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Zhou Y, Shadbolt C, Thuraisingam S, Schilling C, Choong P, Dowsey M. Differences in Outcomes Between Initial Responders and Subsequent Responders to Health Questionnaires for Total Hip and Knee Arthroplasty: An Australian Tertiary Institutional Registry Study. J Arthroplasty 2023; 38:2561-2567. [PMID: 37286051 DOI: 10.1016/j.arth.2023.05.079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 05/16/2023] [Accepted: 05/29/2023] [Indexed: 06/09/2023] Open
Abstract
BACKGROUND Patient-reported outcome measure (PROM) questionnaires in national arthroplasty registries often have low response rates leading to questions about data reliability. In Australia, the SMART (St. Vincent's Melbourne Arthroplasty Outcomes) registry captures all elective total hip (THA) and total knee (TKA) arthroplasty patients with an approximate 98% response rate for preoperative and 12-month PROM scores. This high response rate is due to dedicated registry staff following up patients who do not initially respond (subsequent responders). This study compared initial responders to subsequent responders to find differences in 12-month PROM outcomes for THA and TKA. METHODS All elective THA and TKA patients for osteoarthritis from 2012 to 2021 captured by the SMART registry were included. In total, 1,333 THA and 1,340 TKA patients were included. The PROM scores were assessed using the Veterans-RAND 12 (VR12) and Western Ontario and McMasters Universities Arthritis Index (WOMAC) questionnaires. The primary outcome was differences in mean 12-month PROM scores between initial and subsequent responders. RESULTS Baseline characteristics and PROM scores were similar between initial and subsequent responders. However, 12-month PROM scores varied significantly. The adjusted mean difference showed that for the WOMAC pain score, subsequent responders scored 3.4 points higher in the THA cohort and 7.4 points higher in the TKA cohort compared to initial responders. Significant differences were also found in other WOMAC and VR12 scores for both THA and TKA cohorts at the 12-month timepoint. CONCLUSION This study found that significant differences in PROM outcomes postsurgery occurred in THA and TKA patients based on response to PROM questionnaires, suggesting that loss to follow-up in PROM outcomes should not be treated as missing completely at random (MCAR).
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Affiliation(s)
- Yushy Zhou
- Department of Surgery, St Vincent's Hospital Melbourne, The University of Melbourne, Fitzroy, Victoria, Australia; Department of Orthopaedic Surgery, St. Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
| | - Cade Shadbolt
- Department of Surgery, St Vincent's Hospital Melbourne, The University of Melbourne, Fitzroy, Victoria, Australia
| | - Sharmala Thuraisingam
- Department of Surgery, St Vincent's Hospital Melbourne, The University of Melbourne, Fitzroy, Victoria, Australia
| | - Chris Schilling
- Department of Surgery, St Vincent's Hospital Melbourne, The University of Melbourne, Fitzroy, Victoria, Australia
| | - Peter Choong
- Department of Surgery, St Vincent's Hospital Melbourne, The University of Melbourne, Fitzroy, Victoria, Australia
| | - Michelle Dowsey
- Department of Surgery, St Vincent's Hospital Melbourne, The University of Melbourne, Fitzroy, Victoria, Australia
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Shaharuddin S, Thuraisingam S, Daud NA, Shafie SD, Zulkifly HH. Investigating factors associated with the prevalence of IHD among uncontrolled diabetic patients. Eur Heart J 2023. [DOI: 10.1093/eurheartj/ehac779.059] [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: 01/26/2023] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Other. Main funding source(s): Monash University Malaysia
Background
Ischaemic Heart Disease (IHD) is the leading cause of death in Malaysia (1), and there is an increasing trend in mortality due to IHD from 15.2% in 2019 to 17.2% in 2020 (2). IHD is one of the NCDs, estimated to have an RM100.79 billion burden of disease cost (health burden resulting from disability and loss of healthy life years), equivalent to 7% of GDP (3). Diabetes mellitus (DM) is known to be one of the risk factors for IHD.
Purpose
This study aimed to investigate the risk factors associated with the prevalence of IHD in uncontrolled diabetic patients. Besides, these characteristics were also compared among the duration of uncontrolled DM (<10 years vs. ≥10 years)
Materials and Methods
A single-center, cross-sectional study was conducted in a cardio referral center using Electronic Medical Record from 1 January 2020 to 31 December 2020. Adult patients aged ≥ 18 years old with uncontrolled type 2 diabetes mellitus (defined as HbA1c ≥7%) had their medical records examined for IHD upon first contact with the Diabetes Mellitus Therapy Adherence Clinic (DMTAC) pharmacist.
Results
A total of 495 participants with uncontrolled diabetes were included in the final analysis. The mean age and HbA1c in the overall cohort were 52.2 (10.9) years and 10.5%, respectively, with 59.4% (n=294) of them having <10 years of underlying diabetes. The majority were obese (64.8%) and had underlying hypertension (78.4%) and hyperlipidemia (78.4%). The prevalence of ischemic heart disease (IHD) among the overall cohort was 19.0% (n=94). Patients with longer underlying diabetes (≥10 years) were significantly older [mean age 56.8 (8.4) vs. 49.0 (11.4), p=<0.001], drinks alcohol [12.0% vs. 6.0%; p=0.022], had underlying hypertension [86.6 vs. 72.8; p=<0.001] and more comorbidities [mean 1.7 (0.55) vs. 1.5 (0.65); p=<0.001] compared to those with <10 years respectively. Independent predictors of IHD events were age 40-49 [OR 5.1 (95% CI 1.1-23.3); p=0.038], 50-59 [OR 5.36 (1.2-23.7); p=0.027] and ≥60 [OR 7.1 (1.6-32.3); p=0.011], alcohol use [OR 2.4 (1.1-5.1); p=0.023], ≥10 years of uncontrolled diabetes [OR 2.0 (1.2-3.3); P=0.007], and underlying hypertension [OR 2.6 (1.2-5.8); p=0.016].
Conclusion
IHD has an indirect impact on social and economic development due to the high burden of the disease cost. In our study, older age, alcohol use, prolonged uncontrolled diabetes, and underlying hypertension seem to be associated with the prevalence of IHD complications. With the understanding of the recent outlook on diabetes, health education for the targeted population may negate this complication.
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Affiliation(s)
| | | | - N A Daud
- Hospital Serdang, Pharmacy , Selangor , Malaysia
| | - S D Shafie
- Hospital Serdang, Pharmacy , Selangor , Malaysia
| | - H H Zulkifly
- Universiti Teknologi MARA, Faculty of Pharmacy , Selangor , Malaysia
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Shadbolt C, Naufal E, Bunzli S, Price V, Rele S, Schilling C, Thuraisingam S, Lohmander LS, Balogh ZJ, Clarke P, Choong P, Dowsey M. Analysis of Rates of Completion, Delays, and Participant Recruitment in Randomized Clinical Trials in Surgery. JAMA Netw Open 2023; 6:e2250996. [PMID: 36648945 PMCID: PMC9857498 DOI: 10.1001/jamanetworkopen.2022.50996] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
IMPORTANCE Discontinuation and nonpublication are established sources of avoidable waste among surgical trials, but rates of delayed completion and recruiting shortfalls remain unclear. OBJECTIVES To examine the rate of delayed completion, incomplete enrollment, and discontinuation among randomized clinical trials in surgical populations and the duration of delays and extent of recruiting shortfalls among these trials. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study examined randomized clinical trials in surgical populations registered on ClinicalTrials.gov between January 1, 2010, and December 31, 2014. Analysis was conducted between October 27, 2021, and June 30, 2022. MAIN OUTCOMES AND MEASURES The main outcomes were the percentages of trials completed on time or with full enrollment. Delays and recruiting shortfalls were identified by comparing projected enrollment and study timeframes prespecified at the time of registration with the actual study duration and enrollment reported on completion or discontinuation. Absolute and relative differences between planned and actual trial conduct were presented for discontinued trials and those completed with delays or recruiting shortfalls. RESULTS In total, 2542 randomized clinical trials in surgical populations were included in the study sample, of which 370 (14.6%; 95% CI, 13.2%-15.9%) were completed both on time and with full enrollment. Approximately 1 in 5 trials (20.4%; 95% CI, 18.9%-22.0%) were completed within their planned timeframe, and 1166 trials (45.9%; 95% CI, 43.9%-47.8%) met their prespecified enrollment target. The median delay among completed trials was 12.2 months (IQR, 5.1-24.3 months) or 66.7% (IQR, 30.1%-135.8%) longer than planned. Among completed trials that did not meet their prespecified enrollment target, the median recruiting shortfall was equivalent to 31.0% (IQR, 12.7%-55.5%) of the planned study sample. A total of 546 trials (21.5%; 95% CI, 19.9%-23.1%) were discontinued. The median time to discontinuation was 26.4 months (IQR, 15.2-45.7 months), and the median recruiting shortfall among discontinued trials was equivalent to 92.7% (IQR, 65.0%-100.0%) of the trial's prespecified enrollment target. CONCLUSIONS AND RELEVANCE This cross-sectional study found that delayed completion, recruiting shortfalls, and untimely discontinuation were common among surgical trials. These findings highlight the importance of ensuring that investigators and funders do not overestimate the feasibility of planned trials.
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Affiliation(s)
- Cade Shadbolt
- Department of Surgery, St Vincent’s Hospital Melbourne, The University of Melbourne, Melbourne, Australia
| | - Elise Naufal
- Department of Surgery, St Vincent’s Hospital Melbourne, The University of Melbourne, Melbourne, Australia
| | - Samantha Bunzli
- School of Health Sciences and Social Work, Griffith University, Nathan Campus, Queensland, Australia
- Physiotherapy Department, Royal Brisbane and Women’s Hospital, Queensland, Australia
| | - Veronique Price
- College of Health and Medicine, Australian National University, Canberra, Australia
| | - Siddharth Rele
- Department of Surgery, St Vincent’s Hospital Melbourne, The University of Melbourne, Melbourne, Australia
| | - Chris Schilling
- Department of Surgery, St Vincent’s Hospital Melbourne, The University of Melbourne, Melbourne, Australia
| | - Sharmala Thuraisingam
- Department of Surgery, St Vincent’s Hospital Melbourne, The University of Melbourne, Melbourne, Australia
| | - L. Stefan Lohmander
- Department of Clinical Sciences, Orthopaedics, Lund University, Lund, Sweden
| | - Zsolt J. Balogh
- Department of Traumatology, John Hunter Hospital, University of Newcastle School of Medicine and Public Health, Callaghan, Australia
| | - Philip Clarke
- Health Economics Research Centre, Oxford University, Oxford, England
| | - Peter Choong
- Department of Surgery, St Vincent’s Hospital Melbourne, The University of Melbourne, Melbourne, Australia
| | - Michelle Dowsey
- Department of Surgery, St Vincent’s Hospital Melbourne, The University of Melbourne, Melbourne, Australia
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Zulkifly H, Muda M, Hatta F, Kepli W, Thuraisingam S, Shaharuddin S. Investigating demographic and clinical characteristics of patients admitted with myocardial infarction (MI) and received percutaneous coronary intervention (PCI) in Serdang Hospital. Int J Cardiol 2022. [DOI: 10.1016/j.ijcard.2022.10.102] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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O'Brien P, Thuraisingam S, Bunzli S, Lin I, Bessarab D, Coffin J, Choong PFM, Dowsey MM. Total joint replacement may be a valuable treatment for Aboriginal and Torres Strait Islander people with osteoarthritis, but uptake is low. ANZ J Surg 2022; 92:2676-2682. [PMID: 36054270 PMCID: PMC9804414 DOI: 10.1111/ans.17974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 04/20/2022] [Accepted: 07/28/2022] [Indexed: 01/05/2023]
Abstract
BACKGROUND Despite bearing a higher burden of osteoarthritis, little research has examined disparities in the access, utilisation and surgical outcomes associated with total joint replacement (TJR) among Aboriginal and Torres Strait Islander people. METHODS We conducted a retrospective cohort study to compare the sociodemographic and clinical characteristics of all Aboriginal and Torres Strait Islander and non-Aboriginal patients who underwent primary hip and knee replacement at St Vincent's Hospital Melbourne between 1996 and 2019. RESULTS A total of 10 277 primary total knee or hip replacements were performed in the 1996-2019 study period, of which 49 (0.5%) patients identified as either Aboriginal and/or Torres Strait Islander. Aboriginal and Torres Strait Islander patients were younger (61.7 ± 11.8 vs. 68.3 ± 10.3 years; P < 0.001), recorded higher Body Mass Index scores (median (IQR), 36.0 (29.5-41.4) vs. 30.8 (27.0-35.3); P < 0.001) and were more likely to experience multiple co-morbidities at the time of surgery. Despite these findings, Aboriginal and Torres Strait Islander patients did not experience higher complication rates and experienced comparable, clinically meaningful quality of life improvements 12-months post-surgery. CONCLUSIONS TJR appears to be a valuable treatment option for Aboriginal and Torres Strait Islander people with end-stage osteoarthritis. Our study was limited by the small number of procedures conducted in patients who identify as Aboriginal and Torres Strait Islander. Further research is needed to understand why uptake of TJR by Aboriginal and Torres Strait Islander people is low.
