East Melbourne Research Articles

CLINICAL EFFICACY OF MOXIFLOXACIN IN THE TREATMENT OF BACTERIAL KERATITIS: A RANDOMIZED CLINICAL TRIAL

Wills Eye Institute, Philadelphia, PA Original study reprint requests: Dr Mark Daniell, Centre for Eye Research Australia, University of Melbourne, Corneal Clinic, Royal Victorian Eye and Ear Hospital, Locked Bag 8, East Melbourne 8002, Australia. E-mail address: [email protected].

392 Exercise after stroke in the North East Melbourne Stroke Incidence Study (NEMESIS)

392 Exercise after stroke in the North East Melbourne Stroke Incidence Study (NEMESIS)

Increased Levels of Transforming Growth Factor-Beta1 and -Beta2 in the Aqueous Humor of Patients With Neovascular Glaucoma

To measure the concentrations of transforming growth factor-betal and beta2 (TGF-beta1 and TGF-beta2) in the aqueous humor of patients with neovascular glaucoma (NVG). Patients were divided into four groups: NVG secondary to central retinal vein occlusion (group 1), NVG secondary to proliferative diabetic retinopathy (group 2), central retinal vein occlusion without rubeosis (group 3), and senile cataract (group 4). The total TGF-beta 1 and TGF-beta2 concentrations in the aqueous humor of the four groups were measured by enzyme linked immunosorbent assay. The mean concentrations of total TGF-betal were 600.7 +/-436.7 microg/mL in group 1, 802.0 +/-359.5 pg/mL in group 2, and undetectable in groups 3 and group 4 (P < .05). The mean concentrations of total TGF-beta2 were 6,307.9+/- 2,206.2 microg/mL in group 1, 5,908.0+/-2,033.2 microg/mL in group 2, 899.7+/- 425.6 microg/mL in group 3, and 385.7 +/-89.9 microg/mL in group 4. The total TGF-betal and TGF-beta2 concentrations in groups 1 and 2 were significantly higher than those in groups 3 and 4, whereas the total TGF-beta2 concentration in group 3 was significantly higher than that in group 4 (P < .05). There was no significant difference in the TGF-betal or TGF-beta2 concentrations between groups 1 and 2 (P> .05). The abnormally high concentrations of TGF-betal and TGF-beta2 in the aqueous humor of patients with NVG may explain some aspects of the pathogenesis of NVG and the high failure rate of filtering operations in NVG.

Comparison of residual stromal bed and flap thickness in primary and repeat laser in situ keratomileusis in myopic patients

To compare the change in residual stromal thickness and flap thickness between primary laser in situ keratomileusis (LASIK) and repeat LASIK in myopic patients. Melbourne Excimer Laser Group, East Melbourne, Australia. This retrospective nonrandomized comparative trial comprised 46 eyes of 34 patients who had repeat LASIK. The thickness of the residual stromal bed was calculated by subtracting the calculated stromal ablation from pachymetry of the stromal bed after cutting the flap in primary treatment and directly measuring during retreatment. The thickness of the LASIK flap in primary and repeat LASIK was calculated by subtracting the central pachymetry of the stromal bed after creating the flap from pachymetry before cutting and lifting the flap, respectively. The main outcome measures were comparison of the residual stromal bed and flap thickness between the primary treatment and the retreatment. The mean thickness of the calculated residual stromal bed after primary treatment was 329.8 microm +/- 40.8 (SD), and the mean measured residual stromal bed at retreatment was 317.3 +/- 42.8 microm. The mean difference in residual stromal bed thickness was 12.5 +/- 13.0 microm (P<.001). Sixteen eyes (34.7%) had a decrease in bed thickness between 11 microm and 20 microm. The mean flap thickness during primary LASIK and repeat LASIK was 145.2 +/- 17.1 microm and 169 +/- 18.3 microm, respectively. The mean interval between primary treatment and retreatment was 7.4 +/- 4.1 months. The mean change in flap thickness was 23.8 +/- 15.2 microm (P<.001). Fifteen eyes (32%) had an increase in flap thickness between 11 microm and 20 microm. There was a negative correlation between refractive error before primary treatment and the difference in flap thickness. No correlation was found between the difference in flap thickness and the interval between the primary treatment and the repeat treatment. Intraoperative pachymetry of the stromal bed during retreatment is strongly recommended as the residual stromal bed and flap thickness changes between primary and retreatment. There is a tendency for the measured stromal bed at retreatment to be thinner than the calculated stromal bed and for the flap to be thicker than previously measured.

