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Driscoll A, Meagher S, Kennedy R, Hare DL, Johnson DF, Asker K, Farouque O, Romaniuk H, Orellana L. Impact of a heart failure nurse practitioner service on rehospitalizations, emergency presentations, and survival in patients hospitalized with acute heart failure. Eur J Cardiovasc Nurs 2023; 22:701-708. [PMID: 36413653 DOI: 10.1093/eurjcn/zvac108] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Revised: 11/09/2022] [Accepted: 11/13/2022] [Indexed: 10/12/2023]
Abstract
AIMS Heart failure nurse practitioners (HF NPs) are an emerging component of the heart failure (HF) specialist workforce but their impact in an inpatient setting is untested. The aim of this paper is to explore the impact of an inpatient HF NP service on 12-month all-cause rehospitalizations, emergency department (ED) presentations, and mortality in patients hospitalized with HF compared with usual hospital care. METHODS AND RESULTS Retrospective, two-group comparative design involving patients (n = 408) admitted via ED with acute HF to a metropolitan quaternary hospital between January 2013 and August 2017. Doubly robust estimation with augmented inverse probability weighting (DR-AIPW) was used to account for the non-random allocation of patients to usual hospital care or the HF NP service in addition to usual in-hospital care. Among 408 patients (186 usual care and 222 HF NP service) admitted with acute HF, the mean age was 76.5 [standard deviation (SD) 12.0] years and 56.4% (n = 230) were male. After IPW adjustment, patients seen by the HF NP service had a lower risk of 12-month rehospitalization (61.3 vs. 78.3% usual care; difference -16.9%, 95% CI: -26.4%, -6.6%) and ED presentations (12.6 vs. 22.0%; difference -9.4%, 95% CI: -17.3%, -1.4%) with no difference in 6- or 12-month mortality. The HF NP service improved referrals to a home visiting programme that was available to HF patients (64.4 vs. 45.4%; difference 19%, 95% CI: 8.8%, 28.8%). CONCLUSION Additional support by an inpatient HF NP service has the potential to significantly reduce rehospitalizations and ED presentations over 12 months. Further evidence from a multicentre randomized control trial is warranted.
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Affiliation(s)
- Andrea Driscoll
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research in the Institute for Health Transformation, Deakin University, 1 Gheringhap St, Geelong, VIC 3220, Australia
- Austin Health, Department of Cardiology, Studley Rd, Heidelberg, VIC 3081, Australia
| | - Sharon Meagher
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research in the Institute for Health Transformation, Deakin University, 1 Gheringhap St, Geelong, VIC 3220, Australia
| | - Rhoda Kennedy
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research in the Institute for Health Transformation, Deakin University, 1 Gheringhap St, Geelong, VIC 3220, Australia
| | - David L Hare
- Austin Health, Department of Cardiology, Studley Rd, Heidelberg, VIC 3081, Australia
- Department of Medicine, University of Melbourne, Parkville, VIC 3010, Australia
| | - Douglas F Johnson
- Department of Medicine, University of Melbourne, Parkville, VIC 3010, Australia
- The Royal Melbourne Hospital, Department of General Medicine, Grattan St, Parkville, VIC 3050, Australia
| | - Kristina Asker
- Austin Health, Department of Cardiology, Studley Rd, Heidelberg, VIC 3081, Australia
| | - Omar Farouque
- Austin Health, Department of Cardiology, Studley Rd, Heidelberg, VIC 3081, Australia
- Department of Medicine, University of Melbourne, Parkville, VIC 3010, Australia
| | - Helena Romaniuk
- Biostatistics Unit, Deakin University, 1 Gheringhap St, Geelong, VIC 3220, Australia
| | - Liliana Orellana
- Biostatistics Unit, Deakin University, 1 Gheringhap St, Geelong, VIC 3220, Australia
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Steinfort DP, Johnson DF. Another line of defence. Respirology 2022; 27:804-805. [PMID: 35971646 DOI: 10.1111/resp.14348] [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: 07/27/2022] [Accepted: 08/08/2022] [Indexed: 12/01/2022]
Affiliation(s)
- Daniel P Steinfort
- Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, Victoria, Australia.,Department of Respiratory and Sleep Medicine, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Douglas F Johnson
- Department of General Medicine, Royal Melbourne Hospital, Parkville, Victoria, Australia.,Department of Infectious Diseases, Royal Melbourne Hospital, Parkville, Victoria, Australia.,Department of Medicine, Royal Melbourne Hospital Campus, Melbourne University, Parkville, Victoria, Australia
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Aung AK, Pickles R, Knight A, Shannon L, Bowers A, Donnelly S, Johnson DF, Scott IA, Potter EL. Research Activities in General Medicine: A Scoping Survey by the Internal Medicine Society of Australia and New Zealand (IMSANZ). Intern Med J 2022; 52:1505-1512. [PMID: 35790069 PMCID: PMC9543186 DOI: 10.1111/imj.15866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 06/24/2022] [Indexed: 11/29/2022]
Abstract
Background In developing an effective framework for a collaborative research network (RN) that supports members involved in research, the Internal Medicine Society of Australia and New Zealand (IMSANZ) required a better understanding of the current level of research activity and engagement by general physicians, and factors influencing such engagement. Aims To explore the current research landscape amongst general physicians in Australia and Aotearoa New Zealand. Methods A questionnaire exploring research participation, scope, research enablers and barriers was disseminated to IMSANZ members over a 3‐month period. Core functions of IMSANZ‐RN, research priorities, potential solutions to perceived barriers and required level of support were also evaluated. Results A total of 82 members, mostly senior medical staff (74.4%), responded to the survey (11.8% response rate). More than 70% were involved in impactful research across multiple disciplines, encompassing a wide range of research themes and topics. However, there is limited support and resources available to conduct research, with most projects being self‐instigated and self‐funded. There is overwhelming support to increasing the profile of research in general medicine through the establishment of IMSANZ‐RN, whose principal purposes, as identified by respondents, are to foster collaboration, promote research, provide research education and training, and share information among general physicians. Quality improvement studies (56.1%) and clinical trials (41.5%) were also identified as priority research types. Conclusions This study has profiled the constraints faced by general physicians in conducting high‐quality collaborative research and provides insights into what is needed to support greater research engagement, through development of a discipline‐specific clinical RN.
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Affiliation(s)
- Ar Kar Aung
- Department of General Medicine Alfred Health Melbourne VIC Australia
- School of Public Health and Preventive Medicine Monash University VIC Australia
| | - Robert Pickles
- Department of General Medicine John Hunter Hospital Newcastle NSW Australia
- School of Medicine and Public Health University of Newcastle NSW Australia
| | - Anne Knight
- Manning Base Hospital Taree NSW Australia
- Department of Rural Health University of Newcastle NSW Australia
| | | | - Andrew Bowers
- Department of Medicine University of Otago Dunedin New Zealand
| | - Sinead Donnelly
- Department of Medicine Capital and Coast District Health Board (CCDHB) New Zealand
- Department of Medicine University of Otago Wellington New Zealand
| | - Douglas F. Johnson
- Department of General Medicine Royal Melbourne Hospital Melbourne VIC Australia
- University of Melbourne VIC Australia
| | - Ian A. Scott
- Department of Internal Medicine and Clinical Epidemiology Princess Alexandra Hospital Brisbane QLD Australia
- School of Medicine, University of Queensland QLD Australia
| | - Elizabeth L. Potter
- Department of General Medicine Alfred Health Melbourne VIC Australia
- Baker Heart and Diabetes Institute VIC Australia
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4
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McCabe GA, McHugh JW, Goodwin T, Johnson DF, Fok A, Campbell TG. Ophthalmic manifestations of Cryptococcus gattii species complex: a case series and review of the literature. Int J Ophthalmol 2022; 15:119-127. [PMID: 35047366 DOI: 10.18240/ijo.2022.01.18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 06/25/2021] [Indexed: 12/18/2022] Open
Abstract
AIM To report 4 cases of Cryptococcus gattii (C. gattii) species complex infection with diverse ophthalmic manifestations, and to review the literature to examine pathobiology of disease, classical ophthalmic presentations and outcomes, and treatment modalities for this emerging pathogen. METHODS Cases of C. gattii meningoencephalitis with ophthalmic manifestations were identified via chart review at two institutions in Australia and one institution in the mid-west region of the United States and are reported as a case series. Additionally, a MEDLINE literature review was conducted to identify all reported cases of C. gattii with ophthalmic manifestations from 1990-2020. Cases were reviewed and tabulated, together with our series of patients, in this report. RESULTS Four cases of C. gattii with ophthalmic manifestations are presented; three from Australia and one from the USA. A literature review identified a total of 331 cases of C. gattii with visual sequelae. The majority of cases occurred in immunocompetent individuals. Blurred vision and diplopia were the most common presenting symptoms, with papilloedema the most common sign, reported in 10%-50% of cases. Visual loss was reported in 10%-53% of cases, as compared to rates of visual loss of 1%-9% in C. neoformans infection. Elevated intracranial pressure, cerebrospinal fluid (CSF) fungal burden, and abnormal neurological exam at presentation correlated with poor visual outcomes. The mainstays of treatment are anti-fungal agents and aggressive management of intracranial hypertension with serial lumbar punctures. CSF diversion procedures should be considered for refractory cases. Acetazolamide and mannitol are associated with high complication rates, and adjuvant corticosteroids have demonstrated higher mortality rates; these treatments should be avoided. CONCLUSION Permanent visual loss represents a devastating yet potentially preventable sequelae of C. gattii infection. Intracranial hypertension needs to be recognised early and aggressively managed. Referral to an ophthalmologist/neuro-ophthalmologist in all cases of cryptococcal infection independent of visual symptoms at time of diagnosis is recommended.
