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Peiris D, Feyer AM, Barnard J, Billot L, Bouckley T, Campain A, Cordery D, de Souza A, Downey L, Elshaug AG, Ford B, Hanfy H, Hales L, Khalaj BH, Huckel Schneider C, Inglis J, Jan S, Jorm L, Landon B, Lujic S, Mulley J, Pearson SA, Schierhout G, Sivaprakash P, Stanton C, Stephens A, Willcox D. Overcoming silos in health care systems through meso-level organisations - a case study of health reforms in New South Wales, Australia. Lancet Reg Health West Pac 2024; 44:101013. [PMID: 38384947 PMCID: PMC10879775 DOI: 10.1016/j.lanwpc.2024.101013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 11/24/2023] [Accepted: 01/09/2024] [Indexed: 02/23/2024]
Abstract
Fragmented care delivery is a barrier to improving health system performance worldwide. Investment in meso-level organisations is a potential strategy to improve health system integration, however, its effectiveness remains unclear. In this paper, we provide an overview of key international and Australian integrated care policies. We then describe Collaborative Commissioning - a novel health reform policy to integrate primary and hospital care sectors in New South Wales (NSW), Australia and provide a case study of a model focussed on older person's care. The policy is theorised to achieve greater integration through improved governance (local stakeholders identifying as part of one health system), service delivery (communities perceive new services as preferable to status quo) and incentives (efficiency gains are reinvested locally with progressively higher value care achieved). If effectively implemented at scale, Collaborative Commissioning has potential to improve health system performance in Australia and will be of relevance to similar reform initiatives in other countries.
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Affiliation(s)
- David Peiris
- The George Institute for Global Health, UNSW Sydney, Sydney, Australia
| | | | | | - Laurent Billot
- The George Institute for Global Health, UNSW Sydney, Sydney, Australia
| | - Tristan Bouckley
- The George Institute for Global Health, UNSW Sydney, Sydney, Australia
| | - Anna Campain
- The George Institute for Global Health, UNSW Sydney, Sydney, Australia
| | | | - Alexandra de Souza
- Menzies Centre for Health Policy and Economics, University of Sydney, Sydney, Australia
| | - Laura Downey
- The George Institute for Global Health, UNSW Sydney, Sydney, Australia
| | - Adam G. Elshaug
- Menzies Centre for Health Policy and Economics, University of Sydney, Sydney, Australia
- Centre for Health Policy, University of Melbourne, Melbourne, Australia
| | - Belinda Ford
- The George Institute for Global Health, UNSW Sydney, Sydney, Australia
| | | | | | | | | | - James Inglis
- Northern Sydney Local Health District, Sydney, Australia
| | - Stephen Jan
- The George Institute for Global Health, UNSW Sydney, Sydney, Australia
| | - Louisa Jorm
- Centre for Big Data Research in Health, UNSW Sydney, Sydney, Australia
| | - Bruce Landon
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - Sanja Lujic
- Centre for Big Data Research in Health, UNSW Sydney, Sydney, Australia
| | - John Mulley
- The George Institute for Global Health, UNSW Sydney, Sydney, Australia
| | | | - Gill Schierhout
- The George Institute for Global Health, UNSW Sydney, Sydney, Australia
| | - Prithivi Sivaprakash
- Menzies Centre for Health Policy and Economics, University of Sydney, Sydney, Australia
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Yakubu K, Campain A, Abimbola S, Bouckley T, Peiris D, Joshi R, Shanthosh J. Promoting equitable health workforce distribution through improved migration governance: A mixed methods study of African health professionals' perceptions in Australia. Int J Health Plann Manage 2023; 38:1789-1815. [PMID: 37674361 DOI: 10.1002/hpm.3704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 07/19/2023] [Accepted: 08/21/2023] [Indexed: 09/08/2023] Open
Abstract
BACKGROUND This study examined skilled health worker (SHW) migration governance in African countries and Australia, with an emphasis on areas of influence for achieving an equitable global health workforce distribution. METHODS We used a mixed-methods research design with African SHW migrants in Australia. An institutional and rights-based framing of governance guided thematic analysis of the interviews, which was mapped to survey findings from a Bayesian Exploratory Factor Analysis. RESULTS The findings imply that Australian state actors enforce laws that attract SHW migrants and promote safe clinical practice, but do not adequately address their integration concerns or role in health system strengthening. Non-state actors in Australia make donations to African health institutions but rarely promote health workforce equity. African state actors respond to increased SHW migration trends by increasing health worker training and limiting migration, but they lack a comprehensive governance framework for involving citizens and engaging foreign governments. There is limited evidence of a shared community definition of SHW migration governance in many African countries. CONCLUSION When stakeholders in both sending and receiving countries recognise the indivisibility of the rights at stake (for example, SHW rights as migrants and the right to health), support for an equity-focused SHW migration governance system may increase. Promoting these rights can result in policies that enhance health system strengthening in destination and source countries. Similarly, growing adoption of these rights in sending countries should help inspire a coordinated plan for strengthening health system and SHW migration governance.
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Affiliation(s)
- Kenneth Yakubu
- The George Institute for Global Health, Faculty of Medicine and Health, University of New South Wales, New South Wales, Sydney, Australia
| | - Anna Campain
- The George Institute for Global Health, Faculty of Medicine and Health, University of New South Wales, New South Wales, Sydney, Australia
| | - Seye Abimbola
- School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Tristan Bouckley
- The George Institute for Global Health, Faculty of Medicine and Health, University of New South Wales, New South Wales, Sydney, Australia
| | - David Peiris
- The George Institute for Global Health, Faculty of Medicine and Health, University of New South Wales, New South Wales, Sydney, Australia
| | - Rohina Joshi
- The George Institute for Global Health, Faculty of Medicine and Health, University of New South Wales, New South Wales, Sydney, Australia
- School of Population Health, Faculty of Medicine and Health, University of New South Wales, New South Wales, Sydney, Australia
- The George Institute for Global Health India, New Delhi, India
| | - Janani Shanthosh
- The George Institute for Global Health, Faculty of Medicine and Health, University of New South Wales, New South Wales, Sydney, Australia
- Australian Human Rights Institute, Faculty of Law and Justice, University of New South Wales, Sydney, New South Wales, Australia
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Jun M, Scaria A, Andrade J, Badve SV, Birks P, Bota SE, Campain A, Djurdjev O, Garg AX, Ha J, Harel Z, Hemmelgarn B, Hockham C, James MT, Jardine MJ, Levin A, McArthur E, Ravani P, Shao S, Sood MM, Tan Z, Tangri N, Whitlock R, Gallagher M. Kidney function and the comparative effectiveness and safety of direct oral anticoagulants vs. warfarin in adults with atrial fibrillation: a multicenter observational study. Eur Heart J Qual Care Clin Outcomes 2023; 9:621-631. [PMID: 36302143 DOI: 10.1093/ehjqcco/qcac069] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 10/18/2022] [Accepted: 10/24/2022] [Indexed: 09/13/2023]
Abstract
AIMS The aim of this study was to determine the comparative effectiveness and safety of direct oral anticoagulants (DOACs) and warfarin in adults with atrial fibrillation (AF) by level of kidney function. METHODS AND RESULTS We pooled findings from five retrospective cohorts (2011-18) across Australia and Canada of adults with; a new dispensation for a DOAC or warfarin, an AF diagnosis, and a measure of baseline estimated glomerular filtration rate (eGFR). The outcomes of interest, within 1 year from the cohort entry date, were: (1) the composite of all-cause death, first hospitalization for ischaemic stroke, or transient ischaemic attack (effectiveness), and (2) first hospitalization for major bleeding defined as an intracranial, upper or lower gastrointestinal, or other bleeding (safety). Cox models were used to examine the association of a DOAC vs. warfarin with outcomes, after 1:1 matching via a propensity score. Kidney function was categorized as eGFR ≥60, 45-59, 30-44, and <30 mL/min/1.73 m2. A total of 74 542 patients were included in the matched analysis. DOAC initiation was associated with greater or similar effectiveness compared with warfarin initiation across all eGFR categories [pooled HRs (95% CIs) for eGFR categories: 0.74(0.69-0.79), 0.76(0.54-1.07), 0.68(0.61-0.75) and 0.86(0.76-0.98)], respectively. DOAC initiation was associated with lower or similar risk of major bleeding than warfarin initiation [pooled HRs (95% CIs): 0.75(0.65-0.86), 0.81(0.65-1.01), 0.82(0.66-1.02), and 0.71(0.52-0.99), respectively). Associations between DOAC initiation, compared with warfarin initiation, and study outcomes were not modified by eGFR category. CONCLUSION DOAC use, compared with warfarin use, was associated with a lower or similar risk of all-cause death, ischaemic stroke, and transient ischaemic attack and also a lower or similar risk of major bleeding across all levels of kidney function.
