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Mayrdorfer M, Liefeldt L, Osmanodja B, Naik MG, Schmidt D, Duettmann W, Hammett C, Schrezenmeier E, Friedersdorff F, Wu K, Halleck F, Budde K. A single centre in-depth analysis of death with a functioning kidney graft and reasons for overall graft failure. Nephrol Dial Transplant 2023; 38:1857-1866. [PMID: 36477607 PMCID: PMC10387383 DOI: 10.1093/ndt/gfac327] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Indexed: 08/01/2023] Open
Abstract
BACKGROUND High numbers of unknown classifications and inconsistent methodologies in previous studies make the interpretation of causes leading to graft loss difficult. In addition, data on a holistic view looking at both death with a functioning graft (DWFG) and death-censored graft failure (DCGF) are sparse. METHODS In this single-centre study we included 1477 adult kidney transplants performed between 1997 and 2017, of which all 286 DWFGs until the end of observation were analysed and causes for death assigned. Additionally, the results were compared with the causes of 303 DCGFs of the same cohort to evaluate the impact of causes for overall graft loss. RESULTS The most frequent causes for DWFG were cardiovascular disease (CVD) in 30.8%, malignancy in 28.3% and infections in 21%. Only 9.4% of reasons for DWFG were unknown. Sudden death occurred in 40% (35/88) of patients classified as DWFG due to CVD. Overall graft loss was related to the effect of immunosuppression in 36.2% [infection 20.9% (123/589), malignancy 15.3% (90/589)] and CVD in 22.4% (132/589). In 27.4% (161/589), graft failure was associated with underimmunosuppression (rejection). For infections (60 DWFG, 63 DCGF) and CVD (88 DWFG, 44 DCGF), a considerable overlap was observed between DWFG and DCGF. For patients >70 years of age at transplantation, medical events accounted for 78% of overall graft losses and only 6.5% were associated with rejection. CONCLUSIONS DWFG and DCGF share more causes for graft loss than previously reported and sudden death plays an underestimated role in death with a functioning graft.
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Ronicke S, Osmanodja B, Budde K, Jens A, Hammett C, Koch N, Zukunft B, Bachmann F, Choi M, Weber U, Eberspächer B, Hofmann J, Grunow F, Mikhailov M, Halleck F, Schrezenmeier E. Declining Course of Humoral Immune Response in Initially Responding Kidney Transplant Recipients after Repeated SARS-CoV-2 Vaccination. J Clin Med 2022; 11:jcm11123291. [PMID: 35743365 PMCID: PMC9224612 DOI: 10.3390/jcm11123291] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Revised: 06/01/2022] [Accepted: 06/06/2022] [Indexed: 02/06/2023] Open
Abstract
The immunogenicity of SARS-CoV-2 vaccines in kidney transplant recipients is limited, resulting in inadequately low serological response rates and low immunoglobulin (Ig) levels, correlating with reduced protection against death and hospitalization from COVID-19. We retrospectively examined the time course of anti-SARS-CoV-2 Ig antibody levels after up to five repeated vaccinations in 644 previously nonresponding kidney transplant recipients. Using anti SARS-CoV-2 IgG/IgA ELISA and the total Ig ECLIA assays, we compared antibody levels at 1 month with levels at 2 and 4 months, respectively. Additionally, we correlated the measurements of the used assays. Between 1 and 2 months, and between 1 and 4 months, mean anti-SARS-CoV-2 Ig levels in responders decreased by 14% and 25%, respectively, depending on the assay. Absolute Ig values and time course of antibody levels showed high interindividual variability. Ig levels decreased by at least 20% in 77 of 148 paired samples with loss of sufficient serological protection over time occurring in 18 out of 148 (12.2%). IgG ELISA and total Ig ECLIA assays showed a strong positive correlation (Kendall’s tau = 0.78), yet the two assays determined divergent results in 99 of 751 (13.2%) measurements. IgG and IgA assays showed overall strong correlation but divergent results in 270 of 1.173 (23.0%) cases and only weak correlation of antibody levels in positive samples. Large interindividual variability and significant loss of serological response after 4 months supports repeated serological sampling and consideration of shorter vaccination intervals in kidney transplant recipients.
