ORCID Profile
0000-0002-7736-4000
Current Organisations
MBBS
,
Melbourne Health
,
Monash University
,
University of Melbourne
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Publisher: Wiley
Date: 29-10-2020
DOI: 10.1111/AJO.13270
Publisher: Oxford University Press (OUP)
Date: 10-10-2021
DOI: 10.1093/JTM/TAAA187
Abstract: Melioidosis is a bacterial infection caused by Burkholderia pseudomalleleipseudomallei. This report discusses the case of an immunocompromised traveller who was found to haveacquired cerebral melioidosis during a visit to Thailand, and highlights the need for such travellers to seek specialised travel medicine review prior to travelling to melioidosis endemic regions to discuss preventative strategies.
Publisher: Wiley
Date: 22-06-2022
DOI: 10.1111/IMJ.15699
Abstract: The COVID‐19 pandemic has affected different parts of Australia in distinct ways across 2020 and 2021. In 2020, Melbourne was the epicentre of COVID‐19. As one of the key tertiary centres caring for the patients affected by the outbreaks, the Royal Melbourne Hospital (RMH) managed the majority of the Victorian inpatient caseload. To review the demographics, management and outcomes of patients with COVID‐19 cared for by the RMH services in 2020. A single health service retrospective cohort analysis of demographics, interventions and outcomes was conducted to characterise the RMH experience in 2020. From January to December 2020, 433 patients required admission more than 24 h. The demographics of affected patients and outcomes changed over the course of the study. Overall, 47% (203/433) required oxygen, most frequently (36% 154/433) with low‐flow devices (nasal prongs or hudson mask), and 11% (47/433) of patients required admission to intensive care. We recorded a 30‐day mortality of 24% (104/433) mortality overall, rising to over 50% in patients aged over 80 years. The experience of this health service in 2020 demonstrated changing demographics over time, with associated differences in outcomes notably marked mortality in older populations, frequent complications and limited inter‐site transfer possible with mobilised resources.
Publisher: Wiley
Date: 31-08-2022
DOI: 10.1111/IMJ.15730
Abstract: Bronchiectasis is a serious, debilitating condition warranting specialist care. To determine if care provided in a tertiary hospital general respiratory clinic was guideline concordant and to validate the Bronchiectasis Severity Index (BSI) in the Australian context. A single‐centre ambispective study was conducted. The first stage involved a retrospective medical record audit between 1 January 2015 and 31 December 2016. All aspects of bronchiectasis management were reviewed. In the second prospective phase the cohort was followed for 4 years to determine survival and the validity of the BSI determined. A total of 145 patients was included, with mean age of 65 years (standard deviation = 16.6). The aetiology of bronchiectasis was explicitly documented for 58 (40%) patients, with potential causes identified in another 37 patients. Post‐infectious aetiologies were described in 62 (43%) patients. Most patients had lung function testing ( n = 142 97%) and sputum culture results ( n = 120 83%). Long‐term antibiotics were prescribed to 49 (34%) patients. Only patients culturing Pseudomonas spp. were prescribed inhaled antibiotics. Documentation regarding essential management recommendations was low, including airway clearance (46%), pneumococcal vaccination (27%) and written action plans (32%). Severe disease was common, with more than one‐third (34–48%) having BSI scores . One‐fifth (21%) of the cohort died during the 4‐year follow‐up period. The BSI was significantly associated with mortality risk (odds ratio 7.7 95% confidence interval = 3.1–19.3 P 0.001). Our cohort had a high proportion of patients with severe disease and significant mortality some, but not all, aspects of recommended care were delivered.
Publisher: Elsevier BV
Date: 09-1999
DOI: 10.1046/J.1523-1755.1999.00633.X
Abstract: There is an epidemic of renal failure among Aborigines in the Australia's Northern Territory. The incidence is more than 1000 per million, and is doubling every three to four years. We evaluated the relationship of birthweight to renal disease in adults in one high-risk community. We screened more than 80% of people in the community for renal disease, using the urine albumin/creatinine ratio (ACR, g/mol) as the marker, and reviewed records for birthweights. Birthweights were available with increasing frequency for people born after 1956. In 317 adults aged 20 to 38 years at screening, the mean birthweight (SD) was 2.712+/-0.4 kg, and 35% had been low birthweight (LBW, less than 2.5 kg). Birthweight was positively correlated with body mass index (BMI), blood pressure, and diabetes rates, but was inversely correlated with ACR. The odds ratio for overt albuminuria in LBW persons compared with those of higher birthweights was 2.82 (CI, 1.26 to 6.31) after adjusting for other factors, and LBW contributed to an estimated 27% (CI, 3 to 45%) of the population-based prevalence of overt albuminuria. Multivariate models suggest that increasing BMI and blood pressure and decreasing birthweight act in concert to lify the increases in ACR that accompany increasing age. LBW contributes to renal disease in this high-risk population. The association might be mediated through impaired nephrogenesis caused by intrauterine malnutrition. The renal disease epidemic in Aborigines may partly be the legacy of greatly improved survival of LBW babies over the last four decades. Disease rates should eventually plateau as birthweights continue to improve, if postnatal risk factors can also be contained.
