91,631 results

  • Disgust and behavioral avoidance in colorectal cancer screening and treatment: a systematic review and research agenda

    Reynolds, Lisa; Consedine, Nathan; Pizarro, DA; Bissett, Ian (2013-03)

    Journal article
    The University of Auckland Library

    BACKGROUND: The emotion of disgust appears to promote psychological and behavioral avoidance, a dynamic that has significant implications in physical and psychological outcomes in colorectal cancer (CRC). Patients, caregivers, and health professionals alike are all potentially susceptible to responding with disgust and the associated avoidance. OBJECTIVE: This article aimed to review the early-stage literature related to disgust and CRC, consider the clinical implications, and suggest an appropriate research agenda. METHODS: Given limited research in this area, a systematic review of the literature was broadened to include disgust and all cancers. MEDLINE, Web of Science, SCOPUS, and ProQuest Dissertations and Theses databases were searched, with additional works sourced by reviewing citation lists and/or by contacting the lead authors. RESULTS: Nine studies were identified relating to disgust and cancer screening, and 6 related to disgust and cancer treatment. Two broad findings emerged: (1) disgust appears to be promoting aversion to (and avoidance of) CRC screening, and (2) several known elicitors of disgust are widely apparent in CRC contexts. CONCLUSIONS: Disgust likely represents a key emotional substrate for avoidance among CRC patients, caregivers, and health professionals. Further research is required to identify disgust's elicitors and effects in CRC contexts, informing interventions that target early identification of persons at risk of maladaptive outcomes. Exposure therapies and mindfulness training may be well suited to treating disgust-generated avoidance. IMPLICATIONS FOR PRACTICE: Disgust has significant implications in CRC contexts. Oncology nurses are uniquely positioned to guide clinical interventions and ultimately improve outcomes in this area.

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  • Engagement and Mentor Support as Drivers of Social Development in the Project K Youth Development Program

    Chapman, CM; Deane, Kelsey; Harr??, N; Courtney, MGR; Moore, J (2017-03)

    Journal article
    The University of Auckland Library

    Youth development programs can achieve positive social outcomes, however studies comparing the influence of different program components are rare. Structural equation modeling of longitudinal, multilevel data (N???=???327) from Project K, a multi-component youth development program, assessed how experiences of engagement or support in each component affected social outcomes. Participants reported significant gains in social self-efficacy and sense of community after the program. Engagement in the outdoor adventure and support during the mentoring partnership components significantly contributed to observed social gains, while engagement in the community service component did not. Results confirm youth development programs can positively influence adolescent social development, while highlighting the importance of moving beyond "black box" investigations in order to maximize program impact and efficiency.

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  • Sociology and social work in New Zealand

    Harington, Philip (2016)

    Journal article
    The University of Auckland Library

    A close and reliable connection between sociology and social work seems plausible, indeed sensible but it has seldom been run smoothly. Indeed it has in various settings become insufferable, messy and even fractured. The article melds two sets of observations based on a career being a sociologist located in social work education. It draws out some of the history of the relationship and comments on the issues and contests that arise when an academic domain becomes implicated in the drive for a practitioner qualification to form a professional discipline. Since this relation has been located in New Zealand and has been significantly impacted by debates on indigeneity, feminism, and responding to neo-liberalism, it opens the scope for activism and provision of data to inform social change and the impact of academic or applied professional agency.

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  • Meta-analysis of antecolic versus retrocolic gastric reconstruction after a pylorus-preserving pancreatoduodenectomy

    Bell, R; Pandanaboyana, Sanjay; Shah, N; Bartlett, Adam; Windsor, John; Smith, AM (2015-03)

