1
|
Bailie J, Potts BA, Laycock AF, Abimbola S, Bailie RS, Cunningham FC, Matthews V, Bainbridge RG, Conte KP, Passey ME, Peiris D. Collaboration and knowledge generation in an 18-year quality improvement research programme in Australian Indigenous primary healthcare: a coauthorship network analysis. BMJ Open 2021; 11:e045101. [PMID: 33958341 PMCID: PMC8103942 DOI: 10.1136/bmjopen-2020-045101] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES Though multidisciplinary research networks support the practice and effectiveness of continuous quality improvement (CQI) programmes, their characteristics and development are poorly understood. In this study, we examine publication outputs from a research network in Australian Indigenous primary healthcare (PHC) to assess to what extent the research network changed over time. SETTING Australian CQI research network in Indigenous PHC from 2002 to 2019. PARTICIPANTS Authors from peer-reviewed journal articles and books published by the network. DESIGN Coauthor networks across four phases of the network (2002-2004; 2005-2009; 2010-2014; 2015-2019) were constructed based on author affiliations and examined using social network analysis methods. Descriptive characteristics included organisation types, Indigenous representation, gender, student authorship and thematic research trends. RESULTS We identified 128 publications written by 308 individual authors from 79 different organisations. Publications increased in number and diversity over each funding phase. During the final phase, publication outputs accelerated for organisations, students, project officers, Indigenous and female authors. Over time there was also a shift in research themes to encompass new clinical areas and social, environmental or behavioural determinants of health. Average degree (8.1), clustering (0.81) and diameter (3) indicated a well-connected network, with a core-periphery structure in each phase (p≤0.03) rather than a single central organisation (degree centralisation=0.55-0.65). Academic organisations dominated the core structure in all funding phases. CONCLUSION Collaboration in publications increased with network consolidation and expansion. Increased productivity was associated with increased authorship diversity and a decentralised network, suggesting these may be important factors in enhancing research impact and advancing the knowledge and practice of CQI in PHC. Publication diversity and growth occurred mainly in the fourth phase, suggesting long-term relationship building among diverse partners is required to facilitate participatory research in CQI. Despite improvements, further work is needed to address inequities in female authorship and Indigenous authorship.
Collapse
Affiliation(s)
- Jodie Bailie
- University Centre for Rural Health, The University of Sydney, Lismore, New South Wales, Australia
- School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Boyd Alexander Potts
- University Centre for Rural Health, The University of Sydney, Lismore, New South Wales, Australia
| | - Alison Frances Laycock
- University Centre for Rural Health, The University of Sydney, Lismore, New South Wales, Australia
| | - Seye Abimbola
- School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Ross Stewart Bailie
- University Centre for Rural Health, The University of Sydney, Lismore, New South Wales, Australia
| | | | - Veronica Matthews
- University Centre for Rural Health, The University of Sydney, Lismore, New South Wales, Australia
| | | | - Kathleen Parker Conte
- University Centre for Rural Health, The University of Sydney, Lismore, New South Wales, Australia
- School of Public Health, DePaul University, Chicago, Illinois, USA
| | - Megan Elizabeth Passey
- University Centre for Rural Health, The University of Sydney, Lismore, New South Wales, Australia
| | - David Peiris
- School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| |
Collapse
|
2
|
Baldwin HJ, Nippita TA, Torvaldsen S, McGee TM, Rickard K, Patterson JA. Validation of anaemia, haemorrhage and blood disorder reporting in hospital data in New South Wales, Australia. BMC Res Notes 2021; 14:167. [PMID: 33947454 PMCID: PMC8094525 DOI: 10.1186/s13104-021-05584-x] [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] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 04/23/2021] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE Hospital data are a useful resource for studying pregnancy complications, including bleeding-related conditions, however, the reliability of these data is unclear. This study aims to examine reliability of reporting of bleeding-related conditions, including anaemia, obstetric haemorrhage and blood disorders, and procedures, such as blood transfusion and hysterectomy, in coded hospital records compared with obstetric data from two large tertiary hospitals in New South Wales. RESULTS There were 36,051 births between 2011 and 2015 included in the analysis. Anaemia and blood disorders were poorly reported in the hospital data, with sensitivity ranging from 2.5% to 24.8% (positive predictive value (PPV) 12.0-82.6%). Reporting of postpartum haemorrhage, transfusion and hysterectomy showed high sensitivity (82.8-96.0%, PPV 78.0-89.6%) while moderate consistency with the obstetric data was observed for other types of obstetric haemorrhage (sensitivity: 41.9-65.1%, PPV: 50.0-56.8%) and placental complications (sensitivity: 68.2-81.3%, PPV: 20.3-72.3%). Our findings suggest that hospital data may be a reliable source of information on postpartum haemorrhage, transfusion and hysterectomy. However, they highlight the need for caution for studies of anaemia and blood disorders, given high rates of uncoded and 'false' cases, and suggest that other sources of data should be sought where possible.
