1
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Bagot KL, Bladin CF, Vu M, Bernard S, Smith K, Hocking G, Coupland T, Hutton D, Badcock D, Budge M, Nadurata V, Pearce W, Hall H, Kelly B, Spencer A, Chapman P, Oqueli E, Sahathevan R, Kraemer T, Hair C, Dion S, McGuinness C, Cadilhac DA. Factors influencing the successful implementation of a novel digital health application to streamline multidisciplinary communication across multiple organisations for emergency care. J Eval Clin Pract 2024; 30:184-198. [PMID: 37721181 DOI: 10.1111/jep.13923] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 08/04/2023] [Accepted: 08/15/2023] [Indexed: 09/19/2023]
Abstract
RATIONALE Delivering optimal patient health care requires interdisciplinary clinician communication. A single communication tool across multiple pre-hospital and hospital settings, and between hospital departments is a novel solution to current systems. Fit-for-purpose, secure smartphone applications allow clinical information to be shared quickly between health providers. Little is known as to what underpins their successful implementation in an emergency care context. AIMS To identify (a) whether implementing a single, digital health communication application across multiple health care organisations and hospital departments is feasible; (b) the barriers and facilitators to implementation; and (c) which factors are associated with clinicians' intentions to use the technology. METHODS We used a multimethod design, evaluating the implementation of a secure, digital communication application (Pulsara™). The technology was trialled in two Australian regional hospitals and 25 Ambulance Victoria branches (AV). Post-training, clinicians involved in treating patients with suspected stroke or cardiac events were administered surveys measuring perceived organisational readiness (Organisational Readiness for Implementing Change), clinicians' intentions (Unified Theory of Acceptance and Use of Technology) and internal motivations (Self-Determination Theory) to use Pulsara™, and the perceived benefits and barriers of use. Quantitative data were descriptively summarised with multivariable associations between factors and intentions to use Pulsara™ examined with linear regression. Qualitative data responses were subjected to directed content analysis (two coders). RESULTS Participants were paramedics (n = 82, median 44 years) or hospital-based clinicians (n = 90, median 37 years), with organisations perceived to be similarly ready. Regression results (F(11, 136) = 21.28, p = <0.001, Adj R2 = 0.60) indicated Habit, Effort Expectancy, Perceived Organisational Readiness, Performance Expectancy and Organisation membership (AV) as predictors of intending to use Pulsara™. Themes relating to benefits (95% coder agreement) included improved communication, procedural efficiencies and faster patient care. Barriers (92% coder agreement) included network accessibility and remembering passwords. PulsaraTM was initiated 562 times. CONCLUSION Implementing multiorganisational, digital health communication applications is feasible, and facilitated when organisations are change-ready for an easy-to-use, effective solution. Developing habitual use is key, supported through implementation strategies (e.g., hands-on training). Benefits should be emphasised (e.g., during education sessions), including streamlining communication and patient flow, and barriers addressed (e.g., identify champions and local technical support) at project commencement.
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Affiliation(s)
- Kathleen L Bagot
- Public Health and Health Services Research, Stroke theme, The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Victoria, Australia
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
| | - Chris F Bladin
- Public Health and Health Services Research, Stroke theme, The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Victoria, Australia
- Ambulance Victoria, Doncaster, Victoria, Australia
- Eastern Health Clinical School, Monash University, Clayton, Victoria, Australia
| | - Michelle Vu
- Public Health and Health Services Research, Stroke theme, The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Victoria, Australia
| | - Stephen Bernard
- Ambulance Victoria, Doncaster, Victoria, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Clayton, Victoria, Australia
| | - Karen Smith
- Ambulance Victoria, Doncaster, Victoria, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Clayton, Victoria, Australia
- Department of Paramedicine, Monash University, Clayton, Victoria, Australia
- Research and Innovation, Silverchain Group, Melbourne, Victoria, Australia
| | | | | | - Debra Hutton
- Grampians Health Ballarat, Ballarat, Victoria, Australia
| | | | - Marc Budge
- Bendigo Health, Bendigo, Victoria, Australia
| | | | - Wayne Pearce
- Ambulance Victoria, Doncaster, Victoria, Australia
| | - Howard Hall
- Ambulance Victoria, Doncaster, Victoria, Australia
| | - Ben Kelly
- Grampians Health Ballarat, Ballarat, Victoria, Australia
| | - Angie Spencer
- Grampians Health Ballarat, Ballarat, Victoria, Australia
| | | | - Ernesto Oqueli
- Grampians Health Ballarat, Ballarat, Victoria, Australia
- Department of Medicine, Deakin University, Burwood, Victoria, Australia
| | - Ramesh Sahathevan
- Grampians Health Ballarat, Ballarat, Victoria, Australia
- Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, Victoria, Australia
- Ballarat Clinical School, School of Medicine, Deakin University, Ballarat, Australia
| | - Thomas Kraemer
- Grampians Health Ballarat, Ballarat, Victoria, Australia
| | - Casey Hair
- Grampians Health Ballarat, Ballarat, Victoria, Australia
| | - Stub Dion
- Ambulance Victoria, Doncaster, Victoria, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Clayton, Victoria, Australia
| | - Connor McGuinness
- Public Health and Health Services Research, Stroke theme, The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Victoria, Australia
| | - Dominique A Cadilhac
- Public Health and Health Services Research, Stroke theme, The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Victoria, Australia
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
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Jeddi MF, Zebaze R, Urbano I, Skinner S, Jain V, Budge M. Diabetic lumbosacral plexopathy: an unpredictable clinical entity. Disabil Rehabil 2022:1-5. [PMID: 35862675 DOI: 10.1080/09638288.2022.2099587] [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] [Indexed: 11/03/2022]
Abstract
PURPOSE Diabetic plexopathy is among the most unusual and disabling complication type 2 diabetic mellitus (T2DM) causing major suffering among affected individuals. The clinical presentation includes asymmetric muscle atrophy, weakness, and pain, typically associated with sudden weight loss. In part due to its rarity, this condition can be easily missed with serious consequences including potentially fatal complications. METHODS AND RESULTS A single case report of a 59-year-old woman with T2DM complicated by a lumbosacral plexopathy that presented with unusual clinical signs, symptoms and metabolic changes including (i) a life-threatening cardiac arrest due to a massive saddle pulmonary embolism (PE) secondary to a lower limb deep venous thrombosis ipsilateral to the plexopathy and (ii) an unexpected partial spontaneous remission of T2DM. CONCLUSIONS This case highlights the need for increased awareness and improved investigation and understanding of the pathogenesis and management of diabetic plexopathy, especially in rehabilitation settings for optimizing functional outcomes from rehabilitation input. Implications for rehabilitationDiabetic lumbosacral plexopathy (DLSP) is a distinct cause of neurological impairment requiring rehabilitation with a different natural history and prognosis. Its incidence almost three times higher than that of other common inflammatory neuropathies such as Guillain-Barré.Early recognition of DLSP in order to provide interventions, assessment, and therapeutic strategies in Rehabilitation.Diabetes plexopathy should remain an important consideration in the differential diagnoses when assessing any patient with diabetes presenting with acute pain and weakness in the extremities.