    Journal article
    The University of Auckland Library

    Introduction. Delayed gastric emptying (DGE) is a common complication after a pylorus-preserving pancreatoduodenectomy (PPPD) and is associated with significant morbidity. This study determines whether DGE is affected by antecolic (AC) or retrocolic (RC) reconstruction after a PPPD. Method. An electronic search was performed of the MEDLINE, EMBASE and PubMed databases to identify all articles related to this topic. Pooled risk ratios (RR) were calculated for categorical outcomes, and mean differences (MD) for secondary continuous outcomes using the fixed-effects and random-effects models for meta-analysis. Results. Nine studies including 878 patients met the inclusion criteria. DGE was lower with an AC reconstruction RR 0.31 [0.12, 0.78] Z = 2.47 (P = 0.010). Length of stay (LOS) MD -4 days [-7.63, -1.14] Z = 2.65 (P = 0.008) and days to commence a solid diet MD -5 days [-6.63, -3.15] Z = 5.50 (P ??? 0.000) were also significantly in favour of the AC group. There was no difference in the incidence of pancreatic fistula, intra-abdominal collection/bile leak or mortality between the two groups. Conclusion. AC reconstruction after PPPD is associated with a lower incidence of DGE. Time to oral intake was significantly shorter with AC reconstruction, with a reduced hospital stay.

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  • Meta-analysis of Duct-to-duct versus Roux-en-Y biliary reconstruction following liver transplantation for primary sclerosing cholangitis

    Pandanaboyana, Sanjay; Bell, R; Bartlett, Adam; McCall, J; Hidalgo, E (2015-04)

    Journal article
    The University of Auckland Library

    This meta-analysis aimed to compare outcomes following bile duct reconstruction in patients with primary sclerosing cholangitis (PSC) undergoing liver transplantation depending on whether duct-to-duct or Roux-en-Y anastomosis was utilized. An electronic search was performed of the MEDLINE, EMBASE, PubMed databases using both subject headings (MeSH) and truncated word searches. Pooled risk ratios and mean difference were calculated using the fixed-effects and random-effects models for meta-analysis. Ten studies including 910 patients met the inclusion criteria. There was no difference in the overall incidence of biliary strictures between the two groups [odds ratio (OR) 1.06 (0.68, 1.66); (P??=??0.80)]. The anastomotic stricture rate was similar, [OR 1.18 (0.56, 2.50); (P??=??0.67)]. Ascending cholangitis was higher in the Roux-en-Y group [OR 2.91 (1.17, 7.23); (P??=??0.02)]. Anastomotic bile leak rates, graft survival, PSC recurrence and number of patients diagnosed with cholangiocarcinoma following transplantation were comparable between both groups. Duct-to-duct and Roux-en-Y reconstruction had comparable outcomes. Both techniques are associated with similar incidence of biliary stricture. The bilioenteric reconstruction was associated with a higher risk of cholangitis. The incidence of de novo cholangiocarcinoma was similar in both groups. Duct-to-duct reconstruction should be considered when feasible in patients with PSC.

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  • Hepatic venous outflow obstruction in piggyback liver transplantation: single centre experience

    Arudchelvam, J; Bartlett, Adam; McCall, J; Johnston, P; Gane, E; Munn, S (2017-03)

    Journal article
    The University of Auckland Library

    Hepatic venous outflow obstruction (HVOO) is a rare but serious complication in liver transplantation (LT).We conducted a retrospective analysis of HVOO with venography and gradient measurement in consecutive LT from a single centre.Five hundred and six LTs were performed in 486 patients with a median age of 49 years (range 3 months to 71 years). Nineteen (3.8%) cases of HVOO were identified. Diagnosis was confirmed at a median of 26 days post-LT (1-2312). The incidence fell from 5.5% in the first 253 LT, to 2.0% in the second 253 (P = 0.03). Seventeen were due to narrowing at the anastomosis and two cases were due to thrombosis. In adult patients, reconstruction of the supra-hepatic donor inferior vena cava (IVC) onto two veins versus modified 2-3 hepatic veins did not alter the likelihood of HVOO. 17/19 cases were managed successfully by stenting or venoplasty. Two paediatric patients with early onset HVOO had attempted surgical thrombectomy, one was successful and the other required retransplantation.The incidence of HVOO appears to fall with increasing experience and does not appear to be related to the number of veins the donor IVC is anastomosed to in adult recipients.

