Biomedical subjects

Adrian Esterman

Publications and source records attributed to Adrian Esterman.

15 recordsLinked to original sources

PubMed2006

Effect of dietary resistant starch and protein on colonic fermentation and intestinal tumourigenesis in rats.

Protein as well as starch is fermented in the colon, but the interaction between protein and starch fermentation and the impact on colonic oncogenesis is unknown. High-protein diets increase delivery of protein to the colon and might promote oncogenesis through generation of toxic products. We investigated the interaction of resistant starch (RS) with digestion-resistant potato protein (PP) on colonic fermentation events and their relationship to intestinal tumourigenesis. Male Sprague-Dawley rats were fed an AIN-76A-based diet for 4 weeks and intestinal neoplasms were induced by azoxymethane. Experimental diets included the following: no added RS or PP, 10% high amylose maize starch (source of RS) replacing digestible starch, 15% PP replacing casein and 10% high amylose maize starch+15% PP. Rats were maintained on diets until killed at 30 weeks. Feeding RS significantly increased short-chain fatty acid (SCFA) levels (P<0.001) in the caecum and colon. Importantly, butyrate concentration was significantly increased in the distal colon with RS (P<0.001). Feeding PP increased protein fermentation products, but this effect was reduced by adding RS to the diet. Intestinal neoplasms and colorectal adenocarcinomas were reduced by feeding RS (P<0.01) regardless of whether PP was fed, whereas PP alone increased the incidence and number of small intestinal neoplasms including the adenocarcinomas (P<0.01). In conclusion, RS altered the colonic luminal environment by increasing the concentration of SCFAs including butyrate and lowering production of potentially toxic protein fermentation products. These effects of RS not only protected against intestinal tumourigenesis but also ameliorated the tumour-enhancing effects of feeding indigestible protein.

Animals↗

PubMed2006

Cluster randomized controlled trials in primary care: an introduction.

BACKGROUND: Cluster randomized trials occur when groups or clusters of individuals, rather than the individuals themselves, are randomized to intervention and control groups and outcomes are measured on individuals within those clusters. Within primary care, between 1997 and 2000, there has been a virtual doubling in the number of published cluster randomized trials. A recent systematic review, specifically within primary care, found study quality to be both generally lower than that reported elsewhere and not to have shown any recent quality improvement. OBJECTIVE: To discuss the design, conduct and analysis of cluster randomized trials within primary care in terms of the appropriate expertise required, potential bias, ethical considerations and expense. DISCUSSION: Compared with trials that involve the randomization of individual participants, cluster randomized trials are more complex to design and analyse and, for a given sample size, have decreased power and a broadening of confidence intervals. Cluster randomized trials are specifically prone to potential bias at two levels-the cluster and individual. Regarding the former, it is recommended that cluster allocation be undertaken by a party independent to the research team and careful consideration be given to ensure minimal cluster attrition. Bias at the individual level can be overcome by identifying trial participants before randomization and at this time obtaining consent for intervention, data collection or both. A unique ethical aspect to cluster randomized trials is that cluster leaders may consent to the trial on behalf of potential cluster members. Additional costs of cluster randomized trials include the increased number of patients required, the complexity in their design and conduct and, usually, the need to recruit clusters de novo. CONCLUSION: Cluster randomized trials are a powerful and increasingly popular research tool. They are uniquely placed for the conduct of research within primary-care clusters where intracluster contamination can occur. Associated methodological issues are straightforward and surmountable and just need careful consideration and management.

Bias↗

PubMed2006

Assessment of physical examination and magnetic resonance imaging findings of hamstring injury as predictors for recurrent injury.

