Does inspiratory muscle training improve lung function and quality of life in people with inclusion body myositis? A pilot study.

Inclusion body myositis is the most common acquired myositis in adults, predominantly weakening forearm flexor and knee extensor muscles. Subclinical respiratory muscle weakness has recently been recognised in people with inclusion body myositis, increasing their risk of respiratory complications. Inspiratory muscle training, a technique which demonstrates efficacy and safety in improving respiratory function in people with neuromuscular disorders, has never been explored in those with inclusion body myositis. In this pilot study, six adults with inclusion body myositis (age range 53 to 81 years) completed eight weeks of inspiratory muscle training. Measures of respiratory function, quality of life, sleep quality and a two-minute walk test were performed pre and post-intervention. All participants improved their respiratory function, with maximal inspiratory pressure, sniff nasal inspiratory pressure and forced vital capacity increasing by an average of 50 % (p = .002), 43 % (p = .018) and 13 % (p = .003) respectively. No significant change was observed in quality of life, sleep quality or two-minute walk test performance. No complications occurred due to inspiratory muscle training This pilot study provides the first evidence that inspiratory muscle training may be safe and effective in people with Inclusion Body Myositis, potentially mitigating the complications of poor respiratory function.

Lutetium-177 Labelled Anti-PSMA Monoclonal Antibody (Lu-TLX591) Therapy for Metastatic Prostate Cancer: Treatment Toxicity and Outcomes.

INTRODUCTION: Whilst prostate cancer is the fourth most common cancer globally, effective therapies for patients with advanced disease are lacking. In recent years, interest in using theranostic agents to treat castrate-resistant prostate cancer (CRPC) and metastatic prostate cancer has emerged. Lu-TLX591 monoclonal antibody is a potential agent of significance; however, to date, reports on its toxicity and efficacy have been limited to small clinical trials in heavily pretreated patients. This retrospective study describes the real-world toxicity and efficacy profile of Lu-TLX591. METHODS: Eighteen patients received Lu-TLX591 at two private oncology centres in Australia. Patients were eligible if they had CRPC or metastatic prostate cancer and prostate-specific membrane antigen (PSMA)-avid disease confirmed by PSMA-positron emission tomography (PET). Patients received two cycles of Lu-TLX591 monoclonal antibody (177 Lu-DOTA-rosopatamab) each dosed from 1.01-2.85 GBq, 14 days apart. Patient side effects, blood test results and radiology reports were recorded on the patient's electronic medical record (eMR). RESULTS: Prominent side effects included fatigue (55.6%), anorexia (16.7%), nausea (11.1%), and transfusion reactions (11.1%). All-grade haematological toxicities included lymphopenia (61.1%), anaemia (22.2%), leukopenia (27.8%), neutropenia (27.8%), and thrombocytopenia (27.8%). Grade 4 toxicity included lymphopenia (6.7%) and thrombocytopenia (6.7%). Patients' prostate-specific antigen (PSA) responses were as follows; ≥ 30% PSA decline (27.8%), ≥ 50% PSA decline (11.4%) and any PSA decline (38.9%). Follow-up radiology revealed 54.5% stable disease, 45.4% disease progression and 9.1% disease regression. CONCLUSION: Lu-TLX591 was safely administered at acceptable toxicity and its efficacy reflects previous clinical trials. Larger studies are required and are underway (NCT04786847; NCT05146973; NCT04876651) to determine Lu-TLX591 effectiveness amongst different prostate cancer populations and compare its efficacy against peptide-based radiopharmaceutical agents.

An analysis of child suicide from three centers (2008-2017).