Publisher: Frontiers Media SA
Date: 14-10-2015
Publisher: Wiley
Date: 20-04-2020
Abstract: Pulmonary embolism (PE) is a leading cause of maternal mortality with women at increased risk of PE during pregnancy and the early postpartum period. Clinical assessment of suspected PE during pregnancy is challenging as signs and symptoms associated with PE overlap with physiological changes of pregnancy. Clinical tests and rules commonly used to assess pre‐test probability of PE were historically not well validated in the pregnant population. The challenges of clinical assessment in the pregnant and postpartum population result in a lowered threshold for diagnostic imaging. Computed tomographic pulmonary angiography (CTPA) and nuclear medicine lung scintigraphy or ventilation erfusion (V/Q) scans are the main types of diagnostic imaging for suspected PE. Both methods are associated with small levels of ionising radiation exposure to mother and foetus. Accuracy of the diagnostic imaging tests is paramount. Haemodynamic changes of pregnancy, including increased heart rate, increased blood volume and altered flow velocity in the pulmonary arteries, may influence the quality of imaging. This comprehensive review examines the literature and evidence for the investigation and diagnostic imaging of suspected pulmonary embolism during pregnancy with CTPA and V/Q. Clinical decision‐making tools, biomarkers and diagnostic imaging during pregnancy and postpartum will be considered with a focus on diagnostic accuracy and yield, radiation dose exposure (maternal–foetal) and protocol modifications. Current practice guideline recommendations and recent literature on diagnostic pathways are also presented.
Publisher: Wiley
Date: 06-02-2020
DOI: 10.1111/RESP.13773
Publisher: Springer Science and Business Media LLC
Date: 20-11-2021
DOI: 10.1186/S12879-021-06829-7
Abstract: Convalescent plasma has been widely used to treat COVID-19 and is under investigation in numerous randomized clinical trials, but results are publicly available only for a small number of trials. The objective of this study was to assess the benefits of convalescent plasma treatment compared to placebo or no treatment and all-cause mortality in patients with COVID-19, using data from all available randomized clinical trials, including unpublished and ongoing trials (Open Science Framework, 0.17605/OSF.IO/GEHFX ). In this collaborative systematic review and meta-analysis, clinical trial registries (ClinicalTrials.gov, WHO International Clinical Trials Registry Platform), the Cochrane COVID-19 register, the LOVE database, and PubMed were searched until April 8, 2021. Investigators of trials registered by March 1, 2021, without published results were contacted via email. Eligible were ongoing, discontinued and completed randomized clinical trials that compared convalescent plasma with placebo or no treatment in COVID-19 patients, regardless of setting or treatment schedule. Aggregated mortality data were extracted from publications or provided by investigators of unpublished trials and combined using the Hartung–Knapp–Sidik–Jonkman random effects model. We investigated the contribution of unpublished trials to the overall evidence. A total of 16,477 patients were included in 33 trials (20 unpublished with 3190 patients, 13 published with 13,287 patients). 32 trials enrolled only hospitalized patients (including 3 with only intensive care unit patients). Risk of bias was low for 29/33 trials. Of 8495 patients who received convalescent plasma, 1997 died (23%), and of 7982 control patients, 1952 died (24%). The combined risk ratio for all-cause mortality was 0.97 (95% confidence interval: 0.92 1.02) with between-study heterogeneity not beyond chance (I 2 = 0%). The RECOVERY trial had 69.8% and the unpublished evidence 25.3% of the weight in the meta-analysis. Convalescent plasma treatment of patients with COVID-19 did not reduce all-cause mortality. These results provide strong evidence that convalescent plasma treatment for patients with COVID-19 should not be used outside of randomized trials. Evidence synthesis from collaborations among trial investigators can inform both evidence generation and evidence application in patient care.
