ORCID Profile
0000-0002-0079-5056
Current Organisations
University of New South Wales - Randwick Campus
,
Prince of Wales Hospital and Community Health Services
,
University of Adelaide
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Publications
A coagulopathic dilemma: snakes or genes.
Publisher: Elsevier BV
Date: 06-2014
Sub-mammary injection of ropivacaine resulting in severe toxicity with seizures.
Publisher: Wiley
Date: 21-01-2016
Use and knowledge of single dose activated charcoal: A survey of Australian doctors
Publisher: Wiley
Date: 23-08-2016
Abstract: The use of single dose activated charcoal (SDAC) as a means of gastric decontamination is declining. The present study examined the potential use of SDAC in common overdose scenarios by Australian emergency doctors, compared with clinical toxicologists and current guidelines. We conducted a cross-sectional survey of emergency doctors and toxicologists on the use of SDAC. The survey covered demographic data, education and previous use of SDAC and six clinical scenarios. The scenarios selected included agents not bound to SDAC, sustained-release preparations and ingestions at varying time points. Statistical calculations were performed using Fisher's exact test. There were 397 emergency doctors and 20 toxicologists who responded to the survey. Seventy-one per cent (n = 280/397) of emergency doctors indicated they had received some education on decontamination. Eighty-three per cent (n = 331/397) had administered SDAC during their medical career, 29% (n = 117/397) within the past year. There was a significant difference in responses between emergency doctors and toxicologists in two scenarios a toxic paracetamol ingestion presenting within 1 h (P = 0.009) and verapamil ingestion in a 3 year old boy (P = 0.001). Toxicologists were more likely to administer SDAC in these scenarios, 89% (n = 16/18) and 88% (n = 15/17), respectively, compared with 52% (n = 197/381) and 43% (n = 158/371) of emergency doctors. Our study showed that there is a significant variation in the use of SDAC between toxicologists and emergency doctors in some scenarios. Clinical toxicologists are more likely to administer SDAC in certain overdose settings. It is essential to provide education on the benefits versus actual risks of SDAC in acute poisoning so that doctors will understand when to administer SDAC or seek further advice.
Combining Farmers’ Preferences With Evidence-Based Strategies to Prevent and Lower Farmers’ Distress: Co-design and Acceptability Testing of ifarmwell
Publisher: JMIR Publications Inc.
Date: 11-01-2022
DOI: 10.2196/27631
Abstract: Farming is physically and psychologically hazardous. Farmers face many barriers to help seeking from traditional physical and mental health services however, improved internet access now provides promising avenues for offering support. This study aims to co-design with farmers the content and functionality of a website that helps them adopt transferable coping strategies and test its acceptability in the broader farming population. Research evidence and expert opinions were synthesized to inform key design principles. A total of 18 farmers detailed what they would like from this type of website. Intervention logic and relevant evidence-based strategies were mapped. Website content was drafted and reviewed by 2 independent mental health professionals. A total of 9 farmers provided detailed qualitative feedback on the face validity of the draft content. Subsequently, 9 farmers provided feedback on the website prototype. Following amendments and internal prototype testing and optimization, prototype usability (ie, completion rate) was examined with 157 registered website users who were (105/157, 66.9%) female, aged 21-73 years 95.5% (149/156) residing in inner regional to very remote Australia, and 68.2% (107/157) “sheep, cattle and/or grain farmers.” Acceptability was examined with a subset of 114 users who rated at least module 1. Interviews with 108 farmers who did not complete all 5 modules helped determine why, and detailed interviews were conducted with 18 purposively s led users. Updates were then made according to adaptive trial design methodology. This systematic co-design process resulted in a web-based resource based on acceptance and commitment therapy and designed to overcome barriers to engagement with traditional mental health and well-being strategies—ifarmwell. It was considered an accessible and confidential source of practical and relevant farmer-focused self-help strategies. These strategies were delivered via 5 interactive modules that include written, drawn, and audio- and video-based psychoeducation and exercises, as well as farming-related jokes, metaphors, ex les, and imagery. Module 1 included distress screening and information on how to speak to general practitioners about mental health–related concerns (including a personalized conversation script). Modules were completed fortnightly. SMS text messages offered personalized support and reminders. Qualitative interviews and star ratings demonstrated high module acceptability (average 4.06/5 rating) and suggested that additional reminders, higher quality audio recordings, and shorter modules would be useful. Approximately 37.1% (52/140) of users who started module 1 completed all modules, with too busy or not got to it yet being the main reason for non-completion, and previous module acceptability not predicting subsequent module completion. Sequential integration of research evidence, expert knowledge, and farmers’ preferences in the co-design process allowed for the development of a self-help intervention that focused on important intervention targets and was acceptable to this difficult-to-engage group. Australian New Zealand Clinical Trials Registry ACTRN12617000506392 www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=372526
Measuring Engagement in eHealth and mHealth Behavior Change Interventions: Viewpoint of Methodologies
Publisher: JMIR Publications Inc.
Date: 16-11-2018
DOI: 10.2196/JMIR.9397
A Physical Activity and Diet Program Delivered by Artificially Intelligent Virtual Health Coach: Proof-of-Concept Study
Publisher: JMIR Publications Inc.
Date: 10-07-2020
DOI: 10.2196/17558
Abstract: Poor diet and physical inactivity are leading modifiable causes of death and disease. Advances in artificial intelligence technology present tantalizing opportunities for creating virtual health coaches capable of providing personalized support at scale. This proof of concept study aimed to test the feasibility (recruitment and retention) and preliminary efficacy of physical activity and Mediterranean-style dietary intervention (MedLiPal) delivered via artificially intelligent virtual health coach. This 12-week single-arm pre-post study took place in Adelaide, Australia, from March to August 2019. Participants were inactive community-dwelling adults aged 45 to 75 years, recruited through news stories, social media posts, and flyers. The program included access to an artificially intelligent chatbot, Paola, who guided participants through a computer-based in idualized introductory session, weekly check-ins, and goal setting, and was available 24/7 to answer questions. Participants used a Garmin Vivofit4 tracker to monitor daily steps, a website with educational materials and recipes, and a printed diet and activity log sheet. Primary outcomes included feasibility (based on recruitment and retention) and preliminary efficacy for changing physical activity and diet. Secondary outcomes were body composition (based on height, weight, and waist circumference) and blood pressure. Over 4 weeks, 99 potential participants registered expressions of interest, with 81 of those screened meeting eligibility criteria. Participants completed a mean of 109.8 (95% CI 1.9-217.7) more minutes of physical activity at week 12 compared with baseline. Mediterranean diet scores increased from a mean of 3.8 out of 14 at baseline, to 9.6 at 12 weeks (mean improvement 5.7 points, 95% CI 4.2-7.3). After 12 weeks, participants lost an average 1.3 kg (95% CI –0.1 to –2.5 kg) and 2.1 cm from their waist circumference (95% CI –3.5 to –0.7 cm). There were no significant changes in blood pressure. Feasibility was excellent in terms of recruitment, retention (90% at 12 weeks), and safety (no adverse events). An artificially intelligent virtual assistant-led lifestyle-modification intervention was feasible and achieved measurable improvements in physical activity, diet, and body composition at 12 weeks. Future research examining artificially intelligent interventions at scale, and for other health purposes, is warranted.
The Effectiveness of a Web-Based Computer-Tailored Physical Activity Intervention Using Fitbit Activity Trackers: Randomized Trial
Publisher: JMIR Publications Inc.
Date: 18-12-2018
DOI: 10.2196/11321
Just 'nanging' around - harmful nitrous oxide use: a retrospective case series and review of Internet searches, social media posts and the coroner's database.
Publisher: Wiley
Date: 23-05-2021
DOI: 10.1111/IMJ.15391
Abstract: The chronic recreational inhalation of nitrous oxide (N 2 O) ‘nanging’, can have adverse neurological and psychiatric effects. To evaluate cases of chronic N 2 O use presenting to two hospitals, as well as to evaluate nationally N 2 O deaths reported to the coroner and trends in Internet searches and social media posts related to N 2 O. Retrospective review of two toxicology units, from July 2017 to October 2020, of patients presenting with chronic N 2 O use and neurological and/or psychiatric symptoms. We evaluated 10 years (2010–2019) of Internet search and social media trends involving N 2 O and the National Coronial Information System (NCIS) database for deaths across Australia. Twenty‐two patients were identified: median age 22 years, half female, 17 Asian background and 15 students. Presentations included decreased mobility or unsteady gait ( n = 15) and psychiatric symptoms ( n = 5). The median reported bulb use/day was 300 (interquartile range (IQR): 200–370), for a median of 6 months (IQR: 3–24). On magnetic resonance imaging, 10/18 had subacute combined degeneration of the spinal cord and 7/7 sensorimotor neuropathy on nerve conduction studies. All received high‐dose intramuscular vitamin B 12 and 11 methionine. Despite prolonged rehabilitation, nine required walking aids on discharge. Since 2017, social media posts and Internet searches for N 2 O increased rapidly, the latter mostly directed at obtaining N 2 O canisters. From the NCIS, 36 deaths were identified, 12 unintentional (recreational drug use), 20 intentional self‐harm and 4 traumatic. We report a case series of symptomatic chronic N 2 O use, many with ongoing neurological sequelae. Furthermore, a sharp increase in Internet searches to obtain N 2 O cannisters was noted. Education of high‐risk student groups on the long‐term sequelae is important.
Haemodialysis for lithium poisoning: Translating EXTRIP recommendations into practical guidelines
Publisher: Wiley
Date: 11-02-2020
DOI: 10.1111/BCP.14212
Use of continuous veno-venous haemodiafiltration therapy in dabigatran overdose.
Publisher: Informa UK Limited
Date: 26-03-2014
DOI: 10.3109/15563650.2014.900179
Abstract: Dabigatran etexilate is one of the newer oral anticoagulants and a direct thrombin inhibitor. Concerns regarding dabigatran's use include its lack of validated laboratory markers for measuring its anticoagulation effect, the impact of renal impairment on its clearance, and the lack of effective strategies for reversal of anticoagulation. Hemodialysis has been utilized to reverse the anticoagulant effects of dabigatran in therapeutic doses. However, hemodialysis may not be feasible in hemodynamically unstable patients. There is little data on clearance rates of dabigatran by continuous renal replacement therapies. A 66-year-old male presented following a poly-pharmacy overdose of 9 g of dabigatran in combination with metoprolol, amlodipine, olmesartan, and moxonidine. Eleven hours post overdose extracorporeal elimination was implemented as the patient developed worsening coagulopathy with an elevated international normalized ratio of 11 IU, an activated partial thromboplastin time of 115 s, and had renal impairment with a creatinine of 158 μmol/L. As the patient was hemodynamically unstable, continuous veno-venous hemodiafiltration was preferred over intermittent hemodialysis. Renal replacement therapy was performed for 32 h in total and the patient made a full recovery with no hemorrhagic complications or end organ injury. This patient developed a peak serum dabigatran level of 1560 ng/ml, 11 h postoverdose. Clearance of dabigatran via continuous veno-venous hemodiafiltration was calculated, using both the recovery and A-V pair methods, with a mean clearance of 58.1 and 31.9 ml/h, respectively, and a calculated mean extraction ratio of 0.2. There are few case reports and little experience when dabigatran is taken in overdose. This is a case report of a large dabigatran overdose presenting data on the extraction ratio and clearance of dabigatran using continuous veno-venous hemodiafiltration.
Efficacy and effectiveness of anti-digoxin antibodies in chronic digoxin poisonings from the DORA study (ATOM-1).