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Affiliation(s)
- Grace A McCabe
- Department of Ophthalmology, the Royal Melbourne Hospital, Melbourne, Victoria 3050, Australia
| | - Jack W McHugh
- Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota 55902, USA
| | - Todd Goodwin
- James Cook University, Townsville, Queensland 4811, Australia.,NQ Eye Foundation, Townsville, Queensland 4811, Australia
| | - Douglas F Johnson
- Department of Infectious Disease, the Royal Melbourne Hospital, Melbourne, Victoria 3050, Australia
| | - Anthony Fok
- Department of Neurology, the Royal Melbourne Hospital, Melbourne, Victoria 3050, Australia
| | - Thomas G Campbell
- Department of Ophthalmology, the Royal Melbourne Hospital, Melbourne, Victoria 3050, Australia.,NQ Eye Foundation, Townsville, Queensland 4811, Australia.,Centre for Eye Research Australia, East Melbourne, Victoria 3002, Australia.,Ophthalmology, Department of Surgery, the University of Melbourne, Melbourne, Victoria 3010, Australia
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5
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Cid-Serra X, Royse A, Canty D, Johnson DF, Maier AB, Fazio T, El-Ansary D, Royse CF. Effect of a Multiorgan Focused Clinical Ultrasonography on Length of Stay in Patients Admitted With a Cardiopulmonary Diagnosis: A Randomized Clinical Trial. JAMA Netw Open 2021; 4:e2138228. [PMID: 34932107 PMCID: PMC8693211 DOI: 10.1001/jamanetworkopen.2021.38228] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
IMPORTANCE There are accumulating data about the utility of diagnostic multiorgan focused clinical ultrasonography (FCU) in the assessment of patients admitted with cardiopulmonary symptoms. OBJECTIVE To determine whether adding multiorgan FCU to the initial clinical evaluation of patients admitted with cardiopulmonary symptoms reduces hospital length of stay, hospital readmissions, and in-hospital costs. DESIGN, SETTING, AND PARTICIPANTS This is a prospective, parallel-group, superiority, randomized clinical trial with a 1:1 allocation ratio. The study was conducted at The Royal Melbourne Hospital, a tertiary public hospital located in Melbourne, Victoria, Australia. Adults aged 18 years or older admitted to the internal medicine ward with a cardiopulmonary diagnosis were enrolled between September 2018 and December 2019 and were followed up until hospital discharge. Data analysis was performed from August 2020 to January 2021. INTERVENTIONS The intervention involved an internal medicine physician-performed heart, lung, and 2-point vein compression FCU in addition to standard clinical evaluation. MAIN OUTCOMES AND MEASURES The primary outcome was the difference in the mean length of hospital stay, defined as the number of hours from admission to the internal medicine ward to hospital discharge. A difference of 24 hours was defined as clinically important. Secondary outcomes included hospital readmissions at 30 days and hospital care costs. RESULTS A total of 250 participants were enrolled and 2 were excluded, leaving 248 participants (mean [SD] age, 80.1 [11.0] years; 121 women [48.7%]) in the final analysis. There were 124 patients in the intervention group and 124 patients in the control group. The most common initial diagnoses were acute decompensated heart failure (113 patients [45.5%]), pneumonia (45 patients [18.1%]), and exacerbated chronic pulmonary disease (32 patients [12.9%]). The length of hospital stay was 113.4 hours (95% CI, 91.7-135.1 hours) in the FCU group and 125.3 hours (95% CI, 101.7-148.8 hours) in the control group (P = .53). The 30-day readmission rate was not different between groups (FCU vs control, 20 of 124 patients [16.1%] vs 15 of 124 patients [12.0%]), nor were total in-hospital costs (FCU vs control, A$7831.1 [95% CI, A$5586.1-A$10 076.1] vs A$7895.7 [95% CI, A$6385.9-A$9.405.5]). CONCLUSIONS AND RELEVANCE In this randomized clinical trial, adult patients admitted to an internal medicine ward with a cardiopulmonary diagnosis, who underwent multiorgan FCU of the heart, lungs, and lower extremities veins during their initial clinical assessment, did not have a shorter hospital length of stay by more than 24 hours, compared with patients who received standard care. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry Identifier: ACTRN12618001442291.
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Affiliation(s)
- Ximena Cid-Serra
- Department of Surgery, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Medicine and Community Care, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Alistair Royse
- Department of Surgery, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Surgery, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - David Canty
- Department of Surgery, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Medicine, Monash University, Melbourne, Victoria, Australia
- Department of Anaesthesia and Pain Management, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
- Department of Anesthesia and Perioperative Medicine, Monash Health, Melbourne, Victoria, Australia
| | - Douglas F. Johnson
- Department of Medicine and Community Care, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
- Department of General Medicine, The University of Melbourne, Melbourne, Victoria, Australia
| | - Andrea B. Maier
- Department of Medicine and Community Care, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
- Department of Human Movement Sciences, @AgeAmsterdam, Amsterdam Movement Sciences, Vrije Universitet, Amsterdam, The Netherlands
- Department of Medicine and Aged Care, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Tim Fazio
- Department of Medicine and Community Care, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
- Health Intelligence Unit, Melbourne Health, Melbourne, Victoria, Australia
- Department of Medicine and Radiology, Melbourne Medical School, University of Melbourne, Melbourne, Victoria, Australia
| | - Doa El-Ansary
- Department of Surgery, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Nursing and Allied Health, Swinburne University of Technology, Hawthorn, Melbourne, Victoria, Australia
- Department of Surgery, School of Medicine, University of Melbourne, Melbourne, Victoria, Australia
- Clinical Research Institute, Westmead Private Hospital, Westmead, Sydney, New South Wales, Australia
| | - Colin F. Royse
- Department of Surgery, The University of Melbourne, Melbourne, Victoria, Australia
- Pain Management, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
- Outcomes Research Consortium, The Cleveland Clinic, Cleveland, Ohio
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6
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Douglas N, Gregorevic K, Law M, Thomson BNJ, Johnson DF. Advocacy for COVID-19 vaccination at perioperative consultations: An opportunity for protection. ANZ J Surg 2021; 91:1964-1965. [PMID: 34251735 PMCID: PMC8420485 DOI: 10.1111/ans.17066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 06/28/2021] [Accepted: 06/29/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Ned Douglas
- Department of Anaesthesia and Pain Management, Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Proactive care of Older People having Surgery at the Royal Melbourne Hospital (POPS - RMH), Melbourne, Victoria, Australia.,Department of Critical Care, University of Melbourne Faculty of Medicine and Health Sciences, Melbourne, Victoria, Australia
| | - Katherine Gregorevic
- Proactive care of Older People having Surgery at the Royal Melbourne Hospital (POPS - RMH), Melbourne, Victoria, Australia.,Department of Geriatric Medicine, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Mandy Law
- COVID-19 Vaccination Service, Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Department of Nephrology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Benjamin N J Thomson
- Department of General Surgical Specialties, Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Department of Surgery, University of Melbourne Faculty of Medicine and Health Sciences, Melbourne, Victoria, Australia
| | - Douglas F Johnson
- Department of General Medicine, Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Victorian Infectious Disease Service, Royal Melbourne Hospital, Melbourne, Victoria, Australia
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Steinfort DP, Cowie B, Johnson DF. Impact of general social distancing measures on incidence of influenza in Australia. ERJ Open Res 2020; 6:00507-2020. [PMID: 33263046 PMCID: PMC7682697 DOI: 10.1183/23120541.00507-2020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 08/18/2020] [Indexed: 11/18/2022] Open
Abstract
We read with interest the work by McQuaidet al. [1] exploring the potential impact of social distancing on global transmission of tuberculosis. Influenza is responsible for a large number of deaths, with the World Health Organization estimating up to 650 000 deaths per year globally [2]. We have explored the impact of social distancing on incidence of influenza in Australia. General social distancing measures enacted for control of the #SARSCoV2 pandemic have achieved a profound reduction in incidence of #influenza in Australiahttps://bit.ly/3hXjOkl
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Affiliation(s)
- Daniel P Steinfort
- Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, Australia
| | - Benjamin Cowie
- WHO Collaborating Centre for Viral Hepatitis, The Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - Douglas F Johnson
- Victorian Infectious Diseases Service, Royal Melbourne Hospital, Parkville, Australia
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Friedman ND, Lim SM, James R, Ingram R, O'Reilly M, Pollard JGD, Koning S, George C, Rajkhowa A, Johnson DF, Buising KL. Measuring antimicrobial prescribing quality in outpatient parenteral antimicrobial therapy (OPAT) services: development and evaluation of a dedicated national antimicrobial prescribing survey. JAC Antimicrob Resist 2020; 2:dlaa058. [PMID: 34223015 PMCID: PMC8210186 DOI: 10.1093/jacamr/dlaa058] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 06/11/2020] [Accepted: 06/21/2020] [Indexed: 12/21/2022] Open
Abstract
Background Antimicrobial stewardship programmes are important in driving safety and quality of antimicrobial prescribing. The National Antimicrobial Prescribing Survey (NAPS) is a point-prevalence audit of inpatient antimicrobial prescribing in Australian hospitals. Objectives To design and adapt the NAPS tool for use in the outpatient parenteral antimicrobial therapy (OPAT) and hospital-in-the-home (HITH) setting. Methods An inter-disciplinary working group with expertise in OPAT and HITH services was established to adapt the NAPS template for use in the OPAT setting—called HITH-NAPS. This was initially trialled in 5 HITH services, subsequently adapted following participant feedback, then offered nationally to 50 services in 2017. Results There were 1154 prescriptions for 715 patients audited via the HITH-NAPS. The most common antimicrobials prescribed were cefazolin (22%), flucloxacillin (12%), piperacillin/tazobactam (10%) and ceftriaxone (10%). The most common infections treated were cellulitis (30%) and respiratory tract infections (14%). Eighty-seven percent of prescriptions were assessed as appropriate, 11% inappropriate and 2% not assessable. Prolonged durations of antimicrobials and unnecessarily broad-spectrum antibiotics were used in 9% of prescriptions. Conclusions The HITH-NAPS pilot project revealed that auditing of this type is feasible in HITH. It showed that antibiotic use in these HITH services was generally appropriate, but there are some areas for improvement. A national OPAT/HITH-NAPS can facilitate benchmarking between services, identify potentially inappropriate prescribing and help guide quality improvement.
