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Roberts GW, Krinsley JS, Preiser JC, Quinn S, Rule PR, Brownlee M, Umpierrez GE, Hirsch IB. Malglycemia in the critical care setting. Part III: Temporal patterns, relative potencies, and hospital mortality. J Crit Care 2024; 81:154537. [PMID: 38364665 DOI: 10.1016/j.jcrc.2024.154537] [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: 11/16/2023] [Revised: 02/07/2024] [Accepted: 02/08/2024] [Indexed: 02/18/2024]
Abstract
INTRODUCTION The relationship between critical care mortality and combined impact of malglycemia remains undefined. METHODS We assessed the risk-adjusted relationship (n = 4790) between hospital mortality with malglycemia, defined as hypergycemia (hours Glycemic Ratio ≥ 1.1, where GR is quotient of mean ICU blood glucose (BG) and estimated average BG), absolute hypoglycemia (hours BG < 70 mg/dL) and relative hypoglycemia (excursions GR < 0.7 in those with HbA1c ≥ 8%). RESULTS Each malglycemia was independently associated with mortality - hyperglycemia (OR 1.0020/h, 95%CI 1.0009-1.0031, p = 0.0004), absolute hypoglycemia (OR 1.0616/h, 95%CI 1.0190-1.1061, p = 0.0043), and relative hypoglycemia (OR 1.2813/excursion, 95%CI 1.0704-1.5338, p = 0.0069). Absolute (7.4%) and relative hypoglycemia (6.7%) exposure dominated the first 24 h, decreasing thereafter. While hyperglycemia had lower risk association with mortality, it was persistently present across the length-of-stay (68-76% incidence daily), making it the dominant form of malglycemia. Relative contributions in the first five days from hyperglycemia, absolute hypoglycemia and relative hypoglycemia were 60%, 21% and 19% respectively. CONCLUSIONS Absolute and relative hypoglycemia occurred largely in the first 24 h. Relative to all hypoglycemia, the associated mortality from the seemingly less potent but consistently more prevalent hyperglycemia steadily accumulated with increasing length-of-stay. This has important implications for interpretation of study results.
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Affiliation(s)
- Gregory W Roberts
- SA Pharmacy, Flinders Medical Centre, Bedford Park, SA 5042, Australia; College of Medicine and Public Health, Flinders University, Bedford Park, SA 5042, Australia.
| | - James S Krinsley
- Division of Critical Care, Department of Medicine, Stamford Hospital, and the Columbia Vagelos College of Physicians and Surgeons, Stamford, CT, USA
| | | | - Stephen Quinn
- Department of Health Science and Biostatistics, Swinburne University of Technology, Hawthorn, Victoria, Australia.
| | | | - Michael Brownlee
- Diabetes Research Emeritus, Biomedical Sciences Emeritus, Einstein Diabetes Research Center, Department of Medicine and Pathology Emeritus, Albert Einstein College of Medicine, Bronx, NY, USA.
| | - Guillermo E Umpierrez
- Department of Medicine, Division of Endocrinology, Emory University School of Medicine, Atlanta, GA, USA.
| | - Irl B Hirsch
- Division of Metabolism, Endocrinology and Nutrition, University of Washington Medicine Diabetes Institute, Seattle, WA, USA.
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Roberts G, Krinsley JS, Preiser JC, Quinn S, Rule PR, Brownlee M, Schwartz M, Umpierrez GE, Hirsch IB. The Glycemic Ratio Is Strongly and Independently Associated With Mortality in the Critically Ill. J Diabetes Sci Technol 2024; 18:335-344. [PMID: 36112804 PMCID: PMC10973871 DOI: 10.1177/19322968221124114] [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] [Indexed: 01/08/2023]
Abstract
BACKGROUND Interventional studies investigating blood glucose (BG) management in intensive care units (ICU) have been inconclusive. New insights are needed. We assessed the ability of a new metric, the Glycemic Ratio (GR), to determine the relationship of ICU glucose control relative to preadmission glycemia and mortality. METHODS Retrospective cohort investigation (n = 4790) in an adult medical-surgical ICU included patients with minimum four BGs, hemoglobin (Hgb), and hemoglobin A1c (HbA1c). The GR is the quotient of mean ICU BGs (mBG) and estimated preadmission BG, derived from HbA1c. RESULTS Mortality displayed a J-shaped curve with GR (nadir GR 0.9), independent of background glycemia, consistent for HbA1c <6.5% vs >6.5%, and Hgb >10 g/dL vs <10 g/dL and medical versus surgical. An optimal range of GR 0.80 to 0.99 was associated with decreased mortality compared with GR above and below this range. The mBG displayed a linear relationship with mortality at lower HbA1c but diminished for HbA1c >6.5%, and dependent on preadmission glycemia. In adjusted analysis, GR remained associated with mortality (odds ratio = 2.61, 95% confidence interval = 1.48-4.62, P = .0012), but mBG did not (1.004, 1.000-1.009, .059). A single value on admission was not independently associated with mortality. CONCLUSIONS The GR provided new insight into malglycemia that was not apparent using mBG, or an admission value. Mortality was associated with acute change from preadmission glycemia (GR). Further assessment of the impact of GR deviations from the nadir in mortality at GR 0.80 to 0.99, as both relative hypo- and hyperglycemia, and as duration of exposure and intensity, may further define the multifaceted nature of malglycemia.
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Affiliation(s)
- Greg Roberts
- SA Pharmacy, Flinders Medical Centre, Bedford Park, SA, Australia
- College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia
| | - James S. Krinsley
- Division of Critical Care, Department of Medicine, Stamford Hospital and Columbia University Vagelos College of Physicians and Surgeons, Stamford, CT, USA
| | | | - Stephen Quinn
- Department of Health Science and Biostatistics, Swinburne University of Technology, Melbourne, VIC, Australia
| | - Peter R. Rule
- Pacific Research Institute, Los Altos Hills, CA, USA
| | - Michael Brownlee
- Diabetes Research Emeritus, Biomedical Sciences Emeritus, Einstein Diabetes Research Center, Department of Medicine and Pathology Emeritus, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Michael Schwartz
- Division of Metabolism, Endocrinology and Nutrition, University of Washington Medicine Diabetes Institute, Seattle, WA, USA
| | - Guillermo E. Umpierrez
- Department of Medicine, Division of Endocrinology, Emory University School of Medicine, Atlanta, GA, USA
| | - Irl B. Hirsch
- Department of Medicine, University of Washington Medicine Diabetes Institute, Seattle, WA, USA
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Roberts G, Krinsley JS, Preiser JC, Quinn S, Rule PR, Brownlee M, Umpierrez GE, Hirsch IB. Malglycemia in the critical care setting. Part II: Relative and absolute hypoglycemia. J Crit Care 2024; 79:154429. [PMID: 37713997 DOI: 10.1016/j.jcrc.2023.154429] [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: 05/08/2023] [Revised: 08/31/2023] [Accepted: 09/07/2023] [Indexed: 09/17/2023]
Abstract
INTRODUCTION The relationship between critical care mortality and hypoglycemia, both relative (>30% below average preadmission glycemia) and absolute (blood glucose (BG) <70 mg/dL (<10 mmol/L)) requires further definition. METHODS We assessed the risk-adjusted relationship between hospital mortality with relative hypoglycemia using the Glycemic Ratio (GR), and with absolute hypoglycemia using BG in a retrospective cohort investigation (n = 4790). RESULTS Relative hypoglycemia excursions below GR 0.7 with a of 24-h non-exposure period between excursions in those with HbA1c ≥ 8% were independently associated with mortality (n = 373, OR 2.49, 95% CI 1.54-4.04, p = 0.0002) but not those with HbA1c < 8% (n = 4417, OR 0.98 95% CI 0.89-1.08, p = 0.70). Hours below GR 0.7 (1.0037, 0.9995-1.0080, 0.0846) or minimum GR (0.0896, 0.0030-2.6600, 0.1632) were not independently associated with outcome. Absolute hypoglycemia occurred across the HbA1c spectrum in a U-shaped pattern. There was no difference in mortality associated with exposure to BG < 70 mg/dL for HbA1c ≥ 6.5% vs <6.5% (29.7% vs 24.3%, p = 0.77). Hours below 70 mg/dL demonstrated strongest association with outcome, while minimum BG, and excursions below 70 mg/dL were also independently associated. CONCLUSIONS Relative hypoglycemia represented by excursions below GR 0.7 in those with HbA1c ≥ 8% occurred commonly and was independently associated with mortality. Absolute hypoglycemia had similar association with mortality regardless of HbA1c.
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Affiliation(s)
- Greg Roberts
- SA Pharmacy, Flinders Medical Centre, Bedford Park, SA 5042, Australia; College of Medicine and Public Health, Flinders University, Bedford Park, SA 5042, Australia.
| | - James S Krinsley
- Division of Critical Care, Department of Medicine, Stamford Hospital, and the Columbia Vagelos College of Physicians and Surgeons, Stamford, CT, USA
| | | | - Stephen Quinn
- Department of Health Science and Biostatistics, Swinburne University of Technology, Hawthorn, Victoria, Australia.
| | | | - Michael Brownlee
- Diabetes Research Emeritus, Biomedical Sciences Emeritus, Einstein Diabetes Research Center, Department of Medicine and Pathology Emeritus, Albert Einstein College of Medicine, Bronx, NY, USA.
| | - Guillermo E Umpierrez
- Department of Medicine, Division of Endocrinology, Emory University School of Medicine, Atlanta, GA, USA.
| | - Irl B Hirsch
- Division of Metabolism, Endocrinology and Nutrition, University of Washington Medicine Diabetes Institute, Seattle, WA, USA.
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Lindsay D, Schofield P, Nabukalu D, Roberts MJ, Yaxley J, Quinn S, Richards N, Frydenberg M, Gardiner R, Lawrentschuk N, Juraskova I, Murphy DG, Gordon LG. The impact of management option on out-of-pocket costs and perceived financial burden among men with localised prostate cancer in Australia within 6 months of diagnosis. AUST HEALTH REV 2024; 48:AH23231. [PMID: 38342484 DOI: 10.1071/ah23231] [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] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Accepted: 01/26/2024] [Indexed: 02/13/2024]
Abstract
Objective This study aimed to quantify the out-of-pocket (OOP) costs and perceived financial burden among Australian men with localised prostate cancer in the first 6 months after diagnosis, by primary management option. Methods This cost-analysis quantified OOP costs using administrative claims data and self-reported survey data. Financial burden was assessed using the COmprehensive Score for financial Toxicity-Functional Assessment of Chronic Illness Therapy (COST-FACIT) tool. Participants were recruited into a randomised control trial from public or private treatment centres in Victoria and Queensland. Generalised linear models were used to predict OOP costs and COST-FACIT scores. Results Median total OOP costs within 6 months of diagnosis for 256 Australian patients with localised prostate cancer was A$1172 (A$343-2548). Up to 50% of the sample reported A$0 costs for most medical services. Compared with those managed with active surveillance, men having active treatment had 6.4 (95% CI: 3.2-12.7) times greater total OOP costs. Management option, higher Gleason score at diagnosis and having multiple comorbidities were significant predictors of higher OOP costs. Overall high scores on the COST-FACIT indicated low levels of financial burden for the entire sample. Conclusion Largely attributable to being managed with active surveillance, Australian men diagnosed with localised prostate cancer reported relatively low OOP costs and financial burden in the first 6 months post-diagnosis. Together with clinical outcomes, clinicians can use this up to date evidence on costs and perceived financial burdens to assist localised prostate cancer patients and their families make informed decisions about their preferred management option.
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Affiliation(s)
- Daniel Lindsay
- Health Economics, Population Health Department, QIMR Berghofer Medical Research Institute, 300 Herston Road, Herston, Brisbane, Qld 4006, Australia; and Faculty of Medicine, The University of Queensland, Qld, Australia
| | - Penelope Schofield
- Department of Psychology, Swinburne University of Technology, Melbourne, Vic., Australia; and Behavioural Science Unit, Peter MacCallum Cancer Centre, Melbourne, Vic., Australia; and Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Vic., Australia
| | - Doreen Nabukalu
- Health Economics, Population Health Department, QIMR Berghofer Medical Research Institute, 300 Herston Road, Herston, Brisbane, Qld 4006, Australia
| | - Matthew J Roberts
- Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Vic., Australia; and Centre for Clinical Research, The University of Queensland, Qld, Australia; and Department of Urology, Redcliffe Hospital, Qld, Australia
| | - John Yaxley
- Faculty of Medicine, The University of Queensland, Qld, Australia; and Department of Urology, Royal Brisbane and Women's Hospital, Qld, Australia; and Wesley Urology Clinic, Wesley Hospital, Qld, Australia
| | - Stephen Quinn
- Department of Health Science and Biostatistics, Swinburne University of Technology, Melbourne, Vic., Australia
| | - Natalie Richards
- Behavioural Science Unit, Peter MacCallum Cancer Centre, Melbourne, Vic., Australia
| | - Mark Frydenberg
- Department of Urology, Cabrini Institute, Cabrini Health, Vic., Australia; and Department of Surgery, Monash University, Melbourne, Vic., Australia
| | - Robert Gardiner
- Faculty of Medicine, The University of Queensland, Qld, Australia; and Department of Urology, Royal Brisbane and Women's Hospital, Qld, Australia; and Centre for Clinical Research, The University of Queensland, Qld, Australia
| | - Nathan Lawrentschuk
- EJ Whitten Foundation Prostate Cancer Research Centre, Epworth HealthCare, Melbourne, Vic., Australia; and Department of Surgery, University of Melbourne, Melbourne, Vic., Australia; and Department of Surgery, Royal Melbourne Hospital, Melbourne, Vic., Australia
| | - Ilona Juraskova
- Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), School of Psychology, University of Sydney, Sydney, NSW, Australia
| | - Declan G Murphy
- Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Vic., Australia; and Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Vic., Australia
| | - Louisa G Gordon
- Health Economics, Population Health Department, QIMR Berghofer Medical Research Institute, 300 Herston Road, Herston, Brisbane, Qld 4006, Australia; and Faculty of Medicine, The University of Queensland, Qld, Australia; and School of Nursing and Cancer and Palliative Care Outcomes Centre, Queensland University of Technology, Qld, Australia
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Lambrakis K, Khan E, van den Merkhof A, Papendick C, Chuang A, Zhai Y, Eng-Frost J, Rocheleau S, Lehman SJ, Blyth A, Briffa T, Quinn S, French JK, Cullen L, Chew DP. Impacts of high sensitivity troponin T reporting on care and outcomes in clinical practice: Interactions between low troponin concentrations and participant sex within two randomized clinical trials. Int J Cardiol 2023; 393:131396. [PMID: 37769972 DOI: 10.1016/j.ijcard.2023.131396] [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: 12/07/2022] [Revised: 09/10/2023] [Accepted: 09/22/2023] [Indexed: 10/03/2023]
Abstract
BACKGROUND The impacts of high sensitivity cardiac troponin (hs-cTn) reporting on downstream interventions amongst suspected acute coronary syndrome (ACS) in the emergency department (ED), especially amongst those with newly identified hs-cTn elevations and in consideration of well-established sex-related disparities, has not been critically evaluated to date. This investigation explores the impact of hs-cTnT reporting on care and outcomes, particularly by participant sex. METHODS Two similarly ED-based randomized controlled trials conducted between July 2011 to March 2013 (n = 1988) and August 2015 to April 2019 (n = 3378) were comparatively evaluated. Clinical outcomes were adjudicated to the Fourth Universal Definition of MI. Changes in practice were assessed at 30 days, and death or MI were explored to 12 months. RESULTS The HS-Troponin study demonstrated no difference in death or MI with unmasking amongst those with hs-cTnT <30 ng/L, whereas the RAPID TnT study demonstrated a significantly higher rate. In RAPID TnT, there was significant increase in death or MI associated with unmasking for females with hs-cTnT <30 ng/L (masked: 11[1.5%], unmasked: 25[3.4%],HR: 2.27,95%C.I.:1.87-2.77,P < 0.001). Less cardiac stress testing with unmasking amongst those <30 ng/L was observed in males in both studies, which was significant in RAPID TnT (masked: 92[12.0%], unmasked: 55[7.0%], P = 0.008). In RAPID TnT, significantly higher rates of angiography in males were observed with unmasking, with no such changes amongst females <30 ng/L (masked: 28[3.7%], unmasked: 51[6.5%],P = 0.01). CONCLUSION Compared with males, there were no evident impacts on downstream practices for females with unmasking in RAPID TnT, likely representing missed opportunities to reduce late death or MI.
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Affiliation(s)
- Kristina Lambrakis
- College of Medicine & Public Health, Flinders University of South Australia, Adelaide, Australia; South Australian Department of Health, Adelaide, Australia.
| | - Ehsan Khan
- College of Medicine & Public Health, Flinders University of South Australia, Adelaide, Australia; South Australian Department of Health, Adelaide, Australia
| | - Anke van den Merkhof
- College of Medicine & Public Health, Flinders University of South Australia, Adelaide, Australia; Faculty of Medical Sciences, University of Groningen, the Netherlands
| | - Cynthia Papendick
- South Australian Department of Health, Adelaide, Australia; School of Medicine, University of Adelaide, Adelaide, Australia
| | - Anthony Chuang
- College of Medicine & Public Health, Flinders University of South Australia, Adelaide, Australia; South Australian Department of Health, Adelaide, Australia
| | - Yuze Zhai
- College of Medicine & Public Health, Flinders University of South Australia, Adelaide, Australia
| | | | | | - Sam J Lehman
- College of Medicine & Public Health, Flinders University of South Australia, Adelaide, Australia; South Australian Department of Health, Adelaide, Australia
| | - Andrew Blyth
- College of Medicine & Public Health, Flinders University of South Australia, Adelaide, Australia; South Australian Department of Health, Adelaide, Australia
| | - Tom Briffa
- School of Population and Global Health, University of Western Australia, Perth, Australia
| | - Stephen Quinn
- Department of Statistics, Data Science and Epidemiology, Swinburne University of Technology, Melbourne, Australia
| | - John K French
- Department of Cardiology, Liverpool Hospital, University of New South Wales, Sydney, Australia
| | - Louise Cullen
- Emergency and Trauma Centre, Royal Brisbane and Women's Hospital, Brisbane, Australia; School of Public Health, Queensland University of Technology, Brisbane, Australia; School of Medicine, University of Queensland, Brisbane, Australia
| | - Derek P Chew
- College of Medicine & Public Health, Flinders University of South Australia, Adelaide, Australia; South Australian Department of Health, Adelaide, Australia
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Sewell T, Fung Y, Al-Kufaishi A, Clifford K, Quinn S. Does virtual reality technology reduce pain and anxiety during outpatient hysteroscopy? A randomised controlled trial. BJOG 2023; 130:1466-1472. [PMID: 37218438 DOI: 10.1111/1471-0528.17550] [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] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 05/01/2023] [Accepted: 05/08/2023] [Indexed: 05/24/2023]
Abstract
OBJECTIVE To evaluate the effectiveness of virtual reality technology in reducing pain and anxiety during outpatient hysteroscopy. DESIGN A prospective randomised controlled trial. SETTING A London University Teaching Hospital. POPULATION Women aged 18-70 years undergoing outpatient hysteroscopy procedures. METHODS An unblinded randomised controlled trial was performed between March and October 2022 comparing standard outpatient hysteroscopy care with standard care with the addition of a virtual reality headset playing a virtual reality immersive scenario as a distraction technique. MAIN OUTCOME MEASURES Pain and anxiety numeric rating scores (NRS) from 0 to 11. RESULTS Eighty-three participants were randomly allocated to the control (n = 42) and virtual reality groups (n = 41). The virtual reality group experienced significantly less anxiety during the procedure than the control group (mean NRS 3.29 versus 4.73, mean difference 1.50; 95% confidence interval [CI] 0.12-2.88; P = 0.03). There was no difference in reported average pain (mean NRS 3.73. versus 4.24, mean difference 0.51; 95% CI -1.76 to 0.64; p = 0.41) or maximum pain scores (mean NRS 5.32 versus 5.07, mean difference 0.25; 95% CI -1.05 to 1.55; P = 0.71). CONCLUSIONS The use of virtual reality technology as an adjunct to standard care can reduce patient-reported anxiety but not pain during outpatient hysteroscopy procedures. Continued improvements in the technology and the development of increasingly immersive environments may continue to increase the potential to improve the patient experience in this setting.
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Affiliation(s)
- Thomas Sewell
- Department of Obstetrics and Gynaecology, St Mary's Hospital, London, UK
| | - Yinka Fung
- Department of Obstetrics and Gynaecology, St Mary's Hospital, London, UK
| | - Asmaa Al-Kufaishi
- Department of Obstetrics and Gynaecology, St Mary's Hospital, London, UK
| | - Katy Clifford
- Department of Obstetrics and Gynaecology, St Mary's Hospital, London, UK
| | - Stephen Quinn
- Department of Obstetrics and Gynaecology, St Mary's Hospital, London, UK
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Green A, Quinn S, Kavnagh K, Bradley L, Kenny J, Lynch SA. Genetic knowledge, experience and educational needs of paediatric trainees in Ireland. Ir Med J 2023; 116:856. [PMID: 37874331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 10/25/2023]
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Bhar S, Davison TE, Schofield P, Quinn S, Ratcliffe J, Waloszek JM, Dunkerley S, Silver M, Linossier J, Koder D, Collins R, Milte R. Study protocol for ELders AT Ease (ELATE): a cluster randomised controlled trial of cognitive behaviour therapy to reduce depressive symptoms in aged care residents. BMC Geriatr 2023; 23:555. [PMID: 37700236 PMCID: PMC10498637 DOI: 10.1186/s12877-023-04257-7] [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: 01/22/2023] [Accepted: 08/25/2023] [Indexed: 09/14/2023] Open
Abstract
BACKGROUND This protocol describes a study of the effectiveness of cognitive behaviour therapy (CBT) for reducing depressive symptoms in older adults living in residential aged care (RAC) facilities in Australia. Depressive symptoms are highly prevalent in this population, yet the benefits of CBT for reducing such symptoms in RAC facilities have not been widely investigated. Elders at Ease (ELATE) is a 16-session CBT intervention designed for implementation in RAC facilities. The intervention includes cognitive, behavioural and reminiscence strategies and is delivered by mental health trainees (MHTs) in collaboration with RAC facility staff and residents' family. METHODS AND ANALYSIS ELATE will be evaluated using a cluster randomised trial comparing outcomes for residents who participate in the intervention with those living in usual care control facilities. The participants are RAC residents aged 65 years or above, with depressive symptoms (Patient Health Questionnaire-2 ≥ 3) and normal cognition or mild cognitive impairment (Standardised Mini Mental Status Examination ≥ 21). They are assessed at four time points: baseline prior to randomisation (T1), mid-treatment (T2; 2.5 months post randomisation), post-treatment (T3; 5 months post-randomisation) and 3-month follow-up (T4; 8 months post randomisation). The primary outcome is change in depressive symptoms between T1 and T3. Secondary outcomes are depressive symptoms at T4, anxiety, suicide ideation, sleep problems, quality of life, staff and family knowledge of late-life depression, stress levels and efficacy in caring for residents, and MHT levels of geropsychology competencies. Residents receiving the intervention are hypothesised to report a greater decrease in depressive symptoms between T1 and T3 compared to residents receiving usual care. The primary analysis is a regression, clustered over site to account for correlated readings, and independent variables are condition and depressive symptoms at T1. A cost-utility analysis is also undertaken. DISCUSSION ELATE is a comprehensive CBT intervention for reducing depressive symptoms in RAC residents. It is designed to be implemented in collaboration with facility staff and residents' families, individually tailored to residents with normal cognition to mild cognitive impairment and delivered by trainee therapists. ELATE offers a model that may be widely applicable across the RAC sector. TRIAL REGISTRATION Trial registered with the Australian and New Zealand Clinical Trial Registry (ANZCTR) Number ACTRN12619001037190, prospectively registered on 22 July 2019.