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  • Renal artery embolization prior to nephrectomy for locally advanced renal cell carcinoma

    Zargar, H; Addison, B; McCall, J; Bartlett, Adam; Buckley, B; Rice, M (2014-07)

    Journal article
    The University of Auckland Library

    BACKGROUND: To assess the outcomes of patients undergoing percutaneous renal artery embolization (PRAE) prior to radical nephrectomy. METHODS: We performed retrospective chart review of patients undergoing PRAE in Auckland Public Hospital from January 2004 to December 2011. PRAE was performed under epidural anaesthesia and within 24???h of nephrectomy. We compared our perioperative outcomes with the published literature. RESULTS: Forty-two patients were identified in this series. Patients had predominantly more advanced stage disease with 30 (71%) being T3 or higher (TNM staging). Median operation time was 192???min (range 84-428). 45.2% of patients experienced complications from the surgery. There were no complications associated with PRAE. CONCLUSIONS: PRAE prior to nephrectomy is a safe procedure. There is no convincing evidence in the literature that the benefits outweigh the risks. All published studies are non-randomized and subject to selection bias, so the true role of PRAE has not yet been determined and routine use is probably not justified.

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  • Mitochondrial dysfunction in steatotic rat livers occurs because a defect in complex i makes the liver susceptible to prolonged cold ischemia

    Chu, MJJ; Hickey, Anthony; Jiang, Yannan; Petzer, A; Bartlett, Adam; Phillips, Anthony (2015-03)

    Journal article
    The University of Auckland Library

    Steatotic livers are susceptible to cold ischemia, which is thought to be secondary to mitochondrial dysfunction. Ischemic preconditioning (IPC) has been reported to improve liver function in the setting of warm ischemia/reperfusion injury, but the effect of IPC on steatotic liver mitochondrial function (MF) with cold ischemia has not been previously evaluated. We aimed to evaluate MF with various severities of hepatic steatosis after various durations of cold ischemia storage with or without IPC. Male Sprague-Dawley rats were fed a normal diet or a high-fat/high-sucrose diet for 1, 2, or 4 weeks to induce mild (60%) macrovesicular steatosis, respectively. Liver MF was tested with high-resolution respirometry after 1.5, 4, 8, 12, 18, and 24 hours of cold ischemia. Rats in each group (n???=???10) underwent 10 minutes of IPC or no IPC before cold ischemia. The baseline (time 0) respiration was similar for lean and severely steatotic livers despite decreased mitochondrial complex I (C-I) activity in severely steatotic livers. Hepatic steatosis was associated with increased C-I-mediated leaks and decreased respiratory control ratios (RCRs) after cold ischemia. Mildly, moderately, and severely steatotic livers showed significantly lower RCRs after 8, 1.5, and 1.5 hours of cold ischemia, respectively, in comparison with lean livers. IPC restored RCRs in mildly steatotic livers to levels comparable to those in lean livers for up to 24 hours of cold ischemia via the attenuation of C-I-mediated leaks, but it had no beneficial effect on moderately and severely steatotic livers. In conclusion, steatotic livers exhibited apparent mitochondrial dysfunction through an alteration in C-I activity, and this made them more susceptible to prolonged cold ischemia. The clinically based IPC protocol used here restored MF in cases of mild hepatic steatosis by attenuating C-I-mediated leaks after prolonged cold ischemia, but it did work not in livers with moderate or severe steatosis.

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  • The immunophenotype of antigen presenting cells of the mononuclear phagocyte system in normal human liver--a systematic review

    Strauss, O; Dunbar, Peter; Bartlett, Adam; Phillips, Anthony (2015-02)

    Journal article
    The University of Auckland Library

    The mononuclear phagocytic system (MPS), comprised of monocytes, macrophages, and dendritic cells, is essential in tissue homeostasis and in determining the balance of the immune response through its role in antigen presentation. It has been identified as a therapeutic target in infectious disease, cancer, autoimmune disease and transplant rejection. Here, we review the current understanding of the immunophenotype and function of the MPS in normal human liver. Using well-defined selection criteria, a search of MEDLINE and EMBASE databases identified 76 appropriate studies. The majority (n=67) described Kupffer cells (KCs), although the definition of KC differs between sources, and little data were available regarding their function. Only 10 papers looked at liver dendritic cells (DCs), and largely confirmed the presence of the major dendritic cell subsets identified in human blood. Monocytes were thoroughly characterized in four studies that utilized flow cytometry and fluorescent microscopy and highlighted their prominent role in liver homeostasis and displayed subtle differences from circulating monocytes. There was some limited evidence that liver DCs are tolerogenic but neither liver dendritic cell subsets nor macrophages have been thoroughly characterized, using either multi-colour flow cytometry or multi-parameter fluorescence microscopy. The lobular distribution of different subsets of liver MPS cells was also poorly described, and the ability to distinguish between passenger leukocytes and tissue resident cells remains limited. It was apparent that further research, using modern immunological techniques, is now required to accurately characterize the cells of the MPS in human liver.