Publisher: Informa UK Limited
Date: 27-04-2016
DOI: 10.1080/15563650.2016.1175620
Abstract: We hypothesized that in chronic digoxin toxicity, anti-digoxin antibodies (Fab) would be efficacious in binding digoxin, but this may not translate into improved clinical outcomes. This study aims to investigate changes in free digoxin concentrations and clinical effects on heart rate and potassium concentrations in chronic digoxin poisoning when anti-digoxin Fab are given. This is a prospective observational study. Patients were recruited if they have been treated with anti-digoxin Fab for chronic digoxin poisoning. Data was entered into a standardised prospective form, supplemented with medical records. Their serum or plasma was collected, analysed for free and bound digoxin and free anti-digoxin Fab concentrations. From September 2013 to February 2015, 36 patients (median age, 78 years 22 females) were recruited from 18 hospitals. Median heart rate (HR) was 49 beats/min. Initial median digoxin and potassium concentrations were 4.7 nmol/L (3.6 μg/L) (range: 2.3-11.2 nmol/L) and 5.3 mmol/L (range: 2.9-9.2 mmol/L) respectively. Beta-blockers (n = 18), calcium antagonists (n = 6), spironolactone and/or angiotensin blocking agents (n = 24) were also used concomitantly. Renal impairment and gastrointestinal symptoms were present in 31 (86%) and 22 (63%) patients respectively. Five patients died from conditions unrelated to digoxin toxicity. Median change in HR was 8 beats/min post-Fab with no effect on blood pressure they were 4, 10 and 17 beats/min for the 1, 2 and ≥3 vials of anti-digoxin Fab groups respectively. Concomitant treatments with potassium lowering agents (12/36) and inotropic drugs (7/36) were used. Gastrointestinal effects resolved in all 22 patients. The median decrease for potassium was 0.3 mmol/L. Digoxin concentration reduced from 3.8 to 0 nmol/L post-Fab. There was a rebound observed in the free digoxin concentration in 25 patients but none had associated clinical deterioration. One to two vials of anti-digoxin Fab initially bound all free digoxin confirming Fab efficacy. However, this was associated with only a moderate improvement in HR and potassium, suggesting bradyarrhythmia and hyperkalaemia may be from other co-morbidities.
Retrospective evaluation of repeated supratherapeutic ingestion (RSTI) of paracetamol †.
Publisher: Informa UK Limited
Date: 21-02-2019
How do different occupational factors influence total, occupational, and leisure-time physical activity?
Publisher: Human Kinetics
Date: 02-2015
Abstract: A better understanding of how occupational indicators influence physical activity levels will aid the design of workplace interventions. Cross-sectional data were collected from 1194 participants through a telephone interview in Queensland, Australia. The IPAQ-long was used to measure physical activity. Multiple logistic regression was applied to examine associations. Of participants, 77.9% were employed full-time, 32.3% had professional jobs, 35.7% were engaged in shift work, 39.5% had physically-demanding jobs, and 66.1% had high physical activity levels. Participants with a physicallydemanding job were less likely to have low total (OR = 0.25, 95% CI = 0.17 to 0.38) and occupational (OR = 0.17, 95% CI = 0.12 to 0.25) physical activity. Technical and trade workers were less likely to report low total physical activity (OR = 0.44, 95% CI = 0.20 to 0.97) compared with white-collar workers. Part-time (OR = 1.74, 95% CI = 1.15 to 2.64) and shift workers (OR = 1.86, 95% CI = 1.21 to 2.88) were more likely to report low leisure-time activity. Overall, the impact of different occupational indicators on physical activity was not strong. As expected, the greatest proportion of total physical activity was derived from occupational physical activity. No evidence was found for compensation effects whereby physically-demanding occupations lead to less leisure-time physical activity or vice versa. This study demonstrates that workplaces are important settings to intervene, and that there is scope to increase leisure-time physical activity irrespective of occupational background.
Population pharmacokinetics of immediate-release and modified-release paracetamol and its major metabolites in a supratherapeutic dosing study
Publisher: Informa UK Limited
Date: 03-06-2022
DOI: 10.1080/15563650.2021.1928163
Abstract: Overdose with paracetamol modified-release (MR) formulation, a bilayer tablet containing 69% slow-release component, has been increasing since its introduction to the market. However, little evidence exists for the management of MR paracetamol overdose. We aimed to develop a population pharmacokinetic (PK) model for immediate-release (IR) and MR paracetamol and its major metabolism, and quantitatively understand the formulation difference in toxicity assessment based on the nomogram line. Data from a cross-over study design in nine healthy volunteers administered a single supratherapeutic oral dose (80 mg/kg) of either IR and MR paracetamol were available from a published study. Plasma concentrations for paracetamol and its metabolites glucuronide (APAPG) and sulfate conjugate (APAPS) for both formulations were measured and analysed with population pharmacokinetic (PK) method using NONMEM. Toxicity in both formulations was assessed by comparing the simulated paracetamol concentrations under different paracetamol dose levels with the 150 mg/L nomograms. The difference in the assessment was compared between the two formulations. Paracetamol concentrations for the IR formulation were described with a two-compartment model with first-order input and a lag time. The delayed time-course of MR paracetamol concentrations was best captured by a parallel absorption model in which the slow-release component was a serial zero-order then the first-order process. The formation of APAPG was linear, while APAPS concentrations were best fitted by a Michaelis-Menten process. The relative bioavailability of MR paracetamol compared to IR ( A joint parent-metabolite model to describe time-course profiles of both IR and MR paracetamol and its metabolites APAPG and APAPS concentrations was developed. Simulations from the model showed that toxicity assessment based on the 150 mg/L nomograms is not suitable in MR paracetamol overdoses.
Use of multi-dose activated charcoal in phenytoin toxicity secondary to genetic polymorphism
Publisher: Informa UK Limited
Date: 19-01-2015
DOI: 10.3109/15563650.2014.998338
Abstract: Phenytoin is metabolised in the liver by cytochrome (CYP)2C9 and 2C19 enzymes. Due to saturation of enzyme capacity, the elimination half-life is prolonged at supratherapeutic levels. Genetic polymorphisms of CYP2C9 and 2C19 are reasonably common and further prolong the elimination of phenytoin. There are conflicting reports regarding whether multiple-dose activated charcoal (MDAC) significantly increases the clearance of phenytoin in poisoning. We present 3 patients with phenytoin toxicity and very slow elimination secondary to reduced CYP enzyme function from genetic polymorphisms. MDAC was used in two patients and led to rapid and large reductions in the measured elimination half-lives. This is contrasted with very prolonged elimination in a third patient who did not receive MDAC. MDAC may play a role in the management of chronic phenytoin toxicity, especially in those with very slow endogenous elimination secondary to genetic polymorphisms.
Exploring the Interplay Between Message Format, Need for Cognition and Personal Relevance on Processing Messages About Physical Activity: a Two-Arm Randomized Experimental Trial
Publisher: Springer Science and Business Media LLC
Date: 10-06-2022
DOI: 10.1007/S12529-022-10107-4
Abstract: According to the Elaboration Likelihood Model, persuasion can occur via two different routes (the central route and peripheral route), with the route utilized dependent on factors associated with motivation and ability. This study aimed to explore the moderating role of need for cognition (NFC) and perceived relevance on the processing of physical activity messages designed to persuade via either the central route or the peripheral route. Participants ( N = 50) were randomized to receive messages optimized for central route processing or messages optimized for peripheral route processing. Eye-tracking devices were used to assess attention, which was the primary outcome. Message perceptions and the extent of persuasion (changes in physical activity determinants) were also assessed via self-report as secondary outcomes. Moderator effects were examined using interaction terms within mixed effects models and linear regression models. There were no detected interactions between condition and NFC for any of the study outcomes (all p s .05). Main effects of personal relevance were observed for some self-report outcomes, with increased relevance associated with better processing outcomes. An interaction between need for cognition and personal relevance was observed for perceived behavioral control ( p = 0.002) greater relevance was associated with greater perceived behavioral control for those with a higher need for cognition. Matching physical activity messages based on NFC may not increase intervention efficacy. Relevance of materials is associated with greater change in physical activity determinants and may be more so among those with a higher NFC.
Healthy mind, healthy body: A randomized trial testing the efficacy of a computer-tailored vs. interactive web-based intervention for increasing physical activity and reducing depressive symptoms
Publisher: Elsevier BV
Date: 10-2016
Too much of a good thing: Bicarbonate toxicity following treatment of sodium channel blocker overdose
Publisher: Wiley
Date: 26-04-2022
Abstract: Although sodium bicarbonate can be a life‐saving antidote for patients with overdoses resulting in sodium channel blockade, there has been a concerning rise in cases referred to the Poisons Information Centre where inappropriately large doses of bicarbonate have been used resulting in iatrogenic harm. We present a series of three clinical cases where excessive bicarbonate was used to treat poisonings and discuss our approach to managing cardiotoxicity secondary to sodium channel blockade. Serial blood gas analysis should be performed when using bicarbonate to ensure pH targets are met and severe alkalaemia, hypernatraemia and hypokalaemia are avoided. We encourage clinicians to contact the Poisons Information Centre (13 11 26) or their local clinical toxicologist when managing patients with life‐threatening sodium channel blockade.
Hepatotoxicity in a child following an accidental overdose of liquid paracetamol
Publisher: Informa UK Limited
Date: 18-02-2020
Association between shift work and cognitive performance on the Trail Making Test in emergency department health officers.
Publisher: Wiley
Date: 11-03-2021
Abstract: Shift work has been proposed to disturb alertness and decrease cognitive efficiency. However, studies so far have had varied findings. The aim of the present study was to compare cognitive function following shifts at different times of the day in an Australian ED context. A prospective, self‐controlled observational study was conducted on medical and nursing staff at a tertiary referral centre and regional hospital ED. Participants were required to complete the Trail Making Test (TMT), a neurocognitive test consisting of two parts (TMT‐A and TMT‐B), at baseline (at the start of the day) and at the end of their shift (day, evening or night). Related s les Wilcoxon signed‐rank tests were used to compare post‐shift TMT performance to baseline in medical and nursing staff. Over a 5‐month period, 140 ED staff were recruited including 109 doctors and 31 nurses. After a night shift, medical staff ( n = 85) and nursing staff ( n = 29) took longer to complete the TMT‐B by 3.4 s ( P 0.001) and 7.1 s ( P = 0.01), respectively, compared to baseline. Post‐evening shift, medical staff ( n = 59) took longer to complete the TMT‐A by 0.3 s ( P = 0.02). Night shift work was associated with a longer TMT time. This may indicate a decrease in cognitive performance, in particular, visual attention, processing speed, task switching and executive function and may implicate the quality of care for patients and worker safety.
Examining the use of evidence-based and social media supported tools in freely accessible physical activity intervention websites
Publisher: Springer Science and Business Media LLC
Date: 17-08-2014
TaylorActive – Examining the effectiveness of web-based personally-tailored videos to increase physical activity: a randomised controlled trial protocol
Publisher: Springer Science and Business Media LLC
Date: 05-10-2015
A meta-meta-analysis of the effect of physical activity on depression and anxiety in non-clinical adult populations
Publisher: Informa UK Limited
Date: 03-07-2015
DOI: 10.1080/17437199.2015.1022901
Abstract: Amidst strong efforts to promote the therapeutic benefits of physical activity for reducing depression and anxiety in clinical populations, little focus has been directed towards the mental health benefits of activity for non-clinical populations. The objective of this meta-meta-analysis was to systematically aggregate and quantify high-quality meta-analytic findings of the effects of physical activity on depression and anxiety for non-clinical populations. A systematic search identified eight meta-analytic outcomes of randomised trials that investigated the effects of physical activity on depression or anxiety. The subsequent meta-meta-analyses were based on a total of 92 studies with 4310 participants for the effect of physical activity on depression and 306 study effects with 10,755 participants for the effect of physical activity on anxiety. Physical activity reduced depression by a medium effect [standardised mean difference (SMD) = -0.50 95% CI: -0.93 to -0.06] and anxiety by a small effect (SMD = -0.38 95% CI: -0.66 to -0.11). Neither effect showed significant heterogeneity across meta-analyses. These findings represent a comprehensive body of high-quality evidence that physical activity reduces depression and anxiety in non-clinical populations.
Does physician education and factsheet impact on safe opioid use in emergency patients?