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Affiliation(s)
- Min Jun
- The George Institute for Global Health, UNSW Sydney, Sydney, Newtown, NSW 2042, Australia
| | - Anish Scaria
- The George Institute for Global Health, UNSW Sydney, Sydney, Newtown, NSW 2042, Australia
| | - Jason Andrade
- University of British Columbia, Vancouver General Hospital, Vancouver, BC, Canada
| | - Sunil V Badve
- The George Institute for Global Health, UNSW Sydney, Sydney, Newtown, NSW 2042, Australia
| | - Peter Birks
- University of British Columbia, Vancouver General Hospital, Vancouver, BC, Canada
- Division of Nephrology, University of British Columbia, Vancouver, BC, Canada
| | | | - Anna Campain
- The George Institute for Global Health, UNSW Sydney, Sydney, Newtown, NSW 2042, Australia
| | | | - Amit X Garg
- ICES, ON, Canada
- Department of Medicine, Epidemiology and Biostatistics, Western University, London, ON, Canada
| | - Jeffrey Ha
- The George Institute for Global Health, UNSW Sydney, Sydney, Newtown, NSW 2042, Australia
| | - Ziv Harel
- Division of Nephrology, St. Michael's Hospital, Toronto, ON, Canada
| | - Brenda Hemmelgarn
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Carinna Hockham
- The George Institute for Global Health, Imperial College London, London, UK
| | - Matthew T James
- Cumming School of Medicine, Division of Nephrology, University of Calgary, Calgary AB, Canada
- Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, AB, Canada
| | - Meg J Jardine
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia
| | - Adeera Levin
- University of British Columbia, Vancouver General Hospital, Vancouver, BC, Canada
- Division of Nephrology, University of British Columbia, Vancouver, BC, Canada
- BC Renal, Vancouver, BC, Canada
| | | | - Pietro Ravani
- Cumming School of Medicine, Division of Nephrology, University of Calgary, Calgary AB, Canada
| | | | - Manish M Sood
- The Ottawa Hospital Research Institute and Department of Medicine, The Ottawa Hospital, Ottawa, ON, Canada
| | - Zhi Tan
- Cumming School of Medicine, Division of Nephrology, University of Calgary, Calgary AB, Canada
| | - Navdeep Tangri
- Department of Internal Medicine, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
- Seven Oaks Hospital Chronic Disease Innovation Centre, Winnipeg, MB, Canada
| | - Reid Whitlock
- Department of Internal Medicine, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
- Seven Oaks Hospital Chronic Disease Innovation Centre, Winnipeg, MB, Canada
| | - Martin Gallagher
- The George Institute for Global Health, UNSW Sydney, Sydney, Newtown, NSW 2042, Australia
- Liverpool Clinical School, UNSW Sydney, Sydney, NSWAustralia
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Colbert S, Wilkinson C, Thornton L, Feng X, Campain A, Richmond R. Cross-sectional survey of a convenience sample of Australians who use alcohol home delivery services. Drug Alcohol Rev 2023; 42:986-995. [PMID: 36853829 PMCID: PMC10947259 DOI: 10.1111/dar.13627] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 01/10/2023] [Accepted: 01/23/2023] [Indexed: 03/01/2023]
Abstract
INTRODUCTION Online alcohol purchasing and home delivery has increased in recent years, accelerated by the onset of the coronavirus disease 2019 pandemic. This article aims to investigate the purchasing and drinking behaviour of Australians who use online alcohol delivery services. METHOD A cross-sectional self-report survey with a convenience sample of 1158 Australians ≥18 years (49.3% female) who used an online alcohol delivery service in the past 3 months, recruited through paid social media advertisements from September to November 2021. Quota sampling was used to obtain a sample with age and gender strata proportional to the Australian adult population. Descriptive statistics were generated and logistic regression used to explore variables that predict hazardous/harmful drinking (Alcohol Use Disorders Identification Test score ≥8). RESULTS One-in-five (20.1%, 95% confidence interval [CI] 17.8-22.5) participants had used an alcohol delivery service to extend a home drinking session because they had run out of alcohol and wanted to continue drinking and, of these, one-third (33.9%, 95% CI 27.9-40.4) indicated that if the service was not available they would have stopped drinking. Using delivery services in this way was associated with six times higher odds of drinking at hazardous/harmful levels (odds ratio 6.26, 95% CI 3.78-10.36). Participants ≤25 years were significantly more likely to report never having their identification verified when receiving their alcohol delivery at the door compared with purchasing takeaway alcohol in-person at a bottle shop (p < 0.001, McNemar). DISCUSSION AND CONCLUSION Given the risks associated with alcohol delivery, regulation of these services should be improved to meet the same standards as bricks-and-mortar bottle shops.
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Affiliation(s)
| | - Claire Wilkinson
- Drug Policy Modelling ProgramSocial Policy Research Centre, UNSW SydneySydneyAustralia
- Centre for Alcohol Policy ResearchLa Trobe UniversityMelbourneAustralia
| | - Louise Thornton
- School of Population HealthUNSW SydneySydneyAustralia
- The Matilda Centre for Research in Mental Health and Substance UseThe University of SydneySydneyAustralia
| | - Xiaoqi Feng
- School of Population HealthUNSW SydneySydneyAustralia
- Population Wellbeing and Environment Research Lab (PowerLab)University of WollongongWollongongAustralia
- The George Institute for Global HealthSydneyAustralia
| | - Anna Campain
- The George Institute for Global HealthSydneyAustralia
- Faculty of MedicineUNSW SydneySydneyAustralia
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Ha JT, Scaria A, Andrade J, Badve SV, Birks P, Bota SE, Campain A, Djurdjev O, Garg AX, Harel Z, Hemmelgarn B, Hockham C, James MT, Jardine MJ, Lam D, Levin A, McArthur E, Ravani P, Shao S, Sood MM, Tan Z, Tangri N, Whitlock R, Gallagher M, Jun M. Safety and Effectiveness of Rivaroxaban Versus Warfarin Across GFR Levels in Atrial Fibrillation: A Population-Based Study in Australia and Canada. Kidney Med 2023; 5:100675. [PMID: 37492112 PMCID: PMC10363562 DOI: 10.1016/j.xkme.2023.100675] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2023] Open
Abstract
Rationale & Objective The benefit-risk profile of rivaroxaban versus warfarin for atrial fibrillation (AF) in patients with chronic kidney disease is uncertain. We compared rivaroxaban with warfarin across the range of kidney function in adults with AF. Study Design Multicenter retrospective cohort. Setting & Participants Adults with AF and a measure of estimated glomerular filtration rate (eGFR); using administrative data from 5 jurisdictions across Australia and Canada (2011-2018). Kidney function was categorized as eGFR ≥60, 45-59, 30-44, and <30 mL/min/1.73 m2. Patients receiving dialysis and kidney transplant recipients were excluded. Exposures New dispensation of either rivaroxaban or warfarin. Outcomes Composite (1) effectiveness outcome (all-cause death, ischemic stroke, or transient ischemic attack) and (2) major bleeding events (intracranial, gastrointestinal, or other) at 1 year. Analytical Approach Cox proportional hazards models accounting for propensity score matching were performed independently in each jurisdiction and then pooled using random-effects meta-analysis. Results 55,568 patients (27,784 rivaroxaban-warfarin user matched pairs; mean age 74 years, 46% female, 33.5% with eGFR <60 mL/min/1.73 m2) experienced a total of 4,733 (8.5%) effectiveness and 1,144 (2.0%) bleeding events. Compared to warfarin, rivaroxaban was associated with greater or similar effectiveness across a broad range of kidney function (pooled HRs of 0.72 [95% CI, 0.66-0.78], 0.78 [95% CI, 0.58-1.06], 0.70 [95% CI, 0.57-0.87], and 0.78 [95% CI, 0.62-0.99]) for eGFR ≥60, 45-59, 30-44, and <30 mL/min/1.73 m2, respectively). Rivaroxaban was also associated with similar risk of major bleeding across all eGFR categories (pooled HRs of 0.75 [95% CI, 0.56-1.00], 1.01 [95% CI, 0.79-1.30], 0.87 [95% CI, 0.66-1.15], and 0.63 [95% CI, 0.37-1.09], respectively). Limitations Unmeasured treatment selection bias and residual confounding. Conclusions In adults with AF, rivaroxaban compared with warfarin was associated with lower or similar risk of all-cause death, ischemic stroke and transient ischemic attack and similar risk of bleeding across a broad range of kidney function. Plain-Language Summary This real-world study involved a large cohort of 55,568 adults with atrial fibrillation from 5 jurisdictions across Australia and Canada. It showed that the favorable safety (bleeding) and effectiveness (stroke or death) profile of rivaroxaban compared with warfarin was consistent across different levels of kidney function. This study adds important safety data on the use of rivaroxaban in patients with reduced kidney function, including those with estimated glomerular filtration rate <30 mL/min/1.73 m2 in whom the risks and benefits of rivaroxaban use is most uncertain. Overall, the study supports the use of rivaroxaban as a safe and effective alternative to warfarin for atrial fibrillation across differing levels of kidney function.
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Affiliation(s)
- Jeffrey T. Ha
- The George Institute for Global Health, UNSW Sydney, Sydney, NSW, Australia
| | - Anish Scaria
- The George Institute for Global Health, UNSW Sydney, Sydney, NSW, Australia
| | - Jason Andrade
- University of British Columbia, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Sunil V. Badve
- The George Institute for Global Health, UNSW Sydney, Sydney, NSW, Australia
| | - Peter Birks
- University of British Columbia, Vancouver General Hospital, Vancouver, British Columbia, Canada
- Division of Nephrology, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Anna Campain
- The George Institute for Global Health, UNSW Sydney, Sydney, NSW, Australia
| | | | - Amit X. Garg
- ICES, Ontario, Canada
- Department of Medicine, Epidemiology and Biostatistics, Western University, London, Ontario, Canada
| | - Ziv Harel
- Division of Nephrology, St. Michael’s Hospital, Toronto, Ontario, Canada
| | - Brenda Hemmelgarn
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Carinna Hockham
- The George Institute for Global Health, U.K., Imperial College London, London, United Kingdom
| | - Matthew T. James
- Cumming School of Medicine, Division of Nephrology, University of Calgary, Alberta, Canada
- Libin Cardiovascular Institute of Alberta, University of Calgary, Alberta, Canada
| | - Meg J. Jardine
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia
| | - Dickson Lam
- The George Institute for Global Health, UNSW Sydney, Sydney, NSW, Australia
| | - Adeera Levin
- University of British Columbia, Vancouver General Hospital, Vancouver, British Columbia, Canada
- Division of Nephrology, University of British Columbia, Vancouver, British Columbia, Canada
- BC Provincial Renal Agency, Vancouver, British Columbia, Canada
| | | | - Pietro Ravani
- Cumming School of Medicine, Division of Nephrology, University of Calgary, Alberta, Canada
| | - Selena Shao
- BC Provincial Renal Agency, Vancouver, British Columbia, Canada
| | - Manish M. Sood
- The Ottawa Hospital Research Institute and Department of Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Zhi Tan
- Cumming School of Medicine, Division of Nephrology, University of Calgary, Alberta, Canada
| | - Navdeep Tangri
- Department of Internal Medicine, University of Manitoba, Max Rady College of Medicine, Winnipeg, Manitoba, Canada
- Seven Oaks Hospital Chronic Disease Innovation Centre, Winnipeg, Manitoba, Canada
| | - Reid Whitlock
- Department of Internal Medicine, University of Manitoba, Max Rady College of Medicine, Winnipeg, Manitoba, Canada
- Seven Oaks Hospital Chronic Disease Innovation Centre, Winnipeg, Manitoba, Canada
| | - Martin Gallagher
- The George Institute for Global Health, UNSW Sydney, Sydney, NSW, Australia
- Liverpool Clinical School, UNSW Sydney, Sydney, NSW, Australia
| | - Min Jun
- The George Institute for Global Health, UNSW Sydney, Sydney, NSW, Australia
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Coorey G, Campain A, Mulley J, Usherwood T, Redfern J, Harris M, Zwar N, Peiris D. Management of cardiovascular disease risk in people with comorbid mental illness: A cross sectional study in Australian general practice. Aust N Z J Psychiatry 2023; 57:613-615. [PMID: 36314767 DOI: 10.1177/00048674221133043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Genevieve Coorey
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Anna Campain
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
| | - John Mulley
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
| | - Tim Usherwood
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
- Westmead Applied Research Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Julie Redfern
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Mark Harris
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, NSW, Australia
| | - Nicholas Zwar
- Faculty of Health Sciences & Medicine, Bond University, Gold Coast, QLD, Australia
- School of Population Health, University of New South Wales, Sydney, NSW, Australia
| | - David Peiris
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
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7
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Coorey G, Campain A, Mulley J, Usherwood T, Redfern J, Harris M, Zwar N, Parker S, Coiera E, Peiris D. Utilisation of government-subsidised chronic disease management plans and cardiovascular care in Australian general practices. BMC Prim Care 2022; 23:157. [PMID: 35729493 PMCID: PMC9210726 DOI: 10.1186/s12875-022-01763-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 06/06/2022] [Indexed: 11/10/2022]
Abstract
Abstract
Background
Government-subsidised general practice management plans (GPMPs) facilitate chronic disease management; however, impact on cardiovascular disease (CVD) is unknown. We aimed to determine utilisation and impact of GPMPs for people with or at elevated risk of CVD.