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Affiliation(s)
- Muhammad Faraz Jeddi
- Department of Geriatrics and Rehabilitation Medicine, Bendigo Health, Bendigo, Australia
| | - Roger Zebaze
- Department of Medicine, Monash University, Clayton, Australia
| | - Isabelle Urbano
- Department of Geriatrics and Rehabilitation Medicine, Bendigo Health, Bendigo, Australia
| | - Sarah Skinner
- Department of Geriatrics and Rehabilitation Medicine, Bendigo Health, Bendigo, Australia
| | - Vinamra Jain
- Department of Geriatrics and Rehabilitation Medicine, Bendigo Health, Bendigo, Australia
| | - Marc Budge
- Department of Geriatrics and Rehabilitation Medicine, Bendigo Health, Bendigo, Australia.,Rural School of Health, Monash University, Bendigo, Australia
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3
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Bladin CF, Bagot KL, Vu M, Kim J, Bernard S, Smith K, Hocking G, Coupland T, Pearce D, Badcock D, Budge M, Nadurata V, Pearce W, Hall H, Kelly B, Spencer A, Chapman P, Oqueli E, Sahathevan R, Kraemer T, Hair C, Stub D, Cadilhac DA. Real-world, feasibility study to investigate the use of a multidisciplinary app (Pulsara) to improve prehospital communication and timelines for acute stroke/STEMI care. BMJ Open 2022; 12:e052332. [PMID: 35851025 PMCID: PMC9297229 DOI: 10.1136/bmjopen-2021-052332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES To determine if a digital communication app improves care timelines for patients with suspected acute stroke/ST-elevation myocardial infarction (STEMI). DESIGN Real-world feasibility study, quasi-experimental design. SETTING Prehospital (25 Ambulance Victoria branches) and within-hospital (2 hospitals) in regional Victoria, Australia. PARTICIPANTS Paramedics or emergency department (ED) clinicians identified patients with suspected acute stroke (onset <4.5 hours; n=604) or STEMI (n=247). INTERVENTION The Pulsara communication app provides secure, two-way, real-time communication. Assessment and treatment times were recorded for 12 months (May 2017-April 2018), with timelines compared between 'Pulsara initiated' (Pulsara) and 'not initiated' (no Pulsara). PRIMARY OUTCOME MEASURE Door-to-treatment (needle for stroke, balloon for STEMI) Secondary outcome measures: ambulance and hospital processes. RESULTS Stroke (no Pulsara n=215, Pulsara n=389) and STEMI (no Pulsara n=76, Pulsara n=171) groups were of similar age and sex (stroke: 76 vs 75 years; both groups 50% male; STEMI: 66 vs 63 years; 68% and 72% male). When Pulsara was used, patients were off ambulance stretcher faster for stroke (11(7, 17) vs 19(11, 29); p=0.0001) and STEMI (14(7, 23) vs 19(10, 32); p=0.0014). ED door-to-first medical review was faster (6(2, 14) vs 23(8, 67); p=0.0001) for stroke but only by 1 min for STEMI (3 (0, 7) vs 4 (0, 14); p=0.25). Door-to-CT times were 44 min faster (27(18, 44) vs 71(43, 147); p=0.0001) for stroke, and percutaneous intervention door-to-balloon times improved by 17 min, but non-significant (56 (34, 88) vs 73 (49, 110); p=0.41) for STEMI. There were improvements in the proportions of patients treated within 60 min for stroke (12%-26%, p=0.15) and 90 min for STEMI (50%-78%, p=0.20). CONCLUSIONS In this Australian-first study, uptake of the digital communication app was strong, patient-centred care timelines improved, although door-to-treatment times remained similar.
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Affiliation(s)
- Chris F Bladin
- Ambulance Victoria, Doncaster, Victoria, Australia
- The Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia
- Eastern Health Clinical School, Monash University, Box Hill, Victoria, Australia
| | - Kathleen L Bagot
- The Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia
- Stroke and Ageing Research, Department of Medicine, Monash University, Clayton, Victoria, Australia
| | - Michelle Vu
- Epworth Hospital, Richmond, Victoria, Australia
| | - Joosup Kim
- The Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia
- Stroke and Ageing Research, Department of Medicine, Monash University, Clayton, Victoria, Australia
| | | | - Karen Smith
- Centre for Research and Evaluation, Ambulance Victoria, Doncaster, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | | | | | - Debra Pearce
- Ballarat Health Services, Ballarat, Victoria, Australia
| | | | - Marc Budge
- Bendigo Health, Bendigo, Victoria, Australia
| | | | - Wayne Pearce
- Ambulance Victoria, Doncaster, Victoria, Australia
| | - Howard Hall
- Ambulance Victoria, Doncaster, Victoria, Australia
| | - Ben Kelly
- Ballarat Health Services, Ballarat, Victoria, Australia
| | - Angie Spencer
- Ballarat Health Services, Ballarat, Victoria, Australia
| | | | - Ernesto Oqueli
- Ballarat Health Services, Ballarat, Victoria, Australia
- Department of Medicine, Deakin University, Burwood, Sydney, Australia
| | - Ramesh Sahathevan
- Ballarat Health Services, Ballarat, Victoria, Australia
- Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | | | - Casey Hair
- Ballarat Health Services, Ballarat, Victoria, Australia
| | - Dion Stub
- Ambulance Victoria, Doncaster, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Dominique A Cadilhac
- The Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia
- Stroke and Ageing Research, Department of Medicine, Monash University, Clayton, Victoria, Australia
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4
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Gray K, Chapman W, Khan UR, Borda A, Budge M, Dutch M, Hart GK, Gilbert C, Wani TA. The Rapid Development of Virtual Care Tools in Response to COVID-19: Case Studies in Three Australian Health Services. JMIR Form Res 2022; 6:e32619. [PMID: 35297765 PMCID: PMC8993142 DOI: 10.2196/32619] [Citation(s) in RCA: 2] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 12/24/2021] [Accepted: 03/15/2022] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND News of the impact of COVID-19 around the world delivered a brief opportunity for Australian health services to plan new ways of delivering care to large numbers of people while maintaining staff safety through greater physical separation. The rapid pivot to telemedicine and virtual care provided immediate and longer term benefits; however, such rapid-cycle development also created risks. OBJECTIVE The aim of this study was to understand the sociotechnical aspects of the rapid-cycle development of seven different COVID-19 virtual care tools, and to identify enablers, barriers, and risks at three health services in Victoria, Australia. METHODS A qualitative, embedded, multiple case study design was adopted. Researchers from three health services collaborated with university researchers who were independent from those health services to gather and analyze structured interview data from key people involved in either clinical or technical aspects of designing and deploying seven different virtual care tools. RESULTS The overall objectives of each health service reflected the international requirements for managing large numbers of patients safely but remotely and for protecting staff. However, the governance, digital maturity, and specific use cases at each institution shaped the methodology and specific outcomes required. Dependence on key individuals and their domain knowledge within an existing governance framework generally enabled rapid deployment, but sometimes posed barriers. Existing relationships with technical service developers enabled strong solutions, which in some cases were highly scalable. Conventional project methodologies such as steering committees, scope, budget control, tight functional specification, consumer engagement and codesign, universal accessibility, and postimplementation evaluation were ignored almost universally in this environment. CONCLUSIONS These three health services took a variety of approaches to the rapid-cycle development of virtual care tools to meet their urgent needs for triaging and remote monitoring during the first year of the COVID-19 pandemic. Their experiences provided insights into many social and technical barriers and enablers to the development of virtual care tools. If these are addressed proactively, they will improve clinical governance and technical management of future virtual care. Some changes can be made within individual health services, while others entail health system policy reforms. Enhancing the environment for virtual care tool design and implementation now will yield returns not only during future health emergencies but also in many more routine care settings.
