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Moffat AK, Apajee J, Le Blanc VT, Westaway K, Andrade AQ, Ramsay EN, Blacker N, Pratt NL, Roughead EE. Reducing opioid use for chronic non-cancer pain in primary care using an evidence-based, theory-informed, multistrategic, multistakeholder approach: a single-arm time series with segmented regression. BMJ Qual Saf 2023; 32:623-631. [PMID: 37105724 PMCID: PMC10646855 DOI: 10.1136/bmjqs-2022-015716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 04/12/2023] [Indexed: 04/29/2023]
Abstract
BACKGROUND Many countries have high opioid use among people with chronic non-cancer pain. Knowledge about effective interventions that could be implemented at scale is limited. We designed a national intervention that included audit and feedback, deprescribing guidance, information on catastrophising assessment, pain neuroscience education and a cognitive tool for use by patients with their healthcare providers. METHOD We used a single-arm time series with segmented regression to assess rates of people using opioids before (January 2015 to September 2017), at the time of (October 2017) and after the intervention (November 2017 to August 2019). We used a cohort with historical comparison group and log binomial regression to examine the rate of psychologist claims in opioid users not using psychologist services prior to the intervention. RESULTS 13 968 patients using opioids, 8568 general practitioners, 8370 pharmacies and accredited pharmacists and 689 psychologists were targeted. The estimated difference in opioid use was -0.51 persons per 1000 persons per month (95% CI -0.69, -0.34; p<0.001) as a result of the intervention, equating to 25 387 (95% CI 24 676, 26 131) patient-months of opioid use avoided during the 22-month follow-up. The targeted group had a significantly higher rate of incident patient psychologist claims compared with the historical comparison group (rate ratio: 1.37, 95% CI 1.16, 1.63; p<0.001), equating to an additional 690 (95% CI 289, 1167) patient-months of psychologist treatment during the 22-month follow-up. CONCLUSIONS Our intervention addressed the cognitive, affective and sensory factors that contribute to pain and consequent opioid use, demonstrating it could be implemented at scale and was associated with a reduction in opioid use and increasing utilisation of psychologist services.
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Affiliation(s)
- Anna K Moffat
- Clinical and Health Sciences, University of South Australia, Adelaide, 5000, South Australia, Australia
| | - Jemisha Apajee
- Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Vanessa T Le Blanc
- Clinical and Health Sciences, University of South Australia, Adelaide, 5000, South Australia, Australia
| | - Kerrie Westaway
- Clinical and Health Sciences, University of South Australia, Adelaide, 5000, South Australia, Australia
| | - Andre Q Andrade
- Clinical and Health Sciences, University of South Australia, Adelaide, 5000, South Australia, Australia
| | - Emmae N Ramsay
- Clinical and Health Sciences, University of South Australia, Adelaide, 5000, South Australia, Australia
| | - Natalie Blacker
- Clinical and Health Sciences, University of South Australia, Adelaide, 5000, South Australia, Australia
| | - Nicole L Pratt
- Clinical and Health Sciences, University of South Australia, Adelaide, 5000, South Australia, Australia
| | - Elizabeth Ellen Roughead
- Clinical and Health Sciences, University of South Australia, Adelaide, 5000, South Australia, Australia
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Gilson ND, Papinczak ZE, Haslam C, Mielke GI, Fooken J, Brown WJ. A stepped down physical activity support program for military service veterans: The Active Choices pilot study. Health Promot J Austr 2023. [PMID: 37724696 DOI: 10.1002/hpja.807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 07/31/2023] [Accepted: 08/31/2023] [Indexed: 09/21/2023] Open
Abstract
ISSUE ADDRESSED Referral to supervised physical activity (PA) programs is an effective treatment for military service veterans (MSVs) suffering from a range of chronic diseases. However, many MSVs fail to maintain PA regimes once discharged from supervision. This pilot study assessed Active Choices, a stepped-down program to support MSVs in the transition from allied health treatment to self-managed PA. METHODS Participants were 34 Australian MSVs (mean [SD] age = 61 [15.8] years) who were completing supervised referral to an exercise physiologist or physiotherapist. MSVs stepped-down to Active Choices and received a 12-week, evidence-based PA support program (2020-2021). Analyses compared within-group changes in accelerometer-assessed PA at three time points (Weeks 0, 12, and 24; linear mixed model). Program retention, PA choices, and allied healthcare service costs were also evaluated. RESULTS Relative to baseline (64 [26] min/day), mean (SD) moderate-to-vigorous PA increased (74 [28] min/day; p < .05) and was maintained (62 [28] min/day) at weeks 12 and 24, respectively. Retention in the program was high (86% [29/34 participants] completion rate at 12 weeks), with water-based group activities the most popular PAs of choice (14/24 activities). Average allied healthcare service costs during the study were lower than typical costs for MSVs (60.51 vs. 97.06 AUD/week). CONCLUSION The findings highlight the potential of Active Choices to support MSVs in the transition from supervised to self-managed MVPA. SO WHAT?: The program could promote the health of veterans and reduce costs for ongoing referral if impact is replicated at scale.