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Affiliation(s)
- Sunil Bhar
- Department of Psychological Sciences, School of Health Sciences, Swinburne University of Technology, PO Box 218, H99, Hawthorn, VIC, 3122, Australia.
| | - Tanya E Davison
- Department of Psychological Sciences, School of Health Sciences, Swinburne University of Technology, PO Box 218, H99, Hawthorn, VIC, 3122, Australia
- Silverchain, Osborne Park, WA, Australia
| | - Penelope Schofield
- Department of Psychological Sciences, School of Health Sciences, Swinburne University of Technology, PO Box 218, H99, Hawthorn, VIC, 3122, Australia
- Iverson Health Innovation Research Institute, Swinburne University of Technology, Hawthorn, VIC, Australia
- Health Services Research and Implementation Sciences, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, VIC, Australia
| | - Stephen Quinn
- Department of Health Sciences and Biostatistics, School of Health Sciences, Swinburne University of Technology, Hawthorn, VIC, Australia
| | - Julie Ratcliffe
- Caring Futures Institute, Flinders University, Adelaide, SA, Australia
| | - Joanna M Waloszek
- Department of Psychological Sciences, School of Health Sciences, Swinburne University of Technology, PO Box 218, H99, Hawthorn, VIC, 3122, Australia
| | - Sofie Dunkerley
- Department of Psychological Sciences, School of Health Sciences, Swinburne University of Technology, PO Box 218, H99, Hawthorn, VIC, 3122, Australia
| | - Mark Silver
- Department of Psychological Sciences, School of Health Sciences, Swinburne University of Technology, PO Box 218, H99, Hawthorn, VIC, 3122, Australia
| | - Jennifer Linossier
- Department of Psychological Sciences, School of Health Sciences, Swinburne University of Technology, PO Box 218, H99, Hawthorn, VIC, 3122, Australia
| | - Deborah Koder
- Department of Psychological Sciences, School of Health Sciences, Swinburne University of Technology, PO Box 218, H99, Hawthorn, VIC, 3122, Australia
| | - Rebecca Collins
- Department of Psychological Sciences, School of Health Sciences, Swinburne University of Technology, PO Box 218, H99, Hawthorn, VIC, 3122, Australia
| | - Rachel Milte
- Caring Futures Institute, Flinders University, Adelaide, SA, Australia
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Roberts G, Krinsley JS, Preiser JC, Quinn S, Rule PR, Brownlee M, Umpierrez GE, Hirsch IB. Malglycemia in the critical care setting. Part I: Defining hyperglycemia in the critical care setting using the glycemic ratio. J Crit Care 2023; 77:154327. [PMID: 37178493 DOI: 10.1016/j.jcrc.2023.154327] [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: 01/22/2023] [Revised: 04/29/2023] [Accepted: 05/05/2023] [Indexed: 05/15/2023]
Abstract
INTRODUCTION Stress-induced hyperglycemia (SIH) is conventionally represented by Blood Glucose (BG) although recent evidence indicates the Glycemic Ratio (GR, quotient of mean BG and estimated preadmission BG) is a superior prognostic marker. We assessed the association between in-hospital mortality and SIH, using BG and GR in an adult medical-surgical ICU. METHODS We included patients with hemoglobin A1c (HbA1c) and minimum four BGs in a retrospective cohort investigation (n = 4790). RESULTS A critical SIH threshold of GR 1.1 was identified. Mortality increased with increasing exposure to GR ≥ 1.1 (r2 = 0.94, p = 0.0007). Duration of exposure to BG ≥ 180 mg/dL demonstrated a less robust association with mortality (r2 = 0.75, p = 0.059). In risk-adjusted analyses, hours GR ≥ 1.1 (OR 1.0014, 95%CI (1.0003-1.0026), p = 0.0161) and hours BG ≥ 180 mg/dL (OR 1.0080, 95%CI (1.0034-1.0126), p = 0.0006) were associated with mortality. In the cohort with no exposure to hypoglycemia however, only hours GR ≥ 1.1 was associated with mortality (OR 1.0027, 95%CI (1.0012-1.0043), p = 0.0007), not BG ≥ 180 mg/dL (OR 1.0031, 95%CI (0.9949-1.0114), p = 0.50) and this relationship remained intact for those who never experienced BG outside the 70-180 mg/dL range (n = 2494). CONCLUSIONS Clinically significant SIH commenced above GR 1.1. Mortality was associated with hours of exposure to GR ≥ 1.1 which was a superior marker of SIH compared to BG.
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Affiliation(s)
- Greg Roberts
- SA Pharmacy, Flinders Medical Centre, Bedford Park, SA 5042, Australia; College of Medicine and Public Health, Flinders University, Bedford Park, SA 5042, Australia.
| | - James S Krinsley
- Division of Critical Care, Department of Medicine, Stamford Hospital, and the Columbia Vagelos College of Physicians and Surgeons, Stamford, CT, United States of America
| | | | - Stephen Quinn
- Department of Health Science and Biostatistics, Swinburne University of Technology, Hawthorn, Victoria, Australia.
| | - Peter R Rule
- PRI, Los Altos Hills, CA, United States of America
| | - Michael Brownlee
- Diabetes Research Emeritus, Biomedical Sciences Emeritus, Einstein Diabetes Research Center, Department of Medicine and Pathology Emeritus, Albert Einstein College of Medicine, Bronx, NY, United States of America.
| | - Guillermo E Umpierrez
- Division of Metabolism, Endocrinology and Nutrition, University of Washington Medicine Diabetes Institute, Seattle, WA, United States of America.
| | - Irl B Hirsch
- Department of Medicine, Division of Endocrinology, Emory University School of Medicine, Atlanta, GA, United States of America.
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10
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Kimmage E, Carney C, Conaty S, Cronin A, Digan E, Kennelly SP, McDonagh A, McWilliams O, Nolan E, O'Dwyer A, O'Rourke L, Pierpoint R, Quinn S, Sheridan L, Smith A, Tobin F. 271 DEVELOPMENT OF AN INNOVATIVE INTER-DISCIPLINARY PARKINSON’S CLINIC IN AN AMBULATORY CARE SETTING. Age Ageing 2022. [DOI: 10.1093/ageing/afac218.239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Ambulatory services provide specialist outpatient care, reducing costs associated with inpatient admissions and enabling the person to remain at home for longer (Report of the National Acute Medicine Programme, 2010). An Older Person’s Ambulatory Care Hub was established in a large teaching hospital. Prior service evaluation demonstrated that approximately one third of patients attending had a diagnosis of Parkinson’s Disease (PD). People with PD should have a collaborative approach between patient, family and healthcare providers to optimally manage their condition (NICE, 2017), therefore, the need was identified to evolve the traditional medical model to an interdisciplinary approach. The aim of this project was to complete a service evaluation and breakdown of Interdisciplinary Team (IDT) referrals.
Methods
An IDT working group including Clinical Nutrition (CN), Medical, Nursing, Occupational Therapy (OT), Physiotherapy (PT), and Speech and Language Therapy (SLT) was established. A comprehensive assessment form was developed and outcome measures were chosen. A short pilot was conducted and necessary amendments were made. A weekly clinic was established which included an IDT assessment, followed by a huddle with the medical team where referrals were generated. Data pertaining to the number of attendees and referrals generated were collected over a 3-month period.
Results
Over the data collection period, 31 patients attended the clinic. Referrals were as follows; Medical: 19, PT: 13, SLT: 10, OT: 7, CN: 6, Medical Social Work: 2. Patients requiring urgent medical review were seen immediately after the IDT huddle.
Conclusion
This project demonstrates a service evaluation of a novel IDT PD Clinic. This clinic highlights the need for an IDT approach to management of people with PD. Future service developments include obtaining patient feedback, pre-clinic calls to patients by a Healthcare Assistant to explain the purpose of the clinic, and adapting the clinic as appropriate.
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Affiliation(s)
- E Kimmage
- Tallaght University Hospital , Dublin, Ireland
| | - C Carney
- Tallaght University Hospital , Dublin, Ireland
| | - S Conaty
- Tallaght University Hospital , Dublin, Ireland
| | - A Cronin
- Tallaght University Hospital , Dublin, Ireland
| | - E Digan
- Tallaght University Hospital , Dublin, Ireland
| | - SP Kennelly
- Tallaght University Hospital , Dublin, Ireland
- Trinity College Dublin , Dublin, Ireland
| | - A McDonagh
- Tallaght University Hospital , Dublin, Ireland
| | | | - E Nolan
- Tallaght University Hospital , Dublin, Ireland
| | - A O'Dwyer
- Tallaght University Hospital , Dublin, Ireland
| | - L O'Rourke
- Tallaght University Hospital , Dublin, Ireland
| | - R Pierpoint
- Tallaght University Hospital , Dublin, Ireland
| | - S Quinn
- Tallaght University Hospital , Dublin, Ireland
| | - L Sheridan
- Tallaght University Hospital , Dublin, Ireland
| | - A Smith
- Tallaght University Hospital , Dublin, Ireland
| | - F Tobin
- Tallaght University Hospital , Dublin, Ireland
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11
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Frazer K, Bhardwaj N, Fox P, Niranjan V, Quinn S, Kelleher C, Fitzpatrick P. Rapid systematic review of smoking cessation interventions for people who smoke and have cancer. Eur J Public Health 2022. [DOI: 10.1093/eurpub/ckac129.556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Higher rates of cancer are reported in smokers compared to non-smokers, and continued smoking following a cancer diagnosis is associated with reduced health outcomes and survival. Despite international evidence of increased risks, a substantial percentage of people with a cancer diagnosis continue to smoke. Patients may be unaware of the additional risks associated with continued smoking, and health care professionals may not engage with quit supports. As part of a larger feasibility study to develop a smoking cessation pathway in cancer services in Ireland, a rapid review of the evidence was completed.
Methods
Systematic searches of PubMed, Embase, and CINAHL 2015 to December 2020 were conducted; with studies restricted to adults with a cancer diagnosis [lung, breast, cervical, head and neck] and published in English. No restriction was placed on study designs. 6404 studies were identified and uploaded into COVIDENCE platform, Cochrane's systematic review methods were adopted throughout, PRISMA reporting guidelines were used, and narrative data synthesis was completed (CRD 42020214204).
Results
The twenty-three-studies report evidence from USA, Canada, England, Lebanon, and Australia. The setting for all interventions was hospitals and cancer clinics. Evidence identifies high dropout rates, inconsistencies in approaches and duration of smoking cessation interventions with varied outcomes. A wide-ranging number of critical components emerged associated with optimal quit support- including the timing of and frequency of quit conversations, use of electronic records, in-person support meetings, provision of nicotine replacement therapy and extended use of Varenicline, smoking cessation services embedded in oncology depts, and engaging with families wanting to quit at the same time.
Conclusions
Developing tailored smoking cessation interventions are needed for smokers diagnosed with cancer to enable engagement.
Key messages
• Continued smoking following a cancer diagnosis is associated with reduced health outcomes.
• Smoking cessation programmes for cancer patient should be tailored to meet needs.
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Affiliation(s)
- K Frazer
- Nursing, Midwifery and Health Systems, University College Dublin , Dublin, Ireland
| | - N Bhardwaj
- Public Health, Physiotherapy, Sports Science, University College Dublin , Dublin, Ireland
| | - P Fox
- Nursing, Midwifery and Health Systems, University College Dublin , Dublin, Ireland
| | - V Niranjan
- Public Health, Physiotherapy, Sports Science, University College Dublin , Dublin, Ireland
| | - S Quinn
- Public Health, Physiotherapy, Sports Science, University College Dublin , Dublin, Ireland
| | - C Kelleher
- Public Health, Physiotherapy, Sports Science, University College Dublin , Dublin, Ireland
- Department Preventive Medicine and Health Promotion, St Vincent's University Hospital , Dublin, Ireland
| | - P Fitzpatrick
- Public Health, Physiotherapy, Sports Science, University College Dublin , Dublin, Ireland
- Department Preventive Medicine and Health Promotion, St Vincent's University Hospital , Dublin, Ireland
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12
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Dawson LP, Quinn S, Tong D, Boyle A, Hamilton-Craig C, Adams H, Layland J. Colchicine and quality of life in patients with acute coronary syndromes: Results from the COPS randomized trial. Cardiovasc Revasc Med 2022; 44:53-59. [PMID: 35739010 DOI: 10.1016/j.carrev.2022.06.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 04/26/2022] [Revised: 06/14/2022] [Accepted: 06/15/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Recent data suggest that colchicine may reduce cardiovascular events among patients presenting with acute coronary syndromes. This sub-study of the Australian COPS trial aimed to assess whether colchicine affects health status outcomes. METHODS Health status was assessed at baseline and 12-months using the EuroQol-5 Dimension 5-level (EQ-5D-5L) score and the full 19-question Seattle Angina Questionnaire (SAQ). Data were available for 786 patients (388 randomized to colchicine, 398 to placebo). RESULTS Baseline characteristics were well matched between groups; mean age was 60.1 (SD 14.8) years, and 20 % were female. Baseline health status scores were impaired, and most parameters demonstrated significant improvement from baseline to 12-months (EQ-5D-5L Visual Analogue Score [VAS] 69.3 to 77.7; SAQ angina frequency score 83.0 to 95.3, both p < 0.001). No significant differences in adjusted mean score change among any of the EQ-5D-5L or SAQ dimensions were observed between treatment groups in either intention-to-treat or per-protocol analysis. There were borderline interactions in EQ-5D-5L scores for those with previous MI vs not, and in SAQ scores for those with obesity vs not. In categorical analysis using observed data, patients treated with colchicine were more likely to have clinically significant improvement in physical limitation score over the period (36 % improved vs. 28 %, p < 0.05). Baseline health status scores were not associated with the primary endpoint at 12 months. CONCLUSIONS Treatment with colchicine did not appear to affect change in measures of health status following acute coronary syndromes, but it did lead to a greater likelihood of improvement in physical limitation scores. TRIAL REGISTRATION ACTRN, ACTRN12615000861550. Registered 18/08/2015, https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=368973.
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Affiliation(s)
- Luke P Dawson
- Department of Cardiology, Peninsula Health, Melbourne, Victoria, Australia; Department of Medicine, Monash University, Melbourne, Victoria, Australia; Department of Cardiology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Stephen Quinn
- Swinburne University of Technology, Department of Health Science and Biostatistics, Hawthorn, Victoria, Australia
| | - David Tong
- Department of Cardiology, Peninsula Health, Melbourne, Victoria, Australia; St Vincent's Hospital, Melbourne, Victoria, Australia
| | - Andrew Boyle
- School of Medicine and Public Health, University of Newcastle, New South Wales, Australia
| | - Christian Hamilton-Craig
- The Prince Charles Hospital, Brisbane, Queensland, Australia; School of Medicine, Griffith University, Australia
| | - Heath Adams
- Royal Hobart Hospital, Hobart, Tasmania, Australia
| | - Jamie Layland
- Department of Cardiology, Peninsula Health, Melbourne, Victoria, Australia; Department of Medicine, Monash University, Melbourne, Victoria, Australia.
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13
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Gladman DD, Mease PJ, Bird P, Soriano E, Chakravarty SD, Shawi M, Xu S, Quinn S, Gong C, Leibowitz E, Tam LS, Helliwell P, Kavanaugh A, Deodhar A, Østergaard M, Baraliakos X. AB0894 Efficacy and Safety of Guselkumab in Biologic-Naïve Patients With Active Axial Psoriatic Arthritis: Study Design of a Phase 4, Randomized, Double-Blind, Placebo-Controlled Trial. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.1551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundEstablished criteria for classifying axial psoriatic arthritis (PsA) are lacking, and assessments of disease activity often rely on measures developed for ankylosing spondylitis (AS). There is an unmet need to systematically identify and measure efficacy of treatments for axial PsA patients (pts). Guselkumab (GUS), a selective interleukin (IL)-23p19 inhibitor, was efficacious in improving signs and symptoms of active PsA in 2 phase 3, randomized, placebo (PBO)-controlled studies: DISCOVER-1 and DISCOVER-2. In a post-hoc pooled analysis of DISCOVER-1&2 pts with investigator-confirmed sacroiliitis, GUS-treated pts had greater improvements in axial symptoms compared with PBO.1 Imaging in DISCOVER-1&2 was restricted to the sacroiliac (SI) joints, occurring prior to/at screening as confirmed by the investigator, and locally read.ObjectivesTo design a new, dedicated study to evaluate the effects of GUS on axial PsA prospectively.MethodsCumulative evidence from DISCOVER-1&2, including exposure–response relationship, covariate adjustment for modest baseline imbalances across treatment groups, subgroup analyses, and comparisons within and across these studies, was considered in designing a new trial. Data from the pivotal registrational studies suggest similar efficacy with GUS every-4-weeks (Q4W) and Q8W regimens in treating PsA signs and symptoms, including symptoms of axial involvement. Power calculations were based on mean changes in Bath AS Disease Activity Index (BASDAI) scores in DISCOVER-1&2.ResultsThe phase 4, randomized, PBO-controlled STAR study is specifically designed to prospectively assess efficacy outcomes in PsA pts with magnetic resonance imaging (MRI)-confirmed axial inflammation. Based on observed mean (SD) changes from baseline in BASDAI score from DISCOVER-1&2 (Table 1), 405 pts, randomized (1:1:1) to GUS Q4W, GUS at W0, W4, then Q8W, or PBO →GUS Q8W at W24, are planned for enrollment (Figure 1). STAR eligibility criteria include PsA ≥6 months and active disease (≥3 swollen & ≥3 tender joints, C-reactive protein [CRP] ≥0.3 mg/dL) despite prior non-biologic disease-modifying antirheumatic drugs, apremilast, and/or non-steroidal anti-inflammatory drugs. Pts will be naïve to biologics and Janus kinase inhibitors and have BASDAI ≥4, spinal pain score (visual analog scale [VAS]) ≥4, and screening MRI-confirmed axial disease (positive spine and/or SI joints defined as centrally read Spondyloarthritis Research Consortium of Canada [SPARCC] score ≥3). Follow-up MRIs of spine and SI joints will be obtained at W0, W24, and W52 and also centrally read, with readers blinded to treatment group and timepoint. Spinal/SI joint inflammation will be scored using the SPARCC method, with the former also assessed using the CAN-DEN method. The primary endpoint is mean change in BASDAI at W24; controlled (hierarchical) secondary endpoints, all at W24, include AS Disease Activity Score (ASDAS-CRP), Disease Activity Index for PsA (DAPSA), ≥40% improvement in Assessment in AS criteria (ASAS40), and mean changes in spine/SI joint SPARCC scores.Table 1.Power calculations for the primary endpoint in the Phase 4 STAR study.Historical trial data*Observed mean (SD) change in BASDAI from W0-24Effect sizePower(N=135; α=0.05)**PBO-1.28 (2.24)GUS 100 mg Q4W-2.51 (2.00)1.23>99%GUS 100 mg Q8W-2.61 (2.47)1.33>99%* From the pooled DISCOVER-1&2 trials**Power calculations based on N=135 per study group (1:1:1 randomization) and 2-sided significance of 0.05 using a 2-sample T-test assuming equal variancesBASDAI, Bath Ankylosing Spondylitis Disease Activity Index; GUS, guselkumab; PBO, placebo; Q4W, every 4 weeks; Q8W, every 8 weeks; SD, standard deviation; W, weekConclusionThe phase 4 STAR study will allow for an in-depth, prospective evaluation of the effects of selectively inhibiting the IL-23p19 subunit with GUS in pts with MRI-confirmed axial PsA.References[1]Mease, et al. Lancet Rheum. 2021;3(10):e715-e723.Disclosure of InterestsDafna D Gladman Consultant of: AbbVie, Amgen, BMS, Celgene, Eli Lilly, Galapagos, Gilead, Janssen, Novartis, Pfizer, and UCB, Grant/research support from: Abbvie, Amgen, BMS, Celgene, Eli Lilly, Janssen, Novartis, Pfizer and UCB, Philip J Mease Speakers bureau: AbbVie, Aclaris, Amgen, BMS, Celgene, Eli Lilly, Galapagos, Gilead, GlaxoSmithKline, Inmagene, Janssen, Novartis, Pfizer, SUN Pharma, and UCB, Consultant of: AbbVie, Aclaris, Amgen, BMS, Celgene, Eli Lilly, Galapagos, Gilead, GlaxoSmithKline, Inmagene, Janssen, Novartis, Pfizer, SUN Pharma, and UCB, Grant/research support from: AbbVie, Aclaris, Amgen, BMS, Celgene, Eli Lilly, Galapagos, Gilead, GlaxoSmithKline, Inmagene, Janssen, Novartis, Pfizer, SUN Pharma, and UCB, Paul Bird Speakers bureau: AbbVie, Eli Lilly, Gilead, Janssen, MSD, Pfizer, and UCB, Consultant of: Eli Lilly, Gilead, Janssen, Novartis, and Pfizer, Enrique Soriano Speakers bureau: AbbVie, Amgen, Bristol Myers Squibb, Eli Lilly, Janssen, Novartis, Pfizer, Roche, and UCB, Consultant of: AbbVie, Janssen, Novartis, and Roche, Grant/research support from: AbbVie, Janssen, Novartis, Pfizer, Roche, and UCB, Soumya D Chakravarty Shareholder of: Johnson & Johnson, Employee of: Janssen Scientific Affairs, LLC, May Shawi Shareholder of: Johnson & Johnson, Employee of: Janssen Global Services, LLC, Stephen Xu Shareholder of: Johnson & Johnson, Employee of: Janssen Research & Development, LLC, Sean Quinn Shareholder of: Johnson & Johnson, Employee of: Janssen Scientific Affairs, LLC, Cinty Gong Shareholder of: Johnson & Johnson, Employee of: Janssen Scientific Affairs, LLC, Evan Leibowitz Shareholder of: Johnson & Johnson, Employee of: Janssen Scientific Affairs, LLC, Lai-Shan Tam Consultant of: Janssen, Pfizer, Sanofi, AbbVie, Boehringer Ingelheim, and Lilly, Grant/research support from: Amgen, Boehringer Ingelheim, Janssen, GSK, Novartis, and Pfizer, Philip Helliwell Speakers bureau: AbbVie, Janssen, and Novartis, Consultant of: Galapagos and Janssen, Grant/research support from: AbbVie, Janssen, and Pfizer, Arthur Kavanaugh Consultant of: Abbvie, Amgen, Bristol Myers Squibb, Eli Lilly, Gilead, Janssen, Novartis, Pfizer, and UCB, Atul Deodhar Speakers bureau: AbbVie, Eli Lilly, Janssen, Novartis, Pfizer, and UCB, Consultant of: AbbVie, Amgen, Boehringer Ingelheim, Bristol Myers Squibb, Celgene, Eli Lilly, Galapagos, Glaxo Smith & Kline, Janssen, Novartis, Pfizer, and UCB, Grant/research support from: AbbVie, Eli Lilly, Glaxo Smith & Kline, Novartis, Pfizer, and UCB, Mikkel Østergaard Speakers bureau: AbbVie, Boehringer-Ingelheim, Bristol Myers Squibb, Celgene, Eli-Lilly, Hospira, Janssen, Merck, Novartis, Novo, Orion, Pfizer, Regeneron, Roche, Sandoz, Sanofi, and UCB, Consultant of: AbbVie, Boehringer-Ingelheim, Bristol Myers Squibb, Celgene, Eli-Lilly, Hospira, Janssen, Merck, Novartis, Novo, Orion, Pfizer, Regeneron, Roche, Sandoz, Sanofi, and UCB, Grant/research support from: AbbVie, Bristol Myers Squibb, Celgene, and Novartis, Xenofon Baraliakos Speakers bureau: AbbVie, Biocad, Chugai, Eli Lilly, Janssen, MSD, Novartis, Pfizer, Roche, and UCB, Consultant of: AbbVie, Biocad, Chugai, Eli Lilly, Janssen, MSD, Novartis, Pfizer, Roche, and UCB, Grant/research support from: AbbVie, Biocad, Chugai, Eli Lilly, Janssen, MSD, Novartis, Pfizer, Roche, and UCB
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14
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Chuang MYA, Gnanamanickam ES, Karnon J, Lambrakis K, Horsfall M, Blyth A, Seshadri A, Nguyen MT, Briffa T, Cullen LA, Quinn S, French JK, Chew DP. Cost effectiveness of a 1-hour high-sensitivity troponin-T protocol: An analysis of the RAPID-TnT trial. Int J Cardiol Heart Vasc 2022; 38:100933. [PMID: 35024428 PMCID: PMC8728427 DOI: 10.1016/j.ijcha.2021.100933] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Accepted: 12/17/2021] [Indexed: 11/12/2022]
Abstract
This is the first randomised evaluation of the cost-effectiveness of a 0/1-hour high-sensitivity troponin protocol and has implications on clinical practice on a health system level. The results demonstrate that the 0/1-hour hs-cTnT protocol is safe and does not incur excess resource compared to the conventional 0/3-hour protocol. Whilst this cost-effectiveness analysis demonstrates superior ED efficiency and equivalent safety and resource associated with the 0/1-hour hs-cTnT protocol, further refinements in subsequent management is necessary to facilitate large-scale adaptation.