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Affiliation(s)
- Penny O'Brien
- The University of Melbourne, Department of SurgerySt Vincent's Hospital MelbourneMelbourneVictoriaAustralia
| | - Sharmala Thuraisingam
- The University of Melbourne, Department of SurgerySt Vincent's Hospital MelbourneMelbourneVictoriaAustralia
| | - Samantha Bunzli
- The University of Melbourne, Department of SurgerySt Vincent's Hospital MelbourneMelbourneVictoriaAustralia
| | - Ivan Lin
- The University of Western AustraliaWestern Australian Centre for Rural HealthGeraldtonWestern AustraliaAustralia
| | - Dawn Bessarab
- The University of Western AustraliaCentre for Aboriginal Medical and Dental HealthPerthWestern AustraliaAustralia
| | - Juli Coffin
- Telethon Kids InstituteBroomeWestern AustraliaAustralia
| | - Peter F. M. Choong
- The University of Melbourne, Department of SurgerySt Vincent's Hospital MelbourneMelbourneVictoriaAustralia
| | - Michelle M. Dowsey
- The University of Melbourne, Department of SurgerySt Vincent's Hospital MelbourneMelbourneVictoriaAustralia
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Naufal E, Shadbolt C, Elsiwy Y, Thuraisingam S, Poy Lorenzo YS, Darby J, Babazadeh S, Choong PFM, Dowsey MM, Stevens JM. Patterns and Predictors of Outpatient Antibiotic Dispensation Following Total Hip and Knee Arthroplasty. J Arthroplasty 2022; 37:1040-1047.e1. [PMID: 35176455 DOI: 10.1016/j.arth.2022.02.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 01/26/2022] [Accepted: 02/08/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND This study aimed to evaluate the month-to-month prevalence of antibiotic dispensation in the 12 months before and after total knee arthroplasty (TKA) and total hip arthroplasty (THA) and to identify factors associated with antibiotic dispensation in the month immediately following the surgical procedure. METHODS In total, 4,115 THAs and TKAs performed between April 2013 and June 2019 from a state-wide arthroplasty referral center were analyzed. A cross-sectional study used data from an institutional arthroplasty registry, which was linked probabilistically to administrative dispensing data from the Australian Pharmaceutical Benefits Scheme. Multivariable logistic regression was carried out to identify patient and surgical risk factors for oral antibiotic dispensation. RESULTS Oral antibiotics were dispensed in 18.3% of patients following primary TKA and 12.0% of patients following THA in the 30 days following discharge. During the year after discharge, 66.7% of TKA patients and 58.2% of THA patients were dispensed an antibiotic at some point. Patients with poor preoperative health status were more likely to have antibiotics dispensed in the month following THA or TKA. Older age, undergoing TKA rather than THA, obesity, inflammatory arthritis, and experiencing an in-hospital wound-related or other infectious complications were associated with increased antibiotic dispensation in the 30 days following discharge. CONCLUSION A high rate of antibiotic dispensation in the 30 days following THA and TKA has been observed. Although resource constraints may limit routine wound review for all patients by a surgeon, a select cohort may benefit from timely specialist review postoperatively. Several risk factors identified in this study may aid in identifying appropriate candidates for such changes to follow-up care.
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Affiliation(s)
- Elise Naufal
- Department of Surgery, The University of Melbourne, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
| | - Cade Shadbolt
- Department of Surgery, The University of Melbourne, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
| | - Yassin Elsiwy
- Department of Surgery, The University of Melbourne, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia; Monash Health, Melbourne, Victoria, Australia
| | - Sharmala Thuraisingam
- Department of Surgery, The University of Melbourne, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
| | - Yves S Poy Lorenzo
- Pharmacy Department, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia; University of Melbourne, Melbourne Medical School, Department of Medicine, Fitzroy, Victoria, Australia
| | - Jonathan Darby
- Department of Infectious Diseases, St Vincent's Hospital Melbourne, Vic, Australia
| | - Sina Babazadeh
- Department of Surgery, The University of Melbourne, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia; Department of Orthopaedics, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
| | - Peter F M Choong
- Department of Surgery, The University of Melbourne, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia; Department of Orthopaedics, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
| | - Michelle M Dowsey
- Department of Surgery, The University of Melbourne, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia; Department of Orthopaedics, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
| | - Jarrad M Stevens
- Department of Surgery, The University of Melbourne, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia; Monash Health, Melbourne, Victoria, Australia; University of Melbourne, Melbourne Medical School, Department of Medicine, Fitzroy, Victoria, Australia; Victorian Bone & Joint Specialists
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Thuraisingam S, Chondros P, Dowsey MM, Spelman T, Garies S, Choong PF, Gunn J, Manski-Nankervis JA. Assessing the suitability of general practice electronic health records for clinical prediction model development: a data quality assessment. BMC Med Inform Decis Mak 2021; 21:297. [PMID: 34717599 PMCID: PMC8557028 DOI: 10.1186/s12911-021-01669-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 10/20/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The use of general practice electronic health records (EHRs) for research purposes is in its infancy in Australia. Given these data were collected for clinical purposes, questions remain around data quality and whether these data are suitable for use in prediction model development. In this study we assess the quality of data recorded in 201,462 patient EHRs from 483 Australian general practices to determine its usefulness in the development of a clinical prediction model for total knee replacement (TKR) surgery in patients with osteoarthritis (OA). METHODS Variables to be used in model development were assessed for completeness and plausibility. Accuracy for the outcome and competing risk were assessed through record level linkage with two gold standard national registries, Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR) and National Death Index (NDI). The validity of the EHR data was tested using participant characteristics from the 2014-15 Australian National Health Survey (NHS). RESULTS There were substantial missing data for body mass index and weight gain between early adulthood and middle age. TKR and death were recorded with good accuracy, however, year of TKR, year of death and side of TKR were poorly recorded. Patient characteristics recorded in the EHR were comparable to participant characteristics from the NHS, except for OA medication and metastatic solid tumour. CONCLUSIONS In this study, data relating to the outcome, competing risk and two predictors were unfit for prediction model development. This study highlights the need for more accurate and complete recording of patient data within EHRs if these data are to be used to develop clinical prediction models. Data linkage with other gold standard data sets/registries may in the meantime help overcome some of the current data quality challenges in general practice EHRs when developing prediction models.
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Affiliation(s)
- Sharmala Thuraisingam
- Department of Surgery, University of Melbourne, 29 Regent Street, Fitzroy, VIC 3065 Australia
- Department of General Practice, University of Melbourne, 780 Elizabeth Street, Parkville, VIC 3010 Australia
| | - Patty Chondros
- Department of General Practice, University of Melbourne, 780 Elizabeth Street, Parkville, VIC 3010 Australia
| | - Michelle M. Dowsey
- Department of Surgery, University of Melbourne, 29 Regent Street, Fitzroy, VIC 3065 Australia
| | - Tim Spelman
- Department of Surgery, University of Melbourne, 29 Regent Street, Fitzroy, VIC 3065 Australia
- Karolinska Institute, Solnavagen 1, 171 77 Solna, Sweden
| | - Stephanie Garies
- Department of Family Medicine, Cumming School of Medicine, University of Calgary, Alberta, T2N 4N1 Canada
| | - Peter F. Choong
- Department of Surgery, University of Melbourne, 29 Regent Street, Fitzroy, VIC 3065 Australia
| | - Jane Gunn
- Department of General Practice, University of Melbourne, 780 Elizabeth Street, Parkville, VIC 3010 Australia
- Faculty of Medicine Dentistry & Health Sciences, University of Melbourne, Alan Gilbert Building, Level 2, Carlton, VIC 3053 Australia
| | - Jo-Anne Manski-Nankervis
- Department of General Practice, University of Melbourne, 780 Elizabeth Street, Parkville, VIC 3010 Australia
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Speight J, Holmes-Truscott E, Thuraisingam S, Mohamad Husin H, Manski-Nankervis JA, De La Rue K, Ginnivan L, Audehm R, Clark M, Khunti K, O'Neal D, Furler J. Impact of quarterly professional-mode flash glucose monitoring in adults with type 2 diabetes in general practice (GP-OSMOTIC): Secondary psychological and self-care outcomes of a pragmatic, open-label, 12-month, randomised controlled trial. Diabetes Res Clin Pract 2021; 179:108994. [PMID: 34363864 DOI: 10.1016/j.diabres.2021.108994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 07/27/2021] [Accepted: 08/02/2021] [Indexed: 11/26/2022]
Abstract
AIMS To investigate the impact of quarterly professional-mode flash glucose monitoring on psychological outcomes in adults with type 2 diabetes in primary care. METHODS The GP-OSMOTIC trial randomised 299 adults with type 2 diabetes in 25 general practices to quarterly use of professional-mode flash glucose monitoring (sensor worn for 14 days; data discussed at clinic visit) or usual care. At baseline and 12 months, participants completed validated measures: general emotional well-being (WHO-5), diabetes-specific quality of life (DIDP), satisfaction with glucose monitoring (GME-Q), self-care activities (SDSCA) and perceived involvement in clinical care (PICS). Linear mixed-effects models examined between-group differences at 12 months. RESULTS At 12 months, there were no clinically important between-arm differences in any secondary psychological or self-care outcomes. Per protocol analyses showed no clinically significant between-group differences. CONCLUSIONS The GP-OSMOTIC intervention had no significant impact, at 12 months, on general emotional well-being, diabetes-specific quality of life or satisfaction with glucose monitoring, suggesting no added psychological burden. Lack of positive impact on self-reported self-care activities or perceived involvement in clinical care may warrant closer attention to the fidelity of intervention delivery, the context (e.g. the nature of clinician-patient interactions) and/or the sensitivity of the measures, as these will help plan future studies.
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Affiliation(s)
- Jane Speight
- School of Psychology, Deakin University, Geelong, Victoria, Australia; The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Melbourne, Victoria, Australia.
| | - E Holmes-Truscott
- School of Psychology, Deakin University, Geelong, Victoria, Australia; The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Melbourne, Victoria, Australia
| | - Sharmala Thuraisingam
- The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Melbourne, Victoria, Australia; Department of General Practice, University of Melbourne, Parkville, Victoria, Australia
| | - Hanafi Mohamad Husin
- School of Psychology, Deakin University, Geelong, Victoria, Australia; The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Melbourne, Victoria, Australia
| | | | - Katie De La Rue
- Department of General Practice, University of Melbourne, Parkville, Victoria, Australia
| | - Louise Ginnivan
- Department of General Practice, University of Melbourne, Parkville, Victoria, Australia
| | - Ralph Audehm
- Department of General Practice, University of Melbourne, Parkville, Victoria, Australia
| | - Malcolm Clark
- Department of General Practice, University of Melbourne, Parkville, Victoria, Australia
| | | | - David O'Neal
- Department of Medicine, University of Melbourne, Parkville, Victoria, Australia
| | - John Furler
- Department of General Practice, University of Melbourne, Parkville, Victoria, Australia
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McMorrow R, Thuraisingam S, Furler J, Manski-Nankervis JA. Professional flash glucose monitoring and health service utilisation in type 2 diabetes: A secondary analysis of the GP-OSMOTIC study. Prim Care Diabetes 2021; 15:178-183. [PMID: 32863148 DOI: 10.1016/j.pcd.2020.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 07/30/2020] [Accepted: 08/01/2020] [Indexed: 11/30/2022]
Abstract
AIM Professional flash glucose monitoring involves people with diabetes wearing a glucose monitor for up to two weeks, with the data downloaded by their health professional, and the information used to help guide treatment. This study describes if professional flash glucose monitoring was associated with a change in health services utilisation. METHODS Administrative claims data from three data sources were linked to 288 participants from the GP-OSMOTIC study, a randomised controlled trial evaluating the use of professional flash glucose monitoring versus usual care in people with type 2 diabetes in primary care. Generalised linear models with the Poisson family specified and log link function were used to compare general practice consultations between the intervention and control groups at 0-6- and 6-12-month time points, with adjustment for baseline health services utilisation. RESULTS GP consultations increased in the flash glucose monitoring group in the 6 months following initial flash glucose monitoring sensor application from a median (IQR) 6 (4,9) to 8 (5,11); (P < 0.001). Participants in the professional FGM group were 1.2 times (95 % CI 1.1-1.4 (P = 0.0014)) more likely at 6-12 months to have GP consultation visits. CONCLUSIONS Administrative claims data identified changes in health services utilisation associated with professional flash glucose monitoring, despite minimal changes in glycaemic control.
