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Namsrai T, Phillips C, Parkinson A, Gregory D, Kelly E, Cook M, Desborough J. Diagnostic delay of sarcoidosis: an integrated systematic review. Orphanet J Rare Dis 2024; 19:156. [PMID: 38605384 PMCID: PMC11010435 DOI: 10.1186/s13023-024-03152-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 03/28/2024] [Indexed: 04/13/2024] Open
Abstract
BACKGROUND Sarcoidosis is a chronic inflammatory granulomatous disease of unknown cause. Delays in diagnosis can result in disease progression and poorer outcomes for patients. Our aim was to review the current literature to determine the overall diagnostic delay of sarcoidosis, factors associated with diagnostic delay, and the experiences of people with sarcoidosis of diagnostic delay. METHODS Three databases (PubMed/Medline, Scopus, and ProQuest) and grey literature sources were searched. Random effects inverse variance meta-analysis was used to pool mean diagnostic delay in all types of sarcoidosis subgroup analysis. Diagnostic delay was defined as the time from reported onset of symptoms to diagnosis of sarcoidosis. RESULTS We identified 374 titles, of which 29 studies were included in the review, with an overall sample of 1531 (694 females, 837 males). The overall mean diagnostic delay in all types of sarcoidosis was 7.93 months (95% CI 1.21 to 14.64 months). Meta-aggregation of factors related to diagnostic delay in the included studies identified three categories: (1) the complex and rare features of sarcoidosis, (2) healthcare factors and (3) patient-centred factors. Meta-aggregation of outcomes reported in case studies revealed that the three most frequent outcomes associated with diagnostic delay were: (1) incorrect diagnosis, (2) incorrect treatment and (3) development of complications/disease progression. There was no significant difference in diagnostic delay between countries with gatekeeper health systems (where consumers are referred from a primary care clinician to specialist care) and countries with non-gatekeeper systems. No qualitative studies examining people's experiences of diagnostic delay were identified. CONCLUSION The mean diagnostic delay for sarcoidosis is almost 8 months, which has objective consequences for patient management. On the other hand, there is a paucity of evidence about the experience of diagnostic delay in sarcoidosis and factors related to this. Gaining an understanding of people's experiences while seeking a diagnosis of sarcoidosis is vital to gain insight into factors that may contribute to delays, and subsequently inform strategies, tools and training activities aimed at increasing clinician and public awareness about this rare condition. TRIAL REGISTRATION PROSPERO Registration number: CRD42022307236.
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Affiliation(s)
- Tergel Namsrai
- National Centre for Epidemiology and Population Health, The Australian National University, 63, Eggleston Road, Acton ACT, Canberra, 2601, Australia
| | - Christine Phillips
- School of Medicine and Psychology, The Australian National University, Canberra, Australia
| | - Anne Parkinson
- National Centre for Epidemiology and Population Health, The Australian National University, 63, Eggleston Road, Acton ACT, Canberra, 2601, Australia
| | - Dianne Gregory
- National Centre for Epidemiology and Population Health, The Australian National University, 63, Eggleston Road, Acton ACT, Canberra, 2601, Australia
- Sarcoidosis Lyme Australia, Camden, Australia
| | - Elaine Kelly
- National Centre for Epidemiology and Population Health, The Australian National University, 63, Eggleston Road, Acton ACT, Canberra, 2601, Australia
- Sarcoidosis Lyme Australia, Camden, Australia
| | - Matthew Cook
- John Curtin School of Medical Research, The Australian National University, Canberra, Australia
| | - Jane Desborough
- National Centre for Epidemiology and Population Health, The Australian National University, 63, Eggleston Road, Acton ACT, Canberra, 2601, Australia.
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Zamuner F, Carpenter EK, Gebrekidan H, Arcos-Gómez G, Parkinson A, Cameron AWN, Leury BJ, DiGiacomo K. Successful transfer of passive immunity: the natural alternative to antibiotics for boosting the survival of intensively reared dairy goat kids. Animal 2024; 18:101040. [PMID: 38101110 DOI: 10.1016/j.animal.2023.101040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 11/16/2023] [Accepted: 11/17/2023] [Indexed: 12/17/2023] Open
Abstract
In dairy operations, antibiotics have traditionally been used to treat, prevent, and control diseases. However, given the mounting global crisis of antimicrobial resistance (AMR), farmers are urged to re-assess and reduce their reliance on antibiotics. Thus, this randomized, double-blinded cohort study aimed to estimate the prevalence of failed and successful transfer of passive immunity (FTPI and STPI) in dairy goat kids reared under commercial conditions, and the effects of antibiotic metaphylaxis on the pre-weaning (≤42 d old) mortality in FTPI and STPI kids. Plasma concentration of immunoglobulin G at 1d old (pIgG-24 h) was measured in 747 male Saanen kids for the determination of FTPI and STPI (pIgG-24 h < 12 and ≥12 g/L, respectively). Kids were then randomly divided into two groups: those receiving a single penicillin injection at 1 d old (PEN), and those receiving no treatment (CTR). The mean (±SD) pIgG-24 h and initial BW (IBW) were 17 ± 9.8 g/L and 4.1 ± 0.64 kg. The prevalence of FTPI was 29% (220/747 kids). Gastrointestinal complications were the primary cause of death (41%), followed by septicemia (22%) and arthritis (17%). A single penicillin injection reduced preweaning mortality by 55% (10 vs 22%, PEN vs CTR). However, results suggest that such a decline was mainly driven by the improved survival rates among FTPI kids, which increased by 19% (from 62% in CTR-FTPI to 82% in PEN-FTPI), as opposed to an 8% increase among STPI kids (from 85% in CTR-STPI to 93% in PEN-STPI). Additionally, the odds of mortality ≤ 42 d old were threefold higher in the CTR-FTPI group when compared to both the CTR-STPI and PEN-FTPI groups, suggesting a potential parity between STPI and PEN for mortality rate reduction. Taken together, the results indicate that although metaphylactic antibiotics can halve preweaning mortality, similar improvements are likely to be achieved via increased STPI rates. Furthermore, by targeting metaphylactic interventions to high-risk groups (i.e., those displaying signs of inadequate colostrum intake and/or low birth BW), farmers could reduce treatment costs and mitigate AMR risks. While these findings carry considerable weight for commercial dairy goat practices, their applicability to other systems (i.e., extensive, semi-intensive, mohair, meat systems) warrants further investigation.
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Affiliation(s)
- F Zamuner
- School of Agriculture, Food and Ecosystem Sciences, Faculty of Science - The University of Melbourne, Parkville, Victoria 3010, Australia.
| | - E K Carpenter
- Meredith Dairy Pty Ltd., 106 Cameron Rd, Meredith, Victoria 3333, Australia
| | - H Gebrekidan
- Meredith Dairy Pty Ltd., 106 Cameron Rd, Meredith, Victoria 3333, Australia
| | - G Arcos-Gómez
- Meredith Dairy Pty Ltd., 106 Cameron Rd, Meredith, Victoria 3333, Australia
| | - A Parkinson
- Meredith Dairy Pty Ltd., 106 Cameron Rd, Meredith, Victoria 3333, Australia
| | - A W N Cameron
- Meredith Dairy Pty Ltd., 106 Cameron Rd, Meredith, Victoria 3333, Australia
| | - B J Leury
- School of Agriculture, Food and Ecosystem Sciences, Faculty of Science - The University of Melbourne, Parkville, Victoria 3010, Australia
| | - K DiGiacomo
- School of Agriculture, Food and Ecosystem Sciences, Faculty of Science - The University of Melbourne, Parkville, Victoria 3010, Australia
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Zamuner F, Carpenter EK, Arcos-Gómez G, Parkinson A, Cameron AWN, Leury BJ, DiGiacomo K. Evaluation of plasma immunoglobulin G and BW thresholds for predicting preweaning mortality in commercially raised dairy goat kids. Animal 2023; 17:100989. [PMID: 37801924 DOI: 10.1016/j.animal.2023.100989] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 09/04/2023] [Accepted: 09/07/2023] [Indexed: 10/08/2023] Open
Abstract
The high preweaning mortality rate is a concerning issue for the commercial dairy industry. In this context, early identification of at-risk individuals can be instrumental. To address this, we conducted a prospective cohort study with the objective of evaluating plasma immunoglobulin G concentration (pIgG-24 h) and initial BW (IBW) measured at 1d old in 363 male dairy kids (Saanen) for predicting preweaning mortality under commercial conditions. Receiver operator characteristic (ROC) analysis was used to determine critical thresholds for pIgG-24 h and IBW. Subsequently, areas under the curve (AUC), sensitivity (Se), and specificity (Sp) were examined to assess the accuracy of these thresholds. Multivariable regressions were used to model odds ratios (OR) for mortality, controlling for confounding effects between IBW and pIgG-24 h. The mean (±SD) pIgG-24 h and IBW were 16.4 ± 9.37 g/L and 4.0 ± 0.61 kg. Overall mortality ≤ 14d and ≤42d old was 12% and 21%, respectively. Critical pIgG-24 h thresholds predicting mortality ≤ 14 d and ≤42 d old were < 10.1 g/L (AUC = 0.74, Se = 59%, and Sp = 82%) and <11.4 g/L (AUC 0.70, Se = 53%, and Sp = 77%), respectively. Kids with pIgG-24 h < 10.1 g/L were six times more likely to die ≤ 14 d old [OR; 95% CI (6; 3-12)], and kids with pIgG-24 h < 11.4 g/L were four times more likely to die ≤ 42 d old (4; 2-6). The IBW threshold most linked to mortality ≤ 14 d was <3.95 kg (AUC 0.60, Se = 59%, and Sp = 61%). However, this association became inconclusive after adjusting for pIgG-24 h differences. Conversely, an IBW of <3.0 kg was associated with notably higher mortality odds within both 14 and 42 d, irrespective of pIgG-24 h levels (10; 3-37, and 4; 1-20, respectively), suggesting that kids with an IBW < 3.0 kg face an increased likelihood of dying before 42 d, irrespectively of their IgG levels. While our findings suggest pIgG-24 h < 11.4 g/L and IBW < 3.0 kg as strong indicators of early mortality risks in male dairy kids, these results require further validation for other systems.
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Affiliation(s)
- F Zamuner
- Faculty of Science - The University of Melbourne, Parkville, Victoria 3010, Australia.
| | - E K Carpenter
- Meredith Dairy Pty Ltd, 106 Cameron Rd, Meredith, Victoria 3333, Australia
| | - G Arcos-Gómez
- Meredith Dairy Pty Ltd, 106 Cameron Rd, Meredith, Victoria 3333, Australia
| | - A Parkinson
- Meredith Dairy Pty Ltd, 106 Cameron Rd, Meredith, Victoria 3333, Australia
| | - A W N Cameron
- Meredith Dairy Pty Ltd, 106 Cameron Rd, Meredith, Victoria 3333, Australia
| | - B J Leury
- Faculty of Science - The University of Melbourne, Parkville, Victoria 3010, Australia
| | - K DiGiacomo
- Faculty of Science - The University of Melbourne, Parkville, Victoria 3010, Australia
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Bourke S, Munira SL, Parkinson A, Lancsar E, Desborough J. Exploring the barriers and enablers of diabetes care in a remote Australian context: A qualitative study. PLoS One 2023; 18:e0286517. [PMID: 37498850 PMCID: PMC10373998 DOI: 10.1371/journal.pone.0286517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 05/17/2023] [Indexed: 07/29/2023] Open
Abstract
OBJECTIVE This qualitative study explored the current barriers and enablers of diabetes care in the Indian Ocean Territories (IOT). METHODS A constructivist grounded theory approach that incorporated semi-structured telephone interviews was employed. Initial analysis of the interview transcripts used a line-by-line approach, to identify recurring themes, connections, and patterns, before they were re-labelled and categorised. This was followed by axial coding, categorisation refinement, and mapping of diabetes triggers in the IOT. PARTICIPANTS AND SETTING The IOT, consisting of Christmas Island and the Cocos (Keeling) Islands, are some of the most remote areas in Australia. When compared with mainland Australia, the prevalence of type 2 diabetes in the IOT is disproportionately higher. There were no known cases of type 1 diabetes at the time of the study. Like other remote communities, these communities experience difficulties in accessing health services to prevent and manage diabetes. Twenty health care professionals and health service administrators in the IOT took part in semi-structured telephone interviews held during April-June 2020. Participants included GPs, nurses, dietitians, social and community services workers, school principals, and administrators. The interview questions focused on their perceptions of the current diabetes care in place in the IOT and their views on the challenges of providing diabetes care in the IOT. RESULTS We identified four main barriers and two main enabling factors to the provision of effective diabetes care in the IOT. The barriers were: (i) societal influences; (ii) family; (iii) changing availability of food; (v) sustainability and communication. The two main enablers were: (i) tailoring interventions to meet local and cultural needs and values; and (ii) proactive compliance with the medical model of care. CONCLUSION Due to the cultural and linguistic diversity within the IOT, many of the identified barriers and enablers are unique to this community and need to be considered and incorporated into routine diabetes care to ensure successful and effective delivery of services in a remote context.
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Affiliation(s)
- Siobhan Bourke
- Department of Health Services Research and Policy, National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australia
| | - Syarifah Liza Munira
- Department of Health Services Research and Policy, National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australia
| | - Anne Parkinson
- Department of Health Services Research and Policy, National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australia
| | - Emily Lancsar
- Department of Health Services Research and Policy, National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australia
| | - Jane Desborough
- Department of Health Services Research and Policy, National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australia
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Namsrai T, Phillips C, Desborough J, Gregory D, Kelly E, Cook M, Parkinson A. Diagnostic delay of sarcoidosis: Protocol for an integrated systematic review. PLoS One 2023; 18:e0269762. [PMID: 36812191 PMCID: PMC9946231 DOI: 10.1371/journal.pone.0269762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 11/01/2022] [Indexed: 02/24/2023] Open
Abstract
INTRODUCTION Sarcoidosis is a rare systemic inflammatory granulomatous disease of unknown cause. It can manifest in any organ. The incidence of sarcoidosis varies across countries, and by ethnicity and gender. Delays in the diagnosis of sarcoidosis can lead to extension of the disease and organ impairment. Diagnosis delay is attributed in part to the lack of a single diagnostic test or unified commonly used diagnostic criteria, and to the diversity of disease manifestations and symptom load. There is a paucity of evidence examining the determinants of diagnostic delay in sarcoidosis and the experiences of people with sarcoidosis related to delayed diagnosis. We aim to systematically review available evidence about diagnostic delay in sarcoidosis to elucidate the factors associated with diagnostic delay for this disease in different contexts and settings, and the consequences for people with sarcoidosis. METHODS AND ANALYSIS A systematic search of the literature will be conducted using PubMed/Medline, Scopus, and ProQuest databases, and sources of grey literature, up to 25th of May 2022, with no limitations on publication date. We will include all study types (qualitative, quantitative, and mixed methods) except review articles, examining diagnostic delay, incorrect diagnosis, missed diagnosis or slow diagnosis of all types of sarcoidosis across all age groups. We will also examine evidence of patients' experiences associated with diagnostic delay. Only studies in English, German and Indonesian will be included. The outcomes we examine will be diagnostic delay time, patients' experiences, and factors associated with diagnostic delay in sarcoidosis. Two people will independently screen the titles and abstracts of search results, and then the remaining full-text documents against the inclusion criteria. Disagreements will be resolved with a third reviewer until consensus is reached. Selected studies will be appraised using the Mixed Methods Appraisal Tool (MMAT). A meta-analysis and subgroup analyses of quantitative data will be conducted. Meta-aggregation methods will be used to analyse qualitative data. If there is insufficient data for these analyses, a narrative synthesis will be conducted. DISCUSSION This review will provide systematic and integrated evidence on the diagnostic delay, associated factors, and experiences of diagnosis delay among people with all types of sarcoidosis. This knowledge may shed light on ways to improve diagnosis delays in diagnosis across different subpopulations, and with different disease presentations. ETHICS AND DISSEMINATION Ethical approval will not be required as no human recruitment or participation will be involved. Findings of the study will be disseminated through publications in peer-reviewed journals, conferences, and symposia. TRIAL REGISTRATION PROSPERO Registration number: CRD42022307236. URL of the PROSPERO registration: https://www.crd.york.ac.uk/PROSPEROFILES/307236_PROTOCOL_20220127.pdf.
