Papers by Kylie Mansfield
Research and Reports in Urology, 2009
Muscarinic receptors have long been the target receptors for treatment of patients with overactiv... more Muscarinic receptors have long been the target receptors for treatment of patients with overactive bladder (OAB). These patients experience symptoms of urgency, urinary frequency and nocturia, with or without urge incontinence (the involuntary leakage of urine associated with urge). Fesoterodine, a pro-drug, structurally and functionally related to tolterodine, is the newest agent developed for the treatment of OAB. Fesoterodine is broken down to the active metabolite, 5-hydroxy-methyl-tolterodine (5-HMT) by nonspecific esterases. This metabolism results in the complete breakdown of the parent compound and is responsible for dose related improvements in clinical efficacy and health related quality of life. Like other antimuscarinic agents including tolterodine, fesoterodine is associated with improvements in clinical variables related both to bladder filling (decreasing micturition frequency and increasing mean voided volume) and urgency (urgency and urge incontinence episodes). Improvements in health related quality of life following treatment with fesoterodine is indicated by improvements in 7 of the 9 variables measured by the King's Health Questionnaire. Also like other antimuscarinic agents, fesoterodine use is associated with adverse events including dry mouth. However the incidence of dry mouth is reduced with fesoterodine, compared to oxybutynin, due to the improved bladder selectivity of 5-HMT.
Nitric oxide, a survival factor for lens epithelial cells Purpose: Nitric oxide (NO) is capable o... more Nitric oxide, a survival factor for lens epithelial cells Purpose: Nitric oxide (NO) is capable of promoting either cell death or cell survival depending on cell type and experimental conditions. In this study, the possible effects of NO on the viability of lens epithelial cells were investigated in an explant model used previously to identify cellular changes associated with posterior capsule opacification following cataract surgery. Methods: Rat lens epithelial explants prepared from weanling rats were cultured in a serum-free medium for five days with or without the addition of the nitric oxide synthase inhibitor, L-Nω-nitro-L-arginine methyl ester (L-NAME), using the inactive enantiomer D-NAME as a control. Alternatively, explants were cultured for nine days with or without the NO donor, sodium nitroprusside. Explants were assessed morphologically and immunohistochemically or by determining DNA content. Results: In the presence of L-NAME but not in controls, progressive rounding...
Aims of Workshop The overactive bladder (OAB) syndrome is the main cause of urge incontinence and... more Aims of Workshop The overactive bladder (OAB) syndrome is the main cause of urge incontinence and urgency (generally associated with detrusor overactivity). Approximately 35% of patients with detrusor overactivity are unresponsive to current Antimuscarinic drugs. These “refractory” patients are a hard-core group of sufferers constantly expending health care resources in their search for relief. Recent studies find bacterial cystitis in approximately 30-50% of DO patients refractory to treatment. This workshop will bring together clinicians and scientists to discuss the recent findings on recurrent bacterial cystitis and reasons for antibiotic resistance in relation to the refractory state.
been through the copyediting, typesetting, pagination and proofreading process which may lead to ... more been through the copyediting, typesetting, pagination and proofreading process which may lead to differences between this version and the Version of Record. Please cite this article as doi: 10.1111/nep.12892 This article is protected by copyright. All rights reserved. Title: A comparison of the extent and pattern of cognitive impairment among predialysis, dialysis and transplant patients: a cross sectional study from Australia. Short title: Cognitive impairment among predialysis, dialysis and transplant patients
Australasian Psychiatry
Objective: To investigate beliefs about treatment capabilities of medicinal cannabis (MC), the ef... more Objective: To investigate beliefs about treatment capabilities of medicinal cannabis (MC), the effect of recreational cannabis (RC) on mental health and online cannabis search trends. Method: Participants ( n = 117) completed an online survey, and search engine optimisation software was used to analyse internet search trends. Results: Half the participants perceived RC as harmful to mental health but were uncertain if it impairs treatment for depression or prevents anxiety. Participants believed MC can treat depression and/or anxiety. The Google keyword ‘CBD oil’ is most popular when seeking cannabis information and provides misinformation. Conclusion: Australians are exposed to misinformation about MC online, explaining why participants believed that MC could treat anxiety and/or depression and why there is a reduction in the belief that RC is harmful to mental health. Health authorities should incorporate search engine optimisation strategies to provide accurate information about ...