Prevalence of Depression and Use of Antidepressant Medication at 5-Years Poststroke in the North East Melbourne Stroke Incidence Study

There are few data on the prevalence or treatment of depression from unselected populations long-term poststroke. We assessed the prevalence of depression and antidepressant use at 5-years poststroke in an unselected stroke population. Five-year survivors from a prospective community-based stroke incidence study were assessed for depression with the Irritability, Depression and Anxiety Scale. Medications indicated primarily for treatment of depression were recorded. At 5-years poststroke, 441 (45%) of 978 incident cases were alive (mean age=74+/-15 years, 49% female). Seventeen percent of those assessed were depressed. Twenty-two percent with depression were taking an antidepressant medication. Of those taking an antidepressant, 72% were not depressed. Although nearly one-fifth of survivors were depressed, few were taking antidepressants. Further exploration of this low level of treatment is warranted.

2005 ANZJOG impact factor

In the October 2005 issue of this journal I commented on the concerns that I, and many other journal editors, have regarding the use and misuse of the Institute for Scientific Information (ISI) impact factor.1 The ISI list for 2004 showed that ANZJOG's impact factor was 0.435 (cf. 2003 at 0.601 and 2002 at 0.608), although a recalculation showed it to be of the same order as that of 2003 and 2002. The recently released ISI list for 2005 shows that the impact factor of ANZJOG has risen significantly to 0.854, and I expect it to rise further in 2006 as the policy decisions of the ANZJOG Editorial Board take effect. I trust that researchers in Australia and New Zealand, as well as those in the Asia–Pacific region, will respond by submitting more of their work to a journal that now has a proven record of a rapid and professional peer-reviewed response to submissions. Manuscript Submission Process The Australian and New Zealand Journal of Obstetrics and Gynaecology (ANZJOG) From February 1, 2006 all manuscript submissions to ANZJOG must take place electronically via the ANZJOG Manuscript Central facility found at http://mc.manuscriptcentral.com/anzjog Prospective authors are advised to read the revised Instructions for Authors/Authors Guidelines which are available at the following websites: http://www.blackwellpublishing.com/journals/anzjog or http://www.ranzcog.edu.au/. These guidelines have been revised to remove some ambiguities discovered with the change to submission via Manuscript Central. Attention is drawn to the requirements for Institutional ethics approval of any research or audit style manuscript. A statement is required in the methodology informing the reader that Institutional Ethics Committee approval was sought and gained, or was not deemed to be required as may be the case for some audits. It is important that the identity of the Institutional Ethics Committee is stated. All manuscripts submitted will require an accompanying submission letter signed by all authors; this letter should be submitted electronically as a scanned .pdf file attachment at the time of manuscript submission; alternatively it may be sent to the ANZJOG Editorial Office via mail (ANZJOG Editorial Office, RANZCOG, 254 Albert Street, East Melbourne, Victoria, Australia, 3002) or fax (+61 3 94190672). Once a manuscript is accepted for publication an Exclusive Licence Form will need to be completed and submitted electronically as a scanned .pdf file or mailed to the ANZJOG Editorial Office. To view and download this form, go to the website http://www.blackwellpublishing.com/pdf/ajo_elf.pdf

Control of Hypertension 5 Years After Stroke in the North East Melbourne Stroke Incidence Study