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Affiliation(s)
- Tergel Namsrai
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australia
| | - Christine Phillips
- School of Medicine and Psychology, Australian National University, Canberra, Australia
| | - Jane Desborough
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australia
- * E-mail:
| | - Dianne Gregory
- Sarcoidosis Australia, Australia
- John Curtin School of Medical Research, Australian National University, Canberra, Australia
| | - Elaine Kelly
- Sarcoidosis Australia, Australia
- John Curtin School of Medical Research, Australian National University, Canberra, Australia
| | - Matthew Cook
- John Curtin School of Medical Research, Australian National University, Canberra, Australia
| | - Anne Parkinson
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australia
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Wang STL, Parkinson A, Butler D, Law HD, Fanning V, Desborough J. Real price of health-experiences of out-of-pocket costs in Australia: protocol for a systematic review. BMJ Open 2022; 12:e065932. [PMID: 36600422 PMCID: PMC9772657 DOI: 10.1136/bmjopen-2022-065932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 12/08/2022] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION Australians have substantial out-of-pocket (OOP) health costs compared with other developed nations, even with universal health insurance coverage. This can significantly affect access to care and subsequent well-being, especially for priority populations including those on lower incomes or with multimorbidity and chronic illness. While it is known that high OOP healthcare costs may contribute to poorer health outcomes, it is not clear exactly how these expenses are experienced by people with chronic illnesses. Understanding this may provide critical insights into the burden of OOP costs among this population group and may highlight policy gaps. METHOD AND ANALYSIS A systematic review of qualitative studies will be conducted using Pubmed, CINAHL Complete (EBSCO), Cochrane Library, PsycINFO (Ovid) and EconLit from date of inception to June 2022. Primary outcomes will include people's experiences of OOP costs such as their preferences, priorities, trade-offs and other decision-making considerations. Study selection will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and methodological appraisal of included studies will be assessed using the Critical Appraisal Skills Programme. A narrative synthesis will be conducted for all included studies. ETHICS AND DISSEMINATION Ethics approval was not required given this is a systematic review that does not include human recruitment or participation. The study's findings will be disseminated through conferences and symposia and shared with consumers, policymakers and service providers, and published in a peer-reviewed journal. PROSPERO REGISTRATION NUMBER CRD42022337538.
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Affiliation(s)
- Shelley Ting-Li Wang
- School of Medicine and Psychology, Australian National University College of Health and Medicine, Canberra, Australian Capital Territory, Australia
| | - Anne Parkinson
- National Centre for Epidemiology and Population Health, Australian National University College of Health and Medicine, Canberra, Australian Capital Territory, Australia
| | - Danielle Butler
- National Centre for Epidemiology and Population Health, Australian National University College of Health and Medicine, Canberra, Australian Capital Territory, Australia
| | - Hsei Di Law
- National Centre for Epidemiology and Population Health, Australian National University College of Health and Medicine, Canberra, Australian Capital Territory, Australia
| | - Vanessa Fanning
- National Centre for Epidemiology and Population Health, Australian National University College of Health and Medicine, Canberra, Australian Capital Territory, Australia
| | - Jane Desborough
- National Centre for Epidemiology and Population Health, Australian National University College of Health and Medicine, Canberra, Australian Capital Territory, Australia
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Hall Dykgraaf S, Desborough J, Parkinson A, Sturgiss EA, Kelly P, Kidd M. Implementing mandatory COVID-19 vaccination for Australian aged care workers. Med J Aust 2022; 217:570-574. [PMID: 36403195 PMCID: PMC10099713 DOI: 10.5694/mja2.51770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 08/22/2022] [Accepted: 08/22/2022] [Indexed: 11/21/2022]
Affiliation(s)
- Sally Hall Dykgraaf
- Rural Clinical School, Australian National University, Canberra, ACT.,Academic Unit of General Practice, Australian National University, Canberra, ACT
| | - Jane Desborough
- College of Medicine, Biology and the Environment, Australian National University, Canberra, ACT
| | - Anne Parkinson
- Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT
| | | | - Paul Kelly
- Australian Government Department of Health and Aged Care, Canberra, ACT
| | - Michael Kidd
- Australian Government Department of Health and Aged Care, Canberra, ACT
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Namsrai T, Parkinson A, Chalmers A, Lowe C, Cook M, Phillips C, Desborough J. Diagnostic delay of myositis: an integrated systematic review. Orphanet J Rare Dis 2022; 17:420. [PMID: 36411487 PMCID: PMC9677896 DOI: 10.1186/s13023-022-02570-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 10/30/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Idiopathic inflammatory myopathies (IIM) are a heterogenous group of rare muscular autoimmune diseases characterised by skeletal muscle inflammation with possible diagnostic delay. Our aim was to review the existing evidence to identify overall diagnostic delay for IIM, factors associated with diagnostic delay, and people's experiences of diagnostic delay. METHODS Three databases and grey literature sources were searched. Diagnostic delay was defined as the period between the onset of symptoms and the year of first diagnosis of IIM. We pooled the mean delay using random effects inverse variance meta-analysis and performed subgroup analyses. RESULTS 328 titles were identified from which 27 studies were included. Overall mean diagnostic delay was 27.91 months (95% CI 15.03-40.79, I2 = 99%). Subgroup analyses revealed a difference in diagnostic delay between non-inclusion body myositis (IBM) and IBM types. There was no difference in diagnostic delay between studies in which myositis specific autoantibodies (MSA) were tested or not tested. In countries with gatekeeper health systems, where primary care clinicians authorize access to specialty care, people experienced longer periods of diagnostic delay than people with IIM in countries with non-gatekeeper systems. While studies discussed factors that may influence diagnostic delay, significant associations were not identified. No qualitative studies examining people's experiences of diagnostic delay were identified. CONCLUSION Diagnostic delay of IIM has extensive impacts on the quality of life of people living with this disease. Understanding the experiences of people with IIM, from symptom onset to diagnosis, and factors that influence diagnostic delay is critical to inform clinical practice and training activities aimed at increasing awareness of this rare disease and expediting diagnosis. TRIAL REGISTRATION PROSPERO Registration number: CRD42022307236 URL of the PROSPERO registration: https://www.crd.york.ac.uk/PROSPEROFILES/307236_PROTOCOL_20220127.pdf.
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Affiliation(s)
- Tergel Namsrai
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT, Australia
| | - Anne Parkinson
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT, Australia
| | - Anita Chalmers
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT, Australia
- The Myositis Association- Australia Inc, Berry, NSW, Australia
| | - Christine Lowe
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT, Australia
- The Myositis Association- Australia Inc, Berry, NSW, Australia
| | - Matthew Cook
- John Curtin School of Medical Research, Australian National University, Canberra, ACT, Australia
| | - Christine Phillips
- School of Medicine and Psychology, Australian National University, Canberra, ACT, Australia
| | - Jane Desborough
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT, Australia.
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Brew-Sam N, Parkinson A, Lueck C, Brown E, Brown K, Bruestle A, Chisholm K, Collins S, Cook M, Daskalaki E, Drew J, Ebbeck H, Elisha M, Fanning V, Henschke A, Herron J, Matthews E, Murugappan K, Neshev D, Nolan CJ, Pedley L, Phillips C, Suominen H, Tricoli A, Wright K, Desborough J. The current understanding of precision medicine and personalised medicine in selected research disciplines: study protocol of a systematic concept analysis. BMJ Open 2022; 12:e060326. [PMID: 36691172 PMCID: PMC9454080 DOI: 10.1136/bmjopen-2021-060326] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 08/08/2022] [Indexed: 01/28/2023] Open
Abstract
INTRODUCTION The terms 'precision medicine' and 'personalised medicine' have become key terms in health-related research and in science-related public communication. However, the application of these two concepts and their interpretation in various disciplines are heterogeneous, which also affects research translation and public awareness. This leads to confusion regarding the use and distinction of the two concepts. Our aim is to provide a snapshot of the current understanding of these concepts. METHODS AND ANALYSIS Our study will use Rodgers' evolutionary concept analysis to systematically examine the current understanding of the concepts 'precision medicine' and 'personalised medicine' in clinical medicine, biomedicine (incorporating genomics and bioinformatics), health services research, physics, chemistry, engineering, machine learning and artificial intelligence, and to identify their respective attributes (clusters of characteristics) and surrogate and related terms. A systematic search of the literature will be conducted for 2016-2022 using databases relevant to each of these disciplines: ACM Digital Library, CINAHL, Cochrane Library, F1000Research, IEEE Xplore, PubMed/Medline, Science Direct, Scopus and Web of Science. These are among the most representative databases for the included disciplines. We will examine similarities and differences in definitions of 'precision medicine' and 'personalised medicine' in the respective disciplines and across (sub)disciplines, including attributes of each term. This will enable us to determine how these two concepts are distinguished. ETHICS AND DISSEMINATION Following ethical and research standards, we will comprehensively report the methodology for a systematic analysis following Rodgers' concept analysis method. Our systematic concept analysis will contribute to the clarification of the two concepts and distinction in their application in given settings and circumstances. Such a broad concept analysis will contribute to non-systematic syntheses of the concepts, or occasional systematic reviews on one of the concepts that have been published in specific disciplines, in order to facilitate interdisciplinary communication, translational medical research and implementation science.
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Affiliation(s)
- Nicola Brew-Sam
- National Centre for Epidemiology and Population Health, College of Health and Medicine, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Anne Parkinson
- National Centre for Epidemiology and Population Health, College of Health and Medicine, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Christian Lueck
- School of Medicine and Psychology, College of Health and Medicine, Australian National University, Canberra, Australian Capital Territory, Australia
- Department of Neurology, Canberra Health Services, Canberra, Australian Capital Territory, Australia
| | - Ellen Brown
- National Centre for Epidemiology and Population Health, College of Health and Medicine, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Karen Brown
- National Centre for Epidemiology and Population Health, College of Health and Medicine, Australian National University, Canberra, Australian Capital Territory, Australia
- The Centenary Hospital for Women and Children, Canberra Health Services, Canberra, Australian Capital Territory, Australia
| | - Anne Bruestle
- The John Curtin School of Medical Research, College of Health and Medicine, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Katrina Chisholm
- National Centre for Epidemiology and Population Health, College of Health and Medicine, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Simone Collins
- The Centenary Hospital for Women and Children, Canberra Health Services, Canberra, Australian Capital Territory, Australia
| | - Matthew Cook
- The John Curtin School of Medical Research, College of Health and Medicine, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Eleni Daskalaki
- School of Computing, College of Engineering and Computer Science, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Janet Drew
- National Centre for Epidemiology and Population Health, College of Health and Medicine, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Harry Ebbeck
- National Centre for Epidemiology and Population Health, College of Health and Medicine, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Mark Elisha
- National Centre for Epidemiology and Population Health, College of Health and Medicine, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Vanessa Fanning
- National Centre for Epidemiology and Population Health, College of Health and Medicine, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Adam Henschke
- Department of Philosophy, University of Twente, Enschede, Overijssel, The Netherlands
| | - Jessica Herron
- The Centenary Hospital for Women and Children, Canberra Health Services, Canberra, Australian Capital Territory, Australia
| | - Emma Matthews
- The Centenary Hospital for Women and Children, Canberra Health Services, Canberra, Australian Capital Territory, Australia
| | - Krishnan Murugappan
- Nanotechnology Research Lab, Research School of Chemistry, College of Science, Australian National University, Canberra, Australian Capital Territory, Australia
- CSIRO, Mineral Resources, Clayton South, Victoria, Australia
| | - Dragomir Neshev
- Department of Electronic Materials Engineering, Research School of Physics, College of Science, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Christopher J Nolan
- School of Medicine and Psychology, College of Health and Medicine, Australian National University, Canberra, Australian Capital Territory, Australia
- The John Curtin School of Medical Research, College of Health and Medicine, Australian National University, Canberra, Australian Capital Territory, Australia
- Department of Endocrinology and Diabetes, Canberra Health Services, Canberra, Australian Capital Territory, Australia
| | - Lachlan Pedley
- National Centre for Epidemiology and Population Health, College of Health and Medicine, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Christine Phillips
- School of Medicine and Psychology, College of Health and Medicine, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Hanna Suominen
- School of Computing, College of Engineering and Computer Science, Australian National University, Canberra, Australian Capital Territory, Australia
- Department of Computing, University of Turku, Turku, Finland
| | - Antonio Tricoli
- Nanotechnology Research Lab, Research School of Chemistry, College of Science, Australian National University, Canberra, Australian Capital Territory, Australia
- Nanotechnology Research Laboratory, Faculty of Engineering, The University of Sydney, Sydney, New South Wales, Australia
| | - Kristine Wright
- The Centenary Hospital for Women and Children, Canberra Health Services, Canberra, Australian Capital Territory, Australia
| | - Jane Desborough
- National Centre for Epidemiology and Population Health, College of Health and Medicine, Australian National University, Canberra, Australian Capital Territory, Australia
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10
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Dykgraaf SH, Desborough J, Sturgiss E, Parkinson A, Dut GM, Kidd M. Older people, the digital divide and use of telehealth during the COVID-19 pandemic. Aust J Gen Pract 2022; 51:721-724. [DOI: 10.31128/ajgp-03-22-6358] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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11
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Desborough J, Wright M, Parkinson A, Dykgraaf SH, Ball L, Dut GM, Sturgiss E, de Toca L, Kidd M. What strategies have been effective in optimising COVID-19 vaccine uptake in Australia and internationally? Aust J Gen Pract 2022; 51:725-730. [DOI: 10.31128/ajgp-05-22-6427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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12
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Namsrai T, Desborough J, Chalmers A, Lowe C, Cook M, Phillips C, Parkinson A. Diagnostic delay of myositis: protocol for an integrated systematic review. BMJ Open 2022; 12:e060312. [PMID: 35697457 PMCID: PMC9196154 DOI: 10.1136/bmjopen-2021-060312] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Idiopathic inflammatory myopathies (IIM). described as 'inflammatory myositis', are a heterogeneous group of rare muscular autoimmune diseases characterised by skeletal muscle inflammation. Its complex characteristics with lack of accurate diagnostic tests, unified classification system and comprehensive widely used diagnostic criteria could lead to diagnostic delay. This study will review diagnostic delay in myositis and provide an overview and clearer insight of patients' experiences, causes and consequences of diagnostic delay in myositis. METHODS AND ANALYSIS The literature source will be a systematic search of PubMed/MEDLINE, Scopus, ProQuest and sources of grey literature, conducted from database inception to December 2021 without restrictions on publication date. All study types (qualitative and quantitative) except review articles, examining diagnostic delay, incorrect diagnosis, missed diagnosis or slow diagnosis of all types of myositis in all ages will be included. Evidence of patients' experiences associated with diagnostic delay will also be examined. Studies in languages other than English, German and Indonesian will be excluded. Outcomes will be diagnostic delay time, patients' experiences, and causes and consequences associated with diagnostic delay in myositis. Two review authors will independently screen the titles and abstracts of search results against the inclusion criteria. The Mixed Methods Appraisal Tool (MMAT) will be used to appraise selected studies. Two independent authors will extract data using a prepiloted data extraction tool. If sufficient quantitative data is available, a meta-analysis will be conducted along with subgroup analysis including pooled diagnostic delay in each type of myositis. Qualitative data will be analysed in line with meta-aggregation methods. If data is insufficient, a narrative synthesis will be conducted. ETHICS AND DISSEMINATION As this work is a systematic review, ethical approval was not required. Findings of the study will be disseminated through publications in peer-reviewed journals, conferences and symposia. PROSPERO REGISTRATION NUMBER CRD42022289830.
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Affiliation(s)
- Tergel Namsrai
- National Centre for Epidemiology and Population Health, College of Health and Medicine, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Jane Desborough
- National Centre for Epidemiology and Population Health, College of Health and Medicine, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Anita Chalmers
- National Centre for Epidemiology and Population Health, College of Health and Medicine, Australian National University, Canberra, Australian Capital Territory, Australia
- Myositis Australia Inc, Canberra, Australian Capital Territory, Australia
| | - Christine Lowe
- National Centre for Epidemiology and Population Health, College of Health and Medicine, Australian National University, Canberra, Australian Capital Territory, Australia
- Myositis Australia Inc, Canberra, Australian Capital Territory, Australia
| | - Matthew Cook
- The John Curtin School of Medical Research, College of Health and Medicine, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Christine Phillips
- School of Medicine and Psychology, College of Health and Medicine, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Anne Parkinson
- National Centre for Epidemiology and Population Health, College of Health and Medicine, Australian National University, Canberra, Australian Capital Territory, Australia
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13
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Perkins P, Parkinson A, Hebdon R, Akyea RK. Behaviours of Patients Who Take Their Strong Opioids as Unmeasured 'Sips'. J Pain Symptom Manage 2022; 63:e691-e697. [PMID: 35122962 DOI: 10.1016/j.jpainsymman.2022.01.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 01/18/2022] [Accepted: 01/21/2022] [Indexed: 11/15/2022]
Abstract
CONTEXT Some patients take their strong opioid painkillers as unmeasured sips. OBJECTIVES To investigate how and why patients take their medication in this way. METHODS Patient receiving specialist palliative care who take their strong opioid painkillers as unmeasured sips were recruited. Measurement was made of the mass of two sips per patient and qualitative interviews using a topic guide were conducted. Interview transcripts were thematically analyzed using a phenomenological approach. RESULTS Only two of 16 patients were taking within 20% of the correct dose of their breakthrough liquid strong analgesia. Many varied the dose depending on the severity of the pain episode. Convenience, confusion about the correct dose, and issues with spoons were the other main reasons for people choosing to sip. CONCLUSION This is the first published study exploring the behavior of patients who take their strong analgesia as unmeasured sips. Knowing that patients who sip are likely to be taking an incorrect dose, and the reasons behind sipping may help clinicians to help these patients to manage their pain better.
