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Dalmau M, Coulter C, O'Connor B, Robson J, Field E, Lambert S. A five-year analysis of latent tuberculosis infection in Queensland, 2016-2020. Commun Dis Intell (2018) 2023; 47. [PMID: 37968069 DOI: 10.33321/cdi.2023.47.71] [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] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Indexed: 11/17/2023]
Abstract
Background Australia is aiming to reach tuberculosis pre-elimination targets by 2035. As a low-incidence setting, control efforts will increasingly rely on the management of latent tuberculosis infection (LTBI). We undertook this descriptive analysis to assess the recent trends of LTBI testing in Queensland. Methods Our objective was to describe the features of LTBI testing in Queensland, and to estimate the range of possible annual notifications were it to be made a notifiable condition. We collated both state-wide and region-specific data on tuberculin skin testing (TST) and interferon gamma release assays (IGRA) conducted in Queensland during the five-year period 1 January 2016 - 31 December 2020. We used reports on Medicare-funded TST and IGRA testing in Queensland, as well as tuberculosis notification data, to understand the representativeness of our data and to derive state-wide estimates. Results We analysed 3,899 public TST, 5,463 private TST, 37,802 public pathology IGRA, and 31,656 private pathology IGRA results. The median age of people tested was 31 years; 57% of those tested were female. From our data sources, an annual average of 1,067 positive IGRA and 354 positive TST results occurred in Queensland. Building on this minimum value, we estimate possible latent tuberculosis notifications in Queensland could range from 2,901 to 6,995 per annum. Private laboratory TSTs are estimated to contribute the lowest number of potential notifications (range: 170-340), followed by private laboratory IGRA testing (range: 354-922), public laboratory IGRA testing (range: 706-1,138), and public setting TSTs (range: 1,671-4,595). Conclusion If LTBI were to be made notifiable, these estimates would place it among the ten most notified conditions in Queensland. This has implications for potential surveillance methods and goals, and their associated system and resource requirements.
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Affiliation(s)
- Marguerite Dalmau
- Communicable Diseases Branch, Department of Health, Queensland Health, Brisbane; National Centre for Epidemiology and Population Health, Research School of Population Health, The Australian National University, Canberra.
| | - Chris Coulter
- Communicable Diseases Branch, Department of Health, Queensland Health, Brisbane; Queensland Mycobacterium Reference Laboratory, Pathology Queensland, Brisbane
| | - Bridget O'Connor
- Communicable Diseases Branch, Department of Health, Queensland Health, Brisbane
| | - Jennifer Robson
- Department of Microbiology and Molecular Pathology, Sullivan Nicolaides Pathology, Queensland
| | - Emma Field
- National Centre for Epidemiology and Population Health, Research School of Population Health, The Australian National University, Canberra
| | - Stephen Lambert
- Communicable Diseases Branch, Department of Health, Queensland Health, Brisbane; National Centre for Epidemiology and Population Health, Research School of Population Health, The Australian National University, Canberra; National Centre for Immunisation Research and Surveillance, Westmead
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2
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Bell JM, Fajardo Lubian A, Partridge SR, Gottlieb T, Robson J, Iredell JR, Daley DA, Coombs GW. Australian Group on Antimicrobial Resistance (AGAR) Australian Gram-negative Surveillance Outcome Program (GnSOP) Bloodstream Infection Annual Report 2022. Commun Dis Intell (2018) 2023; 47. [PMID: 37968067 DOI: 10.33321/cdi.2023.47.69] [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] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Indexed: 11/17/2023]
Abstract
The Australian Group on Antimicrobial Resistance (AGAR) performs regular period-prevalence studies to monitor changes in antimicrobial resistance in selected enteric gram-negative pathogens. The 2022 survey was the tenth year to focus on blood stream infections caused by Enterobacterales, and the eighth year where Pseudomonas aeruginosa and Acinetobacter species were included. Fifty-five hospitals Australia-wide participated in 2022. The 2022 survey tested 9,739 isolates, comprising Enterobacterales (8,773; 90.1%), P. aeruginosa (840; 8.6%) and Acinetobacter species (126; 1.3%), using commercial automated methods. The results were analysed using Clinical and Laboratory Standards Institute (CLSI) and European Committee on Antimicrobial Susceptibility Testing (EUCAST) breakpoints (January 2023). Key resistances included resistance to the third-generation cephalosporin ceftriaxone in 12.7%/12.7% (CLSI/EUCAST criteria) of Escherichia coli and in 6.6%/6.6% of Klebsiella pneumoniae complex. Resistance rates to ciprofloxacin were 13.7%/13.7% for E. coli; 7.8%/7.8% for K. pneumoniae complex; 5.3%/5.3% for Enterobacter cloacae complex; and 4.3%/10.0% for P. aeruginosa. Resistance rates to piperacillin-tazobactam were 2.8%/5.9%; 2.9%/8.7%; 18.3%/27.2%; and 6.1%/14.7% for the same four species, respectively. Twenty-nine Enterobacterales isolates from 28 patients were shown to harbour a carbapenemase gene: 18 blaIMP-4; four blaNDM-5; three blaNDM-1; one blaOXA-181; one blaOXA-244; one blaNDM-1 + blaOXA-181; and one blaNDM-5 + blaOXA-181. Transmissible carbapenemase genes were also detected among two Acinetobacter baumannii complex isolates (blaOXA-23) and one P. aeruginosa (blaNDM-1) in the 2022 survey.
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Affiliation(s)
- Jan M Bell
- Australian Group on Antimicrobial Resistance, Adelaide, South Australia, Australia
| | - Alicia Fajardo Lubian
- Westmead Institute for Medical Research, Westmead, New South Wales, Australia; University of Sydney, New South Wales, Australia
| | - Sally R Partridge
- Westmead Institute for Medical Research, Westmead, New South Wales, Australia; University of Sydney, New South Wales, Australia; Westmead Hospital, Westmead, New South Wales, Australia
| | - Thomas Gottlieb
- University of Sydney, New South Wales, Australia; Department of Microbiology and Infectious Diseases, Concord Hospital, Concord, New South Wales, Australia .
| | - Jennifer Robson
- Department of Microbiology, Sullivan Nicolaides Pathology, Bowen Hills, Queensland
| | - Jonathan R Iredell
- Westmead Institute for Medical Research, Westmead, New South Wales, Australia; University of Sydney, New South Wales, Australia ; Westmead Hospital, Westmead, New South Wales, Australia
| | - Denise A Daley
- Australian Group on Antimicrobial Resistance, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
| | - Geoffrey W Coombs
- Antimicrobial Resistance and Infectious Diseases (AMRID) Research Laboratory, Murdoch University, Murdoch, Western Australia, Australia; Department of Microbiology, PathWest Laboratory Medicine-WA, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
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3
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Gramp PE, Dooley J, O'Brien B, Jones A, Tan L, Robson J, Robertson T, Simos P, Fuller R, Gramp DV, Meumann EM. Fatal granulomatous amebic encephalitis initially presenting with a cutaneous lesion. Australas J Dermatol 2023; 64:e256-e261. [PMID: 37154242 DOI: 10.1111/ajd.14068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 03/23/2023] [Accepted: 04/19/2023] [Indexed: 05/10/2023]
Abstract
We present a case of a 66-year-old man with a cutaneous Balamuthia mandrillaris lesion that progressed to fatal granulomatous amoebic encephalitis. We provide a summary of Australian cases and describe the clinical features and approach to diagnosing this rare but devastating condition, including the importance of PCR for diagnosis.
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Affiliation(s)
- Prudence E Gramp
- Dermatology Department, Gold Coast University Hospital, Gold Coast, Queensland, Australia
| | - John Dooley
- NH Diagnostics, Gold Coast, Queensland, Australia
| | - Blake O'Brien
- Sullivan Nicolaides Pathology, Queensland, Brisbane, Australia
| | - Andrew Jones
- Infectious Disease Department, Gold Coast University Hospital, Gold Coast, Queensland, Australia
| | - Leong Tan
- Neurosurgery Department, Pindara Hospital, Queensland, Gold Coast, Australia
| | - Jennifer Robson
- Sullivan Nicolaides Pathology, Queensland, Brisbane, Australia
| | - Thomas Robertson
- Royal Brisbane and Women's Hospital, Queensland, Brisbane, Australia
| | - Peter Simos
- Infectious Disease Department, Gold Coast University Hospital, Gold Coast, Queensland, Australia
| | - Robert Fuller
- Gold Coast University Hospital, Gold Coast, Queensland, Australia
| | - Dallas V Gramp
- Dermatology Department, Gold Coast University Hospital, Gold Coast, Queensland, Australia
| | - Ella M Meumann
- Sullivan Nicolaides Pathology, Queensland, Brisbane, Australia
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4
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Miller E, Crane C, Medlicott E, Robson J, Taylor L. Non-Positive Experiences Encountered by Pupils During Participation in a Mindfulness-Informed School-Based Intervention. School Ment Health 2023; 15:851-872. [PMID: 37720164 PMCID: PMC10504121 DOI: 10.1007/s12310-023-09591-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/16/2023] [Indexed: 09/19/2023]
Abstract
Mindfulness-informed school-based mental health curricula show much promise in cultivating a positive school climate which supports the well-being and mental health of pupils and staff. However, non-positive pupil outcomes and experiences of school-based mental health interventions are often under-recognised and under-reported. This study sought to capture non-positive pupil experiences of a popular mindfulness-informed curriculum. Some pupils across all schools in the study described non-positive experiences, including having troubling thoughts and emotions, and not finding the programme effective. Contexts surrounding these experiences are explored and linked to existing literature, and subsequent recommendations for improvements are made, including the importance of having clear programme structure, definitions and aims, acknowledging and accommodating fidelity issues as best as possible, and better highlighting the potential for non-positive experiences and how they may be reduced.
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Affiliation(s)
- E.J. Miller
- University of Auckland, Auckland, New Zealand
- University of Oxford, Oxford, UK
| | - C. Crane
- University of Oxford, Oxford, UK
- OxfordHealth NHS Foundation Trust, Oxford, UK
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Kneipp CC, Deutscher AT, Coilparampil R, Rose AM, Robson J, Malik R, Stevenson MA, Wiethoelter AK, Mor SM. Clinical investigation and management of Brucella suis seropositive dogs: A longitudinal case series. J Vet Intern Med 2023; 37:980-991. [PMID: 37158452 DOI: 10.1111/jvim.16678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 02/16/2023] [Indexed: 05/10/2023] Open
Abstract
BACKGROUND Brucellosis in dogs caused by Brucella suis is an emerging zoonotic disease. OBJECTIVES To document clinical characteristics, serology, microbiology, and clinical response to treatment in B. suis-seropositive dogs. ANIMALS Longitudinal study of 27 privately-owned dogs. Dogs that tested positive by serology, culture, or real-time polymerase chain reaction (qPCR) were included in the study. METHODS Clinical (physical examination and imaging) and laboratory (serology, hematology, serum biochemistry, and qPCR or culture) assessments were made at baseline and after approximately 3, 6, 12, and 18 months. RESULTS Dogs were followed for 10 895 dog days, with 17/27 dogs completing the 18-month follow-up. Ten dogs had signs consistent with brucellosis before enrollment (n = 4), at baseline (n = 2) or during follow-up (n = 6), with 2 dogs experiencing relapse of historical signs. Antibody titers persisted for the duration of follow-up in 15/17 dogs (88%). Radiographic (n = 5) and ultrasound (n = 11) findings, of variable clinical relevance, were observed. Brucella DNA and organisms were detected in 3 dogs, all of which had clinical signs, including in the milk of a bitch around the time of whelping. Brucella DNA was not detected in blood (n = 92 samples), urine (n = 80), saliva (n = 95) or preputial swabs (n = 78) at any time during follow-up. Six dogs underwent treatment, all of which achieved clinical remission although remission was not reflected by decreasing antibody titers. CONCLUSIONS AND CLINICAL IMPORTANCE Most dogs with B. suis infections have subclinical infections. Serology is poorly associated with clinical disease. Excretion of organisms appears rare except in whelping bitches. Clinical management using antibiotics with or without surgery is recommended.
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Affiliation(s)
- Catherine C Kneipp
- Melbourne Veterinary School, Faculty of Science, The University of Melbourne, Parkville, Victoria, Australia
| | - Ania T Deutscher
- Elizabeth MacArthur Agricultural Institute, NSW Department Primary Industries, Menangle, New South Wales, Australia
| | - Ronald Coilparampil
- Elizabeth MacArthur Agricultural Institute, NSW Department Primary Industries, Menangle, New South Wales, Australia
| | - Anne Marie Rose
- School of Veterinary Science, The University of Queensland, Gatton, Queensland, Australia
| | - Jennifer Robson
- Sullivan Nicolaides Pathology, Brisbane, Queensland, Australia
| | - Richard Malik
- Centre for Veterinary Education, University of Sydney, Sydney, New South Wales, Australia
- School of Animal and Veterinary Sciences, Albert Pugsley Pl, Charles Sturt University, New South Wales, Australia
| | - Mark A Stevenson
- Melbourne Veterinary School, Faculty of Science, The University of Melbourne, Parkville, Victoria, Australia
| | - Anke K Wiethoelter
- Melbourne Veterinary School, Faculty of Science, The University of Melbourne, Parkville, Victoria, Australia
| | - Siobhan M Mor
- Institute of Infection, Veterinary and Ecological Sciences, The University of Liverpool, Liverpool, UK
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6
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Bosworth A, Robson J, Lawrence B, Casey AL, Fair A, Khanam S, Hudson C, O'Shea MK. Deployment of whole genome next-generation sequencing of SARS-CoV-2 in a military maritime setting. BMJ Mil Health 2023:e002296. [PMID: 36759003 DOI: 10.1136/military-2022-002296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 01/20/2023] [Indexed: 02/11/2023]
Abstract
BACKGROUND SARS-CoV-2 can spread rapidly on maritime platforms. Several outbreaks of SARS-CoV-2 have been reported on warships at sea, where transmission is facilitated by living and working in close quarters. Core components of infection control measures such as social distancing, patient isolation and quarantine of exposed persons are extremely difficult to implement. Whole genome sequencing (WGS) of SARS-CoV-2 has facilitated epidemiological investigations of outbreaks, impacting on outbreak management in real time by identifying transmission patterns, clusters of infection and guiding control measures. We suggest such a capability could mitigate against the impact of SARS-CoV-2 in maritime settings. METHODS We set out to establish SARS-CoV-2 WGS using miniaturised nanopore sequencing technology aboard the Royal Fleet Auxiliary ARGUS while at sea. Objectives included designing a simplified protocol requiring minimal reagents and processing steps, the use of miniaturised equipment compatible for use in limited space, and a streamlined and standalone data analysis capability to allow rapid in situ data acquisition and interpretation. RESULTS Eleven clinical samples with blinded SARS-CoV-2 status were tested at sea. Following viral RNA extraction and ARTIC sequencing library preparation, reverse transcription and ARTIC PCR-tiling were performed. Samples were subsequently barcoded and sequenced using the Oxford Nanopore MinION Mk1B. An offline version of the MinKNOW software was used followed by CLC Genomics Workbench for downstream analysis for variant identification and phylogenetic tree construction. All samples were correctly classified, and relatedness identified. CONCLUSIONS It is feasible to establish a small footprint sequencing capability to conduct SARS-CoV-2 WGS in a military maritime environment at sea with limited access to reach-back support. This proof-of-concept study has highlighted the potential of deploying such technology in the future to military environments, both maritime and land-based, to provide meaningful clinical data to aid outbreak investigations.
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Affiliation(s)
- Andrew Bosworth
- Department of Microbiology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Institute for Immunology and Immunotherapy, University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
| | - J Robson
- Department of Microbiology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Defence Pathology, Royal Centre for Defence Medicine, Birmingham, UK
| | - B Lawrence
- Defence Pathology, Royal Centre for Defence Medicine, Birmingham, UK
- Department of Pathology, Portsmouth Hospitals University NHS Trust, Portsmouth, UK
| | - A L Casey
- Department of Microbiology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - A Fair
- Molecular Pathology Diagnostic Service, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - S Khanam
- Department of Microbiology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - C Hudson
- Department of Microbiology, Frimley Park Hospital, Camberley, UK
| | - M K O'Shea
- Institute for Immunology and Immunotherapy, University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
- Defence Pathology, Royal Centre for Defence Medicine, Birmingham, UK
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7
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Badrick T, Shirley K, Sivabalan P, Sowden D, MacDougall R, Robson J. Prothotheca wickerhamii: a case series. Pathology 2023. [DOI: 10.1016/j.pathol.2022.12.331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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8
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Kneipp CC, Rose AM, Robson J, Malik R, Deutscher AT, Wiethoelter AK, Mor SM. Brucella suis in three dogs: presentation, diagnosis and clinical management. Aust Vet J 2023; 101:133-141. [PMID: 36655500 DOI: 10.1111/avj.13227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Revised: 12/01/2022] [Accepted: 12/23/2022] [Indexed: 01/20/2023]
Abstract
Brucella suis is an emerging, zoonotic disease predominantly affecting dogs and humans that engage in feral pig hunting in Australia and other countries. Although B. suis infection in dogs shares some clinical similarities to the host-adapted species (B. canis), B. suis remains an incompletely understood pathogen in dogs with limited published data on its pathogenesis and clinical features. This case series describes the presentations, diagnosis, and clinical management of B. suis infection in three dogs: (1) a bitch with dystocia, abortion and mastitis; (2) an entire male dog with septic arthritis and presumptive osteomyelitis; and (3) a castrated male dog with lymphadenitis. Unique features of these cases are reported including the first documented detection of B. suis from milk and isolation from lymph nodes of canine patients, as well as the follow-up of pups born to a B. suis-infected bitch. Consistent with previous reports, all three dogs showed a favourable clinical response to combination antibiotic therapy with rifampicin and doxycycline. Individually tailored drug regimens were required based on the clinical presentation and other factors, including owner expectations and compliance with therapy as well as a zoonotic risk assessment (generally considered low, except around time of whelping). The authors include their recommendations for the clinical management of dogs that are at-risk or seropositive for B. suis with or without clinical signs or laboratory-confirmed infection.
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Affiliation(s)
- C C Kneipp
- Faculty of Veterinary and Agricultural Sciences, The University of Melbourne, Parkville, Victoria, Australia
| | - A M Rose
- School of Veterinary Science, The University of Queensland, Gatton, Queensland, Australia
| | - J Robson
- Department of Microbiology and Molecular Pathology, Sullivan Nicolaides Pathology, Brisbane, Queensland, Australia
| | - R Malik
- Centre for Veterinary Education, University of Sydney, Sydney, New South Wales, Australia.,School of Animal and Veterinary Sciences, Albert Pugsley Pl, Charles Sturt University, New South Wales, Australia
| | - A T Deutscher
- Elizabeth MacArthur Agricultural Institute, NSW Department Primary Industries, Menangle, New South Wales, Australia
| | - A K Wiethoelter
- Faculty of Veterinary and Agricultural Sciences, The University of Melbourne, Parkville, Victoria, Australia
| | - S M Mor
- Institute of Infection, Veterinary and Ecological Sciences, The University of Liverpool, Liverpool, UK
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9
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Patel M, Ali S, Robson J, Clements R, Theodoulou A, Wright P, Kearney M, Patel R, Sohaib A, Antoniou S. Pharmacist-led multidisciplinary approach in preventing strokes in people with atrial fibrillation. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background/Introduction
Targets set by Public Health England (PHE) state that 90% of patients with atrial fibrillation (AF) are expected to receive anticoagulation by 2029. In 2019/2020, across three London boroughs serving a population of 770,000, the percentage of AF patients at high risk of stroke (CHA2DS2VASc>2) anticoagulated was below the target set by PHE. In addition, optimisation of risk factors can significantly reduce the risk of cardiovascular disease and associated mortality in these patients.
Purpose
To provide specialist input from a cardiovascular pharmacist to prevent AF-related strokes through improvement of anticoagulation rates and optimisation of cardiovascular risk factors in patients with AF across three London boroughs over one year, as well as minimising bleed risk in patients on dual antithrombotic therapy.
Methods
A specialist cardiovascular pharmacist was commissioned to identify high-risk AF patients (CHA2DS2VASc>2) by working with primary care clinicians. Utilising “proactive care frameworks” created by UCLPartners and Clinical Effectiveness Group Queen Mary University of London, patients were stratified and prioritised for review. Patients not on anticoagulation were deemed to be at highest risk, requiring an urgent review to assess suitability for anticoagulation. A virtual multidisciplinary team (MDT) would review any complex patients and agree an action plan. Patients on dual antithrombotic therapy were also assessed to determine if antiplatelet therapy was indicated to minimise risk of major bleeding. All AF patients were reviewed for suitability of statin initiation to optimise cardiovascular risk prevention.