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Osmanodja B, Ronicke S, Budde K, Jens A, Hammett C, Koch N, Seelow E, Waiser J, Zukunft B, Bachmann F, Choi M, Weber U, Eberspächer B, Hofmann J, Grunow F, Mikhailov M, Liefeldt L, Eckardt KU, Halleck F, Schrezenmeier E. Serological Response to Three, Four and Five Doses of SARS-CoV-2 Vaccine in Kidney Transplant Recipients. J Clin Med 2022; 11:jcm11092565. [PMID: 35566691 PMCID: PMC9105533 DOI: 10.3390/jcm11092565] [Citation(s) in RCA: 40] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Revised: 04/27/2022] [Accepted: 05/02/2022] [Indexed: 02/04/2023] Open
Abstract
Mortality from COVID-19 among kidney transplant recipients (KTR) is high, and their response to three vaccinations against SARS-CoV-2 is strongly impaired. We retrospectively analyzed the serological response of up to five doses of the SARS-CoV-2 vaccine in KTR from 27 December 2020 until 31 December 2021. Particularly, the influence of the different dose adjustment regimens for mycophenolic acid (MPA) on serological response to fourth vaccination was analyzed. In total, 4277 vaccinations against SARS-CoV-2 in 1478 patients were analyzed. Serological response was 19.5% after 1203 basic immunizations, and increased to 29.4%, 55.6%, and 57.5% in response to 603 third, 250 fourth, and 40 fifth vaccinations, resulting in a cumulative response rate of 88.7%. In patients with calcineurin inhibitor and MPA maintenance immunosuppression, pausing MPA and adding 5 mg prednisolone equivalent before the fourth vaccination increased the serological response rate to 75% in comparison to the no dose adjustment (52%) or dose reduction (46%). Belatacept-treated patients had a response rate of 8.7% (4/46) after three vaccinations and 12.5% (3/25) after four vaccinations. Except for belatacept-treated patients, repeated SARS-CoV-2 vaccination of up to five times effectively induces serological response in kidney transplant recipients. It can be enhanced by pausing MPA at the time of vaccination.
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Schrezenmeier E, Rincon-Arevalo H, Jens A, Stefanski AL, Hammett C, Osmanodja B, Koch N, Zukunft B, Beck J, Oellerich M, Proß V, Stahl C, Choi M, Bachmann F, Liefeldt L, Glander P, Schütz E, Bornemann-Kolatzki K, López del Moral C, Schrezenmeier H, Ludwig C, Jahrsdörfer B, Eckardt KU, Lachmann N, Kotsch K, Dörner T, Halleck F, Sattler A, Budde K. Temporary antimetabolite treatment hold boosts SARS-CoV-2 vaccination-specific humoral and cellular immunity in kidney transplant recipients. JCI Insight 2022; 7:157836. [PMID: 35349490 PMCID: PMC9090237 DOI: 10.1172/jci.insight.157836] [Citation(s) in RCA: 52] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 03/24/2022] [Indexed: 12/04/2022] Open
Abstract
Transplant recipients exhibit an impaired protective immunity after SARS-CoV-2 vaccination, potentially caused by mycophenolate (MPA) immunosuppression. Recent data from patients with autoimmune disorders suggest that temporary MPA hold might greatly improve booster vaccination outcomes. We applied a fourth dose of SARS-CoV-2 vaccine to 29 kidney transplant recipients during a temporary (5 weeks) MPA/azathioprine hold, who had not mounted a humoral immune response to previous vaccinations. Seroconversion until day 32 after vaccination was observed in 76% of patients, associated with acquisition of virus-neutralizing capacity. Interestingly, 21/25 (84%) calcineurin inhibitor–treated patients responded, but only 1/4 belatacept-treated patients responded. In line with humoral responses, counts and relative frequencies of spike receptor binding domain–specific (RBD-specific) B cells were markedly increased on day 7 after vaccination, with an increase in RBD-specific CD27++CD38+ plasmablasts. Whereas overall proportions of spike-reactive CD4+ T cells remained unaltered after the fourth dose, frequencies were positively correlated with specific IgG levels. Importantly, antigen-specific proliferating Ki67+ and in vivo–activated programmed cell death 1–positive T cells significantly increased after revaccination during MPA hold, whereas cytokine production and memory differentiation remained unaffected. In summary, antimetabolite hold augmented all arms of immunity during booster vaccination. These data suggest further studies of antimetabolite hold in kidney transplant recipients.