STUDY DESIGN: Prospective cohort study. OBJECTIVE: To examine clinical and magnetic resonance imaging (MRI) features of hamstring muscle injury to determine if any are predictive for recurrent injury. BACKGROUND: Hamstring muscle strain injury and subsequent recurrent injury are common. Little information exists on factors that may increase the risk for recurrent injury. METHODS AND MEASURES: The subjects were athletes from 3 professional Australian Rules football teams (n = 162). Anthropometric measurements, clinical signs, convalescent interval, and MRI assessment and measurement were undertaken and recorded in athletes with hamstring muscle strain injury. Athletes were followed for the presence, or absence, of recurrent injury to the same-side posterior thigh over the same and subsequent playing seasons. RESULTS: Thirty athletes met criteria for hamstring injury. Twelve (40%) of 30 athletes had recurrent injury within the same season, with an additional 7 athletes having recurrent injury in the subsequent season. None of the features examined were associated with increased recurrent injury risk within the same playing season. Statistical analysis demonstrated that when combining the same with the subsequent playing season a larger size of initial hamstring injury, as measured by MRI, was associated with an increased risk for recurrent injury (P<.01). A measured transverse size of injury greater than 55% of the muscle, or calculated volume of injury greater than 21.8 cm3, resulted in an increased risk for hamstring recurrence of 2.2 (95% CI, 0.88-5.32) and 2.3 (95% CI, 0.94-5.81) times, respectively, when compared to athletes with hamstring injuries below these measurements. CONCLUSIONS: A larger size of hamstring injury was indicative of higher risk for recurrent injury but only after the subsequent playing season was considered along with the same playing season. None of the other parameters tested, including a shorter convalescent interval and clinical features, were associated with an increased risk for recurrent injury. However, due to low sample size the certainty of these conclusions may be limited.

Adult↗

PubMed2006

Women's decision making at menopause - a focus group study.

BACKGROUND: Women are faced with a confusion of information and uncertainty when making decisions at menopause. METHODS: We conducted four focus groups of 31 women aged 40-64 years, exploring their experience and views about menopause, its management, and decision support needs. RESULTS: Focus group participants saw menopause as a natural progression rather than a medical condition, and decision making about therapies as a personal responsibility. They wanted reliable, agenda free information, and opportunities to discuss personal needs with (preferably female) health professionals. They preferred minimal intervention and found life style strategies helpful. DISCUSSION: Women's preference to make their own decisions at menopause is frustrated by conflicting information and the perceived marketing agenda of information sources. Women need unbiased, timely, menopause information backed by expert commentary in a range of media to suit their access needs.

Adult↗

PubMed2005

A pragmatic 2 x 2 x 2 factorial cluster randomized controlled trial of educational outreach visiting and case conferencing in palliative care-methodology of the Palliative Care Trial [ISRCTN 81117481].

The demand for palliative care is increasing, yet there are few data on the best models of care nor well-validated interventions that translate current evidence into clinical practice. Supporting multidisciplinary patient-centered palliative care while successfully conducting a large clinical trial is a challenge. The Palliative Care Trial (PCT) is a pragmatic 2 x 2 x 2 factorial cluster randomized controlled trial that tests the ability of educational outreach visiting and case conferencing to improve patient-based outcomes such as performance status and pain intensity. Four hundred sixty-one consenting patients and their general practitioners (GPs) were randomized to the following: (1) GP educational outreach visiting versus usual care, (2) Structured patient and caregiver educational outreach visiting versus usual care and (3) A coordinated palliative care model of case conferencing versus the standard model of palliative care in Adelaide, South Australia (3:1 randomization). Main outcome measures included patient functional status over time, pain intensity, and resource utilization. Participants were followed longitudinally until death or November 30, 2004. The interventions are aimed at translating current evidence into clinical practice and there was particular attention in the trial's design to addressing common pitfalls for clinical studies in palliative care. Given the need for evidence about optimal interventions and service delivery models that improve the care of people with life-limiting illness, the results of this rigorous, high quality clinical trial will inform practice. Initial results are expected in mid 2005.

Aged↗

PubMed2005

Proficiency testing in immunopathology: establishing the homogeneity of test material.