Although the overall suicide rate worldwide has changed minimally over the past 100 years, different trends have been observed over time in the USA, Australia, and New Zealand (NZ). However, few studies have focused on suicides in children (< 18 years), making evaluation of possible trends difficult. The last 20 years has also seen an increase in childhood obesity, eating disorders, and body image issues for children in many developed nations; however, few studies have shown whether a significant proportion of child suicides have an abnormal BMI. The current study evaluates child suicides (from 2008 to 2017) in South Australia (Australia), compared with the jurisdictions of Auckland (NZ) and Hennepin County (USA). Demographic data (age, sex, ethnicity), body mass index (BMI), the number of cases of youth suicide, and the method of suicide from these three regions were collected and analyzed. Across the 10-year period, the jurisdiction of Auckland had a downward trend, while Hennepin County and South Australia had increasing numbers of cases. The most common method of child suicide in all centers was hanging, occurring in > 80% of cases in South Australia and Auckland and 56% in Hennepin County. Hennepin County had a greater proportion of suicides using firearms (28%), compared to 1.9% in Auckland and 5.1% in South Australia. Unusual means of suicide were used less frequently by youth than previously.

Wikipedia in Health Professional Schools: from an Opponent to an Ally.

As an online encyclopedia, Wikipedia is the world's largest reference Web site, with 1.7 billion visits per month. Given how easy it is to access and read, students use Wikipedia globally, despite most faculty members' admonitions. Since 2013, health professional schools worldwide have incorporated Wiki-editing into their formal curricula. These courses impact students by (1) strengthening their ability to evaluate evidence-based content and (2) multiplying their contributions to society through improvements to Wikipedia articles accessed by millions. We showcase several models of incorporating Wikipedia-editing assignments into health professions education worldwide. These successful initiatives can be replicated everywhere.

A randomised trial of the effectiveness of instructor versus automated manikin feedback for training junior doctors in life support skills.

INTRODUCTION: Australian Standards require that clinicians undergo regular training in skills required to respond to the acute deterioration of a patient. Training focuses on the ability to appropriately respond to cardiac arrest, including delivering cardiac compressions, ventilation and appropriate defibrillation. Providing such training comes at a significant cost to the organisation and impacts on clinician time in direct patient care. If effective, the use of an automated manikin could significantly reduce costs and provide consistent training experiences. METHODS: Fifty-six resident medical officers were randomised to two groups to test two skills components of hospital life support training under two feedback conditions. The skills components were cardiac compressions and bag-valve-mask ventilation. The feedback conditions were automated feedback delivered by a simulation manikin and traditional feedback delivered by an instructor. All participants were exposed to both skills components and both feedback conditions in a counterbalanced block design. Participants completed surveys before and after training. RESULTS: The results demonstrated significantly better performance in cardiac compressions under the automated manikin feedback condition compared with the instructor feedback condition. This difference was not observed in bag-valve-mask ventilation. The majority of participants found the automated manikin feedback more useful than the instructor feedback. DISCUSSION: Automated manikin feedback was not inferior to instructor feedback for skill acquisition in cardiac compressions training. The automated feedback condition did not achieve the same level of significance in bag-valve-mask ventilation training. Results suggest training with automated feedback presents a cost-effective opportunity to lessen the training burden, whilst improving skill acquisition.

Exploring the efficacy of the expiratory muscle strength trainer to improve swallowing in inclusion body myositis: A pilot study.

Inclusion Body Myositis (IBM) is the most common acquired myopathy in older individuals with more than two thirds of patients experiencing impaired swallowing. There are currently no standardized exercise therapies to improve or sustain swallowing despite good evidence for exercise therapy in limb muscles. Reduced upper esophageal sphincter opening is a common abnormality associated with dysphagia in IBM. This pilot study recruited IBM patients with abnormal upper esophageal sphincter function and dysphagia into an exercise program. It was hypothesized that regular practice using the Expiratory Muscle Strength Trainer (EMST) device would improve hyolaryngeal movement by strengthening suprahyoid musculature and facilitate opening of the upper esophageal sphincter thereby improving swallowing and quality of life. Overall, IBM patients who used the EMST device demonstrated no improvement in swallowing function. Consistent with that result, there was also no change in measures of quality of life. However, further studies are needed to elucidate whether it has a preventative role in the development or progression of dysphagia in IBM as there is a suggestion that patients with a shorter duration of disease may have had some benefit. This research provides pilot data and recommendations that will guide future studies on exercise therapy and swallowing in this area.

'Take 10 to talk about it': Use of a scripted, post-event debriefing tool in a neonatal intensive care unit.