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Schrezenmeier E, Rincon-Arevalo H, Stefanski AL, Potekhin A, Staub-Hohenbleicher H, Choi M, Bachmann F, Proβ V, Hammett C, Schrezenmeier H, Ludwig C, Jahrsdörfer B, Lino AC, Eckardt KU, Kotsch K, Dörner T, Budde K, Sattler A, Halleck F. B and T Cell Responses after a Third Dose of SARS-CoV-2 Vaccine in Kidney Transplant Recipients. J Am Soc Nephrol 2021; 32:3027-3033. [PMID: 34667083 PMCID: PMC8638401 DOI: 10.1681/asn.2021070966] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 09/06/2021] [Accepted: 09/09/2021] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Accumulating evidence sugges ts solid organ transplant recipients, as opposed to the general population, show strongly impaired responsiveness toward standard SARS-CoV-2 mRNA-based vaccination, demanding alternative strategies for protectio n o f this vulnerable group. METHODS In line with recent recommendations, a third dose of either heterologous ChAdOx1 (AstraZeneca) or homologous BNT162b2 (BioNTech) was administered to 25 kidney transplant recipients (KTR) without humoral response after two doses of BNT162b2, followed by analysis of serological responses and vaccine-specific B- and T-cell immunity. RESULTS Nine out of 25 (36%) KTR under standard immunosuppressive treatment seroconverted until day 27 after the third vaccination, whereas one patient developed severe COVID-19 infection immediately after vaccination. Cellular analysis 7 days after the third dose showed significantly elevated frequencies of viral spike-protein receptor-binding domain-specific B cells in humor al responders as compared with nonresponders. Likewise, portions of spike-reactive CD4 + T helper cells were significantly elevated in patients who were seroconverting. Furthermore, overall frequencies of IL-2 + , IL-4 + , and polyfunctional CD4 + T cells significantly increased after the third dose, whereas memory/effector differentiation remained unaffected. CONCLUSIONS Our data suggest a fraction of transplant recipients benefit from triple vaccination, where seroconversion is associated with quantitative and qualitative changes of cellular immunity. At the same time, the study highlights that modified vaccination approaches for immunosuppressed patients remain an urgent medical need. PODCAST This article contains a podcast at https://www.asn-online.org/media/podcast/JASN/2021_11_23_briggsgriffin112321.mp3.
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Hyun K, Brieger D, Briffa T, Chew D, Horsfall M, French J, Ellis C, Hammett C, Nallaiah K, Redfern J. The impact of socioeconomic status on secondary prevention of the acute coronary syndrome. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Although socioeconomic status (SES) has been reported to be associated with health inequities, there are limited studies exploring the association between SES and secondary prevention of acute coronary syndrome (ACS) in countries with universal health cover.
Purpose
The aim is to examine whether SES has an impact on the secondary prevention of ACS in Australia.
Methods
Australian SNAPSHOT ACS data (2012) and its 18-month follow-up data were linked to admissions data from 6 jurisdictions covering all states and territories, national death index and Medicare Pharmaceutical Benefits Scheme data covering up to 3 years post-discharge. The five SES groups (lowest in Group 1 and highest in Group 5) were derived from the Australian Bureau of Statistics Socio-Economic Indexes for Areas (SEIFA) using the residential postcode at baseline. Outcomes were cardiac rehabilitation (CR) participation and smoking rate at 18 months post discharge as well as the use of ≥3 of the 4 indicated medications, all-cause death and cardiovascular disease (CVD) rates by 36 months of discharge. Outcomes were compared between the groups using the multilevel logistic regression with covariates of SES (5 groups), sex, GRACE risk score (4 groups), ACS diagnosis (STEMI/NSTEMI/UA) and the jurisdictions where the admissions data were linked.