Results
At baseline, 86% (7581/8582) of AF patients with a CHA2DS2VASc>2 across the three boroughs were anticoagulated. 1001 patients were reviewed by a specialist pharmacist, with 84% (841/1001) of patients having a CHA2DS2VASc between 2–5, and 28% (280/1001) on antiplatelet monotherapy. Analysis at 12 months following intervention reported that 95% (7888/8280) of AF patients with a CHA2DS2VASc>2 were suitably anticoagulated, an improvement of 9%. 6% (61/1001) of patients were switched from antiplatelets and 25% (246/1001) were newly initiated on anticoagulation. 13% (130/1001) of patients required specialist MDT input to determine appropriateness for anticoagulation initiation. There was also a reduction in dual anticoagulation and antiplatelet therapy from 429 to 252 patients (41% reduction). Lastly of those reviewed, 2609 patients received a recommendation to start a statin for either primary (n=1981) or secondary prevention (n=628).
Conclusion(s)
Provision of a specialist cardiovascular pharmacist supported a multidisciplinary workforce to significantly improve and optimise cardiovascular risk, and reduce the risk of stroke in this high-risk population for people with AF across all three boroughs. By extrapolating these results nationally, 3600 strokes could be averted over 18 months.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- M Patel
- Barts Heart Centre, Pharmacy , Greater London , United Kingdom
| | - S Ali
- NHS Redbridge Clinical Commissioning Group , London , United Kingdom
| | - J Robson
- Queen Mary University of London, Clinical Effectiveness Group , London , United Kingdom
| | - R Clements
- NHS North East London Clinical Commissioning Group , London , United Kingdom
| | - A Theodoulou
- Barts Health NHS Trust, Haematology , London , United Kingdom
| | - P Wright
- Barts Heart Centre, Pharmacy , Greater London , United Kingdom
| | - M Kearney
- UCLPartners , London , United Kingdom
| | - R Patel
- Barts Heart Centre, Cardiology , London , United Kingdom
| | - A Sohaib
- Barking Havering and Redbridge Hospitals NHS trust, Cardiology , London , United Kingdom
| | - S Antoniou
- Barts Heart Centre, Pharmacy , Greater London , United Kingdom
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Zhou J, Wu R, Williams C, Emberson J, Reith C, Keech A, Robson J, Wilkinson K, Armitage J, Collins R, Gray A, Simes J, Baigent C, Mihaylova B. Impact of cardiovascular events on primary and hospital care costs: findings from UK Biobank study. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Need for primary and secondary healthcare increases following cardiovascular disease (CVD) events but there is no data on comparative increases in costs.
Purpose
To estimate annual primary care and hospital inpatient costs associated with key CVD and other adverse events using the UK Biobank (UKB) individual participant data.
Methods
UKB participants with linked primary care data (192,983 participants) or hospital inpatient episodes data (all 501,807 participants) contributed data to this study. The three categories of primary care services (patient consultations, diagnostic and monitoring tests, prescription medications), and hospital episodes were costed (2020 UK£) using the NHS England reference costs. Annual primary care costs and, separately, annual hospital inpatient costs were modelled as functions of participant characteristics at entry (socio-demographic, clinical, prior diseases) and time-updated first occurrences of myocardial infarction, stroke, coronary revascularization, incident cancer, incident diabetes, vascular death and non-vascular death during follow-up (p-value <0.01 in stepwise covariate selection). One-part generalized linear regression model (GLM) with Poisson distribution and identity link function was used for primary care costs, and two-part model was used for inpatient costs (part 1: logistic regression models probability of incurring costs; part 2: GLM with Poisson distribution and identity link function models costs conditional on incurring any). Separate models were fitted among participants with and without previous CVD at entry into UKB.
Results
Most adverse events were associated with excess primary care and hospital inpatient costs. Compared to people without previous CVD, people with previous CVD had on average larger excess primary care and hospital inpatient costs in years with myocardial infarction, stroke and vascular death; but similar excess costs in years with other events. Among both people without and with previous CVD, the excess annual primary care costs were less than 7% of the excess annual hospital inpatient costs for vascular events (Table). However, following diabetes diagnosis the excess annual primary care costs were higher than the excess annual hospital inpatient costs (Table).
Conclusions
These excess primary and hospital care costs associated with CVD events could inform assessments of interventions and policies to reduce CVD risks in UK.
Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): UK National Institute for Health Research (NIHR) Health Technology Assessment (HTA) Programme, UK Medical Research Council (MRC), British Heart Foundation
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Affiliation(s)
- J Zhou
- University of Oxford, Nuffield Department of Population Health , Oxford , United Kingdom
| | - R Wu
- Queen Mary University of London, Wolfson Institute of Population Health , London , United Kingdom
| | - C Williams
- University of Oxford, Nuffield Department of Population Health , Oxford , United Kingdom
| | - J Emberson
- University of Oxford, Nuffield Department of Population Health , Oxford , United Kingdom
| | - C Reith
- University of Oxford, Nuffield Department of Population Health , Oxford , United Kingdom
| | - A Keech
- University of Sydney, NHMRC Clinical Trials Centre , Sydney , Australia
| | - J Robson
- Queen Mary University of London, Wolfson Institute of Population Health , London , United Kingdom
| | - K Wilkinson
- Public Representative , Oxford , United Kingdom
| | - J Armitage
- University of Oxford, Nuffield Department of Population Health , Oxford , United Kingdom
| | - R Collins
- University of Oxford, Nuffield Department of Population Health , Oxford , United Kingdom
| | - A Gray
- University of Oxford, Nuffield Department of Population Health , Oxford , United Kingdom
| | - J Simes
- University of Sydney, NHMRC Clinical Trials Centre , Sydney , Australia
| | - C Baigent
- University of Oxford, Nuffield Department of Population Health , Oxford , United Kingdom
| | - B Mihaylova
- University of Oxford, Nuffield Department of Population Health , Oxford , United Kingdom
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11
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Mihaylova B, Wu R, Williams C, Zhou J, Schlackow I, Emberson J, Reith C, Keech A, Robson J, Wilkinson K, Armitage J, Collins R, Gray A, Simes J, Baigent C. Cost-effectiveness of statin therapy in categories of patients in the UK. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Cardiovascular disease (CVD) mortality has declined steadily over the last few decades across Europe and North America.
Purpose
To provide contemporary estimates of long-term effectiveness and cost-effectiveness of statin therapy in different categories of patients in UK.
Methods
The CTT-UKB micro-simulation model, developed using the Cholesterol Treatment Trialists' Collaboration data (CTT: 118,000 participants; 5 years follow-up), and calibrated in the UK Biobank cohort (UKB: 502,000 participants; 9 years follow-up). The model integrates parametric risk equations for incident myocardial infarction, stroke, coronary revascularization, diabetes, cancer and vascular and nonvascular death, and projects annually these endpoints and survival using patient characteristics at entry. UKB data and linked primary and hospital care data informed healthcare costs in the model (2020 UK£); 2021 UK NHS Drug Tariff informed statin costs (atorvastatin 40mg at £1.22 and 80mg at £1.68 per 28 tablets); and Health Survey for England data informed health-related quality of life in the model. Previous CTT meta-analysis, atorvastatin dose-response randomized trials, and further meta-analyses of statin trials and cohort studies informed effects of 40mg/80mg atorvastatin therapy daily on rates of incident myocardial infarction, stroke, coronary revascularization, vascular death, diabetes, myopathy and rhabdomyolysis.
The model was used to project gains in quality-adjusted life years (QALYs) and additional cost per QALY with lifetime use of atorvastatin 40mg or 80mg daily in categories of UKB participants by sex, age at statin initiation (40–49; 50–59 and 60–70 years), and 10-year CVD risk (QRISK3 risk (%): <5; 5–10, 10–15, 15–20, ≥20). Further scenarios explored effects of 5-year delay of statin initiation in people under 45 years of age or stopping statin therapy at 80 years of age.
Results
Across men and women in categories by age and CVD risk, lifetime use of atorvastatin 40mg daily was associated with increases in survival by 0.44–1.69 years (0.28–1.02 QALYs), and atorvastatin 80mg daily with increases in survival of 0.45–1.87 years (0.32–1.13 QALYs; Figure 1) with gains larger among participants at higher CVD risk. Both atorvastatin 40mg and 80mg doses were in the range of cost-effective treatments with incremental cost per QALY gained with atorvastatin 40mg daily versus no statin therapy below £7200/QALY and with atorvastatin 80mg vs 40mg daily below £16000/QALY (Figure 2) across all patient categories studied. Compared to lifetime statin therapy, stopping therapy at 80 years of age substantially reduced benefits and was not cost-effective in any patient category studied. Similarly, compared to immediate initiation, 5-year delay of statin therapy in 40–45 years old patients was not a cost-effective.
Conclusions
In the UK, statin therapy remains highly cost-effective across men and women 40–70 years old, including those at 10-year CVD risk <5%.
Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): UK National Institute for Health Research (NIHR) Health Technology Assessment (HTA) Programme, UK National Institute for Health Research (NIHR) Health Technology Assessment (HTA) Programme, UK Medical Research Council (MRC), British Heart Foundation
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Affiliation(s)
- B Mihaylova
- University of Oxford, Nuffield Department of Population Health , Oxford , United Kingdom
| | - R Wu
- Queen Mary University of London, Wolfson Institute of Population Health , London , United Kingdom
| | - C Williams
- University of Oxford, Nuffield Department of Population Health , Oxford , United Kingdom
| | - J Zhou
- University of Oxford, Nuffield Department of Population Health , Oxford , United Kingdom
| | - I Schlackow
- University of Oxford , Oxford , United Kingdom
| | - J Emberson
- University of Oxford, Nuffield Department of Population Health , Oxford , United Kingdom
| | - C Reith
- University of Oxford, Nuffield Department of Population Health , Oxford , United Kingdom
| | - A Keech
- University of Sydney, NHMRC Clinical Trials Centre , Sydney , Australia
| | - J Robson
- Queen Mary University of London, Wolfson Institute of Population Health , London , United Kingdom
| | - K Wilkinson
- Public Representative , Oxford , United Kingdom
| | - J Armitage
- University of Oxford, Nuffield Department of Population Health , Oxford , United Kingdom
| | - R Collins
- University of Oxford, Nuffield Department of Population Health , Oxford , United Kingdom
| | - A Gray
- University of Oxford, Nuffield Department of Population Health , Oxford , United Kingdom
| | - J Simes
- University of Sydney, NHMRC Clinical Trials Centre , Sydney , Australia
| | - C Baigent
- University of Oxford, Nuffield Department of Population Health , Oxford , United Kingdom
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Wu R, Williams C, Zhou J, Schlackow I, Emberson J, Reith C, Keech A, Robson J, Wilkinson K, Armitage J, Collins R, Gray A, Simes J, Baigent C, Mihaylova B. Benefit accrual with cardiovascular disease prevention and effects of discontinuation: a modelling study. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Statin therapy reduces rates of heart attacks and strokes and improves survival in people at increased cardiovascular disease (CVD) risk. However, there is some uncertainty when to start and how long to persist with statin therapy so as to optimise benefits.
Purpose
To project the accrual of benefit with statin therapy in population groups by age at therapy initiation using a newly developed micro-simulation model.
Methods
Participants without previous CVD (N=44,412) and with previous CVD (N=13,061) at entry were randomly selected from the UK Biobank cohort, ensuring sufficient representation in respective categories by age, LDL cholesterol, diabetes and 10-year CVD risk categories (QRISK3 score, for those without previous CVD only). The CTT-UKB model, a CVD micro-simulation model [1], was used to predict subsequent survival and quality-adjusted life years (QALYs) of the participants using their characteristics at entry. Treatment with atorvastatin 40mg daily was used as an example to illustrate the effect of the therapy compared to no such therapy. Scenarios include: (1) lifelong preventive therapy, (2) preventive therapy stopped at 80 years of age, and (3) delayed initiation of preventive therapy by 5 years in participants under 45 years of age.
Results
Statin treatment benefits, measured in QALYs gained, accrue over lifetime. The majority of benefits accrue later in life. Men accumulate larger benefits and earlier than women (Figure 1A). The pattern of benefits accrual is similar for participants with and without previous CVD (data not shown). The higher the participants' CVD risk, the larger and earlier the benefits, with younger participants accruing larger benefits (Figure 1B). Compared with lifelong prevention, stopping treatment at 80 years of age leads to large reductions in overall benefits, especially in women and those at lower CVD risk. For example, compared to lifelong therapy, people without previous CVD who initiate therapy in their 50s, would lose 47% of QALYs benefit (if men), 66% (if women), 73% (if with CVD risk <5%), and 35% (if with CVD risk ≥20%), respectively, if they stop treatment when they reach 80 years of age. Five-year delay of statin therapy initiation in people under 45 years of age reduces their benefits by about 4% on average, though the loss is somewhat larger in people at higher CVD risk (Figure 2).
Conclusion
Benefits from lifelong cardiovascular prevention accrue over peoples' lifespan with large share of benefits accruing at older age. Stopping treatment earlier substantially reduces benefits.
Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): UK NationalInstitute for Health Research (NIHR) Health Technology Assessment (HTA) Programme, UK Medical Research Council (MRC), and British Heart Foundation
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Affiliation(s)
- R Wu
- Queen Mary University of London, Wolfson Institute of Population Health , London , United Kingdom
| | - C Williams
- University of Oxford, Nuffield Department of Population Health , Oxford , United Kingdom
| | - J Zhou
- University of Oxford, Nuffield Department of Population Health , Oxford , United Kingdom
| | - I Schlackow
- University of Oxford, Nuffield Department of Population Health , Oxford , United Kingdom
| | - J Emberson
- University of Oxford, Nuffield Department of Population Health , Oxford , United Kingdom
| | - C Reith
- University of Oxford, Nuffield Department of Population Health , Oxford , United Kingdom
| | - A Keech
- University of Sydney, NHMRC Clinical Trials Centre , Sydney , Australia
| | - J Robson
- Queen Mary University of London, Wolfson Institute of Population Health , London , United Kingdom
| | - K Wilkinson
- Public Representative , Oxford , United Kingdom
| | - J Armitage
- University of Oxford, Nuffield Department of Population Health , Oxford , United Kingdom
| | - R Collins
- University of Oxford, Nuffield Department of Population Health , Oxford , United Kingdom
| | - A Gray
- University of Oxford, Nuffield Department of Population Health , Oxford , United Kingdom
| | - J Simes
- University of Sydney, NHMRC Clinical Trials Centre , Sydney , Australia
| | - C Baigent
- University of Oxford, Nuffield Department of Population Health , Oxford , United Kingdom
| | - B Mihaylova
- University of Oxford, Nuffield Department of Population Health , Oxford , United Kingdom
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Graham M, Graves D, Cooley L, Elvy J, Kelley P, Maley M, Porter M, Robson J, Turnidge J. Establishment of RCPA national guidelines for selective reporting of antimicrobials: processes, challenges and measuring the impact. J Antimicrob Chemother 2022; 77:3064-3068. [PMID: 35972404 DOI: 10.1093/jac/dkac279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 07/27/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES In 2016, The Royal College of Pathologists of Australasia (RCPA) initiated the formation of a working group comprising medical microbiologists to establish guidelines to assist Australian laboratories to implement selective and cascade reporting of antimicrobials-the first guidelines of this type in the world. METHODS A 2017 audit of antimicrobial reporting in Australian and New Zealand laboratories identified significant opportunities for improvement and standardization of selective reporting. RESULTS The first draft of the RCPA Selective Reporting Guidelines was circulated to all RCPA Microbiology fellows for feedback in August 2018 and the first version was published in February 2019. Subsequently, version two of the guidelines has recently been published in Australia, and New Zealand adapted these guidelines for formulation of their own national guidelines to accommodate local needs. CONCLUSIONS Here we describe the processes, acceptance and challenges associated with the establishment of these guidelines and measurement of their impact.
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Affiliation(s)
- Maryza Graham
- Department of Microbiology and Infectious Diseases, Monash Health, Clayton, Victoria, Australia.,Faculty of Medicine Nursing & Health Sciences, Monash University, Clayton, Victoria, Australia.,Microbiological Diagnostic Unit Public Health Laboratory, University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Debra Graves
- The Royal College of Pathologists of Australasia
| | - Louise Cooley
- Department of Microbiology and Infectious Diseases, Royal Hobart Hospital & Department of Pathology, University of Tasmania, Hobart, Tasmania, Australia
| | - Juliet Elvy
- New Zealand Microbiology Network & New Zealand National Antimicrobial Susceptibility Testing Committee.,Southern Community Laboratories, Dunedin, New Zealand
| | - Peter Kelley
- Dorevitch Pathology and Peninsula Health, Victoria, Australia.,Eastern Health Pathology, Victoria, Australia
| | - Michael Maley
- Department of Microbiology and Infectious Diseases, NSW Health Pathology, Liverpool, New South Wales, Australia
| | | | | | - John Turnidge
- European Committee on Antimicrobial Susceptibility Testing.,Australian Commission on Safety and Quality in Health Care
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Chapman PR, Llewellyn S, Jennings H, Becker L, Giacomin P, McDougall R, Robson J, Loukas A, McCarthy J. The production of Necator americanus larvae for use in experimental human infection. Parasit Vectors 2022; 15:242. [PMID: 35804460 PMCID: PMC9264692 DOI: 10.1186/s13071-022-05371-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Accepted: 05/03/2022] [Indexed: 11/10/2022] Open
Abstract
Background Although there is unprecedented interest in experimental human hookworm infection, details of hookworm manufacture and characterisation have been sparsely reported. In this report, we detail the production and characterisation of Necator americanus larvae for use in a recently published clinical trial. Methods Faeces was obtained from an experimentally infected donor. Faecal hookworm DNA was determined by quantitative PCR. Paired samples were incubated in either sterile water or sterile water mixed with antimicrobials (amphotericin and gentamicin). Coproculture was performed by modified Harada-Mori method. The harvested larvae were then processed in either sterile water or antiseptic solution. Larval yield was then calculated (larvae per gram), larval viability was determined by thermally induced motility assay and microbial burden was determined at the day of harvest, at 48 h and at 7 days. Results Twenty-eight faecal cultures were performed over 16 months. The faecal hookworm DNA content was variable over this time. There was no association of larval yield with faecal hookworm DNA content. Pre-treatment of faeces with antimicrobials did not influence larval yield. Larval motility was 85.3% (95% CI 79.3–91.3%). Incubation of larvae in antiseptics did not reduce viability at 14 days with a marginal mean of 68.6% (95% CI 59.1–78.1%) washed in water vs. 63.3% (95% CI 53.8 – 72.9%) when incubated in betadine (p = 0.38). Larvae washed in sterile water did not meet microbial bioburden criteria. Incubation in antiseptic resulted in acceptable microbial bioburden at 48 h but not at 7 days. Although the addition of gentamicin did reduce the microbial bio-burden acceptable levels, it was found to significantly lower larval motility at 7 days compared to incubation in sterile water and motility at 7 days 37.8% (95% CI 4.7–70.9%) vs. 67.3% (95% CI 35.2–99.3%, p < 0.001), respectively. Conclusions Despite standardised culture methodologies and the use of a single donor, larval yield varied considerably between batches and had no association with faecal hookworm DNA. Larval viability decreases over time and the age of larvae at time of use are likely to be important. Microbial bioburden maybe temporarily reduced by incubation in antiseptics and has little effect on viability. Incubation of larvae in gentamicin is effective at reducing microbial bioburden but is deleterious to larval viability. Graphical Abstract ![]()
Supplementary Information The online version contains supplementary material available at 10.1186/s13071-022-05371-y.
