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Attwood LO, McKechnie M, Vujovic O, Higgs P, Lloyd‐Jones M, Doyle JS, Stewardson AJ. Review of management priorities for invasive infections in people who inject drugs: highlighting the need for patient-centred multidisciplinary care. Med J Aust 2022; 217:102-109. [PMID: 35754144 PMCID: PMC9539935 DOI: 10.5694/mja2.51623] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 01/20/2022] [Revised: 05/18/2022] [Accepted: 05/30/2022] [Indexed: 09/26/2023]
Abstract
There has been a global increase in the burden of invasive infections in people who inject drugs (PWID). It is essential that patient-centred multidisciplinary care is provided in the management of these infections to engage PWID in care and deliver evidence-based management and preventive strategies. The multidisciplinary team should include infectious diseases, addictions medicine (inclusive of alcohol and other drug services), surgery, psychiatry, pain specialists, pharmacy, nursing staff, social work and peer support workers (where available) to help address the comorbid conditions that may have contributed to the patient's presentation. PWID have a range of antimicrobial delivery options that can be tailored in a patient-centred manner and thus are not limited to prolonged hospital admissions to receive intravenous antimicrobials for invasive infections. These options include discharge with outpatient parenteral antimicrobial therapy, long-acting lipoglycopeptides (dalbavancin and oritavancin) and early oral antimicrobials. Open and respectful discussion with PWID including around harm reduction strategies may decrease the risk of repeat presentations with injecting-related harms.
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Affiliation(s)
| | | | - Olga Vujovic
- Alfred HealthMelbourneVIC
- Monash UniversityMelbourneVIC
| | - Peter Higgs
- Burnet InstituteMelbourneVIC
- La Trobe UniversityMelbourneVIC
| | | | - Joseph S Doyle
- Alfred HealthMelbourneVIC
- Monash UniversityMelbourneVIC
- Burnet InstituteMelbourneVIC
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Katz NT, Lloyd-Jones M, Demediuk L, McLaughlin K, McKechnie M, Gold M. A Case Study of Pain Management at End-of-Life for a Patient on High-Dose Buprenorphine. J Patient Exp 2022; 9:23743735221079141. [PMID: 35174259 PMCID: PMC8841900 DOI: 10.1177/23743735221079141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
In Australia, high-dose sublingual buprenorphine and long-acting injectable buprenorphine are available. High-dose buprenorphine is used predominantly in the setting of opioid use disorder and has a role in chronic pain. Palliative care specialists are increasingly involved in pain management and end-of-life care for patients on these medications, yet there is a lack of education and training about high-dose buprenorphine for palliative care specialists. We describe our experience caring for John (fictional name), a gentleman with chronic pain and a new high-grade post-transplant lymphoproliferative disorder prescribed high-dose buprenorphine. We share the challenges and experience in caring for John as he deteriorated into the terminal phase and died of his illness. We include potential management options and the rationale for our decision to rotate John from high-dose sublingual buprenorphine to subcutaneous oxycodone. We conclude with practice implications and suggestions for improved patient care and clinician experience, including increased collaboration between palliative medicine, acute pain, and addiction medicine services, increased education and training for palliative care specialists about high-dose buprenorphine, and ultimately the development of consensus high-dose buprenorphine to oral morphine equivalence guidelines.
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Affiliation(s)
- Naomi T Katz
- Alfred Health Palliative Care Service, Alfred Health, Prahran, VIC, Australia
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Martyn Lloyd-Jones
- Consultation and Liaison Addictions, Alfred Mental and Addiction Health, Alfred Health, Prahran, VIC, Australia
| | - Lucy Demediuk
- Alfred Health Palliative Care Service, Alfred Health, Prahran, VIC, Australia
| | - Kerry McLaughlin
- Alfred Health Palliative Care Service, Alfred Health, Prahran, VIC, Australia
- Acute Pain Service, Alfred Health, Prahran, VIC, Australia
| | - Megan McKechnie
- Consultation and Liaison Addictions, Alfred Mental and Addiction Health, Alfred Health, Prahran, VIC, Australia
| | - Michelle Gold
- Alfred Health Palliative Care Service, Alfred Health, Prahran, VIC, Australia
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
