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Lee MH, Gooley J, Obeyesekere V, Lu J, Paldus B, Hendrieckx C, MacIsaac RJ, McAuley SA, Speight J, Vogrin S, Jenkins AJ, Holmes-Walker DJ, O'Neal DN, Ward GM. Hybrid Closed Loop in Adults With Type 1 Diabetes and Severely Impaired Hypoglycemia Awareness. J Diabetes Sci Technol 2024:19322968241245627. [PMID: 38613225 DOI: 10.1177/19322968241245627] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/14/2024]
Abstract
BACKGROUND Benefits of hybrid closed-loop (HCL) systems in a high-risk group with type 1 diabetes and impaired awareness of hypoglycemia (IAH) have not been well-explored. METHODS Adults with Edmonton HYPO scores ≥1047 were randomized to 26-weeks HCL (MiniMed™ 670G) vs standard therapy (multiple daily injections or insulin pump) without continuous glucose monitoring (CGM) (control). Primary outcome was percentage CGM time-in-range (TIR; 70-180 mg/dL) at 23 to 26 weeks post-randomization. Major secondary endpoints included magnitude of change in counter-regulatory hormones and autonomic symptom responses to hypoglycemia at 26-weeks post-randomization. A post hoc analysis evaluated glycemia risk index (GRI) comparing HCL with control groups at 26 weeks post-randomization. RESULTS Nine participants (median [interquartile range (IQR)] age 51 [41, 59] years; 44% male; enrolment HYPO score 1183 [1058, 1308]; Clarke score 6 [6, 6]; n = 5 [HCL]; n = 4 [control]) completed the study. Time-in-range was higher using HCL vs control (70% [68, 74%] vs 48% [44, 50%], P = .014). Time <70 mg/dL did not differ (HCL 3.8% [2.7, 3.9] vs control 6.5% [4.3, 8.6], P = .14) although hypoglycemia episode duration was shorter (30 vs 50 minutes, P < .001) with HCL. Glycemia risk index was lower with HCL vs control (38.1 [30.0, 39.2] vs 70.8 [58.5, 72.4], P = .014). Following 6 months of HCL use, greater dopamine (24.0 [12.3, 27.6] vs -18.5 [-36.5, -4.8], P = .014), and growth hormone (6.3 [4.6, 16.8] vs 0.5 [-0.8, 3.0], P = .050) responses to hypoglycemia were observed. CONCLUSIONS Six months of HCL use in high-risk adults with severe IAH increased glucose TIR and improved GRI without increased hypoglycemia, and partially restored counter-regulatory responses. CLINICAL TRIAL REGISTRATION ACTRN12617000520336.
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Affiliation(s)
- Melissa H Lee
- Department of Medicine, The University of Melbourne, Melbourne, VIC, Australia
- Department of Endocrinology and Diabetes, St Vincent's Hospital Melbourne, Melbourne, VIC, Australia
| | - Judith Gooley
- Department of Medicine, The University of Melbourne, Melbourne, VIC, Australia
| | - Varuni Obeyesekere
- Department of Endocrinology and Diabetes, St Vincent's Hospital Melbourne, Melbourne, VIC, Australia
| | - Jean Lu
- Department of Medicine, The University of Melbourne, Melbourne, VIC, Australia
| | - Barbora Paldus
- Department of Medicine, The University of Melbourne, Melbourne, VIC, Australia
- Department of Endocrinology and Diabetes, St Vincent's Hospital Melbourne, Melbourne, VIC, Australia
| | - Christel Hendrieckx
- School of Psychology, Deakin University, Geelong, VIC, Australia
- The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Melbourne, VIC, Australia
| | - Richard J MacIsaac
- Department of Medicine, The University of Melbourne, Melbourne, VIC, Australia
- Department of Endocrinology and Diabetes, St Vincent's Hospital Melbourne, Melbourne, VIC, Australia
| | - Sybil A McAuley
- Department of Medicine, The University of Melbourne, Melbourne, VIC, Australia
- Department of Endocrinology and Diabetes, St Vincent's Hospital Melbourne, Melbourne, VIC, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- Department of Endocrinology & Diabetes, The Alfred, Melbourne, VIC, Australia
| | - Jane Speight
- School of Psychology, Deakin University, Geelong, VIC, Australia
- The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Melbourne, VIC, Australia
| | - Sara Vogrin
- Department of Medicine, The University of Melbourne, Melbourne, VIC, Australia
| | - Alicia J Jenkins
- Department of Medicine, The University of Melbourne, Melbourne, VIC, Australia
- Department of Endocrinology and Diabetes, St Vincent's Hospital Melbourne, Melbourne, VIC, Australia
- National Health and Medical Research Council Clinical Trials Centre, The University of Sydney, Sydney, NSW, Australia
| | - D Jane Holmes-Walker
- Department of Endocrinology, Westmead Hospital, The University of Sydney, Sydney, NSW, Australia
| | - David N O'Neal
- Department of Medicine, The University of Melbourne, Melbourne, VIC, Australia
- Department of Endocrinology and Diabetes, St Vincent's Hospital Melbourne, Melbourne, VIC, Australia
| | - Glenn M Ward
- Department of Medicine, The University of Melbourne, Melbourne, VIC, Australia
- Department of Endocrinology and Diabetes, St Vincent's Hospital Melbourne, Melbourne, VIC, Australia
- Department of Clinical Biochemistry, St Vincent's Hospital Melbourne, Melbourne, VIC, Australia
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McDonald BR, Vogrin S, Said CM. Factors affecting hospital admission, hospital length of stay and new discharge destination post proximal humeral fracture: a retrospective audit. BMC Geriatr 2024; 24:334. [PMID: 38609852 PMCID: PMC11015557 DOI: 10.1186/s12877-024-04928-z] [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: 08/07/2023] [Accepted: 03/28/2024] [Indexed: 04/14/2024] Open
Abstract
BACKGROUND Outcomes following proximal humeral fracture (PHF) may be impacted by a range of clinical, fracture and premorbid factors. The aim of this study was to examine factors impacting hospital admission; length of stay (LOS) and new discharge destination for patients presenting to hospital with PHF. METHODS Retrospective audit conducted at a tertiary health service. Data was collected from adult patients presenting to hospital with a PHF over a 54-month period. Fractures that were pathological or sustained during admission were excluded. Univariable and multivariable logistic and negative binomial regression were used to explore factors associated with hospital admission, LOS and new discharge destination. RESULTS Data were analyzed from 701 participants (age 70 years (IQR 60, 81); 72.8% female); 276 (39.4%) participants required a hospital admission. New discharge destination was required for 109 (15.5%) participants, of whom 49 (45%) changed from home alone to home with family/friend(s). Greater comorbidities, as indicated by the Charlson Comorbidity Index score, were associated with hospital admission, longer LOS and new discharge destination. Premorbid living situations of home with family/friend(s) or from an external care facility were associated with a decreased likelihood of hospital admission, shorter LOS and reduced risk of a new discharge destination. Surgical treatment was associated with shorter LOS. Older age and dementia diagnosis were associated with a new discharge destination. CONCLUSIONS Many factors potentially impact on the likelihood or risk of hospitalization, LOS and new discharge destination post PHF. Patients with greater comorbidities are more likely to have negative outcomes, while patients who had premorbid living situations of home with family/friend(s) or from an external care facility are more likely to have positive outcomes. Early identification of factors that may impact patient outcomes may assist timely decision making in hospital settings. Further research should focus on developing tools to predict hospital outcomes in the PHF population.
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Affiliation(s)
- B R McDonald
- Department of Physiotherapy, Western Health, St Albans, VIC, Australia
- The University of Melbourne, Parkville, VIC, Australia
| | - S Vogrin
- The University of Melbourne, Parkville, VIC, Australia
- Australian Institute for Musculoskeletal Science, St Alban, VIC, Australia
- Department of Medicine, Western Health, St Albans, VIC, Australia
| | - C M Said
- Department of Physiotherapy, Western Health, St Albans, VIC, Australia.
- The University of Melbourne, Parkville, VIC, Australia.
- Australian Institute for Musculoskeletal Science, St Alban, VIC, Australia.
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Rose MT, Mitri EA, Vogrin S, Holmes NE, Chua KYL, Slavin MA, Trubiano JA. Durability of penicillin allergy delabeling and post-testing penicillin utilisation in adults with immune compromise. J Allergy Clin Immunol Pract 2024:S2213-2198(24)00340-4. [PMID: 38582191 DOI: 10.1016/j.jaip.2024.03.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 03/15/2024] [Accepted: 03/26/2024] [Indexed: 04/08/2024]
Affiliation(s)
- Morgan T Rose
- Centre for Antibiotic Allergy and Research, Department of Infectious Diseases, Austin Health, Victoria, Australia; Department of Infectious Diseases, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Parkville, Victoria, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia; The National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Victoria, Australia.
| | - Elise A Mitri
- Centre for Antibiotic Allergy and Research, Department of Infectious Diseases, Austin Health, Victoria, Australia
| | - Sara Vogrin
- Centre for Antibiotic Allergy and Research, Department of Infectious Diseases, Austin Health, Victoria, Australia; Department of Medicine (St Vincent's Health), University of Melbourne, Fitzroy, Victoria, Australia
| | - Natasha E Holmes
- Centre for Antibiotic Allergy and Research, Department of Infectious Diseases, Austin Health, Victoria, Australia; Department of Infectious Diseases, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Parkville, Victoria, Australia
| | - Kyra Y L Chua
- Centre for Antibiotic Allergy and Research, Department of Infectious Diseases, Austin Health, Victoria, Australia; Department of Infectious Diseases, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Parkville, Victoria, Australia
| | - Monica A Slavin
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia; The National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Victoria, Australia
| | - Jason A Trubiano
- Centre for Antibiotic Allergy and Research, Department of Infectious Diseases, Austin Health, Victoria, Australia; Department of Infectious Diseases, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Parkville, Victoria, Australia
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Yuan CY, Kong YW, Amoore T, Brown K, Grosman B, Jenkins A, Jones H, Kurtz N, Lee MH, MacIsaac R, Netzer E, Paldus B, Robinson L, Roy A, Sims CM, Trawley S, Vogrin S, O'Neal DN. Improved Satisfaction While Maintaining Safety and High Time in Range (TIR) With a Medtronic Investigational Enhanced Advanced Hybrid Closed-Loop (e-AHCL) System. Diabetes Care 2024; 47:747-755. [PMID: 38381515 DOI: 10.2337/dc23-2217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Accepted: 01/26/2024] [Indexed: 02/22/2024]
Abstract
OBJECTIVE To determine feasibility and compare acceptance of an investigational Medtronic enhanced advanced hybrid closed-loop (e-AHCL) system in adults with type 1 diabetes with earlier iterations. RESEARCH DESIGN AND METHODS This nonrandomized three-stage (12 weeks each) exploratory study compared e-AHCL (Bluetooth-enabled MiniMed 780G insulin pump with automatic data upload [780G] incorporating an updated algorithm; calibration-free all-in-one disposable sensor; 7-day infusion set) preceded by a run-in (non-Bluetooth 780G [670G V4.0 insulin pump] requiring manual data upload; Guardian Sensor 3 [GS3] requiring calibration; 3-day infusion set), stage 1 (780G; GS3; 3-day infusion set), and stage 2 (780G; calibration-free Guardian Sensor 4; 3-day infusion set). Treatment satisfaction was assessed by Diabetes Technology Questionnaire (DTQ)-current (primary outcome) and other validated treatment satisfaction tools with glucose outcomes by continuous glucose monitoring metrics. RESULTS Twenty-one of 22 (11 women) participants (baseline HbA1c 6.7%/50 mmol/mol) completed the study. DTQ-current scores favored e-AHCL (123.1 [17.8]) versus run-in (101.6 [24.2]) and versus stage 1 (110.6 [20.8]) (both P < 0.001) but did not differ from stage 2 (119.4 [16.0]; P = 0.271). Diabetes Medication System Rating Questionnaire short-form scores for "Convenience and Efficacy" favored e-AHCL over run-in and all stages. Percent time in range 70-180 mg/dL was greater with e-AHCL versus run-in and stage 2 (+2.9% and +3.6%, respectively; both P < 0.001). Percent times of <70 mg/dL for e-AHCL were significantly lower than run-in, stage 1, and stage 2 (-0.9%, -0.6%, and -0.5%, respectively; all P < 0.01). CONCLUSIONS e-AHCL was feasible. User satisfaction increased compared with earlier Medtronic HCL iterations without compromising glucose control.
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Affiliation(s)
- Cheng Yi Yuan
- University of Melbourne Department of Medicine, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
- Department of Endocrinology, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
| | - Yee W Kong
- University of Melbourne Department of Medicine, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
- Department of Endocrinology, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
| | - Tess Amoore
- University of Melbourne Department of Medicine, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
| | - Katrin Brown
- University of Melbourne Department of Medicine, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
| | | | - Alicia Jenkins
- University of Melbourne Department of Medicine, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
- Department of Endocrinology, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
- The Baker Institute, Prahran, Victoria, Australia
- The Australian Centre for Accelerating Diabetes Innovations, Melbourne, Victoria, Australia
| | - Hannah Jones
- Department of Endocrinology, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
| | | | - Melissa H Lee
- University of Melbourne Department of Medicine, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
- Department of Endocrinology, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
| | - Richard MacIsaac
- University of Melbourne Department of Medicine, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
- Department of Endocrinology, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
- The Australian Centre for Accelerating Diabetes Innovations, Melbourne, Victoria, Australia
| | - Emma Netzer
- University of Melbourne Department of Medicine, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
| | - Barbora Paldus
- University of Melbourne Department of Medicine, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
| | - Lesley Robinson
- University of Melbourne Department of Medicine, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
| | | | - Catriona M Sims
- University of Melbourne Department of Medicine, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
| | - Steven Trawley
- University of Melbourne Department of Medicine, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
- Cairnmiller Institute, Hawthorn East, Victoria, Australia
| | - Sara Vogrin
- University of Melbourne Department of Medicine, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
| | - David N O'Neal
- University of Melbourne Department of Medicine, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
- Department of Endocrinology, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
- The Australian Centre for Accelerating Diabetes Innovations, Melbourne, Victoria, Australia
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Kathpal E, Boehm E, Nguyen CS, Vogrin S, Hamblin PS. Systemic and iatrogenic factors contribute to the development of severe hypernatraemia in vulnerable inpatients. Clin Endocrinol (Oxf) 2024; 100:350-357. [PMID: 37807424 DOI: 10.1111/cen.14978] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 08/29/2023] [Accepted: 09/21/2023] [Indexed: 10/10/2023]
Abstract
OBJECTIVES To determine all-cause in-hospital mortality associated with severe hypernatraemia and the causes, comorbidities, time to treatment, discharge destination and postdischarge mortality. DESIGN Retrospective observational cohort study. PATIENTS Severe hypernatraemia, (sodium concentration ≥ 155 mmol/L), at any time during a tertiary hospital admission in Melbourne, Australia, 1 January 2019 to 31 December 2019 (pre-COVID19). MEASUREMENTS Deaths, Charlson Comorbidity Index (CCI), hypernatraemia causes, time to treatment, discharge destination. RESULTS One hundred and one inpatients: 64 community-acquired, 37 hospital-acquired. In-hospital mortality was 38%, but cumulative mortality was 65% by 1 month after discharge, with only a minor further increase at 6 and 12 months. After adjusting for peak sodium concentration, the community acquired group had significantly reduced odds of in-hospital mortality (odds ratio 0.15, 95% confidence interval [0.04-0.54], p = .003). Iatrogenic factors were present in 57% (21/37) of the hospital-acquired group. Only 55% of all cases received active sodium directed treatment. Time to start treatment did not affect outcomes. High levels of comorbidity were present, median CCI (IQR) was 6 (5-8) in the community and 5 (4-7) in the hospital group. Dementia prevalence was higher in the community group, 66% (42/64) versus 19% (7/37) (p = .001). Infection was the most common precipitant with 52% (33/64) in the community and 32% (12/37) in the hospital group. Of the survivors, 32% who had been living independently required residential care after discharge. CONCLUSIONS Mortality was high and loss of independence in survivors common. To potentially improve outcomes, hypernatraemia-specific guidelines should be formulated and efforts made to reduce system and iatrogenic factors.
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Affiliation(s)
- Esha Kathpal
- Department of Endocrinology & Diabetes, Western Health, Victoria, Australia
| | - Emma Boehm
- Department of Endocrinology & Diabetes, Western Health, Victoria, Australia
| | | | - Sara Vogrin
- Department of Medicine, Western Health, University of Melbourne, Victoria, Australia
| | - Peter S Hamblin
- Department of Endocrinology & Diabetes, Western Health, Victoria, Australia
- Department of Medicine, Western Health, University of Melbourne, Victoria, Australia
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Yuan CY, Halim B, Kong YW, Lu J, Dutt-Ballerstadt R, Eckenberg P, Hillen K, Koski A, Milenkowic V, Netzer E, Obeyesekere V, Reid S, Sims C, Vogrin S, Wu HP, Seidl T, O'Neal DN. Combining an Electrochemical Continuous Glucose Sensor With an Insulin Delivery Cannula: A Feasibility Study. J Diabetes Sci Technol 2024:19322968241236771. [PMID: 38491800 DOI: 10.1177/19322968241236771] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/18/2024]
Abstract
BACKGROUND Combining a continuous glucose monitor with an insulin delivery cannula (CGM-IS) could benefit clinical outcomes. We evaluated the feasibility of a single-needle insertion electrochemical investigational CGM-IS (Pacific Diabetes Technologies, Portland, Oregon) in type 1 diabetes adults. METHODS Following 48 hours run-in using a Medtronic 780G in manual mode with a commercial insulin set, 12 participants commenced insulin delivery using the CGM-IS. A standardized test meal was eaten on the mornings of days 1 and 4. Venous samples were collected every 10 minutes one hour prior to and 15 minutes post-meal for four hours. CGM-IS glucose measurements were post-processed with a single capillary blood calibration during warm-up and benchmarked against YSI. A Dexcom G6 sensor was worn post-consent to study end. RESULTS Mean absolute relative difference (MARD) for the CGM-IS glucose measurements was 9.2% (484 paired data points). Consensus error grid revealed 88.6% within zone A and 100% in A + B. Mean (SD) % bias was -3.5 (11.7) %. There were 35 paired YSI readings <100 mg/dL cutoff and 449 ≥100 mg/dL with 81.4% within ±15 mg/dL or ±15%, and 89.9% within ±20 mg/dL or ±20%. Two cannula occlusions required discontinuation of insulin delivery: one at 70 hours post insertion and another during the day 4 meal test. Mean (SD) Dexcom glucose measurements during run-in and between meal tests was respectively 161.3 ± 27.3 mg/dL versus 158.0 ± 25.6 mg/dL; P = .39 and corresponding mean total daily insulin delivered by the pump was 58.0 ± 25.4 Units versus 57.1 ± 28.8 Units; P = .47. CONCLUSIONS Insulin delivery and glucose sensing with the investigational CGM-IS was feasible. Longer duration studies are needed.
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Affiliation(s)
- Cheng Yi Yuan
- Department of Medicine, St Vincent's Hospital Melbourne, The University of Melbourne, Fitzroy, VIC, Australia
| | - Bella Halim
- Department of Medicine, St Vincent's Hospital Melbourne, The University of Melbourne, Fitzroy, VIC, Australia
| | - Yee W Kong
- Department of Medicine, St Vincent's Hospital Melbourne, The University of Melbourne, Fitzroy, VIC, Australia
| | - Jean Lu
- Department of Medicine, St Vincent's Hospital Melbourne, The University of Melbourne, Fitzroy, VIC, Australia
| | | | | | - Ken Hillen
- Pacific Diabetes Technologies, Portland, OR, USA
| | - Anh Koski
- Pacific Diabetes Technologies, Portland, OR, USA
| | | | - Emma Netzer
- Department of Medicine, St Vincent's Hospital Melbourne, The University of Melbourne, Fitzroy, VIC, Australia
| | - Varuni Obeyesekere
- Department of Medicine, St Vincent's Hospital Melbourne, The University of Melbourne, Fitzroy, VIC, Australia
| | - Solomon Reid
- Pacific Diabetes Technologies, Portland, OR, USA
| | - Catriona Sims
- Department of Medicine, St Vincent's Hospital Melbourne, The University of Melbourne, Fitzroy, VIC, Australia
| | - Sara Vogrin
- Department of Medicine, St Vincent's Hospital Melbourne, The University of Melbourne, Fitzroy, VIC, Australia
| | - Huan-Ping Wu
- Pacific Diabetes Technologies, Portland, OR, USA
| | - Thomas Seidl
- Pacific Diabetes Technologies, Portland, OR, USA
| | - David N O'Neal
- Department of Medicine, St Vincent's Hospital Melbourne, The University of Melbourne, Fitzroy, VIC, Australia
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Prentice R, Flanagan E, Wright EK, Gibson PR, Rosella S, Rosella O, Begun J, An YK, Lawrance IC, Kamm MA, Sparrow M, Goldberg R, Prideaux L, Vogrin S, Kiburg KV, Ross AL, Burns M, Bell SJ. Vedolizumab and Ustekinumab Levels in Pregnant Women With Inflammatory Bowel Disease and Infants Exposed In Utero. Clin Gastroenterol Hepatol 2024:S1542-3565(24)00252-0. [PMID: 38492905 DOI: 10.1016/j.cgh.2024.02.025] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 02/21/2024] [Accepted: 02/23/2024] [Indexed: 03/18/2024]
Abstract
BACKGROUND & AIMS Vedolizumab and ustekinumab pharmacokinetics in pregnancy and the infant after in utero exposure remain incompletely defined. We aim to define the antenatal stability of ustekinumab and vedolizumab levels and the time at which infant drug levels become undetectable. METHODS This multicenter prospective observational cohort study recruited pregnant or preconception women with inflammatory bowel disease receiving vedolizumab or ustekinumab. Trough drug levels, clinical data, and biochemical data were documented preconception, during each trimester of pregnancy, and postpartum. Maternal and cord blood drug levels were measured at delivery and in infants until undetectable. Infant outcomes were assessed until 2 years of age. RESULTS A total of 102 participants (vedolizumab, n = 58) were included. The majority of mothers were, and remained, in clinical and biochemical remission. Maternal vedolizumab levels decreased over the course of pregnancy in association with increasing weight, rather than increasing gestation. Maternal ustekinumab levels remained stable. The median time to drug becoming undetectable in the infant was shorter for vedolizumab (11 wk; range, 5-19 wk; n = 32) than ustekinumab (14 wk; range, 9-36 wk; n = 17) and correlated positively with infant delivery level. Thirty-two of 41 (88%) and 17 of 30 (67%) vedolizumab- and ustekinumab-exposed infants had undetectable drug levels by 15 weeks of age, respectively. Pregnancy and infant outcomes were favorable. Twenty infants with undetectable drug levels received the rotavirus vaccine, with no adverse reactions reported. CONCLUSIONS Maternal vedolizumab levels decreased, whereas ustekinumab levels remained stable over the course of pregnancy. Most vedolizumab- and approximately half of ustekinumab-exposed infants had undetectable drug levels by 15 weeks of age. No concerning maternal or infant safety signals were identified.