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  • A systematic review and meta-analysis of portal vein ligation versus portal vein embolization for elective liver resection

    Pandanaboyana, Sanjay; Bell, R; Hidalgo, E; Toogood, G; Prasad, KR; Bartlett, Adam; Lodge, JP (2015-04)

    Journal article
    The University of Auckland Library

    INTRODUCTION: This meta-analysis aimed to review the percentage increase in future liver remnant (FLR) and perioperative outcomes after portal vein ligation (PVL) and portal vein embolization (PVE) before liver resection. METHODS: An electronic search was performed of the MEDLINE, EMBASE, and PubMed databases using both subject headings (MeSH) and truncated word searches to identify all articles published that related to this topic. Pooled risk ratios were calculated for categorical outcomes and mean differences for secondary continuous outcomes using the fixed-effects and random-effects models for meta-analysis. RESULTS: Seven studies involving 218 patients met the inclusion criteria. There was no difference in the increase in FLR between the 2 groups 39% (PVE) versus 27% (PVL; mean difference [MD] 6.04; 95% CI, -0.23, 12.32; Z = 1.89; P = .06). Similarly, there was no difference in the morbidity (risk ratio [RR], 1.08; 95% CI, 0.55, 2.09; Z = 0.21; P = .83) and mortality (RR, 0.87; 95% CI, 0.19, 3.92; Z = 0.18; P = .85) in the 2 groups after liver resection. While awaiting liver resection after PVL and PVE, no difference was noted in the number of patients developing disease progression (RR, 0.93; 95% CI, 0.52, 1.66; Z = 0.24; P = .81). In a subset analysis comparing FLR with PVE and PVL as part of the procedure called an associating liver partition with PVL for staged hepatectomy (ALPPS), there was a significant increase in FLR in favor of ALPPS (MD, -17.09; 95% CI, -32.78, -1.40; Z = 2.14; P = .03). CONCLUSION: PVL and PVE result in comparable percentage increase in FLR with similar morbidity and mortality rates. The ALPPS procedure results in an improved percentage increase in FLR compared with PVE alone.

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  • Screening and Biological Effects of Marine Pyrroloiminoquinone Alkaloids: Potential Inhibitors of the HIF-1??/p300 Interaction

    Goey, AKL; Chau, CH; Sissung, TM; Cook, KM; Venzon, DJ; Castro, A; Ransom, TR; Henrich, CJ; McKee, TC; McMahon, JB; Grkovic, T; Cadelis, Melissa; Copp, Brent; Gustafson, KR; Figg, WD (2016-05-03)

    Journal article
    The University of Auckland Library

    Inhibition of the hypoxia-inducible factor 1?? (HIF-1??) pathway by disrupting its association with the transcriptional coactivator p300 inhibits angiogenesis and tumor development. Development of HIF-1??/p300 inhibitors has been hampered by preclinical toxicity; therefore, we aimed to identify novel HIF-1??/p300 inhibitors. Using a cell-free assay designed to test compounds that block HIF-1??/p300 binding, 170???298 crude natural product extracts and prefractionated samples were screened, identifying 25 active extracts. One of these extracts, originating from the marine sponge Latrunculia sp., afforded six pyrroloiminoquinone alkaloids that were identified as positive hits (IC50 values: 1-35 ??M). Luciferase assays confirmed inhibition of HIF-1?? transcriptional activity by discorhabdin B (1) and its dimer (2), 3-dihydrodiscorhabdin C (3), makaluvamine F (5), discorhabdin H (8), discorhabdin L (9), and discorhabdin W (11) in HCT 116 colon cancer cells (0.1-10 ??M, p < 0.05). Except for 11, all of these compounds also reduced HIF-1?? transcriptional activity in LNCaP prostate cancer cells (0.1-10 ??M, p < 0.05). These effects occurred at noncytotoxic concentrations (< 0.05). In COLO 205 colon cancer cells no activity was shown in the luciferase or cytotoxicity assays. Pyrroloiminoquinone alkaloids are a novel class of HIF-1?? inhibitors, which interrupt the protein-protein interaction between HIF-1?? and p300 and consequently reduce HIF-related transcription.