Collapse
Affiliation(s)
- Heather J. Baldwin
- The University of Sydney Northern Clinical School, Women and Babies Research, C/O University Department of O&G, Level 5, Douglas Building, Royal North Shore Hospital, St Leonards, NSW 2065 Australia
- Northern Sydney Local Health District, Kolling Institute, St Leonards, NSW Australia
| | - Tanya A. Nippita
- The University of Sydney Northern Clinical School, Women and Babies Research, C/O University Department of O&G, Level 5, Douglas Building, Royal North Shore Hospital, St Leonards, NSW 2065 Australia
- Northern Sydney Local Health District, Kolling Institute, St Leonards, NSW Australia
- Department of Obstetrics and Gynaecology, Royal North Shore Hospital, St Leonards, NSW Australia
| | - Siranda Torvaldsen
- The University of Sydney Northern Clinical School, Women and Babies Research, C/O University Department of O&G, Level 5, Douglas Building, Royal North Shore Hospital, St Leonards, NSW 2065 Australia
- Northern Sydney Local Health District, Kolling Institute, St Leonards, NSW Australia
- School of Public Health and Community Medicine, UNSW, Sydney, NSW Australia
| | - Therese M. McGee
- OG Department, Clinical Support Unit, Level 3, G Block, Westmead Hospital, Westmead, NSW Australia
- The University of Sydney Westmead Clinical School, Westmead, NSW Australia
| | - Kristen Rickard
- The University of Sydney Northern Clinical School, Women and Babies Research, C/O University Department of O&G, Level 5, Douglas Building, Royal North Shore Hospital, St Leonards, NSW 2065 Australia
- Northern Sydney Local Health District, Kolling Institute, St Leonards, NSW Australia
- Department of Obstetrics and Gynaecology, Royal North Shore Hospital, St Leonards, NSW Australia
| | - Jillian A. Patterson
- The University of Sydney Northern Clinical School, Women and Babies Research, C/O University Department of O&G, Level 5, Douglas Building, Royal North Shore Hospital, St Leonards, NSW 2065 Australia
- Northern Sydney Local Health District, Kolling Institute, St Leonards, NSW Australia
| |
Collapse
|
3
|
Blood Z, Tran A, Caleo L, Saw R, Dieng M, Shackleton M, Soyer HP, Arnold C, Mann GJ, Morton RL. Implementation of patient-reported outcome measures and patient-reported experience measures in melanoma clinical quality registries: a systematic review. BMJ Open 2021; 11:e040751. [PMID: 33574144 PMCID: PMC7880114 DOI: 10.1136/bmjopen-2020-040751] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVES To identify patient-reported outcome measures (PROMs) and patient-reported experience measures (PREMs) in clinical quality registries, for people with cutaneous melanoma, to inform a new Australian Melanoma Clinical Outcomes Registry; and describe opportunities and challenges of routine PROM/PREM collection, especially in primary care. DESIGN Systematic review. PRIMARY AND SECONDARY OUTCOME MEASURES Which PROMs and PREMs are used in clinical quality registries for people with cutaneous melanoma, how they are collected, frequency of collection, participant recruitment methods and funding models for each registry. RESULTS 1134 studies were identified from MEDLINE, PreMEDLINE, Embase, PsychInfo, Cochrane Database of Abstracts of Reviews of Effects databases and TUFTS Cost-Effectiveness Analysis Registry, alongside grey literature, from database inception to 5th February 2020. Following screening, 14 studies were included, identifying four relevant registries: Dutch Melanoma Registry, Adelphi Real-World Disease-Specific Programme (Melanoma), Patient-Reported Outcomes Following Initial treatment and Long-term Evaluation of Survivorship Registry, and Cancer Experience Registry. These used seven PROMs: EuroQol-5 Dimensions, Functional Assessment of Cancer-General (FACT-G) and FACT-Melanoma (FACT-M), European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-Cancer 30 (EORTC QLQ-C30), Fatigue Assessment Scale Hospital Anxiety and Depression Scale, Patient-Reported Outcome Measures Information System-29 and one PREM; EORTC QLQ-Information Module 26. PROMs/PREMs in registries were reported to improve transparency of care; facilitate clinical auditing for quality assessment; enable cost-effectiveness analyses and create large-scale research platforms. Challenges included resource burden for data entry and potential collection bias toward younger, more affluent respondents. Feedback from patients with melanoma highlighted the relevance of PROMs/PREMs in assessing patient outcomes and patient experiences. CONCLUSIONS Clinical registries indicate PROMs/PREMs for melanoma care can be incorporated and address important gaps, however cost and collection bias may limit generalisability. PROSPERO REGISTRATION NUMBER CRD42018086737.