Publisher: Frontiers Media SA
Date: 10-03-2022
Publisher: Wiley
Date: 2000
Publisher: Wiley
Date: 02-2019
DOI: 10.1111/IMJ.14196
Publisher: Wiley
Date: 10-2019
DOI: 10.1111/AJO.13007
Publisher: Wiley
Date: 10-08-2020
DOI: 10.1111/AJO.13204
Publisher: Wiley
Date: 30-05-2023
DOI: 10.1111/IMJ.16125
Abstract: Coronavirus disease (COVID‐19) is an infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) with a heterogeneous presentation ranging from severe pneumonitis to asymptomatic infection. International studies have demonstrated the utility of respiratory care units (RCUs) to facilitate the delivery of non‐invasive ventilation techniques to patients with COVID‐19 pneumonitis. This study aims to describe the patient characteristics, flow and outcomes of admissions to the Royal Melbourne Hospital (RMH) COVID‐19 RCU (CRCU) during its initial period of operation. Single‐centre retrospective cohort study, all patients admitted to CRCU between 17 September and 10 December 2021 were included in this study. Patient demographics, including comorbidities and limitations of medical treatment, were analysed. Admission source and discharge destination were reviewed. Length of stay was recorded. Finally, in‐hospital and CRCU mortality were analysed. Ninety‐seven patients, comprising 111 admissions, occurred during the study period with median age of 65 years (48% female). Most patients were admitted from and discharged to the ward. Twenty patients died in hospital (21%), with age, 4C score, comorbidity and presence of obstructive lung disease predicting mortality (area under the curve (AUC) 0.85, P 0.001). Mortality was significantly higher in those over 65 years of age compared to those under 65 ( P 0.001), or those deemed not for intubation compared to those for intubation ( P = 0.0019). This study demonstrates the feasibility of operating a CRCU within an Australian tertiary healthcare setting.
Publisher: Wiley
Date: 19-01-2022
DOI: 10.1111/RESP.14208
Abstract: The severe acute respiratory syndrome coronavirus (SARS‐CoV‐2) disease or COVID‐19 pandemic is associated with more than 230 million cases and has challenged healthcare systems globally. Many healthcare workers (HCWs) have acquired the infection, often through their workplace, with a significant number dying. The epidemiology of COVID‐19 infection in HCWs continues to be explored, with manifold exposure risks identified, leading to COVID‐19 being recognised as an occupational disease for HCWs. The physical illness due to COVID‐19 in HCWs is similar to the general population, with some HCWs experiencing a long‐term illness, which may impact their ability to return to work. HCWs have also been affected by the immense workplace and psychosocial disruption caused by the pandemic. The impacts on the psychological well‐being of HCWs globally have been profound, with high prevalence estimates for mental health symptoms, including emotional exhaustion. Globally, governments, healthcare organisations and employers have key responsibilities, including: to be better prepared for crises with comprehensive disaster response management plans, and to protect and preserve the health workforce from the physical and psychological impacts of the pandemic. While prioritising HCWs in vaccine rollouts globally has been critical, managing exposures and outbreaks occurring in healthcare settings remains challenging and continues to lead to substantial disruption to the health workforce. Safeguarding healthcare workforces during crises is critical as we move forward on the new path of ‘COVID normal’.
Publisher: American Chemical Society (ACS)
Date: 30-10-2015
DOI: 10.1021/PR5010086
Abstract: Interactions between a host and a bacterial pathogen are mediated by cross-talk between molecules present on, or secreted by, pathogens and host binding-molecules. Identifying proteins involved at this interface would provide substantial insights into this interaction. Although numerous studies have examined in vitro models of infection at the level of transcriptional change and proteomic profiling, there is virtually no information available on naturally occurring host-pathogen interactions in vivo. We employed membrane shaving to identify peptide fragments cleaved from surface-expressed bacterial proteins and also detected proteins originating from the infected host. We optimized this technique for media-cultured Corynebacterium pseudotuberculosis, a sheep pathogen, revealing a set of 247 surface proteins. We then studied a natural host-pathogen interaction by performing membrane shaving on C. pseudotuberculosis harvested directly from naturally infected sheep lymph nodes. Thirty-one bacterial surface proteins were identified, including 13 not identified in culture media, suggesting that a different surface protein repertoire is expressed in this hostile environment. Forty-nine host proteins were identified, including immune mediators and antimicrobial peptides such as cathelicidin. This novel application of proteolytic shaving has documented sets of host and pathogen proteins present at the bacterial surface in an infection of the native host.