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Affiliation(s)
- Paul R Chapman
- Clinical Tropical Medicine, QIMR Berghofer Medical Research Institute, Herston, QLD, Australia. .,RBWH Infectious Diseases, Bowen Hills and Herston, Australia.
| | - Stacey Llewellyn
- Statistics Unit, QIMR Berghofer Medical Research Institute, Herston, QLD, Australia
| | - Helen Jennings
- Clinical Tropical Medicine, QIMR Berghofer Medical Research Institute, Herston, QLD, Australia
| | - Luke Becker
- Centre for Molecular Therapeutics, Australian Institute of Tropical Health and Medicine, James Cook University, Cairns, QLD, Australia
| | - Paul Giacomin
- Centre for Molecular Therapeutics, Australian Institute of Tropical Health and Medicine, James Cook University, Cairns, QLD, Australia
| | - Rodney McDougall
- Sullivan Nicolaides Pathology, Bowen Hills and Herston, Australia
| | - Jennifer Robson
- Sullivan Nicolaides Pathology, Bowen Hills and Herston, Australia
| | - Alex Loukas
- Centre for Molecular Therapeutics, Australian Institute of Tropical Health and Medicine, James Cook University, Cairns, QLD, Australia
| | - James McCarthy
- Centre for Molecular Therapeutics, Australian Institute of Tropical Health and Medicine, James Cook University, Cairns, QLD, Australia
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Patel M, Ali S, Robson J, Clements R, Theodoulou A, Wright P, Kearney M, Patel R, Sohaib A, Antoniou S. Pharmacist-led multidisciplinary approach in preventing strokes in people with atrial fibrillation. Eur J Cardiovasc Nurs 2022. [DOI: 10.1093/eurjcn/zvac060.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background/Introduction
In England, 90% of patients with atrial fibrillation (AF) are expected to receive anticoagulation as part of targets set by Public Health England by 2029. In 2019/2020, across three London boroughs serving a population of 770,000, the percentage of AF patients at high risk of stroke (CHA2DS2VASc>2) anticoagulated was 87%, 83% and 84%. This placed two of the three localities in the bottom 10% compared to others in England. In addition, optimising cholesterol and lifestyle choices can significantly reduce the risk of cardiovascular disease and associated mortality in these patients.
Purpose
To prevent AF-related strokes by improving anticoagulation rates and optimising cardiovascular risk factors in patients with AF in all general practices across three London boroughs over one year, and to minimise risk of bleeding in patients on concurrent anticoagulation and antiplatelet therapy.
Methods
A specialist cardiovascular pharmacist was commissioned to systemically identify high-risk AF patients (CHA2DS2VASc>2) by working with primary care clinicians, including up-skilling of primary care pharmacists. Through utilisation of ‘proactive care frameworks’ created by the Clinical Effectiveness Group Queen Mary University of London and UCL Partners, patients were able to be stratified and prioritised for review. AF patients not on anticoagulation or on antiplatelet monotherapy were deemed to be at highest risk, and these patients were reviewed to assess suitability for anticoagulation. Subsequently, patients on concurrent anticoagulation and antiplatelets were assessed to determine if dual antithrombotic prescribing was still indicated to minimise risk of major bleeding. Lastly, to optimise cardiovascular risk prevention, all AF patients were reviewed for suitability of statin initiation for primary or secondary prevention. A virtual multidisciplinary team was convened for complex patients, which included a cardiologist, haematologist, general practitioner and pharmacist to review and agree an action plan.
Results
An interim analysis at 9 months reported that 94% (6745/7145) of patients with a CHA2DS2VASc>2 across the three boroughs were suitably anticoagulated, an improvement of 6% on the initial 88% (6585/7391). There was a reduction in concurrent anticoagulation and antiplatelet therapy from 381 to 262 patients (31.2% reduction) following specialist review. Lastly 2285 patients were reviewed with a recommendation to start a statin for either primary (n=1783) or secondary prevention (n=502).
Conclusion(s)
Provision of a specialist cardiovascular pharmacist supported a multidisciplinary workforce with significant improvement in anticoagulation rates across all three boroughs, reducing the risk of stroke in this high-risk population. In addition, we were able to reduce the risk of bleeding in this cohort of patients by stopping inappropriate antiplatelet therapy, and reduced the risk of cardiovascular disease through statin initiation.
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Affiliation(s)
- M Patel
- Barts Heart Centre, Pharmacy , Greater London , United Kingdom of Great Britain & Northern Ireland
| | - S Ali
- NHS Redbridge Clinical Commissioning Group , London , United Kingdom of Great Britain & Northern Ireland
| | - J Robson
- Queen Mary University of London, Clinical Effectiveness Group , London , United Kingdom of Great Britain & Northern Ireland
| | - R Clements
- NHS North East London Clinical Commissioning Group , London , United Kingdom of Great Britain & Northern Ireland
| | - A Theodoulou
- Barts Health NHS Trust, Haematology , London , United Kingdom of Great Britain & Northern Ireland
| | - P Wright
- Barts Heart Centre, Pharmacy , Greater London , United Kingdom of Great Britain & Northern Ireland
| | - M Kearney
- UCLPartners , London , United Kingdom of Great Britain & Northern Ireland
| | - R Patel
- Barts Heart Centre, Cardiology , London , United Kingdom of Great Britain & Northern Ireland
| | - A Sohaib
- Barking Havering and Redbridge Hospitals NHS trust, Cardiology , London , United Kingdom of Great Britain & Northern Ireland
| | - S Antoniou
- Barts Heart Centre, Pharmacy , Greater London , United Kingdom of Great Britain & Northern Ireland
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Raju Paul S, Scholzen A, Mukhtar G, Wilkinson S, Hobson P, Dzeng RK, Evans J, Robson J, Cobbold R, Graves S, Poznansky MC, Garritsen A, Sluder AE. Natural Exposure- and Vaccination-Induced Profiles of Ex Vivo Whole Blood Cytokine Responses to Coxiella burnetii. Front Immunol 2022; 13:886698. [PMID: 35812430 PMCID: PMC9259895 DOI: 10.3389/fimmu.2022.886698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 05/25/2022] [Indexed: 11/13/2022] Open
Abstract
Q fever is a zoonotic disease caused by the highly infectious Gram-negative coccobacillus, Coxiella burnetii (C. burnetii). The Q fever vaccine Q-VAX® is characterised by high reactogenicity, requiring individuals to be pre-screened for prior exposure before vaccination. To date it remains unclear whether vaccine side effects in pre-exposed individuals are associated with pre-existing adaptive immune responses to C. burnetii or are also a function of innate responses to Q-VAX®. In the current study, we measured innate and adaptive cytokine responses to C. burnetii and compared these among individuals with different pre-exposure status. Three groups were included: n=98 Dutch blood bank donors with unknown exposure status, n=95 Dutch village inhabitants with known natural exposure status to C. burnetii during the Dutch Q fever outbreak of 2007-2010, and n=96 Australian students receiving Q-VAX® vaccination in 2021. Whole blood cytokine responses following ex vivo stimulation with heat-killed C. burnetii were assessed for IFNγ, IL-2, IL-6, IL-10, TNFα, IL-1β, IP-10, MIP-1α and IL-8. Serological data were collected for all three cohorts, as well as data on skin test and self-reported vaccine side effects and clinical symptoms during past infection. IFNγ, IP-10 and IL-2 responses were strongly elevated in individuals with prior C. burnetii antigen exposure, whether through infection or vaccination, while IL-1β, IL-6 and TNFα responses were slightly increased in naturally exposed individuals only. High dimensional analysis of the cytokine data identified four clusters of individuals with distinct cytokine response signatures. The cluster with the highest levels of adaptive cytokines and antibodies comprised solely individuals with prior exposure to C. burnetii, while another cluster was characterized by high innate cytokine production and an absence of C. burnetii-induced IP-10 production paired with high baseline IP-10 levels. Prior exposure status was partially associated with these signatures, but could not be clearly assigned to a single cytokine response signature. Overall, Q-VAX® vaccination and natural C. burnetii infection were associated with comparable cytokine response signatures, largely driven by adaptive cytokine responses. Neither individual innate and adaptive cytokine responses nor response signatures were associated retrospectively with clinical symptoms during infection or prospectively with side effects post-vaccination.
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Affiliation(s)
- Susan Raju Paul
- Vaccine and Immunotherapy Center, Massachusetts General Hospital, Boston, MA, United States
| | | | - Ghazel Mukhtar
- Vaccine and Immunotherapy Center, Massachusetts General Hospital, Boston, MA, United States
| | | | - Peter Hobson
- Sullivan Nicolaides Pathology, Brisbane, QLD, Australia
| | - Richard K. Dzeng
- Vaccine and Immunotherapy Center, Massachusetts General Hospital, Boston, MA, United States
| | | | | | - Rowland Cobbold
- School of Veterinary Science, University of Queensland, Gatton, QLD, Australia
| | - Stephen Graves
- Australian Rickettsial Reference Laboratory, Geelong, VIC, Australia
| | - Mark C. Poznansky
- Vaccine and Immunotherapy Center, Massachusetts General Hospital, Boston, MA, United States
- *Correspondence: Ann E. Sluder, ; Anja Garritsen, ; Mark C. Poznansky,
| | - Anja Garritsen
- InnatOss Laboratories B.V., Oss, Netherlands
- *Correspondence: Ann E. Sluder, ; Anja Garritsen, ; Mark C. Poznansky,
| | - Ann E. Sluder
- Vaccine and Immunotherapy Center, Massachusetts General Hospital, Boston, MA, United States
- *Correspondence: Ann E. Sluder, ; Anja Garritsen, ; Mark C. Poznansky,
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Robson J, Almeida C, Dawson J, Dures E, Greenwood R, Guly C, Mackie S, Bromhead A, Stern S, Ndosi M. POS0003 DEVELOPMENT AND VALIDATION OF A DISEASE SPECIFIC PATIENT REPORTED OUTCOME FOR GIANT CELL ARTERITIS. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.1769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundGiant cell arteritis (GCA) is caused by inflammation of the blood vessels of the head and neck; patients can present with cranial, ocular or large vessel vasculitis involvement. Treatment is with glucocorticoids, steroid sparing agents and biologics to control inflammation and protect sight.ObjectivesThe aim of this study was to produce a validated disease specific PROM for patients with GCA, to capture the impact of GCA and its treatment on health-related quality of life.MethodsPatients with clinician- confirmed GCA from the UK, either diagnosed in the last three years or with a flare in the last year, were included in the survey. A longlist of 40 candidate questionnaire items, each with a 5-point Likert scale, had previously been developed, based on a qualitative study with patients from the UK and Australia [1]. In this cross-sectional survey, patients completed the 40-item draft GCA-PROM alongside EQ5D-5L, CAT-PRO5 and self-report of GCA disease activity. Rasch and factor analysis were used in an iterative manner to determine the underlying construct validity of the new PROM. Items were fitted to the Rasch model to determine its construct validity, reliability, unidimensionality and statistical sufficiency of the total score from the scale. Factor analysis was used to establishing factor structure. Item reduction decisions were be based on clinical importance, lack of fit to the Rasch model, and redundancy detected during principal component analysis. External validity was tested by comparing the scores of the newly validated GCA-PROM (i) in participants who self-identify as having ‘active disease’ versus patients ‘in remission’ (known groups validity) (ii) with scores derived from EQ5D-5L and CAT-PRO5 (convergent validity).ResultsThe survey included 428 patients; 327 (76%) cranial GCA, 114 (26.6%) large vessel vasculitis and 142 (33.2%) ocular involvement. 285 (67%) of participants were female with a mean age (SD) of 74.2 (7.2). 167 (39%) temporal artery biopsies and 177 (41.4%) temporal artery ultrasounds, and 51 (11.9%) Positron Emission Tomography and Computed Tomography (PET-CT)s were reported as positive. 108 (25%) received second-line immunosuppressants, and 34 (7.9%) anti-IL6 therapy. Active disease was reported in 197 (46%). Four factors (domains) were identified after deletion of 10 redundant items: Acute symptoms (8 items), Activities of daily living (7 items), Psychological (7 items) and Participation (8 items). The four domains were analysed as ‘super-items’ and shown to fit the Rasch model. The overall scale had an adequate fit to the Rasch model: X2 = 25.219, DF=24, p=0.394 including reliability PSI=0.828. The raw-to-linear transformation scale was calibrated to enable parametric analyses if desired. Each domain was shown to have known-groups validity (p<0.001 patients reporting active versus inactive disease) and correlation with EQ5D-5L and CAT-PRO5 (Rs) ranging between 0.4.42 and 0.778.ConclusionThe GCA-PROM is a new patient reported outcome measure for patients with GCA which demonstrates good internal and external validity.References[1]Robson JC, Almeida C, Dawson J, Bromhead A, Dures E, Guly C, Hoon E, Mackie S, Ndosi M, Pauling J, Hill C. Patient perceptions of health-related quality of life in giant cell arteritis; international development of a disease-specific Patient-Reported Outcome Measure. Rheumatology (Oxford). 2021:keab076. http://dx.doi.org/10.1093/rheumatology/keab076Disclosure of InterestsJoanna Robson Speakers bureau: Vifor Pharma EULAR 2021 Symposium, Consultant of: Vifor Pharma Advisory board 2021, Grant/research support from: Vifor Pharma Steroid PRO grant, Celia Almeida: None declared, Jill Dawson: None declared, Emma Dures: None declared, Rosemary Greenwood: None declared, Catherine Guly: None declared, Sarah Mackie Speakers bureau: Roche/Chugai Educational talk on GCA., Consultant of: Roche/ChugaiSanofiAbbvie (2021-)AstraZeneca (2021-), Grant/research support from: Vifor Pharma Steroid PRO 2020Vifor Pharma GTI Validation 2020Roche GCA Tocilizumab Registry 2019, Alison Bromhead: None declared, Steve Stern: None declared, Mwidimi Ndosi: None declared
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Bridgewater S, Shepherd MA, Dawson J, Richards P, Silverthorne C, Ndosi M, Almeida C, Black RJ, Cheah JTL, Dures E, Ghosh N, Hoon EA, Lyne S, Navarro-Millan I, Pearce-Fisher D, Ruediger C, Tieu J, Yip K, Mackie S, Goodman S, Hill C, Robson J. POS0040-HPR PATIENT PERCEPTIONS OF IMPACT OF GLUCOCORTICOID THERAPY IN THE RHEUMATIC DISEASES: INTERNATIONAL DEVELOPMENT OF A TREATMENT-SPECIFIC PATIENT REPORTED OUTCOME MEASURE. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.1479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundGlucocorticoids (GCs) are a key treatment for inflammatory rheumatic diseases, but they cause a wide range of adverse side-effects which are of concern both to patients and clinicians.ObjectivesThe objective of this study was to explore the impact of GC therapy on health-related quality of life (HRQoL) during treatment for rheumatic diseases, as a basis for development of a Patient-Reported Outcome Measure (PROM) to be used in clinical trials and practice.MethodsPatients from the UK, USA and Australia who were treated with GCs in the last two years for a rheumatic condition were invited to take part in semi-structured qualitative interviews. Purposive sampling was used to include participants with a range of demographic and disease features. A steering committee of patient research partners, clinicians and methodologists devised an initial conceptual framework, which informed interview prompts and cues. Interviews were carried out by experienced qualitative researchers who encouraged participants to tell their stories and talk about the effects, both adverse and beneficial, of their experiences and perceptions of treatment with GCs, to identify salient physical and psychological symptoms and aspects of HRQoL. The interview data were organised using NVivo, and inductive analysis identified initial themes and domains. Candidate questionnaire items were developed and refined using cognitive interviewing, linguistic assessment, and input from patient research partners.ResultsSixty semi-structured qualitative interviews were conducted (UK n=34, USA n=10, Australia n=16). Mean participant age was 58 years; 39 (66.1%) were female. Purposive sampling of participants provided a broad range of demographic features, GC dosages and inflammatory rheumatic conditions, with 27% having connective tissue disease, 25% inflammatory arthritis, 30% systemic vasculitis and 16% other rheumatic conditions.Initial domains were developed to identify key themes relating to treatment using GCs and their impact on HRQoL; see Figure 1.Figure 1.Steroid PRO Initial ThemesA long-list of 134 initial candidate questionnaire items was developed from the individual themes. These items were reviewed by a qualitative working group of patient research partners, researchers and clinicians to reduce duplication and ambiguity of items. The resulting 62 items were tested and refined by piloting with patient research partners, iterative rounds of cognitive interviews with patients with a range of rheumatic conditions from the UK, USA and Australia, and a linguistic translatability assessment, to define a draft questionnaire of 40 items.ConclusionThis international qualitative study underpins the development of candidate items for a treatment-specific PROM for patients with rheumatic diseases. The draft questionnaire is currently being tested in an online large-scale survey to determine the final scale structure and measurement properties using Rasch analysis, factor analysis, test-retest, comparison with EQ5D, and known groups analysis.Disclosure of InterestsSusan Bridgewater Grant/research support from: Vifor Pharma, Michael A Shepherd Grant/research support from: Vifor Pharma, Jill Dawson: None declared, Pamela Richards: None declared, Christine Silverthorne: None declared, Mwidimi Ndosi: None declared, Celia Almeida: None declared, Rachel J Black: None declared, Jonathan T.L. Cheah: None declared, Emma Dures: None declared, Nilasha Ghosh: None declared, Elizabeth A Hoon: None declared, Suellen Lyne: None declared, Iris Navarro-Millan Consultant of: Honorarium on Swedish Orpham Biovitrum (SOBI) advisory board 2021, Diyu Pearce-Fisher: None declared, Carlee Ruediger: None declared, Joanna Tieu: None declared, Kevin Yip: None declared, Sarah Mackie: None declared, Susan Goodman: None declared, Catherine Hill: None declared, Joanna Robson Speakers bureau: EULAR Symposium 2021 for Vifor Pharma, Consultant of: Honorarium for Vifor Pharma advisory board 2021, Grant/research support from: Vifor Pharma 2020-2022
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Capewell P, Loane J, Robson J, Vansteenhouse H, Andersen D. 54P Development of a prognostic test for breast cancer recurrence using a highly efficient molecular profiling platform. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.03.069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Wu R, Williams C, Schlackow I, Zhou J, Emberson J, Reith C, Keech A, Robson J, Wilkinson K, Armitage J, Collins R, Gray A, Simes J, Baigent C, Mihaylova B. A model of lifetime health outcomes in cardiovascular disease based on clinical trials and large cohorts. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.3149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Background and purpose
Cardiovascular disease (CVD) risk of individuals depends on their socio-demographic characteristics, clinical risk factors, and treatments, and strongly influences their quality of life and survival. Individual-based long-term disease models, which aim to more accurately calculate the lifetime consequences, can help to target treatments, develop disease management programmes, and assess the value of new therapies. We present a new micro-simulation CVD model.
Methods
This micro-simulation model was developed using individual participant data from the Cholesterol Treatment Trialists' collaboration (CTT: 118,000 participants; 15 trials) and calibrated (with added socioeconomic deprivation, ethnicity, physical activity, mental illness, cancer and incident diabetes) in the UK Biobank cohort (UKB: 502,000 participants). Parametric survival models estimated risks of key endpoints (myocardial infarction (MI), stroke, coronary revascularisation (CRV), diabetes, cancer and vascular (VD) and nonvascular death (NVD) using participants' age, sex, ethnicity, physical activity, socioeconomic deprivation, smoking history, lipids, blood pressure, creatinine, previous cardiovascular diseases, diabetes, mental illness and cancer at entry and non-fatal incidents of the key endpoints during follow-up. The model integrates the risk equations and enables annual projection of endpoints and survival over individuals' lifetimes. The model was used to project remaining life expectancy across UK Biobank participants.
Results
Nonfatal cardiovascular events and age were the major determinants of CVD risk and, together with incident diabetes and cancer, of individuals' survival. The cumulative incidence of the key endpoints predicted by the CTT-UKB model corresponded well to their observed incidence in the UK Biobank cohort, overall (Figure 1) and in categories of participants by age, sex, prior CVD and CVD risk. Predicted remaining life expectancy across UK Biobank participants without history of CVD ranged between 22 and 43 years in men and between 24 and 46 years in women, depending on their age and CVD risk (Figure 2). Among UK Biobank participants with history of CVD, depending on their age, predicted remaining life expectancy ranged from 20 to 32 years in men and from 26 to 38 years in women.
Conclusion
This new lifetime CVD model accurately predicts morbidity and mortality in a large UK population cohort. It will be made available to provide individualised projections of expected lifetime health outcomes and benefits of treatments.
Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): UK National Institute for Health Research (NIHR) Health Technology Assessment (HTA) Programme, UK Medical Research Council (MRC), British Heart Foundation Figure 1. Predicted (in black) versus observed (95% CI; in red) incidence of major clinical outcomes in the UK Biobank.Figure 2. Predicted remaining life expectancy of participants in UK Biobank cohort, by age and CVD risk or previous CVD at entry. QRISK, a 10-year CVD risk scoring algorithm for people without previous CVD, recommended for use in the UK National Health Service.