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Affiliation(s)
- Rita McMorrow
- Department of General Practice, University of Melbourne, Level 2, 780 Elizabeth St, Melbourne, VIC 3004, Australia.
| | - Sharmala Thuraisingam
- Department of General Practice, University of Melbourne, Level 2, 780 Elizabeth St, Melbourne, VIC 3004, Australia
| | - John Furler
- Department of General Practice, University of Melbourne, Level 2, 780 Elizabeth St, Melbourne, VIC 3004, Australia
| | - Jo-Anne Manski-Nankervis
- Department of General Practice, University of Melbourne, Level 2, 780 Elizabeth St, Melbourne, VIC 3004, Australia
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10
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Gould D, Thuraisingam S, Shadbolt C, Knight J, Young J, Schilling C, Choong PF, Dowsey MM. Cohort profile: the St Vincent's Melbourne Arthroplasty Outcomes (SMART) Registry, a pragmatic prospective database defining outcomes in total hip and knee replacement patients. BMJ Open 2021; 11:e040408. [PMID: 33483441 PMCID: PMC7825265 DOI: 10.1136/bmjopen-2020-040408] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 12/01/2020] [Accepted: 12/07/2020] [Indexed: 11/08/2022] Open
Abstract
PURPOSE The St Vincent's Melbourne Arthroplasty Outcomes (SMART) Registry is an institutional clinical registry housed at a tertiary referral hospital in Australia. The SMART Registry is a pragmatic prospective database, which was established to capture a broad range of longitudinal clinical and patient-reported outcome data to facilitate collaborative research that will improve policy and practice relevant to arthroplasty surgery for people with advanced arthritis of the hip or knee. The purpose of this cohort profile paper is to describe the rationale for the SMART Registry's creation, its methods, baseline data and future plans for the Registry. A full compilation of the data is provided as a reference point for future collaborators. PARTICIPANTS The SMART Registry cohort comprises over 13 000 consecutive arthroplasty procedures in more than 10 000 patients who underwent their procedure at St Vincent's Hospital Melbourne, since January 1998. Participant recruitment, data collection and follow-up is ongoing and currently includes up to 20 years follow-up data. FINDINGS TO DATE SMART Registry data are used for clinical audit and feedback, as well as for a broad range of research including epidemiological studies, predictive statistical modelling and health economic evaluations. At the time of writing, there were 46 publications from SMART Registry data, with contributions from more than 67 coauthors. FUTURE PLANS With the recent linking of the SMART Registry with Medicare Benefits Schedule and Pharmaceutical Benefits Scheme data through the Australian Institute of Health and Welfare, research into prescribing patterns and health system utilisation is currently underway. The SMART Registry is also being updated with the Clavien-Dindo classification of surgical complications.
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Affiliation(s)
- Daniel Gould
- Department of Surgery, The University of Melbourne St Vincent's, Fitzroy, Victoria, Australia
| | - Sharmala Thuraisingam
- Department of Surgery, The University of Melbourne St Vincent's, Fitzroy, Victoria, Australia
- Department of General Practice, The University of Melbourne, Carlton, Victoria, Australia
| | - Cade Shadbolt
- Department of Surgery, The University of Melbourne St Vincent's, Fitzroy, Victoria, Australia
| | - Josh Knight
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Jesse Young
- Melbourne School of Population and Global Health, The University of Melbourne Centre for Health Equity, Melbourne, Victoria, Australia
- Centre for Adolescent Health, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
| | - Chris Schilling
- Department of Surgery, The University of Melbourne St Vincent's, Fitzroy, Victoria, Australia
| | - Peter F Choong
- Department of Surgery, The University of Melbourne St Vincent's, Fitzroy, Victoria, Australia
- Department of Orthopaedics, St Vincent's Hospital Melbourne Pty Ltd, Fitzroy, Victoria, Australia
| | - Michelle M Dowsey
- Department of Surgery, The University of Melbourne St Vincent's, Fitzroy, Victoria, Australia
- Department of Orthopaedics, St Vincent's Hospital Melbourne Pty Ltd, Fitzroy, Victoria, Australia
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Thuraisingam S, Dowsey M, Manski-Nankervis JA, Spelman T, Choong P, Gunn J, Chondros P. Developing prediction models for total knee replacement surgery in patients with osteoarthritis: Statistical analysis plan. Osteoarthritis and Cartilage Open 2020; 2:100126. [DOI: 10.1016/j.ocarto.2020.100126] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 11/17/2020] [Indexed: 12/16/2022] Open
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Chiang JI, Furler J, Mair F, Jani BD, Nicholl BI, Thuraisingam S, Manski-Nankervis JA. Associations between multimorbidity and glycaemia (HbA1c) in people with type 2 diabetes: cross-sectional study in Australian general practice. BMJ Open 2020; 10:e039625. [PMID: 33243798 PMCID: PMC7692835 DOI: 10.1136/bmjopen-2020-039625] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVES To explore the prevalence of multimorbidity as well as individual and combinations of long-term conditions (LTCs) in people with type 2 diabetes (T2D) attending Australian general practice, using electronic health record (EHR) data. We also examine the association between multimorbidity condition count (total/concordant(T2D related)/discordant(unrelated)) and glycaemia (glycated haemoglobin, HbA1c). DESIGN Cross-sectional study. SETTING Australian general practice. PARTICIPANTS 69 718 people with T2D with a general practice encounter between 2013 and 2015 captured in the MedicineInsight database (EHR Data from 557 general practices and >3.8 million Australian patients). PRIMARY AND SECONDARY OUTCOME MEASURES Prevalence of multimorbidity, individual and combinations of LTCs. Multivariable linear regression models used to examine associations between multimorbidity counts and HbA1c (%). RESULTS Mean (SD) age 66.42 (12.70) years, 46.1% female and mean (SD) HbA1c 7.1 (1.4)%. More than 90% of participants with T2D were living with multimorbidity. Discordant conditions were more prevalent (83.4%) than concordant conditions (69.9 %). The three most prevalent discordant conditions were: painful conditions (55.4%), dyspepsia (31.6%) and depression (22.8%). The three most prevalent concordant conditions were hypertension (61.4%), coronary heart disease (17.1%) and chronic kidney disease (8.5%). The three most common combinations of conditions were: painful conditions and hypertension (38.8%), painful conditions and dyspepsia (23.1%) and hypertension and dyspepsia (22.7%). We found no associations between any multimorbidity counts (total, concordant and discordant) or combinations and HbA1c. CONCLUSIONS Multimorbidity was common in our cohort of people with T2D attending Australian general practice, but was not associated with glycaemia. Although we did not explore mortality in this study, our results suggest that the increased mortality in those with multimorbidity and T2D observed in other studies may not be linked to glycaemia. Interestingly, discordant conditions were more prevalent than concordant conditions with painful conditions being the second most common comorbidity. Better understanding of the implications of different patterns of multimorbidity in people with T2D will allow more effective tailored care.
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Affiliation(s)
- Jason I Chiang
- Department of General Practice and Primary Health Care, University of Melbourne, Melbourne, Victoria, Australia
| | - John Furler
- Department of General Practice and Primary Health Care, University of Melbourne, Melbourne, Victoria, Australia
| | - Frances Mair
- General Practice and Primary Care, University of Glasgow, Glasgow, UK
| | - Bhautesh D Jani
- General Practice and Primary Care, University of Glasgow, Glasgow, UK
| | - Barbara I Nicholl
- General Practice and Primary Care, University of Glasgow, Glasgow, UK
| | - Sharmala Thuraisingam
- Department of General Practice and Primary Health Care, University of Melbourne, Melbourne, Victoria, Australia
| | - Jo-Anne Manski-Nankervis
- Department of General Practice and Primary Health Care, University of Melbourne, Melbourne, Victoria, Australia
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Chiang JI, Manski-Nankervis JA, Thuraisingam S, Jenkins A, O'Neal D, Mair FS, Jani BD, Nicholl BI, Furler J. Multimorbidity, glycaemic variability and time in target range in people with type 2 diabetes: A baseline analysis of the GP-OSMOTIC trial. Diabetes Res Clin Pract 2020; 169:108451. [PMID: 32949650 DOI: 10.1016/j.diabres.2020.108451] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 08/12/2020] [Accepted: 09/14/2020] [Indexed: 11/25/2022]
Abstract
AIMS To explore associations between multimorbidity condition counts (total; concordant (diabetes-related); discordant (unrelated to diabetes)) and glycaemia (HbA1c; glycaemic variability (GV); time in range (TIR)) using data from a randomised controlled trial examining effectiveness of continuous glucose monitoring (CGM) in people with type 2 diabetes (T2D). METHODS Cross-sectional study: 279 people with T2D using baseline data from the General Practice Optimising Structured MOnitoring To Improve Clinical outcomes (GP-OSMOTIC) trial from 25 general practices in Australia. Number of long-term conditions (LTCs) in addition to T2D used to quantify total/concordant/discordant multimorbidity counts. GV (measured by coefficient of variation (CV)) and TIR derived from CGM data. Multivariable linear regression models used to examine associations between multimorbidity counts, HbA1c (%), GV and TIR. RESULTS Mean (SD) age of participants 60.4 (9.9) years; 40.9% female. Multimorbidity was present in 89.2% of participants. Most prevalent comorbid LTCs: hypertension (57.4%), painful conditions (29.8%), coronary heart disease (22.6%) and depression (19.0%). No evidence of associations between multimorbidity counts, HbA1c, GV and TIR. CONCLUSIONS While multimorbidity was common in this T2D cohort, it was not associated with HbA1c, CV or TIR. Future studies should explore factors other than glycaemia that contribute to the increased mortality observed in those with multimorbidity and T2D.
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Affiliation(s)
- Jason I Chiang
- Department of General Practice, University of Melbourne, Australia.
| | | | | | - Alicia Jenkins
- NHMRC Clinical Trials Centre, University of Sydney, Australia
| | - David O'Neal
- Department of Medicine, St Vincent's Hospital, University of Melbourne, Australia
| | - Frances S Mair
- General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, UK
| | - Bhautesh Dinesh Jani
- General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, UK
| | - Barbara I Nicholl
- General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, UK
| | - John Furler
- Department of General Practice, University of Melbourne, Australia
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Holmes-Truscott E, Ventura AD, Thuraisingam S, Pouwer F, Speight J. Psychosocial Moderators of the Impact of Diabetes Stigma: Results From the Second Diabetes MILES - Australia (MILES-2) Study. Diabetes Care 2020; 43:2651-2659. [PMID: 32887706 DOI: 10.2337/dc19-2447] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Accepted: 07/25/2020] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To examine the association of diabetes stigma with psychological, behavioral, and HbA1c outcomes and to investigate moderation effects of self-esteem, self-efficacy, and/or social support. RESEARCH DESIGN AND METHODS The national Second Diabetes MILES - Australia (MILES-2) survey included adults with type 1 diabetes (n = 959, 41% of whom were male, with mean ± SD age 44 ± 15 years), insulin-treated type 2 diabetes (n = 487, 60% male, age 61 ± 9 years), and non-insulin-treated type 2 diabetes (n = 642, 55% male, age 61 ± 10 years). (Un)adjusted linear regression analyses tested the association between diabetes stigma (Diabetes Stigma Assessment Scale [DSAS]) and psychological outcomes (depressive symptoms [eight-item version of the Patient Health Questionnaire (PHQ-8)], anxiety symptoms [Generalized Anxiety Disorder 7-item (GAD-7) questionnaire], and diabetes-specific distress [20-item Problem Areas In Diabetes (PAID) scale]), behavioral outcomes (healthy diet and physical activity [Summary of Diabetes Self-Care Activities (SDSCA)]), and self-reported HbA1c. Interaction effects tested whether associations varied by self-esteem (Rosenberg Self-Esteem Scale [RSES]), self-efficacy (Confidence in Diabetes Self-Care [CIDS] scale), or diabetes-specific social support (Diabetes Support Scale [DSS]). RESULTS Significant positive associations were observed between DSAS and PHQ-8, GAD-7, and PAID across diabetes type/treatment groups (all P < 0.001), whereby each SD increase in DSAS scores was associated with approximately one-half SD deterioration in emotional well-being. Associations between DSAS and SDSCA and HbA1c were nonmeaningful. Self-esteem moderated psychological outcomes among participants with type 1 and non-insulin-treated type 2 diabetes and diabetes distress among those with insulin-treated type 2 diabetes. Interaction effects were partially observed for social support but not for self-efficacy. CONCLUSIONS This study provides evidence of the association between diabetes stigma and depressive/anxiety symptoms and diabetes distress and for the moderating effects of self-esteem and social support among adults with type 1 and type 2 diabetes. Further research is needed to examine associations with objectively measured behavioral and clinical outcomes.