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Affiliation(s)
- Paul Perkins
- Gloucestershire Hospitals NHS Foundation Trust (P.P.), Cheltenham, UK; Sue Ryder Leckhampton Court Hospice (P.P., A.P.), Cheltenham, UK.
| | - Anne Parkinson
- Sue Ryder Leckhampton Court Hospice (P.P., A.P.), Cheltenham, UK
| | - Rob Hebdon
- NHS Midlands and Lancashire Commissioning Support Unit (R.H.), Stoke-on-Trent, UK
| | - Ralph K Akyea
- Centre for Academic Primary Care (R.K.A.), School of Medicine, University of Nottingham, Nottingham, UK
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14
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Yeung S, Perriman D, Chhabra M, Phillips C, Parkinson A, Glasgow N, Douglas KA, Cox D, Smith P, Desborough J. ACT Transition from Hospital to Home Orthopaedic Survey: a cross-sectional survey of unplanned 30-day readmissions for patients having total hip arthroplasty. BMJ Open 2022; 12:e055576. [PMID: 35636791 PMCID: PMC9152933 DOI: 10.1136/bmjopen-2021-055576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES The aim of this study was to identify patient, hospital and transitional factors associated with unplanned 30-day readmissions in patients who had a total hip arthroplasty (THA). DESIGN A cross-sectional survey was performed. All patients attending a 6-week follow-up after a THA in the Australian Capital Territory (ACT) at four public and private clinics in the ACT from 1 February 2018 to 31 January 2019, were invited to complete an ACT Transition from Hospital to Home Orthopaedic Survey. PARTICIPANTS Within the ACT, 431 patients over the age of 16 attending their 6-week post-surgery consultation following a THA entered and completed the survey (response rate 77%). PRIMARY OUTCOME MEASURE The primary outcome measure was self-reported readmissions for any reason within 30 days of discharge after a THA. Multiple logistic regression was used to estimate ORs of factors associated with unplanned 30-day readmissions. RESULTS Of the 431 participants (representing 40% of all THAs conducted in the ACT during the study period), 27 (6%) were readmitted within 30 days of discharge. After controlling for age and sex, patients who did not feel rested on discharge were more likely to be readmitted within 30 days than those who felt rested on discharge (OR=5.75, 95% CI: (2.13 to 15.55), p=0.001). There was no association between post-hospital syndrome (ie, in-hospital experiences of pain, sleep and diet) overall and readmission. Patients who suffered peripheral vascular disease (PVD) were significantly more likely to have an unplanned 30-day readmission (OR=16.9, 95% CI: (3.06 to 93.53), p=0.001). There was no significant difference between private and public patient readmissions CONCLUSIONS: Hospitals should develop strategies that maximise rest and sleep during patients' hospital stay. Diagnosis and optimum treatment of pre-existing PVD prior to THA should also be a priority to minimise the odds of subsequent unplanned readmissions.
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Affiliation(s)
- Sybil Yeung
- Australian National University Medical School, Canberra, Australian Capital Territory, Australia
| | - Diana Perriman
- Australian National University Medical School, Canberra, Australian Capital Territory, Australia
- ACT Health, Canberra City, Australian Capital Territory, Australia
| | - Madhur Chhabra
- Department of Health Services Research and Policy, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Christine Phillips
- Australian National University, Canberra, Australian Capital Territory, Australia
| | - Anne Parkinson
- Australian Primary Health Care Research Institute, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Nicholas Glasgow
- Australian National University Research School of Population Health, Canberra, Australian Capital Territory, Australia
| | - Kirsty A Douglas
- Australian National University Medical School, Canberra, Australian Capital Territory, Australia
| | - Darlene Cox
- Health Care Consumer Association, Canberra, Australian Capital Territory, Australia
| | - Paul Smith
- Australian National University Medical School, Canberra, Australian Capital Territory, Australia
- The Trauma and Orthopaedic Resarch Unit, ACT Health, Canberra City, Australian Capital Territory, Australia
| | - Jane Desborough
- Department of Health Services Research and Policy, Australian National University, Canberra, Australian Capital Territory, Australia
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15
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Parkinson A, Brunoro C, Leayr J, Fanning V, Chisholm K, Drew J, Desborough J, Phillips C. Front Cover: Volume 25 Issue 3. Health Expect 2022. [DOI: 10.1111/hex.13543] [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: 11/30/2022] Open
Affiliation(s)
- Anne Parkinson
- Department of Health Services Research and Policy Australian National University Acton Australia
| | - Crystal Brunoro
- Department of Health Services Research and Policy Australian National University Acton Australia
| | - Jack Leayr
- Department of Health Services Research and Policy Australian National University Acton Australia
| | - Vanessa Fanning
- Department of Health Services Research and Policy Australian National University Acton Australia
| | - Katrina Chisholm
- Department of Health Services Research and Policy Australian National University Acton Australia
| | - Janet Drew
- Department of Health Services Research and Policy Australian National University Acton Australia
| | - Jane Desborough
- Department of Health Services Research and Policy Australian National University Acton Australia
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16
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Parkinson A, Matenge S, Desborough J, Hall Dykgraaf S, Ball L, Wright M, Sturgiss EA, Kidd M. The impact of
COVID
‐19 on chronic disease management in primary care: lessons for Australia from the international experience. Med J Aust 2022; 216:445-448. [PMID: 35403236 PMCID: PMC9114997 DOI: 10.5694/mja2.51497] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 12/08/2021] [Accepted: 12/15/2021] [Indexed: 12/22/2022]
Affiliation(s)
- Anne Parkinson
- National Centre for Epidemiology and Population Health Australian National University Canberra ACT
| | - Sethunya Matenge
- National Centre for Epidemiology and Population Health Australian National University Canberra ACT
| | - Jane Desborough
- National Centre for Epidemiology and Population Health Australian National University Canberra ACT
| | | | - Lauren Ball
- Centre for Health Practice Innovation Griffith University Brisbane QLD
| | - Michael Wright
- Centre for Health Economics Research and Evaluation University of Technology Sydney Sydney NSW
| | | | - Michael Kidd
- Australian National University Canberra ACT
- COVID‐19 Primary Care Response Group Australian Government Department of Health Canberra ACT
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17
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Chhabra M, Perriman D, Phillips C, Parkinson A, Glasgow N, Douglas K, Cox D, Smith P, Desborough J. Understanding factors affecting 30-day unplanned readmissions for patients undergoing total knee arthroplasty (TKA): the ACT Transition from Hospital to Home Orthopaedics Survey. BMJ Open 2022; 12:e053831. [PMID: 35410923 PMCID: PMC9003601 DOI: 10.1136/bmjopen-2021-053831] [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: 11/03/2022] Open
Abstract
OBJECTIVES The aim of this study was to investigate factors associated with unplanned 30-day readmissions following a total knee arthroplasty (TKA), including association with post-hospital syndrome, patient enablement and transition from hospital to home. DESIGN, SETTING AND PARTICIPANTS A cross-sectional written survey of public and private patients attending a 6-week follow-up appointment after TKA at one of four clinical services in the Australian Capital Territory (ACT) between 1 February 2018 and 31 January 2019. Multiple logistic regression analyses were used to measure associations between patient, hospital and transitional care factors with unplanned 30-day readmissions, while controlling for known confounders. RESULTS Of the 380 participants who completed the survey (n=380, 54% of TKAs undertaken over the study period), 3.4% (n=13; 95% CI: 1.8 to 5.8) were subsequently readmitted within 30 days of discharge after a primary hospitalisation. Public patients were significantly more likely to be readmitted within 30 days compared with private patients (adjusted OR=6.31, 95% CI: 1.59 to 25.14, p=0.009), and patients who attended rehabilitation were significantly less likely to be readmitted within 30 days of discharge than those who did not (adjusted OR=0.16, 95% CI: 0.04 to 0.57, p=0.005). There were no associations between post-hospital syndrome or patient enablement and 30-day readmissions in this study. CONCLUSION Reasons underlying the difference in unplanned readmission rates for public versus private patients need to be explored, including differences in surgical waiting times and the consequences for impairment and disease complexity. Strategies to foster increased participation post-surgical rehabilitation programmes need to be developed as an avenue to mitigate the burden of unplanned 30-day readmissions on individuals and health systems.
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Affiliation(s)
- Madhur Chhabra
- Department of Health Services Research and Policy, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Diana Perriman
- Trauma and Orthopaedic Research Unit, ACT Health, Canberra City, Australian Capital Territory, Australia
- Australian National University Medical School, Canberra, Australian Capital Territory, Australia
| | - Christine Phillips
- Australian National University Medical School, Canberra, Australian Capital Territory, Australia
| | - Anne Parkinson
- Department of Health Services Research and Policy, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Nicholas Glasgow
- Australian National University Medical School, Canberra, Australian Capital Territory, Australia
| | - Kirsty Douglas
- Australian National University Medical School, Canberra, Australian Capital Territory, Australia
| | - Darlene Cox
- Health Care Consumers Association, ACT, Canberra, Australian Capital Territory, Australia
| | - Paul Smith
- Trauma and Orthopaedic Research Unit, ACT Health, Canberra City, Australian Capital Territory, Australia
- Australian National University Medical School, Canberra, Australian Capital Territory, Australia
| | - Jane Desborough
- Department of Health Services Research and Policy, Australian National University, Canberra, Australian Capital Territory, Australia
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18
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Daskalaki E, Parkinson A, Brew-Sam N, Hossain MZ, O'Neal D, Nolan CJ, Suominen H. The Potential of Current Noninvasive Wearable Technology for the Monitoring of Physiological Signals in the Management of Type 1 Diabetes: Literature Survey. J Med Internet Res 2022; 24:e28901. [PMID: 35394448 PMCID: PMC9034434 DOI: 10.2196/28901] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 12/06/2021] [Accepted: 12/23/2021] [Indexed: 11/13/2022] Open
Abstract
Background Monitoring glucose and other parameters in persons with type 1 diabetes (T1D) can enhance acute glycemic management and the diagnosis of long-term complications of the disease. For most persons living with T1D, the determination of insulin delivery is based on a single measured parameter—glucose. To date, wearable sensors exist that enable the seamless, noninvasive, and low-cost monitoring of multiple physiological parameters. Objective The objective of this literature survey is to explore whether some of the physiological parameters that can be monitored with noninvasive, wearable sensors may be used to enhance T1D management. Methods A list of physiological parameters, which can be monitored by using wearable sensors available in 2020, was compiled by a thorough review of the devices available in the market. A literature survey was performed using search terms related to T1D combined with the identified physiological parameters. The selected publications were restricted to human studies, which had at least their abstracts available. The PubMed and Scopus databases were interrogated. In total, 77 articles were retained and analyzed based on the following two axes: the reported relations between these parameters and T1D, which were found by comparing persons with T1D and healthy control participants, and the potential areas for T1D enhancement via the further analysis of the found relationships in studies working within T1D cohorts. Results On the basis of our search methodology, 626 articles were returned, and after applying our exclusion criteria, 77 (12.3%) articles were retained. Physiological parameters with potential for monitoring by using noninvasive wearable devices in persons with T1D included those related to cardiac autonomic function, cardiorespiratory control balance and fitness, sudomotor function, and skin temperature. Cardiac autonomic function measures, particularly the indices of heart rate and heart rate variability, have been shown to be valuable in diagnosing and monitoring cardiac autonomic neuropathy and, potentially, predicting and detecting hypoglycemia. All identified physiological parameters were shown to be associated with some aspects of diabetes complications, such as retinopathy, neuropathy, and nephropathy, as well as macrovascular disease, with capacity for early risk prediction. However, although they can be monitored by available wearable sensors, most studies have yet to adopt them, as opposed to using more conventional devices. Conclusions Wearable sensors have the potential to augment T1D sensing with additional, informative biomarkers, which can be monitored noninvasively, seamlessly, and continuously. However, significant challenges associated with measurement accuracy, removal of noise and motion artifacts, and smart decision-making exist. Consequently, research should focus on harvesting the information hidden in the complex data generated by wearable sensors and on developing models and smart decision strategies to optimize the incorporation of these novel inputs into T1D interventions.
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Affiliation(s)
- Elena Daskalaki
- School of Computing, College of Engineering and Computer Science, The Australian National University, Canberra, Australia
| | - Anne Parkinson
- Department of Health Services Research and Policy, Research School of Population Health, College of Health and Medicine, The Australian National University, Canberra, Australia
| | - Nicola Brew-Sam
- Department of Health Services Research and Policy, Research School of Population Health, College of Health and Medicine, The Australian National University, Canberra, Australia
| | - Md Zakir Hossain
- School of Computing, College of Engineering and Computer Science, The Australian National University, Canberra, Australia.,School of Biology, College of Science, The Australian National University, Canberra, Australia.,Bioprediction Activity, Commonwealth Industrial and Scientific Research Organisation, Canberra, Australia
| | - David O'Neal
- Department of Medicine, University of Melbourne, Melbourne, Australia.,Department of Endocrinology and Diabetes, St Vincent's Hospital Melbourne, Melbourne, Australia
| | - Christopher J Nolan
- Australian National University Medical School and John Curtin School of Medical Research, College of Health and Medicine, The Autralian National University, Canberra, Australia.,Department of Diabetes and Endocrinology, The Canberra Hospital, Canberra, Australia
| | - Hanna Suominen
- School of Computing, College of Engineering and Computer Science, The Australian National University, Canberra, Australia.,Data61, Commonwealth Industrial and Scientific Research Organisation, Canberra, Australia.,Department of Computing, University of Turku, Turku, Finland
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19
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Desborough J, Hall Dykgraaf S, Sturgiss E, Parkinson A, Dut G, Kidd M. What has the COVID-19 pandemic taught us about the use of virtual consultations in primary care? Aust J Gen Pract 2022; 51:179-183. [PMID: 35224583 DOI: 10.31128/ajgp-09-21-6184] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Telehealth has been a very useful resource in primary care consultations during the COVID-19 pandemic. OBJECTIVE The aim of this article is to examine primary care providers' (PCPs') and patients' experiences of using video and telephone modalities and their perceptions of the quality of telehealth. DISCUSSION Video consultations offer the advantage of enabling visualisation of a patient's visual affect and physical appearance, and they are helpful in building therapeutic relationships. However, many PCPs and patients find telephone consultations of equal value, and this has been the preferred telehealth modality internationally. This may be due to challenges experienced by PCPs and patients with the set-up and use of video consultation technologies, and the quality of these experiences. Some members of a number of at-risk groups have experienced greater challenges with this. The future of telehealth in primary care requires its coherent integration into clinical infrastructure and substantial bolstering of community access and capacity to use both video and telephone modalities.
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Affiliation(s)
- Jane Desborough
- RN, RM, MPH, PhD, Action Research, COVID-19 Primary Care Response Group (seconded), Primary Care Division, Australian Government Department of Health, ACT; Senior Research Fellow, Research School of Population Health, Australian National University, ACT
| | - Sally Hall Dykgraaf
- RN, Grad Cert Clin Man, PhD Scholar, Action Research, COVID-19 Primary Care Response Group (seconded), Primary Care Division, Australian Government Department of Health, ACT; Research Manager, Rural Clinical School, ANU Medical School, College of Health and Medicine, Australian National University, ACT
| | - Elizabeth Sturgiss
- PhD, FRACGP, BMed, MPH, MForensMed, Senior Lecturer, Department of General Practice, Monash University, Vic; Visiting Fellow, Australian National University, ACT.
| | - Anne Parkinson
- BA, PhD, AFHEA, Action Research, COVID-19 Primary Care Response Group (seconded), Primary Care Division, Australian Government Department of Health, Canberra, ACT; Postdoctoral Fellow, Research School of Population Health, College of Health and Medicine, Australian National University, Canberra, ACT
| | - Garang Dut
- MD, MPH, MBA, Action Research, COVID-19 Primary Care Response Group (seconded), Primary Care Division, Australian Government Department of Health, Canberra, ACT; Fellow in Health Systems, College of Health @ Medicine, Australian National University, Canberra, ACT
| | - Michael Kidd
- AM MBBS (Hons), MD, DCCH, DipRACOG, MCFP, FAHMS, Principal Medical Advisor and Deputy Chief Medical Officer, Australian Government Department of Health, ACT; Professor of Primary Care Reform, Australian National University, ACT; Adjunct Professor, Department of Family and Community Medicine, University of Toronto, Canada; Emeritus Director, World Health Organization Collaborating Centre on Family Medicine and Primary Care, GVA; Professorial Fellow, Murdoch Children@s Research Institute, The Royal Children@s Hospital Melbourne, Vic; Honorary Professor of Global Primary Care, Southgate Institute for Health, Society and Equity, Flinders University, SA
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20
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Desborough J, Parkinson A, Lewis F, Ebbeck H, Banfield M, Phillips C. Outside Front Cover: Volume 25 Issue 1. Health Expect 2022. [DOI: 10.1111/hex.13458] [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: 11/27/2022] Open
Affiliation(s)
- Jane Desborough
- Department of Health Services, Research and Policy, Research School of Population Health, College of Health and Medicine Australian National University Canberra Australian Capital Territory Australia
| | - Anne Parkinson
- Department of Health Services, Research and Policy, Research School of Population Health, College of Health and Medicine Australian National University Canberra Australian Capital Territory Australia
| | - Fiona Lewis
- Australian National University Medical School, College of Health and Medicine Australian National University Canberra Australian Capital Territory Australia
| | - Harry Ebbeck
- Department of Health Services, Research and Policy, Research School of Population Health, College of Health and Medicine Australian National University Canberra Australian Capital Territory Australia
| | - Michelle Banfield
- Centre for Mental Health Research, Research School of Population Health, College of Health and Medicine Australian National University Canberra Australian Capital Territory Australia
| | - Christine Phillips
- Australian National University Medical School, College of Health and Medicine Australian National University Canberra Australian Capital Territory Australia
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21
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Parkinson A, Brunoro C, Leayr J, Fanning V, Chisholm K, Drew J, Desborough J, Phillips C. Intertwined like a double helix: A meta-synthesis of the qualitative literature examining the experiences of living with someone with multiple sclerosis. Health Expect 2022; 25:803-822. [PMID: 35118764 PMCID: PMC9122458 DOI: 10.1111/hex.13432] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 11/16/2021] [Accepted: 12/31/2021] [Indexed: 12/01/2022] Open
Abstract
Background Multiple sclerosis (MS) is a chronic serious condition of uncertain course and outcome. There is relatively little literature on the experiences of people who live with a person with MS. They inhabit a locus of care that spans caring for (a relational act) and caring about (a moral stance, addressing fairness, compassion and justice) the person with MS. Methods Using the theoretical lens of personhood, we undertook a scoping review and meta‐synthesis of the qualitative literature on the experiences of people who live with a person with MS, focusing on the nature of, and constraints upon, caring. Results Of 330 articles, 49 were included in the review. We identified five themes. One of these—seeking information and support—reflects the political economy of care. Two are concerned with the moral domain of care: caring as labour and living with uncertainty. The final two themes—changing identities and adapting to life with a person with MS—point to the negotiation and reconstitution of personhood for both the person with MS and the people they live with. Conclusion People with MS are embedded in relational social networks of partners, family and friends, which are fundamental in the support of their personhood; the people who live with them are ‘co‐constituents of the patient's identity’ assisting them to make sense of their world and self in times of disruption due to illness. Support services and health care professionals caring for people with MS are currently very much patient‐centred; young people in particular report that their roles are elided in the health system's interaction with a parent with MS. There is a need to look beyond the person with MS and recognize the relational network of people who surround them and broaden their focus to encompass this network. Patient and Public Involvement Our research team includes four members with MS and two members with lived experience of living or working with people with MS. A third person (not a team member) who lives with a partner with MS provided feedback on the paper.