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 06-2018
DOI: 10.1097/CXA.0000000000000019
Abstract: To evaluate whether an intervention involving educating doctors and providing leaflets to patients implemented in the Emergency Department (ED) can improve patient knowledge and self-reported practices regarding safe opioid use for acute painful conditions and to investigate patterns of opioid use upon discharge from ED. This is a prospective non-randomized controlled study. Patients ≥16 years discharged from a tertiary ED with oxycodone for acute painful conditions were recruited. They were interviewed by a single investigator within 24 hours, and subsequently 1 week following discharge. After the control arm was recruited, emergency doctors were given an education session on the safe use of opioids for acute painful conditions and asked to provide education and distribute factsheets to patients. Patient knowledge and postdischarge self-reported practices were compared in the 2 groups, and to determine the pattern of opioid use postdischarge from ED. A total of 233 patients were recruited, 110 and 123 in control and intervention arm respectively. 60% (n = 74/123) of intervention arm patients received factsheets. Patients in the intervention group were more likely to know their recommended dosage and recall adverse effects: 56% (n = 62/110) versus 81% (n = 100/123) ( P 0.001) and 71% (n = 78/110) versus 83% (n = 102/123) ( P 0.01) respectively. Patients’ self-reported practices significantly improved ( P 0.05) regarding safe storage (OR = 15.09), driving (OR = 6.48) and co-ingestion of sedatives (OR = 16.93). 56/197 (28%) patients did not take any oxycodone following discharge. Our intervention, which consisted of educating doctors and providing leaflets to patients, has successfully influenced clinical practice, enhancing education that doctors provided to patients and improved patient knowledge and safer opioid use post-discharge. Évaluer si une intervention impliquant l’éducation des médecins et fournissant des dépliants aux patients mis en œuvre au service des urgences (ED) peut améliorer les connaissances des patients et les pratiques auto-déclarées concernant l’utilisation sécuritaire des opioïdes dans les cas d’affection douloureuses aiguës et étudier les schémas d’utilisation des opioïdes après libération d’une ED. Il s’agit d’une étude prospective non aléatoire contrôlée. Des patients âgés de 16 ans et plus libérés d’un ED tertiaire après avoir reçu un traitement à l’oxycodone pour des affections douloureuses aiguës ont été recrutés. Ils ont été interrogés par un seul enquêteur dans les 24 heures, puis 1 semaine après la sortie. Après le recrutement du bras de contrôle, les médecins d’urgence ont reçu une séance d’éducation sur l’utilisation sans danger des opioïdes pour les affections douloureuses aiguës et ont été demandé à fournir une éducation et à distribuer des fiches d’information aux patients. Les connaissances des patients et les pratiques auto-déclarées post-congé ont été comparées dans les deux groupes et pour déterminer le profil d’utilisation des opioïdes après la sortie de l’urgence (ED). 233 patients ont été recrutés, 110 et 123 respectivement dans le groupe contrôle et le groupe d’intervention. 60% (n = 74/123) des patients sous bras d’intervention ont reçu des fiches d’information. Les patients du groupe d’intervention étaient plus susceptibles de connaître la dose recommandée et de se rappeler les effets indésirables: 56% (n = 62/110) contre 81% (n = 100/123) ( P ,001) et 71% (n = 78 / 110) contre 83% (n = 102/123) ( P ,01) respectivement. Les pratiques auto-déclarées des patients se sont significativement améliorées ( P ,05) en ce qui concerne l’entreposage sécuritaire (RC = 15,09), la conduite (RC = 6,48) et la co-ingestion de sédatifs (RC = 16,93). 56/197 patients (28%) n’ont pas pris d’oxycodone après leur sortie. Notre intervention, qui consistait à éduquer les médecins et à distribuer des tracts aux patients, a influencé avec succès la pratique clinique, améliorant la formation dispensée par les médecins aux patients et améliorant les connaissances des patients et une utilisation plus sÛre des opioïdes.
How do different delivery schedules of tailored web-based physical activity advice for breast cancer survivors influence intervention use and efficacy?
Publisher: Springer Science and Business Media LLC
Date: 06-08-2016
DOI: 10.1007/S11764-016-0565-0
Abstract: The purpose of the study is to investigate the impact of differing delivery schedules of computer-tailored physical activity modules on engagement and physical activity behaviour change in a web-based intervention targeting breast cancer survivors. Insufficiently active breast cancer survivors (n = 492) were randomly assigned to receive one of the following intervention schedules over 12 weeks: a three-module intervention delivered monthly, a three-module intervention delivered weekly or a single module intervention. Engagement with the website (number of logins, time on site, modules viewed, action plans completed) was measured using tracking software. Other outcomes (website acceptability, physical activity behaviour) were assessed using online surveys. Physical activity outcomes were analysed using regression models for both study completers and when applying intention-to-treat (using multiple imputation). Completers allocated to the monthly module group rated the intervention higher (b = 2.2 95 % CI = 0.02-4.53) on acceptability and had higher levels of resistance-training (IRR = 1.88, 95 % CI = 1.16-3.04) than those in the single module group. When accounting for missing data, these differences were no longer significant. The completion of at least two action plans was higher among those allocated to the monthly module group compared to those in the weekly module group (53 vs 40 %, p = 0.02) though the completion of at least two modules was higher in the weekly module group compared to the monthly module group (60 vs 46 % p = 0.01). There were no other significant between group differences observed. This study provides preliminary evidence that web-based computer-tailored interventions can be used to increase physical activity among breast cancer survivors. Further, there were some outcome differences based on how the tailored modules were delivered, with the most favourable outcomes observed in the monthly delivery group. This study will be useful for informing the design of future web-based interventions targeting breast cancer survivors.
Evidence for the changing regimens of acetylcysteine
Publisher: Wiley
Date: 23-11-2016
DOI: 10.1111/BCP.12789
Interventions for paracetamol (acetaminophen) overdose.
Publisher: Wiley
Date: 23-02-2018
Activity Trackers Implement Different Behavior Change Techniques for Activity, Sleep, and Sedentary Behaviors
Publisher: JMIR Publications Inc.
Date: 14-08-2017
DOI: 10.2196/IJMR.6685
Chronic methyl bromide toxicity is ameliorated by haemodialysis
Publisher: Wiley
Date: 03-2020
DOI: 10.1111/IMJ.14757
The relationship between admission glucose and lactate with critical illness amongst adult patients presenting to the emergency department.
Publisher: Springer Science and Business Media LLC
Date: 02-05-2021
Identifying correlates of breaks in occupational sitting: a cross-sectional study
Publisher: Informa UK Limited
Date: 09-06-2015
Social ecological influences on treatment decision‐making in men diagnosed with low risk, localised prostate cancer
Publisher: Hindawi Limited
Date: 22-09-2022
DOI: 10.1111/ECC.13697
Abstract: In iduals diagnosed with low risk, localised prostate cancer (PCa) face a difficult decision between active surveillance (AS) and definitive treatment. We aimed to explore perceived influences on treatment decision-making from the patient and partner's perspectives. Patients (and partners) who met AS criteria and had chosen their treatment were recruited. Semi-structured in idual interviews were conducted via telephone to explore experiences of diagnosis, impact on patient lifestyle, experiences with physicians, treatment preferences/choice, treatment information understanding and needs, and overall decision-making process. Interviews were audio recorded, transcribed verbatim, and analysed using Reflexive Thematic Analysis. Twenty-four male patients (18 chose AS) and 12 female partners participated. Five themes relating to social-ecological influences on treatment choice were identified: (1) partner support and direct influence on patient treatment choice, (2) patient and partner vicarious experiences may influence treatment decisions, (3) the influence of the patient's life circumstances, (4) disclosing to wider social networks: friends, family, and co-workers, and (5) the importance of a good relationship and experience with physicians. Additionally, two themes were identified relating to information patients and partners received about the treatment options during their decision-making process. A range of in idual and social influences on treatment decision-making were reported. Physicians providing treatment recommendations should consider and discuss the patient and partner's existing beliefs and treatment preferences and encourage shared decision-making. Further research on treatment decision-making of partnered and non-partnered PCa patients is required. We recommend research considers social ecological factors across the personal, interpersonal, community, and policy levels.
Integrative epigenome-wide analysis demonstrates that DNA methylation may mediate genetic risk in inflammatory bowel disease
Publisher: Springer Science and Business Media LLC
Date: 25-11-2016
DOI: 10.1038/NCOMMS13507
Abstract: Epigenetic alterations may provide important insights into gene-environment interaction in inflammatory bowel disease (IBD). Here we observe epigenome-wide DNA methylation differences in 240 newly-diagnosed IBD cases and 190 controls. These include 439 differentially methylated positions (DMPs) and 5 differentially methylated regions (DMRs), which we study in detail using whole genome bisulphite sequencing. We replicate the top DMP ( RPS6KA2 ) and DMRs ( VMP1, ITGB2 and TXK ) in an independent cohort. Using paired genetic and epigenetic data, we delineate methylation quantitative trait loci VMP1/microRNA-21 methylation associates with two polymorphisms in linkage disequilibrium with a known IBD susceptibility variant. Separated cell data shows that IBD-associated hypermethylation within the TXK promoter region negatively correlates with gene expression in whole-blood and CD8 + T cells, but not other cell types. Thus, site-specific DNA methylation changes in IBD relate to underlying genotype and associate with cell-specific alteration in gene expression.
Re: External validation of the paracetamol-aminotransferase multiplication product to predict hepatotoxicity from paracetamol overdose
Publisher: Informa UK Limited
Date: 15-10-2015
The Association Between Physical Activity, Sitting Time, Sleep Duration, and Sleep Quality as Correlates of Presenteeism
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 03-2015
Characteristics of Adopters of an Online Social Networking Physical Activity Mobile Phone App: Cluster Analysis (Preprint)
Publisher: JMIR Publications Inc.
Date: 17-10-2018
Abstract: o date, many online health behavior programs developed by researchers have not been translated at scale. To inform translational efforts, health researchers must work with marketing experts to design cost-effective marketing c aigns. It is important to understand the characteristics of end users of a given health promotion program and identify key market segments. his study aimed to describe the characteristics of the adopters of Active Team, a gamified online social networking physical activity app, and identify potential market segments to inform future research translation efforts. articipants (N=545) were Australian adults aged 18 to 65 years who responded to general advertisements to join a randomized controlled trial (RCT) evaluating the Active Team app. At baseline they provided demographic (age, sex, education, marital status, body mass index, location of residence, and country of birth), behavioral (sleep, assessed by the Pittsburgh Quality Sleep Index) and physical activity (assessed by the Active Australia Survey), psychographic information (health and well-being, assessed by the PERMA [Positive Emotion, Engagement, Relationships, Meaning, Achievement] Profile depression, anxiety and stress, assessed by the Depression, Anxiety, and Stress Scale [DASS-21] and quality of life, assessed by the 12-Item Short Form Health Survey [SF-12]). Descriptive analyses and a k-medoids cluster analysis were performed using the software R 3.3.0 (The R Foundation) to identify key characteristics of the s le. luster analyses revealed four clusters: (1) younger inactive women with poor well-being (218/545), characterized by a higher score on the DASS-21, low mental component summary score on the SF-12, and relatively young age (2) older, active women (153/545), characterized by a lower score on DASS-21, a higher overall score on the SF-12, and relatively older age (3) young, active but stressed men (58/545) with a higher score on DASS-21 and higher activity levels and (4) older, low active and obese men (30/545), characterized by a high body mass index and lower activity levels. nderstanding the characteristics of population segments attracted to a health promotion program will guide the development of cost-effective research translation c aigns. ustralian New Zealand Clinical Trial Registry ACTRN12617000113358 www.anzctr.org .au/Trial/Registration/TrialReview.aspx?id=371463 R2-10.1186/s12889-017-4882-7
The serotonin toxidrome: shortfalls of current diagnostic criteria for related syndromes
Publisher: Informa UK Limited
Date: 22-11-2022
DOI: 10.1080/15563650.2021.1993242
Abstract: Serotonin syndrome (toxicity) describes adverse drug effects from toxic amounts of intra-synaptic central nervous system serotonin. A wide range of drugs have been implicated to cause serotonin toxicity, not all justifiably. The plausible agents all have a final common pathway resulting in a substantial increase in central nervous system serotonergic neurotransmission. Serotonin toxicity is characterized by neuromuscular excitation, mental status changes, and autonomic dysregulation. Signs and symptoms represent a spectrum of toxicity (mild to life-threatening) related to increasing serotonin concentrations. As there is no consensus on the threshold for "toxicity" or diagnostic criteria, the true incidence of serotonin toxicity is unknown. The incidence in overdose is easier to quantify and is reasonably common in serotonergic antidepressant overdoses. In a large case series of overdoses, moderate serotonin toxicity occurred in 14% of poisonings with a selective serotonin reuptake inhibitor. While half those ingesting a monoamine oxidase inhibitor in combination with a serotonergic agent in overdose exhibit at least moderately severe serotonin toxicity. In contrast, the incidence of serotonin toxicity in those on therapeutic serotonergic agents appears to be very low. To provide a narrative review of the current diagnostic criteria, utilizing case reports of fatalities to evaluate how many meet the various diagnostic criteria and propose practical solutions to resolve controversies in diagnosis. A review of serotonin toxicity diagnostic criteria in the English literature was completed by searching Embase and PubMed from January 1990 to July 2021 for the keywords "serotonin syndrome/toxicity" paired with "diagnostic criteria" or "diagnosis." Also, fatal cases of serotonin toxicity identified from a recent systematic review were independently examined to determine what diagnostic criteria were met and whether serotonin toxicity or another cause was most likely. Serotonin toxicity is a clinical diagnosis, four diagnostic criteria (Sternbach, Serotonin Syndrome Scale, Radomski, and Hunter) have been proposed. However, the Serotonin Syndrome Scale has not been validated in patients with serotonin toxicity and only utilized in those on a serotonergic agent. The remaining three criteria are utilized more widely but have undergone little refinement or validation. Shortfalls with diagnostic criteria can be illustrated by examining case fatalities. Of 55 fatal cases reviewed, 12 (22%) were unlikely to be serotonin toxicity. Sternbach and Radomski criteria were met by 25 (45%), 20 (36%) had insufficient data reported and 10 (18%) met an exclusion criterion. Few had sufficient information reported to determine whether Hunter Criteria were met, with only 13 (24%) documented as meeting the criteria, the remaining 42 (76%) had insufficient data. As serotonin toxicity is a clinical diagnosis, issues arise when basing the diagnosis on symptom criteria alone, without considering whether the drug/s ingested increase central nervous system serotonin or whether there is an alternative diagnosis. This has resulted in case reports and government warnings for drugs that cannot plausibly cause significant serotonin toxicity (e.g., ondansetron and antipsychotics). We propose when assessing for a serotonin toxidrome, both the causative agent(s) and clinical scenario is considered to determine the likelihood of serotonin toxicity. Then the clinical features assessed, those with a moderate to high prior probability (e.g., serotonergic drug-drug interaction, overdose, recent initiation or increase in dose of serotonergic agent/s) could be diagnosed based on the Hunter criteria. However, those with a low probability (e.g., stable therapeutic doses of a serotonergic agent) require more specific and stringent criteria. Finally, we propose a minimum dataset for case reports/series of serotonin toxicity. More complete and accurate reporting of serotonin toxicity cases is required in the future, to avoid further misleading associations that are physiologically implausible.
