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Pisaniello HL, Lester S, Russell O, Black R, Tieu J, Richards B, Barrett C, Lassere M, March L, Buchbinder R, Whittle SL, Hill CL. Trajectories of self-reported pain-related health outcomes and longitudinal effects on medication use in rheumatoid arthritis: a prospective cohort analysis using the Australian Rheumatology Association Database (ARAD). RMD Open 2023; 9:e002962. [PMID: 37507204 PMCID: PMC10391633 DOI: 10.1136/rmdopen-2022-002962] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 07/07/2023] [Indexed: 07/30/2023] Open
Abstract
OBJECTIVE To determine distinct trajectories of self-reported pain-related health status in rheumatoid arthritis (RA), their relationship with sociodemographic factors and medication use. METHODS 988 Australian Rheumatology Association Database participants with RA (71% female, mean age 54 years, mean disease duration 2.3 years) were included. Distinct multi-trajectories over 15-year follow-up for five different self-reported pain-related health outcome measures (Health Assessment Questionnaire Disability Index, visual analogue scores for pain, arthritis, global health and the Assessment of Quality of Life utility index) were identified using latent variable discrete mixture modelling. Random effects models were used to determine associations with medication use and biologic therapy modification during follow-up. RESULTS Four, approximately equally sized, pain/health status groups were identified, ranging from 'better' to 'poorer', within which changes over time were relatively small. Important determinants of those with poorer pain/health status included female gender, obesity, smoking, socioeconomic indicators and comorbidities. While biologic therapy use was similar between groups during follow-up, biologic therapy modifications (plinear<0.001) and greater tendency of non-tumour necrosis factor inhibitor use (plinear<0.001) were observed in those with poorer pain/health status. Similarly, greater use of opioids, prednisolone and non-steroidal anti-inflammatory drugs was seen in those with poorer pain/health status. CONCLUSION In the absence of disease activity information, distinct trajectories of varying pain/health status were seen from the outset and throughout the disease course in this RA cohort. More biologic therapy modifications and greater use in anti-inflammatories, opioids and prednisolone were seen in those with poorer pain/health status, reflecting undesirable lived experience of persistent pain in RA.
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Affiliation(s)
- Huai Leng Pisaniello
- Discipline of Medicine, The University of Adelaide, Adelaide, South Australia, Australia
- Rheumatology Research Group, Basil Hetzel Institute for Translational Health Research, The Queen Elizabeth Hospital, Woodville South, South Australia, Australia
| | - Susan Lester
- Rheumatology Research Group, Basil Hetzel Institute for Translational Health Research, The Queen Elizabeth Hospital, Woodville South, South Australia, Australia
- Deaprtment of Rheumatology, The Queen Elizabeth Hospital, Woodville South, South Australia, Australia
| | - Oscar Russell
- Discipline of Medicine, The University of Adelaide, Adelaide, South Australia, Australia
- Rheumatology Research Group, Basil Hetzel Institute for Translational Health Research, The Queen Elizabeth Hospital, Woodville South, South Australia, Australia
- Deaprtment of Rheumatology, The Queen Elizabeth Hospital, Woodville South, South Australia, Australia
| | - Rachel Black
- Rheumatology Research Group, Basil Hetzel Institute for Translational Health Research, The Queen Elizabeth Hospital, Woodville South, South Australia, Australia
- Deaprtment of Rheumatology, The Queen Elizabeth Hospital, Woodville South, South Australia, Australia
| | - Joanna Tieu
- Rheumatology Research Group, Basil Hetzel Institute for Translational Health Research, The Queen Elizabeth Hospital, Woodville South, South Australia, Australia
- Deaprtment of Rheumatology, The Queen Elizabeth Hospital, Woodville South, South Australia, Australia
| | - Bethan Richards
- Department of Rheumatology, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
- Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, New South Wales, Australia
