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Biomedical subjects

Bin Jalaludin

Publications and source records attributed to Bin Jalaludin.

16 recordsLinked to original sources
PubMed2006

Patterns of practice in the management of prostate cancer: results from multidisciplinary surveys of clinicians in Australia and New Zealand in 1995 and 2000.

OBJECTIVE: To investigate and compare patterns of practice in prostate cancer management in Australia and New Zealand from 1995 to 2000, as there are insufficient randomized trials to guide clinicians in the management of prostate cancer. SUBJECTS AND METHODS: This study represents the two largest published surveys of Australian and New Zealand clinicians dealing with prostate cancer. We sent structured questionnaires on the management of prostate cancer patients to 804 urologists, radiation oncologists and medical oncologists in Australia and New Zealand in December 2000. We compared responses to a similar survey of 579 specialist clinicians in 1995. RESULTS: The response rates were 56% in 1995 and 62% in 2000. In the management of clinically localized disease, the proportion recommending surgery or radiotherapy remained relatively constant between 1995 and 2000, although there was an increase in the use of brachytherapy and adjuvant hormonal therapy, and a reduced tendency to treat pelvic nodes. In the treatment of locally advanced disease, there was an increased use of hormonal treatment and local radiotherapy, with a reduction in the use of total androgen blockade and orchidectomy. In managing positive margins after prostatectomy, there was a clear lack of consensus, with a wide variety of treatment options proposed. CONCLUSIONS: Practice has changed in several areas in 2000 compared to 1995, but not all changes were influenced by the publication of randomized trials or evidence-based guidelines.

Antineoplastic Agents↗
PubMed2006

Associations between ambient air pollution and daily emergency department attendances for cardiovascular disease in the elderly (65+ years), Sydney, Australia.

There are no reported studies on the effects of ambient air pollution on emergency department (ED) attendances in Sydney, Australia. This study aimed to determine associations between ambient air pollutants and ED attendances for cardiovascular disease (CVD) in those aged 65+ years. We constructed daily time series of hospital ED attendances, air pollutants and meteorological factors for the Sydney metropolitan area from 1 January 1997 to 31 December 2001. We used generalised linear models to determine associations between daily air pollution and daily ED attendances and controlled for the effects of long-term trends, seasonality, weather and other potential confounders. Increased ED attendances for all CVD, cardiac disease and ischaemic heart disease were seen with 24-h particulate pollution, 1-h NO(2), 8-h CO and 24-h SO(2). Air pollutants were associated with decreased ED attendances for stroke. The effects of air pollutants on CVD, cardiac disease and stroke attendances were generally greater in the cool period compared to the warm period. The single-pollutant effects of CO, O(3), NO(2) and SO(2) were essentially unchanged in two-pollutant models. Although air pollution levels in Sydney are relatively low compared to similar cities, we have demonstrated associations between ambient air pollutants and ED attendances for CVD in people aged 65+ years. Our study adds to the growing evidence for the effects of ambient air pollution on CVD outcomes even at relatively low ambient concentrations.

Aged↗
PubMed2006

Incidence and risk factors for hepatitis C seroconversion in injecting drug users in Australia.

AIMS: To determine the incidence of hepatitis C virus (HCV) infection and identify risk factors for seroconversion. DESIGN: Prospective cohort study. Participants were recruited through direct approaches, street-based outreach, methadone and sexual health clinics and needle and syringe programmes. SETTING: Urban, regional and rural settings in New South Wales, Australia. PARTICIPANTS: Injecting drug users (IDUs) (n = 584) were screened and tested for exposure to HCV. Between 1999 and 2002 antibody HCV negative IDUs (n = 368) were enrolled and followed-up every 3-6 months until seroconversion or study completion. MEASUREMENTS: Interviewer-administered baseline and follow-up questionnaires consisted of 131 items and included demographics, drug use and risk behaviour. Approximately 10 cc of whole blood was drawn at each visit. Specimens were stored at -70C and serology performed using one or two third-generation enzyme-linked immunosorbent assays and polymerase chain reaction testing. FINDINGS: Sixty-eight seroconversions were observed and incidence was 30.8 per 100 person-years, with incidence in IDUs injecting < 1 year, 133 per 100 person-years. Independent predictors of seroconversion were female gender, duration of injecting, injecting cocaine, shared use of filters and recruitment strategy. CONCLUSIONS: Women, new initiates and IDUs recruited via outreach appear to be at increased risk of infection. Results confirm the significance of cocaine injection as a risk factor and provide the first evidence outside North America of the link between shared use of drug preparation equipment and incident HCV infection. Prevention efforts should attempt to raise awareness of the risks associated with drug sharing and, in particular, the role of potentially contaminated syringes in HCV infection.