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Affiliation(s)
- Ralley Prentice
- Department of Gastroenterology, Monash Health, Clayton, Victoria, Australia; Department of Gastroenterology, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia; Centre of Inflammatory Disease, Department of Medicine, Monash University, Clayton, Victoria, Australia.
| | - Emma Flanagan
- Department of Gastroenterology, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia; University of Melbourne, Parkville, Victoria, Australia
| | - Emily K Wright
- Department of Gastroenterology, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia; University of Melbourne, Parkville, Victoria, Australia
| | - Peter R Gibson
- Department of Gastroenterology, Central Clinical School, Monash University and Alfred Health, Melbourne, Victoria, Australia
| | - Sam Rosella
- Department of Gastroenterology, Central Clinical School, Monash University and Alfred Health, Melbourne, Victoria, Australia
| | - Ourania Rosella
- Department of Gastroenterology, Central Clinical School, Monash University and Alfred Health, Melbourne, Victoria, Australia
| | - Jakob Begun
- Department of Gastroenterology, Mater Hospital, Brisbane, Queensland, Australia
| | - Yoon-Kyo An
- Department of Gastroenterology, Mater Hospital, Brisbane, Queensland, Australia
| | - Ian C Lawrance
- School of Medicine and Pharmacology, Faculty of Medicine and Dentistry at the University of Western Australia, Perth, Western Australia, Australia; St John of God Subiaco Hospital, Perth, Western Australia, Australia
| | - Michael A Kamm
- Department of Gastroenterology, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia; University of Melbourne, Parkville, Victoria, Australia
| | - Miles Sparrow
- Department of Gastroenterology, Central Clinical School, Monash University and Alfred Health, Melbourne, Victoria, Australia
| | - Rimma Goldberg
- Department of Gastroenterology, Monash Health, Clayton, Victoria, Australia; Centre of Inflammatory Disease, Department of Medicine, Monash University, Clayton, Victoria, Australia
| | - Lani Prideaux
- Department of Gastroenterology, Monash Health, Clayton, Victoria, Australia
| | - Sara Vogrin
- University of Melbourne, Parkville, Victoria, Australia
| | | | - Alyson L Ross
- Department of Gastroenterology, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
| | - Megan Burns
- Department of Gastroenterology, Monash Health, Clayton, Victoria, Australia
| | - Sally J Bell
- Department of Gastroenterology, Monash Health, Clayton, Victoria, Australia; Centre of Inflammatory Disease, Department of Medicine, Monash University, Clayton, Victoria, Australia; University of Melbourne, Parkville, Victoria, Australia
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8
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D'Elia N, Vogrin S, Brennan AL, Dinh D, Lefkovits J, Reid CM, Stub D, Bloom J, Haji K, Noaman S, Kaye DM, Cox N, Chan W. Electrocardiographic patterns and clinical outcomes of acute coronary syndrome cardiogenic shock in patients undergoing percutaneous coronary intervention - A propensity score analysis. Cardiovasc Revasc Med 2024:S1553-8389(24)00075-7. [PMID: 38448259 DOI: 10.1016/j.carrev.2024.02.022] [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: 12/05/2023] [Revised: 02/16/2024] [Accepted: 02/28/2024] [Indexed: 03/08/2024]
Abstract
OBJECTIVES To determine the influence of presenting electrocardiographic (ECG) changes on prognosis in acute coronary syndrome cardiogenic shock (ACS-CS) patients undergoing percutaneous coronary angiography (PCI). BACKGROUND The effect of initial ECG changes such as ST-elevation myocardial infarction (STEMI) versus non-STEMI among patients ACS-CS on prognosis remains unclear. METHODS We analysed data from consecutive patients with ACS-CS enrolled in the Victorian Cardiac Outcomes registry between 2014 and 2020. Inverse probability of treatment weighting analysis (IPTW) was used to assess the effect of ECG changes on 30-day mortality. RESULTS Of 1564 patients with ACS-CS who underwent PCI, 161 had non-STEMI and 1403 had STEMI on ECG. The mean age was 66 ± 13 years, and 74 % (1152) were males. Patients with non-STEMI compared to STEMI were older (70 ± 12 vs 65 ± 13 years), had higher rates of diabetes (34 % vs 21 %), prior coronary artery bypass graft surgery (14 % vs 3.3 %), peripheral arterial disease (10.6 % vs 4.1 %, p < 0.01), and lower baseline eGFR (53.8 [37.1, 75.4] vs 65.3 [46.3, 87.8] ml/min/1.73m2), all p ≤ 0.01. Non-STEMI patients were more likely to have a culprit left circumflex artery (29 % vs 20 %) and more often underwent multivessel percutaneous coronary intervention (30 % vs 20 %) but had lower rates of out-of-hospital cardiac arrest (21 % vs 39 %), all p ≤ 0.01. Propensity score analysis with IPTW confirmed that non-STEMI ECG was associated with lower odds for 30-day all-cause mortality (OR 0.47 [0.32, 0.69], p < 0.001), and 30-day major adverse cardiovascular and cerebrovascular events (OR 0.48 [0.33, 0.70]). CONCLUSIONS In patients undergoing PCI, Non-STEMI as compared to STEMI on index ECG was associated with approximately half the relative risk of both 30-day mortality and 30-day MACCE and could be a useful variable to integrate in ACS-CS risk scores.
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Affiliation(s)
- Nicholas D'Elia
- Western Health Department of Cardiology, Victoria, Australia; Baker Heart and Diabetes Institute, Victoria, Australia
| | - Sara Vogrin
- Department of Medicine, University of Melbourne, Victoria, Australia
| | - Angela L Brennan
- Centre of Cardiovascular Research & Education in Therapeutics, School of Public Health and Preventive Medicine, Monash University, Victoria, Australia
| | - Diem Dinh
- Centre of Cardiovascular Research & Education in Therapeutics, School of Public Health and Preventive Medicine, Monash University, Victoria, Australia
| | - Jeffrey Lefkovits
- Centre of Cardiovascular Research & Education in Therapeutics, School of Public Health and Preventive Medicine, Monash University, Victoria, Australia; Department of Cardiology, Royal Melbourne Hospital, Victoria, Australia
| | - Christopher M Reid
- Centre of Cardiovascular Research & Education in Therapeutics, School of Public Health and Preventive Medicine, Monash University, Victoria, Australia; School of Population Health, Curtin University, Perth, Western Australia, Australia
| | - Dion Stub
- Western Health Department of Cardiology, Victoria, Australia; School Epidemiology and Preventive Medicine, Monash University, Victoria, Australia; Department of Cardiology, Alfred Hospital, Victoria, Australia
| | - Jason Bloom
- Baker Heart and Diabetes Institute, Victoria, Australia
| | - Kawa Haji
- Western Health Department of Cardiology, Victoria, Australia
| | - Samer Noaman
- Western Health Department of Cardiology, Victoria, Australia; Baker Heart and Diabetes Institute, Victoria, Australia; Department of Cardiology, Alfred Hospital, Victoria, Australia
| | - David M Kaye
- Baker Heart and Diabetes Institute, Victoria, Australia; Department of Cardiology, Alfred Hospital, Victoria, Australia
| | - Nicholas Cox
- Western Health Department of Cardiology, Victoria, Australia; Department of Medicine, Western Health, University of Melbourne, St Albans, Victoria, Australia
| | - William Chan
- Western Health Department of Cardiology, Victoria, Australia; Baker Heart and Diabetes Institute, Victoria, Australia; Department of Medicine, University of Melbourne, Victoria, Australia; Department of Cardiology, Alfred Hospital, Victoria, Australia; Department of Medicine, Western Health, University of Melbourne, St Albans, Victoria, Australia.
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9
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Halim B, Abraham MB, Manos G, Arrieta A, Dai Z, Vogrin S, Lu J, MacIsaac R, Ekinci EI, Davis EA, Jenkins A, Shin J, Vigersky RA, Jones TW, O'Neal D. Advances in Automated Insulin Delivery with the Medtronic 780G: The Australian Experience. Diabetes Technol Ther 2024; 26:190-197. [PMID: 38444313 DOI: 10.1089/dia.2023.0348] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/07/2024]
Abstract
Aim: To assess the real-world performance of MiniMed™ 780G for Australians with type 1 diabetes (T1D) following advanced hybrid closed loop (AHCL) activation and to evaluate the effect of changing from MiniMed 670/770G to 780G. Methods: We analyzed deidentified Carelink™ continuous glucose monitoring (CGM) data from Australian users from January 2020 to December 2022, including the proportion attaining three major consensus targets: Glucose management indicator (GMI <7.0%), time in range (TIR 70-180 mg/dL >70%), and time below range (TBR 70 mg/dL <4%). Results: Comparing 670/770G users (n = 5676) for mean ± standard deviation 364 ± 244 days with 780G users (n = 3566) for 146 ± 145 days, the latter achieved a higher TIR (72.6% ± 10.6% vs. 67.3% ± 11.4%; P < 0.001), lower time above range (TAR) (25.5% ± 10.9% vs. 30.6% ± 11.7%; P < 0.001), and lower GMI (6.9% ± 0.4% vs. 7.2% ± 0.4%; P < 0.001) without compromising TBR (1.9% ± 1.8% vs. 2.0% ± 1.8%; P = 0.0015). Of 1051 670/770G users transitioning to 780G, TIR increased (70.0% ± 10.7% to 74.0% ± 10.2%; P < 0.001), TAR decreased (28.1% ± 10.9% to 24.0% ± 10.7%; P < 0.001), and TBR was unchanged. The percentage of users attaining all three CGM targets was higher in 780G users (50.1% vs. 29.5%; P < 0.001). CGM metrics were stable at 12 months post-transition. Conclusion: Real-world data from Australia shows that a higher proportion of MiniMed 780G users meet clinical targets for CGM consensus metrics compared to MiniMed 670/770G users and glucose control was sustained over 12 months.
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Affiliation(s)
- Bella Halim
- Department of Medicine, University of Melbourne, Melbourne, Australia
- Department of Endocrinology and Diabetes, St Vincent's Hospital Melbourne, Melbourne, Australia
| | - Mary B Abraham
- Children's Diabetes Centre, Telethon Kids Institute, University of Western Australia, Perth, Australia
- Department of Endocrinology and Diabetes, Perth Children's Hospital, Perth, Australia
| | - Georgina Manos
- Department of Medicine, University of Melbourne, Melbourne, Australia
- Department of Endocrinology and Diabetes, St Vincent's Hospital Melbourne, Melbourne, Australia
| | | | - Zheng Dai
- Medtronic, Northridge, California, USA
| | - Sara Vogrin
- Department of Medicine, University of Melbourne, Melbourne, Australia
| | - Jean Lu
- Department of Medicine, University of Melbourne, Melbourne, Australia
| | - Richard MacIsaac
- Department of Medicine, University of Melbourne, Melbourne, Australia
- Department of Endocrinology and Diabetes, St Vincent's Hospital Melbourne, Melbourne, Australia
- The Australian Centre for Accelerating Diabetes Innovation, Melbourne Medical School, The University of Melbourne, Melbourne, Australia
| | - Elif I Ekinci
- Department of Medicine, University of Melbourne, Melbourne, Australia
- The Australian Centre for Accelerating Diabetes Innovation, Melbourne Medical School, The University of Melbourne, Melbourne, Australia
- Department of Endocrinology, Austin Health, Melbourne, Australia
| | - Elizabeth A Davis
- Children's Diabetes Centre, Telethon Kids Institute, University of Western Australia, Perth, Australia
- Department of Endocrinology and Diabetes, Perth Children's Hospital, Perth, Australia
| | - Alicia Jenkins
- Department of Medicine, University of Melbourne, Melbourne, Australia
- Department of Endocrinology and Diabetes, St Vincent's Hospital Melbourne, Melbourne, Australia
- Department of Diabetes and Vascular Medicine, Baker Heart and Diabetes Institute, Melbourne, Australia
| | - John Shin
- Medtronic, Northridge, California, USA
| | | | - Timothy W Jones
- Children's Diabetes Centre, Telethon Kids Institute, University of Western Australia, Perth, Australia
- Department of Endocrinology and Diabetes, Perth Children's Hospital, Perth, Australia
| | - David O'Neal
- Department of Medicine, University of Melbourne, Melbourne, Australia
- Department of Endocrinology and Diabetes, St Vincent's Hospital Melbourne, Melbourne, Australia
- The Australian Centre for Accelerating Diabetes Innovation, Melbourne Medical School, The University of Melbourne, Melbourne, Australia
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10
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Wong AK, Klepstad P, Rubio JP, Somogyi AA, Vogrin S, Le B, Philip J. Opioid Switch Dosing in Chronic Cancer Pain: A Prospective Longitudinal Study. J Palliat Med 2024; 27:388-393. [PMID: 37955655 DOI: 10.1089/jpm.2023.0541] [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] [Indexed: 11/14/2023] Open
Abstract
Background: Opioid switching is common, however, conversion tables have limitations. Guidelines suggest postswitch dose reduction, yet, observations show opioid doses may increase postswitch. Objectives: To document the opioid conversion factor postswitch in cancer, and whether pain and adverse effect outcomes differ between switched opioid groups. Design/Setting: This multicenter prospective longitudinal study included people with advanced cancer in Australia. Clinical data (demographics, opioids) and validated instruments (pain, adverse effects) were collected twice, seven days apart. Results: Opioid switch resulted in dose increase (median oral morphine equivalent daily dose 90 mg [interquartile range {IQR} 45-184] to 150 mg [IQR 79-270]), reduced average pain (5.1 [standard deviation {SD} 1.7] to 3.8 [SD 1.6]), and reduced adverse effects. Hydromorphone dose increased 2.5 times (IQR 1.0-3.6) above the original conversion factor used. Conclusions: Opioid switching resulted in overall dose increase, particularly when switching to hydromorphone. Higher preswitch dosing may require higher dose conversion ratios. Dose reduction postswitch risks undertreatment and may not be always appropriate.
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Affiliation(s)
- Aaron K Wong
- Department of Palliative Care, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Department of Palliative Care, The Royal Melbourne Hospital, Parkville, Victoria, Australia
- Department of Medicine, University of Melbourne, Fitzroy, Victoria, Australia
| | - Pal Klepstad
- Department Intensive Care Medicine, St. Olavs University Hospital, Trondheim, Norway
| | - Justin P Rubio
- Florey Department of Neuroscience and Mental Health, Florey Institute of Neuroscience and Mental Health, Victoria, Australia
| | - Andrew A Somogyi
- Department of Clinical & Experimental Pharmacology, Discipline of Pharmacology, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, Australia
| | - Sara Vogrin
- Department of Medicine, St Vincent's Hospital Melbourne, University of Melbourne, Victoria, Australia
| | - Brian Le
- Department of Palliative Care, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Department of Palliative Care, The Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Jennifer Philip
- Department of Palliative Care, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Department of Palliative Care, The Royal Melbourne Hospital, Parkville, Victoria, Australia
- Department of Medicine, University of Melbourne, Fitzroy, Victoria, Australia
- Department of Palliative Care, Palliative Care Service, St Vincent's Hospital, Fitzroy, Victoria, Australia
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11
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Wong AK, Vogrin S, Le B, Klepstad P, Rubio JP, Somogyi AA, Philip J. Background and Breakthrough Opioid Choice May Determine Different Pain Outcomes. J Pain Symptom Manage 2024; 67:e259-e261. [PMID: 38101491 DOI: 10.1016/j.jpainsymman.2023.12.009] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 11/26/2023] [Accepted: 12/01/2023] [Indexed: 12/17/2023]
Affiliation(s)
- Aaron K Wong
- Peter MacCallum Cancer Centre (A.K.W., B.L., J.P.), Melbourne, Victoria, Australia; The Royal Melbourne Hospital (A.K.W., B.L., J.P.), Parkville, Victoria, Australia; Department of Medicine (A.K.W., B.L., J.P.), University of Melbourne Eastern Hill Campus, Victoria Parade, Fitzroy, Victoria, Australia; Department of Medicine (S.V.), St Vincent's Hospital Melbourne, University of Melbourne, Victoria, Australia; Department Intensive Care Medicine (P.K.), St. Olavs University Hospital, Trondheim, Norway; Florey Institute of Neuroscience & Mental Health (J.P.R.), Victoria, Australia; Clinical and Experimental Pharmacology (A.A.S.), Discipline of Pharmacology, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, Australia; St Vincent's Hospital, Palliative Care Service (J.P.), Victoria Parade, Fitzroy, Victoria, Australia.
| | - Sara Vogrin
- Peter MacCallum Cancer Centre (A.K.W., B.L., J.P.), Melbourne, Victoria, Australia; The Royal Melbourne Hospital (A.K.W., B.L., J.P.), Parkville, Victoria, Australia; Department of Medicine (A.K.W., B.L., J.P.), University of Melbourne Eastern Hill Campus, Victoria Parade, Fitzroy, Victoria, Australia; Department of Medicine (S.V.), St Vincent's Hospital Melbourne, University of Melbourne, Victoria, Australia; Department Intensive Care Medicine (P.K.), St. Olavs University Hospital, Trondheim, Norway; Florey Institute of Neuroscience & Mental Health (J.P.R.), Victoria, Australia; Clinical and Experimental Pharmacology (A.A.S.), Discipline of Pharmacology, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, Australia; St Vincent's Hospital, Palliative Care Service (J.P.), Victoria Parade, Fitzroy, Victoria, Australia
| | - Brian Le
- Peter MacCallum Cancer Centre (A.K.W., B.L., J.P.), Melbourne, Victoria, Australia; The Royal Melbourne Hospital (A.K.W., B.L., J.P.), Parkville, Victoria, Australia; Department of Medicine (A.K.W., B.L., J.P.), University of Melbourne Eastern Hill Campus, Victoria Parade, Fitzroy, Victoria, Australia; Department of Medicine (S.V.), St Vincent's Hospital Melbourne, University of Melbourne, Victoria, Australia; Department Intensive Care Medicine (P.K.), St. Olavs University Hospital, Trondheim, Norway; Florey Institute of Neuroscience & Mental Health (J.P.R.), Victoria, Australia; Clinical and Experimental Pharmacology (A.A.S.), Discipline of Pharmacology, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, Australia; St Vincent's Hospital, Palliative Care Service (J.P.), Victoria Parade, Fitzroy, Victoria, Australia
| | - Pal Klepstad
- Peter MacCallum Cancer Centre (A.K.W., B.L., J.P.), Melbourne, Victoria, Australia; The Royal Melbourne Hospital (A.K.W., B.L., J.P.), Parkville, Victoria, Australia; Department of Medicine (A.K.W., B.L., J.P.), University of Melbourne Eastern Hill Campus, Victoria Parade, Fitzroy, Victoria, Australia; Department of Medicine (S.V.), St Vincent's Hospital Melbourne, University of Melbourne, Victoria, Australia; Department Intensive Care Medicine (P.K.), St. Olavs University Hospital, Trondheim, Norway; Florey Institute of Neuroscience & Mental Health (J.P.R.), Victoria, Australia; Clinical and Experimental Pharmacology (A.A.S.), Discipline of Pharmacology, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, Australia; St Vincent's Hospital, Palliative Care Service (J.P.), Victoria Parade, Fitzroy, Victoria, Australia
| | - Justin P Rubio
- Peter MacCallum Cancer Centre (A.K.W., B.L., J.P.), Melbourne, Victoria, Australia; The Royal Melbourne Hospital (A.K.W., B.L., J.P.), Parkville, Victoria, Australia; Department of Medicine (A.K.W., B.L., J.P.), University of Melbourne Eastern Hill Campus, Victoria Parade, Fitzroy, Victoria, Australia; Department of Medicine (S.V.), St Vincent's Hospital Melbourne, University of Melbourne, Victoria, Australia; Department Intensive Care Medicine (P.K.), St. Olavs University Hospital, Trondheim, Norway; Florey Institute of Neuroscience & Mental Health (J.P.R.), Victoria, Australia; Clinical and Experimental Pharmacology (A.A.S.), Discipline of Pharmacology, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, Australia; St Vincent's Hospital, Palliative Care Service (J.P.), Victoria Parade, Fitzroy, Victoria, Australia
| | - Andrew A Somogyi
- Peter MacCallum Cancer Centre (A.K.W., B.L., J.P.), Melbourne, Victoria, Australia; The Royal Melbourne Hospital (A.K.W., B.L., J.P.), Parkville, Victoria, Australia; Department of Medicine (A.K.W., B.L., J.P.), University of Melbourne Eastern Hill Campus, Victoria Parade, Fitzroy, Victoria, Australia; Department of Medicine (S.V.), St Vincent's Hospital Melbourne, University of Melbourne, Victoria, Australia; Department Intensive Care Medicine (P.K.), St. Olavs University Hospital, Trondheim, Norway; Florey Institute of Neuroscience & Mental Health (J.P.R.), Victoria, Australia; Clinical and Experimental Pharmacology (A.A.S.), Discipline of Pharmacology, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, Australia; St Vincent's Hospital, Palliative Care Service (J.P.), Victoria Parade, Fitzroy, Victoria, Australia
| | - Jennifer Philip
- Peter MacCallum Cancer Centre (A.K.W., B.L., J.P.), Melbourne, Victoria, Australia; The Royal Melbourne Hospital (A.K.W., B.L., J.P.), Parkville, Victoria, Australia; Department of Medicine (A.K.W., B.L., J.P.), University of Melbourne Eastern Hill Campus, Victoria Parade, Fitzroy, Victoria, Australia; Department of Medicine (S.V.), St Vincent's Hospital Melbourne, University of Melbourne, Victoria, Australia; Department Intensive Care Medicine (P.K.), St. Olavs University Hospital, Trondheim, Norway; Florey Institute of Neuroscience & Mental Health (J.P.R.), Victoria, Australia; Clinical and Experimental Pharmacology (A.A.S.), Discipline of Pharmacology, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, Australia; St Vincent's Hospital, Palliative Care Service (J.P.), Victoria Parade, Fitzroy, Victoria, Australia
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12
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Jayaram L, King PT, Hunt J, Lim M, Park C, Hu E, Dousha L, Ha P, Bartlett JB, Southcott AM, Muruganandan S, Vogrin S, Rees MA, Dean OM, Wong CA. Evaluation of high dose N- Acetylcysteine on airway inflammation and quality of life outcomes in adults with bronchiectasis: A randomised placebo-controlled pilot study. Pulm Pharmacol Ther 2024; 84:102283. [PMID: 38141851 DOI: 10.1016/j.pupt.2023.102283] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Revised: 11/09/2023] [Accepted: 12/11/2023] [Indexed: 12/25/2023]
Abstract
BACKGROUND High dose N acetylcysteine (NAC), a mucolytic, anti-inflammatory and antioxidant agent has been shown to significantly reduce exacerbations, and improve quality of life in placebo controlled, double blind randomised (RCT) studies in patients with COPD, and in an open, randomised study in bronchiectasis. In this pilot, randomised, double-blind, placebo-controlled study, we wished to investigate the feasibility of a larger clinical trial, and the anti-inflammatory and clinical benefits of high dose NAC in bronchiectasis. AIMS Primary outcome: to assess the efficacy of NAC 2400 mg/day at 6 weeks on sputum neutrophil elastase (NE), a surrogate marker for exacerbations. Secondary aims included assessing the efficacy of NAC on sputum MUC5B, IL-8, lung function, quality of life, and adverse effects. METHODS Participants were randomised to receive 2400 mg or placebo for 6 weeks. They underwent 3 visits: at baseline, week 3 and week 6 where clinical and sputum measurements were assessed. RESULTS The study was stopped early due to the COVID pandemic. In total 24/30 patients were recruited, of which 17 completed all aspects of the study. Given this, a per protocol analysis was undertaken: NAC (n = 9) vs placebo (n = 8): mean age 72 vs 62 years; male gender: 44% vs 50%; baseline median FEV11.56 L (mean 71.5 % predicted) vs 2.29L (mean 82.2% predicted). At 6 weeks, sputum NE fell by 47% in the NAC group relative to placebo (mean fold difference (95%CI: 0.53 (0.12,2.42); MUC5B increased by 48% with NAC compared with placebo. Lung function, FVC improved significantly with NAC compared with placebo at 6 weeks (mean fold difference (95%CI): 1.10 (1.00, 1.20), p = 0.045. Bronchiectasis Quality of life measures within the respiratory and social functioning domains demonstrated clinically meaningful improvements, with social functioning reaching statistical significance. Adverse effects were similar in both groups. CONCLUSION High dose NAC exhibits anti-inflammatory benefits, and improvements in aspects of quality of life and lung function measures. It is safe and well tolerated. Further larger placebo controlled RCT's are now warranted examining its role in reducing exacerbations.
