The Medical Link – Issue 145

medical link THE OFFICIAL PUBLICATION OF THE GOLD COAST MEDICAL ASSOCIATION INC.

In Loving Memory of Professor John Corbett "A true gentleman of wisdom and compassion, who will be greatly missed by all who knew him."

ISSUE 145 | JUNE – JULY 2023

Trusted by Doctors... Preferred by Patients

PIMPAMA

EXIT 49

NOW OPEN

South Coast Radiology is pleased to announce the opening of a new imaging practice in Pimpama, April 2023. For over 50 years, South Coast Radiology has serviced the Gold Coast community by providing expert and compassionate medical imaging for patients. Now expanding into the northern Gold Coast suburbs, the new Pimpama site will offer a comprehensive range of services including MRI, CT and Nuclear Medicine, same day appointments, acceptance of all referrals, free easy access parking and bulk billing for majority of services.

We look forward to welcoming our patients to a brand new, bright and inviting practice!

Bulk Billing available for majority of services

Located at Pimpama Health Precinct 7 Attenborough Blvd, QLD 4209 P: (07) 5616 6370 | F: (07) 5616 6379 Monday to Friday 8:00am - 5:00pm

Imaging Services Available at Pimpama • • • • •

Digital X-Ray Ultrasound CT Scan 3T MRI Dental

• • • • •

Nuclear Medicine Obstetric Ultrasound CT Angiography Interventional Procedures Calcium Score

Pimpama | Burleigh Waters | Benowa | Hope Island Pindara Private Hospital | John Flynn Private Hospital Oxenford | Palm Beach | Robina | Runaway Bay Miami | Southport | Smith Street | Tweed Heads The Women’s Imaging Centre Southport Darling Downs | Mackay

1300 197 297 www.scr.com.au

Specialist Insight.

Trusted Care.

Benowa Clinic Now Open 117 Ashmore Rd, Benowa (In the AMart Complex) Panorama Radiology Specialists' state-of-the-art Benowa clinic is now open at 117 Ashmore Rd (in the AMart Complex).

As the Benowa medical precinct’s only comprehensive, doctor-owned medical imaging clinic, our highly experienced technologist team led by principal radiologist Dr Angus Watts, are committed to providing our local Gold Coast community with personalised patient-focussed care, premium and innovative technologies, and outcomes-driven imaging-guided pain management.

The Panorama team are passionate about our craft and committed to providing the highest standard of medical imaging for our patients and referrers in a personalised, non-corporate environment.

BULK BILLING OF ALL MEDICARE-ELIGIBLE REFERRALS ALL REFERRALS ACCEPTED 90 FREE ONSITE CARPARKS As a Fellowship-trained musculoskeletal and interventional radiologist with 2 decades of experience in private radiology, Dr Watts is always happy to discuss clinical cases and imaging-guided pain management pathways with referring clinicians.

Call (07) 5654 5133

Monday to Friday 8am - 5pm

General Medical Imaging.

Spine, Joint & Interventional Specialists.

3T MRI - with Deep Resolve AI, in-scan TV & 80% noise suppression Low Dose 640-slice CT with AI Low Dose Cardiac CT Ultrasound Echocardiography EOS Spine & Joint Scans X-Ray Imaging-Guided Pain Management Biopsies OPG & Cephalometry CT Dentascan BMD & Body Composition

• Same-Day MRI (standard fee $295).

• Same-Day Echocardiography (Bulk Billed).

• CT Coronary Angiography & Calcium Scoring (Specialist & GP referrals).

• Subspecialist Musculoskeletal Imaging and Interventional Pain Management.

• 2 minutes from Pindara Hospital.

• Industry-leading Technology.

• Radiologist owned & operated.

• Prompt, clinically-focussed reporting.

Book online at panoramaradiology.com.au

THE MEDICAL LINK •

Contents 06 A Message From the GCMA President Prof Philip Morris AM FEATURE STORY 10

Obituary for Professor John Corbett

EDITORIALS 14

Panorama Radiology Specialists' State-of-the-Art Benowa Clinic: Re-Focussing on Personalised, Patient-Centric Care Panorama Radiology Specialists

18 South Coast Radiology Revolutionises MRI Services on the Gold Coast

by Expanding Access to Advanced Imaging Technology South Coast Radiology 24

The Illness and Death of Robert Louis Stevenson Prof Gordon Wright

28 Physical Mobility and Dysphagia Severity in the Elderly Celine Raschilla SOCIALS 20

The Gold Coast Medical Association Monthly Meeting, May 2023

The Medical Link would like to issue a statement of editorial retraction for our recent publication of the article titled 'Improving Access to Lymphoedema Screening and Early Intervention'. We deeply apologise for the misprint and misattribution of the author Dr. Mohammed Islam. We understand the importance of proper attribution and regret any confusion this may have caused. We take full responsibility for this error and are taking steps to ensure that this does not happen again in the future. We are committed to upholding the highest standards of journalistic integrity. We extend our sincerest apologies to Dr. Islam and all of our readers.

medicallink.com.au • 5

• THE MEDICAL LINK

A Message from the GCMA President Prof Philip Morris AM, President GCMA MB BS BSc PhD FAChAM (RACP) FRANZCP FPOA FFP ABPN info@drphilipmorris.com | 0422 545 753 | www.drphilipmorris.com

Dear GCMA colleagues, Our monthly Thursday evening dinner meeting in May was well attended and members benefitted from a lively discussion about weight loss interventions comparing surgical approaches (Dr Harald Puhalla) with the new diabetes weight loss medications (Dr Mark Forbes). We hope this presentation will be the basis of an upcoming article for The Medical Link.