Vasoplegic Shock Treated with Methylene Blue Complicated by Severe Serotonin Syndrome
Publisher: Springer Science and Business Media LLC
Date: 13-11-2018
Optimising alkalinisation and its effect on QRS narrowing in tricyclic antidepressant poisoning
Publisher: Wiley
Date: 31-08-2022
DOI: 10.1111/BCP.15008
Abstract: The objectives were to determine the effect of NaHCO 3 and/or mechanical ventilation on the biochemical profile and serum alkalinisation in tricyclic antidepressant (TCA) poisoning and investigate the impact of effective alkalinisation therapy on the QRS interval in TCA poisoning. This was a retrospective review of TCA poisonings from three Australian toxicology units and a poisons information centre (Jan 2013 to Jan 2019). We included patients with TCA toxicity who ingested mg/kg or had clinically significant toxicities consistent with TCA poisoning, and analysed patients' clinical, electrocardiogram and biochemical data. Of 210 patients, 84 received NaHCO 3 and ventilation (dual therapy), 12 NaHCO 3 , 46 ventilation and 68 supportive care treatment. When compared with single/supportive groups, patients who received dual therapy had taken a significantly higher median dose of TCA (1.5 g vs 1.3 g, P .001), a longer median maximum QRS interval (124 ms, interquartile ranges [IQR] 108‐138 vs 106 ms, IQR 98‐115, P .001) and were more likely to have seizures (14% vs 3%, P = .006) and arrhythmias (17% vs 1%, P .001). The dual therapy group demonstrated greater increases in serum pH (median 0.11, IQR 0.04‐0.17) compared to the single/supportive therapy group (median 0.03, IQR −0.01‐0.09, p .001). A greater proportion of patients reached the target pH 7.45‐7.55 in the dual therapy group (59%) compared to the single/supportive therapy group (10%) ( P .001). For each 100 mmol bolus of NaHCO 3 given, the median increase in serum sodium was 2.5 mmol/L (IQR 1.5‐4.0). QRS narrowing occurred twice as quickly in the dual therapy vs single/supportive therapy group. A combination of NaHCO 3 and mechanical ventilation was most effective in achieving serum alkalinisation and was associated with a more rapid narrowing of the QRS interval. We advise that the maximal dose of NaHCO 3 should be mmol (6 mmol/kg).
Individual characteristics associated with physical activity intervention delivery mode preferences among adults
Publisher: Springer Science and Business Media LLC
Date: 2014
Authors' reply to comment on the serotonin toxidrome: shortfalls of current diagnostic criteria for related syndromes.
Publisher: Informa UK Limited
Date: 22-07-2022
Summary statement: new guidelines for the management of paracetamol poisoning in Australia and New Zealand
Publisher: AMPCo
Date: 09-2015
DOI: 10.5694/MJA15.00614
Response to ‘Comment on ‘‘Massive’ metformin overdose’ by Chiew et al.’
Publisher: Wiley
Date: 02-10-2018
DOI: 10.1111/BCP.13747
Clean the skin: Reducing blood culture contamination in the emergency department
Publisher: Wiley
Date: 29-09-2022
Abstract: To determine whether blood culture contamination (BCC) rates could be decreased in the ED by an educational programme. Educational intervention focusing on a 1‐min venepuncture cleaning time and providing a larger chlorhexidine alcohol swab. BCC rates were examined retrospectively 12‐month pre‐, and 9‐month post‐intervention. Six thousand nine hundred and fifty‐three blood cultures were collected over the study period. The BCC rate was 2.4% pre‐intervention versus 1.8% post‐intervention, with no significant difference in BCC rates ( Z ‐score = 1.862, P = 0.063). This educational intervention focusing on skin clean time did not significantly decrease BCC rates in a setting of an already low ( %) BCC rate.
N-Acetylcysteine in the poisoned patient
Publisher: Springer Singapore
Date: 21-09-2018
Seasonal and temperature effect on serum lithium concentrations
Publisher: SAGE Publications
Date: 29-11-2019
Abstract: Lithium remains the gold standard treatment for bipolar disorder. However, it has a very narrow therapeutic index (0.6–0.8 mmol/L). It has been suggested that high environmental temperature can lead to dehydration, elevated plasma lithium concentration and then lithium toxicity. We aimed to investigate the effect of seasonal and short-term changes in temperature on serum lithium concentrations in Sydney, Australia. We retrospectively analysed data from all patients who had serum lithium concentrations taken from the Prince of Wales and Sutherland Hospitals between 2008 and 2018. Temperature data came from the Bureau of Meteorology. We examined correlations between lithium concentrations and the preceding 5 days maximum temperatures, month and season. We also performed a longitudinal analysis of the effect of temperature and seasons within selected patients who had repeated levels. A total of 11,912 serum lithium concentrations from 2493 patients were analysed. There was no significant association between higher lithium concentration and preceding higher temperatures ( r = –0.008, p = 0.399). There was also no important seasonal or monthly variation, across all patients or in the smaller cohort with longitudinal data ( n = 123, r = 0.008, 95% confidence interval: [–0.04, 0.06]). There were no clinically important differences in serum lithium concentration related to seasons, months or temperatures, which suggests that patients on lithium are able to adequately maintain hydration during hot weather in Sydney.
Examining moderators of the effectiveness of a web- and video-based computer-tailored physical activity intervention
Publisher: Elsevier BV
Date: 06-2021
Quality, Features, and Presence of Behavior Change Techniques in Mobile Apps Designed to Improve Physical Activity in Pregnant Women: Systematic Search and Content Analysis (Preprint)
Publisher: JMIR Publications Inc.
Date: 18-08-2020
Abstract: hysical activity during pregnancy is associated with several health benefits for the mother and child. However, very few women participate in regular physical activity during pregnancy. eHealth platforms (internet and mobile apps) have become an important information source for pregnant women. Although the use of pregnancy-related apps has significantly increased among pregnant women, very little is known about their theoretical underpinnings, including their utilization of behavior change techniques (BCTs). This is despite research suggesting that inclusion of BCTs in eHealth interventions are important for promoting healthy behaviors, including physical activity. he aim of this study was to conduct a systematic search and content analysis of app quality, features, and the presence of BCTs in apps designed to promote physical activity among pregnant women. systematic search in the Australian App Store and Google Play store using search terms relating to i exercise /i and i regnancy /i was performed. App quality and features were assessed using the 19-item Mobile App Rating Scale (MARS), and a taxonomy of BCTs was used to determine the presence of BCTs (26 items). BCTs previously demonstrating efficacy in behavior changes during pregnancy were also identified from a literature review. Spearman correlations were used to investigate the relationships between app quality, app features, and number of BCTs identified. ineteen exercise apps were deemed eligible for this review and they were accessed via Google Play (n=13) or App Store (n=6). The MARS overall quality scores indicated moderate app quality (mean 3.5 [SD 0.52]). Functionality was the highest scoring MARS domain (mean 4.2 [SD 0.5]), followed by aesthetics (mean 3.7 [SD 0.6]) and information quality (mean 3.16 [SD 0.42]). Subjective app quality (mean 2.54 [SD 0.64]) and likelihood for behavioral impact (mean 2.5 [SD 0.6]) were the lowest scoring MARS domains. All 19 apps were found to incorporate at least two BCTs (mean 4.74, SD 2.51 range 2-10). However, only 11 apps included BCTs that previously demonstrated efficacy for behavior change during pregnancy, the most common being i rovide opportunities for social comparison /i (n=8) and i rompt self-monitoring of behavior /i (n=7). There was a significant positive correlation between the number of BCTs with engagement and aesthetics scores, but the number of BCTs was not significantly correlated with functionality, information quality, total MARS quality, or subjective quality. ur findings showed that apps designed to promote physical activity among pregnant women were functional and aesthetically pleasing, with overall moderate quality. However, the incorporation of BCTs was low, with limited prevalence of BCTs previously demonstrating efficacy in behavior change during pregnancy. Future app development should identify and adopt factors that enhance and encourage user engagement, including the use of BCTs, especially those that have demonstrated efficacy for promoting physical activity behavior change among pregnant women.
Carbon monoxide poisoning in the 21st century
Publisher: Springer Science and Business Media LLC
Date: 2014
DOI: 10.1186/CC13846
Impact of increasing social media use on sitting time and body mass index
Publisher: Wiley
Date: 28-10-2016
DOI: 10.1071/HE16026
2-Methyl-4-chlorophenoxyacetic acid (MCPA) and bromoxynil herbicide ingestion
Publisher: Informa UK Limited
Date: 09-10-2018
DOI: 10.1080/15563650.2017.1385790
Abstract: Ingestion of bromoxynil and 2-methyl-4-chlorophenoxyacetic acid (MCPA) in combination is associated with high mortality. Toxicity is characterised by hyperthermia and metabolic acidosis. Dialysis is a proposed treatment, but little data exist regarding its effectiveness. Case 1: A 50-year-old female presented 18 h post-ingestion of 200 mL of bromoxynil(200 g/L) and MCPA(200 g/L). She was agitated, tachycardic and tachypnoeic. She was intubated and continuous venovenous haemodiafiltration (CVVHDF) was commenced. She deteriorated, becoming hypotensive, hyperthermic (39.5 °C) and hypercapnic (80 mmHg). She was cooled, paralysed, received CVVHDF for 2d and was extubated on day 4 making a full recovery. Case 2: A 60-year-old male presented 6 h post-ingestion of an unknown amount of bromoxynil (200 g/L) and MCPA (200 g/L). On arrival, he was tachycardic and tachypneic (pCO CVVHDF did not result in significant clearance of either herbicide but may have assisted with hyperthermia control. Both patients survived with vigorous cooling, paralysis and ventilatory support.