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Affiliation(s)
- L Jayaram
- Western Health, Gordon Street, Footscray, VIC, 3011, Australia; University of Melbourne, Parkville, VIC, 3010, Australia.
| | - P T King
- Monash Medical Centre, Clayton Road, Clayton, VIC, 3068, Australia; Monash University, Wellington Road, Clayton, VIC, 3068, Australia
| | - J Hunt
- Western Health, Gordon Street, Footscray, VIC, 3011, Australia
| | - M Lim
- Western Health, Gordon Street, Footscray, VIC, 3011, Australia
| | - C Park
- Western Health, Gordon Street, Footscray, VIC, 3011, Australia
| | - E Hu
- Western Health, Gordon Street, Footscray, VIC, 3011, Australia
| | - L Dousha
- Monash Medical Centre, Clayton Road, Clayton, VIC, 3068, Australia; Monash University, Wellington Road, Clayton, VIC, 3068, Australia
| | - P Ha
- Western Health, Gordon Street, Footscray, VIC, 3011, Australia
| | - J B Bartlett
- Western Health, Gordon Street, Footscray, VIC, 3011, Australia; University of Melbourne, Parkville, VIC, 3010, Australia
| | - A M Southcott
- Western Health, Gordon Street, Footscray, VIC, 3011, Australia; University of Melbourne, Parkville, VIC, 3010, Australia
| | - S Muruganandan
- University of Melbourne, Parkville, VIC, 3010, Australia; Northern Health, Epping, VIC, 3076 Australia
| | - S Vogrin
- University of Melbourne, Parkville, VIC, 3010, Australia
| | - M A Rees
- University of Melbourne, Parkville, VIC, 3010, Australia; Royal Melbourne Hospital, Gratten St, VIC, 3050, Australia
| | - O M Dean
- Deakin University, IMPACT - the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, 3220 Australia; Florey Institute for Neuroscience and Mental Health and the Department of Psychiatry, The University of Melbourne, VIC , 3010, Australia
| | - C A Wong
- Middlemore Hospital, Te Whatu Ora, Otahuhu, Auckland, 1025, New Zealand; University of Auckland, Park Road, Auckland, 1010, New Zealand
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13
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Lee MH, Vogrin S, Jones TW, O'Neal DN. Hybrid Closed-Loop Versus Manual Insulin Delivery in Adults With Type 1 Diabetes: A Post Hoc Analysis Using the Glycemia Risk Index. J Diabetes Sci Technol 2024:19322968241231307. [PMID: 38372246 DOI: 10.1177/19322968241231307] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/20/2024]
Abstract
BACKGROUND Glycemia risk index (GRI) is a novel composite metric assessing overall glycemic risk, accounting for both hypoglycemia and hyperglycemia and weighted toward extremes. Data assessing GRI as an outcome measure in closed-loop studies and its relation with conventional key continuous glucose monitoring (CGM) metrics are limited. METHODS A post hoc analysis was performed to evaluate the sensitivity of GRI in assessing glycemic quality in adults with type 1 diabetes randomized to 26 weeks hybrid closed-loop (HCL) or manual insulin delivery (control). The primary outcome was GRI comparing HCL with control. Comparisons were made with changes in other CGM metrics including time in range (TIR), time above range (TAR), time below range (TBR), and glycemic variability (standard deviation [SD] and coefficient of variation [CV]). RESULTS GRI with HCL (N = 61) compared with control (N = 59) was significantly lower (mean [SD] 33.5 [11.7] vs 56.1 [14.4], respectively; mean difference -22.8 [-27.2, -18.3], P = .001). The mean increase in TIR was +14.8 (11.0, 18.5)%. GRI negatively correlated with TIR for combined arms (r = -.954; P = .001), and positively with TAR >250 mg/dL (r = .901; P = .001), TBR < 54 mg/dL (r = .416; P = .001), and glycemic variability (SD [r = .916] and CV [r = .732]; P = .001 for both). CONCLUSIONS Twenty-six weeks of HCL improved GRI, in addition to other CGM metrics, compared with standard insulin therapy. The improvement in GRI was proportionally greater than the change in TIR, and GRI correlated with all CGM metrics. We suggest that GRI may be an appropriate primary outcome for closed-loop trials.
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Affiliation(s)
- Melissa H Lee
- Department of Medicine, The University of Melbourne, Melbourne, VIC, Australia
- Department of Endocrinology and Diabetes, St Vincent's Hospital Melbourne, Melbourne, VIC, Australia
| | - Sara Vogrin
- Department of Medicine, The University of Melbourne, Melbourne, VIC, Australia
| | - Timothy W Jones
- Department of Endocrinology and Diabetes, Perth Children's Hospital, Perth, WA, Australia
- Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia
- School of Paediatrics and Child Health, The University of Western Australia, Perth, WA, Australia
| | - David N O'Neal
- Department of Medicine, The University of Melbourne, Melbourne, VIC, Australia
- Department of Endocrinology and Diabetes, St Vincent's Hospital Melbourne, Melbourne, VIC, Australia
- The Australian Centre for Accelerating Diabetes Innovations, Melbourne, VIC, Australia
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14
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Prentice R, Flanagan E, Wright E, Prideaux L, Connell W, Sparrow M, De Cruz P, Lust M, Hardikar W, Goldberg R, Vogrin S, Palmer K, Ross A, Burns M, Greeve T, Bell S. Thiopurine metabolite shunting in late pregnancy increases the risk of intrahepatic cholestasis of pregnancy in women with inflammatory bowel disease, and can be managed with split-dosing. J Crohns Colitis 2024:jjae023. [PMID: 38366352 DOI: 10.1093/ecco-jcc/jjae023] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Indexed: 02/18/2024]
Abstract
BACKGROUND AND AIMS The risk of intrahepatic cholestasis of pregnancy (ICP) is increased in thiopurine exposed pregnancies. Thiopurine 'shunting', with a 6-methylmecrcaptopurine (MMP) to 6-thioguanine (TGN) ratio of >11, progresses over pregnancy, and may promote ICP development. We aimed to explore the association between thiopurine exposure and ICP, including the hypothesized impact of thiopurine shunting, and identify risk minimization strategies. METHODS This prospective multi-centre cohort study compared thiopurine and biologic monotherapy exposed pregnant participants. Disease activity and obstetric outcome data, thiopurine metabolites, bile acids and transaminases were obtained preconception, in each trimester, at delivery, and post-partum. Thiopurine dose management was at the discretion of the treating physician. RESULTS 131 thiopurine and 147 biologic monotherapy exposed pregnancies were included. MMP/TGN ratio increased from preconception to third trimester (p<0.01), with approximately 25% of participants shunting in pregnancy. Second trimester split-dosing led to a decrease in the median MMP/TGN ratio from 18 (IQR 6-57) to 3 (IQR 2-3.5) at delivery (p=0.04). The risk of ICP was increased in thiopurine exposed pregnancies (6.7% (7/105) vs 0% (0/112), p<0.001), with all ICP cases occurring in the setting of antenatal thiopurine shunting. Thiopurine dose increases (RR 8.10 [95% CI 1.88-34.85] p=0.005) and shunting in third trimester (6.20 [1.21-30.73] p=0.028) and at delivery (14.18 [1.62-123.9] p=0.016) were associated with an increased risk of ICP. CONCLUSIONS Thiopurine exposure is associated with an increased risk of ICP, particularly following dose increases antenatally and with shunting in late pregnancy. The latter may be effectively managed with split dosing, although further studies are warranted.
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Affiliation(s)
- Ralley Prentice
- Monash Health, Gastroenterology Department, Melbourne, Australia
- St Vincent's Hospital Melbourne, Gastroenterology Department, Melbourne, Australia
- Monash University, Melbourne, Australia
| | - Emma Flanagan
- St Vincent's Hospital Melbourne, Gastroenterology Department, Melbourne, Australia
- University of Melbourne, Melbourne, Australia
| | - Emily Wright
- St Vincent's Hospital Melbourne, Gastroenterology Department, Melbourne, Australia
- University of Melbourne, Melbourne, Australia
| | - Lani Prideaux
- Monash Health, Gastroenterology Department, Melbourne, Australia
| | - William Connell
- St Vincent's Hospital Melbourne, Gastroenterology Department, Melbourne, Australia
- University of Melbourne, Melbourne, Australia
| | - Miles Sparrow
- Monash University, Melbourne, Australia
- Alfred Health, Gastroenterology Department, Melbourne, Australia
| | - Peter De Cruz
- Monash University, Melbourne, Australia
- Austin Health, Gastroenterology Department, Melbourne, Australia
| | - Mark Lust
- St Vincent's Hospital Melbourne, Gastroenterology Department, Melbourne, Australia
| | - Winita Hardikar
- University of Melbourne, Melbourne, Australia
- Royal Children's Hospital, Gastroenterology Department, Melbourne, Australia
| | - Rimma Goldberg
- Monash Health, Gastroenterology Department, Melbourne, Australia
- Monash University, Melbourne, Australia
| | - Sara Vogrin
- University of Melbourne, Melbourne, Australia
| | - Kirsten Palmer
- Monash University, Melbourne, Australia
- Monash Health, Maternofoetal Medicine Department, Melbourne, Australia
- Monash Health, Obstetrics and Gynaecology Department, Melbourne, Australia
| | - Alyson Ross
- St Vincent's Hospital Melbourne, Gastroenterology Department, Melbourne, Australia
| | - Megan Burns
- Monash Health, Gastroenterology Department, Melbourne, Australia
| | - Tessa Greeve
- Monash Health, Gastroenterology Department, Melbourne, Australia
| | - Sally Bell
- Monash Health, Gastroenterology Department, Melbourne, Australia
- Monash University, Melbourne, Australia
- University of Melbourne, Melbourne, Australia
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15
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Prentice R, Flanagan E, Wright E, Hardikar W, Ross A, Burns M, Prideaux L, Connell W, Sparrow M, De Cruz P, Lust M, Goldberg R, Vogrin S, Greeve T, Bell S. Thrombocytosis and Transaminitis in Infants Born to Women With Inflammatory Bowel Disease Is Associated With Exposure to Maternal Inflammation In Utero. Inflamm Bowel Dis 2024:izae008. [PMID: 38330216 DOI: 10.1093/ibd/izae008] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Indexed: 02/10/2024]
Abstract
BACKGROUND Despite reassuring clinical safety data, thrombocytosis, anemia, lymphopenia, and liver function derangements have been observed in infants born to women with inflammatory bowel disease (IBD) treated with thiopurines and biologics. We aimed to define the prevalence, course, associations, and clinical impact of hematological and biochemical abnormalities in such infants. METHODS This multicenter prospective cohort study assessed clinical, hematologic, and biochemical outcomes of infants exposed to thiopurines or biologics in utero for management of maternal IBD. Liver transaminases, full blood examination, and infant thiopurine metabolites (where exposed) were taken at delivery and 6 weeks of age. Abnormal results were repeated until normalization. Infants were followed clinically by a pediatric gastroenterologist up to 2 years of age. RESULTS A total of 130 infants were included. Thrombocytosis and elevated alanine transaminase (ALT) were seen in over half of infants up to 6 months of age with no significant clinical impact. Elevated ALT was associated with increasing maternal C-reactive protein in second trimester, while thrombocytosis was associated with increasing maternal C-reactive protein and fecal calprotectin in third trimester. Preceding infection and vaccination were associated with an increased risk of elevated alkaline phosphatase at 3 months. In those exposed to thiopurines, increasing maternal 6-methylmercaptopurine at delivery was associated with increased ALT to 6 months. CONCLUSIONS Infants born to women with IBD commonly developed thrombocytosis, elevated alkaline phosphatase, and elevated ALT. These findings were associated with exposure to maternal inflammation, elevated 6-methylmercaptopurine at delivery, and infant vaccinations and infections, and had minimal clinical consequence.
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Affiliation(s)
- Ralley Prentice
- Gastroenterology Department, Monash Health, Melbourne, Australia
- Gastroenterology Department, St Vincent's Hospital Melbourne, Melbourne, Australia
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Emma Flanagan
- Gastroenterology Department, St Vincent's Hospital Melbourne, Melbourne, Australia
- Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia
| | - Emily Wright
- Gastroenterology Department, St Vincent's Hospital Melbourne, Melbourne, Australia
- Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia
| | - Winita Hardikar
- Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia
- Gastroenterology Department, Royal Children's Hospital, Melbourne, Australia
| | - Alyson Ross
- Gastroenterology Department, St Vincent's Hospital Melbourne, Melbourne, Australia
| | - Megan Burns
- Gastroenterology Department, Monash Health, Melbourne, Australia
| | - Lani Prideaux
- Gastroenterology Department, Monash Health, Melbourne, Australia
| | - William Connell
- Gastroenterology Department, St Vincent's Hospital Melbourne, Melbourne, Australia
- Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia
| | - Miles Sparrow
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
- Gastroenterology Department, Alfred Health, Melbourne, Australia
| | - Peter De Cruz
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
- Gastroenterology Department, Austin Health, Melbourne, Australia
| | - Mark Lust
- Gastroenterology Department, St Vincent's Hospital Melbourne, Melbourne, Australia
| | - Rimma Goldberg
- Gastroenterology Department, Monash Health, Melbourne, Australia
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Sara Vogrin
- Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia
| | - Tessa Greeve
- Gastroenterology Department, Monash Health, Melbourne, Australia
| | - Sally Bell
- Gastroenterology Department, Monash Health, Melbourne, Australia
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
- Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia
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16
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Kwon HJ, Trawley S, Vogrin S, Mohammad Alipoor A, Colman PG, Fourlanos S, Grills CA, Lee MH, MacIsaac RJ, O'Neal DN, O'Regan NA, Sundararajan V, Ward GM, McAuley SA. Driving-related glucose patterns among older adults with type 1 diabetes. Diabetes Technol Ther 2024. [PMID: 38315502 DOI: 10.1089/dia.2023.0416] [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: 02/07/2024]
Abstract
Older adults with type 1 diabetes may face challenges driving safely. Glucose "above 5 to drive" is often recommended for insulin-treated diabetes to minimize hypoglycemia while driving. However, the effectiveness of this recommendation among older adults has not been evaluated. Older drivers with type 1 diabetes were assessed while using sensor-augmented insulin pumps during a 2-week clinical trial run-in. Twenty-three drivers (median age 69 years [IQR 65-72]; diabetes duration 37 years [20-45]) undertook 618 trips (duration 10 min [5-21]). Most trips (n = 535; 87%) were <30-min duration; nine trips (1.5%) exceeded 90 min and three trips (0.5%) exceeded 120 min. Pre-trip continuous glucose monitoring (CGM) was >5.0 mmol/L for 577 trips (93%) and none of these had CGM <3.9 mmol/L during driving (including eight trips >90 min and three trips >120 min). During 41 trips with pre-trip CGM ≤5.0 mmol/L, 11 trips had CGM <3.9 mmol/L. Seventy-one CGM alerts occurred during 60 trips (10%), of which 54/71 (76%) were unrelated to hypoglycemia. Our findings support a glucose "above-5-to-drive" recommendation to avoid CGM-detected hypoglycemia among older drivers, including for prolonged drives, and highlight the importance of active CGM low-glucose alerts to prevent hypoglycemia during driving. Driving-related CGM usability and alert functionality warrants investigation.
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Affiliation(s)
- Hye Jin Kwon
- The University of Melbourne, 2281, Department of Medicine, Melbourne, Victoria, Australia
- St Vincent's Hospital Melbourne Pty Ltd, 60078, Department of Endocrinology & Diabetes, Melbourne, Victoria, Australia;
| | - Steven Trawley
- The University of Melbourne, 2281, Department of Medicine, Melbourne, Victoria, Australia
- Cairnmillar Institute, 179842, Department of Psychology, Melbourne, Victoria, Australia;
| | - Sara Vogrin
- The University of Melbourne, 2281, Department of Medicine, Melbourne, Victoria, Australia;
| | - Andisheh Mohammad Alipoor
- The University of Melbourne, 2281, Department of Medicine, Melbourne, Victoria, Australia
- St Vincent's Hospital Melbourne Pty Ltd, 60078, Department of Endocrinology & Diabetes, Melbourne, Victoria, Australia;
| | - Peter G Colman
- The University of Melbourne, 2281, Department of Medicine, Melbourne, Victoria, Australia
- The Royal Melbourne Hospital, 90134, Diabetes and Endocrinology, Melbourne, Victoria, Australia;
| | - Spiros Fourlanos
- The University of Melbourne, 2281, Department of Medicine, Melbourne, Victoria, Australia
- The Royal Melbourne Hospital, 90134, Diabetes and Endocrinology, Melbourne, Victoria, Australia
- The University of Melbourne, 2281, Australian Centre for Accelerating Diabetes Innovations, Melbourne, Victoria, Australia;
| | - Charlotte A Grills
- St Vincent's Hospital Melbourne Pty Ltd, 60078, Department of Endocrinology & Diabetes, Melbourne, Victoria, Australia;
| | - Melissa H Lee
- The University of Melbourne, 2281, Department of Medicine, Melbourne, Victoria, Australia
- St Vincent's Hospital Melbourne Pty Ltd, 60078, Department of Endocrinology & Diabetes, Melbourne, Victoria, Australia;
| | - Richard J MacIsaac
- The University of Melbourne, 2281, Department of Medicine, Melbourne, Victoria, Australia
- St Vincent's Hospital Melbourne Pty Ltd, 60078, Department of Endocrinology & Diabetes, Melbourne, Victoria, Australia
- The University of Melbourne, 2281, Australian Centre for Accelerating Diabetes Innovations, Melbourne, Victoria, Australia;
| | - David N O'Neal
- The University of Melbourne, 2281, Department of Medicine, Melbourne, Victoria, Australia
- St Vincent's Hospital Melbourne Pty Ltd, 60078, Department of Endocrinology & Diabetes, Melbourne, Victoria, Australia
- The University of Melbourne, 2281, Australian Centre for Accelerating Diabetes Innovations, Melbourne, Victoria, Australia;
| | - Niamh A O'Regan
- University Hospital Waterford, 58041, Department of Geriatric Medicine, Waterford Integrated Care for Older People, Waterford, Please Select, Ireland;
| | - Vijaya Sundararajan
- The University of Melbourne, 2281, Department of Medicine, Melbourne, Victoria, Australia
- La Trobe University, 2080, Department of Public Health, Melbourne, Victoria, Australia;
| | - Glenn M Ward
- The University of Melbourne, 2281, Department of Medicine, Melbourne, Victoria, Australia
- St Vincent's Hospital Melbourne Pty Ltd, 60078, Department of Endocrinology & Diabetes, Melbourne, Victoria, Australia;
| | - Sybil A McAuley
- The University of Melbourne, 2281, Department of Medicine, Melbourne, Victoria, Australia
- St Vincent's Hospital Melbourne Pty Ltd, 60078, Department of Endocrinology & Diabetes, Melbourne, Victoria, Australia
- Cairnmillar Institute, 179842, Department of Psychology, Melbourne, Victoria, Australia
- The Alfred, 5390, Department of Endocrinology & Diabetes, Melbourne, Victoria, Australia;
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17
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Debruin DA, Miksa K, Vogrin S, Duque G, Sales M, Hayes A. Exploring new balance and gait factors that are associated with osteosarcopenia in patients with a previous fall and/or fracture history. Arch Gerontol Geriatr 2024; 117:105221. [PMID: 37832464 DOI: 10.1016/j.archger.2023.105221] [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: 07/19/2023] [Revised: 10/02/2023] [Accepted: 10/05/2023] [Indexed: 10/15/2023]
Abstract
Osteosarcopenic individuals have poor muscle function and increased bone fragility, which results in a severe detriment to health outcomes. Hence, there is a necessity to discover easily accessible factors associated with osteosarcopenia to develop timely interventions. This study aimed to determine new sensitive balance and/or gait variables that are associated with osteosarcopenia in a population of older people with a history of falls and/or fractures. In a cross-sectional cohort study, 306 men and women aged ≥65 years completed a series of questionnaires, clinical assessments and muscle strength and function tests. Subsequently, participants were separated into osteopenia, osteoporosis and osteosarcopenia, groups for comparison and further analysis. Osteosarcopenia performed worse than osteopenia and osteoporosis in grip strength, gait speed, physical function scores and in multiple gait and balance indices (p<0.001). During posturography testing, there were larger elliptical areas with eyes open (p = 0.003), and eyes closed (p = 0.043) and increased sway velocity on a firm platform (p = 0.007) in the osteosarcopenia group, compared to osteoporosis. Limits of stability and eyes open ellipse area significantly contributed to the multivariable model (p = 0.029 and p = 0.038, respectively), suggesting that these balance parameters, along with grip strength, may be useful in identifying older adults with osteosarcopenia from those with only osteopenia/osteoporosis. Older adults with osteosarcopenia and a history of falls and/or fractures demonstrated inferior strength, function, and gait characteristics. This study identified indices of balance that were sensitive discriminators for osteosarcopenia and could be easily implemented into routine assessment.