Our next Thursday evening meeting will be on 20 July. The topic will cover ‘New treatments for skin cancers’ by Dr David Christie (Genesis Care, John Flynn Hospital). Please noteour venue will change for this and subsequent Thursday evening meetings. We will be meeting at Bumbles Café at

19 River Drive (Budds Beach) in Surfers Paradise.

A complimentary special cocktail beverage will mark our move to Bumbles. Dinner will be provided as well for GCMA members and guests.

Please come along and bring a colleague.

The next Thursday evening meeting after that will be on 18 November. This meeting will cover issues relevant to ‘Veterans’ Mental Health’. The presenter is Dr Kenneth Cameron from Innovative Medicine Queensland.

In between these meetings will be our blockbuster Samoan Medical Conference in Apia, Samoa from 29-30 September 2023.

This medical conference is a joint effort with our sister association, the Samoan Medical Association, and is in collaboration with the Oceania University of Medicine, the National University of Samoa Medical School, and the Samoan Ministry of Health. The meeting is sponsored and supported by our own Bond and Griffith Universities. The meeting venue is the fabulous Taumeasina Island Resort, Apia. We have negotiated an amazing discount on accommodation prices at this resort.

When you register at the link below please get the conference accommodation codes to use to get this discount when you book your accommodation at the resort by email or at the resort website.

presents

FIND THEM

SAVE THE DATE

Proposed RACGP Educational Activity Hours Event

WHEN: Saturday 19th August 2023, 8.30am - 3.30pm WHERE: Pier 33, Mooloolaba MC Dr Rob Park | Pain Specialist, Dr Ingrid Hutton | Rheumatologist, Dr Stephen Byrne | Neurosurgeon, Dr James Tunggal | Orthopaedic Surgeon, Travis Schultz | Lawyer, Dr Paul Frank | Pain Physician, Dr Peter Georgius | Pain Physician, Dr Daevyd Rodda | Orthopaedic Surgeon, Dr Tim Butson | Rehab Physician + Psychologist, Neurologist, Sports Doctor, Musculoskeletal GP & more!

RSVP: conference@sportsandspinalphysio.com.au

THE GCMA PRESIDENT'S REPORT •

The meeting is within the Queensland school holidays, so please consider taking your family for a wonderful South Pacific Island holiday in Samoa at the same time. Direct flights from Brisbane to Samoa are now available. Please go to the link below to see the program, to register, and to get the resort accommodation codes. I do hope you will support the GCMA and our Samoan medical colleagues by coming to this conference. www.eventbrite.com.au/e/gcmasamoan-medical-conference-2023tickets-524227046207

We are always looking to expand our membership.

I encourage you to invite your doctor colleagues to join the GCMA. It is very easy to do. Just go to the GCMA website (www.gcma.org.au) and click through to the ‘Become a Member’ page to join. The registration page can take credit card payments. The $150 annual membership is extremely good value. It covers Thursday evening meetings where salient updates on clinical and professional matters are presented as well as a twocourse meal and complimentary beverage, and the opportunity to interact with colleagues from all professional disciplines. I would like to thank those members who have renewed their membership for 2023. Your support is always appreciated.

The GCMA is always ready to welcome new members to the leadership team. Please give me a call on phone number is 0422 545 753 if you are interested.

I look forward to seeing you at our July dinner meeting.

Yours sincerely, Prof Philip Morris AM President GCMA

Advertising in The Medical Link If you would like to advertise your products or services, positions vacant, rooms for rent etc. in The Medical Link, please feel free to contact us at admin@themedicallink.com.au.

Advertising of medical services in The Medical Link should comply with the same advertising guidelines released in the Medical Board of Australia Code of Conduct: Be factual and verifiable | Not include testimonials | Only make justifiable claims regarding quality and outcomes | Not raise unrealistic expectation | Not offer inducements | Not make unfair or inaccurate comparisons between your services and those of colleagues The Medical Link is designed and published by Swan Management Services. It is the advertiser’s responsibility to ensure that advertisements comply with the Trade Practices Act 1947 as amended. All advertisements are published on the condition that the advertiser indemnifies the publisher and its servants against all claims, suits, actions, loss and/ or damages as a result of anything published on the advertiser’s behalf.

DISCLAIMER: The contents of articles and opinions published are not necessarily held by the publisher, editor or the Gold Coast Medical Association. No responsibility is accepted by the publisher, editor or Gold Coast Medical Association for the accuracy of information contained in any opinion, information, editorial or advertisement contained in this publication and readers should rely upon their own enquiries in making decisions touching own interest. Unless specifically stated, products and services advertised or otherwise appearing in The Medical Link are not endorsed by the publisher, editor or the Gold Coast Medical Association.

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MEDICAL EDITORIAL COMMITTEE

Philip Morris, Geoff Adsett, Stephen Withers, John Kearney, Maria Coliat

GCMA MEMBERS gcma.org.au

GCMA EXECUTIVE COMMITTEE

President Prof Philip Morris 5531 4838 Vice-President Dr Maria Coliat 5571 7233 Secretary Prof Philip Morris 5531 4838 Immediate Past President Dr Sonu Haikerwal 5564 6255 Treasurer Dr Geoff Adsett 5578 6866 Specialist Representative Prof John Kearney 5519 8319 GP Representative Dr Katrina McLean 5564 6501 Academic Representative Prof Gordon Wright 5595 4414

Keeping the Medical Community Informed The Medical Link enriches the Gold Coast medical community by uniting the voice of its doctors.

Here you will find insightful stories and the latest trends in field research conducted abroad, and of course, right here on the Gold Coast. Keep informed of new health services, developments in the medical profession, and general interest items.