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Affiliation(s)
- R Wu
- Queen Mary University of London, London, United Kingdom
| | - C Williams
- University of Oxford, Nuffield Department of Population Health, Oxford, United Kingdom
| | - I Schlackow
- University of Oxford, Nuffield Department of Population Health, Oxford, United Kingdom
| | - J Zhou
- University of Oxford, Nuffield Department of Population Health, Oxford, United Kingdom
| | - J Emberson
- University of Oxford, Nuffield Department of Population Health, Oxford, United Kingdom
| | - C Reith
- University of Oxford, Nuffield Department of Population Health, Oxford, United Kingdom
| | - A Keech
- University of Sydney, Clinical Trials Centre, Sydney, Australia
| | - J Robson
- Queen Mary University of London, London, United Kingdom
| | - K Wilkinson
- Public Representative, Oxford, United Kingdom
| | - J Armitage
- University of Oxford, Nuffield Department of Population Health, Oxford, United Kingdom
| | - R Collins
- University of Oxford, Nuffield Department of Population Health, Oxford, United Kingdom
| | - A Gray
- University of Oxford, Nuffield Department of Population Health, Oxford, United Kingdom
| | - J Simes
- University of Sydney, Clinical Trials Centre, Sydney, Australia
| | - C Baigent
- University of Oxford, Nuffield Department of Population Health, Oxford, United Kingdom
| | - B Mihaylova
- University of Oxford, Nuffield Department of Population Health, Oxford, United Kingdom
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Abstract
Abstract
Background
Hypertension and hypercholesterolaemia are major modifiable risk factors for cardiovascular diseases (CVD) with available effective and low-cost treatments. However, their suboptimal treatment remains widespread. We characterise treatment gaps in a large urban population and quantify the potential long-term health and economic impact with optimised use.
Methods
We studied 1 million UK urban residents served by 123 primary care practices in 2019. We categorised antihypertensive treatment in adults with diagnosed hypertension, and statin treatment in adults with diagnosed CVD, into optimal, suboptimal and not treated following UK clinical guidelines. A long-term CVD model was used to project cardiovascular events avoided, years of life and quality-adjusted life years (QALYs) gained, and healthcare costs saved with optimised treatments for individual patients accounting for their socio-demographic characteristics and risk factors.
Results
21,954 (24%, mean age 59 years; 49% female) of the 91,828 adults with hypertension were either suboptimally treated (20%) or untreated (4%) and 9,062 (38%, mean age 69 years; 43% female) of the 23,723 adults with CVD were either suboptimally treated (24%) or untreated (14%). Per 1000 patients (95% CI) optimised over lifespan, hypertension treatment would prevent 154 (72–230) major vascular events (MVEs, including heart attack, stroke or arterial revascularisation) and 69 (28–103) vascular deaths, and gain 769 (436–1038) QALYs for those sub-optimally treated, and prevent 138 (68–201) MVEs and 50 (21–76) vascular deaths, and gain 674 (386–920) QALYs for those not treated; statin treatment would prevent 68 (46–88) MVEs and 17 (12–21) vascular deaths, and gain 145 (113–178) QALYs for those sub-optimally treated, and prevent 260 (190–319) MVEs and 55 (40–68) vascular deaths, and gain 535 (412–651) QALYs for those not treated (Figure). Hospital cost savings net of medication costs were about £1100 per person over their remaining lifespan.
Conclusion
Optimising preventive cardiovascular treatments in UK primary care is likely to cost-effectively reduce cardiovascular risk and improve life expectancy, while reducing population inequalities.
Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): Barts Charity, British Heart Foundation, and Health Data Research UK Predicted benefits from optimisation
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Affiliation(s)
- R Wu
- Queen Mary University of London, Institute of Population Health Sciences, London, United Kingdom
| | - S Rison
- Queen Mary University of London, Institute of Population Health Sciences, London, United Kingdom
| | - Z Raisi-Estabragh
- Queen Mary University of London, William Harvey Research Institute, London, United Kingdom
| | - I Dostal
- Queen Mary University of London, Institute of Population Health Sciences, London, United Kingdom
| | - C Carvalho
- Queen Mary University of London, Institute of Population Health Sciences, London, United Kingdom
| | - J Robson
- Queen Mary University of London, Institute of Population Health Sciences, London, United Kingdom
| | - B Mihaylova
- Queen Mary University of London, Institute of Population Health Sciences, London, United Kingdom
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Putsathit P, Hong S, George N, Hemphill C, Huntington PG, Korman TM, Kotsanas D, Lahra M, McDougall R, McGlinchey A, Moore CV, Nimmo GR, Prendergast L, Robson J, Waring L, Wehrhahn MC, Weldhagen GF, Wilson RM, Riley TV, Knight DR. Antimicrobial resistance surveillance of Clostridioides difficile in Australia, 2015-18. J Antimicrob Chemother 2021; 76:1815-1821. [PMID: 33895826 DOI: 10.1093/jac/dkab099] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 03/05/2021] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Clostridioides difficile was listed as an urgent antimicrobial resistance (AMR) threat in a report by the CDC in 2019. AMR drives the evolution of C. difficile and facilitates its emergence and spread. The C. difficile Antimicrobial Resistance Surveillance (CDARS) study is nationwide longitudinal surveillance of C. difficile infection (CDI) in Australia. OBJECTIVES To determine the antimicrobial susceptibility of C. difficile isolated in Australia between 2015 and 2018. METHODS A total of 1091 strains of C. difficile were collected over a 3 year period by a network of 10 diagnostic microbiology laboratories in five Australian states. These strains were tested for their susceptibility to nine antimicrobials using the CLSI agar incorporation method. RESULTS All strains were susceptible to metronidazole, fidaxomicin, rifaximin and amoxicillin/clavulanate and low numbers of resistant strains were observed for meropenem (0.1%; 1/1091), moxifloxacin (3.5%; 38/1091) and vancomycin (5.7%; 62/1091). Resistance to clindamycin was common (85.2%; 929/1091), followed by resistance to ceftriaxone (18.8%; 205/1091). The in vitro activity of fidaxomicin [geometric mean MIC (GM) = 0.101 mg/L] was superior to that of vancomycin (1.700 mg/L) and metronidazole (0.229 mg/L). The prevalence of MDR C. difficile, as defined by resistance to ≥3 antimicrobial classes, was low (1.7%; 19/1091). CONCLUSIONS The majority of C. difficile isolated in Australia did not show reduced susceptibility to antimicrobials recommended for treatment of CDI (vancomycin, metronidazole and fidaxomicin). Resistance to carbapenems and fluoroquinolones was low and MDR was uncommon; however, clindamycin resistance was frequent. One fluoroquinolone-resistant ribotype 027 strain was detected.
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Affiliation(s)
- Papanin Putsathit
- School of Medical and Health Sciences, Edith Cowan University, Joondalup 6027, WA, Australia
| | - Stacey Hong
- Marshall Centre for Infectious Diseases Research and Training, School of Biomedical Sciences, The University of Western Australia, Queen Elizabeth II Medical Centre, Nedlands 6009, WA, Australia.,Medical, Molecular and Forensic Sciences, Murdoch University, Murdoch 6150, WA, Australia
| | - Narelle George
- Pathology Queensland, Royal Brisbane and Women's Hospital, Herston 4029, QLD, Australia
| | | | - Peter G Huntington
- Department of Microbiology, NSW Health Pathology, Royal North Shore Hospital, St Leonards, 2065, NSW, Australia
| | - Tony M Korman
- Monash Infectious Diseases, Monash Health, Monash Medical Centre, Clayton 3168, VIC, Australia
| | - Despina Kotsanas
- Monash Infectious Diseases, Monash Health, Monash Medical Centre, Clayton 3168, VIC, Australia
| | - Monica Lahra
- Department of Microbiology, The Prince of Wales Hospital, Randwick 2031, NSW, Australia
| | | | | | - Casey V Moore
- Microbiology and Infectious Diseases Laboratories, SA Pathology, Adelaide 5000, SA, Australia
| | - Graeme R Nimmo
- Pathology Queensland, Royal Brisbane and Women's Hospital, Herston 4029, QLD, Australia
| | | | | | | | | | - Gerhard F Weldhagen
- Microbiology and Infectious Diseases Laboratories, SA Pathology, Adelaide 5000, SA, Australia
| | - Richard M Wilson
- Australian Clinical Labs, Microbiology Department, Wayville 5034, SA, Australia
| | - Thomas V Riley
- School of Medical and Health Sciences, Edith Cowan University, Joondalup 6027, WA, Australia.,Marshall Centre for Infectious Diseases Research and Training, School of Biomedical Sciences, The University of Western Australia, Queen Elizabeth II Medical Centre, Nedlands 6009, WA, Australia.,Medical, Molecular and Forensic Sciences, Murdoch University, Murdoch 6150, WA, Australia.,Department of Microbiology, PathWest Laboratory Medicine, Queen Elizabeth II Medical Centre, Nedlands 6009, WA, Australia
| | - Daniel R Knight
- Marshall Centre for Infectious Diseases Research and Training, School of Biomedical Sciences, The University of Western Australia, Queen Elizabeth II Medical Centre, Nedlands 6009, WA, Australia.,Medical, Molecular and Forensic Sciences, Murdoch University, Murdoch 6150, WA, Australia
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Sweeney AMT, Robson J, Flurey C, Richards P, Mccabe C, Ndosi M. POS0158-HPR UNDERSTANDING NURSE-LED CARE IN EARLY RA: INTERVIEW STUDY WITH RHEUMATOLOGY NURSE SPECIALISTS. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Nurse-led care in early RA is not well defined in the literature and the current recommendations.Objectives:This study aimed to develop an understanding of what comprises nurse-led care in early RA from the perspective of rheumatology nurse specialists.Methods:This was a qualitative study using semi-structured telephone interviews with rheumatology nurse specialists in England (Summer 2020). Interviews were audio-recorded, transcribed verbatim and analysed using inductive thematic analysis.[1]Results:Sixteen nurses were recruited and interviews lasted between 30 to 60 minutes. Seven themes were identified.Early disease managementCare was characterised by evidence-based RA management provided by experienced nurse specialists with a high degree of autonomy, in the context of a rheumatology multidisciplinary team. The aims of care were to: start treatment, keep in treatment, educate and support.’So treat to target...escalating treatment as necessary, and addressing any concerns that the patients might have’ (CNS14)Addressing psychosocial needsPatients with early RA experience shock, fear, anger, grief and denial while feeling unwell with pain and fatigue. Nurses use a holistic, person-centred and empathetic approach to address psychosocial needs, building a working relationship, listening and creating trust.’Because it all relates, and if they’re stressed because they’re not coping at work, then their arthritis isn’t going to be so good. So everything relates to one another really’ (CNS06)Monitoring treatment, disease impact and patient outcomesNurses monitor disease activity and disease impact using validated outcome measures and by asking questions during the consultation. Good outcomes are disease control, managing disease impact, medication and side effects, wellbeing and keeping in work.’When you get them stable, when you get them into remission, when they’re happy, when they’re feeling well, I think there’s lots of ways you can measure that’… (CNS13)Coordinating care, referring and signpostingNurses coordinate care, refer to other health professionals and signpost patients to relevant services and charities. Lack of access to psychology expertise was highlighted.‘And whilst most of us have got some degree of understanding of…self management, or psychology…we’re not psychologists’ (CNS02)Providing a ‘lifeline’Nurse-led telephone advice services provide a ‘lifeline’ for patients. If patients struggle, they can call and speak with a specialist who knows them and their RA well.’The advice line has been a lifeline to them, to be able to speak to someone, to be able to get a response quickly to their questions, they feel very well supported, they know that they can always call us’ (CNS16)Service evaluation and auditingThe individual clinics are reviewed regularly. Patients are asked for feedback on their experience of appointments, if their needs were met and about changes to the service....‘It’s really important to ask them initially what they expect to have from the consultation...We’ve always had really good feedback in general’… (CNS02)COVID-19 challenges and opportunitiesThe pandemic caused major disruptions to the services, prohibiting most face-to-face consultations which was an essential aspect of clinical assessments. Despite the challenges imposed by the pandemic, the services adapted fast, using telephone, video clinics and digital solutions, which streamlined procedures and improved documentation and communication.‘I do have to rely on them telling me what’s going on, because I can’t see it at the moment’ (CNS14)’With Covid we’re doing it over the telephone, and we’re getting them to watch the video [injection tutorial] before we have the appointment with them’ (CNS04)Conclusion:Nurse-led care in early arthritis is a specialist service, addressing complex needs of patients, using evidence based and person-centred approaches. Innovation and service improvement are seen as part of the role.References:[1]Braun V, Clarke V. Successful Qualitative Research. First edition. London: SAGE 2013.Disclosure of Interests:None declared
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Silverthorne C, Daniels J, Thompson M, Robson J, Ndosi M, Swales C, Wilkins K, Dures E. POS1472-HPR CLINICIANS’ PERSPECTIVES ON PSYCHOLOGICAL DISTRESS AND MEETING PATIENTS’ SUPPORT NEEDS IN RHEUMATOLOGY CARE SETTINGS. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.2429] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:People with inflammatory rheumatic diseases (IRDs) face challenges that include fluctuations in pain, fatigue and flares of disease activity, complex medical regimens, and decisions about when to seek clinical help with symptoms [1,2]. Evidence suggests levels of anxiety and depression are higher in people with IRDs compared to the general population [3]. Rheumatology teams report that psychologically distressed patients can have additional support needs and require more time. Patients’ concerns include health-related anxiety and difficulty accepting the diagnosis. This group can have poor outcomes and poor adherence to treatments. However, little is currently known about optimal ways to meet these patients’ support needs.Objectives:To understand rheumatology clinicians’ perspectives on psychological distress in care settings with the long-term aim to develop a proposed model/pathway of support.Methods:Telephone interviews were conducted with members of UK rheumatology teams who have clinical experience with patients experiencing distress. The semi-structured interviews explored both ‘what happens now’ (current clinical practice) and ‘what should happen’ (acceptable models of future psychological support provision). The semi-structured format provided flexibility to probe more deeply and develop new lines of enquiry based on participants’ responses.Results:Fourteen interviews were conducted with rheumatology clinicians including 2 consultants, 4 nurses, 1 physiotherapist, 4 occupational therapists, 2 clinical psychologists and 1 podiatrist. Inductive thematic analysis was used to analyse the data. Two main themes represent the data (Table 1).Table 1.Main ThemeSub-themes1. ‘No one shoe fits all’ – the many manifestations of distress in patients.‘I pick up on distress as increased emotion…tearfulness and sadness I suppose, but also frustration, anger...A lot of helplessness comments’1. ‘Distress can be quite emotive and quite obvious, but then it can also hide away’2. ‘They’re [patients] trying to manage their own conditions, but they’re also trying to manage life’2. ‘If Rheumatology could be interwoven with psychological principles’ – the need to attend to the psychological impact of IRDs, alongside the physical impact.‘The physical and mental health side of things are so closely linked because one affects the other…after a while they [patients] don’t really know what’s affecting what’1. ‘Prioritising physical health…sometimes the stress gets not thought about’2. ‘Make best use of everyone in the team to work with patients who are struggling’3. ‘For the psychological side of things we don’t measure anything about that at all’Conclusion:Distress can be obvious or hidden and cause issues for both patient and clinician. It can lead to poor engagement with care provision. Clinicians differ in their perceptions of distress and in their thresholds for dealing with distress and have described the inconsistency of support offered for distressed patients. They described the powerful link between physical and mental distress, the vicious cycle that can develop, and the benefits of incorporating a psychological approach to treatment. This study suggests psychological support should be embedded within the team as it is felt there is a need for speciality understanding and for patients’ emotional wellbeing to consistently be given equal priority to their physical wellbeing.References:[1]Gettings L. Psychological well-being in rheumatoid arthritis: a review of the literature. Musculoskeletal care 2010;8(2):99-106. doi: 10.1002/msc.171 [published Online First: 2010/03/17][2]Homer D. Addressing psychological and social issues of rheumatoid arthritis within the consultation: a case report. Musculoskeletal care 2005;3(1):54-9. doi: 10.1002/msc.26 [published Online First: 2006/10/17][3]Isik A, Koca SS, Ozturk A, et al. Anxiety and depression in patients with rheumatoid arthritis. Clinical rheumatology 2007;26(6):872-8. doi: 10.1007/s10067-006-0407-y [published Online First: 2006/08/31]Disclosure of Interests:None declared
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Peetz J, Robson J, Xuereb S. The Role of Income Volatility and Perceived Locus of Control in Financial Planning Decisions. Front Psychol 2021; 12:638043. [PMID: 34135807 PMCID: PMC8200394 DOI: 10.3389/fpsyg.2021.638043] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 04/26/2021] [Indexed: 11/13/2022] Open
Abstract
Two studies examine whether income volatility might lead to greater personal financial insecurity and might create a decision environment that discourages planning ahead on personal finances. In Study 1 (N = 982), participants who reported more month-to-month variability in their actual income were less likely to have planned for financial contingencies. A lower internal locus of control partially mediated the link between volatility and financial planning decisions in Study 1, and lower internal locus of economic control predicted financial planning decisions independently of volatility. In Study 2 (N = 149), participants who were randomly assigned to receive volatile (vs. stable) payments in a simulated work environment were less likely to save their compensation for this work. Again, lower internal locus of economic control predicted financial planning decisions independently of volatility. This is the first study to demonstrate a causal link between income volatility and financial decisions, specifically a heightened tendency to make short-term financial decisions. Both studies also underlined the importance of internal locus of control for financial planning decisions.
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Affiliation(s)
- Johanna Peetz
- Department of Psychology, Carleton University, Ottawa, ON, Canada
| | - Jennifer Robson
- Department of Political Management, Carleton University, Ottawa, ON, Canada
| | - Silas Xuereb
- Department of Psychology, Carleton University, Ottawa, ON, Canada
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Bridgewater S, Dawson J, Ndosi M, Black RJ, Cheah JTL, Dures E, Ghosh N, Hoon EA, Navarro-Millan I, Pearce-Fisher D, Richards P, Ruediger C, Silverthorne C, Tieu J, Mackie S, Goodman S, Hill C, Robson J. AB0834 DEVELOPMENT OF A CONCEPTUAL FRAMEWORK FOR A PATIENT REPORTED OUTCOME MEASURE TO CAPTURE PATIENTS’ PERCEPTIONS OF GLUCOCORTICOID THERAPY DURING TREATMENT FOR RHEUMATIC DISEASES. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.164] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Glucocorticoids (GCs) are a key treatment for the autoimmune rheumatic diseases; however, they produce numerous physical and psychological side effects.1 The Outcome Measures in Rheumatology (OMERACT) Glucocorticoid Working Group have identified that there are no Patient Reported Outcome Measures (PROMs) for assessing the impact of systemic GC therapy across multiple rheumatic diseases from the patient’s perspective.2,3Objectives:The aim is to explore the impact of GCs on the symptoms and health-related quality of life of adults with rheumatic inflammatory diseases, to inform items for inclusion in a PROM. Key considerations will include patient perceptions of GC therapy at diagnosis and over the course of treatment, for use in future randomised controlled trials or in clinical practice.Methods:An international steering committee comprising researchers, rheumatology clinicians, methodologists and patient partners in the UK, Australia and USA developed an initial conceptual framework informed by a review of the literature. Semi-structured interviews were conducted in each country with patients who had an autoimmune rheumatic disease and had received GC therapy. The interviews explored salient aspects of health-related quality of life associated with being treated with GCs.Results:Interviews have been completed in three continents with patients who had a range of demographic features, rheumatological conditions and duration and dosage of GC therapy. Figure 1 shows the initial conceptual framework for developing the GC PROM (Steroid PRO).Figure 1.Conclusion:This conceptual framework will act as an evolving guide in the development of a PROM for assessing patients’ perspectives of systemic glucocorticoid therapy. Future work will include inductive analysis of qualitative transcripts to inform candidate questionnaire items, cognitive interviewing, linguistic translatability assessment, and an international validation survey to define the final PROM questionnaire and its measurement properties.References:[1]Cheah JTL, Robson JC, Black RJ, et al. The patient’s perspective of the adverse effects of glucocorticoid use: A systematic review of quantitative and qualitative studies. From an OMERACT working group. Semin Arthritis Rheum. 2020 Oct; 50(5):996-1005.[2]Black RJ, Robson JC, Goodman SM, et al. A Patient-reported Outcome Measure for Effect of Glucocorticoid Therapy in Adults with Inflammatory Diseases Is Needed: Report from the OMERACT 2016 Special Interest Group. J Rheumatol. 2017; 44(11):1754-8.[3]Cheah JTL, Black RJ, Robson JC, et al. Toward a Core Domain Set for Glucocorticoid Impact in Inflammatory Rheumatic Diseases: The OMERACT 2018 Glucocorticoid Impact Working Group. J Rheumatol. 2019; 46(9):1179-1182.Disclosure of Interests:Susan Bridgewater Grant/research support from: Grant from Vifor Pharma for an independent investigator-led study to develop a PRO for steroids, Jill Dawson: None declared, Mwidimi Ndosi: None declared, Rachel J Black: None declared, Jonathan T.L. Cheah: None declared, Emma Dures: None declared, Nilasha Ghosh: None declared, Elizabeth A Hoon: None declared, Iris Navarro-Millan Consultant of: Received consultant fees from SOBI, Diyu Pearce-Fisher: None declared, Pamela Richards: None declared, Carlee Ruediger: None declared, Christine Silverthorne: None declared, Joanna Tieu Grant/research support from: Vifor Pharma, Sarah Mackie Consultant of: Consultancy on behalf of institution for Roche/Chugai, Sanofi, AbbVie and AstraZeneca, Grant/research support from: Educational grant from Roche to attend EULAR2019, Susan Goodman: None declared, Catherine Hill: None declared, Joanna Robson Speakers bureau: Vifor Pharma for educational webinar, Grant/research support from: Grant from Vifor Pharma for an independent investigator-led study to develop a PRO for steroids
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Wehrhahn MC, Brown SJ, Newcombe JP, Chong S, Evans J, Figtree M, Hainke L, Hueston L, Khan S, Marland E, O'Sullivan MVN, Powell H, Roy J, Waring L, Yu M, Robson J. An evaluation of 4 commercial assays for the detection of SARS-CoV-2 antibodies in a predominantly mildly symptomatic low prevalence Australian population. J Clin Virol 2021; 138:104797. [PMID: 33770657 PMCID: PMC7968170 DOI: 10.1016/j.jcv.2021.104797] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 02/28/2021] [Accepted: 03/14/2021] [Indexed: 02/08/2023]
Abstract
A total of 1080 individual patient samples (158 positive serology samples from confirmed, predominantly mildly symptomatic COVID-19 patients and 922 serology negative including 496 collected pre-COVID) from four states in Australia were analysed on four commercial SARS-CoV-2 serological assays targeting antibodies to different antigens (Roche Elecsys and Abbott Architect: nucleocapsid; Diasorin Liaison and Euroimmun: spike). A subset was compared to immunofluorescent antibody (IFA) and micro-neutralisation. Sensitivity and specificity of the Roche (n = 1033), Abbott (n = 806), Diasorin (n = 1034) and Euroimmun (n = 175) were 93.7 %/99.5 %, 90.2 %/99.4 %, 88.6 %/98.6 % and 91.3 %/98.8 %, respectively. ROC analysis with specificity held at 99 % increased the sensitivity for the Roche and Abbott assays from 93.7% to 98.7% (cut-off 0.21) and 90.2 % to 94.0 % (cut-off 0.91), respectively. Overall seropositivity of samples increased from a maximum of 23 % for samples 0−7 days-post-onset of symptoms (dpos), to 61 % from samples 8−14dpos and 93 % from those >14dpos. IFA and microneutralisation values correlated best with assays targeting antibodies to spike protein with values >80 AU/mL on the Diasorin assay associated with neutralising antibody. Detectable antibody was present in 22/23 (96 %), 20/23 (87 %), 15/23 (65 %) and 9/22 (41 %) patients with samples >180dpos on the Roche, Diasorin, Abbott and microneutralisation assays respectively. Given the low prevalence in this community, two-step algorithms on initial positive results saw an increase in the positive predictive value (PPV) of positive samples (39 %–65 % to ≥98 %) for all combinations. Similarly accuracy increased from a range of 98.5 %–99.4 % to ≥99.8 % assuming a 1 % seroprevalence. Negative predictive value (NPV) was high (≥99.8 %) regardless of which assay was used initially.