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Affiliation(s)
- Anne Parkinson
- Department of Health Services Research and Policy, Australian National University, Acton, Australia
| | - Crystal Brunoro
- Department of Health Services Research and Policy, Australian National University, Acton, Australia
| | - Jack Leayr
- Department of Health Services Research and Policy, Australian National University, Acton, Australia
| | - Vanessa Fanning
- Department of Health Services Research and Policy, Australian National University, Acton, Australia
| | - Katrina Chisholm
- Department of Health Services Research and Policy, Australian National University, Acton, Australia
| | - Janet Drew
- Department of Health Services Research and Policy, Australian National University, Acton, Australia
| | - Jane Desborough
- Department of Health Services Research and Policy, Australian National University, Acton, Australia
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Suominen H, Manocha M, Desborough J, Parkinson A, Apthorp D. Finger Tapping Measures for Parkinson's Disease: Preliminary Evaluation of an Android Application for Data Collection in Australia. Stud Health Technol Inform 2021; 284:475-480. [PMID: 34920574 DOI: 10.3233/shti210775] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Parkinson's Disease (PD) is a progressive chronic disorder with a high misdiagnosis rate. Because finger-tapping tasks correlate with its fine-motor symptoms, they could be used to help diagnose and assess PD. We first designed and developed an Android application to perform finger-tapping tasks without trained supervision, which is not always feasible for patients. Then, we conducted a preliminary user evaluation in Australia with six patients clinically diagnosed with PD and sixteen controls without PD. The application could be used in research and healthcare for regular symptom and progression assessment and feedback.
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Affiliation(s)
- Hanna Suominen
- The Australian National University (ANU), Australia.,Data61/Commonwealth Scientific and Industrial Research Organisation, Australia.,University of Turku, Finland
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23
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Desborough J, Parkinson A, Lewis F, Ebbeck H, Banfield M, Phillips C. A framework for involving coproduction partners in research about young people with type 1 diabetes. Health Expect 2021; 25:430-442. [PMID: 34890473 PMCID: PMC8849360 DOI: 10.1111/hex.13403] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 06/24/2021] [Accepted: 11/14/2021] [Indexed: 12/02/2022] Open
Abstract
Background Involvement of end‐users in research can enhance its quality, relevance, credibility and legitimacy; however, the processes through which these changes occur are unclear. Our aim was to explore a coproduction research team's experiences of their involvement in research about young people with type 1 diabetes mellitus (T1DM). Methods Semi‐structured interviews conducted with two young people with T1DM, two parents, one diabetes educator, one endocrinologist‐scientist and one research‐engineer explored experiences of coproduction research and its impact on both the research and the participants. Drawing on grounded theory, we undertook inductive analysis and storyline mapping to develop a theorized framework of mechanisms supporting the process of coproduction in T1DM research with young people. Findings The framework involving coproduction partners in research about young people with type 1 diabetes centres on the unique expertize that different team members bring to the research and describes conditions that enable expert contributions through the enactment of a variety of expert roles. The framework also describes outcomes—the impact of the expert contributions on both the research and the team members involved. Conclusion The findings of this small exploratory study provide a sound foundation to develop further understanding about structures and processes that are integral for the success of coproduction research teams. The framework may provide a guide for researchers planning to incorporate coproduction, on elements that are important for this model of research to succeed. It may also inform coproduction impact assessment research and be used for hypothesis testing and expansion in future studies.
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Affiliation(s)
- Jane Desborough
- Department of Health Services, Research and Policy, Research School of Population Health, College of Health and Medicine, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Anne Parkinson
- Department of Health Services, Research and Policy, Research School of Population Health, College of Health and Medicine, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Fiona Lewis
- Australian National University Medical School, College of Health and Medicine, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Harry Ebbeck
- Department of Health Services, Research and Policy, Research School of Population Health, College of Health and Medicine, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Michelle Banfield
- Centre for Mental Health Research, Research School of Population Health, College of Health and Medicine, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Christine Phillips
- Australian National University Medical School, College of Health and Medicine, Australian National University, Canberra, Australian Capital Territory, Australia
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Parkinson A, Brew-Sam N, Hall Dykgraaf S, Nolan C, Lafferty A, Schmidli R, Brown E, Brown K, Pedley L, Ebbeck H, Pedley E, Wright K, Phillips C, Desborough J. Managing type 1 diabetes during the COVID-19 pandemic is a team effort: a qualitative study of the experiences of young people and their parents. Integr Healthc J 2021; 3:e000082. [PMID: 38607941 PMCID: PMC8593267 DOI: 10.1136/ihj-2021-000082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 10/26/2021] [Indexed: 11/03/2022] Open
Abstract
Objective To explore the experiences of young people with type 1 diabetes mellitus (T1DM) and their parents in accessing integrated family-centred care in the Australian Capital Territory during the COVID-19 pandemic. Methods and analysis This is a pragmatic, qualitative descriptive study for which we conducted semistructured interviews with 11 young people with T1DM aged 12-16 years and 10 of their parents who attended an outpatient diabetes service in Canberra, Australia. Thematic analysis was conducted in accordance with the methods outlined by Braun and Clarke. Results Three themes were identified: feeling vulnerable, new ways of accessing care and trust in the interdisciplinary diabetes healthcare team. Participants believed having T1DM made them more vulnerable to poor outcomes if they contracted COVID-19, resulting in avoidance of face-to-face care. Telephone consultations offered a convenient and contact-free way to undertake 3-monthly reviews. The greatest difference between telephone and face-to-face consultations was not having access to the whole interdisciplinary diabetes support team at one appointment, physical examination and haemoglobin A1c testing during telehealth consultations. Participants trusted that clinicians would arrange face-to-face meetings if required. Some felt a video option might be better than telephone, reflecting in part the need for more training in communication skills for remote consultations. Conclusion Young people with T1DM and their parents require collaborative care and contact with multiple healthcare professionals to facilitate self-management and glycaemic control. While telephone consultations offered convenient, safe, contact-free access to healthcare professionals during the COVID-19 pandemic, the added value of video consultations and facilitating access to the whole interdisciplinary diabetes support team need to be considered in future clinical implementation of telehealth.
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Affiliation(s)
- Anne Parkinson
- Department of Health Services Research and Policy, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Nicola Brew-Sam
- Department of Health Services Research and Policy, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Sally Hall Dykgraaf
- Medical School, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Christopher Nolan
- Medical School, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Antony Lafferty
- Medical School, Australian National University, Canberra, Australian Capital Territory, Australia
- Department of Paediatrics, Canberra Hospital, Canberra, Australian Capital Territory, Australia
| | - Robert Schmidli
- Medical School, Australian National University, Canberra, Australian Capital Territory, Australia
- Department of Paediatrics, Canberra Hospital, Canberra, Australian Capital Territory, Australia
| | - Ellen Brown
- Department of Health Services Research and Policy, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Karen Brown
- Department of Health Services Research and Policy, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Lachlan Pedley
- Department of Health Services Research and Policy, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Harry Ebbeck
- Department of Health Services Research and Policy, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Elizabeth Pedley
- Department of Health Services Research and Policy, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Kristine Wright
- Department of Health Services Research and Policy, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Christine Phillips
- Medical School, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Jane Desborough
- Department of Health Services Research and Policy, Australian National University, Canberra, Australian Capital Territory, Australia
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25
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Parkinson A, Drew J, Hall Dykgraaf S, Fanning V, Chisholm K, Elisha M, Lueck C, Phillips C, Desborough J. 'They're getting a taste of our world': A qualitative study of people with multiple sclerosis' experiences of accessing health care during the COVID-19 pandemic in the Australian Capital Territory. Health Expect 2021; 24:1607-1617. [PMID: 34227728 PMCID: PMC8483188 DOI: 10.1111/hex.13284] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 04/13/2021] [Accepted: 05/06/2021] [Indexed: 12/24/2022] Open
Abstract
Background People with multiple sclerosis (MS), who are often immunocompromised, require complex care and engage with a variety of health‐care providers to manage their health. Objective To elucidate people with MS' experiences of accessing health care during the COVID‐19 pandemic in Australia. Design A qualitative study involving semi‐structured interviews and thematic analysis. Settings and participants Eight adults with a clinical diagnosis of MS participated in telephone or video call interviews between June and July 2020. Results Participants were aware that having MS made them more vulnerable to contracting COVID‐19. In some cases, usual care was postponed or not sought. Some circumstances warranted the risk of a face‐to‐face consultation. Benefits of telehealth consultations included improved access, convenience and being contact‐free. In comparison with video consultations, those via telephone were considered less personal and limited capacity to read body language, and for physical examination. Most participants hoped to incorporate telehealth into their future health‐care routines. Discussion and conclusion Personal risk assessment and trust in health‐care professionals are determinants of the mode through which people with MS accessed health care during the COVID‐19 pandemic. Telehealth has been a valuable tool to mitigate COVID‐19 transmission through enabling contact‐free consultations. People with MS may find specific value in video consultations, which enable visualization of physical function. There is a need for training and support for all clinicians to conduct remote consultations. Patient or public contribution This study was conducted by a team comprised of four people with MS, a neurologist and four health services researchers.
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Affiliation(s)
- Anne Parkinson
- Department of Health Services, Research and Policy, Australian National University, Canberra, ACT, Australia
| | - Janet Drew
- Department of Health Services, Research and Policy, Australian National University, Canberra, ACT, Australia
| | | | - Vanessa Fanning
- Department of Health Services, Research and Policy, Australian National University, Canberra, ACT, Australia
| | - Katrina Chisholm
- Department of Health Services, Research and Policy, Australian National University, Canberra, ACT, Australia
| | - Mark Elisha
- Department of Health Services, Research and Policy, Australian National University, Canberra, ACT, Australia
| | - Christian Lueck
- Medical School, Australian National University, Canberra, ACT, Australia.,Department of Neurology, Canberra Hospital, Canberra, ACT, Australia
| | - Christine Phillips
- Medical School, Australian National University, Canberra, ACT, Australia
| | - Jane Desborough
- Department of Health Services, Research and Policy, Australian National University, Canberra, ACT, Australia
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26
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Perkins P, Parkinson A, Taylor V, Husbands E. Nasal fentanyl and buccal midazolam carer administration 'as needed' for breakthrough symptom control in a specialist palliative care unit: a nested qualitative study. BMJ Support Palliat Care 2021; 11:440-443. [PMID: 33766820 DOI: 10.1136/bmjspcare-2020-002729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 02/20/2021] [Accepted: 03/11/2021] [Indexed: 11/03/2022]
Abstract
INTRODUCTION When people are dying and unable to take oral medication, injectable medication is commonly used, usually administered by healthcare professionals. There may be delays to symptom relief due to travel to the person's home. In a randomised controlled trial (RCT) previously reported, nasal fentanyl (NF) or buccal midazolam (BM) were administered by lay carers in a hospice. OBJECTIVE (1) To report experiences of lay carers who administered NF and BM for symptom control and (2) To use feedback to develop guidance informing a future definitive RCT to determine whether NF and BM administered by lay carers can lead to timely, improved symptom control for people dying at home and fewer 'emergency' community nursing visits than standard breakthrough medication administered by healthcare professionals. MATERIAL AND METHODS Semistructured interviews with lay carers who gave trial medication were conducted. Interview data were analysed using a stage by stage method to code and categorise transcripts. FINDINGS The six themes were: (1) Participation-lay carers welcomed the opportunity to administer medication; (2) Ease of use-lay carers found preparations easy to use; (3) How things could have been done differently-lay carers would have liked access to trial drugs at home; (4) Training-lay carers were happy with the training they received; (5) Timing-lay carers liked the immediacy of trial drugs and (6) Evaluation-assessing symptom intensity and drug efficacy. CONCLUSIONS Participation was acceptable to patients and lay carers, and beneficial for symptom relief. The findings will inform planning for a future community-based study.
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Affiliation(s)
- Paul Perkins
- Leckhampton Court Hospice, Cheltenham, Gloucestershire, UK .,Palliative Medicine, Gloucestershire Hospitals NHS Foundation Trust, Cheltenham, Gloucestershire, UK
| | - Anne Parkinson
- Leckhampton Court Hospice, Cheltenham, Gloucestershire, UK
| | - Vanessa Taylor
- Department of Nursing, Midwifery & Health, Northumbria University Faculty of Health and Life Sciences, Newcastle upon Tyne, UK
| | - Emma Husbands
- Palliative Medicine, Gloucestershire Hospitals NHS Foundation Trust, Cheltenham, Gloucestershire, UK
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27
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Hayes AG, Corlies P, Tate C, Barrington M, Bell JF, Maki JN, Caplinger M, Ravine M, Kinch KM, Herkenhoff K, Horgan B, Johnson J, Lemmon M, Paar G, Rice MS, Jensen E, Kubacki TM, Cloutis E, Deen R, Ehlmann BL, Lakdawalla E, Sullivan R, Winhold A, Parkinson A, Bailey Z, van Beek J, Caballo-Perucha P, Cisneros E, Dixon D, Donaldson C, Jensen OB, Kuik J, Lapo K, Magee A, Merusi M, Mollerup J, Scudder N, Seeger C, Stanish E, Starr M, Thompson M, Turenne N, Winchell K. Pre-Flight Calibration of the Mars 2020 Rover Mastcam Zoom (Mastcam-Z) Multispectral, Stereoscopic Imager. Space Sci Rev 2021; 217:29. [PMID: 33678912 PMCID: PMC7892537 DOI: 10.1007/s11214-021-00795-x] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 01/12/2021] [Indexed: 05/28/2023]
Abstract
UNLABELLED The NASA Perseverance rover Mast Camera Zoom (Mastcam-Z) system is a pair of zoomable, focusable, multi-spectral, and color charge-coupled device (CCD) cameras mounted on top of a 1.7 m Remote Sensing Mast, along with associated electronics and two calibration targets. The cameras contain identical optical assemblies that can range in focal length from 26 mm ( 25.5 ∘ × 19.1 ∘ FOV ) to 110 mm ( 6.2 ∘ × 4.2 ∘ FOV ) and will acquire data at pixel scales of 148-540 μm at a range of 2 m and 7.4-27 cm at 1 km. The cameras are mounted on the rover's mast with a stereo baseline of 24.3 ± 0.1 cm and a toe-in angle of 1.17 ± 0.03 ∘ (per camera). Each camera uses a Kodak KAI-2020 CCD with 1600 × 1200 active pixels and an 8 position filter wheel that contains an IR-cutoff filter for color imaging through the detectors' Bayer-pattern filters, a neutral density (ND) solar filter for imaging the sun, and 6 narrow-band geology filters (16 total filters). An associated Digital Electronics Assembly provides command data interfaces to the rover, 11-to-8 bit companding, and JPEG compression capabilities. Herein, we describe pre-flight calibration of the Mastcam-Z instrument and characterize its radiometric and geometric behavior. Between April 26 t h and May 9 t h , 2019, ∼45,000 images were acquired during stand-alone calibration at Malin Space Science Systems (MSSS) in San Diego, CA. Additional data were acquired during Assembly Test and Launch Operations (ATLO) at the Jet Propulsion Laboratory and Kennedy Space Center. Results of the radiometric calibration validate a 5% absolute radiometric accuracy when using camera state parameters investigated during testing. When observing using camera state parameters not interrogated during calibration (e.g., non-canonical zoom positions), we conservatively estimate the absolute uncertainty to be < 10 % . Image quality, measured via the amplitude of the Modulation Transfer Function (MTF) at Nyquist sampling (0.35 line pairs per pixel), shows MTF Nyquist = 0.26 - 0.50 across all zoom, focus, and filter positions, exceeding the > 0.2 design requirement. We discuss lessons learned from calibration and suggest tactical strategies that will optimize the quality of science data acquired during operation at Mars. While most results matched expectations, some surprises were discovered, such as a strong wavelength and temperature dependence on the radiometric coefficients and a scene-dependent dynamic component to the zero-exposure bias frames. Calibration results and derived accuracies were validated using a Geoboard target consisting of well-characterized geologic samples. SUPPLEMENTARY INFORMATION The online version contains supplementary material available at 10.1007/s11214-021-00795-x.