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Affiliation(s)
- Elizabeth Holmes-Truscott
- School of Psychology, Deakin University, Geelong, Victoria, Australia .,The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Melbourne, Victoria, Australia
| | - Adriana D Ventura
- School of Psychology, Deakin University, Geelong, Victoria, Australia.,The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Melbourne, Victoria, Australia
| | - Sharmala Thuraisingam
- School of Psychology, Deakin University, Geelong, Victoria, Australia.,The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Melbourne, Victoria, Australia
| | - Frans Pouwer
- School of Psychology, Deakin University, Geelong, Victoria, Australia.,Department of Psychology, University of Southern Denmark, Odense, Denmark
| | - Jane Speight
- School of Psychology, Deakin University, Geelong, Victoria, Australia.,The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Melbourne, Victoria, Australia.,Department of Psychology, University of Southern Denmark, Odense, Denmark
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Shadbolt C, Gould D, Camacho X, Knight J, Rele S, Thuraisingam S, Zhang Y, Dowsey MM, Choong PF. Preoperative opioid use and complications following total joint replacement: a protocol for a systematic review and meta-analysis. BMJ Open 2020; 10:e035377. [PMID: 32554741 PMCID: PMC7304809 DOI: 10.1136/bmjopen-2019-035377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 04/03/2020] [Accepted: 05/06/2020] [Indexed: 12/04/2022] Open
Abstract
INTRODUCTION Mounting evidence now indicates that preoperative opioid use is associated with an array of complications following total joint replacement (TJR). However, evidence of these risks remains fragmented. A comprehensive and well-integrated understanding of this body of evidence is necessary to appropriately inform treatment decisions, the allocation of limited healthcare resources, and the direction of future clinical research. The proposed systematic review and meta-analysis aims to identify and synthesise the available evidence of an association between opioid use prior to TJR and postoperative complications, categorised by complication type. METHODS AND ANALYSIS We will search MEDLINE, EMBASE, CINAHL, PsycINFO, and Web of Science from inception to April 2020. Observational and experimental studies that compare preoperative opioid users who have undergone elective TJR to opioid naïve TJR patients will be included. The primary outcomes will be postoperative complications, which will be categorised as either mortality, morbidity, or joint-related complications. The secondary outcomes will be persistent postoperative opioid use, readmission, and length of stay. Individual study quality will be assessed using the relevant NIH-NHLBI study quality assessment tools. Findings will be reported in narrative and tabular form, and, where possible, odds ratios (dichotomous outcomes) or standardised mean differences (continuous outcomes) will be reported with 95% confidence intervals. Where appropriate, random effect meta-analyses will be conducted for each outcome, and heterogeneity will be quantified using the I2 statistic and Cochran's Q test. This study will be reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and Meta-analyses Of Observational Studies in Epidemiology (MOOSE) guidelines. ETHICS AND DISSEMINATION Ethics approval will not be required as no primary or private data are being collected. Findings will be disseminated through peer-reviewed publication and presentation at academic conferences. PROSPERO REGISTRATION NUMBER CRD42020153047.
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Affiliation(s)
- Cade Shadbolt
- Department of Surgery, The University of Melbourne, St Vincent's Hospital, Melbourne, Victoria, Australia
| | - Daniel Gould
- Department of Surgery, The University of Melbourne, St Vincent's Hospital, Melbourne, Victoria, Australia
| | - Ximena Camacho
- Centre for Digital Transformation of Health, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Josh Knight
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Siddharth Rele
- Department of Surgery, The University of Melbourne, St Vincent's Hospital, Melbourne, Victoria, Australia
- Melbourne Medical School, The University of Melbourne, Melbourne, Victoria, Australia
| | - Sharmala Thuraisingam
- Department of Surgery, The University of Melbourne, St Vincent's Hospital, Melbourne, Victoria, Australia
- Department of General Practice, The University of Melbourne, Melbourne, Victoria, Australia
| | - Yuting Zhang
- Melbourne Institute: Applied Economic & Social Research, Faculty of Business & Economics, The University of Melbourne, Melbourne, Victoria, Australia
| | - Michelle M Dowsey
- Department of Surgery, The University of Melbourne, St Vincent's Hospital, Melbourne, Victoria, Australia
- Department of Orthopaedics, St Vincent's Hospital, Melbourne, Fitzroy, Victoria, Australia
| | - Peter Fm Choong
- Department of Surgery, The University of Melbourne, St Vincent's Hospital, Melbourne, Victoria, Australia
- Department of Orthopaedics, St Vincent's Hospital, Melbourne, Fitzroy, Victoria, Australia
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Chiang JI, Hanlon P, Li TC, Jani BD, Manski-Nankervis JA, Furler J, Lin CC, Yang SY, Nicholl BI, Thuraisingam S, Mair FS. Multimorbidity, mortality, and HbA1c in type 2 diabetes: A cohort study with UK and Taiwanese cohorts. PLoS Med 2020; 17:e1003094. [PMID: 32379755 PMCID: PMC7205223 DOI: 10.1371/journal.pmed.1003094] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 04/10/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND There is emerging interest in multimorbidity in type 2 diabetes (T2D), which can be either concordant (T2D related) or discordant (unrelated), as a way of understanding the burden of disease in T2D. Current diabetes guidelines acknowledge the complex nature of multimorbidity, the management of which should be based on the patient's individual clinical needs and comorbidities. However, although associations between multimorbidity, glycated haemoglobin (HbA1c), and mortality in people with T2D have been studied to some extent, significant gaps remain, particularly regarding different patterns of multimorbidity, including concordant and discordant conditions. This study explores associations between multimorbidity (total condition counts/concordant/discordant/different combinations of conditions), baseline HbA1c, and all-cause mortality in T2D. METHODS AND FINDINGS We studied two longitudinal cohorts of people with T2D using the UK Biobank (n = 20,569) and the Taiwan National Diabetes Care Management Program (NDCMP) (n = 59,657). The number of conditions in addition to T2D was used to quantify total multimorbidity, concordant, and discordant counts, and the effects of different combinations of conditions were also studied. Outcomes of interest were baseline HbA1c and all-cause mortality. For the UK Biobank and Taiwan NDCMP, mean (SD) ages were 60.2 (6.8) years and 60.8 (11.3) years; 7,579 (36.8%) and 31,339 (52.5%) were female; body mass index (BMI) medians (IQR) were 30.8 (27.7, 34.8) kg/m2 and 25.6 (23.5, 28.7) kg/m2; and 2,197 (10.8%) and 9,423 (15.8) were current smokers, respectively. Increasing total and discordant multimorbidity counts were associated with lower HbA1c and increased mortality in both datasets. In Taiwan NDCMP, for those with four or more additional conditions compared with T2D only, the mean difference (95% CI) in HbA1c was -0.82% (-0.88, -0.76) p < 0.001. In UK Biobank, hazard ratios (HRs) (95% CI) for all-cause mortality in people with T2D and one, two, three, and four or more additional conditions compared with those without comorbidity were 1.20 (0.91-1.56) p < 0.001, 1.75 (1.35-2.27) p < 0.001, 2.17 (1.67-2.81) p < 0.001, and 3.14 (2.43-4.03) p < 0.001, respectively. Both concordant/discordant conditions were significantly associated with mortality; however, HRs were largest for concordant conditions. Those with four or more concordant conditions had >5 times the mortality (5.83 [4.28-7.93] p <0.001). HRs for NDCMP were similar to those from UK Biobank for all multimorbidity counts. For those with two conditions in addition to T2D, cardiovascular diseases featured in 18 of the top 20 combinations most highly associated with mortality in UK Biobank and 12 of the top combinations in the Taiwan NDCMP. In UK Biobank, a combination of coronary heart disease and heart failure in addition to T2D had the largest effect size on mortality, with a HR (95% CI) of 4.37 (3.59-5.32) p < 0.001, whereas in the Taiwan NDCMP, a combination of painful conditions and alcohol problems had the largest effect size on mortality, with an HR (95% CI) of 4.02 (3.08-5.23) p < 0.001. One limitation to note is that we were unable to model for changes in multimorbidity during our study period. CONCLUSIONS Multimorbidity patterns associated with the highest mortality differed between UK Biobank (a population predominantly comprising people of European descent) and the Taiwan NDCMP, a predominantly ethnic Chinese population. Future research should explore the mechanisms underpinning the observed relationship between increasing multimorbidity count and reduced HbA1c alongside increased mortality in people with T2D and further examine the implications of different patterns of multimorbidity across different ethnic groups. Better understanding of these issues, especially effects of condition type, will enable more effective personalisation of care.
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Affiliation(s)
- Jason I. Chiang
- Department of General Practice, University of Melbourne, Melbourne, Australia
- * E-mail:
| | - Peter Hanlon
- General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Tsai-Chung Li
- Department of Public Health, College of Public Health, China Medical University, Taichung, Taiwan
| | - Bhautesh Dinesh Jani
- General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | | | - John Furler
- Department of General Practice, University of Melbourne, Melbourne, Australia
| | - Cheng-Chieh Lin
- Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Shing-Yu Yang
- Department of Public Health, College of Public Health, China Medical University, Taichung, Taiwan
| | - Barbara I. Nicholl
- General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | | | - Frances S. Mair
- General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
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Furler J, O'Neal D, Speight J, Blackberry I, Manski-Nankervis JA, Thuraisingam S, de La Rue K, Ginnivan L, Doyle R, Holmes-Truscott E, Khunti K, Dalziel K, Chiang J, Audehm R, Kennedy M, Clark M, Jenkins A, Lake AJ, Januszewski AS, Catchpool M, Liew D, Clarke P, Best J. Use of professional-mode flash glucose monitoring, at 3-month intervals, in adults with type 2 diabetes in general practice (GP-OSMOTIC): a pragmatic, open-label, 12-month, randomised controlled trial. Lancet Diabetes Endocrinol 2020; 8:17-26. [PMID: 31862147 DOI: 10.1016/s2213-8587(19)30385-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 10/30/2019] [Accepted: 11/04/2019] [Indexed: 01/22/2023]
Abstract
BACKGROUND Continuous glucose monitoring, either real-time (personal) or retrospective (professional mode), can identify day-to-day glucose profiles to guide management decisions for people with type 2 diabetes. We aimed to examine the effects of professional-mode flash glucose monitoring, done at 3-month intervals, in adults with type 2 diabetes in general practice. METHODS We did a pragmatic, two-arm, open label, 12-month, individually randomised controlled trial (GP-OSMOTIC) in 25 general practices in Victoria, Australia. Eligible participants were adults aged 18-80 years, with type 2 diabetes diagnosed for at least 1 year and HbA1c at least 5·5 mmol/mol (0·5%) above their target in the past month despite being prescribed at least two non-insulin glucose-lowering drugs, insulin, or both (with therapy stable for at least 4 months). We randomly assigned participants (1:1) to either use of a professional-mode flash glucose monitoring system or usual clinical care (control). All participants wore the flash glucose monitoring sensor at baseline, and electronic randomisation (using permuted block sizes of four and six, and stratified by clinic) was done after the sensor was attached. Masking of participants and treating clinicians to group allocation was not possible, but the study statistician was masked to allocation when analysing the data. At baseline, and 3, 6, 9, and 12 months, participants in the flash glucose monitoring group wore the professional-mode flash glucose monitoring sensor for 5-14 days before their general practice visit. The sensor recorded interstitial glucose concentrations every 15 min, but the glucose data were not available to the participant until their general practice visit, where the sensor output would be uploaded to a computer by the health professional and discussed. Control group participants wore the sensor at baseline and at 12 months for data analysis only, and had usual care visits every 3 months. The primary outcome was the between-group difference in mean HbA1c at 12 months. Secondary outcomes were the between-group differences in: mean percentage time in target glucose range (4-10 mmol/L), based on ambulatory glucose profile data at 12 months; mean diabetes-specific distress (assessed with the Problem Areas In Diabetes [PAID] scale) at 12 months; and mean HbA1c at 6 months. Analysis was done by intention to treat. This trial is registered at the Australian and New Zealand Clinical Trials Registry, ACTRN12616001372471. FINDINGS Between Oct 4, 2016, and Nov 17, 2017, we randomly assigned 299 adults: 149 to flash glucose monitoring and 150 to usual care. At 6 months, HbA1c was lower in the flash glucose monitoring group than in the usual care group (difference -0·5%, 95% CI -0·8% to -0·3%; p=0·0001). However, at 12 months (primary outcome), there was no significant between-group difference in estimated mean HbA1c (8·2% [95% CI 8·0 to 8·4] for flash glucose monitoring vs 8·5% [8·3 to 8·7] for usual care; between-group difference -0·3%, 95% CI -0·5 to 0·01; [66 mmol/mol, 95% CI 64 to 68 vs 69 mmol/mol, 67 to 72; between-group difference -3·0, 95% CI -5·0 to 0·1]; p=0·059). Mean percentage time spent in target glucose range at 12 months was 7·9% (95% CI 2·3 to 13·5) higher in the flash glucose monitoring group than in the usual care group (p=0·0060). Diabetes-specific distress PAID scores were unchanged at 12 months (between-group difference -0·7, 95% CI -3·3 to 1·9; p=0·61). No episodes of severe hypoglycaemia or treatment-related deaths were reported. One participant died during the study from causes unrelated to the intervention (following complications post-myocardial infarction with multiple comorbidities). INTERPRETATION Professional-mode flash glucose monitoring in adults with type 2 diabetes in general practice did not improve the primary outcome of HbA1c at 12 months or diabetes-specific distress compared with usual care, but did improve time in target glucose range at 12 months and HbA1c at 6 months. Our findings suggest that professional-mode flash glucose monitoring can be implemented in a pragmatic primary care environment. Although there was no change in HbA1c at 12 months, the improved time in target range might reflect the potential of the technology to support personalised clinical care by providing insights into glycaemic profiles for some people with type 2 diabetes. FUNDING National Health and Medical Research Council of Australia, Sanofi Australia, and Abbott Diabetes Care.