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Affiliation(s)
- Nicholas D Gilson
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Zoe E Papinczak
- Queensland Centre for Mental Health Research, School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
| | - Catherine Haslam
- School of Psychology, The University of Queensland, Brisbane, Queensland, Australia
| | - Gregore I Mielke
- School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
| | - Jonas Fooken
- Centre for the Business and Economics of Health, The University of Queensland, Brisbane, Queensland, Australia
| | - Wendy J Brown
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Queensland, Australia
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
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Dell L, Sbisa AM, Forbes A, O'Donnell M, Bryant R, Hodson S, Morton D, Battersby M, Tuerk PW, Wallace D, Forbes D. Effect of massed v. standard prolonged exposure therapy on PTSD in military personnel and veterans: a non-inferiority randomised controlled trial. Psychol Med 2023; 53:4192-4199. [PMID: 35440345 PMCID: PMC10317798 DOI: 10.1017/s0033291722000927] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 03/21/2022] [Accepted: 03/22/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND A short, effective therapy for posttraumatic stress disorder (PTSD) could decrease barriers to implementation and uptake, reduce dropout, and ameliorate distressing symptoms in military personnel and veterans. This non-inferiority RCT evaluated the efficacy of 2-week massed prolonged exposure (MPE) therapy compared to standard 10-week prolonged exposure (SPE), the current gold standard treatment, in reducing PTSD severity in both active serving and veterans in a real-world health service system. METHODS This single-blinded multi-site non-inferiority RCT took place in 12 health clinics across Australia. The primary outcome was PTSD symptom severity measured by the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) at 12 weeks. 138 military personnel and veterans with PTSD were randomised. 71 participants were allocated to SPE, with 63 allocated to MPE. RESULTS The intention-to-treat sample included 138 participants, data were analysed for 134 participants (88.1% male, M = 46 years). The difference between the mean MPE and SPE group PTSD scores from baseline to 12 weeks-post therapy was 0.94 [95% confidence interval (CI) -4.19 to +6.07]. The upper endpoint of the 95% CI was below +7, indicating MPE was non-inferior to SPE. Significant rates of loss of PTSD diagnosis were found for both groups (MPE 53.8%, SPE 54.1%). Dropout rates were 4.8% (MPE) and 16.9% (SPE). CONCLUSIONS MPE was non-inferior to SPE in significantly reducing symptoms of PTSD. Significant reductions in symptom severity, low dropout rates, and loss of diagnosis indicate MPE is a feasible, accessible, and effective treatment. Findings demonstrate novel methods to deliver gold-standard treatments for PTSD should be routinely considered.
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Affiliation(s)
- Lisa Dell
- Phoenix Australia – Center for Posttraumatic Mental Health, Department of Psychiatry, The University of Melbourne, Melbourne, Victoria, Australia
| | - Alyssa M. Sbisa
- Phoenix Australia – Center for Posttraumatic Mental Health, Department of Psychiatry, The University of Melbourne, Melbourne, Victoria, Australia
| | - Andrew Forbes
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Meaghan O'Donnell
- Phoenix Australia – Center for Posttraumatic Mental Health, Department of Psychiatry, The University of Melbourne, Melbourne, Victoria, Australia
| | - Richard Bryant
- School of Psychology, University of New South Wales, Sydney, New South Wales, Australia
| | - Stephanie Hodson
- Department of Veteran's Affairs, Canberra, Australian Capital Territory, Australia
| | - David Morton
- Department of Defence, Canberra, Australian Capital Territory, Australia
| | - Malcolm Battersby
- College of Medicine and Public Health, Flinders University, South Australia, Australia
| | - Peter W. Tuerk
- Sheila C. Johnson Center for Clinical Services, Department of Human Services, University of Virginia, Charlottesville, Virginia, USA
| | - Duncan Wallace
- Australian Defence Force Center for Mental Health, Sydney, New South Wales, Australia
| | - David Forbes
- Phoenix Australia – Center for Posttraumatic Mental Health, Department of Psychiatry, The University of Melbourne, Melbourne, Victoria, Australia
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Hinton M, Metcalf O, Varker T, Roebuck G, McGaw V, Watson L, Fredrickson J, Johnson L, Forbes D, Phelps A, Kartal D, Dell L, Bryant R, McFarlane AC, Hopwood M, O'Donnell M. A Qualitative Study of the Expectations, Experiences, and Perceptions That Underpin Decisions Regarding PTSD Treatment in Help-seeking Veterans. Mil Med 2022; 188:usac374. [PMID: 36433752 DOI: 10.1093/milmed/usac374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 10/06/2022] [Accepted: 11/14/2022] [Indexed: 02/17/2024] Open
Abstract
INTRODUCTION A range of evidence-based treatments are available for PTSD. However, many veterans with PTSD do not engage in these treatments. Concurrently, various novel PTSD treatments with little or no evidence based are increasingly popular among veterans. This qualitative study explored the expectations, experiences, and perceptions of help-seeking veterans with PTSD to improve understanding of how these veterans make treatment decisions. MATERIALS AND METHODS Fifteen treatment-seeking veterans with PTSD participated in the study. Participants took part in semi-structured interviews. Data were analyzed using interpretative phenomenological analysis. RESULTS A number of themes and subthemes emerged from the data, providing a detailed account of the factors that influenced participants' treatment decisions. Most participants were in an acute crisis when they made the initial decision to seek treatment for their PTSD. In choosing a specific treatment, they tended to follow recommendations made by other veterans or health professionals or orders or directions from their superiors, health providers, or employers. Few participants actively considered the scientific evidence supporting different treatments. Participants had a strong preference for treatment provided by or involving other veterans. They reported finding PTSD treatments helpful, although some were not convinced of the value of evidence-based treatments specifically. Many participants reported negative experiences with treatment providers. CONCLUSIONS These findings will inform strategies to improve engagement of veterans in evidence-based PTSD treatments and advance progress toward veteran-centered care.
