Research Flagships, Centres and Institutes

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    Evaluation of corneal transplantation
    (BMJ Publishing Group - http://bjo.bmjjournals.com/, 1997-08) Coster, Douglas John
    Editorial / comment on corneal transplantation.
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    Oral administration of antigen in the treatment of eye disease
    (BMJ Publishing Group - http://bjo.bmjjournals.com/, 1997-09) Williams, Keryn Anne
    Comment on the Oral administration of antigen in the treatment of eye disease
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    Influence of advanced recipient and donor age on the outcome of corneal transplantation. Australian Corneal Graft Registry.
    (BMJ Publishing Group - http://bjo.bmjjournals.com/, 1997-10) Williams, Keryn Anne ; Muehlberg, S M ; Lewis, R F ; Coster, Douglas John
    AIMS: The aims of this study were to examine the influence of advanced recipient and donor age on the long term outcome of corneal transplantation. METHODS: Records of 1036 penetrating corneal grafts in recipients aged > or = 80 years at surgery (defined as the elderly subset) and 8092 donor corneas used for transplantation were obtained from the Australian Corneal Graft Register database, Kaplan-Meier graft survival plots were compared using log rank statistics. RESULTS: Elderly recipients constituted 15% of the recipient pool. The major indication for corneal transplantation in the elderly was bullous keratopathy. Graft survival fell with increasing recipient age (p < 0.00001); the major cause of graft failure was rejection (33%). The desired outcome in 51% of cases was to improve vision and in 42% of cases to relieve pain; 23% of elderly recipients achieved a Snellen acuity of 6/18 or better in the grafted eye and 66% recorded improved acuity after transplantation. Elderly recipients suffered more complications and comorbidities in the grafted eye than did younger recipients. Donor age (stratified in 10 year intervals) did not influence corneal graft survival significantly (p = 0.10). CONCLUSIONS: Elderly graft recipients fared less well after corneal transplantation than did younger recipients, but outcomes in terms of long term graft survival and visual rehabilitation were still good. Donor age did not affect graft survival.
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    An instrument for assessment of subjective visual disability in cataract patients
    (BMJ Publishing Group - http://bjo.bmjjournals.com/, 1998) Pesudovs, Konrad ; Coster, Douglas John
    The construction and validation of an instrument for the assessment of subjective visual disability in the cataract patient is described. This instrument is specifically designed for measuring the outcome of cataract surgery with respect to visual disability. METHODS: Visually related activities thought to be affected by cataract were considered for the questionnaire. These were reduced by pilot study and principal components analysis to 18 items. A patient's assessment of his/her ability to perform each task was scored on a four point scale. Scores were averaged to create an overall index of visual disability, as well as subscale indices for mobility related disability, distance/lighting/reading related disability, and near and related tasks visual disability. The questionnaire, administered verbally is entitled "The Visual Disability Assessment (VDA)". Reliability testing included test-retest reliability, interobserver reliability (p, the intraclass correlation coefficient), and internal consistency reliability (Cronbach's alpha). Construct validation, the process for proving that a test measures what it is supposed to measure, included consideration of content validity, comparison with the established Activities of Daily Vision Scale (ADVS) and empirical support with factor analysis. RESULTS: For the four indices, interobserver reliability varied from 0.92 to 0.94, test-retest reliability varied from 0.96 to 0.98, and internal consistency reliability varied from 0.80 to 0.93. The VDA compared favourably with the ADVS by correlation, but Bland-Altman analysis demonstrated that the two instruments were not clinically interchangeable. Factor analysis suggests that all test items measure a common theme, and the subgroupings reflect common themes. CONCLUSIONS: The VDA is easy to administer because it has a short test time and scoring is straightforward. It has excellent interobserver, test-retest, and internal consistency reliability, and compares favourably with the ADVS, another test of visual disability. Factor analysis demonstrated that the 18 items measure a related theme, which can be assumed to be visual disability. The VDA is a valid instrument which provides a comprehensive assessment of visual disability in cataract patients and is designed to detect changes within a patient over time.
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    Assessment of surgically induced astigmatism: toward an international standard. [comment.] [Post print]
    (Elsevier, 1998-12) Goggin, M ; Pesudovs, Konrad
    Letter that recommends minimun data sets to be reported in studies of the changes in astigmatism brought about by surgery.