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Affiliation(s)
- N Deborah Friedman
- National Centre for Antimicrobial Stewardship, Melbourne, VIC, Australia.,Barwon Health, Geelong, VIC, Australia
| | - Seok M Lim
- Department of General Medicine, Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Rodney James
- National Centre for Antimicrobial Stewardship, Melbourne, VIC, Australia
| | - Robyn Ingram
- National Centre for Antimicrobial Stewardship, Melbourne, VIC, Australia
| | | | - James G D Pollard
- Barwon Health, Geelong, VIC, Australia.,Cabrini Health, VIC, Australia
| | | | - Catherine George
- National Centre for Antimicrobial Stewardship, Melbourne, VIC, Australia.,Pharmacy Department, Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Arjun Rajkhowa
- National Centre for Antimicrobial Stewardship, Melbourne, VIC, Australia
| | - Douglas F Johnson
- Department of General Medicine, Royal Melbourne Hospital, Melbourne, VIC, Australia.,Department of Infectious Diseases, Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Kirsty L Buising
- National Centre for Antimicrobial Stewardship, Melbourne, VIC, Australia.,Department of Infectious Diseases, Royal Melbourne Hospital, Melbourne, VIC, Australia
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Johnson DF, Steinfort DP, Cowie B. Navigating shifting waters: rapid response to change in the era of COVID-19. Intern Med J 2020; 50:786-790. [PMID: 32656969 PMCID: PMC7405183 DOI: 10.1111/imj.14921] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 05/15/2020] [Accepted: 05/15/2020] [Indexed: 12/23/2022]
Affiliation(s)
- Douglas F. Johnson
- Department of General MedicineRoyal Melbourne HospitalMelbourneVictoriaAustralia
- Victorian Infectious Diseases ServiceRoyal Melbourne HospitalMelbourneVictoriaAustralia
- Faculty of Medicine, Dentistry and Health SciencesThe University of MelbourneMelbourneVictoriaAustralia
| | - Daniel P. Steinfort
- Faculty of Medicine, Dentistry and Health SciencesThe University of MelbourneMelbourneVictoriaAustralia
| | - Benjamin Cowie
- Victorian Infectious Diseases ServiceRoyal Melbourne HospitalMelbourneVictoriaAustralia
- Faculty of Medicine, Dentistry and Health SciencesThe University of MelbourneMelbourneVictoriaAustralia
- WHO Collaborating Centre for Viral HepatitisThe Peter Doherty Institute for Infection and Immunity,MelbourneVictoriaAustralia
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Torkamani N, Churilov L, Robbins R, Jerums G, Beik V, Radcliffe N, Patterson S, Bellomo R, Burns J, Hart GK, Lam Q, Power DA, MacIsaac RJ, Johnson DF, Zajac J, Ekinci EI. Diabetes and higher HbA1c levels are independently associated with adverse renal outcomes in inpatients following multiple hospital admissions. J Diabetes Complications 2020; 34:107465. [PMID: 31735639 DOI: 10.1016/j.jdiacomp.2019.107465] [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: 06/27/2019] [Revised: 09/02/2019] [Accepted: 09/25/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To assess the association between glycaemic status prior to the first hospital presentation with developing adverse renal outcomes overtime in patients with multiple hospital re-admissions. DESIGN A prospective observational cohort study. PARTICIPANTS All inpatients aged ≥54 years admitted between 2013 and 16 to a tertiary hospital. MAIN OUTCOMES We prospectively measured HbA1c levels in all inpatients aged ≥54 years admitted between 2013 and 16. Diabetes was defined as prior documented diagnosis of diabetes and/or HbA1c ≥6.5% (47·5 mmol/L). Included patients had ≥ two admissions (at least 90 days apart), baseline estimated glomerular filtration rate (eGFR) >30 ml/min/1·73m2 and no history of renal replacement therapy. We assessed several renal outcomes: (a) 50% decline in eGFR; (b) rapid decline in renal function (eGFR decline >5 mL/min/1·73m2/year) and (c) final eGFR<30 ml/min/1·73m2. RESULTS Of 4126 inpatients with a median follow-up of 465 days (254, 740), 26% had diabetes. The presence of diabetes was associated with higher odds of (a) 50% decline in eGFR (OR = 1·42;95% CI:1·18-1·70;p < 0·001); (b) rapid decline in renal function (OR = 1·40;95%CI:1·20-1·63;p < 0·001), and (c) reaching eGFR<30 ml/min/1.73m2 (OR = 1·25;95%CI:1·03-1·53;p < 0·05). Every 1% (11 mmol/L) increase in baseline HbA1c was associated with significantly greater odds of (a) >50% decline in eGFR (OR = 1·07;95% CI:1·01-1·4;p < 0·05) and (b) rapid decline in renal function (OR = 1·11;95% CI:1·05-1·18;p < 0·001). CONCLUSIONS In patients with ≥two admissions, the presence of diabetes and higher HbA1c levels were strongly and independently associated with adverse renal outcomes at follow up. Such patients are at high risk of relatively rapid deterioration in renal function and a logical target for structured preventive interventions.
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Affiliation(s)
- N Torkamani
- Department of Medicine, University of Melbourne, Austin Health, Heidelberg, Victoria, Australia; Department of Endocrinology, Austin Health, Melbourne, Victoria, Australia
| | - L Churilov
- Department of Medicine, University of Melbourne, Austin Health, Heidelberg, Victoria, Australia
| | - R Robbins
- Department of Administrative Informatics, Austin Health, Heidelberg, Victoria, Australia
| | - G Jerums
- Department of Endocrinology, Austin Health, Melbourne, Victoria, Australia
| | - V Beik
- School of Engineering, RMIT University, Melbourne, Victoria, Australia
| | - N Radcliffe
- Department of General Medicine, Austin Health, Melbourne, Victoria, Australia
| | - S Patterson
- Department of Endocrinology, Austin Health, Melbourne, Victoria, Australia
| | - R Bellomo
- Department of Intensive Care, Austin Health, Heidelberg, Victoria, Australia; Department of Medicine, The University of Melbourne, Parkville, Australia
| | - J Burns
- Clinical Informatics Unit, Austin Health, Heidelberg, Victoria, Australia
| | - G K Hart
- Department of Intensive Care, Austin Health, Heidelberg, Victoria, Australia; Centre for Digital Transformation of Health, University of Melbourne
| | - Q Lam
- Department of Pathology, Austin Health, Heidelberg, Victoria, Australia
| | - D A Power
- Department of Nephrology, Austin Health, Heidelberg, Victoria, Australia
| | - R J MacIsaac
- Department of Medicine, The University of Melbourne, Parkville, Australia; Department of Endocrinology and Diabetes, St. Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
| | - D F Johnson
- Department of General Medicine, Austin Health, Melbourne, Victoria, Australia; Department of Medicine, The University of Melbourne, Parkville, Australia
| | - J Zajac
- Department of Medicine, University of Melbourne, Austin Health, Heidelberg, Victoria, Australia; Department of Endocrinology, Austin Health, Melbourne, Victoria, Australia
| | - E I Ekinci
- Department of Medicine, University of Melbourne, Austin Health, Heidelberg, Victoria, Australia; Department of Endocrinology, Austin Health, Melbourne, Victoria, Australia.
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Vazirani J, Moraes J, Barnett S, Johnson DF, Knight S, Miller A, Wright G, Alam NZ, Conron M, Irving LB, Antippa P, Steinfort DP. Outcomes following resection of non-small cell lung cancer in octogenarians. ANZ J Surg 2018; 88:1322-1327. [DOI: 10.1111/ans.14861] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Revised: 08/04/2018] [Accepted: 08/06/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Jaideep Vazirani
- Department of Respiratory and Sleep Medicine; The Royal Melbourne Hospital; Melbourne Victoria Australia
| | - Johanna Moraes
- Department of Respiratory and Sleep Medicine; The Royal Melbourne Hospital; Melbourne Victoria Australia
| | - Stephen Barnett
- Department of Cardiothoracic Surgery; The Royal Melbourne Hospital; Melbourne Victoria Australia
- Department of Thoracic Surgery; Austin Hospital; Melbourne Victoria Australia
- Division of Cancer Surgery; Peter MacCallum Cancer Centre; Melbourne Victoria Australia
- Department of Surgery; The University of Melbourne; Melbourne Victoria Australia
| | - Douglas F. Johnson
- Department of Medicine; The Royal Melbourne Hospital; Melbourne Victoria Australia
- Department of Medicine; University of Melbourne; Melbourne Victoria Australia
| | - Simon Knight
- Department of Thoracic Surgery; Austin Hospital; Melbourne Victoria Australia
- Department of Surgery; The University of Melbourne; Melbourne Victoria Australia
| | - Alistair Miller
- Department of Respiratory and Sleep Medicine; Monash Health; Melbourne Victoria Australia
| | - Gavin Wright
- Department of Cardiothoracic Surgery; The Royal Melbourne Hospital; Melbourne Victoria Australia
- Division of Cancer Surgery; Peter MacCallum Cancer Centre; Melbourne Victoria Australia
- Department of Surgery; The University of Melbourne; Melbourne Victoria Australia
- Department of Cardiothoracic Surgery; St Vincent's Hospital; Melbourne Victoria Australia
| | - Naveed Z. Alam
- Department of Surgery; The University of Melbourne; Melbourne Victoria Australia
- Department of Cardiothoracic Surgery; St Vincent's Hospital; Melbourne Victoria Australia
| | - Matthew Conron
- Department of Respiratory and Sleep Medicine; St Vincent's Hospital; Melbourne Victoria Australia
- Department of Cancer Medicine; Peter MacCallum Cancer Centre; Melbourne Victoria Australia
| | - Louis B. Irving
- Department of Respiratory and Sleep Medicine; The Royal Melbourne Hospital; Melbourne Victoria Australia
- Department of Medicine; University of Melbourne; Melbourne Victoria Australia
- Department of Cancer Medicine; Peter MacCallum Cancer Centre; Melbourne Victoria Australia
| | - Phillip Antippa
- Department of Cardiothoracic Surgery; The Royal Melbourne Hospital; Melbourne Victoria Australia
- Division of Cancer Surgery; Peter MacCallum Cancer Centre; Melbourne Victoria Australia
- Department of Surgery; The University of Melbourne; Melbourne Victoria Australia
| | - Daniel P. Steinfort
- Department of Respiratory and Sleep Medicine; The Royal Melbourne Hospital; Melbourne Victoria Australia
- Department of Medicine; University of Melbourne; Melbourne Victoria Australia
- Department of Cancer Medicine; Peter MacCallum Cancer Centre; Melbourne Victoria Australia
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12
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Grigg SE, Date P, Loh Z, Estacio O, Johnson DF, Hawkes EA, Grigg A. Urine cultures at the onset of febrile neutropenia rarely impact antibiotic management in asymptomatic adult cancer patients. Support Care Cancer 2018; 27:1223-1227. [PMID: 30259115 DOI: 10.1007/s00520-018-4476-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 05/21/2018] [Accepted: 09/17/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE There is a paucity of data regarding the utility of routine urine cultures in adults with febrile neutropenia (FN) without urinary symptoms receiving protocolised antibiotics. This is reflected by inconsistent recommendations in international and regional FN guidelines. We addressed this issue by retrospectively reviewing the impact of routine urine cultures on antibiotic management in haematology cancer inpatients at a tertiary hospital. METHODS All haematology inpatients over a 5-year period (2011-2015) were retrospectively reviewed for episodes of FN (neutrophil count < 0.5 × 109/L and fever > 37.5 °C). For each episode, demographic data, urinary tract symptoms and signs (absence of which was termed 'asymptomatic'), urinalysis and urine culture results, antibiotic therapy and duration, and patient outcomes were collected. A urine culture was considered positive if > 105 colony forming units (CFU)/L were detected. Empiric antibiotic therapy for FN consisted of intravenous piperacillin/tazobactam in stable patients, with the addition of vancomycin and a single dose of gentamicin if systemically compromised. RESULTS Four hundred and thirty-three episodes of FN were identified in 317 patients. Urine cultures were performed in 362 (84%) episodes. Cultures were positive in 9 of 48 (19%) symptomatic episodes versus 8 of 314 (2.5%) asymptomatic episodes (RR = 7.4, p < 0.0001). A change in antibiotic management due a positive urine culture occurred in only 5 episodes (1.4%): 3 of 48 (6.3%) symptomatic and 2 of 314 (0.6%) asymptomatic episodes respectively (RR = 9.8, p = 0.01). CONCLUSION Routine urine cultures in FN patients without urinary symptoms who are already receiving protocolised broad spectrum antibiotics rarely impact subsequent antibiotic management.
