider intervention models that improve the school environment as a key strategy within a health promoting school.

Adolescent↗
PubMed1999

Developing algorithms to enhance the sensitivity of cancellation tests of visuospatial neglect.

We describe a set of algorithms that enhance the sensitivity of cancellation tests used in assessing visuospatial neglect. The algorithms can be readily implemented on a computer and can provide temporal and nontemporal data on strategies used during cancellation. We also present preliminary results from a group of 68 right-hemisphere brain-damaged patients and 12 age-matched control participants, which demonstrate the clinical significance of the measures we have defined.

Adult↗
PubMed1999

Searching for impossible objects: processing form and attributes in early vision.

In five experiments, we investigated the extent to which form (shape) and metric attributes (three-dimensional, 3-D, orientation), both defined by relations between line elements, are processed in early vision. Search for a target defined by an abstract property of form (i.e., impossibility) was slow and serial. In contrast, search for a 3-D orientation target was considerably easier. Subsequent experiments suggest that this difference reflects the fact that 3-D orientation is derivable from localized sets of lines, whereas impossibility is an idiosyncratic property of the complete set of relations between lines. We conclude that only "gross" aspects of form are available in early vision as the complete set of line relations is not processed preattentively. However, localized processing of line relations is sufficient to derive 3-D orientation.

Analysis of Variance↗
PubMed1998

Visual synchrony affects binding and segmentation in perception.

The visual system analyses information by decomposing complex objects into simple components (visual features) that are widely distributed across the cortex. When several objects are present simultaneously in the visual field, a mechanism is required to group (bind) together visual features that belong to each object and to separate (segment) them from features of other objects. An attractive scheme for binding visual features into a coherent percept consists of synchronizing the activity of their neural representations. If synchrony is important in binding, one would expect that binding and segmentation are facilitated by visual displays that are temporally manipulated to induce stimulus-dependent synchrony. Here we show that visual grouping is indeed facilitated when elements of one percept are presented at the same time as each other and are temporally separated (on a scale below the integration time of the visual system) from elements of another percept or from background elements. Our results indicate that binding is due to a global mechanism of grouping caused by synchronous neural activation, and not to a local mechanism of motion computation.

Cortical Synchronization↗
PubMed1998

Differential effects of protein kinase C agonists on prostaglandin production and growth in human breast cancer cells.

A regulatory role for protein kinase C (PKC) and eicosanoids has been implicated in the control of breast cancer cell growth and function. Here we report on the effects of the two PKC agonists 12-O-tetradecanoyl-phorbol-13-acetate (TPA) and bryostatin 1 on arachidonic acid metabolism, prostaglandin E2 (PGE2) production, and growth in MDA MB 231 human breast cancer cells. TPA caused a dose-dependent increase in PGE2 production which was maximal at 100 nM and which was blocked in the presence of an equimolar concentration of bryostatin 1. Bryostatin 1 alone had no effect on PGE2 synthesis. Both TPA and bryostatin 1 stimulated arachidonic acid release and reduced fatty acid incorporation into phosphatidylinositol, their combined effect being less than additive in co-incubation. Interleukin-1beta (IL-1beta) induced a tenfold and twofold synergistic increase in PGE2 production in the presence of TPA (10 nM) and bryostatin 1 (10 nM) respectively. Bryostatin 1 caused a dose-dependent inhibition of the phorbol ester-potentiated IL-1beta response. Treatment of MDA MB 231 cells for 4 days with TPA (10 nM) or bryostatin 1 (10 nM) inhibited cell growth by 74% and 20% respectively. Co-treatment with both PKC agonists reversed the anti-proliferative effect of TPA to that seen with bryostatin 1 alone. In contrast the anti-proliferative action of ceramide, another PKC modulator, was unaffected in the presence of bryostatin 1. TPA also induced morphological changes in MDA MB 231 cells which were prevented by co-treatment with bryostatin 1. This study further supports a regulatory role for PKC in the control of eicosanoid synthesis and growth in human breast cancer cells. Although the findings are consistent with bryostatin 1 acting as an antagonist/weak agonist in relation to TPA action, the mechanistic basis for this differential action of TPA and bryostatin 1 is uncertain.

Antineoplastic Agents↗
PubMed1998

Impact in general practice of the policies of the organised approach to preventing cancer of the cervix.

This cross-sectional survey of cancer screening in May 1996 used a national random sample of a specified group of general practitioners (GPs). The survey included items to assess the impact of the Organised Approach to the Prevention of Cervical Cancer (OAPCC). Of the 1,271 GPs who satisfied the eligibility criteria, 855 (67%) returned a completed questionnaire. Fifty-two per cent indicated they would be 'highly' likely to introduce a discussion about cervical smears to a 58-year-old woman who was in good health and had come for a non-gynaecological consultation. Female sex, RACGP affiliation, practising in a metropolitan area and awareness of the OAPCC booklet were independent predictors of an opportunistic orientation. By contrast, 91% indicated that they would be 'highly' likely to include a Pap smear in a general health checkup. Thirty-eight per cent reported that they had found the booklet about the 1991 screening policy 'very' useful, while 38% found the NHMRC guidelines for the management of women with screen detected abnormalities 'very' useful. Around one-fifth of the GPs were not aware of these documents. Overall, 19% still recommended annual or more frequent screening. GPs from NSW and Queensland were less likely to support biennial screening than GPs from other states. Overall, 26% of GPs did not indicate that they would refer a woman who had tested positive for any grade of CIN for colposcopic assessment. Female GPs were more likely to refer women with CIN for colposcopic assessment while older doctors were less likely to do so.

Adult↗
PubMed1996

Prescription drug utilization following patient co-payment changes in Australia.

In November 1990 major patient co-payment changes were introduced into the Pharmaceutical Benefits Scheme (PBS), which accounts for around 90% of all community prescriptions in Australia. Interrupted time series analyses were performed to assess the impact of these co-payment changes on the prescription levels of defined groups of 'discretionary' and 'essential' drugs for both the general community and for a subgroup comprising elderly returned servicemen and women. While the co-payment changes themselves had a significant immediate effect on lowering the use of both categories of drugs, the effects were substantially larger for the 'discretionary' groups in both cases. Notably there was a clear post-intervention trend for increased prescriptions of 'essential' drugs after the initial decline, which was not evident for the 'discretionary' drugs. The introduction of programmes to compensate high risk groups in Australia may have enabled the co-payment to become a more selective policy instrument than has been shown in other settings.

Journal Article↗