Collapse
Affiliation(s)
- Zachary Blood
- NHMRC Clinical Trials Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Anh Tran
- NHMRC Clinical Trials Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Lauren Caleo
- NHMRC Clinical Trials Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Robyn Saw
- Melanoma Institute Australia, North Sydney, New South Wales, Australia
| | - Mbathio Dieng
- NHMRC Clinical Trials Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Mark Shackleton
- Department of Medicine, Monash University, Clayton, Victoria, Australia
| | - H Peter Soyer
- The University of Queensland Diamantina Institute, Dermatology Research Centre, The University of Queensland, Saint Lucia, Queensland, Australia
| | - Chris Arnold
- Skin Health Institute, Melbourne, Victoria, Australia
- BioGrid Australia, Parkville, Victoria, Australia
| | - Graham J Mann
- Western Clinical School, Westmead Millennium Institute, The University of Sydney, Sydney, New South Wales, Australia
- John Curtin School of Medical Research, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Rachael L Morton
- NHMRC Clinical Trials Centre, The University of Sydney, Sydney, New South Wales, Australia
| |
Collapse
|
4
|
Jiang I, Major G, Singh-Grewal D, Teng C, Kelly A, Niddrie F, Chaitow J, O'Neill S, Hassett G, Damodaran A, Bernays S, Manera K, Tong A, Tunnicliffe DJ. Patient and parent perspectives on transition from paediatric to adult healthcare in rheumatic diseases: an interview study. BMJ Open 2021; 11:e039670. [PMID: 33397662 PMCID: PMC7783517 DOI: 10.1136/bmjopen-2020-039670] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVES To describe the experiences, priorities, and needs of patients with rheumatic disease and their parents during transition from paediatric to adult healthcare. SETTING Face-to-face and telephone semistructured interviews were conducted from December 2018 to September 2019 recruited from five hospital centres in Australia. PARTICIPANTS Fourteen young people and 16 parents were interviewed. Young people were included if they were English speaking, aged 14-25 years, diagnosed with an inflammatory rheumatic disease (eg, juvenile idiopathic arthritis, juvenile dermatomyositis, systemic lupus erythematosus, panniculitis, familial Mediterranean fever) before 18 years of age. Young people were not included if they were diagnosed in the adult setting. RESULTS We identified four themes with respective subthemes: avoid repeat of past disruption (maintain disease stability, preserve adjusted personal goals, protect social inclusion); encounter a daunting adult environment (serious and sombre mood, discredited and isolated identity, fear of a rigid system); establish therapeutic alliances with adult rheumatology providers (relinquish a trusting relationship, seek person-focused care, redefine personal-professional boundaries, reassurance of alternative medical supports, transferred trust to adult doctor) and negotiate patient autonomy (confidence in formerly gained independence, alleviate burden on patients, mediate parental anxiety). CONCLUSIONS During transition, patients want to maintain disease stability, develop a relationship with their adult provider centralised on personal goals and access support networks. Strategies to comprehensively communicate information between providers, support self-management, and negotiate individualised goals for independence during transition planning may improve satisfaction, and health and treatment outcomes.
Collapse
Affiliation(s)
- Ivy Jiang
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
- Centre for Kidney Research, Children's Hospital at Westmead, Westmead, New South Wales, Australia
- Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Gabor Major
- Department of Rheumatology, Bone and Joint Centre, Royal Newcastle Centre, John Hunter Hospital, Newcastle, New South Wales, Australia
- School of Medicine and Public Health, The University of Newcastle Faculty of Health and Medicine, Callaghan, New South Wales, Australia
| | - Davinder Singh-Grewal
- Department of Rheumatology, Liverpool Hospital, Liverpool, New South Wales, Australia
- Department of Rheumatology, The Sydney Children's Hospitals Network Randwick and Westmead, Westmead, New South Wales, Australia
| | - Claris Teng
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
- Centre for Kidney Research, Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Ayano Kelly
- Rheumatology, Canberra Rheumatology, Canberra City, Australian Capital Territory, Australia
- College of Health and Medicine, Australian National University Medical School, Canberra, Australian Capital Territory, Australia
| | - Fiona Niddrie
- Department of Rheumatology, Bone and Joint Centre, Royal Newcastle Centre, John Hunter Hospital, Newcastle, New South Wales, Australia
| | - Jeffrey Chaitow
- Department of Rheumatology, Bone and Joint Centre, Royal Newcastle Centre, John Hunter Hospital, Newcastle, New South Wales, Australia
- Department of Rheumatology, The Sydney Children's Hospitals Network Randwick and Westmead, Westmead, New South Wales, Australia
| | - Sean O'Neill
- Department of Rheumatology, Liverpool Hospital, Liverpool, New South Wales, Australia
- Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
| | - Geraldine Hassett
- Department of Rheumatology, Liverpool Hospital, Liverpool, New South Wales, Australia
- Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
| | - Arvin Damodaran
- Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
- Department of Rheumatology, Prince of Wales Hospital and Community Health Services, Randwick, New South Wales, Australia
| | - Sarah Bernays
- School of Public Health, The University of Sydney, Camperdown, New South Wales, Australia
- Global Health and Development, London School of Hygiene and Tropical Medicine Faculty of Public Health and Policy, London, UK
| | - Karine Manera
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
- Centre for Kidney Research, Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Allison Tong
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - David J Tunnicliffe
- Centre for Kidney Research, Children's Hospital at Westmead, Westmead, New South Wales, Australia
- University of Sydney, Sydney School of Public Health, New South Wales Ministry of Health, Sydney, New South Wales, Australia
| |
Collapse
|
5
|
Abimbola S, Keelan S, Everett M, Casburn K, Mitchell M, Burchfield K, Martiniuk A. The medium, the message and the measure: a theory-driven review on the value of telehealth as a patient-facing digital health innovation. Health Econ Rev 2019; 9:21. [PMID: 31270685 PMCID: PMC6734475 DOI: 10.1186/s13561-019-0239-5] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Accepted: 06/18/2019] [Indexed: 05/07/2023]
Abstract
By what measure should a policy maker choose between two mediums that deliver the same or similar message or service? Between, say, video consultation or a remote patient monitoring application (i.e. patient-facing digital health innovations) and in-person consultation? To answer this question, we sought to identify measures which are used in randomised controlled trials. But first we used two theories to frame the effects of patient-facing digital health innovations on - 1) transaction costs (i.e. the effort, time and costs required to complete a clinical interaction); and 2) process outcomes and clinical outcomes along the care cascade or information value chain, such that the 'value of information' (VoI) is different at each point in the care cascade or value chain. From the trials, we identified three categories of measures: outcome (process or clinical), satisfaction, and cost. We found that although patient-facing digital health innovations tend to confer much of their value by altering process outcomes, satisfaction, and transaction costs, these measures are inconsistently assessed. Efforts to determine the relative value of and choose between mediums of service delivery should adopt a metric (i.e. mathematical combination of measures) that capture all dimensions of value. We argue that 'value of information' (VoI) is such a metric - it is calculated as the difference between the 'expected utility' (EU) of alternative options. But for patient-facing digital health innovations, 'expected utility' (EU) should incorporate the probability of achieving not only a clinical outcome, but also process outcomes (depending on the innovation under consideration); and the measures of utility should include satisfaction and transaction costs; and also changes in population access to services, and health system capacity to deliver more services, which may result from reduction in transaction costs.
Collapse
Affiliation(s)
- Seye Abimbola
- School of Public Health, University of Sydney, Sydney, Australia
- Royal Far West, Sydney, Australia
- The George Institute for Global Health, Sydney, Australia
| | - Sarah Keelan
- School of Public Health, University of Sydney, Sydney, Australia
- Royal Far West, Sydney, Australia
| | | | | | | | | | - Alexandra Martiniuk
- School of Public Health, University of Sydney, Sydney, Australia
- Royal Far West, Sydney, Australia
- The George Institute for Global Health, Sydney, Australia
- University of Toronto, Toronto, Canada
| |
Collapse
|
6
|
Passam F, Chiu J, Ju L, Pijning A, Jahan Z, Mor-Cohen R, Yeheskel A, Kolšek K, Thärichen L, Aponte-Santamaría C, Gräter F, Hogg PJ. Mechano-redox control of integrin de-adhesion. eLife 2018; 7:e34843. [PMID: 29932420 PMCID: PMC6054529 DOI: 10.7554/elife.34843] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Accepted: 06/21/2018] [Indexed: 12/17/2022] Open
Abstract
How proteins harness mechanical force to control function is a significant biological question. Here we describe a human cell surface receptor that couples ligand binding and force to trigger a chemical event which controls the adhesive properties of the receptor. Our studies of the secreted platelet oxidoreductase, ERp5, have revealed that it mediates release of fibrinogen from activated platelet αIIbβ3 integrin. Protein chemical studies show that ligand binding to extended αIIbβ3 integrin renders the βI-domain Cys177-Cys184 disulfide bond cleavable by ERp5. Fluid shear and force spectroscopy assays indicate that disulfide cleavage is enhanced by mechanical force. Cell adhesion assays and molecular dynamics simulations demonstrate that cleavage of the disulfide induces long-range allosteric effects within the βI-domain, mainly affecting the metal-binding sites, that results in release of fibrinogen. This coupling of ligand binding, force and redox events to control cell adhesion may be employed to regulate other protein-protein interactions.