AIM: This study assessed the impact of a scripted, post-event debriefing tool in identifying logistical, procedural, personnel and performance obstacles and successes in a clinical setting. It was predicted that the debriefing tool would highlight the importance of routine debriefing following challenging clinical events. METHODS: The study was conducted in a 22-bed neonatal intensive care unit at a tertiary hospital and involved all staff members in the perinatal service. The debriefing tool, a two-page form providing a structured, scripted approach, was used at the earliest opportunity after acute clinical deteriorations, emergency caesarean sections and any other critical events as decided by the neonatal team. Sessions were facilitated by either a nursing or medical member of the neonatal team. Following a 2-month trial, impact was measured via the comparison of before and after survey questions as well as review of a database of issues raised, subsequent actions and outcomes. RESULTS: Significant, positive changes were observed for survey questions specific to the frequency of debriefing, team communication, provision of learning opportunities and identification of logistical, equipment and procedural issues. In addition, the database highlighted the significant positive impact in day-to-day practice as a result of changes initiated by the debriefing tool. All participants requested the unit to continue using the tool. CONCLUSION: Scripted, post-event debriefing is achievable and valuable in the clinical setting. It encourages a supportive workplace culture and empowers team members to initiate practical change in their organisations.

Dysphagia in Patients with Sporadic Inclusion Body Myositis: Management Challenges.

Dysphagia in inclusion body myositis (IBM) is common and associated with increased mortality and morbidity due to aspiration pneumonia, malnutrition and dehydration. There is currently no consensus on treatment of dysphagia in IBM and outcomes are variable depending on timing of intervention, patient preference and available expertise. There is a paucity of research exploring the pathophysiology of dysphagia in IBM and appropriate investigations. Increased knowledge of the aetiopathogenesis is likely to change the approach to treatment as well as improve the quality of life for patients. This review explores the epidemiology and pathophysiology of dysphagia in IBM and the currently available treatment strategies.

Radiology teaching for interns: Experiences, current practice and suggestions for improvement.

INTRODUCTION: Junior doctors are typically responsible for requesting and interpreting diagnostic imaging studies. European studies have highlighted the paucity of radiology teaching leading to junior doctors feeling underprepared for clinical practice involving radiology. There is a lack of published data on the experiences of Australian medical students and junior doctors. This study aimed to describe the experiences of interns in Western Australia to establish whether they felt prepared for clinical practice by the radiology teaching they received at medical school and beyond. METHODS: This cross-sectional observational study involved a needs analysis questionnaire. The study population included all interns currently employed by Fiona Stanley Hospital (n = 121). RESULTS: Radiology teaching at medical school was reportedly mostly informal and infrequent. More than half felt this was inadequate (52%). Current teaching was also reportedly infrequent and 31% reported receiving no radiology teaching in their current rotation. The interns reported requesting high volumes of diagnostic imaging with 66% reporting requesting imaging once a day or more frequently. The overwhelming majority stated their clinical practice would benefit from additional teaching in radiology (98%). CONCLUSION: This study has demonstrated a paucity of radiology teaching provided to interns in a large Australian teaching hospital. As they request and interpret high volumes of diagnostic imaging, skills in this domain are paramount in the provision of safe, effective and timely patient care. The results are being used in the design and implementation of a high-quality radiology teaching programme to improve junior doctors' skill and develop the radiologist-clinical referrer interface.

Pulmonary arterial hypertension outcomes upon endothelin-1 receptor antagonist switch to macitentan.

OBJECTIVES: To assess whether switching patients with suboptimally controlled pulmonary arterial hypertension from bosentan or ambrisentan to macitentan would improve six-minute walk test (6MWT) distance and World Health Organization functional class. METHODS: This was a retrospective cohort analysis of 37 patients from a single center. Patients were separated into three heterogeneous treatment groups and followed for 18 months: switch group (n = 14): patients switched to macitentan from bosentan/ambrisentan; added group (n = 11): patients who began macitentan as de novo therapy (n = 5) or who added macitentan to an existing sildenafil regimen (n = 6); and control group (n = 12): patients for whom sildenafil and/or bosentan/ambrisentan therapy was unchanged. RESULTS: Mortality was observed in two patients (one each, switch and added groups). Patients in the control group had one hospital admission and 100% survival. There was significant improvement in functional class for the switch and added groups. Statistically significant improvement was observed in 6MWT distance in the added group alone. Overall, 92% of patients continued macitentan throughout the study. CONCLUSION: Macitentan was well tolerated. For bosentan/ambrisentan-treated patients with suboptimally controlled pulmonary arterial hypertension, switching to macitentan may facilitate an improvement in functional class.

