ORCID Profile
0000-0003-2693-9000
Current Organisation
Flinders Medical Centre
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Publisher: Wiley
Date: 03-01-2021
DOI: 10.1111/JGH.15352
Abstract: While the global prevalence of antibiotic‐resistant Helicobacter pylori ( H. pylori ) is increasing, there is much regional variation, and local data are required to guide eradication therapy. We performed a systematic review and meta‐analysis to determine rates of H. pylori antibiotic resistance in Australia and New Zealand. Random effects meta‐analysis of data from 15 published studies and three published abstracts reporting prevalence of primary or secondary H. pylori antibiotic resistance in Australasia. PubMed, EMBASE, MEDLINE, PROSPERO, and the Cochrane Library were searched until August, 2020. Fifteen published studies and three published abstracts were identified one study was excluded due to high risk of bias. Seventeen studies conducted between 1996 and 2013 were included in the final analysis, 12 reporting primary and five reporting secondary antibiotic resistance. Prevalence of primary resistance was clarithromycin 7.4% (95% confidence interval [CI], 5.3–9.7%), metronidazole 50.0% (95%CI, 23.9–56.1%), fluoroquinolones 3.7% (95%CI, 0.004–14.8%), and both amoxicillin and tetracycline .5%. Subgroup analysis (last 20 years) showed doubling of clarithromycin resistance to 16.1% (95%CI 11.2–21.7%) with other resistance stable. Prevalence of secondary resistance was high for all antibiotics, particularly clarithromycin 78.7% (95%CI, 64.1–90.1%) and metronidazole 68.3% (95%CI, 59.9–76.1%). The outcomes reveal an increase in primary H. pylori clarithromycin resistance since the year 2000, while metronidazole resistance has remained stable and primary resistance to amoxicillin, tetracycline, and fluoroquinolones is low. Rates of secondary resistance to metronidazole and clarithromycin are high. The results highlight the need for contemporary local data on antibiotic resistance in Australia and New Zealand.
Publisher: Elsevier BV
Date: 09-2011
Publisher: Wiley
Date: 11-07-2023
DOI: 10.1111/AJO.13719
Abstract: Intrahepatic cholestasis of pregnancy (ICP) is a pregnancy liver disease, characterised by pruritus and increased total serum bile acids (TSBA), Australian incidence 0.6–0.7%. ICP is diagnosed by non‐fasting TSBA ≥ 19 μmol/L in a pregnant woman with pruritus without rash without a known pre‐existing liver disorder. Peak TSBA ≥ 40 and ≥ 100 μmol/L identify severe and very severe disease respectively, associated with spontaneous preterm birth when severe, and with stillbirth, when very severe. Benefit‐vs‐risk for iatrogenic preterm birth in ICP remains uncertain. Ursodeoxycholic acid remains the best pharmacotherapy preterm, improving perinatal outcome and reducing pruritus, although it has not been shown to reduce stillbirth.
Publisher: American Society of Civil Engineers (ASCE)
Date: 11-2011
Publisher: SAGE Publications
Date: 11-12-2018
Abstract: Asymptomatic mild primary hyperparathyroidism is increasingly being identified during pregnancy. Recent studies have demonstrated inconsistent findings with regard to pregnancy complications and the need for surgical intervention during pregnancy. A retrospective audit of outcomes of pregnancies complicated by hypercalcaemia over a 15-year period was performed. Twenty-nine pregnancies to 26 women with hypercalcaemia were identified, corresponding to 37 cases per 100,000 deliveries. Hypercalcaemia was due to primary hyperparathyroidism in 90% of cases, with mean serum calcium of 2.89 mmol/l and mean ionised calcium 1.43 mmol/l. Four women underwent successful neck exploration during pregnancy. Pregnancy complications were limited to three cases of pre-ecl sia and one case of symptomatic neonatal hypoparathyroidism. Close observation without surgical intervention would seem reasonable in women with mild hypercalcaemia during pregnancy.