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Affiliation(s)
- Kathleen Gray
- Centre for Digital Transformation of Health, University of Melbourne, Melbourne, Australia
| | - Wendy Chapman
- Centre for Digital Transformation of Health, University of Melbourne, Melbourne, Australia
| | - Urooj R Khan
- Centre for Digital Transformation of Health, University of Melbourne, Melbourne, Australia
| | - Ann Borda
- Centre for Digital Transformation of Health, University of Melbourne, Melbourne, Australia
| | | | | | | | - Cecily Gilbert
- Centre for Digital Transformation of Health, University of Melbourne, Melbourne, Australia
| | - Tafheem Ahmad Wani
- Centre for Digital Transformation of Health, University of Melbourne, Melbourne, Australia
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5
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Haydon HM, Caffery LJ, Snoswell CL, Thomas EE, Taylor M, Budge M, Probert J, Smith AC. Optimising specialist geriatric medicine services by telehealth. J Telemed Telecare 2021; 27:674-679. [PMID: 34726995 DOI: 10.1177/1357633x211041859] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Telehealth can effectively increase access to specialist care and reduce the need for travel. The Geri-Connect service was established in 2017 to support people living in residential aged care facilities in regional Victoria, Australia. Using the Model for the Assessment of Telemedicine, an evaluation of the Geri-Connect service identified service activity patterns and factors associated with uptake. Service activity from 2017 to 2020 and 10 semi-structured, key stakeholder interviews were captured and analysed. Between 2017 and 2020, video consultations were provided to 53 residential aged care facilities. Sustained growth (over 178%) and strong stakeholder acceptance highlight the effectiveness of this telegeriatric service. Four recommendations provide opportunities to further enhance service delivery including: implementation of an integrated health information system; systematic evaluation of service impact on stakeholders and residents, auditing and subsequent provision of targeted training; and regular auditing of software and hardware. Additionally, the need to augment fixed room hardware with mobile telehealth systems would increase access for residents with mobility problems. Dedicated personnel of the centralised team are best suited to implementing the recommendations. Whilst the provision of routine telehealth services into residential aged care facilities is challenging, the Geri-Connect service demonstrates that telehealth can be effectively provided to residential aged care facility residents needing specialist geriatric care.
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Affiliation(s)
- Helen M Haydon
- Centre for Online Health, 1974The University of Queensland, Australia.,Centre for Health Services Research, 1974The University of Queensland, Australia
| | - Liam J Caffery
- Centre for Online Health, 1974The University of Queensland, Australia.,Centre for Health Services Research, 1974The University of Queensland, Australia
| | - Centaine L Snoswell
- Centre for Online Health, 1974The University of Queensland, Australia.,Centre for Health Services Research, 1974The University of Queensland, Australia
| | - Emma E Thomas
- Centre for Online Health, 1974The University of Queensland, Australia.,Centre for Health Services Research, 1974The University of Queensland, Australia
| | - Monica Taylor
- Centre for Online Health, 1974The University of Queensland, Australia.,Centre for Health Services Research, 1974The University of Queensland, Australia
| | - Marc Budge
- Integrated Care Services, Bendigo Health, Australia.,Monash University, Australia
| | - Jacinta Probert
- Integrated Care Services, Bendigo Health, Australia.,Monash University, Australia
| | - Anthony C Smith
- Centre for Online Health, 1974The University of Queensland, Australia.,Centre for Health Services Research, 1974The University of Queensland, Australia.,Centre for Innovative Medical Technology, University of Southern Denmark, Denmark
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Wagner K, Reimann S, Budge M, Claydon M, Musicki K, Ban EJ. 479 Penetrating Chest Trauma Causing A Superior Mesenteric Artery-Inferior Vena Cava Fistula and Pancreatic Injury: A Case Report. Br J Surg 2021. [DOI: 10.1093/bjs/znab259.292] [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]
Abstract
Abstract
Penetrating traumatic injuries can present a challenging scenario due to the potential for multisystem involvement requiring swift collaboration between surgical specialities. We present the case of a 66-year-old female who was stabbed in the right posterior chest. CT revealed a diaphragmatic injury, liver laceration involving segments 6/7 with active bleeding, and a posterior superior mesenteric artery (SMA) to anterior inferior vena cava (IVC) fistula. Due to the proximity of the SMA injury to a replaced right hepatic artery origin, the fistulous connection with the suprarenal IVC, and suspected pancreatic and duodenal injuries, a hybrid rather than a purely endovascular approach was taken. A large compliant occlusion balloon was placed percutaneously in the hepatic IVC. Subsequent trauma laparotomy and right medial visceral rotation identified SMA and SMV injuries, which were repaired with temporary supracoeliac aortic clamping. Further kocherisation of the duodenum revealed a 10 cm longitudinal IVC laceration causing sudden large volume venous haemorrhage. This was repaired after control was gained with supracoeliac aortic clamping, infrarenal IVC vessel loop and balloon inflation. An abdominal VAC dressing was applied. Before transfer to ICU, however, 1L of blood was noted in the VAC cannister and a relook laparotomy demonstrated more than 1L of intrabdominal fresh blood. Bleeding vessels around the uncinate process were ligated. After 48 hours, a relook laparotomy revealed no significant bleeding, and the abdomen was closed. A post-operative MRCP demonstrated pancreatic divisum and likely laceration of the aberrant ventral duct. A subsequent peripancreatic collection was managed conservatively.