Control of blood pressure after stroke is important for reducing the risk of recurrent stroke. We examined the control of hypertension in a community-based population of 5-year stroke survivors. Cases of first-ever stroke from the North East Melbourne Stroke Incidence Study were interviewed at 5 years poststroke. Blood pressure, history of hypertension, and antihypertensive medications were recorded. Individuals were classified as normotensive (blood pressure < 140/90 mm Hg, no history of hypertension, and no antihypertensive medications), controlled hypertensive (blood pressure < 140/90 mm Hg, history of hypertension, and/or taking antihypertensive medications), uncontrolled hypertensive (blood pressure > or = 140/90 mm Hg, history of hypertension, and/or taking antihypertensive medications), or uninformed hypertensive (blood pressure > or = 140/90 mm Hg, no known history of hypertension, and no antihypertensive medications). At 5 years poststroke, 441 (45%) of 978 first-ever stroke cases were alive. Of these, 305 (69%) had complete data on blood pressure, antihypertensive medication use, and history of hypertension. No statistical differences existed between those with or without these data. Eight-two percent were hypertensive; 63% had controlled hypertension, 30% had uncontrolled hypertension, and 7% were unaware that they were hypertensive. Overall, 67% of individuals classified as uncontrolled or uninformed hypertensive subjects were receiving treatment that was insufficient to achieve target blood pressure levels. Uncontrolled hypertensive subjects were more likely to recall receiving advice to manage their hypertension with medication (P < 0.02) and diet (P < 0.09). Although the majority of hypertensive individuals had controlled hypertension at 5 years poststroke, considerable improvement can be made in the control of hypertension after stroke.

NexTemp thermometer can be used interchangeably with tympanic or mercury thermometers for emergency department use

To determine the agreement between the chemical dot NexTemp thermometer with mercury and tympanic thermometers and the repeatability of measurements using these devices. A prospective study involving a convenience sample of 194 consenting adult patients presenting to the ED, Freemasons Hospital, East Melbourne, Victoria, Australia. A survey of emergency medical staff was conducted to determine what they considered an acceptable level of agreement and repeatability for a putative new thermometer. The NexTemp thermometer's performance was judged against this. For each thermometer, a set of two temperature measurements was made in every patient. The sequence of the set of readings (and hence device) was random between patients and the staff member performing one set was blinded to the results of the other two sets of readings in each patient. The method of Bland and Altman was used for assessing agreement and repeatability. Clinicians considered that a new thermometer should exhibit repeatability of +/- 0.3 degrees C and agree with existing devices within +/- 0.5 degrees C. The tympanic thermometer had 95% limits of repeatability of -0.8-0.5 degrees C compared with the NexTemp (-0.3-0.4 degrees C) and mercury thermometers (-0.3-0.4 degrees C). The NexTemp thermometer agreed with mercury thermometer within -0.6-0.5 degrees C. The tympanic thermometer agreed with the mercury thermometer within -1.0-1.1 degrees C. Based on temperature measurement only, the NexTemp thermometer can be used interchangeably with current mercury and tympanic thermometers.

Mirror-Image Congenital Esotropia in Monozygotic Twins

Monozygotic twins had mirror-image congenital esotropia and discordant refractive errors. One had right congenital esotropia surgically corrected during childhood, and the other had left congenital esotropia surgically corrected at 3 and 6 years old.

Quality of Life After Stroke: The North East Melbourne Stroke Incidence Study (NEMESIS)

Quality of Life After Stroke: The North East Melbourne Stroke Incidence Study (NEMESIS)