Adolescent↗
PubMed2005

An evaluation of compliance with practice guidelines on interhospital trauma transfer.

STUDY OBJECTIVES: To prospectively evaluate compliance with current interhospital trauma transfer guidelines in South West Sydney, before and after an implementation programme was instituted. METHODS: A scoring system was developed to assess compliance with the 11 main components of the guideline. Baseline compliance was measured during an initial 3-month period (pre), followed by an implementation programme to alert staff at referring hospitals to the presence of the guidelines. Following this, compliance was again measured over 3 months (post). RESULTS: Twenty-two patients were transferred during the pre-implementation phase and 35 patients during the post-phase. Overall compliance with the guidelines increased from 62 to 67%. Mean pre-hospital compliance rose from 75 to 95%, and referring hospital compliance rose from 59 to 63%. While there was an improvement in compliance with the use of the dedicated trauma hotline (86-97%), the use of a transfer checklist (41-53%), and appropriateness of transfer (95-100%), none of these reached statistical significance. CONCLUSION: Practice guidelines have been developed to optimise the process of interhospital trauma transfers. An implementation programme met with limited success in improving compliance with the guidelines. Further work is needed to ensure awareness of these guidelines, with ongoing monitoring to ensure best practice and optimal patient outcome.

Adult↗
PubMed2005

Surgical management of colorectal cancer in south-western Sydney 1997-2001: a prospective series of 1293 unselected cases from six public hospitals.

BACKGROUND: The aim of the present study is to provide local data for the management of colorectal cancers in the south-western Sydney health area from 1997 to 2001. METHODS: The data were collected prospectively. Follow up was conducted in late 2001 and early 2002. Data were cross-validated with hospital and area databases and with data from the New South Wales Registry of Births, Deaths and Marriages. RESULTS: This was an unselected series of 1293 patients from 36 surgeons; 16.5% of patients presented as emergencies. Only 3% presented as a result of bowel cancer screening. Of the 1293 patients, 1270 received an operation. There were 598 elective colonic resections with the mortality rate of 1.2%, reoperation rate of 2.7% and anastomotic leak rate of 0.8%. For the 410 elective rectal resections, the rates were 2.9%, 2.7% and 1.2%, respectively. For the 290 emergency operations, the rates were much worse at 7.7%, 6.6% and 4.8%, respectively. The corrected overall 3-year survival rate was 64%. For Dukes' A, B, C and D, the figures were 94%, 87%, 61% and 7%, respectively. CONCLUSIONS: Colorectal cancer is a major cause of mortality and morbidity in our community. Very few bowel cancers were discovered at the asymptomatic stage. This paper strongly supports community bowel cancer screening and early diagnosis. The local database has provided a rich source of information to benchmark management and outcomes of bowel cancer patients treated in the South Western Sydney Area Health Service. An area-wide computer network with online data input facilities at individual workplaces will improve data integrity and data collection efficiency.

Adult↗
PubMed2005

Abdominal trauma: a disease in evolution.

BACKGROUND: The last decade has seen many changes in the way we investigate and manage abdominal injuries. This study assessed the pattern of abdominal injury and its investigation in patients admitted to a major trauma centre. METHODS: A retrospective registry review of all adult trauma patients admitted to Liverpool Hospital between January 1996 and December 2003 was undertaken. All adult trauma patients were included, identifying mechanism of injury, injury severity score, abbreviated injury score for the abdomen, investigations and intervention. The study period was divided (period 1 from 1996 to 1999, period 2 from 2000 to 2003) and the two periods compared to assess change. RESULTS: The study involved 1224 patients with abdominal injuries. Of these, 969 (79%) were a result of blunt trauma. The main causes were road accidents (61%), interpersonal violence (24%) and falls (7%). Penetrating injury increased from 16% to 25% between the two periods. There were 1274 intra-abdominal injuries, made up of 607 solid organ (liver (n = 220, 36%), spleen (n = 195, 32%), renal (n = 144, 24%) ), 291 hollow viscus (small bowel (n = 160, 55%), large bowel (n = 104, 36%) ) and 168 vascular. Four hundred and thirty-six (36%) patients underwent laparotomy, 65% for blunt trauma. Between the two periods there was a 46% decrease in the use of diagnostic peritoneal lavage, with a 40% increase in computed tomography and 325% increase in focused assessment with sonography for trauma. CONCLUSIONS: This study defined abdominal injury pattern and identified a significant shift in mechanism of injury and abdominal investigation at a major trauma centre during an 8-year study period. Abdominal trauma is indeed a disease in evolution.

