DoRA 2.0 | Database of Research Activity
http://dora.health.qld.gov.au:80/qldresearchjspui
The DORA digital repository system captures, stores, indexes, preserves, and distributes digital research material.2024-03-27T18:33:56ZEstimation of kidney function for medication dosing in adult patients with chronic kidney disease: a practice update
https://dora.health.qld.gov.au/qldresearchjspui/handle/1/5491
Title: Estimation of kidney function for medication dosing in adult patients with chronic kidney disease: a practice update
Authors: Mirkov, Sanja; Scuderi, Carla; Lloyd, Jess; Coutsouvelis, John; O'Connor, Shaun; Potts, Simon; Newman, Suzanne; Roberts, Jason
Abstract: Chronic kidney disease (CKD) is a major health concern with a growing disease burden and inequalities in access to treatments. Glo-merularfiltration rate (GFR) is accepted as the best overall measure of kidney function and is considered the most important measurefor medications cleared by the kidneys. In clinical practice, equations that estimate GFR using validated prediction equations are rou-tinely used. This practice update was developed by a Working Group comprising clinical pharmacists representing the Society of Hos-pital Pharmacists of Australia (SHPA) Specialty Practice streams of Nephrology, Oncology and haematology, Critical care andInfectious diseases. It is intended to provide practical recommendations for clinical pharmacists who use equations to estimate GFR formedication dosing decisions. The limitations of the various equations in use—such as the Chronic Kidney Disease Epidemiology Col-laboration (CKD-EPI), the Cockcroft–Gault equation and Modification of Diet in Renal Disease—are summarised and compared todirect measures of kidney function using exogenous markers. The CKD-EPI equation is recommended to be used routinely as a primarymeasure of kidney function. Dose adjustments should also consider medication-specific, patient-related, and disease-related characteris-tics. Kidney function and the response to therapy should be continuously assessed by monitoring the signs, symptoms and disease out-comes, the emergence of adverse reactions or medication-induced disorders and use therapeutic drug monitoring (if available) to adjustdoses accordingly.
Description: Cairns & Hinterland Hospital and Health Service (CHHHS) affiliated author: Sanja Mirkov2024-01-01T00:00:00ZDoctor's Perceptions of the Systemic Influences on Advance Care Plan Application: A Thematic Analysis
https://dora.health.qld.gov.au/qldresearchjspui/handle/1/5490
Title: Doctor's Perceptions of the Systemic Influences on Advance Care Plan Application: A Thematic Analysis
Authors: Craig, Denise Patricia; Ray, Robin A
Abstract: Healthcare consumers are encouraged to develop an Advance Care Plan (ACP) to help to ensure their preferences are known and respected. However, the role of governing systems in the application of ACPs must be understood if patients' voices (expressed within this medium) are to be heard. To explore systemic barriers influencing Queensland public hospital doctors' application of the Advance Care Plans of hospitalized people with a neurodegenerative disorder. Using a constructivist grounded theory approach, 16 semi structured interviews were conducted with public hospital doctors. Data were inductively analysed using open and focused coding. Analysis revealed two main themes: Practicing Medicine within a Legal Construct, and Delegitimizing ACP. Participants found the application of ACP in Queensland unduly complex, and they were inadequately prepared by education or training. Doctors maintained a dominant role in temporal medical decision-making and cited hospital practice culture for delegitimizing patient-owned ACPs. The public healthcare system in Queensland exerts considerable influence over the degree to which ACPs influence decision-making. Despite the premise that ACPs give patients a powerful voice, hospital doctors often do not understand the underpinning law on which they depend when citing their responsibility for good medical practice. Systemic influences have contributed to a practice culture that has delegitimized the patient's voice when expressed through an ACP.