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Affiliation(s)
- Danielle A Debruin
- Australian Institute for Musculoskeletal Science (AIMSS), Western Health, Melbourne, VIC, Australia; Institute of Health and Sport (IHeS), Victoria University, Melbourne, VIC, Australia; Department of Medicine-Western Health, Melbourne Medical School, The University of Melbourne, Melbourne, VIC, Australia; Department of Biochemical and Physiological Sciences, School of Biosciences, Faculty of Health and Medical Science, University of Surrey, Guildford, Surrey, United Kingdom
| | - Kayley Miksa
- Australian Institute for Musculoskeletal Science (AIMSS), Western Health, Melbourne, VIC, Australia; Institute of Health and Sport (IHeS), Victoria University, Melbourne, VIC, Australia
| | - Sara Vogrin
- Australian Institute for Musculoskeletal Science (AIMSS), Western Health, Melbourne, VIC, Australia; Department of Medicine-Western Health, Melbourne Medical School, The University of Melbourne, Melbourne, VIC, Australia
| | - Gustavo Duque
- Australian Institute for Musculoskeletal Science (AIMSS), Western Health, Melbourne, VIC, Australia; Department of Medicine-Western Health, Melbourne Medical School, The University of Melbourne, Melbourne, VIC, Australia; Research Institute of the McGill University Health Centre, Montreal, QC, Canada; Dr. Joseph Kaufmann Chair in Geriatric Medicine, Department of Medicine, McGill University, Montreal, QC, Canada
| | - Myrla Sales
- Australian Institute for Musculoskeletal Science (AIMSS), Western Health, Melbourne, VIC, Australia
| | - Alan Hayes
- Australian Institute for Musculoskeletal Science (AIMSS), Western Health, Melbourne, VIC, Australia; Institute of Health and Sport (IHeS), Victoria University, Melbourne, VIC, Australia; Department of Medicine-Western Health, Melbourne Medical School, The University of Melbourne, Melbourne, VIC, Australia.
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18
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Trubiano JA, Vogrin S, Douglas AP, Chua KYL. Reply to Olans and Olans. Clin Infect Dis 2024; 78:227-228. [PMID: 37586094 DOI: 10.1093/cid/ciad479] [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] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 08/11/2023] [Indexed: 08/18/2023] Open
Affiliation(s)
- Jason A Trubiano
- Centre for Antibiotic Allergy and Research, Department of Infectious Diseases, Austin Health, Heidelberg, Victoria, Australia
- Department of Infectious Diseases, University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Sara Vogrin
- Centre for Antibiotic Allergy and Research, Department of Infectious Diseases, Austin Health, Heidelberg, Victoria, Australia
- Department of Infectious Diseases, University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Abby P Douglas
- Centre for Antibiotic Allergy and Research, Department of Infectious Diseases, Austin Health, Heidelberg, Victoria, Australia
- Department of Infectious Diseases, The National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Parkville, Victoria, Australia
| | - Kyra Y L Chua
- Centre for Antibiotic Allergy and Research, Department of Infectious Diseases, Austin Health, Heidelberg, Victoria, Australia
- Department of Infectious Diseases, University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
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19
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Ranasinghe MP, Koh Y, Vogrin S, Nelson CL, Cohen ND, Voskoboinik A, Nanayakkara S, Haikerwal D, Mateevici C, Wharton J, Casey E, Papapostolou S, Costello B. Early Discharge to Clinic-Based Therapy of Patients Presenting With Decompensated Heart Failure (EDICT-HF): Study Protocol for a Multi-Centre Randomised Controlled Trial. Heart Lung Circ 2024; 33:78-85. [PMID: 38158264 DOI: 10.1016/j.hlc.2023.11.021] [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: 10/25/2023] [Accepted: 11/20/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND Acute decompensated heart failure involves a high rate of mortality and complications. Management typically involves a multi-day hospital admission. However, patients often lose part of their function with each successive admission, and are at a high risk for hospital-associated complications such as nosocomial infection. This study aims to determine the safety and efficacy of the management of patients presenting with acute decompensated heart failure to clinic-based therapy vs usual inpatient care using a reproducible management pathway. METHOD An investigator-initiated, prospective, non-inferiority, 1:1 randomised-controlled trial, stratified by left ventricular ejection fraction including 460 patients with a minimum follow-up of 7 days. This is a multi-centre study to be performed in centres across Victoria, Australia. Participants will be patients with either heart failure with reduced ejection fraction (HFrEF) or heart failure with preserved ejection fraction (HFpEF), admitted for acute decompensation of heart failure. INTERVENTION Early discharge to an outpatient-based Heart Failure Rapid Access Clinical Review (RACER) in addition to frequent medical/nursing at-home review for patients admitted with decompensated heart failure. RESULTS The primary endpoint will be a non-inferiority assessment of re-hospitalisation at 30 days. Secondary outcomes include superiority assessment of hospitalisation at 30 days, a composite clinical endpoint of major adverse cardiac and cerebrovascular event (MACCE), hospital re-admission or mortality at 3 months, achievement of guideline-directed medical therapy, patient assessment of symptoms (visual-analogue scale quantified as area under curve and Kansas City Cardiomyopathy Questionnaire-12 [KCCQ-12]), attendance at 3-month outpatient follow-up, number of bed stays/clinics attended, proportion of patients free from congestion, change in serum creatinine level, treatment for electrolyte disturbances, time to transition from intravenous to oral diuretics, and health economics analysis (cost-benefit analysis, cost-utility analysis, incremental cost-effectiveness ratio). CONCLUSIONS The Early Discharge to Clinic-Based Therapy of Patients Presenting with Decompensated Heart Failure (EDICT-HF) trial will help determine whether earlier discharge to out-of-hospital care is non-inferior to the usual practice of inpatient care, in patients with heart failure admitted to hospital for acute decompensation, as an alternative model of care.
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Affiliation(s)
- Mark P Ranasinghe
- Western Health, Department of Cardiology, Melbourne, Vic, Australia; The University of Melbourne, Faculty of Medicine, Dentistry and Health Sciences, Melbourne, Vic, Australia
| | - Youlin Koh
- Western Health, Department of Cardiology, Melbourne, Vic, Australia
| | - Sara Vogrin
- The University of Melbourne, Faculty of Medicine, Dentistry and Health Sciences, Melbourne, Vic, Australia
| | - Craig L Nelson
- Western Health, Division of Chronic and Complex Care, Melbourne, Vic, Australia; Western Health, Department of Nephrology, Melbourne, Vic, Australia
| | - Neale D Cohen
- Baker Heart and Diabetes Institute, Diabetes Clinical Research, Melbourne, Vic, Australia
| | - Aleksandr Voskoboinik
- Western Health, Department of Cardiology, Melbourne, Vic, Australia; Heart Centre, The Alfred Hospital, Melbourne, Vic, Australia
| | | | - Deepak Haikerwal
- Western Health, Department of Cardiology, Melbourne, Vic, Australia
| | - Cristina Mateevici
- Western Health, Ambulatory Care Unit, Melbourne, Vic, Australia; Western Health, Department of Infectious Diseases, Melbourne, Vic, Australia
| | - James Wharton
- Western Health, Ambulatory Care Unit, Melbourne, Vic, Australia
| | - Erin Casey
- Western Health, Division of Chronic and Complex Care, Melbourne, Vic, Australia
| | - Stavroula Papapostolou
- Western Health, Department of Cardiology, Melbourne, Vic, Australia; Heart Centre, The Alfred Hospital, Melbourne, Vic, Australia
| | - Ben Costello
- Western Health, Department of Cardiology, Melbourne, Vic, Australia.
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20
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Affiliation(s)
- Laura E. Donaldson
- The University of Melbourne, Melbourne, VIC, Australia
- St Vincent’s Hospital Melbourne, Melbourne, VIC, Australia
- The Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Sara Vogrin
- The University of Melbourne, Melbourne, VIC, Australia
| | - Sybil A. McAuley
- The University of Melbourne, Melbourne, VIC, Australia
- St Vincent’s Hospital Melbourne, Melbourne, VIC, Australia
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21
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Donaldson LE, Fourlanos S, Vogrin S, MacIsaac RJ, Colman PG, McAuley SA. Automated insulin delivery among adults with type 1 diabetes for up to 2 years: a real-world, multicentre study. Intern Med J 2024; 54:121-128. [PMID: 37255209 DOI: 10.1111/imj.16143] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 12/23/2022] [Accepted: 05/16/2023] [Indexed: 06/01/2023]
Abstract
BACKGROUND AND AIMS Automated insulin delivery (AID) improves glycaemia among people with type 1 diabetes in clinical trials and overseas real-world studies. Whether improvements are sustained beyond 12 months in the real world, and whether they occur in the Australian context, has not yet been established. We aimed to observe, up to 2 years, the effectiveness of initiating first-generation AID for type 1 diabetes management. METHODS Retrospective, real-world, observational study using medical records, conducted across five sites in Australia. Adults with type 1 diabetes, who had AID initiated between February 2019 and December 2021, were observed for 6-24 months after initiation (until June 2022). Outcomes examined included glucose metrics assessed by glycated haemoglobin (HbA1c ) and continuous glucose monitoring (CGM), safety and therapy continuation. RESULTS Ninety-four adults were studied (median age 39 years (interquartile range, IQR: 31-51); pre-initiation HbA1c 7.8% (7.2-8.6)). After AID initiation, HbA1c decreased by mean 0.5 percentage points (95% confidence interval (CI): -0.7 to -0.2) at 3 months (P < 0.001); CGM time in range 3.9-10.0 mmol/L increased by 11 percentage points (9-14) at 1 month (P < 0.001); these improvements were maintained up to 24 months (all P < 0.02). Median CGM time below 3.9 mmol/L was <1.5% pre- and post-AID initiation. The subgroup with pre-initiation HbA1c above 8.5% had the greatest HbA1c improvement (-1.4 percentage points (-1.8 to -1.1) at 3 months). Twelve individuals (13%) discontinued AID, predominantly citing difficulties with CGM. During the 150 person-years observed, four diabetes-related emergencies were documented: three severe hypoglycaemic events and one hyperglycaemic event without ketoacidosis. CONCLUSIONS Early glucose improvements were observed after real-world AID initiation, sustained up to 2 years, without excess adverse events. The greatest benefits were observed among individuals with highest glycaemia before initiation. Future-generation systems with increased user-friendliness may enhance therapy continuation.
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Affiliation(s)
- Laura E Donaldson
- Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Endocrinology & Diabetes, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
- Department of Diabetes and Endocrinology, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Spiros Fourlanos
- Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Diabetes and Endocrinology, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
- Australian Centre for Accelerating Diabetes Innovations (ACADI), The University of Melbourne, Melbourne, Victoria, Australia
| | - Sara Vogrin
- Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
| | - Richard J MacIsaac
- Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Endocrinology & Diabetes, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
- Australian Centre for Accelerating Diabetes Innovations (ACADI), The University of Melbourne, Melbourne, Victoria, Australia
| | - Peter G Colman
- Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Diabetes and Endocrinology, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Sybil A McAuley
- Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Endocrinology & Diabetes, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
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22
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Wong AK, Klepstad P, Somogyi AA, Vogrin S, Le B, Philip J, Rubio JP. Effect of gene variants on opioid dose, pain and adverse effect outcomes in advanced cancer: an explorative study. Pharmacogenomics 2023; 24:901-913. [PMID: 38126330 DOI: 10.2217/pgs-2023-0207] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023] Open
Abstract
Aim: Associations between gene variants and opioid net effect are unclear. We conducted an exploratory pharmacogenetic analysis of 35 gene variants and opioid response in advanced cancer. Patients & methods: This multi-center prospective cohort study included clinical data, questionnaires (pain and adverse effects) and DNA (blood). Negative binomial regression and logistic regression were used. Results: Within 54 participants, eight statistically significant associations (p = 0.002-0.038) were observed between gene variants and opioid dose, pain scores or adverse effects, the majority being within the neuroimmune TLR4 pathway (IL1B [rs1143634], IL2 [rs2069762], IL6 [rs1800795], BDNF [rs6265]) and ARRB2 pathway (ARRB2 [rs3786047], DRD2 [rs6275]). Conclusion: Neuroimmune pathway genes may contribute to differences in opioid response in cancer and may be included in future similar studies.
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Affiliation(s)
- Aaron K Wong
- Peter MacCallum Cancer center, 305 Grattan St, Melbourne, Victoria, 3000, Australia
- The Royal Melbourne Hospital, 300 Grattan St, Parkville, Victoria, 3050, Australia
- Department of Medicine, University of Melbourne Eastern Hill Campus, Victoria Parade, Fitzroy, Victoria, 3065, Australia
| | - Pal Klepstad
- Department Intensive Care Medicine, St. Olavs University Hospital, Trondheim, Norway
| | - Andrew A Somogyi
- Professor of Clinical & Experimental Pharmacology, Discipline of Pharmacology, Faculty of Health & Medical Sciences, University of Adelaide, Adelaide, 5005, Australia
| | - Sara Vogrin
- Department of Medicine, St Vincent's Hospital Melbourne, University of Melbourne, Victoria, Australia
| | - Brian Le
- Peter MacCallum Cancer center, 305 Grattan St, Melbourne, Victoria, 3000, Australia
- The Royal Melbourne Hospital, 300 Grattan St, Parkville, Victoria, 3050, Australia
| | - Jennifer Philip
- Peter MacCallum Cancer center, 305 Grattan St, Melbourne, Victoria, 3000, Australia
- The Royal Melbourne Hospital, 300 Grattan St, Parkville, Victoria, 3050, Australia
- Department of Medicine, University of Melbourne Eastern Hill Campus, Victoria Parade, Fitzroy, Victoria, 3065, Australia
- St Vincent's Hospital, Palliative Care Service Victoria Parade, Fitzroy, Victoria, 3065, Australia
| | - Justin P Rubio
- Principal Research Fellow Florey Institute of Neuroscience & Mental Health, 30 Royal Parade, Victoria, 3052, Australia
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23
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Trawley S, Kubilay E, Colman PG, Lee MH, O'Neal DN, Sundararajan V, Vogrin S, McAuley SA. What difference does sleep make? Continuous glucose monitoring metrics during fixed-overnight time versus sleep periods among older adults with type 1 diabetes. J Sleep Res 2023:e14106. [PMID: 38050705 DOI: 10.1111/jsr.14106] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 10/18/2023] [Accepted: 11/02/2023] [Indexed: 12/06/2023]
Abstract
Hypoglycaemia during sleep is a common and clinically important issue for people living with insulin-treated diabetes. Continuous glucose monitoring devices can help to identify nocturnal hypoglycaemia and inform treatment strategies. However, sleep is generally inferred, with diabetes researchers and physicians using a fixed-overnight period as a proxy for sleep-wake status when analysing and interpretating continuous glucose monitoring data. No study to date has validated such an approach with established sleep measures. Continuous glucose monitoring and research-grade actigraphy devices were worn and sleep diaries completed for 2 weeks by 28 older adults (mean age 67 years [SD 5]; 17 (59%) women) with type 1 diabetes. Using continuous glucose monitoring data from a total of 356 nights, fixed-overnight (using the recommended period of 00:00 hours-06:00 hours) and objectively-measured sleep periods were compared. The fixed-overnight period approach missed a median 57 min per night (interquartile range: 49-64) of sleep for each participant, including five continuous glucose monitoring-detected hypoglycaemia episodes during objectively-measured sleep. Twenty-seven participants (96%) had at least 1 night with continuous glucose monitoring time-in-range and time-above-range discrepancies both ≥ 10 percentage points, a clinically significant discrepancy. The utility of fixed-overnight time continuous glucose monitoring as a proxy for sleep-awake continuous glucose monitoring is inadequate as it consistently excludes actual sleep time, obscures glycaemic patterns, and misses sensor hypoglycaemia episodes during sleep. The use of validated measures of sleep to aid interpretation of continuous glucose monitoring data is encouraged.
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Affiliation(s)
- Steven Trawley
- Department of Psychology, The Cairnmillar Institute, Melbourne, Victoria, Australia
- Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
| | - Erin Kubilay
- Department of Psychology, The Cairnmillar Institute, Melbourne, Victoria, Australia
| | - Peter G Colman
- Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Diabetes and Endocrinology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Melissa H Lee
- Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Endocrinology & Diabetes, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - David N O'Neal
- Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Endocrinology & Diabetes, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Vijaya Sundararajan
- Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Public Health, La Trobe University, Melbourne, Victoria, Australia
| | - Sara Vogrin
- Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
| | - Sybil A McAuley
- Department of Psychology, The Cairnmillar Institute, Melbourne, Victoria, Australia
- Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Endocrinology & Diabetes, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
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24
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Perera D, Vogrin S, Khumra S, Motaganahalli S, Batrouney A, Urbancic K, Devchand M, Mitri E, Clements R, Nunn A, Reynolds G, Trubiano JA. Impact of a sustained, collaborative antimicrobial stewardship programme in spinal cord injury patients. JAC Antimicrob Resist 2023; 5:dlad111. [PMID: 38021039 PMCID: PMC10664407 DOI: 10.1093/jacamr/dlad111] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 09/19/2023] [Indexed: 12/01/2023] Open
Abstract
Background In patients with spinal cord injuries (SCIs), infections continue to be a leading cause of morbidity, mortality and hospital admission. Objectives This study evaluated the long-term impact of a weekly, multidisciplinary Spinal/Antimicrobial Stewardship (AMS) meeting for acute-care SCI inpatients, on antimicrobial prescribing over 3 years. Methods A retrospective, longitudinal, pre-post comparison of antimicrobial prescribing was conducted at our tertiary hospital in Melbourne. Antimicrobial prescribing was audited in 6 month blocks pre- (25 April 2017 to 24 October 2017), immediately post- (27 March 2018 to 25 September 2018) and 3 years post-implementation (2 March 2021 to 31 August 2021). Antimicrobial orders for patients admitted under the spinal unit at the meeting time were included. Results The number of SCI patients prescribed an antimicrobial at the time of the weekly meeting decreased by 40% at 3 years post-implementation [incidence rate ratio (IRR) 0.63; 95% CI 0.51-0.79; P ≤ 0.001]. The overall number of antimicrobial orders decreased by over 22% at 3 years post-implementation (IRR 0.78; 95% CI 0.61-1.00; P = 0.052). A shorter antimicrobial order duration in the 3 year post-implementation period was observed (-28%; 95% CI -39% to -15%; P ≤ 0.001). This was most noticeable in IV orders at 3 years (-36%; 95% CI -51% to -16%; P = 0.001), and was also observed for oral orders at 3 years (-25%; 95% CI -38% to -10%; P = 0.003). Antimicrobial course duration (days) decreased for multiple indications: skin and soft tissue infections (-43%; 95% CI -67% to -1%; P = 0.045), pulmonary infections (-45%; 95% CI -67% to -9%; P = 0.022) and urinary infections (-31%; 95% CI -47% to -9%; P = 0.009). Ninety-day mortality rates were not impacted. Conclusions This study showed that consistent, collaborative meetings between the Spinal and AMS teams can reduce antimicrobial exposure for acute-care SCI patients without adversely impacting 90 day mortality.