Collapse
Affiliation(s)
| | - Joyce Chiu
- The Centenary InstituteNewtownAustralia
- National Health and Medical Research Council Clinical Trials CentreUniversity of SydneySydneyAustralia
| | - Lining Ju
- Heart Research Institute and Charles Perkins CentreUniversity of SydneySydneyAustralia
| | | | | | - Ronit Mor-Cohen
- The Amalia Biron Research Institute of Thrombosis and Hemostasis, Sheba Medical Center, Tel Hashomer and Sackler Faculty of MedicineTel Aviv UniversityTel AvivIsrael
| | - Adva Yeheskel
- The Bioinformatics Unit, George S. Wise Faculty of Life ScienceTel Aviv UniversityTel AvivIsrael
| | - Katra Kolšek
- Heidelberg Institute of Theoretical StudiesHeidelbergGermany
- Interdisciplinary Center for Scientific ComputingHeidelberg UniversityHeidelbergGermany
| | - Lena Thärichen
- Heidelberg Institute of Theoretical StudiesHeidelbergGermany
- Interdisciplinary Center for Scientific ComputingHeidelberg UniversityHeidelbergGermany
| | - Camilo Aponte-Santamaría
- Heidelberg Institute of Theoretical StudiesHeidelbergGermany
- Max Planck Tandem Group in Computational BiophysicsUniversity of Los AndesBogotáColombia
| | - Frauke Gräter
- Heidelberg Institute of Theoretical StudiesHeidelbergGermany
- Interdisciplinary Center for Scientific ComputingHeidelberg UniversityHeidelbergGermany
| | - Philip J Hogg
- The Centenary InstituteNewtownAustralia
- National Health and Medical Research Council Clinical Trials CentreUniversity of SydneySydneyAustralia
| |
Collapse
|
7
|
Wong ATY, Mannix C, Grantham JJ, Allman-Farinelli M, Badve SV, Boudville N, Byth K, Chan J, Coulshed S, Edwards ME, Erickson BJ, Fernando M, Foster S, Haloob I, Harris DCH, Hawley CM, Hill J, Howard K, Howell M, Jiang SH, Johnson DW, Kline TL, Kumar K, Lee VW, Lonergan M, Mai J, McCloud P, Peduto A, Rangan A, Roger SD, Sud K, Torres V, Vilayur E, Rangan GK. Randomised controlled trial to determine the efficacy and safety of prescribed water intake to prevent kidney failure due to autosomal dominant polycystic kidney disease (PREVENT-ADPKD). BMJ Open 2018; 8:e018794. [PMID: 29358433 PMCID: PMC5780847 DOI: 10.1136/bmjopen-2017-018794] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
INTRODUCTION Maintaining fluid intake sufficient to reduce arginine vasopressin (AVP) secretion has been hypothesised to slow kidney cyst growth in autosomal dominant polycystic kidney disease (ADPKD). However, evidence to support this as a clinical practice recommendation is of poor quality. The aim of the present study is to determine the long-term efficacy and safety of prescribed water intake to prevent the progression of height-adjusted total kidney volume (ht-TKV) in patients with chronic kidney disease (stages 1-3) due to ADPKD. METHODS AND ANALYSIS A multicentre, prospective, parallel-group, open-label, randomised controlled trial will be conducted. Patients with ADPKD (n=180; age ≤65 years, estimated glomerular filtration rate (eGFR) ≥30 mL/min/1.73 m2) will be randomised (1:1) to either the control (standard treatment+usual fluid intake) or intervention (standard treatment+prescribed fluid intake) group. Participants in the intervention arm will be prescribed an individualised daily fluid intake to reduce urine osmolality to ≤270 mOsmol/kg, and supported with structured clinic and telephonic dietetic review, self-monitoring of urine-specific gravity, short message service text reminders and internet-based tools. All participants will have 6-monthly follow-up visits, and ht-TKV will be measured by MRI at 0, 18 and 36 months. The primary end point is the annual rate of change in ht-TKV as determined by serial renal MRI in control vs intervention groups, from baseline to 3 years. The secondary end points are differences between the two groups in systemic AVP activity, renal disease (eGFR, blood pressure, renal pain), patient adherence, acceptability and safety. ETHICS AND DISSEMINATION The trial was approved by the Human Research Ethics Committee, Western Sydney Local Health District. The results will inform clinicians, patients and policy-makers regarding the long-term safety, efficacy and feasibility of prescribed fluid intake as an approach to reduce kidney cyst growth in patients with ADPKD. TRIAL REGISTRATION NUMBER ANZCTR12614001216606.
Collapse
Affiliation(s)
- Annette T Y Wong
- Centre for Transplant and Renal Research, The Westmead Institute for Medical Research, The University of Sydney, Sydney, Australia
- Department of Renal Medicine, Westmead Hospital, Western Sydney Local Health District, Sydney, Australia
| | - Carly Mannix
- Centre for Transplant and Renal Research, The Westmead Institute for Medical Research, The University of Sydney, Sydney, Australia
- Department of Renal Medicine, Westmead Hospital, Western Sydney Local Health District, Sydney, Australia
| | - Jared J Grantham
- The Kidney Institute, Division of Nephrology and Hypertension, Kansas University Medical Center, Kansas City, Kansas, USA
| | - Margaret Allman-Farinelli
- School of Life and Environmental Sciences, The Charles Perkins Centre, The University of Sydney, Sydney, Australia
| | - Sunil V Badve
- Department of Renal Medicine, St. George Hospital, Sydney, Australia
| | - Neil Boudville
- Department of Renal Medicine, Sir Charles Gairdner Hospital, Nedlands and the Harry Perkins Institute of Medical Research, University of Western Australia, Sydney, Australia
| | - Karen Byth
- Research and Education Network, Westmead Hospital, Western Sydney Local Health District, Sydney, Australia
| | | | | | - Marie E Edwards
- Translational Polycystic Kidney Disease Center, Mayo Clinic, Rochester, Minnesota, USA
| | - Bradley J Erickson
- Translational Polycystic Kidney Disease Center, Mayo Clinic, Rochester, Minnesota, USA
| | - Mangalee Fernando