Focus on Health Professional Education: A Multi-Professional Journal
Introduction: Across higher education, curriculum mapping has attracted great interest, partly dr... more Introduction: Across higher education, curriculum mapping has attracted great interest, partly driven by the need to map graduate competencies to learning and assessment for quality assurance and accreditation. Other drivers have included the need to: a) provide tools for curriculum design and renewal, b) improve communication amongst teachers and curriculum developers and c) support learning by informing students about the scope and sequence of their programs. Those embarking on curriculum mapping have sought clarification about what elements of the curriculum should be mapped, how to develop their own map or whether they should adopt externally available products. During our combined experience of mapping six different medical programs over the course of 15 years, we have frequently sought answers to these questions. However, due to the many and varying types of curriculum maps and curriculum-mapping processes that are described in the literature, answers have not been readily forthcoming. Methods: We conducted a comprehensive review of the higher education-including health professions-literature to develop a four-dimensional typology for curriculum maps, which details features related to their purpose, product, process and display. The typology was validated by testing the parameters against six curriculum maps from medical schools around Australia.
Australian Journal of Rural Health
Objective: This pilot project aimed to assess whether the Direct Access Colonoscopy Clinic is an ... more Objective: This pilot project aimed to assess whether the Direct Access Colonoscopy Clinic is an effective and safe model to reduce the time from a positive faecal occult blood test referral to a gastroenterologist-performed colonoscopy, and its effect on meeting the 120-day recommendation. Design: Before/after clinical practice and patient file audit.
Nutrition & Dietetics
J. (2019). Qualitative exploration of the experiences of renal dietitians and how they help patie... more J. (2019). Qualitative exploration of the experiences of renal dietitians and how they help patients with end stage kidney disease to understand the renal diet. Nutrition and Dietetics, 76 (2), 126-134. Qualitative exploration of the experiences of renal dietitians and how they help patients with end stage kidney disease to understand the renal diet Abstract Aim: Dietary modification is integral to the management of end stage kidney disease. However, adherence to the renal diet is poor. Few studies have explored the perspectives of renal dietitians and how they work with patients to facilitate dietary change. The objectives of this study were to explore the experiences of renal dietitians about educating patients with end stage kidney disease; and to describe the strategies perceived to help patients understand the renal diet. Methods: Semi-structured interviews based on Sensemaking theory were conducted with renal dietitians (n=27) working in Australia and New Zealand from a range of metropolitan, regional and remote areas. Results: Five major themes across two categories were derived from the data. The renal dietitians in this study experienced feelings of frustration, frequently worked in practice environments with limited or inadequate resources and perceived that establishing trust and demonstrating empathy were important to sense making. Renal dietitians helped patients make sense of and understand the diet by clarifying ambiguities and conflicting information; and simplifying complexity by using simple explanations, individualised advice and practical support. These strategies were considered critical to the renal diet sense making process. Conclusions: The experience of providing renal diet advice to adults with end stage kidney disease was emotionally and professionally challenging. Alternative approaches to patient education may help dietitians to empower patients to better understand the renal diet. Further research exploring the experiences of learning about the renal diet from the patient and carer perspective would also help to inform future alternative approaches.
