New methods to detect multiple sclerosis

This paper describes multifocal visual evoked potentials (mfVEPs) recorded to different levels of temporal sparseness. It presents the usefulness and diagnostic value of mfVEPs in multiple sclerosis (MS) and optic neuritis (ON). The paper also discusses the usefulness of frequency doubling (FD) illusion and the effect of binocularity in Normal and MS study groups

Human scotopic dark adaptation: Comparison of recoveries of psychophysical threshold and ERG b-wave sensitivity

We have compared the time course of dark adaptation of the human scotopic visual system, measured psychophysically and from the b-wave of the electroretinogram (ERG), for bleaches ranging from a few percent to near total. We also measured light adaptation, in order to apply a "Crawford transformation" to convert the raw measurements of dark adaptation into equivalent background intensities. For both the "psychophysical threshold equivalent" intensity and the "ERG b-wave sensitivity equivalent" intensity, the equivalent background declined over much of its range with an "S2" component, though with somewhat different slopes of -0.36 (psychophysical) and -0.22 (ERG) log10 unit min-1, respectively. In addition, the magnitude of the equivalent background was approximately 1 log10 unit lower in the psychophysical experiments than in the ERG experiments. Despite these differences, the two approaches extract a common time course for the decline in level of free opsin following moderately large bleaches. We conclude that the recovery of psychophysical scotopic visual threshold over the S2 region reflects events that are present by the stage of the first synapse of rod vision, stemming ultimately from the presence of unregenerated opsin in the rod outer segments

GPs’ Insights into Prostate Cancer Diagnosis and Care in Regional Victoria, Australia

The aim of this research was to ascertain General Practitioners’ (GPs) perceptions and experiences of prostate cancer (PCa) diagnosis, treatment, and care in metropolitan Melbourne and in a regional area of Victoria, Australia, associated with poorer PCa outcomes. Semi-structured qualitative interviews were conducted with GPs (N= 10) practising in the selected region and in metropolitan Melbourne, Australia. GPs thought that most men wanted PSA testing and were willing to undergo rectal examination. Some GPs were troubled by inconsistent screening guidelines from different professional bodies. They identified a need for resources to support them in educating patients about PCa. GPs thought it might be more difficult for young female GPs to care for patients in relation to PCa screening; differences were evident between younger female GPs and older male GPs in the approach they adopted in interviews. Regional GPs often referred patients to services in larger centres because no local specialists were available. GPs also found it hard to explain differences in PCa outcomes in regional and metropolitan areas. Potential age and gender differences in GPs in relation to prostate care warrant further examination. Although GPs were able to offer only limited insights into the poorer outcomes in regional areas, they identified ways in which they could be assisted to provide best-practice care. Multidisciplinary care, resources for patients, and consistent guidelines for the detection and treatment of PCa should contribute to better care in all areas

Development of South Australian-Victorian Prostate Cancer Health Outcomes Research Dataset

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.BACKGROUND: Prostate cancer is the most commonly diagnosed and prevalent malignancy reported to Australian cancer registries, with numerous studies from single institutions summarizing patient outcomes at individual hospitals or States. In order to provide an overview of patterns of care of men with prostate cancer across multiple institutions in Australia, a specialized dataset was developed. This dataset, containing amalgamated data from South Australian and Victorian prostate cancer registries, is called the South Australian-Victorian Prostate Cancer Health Outcomes Research Dataset (SA-VIC PCHORD). RESULTS: A total of 13,598 de-identified records of men with prostate cancer diagnosed and consented between 2008 and 2013 in South Australia and Victoria were merged into the SA-VIC PCHORD. SA-VIC PCHORD contains detailed information about socio-demographic, diagnostic and treatment characteristics of patients with prostate cancer in South Australia and Victoria. Data from individual registries are available to researchers and can be accessed under individual data access policies in each State. CONCLUSIONS: The SA-VIC PCHORD will be used for numerous studies summarizing trends in diagnostic characteristics, survival and patterns of care in men with prostate cancer in Victoria and South Australia. It is expected that in the future the SA-VIC PCHORD will become a principal component of the recently developed bi-national Australian and New Zealand Prostate Cancer Outcomes Registry to collect and report patterns of care and standardised patient reported outcome measures of men nation-wide in Australia and New Zealand

Evaluating the impact of 2006 Australasian Clinical Practice Guidelines for nutrition in children with cystic fibrosis in Australia

Objectives: To determine the association between the implementation of the 2006 Australasian Clinical Practice Guidelines for Nutrition in Cystic Fibrosis (CF) and the nutritional status of children participating in the Australian Cystic Fibrosis Data Registry (ACFDR). Methods: This research consisted of a quantitative study using ACFDR data and a survey of clinicians and dietitians treating children with CF. Two independent cohorts of children (2–5 years and 6–11 years) were selected from ACFDR between 1998 and 2014 (N = 2304). Generalised estimating equation model was used to assess weight, height and body mass index (BMI) z-scores for each patient before and after the implementation of the nutrition guidelines. A nationwide online survey was sent to 48 clinicians to explore the enablers and barriers to implementation of the guidelines. Results: Data analysis showed significant increase (p < 0.05) in mean weight, height and BMI z-scores ranging from 0.06 to 0.18 after implementation of the guidelines in both cohorts of children. Nineteen (39%) clinicians participated in the survey. The majority of the respondents adopted the recommendations into their practice and used the guidelines as part of their professional development. Structural barriers included a lack of adequate staff resources and clinic space for consultations, inappropriate staff classification, high staff turnover and lack of mentoring support. Conclusion: In children participating in the ACFDR, nutritional status improved after the implementation of the 2006 guidelines. Survey results revealed enablers and barriers to guideline implementation and will inform implementation strategies for the revised Australasian nutrition guidelines for CF, released in 2017

