Developing a dialysis centre foot screening culture

Foot lesions are common in the dialysis population and contribute to increased morbidity and mortality (Broersma 2004). lmportantly, patients on dialysis with and without diabetes are at increased risk of foot ulcers (Jones et al. 2012) and lower limb amputation (Kaminski, Frescos & Tucker 2012). Simple foot screening in dialysis centres can identify those at risk of foot complications and the presence of foot ulcers (Ahmad 2009; Ng et al. 2003). Valid and reliable foot screening tools have been developed in the dialysis context to identify those at risk and those with actual ulcers (Murphy et al. 2012).ln 2011, following the completion of a Diabetes and Renal Pilot Study and staff education, Moorabbin Haemodialysis Unit and Southern Health, identified the need to formalise foot screening for all patients and increase the rate at which these were conducted. The aim of this report is to present a summary of the audit evaluation of foot health screens and referrals in our dialysis centre.

Screening, referral and treatment for depression in patients with coronary heart disease: a consensus statement from the National Heart Foundation of Australia

In 2003, the National Heart Foundation of Australia position statement on “stress” and heart disease found that depression was an important risk factor for coronary heart disease (CHD). This 2013 statement updates the evidence on depression (mild, moderate and severe) in patients with CHD, and provides guidance for health professionals on screening and treatment for depression in patients with CHD.

The prevalence of depression is high in patients with CHD and it has a significant impact on the patient’s quality of life and adherence to therapy, and an independent effect on prognosis. Rates of major depressive disorder of around 15% have been reported in patients after myocardial infarction or coronary artery bypass grafting.

To provide the best possible care, it is important to recognise depression in patients with CHD. Routine screening for depression in all patients with CHD is indicated at first presentation, and again at the next follow-up appointment. A follow-up screen should occur 2–3 months after a CHD event. Screening should then be considered on a yearly basis, as for any other major risk factor for CHD.

A simple tool for initial screening, such as the Patient Health Questionnaire-2 (PHQ-2) or the short-form Cardiac Depression Scale (CDS), can be incorporated into usual clinical practice with minimum interference, and may increase uptake of screening.

Patients with positive screening results may need further evaluation. Appropriate treatment should be commenced, and the patient monitored. If screening is followed by comprehensive care, depression outcomes are likely to be improved.

Patients with CHD and depression respond to cognitive behaviour therapy, collaborative care, exercise and some drug therapies in a similar way to the general population. However, tricyclic antidepressant drugs may worsen CHD outcomes and should be avoided.

Coordination of care between health care providers is essential for optimal outcomes for patients. The benefits of treating depression include improved quality of life, improved adherence to other therapies and, potentially, improved CHD outcomes.

Lacan Palestine : presentation and film screening

As part of the monthly 'Outside the Outside' series of presentation / screenings curated by Dirk de Bruyn and Glenn D'Cruz in response to the changing landscape of Dandenong's inner city rejuvenation, deBruyn will present Mike Hoolboom's recent 'Lacan Palestine'. The film will be preceded by a 20-minute multimedia presentation contextualizing Hoolboom's practice.

Zebrafish as a genetic model in pre-clinical drug testing and screening

The traditional drug discovery pipeline for the identification and development of compounds that selectively target specific molecules to ameliorate disease remains a major focus for medical research. However, the zebrafish is increasingly providing alternative strategies for various components of this pipeline. Zebrafish and their embryos are small, easily accessible and relatively low cost, making them applicable to high-throughput, small molecule screening. Zebrafish can also be manipulated by a range of forward and reverse genetics techniques to facilitate gene discovery and functional studies. Moreover, their physiological and developmental complexity provides accurate models of human disease to underpin mechanism of action and in vivo validation studies. Finally, several of these biological characteristics make zebrafish eminently suitable for toxicity testing, including eco-toxicology. Here we review the application of zebrafish to preclinical drug development and toxicity testing, including recent advances in mutant generation, drug screening and toxicology that serve to further enhance the capabilities of this valuable model organism in drug discovery.

Offering fragile X syndrome carrier screening: a prospective mixed-methods observational study comparing carrier screening of pregnant and non-pregnant women in the general population

Article focus
▪ This article is a protocol of a study that involves offering fragile X syndrome carrier screening to pregnant and non-pregnant women in the general population. We are undertaking a programme evaluation approach using mixed methods to collect data about informed decisionmaking and predictors of test uptake, with a focus on psychosocial measures. We are also undertaking an economic appraisal.

Knowing doesn’t mean doing—bridging the colorectal cancer screening gap

Two behavioural approaches to influence colorectal cancer screening uptake were investigated. Results suggest that the impact of messages that address (1) ease and convenience and (2) social support and endorsement may depend upon the extent to which they successfully address concerns specific to an individual’s current state of readiness to participate.

Screening for resistance to potato cyst nematode in Australian potato cultivars and alternative solanaceous hosts

The potato cyst nematodes (PCN), Globodera rostochiensis (Woll.) and G. pallida (Stone), are major pests of ware and seed potato (Solanum tuberosum L.) crops worldwide and severely impact the movement of potatoes around the globe through quarantine restrictions. In Australia, only G. rostochiensis has been discovered, on four separate occasions between 1986 and 2008. The infested areas are the subject of strict regulation and quarantine procedures and while they are considered to be contained, managing nematode populations remains a priority. This study has identified the G. rostochiensis Ro1 resistance-status of potato cultivars currently grown by Australian potato growers, and new cultivars emerging from the Australian Potato Breeding Program. Resistance was assessed by a simple and robust procedure carried out in a purpose-built quarantine facility. Of the 24 potato cultivars grown in the affected Koo Wee Rup district in 2004, 10 were resistant to nematode infestation, including the locally important cultivar Atlantic. Other cultivars important to the Victorian and Australian potato industry, such as Kennebec, Desiree, Sebago and Coliban, were classified as susceptible. Importantly, this study provided evidence that the Koo Wee Rup PCN population was able to complete its lifecycle on the native plant species, S. aviculare (kangaroo apple), potentially acting as an alternate host and spreading PCN among potato crops.