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O'Brien H, Di Rico R, Dean E, Smoker G, Lloyd-Jones M, McKechnie M, Dietze PM, Doyle JS. Screening for risky drinkers among hospitalised inpatients using the AUDIT: A feasibility, point prevalence and data linkage study. Drug Alcohol Rev 2021; 41:293-302. [PMID: 34184348 DOI: 10.1111/dar.13343] [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: 07/11/2020] [Revised: 06/05/2021] [Accepted: 06/07/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Risky drinking frequently remains undiagnosed or untreated, including in hospitalised inpatients. Using the Alcohol Use Disorders Identification Test (AUDIT), we assessed the feasibility of screening for risky drinking and whether screening results aligned with alcohol-attributable diagnoses in an inpatient population. METHODS We conducted a cross-sectional survey across a tertiary health service in Melbourne, Australia. Researchers collected demographics, AUDIT scores and acceptability from all eligible adult inpatients available on day of survey. Main outcomes were prevalence of risky drinking (AUDIT ≥8), mean AUDIT score and patient acceptability. Identification of risky drinking by the abbreviated 'AUDIT-C' or discharge diagnoses (extracted by data-linkage with medical records) was compared. RESULTS Of 473 eligible inpatients, 61% (n = 289) participated, 22% (n = 103) were unavailable and 17% (n = 81) declined. Median age was 64 years (IQR = 48, 76); 54% (n = 157) were male. Mean AUDIT score was 4.4 (SD = 5.5). Risky drinking prevalence was 20% (n = 57), 2% (n = 7) had scores suggestive of dependence (AUDIT ≥20, a subset of risky drinkers). Odds of risky drinking were reduced in females (OR 0.19, 95% CI 0.09, 0.41; P < 0.001) and participants ≥70 years (OR 0.22, 95% CI 0.07, 0.71; P = 0.01). Alcohol-attributable diagnoses did not consistently align with risky drinking, with half of inpatients with wholly attributable diagnoses classified as low risk. Most inpatients considered screening acceptable (89%, n = 256). DISCUSSION AND CONCLUSIONS Pre-admission risky drinking was evident in one-fifth of hospital inpatients, but alcohol-attributable diagnoses were unreliable proxy measures of risky drinking. Screening in-patients with the AUDIT was acceptable to inpatients and can be feasibly implemented in an Australian tertiary hospital setting.
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Affiliation(s)
- Helen O'Brien
- Program for Behaviours and Health Risks, Burnet Institute, Melbourne, Australia
| | - Rehana Di Rico
- Program for Behaviours and Health Risks, Burnet Institute, Melbourne, Australia.,Epworth Monash Rehabilitation Medicine Unit, Epworth HealthCare, Melbourne, Australia
| | - Emma Dean
- Population Health, Alfred Health, Melbourne, Australia.,Quit, Cancer Council Victoria, Melbourne, Australia
| | - Gemma Smoker
- Population Health, Alfred Health, Melbourne, Australia
| | - Martyn Lloyd-Jones
- Department of Mental and Addiction Health, Alfred Hospital, Melbourne, Australia
| | - Megan McKechnie
- Department of Mental and Addiction Health, Alfred Hospital, Melbourne, Australia
| | - Paul M Dietze
- Program for Behaviours and Health Risks, Burnet Institute, Melbourne, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia.,National Drug Research Institute, Curtin University, Melbourne, Australia
| | - Joseph S Doyle
- Program for Disease Elimination, Burnet Institute, Melbourne, Australia.,Department of Infectious Diseases, Alfred Health and Monash University, Melbourne, Australia
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Wahesh E, Moreton A, McKechnie M. The Indirect Effect of Distress Tolerance on Young Adult Alcohol Use Behaviors via Coping Motives. Journal of Addictions & Offender Counseling 2020. [DOI: 10.1002/jaoc.12084] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Affiliation(s)
- Edward Wahesh
- Department of Education and Counseling Villanova University
| | - Amanda Moreton
- Department of Education and Counseling Villanova University
- Now at The Lincoln Center for Family and Youth AudubonPennsylvania
| | - Megan McKechnie
- Department of Education and Counseling Villanova University
- Now at Merakey Behavioral Health Services PhiladelphiaPennsylvania
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Abstract
Participants with ADHD (n = 45) and participants without ADHD (n = 130, total n = 175) judged hypothetical moral and conventional rule violations that varied the impulsivity of the act, the ADHD diagnosis, and the gender of the actor in order to examine (1) social reasoning about impulsiveness and (2) whether participants infer impulsiveness from the characteristics of the actor, including gender and ADHD-status. Moral violations were judged more negatively than conventional violations, even when they were impulsive. The characteristics of the actor influenced judgments in that participants judged boys' behavior as more acceptable, as having less control, and as deserving of less punishment compared to girls. In addition, actors who were described as having ADHD were judged overall more positively. Participants with ADHD judged that all actors should receive similar punishment, regardless of the actor's ADHD diagnosis, while participants without ADHD judged actors with ADHD should receive less punishment than those without.