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Affiliation(s)
- Mark Hinton
- Phoenix Australia-Centre for Posttraumatic Mental Health, Department of Psychiatry, University of Melbourne, Carlton, VIC 3053, Australia
| | - Olivia Metcalf
- Phoenix Australia-Centre for Posttraumatic Mental Health, Department of Psychiatry, University of Melbourne, Carlton, VIC 3053, Australia
| | - Tracey Varker
- Phoenix Australia-Centre for Posttraumatic Mental Health, Department of Psychiatry, University of Melbourne, Carlton, VIC 3053, Australia
| | - Greg Roebuck
- Phoenix Australia-Centre for Posttraumatic Mental Health, Department of Psychiatry, University of Melbourne, Carlton, VIC 3053, Australia
- The Institute for Mental and Physical Health and Clinical Translation (IMPACT), School of Medicine, Deakin University, Geelong, VIC 3220, Australia
| | - Violette McGaw
- Phoenix Australia-Centre for Posttraumatic Mental Health, Department of Psychiatry, University of Melbourne, Carlton, VIC 3053, Australia
| | - Loretta Watson
- Phoenix Australia-Centre for Posttraumatic Mental Health, Department of Psychiatry, University of Melbourne, Carlton, VIC 3053, Australia
| | - Julia Fredrickson
- Phoenix Australia-Centre for Posttraumatic Mental Health, Department of Psychiatry, University of Melbourne, Carlton, VIC 3053, Australia
| | - Lucinda Johnson
- Phoenix Australia-Centre for Posttraumatic Mental Health, Department of Psychiatry, University of Melbourne, Carlton, VIC 3053, Australia
| | - David Forbes
- Phoenix Australia-Centre for Posttraumatic Mental Health, Department of Psychiatry, University of Melbourne, Carlton, VIC 3053, Australia
| | - Andrea Phelps
- Phoenix Australia-Centre for Posttraumatic Mental Health, Department of Psychiatry, University of Melbourne, Carlton, VIC 3053, Australia
| | - Dzenana Kartal
- Phoenix Australia-Centre for Posttraumatic Mental Health, Department of Psychiatry, University of Melbourne, Carlton, VIC 3053, Australia
| | - Lisa Dell
- Phoenix Australia-Centre for Posttraumatic Mental Health, Department of Psychiatry, University of Melbourne, Carlton, VIC 3053, Australia
| | - Richard Bryant
- School of Psychology, University of New South Wales, Kensington, NSW 2052, Australia
| | - Alexander C McFarlane
- Adelaide Medical School, University of Adelaide, Adelaide Health and Medical Sciences building, Adelaide, SA 5000, Australia
| | - Malcolm Hopwood
- Department of Psychiatry, University of Melbourne, Parkville, VIC 3010, Australia
| | - Meaghan O'Donnell
- Phoenix Australia-Centre for Posttraumatic Mental Health, Department of Psychiatry, University of Melbourne, Carlton, VIC 3053, Australia
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Dickie S, Woods J, Machado P, Lawrence M. Nutrition Classification Schemes for Informing Nutrition Policy in Australia: Nutrient-Based, Food-Based, or Dietary-Based? Curr Dev Nutr 2022; 6:nzac112. [PMID: 36060220 PMCID: PMC9429971 DOI: 10.1093/cdn/nzac112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 05/27/2022] [Accepted: 06/22/2022] [Indexed: 11/23/2022] Open
Abstract
Background Policy makers are increasingly using nutrition classification schemes (NCSs) to assess a food's health potential for informing nutrition policy actions. However, there is wide variability among the NCSs implemented and no standard benchmark against which their contrasting assessments can be validated. Objectives This study aimed to compare the agreement of nutrient-, food-, and dietary-based NCSs in their assessment of a food's health potential within the Australian food supply, and examine the conceptual underpinnings and technical characteristics that explain differences in performance. Methods A dataset combining food compositional data from the Mintel Global New Products Database and the Australian Food Composition Database (AUSNUT 2011-2012) (n = 7322) was assembled. Products were classified by 7 prominent NCSs that were selected as representative of one or other of 1) nutrient-based NCSs [the Chilean nutrient profile model (NPM), Health Star Rating (HSR), Nutri-Score, the WHO European Region's NPM (WHO-Euro NPM), and the Pan American Health Organization's (PAHO) NPM]; 2) food-based NCS (NOVA), and 3) dietary-based NCS [Australian Dietary Guidelines (ADGs)]. Results The PAHO NPM classified the lowest proportion (22%) of products as "healthy", and the HSR the highest (63%). The PAHO NPM, NOVA, WHO-Euro NPM, and the Chilean NPM classified >50% of products as "unhealthy," and the ADGs, HSR, and Nutri-Score classified <50% of products as "unhealthy." The HSR and Nutri-Score had the highest pairwise agreement (κ = 0.7809, 89.70%), and the PAHO NPM and HSR the lowest (κ = 0.1793, 53.22%). Characteristics of NCSs that more effectively identified ultraprocessed and discretionary foods were: category-specific assessment, the classification of categories as always "healthy" or "unhealthy," consideration of level of food processing, thresholds for "risk" nutrients that do not penalize whole foods; and no allowance for the substitution of ingredients. Conclusions Wide variation was observed in agreement of the assessment of a food's health potential among the NCSs analyzed due to differing conceptual underpinnings and technical characteristics.