We invite you to submit your company updates, new recruits and promotions to the following email: admin@themedicallink.com.au And if you would like to advertise your products or services, positions vacant, rooms for rent etc. in The Medical Link, please feel free to contact us admin@themedicallink.com.au.

Obituary for Professor John Corbett 1940 – 2023 It is with a sad heart I note the recent passing of our respected and esteemed college, Prof John Corbett (obituary on following pages). John was an exceptional neurologist and the Gold Coast was privileged to have him as a practitioner here. He was thoughtful mentor and educator to medical students and physician trainees and a respected advisor to medical colleagues. He brought sophisticated neurological investigation techniques to the Gold Coast at his distinctive Queenslander home/ practice in Southport. We will all miss John. We pass on our most sincere sympathy and condolences to his wife Lorraine and his family.

Prof Philip Morris AM President GCMA

10 • Issue 145

medicallink.com.au • 11

FEATURE STORY • THE MEDICAL LINK

A true gentleman of wisdom and compassion, who will be greatly missed by all who knew him.

Passing of eminent Gold Coast neurologist, Professor John Corbett One of the Gold Coast's most respected medical practitioners, Professor John Corbett, has died.

An eminent neurologist, Rhodes Scholar and founder of Corbett Neurophysiology Services, 82-year-old Professor Corbett served the Gold Coast for three decades in the fields of neurology, neurophysiology, and sleep medicine. His passing closes a medical, scientific and business career that spanned more than 50 years in the UK, US and Australia.

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Born in Brisbane in 1940, John Corbett excelled in his early studies becoming Dux of his primary school and a captain of Gregory Terrace. The recipient of an Open Scholarship to the University of Queensland, he graduated in 1964 with a Bachelor of Medicine and a Bachelor of Surgery.

In 1965, Professor Corbett was awarded a Rhodes Scholarship and spent the next nine years at the University of Oxford, where he completed his PhD in Neurophysiology. He also became the inaugural BMA Research Fellow, an Oxford Don and published more than 50 articles in learned academic journals.

New opportunities tempted him away from Oxford and in 1973 he took up senior neurology appointments at Harvard University and Massachusetts General Hospital in the US. Returning to Australia in 1974, he fulfilled a Senior Neurology role at the Royal Brisbane Hospital before launching his private neurology clinical practice in Sydney. His expertise proved invaluable in the medical arena and the law, culminating in more than 5,000 medico-legal reports and regular appearances as an expert witness. He was involved in placing the first ever CT machines in Australia into the North Shore Private Hospital and other locations.

Obituary for Professor John Corbett 1940 – 2023 In the 1980s, Professor Corbett decided to try his hand at business and industry. To this end he worked in the field of mining of minerals – clay, tin and gold and he was an innovator in the development of ultrasonic engineering applications for piling, earthmoving, mining and mineral processing. His next foray was Weapons Training Systems, involving high level contracts with the Australian Army and various international contracts, such as the USA Army.

He was regarded as the saviour of the Kemtron and Lomah groups. Like everything he turned his mind to, he proved to be a successful businessman but he missed the challenges medicine had given him and ultimately, resumed his medical career.

Professor Corbett launched Corbett Medical Services on the Gold Coast in 1994, operating out of the magnificent family home, Surrey House, in Southport. He was also a founding member of SNORE Australia, which became Australia’s largest provider of Level 1 sleep studies.

In 2000 John and Lorraine purchased a 156-acre botanical estate at Springbrook adjacent to the World Heritage Rain Forest and spent 22 years fulfilling his love of nature, he worked tirelessly on beautifying the land. He could then be found on the weekends on a tractor plowing fields and planting tree farms.

He received the Australian Centenary Medal Award in 2001 for Distinguished Service in the Field of Medicine. In 2011, Epilepsy Queensland presented him with its Flame Award for his years of services and support.

In 2021, Professor Corbett was diagnosed with the terminal condition Progressive Supranuclear Palsy. He is survived by his devoted wife Lorraine, much loved daughter Vanessa, son in law Sean, and grandchildren Brooke and Harrison.

A true gentleman of wisdom and compassion, who will be greatly missed by all who knew him.

medicallink.com.au • 13

"The clinic’s launch is a reflection of an emerging shift in the Australian diagnostic imaging market, whereby after a decade of virtual monopolisation by multinational corporate providers, we're now seeing the pendulum swing back toward the traditional doctor-owned model."

14 • Issue 145

ADVERTORIAL

Panorama Radiology Specialists' State-of-the-Art Benowa Clinic: Re-Focussing on Personalised, Patient-Centric Care Panorama Radiology Specialists 13/117 Ashmore Rd, Benowa (in the Amart Complex) (07) 5654 5133 | panoramaradiology.com.au

The April opening of Panorama Radiology Specialists' new comprehensive independent clinic at 117 Ashmore Rd, Benowa (in the AMart complex) delivered a much needed boost to radiology service accessibility in the Benowa medical precinct, offering Bulk Billing of all Medicare eligible referrals, industry-leading equipment and personalised, patient-centric care delivered by a team with two decades of experience.

Same day appointments are generally available for CT, MRI, Echocardiography, EOS scans, DEXA, Dental Imaging and XRays.

Principal radiologist, Dr Angus Watts, said "the clinic’s launch is a reflection of an emerging shift in the Australian diagnostic imaging market, whereby after a decade of virtual monopolisation by multinational corporate providers, we're now seeing the pendulum swing back toward the traditional doctor-owned model, with a focus on high quality service provision and personalised patient-centric care, rather than turnover volumes and share prices. With the rapidly-growing ageing population on the Gold Coast and the recent pandemic-driven migration from southern states,

there has been a period of substantial growth in demand for medical services, and a steadily-rising mismatch between demand for diagnostic imaging services and accessibility by the local community. It became apparent that the sheer volume of demand for diagnostic imaging in the region was beginning to take a toll on the accessibility, affordability and quality of imaging services for many patients, particularly for complex diagnostic services such as MRI, CT Coronary Angiography and imaging guided pain management procedures.”