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Affiliation(s)
- K Wagner
- Alfred Health Trauma Unit, Alfred Hospital, Melbourne, Australia
| | - S Reimann
- Department of Vascular Surgery, Alfred Health, Melbourne, Australia
| | - M Budge
- Department of Surgery, Central Clinical School, Monash University, Melbourne, Australia
- Monash University Endocrine Surgery Unit, Alfred Hospital, Melbourne, Australia
| | - M Claydon
- Department of Vascular Surgery, Alfred Health, Melbourne, Australia
| | - K Musicki
- Department of Vascular Surgery, Alfred Health, Melbourne, Australia
| | - E.-Jun Ban
- Alfred Health Trauma Unit, Alfred Hospital, Melbourne, Australia
- Department of Surgery, Central Clinical School, Monash University, Melbourne, Australia
- National Trauma Research Institute and Trauma Service, Alfred Health, Melbourne, Australia
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7
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Bagot KL, Cadilhac DA, Smith K, Bernard S, Kim J, Coupland T, Pearce W, Putland M, Budge M, Nadurata V, Pearce D, Hall H, Hocking G, Kelly B, Spencer A, Chapman P, Oqueli E, Sahathevan R, Kraemer T, Stub D, Bladin CF. Abstract WP303: Improving Treatment Within the Golden Hour in and Out of Hours With a Multi-Disciplinary Pre-Hospital, Within-Hospital Communication System. Stroke 2019. [DOI: 10.1161/str.50.suppl_1.wp303] [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: 11/16/2022]
Abstract
Delivery of time-critical stroke care requires rapid assessment, diagnosis and treatment, involving multiple clinicians. However, disparate communication systems exist between in-field paramedics and hospital clinicians, with variation for in and out of hours presentations. Repetition of patient information and fragmented systems may contribute to delayed processes.
Aim:
To determine if smartphone communication technology can improve clinical care timelines for patients with suspected acute stroke in and out of hours.
Methods:
A 12 month pre-post historical-control design was used. The Pulsara
TM
Stop Stroke/STEMI smartphone and tablet app (Pulsara) was implemented in 25 Ambulance Victoria branches and 2 hospitals in rural Victoria, Australia, during 2016/2017. Pulsara provides secure, simultaneous, two-way, real-time communication. Eligible patients had suspected acute stroke as assessed by paramedics or hospital clinicians. Analyses compare timelines (median minutes) for when Pulsara is (Pulsara+), or is not (Pulsara-), used by clinicians in hours (08:00-17:00; IH) and out of hours (17:01-07:59; OH).
Results:
Pulsara was used in 80% (210/265) of cases. Using Pulsara, patients are off-ambulance stretcher 5 minutes faster (10 minutes Pulsara+ vs 15 minutes Pulsara- ; p=0.23), and depart hospital 4 minutes faster (11 minutes Pulsara+ vs 15 minutes Pulsara- ; p=0.02). The time to first medical review is similar IH (7 minutes), but 7 minutes faster OH (7 minutes Pulsara+ vs 14 minutes Pulsara-; p=.03). Time to CT scan is 40 minutes faster IH (27 minutes Pulsara+ vs 67 minutes Pulsara- ; p=.02), and 29 minutes faster OH (29 minutes Pulsara+ vs 58 minutes Pulsara- ; p=.0001). Pulsara was used on all cases receiving thrombolysis. Compared to the pre-Pulsara period, when Pulsara was used the proportion treated within 60 minutes increased from 9% (1/11) to 23% (3/13) during in hours, and from 13% (2/15) to 26% (7/27) out of hours.
Conclusion:
The use of Pulsara improved hospital metrics and care timelines for treatment of patients with suspected stroke. There is a two-fold increase of patients treated within 60 minutes in hours, and also out of hours (when staffing levels are less). Pulsara has significantly improved stroke care in these two rural hospitals.
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Affiliation(s)
- Kathleen L Bagot
- Public Health & Health Services Rsch Group, The Florey Institute of Neuroscience and Mental Health, Melbourne, Australia
| | - Dominique A Cadilhac
- Stroke and Ageing Rsch (STAR), Dept of Medicine, Monash Univ, Clayton, Australia
| | - Karen Smith
- Cntr for Rsch and Evaluation, Ambulance Victoria, Melbourne, Australia
| | | | - Joosup Kim
- Public Health & Health Services Rsch Group, The Florey Institute of Neuroscience and Mental Health, Melbourne, Australia
| | | | | | - Mark Putland
- Emergency Dept, Royal Melbourne Hosp, Melbourne, Australia
| | - Marc Budge
- Sub-Acute Services, Bendigo Health, Melbourne, Australia
| | | | - Debra Pearce
- Emergency Dept, Ballarat Health Services, Melbourne, Australia
| | | | | | - Ben Kelly
- Acute Operations, Ballarat Health Services, Melbourne, Australia
| | - Angie Spencer
- Acute Operations, Ballarat Health Services, Melbourne, Australia
| | - Pauline Chapman
- Emergency Dept, Ballarat Health Services, Melbourne, Australia
| | | | | | | | - Dion Stub
- Ambulance Victoria, Melbourne, Australia
| | - Chris F Bladin
- Public Health & Health Services Rsch Group, The Florey Institute of Neurosciences and Mental Health, Melbourne, Australia
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Abstract
The relationship between body mass index (BMI) (in midlife and late-life) and dementia was investigated in meta-analyses of 16 articles reporting on 15 prospective studies. Follow-ups ranged from 3.2 to 36.0 years. Meta-analyses were conducted on samples including 25 624 participants evaluated for Alzheimer's disease (AD), 15 435 participants evaluated for vascular dementia (VaD) and 30 470 followed for any type of dementia (Any Dementia). Low BMI in midlife was associated with 1.96 [95% confidence interval (CI): 1.32, 2.92] times the risk of developing AD. The pooled relative risks for AD, VaD and Any Dementia for overweight BMI in midlife compared with normal BMI were 1.35 (95% CI:1.19, 1.54), 1.33 (95% CI: 1.02, 1.75) and 1.26 (95% CI: 1.10, 1.44), respectively. The pooled relative risks of AD and Any Dementia for obese BMI in midlife compared to normal BMI were 2.04 (95% CI: 1.59, 2.62) and 1.64 (95% CI: 1.34, 2.00), respectively. Continuous BMI in late-life was not associated with dementia. Small numbers of studies included in pooled analyses reduce generalizability of findings, and emphasize the need for publication of additional findings. We conclude that underweight, overweight and obesity in midlife increase dementia risk. Further research evaluating late-life BMI and dementia is required.