Osteoarthritis is associated with increased failure of proximal femoral fracture fixation.

PURPOSE: The purpose of this study was to evaluate whether the presence of hip osteoarthritis at the time of hip fracture increases treatment failure rates when using either a sliding hip screw (SHS) or proximal femoral nail (PFN) for fracture fixation. METHODS: A retrospective study of a consecutive series of 455 women and 148 men (median age, 83.8 years) treated with SHS or PFN was performed. Osteoarthritis was evaluated based on pre-operative radiographs using the Kellgren and Lawrence grading system. Treatment failure, which was defined as non-union, avascular necrosis, backing out of the implant, cut out of the proximal screws, peri-prosthetic fracture, implant breakage, or conversion to hemi- or total hip arthroplasty, was evaluated for a follow-up period of four to seven years. Optimal placement of the implant (tip-apex distance (TAD) and 3-point fixation) and the effects of age, sex, the quality of reduction, implant type, fracture stability, fracture type, and time to failure were considered confounders of the relationship between failure and osteoarthritis (OA). RESULTS: Among the 32 cases (5.3%) of treatment failure, 12 (2%) showed evidence of osteoarthritis. After controlling for age, sex, the quality of reduction, implant type, fracture stability, fracture type, and TAD, osteoarthritis was associated a greater than threefold increase in treatment failure compared with that of patients without pre-operative evidence of osteoarthritis (OR, 3.26; 95% CI, 1.4-7.65; P = 0.006). CONCLUSIONS: After adjusting for potential confounding factors, radiographic evidence of hip osteoarthritis at the time of hip fracture increases the incidence of treatment failure.

Effectiveness and efficiency of training in digital healthcare packages: training doctors to use digital medical record keeping software.

Objective Fiona Stanley Hospital (FSH) is the first hospital in Western Australia to implement a digital medical record (BOSSnet, Core Medical Solutions, Australia). Formal training in the use of the digital medical record is provided to all staff as part of the induction program. The aim of the present study was to evaluate whether the current training program facilitates efficient and accurate use of the digital medical record in clinical practice. Methods Participants were selected from the cohort of junior doctors employed at FSH in 2015. An e-Learning package of clinically relevant tasks from the digital medical record was created and, along with a questionnaire, completed by participants on two separate occasions. The time taken to complete all tasks and the number of incorrect mouse clicks used to complete each task were recorded and used as measures of efficiency and accuracy respectively. Results Most participants used BOSSnet more than 10 times per day in their clinical roles and self-rated their baseline overall computer proficiency level as high. There was a significant increase in the self-rating of proficiency levels in successive tests. In addition, a significant improvement in both efficiency and accuracy for all participants was measured between the two tests. Interestingly, both groups ended up with similar accuracy on the second trial, despite the second group of participants starting with significantly poorer accuracy. Conclusions Overall, the greatest improvements in task performance followed daily ward-based experience using BOSSnet rather than formalised training. The greatest benefits of training were noted when training was delivered in close proximity to the onset of employment. What is known about the topic? Formalised training in the use of information and communications technology (ICT) is widespread in the health service. However, there is limited evidence to support the modes of learning typically used. Formalised training is often costly and there is little other than anecdotal evidence that currently supports its efficacy in the workplace. What does the paper add? Assessment of accuracy when using the BOSSnet system over time revealed that daily use rather than formalised training appeared to have the most impact on performance. Formalised training was rated poorly, and this appeared to correlate with time between training and use. The present study suggests that formalised training, if required, should be delivered close in time to actual use of the system to benefit end-users. The study also shows that daily experience is more effective than formalised training to improve accuracy. What are the implications for practitioners? Formalised training for ICT needs to be scheduled in close proximity to end-user use of the ICT. Current scheduling may be beneficial for ease of delivery, but unless it is delivered at a suitable time the benefits are minimal. Formalised training programs may not be critical for all staff and all staff improve with contextualised experience given time. Training may be better suited to optional rather than compulsory delivery programs with ongoing delivery to suit user schedules.