The Panorama Radiology Specialists team - Andrew, Nikki, Sam, Dr Angus Watts, Ashley, Zoe, Jack, Helen and Carolyn.

medicallink.com.au • 15

• THE MEDICAL LINK

“The escalating demand and accessibility shortfall led me to explore the concept of a large-format 'one stop shop' for medical imaging services, offering high quality comprehensive diagnostic and interventional services with a personalised, patient-centric focus, Medicare Bulk Billing, extensive onsite parking, easy ground floor access for older patients and minimal waiting times.”

The 1300sqm site in the Benowa Amart complex was once an ice skating rink in the '80s, and later a furniture warehouse. But following a major infrastructure upgrade and redevelopment, the completed site comprises an 850sqm radiology facility fitted with industry-leading technology, conference facilities, and collocated medical consulting suites, which currently have lease availability through Ray White Commercial.

A self-confessed tech geek, Dr Watts and Panorama’s technologist team, led by leading MRI technologist Sam Bradshaw, are committed to exploring new and innovative technologies including Deep Resolve AI image enhancement for the clinic's Siemens 3T MRI scanner.

Dr Watts said "the scanner is game-changing technology which is producing exceptional detail of fine structures such as the scapho-lunate and LisFranc ligaments, substantially more detail than conventional 3T MRI machines were producing even 2 years ago. As a musculoskeletal radiologist this is an exciting development, and brings a greater level of certainty to the diagnosis of subtle nerve and tendo-ligamentous pathologies, in addition to oncology and neuro-imaging applications. We’re also exploring emerging technologies such as MRI Discography (Disc Spectroscopy) for non-invasive

localisation of discogenic back pain, and DTI (Diffusion Tensor Imaging) for mapping of neural pathways and muscle tears.

Panorama's advanced low dose EOS scanner offers precise spinal alignment and leg length measurements to complement the range of spinal imaging and imaging guided pain management services. The clinic also offers specialist and GPreferred low-dose CT Coronary Angiography and CT Calcium Scoring using an advanced 640-slice CT Scanner with AI image enhancement, in addition to bulk billed Echocardiography, Imaging-guided Pain Management Procedures, Ultrasound, Xray, dental imaging and DEXA. "Now we’re well into our second month of service provision, it's very clear that there is indeed a strong demand for accessible and affordable, high quality personalised imaging services, and it's been extremely rewarding to have received overwhelmingly glowing feedback from our patients and clinicians that we are meeting that demand and exceeding expectations."

Dr Watts is a fellowship-trained Musculoskeletal and Interventional Radiologist with two decades of experience, was formerly a Managing Partner and Clinical Director at SCR, and served as a musculoskeletal radiologist at the 2018 Commonwealth Games. He is also an accredited CT Coronary Angiography reader, and an experienced prostate mpMRI reader.

Dr Watts is always happy to discuss clinical cases and interventional pathways with referring clinicians.

Panorama Radiology Specialists 3T MRI offers in-scan audiovisual entertainment and 80% noise reduction for optimal in-scan patient comfort.

16 • Issue 145

OncoBeta® Rhenium-SCT®: a non-invasive approach to non-melanoma skin cancer therapy is now available1 OncoBeta® Rhenium-SCT® is a precise, personalised treatment for non-melanoma skin cancer (NMSC) lesions.1 It is the only therapy available that utilises the rhenium-188 isotope to treat NMSCs. Available now at John Flynn Private Hospital, Tugun, as part of a program headed by A/Prof Sid Baxi (Radiation Oncologist, Regional Medical Director - Gold Coast, MBBS, GAICD, FRANZCR).

How does it work?

Rhenium-SCT® provides localised skin irradiation with the rhenium-188 isotope.2-4 Its therapeutic effect is based on the celldestroying effect of emitted β particles, which triggers both local cell death and reactions of the immune system to repair itself.2-4 Rhenium-SCT® releases a maximum 2.1 MeV with penetration depths of 2-3mm.2-4 Since 90% of its energy is released within the first 2 mm, Rhenium-SCT® spares the underlying tissue layers.3,4 Additionally, its short half-life means the isotope decays within hours.2,3

What does OncoBeta® RheniumSCT® mean for your patients?

•

No pain during treatment With Rhenium-SCT®, patients experience no pain for the duration of treatment with well-tolerated skin reactions.4

•

No surgery, no anaesthesia and minimal scarring Rhenium-SCT® is non-invasive and does not require hospitalisation or anaesthesia.2-4 The procedure also results in little to no scarring.2,4

References: 1.

Therapeutic Goods Administration. ARTG Public summary 400142. OncoBeta Therapeutics Pty Ltd - Radionuclide system, therapeutic, brachytherapy, manual.

Effective date: 24/11/2022.

2.

Sedda AF, et al. Clin Exper Dermatol. 2008; 33:745-749.

3.

Cipriani C, et al. J Dermatol Treat. 2022;33(2):969-975.

4.

Castelluci P, et al. Eur J Nucl Med Mol Imaging. 2021;48(5):1511-1521 5.

Cipriani, C., Sedda, A.F. (2012). Epidermal Radionuclide Therapy: Dermatological HighDose-Rate Brachytherapy for the Treatment of Basal and Squamous Cell Carcinoma.

