Use of guideline-recommended adjuvant therapies and survival outcomes for people with colorectal cancer at tertiary referral hospitals in South Australia

Rationale, aims and objectives: Adjuvant care for colorectal cancer (CRC) has increased over the past 3 decades in South Australia (SA) in accordance with national treatment guidelines. This study explores the (1) receipt of adjuvant therapy for CRC in SA as related to national guideline recommendations, with a focus on stage C colon and stage B and C rectal cancer; (2) timing of these adjuvant therapies in relation to surgery; and (3) comparative survival outcomes. Methods: Data from the SA Clinical Cancer Registry from 4 tertiary referral hospitals for 2000 to 2010 were examined. Patterns of care were compared with treatment guidelines using multivariable logistic regression. Disease‐specific survivals were calculated by treatment pathway. Results: Four hundred forty‐three (60%) patients with stage C colon cancer and 363 (46%) with stage B and C rectal cancer received guideline‐recommended care. While an overall increase in proportion receiving adjuvant care was not evident across the study period, the proportion having neoadjuvant care increased substantially. Older age was an independent predictor of not receiving adjuvant care. Patients with stage C colon cancer who received recommended adjuvant care had a higher 5‐year survival than those not receiving this care, ie, 71.2% vs 53.2%. Similarly adjuvant therapy was associated with better outcomes for stage C rectal cancers. The median time for receiving adjuvant care was 8 weeks. Conclusions: Survival was better for stage C CRC treated according to guidelines. Adjuvant care should be provided except where clear contraindications present. Other possible contributors to guideline adherence warranting additional investigation include co‐morbidity status, multidisciplinary team involvement, and choice.Pamela Adelson, Kellie Fusco, Christos Karapetis, David Wattchow, Rohit Joshi, Timothy Price, Greg Sharplin, David Rode

Healthy Living after Cancer: A dissemination and implementation study evaluating a telephone-delivered healthy lifestyle program for cancer survivors

© 2015 Eakin et al. Background: Given evidence shows physical activity, a healthful diet and weight management can improve cancer outcomes and reduce chronic disease risk, the major cancer organisations and health authorities have endorsed related guidelines for cancer survivors. Despite these, and a growing evidence base on effective lifestyle interventions, there is limited uptake into survivorship care. Methods/Design: Healthy Living after Cancer (HLaC) is a national dissemination and implementation study that will evaluate the integration of an evidence-based lifestyle intervention for cancer survivors into an existing telephone cancer information and support service delivered by Australian state-based Cancer Councils. Eligible participants (adults having completed cancer treatment with curative intent) will receive 12 health coaching calls over 6 months from Cancer Council nurses/allied health professionals targeting national guidelines for physical activity, healthy eating and weight control. Using the RE-AIM evaluation framework, primary outcomes are service-level indicators of program reach, adoption, implementation/costs and maintenance, with secondary (effectiveness) outcomes of patient-reported anthropometric, behavioural and psychosocial variables collected at pre- and post-program completion. The total participant accrual target across four participating Cancer Councils is 900 over 3 years. Discussion: The national scope of the project and broad inclusion of cancer survivors, alongside evaluation of service-level indicators, associated costs and patient-reported outcomes, will provide the necessary practice-based evidence needed to inform future allocation of resources to support healthy living among cancer survivors. Trial registration: Australian and New Zealand Clinical Trials Registry (ANZCTR) - ACTRN12615000882527(registered on 24/08/2015

Effekte von Morphin, Fentanyl und Ketamin auf leukozytäre Funktion, Transkriptionsfaktoren und Interleukin-8-Synthese