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Affiliation(s)
- K J Anstey
- Ageing Research Unit, Centre for Mental Health Research Medical School, Australian National University, Canberra, ACT, Australia.
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9
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Maller JJ, Réglade-Meslin C, Chan P, Daskalakis ZJ, Thomson RHS, Anstey KJ, Budge M, Sachdev P, Fitzgerald PB. Hippocampal sulcal cavities: prevalence, risk factors and relationship to memory impairment. Brain Res 2010; 1368:222-30. [PMID: 21040716 DOI: 10.1016/j.brainres.2010.10.089] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2010] [Revised: 10/18/2010] [Accepted: 10/24/2010] [Indexed: 02/02/2023]
Abstract
While hippocampal volumes have been extensively examined in neuropsychiatric disorders and ageing, small areas of signal variation within the hippocampus commonly observed on MRI, described as hippocampal sulcal cavities (HSCs), have received less attention. We review the published literature on HSCs to examine their prevalence, putative aetiological factors such as hypertension, and possible cognitive correlates. HSCs were reported in 77% (66% weighted mean) of patients with memory disorders and 48% (47% weighted mean) of controls, and the prevalence increased with age in healthy subjects (r=0.64, p=0.047). A number of studies reported hypertension as a risk factor, and related their presence to poorer memory function. Further work is needed to fully understand the clinical significance of these lesions.
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Affiliation(s)
- Jerome J Maller
- Monash Alfred Psychiatry Research Centre, The Alfred & Monash University School of Psychology and Psychiatry, Melbourne, Victoria, Australia.
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10
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Janke AL, Budge M, Rodell A. P3‐089: ANDI ‐ tools and methods for amalgamating large neuroimaging databases. Alzheimers Dement 2009. [DOI: 10.1016/j.jalz.2009.04.1165] [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: 10/20/2022]
Affiliation(s)
| | - Marc Budge
- The Australian National UniversityCanberraAustralia
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Nepal B, Ranmuthugala G, Brown L, Budge M. Modelling costs of dementia in Australia: evidence, gaps, and needs. AUST HEALTH REV 2008; 32:479-87. [PMID: 18666875 DOI: 10.1071/ah080479] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2007] [Revised: 07/11/2007] [Accepted: 11/29/2007] [Indexed: 11/23/2022]
Abstract
With the rapid ageing of the Australian population, dementia has emerged as a major health and economic challenge. Consensus exists that the number of people with dementia will grow significantly because the prevalence is strongly correlated with age. However, there are substantial gaps in our understanding of the impacts on the dementia "epidemic" of changes in non-demographic risk factors and of our knowledge of the economic implications. Only a few prevalence-based studies have been conducted to examine the health economics of dementia in Australia. These studies have suggested that considerable resources are absorbed by dementia care, yet there is a lack of integrated models that simultaneously explore epidemiologic and economic perspectives incorporating the impact of preventive and early intervention initiatives. This study reviews the current evidence on the economic implications of dementia in Australia and approaches taken to project the future costs of dementia.
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Affiliation(s)
- Binod Nepal
- National Centre for Social and Economic Modelling (NATSEM), University of Canberra, Canberra, ACT 2601, Australia.
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Janke AL, Budge M. P1‐251: The Australian Normative and Dementia Imaging (ANDI) collaborative network: Software tools for large databases. Alzheimers Dement 2008. [DOI: 10.1016/j.jalz.2008.05.841] [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: 11/28/2022]
Affiliation(s)
| | - Marc Budge
- Australian National UniversityCanberraAustralia
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Braithwaite J, Westbrook JI, Foxwell AR, Boyce R, Devinney T, Budge M, Murphy K, Ryall MA, Beutel J, Vanderheide R, Renton E, Travaglia J, Stone J, Barnard A, Greenfield D, Corbett A, Nugus P, Clay-Williams R. An action research protocol to strengthen system-wide inter-professional learning and practice [LP0775514]. BMC Health Serv Res 2007; 7:144. [PMID: 17854507 PMCID: PMC2212639 DOI: 10.1186/1472-6963-7-144] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2007] [Accepted: 09/13/2007] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Inter-professional learning (IPL) and inter-professional practice (IPP) are thought to be critical determinants of effective care, improved quality and safety and enhanced provider morale, yet few empirical studies have demonstrated this. Whole-of-system research is even less prevalent. We aim to provide a four year, multi-method, multi-collaborator action research program of IPL and IPP in defined, bounded health and education systems located in the Australian Capital Territory (ACT). The project is funded by the Australian Research Council under its industry Linkage Program. METHODS/DESIGN The program of research will examine in four inter-related, prospective studies, progress with IPL and IPP across tertiary education providers, professional education, regulatory and registration bodies, the ACT health system's streams of care activities and teams, units and wards of the provider facilities of the ACT health system. One key focus will be on push-pull mechanisms, ie, how the education sector creates student-enabled IPP and the health sector demands IPL-oriented practitioners. The studies will examine four research aims and meet 20 research project objectives in a comprehensive evaluation of ongoing progress with IPL and IPP. DISCUSSION IPP and IPL are said to be cornerstones of health system reforms. We will measure progress across an entire health system and the clinical and professional education systems that feed into it. The value of multi-methods, partnership research and a bi-directional push-pull model of IPL and IPP will be tested. Widespread dissemination of results to practitioners, policymakers, managers and researchers will be a key project goal.
