Epworth Collection:
http://hdl.handle.net/11434/25
2024-03-28T14:51:24ZInvestigating burnout of rehabilitation medicine trainees: an Australian cross-sectional study.
http://hdl.handle.net/11434/2277
Title: Investigating burnout of rehabilitation medicine trainees: an Australian cross-sectional study.
Epworth Authors: Ponsford, Michael; McKenzie, Dean; Fedele, Bianca; Olver, John
Abstract: Background:
In Rehabilitation Medicine, there is an increased incidence of burnout compared with other specialties, with burnout affecting over 50% of rehabilitation physicians. There remains limited research investigating burnout in Rehabilitation Medicine trainees.
Aim:
To investigate the frequency of burnout, and associations between burnout and workplace and demographic factors, among Australian registered Rehabilitation Medicine trainees.
Methods
This cross-sectional study administered the Mini-Z Burnout Survey via the Qualtrics survey platform. The presence of burnout was determined on responses to Survey Item 3. Binary logistic regression evaluated associations between burnout presence and workplace and demographic (age, sex, and stage of training) variables. An open-ended question addressing workplace stresses underwent qualitative content analysis.
Results:
Of the potential 220 registered trainees, 18.2% (39) consented to participate. Burnout was reported by 54.6% (18/33) of respondents with complete data. Logistic regression analyses revealed 2 Mini-Z items were significantly associated with burnout; job stress (odds ratio=22.9; 95% CI=3.5–145.8, P<0.001) and a hectic/chaotic work atmosphere (odds ratio=5.0; 95% CI=1.01–24, P=0.045). There was no significant association between burnout and the remaining Mini-Z items or between burnout and the demographic variables. Content analysis of responses to the open-ended question identified 3 themes: training issues; work place demands; personal health/work-life balance concerns.
Conclusion:
This Australian-first study identified significant burnout in a cohort of Rehabilitation Medicine trainees. The sources of stress identified can be used to modify workplace environments and education requirements and promote well-being among trainees.2023-03-01T00:00:00ZUtility of acute and subacute blood biomarkers to assist diagnosis in CT negative isolated mild traumatic brain injury.
http://hdl.handle.net/11434/2275
Title: Utility of acute and subacute blood biomarkers to assist diagnosis in CT negative isolated mild traumatic brain injury.
Epworth Authors: Reyes, Jonathan; Ponsford, Jennie; Willmott, Catherine
Abstract: Objectives: Blood biomarkers GFAP and UCH-L1 have recently been FDA approved as predictors of intracranial lesions on CT after mild traumatic brain injury (mTBI). However, the vast majority of mTBI cases are CT negative, and no biomarkers are approved to assist diagnosis in these individuals. Here we aimed to determine the optimal combination of blood biomarkers to assist mTBI diagnosis in otherwise healthy adults aged under 50 presenting to an ED within 6h of injury. To further understand the utility of biomarkers, we assessed how biological sex, presence or absence of loss of consciousness and/or post traumatic amnesia (LOC/PTA), and delayed presentation, affected classification performance.
Methods: Blood samples, symptom questionnaires and cognitive tests were conducted prospectively for mTBI participants recruited from The Alfred Hospital Level 1 Emergency & Trauma Centre and uninjured controls. Follow-up testing was conducted at 7 days. Simoa® quantified plasma GFAP, UCH-L1, Tau, NfL, IL-6 and IL-1β. AUC analysis assessed classification accuracy for diagnosed mTBI and logistic regression models identified optimal biomarker combinations.
Results: Plasma IL-6 (AUC=0.91, 95%CI=0.86-0.96), GFAP (AUC=0.85, 95%CI=0.78-0.93) and UCH-L1 (AUC=0.79, 95%CI=0.70-0.88) best differentiated mTBI (n=74) from controls (n=44) acutely (<6h), with NfL (AUC=0.81, 95%CI=0.72-0.90) the only marker to have such utility sub-acutely (7 days). Biomarker performance was similar between sexes and for participants with and without LOC/PTA, with the exception at 7 days, where GFAP and IL-6 retained some utility in female participants (GFAP AUC=0.71, 95%CI=0.55-0.88; IL-6 AUC=0.71, 95%CI=0.55-0.87) and those with LOC/PTA (GFAP AUC=0.73, 95%CI=0.59-0.86; IL-6 AUC=0.71, 95%CI=0.57-0.84). Acute IL-6 (R2=0.50, 95%CI=0.34-0.64) outperformed GFAP and UCH-L1 combined (R2=0.35, 95%CI=0.17-0.50), with the best acute model featuring GFAP and IL-6 (R2=0.54, 95%CI=0.34-0.68).