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Affiliation(s)
- Sarah Dickie
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Victoria, Australia
| | - Julie Woods
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Victoria, Australia
| | - Priscila Machado
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Victoria, Australia
| | - Mark Lawrence
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Victoria, Australia
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Williams CM, Menz HB, Lazzarini PA, Gordon J, Harrison C. Australian children's foot, ankle and leg problems in primary care: a secondary analysis of the Bettering the Evaluation and Care of Health (BEACH) data. BMJ Open 2022; 12:e062063. [PMID: 35896301 PMCID: PMC9335039 DOI: 10.1136/bmjopen-2022-062063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To explore children's foot, ankle and leg consultation patterns and management practices in Australian primary care. DESIGN Cross-sectional, retrospective study. SETTING Australia Bettering the Evaluation and Care of Health program dataset. PARTICIPANTS Data were extracted for general practitioners (GPs) and patients <18 years from April 2000 to March 2016 inclusive. MAIN OUTCOME MEASURES Demographic characteristics: sex, GP age groups (ie, <45, 45-54, 55+ years), GP country of training, patient age grouping (0-4, 5-9, 10-14, 15-18 years), postcode, concession card status, indigenous status, up to three patient encounter reasons, up to four encounter problems/diagnoses and the clinical management actioned by the GP. RESULTS Children's foot, ankle or leg problems were managed at a rate of 2.05 (95% CI 1.99 to 2.11) per 100 encounters during 229 137 GP encounters with children. There was a significant increase in the rate of foot, ankle and leg problems managed per 100 children in the population, from 6.1 (95% CI 5.3 to 6.8) in 2005-2006 to 9.0 (95% CI 7.9 to 10.1) in 2015-2016. Management of children's foot, ankle and leg problems were independently associated with male patients (30% more than female), older children (15-18 years were 7.1 times more than <1 years), male GPs (13% more) and younger GPs (<45 years of age 13% more than 55+). The top four most frequently managed problems were injuries (755.9 per 100 000 encounters), infections (458.2), dermatological conditions (299.4) and unspecified pain (176.3). The most frequently managed problems differed according to age grouping. CONCLUSIONS Children commonly present to GPs for foot, ankle and leg problems. Presentation frequencies varied according to age. Unexpectedly, conditions presenting commonly in adults, but rarely in children, were also frequently recorded. This data highlights the importance of initiatives supporting contemporary primary care knowledge of diagnoses and management of paediatric lower limb problems to minimise childhood burden of disease.
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Affiliation(s)
- Cylie M Williams
- School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Frankston, Victoria, Australia
| | - Hylton B Menz
- Discipline of Podiatry, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, Australia
| | - Peter A Lazzarini
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, Australia
- Allied Health Research Collaborative, The Prince Charles Hospital, Brisbane, Queensland, Australia
| | - Julie Gordon
- WHO-CC for Strengthening Rehabilitation Capacity in Health Systems, School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Christopher Harrison
- Menzies Centre for Health Policy, School of Public Health, Faculty of Medicine and Health, University of Sydney, Parramatta, New South Wales, Australia
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Muir SD, de Boer K, Nedeljkovic M, Meyer D. Barriers and facilitators of videoconferencing psychotherapy implementation in veteran mental health care environments: a systematic review. BMC Health Serv Res 2020; 20:999. [PMID: 33131495 PMCID: PMC7603749 DOI: 10.1186/s12913-020-05858-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 10/22/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Whilst treatment for mental health issues has traditionally been conducted in-person, advances in technology has seen a recent growth in the use of online video therapy services to help overcome access-to-care barriers faced by those living in rural locations and those unable to travel. These barriers are particularly apparent in the case of veteran populations, which is the focus of this review. Whilst the research investigating the efficacy of online video therapy to treat mental health issues among veterans is promising, widespread adoption and utilisation of this modality remains low with efforts often failing to progress past the pilot phase to implementation. This review focuses on the implementation of online video therapy in veteran mental health care settings and aims to identify the potential barriers and facilitators relevant to implementing the modality in military organisations. METHODS A systematic search of three databases (PsycInfo, PubMed, and Web of Science) was conducted. To be eligible for inclusion, studies had to investigate the challenges, lessons learnt, or factors operating as barriers and/or facilitators to the implementation of online video therapy in veteran health care systems. RESULTS The initial search revealed a total of 202 articles. This was reduced to 133 when duplicates were removed. After screening the titles and abstracts a further 70 articles were excluded leaving 63 to be retrieved for full review. A total of 10 studies were included in this review. The most commonly reported barriers were related to clinician concerns, logistical problems, and technology. Other barriers included access to resources as well as challenges posed by collaborations, policy and recruitment. Facilitators included experience using the modality and having dedicated staff responsible for promoting and managing the new service (e.g., on-site champions and telehealth technicians). CONCLUSIONS This review suggests that numerous barriers must be identified and addressed before attempting to implement an online video therapy service in veteran organisations. Further research is needed to establish best practice for implementation, particularly across geographically dispersed sites. It is hoped that the findings of this review will be used to help inform future implementation efforts and research initiatives in this space.