In: Baum, R. (eds) Therapeutic Nuclear Medicine. Medical Radiology(). Springer, Berlin, Heidelberg. https://doi.org/10.1007/174_2012_778.

6.

Carrozzo AM, et al. Eur J Dermatol. 2013;23(2):183-188.

7.

Carrozzo AM, et al. G Ital Dermatol Venereol. 2014;149(1):115-21.

Who is suitable for OncoBeta® Rhenium-SCT®?

Oncobeta® Rhenium-SCT® is approved for the treatment of basal and squamous cell carcinomas of the skin.1 It offers a valid alternative to surgery in cases where multiple lesions require treatment, or where aesthetic or functional outcomes may be difficult to achieve with surgery due to tumour location.2-4,7 This therapy is also suitable for patients where relapse has occurred after previous surgical procedures and in patients who aren’t candidates for surgery due to age, comorbidities or refusal.2-4 Rhenium-SCT® is contraindicated with pregnancy or suspected pregnancy or in people less than 18 years of age.5 It is also not appropriate for patients who have a diagnosis of melanoma skin cancer, have tumours that involve nerves or bony structures, or are located on the upper eyelid, and/or have disorders that could affect wound healing.

Now available through GenesisCare at John Flynn Private Hospital, Tugun.

To refer patients: T: 07 5507 3600 | F: 07 5507 3610 E: receptiononcologytugun@genesiscare.com (Or visit the healthcare professional portal genesiscare.com).

"South Coast Radiology’s network of MRI scanners and mix of Medicare funding offers patients a unique one point of contact access to the most affordable and advanced technology available, conveniently located close to where they reside."

— Warren Berry

18 • Issue 145

ADVERTORIAL

South Coast Radiology Revolutionises MRI Services on the Gold Coast by Expanding Access to Advanced Imaging Technology South Coast Radiology Varsity One, Level 3, 1 Lake Orr Drive, Varsity Lakes 1300 197 297 | www.scr.com.au

South Coast Radiology has opened a sixth MRI clinic in Pimpama to provide world class MRI services for the northern part of the Gold Coast community.

With the opening of South Coast Radiology Pimpama practice in April 2023, South Coast Radiology’s network of medical imaging clinics now includes 6 MRI scanners across the Gold Coast. Their network of 15 practices are staffed daily by sub-specialised Medical Imaging Radiologists trained in reporting MRI scans as far north as Pimpama, and as far south as John Flynn Hospital.

In addition, South Coast Radiology’s Benowa and John Flynn Hospital MRI scanners are fully licensed by Medicare, while Medicare partially licenses their Smith Street and Robina MRI scanners. These four MRI scanners are amongst the very few which patients receive a rebate from Medicare on the Gold Coast.

To receive the rebate from Medicare, the exam type must be listed on the Medicare Benefits Schedule (MBS), be performed on a Medicare-eligible MRI scanner and the request form must reference the appropriate Medicare item number or clinical details.* Not only is South Coast Radiology able to access Medicare rebates for MRI scans, but they were also the first in Australia to provide MRI “AIR” Technology at their Robina and Smith Street clinics. This technology uses AIR Recon DL, a deep learning-based reconstruction tool to improve image quality and sharpness, delivering superior image quality compared to previous technologies in a significantly reduced scan time.

Overall, this means that the patient spends less time in the MRI scanner without any compromise on image quality.

SCR General Manager Warren Berry says that because of these MRI technology advancements,

South Coast Radiology can provide the entire Gold Coast region with world class medical imaging while ensuring convenient access for all patients across the city.

“South Coast Radiology’s network of MRI scanners and mix of Medicare funding offers patients a unique one point of contact access to the most affordable and advanced technology available, conveniently located close to where they reside.”

To discover more about South Coast Radiology’s MRI services across the Gold Coast, please visit www.scr.com.au/services/mri today. *Please refer to the MBS for the specific clinical indications that are rebateable or contact the South Coast Radiology Bookings Team on 1300 197 297.

medicallink.com.au • 19

SOCIALS • THE MEDICAL LINK

Gold Coast Medical Association Monthly Meeting, May 2023

Dr Alison Sprague, Dr Stephen Sprague and Dr Mohammed Khateeb

Dr Graham Sivyer

Prof Gordon Wright and Dr Roger Wilson

Prof Stephen Weinstein and Dr Mark Forbes

SOCIALS • THE MEDICAL LINK

Dr Maryse Badawy and A/Prof Athol Mackay

Prof Stephen Weinstein introducing A/Prof Harald Puhalla

A/Prof Harald Puhalla and Dr Cherian Varughese

A/Prof Harald Puhalla

The Illness and Death of Robert Louis Stevenson "No appropriate laboratory or radiological tests were available during his life. It is fascinating to speculate about the cause of his death."

Prof Gordon Wright B.Sc, M.B. Ch.B. F.R.C.P.A. gwright@bond.edu.au

24 • Issue 145

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• THE MEDICAL LINK

Robert Louis Stevenson was one of the three major Scottish Literary figures of the 18th and 19th centuries along with Scott and Burns. His short life, which was prolific and influential, featured constant travel to find environments beneficial to his health. He finally settled in Samoa where he died after a stroke at the age of 44.

Stevenson was born in Edinburgh into a wealthy upper middle-class family of engineers famous for their design and construction of lighthouses. He was an only child and sickly. He was described as having weak lungs from early infancy and by the age of two had his own nurse. Although he was a slow reader, he was noted to be bright and creative.

As a child he won poetry competitions and at the age of 16 his historic novel “The Pentland Rising” was published by his father. He had remarkably little schooling – spending less than one year at Edinburgh Academy. Private tutors were hired, and he later attended Edinburgh University from the age of 16. The study of science and engineering did not capture his attention and disappointed his father. He wanted to be a writer. A compromise was reached with his father, and he studied law and qualified as an advocate.