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Affiliation(s)
- Michael C Wehrhahn
- Department of Microbiology, Douglass Hanly Moir Pathology, New South Wales, Australia.
| | - Suzanne J Brown
- Department of Endocrinology, Sir Charles Gairdner Hospital, Western Australia, Australia
| | - James P Newcombe
- Department of Microbiology, Douglass Hanly Moir Pathology, New South Wales, Australia; NSW Health Pathology, Department of Microbiology, Royal North Shore Hospital, New South Wales, Australia
| | - Smathi Chong
- Department of Microbiology, Clinipath Pathology, Western Australia, Australia
| | - Jenny Evans
- Department of Microbiology, Sullivan Nicolaides Pathology, Queensland, Australia
| | - Melanie Figtree
- NSW Health Pathology, Department of Microbiology, Royal North Shore Hospital, New South Wales, Australia
| | - Laurence Hainke
- Department of Microbiology, Clinipath Pathology, Western Australia, Australia
| | - Linda Hueston
- NSW Health Pathology, Institute of Clinical Pathology and Medical Research, Westmead, New South Wales, Australia
| | - Sadid Khan
- Department of Microbiology, Melbourne Pathology, Victoria, Australia
| | - Elizabeth Marland
- Department of Microbiology, Douglass Hanly Moir Pathology, New South Wales, Australia
| | - Matthew V N O'Sullivan
- NSW Health Pathology, Institute of Clinical Pathology and Medical Research, Westmead, New South Wales, Australia; Faculty of Medicine and Health, University of Sydney, New South Wales, Australia
| | - Helen Powell
- Department of Microbiology, Sullivan Nicolaides Pathology, Queensland, Australia
| | - Jhumur Roy
- Department of Microbiology, Clinpath Pathology, South Australia, Australia
| | - Lynette Waring
- Department of Microbiology, Melbourne Pathology, Victoria, Australia
| | - Megan Yu
- Department of Microbiology, Douglass Hanly Moir Pathology, New South Wales, Australia
| | - Jennifer Robson
- Department of Microbiology, Sullivan Nicolaides Pathology, Queensland, Australia
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Shield J, Braat S, Watts M, Robertson G, Beaman M, McLeod J, Baird RW, Hart J, Robson J, Lee R, McKessar S, Nicholson S, Mayer-Coverdale J, Biggs BA. Seropositivity and geographical distribution of Strongyloides stercoralis in Australia: A study of pathology laboratory data from 2012-2016. PLoS Negl Trop Dis 2021; 15:e0009160. [PMID: 33690623 PMCID: PMC7978363 DOI: 10.1371/journal.pntd.0009160] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 03/19/2021] [Accepted: 01/20/2021] [Indexed: 11/18/2022] Open
Abstract
Background There are no national prevalence studies of Strongyloides stercoralis infection in Australia, although it is known to be endemic in northern Australia and is reported in high risk groups such as immigrants and returned travellers. We aimed to determine the seropositivity (number positive per 100,000 of population and percent positive of those tested) and geographical distribution of S. stercoralis by using data from pathology laboratories. Methodology We contacted all seven Australian laboratories that undertake Strongyloides serological (ELISA antibody) testing to request de-identified data from 2012–2016 inclusive. Six responded. One provided positive data only. The number of people positive, number negative and number tested per 100,000 of population (Australian Bureau of Statistics data) were calculated including for each state/territory, each Australian Bureau of Statistics Statistical Area Level 3 (region), and each suburb/town/community/locality. The data was summarized and expressed as maps of Australia and Greater Capital Cities. Principal findings We obtained data for 81,777 people who underwent serological testing for Strongyloides infection, 631 of whom were from a laboratory that provided positive data only. Overall, 32 (95% CI: 31, 33) people per 100,000 of population were seropositive, ranging between 23/100,000 (95% CI: 19, 29) (Tasmania) and 489/100,000 population (95%CI: 462, 517) (Northern Territory). Positive cases were detected across all states and territories, with the highest (260-996/100,000 and 17–40% of those tested) in regions across northern Australia, north-east New South Wales and north-west South Australia. Some regions in Greater Capital Cities also had a high seropositivity (112-188/100,000 and 17–20% of those tested). Relatively more males than females tested positive. Relatively more adults than children tested positive. Children were under-represented in the data. Conclusions/Significance The study confirms that substantial numbers of S. stercoralis infections occur in Australia and provides data to inform public health planning. Strongyloides stercoralis, a parasitic roundworm, is endemic in many countries world-wide. In Australia, groups at risk for strongyloidiasis include Aboriginal and/or Torres Strait Islander people, who acquired this parasite locally, and immigrants and returned travellers who acquired the infection outside Australia. We obtained deidentified results of ELISA IgG antibody tests for Strongyloides from diagnostic pathology laboratories during 2012 to 2016 and calculated the number of people who were positive at least once and the number who never had a positive result. We drew maps showing the number positive per 100,000 of population, the percent positive of those tested, and the number tested/100,000 for each region and the number positive in each suburb of residence according to the Australian Bureau of Statistics. The highest seropositivity (260-996/100,000 of population) was in Northern Australia, north-west South Australia and north-east New South Wales where many Aboriginal and Torres Strait Islander people live in remote communities. There were also some regions in Greater Capital Cities with a high number of people positive per 100,000 of population (112-188/100,000), likely reflecting higher populations of immigrants and returned travellers who were infected outside Australia.
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Affiliation(s)
- Jennifer Shield
- Departments of Medicine and Infectious Diseases at the Doherty Institute, University of Melbourne, Melbourne, Victoria, Australia
- Department of Pharmacy and Applied Science, La Trobe University, Bendigo, Victoria, Australia
- * E-mail:
| | - Sabine Braat
- Departments of Medicine and Infectious Diseases at the Doherty Institute, University of Melbourne, Melbourne, Victoria, Australia
- Melbourne School of Population and Global Health, University of Melbourne, Parkville, Victoria, Australia
| | - Matthew Watts
- Centre for Infectious Diseases and Microbiology, Pathology West-ICPMR and Marie Bashir Institute, University of Sydney, Westmead Hospital, Westmead, New South Wales, Australia
| | | | - Miles Beaman
- PathWest Laboratory Medicine, Nedlands, Western Australia, Australia
| | - James McLeod
- Territory Pathology, Alice Springs Hospital, Alice Springs, Northern Territory, Australia
| | - Robert W. Baird
- Territory Pathology, Royal Darwin Hospital, Tiwi, Northern Territory, Australia
| | - Julie Hart
- PathWest Laboratory Medicine, Nedlands, Western Australia, Australia
| | - Jennifer Robson
- Sullivan Nicolaides Pathology, Bowen Hills, Queensland, Australia
| | - Rogan Lee
- Centre for Infectious Diseases and Microbiology, Pathology West-ICPMR and Marie Bashir Institute, University of Sydney, Westmead Hospital, Westmead, New South Wales, Australia
| | | | - Suellen Nicholson
- Victorian Infectious Diseases Reference Laboratory, Doherty Institute, Melbourne, Victoria, Australia
| | | | - Beverley-Ann Biggs
- Departments of Medicine and Infectious Diseases at the Doherty Institute, University of Melbourne, Melbourne, Victoria, Australia
- Victorian Infectious Disease Service, Royal Melbourne Hospital, Melbourne, Victoria, Australia
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Davidson N, Evans J, Giammichele D, Powell H, Hobson P, Teis B, Glover H, Guppy-Coles KB, Robson J. Comparative analysis of three laboratory based serological assays for SARS-CoV-2 in an Australian cohort. Pathology 2020; 52:764-769. [PMID: 33070955 PMCID: PMC7524654 DOI: 10.1016/j.pathol.2020.09.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 09/21/2020] [Accepted: 09/28/2020] [Indexed: 10/29/2022]
Abstract
Many unanswered questions remain regarding the role of SARS-CoV-2 serological assays in this unfolding COVID-19 pandemic. These include their utility for the diagnosis of acute SARS-CoV-2 infection, past infection or exposure, correlation with immunity and the effective duration of immunity. This study examined the performance of three laboratory based serological assays, EUROIMMUN Anti-SARS-CoV-2 IgA/IgG, MAGLUMI 2000 Plus 2019-nCov IgM/IgG and EDI Novel Coronavirus (COVID-19) IgM/IgG immunoassays. We evaluated 138 samples from a reference non-infected population and 71 samples from a cohort of 37 patients with SARS-CoV-2 confirmed positive by RT-PCR. The samples were collected at various intervals of 0-45 days post symptoms onset (PSO). Specificity and sensitivity of these assays was 60.9%/71.4% (IgA) and 94.2%/63.3% (IgG) for EUROIMMUN; 98.5%/18.4% (IgM) and 97.8%/53.1% (IgG) for MAGLUMI; and 94.9%/22.5% (IgM) and 93.5%/57.1% (IgG) for EDI, respectively. When samples collected ≥14 days PSO were considered, the sensitivities were 100.0 and 100.0%; 31.0 and 82.8%; 34.5 and 57.1%, respectively. Using estimated population prevalence of 0.1, 1, and 10%, the positive predictive value of all assays remained low. The EUROIMMUN Anti-SARS-CoV-2 IgA lacked specificity for acute diagnosis and all IgM assays offered poor diagnostic utility. Seroconversion can be delayed although all patients had seroconverted at 28 days in our cohort with the EUROIMMUN Anti-SARS-CoV-2 IgG. Despite this, with specificity of only 94% this assay would not be satisfactory for seroprevalence studies in the general Australian population given this is likely to be currently <1%.
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Affiliation(s)
- N Davidson
- Sullivan Nicolaides Pathology, Brisbane, Qld, Australia.
| | - J Evans
- Sullivan Nicolaides Pathology, Brisbane, Qld, Australia
| | - D Giammichele
- Sullivan Nicolaides Pathology, Brisbane, Qld, Australia
| | - H Powell
- Sullivan Nicolaides Pathology, Brisbane, Qld, Australia
| | - P Hobson
- Sullivan Nicolaides Pathology, Brisbane, Qld, Australia
| | - B Teis
- Sullivan Nicolaides Pathology, Brisbane, Qld, Australia
| | - H Glover
- Sullivan Nicolaides Pathology, Brisbane, Qld, Australia
| | | | - J Robson
- Sullivan Nicolaides Pathology, Brisbane, Qld, Australia
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Garriga C, Robson J, Coupland C, Lay-Flurrie S, Hippisley-Cox J. Nationwide health check program by patients with severe mental illness or long-term antidepressants. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa165.1193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
The English NHS Health Check is a unique national risk assessment, awareness and management programme for preventing cardiovascular disease (CVD), diabetes and chronic kidney disease (CKD). We aimed to assess their uptake and association with new diagnoses (CVD, hypertension, type-2 diabetes and CKD) in patients with severe mental illness (SMI) compared to patients without this condition and for patients on long-term antidepressant treatment (LTAD) (≥6 prescriptions vs < 6).
Methods
Cohort study (2013-2017) using the QResearch database. 1,319 general practices across England contributed of over nine million patients aged 40-74 years. 3,492,186 patients were eligible for NHS Health Checks of which 590,218 attended. Outcomes: hazard ratios (HR) with 95% confidence intervals (CI) for uptake of NHS Health Checks and for new diagnoses within 1 year in attendees. Models were adjusted for sex, age, ethnicity, deprivation and region.
Results
65,490 people with SMI and 46,437 people on LTAD (20% of the total eligible with SMI/LTAD, respectively) attended an NHS Health Check. People with SMI or on LTAD were more likely to attend compared to people without those conditions, adjusted HRs 1.05 (95% CI 1.02-1.08) and 1.10 (95% CI 1.08-1.13), respectively. Among attendees, people with SMI and on LTAD were 23% and 55% more likely to be diagnosed with CKD (95% CI 1.12-1.34 and 1.42-1.70, respectively) than people without these conditions. Attendees on LTAD were 66% more likely to have a major CVD event within 1 year than those without LTAD (95% CI 1.41-1.94) or a new diagnosis of hypertension and type 2 diabetes, HRs 1.12 (95% CI 1.05-1.20) and 1.45 (95% CI 1.31-1.60), respectively.
Conclusions
People with SMI or on LTAD were more likely to attend NHS Health Checks than people without these conditions. Higher rates of CKD in patients with SMI/LTAD and CVD, hypertension and type 2 diabetes in the latter might indicate increased risks and unmet need in these patient groups
Key messages
People with SMI/LTAD were more likely to attend NHS Health Checks. People on LTAD were more likely to be diagnosed with CVD, CKD, hypertension and type-2 diabetes than people without these conditions. SMI attendees were more likely to be diagnosed with CKD.
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Affiliation(s)
- C Garriga
- Nuffield Department of Primary Care Health Science, University of Oxford, Oxford, UK
| | - J Robson
- Institute of Population Health Sciences, Queen Mary University of London, London, UK
| | - C Coupland
- Faculty of Medicine & Health Sciences, University of Nottingham, Nottingham, UK
| | - S Lay-Flurrie
- Nuffield Department of Primary Care Health Science, University of Oxford, Oxford, UK
| | - J Hippisley-Cox
- Nuffield Department of Primary Care Health Science, University of Oxford, Oxford, UK
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31
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Smith DM, Scaife AA, Eade R, Athanasiadis P, Bellucci A, Bethke I, Bilbao R, Borchert LF, Caron LP, Counillon F, Danabasoglu G, Delworth T, Doblas-Reyes FJ, Dunstone NJ, Estella-Perez V, Flavoni S, Hermanson L, Keenlyside N, Kharin V, Kimoto M, Merryfield WJ, Mignot J, Mochizuki T, Modali K, Monerie PA, Müller WA, Nicolí D, Ortega P, Pankatz K, Pohlmann H, Robson J, Ruggieri P, Sospedra-Alfonso R, Swingedouw D, Wang Y, Wild S, Yeager S, Yang X, Zhang L. North Atlantic climate far more predictable than models imply. Nature 2020; 583:796-800. [PMID: 32728237 DOI: 10.1038/s41586-020-2525-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 05/01/2020] [Indexed: 11/09/2022]
Abstract
Quantifying signals and uncertainties in climate models is essential for the detection, attribution, prediction and projection of climate change1-3. Although inter-model agreement is high for large-scale temperature signals, dynamical changes in atmospheric circulation are very uncertain4. This leads to low confidence in regional projections, especially for precipitation, over the coming decades5,6. The chaotic nature of the climate system7-9 may also mean that signal uncertainties are largely irreducible. However, climate projections are difficult to verify until further observations become available. Here we assess retrospective climate model predictions of the past six decades and show that decadal variations in North Atlantic winter climate are highly predictable, despite a lack of agreement between individual model simulations and the poor predictive ability of raw model outputs. Crucially, current models underestimate the predictable signal (the predictable fraction of the total variability) of the North Atlantic Oscillation (the leading mode of variability in North Atlantic atmospheric circulation) by an order of magnitude. Consequently, compared to perfect models, 100 times as many ensemble members are needed in current models to extract this signal, and its effects on the climate are underestimated relative to other factors. To address these limitations, we implement a two-stage post-processing technique. We first adjust the variance of the ensemble-mean North Atlantic Oscillation forecast to match the observed variance of the predictable signal. We then select and use only the ensemble members with a North Atlantic Oscillation sufficiently close to the variance-adjusted ensemble-mean forecast North Atlantic Oscillation. This approach greatly improves decadal predictions of winter climate for Europe and eastern North America. Predictions of Atlantic multidecadal variability are also improved, suggesting that the North Atlantic Oscillation is not driven solely by Atlantic multidecadal variability. Our results highlight the need to understand why the signal-to-noise ratio is too small in current climate models10, and the extent to which correcting this model error would reduce uncertainties in regional climate change projections on timescales beyond a decade.