Publisher: SAGE Publications
Date: 2021
DOI: 10.1177/20420986211052344
Abstract: Older patients from nursing homes are commonly exposed to polypharmacy before a hospital admission. Deprescribing has been promoted as a solution to this problem, though systematic reviews have not found benefit. The aim of this study was to understand if in-hospital deprescribing of certain classes of medications is associated with certain benefits or risks. We conducted a prospective, multicentre, cohort study in 239 medical inpatients ⩾75 years (mean age 87.4 years) who were exposed to polypharmacy (⩾5 medications) prior to admission and discharged to a nursing home for permanent placement. Patients were categorised by whether deprescribing occurred, mortality and readmissions were assessed 30 and 90 days after hospital discharge. The EQ-5D-5 L health survey assessed changes in health-related quality of life (HRQOL) at 90 days, with comparison to EQ-5D-5 L results at day 30. Latent class analysis (LCA) was used to investigate associations between patterns of prescribed and deprescribed medications and mortality. Patients for whom deprescribing occurred had a higher Charlson Index there were no differences between the groups in principal diagnosis, total or Beers list number of medications on admission. The number of Beers list medications increased in both groups before discharge. Patients who had medications deprescribed had nonsignificantly greater odds of dying within 90 days [odds ration (OR) = 3.23 (95% confidence interval (CI): 0.68, 14.92 p = 0.136]. Deprescribing of certain classes was associated with higher 90-day mortality: antihypertensives (OR = 2.27, 95% CI: 1.004, 5 p = 0.049) and statins (OR = 5, 95% CI: 1.61, 14.28 p = 0.005). Readmissions and 1-year mortality rates were similar. There was no deterioration in HRQOL when medications were deprescribed. LCA showed that patients with the least medication changes had the lowest mortality. Deprescribing certain classes of medications during hospitalisation was associated with worse mortality, but not readmissions or overall HRQOL. Larger controlled deprescribing studies targeting specific medications are warranted to further investigate these findings. This study was registered with the Australian and New Zealand Clinical Trials Registry, ACTRN1 2616001336471. Background: When an older person living in a nursing home is admitted to hospital, does stopping long-term medications help them? Many older people from nursing homes take a large number of medications each day to treat symptoms and prevent adverse events. “Polypharmacy” is a term used to describe taking multiple long-term medications, and it is associated with many negative outcomes such as increased number of falls, cognitive decline, hospital readmission, even death. Deprescribing of nonessential medications – whether stopping or reducing the dose – is promoted as good hospital practice and is assumed to help older frail people live longer and feel better. However, we often don’t fully understand what is and is not essential. We wanted to better understand the effect of deprescribing long-term medications for older frail patients during an unplanned hospital admission as they were going to a nursing home to live. Methods: While admitted to hospital, medications are often reviewed by a clinical pharmacist and specialist physician. Sometimes medications are ceased sometimes they are not. This gave us the opportunity to study two groups of older frail people from nursing homes: those who had regular, long-term medications ceased or reduced and those who did not. We wanted to see if one group did better. For ex le, did they feel worse if we stopped certain medications? Did they suffer other bad events compared with those patients for whom no medications were ceased? Were they readmitted to hospital earlier or more often? Results and conclusion: Despite the assumption that stopping medications for this type of patient is good practice, we found no benefit. We were also surprised to find stopping or reducing certain drug classes (e.g. antihypertensives and cholesterol-lowering drugs) was associated with greater mortality. Larger, randomised studies will better answer these important questions.
Publisher: SAGE Publications
Date: 24-03-2019
Abstract: Mineralocorticoid receptor antagonists are highly effective in the management of resistant hypertension and primary hyperaldosteronism. Recent studies demonstrate that mineralocorticoid receptor antagonists significantly reduce blood pressure, severity of obstructive sleep apnoea and arterial stiffness in patients with resistant hypertension and moderate–severe obstructive sleep apnoea. Eplerenone is a selective mineralocorticoid receptor antagonist that does not act as an androgen receptor blocker, thus reducing the risk of fetal anti-androgenic effects. Rat and rabbit studies demonstrated that when exposed to 30 times the equivalent therapeutic human dose, 100 mg/day, there were no teratogenic or demasculinisation effects. To date, the use of eplerenone has been reported in six human pregnancies in women with Gitelman syndrome, primary hyperaldosteronism and cardiac failure, in which no teratogenic effects were seen. Described here is a case of resistant hypertension associated with obstructive sleep apnoea in pregnancy, treated with eplerenone. The potential role of using eplerenone in pregnancy as treatment for resistant hypertension is discussed. Trial registration: Not applicable.
Publisher: American Society of Civil Engineers (ASCE)
Date: 12-2012
No related grants have been discovered for Jessica Gehlert.