This study examined the effectiveness of the Otago screening protocol in identifying school-aged children with severe speech and language impairments. In order to do so, the results of the Otago screening protocol were compared with those of comprehensive language assessment as determined by best practice protocol (Gillon & Schwarz, 1998, Kennedy, 2002). Following the completion of the screening and the comprehensive assessments, an evaluation of the true positives and false positives was calculated, and an analysis of the false negative outcomes made. Findings indicated that fourteen of the twenty participants were true positives, three were true negatives, three were false positives, and none were false negatives. The Positive Predictive Value and Negative Predictive Value of the screening protocol was 100%. Test Sensitivity and Specificity were very high at 82% and 100%. Inter-rater reliability was very high, generally ranging from 92-100%. Adding a standardised measure of phonological awareness would improve efficiency of the screening protocol. Consideration of alternative screening tools, such as the GAPS test (Gardner et al, 2006) and the CELF-4 screening test (Semel, Secord & Wiig, 2004), should be made. Additional factors which could influence a screening protocol are discussed. The Otago screening protocol is a valid procedure to detect severe speech and language impairments in school-aged students referred to Special Education.

Title page, table of contents and summary only. The complete thesis in print form is available from the University of Adelaide Library. / I hereby submit a body of original research for consideration of the award of Doctor of Medicine from the University of Adelaide. This is a collection of published original research that has made substantial contributions to the modern diagnosis and management of breast cancer. The publications have been presented in three clusters, each of which represents one facet of the modern approach to the diagnosis and management of breast cancer. The first section presents my publications on the theme of population based mammographic screening for the early detection of breast cancer. Broadly, the research focus in these publications is on the evaluation of existing methods of assessment of screen-detected breast lesions in order to improve diagnostic accuracy and limit the morbidity associated with mammographic screening. The clinical value of these contributions has been demonstrated independently since this body of work has informed many of the algorithms and protocols used by the South Australian breast cancer screening program. In addition, the protocols have been adopted for use outside of the screening setting into the wider diagnostic arena. The clinical endorsement of my research contributions is a significant acknowledgement of their practical value. The middle group of publications describe my contributions towards the evolving role of sentinel node biopsy as an alternative to axillary clearance for the staging of breast cancer. This area is of particular cogent to our setting, since a large proportion of screen-detected breast cancers, approximately 80%, are node negative. Thus, avoidance of the morbidity of axillary clearance while still achieving accurate axillary staging is of enormous appeal to our patients. My pioneering work in devising and evaluating protocols for the pathologic examination of sentinel nodes has informed the recommendations of the NHMRC sponsored SNAC (Sentinel Node versus Axillary Clearance) randomised trial. Consequently, these protocols have been used extensively and even outside of the trial setting, most pathology laboratories utilise similar assessment protocols as was recommended in SNAC. Furthermore, the United Kingdom's recommendations for the pathology examination of sentinel nodes have drawn on our research. After validating the concept of SNs in breast cancer, many of the clinically important questions emerging in this field have been addressed by our team. For example, my work on intra-operative imprint cytology was a conclusive demonstration of the value and limitations of this technique for one stage axillary surgery. In the light of our findings intra-operative assessment of sentinel nodes has been expanded to many centres and is endorsed by the SNAC trial. In the third section of this thesis, my contributions to the rapidly evolving field of molecular and genetics of breast cancer are highlighted . Through the Australian HER2 Advisory Board, we have led the evaluation and roll out of alternative platforms for HER2 testing and in developing algorithms for the efficient use of resources. We have devised national testing algorithms in both settings of metastatic and early breast cancer. These algorithms have since been utilised by the international HER2 testing bodies. In a further bold initiative, our group pioneered the move to the national adoption of bright field In situ hybridization as the first line testing platform for all newly diagnosed breast cancers throughout Australia. This ambitious undertaking entailed design and implementation of a nation-wide program of training, certification, quality assurance and evaluation. It has been deployed successfully and under my leadership, our laboratory was one of only four laboratories in Australia to commence this test in October 2006. Similarly, in the area of the genetics of breast cancer, my interest in this field and membership of the pathology subcommittee of KCONFAB has provided opportunities to contribute to significant new knowledge that illustrate the role of pathology in identification of mutation associated breast cancers. Under my leadership, our multi-centre studies have provided cogent arguments in favour of the inclusion of the histopathologic and immunophenotypic characteristics of breast cancers in the triage of patients for genetic testing. These results were published in pre-eminent pathology journals and have been referred to at major scientific conferences. Plans are afoot for the future extensions of this work. I am committed to utilising my expertise for the provision of high quality diagnostic services as part of a multi-disciplinary team involved in the treatment of women with breast diseases. I believe an evidence-based approach is central to achieving continuous improvements in these efforts. I am persuaded that there is substantial evidence demonstrating the value of population based mammographic screening in interrupting the natural history of breast cancer and reducing mortality from this disease. I am grateful to have the opportunity to contribute to the provision of this care. / http://proxy.library.adelaide.edu.au/login?url= http://library.adelaide.edu.au/cgi-bin/Pwebrecon.cgi?BBID=1473394 / Thesis (M.D.) -- University of Adelaide, School of Medical Sciences, 2010