European Urology Supplements
Journal of Renal Care
Background: Dietary modification is an integral part of chronic kidney disease (CKD) management. ... more Background: Dietary modification is an integral part of chronic kidney disease (CKD) management. However, adherence to the renal diet is often suboptimal. Methods: The aims of this study were to (i) describe the experiences of patients with CKD and their carers in their process of interpreting and implementing renal dietary advice; (ii) to explore strategies they used to make sense of and apply renal diet information and (iii) to develop recommendations for improved clinical practice. To achieve these aims, individual semi-structured interviews with 26 patients and 10 carers were conducted, using interview questions guided by Sensemaking theory. Findings: Six themes emerged from the data which did not differ according to CKD stage, geographic location or renal replacement therapy (RRT) type. The renal diet was perceived by patients and carers to be overwhelming, frustrating and emotionally demanding; as well as being complex and challenging. To help make sense of and apply renal dietary advice, participants highly valued the input of the dietitian; and patients believed that their carer support was important. Individual problem-solving strategies were developed by participants to help them make sense of the renal diet, and many of them expressed a desire for additional resources and/or support. Conclusions: This study highlights that learning to make sense of renal diet information is an emotionally challenging journey for patients and carers. In addition to utilising the expertise of dietitians, carer support was perceived to be integral to learning and using renal dietary advice. The study describes a number of important problem-solving strategies utilised by patients and carers, as well as recommendations to help improve sensemaking and adherence to the renal diet.
BMC Nephrology
Background: Dietary modification is an important component of the management of end stage kidney ... more Background: Dietary modification is an important component of the management of end stage kidney disease (ESKD). The diet for ESKD involves modifying energy and protein intake, and altering sodium, phosphate, potassium and fluid intake. There have been no comprehensive reviews to date on this topic. The aims of this integrative review were to (i) describe the methods used to measure dietary adherence (ii) determine the rate of dietary adherence and (iii) describe factors associated with dietary adherence in ESKD. Methods: The Web of Science and Scopus databases were searched using the search terms 'adherence' and 'end stage kidney disease'. Of the 787 potentially eligible papers retrieved, 60 papers of 24,743 patients were included in this review. Of these papers, 44 reported the rate of dietary adherence and 44 papers described factors associated with adherence. Results: Most of the evidence regarding dietary adherence is derived from studies of hemodialysis patients (72% of patients). The most common method of measuring dietary adherence in ESKD was subjective techniques (e.g. food diaries or adherence questionnaires). This was followed by indirect methods (e.g. serum potassium, phosphate or interdialytic weight gain). The weighted mean adherence rate to ESKD dietary recommendations was 31.5% and 68. 5% for fluid recommendations. Adherence to protein, sodium, phosphate, and potassium recommendations were highly variable due to differences in measurement methods used, and were often derived from a limited evidence base. Socioeconomic status, age, social support and self-efficacy were associated with dietary adherence. However, factors such as taste, the impact of the diet on social eating occasions; and dietetic staffing also appear to play a role in dietary adherence. Conclusion: Dietary adherence rates in people with ESKD are suboptimal. Further research is required on dietary adherence in patients with ESKD from different social, educational, economic and ethnic groups. This research may identify other factors which may impact upon adherence, and could be used to inform the design of future strategies to improve dietary adherence. Future research that reports not just the rate of adherence to individual components of the nutrient prescription but also the overall quality of the diet would be useful.
Journal of renal nutrition : the official journal of the Council on Renal Nutrition of the National Kidney Foundation, 2017
Mobile phone applications (apps) are increasingly being used by patients with chronic kidney dise... more Mobile phone applications (apps) are increasingly being used by patients with chronic kidney disease (CKD). We sought to describe the main purpose of commonly available renal diet apps and to quantify the accuracy of information, technical quality, and health literacy demand of renal diet apps. The design was content analysis. All eligible renal diet apps in the Australian Apple App Store, Google Play, Windows Phone, and Blackberry App World were evaluated. Eligible apps were in English and were related to kidney disease in humans (of any type or stage). Exclusion criteria included apps which were prohibited because of password protection. Renal diet information in the apps was compared with evidence-based guidelines for the management of kidney disease to quantify information accuracy. App information was evaluated using the Silberg Scale. Technical quality and health literacy demand were evaluated using the Mobile Application Rating Scale. A total of 21 apps were eligible for eval...