Experience of a tutor centric model for sonography training of emergency department registrars in an Australian urban emergency department 2009-2012.

Purpose: To assess the impact of a regular sonographer proctored training program for emergency medicine trainees in the use of Emergency Department bedside ultrasound Methods: Emergency Department (ED) Registrars in the Swan District Hospital ED were provided with proctored instruction in bedside ultrasound in performance of extended focused assessment sonography in trauma (eFAST) and abdominal aortic aneurysm (AAA) detection. Training was conducted by credentialed sonographers for individual trainees in a 1:1 or 1:2 setting for 1 hour on a weekly basis. Registrars who trained in the Department between Jan 2009 to Dec 2012 were invited to participate in a survey conducted between June-August 2013 designed to assess the impact of training on their confidence and use of bedside sonography. Results: Registrars reported increased perception of their skill level in AAA and eFAST post-training. High levels of confidence in their ability to adjust machine settings for image optimisation, recognition of free fluid in the abdomen and ability to recognise an AAA were also reported. The participants who completed at least 10 hours of training and at least 20 scans showed significantly greater improvement in their perception of skill and confidence levels than those with less time. Registrars reported training was of significant benefit, improving their confidence in obtaining good quality images and their understanding of the equipment, which contributed to them obtaining accreditation. Benefits were ongoing and 50% of participants reported using ultrasound in clinical practice at least 3 times per week and a further 30% at least weekly after leaving ED. Conclusion: Proctored training in the clinical context for ED registrars resulted in improvement in skills, confidence and willingness to maintain skills through practice in the clinical context over the long-term.

The benefits and limitations of using ultrasonography to supplement anatomical understanding.

Anatomical understanding is critical to medical education. With reduced teaching time and limited cadaver availability, it is important to investigate how best to utilize in vivo imaging to supplement anatomical understanding and better prepare medical graduates for the proliferation of point-of-care imaging in the future. To investigate whether using short sessions of in vivo imaging using ultrasonography could benefit students' anatomical knowledge and clinical application, we conducted a 2-hour session on abdominal anatomy using ultrasonography in small groups of five to six students, for both first- and second-year student cohorts. Individual feedback was collected to assess student perceptions. To measure retention and understanding, a short examination containing ultrasound images and questions and performance of a clinical skill (gastrointestinal' tract examination) were assessed. Ultrasonography sessions were highly valued by the students, with 90% of the students reporting their understanding was improved, and over 70% reporting increased confidence in their anatomical knowledge. However, the assessments showed no appreciable impact on skills or understanding related to abdominal anatomy and examination. We conclude that the risk associated with limited exposure increasing confidence without increasing skills remains real and that in vivo imaging is not effective when used as a short adjunct teaching tool. The widespread use of ultrasonography means finding the best way to incorporate ultrasound into medical education remains important. To this end, we are currently implementing an extended program including echocardiography and multiple anatomical sessions that will determine if frequency and repetition of use can positively impact on student performance and understanding.

Fluency Profiling System: an automated system for analyzing the temporal properties of speech.

The temporal characteristics of speech can be captured by examining the distributions of the durations of measurable speech components, namely speech segment durations and pause durations. However, several barriers prevent the easy analysis of pause durations: The first problem is that natural speech is noisy, and although recording contrived speech minimizes this problem, it also discards diagnostic information about cognitive processes inherent in the longer pauses associated with natural speech. The second issue concerns setting the distribution threshold, and consists of the problem of appropriately classifying pause segments as either short pauses reflecting articulation or long pauses reflecting cognitive processing, while minimizing the overall classification error rate. This article describes a fully automated system for determining the locations of speech-pause transitions and estimating the temporal parameters of both speech and pause distributions in natural speech. We use the properties of Gaussian mixture models at several stages of the analysis, in order to identify theoretical components of the data distributions, to classify speech components, to compute durations, and to calculate the relevant statistics.