AIMS: To develop a technique for homogeneity testing of serum aliquot samples suitable for use in the Quality Assurance Program in Clinical Immunology (QAP Pty Ltd). METHODS: Albumin was selected as the surrogate protein marker for the product to be tested and the coefficient of dispersion (COD) calculated as the measure of homogeneity. To detect changes in the average level of homogeneity, cumulative sum control (cusum) charts were used. RESULTS: The COD(%) for each triplicate reading of albumin obtained from 34 specimens was normally distributed with a mean of 0.49% and a standard deviation of 0.25%. In industrial quality control schemes the action line is generally set at the upper 99% confidence limits, hence any triplicate sample would be considered to have acceptable homogeneity if the COD was < or = 1.08%. Cusum charts were created to monitor albumin homogeneity over time. CONCLUSIONS: The use of albumin measurement as the surrogate appears statistically suitable for homogeneity testing in QAP programs for immunodiagnostic testing. CUSUM charts are particularly useful to monitor such homogeneity testing.

Albumins↗

PubMed2005

A synbiotic combination of resistant starch and Bifidobacterium lactis facilitates apoptotic deletion of carcinogen-damaged cells in rat colon.

Recent reports suggest that combinations of prebiotics and probiotics may be protective against colorectal cancer. We examined in rats the effects of probiotic bacteria, resistant starch (RS), and their interaction on luminal and epithelial events of relevance to the development of colorectal cancer. Lyophilized cultures (1 x 10(10) cfu/g) of Lactobacillus acidophilus and/or Bifidobacterium lactis were added at a concentration of 1% by weight to a semipurified diet containing either low-RS (no supplemented RS) or moderate-RS (10% Hi-maize) and fed to male Sprague-Dawley rats for 4 wk. Experimental end-points included cecal bacterial enumeration, fecal and cecal pH, SCFA levels, cell proliferation, and the acute apoptotic response to a genotoxic carcinogen (AARGC; measured 6 h after a single azoxymethane injection). A significant interaction between dietary RS and supplemental bacteria was observed for the AARGC in the colon and fecal pH (P < 0.01). Rats fed the moderate-RS diet in combination with B. lactis had a significantly greater AARGC in the colon than those fed that diet without B. lactis. Fecal pH was elevated in the moderate-RS fed rats supplemented with bacteria. The moderate-RS diet increased cell proliferation and crypt column height (P < 0.001) compared with the low-RS diet. SCFA levels and numbers of bifidobacteria and lactobacilli species were also increased (P < 0.001) by the moderate-RS diet, whereas pH levels and total coliforms were lowered (P < 0.001). The synbiotic combination of RS and B. lactis significantly facilitated the apoptotic response to a genotoxic carcinogen in the distal colon of rats. It appears likely that ingested RS acts as a metabolic substrate, thus creating the right conditions for B. lactis to exert its proapoptotic action. Because the synbiotic combination of these agents facilitates the apoptotic response to DNA damage by a cancer initiator in the colon of rats, it warrants further study for its capacity to protect against colorectal cancer.

Animals↗

PubMed2005

Perceptions of working as a nurse in an acute care setting.

This paper focuses on the changing nature of nurses' perceptions of their work. It examines the major sources of satisfaction and dissatisfaction experienced by nurses working at a major teaching hospital in May 2000. Coding categories reflected four components of nurses' work experiences: organizational, interpersonal, structural and professional. Organizational aspects of work were over-represented as sources of satisfaction and dissatisfaction and related to perceived changes in management philosophy (increasing productivity with limited resources). Study findings provide some clear goals for responsive, sensitive management.

Adult↗

PubMed2005

Foot shape and its effect on functioning in Royal Australian Air Force recruits. Part 1: Prospective cohort study.

OBJECTIVE: To determine whether foot shape (flat, normal, or cavus feet) affects functioning among military recruits. METHODS: A total of 230 Royal Australian Air Force recruits embarking on a 10-week basic training course took part in a prospective cohort study of foot shape and its effect on functioning. Recruits were divided into three groups based on their foot shape, i.e., flat feet (n = 22), normal feet (n = 139), and cavus feet (n = 44), with the diagnosis being made from the arch index measured from their footprints. The groups were assessed at baseline and week 8. Outcome measures included pain, injury, foot health, and quality of life. RESULTS: There were no significant differences in outcome measures at baseline. At the end of the trial, foot shape was not related to injury. The flat feet group had significantly poorer subjective physical health than did the normal feet group (p = 0.001). CONCLUSION: This study provides high-level evidence that foot shape has little impact on pain, injury, and functioning among military recruits.