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Affiliation(s)
- Alexander G. Hayes
- Department of Astronomy, Cornell University, Ithaca, NY 14850 USA
- Cornell Center for Astrophysics and Planetary Science, Cornell University, Ithaca, NY 14850 USA
| | - P. Corlies
- Department of Astronomy, Cornell University, Ithaca, NY 14850 USA
- Department of Earth, Atmospheric, and Planetary Sciences, Massachusetts Institute of Technology, Cambridge, MA 02139 USA
| | - C. Tate
- Department of Astronomy, Cornell University, Ithaca, NY 14850 USA
| | - M. Barrington
- Department of Astronomy, Cornell University, Ithaca, NY 14850 USA
| | - J. F. Bell
- School of Earth and Space Exploration, Arizona State University, Phoenix, AZ 85287 USA
| | - J. N. Maki
- Jet Propulsion Laboratory, Pasadena, CA 91109 USA
| | - M. Caplinger
- Malin Space Science Systems, San Diego, CA 92121 USA
| | - M. Ravine
- Malin Space Science Systems, San Diego, CA 92121 USA
| | - K. M. Kinch
- Niels Bohr Institute, University of Copenhagen, Copenhagen, Denmark
| | - K. Herkenhoff
- USGS Astrogeology Science Center, 2255 N. Gemini Drive, Flagstaff, AZ 86001 USA
| | - B. Horgan
- Earth, Atmospheric, and Planetary Sciences Department, Purdue University, West Lafayette, IN 47907 USA
| | - J. Johnson
- Johns Hopkins Applied Physics Laboratory, Laurel, MD 20723 USA
| | - M. Lemmon
- Space Science Institute, 4765 Walnut St., Suite B, Boulder, CO 80301 USA
| | - G. Paar
- Joanneum Research Forschungsgesellschaft mbH, Steyrergasse 17, 8010 Graz, Austria
| | - M. S. Rice
- Geology Department, Western Washington University, Bellingham, WA 98225 USA
| | - E. Jensen
- Malin Space Science Systems, San Diego, CA 92121 USA
| | - T. M. Kubacki
- Malin Space Science Systems, San Diego, CA 92121 USA
| | - E. Cloutis
- Geography Department, University of Winnepeg, 515 Portage Ave, Winnipeg, MB R3B 2E9 Canada
| | - R. Deen
- Jet Propulsion Laboratory, Pasadena, CA 91109 USA
| | - B. L. Ehlmann
- Jet Propulsion Laboratory, Pasadena, CA 91109 USA
- Division of Geological and Planetary Sciences, California Institute of Technology, Pasadena, CA 91101 USA
| | - E. Lakdawalla
- The Planetary Society, 60 S Los Robles, Pasadena, CA 91101 USA
| | - R. Sullivan
- Cornell Center for Astrophysics and Planetary Science, Cornell University, Ithaca, NY 14850 USA
| | - A. Winhold
- School of Earth and Space Exploration, Arizona State University, Phoenix, AZ 85287 USA
| | - A. Parkinson
- Centre for Terrestrial and Planetary Exploration, University of Winnipeg, 515 Portage Ave, Winnipeg, MB R3B 2E9 Canada
| | - Z. Bailey
- Jet Propulsion Laboratory, Pasadena, CA 91109 USA
| | - J. van Beek
- Jet Propulsion Laboratory, Pasadena, CA 91109 USA
| | - P. Caballo-Perucha
- Joanneum Research Forschungsgesellschaft mbH, Steyrergasse 17, 8010 Graz, Austria
| | - E. Cisneros
- School of Earth and Space Exploration, Arizona State University, Phoenix, AZ 85287 USA
| | - D. Dixon
- Malin Space Science Systems, San Diego, CA 92121 USA
| | - C. Donaldson
- Malin Space Science Systems, San Diego, CA 92121 USA
| | - O. B. Jensen
- Niels Bohr Institute, University of Copenhagen, Copenhagen, Denmark
| | - J. Kuik
- Centre for Terrestrial and Planetary Exploration, University of Winnipeg, 515 Portage Ave, Winnipeg, MB R3B 2E9 Canada
| | - K. Lapo
- Geology Department, Western Washington University, Bellingham, WA 98225 USA
| | - A. Magee
- Malin Space Science Systems, San Diego, CA 92121 USA
| | - M. Merusi
- Niels Bohr Institute, University of Copenhagen, Copenhagen, Denmark
| | - J. Mollerup
- Geology Department, Western Washington University, Bellingham, WA 98225 USA
| | - N. Scudder
- Earth, Atmospheric, and Planetary Sciences Department, Purdue University, West Lafayette, IN 47907 USA
| | - C. Seeger
- Geology Department, Western Washington University, Bellingham, WA 98225 USA
| | - E. Stanish
- Centre for Terrestrial and Planetary Exploration, University of Winnipeg, 515 Portage Ave, Winnipeg, MB R3B 2E9 Canada
| | - M. Starr
- Malin Space Science Systems, San Diego, CA 92121 USA
| | - M. Thompson
- Jet Propulsion Laboratory, Pasadena, CA 91109 USA
| | - N. Turenne
- Centre for Terrestrial and Planetary Exploration, University of Winnipeg, 515 Portage Ave, Winnipeg, MB R3B 2E9 Canada
| | - K. Winchell
- Malin Space Science Systems, San Diego, CA 92121 USA
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Brew-Sam N, Chhabra M, Parkinson A, Hannan K, Brown E, Pedley L, Brown K, Wright K, Pedley E, Nolan CJ, Phillips C, Suominen H, Tricoli A, Desborough J. Experiences of Young People and Their Caregivers of Using Technology to Manage Type 1 Diabetes Mellitus: Systematic Literature Review and Narrative Synthesis. JMIR Diabetes 2021; 6:e20973. [PMID: 33528374 PMCID: PMC7886614 DOI: 10.2196/20973] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 07/23/2020] [Accepted: 12/29/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND In the last decade, diabetes management has begun to transition to technology-based care, with young people being the focus of many technological advances. Yet, detailed insights into the experiences of young people and their caregivers of using technology to manage type 1 diabetes mellitus are lacking. OBJECTIVE The objective of our study was to describe the breadth of experiences and perspectives on diabetes technology use among children and adolescents with type 1 diabetes mellitus and their caregivers. METHODS This systematic literature review used integrated thematic analysis to guide a narrative synthesis of the included studies. We analyzed the perspectives and experiences of young people with type 1 diabetes mellitus and their caregivers reported in qualitative studies, quantitative descriptive studies, and studies with a mixed methods design. RESULTS Seventeen articles met the inclusion criteria, and they included studies on insulin pump, glucose sensors, and remote monitoring systems. The following eight themes were derived from the analysis: (1) expectations of the technology prior to use, (2) perceived impact on sleep and overnight experiences, (3) experiences with alarms, (4) impact on independence and relationships, (5) perceived usage impact on blood glucose control, (6) device design and features, (7) financial cost, and (8) user satisfaction. While many advantages of using diabetes technology were reported, several challenges for its use were also reported, such as cost, the size and visibility of devices, and the intrusiveness of alarms, which drew attention to the fact that the user had type 1 diabetes mellitus. Continued use of diabetes technology was underpinned by its benefits outweighing its challenges, especially among younger people. CONCLUSIONS Diabetes technologies have improved the quality of life of many young people with type 1 diabetes mellitus and their caregivers. Future design needs to consider the impact of these technologies on relationships between young people and their caregivers, and the impact of device features and characteristics such as size, ease of use, and cost.
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Affiliation(s)
- Nicola Brew-Sam
- Department of Health Services Research and Policy, Research School of Population Health, College of Health and Medicine, Australian National University, Canberra, Australia
| | - Madhur Chhabra
- Department of Health Services Research and Policy, Research School of Population Health, College of Health and Medicine, Australian National University, Canberra, Australia
| | - Anne Parkinson
- Department of Health Services Research and Policy, Research School of Population Health, College of Health and Medicine, Australian National University, Canberra, Australia
| | - Kristal Hannan
- Department of Health Services Research and Policy, Research School of Population Health, College of Health and Medicine, Australian National University, Canberra, Australia
| | - Ellen Brown
- Department of Health Services Research and Policy, Research School of Population Health, College of Health and Medicine, Australian National University, Canberra, Australia
| | - Lachlan Pedley
- Department of Health Services Research and Policy, Research School of Population Health, College of Health and Medicine, Australian National University, Canberra, Australia
| | - Karen Brown
- Department of Health Services Research and Policy, Research School of Population Health, College of Health and Medicine, Australian National University, Canberra, Australia.,Canberra Health Services, Canberra, Australia
| | - Kristine Wright
- Department of Health Services Research and Policy, Research School of Population Health, College of Health and Medicine, Australian National University, Canberra, Australia.,Canberra Health Services, Canberra, Australia
| | - Elizabeth Pedley
- Department of Health Services Research and Policy, Research School of Population Health, College of Health and Medicine, Australian National University, Canberra, Australia.,Canberra Health Services, Canberra, Australia
| | - Christopher J Nolan
- Canberra Health Services, Canberra, Australia.,ANU Medical School, College of Health and Medicine, Australian National University, Canberra, Australia.,The John Curtin School of Medical Research, College of Health and Medicine, Australian National University, Canberra, Australia
| | - Christine Phillips
- ANU Medical School, College of Health and Medicine, Australian National University, Canberra, Australia
| | - Hanna Suominen
- School of Computing, College of Engineering and Computer Science, Australian National University, Canberra, Australia.,Department of Computing, University of Turku, Turku, Finland.,Data61, Commonwealth Scientific and Industrial Research Organisation, Canberra, Australia
| | - Antonio Tricoli
- The John Curtin School of Medical Research, College of Health and Medicine, Australian National University, Canberra, Australia.,Nanotechnology Research Lab, Research School of Chemistry, College of Science, Australian National University, Canberra, Australia
| | - Jane Desborough
- Department of Health Services Research and Policy, Research School of Population Health, College of Health and Medicine, Australian National University, Canberra, Australia
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Perkins P, Parkinson A, Parker R, Blaken A, Akyea RK. Does acupressure help reduce nausea and vomiting in palliative care patients? A double blind randomised controlled trial. BMJ Support Palliat Care 2020; 12:58-63. [PMID: 33033062 DOI: 10.1136/bmjspcare-2020-002434] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 07/25/2020] [Accepted: 07/28/2020] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Nausea and vomiting are common symptoms for patients with advanced cancer. While there is evidence for acupuncture point stimulation for treatment of these symptoms for patients having anticancer treatment, there is little for when they are not related to such treatment. OBJECTIVE To determine whether acupressure at the pericardium 6 site can help in the treatment of nausea and vomiting suffered by palliative care patients with advanced cancer. MATERIALS AND METHODS Double blind randomised controlled trial-active versus placebo acupressure wristbands. In-patients with advanced cancer in two specialist palliative care units who fitted either or both of the following criteria were approached: Nausea that was at least moderate; Vomiting daily on average for the prior 3 days. RESULTS 57 patients were randomised to have either active or placebo acupressure wristbands. There was no difference in any of the outcome measures between the two groups: change from baseline number of vomits; Visual Analogue Scale for 'did acupressure wristbands help you to feel better?'; total number of as needed doses of antiemetic medication; need for escalation of antiemetics. CONCLUSIONS In contrast to a previously published feasibility study, active acupressure wristbands were no better than placebo for specialist palliative care in-patients with advanced cancer and nausea and vomiting.
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Affiliation(s)
- Paul Perkins
- Sue Ryder Leckhampton Court Hospice, Cheltenham, Gloucestershire, UK .,Palliative Medicine, Gloucestershire Hospitals NHS Foundation Trust, Cheltenham, Gloucestershire, UK
| | - Anne Parkinson
- Sue Ryder Leckhampton Court Hospice, Cheltenham, Gloucestershire, UK
| | - Rebecca Parker
- Sue Ryder Leckhampton Court Hospice, Cheltenham, Gloucestershire, UK
| | | | - Ralph K Akyea
- Division of Primary Care, University of Nottingham, Nottingham, UK
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DellaGiustina DN, Burke KN, Walsh KJ, Smith PH, Golish DR, Bierhaus EB, Ballouz RL, Becker TL, Campins H, Tatsumi E, Yumoto K, Sugita S, Deshapriya JDP, Cloutis EA, Clark BE, Hendrix AR, Sen A, Al Asad MM, Daly MG, Applin DM, Avdellidou C, Barucci MA, Becker KJ, Bennett CA, Bottke WF, Brodbeck JI, Connolly HC, Delbo M, de Leon J, Drouet d'Aubigny CY, Edmundson KL, Fornasier S, Hamilton VE, Hasselmann PH, Hergenrother CW, Howell ES, Jawin ER, Kaplan HH, Le Corre L, Lim LF, Li JY, Michel P, Molaro JL, Nolan MC, Nolau J, Pajola M, Parkinson A, Popescu M, Porter NA, Rizk B, Rizos JL, Ryan AJ, Rozitis B, Shultz NK, Simon AA, Trang D, Van Auken RB, Wolner CWV, Lauretta DS. Variations in color and reflectance on the surface of asteroid (101955) Bennu. Science 2020; 370:science.abc3660. [PMID: 33033157 DOI: 10.1126/science.abc3660] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 09/24/2020] [Indexed: 11/02/2022]
Abstract
Visible-wavelength color and reflectance provide information about the geologic history of planetary surfaces. Here we present multispectral images (0.44 to 0.89 micrometers) of near-Earth asteroid (101955) Bennu. The surface has variable colors overlain on a moderately blue global terrain. Two primary boulder types are distinguishable by their reflectance and texture. Space weathering of Bennu surface materials does not simply progress from red to blue (or vice versa). Instead, freshly exposed, redder surfaces initially brighten in the near-ultraviolet region (i.e., become bluer at shorter wavelengths), then brighten in the visible to near-infrared region, leading to Bennu's moderately blue average color. Craters indicate that the time scale of these color changes is ~105 years. We attribute the reflectance and color variation to a combination of primordial heterogeneity and varying exposure ages.