Greater bed- and wake-time variability is associated with less healthy lifestyle behaviors: a cross-sectional study
Publisher: Springer Science and Business Media LLC
Date: 20-10-2015
Effect of tourniquet time on whole blood point-of-care lactate concentration: A healthy human volunteer study
Publisher: Wiley
Date: 04-01-2021
Abstract: Lactate is frequently utilised in clinical practice. Some have concerns that tourniquet application for venous blood collection may falsely elevate venous lactate. The objective of the present study was to determine the effect of tourniquet time on varying venous lactate concentrations. This is a healthy volunteer study, in which subjects were their own controls. A cannula was inserted into each arm, with a tourniquet remaining on one. Subjects were allocated to one of three groups rest (no activity), exercise (maximal exertion to elevate lactate concentrations) with immediate tourniquet application or exercise with delayed (5‐min post‐exercise) tourniquet application. In all blood was drawn simultaneously from both cannulas at 0, 2.5, 5, 10 and 15‐min post‐tourniquet application and analysed for lactate on a point‐of‐care device. The primary outcome was a clinically significant difference ( mmol/L) in tourniquet versus non‐tourniquet arm lactate concentration. There were 10 subjects per group the exercise groups achieved a mean maximum lactate concentration of 10.4 mmol/L (standard deviation [SD] 3.6) (exercise with immediate tourniquet application group) and 8.9 mmol/L (SD 2.5) (exercise with delayed tourniquet application group). There was no clinically significant increase in lactate concentration in the tourniquet compared to non‐tourniquet arm in all groups, across all tourniquet application times, and over a range of lactate concentrations. In the rest group after 15‐min of tourniquet application the mean lactate concentration of the tourniquet versus non‐tourniquet arm was 0.91 mmol/L (SD 0.55) versus 0.89 mmol/L (SD 0.46) ( P = 0.99), respectively. In the present study tourniquet application for blood collection did not significantly increase lactate concentration. Hence, clinically a raised venous lactate concentration should not be attributed to prolonged tourniquet application.
Delayed Acetaminophen Absorption Resulting in Acute Liver Failure
Publisher: Hindawi Limited
Date: 07-05-2022
DOI: 10.1155/2022/3672248
Abstract: Introduction. Acetaminophen is a common medication involved in deliberate and accidental self-poisoning. The acetaminophen treatment nomogram is used to guide acetylcysteine treatment. It is rare to develop hepatotoxicity with an initial acetaminophen concentration below the nomogram line. We present a case of acetaminophen ingestion with an initial concentration below the nomogram line that developed hepatic failure, due to a delayed peak acetaminophen concentration secondary to coingesting medications that slow gastric emptying. Case Report. A 43-year-old (55 kg) female presented after ingesting an unknown quantity of acetaminophen, clonidine, and alcohol. Her acetaminophen level was 41 mg/L (256 μmol/L) at 4.5 h post-ingestion, well below the nomogram line, and ALT was 25 U/L. Hence, acetylcysteine was not commenced. She was intubated for decreased level of conscious. A repeat acetaminophen level 4 h later was 39 mg/L (242 μmol/L), still below the nomogram line. She was extubated 24 h later.At 38 h post-ingestion she developed abdominal pain, the repeat acetaminophen level was 85 mg/L (560 μmol/L), ALT was 489 U/L, and acetylcysteine was commenced. The patient developed hepatic failure with a peak ALT of 7009 U/L and INR of 7.5 but made a full recovery. It was discovered that she had ingested a combination acetaminophen product containing dextromethorphan and chlorphenamine. Acetaminophen metabolites were measured, including nontoxic glucuronide and sulfate conjugates and toxic cytochrome P450 (CYP) metabolites. The metabolite data demonstrated increasing CYP metabolites in occurrence with the delayed acetaminophen peak concentration. Discussion. Opioids and antimuscarinic agents are known to delay gastric emptying and clonidine may also have contributed. These coingested medications resulted in delayed acetaminophen absorption. This case highlights the issue of altered pharmacokinetics when patients coingest gut slowing agents.
Clinical decision rule for non-traumatic computed tomography of the brain.
Publisher: Wiley
Date: 14-04-2019
Abstract: The aims of the present study were to derive and validate a clinical decision rule (CDR) to rule out the need for computed tomography of the brain (CTB) in non-traumatic patients who present to the ED. This is a retrospective review of non-traumatic patients who presented to the EDs in two urban hospitals and received CTB from January 2014 to December 2016. Data from one hospital were used to develop a CDR for clinically significant CTB findings. Clinically significant CTB findings were defined as acute infarction, intracranial neoplasm, intracranial haemorrhage, acute hydrocephalus, cerebral oedema and intracranial infection. Patients from another hospital were used as a validation cohort to evaluate the CDR and compare it to four previously derived CDRs. There were 5296 cases in the derivation cohort, with 345 (6.5%) clinically significant CTB findings. Identified risk factors were: focal neurological deficit (adjusted odds ratio [OR] 3.4, 95% confidence interval [CI] 2.6-4.4), Glasgow Coma Scale <15 (adjusted OR 3.5, 95% CI 2.6-4.6), history of malignancy (adjusted OR 3.2, 95% CI 2.4-4.2), nausea and/or vomiting (adjusted OR 1.6, 95% CI 1.1-2.1), headache (adjusted OR 1.1, 95% CI 0.9-1.5) and coagulopathy (adjusted OR 9.2, 95% CI 2.1-41.5). These criteria and four pre-existing CDRs were applied to the validation cohort of 5098 patients from the second hospital, which had 338 (6.6%) clinically significant CTB findings. Our criteria were found to have a sensitivity of 99.7% (95% CI 99.1-100.0) and a specificity of 11.0% (95% CI 10.1-11.9). The risk of having a clinically significant CTB finding is 0.3% if patients do not meet any of the criteria. The CDR derived in the present study achieved the highest sensitivity and a moderate specificity when compared with four other pre-existing CDRs for non-traumatic brain injury patients.
Bromoxynil and 2-methyl-4-chlorophenoxyacetic acid (MCPA) poisoning could be a bad combination
Publisher: Informa UK Limited
Date: 30-01-2018
A Self-Help Online Intervention Is Associated with Reduced Distress and Improved Mental Wellbeing in Australian Farmers: The Evaluation and Key Mechanisms of www.ifarmwell.com.au
Publisher: Informa UK Limited
Date: 17-12-2022
Massive paracetamol overdose: an observational study of the effect of activated charcoal and increased acetylcysteine dose (ATOM-2).
Publisher: Informa UK Limited
Date: 23-06-2017
DOI: 10.1080/15563650.2017.1334915
Abstract: Paracetamol is commonly taken in overdose, with increasing concerns that those taking "massive" overdoses have higher rates of hepatotoxicity and may require higher doses of acetylcysteine. The objective was to describe the clinical characteristics and outcomes of "massive" (≥ 40 g) paracetamol overdoses. Patients were identified through the Australian Paracetamol Project, a prospective observational study through Poisons Information Centres in NSW and Queensland, over 3 and 1.5 years, respectively, and retrospectively from three clinical toxicology unit databases (over 2.5 to 20 years). Included were immediate-release paracetamol overdoses ≥ 40 g ingested over ≤ 8 h. Outcomes measured included paracetamol ratio[defined as the ratio of the first paracetamol concentration taken 4-16 h post-ingestion to the standard (150 mg/L at 4 h) nomogram line at that time] and hepatotoxicity (ALT >1000 U/L). Two hundred paracetamol overdoses were analysed, reported median dose ingested was 50 g (interquartile range (IQR): 45-60 g) and median paracetamol ratio 1.9 (IQR: 1.4-2.9, n = 173). One hundred and ninety-three received acetylcysteine at median time of 6.3 h (IQR: 4-9.3 h) post-ingestion. Twenty-eight (14%) developed hepatotoxicity, including six treated within 8 h of ingestion. Activated charcoal was administered to 49(25%), at median of 2 h post-ingestion (IQR:1.5-5 h). Those receiving activated charcoal (within 4 h of ingestion), had significantly lower paracetamol ratio versus those who did not: 1.4 (n = 33, IQR: 1.1-1.6) versus 2.2 (n = 140, IQR: 1.5-3.0) (p < .0001) (paracetamol concentration measured ≥ 1 h after charcoal). Furthermore, they had lower rates of hepatotoxicity [unadjusted OR: 0.12 (95% CI: <0.001-0.91) adjusted for time to acetylcysteine OR: 0.20 (95%CI: 0.002-1.74)]. Seventy-nine had a paracetamol ratio ≥2, 43 received an increased dose of acetylcysteine in the first 21 h most commonly a double dose in the last bag (100 to 200 mg/kg/16 h). Those receiving increased acetylcysteine had a significant decrease risk of hepatotoxicity [OR:0.27 (95% CI: 0.08-0.94)]. The OR remained similar after adjustment for time to acetylcysteine and paracetamol ratio. Massive paracetamol overdose can result in hepatotoxicity despite early treatment. Paracetamol concentrations were markedly reduced in those receiving activated charcoal within 4 h. In those with high paracetamol concentrations, treatment with increased acetylcysteine dose within 21 h was associated with a significant reduction in hepatotoxicity.
Comparison of Wells and YEARS clinical decision rules with D-dimer for low-risk pulmonary embolus patients.
Publisher: Wiley
Date: 06-2019
DOI: 10.1111/IMJ.14138
Abstract: Assessment of pulmonary embolism (PE) remains a diagnostic and investigative burden to emergency departments. The decision of which D-dimer cut-off to use in low-risk patients remains controversial. To compare the sensitivity and specificity of varying D-dimer cut-offs in the diagnosis of PE for Wells low-risk patients. Retrospective review of patients presenting to a tertiary emergency department over 42 months who had a D-dimer performed for PE risk stratification. Wells scores were calculated for each patient, those with Wells score of ≤4 ('PE unlikely') were analysed. Four D-dimer thresholds were compared, including traditional threshold (≥0.5 μg/mL), age-adjusted (≥age in years × 0.01 μg/mL), doubled-traditional threshold and YEARS criteria. During the study period, 2291 D-dimers were ordered for suspected PE, of which 2125 were low risk for PE. Of these low-risk patients 46 (2.2%) were found to have a PE. The sensitivity and specificity for each D-dimer threshold were traditional threshold (95.6% and 65.6%), age-adjusted (93.5% and 71.7%), doubled traditional (69.6% and 85.5%) and YEARS criteria (80.4% and 84.0%). Utilising an age-adjusted threshold, YEARS criteria or doubled-traditional threshold would have resulted in 70, 217 and 245 fewer imaging investigations. The prevalence of PE in this low-risk cohort was very low. Utilising an age-adjusted D-dimer would have reduced imaging tests performed while maintaining good sensitivity. Although The YEARS criteria and doubled-traditional threshold would have reduced scanning considerably both had sensitivities of less than 90%.
A Physical Activity and Diet Program Delivered by Artificially Intelligent Virtual Health Coach: Proof-of-Concept Study (Preprint)
Publisher: JMIR Publications Inc.
Date: 19-12-2019
Abstract: oor diet and physical inactivity are leading modifiable causes of death and disease. Advances in artificial intelligence technology present tantalizing opportunities for creating virtual health coaches capable of providing personalized support at scale. his proof of concept study aimed to test the feasibility (recruitment and retention) and preliminary efficacy of physical activity and Mediterranean-style dietary intervention (MedLiPal) delivered via artificially intelligent virtual health coach. his 12-week single-arm pre-post study took place in Adelaide, Australia, from March to August 2019. Participants were inactive community-dwelling adults aged 45 to 75 years, recruited through news stories, social media posts, and flyers. The program included access to an artificially intelligent chatbot, Paola, who guided participants through a computer-based in idualized introductory session, weekly check-ins, and goal setting, and was available 24/7 to answer questions. Participants used a Garmin Vivofit4 tracker to monitor daily steps, a website with educational materials and recipes, and a printed diet and activity log sheet. Primary outcomes included feasibility (based on recruitment and retention) and preliminary efficacy for changing physical activity and diet. Secondary outcomes were body composition (based on height, weight, and waist circumference) and blood pressure. ver 4 weeks, 99 potential participants registered expressions of interest, with 81 of those screened meeting eligibility criteria. Participants completed a mean of 109.8 (95% CI 1.9-217.7) more minutes of physical activity at week 12 compared with baseline. Mediterranean diet scores increased from a mean of 3.8 out of 14 at baseline, to 9.6 at 12 weeks (mean improvement 5.7 points, 95% CI 4.2-7.3). After 12 weeks, participants lost an average 1.3 kg (95% CI –0.1 to –2.5 kg) and 2.1 cm from their waist circumference (95% CI –3.5 to –0.7 cm). There were no significant changes in blood pressure. Feasibility was excellent in terms of recruitment, retention (90% at 12 weeks), and safety (no adverse events). n artificially intelligent virtual assistant-led lifestyle-modification intervention was feasible and achieved measurable improvements in physical activity, diet, and body composition at 12 weeks. Future research examining artificially intelligent interventions at scale, and for other health purposes, is warranted.