Results
Of 1655 patients with ACS (mean age 68±13.5 yrs, 65% were male), who were discharged from hospital alive and had linked data available, 353 (21%) were in SES Group 1 (lowest SES), 369 (22%) in Group 2, 382 (23%) in Group 3, 296 (18%) in Group 4 and 255 (15%) in Group 5 (highest SES). Baseline clinical characteristics were comparable across the five SES groups. At 18-month after discharge, 1014 (61%) patients were followed-up with comparable loss to follow-up in each group. After adjustment, fewer patients in the lower SES groups (Groups 1 and 2) had participated in CR than those in the highest SES group (Group 5) (OR (95% CI): 0.60 (0.36, 0.99) and 0.56 (0.35, 0.91), respectively). Moreover, the odds of smoking was greater in Group 3 than Group 5 (2.60 (1.15, 5.89)) but no trend was found across the groups. By 36 months of discharge after adjustment, there was no difference in the odds of using ≥3 out of 4 medications between the SES groups. Despite this, patients in Groups 1 and 2 were significantly more likely to die than those in the highest SES group (1.96 (1.19, 3.21) and 1.91 (1.19, 3.07), respectively). The odds of CVD readmission did not differ across SES groups.
Conclusion
This study suggests that patients with low SES were less likely to participate in CR programs and more likely to die than those with high SES. Smoking rates varied between patients with intermediate and high SES but no trend was found across the groups. Despite the universal health cover available, inequity between the SES groups still exist. Future research is needed to further explore strategies to help close the evidence-practice gaps.
Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): Australian National Heart Foundation Postdoctoral Fellowship
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Redfern J, Hyun K, Brieger D, Chew D, French J, Hammett C, Ellis C, Astley C, Carr B, Lefkovits J, Nalliaih K, Lintern K, Briffa T. SNAPSHOT ACS Cohort Follow-Up – What Happens to Australian Patients in the 3 Years after Hospital Discharge: A National Data Linkage Study. Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.06.558] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Michael A, Prasad S, Hammett C, Atherton J. Impact of the Introduction of CT Coronary Angiography on Alternative Tests for the Diagnosis of Coronary Artery Disease: Australia-Wide Trends. Heart Lung Circ 2016. [DOI: 10.1016/j.hlc.2016.06.107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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9
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Ellis C, Hammett C, Ranasinghe I, French J, Briffa T, Devlin G, Elliott J, Lefkovitz J, Aliprandi-Costa B, Astley C, Redfern J, Howell T, Carr B, Lintern K, Bloomer S, Farshid A, Matsis P, Hamer A, Williams M, Troughton R, Horsfall M, Hyun K, Gamble G, White H, Brieger D, Chew D. Comparison of the management and in-hospital outcomes of acute coronary syndrome patients in Australia and New Zealand: results from the binational SNAPSHOT acute coronary syndrome 2012 audit. Intern Med J 2015; 45:497-509. [DOI: 10.1111/imj.12739] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2014] [Accepted: 03/04/2015] [Indexed: 12/22/2022]
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10
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Etaher A, Chew D, Briffa T, Ellis C, Hammett C, Redfern J, Lefkovits J, Elliott J, Cullen L, Brieger D, French J. Cardiac troponin type II myocardial infarction and late mortality: a report from the 2012 SNAPSHOT OF ACS Care Across Australia and New Zealand. Heart Lung Circ 2015. [DOI: 10.1016/j.hlc.2015.06.062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Ellis C, Hammett C, French J, Briffa T, Lefkovitz J, Ranasinghe I, Devlin G, Elliott J, Turbull F, Redfern J, Aliprandi-Costa B, Astley C, Gamble G, Brieger D, Chew D. A comparison of invasive angiography, revascularisation and time delays delivered to Australian and New Zealand non-ST-elevation myocardial infarction/unstable angina pectoris (NSTEMI/UAP) patients: results of the 2012 SNAPSHOT Bi-National acute coronary Syndrome (ACS) audit. Heart Lung Circ 2014. [DOI: 10.1016/j.hlc.2014.04.186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Cullen L, Parsonage W, Greeenslade J, Aldous S, George P, Hammett C, Lamanna A, Ungerer J, Richards M, Pemberton C, Than M. Diagnosis of Acute Myocardial Infarction in Emergency Patients with Chest Pain Using a Two Hour Algorithm with Highly Sensitive Troponin I Assay Results. Heart Lung Circ 2013. [DOI: 10.1016/j.hlc.2013.05.084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Cullen L, Greenslade J, Than M, Aldous S, George P, Hawkins T, Brown A, Richards M, Pemberton C, Hammett C, Parsonage W. Identification of Low Risk Emergency Patients with Symptoms of Possible Acute Coronary Syndrome: External Validation of the Vancouver Chest Pain Rule. Heart Lung Circ 2013. [DOI: 10.1016/j.hlc.2013.05.100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Parsonage W, Greenslade J, Ungerer J, Tate J, Pretorius C, Hammett C, Lamanna A, Chu K, Brown A, Cullen L. A Study of the Effect of the Manufacturers Advised Recalculation of the High Sensitivity Troponin T Assay on the Early Detection of Acute Myocardial Infarction in Patients Presenting to the Emergency Department. Heart Lung Circ 2013. [DOI: 10.1016/j.hlc.2013.05.495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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15