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Affiliation(s)
- D Perera
- Department of Infectious Diseases, Austin Health, 145 Studley Road, Heidelberg 3084, Victoria, Australia
- Department of Pharmacy, Austin Health, 145 Studley Road, Heidelberg 3084, Victoria, Australia
| | - S Vogrin
- Department of Infectious Diseases, Austin Health, 145 Studley Road, Heidelberg 3084, Victoria, Australia
- Department of Medicine, St Vincent's Health, The University of Melbourne, 29 Regent Street, Fitzroy 3065, Victoria, Australia
| | - S Khumra
- Department of Infectious Diseases, Austin Health, 145 Studley Road, Heidelberg 3084, Victoria, Australia
- Department of Pharmacy, Austin Health, 145 Studley Road, Heidelberg 3084, Victoria, Australia
| | - S Motaganahalli
- Department of Infectious Diseases, Austin Health, 145 Studley Road, Heidelberg 3084, Victoria, Australia
| | - A Batrouney
- Department of Infectious Diseases, Austin Health, 145 Studley Road, Heidelberg 3084, Victoria, Australia
- Department of Pharmacy, Austin Health, 145 Studley Road, Heidelberg 3084, Victoria, Australia
| | - K Urbancic
- Department of Infectious Diseases, Austin Health, 145 Studley Road, Heidelberg 3084, Victoria, Australia
- Department of Pharmacy, Austin Health, 145 Studley Road, Heidelberg 3084, Victoria, Australia
| | - M Devchand
- Department of Infectious Diseases, Austin Health, 145 Studley Road, Heidelberg 3084, Victoria, Australia
- Department of Pharmacy, Austin Health, 145 Studley Road, Heidelberg 3084, Victoria, Australia
| | - E Mitri
- Department of Infectious Diseases, Austin Health, 145 Studley Road, Heidelberg 3084, Victoria, Australia
- Department of Pharmacy, Austin Health, 145 Studley Road, Heidelberg 3084, Victoria, Australia
- Department of Infectious Diseases, Doherty Institute, University of Melbourne, 792 Elizabeth St, Melbourne 3000, Victoria, Australia
| | - R Clements
- Victorian Spinal Cord Service, Austin Health, 145 Studley Road, Heidelberg 3084, Victoria, Australia
| | - A Nunn
- Victorian Spinal Cord Service, Austin Health, 145 Studley Road, Heidelberg 3084, Victoria, Australia
| | - G Reynolds
- Department of Infectious Diseases, Austin Health, 145 Studley Road, Heidelberg 3084, Victoria, Australia
- National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne 3000, Victoria, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne 3000, Victoria, Australia
| | - J A Trubiano
- Department of Infectious Diseases, Austin Health, 145 Studley Road, Heidelberg 3084, Victoria, Australia
- Department of Infectious Diseases, Doherty Institute, University of Melbourne, 792 Elizabeth St, Melbourne 3000, Victoria, Australia
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25
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Clark N, MacIsaac M, Little R, Vogrin S, Harrison M, Tiang T, Keck J, Johnston M, Cunningham G, Wright E, Connell W. Have changing practices in salvage medical options affected colectomy rates in acute severe ulcerative colitis? Intern Med J 2023; 53:2231-2239. [PMID: 36916208 DOI: 10.1111/imj.16074] [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: 08/10/2022] [Accepted: 03/07/2023] [Indexed: 03/16/2023]
Abstract
BACKGROUND In 2014, infliximab (IFX) was listed on the Australian Pharmaceutical Benefits Scheme for acute severe ulcerative colitis (ASUC) and is now the preferred option for medical salvage, superseding cyclosporin A (CsA). Optimal dosing schedules for IFX remain unknown. AIM The authors aim to evaluate the effect of changing from predominantly CsA to almost exclusively IFX for the treatment of steroid-refractory ASUC on colectomy rates. METHODS A retrospective review was performed of patients admitted with ASUC between 2012 and 2020. Patients were categorised into two groups according to year of presentation - either 'historical treatment' cohort (2012-2014), when CsA was primarily used, or 'contemporary treatment' cohort (2014-2020), when IFX was mostly prescribed, in either standard or intensive doses. RESULTS One hundred thirty-nine patients were included; 37 in the historical treatment cohort and 102 in the contemporary treatment cohort. In the historical treatment cohort, 12 of 37 received salvage therapy and eight (67%) received CsA. In the contemporary treatment cohort, 49 of 102 patients received salvage therapy, 40 (82%) with IFX, of whom 22 (53%) received intensified doses. Colectomy rates were similar at 30 days, 6 months and 12 months between historical and contemporary treatment cohorts (14% vs 12% [P = 0.77], 19% vs 18% [P > 0.99],and 22% vs 18% [P = 0.63], respectively). Difference in 12-month colectomy rates between standard versus intensive IFX did not meet statistical significance (three of 21 [14%] vs nine of 22 [41%]. respectively; P = 0.09). CONCLUSION There was no difference in 30-day, 6-month or 12-month colectomy rates between the historical treatment and contemporary treatment cohorts. The use of IFX, rather than CsA, even at intensified dosing, does not appear to reduce the colectomy rate observed in our patients.
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Affiliation(s)
- Nicholas Clark
- Department of Gastroenterology, St Vincent's Hospital, Melbourne, Victoria, Australia
| | - Michael MacIsaac
- Department of Gastroenterology, St Vincent's Hospital, Melbourne, Victoria, Australia
| | - Robert Little
- Department of Gastroenterology, The Alfred Hospital, Melbourne, Australia
- Monash University, Monash Health, Victoria, Melbourne, Australia
| | - Sara Vogrin
- Department of Gastroenterology, St Vincent's Hospital, Melbourne, Victoria, Australia
- The University of Melbourne, Melbourne, Victoria, Australia
| | - Maria Harrison
- Department of Gastroenterology, St Vincent's Hospital, Melbourne, Victoria, Australia
| | - Thomas Tiang
- Department of Colorectal Surgery, St Vincent's Hospital, Melbourne, Victoria, Australia
| | - James Keck
- Department of Colorectal Surgery, St Vincent's Hospital, Melbourne, Victoria, Australia
| | - Michael Johnston
- Department of Colorectal Surgery, St Vincent's Hospital, Melbourne, Victoria, Australia
| | - Georgina Cunningham
- Department of Gastroenterology, St Vincent's Hospital, Melbourne, Victoria, Australia
| | - Emily Wright
- Department of Gastroenterology, St Vincent's Hospital, Melbourne, Victoria, Australia
| | - William Connell
- Department of Gastroenterology, St Vincent's Hospital, Melbourne, Victoria, Australia
- The University of Melbourne, Melbourne, Victoria, Australia
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26
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Zanker J, Scott D, Szoeke C, Vogrin S, Patel S, Blackwell T, Bird S, Kirk B, Center J, Alajlouni DA, Gill T, Jones G, Pasco JA, Waters DL, Cawthon PM, Duque G. Predicting Slow Walking Speed From a Pooled Cohort Analysis: Sarcopenia Definitions, Agreement, and Prevalence in Australia and New Zealand. J Gerontol A Biol Sci Med Sci 2023; 78:2415-2425. [PMID: 37428864 PMCID: PMC10692428 DOI: 10.1093/gerona/glad165] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Indexed: 07/12/2023] Open
Abstract
BACKGROUND Recent operational definitions of sarcopenia have not been replicated and compared in Australia and New Zealand (ANZ) populations. We aimed to identify sarcopenia measures that discriminate ANZ adults with slow walking speed (<0.8 m/s) and determine the agreement between the Sarcopenia Definitions and Outcomes Consortium (SDOC) and revised European Working Group for Sarcopenia in Older People (EWGSOP2) operational definitions of sarcopenia. METHODS Eight studies comprising 8 100 ANZ community-dwelling adults (mean age ± standard deviation, 62.0 ± 14.4 years) with walking speed, grip strength (GR), and lean mass data were combined. Replicating the SDOC methodology, 15 candidate variables were included in sex-stratified classification and regression tree models and receiver operating characteristic curves on a pooled cohort with complete data to identify variables and cut points discriminating slow walking speed (<0.8 m/s). Agreement and prevalence estimates were compared using Cohen's Kappa (CK). RESULTS Receiver operating characteristic curves identified GR as the strongest variable for discriminating slow from normal walking speed in women (GR <20.50 kg, area under curve [AUC] = 0.68) and men (GR <31.05 kg, AUC = 0.64). Near-perfect agreement was found between the derived ANZ cut points and SDOC cut points (CK 0.8-1.0). Sarcopenia prevalence ranged from 1.5% (EWGSOP2) to 37.2% (SDOC) in women and 1.0% (EWGSOP2) to 9.1% (SDOC) in men, with no agreement (CK <0.2) between EWGSOP2 and SDOC. CONCLUSIONS Grip strength is the primary discriminating characteristic for slow walking speed in ANZ women and men, consistent with findings from the SDOC. Sarcopenia Definitions and Outcomes Consortium and EWGSOP2 definitions showed no agreement suggesting these proposed definitions measure different characteristics and identify people with sarcopenia differently.
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Affiliation(s)
- Jesse Zanker
- Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, St. Albans, Victoria, Australia
- Department of Medicine, Western Health, The University of Melbourne, St. Albans, Victoria, Australia
| | - David Scott
- Institute for Physical Activity and Nutrition, Deakin University, Burwood, Victoria, Australia
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
| | - Cassandra Szoeke
- Department of Medicine, Royal Melbourne Hospital, The University of Melbourne, Parkville, Victoria, Australia
| | - Sara Vogrin
- Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, St. Albans, Victoria, Australia
- Department of Medicine, Western Health, The University of Melbourne, St. Albans, Victoria, Australia
| | - Sheena Patel
- Research Institute, California Pacific Medical Center, San Francisco, California, USA
| | - Terri Blackwell
- Research Institute, California Pacific Medical Center, San Francisco, California, USA
| | - Stefanie Bird
- Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, St. Albans, Victoria, Australia
- Institute for Physical Activity and Nutrition, Deakin University, Burwood, Victoria, Australia
| | - Ben Kirk
- Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, St. Albans, Victoria, Australia
- Department of Medicine, Western Health, The University of Melbourne, St. Albans, Victoria, Australia
| | - Jacqueline Center
- Skeletal Diseases Program, Garvan Institute of Medical Research, Sydney, New South Wales, Australia
- Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Dima A Alajlouni
- Skeletal Diseases Program, Garvan Institute of Medical Research, Sydney, New South Wales, Australia
- Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Tiffany Gill
- Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
| | - Graeme Jones
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Julie A Pasco
- Department of Medicine, Western Health, The University of Melbourne, St. Albans, Victoria, Australia
- IMPACT-Institute for Mental and Physical Health and Clinical Translation, Barwon HealthDeakin University, Geelong, Victoria, Australia
| | - Debra L Waters
- Department of Medicine, School of Physical Education, Sport and Exercise Sciences, University of Otago, Dunedin, New Zealand
- Department of Internal Medicine/Geriatrics, University of New Mexico, Albuquerque, New Mexico, USA
| | - Peggy M Cawthon
- Research Institute, California Pacific Medical Center, San Francisco, California, USA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA
| | - Gustavo Duque
- Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, St. Albans, Victoria, Australia
- Department of Medicine, Research Institute of the McGill University Health Centre, McGill University, Montreal, Quebec, Canada
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27
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Zanker J, Scott D, Alajlouni D, Kirk B, Bird S, DeBruin D, Vogrin S, Bliuc D, Tran T, Cawthon P, Duque G, Center JR. Mortality, falls and slow walking speed are predicted by different muscle strength and physical performance measures in women and men. Arch Gerontol Geriatr 2023; 114:105084. [PMID: 37290229 DOI: 10.1016/j.archger.2023.105084] [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: 02/16/2023] [Revised: 05/21/2023] [Accepted: 05/29/2023] [Indexed: 06/10/2023]
Abstract
BACKGROUND Different measures of muscle strength, physical performance and body size/composition are used in various sarcopenia definitions. This study investigated which baseline measures best predict incident mortality and falls, and prevalent slow walking speed in older women and men. MATERIALS AND METHODS Data for 899 women (mean age±standard deviation, 68.7 ± 4.3 years) and 497 men (69.4 ± 3.9 years) from the Dubbo Osteoporosis Epidemiology Study 2, comprising sixty variables for muscle strength (quadriceps strength), physical performance (walking speed, timed up and go (TUG) test, sit to stand (STS) test), body size (weight, height, body mass index) and body composition (lean mass, body fat) were included. Sex-stratified Classification and Regression Tree (CART) analyses calculated baseline variable accuracy for predicting incident mortality and falls, and prevalent slow walking speed (<0.8 m/s). RESULTS Over 14.5 years, 103/899 (11.5%) women and 96/497 (19.3%) men died, 345/899 (38.4%) women and 172/497 (34.6%) men had ≥1 fall, and 304/860 (35.3%) women and 172/461 (31.7%) had baseline slow walking speed (<0.8 m/s). CART models identified age and walking speed adjusted for height as the most important predictors for mortality in women, and quadriceps strength (with adjustments) as the most important predictor for mortality in men. In both sexes, STS (with adjustments) was the most important predictor for incident falls, and TUG test was the most important predictor for prevalent slow walking speed. Body composition measures were not important predictors for any outcome. CONCLUSIONS Muscle strength and physical performance variables and cut points predict falls and mortality differently in women and men, suggesting targeted sex-specific application of selected measures may improve outcome prediction in older adults.
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Affiliation(s)
- Jesse Zanker
- Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, St. Albans, Victoria, Australia; Department of Medicine - Western Health, The University of Melbourne, St. Albans, Victoria, Australia.
| | - David Scott
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Burwood, Victoria, Australia; Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
| | - Dima Alajlouni
- Skeletal Diseases Program, Garvan Institute of Medical Research, Sydney, New South Wales, Australia; Clinical School, St Vincent's Hospital, Faculty of Medicine and Health, University of New South Wales Sydney, Sydney, Australia
| | - Ben Kirk
- Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, St. Albans, Victoria, Australia; Department of Medicine - Western Health, The University of Melbourne, St. Albans, Victoria, Australia
| | - Stefanie Bird
- Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, St. Albans, Victoria, Australia; Department of Medicine - Western Health, The University of Melbourne, St. Albans, Victoria, Australia; Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Burwood, Victoria, Australia
| | - Danielle DeBruin
- Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, St. Albans, Victoria, Australia; Department of Medicine - Western Health, The University of Melbourne, St. Albans, Victoria, Australia; Institute of Health and Sport (IHeS), Victoria University, Melbourne, VIC, Australia
| | - Sara Vogrin
- Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, St. Albans, Victoria, Australia; Department of Medicine - Western Health, The University of Melbourne, St. Albans, Victoria, Australia
| | - Dana Bliuc
- Skeletal Diseases Program, Garvan Institute of Medical Research, Sydney, New South Wales, Australia; Clinical School, St Vincent's Hospital, Faculty of Medicine and Health, University of New South Wales Sydney, Sydney, Australia
| | - Thach Tran
- Skeletal Diseases Program, Garvan Institute of Medical Research, Sydney, New South Wales, Australia; Clinical School, St Vincent's Hospital, Faculty of Medicine and Health, University of New South Wales Sydney, Sydney, Australia
| | - Peggy Cawthon
- Research Institute, California Pacific Medical Center, San Francisco, USA; Department of Epidemiology and Biostatistics, University of California, San Francisco, USA
| | - Gustavo Duque
- Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, St. Albans, Victoria, Australia; Department of Medicine - Western Health, The University of Melbourne, St. Albans, Victoria, Australia; Research Institute of the McGill University Health Centre, Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - Jacqueline R Center
- Skeletal Diseases Program, Garvan Institute of Medical Research, Sydney, New South Wales, Australia; Clinical School, St Vincent's Hospital, Faculty of Medicine and Health, University of New South Wales Sydney, Sydney, Australia
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28
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Kuol N, Godlewski J, Kmiec Z, Vogrin S, Fraser S, Apostolopoulos V, Nurgali K. Cholinergic signaling influences the expression of immune checkpoint inhibitors, PD-L1 and PD-L2, and tumor hallmarks in human colorectal cancer tissues and cell lines. BMC Cancer 2023; 23:971. [PMID: 37828429 PMCID: PMC10568879 DOI: 10.1186/s12885-023-11410-3] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 09/16/2023] [Indexed: 10/14/2023] Open
Abstract
BACKGROUND Cancer cells express immunosuppressive molecules, such as programmed death ligands (PD-L)1 and PD-L2, enabling evasion from the host's immune system. Cancer cells synthesize and secrete acetylcholine (ACh), acting as an autocrine or paracrine hormone to promote their proliferation, differentiation, and migration. METHODS We correlated the expression of PD-L1, PD-L2, cholinergic muscarinic receptor 3 (M3R), alpha 7 nicotinic receptor (α7nAChR), and choline acetyltransferase (ChAT) in colorectal cancer (CRC) tissues with the stage of disease, gender, age, risk, and patient survival. The effects of a muscarinic receptor blocker, atropine, and a selective M3R blocker, 4-DAMP, on the expression of immunosuppressive and cholinergic markers were evaluated in human CRC (LIM-2405, HT-29) cells. RESULTS Increased expression of PD-L1, M3R, and ChAT at stages III-IV was associated with a high risk of CRC and poor survival outcomes independent of patients' gender and age. α7nAChR and PD-L2 were not changed at any CRC stages. Atropine and 4-DAMP suppressed the proliferation and migration of human CRC cells, induced apoptosis, and decreased PD-L1, PD-L2, and M3R expression in CRC cells via inhibition of EGFR and phosphorylation of ERK. CONCLUSIONS The expression of immunosuppressive and cholinergic markers may increase the risk of recurrence of CRC. These markers might be used in determining prognosis and treatment regimens for CRC patients. Blocking cholinergic signaling may be a potential therapeutic for CRC through anti-proliferation and anti-migration via inhibition of EGFR and phosphorylation of ERK. These effects allow the immune system to recognize and eliminate cancer cells.
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Affiliation(s)
- Nyanbol Kuol
- Institute for Health and Sport, Victoria University, Melbourne, Australia.
- Department of Physiology and Cell Biology, University of Nevada, Reno, USA.
| | | | - Zbigniew Kmiec
- Department of Histology, Medical University of Gdansk, Gdansk, Poland
| | - Sara Vogrin
- Department of Medicine Western Health, University of Melbourne, Melbourne, Australia
| | - Sarah Fraser
- Institute for Health and Sport, Victoria University, Melbourne, Australia
| | - Vasso Apostolopoulos
- Institute for Health and Sport, Victoria University, Melbourne, Australia
- Immunology Program, Australian Institute of Musculoskeletal Sciences, Melbourne, Australia
| | - Kulmira Nurgali
- Institute for Health and Sport, Victoria University, Melbourne, Australia
- Department of Medicine Western Health, University of Melbourne, Melbourne, Australia
- Regenerative Medicine Program, Australian Institute of Musculoskeletal Sciences, Melbourne, Australia
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29
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Hanson L, Vogrin S, Noaman S, Goh CY, Zheng W, Wexler N, Jumaah H, Al-Mukhtar O, Bloom J, Haji K, Schneider D, Kadhmawi A, Stub D, Cox N, Chan W. Left Ventricular End-Diastolic Pressure for the Prediction of Contrast-Induced Nephropathy and Clinical Outcomes in Patients With ST-Elevation Myocardial Infarction Who Underwent Primary Percutaneous Intervention (the ELEVATE Study). Am J Cardiol 2023; 203:219-225. [PMID: 37499602 DOI: 10.1016/j.amjcard.2023.06.111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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] [Received: 03/06/2023] [Revised: 06/10/2023] [Accepted: 06/26/2023] [Indexed: 07/29/2023]
Abstract
Contrast-induced nephropathy (CIN) is an important complication of percutaneous coronary intervention (PCI). We investigated whether left ventricular end-diastolic pressure (LVEDP) in patients who underwent PCI might be additive to current risk stratification of CIN. Data from consecutive patients who underwent primary PCI for ST-elevation myocardial infarction between 2013 and 2018 at Western Health in Victoria, Australia were analyzed. CIN was defined as a 25% increase in serum creatinine from baseline or 44 µmol/L increase in absolute value within 48 hours of contrast administration. Compared with patients without CIN (n = 455, 93%), those who developed CIN (n = 35, 7%) were older (64 vs 58 years, p = 0.006), and had higher peak creatine kinase (2,862 [1,258 to 3,952] vs 1,341 U/L [641 to 2,613], p = 0.02). The CIN group had higher median LVEDP (30 [21-33] vs 25 mm Hg [20-30], p = 0.013) and higher median Mehran risk score (MRS) (5 [2-8] vs 2 [1-5], p <0.001). Patients with CIN had more in-hospital major adverse cardiovascular and cerebrovascular events (composite end point of death, new or recurrent myocardial infarction or stent thrombosis, target vessel revascularization or stroke) (23% vs 8.6%, p = 0.01), but similar 30-day major adverse cardiovascular and cerebrovascular events (20% vs 15%, p = 0.46). An LVEDP >30 mm Hg independently predicted CIN (odds ratio 3.4, 95% confidence interval 1.46 to 8.03, p = 0.005). The addition of LVEDP ≥30 mm Hg to MRS marginally improved risk prediction for CIN compared with MRS alone (area-under-curve, c-statistic = 0.71 vs c-statistic = 0.63, p = 0.08). In conclusion, elevated LVEDP ≥30 mm Hg during primary PCI was an independent predictor of CIN in patients treated for ST-elevation myocardial infarction. The addition of LVEDP to the MRS may improve risk prediction for CIN.
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Affiliation(s)
- Laura Hanson
- Department of Cardiology, Western Health, Melbourne, Victoria, Australia; Department of Cardiology, Alfred Health, Melbourne, Victoria, Australia
| | - Sara Vogrin
- Department of Medicine, University of Melbourne, Melbourne, Australia
| | - Samer Noaman
- Department of Cardiology, Western Health, Melbourne, Victoria, Australia; Department of Cardiology, Alfred Health, Melbourne, Victoria, Australia
| | - Cheng Yee Goh
- Department of Cardiology, Western Health, Melbourne, Victoria, Australia; Department of Cardiology, University of Ottawa Heart Institute Ottawa, Ontario, Canada
| | - Wayne Zheng
- Department of Cardiology, Western Health, Melbourne, Victoria, Australia; Department of Cardiology, Alfred Health, Melbourne, Victoria, Australia
| | - Noah Wexler
- Department of Cardiology, Western Health, Melbourne, Victoria, Australia
| | - Haider Jumaah
- Department of Cardiology, Western Health, Melbourne, Victoria, Australia
| | - Omar Al-Mukhtar
- Department of Cardiology, Western Health, Melbourne, Victoria, Australia
| | - Jason Bloom
- Department of Cardiology, Alfred Health, Melbourne, Victoria, Australia
| | - Kawa Haji
- Department of Cardiology, Western Health, Melbourne, Victoria, Australia; Department of Cardiology, Alfred Health, Melbourne, Victoria, Australia
| | - Daniel Schneider
- Department of Cardiology, Western Health, Melbourne, Victoria, Australia; Department of Gastroenterology, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Ahmed Kadhmawi
- Department of Cardiology, Western Health, Melbourne, Victoria, Australia
| | - Dion Stub
- Department of Cardiology, Alfred Health, Melbourne, Victoria, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Victoria, Australia; The Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Nicholas Cox
- Department of Cardiology, Western Health, Melbourne, Victoria, Australia; Department of Medicine, University of Melbourne, Melbourne, Australia
| | - William Chan
- Department of Cardiology, Western Health, Melbourne, Victoria, Australia; Department of Cardiology, Alfred Health, Melbourne, Victoria, Australia; Department of Medicine, University of Melbourne, Melbourne, Australia; The Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia.