Abdominal Injuries↗
PubMed2005

Serum intact parathyroid hormone as a predictor of hypocalcaemia after total thyroidectomy.

BACKGROUND: Hypocalcaemia from hypoparathyroidism is a complication of total thyroidectomy. The aim of the present study was to determine whether an early postoperative level of serum parathyroid hormone (PTH) after total thyroidectomy predicts the development of significant hypocalcaemia and the need for treatment. METHODS: Patients undergoing total thyroidectomy had their serum level of intact PTH checked 1 h after removal of the thyroid gland. Serum calcium level was checked on the following morning. Oral calcium and/or calcitriol was commenced if the patient developed hypocalcaemic symptoms, or if the corrected serum calcium level was <2.0 mmol/L. RESULTS: Seventy-nine patients were included in the present study. Thirteen patients had symptoms of hypocalcaemia on postoperative days 1 or 2 and 66 patients remained asymptomatic. The postoperative intact PTH, day 1 calcium and day 2 calcium was 0.32 +/- 0.60 pmol/L, 2.01 +/- 0.11 mmol/L, and 2.02 +/- 0.16 mmol/L, respectively, for the symptomatic group and 1.98 +/- 1.25, 2.21 +/- 0.13, and 2.19 +/- 0.14, respectively, for the asymptomatic group. Calcium support was given to 25 patients, of whom 14 also required calcitriol. CONCLUSION: Serum PTH 1-h after total thyroidectomy is a reliable predictor of hypocalcaemia and can allow safe early discharge of patients from hospital.

Female↗
PubMed2004

PTEN mutations are common in sporadic microsatellite stable colorectal cancer.

The tumour suppressor gene PTEN, located at chromosome sub-band 10q23.3, encodes a dual-specificity phosphatase that negatively regulates the phosphatidylinositol 3'-kinase (PI3 K)/Akt-dependent cellular survival pathway. PTEN is frequently inactivated in many tumour types including glioblastoma, prostate and endometrial cancers. While initial studies reported that PTEN gene mutations were rare in colorectal cancer, more recent reports have shown an approximate 18% incidence of somatic PTEN mutations in colorectal tumours exhibiting microsatellite instability (MSI+). To verify the role of this gene in colorectal tumorigenesis, we analysed paired normal and tumour DNA from 41 unselected primary sporadic colorectal cancers for PTEN inactivation by mutation and/or allelic loss. We now report PTEN gene mutations in 19.5% (8/41) of tumours and allele loss, including all or part of the PTEN gene, in a further 17% (7/41) of the cases. Both PTEN alleles were affected in over half (9/15) of these cases showing PTEN genetic abnormalities. Using immunohistochemistry, we have further shown that all tumours harbouring PTEN alterations have either reduced or absent PTEN expression and this correlated strongly with later clinical stage of tumour at presentation (P=0.02). In contrast to previous reports, all but one of the tumours with PTEN gene mutations were microsatellite stable (MSI-), suggesting that PTEN is involved in a distinct pathway of colorectal tumorigenesis that is separate from the pathway of mismatch repair deficiency. This work therefore establishes the importance of PTEN in primary sporadic colorectal cancer.

Alleles↗
PubMed2004

Waiting times for radiotherapy--a survey of patients' attitudes.