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Affiliation(s)
- Sam E Grigg
- University of Melbourne, Parkville, Victoria, Australia
| | - Patrick Date
- University of Melbourne, Parkville, Victoria, Australia
| | - Zoe Loh
- University of Melbourne, Parkville, Victoria, Australia
| | - Ortis Estacio
- University of Melbourne, Parkville, Victoria, Australia
| | - Douglas F Johnson
- Department of Infectious Diseases, Austin Hospital, Heidelberg, Victoria, Australia.,Department of Medicine, Austin Hospital, Heidelberg, Victoria, Australia
| | - Eliza A Hawkes
- University of Melbourne, Parkville, Victoria, Australia.,Department of Clinical Haematology, Austin Hospital, Heidelberg, Victoria, Australia.,Olivia Newton John Cancer Research Institute, Heidelberg, Victoria, Australia
| | - Andrew Grigg
- University of Melbourne, Parkville, Victoria, Australia. .,Department of Clinical Haematology, Austin Hospital, Heidelberg, Victoria, Australia. .,Olivia Newton John Cancer Research Institute, Heidelberg, Victoria, Australia.
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13
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Pai Mangalore R, Johnson DF, Leder K. Travellers visiting friends and relatives: a high-risk, under-recognised group for imported infectious diseases. Intern Med J 2018; 48:759-762. [DOI: 10.1111/imj.13956] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Revised: 04/29/2018] [Accepted: 04/29/2018] [Indexed: 12/27/2022]
Affiliation(s)
- Rekha Pai Mangalore
- Department of Infectious Diseases; Alfred Health; Melbourne Victoria Australia
| | - Douglas F. Johnson
- Department of Infectious Diseases; Austin Health; Melbourne Victoria Australia
- Department of General Medicine; Austin Health; Melbourne Victoria Australia
| | - Karin Leder
- School of Epidemiology and Preventive Medicine; Monash University; Melbourne Victoria Australia
- Victorian Infectious Disease Service; Royal Melbourne Hospital at the Doherty Institute for Infection and Immunity; Melbourne Victoria Australia
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14
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Johnson DF, Stout JE. Corticosteroids for tuberculous pericarditis: can we learn from variability? Int J Tuberc Lung Dis 2018; 22:475. [DOI: 10.5588/ijtld.18.0134] [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: 11/10/2022] Open
Affiliation(s)
- Douglas F. Johnson
- Department of Infectious Diseases, Austin Hospital, Heidelberg, Melbourne, VIC, Australia; Department of Medicine, Melbourne University, Melbourne, VIC, Australia
| | - Jason E. Stout
- Division of Infectious Diseases and International Health, Department of Medicine, Duke University Medical Center, Durham, NC, USA.
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15
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Neef PA, Burrell LM, McDonald CF, Irving LB, Johnson DF, Steinfort DP. Author reply. Intern Med J 2018; 48:228-229. [DOI: 10.1111/imj.13700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2017] [Accepted: 11/29/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Pieter A. Neef
- Department of General Medicine; Austin Health; Melbourne Victoria Australia
| | - Louise M. Burrell
- Department of General Medicine; Austin Health; Melbourne Victoria Australia
- Department of Medicine and Cardiology; The University of Melbourne; Melbourne Victoria Australia
| | - Christine F. McDonald
- Department of Respiratory and Sleep Medicine; Austin Health; Melbourne Victoria Australia
- Department of Medicine; The University of Melbourne; Melbourne Victoria Australia
| | - Louis B. Irving
- Department of Medicine; The University of Melbourne; Melbourne Victoria Australia
- Department of Respiratory and Sleep Medicine; Melbourne Health; Melbourne Victoria Australia
| | - Douglas F. Johnson
- Department of General Medicine; Austin Health; Melbourne Victoria Australia
- Department of Medicine; The University of Melbourne; Melbourne Victoria Australia
| | - Daniel P. Steinfort
- Department of Medicine; The University of Melbourne; Melbourne Victoria Australia
- Department of Respiratory and Sleep Medicine; Melbourne Health; Melbourne Victoria Australia
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16
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Plant LD, Taylor DM, Worland T, Puri A, Ugoni A, Patel SK, Johnson DF, Burrell LM. Development of Acute Decompensated Heart Failure Among Hospital Inpatients: Incidence, Causes and Outcomes. Heart Lung Circ 2017. [PMID: 29519692 DOI: 10.1016/j.hlc.2017.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND We aimed to investigate the incidence, precipitants, and outcomes of acute decompensated heart failure (ADHF) that develops during the inpatient stay. METHODS We undertook a case-control study in the medical, oncology, surgical, and orthopaedic wards of a tertiary referral hospital (February-May, 2016). Patients aged ≥18 years who developed ADHF during their inpatient stay were enrolled as cases. One control patient was matched to each case by age, gender, presenting complaint/surgery performed and co-morbidities. Multivariate regression was employed to determine variables associated with ADHF. RESULTS The incidence of ADHF was 1.0% of patients. Eighty cases were well-matched to 80 controls (p>0.05). ADHF precipitants comprised infection (30%), inappropriate intravenous (IV) fluid and medication management (23.8% and 8.8%, respectively), tachyarrhythmia (12.5%), ischaemic heart disease (8.8%), renal failure (1.3%), and other/unclear causes (15%). Three variables were associated with ADHF: not having English as the preferred language (OR 3.5, 95%CI 1.2-9.8), a history of ischaemic heart disease (OR 3.3, 95%CI 1.2-9.1), and the administration of >2000ml of IV fluid on the day before the ADHF (OR 8.3, 95%CI 1.5-48.0). The day before the ADHF, cases were administered significantly more IV fluids than controls (median 2,757.5 versus 975ml, p=0.001). Medication errors mostly related to failure to restart regular diuretics. Cases had significantly greater length of stay (median 15 versus 6 days, p<0.001) and mortality (12.5% versus 1.3%, p=0.01). CONCLUSIONS New onset ADHF is common and a substantial proportion of cases are iatrogenic. Cases experience significantly increased length of hospital stay, morbidity, and mortality.
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Affiliation(s)
- Luke D Plant
- Department of Emergency Medicine, Austin Hospital, Melbourne, Vic, Australia
| | - David McDonald Taylor
- Department of Emergency Medicine, Austin Hospital, Melbourne, Vic, Australia; Department of Medicine, University of Melbourne, Melbourne, Vic, Australia.
| | - Thomas Worland
- Department of Medicine, Austin Hospital, Melbourne, Vic, Australia
| | - Arvind Puri
- Department of Medicine, Austin Hospital, Melbourne, Vic, Australia
| | - Antony Ugoni
- Department of Medicine, University of Melbourne, Melbourne, Vic, Australia
| | - Sheila K Patel
- Department of Medicine, University of Melbourne, Melbourne, Vic, Australia; Department of Medicine, Austin Hospital, Melbourne, Vic, Australia
| | - Douglas F Johnson
- Department of Medicine, University of Melbourne, Melbourne, Vic, Australia; Department of Medicine, Austin Hospital, Melbourne, Vic, Australia; Department of Infectious Diseases, Austin Hospital, Melbourne, Vic, Australia
| | - Louise M Burrell
- Department of Medicine, University of Melbourne, Melbourne, Vic, Australia; Department of Medicine, Austin Hospital, Melbourne, Vic, Australia
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17
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Neef PA, Burrell LM, McDonald CF, Irving LB, Johnson DF, Steinfort DP. Commencement of cardioselective beta-blockers during hospitalisation for acute exacerbations of chronic obstructive pulmonary disease. Intern Med J 2017; 47:1043-1050. [DOI: 10.1111/imj.13518] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Revised: 05/24/2017] [Accepted: 05/29/2017] [Indexed: 12/18/2022]
Affiliation(s)
- Pieter A. Neef
- Department of General Medicine; Austin Health; Melbourne Victoria Australia
| | - Louise M. Burrell
- Department of General Medicine; Austin Health; Melbourne Victoria Australia
- Department of Medicine and Cardiology; The University of Melbourne; Melbourne Victoria Australia
| | - Christine F. McDonald
- Department of Respiratory and Sleep Medicine; Austin Health; Melbourne Victoria Australia
- Department of Medicine; The University of Melbourne; Melbourne Victoria Australia
| | - Louis B. Irving
- Department of Medicine; The University of Melbourne; Melbourne Victoria Australia
- Department of Respiratory and Sleep Medicine; Melbourne Health; Melbourne Victoria Australia
| | - Douglas F. Johnson
- Department of General Medicine; Austin Health; Melbourne Victoria Australia
- Department of Medicine; The University of Melbourne; Melbourne Victoria Australia
| | - Daniel P. Steinfort
- Department of Medicine; The University of Melbourne; Melbourne Victoria Australia
- Department of Respiratory and Sleep Medicine; Melbourne Health; Melbourne Victoria Australia
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18
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Neef PA, McDonald CF, Burrell LM, Irving LB, Johnson DF, Steinfort DP. Beta-blockers are under-prescribed in patients with chronic obstructive pulmonary disease and co-morbid cardiac disease. Intern Med J 2017; 46:1336-1340. [PMID: 27813357 DOI: 10.1111/imj.13240] [Citation(s) in RCA: 14] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Revised: 05/30/2016] [Accepted: 06/21/2016] [Indexed: 11/29/2022]
Abstract
The use of beta-blockers in patients with chronic obstructive pulmonary disease and co-morbid cardiovascular disease is controversial, despite increasing evidence to support their use as safe and efficacious. This study retrospectively assessed the rates of beta-blocker prescription in patients admitted to two Australian tertiary hospitals for acute exacerbation of chronic obstructive pulmonary disease. This revealed that less than half of patients (45%) with known cardiac indications were receiving beta-blocker therapy, evident across all degrees of airways disease severity. Further work is needed to ensure that medical management of this patient group is optimised.