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Claire Barrett
- Department of Medicine, The University of Queensland, Brisbane, Queensland, Australia
- Department of Rheumatology, Redcliffe Hospital, Redcliffe, Queensland, Australia
| | - Marissa Lassere
- Department of Medicine, University of New South Wales, Sydney, New South Wales, Australia
- Department of Rheumatology, St George Hospital, Kogarah, New South Wales, Australia
| | - Lyn March
- Florance and Cope Professorial Department of Rheumatology, Royal North Shore Hospital, St Leonards, New South Wales, Australia
- Department of Rheumatology, Institute of Bone and Joint Research at Kolling Institute, University of Sydney, Sydney, New South Wales, Australia
| | - Rachelle Buchbinder
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Victoria, Australia
| | - Samuel L Whittle
- Rheumatology Research Group, Basil Hetzel Institute for Translational Health Research, The Queen Elizabeth Hospital, Woodville South, South Australia, Australia
- Deaprtment of Rheumatology, The Queen Elizabeth Hospital, Woodville South, South Australia, Australia
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Victoria, Australia
| | - Catherine L Hill
- Rheumatology Research Group, Basil Hetzel Institute for Translational Health Research, The Queen Elizabeth Hospital, Woodville South, South Australia, Australia
- Deaprtment of Rheumatology, The Queen Elizabeth Hospital, Woodville South, South Australia, Australia
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Russell O, Lester S, Black RJ, Hill CL. Socioeconomic Status and Medication Use in Rheumatoid Arthritis: A Scoping Review. Arthritis Care Res (Hoboken) 2023; 75:92-100. [PMID: 36106932 PMCID: PMC10100498 DOI: 10.1002/acr.25024] [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] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 08/22/2022] [Accepted: 09/13/2022] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Socioeconomic status (SES) influences disease outcomes in rheumatoid arthritis (RA) patients. Differences in medication use may partly explain this association. A scoping review was used to identify research conducted on this topic and determine what knowledge gaps remain. METHODS Medline, Embase, and PsychInfo were searched from their inception until February 2022 for studies that assessed SES and medication use as an outcome variable. Data was extracted on the use of specific SES measures, medication use, and whether differences in SES variables were associated with differences in medication use. RESULTS We identified 2,103 studies, of which 81 were selected for inclusion. Included studies originated most frequently from the US (42%); the mean ± SD age of participants was 55.9 ± 6.8 years, and most were female (75%). Studies measured a median of 4 SES variables (interquartile range 3-6), with educational, area-level SES, and income being the most frequent measurements used. Patients' race and/or ethnicity were documented by 34 studies. Studies primarily assessed the likelihood of prescription of disease-modifying antirheumatic drugs or dispensation, medication adherence, or treatment delays. A majority of studies documented at least 1 SES measure associated with a difference in medication use. CONCLUSION There is some evidence that SES affects use of medications in patients with RA; however, multiple definitions of SES have been utilized, making comparisons between studies difficult. Prospective studies with consistently defined SES will be needed to determine whether differences in medication use accounts for the poorer outcomes experienced by patients of lower SES.
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Affiliation(s)
- Oscar Russell
- The Queen Elizabeth Hospital, Woodville, South Australia, Australia, and Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
| | - Susan Lester
- The Queen Elizabeth Hospital, Woodville, South Australia, Australia, and Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
| | - Rachel J Black
- The Queen Elizabeth Hospital, Woodville, South Australia, Australia, and Adelaide Medical School, The University of Adelaide and Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Catherine L Hill
- The Queen Elizabeth Hospital, Woodville, South Australia, Australia, and Adelaide Medical School, The University of Adelaide and Royal Adelaide Hospital, Adelaide, South Australia, Australia