Background To understand the economic impact of an accelerated 0/1-hour high-sensitivity troponin-T (hs-cTnT) protocol. Objective To conduct a patient-level economic analysis of the RAPID-TnT randomised trial in patients presenting with suspected acute coronary syndrome (ACS). Methods An economic evaluation was conducted with 3265 patients randomised to either the 0/1-hour hs-cTnT protocol (n = 1634) or the conventional 0/3-hour standard-of-care protocol (n = 1631) with costs reported in Australian dollars. The primary clinical outcome was all-cause mortality or new/recurrent myocardial infarction. Results Over 12-months, mean per patient costs were numerically higher in the 0/1-hour arm compared to the conventional 0/3-hour arm (by $472.49/patient, 95% confidence interval [95 %CI]: $-1,380.15 to $2,325.13, P = 0.617) with no statistically significant difference in primary outcome (0/1-hour: 62/1634 [3.8%], 0/3-hour: 82/1631 [5.0%], HR: 1.32 [95 %CI: 0.95–1.83], P = 0.100). The mean emergency department (ED) length of stay (LOS) was significantly lower in the 0/1-hour arm (by 0.62 h/patient, 95 %CI: 0.85 to 0.39, P < 0.001), but the subsequent 12-month unplanned inpatient costs was numerically higher (by $891.22/patient, 95 %CI: $-96.07 to 1,878.50, P = 0.077). Restricting the analysis to patients with hs-cTnT concentrations ≤ 29 ng/L, mean per patient cost remained numerically higher in the 0/1-hour arm (by $152.44/patient, 95 %CI:$-1,793.11 to $2,097.99, P = 0.988), whilst the reduction in ED LOS was more pronounced (by 0.70 h/patient, 95 %CI: 0.45–0.95, P < 0.001). Conclusions There were no differences in resource utilization between the 0/1-hour hs-cTnT protocol versus the conventional 0/3-hour protocol for the assessment of suspected ACS, despite improved initial ED efficiency. Further refinements in strategies to improve clinical outcomes and subsequent management efficiency are needed.
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Affiliation(s)
- Ming-Yu Anthony Chuang
- College of Medicine & Public Health, Flinders University of South Australia, Adelaide, Australia.,South Australian Department of Health, Adelaide, Australia
| | - Emmanuel S Gnanamanickam
- College of Medicine & Public Health, Flinders University of South Australia, Adelaide, Australia.,South Australian Department of Health, Adelaide, Australia
| | - Jonathan Karnon
- College of Medicine & Public Health, Flinders University of South Australia, Adelaide, Australia
| | - Kristina Lambrakis
- College of Medicine & Public Health, Flinders University of South Australia, Adelaide, Australia.,South Australian Department of Health, Adelaide, Australia
| | | | - Andrew Blyth
- College of Medicine & Public Health, Flinders University of South Australia, Adelaide, Australia.,South Australian Department of Health, Adelaide, Australia
| | - Anil Seshadri
- College of Medicine & Public Health, Flinders University of South Australia, Adelaide, Australia.,South Australian Department of Health, Adelaide, Australia
| | - Mau T Nguyen
- College of Medicine & Public Health, Flinders University of South Australia, Adelaide, Australia.,South Australian Department of Health, Adelaide, Australia
| | - Tom Briffa
- School of Population and Global Health, University of Western Australia, Perth, Australia
| | - Louise A Cullen
- School of Medicine, University of Adelaide, Adelaide, Australia.,Department of Emergency Medicine, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Stephen Quinn
- Department of Health Science and Biostatistics, Swinburne University of Technology, Melbourne, Australia
| | - John K French
- Department of Cardiology, Liverpool Hospital, University of New South Wales, Sydney, Australia
| | - Derek P Chew
- College of Medicine & Public Health, Flinders University of South Australia, Adelaide, Australia.,South Australian Department of Health, Adelaide, Australia
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15
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Khan E, Lambrakis K, Briffa T, Cullen L, Karnon J, Papendick C, Quinn S, Tideman P, Van Den Hengel A, Verjans J, Chew D. Re-Engineering the Clinical Approach to Suspected Cardiac Chest Pain Assessment in the Emergency Department by Expediting Research Evidence to Practice Using Artificial Intelligence (RAPIDx AI) – A Cluster Randomised Clinical Trial Design. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.373] [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: 10/16/2022]
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16
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Roberts G, Sires J, Chen A, Thynne T, Sullivan C, Quinn S, Chen WS, Meyer E. A comparison of the stress hyperglycemia ratio, glycemic gap, and glucose to assess the impact of stress-induced hyperglycemia on ischemic stroke outcome. J Diabetes 2021; 13:1034-1042. [PMID: 34536055 DOI: 10.1111/1753-0407.13223] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [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: 05/16/2021] [Revised: 08/12/2021] [Accepted: 09/01/2021] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND The aim of this study is to compare metrics specific for stress-induced hyperglycemia (SIH) with glucose for predicting ischemic stroke outcome. METHODS This observational retrospective study (n = 300) included patients acutely hospitalized for ischemic stroke over a 3.8-year period. We assessed the association between acute ischemic stroke outcome with the stress hyperglycemia ratio (SHR, relative increase in glycemia) and glycemic gap (GG, absolute increase in glycemia) using admission values and 5-day maximum values, along with incidence of poor outcome above recognized clinical thresholds of glucose 10 mmol/L, SHR 1.14, and GG 2.5 mmol/L. RESULTS At admission, only SHR was associated with outcome after adjustment for clinical covariates (odds ratio [OR] = 2.88; 95% CI: 1.05-7.91; P = .041), while glucose or GG were not. Admission SHR ≥ 1.14 was also an indicator of poor outcome (39.1% vs 23.4%, P = .016), but not glucose ≥10 mmol/L or GG ≥ 2.5 mmol/L. All 5-day maximum glucose metrics were associated with outcome, as was any SHR ≥ 1.14 (40.9% vs 20.1%, P < .001) or GG ≥ 2.5 mmol/L (42.9% vs 23.4%, P = .011), but not glucose ≥10 mmol/L. Increased comorbidity was strongly associated with worse outcome (P < .001) in all models. CONCLUSIONS SHR provided the best prognostic insight at admission to assess the relationship between SIH and ischemic stroke outcome. Absolute glucose levels failed to account for natural interpatient variation in background glycemia and provided little prognostic insight. To assess the impact of SIH, future interventional studies need to be designed using designated markers of SIH such as SHR in preference to absolute glucose.
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Affiliation(s)
- Gregory Roberts
- SA Pharmacy, Flinders Medical Centre, Bedford Park, South Australia, Australia
- College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
| | - James Sires
- College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
| | - Angela Chen
- Diabetes and Endocrine Services, Flinders Medical Centre, Flinders Drive, Bedford Park, South Australia, Australia
| | - Tilenka Thynne
- College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
- Department of Clinical Pharmacology, Flinders Medical Centre, Bedford Park, South Australia, Australia
| | - Cheyne Sullivan
- SA Pharmacy, Flinders Medical Centre, Bedford Park, South Australia, Australia
| | - Stephen Quinn
- Department of Health Science and Biostatistics, Swinburne University of Technology, Hawthorn, Victoria, Australia
| | - Won Sun Chen
- Department of Health Science and Biostatistics, Swinburne University of Technology, Hawthorn, Victoria, Australia
| | - Emily Meyer
- Diabetes and Endocrine Services, Flinders Medical Centre, Flinders Drive, Bedford Park, South Australia, Australia
- Endocrine and Metabolic Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia
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Christoffel L, Bends R, Toub D, Schiermeier S, Pschadka G, Engelhardt M, Quinn S, Hartmann M, Habiba M, Felberbaum R, Brössner A, Schippert C, Römer T. Pregnancy Outcomes After Transcervical Radiofrequency Ablation of Uterine Fibroids with the Sonata System. J Gynecol Surg 2021; 38:207-213. [PMID: 35785107 PMCID: PMC9245720 DOI: 10.1089/gyn.2021.0136] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Objective: To describe pregnancy outcomes in women who conceived after undergoing transcervical fibroid ablation (TFA) as treatment for symptomatic uterine fibroids. Materials and Methods: TFA was used to treat symptomatic uterine fibroids with radiofrequency energy, both under clinical trial protocol and commercial usage in hospitals in Europe, the United Kingdom, Mexico, and the United States. All women who reported pregnancies to their physicians after undergoing TFA with the Sonata® System and provided consent for use of their data were included. Results: There have been 36 pregnancies representing 20 deliveries among 28 women who were treated with TFA. Five women conceived more than once postablation, and four conceived as a result of assisted reproductive technology (ART). Outcomes include 8 vaginal deliveries, 12 Cesarean sections, 3 therapeutic abortions, and 8 first trimester spontaneous abortions (four occurring in a patient with a history of recurrent pregnancy loss and an immunologic disorder). Five women are currently pregnant, two of whom previously delivered after TFA. There were no 5-minute Apgar scores <7, and all neonates weighed >2500 g. All deliveries occurred at ≥37 weeks except for one delivery at 35 6/7 weeks. There were no uterine ruptures or abnormal placentation and no reports of postpartum hemorrhage or stillbirths. Ablated fibroids included transmural, submucous, and intramural myomata up to 7 cm in diameter. Conclusions: Normal pregnancy outcomes at term have occurred after TFA with the Sonata System, including in women with recurrent abortion and in those undergoing ART. There were no instances of low Apgar scores, low birthweight, stillbirth, postpartum hemorrhage, or uterine rupture (FAST-EU, NCT01226290; SONATA, NCT02228174; SAGE, NCT03 118037). (J GYNECOL SURG 38:207)
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Affiliation(s)
- Ladina Christoffel
- Chefärztin Gynäkologie/Geburtshilfe, Spital Oberengadin, Samedan, Switzerland
| | - Ralf Bends
- Evangelisches Klinikum Köln-Weyertal, Köln, Germany
| | - David Toub
- Gynesonics, Redwood City, California, USA
| | - Sven Schiermeier
- Zentrum für Frauenheilkunde und Geburtshilfe, Marien Hospital, Witten, Germany
| | | | | | - Stephen Quinn
- Department of Gynaecology, St Mary's Hospital, Imperial College Healthcare Trust, London, United Kingdom
| | | | - Marwan Habiba
- Obstetrics and Gynaecology, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
| | | | | | | | - Thomas Römer
- Evangelisches Klinikum Köln-Weyertal, Köln, Germany
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18
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Tong DC, Bloom JE, Quinn S, Nasis A, Hiew C, Roberts-Thomson P, Adams H, Sriamareswaran R, Htun NM, Wilson W, Stub D, van Gaal W, Howes L, Yeap A, Yip B, Wu S, Perera P, Collins N, Yong A, Bhindi R, Whitbourn R, Lee A, Premaratne M, Asrress K, Freeman M, Amerena J, Layland J. Colchicine in Patients With Acute Coronary Syndrome: Two-Year Follow-Up of the Australian COPS Randomized Clinical Trial. Circulation 2021; 144:1584-1586. [PMID: 34748393 DOI: 10.1161/circulationaha.121.054610] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- David C Tong
- St. Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia (D.C.T., R.W., J.L.)
- Cardiology, Department of Medicine, Peninsula Health, Frankston, Victoria, Australia (D.C.T., J.E.B., R.S., N.M.H., A. Yeap, B.Y., S.W., P.P., M.P., J.L.)
| | - Jason E Bloom
- Cardiology, Department of Medicine, Peninsula Health, Frankston, Victoria, Australia (D.C.T., J.E.B., R.S., N.M.H., A. Yeap, B.Y., S.W., P.P., M.P., J.L.)
- Department of Cardiology, Alfred Hospital, Melbourne, Victoria, Australia (J.E.B., D.S.)
- The Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia (J.E.B.)
| | - Stephen Quinn
- Swinburne University of Technology, Department of Health Science and Biostatistics, Hawthorn, Victoria, Australia (S.Q.)
| | - Arthur Nasis
- MonashHeart, Monash Health, Clayton, Victoria, Australia (A.N.)
| | - Chin Hiew
- Barwon Health - University Hospital Geelong, Victoria, Australia (C.H., J.A.)
| | | | - Heath Adams
- Royal Hobart Hospital, Hobart, Tasmania, Australia (P.R.-T., H.A.)
| | - Rumes Sriamareswaran
- Cardiology, Department of Medicine, Peninsula Health, Frankston, Victoria, Australia (D.C.T., J.E.B., R.S., N.M.H., A. Yeap, B.Y., S.W., P.P., M.P., J.L.)
| | - Nay M Htun
- Cardiology, Department of Medicine, Peninsula Health, Frankston, Victoria, Australia (D.C.T., J.E.B., R.S., N.M.H., A. Yeap, B.Y., S.W., P.P., M.P., J.L.)
| | - William Wilson
- Royal Melbourne Hospital, Parkville, Victoria, Australia (W.W.)
| | - Dion Stub
- Department of Cardiology, Alfred Hospital, Melbourne, Victoria, Australia (J.E.B., D.S.)
- Western Health, St Albans, Victoria, Australia (D.S.)
| | | | - Laurie Howes
- Gold Coast University Hospital, Southport, Queensland, Australia (L.H.)
| | - Allysha Yeap
- Cardiology, Department of Medicine, Peninsula Health, Frankston, Victoria, Australia (D.C.T., J.E.B., R.S., N.M.H., A. Yeap, B.Y., S.W., P.P., M.P., J.L.)
| | - Brian Yip
- Cardiology, Department of Medicine, Peninsula Health, Frankston, Victoria, Australia (D.C.T., J.E.B., R.S., N.M.H., A. Yeap, B.Y., S.W., P.P., M.P., J.L.)
| | - Sam Wu
- Cardiology, Department of Medicine, Peninsula Health, Frankston, Victoria, Australia (D.C.T., J.E.B., R.S., N.M.H., A. Yeap, B.Y., S.W., P.P., M.P., J.L.)
| | - Padeepa Perera
- Cardiology, Department of Medicine, Peninsula Health, Frankston, Victoria, Australia (D.C.T., J.E.B., R.S., N.M.H., A. Yeap, B.Y., S.W., P.P., M.P., J.L.)
| | - Nicholas Collins
- John Hunter Hospital, New Lambton Heights, New South Wales, Australia (N.C.)
| | - Andy Yong
- Concord Repatriation General Hospital, New South Wales, Australia (A. Yong)
| | - Ravinay Bhindi
- Royal North Shore Hospital, St Leonards, New South Wales, Australia (R.B.)
| | - Robert Whitbourn
- St. Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia (D.C.T., R.W., J.L.)
| | - Astin Lee
- Wollongong Hospital, New South Wales, Australia (A.L.)
| | - Manuja Premaratne
- Cardiology, Department of Medicine, Peninsula Health, Frankston, Victoria, Australia (D.C.T., J.E.B., R.S., N.M.H., A. Yeap, B.Y., S.W., P.P., M.P., J.L.)
| | - Kaleab Asrress
- Bankstown-Lidcombe Hospital, New South Wales, Australia (K.A.)
| | | | - John Amerena
- Barwon Health - University Hospital Geelong, Victoria, Australia (C.H., J.A.)
| | - Jamie Layland
- St. Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia (D.C.T., R.W., J.L.)
- Cardiology, Department of Medicine, Peninsula Health, Frankston, Victoria, Australia (D.C.T., J.E.B., R.S., N.M.H., A. Yeap, B.Y., S.W., P.P., M.P., J.L.)
- Peninsula Clinical School, Central Clinical School, Monash University, Victoria, Australia (J.L.)
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19
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Dawson L, Quinn S, Tong D, Boyle A, Hamilton-Craig C, Adams H, Layland J. Colchicine and quality of life in patients with acute coronary syndromes: results from the COPS randomized trial. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Recent data suggest that colchicine may reduce cardiovascular events among patients presenting with acute coronary syndromes. This sub-study of the Australian COPS trial aimed to assess whether colchicine affects health status outcomes.
Methods
Health status was assessed at baseline and 12-months using the EuroQol-5 Dimension 5-level (EQ-5D-5L) score and the full 19-question Seattle Angina Questionnaire (SAQ). Data were available for 786 patients (388 randomized to colchicine, 398 to placebo).
Results
Baseline characteristics were well matched between groups; mean age was 60.1 (SD 14.8) years, and 20% were female. Baseline health status scores were impaired, and most parameters demonstrated significant improvement from baseline to 12-months (EQ-5D-5L Visual Analogue Score [VAS] 69.3 to 77.7; SAQ angina frequency score 83.0 to 95.3, both p<0.001). No significant differences in adjusted mean score change among any of the EQ-5D-5L or SAQ dimensions were observed between treatment groups in either intention-to-treat or per-protocol analysis. There were borderline interactions in EQ-5D-5L scores for those with previous MI vs not, and in SAQ scores for those with obesity vs not. In categorical analysis using observed data, patients treated with colchicine were more likely to have clinically significant improvement in physical limitation score over the period (36% improved vs. 28%, P<0.05). Baseline health status scores were not associated with the primary endpoint at 12 months.
Conclusions
Treatment with colchicine did not appear to affect change in measures of health status following acute coronary syndromes, but it did lead to a greater likelihood of improvement in physical limitation scores.
Funding Acknowledgement
Type of funding sources: Public hospital(s). Main funding source(s): Peninsula Health, Monash University
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Affiliation(s)
- L Dawson
- Royal Melbourne Hospital, Melbourne, Australia
| | - S Quinn
- Swinburne University of Technology, Department of Health Science and Biostatistics, Melbourne, Australia
| | - D Tong
- Peninsula Health, Department of Cardiology, Melbourne, Australia
| | - A Boyle
- University of Newcastle, Newcastle, Australia
| | | | - H Adams
- Royal Hobart Hospital, Hobart, Australia
| | - J Layland
- Peninsula Health, Department of Cardiology, Frankston, Australia
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20
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Cole J, Htun N, Lew R, Freilich M, Quinn S, Layland J. COlchicine to Prevent PeriprocEdural myocardial Injury in Percutaneous Coronary Intervention (COPE-PCI): A descriptive cytokine pilot sub-study. Cardiovasc Revasc Med 2021; 39:84-89. [PMID: 34686461 DOI: 10.1016/j.carrev.2021.09.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 09/26/2021] [Accepted: 09/27/2021] [Indexed: 01/05/2023]
Abstract
BACKGROUND High levels of inflammation pre- and post-percutaneous coronary intervention (PCI) are associated with worse outcomes. Recent trials have suggested a benefit from treating inflammation with colchicine in coronary artery disease. In this randomised pilot COPE-PCI sub-study, we aimed to determine if administration of colchicine pre-PCI, would attenuate the inflammatory effect of PCI. METHODS PCI patients were randomised to colchicine or placebo, 6 to 24-hours pre-procedure. Study blood samples were taken immediately pre-PCI, and 24-hours post-procedure. Samples were tested for a broad array of inflammatory biomarkers including high-sensitive(hs)-CRP, leucocyte counts, and hs-troponin-. Periprocedural Myocardial Injury (PM-Injury) was defined as per the ESC Third Universal Definitions of Myocardial Infarction. RESULTS Thirty-six were randomised to colchicine and 39 to placebo. Treatment groups were similar for baseline variables. The median time from drug administration to pre-PCI blood sampling was 18-hours. Overall inflammation was low across the patient population, pre- & post-PCI hsCRP was <1.4 mg/L. Colchicine patients had numerically lower levels of pre-PCI cytokines: IL-1β (p = 0.01), IL-6 (p = 0.02), IL-10 (p = 0.01), IFNγ (p = 0.01), TNFα (p = 0.02) and WBC-count (p = 0.04). Post-PCI (38-hours post-drug) measures of inflammation were similar between treatment arms. Absolute troponin change (post-PCI - pre-PCI levels) was less in colchicine patients (p = 0.02). CONCLUSION The reduction in PCI-related myocardial injury that resulted from colchicine given on median 18 h pre-PCI, was associated with numerically lower levels of inflammation pre-PCI but no difference one day post-PCI in the colchicine vs placebo groups. CLINICAL TRIAL REGISTRATION The trial was publicly registered at www.anzctr.org.au, Trial ID: ACTRN12615000485538.
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Affiliation(s)
- Justin Cole
- Peninsula Heart Service, Peninsula Health, Australia; Peninsula Clinical School, Monash University, Australia
| | - Nay Htun
- Peninsula Heart Service, Peninsula Health, Australia; Peninsula Clinical School, Monash University, Australia
| | - Robert Lew
- Peninsula Heart Service, Peninsula Health, Australia
| | - Mark Freilich
- Peninsula Heart Service, Peninsula Health, Australia
| | - Stephen Quinn
- Department of Health Science and Biostatistics, Swinburne University of Technology, Australia
| | - Jamie Layland
- Peninsula Heart Service, Peninsula Health, Australia; Peninsula Clinical School, Monash University, Australia.
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21
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Hewitt K, Carron J, Quinn S, Sheahan R. A practical approach to cardiac imaging in adults with Duchenne muscular dystrophy - echocardiography or cardiac MRI? Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeab090.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
The incidence of cardiomyopathy in Duchenne muscular dystrophy (DMD) increases with age, accounting for up to 20% of mortality in the third decade of life. As patients are frequently asymptomatic until advanced stages of disease, imaging plays an essential role in screening for cardiac involvement and monitoring progression. Guidelines recommend annual transthoracic echocardiography assessment, with periodic use of cardiac magnetic resonance imaging (CMR). However, some studies suggest that CMR should be the gold standard imaging in DMD. This study aimed to review the use echo and CMR in adult patients with DMD, with particular focus on practical utility and real-world limitations.