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Affiliation(s)
- Samuel D Muir
- School of Health Sciences, Swinburne University of Technology, Melbourne, Australia.
| | - Kathleen de Boer
- School of Health Sciences, Swinburne University of Technology, Melbourne, Australia
| | - Maja Nedeljkovic
- School of Health Sciences, Swinburne University of Technology, Melbourne, Australia
| | - Denny Meyer
- School of Health Sciences, Swinburne University of Technology, Melbourne, Australia
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Andrade AQ, LeBlanc VT, Kalisch-Ellett LM, Pratt NL, Moffat A, Blacker N, Westaway K, Barratt JD, Roughead EE. Determinants of usefulness in professional behaviour change interventions: observational study of a 15-year national program. BMJ Open 2020; 10:e038016. [PMID: 33055116 PMCID: PMC7559049 DOI: 10.1136/bmjopen-2020-038016] [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: 11/30/2022] Open
Abstract
OBJECTIVE Educational, and audit and feedback interventions are effective in promoting health professional behaviour change and evidence adoption. However, we lack evidence to pinpoint which particular features make them most effective. Our objective is to identify determinants of quality in professional behaviour change interventions, as perceived by participants. DESIGN We performed a comparative observational study using data from the Veterans' Medicines Advice and Therapeutics Education Services program, a nation-wide Australian Government Department of Veterans' Affairs funded program that provides medicines advice and promotes physician adoption of best practices by use of a multifaceted intervention (educational material and a feedback document containing individual patient information). SETTING Primary care practices providing care to Australian veterans. PARTICIPANTS General practitioners (GPs) targeted by 51 distinct behaviour change interventions, implemented between November 2004 and June 2018. PRIMARY AND SECONDARY OUTCOME MEASURES We extracted features related to presentation (number of images, tables and characters), content (polarity and subjectivity using sentiment analysis, number of external links and medicine mentions) and the use of five behaviour change techniques (prompt/cues, goal setting, discrepancy between current behaviour and goal, information about health consequences, feedback on behaviour). The main outcome was perceived usefulness, extracted from postintervention survey. RESULTS On average, each intervention was delivered to 9667 GPs. Prompt and goal setting strategies in the audit and feedback were independently correlated to perceived usefulness (p=0.030 and p=0.005, respectively). The number of distinct behaviour change techniques in the audit and feedback was correlated with improved usefulness (Pearson's coefficient 0.45 (0.19, 0.65), p=0.001). No presentation or content features in the educational material were correlated with perceived usefulness. CONCLUSIONS The finding provides additional evidence encouraging the use of behaviour change techniques, in particular prompt and goal setting, in audit and feedback interventions.
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Affiliation(s)
- Andre Q Andrade
- Quality Use of Medicines and Pharmacy Research Centre, University of South Australia, Adelaide, South Australia, Australia
| | - Vanessa T LeBlanc
- Quality Use of Medicines and Pharmacy Research Centre, University of South Australia, Adelaide, South Australia, Australia
| | - Lisa M Kalisch-Ellett
- Quality Use of Medicines and Pharmacy Research Centre, University of South Australia, Adelaide, South Australia, Australia
| | - Nicole L Pratt
- Quality Use of Medicines and Pharmacy Research Centre, University of South Australia, Adelaide, South Australia, Australia
| | - Anna Moffat
- Quality Use of Medicines and Pharmacy Research Centre, University of South Australia, Adelaide, South Australia, Australia
| | - Natalie Blacker
- Quality Use of Medicines and Pharmacy Research Centre, University of South Australia, Adelaide, South Australia, Australia
| | - Kerrie Westaway
- Quality Use of Medicines and Pharmacy Research Centre, University of South Australia, Adelaide, South Australia, Australia
| | - John D Barratt
- Quality Use of Medicines and Pharmacy Research Centre, University of South Australia, Adelaide, South Australia, Australia
| | - Elizabeth E Roughead
- Quality Use of Medicines and Pharmacy Research Centre, University of South Australia, Adelaide, South Australia, Australia
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Abstract
IMPACT STATEMENT Brain degenerative disorders, which include some neurodevelopmental disorders and age-associated diseases, cause debilitating neurological deficits and are generally fatal. A large body of emerging evidence indicates that iron accumulation in neurons within specific regions of the brain plays an important role in the pathogenesis of many of these disorders. Iron homeostasis is a highly complex and incompletely understood process involving a large number of regulatory molecules. Our review provides a description of what is known about how iron is obtained by the body and brain and how defects in the homeostatic processes could contribute to the development of brain diseases, focusing on Alzheimer's disease and Parkinson's disease as well as four other disorders belonging to a class of inherited conditions referred to as neurodegeneration based on iron accumulation (NBIA) disorders. A description of potential therapeutic approaches being tested for each of these different disorders is provided.