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  • The impact of hepatic steatosis on hepatic ischemia-reperfusion injury in experimental studies: a systematic review

    Chu, MJJ; Hickey, Anthony; Phillips, Anthony; Bartlett, Adam (2013)

    Journal article
    The University of Auckland Library

    BACKGROUND: The impact of hepatic steatosis on outcome following hepatic ischemia-reperfusion injury (IRI) remains controversial with conflicting clinical results. A number of experimental studies have been published examining the relationship between hepatic steatosis and IRI. This systematic review evaluates these experimental studies. METHODS: An electronic search of the Medline and Embase databases (January 1946 to June 2012) was performed to identify studies that reported relevant outcomes in animal models of hepatic steatosis subjected to IRI. RESULTS: A total of 1314 articles were identified, of which 33 met the predefined criteria and were included in the study. There was large variation in the type of animal model, duration, and type of IRI and reporting of histological findings. Increased macrovesicular steatosis (>30%) was associated with increased histological damage, liver function derangement, and reduced survival. Increased duration of warm or cold ischemia had a negative impact on all outcomes measured. Microvesicular steatosis did not influence outcome. CONCLUSIONS: Findings from this systemic review support the hypothesis that livers with >30% macrovesicular steatosis are less tolerant of IRI. Clinically, it is likely that these findings are applicable to patients undergoing hepatic resection, but further studies are required to confirm these data.

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  • Application of Arterial Spin Labelling in the Assessment of Ocular Tissues

    Vaghefi Rezaei, Seyed; Pontr??, B (2016)

    Journal article
    The University of Auckland Library

    Arterial spin labelling (ASL) is a noninvasive magnetic resonance imaging (MRI) modality, capable of measuring blood perfusion without the use of a contrast agent. While ASL implementation for imaging the brain and monitoring cerebral blood flow has been reviewed in depth, the technique is yet to be widely used for ocular tissue imaging. The human retina is a very thin but highly stratified structure and it is also situated close to the surface of the body which is not ideal for MR imaging. Hence, the application of MR imaging and ASL in particular has been very challenging for ocular tissues and retina. That is despite the fact that almost all of retinal pathologies are accompanied by blood perfusion irregularities. In this review article, we have focused on the technical aspects of the ASL and their implications for its optimum adaptation for retinal blood perfusion monitoring. Retinal blood perfusion has been assessed through qualitative or invasive quantitative methods but the prospect of imaging flow using ASL would increase monitoring and assessment of retinal pathologies. The review provides details of ASL application in human ocular blood flow assessment.

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  • Modeling the hepatic arterial buffer response in the liver

    Ho, Harvey; Sorrell, K; Bartlett, Adam; Hunter, Peter (2013-08)

    Journal article
    The University of Auckland Library

    In this paper we present an electrical analog model for the hepatic arterial buffer response (HABR), an intrinsic regulation mechanism in the liver whereby the arterial flow counteracts the changes in portal venous flow. The model itself is a substantial simplification of a previously published model, with nonlinear arterial and portal resistors introduced to account for the dynamic HABR effects. We calibrate the baseline model using published hemodynamic data, and then perform a virtual portal occlusion simulation where the portal vein is half or fully occluded. The simulation results, which suggest that the increased arterial flow cannot fully compensate lost portal perfusion, are consistent with clinical reports and animal model findings. Since HABR functions in both the whole liver and liver graft after transplantation, we also simulate blood flow in a virtual right-lobe graft by adjusting the electronic component parameters in the electric circuit, and our model is able to reproduce the portal venous hyperperfusion and hepatic arterial hypoperfusion conditions due to the HABR effects.

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  • Sap flow of the southern conifer, Agathis australis during wet and dry summers

    Ng, Catriona; Wyse, S; Veale, A; Schwendenmann, Luitgard; Clearwater, M (2016-02-01)