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Affiliation(s)
- D M Smith
- Met Office Hadley Centre, Exeter, UK.
| | - A A Scaife
- Met Office Hadley Centre, Exeter, UK.,College of Engineering, Mathematics and Physical Sciences, Exeter University, Exeter, UK
| | - R Eade
- Met Office Hadley Centre, Exeter, UK
| | - P Athanasiadis
- Centro Euro-Mediterraneo sui Cambiamenti Climatici, Bologna, Italy
| | - A Bellucci
- Centro Euro-Mediterraneo sui Cambiamenti Climatici, Bologna, Italy
| | - I Bethke
- Geophysical Institute, University of Bergen and Bjerknes Centre for Climate Research, Bergen, Norway
| | - R Bilbao
- Barcelona Supercomputing Center, Barcelona, Spain
| | - L F Borchert
- Sorbonne Universités, LOCEAN Laboratory, Institut Pierre Simon Laplace (IPSL), Paris, France
| | - L-P Caron
- Barcelona Supercomputing Center, Barcelona, Spain
| | - F Counillon
- Geophysical Institute, University of Bergen and Bjerknes Centre for Climate Research, Bergen, Norway.,Nansen Environmental and Remote Sensing Center and Bjerknes Centre for Climate Research, Bergen, Norway
| | - G Danabasoglu
- National Center for Atmospheric Research, Boulder, CO, USA
| | - T Delworth
- Geophysical Fluid Dynamics Laboratory, Princeton University, Princeton, NJ, USA
| | - F J Doblas-Reyes
- Barcelona Supercomputing Center, Barcelona, Spain.,Institució Catalana de Recerca i Estudis Avançats (ICREA), Barcelona, Spain
| | | | - V Estella-Perez
- Sorbonne Universités, LOCEAN Laboratory, Institut Pierre Simon Laplace (IPSL), Paris, France
| | - S Flavoni
- Sorbonne Universités, LOCEAN Laboratory, Institut Pierre Simon Laplace (IPSL), Paris, France
| | | | - N Keenlyside
- Geophysical Institute, University of Bergen and Bjerknes Centre for Climate Research, Bergen, Norway.,Nansen Environmental and Remote Sensing Center and Bjerknes Centre for Climate Research, Bergen, Norway
| | - V Kharin
- Canadian Centre for Climate Modelling and Analysis, Environment and Climate Change Canada, Victoria, British Columbia, Canada
| | - M Kimoto
- Atmosphere and Ocean Research Institute, University of Tokyo, Kashiwa, Japan
| | - W J Merryfield
- Canadian Centre for Climate Modelling and Analysis, Environment and Climate Change Canada, Victoria, British Columbia, Canada
| | - J Mignot
- Sorbonne Universités, LOCEAN Laboratory, Institut Pierre Simon Laplace (IPSL), Paris, France
| | - T Mochizuki
- Department of Earth and Planetary Sciences, Kyushu University, Fukuoka, Japan.,Japan Agency for Marine-Earth Science and Technology, Yokohama, Japan
| | - K Modali
- Max-Planck-Institut für Meteorologie, Hamburg, Germany.,Regional Computing Center, University of Hamburg, Hamburg, Germany
| | - P-A Monerie
- National Centre for Atmospheric Science, Department of Meteorology, University of Reading, Reading, UK
| | - W A Müller
- Max-Planck-Institut für Meteorologie, Hamburg, Germany
| | - D Nicolí
- Centro Euro-Mediterraneo sui Cambiamenti Climatici, Bologna, Italy
| | - P Ortega
- Barcelona Supercomputing Center, Barcelona, Spain
| | - K Pankatz
- Deutscher Wetterdienst, Hamburg, Germany
| | - H Pohlmann
- Max-Planck-Institut für Meteorologie, Hamburg, Germany.,Deutscher Wetterdienst, Hamburg, Germany
| | - J Robson
- National Centre for Atmospheric Science, Department of Meteorology, University of Reading, Reading, UK
| | - P Ruggieri
- Centro Euro-Mediterraneo sui Cambiamenti Climatici, Bologna, Italy
| | - R Sospedra-Alfonso
- Canadian Centre for Climate Modelling and Analysis, Environment and Climate Change Canada, Victoria, British Columbia, Canada
| | - D Swingedouw
- CNRS-EPOC, Université de Bordeaux, Pessac, France
| | - Y Wang
- Nansen Environmental and Remote Sensing Center and Bjerknes Centre for Climate Research, Bergen, Norway
| | - S Wild
- Barcelona Supercomputing Center, Barcelona, Spain
| | - S Yeager
- National Center for Atmospheric Research, Boulder, CO, USA
| | - X Yang
- Geophysical Fluid Dynamics Laboratory, Princeton University, Princeton, NJ, USA
| | - L Zhang
- Geophysical Fluid Dynamics Laboratory, Princeton University, Princeton, NJ, USA
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Abstract
This article documents Canada's main public policy responses to promote income security among working-age adults during the coronavirus disease 2019 (COVID-19) crisis between March and early June 2020. This period of rapid policy change unfolded broadly in three phases, starting with minor adjustments to existing policy instruments, followed by larger amendments to a wider range of programs, and finally ending with the creation of new and quite generous benefits. The pathway of policy change is best described as incremental, but it resulted in a more radical shift to "trust but verify" to administer benefits rather than the pre-COVID-19 practice of verifying eligibility before paying benefits. The reasons and precedents for this decision are discussed. I conclude with some observations on the applicability and limitations of trust but verify for income security policy in the post-COVID-19 period.
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Affiliation(s)
- Jennifer Robson
- Department of Political Management, Carleton University, Ottawa, Ontario
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33
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Sweeney AMT, Mccabe C, Flurey C, Robson J, Berry A, Richards P, Ndosi M. SAT0643-HPR NURSE-LED CARE FROM THE PERSPECTIVE OF PEOPLE WITH EARLY RHEUMATOID ARTHRITIS: A QUALITATIVE SYSTEMATIC REVIEW. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Nurse-led care has been shown to be clinically effective and cost effective in rheumatoid arthritis (RA) but the role of the nurse in early RA is not well defined. Evidence for processes of care in RA is limited and it is not known how well rheumatology nurse-led clinics meet care needs of people with early RA.Objectives:The aim of this study was to develop an understanding of rheumatology nurse-led care from the perspective of people with early RA.Methods:A qualitative systematic review was conducted. The review protocol is published in the International prospective register of systematic reviews.In March 2019, the following databases were searched: MEDLINE, EMBASE, CINAHL, PsycINFO and OpenGrey. Due to lack of studies in early RA this review included adults with early and established inflammatory arthritis, qualitative studies with data on patients’ perspectives of nurse-led care, published in peer-reviewed journals in English between 2010 and 2019. Two reviewers screened titles, abstracts and full texts. Data were extracted and managed in tables. Joanna Briggs Institute Critical Appraisal Checklist was used for quality assessment of the included studies. A thematic synthesis was undertaken using the framework of Thomas and Harden.1Results:The search identified 1034 records. After screening and assessing for eligibility, 8 qualitative studies were included in the review (133 patients), 2 studies included people with early RA. Three main themes were identified (Figure 1).Figure 1.Themes of nurse-led care from the perspective of people with RAProviding knowledge and skill. This theme delineated rheumatology nursing as providing professional expertise in the planning and delivery of care. The rheumatology nurse-led service included easy access via telephone helpline, consultations with the clinical nurse specialist for assessment of disease activity and care needs, planning of care, disease information and education, supporting self-management, and referral to rheumatologist and the multi-disciplinary team. People with RA highly valued the nurse expertise and specialist knowledge provided at nurse-led clinics.‘She was very good at informing me, so I have only praise for this ... because I have never had it like this before’. (Person with early RA).Using a person-centred approach.This theme showed nurse-led care using a person-centred approach combined with empathy and good communication skills, which created a good therapeutic environment. People with RA appreciated the person-centeredness, empathy and involvement of the nurse. ‘She is very sensitive. She can see if I am feeling bad and comes straight to me and asks: “How are you today?” ...You are treated and taken seriously’. (Person with early RA).Meeting patients‘ care needs. This theme presented nurse-led care as creating a sense of being empowered and psychologically supported in the management of RA and its impact. Nurse-led care made people with RA feel cared for, secure and confident. It added value to rheumatology care and made care complete.‘The thought of sticking a needle into my own stomach... it felt a bit like I would never manage to do that. However, they have been absolutely wonderful here ... and now I can do it myself’. (Person with early RA).Conclusion:Nurse-led care for people with RA is characterised by provision of rheumatology expertise using a person-centred approach, and patients‘ holistic care needs are being met. This study found a dearth of literature on perceptions of nurse-led care in people with early RA, which highlights the need for further research in this population.References:[1]Thomas J, Harden A. Methods for the thematic synthesis of qualitative research in systematic reviews.BMC Med Res Methodol2008; 8: 45.Disclosure of Interests:Anne-Marie Tetsche Sweeney: None declared, Candy McCabe: None declared, Caroline Flurey: None declared, Joanna Robson: None declared, Alice Berry: None declared, Pamela Richards: None declared, Mwidimi Ndosi Grant/research support from: Bristol Myers Squibb, Consultant of: Janssen, Pfizer
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Wehrhahn MC, Robson J, Brown S, Bursle E, Byrne S, New D, Chong S, Newcombe JP, Siversten T, Hadlow N. Self-collection: An appropriate alternative during the SARS-CoV-2 pandemic. J Clin Virol 2020; 128:104417. [PMID: 32403007 PMCID: PMC7198188 DOI: 10.1016/j.jcv.2020.104417] [Citation(s) in RCA: 71] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 04/30/2020] [Indexed: 12/24/2022]
Abstract
First study providing evidence of equivalence of self-collection for SARS-CoV-2. Self-collection has potential to increase accessibility and detection of SARS-CoV-2. Self-collection has potential to preserve PPE supplies. Self-collection has potential to reduce exposure to others. Self-collection was easy to perform and preferred by the majority of participants.
Objectives To evaluate the reliability of self-collection for SARS-CoV-2 and other respiratory viruses because swab collections for SARS-CoV-2 put health workers at risk of infection and require use of personal protective equipment (PPE). Methods In a prospective study, patients from two states in Australia attending dedicated COVID-19 collection clinics were offered the option to first self-collect (SC) nasal and throat swabs (SCNT) prior to health worker collect (HC) using throat and nasal swabs (Site 1) or throat and nasopharyngeal swabs (Site 2). Samples were analysed for SARS-CoV-2 as well as common respiratory viruses. Concordance of results between methods was assessed using Cohen's kappa (κ) and Cycle threshold (Ct) values were recorded for all positive results as a surrogate measure for viral load. Results Of 236 patients sampled by HC and SC, 25 had SARS-CoV-2 (24 by HC and 25 by SC) and 63 had other respiratory viruses (56 by HC and 58 by SC). SC was highly concordant with HC (κ = 0.890) for all viruses including SARS-CoV-2 and more concordant than HC to positive results by any method (κ = 0.959 vs 0.933). Mean SARS-CoV-2 E-gene and N-gene, rhinovirus and parainfluenza Ct values did not differ between HC and SCNT. Conclusions Self-collection of nasal and throat swabs offers a reliable alternative to health worker collection for the diagnosis of SARS-CoV-2 and other respiratory viruses and provides patients with easier access to testing, reduces exposure of the community and health workers to those being tested and reduces requirement for PPE.
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Affiliation(s)
- Michael C Wehrhahn
- Douglass Hanly Moir Pathology, 14 Giffnock Ave, Macquarie Park, NSW, 2113, Australia.
| | - Jennifer Robson
- Sullivan Nicolaides Pathology, 24 Hurworth St, Bowen Hills, QLD, 4006, Australia
| | - Suzanne Brown
- Department of Endocrinology & Diabetes, Sir Charles Gairdner Hospital, Hospital Ave, Nedlands, WA, 6009, Australia
| | - Evan Bursle
- Sullivan Nicolaides Pathology, 24 Hurworth St, Bowen Hills, QLD, 4006, Australia
| | - Shane Byrne
- Sullivan Nicolaides Pathology, 24 Hurworth St, Bowen Hills, QLD, 4006, Australia
| | - David New
- Clinipath Pathology, 310 Selby St, North Osborne Park, WA, 6017, Australia
| | - Smathi Chong
- Clinipath Pathology, 310 Selby St, North Osborne Park, WA, 6017, Australia
| | - James P Newcombe
- Douglass Hanly Moir Pathology, 14 Giffnock Ave, Macquarie Park, NSW, 2113, Australia
| | - Terri Siversten
- Douglass Hanly Moir Pathology, 14 Giffnock Ave, Macquarie Park, NSW, 2113, Australia
| | - Narelle Hadlow
- Clinipath Pathology, 310 Selby St, North Osborne Park, WA, 6017, Australia
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Marshall C, Cheyne L, Rodger K, Robson J, Paramasivam E, Darby M, Milton R, Kennedy M, Callister M. Sustained lung cancer mortality reduction following a symptom awareness campaign. Lung Cancer 2020. [DOI: 10.1016/s0169-5002(20)30048-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Hall H, Tocock A, Ricketts W, Robson J, Round T, Gorolay S, Chung D, Janes S, Møller H, Peake M, Navani N. Association between time-to-treatment and outcomes in non-small cell lung cancer: a systematic review. Lung Cancer 2020. [DOI: 10.1016/s0169-5002(20)30233-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Peterson KA, Gleich GJ, Limaye NS, Crispin H, Robson J, Fang J, Saffari H, Clayton F, Leiferman KM. Eosinophil granule major basic protein 1 deposition in eosinophilic esophagitis correlates with symptoms independent of eosinophil counts. Dis Esophagus 2019; 32:5532758. [PMID: 31310661 DOI: 10.1093/dote/doz055] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 04/25/2019] [Accepted: 05/01/2019] [Indexed: 12/11/2022]
Abstract
In patients with eosinophilic esophagitis (EoE), symptoms often do not correlate with peak eosinophil counts (PEC) determined on histopathological examination of biopsy specimens. This may be because eosinophils degranulate during active disease and lose their morphological identity as intact cells and, therefore, are not enumerated on microscopic examination. Eosinophil granule proteins that are released into tissues with degranulation, including major basic protein 1 (eMBP1), likely contribute to disease pathogenesis and, therefore, may correlate with symptoms better than PEC. We sought to determine whether symptoms in patients with EoE more closely relate to eosinophil granule protein deposition than to eosinophil enumeration, especially in patients with fewer than 15 eosinophils per high power field (HPF). Esophageal biopsy specimens from 34 patients diagnosed with EoE were obtained for histopathological examination and for evaluation of eMBP1 staining by indirect immunofluorescence. PEC by histopathology were compared to extracellular eMBP1 grades by immunostaining. PEC and eMBP1 grades also were analyzed for their relationship to symptoms and clinical course. Biopsy specimens from 19 of the 34 patients had fewer than 15 PEC on histopathological examination, and the other 15 patients had 15 or greater PEC. Positive eMBP1 immunostaining was found in all symptomatic patients. EoE symptoms were related to eMBP1 immunostaining grades (p = 0.0001), but not PEC (P = 0.14). Eosinophil granule protein deposition, specifically eMBP1, is increased in esophageal biopsy specimens from symptomatic patients with EoE and may be a marker of disease activity, including patients with EoE who have 'resolved' disease.
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Affiliation(s)
- K A Peterson
- Division of Gastroenterology, Department of Medicine
| | - G J Gleich
- Department of Dermatology.,Department of Medicine
| | - N S Limaye
- Division of Gastroenterology, Department of Medicine, Loma Linda University, Loma Linda, California, USA
| | | | - J Robson
- Division of Pediatric Gastroenterology, Department of Pediatrics
| | - J Fang
- Division of Gastroenterology, Department of Medicine
| | - H Saffari
- Division of Gastroenterology, Department of Medicine.,Department of Dermatology
| | - F Clayton
- Department of Pathology, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
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Mor SM, Wiethoelter AK, Massey PD, Robson J, Wilks K, Hutchinson P. Pigs, pooches and pasteurisation: The changing face of brucellosis in Australia. Aust J Gen Pract 2019; 47:99-103. [PMID: 29621840 DOI: 10.31128/afp-08-17-4289] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Brucellosis, also known as undulant, Mediterranean or Malta fever, is a systemic infection that causes fever, sweats, arthralgias and myalgias. A globally important disease, brucellosis is re-emerging in Australia in association with feral pig hunting activities. OBJECTIVE This article aims to provide clinicians with an overview of brucellosis, covering epidemiology, clinical features, diagnosis, management and prevention. DISCUSSION Brucellosis should be suspected in all patients with non-specific, flu-like illness who fall into one of the major risk groups (feral pig hunters, overseas travellers and migrants). Depression is common and often severe, relative to other symptoms. Early diagnosis and treatment are important for preventing complications, which include osteoarticular, genitourinary or, more rarely, neurological or cardiovascular diseases. Diagnosing acute infections is based on serology and blood cultures; imaging and biopsy may be required for diagnosis of focal infections. Dual therapy with doxycycline and gentamicin is the recommended treatment. Relapse occurs in up to 10% of patients. Prevention is achieved through the use of protective gear during hunting and avoidance of unpasteurised dairy products in countries where occur in animals.