Methods
Secondary analysis of baseline data from the CONNECT randomised controlled trial linked to Medicare Benefits Schedule (MBS) and Pharmaceutical Benefits Scheme (PBS) claims. Multivariate regression examining the association of GPMP receipt and review with: (1) ≥ 1 MBS-subsidised allied health visit in the previous 24 months; (2) adherence to dual cardioprotective medication (≥ 80% of days covered with a dispensed PBS prescription); and (3) meeting recommended LDL-cholesterol and blood pressure (BP) targets concurrently.
Results
Overall, 905 trial participants from 24 primary health care services consented to data linkage. Participants with a GPMP (46.6%, 422/905) were older (69.4 vs 66.0 years), had lower education (32.3% vs 24.7% high school or lower), lower household income (27.5% vs 17.0% in lowest bracket), and more comorbidities, particularly diabetes (42.2% vs 17.6%) compared to those without a GPMP. After adjustment, a GPMP was strongly associated with allied health visits (odds ratio (OR) 14.80, 95% CI: 9.08–24.11) but not higher medication adherence rates (OR 0.82, 95% CI: 0.52–1.29) nor meeting combined LDL and BP targets (OR 1.31, 95% CI: 0.72–2.38). Minor differences in significant covariates were noted in models using GPMP review versus GPMP initiation.
Conclusions
In people with or at elevated risk of CVD, GPMPs are under-utilised overall. They are targeting high-needs populations and facilitate allied health access, but are not associated with improved CVD risk management, which represents an opportunity for enhancing their value in supporting guideline-recommended care.
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Campain A, Hockham C, Sukkar L, Rogers K, Chow CK, Lung T, Jun M, Pollock C, Cass A, Sullivan D, Comino E, Peiris D, Jardine M. Prior Cardiovascular Treatments-A Key Characteristic in Determining Medication Adherence After an Acute Myocardial Infarction. Front Pharmacol 2022; 13:834898. [PMID: 35330840 PMCID: PMC8940291 DOI: 10.3389/fphar.2022.834898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 02/15/2022] [Indexed: 11/30/2022] Open
Abstract
Objective: To investigate long-term adherence to guideline-recommended cardioprotective medications following hospitalization for an acute myocardial infarction (AMI), and identify characteristics associated with adherence. Methods: An Australian population-based cohort study was used to identify participants who had their first AMI between 2006 and 2014 and were alive after 12 months. Linked routinely collected hospital, and prescription medication claims data was used to study adherence over time. Predictors and rates of adherence to both lipid-lowering medication and renin-angiotensin system blockade at 12 months post-AMI was assessed. Results: 14,200 people (mean age 69.9 years, 38.7% female) were included in our analysis. At 12 months post-AMI, 29.5% (95% CI: 28.8–30.3%) of people were adherent to both classes of medication. Individuals receiving treatment with both lipid-lowering medication and renin-angiotensin system blockade during the 6 months prior to their AMI were over 9 times more likely to be adherent to both medications at 12 months post-AMI (66.2% 95% CI: 64.8–67.5%) compared to those with no prior medication use (treatment naïve) (7.1%, 95% CI: 6.4–7.9%). Prior cardiovascular treatment was the strongest predictor of long-term adherence even after adjusting for age, sex, education and income. Conclusions: Despite efforts to improve long-term medication adherence in patients who have experienced an acute coronary event, considerable gaps remain. Of particular concern are people who are commencing guideline-recommended cardioprotective medication at the time of their AMI. The relationship between prior cardiovascular treatments and post AMI adherence offers insight into the support needs for the patient. Health care intervention strategies, strengthened by enabling policies, are needed to provide support to patients through the initial months following their AMI.
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Affiliation(s)
- Anna Campain
- The George Institute for Global Heath, UNSW, Sydney, NSW, Australia.,Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Carinna Hockham
- School of Public Health, Imperial College London, The George Institute for Global Health, London, United Kingdom
| | - Louisa Sukkar
- The George Institute for Global Heath, UNSW, Sydney, NSW, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Kris Rogers
- The George Institute for Global Heath, UNSW, Sydney, NSW, Australia.,Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia.,Graduate School of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Clara K Chow
- The George Institute for Global Heath, UNSW, Sydney, NSW, Australia.,Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia.,Department of Cardiology, Westmead Hospital, Sydney, NSW, Australia
| | - Thomas Lung
- The George Institute for Global Heath, UNSW, Sydney, NSW, Australia.,Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Min Jun
- The George Institute for Global Heath, UNSW, Sydney, NSW, Australia.,Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Carol Pollock
- Renal Division, Kolling Institute for Medical Research, Sydney, NSW, Australia.,University of Sydney, Sydney, NSW, Australia
| | - Alan Cass
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
| | - David Sullivan
- Department of Chemical Pathology Royal Prince Alfred Hospital, Camperdown, NSW, Australia.,NSW Health Pathology, Newcastle, NSW, Australia.,Central Clinical School, University of Sydney, Camperdown, NSW, Australia
| | - Elizabeth Comino
- Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - David Peiris
- The George Institute for Global Heath, UNSW, Sydney, NSW, Australia.,Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Meg Jardine
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.,NHMRC Clinical Trials Centre, The University of Sydney, Sydney, NSW, Australia.,Concord Repatriation General Hospital, Sydney, NSW, Australia
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9
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Serhal S, Armour C, Billot L, Krass I, Emmerton L, Saini B, Bosnic-Anticevich S, Bereznicki B, Bereznicki L, Shan S, Campain A. Integrating Pharmacy and Registry Data Strengthens Clinical Assessments of Patient Adherence. Front Pharmacol 2022; 13:869162. [PMID: 35401235 PMCID: PMC8990834 DOI: 10.3389/fphar.2022.869162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 02/28/2022] [Indexed: 11/13/2022] Open
Abstract
Background: Accurate clinical assessment of patient adherence using reliable and valid measures is essential in establishing the presence of adherence issues and support practices for pharmacists.Objective: This investigation aims to conduct a novel assessment of patient adherence to asthma controller therapy by combining 1) patient-specific dosage data found in pharmacy dispensing data with 2) centrally collected administrative claims records, to determine the added value of using both sources of data.Methods: A total of 381 clinically uncontrolled asthma patients, from 95 community pharmacies across three Australian States were recruited and provided consent for the retrieval of their claims records and pharmacy dispensing data. Patients were stratified as multiple or single pharmacy users and adherence scores were calculated via the proportion of days covered (PDC) method using 1) patient claims records, 2) patient pharmacy dispensing data, and 3) combined claims records and pharmacy dispensing data. Cohort and subgroup adherence estimates were then compared.Results: Low levels of adherence were evident amongst the cohort irrespective of the data source used. PDC estimates based on claims records alone or combined claims records and pharmacy dispensing data were significantly higher than estimates based on pharmacy dispensing data for the total cohort (56%, 52%, 42% respectively, p < 0.001) and more noticeably for multiple pharmacy users (67%, 64%, 35% respectively, p < 0.001). PDC estimates based on combined claims records and pharmacy dispensing data were significantly lower than estimates based on claims records alone, indicating that perhaps standard daily dose is not a robust proxy for prescribed dosage to inhaled respiratory devices in adherence approximations. Poorer adherence was found amongst single pharmacy users than multiple pharmacy users when combined claims records and pharmacy dispensing data (46% compared to 64% respectively, p < 0.001) or claims records alone (51% compared to 67% respectively, p < 0.001) were compared.Conclusion: Access to routine collected data increases clinical acuity over patient adherence to asthma controller medications and is a valuable resource for health care professionals. A policy of secure accessibility of such data at the patient-pharmacist or patient-GP interface may allow real-time intervention and assist in decision making across numerous therapeutic areas.
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Affiliation(s)
- Sarah Serhal
- Woolcock Institute of Medical Research, Sydney, NSW, Australia
- School of Pharmacy, The University of Sydney, Sydney, NSW, Australia
- *Correspondence: Sarah Serhal,
| | - Carol Armour
- Woolcock Institute of Medical Research, Sydney, NSW, Australia
- Central Sydney Area Health Service, Sydney, NSW, Australia
| | - Laurent Billot
- The George Institute, Newtown, NSW, Australia
- Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Ines Krass
- School of Pharmacy, The University of Sydney, Sydney, NSW, Australia
| | - Lynne Emmerton
- Curtin Medical School, Curtin University, Perth, WA, Australia
| | - Bandana Saini
- Woolcock Institute of Medical Research, Sydney, NSW, Australia
- School of Pharmacy, The University of Sydney, Sydney, NSW, Australia
| | - Sinthia Bosnic-Anticevich
- Woolcock Institute of Medical Research, Sydney, NSW, Australia
- Central Sydney Area Health Service, Sydney, NSW, Australia
| | | | - Luke Bereznicki
- School of Pharmacy and Pharmacology, University of Tasmania, Hobart, TAS, Australia
| | - Sana Shan
- The George Institute, Newtown, NSW, Australia
| | - Anna Campain
- The George Institute, Newtown, NSW, Australia
- Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
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10
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Zhang H, Rogers K, Sukkar L, Jun M, Kang A, Young T, Campain A, Cass A, Chow CK, Comino E, Foote C, Gallagher M, Knight J, Liu B, Lung T, McNamara M, Peiris D, Pollock C, Sullivan D, Wong G, Zoungas S, Jardine M, Hockham C. Prevalence, incidence and risk factors of diabetes in Australian adults aged ≥45 years: A cohort study using linked routinely-collected data. J Clin Transl Endocrinol 2020; 22:100240. [PMID: 33294382 PMCID: PMC7691170 DOI: 10.1016/j.jcte.2020.100240] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 09/12/2020] [Accepted: 11/04/2020] [Indexed: 01/03/2023]
Abstract
Aims To use linked routinely-collected health data to estimate diabetes prevalence and incidence in an Australian cohort of adults aged ≥45 years, and examine risk factors associated with incident disease. Research design and methods The EXamining ouTcomEs in chroNic Disease in the 45 and Up Study (EXTEND45) Study is a linked data study that combines baseline questionnaire responses from the population-based 45 and Up Study (2006–2009, n = 267,153) with multiple routinely-collected health databases up to December 2014. Among participants with ≥1 linked result for any laboratory test, diabetes status was determined from multiple data sources according to standard biochemical criteria, use of glucose-lowering medication or self-report, and the prevalence and incidence rate calculated. Independent risk factors of incident diabetes were examined using multivariable Cox regression. Results Among 152,169 45 and Up Study participants with ≥1 linked laboratory result in the EXTEND45 database (mean age 63.0 years; 54.9% female), diabetes prevalence was 10.8% (95% confidence interval [CI] 10.6%–10.9%). Incident disease in those without diabetes at baseline (n = 135,810; mean age 62.5 years; 56.1% female) was 10.0 per 1,000 person-years (95% CI 9.8–10.2). In all age groups, diabetes incidence was lower in women compared to men, an association that persisted in the fully adjusted analyses. Other independent risk factors of diabetes were older age, being born outside of Australia (with the highest rate of 19.2 per 1,000 person-years observed in people born in South and Central Asia), lower education status, lower annual household income, residence in a major city, family history of diabetes, personal history of cardiovascular disease or hypertension, higher body mass index, smoking and long sleeping hours. Conclusions Our study represents an efficient approach to assessing diabetes frequency and its risk factors in the community. The infrastructure provided by the EXTEND45 Study will be useful for diabetes surveillance and examining other important clinical and epidemiological questions.