Discussion: : These findings indicate that adding IL-6 to a panel of brain-specific proteins such as GFAP and UCH-L1 might assist in the acute diagnosis of mTBI in adults under 50. Multiple markers had high classification accuracy in participants without LOC/PTA. When compared with the best performing acute markers, sub-acute measures of plasma NfL resulted in minimal reduction in classification accuracy. Future studies will investigate the optimal time frame over which plasma IL-6 might assist diagnostic decisions and how extracranial trauma affects utility.2023-10-01T00:00:00ZTransdiagnostic MRI markers of psychopathology following traumatic brain injury: a systematic review and network meta-analysis protocol.
http://hdl.handle.net/11434/2270
Title: Transdiagnostic MRI markers of psychopathology following traumatic brain injury: a systematic review and network meta-analysis protocol.
Epworth Authors: Ponsford, Jennie; Samiotis, Alexia; Hicks, Amelia; Spitz, Gershon
Abstract: Introduction: Psychopathology following traumatic brain injury (TBI) is a common and debilitating consequence that is often associated with reduced functional and psychosocial outcomes. There is a lack of evidence regarding the neural underpinnings of psychopathology following TBI, and whether there may be transdiagnostic neural markers that are shared across traditional psychiatric diagnoses. The aim of this systematic review and meta-analysis is to examine the association of MRI-derived markers of brain structure and function with both transdiagnostic and specific psychopathology following moderate-severe TBI.
Methods and analysis: A systematic literature search of Embase (1974-2022), Ovid MEDLINE (1946-2022) and PsycINFO (1806-2022) will be conducted. Publications in English that investigate MRI correlates of psychopathology characterised by formal diagnoses or symptoms of psychopathology in closed moderate-severe TBI populations over 16 years of age will be included. Publications will be excluded that: (a) evaluate non-MRI neuroimaging techniques (CT, positron emission tomography, magnetoencephalography, electroencephalogram); (b) comprise primarily a paediatric cohort; (c) comprise primarily penetrating TBI. Eligible studies will be assessed against a modified Joanna Briggs Institute Critical Appraisal Instrument and data will be extracted by two independent reviewers. A descriptive analysis of MRI findings will be provided based on qualitative synthesis of data extracted. Quantitative analyses will include a meta-analysis and a network meta-analysis where there are sufficient data available.
Ethics and dissemination: Ethics approval is not required for the present study as there will be no original data collected. We intend to disseminate the results through publication to a high-quality peer-reviewed journal and conference presentations on completion.2023-09-01T00:00:00ZAccess to healthcare following serious injury: perspectives of allied health professionals in urban and regional settings.
http://hdl.handle.net/11434/2252
Title: Access to healthcare following serious injury: perspectives of allied health professionals in urban and regional settings.
Epworth Authors: Keeves, Jemma
Abstract: Barriers to accessing healthcare exist following serious injury. These issues are not well understood and may have dire consequences for healthcare utilisation and patients' long-term recovery. The aim of this qualitative study was to explore factors perceived by allied health professionals to affect access to healthcare beyond hospital discharge for people with serious injuries in urban and regional Victoria, Australia. Twenty-five semi-structured interviews were conducted with community-based allied health professionals involved in post-discharge care for people following serious injury across different urban and regional areas. Interview transcripts were analysed using thematic analysis. Many allied health professionals perceived that complex funding systems and health services restrict access in both urban and regional areas. Limited availability of necessary health professionals was consistently reported, which particularly restricted access to mental healthcare. Access to healthcare was also felt to be hindered by a reliance on others for transportation, costs, emotional stress and often lengthy time of travel. Across urban and regional areas, a number of factors limit access to healthcare. Better understanding of health service delivery models and areas for change, including the use of technology and telehealth, may improve equitable access to healthcare.2021-01-01T00:00:00Z