Adult↗

PubMed2005

Foot shape and its effect on functioning in Royal Australian Air Force recruits. Part 2: Pilot, randomized, controlled trial of orthotics in recruits with flat feet.

As part of a larger study of the effect of foot shape on functioning, 47 Royal Australian Air Force recruits with flexible flat feet who were embarking on a 10-week basic training course took part in a randomized controlled trial of orthotic therapy. In particular, recruits were assigned at random to an untreated group or a group that received Australian Orthotics Laboratory, three-quarter-length, flexible, shoe inserts. The groups were assessed at baseline and week 8. Outcome measures included pain, injury, foot health, and quality of life. The untreated group (n = 22) had a greater proportion of heavier recruits than did the treated group (n = 25). There were no significant differences in outcome measures at baseline. Only one-half of the group assigned to orthotic therapy wore the orthotics most or all of the time. At the end of the trial, although the results were not statistically significant, those who were provided with orthotics and wore them had the least lower limb pain and the best general foot health and quality of life. Notably, none of the recruits who wore their orthotics most or all of the time sustained a training injury.

Adult↗

PubMed2004

An outreach intervention to implement evidence based practice in residential care: a randomized controlled trial [ISRCTN67855475].

BACKGROUND: The aim of this project was to assess whether outreach visits would improve the implementation of evidence based clinical practice in the area of falls reduction and stroke prevention in a residential care setting. METHODS: Twenty facilities took part in a randomized controlled trial with a seven month follow-up period. Two outreach visits were delivered by a pharmacist. At the first a summary of the relevant evidence was provided and at the second detailed audit information was provided about fall rates, psychotropic drug prescribing and stroke risk reduction practices (BP monitoring, aspirin and warfarin use) for the facility relevant to the physician. The effect of the interventions was determined via pre- and post-intervention case note audit. Outcomes included change in percentage patients at risk of falling who fell in a three month period prior to follow-up and changes in use of psychotropic medications. Chi-square tests, independent samples t-test, and logistic regression were used in the analysis. RESULTS: Data were available from case notes at baseline (n = 897) and seven months follow-up (n = 902), 452 residential care staff were surveyed and 121 physicians were involved with 61 receiving outreach visits. Pre-and post-intervention data were available for 715 participants. There were no differences between the intervention and control groups for the three month fall rate. We were unable to detect statistically significant differences between groups for the psychotropic drug use of the patients before or after the intervention. The exception was significantly greater use of "as required" antipsychotics in the intervention group compared with the control group after the pharmacy intervention (RR = 4.95; 95%CI 1.69-14.50). There was no statistically significant difference between groups for the numbers of patients "at risk of stroke" on aspirin at follow-up. CONCLUSIONS: While the strategy was well received by the physicians involved, there was no change in prescribing patterns. Patient care in residential settings is complex and involves contributions from the patient's physician, family and residential care staff. The project highlights challenges of delivering evidence based care in a setting in which there is a paucity of well controlled trial evidence but where significant health outcomes can be attained.

Accidental Falls↗

PubMed2004

Cohort study of examination performance of undergraduate medical students learning in community settings.