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    Assessment of surgically induced astigmatism: toward an international standard II [comment.] [Post print]
    (Elsevier, 1998-12) Goggin, M ; Pesudovs, Konrad
    Letter in response to Holladay JT, Dudega DR, Koch DD "Evaluating and reporting astigmatism for individual and aggregate data", Journal of Cataract and Refractive Surgery, 1998, vol 24, 57-65
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    The Umoona Kidney Project
    (Aboriginal and Islander Health Worker Journal, 2000) Shephard, Mark Douglas ; Brown, Michael A ; Hudson, Maryanne ; Riessen, Cissie ; Braun, Janice
    Kidney disease is one of the most serious problems facing Aboriginal Australians. Nationally the number of Aboriginal people with advanced or end-stage kidney disease is six times that of non-Aboriginal Australians. It has recently been predicted that a further 500 Aboriginal people will develop end-stage kidney disease by the year 2004. The only treatment options for Aboriginal people with advanced stage kidney disease are dialysis or transplantation, both of which cause significant social and cultural trauma for the individual and their family. Early detection of renal disease is critical because, if identified early enough, progression to end-stage kidney disease can be slowed or even prevented. As a result, early detection has the potential to significantly reduce the number of Aboriginal people who may ultimately require dialysis or transplantation.
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    Apoptosis is a prominent feature of acute anterior uveitis in the Fischer 344 rat
    (BMJ Publishing Group - http://bjo.bmjjournals.com/, 2000-02) Smith, Justine R ; Hart, Prue ; Standfield, Scott D ; Coster, Douglas John ; Wing, Sarah J ; Williams, Keryn Anne
    AIMS: To examine the hypothesis that apoptosis of infiltrating cells contributes to spontaneous resolution of uveitis in clinically relevant rodent models. METHODS: Experimental melanin induced uveitis (EMIU) was induced in Fischer 344 rats by immunisation with 250 microg bovine ocular melanin. Endotoxin induced uveitis (EIU) was induced by injection of 200 microg Escherichia coli lipopolysaccharide. Formalin fixed, paraffin embedded ocular cross sections were stained by terminal deoxynucleotidyl transferase mediated deoxyuridine triphosphate biotin nick end labelling (TUNEL) to identify apoptotic cells. Indirect immunoperoxidase staining of paraformaldehyde lysine periodate fixed tissue cross sections was used to demonstrate expression of inducible nitric oxide synthase (iNOS). RESULTS: TUNEL positive mononuclear cells were observed in the anterior uvea during both EMIU and EIU at all selected time points. However, whereas the majority of mononuclear cells appeared apoptotic from the outset of disease, neutrophils were notably TUNEL negative at all time points examined. Many infiltrating neutrophils expressed iNOS. CONCLUSION: Apoptosis occurs early in the course of rat EMIU and EIU, and may contribute to resolution of these diseases. In general, infiltrating mononuclear cells die rapidly, while neutrophils survive, producing inducible nitric oxide synthase which may contribute to disease pathogenesis.
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    Screening for renal disease in a remote Aboriginal community using the Bayer DCA 2000
    (Australian Institute of Medical Scientists, 2001) Shephard, Mark Douglas ; Allen, G G
    End-stage renal disease among Aboriginal Australians has reached alarming proportions during the past decade. The early identification of this disease through community screening programs is a key strategy in reducing the long-term financial and cultural burden of the disease. The small point-of-care Bayer DCA 2000 analyser, which tests for urine albumin:creatinine ratio (ACR), was used as a marker for early renal disease in an adult screening program in a remote South Australian Aboriginal community. Nineteen percent of 149 adults screened had previously undiagnosed persistent microalbuminuria (ACR between 3.4 and 33.9 mg/mmol), while a further 9% had persistent overt albuminuria (ACR greater than or equal to 34 mg/mmol). Aboriginal health workers were trained in the operation of the DCA 2000 to enable screening to be an ongoing, sustainable activity within the community setting. The DCA exhibited excellent analytical performance characteristics and was robust and reliable throughout the study period.
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    Systemic factors that perpetuate smoking among community and institutionalised public mental health service populations
    ( 2001) Lawn, Sharon Joy
    Despite a vast body of research on smoking, quit rates for people with a concurrent mental illness remain extremely low. Research has established that these groups smoke more heavily, for more years and in greater proportions than the general population - up to 90% compared with 25% respectively. This thesis reports on the findings of a study investigating the barriers to quitting among community-based and institutionalised psychiatric populations. Participants were drawn from the four diagnostic categories of schizophrenia, bipolar affective disorder, major depression and borderline personality disorder. Interviews were performed with smokers from each diagnostic group as well as with clients who had successfully quit smoking. Multi-disciplinary staff from community and inpatient mental health services were also interviewed. Participant observation of inpatient settings and community hostels completed the triangulation of method.