Frances Osbourne, an American woman studying in France. The relationship was complicated because she had separated from her philandering husband, and she had two children. While it was clear that there was deep affection between them and she was a great champion of his work, they were cautious because Stevenson was to some extent dependant of financial support from his father. As a result, Frances returned to California.

Stevenson’s health at this stage was poor but deterioration was minimal. Frances, or Fanny as she was usually called, cabled Stevenson about her dire circumstances resulting from her divorce and her deteriorating mental health. This encouraged the now impoverished Stevenson to travel second class on the “Devonia” from Port Glasgow to New York where he hoped to find a US publisher. Initially he was unsuccessful. His health was deteriorating, and he used his minimal resources to travel across America on a migrant train. He was near death when he was reunited with Fanny and took some time to recover. He suffered repeated pulmonary haemorrhage but recovered and following Frances’ divorce, they married. Stevenson eked out a living with some published articles and his parents accepted the situation and provided an annuity.

All through this time, his health was poor and in addition to dyspnoea and cough he was noted to have pulmonary haemorrhages. A diagnosis of tuberculosis was made. The search for a climate that would improve his respiratory symptoms had begun.

Initially he travelled with his cousin to France, and he wrote two travel books which were well received. His health was remarkably good at this time and his life would change for ever. He met

Stevenson, accompanied by his wife and twelveyear-old stepson, Lloyd, returned to Scotland in August 1880 and went on holiday with his parents (with whom there was a full reconciliation) to Strathpeffer, in the highlands. Thenceforward Stevenson's life was that of an invalid suffering from chronic lung disease and at risk from haemorrhages and prostrating coughs and fevers.

Two winters were spent on medical advice, at Davos, a dismal health resort in the Swiss Alps.

In July 1884 Stevenson and his wife moved to Bournemouth, where Lloyd Osbourne was at school, and finally decided to settle there. Thomas Stevenson bought his daughter-in-law a house in nearby Alum Chine, which they renamed Skerryvore . For most of his years in Bournemouth, Stevenson lived the life of an invalid plagued by colds and haemorrhages—a life later remembered as that of 'the pallid brute that lived in Skerryvore like a weevil in a biscuit'. Bournemouth was seen as a health resort in the 19th century. A change of air was often prescribed for patients with consumption. It has been considered by some experts that this was the reason Stevenson persisted in living there despite his reported deterioration. It is notable that his most successful writing occurred during this period. It was the time his fortune was made, and his financial security was established.

Treasure Island, The Strange Case of Dr Jekyll and Mr Hyde and Kidnapped were published between 1884 and 1887. Kidnapped was mostly written in his sick bed by Stevenson. The author’s health was so poor that a new change of air was needed.

Now financially secure Stevenson and his family returned to the USA. They stayed in upstate New York where he wrote The Master of Ballantrae.

In the cold snowy landscape near the Canadian border his health improved, and the family travelled in style to California. The California air kept his cough under control and soon the Pacific voyaging commenced. The family sailed to Hawaii where they lived in the small village of Waikiki for over a year and more writing continued. Restless for adventure they sailed to the Marquesas and Kiribati, then named the Gilbert Islands. All these experiences influenced his subsequent decisions and his writing. After visiting Tahiti, they settled in Samoa. During this period Stevenson was remarkably well, except for a pulmonary haemorrhage in Tahiti.

For the last four years of his life Stevenson made his home on his plantation of Vailima, beautifully situated 600 feet above sea-level, on the mountainside among thick woods, with fine views of the Pacific. His main absences were two brief visits to Sydney, in the spring of 1891 and again in 1893, and a visit to Honolulu in the autumn of 1893; he returned from all of these in worse health. They moved into the new house in April 1891. Stevenson gathered his family around him and lived in patriarchal style, like a clan chieftain.

Stevenson spent the morning of 3 December 1894 happily dictating Weir of Hermiston to his stepdaughter. At sunset he joined his wife on the verandah and collapsed while helping her to prepare a mayonnaise for dinner: two hours later, without regaining consciousness, he died of a cerebral haemorrhage. The following day forty Samoans cut a steep path up the mountainside, and he was buried (by his own wish) on the summit of Mount Vaea.

The Vailima homestead in the 1890s.

26 • Issue 145

The certified cause of Stevenson’s death was cerebral haemorrhage. The details of Stevenson’s

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medical history have been well documented.

There are pros and cons regarding the diagnosis of tuberculosis, and tuberculosis was supported by senior clinicians of the time. No appropriate laboratory or radiological tests were available during his life. It is fascinating to speculate about the cause of his death.

Using artificial intelligence (chat gpt) and inserting the clinical history the following information was provided: There could be other possible diseases or conditions that could have contributed to the sudden death of the man based on the information provided. Some potential considerations could include: Cardiovascular diseases: Conditions such as a heart attack (myocardial infarction), aortic dissection, or other cardiovascular abnormalities can lead to collapse and loss of consciousness.

Stroke: Apart from a cerebral haemorrhage, an ischemic stroke (blockage of blood flow to the brain) or other types of brain-related conditions could result in collapse and unconsciousness.

Pulmonary conditions: In addition to pulmonary

tuberculosis, other respiratory conditions such as severe asthma exacerbation, pulmonary embolism, or severe chronic obstructive pulmonary disease (COPD) exacerbation could lead to collapse.

Neurological conditions: Certain neurological disorders, such as epileptic seizures or brain tumors, may cause sudden loss of consciousness and subsequent death.