- Department of Renal Medicine, Prince of Wales Hospital, Eastern Sydney Health District and the University of New South Wales, Randwick, Australia
| | - Sheryl Foster
- Department of Radiology, Westmead Hospital, Western Sydney Local Health District, Sydney, Australia
- Faculty of Health Sciences, The University of Sydney, Sydney, Australia
| | - Imad Haloob
- Department of Renal Medicine, Bathurst Base Hospital, Bathurst, Australia
| | - David C H Harris
- Centre for Transplant and Renal Research, The Westmead Institute for Medical Research, The University of Sydney, Sydney, Australia
- Department of Renal Medicine, Westmead Hospital, Western Sydney Local Health District, Sydney, Australia
| | - Carmel M Hawley
- Australasian Kidney Trials Network, University of Queensland at Princess Alexandra Hospital, Woolloongabba, Australia
| | - Julie Hill
- McCloud Consulting Group, Gordon, Australia
| | - Kirsten Howard
- School of Public Health, University of Sydney, Sydney, Australia
| | - Martin Howell
- School of Public Health, University of Sydney, Sydney, Australia
| | - Simon H Jiang
- Department of Renal Medicine, Canberra Hospital, Garran, Australia
- Department of Immunology and Infectious Diseases, John Curtin School of Medical Research, Australian National University, Canberra, Australia
| | - David W Johnson
- Australasian Kidney Trials Network, University of Queensland at Princess Alexandra Hospital, Woolloongabba, Australia
| | - Timothy L Kline
- Translational Polycystic Kidney Disease Center, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Vincent W Lee
- Centre for Transplant and Renal Research, The Westmead Institute for Medical Research, The University of Sydney, Sydney, Australia
- Department of Renal Medicine, Westmead Hospital, Western Sydney Local Health District, Sydney, Australia
- Department of Renal Medicine, Norwest Private Hospital, Sydney, Australia
| | - Maureen Lonergan
- Department of Renal Medicine, Wollongong Hospital, Illawarra Shoalhaven Local Health District, Wollongong, Australia
| | - Jun Mai
- Department of Renal Medicine, Liverpool Hospital, Southwestern Sydney Local Health District, Liverpool, Australia
| | | | - Anthony Peduto
- Department of Radiology, Westmead Hospital, Western Sydney Local Health District, Sydney, Australia
| | - Anna Rangan
- School of Life and Environmental Sciences, The Charles Perkins Centre, The University of Sydney, Sydney, Australia
| | | | - Kamal Sud
- Department of Renal Medicine, Westmead Hospital, Western Sydney Local Health District, Sydney, Australia
- Department of Renal Medicine, Nepean Hospital, Nepean Blue Mountains Local Health District, Sydney, Australia
- Nepean Clinical School, The University of Sydney Medical School, Sydney, Australia
| | - Vincent Torres
- Translational Polycystic Kidney Disease Center, Mayo Clinic, Rochester, Minnesota, USA
| | - Eswari Vilayur
- Department of Nephrology, John Hunter Hospital, Newcastle, Australia
| | - Gopala K Rangan
- Centre for Transplant and Renal Research, The Westmead Institute for Medical Research, The University of Sydney, Sydney, Australia
- Department of Renal Medicine, Westmead Hospital, Western Sydney Local Health District, Sydney, Australia
| |
Collapse
|
8
|
Fitzpatrick EFM, Carter M, Oscar J, Lawford T, Martiniuk ALC, D'Antoine HA, Elliott EJ. Research protocol for the Picture Talk Project: a qualitative study on research and consent with remote Australian Aboriginal communities. BMJ Open 2017; 7:e018452. [PMID: 29288181 PMCID: PMC5770946 DOI: 10.1136/bmjopen-2017-018452] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION Research with Indigenous populations is not always designed with cultural sensitivity. Few publications evaluate or describe in detail seeking consent for research with Indigenous participants. When potential participants are not engaged in a culturally respectful manner, participation rates and research quality can be adversely affected. It is unethical to proceed with research without truly informed consent. METHODS AND ANALYSIS We describe a culturally appropriate research protocol that is invited by Aboriginal communities of the Fitzroy Valley in Western Australia. The Picture Talk Project is a research partnership with local Aboriginal leaders who are also chief investigators. We will interview Aboriginal leaders about research, community engagement and the consent process and hold focus groups with Aboriginal community members about individual consent. Cultural protocols will be applied to recruit and conduct research with participants. Transcripts will be analysed using NVivo10 qualitative software and themes synthesised to highlight the key issues raised by the community about the research process. This protocol will guide future research with the Aboriginal communities of the Fitzroy Valley and may inform the approach to research with other Indigenous communities of Australia or the world. It must be noted that no community is the same and all research requires local consultation and input. To conduct culturally sensitive research, respected local people from the community who have knowledge of cultural protocol and language are engaged to guide each step of the research process from the project design to the delivery of results. ETHICS AND DISSEMINATION Ethics approval was granted by the University of Sydney Human Research Ethics Committee (No. 2012/348, reference:14760), the Western Australia Country Health Service Ethics Committee (No. 2012:15), the Western Australian Aboriginal Health Ethics Committee and reviewed by the Kimberley Aboriginal Health Planning Forum Research Sub-Committee (No. 2012-008). Results will be disseminated through peer review articles, a local Fitzroy Valley report and conference presentations.