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Affiliation(s)
- P A Neef
- General Medicine, Melbourne, Victoria, Australia.
| | - C F McDonald
- Department of Respiratory and Sleep Medicine, Austin Health, Melbourne, Victoria, Australia.,Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
| | - L M Burrell
- Department of Medicine and Cardiology, The University of Melbourne, Austin Health, Melbourne, Victoria, Australia
| | - L B Irving
- Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia.,Department of Respiratory and Sleep Medicine, Melbourne Health, Melbourne, Victoria, Australia
| | - D F Johnson
- General Medicine, Melbourne, Victoria, Australia.,Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
| | - D P Steinfort
- Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia.,Department of Respiratory and Sleep Medicine, Melbourne Health, Melbourne, Victoria, Australia
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19
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Huynh A, Leong K, Jones N, Crump N, Russell D, Anderson M, Steinfort D, Johnson DF. Outcomes of exertional rhabdomyolysis following high-intensity resistance training. Intern Med J 2017; 46:602-8. [PMID: 26949203 DOI: 10.1111/imj.13055] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [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: 10/04/2015] [Revised: 02/17/2016] [Accepted: 02/26/2016] [Indexed: 12/29/2022]
Abstract
BACKGROUND High-intensity resistance training (HIRT) programmes are increasingly popular amongst personal trainers and those attending gymnasiums. We report the experience of exertional rhabdomyolysis (ER) at two tertiary hospitals in Melbourne, Australia. AIMS To compare the clinical outcomes of ER with other causes of rhabdomyolysis. METHODS Retrospective cross-sectional study of patients presenting with a serum creatine kinase (CK) of greater than 25 000 units/L from 1 September 2013 to 31 August 2014 at two tertiary referral hospitals in Melbourne, Australia. Records were examined to identify care measures implemented during hospital stay, clinical outcomes during admission and on subsequent follow up. RESULTS Thirty four cases of rhabdomyolysis with a CK of greater than 25 000 units/L (normal range: 20-180 units/L) were identified during the 12-month study period. Twelve of the 34 cases (35%) had ER with 10 of 12 related to HIRT. No acute kidney injury, intensive care admission or death were seen among those with ER. All cases were managed conservatively, with 11 admitted and 9 receiving intravenous fluids only. In contrast, patients with rhabdomyolysis from other causes experienced significantly higher rates of intensive care admission (64%, P = 0.0002), acute kidney injury (82%, P = 0.0001) and death (27%, P = 0.069). CONCLUSION ER resulting from HIRT appears to have a benign course compared with rhabdomyolysis of other aetiologies in patients with a serum CK greater than 25 000 units/L. Conservative management of ER appears to be adequate, although this requires confirmation in future prospective studies.
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Affiliation(s)
- A Huynh
- Department of General Medicine, Austin Health, Melbourne, Victoria, Australia
| | - K Leong
- Department of General Medicine, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - N Jones
- Department of General Medicine, Austin Health, Melbourne, Victoria, Australia
| | - N Crump
- Department of Neurology, Austin Health, Melbourne, Victoria, Australia
| | - D Russell
- Department of General Medicine, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - M Anderson
- Shinbone Medical Centre, Melbourne, Victoria, Australia
| | - D Steinfort
- Department of Respiratory Medicine, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - D F Johnson
- Department of General Medicine, Austin Health, Melbourne, Victoria, Australia
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20
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Tai AY, McGuinness SL, Robosa R, Turner D, Huang GKL, Leder K, Korman TM, Thevarajan I, Stewardson AJ, Padiglione AA, Johnson DF. Management of dengue in Australian travellers: a retrospective multicentre analysis. Med J Aust 2017; 206:295-300. [PMID: 28403751 DOI: 10.5694/mja16.01056] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2016] [Accepted: 12/01/2016] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To describe the epidemiology, clinical and laboratory features and outcomes of dengue in returned Australian travellers, applying the revised WHO dengue classification (2009) to this population. DESIGN, SETTING AND PARTICIPANTS Retrospective case series analysis of confirmed dengue cases hospitalised at one of four Australian tertiary hospitals, January 2012 - May 2015. MAIN OUTCOME MEASURES Clinical features, laboratory findings and outcomes of patients with dengue; dengue classification according to 2009 WHO guidelines. RESULTS 208 hospitalised patients (median age, 32 years; range, 4-76 years) were included in the study. Dengue was most frequently acquired in Indonesia (94 patients, 45%) and Thailand (40, 19%). The most common clinical features were fever (98% of patients) and headache (76%). 84 patients (40%) met the WHO criteria for dengue with warning signs, and one the criteria for severe dengue; the most common warning signs were mucosal bleeding (44 patients, 21%) and abdominal pain (43, 21%). Leukopenia (176 patients, 85%), thrombocytopenia (133, 64%), and elevated liver enzyme levels (154, 76%) were the most common laboratory findings. 46 patients (22%) had serological evidence of previous exposure to dengue virus. WHO guidelines were documented as a management benchmark in ten cases (5%); 46 patients (22%) received non-steroidal anti-inflammatory drugs (NSAIDs). CONCLUSIONS A significant proportion of returning Australian travellers hospitalised for dengue have unrecognised warning signs of severe disease. Many received NSAIDs, which can increase the risk of haemorrhage in dengue. As travel to Asia from Australia continues to increase, it is vital for averting serious outcomes that clinicians can recognise and manage dengue.
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Affiliation(s)
| | | | - Roselle Robosa
- Monash Infectious Diseases, Monash Health and Monash University, Melbourne, VIC
| | - David Turner
- Victorian Infectious Disease Service, Royal Melbourne Hospital, Melbourne, VIC
| | | | - Karin Leder
- Victorian Infectious Disease Service, Royal Melbourne Hospital, Melbourne, VIC
| | - Tony M Korman
- Monash Infectious Diseases, Monash Health and Monash University, Melbourne, VIC
| | - Irani Thevarajan
- Victorian Infectious Disease Service, Royal Melbourne Hospital, Melbourne, VIC
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21
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Trubiano JA, Pai Mangalore R, Baey YW, Le D, Graudins LV, Charles PGP, Johnson DF, Aung AK. Old but not forgotten: Antibiotic allergies in General Medicine (the AGM Study). Med J Aust 2016; 204:273. [PMID: 27078602 DOI: 10.5694/mja15.01329] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Accepted: 01/19/2016] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To determine the nature, prevalence and description accuracy of recorded antibiotic allergy labels (AALs) in a cohort of general medical inpatients, and to assess the feasibility of an oral antibiotic re-challenge study. DESIGN Multicentre cross-sectional study. SETTING AND PARTICIPANTS All patients admitted to the general medical units of Austin Health and Alfred Health, 18 May - 5 June 2015. MAIN OUTCOME MEASURES Baseline demographics, medical and allergy history, infection diagnoses and antibiotic prescribing data for general medical inpatients were collected. A questionnaire was administered to clarify AAL history, followed by correlation of responses with electronic and admissions record descriptions. A hypothetical oral re-challenge in a supervised setting was offered to patients with low risk allergy phenotypes (non-immediate reaction, non-severe cutaneous adverse reaction, or unknown reaction more than 10 years ago). RESULTS Of the 453 inpatients, 107 (24%) had an AAL (median age, 82 years; interquartile range, 74-87 years); 160 individual AALs were recorded, and there was a mismatch in AAL description between recording platforms in 25% of cases. Most patients with an AAL were women (64%; P < 0.001), and more presented with concurrent immunosuppression than those without an AAL (23% v 8%; P < 0.001). β-Lactam penicillins were employed less frequently in patients with an AAL (16% v 35%; P = 0.02), while ceftriaxone (32% v 20%; P = 0.02) and fluoroquinolones (6% v 2%; P = 0.04) were used more often. Fifty-four per cent of patients with AALs were willing to undergo oral re-challenge, of whom 48% had a low risk allergy phenotype. CONCLUSIONS AAL prevalence in general medical inpatients was 24%, and was associated with excessive use of broad spectrum antibiotics. Allergies in a large proportion of patients with AALs were incorrectly documented, and were non-immune-mediated and potentially amenable to oral re-challenge. A direct oral re-challenge study in carefully selected patients with low risk allergy phenotypes appears feasible.
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Affiliation(s)
| | | | | | - Duy Le
- Austin Health, Melbourne, VIC
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22
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Foo CT, Burrell LM, Johnson DF. An unusual presentation of carcinomatous meningitis. Oxf Med Case Reports 2016; 2016:omw068. [PMID: 27574561 PMCID: PMC5002064 DOI: 10.1093/omcr/omw068] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Revised: 06/23/2016] [Accepted: 06/25/2016] [Indexed: 11/14/2022] Open
Abstract
A 67-year old previously well male presented with a 1 week history of confusion on a background of 3 weeks of headache. Past history included two superficial melanomas excised 5 years ago. Treatment for meningoencephalitis was commenced based on lumbar puncture (LP) and non-contrast brain magnetic resonance imaging (MRI) results. Lack of a clinical response to antibiotics resulted in a second LP and contrast brain MRI which demonstrated hydrocephalus and leptomeningeal disease. Ongoing deterioration led to a whole-body computed tomographic and spinal MRI that showed widespread metastatic disease and extensive leptomeningeal involvement of the spinal cord. The diagnosis of metastatic melanoma with carcinomatous meningitis was made based on cytological analysis of cerebrospinal fluid. He died 2 weeks later in a palliative care facility. This case illustrates that the diagnosis of carcinomatous meningitis can be difficult to make as the heterogeneous nature of its presentation often delays the diagnosis.