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Leo VD, Lawless C, Roussel MP, Gorman G, Russell O, Tuppen H, Duchesne E, Vincent A. P.202 Mitochondrial dysfunction in myotonic dystrophy type 1 patients. Neuromuscul Disord 2022. [DOI: 10.1016/j.nmd.2022.07.364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Tieu J, Cheah JT, Black RJ, Christensen R, Ghosh N, Richards P, Robson J, Shea B, Simon LS, Singhi JA, Tugwell P, Boers M, Garibay MAA, Campochiaro C, Decary S, de Witt M, Fernandez AP, Keen HI, King L, Hinojosa-Azaola A, Hofstetter C, Gaydukova I, George MD, Gupta L, Lyne S, Makol A, Mukhtyar C, Oo WM, Petri M, Pisaniello HL, Sattui SE, Russell O, Teixeira V, Toupin-April K, Uhunmwangho C, Whitstock M, Yip K, Mackie SL, Goodman SM, Hill CL. Improving benefit-harm assessment of glucocorticoid therapy incorporating the patient perspective: The OMERACT glucocorticoid core domain set. Semin Arthritis Rheum 2021; 51:1139-1145. [PMID: 34253398 DOI: 10.1016/j.semarthrit.2021.06.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 04/05/2021] [Revised: 06/14/2021] [Accepted: 06/15/2021] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Our primary objective was to develop an Outcome Measures in Rheumatology (OMERACT) core domain set to capture the impact of glucocorticoids (GC), both positive and negative, on patients with Rheumatic conditions. METHODS The OMERACT Filter 2.1 was used to guide core domain selection. Systematic literature reviews, qualitative studies and quantitative surveys were conducted by the OMERACT GC Impact working group to identify candidate domains for a core domain set. A summary of prior work and Delphi exercise were presented at the OMERACT 2020 virtual GC workshop. A proposed GC Impact core domain set derived from this work was presented for discussion in facilitated breakout groups. Participants voted on the proposed GC Impact core domain set. RESULTS 113 people, including 23 patient research partners, participated in two virtual workshops conducted at different times on the same day. The proposed mandatory domains to be evaluated in clinical trials involving GCs were: infection, bone fragility, hypertension, diabetes, weight, fatigue, mood disturbance and death. In addition, collection of disease specific outcomes was included in the core domain set as "mandatory in specific circumstances". The proposed core domain set was endorsed by 100% (23/23) of the patient research partners and 92% (83/90) of the remaining participants, including clinicians, researchers and industry stakeholders. CONCLUSION A GC Impact core domain set was endorsed at the OMERACT 2020 virtual workshop. The OMERACT GC Impact working group will now progress to identify, develop and validate measurement tools to best address these domains in clinical trials.
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Affiliation(s)
- Joanna Tieu
- Rheumatology Research Group, Basil Hetzel Institute, Adelaide, Australia, Adelaide Medical School, University of Adelaide, Rheumatology Unit, The Queen Elizabeth Hospital, Adelaide, Australia, Rheumatology Unit, Lyell McEwin Hospital, Adelaide, Australia, Adelaide, Australia
| | - Jonathan Tl Cheah
- Division of Rheumatology, University of Massachusetts Medical School, Worcester, Massachusetts, USA, Division of Rheumatology, UMass Memorial Health Care, Worcester, MA, USA
| | - Rachel J Black
- Rheumatology Research Group, Basil Hetzel Institute, Adelaide, Australia, Adelaide Medical School, University of Adelaide, Adelaide, Australia, Rheumatology Unit, The Queen Elizabeth Hospital, Adelaide, Australia, Rheumatology Unit, Royal Adelaide Hospital, Adelaide, Australia
| | - Robin Christensen
- Musculoskeletal Statistics Unit at The Parker Institute, Bispebjerg, Denmark, Frederiksberg Hospital, Copenhagen & Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital, Denmark
| | - Nilasha Ghosh
- Division of Rheumatology, Hospital for Special Surgery, New York, USA
| | | | - Joanna Robson
- Rheumatology Research, Centre for Health and Clinical Research, University of the West of England, Bristol, UK, Rheumatology Department, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Beverley Shea