Long-Term Outcome in the North East Melbourne Stroke Incidence Study

Although much is known about the long-term outcome of stroke patients in terms of mortality and disability, there has been little research on the patient-centered outcome of health-related quality of life (HRQoL). There are limited natural history data on HRQoL beyond 2 years after stroke and no data on those factors present at stroke onset that predict HRQoL beyond 2 years after stroke. For these reasons, we aimed to examine these aspects of HRQoL in an unselected population of stroke patients. All cases of first-ever stroke from a prospective community-based stroke incidence study (excluding subarachnoid hemorrhage) were assessed 5 years after stroke. HRQoL was measured with the assessment of quality of life instrument. ANOVA was used to determine baseline predictors of HRQoL. In total, 978 cases were recruited, 45% were male, and the mean age (+/-SD) was 75.5+/-13.8 years. Five years after stroke, 441 (45.1%) were alive and 356 were assessed (80.7%). Those assessed were more often born in Australia and older in age (both P<0.05). Seventy-one survivors (20%) had a very low HRQoL (score < or =0.1). The independent baseline predictors of low HRQoL at 5 years after stroke were increasing age, lower socioeconomic status, and markers of stroke severity. At 5 years after stroke, we found that a substantial proportion of survivors were suffering from poor HRQoL. As our population ages, the number of strokes and, thus, stroke survivors with poor HRQoL is likely to increase. Therefore, strategies to improve HRQoL should be vigorously pursued.

Stroke Units, Tissue Plasminogen Activator, Aspirin and Neuroprotection: Which Stroke Intervention Could Provide the Greatest Community Benefit?

Background: Although a number of acute stroke interventions are of proven efficacy, there is uncertainty about their community benefits. We aimed to assess this within a defined population. Methods: Eligibility for tissue plasminogen activator (tPA), aspirin, stroke unit management and neuroprotection were assessed among incident stroke cases within the community-based North East Melbourne Stroke Incidence Study. Results: Among 306,631 people, there were 645 incident strokes managed in hospital. When eligible patients were extrapolated to the Australian population, for every 1,000 cases, 46 (95% CI 17–69) could have been saved from death or dependency with stroke unit management, 6 (95% CI 1–11) by using aspirin, 11 (95% CI 5–17) or 10 (95% CI 3–16) by using tPA at 3 and 6 h, respectively. Conclusions: Although tPA is the most potent intervention, management in stroke units has the greatest population benefit and should be a priority.

Native to the Nation: Disciplining Landscapes and Bodies in Australia

Native to the Nation: Disciplining Landscapes and Bodies in Australia. By Allaine Cerwonka. Minneapolis: University of Minnesota Press, 2004. 269p. $74.95 cloth, $24.95 paper.It is unusual for a book on Australia to be written by an outsider and published by an American press. This is to be welcomed. Outsiders are often free of local myths and attitudes, which are well entrenched in Australia, despite its character as a relatively new nation. Allaine Cerwonka did intensive fieldwork in two inner-city suburbs of Melbourne, Australia's second city. As a resident for 10 years in neighboring Carlton, I found her sensitivity to the nuances of the complex areas of East Melbourne and Fitzroy quite unusual.

Letter to the Editor

Australasian RadiologyVolume 49, Issue 2 p. 196-196 Letter to the Editor C Acton, C Acton Breast Imaging Victoria, East Melbourne, Victoria, AustraliaSearch for more papers by this author C Acton, C Acton Breast Imaging Victoria, East Melbourne, Victoria, AustraliaSearch for more papers by this author First published: 21 April 2005 https://doi.org/10.1111/j.1440-1673.2005.01425.xRead the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume49, Issue2April 2005Pages 196-196 RelatedInformation

OPL038 Determinants of health-related quality of life (HRQoL) five years after stroke in the North East Melbourne stroke incidence study (NEMESIS)

OPL038 Determinants of health-related quality of life (HRQoL) five years after stroke in the North East Melbourne stroke incidence study (NEMESIS)

East Melbourne Group Inc v Minister for Planning and Another

East Melbourne Group Inc v Minister for Planning and Another

American Society of Clinical Oncology Conference

Journal of Pharmacy Practice and ResearchVolume 34, Issue 3 p. 207-209 Pharmacy Practice American Society of Clinical Oncology Conference Carol A Rice BPharm, Corresponding Author Senior Clinical Trials Pharmacist Pharmacy Department, Peter MacCallum Cancer Centre, East Melbourne, VictoriaCarol Rice, Peter MacCallum Cancer Centre, Locked Bag No 1 A'Beckett Street, East Melbourne Vic. 8006, Australia E-mail: Carol.Rice@petermac.orgSearch for more papers by this author Carol A Rice BPharm, Corresponding Author Senior Clinical Trials Pharmacist Pharmacy Department, Peter MacCallum Cancer Centre, East Melbourne, VictoriaCarol Rice, Peter MacCallum Cancer Centre, Locked Bag No 1 A'Beckett Street, East Melbourne Vic. 8006, Australia E-mail: Carol.Rice@petermac.orgSearch for more papers by this author First published: 01 September 2004 https://doi.org/10.1002/jppr2004343207AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onEmailFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume34, Issue3September 2004Pages 207-209 RelatedInformation