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Affiliation(s)
- Chuan T. Foo
- Department of Medicine, Austin Health, Heidelberg, Victoria3084, Australia
| | - Louise M. Burrell
- Department of Medicine, University of Melbourne, Heidelberg, Victoria3084, Australia
| | - Douglas F. Johnson
- Department of Medicine, Austin Health, Heidelberg, Victoria3084, Australia
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23
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Macesic N, Abbott IJ, Johnson DF. PHOTO QUIZ. Fever and Rash in a Husband and Wife Returning From the Cook Islands. Clin Infect Dis 2016; 61:1445, 1485-6. [PMID: 26453655 DOI: 10.1093/cid/civ401] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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24
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Abstract
Literature is summarized regarding the older worker from the perspective of industrial psychology. Suggestions about manag ing the older worker are derived from examining the areas of personnel psychology, organizational psychology, and human factors in the physical environment of work. Problems facing the older worker are examined at both individual and organizational levels. Solutions to problems caused by age bias are suggested.
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26
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McGuinness SL, Spelman T, Johnson DF, Leder K. Response to Letter. J Travel Med 2015; 22:429-30. [PMID: 26503097 DOI: 10.1111/jtm.1_12238] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Accepted: 08/12/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Sarah L McGuinness
- Victorian Infectious Diseases Service (VIDS), Royal Melbourne Hospital, Melbourne, Australia
| | - Tim Spelman
- Victorian Infectious Diseases Service (VIDS), Royal Melbourne Hospital, Melbourne, Australia
| | - Douglas F Johnson
- Department of General Medicine and Infectious Diseases, Austin Health, Melbourne, Australia
| | - Karin Leder
- Victorian Infectious Diseases Service (VIDS), Royal Melbourne Hospital, Melbourne, Australia.,Infectious Disease Epidemiology Unit, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
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27
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McGuinness SL, Spelman T, Johnson DF, Leder K. Immediate recall of health issues discussed during a pre-travel consultation. J Travel Med 2015; 22:145-51. [PMID: 25594824 DOI: 10.1111/jtm.12183] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Revised: 10/24/2014] [Accepted: 10/27/2014] [Indexed: 01/15/2023]
Abstract
BACKGROUND An important role of pre-travel consultations is to improve travelers' understanding of travel-related diseases, but the efficacy of education provided is unknown. This study sought to assess recall and knowledge immediately following a pre-travel consultation. METHODS The study was conducted at a hospital-based pre-travel clinic in Melbourne, Australia. Travelers aged ≥16 years seen between September 2010 and March 2012 were invited to complete an anonymous self-administered questionnaire immediately following their consultation to assess knowledge of appropriate preventive measures and presumptive self-treatment strategies for common travel risks. The doctor of each participating traveler also completed a survey regarding issues discussed. RESULTS A total of 300 participants were recruited (34% male, median age 31 years). Most were traveling for vacation (77%) and reported previous travel (95%). Main travel destinations were Asia (43%), Americas (21%), and Africa (17%). Doctors' and travelers' surveys showed variable levels of concordance: 94% of patients recalled discussion of malaria, 84% rabies, and 76% dengue. For malaria, 95% remembered discussions regarding insect repellents, and 92% recalled that medical advice should be sought if fever developed. For travelers with whom rabies was discussed, 94% recalled that medical advice must be urgently sought following a bite/scratch. For travelers' diarrhea (TD), 99% knew to drink only boiled/bottled water, but 13% did not recall avoiding unpeeled fruit/vegetables as a prevention strategy. There was 20% discordance between doctors and travelers regarding antibiotics for TD self-treatment, but only 4% discordance regarding prescription of malaria prophylaxis. Factors associated with improved recall were doctor discussion, previous travel, and a university education. CONCLUSIONS Key travel health messages are well assimilated after pre-travel consultation. However, large amounts of information are discussed and immediate recollection of all information is not possible. This study reinforces the importance of providing supplementary information (eg, written and/or electronic resources) to accompany pre-travel consultations.
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Affiliation(s)
- Sarah L McGuinness
- Victorian Infectious Diseases Service (VIDS), Royal Melbourne Hospital, Melbourne, Australia
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Geake J, Hammerschlag G, Nguyen P, Wallbridge P, Jenkin GA, Korman TM, Jennings B, Johnson DF, Irving LB, Farmer M, Steinfort DP. Utility of EBUS-TBNA for diagnosis of mediastinal tuberculous lymphadenitis: a multicentre Australian experience. J Thorac Dis 2015; 7:439-48. [PMID: 25922723 PMCID: PMC4387413 DOI: 10.3978/j.issn.2072-1439.2015.01.33] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Accepted: 12/17/2014] [Indexed: 12/23/2022]
Abstract
BACKGROUND Endobronchial ultrasound (EBUS) transbronchial needle aspiration (TBNA) is an important diagnostic procedure for the interrogation of mediastinal lymph nodes. There is limited data describing the accuracy & safety of this technique for the diagnosis of tuberculous mediastinal lymphadenitis. METHODS A multi-centre retrospective study of all EBUS-guided TBNA procedures that referred samples for mycobacteriology was performed. Results were correlated with post-procedural diagnoses after a period of surveillance and cross-checked against relevant statewide tuberculosis (TB) registries, and sensitivity and specificity was calculated. In addition, nucleic acid amplification techniques (NAAT) were assessed, and sensitivity and specificity calculated using positive mycobacterial culture as the reference gold standard. RESULTS One hundred and fifty-nine patients underwent EBUS-TBNA and had tissue referred for mycobacterial culture, of which 158 were included in the final analysis. Thirty-nine were ultimately diagnosed with TB (25%). Sensitivity of EBUS-TBNA for microbiologically confirmed tuberculous mediastinal lymphadenitis was 62% (24/39 cases). Specificity was 100%. Negative predictive value (NPV) and diagnostic accuracy for microbiologic diagnosis was 89% [95% confidence intervals (CI), 82-93%] and 91% (95% CI, 84-94%) respectively. For a composite clinicopathologic diagnosis of TB NPV and accuracy were 98% (95% CI, 93-99%) and 98% (95% CI, 95-99%) respectively. Sensitivity for NAAT was 38% (95% CI, 18-65%). CONCLUSIONS EBUS-TBNA is a safe and well tolerated procedure in the assessment of patients with suspected isolated mediastinal lymphadenitis and demonstrates good sensitivity for a microbiologic diagnosis of isolated mediastinal lymphadenitis. When culture and histological results are combined with high clinical suspicion, EBUS-TBNA demonstrates excellent diagnostic accuracy and NPV for the diagnosis of mediastinal TB lymphadenitis. We suggest EBUS-TBNA should be considered the procedure of choice for patients in whom TB is suspected.
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Torresi J, Johnson DF, Leder K. Response to letters. J Travel Med 2013; 20:409-10. [PMID: 24165388 DOI: 10.1111/jtm.12068_2] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Joseph Torresi
- Department of Infectious Diseases, Austin Hospital, Heidelberg, Victoria, Australia; Victorian Infectious Diseases Service, Royal Melbourne Hospital, Parkville, Victoria, Australia
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Luzze H, Johnson DF, Dickman K, Mayanja-Kizza H, Okwera A, Eisenach K, Cave MD, Whalen CC, Johnson JL, Boom WH, Joloba M. Relapse more common than reinfection in recurrent tuberculosis 1-2 years post treatment in urban Uganda. Int J Tuberc Lung Dis 2013; 17:361-7. [PMID: 23407224 DOI: 10.5588/ijtld.11.0692] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE To determine the proportion of recurrent tuberculosis (TB) due to relapse with the patient's initial strain or reinfection with a new strain of Mycobacterium tuberculosis 1-2 years after anti-tuberculosis treatment in Uganda, a sub-Saharan TB-endemic country. DESIGN Records of patients with culture-confirmed TB who completed treatment at an urban Ugandan clinic were reviewed. Restriction fragment length polymorphism (RFLP) patterns were used to determine relapse or reinfection. Associations between human immunodeficiency virus (HIV) positivity and type of TB recurrence were determined. RESULTS Of 1701 patients cured of their initial TB episode with a median follow-up of 1.24 years, 171 (10%) had TB recurrence (8.4 per 100 person-years). Rate and risk factors for recurrence were similar to other studies from sub-Saharan Africa. Insertion sequence (IS) 6110-based RFLP of paired isolates from 98 recurrences identified 80 relapses and 18 reinfections. Relapses among HIV-positive and -negative patients were respectively 79% and 85% of recurrences. CONCLUSIONS Relapse was more common and presented earlier than reinfection in both HIV-positive and -negative TB patients 1-2 years after completing treatment. These findings impact both the choice of retreatment drug regimen, as relapsing patients are at higher risk for acquired drug resistance, and clinical trials of new TB regimens with relapse as clinical endpoint.