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Copaescu AM, Vogrin S, James F, Chua KYL, Rose MT, De Luca J, Waldron J, Awad A, Godsell J, Mitri E, Lambros B, Douglas A, Youcef Khoudja R, Isabwe GAC, Genest G, Fein M, Radojicic C, Collier A, Lugar P, Stone C, Ben-Shoshan M, Turner NA, Holmes NE, Phillips EJ, Trubiano JA. Efficacy of a Clinical Decision Rule to Enable Direct Oral Challenge in Patients With Low-Risk Penicillin Allergy: The PALACE Randomized Clinical Trial. JAMA Intern Med 2023; 183:944-952. [PMID: 37459086 PMCID: PMC10352926 DOI: 10.1001/jamainternmed.2023.2986] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [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] [Received: 04/07/2023] [Accepted: 05/17/2023] [Indexed: 07/20/2023]
Abstract
Importance Fewer than 5% of patients labeled with a penicillin allergy are truly allergic. The standard of care to remove the penicillin allergy label in adults is specialized testing involving prick and intradermal skin testing followed by an oral challenge with penicillin. Skin testing is resource intensive, limits practice to specialist-trained physicians, and restricts the global population who could undergo penicillin allergy delabeling. Objective To determine whether a direct oral penicillin challenge is noninferior to the standard of care of penicillin skin testing followed by an oral challenge in patients with a low-risk penicillin allergy. Design, Setting, and Participants This parallel, 2-arm, noninferiority, open-label, multicenter, international randomized clinical trial occurred in 6 specialized centers, 3 in North America (US and Canada) and 3 in Australia, from June 18, 2021, to December 2, 2022. Eligible adults had a PEN-FAST score lower than 3. PEN-FAST is a prospectively derived and internationally validated clinical decision rule that enables point-of-care risk assessment for adults reporting penicillin allergies. Interventions Patients were randomly assigned to either direct oral challenge with penicillin (intervention arm) or a standard-of-care arm of penicillin skin testing followed by oral challenge with penicillin (control arm). Main Outcome and Measure The primary outcome was a physician-verified positive immune-mediated oral penicillin challenge within 1 hour postintervention in the intention-to-treat population. Noninferiority was achieved if a 1-sided 95% CI of the risk difference (RD) did not exceed 5 percentage points (pp). Results A total of 382 adults were randomized, with 377 patients (median [IQR] age, 51 [35-65] years; 247 [65.5%] female) included in the analysis: 187 in the intervention group and 190 in the control group. Most patients had a PEN-FAST score of 0 or 1. The primary outcome occurred in 1 patient (0.5%) in the intervention group and 1 patient (0.5%) in the control group, with an RD of 0.0084 pp (90% CI, -1.22 to 1.24 pp). The 1-sided 95% CI was below the noninferiority margin of 5 pp. In the 5 days following the oral penicillin challenge, 9 immune-mediated adverse events were recorded in the intervention group and 10 in the control group (RD, -0.45 pp; 95% CI, -4.87 to 3.96 pp). No serious adverse events occurred. Conclusions and Relevance In this randomized clinical trial, direct oral penicillin challenge in patients with a low-risk penicillin allergy was noninferior compared with standard-of-care skin testing followed by oral challenge. In patients with a low-risk history, direct oral penicillin challenge is a safe procedure to facilitate the removal of a penicillin allergy label. Trial Registration ClinicalTrials.gov Identifier: NCT04454229.
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Affiliation(s)
- Ana Maria Copaescu
- Centre for Antibiotic Allergy and Research, Department of Infectious Diseases, Austin Health, Heidelberg, Victoria, Australia
- Division of Allergy and Clinical Immunology, Department of Medicine, McGill University Health Centre, McGill University, Montreal, Quebec, Canada
- The Research Institute of the McGill University Health Centre, McGill University Health Centre, McGill University, Montreal, Quebec, Canada
- Department of Medicine, Austin Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Sara Vogrin
- Department of Medicine, St Vincent’s Hospital, The University of Melbourne, Melbourne, Victoria, Australia
| | - Fiona James
- Centre for Antibiotic Allergy and Research, Department of Infectious Diseases, Austin Health, Heidelberg, Victoria, Australia
| | - Kyra Y. L. Chua
- Centre for Antibiotic Allergy and Research, Department of Infectious Diseases, Austin Health, Heidelberg, Victoria, Australia
| | - Morgan T. Rose
- Centre for Antibiotic Allergy and Research, Department of Infectious Diseases, Austin Health, Heidelberg, Victoria, Australia
- Department of Medicine, Austin Health, The University of Melbourne, Melbourne, Victoria, Australia
- The National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Joseph De Luca
- Centre for Antibiotic Allergy and Research, Department of Infectious Diseases, Austin Health, Heidelberg, Victoria, Australia
- Department of Medicine, Austin Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Jamie Waldron
- Centre for Antibiotic Allergy and Research, Department of Infectious Diseases, Austin Health, Heidelberg, Victoria, Australia
| | - Andrew Awad
- Centre for Antibiotic Allergy and Research, Department of Infectious Diseases, Austin Health, Heidelberg, Victoria, Australia
| | - Jack Godsell
- Centre for Antibiotic Allergy and Research, Department of Infectious Diseases, Austin Health, Heidelberg, Victoria, Australia
- Department of Clinical Immunology and Allergy, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Elise Mitri
- Centre for Antibiotic Allergy and Research, Department of Infectious Diseases, Austin Health, Heidelberg, Victoria, Australia
| | - Belinda Lambros
- The National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Abby Douglas
- Centre for Antibiotic Allergy and Research, Department of Infectious Diseases, Austin Health, Heidelberg, Victoria, Australia
- The National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Rabea Youcef Khoudja
- The Research Institute of the McGill University Health Centre, McGill University Health Centre, McGill University, Montreal, Quebec, Canada
| | - Ghislaine A. C. Isabwe
- Division of Allergy and Clinical Immunology, Department of Medicine, McGill University Health Centre, McGill University, Montreal, Quebec, Canada
- The Research Institute of the McGill University Health Centre, McGill University Health Centre, McGill University, Montreal, Quebec, Canada
| | - Genevieve Genest
- Division of Allergy and Clinical Immunology, Department of Medicine, McGill University Health Centre, McGill University, Montreal, Quebec, Canada
- The Research Institute of the McGill University Health Centre, McGill University Health Centre, McGill University, Montreal, Quebec, Canada
| | - Michael Fein
- Division of Allergy and Clinical Immunology, Department of Medicine, McGill University Health Centre, McGill University, Montreal, Quebec, Canada
| | - Cristine Radojicic
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Ann Collier
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Patricia Lugar
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Cosby Stone
- Center for Drug Safety and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Moshe Ben-Shoshan
- The Research Institute of the McGill University Health Centre, McGill University Health Centre, McGill University, Montreal, Quebec, Canada
- Division of Allergy, Immunology and Dermatology, Montreal Children’s Hospital, McGill University Health Centre McGill University, Montreal, Quebec, Canada
| | - Nicholas A. Turner
- Department of Infectious Diseases, Duke University Medical Center, Durham, North Carolina
| | - Natasha E. Holmes
- Centre for Antibiotic Allergy and Research, Department of Infectious Diseases, Austin Health, Heidelberg, Victoria, Australia
- Department of Infectious Diseases, The Peter Doherty Institute for Infection and Immunity, The University of Melbourne, Melbourne, Victoria, Australia
| | - Elizabeth J. Phillips
- Center for Drug Safety and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee
- Institute for Immunology and Infectious Diseases, Murdoch University, Murdoch, Western Australia, Australia
| | - Jason A. Trubiano
- Centre for Antibiotic Allergy and Research, Department of Infectious Diseases, Austin Health, Heidelberg, Victoria, Australia
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Department of Infectious Diseases, The Peter Doherty Institute for Infection and Immunity, The University of Melbourne, Melbourne, Victoria, Australia
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Buratto J, Kirk B, Phu S, Vogrin S, Duque G. Safety and Efficacy of Testosterone Therapy on Musculoskeletal Health and Clinical Outcomes in Men: A Systematic Review and Meta-Analysis of Randomized Placebo-Controlled Trials. Endocr Pract 2023; 29:727-734. [PMID: 37164187 DOI: 10.1016/j.eprac.2023.04.013] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 04/27/2023] [Accepted: 04/29/2023] [Indexed: 05/12/2023]
Abstract
OBJECTIVE Age-related declines in muscle and bone, alongside a shift toward greater adiposity, contribute to falls and fracture risk. Testosterone is osteogenic, myogenic, and catabolic to fat. As such, we examined the effects of testosterone therapy on musculoskeletal health and clinical outcomes in men. METHODS Electronic databases (Medline, Embase, Web of Science, Central) were systematically searched for randomized controlled trials (RCTs) reporting on the effects of testosterone therapy versus placebo on any primary outcome (bone density, muscle mass, fat mass, muscle strength/physical performance) or secondary outcome (falls, fractures, disability, adverse events) in men (≥18 years). A random effects meta-regression examined the effects of testosterone on prespecified outcomes. RESULTS One thousand seven hundred twenty-eight men across 16 RCTs were included (mean age: 77.1 ± 7.6 years). Baseline mean serum testosterone ranged from 7.5 ± 0.3 to 18.9 ± 1.2 nmol/L. Compared to placebo, 6 months of testosterone therapy increased hip bone density and total lean mass, but effects for handgrip and total fat mass did not reach statistical significance. No significant effects of testosterone therapy on musculoskeletal outcomes were evident at 12 months. The limited number of RCTs reporting on adverse events/clinical outcomes, and the low incidence of these events across RCTs, prohibited statistical comparisons. CONCLUSION After 6 months, testosterone effectively increases hip bone density and total lean mass in men, but its effects are unclear for lumbar spine bone density and handgrip strength. Further, RCTs are needed to clarify the safety and efficacy of testosterone on musculoskeletal health and clinical outcomes.
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Affiliation(s)
- Jared Buratto
- Department of Medicine, Western Health, Melbourne Medical School, The University of Melbourne, Melbourne, Victoria, Australia; Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, Melbourne, Victoria, Australia
| | - Ben Kirk
- Department of Medicine, Western Health, Melbourne Medical School, The University of Melbourne, Melbourne, Victoria, Australia; Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, Melbourne, Victoria, Australia
| | - Steven Phu
- Department of Medicine, Western Health, Melbourne Medical School, The University of Melbourne, Melbourne, Victoria, Australia; Falls, Balance and Injury Research Centre, Neuroscience Research Australia (NeuRA), Randwick, New South Wales, Australia; Faculty of Medicine and Health, School of Population Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Sara Vogrin
- Department of Medicine, Western Health, Melbourne Medical School, The University of Melbourne, Melbourne, Victoria, Australia; Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, Melbourne, Victoria, Australia
| | - Gustavo Duque
- Department of Medicine, Western Health, Melbourne Medical School, The University of Melbourne, Melbourne, Victoria, Australia; Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, Melbourne, Victoria, Australia; Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada; Dr. Joseph Kaufmann Chair in Geriatric Medicine, McGill University, Montreal, Quebec, Canada.
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32
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De Luca JF, Awad A, Vogrin S, Waldron JL, McInnes K, Gibney G, Hall R, Douglas AP, Chua KYL, Holmes NE, Trubiano JA. Delayed cutaneous hypersensitivities to COVID-19 vaccination: Phenotypic distribution and tolerability of vaccine rechallenge. J Allergy Clin Immunol Pract 2023; 11:2605-2607.e2. [PMID: 37178767 PMCID: PMC10174467 DOI: 10.1016/j.jaip.2023.04.045] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 04/11/2023] [Accepted: 04/23/2023] [Indexed: 05/15/2023]
Affiliation(s)
- Joseph F De Luca
- Department of Infectious Diseases, Austin Health, Heidelberg, Victoria, Australia; Department of Infectious Diseases, University of Melbourne, Peter Doherty Institute for Infection and Immunity, Victoria, Melbourne, Australia.
| | - Andrew Awad
- Department of Infectious Diseases, Austin Health, Heidelberg, Victoria, Australia
| | - Sara Vogrin
- Department of Infectious Diseases, Austin Health, Heidelberg, Victoria, Australia; Department of Infectious Diseases, University of Melbourne, Peter Doherty Institute for Infection and Immunity, Victoria, Melbourne, Australia
| | - Jamie L Waldron
- Department of Infectious Diseases, Austin Health, Heidelberg, Victoria, Australia
| | - Kerryn McInnes
- Department of Infectious Diseases, Austin Health, Heidelberg, Victoria, Australia
| | - Grace Gibney
- Department of Infectious Diseases, Austin Health, Heidelberg, Victoria, Australia
| | - Rebecca Hall
- Department of Infectious Diseases, Austin Health, Heidelberg, Victoria, Australia
| | - Abby P Douglas
- Department of Infectious Diseases, Austin Health, Heidelberg, Victoria, Australia
| | - Kyra Y L Chua
- Department of Infectious Diseases, Austin Health, Heidelberg, Victoria, Australia
| | - Natasha E Holmes
- Department of Infectious Diseases, Austin Health, Heidelberg, Victoria, Australia; Department of Infectious Diseases, University of Melbourne, Peter Doherty Institute for Infection and Immunity, Victoria, Melbourne, Australia
| | - Jason A Trubiano
- Department of Infectious Diseases, Austin Health, Heidelberg, Victoria, Australia; Department of Infectious Diseases, University of Melbourne, Peter Doherty Institute for Infection and Immunity, Victoria, Melbourne, Australia
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33
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Rose M, Holmes N, Eastwood G, Vogrin S, James F, Phung M, Barnes S, Murfin B, Rogers B, Lambros B, Peel T, Gibney G, Slavin M, Trubiano J. Oral challenge vs routine care to assess low-risk penicillin allergy in critically ill hospital patients (ORACLE): a pilot randomised controlled trial. Pilot Feasibility Stud 2023; 9:126. [PMID: 37475038 DOI: 10.1186/s40814-023-01337-8] [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: 01/13/2023] [Accepted: 06/07/2023] [Indexed: 07/22/2023] Open
Abstract
BACKGROUND Self-reported penicillin allergies are highly prevalent in hospitalised patients and are associated with poor health and health service outcomes. Critically ill patients have historically been underrepresented in prospective delabelling studies in part due to concerns around clinical stability and reliability of penicillin skin testing. Allergy assessment tools exist to identify low-risk penicillin allergy phenotypes and facilitate direct oral challenge delabelling. PEN-FAST is a clinical decision rule that has been validated to predict true penicillin allergy in a cohort of non-critically ill patients. There is however limited evidence regarding the feasibility, safety and efficacy of direct oral challenges and the use of delabelling clinical decisions rules in the intensive care setting. METHODS Critically ill patients in the intensive care unit (ICU) with low-risk penicillin allergy phenotypes (PEN-FAST score < 3) will be randomised 1:1 to direct oral penicillin challenge (single dose 250 mg oral amoxicillin or implicated penicillin) or routine care, followed by a 2-h observation period. Patients will receive a second oral challenge/observation prior to hospital discharge (with subsequent observation for 2 h). An assessment for antibiotic-associated adverse events will also be undertaken at 24 h and 5 days post each challenge/observation and again at 90 days post-randomisation. The primary outcome measures are feasibility (proportion of eligible patients recruited and protocol compliance) and safety (proportion of patients who experience an antibiotic-associated immune-mediated adverse event or serious adverse event). DISCUSSION We will report the feasibility and safety of point-of-care penicillin direct oral challenge in this first randomised controlled trial of low-risk penicillin allergy in critically ill hospitalised patients. Upon completion of the project, important findings will inform the design of planned large prospective multi-centre clinical trials in Australian and international ICUs, further examining safety and efficacy and exploring antimicrobial prescribing-related outcomes following penicillin oral challenge. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry Registration Number: ACTRN12621000051842 Date registered: 20/01/2021 https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=379735&isReview=true.
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Affiliation(s)
- Morgan Rose
- Centre for Antibiotic Allergy and Research, Department of Infectious Diseases, Austin Health, Level 7, Harold Stokes Building, 145 Studley Road, Heidelberg, VIC, 3084, Australia.
- National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.
| | - Natasha Holmes
- Centre for Antibiotic Allergy and Research, Department of Infectious Diseases, Austin Health, Level 7, Harold Stokes Building, 145 Studley Road, Heidelberg, VIC, 3084, Australia
- Department of Infectious Diseases, University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia
- Data Analytics Research and Evaluation Centre, Austin Health/University of Melbourne, Heidelberg, VIC, Australia
- Department of Critical Care, The University of Melbourne, Parkville, VIC, Australia
| | - Glenn Eastwood
- Department of Intensive Care, Austin Hospital, Heidelberg, VIC, Australia
| | - Sara Vogrin
- Department of Medicine (St Vincent's Hospital), University of Melbourne, Melbourne, VIC, Australia
| | - Fiona James
- Centre for Antibiotic Allergy and Research, Department of Infectious Diseases, Austin Health, Level 7, Harold Stokes Building, 145 Studley Road, Heidelberg, VIC, 3084, Australia
| | - Michelle Phung
- Pharmacy Department, Monash Health, Clayton, VIC, Australia
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, VIC, Australia
| | - Sara Barnes
- Monash Lung Sleep Allergy and Immunology, Monash Health, Clayton, VIC, Australia
| | - Brendan Murfin
- Intensive Care Unit, Monash Health, Clayton, VIC, Australia
| | - Ben Rogers
- Monash Infectious Diseases, Monash Health, Clayton, VIC, Australia
- School of Clinical Sciences, Monash University, Clayton, VIC, Australia
| | - Belinda Lambros
- National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Trisha Peel
- Department of Infectious Diseases, Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
- Department of Infectious Diseases, Alfred Health, Melbourne, VIC, Australia
| | - Grace Gibney
- Centre for Antibiotic Allergy and Research, Department of Infectious Diseases, Austin Health, Level 7, Harold Stokes Building, 145 Studley Road, Heidelberg, VIC, 3084, Australia
| | - Monica Slavin
- National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, VIC, Australia
- Immunocompromised Host Infection Service, Victorian Infectious Diseases Service, Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Jason Trubiano
- Centre for Antibiotic Allergy and Research, Department of Infectious Diseases, Austin Health, Level 7, Harold Stokes Building, 145 Studley Road, Heidelberg, VIC, 3084, Australia
- National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Department of Infectious Diseases, University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia
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Trubiano JA, Vogrin S, Mitri E, Hall R, Copaescu A, Waldron J, De Luca J, Rose M, Mackay G, Lambros B, Douglas AP, Holmes NE, Chua KYL. The Who, What, When, and Where of Inpatient Direct Oral Penicillin Challenge-Implications for Health Services Implementation. Clin Infect Dis 2023; 77:19-22. [PMID: 36929823 DOI: 10.1093/cid/ciad156] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [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: 01/03/2023] [Revised: 02/13/2023] [Accepted: 03/14/2023] [Indexed: 03/18/2023] Open
Abstract
Inpatient direct oral challenge programs are increasingly deployed as part of antimicrobial stewardship initiatives to reduce the burden and impacts of penicillin allergy labels on antibiotic prescribing. Using data from a prospective, multicenter cohort inpatient penicillin allergy program, we identify the key targets for delabeling to aid health service implementation.