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Affiliation(s)
- D N DellaGiustina
- Lunar and Planetary Laboratory, University of Arizona, Tucson, AZ, USA. .,Department of Geosciences, University of Arizona, Tucson, AZ, USA
| | - K N Burke
- Lunar and Planetary Laboratory, University of Arizona, Tucson, AZ, USA
| | - K J Walsh
- Southwest Research Institute, Boulder, CO, USA
| | - P H Smith
- Lunar and Planetary Laboratory, University of Arizona, Tucson, AZ, USA
| | - D R Golish
- Lunar and Planetary Laboratory, University of Arizona, Tucson, AZ, USA
| | | | - R-L Ballouz
- Lunar and Planetary Laboratory, University of Arizona, Tucson, AZ, USA
| | - T L Becker
- Lunar and Planetary Laboratory, University of Arizona, Tucson, AZ, USA
| | - H Campins
- Department of Physics, University of Central Florida, Orlando, FL, USA
| | - E Tatsumi
- Instituto de Astrofísica de Canarias and Departamento de Astrofísica, Universidad de La Laguna, Tenerife, Spain.,Department of Earth and Planetary Science, University of Tokyo, Tokyo, 113-0033, Japan
| | - K Yumoto
- Department of Earth and Planetary Science, University of Tokyo, Tokyo, 113-0033, Japan
| | - S Sugita
- Department of Earth and Planetary Science, University of Tokyo, Tokyo, 113-0033, Japan
| | - J D Prasanna Deshapriya
- LESIA (Laboratoire d'Etudes Spatiales et d'Instrumentation en Astrophysique), Observatoire de Paris, Université PSL (Paris Sciences & Lettres), CNRS (Centre National de la Recherche Scientifique), Université de Paris, Sorbonne Université, 92195 Meudon, France
| | - E A Cloutis
- Department of Geography, University of Winnipeg, Winnipeg, MB R3B 2E9, Canada
| | - B E Clark
- Department of Physics and Astronomy, Ithaca College, Ithaca, NY, USA
| | - A R Hendrix
- Planetary Science Institute, Tucson, AZ, USA
| | - A Sen
- Department of Physics and Astronomy, Ithaca College, Ithaca, NY, USA
| | - M M Al Asad
- Department of Earth, Ocean and Atmospheric Sciences, University of British Columbia, Vancouver, BC, Canada
| | - M G Daly
- The Centre for Research in Earth and Space Science, York University, Toronto, ON, Canada
| | - D M Applin
- Department of Geography, University of Winnipeg, Winnipeg, MB R3B 2E9, Canada
| | - C Avdellidou
- Université Côte d'Azur, Observatoire de la Côte d'Azur, CNRS, Laboratoire Lagrange, Nice, France
| | - M A Barucci
- LESIA (Laboratoire d'Etudes Spatiales et d'Instrumentation en Astrophysique), Observatoire de Paris, Université PSL (Paris Sciences & Lettres), CNRS (Centre National de la Recherche Scientifique), Université de Paris, Sorbonne Université, 92195 Meudon, France
| | - K J Becker
- Lunar and Planetary Laboratory, University of Arizona, Tucson, AZ, USA
| | - C A Bennett
- Lunar and Planetary Laboratory, University of Arizona, Tucson, AZ, USA
| | - W F Bottke
- Southwest Research Institute, Boulder, CO, USA
| | - J I Brodbeck
- Lunar and Planetary Laboratory, University of Arizona, Tucson, AZ, USA
| | - H C Connolly
- Department of Geology, Rowan University, Glassboro, NJ, USA
| | - M Delbo
- Université Côte d'Azur, Observatoire de la Côte d'Azur, CNRS, Laboratoire Lagrange, Nice, France
| | - J de Leon
- Instituto de Astrofísica de Canarias and Departamento de Astrofísica, Universidad de La Laguna, Tenerife, Spain
| | | | - K L Edmundson
- Lunar and Planetary Laboratory, University of Arizona, Tucson, AZ, USA
| | - S Fornasier
- LESIA (Laboratoire d'Etudes Spatiales et d'Instrumentation en Astrophysique), Observatoire de Paris, Université PSL (Paris Sciences & Lettres), CNRS (Centre National de la Recherche Scientifique), Université de Paris, Sorbonne Université, 92195 Meudon, France.,Institut Universitaire de France (IUF), 1 rue Descartes, 75231 Paris CEDEX 05, France
| | | | - P H Hasselmann
- LESIA (Laboratoire d'Etudes Spatiales et d'Instrumentation en Astrophysique), Observatoire de Paris, Université PSL (Paris Sciences & Lettres), CNRS (Centre National de la Recherche Scientifique), Université de Paris, Sorbonne Université, 92195 Meudon, France
| | - C W Hergenrother
- Lunar and Planetary Laboratory, University of Arizona, Tucson, AZ, USA
| | - E S Howell
- Lunar and Planetary Laboratory, University of Arizona, Tucson, AZ, USA
| | - E R Jawin
- Smithsonian Institution National Museum of Natural History, Washington, DC, USA
| | - H H Kaplan
- NASA Goddard Space Flight Center, Greenbelt, MD, USA
| | - L Le Corre
- Planetary Science Institute, Tucson, AZ, USA
| | - L F Lim
- Smithsonian Institution National Museum of Natural History, Washington, DC, USA
| | - J Y Li
- Planetary Science Institute, Tucson, AZ, USA
| | - P Michel
- Université Côte d'Azur, Observatoire de la Côte d'Azur, CNRS, Laboratoire Lagrange, Nice, France
| | - J L Molaro
- Planetary Science Institute, Tucson, AZ, USA
| | - M C Nolan
- Lunar and Planetary Laboratory, University of Arizona, Tucson, AZ, USA
| | - J Nolau
- Lockheed Martin Space, Littleton, CO, USA
| | - M Pajola
- Istituto Nazionale di Astrofisica (INAF), Osservatorio Astronomico di Padova, Padua, Italy
| | - A Parkinson
- Department of Geography, University of Winnipeg, Winnipeg, MB R3B 2E9, Canada
| | - M Popescu
- Astronomical Institute of the Romanian Academy, Bucharest, Romania.,Instituto de Astrofísica de Canarias and Departamento de Astrofísica, Universidad de La Laguna, Tenerife, Spain
| | - N A Porter
- Lunar and Planetary Laboratory, University of Arizona, Tucson, AZ, USA
| | - B Rizk
- Lunar and Planetary Laboratory, University of Arizona, Tucson, AZ, USA
| | - J L Rizos
- Instituto de Astrofísica de Canarias and Departamento de Astrofísica, Universidad de La Laguna, Tenerife, Spain
| | - A J Ryan
- Lunar and Planetary Laboratory, University of Arizona, Tucson, AZ, USA
| | - B Rozitis
- The School of Physical Sciences, The Open University, Milton Keynes, UK
| | - N K Shultz
- Lunar and Planetary Laboratory, University of Arizona, Tucson, AZ, USA
| | - A A Simon
- NASA Goddard Space Flight Center, Greenbelt, MD, USA
| | - D Trang
- University of Hawai'i at Mānoa, Hawai'i Institute of Geophysics and Planetology, Honolulu, HI, USA
| | - R B Van Auken
- Lunar and Planetary Laboratory, University of Arizona, Tucson, AZ, USA
| | - C W V Wolner
- Lunar and Planetary Laboratory, University of Arizona, Tucson, AZ, USA
| | - D S Lauretta
- Lunar and Planetary Laboratory, University of Arizona, Tucson, AZ, USA
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Sha S, Du W, Parkinson A, Glasgow N. Relative importance of clinical and sociodemographic factors in association with post-operative in-hospital deaths in colorectal cancer patients in New South Wales: An artificial neural network approach. J Eval Clin Pract 2020; 26:1389-1398. [PMID: 31733029 DOI: 10.1111/jep.13318] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 10/28/2019] [Accepted: 10/30/2019] [Indexed: 11/27/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVES Co-morbidities in colorectal cancer patients complicate hospital care, and their relative importance to post-operative deaths is largely unknown. This study was conducted to examine a range of clinical and sociodemographic factors in relation to post-operative in-hospital deaths in colorectal cancer patients and identify whether these contributions would vary by severity of co-morbidities. METHODS In this multicentre retrospective cohort study, we used the complete census of New South Wales inpatient data to select colorectal cancer patients admitted to public hospitals for acute surgical care, who underwent procedures on the digestive system during the period of July 2001 to June 2014. The primary outcome was in-hospital death at the end of acute care. Multilayer perceptron and back-propagation artificial neural networks (ANNs) were used to quantify the relative importance of a wide range of clinical and sociodemographic factors in relation to post-operative deaths, stratified by severity of co-morbidities based on Charlson co-morbidity index. RESULTS Of 6288 colorectal cancer patients, approximately 58.3% (n = 3669) had moderate to severe co-morbidities. A total of 464 (7.4%) died in hospitals. The performance for ANN models was superior to logistic models. Co-morbid musculoskeletal and mental disorders, adverse events in health care, and socio-economic factors including rural residence and private insurance status contributed to post-operative deaths in hospitals. CONCLUSION Identification of relative importance of factors contributing to in-hospital deaths in colorectal cancer patients using ANN may help to enhance patient-centred strategies to meet complex needs during acute surgical care and prevent post-operative in-hospital deaths.
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Affiliation(s)
- Sha Sha
- Research School of Population Health, Australian National University, Canberra, Australia
| | - Wei Du
- Research School of Population Health, Australian National University, Canberra, Australia
| | - Anne Parkinson
- Research School of Population Health, Australian National University, Canberra, Australia
| | - Nicholas Glasgow
- Research School of Population Health, Australian National University, Canberra, Australia
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Li X, Du W, Parkinson A, Glasgow N. Postoperative Delirium Following Joint Replacement in Patients With Dementia in New South Wales, Australia: A State-Wide Retrospective Cohort Study. Res Gerontol Nurs 2020; 13:243-253. [PMID: 32101321 DOI: 10.3928/19404921-20200214-01] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Accepted: 10/16/2019] [Indexed: 11/20/2022]
Abstract
The objective of the current study was to investigate the variation in postoperative delirium in patients with dementia undergoing joint replacement in New South Wales (NSW) Australia public hospitals, identify factors related to its occurrence, and explore the volume-outcome relationship. The NSW Admitted Patient Data (July 2001 to June 2014) were used in this study and included patients with dementia undergoing joint replacement who were 65 or older with minor to severe comorbidities. Mixed-effect logistic models were applied to investigate hospital-level variation and factors associated with postoperative delirium. The between-hospital variability of postoperative delirium was 0.19% prior to 2008-2009 and 8.32% after 2008-2009. Hospital volume was not inversely associated with postoperative delirium rate. During 2001-2014, the incidence of postoperative delirium increased by 13% per annum (95% confidence interval [CI] 10% to 16%), while it increased by 15% per annum (95% CI 8% to 22%) after 2008-2009. An integrated approach addressing complex needs of patients with dementia may reduce the observed unwarranted variation and improve surgical outcomes. [Research in Gerontological Nursing, 13(5), 243-253.].
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33
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Desborough J, Brunoro C, Parkinson A, Chisholm K, Elisha M, Drew J, Fanning V, Lueck C, Bruestle A, Cook M, Suominen H, Tricoli A, Henschke A, Phillips C. 'It struck at the heart of who I thought I was': A meta-synthesis of the qualitative literature examining the experiences of people with multiple sclerosis. Health Expect 2020; 23:1007-1027. [PMID: 32578287 PMCID: PMC7696124 DOI: 10.1111/hex.13093] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 05/20/2020] [Accepted: 06/02/2020] [Indexed: 02/03/2023] Open
Abstract
Background People with multiple sclerosis (MS) have varied experiences and approaches to self‐management. This review aimed to explore the experiences of people with MS, and consider the implications of these experiences for clinical practice and research. Methods A meta‐synthesis of the qualitative literature examining experiences of people with MS was conducted using systematic searches of ProQuest, PubMed, CINAHL and PsycINFO. We incorporated feedback from team members with MS as expert patient knowledge‐users to capture the complex subjectivities of persons with lived experience responding to research on lived experience of the same disease. Results Of 1680 unique articles, 77 met the inclusion criteria. We identified five experiential themes: (a) the quest for knowledge, expertise and understanding, (b) uncertain trajectories (c) loss of valued roles and activities, and the threat of a changing identity, (d) managing fatigue and its impacts on life and relationships, and (f) adapting to life with MS. These themes were distributed across three domains related to disease (symptoms; diagnosis; progression and relapse) and two contexts (the health‐care sector; and work, social and family life). Conclusion The majority of people in the studies included in this review expressed a determination to adapt to MS, indicating a strong motivation for people with MS and clinicians to collaborate in the quest for knowledge. Clinicians caring for people with MS need to consider the experiential and social outcomes of this disease such as fatigue and the preservation of valued social roles, and incorporate this into case management and clinical planning.
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Affiliation(s)
- Jane Desborough
- Department of Health Services Research and Policy, Research School of Population Health, College of Health and Medicine, Australian National University, Canberra, ACT, Australia
| | - Crystal Brunoro
- Department of Health Services Research and Policy, Research School of Population Health, College of Health and Medicine, Australian National University, Canberra, ACT, Australia
| | - Anne Parkinson
- Department of Health Services Research and Policy, Research School of Population Health, College of Health and Medicine, Australian National University, Canberra, ACT, Australia
| | - Katrina Chisholm
- Department of Health Services Research and Policy, Research School of Population Health, College of Health and Medicine, Australian National University, Canberra, ACT, Australia
| | - Mark Elisha
- Department of Health Services Research and Policy, Research School of Population Health, College of Health and Medicine, Australian National University, Canberra, ACT, Australia
| | - Janet Drew
- Department of Health Services Research and Policy, Research School of Population Health, College of Health and Medicine, Australian National University, Canberra, ACT, Australia
| | - Vanessa Fanning
- Department of Health Services Research and Policy, Research School of Population Health, College of Health and Medicine, Australian National University, Canberra, ACT, Australia
| | - Christian Lueck
- Australian National University Medical School, College of Health and Medicine, Australian National University, Canberra, ACT, Australia
| | - Anne Bruestle
- John Curtin School of Medical Research, College of Health and Medicine, Australian National University, Canberra, ACT, Australia
| | - Matthew Cook
- Australian National University Medical School, College of Health and Medicine, Australian National University, Canberra, ACT, Australia.,John Curtin School of Medical Research, College of Health and Medicine, Australian National University, Canberra, ACT, Australia
| | - Hanna Suominen
- School of Computer Science, College of Engineering and Computer Science, Australian National University, Canberra, ACT, Australia
| | - Antonio Tricoli
- Research School of Electrical Energy & Materials Engineering, College of Engineering and Computer Science, Australian National University, Canberra, ACT, Australia
| | - Adam Henschke
- National Security College, College of Asia and the Pacific, Australian National University, Canberra, ACT, Australia
| | - Christine Phillips
- Australian National University Medical School, College of Health and Medicine, Australian National University, Canberra, ACT, Australia
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Casey AN, Islam MM, Schütze H, Parkinson A, Yen L, Shell A, Winbolt M, Brodaty H. GP awareness, practice, knowledge and confidence: evaluation of the first nation-wide dementia-focused continuing medical education program in Australia. BMC Fam Pract 2020; 21:104. [PMID: 32522153 PMCID: PMC7285709 DOI: 10.1186/s12875-020-01178-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 05/28/2020] [Indexed: 01/04/2023]
Abstract
Background Dementia is under-diagnosed in primary care. Timely diagnosis and care management improve outcomes for patients and caregivers. This research evaluated the effectiveness of a nationwide Continuing Medical Education (CME) program to enhance dementia-related awareness, practice, knowledge and confidence of general practitioners (GPs) in Australia. Methods Data were collected from self-report surveys by GPs who participated in an accredited CME program face-to-face or online; program evaluations from GPs; and process evaluations from workshop facilitators. CME participants completed surveys at one or more time-points (pre-, post-program, six to 9 months follow-up) between 2015 and 2017. Paired samples t-test was used to determine difference in mean outcome scores (self-reported change in awareness, knowledge, confidence, practice) between time-points. Multivariable regression analyses were used to investigate associations between respondent characteristics and key variables. Qualitative feedback was analysed thematically. Results Of 1352 GPs who completed a survey at one or more time-points (pre: 1303; post: 1017; follow-up: 138), mean scores increased between pre-CME and post-program for awareness (Mpost-pre = 0.9, p < 0.0005), practice-related items (Mpost-pre = 1.3, p < 0.0005), knowledge (Mpost-pre = 2.2, p < 0.0005), confidence (Mpost-pre = 2.1, p < 0.0005). Significant increases were seen in all four outcomes for GPs who completed these surveys at both pre- and follow-up time-points. Male participants and those who had practised for five or more years showed greater change in knowledge and confidence. Age, years in practice, and education delivery method significantly predicted post-program knowledge and confidence. Most respondents who completed additional program evaluations (> 90%) rated the training as relevant to their practice. These participants, and facilitators who completed process evaluations, suggested adding more content addressing patient capacity and legal issues, locality-specific specialist and support services, case studies and videos to illustrate concepts. Conclusions The sustainability of change in key elements relating to health professionals’ dementia awareness, knowledge and confidence indicated that dementia CME programs may contribute to improving capacity to provide timely dementia diagnosis and management in general practice. Low follow-up response rates warrant cautious interpretation of results. Dementia CME should be adopted in other contexts and updated as more research becomes available.
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Affiliation(s)
- Anne-Nicole Casey
- Dementia Centre for Research Collaboration, University of New South Wales (UNSW) Sydney, AGSM Building, Sydney, NSW, 2052, Australia.,Centre for Healthy Brain Ageing, School of Psychiatry, UNSW Sydney, Sydney, NSW, 2052, Australia
| | - M Mofizul Islam
- Department of Public Health, School of Psychology and Public Health, La Trobe University, Melbourne, VIC, 3086, Australia
| | - Heike Schütze
- School of Health and Society, University of Wollongong, Wollongong, NSW, 2522, Australia.,School of Public Health and Community Medicine, UNSW Sydney, Sydney, NSW, 2052, Australia
| | - Anne Parkinson
- Department of Health Services Research & Policy, Research School of Population Health, Australian National University, Canberra, NSW, 2601, Australia
| | - Laurann Yen
- Department of Health Services Research & Policy, Research School of Population Health, Australian National University, Canberra, NSW, 2601, Australia
| | - Allan Shell
- Dementia Centre for Research Collaboration, University of New South Wales (UNSW) Sydney, AGSM Building, Sydney, NSW, 2052, Australia
| | - Margaret Winbolt
- Dementia Training Australia, La Trobe University, Melbourne, VIC, 3086, Australia
| | - Henry Brodaty
- Dementia Centre for Research Collaboration, University of New South Wales (UNSW) Sydney, AGSM Building, Sydney, NSW, 2052, Australia. .,Centre for Healthy Brain Ageing, School of Psychiatry, UNSW Sydney, Sydney, NSW, 2052, Australia. .,Academic Department for Old Age Psychiatry, Prince of Wales Hospital, Randwick, NSW, 2031, Australia.