Open reduction and internal fixation of mandibular angle fractures: does the transbuccal technique produce fewer complications after treatment than the transoral technique?

PURPOSE: The study's purpose was to answer the following clinical question: in patients with mandibular angle fractures requiring open reduction and internal fixation, do those who have fixation screws inserted using a transbuccal approach compared with those with fixation screws inserted using a transoral approach have fewer complications after treatment? The investigators hypothesized that the transoral approach was associated with a higher risk of complications. MATERIALS AND METHODS: A multicenter retrospective cohort study was performed in patients who had open reduction and internal fixation of mandibular angle fractures from 2008 to 2010 within Western Australia. Patients were divided into transbuccal and transoral groups and then further subdivided into groups with and without fixation failures (primary outcome variable) and statistically compared. Binary logistic regression was used to control for possible confounders, which included patient gender, age, a wisdom tooth within the fracture not extracted, dental caries, partial dentition, bilateral/unilateral fractures, and smoking. RESULTS: In total 597 patients were in the study. Sixteen percent of patients in the transoral group had complications after treatment versus 10% in the transbuccal group. For the transoral technique, the odds of having fixation failure was 1.71 times greater than with the transbuccal technique (95% confidence interval, 1.02 to 2.93; P = .04). Incidences of all complication variables (hardware loosening/fracturing, wound dehiscence, secondary infection, surgery redo, nonunion/malunion of fracture, and removal of plate) were lower in the transbuccal group apart from plate fracture. CONCLUSION: The transbuccal technique was associated with fewer complications after treatment compared with the transoral technique.

Effects of high-dose fish oil supplementation during early infancy on neurodevelopment and language: a randomised controlled trial.

n-3 Long-chain PUFA (LC-PUFA) intake during infancy is important for neurodevelopment; however, previous studies of n-3 LC-PUFA supplementation have been inconclusive possibly due to an insufficient dose and limited methods of assessment. The present study aimed to evaluate the effects of direct supplementation with high-dose fish oil (FO) on infant neurodevelopmental outcomes and language. In the present randomised, double-blind, placebo-controlled trial, 420 healthy term infants were assigned to receive a DHA-enriched FO supplement (containing at least 250 mg DHA/d and 60 mg EPA/d) or a placebo (olive oil) from birth to 6 months. Assessment occurred at 18 months via the Bayley Scales of Infant and Toddler Development (3rd edition; BSID-III) and the Child Behavior Checklist. Language assessment occurred at 12 and 18 months via the Macarthur-Bates Communicative Development Inventory. The FO group had significantly higher erythrocyte DHA (P = 0·03) and plasma phospholipid DHA (P = 0·01) levels at 6 months of age relative to placebo. In a small subset analysis (about 40% of the total population), children in the FO group had significantly higher percentile ranks of both later developing gestures at 12 and 18 months (P = 0·007; P = 0·002, respectively) and the total number of gestures (P = 0·023; P = 0·006, respectively). There was no significant difference between the groups in the standard or composite scores of the BSID-III. The results suggest that improved postnatal n-3 LC-PUFA intake in the first 6 months of life using high-dose infant FO supplementation was not beneficial to global infant neurodevelopment. However, some indication of benefits to early communicative development was observed.

Allergic disease in the first year of life is associated with differences in subsequent neurodevelopment and behaviour.