The changing face of paracetamol toxicity and new regimens for an old antidote acetylcysteine.
Publisher: Wiley
Date: 03-08-2020
DOI: 10.1111/BCP.14495
Physical Activity, Sedentary Behavior, and Diet-Related eHealth and mHealth Research: Bibliometric Analysis (Preprint)
Publisher: JMIR Publications Inc.
Date: 26-09-2017
Abstract: lectronic health (eHealth) and mobile health (mHealth) approaches to address low physical activity levels, sedentary behavior, and unhealthy diets have received significant research attention. However, attempts to systematically map the entirety of the research field are lacking. This gap can be filled with a bibliometric study, where publication-specific data such as citations, journals, authors, and keywords are used to provide a systematic overview of a specific field. Such analyses will help researchers better position their work. he objective of this review was to use bibliometric data to provide an overview of the eHealth and mHealth research field related to physical activity, sedentary behavior, and diet. he Web of Science (WoS) Core Collection was searched to retrieve all existing and highly cited (as defined by WoS) physical activity, sedentary behavior, and diet related eHealth and mHealth research papers published in English between January 1, 2000 and December 31, 2016. Retrieved titles were screened for eligibility, using the abstract and full-text where needed. We described publication trends over time, which included journals, authors, and countries of eligible papers, as well as their keywords and subject categories. Citations of eligible papers were compared with those expected based on published data. Additionally, we described highly-cited papers of the field (ie, top ranked 1%). he search identified 4805 hits, of which 1712 (including 42 highly-cited papers) were included in the analyses. Publication output increased on an average of 26% per year since 2000, with 49.00% (839/1712) of papers being published between 2014 and 2016. Overall and throughout the years, eHealth and mHealth papers related to physical activity, sedentary behavior, and diet received more citations than expected compared with papers in the same WoS subject categories. The Journal of Medical Internet Research published most papers in the field (9.58%, 164/1712). Most papers originated from high-income countries (96.90%, 1659/1717), in particular the United States (48.83%, 836/1712). Most papers were trials and studied physical activity. Beginning in 2013, research on Generation 2 technologies (eg, smartphones, wearables) sharply increased, while research on Generation 1 (eg, text messages) technologies increased at a reduced pace. Reviews accounted for 20 of the 42 highly-cited papers (n=19 systematic reviews). Social media, smartphone apps, and wearable activity trackers used to encourage physical activity, less sedentary behavior, and/or healthy eating were the focus of 14 highly-cited papers. his study highlighted the rapid growth of the eHealth and mHealth physical activity, sedentary behavior, and diet research field, emphasized the sizeable contribution of research from high-income countries, and pointed to the increased research interest in Generation 2 technologies. It is expected that the field will grow and ersify further and that reviews and research on most recent technologies will continue to strongly impact the field.
Comment on: “population pharmacokinetic analysis of acetaminophen overdose with immediate release, extended release and modified release formulations”
Publisher: Informa UK Limited
Date: 20-10-2023
Modified release paracetamol overdose: a prospective observational study (ATOM-3).
Publisher: Informa UK Limited
Date: 16-02-2018
DOI: 10.1080/15563650.2018.1439950
Abstract: Modified-release (MR) paracetamol is available in many countries as 665 mg tablets of which 69% is MR and 31% is immediate release. There are concerns that MR paracetamol overdose has higher rates of liver injury despite standard treatment algorithms. The objective of this study was to describe the clinical characteristics and outcomes of acute MR paracetamol overdose. Prospective observational study, recruiting patients from January 2013 to June 2017, from five clinical toxicology units and calls to two Poisons Information Centres in Australia. Included were patients >14 years who ingested ≥10 g or 200 mg/kg (whichever is less) of MR paracetamol. Data collected included demographics, ingestion history, pathology results, treatments, and outcomes including hepatotoxicity (ALT >1000 U/L). In total, 116 patients were recruited, 85(73%) were female. The median dose ingested was 32 g (IQR: 20-49 g) and median time to presentation was 3 h (IQR: 2-9 h). 78(67%) had an initial paracetamol concentration above the nomogram line (150 mg/L at 4 h). A further 12(10%) crossed the nomogram after repeat paracetamol measurements, of which five crossed after two non-toxic levels 4 h apart. Six had a double paracetamol peak, in three occurring >24 h post-ingestion. 113(97%) received acetylcysteine of which 67 received prolonged treatment beyond the standard 21 h. This was because of an elevated paracetamol concentration at the completion of acetylcysteine in 39 (median paracetamol concentration 25 mg/L, IQR: 16-62 mg/L). 21 (18%) developed hepatotoxicity, including six treated within 8 h of ingestion. Activated charcoal and double doses of acetylcysteine did not significantly decrease the risk of hepatotoxicity. Drug regulatory authorities are considering restrictions on MR paracetamol preparations. Following an acute MR paracetamol overdose, this study found that many patients had a persistently elevated paracetamol concentrations, many required prolonged treatment and some developed liver injury despite early acetylcysteine treatment. Furthermore, activated charcoal and increased acetylcysteine did not appear to significantly alter the risk of liver injury. Hence, research into better treatment strategies is required. Australian Toxicology Monitoring (ATOM) Study - Australian Paracetamol Project: ACTRN12612001240831 (ANZCTR) Date of registration: 23/11/2012.
Clinical outcomes from early use of digoxin-specific antibodies versus observation in chronic digoxin poisoning (ATOM-4)
Publisher: Informa UK Limited
Date: 26-12-2019
Differences in health-related quality of life between three clusters of physical activity, sitting time, depression, anxiety, and stress
Publisher: Springer Science and Business Media LLC
Date: 20-10-2014
Clinical experience with titrating doses of digoxin antibodies in acute digoxin poisoning. (ATOM-6)
Publisher: Informa UK Limited
Date: 23-08-2022
DOI: 10.1080/15563650.2021.1968422
Abstract: For acute digoxin poisoning, it has been recommended to give bolus doses of 10-20 vials or potentially larger than needed doses calculated from dose ingested or the measured concentration. However, a recent revision of internal Poisons Information Centre guidelines prompted a change of our recommendations, specifically instead of large boluses, to use titrating repeated low doses of digoxin antibodies(Digoxin-Fab) based on bedside assessment of cardiac toxicity. This is a prospective observational study of patients with acute digoxin poisoning identified through two Poisons Information Centres and three toxicology units. Patient demographics, signs and symptoms of digoxin toxicity, doses and response to Digoxin-Fab, free and bound serum digoxin concentrations. Outcomes were recorded and analysed. From September 2013 to September 2020, 23 patients with 25 presentations (median age 56 years, females 56%) were recruited. Median dose ingested was 13 mg(IQR: 9.5-25). Median heart rate (HR) was 41 beats/min before treatment. Initial median digoxin and potassium concentrations were 14.5 nmol/L (IQR: 10.9-20) [11.2 µg/L(IQR: 8.4-15.4)] and 5 mmol/L (IQR: 4.5-5.4 mmol/L), respectively. Gastrointestinal symptoms and acute kidney injury were present in 22 patients (88%) and 5 patients (20%), respectively. Four patients received an initial bolus dose of Digoxin-Fab of 5-20 vials. Twenty-one patients received repeated titrated doses (1-2 vials) of Digoxin-Fab and the median total dose was 4 vials (IQR: 2-7.5). Median maximal change in HR post-Digoxin-Fab was 19 beats/min. The median potassium concentration decrease post-Digoxin-Fab was 0.3 mmol/L. Total dose used in the titration group was 25% and 35% of the predicted doses based on the amount of digoxin ingested or measured serum concentration, respectively. Twelve had free digoxin concentrations measured. Free digoxin concentrations dropped to almost zero after any dose of Digoxin-Fab. Ten patients had a rebound of digoxin >2.6 nmol/L (2 µg/L). There were no deaths from acute digoxin toxicity. The new practice of using small, titrated doses of Digoxin-Fab led to a considerable reduction in total usage and major savings. The clinical response to titrated doses was safe and acceptable in acute digoxin poisoning.
Review article: Up (to) date for Australian Toxicology and Toxinology guidelines
Publisher: Wiley
Date: 29-10-2021
Authors' responses to letter to the editor re: Efficacy and effectiveness of anti-digoxin antibodies in chronic digoxin poisonings from the DORA study (ATOM-1).
Publisher: Informa UK Limited
Date: 17-08-2016
Catecholamine-induced cardiomyopathy resulting from life-threatening funnel-web spider envenoming
Publisher: AMPCo
Date: 10-2015
DOI: 10.5694/MJA15.00279
Combining Farmers’ Preferences With Evidence-Based Strategies to Prevent and Lower Farmers’ Distress: Co-design and Acceptability Testing of ifarmwell (Preprint)
Publisher: JMIR Publications Inc.
Date: 02-2021
Abstract: arming is physically and psychologically hazardous. Farmers face many barriers to help seeking from traditional physical and mental health services however, improved internet access now provides promising avenues for offering support. his study aims to co-design with farmers the content and functionality of a website that helps them adopt transferable coping strategies and test its acceptability in the broader farming population. esearch evidence and expert opinions were synthesized to inform key design principles. A total of 18 farmers detailed what they would like from this type of website. Intervention logic and relevant evidence-based strategies were mapped. Website content was drafted and reviewed by 2 independent mental health professionals. A total of 9 farmers provided detailed qualitative feedback on the face validity of the draft content. Subsequently, 9 farmers provided feedback on the website prototype. Following amendments and internal prototype testing and optimization, prototype usability (ie, completion rate) was examined with 157 registered website users who were (105/157, 66.9%) female, aged 21-73 years 95.5% (149/156) residing in inner regional to very remote Australia, and 68.2% (107/157) “sheep, cattle and/or grain farmers.” Acceptability was examined with a subset of 114 users who rated at least module 1. Interviews with 108 farmers who did not complete all 5 modules helped determine why, and detailed interviews were conducted with 18 purposively s led users. Updates were then made according to adaptive trial design methodology. his systematic co-design process resulted in a web-based resource based on acceptance and commitment therapy and designed to overcome barriers to engagement with traditional mental health and well-being strategies—ifarmwell. It was considered an accessible and confidential source of practical and relevant farmer-focused self-help strategies. These strategies were delivered via 5 interactive modules that include written, drawn, and audio- and video-based psychoeducation and exercises, as well as farming-related jokes, metaphors, ex les, and imagery. Module 1 included distress screening and information on how to speak to general practitioners about mental health–related concerns (including a personalized conversation script). Modules were completed fortnightly. SMS text messages offered personalized support and reminders. Qualitative interviews and star ratings demonstrated high module acceptability (average 4.06/5 rating) and suggested that additional reminders, higher quality audio recordings, and shorter modules would be useful. Approximately 37.1% (52/140) of users who started module 1 completed all modules, with i too busy /i or i not got to it yet /i being the main reason for non-completion, and previous module acceptability not predicting subsequent module completion. equential integration of research evidence, expert knowledge, and farmers’ preferences in the co-design process allowed for the development of a self-help intervention that focused on important intervention targets and was acceptable to this difficult-to-engage group. ustralian New Zealand Clinical Trials Registry ACTRN12617000506392 www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=372526
Home Therapies to Neutralize Button Battery Injury in a Porcine Esophageal Model
Publisher: Elsevier BV
Date: 09-2023
Optimising Web-Based Computer-Tailored Physical Activity Interventions for Prostate Cancer Survivors: A Randomised Controlled Trial Examining the Impact of Website Architecture on User Engagement
Publisher: MDPI AG
Date: 28-10-2020
Abstract: Background: Web-based computer-tailored interventions can assist prostate cancer survivors to become more physically active by providing personally relevant behaviour change support. This study aimed to explore how changing the website architecture (free choice vs. tunnelled) impacted engagement within a physical activity computer-tailored intervention targeting prostate cancer survivors. Methods: On a 2:2:1 ratio, 71 Australian prostate cancer survivors with local or locally advanced disease (mean age: 66.6 years ± 9.66) were randomised into either a free-choice (N = 27), tunnelled (N = 27) or minimal intervention control arm (N =17). The primary outcome was differences in usage of the physical activity self-monitoring and feedback modules between the two intervention arms. Differences in usage of other website components between the two intervention groups were explored as secondary outcomes. Further, secondary outcomes involving comparisons between all study groups (including the control) included usability, personal relevance, and behaviour change. Results: The average number of physical activity self-monitoring and feedback modules accessed was higher in the tunnelled arm (M 2.6 SD 1.3) compared to the free-choice arm (M 1.5 SD 1.4), p = 0.01. However, free-choice participants were significantly more likely to have engaged with the social support (p = 0.008) and habit formation (p = 0.003) ‘once-off’ modules compared to the standard tunnelled arm. There were no other between-group differences found for any other study outcomes. Conclusion: This study indicated that website architecture influences behavioural engagement. Further research is needed to examine the impact of differential usage on mechanisms of action and behaviour change.