In der hier vorliegenden Arbeit wird der Einfluß der in der Anästhesie gebräuchlichen Analgetika Morphin, Fentanyl und Ketamin auf die Funktion neutrophiler Granulozyten dargelegt. Dazu wurden immunologische, durchflußzytometrische und molekularbiologische Untersuchungsverfahren eingesetzt. Die untersuchten Substanzen modulieren die Funktion, transkriptionelle Regulation und Proteinexpression von Granulozyten in unterschiedlicher Weise. Morphin hemmt die Funktion neutrophiler Granulozyten konzentrations- und zeitabhängig. Erstmals wird dargestellt, daß der inhibitorische Effekt von Morphin auf die Phagozytose und den Oxidativen Burst durch die Freisetzung von NO als second messenger hervorgerufen wird. Die verminderte Expression von Komplement-, Fcg- und CD14-Rezeptoren korreliert mit diesen Funktionseinschränkungen. Zudem reguliert Morphin die intrazelluläre Signaltransduktion und führt dadurch zu einer Minderung der LPS-induzierten DNA-Bindungsaktivität der Transkriptionsfaktoren NF-kB und AP-1. Die hemmende Wirkung von Morphin auf transkriptionsregulierende Proteine wird in dieser Arbeit erstmals an humanen Leukozyten nachgewiesen. Dabei stellt die Morphin-abhängige Freisetzung von NO das Schlüsselereignis für die hemmenden Effekte von Morphin dar: Durch NOS-Antagonisten kann die Morphin-induzierte Hemmung von Rezeptorenexpression, Granulozytenfunktion und Transkriptionsfaktoren verhindert werden, während NO-Donoren die Morphin-Wirkung imitieren. Die Blockade von Opiatrezeptoren mit Naloxon hebt die inhibierende Wirkung von Morphin ebenfalls auf, so daß eine Bindung an NO-freisetzende µ-Rezeptoren auf Granulozyten als kausaler Mechanismus angesehen werden kann. Die Inhibierung der Transkriptionsfaktoren NF-kB und AP-1 korreliert im Vollblut nicht mit einer verminderten Produktion von IL-8 als NF-kB- bzw. AP-1-abhängigem Mediator. Die exakten intrazellulären Mechanismen und die funktionelle Bedeutung dieser Granulozyten-inhibierenden Effekte von Morphin auf das Entzündungsgeschehen müssen in zukünftigen Untersuchungen geklärt werden. Fentanyl zeigt weder aktivierende noch inhibierende Wirkungen auf Granulozytenfunktion und Expression von Oberflächenrezeptoren. Grundlage hierfür kann die mangelnde Affinität von Fentanyl für die auf Leukozyten exprimierten Opiatrezeptoren sein. Basierend auf der Annahme, daß diese Substanz immunologisch inert ist, wurden Effekte auf transkriptionelle Regulation und Proteinsynthese nicht untersucht. Ketamin hemmt die Granulozytenfunktion und die Expression von Komplement-, Fcg- und CD14-Rezeptoren konzentrationsabhängig, wobei die Dauer der Ketamin-Inkubation nicht von Bedeutung ist. Erstmals wird in dieser Arbeit ein inhibitorischer Effekt von Ketamin auf die LPS-induzierte DNA-Bindungsaktivität der Transkriptionsfaktoren NF-kB und AP-1 beschrieben, wobei konsekutiv die leukozytäre Produktion von IL-8 auf transkriptioneller Ebene gehemmt wird. Das Ausmaß der Hemmung durch Ketamin hängt dabei von der zur Stimulation eingesetzten LPS-Dosierung ab. Im Gegensatz zu Morphin-induzierten Veränderungen sind diese Effekte unabhängig von NO als second messenger und werden nicht durch Opiat- oder NMDA-Rezeptoren vermittelt. Damit unterscheiden sich die Signaltransduktionswege Ketamin-vermittelter Effekte auf Immunzellen grundlegend von denjenigen, die für die anästhetische und psychomimetische Wirkung dieser Substanz im ZNS verantwortlich sind. Enantiomer-spezifische Effekte spielen für die immunsupprimierende Wirkung von Ketamin nur eine untergeordnete Rolle. Folgestudien sind erforderlich, um die an der Ketamin-abhängigen Inhibierung beteiligten intrazellulären Mediatoren und Stoffwechselwege in Leukozyten zu definieren. Der in dieser Studie erstmals zur Untersuchung von Analgetika-induzierten Veränderungen von Transkriptionsfaktoren angewandte durchflußzytometrische Vollblut-Assay weist eine hohe Reproduzierbarkeit auf, ermöglicht eine verläßliche und schnelle Quantifizierung des nukleären NF-kB- bzw. AP-1-Gehalts und liefert mit klassischen Verfahren vergleichbare Ergebnisse. Bei dieser Technik kann auf eine Zellseparation verzichtet werden, so daß die physiologischen Zustände im Vollblut berücksichtigt werden. Eine eventuelle Anwendung dieses Verfahrens zum Screening von Risikopatienten in Anästhesie und Intensivmedizin sollte in zukünftigen Untersuchungen evaluiert werden. Der differente Einfluß dieser Analgetika auf das Immunsystem sollte bei den verschiedenen Indikationen in Anästhesie, Intensivmedizin und Schmerztherapie Beachtung finden und in klinischen Studien weiter abgeklärt werden, um nicht nur eine effiziente Analgesie zu erzielen, sondern auch um etwaige Vor- bzw. Nachteile einer Immunmodulation durch diese Substanzen berücksichtigen zu können

Developing strategies at the pre-service level to address critical teacher attraction and retention issues in Australian rural, regional and remote schools