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Affiliation(s)
- Siobhan M Mor
- BSc(Vet), BVSc, MANZCVS, PhD, School of Veterinary Science, Faculty of Science, The University of Sydney, Sydney, NSW; Marie Bashir Institute for Infection and Biosecurity, University of Sydney, Sydney, NSW
| | - Anke K Wiethoelter
- DrMedVet, MVPHMgt, Faculty of Veterinary and Agricultural Sciences, University of Melbourne, Melbourne, Vic
| | - Peter D Massey
- DrPH, GCPH, RN, Hunter New England Population Health, Wallsend, NSW; College of Medicine @ Dentistry, James Cook University, Townsville, Qld
| | - Jennifer Robson
- FRACP, FRCPA, FACTM, Sullivan Nicolaides Pathology, Brisbane, Qld
| | - Kathryn Wilks
- BVMS, MBBS, FRACP, FRCPA, PhD, Faculty of Medicine, University of Queensland, Brisbane, Qld
| | - Penny Hutchinson
- BMed, FRACGP, MPH@TM, FAFPHM, FNZCPHM, Darling Downs Hospital and Health Service, Toowoomba, Qld
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McLean K, Glasbey J, Borakati A, Brooks T, Chang H, Choi S, Goodson R, Nielsen M, Pronin S, Salloum N, Sewart E, Vanniasegaram D, Drake T, Gillies M, Harrison E, Chapman S, Khatri C, Kong C, Claireaux H, Bath M, Mohan M, McNamee L, Kelly M, Mitchell H, Fitzgerald J, Bhangu A, Nepogodiev D, Antoniou I, Dean R, Davies N, Trecarten S, Henderson I, Holmes C, Wylie J, Shuttleworth R, Jindal A, Hughes F, Gouda P, Fleck R, Hanrahan M, Karunakaran P, Chen J, Sykes M, Sethi R, Suresh S, Patel P, Patel M, Varma R, Mushtaq J, Gundogan B, Bolton W, Khan T, Burke J, Morley R, Favero N, Adams R, Thirumal V, Kennedy E, Ong K, Tan Y, Gabriel J, Bakhsh A, Low J, Yener A, Paraoan V, Preece R, Tilston T, Cumber E, Dean S, Ross T, McCance E, Amin H, Satterthwaite L, Clement K, Gratton R, Mills E, Chiu S, Hung G, Rafiq N, Hayes J, Robertson K, Dynes K, Huang H, Assadullah S, Duncumb J, Moon R, Poo S, Mehta J, Joshi K, Callan R, Norris J, Chilvers N, Keevil H, Jull P, Mallick S, Elf D, Carr L, Player C, Barton E, Martin A, Ratu S, Roberts E, Phan P, Dyal A, Rogers J, Henson A, Reid N, Burke D, Culleton G, Lynne S, Mansoor S, Brennan C, Blessed R, Holloway C, Hill A, Goldsmith T, Mackin S, Kim S, Woin E, Brent G, Coffin J, Ziff O, Momoh Z, Debenham R, Ahmed M, Yong C, Wan J, Copley H, Raut P, Chaudhry F, Nixon G, Dorman C, Tan R, Kanabar S, Canning N, Dolaghan M, Bell N, McMenamin M, Chhabra A, Duke K, Turner L, Patel T, Chew L, Mirza M, Lunawat S, Oremule B, Ward N, Khan M, Tan E, Maclennan D, McGregor R, Chisholm E, Griffin E, Bell L, Hughes B, Davies J, Haq H, Ahmed H, Ungcharoen N, Whacha C, Thethi R, Markham R, Lee A, Batt E, Bullock N, Francescon C, Davies J, Shafiq N, Zhao J, Vivekanantham S, Barai I, Allen J, Marshall D, McIntyre C, Wilson H, Ashton A, Lek C, Behar N, Davis-Hall M, Seneviratne N, Esteve L, Sirakaya M, Ali S, Pope S, Ahn J, Craig-McQuaide A, Gatfield W, Leong S, Demetri A, Kerr A, Rees C, Loveday J, Liu S, Wijesekera M, Maru D, Attalla M, Smith N, Brown D, Sritharan P, Shah A, Charavanamuttu V, Heppenstall-Harris G, Ng K, Raghvani T, Rajan N, Hulley K, Moody N, Williams M, Cotton A, Sharifpour M, Lwin K, Bright M, Chitnis A, Abdelhadi M, Semana A, Morgan F, Reid R, Dickson J, Anderson L, McMullan R, Ahern N, Asmadi A, Anderson L, Boon Xuan JL, Crozier L, McAleer S, Lees D, Adebayo A, Das M, Amphlett A, Al-Robeye A, Valli A, Khangura J, Winarski A, Ali A, Woodward H, Gouldthrope C, Turner M, Sasapu K, Tonkins M, Wild J, Robinson M, Hardie J, Heminway R, Narramore R, Ramjeeawon N, Hibberd A, Winslow F, Ho W, Chong B, Lim K, Ho S, Crewdson J, Singagireson S, Kalra N, Koumpa F, Jhala H, Soon W, Karia M, Rasiah M, Xylas D, Gilbert H, Sundar-Singh M, Wills J, Akhtar S, Patel S, Hu L, Brathwaite-Shirley C, Nayee H, Amin O, Rangan T, Turner E, McCrann C, Shepherd R, Patel N, Prest-Smith J, Auyoung E, Murtaza A, Coates A, Prys-Jones O, King M, Gaffney S, Dewdney C, Nehikhare I, Lavery J, Bassett J, Davies K, Ahmad K, Collins A, Acres M, Egerton C, Cheng K, Chen X, Chan N, Sheldon A, Khan S, Empey J, Ingram E, Malik A, Johnstone M, Goodier R, Shah J, Giles J, Sanders J, McLure S, Pal S, Rangedara A, Baker A, Asbjoernsen C, Girling C, Gray L, Gauntlett L, Joyner C, Qureshi S, Mogan Y, Ng J, Kumar A, Park J, Tan D, Choo K, Raman K, Buakuma P, Xiao C, Govinden S, Thompson O, Charalambos M, Brown E, Karsan R, Dogra T, Bullman L, Dawson P, Frank A, Abid H, Tung L, Qureshi U, Tahmina A, Matthews B, Harris R, O'Connor A, Mazan K, Iqbal S, Stanger S, Thompson J, Sullivan J, Uppal E, MacAskill A, Bamgbose F, Neophytou C, Carroll A, Rookes C, Datta U, Dhutia A, Rashid S, Ahmed N, Lo T, Bhanderi S, Blore C, Ahmed S, Shaheen H, Abburu S, Majid S, Abbas Z, Talukdar S, Burney L, Patel J, Al-Obaedi O, Roberts A, Mahboob S, Singh B, Sheth S, Karia P, Prabhudesai A, Kow K, Koysombat K, Wang S, Morrison P, Maheswaran Y, Keane P, Copley P, Brewster O, Xu G, Harries P, Wall C, Al-Mousawi A, Bonsu S, Cunha P, Ward T, Paul J, Nadanakumaran K, Tayeh S, Holyoak H, Remedios J, Theodoropoulou K, Luhishi A, Jacob L, Long F, Atayi A, Sarwar S, Parker O, Harvey J, Ross H, Rampal R, Thomas G, Vanmali P, McGowan C, Stein J, Robertson V, Carthew L, Teng V, Fong J, Street A, Thakker C, O'Reilly D, Bravo M, Pizzolato A, Khokhar H, Ryan M, Cheskes L, Carr R, Salih A, Bassiony S, Yuen R, Chrastek D, Rosen O'Sullivan H, Amajuoyi A, Wang A, Sitta O, Wye J, Qamar M, Major C, Kaushal A, Morgan C, Petrarca M, Allot R, Verma K, Dutt S, Chilima C, Peroos S, Kosasih S, Chin H, Ashken L, Pearse R, O'Loughlin R, Menon A, Singh K, Norton J, Sagar R, Jathanna N, Rothwell L, Watson N, Harding F, Dube P, Khalid H, Punjabi N, Sagmeister M, Gill P, Shahid S, Hudson-Phillips S, George D, Ashwood J, Lewis T, Dhar M, Sangal P, Rhema I, Kotecha D, Afzal Z, Syeed J, Prakash E, Jalota P, Herron J, Kimani L, Delport A, Shukla A, Agarwal V, Parthiban S, Thakur H, Cymes W, Rinkoff S, Turnbull J, Hayat M, Darr S, Khan U, Lim J, Higgins A, Lakshmipathy G, Forte B, Canning E, Jaitley A, Lamont J, Toner E, Ghaffar A, McDowell M, Salmon D, O'Carroll O, Khan A, Kelly M, Clesham K, Palmer C, Lyons R, Bell A, Chin R, Waldron R, Trimble A, Cox S, Ashfaq U, Campbell J, Holliday R, McCabe G, Morris F, Priestland R, Vernon O, Ledsam A, Vaughan R, Lim D, Bakewell Z, Hughes R, Koshy R, Jackson H, Narayan P, Cardwell A, Jubainville C, Arif T, Elliott L, Gupta V, Bhaskaran G, Odeleye A, Ahmed F, Shah R, Pickard J, Suleman Y, North A, McClymont L, Hussain N, Ibrahim I, Ng G, Wong V, Lim A, Harris L, Tharmachandirar T, Mittapalli D, Patel V, Lakhani M, Bazeer H, Narwani V, Sandhu K, Wingfield L, Gentry S, Adjei H, Bhatti M, Braganza L, Barnes J, Mistry S, Chillarge G, Stokes S, Cleere J, Wadanamby S, Bucko A, Meek J, Boxall N, Heywood E, Wiltshire J, Toh C, Ward A, Shurovi B, Horth D, Patel B, Ali B, Spencer T, Axelson T, Kretzmer L, Chhina C, Anandarajah C, Fautz T, Horst C, Thevathasan A, Ng J, Hirst F, Brewer C, Logan A, Lockey J, Forrest P, Keelty N, Wood A, Springford L, Avery P, Schulz T, Bemand T, Howells L, Collier H, Khajuria A, Tharakan R, Parsons S, Buchan A, McGalliard R, Mason J, Cundy O, Li N, Redgrave N, Watson R, Pezas T, Dennis Y, Segall E, Hameed M, Lynch A, Chamberlain M, Peck F, Neo Y, Russell G, Elseedawy M, Lee S, Foster N, Soo Y, Puan L, Dennis R, Goradia H, Qureshi A, Osman S, Reeves T, Dinsmore L, Marsden M, Lu Q, Pitts-Tucker T, Dunn C, Walford R, Heathcote E, Martin R, Pericleous A, Brzyska K, Reid K, Williams M, Wetherall N, McAleer E, Thomas D, Kiff R, Milne S, Holmes M, Bartlett J, Lucas de Carvalho J, Bloomfield T, Tongo F, Bremner R, Yong N, Atraszkiewicz B, Mehdi A, Tahir M, Sherliker G, Tear A, Pandey A, Broyd A, Omer H, Raphael M, Chaudhry W, Shahidi S, Jawad A, Gill C, Fisher IH, Adeleja I, Clark I, Aidoo-Micah G, Stather P, Salam G, Glover T, Deas G, Sim N, Obute R, Wynell-Mayow W, Sait M, Mitha N, de Bernier G, Siddiqui M, Shaunak R, Wali A, Cuthbert G, Bhudia R, Webb E, Shah S, Ansari N, Perera M, Kelly N, McAllister R, Stanley G, Keane C, Shatkar V, Maxwell-Armstrong C, Henderson L, Maple N, Manson R, Adams R, Semple E, Mills M, Daoub A, Marsh A, Ramnarine A, Hartley J, Malaj M, Jewell P, Whatling E, Hitchen N, Chen M, Goh B, Fern J, Rogers S, Derbyshire L, Robertson D, Abuhussein N, Deekonda P, Abid A, Harrison P, Aildasani L, Turley H, Sherif M, Pandey G, Filby J, Johnston A, Burke E, Mohamud M, Gohil K, Tsui A, Singh R, Lim S, O'Sullivan K, McKelvey L, O'Neill S, Roberts H, Brown F, Cao Y, Buckle R, Liew Y, Sii S, Ventre C, Graham C, Filipescu T, Yousif A, Dawar R, Wright A, Peters M, Varley R, Owczarek S, Hartley S, Khattak M, Iqbal A, Ali M, Durrani B, Narang Y, Bethell G, Horne L, Pinto R, Nicholls K, Kisyov I, Torrance H, English W, Lakhani S, Ashraf S, Venn M, Elangovan V, Kazmi Z, Brecher J, Sukumar S, Mastan A, Mortimer A, Parker J, Boyle J, Elkawafi M, Beckett J, Mohite A, Narain A, Mazumdar E, Sreh A, Hague A, Weinberg D, Fletcher L, Steel M, Shufflebotham H, Masood M, Sinha Y, Jenvey C, Kitt H, Slade R, Craig A, Deall C, Reakes T, Chervenkoff J, Strange E, O'Bryan M, Murkin C, Joshi D, Bergara T, Naqib S, Wylam D, Scotcher S, Hewitt C, Stoddart M, Kerai A, Trist A, Cole S, Knight C, Stevens S, Cooper G, Ingham R, Dobson J, O'Kane A, Moradzadeh J, Duffy A, Henderson C, Ashraf S, McLaughin C, Hoskins T, Reehal R, Bookless L, McLean R, Stone E, Wright E, Abdikadir H, Roberts C, Spence O, Srikantharajah M, Ruiz E, Matthews J, Gardner E, Hester E, Naran P, Simpson R, Minhas M, Cornish E, Semnani S, Rojoa D, Radotra A, Eraifej J, Eparh K, Smith D, Mistry B, Hickling S, Din W, Liu C, Mithrakumar P, Mirdavoudi V, Rashid M, Mcgenity C, Hussain O, Kadicheeni M, Gardner H, Anim-Addo N, Pearce J, Aslanyan A, Ntala C, Sorah T, Parkin J, Alizadeh M, White A, Edozie F, Johnston J, Kahar A, Navayogaarajah V, Patel B, Carter D, Khonsari P, Burgess A, Kong C, Ponweera A, Cody A, Tan Y, Ng A, Croall A, Allan C, Ng S, Raghuvir V, Telfer R, Greenhalgh A, McKerr C, Edison M, Patel B, Dear K, Hardy M, Williams P, Hassan S, Sajjad U, O'Neill E, Lopes S, Healy L, Jamal N, Tan S, Lazenby D, Husnoo S, Beecroft S, Sarvanandan T, Weston C, Bassam N, Rabinthiran S, Hayat U, Ng L, Varma D, Sukkari M, Mian A, Omar A, Kim J, Sellathurai J, Mahmood J, O'Connell C, Bose R, Heneghan H, Lalor P, Matheson J, Doherty C, Cullen C, Cooper D, Angelov S, Drislane C, Smith A, Kreibich A, Palkhi E, Durr A, Lotfallah A, Gold D, Mckean E, Dhanji A, Anilkumar A, Thacoor A, Siddiqui Z, Lim S, Piquet A, Anderson S, McCormack D, Gulati J, Ibrahim A, Murray S, Walsh S, McGrath A, Ziprin P, Chua E, Lou C, Bloomer J, Paine H, Osei-Kuffour D, White C, Szczap A, Gokani S, Patel K, Malys M, Reed A, Torlot G, Cumber E, Charania A, Ahmad S, Varma N, Cheema H, Austreng L, Petra H, Chaudhary M, Zegeye M, Cheung F, Coffey D, Heer R, Singh S, Seager E, Cumming S, Suresh R, Verma S, Ptacek I, Gwozdz A, Yang T, Khetarpal A, Shumon S, Fung T, Leung W, Kwang P, Chew L, Loke W, Curran A, Chan C, McGarrigle C, Mohan K, Cullen S, Wong E, Toale C, Collins D, Keane N, Traynor B, Shanahan D, Yan A, Jafree D, Topham C, Mitrasinovic S, Omara S, Bingham G, Lykoudis P, Miranda B, Whitehurst K, Kumaran G, Devabalan Y, Aziz H, Shoa M, Dindyal S, Yates J, Bernstein I, Rattan G, Coulson R, Stezaker S, Isaac A, Salem M, McBride A, McFarlane H, Yow L, MacDonald J, Bartlett R, Turaga S, White U, Liew W, Yim N, Ang A, Simpson A, McAuley D, Craig E, Murphy L, Shepherd P, Kee J, Abdulmajid A, Chung A, Warwick H, Livesey A, Holton P, Theodoreson M, Jenkin S, Turner J, Entwisle J, Marchal S, O'Connor S, Blege H, Aithie J, Sabine L, Stewart G, Jackson S, Kishore A, Lankage C, Acquaah F, Joyce H, McKevitt K, Coffey C, Fawaz A, Dolbec K, O'Sullivan D, Geraghty J, Lim E, Bolton L, FitzPatrick D, Robinson C, Ramtoola T, Collinson S, Grundy L, McEnhill P, Harbhajan Singh G, Loughran D, Golding D, Keeling R, Williams R, Whitham R, Yoganathan S, Nachiappan R, Egan R, Owasil R, Kwan M, He A, Goh R, Bhome R, Wilson H, Teoh P, Raji K, Jayakody N, Matthams J, Chong J, Luk C, Greig R, Trail M, Charalambous G, Rocke A, Gardiner N, Bulley F, Warren N, Brennan E, Fergurson P, Wilson R, Whittingham H, Brown E, Khanijau R, Gandhi K, Morris S, Boulton A, Chandan N, Barthorpe A, Maamari R, Sandhu S, McCann M, Higgs L, Balian V, Reeder C, Diaper C, Sale T, Ali H, Archer C, Clarke A, Heskin J, Hurst P, Farmer J, O'Flynn L, Doan L, Shuker B, Stott G, Vithanage N, Hoban K, Nesargikar P, Kennedy H, Grossart C, Tan E, Roy C, Sim P, Leslie K, Sim D, Abul M, Cody N, Tay A, Woon E, Sng S, Mah J, Robson J, Shakweh E, Wing V, Mills H, Li M, Barrow T, Balaji S, Jordan H, Phillips C, Naveed H, Hirani S, Tai A, Ratnakumaran R, Sahathevan A, Shafi A, Seedat M, Weaver R, Batho A, Punj R, Selvachandran H, Bhatt N, Botchey S, Khonat Z, Brennan K, Morrison C, Devlin E, Linton A, Galloway E, McGarvie S, Ramsay N, McRobbie H, Whewell H, Dean W, Nelaj S, Eragat M, Mishra A, Kane T, Zuhair M, Wells M, Wilkinson D, Woodcock N, Sun E, Aziz N, Ghaffar MKA. Critical care usage after major gastrointestinal and liver surgery: a prospective, multicentre observational study. Br J Anaesth 2019; 122:42-50. [PMID: 30579405 DOI: 10.1016/j.bja.2018.07.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 07/19/2018] [Accepted: 07/23/2018] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Patient selection for critical care admission must balance patient safety with optimal resource allocation. This study aimed to determine the relationship between critical care admission, and postoperative mortality after abdominal surgery. METHODS This prespecified secondary analysis of a multicentre, prospective, observational study included consecutive patients enrolled in the DISCOVER study from UK and Republic of Ireland undergoing major gastrointestinal and liver surgery between October and December 2014. The primary outcome was 30-day mortality. Multivariate logistic regression was used to explore associations between critical care admission (planned and unplanned) and mortality, and inter-centre variation in critical care admission after emergency laparotomy. RESULTS Of 4529 patients included, 37.8% (n=1713) underwent planned critical care admissions from theatre. Some 3.1% (n=86/2816) admitted to ward-level care subsequently underwent unplanned critical care admission. Overall 30-day mortality was 2.9% (n=133/4519), and the risk-adjusted association between 30-day mortality and critical care admission was higher in unplanned [odds ratio (OR): 8.65, 95% confidence interval (CI): 3.51-19.97) than planned admissions (OR: 2.32, 95% CI: 1.43-3.85). Some 26.7% of patients (n=1210/4529) underwent emergency laparotomies. After adjustment, 49.3% (95% CI: 46.8-51.9%, P<0.001) were predicted to have planned critical care admissions, with 7% (n=10/145) of centres outside the 95% CI. CONCLUSIONS After risk adjustment, no 30-day survival benefit was identified for either planned or unplanned postoperative admissions to critical care within this cohort. This likely represents appropriate admission of the highest-risk patients. Planned admissions in selected, intermediate-risk patients may present a strategy to mitigate the risk of unplanned admission. Substantial inter-centre variation exists in planned critical care admissions after emergency laparotomies.
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Malawana M, Hutchings A, Mathur R, Robson J. Ethnic variations in the risk of hypoglycaemia among people with Type 2 diabetes prescribed insulins and/or sulfonylureas: a historical cohort study using general practice-recorded data. Diabet Med 2018; 35:1707-1715. [PMID: 30264528 DOI: 10.1111/dme.13828] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/25/2018] [Indexed: 01/20/2023]
Abstract
AIM To identify ethnic differences in hypoglycaemic risk among people with Type 2 diabetes prescribed insulins and/or sulfonylureas in community settings. METHODS Using routine general practice-recorded data, two cohorts of adults with Type 2 diabetes from east London were studied between January 2013 and December 2015: (1) adults prescribed insulins ± other antidiabetes medications (n=7269) and (2) adults prescribed sulfonylureas ± other antidiabetes medications excluding insulins (n=12 502). Incidence rate ratios of hypoglycaemia by ethnicity, adjusting for age, sex, socio-economic status and clustering within Clinical Commissioning Groups, were estimated using random effects Poisson regression. RESULTS Compared with white British people prescribed insulins, those of black Caribbean ethnicity were at increased hypoglycaemic risk [adjusted incidence rate ratio 1.56 (95% CI 1.21,2.01)], while Bangladeshi people had a lower risk [adjusted incidence rate ratio 0.49 (95% CI, 0.38,0.64)]. In the sulfonylurea cohort, black Caribbean, black African and Indian people all had increased risks of hypoglycaemia compared with white British people [adjusted incidence rate ratios 1.63 (95% CI 1.15,2.29), 1.90 (95% CI 1.32,2.75) and 1.93 (95% CI 1.39,2.69), respectively]. CONCLUSION The differences in hypoglycaemic risk among people with Type 2 diabetes prescribed insulin and/or sulfonylureas warrant further investigation of any differing biological responses and/or cultural attitudes to antidiabetes therapy among ethnic groups, and should be considered by clinicians evaluating the treatment goals of people with Type 2 diabetes using insulins or sulfonylureas.
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Affiliation(s)
- M Malawana
- Centre for Primary Care and Public Health, Queen Mary University of London, London, UK
| | - A Hutchings
- Departments of Health Services Research and Policy, London, UK
| | - R Mathur
- Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - J Robson
- Centre for Primary Care and Public Health, Queen Mary University of London, London, UK
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Bishop DVM, Robson J. Unimpaired Short-term Memory and Rhyme Judgement in Congenitally Speechless Individuals: Implications for the Notion of “Articulatory Coding”. ACTA ACUST UNITED AC 2018. [DOI: 10.1080/14640748908402356] [Citation(s) in RCA: 74] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
In normal adults, concurrent articulation impairs short-term memory, abolishing both the phonological similarity effect and the word length effect when visual presentation is used. It also interferes with ability to judge whether visually presented words rhyme. It is generally assumed that concurrent articulation impairs performance because it prevents people from recoding material into an articulatory form. If this is the explanation, then individuals who are congenitally speechless (anarthric) or speech-impaired (dysarthric) should show the same impairments as normal individuals who are concurrently articulating—i.e. they should have reduced memory spans, fail to show word length and phonological similarity effects in short-term memory, and find rhyme judgement difficult. These predictions were tested in a study of 48 cerebral palsied individuals: 12 anarthric, 12 dysarthric, and 24 controls individually matched to the speech-impaired subjects. There was no impairment of memory span in speech-impaired subjects, who showed normal phonological similarity and word-length effects in short-term memory. Speech-impaired subjects did not differ from their controls in ability to tell whether names of pairs of pictures rhymed. These results challenge the notion that “articulatory coding” is implicated in short-term memory and rhyme judgement and suggests that processes such as rehearsal and phonemic segmentation involve generation of a more abstract central phonological code.
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Chapman B, Slavin M, Marriott D, Halliday C, Kidd S, Arthur I, Bak N, Heath CH, Kennedy K, Morrissey CO, Sorrell TC, van Hal S, Keighley C, Goeman E, Underwood N, Hajkowicz K, Hofmeyr A, Leung M, Macesic N, Botes J, Blyth C, Cooley L, George CR, Kalukottege P, Kesson A, McMullan B, Baird R, Robson J, Korman TM, Pendle S, Weeks K, Liu E, Cheong E, Chen S. Changing epidemiology of candidaemia in Australia. J Antimicrob Chemother 2017; 72:1103-1108. [PMID: 28364558 DOI: 10.1093/jac/dkw422] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Accepted: 09/07/2016] [Indexed: 01/07/2023] Open
Abstract
Objectives Knowledge of contemporary epidemiology of candidaemia is essential. We aimed to identify changes since 2004 in incidence, species epidemiology and antifungal susceptibilities of Candida spp. causing candidaemia in Australia. Methods These data were collected from nationwide active laboratory-based surveillance for candidaemia over 1 year (within 2014-2015). Isolate identification was by MALDI-TOF MS supplemented by DNA sequencing. Antifungal susceptibility testing was performed using Sensititre YeastOne™. Results A total of 527 candidaemia episodes (yielding 548 isolates) were evaluable. The mean annual incidence was 2.41/105 population. The median patient age was 63 years (56% of cases occurred in males). Of 498 isolates with confirmed species identity, Candida albicans was the most common (44.4%) followed by Candida glabrata complex (26.7%) and Candida parapsilosis complex (16.5%). Uncommon Candida species comprised 25 (5%) isolates. Overall, C. albicans (>99%) and C. parapsilosis (98.8%) were fluconazole susceptible. However, 16.7% (4 of 24) of Candida tropicalis were fluconazole- and voriconazole-resistant and were non-WT to posaconazole. Of C. glabrata isolates, 6.8% were resistant/non-WT to azoles; only one isolate was classed as resistant to caspofungin (MIC of 0.5 mg/L) by CLSI criteria, but was micafungin and anidulafungin susceptible. There was no azole/echinocandin co-resistance. Conclusions We report an almost 1.7-fold proportional increase in C. glabrata candidaemia (26.7% versus 16% in 2004) in Australia. Antifungal resistance was generally uncommon, but azole resistance (16.7% of isolates) amongst C. tropicalis may be emerging.