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Affiliation(s)
- Hongmei Zhang
- The George Institute for Global Health, UNSW, Sydney, NSW, Australia
- Department of Endocrinology, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Kris Rogers
- The George Institute for Global Health, UNSW, Sydney, NSW, Australia
- Graduate School of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Louisa Sukkar
- The George Institute for Global Health, UNSW, Sydney, NSW, Australia
- School of Public Health, University of Sydney, Sydney, Australia
| | - Min Jun
- The George Institute for Global Health, UNSW, Sydney, NSW, Australia
- Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Amy Kang
- The George Institute for Global Health, UNSW, Sydney, NSW, Australia
- Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Tamara Young
- The George Institute for Global Health, UNSW, Sydney, NSW, Australia
- Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Anna Campain
- The George Institute for Global Health, UNSW, Sydney, NSW, Australia
- Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Alan Cass
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
| | - Clara K Chow
- The George Institute for Global Health, UNSW, Sydney, NSW, Australia
- Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
- Department of Cardiology, Westmead Hospital, Sydney, Australia
| | - Elizabeth Comino
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, NSW, Australia
| | - Celine Foote
- The George Institute for Global Health, UNSW, Sydney, NSW, Australia
- Concord Repatriation General Hospital, Sydney, NSW, Australia
| | - Martin Gallagher
- The George Institute for Global Health, UNSW, Sydney, NSW, Australia
- Faculty of Medicine, University of New South Wales, Sydney, Australia
- Concord Repatriation General Hospital, Sydney, NSW, Australia
- Sydney Medical School, University of Sydney, Sydney, Australia
| | - John Knight
- The George Institute for Global Health, UNSW, Sydney, NSW, Australia
- Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Bette Liu
- School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Thomas Lung
- The George Institute for Global Health, UNSW, Sydney, NSW, Australia
- Faculty of Medicine, University of New South Wales, Sydney, Australia
| | | | - David Peiris
- The George Institute for Global Health, UNSW, Sydney, NSW, Australia
- Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Carol Pollock
- Renal Division, Kolling Institute for Medical Research, Sydney, Australia
- University of Sydney, Sydney, Australia
| | - David Sullivan
- Sydney Medical School, University of Sydney, Sydney, Australia
- Department of Chemical Pathology, Royal Prince Alfred Hospital, Sydney, Australia
| | - Germaine Wong
- School of Public Health, University of Sydney, Sydney, Australia
- Centre for Transplant and Renal Research, Westmead Hospital, Sydney, Australia
| | - Sophia Zoungas
- The George Institute for Global Health, UNSW, Sydney, NSW, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Meg Jardine
- The George Institute for Global Health, UNSW, Sydney, NSW, Australia
- Faculty of Medicine, University of New South Wales, Sydney, Australia
- Concord Repatriation General Hospital, Sydney, NSW, Australia
| | - Carinna Hockham
- The George Institute for Global Health, UNSW, Sydney, NSW, Australia
- Faculty of Medicine, University of New South Wales, Sydney, Australia
- Corresponding author at: The George Institute for Global Health, 1 King Street, Newtown, NSW 2042, Australia.
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11
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Xie Y, Baker J, Young T, Jun M, Sukkar L, Campain A, Kang A, Cass A, Hu J, Peiris D, Pollock C, Wong G, Zoungas S, Rogers K, Jardine M, Hockham C. Therapy Escalation Following an Elevated HbA 1c in Adults Aged 45 Years and Older Living With Diabetes in Australia: A Real-World Observational Analysis. Diabetes Care 2020; 43:e185-e187. [PMID: 32928956 DOI: 10.2337/dc20-0269] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 08/07/2020] [Indexed: 02/03/2023]
Affiliation(s)
- Ying Xie
- The Second Affiliated Hospital of Soochow University, Suzhou, China.,The George Institute for Global Health, Sydney, New South Wales, Australia
| | - Jannah Baker
- The George Institute for Global Health, Sydney, New South Wales, Australia
| | - Tamara Young
- The George Institute for Global Health, Sydney, New South Wales, Australia.,Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Min Jun
- The George Institute for Global Health, Sydney, New South Wales, Australia.,Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Louisa Sukkar
- The George Institute for Global Health, Sydney, New South Wales, Australia.,School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Anna Campain
- The George Institute for Global Health, Sydney, New South Wales, Australia.,Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Amy Kang
- The George Institute for Global Health, Sydney, New South Wales, Australia.,Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Alan Cass
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Ji Hu
- The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - David Peiris
- The George Institute for Global Health, Sydney, New South Wales, Australia.,Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Carol Pollock
- Renal Division, Kolling Institute for Medical Research, Sydney, New South Wales, Australia.,University of Sydney, Sydney, New South Wales, Australia
| | - Germaine Wong
- School of Public Health, University of Sydney, Sydney, New South Wales, Australia.,Centre for Transplant and Renal Research, Westmead Hospital, Sydney, New South Wales, Australia
| | - Sophia Zoungas
- The George Institute for Global Health, Sydney, New South Wales, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Kris Rogers
- The George Institute for Global Health, Sydney, New South Wales, Australia.,Graduate School of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Meg Jardine
- The George Institute for Global Health, Sydney, New South Wales, Australia.,Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia.,Concord Repatriation General Hospital, Sydney, New South Wales, Australia
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12
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Hespe CM, Campain A, Webster R, Patel A, Rychetnik L, Harris MF, Peiris DP. Implementing cardiovascular disease preventive care guidelines in general practice: an opportunity missed. Med J Aust 2020; 213:327-328. [DOI: 10.5694/mja2.50756] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Accepted: 05/29/2020] [Indexed: 11/17/2022]
Affiliation(s)
| | - Anna Campain
- The George Institute for Global Health Sydney NSW
- University of New South Wales Sydney NSW
| | - Ruth Webster
- The George Institute for Global Health Sydney NSW
| | | | - Lucie Rychetnik
- The University of Notre Dame Australia Sydney NSW
- The Australian Health Prevention Partnership Sax Institute Sydney NSW
| | - Mark F Harris
- Centre for Primary Health Care and Equity University of New South Wales Sydney NSW
- Office of the Chief Scientist The George Institute for Global Health Sydney NSW
| | - David P Peiris
- Office of the Chief Scientist The George Institute for Global Health Sydney NSW
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13
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Foote C, Hockham C, Sukkar L, Campain A, Kang A, Young T, Cass A, Chow CK, Comino E, Gallagher M, Jan S, Knight J, Liu B, McNamara M, Peiris D, Pollock C, Sullivan D, Wong G, Zoungas S, Rogers K, Jun M, Jardine M. EXamining ouTcomEs in chroNic Disease in the 45 and Up Study (the EXTEND45 Study): Protocol for an Australian Linked Cohort Study. JMIR Res Protoc 2020; 9:e15646. [PMID: 32285803 PMCID: PMC7189250 DOI: 10.2196/15646] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2019] [Revised: 12/06/2019] [Accepted: 01/07/2020] [Indexed: 01/04/2023] Open
Abstract
Background Chronic kidney disease (CKD) and diabetes are the major causes of death and disability worldwide. They are associated with high health service utilization persisting over many years. Their slow progression and wide clinical variation make them eminently suitable for study in population-based cohorts. However, current understanding of their prevalence, incidence, and progression is largely based on studies conducted in clinical populations. Objective This study aims to establish a novel link between an existing population-based cohort (the 45 and Up Study) and routinely collected laboratory and administrative data to facilitate research across the full disease spectrum of CKD and diabetes. Methods In the EXTEND45 Study (EXamining OuTcomEs in chroNic Disease in the 45 and Up Study), baseline questionnaire responses of over 260,000 participants of the 45 and Up Study aged ≥45 years living in New South Wales (NSW), collected between January 2006 and December 2009, are linked to data from laboratory service providers as well as national- and state-based administrative datasets via probabilistic linkage. Routinely collected data were obtained for participants who could be linked between January 2005 and July 2013. Laboratory data will enable the identification of early cases of chronic disease and the assessment of clinically relevant biochemical targets during the disease course. Health administrative datasets will allow for the examination of health service use, pharmacological management, and clinical outcomes. Results The study received ethics approval from the NSW Population and Health Services Research Ethics Committee in February 2014. Data linkage for 267,153 of the 45 and Up Study participants was completed in June 2016, with congruent linkage achieved for 265,086 (99.23%) individuals. To date, the CKD and diabetes cohorts have been identified (published elsewhere), and a diverse portfolio of research projects relating to disease burden, risk factors, health outcomes, and health service utilization is in development. Conclusions The EXTEND45 Study represents an unparalleled opportunity to perform extensive research into diseases of considerable public health and clinical importance. Strengths include the population-based nature of the cohort and the availability of longitudinal information on the complete disease pathway for affected individuals. International Registered Report Identifier (IRRID) RR1-10.2196/15646
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Affiliation(s)
- Celine Foote
- The George Institute for Global Health, Sydney, Australia.,Concord Repatriation General Hospital, Sydney, Australia
| | - Carinna Hockham
- The George Institute for Global Health, Sydney, Australia.,Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Louisa Sukkar
- The George Institute for Global Health, Sydney, Australia.,School of Public Health, University of Sydney, Sydney, Australia
| | - Anna Campain
- The George Institute for Global Health, Sydney, Australia.,Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Amy Kang
- The George Institute for Global Health, Sydney, Australia.,Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Tamara Young
- The George Institute for Global Health, Sydney, Australia.,Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Alan Cass
- Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | - Clara K Chow
- The George Institute for Global Health, Sydney, Australia.,Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Sydney, Australia.,Department of Cardiology, Westmead Hospital, Sydney, Australia
| | - Elizabeth Comino
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, Australia
| | - Martin Gallagher
- The George Institute for Global Health, Sydney, Australia.,Concord Repatriation General Hospital, Sydney, Australia.,Faculty of Medicine, University of New South Wales, Sydney, Australia.,Sydney Medical School, University of Sydney, Sydney, Australia
| | - Stephen Jan
- The George Institute for Global Health, Sydney, Australia.,Faculty of Medicine, University of New South Wales, Sydney, Australia.,Sydney Medical School, University of Sydney, Sydney, Australia
| | - John Knight
- The George Institute for Global Health, Sydney, Australia.,Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Bette Liu
- School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia
| | | | - David Peiris
- The George Institute for Global Health, Sydney, Australia.,Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Carol Pollock
- Renal Division, Kolling Institute for Medical Research, Sydney, Australia.,University of Sydney, Sydney, Australia
| | - David Sullivan
- Sydney Medical School, University of Sydney, Sydney, Australia.,Department of Chemical Pathology, Royal Prince Alfred Hospital, Sydney, Australia
| | - Germaine Wong
- School of Public Health, University of Sydney, Sydney, Australia.,Centre for Transplant and Renal Research, Westmead Hospital, Sydney, Australia
| | - Sophia Zoungas
- The George Institute for Global Health, Sydney, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Kris Rogers
- The George Institute for Global Health, Sydney, Australia.,Graduate School of Health, University of Technology Sydney, Sydney, Australia
| | - Min Jun
- The George Institute for Global Health, Sydney, Australia.,Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Meg Jardine
- The George Institute for Global Health, Sydney, Australia.,Concord Repatriation General Hospital, Sydney, Australia
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14
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Webster R, Hespe C, Campain A, Patel A, Peiris D. P5319Evidence-practice gaps in the screening and management of cardiovascular risk factors in the Australian General Practice population. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Cardiovascular disease (CVD) is a major cause of death and disability in Australia affecting 1 in 6 of the Australian population. Studies a decade ago showed large evidence-practice gaps in the screening and management of CVD risk in Australian General Practice. A new risk-based screening and management guideline was launched in 2012.