Methods
A retrospective chart review of 24 patients attending our DMD cardiomyopathy clinic was undertaken. Demographic data including age, genotyping and medical therapy were noted. Results of cardiac imaging, as well as discussions regarding referral for CMR were recorded.
Results
All patients had echocardiography performed in our facility (table 1) and all had a documented discussion regarding referral for CMR in their medical notes. 15 patients (60%) were unsuitable for CMR and were not referred. Reasons were inability to lie flat due to breathing/claustrophobia (n = 12) and difficulty with positioning due to contractures (n = 9). 2 patients (8%) attended for CMR but were unable to proceed due to difficulty with positioning in the scanner. 4 patients (16.5%) had CMR performed, 3 additional patients were referred and awaited CMR. Results outlined in table 1 and image 1 show correlation between measurement of left ventricular ejection fraction (LVEF) on echo and CMR. Wall motion abnormalities and fibrosis were better detected with CMR.
Conclusion
Significant limitations were seen with both imaging techniques. Accessibility of CMR for adults with DMD is poor, related primarily to the severity of underlying musculoskeletal and respiratory disease. Echocardiography is easily accessible, but images are frequently suboptimal. Despite this, strong correlation was seen in assessment of LV function in those who underwent both echocardiography and CMR, with indication that echocardiography can accurately guide intensification of medications and cardiac device therapy. CMR remains the optimal modality for the assessment of myocardial fibrosis. Improving accessibility of CMR for patients with DMD should be prioritised for the future of this modality.
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Affiliation(s)
- K Hewitt
- Beaumont Hospital, Dublin, Ireland
| | - J Carron
- Beaumont Hospital, Dublin, Ireland
| | - S Quinn
- Beaumont Hospital, Dublin, Ireland
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22
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Khan E, Lambrakis K, Blyth A, Seshadri A, Edmonds MJR, Briffa T, Cullen LA, Quinn S, Horsfall M, Morton E, French JK, Papendick C, Nelson AJ, Chew DP. Classification performance of clinical risk scoring in suspected acute coronary syndrome beyond a rule-out troponin profile. Eur Heart J Acute Cardiovasc Care 2021; 10:1038-1047. [PMID: 34195809 DOI: 10.1093/ehjacc/zuab040] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 05/19/2021] [Accepted: 05/22/2021] [Indexed: 11/15/2022]
Abstract
AIMS High-sensitivity cardiac troponin strategies can provide risk stratification in patients with suspected acute coronary syndrome (ACS) in the emergency department (ED). This study evaluated whether clinical risk scoring improves the classification performance of a rule-out profile in suspected ACS. METHODS AND RESULTS Patients presenting to ED with suspected ACS as part of the RAPID-TnT trial randomized to the intervention arm were included. Results ≥5 ng/L were available for all participants in this analysis. We evaluated the Thrombolysis In Myocardial Infarction (TIMI) risk score, History ECG Age Risk factors Troponin (HEART) score, and Emergency Department Assessment of Chest pain Score (EDACS) in addition to a rule-out profile based on the 0/1-h high-sensitivity cardiac troponin T protocol (<5 ng/L or ≤12 ng/L and a change of <3 ng/L at 1-h) using test performance parameters focusing on low-risk groups to identify the primary endpoint (TIMI ≤ 1, HEART ≤ 3, EDACS < 16). Primary endpoint was a composite of type 1/2 myocardial infarction (MI) at index presentation and all-cause mortality or type 1/2 MI at 30 days. A total of 3378 participants were enrolled between August 2015 and April 2019 of which 108 were ineligible/withdrew consent (intervention arm: n = 1638). Sensitivity, specificity, negative predictive value (NPV), and area under the curve (AUC) of the rule-out profile was 94.4%, 76.8%, 99.6%, and 0.86, respectively with 72.9% identified as 'low-risk'. Adding the clinical risk scores did not improve the sensitivity, NPV, or AUC with significantly lower specificity and 'low-risk' classified participants. CONCLUSIONS Addition of clinical risk scores to rule-out profile did not demonstrate improved classification performance for identifying the composite of type 1/2 MI at index presentation and all-cause mortality or type 1/2 MI at 30 days. CLINICAL TRIALS REGISTRATION URL: https://www.anzctr.org.au. Reg. No. ACTRN12615001379505.
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Affiliation(s)
- Ehsan Khan
- College of Medicine & Public Health, Flinders University, Sturt Road, Bedford Park, SA 5042, Australia
- South Australian Department of Health, 11 Hindmarsh Square, Adelaide, SA 5000, Australia
| | - Kristina Lambrakis
- College of Medicine & Public Health, Flinders University, Sturt Road, Bedford Park, SA 5042, Australia
- South Australian Department of Health, 11 Hindmarsh Square, Adelaide, SA 5000, Australia
| | - Andrew Blyth
- College of Medicine & Public Health, Flinders University, Sturt Road, Bedford Park, SA 5042, Australia
- South Australian Department of Health, 11 Hindmarsh Square, Adelaide, SA 5000, Australia
| | - Anil Seshadri
- College of Medicine & Public Health, Flinders University, Sturt Road, Bedford Park, SA 5042, Australia
- South Australian Department of Health, 11 Hindmarsh Square, Adelaide, SA 5000, Australia
| | - Michael J R Edmonds
- South Australian Department of Health, 11 Hindmarsh Square, Adelaide, SA 5000, Australia
| | - Tom Briffa
- School of Population and Global Health, University of Western Australia, Clifton Street, Nedlands, Perth, WA 6009, Australia
| | - Louise A Cullen
- Emergency and Trauma Centre, Royal Brisbane and Women's Hospital, Butterfield Street, Herston, Brisbane, QLD 4029, Australia
- School of Public Health, Queensland University of Technology, George Street, Brisbane, QLD 4000, Australia
- School of Medicine, University of Queensland, St Lucia, Brisbane, QLD 4072, Australia
| | - Stephen Quinn
- Department of Statistics, Swinburne University of Technology, John Street, Hawthorne, Melbourne, VIC 3122, Australia
- Department of Health Science and Biostatistics, Swinburne University of Technology, John Street, Hawthorne, Melbourne, VIC 3122, Australia
| | - Matthew Horsfall
- College of Medicine & Public Health, Flinders University, Sturt Road, Bedford Park, SA 5042, Australia
- South Australian Department of Health, 11 Hindmarsh Square, Adelaide, SA 5000, Australia
| | - Erin Morton
- College of Medicine & Public Health, Flinders University, Sturt Road, Bedford Park, SA 5042, Australia
| | - John K French
- Department of Cardiology, Liverpool Hospital, Elizabeth & Goulburn Street, Liverpool, Sydney, NSW 2170, Australia
| | - Cynthia Papendick
- School of Population and Global Health, University of Western Australia, Clifton Street, Nedlands, Perth, WA 6009, Australia
| | - Adam J Nelson
- South Australian Department of Health, 11 Hindmarsh Square, Adelaide, SA 5000, Australia
- South Australian Health and Medical Research Institute, North Terrace, Adelaide, SA 5000, Australia
- School of Medicine, University of Adelaide, North Terrrace, Adelaide, SA 5000, Australia
| | - Derek P Chew
- College of Medicine & Public Health, Flinders University, Sturt Road, Bedford Park, SA 5042, Australia
- South Australian Department of Health, 11 Hindmarsh Square, Adelaide, SA 5000, Australia
- School of Population and Global Health, University of Western Australia, Clifton Street, Nedlands, Perth, WA 6009, Australia
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23
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Murray K, Quinn S, Turk M, O’rourke A, Molloy E, O’neill L, Mongey AB, Fearon U, Veale D. POS1216 SYMPTOM RATES, ATTITUDES AND MEDICATION ADHERENCE OF RHEUMATIC AND MUSCULOSKELETAL DISEASE PATIENTS DURING THE SARS-CoV2 PANDEMIC. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.2579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:SARS-CoV2 has caused over two million deaths globally. The relationship between rheumatic and musculoskeletal disease (RMDs), immunosuppressive medications and COVID-19 is unclear.Objectives:This study explores the rates of COVID-19 symptoms and positive tests, DMARD adherence and attitudes to virtual clinics. amongst RMD patients.Methods:An online population survey was disseminated via the Arthritis Ireland website and social media channels.Results:There were 1381 respondents with RMD, 74.8% were on immunosuppressive medication. COVID-19 symptoms were reported by 3.7% of respondents of which 0.46% tested positive, no different from the general population at that timepoint. The frequency of COVID-19 symptoms was higher for respondents with spondyloarthropathy [odds ratio (OR) 2.06, 95% CI: 1.14, 3.70] and lower in those on immunosuppressive medication (OR 0.48, 95% CI: 0.27, 0.88), and those compliant with health authority (HSE) guidance (OR 0.47, 95% CI: 0.25, 0.89). Adherence to RMD medications was reported in 84.1%, with 57.1% using health authority guidelines for information on medication use. Importantly, adherence rates were higher amongst those who cited guidelines (89.3% vs 79.9%, P <0.001), and conversely lower in those with COVID-19 symptoms (64.0% vs 85.1%, P =0.009). Finally, the use of virtual clinics was supported by 70.4% of respondents.Conclusion:The rate of COVID-19 positivity in RMD patients was similar to the general population. COVID-19 symptoms were lower amongst respondents on immunosuppressive medication and those adherent to medication guidelines. Respondents were supportive of HSE advice and virtual rheumatology clinics.Disclosure of Interests:Kieran Murray Grant/research support from: Bresnihan Molloy and Newman fellowships, Sean Quinn: None declared, Matthew Turk: None declared, Anna O’Rourke: None declared, Eamonn Molloy: None declared, Lorraine O’Neill: None declared, Anne Barbara Mongey: None declared, Ursula Fearon: None declared, Douglas Veale: None declared.
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24
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Quinn S, Maguire S, O’shea FB, O’neill L, Molloy E, Fearon U, Gallagher P, Veale D. POS0964 CHARACTERISTICS AND BURDEN OF DISEASE IN PATIENTS WITH RADIOGRAPHIC VERSUS NON-RADIOGRAPHIC AXIAL SPONDYLOARTHRITIS IN THE ANKYLOSING SPONDYLITIS REGISTRY OF IRELAND COHORT. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.1056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Axial spondyloarthritis (axSpA) is an umbrella term for types of inflammatory arthritis that primarily affect the spine and the sacroiliac joints. It is comprised of patients with both radiographic (r-axSpA) and non-radiographic features (nr-axSpA). R-axSpA was historically known as Ankylosing Spondylitis. Previous studies have shown the burden of disease to be largely similar in patients with radiographic versus non-radiographic axial spondyloarthritis in cohorts both in the US and Europe [1]. The Ankylosing Spondylitis Registry of Ireland (ASRI) was formed with the objective to measure the burden of axial spondyloarthritis in the population and identify early predictors of a poor outcome. All patients in the registry are 18 years or older and meet Assessment of Spondyloarthritis International Society (ASAS) criteria for a diagnosis of SpA.Objectives:To compare the characteristics and burden of disease in patients with radiographic versus non-radiographic axial spondyloarthritis in the ASRI cohort.Methods:Patients with radiographic axial spondyloarthritis (r-axSpA) were defined as those with x-ray evidence of sacroiliitis. Patients with non-radiographic axial spondyloarthritis (nr-axSpA) were defined as having MRI evidence of sacroiliitis but no x-ray evidence of sacroiliitis. A standardised clinical assessment was performed on each patient and structured interviews provided patient-reported data. For each patient the following scores were captured: Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI), Bath Ankylosing Spondylitis Metrology Index (BASMI), Health Assessment Questionnaire (HAQ) assesses the self-reported functional status for performing activities of daily living, and the Ankylosing Spondylitis Quality of Life (ASQoL) questionnaire. Categorical variables were summarized as percentages with frequency counts, and continuous variables with a mean and standard deviation. Statistical comparisons between subgroups were evaluated using 2 sample t-tests for continuous variables and chi-square tests for categorical variables.Results:764 patients were available for analysis. Analysis of radiographic status showed 88.1% (n=673) of patients with r-axSpA and 11.9% (n=91) with nr-axSpA. Patients with nr-axSpA were younger (41.3 vs. 46.6 years, p<0.01), had shorter disease duration (14.8 vs. 20.2 years, p<0.01), lower proportion of males (66.6% vs. 78.4%, p=0.02) with lower rates of HLA-B27 positivity (73.6% vs. 90.5%, p<0.01). The nr-axSpA group had lower BASDAI (3.37 vs. 4.05, p=0.01), BASFI (2.46 vs. 3.88, p<0.01), BASMI (2.33 vs. 4.34, p<0.01), ASQoL (5.2 vs. 6.67, p=0.02), and HAQ scores (0.38 vs. 0.57, p<0.01). There were no significant differences in the prevalence of extra-articular manifestations.Conclusion:This study provides evidence that the burden of disease is less in patients with non-radiographic axial spondyloarthritis than radiographic axial spondyloarthritis, as demonstrated by better BASDAI, BASFI, BASMI, HAQ and ASQoL scores.References:[1]López-Medina C, et al. Characteristics and burden of disease in patients with radiographic and non-radiographic axial Spondyloarthritis: a comparison by systematic literature review and meta-analysis. RMD Open, 2019. 5(2) p1108.Table 1.r-axSpAnr-axSpAp valuen67391Age (years)46.6 (+/-12.4)41.3 (+/-12.4)<0.01Disease duration (years)20.2 (+/-12.4)14.8 (+/-11.7)<0.01Delay to diagnosis (years)8.41 (+/-8.6)6.34 (+/-7.2)0.03Males78.8% (528)65.9% (60)0.02Females21.5% (145)34.1% (31)0.02HLA-B27+90.50%(440 of 486 available results)73.60%(53 of 72 available results)<0.01BASDAI4.05 (+/-2.39)3.37 (+/-2.31)0.01BASFI3.88 (+/-3.00)2.46 (+/-2.39)<0.01BASMI4.34 (+/-2.08)2.33 (+/-1.42)<0.01ASQoL6.67 (+/-5.55)5.2 (+/-5.53)0.02HAQ0.57 (+/-0.54)0.38 (+/-0.44)<0.01Psoriasis17.8% (120)15.4% (14)0.31IBD11% (74)8.8% (8)0.58Uveitis33.9% (228)34.1% (31)0.54Disclosure of Interests:Sean Quinn: None declared, Sinead Maguire: None declared, Finbar Barry O’Shea: None declared, Lorraine O’Neill: None declared, Eamonn Molloy: None declared, Ursula Fearon Speakers bureau: Abbvie, Grant/research support from: Janssen, Abbvie, Pfizer, UCB, Phil Gallagher: None declared, Douglas Veale Speakers bureau: AbbVie, BMS, Celgene, Pfizer, MSD, Roche, Consultant of: AbbVie, Actelion, BMS, Novartis, Pfizer, MSD, Roche, Regeneron/Sanofi, Grant/research support from: AbbVie, Pfizer, MSD, Novartis, Roche, Janssen.
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McNeill D, Karapetis CS, Price TJ, Meagher P, Piantadosi C, Quinn S, Roder D, Padbury R, Maddern G, Townsend A, Jayawardana MW, Roy AC. Treatment and outcomes of metastatic colorectal cancer patients in public and private hospitals: results from the South Australian Metastatic Colorectal Cancer Registry. Intern Med J 2021; 51:69-77. [PMID: 31985128 DOI: 10.1111/imj.14765] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 01/10/2020] [Accepted: 01/11/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Studies have reported significant differences in baseline characteristics and outcomes of metastatic colorectal cancer (mCRC) patients when managed in private versus public hospitals. AIMS To compare disease, treatment and survival outcomes of patients with mCRC in public versus private hospitals in South Australia (SA). METHODS Analysis of prospectively collected data from the SA mCRC Registry. Patterns of care and outcome data according to location of care and socioeconomic status based on Index of Relative Socio-Economic Advantage and Disadvantage were analysed. RESULTS A total of 3470 patients' data was analysed during February 2006-January 2015. The majority (70%) of patients received treatment in public hospitals. Patients in the upper 50% for Index of Relative Socio-Economic Advantage and Disadvantage score were more likely to receive treatment at a private hospital (41.2% vs 21.56%) compared to <50%. Public patients had higher burden of disease (10.49% vs 7.41%, P = 0.005). Public patients received less treatment compared to the private patients (odds ratio = 0.48 (0.38-0.61), P = 0.01) and rates of surgical resections were lower in public patients. After adjusting for the covariates, public patients survive 1.33 months (P = 0.025) shorter than private patients with follow-up time of 5 years. Patients receiving metastasectomy and more than three lines of treatment were shown to have the greatest survival benefit. CONCLUSION Public patients have a higher burden of disease and in comparison are less likely to receive systemic therapy and have lower survival than patients treated in private hospitals.
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Affiliation(s)
- David McNeill
- Intensive and Critical Care Unit, Flinders Medical Centre, Adelaide, South Australia, Australia
| | - Christos S Karapetis
- Department of Medical Oncology, Flinders Medical Centre and Flinders University, Adelaide, South Australia, Australia
| | - Timothy J Price
- Department of Medical Oncology, The Queen Elizabeth Hospital and University of Adelaide, Adelaide, South Australia, Australia
| | - Philip Meagher
- Engineering and Materials Science Centre, University College Dublin, Dublin, Ireland
| | - Cynthia Piantadosi
- Intensive and Critical Care Unit, Flinders Medical Centre, Adelaide, South Australia, Australia
| | - Stephen Quinn
- Department of Statistics, Data Science and Epidemiology, Swinburne University of Technology, Melbourne, Victoria, Australia
| | - David Roder
- Cancer Epidemiology and Population Health, University of South Australia, Adelaide, South Australia, Australia
| | - Rob Padbury
- Department of Surgery, Flinders Medical Centre, Adelaide, South Australia, Australia
| | - Guy Maddern
- Department of Surgery, The Queen Elizabeth Hospital and University of Adelaide, Adelaide, South Australia, Australia
| | - Amanda Townsend
- Department of Medical Oncology, The Queen Elizabeth Hospital and University of Adelaide, Adelaide, South Australia, Australia
| | - Madawa W Jayawardana
- Office of Cancer Research, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Amitesh C Roy
- Department of Medical Oncology, Flinders Medical Centre and Flinders University, Adelaide, South Australia, Australia
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Cole J, Htun N, Lew R, Freilich M, Quinn S, Layland J. Colchicine to Prevent Periprocedural Myocardial Injury in Percutaneous Coronary Intervention: The COPE-PCI Pilot Trial. Circ Cardiovasc Interv 2021; 14:e009992. [PMID: 34003667 DOI: 10.1161/circinterventions.120.009992] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [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: 12/12/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- Justin Cole
- Peninsula Heart Service, Peninsula Health, Frankston, Australia (J.C., N.H., R.L., M.F., J.L.).,Peninsula Clinical School, Monash University, Frankston, Australia (J.C., N.H., J.L.)
| | - Nay Htun
- Peninsula Heart Service, Peninsula Health, Frankston, Australia (J.C., N.H., R.L., M.F., J.L.).,Peninsula Clinical School, Monash University, Frankston, Australia (J.C., N.H., J.L.)
| | - Robert Lew
- Peninsula Heart Service, Peninsula Health, Frankston, Australia (J.C., N.H., R.L., M.F., J.L.)
| | - Mark Freilich
- Peninsula Heart Service, Peninsula Health, Frankston, Australia (J.C., N.H., R.L., M.F., J.L.)
| | - Stephen Quinn
- Department of Health Science and Biostatistics, Swinburne University of Technology, Hawthorn, Victoria, Australia (S.Q.)
| | - Jamie Layland
- Peninsula Heart Service, Peninsula Health, Frankston, Australia (J.C., N.H., R.L., M.F., J.L.).,Peninsula Clinical School, Monash University, Frankston, Australia (J.C., N.H., J.L.)
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Lambrakis K, Papendick C, French JK, Quinn S, Blyth A, Seshadri A, Edmonds MJR, Chuang A, Khan E, Nelson AJ, Wright D, Horsfall M, Morton E, Karnon J, Briffa T, Cullen LA, Chew DP. Late Outcomes of the RAPID-TnT Randomized Controlled Trial: 0/1-Hour High-Sensitivity Troponin T Protocol in Suspected ACS. Circulation 2021; 144:113-125. [PMID: 33998255 DOI: 10.1161/circulationaha.121.055009] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [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: 11/16/2022]
Abstract
BACKGROUND High-sensitivity troponin assays are increasingly being adopted to expedite evaluation of patients with suspected acute coronary syndromes. Few direct comparisons have examined whether the enhanced performance of these assays at low concentrations leads to changes in care that improves longer-term outcomes. This study evaluated late outcomes of participants managed under an unmasked 0/1-hour high-sensitivity cardiac troponin T (hs-cTnT) protocol compared with a 0/3-hour masked hs-cTnT protocol. METHODS We conducted a multicenter prospective patient-level randomized comparison of care informed by unmasked 0/1-hour hs-cTnT protocol (reported to <5 ng/L) versus standard practice masked hs-cTnT testing (reported to ≤29 ng/L) assessed at 0/3 hours and followed participants for 12 months. Participants included were those presenting to metropolitan emergency departments with suspected acute coronary syndromes, without ECG evidence of coronary ischemia. The primary end point was time to all-cause death or myocardial infarction using Cox proportional hazards models adjusted for clustering within hospitals. RESULTS Between August 2015 and April 2019, we randomized 3378 participants, of whom 108 withdrew, resulting in 12-month follow-up for 3270 participants (masked: 1632; unmasked: 1638). Among these, 2993 (91.5%) had an initial troponin concentration of ≤29 ng/L. Deployment of the 0/1-hour hs-cTnT protocol was associated with reductions in functional testing. Over 12-month follow-up, there was no difference in invasive coronary angiography (0/1-hour unmasked: 232/1638 [14.2%]; 0/3-hour masked: 202/1632 [12.4%]; P=0.13), although an increase was seen among patients with hs-cTnT levels within the masked range (0/1-hour unmasked arm: 168/1507 [11.2%]; 0/3-hour masked arm: 124/1486 [8.3%]; P=0.010). By 12 months, all-cause death and myocardial infarction did not differ between study arms overall (0/1-hour: 82/1638 [5.0%] versus 0/3-hour: 62/1632 [3.8%]; hazard ratio, 1.32 [95% CI, 0.95-1.83]; P=0.10). Among participants with initial troponin T concentrations ≤29 ng/L, unmasked hs-cTnT reporting was associated with an increase in death or myocardial infarction (0/1-hour: 55/1507 [3.7%] versus 0/3-hour: 34/1486 [2.3%]; hazard ratio, 1.60 [95% CI, 1.05-2.46]; P=0.030). CONCLUSIONS Unmasked hs-cTnT reporting deployed within a 0/1-hour protocol did not reduce ischemic events over 12-month follow-up. Changes in practice associated with the implementation of this protocol may be associated with an increase in death and myocardial infarction among those with newly identified troponin elevations. Registration: URL: https://www.anzctr.org.au; Unique identifier: ACTRN12615001379505.
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Affiliation(s)
- Kristina Lambrakis
- College of Medicine and Public Health, Flinders University of South Australia, Adelaide (K.L., A.B., A.S., A.C., E.K., E.M., J.K., D.P.C.)