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Affiliation(s)
- Belinda Chapman
- Westmead Institute for Medical Research, The University of Sydney, Sydney, NSW, Australia
| | - Monica Slavin
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, Victorian Infectious Diseases Service at the Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia
| | - Debbie Marriott
- Department of Microbiology and Infectious Diseases, St Vincent's Hospital, Sydney, NSW, Australia
| | - Catriona Halliday
- Centre for Infectious Diseases and Microbiology Laboratory Services, ICPMR, Westmead Hospital, Westmead, Sydney, NSW, Australia
| | - Sarah Kidd
- National Mycology Reference Centre, SA Pathology, Adelaide, SA, Australia
| | - Ian Arthur
- Department of Microbiology, PathWest Laboratory Medicine, QEII Medical Centre, Nedlands, WA, Australia
| | - Narin Bak
- Department of Infectious Diseases, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Christopher H Heath
- Department of Microbiology and Infectious Diseases, Royal Perth Hospital, Department of Microbiology, PathWest Laboratory Medicine Fiona Stanley Hospital, School of Medicine and Pharmacology, University of Western Australia, Perth, WA, Australia
| | - Karina Kennedy
- Department of Infectious Diseases and Microbiology, Canberra Hospital, Australian National University Medical School, Canberra, ACT, Australia
| | - C Orla Morrissey
- Department of Infectious Diseases, Alfred Health and Monash University, Melbourne, VIC, Australia
| | - Tania C Sorrell
- Westmead Institute for Medical Research, The University of Sydney, Sydney, NSW, Australia.,Centre for Infectious Diseases and Microbiology Westmead Institute for Medical Research, Westmead Hospital and the Marie Bashir Institute for Infectious Diseases and Biosecurity, University of Sydney, Sydney, NSW, Australia
| | - Sebastian van Hal
- Department of Infectious Diseases and Microbiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Caitlin Keighley
- Centre for Infectious Diseases and Microbiology Westmead Institute for Medical Research, Westmead Hospital and the Marie Bashir Institute for Infectious Diseases and Biosecurity, University of Sydney, Sydney, NSW, Australia
| | - Emma Goeman
- Department of Microbiology and Infectious Diseases, St Vincent's Hospital, Sydney, NSW, Australia
| | - Neil Underwood
- Infection Management Services, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Krispin Hajkowicz
- Department of Infectious Diseases, Royal Brisbane and Women's Hospital, School of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Ann Hofmeyr
- Department of Microbiology and Infectious Diseases, Liverpool Hospital, Sydney, NSW, Australia
| | - Michael Leung
- Department of Microbiology, PathWest Laboratory Medicine, QEII Medical Centre, Nedlands, WA, Australia
| | - Nenad Macesic
- Department of Infectious Diseases, Austin Hospital, Heidelberg, VIC, Australia and Division of Infectious Diseases, Columbia University Medical Center, New York City, NY, USA
| | - Jeannie Botes
- Department of Microbiology, SEALS South Pathology, Wollongong Hospital, Wollongong, NSW, Australia
| | - Christopher Blyth
- School of Paediatrics and Child Health, University of Western Australia, Subiaco, WA, Australia and Department of Infectious Diseases, Princess Margaret Hospital, Subiaco, WA, Australia
| | - Louise Cooley
- Department of Microbiology and Infectious Diseases, Royal Hobart Hospital, Hobart, Tasmania, Australia
| | - C Robert George
- Department of Microbiology, South Eastern Area Laboratory Services, Prince of Wales Hospital, Sydney, NSW, Australia
| | - Pankaja Kalukottege
- Department of Microbiology, Pathology -North, Hunter, Newcastle, NSW, Australia
| | - Alison Kesson
- Department of Infectious Diseases and Microbiology, The Children's Hospital, Westmead and Discipline of Paediatrics and Child Health, University of Sydney, Sydney, NSW, Australia
| | - Brendan McMullan
- Department of Immunology and Infectious Diseases, Sydney Children's Hospital, Randwick, NSW, Australia
| | - Robert Baird
- Department of Microbiology, Royal Darwin Hospital, Darwin, NT, Australia
| | - Jennifer Robson
- Sullivan and Nicolaides Pathology, Brisbane, Queensland, Australia
| | - Tony M Korman
- Monash Infectious Diseases, Monash University and Monash Health, Melbourne, VIC, Australia
| | - Stella Pendle
- Department of Microbiology, Australian Clinical Laboratories, Sydney, NSW, Australia
| | - Kerry Weeks
- Department of Microbiology, Pathology North, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Eunice Liu
- Department of Microbiology and Infectious Diseases, Concord Hospital, Sydney, NSW, Australia
| | - Elaine Cheong
- Department of Microbiology and Infectious Diseases, Concord Hospital, Sydney, NSW, Australia
| | - Sharon Chen
- Centre for Infectious Diseases and Microbiology Laboratory Services, ICPMR, Westmead Hospital, Westmead, Sydney, NSW, Australia.,Centre for Infectious Diseases and Microbiology Westmead Institute for Medical Research, Westmead Hospital and the Marie Bashir Institute for Infectious Diseases and Biosecurity, University of Sydney, Sydney, NSW, Australia
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Douglas P, Posey DL, Zenner D, Robson J, Abubakar I, Giovinazzo G. Capacity strengthening through pre-migration tuberculosis screening programmes: IRHWG experiences. Int J Tuberc Lung Dis 2017; 21:737-745. [PMID: 28633697 PMCID: PMC10461077 DOI: 10.5588/ijtld.17.0019] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Effective tuberculosis (TB) prevention and care for migrants requires population health-based approaches that treat the relationship between migration and health as a progressive, interactive process influenced by many variables and addressed as far upstream in the process as possible. By including capacity building in source countries, pre-migration medical screening has the potential to become an integral component of public health promotion, as well as infection and disease prevention, in migrant-receiving nations, while simultaneously increasing capabilities in countries of origin. This article describes the collaborative experiences of five countries (Australia, Canada, New Zealand, United Kingdom and the United States of America, members of the Immigration and Refugee Health Working Group [IRHWG]), with similar pre-migration screening programmes for TB that are mandated. Qualitative examples of capacity building through IRHWG programmes are provided. Combined, the IRHWG member countries screen approximately 2 million persons overseas every year. Large-scale pre-entry screening programmes undertaken by IRHWG countries require building additional capacity for health care providers, radiology facilities and laboratories. This has resulted in significant improvements in laboratory and treatment capacity, providing availability of these facilities for national public health programmes. As long as global health disparities and disease prevalence differentials exist, national public health programmes and policies in migrant-receiving nations will continue to be challenged to manage the diseases prevalent in these migrating populations. National TB programmes and regulatory systems alone will not be able to achieve TB elimination. The management of health issues resulting from population mobility will require integration of national and global health initiatives which, as demonstrated here, can be supported through the capacity-building endeavours of pre-migration screening programmes.
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Affiliation(s)
- P Douglas
- Health Services and Policy Division, Department of Immigration and Border Protection, Sydney, New South Wales, Australia
| | - D L Posey
- Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - D Zenner
- Centre of Infectious Disease Surveillance and Control, Public Health England and Institute of Global Health University College, London, UK
| | - J Robson
- Service Design and Performance, Immigration New Zealand, Wellington, New Zealand
| | - I Abubakar
- Institute for Global Health, University College London, London, UK
| | - G Giovinazzo
- Immigration, Refugees and Citizenship Canada, Migration Health Branch, Ottawa, Ontario, Canada
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Johnstone KJ, Robson J, Cherian SG, Wan Sai Cheong J, Kerr K, Bligh JF. Cystic neutrophilic granulomatous mastitis associated with Corynebacterium including Corynebacterium kroppenstedtii. Pathology 2017; 49:405-412. [DOI: 10.1016/j.pathol.2017.01.006] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Revised: 12/17/2016] [Accepted: 01/05/2017] [Indexed: 01/16/2023]
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Chapman B, Slavin M, Marriott D, Halliday C, Kidd S, Arthur I, Bak N, Heath CH, Kennedy K, Morrissey CO, Sorrell TC, van Hal S, Keighley C, Goeman E, Underwood N, Hajkowicz K, Hofmeyr A, Leung M, Macesic N, Botes J, Blyth C, Cooley L, George CR, Kalukottege P, Kesson A, McMullan B, Baird R, Robson J, Korman TM, Pendle S, Weeks K, Liu E, Cheong E, Chen S. Changing epidemiology of candidaemia in Australia. J Antimicrob Chemother 2017; 72:1270. [PMID: 28204502 DOI: 10.1093/jac/dkx047] [Citation(s) in RCA: 107] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Belinda Chapman
- Westmead Institute for Medical Research, The University of Sydney, Sydney, NSW, Australia
| | - Monica Slavin
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, Victorian Infectious Diseases Service at the Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia
| | - Debbie Marriott
- Department of Microbiology and Infectious Diseases, St Vincent's Hospital, Sydney, NSW, Australia
| | - Catriona Halliday
- Centre for Infectious Diseases and Microbiology Laboratory Services, ICPMR, Westmead Hospital, Westmead, Sydney, NSW, Australia
| | - Sarah Kidd
- National Mycology Reference Centre, SA Pathology, Adelaide, SA, Australia
| | - Ian Arthur
- Department of Microbiology, PathWest Laboratory Medicine, QEII Medical Centre, Nedlands, WA, Australia
| | - Narin Bak
- Department of Infectious Diseases, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Christopher H Heath
- Department of Microbiology and Infectious Diseases, Royal Perth Hospital, Department of Microbiology, PathWest Laboratory Medicine Fiona Stanley Hospital, School of Medicine and Pharmacology, University of Western Australia, Perth, WA, Australia
| | - Karina Kennedy
- Department of Infectious Diseases and Microbiology, Canberra Hospital, Australian National University Medical School, Canberra, ACT, Australia
| | - C Orla Morrissey
- Department of Infectious Diseases, Alfred Health and Monash University, Melbourne, VIC, Australia
| | - Tania C Sorrell
- Westmead Institute for Medical Research, The University of Sydney, Sydney, NSW, Australia.,Centre for Infectious Diseases and Microbiology Westmead Institute for Medical Research, Westmead Hospital and the Marie Bashir Institute for Infectious Diseases and Biosecurity, University of Sydney, Sydney, NSW, Australia
| | - Sebastian van Hal
- Department of Infectious Diseases and Microbiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Caitlin Keighley
- Centre for Infectious Diseases and Microbiology Westmead Institute for Medical Research, Westmead Hospital and the Marie Bashir Institute for Infectious Diseases and Biosecurity, University of Sydney, Sydney, NSW, Australia
| | - Emma Goeman
- Department of Microbiology and Infectious Diseases, St Vincent's Hospital, Sydney, NSW, Australia
| | - Neil Underwood
- Infection Management Services, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Krispin Hajkowicz
- Department of Infectious Diseases, Royal Brisbane and Women's Hospital, School of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Ann Hofmeyr
- Department of Microbiology and Infectious Diseases, Liverpool Hospital, Sydney, NSW, Australia
| | - Michael Leung
- Department of Microbiology, PathWest Laboratory Medicine, QEII Medical Centre, Nedlands, WA, Australia
| | - Nenad Macesic
- Department of Infectious Diseases, Austin Hospital, Heidelberg, Victoria and Division of Infectious Diseases, Columbia University Medical Center, New York City, NY, USA
| | - Jeannie Botes
- Department of Microbiology, SEALS South Pathology, Wollongong Hospital, Wollongong, NSW, Australia
| | - Christopher Blyth
- School of Paediatrics and Child Health, University of Western Australia, Subiaco and Department of Infectious Diseases, Princess Margaret Hospital, Subiaco, WA, Australia
| | - Louise Cooley
- Department of Microbiology and Infectious Diseases, Royal Hobart Hospital, Hobart, Tasmania, Australia
| | - C Robert George
- Department of Microbiology, South Eastern Area Laboratory Services, Prince of Wales Hospital, Sydney, NSW, Australia
| | - Pankaja Kalukottege
- Department of Microbiology, Pathology-North, Hunter, Newcastle, NSW, Australia
| | - Alison Kesson
- Department of Infectious Diseases and Microbiology, The Children's Hospital, Westmead and Discipline of Paediatrics and Child Health, University of Sydney, Sydney, NSW, Australia
| | - Brendan McMullan
- Department of Immunology and Infectious Diseases, Sydney Children's Hospital, Randwick, NSW, Australia
| | - Robert Baird
- Department of Microbiology, Royal Darwin Hospital, Darwin, NT, Australia
| | - Jennifer Robson
- Sullivan and Nicolaides Pathology, Brisbane, Queensland, Australia
| | - Tony M Korman
- Monash Infectious Diseases, Monash University and Monash Health, Melbourne, VIC, Australia
| | - Stella Pendle
- Department of Microbiology, Australian Clinical Laboratories, Sydney, NSW, Australia
| | - Kerry Weeks
- Department of Microbiology, Pathology North, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Eunice Liu
- Department of Microbiology and Infectious Diseases, Concord Hospital, Sydney, NSW, Australia
| | - Elaine Cheong
- Department of Microbiology and Infectious Diseases, Concord Hospital, Sydney, NSW, Australia
| | - Sharon Chen
- Centre for Infectious Diseases and Microbiology Laboratory Services, ICPMR, Westmead Hospital, Westmead, Sydney, NSW, Australia.,Centre for Infectious Diseases and Microbiology Westmead Institute for Medical Research, Westmead Hospital and the Marie Bashir Institute for Infectious Diseases and Biosecurity, University of Sydney, Sydney, NSW, Australia
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Gracie K, Kennedy M, Robson J, Callister M. S131 What proportion of the uk population would be eligible for ct screening for lung cancer according to various proposed inclusion criteria? Thorax 2016. [DOI: 10.1136/thoraxjnl-2016-209333.137] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Gracie K, Kennedy M, Ellames D, Hawramy B, Al-Ameri A, Esterbrook G, Blaxill P, Smith G, Smith P, Naseer R, Rodger K, Robson J, Paramasivam E, Callister M. S129 What proportion of patients with lung cancer would have been eligible for ct screening according to various proposed inclusion criteria? Thorax 2016. [DOI: 10.1136/thoraxjnl-2016-209333.135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Knox J, Gregory C, Prendergast L, Perera C, Robson J, Waring L. Laboratory detection of intestinal carriage of carbapenemase-producing Enterobacteriaceae - A comparison of algorithms using the Carba NP test. Diagn Microbiol Infect Dis 2016; 87:17-21. [PMID: 27760718 DOI: 10.1016/j.diagmicrobio.2016.09.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Revised: 09/19/2016] [Accepted: 09/20/2016] [Indexed: 01/04/2023]
Abstract
Stool specimens spiked with a panel of 46 carbapenemase-producing Enterobacteriaceae (CPE) and 59 non-carbapenemase producers were used to compare the diagnostic accuracy of 4 testing algorithms for the detection of intestinal carriage of CPE: (1) culture on Brilliance ESBL agar followed by the Carba NP test; (2) Brilliance ESBL followed by the Carba NP test, plus chromID OXA-48 agar with no Carba NP test; (3) chromID CARBA agar followed by the Carba NP test; (4) chromID CARBA followed by the Carba NP test, plus chromID OXA-48 with no Carba NP test. All algorithms were 100% specific. When comparing algorithms (1) and (3), Brilliance ESBL agar followed by the Carba NP test was significantly more sensitive than the equivalent chromID CARBA algorithm at the lower of 2 inoculum strengths tested (84.8% versus 63.0%, respectively [P<0.02]). With the addition of chromID OXA-48 agar, the sensitivity of these algorithms was marginally increased.
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Affiliation(s)
- James Knox
- Microbiology Department, Melbourne Pathology, 103 Victoria Pde, Collingwood, Melbourne, 3066, Australia.
| | - Claire Gregory
- Microbiology Department, Melbourne Pathology, 103 Victoria Pde, Collingwood, Melbourne, 3066, Australia
| | - Louise Prendergast
- Microbiology Department, Melbourne Pathology, 103 Victoria Pde, Collingwood, Melbourne, 3066, Australia
| | - Chandrika Perera
- Microbiology Department, Melbourne Pathology, 103 Victoria Pde, Collingwood, Melbourne, 3066, Australia
| | - Jennifer Robson
- Microbiology Department, Sullivan Nicolaides Pathology, PO, Box 344, Indooroopilly, Brisbane, 4068, Australia
| | - Lynette Waring
- Microbiology Department, Melbourne Pathology, 103 Victoria Pde, Collingwood, Melbourne, 3066, Australia
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Affiliation(s)
- Evan Bursle
- Sullivan Nicolaides Pathology, Taringa, Queensland
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Petridis M, Vickers C, Robson J, McKenzie JL, Bereza M, Sharrock A, Aung HL, Arcus VL, Cook GM. Structure and Function of AmtR in Mycobacterium smegmatis: Implications for Post-Transcriptional Regulation of Urea Metabolism through a Small Antisense RNA. J Mol Biol 2016; 428:4315-4329. [PMID: 27640309 DOI: 10.1016/j.jmb.2016.09.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2016] [Revised: 09/02/2016] [Accepted: 09/07/2016] [Indexed: 01/19/2023]
Abstract
Soil-dwelling bacteria of the phylum actinomycetes generally harbor either GlnR or AmtR as a global regulator of nitrogen metabolism. Mycobacterium smegmatis harbors both of these canonical regulators; GlnR regulates the expression of key genes involved in nitrogen metabolism, while the function and signal transduction pathway of AmtR in M. smegmatis remains largely unknown. Here, we report the structure and function of the M. smegmatis AmtR and describe the role of AmtR in the regulation of nitrogen metabolism in response to nitrogen availability. To determine the function of AmtR in M. smegmatis, we performed genome-wide expression profiling comparing the wild-type versus an ∆amtR mutant and identified significant changes in the expression of 11 genes, including an operon involved in urea degradation. An AmtR consensus-binding motif (CTGTC-N4-GACAG) was identified in the promoter region of this operon, and ligand-independent, high-affinity AmtR binding was validated by both electrophoretic mobility shift assays and surface plasmon resonance measurements. We confirmed the transcription of a cis-encoded small RNA complementary to the gene encoding AmtR under nitrogen excess, and we propose a post-transcriptional regulatory mechanism for AmtR. The three-dimensional X-ray structure of AmtR at 2.0Å revealed an overall TetR-like dimeric structure, and the alignment of the M. smegmatis AmtR and Corynebacterium glutamicum AmtR regulatory domains showed poor structural conservation, providing a potential explanation for the lack of M. smegmatis AmtR interaction with the adenylylated PII protein. Taken together, our data suggest an AmtR (repressor)/GlnR (activator) competitive binding mechanism for transcriptional regulation of urea metabolism that is controlled by a cis-encoded small antisense RNA.
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Affiliation(s)
- Michael Petridis
- Department of Microbiology and Immunology, Otago School of Medical Sciences, University of Otago, Dunedin 9054, New Zealand.
| | - Chelsea Vickers
- Department of Biological Sciences, University of Waikato, Hamilton 3240, New Zealand.
| | - Jennifer Robson
- Department of Microbiology and Immunology, Otago School of Medical Sciences, University of Otago, Dunedin 9054, New Zealand.
| | - Joanna L McKenzie
- Department of Biological Sciences, University of Waikato, Hamilton 3240, New Zealand.
| | - Magdalena Bereza
- Department of Biological Sciences, University of Waikato, Hamilton 3240, New Zealand.
| | - Abigail Sharrock
- Department of Biological Sciences, University of Waikato, Hamilton 3240, New Zealand.
| | - Htin Lin Aung
- Department of Microbiology and Immunology, Otago School of Medical Sciences, University of Otago, Dunedin 9054, New Zealand.
| | - Vickery L Arcus
- Department of Biological Sciences, University of Waikato, Hamilton 3240, New Zealand.
| | - Gregory M Cook
- Department of Microbiology and Immunology, Otago School of Medical Sciences, University of Otago, Dunedin 9054, New Zealand; Maurice Wilkins Centre for Molecular Biodiscovery, The University of Auckland, Private Bag 92019, Auckland 1042, New Zealand.
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