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Affiliation(s)
- Jeffrey Braithwaite
- Centre for Clinical Governance Research, Faculty of Medicine, University of New South Wales, 10 Arthur St, Kensington, NSW 2052, Australia
- School of Public Health and Community Medicine, Faculty of Medicine, University of New South Wales, Samuels Building, Kensington, NSW 2052, Australia
| | - Johanna I Westbrook
- Health Informatics Research & Evaluation Unit, Faculty of Health Sciences, The University of Sydney, 75 East St Lidcombe, NSW 1825, Australia
| | | | - Rosalie Boyce
- School of Health & Rehabilitation Sciences, The University of Queensland, St Lucia, Queensland 4072, Australia
| | - Timothy Devinney
- Australian Graduate School of Management, University of New South Wales, Sydney NSW 2052, Australia
| | - Marc Budge
- ANU Medical School, The Australian National University, C/- The Canberra Hospital, PO Box 11, ACT 2606, Australia
| | - Karen Murphy
- ACT Health, Allied Health Adviser's Office, Level 2, 11 Moore Street, Canberra City, ACT, Australia
| | - Mary-Ann Ryall
- ACT Health, c/- 11 Moore St Canberra City, ACT, Australia
| | - Jenny Beutel
- Department of Health, CitiCentre Building, 11 Hindmarsh Square, Adelaide South Australia, 5000, Australia
| | - Rebecca Vanderheide
- School of Health Sciences – Nursing, University of Canberra, Canberra, ACT 2601, Australia
| | | | - Joanne Travaglia
- Centre for Clinical Governance Research, Faculty of Medicine, University of New South Wales, 10 Arthur St, Kensington, NSW 2052, Australia
- School of Public Health and Community Medicine, Faculty of Medicine, University of New South Wales, Samuels Building, Kensington, NSW 2052, Australia
| | - Judy Stone
- ACT Health, Allied Health Adviser's Office, Level 2, 11 Moore Street, Canberra City, ACT, Australia
| | - Amanda Barnard
- ANU Medical School, The Australian National University, C/- The Canberra Hospital, PO Box 11, ACT 2606, Australia
| | - David Greenfield
- Centre for Clinical Governance Research, Faculty of Medicine, University of New South Wales, 10 Arthur St, Kensington, NSW 2052, Australia
- School of Public Health and Community Medicine, Faculty of Medicine, University of New South Wales, Samuels Building, Kensington, NSW 2052, Australia
| | - Angus Corbett
- Faculty of Law, University of New South Wales, Sydney, NSW 2052, Australia
| | - Peter Nugus
- Centre for Clinical Governance Research, Faculty of Medicine, University of New South Wales, 10 Arthur St, Kensington, NSW 2052, Australia
- School of Public Health and Community Medicine, Faculty of Medicine, University of New South Wales, Samuels Building, Kensington, NSW 2052, Australia
| | - Robyn Clay-Williams
- Centre for Clinical Governance Research, Faculty of Medicine, University of New South Wales, 10 Arthur St, Kensington, NSW 2052, Australia
- School of Public Health and Community Medicine, Faculty of Medicine, University of New South Wales, Samuels Building, Kensington, NSW 2052, Australia
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Budge M. P‐155: The establishment of Australian Dementia Collaborative Research Centres: A new model. Alzheimers Dement 2007. [DOI: 10.1016/j.jalz.2007.04.118] [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: 11/29/2022]
Affiliation(s)
- Marc Budge
- The Australian National UniversityGarranACTAustralia
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Celler BG, Basilakis J, Budge M, Lovel NH. A clinical monitoring and management system for residential aged care facilities. Conf Proc IEEE Eng Med Biol Soc 2006; 2006:3301-3304. [PMID: 17947017 DOI: 10.1109/iembs.2006.259974] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
In response to an extended user needs analysis, a home telecare system designed for the management of patients with chronic disease was adapted for use in residential aged care facilities (RACFs). The system architecture and hardware and software components are described for both the client- and server-side. The client-side includes medication dispensing, scheduled clinical measurements and questionnaire delivery. The server-side supports Web-based administrative tools for scheduling and medications management, as well as automated reporting functions. A brief discussion on a trial of the system in five different RACFs focuses on how clinical information technology can support and improve care standards and deliver better health outcomes for residents in Australian aged care homes.
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Affiliation(s)
- Branko G Celler
- Biomed. Syst. Lab., New South Wales Univ., Sydney, NSW, Australia
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Hogervorst E, De Jager C, Budge M, Smith AD. Serum levels of estradiol and testosterone and performance in different cognitive domains in healthy elderly men and women. Psychoneuroendocrinology 2004; 29:405-21. [PMID: 14644069 DOI: 10.1016/s0306-4530(03)00053-2] [Citation(s) in RCA: 81] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Sex hormones could protect against age-related cognitive decline in elderly men and women. We investigated the relationships between serum total testosterone (TT), total estradiol (TE2) levels and cognitive function in 145 non-demented elderly volunteers (aged 61-91 years) who were not using hormone replacement therapy (HRT). Women (n=66) were better at verbal recall than men (n=79) and men were slightly better at naming. There was a positive relationship between serum levels of TE2 and verbal list recall but not with other verbal memory tests (e.g. Verbal Paired Associates) in women. There was a negative relationship of serum TT levels with verbal recall. Surprisingly, women who were in the upper age tertile (> 77 years of age) were better at verbal recall than men and than women younger than 72; this effect was independent of hormone levels. Men between 61 and 72 years of age showed a positive relationship between high TE2 levels and Spatial Span performance and between high TT levels and speed of information processing, while for women of this age-group, a negative relationship was found. These preliminary results were unchanged when controlling for education, sex hormone binding globulin levels, body mass index, depression, daily alcohol use and smoking. In sum, not all cognitive functions were better with higher levels of sex steroids and effects seemed to be modified by sex; the sex-sensitive tests showing the clearest effects. More research is required to investigate whether there is a window of time in which hormone therapy could be beneficial for middle-aged men.
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Affiliation(s)
- Eva Hogervorst
- Oxford Project to Investigate Memory and Ageing and the Department of Pharmacology, University of Oxford and Radcliffe Infirmary Trust, Oxford, OX2 6HE, UK.