- South Australian Department of Health, Adelaide (K.L., C.P., A.B., A.S., M.J.R.E., A.C., E.K., A.J.N., D.W., M.H., D.P.C.)
| | - Cynthia Papendick
- South Australian Department of Health, Adelaide (K.L., C.P., A.B., A.S., M.J.R.E., A.C., E.K., A.J.N., D.W., M.H., D.P.C.)
- School of Medicine, University of Adelaide, Australia (C.P., A.J.N.)
| | - John K French
- Department of Cardiology, Liverpool Hospital, University of New South Wales, Sydney, Australia (J.K.F.)
| | - Stephen Quinn
- Department of Statistics, Data Science and Epidemiology (S.Q.), Swinburne University of Technology, Melbourne, Australia
| | - Andrew Blyth
- College of Medicine and Public Health, Flinders University of South Australia, Adelaide (K.L., A.B., A.S., A.C., E.K., E.M., J.K., D.P.C.)
- South Australian Department of Health, Adelaide (K.L., C.P., A.B., A.S., M.J.R.E., A.C., E.K., A.J.N., D.W., M.H., D.P.C.)
| | - Anil Seshadri
- College of Medicine and Public Health, Flinders University of South Australia, Adelaide (K.L., A.B., A.S., A.C., E.K., E.M., J.K., D.P.C.)
- South Australian Department of Health, Adelaide (K.L., C.P., A.B., A.S., M.J.R.E., A.C., E.K., A.J.N., D.W., M.H., D.P.C.)
| | - Michael J R Edmonds
- South Australian Department of Health, Adelaide (K.L., C.P., A.B., A.S., M.J.R.E., A.C., E.K., A.J.N., D.W., M.H., D.P.C.)
| | - Anthony Chuang
- College of Medicine and Public Health, Flinders University of South Australia, Adelaide (K.L., A.B., A.S., A.C., E.K., E.M., J.K., D.P.C.)
- South Australian Department of Health, Adelaide (K.L., C.P., A.B., A.S., M.J.R.E., A.C., E.K., A.J.N., D.W., M.H., D.P.C.)
| | - Ehsan Khan
- College of Medicine and Public Health, Flinders University of South Australia, Adelaide (K.L., A.B., A.S., A.C., E.K., E.M., J.K., D.P.C.)
- South Australian Department of Health, Adelaide (K.L., C.P., A.B., A.S., M.J.R.E., A.C., E.K., A.J.N., D.W., M.H., D.P.C.)
| | - Adam J Nelson
- South Australian Department of Health, Adelaide (K.L., C.P., A.B., A.S., M.J.R.E., A.C., E.K., A.J.N., D.W., M.H., D.P.C.)
- School of Medicine, University of Adelaide, Australia (C.P., A.J.N.)
| | - Deborah Wright
- South Australian Department of Health, Adelaide (K.L., C.P., A.B., A.S., M.J.R.E., A.C., E.K., A.J.N., D.W., M.H., D.P.C.)
| | - Matthew Horsfall
- South Australian Department of Health, Adelaide (K.L., C.P., A.B., A.S., M.J.R.E., A.C., E.K., A.J.N., D.W., M.H., D.P.C.)
| | - Erin Morton
- College of Medicine and Public Health, Flinders University of South Australia, Adelaide (K.L., A.B., A.S., A.C., E.K., E.M., J.K., D.P.C.)
| | - Jonathan Karnon
- College of Medicine and Public Health, Flinders University of South Australia, Adelaide (K.L., A.B., A.S., A.C., E.K., E.M., J.K., D.P.C.)
| | - Tom Briffa
- School of Population and Global Health, University of Western Australia, Perth (T.B.)
| | - Louise A Cullen
- Emergency and Trauma Centre, Royal Brisbane and Women's Hospital, Australia (L.A.C.)
- School of Public Health, Queensland University of Technology, Brisbane, Australia (L.A.C.)
- School of Medicine, University of Queensland, Brisbane, Australia (L.A.C.)
| | - Derek P Chew
- College of Medicine and Public Health, Flinders University of South Australia, Adelaide (K.L., A.B., A.S., A.C., E.K., E.M., J.K., D.P.C.)
- South Australian Health and Medical Research Institute, Adelaide (D.P.C.)
- South Australian Department of Health, Adelaide (K.L., C.P., A.B., A.S., M.J.R.E., A.C., E.K., A.J.N., D.W., M.H., D.P.C.)
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Chew DP, Hyun K, Morton E, Horsfall M, Hillis GS, Chow CK, Quinn S, D'Souza M, Yan AT, Gale CP, Goodman SG, Fox K, Brieger D. Objective Risk Assessment vs Standard Care for Acute Coronary Syndromes: A Randomized Clinical Trial. JAMA Cardiol 2021; 6:304-313. [PMID: 33295965 DOI: 10.1001/jamacardio.2020.6314] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Although international guidelines recommend use of the Global Registries of Acute Coronary Events (GRACE) risk score (GRS) to guide acute coronary syndrome (ACS) treatment decisions, the prospective utility of the GRS in improving care and outcomes is unproven. Objective To assess the effect of routine GRS implementation on guideline-indicated treatments and clinical outcomes of hospitalized patients with ACS. Design, Setting, and Participants Prospective cluster (hospital-level) randomized open-label blinded end point (PROBE) clinical trial using a multicenter ACS registry of acute care cardiology services. Fixed sampling of the first 10 patients within calendar month, with either ST-segment elevation or non-ST-segment elevation ACS. The study enrolled patients from June 2014 to March 2018, and data were analyzed between February 2020 and April 2020. Interventions Implementation of routine risk stratification using the GRS and guideline recommendations. Main Outcomes and Measures The primary outcome was a performance score based on receipt of early invasive treatment, discharge prescription of 4 of 5 guideline-recommended pharmacotherapies, and cardiac rehabilitation referral. Clinical outcomes included a composite of all-cause death and/or myocardial infarction (MI) within 1 year. Results This study enrolled 2318 patients from 24 hospitals and was stopped prematurely owing to futility. Of the patients enrolled, median age was 65 years (interquartile range, 56-74 years), 29.5% were women (n = 684), and 62.9% were considered high risk (n = 1433). Provision of all 3 measures among high-risk patients did not differ between the randomized arms (GRS: 424 of 717 [59.9%] vs control: 376 of 681 [55.2%]; odds ratio [OR], 1.04; 95% CI, 0.63-1.71; P = .88). The provision of early invasive treatment was increased compared with the control arm (GRS: 1042 of 1135 [91.8%] vs control: 989 of 1183 [83.6%]; OR, 2.26; 95% CI, 1.30-3.96; P = .004). Prescription of 4 of 5 guideline-recommended pharmacotherapies (GRS: 864 of 1135 [76.7%] vs control: 893 of 1183 [77.5%]; OR, 0.97; 95% CI, 0.68-1.38) and cardiac rehabilitation (GRS: 855 of 1135 [75.1%] vs control: 861 of 1183 [72.8%]; OR, 0.68; 95% CI, 0.32-1.44) were not different. By 12 months, GRS intervention was not associated with a significant reduction in death or MI compared with the control group (GRS: 96 of 1044 [9.2%] vs control: 146 of 1087 [13.4%]; OR, 0.66; 95% CI, 0.38-1.14). Conclusions and Relevance Routine GRS implementation in cardiology services with high levels of clinical care was associated with an increase in early invasive treatment but not other aspects of care. Low event rates and premature study discontinuation indicates the need for further, larger scale randomized studies. Trial Registration anzctr.org.au Identifier: ACTRN12614000550606.
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Affiliation(s)
- Derek P Chew
- College of Medicine and Public Health, Flinders University of South Australia, Adelaide, Australia
| | - Karice Hyun
- Westmead Applied Research Centre, Faulty of Medicine and Health, University of Sydney, Sydney, Australia.,Department of Cardiology, Westmead Hospital, Sydney, Australia
| | - Erin Morton
- College of Medicine and Public Health, Flinders University of South Australia, Adelaide, Australia
| | - Matt Horsfall
- College of Medicine and Public Health, Flinders University of South Australia, Adelaide, Australia
| | - Graham S Hillis
- School of Medicine, University of Western Australia, Perth, Australia
| | - Clara K Chow
- Westmead Applied Research Centre, Faulty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Stephen Quinn
- Department of Health Science and Biostatistics, Swinburne University of Technology, Melbourne, Australia
| | - Mario D'Souza
- Westmead Applied Research Centre, Faulty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Andrew T Yan
- St Michael's Hospital, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Chris P Gale
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, England
| | - Shaun G Goodman
- St Michael's Hospital, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Keith Fox
- Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, Scotland
| | - David Brieger
- Cardiology Department, Concord Repatriation General Hospital, Sydney, Australia
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Schofield P, Gough K, Hyatt A, White A, Frydenberg M, Chambers S, Gordon LG, Gardiner R, Murphy DG, Cavedon L, Richards N, Murphy B, Quinn S, Juraskova I. Correction to: Navigate: a study protocol for a randomised controlled trial of an online treatment decision aid for men with low-risk prostate cancer and their partners. Trials 2021; 22:97. [PMID: 33504356 PMCID: PMC7839185 DOI: 10.1186/s13063-021-05070-6] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Affiliation(s)
- Penelope Schofield
- Department of Psychology, Swinburne University of Technology, Melbourne, Victoria, Australia. .,Behavioural Science Unit, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia. .,Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Victoria, Australia. .,Swinburne University of Technology, John Street, Hawthorn, Australia.
| | - Karla Gough
- Behavioural Science Unit, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Department of Nursing, The University of Melbourne, Parkville, Victoria, Australia
| | - Amelia Hyatt
- Behavioural Science Unit, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Alan White
- Behavioural Science Unit, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Mark Frydenberg
- Department of Urology, Cabrini Institute, Cabrini Health, Malvern, Australia.,Department of Surgery, Monash University, Melbourne, Victoria, Australia
| | - Suzanne Chambers
- Faculty of Health, University of Technology Sydney, Sydney, Australia.,Health and Wellness Institute, Edith Cowan University, Perth, Australia.,Institute for Resilient Regions, University of Southern Queensland, Springfield, Australia.,Menzies Health Institute Queensland, Griffith University, Southport, Australia
| | - Louisa G Gordon
- Population Health Department, Health Economics, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia.,School of Nursing, Queensland University of Technology (QUT), Brisbane, Queensland, Australia.,School of Public Health, University of Queensland, Brisbane, Queensland, Australia
| | - Robert Gardiner
- School of Medicine, University of Queensland, Brisbane, Queensland, Australia.,Department of Urology, Royal Brisbane & Women's Hospital, Herston, Queensland, Australia
| | - Declan G Murphy
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Victoria, Australia.,Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Lawrence Cavedon
- School of Science, RMIT University, Melbourne, Victoria, Australia
| | - Natalie Richards
- Behavioural Science Unit, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Barbara Murphy
- Department of Psychology, The University of Melbourne, Parkville, Victoria, Australia.,Faculty of Health, Deakin University, Bundoora, Victoria, Australia
| | - Stephen Quinn
- Department of Health Science and Biostatistics, Swinburne University of Technology, Melbourne, Victoria, Australia
| | - Ilona Juraskova
- School of Psychology, Faculty of Science, Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), University of Sydney, Sydney, New South Wales, Australia
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Schofield P, Gough K, Hyatt A, White A, Frydenberg M, Chambers S, Gordon LG, Gardiner R, Murphy DG, Cavedon L, Richards N, Murphy B, Quinn S, Juraskova I. Navigate: a study protocol for a randomised controlled trial of an online treatment decision aid for men with low-risk prostate cancer and their partners. Trials 2021; 22:49. [PMID: 33430950 PMCID: PMC7802237 DOI: 10.1186/s13063-020-04986-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 12/18/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Active surveillance (AS) is the disease management option of choice for low-risk prostate cancer. Despite this, men with low-risk prostate cancer (LRPC) find management decisions distressing and confusing. We developed Navigate, an online decision aid to help men and their partners make management decisions consistent with their values. The aims are to evaluate the impact of Navigate on uptake of AS; decision-making preparedness; decisional conflict, regret and satisfaction; quality of illness communication; and prostate cancer-specific quality of life and anxiety. In addition, the healthcare cost impact, cost-effectiveness and patterns of use of Navigate will be assessed. This paper describes the study protocol. METHODS Three hundred four men and their partners are randomly assigned one-to-one to Navigate or to the control arm. Randomisation is electronically generated and stratified by site. Navigate is an online decision aid that presents up-to-date, unbiased information on LRPC tailored to Australian men and their partners including each management option and potential side-effects, and an interactive values clarification exercise. Participants in the control arm will be directed to the website of Australia's peak national body for prostate cancer. Eligible patients will be men within 3 months of being diagnosed with LRPC, aged 18 years or older, and who are yet to make a treatment decision, who are deemed eligible for AS by their treating clinician and who have Internet access and sufficient English to participate. The primary outcome is self-reported uptake of AS as the first-line management option. Secondary outcomes include self-reported preparedness for decision-making; decisional conflict, regret and satisfaction; quality of illness communication; and prostate cancer-specific quality of life. Uptake of AS 1 month after consent will be determined through patient self-report. Men and their partners will complete study outcome measures before randomisation and 1, 3 and 6 months after study consent. DISCUSSION The Navigate online decision aid has the potential to increase the choice of AS in LRPC, avoiding or delaying unnecessary radical treatments and associated side effects. In addition, Navigate is likely to reduce patients' and partners' confusion and distress in management decision-making and increase their quality of life. TRIAL REGISTRATION Australian and New Zealand Clinical Trial Registry ACTRN12616001665426 . Registered on 2 December 2016. All items from the WHO Trial Registration Data set can be found in this manuscript.
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Affiliation(s)
- Penelope Schofield
- Department of Psychology, Swinburne University of Technology, Melbourne, Victoria, Australia. .,Behavioural Science Unit, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia. .,Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Victoria, Australia. .,Swinburne University of Technology, John Street, Hawthorn, Australia.
| | - Karla Gough
- Behavioural Science Unit, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Department of Nursing, The University of Melbourne, Parkville, Victoria, Australia
| | - Amelia Hyatt
- Behavioural Science Unit, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Alan White
- Behavioural Science Unit, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Mark Frydenberg
- Department of Urology, Cabrini Institute, Cabrini Health, Malvern, Australia.,Department of Surgery, Monash University, Melbourne, Victoria, Australia
| | - Suzanne Chambers
- Faculty of Health, University of Technology Sydney, Sydney, Australia.,Health and Wellness Institute, Edith Cowan University, Perth, Australia.,Institute for Resilient Regions, University of Southern Queensland, Springfield, Australia.,Menzies Health Institute Queensland, Griffith University, Southport, Australia
| | - Louisa G Gordon
- Population Health Department, Health Economics, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia.,School of Nursing, Queensland University of Technology (QUT), Brisbane, Queensland, Australia.,School of Public Health, University of Queensland, Brisbane, Queensland, Australia
| | - Robert Gardiner
- School of Medicine, University of Queensland, Brisbane, Queensland, Australia.,Department of Urology, Royal Brisbane & Women's Hospital, Herston, Queensland, Australia
| | - Declan G Murphy
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Victoria, Australia.,Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Lawrence Cavedon
- School of Science, RMIT University, Melbourne, Victoria, Australia
| | - Natalie Richards
- Behavioural Science Unit, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Barbara Murphy
- Department of Psychology, The University of Melbourne, Parkville, Victoria, Australia.,Faculty of Health, Deakin University, Bundoora, Victoria, Australia
| | - Stephen Quinn
- Department of Health Science and Biostatistics, Swinburne University of Technology, Melbourne, Victoria, Australia
| | - Ilona Juraskova
- School of Psychology, Faculty of Science, Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), University of Sydney, Sydney, New South Wales, Australia
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Tong DC, Quinn S, Nasis A, Hiew C, Roberts-Thomson P, Adams H, Sriamareswaran R, Htun NM, Wilson W, Stub D, van Gaal W, Howes L, Collins N, Yong A, Bhindi R, Whitbourn R, Lee A, Hengel C, Asrress K, Freeman M, Amerena J, Wilson A, Layland J. Colchicine in Patients With Acute Coronary Syndrome. Circulation 2020; 142:1890-1900. [DOI: 10.1161/circulationaha.120.050771] [Citation(s) in RCA: 127] [Impact Index Per Article: 31.8] [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: 12/20/2022]
Abstract
Background:
Inflammation plays a crucial role in clinical manifestations and complications of acute coronary syndromes (ACS). Colchicine, a commonly used treatment for gout, has recently emerged as a novel therapeutic option in cardiovascular medicine owing to its anti-inflammatory properties. We sought to determine the potential usefulness of colchicine treatment in patients with ACS.
Methods:
This was a multicenter, randomized, double-blind, placebo-controlled trial involving 17 hospitals in Australia that provide acute cardiac care service. Eligible participants were adults (18–85 years) who presented with ACS and had evidence of coronary artery disease on coronary angiography managed with either percutaneous coronary intervention or medical therapy. Patients were assigned to receive either colchicine (0.5 mg twice daily for the first month, then 0.5 mg daily for 11 months) or placebo, in addition to standard secondary prevention pharmacotherapy, and were followed up for a minimum of 12 months. The primary outcome was a composite of all-cause mortality, ACS, ischemia-driven (unplanned) urgent revascularization, and noncardioembolic ischemic stroke in a time to event analysis.
Results:
A total of 795 patients were recruited between December 2015 and September 2018 (mean age, 59.8±10.3 years; 21% female), with 396 assigned to the colchicine group and 399 to the placebo group. Over the 12-month follow-up, there were 24 events in the colchicine group compared with 38 events in the placebo group (
P
=0.09, log-rank). There was a higher rate of total death (8 versus 1;
P
=0.017, log-rank) and, in particular, noncardiovascular death in the colchicine group (5 versus 0;
P
=0.024, log-rank). The rates of reported adverse effects were not different (colchicine 23.0% versus placebo 24.3%), and they were predominantly gastrointestinal symptoms (colchicine, 23.0% versus placebo, 20.8%).
Conclusions:
The addition of colchicine to standard medical therapy did not significantly affect cardiovascular outcomes at 12 months in patients with ACS and was associated with a higher rate of mortality.
Registration:
URL:
https://www.anzctr.org.au
; Unique identifier: ACTRN12615000861550.
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Affiliation(s)
- David C. Tong
- St Vincent’s Hospital Melbourne, Fitzroy, Victoria, Australia (D.C.T., R.W., A.W., J.L.)
- Cardiology, Department of Medicine, Peninsula Health, Frankston, Victoria, Australia (D.C.T., R.S., N.M.H., J.L.)
| | - Stephen Quinn
- Swinburne University of Technology, Department of Health Science and Biostatistics, Hawthorn, Victoria, Australia (S.Q.)
| | - Arthur Nasis
- MonashHeart, Monash Health, Clayton, Victoria, Australia (A.N.)
| | - Chin Hiew
- Barwon Health, University Hospital Geelong, Victoria, Australia (C.H., J.A.)
| | | | - Heath Adams
- Royal Hobart Hospital, Tasmania, Australia (P.R.-T., H.A.)
| | - Rumes Sriamareswaran
- Cardiology, Department of Medicine, Peninsula Health, Frankston, Victoria, Australia (D.C.T., R.S., N.M.H., J.L.)
| | - Nay M. Htun
- Cardiology, Department of Medicine, Peninsula Health, Frankston, Victoria, Australia (D.C.T., R.S., N.M.H., J.L.)
| | - William Wilson
- Royal Melbourne Hospital, Parkville, Victoria, Australia (W.W.)
| | - Dion Stub
- Western Health, St Albans, Victoria, Australia (D.S.)
| | | | - Laurie Howes
- Gold Coast University Hospital, Southport, Queensland, Australia (L.H.)
| | - Nicholas Collins
- John Hunter Hospital, New Lambton Heights, New South Wales, Australia (N.C.)
| | - Andy Yong
- Concord Repatriation General Hospital, New South Wales, Australia (A.Y.)
| | - Ravinay Bhindi
- Royal North Shore Hospital, St Leonards, New South Wales, Australia (R.B.)
| | - Robert Whitbourn
- St Vincent’s Hospital Melbourne, Fitzroy, Victoria, Australia (D.C.T., R.W., A.W., J.L.)
| | - Astin Lee
- Wollongong Hospital, New South Wales, Australia (A.L.)
| | - Chris Hengel
- Ballarat Health Services, Victoria, Australia (C.H.)
| | - Kaleab Asrress
- Bankstown-Lidcombe Hospital, Bankstown, New South Wales, Australia (K.A.)
| | | | - John Amerena
- Barwon Health, University Hospital Geelong, Victoria, Australia (C.H., J.A.)
| | - Andrew Wilson
- St Vincent’s Hospital Melbourne, Fitzroy, Victoria, Australia (D.C.T., R.W., A.W., J.L.)
| | - Jamie Layland
- St Vincent’s Hospital Melbourne, Fitzroy, Victoria, Australia (D.C.T., R.W., A.W., J.L.)
- Cardiology, Department of Medicine, Peninsula Health, Frankston, Victoria, Australia (D.C.T., R.S., N.M.H., J.L.)
- Peninsula Clinical School, Central Clinical School, Monash University, Victoria, Australia (J.L.)
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32
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von Doetinchem P, Perez K, Aramaki T, Baker S, Barwick S, Bird R, Boezio M, Boggs S, Cui M, Datta A, Donato F, Evoli C, Fabris L, Fabbietti L, Ferronato Bueno E, Fornengo N, Fuke H, Gerrity C, Gomez Coral D, Hailey C, Hooper D, Kachelriess M, Korsmeier M, Kozai M, Lea R, Li N, Lowell A, Manghisoni M, Moskalenko I, Munini R, Naskret M, Nelson T, Ng K, Nozzoli F, Oliva A, Ong R, Osteria G, Pierog T, Poulin V, Profumo S, Pöschl T, Quinn S, Re V, Rogers F, Ryan J, Saffold N, Sakai K, Salati P, Schael S, Serksnyte L, Shukla A, Stoessl A, Tjemsland J, Vannuccini E, Vecchi M, Winkler M, Wright D, Xiao M, Xu W, Yoshida T, Zampa G, Zuccon P. Cosmic-ray antinuclei as messengers of new physics: status and outlook for the new decade. J Cosmol Astropart Phys 2020; 2020:035. [PMID: 34712102 PMCID: PMC8549764 DOI: 10.1088/1475-7516/2020/08/035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The precise measurement of cosmic-ray antinuclei serves as an important means for identifying the nature of dark matter and other new astrophysical phenomena, and could be used with other cosmic-ray species to understand cosmic-ray production and propagation in the Galaxy. For instance, low-energy antideuterons would provide a "smoking gun" signature of dark matter annihilation or decay, essentially free of astrophysical background. Studies in recent years have emphasized that models for cosmic-ray antideuterons must be considered together with the abundant cosmic antiprotons and any potential observation of antihelium. Therefore, a second dedicated Antideuteron Workshop was organized at UCLA in March 2019, bringing together a community of theorists and experimentalists to review the status of current observations of cosmic-ray antinuclei, the theoretical work towards understanding these signatures, and the potential of upcoming measurements to illuminate ongoing controversies. This review aims to synthesize this recent work and present implications for the upcoming decade of antinuclei observations and searches. This includes discussion of a possible dark matter signature in the AMS-02 antiproton spectrum, the most recent limits from BESS Polar-II on the cosmic antideuteron flux, and reports of candidate antihelium events by AMS-02; recent collider and cosmic-ray measurements relevant for antinuclei production models; the state of cosmic-ray transport models in light of AMS-02 and Voyager data; and the prospects for upcoming experiments, such as GAPS. This provides a roadmap for progress on cosmic antinuclei signatures of dark matter in the coming years.