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    Pythium insidiosum keratitis confirmed by DNA sequence analysis
    (BMJ Publishing Group - http://bjo.bmjjournals.com/, 2001-04) Badenoch, Paul Raymond ; Coster, Douglas John ; Wetherall, Bruce Lawrence ; Brettig, Helen T ; Rozenbilds, Maris A M ; Drenth, Andre ; Wagels, Gabriele
    Case report/letter detailing identification of the pathogen pythium insidiosum by nucleic acid sequencing.
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    A simple corneal perfusion chamber for drug penetration and toxicity studies
    (BMJ Publishing Group - http://bjo.bmjjournals.com/, 2001-04) Thiel, Michael A ; Morlet, N ; Schulz, D ; Edelhauser, HF ; Dart, JK ; Coster, Douglas John ; Williams, Keryn Anne
    AIMS: Corneal perfusion chambers are important tools in the development and assessment of ophthalmic drugs. The aim of this study was to design and test a modified perfusion chamber suitable for topical application of drugs to isolated corneoscleral preparations, and which allowed continuous monitoring of endothelial cell function. METHODS: A polycarbonate and stainless steel perfusion chamber was designed to clamp corneas in a horizontal plane suitable for topical drug delivery. Endothelial cell function was assessed by ultrasonic pachymetry and specular microscopy during perfusion. Epithelial barrier function was assessed by penetration of fluorescein. Leakage was examined by measuring penetration of a large protein, IgG. Tissue architecture after perfusion was examined by conventional histology. RESULTS: Corneas maintained a functionally and morphologically intact endothelial monolayer during perfusion periods of up to 14 hours. The epithelial barrier function was well preserved. The tissue clamp sealed the preparation effectively against leakage of macromolecules. CONCLUSION: The new chamber device forms a reliable tool for in vitro drug penetration and toxicity studies in isolated perfused corneoscleral tissue.
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    The long term outcome of limbal allografts: the search for surviving cells
    (BMJ Publishing Group - http://bjo.bmjjournals.com/, 2001-05) Henderson, Timothy R ; Coster, Douglas John ; Williams, Keryn Anne
    BACKGROUND/AIMS: Limbal allotransplantation is increasingly being used for ocular surface repair in patients with limbal stem cell dysfunction. However, it is uncertain whether donor cells survive long term on the ocular surface and whether patients maintain the early benefits of the procedure. The aims of this study were to investigate the long term outcome of clinical limbal allografts and to correlate outcome with donor cell survival. METHODS: Five patients who had undergone allotransplantation-four keratolimbal allografts and one tarsoconjunctival allograft-from 3-5 years previously, and for whom residual frozen donor ocular tissue was available, were reviewed. Survival of donor cells lifted from the recipient ocular surface by impression cytology was investigated by DNA fingerprinting using primers detecting variable nucleotide tandem repeat sequences. Recipient buccal cells and scleral samples from the remnant donor eye were used to genotype recipients and donors, respectively. Polymerase chain reaction products were sized by Genescan analysis. RESULTS: An objective long term benefit from the procedure (improved Snellen acuity, reduced frequency of epithelial defects, reduced vascularisation, and scarring) was recorded for four patients. Some subjective benefit was also reported. However, in no instances were donor cells recovered from the ocular surface at 3-5 years post-graft. Initial experiments to examine sensitivity indicated that any surviving donor cells must have constituted less than 2.5% of cells sampled. CONCLUSION: Limbal stem cell allotransplantation can provide long term benefits, as measured by objective criteria. However, such benefits do not necessarily correlate with survival of measurable numbers of donor cells on the ocular surface.
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    Performance indicators in community health: development of a process. Final project report.
    (South Australian Community Health Research Unit, 2002) Performance Indicators in Community Health Project Working Group
    The South Australian Performance Indicators in Community Health project was a joint initiative between the Department of Human Services and Community Health Services in South Australia. The report describes the findings of the project undertaken in 2000-2001 to develop and trial a process for the identification of meaningful and robust performance indicators. The report outlines the context of the project and some of the challenges for community health as identified in the performance indicator literature. The project activities are described in detail, with appendices containing worksheets and examples of outcomes from the project's work. The findings are discussed in terms of the complexity of community health context, the nature of performance indicators, resources, data collection systems, the potential for transferability of performance indicators across services and language/cultural appropriateness. Reflection by the working group on the project's outcomes led to some recommendations and a refined process for identifying and trialling performance indicators.