The Effectiveness of a Web-Based Computer-Tailored Physical Activity Intervention Using Fitbit Activity Trackers: Randomized Trial (Preprint)
Publisher: JMIR Publications Inc.
Date: 18-06-2018
Abstract: eb-based interventions that provide personalized physical activity advice have demonstrated good effectiveness but rely on self-reported measures of physical activity, which are prone to overreporting, potentially reducing the accuracy and effectiveness of the advice provided. his study aimed to examine whether the effectiveness of a Web-based computer-tailored intervention could be improved by integrating Fitbit activity trackers. articipants received the 3-month TaylorActive intervention, which included 8 modules of theory-based, personally tailored physical activity advice and action planning. Participants were randomized to receive the same intervention either with or without Fitbit tracker integration. All intervention materials were delivered on the Web, and there was no face-to-face contact at any time point. Changes in physical activity (Active Australia Survey), sitting time (Workforce Sitting Questionnaire), and body mass index (BMI) were assessed 1 and 3 months post baseline. Advice acceptability, website usability, and module completion were also assessed. total of 243 Australian adults participated. Linear mixed model analyses showed a significant increase in total weekly physical activity (adjusted mean increase=163.2 95% CI 52.0-274.5 P=.004) and moderate-to-vigorous physical activity (adjusted mean increase=78.6 95% CI 24.4-131.9 P=.004) in the Fitbit group compared with the non-Fitbit group at the 3-month follow-up. The sitting time and BMI decreased more in the Fitbit group, but no significant group × time interaction effects were found. The physical activity advice acceptability and the website usability were consistently rated higher by participants in the Fitbit group. Non-Fitbit group participants completed 2.9 (SD 2.5) modules, and Fitbit group participants completed 4.4 (SD 3.1) modules. ntegrating physical activity trackers into a Web-based computer-tailored intervention significantly increased intervention effectiveness. ustralian New Zealand Clinical Trials Registry ACTRN12616001555448 www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=371793 (Archived by WebCite at 3ioTxQX2)
SNAP – A Large Step in the Move towards Personalised Dosing of Acetylcysteine
Publisher: Elsevier BV
Date: 05-2019
Sulfate conjugation may be the key to hepatotoxicity in paracetamol overdose
Publisher: Wiley
Date: 07-12-2020
DOI: 10.1111/BCP.14642
Physical activity recommendations from general practitioners in Australia. Results from a national survey
Publisher: Elsevier BV
Date: 02-2016
Abstract: To identify subgroups of Australian adults likely to receive physical activity advice from their general practitioner and to evaluate the content of the advice provided. Participants (n=1,799), recruited from the Australian Health and Social Science panel, completed an online survey. Signal Detection Analysis was used to identify subgroups that were more/less likely to have received physical activity recommendations. Overall, 18% of participants received a physical activity recommendation from their general practitioner in the past 12 months and eight unique subgroups were identified. The subgroup with the highest proportion (54%) of participants reporting that they received a physical activity recommendation was those with poor physical and mental health-related quality of life and an average daily sitting time of <11 hours. Other subgroups with high proportions of in iduals receiving recommendations were characterised by higher weight and/or the presence of co-morbidities. The most commonly prescribed physical activity type was aerobic activity. Few participants received specific physical activity advice. General practitioners are incorporating physical activity promotion into their practice, but primarily as a disease management tool and with limited specificity. Strategies to assist Australian general practitioners to effectively promote physical activity are needed.
Understanding occupational sitting: Prevalence, correlates and moderating effects in Australian employees
Publisher: Elsevier BV
Date: 10-2014
DOI: 10.1016/J.YPMED.2014.07.031
Abstract: To (1) compare occupational sitting between different socio-demographic, health-related, work-related and psychosocial categories, (2) identity socio-demographic, health-related, work-related and psychosocial correlates of occupational sitting, and (3) examine the moderating effect of work-related factors in the relation between correlates and occupational sitting. Randomly-selected Australian adults completed a web-based survey assessing socio-demographic (country of birth, gender, age, education, income), health-related (general health, weight, physical activity), work-related (employment status, occupational task, occupational classification) and sedentary-specific psychosocial (social norm, social support, self-efficacy, control, advantages, disadvantage, intention) factors, and occupational sitting-time. t-tests, ANOVAs and multiple linear regression analyses were conducted (in 2013) on a s le of employees (n=993). Respondents sat on average for 3.75 (SD=2.45) h/day during work. Investigated correlates explained 41% of the variance in occupational sitting. More occupational sitting was associated with being male, being younger, higher education and income, part-time and full-time employment, sedentary job tasks, white-collar rofessional occupations, higher BMI, and perceiving more advantages of sitting less at work. Employment status and occupational classification moderated the association between control to sit less and occupational sitting. A lack of control to sit less was associated with higher occupational sitting in part-time and full-time workers, but not in casual workers and in white-collar and professional workers, but not in blue-collar workers. Most important contributors to occupational sitting were work-related and socio-demographic correlates. More research is needed to confirm present results.
Correlates of resistance training in post-treatment breast cancer survivors
Publisher: Springer Science and Business Media LLC
Date: 08-05-2014
DOI: 10.1007/S00520-014-2273-5
Abstract: To explore demographic, health, social-cognitive and behavioural correlates of resistance training among post-treatment breast cancer survivors. A s le of 330 post-treatment breast cancer survivors recruited from across Australia completed a mailed questionnaire. A multivariate logistical regression model was used to test associations between independent variables and meeting the resistance training guidelines. Less than a quarter of the participants were meeting the resistance training guidelines of at least two sessions of resistance training per week. Higher task self-efficacy for resistance training (p < 0.01) and greater goal-setting behaviour (p < 0.05) were identified as significant predictors of meeting the resistance training guidelines, with a one unit increase in task self-efficacy and goal setting, increasing the odds of meeting the resistance training guidelines by a factor of approximately 1.2 (odds ratio (OR) task self-efficacy = 1.23, 95 % confidence interval (CI) = 1.05-1.43 goal-setting OR = 1.20, 95 % CI = 1.04-1.38). No other variables significantly predicted meeting the resistance training guidelines in the multivariate analysis. Strategies targeting task self-efficacy and goal-setting behaviours are likely to be important intervention components in resistance training interventions for breast cancer survivors. The findings of this study will be useful for informing the development of evidence-based interventions aiming to promote resistance training among this group.
Designing more engaging computer-tailored physical activity behaviour change interventions for breast cancer survivors: lessons from the iMove More for Life study
Publisher: Springer Science and Business Media LLC
Date: 17-06-2017
DOI: 10.1007/S00520-017-3786-5
Abstract: Participating in regular physical activity is a recommended cancer recovery strategy for breast cancer survivors. However, tailored support services are not widely available and most survivors are insufficiently active to obtain health benefits. Delivering tailored programs via the Internet offers one promising approach. However, recent evaluations of such programs suggest that major improvements are needed to ensure programs meet the needs of users and are delivered in an engaging way. Understanding participants' experiences with current programs can help to inform the next generation of systems. The purposes of this study are to explore breast cancer survivor's perspectives of and experiences using a novel computer-tailored intervention and to describe recommendations for future iterations. Qualitative data from a sub-s le of iMove More for Life study participants were analysed thematically to identify key themes. Participants long-term goals for participating in the program were explored by analysing open-ended data extracted from action plans completed during the intervention (n = 370). Participants negative and positive perceptions of the website and recommendations for improvement were explored using data extracted from open-ended survey items collected at the immediate intervention follow-up (n = 156). The majority of participants reported multi-faceted goals, consisting of two or more outcomes they hoped to achieve within a year. While clear themes were identified (e.g. 'being satisfied with body weight'), there was considerable variability in the scope of the goal (e.g. desired weight loss ranged from 2 to 30 kg). Participants' perceptions of the website were mixed, but clear indications were provided of how intervention content and structure could be improved. This study provides insight into how to better accommodate breast cancer survivors in the future and ultimately design more engaging computer-tailored interventions.
Examining participant engagement in an information technology-based physical activity and nutrition intervention for men: the ManUp randomized controlled trial
Publisher: JMIR Publications Inc.
Date: 03-01-2014
DOI: 10.2196/RESPROT.2776
Prevalence and correlates of psychological distress, unmet supportive care needs, and fear of cancer recurrence among haematological cancer patients during the COVID-19 pandemic
Publisher: Springer Science and Business Media LLC
Date: 23-06-2021
Acetaminophen Metabolites on Presentation Following an Acute Acetaminophen Overdose (ATOM‐7)
Publisher: Wiley
Date: 06-04-2023
DOI: 10.1002/CPT.2888
Abstract: Acetaminophen (APAP) is commonly taken in overdose and can cause acute liver injury via the toxic metabolite NAPQI formed by cytochrome (CYP) P450 pathway. We aimed to evaluate the concentrations of APAP metabolites on presentation following an acute APAP poisoning and whether these predicted the subsequent onset of hepatotoxicity (peak alanine aminotransferase 1,000 U/L). The Australian Toxicology Monitoring (ATOM) study is a prospective observational study, recruiting via two poison information centers and four toxicology units. Patients following an acute APAP ingestion presenting 24 hours post‐ingestion were recruited. Initial s les were analyzed for APAP metabolites, those measured were the nontoxic glucuronide (APAP‐Glu) and sulfate (APAP‐Sul) conjugates and NAPQI (toxic metabolite) conjugates APAP‐cysteine (APAP‐Cys) and APAP‐mercapturate (APAP‐Mer). The primary outcome was hepatotoxicity. In this study, 200 patients were included, with a median ingested dose of 20 g, 191 received acetylcysteine at median time of 5.8 hours post‐ingestion. Twenty‐six patients developed hepatotoxicity, one had hepatotoxicity on arrival (excluded from analysis). Those who developed hepatotoxicity had significantly higher total CYP metabolite concentrations: (36.8 μmol/L interquartile range (IQR): 27.8–51.7 vs. 10.8 μmol/L IQR: 6.9–19.5) and these were a greater proportion of total metabolites (5.4%, IQR: 3.8–7.7) vs. 1.7%, IQR: 1.3–2.6, P 0.001)]. Furthermore, those who developed hepatotoxicity had lower APAP‐Sul concentrations (49.1 μmol/L, IQR: 24.7–72.2 vs. 78.7 μmol/L, IQR: 53.6–116.4) and lower percentage of APAP‐Sul (6.3%, IQR: 4.6–10.9 vs. 13.1%, IQR, 9.1–20.8, P 0.001)]. This study found that those who developed hepatotoxicity had higher APAP metabolites derived from CYP pathway and lower sulfation metabolite on presentation. APAP metabolites may be utilized in the future to identify patients who could benefit from increased acetylcysteine or newer adjunct or research therapies.