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Affiliation(s)
- P. von Doetinchem
- Department of Physics and Astronomy, University of Hawaii at Manoa, 2505 Correa Rd, Honolulu, HI 96822 U.S.A
| | - K. Perez
- Department of Physics, Massachusetts Institute of Technology, 77 Massachusetts Ave, Cambridge, MA 02139 U.S.A
| | - T. Aramaki
- Stanford Linear Accelerator Center, 2575 Sand Hill Rd, Menlo Park, CA 94025 U.S.A
| | - S. Baker
- Imperial College London, London, SW7 2AZ, U.K
| | - S. Barwick
- Department of Physics & Astronomy, University of California at Irvine, 4129 Frederick Reines Hall, Irvine, CA 92697, U.S.A
| | - R. Bird
- Department of Physics and Astronomy, University of California at Los Angeles, 475 Portola Plaza, Los Angeles, CA 90095, U.S.A
| | - M. Boezio
- INFN, Sezione di Trieste, Padriciano 99, 34149 Trieste, Italy
| | - S.E. Boggs
- Department of Physics, University of California at San Diego, 9500 Gilman Dr., La Jolla, CA 90037, U.S.A
| | - M. Cui
- Purple Mountain Observatory, Yuanhua Road, Qixia District, Nanjing 210033, China
| | - A. Datta
- Department of Physics and Astronomy, University of Hawaii at Manoa, 2505 Correa Rd, Honolulu, HI 96822 U.S.A
| | - F. Donato
- Department of Physics, University of Turin, Via Pietro Giuria, 1, 10125 Torino, Italy
- INFN, Sezione di Torino, Via Pietro Giuria, 1, 10125 Torino, Italy
| | - C. Evoli
- Gran Sasso Science Institute, Viale Francesco Crispi 7, 67100 L’Aquila, Italy
- INFN, Laboratori Nazionali del Gran Sasso, Via G. Acitelli, 22, 67100 Assergi, L’Aquila, Italy
| | - L. Fabris
- Isotope and Fuel Cycle and Technology Division, Oak Ridge National Laboratory, PO BOX 2008, Oak Ridge, TN 37831, U.S.A
| | - L. Fabbietti
- Department of Physics, Technical University of Munich, James-Franck Str. 1, 85748 Garching, Germany
| | - E. Ferronato Bueno
- Kapteyn Astronomical Institute, Rijksuniversiteit Groningen, Landleven 12, 9717 AD Groningen, The Netherlands
| | - N. Fornengo
- Department of Physics, University of Turin, Via Pietro Giuria, 1, 10125 Torino, Italy
- INFN, Sezione di Torino, Via Pietro Giuria, 1, 10125 Torino, Italy
| | - H. Fuke
- Institute of Space and Astronautical Science, Japan Aerospace Exploration Agency (ISAS/JAXA), Sagamihara, Kanagawa 252-5210, Japan
| | - C. Gerrity
- Department of Physics and Astronomy, University of Hawaii at Manoa, 2505 Correa Rd, Honolulu, HI 96822 U.S.A
| | - D. Gomez Coral
- Department of Physics and Astronomy, University of Hawaii at Manoa, 2505 Correa Rd, Honolulu, HI 96822 U.S.A
- Institute of Physics, National Autonomous University of Mexico, Circuito de la investigación científica, C.U. 04510, Ciudad de México, Mexico
| | - C. Hailey
- Department of Physics, Columbia University, 500 W 120th St, New York, NY 10027, U.S.A
| | - D. Hooper
- Theoretical Astrophysics, Fermi National Accelerator Laboratory, Wilson and Kirk Rds, Batavia, IL 60510, U.S.A
- Department of Astronomy and Astrophysics, University of Chicago, 5640 S. Ellis Ave, Chicago, IL 60637, U.S.A
- Kavli Institute for Cosmological Physics, University of Chicago, 5640 S. Ellis Ave, Chicago, IL 60637, U.S.A
| | - M. Kachelriess
- Department of Physics, Norwegian University of Science and Technology, 7491 Trondheim, Norway
| | - M. Korsmeier
- Department of Physics, University of Turin, Via Pietro Giuria, 1, 10125 Torino, Italy
- INFN, Sezione di Torino, Via Pietro Giuria, 1, 10125 Torino, Italy
- Institute for Theoretical Particle Physics and Cosmology, RWTH Aachen University, 52056 Aachen, Germany
| | - M. Kozai
- Institute of Space and Astronautical Science, Japan Aerospace Exploration Agency (ISAS/JAXA), Sagamihara, Kanagawa 252-5210, Japan
| | - R. Lea
- INFN, Sezione di Trieste, Padriciano 99, 34149 Trieste, Italy
- Dipartimento di Fisica dell’Universitá Trieste, Via Valerio 2, 34127 Trieste, Italy
| | - N. Li
- CAS Key Laboratory of Theoretical Physics, Institute of Theoretical Physics, Chinese Academy of Sciences, Beijing 100190, China
- University of Chinese Academy of Sciences, No.19A Yuquan Road, Shijingshan District, Beijing 100049, China
| | - A. Lowell
- Department of Physics, University of California at San Diego, 9500 Gilman Dr., La Jolla, CA 90037, U.S.A
| | - M. Manghisoni
- INFN, Sezione di Pavia, Via Agostino Bassi 6, 27100 Pavia, Italy
- Dipartimento di Ingegneria Industriale, Università di Bergamo, Viale Marconi 5, 24044 Dalmine, Italy
| | - I.V. Moskalenko
- Hansen Experimental Physics Laboratory, Stanford University, 452 Lomita Mall, Stanford, CA 94305, U.S.A
- Kavli Institute for Particle Astrophysics and Cosmology, Stanford University, CA 94305, U.S.A
| | - R. Munini
- INFN, Sezione di Trieste, Padriciano 99, 34149 Trieste, Italy
| | - M. Naskret
- Department of Physics and Astronomy, University of Hawaii at Manoa, 2505 Correa Rd, Honolulu, HI 96822 U.S.A
- Institute of Theoretical Physics, University of Wroclaw, pl. M. Borna 9, 50-204 Wroclaw, Poland
| | - T. Nelson
- Department of Physics and Astronomy, University of Hawaii at Manoa, 2505 Correa Rd, Honolulu, HI 96822 U.S.A
| | - K.C.Y. Ng
- Department of Particle Physics and Astrophysics, Weizmann Institute of Science, Rehovot 76100, Israel
| | - F. Nozzoli
- INFN, Trento Institute for Fundamental Physics and Applications, Via Sommarive, 14, 38123 Povo, Italy
| | - A. Oliva
- INFN, Sezione di Bologna, Via Irnerio 46, Bologna 40126, Italy
| | - R.A. Ong
- Department of Physics and Astronomy, University of California at Los Angeles, 475 Portola Plaza, Los Angeles, CA 90095, U.S.A
| | - G. Osteria
- INFN, Sezione di Napoli, Strada Comunale Cinthia, 80126 Naples, Italy
| | - T. Pierog
- Institute for Nuclear Physics, Karlsruhe Institute of Technology, Hermann-von-Helmholtz-Platz 1, 76344 Eggenstein-Leopoldshafen, Germany
| | - V. Poulin
- Laboratoire Univers & Particules de Montpellier, CNRS, Université de Montpellier, Place Eugène Bataillon, 34095 Montpellier Cedex 05, France
| | - S. Profumo
- Department of Physics and Santa Cruz Institute for Particle Physics, University of California, Santa Cruz, CA 95064, U.S.A
| | - T. Pöschl
- Department of Physics, Technical University of Munich, James-Franck Str. 1, 85748 Garching, Germany
| | - S. Quinn
- Department of Physics and Astronomy, University of California at Los Angeles, 475 Portola Plaza, Los Angeles, CA 90095, U.S.A
| | - V. Re
- INFN, Sezione di Pavia, Via Agostino Bassi 6, 27100 Pavia, Italy
- Dipartimento di Ingegneria Industriale, Università di Bergamo, Viale Marconi 5, 24044 Dalmine, Italy
| | - F. Rogers
- Department of Physics, Massachusetts Institute of Technology, 77 Massachusetts Ave, Cambridge, MA 02139 U.S.A
| | - J. Ryan
- Department of Physics and Astronomy, University of California at Los Angeles, 475 Portola Plaza, Los Angeles, CA 90095, U.S.A
| | - N. Saffold
- Department of Physics, Columbia University, 500 W 120th St, New York, NY 10027, U.S.A
| | - K. Sakai
- NASA-Goddard Space Flight Center), 8800 Greenbelt Rd, Greenbelt, MD 20771, U.S.A
- CRESST, University of Maryland, Baltimore County, MD 21250, U.S.A
| | - P. Salati
- Laboratoire d’Annecy-le-Vieux de Physique Théorique, 9 Chemin de Bellevue, 74940 Annecy, France
| | - S. Schael
- I. Physikalisches Institut, RWTH Aachen University, Sommerfeldstr. 14, 52074 Aachen, Germany
| | - L. Serksnyte
- Department of Physics, Technical University of Munich, James-Franck Str. 1, 85748 Garching, Germany
| | - A. Shukla
- Department of Physics and Astronomy, University of Hawaii at Manoa, 2505 Correa Rd, Honolulu, HI 96822 U.S.A
| | - A. Stoessl
- Department of Physics and Astronomy, University of Hawaii at Manoa, 2505 Correa Rd, Honolulu, HI 96822 U.S.A
| | - J. Tjemsland
- Department of Physics, Norwegian University of Science and Technology, 7491 Trondheim, Norway
| | - E. Vannuccini
- INFN, Sezione di Firenze, 50019 Sesto Fiorentino, Florence, Italy
| | - M. Vecchi
- Kapteyn Astronomical Institute, Rijksuniversiteit Groningen, Landleven 12, 9717 AD Groningen, The Netherlands
| | - M.W. Winkler
- The Oskar Klein Centre for Cosmoparticle Physics, Department of Physics, Stockholm University, Alba Nova, 10691 Stockholm, Sweden
| | - D. Wright
- Stanford Linear Accelerator Center, 2575 Sand Hill Rd, Menlo Park, CA 94025 U.S.A
| | - M. Xiao
- Department of Physics, Massachusetts Institute of Technology, 77 Massachusetts Ave, Cambridge, MA 02139 U.S.A
| | - W. Xu
- Department of Physics, Harvard University, 17 Oxford St, Cambridge, MA, 95129, U.S.A
| | - T. Yoshida
- Institute of Space and Astronautical Science, Japan Aerospace Exploration Agency (ISAS/JAXA), Sagamihara, Kanagawa 252-5210, Japan
| | - G. Zampa
- INFN, Sezione di Trieste, Padriciano 99, 34149 Trieste, Italy
| | - P. Zuccon
- INFN, Trento Institute for Fundamental Physics and Applications, Via Sommarive, 14, 38123 Povo, Italy
- Department of Physics, University of Trento, Via Sommarive 14, 38123 Povo, Italy
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Wali S, Balfoussia D, Touqmatchi D, Quinn S. Misoprostol for open myomectomy: a systematic review and meta-analysis of randomised control trials. BJOG 2020; 128:476-483. [PMID: 32613769 DOI: 10.1111/1471-0528.16389] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/19/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Excessive blood loss is a significant risk of myomectomy with the potential need for hysterectomy. OBJECTIVE To study the effectiveness of preoperative misoprostol compared with placebo at open myomectomy on intra- and postoperative outcomes. SEARCH STRATEGY PubMed, Cochrane, Scopus, MEDLINE and EMBASE. SELECTION CRITERIA Randomised control studies of women undergoing open myomectomy for symptomatic fibroids who were given either misoprostol or placebo preoperatively. DATA COLLECTION AND ANALYSIS The revised Cochrane risk-of-bias tool for randomised trials was used to assess the risk of bias. Primary outcomes were blood loss, drop in haemoglobin and need for blood transfusion. Secondary outcomes were operative time, postoperative pyrexia and length of postoperative stay. Pooled effect sizes with corresponding 95% CI were calculated using random effects models. Data were analysed using two statistical models for statistical reliability. RESULTS Eight studies were included with a total of 385 patients, of which 192 received misoprostol. Preoperative misoprostol was significantly associated with lower blood loss by -170.32 ml (95% CI -201.53 to -139.10), lower drop in haemoglobin by -0.48 g/dl (95% CI -0.65 to -0.31), reduced need for blood transfusion (odds ratio [OR] -0.48, 95% CI -0.65 to -0.31), and a reduction in operative time by -11.64 minutes (95% CI -15.73 to -7.54). There was no difference in postoperative pyrexia or length of postoperative stay. CONCLUSION Moderate- to high-quality studies have established that misoprostol minimises blood loss and need for blood transfusion at open myomectomy. This low-cost and readily available drug should be routinely administered prior to open myomectomy to improve clinical outcomes. TWEETABLE ABSTRACT Use of misoprostol at open myomectomy reduces blood loss and need for blood transfusion with no impact on postoperative pyrexia.
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Affiliation(s)
- S Wali
- Department of Obstetrics and Gynaecology, Hillingdon Hospital, London, UK
| | - D Balfoussia
- Department of Obstetrics and Gynaecology, Hillingdon Hospital, London, UK
| | - D Touqmatchi
- Department of Obstetrics and Gynaecology, Hillingdon Hospital, London, UK
| | - S Quinn
- Department of Obstetrics and Gynaecology, St Mary's Hospital Paddington, London, UK
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34
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Ayoola A, Sukumaran S, Jain K, Kumar R, Gordon D, Honda-Okubo Y, Quinn S, Roy A, Vatandoust S, Koczwara B, Kichenadasse G, Richards A, Mead K, Karapetis C. Efficacy of influenza vaccine (Fluvax) in cancer patients on treatment: a prospective single arm, open-label study. Support Care Cancer 2020; 28:5411-5417. [PMID: 32144585 DOI: 10.1007/s00520-020-05384-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 02/26/2020] [Indexed: 11/27/2022]
Abstract
PURPOSE Influenza virus infection has significant morbidity and mortality in patients with medical co-morbidities who are also immunosuppressed. The efficacy of the seasonal influenza vaccine has not been well studied in patients receiving chemotherapy. We assessed the efficacy of seasonal influenza vaccine in patients with non-haematological malignancy on active treatment (chemotherapy and targeted therapy). METHODS A prospective single arm, open label study with 53 patients with non-haematological cancers recruited during the 2011 and 2012 influenza seasons. Participants had one dose of 2011/2012 trivalent vaccine containing strains A/California/7/2009(H1N1), A/Perth/16/2009 (H3N2) and B/Brisbane/60/2008 (Fluvax) prior to or in-between treatment cycles. Haemagglutination inhibition antibody (HIA) titres in serum were measured at baseline 3, 6 and 24 weeks. Primary endpoint: seroconversion rate (SCR) at 3 weeks. Secondary endpoints: late SCR at 6 weeks. rate of sustained sero-protection titres (SPR) at 24 weeks. Seroconversion was defined as postvaccination ≥ 4-fold increase in HIA titre and sero-protection defined as a HIA ≥ 1:40. RESULTS The SCR at 3 weeks were 35%, 30% and 22.5% to the H1N1, H3N2 and B/Bris strains, respectively. There were no new cases of late SC at 6 weeks or 24 weeks. The SPR at 3 weeks were 72.5%, 65% and 40%, respectively, to H1N1, H3N2 and B/Bris. The SPR at 24 weeks to H1N1, H3N2 and B/Bris were 40%, 52.5% and 17.5%, respectively. CONCLUSIONS Patients on various solid tumour treatments achieve sero-protection rate congruent with the general population. The sero-protection HIA titres were not sustained at 24 weeks postvaccination.
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Affiliation(s)
- A Ayoola
- Department of Medical Oncology, Flinders Medical Centre, Bedford Park, Adelaide, 5042, Australia.
| | - S Sukumaran
- Department of Medical Oncology, Flinders Medical Centre, Bedford Park, Adelaide, 5042, Australia
- Flinders Centre for Innovation in Cancer, Flinders University, Bedford Park, Adelaide, 5042, Australia
| | - K Jain
- Department of Medical Oncology, Flinders Medical Centre, Bedford Park, Adelaide, 5042, Australia
| | - R Kumar
- Department of Medical Oncology, Flinders Medical Centre, Bedford Park, Adelaide, 5042, Australia
| | - D Gordon
- Department of Microbiology and Infectious Diseases, Flinders University and Flinders Medical Centre, Bedford Park, Adelaide, 5042, Australia
| | - Y Honda-Okubo
- Department of Endocrinology, Flinders Medical Centre, Bedford Park, Adelaide, 5042, Australia
| | - S Quinn
- Department of Statistics, Data Science and Epidemiology, Swinburne University of Technology, Melbourne, 3122, Australia
| | - A Roy
- Department of Medical Oncology, Flinders Medical Centre, Bedford Park, Adelaide, 5042, Australia
- Flinders Centre for Innovation in Cancer, Flinders University, Bedford Park, Adelaide, 5042, Australia
| | - S Vatandoust
- Department of Medical Oncology, Flinders Medical Centre, Bedford Park, Adelaide, 5042, Australia
- Flinders Centre for Innovation in Cancer, Flinders University, Bedford Park, Adelaide, 5042, Australia
| | - B Koczwara
- Department of Medical Oncology, Flinders Medical Centre, Bedford Park, Adelaide, 5042, Australia
- Flinders Centre for Innovation in Cancer, Flinders University, Bedford Park, Adelaide, 5042, Australia
| | - G Kichenadasse
- Department of Medical Oncology, Flinders Medical Centre, Bedford Park, Adelaide, 5042, Australia
- Flinders Centre for Innovation in Cancer, Flinders University, Bedford Park, Adelaide, 5042, Australia
| | - A Richards
- Department of Medical Oncology, Flinders Medical Centre, Bedford Park, Adelaide, 5042, Australia
| | - K Mead
- Department of Medical Oncology, Flinders Medical Centre, Bedford Park, Adelaide, 5042, Australia
| | - C Karapetis
- Department of Medical Oncology, Flinders Medical Centre, Bedford Park, Adelaide, 5042, Australia
- Flinders Centre for Innovation in Cancer, Flinders University, Bedford Park, Adelaide, 5042, Australia
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Cole J, Lew R, Quinn S, Htun N, Freilich M, Layland J. 806 COlchicine to Prevent PeriprocEdural Myocardial Injury in Percutaneous Coronary Intervention (COPE-PCI Trial). Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.813] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Barcroft JF, Al-Kufaishi A, Lowe J, Quinn S. Risk of vasopressin use: a case of acute pulmonary oedema, post intramyometrial infiltration of vasopressin in laparoscopic myomectomy. BMJ Case Rep 2019; 12:12/12/e231331. [PMID: 31831516 PMCID: PMC6936500 DOI: 10.1136/bcr-2019-231331] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A 34-year-old patient underwent a laparoscopic myomectomy, complicated by a profound episode of bradycardia and hypotension following intramyometrial infiltration of vasopressin (20 IU), promptly corrected with intravenous ephedrine (6 mg) and glycopyrrolate (200 µg). At extubation, pink frothy fluid was noted in the endotracheal tube; she was visibly distressed, desaturated to 89% in air and was coughing up pink stained fluid. Acute pulmonary oedema secondary to vasopressin was suspected. A tight-fitting oxygen mask (100%) with positive end expiratory pressure was applied and intravenous furosemide (20 mg) and diamorphine (4 mg, 1 mg increments) were administered to facilitate diuresis and oxygenation. Chest X-ray confirmed acute pulmonary oedema. Arterial blood gas demonstrated type 2 respiratory failure. Over 12 hours, the oxygen was weaned to 1 L/min. She demonstrated excellent diuresis. Troponin and brain-natriuretic peptide were elevated, but echocardiogram was normal. The cardiology diagnosis was vasopressin-induced coronary vasospasm, precipitating acute pulmonary oedema. She was discharged home on day 5.
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Affiliation(s)
| | | | - Justine Lowe
- Imperial College Healthcare NHS Trust, London, UK
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Roberts G, Chong C, Quinn S, Cameron‐Collins S, Forbes H, Johnson JL, Kitto L, Marotti S, Nguyen H, Reid S, Sullivan C, Spyrou N, Wierenga L, Wisdom A. Evaluation of the effect of direct oral anticoagulant availability on hospital presentations for bleeding related to oral anticoagulation in South Australia. J Pharm Pract Res 2019. [DOI: 10.1002/jppr.1567] [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] [Indexed: 11/07/2022]
Affiliation(s)
- Greg Roberts
- SA Pharmacy Flinders Medical Centre Adelaide Australia
- School of Medicine Flinders University Adelaide Australia
| | - Cher‐Rin Chong
- SA Pharmacy The Queen Elizabeth Hospital Adelaide Australia
- School of Medicine University of Adelaide Adelaide Australia
| | - Stephen Quinn
- Department of Statistics Data Science and Epidemiology Swinburne University of Technology Melbourne Australia
| | | | - Heather Forbes
- SA Pharmacy Repatriation General Hospital Adelaide Australia
| | - Jacinta Lee Johnson
- SA Pharmacy Flinders Medical Centre Adelaide Australia
- School of Pharmacy and Medical Sciences University of South Australia Adelaide Australia
| | - Lisa Kitto
- SA Pharmacy Noarlunga Hospital Adelaide Australia
| | - Sally Marotti
- SA Pharmacy The Queen Elizabeth Hospital Adelaide Australia
| | - Hahn Nguyen
- SA Pharmacy The Queen Elizabeth Hospital Adelaide Australia
| | - Susan Reid
- SA Pharmacy Royal Adelaide Hospital Adelaide Australia
| | | | - Nick Spyrou
- SA Pharmacy The Queen Elizabeth Hospital Adelaide Australia
| | - Lauren Wierenga
- SA Pharmacy Repatriation General Hospital Adelaide Australia
| | - Alice Wisdom
- SA Pharmacy Noarlunga Hospital Adelaide Australia
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Lambert GW, Head GA, Chen WS, Hamer M, Malan NT, Quinn S, Schlaich MP, Malan L. Ambulatory blood pressure monitoring and morning surge in blood pressure in adult black and white South Africans. J Clin Hypertens (Greenwich) 2019; 22:21-28. [PMID: 31769175 DOI: 10.1111/jch.13740] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 07/15/2019] [Revised: 09/24/2019] [Accepted: 10/07/2019] [Indexed: 12/01/2022]
Abstract
We examined whether there were differences in the circadian variation in blood pressure and the morning surge in blood pressure between black and white Africans. Clinic and ambulatory blood pressure data obtained from the Sympathetic Activity and Ambulatory Blood Pressure in Africans (SABPA) study was examined (n = 406; 49% black African). Ambulatory blood pressure readings were fitted to a six-parameter double logistic equation to determine the power and rate of the morning surge in blood pressure. Multiple linear regression analysis was used to examine differences in blood pressure between black and white participants. Clinic and ambulatory blood pressure were higher in black participants throughout the day and night. In those taking medications, blood pressure was less well controlled in black subjects. Despite the higher systolic blood pressure, the day-night difference estimated by the logistic function was similar in black and white participants. However, the rate of rise and power in the morning surge in blood pressure was lower in black participants. We conclude that black participants of the SABPA study present with higher blood pressure throughout the day and night but have a lower power of the morning surge in blood pressure due to a slower morning rate of increase. Moreover, they had an increased prevalence of undiagnosed hypertension and, in those taking medication, were less likely to have their blood pressure controlled than their white counterparts.