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    Creating inclusive communities through balancing social mix: a critical relationship or tenuous link?
    (Taylor and Francis, 2002) Arthurson, Kathy
    This paper explores some fundamental assumptions being linked by State Housing Authorities to ‘social mix’ strategies in contemporary Australian public housing estate regeneration policy. Six case study estates, two each in new South Wales, South Australia and Queensland form the basis for the empirical analysis. The two major ideas emerging from South Australian and Queensland projects are: first that lowering concentrations of public housing and developing more mixed income communities offers a means to reconnect socially excluded public housing tenants to mainstream society; second that a balanced social mix is a prerequisite for the development of ‘inclusive’, ‘sustainable’ and ‘cohesive’ communities. However, in light of the empirical findings that strong cohesive communities already exist on some estates prior to regeneration commencing, there is no evidence that a balanced social mix is a necessary condition for building inclusive communities. Coupled with findings in the projects of inadvertent negative consequences of implementing social mix policies, the paper questions whether policy makers are over-emphasising the extent to which social mix assists regeneration.
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    Point-of-care in Aboriginal hands
    (Aboriginal and Islander Health Worker Journal, 2002) Jones, Richard ; Mazzachi, Beryl C ; Shephard, Mark Douglas
    Diabetes, kidney disease and heart disease (all chronic diseases) are among the most serious health problems facing Aboriginal people today. The point-of-care program has a broad chronic disease focus that (a) looks for early signs of diabetes, kidney disease and heart disease collectively and (b) provides follow-up management for people identified as being at risk for chronic disease.
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    Assessment of the point-of-care Cholestech Lipid Analyser for lipid screening in Aboriginal communities
    (Australian Institute of Medical Scientists, 2002) Shephard, Mark Douglas ; Tallis, George A
    Cardiovascular disease is the leading cause of mortality in Aboriginal Australians. Screening for cardiovascular disease risk factors, notably elevated blood lipids, is urgently needed. The small portable Cholestech machine (Point-of-Care Diagnostics) can enzymatically measure total cholesterol, triglyceride and HDL cholesterol (without the prior need for precipitation of other lipoproteins)on 35 microlitres of capillary or veinous whole blood in under 5 minutes. It also calculates LDL cholesterol. Its suitability for use in Aboriginal communities was assessed. With its simple operation, fully automated nature, sound analytic performance and ability to produce a full lipid profile in under 5 minutes, the Cholestech would be suitable for the Aboriginal health care setting.
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    If only numbers count: performance indicators for community health.
    (South Australian Community Health Research Unit, 2003) Jolley, Gwyneth Margaret
    This report presents the outcomes from a study to examine the use of performance indicators as an evaluation tool for the community health sector in Australia. The purpose of the study was to investigate performance measurement in primary health care services provided by the community health sector, assess the effectiveness of the performance measurement approach and consider future options. Study methods included a review of national and international literature on performance measurement in the public sector and in the primary health care and community health sectors; interviews with eleven key stakeholders in South Australia; and development of sample performance indicators for community health based on the National Health Performance Committee Framework. In a climate of fiscal constraint and evidence-based practice, the community health sector is being asked to provide evidence for the effectiveness of its approach and the achievement of enhanced health for the community. The challenge is to obtain and present this evidence while acknowledging the large role played by the social and environmental determinants of health outside the control of the sector, and protecting the value-base of primary health care as reflected in the emphasis on health promotion, participation, collaboration and equity.
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    Albuminuria in a remote South Australian Aboriginal community: results of a community based screening program for renal disease
    ( 2003) Vanajek, Anne ; Paizis, K ; Allen, G G ; Shephard, Mark Douglas ; Barbara, Jeffrey A J ; Barratt, L J ; Brown, Michael A ; McLeod, G
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    Public health nutrition: identifying models and effective approaches to workforce development.
    (South Australian Community Health Research Unit, 2003) Jolley, Gwyneth Margaret ; Masters, Stacey Cynthia
    This literature review has drawn on published literature, reports and expert knowledge to identify models and effective approaches to workforce development for the nutrition, primary health care and other relevant non-health sector workforces. The review next illustrates the three approaches to workforce development using case study examples, and it discusses the lessons for public health nutrition workforce development.