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Affiliation(s)
- Clare Conry-Murray
- Department of Psychology, Saint Joseph's University, Philadelphia, PA, USA
| | - Megan McKechnie
- Department of Psychology, Saint Joseph's University, Philadelphia, PA, USA
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McKechnie M, Cartwright S, Livernois A, Mallard B. PSXVI-26 Physiological Effect of Heat Stress on Canadian Holstein Dairy Cows Classified based on Immune Response Capacity. J Anim Sci 2018. [DOI: 10.1093/jas/sky404.837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- M McKechnie
- University of Guelph - Ontario Veterinary College - Department of Pathobiology,Guelph, ON, Canada
| | - S Cartwright
- University of Guelph - Ontario Veterinary College - Department of Pathobiology,Guelph, ON, Canada
| | - A Livernois
- Food from Thought, University of Guelph,Guelph, ON, Canada
| | - B Mallard
- University of Guelph - Ontario Veterinary College - Department of Pathobiology,Guelph, ON, Canada
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Cobine CA, McKechnie M, Brookfield RJ, Hannigan KI, Keef KD. Comparison of inhibitory neuromuscular transmission in the Cynomolgus monkey IAS and rectum: special emphasis on differences in purinergic transmission. J Physiol 2018; 596:5319-5341. [PMID: 30198065 DOI: 10.1113/jp275437] [Citation(s) in RCA: 7] [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] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Accepted: 09/07/2018] [Indexed: 01/04/2023] Open
Abstract
KEY POINTS Inhibitory neuromuscular transmission (NMT) was compared in the internal anal sphincter (IAS) and rectum of the Cynomolgus monkey, an animal with high gene sequence identity to humans. Nitrergic NMT was present in both muscles while purinergic NMT was limited to the rectum and VIPergic NMT to the IAS. The profile for monkey IAS more closely resembles humans than rodents. In both muscles, SK3 channels were localized to PDGFRα+ cells that were closely associated with nNOS+ /VIP+ nerves. Gene expression levels of P2RY subtypes were the same in IAS and rectum while KCNN expression levels were very similar. SK3 channel activation and inhibition caused faster/greater changes in contractile activity in rectum than IAS. P2Y1 receptor activation inhibited contraction in rectum while increasing contraction in IAS. The absence of purinergic NMT in the IAS may be due to poor coupling between P2Y1 receptors and SK3 channels on PDGFRα+ cells. ABSTRACT Inhibitory neuromuscular transmission (NMT) was compared in the internal anal sphincter (IAS) and rectum of the Cynomolgus monkey, an animal with a high gene sequence identity to humans. Electrical field stimulation produced nitric oxide synthase (NOS)-dependent contractile inhibition in both muscles whereas P2Y1-dependent purinergic NMT was restricted to rectum. An additional NOS-independent, α-chymotrypsin-sensitive component was identified in the IAS consistent with vasoactive intestinal peptide-ergic (VIPergic) NMT. Microelectrode recordings revealed slow NOS-dependent inhibitory junction potentials (IJPs) in both muscles and fast P2Y1-dependent IJPs in rectum. The basis for the difference in purinergic NMT was investigated. PDGFRα+ /SK3+ cells were closely aligned with nNOS+ /VIP+ neurons in both muscles. Gene expression of P2RY was the same in IAS and rectum (P2RY1>>P2RY2-14) while KCNN3 expression was 32% greater in rectum. The SK channel inhibitor apamin doubled contractile activity in rectum while having minimal effect in the IAS. Contractile inhibition elicited with the SK channel agonist CyPPA was five times faster in rectum than in the IAS. The P2Y1 receptor agonist MRS2365 inhibited contraction in rectum but increased contraction in the IAS. In conclusion, both the IAS and the rectum have nitrergic NMT whereas purinergic NMT is limited to rectum and VIPergic NMT to the IAS. The profile in monkey IAS more closely resembles that of humans than rodents. The lack of purinergic NMT in the IAS cannot be attributed to the absence of PDGFRα+ cells, P2Y1 receptors or SK3 channels. Rather, it appears to be due to poor coupling between P2Y1 receptors and SK3 channels on PDGFRα+ cells.