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Poolman M, Roberts J, Wright S, Hendry A, Goulden N, Holmes EA, Byrne A, Perkins P, Hoare Z, Nelson A, Hiscock J, Hughes D, O'Connor J, Foster B, Reymond L, Healy S, Lewis P, Wee B, Johnstone R, Roberts R, Parkinson A, Roberts S, Wilkinson C. Carer administration of as-needed subcutaneous medication for breakthrough symptoms in people dying at home: the CARiAD feasibility RCT. Health Technol Assess 2020; 24:1-150. [PMID: 32484432 DOI: 10.3310/hta24250] [Citation(s) in RCA: 4] [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: 01/03/2023] Open
Abstract
BACKGROUND Most people who are dying want to be cared for at home, but only half of them achieve this. The likelihood of a home death often depends on the availability of able and willing lay carers. When people who are dying are unable to take oral medication, injectable medication is used. When top-up medication is required, a health-care professional travels to the dying person's home, which may delay symptom relief. The administration of subcutaneous medication by lay carers, although not widespread UK practice, has proven to be key in achieving better symptom control for those dying at home in other countries. OBJECTIVES To determine if carer administration of as-needed subcutaneous medication for common breakthrough symptoms in people dying at home is feasible and acceptable in the UK, and if it would be feasible to test this intervention in a future definitive randomised controlled trial. DESIGN We conducted a two-arm, parallel-group, individually randomised, open pilot trial of the intervention versus usual care, with a 1 : 1 allocation ratio, using convergent mixed methods. SETTING Home-based care without 24/7 paid care provision, in three UK sites. PARTICIPANTS Participants were dyads of adult patients and carers: patients in the last weeks of their life who wished to die at home and lay carers who were willing to be trained to give subcutaneous medication. Strict risk assessment criteria needed to be met before approach, including known history of substance abuse or carer ability to be trained to competency. INTERVENTION Intervention-group carers received training by local nurses using a manualised training package. MAIN OUTCOME MEASURES Quantitative data were collected at baseline and 6-8 weeks post bereavement and via carer diaries. Interviews with carers and health-care professionals explored attitudes to, experiences of and preferences for giving subcutaneous medication and experience of trial processes. The main outcomes of interest were feasibility, acceptability, recruitment rates, attrition and selection of the most appropriate outcome measures. RESULTS In total, 40 out of 101 eligible dyads were recruited (39.6%), which met the feasibility criterion of recruiting > 30% of eligible dyads. The expected recruitment target (≈50 dyads) was not reached, as fewer than expected participants were identified. Although the overall retention rate was 55% (22/40), this was substantially unbalanced [30% (6/20) usual care and 80% (16/20) intervention]. The feasibility criterion of > 40% retention was, therefore, considered not met. A total of 12 carers (intervention, n = 10; usual care, n = 2) and 20 health-care professionals were interviewed. The intervention was considered acceptable, feasible and safe in the small study population. The context of the feasibility study was not ideal, as district nurses were seriously overstretched and unfamiliar with research methods. A disparity in readiness to consider the intervention was demonstrated between carers and health-care professionals. Findings showed that there were methodological and ethics issues pertaining to researching last days of life care. CONCLUSION The success of a future definitive trial is uncertain because of equivocal results in the progression criteria, particularly poor recruitment overall and a low retention rate in the usual-care group. Future work regarding the intervention should include understanding the context of UK areas where this has been adopted, ascertaining wider public views and exploring health-care professional views on burden and risk in the NHS context. There should be consideration of the need for national policy and of the most appropriate quantitative outcome measures to use. This will help to ascertain if there are unanswered questions to be studied in a trial. TRIAL REGISTRATION Current Controlled Trials ISRCTN11211024. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 24, No. 25. See the NIHR Journals Library website for further project information.
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Affiliation(s)
| | | | - Stella Wright
- School of Health Sciences, Bangor University, Bangor, UK
| | - Annie Hendry
- School of Health Sciences, Bangor University, Bangor, UK
| | - Nia Goulden
- North Wales Organisation for Randomised Trials in Health, Bangor University, Bangor, UK
| | | | - Anthony Byrne
- Marie Curie Research Centre, School of Medicine, Cardiff University, Cardiff, UK
| | - Paul Perkins
- Gloucestershire Hospitals NHS Foundation Trust, Gloucester, UK.,Sue Ryder Leckhampton Court Hospice, Cheltenham, UK
| | - Zoe Hoare
- North Wales Organisation for Randomised Trials in Health, Bangor University, Bangor, UK
| | - Annmarie Nelson
- Marie Curie Research Centre, School of Medicine, Cardiff University, Cardiff, UK
| | - Julia Hiscock
- School of Health Sciences, Bangor University, Bangor, UK
| | - Dyfrig Hughes
- School of Health Sciences, Bangor University, Bangor, UK
| | | | - Betty Foster
- Public Contributor, North Wales Cancer Patient Forum, North Wales Cancer Treatment Centre, Bodelwyddan, UK
| | - Liz Reymond
- Brisbane South Palliative Care Collaborative, School of Medicine, Griffith University, Southport, QLD, Australia
| | - Sue Healy
- Metro South Palliative Care Service, Brisbane, QLD, Australia
| | - Penney Lewis
- Centre for Medical Law and Ethics, King's College London, London, UK
| | - Bee Wee
- Harris Manchester College, University of Oxford, Oxford, UK
| | | | | | | | - Sian Roberts
- Betsi Cadwaladr University Health Board, Bangor, UK
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Perkins P, Parkinson A, Akyea RK, Husbands E. Nasal fentanyl alone plus buccal midazolam: an open-label, randomised, controlled feasibility study in the dying. BMJ Support Palliat Care 2020; 10:300-303. [PMID: 32376759 DOI: 10.1136/bmjspcare-2019-002029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 04/09/2020] [Indexed: 11/03/2022]
Abstract
INTRODUCTION Many patients want to stay at home to die. They invariably become unable to take oral medication during their terminal phase. Symptoms are usually controlled by subcutaneous medications. There have been no studies on nasal fentanyl (NF) or buccal midazolam (BM) to control symptoms in the dying. OBJECTIVE To establish how best to conduct a definitive, randomised controlled trial (RCT) to determine whether NF and BM administered by families, for patients dying at home, lead to faster and better symptom control and fewer community nursing visits than standard breakthrough medication by healthcare professionals. METHODS This open-label mixed-method feasibility RCT compared the efficacy of NF and BM by family members to standard breakthrough medication by nurses for the terminally ill in a specialist palliative care unit. Partway through the study, a third observational arm was introduced where BM alone was used. The primary outcomes were whether recruitment and randomisation were possible, assessment of withdrawal and drop-out, and whether the methods were acceptable and appropriate. RESULTS Administration of NF and BM was acceptable to patients and families. Both were well tolerated. We were unable to obtain quality of life data consistently but did get time period data for dose-controlled symptoms. CONCLUSIONS Study participation in a hospice population of the dying was acceptable. The results will help guide future community study planning. TRIAL REGISTRATION NUMBER NCT02009306.
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Affiliation(s)
- Paul Perkins
- Sue Ryder Leckhampton Court Hospice, Cheltenham, Gloucestershire, UK .,Palliative Medicine, Gloucestershire Hospitals NHS Foundation Trust, Cheltenham, Gloucestershire, UK
| | - Anne Parkinson
- Sue Ryder Leckhampton Court Hospice, Cheltenham, Gloucestershire, UK
| | - Ralph Kwame Akyea
- Division of Primary Care, University of Nottingham, Nottingham, Nottinghamshire, UK
| | - Emma Husbands
- Palliative Medicine, Gloucestershire Hospitals NHS Foundation Trust, Cheltenham, Gloucestershire, UK
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Islam MM, Parkinson A, Burns K, Woods M, Yen L. A training program for primary health care nurses on timely diagnosis and management of dementia in general practice: An evaluation study. Int J Nurs Stud 2020; 105:103550. [PMID: 32145467 DOI: 10.1016/j.ijnurstu.2020.103550] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 02/06/2020] [Accepted: 02/12/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Primary health care nurses can play an important role in assisting the diagnosis and management of dementia. This study describes the evaluation outcome of a training program developed on the 'Four Steps to Building Dementia Practice in Primary Care'. OBJECTIVE To evaluate a training program for primary health care nurses by assessing change in current practice and future intention; and their knowledge, confidence, and perceived importance about dementia diagnosis and management. DESIGN A longitudinal survey. Participants were surveyed at three time points: pre-training, immediately post-training and six months (+/- 3 months) following their training. SETTING All states and territories in Australia. PARTICIPANTS Primary health care nurses (n = 1,290). METHODS A face-to-face and online training program on timely diagnosis and management of dementia was offered to primary health care nurses. A questionnaire was administered face-to-face and online to assess whether certain processes and services were 'currently in practice', 'working towards', or 'not in current practice' in their primary care facility. Three 10-point Likert scales were created to assess self-perceived levels of importance, knowledge and confidence about the diagnosis and management of dementia. A paired t-test was used to examine the differences between (a) post and pre-scores, and (b) follow-up and post scores. Linear regressions were used to identify the significant factors associated with pre-training scores for importance, confidence and knowledge. RESULTS Of 1290 primary health care nurses who participated in the training, 471 attended face-to-face and 819 participated online. Participants demonstrated improvements in all items in all four steps of the survey, with considerably higher improvement in the face-to-face mode. The average post-training score was significantly higher than the pre-training score for perceived importance, knowledge and confidence. The average follow-up score was significantly higher than the post-training score for perceived knowledge and confidence but not for perceived importance. Primary health care nurses who had 20 or more years of experience reported significantly more knowledge in attending patients with dementia than those with less than five years of experience (0.56, 95% CI: 0.11-1.01). CONCLUSIONS With a growing ageing population, the demand for dementia care is rising. Primary health care nurses can lead practice change and promote the timely diagnosis and management of dementia in general practice. Training programs of this kind that build knowledge, confidence, awareness and skills should be made available to the primary care nursing workforce. Further research is recommended to examine the translation of this training outcome into practice.
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Affiliation(s)
- M Mofizul Islam
- Department of Public Health, La Trobe University, Melbourne Australia.
| | - Anne Parkinson
- Department of Health Services Research and Policy, Research School of Population Health, The Australian National University, Canberra, Australia
| | - Kelly Burns
- Centre for Dementia Learning, Dementia Australia, Melbourne, Australia
| | - Murphy Woods
- Australian Primary Health Care Nurses Association (APNA), Melbourne, Australia
| | - Laurann Yen
- Department of Health Services Research and Policy, Research School of Population Health, The Australian National University, Canberra, Australia
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Bagheri N, Konings P, Wangdi K, Parkinson A, Mazumdar S, Sturgiss E, Lal A, Douglas K, Glasgow N. Identifying hotspots of type 2 diabetes risk using general practice data and geospatial analysis: an approach to inform policy and practice. Aust J Prim Health 2019; 26:PY19043. [PMID: 31751519 DOI: 10.1071/py19043] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Accepted: 08/23/2019] [Indexed: 01/06/2023]
Abstract
The prevalence of type 2 diabetes (T2D) is increasing worldwide and there is a need to identify communities with a high-risk profile and to develop appropriate primary care interventions. This study aimed to predict future T2D risk and identify community-level geographic variations using general practices data. The Australian T2D risk assessment (AUSDRISK) tool was used to calculate the individual T2D risk scores using 55693 clinical records from 16 general practices in west Adelaide, South Australia, Australia. Spatial clusters and potential 'hotspots' of T2D risk were examined using Local Moran's I and the Getis-Ord Gi* techniques. Further, the correlation between T2D risk and the socioeconomic status of communities were mapped. Individual risk scores were categorised into three groups: low risk (34.0% of participants), moderate risk (35.2% of participants) and high risk (30.8% of participants). Spatial analysis showed heterogeneity in T2D risk across communities, with significant clusters in the central part of the study area. These study results suggest that routinely collected data from general practices offer a rich source of data that may be a useful and efficient approach for identifying T2D hotspots across communities. Mapping aggregated T2D risk offers a novel approach to identifying areas of unmet need.
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Affiliation(s)
- Nasser Bagheri
- Centre for Mental Health Research, Research School of Population Health, Australian National University, 63 Eggleston Road, Acton 2601, Australia; and Corresponding author
| | - Paul Konings
- Department of Health Services Research and Policy, Research School of Population Health, Australian National University, 62 Eggleston Road, Acton, ACT 2601, Australia
| | - Kinley Wangdi
- Department of Global Health, Research School of Population Health, Australian National University, 62 Eggleston Road, Acton, ACT 2601, Australia
| | - Anne Parkinson
- Department of Health Services Research and Policy, Research School of Population Health, Australian National University, 62 Eggleston Road, Acton, ACT 2601, Australia
| | - Soumya Mazumdar
- Healthy People and Place Unit, Population Health, Liverpool Hospital, South West Sydney Local Health District, New South Wales Health, 52 Scrivener Street, Warwick Farm, NSW 2170, Australia
| | - Elizabeth Sturgiss
- Department of General Practice, Monash University, 270 Ferntree Gully Road, Notting Hill, Vic. 3168, Australia
| | - Aparna Lal
- National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University, 62 Eggleston Road, Acton, ACT 2601, Australia
| | - Kirsty Douglas
- Department of General Practice, Monash University, 270 Ferntree Gully Road, Notting Hill, Vic. 3168, Australia
| | - Nicholas Glasgow
- Department of Health Services Research and Policy, Research School of Population Health, Australian National University, 62 Eggleston Road, Acton, ACT 2601, Australia
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Pettit S, Simpson P, Jones J, Williams M, Islam MM, Parkinson A, Calabria B, Butler T. Holistic primary health care for Aboriginal and Torres Strait Islander prisoners: exploring the role of Aboriginal Community Controlled Health Organisations. Aust N Z J Public Health 2019; 43:538-543. [DOI: 10.1111/1753-6405.12941] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 08/01/2019] [Accepted: 08/01/2019] [Indexed: 11/28/2022] Open
Affiliation(s)
- Simon Pettit
- The Kirby Institute, University of New South Wales
| | - Paul Simpson
- The Kirby Institute, University of New South Wales
| | - Jocelyn Jones
- Faculty of Health and Medical Sciences, The University of Western Australia
| | - Megan Williams
- Graduate School of Health, University of Technology Sydney, New South Wales
| | | | - Anne Parkinson
- Research School of Population Health, Australian National University, Australian Capital Territory
| | - Bianca Calabria
- Research School of Population Health, Australian National University, Australian Capital Territory
| | - Tony Butler
- The Kirby Institute, University of New South Wales
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Qin D, Du W, Sha S, Parkinson A, Glasgow N. Hospital psychosocial interventions for patients with brain functional impairment: A retrospective cohort study. Int J Ment Health Nurs 2019; 28:1152-1161. [PMID: 31257721 DOI: 10.1111/inm.12627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/02/2019] [Indexed: 11/30/2022]
Abstract
Psychosocial interventions could improve health and care outcomes, however, little is known about their use for patients with complex needs in the acute hospital care setting. This study aimed to evaluate factors associated with psychosocial intervention use when treating patients with brain functional impairment during their hospital care. The all-inclusive New South Wales (NSW) Admitted Patient Data were employed to identify patients with neurodevelopment disorders, brain degenerative disorders, or traumatic brain injuries admitted to NSW public hospitals for acute care from July 2001 to June 2014. We considered receipt of psychosocial interventions as the primary outcome, and used mixed effect logistic models to quantify factors in relation to outcome. Of important note, psychosocial intervention use was more common in principal hospitals, and amongst those receiving intensive care or having comorbid mental disorders in the study populations. Approximate 70.8% of patients with traumatic brain injuries did not receive psychosocial interventions, despite attempts to target those in need and an overall increasing trend in adoption. Continuing efforts are warranted to improve service delivery and uptake.
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Affiliation(s)
- Danling Qin
- Department of Health Services Research & Policy, Australian National University, Canberra, ACT, Australia
| | - Wei Du
- Department of Health Services Research & Policy, Australian National University, Canberra, ACT, Australia
| | - Sha Sha
- Department of Health Services Research & Policy, Australian National University, Canberra, ACT, Australia
| | - Anne Parkinson
- Department of Health Services Research & Policy, Australian National University, Canberra, ACT, Australia
| | - Nicholas Glasgow
- Department of Health Services Research & Policy, Australian National University, Canberra, ACT, Australia
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Desborough J, Parkinson A, Korda R, Han J, McManus M, Aung E. The practical use of the Patient Enablement and Satisfaction Model in nurse-led outpatient cardiac clinics. Collegian 2019. [DOI: 10.1016/j.colegn.2018.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Bourgeois AC, Zulz T, Bruce MG, Stenz F, Koch A, Parkinson A, Hennessy T, Cooper M, Newberry C, Randell E, Proulx JF, Hanley BE, Soini H, Arnesen TM, Mariandyshev A, Jonsson J, Søborg B, Wolfe J, Balancev G, Bruun de Neergaard R, Archibald CP. Tuberculosis in the Circumpolar Region, 2006-2012. Int J Tuberc Lung Dis 2019; 22:641-648. [PMID: 29862948 DOI: 10.5588/ijtld.17.0525] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
SETTING The northern circumpolar jurisdictions Canada (Northwest Territories, Nunavik, Nunavut, Yukon), Finland, Greenland, Norway, Russian Federation (Arkhangelsk), Sweden and the United States (Alaska). OBJECTIVE To describe and compare demographic, clinical and laboratory characteristics, including drug resistance and treatment completion, of tuberculosis (TB) cases in the northern circumpolar populations. DESIGN Descriptive analysis of all active TB cases reported from 2006 to 2012 for incidence rate (IR), age and sex distribution, sputum smear and diagnostic site characteristics, drug resistance and treatment completion rates. RESULTS The annual IR of TB disease ranged from a low of 4.3 per 100 000 population in Northern Sweden to a high of 199.5/100 000 in Nunavik, QC, Canada. For all jurisdictions, IR was higher for males than for females. Yukon had the highest proportion of new cases compared with retreatment cases (96.6%). Alaska reported the highest percentage of laboratory-confirmed cases (87.4%). Smear-positive pulmonary cases ranged from 25.8% to 65.2%. Multidrug-resistant cases ranged from 0% (Northern Canada) to 46.3% (Arkhangelsk). Treatment outcome data, available up to 2011, demonstrated >80% treatment completion for four of the 10 jurisdictions. CONCLUSION TB remains a serious public health issue in the circumpolar regions. Surveillance data contribute toward a better understanding and improved control of TB in the north.