Quality of life after stroke: the North East Melbourne Stroke Incidence Study (NEMESIS).

Health-related quality of life (HRQoL) data are scarce from unselected populations. The aims were to assess HRQoL at 2 years poststroke, to identify determinants of HRQoL in stroke survivors, and to identify predictors at stroke onset of subsequent HRQoL. All first-ever cases of stroke in a population of 306 631 over a 1-year period were assessed. Stroke severity, comorbidity, and demographic information were recorded. Two-year poststroke HRQoL was assessed using the Assessment of Quality of Life (AQoL) instrument (deceased patients score=0). Handicap, disability, physical impairment, depression, anxiety, living arrangements, and recurrent stroke at 2 years were documented. If necessary, proxy assessments were obtained, except for mood. Linear regression analyses were performed to identify factors independently associated with HRQoL. Of 266 incident cases alive at 2 years, 225 (85%) were assessed. The mean AQoL utility score for all survivors was 0.47 (95% CI, 0.42 to 0.52). Almost 25% of survivors had a score of < or =0.1. The independent determinants of HRQoL in survivors were handicap, physical impairment, anxiety and depression, disability, institutionalization, dementia, and age. The factors present at stroke onset that independently predicted HRQoL at 2 years poststroke were age, female sex, initial NIHSS score, neglect, and low socioeconomic status. A substantial proportion of stroke survivors have very poor HRQoL. Interventions targeting handicap and mood have the potential to improve HRQoL independently of physical impairment and disability.

Confirmation of the Activity of the Interleukin-2 Fusion Toxin Denileukin Diftitox against Chemorefractory Chronic Lymphocytic Leukemia, including Cases with Chromosome 17p Deletions and without Detectable CD25 Expression

Confirmation of the Activity of the Interleukin-2 Fusion Toxin Denileukin Diftitox against Chemorefractory Chronic Lymphocytic Leukemia, including Cases with Chromosome 17p Deletions and without Detectable CD25 Expression

Trial Application of a Model of Resource Utilization, Costs, and Outcomes for Stroke (MORUCOS) to Assist Priority Setting in Stroke

Cost-effectiveness data for stroke interventions are limited, and comparisons between studies are confounded by methodological inconsistencies. The aim of this study was to trial the use of the intervention module of the economic model, a Model of Resource Utilization, Costs, and Outcomes for Stroke (MORUCOS) to facilitate evaluation and ranking of the options. The approach involves using an economic model together with added secondary considerations. A consistent approach was taken using standard economic evaluation methods. Data from the North East Melbourne Stroke Incidence Study (NEMESIS) were used to model "current practice" (base case), against which 2 interventions were compared. A 2-stage process was used to measure benefit: health gains (expressed in disability-adjusted life years [DALYs]) and filter analysis. Incremental cost-effectiveness ratios (ICERs) were calculated, and probabilistic uncertainty analysis was undertaken. Aspirin, a low-cost intervention applicable to a large number of stroke patients (9153 first-ever cases), resulted in modest health benefits (946 DALYs saved) and a mean ICER (based on incidence costs) of US 1421 dollars per DALY saved. Although the health gains from recombinant tissue-type plasminogen activator (rtPA) were less (155 DALYs saved), these results were impressive given the small number of persons (256) eligible for treatment. rtPA dominates current practice because it is more effective and cost-saving. If used to assess interventions across the stroke care continuum, MORUCOS offers enormous capacity to support decision-making in the prioritising of stroke services.