Purpose
This study aimed to update the evidence to evaluate appropriate screening for, and management of, cardiovascular risk factors in Australian General Practice and explore practice and patient level predictors for appropriate screening and management.
Methods
Cross-sectional de-identified data from GP electronic health records were extracted for patients >18 years having attended at least once in the last 6 months and 3 times in the last 2 years (i.e. active patients). Practice-level data were also collected manually. The statistical cohort included Aboriginal and Torres Strait Islander people 35+ years and all others 45+ years, or any individual classified as “high CVD risk” regardless of age. High risk was defined as having either established CVD, pre-defined clinically high risk conditions or a calculated 5-year risk >15% using a Framingham based risk calculator. Appropriate screening was defined as having recorded/updated all essential risk factors for measurement of CVD risk within recommended time frames. Appropriate management was defined as: ≥1 BP lowering drug and a statin for people at high risk without CVD and the addition of an antiplatelet or anticoagulant agent for people with established CVD.
Results
Data were available on 110686 patients from 98 General Practices of which 55% were female, 1.4% of Aboriginal or Torres Strait Islander background, 14% current or ex-smoker and 15% with Diabetes. Forty-nine percent had complete and up to date screening information. Twenty-six percent were classified as high risk of which 11% had established CVD. Fifty-one per cent of those with established CVD were on appropriate treatment, vs 38% of those at high risk but without CVD. A greater proportion of males received appropriate screening (51.5% vs 47.5%). Females were less likely to receive recommended therapy (44.2% vs 55.1%) for secondary prevention but more likely for primary prevention (42% vs 35.5%). For those on BP lowering therapy, only 37% of those with CVD were reaching their target BP compared to 54% of those at high risk without established disease. 56% of those with CVD on lipid lowering therapy were reaching their targets compared to 45% of those at high risk without CVD.
Conclusion
Despite availability of a national guideline, gaps remain large for the management of CVD in Australian General Practice. Female primary prevention patients appear to receive better screening and treatment than their male counterparts, but this is reversed when they have established disease. Analysis of patient and practice level predictors for these gaps is currently underway.
Acknowledgement/Funding
National Health and Medical Research Council
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Affiliation(s)
- R Webster
- The George Institute for Global Health, Sydney, Australia
| | - C Hespe
- University of Notre Dame, Sydney, Australia
| | - A Campain
- The George Institute for Global Health, Sydney, Australia
| | - A Patel
- The George Institute for Global Health, Sydney, Australia
| | - D Peiris
- The George Institute for Global Health, Sydney, Australia
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15
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Lee MG, Marshall NS, Clemons TE, Hunter ML, James AL, Grunstein RR, Nguyen V, Campain A, Gillies MC. No association between sleep apnoea and macular telangiectasia type 2 and its markers of severity and progression: a case-control study and retrospective cohort study. Clin Exp Ophthalmol 2018; 47:63-68. [PMID: 30047178 DOI: 10.1111/ceo.13363] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 06/26/2018] [Accepted: 07/21/2018] [Indexed: 11/30/2022]
Abstract
IMPORTANCE Idiopathic Macular Telangiectasia Type 2 (MacTel) is an uncommon, progressive retinal disease usually affecting both eyes. Currently there is no know treatment however with similar comorbidities to Obstructive Sleep Apnoea (OSA) there is plausibility of an association which may accelerate disease progression. BACKGROUND To identify an association between MacTel and OSA and whether OSA may result in increased disease progression. DESIGN Matched case-control study and retrospective cohort analysis. PARTICIPANTS Fifty-seven patients with MacTel and 165 matched controls from the Busselton Health Study. METHODS MacTel participants were matched based on age, gender and body mass index (BMI) (and where possible hypertension and diabetes) on a 3:1 ratio with controls from the Busselton Health Study. Participants undertook a sleep questionnaire using a previously validated questionnaire. In a subset sleep apnoea severity was objectively measured via overnight ambulatory polygraphy (30 cases and 83 matched controls; ApneaLink device; ResMed, Sydney, Australia). In a retrospective analysis of the suspected MacTel cases we assessed whether major markers of OSA severity and MacTel progression were associated. MAIN OUTCOME MEASURES Apnoea Hypopnea Index along with key markers of MacTel progression. RESULTS MacTel patients did not have a higher risk of sleep apnoea when compared to age, sex and BMI -matched controls (mean ± SD Apnoea hypopnea index [AHI] cases 9.6 ± 14.7 vs. controls 9.7 ± 10.8, P = 0.95). No markers of disease progression in the cases were associated with any marker of OSA severity. CONCLUSIONS AND RELEVANCE Sleep apnoea does not increase the risk or accelerate the progression of MacTel.
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Affiliation(s)
- Martin G Lee
- Save Sight Institute, University of Sydney, Sydney, Australia
| | - Nathaniel S Marshall
- CIRUS- Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, Sydney, Australia.,Sydney Nursing School, University of Sydney, Sydney, Australia
| | | | - Michael L Hunter
- School of Population Health, University of Western Australia, Perth, Western Australia, Australia
| | - Alan L James
- Department of Pulmonary Physiology and Sleep Medicine, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - Ron R Grunstein
- CIRUS- Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, Sydney, Australia.,Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Sydney, Australia
| | - Vuong Nguyen
- Save Sight Institute, University of Sydney, Sydney, Australia
| | - Anna Campain
- Save Sight Institute, University of Sydney, Sydney, Australia
| | - Mark C Gillies
- Save Sight Institute, University of Sydney, Sydney, Australia
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16
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Mehta H, Hennings C, Gillies MC, Nguyen V, Campain A, Fraser‐Bell S. Anti-vascular endothelial growth factor combined with intravitreal steroids for diabetic macular oedema. Cochrane Database Syst Rev 2018; 4:CD011599. [PMID: 29669176 PMCID: PMC6494419 DOI: 10.1002/14651858.cd011599.pub2] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND The combination of steroid and anti-vascular endothelial growth factor (VEGF) intravitreal therapeutic agents could potentially have synergistic effects for treating diabetic macular oedema (DMO). On the one hand, if combined treatment is more effective than monotherapy, there would be significant implications for improving patient outcomes. Conversely, if there is no added benefit of combination therapy, then people could be potentially exposed to unnecessary local or systemic side effects. OBJECTIVES To assess the effects of intravitreal agents that block vascular endothelial growth factor activity (anti-VEGF agents) plus intravitreal steroids versus monotherapy with macular laser, intravitreal steroids or intravitreal anti-VEGF agents for managing DMO. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (which contains the Cochrane Eyes and Vision Trials Register) (2018, Issue 1); Ovid MEDLINE; Ovid Embase; LILACS; the ISRCTN registry; ClinicalTrials.gov and the ICTRP. The date of the search was 21 February 2018. SELECTION CRITERIA We included randomised controlled trials (RCTs) of intravitreal anti-VEGF combined with intravitreal steroids versus intravitreal anti-VEGF alone, intravitreal steroids alone or macular laser alone for managing DMO. We included people with DMO of all ages and both sexes. We also included trials where both eyes from one participant received different treatments. DATA COLLECTION AND ANALYSIS We used standard methodological procedures recommended by Cochrane.Two authors independently reviewed all the titles and abstracts identified from the electronic and manual searches against the inclusion criteria. Our primary outcome was change in best corrected visual acuity (BCVA) between baseline and one year. Secondary outcomes included change in central macular thickness (CMT), economic data and quality of life. We considered adverse effects including intraocular inflammation, raised intraocular pressure (IOP) and development of cataract. MAIN RESULTS There were eight RCTs (703 participants, 817 eyes) that met our inclusion criteria with only three studies reporting outcomes at one year. The studies took place in Iran (3), USA (2), Brazil (1), Czech Republic (1) and South Korea (1). Seven studies used the unlicensed anti-VEGF agent bevacizumab and one study used licensed ranibizumab. The study that used licensed ranibizumab had a unique design compared with the other studies in that included eyes had persisting DMO after anti-VEGF monotherapy and received three monthly doses of ranibizumab prior to allocation. The anti-VEGF agent was combined with intravitreal triamcinolone in six studies and with an intravitreal dexamethasone implant in two studies. The comparator group was anti-VEGF alone in all studies; two studies had an additional steroid monotherapy arm, another study had an additional macular laser photocoagulation arm. Whilst we judged these studies to be at low risk of bias for most domains, at least one domain was at unclear risk in all studies.When comparing anti-VEGF/steroid with anti-VEGF monotherapy as primary therapy for DMO, we found no meaningful clinical difference in change in BCVA (mean difference (MD) -2.29 visual acuity (VA) letters, 95% confidence interval (CI) -6.03 to 1.45; 3 RCTs; 188 eyes; low-certainty evidence) or change in CMT (MD 0.20 μm, 95% CI -37.14 to 37.53; 3 RCTs; 188 eyes; low-certainty evidence) at one year. There was very low-certainty evidence on intraocular inflammation from 8 studies, with one event in the anti-VEGF/steroid group (313 eyes) and two events in the anti-VEGF group (322 eyes). There was a greater risk of raised IOP (Peto odds ratio (OR) 8.13, 95% CI 4.67 to 14.16; 635 eyes; 8 RCTs; moderate-certainty evidence) and development of cataract (Peto OR 7.49, 95% CI 2.87 to 19.60; 635 eyes; 8 RCTs; moderate-certainty evidence) in eyes receiving anti-VEGF/steroid compared with anti-VEGF monotherapy. There was low-certainty evidence from one study of an increased risk of systemic adverse events in the anti-VEGF/steroid group compared with the anti-VEGF alone group (Peto OR 1.32, 95% CI 0.61 to 2.86; 103 eyes).One study compared anti-VEGF/steroid versus macular laser therapy. At one year investigators did not report a meaningful difference between the groups in change in BCVA (MD 4.00 VA letters 95% CI -2.70 to 10.70; 80 eyes; low-certainty evidence) or change in CMT (MD -16.00 μm, 95% CI -68.93 to 36.93; 80 eyes; low-certainty evidence). There was very low-certainty evidence suggesting an increased risk of cataract in the anti-VEGF/steroid group compared with the macular laser group (Peto OR 4.58, 95% 0.99 to 21.10, 100 eyes) and an increased risk of elevated IOP in the anti-VEGF/steroid group compared with the macular laser group (Peto OR 9.49, 95% CI 2.86 to 31.51; 100 eyes).One study provided very low-certainty evidence comparing anti-VEGF/steroid versus steroid monotherapy at one year. There was no evidence of a meaningful difference in BCVA between treatments at one year (MD 0 VA letters, 95% CI -6.1 to 6.1, low-certainty evidence). Likewise, there was no meaningful difference in the mean CMT at one year (MD - 9 μm, 95% CI -39.87μm to 21.87μm between the anti-VEGF/steroid group and the steroid group. There was very low-certainty evidence on raised IOP at one year comparing the anti-VEGF/steroid versus steroid groups (Peto OR 0.75, 95% CI 0.16 to 3.55).No included study reported impact of treatment on patients' quality of life or economic data. None of the studies reported any cases of endophthalmitis. AUTHORS' CONCLUSIONS Combination of intravitreal anti-VEGF plus intravitreal steroids does not appear to offer additional visual benefit compared with monotherapy for DMO; at present the evidence for this is of low-certainty. There was an increased rate of cataract development and raised intraocular pressure in eyes treated with anti-VEGF plus steroid versus anti-VEGF alone. Patients were exposed to potential side effects of both these agents without reported additional benefit. The majority of the evidence comes from studies of bevacizumab and triamcinolone used as primary therapy for DMO. There is limited evidence from studies using licensed intravitreal anti-VEGF agents plus licensed intravitreal steroid implants with at least one year follow-up. It is not known whether treatment response is different in eyes that are phakic and pseudophakic at baseline.