Infectious diseases: Various severe infections, including sepsis or meningitis, can lead to rapid deterioration and loss of consciousness.

These are just a few examples of potential alternative diagnoses that could be considered.

However, it's important to note that an accurate diagnosis would require a comprehensive evaluation of the man's medical history, physical examination, and possibly additional tests. Only a qualified healthcare professional, reviewing all relevant information, would be able to provide a definitive diagnosis.

Consumption or tuberculosis was a destroyer of lives and livelihoods. Before 1850, it was responsible for one in four deaths worldwide. Until the 1870s it was the number one killer of Britons.

Because consumption was so rampant, the medical and social perceptions of the disease influenced where and when consumptive patients went for the Change of Air if they were able to move about at all. Not at all surprisingly, consumptive patients dominated the travelling invalid scene; in 1850, an estimated 90% of travelling British invalids suffered from consumption. Because consumption had no cure, all its treatments were palliative; they involved making the patient as comfortable as possible in the right climate, so the body could, in the fulness of time, possibly heal itself.

Tuberculosis must be regarded as the most likely cause of Stevenson’s pulmonary disease. The most important differential diagnosis is bronchiectasis.

The early onset of illness and stabilisation in middle age could fit with this diagnosis.

I am not sure about Stevenson’s cause of death but from the history cerebral haemorrhage is a likely cause.

medicallink.com.au • 27

"It is clear epidemiologically that dysphagia is highly prevalent in the elderly, however, the relationship between dysphagia and significant medical factors such as mobility is not well-established despite both sharing a function of the neuromuscular system."

28 • Issue 145

Physical Mobility and Dysphagia Severity in the Elderly Celine Raschilla celine.schirripa@oum.edu.ws

Abstract

Background

Background: The purpose of the study performed was to determine if there was a positive correlation between physical mobility status and dysphagia outcomes within the elderly population (65 years and above) with oropharyngeal dysphagia.

Previous research into this relationship exists primarily within the paediatric population and is more specifically with reference to paediatric neuromuscular conditions, however, the focus of our study was to identify whether similar findings will also apply to adult populations.

Dysphagia; described generically as a difficulty with swallowing, can be further isolated and defined as oropharyngeal in aetiology and is associated with inability to safely and comfortably transition a food bolus from mouth to oesophagus [1]. Oropharyngeal dysphagia is well-known and established to affect older populations of individuals with much more significant epidemiology as compared to younger adults and children [1]. Australian and New Zealand statistics indicate that a significant proportion of older adults experience dysphagia, with estimates as high as a prevalence of 22% and an incidence of 40-50% for elderly adults who reside in residential or long-term care facilities [2]. Dysphagia has also been associated with consequent impact on quality of life of the individual as they may withdraw from enjoyable activities surrounding eating or drinking which can result in social isolation and low mood [3]. When factoring in the estimated incidence with the social and emotional impact of the condition the importance becomes highly evident for increasing our understanding of how to prevent dysphagia, its deterioration and subsequent outcomes.

severity [4] but that there was a significant increase in odds of having oropharyngeal dysphagia for children who were non-ambulant compared to those were ambulant. A further study performed

by Kim et al. [5] explored the characteristics of dysphagia in children with Cerebral Palsy, related to gross motor function. They reported that in the more severely impaired mobility group characteristics such as reduced lip closure, inadequate bolus formation, residue in the oral cavity, delayed triggering of pharyngeal swallow, reduced larynx elevation, delayed pharyngeal transit time and aspiration were significantly more common. They reported that aspiration occurred in 50% of the children who had severe CP and corresponding gross motor disability compared to 14.3% with moderate and none with mild CP [5]. One study was found regarding the older adult population which utilised self-surveys in the context of Parkinson’s Disease, whereby the researchers found a significant association between declining gross motor function and dysphagia [6]. This was the only study however focusing this relationship within the older adult setting amongst the literature.

Studies on the relationship between physical mobility and dysphagia have been explored in greater depth in the paediatric population, particularly within the medical context of Cerebral Palsy (CP) and much less so with adults. A study performed by Benfer et al. [4] investigated the prevalence of oropharyngeal dysphagia and its subtypes (oral phase, pharyngeal phase and saliva control) and the relationship between gross motor skills in preschool children with diagnosed Cerebral Palsy. They hypothesised that oropharyngeal dysphagia would be present in children across all levels of mobility status however with more severe physical mobility impairment there would likely be more severe oropharyngeal dysphagia. The study confirmed that oropharyngeal dysphagia was indeed present across all levels of gross motor

It is clear epidemiologically that dysphagia is highly prevalent in the elderly, however, the relationship between dysphagia and significant medical factors such as mobility is not well-established despite both sharing a function of the neuromuscular system.

The singular, primary aim of this preliminary research was to establish whether a correlation between physical mobility and dysphagia was present, thus establishing the basis for future more in-depth research and guide clinical management and support positive health outcomes for this population. It was hypothesised in our study that elderly individuals with oropharyngeal dysphagia would likely experience worse dysphagia severity with poorer mobility status than those with better mobility status.

Methods: A retrospective review of client medical charts from an aged care facility within Western Australia was performed to gather data for this research. Participants were grouped based on mobility status as either; non-ambulant, semi-ambulant and ambulant. Corresponding evaluation of dysphagia was then determined and each participant was allocated a score from 0-5 (no dysphagia to severe dysphagia).

Results: A chi-square test for independence found that the frequency of dysphagia was significantly different with decreasing mobility status (X2 = 16.09, p= 0.0003, Cramer’s V=0.47). Further ANOVA analysis with an additional Turkey HSD test demonstrated a significant difference in mean dysphagia score (P<.05), specifically between the semi-ambulant and the non-ambulant group.