Publisher: Wiley
Date: 17-02-2019
DOI: 10.1111/AJO.12958
Abstract: Obstructive sleep apnoea (OSA) during pregnancy has been associated with gestational diabetes mellitus, hypertension and low birth weight. Multiple pregnancy is associated with similar adverse perinatal outcomes. Multiple pregnancy rates have risen with increased access to assisted conception simultaneously, advancing maternal age and weight are also driving a rise in the incidence of OSA in pregnancy. The intersection of OSA and multiple pregnancy would be presumed to have significant maternal and fetal morbidity however, specific data are sparse. We review the current state of knowledge on OSA in multiple pregnancy.
Publisher: Wiley
Date: 05-12-2023
DOI: 10.5694/MJA2.51800
Publisher: European Respiratory Society (ERS)
Date: 12-09-2020
Publisher: Elsevier BV
Date: 12-1998
Publisher: International Union Against Tuberculosis and Lung Disease
Date: 09-2020
Publisher: Springer Science and Business Media LLC
Date: 14-07-2020
DOI: 10.1186/S13063-020-04576-9
Abstract: To determine if lopinavir/ritonavir +/- hydroxychloroquine will reduce the proportion of participants who survive without requiring ventilatory support, 15 days after enrolment, in adult participants with non-critically ill SARS-CoV-2 infection. ASCOT is an investigator-initiated, multi-centre, open-label, randomised controlled trial. Participants will have been hospitalised with confirmed COVID-19, and will be randomised 1:1:1:1 to receive lopinavir /ritonavir, hydroxychloroquine, both or neither drug in addition to standard of care management. Participants will be recruited from hospitals across Australia and New Zealand, representing metropolitan and regional centres in both public and private sectors. Admitted patients will be eligible if aged ≥ 18 years, have confirmed SARS-CoV-2 by nucleic acid testing in the past 12 days and are expected to remain an inpatient for at least 48 hours from the time of randomisation. Potentially eligible participants will be excluded if admitted to intensive care or requiring high level respiratory support, are currently receiving study drugs or their use is contraindicated due to allergy, drug interaction or comorbidities (including baseline QTc prolongation of 470ms for women or 480ms for men), or death is anticipated imminently. Participants will be randomised 1:1:1:1 to: Group 1 : standard of care Group 2 : lopinavir (400mg) / ritonavir (100mg) twice daily for 10 days in tablet form Group 3 : hydroxychloroquine (800mg) 4x200mg administered 12 hours apart on Day 1, followed by 400mg twice a day for 6 days Group 4 : lopinavir /ritonavir plus hydroxychloroquine. Proportion of participants alive and not having required intensive respiratory support (invasive or non-invasive ventilation) at 15 days after enrolment. A range of clinical and virological secondary outcomes will also be evaluated. The randomisation schedule will be generated by an independent statistician. Randomisation will be stratified by site and will be in permuted blocks of variable block size. The randomised sequence allocation will only be accessible to the data management group, and site investigators will have in idual participant allocation provided through a web-based trial enrolment platform. This is an open-label study, with researchers assessing the laboratory outcomes blinded to treatment allocation. No unblinding procedures relating to potential adverse effects are therefore required. We assumed that 5% of participants receiving standard of care would meet the primary outcome, aimed to evaluate whether interventions could lead to a relative risk of 0.5, assuming no interaction between intervention arms. This corresponds to a required s le size of 610 per arm, with a 5% two-sided significance level (alpha) and 80% power. The total s le size therefore is planned to be 2440. ASCOT protocol version 3, May 5, 2020. Recruitment opened April 4, 2020 and is ongoing, with planned completion of enrolment July 31, 2021. Australian New Zealand Clinical Trials Registry ( ACTRN12620000445976 ). Prospectively registered April 6, 2020. The full protocol is attached as an additional file, accessible from the Trials website (Additional file 1). In the interest in expediting dissemination of this material, the familiar formatting has been eliminated this Letter serves as a summary of the key elements of the full protocol.
Publisher: Elsevier BV
Date: 10-1998
No related grants have been discovered for Megan Rees.