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Affiliation(s)
- Gavin W Lambert
- Iverson Health Innovation Research Institute, Swinburne University of Technology, Melbourne, Vic., Australia.,School of Health Science, Swinburne University of Technology, Melbourne, Vic., Australia.,Human Neurotransmitters Laboratory, Baker Heart and Diabetes Institute, Melbourne, Vic., Australia
| | - Geoffrey A Head
- Neuropharmacology Laboratory, Baker Heart and Diabetes Institute, Melbourne, Vic., Australia
| | - Won Sun Chen
- Department of Statistics, Data Science and Epidemiology, Swinburne University of Technology, Melbourne, Vic., Australia
| | - Mark Hamer
- School Sport, Exercise & Health Sciences, Loughborough University, Loughborough, UK
| | - Nicolaas T Malan
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa
| | - Stephen Quinn
- Department of Statistics, Data Science and Epidemiology, Swinburne University of Technology, Melbourne, Vic., Australia
| | - Markus P Schlaich
- Neurovascular Hypertension and Kidney Disease Laboratory, Baker Heart and Diabetes Institute, Melbourne, Vic, Australia.,Royal Perth Hospital Unit, Dobney Hypertension Centre, School of Medicine, University of Western Australia, Perth, WA, Australia
| | - Leone Malan
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa
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Lenferink A, van der Palen J, van der Valk PDLPM, Cafarella P, van Veen A, Quinn S, Groothuis-Oudshoorn CGM, Burt MG, Young M, Frith PA, Effing TW. Exacerbation action plans for patients with COPD and comorbidities: a randomised controlled trial. Eur Respir J 2019; 54:13993003.02134-2018. [PMID: 31413163 DOI: 10.1183/13993003.02134-2018] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Accepted: 07/22/2019] [Indexed: 11/05/2022]
Abstract
This international randomised controlled trial evaluated whether COPD patients with comorbidities, trained in using patient-tailored multidisease exacerbation action plans, had fewer COPD exacerbation days than usual care (UC).COPD patients (Global Initiative for Chronic Obstructive Lung Disease (GOLD) classification II-IV) with ≥1 comorbidity (ischaemic heart disease, heart failure, diabetes, anxiety, depression) were randomised to a patient-tailored self-management intervention (n=102) or UC (n=99). Daily symptom diaries were completed for 12 months. The primary outcome "COPD exacerbation days per patient per year" was assessed using intention-to-treat analyses.No significant difference was observed in the number of COPD exacerbation days per patient per year (self-management: median 9.6 (interquartile range (IQR) 0.7-31.1); UC: median 15.6 (IQR 3.0-40.3); incidence rate ratio (IRR) 0.87 (95% CI 0.54; 1.39); p=0.546). There was a significantly shorter duration per COPD exacerbation for self-management (self-management: median 8.1 (IQR 4.8-10.1) days; UC: median 9.5 (IQR 7.0-15.1) days; p=0.021), with no between-group differences in the total number of respiratory hospitalisations (IRR 0.76 (95% CI 0.42; 1.35); p=0.348), but a lower probability of ≥1 for respiratory-related hospitalisation compared to UC (relative risk 0.55 (95% CI 0.35; 0.87); p=0.008). No between-group differences were observed in all-cause hospitalisations (IRR 1.07 (95% CI 0.66; 1.72)) or mortality (self-management: n=4 (3.9%); UC: n=7 (7.1%); relative risk 0.55 (95% CI 0.17; 1.84)).Patient-tailored exacerbation action plans for COPD patients with comorbidities did not significantly reduce exacerbation days, but reduced the duration per COPD exacerbation and the risk of having at least one respiratory-related hospitalisation during follow-up, without excess all-cause mortality.
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Affiliation(s)
- Anke Lenferink
- Dept of Pulmonary Medicine, Medisch Spectrum Twente, Enschede, The Netherlands .,Dept of Health Technology and Services Research, Faculty of Behavioural, Management and Social Sciences, Technical Medical Centre, University of Twente, Enschede, The Netherlands.,College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Job van der Palen
- Dept of Pulmonary Medicine, Medisch Spectrum Twente, Enschede, The Netherlands.,Dept of Research Methodology, Measurement, and Data-Analysis, Faculty of Behavioural, Management and Social Sciences, University of Twente, Enschede, The Netherlands
| | | | - Paul Cafarella
- College of Medicine and Public Health, Flinders University, Adelaide, Australia.,Dept of Respiratory Medicine, Southern Adelaide Local Health Network, Adelaide, Australia
| | - Anneke van Veen
- Dept of Pulmonary Medicine, Canisius-Wilhelmina Ziekenhuis, Nijmegen, The Netherlands
| | - Stephen Quinn
- Dept of Statistics, Data Science and Epidemiology, Swinburne University of Technology, Melbourne, Australia
| | - Catharina G M Groothuis-Oudshoorn
- Dept of Health Technology and Services Research, Faculty of Behavioural, Management and Social Sciences, Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | - Morton G Burt
- College of Medicine and Public Health, Flinders University, Adelaide, Australia.,Southern Adelaide Diabetes and Endocrine Services, Flinders Medical Centre, Adelaide, Australia
| | - Mary Young
- Dept of Thoracic Medicine, Royal Adelaide Hospital, Adelaide, Australia
| | - Peter A Frith
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Tanja W Effing
- College of Medicine and Public Health, Flinders University, Adelaide, Australia.,Dept of Respiratory Medicine, Southern Adelaide Local Health Network, Adelaide, Australia
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Aab A, Abreu P, Aglietta M, Albuquerque I, Albury J, Allekotte I, Almela A, Alvarez Castillo J, Alvarez-Muñiz J, Anastasi G, Anchordoqui L, Andrada B, Andringa S, Aramo C, Asorey H, Assis P, Avila G, Badescu A, Bakalova A, Balaceanu A, Barbato F, Barreira Luz R, Baur S, Becker K, Bellido J, Berat C, Bertaina M, Bertou X, Biermann P, Biteau J, Blaess S, Blanco A, Blazek J, Bleve C, Boháčová M, Boncioli D, Bonifazi C, Borodai N, Botti A, Brack J, Bretz T, Bridgeman A, Briechle F, Buchholz P, Bueno A, Buitink S, Buscemi M, Caballero-Mora K, Caccianiga L, Calcagni L, Cancio A, Canfora F, Carceller J, Caruso R, Castellina A, Catalani F, Cataldi G, Cazon L, Cerda M, Chinellato J, Chudoba J, Chytka L, Clay R, Cobos Cerutti A, Colalillo R, Coleman A, Coluccia M, Conceição R, Condorelli A, Consolati G, Contreras F, Convenga F, Cooper M, Coutu S, Covault C, Daniel B, Dasso S, Daumiller K, Dawson B, Day J, de Almeida R, de Jong S, De Mauro G, de Mello Neto J, De Mitri I, de Oliveira J, de Oliveira Salles F, de Souza V, Debatin J, del Río M, Deligny O, Dhital N, Díaz Castro M, Diogo F, Dobrigkeit C, D’Olivo J, Dorosti Q, dos Anjos R, Dova M, Dundovic A, Ebr J, Engel R, Erdmann M, Escobar C, Etchegoyen A, Falcke H, Farmer J, Farrar G, Fauth A, Fazzini N, Feldbusch F, Fenu F, Ferreyro L, Figueira J, Filipčič A, Freire M, Fujii T, Fuster A, García B, Gemmeke H, Gherghel-Lascu A, Ghia P, Giaccari U, Giammarchi M, Giller M, Głas D, Glombitza J, Gobbi F, Golup G, Gómez Berisso M, Gómez Vitale P, Gongora J, González N, Goos I, Góra D, Gorgi A, Gottowik M, Grubb T, Guarino F, Guedes G, Guido E, Halliday R, Hampel M, Hansen P, Harari D, Harrison T, Harvey V, Haungs A, Hebbeker T, Heck D, Heimann P, Hill G, Hojvat C, Holt E, Homola P, Hörandel J, Horvath P, Hrabovský M, Huege T, Hulsman J, Insolia A, Isar P, Jandt I, Johnsen J, Josebachuili M, Jurysek J, Kääpä A, Kampert K, Keilhauer B, Kemmerich N, Kemp J, Klages H, Kleifges M, Kleinfeller J, Krause R, Kuempel D, Kukec Mezek G, Kuotb Awad A, Lago B, LaHurd D, Lang R, Legumina R, Leigui de Oliveira M, Lenok V, Letessier-Selvon A, Lhenry-Yvon I, Lippmann O, Lo Presti D, Lopes L, López R, López Casado A, Lorek R, Luce Q, Lucero A, Malacari M, Mancarella G, Mandat D, Manning B, Mantsch P, Mariazzi A, Mariş I, Marsella G, Martello D, Martinez H, Martínez Bravo O, Mastrodicasa M, Mathes H, Mathys S, Matthews J, Matthiae G, Mayotte E, Mazur P, Medina-Tanco G, Melo D, Menshikov A, Merenda KD, Michal S, Micheletti M, Middendorf L, Miramonti L, Mitrica B, Mockler D, Mollerach S, Montanet F, Morello C, Morlino G, Mostafá M, Müller A, Muller M, Müller S, Mussa R, Nellen L, Nguyen P, Niculescu-Oglinzanu M, Niechciol M, Nitz D, Nosek D, Novotny V, Nožka L, Nucita A, Núñez L, Olinto A, Palatka M, Pallotta J, Panetta M, Papenbreer P, Parente G, Parra A, Pech M, Pedreira F, Pȩkala J, Pelayo R, Peña-Rodriguez J, Pereira L, Perlin M, Perrone L, Peters C, Petrera S, Phuntsok J, Pierog T, Pimenta M, Pirronello V, Platino M, Poh J, Pont B, Porowski C, Prado R, Privitera P, Prouza M, Puyleart A, Querchfeld S, Quinn S, Ramos-Pollan R, Rautenberg J, Ravignani D, Reininghaus M, Ridky J, Riehn F, Risse M, Ristori P, Rizi V, Rodrigues de Carvalho W, Rodriguez Rojo J, Roncoroni M, Roth M, Roulet E, Rovero A, Ruehl P, Saffi S, Saftoiu A, Salamida F, Salazar H, Salina G, Sanabria Gomez J, Sánchez F, Santos E, Santos E, Sarazin F, Sarmento R, Sarmiento-Cano C, Sato R, Savina P, Schauer M, Scherini V, Schieler H, Schimassek M, Schimp M, Schlüter F, Schmidt D, Scholten O, Schovánek P, Schröder F, Schröder S, Schumacher J, Sciutto S, Scornavacche M, Shellard R, Sigl G, Silli G, Sima O, Šmída R, Snow G, Sommers P, Soriano J, Souchard J, Squartini R, Stanca D, Stanič S, Stasielak J, Stassi P, Stolpovskiy M, Streich A, Suarez F, Suárez-Durán M, Sudholz T, Suomijärvi T, Supanitsky A, Šupík J, Szadkowski Z, Taboada A, Taborda O, Tapia A, Timmermans C, Todero Peixoto C, Tomé B, Torralba Elipe G, Travaini A, Travnicek P, Trini M, Tueros M, Ulrich R, Unger M, Urban M, Valdés Galicia J, Valiño I, Valore L, van Bodegom P, van den Berg A, van Vliet A, Varela E, Vargas Cárdenas B, Veberič D, Ventura C, Vergara Quispe I, Verzi V, Vicha J, Villaseñor L, Vink J, Vorobiov S, Wahlberg H, Watson A, Weber M, Weindl A, Wiedeński M, Wiencke L, Wilczyński H, Winchen T, Wirtz M, Wittkowski D, Wundheiler B, Yang L, Yushkov A, Zas E, Zavrtanik D, Zavrtanik M, Zehrer L, Zepeda A, Zimmermann B, Ziolkowski M, Zong Z, Zuccarello F. Data-driven estimation of the invisible energy of cosmic ray showers with the Pierre Auger Observatory. Int J Clin Exp Med 2019. [DOI: 10.1103/physrevd.100.082003] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Chew DP, Lambrakis K, Blyth A, Seshadri A, Edmonds MJR, Briffa T, Cullen LA, Quinn S, Karnon J, Chuang A, Nelson AJ, Wright D, Horsfall M, Morton E, French JK, Papendick C. A Randomized Trial of a 1-Hour Troponin T Protocol in Suspected Acute Coronary Syndromes: The Rapid Assessment of Possible Acute Coronary Syndrome in the Emergency Department With High-Sensitivity Troponin T Study (RAPID-TnT). Circulation 2019; 140:1543-1556. [PMID: 31478763 DOI: 10.1161/circulationaha.119.042891] [Citation(s) in RCA: 132] [Impact Index Per Article: 26.4] [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: 11/16/2022]
Abstract
BACKGROUND High-sensitivity troponin assays promise earlier discrimination of myocardial infarction. Yet, the benefits and harms of this improved discriminatory performance when incorporated within rapid testing protocols, with respect to subsequent testing and clinical events, has not been evaluated in an in-practice patient-level randomized study. This multicenter study evaluated the noninferiority of a 0/1-hour high-sensitivity cardiac troponin T (hs-cTnT) protocol in comparison with a 0/3-hour masked hs-cTnT protocol in patients with suspected acute coronary syndrome presenting to the emergency department (ED). METHODS Patients were randomly assigned to either a 0/1-hour hs-cTnT protocol (reported to the limit of detection [<5 ng/L]) or masked hs-cTnT reported to ≤29 ng/L evaluated at 0/3-hours (standard arm). The 30-day primary end point was all-cause death and myocardial infarction. Noninferiority was defined as an absolute margin of 0.5% determined by Poisson regression. RESULTS In total, 3378 participants with an emergency presentation were randomly assigned between August 2015 and April 2019. Ninety participants were deemed ineligible or withdrew consent. The remaining participants received care guided either by the 0/1-hour hs-cTnT protocol (n=1646) or the 0/3-hour standard masked hs-cTnT protocol (n=1642) and were followed for 30 days. Median age was 59 (49-70) years, and 47% were female. Participants in the 0/1-hour arm were more likely to be discharged from the ED (0/1-hour arm: 45.1% versus standard arm: 32.3%, P<0.001) and median ED length of stay was shorter (0/1-hour arm: 4.6 [interquartile range, 3.4-6.4] hours versus standard arm: 5.6 (interquartile range, 4.0-7.1) hours, P<0.001). Those randomly assigned to the 0/1-hour protocol were less likely to undergo functional cardiac testing (0/1-hour arm: 7.5% versus standard arm: 11.0%, P<0.001). The 0/1-hour hs-cTnT protocol was not inferior to standard care (0/1-hour arm: 17/1646 [1.0%] versus 16/1642 [1.0%]; incidence rate ratio, 1.06 [ 0.53-2.11], noninferiority P value=0.006, superiority P value=0.867), although an increase in myocardial injury was observed. Among patients discharged from ED, the 0/1-hour protocol had a negative predictive value of 99.6% (95% CI, 99.0-99.9%) for 30-day death or myocardial infarction. CONCLUSIONS This in-practice evaluation of a 0/1-hour hs-cTnT protocol embedded in ED care enabled more rapid discharge of patients with suspected acute coronary syndrome. Improving short-term outcomes among patients with newly recognized troponin T elevation will require an evolution in management strategies for these patients. CLINICAL TRIAL REGISTRATION URL: https://www.anzctr.org.au. Unique identifier: ACTRN12615001379505.
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Affiliation(s)
- Derek P Chew
- College of Medicine & Public Health, Flinders University of South Australia, Adelaide (D.P.C., A.B., A.S., J.K., A.C., E.M.).,South Australian Health and Medical Research Institute, Adelaide (D.P.C., A.J.C.).,South Australian Department of Health, Adelaide (D.P.C., K.L., A.B., A.S., M.J.R.E., A.C., D.W., M.H., C.P.)
| | - Kristina Lambrakis
- South Australian Department of Health, Adelaide (D.P.C., K.L., A.B., A.S., M.J.R.E., A.C., D.W., M.H., C.P.)
| | - Andrew Blyth
- College of Medicine & Public Health, Flinders University of South Australia, Adelaide (D.P.C., A.B., A.S., J.K., A.C., E.M.).,South Australian Department of Health, Adelaide (D.P.C., K.L., A.B., A.S., M.J.R.E., A.C., D.W., M.H., C.P.)
| | - Anil Seshadri
- College of Medicine & Public Health, Flinders University of South Australia, Adelaide (D.P.C., A.B., A.S., J.K., A.C., E.M.).,South Australian Department of Health, Adelaide (D.P.C., K.L., A.B., A.S., M.J.R.E., A.C., D.W., M.H., C.P.)
| | - Michael J R Edmonds
- South Australian Department of Health, Adelaide (D.P.C., K.L., A.B., A.S., M.J.R.E., A.C., D.W., M.H., C.P.)
| | - Tom Briffa
- School of Population and Global Health, University of Western Australia, Perth (T.B.)
| | - Louise A Cullen
- Department of Emergency Medicine, Royal Brisbane and Women's Hospital, Australia (L.A.C.).,School of Public Health, Queensland University of Technology, Brisbane, Australia (L.A.C.).,School of Medicine, University of Queensland, Brisbane, Australia (L.A.C.)
| | - Stephen Quinn
- Department of Statistics, Data Science and Epidemiology, Swinburne University of Technology, Melbourne, Australia (S.Q.)
| | - Jonathan Karnon
- College of Medicine & Public Health, Flinders University of South Australia, Adelaide (D.P.C., A.B., A.S., J.K., A.C., E.M.)
| | - Anthony Chuang
- College of Medicine & Public Health, Flinders University of South Australia, Adelaide (D.P.C., A.B., A.S., J.K., A.C., E.M.).,South Australian Department of Health, Adelaide (D.P.C., K.L., A.B., A.S., M.J.R.E., A.C., D.W., M.H., C.P.)
| | - Adam J Nelson
- South Australian Health and Medical Research Institute, Adelaide (D.P.C., A.J.C.).,School of Medicine, University of Adelaide, Australia (A.J.C.)
| | - Deborah Wright
- South Australian Department of Health, Adelaide (D.P.C., K.L., A.B., A.S., M.J.R.E., A.C., D.W., M.H., C.P.)
| | - Matthew Horsfall
- South Australian Department of Health, Adelaide (D.P.C., K.L., A.B., A.S., M.J.R.E., A.C., D.W., M.H., C.P.)
| | - Erin Morton
- College of Medicine & Public Health, Flinders University of South Australia, Adelaide (D.P.C., A.B., A.S., J.K., A.C., E.M.)
| | - John K French
- Department of Cardiology, University of New South Wales, Sydney, Australia (J.K.F.)
| | - Cynthia Papendick
- South Australian Department of Health, Adelaide (D.P.C., K.L., A.B., A.S., M.J.R.E., A.C., D.W., M.H., C.P.)
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Schultz R, Quinn S, Wilson B, Abbott T, Cairney S. Structural modelling of wellbeing for Indigenous Australians: importance of mental health. BMC Health Serv Res 2019; 19:488. [PMID: 31307436 PMCID: PMC6631670 DOI: 10.1186/s12913-019-4302-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Accepted: 06/26/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Australia provides health care services for Indigenous peoples as part of its effort to enhance Indigenous peoples' wellbeing. However, biomedical frameworks shape Australia's health care system, often without reference to Indigenous wellbeing priorities. Under Indigenous leadership the Interplay research project explored wellbeing for Indigenous Australians in remote regions, through defining and quantifying Indigenous people's values and priorities. This article aimed to quantify relationships between health care access, mental and physical health, and wellbeing to guide services to enhance wellbeing for Indigenous Australians in remote regions. METHODS Indigenous and non-Indigenous researchers worked with Indigenous people in remote Australia to create a framework of wellbeing priorities. Indigenous community priorities were community, culture and empowerment; these interplay with government priorities for Indigenous development of health, education and employment. The wellbeing framework was further explored in four Indigenous communities through a survey which measured aspects of the wellbeing priorities. Indigenous community researchers administered the survey in their home communities to 841 Indigenous people aged 15 to 34 years from June 2014. From the survey items, exploratory factor analysis was used to develop constructs for mental and physical health, barriers to health care access and wellbeing. Relationships between these constructs were quantified through structural equation modelling. RESULTS Participants reported high levels of health and physical health (mean scores (3.17/4 [SD 0.96]; and 3.76/4 [SD 0.73]) and wellbeing 8.07/10 [SD 1.94]. Transport and costs comprised the construct for barriers to health care access (mean access score 0.89/1 [SD 0.28]). Structural equation modelling showed that mental health, but not physical health was associated with wellbeing (β = 0.25, P < 0.001; β = - 0.038, P = 0.3). Health care access had an indirect positive relationship with wellbeing through mental health (β = 0.047, P = 0.007). Relationships differed significantly for participants in remote compared with those in very remote communities. CONCLUSIONS Greater attention to mental health and recognition of the role of services outside the health care sector may have positive impacts on wellbeing for Indigenous people in remote/ very remote Australia. Aggregation of remote and very remote populations may obscure important differences between Indigenous communities.
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Affiliation(s)
- Rosalie Schultz
- Centre for Remote Health, Flinders University, PO Box 4066, Alice Springs, NT, 0871, Australia.
| | - Stephen Quinn
- Department of Statistics, Data Science and Epidemiology, Swinburne University, Melbourne, VIC, Australia
| | - Byron Wilson
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
| | - Tammy Abbott
- Ninti One Ltd, Cooperative Research Centre for Remote Economic Participation, Alice Springs, NT, Australia
| | - Sheree Cairney
- Centre for Remote Health, Flinders University, PO Box 4066, Alice Springs, NT, 0871, Australia
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Huber J, Woods T, Fushi A, Duong MT, Eidelman AS, Zalal AR, Urquhart O, Colangelo E, Quinn S, Carrasco-Labra A. Social Media Research Strategy to Understand Clinician and Public Perception of Health Care Messages. JDR Clin Trans Res 2019; 5:71-81. [PMID: 31067411 PMCID: PMC6918023 DOI: 10.1177/2380084419849439] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Introduction: Despite the potential of social media to influence public health and generate
insights, the process of monitoring and analyzing the dissemination of
health care messages on social media has been described as difficult and in
need of improvement. Objectives: The objective of this study was to describe and demonstrate a reproducible
methodology for cataloging and analyzing health care–related social media
comments and provide insight into how clinicians and members of the general
public respond to health care messaging on social media. Methods: We collected social media comments related to the American Dental
Association’s 2016 “Evidence-Based Clinical Practice Guideline for the Use
of Pit-and-Fissure Sealants” between April 10, 2017, and October 31, 2017,
from Facebook, Twitter, LinkedIn, Reddit, and online message boards for the
New York Times, FiveThirtyEight, and Dentaltown. Using
data provided in the comments, we conducted engagement analysis as well as
content, network, and sentiment analysis across 8 categories. Results: We collected 671 comments. Among our findings, Facebook (472 of 671) was the
most popular platform among commentators; almost half of all comments (335
of 671) aligned with the recommendations of the 2016 American Dental
Association sealants guideline; clinicians were more likely than the general
public to like a comment that suggested an improvement to the guideline; and
>75% of comments (521 of 671) were supported by anecdotal evidence. Conclusion: As the prevalence of anecdotes on social media suggests, the likelihood of
falsehoods spreading on social media is high. Insights gleaned from the
methodology described in this research could help combat the spread of such
misinformation by providing disseminators of health care messaging with
insight into their target audiences. Armed with this knowledge,
disseminators can craft health care messages that more effectively engage
clinicians and the general public. Knowledge Transfer Statement: The methodology used in this research provides a reproducible strategy for
tracking social media engagement with health care messages. Engagement
results can assist future delivery of health care messages to key
stakeholders and ensure better implementation and adoption of these
communications.