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Affiliation(s)
- Hemal Mehta
- Royal Free London NHS Foundation TrustLondonUK
- University of SydneyMacular Research Group, Save Sight InstituteSydneyAustralia
| | | | - Mark C Gillies
- University of SydneyMacular Research Group, Save Sight InstituteSydneyAustralia
| | - Vuong Nguyen
- University of SydneyMacular Research Group, Save Sight InstituteSydneyAustralia
| | - Anna Campain
- University of SydneyMacular Research Group, Save Sight InstituteSydneyAustralia
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Barthelmes D, Campain A, Nguyen P, Arnold JJ, McAllister IL, Simpson JM, Hunyor AP, Guymer R, Essex RW, Morlet N, Gillies MC. Effects of switching from ranibizumab to aflibercept in eyes with exudative age-related macular degeneration. Br J Ophthalmol 2016; 100:1640-1645. [PMID: 26994110 PMCID: PMC5256411 DOI: 10.1136/bjophthalmol-2015-308090] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Revised: 02/13/2016] [Accepted: 02/22/2016] [Indexed: 12/20/2022]
Abstract
Aims To examine 12-month outcomes of eyes switching from intravitreal ranibizumab to aflibercept for neovascular age-related macular degeneration (nAMD). Methods Database observational study of eyes with nAMD tracked by the Fight Retinal Blindness outcome registry that received ranibizumab for at least 12 months before switching to aflibercept and followed for at least 12 months after the switch. Visual acuity (VA) recorded at 12 months after the switch was analysed using locally weighted scatterplot smoothing curves. Lesion activity was graded according to a prospectively identified definition. Main outcomes were change in VA and treatment intervals 12 months after the treatment switch. Secondary outcomes included change in activity grading, effect of duration of treatment before switching and analysis of eyes that switched back. Results A total of 384 eyes switched from ranibizumab to aflibercept after a mean duration of 39.8 months on the original treatment. The mean VA did not change from the time of switching treatment (63.4, SD 15.9 logarithm of the minimum angle of resolution letters) to 12 months later (63.3, SD 16.7). While 10% of eyes gained 10 or more letters 12 months after the switch, 13% lost the same amount. The mean number of injections decreased by around one injection in the 12 months after switching (p<0.001), with a decrease in the proportion of choroidal neovascular membrane lesions that were graded as active. Eyes that had been treated for the longest time (49 or more months) before switching had worse vision at the point of switch but neither change in VA nor treatment interval was different between groups. The small proportion (6.9%) of eyes that switched back again to ranibizumab had already lost a mean of 5.2 letters from the first switch to the switch back and continued to lose vision at a similar rate for at least 6 months. Conclusions The mean VA of eyes that switched treatments from ranibizumab to aflibercept was not different 12 months later. There was a modest increase in treatment intervals and a somewhat greater proportion of eyes that were graded as inactive after the switch.
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Affiliation(s)
- Daniel Barthelmes
- The Save Sight Institute, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia.,Department of Ophthalmology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Anna Campain
- The Save Sight Institute, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Phuc Nguyen
- The Save Sight Institute, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | | | - Ian L McAllister
- The Lions Eye Institute, Center for Ophthalmology and Vision Science, University of Western Australia, Perth, Western Australia, Australia
| | - Judy M Simpson
- Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Alex P Hunyor
- The Save Sight Institute, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia.,Retina Associates, Chatswood, New South Wales, Australia
| | - Robyn Guymer
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, University of Melbourne, Melbourne, Victoria, Australia
| | - Rohan W Essex
- Department of Ophthalmology, Canberra Hospital, Garran, Australian Capital Territory, Australia
| | - Nigel Morlet
- Department of Population Health, University of Western Australia, Perth, Western Australia, Australia
| | - Mark C Gillies
- The Save Sight Institute, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
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Fraser-Bell S, Lim LL, Campain A, Mehta H, Aroney C, Bryant J, Li J, Quin GJ, McAllister IL, Gillies MC. Bevacizumab or Dexamethasone Implants for DME: 2-year Results (The BEVORDEX Study). Ophthalmology 2016; 123:1399-401. [PMID: 26783096 DOI: 10.1016/j.ophtha.2015.12.012] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Revised: 12/02/2015] [Accepted: 12/02/2015] [Indexed: 11/26/2022] Open
Affiliation(s)
- Samantha Fraser-Bell
- Save Sight and Eye Health Institute, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Lyndell L Lim
- Centre for Eye Research Australia, University of Melbourne, Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria, Australia
| | - Anna Campain
- Save Sight and Eye Health Institute, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Hemal Mehta
- Save Sight and Eye Health Institute, Sydney Medical School, University of Sydney, Sydney, NSW, Australia.
| | - Christine Aroney
- Save Sight and Eye Health Institute, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Jaclyn Bryant
- Save Sight and Eye Health Institute, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Ji Li
- Save Sight and Eye Health Institute, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Godfrey J Quin
- Save Sight and Eye Health Institute, Sydney Medical School, University of Sydney, Sydney, NSW, Australia; Ophthalmology Department, Australian School of Advanced Medicine, Macquarie University, Sydney, NSW, Australia
| | - Ian L McAllister
- Lions Eye Institute, Centre for Ophthalmology and Visual Science, University of Western Australia, Australia
| | - Mark C Gillies
- Save Sight and Eye Health Institute, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
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Mehta H, Fraser-Bell S, Yeung A, Campain A, Lim LL, Quin GJ, McAllister IL, Keane PA, Gillies MC. Efficacy of dexamethasone versus bevacizumab on regression of hard exudates in diabetic maculopathy: data from the BEVORDEX randomised clinical trial. Br J Ophthalmol 2015; 100:1000-1004. [PMID: 26537156 DOI: 10.1136/bjophthalmol-2015-307797] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2015] [Revised: 10/07/2015] [Accepted: 10/15/2015] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To report the effect of bevacizumab versus dexamethasone on hard exudates (HEX) in diabetic macular oedema (DME). DESIGN Post hoc analysis of 24-month data from the Randomised clinical trial of BEVacizumab OR DEXamethasone for diabetic macular oedema (BEVORDEX) phase 2 multicentre randomised clinical trial. Eyes with centre-involving DME resistant to or unlikely to benefit from macular laser therapy were included. Eyes were randomly assigned to bevacizumab every 4 weeks or Ozurdex dexamethasone implant (DEX) every 16 weeks, both as required. The 68 eyes from 48 patients that completed 24-month follow-up were analysed. Two masked graders assessed extent and location of HEX on baseline, 12-month and 24-month foveal-centred colour fundus photographs using validated grading software. RESULTS Macular HEX was present in 60% of study eyes. Of these, 21 eyes were treated with DEX and 20 eyes with bevacizumab. Both treatments led to reduction in area of macular HEX at 12 months and 24 months. There was greater regression of HEX from the foveal centre in DEX-treated eyes (median change +890 µm, IQR=1040 µm) than bevacizumab-treated eyes (median change +7.0 µm, IQR=590 µm) at 12 months (p=0.04) but the difference was no longer statistically significant (p=0.10) by 24 months (DEX +1400 µm, IQR=1590 µm; bevacizumab +20 µm, IQR=2680 µm). Reassuringly, no study eye developed HEX at the foveal centre, a visually devastating consequence of diabetic maculopathy. CONCLUSIONS Bevacizumab and DEX were effective in reducing area of HEX in eyes with DME. DEX provided more rapid regression of HEX from the foveal centre although bevacizumab-treated eyes started to catch up by 24 months. Distance from the foveal centre as well as total area of macular HEX should be assessed when evaluating treatments for foveal-threatening HEX. TRIAL REGISTRATION NUMBER NCT01298076; Post-results.