BACKGROUND: Recent trials suggest a link between neuropsychological function, atopy and allergic disease particularly in early childhood; however the nature of this association remains unclear. AIMS: To investigate the relationship between early allergic disease and sensitisation at 12 months of age and neurodevelopmental outcomes at 18 months. STUDY DESIGN: Linear or binary logistic regression analysis was used to determine whether allergic diseases or sensitization at 12 months of age was a significant predictor of neurodevelopmental test scores at the 18 months. SUBJECTS: Infants with a maternal history of allergic disease (n=324). OUTCOME MEASURES: Allergic outcomes at 12 months of age included allergen sensitisation, eczema, IgE-mediated and food allergy, and neurodevelopmental outcomes at 18 included the Bayley Scales of Infant Toddler Development III Edition, the Achenbach Child Behaviour Checklist and the Macarthur Scales of Infant Toddler Development. RESULTS: Children with any diagnosed allergic disease at 12 months had evidence of reduced motor scores (p=.016), and this was most apparent for a diagnosis of eczema (p=.007). Non-IgE mediated food allergy was significantly positively associated with problem Internalising Behaviours (p=.010), along with a trend for effects on the Social-Emotional composite score for IgE-Mediated food allergies (p=.052). Allergic sensitisation was not independently associated with any effects on neurodevelopmental outcomes. CONCLUSION: This study provides evidence that an allergic phenotype in infancy is associated with effects on neurodevelopment. Further research is required to investigate the nature of this relationship.

Very early poststroke aphasia therapy: a pilot randomized controlled efficacy trial.

BACKGROUND AND PURPOSE: Early stroke rehabilitation has shown benefits over spontaneous recovery. Insufficient evidence exists to determine the benefits of early aphasia intervention. We hypothesized that daily aphasia therapy would show better communication outcomes than usual care (UC) in early poststroke recovery. METHOD: This prospective, randomized, single-blinded, controlled trial was conducted in three acute-care hospitals in Perth, Australia, each with over 200 stroke admissions annually. Patients with acute stroke causing moderate to severe aphasia were recruited at a median of three-days (range: 0-10 days) to receive daily aphasia therapy or usual care therapy. Individually tailored, impairment-based intervention was provided for the acute hospital stay or intervention phase (median: 19 days; range: 5-76). Primary outcome measures were the aphasia quotient and functional communication profile at acute hospital discharge or four-weeks poststroke, whichever came first. A random-number generator and sealed envelopes were used to randomize participants. Assessments were completed by a blinded assessor. RESULTS: Fifty-nine participants were recruited, with six withdrawals (10%) and seven deaths (12%) at six-months. Ninety percent had ischemic strokes, with 56·5% experiencing a total anterior circulation stroke. The group mean (± SD) age was 69·1 (± 13·9) years. Six participants (18·75%) in the daily aphasia therapy group did not complete the minimum (150 min) therapy required for this study. The daily aphasia therapy intervention phase mean therapy session time was 45 min (range: 30-80) and the total mean amount of therapy for the daily aphasia therapy participants was 331 min (range: 30-1415). Four (15%) participants in the usual care group received therapy. The collective total therapy provided to these participants was 295 min over seven sessions. Usual care participants received an average of 10·5 min of therapy per week during the intervention phase. At the primary end point, a generalized estimating equations model demonstrated that after controlling for initial aphasia severity, participants receiving daily aphasia therapy scored 15·1 more points (P = 0·010) on the aphasia quotient and 11·3 more points (P = 0·004) on the functional communication profile than those receiving usual care therapy. CONCLUSIONS: Daily aphasia therapy in very early stroke recovery improved communication outcomes in people with moderate to severe aphasia.

Students and teachers' preferences for undergraduate dementia education in Western Australia.

Medical graduates require positive attitudes toward older people with cognitive impairment, in addition to knowledge and skills in the diagnosis and management of dementia. The Student Training Project in Dementia (STriDE) project was conducted to ensure that these needs are met through curricula in Western Australian medical schools. Two medical schools in Perth, Western Australia, participated. Mixed methods were utilized comprising a) focus groups and interviews and b) a survey of teachers and students. Participants recommended clearer structure and standardization in the curriculum to ensure that all students receive similar educational experiences regardless of hospital placement. Both teachers, and to a lesser extent students, held positive attitudes toward older people. Teachers tended to be more dissatisfied with current curricula than students. Teachers and learners endorsed a broad range of teaching and learning methods, assessments, and skills/competencies. The results of this study present major challenges for professional entry dementia education given the breadth, flexibility, and depth of dementia education recommended by teachers and learners.