Description: Cairns & Hinterland Hospital and Health Service (CHHHS) affiliated author: Denise Patricia Craig2024-01-01T00:00:00ZClinician and consumer perceptions of head and neck cancer services in rural areas: Implications for speech pathology service delivery
https://dora.health.qld.gov.au/qldresearchjspui/handle/1/5489
Title: Clinician and consumer perceptions of head and neck cancer services in rural areas: Implications for speech pathology service delivery
Authors: Foley, Jasmine; Nund, Rebecca L; Ward, Elizabeth C; Burns, Clare L; Wishart, Laurelie R; Graham, Nicky; Patterson, Corey; Ashley, Amy; Fink, Julie; Tiavaasue, Emily; Comben, Wendy
Abstract: Individuals with head and neck cancer residing in rural areas face numerous challenges accessing post-acute rehabilitation services, including speech pathology services. In order to inform future service enhancements, the key issues impacting access to, and the provision of, speech pathology head and neck cancer services in rural areas was explored through the perspectives of patients, carers, speech pathology clinicians and service managers. A rural health referral network in Queensland consisting of tertiary, regional and remote hospitals. Twenty-eight participants, including 12 speech pathology staff/managers and 16 consumers (people with head and neck cancer/carers). Qualitative methodology using semi-structured interviews was analysed using content analysis. Two themes were identified from the consumer group including (a) navigating health services for head and neck cancer management and (b) burden of accessing head and neck cancer care. Speech pathology staff/managers interviews raised 3 themes: (a) transfer of care and access to local services, (b) workforce and workload and (c) travelling impacts the service our patients can receive. An integrative theme across both groups highlighted the perceived disparity in health care access that existed for people with head and neck cancer in rural areas. In rural areas, consumers face multiple barriers navigating the head and neck cancer treatment pathway, while health services encounter specific challenges ensuring access and equity in care. Despite the complexities, possible avenues for service change and service enhancement are proposed. Speech pathology services in rural areas need to proactively evaluate services and address existing disparities in order to enact positive change for people with head and neck cancer living outside metropolitan locations.2022-04-01T00:00:00ZClinical signs of trachoma and laboratory evidence of ocular Chlamydia trachomatis infection in a remote Queensland community: a serial cross-sectional study
https://dora.health.qld.gov.au/qldresearchjspui/handle/1/5488
Title: Clinical signs of trachoma and laboratory evidence of ocular Chlamydia trachomatis infection in a remote Queensland community: a serial cross-sectional study
Authors: Lynch, Kathleen D; Morotti, Wendy; Brian, Garry; Ketchup, Lenore; Kingston, Kozue; Starr, Mitchell; Ware, Robert S; Everill, Beth; Asgar, Nazihah; O'Keefe, Anne; Whop, Lisa J; Kaldor, John M; Lambert, Stephen B
Abstract: To compare the findings of standard clinical assessments and of complementary clinical and laboratory methods for determining whether community-wide treatment for trachoma is warranted in a remote Queensland community. Three cross-sectional screening surveys, 2019-2021, complemented by laboratory pathology testing. Small community in northwest Queensland with geographic and cultural ties to Northern Territory communities where trachoma persists. Children aged 1-14 years; opportunistic screening of people aged 15 years or more. Prevalence of clinical signs of trachoma, Chlamydia trachomatis infection, ocular non-chlamydial infections, and seropositivity for antibodies to the C. trachomatis Pgp3 protein. During the three surveys, 73 examinations of 58 children aged 1-4 years, 309 of 171 aged 5-9 years, and 142 of 105 aged 10-14 years for trachoma were undertaken, as were 171 examinations of 164 people aged 15 years or more; 691 of 695 examinations were of Aboriginal or Torres Strait Islander people (99%), 337 were of girls or young women (48%). Clinical signs consistent with trachomatous inflammation-follicular were identified in 5-9-year-old children 23 times (7%), including in eleven with non-chlamydial infections and one with a C. trachomatis infection. One child (10-14 years) met the criteria for trachomatous scarring. Two of 272 conjunctival swab samples (all ages) were polymerase chain reaction-positive for C. trachomatis (0.7%). Two of 147 people aged 15 years or more examined in 2019 had trichiasis, both aged 40 years or more. Seven of 53 children aged 1-9 years in 2019 and seven of 103 in 2021 were seropositive for anti-Pgp3 antibodies. Despite the prevalence of clinical signs consistent with trachomatous inflammation-follicular among 5-9-year-old children exceeding the 5% threshold for community-wide treatment, laboratory testing indicated that childhood exposure to ocular C. trachomatis is rare in this community. Laboratory testing should be integrated into Australian trachoma guidelines.2022-11-21T00:00:00Z