Collapse
Affiliation(s)
- Emily F M Fitzpatrick
- Discipline of Child and Adolescent Health, University of Sydney Medical School, Sydney, Australia
- Discipline of Child and Adolescent Health, Sydney Children's Hospitals Network Randwick and Westmead, Sydney, Australia
| | - Maureen Carter
- Nindilingarri Cultural Health Services, Fitzroy Crossing, Australia
| | - June Oscar
- Marninwarntikura Women's Resource Centre, Fitzroy Crossing, Australia
- Nulungu Research Institute, The University of Notre Dame, Broome, Australia
| | - Tom Lawford
- Kimberley Aboriginal Law and Culture Centre, Fitzroy Crossing, Australia
| | - Alexandra L C Martiniuk
- School of Public Health, University of Sydney Medical School, Sydney, Australia
- Dalla Lana School of Public Health, University of Toronto - Mississauga, Mississauga, Canada
- Epidemiology Division, The George Institute for Global Health, Sydney, Australia
| | - Heather A D'Antoine
- Division of Education and Capacity Building, Menzies School of Health Research, Darwin, Australia
| | - Elizabeth J Elliott
- Discipline of Child and Adolescent Health, University of Sydney Medical School, Sydney, Australia
- Discipline of Child and Adolescent Health, Sydney Children's Hospitals Network Randwick and Westmead, Sydney, Australia
| |
Collapse
|
9
|
Aminnejad M, Cogliati M, Duan S, Arabatzis M, Tintelnot K, Castañeda E, Lazéra M, Velegraki A, Ellis D, Sorrell TC, Meyer W. Identification and Characterization of VNI/VNII and Novel VNII/VNIV Hybrids and Impact of Hybridization on Virulence and Antifungal Susceptibility Within the C. neoformans/C. gattii Species Complex. PLoS One 2016; 11:e0163955. [PMID: 27764108 PMCID: PMC5072701 DOI: 10.1371/journal.pone.0163955] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Accepted: 09/16/2016] [Indexed: 12/14/2022] Open
Abstract
Cryptococcus neoformans and C. gattii are pathogenic basidiomycetous yeasts and the commonest cause of fungal infection of the central nervous system. Cryptococci are typically haploid but several inter-species, inter-varietal and intra-varietal hybrids have been reported. It has a bipolar mating system with sexual reproduction occurring normally between two individuals with opposite mating types, α and a. This study set out to characterize hybrid isolates within the C. neoformans/C. gattii species complex: seven unisexual mating intra-varietal VNI/VNII (αAAα) and six novel inter-varietal VNII/VNIV (aADα). The URA5-RFLP pattern for VNII/VNIV (aADα) differs from the VNIII (αADa) hybrids. Analysis of the allelic patterns of selected genes for AD hybrids showed 79% or more heterozygosis for the studied loci except for CBS132 (VNIII), which showed 50% of heterozygosity. MALDI-TOF MS was applied to hybrids belonging to different sero/mating type allelic patterns. All hybrid isolates were identified as belonging to the same hybrid group with identification scores ranging between 2.101 to 2.634. All hybrids were virulent when tested in the Galleria mellonella (wax moth) model, except for VNII/VNIV (aADα) hybrids. VNI/VGII hybrids were the most virulent hybrids. Hybrids recovered from larvae manifested a significant increase in capsule and total cell size and produced a low proportion (5-10%) of giant cells compared with the haploid control strains. All strains expressed the major virulence factors-capsule, melanin and phospholipase B-and grew well at 37°C. The minimal inhibitory concentration of nine drugs was measured by micro-broth dilution and compared with published data on haploid strains. MICs were similar amongst hybrids and haploid parental strains. This is the first study reporting natural same sex αAAα intra-varietal VNI/VNII hybrids and aADα inter-varietal VNII/VNIV hybrids.