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Affiliation(s)
- H Luzze
- National Tuberculosis and Leprosy Program, Mulago Hospital and Complex, Kampala, Uganda
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Johnson DF, Leder K, Torresi J. Hepatitis B and C infection in international travelers. J Travel Med 2013; 20:194-202. [PMID: 23577866 DOI: 10.1111/jtm.12026] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2012] [Revised: 01/10/2013] [Accepted: 01/14/2013] [Indexed: 01/07/2023]
Abstract
BACKGROUND Hepatitis B and C virus (HBV and HCV) cause significant morbidity and mortality worldwide. With the rise in international travel over the last three decades, many travelers are at risk of HBV and HCV infection. METHODS This review focuses on the epidemiology of HBV and HCV in international travelers, the modes of transmission, and the prevention of infection in travelers. RESULTS The risk of HBV and HCV infection varies widely and depends on the prevalence of the destination country, the duration of travel, and the activities undertaken while abroad. Travelers commonly undertake high-risk activities that place them at risk of both HBV and HCV infection. Poor uptake of preventative health measures and poor adherence to health recommendations are also common. The monthly incidence of HBV infection for long-term travelers to endemic countries ranges from 25 to 420 per 100,000 travelers. HBV infection can be prevented through timely vaccination of travelers. HBV vaccination is safe and efficacious with protective levels of antibodies achieved in >90% of recipients. Information regarding the risk of HCV acquisition is scarce and until recently was limited to case reports following medical interventions. CONCLUSIONS This review demonstrates international travelers are at risk of HBV and HCV infection and provides evidence-based information enabling health practitioners to provide more appropriate pre-travel advice. HBV vaccination should be considered in all travelers to countries with a moderate to high HBV prevalence (HBsAg ≥ 2%) and the risk and benefits discussed with the individuals in consultation with the health practitioner. There is no duration of travel without risk of HBV infection. However, it is apparent that those travelers with a longer duration of travel are at greatest risk of HBV infection (ie, expatriates). Travelers should also receive advice regarding the modes of transmission and the activities that place them at risk of both HBV and HCV infection.
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Affiliation(s)
- Douglas F Johnson
- Department of Infectious Diseases, Austin Hospital, University of Melbourne, Heidelberg, Victoria, Australia
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Johnson DF, Ratnam I, Matchett E, Earnest-Silveria L, Christiansen D, Leder K, Grayson ML, Torresi J. The incidence of HBV and HCV infection in Australian travelers to Asia. J Travel Med 2013; 20:203-5. [PMID: 23577867 DOI: 10.1111/jtm.12029] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2012] [Revised: 12/26/2012] [Accepted: 01/02/2013] [Indexed: 11/30/2022]
Abstract
We analyzed paired pre- and post-travel sera in a cohort of Australian travelers to Asia and demonstrated the acquisition of hepatitis C virus (HCV) and hepatitis B virus (HBV) infection. The incidence density in nonimmune travelers for HCV infection was calculated as 1.8 infections per 10,000 traveler-days and for HBV infection 2.19 per 10,000 traveler-days.
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Affiliation(s)
- Douglas F Johnson
- Department of Infectious Diseases, Austin Hospital, University of Melbourne, Heidelberg, Victoria, Australia
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Mahan CS, Johnson DF, Curley C, van der Kuyp F. Concordance of a positive tuberculin skin test and an interferon gamma release assay in bacille Calmette-Guérin vaccinated persons. Int J Tuberc Lung Dis 2011; 15:174-i. [PMID: 21219677] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023] Open
Abstract
BACKGROUND False-positive tuberculin skin test (TST) results due to prior bacille Calmette-Guérin (BCG) vaccination may lead to unnecessary treatment of presumed latent tuberculosis infection (LTBI). Recently approved interferon-gamma release assays (IGRAs) are more specific for LTBI in this group. METHODS A total of 316 BCG-vaccinated foreign-born individuals with a positive TST had a commercially available IGRA (QuantiFERON®-TB Gold In-Tube) performed as part of a two-step procedure to determine the need for isoniazid therapy. Baseline demographic information and TST size were recorded and analyzed for characteristics associated with an increased likelihood of having a positive IGRA. RESULTS Increasing age, male sex, origin from a country with a high prevalence of tuberculosis (TB), shorter time since arrival in the United States, and increasing TST size were all independently associated with a positive IGRA. CONCLUSION Patient characteristics and TST size can help determine those at highest risk for LTBI. A two-step procedure for LTBI screening should be considered for foreign-born persons with prior BCG vaccination and a positive TST.
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Affiliation(s)
- C S Mahan
- Department of Medicine, MetroHealth Medical Center, Cleveland, Ohio 44109, USA.
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Abstract
The presence of cholesterol in Solanum tuberosum and Dioscorea spiculiflora plants was demonstrated by gas-liquid chromatography, thin-layer chromatography, isolation and mixed melting point, and purification to constant radioactivity after dilution with authentic cholesterol.
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Abstract
Two cases of Old World cutaneous leishmaniasis (OWCL) acquired by travelers to Morocco are described. In Australia, OWCL is more frequently seen in migrants rather than returned travelers. The patients were treated with sodium stibogluconate and fluconazole. Optimal treatment is not established, particularly in returned travelers, but identification of Leishmania species can help with the selection of appropriate therapy.
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Affiliation(s)
- Andrew J Stewardson
- Department of Infectious Diseases, Austin Health, Heidelberg, Victoria, Australia.
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Worthley DL, Johnson DF, Eisen DP, Dean MM, Heatley SL, Tung JP, Scott J, Padbury RTA, Harley HA, Bardy PG, Angus PW, Mullighan CG. Donor mannose-binding lectin deficiency increases the likelihood of clinically significant infection after liver transplantation. Clin Infect Dis 2009; 48:410-7. [PMID: 19143554 DOI: 10.1086/596313] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Mannose-binding lectin (MBL) is an important mediator of innate immunity and is synthesized primarily by the liver. Low MBL levels are common, are due primarily to polymorphisms in the gene encoding MBL (MBL2), and are associated with an increased risk of infection, particularly when immunity is compromised. We report a large, retrospective study that examined the association between MBL status and clinically significant infection following orthotopic liver transplantation. METHODS One hundred two donor-recipient orthotopic liver transplantation pairs were studied. Five polymorphisms in the promoter and coding regions of MBL2 were examined. MBL levels were measured, using the mannan-binding and C4-deposition assays, in serum samples obtained before and after transplantation. Associations between MBL status, as assessed by serum MBL levels and MBL2 genotype, and time to first clinically significant infection (CSI) after transplantation were examined in survival analysis with consideration of competing risks. RESULTS The median duration of follow-up after orthotopic liver transplantation was 4 years. Thirty-six percent of recipients developed CSI after transplantation. The presence of MBL2 coding mutations in the donor was significantly associated with CSI in the recipient; the cumulative incidence function of infection was 55% in recipients of deficient livers, compared with 32% for recipients of wild-type livers (P = .002). Infection was not associated with recipient MBL2 genotype. Low MBL levels after orthotopic liver transplantation levels (mannan-binding <1 microg/mL or C4 deposition <0.2 C4 U/microL) were also associated with CSI (cumulative incidence function, 52% vs. 20%, P = .003; and cumulative incidence function, 54% vs. 24%, P = .007, respectively). In multivariate analysis, mutation in the MBL2 coding region of the donor (hazard ratio, 2.8; P = .005) and the use of cytomegalovirus prophylaxis (hazard ratio, 2.6; P = .005) were independently associated with CSI. CONCLUSIONS Recipients of MBL-deficient livers have almost a 3-fold greater likelihood of developing CSI and may benefit from MBL replacement.
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Affiliation(s)
- Daniel L Worthley
- RBWH Foundation Clinical Research Centre, Royal Brisbane and Women's Hospital and Queensland Institute of Medical Research, Brisbane, Queensland, Australia
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Johnson DF, Druce JD, Birch C, Grayson ML. A quantitative assessment of the efficacy of surgical and N95 masks to filter influenza virus in patients with acute influenza infection. Clin Infect Dis 2009; 49:275-7. [PMID: 19522650 DOI: 10.1086/600041] [Citation(s) in RCA: 124] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
We assessed the in vivo efficacy of surgical and N95 (respirator) masks to filter reverse transcription-polymerase chain reaction (RT-PCR)-detectable virus when worn correctly by patients with laboratory-confirmed acute influenza. Of 26 patients with a clinical diagnosis of influenza, 19 had the diagnosis confirmed by RT-PCR, and 9 went on to complete the study. Surgical and N95 masks were equally effective in preventing the spread of PCR-detectable influenza.
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Affiliation(s)
- D F Johnson
- Infectious Diseases Department, Austin Health, Heidelberg, Victoria, Australia
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Steinfort DP, Johnson DF, Connell TG, Irving LB. Endobronchial ultrasound-guided biopsy in the evaluation of intrathoracic lymphadenopathy in suspected tuberculosis: a minimally invasive technique with a high diagnostic yield. J Infect 2009; 58:309-11. [PMID: 19285731 DOI: 10.1016/j.jinf.2009.02.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2009] [Revised: 02/10/2009] [Accepted: 02/10/2009] [Indexed: 11/25/2022]
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Johnson DF, Druce JD, Chapman S, Swaminathan A, Wolf J, Richards JS, Korman T, Birch C, Richards MJ. Chikungunya virus infection in travellers to Australia. Med J Aust 2008; 188:41-3. [PMID: 18205563 DOI: 10.5694/j.1326-5377.2008.tb01504.x] [Citation(s) in RCA: 16] [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] [Received: 07/11/2007] [Accepted: 10/24/2007] [Indexed: 11/17/2022]
Abstract
We report eight recent cases of Chikungunya virus infection in travellers to Australia. Patients presented with fevers, rigors, headaches, arthralgia, and rash. The current Indian Ocean epidemic and Italian outbreak have featured prominently on Internet infectious disease bulletins, and Chikungunya virus infection had been anticipated in travellers from the outbreak areas. Diagnosis was by a generic alphavirus reverse transcriptase polymerase chain reaction with confirmatory sequencing. Prompt diagnosis of Chikungunya virus infections is of public health significance as the mosquito vectors for transmission exist in Australia. There is potential for this infection to spread in the largely naïve Australian population.