- Bruyère Research Institute, Senior Methodologist, Ottawa Hospital Research Institute, Ottawa, Canada, Adjunct Professor, Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Canada
| | | | - Jasvinder A Singhi
- Medicine Service, VA Medical Center, 700 19th St S, Birmingham, AL 35233 USA, Department of Medicine at the School of Medicine, University of Alabama at Birmingham (UAB), 1720 Second Ave. South, Birmingham, AL 35294-0022, USA, Department of Epidemiology at the UAB School of Public Health, 1665 University Blvd., Ryals Public Health Building, Room 220, Birmingham, AL, 35294-0022, USA
| | - Peter Tugwell
- Division of Rheumatology, Department of Medicine, University of Ottawa, School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Abbreviation
| | - Maarten Boers
- Department of Epidemiology & Data Science, Amsterdam Rheumatology and Immunology Center, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands, Marco A Alba Garibay, Vasculitis Research Unit, Department of Autoimmune Diseases, Hospital Clínic, University of Barcelona, IRB-CELLEX, Institut d'Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), Barcelona, Spain
| | - Marco A Alba Garibay
- Vasculitis Research Unit, Department of Autoimmune Diseases, Hospital Clínic, University of Barcelona, IRB-CELLEX, Institut d'Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), Barcelona, Spain
| | - Corrado Campochiaro
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), IRCCS San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | - Simon Decary
- Patient-Oriented Rehabilitation Lab (SPOR-REHAB), University of Sherbrooke, Faculty of Medicine and Health Sciences, School of Rehabilitation, Research Centre of the CHUS, CIUSSS de l'Estrie-CHUS, Canada
| | | | - Anthony P Fernandez
- Department of Dermatology & Department of Pathology Cleveland Clinic, Cleveland, OH, USA
| | - Helen I Keen
- School of Medicine, University of Western Australia, Perth, Australia, Rheumatology Department, Fiona Stanley Hospital, Perth, Australia
| | - Lauren King
- Department of Medicine, University of Toronto, Canada
| | - Andrea Hinojosa-Azaola
- Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | | | - Inna Gaydukova
- North-Western State medical University named after II Mechnikov, Saint-Petersburg, Russia
| | - Michael D George
- University of Pennsylvania, Division of Rheumatology, Philadelphia, PA, USA
| | - Latika Gupta
- Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow India
| | - Suellen Lyne
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, College of Medicine and Public Health, Flinders University, Adelaide, South Australia
| | - Ashima Makol
- Division of Rheumatology, Mayo Clinic, Rochester, MN, USA
| | - Chetan Mukhtyar
- Rheumatologist, Norfolk and Norwich University Hospital NHS Foundation Trust, Norwich, UK
| | - Win Min Oo
- Rheumatology department, Royal North Shore Hospital, Institute of Bone and Joint Research, Kolling Institute, University of Sydney, Sydney, Australia, University of Medicine, Mandalay, Mandalay, Myanmar
| | - Michelle Petri
- Division of Rheumatology, Johns Hopkins University School of Medicine, USA
| | - Huai Leng Pisaniello
- Discipline of Medicine, Faculty of Health and Medical Sciences, The University of Adelaide, South Australia, Australia, Rheumatology Research Group, Basil Hetzel Institute for Translational Health Research, The Queen Elizabeth Hospital, Woodville South, South Australia, Australia
| | | | - Oscar Russell
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia
| | - Vitor Teixeira
- Serviço de Reumatologia, Hospital de Faro, Centro Hospitalar Universitário do Algarve, Portugal
| | - Karine Toupin-April
- School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Department of Pediatrics, Faculty of Medicine, University of Ottawa, Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada
| | | | | | - Kevin Yip
- Division of Rheumatology, Hospital for Special Surgery, New York, USA
| | - Sarah L Mackie
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Susan M Goodman
- Division of Rheumatology, Hospital for Special Surgery, New York, USA, Weill Cornell Medical College, New York, USA
| | - Catherine L Hill
- Rheumatology Unit, The Queen Elizabeth Hospital, Adelaide, Australia, Rheumatology Research Group, Basil Hetzel Institute, Adelaide, Australia, Adelaide Medical School, University of Adelaide, Adelaide, Australia.