BACKGROUND. There are various methods of health care follow-up of children born very preterm (VP, ≤31 week gestation) from a neonatal intensive care unit (NICU). Whilst the gold standard is the systematic NICU based follow-up program, which provides highly specialised neurodevelopmental and medical assessment, it is not feasible at all the appropriate times for all infants because of cost and geographical constraints. In Queensland, and elsewhere, 50% of children born VP rely on primary care-general practice for their screening and health needs once discharged from hospital. Recently, randomised and interrater agreement studies have shown the feasibility of the use of a questionnaire-based collection of late health status in children born VP. A preterm-targeted childhood primary health screening and surveillance program which draws from these methods may be effective in collecting long-term disability data and meeting the screening needs of children born VP. AIM. To (1) develop and (2) assess a Preterm-Targeted Screening and Surveillance Program against the routine National Health Medical Research Council (NHMRC) program for the early detection of sensorineural based disability in children born VP by general practitioners in the primary health setting for (1) prevalence estimation and (2) as a screening tool. METHODS. A two-part approach was chosen. Part 1 was a reconstructed cross-sectional cohort of 388 of 523 (74.2%) located and consented 2, 4 and 7 year ca (corrected age) children with a birthweight ≤ 1250 grams (g) born in Queensland. Epidemiological information was collected on child health outcomes and factors relating to the feasibility of providing a standardised targeted screening and surveillance program to be used by general practitioners to detect sensorineural based disability in children born VP. The Preterm- Targeted Screening and Surveillance Program was developed using World Health Organisation (WHO) screening program criteria and NHMRC evidence based health practice criteria. Part 2 was a multicentred randomised controlled trial to test the efficacy of the newly developed program in 202 VP infants who were randomised to receive the NHMRC or Preterm-Targeted Screening and Surveillance Program. The primary outcome was correct identification of sensorineural disability (developmental quotient >-1 standard deviation (SD), cerebral palsy, bilateral blindness or deafness requiring aids) at 12-months ca by general practitioners assessed against gold standard paediatric assessments. The odds ratios (OR) calculated the disability status (agreed vs. disagreed/unsure). Kappa statistics (k) and screening test characteristics calculated interrater agreement and screening accuracy (agreed vs. disagreed). Logistic regression investigated factors that might affect agreement between general practitioners and paediatric assessment for disability. Secondary outcomes were designed to be descriptive and included post-natal depression, parental stress, health service utilisation and satisfaction. RESULTS. Part 1 demonstrated that in Queensland there is no state-based information on 25.8% of children born VP. Children assessed suffer from sensorineural impairment and a range of other health and developmental problems. In addition, there is limited specialist child health resources located outside the major metropolitan areas and families rely heavily on general practitioners for child health care. Parents and general practitioners clearly demonstrated that they would use an evidence-based targeted childhood screening and surveillance program for children born VP. The Preterm-Targeted Screening and Surveillance Program provide parents and health practitioners with an evidence based-high accuracy standardised screening for sensorineural and non-sensorineural domains. In Part 2, 195 of 202 infants randomised were assessed for the primary outcome. There was no difference in the correct identification of sensorineural disability between general practitioners in either group shown by an OR of 0.91 (95%CI 0.50, 1.65) (preterm-targeted 65.6% vs. NHMRC 67.6%). No prognostic factors independently affected this outcome. Interrater agreement was fair (preterm-targeted k =0.30, p for Ho=0.001 vs. NHMRC k =0.29, p for Ho=0.002). The preterm-targeted group had more disability identified (73% vs. 33%) with less under-referrals (27% vs. 67%) but poorer specificity (70% vs. 92%) with more over-referrals (30% vs. 8%) compared to the NHMRC group. Secondary outcomes showed that children born VP experience high rates of health services use but their families experience similar rates of depression and parental stress compared to the general paediatric population. Satisfaction results suggest that the program was well received. CONCLUSION. A comprehensive epidemiological approach to collecting a broad range of VP child health outcomes and health service data was successfully used to develop an evidence-based Preterm-Targeted Screening and Surveillance Program which proved to have excellent uptake by parents and general practitioners. Assessing the program using a randomised methodology has allowed demonstration of its efficacy as a screening tool when used by general practitioners in the primary health setting. The Preterm-Targeted Screening and Surveillance Program is superior in identifying disability at 12-month ca compared to the standard NHMRC program. Whilst the results are promising, the program will not provide totally accurate prevalence of disability data because of the overestimation of disability.

Proefschrift Universiteit van Amsterdam. / Met bibliogr., lit. opg. - Met samenvatting in het Nederlands.

Proefschrift Universiteit van Amsterdam. / Met bibliogr., lit. opg. - Met samenvatting in het Nederlands.

Zugl.: Hamburg, Univ., Diss., 2005

München, Techn. Universiẗat, Diss., 2007.

Tübingen, Univ., Diss., 2009.

Thesis (M.Nurs.)--University of Hong Kong, 2008. / Includes bibliographical references (p. 162-174)

Thesis (M.P.H.)--Georgia State University, 2007. / Title from file title page. Michael P. Eriksen, committee chair; Marshall W. Kreuter, Amy DeGroff, committee members. Electronic text (145 p. : ill. (some col.)) : digital, PDF file. Description based on contents viewed May 23, 2008. Includes bibliographical references (p. 96-104).