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Affiliation(s)
- John Furler
- Department of General Practice, University of Melbourne, Parkville, VIC, Australia.
| | - David O'Neal
- Department of Medicine, University of Melbourne, Parkville, VIC, Australia
| | - Jane Speight
- School of Psychology, Deakin University, Geelong, VIC, Australia; Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Melbourne, VIC, Australia
| | - Irene Blackberry
- John Richards Centre for Rural Ageing Research, La Trobe Rural Health School, La Trobe University, Wodonga, VIC, Australia
| | | | | | - Katie de La Rue
- Department of General Practice, University of Melbourne, Parkville, VIC, Australia
| | - Louise Ginnivan
- Department of General Practice, University of Melbourne, Parkville, VIC, Australia
| | - Rebecca Doyle
- Department of General Practice, University of Melbourne, Parkville, VIC, Australia
| | - Elizabeth Holmes-Truscott
- School of Psychology, Deakin University, Geelong, VIC, Australia; Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Melbourne, VIC, Australia
| | - Kamlesh Khunti
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, UK
| | - Kim Dalziel
- School of Global and Population Health, University of Melbourne, Parkville, VIC, Australia
| | - Jason Chiang
- Department of General Practice, University of Melbourne, Parkville, VIC, Australia
| | - Ralph Audehm
- Department of General Practice, University of Melbourne, Parkville, VIC, Australia
| | - Mark Kennedy
- Department of General Practice, University of Melbourne, Parkville, VIC, Australia
| | - Malcolm Clark
- Department of General Practice, University of Melbourne, Parkville, VIC, Australia
| | - Alicia Jenkins
- National Health and Medical Research Council of Australia Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia
| | - Amelia J Lake
- School of Psychology, Deakin University, Geelong, VIC, Australia; Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Melbourne, VIC, Australia
| | - Andrzej S Januszewski
- National Health and Medical Research Council of Australia Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia
| | - Max Catchpool
- School of Global and Population Health, University of Melbourne, Parkville, VIC, Australia
| | - Danny Liew
- Centre of Cardiovascular Research and Education in Therapeutics, Monash University, Melbourne, VIC, Australia
| | - Philip Clarke
- School of Global and Population Health, University of Melbourne, Parkville, VIC, Australia
| | - James Best
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore; Imperial College London, London, UK
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18
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Sanci L, Kauer S, Thuraisingam S, Davidson S, Duncan AM, Chondros P, Mihalopoulos C, Buhagiar K. Effectiveness of a Mental Health Service Navigation Website (Link) for Young Adults: Randomized Controlled Trial. JMIR Ment Health 2019; 6:e13189. [PMID: 31625945 PMCID: PMC6913099 DOI: 10.2196/13189] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 05/31/2019] [Accepted: 06/11/2019] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Mental health and substance use disorders are the main causes of disability among adolescents and young adults yet fewer than half experiencing these problems seek professional help. Young people frequently search the Web for health information and services, suggesting that Web-based modalities might promote help-seeking among young people who need it. To support young people in their help-seeking, we developed a Web-based mental health service navigation website called Link. Link is based on the Theory of Planned Behavior and connects young people with treatment based on the type and severity of mental health symptoms that they report. OBJECTIVE The study aimed to investigate the effect of Link on young people's positive affect (PA) compared with usual help-seeking strategies immediately post intervention. Secondary objectives included testing the effect of Link on negative affect (NA), psychological distress, barriers to help-seeking, and help-seeking intentions. METHODS Young people, aged between 18 and 25 years, were recruited on the Web from an open access website to participate in a randomized controlled trial. Participants were stratified by gender and psychological distress into either the intervention arm (Link) or the control arm (usual help-seeking strategies). Baseline, immediate postintervention, 1-month, and 3-month surveys were self-reported and administered on the Web. Measures included the PA and NA scales, Kessler psychological distress scale (K10), barriers to adolescent help-seeking scale (BASH), and the general help-seeking questionnaire (GHSQ). RESULTS In total 413 young people were recruited to the trial (intervention, n=205; control, n=208) and 78% (160/205) of those randomized to the intervention arm visited the Link website. There was no evidence to support a difference between the intervention and control arms on the primary outcome, with PA increasing equally by approximately 30% between baseline and 3 months in both arms. NA decreased for the intervention arm compared with the control arm with a difference of 1.4 (95% CI 0.2-2.5) points immediately after the intervention and 2.6 (95% CI 1.1-4.1) at 1 month. K10 scores were unchanged and remained high in both arms. No changes were found on the BASH or GHSQ; however, participants in the intervention arm appeared more satisfied with their help-seeking process and outcomes at 1 and 3 months postintervention. CONCLUSIONS The process of prompting young people to seek mental health information and services appears to improve their affective state and increase help-seeking intentions, regardless of whether they use a Web-based dedicated youth-focused tool, such as Link, or their usual search strategies. However, young people report greater satisfaction using tools designed specifically for them, which may encourage future help-seeking. The ability of Web-based tools to match mental health needs with appropriate care should be explored further. CLINICAL TRIAL Australian New Zealand Clinical Trials Registry ACTRN12614001223628; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=366731.
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Affiliation(s)
- Lena Sanci
- Department of General Practice, University of Melbourne, Parkville, Australia
| | - Sylvia Kauer
- Department of General Practice, University of Melbourne, Parkville, Australia
| | | | - Sandra Davidson
- Department of General Practice, University of Melbourne, Parkville, Australia
| | - Ann-Maree Duncan
- Department of General Practice, University of Melbourne, Parkville, Australia
| | - Patty Chondros
- Department of General Practice, University of Melbourne, Parkville, Australia
| | - Cathrine Mihalopoulos
- Deakin Health Economics, Institute for Health Transformation, School of Health and Social Development, Deakin University, Burwood, Australia
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19
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Manski-Nankervis JAE, Thuraisingam S, Sluggett JK, Lau P, Blackberry I, Ilomaki J, Furler J, Bell JS. Prescribing for people with type 2 diabetes and renal impairment in Australian general practice: A national cross sectional study. Prim Care Diabetes 2019; 13:113-121. [PMID: 30262176 DOI: 10.1016/j.pcd.2018.09.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2017] [Revised: 03/23/2018] [Accepted: 09/01/2018] [Indexed: 11/25/2022]
Abstract
AIM To determine whether the prescribing of non-insulin anti-hyperglycaemic medications in Australian general practice is consistent with current guidelines for treatment of type 2 diabetes (T2D) in people with renal impairment. METHODS Cross-sectional study of 9624 people with T2D in the NPS MedicineInsight dataset aged≥18years with average estimated glomerular filtration rate (eGFR) <60ml/min/1.73m2 and prescribed at least one non-insulin anti-hyperglycaemic medication from October 2014 to September 2015. The primary outcome was the proportion of non-insulin anti-hyperglycaemic medications prescribed at doses inconsistent with current guidelines. RESULTS 4650 (48.3%) patients were prescribed at least one non-insulin anti-hyperglycaemic medication at a dose inconsistent with Australian Diabetes Society guidelines. The majority (88.0%) had an average eGFR of 30-59ml/min/1.73m2. Metformin was the most frequently prescribed agent (n=7408; 77.0%), and was prescribed at a dose inconsistent with guidelines for 52% of patients. 123/136 (90.5%) people prescribed a sodium glucose co-transporter 2 inhibitor and 1114/2194 (50.8%) prescribed a dipeptidyl peptidase-4 inhibitor were prescribed a dose inconsistent with guidelines. Decreasing age, being male or being on insulin was associated with greater odds of at least one prescription inconsistent with guidelines. CONCLUSION Nearly half of people with T2D and renal impairment were prescribed a non-insulin anti-hyperglycaemic medication at a dose inconsistent with current Australian guidelines, the majority of whom had an eGFR consistent with stage 3 chronic kidney disease.
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Affiliation(s)
| | | | - Janet K Sluggett
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Australia
| | - Phyllis Lau
- Department of General Practice, University of Melbourne, Carlton, Australia
| | - Irene Blackberry
- Department of General Practice, University of Melbourne, Carlton, Australia; John Richards Initiative, La Trobe University, Wodonga, Australia
| | - Jenni Ilomaki
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Australia
| | - John Furler
- Department of General Practice, University of Melbourne, Carlton, Australia
| | - J Simon Bell
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Australia
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20
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Manski-Nankervis JA, Thuraisingam S, Sluggett JK, Kilov G, Furler J, O'Neal D, Jenkins A. Prescribing of diabetes medications to people with type 2 diabetes and chronic kidney disease: a national cross-sectional study. BMC Fam Pract 2019; 20:29. [PMID: 30777033 PMCID: PMC6378720 DOI: 10.1186/s12875-019-0915-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Accepted: 01/29/2019] [Indexed: 12/27/2022]
Abstract
Background Previous studies in general practice and hospital settings have identified that prescribing of non-insulin diabetes medications may be sub-optimal in people with type 2 diabetes (T2D) and renal impairment. Since these publications, a number of new medications have become available for the management of T2D. Study aims were to, in a cohort of Australians with T2D and renal impairment attending general practice, (1) investigate whether the prescribing of non-insulin diabetes medications is consistent with dosing adjustments recommended within current Australian Diabetes Society (ADS) guidelines; and (2) identify patient socio-demographic and clinical factors associated with at least one prescription of a non-insulin diabetes medication inconsistent with current ADS guidelines for medication doses. Methods Cross-sectional study using data from the MedicineInsight general practice database managed by NPS MedicineWise. Patients with T2D who were aged 18 years and over, with an average eGFR< 60 ml/min/1.73m2 and at least one prescription of a non-insulin diabetes medication between 1st January 2015 and 30th June 2017 were included. Descriptive statistics were used to summarise patient characteristics and medication use. Marginal logistic regression models were used to estimate associations between sociodemographic and clinical factors and prescribing of ≥1non-insulin diabetes medicine not consistent with ADS guidelines. Results The majority of the 3505 patients included (90.4%) had an average eGFR of 30-59 ml/min/1.73m2. In terms of absolute numbers, metformin was the medication most frequently prescribed at a dose not consistent with current ADS guidelines for dosing in renal impairment (n = 1601 patients), followed by DPP4 inhibitors (n = 611) and sulphonylureas (n = 278). The drug classes with the highest proportion of prescriptions with dosage not consistent with ADS guidelines were SGLT2 inhibitors (83%), followed by biguanides (58%) and DPP4 inhibitors (46%). Higher HbA1c, longer known diabetes duration and diagnosis of retinopathy were associated with receiving ≥1prescription with a dosage not consistent with guidelines. Conclusions Prescribing of non-insulin diabetes medications at doses inconsistent with current ADS guideline recommendations for dosing adjustments for people with renal impairment was common. Further research is needed to understand how general practitioners access, interpret and apply the ADS guidelines and the impact this may have on patient outcomes. Electronic supplementary material The online version of this article (10.1186/s12875-019-0915-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | | | - Janet K Sluggett
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Australia
| | - Gary Kilov
- Department of General Practice, University of Melbourne, Carlton, Australia
| | - John Furler
- Department of General Practice, University of Melbourne, Carlton, Australia
| | - David O'Neal
- Department of Medicine, St Vincent's Hospital and University of Melbourne, Fitzroy, Australia.,Department of Endocrinology and Diabetes, St Vincent's Hospital, Fitzroy, Australia
| | - Alicia Jenkins
- Department of Medicine, St Vincent's Hospital and University of Melbourne, Fitzroy, Australia.,Department of Endocrinology and Diabetes, St Vincent's Hospital, Fitzroy, Australia.,NHMRC Clinical Trials Centre, University of Sydney, Camperdown, Australia
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21
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Thuraisingam S, Chondros P, Catchpool M, Dalziel K, Manski-Nankervis JA, Speight J, Holmes-Truscott E, Audehm R, Chiang J, Blackberry I, O'Neal D, Khunti K, Best J, Furler J. Update on the General Practice Optimising Structured Monitoring to Improve Clinical Outcomes in Type 2 Diabetes (GP-OSMOTIC) trial: statistical analysis plan for a multi-centre randomised controlled trial. Trials 2019; 20:93. [PMID: 30700324 PMCID: PMC6354399 DOI: 10.1186/s13063-018-3126-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2018] [Accepted: 12/11/2018] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND General Practice Optimising Structured Monitoring to Improve Clinical Outcomes in Type 2 Diabetes (GP-OSMOTIC) is a multicentre, individually randomised controlled trial aiming to compare the use of intermittent retrospective continuous glucose monitoring (r-CGM) to usual care in patients with type 2 diabetes attending general practice. The study protocol was published in the British Medical Journal Open and described the principal features of the statistical methods that will be used to analyse the trial data. This paper provides greater detail on the statistical analysis plan, including background and justification for the statistical methods chosen, in accordance with SPIRIT guidelines. OBJECTIVE To describe in detail the data management process and statistical methods that will be used to analyse the trial data. METHODS An overview of the trial design and primary and secondary research questions are provided. Sample size assumptions and calculations are explained, and randomisation and data management processes are described in detail. The planned statistical analyses for primary and secondary outcomes and sub-group analyses are specified along with the intended table layouts for presentation of the results. CONCLUSION In accordance with best practice, all analyses outlined in the document are based on the aims of the study and have been pre-specified prior to the completion of data collection and outcome analyses. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry, ACTRN12616001372471 . Registered on 3 August 2016.