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Russell O, Lester S, Black R, Hill C. AB0142 SOCIOECONOMIC STATUS (SES) AND MEDICATION USE IN RHEUMATOID ARTHRITIS (RA): A SCOPING REVIEW. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.3439] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Socioeconomic status (SES) influences disease outcomes in rheumatoid arthritis (RA) patients. (1, 2) Differences in medication use could partly explain this association. (3) A scoping review was used to identify research conducted on this topic and determine what knowledge gaps remain.Objectives:To determine what research has been conducted on this topic, how this research has defined SES and medication use, and establish what knowledge gaps remain.Methods:MEDLINE, EMBASE and PsychInfo were searched from their inception until May 2019 for studies which assessed SES and medication use as outcome variables. Studies were included if they measured medication use and incorporated an SES measure as a comparator variable.SES was defined using any of the “PROGRESS” framework variables (4) including patients’ stated gender, age, educational attainment, employment, occupational class, personal income, marital status, health insurance coverage, area- (neighbourhood) level SES, or patients’ stated race and/or ethnicity. Medication use was broadly defined as either prescription or dispensation of a medicine, medication adherence, or delays in treatment. Data was extracted on studies’ primary objectives, measurement of specific SES measures, patients’ medication use, and whether studies assessed for differences in patients’ medication use according to SES variables.Results:1464 studies were identified by this search from which 74 studies were selected for inclusion, including 52 published articles. Studies’ publication year ranged from 1994-2019, and originated from 20 countries; most commonly from the USA.Studies measured a median of 4 SES variables (IQR 3-6), with educational achievement, area level SES and race/ethnicity the most frequently recorded.Likelihood of disease modifying antirheumatic drug (DMARD) prescription was the most frequent primary objective recorded.96% of studies reported on patients’ use of DMARDs, with glucocorticoids and analgesics being reported in fewer studies (51% and 23% respectively.)Most included studies found at least one SES measure to be significantly associated with differences in patients’ medication use. In some studies, however, this result was not necessarily drawn from the primary outcome and therefore may not have been adjusted for covariates.70% of published studies measuring patients’ income (n=14 of 20) and 58% of those that measured race/ethnicity (n=14 of 24) documented significant differences in patients’ medication use according to these SES variables, although the direction of this effect – whether it led to ‘greater’ or ‘lesser’ medication use – varied between studies.Conclusion:Multiple definitions of SES are used in studies of medication use in RA patients. Despite this, most identified studies found evidence of a difference in medication use by patient groups that differed by an SES variable, although how medication use differed was found to vary between studies. This latter observation may relate to contextual factors pertaining to differences in countries’ healthcare systems. Further prospective studies with clearly defined SES and medication use measures may help confirm the apparent association between SES and differences in medication use.References:[1]Jacobi CE, Mol GD, Boshuizen HC, Rupp I, Dinant HJ, Van Den Bos GA. Impact of socioeconomic status on the course of rheumatoid arthritis and on related use of health care services. Arthritis Rheum. 2003;49(4):567-73.[2]ERAS Study Group. Socioeconomic deprivation and rheumatoid disease: what lessons for the health service? ERAS Study Group. Early Rheumatoid Arthritis Study. Annals of the rheumatic diseases. 2000;59(10):794-9.[3]Verstappen SMM. The impact of socio-economic status in rheumatoid arthritis. Rheumatology (Oxford). 2017;56(7):1051-2.[4]O’Neill J, Tabish H, Welch V, Petticrew M, Pottie K, Clarke M, et al. Applying an equity lens to interventions: using PROGRESS ensures consideration of socially stratifying factors to illuminate inequities in health. J Clin Epidemiol. 2014;67(1):56-64.Acknowledgements:This research was supported by an Australian Government Research Training Program Scholarship.Disclosure of Interests:None declared
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Smith G, Gujari D, Russell O, Palmer L, Toews M, Wong G, Lim W, McDonald S, Clayton P, Martin D, Coates PT. International travel by Australians for overseas transplantation. Med J Aust 2019; 211:460. [PMID: 31502265 DOI: 10.5694/mja2.50333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 06/25/2019] [Indexed: 11/17/2022]
Affiliation(s)
| | | | | | | | - Maeghan Toews
- Adelaide Law School, University of Adelaide, Adelaide, SA
| | | | - Wai Lim
- Sir Charles Gairdner Hospital, Perth, WA