    Journal article
    The University of Auckland Library

    Key message: Analysis of sap flux density during drought suggests that the large sapwood and rooting volumes of larger trees provide a buffer against drying soil. Abstract: The southern conifer Agathis australis is amongst the largest and longest-lived trees in the world. We measured sap flux densities (Fd) in kauri trees with a DBH range of 20???176??cm to explore differences in responses of trees of different sizes to seasonal conditions and summer drought. Fd was consistently higher in larger trees than smaller trees. Peak Fd was 20 and 8??g??m???2??s???1 for trees of diameters of 176 and 20??cm, respectively, during the wet summer. Multiple regression analysis revealed photosynthetically active radiation (PAR) and vapour pressure deficit (D) were the main drivers of Fd. During drought, larger trees were more responsive to D whilst smaller trees were more responsive to soil drying. Our largest tree had a sapwood area of 3,600??cm2. Preliminary analysis suggests stem water storage provides a buffer against drying soil in larger trees. Furthermore, Fd of smaller trees had higher R2 values for soil moisture at 30 and 60??cm depth than soil moisture at 10??cm depth (R2??=??0.68???0.97 and 0.55???0.67, respectively) suggesting that deeper soil moisture is more important for these trees. Larger trees did not show a relationship between Fd and soil moisture, suggesting they were accessing soil water deeper than 60??cm. These results suggest that larger trees may be better prepared for increasing frequency and intensity of summer droughts due to deeper roots and/or larger stem water storage capacity.

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  • Cerebral asymmetry for language: Comparing production with comprehension

    Haberling, Isabelle; Steinemann, A; Corballis, Michael (2016-01)

    Journal article
    The University of Auckland Library

    Although left-hemispheric damage can impair both the production and comprehension of language, it has been claimed that comprehension is more bilaterally represented than is production. A variant of this theme is based on the theory that different aspects of language are processed by a dorsal stream, responsible for mapping words to articulation, and a ventral stream for processing input for meaning. Some have claimed that the dorsal stream is left-hemispheric, while the ventral stream is bilaterally organized. We used fMRI to record activation while left- and right-handed participants performed covert word-generation task and judged whether word pairs were synonyms. Regions of interest were Broca's area as part of the dorsal stream and the superior and middle temporal gyri as part of the ventral stream. Laterality indices showed equal left-hemispheric lateralization in Broca's area for word generation and both Broca's area and temporal lobe for the synonym judgments. Handedness influenced laterality equally in each area and task, with right-handers showing stronger left-hemispheric dominance than left-handers. Although our findings provide no evidence that asymmetry is more pronounced for production than for comprehension, correlations between the tasks and regions of interest support the view that lateralization in the temporal lobe depends on feedback influences from frontal regions.

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  • The Use of Mobile Health to Deliver Self-Management Support to Young People With Type 1 Diabetes: A Cross-Sectional Survey

    Dobson, Rosie; Whittaker, Robyn; Murphy, Rinki; Khanolkar, M; Miller, S; Naylor, J; Maddison, R (2017)

    Journal article
    The University of Auckland Library

    Background: Young people living with type 1 diabetes face not only the challenges typical of adolescence, but also the challenges of daily management of their health and evolving understanding of the impact of their diagnosis on their future. Adolescence is a critical time for diabetes self-management, with a typical decline in glycemic control increasing risk for microvascular diabetes complications. To improve glycemic control, there is a need for evidence-based self-management support interventions that address the issues pertinent to this population, utilizing platforms that engage them. Increasingly, mobile health (mHealth) interventions are being developed and evaluated for this purpose with some evidence supporting improved glycemic control. A necessary step to enhance effectiveness of such approaches is to understand young people???s preferences for this mode of delivery. Objective: A cross-sectional survey was conducted to investigate the current and perceived roles of mHealth in supporting young people to manage their diabetes. Methods: Young adults (16-24 years) with type 1 diabetes in Auckland, New Zealand, were invited to take part in a survey via letter from their diabetes specialist. Results: A total of 115 young adults completed the survey (mean age 19.5 years; male 52/115, 45%; European 89/115, 77%), with all reporting they owned a mobile phone and 96% (110/115) of those were smartphones. However, smartphone apps for diabetes management had been used by only 33% (38/115) of respondents. The most commonly reported reason for not using apps was a lack of awareness that they existed. Although the majority felt they managed their diabetes well, 63% (72/115) reported wanting to learn more about diabetes and how to manage it. A total of 64% (74/115) respondents reported that they would be interested in receiving diabetes self-management support via text message (short message service, SMS). Conclusions: Current engagement with mHealth in this population appears low, although the findings from this study provide support for the use of mHealth in this group because of the ubiquity and convenience of mobile devices. mHealth has potential to provide information and support to this population, utilizing mediums commonplace for this group and with greater reach than traditional methods.