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Affiliation(s)
- Julian D. Druce
- Victorian Infectious Diseases Reference Laboratory, North Melbourne, Victoria, Australia
| | | | - Thomas Tran
- Victorian Infectious Diseases Reference Laboratory, North Melbourne, Victoria, Australia
| | | | - Christopher J. Birch
- Victorian Infectious Diseases Reference Laboratory, North Melbourne, Victoria, Australia
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Lewis MJ, Rada P, Johnson DF, Avena NM, Leibowitz SF, Hoebel BG. Galanin and alcohol dependence: neurobehavioral research. Neuropeptides 2005; 39:317-21. [PMID: 15885773 DOI: 10.1016/j.npep.2004.12.027] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2004] [Accepted: 12/17/2004] [Indexed: 10/25/2022]
Abstract
It is known that microinjection of galanin (GAL) intraventricularly or in specific hypothalamic sites increases food consumption and, conversely, the intake of food increases the expression of GAL in hypothalamic sites. Ethanol (EtOH) is a calorie-rich food as well as a drug of abuse. The research reviewed here shows that GAL may play a similar role in alcohol intake. First, experiments in which GAL was microinjected into the third ventricle or the paraventricular nucleus (PVN) showed increases in EtOH consumption. The increase in EtOH consumption occurred during both the light and dark cycles after GAL injection in the third ventricle in rats with limited EtOH access. Injection of GAL did not increase food intake in rats that had been chronically drinking alcohol. GAL receptor blockade reversed these increases. Microinjection of GAL directly into the PVN also increased ad libitum EtOH intake and blockade of these receptors in the PVN inhibited ad libitum EtOH consumption. Secondly, rats administered EtOH showed increases in GAL in the PVN and related hypothalamic sites. EtOH injection and voluntary intake, both ad libitum and limited access, increased GAL gene and peptide expression in the PVN consistently across administration procedures. These experiments show that GAL injection increases alcohol intake and that the intake of alcohol increases GAL, suggesting a positive feedback relationship between alcohol intake and specific hypothalamic GAL systems. Such a relationship may contribute to the motivation to consume excessive alcoholic beverages and the development of alcohol dependence.
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Affiliation(s)
- M J Lewis
- Department of Psychology, Princeton University, Green Hall, Princeton, NJ 08544, USA
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Rada P, Johnson DF, Lewis MJ, Hoebel BG. In alcohol-treated rats, naloxone decreases extracellular dopamine and increases acetylcholine in the nucleus accumbens: evidence of opioid withdrawal. Pharmacol Biochem Behav 2004; 79:599-605. [PMID: 15582668 DOI: 10.1016/j.pbb.2004.09.011] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2004] [Accepted: 09/07/2004] [Indexed: 10/26/2022]
Abstract
Withdrawal from ethanol is aversive. The question is why. As with the withdrawal from morphine, nicotine, diazepam and sugar, the ethanol withdrawal state may involve an increase in nucleus accumbens (NAc) acetylcholine (ACh) causing an alteration of the dopamine (DA)-ACh balance in favor of ACh. Therefore the effects of acute and chronic alcohol (1 gm/kg/day i.p.) treatment on extracellular concentrations of NAc ACh and DA were determined before and after naloxone-precipitated withdrawal. Ethanol initially increased DA to 119% of baseline as measured by microdialysis. This was still the case on the 21st day of ethanol injection when DA increased to 126%. There was no effect of ethanol on ACh. However, naloxone (3 mg/kg s.c.) injected the next day decreased extracellular DA to 83% of baseline and caused a significant rise in ACh to 119%. This state of high ACh combined with low DA may contribute to the aversive aspects of alcohol withdrawal.
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Affiliation(s)
- P Rada
- Psychology Department, Princeton University, Princeton, NJ 08544, USA
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Abstract
The contribution of taste to the food choices of foraging rats was examined. Rats in a laboratory foraging paradigm searched for sequential opportunities to eat at two feeders containing chow-based food pellets that were plain or flavored with saccharin or citric acid. Pellets cost the same number of bar presses at both feeders. Saccharin adulteration had no effect on intake parameters. Citric-acid-flavored pellets were eaten more slowly and in smaller meals. If there was no alternative food, daily intake was slightly reduced. When the alternative food was plain, fewer meals and fewer pellets were taken of the citric-acid-flavored than plain pellets. When we gradually increased the price of the plain pellets at one feeder, while the price at the alternative feeder (which contained either plain or citric-acid-flavored pellets) remained low, the rate of eating (profitability) decreased at the higher-price feeder, and the rats shifted their intake toward the less-costly, more profitable pellets. We compared the relationship between the relative eating rate at each feeder and the relative meal size (or daily intake) at each feeder when the low-priced food was plain and when it was flavored with citric acid, and found no differences. This indicates that taste may influence choice via its effect on rate of intake.
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Affiliation(s)
- D F Johnson
- Department of Psychology, Rutgers University, 152 Frelinghuysen Road, Piscataway, NJ 08854, USA.
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Johnson DF, Love DT, Love BR, Lester DK. Dermal hypoesthesia after total knee arthroplasty. Am J Orthop (Belle Mead NJ) 2000; 29:863-6. [PMID: 11079104] [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: 02/18/2023]
Abstract
Dermal hypoesthesia is a well-recognized sequelae of total knee arthroplasty (TKA). However, it is poorly documented. Thirty-five knees were evaluated for hypoesthesia among 26 patients after TKA to determine the incidence, area affected, and change over time in situ. All knees sustained an area of hypoesthesia, showing diminution over time. All were affected lateral to the medial parapatellar incision. A 71% decline of the area affected was seen over the first 2 years after surgery. All patients had some residual hypoesthesia with a mean of 33 cm2 at 2 years.
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Affiliation(s)
- D F Johnson
- Department of Orthopaedic Surgery, St. Vincent's Hospital, University of Melbourne, Australia
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Abstract
Prominent psychologists, including G. Stanley Hall, James Mark Baldwin, and James McKeen Cattell, cultivated the field of psychological publishing with privately owned and managed journals. Hall's journals, including the American Journal of Psychology and Pedagogical Seminary, reflected his view of psychology as the empirical study of human nature and his support for applied psychology. Baldwin and Cattell's periodicals, including Psychological Review and Psychological Monographs, reflected a narrower scientific and academic view of psychology. Baldwin and Cattell were more successful editors than Hall and strategically linked their journals to the American Psychological Association (APA). The Psychological Review journals were purchased by APA in 1925. The narrower vision represented in these journals may have contributed to applied psychologists' dissatisfaction with APA during the late 1920s and early 1930s.
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Affiliation(s)
- D F Johnson
- Department of Psychology, University of Southern Maine, Portland 04104-9300, USA
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Abstract
The avid consumption of pure carbohydrate solutions, which often results in a distortion of nutrient balance, is generally presumed to be driven by their taste. In the first of two experiments, we examined the effect of consumption cost on rats' intake of three concentrations of sucrose solution (8%, 16%, and 32%) when a nutritionally complete chow was concurrently freely available. In the second experiment, we examined the intake of 24% sucrose solution and chow as the consumption costs of both were varied. Increasing the cost of sucrose resulted in a reduction in the percent calories taken from sucrose; the steepness of the decline in intake with price was inversely related to the sucrose concentration and to the cost of chow. Chow calories were substituted for relatively expensive sucrose calories. An increase in the cost of chow resulted in a reduction in the percent of calories taken from chow and a protein-poor diet. The cost of sucrose did not affect the slope of the chow intake curve, presumably because, despite its sweet taste, sucrose was not a substitute for the protein, fat, and micronutrients in chow. Total caloric intake was conserved in all cases.Thus, the avid consumption of sucrose solution is curtailed when it is costly; but the degree of change in intake with cost depends on the cost of an alternative food. These results suggest that diet selection involves a comparison not only of the taste and post-ingestive consequences of available foods, but also of the cost of calories and nutrients in the foods. Selection appears to be guided first by caloric requirements and the relative cost of calories, then by nutrient requirements and the relative cost of nutrients, and finally by taste.
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Affiliation(s)
- G Collier
- Department of Psychology, Rutgers University, 152 Frelinghuysen Road, Piscataway, NJ 08854, USA.
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Mann DD, Eland DC, Patriquin DA, Johnson DF. Increasing osteopathic manipulative treatment skills and confidence through mastery learning. J Am Osteopath Assoc 2000; 100:301-4, 309. [PMID: 10850016] [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: 02/16/2023]
Abstract
Several recent studies document the declining use of osteopathic manipulative treatment (OMT) in clinical practice. In this article, the authors contend that developing new teaching materials based on the mastery learning approach can augment time-tested methods of teaching OMT and help to stop or reverse this decline. The Spencer technique for shoulder manipulation is used to demonstrate the development and evaluation of OMT mastery learning materials. These materials could be developed as part of a progressive teaching sequence requiring increasing diagnostic acumen, palpatory skill, and therapeutic subtlety. Such a program could be used throughout osteopathic medical training and for continuing medical education to increase skills and confidence in the use of OMT.
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Affiliation(s)
- D D Mann
- Department of Social Medicine, Ohio University College of Osteopathic Medicine, Athens, USA
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Abstract
Certain popular models of the regulation of food intake predict a positive correlation between the size of a meal and the preceding and/or following intermeal interval. However, the reported strength of these prandial correlations has varied widely in the literature. To determine what factors may influence the strength of these relationships, we measured the timing of and amount consumed in meals of laboratory rats as a function of 1) whether they were housed in isolation or with partial access to peers or a running wheel, 2) whether they were disturbed daily or weekly for maintenance procedures, and 3) whether food was free or contingent on operant responding. We also compared two definitions of "meal" and "intermeal interval." Strong prandial correlations were found only occasionally. Caging, food cost, and maintenance frequency did not affect the size of the correlations, although these factors did influence the rats' meal patterns. We conclude the regulation of food intake cannot be explained by models relying on a regular relationship between meal size and intermeal interval.
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Affiliation(s)
- G Collier
- Department of Psychology, Rutgers University, Piscataway, NJ 08854-8020, USA.
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50
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Abstract
We examined meal-ending decisions by rats feeding in depleting patches (where the rate of return decreased during a meal) and nondepleting patches (where the rate of return was constant) in a closed-economy, laboratory setting that allowed the precise measurement of feeding rates and meal patterns. The rats were free living in an environment where costs were imposed with bar-press requirements for (1) travelling to a patch to begin a meal and (2) earning prey during the ensuing meal in that patch. The prey in each patch were large or small, and dense or sparse. In both depleting and nondepleting patches, meals were larger as travel price increased. In nondepleting patches, meal size (in grams) was unaffected by the rate of return within the patch, but in depleting patches, meals were larger where the rate of return was higher. In depleting patches, the rats ate the same number of small and large prey per meal, suggesting that meals end when the rate of return reaches some level relative to a comparison value; however, the end-of-meal rate was lower than the average rate (calculated over foraging and feeding time), and thus meals were too large to maximize rate or minimize cost. No obvious rule of thumb explained meal size in both depleting and nondepleting patches. Copyright 1999 The Association for the Study of Animal Behaviour.
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Affiliation(s)
- DF Johnson
- Department of Psychology, Rutgers University
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