Conclusion: From these findings we were able to establish that with decreasing mobilising capacity, particularly in the jump from semi-ambulant (requiring minimal assistance) to complete assistance necessary such in the case of nonambulant, dysphagia presence and severity is more pronounced.

medicallink.com.au • 29

• THE MEDICAL LINK

Methodology The study was approved by the Institutional Review Board of Oceania University of Medicine which was inclusive of ethics approval. IRB reference number is 21-1010CR. This preliminary study consisted of collecting data from chart review of eligible elderly participants within an aged care facility in Perth, Western Australia. Data was collected from within a sixmonth period that was inclusive of July 2022 to January 2023. Inclusion criteria of the study included; participants being over 65 years of age who reside in the aged care facility who of which had a dysphagia diagnosis of 6 months or greater to establish chronicity. Exclusion criteria included: Newly diagnosed dysphagia. Dysphagia aetiologies secondary to surgical intervention or an offending agent. Diagnoses of dysphagia clearly attributed to uniquely oropharyngeal pathology (e.g surgical structural interventions, oropharyngeal masses etc) and participants with dysphagia diagnoses clearly attributed to specific medications that cause oesophageal dysmotility (such as tetracyclines) were excluded from the study.

No materials were necessary to facilitate the study. Convenience sampling was utilised of all individual’s medical files residing at the facility

unless they were deemed ineligible as per criteria to participate.

The participants were split into groups based on their mobility status which was: ambulatory (mobilising without assistance), semi-ambulatory (mobilising but required an assistant for transfers) and non-ambulatory (unable to mobilise without significant assistance). Within these groups, the participants were then provided a dysphagia severity rating ascertained from clinical assessment records ranging from: 0 (not present), 1 (mildly present), 2 (mild-to-moderate), 3 (moderate), 4 (moderate-to-severe) and 5 (severe). Severity was quantified based on the use of the IDDSI ([7]; see Appendices) classification which allocates various numerical degrees of diet texture and liquid modification (from levels 0 to 7) based on the physiological function of the oropharyngeal system. Within the IDDSI classification system, food textures fall into levels three to seven, with level 3 having the highest level of modification (liquidised consistency) to level 7 being unmodified or very minimally modified to be softer in consistency. These levels correspond to the participant having severe dysphagia through to essentially no presence of dysphagia, respectively.

The IDDSI classification of liquids refers to levels

zero to four, with level 0 being no modification (regular ‘thin’ fluids) through to level 4 which is extremely thick fluids, which are additionally allocated as per level of dysphagia severity ranging from no dysphagia to severe dysphagia. For the purposes of this study, participants were allocated their dysphagia score/severity based on their IDDSI modification prescription. Participants who were allocated levels 7 and 0 were labelled as no dysphagia. Participants allocated food level 6 or drink level 1/2 were considered to have mild dysphagia. Participants allocated food level 5 or drink level 3 were considered to have moderate dysphagia. Participants allocated food level 4 or drink level 4 were considered to have severe dysphagia. Participants were allocated as falling between the two most closely fitting severities when food and drink levels were not consistent (for example if a participant had been prescribed food level 6 (“mild”) and drink level 3 (“moderate”) they were then deemed as having a severity rating of 2 which was “mild-to-moderate”.

The data was analysed using a Chi square test of independence which was inclusive of dichotomous variable which in this study was the presence or absence of dysphagia. An ANOVA utilising mean dysphagia scores with post-hoc analysis was

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then performed to identify where the significant relationship lied. VassarStats Website for Statistical Computation was used in order to perform the statistical evaluations.

Results There were 72 participants in the study, including 47 females (65%) and 25 males (35%), who ranged in age from 72 to 99 (M = 87.22, SD= 6.77). There were 41 ambulant participants, 10 semi-ambulant participants and 21 non-ambulant participants.

Demographic data is further described in Table 1. Mobility status and corresponding dysphagia severities of participants expressed as percentages are delineated in Table 2. ANOVA analyses confirmed there was no statistical significance in ages between the groups.

The hypothesis of this project was to determine if a positive correlation between greater degrees of physical mobility and dysphagia existed within the elderly participants being studied. Statistical analyses of the gathered data were analysed using various modalities in order to establish whether there was significance present within the grouped data, which once determined was then further

analysed in order to delineate where the significant relationship was found within the data. Post-hoc analyses were required to achieve this.

The initial analysis utilised the chi-square test for independence which found that the presence of dysphagia was significantly different with decreasing mobility status (2 = 16.09, p= 0.0003, Cramer’s V=0.47), thus allowing for refusal of the null hypothesis. Secondary analysis with one-way ANOVA using the mean dysphagia scores for each of the three mobility groups revealed that there were significant differences between groups with differing levels of mobility (F= 5.09, p=0.012).

Post-hoc analysis demonstrated a significant relationship between the mean dysphagia score of the semi-ambulant group and the non-ambulant group (P<.05), visualised in Figure 1. From this data, we can establish that the decline in mobilising capacity from semi-impairment to complete impairment correlated with a significantly notable increase in dysphagia severity.

ambulate. Interestingly, a significant relationship was not found between the ambulant and semiambulant cohort or ambulant and non-ambulant cohort. This may highlight a possible distinctive clinical relevance with the final segmental loss of mobility, which in the greater picture may represent a clinical scenario of chronicity versus acute decline.

For Discussion and a full list of References, please head to www.themedicallink.com.au to continue reading.

The results of this study positively shed light to the relationship that exists between impaired mobility and degree of oropharyngeal dysphagia severity, particularly with the step-decline from partial capacity to ambulate to inability to independently

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