American journal of physiology. Renal physiology, Jan 13, 2018
Tachykinins are expressed within bladder innervating sensory afferents and have been shown to gen... more Tachykinins are expressed within bladder innervating sensory afferents and have been shown to generate detrusor contraction and trigger micturition. The release of tachykinins from these sensory afferents may also activate tachykinin receptors on the urothelium, or sensory afferents directly. Here we investigated the direct and indirect influence of tachykinins on mechanosensation by recording sensory signalling from the bladder during distension, urothelial transmitter release ex-vivo, and direct responses to NKA on isolated mouse urothelial cells and bladder-innervating DRG neurons. Bath application of NKA induced concentration-dependent increases in bladder afferent firing and intravesical pressure that were attenuated by nifedipine and by the NK2 receptor antagonist GR159897 (100nM). Intravesical NKA significantly decreased bladder compliance, but had no direct effect on mechanosensitivity to bladder distension (30µl/min). GR159897 alone enhanced bladder compliance, but had no e...
BMC medical education, Jan 23, 2018
Standard setting of assessment is critical in quality assurance of medical programs. The aims of ... more Standard setting of assessment is critical in quality assurance of medical programs. The aims of this study were to identify and compare the impact of methods used to establish the passing standard by the 13 medical schools who participated in the 2014 Australian Medical Schools Assessment Collaboration (AMSAC). A survey was conducted to identify the standard setting procedures used by participating schools. Schools standard setting data was collated for the 49 multiple choice items used for benchmarking by AMSAC in 2014. Analyses were conducted for nine schools by their method of standard setting and key characteristics of 28 panel members from four schools. Substantial differences were identified between AMSAC schools that participated in the study, in both the standard setting methods and how particular techniques were implemented. The correlation between the item standard settings data by school ranged from - 0.116 to 0.632. A trend was identified for panel members to underestim...
Purinergic Signalling
Psoriasis is a chronic inflammatory skin disorder, characterised by epidermal hyperplasia (acanth... more Psoriasis is a chronic inflammatory skin disorder, characterised by epidermal hyperplasia (acanthosis) and leukocyte infiltration of the skin. Current therapies are inadequate, highlighting the need for new therapeutic targets. The P2X7 receptor is implicated in the pathogenesis of psoriasis. This study investigated the role of P2X7 in imiquimod (IMQ)-induced psoriasis-like inflammation. Topically applied IMQ caused twofold greater ear swelling in BALB/c mice compared to C57BL/6 mice, which encode a partial loss-of-function missense mutation in the P2RX7 gene. However, there was no difference in histological skin pathology (acanthosis and leukocyte infiltration) between the two strains. IMQ treatment up-regulated P2X7 expression in skin from both mouse strains. Additionally, IMQ induced ATP release from cultured human keratinocytes, a process independent of cell death. Injection of the P2X7 antagonist Brilliant Blue G (BBG) but not A-804598 partly reduced ear swelling compared to vehicle-injected control mice. Neither antagonist altered skin pathology. Moreover, no difference in ear swelling or skin pathology was observed between C57BL/6 and P2X7 knockout (KO) mice. Flow cytometric analysis of IMQ-treated skin from C57BL/6 and P2X7 KO mice demonstrated similar leukocyte infiltration, including neutrophils, macrophages and T cells. In conclusion, this study demonstrates that P2X7 is not essential for development of IMQ-induced psoriasis-like inflammation but does not exclude a role for this receptor in psoriasis development in humans or other mouse models of this disease.