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Affiliation(s)
- A-C Bourgeois
- Centre for Communicable Diseases and Infection Control, Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - T Zulz
- Arctic Investigations Program, Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Diseases, US Centers for Disease Control and Prevention, Anchorage, Alaska, USA
| | - M G Bruce
- Arctic Investigations Program, Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Diseases, US Centers for Disease Control and Prevention, Anchorage, Alaska, USA
| | - F Stenz
- National Board of Health, Nuuk, Greenland
| | - A Koch
- Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark, Ilisimatusarfik, University of Greenland, Nuuk, Greenland
| | - A Parkinson
- Arctic Investigations Program, Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Diseases, US Centers for Disease Control and Prevention, Anchorage, Alaska, USA
| | - T Hennessy
- Arctic Investigations Program, Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Diseases, US Centers for Disease Control and Prevention, Anchorage, Alaska, USA
| | - M Cooper
- Department of Health and Social Services, Division of Public Health, State of Alaska, Anchorage, Alaska, USA
| | - C Newberry
- Population Health Division, Government of Northwest Territories, Yellowknife, Northwest Territories
| | - E Randell
- Department of Health, Government of Nunavut, Iqaluit, Nunavut
| | - J-F Proulx
- Infectious Diseases, Public Health Department, Nunavik Regional Board of Health and Social Services, Kuujjuaq, Quebec
| | - B E Hanley
- Health and Social Services, Government of Yukon, Whitehorse, Yukon Territory, Canada
| | - H Soini
- Infectious Disease Control and Vaccinations Unit, Department of Health Security, National Institute for Health and Welfare, Helsinki, Finland
| | - T M Arnesen
- Department of Tuberculosis, Blood Borne and Sexually Transmitted Infections, Norwegian Institute of Public Health, Oslo, Norway
| | - A Mariandyshev
- Department of Tuberculosis, Northern State Medical University, Arkhangelsk, Russian Federation
| | - J Jonsson
- Swedish Institute for Infectious Disease Control, Department of Preparedness, Stockholm, Sweden
| | - B Søborg
- Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark
| | - J Wolfe
- National Reference Centre for Mycobacteriology, National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Manitoba, Canada
| | - G Balancev
- Department of Tuberculosis, Northern State Medical University, Arkhangelsk, Russian Federation
| | | | - C P Archibald
- Centre for Communicable Diseases and Infection Control, Public Health Agency of Canada, Ottawa, Ontario, Canada
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Zhou M, Desborough J, Parkinson A, Douglas K, McDonald D, Boom K. Barriers to pharmacist prescribing: a scoping review comparing the UK, New Zealand, Canadian and Australian experiences. International Journal of Pharmacy Practice 2019; 27:479-489. [DOI: 10.1111/ijpp.12557] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 05/07/2019] [Accepted: 06/03/2019] [Indexed: 12/01/2022]
Abstract
Abstract
Objectives
Non-medical prescribers, including pharmacists, have been found to achieve comparable clinical outcomes with doctors for certain health conditions. Legislation supporting pharmacist prescribing (PP) has been implemented in the United Kingdom (UK), Canada and New Zealand (NZ); however, to date, Australian pharmacists have not been extended prescribing rights. The purpose of this review was to describe the barriers to PP found in the literature from the UK, Canada, NZ and Australia, and examine the implications of these for the development of PP in Australia.
Methods
We conducted a scoping review, which included peer-reviewed and grey literature, and consultation with stakeholders. Sources – Scopus, PubMed and CINAHL; Google Scholar, OpenGrey and organisational websites from January 2003 to March 2018 in the UK, Canada, NZ and Australia. Inclusion criteria – articles published in English, related to implementation of PP and articulated barriers to PP.
Key findings
Of 863 unique records, 120 were reviewed and 64 articles were eligible for inclusion. Three key themes emerged: (1) Socio-political context, (2) Resourcing issues and (3) Prescriber competence. The most common barriers were inadequate training regarding diagnostic knowledge and skills, inadequate support from authorities and stakeholders, and insufficient funding/reimbursement.
Conclusions
If implementation of PP is to occur, attention needs to be focused on addressing identified barriers to PP implementation, including fostering a favourable socio-political context and prescriber competence. As such, a concerted effort is required to develop clear policy pathways, including targeted training courses, raising stakeholder recognition of PP and identifying specific funding, infrastructure and resourcing needs to ensure the smooth integration of pharmacist prescribers within interprofessional clinical teams.
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Affiliation(s)
- Mingming Zhou
- People’s Hospital of Xinjiang Uygur Autonomous Region, Urumqi, China
- Department of Health Services Research and Policy, Research School of Population Health, College of Health and Medicine, Australian National University, Canberra, ACT, Australia
| | - Jane Desborough
- Department of Health Services Research and Policy, Research School of Population Health, College of Health and Medicine, Australian National University, Canberra, ACT, Australia
| | - Anne Parkinson
- Department of Health Services Research and Policy, Research School of Population Health, College of Health and Medicine, Australian National University, Canberra, ACT, Australia
| | - Kirsty Douglas
- Academic Unit of General Practice, ANU Medical School, College of Health and Medicine, Australian National University, Canberra, ACT, Australia
| | - David McDonald
- National Centre for Epidemiology and Population Health, Research School of Population Health, College of Health and Medicine, Australian National University, Canberra, ACT, Australia
| | - Katja Boom
- Independent Consultant/Accredited Australian Pharmacist Working in General Practice, Canberra, ACT, Australia
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El-Sharkawi D, Sharma S, Cook L, Hanley B, Johnston R, Arasaretnam A, Lazana I, Greaves P, Parkinson A, Peng Y, Kassam S, Peacock V, Kaczmarski R, Bower M, Cheung B, De Lord C, Cross M, Vroobel K, Wotherspoon A, Aldridge F, Khwaja J, Sharma B, Cwynarski K, Pettengell R, Chau I, Cunningham D, Naresh K, Iyengar S. COMPARISON OF OUTCOMES BETWEEN PATIENTS WITH MYC
REARRANGED DLBCL AND DOUBLE/ TRIPLE HIT HIGH-GRADE B CELL LYMPHOMA: A PAN-LONDON RETROSPECTIVE REVIEW. Hematol Oncol 2019. [DOI: 10.1002/hon.11_2631] [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: 11/08/2022]
Affiliation(s)
- D. El-Sharkawi
- Haematology; Royal Marsden Hospital; Sutton United Kingdom
| | - S. Sharma
- Haematology; Royal Marsden Hospital; Sutton United Kingdom
| | - L. Cook
- Haematology; Hammersmith Hospital; London United Kingdom
| | - B. Hanley
- Haematology; Hammersmith Hospital; London United Kingdom
| | - R. Johnston
- Haematology; Royal Sussex County Hospital; Brighton United Kingdom
| | - A. Arasaretnam
- Haematology; Royal Sussex County Hospital; Brighton United Kingdom
| | - I. Lazana
- Haematology; King's College Hospital; London United Kingdom
| | - P. Greaves
- Haematology; Queen's Hospital; Romford United Kingdom
| | - A. Parkinson
- Haematology; Queen's Hospital; Romford United Kingdom
| | - Y. Peng
- Haematology; St George's University Hospitals NHS Foundation Trust; London United Kingdom
| | - S. Kassam
- Haematology; King's College Hospital; London United Kingdom
| | - V. Peacock
- Haematology; King's College Hospital; London United Kingdom
| | - R. Kaczmarski
- Haematology; Hillingdon Hospital; Uxbridge United Kingdom
| | - M. Bower
- Haematology; Chelsea and Westminster Hospital; London United Kingdom
| | - B. Cheung
- Haematology; Croydon University Hospital; Croydon United Kingdom
| | - C. De Lord
- Haematology; St Helier Hospital; Carshalton United Kingdom
| | - M. Cross
- Haematology; Royal Marsden Hospital; Sutton United Kingdom
| | - K. Vroobel
- Histopathology; Royal Marsden Hospital; Sutton United Kingdom
| | - A. Wotherspoon
- Histopathology; Royal Marsden Hospital; Sutton United Kingdom
| | - F. Aldridge
- Clinical Cytogenetics; Royal Marsden Hospital; Sutton United Kingdom
| | - J. Khwaja
- Haematology; University College Hospital; London United Kingdom
| | - B. Sharma
- Radiology; Royal Marsden Hospital; Sutton United Kingdom
| | - K. Cwynarski
- Haematology; University College Hospital; London United Kingdom
| | - R. Pettengell
- Haematology; St George's University Hospitals NHS Foundation Trust; London United Kingdom
| | - I. Chau
- Department of Medicine; Royal Marsden Hospital; Sutton United Kingdom
| | - D. Cunningham
- Department of Medicine; Royal Marsden Hospital; Sutton United Kingdom
| | - K. Naresh
- Histopathology; Hammersmith Hospital; Hammersmith United Kingdom
| | - S. Iyengar
- Haematology; Royal Marsden Hospital; Sutton United Kingdom
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Banfield M, Jowsey T, Parkinson A, Douglas KA, Dawda P. Experiencing integration: a qualitative pilot study of consumer and provider experiences of integrated primary health care in Australia. BMC Fam Pract 2017; 18:2. [PMID: 28073346 PMCID: PMC5225665 DOI: 10.1186/s12875-016-0575-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Accepted: 12/09/2016] [Indexed: 11/10/2022]
Abstract
BACKGROUND The terms integration and integrated care describe the complex, patient-centred strategies to improve coordination of healthcare services. Frameworks exist to conceptualise these terms, but these have been developed from a professional viewpoint. The objective of this study was to explore consumers' and providers' concepts, expectations and experience of integrated care. A key focus was whether frameworks developed from a professional perspective are effective models to explore people's experiences. METHODS A qualitative pilot study was undertaken at one Australian multidisciplinary primary health care centre. Semi-structured interviews were conducted with consumers (N = 19) and staff (N = 10). Data were analysed using a framework analysis approach. RESULTS Consumers' experience of integrated care tended to be implicit in their descriptions of primary healthcare experiences more broadly. Experiences related to the typologies involved clinical and functional integration, such as continuity of providers and the usefulness of shared information. Staff focused on clinical level integration, but also talked about a cultural shift that demonstrated normative, professional and functional integration. CONCLUSIONS Existing frameworks for integration have been heavily influenced by the provider and organisational perspectives. They are useful for conceptualising integration from a professional perspective, but are less relevant for consumers' experiences. Consumers of integrated primary health care may be more focussed on relational aspects of care and outcomes of care.
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Affiliation(s)
- Michelle Banfield
- Centre for Mental Health Research, Research School of Population Health, The Australian National University, 63 Eggleston Rd, Acton, ACT 2601, Australia.
| | - Tanisha Jowsey
- Centre for Medical and Health Sciences Education The University of Auckland, Auckland City Hospital, Building 599, Level 12, Auckland, 1023, New Zealand
| | - Anne Parkinson
- Department of Health Services Research and Policy, Research School of Population Health, The Australian National University, 63 Eggleston Rd, Acton, ACT 2601, Australia
| | - Kirsty A Douglas
- ANU Medical School, Canberra Hospital, Bldg 4, Level 2, Garran, ACT 2605, Australia
| | - Paresh Dawda
- Ochre Health Medical Centre, Cnr Allawoona Street & Ginninderra Drive, Bruce, ACT 2617, Australia
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Burke J, Shatkar V, Parkinson A, Asher S, Almoudaris A, Huang J. TEMS experience from a tertiary referral centre. Int J Surg 2016. [DOI: 10.1016/j.ijsu.2016.08.177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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McRae I, Dawda P, Banfield M, Parkinson A. Can we measure integration of healthcare from administrative and clinical records? Aust Fam Physician 2016; 45:672-675. [PMID: 27606372] [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] [Indexed: 06/06/2023]
Abstract
BACKGROUND A major component of integrated care is shared information. Computer-based clinical and administrative systems, particularly in multidisciplinary environments, provide an opportunity to directly measure the degree of integration. OBJECTIVE The objective of this article is to explore the viability of automated measurement of integration within a multidisciplinary healthcare centre. METHODS With the assistance of practice staff, researchers explored the structure and content of selected patient records in two practices to understand the viability of automated measurement. RESULTS Extracted patient records can be used to understand integration to the degree that communication is recorded, but at significant expense to the practices and researchers. Automated systems are practical to the degree that clinicians complete all relevant identifying fields. DISCUSSION Computerised clinical systems provide opportunities for exploring integration of care if they include a range of care providers and all relevant fields are always completed. The latter condition will always be difficult to achieve.
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Affiliation(s)
- Ian McRae
- BSc(Hons), BA, MSc, PhD, is Senior Research Fellow, Australian Primary Health Care Research Institute, Australian National University, Canberra, Australian Capital Territory
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Le Grande MR, Murphy BM, Higgins RO, Worcester MUC, Parkinson A, Brown SL, Elliott PC, Goble AJ. Physical activity and negative emotional response after percutaneous coronary intervention. ACTA ACUST UNITED AC 2016; 13:254-60. [PMID: 16575281 DOI: 10.1097/01.hjr.0000189808.22224.b0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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
BACKGROUND The aims of this study were to investigate the association between negative emotional response (NER) and physical activity levels in percutaneous coronary intervention (PCI) patients, and to examine the extent to which physical activity levels were influenced by factors such as the patients' age, sex, and attendance at a cardiac rehabilitation (CR) programme. METHODS A consecutive series of 200 PCI patients [mean age 59.0 (+/-10.1) years] completed telephone interviews 2 weeks and 6 months after their procedure. NER was assessed using 12 items addressing patients' perceptions and concerns regarding symptoms, diagnosis and prognosis. Physical activity was assessed by asking four questions relating to the frequency and duration of walking and of moderate activity. CR attendance, medical history and sociodemographic data were also collected. Hierarchical linear regression was used to assess the association between NER and physical activity over time. RESULTS After controlling for baseline levels of moderate activity and other covariates, NER significantly predicted change in moderate activity over 6 months. Only baseline walking levels predicted the duration and frequency of walking at 6 months. CONCLUSION NER can be considered an inhibitive factor towards increased moderate activity uptake after PCI. Walking after PCI does not appear to be affected by NER. These findings highlight the need to focus on improving the emotional aspects of patients' recovery.
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Jowsey T, Dennis S, Yen L, Mofizul Islam M, Parkinson A, Dawda P. Time to manage: patient strategies for coping with an absence of care coordination and continuity. Sociol Health Illn 2016; 38:854-873. [PMID: 26871716 DOI: 10.1111/1467-9566.12404] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
This paper examines how people with chronic illnesses respond to absences of continuity and coordination of care. Little work has been done on how the ill person might mitigate flaws in a less than optimal system. Our qualitative research, carried out among 91 participants in Australia, reveals that people with chronic illnesses create strategies to facilitate the management of their care. These strategies included efforts to improve communication between themselves and their health care practitioners; keeping personal up-to-date medication lists; and generating their own specific management plans. While we do not submit that it is patients' responsibility to attend to gaps in the health system, our data suggests that chronically ill people can, in and through such strategies, exert a measure of agency over their own care; making it effectively more continuous and coordinated. Participants crafted strategies according to the particular social and bodily rhythms that their ongoing illnesses had lent to their lives. Our analysis advances the view that the ill body itself is capable of enfolding the health system into the rhythms of illness - rather than the ill body always fitting into the overarching structural tempo. This entails an agent-centric view of time in illness experience. A Virtual Abstract of this paper can be found at: https://youtu.be/UwbxlEJOTx8.
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Affiliation(s)
- Tanisha Jowsey
- Centre for Medical and Health Sciences Education, The University of Auckland, New Zealand
- Australian Primary Health Care Research Institute, Australian National University, Australia
| | - Simone Dennis
- School of Archaeology and Anthropology, The Australian National University
| | - Laurann Yen
- Australian Primary Health Care Research Institute, Australian National University, Australia
| | - M Mofizul Islam
- Australian Primary Health Care Research Institute, Australian National University, Australia
| | - Anne Parkinson
- Australian Primary Health Care Research Institute, Australian National University, Australia
| | - Paresh Dawda
- Australian Primary Health Care Research Institute, Australian National University, Australia
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Gardner K, Parkinson A, Banfield M, Sargent GM, Desborough J, Hehir KK. Usability of patient experience surveys in Australian primary health care: a scoping review. Aust J Prim Health 2016; 22:93-99. [DOI: 10.1071/py14179] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Accepted: 06/20/2015] [Indexed: 11/23/2022]
Abstract
Monitoring patient experience is essential for stimulating innovation in health care and improving quality and accountability. Internationally, standardised approaches are used to collect patient experience information, but in Australian primary health care (PHC), little is known about which patient experience surveys are used and which aspects of experience they measure. This prevents routine inclusion of patient experience data in quality improvement or system performance measurement. A scoping review was undertaken to identify relevant surveys. Data on survey availability, psychometric properties, target population, method and frequency of administration were extracted. Survey items were mapped against six dimensions of patient experience described internationally. Ninety-five surveys were identified; 34 were developed for use in Australia. Surveys vary in content, size, aspects of experience measured and methods of administration. The quality of data collected and the extent to which it is used in quality improvement is unclear. Collection of patient experience data in Australian PHC is not well developed or standardised and there are few publicly available instruments. There is a need to clearly identify the purposes for which data are to be used and to develop an integrated approach that articulates these collections with other quality and performance data. Some options are discussed.
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