This ALTC project is a collaborative endeavour between the four public universities involved in teacher education in Western Australia (Curtin University, Edith Cowan University, Murdoch University and The University of Western Australia), focussed on improving the quality of preparation of pre-service teachers for rural, regional and remote appointments. The project will create a nexus between the theory and practice of teaching and learning by developing models of pre-service teacher rural, regional and remote practicums. The project builds on the work of other recent Australian rural education research projects (conducted through TERRA Nova and the Renewing Rural and Regional Teacher Education ALTC Curriculum Project. Existing rural health collaborative models will be drawn upon to inform the developing project. The project bring s together rural community and professional partnerships (including SPERA and SiMMER) that will help to sustain rural communities through the provision of quality, prepared rural, regional and remote teachers

The relationship between sun protection policies and practices in schools with primary-age students: the role of school demographics, policy comprehensiveness and SunSmart membership

First published online: November 22, 2013Schools can implement evidence-based sun protection policies that guide practices to help protect children from harmful sun exposure. This national study assessed the relationship between the existence and comprehensiveness of written policies and the comprehensiveness of sun protection practices. The impact of school demographics on the strength of the relationship was also examined, as was the possibility that 'SunSmart' membership would have an additional impact on practices, beyond having any formal policy. In 2011-12, staff members of 1573 schools catering to primary-age students completed a self-administered survey about sun protection policies and practices (response rate of 57%). Results showed that schools with a written policy had more comprehensive practices than schools without a written policy. The relationship between having a written policy and sun protection practices was stronger for remote schools compared with metropolitan and regional schools, and for schools catering to both primary and secondary students compared with primary students only. In addition, policy comprehensiveness was associated with practice comprehensiveness, and SunSmart membership was indirectly related to practice comprehensiveness via policy comprehensiveness. These results indicate that written policies relate to practice comprehensiveness, but the strength of the association can vary according to the characteristics of the organization.J. Dono, K. A. Ettridge, G. R. Sharplin and C. J. Wilso

Faecal occult blood testing (FOBT)-based colorectal cancer screening trends and predictors of non-use: findings from the South Australian setting and implications for increasing FOBT uptake

Published online 2 March 2017Objective. The present study used data from three South Australian population health surveys to examine trends in knowledge, recent use and reasons for use or non-use of faecal occult blood testing (FOBT) for colorectal cancer (CRC) screening from 2011 to 2014. Screening awareness and demographic factors related to non-use were also examined. Methods. FOBT trends were examined for respondents aged 50-75 years across survey years (n ~ 1000). Logistic regression analyses were undertaken to determine predictors of non-use and reasons for non-use of FOBT based on latest data. Results. The proportion of respondents reporting recent FOBT use has trended up, whereas the proportion reporting non-use has trended down. Awareness of screening recommendations has increased. Respondents who were aware of screening recommendations and those aged 65-69 years were significantly less likely to report non-use. The most commonly reported reasons for FOBT use were as part the national screening program or routine examination, whereas reasons for non-use were not having symptoms and doctor not advising to have the test. Conclusions. FOBT screening trends are indicative of the positive effect of the continued expansion of the national screening program. FOBT uptake may be increased by addressing salient barriers, as indicated by persisting reasons for non-use of FOBT. What is known about the topic? Australia has one of the highest age-standardised incidence rates of CRC (or bowel cancer) in the world. Population screening using non-invasive stool-based FOBT was implemented in Australia in 2006 with the introduction of the National Bowel Cancer Screening Program (NBCSP). To date, the NBCSP has been extended to only a small proportion of the target population and FOBT screening rates remain well below desired levels to effect changes in CRC outcomes at the population level. There is a recognised need for more robust data on CRC screening practices to inform interventions aimed at increasing FOBT uptake, beyond the scope of the NBCSP. What does this paper add? The study provides valuable insights into trends of FOBT screening indicators over time in the South Australia, drawing on data from population state health surveys undertaken from 2011 to 2014. A particular advantage of the dataset was that it included data on reasons for use and non-use of FOBT. These data are not routinely assessed in population-level studies of FOBT uptake, although such information would be beneficial for tracking implementation of the national program and identifying salient barriers to FOBT uptake in low-participation groups. Thus, the study also describes factors related to non-use and reasons for non-use of FOBT among the target population for CRC screening. What are the implications for practitioners? Results suggest that there have been considerable shifts in community knowledge and FOBT screening participation rates from 2011 to 2014, reflecting the positive effect of the NBCSP. Reliance on physician recommendation to screen, as well as knowledge deficits related to screening frequency and the perceived relevance of screening remain prominent barriers to FOBT uptake. Recommendations for increasing FOBT uptake are made in view of salient barriers and identified segments of the population less likely to report FOBT use.Kamelia Todorov, Carlene Wilson, Greg Sharplin, Nadia Corsin

A united approach to rural preparedness for pre-service teachers - a collaborative proposal by four Western Australian Universities

No abstract availabl