| | - Stephen McDonald
- Royal Adelaide Hospital, Adelaide, SA.,University of Adelaide, Adelaide, SA
| | - Phillip Clayton
- Royal Adelaide Hospital, Adelaide, SA.,Australia and New Zealand Dialysis and Transplant Registry (ANZDATA), South Australian Health and Medical Research Institute, Adelaide, SA
| | | | - Patrick T Coates
- Royal Adelaide Hospital, Adelaide, SA.,University of Adelaide, Adelaide, SA
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BIMAL GUJARI D, Clayton P, Russell O, Palmer L, Smith G, Toews M, Martin D, Coates T. SAT-075 AUSTRALIAN ENGAGEMENT IN INTERNATIONAL TRAVEL FOR ORGAN TRANSPLANTATION: A DESCRIPTIVE SURVEY. Kidney Int Rep 2019. [DOI: 10.1016/j.ekir.2019.05.101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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van Leth F, Conway B, Laplumé H, Martin D, Fisher M, Jelaska A, Wit FW, Lange JMA, Laplumé H, Lasala MB, Losso MH, Bogdanowicz E, Lattes R, Krolewiecki A, Zala C, Orcese C, Terlizzi S, Duran A, Ebensrteijn J, Bloch M, Russell O, Russell DB, Roth NR, Eu B, Austin D, Gowers A, Quan D, Demonty J, Peleman R, Vandercam B, Vogelaers D, van der Gucht B, van Wanzeele F, Moutschen MM, Badaro R, Grinsztejn B, Schechter M, Uip D, Netto EN, Coelho SS, Badaró F, Pilotto JH, Schubach A, Barros ML, Leite OHM, Kiffer CRV, Wunsch CT, Nunes D, Catalani A, de Cassia Alves LR, Dossin TJ, D'Alló de Oliveira MT, Martini S, Conway B, de Wet JJ, Montaner JSG, Murphy C, Woodfall B, Sestak P, Phillips P, Montessori V, Harris M, Tesiorowski A, Willoughby B, Voigt R, Farley J, Reynolds R, Devlaming S, Livrozet JM, Rozenbaum W, Sereni D, Valantin MA, Lascoux C, Milpied B, Brunet C, Billaud E, Huart A, Reliquet V, Charonnat MF, Sicot M, Esnault JL, Slama L, Staszewski S, Bickel M, Lazanas MK, Stavrianeas N, Mangafas N, Zagoreos I, Kourkounti S, Paparizos V, Botsi C, Clarke S, Brannigan E, Boyle N, Chiriani A, Leoncini F, Montella F, Francesco L, Ambu S, Farese A, Gargiulo M, Di Sora F, Lavria F, Folgori F, Beniowski M, Boron Kaczmarska A, Halota W, Prokopowicz D, Bander DB, Leszuzyszyn-Pynka MLP, Wnuk AW, Bakowska E, Pulik P, Flisiak R, Wiercinska-Drapalo A, Mularska E, Witor A, Antunes F, Sarmento RSE, Doroana M, Horta AA, Vasconcelos O, Andrews SM, Huisamen CB, Johnson D, Martin O, Bekker LG, Maartens G, Wilson D, Visagie CJ, David NJ, Rattley M, Nettleship E, Martin DJ, Keyser V, Moraites TM, Moorhouse MA, Pitt JA, Orrell CJ, Bester C, Parboosing R, Moodley P, Gathiram V, Woolf D, Bernasconi E, Magenta L, Cardiello P, Kroon E, Ungsedhapand C, Fisher M, Wilkins EGL, Stockwell E, Day J, Daintith RS, Perry N, Timaeus C, Intosh-Roffet JM, Powell A, Youle M, Tyrer M, Madge S, Drinkwater A, Cuthbertson Z, Carroll A, Becker S, Katner H, Rimland D, Saag MS, Thompson M, Witt M, Aguilar MM, LaVoy A, Illeman M, Guerrero M, Gatell J, Belsey E, Hirschel B, Potarca A, Cronenberg M, Kreekel L, Meester R, Khodabaks J, Botma HJ, Esrhir N, Farida I, Feenstra M, Jansen K, Klotz A, Mulder M, Ruiter G, Bass CB, Pluymers E, de Vlegelaer E, Leeneman (VCL) R, Carlier H, van Steenberge E, Hall D. Quality of Life in Patients Treated with First-Line Antiretroviral Therapy Containing Nevirapine And/Or Efavirenz. Antivir Ther 2004. [DOI: 10.1177/135965350400900512] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective To assess whether differences in safety profiles between nevirapine (NVP) and efavirenz (EFV), as observed in the 2NN study, translated into differences in ‘health related quality of life’ (HRQoL). Design A sub-study of the 2NN study, with antiretro-viral-naive patients randomly allocated to NVP (once or twice daily), EFV or NVP+EFV, in addition to stavudine and lamivudine. Methods Comparing differences in changes of HRQoL over 48 weeks as measured with the Medical Outcomes Study HIV Health Survey (MOS-HIV) questionnaire, using analysis of variance. Results The 2NN study enrolled 1216 patients. No validated questionnaires were available for 244 patients, and 55 patients had no HRQoL data at all, leaving 917 patients eligible for this sub-study. A total of 471 (51%) had HRQoL measurements both at baseline and week 48. The majority (69%) of patients without HRQoL measurements did, however, complete the study. The change in the physical health score (PHS) was 3.9 for NVP, 3.4 for EFV and 2.4 for NVP+EFV ( P=0.712). For the mental health score (MHS) these values were 6.1, 7.0 and 3.9, respectively ( P=0.098). A baseline plasma HIV-1 RNA concentration (pVL) ≥100 000 copies/ml and a decline in pVL (per log10) were independently associated with an increase of PHS. An increase of MHS was only associated with pVL decline. Patients experiencing an adverse event during follow-up had a comparable change in PHS but a significantly smaller change in MHS, compared with those without an adverse event. Conclusions First-line ART containing NVP and/or EFV leads to an improvement in HRQoL. The gain in HRQoL was similar for NVP and EFV, but slightly lower for the combination of these drugs.