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Affiliation(s)
- Jason Anthony Trubiano
- Department of Infectious Diseases, Centre for Antibiotic Allergy and Research, Austin Health, Heidelberg, Victoria, Australia
- Department of Infectious Diseases, University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Sara Vogrin
- Department of Infectious Diseases, Centre for Antibiotic Allergy and Research, Austin Health, Heidelberg, Victoria, Australia
- Department of Infectious Diseases, University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Elise Mitri
- Department of Infectious Diseases, Centre for Antibiotic Allergy and Research, Austin Health, Heidelberg, Victoria, Australia
- Department of Infectious Diseases, University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
- Department of Pharmacy, Austin Health, Heidelberg, Victoria, Australia
| | - Rebecca Hall
- Department of Infectious Diseases, Centre for Antibiotic Allergy and Research, Austin Health, Heidelberg, Victoria, Australia
| | - Ana Copaescu
- Department of Infectious Diseases, Centre for Antibiotic Allergy and Research, Austin Health, Heidelberg, Victoria, Australia
- Department of Infectious Diseases, University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
- Department of Medicine, Division of Allergy and Clinical Immunology, McGill University Health Center, Montreal, Quebec, Canada
| | - Jamie Waldron
- Department of Infectious Diseases, Centre for Antibiotic Allergy and Research, Austin Health, Heidelberg, Victoria, Australia
| | - Joseph De Luca
- Department of Infectious Diseases, Centre for Antibiotic Allergy and Research, Austin Health, Heidelberg, Victoria, Australia
| | - Morgan Rose
- Department of Infectious Diseases, Centre for Antibiotic Allergy and Research, Austin Health, Heidelberg, Victoria, Australia
- Department of Infectious Diseases, University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
- Department of Infectious Diseases, The National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Parkville, VIC, Australia
| | - Geoff Mackay
- Albury Wodonga Health, Albury, New South Wales, Australia
| | - Belinda Lambros
- Department of Infectious Diseases, The National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Parkville, VIC, Australia
| | - Abby P Douglas
- Department of Infectious Diseases, Centre for Antibiotic Allergy and Research, Austin Health, Heidelberg, Victoria, Australia
- Department of Infectious Diseases, The National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Parkville, VIC, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia
| | - Natasha E Holmes
- Department of Infectious Diseases, Centre for Antibiotic Allergy and Research, Austin Health, Heidelberg, Victoria, Australia
- Department of Infectious Diseases, University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
- Data Analytics Research and Evaluation (DARE) Centre, Austin Health and The University of Melbourne, Heidelberg, Victoria, Australia
| | - Kyra Y L Chua
- Department of Infectious Diseases, Centre for Antibiotic Allergy and Research, Austin Health, Heidelberg, Victoria, Australia
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Collis B, Vogrin S, Trubiano JA, Reynolds G. Validation Study of a Clinical Predictive Model for Fluconazole Resistance in Patients With Candida Bloodstream Infection. Open Forum Infect Dis 2023; 10:ofad323. [PMID: 37496611 PMCID: PMC10368446 DOI: 10.1093/ofid/ofad323] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 07/09/2023] [Indexed: 07/28/2023] Open
Affiliation(s)
- Brennan Collis
- Department of Infectious Diseases, Austin Health, Heidelberg, Victoria, Australia
| | - Sara Vogrin
- Department of Medicine, University of Melbourne, Parkville, Victoria, Australia
| | - Jason A Trubiano
- Department of Infectious Diseases, Austin Health, Heidelberg, Victoria, Australia
- Department of Medicine, University of Melbourne, Parkville, Victoria, Australia
- National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Department of Infectious Diseases, The Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, Australia
| | - Gemma Reynolds
- Correspondence: Gemma Reynolds, BArts (Hons), MBBS (Hons), MIDI (Dist), FRACP, Department of Infectious Diseases, Austin Health, 145 Studley Road, Heidelberg, Victoria 3084, Australia ()
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Halliday AJ, Vogrin S, Ignatiadis S, Gillinder L, Jones D, Kiley M, Kwan P, Seneviratne U, Somerville E, Whitham E. The efficacy and tolerability of adjunctive brivaracetam for the treatment of adult epilepsy: An Australian multi-center retrospective real-world observational cohort study. Epilepsy Behav 2023; 145:109287. [PMID: 37336131 DOI: 10.1016/j.yebeh.2023.109287] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 05/25/2023] [Accepted: 05/25/2023] [Indexed: 06/21/2023]
Abstract
OBJECTIVE Assess the efficacy and tolerability of add-on therapy brivaracetam (BRV) in adult patients with epilepsy in a real-world setting. METHODS This multi-center retrospective observational cohort study examined all adult patients who commenced on BRV at 11 Australian epilepsy centers between 2017 and 2020. Primary outcomes were seizure response (≥50% reduction in frequency) and seizure freedom 12 months post BRV commencement, and tolerability. We report three approaches to missing data (complete case analysis, CCA; last observation carried forward, LOCF; and intention to treat, ITT). Secondary outcomes included the durability of early BRV response and continuous seizure freedom from BRV initiation. Subgroup analysis examined patients with focal and generalized epilepsy and patients with refractory (≥4 prior ASMs) and highly refractory (≥7 prior ASMs) epilepsy. Outcomes were also assessed at 'personalized' seizure outcome time points based on baseline seizure frequency. RESULTS Baseline and follow-up data were available for 228 patients. The mean age was 41.5 years (IQR 30, 50). Most had focal epilepsy (188/228, 82.5%). Median number of previous ASMs was 4 (2, 7), and concomitant ASMs 2 (2, 3). Twelve-month responder rate was: 46.3% using CCA (95% CI 34.0, 58.9); 39.5% using LOCF (33.1, 46.1); and 15.4% using ITT (10.9, 20.7). Twelve-month seizure freedom was: 23.9% using CCA (14.3, 35.9); 24.6% using LOCF (19.1, 30.7); and 7.9% using ITT (4.7, 12.1). The most frequent adverse effects were sedation or cognitive slowing (33/228, 14.5%), irritability or aggression (16/228, 7.0%), and low mood (14/228, 6.1%). Outcomes were similar using continuous outcome definitions and 'personalized' outcome assessment time points. Early responses were highly durable, with 3-month response maintained at all subsequent time points at 83%, and seizure freedom maintained at 85%. Outcomes were similar in focal (n = 187) and generalizsed (n = 25) subgroups. Outcomes were similar in refractory patients (n = 129), but lower in the highly refractory group (n = 62), however improvement with BRV was still observed with 12-month seizure freedom of 8.3% using CCA (1.0, 27), 6.5% using LOCF (1.8, 15.7); and 3.2% using ITT (0.4, 11.2). CONCLUSIONS Meaningful real-world responder and seizure freedom rates can be still observed in a refractory epilepsy population. Brivaracetam response can occur early and appears to be maintained with minimal later relapse. The results should be interpreted with caution given the retrospective nature of the study and the quantities of missing data at later time points.
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Affiliation(s)
- Amy J Halliday
- Department of Clinical Neurosciences, St Vincent's Hospital Melbourne, Melbourne, Australia; Department of Medicine, St. Vincents Hospital Melbourne, University of Melbourne, Melbourne, Australia.
| | - Sara Vogrin
- Department of Medicine, St. Vincents Hospital Melbourne, University of Melbourne, Melbourne, Australia.
| | - Sophia Ignatiadis
- Department of Clinical Neurosciences, St Vincent's Hospital Melbourne, Melbourne, Australia; Department of Medicine, St. Vincents Hospital Melbourne, University of Melbourne, Melbourne, Australia.
| | - Lisa Gillinder
- Mater Centre for Neurosciences, Mater Hospital Brisbane, South Brisbane, Queensland, Australia; Neurology Department, Princess Alexandra Hospital, Brisbane, Queensland, Australia.
| | - Dean Jones
- Department of Neurology, Royal Hobart Hospital, 48 Liverpool Street, Hobart, Tasmania, Australia; Tasmanian School of Medicine, University of Tasmania, Churchill Ave, Hobart Tasmania 7005, Australia.
| | - Michelle Kiley
- Department of Neurology, Royal Adelaide Hospital, Australia.
| | - Patrick Kwan
- Neurology Department, Alfred Health, Melbourne, Victoria, Australia; Department of Neurosciences, Central Clinical School, Monash University, Alfred Hospital, 99 Commercial Road, Melbourne 3004, Australia; School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne 3004, Australia.
| | - Udaya Seneviratne
- Department of Neurology, Monash Medical Centre, Melbourne, Australia.
| | - Ernest Somerville
- Prince of Wales Clinical School, University of New South Wales, Sydney, NSW, Australia; Comprehensive Epilepsy Service, Prince of Wales Hospital, Sydney, NSW, Australia.
| | - Emma Whitham
- Department of Neurology, Flinders Medical Centre, Australia.
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Waldron JL, Rose M, Vogrin S, Krantz MS, Bolotte R, Phillips EJ, Trubiano JA. Development and Validation of a Sulfa Antibiotic Allergy Clinical Decision Rule. JAMA Netw Open 2023; 6:e2316776. [PMID: 37273210 DOI: 10.1001/jamanetworkopen.2023.16776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/06/2023] Open
Affiliation(s)
- Jamie L Waldron
- Centre for Antibiotic Allergy and Research, Department of Infectious Diseases, Austin Health, Heidelberg, Victoria, Australia
| | - Morgan Rose
- Centre for Antibiotic Allergy and Research, Department of Infectious Diseases, Austin Health, Heidelberg, Victoria, Australia
| | - Sara Vogrin
- Centre for Antibiotic Allergy and Research, Department of Infectious Diseases, Austin Health, Heidelberg, Victoria, Australia
- Department of Medicine (St Vincent's Health), University of Melbourne, Fitzroy, Victoria, Australia
| | - Matthew S Krantz
- Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
- Center for Drug Safety and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Ryan Bolotte
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Elizabeth J Phillips
- Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
- Center for Drug Safety and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Jason A Trubiano
- Centre for Antibiotic Allergy and Research, Department of Infectious Diseases, Austin Health, Heidelberg, Victoria, Australia
- Department of Infectious Diseases, University of Melbourne, Parkville, Victoria, Australia
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Kirk B, French C, Gebauer M, Vogrin S, Zanker J, Sales M, Duque G. Diagnostic power of relative sit-to-stand muscle power, grip strength, and gait speed for identifying a history of recurrent falls and fractures in older adults. Eur Geriatr Med 2023:10.1007/s41999-023-00778-x. [PMID: 37058233 DOI: 10.1007/s41999-023-00778-x] [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] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 03/31/2023] [Indexed: 04/15/2023]
Abstract
PURPOSE To compare the diagnostic value of relative sit-to-stand muscle power with grip strength or gait speed for identifying a history of recurrent falls and fractures in older adults. METHODS Data from an outpatient clinic included anthropometry (height/weight), bone density, 5 times sit-to-stand time (stopwatch and standardized chair), grip strength (hydraulic dynamometer), and gait speed (4 m). Relative sit-to-stand muscle power (W.kg-1, normalised to body mass) was calculated using a validated equation. Outcomes of falls (past 1 year) and fractures (past 5 years) were self-reported and verified by medical records wherever possible. Binary logistic regression considering for potential confounders (age, sex, BMI, Charlson comorbidity index, femoral neck bone density) and receiver operating characteristics (ROC) curves were used in statistical analysis. RESULTS 508 community-dwelling older adults (median age: 78 years, interquartile range: 72, 83, 75.2% women) were included. Compared to greater relative sit-to-stand muscle power (1.62-3.78W.kg-1 for women; 2.03-3.90W.kg-1 for men), those with extremely low relative sit-to-stand muscle power were 2.35 (95% CI 1.54, 3.60, p < 0.001) and 2.41 (95% CI 1.25, 4.65, p = 0.009) times more likely to experience recurrent falls and fractures, respectively, in fully adjusted model. Compared to grip strength or gait speed, relative sit-to-stand muscle power showed the highest area under the ROC curve for identifying recurrent falls (AUC: 0.64) and fractures (AUC: 0.62). All tests showed low diagnostic power (AUC: < 0.7). CONCLUSION Relative sit-to-stand muscle power performed slightly (but not statistically) better than grip strength or gait speed for identifying a history of recurrent falls and fractures in older adults. However, all tests showed low diagnostic power.
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Affiliation(s)
- Ben Kirk
- Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, St Albans, VIC, 3021, Australia
- Department of Medicine-Western Health, Melbourne Medical School, The University of Melbourne, St Albans, VIC, 3021, Australia
| | - Chloe French
- Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, St Albans, VIC, 3021, Australia
- Department of Medicine-Western Health, Melbourne Medical School, The University of Melbourne, St Albans, VIC, 3021, Australia
- School of Health Sciences, University of Manchester, Manchester, UK
| | - Maria Gebauer
- Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, St Albans, VIC, 3021, Australia
- Department of Medicine-Western Health, Melbourne Medical School, The University of Melbourne, St Albans, VIC, 3021, Australia
- University Hospital of Guadalajara, Guadalajara, Spain
| | - Sara Vogrin
- Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, St Albans, VIC, 3021, Australia
- Department of Medicine-Western Health, Melbourne Medical School, The University of Melbourne, St Albans, VIC, 3021, Australia
| | - Jesse Zanker
- Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, St Albans, VIC, 3021, Australia
- Department of Medicine-Western Health, Melbourne Medical School, The University of Melbourne, St Albans, VIC, 3021, Australia
| | - Myrla Sales
- Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, St Albans, VIC, 3021, Australia
- Department of Medicine-Western Health, Melbourne Medical School, The University of Melbourne, St Albans, VIC, 3021, Australia
| | - Gustavo Duque
- Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, St Albans, VIC, 3021, Australia.
- Department of Medicine-Western Health, Melbourne Medical School, The University of Melbourne, St Albans, VIC, 3021, Australia.
- Research Institute of the McGill University Health Centre, Montreal, QC, H4A 3J1, Canada.
- Dr. Joseph Kaufmann Chair in Geriatric Medicine, Department of Medicine, McGill University, Montreal, QC, Canada.
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Donaldson LE, Vogrin S, So M, Ward GM, Krishnamurthy B, Sundararajan V, MacIsaac RJ, Kay TW, McAuley SA. Continuous glucose monitoring-based composite metrics: a review and assessment of performance in recent-onset and long-duration type 1 diabetes. Diabetes Technol Ther 2023. [PMID: 37010375 DOI: 10.1089/dia.2022.0563] [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: 04/04/2023]
Abstract
This study examined correlations between continuous glucose monitoring (CGM)-based composite metrics and standard glucose metrics within CGM data sets from individuals with recent-onset and long-duration type 1 diabetes. First, a literature review and critique of published CGM-based composite metrics was undertaken. Second, composite metric results were calculated for the two CGM data sets and correlations with six standard glucose metrics were examined. Fourteen composite metrics met selection criteria; these metrics focused on overall glycemia (n = 8), glycemic variability (n = 4), and hypoglycemia (n = 2), respectively. Results for the two diabetes cohorts were similar. All eight metrics focusing on overall glycemia strongly correlated with glucose time in range; none strongly correlated with time below range. The eight overall glycemia-focused and two hypoglycemia-focused composite metrics were all sensitive to automated insulin delivery therapeutic intervention. Until a composite metric can adequately capture both achieved target glycemia and hypoglycemia burden, the current two-dimensional CGM assessment approach may offer greatest clinical utility.
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Affiliation(s)
- Laura E Donaldson
- The University of Melbourne, 2281, Department of Medicine, Melbourne, Victoria, Australia
- St Vincent's Hospital Melbourne Pty Ltd, 60078, Department of Endocrinology & Diabetes, Melbourne, Victoria, Australia;
| | - Sara Vogrin
- The University of Melbourne, 2281, Department of Medicine, Melbourne, Victoria, Australia;
| | - Michelle So
- St Vincent's Institute of Medical Research, 85092, Melbourne, Victoria, Australia
- The Royal Melbourne Hospital, 90134, Department of Diabetes and Endocrinology, Parkville, Victoria, Australia
- Northern Health NCHER, 569275, Department of Endocrinology and Diabetes, Melbourne, Victoria, Australia;
| | - Glenn M Ward
- The University of Melbourne, 2281, Department of Medicine, Melbourne, Victoria, Australia
- St Vincent's Hospital Melbourne Pty Ltd, 60078, Department of Endocrinology & Diabetes, Melbourne, Victoria, Australia;
| | - Balasubramanian Krishnamurthy
- The University of Melbourne, 2281, Department of Medicine, Melbourne, Victoria, Australia
- St Vincent's Institute of Medical Research, 85092, Melbourne, Victoria, Australia;
| | - Vijaya Sundararajan
- The University of Melbourne, 2281, Department of Medicine, Melbourne, Victoria, Australia;
| | - Richard J MacIsaac
- The University of Melbourne, 2281, Department of Medicine, Melbourne, Victoria, Australia
- St Vincent's Hospital Melbourne Pty Ltd, 60078, Department of Endocrinology & Diabetes, Melbourne, Victoria, Australia;
| | - Thomas Wh Kay
- St Vincent's Institute of Medical Research, 85092, Melbourne, Victoria, Australia;
| | - Sybil A McAuley
- The University of Melbourne, 2281, Department of Medicine, Melbourne, Victoria, Australia
- St Vincent's Hospital Melbourne Pty Ltd, 60078, Department of Endocrinology & Diabetes, Melbourne, Victoria, Australia;
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Kubilay E, Trawley S, Ward GM, Fourlanos S, Grills CA, Lee MH, MacIsaac RJ, O'Neal DN, O'Regan NA, Sundararajan V, Vogrin S, Colman PG, McAuley SA. Lived experience of older adults with type 1 diabetes using closed-loop automated insulin delivery in a randomised trial. Diabet Med 2023; 40:e15020. [PMID: 36468784 DOI: 10.1111/dme.15020] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 10/25/2022] [Accepted: 12/01/2022] [Indexed: 12/12/2022]
Abstract
AIM To explore the lived experience of older adults with type 1 diabetes using closed-loop automated insulin delivery, an area previously receiving minimal attention. METHODS Semi-structured interviews were conducted with adults aged 60 years or older with long-duration type 1 diabetes who participated in a randomised, open-label, two-stage crossover trial comparing first-generation closed-loop therapy (MiniMed 670G) versus sensor-augmented pump therapy. Interview recordings were transcribed, thematically analysed and assessed. RESULTS Twenty-one older adults participated in interviews after using closed-loop therapy. Twenty were functionally independent, without frailty or major cognitive impairment; one was dependent on caregiver assistance, including for diabetes management. Quality of life benefits were identified, including improved sleep and reduced diabetes-related psychological burden, in the context of experiencing improved glucose levels. Gaps between expectations and reality of closed-loop therapy were also experienced, encountering disappointment amongst some participants. The cost was perceived as a barrier to continued closed-loop access post-trial. Usability issues were identified, such as disruptive overnight alarms and sensor inaccuracy. CONCLUSIONS The lived experience of older adults without frailty or major cognitive impairment using first-generation closed-loop therapy was mainly positive and concordant with glycaemic benefits found in the trial. Older adults' lived experience using automated insulin delivery beyond trial environments requires exploration; moreover, the usability needs of older adults should be considered during future device development.
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Affiliation(s)
- Erin Kubilay
- Department of Psychology, The Cairnmillar Institute, Melbourne, Australia
| | - Steven Trawley
- Department of Psychology, The Cairnmillar Institute, Melbourne, Australia
- Department of Medicine, The University of Melbourne, Melbourne, Australia
| | - Glenn M Ward
- Department of Medicine, The University of Melbourne, Melbourne, Australia
- Department of Endocrinology & Diabetes, St Vincent's Hospital Melbourne, Melbourne, Australia
| | - Spiros Fourlanos
- Department of Medicine, The University of Melbourne, Melbourne, Australia
- Department of Diabetes and Endocrinology, Royal Melbourne Hospital, Melbourne, Australia
- Australian Centre for Accelerating Diabetes Innovations, The University of Melbourne, Melbourne, Australia
| | - Charlotte A Grills
- Department of Medicine, The University of Melbourne, Melbourne, Australia
- Department of Endocrinology & Diabetes, St Vincent's Hospital Melbourne, Melbourne, Australia
| | - Melissa H Lee
- Department of Medicine, The University of Melbourne, Melbourne, Australia
- Department of Endocrinology & Diabetes, St Vincent's Hospital Melbourne, Melbourne, Australia
| | - Richard J MacIsaac
- Department of Medicine, The University of Melbourne, Melbourne, Australia
- Department of Endocrinology & Diabetes, St Vincent's Hospital Melbourne, Melbourne, Australia
- Australian Centre for Accelerating Diabetes Innovations, The University of Melbourne, Melbourne, Australia
| | - David N O'Neal
- Department of Medicine, The University of Melbourne, Melbourne, Australia
- Department of Endocrinology & Diabetes, St Vincent's Hospital Melbourne, Melbourne, Australia
| | - Niamh A O'Regan
- Department of Geriatric Medicine, Waterford Integrated Care for Older People, University Hospital Waterford, Waterford, Ireland
| | - Vijaya Sundararajan
- Department of Medicine, The University of Melbourne, Melbourne, Australia
- Department of Public Health, La Trobe University, Melbourne, Australia
| | - Sara Vogrin
- Department of Medicine, The University of Melbourne, Melbourne, Australia
| | - Peter G Colman
- Department of Medicine, The University of Melbourne, Melbourne, Australia
- Department of Diabetes and Endocrinology, Royal Melbourne Hospital, Melbourne, Australia
| | - Sybil A McAuley
- Department of Psychology, The Cairnmillar Institute, Melbourne, Australia
- Department of Medicine, The University of Melbourne, Melbourne, Australia
- Department of Endocrinology & Diabetes, St Vincent's Hospital Melbourne, Melbourne, Australia
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Nguyen KM, Mattoo VY, Vogrin S, Basnayake C, Connell WR, Ding NS, Flanagan E, Kamm MA, Lust M, Niewiadomski O, Schulberg JD, Wright EK. Relationship Between Serum Ustekinumab Trough Concentration and Clinical and Biochemical Disease Activity: A Real-World Study in Adult Patients with Crohn's Disease. Eur J Drug Metab Pharmacokinet 2023; 48:271-279. [PMID: 36952135 DOI: 10.1007/s13318-023-00824-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/05/2023] [Indexed: 03/24/2023]
Abstract
BACKGROUND AND OBJECTIVES The role of therapeutic drug monitoring for ustekinumab in the treatment of Crohn's disease has not been defined. This study aimed to explore the relationship of serum ustekinumab trough concentration (UTC) with clinical and biochemical disease outcomes in a real-world setting. METHODS We performed a retrospective analysis of Crohn's disease patients treated at a single tertiary centre. Ustekinumab was given as a single intravenous induction dose, followed by maintenance subcutaneous injections every 4 to 8 weeks. Rates of clinical remission (Harvey-Bradshaw Index ≤ 4), biochemical remission (C-reactive protein < 5 mg/l and faecal calprotectin < 150 μg/g) and complete remission were assessed at baseline and at the time of UTC testing during maintenance therapy. The association between baseline variables and UTC was tested using linear regression. We also performed an external validation analysis of UTC cut-offs established in four previously published studies. RESULTS This study included 43 patients. Compared to 8-weekly dosing, a 2.49- and 2.65-fold increase in UTC was associated with 6-weekly and 4-weekly dosing respectively. However, there was no significant difference in clinical, biochemical or complete remission among the dosing groups. An external validation of previously published optimal UTC cut-offs found low predictive value for our patient population. CONCLUSIONS In this study, dosing interval was the only determinant significantly associated with a higher UTC for patients on maintenance ustekinumab therapy. While a higher UTC may be achieved with dose escalation, it was not associated with improved rates of clinical or biochemical response in our cohort.
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Affiliation(s)
- Khue M Nguyen
- Department of Gastroenterology, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Vandita Y Mattoo
- Department of Gastroenterology, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Sara Vogrin
- Faculty of Medicine, Dentistry and Health Sciences, Melbourne Medical School, The University of Melbourne, Melbourne, Victoria, Australia
| | - Chamara Basnayake
- Department of Gastroenterology, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
- Faculty of Medicine, Dentistry and Health Sciences, Melbourne Medical School, The University of Melbourne, Melbourne, Victoria, Australia
| | - William R Connell
- Department of Gastroenterology, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
- Faculty of Medicine, Dentistry and Health Sciences, Melbourne Medical School, The University of Melbourne, Melbourne, Victoria, Australia
| | - Nik S Ding
- Department of Gastroenterology, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
- Faculty of Medicine, Dentistry and Health Sciences, Melbourne Medical School, The University of Melbourne, Melbourne, Victoria, Australia
| | - Emma Flanagan
- Department of Gastroenterology, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Michael A Kamm
- Department of Gastroenterology, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
- Faculty of Medicine, Dentistry and Health Sciences, Melbourne Medical School, The University of Melbourne, Melbourne, Victoria, Australia
| | - Mark Lust
- Department of Gastroenterology, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Ola Niewiadomski
- Department of Gastroenterology, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Julien D Schulberg
- Department of Gastroenterology, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Emily K Wright
- Department of Gastroenterology, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia.