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Parsonage W, Cullen L, Greenslade J, Aldous S, George P, Lamanna A, Hammett C, Ungerer J, Pemberton C, Richards M, Than M. A Study Comparing Diagnostic Accuracy of High Sensitivity Assays of Troponin I and Troponin T for Myocardial Infarction Within Two Hours of Presentation to the Emergency Room. Heart Lung Circ 2013. [DOI: 10.1016/j.hlc.2013.05.494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Cullen L, Parsonage W, Greenslade J, Lamanna A, Hammett C, Than M, Tate J, Kalinowski L, Ungerer J, Chu K, Brown A. Delta Troponin for the Diagnosis of AMI: Comparison of 2 and 6h Metrics Using a Contemporary Troponin Assay for Emergency Department Patients with Chest Pain. Heart Lung Circ 2012. [DOI: 10.1016/j.hlc.2012.05.094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Bilesky J, Cullen L, Greenslade J, Lamanna A, Hammett C, Brown A, Chu K, Parsonage W. Prospective Observational Validation of the Heart Foundation of Australia (HF)/Cardiac Society of Australian and New Zealand (CSANZ) Risk Stratification Tool in Patients Presenting to the Emergency Department with Acute Chest Pain. Heart Lung Circ 2012. [DOI: 10.1016/j.hlc.2012.05.126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Incani A, Butler T, Chen T, Poon K, Savage M, Dahl M, Fu J, Muller H, Colburn D, Renkin K, Callow D, Hammett C, Walters D. A Comparison of the Mode of Presentation of Three Cohorts of ACS Patients (<45, 45–60 and >60 years) in Queensland. Heart Lung Circ 2012. [DOI: 10.1016/j.hlc.2012.05.072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Incani A, Poon K, Savage M, Dahl M, Fu J, Muller H, Colburn D, Renkin K, Callow D, Hammett C, Walters D. Reduced Times to Transfer Using a Novel Web-based Triage and Transfer System for Acute Coronary Syndrome: A Five Year Experience. Heart Lung Circ 2012. [DOI: 10.1016/j.hlc.2012.05.427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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20
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Incani A, Poon K, Savage M, Dahl M, Fu J, Muller H, Colburn D, Renkin K, Callow D, Hammett C, Walters D. Diurnal and Seasonal Variation in the Timing of Symptom Onset in Acute Coronary Syndromes. Heart Lung Circ 2012. [DOI: 10.1016/j.hlc.2012.05.752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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21
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Bilesky J, Younger J, Parsonage W, Greenslade J, Lamanna A, Hammett C, Brown A, Chu K, Cullen L. Suitability of Emergency Department (ED) Patients with Undifferentiated Chest Pain for CT Coronary Angiography (CTCA). Heart Lung Circ 2012. [DOI: 10.1016/j.hlc.2012.05.637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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22
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Cullen L, Parsonage W, Greenslade J, Lamanna A, Hammett C, O’Kane S, Chu K, Brown A. Comparison of Early Biomarker Strategies with the Heart Foundation of Australia/Cardiac Society of Australia and New Zealand Guidelines (HFA/CS-ANZ) for Risk Stratification of Emergency Department Patients Presenting with Chest Pain. Heart Lung Circ 2012. [DOI: 10.1016/j.hlc.2012.05.089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Hunter J, Hammett C, Cullen L, Greenslade J, Brown A, Chu K, Parsonage W. Indeterminate Troponin Elevations Have Poor Positive Predictive Value for Acute Coronary Syndrome in an Emergency Department population. Heart Lung Circ 2011. [DOI: 10.1016/j.hlc.2011.05.091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Incani A, Poon K, Dahl M, Fu J, Muller H, Dooris M, Hammett C, Walters D. Reduced Times to Transfer Using a Novel Web-based Triage and Transfer System for Acute Coronary Syndrome as Part of the Development of a Clinical Network in Queensland. Heart Lung Circ 2011. [DOI: 10.1016/j.hlc.2011.05.528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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25