OBJECTIVES: To determine whether moving clinical medical education out of the tertiary hospital into a community setting compromises academic standards. DESIGN: Cohort study. SETTING: Flinders University four year graduate entry medical course. In their third year, students are able to choose to study at the tertiary teaching hospital in Adelaide, in rural general practices, or at Royal Darwin Hospital, a regional secondary referral hospital. PARTICIPANTS: All 371 medical students who did their year 3 study from 1998-2002. MAIN OUTCOME MEASURES: Mean student examination score (%) at the end of year 3. RESULTS: The unadjusted mean year 3 scores at each location differed significantly (P < 0.001); the mean score was 65.2 (SE = 0.43) for Adelaide students, 68.2 (0.83) for Darwin students, and 69.3 (0.97) for students on the rural programme. Mean year 2 scores were similar for each location. Post hoc tests of means adjusted for sex, age, year 2 score, and cohort year showed that the rural and Darwin groups had a significantly improved score in year 3 compared with the Adelaide group (adjusted mean difference = 3.08, 95% confidence interval 1.25 to 4.90, P < 0.001 for rural group; 1.91, 0.47 to 3.36, P = 0.001 for Darwin group). CONCLUSIONS: These findings show that the concern that student academic performance in the tertiary hospital would be better than that of students in the regional hospital and community settings is not justified. This challenges the orthodoxy of a tertiary hospital education being the gold standard for undergraduate medical students.

Adult↗

PubMed2004

A study of environmental tobacco smoke in South Australian pubs, clubs and cafes.

Exposure to Environmental Tobacco Smoke (ETS) in hotels and clubs is of community concern and may lead to a variety of adverse health outcomes for workers and patrons. This study sought to measure ETS in both smoking and non-smoking areas of hospitality venues in South Australia and to assess the effectiveness of ETS control measures. Seven hotels, clubs and cafes were investigated and the concentrations of airborne nicotine and particulate matter (PM(10)) were measured as markers of ETS exposure during normal to busy periods. Overall average concentrations were higher in smoking areas (nicotine = 15 microg/m(3) and PM(10) = 255microg/m(3)) compared with non-smoking dining areas (nicotine = 7 microg/m(3) and PM(10) = 192 microg/m(3)). The data demonstrate an approximate two-fold reduction of ETS within non-smoking areas and suggest that mechanical ventilation is only partially effective in preventing propagation of ETS throughout premises. Risk models suggest that ETS exposures in non-smoking areas may still represent an appreciable health risk. It is recommended that smoking be totally banned in enclosed publicly accessible areas.

Air Pollution, Indoor↗

PubMed2004

The Abbey pain scale: a 1-minute numerical indicator for people with end-stage dementia.

The need for a specialized clinical regimen for patients with dementia who require palliative care has only recently been recognized. Structured approaches to palliative care are not well developed. The recognition and treatment of pain is an important part of this management risk. However, pain is consistently underdiagnosed and undertreated in this population. A factor contributing to this has been a lack of appropriate tools to help recognize and document pain. This study sought to develop and validate an easy-to-use pain scale for use in residential aged care homes. The tool was developed with residents with end- or late-stage dementia who were unable to articulate their needs, identified by the registered nurses who knew them. Results showed that following pain-relief intervention the average pain score recorded using the scale fell by more than half. A paired Student's t-test showed the reduction to be highly significant (P<0.001). Validity and internal reliability, assessed by calculating Gamma and Cronbach's alpha, were found to be satisfactory. Qualitative evidence gathered from users of the scale indicated that it was considered a useful clinical device that could be completed within one minute. Further analysis of the use of the scale in clinical settings, testing of inter-rater reliability and examination of the limitations found in this study will commence early in 2004.

Aged↗

PubMed2002

The South Oaks Gambling Screen: a review with reference to Australian use.

The South Oaks Gambling Screen (SOGS) is a psychometric instrument widely used internationally to assess the presence of pathological gambling. Developed by Lesieur and Blume (1987) in the United States of America (USA) as a self-rated screening instrument, it is based on DSM-III and DSM-III-R criteria. This paper describes the origins and psychometric development of the SOGS and comments critically in relation to its construct validity and cutoff scores. Reference is made to the use of the SOGS in the Australian setting, where historically gambling has been a widely accepted part of the culture, corresponding to one of the highest rates of legaliZed gambling and gambling expenditure in the world. An alternative approach to the development of an instrument to detect people who have problems in relation to gambling is proposed.

Australia↗