Education Sciences
Background: This study aimed to assess and compare health literacy levels in a range of universit... more Background: This study aimed to assess and compare health literacy levels in a range of university-based health students. Methods: A survey containing the Health Literacy Questionnaire (HLQ) was administered to students enrolled in university-based medical, allied health or nursing degree programs. The HLQ scores and scale scores were compared across student groups. Results: In total, 374 students (24% response rate) with a median age of 25 years (range: 17-61 years), returned completed surveys. Three students who did not identify their degree programs were excluded from the final analysis which included 371 respondents; 242 graduate-entry medical students (65%), 67 allied health students (18%) and 62 nursing students (17%). Overall, the medical students had the highest score for seven of the nine HLQ scales; while the nursing students had the lowest score for all of the nine HLQ scales. Conclusion: These results show that health literacy profiles are different across student groups. In order to provide excellent patient-centred care, and to successfully look after their own health, a high level of health literacy is required by future health professionals. Health literacy training modules, tailored according to the different needs of the student groups, should therefore be included in university-based health professional degree programs.
Journal of Medical Education and Curricular Development, 2017
Evidence-based medical practice is best achieved by developing research understanding in medical ... more Evidence-based medical practice is best achieved by developing research understanding in medical practitioners. To this end, medical councils worldwide increasingly recognise the importance of medical schools graduating students with well-developed research skills and research capacity. To meet this need, the principles of programmatic assessment were implemented in designing a research and critical analysis curriculum and assessment program that aimed to enhance the research and critical analysis skills of medical students. The program was developed by mapping assessment tasks to a research capabilities framework that was in turn scaffolded to different levels of Miler’s pyramid. The curriculum and assessments were integrated with the science, clinical, and professional aspects of the medical course. The progressive longitudinal development of research skills, with feedback and academic mentoring, culminated in the students’ capacity to undertake an independent research project. De...
American journal of physiology. Regulatory, integrative and comparative physiology, May 2, 2017
ATP release from urinary bladder is vital for afferent signaling. The aims of this study were to ... more ATP release from urinary bladder is vital for afferent signaling. The aims of this study were to localize CALHM1 and pannexin-1 expression and to determine their involvement in mediating ATP release in the bladder. Gene expression by PCR and immunohistochemistry were performed in the porcine bladder. CALHM1 and pannexin-1 mediated ATP release in response to hypotonic solution (0.45% NaCl) induced stretch and extracellular Ca(2+) depletion ([Ca(2+)]0) was measured in isolated urothelial, suburothelial and detrusor muscle cells. CALHM1 and pannexin-1 mRNA and immunoreactivity were detected in urothelial, suburothelial and detrusor muscle layers with a highest expression on urothelium. Hypotonic stretch caused a 2.7-fold rise in ATP release from all three cell populations (P < 0.01), which was significantly attenuated by the pannexin-1 inhibitor, (10)Panx1, and by CALHM1 antibody. Brefeldin A, a vesicular transport inhibitor, and ruthenium red, a non-selective CALHM1 channel blocker...
Nephrology (Carlton, Vic.), Jan 9, 2016
A comparison of the extent and pattern of cognitive impairment among predialysis, dialysis and tr... more A comparison of the extent and pattern of cognitive impairment among predialysis, dialysis and transplant patients: a cross sectional study from Australia AIM: The aim of this study was to compare the extent of cogntive impairment and the types of cognitive deficits in an Australian cohort of four patient groups with end stage kidney disease. Characteristics predicting the presence of cognitive impairment were also evaluated. Observational cross sectional study of one hundred and fifty five patients with end stage kidney disease recruited from a regional Australian renal unit. Eligible participants included those whose estimated Glomerular Filtration Rate was < 30 ml/min/1.73 m(2) ; were undertaking peritoneal or hemodialysis, or had received a kidney transplant. The Montreal Cognitive Assessment tool was used to screen the study participants for cognitive impairment and evaluate cognitive deficits. Cognitive impairment was defined as a total Montreal Cognitive Assessment tool sc...
Neurourology and Urodynamics, 2012
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Papers by Kylie Mansfield