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  • Meta-analysis of intermittent Pringle manoeuvre versus no Pringle manoeuvre in elective liver surgery

    Pandanaboyana, Sanjay; Ong, I; Bartlett, Adam; Powell, JJ; Wigmore, SJ (2013-10)

    Journal article
    The University of Auckland Library

    Background and objectives: Intermittent Pringle manoeuvre (IPM) is frequently used during liver surgery. This meta-analysis aimed to review the impact on blood loss, operating time and morbidity and mortality with and without use of IPM. Methods: An electronic search was performed of the MEDLINE, EMBASE, PubMed databases using both subject headings (MeSH) and truncated word searches to identify all articles published that related to this topic. Pooled risk ratios were calculated for categorical outcomes, and mean differences (MDs) for secondary continuous outcomes, using the fixed-effects and random-effects models for meta-analysis. Results: Four randomized controlled trials encompassing 392 patients were analysed to achieve a summated outcome. Pooled data analysis showed the use of IPM resulted in reduced transection time/cm2 (MD -0.53 (-0.88, -0.18) min/cm2 (P = 0.003)) but with comparable blood loss (mL/cm2) (MD -1.67 (-4.41, 1.08) mL/cm2, P = 0.23), overall blood loss (MD -20.42 (-89.42, 48.58) mL), blood transfusion requirements (risk ratio 0.78 (0.40, 1.52, P = 0.47)) and morbidity and mortality compared to no Pringle manoeuvre. In addition, there was no significant difference in the post-operative hospital stay (MD 0.37 (-0.60, 1.34) days). Conclusions: There is no evidence that the routine use of IPM improves perioperative and post-operative outcomes compared to no Pringle manoeuvre and its routine may not be recommended.

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  • The effectiveness of mobile-health behaviour change interventions for cardiovascular disease self-management: A systematic review

    Pfaeffli Dale, L; Dobson, Rosie; Whittaker, R; Maddison, R (2016)

    Journal article
    The University of Auckland Library

    Background: Mobile wireless devices (mHealth) have been used to deliver cardiovascular disease self-management interventions to educate and support patients in making healthy lifestyle changes. This systematic review aimed to determine the effectiveness of mHealth interventions on behavioural lifestyle changes and medication adherence for cardiovascular disease self-management. Methods: A comprehensive literature search was conducted from inception through to 3 March 2015 using MEDLINE, PubMed, PsycINFO, EMBASE and The Cochrane Library. Eligible studies used an experimental trial design to determine the effectiveness of an mHealth intervention to change lifestyle behaviours in any cardiovascular disease population. Data extracted included intervention and comparison group characteristics with a specific focus on the use of behaviour change techniques. Results: Seven studies met our inclusion criteria and were included in the qualitative synthesis. All interventions were delivered in part by mobile phone text messaging. Three studies were effective at improving adherence to medication and two studies increased physical activity behaviour. No effects were observed on dietary behaviour or smoking cessation, measured in one study each. Simple text messaging interventions appeared to be most effective; however, no clear relationships were found between study findings and intervention dose, duration or behaviour change techniques targeted. Conclusions: Our review found mHealth has the potential to change lifestyle behaviour. Results are still limited to a small number of trials, inconsistent outcome measures and ineffective reporting of intervention characteristics. Large scale, longitudinal studies are now warranted to gain a clear understanding of the effects of mHealth on behaviour change in the cardiovascular disease population.

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  • Critical care of the potential organ donor

    Dare, AJ; Bartlett, Adam; Fraser, JF (2012-08)

    Journal article
    The University of Auckland Library

    Organ transplantation represents one of the great success stories of 20th century medicine. However, its continued success is greatly limited by the shortage of donor organs. This has led to an increased focus within the critical care community on optimal identification and management of the potential organ donor. The multi-organ donor can represent one of the most complex intensive care patients, with numerous competing physiological priorities. However, appropriate management of the donor not only increases the number of organs that can be successfully donated but has long-term implications for the outcomes of multiple recipients. This review outlines current understandings of the physiological derangements seen in the organ donor and evaluates the available evidence for management strategies designed to optimize donation potential and organ recovery. Finally, emerging management strategies for the potential donor are discussed within the current ethical and legal frameworks permitting donation after both brain and circulatory death.

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