BACKGROUND AND PURPOSE: To determine the maximum time cancer patients were willing to wait for radiotherapy. PATIENTS AND METHODS: Using a trade-off technique (TOT) the maximum time patients were prepared to wait for treatment at the centre closest to home before electing to transfer their care to a centre located (1) at a distance necessitating an extra 30 min travelling each day (MWT 1) or (2) at a distance necessitating staying away from home for the duration of therapy (MWT 2) was determined. A TOT was utilised to determine the loss in treatment effectiveness (LIE 1, LIE 2) patients were willing to accept as a consequence of their MWT 1 and MWT 2 choices. RESULTS: The median MWT 1 was 4 weeks while the median MWT 2 was 8 weeks. A longer MWT 1 was associated with increasing patient age and a problem with travelling an extra 30 min. Symptomatic patients were less likely to accept a longer MWT 1. The MWT 2 increased as the expected duration of treatment increased but patients in regional areas were less likely to accept a longer MWT 2. The majority of patients indicated that they were unwilling to accept any loss in treatment effectiveness. Patients who had a problem with travelling an extra 30 min daily or who were unable to drive were willing to accept a loss in treatment effectiveness. CONCLUSIONS: This study provides an estimate of the waiting times cancer patients are prepared to accept for radiation therapy and suggests that cancer patients are unlikely to trade-off effectiveness for convenience.

Attitude to Health↗
PubMed2004

Risk behaviors and antibody hepatitis B and C prevalence among injecting drug users in south-western Sydney, Australia.

BACKGROUND AND AIM: Hepatitis C virus (HCV) infection is now the leading notifiable disease in Australia. The current study aimed to determine the prevalence of HCV and hepatitis B virus (HBV) infection and associated risk behaviors among injecting drug users (IDUs) screened in south-western Sydney as part of a multisite prospective cohort study. METHODS: Using a combination of snowball sampling and word-of-mouth recruitment strategies, 377 IDUs were interviewed using a structured questionnaire and tested for exposure to HCV and HBV. Entry criteria were injecting drug use in the previous 6 months and antibody HCV serostatus not known to be positive. RESULTS: More than one-third (36.6%) tested HCV antibody positive and one-quarter (28%) had been exposed to HBV. Independent predictors of HCV seropositivity were HBV core antibody positive serostatus, incarceration in the past year, injecting in public, Asian ethnicity and duration of injecting. Individual risk behaviors, including sharing needles and syringes, sharing other injecting equipment and being injected by others, were not significant in either bivariate or multivariate models. CONCLUSIONS: Results indicate an urgent need for structural interventions designed to reduce the exposure of IDUs, particularly indigenous Australian and Asian injectors, to risk environments. Structural interventions, including population-based hepatitis B immunization, expanded access to needle and syringe programs and drug treatment, prison diversion programs and medically supervised injecting facilities, should be incorporated into existing blood-borne virus prevention efforts.

Adolescent↗
PubMed2003

Cancer knowledge and skills of interns in Australia and New Zealand in 2001: comparison with 1990, and between course types.

OBJECTIVE: To compare the cancer knowledge and skills of interns in 2001 who graduated from graduate medical program (GMP) courses with those from non-GMP courses, and to compare the cancer knowledge and skills of interns in 2001 with those who completed a similar survey in 1990. DESIGN: Questionnaire survey of recently graduated interns in a random sample of Australian and New Zealand hospitals. The questionnaire was designed to allow direct comparison with the 1990 survey, and was guided by the Australian Cancer Society's Ideal Oncology Curriculum for Medical Schools. RESULTS: 443 interns completed the survey (response rate, 62%; 42 were excluded, leaving 401 surveys for analysis: 118 from GMP courses and 283 from non-GMP courses). Interns from GMP courses felt more competent than those from non-GMP courses at discussing death (P = 0.02), breaking bad news (P = 0.04) and advising on smoking cessation (P = 0.02), but less competent at preparing a patient for a hazardous procedure (P = 0.02). More GMP interns would refer a breast cancer patient to a multidisciplinary clinic (83% versus 70%; P = 0.03). Knowledge about cancer risks and prognosis was significantly less in GMP interns, but GMP interns rated their clinical skills, such as taking a Pap smear, higher than non-GMP interns. The GMP and non-GMP groups did not differ in their exposure to cancer patients, but compared with 1990 interns recent graduates had less exposure to patients with cancer. CONCLUSIONS: GMP curricula appear to have successfully introduced new course material and new methods of teaching, but have not always succeeded in producing doctors with better knowledge about cancer. Recent graduates have less exposure to cancer patients than those who trained 10 years ago.

Adult↗
PubMed2003

A model for decision making for the use of radiotherapy in lung cancer.