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Affiliation(s)
- Hemal Mehta
- The Save Sight and Eye Health Institute, Sydney Medical School, University of Sydney, Sydney, Australia.,National Institute for Health Research Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
| | - Samantha Fraser-Bell
- The Save Sight and Eye Health Institute, Sydney Medical School, University of Sydney, Sydney, Australia
| | - Aaron Yeung
- The Save Sight and Eye Health Institute, Sydney Medical School, University of Sydney, Sydney, Australia
| | - Anna Campain
- The Save Sight and Eye Health Institute, Sydney Medical School, University of Sydney, Sydney, Australia
| | - Lyndell L Lim
- Centre for Eye Research Australia, University of Melbourne, Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria, Australia
| | - Godfrey J Quin
- The Save Sight and Eye Health Institute, Sydney Medical School, University of Sydney, Sydney, Australia.,Ophthalmology Department, Australian School of Advanced Medicine, Macquarie University, Sydney, Australia
| | - Ian L McAllister
- Lions Eye Institute, Centre for Ophthalmology and Visual Science, University of Western Australia, Perth, Western Australia, Australia
| | - Pearse A Keane
- National Institute for Health Research Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
| | - Mark C Gillies
- The Save Sight and Eye Health Institute, Sydney Medical School, University of Sydney, Sydney, Australia
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Abstract
Background Patient-centered care recognizes the obligation to understand and meet patient’s expectations. An individual’s satisfaction has been found to affect health-related decisions and treatment-related behaviours, which in turn affect medical compliance, follow-up, the success of treatment and the appropriate use of services. We studied the expectations, experiences and satisfaction of patients who participated in clinical trials for retinal diseases at the Sydney Eye Hospital. Methods The study was undertaken at the research clinic of the major public quaternary eye hospital in New South Wales, Australia. A 37-question survey was conducted on patients enrolled in or who had finished a clinical trial for macular disease in the 12 months preceding this study in November 2012. Patient satisfaction was assessed using close-ended, multiple choice questions. First, the decision making process for entering into the clinical trial was evaluated. Then the level of patient understanding and experience during the study was assessed. Finally, there was a series of questions to gauge the participants’ perception of trial outcomes and overall impression gained from the experience. Results Eighty patients completed the questionnaire. Overall patient satisfaction was high with the majority of patients stating they would recommend participation in a retinal clinical trial (94 %) and participate in a subsequent trial (78 %). Most patients rated themselves as the most important factor in making the decision to join a trial. Patients felt well informed and expectations were generally felt to be met, however 14 % did not believe that they could withdraw from the study voluntarily. The most common reasons for trial participation were to contribute to medical science and to have improved treatment outcomes. Conclusions We found that patients generally found participation in retinal clinical trials to be a positive experience. Factors contributing to dissatisfaction mainly related to inconvenience experienced by transportation and waiting times. We also found that patients felt well informed about the study, but some did not have a complete understanding of their rights, which had been communicated to them when they entered the study. There were both altruistic and self-motivated reasons behind patients’ decisions to join a retinal trial. Electronic supplementary material The online version of this article (doi:10.1186/s12886-015-0071-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Cheryl Pui-Yan Au
- Department of Ophthalmology, Westmead Hospital, Sydney, Australia. .,Sydney Medical School, University of Sydney, Sydney, Australia.
| | - Nicole Fardell
- Sydney Medical School, University of Sydney, Sydney, Australia.
| | - Maria Williams
- Macular Research Group, Room 116, Level 1, Save Sight Institute, Campus of Sydney Eye Hospital, 8 Macquarie St, Sydney, NSW, 2000, Australia.
| | - Samantha Fraser-Bell
- Macular Research Group, Room 116, Level 1, Save Sight Institute, Campus of Sydney Eye Hospital, 8 Macquarie St, Sydney, NSW, 2000, Australia.
| | - Anna Campain
- Macular Research Group, Room 116, Level 1, Save Sight Institute, Campus of Sydney Eye Hospital, 8 Macquarie St, Sydney, NSW, 2000, Australia.
| | - Mark Gillies
- Sydney Medical School, University of Sydney, Sydney, Australia. .,Macular Research Group, Room 116, Level 1, Save Sight Institute, Campus of Sydney Eye Hospital, 8 Macquarie St, Sydney, NSW, 2000, Australia.
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Gillies MC, Campain A, Barthelmes D, Simpson JM, Arnold JJ, Guymer RH, McAllister IL, Essex RW, Morlet N, Hunyor AP. Long-Term Outcomes of Treatment of Neovascular Age-Related Macular Degeneration: Data from an Observational Study. Ophthalmology 2015; 122:1837-45. [PMID: 26096346 DOI: 10.1016/j.ophtha.2015.05.010] [Citation(s) in RCA: 190] [Impact Index Per Article: 21.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Revised: 05/05/2015] [Accepted: 05/05/2015] [Indexed: 11/26/2022] Open
Abstract
PURPOSE To analyze the long-term outcomes of eyes with neovascular age-related macular degeneration (AMD) starting treatment with vascular endothelial growth factor (VEGF) inhibitors at least 5 years earlier. DESIGN Database observational study. PARTICIPANTS Treatment-naïve eyes with neovascular AMD tracked by the Fight Retinal Blindness outcome registry that received at least 1 anti-VEGF injection. METHODS Locally weighted scatterplot smoothing curves were used to display visual acuity (VA) results. MAIN OUTCOME MEASURES Change in mean VA and number of injections and visits from baseline up to 7 years after initiating treatment. RESULTS The mean follow-up time of all 1212 identified eyes was 53.5 months, and 549 (45%) continued attending after 60 months. Mean VA improved from 55.1 to 61.4 letters after 6 months and remained above the mean presenting VA for approximately 6 years. After 7 years, mean VA was 2.6 letters lower than baseline for the 131 eyes still being followed; 40% had VA ≥70 (20/40) letters, and 18% had VA ≤35 letters (20/200). Of those with 20/40 VA before treatment, 40% had lost it after 7 years. Geographic atrophy affecting the fovea was thought to be the cause of a ≥10-letter loss after 6.5 years in 37% of a subset of such eyes that were retrospectively analyzed. A median of 6 injections and 9 visits were recorded over the first 12 months, and then 5 treatments and 7 to 9 visits per annum thereafter through 7 years. Treatment was discontinued for 663 eyes (53%) within the first 5 years. Despite initial gains in vision, the mean VA of these eyes had deteriorated to baseline or worse around the time treatment was discontinued. The rate of serious adverse events was low. CONCLUSIONS Good long-term outcomes of VEGF inhibition for neovascular AMD were found in this study. These results may be better than other reports because more injections were given to our patients, possibly associated with a greater incentive for the physician to treat. Further studies to determine how to maximize the proportion of eyes that retain the initial VA gains of anti-VEGF are warranted.
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Affiliation(s)
- Mark C Gillies
- The Save Sight Institute, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Anna Campain
- The Save Sight Institute, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Daniel Barthelmes
- The Save Sight Institute, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia; Department of Ophthalmology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
| | - Judy M Simpson
- School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | | | - Robyn H Guymer
- Centre for Eye Research Australia, University of Melbourne, Royal Victorian Eye and Ear Hospital, Victoria, Australia
| | - Ian L McAllister
- Lions Eye Institute, Centre for Ophthalmology and Vision Science, University of Western Australia, Perth, Australia
| | - Rohan W Essex
- Academic Unit of Ophthalmology, Australian National University, Acton, ACT, Australia
| | - Nigel Morlet
- University of Western Australia Department of Population Health, Perth, Australia
| | - Alex P Hunyor
- The Save Sight Institute, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia; Retina Associates, Chatswood, New South Wales, Australia
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Arnold JJ, Campain A, Barthelmes D, Simpson JM, Guymer RH, Hunyor AP, McAllister IL, Essex RW, Morlet N, Gillies MC, Gillies M, Hunt A, Hunyor A, Arnold J, Young S, Clark G, Banerjee G, Phillips R, Perks M, Essex R, McAllister I, Constable I, Guymer R, Guymer R, Lim L, Harper A, Chow L, Wickremansinghe S, Wickremasinghe S, Wickremasinghe S. Two-year outcomes of "treat and extend" intravitreal therapy for neovascular age-related macular degeneration. Ophthalmology 2015; 122:1212-9. [PMID: 25846847 DOI: 10.1016/j.ophtha.2015.02.009] [Citation(s) in RCA: 138] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2014] [Revised: 02/06/2015] [Accepted: 02/06/2015] [Indexed: 11/25/2022] Open
Abstract
PURPOSE To report 24-month outcomes of anti-vascular endothelial growth factor (VEGF) therapy for treatment-naïve eyes with neovascular age-related macular degeneration (nAMD) using a treat and extend treatment regimen in routine clinical practice. DESIGN Database observational study. PARTICIPANTS We included treatment-naïve eyes receiving predominantly ranibizumab for nAMD in routine clinical practice treated using a treat and extend regimen that were tracked in the Fight Retinal Blindness observational registry. METHODS A cohort of eyes treated by practitioners using exclusively a treat and extend regimen was extracted from the Fight Retinal Blindness observational registry. MAIN OUTCOME MEASURES Change in visual acuity (VA) over 2 years and number of injections and visits. RESULTS Data from 1198 eyes from 1011 patients receiving anti-VEGF therapy using a treat and extend regimen for treatment-naïve nAMD between January 2007 and December 2012 and with 24-month follow-up were included in the analysis. Mean VA increased by +5.3 logarithm of the minimum angle of resolution letters from 56.5 letters (20/80+1) at initial visit to 61.8 (20/60+2) letters at 24 months. Mean VA gains improved and number of injections increased with successive years from +2.7 letters for eyes commencing in 2007 after a mean of 9.7 injections in 2 years, to +7.8 letters for eyes commencing in 2012 after a mean of 14.2 injections over 2 years. The proportion of eyes with VA >20/40 increased from 27% when starting treatment to 45% after 24 months; the proportion with vision of <20/200 remained unchanged (13% initial, 11% at 24 months). Of the included eyes, 90.5% avoided a vision loss of ≥15 letters. There was an overall mean of 13.0 injections over the 24 months, 7.5 injections in the first year and 5.5 in the second year, with a mean of 14.8 clinic visits. CONCLUSIONS These data indicate that eyes managed in routine clinical practice with a treat and extend regimen can achieve good visual outcomes while decreasing the burden of treatments and clinic visits.