Collapse
Affiliation(s)
- Mojgan Aminnejad
- Molecular Mycology Research Laboratory, Centre for Infectious Diseases and Microbiology, Sydney Medical School – Westmead Hospital, Marie Bashir Institute for Infectious Diseases and Biosecurity, The University of Sydney, Westmead Institute for Medical Research, Sydney, Australia
| | - Massimo Cogliati
- Laboratory Micologia Medica, Dip. Scienze Biomediche per la Salute, Università degli Studi di Milano, Milano, Italy
| | - Shuyao Duan
- Molecular Mycology Research Laboratory, Centre for Infectious Diseases and Microbiology, Sydney Medical School – Westmead Hospital, Marie Bashir Institute for Infectious Diseases and Biosecurity, The University of Sydney, Westmead Institute for Medical Research, Sydney, Australia
| | - Michael Arabatzis
- Mycology Research Laboratory, Department of Microbiology, Medical School, National Kapodistrian University of Athens, Athens, Greece
| | | | | | - Marcia Lazéra
- Mycology Laboratory, National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Aristea Velegraki
- Mycology Research Laboratory, Department of Microbiology, Medical School, National Kapodistrian University of Athens, Athens, Greece
| | - David Ellis
- School of Molecular & Biomedical Sciences, University of Adelaide, Adelaide, SA 5005, Australia
| | - Tania C. Sorrell
- Molecular Mycology Research Laboratory, Centre for Infectious Diseases and Microbiology, Sydney Medical School – Westmead Hospital, Marie Bashir Institute for Infectious Diseases and Biosecurity, The University of Sydney, Westmead Institute for Medical Research, Sydney, Australia
| | - Wieland Meyer
- Molecular Mycology Research Laboratory, Centre for Infectious Diseases and Microbiology, Sydney Medical School – Westmead Hospital, Marie Bashir Institute for Infectious Diseases and Biosecurity, The University of Sydney, Westmead Institute for Medical Research, Sydney, Australia
| |
Collapse
|
10
|
Gow ML, Baur LA, Ho M, Chisholm K, Noakes M, Cowell CT, Garnett SP. Can early weight loss, eating behaviors and socioeconomic factors predict successful weight loss at 12- and 24-months in adolescents with obesity and insulin resistance participating in a randomised controlled trial? Int J Behav Nutr Phys Act 2016; 13:43. [PMID: 27036113 PMCID: PMC4818484 DOI: 10.1186/s12966-016-0367-9] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Accepted: 03/23/2016] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Lifestyle interventions in adolescents with obesity can result in weight loss following active intervention but individual responses vary widely. This study aimed to identify predictors of weight loss at 12- and 24-months in adolescents with obesity and clinical features of insulin resistance. METHODS Adolescents (n = 111, 66 girls, aged 10-17 years) were participants in a randomised controlled trial, the RESIST study, examining the effects of two diets differing in macronutrient content on insulin sensitivity. Eighty-five completed the 12-month program and 24-month follow-up data were available for 42 adolescents. Change in weight was determined by BMI expressed as a percentage of the 95th percentile (BMI95). The study physician collected socioeconomic data at baseline. Physical activity and screen time, and psychological dimensions of eating behavior were self-reported using the validated CLASS and EPI-C questionnaires, respectively. Stepwise multiple regressions were conducted to identify models that best predicted change in BMI95 at 12- and 24-months. RESULTS Mean BMI95 was reduced at 12-months compared with baseline (mean difference [MD] ± SE: -6.9 ± 1.0, P < 0.001) but adolescents had significant re-gain from 12- to 24-months (MD ± SE: 3.7 ± 1.5, P = 0.017). Participants who achieved greater 12-month weight loss had: greater 3-month weight loss, a father with a higher education, lower baseline external eating and parental pressure to eat scores and two parents living at home. Participants who achieved greater 24-month weight loss had: greater 12-month weight loss and a lower baseline emotional eating score. CONCLUSIONS Early weight loss is consistently identified as a strong predictor of long-term weight loss. This could be because early weight loss identifies those more motivated and engaged individuals. Patients who have baseline factors predictive of long-term weight loss failure may benefit from additional support during the intervention. Additionally, if a patient does not achieve early weight loss, further support or transition to an alternate intervention where they may have increased success may be considered. TRIAL REGISTRATION Australian New Zealand Clinical Trial Registration Number (ACTRN) 12608000416392 https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=83071.
Collapse
Affiliation(s)
- Megan L. Gow
- />Institute of Endocrinology and Diabetes, The Children’s Hospital at Westmead, Locked Bag 4001, Westmead, NSW 2145 Australia
- />The Children’s Hospital at Westmead Clinical School, University of Sydney, Locked Bag 4001, Westmead, NSW 2145 Australia
| | - Louise A. Baur
- />The Children’s Hospital at Westmead Clinical School, University of Sydney, Locked Bag 4001, Westmead, NSW 2145 Australia
- />Kids Research Institute, The Children’s Hospital at Westmead, Locked Bag 4001, Westmead, NSW 2145 Australia
| | - Mandy Ho
- />The Children’s Hospital at Westmead Clinical School, University of Sydney, Locked Bag 4001, Westmead, NSW 2145 Australia
| | - Kerryn Chisholm
- />Nutrition and Dietetics and Weight Management Services, The Children’s Hospital at Westmead, Locked Bag 4001, Westmead, NSW 2145 Australia
| | - Manny Noakes
- />CSIRO Food and Nutritional Sciences, PO Box 10041, Adelaide BC, SA 5000 Australia
| | - Chris T. Cowell
- />Institute of Endocrinology and Diabetes, The Children’s Hospital at Westmead, Locked Bag 4001, Westmead, NSW 2145 Australia
- />The Children’s Hospital at Westmead Clinical School, University of Sydney, Locked Bag 4001, Westmead, NSW 2145 Australia
- />Kids Research Institute, The Children’s Hospital at Westmead, Locked Bag 4001, Westmead, NSW 2145 Australia
| | - Sarah P. Garnett
- />Institute of Endocrinology and Diabetes, The Children’s Hospital at Westmead, Locked Bag 4001, Westmead, NSW 2145 Australia
- />The Children’s Hospital at Westmead Clinical School, University of Sydney, Locked Bag 4001, Westmead, NSW 2145 Australia
- />Kids Research Institute, The Children’s Hospital at Westmead, Locked Bag 4001, Westmead, NSW 2145 Australia
| |
Collapse
|