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Johnson N, Bell P, Jonovska V, Budge M, Sim E. NAT gene polymorphisms and susceptibility to Alzheimer's disease: identification of a novel NAT1 allelic variant. BMC Med Genet 2004; 5:6. [PMID: 15142281 PMCID: PMC395831 DOI: 10.1186/1471-2350-5-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/14/2003] [Accepted: 03/17/2004] [Indexed: 11/10/2022]
Abstract
BACKGROUND Alzheimer's disease is multifactorial, having environmental, toxicological and genetic risk factors. Impaired folate and homocysteine metabolism has been hypothesised to increase risk. In addition to its xenobiotic-metabolising capacity, human arylamine N-acetyltransferase type-1 (NAT1) acetylates the folate catabolite para-aminobenzoylglutamate and is implicated in folate metabolism. The purpose of this study was to determine whether polymorphisms in the human NAT genes influence susceptibility to Alzheimer's disease. METHODS Elderly individuals with and without Alzheimer's disease were genotyped at the polymorphic NAT1 (147 cases; 111 controls) and NAT2 (45 cases; 63 controls) loci by polymerase chain reaction-restriction fragment length polymorphism, and the genotype and allele frequencies were compared using the chi-squared test. RESULTS Although a trend towards fast NAT2 acetylator-associated Alzheimer's disease susceptibility was indicated and the NAT1*10/1*10 genotype was observed only in cases of Alzheimer's disease (6/147, 4.1%), no significant difference in the frequency of NAT2 (p = 0.835) or NAT1 (p = 0.371) genotypes was observed between cases and controls. In addition, a novel NAT1 variant, NAT1*11B, was identified. CONCLUSIONS These results suggest that genetic polymorphisms in NAT1 and NAT2 do not influence susceptibility to Alzheimer's disease, although the increase in frequency of the NAT1*10 allele in Alzheimer's disease is worthy of further investigation. Due to its similarity with the NAT1*11A allele, NAT1*11B is likely to encode an enzyme with reduced NAT1 activity.
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Affiliation(s)
- Nichola Johnson
- University Department of Pharmacology, University of Oxford, Mansfield Road, Oxford OX1 3QT, UK
| | - Peter Bell
- University Department of Pharmacology, University of Oxford, Mansfield Road, Oxford OX1 3QT, UK
| | - Vesna Jonovska
- University Department of Pharmacology, University of Oxford, Mansfield Road, Oxford OX1 3QT, UK
| | - Marc Budge
- OPTIMA, The Radcliffe Infirmary, Woodstock Road, Oxford OX2 6HE, UK
| | - Edith Sim
- University Department of Pharmacology, University of Oxford, Mansfield Road, Oxford OX1 3QT, UK
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Hogervorst E, Ribeiro HM, Molyneux A, Budge M, Smith AD. Plasma homocysteine levels, cerebrovascular risk factors, and cerebral white matter changes (leukoaraiosis) in patients with Alzheimer disease. Arch Neurol 2002; 59:787-93. [PMID: 12020261 DOI: 10.1001/archneur.59.5.787] [Citation(s) in RCA: 124] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CONTEXT The pathogenesis of leukoaraiosis on computed tomographic (CT) scanning is unknown, but cerebrovascular risk factors for leukoaraiosis show overlap with those for Alzheimer disease (AD). OBJECTIVE To investigate the contribution of cerebrovascular risk factors, in particular plasma total homocysteine (tHcy), to leukoaraiosis in patients with AD and controls. DESIGN Cross-sectional case-control study. SETTING Referral population to a hospital clinic and community volunteers from the Oxfordshire region in England seen between July 1, 1988, and July 1, 2000. PARTICIPANTS One hundred thirty-seven AD cases (104 confirmed post mortem) and 277 controls matched for age (mean +/- SD, 73 +/- 8 years) and sex. MAIN OUTCOME MEASURES Cerebrovascular risk factors and leukoaraiosis on CT scans of cases and controls; the odds ratio (OR) of having moderate to severe leukoaraiosis with higher levels of plasma tHcy and cerebrovascular risk factors such as age, sex, systolic blood pressure, smoking, diabetes mellitus, and apolipoprotein E epsilon4 genotype. RESULTS Leukoaraiosis was more prevalent in AD cases. For a 5-micromol/L increase in tHcy levels, the OR for leukoaraiosis was 1.40 (95% confidence interval, 1.02-1.91) independent of other risk factors. The distribution pattern of leukoaraiosis was more marked in the deep white matter than in the periventricular area in individuals with elevated tHcy levels, particularly in patients with AD. CONCLUSIONS Higher tHcy levels are an independent risk factor for moderate to severe leukoaraiosis in individuals with AD and of leukoaraiosis of the deep white matter in particular. The nature of the relationship between tHcy levels and leukoaraiosis in AD requires further longitudinal and intervention studies.
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Affiliation(s)
- Eva Hogervorst
- Oxford Project To Investigate Memory and Ageing, Department of Pharmacology, University of Oxford and Radcliffe Infirmary Trust, Oxford OX2 6HE, England.
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Abstract
BACKGROUND Early detection of cognitive decline in the elderly is important because this may precede progression to Alzheimer's disease. The aim of this study was to see whether sensitive neuropsychological tests could identify pre-clinical cognitive deficits and to characterize the cognitive profile of a subgroup with poor memory. METHODS A neuropsychological test battery was administered to a community-dwelling sample of 155 elderly volunteers who were screened with CAMCOG at enrolment (mean age 74.7 years). The battery included tests of episodic memory. semantic and working memory, language and processing speed. RESULTS Episodic memory test z scores below 1 S.D. from the cohort mean identified 25 subjects with non-robust' memory performance. This group was compared to the remaining 'robust memory' group with a General Linear Model controlling for age, IQ, education and gender. Test performance was significantly different in all tests for episodic and semantic memory, but not in tests for working memory, processing speed and language. CANTAB paired associates learning and spatial recognition tests identified the highest percentages of those in the 'non-robust memory group. Processing speed partialled out the age effect on memory performance for the whole cohort, but the 'non-robust memory' group's performance was not associated with age or processing speed. CONCLUSIONS Sensitive neuropsychological tests can detect performance below the norm in elderly people whose performance on MMSE and CAMCOG tests is well within the normal range. Age-related decline in memory performance in a cohort of the elderly may be largely due to inclusion within the cohort of individuals with undetected pre-clinical Alzheimer's disease or isolated memory impairment.
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Abstract
The present study investigated the sensitivity and specificity of the Hopkins Verbal Learning Test (HVLT) for demented patients (n = 82, using NINCDS criteria) and 114 healthy controls--equivalent in age, years of education and gender-ratio--from the Oxford Project to Investigate Memory and Ageing. The HVLT 'Total Recall' score had 87% sensitivity and 98% specificity for dementia using a cut-off score of 14.5. Using a 'Memory' score (the sum of the 'Total Recall' and the 'Discrimination Index') with a cut-off score of 24.5 gave a 91% sensitivity and 98% specificity for Alzheimer's disease cases when compared to controls. Unlike the MMSE, the HVLT has no ceiling effects and does not have to be adjusted for education. We conclude that the HVLT is an easy to administer, quick and well tolerated tool for the screening of dementia.
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Affiliation(s)
- Eva Hogervorst
- University of Oxford, Oxford Project to Investigate Memory and Ageing, Oxford, UK.