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Affiliation(s)
| | - Anna Campain
- The Save Sight Institute, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Daniel Barthelmes
- The Save Sight Institute, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia; Department of Ophthalmology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
| | - Judy M Simpson
- School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Robyn H Guymer
- Centre for Eye Research Australia, University of Melbourne, Royal Victorian Eye and Ear Hospital, Victoria, Australia
| | - Alex P Hunyor
- The Save Sight Institute, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia; Retina Associates, Chatswood, New South Wales, Australia
| | - Ian L McAllister
- Lions Eye Institute, Centre for Ophthalmology and Vision Science, University of Western Australia, Western Australia
| | - Rohan W Essex
- Academic Unit of Ophthalmology, Australian National University, Acton, Canberra, Australia
| | - Nigel Morlet
- University of Western Australia Department of Population Health, Perth, Western Australia
| | - Mark C Gillies
- Marsden Eye Specialists, Parramatta, New South Wales, Australia
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Mehta H, Fraser-Bell S, Campain A, Gillies MC. Anti-vascular endothelial growth factor combined with intravitreal steroids for diabetic macular oedema. Hippokratia 2015. [DOI: 10.1002/14651858.cd011599] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Hemal Mehta
- University of Sydney; Macular Research Group, Save Sight Institute; 8 Macquarie Street Sydney Australia 2000
| | - Samantha Fraser-Bell
- University of Sydney; Macular Research Group, Save Sight Institute; 8 Macquarie Street Sydney Australia 2000
| | - Anna Campain
- University of Sydney; Macular Research Group, Save Sight Institute; 8 Macquarie Street Sydney Australia 2000
| | - Mark C Gillies
- University of Sydney; Macular Research Group, Save Sight Institute; 8 Macquarie Street Sydney Australia 2000
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Gillies MC, Campain A, Walton R, Simpson JM, Arnold JJ, Guymer RH, McAllister IL, Hunyor AP, Essex RW, Morlet N, Barthelmes D, Gillies MC, Campain AE, Walton R, Simpson JM, Arnold JJ, Guymer RH, McAllister IL, Hunyor AP, Essex RW, Morlet N, Barthelmes D. Time to Initial Clinician-Reported Inactivation of Neovascular Age-Related Macular Degeneration Treated Primarily with Ranibizumab. Ophthalmology 2015; 122:589-594.e1. [DOI: 10.1016/j.ophtha.2014.10.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Revised: 10/01/2014] [Accepted: 10/01/2014] [Indexed: 11/16/2022] Open
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Gillies MC, Lim LL, Campain A, Quin GJ, Salem W, Li J, Goodwin S, Aroney C, McAllister IL, Fraser-Bell S. A randomized clinical trial of intravitreal bevacizumab versus intravitreal dexamethasone for diabetic macular edema: the BEVORDEX study. Ophthalmology 2014; 121:2473-81. [PMID: 25155371 DOI: 10.1016/j.ophtha.2014.07.002] [Citation(s) in RCA: 224] [Impact Index Per Article: 22.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Revised: 06/26/2014] [Accepted: 07/02/2014] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE To report the 12-month results of the first head-to-head comparison of a dexamethasone implant (Ozurdex; Allergan, Inc., Irvine, CA) versus bevacizumab (Avastin; Genentech, South San Francisco, CA) for center-involving diabetic macular edema (DME). DESIGN Phase 2, prospective, multicenter, randomized, single-masked clinical trial (clinicaltrials.gov identifier NCT01298076). PARTICIPANTS We enrolled 88 eyes of 61 patients with center-involving DME. METHODS Forty-two eyes were randomized to receive bevacizumab every 4 weeks and 46 eyes were randomized to receive a dexamethasone implant every 16 weeks, both pro re nata. Results were analyzed using linear regression with generalized estimation equation methods to account for between-eye correlation. MAIN OUTCOME MEASURES The primary outcome was the proportion of eyes that improved vision by 10 logarithm of minimum angle of resolution letters. Secondary outcomes included mean change in best-corrected visual acuity (BCVA), change in central macular thickness (CMT), injection frequency, and adverse events. Patient-reported outcomes were measured using the Impact of Vision Impairment (IVI) questionnaire. RESULTS Improvement in BCVA of 10 or more letters was found in 17 of 42 eyes (40%) treated with bevacizumab compared with 19 of 46 dexamethasone implant-treated eyes (41%; P = 0.83). None of the 42 bevacizumab eyes lost 10 letters or more, whereas 5 of 46 (11%) dexamethasone implant eyes did, mostly because of cataract. Mean CMT decreased by 122 μm for bevacizumab eyes and by 187 μm for dexamethasone implant eyes (P = 0.015). Bevacizumab-treated eyes received a mean of 8.6 injections compared with 2.7 injections for dexamethasone implant eyes. Significant improvement in IVI scores occurred for both treatment groups. CONCLUSIONS Dexamethasone implant achieved similar rates of visual acuity improvement compared with bevacizumab for DME, with superior anatomic outcomes and fewer injections. Both treatments were associated with improvement in visual quality-of-life scores. However, more dexamethasone implant-treated eyes lost vision, mainly because of cataract.
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Affiliation(s)
- Mark C Gillies
- The Save Sight and Eye Health Institute, Sydney Medical School, The University of Sydney, Sydney NSW, Australia
| | - Lyndell L Lim
- Centre for Eye Research Australia, University of Melbourne, Royal Victorian Eye and Hospital, East Melbourne, Victoria, Australia
| | - Anna Campain
- The Save Sight and Eye Health Institute, Sydney Medical School, The University of Sydney, Sydney NSW, Australia
| | - Godfrey J Quin
- The Save Sight and Eye Health Institute, Sydney Medical School, The University of Sydney, Sydney NSW, Australia
| | - Wedad Salem
- The Save Sight and Eye Health Institute, Sydney Medical School, The University of Sydney, Sydney NSW, Australia
| | - Ji Li
- The Save Sight and Eye Health Institute, Sydney Medical School, The University of Sydney, Sydney NSW, Australia
| | - Stephanie Goodwin
- The Save Sight and Eye Health Institute, Sydney Medical School, The University of Sydney, Sydney NSW, Australia
| | - Christine Aroney
- The Save Sight and Eye Health Institute, Sydney Medical School, The University of Sydney, Sydney NSW, Australia
| | - Ian L McAllister
- Lions Eye Institute, Centre for Ophthalmology and Visual Science, University of Western Australia, Australia
| | - Samantha Fraser-Bell
- The Save Sight and Eye Health Institute, Sydney Medical School, The University of Sydney, Sydney NSW, Australia.
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Barthelmes D, Walton RJ, Arnold JJ, McAllister IL, Simpson JM, Campain A, Hunyor AP, Guymer R, Essex RW, Morlet N, Gillies MC. Intravitreal therapy in bilateral neovascular age-related macular degeneration. Ophthalmology 2014; 121:2073-4. [PMID: 24939512 DOI: 10.1016/j.ophtha.2014.05.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Accepted: 05/09/2014] [Indexed: 11/30/2022] Open
Affiliation(s)
- Daniel Barthelmes
- The Save Sight Institute, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia; Department of Ophthalmology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Richard J Walton
- The Save Sight Institute, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | | | - Ian L McAllister
- The Lions Eye Institute, Center for Ophthalmology and Vision Science, University of Western Australia, Perth, Western Australia, Australia
| | - Judy M Simpson
- Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Anna Campain
- The Save Sight Institute, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Alex P Hunyor
- The Save Sight Institute, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia; Retina Associates, Chatswood, New South Wales, Australia
| | - Robyn Guymer
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, University of Melbourne, Melbourne, Victoria, Australia
| | - Rohan W Essex
- Department of Ophthalmology, Canberra Hospital, Garran, Australian Capital Territory, Australia
| | - Nigel Morlet
- Department of Population Health, University of Western Australia, Perth, Western Australia, Australia
| | - Mark C Gillies
- The Save Sight Institute, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
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Oates J, Casikar I, Campain A, Müller S, Yang J, Reid S, Condous G. A prediction model for viability at the end of the first trimester after a single early pregnancy evaluation. Aust N Z J Obstet Gynaecol 2013; 53:51-7. [DOI: 10.1111/ajo.12046] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2012] [Accepted: 11/27/2012] [Indexed: 12/01/2022]
Affiliation(s)
- Jennifer Oates
- Early Pregnancy and Advanced Endosurgery Unit; Acute Gynaecology; Nepean Centre for Perinatal Care; Nepean Clinical School; Nepean Hospital; University of Sydney; Kingswood; Australia
| | - Ishwari Casikar
- Early Pregnancy and Advanced Endosurgery Unit; Acute Gynaecology; Nepean Centre for Perinatal Care; Nepean Clinical School; Nepean Hospital; University of Sydney; Kingswood; Australia
| | - Anna Campain
- School of Mathematics and Statistics; University of Sydney; Sydney; Australia
| | - Samuel Müller
- School of Mathematics and Statistics; University of Sydney; Sydney; Australia
| | - Jean Yang
- School of Mathematics and Statistics; University of Sydney; Sydney; Australia
| | - Shannon Reid
- Early Pregnancy and Advanced Endosurgery Unit; Acute Gynaecology; Nepean Centre for Perinatal Care; Nepean Clinical School; Nepean Hospital; University of Sydney; Kingswood; Australia
| | - George Condous
- Early Pregnancy and Advanced Endosurgery Unit; Acute Gynaecology; Nepean Centre for Perinatal Care; Nepean Clinical School; Nepean Hospital; University of Sydney; Kingswood; Australia
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Loi TH, Campain A, Bryant A, Molloy TJ, Lutherborrow M, Turner J, Yang YHJ, Ma DDF. Discriminating lymphomas and reactive lymphadenopathy in lymph node biopsies by gene expression profiling. BMC Med Genomics 2011; 4:27. [PMID: 21453471 PMCID: PMC3080274 DOI: 10.1186/1755-8794-4-27] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2010] [Accepted: 03/31/2011] [Indexed: 12/11/2022] Open
Abstract
Background Diagnostic accuracy of lymphoma, a heterogeneous cancer, is essential for patient management. Several ancillary tests including immunophenotyping, and sometimes cytogenetics and PCR are required to aid histological diagnosis. In this proof of principle study, gene expression microarray was evaluated as a single platform test in the differential diagnosis of common lymphoma subtypes and reactive lymphadenopathy (RL) in lymph node biopsies. Methods 116 lymph node biopsies diagnosed as RL, classical Hodgkin lymphoma (cHL), diffuse large B cell lymphoma (DLBCL) or follicular lymphoma (FL) were assayed by mRNA microarray. Three supervised classification strategies (global multi-class, local binary-class and global binary-class classifications) using diagonal linear discriminant analysis was performed on training sets of array data and the classification error rates calculated by leave one out cross-validation. The independent error rate was then evaluated by testing the identified gene classifiers on an independent (test) set of array data. Results The binary classifications provided prediction accuracies, between a subtype of interest and the remaining samples, of 88.5%, 82.8%, 82.8% and 80.0% for FL, cHL, DLBCL, and RL respectively. Identified gene classifiers include LIM domain only-2 (LMO2), Chemokine (C-C motif) ligand 22 (CCL22) and Cyclin-dependent kinase inhibitor-3 (CDK3) specifically for FL, cHL and DLBCL subtypes respectively. Conclusions This study highlights the ability of gene expression profiling to distinguish lymphoma from reactive conditions and classify the major subtypes of lymphoma in a diagnostic setting. A cost-effective single platform "mini-chip" assay could, in principle, be developed to aid the quick diagnosis of lymph node biopsies with the potential to incorporate other pathological entities into such an assay.
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Affiliation(s)
- To Ha Loi
- Blood Stem Cell and Cancer Research Unit, Department of Haematology, St Vincent's Hospital, Victoria Street, Darlinghurst, Australia
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Abstract
BACKGROUND Meta-analysis methods exist for combining multiple microarray datasets. However, there are a wide range of issues associated with microarray meta-analysis and a limited ability to compare the performance of different meta-analysis methods. RESULTS We compare eight meta-analysis methods, five existing methods, two naive methods and a novel approach (mDEDS). Comparisons are performed using simulated data and two biological case studies with varying degrees of meta-analysis complexity. The performance of meta-analysis methods is assessed via ROC curves and prediction accuracy where applicable. CONCLUSIONS Existing meta-analysis methods vary in their ability to perform successful meta-analysis. This success is very dependent on the complexity of the data and type of analysis. Our proposed method, mDEDS, performs competitively as a meta-analysis tool even as complexity increases. Because of the varying abilities of compared meta-analysis methods, care should be taken when considering the meta-analysis method used for particular research.
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Affiliation(s)
- Anna Campain
- School of Mathematics and Statistics, Center of Mathematical Biology, University of Sydney, F07 Sydney, NSW 2006, Australia.
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