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O’Donohue P, Dahl M, Colburn D, Rashford S, Cardwell R, George T, Larsen P, Williamson D, Callow D, Dooris M, Walters D, Raffel C, Pincus M, Hammett C. The Sunshine Coast STEMI Pilot: An Integrated Network Model for Immediate Transfer of Regional patients to a PCI-Capable Hospital. Heart Lung Circ 2011. [DOI: 10.1016/j.hlc.2011.05.373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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26
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Incani A, Poon K, Chen T, Dahl M, Fu J, Muller H, Dooris M, Hammett C, Walters D. The Clinical Characteristics of Young Patients (<45 Years) Referred with Acute Coronary Syndromes. Heart Lung Circ 2011. [DOI: 10.1016/j.hlc.2011.05.107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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27
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Incani A, Poon K, Dahl M, Fu J, Muller H, Dooris M, Hammett C, Walters D. Does the Presence of Ongoing Chest Pain Influence Triage and Transfer in an Acute Coronary Syndrome Network? Heart Lung Circ 2011. [DOI: 10.1016/j.hlc.2011.05.503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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28
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Camuglia A, Gibson J, Hammett C, Brown A, Cullen L, Parsonage W. Positive Predictive Value of Exercise Electrocardiography in Patients Referred from a Brisbane Emergency Department with Chest Pain. Heart Lung Circ 2010. [DOI: 10.1016/j.hlc.2010.06.742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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29
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Liew G, Hammett C, Thomas A, Dundon B, Worthley M, Zaman A, Worthley S. Saphenous Vein Graft Plaque Characterization by Multi-detector Computed Tomography with Histopathological Correlation of Embolic Debris during Intervention. Heart Lung Circ 2009. [DOI: 10.1016/j.hlc.2009.05.113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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30
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Liew G, Hammett C, Thomas A, Worthley M, Zaman A, Worthley S. High resolution histopathological quantification and assessment of embolic debris captured during saphenous vein graft intervention. Heart Lung Circ 2009. [DOI: 10.1016/j.hlc.2009.05.529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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31
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Liew G, Hammett C, Dundon B, Teo K, Worthley M, Nicholls S, Zaman A, Worthley S. Multi-Detector Computed Tomography (MDCT) and Magnetic Resonance Imaging (MRI) Non-Invasively Quantifies Saphenous Vein Graft Atherosclerotic Plaque: A Comparison with Intravascular Ultrasound (IVUS). Heart Lung Circ 2007. [DOI: 10.1016/j.hlc.2007.06.117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Fine R, Hammett C, Sernick D, Steinhouse K. The Self-Help Clearinghouse of Metropolitan Toronto: reflections on seven years of survival and beyond. CANADIAN JOURNAL OF COMMUNITY MENTAL HEALTH = REVUE CANADIENNE DE SANTE MENTALE COMMUNAUTAIRE 1996; 14:113-21. [PMID: 10163396 DOI: 10.7870/cjcmh-1995-0019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
In May of 1987, Health and Welfare Canada awarded the Self-Help Clearinghouse of Metropolitan Toronto a three-year demonstration grant. Today, the Toronto Clearinghouse remains the only free-standing self-help resource of its kind in Canada and is a registered charitable organization whose mandate is to facilitate the growth and development of self-help/mutual-aid groups, networks, and resources. This paper describes the unique Toronto Clearinghouse model which from its earliest beginnings has been a partnership between the self-help community and interested and supportive professionals. The success of this model stems from its strong grassroots origins, respect for a community empowerment approach, and focused goals and objectives. Using information gleaned from the archival history of the Toronto Clearinghouse and through a series of interviews with past and current members of the Clearinghouse board of directors, program staff, and local self-help group members, the paper explains the "roller coaster ride" which has characterized the history of the Clearinghouse to date. Finally, the paper illustrates that while the achievement of financial stability has been an ongoing challenge in the face of variable community and political support, the Toronto Clearinghouse is, today, a strong centre of self-help activity and promotion, involved in a unique exercise to determine the role that self-help can play as a strategic component of an overall health and social services system-and with every reason to be optimistic about its future.
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