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Affiliation(s)
- J Huber
- Center for Evidence-Based Dentistry, Science Institute, American Dental Association, Chicago, IL, USA
| | - T Woods
- Center for Evidence-Based Dentistry, Science Institute, American Dental Association, Chicago, IL, USA
| | - A Fushi
- College of Dental Medicine, Midwestern University, Downers Grove, IL, USA
| | - M T Duong
- The Center for Advanced Oral Health, Arizona School of Dentistry & Oral Health, Mesa, AZ, USA.,Sundance Dental Care, Phoenix, AZ, USA
| | - A S Eidelman
- School of Dental Medicine, Tufts University, Boston, MA, USA
| | - A R Zalal
- School of Dentistry, University of North Carolina, Chapel Hill, NC, USA
| | - O Urquhart
- Center for Evidence-Based Dentistry, Science Institute, American Dental Association, Chicago, IL, USA
| | - E Colangelo
- Center for Evidence-Based Dentistry, Science Institute, American Dental Association, Chicago, IL, USA.,Current affiliation: Center for Dental Practice / Practice Institute, American Dental Association, Chicago, IL, USA
| | - S Quinn
- American Dental Association, Chicago, IL, USA.,Current affiliation: Walgreens, Deerfield, IL, USA
| | - A Carrasco-Labra
- Center for Evidence-Based Dentistry, Science Institute, American Dental Association, Chicago, IL, USA
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Lambrakis K, French JK, Scott IA, Briffa T, Brieger D, Farkouh ME, White H, Chuang AMY, Tiver K, Quinn S, Kaambwa B, Horsfall M, Morton E, Chew DP. The appropriateness of coronary investigation in myocardial injury and type 2 myocardial infarction (ACT-2): A randomized trial design. Am Heart J 2019; 208:11-20. [PMID: 30522086 DOI: 10.1016/j.ahj.2018.09.016] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [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: 08/17/2018] [Accepted: 09/30/2018] [Indexed: 12/01/2022]
Abstract
BACKGROUND Elevated troponin level findings among patients presenting with suspected acute coronary syndrome (ACS) or another intercurrent illness undeniably identifies patients at increased risk of mortality. Whilst enhancing our capacity to discriminate risk, the use of high-sensitivity troponin assays frequently identifies patients with myocardial injury (i.e. troponin rise without acute signs of myocardial ischemia) or type 2 myocardial infarction (T2MI; oxygen supply-demand imbalance). This leads to the clinically challenging task of distinguishing type 1 myocardial infarction (T1MI; coronary plaque rupture) from myocardial injury and T2MI in the context of concurrent acute illness. Diagnostic discernment in this context is crucial because MI classification has implications for further investigation and care. Early invasive management is of well-established benefit among patients with T1MI. However, the appropriateness of this investigation in the heterogeneous context of T2MI, where there is high competing mortality risk, remains unknown. Although coronary angiography in T2MI is advocated by some, there is insufficient evidence in existing literature to support this opinion as highlighted by current national guidelines. OBJECTIVE The objective is to evaluate the clinical and economic impact of early invasive management with coronary angiography in T2MI in terms of all-cause mortality and cost effectiveness. DESIGN This prospective, pragmatic, multicenter, randomized trial among patients with suspected supply demand ischemia leading to troponin elevation (n=1,800; T2MI [1,500], chronic myocardial injury [300]) compares the impact of invasive angiography (or computed tomography angiography as per local preference) within 5 days of randomization versus conservative management (with or without functional testing at clinician discretion) on all-cause mortality by 2 years. Randomized treatment allocation will be stratified by baseline estimated risk of mortality using the Acute Physiology, Age, and Chronic Health Evaluation (APACHE) III risk score. Cost-effectiveness will be evaluated by follow-up on clinical events, quality of life, and resource utilization over 24 months. SUMMARY Ascertaining the most appropriate first-line investigative strategy for these commonly encountered high-risk T2MI patients in a randomized comparative study will be pivotal in informing evidence-based guidelines that lead to better patient and health care outcomes.
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Affiliation(s)
| | - John K French
- School of Medicine, University of New South Wales, Sydney, Australia
| | - Ian A Scott
- School of Clinical Medicine, University of Queensland, Brisbane, Australia
| | - Tom Briffa
- School of Population and Global Health, University of Western Australia, Perth, Australia
| | - David Brieger
- Department of Cardiology, Concord Hospital, Sydney, Australia
| | - Michael E Farkouh
- Peter Munk Cardiac Centre and the Heart and Stroke Richard Lewar Centre, University of Toronto, Toronto, Canada
| | - Harvey White
- Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand
| | | | - Kathryn Tiver
- Department of Cardiology, Flinders Medical Centre, Adelaide, Australia
| | - Stephen Quinn
- Department of Statistics, Data Science and Epidemiology, Swinburne University of Technology, Melbourne, Australia
| | - Billingsley Kaambwa
- College of Medicine and Public Health, Flinders University of South Australia, Adelaide, Australia
| | - Matthew Horsfall
- Department of Cardiology, Flinders Medical Centre, Adelaide, Australia
| | - Erin Morton
- College of Medicine and Public Health, Flinders University of South Australia, Adelaide, Australia
| | - Derek P Chew
- Department of Cardiology, Flinders Medical Centre, Adelaide, Australia; College of Medicine and Public Health, Flinders University of South Australia, Adelaide, Australia.
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Mok T, Nakagawa K, Rosell R, Lee K, Corral J, Migliorino M, Pluzanski A, Linke R, Devgan G, Sbar E, Quinn S, Wang T, Wu Y. MA26.11 Effects of Dose Modifications on the Safety and Efficacy of Dacomitinib for EGFR Mutation-Positive NSCLC. J Thorac Oncol 2018. [DOI: 10.1016/j.jtho.2018.08.546] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Battersby M, Kidd MR, Licinio J, Aylward P, Baker A, Ratcliffe J, Quinn S, Castle DJ, Zabeen S, Fairweather-Schmidt AK, Lawn S. Improving cardiovascular health and quality of life in people with severe mental illness: study protocol for a randomised controlled trial. Trials 2018; 19:366. [PMID: 29996886 PMCID: PMC6042320 DOI: 10.1186/s13063-018-2748-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 06/19/2018] [Indexed: 11/30/2022] Open
Abstract
Background The estimated 300,000 adults in Australia with severe mental illness (SMI) have markedly reduced life expectancy compared to the general population, mainly due to physical health comorbidities. Cardiovascular disease (CVD) is the commonest cause of early death and people with SMI have high rates of most modifiable risk factors, with associated quality of life (QoL) reduction. High blood pressure, smoking, dyslipidaemia, diabetes and obesity are major modifiable CVD risk factors. Poor delivery of recommended monitoring and risk reduction is a national and international problem. Therefore, effective preventive interventions to safeguard and support physical health are urgently needed in this population. Methods This trial used a rigorous process, including extensive piloting, to develop an intervention that delivers recommended physical health care to reduce CVD risk and improve QoL for people with SMI. Components of this intervention are integrated using the Flinders Program of chronic condition management (CCM) which is a comprehensive psychosocial care planning approach that places the patient at the centre of their care, and focuses on building their self-management capacity within a collaborative approach, therefore providing a recovery-oriented framework. The primary project aim is to evaluate the effectiveness and health economics of the CCM intervention. The main outcome measures examine CVD risk and quality of life. The second aim is to identify essential components, enablers and barriers at patient, clinical and organisational levels for national, sustained implementation of recommended physical health care delivery to people with SMI. Participants will be recruited from a community-based public psychiatric service. Discussion This study constitutes the first large-scale trial, worldwide, using the Flinders Program with this population. By combining a standardised yet flexible motivational process with a targeted set of evidence-based interventions, the chief aim is to reduce CVD risk by 20%. If achieved, this will be a ground-breaking outcome, and the program will be subsequently translated nationwide and abroad. The trial will be of great interest to people with mental illness, family carers, mental health services, governments and primary care providers because the Flinders Program can be delivered in diverse settings by any clinical discipline and supervised peers. Trial registration Australian and New Zealand Clinical Trials Registry, ACTRN12617000474358. Registered on 31 March 2017. Electronic supplementary material The online version of this article (10.1186/s13063-018-2748-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Malcolm Battersby
- Mental Health Services, Southern Adelaide Local Health Network (SAHLN), Margaret Tobin Centre, Bedford Park, South Australia, 5042, Australia.,Flinders Human Behaviour & Health Research Unit (FHBHRU), Discipline of Psychiatry, College of Medicine and Public Health, Flinders University, Margaret Tobin Centre, GPO Box 2100, Adelaide, South Australia, 5001, Australia
| | - Michael R Kidd
- Department of Family & Community Medicine, University of Toronto, 500 University Avenue, Toronto, ON, M5G 1V7, Canada.,Global Primary Care, Southgate Institute for Health, Society and Equity, Flinders University, GPO Box 2100, Adelaide, South Australia, 5001, Australia
| | - Julio Licinio
- South Australian Health and Medical Research Institute, North Terrace, Adelaide, South Australia, 5000, Australia
| | - Philip Aylward
- Division of Medicine, Cardiac and Critical Care Services, Southern Adelaide Local Health Network (SALHN), Flinders Cardiac Clinic, Flinders Private Hospital, Bedford Park, South Australia, 5042, Australia
| | - Amanda Baker
- NHMRC Centre of Research Excellence in Mental Health and Substance Use, NHMRC Senior Research Fellow, School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, 2308, Australia
| | - Julie Ratcliffe
- Health Economics in the Institute for Choice, School of Business, University of South Australia, City West Campus (WL3-65), GPO Box 2471, Adelaide, South Australia, 5001, Australia
| | - Stephen Quinn
- Department of Statistics, Data Science and Epidemiology, Swinburne University of Technology, ATC-922, John Street, Hawthorn, VIC, 3122, Australia
| | - David J Castle
- St. Vincent's Hospital Melbourne and The University of Melbourne, PO Box 2900, Fitzroy, VIC, 3065, Australia
| | - Sara Zabeen
- Flinders Human Behaviour & Health Research Unit (FHBHRU), Discipline of Psychiatry, College of Medicine and Public Health, Flinders University, Margaret Tobin Centre, GPO Box 2100, Adelaide, South Australia, 5001, Australia
| | - A Kate Fairweather-Schmidt
- Flinders Human Behaviour & Health Research Unit (FHBHRU), Discipline of Psychiatry, College of Medicine and Public Health, Flinders University, Margaret Tobin Centre, GPO Box 2100, Adelaide, South Australia, 5001, Australia
| | - Sharon Lawn
- Flinders Human Behaviour & Health Research Unit (FHBHRU), Discipline of Psychiatry, College of Medicine and Public Health, Flinders University, Margaret Tobin Centre, GPO Box 2100, Adelaide, South Australia, 5001, Australia.
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Alsubaiei ME, Frith PA, Cafarella PA, Quinn S, Al Moamary MS, McEvoy RD, Effing TW. COPD care in Saudi Arabia: physicians' awareness and knowledge of guidelines and barriers to implementation. Int J Tuberc Lung Dis 2018; 21:592-595. [PMID: 28399976 DOI: 10.5588/ijtld.16.0656] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE To assess Saudi physicians' awareness and knowledge about chronic obstructive pulmonary disease (COPD) guideline recommendations. METHODS Cross-sectional study including physicians involved in COPD care in five hospitals in the Eastern Province of Saudi Arabia. The level of physicians' knowledge was considered as satisfactory (score > 80%), fair (score 50-80%) or poor (<50% of total score). RESULTS Among the 44 physicians included in the study, the mean ± standard deviation knowledge score was 29.5 ± 4.2 out of 45 points (65.5%). Most physicians appeared to be unaware of any COPD guidelines (n = 27, 61.4%), and reported not adhering to guidelines (n = 28, 63.6%). CONCLUSION Saudi physicians' knowledge about Global Initiative for Chronic Obstructive Lung Disease guidelines was assessed as fair. It is therefore highly recommended to increase physicians' awareness and knowledge about COPD-related guidelines.
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Affiliation(s)
- M E Alsubaiei
- Southern Adelaide Local Health Network, Department of Respiratory Medicine, Adelaide, South Australia, School of Medicine, Flinders University, Adelaide, South Australia
| | - P A Frith
- Southern Adelaide Local Health Network, Department of Respiratory Medicine, Adelaide, South Australia, School of Medicine, Flinders University, Adelaide, South Australia
| | - P A Cafarella
- Southern Adelaide Local Health Network, Department of Respiratory Medicine, Adelaide, South Australia, School of Medicine, Flinders University, Adelaide, South Australia
| | - S Quinn
- Department of Statistics, Data Science and Epidemiology, Swinburne University, Melbourne, Victoria, Australia
| | - M S Al Moamary
- Department of Medicine, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Saudi Arabia
| | - R D McEvoy
- School of Medicine, Flinders University, Adelaide, South Australia, Southern Adelaide Local Health Network, Sleep Health Service, Adelaide, South Australia, Australia
| | - T W Effing
- Southern Adelaide Local Health Network, Department of Respiratory Medicine, Adelaide, South Australia, School of Medicine, Flinders University, Adelaide, South Australia
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Aab A, Abreu P, Aglietta M, Al Samarai I, Albuquerque I, Allekotte I, Almela A, Alvarez Castillo J, Alvarez-Muñiz J, Anastasi G, Anchordoqui L, Andrada B, Andringa S, Aramo C, Arqueros F, Arsene N, Asorey H, Assis P, Aublin J, Avila G, Badescu A, Balaceanu A, Barbato F, Barreira Luz R, Beatty J, Becker K, Bellido J, Berat C, Bertaina M, Bertou X, Biermann P, Biteau J, Blaess S, Blanco A, Blazek J, Bleve C, Boháčová M, Boncioli D, Bonifazi C, Borodai N, Botti A, Brack J, Brancus I, Bretz T, Bridgeman A, Briechle F, Buchholz P, Bueno A, Buitink S, Buscemi M, Caballero-Mora K, Caccianiga L, Cancio A, Canfora F, Caramete L, Caruso R, Castellina A, Catalani F, Cataldi G, Cazon L, Chavez A, Chinellato J, Chudoba J, Clay R, Cobos A, Colalillo R, Coleman A, Collica L, Coluccia M, Conceição R, Consolati G, Contreras F, Cooper M, Coutu S, Covault C, Cronin J, D’Amico S, Daniel B, Dasso S, Daumiller K, Dawson B, de Almeida R, de Jong S, De Mauro G, de Mello Neto J, De Mitri I, de Oliveira J, de Souza V, Debatin J, Deligny O, Díaz Castro M, Diogo F, Dobrigkeit C, D’Olivo J, Dorosti Q, dos Anjos R, Dova M, Dundovic A, Ebr J, Engel R, Erdmann M, Erfani M, Escobar C, Espadanal J, Etchegoyen A, Falcke H, Farmer J, Farrar G, Fauth A, Fazzini N, Fenu F, Fick B, Figueira J, Filipčič A, Fratu O, Freire M, Fujii T, Fuster A, Gaior R, García B, Garcia-Pinto D, Gaté F, Gemmeke H, Gherghel-Lascu A, Ghia P, Giaccari U, Giammarchi M, Giller M, Głas D, Glaser C, Golup G, Gómez Berisso M, Gómez Vitale P, González N, Gorgi A, Gorham P, Grillo A, Grubb T, Guarino F, Guedes G, Halliday R, Hampel M, Hansen P, Harari D, Harrison T, Harton J, Haungs A, Hebbeker T, Heck D, Heimann P, Herve A, Hill G, Hojvat C, Holt E, Homola P, Hörandel J, Horvath P, Hrabovský M, Huege T, Hulsman J, Insolia A, Isar P, Jandt I, Johnsen J, Josebachuili M, Jurysek J, Kääpä A, Kambeitz O, Kampert K, Keilhauer B, Kemmerich N, Kemp E, Kemp J, Kieckhafer R, Klages H, Kleifges M, Kleinfeller J, Krause R, Krohm N, Kuempel D, Kukec Mezek G, Kunka N, Kuotb Awad A, Lago B, LaHurd D, Lang R, Lauscher M, Legumina R, Leigui de Oliveira M, Letessier-Selvon A, Lhenry-Yvon I, Link K, Lo Presti D, Lopes L, López R, López Casado A, Lorek R, Luce Q, Lucero A, Malacari M, Mallamaci M, Mandat D, Mantsch P, Mariazzi A, Mariş I, Marsella G, Martello D, Martinez H, Martínez Bravo O, Masías Meza J, Mathes H, Mathys S, Matthews J, Matthews J, Matthiae G, Mayotte E, Mazur P, Medina C, Medina-Tanco G, Melo D, Menshikov A, Merenda KD, Michal S, Micheletti M, Middendorf L, Miramonti L, Mitrica B, Mockler D, Mollerach S, Montanet F, Morello C, Mostafá M, Müller A, Müller G, Muller M, Müller S, Mussa R, Naranjo I, Nellen L, Nguyen P, Niculescu-Oglinzanu M, Niechciol M, Niemietz L, Niggemann T, Nitz D, Nosek D, Novotny V, Nožka L, Núñez L, Ochilo L, Oikonomou F, Olinto A, Palatka M, Pallotta J, Papenbreer P, Parente G, Parra A, Paul T, Pech M, Pedreira F, Pękala J, Pelayo R, Peña-Rodriguez J, Pereira L, Perlin M, Perrone L, Peters C, Petrera S, Phuntsok J, Piegaia R, Pierog T, Pimenta M, Pirronello V, Platino M, Plum M, Porowski C, Prado R, Privitera P, Prouza M, Quel E, Querchfeld S, Quinn S, Ramos-Pollan R, Rautenberg J, Ravignani D, Ridky J, Riehn F, Risse M, Ristori P, Rizi V, Rodrigues de Carvalho W, Rodriguez Fernandez G, Rodriguez Rojo J, Rogozin D, Roncoroni M, Roth M, Roulet E, Rovero A, Ruehl P, Saffi S, Saftoiu A, Salamida F, Salazar H, Saleh A, Salesa Greus F, Salina G, Sánchez F, Sanchez-Lucas P, Santos E, Santos E, Sarazin F, Sarmento R, Sarmiento-Cano C, Sato R, Schauer M, Scherini V, Schieler H, Schimp M, Schmidt D, Scholten O, Schovánek P, Schröder F, Schröder S, Schulz A, Schumacher J, Sciutto S, Segreto A, Shadkam A, Shellard R, Sigl G, Silli G, Sima O, Śmiałkowski A, Šmída R, Smith B, Snow G, Sommers P, Sonntag S, Squartini R, Stanca D, Stanič S, Stasielak J, Stassi P, Stolpovskiy M, Strafella F, Streich A, Suarez F, Suarez Durán M, Sudholz T, Suomijärvi T, Supanitsky A, Šupík J, Swain J, Szadkowski Z, Taboada A, Taborda O, Theodoro V, Timmermans C, Todero Peixoto C, Tomankova L, Tomé B, Torralba Elipe G, Travnicek P, Trini M, Ulrich R, Unger M, Urban M, Valdés Galicia J, Valiño I, Valore L, van Aar G, van Bodegom P, van den Berg A, van Vliet A, Varela E, Vargas Cárdenas B, Varner G, Vázquez R, Veberič D, Ventura C, Vergara Quispe I, Verzi V, Vicha J, Villaseñor L, Vorobiov S, Wahlberg H, Wainberg O, Walz D, Watson A, Weber M, Weindl A, Wiencke L, Wilczyński H, Wileman C, Wirtz M, Wittkowski D, Wundheiler B, Yang L, Yushkov A, Zas E, Zavrtanik D, Zavrtanik M, Zepeda A, Zimmermann B, Ziolkowski M, Zong Z, Zuccarello F. Inferences on mass composition and tests of hadronic interactions from 0.3 to 100 EeV using the water-Cherenkov detectors of the Pierre Auger Observatory. Int J Clin Exp Med 2017. [DOI: 10.1103/physrevd.96.122003] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Abstract
A 58-year-old woman presented to the emergency department with left ptosis and complete ophthalmoplegia. Imaging demonstrated a left orbital abscess. Her past medical history included cavitatory lung disease and "aseptic" meningitis 2 months previously. An anaerobic organism and commensal of the oral flora, Peptostreptococcus sp., was cultured from the orbital abscess. The patient was found to have a carious upper molar with chronic buccal abscess, which was extracted. This case presents an uncommon pathogen arising from an odontogenic infection as the etiology for orbital abscess, cavitatory lung disease, and meningitis in one patient.
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Affiliation(s)
- E Hughes
- a Department of Ophthalmology , Mater Misericordiae University Hospital , Dublin , Republic of Ireland
| | - N Wynne
- b Department of Ophthalmology , Sligo University Hospital , Sligo , Republic of Ireland
| | - S Quinn
- b Department of Ophthalmology , Sligo University Hospital , Sligo , Republic of Ireland
| | - T Fulcher
- a Department of Ophthalmology , Mater Misericordiae University Hospital , Dublin , Republic of Ireland
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Abstract
BACKGROUND The aim of the meta-analysis was to derive a range of mean normal clinical electrooculogram (EOG) values from a systematic review of published EOG studies that followed the guidelines of the ISCEV standard for clinical electro-oculography. METHODS A systematic literature review was performed using four relevant databases limited to peer-reviewed articles in English between 1967 and February 2017. Studies reporting clinical EOG or FO normal values were included when the report used a standard 30° horizontal saccade, a retinal luminance of between 100 and 250 cd m-2, and had > 10 subjects in their normative values. The search identified 1145 articles after duplicates were removed with subsequent screening of the abstracts excluding a further 1098, resulting in 47 full-text articles that were then assessed by the author (PC) with a final nine articles meeting the inclusion criteria. An overall effect estimate using inverse variance-weighted meta-analysis was performed to estimate the mean values for the light peak/dark trough ratio (LP:DT ratio) (dilated and undilated), the time to the LP, the amplitude of the LP, dark trough (DT) and the fast oscillation (FO) peak-to-trough ratio from the included studies. RESULTS The mean dilated LP:DT ratio was 2.35 (95% CI 2.28-2.42); undilated LP:DT ratio was 2.37 (95% CI 2.28-2.45); LP amplitude was 835 (95% CI 631-1039) µV and the mean time to the LP being 8.2 (95% CI 7.7-8.7) min. The mean DT amplitude was 358 (95% CI 292-424) µV, and the mean FO peak-to-trough ratio was 1.13 (95% CI 1.11-1.16). The results of the LP/DT ratio are drawn from studies with a mean ± standard deviation (SD) age of 34.08 ± 12.93 years for dilated and 33.65 ± 12.28 years for undilated LP/DT ratios. CONCLUSIONS The meta-analysis of EOG studies has generated a reference range of normal mean values for clinicians to refer to when using the ISCEV clinical EOG. It provides a potential method to generate similar data sets from published normal values in related visual electrophysiology tests.
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Affiliation(s)
- Paul A Constable
- College of Nursing and Health Sciences, Flinders University, GPO Box 2100, Adelaide, SA, 5001, Australia.
| | - David Ngo
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Stephen Quinn
- Department of Statistics, Data Science and Epidemiology, Swinburne University of Technology, Melbourne, Australia
| | - Dorothy A Thompson
- Clinical and Academic Department of Ophthalmology, Great Ormond Street Hospital for Children, London, UK
- UCL Great Ormond Street Institute for Child Health, London, UK
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