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Affiliation(s)
- C A Cobine
- Department of Physiology and Cell Biology, University of Nevada, Reno School of Medicine, Reno, NV, USA
| | - M McKechnie
- Department of Physiology and Cell Biology, University of Nevada, Reno School of Medicine, Reno, NV, USA
| | - R J Brookfield
- Department of Physiology and Cell Biology, University of Nevada, Reno School of Medicine, Reno, NV, USA
| | - K I Hannigan
- Department of Physiology and Cell Biology, University of Nevada, Reno School of Medicine, Reno, NV, USA
| | - K D Keef
- Department of Physiology and Cell Biology, University of Nevada, Reno School of Medicine, Reno, NV, USA
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Maxwell P, Labonte M, McKechnie M, Duddy O, Armstrong C, Ong C, Zoubeidi A, Worthington J, Waugh D. Treatment-induced hypoxia attenuates enzalutamide response and promotes resistance in pre-clinical models of prostate cancer. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx361.028] [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: 11/12/2022] Open
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Yang M, Prestage G, Maycock B, Brown G, de Wit J, McKechnie M, Guy R, Keen P, Fairley CK, Zablotska IB. The acceptability of different HIV testing approaches: cross-sectional study among GMSM in Australia. Sex Transm Infect 2014; 90:592-5. [PMID: 25015651 DOI: 10.1136/sextrans-2013-051495] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND We explored the attitudes of Australian gay and other men who have sex with men (GMSM) about the current standard-of-care (non-rapid tests at healthcare settings) and alternative approaches (rapid tests and testing in non-healthcare settings) to better understand the acceptability of alternative testing approaches. METHODS The Contemporary Norms in Networks and Communities of GMSM study enrolled GMSM in Sydney, Melbourne and Perth in 2011-2012 using peer referrals. We explored the self-reported preferences for testing: rapid versus non-rapid and in non-healthcare settings (community-based or home-based testing) versus in healthcare settings, and examined factors associated with preferences for these approaches. Analyses of associations used standard univariate and age-adjusted logistic regression models. RESULTS Among 827 sexually active non-HIV-positive participants, 89% had been tested for HIV. Most preferred by participants was home rapid testing (46%), followed by standard-of-care (23%) and rapid testing in healthcare (20%) or community settings (7%). About 73% of participants preferred rapid over non-rapid testing, and 56% preferred testing in non-healthcare settings rather than in healthcare settings. Preference for rapid testing was associated with being fully employed (adjusted OR (aOR): 1.81; 95% CI 1.16 to 2.82), managerial/professional occupation (aOR: 2.03; 95% CI 1.19 to 3.46) and engaging in unprotected anal intercourse with casual partners (aOR: 1.89; 95% CI 1.29 to 2.78). The same factors were associated with preference for testing in non-healthcare settings. CONCLUSIONS Australian GMSM prefer alternative testing approaches, possibly due to their convenience. The availability of new testing approaches may provide more options for GMSM at risk for HIV infection, improve access to HIV testing and potentially increase HIV testing rates.
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Affiliation(s)
- M Yang
- The Kirby Institute, The University of New South Wales Australia, Sydney, New South Wales, Australia
| | - G Prestage
- The Kirby Institute, The University of New South Wales Australia, Sydney, New South Wales, Australia The Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Victoria, Australia
| | - B Maycock
- Curtin University, Perth, Western Australia, Australia
| | - G Brown
- The Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Victoria, Australia Curtin University, Perth, Western Australia, Australia
| | - J de Wit
- Centre for Social Research in Health, The University of NSW Australia, Sydney, New South Wales, Australia
| | - M McKechnie
- The Kirby Institute, The University of New South Wales Australia, Sydney, New South Wales, Australia
| | - R Guy
- The Kirby Institute, The University of New South Wales Australia, Sydney, New South Wales, Australia
| | - P Keen
- The Kirby Institute, The University of New South Wales Australia, Sydney, New South Wales, Australia
| | - C K Fairley
- Melbourne School of Population Health, University of Melbourne, Victoria, Australia Melbourne Sexual Health Centre, Melbourne, Victoria, Australia Central Clinical School, Monash University, Alfred Hospital, Melbourne, Victoria, Australia
| | - I B Zablotska
- The Kirby Institute, The University of New South Wales Australia, Sydney, New South Wales, Australia
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Abstract
Using data from Australian Gay Community Periodic Surveys 1998-2010, we assessed the prevalence, trends and characteristics of gay men not tested for HIV. In 2010, one in eight Australian gay socially-engaged men were never tested for HIV, most of them sexually active and 56.5 % reporting unprotected anal intercourse. The proportion of not tested men was significantly higher in men younger than 30, of non-European origin and living outside of gay metropolitan areas. Although frequency of testing was associated with sexual practices, significant proportions of men with multiple sex partners and reporting unprotected anal intercourse were not tested as recommended. There were issues with using gay-friendly testing services in gay metropolitan areas. Despite Australia's success in HIV testing, improvement is needed for early detection of HIV infections. Interventions should encourage regular testing, engage with young gay men, improve access and convenience of testing, train service providers and expand testing options.
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Affiliation(s)
- I Zablotska
- Kirby Institute, The University of New South Wales, Sydney, NSW 2052, Australia.
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Abstract
A case is presented of unilateral tension pneumothorax associated with flail chest and pulmonary contusions in a spontaneously ventilating patient after a fall. The tension element was not suspected until chest x ray was available, nor was immediate needle thoracocentesis performed. No morbidity resulted as a consequence. This case highlights the difficulty in deciding whether or not tension pneumothorax is the predominant cause of respiratory distress in a patient with multiple chest injuries. It provides further evidence challenging some of the doctrine on how to treat suspected tension pneumothorax.
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Affiliation(s)
- R McRoberts
- Emergency Department, The Royal Infirmary, Edinburgh, UK
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