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Affiliation(s)
- Sharmala Thuraisingam
- Department of General Practice, University of Melbourne, 200 Berkeley St, Carlton, VIC, 3053, Australia.
| | - Patty Chondros
- Department of General Practice, University of Melbourne, 200 Berkeley St, Carlton, VIC, 3053, Australia
| | - Max Catchpool
- Centre for Health Policy, University of Melbourne, Level 4, 207 Bouverie St, Carlton, VIC, 3053, Australia
| | - Kim Dalziel
- Centre for Health Policy, University of Melbourne, Level 4, 207 Bouverie St, Carlton, VIC, 3053, Australia
| | - Jo-Anne Manski-Nankervis
- Department of General Practice, University of Melbourne, 200 Berkeley St, Carlton, VIC, 3053, Australia
| | - Jane Speight
- School of Psychology, Deakin University, 1 Gheringhap St, Geelong, VIC, 3220, Australia.,The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, 570 Elizabeth St, Melbourne, VIC, 3000, Australia
| | - Elizabeth Holmes-Truscott
- School of Psychology, Deakin University, 1 Gheringhap St, Geelong, VIC, 3220, Australia.,The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, 570 Elizabeth St, Melbourne, VIC, 3000, Australia
| | - Ralph Audehm
- Department of General Practice, University of Melbourne, 200 Berkeley St, Carlton, VIC, 3053, Australia
| | - Jason Chiang
- Department of General Practice, University of Melbourne, 200 Berkeley St, Carlton, VIC, 3053, Australia
| | - Irene Blackberry
- John Richards Centre for Rural Ageing Research, Latrobe University, 133 McKoy St, West Wodonga, VIC, 3689, Australia
| | - David O'Neal
- Department of General Practice, University of Melbourne, 200 Berkeley St, Carlton, VIC, 3053, Australia
| | - Kamlesh Khunti
- Diabetes Research Centre, University of Leicester, Gwendolen Rd, Leicester, LE1 7RH, UK
| | - James Best
- Lee Kong Chian School of Medicince, Nanyang Technological University, 50 Nanyang Ave, Singapore, 639798, Singapore
| | - John Furler
- Department of General Practice, University of Melbourne, 200 Berkeley St, Carlton, VIC, 3053, Australia
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22
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Tarzia L, Thuraisingam S, Novy K, Valpied J, Quake R, Hegarty K. Exploring the relationships between sexual violence, mental health and perpetrator identity: a cross-sectional Australian primary care study. BMC Public Health 2018; 18:1410. [PMID: 30591033 PMCID: PMC6307303 DOI: 10.1186/s12889-018-6303-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [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: 05/23/2018] [Accepted: 12/05/2018] [Indexed: 11/10/2022] Open
Abstract
Background Research supports the association between adult sexual violence (SV) and poor mental health. However, most studies focus on rape and physical sexual assault. Little is known about how more subtle forms of SV affect women’s well-being. Furthermore, evidence for the impact of the perpetrator’s identity is mixed. There is also little data from clinical populations to help health practitioners identify SV. This paper addresses these gaps by exploring the associations between different types of adult SV, perpetrator identity, and women’s mental health in the Australian primary care setting. Methods We conducted a descriptive, cross-sectional study in general practice clinics. Adult women completed an anonymous survey while waiting for the doctor. Measures included PHQ-9 (depression), GAD-7 (anxiety) and PCL-C (post-traumatic stress disorder). SV was measured using items from the National Intimate Partner and Sexual Violence Survey and categorised into three groups (rape/sexual assault; coercive behaviours and/or reproductive control; and unwanted sexual contact). Results We found significant associations between rape/sexual assault and poor mental health, and between coercion and/or reproductive control and higher PTSD and anxiety scores, compared to women with no SV experiences. SV perpetrated by an intimate partner was associated with significantly higher mean PTSD scores than SV perpetrated by a stranger, and significantly higher depression scores than SV perpetrated by another known person. Conclusion Findings suggest that associations between SV and mental health are mediated by type of SV and perpetrator identity. Health practitioners should enquire about different types of SV beyond stranger rape as a cause of poor mental health, and about perpetrator identity to inform them about the likelihood of ongoing symptoms. Electronic supplementary material The online version of this article (10.1186/s12889-018-6303-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Laura Tarzia
- Department of General Practice, The University of Melbourne, 200 Berkeley Street, Carlton, Victoria, 3053, Australia. .,Centre for Family Violence Prevention, The Royal Women's Hospital, Parkville, Australia.
| | - Sharmala Thuraisingam
- Department of General Practice, The University of Melbourne, 200 Berkeley Street, Carlton, Victoria, 3053, Australia
| | - Kitty Novy
- Department of General Practice, The University of Melbourne, 200 Berkeley Street, Carlton, Victoria, 3053, Australia
| | - Jodie Valpied
- Department of General Practice, The University of Melbourne, 200 Berkeley Street, Carlton, Victoria, 3053, Australia
| | - Rebecca Quake
- Department of General Practice, The University of Melbourne, 200 Berkeley Street, Carlton, Victoria, 3053, Australia
| | - Kelsey Hegarty
- Department of General Practice, The University of Melbourne, 200 Berkeley Street, Carlton, Victoria, 3053, Australia.,Centre for Family Violence Prevention, The Royal Women's Hospital, Parkville, Australia
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23
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Tan ML, Manski-Nankervis JA, Thuraisingam S, Jenkins A, O’Neal D, Furler J. Socioeconomic status and time in glucose target range in people with type 2 diabetes: a baseline analysis of the GP-OSMOTIC study. BMC Endocr Disord 2018; 18:47. [PMID: 30031385 PMCID: PMC6054739 DOI: 10.1186/s12902-018-0279-6] [Citation(s) in RCA: 9] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Accepted: 07/13/2018] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Optimal glycaemia, reflected by glycated haemoglobin (HbA1c) levels, is key in reducing type 2 diabetes (T2D) complications. However, most people with T2D have suboptimal recall and understanding of HbA1c. Continuous glucose monitoring (CGM) measures glucose levels every 5 to 15-min over days and may be more readily understood. Given that T2D is more common in lower socioeconomic settings, we aim to study relationships between socioeconomic status (SES) and percentage time in glucose target range (TIR) which is a key metric calculated from CGM. METHODS Analysis of baseline data from the General Practice Optimising Structured MOnitoring To Improve Clinical outcomes (GP-OSMOTIC) randomised controlled trial (October 2016 - November 2017) of 300 people with T2D from 25 Victorian General Practices. FreeStyle Libre Pro® sensor patch was used for this study. SES was defined by the Index of Relative Socio-economic Disadvantage (IRSD) and educational attainment. Univariable and multivariable mixed-effects linear regression analyses controlling for age, BMI, diet, exercise and study arm were performed. RESULTS One hundred and sixty-seven (60.1%) participants were male, the mean (SD) participant age was 61.0 (9.7) years, and the mean (SD) duration of CGM use was 12.3 (2.5) days. The 10th IRSD decile (least disadvantaged) was associated with a 15% higher TIR vs. the 1st decile (most disadvantaged) (95% CI 5, 25; p = 0.003) and a 0.6% lower HbA1c (95% CI 0.1, 1; p = 0.03). There was no evidence of an association between educational attainment and TIR/HbA1c. CONCLUSION Higher SES measured at an area level is associated with better achievement of glycaemic target using complementary measures of HbA1c and TIR in the GP-OSMOTIC cohort. Given that TIR may be more easily used in patient education and self-management support compared to HbA1c values, the social gradient identified in TIR provides an opportunity for clinicians and policy makers to address health inequities in T2D. TRIAL REGISTRATION Australian and New Zealand Clinical Trials Registry Trial ACTRN12616001372471 , prospective, Date registered 4/10/2016.
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Affiliation(s)
- Mei Lyn Tan
- Department of General Practice, University of Melbourne, Level 1, 200 Berkeley St, Carlton, VIC 3010 Australia
| | - Jo-Anne Manski-Nankervis
- Department of General Practice, University of Melbourne, Level 1, 200 Berkeley St, Carlton, VIC 3010 Australia
| | - Sharmala Thuraisingam
- Department of General Practice, University of Melbourne, Level 1, 200 Berkeley St, Carlton, VIC 3010 Australia
| | - Alicia Jenkins
- NHMRC Clinical Trials Centre, University of Sydney, Levels 4-6 Medical Foundation Building, 92-94 Parramatta Rd, Camperdown, NSW 2050 Australia
| | - David O’Neal
- Department of Medicine, St Vincent’s Hospital, The University of Melbourne, Level 4, Clinical Sciences Building, 29 Regent St, Fitzroy, VIC 3065 Australia
| | - John Furler
- Department of General Practice, University of Melbourne, Level 1, 200 Berkeley St, Carlton, VIC 3010 Australia
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Furler J, O’Neal DN, Speight J, Blackberry I, Manski-Nankervis JA, Thuraisingam S, de La Rue K, Ginnivan L, Browne JL, Holmes-Truscott E, Khunti K, Dalziel K, Chiang J, Audehm R, Kennedy M, Clark M, Jenkins AJ, Liew D, Clarke P, Best J. GP-OSMOTIC trial protocol: an individually randomised controlled trial to determine the effect of retrospective continuous glucose monitoring (r-CGM) on HbA1c in adults with type 2 diabetes in general practice. BMJ Open 2018; 8:e021435. [PMID: 30018097 PMCID: PMC6059310 DOI: 10.1136/bmjopen-2017-021435] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Revised: 05/24/2018] [Accepted: 06/01/2018] [Indexed: 01/13/2023] Open
Abstract
INTRODUCTION Optimal glycaemia can reduce type 2 diabetes (T2D) complications. Observing retrospective continuous glucose monitoring (r-CGM) patterns may prompt therapeutic changes but evidence for r-CGM use in T2D is limited. We describe the protocol for a randomised controlled trial (RCT) examining intermittent r-CGM use (up to 14 days every three months) in T2D in general practice (GP). METHODS AND ANALYSIS General Practice Optimising Structured MOnitoring To achieve Improved Clinical Outcomes is a two-arm RCT asking 'does intermittent r-CGM in adults with T2D in primary care improve HbA1c?' PRIMARY OUTCOME Absolute difference in mean HbA1c at 12 months follow-up between intervention and control arms. SECONDARY OUTCOMES (a) r-CGM per cent time in target (4-10 mmol/L) range, at baseline and 12 months; (b) diabetes-specific distress (Problem Areas in Diabetes). ELIGIBILITY Aged 18-80 years, T2D for ≥1 year, a (past month) HbA1c>5.5 mmol/mol (0.5%) above their individualised target while prescribed at least two non-insulin hypoglycaemic therapies and/or insulin (therapy stable for the last four months). Our general glycaemic target is 53 mmol/mol (7%) (patients with a history of severe hypoglycaemia or a recorded diagnosis of hypoglycaemia unawareness will have a target of 64 mmol/mol (8%)).Our trial compares r-CGM use and usual care. The r-CGM report summarising daily glucose patterns will be reviewed by GP and patient and inform treatment decisions. Participants in both arms are provided with 1 hour education by a specialist diabetes nurse.The sample (n=150/arm) has 80% power to detect a mean HbA1c difference of 5.5 mmol/mol (0.5%) with an SD of 14.2 (1.3%) and alpha of 0.05 (allowing for 10% clinic and 20% patient attrition). ETHICS AND DISSEMINATION University of Melbourne Human Ethics Sub-Committee (ID 1647151.1). Dissemination will be in peer-reviewed journals, conferences and a plain-language summary for participants. TRIAL REGISTRATION NUMBER >ACTRN12616001372471; Pre-results.
