To improve cancer outcomes for Aboriginal and Torres Strait Islander people through the development and national endorsement of the first population-specific optimal care pathway (OCP) to guide the ...delivery of high-quality, culturally appropriate, and evidence-based cancer care.
An iterative methodology was undertaken over a 2-year period, and more than 70 organizations and individuals from diverse cultural, geographic, and sectorial backgrounds provided input. Cancer Australia reviewed experiences of care and the evidence base and undertook national public consultation with the indigenous health sector and community, health professionals, and professional colleges. Critical to the OCP development was the leadership of Aboriginal and Torres Strait Islander health experts and consumers.
The OCP received unanimous endorsement by all federal, state, and territory health ministers. Key elements of the OCP include attention to the cultural appropriateness of the health care environment; improvement in cross-cultural communication; relationship building with local community; optimization of health literacy; recognition of men's and women's business; and the need to use culturally appropriate resources. The OCP can be used as a tool for health services and health professionals to identify gaps in current cancer services and to inform quality improvement initiatives across all aspects of the care pathway.
The development of the OCP identified a number of areas that require prioritization. Ensuring culturally safe and accessible health services is essential to support early presentation and diagnosis. Multidisciplinary treatment planning and patient-centered care are required for all Aboriginal and Torres Strait Islander people, irrespective of location. Health planners and governments acknowledge the imperative for change and have expressed strong commitment to work with indigenous Australians to improve the accessibility, cultural appropriateness, and quality of cancer care.
For the first time, there is a real opportunity to deal comprehensively with the shameful situation of Indigenous communities in Australia - but the commitment needs to be huge.
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3.
What is wrong with Medicare? Karagiannis, Arthur; Glasson, William J H
Medical journal of Australia,
February 2012, Volume:
196, Issue:
3
Journal Article
Peer reviewed
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FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
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6.
What is wrong with Medicare? Comment Karagiannis, Arthur; Glasson, William J H
Medical journal of Australia,
2012-Feb-20, 20120220, Volume:
196, Issue:
3
Journal Article
Peer reviewed
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To determine if a circulating microRNA (miRNA) panel could be used to distinguish between uveal melanoma and uveal nevi.
We report on a multicenter, cross-sectional study conducted between June 2012 ...and September 2015. The follow-up time was approximately 3 to 5 years. Blood was drawn from participants presenting with a uveal nevus (
= 10), localized uveal melanoma (
= 50), or metastatic uveal melanoma (
= 5). Levels of 17 miRNAs were measured in blood samples of study participants using a sensitive real-time PCR system.
A panel of six miRNAs (miR-16, miR-145, miR-146a, miR-204, miR-211, and miR-363-3p) showed significant differences between participants with uveal nevi compared with patients with localized and metastatic uveal melanoma. Importantly, miR-211 was able to accurately distinguish metastatic disease from localized uveal melanoma (
< 0.0001; area under the curve = 0.96). When the six-miRNA panel was evaluated as a group it had the ability to identify uveal melanoma when four or more miRNAs (93% sensitivity and 100% specificity) reached or exceeded their cut-point.
This miRNA panel, in tandem with clinical findings, may be suited to confirm benign lesions. In addition, due to the panel's high precision in identifying malignancy, it has the potential to augment melanoma detection in subsequent clinical follow-up of lesions with atypical clinical features.
Uveal nevi mimic the appearance of uveal melanoma and their transformation potential cannot be definitively determined without a biopsy. This panel is most relevant at the nevus stage and in lesions with uncertain malignant potential as a companion diagnostic tool to assist in clinical decision-making.
Germline mutations of BRCA1 and BRCA2 predispose individuals to a high risk of breast and ovarian cancer, and elevated risk of other cancers, including those of the pancreas and prostate. BRCA2 ...mutation carriers may have increased risk of uveal melanoma (UM) and cutaneous melanoma (CM), but associations with these cancers in BRCA1 mutation carriers have been mixed. Here, we further assessed whether UM and CM are associated with BRCA1 or BRCA2 by assessing the presence, segregation and reported/predicted pathogenicity of rare germline mutations (variant allele frequency < 0.01) in families with multiple members affected by these cancers. Whole-genome or exome sequencing was performed on 160 CM and/or UM families from Australia, the Netherlands, Denmark and Sweden. Between one and five cases were sequenced from each family, totalling 307 individuals. Sanger sequencing was performed to validate BRCA1 and BRCA2 germline variants and to assess carrier status in other available family members. A nonsense and a frameshift mutation were identified in BRCA1, both resulting in premature truncation of the protein (the first at p.Q516 and the second at codon 91, after the introduction of seven amino acids due to a frameshift deletion). These variants co-segregated with CM in individuals who consented for testing and were present in individuals with pancreatic, prostate and breast cancer in the respective families. In addition, 33 rare missense mutations (variant allele frequency ranging from 0.00782 to 0.000001 in the aggregated ExAC data) were identified in 34 families. Examining the previously reported evidence of functional consequence of these variants revealed all had been classified as either benign or of unknown consequence. Seeking further evidence of an association between BRCA1 variants and melanoma, we examined two whole-genome/exome sequenced collections of sporadic CM patients (total N = 763). We identified one individual with a deleterious BRCA1 variant, however, this allele was lost (with the wild-type allele remaining) in the corresponding CM, indicating that defective BRCA1 was not a driver of tumorigenesis in this instance. Although this is the first time that deleterious BRCA1 mutations have been described in high-density CM families, we conclude that there is an insufficient burden of evidence to state that the increased familial CM or UM susceptibility is because of these variants. In addition, in conjunction with other studies, we conclude that the previously described association between BRCA2 mutations and UM susceptibility represents a rare source of increased risk.
Since ethylene application did not induce ripening in detached fruits of the nonripening mutant rin we initiated studies to determine possible involvement of other hormones. We proposed that the lack ...of ripening in mutant rin tomato fruit may result from a lack of abscisic acid or from excessive endogenous levels of cytokinin. Application of abscisic acid (3 × 10-5 M and 10-3 M) to detached fruits of a normal strain (Lycopersicon esculentum Mill. cv. 'Rutgers') reduced the time to initiate ripening by about 50%. This acceleration of the onset of ripening appeared not to be due to an increased rate of ethylene production. Abscisic acid did not alter respiration or ethylene production or induce ripening in rin fruit. Ripening in Rutgers fruit was not influenced by treatment with 6-benzyladenine (4.44 × 10-6 M, 4.44 × 10-5 M or 1.8 × 10-4 M). Fruits of the mutant rin showed no response to exogenous BA. However, senescence rates of leaf disks of both Rutgers and rin were significantly inhibited by as little as 10-7 M exogenous benzyladenine. The results are discussed in relation to previous studies of the physiology of rin fruits and it is concluded that endogenous levels of ABA and cytokinins do not account for the lack of ripening in rin fruit.
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