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Affiliation(s)
| | - Frank van Leth
- International Antiviral Therapy Evaluation Center (IATEC); Department of Internal Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Brian Conway
- University of British Columbia, Vancouver, BC, Canada
| | - Hector Laplumé
- Hospital Profesor Alejandro Posadas, Buenos Aires, Argentina
| | - Des Martin
- Toga Laboratories, Edenvale, South Africa
| | - Martin Fisher
- Brighton and Sussex University Hospitals, Brighton, UK
| | - Ante Jelaska
- Boehringer Ingelheim Pharmaceuticals, Inc., Ridgefield, Conn., USA
| | - Ferdinand W Wit
- International Antiviral Therapy Evaluation Center (IATEC); Department of Internal Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Joep MA Lange
- International Antiviral Therapy Evaluation Center (IATEC); Department of Internal Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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Abstract
OBJECTIVE To compare general practitioners' care of adult patients with learning disability with that of control patients in the same practice. DESIGN Case-control study of patients and controls by a structured interview study of general practitioners. SETTING Avon. PATIENTS 78 adult patients with learning disability and 78 age and sex matched controls--cared for by 62 general practitioners. MAIN MEASURES Number and content of consultations and opinions of the general practitioners. RESULTS There were more consultations for diseases of the central nervous system and of the skin among the patients than the controls (15 v 3 for central nervous system disease and 15 v 4 skin disease). There were also significantly fewer recordings of blood pressure and cervical cytology tests (34 v 51 for blood pressure and 2 v 18 for cytology). Although more patients were taking drugs affecting the central nervous system (33 v 6), more controls were taking drugs for musculoskeletal complaints (17 v 7). CONCLUSION Although adult patients with learning disability consult with their general practitioners at equivalent rates to other patients, they get less preventive care and consult for different types of problems than do other patients. The reasons for these differences in preventive care are not clear. Carers and general practitioners should be informed of these differences to ensure that appropriate care is given.
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Affiliation(s)
- M Whitfield
- Department of Social Medicine, University of Bristol, UK
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10
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Harris P, Russell O. How to meet a challenge. Health Serv J 1992; 102:28-9. [PMID: 10122024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
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11
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Abstract
Thirty one married men, under 65 yr of age, who were admitted to hospital with a suspected myocardial infarction, were interviewed on four occasions over six months. The patients' social and psychological responses during the course of his rehabilitation were elicited using a semistructured interview schedule. Determinants of outcome were assessed using multiple regression analysis. Return to work, exercise, leisure and sexual activity were all strongly influenced by somatic symptoms of chest pain, breathlessness, and tiredness. Lack of depression, not smoking, and support from the family doctor were important contributors to successful rehabilitation. Cardiac damage sustained at the time of admission did not appear to have any consistent influence on outcome. Half of the smokers had not resumed their habit at six months. Fewer men were working at six months than on admission. Somatic symptoms, anxiety and depression were considerable.
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12
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Russell O. The starving of the medical schools. West J Med 1982. [DOI: 10.1136/bmj.284.6314.504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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13
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Abstract
This review of recent literature explores the similarities and differences between the work of community psychiatric nurses and their mental handicap counterparts. The comparisons which have been made between these groups of nurses are related to the authors' own research studies. These included an observational study of one community mental handicap nursing team and a national survey of all such teams in England and Wales. The importance of trad union membership, the place of the Community Psychiatric Nursing Association and the implications of joint training courses are discussed. The emergence of a new professional role, that of the "community mental health nurse" is discussed and the implications which this might have for the future organization of community psychiatric nursing services is outlined.
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