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Affiliation(s)
- John Furler
- Department of General Practice, University of Melbourne, Carlton, Victoria, Australia
| | - David Norman O’Neal
- Department of Medicine, St Vincent’s Hospital, University of Melbourne, Melbourne, Australia
| | - Jane Speight
- School of Psychology, Deakin University, Geelong, Victoria, Australia
- The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Melbourne, Victoria, Australia
| | | | | | - Sharmala Thuraisingam
- Department of General Practice, University of Melbourne, Carlton, Victoria, Australia
| | - Katie de La Rue
- Department of General Practice, University of Melbourne, Carlton, Victoria, Australia
| | - Louise Ginnivan
- Department of General Practice, University of Melbourne, Carlton, Victoria, Australia
| | - Jessica Lea Browne
- School of Psychology, Deakin University, Geelong, Victoria, Australia
- The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Melbourne, Victoria, Australia
| | - Elizabeth Holmes-Truscott
- School of Psychology, Deakin University, Geelong, Victoria, Australia
- The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Melbourne, Victoria, Australia
| | - Kamlesh Khunti
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, UK
| | - Kim Dalziel
- University of Melbourne, Melbourne, Australia
| | - Jason Chiang
- Department of General Practice, University of Melbourne, Carlton, Victoria, Australia
| | - Ralph Audehm
- Department of General Practice, University of Melbourne, Carlton, Victoria, Australia
| | - Mark Kennedy
- Department of General Practice, University of Melbourne, Carlton, Victoria, Australia
| | - Malcolm Clark
- Department of General Practice, University of Melbourne, Carlton, Victoria, Australia
| | | | - Danny Liew
- Centre of Cardiovascular Research and Education in Therapeutics, Monash University, Melbourne, Victoria, Australia
| | | | - James Best
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
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25
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Manski-Nankervis JAE, Thuraisingam S, Lau P, Blackberry I, Sluggett JK, Ilomaki J, Bell JS, Furler J. Screening and diagnosis of chronic kidney disease in people with type 2 diabetes attending Australian general practice. Aust J Prim Health 2018; 24:280-286. [DOI: 10.1071/py17156] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Accepted: 02/14/2018] [Indexed: 01/28/2023]
Abstract
Australian guidelines recommend annual screening and monitoring of chronic kidney disease (CKD) in people with type 2 diabetes (T2D). A cross-sectional study utilising data from NPS MedicineWise MedicineInsight program from June 2015 to May 2016 was undertaken to explore: (1) the proportion of patients with T2D attending general practice who have had screening for, or ongoing monitoring of, CKD; (2) the proportion of patients without a documented diagnosis of CKD who have pathology consistent with CKD diagnosis; and (3) the patient factors associated with screening and the recording of a diagnosis of CKD. Of 90550 patients with T2D, 44394 (49.0%) were appropriately screened or monitored. There were 8030 (8.9%) patients with a recorded diagnosis of CKD, whereas 6597 (7.3%) patients had no recorded diagnosis of CKD despite pathology consistent with a diagnosis. Older age and diagnosis of hypertension or hyperlipidaemia were associated with increased odds of CKD diagnosis being recorded. Older patients, males, those with recorded diagnoses of hypertension or hyperlipidaemia and those who had their medical record opened more frequently were more likely to be screened appropriately. Screening and monitoring of CKD appears suboptimal. Research to explore barriers to screening, recording and monitoring of CKD, and strategies to address these, is required.
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26
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Johnson S, Thuraisingam S, Furler J, Nankervis JAM. Changes in health services usage associated with insulin initiation in primary care. Aust J Prim Health 2018; 24:155-161. [DOI: 10.1071/py17152] [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] [Received: 10/26/2017] [Accepted: 12/05/2017] [Indexed: 11/23/2022]
Abstract
Insulin initiation is often delayed in primary care partly because of clinician concerns about the additional clinical work. This study describes health services usage (HSU) pre- and post-insulin initiation in people with type 2 diabetes and out-of-target glycaemic levels. Secondary analysis of participant data from the Stepping Up randomised controlled trial of a model of care for insulin initiation in general practice was undertaken. For 142 people who commenced insulin, HSU in the 6 months prior was compared to that in the 12 months following insulin initiation. Overall, HSU events increased in the 6 months following insulin initiation from a median (IQR) of 18 (15, 29) to 23 (16, 36); (P=0.05), mostly because of an increase in general practitioner (GP) consultations (6 (4, 10) to 8 (5, 11); (P=0.01)). HSU and GP consultations subsequently returned to baseline at 12 months. There was no effect on hospitalisations or specialist consultations. Insulin initiation is associated with a small increase in GP consultations that reverts to baseline after 12 months without affecting other health services. This study can inform health services planning and resource allocation at practice and health policy levels to support insulin initiation in general practice.
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Ee CC, Thuraisingam S, Pirotta MV, French SD, Xue CC, Teede HJ. Expectancy after the first treatment and response to acupuncture for menopausal hot flashes. PLoS One 2017; 12:e0186966. [PMID: 29077767 PMCID: PMC5659680 DOI: 10.1371/journal.pone.0186966] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Accepted: 10/11/2017] [Indexed: 12/02/2022] Open
Abstract
Background Evidence on the impact of expectancy on acupuncture treatment response is conflicting. Objectives This secondary analysis of a randomized sham-controlled trial on acupuncture for menopausal hot flashes investigated whether treatment expectancy score was associated with hot flash score at end-of-treatment. Secondary analyses investigated whether there were associations between other pre-specified factors and hot flash score. Study design Women experiencing moderately-severe hot flashes were randomized to receive 10 sessions of real or sham acupuncture over eight weeks. Hot flash score was collected using a seven-day hot flash diary, and expectancy using the modified Credibility and Expectancy Questionnaire immediately after the first treatment. Linear mixed-effects models with random intercepts were used to identify associations between expectancy score and hot flash score at end-of-treatment. Regression was also used to identify associations between pre-specified factors of interest and hot flash score. Because there was no difference between real and sham acupuncture for the primary outcome of hot flash score, both arms were combined in the analysis. Results 285 women returned the Credibility and Expectancy Questionnaire, and 283 women completed both expectancy measures. We found no evidence for an association between expectancy and hot flash score at end-of-treatment for individual cases in either acupuncture or sham group. Hot flash scores at end-of-treatment were 8.1 (95%CI, 3.0 to 13.2; P = 0.002) points lower in regular smokers compared to those who had never smoked, equivalent to four fewer moderate hot flashes a day. Conclusion In our study of acupuncture for menopausal hot flashes, higher expectancy after the first treatment did not predict better treatment outcomes. Future research may focus on other determinants of outcomes in acupuncture such as therapist attention. The relationship between smoking and hot flashes is poorly understood and needs further exploration.
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Affiliation(s)
- Carolyn C. Ee
- National Institute of Complementary Medicine, Western Sydney University, Sydney, New South Wales, Australia
- Department of General Practice, University of Melbourne, Melbourne, Victoria, Australia
- * E-mail:
| | - Sharmala Thuraisingam
- Department of General Practice, University of Melbourne, Melbourne, Victoria, Australia
| | - Marie V. Pirotta
- Department of General Practice, University of Melbourne, Melbourne, Victoria, Australia
| | - Simon D. French
- School of Rehabilitation Therapy, Queens University, Kingston, Ontario, Canada
- Department of Chiropractic, Faculty of Science and Engineering, Macquarie University, New South Wales, Australia
| | - Charlie C. Xue
- School of Health and Biomedical Sciences, RMIT University, Melbourne, Victoria, Australia
| | - Helena J. Teede
- Monash Centre for Health Research and Implementation: a partnership between Monash Health and the School of Public Health, Monash University, Melbourne, Victoria, Australia
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Manski-Nankervis JA, Furler J, O'Neal D, Ginnivan L, Thuraisingam S, Blackberry I. Overcoming clinical inertia in insulin initiation in primary care for patients with type 2 diabetes: 24-month follow-up of the Stepping Up cluster randomised controlled trial. Prim Care Diabetes 2017; 11:474-481. [PMID: 28705697 DOI: 10.1016/j.pcd.2017.06.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Revised: 06/09/2017] [Accepted: 06/09/2017] [Indexed: 11/27/2022]
Abstract
AIM To examine the two-year impact of Stepping Up, a general practice based model of care intervention for insulin initiation and titration in Australia. METHODS 266 participants from 74 general practices participated in the Stepping Up cluster randomised controlled trial between 2012-2014. Control practices received training in the model of care on completion of the 12-month trial. Patients were followed for 24 months. Participant baseline characteristics, insulin and non-insulin medication use were summarised for each study group. Linear mixed-effects models with random intercepts were used to estimate differences in mean outcome (HbA1c and weight) between the study groups using restricted maximum likelihood estimation. RESULTS At baseline 61% of patients were male, mean (SD) age 62 (10) years, diabetes duration 9 (5, 13) years and mean (95% CI) HbA1c was 8.9 (8.8-9.1)% (74 (73-76)mmol/mol) for both groups. There was a significant between group difference at 6 months which was sustained at 24 months; Mean (95% CI) HbA1c at 24 months in the intervention group was 7.6 (7.5-7.8)% (60 (58-62)mmol/mol) and 8.0 (7.7-8.4)% (64 (61-68)mmol/mol) in the control group. At 24 months 97 (71.3%) of the intervention group and 26 (31.0%) of the control group were prescribed insulin; there was no significant difference in weight. Use of non-insulin anti-hyperglycaemic agents was similar in both groups with the exception of dipeptidyl peptidase-4 inhibitors which were prescribed more frequently in the control group (30(36%) vs 21(16%)). CONCLUSION Stepping Up was associated with improved glycaemic control compared to usual care for 24 months, suggesting that the model facilitated more timely treatment intensification. Ongoing RN-CDE support may be needed to facilitate ongoing treatment intensification.
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Affiliation(s)
- Jo-Anne Manski-Nankervis
- Department of General Practice, University of Melbourne, 200 Berkeley St, Carlton, Victoria 3053, Australia.