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Affiliation(s)
| | - Mark C Kindy
- Department of Pharmaceutical Sciences, College of Pharmacy, University of South Florida, Tampa, FL 33612, USA
- James A. Haley Veterans Affairs Medical Center, Tampa, FL 33612, USA
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Webster JM, Darling AL, Sanders TA, Blazier DM, Vidal-Aguiar Y, Beaulieu-Abdelahad D, Plemmons DG, Hill SE, Uversky VN, Bickford PC, Dickey CA, Blair LJ. Hsp22 with an N-Terminal Domain Truncation Mediates a Reduction in Tau Protein Levels. Int J Mol Sci 2020; 21:E5442. [PMID: 32751642 PMCID: PMC7432035 DOI: 10.3390/ijms21155442] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 07/27/2020] [Accepted: 07/28/2020] [Indexed: 11/21/2022] Open
Abstract
Misfolding, aggregation and accumulation of proteins are toxic elements in the progression of a broad range of neurodegenerative diseases. Molecular chaperones enable a cellular defense by reducing or compartmentalizing these insults. Small heat shock proteins (sHsps) engage proteins early in the process of misfolding and can facilitate their proper folding or refolding, sequestration, or clearance. Here, we evaluate the effects of the sHsp Hsp22, as well as a pseudophosphorylated mutant and an N-terminal domain deletion (NTDΔ) variant on tau aggregation in vitro and tau accumulation and aggregation in cultured cells. Hsp22 wild-type (WT) protein had a significant inhibitory effect on heparin-induced aggregation in vitro and the pseudophosphorylated mutant Hsp22 demonstrated a similar effect. When co-expressed in a cell culture model with tau, these Hsp22 constructs significantly reduced soluble tau protein levels when transfected at a high ratio relative to tau. However, the Hsp22 NTDΔ protein drastically reduced the soluble protein expression levels of both tau WT and tau P301L/S320F even at lower transfection ratios, which resulted in a correlative reduction of the triton-insoluble tau P301L/S320F aggregates.
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Affiliation(s)
- Jack M. Webster
- Department of Molecular Medicine, Morsani College of Medicine, University of South Florida, Tampa, FL 33620, USA; (J.M.W.); (A.L.D.); (T.A.S.); (D.M.B.); (Y.V.-A.); (D.B.-A.); (D.G.P.); (S.E.H.); (V.N.U.); (C.A.D.)
- USF Health Byrd Alzheimer’s Institute, University of South Florida, Tampa, FL 33620, USA
| | - April L. Darling
- Department of Molecular Medicine, Morsani College of Medicine, University of South Florida, Tampa, FL 33620, USA; (J.M.W.); (A.L.D.); (T.A.S.); (D.M.B.); (Y.V.-A.); (D.B.-A.); (D.G.P.); (S.E.H.); (V.N.U.); (C.A.D.)
- USF Health Byrd Alzheimer’s Institute, University of South Florida, Tampa, FL 33620, USA
| | - Taylor A. Sanders
- Department of Molecular Medicine, Morsani College of Medicine, University of South Florida, Tampa, FL 33620, USA; (J.M.W.); (A.L.D.); (T.A.S.); (D.M.B.); (Y.V.-A.); (D.B.-A.); (D.G.P.); (S.E.H.); (V.N.U.); (C.A.D.)
- USF Health Byrd Alzheimer’s Institute, University of South Florida, Tampa, FL 33620, USA
| | - Danielle M. Blazier
- Department of Molecular Medicine, Morsani College of Medicine, University of South Florida, Tampa, FL 33620, USA; (J.M.W.); (A.L.D.); (T.A.S.); (D.M.B.); (Y.V.-A.); (D.B.-A.); (D.G.P.); (S.E.H.); (V.N.U.); (C.A.D.)
- USF Health Byrd Alzheimer’s Institute, University of South Florida, Tampa, FL 33620, USA
| | - Yamile Vidal-Aguiar
- Department of Molecular Medicine, Morsani College of Medicine, University of South Florida, Tampa, FL 33620, USA; (J.M.W.); (A.L.D.); (T.A.S.); (D.M.B.); (Y.V.-A.); (D.B.-A.); (D.G.P.); (S.E.H.); (V.N.U.); (C.A.D.)
- USF Health Byrd Alzheimer’s Institute, University of South Florida, Tampa, FL 33620, USA
| | - David Beaulieu-Abdelahad
- Department of Molecular Medicine, Morsani College of Medicine, University of South Florida, Tampa, FL 33620, USA; (J.M.W.); (A.L.D.); (T.A.S.); (D.M.B.); (Y.V.-A.); (D.B.-A.); (D.G.P.); (S.E.H.); (V.N.U.); (C.A.D.)
- USF Health Byrd Alzheimer’s Institute, University of South Florida, Tampa, FL 33620, USA
| | - Drew G. Plemmons
- Department of Molecular Medicine, Morsani College of Medicine, University of South Florida, Tampa, FL 33620, USA; (J.M.W.); (A.L.D.); (T.A.S.); (D.M.B.); (Y.V.-A.); (D.B.-A.); (D.G.P.); (S.E.H.); (V.N.U.); (C.A.D.)
- USF Health Byrd Alzheimer’s Institute, University of South Florida, Tampa, FL 33620, USA
| | - Shannon E. Hill
- Department of Molecular Medicine, Morsani College of Medicine, University of South Florida, Tampa, FL 33620, USA; (J.M.W.); (A.L.D.); (T.A.S.); (D.M.B.); (Y.V.-A.); (D.B.-A.); (D.G.P.); (S.E.H.); (V.N.U.); (C.A.D.)
