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Biomedical subjects

Bogda Koczwara

Publications and source records attributed to Bogda Koczwara.

9 recordsLinked to original sources
PubMed2006

The "therapeutic footprint" of medical, complementary and alternative therapies and a doctor's duty of care.

Complex societal factors unrelated to evidence of efficacy influence the increasing use of complementary and alternative therapies, which can be viewed as one form of health consumerism. The "therapeutic footprint" is a conceptual model that "plots" medical therapies and complementary and alternative therapies in relationship to one another and to their levels of risk and supporting evidence, acknowledging that medical therapies also entail risks. Philosophies about management of risk and adverse effects differ between complementary and alternative therapies and standard medical care, due to fundamental differences between professionalism within medicine and the demands of health consumerism. In standard medical care, patients' risks are mediated prior to treatment via the doctor-patient relationship and informed consent. With complementary and alternative therapies, protection mechanisms for consumers come into effect mainly after a problem has occurred. Understanding this difference helps doctors whose patients are using complementary or alternative therapies to define the boundaries between these therapies and professional medicine and provide appropriate disclosure of risks. Discussing complementary and alternative therapies and how they differ from standard medical care can provide opportunities to explore patients' concerns and improve the therapeutic relationship.

Complementary Therapies↗
PubMed2006

Validity of the malnutrition screening tool as an effective predictor of nutritional risk in oncology outpatients receiving chemotherapy.

GOALS OF WORK: To determine the relative validity of the Malnutrition Screening Tool (MST) compared with a full nutrition assessment by the scored Patient Generated-Subjective Global Assessment (PG-SGA) and to assess MST inter-rater reliability in patients receiving chemotherapy. PATIENTS AND METHODS: An observational, cross-sectional study was conducted at an Australian public hospital in 50 oncology outpatients receiving chemotherapy. Inter-rater reliability was assessed in a subsample of 20 patients. MAIN RESULTS: According to PG-SGA global rating, the prevalence of malnutrition was 26%. The MST was a strong predictor of nutritional risk relative to the PG-SGA (100% sensitivity, 92% specificity, 0.8 positive predictive value, 1.0 negative predictive value). MST inter-rater reliability was acceptable with agreement by administration staff/nursing staff/patient and the dietitian in 18/20 cases (kappa=0.83; p0.001). CONCLUSION: The MST has acceptable relative validity, inter-rater reliability, sensitivity, and specificity to identify chemotherapy outpatients at risk of malnutrition and, hence, is an acceptable nutrition screening tool in this patient population.

Adult↗
PubMed2006

What should doctors know about cancer? Undergraduate medical education from a societal perspective.

Cancer is a major health problem, but medical undergraduate education about cancer leaves many practitioners ill-prepared. All practitioners need some knowledge of cancer. Those practising in rural areas might need more knowledge because of their isolation from tertiary services. We review the need for cancer education from the perspective of patients and clinicians, and examine the cancer-knowledge skills and attitudes of medical undergraduates. Patients with cancer expect their family practitioner to be knowledgeable enough to act as their advocate and to be able to interpret for them the complex array of tests and treatments that they could face. Many oncologists think that they do not have adequate access to students because of entrenched attitudes within universities that aim to protect established teaching programmes and leave little room to adapt teaching to the changing needs of society. Surveys of medical undergraduates have shown that, over the past decade, students have less contact with patients and retain some misconceptions about cancer. To deliver appropriate standards of cancer teaching, an undergraduate programme should incorporate a national or international standard curriculum and a minimum number of essential experiences. Because assessment drives education, students' knowledge, skills, and attitudes relating to cancer should be assessed, and the outcomes of such assessment should inform the curriculum.

Attitude of Health Personnel↗
PubMed2005

Achieving equal standards in medical student education: is a national exit examination the answer?

Although it is commonly assumed that the quality of medical school education in Australia is uniformly high, there is no national process for assessing its outcomes. There is substantial variability in the content of medical school curricula, and the process of curriculum change is becoming more challenging because of intense competition for time and space in the course. A national exit examination could provide a uniform standard of assessment for all medical school graduates in Australia, as well as foreign graduates applying to work in Australia. Such an examination could assess medical school outcomes, monitor the effects of curriculum change, and provide a benchmark for new medical schools that would help medical curricula evolve to better meet society's needs.

Australia↗
PubMed2005

Predicting worries about health after breast cancer surgery.

Given the widespread worries about future health in women with breast cancer, it is important to understand the predictors of such fear so that possible avenues for intervention can be formulated. In this longitudinal study of 44 women who had undergone breast cancer surgery, we look at demographic variables, cancer and treatment related symptoms, and denial coping measured post-surgery and their ability to predict future health fears at 6-weeks and 12-weeks post-surgery. At both follow-up periods, around 1 in 5 women had strong worries about their future health, and post-surgery future health fears significantly predicted future health fears. In a hierarchical multiple regression, controlling for post-surgery health fears, future health fears at both follow-up periods were predicted only by denial coping. Cross-lag analyses suggested that these relationships were causal. Findings suggest that denial coping is a powerful predictor of future health fears, with this relationship growing stronger over time. Future research should investigate which interventions can decrease denial, and whether this then decreases health fears in the aftermath of breast cancer surgery.

Adult↗