To develop an evidence-based benchmark for the use of radiotherapy in lung cancer, we did a systematic review of treatment guidelines on radiotherapy for lung cancer. We then constructed an optimum use of radiotherapy "tree" from epidemiological data, which shows the proportion of patients with clinical attributes indicating that they would benefit from radiotherapy. We calculated that the proportion of patients with lung cancer in whom radiotherapy is indicated (according to the best available evidence) is 76%. We then compared this ideal rate with the actual rates of use of radiotherapy for lung cancer in Australia, and internationally, in the past decade. A substantial discrepancy was found between the evidence-based recommended rate of use and the actual rates reported in clinical practice. We hope this model will be used to plan efficient and cost-effective radiotherapy services.

Benchmarking↗
PubMed2003

Implications for urgent transfusion of uncrossmatched blood in the emergency department: The prevalence of clinically significant red cell antibodies within different patient groups.

OBJECTIVE: To define the prevalence of alloantibodies as a factor of age and underlying clinical disease, with particular relevance to the prediction of the safety of uncrossmatched blood in different demographic groups. METHODS: A retrospective review was conducted of all immunohaematological studies on blood samples submitted to the blood bank of a tertiary referral hospital between January 1998 and December 1999. RESULTS: A total of 27 968 antibody screens in 15 966 patients were analysed. When only clinically significant antibodies were considered, the total alloimmunization prevalence was 1.9% and the prevalence of antibodies capable of causing an immediate transfusion reaction was 0.6%. The prevalence of antibodies capable of causing an immediate transfusion reaction was 0.1% in the under 30 years of age group. Clinically significant antibodies were found in 5.1% in the haematology and oncology unit patients. The risk rises with age and female sex. CONCLUSION: We conclude that uncrossmatched blood is associated with low risk in patients < 30 years of age. The knowledge that patients have not been exposed to previous transfusion or pregnancy will reduce the risk even further.

Adult↗
PubMed2002

Optimal position for a cervical collar incision: a prospective study.

BACKGROUND: The descriptions of the optimal method for placing a cervical collar incision for thyroidectomy or parathyroidectomy are varied. It has been our impression that a collar incision marked in the neutral upright neck, migrates superiorly relative to the sternal notch when the patient is placed in the supine position. The aim of this study was to investigate the validity of this impression and to assess whether this is influenced by patient factors and/or pathology. METHODS: Fifty patients undergoing either thyroid or parathyroid surgery had a planned incision marked 1 finger-breadth (17 mm) above the sternal notch when sitting in the upright position. When placed in the supine position, with neck extended, the distance from the sternal notch to the marked incision was remeasured. Patient variables such as body mass index, height, weight and neck circumference were documented prospectively and data were recorded on operative details and tumour pathology. RESULTS: The collar incision marked in the neutral upright neck, migrated on average 21 mm superiorly once the patient was placed supine with the neck extended (P=0. 0001 ).The extent of migration was independent of all patient factors, type of operation and thyroid or parathyroid pathology. CONCLUSIONS: Migration of a proposed cervical collar incision does occur. An inappropriately placed incision may lead to excessive scarring if it is too low, or unusual prominence if it is too high. We believe a good position for marking such an incision is 1 fingerbreadth above the sternal notch with the patient in a neutral, upright position.

Cicatrix↗
PubMed2002

The development of a model of outpatient chemotherapy delivery--chemotherapy basic treatment equivalent (CBTE).

The aims of this study were to study the patient-, tumour- and treatment-related factors that significantly impact on treatment episode duration for outpatient chemotherapy treatment delivery, and to develop a new measure of outpatient chemotherapy throughput that considers variations in treatment duration compared with the older measures of patients treated per day. A pilot study in our institution randomly measured the duration of outpatient chemotherapy delivery for 266 occasions of service. Patient, tumour and treatment factors were collected and assessed for their impact on treatment duration using multivariate analysis. A new model of outpatient chemotherapy was developed using various modeling processes. Median treatment duration was 90 min. Significant factors that impacted on treatment duration were the chemotherapy regimen, type of infusion, patient age and whether the patients required a community nurse to be organized. A measure was developed (Chemotherapy Basic Treatment Equivalent or CBTE) that considers the variations in treatment duration and showed that although the daily number of patients treated in our department each day remained stable, there were wide fluctuations in workload when variations in treatment duration were considered. A new measure of chemotherapy workload has therefore been proposed although further testing across departments is required. If broadly implemented this could substantially improve resource planning, resource use and patient satisfaction as it considers variations in treatment duration, which is not previously considered in chemotherapy throughput statistics.

Antineoplastic Agents↗