- USF Health Byrd Alzheimer’s Institute, University of South Florida, Tampa, FL 33620, USA
| | - Vladimir N. Uversky
- Department of Molecular Medicine, Morsani College of Medicine, University of South Florida, Tampa, FL 33620, USA; (J.M.W.); (A.L.D.); (T.A.S.); (D.M.B.); (Y.V.-A.); (D.B.-A.); (D.G.P.); (S.E.H.); (V.N.U.); (C.A.D.)
| | - Paula C. Bickford
- Research Service, James A Haley Veterans Hospital, 13000 Bruce B Downs Blvd, Tampa, FL 33612, USA;
- Department of Neurosurgery and Brain Repair, Morsani College of Medicine, University of South Florida Health, 12901 Bruce B Downs Blvd, Tampa, FL 33612, USA
- Department of Molecular Pharmacology and Physiology, Morsani College of Medicine, University of South Florida Health, 12901 Bruce B Downs Blvd, Tampa, FL 33612, USA
| | - Chad A. Dickey
- Department of Molecular Medicine, Morsani College of Medicine, University of South Florida, Tampa, FL 33620, USA; (J.M.W.); (A.L.D.); (T.A.S.); (D.M.B.); (Y.V.-A.); (D.B.-A.); (D.G.P.); (S.E.H.); (V.N.U.); (C.A.D.)
- USF Health Byrd Alzheimer’s Institute, University of South Florida, Tampa, FL 33620, USA
- Research Service, James A Haley Veterans Hospital, 13000 Bruce B Downs Blvd, Tampa, FL 33612, USA;
| | - Laura J. Blair
- Department of Molecular Medicine, Morsani College of Medicine, University of South Florida, Tampa, FL 33620, USA; (J.M.W.); (A.L.D.); (T.A.S.); (D.M.B.); (Y.V.-A.); (D.B.-A.); (D.G.P.); (S.E.H.); (V.N.U.); (C.A.D.)
- USF Health Byrd Alzheimer’s Institute, University of South Florida, Tampa, FL 33620, USA
- Research Service, James A Haley Veterans Hospital, 13000 Bruce B Downs Blvd, Tampa, FL 33612, USA;
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Abstract
OBJECTIVE To determine time to opioid cessation post discharge from hospital in persons who had been admitted to hospital for a surgical procedure and were previously naïve to opioids. DESIGN, SETTING AND PARTICIPANTS Retrospective cohort study using administrative health claims database from the Australian Government Department of Veterans' Affairs (DVA). DVA gold card holders aged between 18 and 100 years who were admitted to hospital for a surgical admission between 1 January 2014 and 30 December 2015 and naïve to opioid therapy prior to admission were included in the study. Gold card holders are eligible for all health services that DVA funds. MAIN OUTCOME MEASURES The outcome of interest was time to cessation of opioids, with follow-up occurring over 12 months. Cessation was defined as a period without an opioid prescription that was equivalent to three times the estimated supply duration. The proportion who became chronic opioid users was defined as those who continued taking opioids for greater than 90 days post discharge. Cumulative incidence function with death as a competing event was used to determine time to cessation of opioids post discharge. RESULTS In 2014-2015, 24 854 persons were admitted for a surgical admission. In total 3907 (15.7%) were discharged on opioids. In total 3.9% of those discharged on opioids became chronic users of opioids. The opioid that the patients were most frequently discharged with was oxycodone; oxycodone alone accounted for 43%, while oxycodone with naloxone accounted for 8%. CONCLUSIONS Opioid initiation post-surgical hospital admission leads to chronic use of opioids in a small percentage of the population. However, given the frequency at which surgical procedures occur, this means that a large number of people in the population may be affected. Post-discharge assessment and follow-up of at-risk patients is important, particularly where psychosocial elements such as anxiety and catastrophising are identified.
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Affiliation(s)
| | - Renly Lim
- Quality Use of Medicines and Pharmacy Research Centre, University of South Australia Division of Health Sciences, Adelaide, South Australia, Australia
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12
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Salunkhe VA, Veluthakal R, Kahn SE, Thurmond DC. Novel approaches to restore beta cell function in prediabetes and type 2 diabetes. Diabetologia 2018; 61:1895-1901. [PMID: 29947922 PMCID: PMC6070408 DOI: 10.1007/s00125-018-4658-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 05/14/2018] [Indexed: 12/18/2022]
Abstract
The World Health Organization estimates that diabetes prevalence has risen from 108 million in 1980 to 422 million in 2014, with type 2 diabetes accounting for more than 90% of these cases. Furthermore, the prevalence of prediabetes (impaired fasting glucose and/or impaired glucose tolerance) is more than 40% in some countries and is associated with a global rise in obesity. Therefore it is imperative that we develop new approaches to reduce the development of prediabetes and progression to type 2 diabetes. In this review, we explore the gains made over the past decade by focused efforts to improve insulin secretion by the beta cell or insulin sensitivity of target tissues. We also describe multitasking candidates, which could improve both beta cell dysfunction and peripheral insulin sensitivity. Moreover, we highlight provocative findings indicating that additional glucose regulatory tissues, such as the brain, may be key therapeutic targets. Taken together, the promise of these new multi-faceted approaches reinforces the importance of understanding and tackling type 2 diabetes pathogenesis from a multi-tissue perspective.