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Abstract
The currently available clinical diagnostic tools do not allow an accurate and reliable diagnosis of Alzheimer's disease (AD) in other than demented patients. Furthermore, they do not allow the identification of subjects with pre-clinical AD. Cell cycle regulatory failure in neurones appears to be a very early event in the pathogenesis of AD. Our earlier findings indicate that there is a specific failure of the G1/S transition checkpoint that may not be restricted to neurones alone. We tested the possibility that lymphocytes of AD sufferers may also show signs of G1 regulatory failure. We found that the in vitro responsiveness of lymphocytes to G1 inhibitor treatment was significantly less effective in AD patients than in control subjects. Additionally, in subjects showing neuropsychological signs of pre-clinical AD, the lymphocyte response was similar to that seen in AD patients. We present direct evidence to support the hypothesis that the failure of the G1/S transition control is not restricted to neurones in AD patients, but occurs in peripheral cells, such as lymphocytes, as well. Our findings could provide the basis for new clinical tests that rely on eliciting the activation of the G1/S transition checkpoint in lymphocyte cultures. We propose that the introduction of the test could be useful in identifying people who do not yet fulfil the requirements of the NINCDS criteria for dementia, but who would benefit from the use of preventive measures for AD.
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Affiliation(s)
- Zsuzsanna Nagy
- OPTIMA, Department of Neuropathology, Radcliffe Infirmary NHS Trust, University of Oxford, Woodstock Road, Oxford OX2 6HE, UK.
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Hogervorst E, Williams J, Budge M, Barnetson L, Combrinck M, Smith AD. Serum total testosterone is lower in men with Alzheimer's disease. Neuro Endocrinol Lett 2001; 22:163-8. [PMID: 11449190] [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] [Subscribe] [Scholar Register] [Received: 05/18/2001] [Accepted: 05/18/2001] [Indexed: 02/20/2023]
Abstract
OBJECTIVES The purpose of this study was to determine whether the level of serum total testosterone (TT) was different in cases of Dementia of the Alzheimer's Type (DAT) than in controls. SETTING AND DESIGN We included 83 referred DAT cases and 103 cognitively screened volunteers (aged 75+/-9 years) from the Oxford Project To Investigate Memory and Ageing. METHODS Information was obtained about potential confounds in the relation of DAT with testosterone, including age, gender, education, body mass index, smoking, (ab)use of alcohol, diabetes mellitus, endocrine therapy, and having undergone hysterectomy. TT was measured in non-fasting serum obtained between 10 and 12 a.m. using a competitive enzyme immunoassay. RESULTS Men with DAT (n=39) had lower levels (p =0.005) of total serum testosterone (TT=14+/-5 nmol/L) than controls (n=41, TT=18+/-6 nmol/L). Lower TT was more likely in men with DAT, independent of potential confounds (Odds Ratio=0.78, 95% C.I.=0.68 to 0.91). In women there was no difference in TT levels between cases (n=44) and controls (n=62). MAIN FINDINGS Our results suggested that low TT may be a co-morbid feature of DAT in men. However, low TT levels could also exacerbate the disease. CONCLUSIONS Prospective longitudinal studies should investigate whether low TT levels precede or follow the onset of DAT (209 words).
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Affiliation(s)
- E Hogervorst
- Oxford Project To Investigate Memory and Ageing, University Department of Pharmacology and the Radcliffe Infirmary Trust, Oxford, United Kingdom.
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Hogervorst E, Williams J, Budge M, Riedel W, Jolles J. The nature of the effect of female gonadal hormone replacement therapy on cognitive function in post-menopausal women: a meta-analysis. Neuroscience 2001; 101:485-512. [PMID: 11113299 DOI: 10.1016/s0306-4522(00)00410-3] [Citation(s) in RCA: 280] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
We reviewed epidemiological and experimental studies of female gonadal hormone replacement therapy (HRT) on cognitive function in post-menopausal women and carried out meta-analyses. In healthy ageing women, HRT has small and inconsistent effects that include enhancement of verbal memory, abstract reasoning and information processing. Epidemiological studies show larger effects than experimental studies, which is not related to sample size. Important confounds may be that women who start using HRT are healthier than women who do not. Also, controlling for socio-economic status diminishes the effect of HRT. The effects of HRT may depend on the age and type of menopause and the therapeutic intervention used, with the most widely used drug, Premarin, having least effect. However, the effects are independent of mood and climacteric symptom alleviation. There is a paucity of experimental studies that include healthy elderly women. The evidence for an estrogen deficiency in women with dementia and cognitive dysfunction is inconsistent. Nevertheless, epidemiological studies suggest that HRT protects against the development of clinically diagnosed Alzheimer's disease. However, poor recall of HRT use by patients and altered physician behaviour may have confounded the effects. Surprisingly, both healthy and demented women with low education seem to benefit most from HRT. Three recent controlled experimental studies using Premarin showed no effects of HRT in preventing further cognitive decline in women who already have Alzheimer's disease. Duration of treatment seems to play an important role, with beneficial effects declining-and even reversing-with longer treatment in women with Alzheimer's disease.Future research should further investigate the cognitive effect of different HRT preparations, serum estrogen levels, and the interactions of HRT with age, menopausal status and existing protective (e.g. education) and risk factors (e.g. smoking and apolipoprotein E genotype) for cognitive decline and Alzheimer's disease.
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Affiliation(s)
- E Hogervorst
- Oxford Project To Investigate Memory and Ageing (OPTIMA), Radcliffe Infirmary, Department of Pharmacology, University of Oxford, Woodstock Road, OX2 6HE, Oxford, UK.
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Budge M, Johnston C, Hogervorst E, de Jager C, Milwain E, Iversen SD, Barnetson L, King E, Smith AD. Plasma total homocysteine and cognitive performance in a volunteer elderly population. Ann N Y Acad Sci 2000; 903:407-10. [PMID: 10818531 DOI: 10.1111/j.1749-6632.2000.tb06392.x] [Citation(s) in RCA: 70] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- M Budge
- OPTIMA (Oxford Project To Investigate Memory and Ageing), Department of Pharmacology, University of Oxford, UK.
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Clarke R, Joachim C, Esiri M, Morris J, Bungay H, Molyneux A, Budge M, Frost C, King E, Barnetson L, Smith AD. Leukoaraiosis at presentation and disease progression during follow-up in histologically confirmed cases of dementia. Ann N Y Acad Sci 2000; 903:497-500. [PMID: 10818544 DOI: 10.1111/j.1749-6632.2000.tb06405.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- R Clarke
- Clinical Trial Service Unit, Radcliffe Infirmary, Oxford, United Kingdom.
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