- Faculty of Medicine, Dentistry and Health Sciences, Melbourne Medical School, The University of Melbourne, Melbourne, Victoria, Australia.
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Kirk B, Zhang S, Vogrin S, Harijanto C, Sales M, Duque G. Comparing the Fracture Profile of Osteosarcopenic Older Adults with Osteopenia/Osteoporosis Alone. Calcif Tissue Int 2023; 112:297-307. [PMID: 36436030 DOI: 10.1007/s00223-022-01044-1] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 11/13/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE To determine whether osteosarcopenia is associated with a greater likelihood of recurrent fractures, as well as type of fracture, than osteopenia/osteoporosis or sarcopenia alone. METHODS Anthropometry (height/weight; scales and stadiometer), body composition (bone mineral density [BMD] and appendicular lean mass; dual-energy x-ray absorptiometry), grip strength (hydraulic dynamometer), and gait speed (4 m) were measured in an outpatient clinic. WHO definition for osteopenia/osteoporosis (BMD T-score below -1 SDs) while sarcopenia was defined by SDOC or EWGSOP2. Number and location of fractures within the past 5 years were self-reported and verified by medical records (unverified fractures excluded). Univariable and multivariable regressions were used to examine the association between the exposure and outcome while adjusting for confounders. RESULTS 481 community-dwelling older adults (median age: 78, IQR: 72, 83; 75.9% women) were included. Prevalence of osteosarcopenia depended on the definition (SDOC: 179 (37.2%); EWGSOP2: 123 (25.6%)). In multivariable analysis adjusting for age, sex, alcohol, smoking, BMI, lowest BMD T-score, physical activity, and comorbidities, the likelihood of recurrent fractures (≥ 2 vs 0-1) was significantly higher in those with osteosarcopenia versus osteopenia/osteoporosis irrespective of the definition (SDOC: odds ratio [OR]: 1.63, 95% CI: 1.03, 2.59, p = 0.037; EWGSOP2: OR: 1.83, 95% CI: 1.12, 3.01, p = 0.016]. Associations with sarcopenia alone (SDOC: 10; EWGSOP2: 7) were not possible due to the extremely low prevalence of this condition in those with normal BMD. CONCLUSION Our data suggest osteosarcopenia is associated with a greater likelihood of recurrent fractures versus osteopenia/osteoporosis alone. Further studies are needed to evaluate the relationship with sarcopenia alone.
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Affiliation(s)
- Ben Kirk
- Department of Medicine, Melbourne Medical School, University of Melbourne, Western Health, St Albans, Melbourne, VIC, Australia
- Australian Institute for Musculoskeletal Science (AIMSS), University of Melbourne and Western Health, St Albans, Melbourne, VIC, Australia
| | - Simon Zhang
- Department of Medicine, Melbourne Medical School, University of Melbourne, Western Health, St Albans, Melbourne, VIC, Australia
- Australian Institute for Musculoskeletal Science (AIMSS), University of Melbourne and Western Health, St Albans, Melbourne, VIC, Australia
| | - Sara Vogrin
- Department of Medicine, Melbourne Medical School, University of Melbourne, Western Health, St Albans, Melbourne, VIC, Australia
- Australian Institute for Musculoskeletal Science (AIMSS), University of Melbourne and Western Health, St Albans, Melbourne, VIC, Australia
| | - Christel Harijanto
- Department of Medicine, Melbourne Medical School, University of Melbourne, Western Health, St Albans, Melbourne, VIC, Australia
- Australian Institute for Musculoskeletal Science (AIMSS), University of Melbourne and Western Health, St Albans, Melbourne, VIC, Australia
| | - Myrla Sales
- Department of Medicine, Melbourne Medical School, University of Melbourne, Western Health, St Albans, Melbourne, VIC, Australia
- Australian Institute for Musculoskeletal Science (AIMSS), University of Melbourne and Western Health, St Albans, Melbourne, VIC, Australia
| | - Gustavo Duque
- Department of Medicine, Melbourne Medical School, University of Melbourne, Western Health, St Albans, Melbourne, VIC, Australia.
- Australian Institute for Musculoskeletal Science (AIMSS), University of Melbourne and Western Health, St Albans, Melbourne, VIC, Australia.
- Department of Medicine and Research Institute, McGill University Health Centre, 1001 Decarie Boulevard, Montreal, QC, H4A 3J1, Canada.
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De Luca JF, James F, Vogrin S, Chua K, Fletcher L, Nazareth J, Guha R, Hardidge A, Douglas N, Carruthers J, Stewardson A, Cheng AC, Johnson D, Douglass J, Peel T, Trubiano J. Study protocol for PREPARE: a phase II feasibility/safety randomised controlled trial on PeRiopErative Penicillin AlleRgy TEsting. BMJ Open 2023; 13:e067653. [PMID: 36828661 PMCID: PMC9972415 DOI: 10.1136/bmjopen-2022-067653] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 01/23/2023] [Indexed: 02/26/2023] Open
Abstract
INTRODUCTION Patient-reported antibiotic allergy labels (AALs) are common. These labels have been demonstrated to have a negative impact on use of appropriate antibiotics and patient-related health outcomes. These patients are more likely to receive suboptimal antibiotics, have increased rates of surgical site infections and are more likely to be colonised with multidrug-resistant organisms. Increasing recognition that antibiotic allergy forms a key part of good antimicrobial stewardship has led to calls for greater access to antibiotic allergy assessment.PREPARE is a pilot randomised controlled trial of beta-lactam allergy assessment and point of care delabelling in perioperative patients utilising a validated antibiotic allergy assessment tool that has been repurposed into a smartphone application. The aim of the study is to assess the feasibility and safety of this approach in the perioperative outpatient setting. METHODS AND ANALYSIS Adult participants requiring elective surgery and are likely to require prophylactic intravenous antibiotics will be recruited. During the intervention phase, participants will be randomised to the intervention or control arm, with control patients receiving usual standard of care. Those randomised to intervention undertake a risk assessment via the smartphone application, with those deemed low risk proceeding to direct oral provocation with either a penicillin or cephalosporin. Study outcomes will be evaluated in the postintervention phase, 30 and 90 days after surgery.Feasibility of intervention delivery and recruitment will be reported as proportions with respective 95% CIs. Participants who experience an antibiotic adverse event will be reported by group with respective 95% CIs and compared using modified Poisson regression model with robust SE estimation. ETHICS AND DISSEMINATION This protocol has received approval from the Austin Health human research and ethics committee, Heidelberg, Victoria, Australia (HREC/17/Austin/575). Results will be disseminated via publication in peer-reviewed journals as well as presentation at international conferences. TRIAL REGISTRATION NUMBER ACTRN12620001295932.
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Affiliation(s)
- Joseph F De Luca
- Department of Infectious Diseases, Austin Health, Heidelberg, Victoria, Australia
- Department of Medicine Austin Health, The University of Melbourne, Heidelberg, Victoria, Australia
| | - Fiona James
- Department of Infectious Diseases, Austin Health, Heidelberg, Victoria, Australia
| | - Sara Vogrin
- St Vincent's Department of Medicine, The University of Melbourne, Fitzroy, Victoria, Australia
| | - Kyra Chua
- Department of Infectious Diseases, Austin Health, Heidelberg, Victoria, Australia
- Department of Medicine Austin Health, The University of Melbourne, Heidelberg, Victoria, Australia
| | - Luke Fletcher
- Department of Anaesthesia, Austin Health, Heidelberg, Victoria, Australia
| | - Justin Nazareth
- Department of Anaesthesia, Austin Health, Heidelberg, Victoria, Australia
| | - Ranjan Guha
- Department of Anaesthesia, Austin Health, Heidelberg, Victoria, Australia
| | - Andrew Hardidge
- Department of Orthopaedic Surgery, Austin Health, Heidelberg, Victoria, Australia
| | - Ned Douglas
- Department of Anaesthesia, Melbourne Health, Parkville, Victoria, Australia
| | - John Carruthers
- Department of Anaesthesia, Alfred Health, Melbourne, Victoria, Australia
| | - Andrew Stewardson
- Infectious Diseases, Alfred Health, Melbourne, Victoria, Australia
- Infectious Diseases, Monash University, Melbourne, Victoria, Australia
| | - Allen C Cheng
- Infectious Diseases, Alfred Health, Melbourne, Victoria, Australia
- Department of Epidemiology and Preventive Medicine Clinical Trials Centre, Monash University, Melbourne, Victoria, Australia
| | - Douglas Johnson
- Department of General Medicine, Melbourne Health, Parkville, Victoria, Australia
- Department of Medicine RMH, The University of Melbourne, Parkville, Victoria, Australia
| | - Jo Douglass
- Department of Medicine RMH, The University of Melbourne, Parkville, Victoria, Australia
| | - Trisha Peel
- Infectious Diseases, Monash University, Melbourne, Victoria, Australia
- Infectious Diseases, Alfred Hospital, Melbourne, Victoria, Australia
| | - Jason Trubiano
- Department of Infectious Diseases, Austin Health, Heidelberg, Victoria, Australia
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Waldron JL, James F, Vogrin S, Chua KYL, Holmes NE, DeLuca J, Goh MS, Douglas AP, Trubiano JA. A Shorter Time to Drug Reaction With Eosinophilia and Systemic Symptoms (DRESS): Redefining Beta-Lactam-Associated DRESS. Clin Infect Dis 2023; 76:772-774. [PMID: 36190825 DOI: 10.1093/cid/ciac798] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 09/25/2022] [Accepted: 09/28/2022] [Indexed: 11/12/2022] Open
Affiliation(s)
- Jamie L Waldron
- Department of Infectious Diseases, Austin Health, Heidelberg, Victoria, Australia
| | - Fiona James
- Department of Infectious Diseases, Austin Health, Heidelberg, Victoria, Australia
| | - Sara Vogrin
- Department of Medicine-St Vincent's Health, University of Melbourne, Fitzroy, Victoria, Australia
| | - Kyra Y L Chua
- Department of Infectious Diseases, Austin Health, Heidelberg, Victoria, Australia
| | - Natasha E Holmes
- Department of Infectious Diseases, Austin Health, Heidelberg, Victoria, Australia
| | - Joseph DeLuca
- Department of Infectious Diseases, Austin Health, Heidelberg, Victoria, Australia
| | - Michelle S Goh
- Department of Dermatology, St Vincent's Hospital, Melbourne, Victoria, Australia
| | - Abby P Douglas
- Department of Infectious Diseases and the National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Parkville, Australia
| | - Jason A Trubiano
- Department of Infectious Diseases, Austin Health, Heidelberg, Victoria, Australia
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Mangira D, Raftopoulos S, Vogrin S, Hartley I, Mack A, Gazelakis K, Nalankilli K, Trinh A, Metz AJ, Appleyard M, Grimpen F, Elliott T, Brown G, Moss A. Effectiveness and safety of cold snare polypectomy and cold endoscopic mucosal resection for 10-19 mm non-pedunculated colorectal polyps: a multicenter observational cohort study. Endoscopy 2023. [PMID: 36750222 DOI: 10.1055/a-2029-9539] [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: 02/09/2023]
Abstract
BACKGROUND AND AIMS CSP is standard of care for resecting small (<10mm) colonic polyps. Limited data exist for its efficacy for medium-sized (10-19mm) non-pedunculated polyps, especially conventional adenomas. This study evaluated the effectiveness and safety of CSP/C-EMR for medium-sized non-pedunculated colonic polyps. METHODS A prospective multicentre observational study was conducted between May-2018 and June-2021 of all morphologically suitable 10-19mm non-pedunculated colonic polyps removed by CSP/C-EMR. Once resection was complete, multiple biopsies were taken of the margins circumferentially and centrally. PRIMARY OUTCOME Incomplete resection rate (IRR) based on residual polyp in these biopsy specimens. SECONDARY OUTCOMES Recurrence rate at first surveillance colonoscopy and rates of adverse events. RESULTS CSP/C-EMR was performed for 350 polyps in 295 patients. Median polyp size: 15mm. 266 (76.0%) Paris 0-IIa classification. Submucosal injection used for 87.1%(n=305) of polyps. HISTOLOGY 68.5% adenomas, 26.2% SSL without dysplasia, 3.8% SSL with dysplasia and 1.4% hyperplastic. PRIMARY OUTCOME IRR based on margin or central biopsies being positive was 1.7%(n=6) and 0.3%(n=1) respectively. SECONDARY OUTCOMES Polyp recurrence rate was 1.7%(n=4) at first surveillance colonoscopy that was completed for 65.4%(n=229) of polyps at median interval of 9.7 months. Adverse events occurred in 3.4%(n=10) of patients: 1 intraprocedural bleed treated with clips, 3 self-limiting post-polypectomy bleeds, 4 post-polypectomy pain; 2 post-polypectomy-syndrome-like presentations. There were no perforations. CONCLUSION CSP/C-EMR for morphologically suitable 10-19mm non-pedunculated colonic polyps is effective and safe, including for conventional adenomas. Rates of incomplete resection and recurrence were low, with few adverse events. Studies directly comparing to hot snare resection are required.
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Affiliation(s)
- Dileep Mangira
- Gastroenterology and Hepatology, Western Health, Footscray, Australia
| | - Spiro Raftopoulos
- Department of Gastroenterology, Sir Charles Gairdner Hospital, Nedlands, Australia
| | - Sara Vogrin
- Australian Institute for Musculoskeletal Science, Melbourne, Australia, The Australian Institute of Musculoskeletal Sciences, St Albans, Australia
| | - Imogen Hartley
- Gastroenterology and Hepatology, Western Health, Footscray, Australia
| | - Alexandra Mack
- Gastroenterology and Hepatology, Western Health, Footscray, Australia
| | - Kathryn Gazelakis
- Gastroenterology and Hepatology, Western Health, Footscray, Australia
| | | | - Andrew Trinh
- Department of Gastroenterology, Royal Melbourne Hospital, Melbourne, Australia
| | - Andrew J Metz
- Department of Gastroenterology, Royal Melbourne Hospital, Melbourne, Australia
| | - Mark Appleyard
- Gastroenterology and Hepatology, Royal Brisbane and Women's Hospital, Herston, Australia
| | - Florian Grimpen
- Gastroenterology and Hepatology, Royal Brisbane and Women's Hospital, Herston, Australia
| | - Timothy Elliott
- Internal Medicine Services, Ballarat Health Services, Ballarat, Australia
| | - Gregor Brown
- Gastroenterology, The Alfred Hospital, Prahran, Australia
| | - Alan Moss
- Gastroenterology and Hepatology, Western Health, Footscray, Australia
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46
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De Luca J, Awad A, Vogrin S, Waldron J, Douglas A, Chua K, Holmes N, Trubiano J. Phenotypic distribution and tolerability of re-vaccination in individuals with delayed hypersensitivity to COVID-19 vaccines. J Allergy Clin Immunol 2023. [DOI: 10.1016/j.jaci.2022.12.179] [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: 02/05/2023]
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47
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James F, Waldron J, Vogrin S, Chua K, Holmes N, DeLuca J, Goh M, Douglas A, Trubiano J. A Shorter Time to DRESS – Redefining beta-lactam associated drug reaction with eosinophilia and systemic symptoms. J Allergy Clin Immunol 2023. [DOI: 10.1016/j.jaci.2022.12.643] [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: 02/05/2023]
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48
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O'Neal DN, Cohen O, Vogrin S, Vigersky RA, Jenkins AJ. An Assessment of Clinical Continuous Glucose Monitoring Targets for Older and High-Risk People Living with Type 1 Diabetes. Diabetes Technol Ther 2023; 25:108-115. [PMID: 36315189 DOI: 10.1089/dia.2022.0350] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Aim: To assess relationships between continuous glucose monitoring (CGM) time in range (TIR), 70-180 mg/dL, time below range (TBR), <70 mg/dL, time above range (TAR), >180 mg/dL, and glucose coefficient of variation (CV) in relation to currently recommended clinical CGM targets for older people, which recommend reduced TIR and TBR targets relative to the general type 1 diabetes population. Methods: We conducted a post hoc analysis using the JDRF Australia Adult Hybrid Closed Loop trial database examining correlations in 120 adults with type 1 diabetes of 3 weeks masked CGM (Guardian Sensor 3; Medtronic) metrics (n = 61 on multiple daily injections, 59 on non-CGM augmented pumps) using manual insulin dosing at baseline and at 26-weeks, with 50% randomized to automated insulin dosing (AID). Results: Correlations between baseline TIR and TAR were strong (r = -0.966; P < 0.0001), weak for TBR (r = 0.363; P < 0.0001), and glucose CV (r = 0.037; P = 0.687) while moderate between CV and TBR (r = 0.726; P < 0.0001). Associations were similar for participants aged >60 years (n = 15) versus younger subjects. Correlations of changes in (Δ) TIR with ΔTAR over 26 weeks were strong (r = -0.945; P < 0.001) and correlations for ΔTBR were weak (r = 0.025; P = 0.802). ΔCV did not significantly correlate with ΔTAR (r = -0.064; P = 0.526) but did with ΔTBR (r = 0.770; P = <0.001). Conclusions: Changes in TIR are not associated with changes in TBR. Thus, we recommend that for older AID users whilst TBR targets should be prioritized to reduce hypoglycemia-related risk, TBR should be addressed independently of TIR. Clinical Trial Registratrion number: (ACTRN12617000520336).
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Affiliation(s)
- David N O'Neal
- Department of Medicine, University of Melbourne, Parkville, Australia
- Department of Endocrinology, St. Vincent's Hospital Melbourne, Fitzroy, Australia
- The Australian Centre for Accelerating Diabetes Innovations, Parkville, Australia
| | - Ohad Cohen
- Institute of Endocrinology, Ch. Sheba Medical Center, Tel-Aviv, Israel
| | - Sara Vogrin
- Department of Medicine, University of Melbourne, Parkville, Australia
| | - Robert A Vigersky
- Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Alicia J Jenkins
- Department of Medicine, University of Melbourne, Parkville, Australia
- Department of Endocrinology, St. Vincent's Hospital Melbourne, Fitzroy, Australia
- The Australian Centre for Accelerating Diabetes Innovations, Parkville, Australia
- NHMRC Clinical Trials Centre, University of Sydney, Camperdown, Australia
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49
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Waldron J, Rose M, Vogrin S, Krantz M, Bolotte R, Phillips E, Trubiano J. Validation of an Allergy Clinical Decision Rule for "Sulfa" antibiotic allergy label – S-FAST. J Allergy Clin Immunol 2023. [DOI: 10.1016/j.jaci.2022.12.723] [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: 02/05/2023]
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50
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Kositsawat J, Vogrin S, French C, Gebauer M, Candow DG, Duque G, Kirk B. Relationship Between Plasma Homocysteine and Bone Density, Lean Mass, Muscle Strength and Physical Function in 1480 Middle-Aged and Older Adults: Data from NHANES. Calcif Tissue Int 2023; 112:45-54. [PMID: 36344761 PMCID: PMC9813058 DOI: 10.1007/s00223-022-01037-0] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 10/26/2022] [Indexed: 11/09/2022]
Abstract
Hyperhomocysteinemia induces oxidative stress and chronic inflammation (both of which are catabolic to bone and muscle); thus, we examined the association between homocysteine and body composition and physical function in middle-aged and older adults. Data from the National Health and Nutrition Examination Survey was used to build regression models. Plasma homocysteine (fluorescence immunoassay) was used as the exposure and bone mineral density (BMD; dual-energy X-ray absorptiometry; DXA), lean mass (DXA), knee extensor strength (isokinetic dynamometer; newtons) and gait speed (m/s) were used as outcomes. Regression models were adjusted for confounders (age, sex, race/Hispanic origin, height, fat mass %, physical activity, smoking status, alcohol intakes, cardiovascular disease, diabetes, cancer and vitamin B12). All models accounted for complex survey design by using sampling weights provided by NHANES. 1480 adults (median age: 64 years [IQR: 56, 73]; 50.3% men) were included. In multivariable models, homocysteine was inversely associated with knee extensor strength (β = 0.98, 95% CI 0.96, 0.99, p = 0.012) and gait speed (β = 0.85, 95% CI 0.78, 0.94, p = 0.003) and borderline inversely associated with femur BMD (β = 0.84, 95% CI 0.69, 1.03, p = 0.086). In the sub-group analysis of older adults (≥ 65 years), homocysteine was inversely associated with gait speed and femur BMD (p < 0.05) and the slope for knee extensor strength and whole-body BMD were in the same direction. No significant associations were observed between homocysteine and total or appendicular lean mass in the full or sub-group analysis. We found inverse associations between plasma homocysteine and muscle strength/physical function, and borderline significant inverse associations for femur BMD.
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Affiliation(s)
| | - Sara Vogrin
- Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, 176 Furlong Road, St. Albans, VIC, 3021, Australia
- Department of Medicine-Western Health, Melbourne Medical School, The University of Melbourne, St Albans, VIC, 3021, Australia
| | - Chloe French
- Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, 176 Furlong Road, St. Albans, VIC, 3021, Australia
- Department of Medicine-Western Health, Melbourne Medical School, The University of Melbourne, St Albans, VIC, 3021, Australia
- School of Health Sciences, University of Manchester, Manchester, UK
| | - Maria Gebauer
- Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, 176 Furlong Road, St. Albans, VIC, 3021, Australia
- Department of Medicine-Western Health, Melbourne Medical School, The University of Melbourne, St Albans, VIC, 3021, Australia
- University Hospital of Guadalajara, Guadalajara, Spain
| | - Darren G Candow
- Faculty of Kinesiology and Health Studies, University of Regina, Regina, Canada
| | - Gustavo Duque
- Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, 176 Furlong Road, St. Albans, VIC, 3021, Australia
- Department of Medicine-Western Health, Melbourne Medical School, The University of Melbourne, St Albans, VIC, 3021, Australia
| | - Ben Kirk
- Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, 176 Furlong Road, St. Albans, VIC, 3021, Australia.
- Department of Medicine-Western Health, Melbourne Medical School, The University of Melbourne, St Albans, VIC, 3021, Australia.
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