Repeat workers' compensation claims: risk factors, costs and work disability

<p>Abstract</p> <p>Background</p> <p>The objective of our study was to describe factors associated with repeat workers' compensation claims and to compare the work disability arising in workers with single and multiple compensation claims.</p> <p>Methods</p> <p>All initial injury claims lodged by persons of working age during a five year period (1996 to 2000) and any repeat claims were extracted from workers' compensation administrative data in the state of Victoria, Australia. Groups of workers with single and multiple claims were identified. Descriptive analysis of claims by affliction, bodily location, industry segment, occupation, employer and workplace was undertaken. Survival analysis determined the impact of these variables on the time between the claims. The economic impact and duration of work incapacity associated with initial and repeat claims was compared between groups.</p> <p>Results</p> <p>37% of persons with an initial claim lodged a second claim. This group contained a significantly greater proportion of males, were younger and more likely to be employed in manual occupations and high-risk industries than those with single claims. 78% of repeat claims were for a second injury. Duration between the claims was shortest when the working conditions had not changed. The initial claims of repeat claimants resulted in significantly (<it>p < 0.001</it>) lower costs and work disability than the repeat claims.</p> <p>Conclusions</p> <p>A substantial proportion of injured workers experience a second occupational injury or disease. These workers pose a greater economic burden than those with single claims, and also experience a substantially greater cumulative period of work disability. There is potential to reduce the social, health and economic burden of workplace injury by enacting prevention programs targeted at these workers.</p

Effect of temporal sparseness and dichoptic presentation on multifocal visual evoked potentials

Multifocal VEP (mfVEP) responses were obtained from 13 normal human subjects for nine test conditions, covering three viewing conditions (dichoptic and left and right monocular), and three different temporal stimulation forms (rapid contrast reversal, rapid pattern pulse presentation, and slow pattern pulse presentation). The rapid contrast reversal stimulus had pseudorandomized reversals of checkerboards in each visual field region at a mean rate of 25 reversals/s, similar to most mfVEP studies to date. The rapid pattern pulse presentation had pseudorandomized presentations of a checkerboard for one frame, interspersed with uniform grey frames, with a mean rate of 25 presentations/s per region per eye. The slow pattern pulse stimulus had six presentations/s per region per eye. Recording time was 5.3 min/condition. For dichoptic presentation slow pattern pulse responses were 4.6 times larger in amplitude than the contrast reversal responses. Binocular suppression was greatest for the contrast reversal stimulus. Consideration of the signal-to-noise ratios indicated that to achieve a given level of reliability, slow pattern pulse stimuli would require half the recording time of contrast reversal stimuli for monocular viewing, and 0.4 times the recording time for dichoptically presented stimuli. About half the responses to the slow pattern pulse stimuli had peak value exceeding five times their estimated standard error. Responses were about 20% smaller in the upper visual field locations. Space-time decomposition showed that responses to slow pattern pulse were more consistent across visual field locations. We conclude that the pattern pulse stimuli, which we term temporally sparse, maintain the visual system in a high contrast gain state. This more than compensates for the smaller number of presentations in the run, and provides signal-to-noise advantages that may be valuable in clinical application

Frequency doubling illlusion VEPs and automated perimetry in multiple sclerosis

We examined frequency doubling (FD) illusion based automated perimetry (FDT) and dichoptic FD multifocal visual evoked potentials (FDmfVEPs) in Normal and multiple sclerosis (MS) subjects. Contrast thresholds were determined at 17 visual field locations using an FDT perimeter. The stimuli presented to each location were 0.25 cpd gratings presented with rapid (25 Hz) counterphase flicker and thus displayed the spatial FD illusion. Dichoptic mfVEPs were recorded by concurrently stimulating eight regions/eye with FD stimuli presented at 95% contrast. Recordings were obtained from 27 Normal subjects, 26 MS patients who had experienced Optic Neuritis (MSON) and 24 MS patients without a history of ON (MSNON). The FDT thresholds showed enhanced contrast sensitivity for MSON patients (P < 0.0001) but not for MSNON patients. Response amplitudes for the central four regions of the mfVEP stimulus were reduced in both patient groups (P < 0.005). A classification model based upon the FDT thresholds performed at a specificity of 96% for a sensitivity of 97% in MSON patients, but the accuracy (simultaneously largest sensitivities and specificities) was poor (∼60%) in MSNON patients. Discriminant models based on the FDT thresholds and FDmfVEPs were able to diagnose more that 90% MSON patients but performed poorly for MSNON patients