| | - John Furler
- Department of General Practice, University of Melbourne, 200 Berkeley St, Carlton, Victoria 3053, Australia
| | - David O'Neal
- Department of Medicine, St Vincent's Hospital, 41 Victoria Parade, Fitzroy, Victoria 3065, Australia
| | - Louise Ginnivan
- Department of General Practice, University of Melbourne, 200 Berkeley St, Carlton, Victoria 3053, Australia
| | - Sharmala Thuraisingam
- Department of General Practice, University of Melbourne, 200 Berkeley St, Carlton, Victoria 3053, Australia
| | - Irene Blackberry
- Department of General Practice, University of Melbourne, 200 Berkeley St, Carlton, Victoria 3053, Australia; John Richards Initiative in Rural Ageing Research at La Trobe University, Wodonga, Victoria 3690, Australia
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Ee C, Thuraisingam S, Pirotta M, French S, Xue C, Teede H, Kristoffersen AE, Sirois F, Stub T, Engler J, Joos S, Güthlin C, Felenda J, Beckmann C, Stintzing F, Evans R, Bronfort G, Keefe D, Taberko A, Hanson L, Haley A, Ma H, Jolton J, Yarosh L, Keefe F, Nam J, Evans R, Ojala L, Kreitzer MJ, Hanson L, Fink C, Kraft K, Flower A, Lewith G, Harman K, Stuart B, Bishop FL, Frawley J, Füleki L, Kiss E, Vancsik T, Krenacs T, Funabashi M, Pohlman KA, Mior S, Thiel H, Hill MD, Cassidy DJ, Westaway M, Yager J, Hurwitz E, Kawchuk GN, O’Beirne M, Vohra S, Gaboury I, Morin C, Gaertner K, Torchetti L, Frei-Erb M, Kundi M, Frass M, Gallo E, Maggini V, Comite M, Sofi F, Baccetti S, Vannacci A, Di Stefano M, Monechi MV, Gori L, Rossi E, Firenzuoli F, Mediati RD, Ballerini G, Gardiner P, Lestoquoy AS, Negash L, Stillman S, Shah P, Liebschutz J, Adelstein P, Farrell-Riley C, Brackup I, Penti B, Saper R, Sampedro IG, Carvajal G, Gleiss A, Gross MM, Brendlin D, Röttger J, Stritter W, Seifert G, Grzanna N, Stange R, Guendling PW, Gu W, Lu Y, Wang J, Zhang C, Hajimonfarednejad M, Hannan N, Hellsing R, Wode K, Nordberg JH, Nordberg JH, Andermo S, Arman M, von Hörsten I, Torrielo PV, Bai H, Vilaró CLA, Cabrera FC, Huber R, Hui H, Ziea E, Tsui D, Hsieh J, Lam C, Chan E, Jensen MP, He Y, Battalio SL, Chan J, Edwards KA, Gertz KJ, Day MA, Sherlin LH, Ehde DM, Kim KH, Jang S, Jang BH, Zhang X, Go HY, Park S, Ko SG, Kraft K, Janik H, Börner A, Lee J, Lee B, Chang GT, Menassa A, Zhang Z, Motoo Y, Müller J, Rabini S, Vinson B, Kelber O, Storr M, Kraft K, Niemeijer M, Baars E, Hoekman J, Wang D, Ruijssenaaars W, Njoku FC, Klose P, Brinkhaus B, Michalsen A, Dobos G, Cramer H, Norheim AJ, Alræk T, Okumus F, Meng F, Oncu-Celik H, Hagel A, Albrecht H, Vollbracht C, Dauth W, Hagel W, Vitali F, Ganzleben I, Schultis H, Konturek P, Stein J, Neurath M, Raithel M, Hagel A, Vollbracht C, Raithel M, Konturek P, Krick B, Haller H, Klose P, Dobos G, Kümmel S, Cramer H, Haller H, Saha FJ, Kowoll A, Ebner B, Berger B, Dobos G, Choi KE, He L, Wang H, He X, Gu C, Zhang Y, Zhao L, Tong X, He L, Wang H, He X, Gu C, Zhang Y, Zhao L, Tong X, He L, Wang H, He X, Gu C, Zhang Y, Zhao L, Tong X, Ho RST, Chung VCH, Wu X, Wong CHL, Wu JCY, Wong SYS, Lau AYL, Sit RWS, Wong W, Holmes M, Bishop F, Calman L, Holmes M, Bishop F, Lewith G, Newell D, Field J, Htut WL, Han D, Choi DI, Choi SJ, Kim HY, Hwang JH, Huang CW, Jang BH, Chen FP, Ko SG, Huang W, Jin D, Lian F, Jang S, Kim KH, Lee EK, Sun SH, Go HY, Ko Y, Park S, Jang BH, Shin YC, Ko SG, Janik H, Greiffenhagen N, Bolte J, Kraft K, Jaworski M, Adamus M, Dobrzynska A, Jeitler M, Jaspers J, von Scheidt C, Koch B, Michalsen A, Steckhan N, Kessler C, Jin D, Huang WJ, Pang B, Lian FM, Jong M, Baars E, Glockmann A, Hamre H, Kainuma M, Murakami A, Kubota T, Kobayashi D, Sumoto Y, Furusyo N, Ando SI, Shimazoe T, Kelber O, Verjee S, Gorgus E, Schrenk D, Kemper K, Hill E, Kemper K, Rao N, Gascon G, Mahan J, Kienle G, Dietrich J, Schmoor C, Huber R, Kim WH, Han D, Ahmed M, He L, Hwang JH, Kiss E, Vancsik T, Meggyeshazi N, Kovago C, Krenacs T, Klaus AK, Zerm R, Pranga D, Ostermann T, Reif M, von Laue HB, Brinkhaus B, Kröz M, Klaus AK, Zerm R, Pranga D, Recchia DR, Ostermann T, Reif M, von Laue HB, Brinkhaus B, Kröz M, Klein-Laansma CT, Jong M, von Hagens C, Jansen JP, van Wietmarschen H, Jong MC, Ko Y, Sun SH, Go HY, Jeon CY, Song YK, Ko SG, Koch AK, Rabsilber S, Lauche R, Kümmel S, Dobos G, Langhorst J, Cramer H, Koch AK, Trifunovic-Koenig M, Klose P, Cramer H, Dobos G, Langhorst J, Koster E, Baars E, Delnoij D, Kroll L, Weiss K, Kubo A, Hendlish S, Altschuler A, Connolly N, Avins A, Lauche R, Recchia DR, Cramer H, Wardle J, Lee D, Sibbritt D, Adams J, Ostermann T, Lauche R, Sibbritt D, Park C, Mishra G, Adams J, Cramer H, Lechner J, Lee I, Chae Y, Lee J, Cho SH, Choi Y, Lee JY, Ryu HS, Yoon SS, Oh HK, Hyun LK, Kim JO, Yoon SW, Lee JY, Shin SH, Jang M, Müller I, Park SHJ, Lestoquoy AS, Laird L, Negash L, Mitchell S, Gardiner P, Li X, Wang Y, Zhen J, Yu H, Liu T, Gu X, Liu H, Ma W, Zhang C, Shang X, Bai Y, Meng F, Liu W, Rooney C, Smith A, Lopes S, Demarzo M, do Patrocínio Nunes M, Lorenz P, Gründemann C, Heinrich M, Garcia-Käufer M, Grunewald F, Messerschmidt S, Herrick A, Gruber K, Beckmann C, Knödler M, Huber R, Steinborn C, Stintzing F, Lu T, Wang L, Wu D, Luberto CM, Hall DL, Chad-Friedman E, Lechner S, Park ER, Luberto CM, Park E, Goodman J, Luer S, Heri M, von Ammon K, Frei-Erb M, Ma W, Meng F, Maggini V, Gallo E, Landini I, Lapucci A, Nobili S, Mini E, Firenzuoli F, McDermott C, Lewith G, Richards S, Cox D, Frossell S, Leydon G, Eyles C, Raphael H, Rogers R, Selby M, Adler C, Allam J, Meng F, Gu W, Zhang C, Bai H, Zhang Z, Wang D, Bu X, Zhang H, Zhang J, Liu H, Mikolasek M, Berg J, Witt C, Barth J, Miskulin I, Lalic Z, Miskulin M, Dumic A, Sebo D, Vcev A, Mohammed NAA, Han D, Ahmed M, Choi SJ, Im HB, Hwang JH, Mukherjee A, Kandhare A, Bodhankar S, Mukherjee A, Kandhare A, Thakurdesai P, Bodhankar S, Munk N, Evans E, Froman A, Kline M, Bair MJ, Musial F, Kristoffersen AE, Alræk T, Hamre HJ, Stub T, Björkman L, Fønnebø VM, Pang B, Lian FM, Ni Q, Tong XL, Li XL, Liu WK, Feng S, Zhao XY, Zheng YJ, Zhao XM, Lin YQ, Pang B, Lian FM, Tong XL, Zhao TY, Zhao XY, Phd HC, Zhang C, Pang B, Liu F, Tong XL, Zhao LH, Zhao XM, Ye R, Gu CJ, Pang B, Ni Q, Tong XL, Lian FM, Zhao XY, Jin D, Zhao XM, Zheng YJ, Lin YQ, Peng W, Lauche R, Sibbritt D, Adams J, Peng W, Wardle J, Cramer H, Mishra G, Lauche R, Pohlman KA, Mior S, Funabashi M, De Carvalho D, El-Bayoumi M, Haig B, Kelly K, Wade DJ, O’Beirne M, Vohra S, Portalupi E, Gobo G, Bellavita L, Guglielmetti C, Raak C, Teuber M, Molsberger F, von Rath U, Reichelt U, Schwanebeck U, Zeil S, Vogelberg C, Veintimilla DR, Vollbracht C, Mery GT, Villavicencio MM, Moran SH, Sachse C, Gündlin PW, Stange R, Sahebkarkhorasani M, Azizi H, Schumann D, Lauche R, Sundberg T, Leach MJ, Cramer H, Seca S, Greten H, Selliah S, Shakya A, Han D, Kim HY, Choi DI, Im HB, Choi SJ, Sherbakova A, Ulrich-Merzenich G, Kelber O, Abdel-Aziz H, Sibinga E, Webb L, Ellen J, Skrautvol K, Nåden D, Song R, Grabowska W, Osypiuk K, Diaz GV, Bonato P, Park M, Hausdorff J, Fox M, Sudarsky LR, Tarsy D, Novakowski J, Macklin EA, Wayne PM, Song R, Hwang I, Ahn S, Lee MA, Wayne PM, Sohn MK, Sorokin O, Steckhan N, Heydeck D, Borchert A, Hohmann CD, Kühn H, Michalsen A, Kessler C, Steckhan N, Hohmann CD, Cramer H, Michalsen A, Dobos G, von Scheidt C, Kirschbaum C, Stalder T, Stöckigt B, Teut M, Suhr R, Sulmann D, Brinkhaus B, Streeter C, Gerbarg P, Silveri M, Brown R, Jensen J, Stritter W, Rutert B, Eggert A, Längler A, Seifert G, Holmberg C, Sun J, Deng X, Li WY, Wen B, Robinson N, Liu JP, Sung HK, Yang N, Go HY, Shin SM, Jung H, Kim YJ, Jung WS, Park TY, Suzuki K, Ito T, Uchida S, Kamohara S, Ono N, Takamura M, Yokochi A, Maruyama K, Tapia P, Thabaut K, Brinkhaus B, Stöckigt B, Thronicke A, Kröz M, Steele M, Matthes H, Herbstreit C, Schad F, Tian J, Lian F, Yang L, Tong X, Tian T, Zhang H, Tian X, Wang C, Chai QY, Zhang L, Xia R, Huang N, Fei Y, Liu J, Trent N, Miraglia M, Dusek J, Pasalis E, Khalsa SB, Trifunovic-König M, Klose P, Cramer H, Lauche R, Koch A, Dobos G, Langhorst J, Uebelacker L, Tremont G, Gillette L, Epstein-Lubow G, Strong D, Abrantes A, Tyrka A, Tran T, Gaudiano B, Miller I, Ullmann G, Ullmann G, Li Y, Vaidya S, Marathe V, Vale AC, Motta J, Donadão F, Valente AC, Valente LCC, Ghelman R, Vesovic D, Jevdic D, Jevdic A, Jevdic K, Djacic M, Letic D, Bozic D, Markovic M, Dunjic S, Vesovic D, Jevdic D, Jevdic A, Jevdic K, Djacic M, Letic D, Bozic D, Markovic M, Ruscuklic G, Baksa D, Dunjic S, Vesovic D, Jevdic D, Jevdic A, Jevdic K, Djacic M, Letic D, Bozic D, Markovic M, Ruscuklic G, Baksa D, Dunjic S, Vesovic D, Jevdic D, Jevdic A, Jevdic K, Djacic M, Letic D, Bozic D, Markovic M, Ruscuklic G, Baksa D, Dunjic S, Vesovic D, Jevdic D, Jevdic A, Jevdic K, Djacic M, Letic D, Bozic D, Markovic M, Vrca K, Dunjic S, Vincent A, Wahner-Roedler D, Whipple M, Vogelius MM, Vollbracht C, Friesecke I, Gündling PW, Wahner-Roedler D, Mahapatra S, Hynes R, Van Rooy K, Looker S, Ghosh A, Bauer B, Cutshall S, Walach H, Flores AB, Walach H, Ofner M, Kastner A, Schwarzl G, Schwameder H, Alexander N, Strutzenberger G, Wang J, Lu Y, Gu W, Zhang C, Bu X, Zhang H, Zhang J, He Y, Zhang X, Meng F, Wang S, Yu H, Shi J, Hao Y, Liu T, Wu J, Qiu Z, Gu X, Wang YH, Lou CJ, Watts S, Wayne P, Osypiuk K, Vergara-Diaz G, Bonato P, Gow B, Hausdorff J, Miranda J, Sudarsky L, Tarsy D, Fox M, Macklin E, Wode K, Bergqvist J, Bernhardsson BM, Nordberg JH, Kienle G, Sharp L, Henriksson R, Woo Y, Hyun MK, Wu H, Wang TF, Zhao Y, Wei Y, Tian L, He L, Wang X, Wu R, Feng S, Han M, Caldwell PHY, Liu S, Zhang J, Liu J, Xia R, Chai Q, Fei Y, Guo Z, Wang C, Liu Z, Li X, Zhang Y, Liu J, Yang IJ, Lincha VR, Ahn SH, Lee DU, Shin HM, Yang L, Sibbritt D, Peng W, Adams J, Yang N, Sung H, Shin SM, Go HY, Jung H, Kim Y, Park TY, Yap A, Kwan YH, Tan CS, Ibrahim S, Ang SB, Yayi A, Han D, Im HB, Hwang JH, Choi SJ, Yoo JE, Yoo HR, Jang SB, Lee HL, Youssef A, Ezzat S, Motaal AA, El-Askary H, Yu X, Cui Y, Zhang Y, Lian F, Yun Y, Ko Y, Ahn JH, Jang BH, Kim KS, Ko SG, Choi I, Zerm R, Glinz A, Pranga D, Berger B, ten Brink F, Reif M, Büssing A, Gutenbrunner C, Kröz M, Zerm R, Helbrecht B, Pranga D, Brinkhaus B, Michalsen A, Kröz M, Zhang H, Fang T, Wang J, Zhang C, He Y, Zhang X, Zhang Z, Wang D, Meng F, Zhang J, Zhang C, Bai H, Shen Z, Ma W, Liu H, Bai Y, Shang X, Meng F, Zhang R, Wu F, Li M, Xuan X, Shen X, Ren K, Berman B, Zhen J, Li X, Gu X, Yu H, Zheng Z, Wan Y, Wang Y, Ma X, Dong F, Liu T, Zhen J, Li X, Gu X, Yu H, Zheng Z, Wan Y, Wang Y, Ma X, Dong F, Liu T, Zick S, Harris R, Bae GE, Kwon JN, Lee HY, Nam JK, Lee SD, Lee DH, Han JY, Yun YJ, Lee JH, Park HL, Park SH, Bocci C, Ivaldi GB, Vietti I, Meaglia I, Guffi M, Ruggiero R, Gualea M, Longa E, Bonucci M, Croke S, Rodriguez LD, Caracuel-Martínez JC, Fajardo-Rodríguez MF, Ariza-García A, la Fuente FGD, Arroyo-Morales M, Estrems MS, Gómez VG, Estrems MS, Sabater MV, Ferreri R, Bernardini S, Pulcri R, Cracolici F, Rinaldi M, Porciani C, Firenzuoli F, Baccetti S, Di Stefano M, Monechi MV, Gallo E, Maggini V, Gori L, Rossi E, Fisher P, Hughes J, Mendoza A, MacPherson H, Witt C, Filshie J, Lewith G, Di Francesco A, Bernardini A, Messe M, Primitivo V, Iasella PA, Ghelman R, Taminato M, Alcantara JDC, De Oliveira KR, Rodrigues DCDA, Mumme JRC, Sunakozawa OKM, Filho VO, Seifert G, Goldenberg J, Day A, Sasagawa M, Ward L, Cooley K, Gunnarsdottir T, Hjaltadottir I. World Congress Integrative Medicine & Health 2017: part two. BMC Complement Altern Med 2017. [PMCID: PMC5498867 DOI: 10.1186/s12906-017-1783-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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