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Affiliation(s)
- Vishal A Salunkhe
- Department of Molecular and Cellular Endocrinology, Diabetes and Metabolism Research Institute, Beckman Research Institute of City of Hope, 1500 E. Duarte Rd, Duarte, CA, 91010, USA
| | - Rajakrishnan Veluthakal
- Department of Molecular and Cellular Endocrinology, Diabetes and Metabolism Research Institute, Beckman Research Institute of City of Hope, 1500 E. Duarte Rd, Duarte, CA, 91010, USA
| | - Steven E Kahn
- Division of Metabolism, Endocrinology and Nutrition, Department of Medicine, VA Puget Sound Health Care System and University of Washington, Seattle, WA, USA
| | - Debbie C Thurmond
- Department of Molecular and Cellular Endocrinology, Diabetes and Metabolism Research Institute, Beckman Research Institute of City of Hope, 1500 E. Duarte Rd, Duarte, CA, 91010, USA.
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Kalisch Ellett LM, Lim R, Pratt NL, Kerr M, Ramsay EN, LeBlanc TV, Barratt JD, Roughead EE. Reducing hypnotic use in insomnia management among Australian veterans: results from repeated national interventions. BMC Health Serv Res 2018; 18:626. [PMID: 30092801 PMCID: PMC6085677 DOI: 10.1186/s12913-018-3443-9] [Citation(s) in RCA: 5] [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] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Accepted: 08/02/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The Australian Government Department of Veterans' Affairs (DVA) Veterans' Medicines Advice and Therapeutics Education Services (Veterans' MATES) programme conducted two intervention (March 2009, follow-up intervention June 2012) both of which aimed to reduce hypnotic use among Australian veterans. We evaluated the effectiveness of the interventions, and estimated the associated health consequences. METHODS Both interventions targeted veterans who had been dispensed hypnotics prior to the intervention. Patient-specific prescriber feedback containing patient details and the volume of hypnotics dispensed, along with tailored educational information, was mailed to general practitioners. Veterans, pharmacists and directors of care in residential aged care facilities were mailed tailored educational information. Interrupted time-series and segmented regression modelling were used to determine the effect of the two interventions on the rate of hypnotics dispensing. The cumulative patient-months of hypnotic treatment avoided as a result of the interventions was calculated. We estimated improvements in health consequences of as a result of hypnotic treatment avoided based on the results of cohort studies in the same population identifying the association between hypnotic and sedative use on the outcomes of falls, and confusion. RESULTS After the first Veterans' MATES intervention in March 2009, hypnotic use declined by 0.2% each month, when compared to the baseline level (p = 0.006). The intervention effect was attenuated after one year, and use of hypnotics was found to increase by 0.2% per month after March 2010. Following the second intervention in June 2012, there was a further significant decline in use of 0.18% each month over the 12 months of follow up (p = 0.049). The cumulative effect of both interventions resulted in 20,850 fewer patient-months of treatment with hypnotics. This cumulative reduction in hypnotic use was estimated to lead to a minimum of 1 fewer hospital admissions for acute confusion and 7 fewer hospital admissions due to falls. CONCLUSIONS The Veterans' MATES insomnia interventions which involved multiple stakeholders were effective in reducing hypnotic use among older Australians. Repetition of key messages led to sustained practice change.
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Affiliation(s)
- Lisa M. Kalisch Ellett
- Quality Use of Medicines and Pharmacy Research Centre, School of Pharmacy and Medical Sciences, University of South Australia, GPO Box 2471, Adelaide, South Australia 5001 Australia
| | - Renly Lim
- Quality Use of Medicines and Pharmacy Research Centre, School of Pharmacy and Medical Sciences, University of South Australia, GPO Box 2471, Adelaide, South Australia 5001 Australia
| | - Nicole L. Pratt
- Quality Use of Medicines and Pharmacy Research Centre, School of Pharmacy and Medical Sciences, University of South Australia, GPO Box 2471, Adelaide, South Australia 5001 Australia
| | - Mhairi Kerr
- Quality Use of Medicines and Pharmacy Research Centre, School of Pharmacy and Medical Sciences, University of South Australia, GPO Box 2471, Adelaide, South Australia 5001 Australia
| | - Emmae N. Ramsay
- Quality Use of Medicines and Pharmacy Research Centre, School of Pharmacy and Medical Sciences, University of South Australia, GPO Box 2471, Adelaide, South Australia 5001 Australia
| | - Tammy V. LeBlanc
- Quality Use of Medicines and Pharmacy Research Centre, School of Pharmacy and Medical Sciences, University of South Australia, GPO Box 2471, Adelaide, South Australia 5001 Australia
| | - John D. Barratt
- Quality Use of Medicines and Pharmacy Research Centre, School of Pharmacy and Medical Sciences, University of South Australia, GPO Box 2471, Adelaide, South Australia 5001 Australia
| | - Elizabeth E. Roughead
- Quality Use of Medicines and Pharmacy Research Centre, School of Pharmacy and Medical Sciences, University of South Australia, GPO Box 2471, Adelaide, South Australia 5001 Australia
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