Population Pharmacokinetic Modeling of Acetaminophen Protein Adducts in Adults and Children
Publisher: Wiley
Date: 04-12-2019
DOI: 10.1002/JCPH.1555
Abstract: Acetaminophen protein adducts (adducts) are a well‐established biomarker to diagnose acetaminophen toxicity. To date, the quantitative relationship between acetaminophen exposure, which drives adduct formation, and adduct exposure remains to be established. Our study characterized the adduct formation and disposition in adults using the approach of population parent‐metabolite modeling. It demonstrated formation‐limited pharmacokinetics (PK) for adducts in healthy subjects. This finding expands the existing knowledge on adduct PK that showed an apparent long elimination half‐life. We then allometrically scaled the adduct PK model to children, simulated the adduct profiles, and compared these simulated profiles with those observed in an independent cohort of children. The scaled model significantly overpredicted the adduct concentrations in children early on in treatment and underpredicted concentrations following repeated acetaminophen doses. These results suggest that children demonstrate different adduct PK behavior from that of adults, most likely because of increased reactive metabolite detoxification in children. In summary, we described the first PK model linking acetaminophen and acetaminophen protein adduct concentrations, which provides a semimechanistic understanding of varying profiles of adduct exposure in adults and children.
Examining the accessibility of high-quality physical activity behaviour change support freely available online for men with prostate cancer
Publisher: Springer Science and Business Media LLC
Date: 04-09-2017
DOI: 10.1007/S11764-017-0638-8
Abstract: While the internet is considered a promising avenue for providing physical activity support to prostate cancer survivors, little is known about the accessibility of quality websites in the real world. This work aimed to explore what websites prostate cancer survivors are likely to find when seeking physical activity support online and to evaluate their quality using evidenced-based criteria. A search strategy was developed in consultation with prostate cancer survivors (n = 44) to reflect the most common ways they are likely to search the internet. The search was then conducted by a single reviewer, and identified websites were assessed for quality by two reviewers using an evidence-based quality assessment tool developed for this study. Discrepancies were resolved by a third reviewer. Of the 45 identified websites, 13 (29%) received a high quality rating, 22 (49%) received a moderate rating and 10 (22%) received a low quality rating. Higher-quality websites tended to have a .org or .gov domain and tended to be located using searches specific to prostate cancer or prostate cancer and exercise. Very few websites contained complete information regarding the physical activity guidelines for cancer survivors, and no websites provided comprehensive behaviour change support. There are some good-quality physical activity websites accessible to men with prostate cancer. However, they may be difficult to find and/or require updating to include complete recommendations and more behaviour change support. Efforts to improve physical activity information online and strategies to direct prostate cancer survivors to higher-quality websites and support services are needed to ensure safety and efficacy.
Early acetaminophen-protein adducts predict hepatotoxicity following overdose (ATOM-5).
Publisher: Elsevier BV
Date: 03-2019
DOI: 10.1016/J.JHEP.2019.10.030
Abstract: Acetaminophen-protein adducts are specific biomarkers of toxic acetaminophen (paracetamol) metabolite exposure. In patients with hepatotoxicity (alanine aminotransferase [ALT] >1,000 U/L), an adduct concentration ≥1.0 nmol/ml is sensitive and specific for identifying cases secondary to acetaminophen. Our aim was to characterise acetaminophen-protein adduct concentrations in patients following acetaminophen overdose and determine if they predict toxicity. We performed a multicentre prospective observational study, recruiting patients 14 years of age or older with acetaminophen overdose regardless of intent or formulation. Three serum s les were obtained within the first 24 h of presentation and analysed for acetaminophen-protein adducts. Acetaminophen-protein adduct concentrations were compared to ALT and other indicators of toxicity. Of the 240 patients who participated, 204 (85%) presented following acute ingestions, with a median ingested dose of 20 g (IQR 10-40), and 228 (95%) were treated with intravenous acetylcysteine at a median time of 6 h (IQR 3.5-10.5) post-ingestion. Thirty-six (15%) patients developed hepatotoxicity, of whom 22 had an ALT ≤1,000 U/L at the time of initial acetaminophen-protein adduct measurement. Those who developed hepatotoxicity had a higher initial acetaminophen-protein adduct concentration compared to those who did not, 1.63 nmol/ml (IQR 0.76-2.02, n = 22) vs. 0.26 nmol/ml (IQR 0.15-0.41 n = 204 p <0.0001), respectively. The AUROC for hepatotoxicity was 0.98 (95% CI 0.96-1.00 n = 226 p <0.0001) with acetaminophen-protein adduct concentration and 0.89 (95% CI 0.82-0.96 n = 219 p <0.0001) with ALT. An acetaminophen-protein adduct concentration of 0.58 nmol/ml was 100% sensitive and 91% specific for identifying patients with an initial ALT ≤1,000 U/L who would develop hepatotoxicity. Adding acetaminophen-protein adduct concentrations to risk prediction models improved prediction of hepatotoxicity to a level similar to that obtained by more complex models. Acetaminophen-protein adduct concentration on presentation predicted which patients with acetaminophen overdose subsequently developed hepatotoxicity, regardless of time of ingestion. An adduct threshold of 0.58 nmol/L was required for optimal prediction. Acetaminophen poisoning is one of the most common causes of liver injury. This study examined a new biomarker of acetaminophen toxicity, which measures the amount of toxic metabolite exposure called acetaminophen-protein adduct. We found that those who developed liver injury had a higher initial level of acetaminophen-protein adducts than those who did not. Australian Toxicology Monitoring (ATOM) Study-Australian Paracetamol Project: ACTRN12612001240831 (ANZCTR) Date of registration: 23/11/2012.
Comparing motivational, self-regulatory and habitual processes in a computer-tailored physical activity intervention in hospital employees - protocol for the PATHS randomised controlled trial
Publisher: Springer Science and Business Media LLC
Date: 26-05-2017
Comparative efficacy of simultaneous versus sequential multiple health behavior change interventions among adults: A systematic review of randomised trials
Publisher: Elsevier BV
Date: 08-2016
DOI: 10.1016/J.YPMED.2016.06.012
Abstract: Growing evidence points to the benefits of addressing multiple health behaviors rather than single behaviors. This review evaluates the relative effectiveness of simultaneous and sequentially delivered multiple health behavior change (MHBC) interventions. Secondary aims were to identify: a) the most effective spacing of sequentially delivered components b) differences in efficacy of MHBC interventions for adoption/cessation behaviors and lifestyle/addictive behaviors, and c) differences in trial retention between simultaneously and sequentially delivered interventions. MHBC intervention trials published up to October 2015 were identified through a systematic search. Eligible trials were randomised controlled trials that directly compared simultaneous and sequential delivery of a MHBC intervention. A narrative synthesis was undertaken. Six trials met the inclusion criteria and across these trials the behaviors targeted were smoking, diet, physical activity, and alcohol consumption. Three trials reported a difference in intervention effect between a sequential and simultaneous approach in at least one behavioral outcome. Of these, two trials favoured a sequential approach on smoking. One trial favoured a simultaneous approach on fat intake. There was no difference in retention between sequential and simultaneous approaches. There is limited evidence regarding the relative effectiveness of sequential and simultaneous approaches. Given only three of the six trials observed a difference in intervention effectiveness for one health behavior outcome, and the relatively consistent finding that the sequential and simultaneous approaches were more effective than a usual/minimal care control condition, it appears that both approaches should be considered equally efficacious. PROSPERO registration number: CRD42015027876.
Associations of overall sitting time and sitting time in different contexts with depression, anxiety, and stress symptoms
Publisher: Elsevier BV
Date: 06-2014
Updated guidelines for the management of paracetamol poisoning in Australia and New Zealand
Publisher: AMPCo
Date: 12-2019
DOI: 10.5694/MJA2.50428
Abstract: Paracetamol is a common agent taken in deliberate self-poisoning and in accidental overdose in adults and children. Paracetamol poisoning is the commonest cause of severe acute liver injury. Since the publication of the previous guidelines in 2015, several studies have changed practice. A working group of experts in the area, with representation from all Poisons Information Centres of Australia and New Zealand, were brought together to produce an updated evidence-based guidance. The optimal management of most patients with paracetamol overdose is usually straightforward. Patients who present early should be given activated charcoal. Patients at risk of hepatotoxicity should receive intravenous acetylcysteine. The paracetamol nomogram is used to assess the need for treatment in acute immediate release paracetamol ingestions with a known time of ingestion. Cases that require different management include modified release paracetamol overdoses, large or massive overdoses, accidental liquid ingestion in children, and repeated supratherapeutic ingestions. The new guidelines recommend a two-bag acetylcysteine infusion regimen (200 mg/kg over 4 h, then 100 mg/kg over 16 h). This has similar efficacy but significantly reduced adverse reactions compared with the previous three-bag regimen. Massive paracetamol overdoses that result in high paracetamol concentrations more than double the nomogram line should be managed with an increased dose of acetylcysteine. All potentially toxic modified release paracetamol ingestions (≥ 10 g or ≥ 200 mg/kg, whichever is less) should receive a full course of acetylcysteine. Patients ingesting ≥ 30 g or ≥ 500 mg/kg should receive increased doses of acetylcysteine.
Prescribing trend of tapentadol in a Sydney local health district
Publisher: Wiley
Date: 07-07-2022
DOI: 10.1111/BCP.15448
Abstract: Tapentadol, an opioid with mu‐opioid receptor agonism and noradrenaline reuptake inhibition, has been increasingly used in Australia since 2011. However, data on hospital prescribing trends and indications are scarce. This study aimed to investigate hospital prescribing trends of tapentadol, oxycodone and tramadol in a Sydney local health district (LHD) and the indications for tapentadol hospital prescriptions in an Australian tertiary hospital. We analysed 5‐year patient dispensing for tapentadol, oxycodone and tramadol from four hospitals in a Sydney LHD with data expressed as oral morphine equivalents (OME). We also conducted a retrospective review of 140 and 54 patients prescribed tapentadol at a tertiary hospital's surgical and spinal units in 2020. Over 5 years in the Sydney LHD, there was a 19.5% reduction in total dispensing of these opioids from 1 225 210 to 986 477.5 OME milligrams. Decreases were specifically for oxycodone (−37.8% immediate‐release, −65.2% sustained‐release) and tramadol (−74.6% immediate‐release, −70.1% sustained‐release). Contrastingly, hospital prescriptions of tapentadol immediate‐release increased by 223.2% between 2018–19 and 2020–21 while sustained‐release increased by 17.9% from 2016–17 to 2020–21. By 2020–21, tapentadol overtook oxycodone to become the most prescribed opioid in the Sydney LHD (51.4%). At the hospital's surgical units, 137 (97.9%) patients were prescribed tapentadol for acute post‐operative pain with the majority (54.0%) prescribed both immediate‐release and sustained‐release tapentadol, while 71.1% were prescribed for neuropathic pain in the spinal units. In a Sydney LHD, tapentadol prescriptions increased significantly to become the preferred opioid analgesic. At the hospital's surgical units, off‐label prescriptions of tapentadol sustained‐release for acute post‐operative pain were observed.
Tapentadol exposures and poisonings in Australia.
Publisher: Informa UK Limited
Date: 07-06-2022
DOI: 10.1080/15563650.2022.2074857
Abstract: Tapentadol is an atypical opioid with mu-receptor affinity and noradrenaline reuptake inhibition approved for use in Australia in 2011. However, data on tapentadol poisoning are scarce. To investigate tapentadol poisonings and related deaths in Australia. We performed a retrospective review of tapentadol poisonings from New South Wales Poisons Information Centre (NSWPIC) and three toxicology units in Australia. The National Coronial Information System (NCIS) database was searched to determine the number of tapentadol-related deaths. Between 2016 and 2020, 220 tapentadol calls were made to NSWPIC, with a 4.5-fold increase in tapentadol exposure calls. The median dose ingested was 575 mg (IQR: 300-1163 mg). Most overdoses included co-ingestions (75%), especially benzodiazepines (26%) and opioids (25%). From Jan 2016 to Dec 2021, 107 patients presented to the three toxicology units with tapentadol poisoning. The median dose ingested was 500 mg (IQR: 200-1400 mg). Most patients took co-ingestants (84%), including benzodiazepines (40%) and opioids (32%). Naloxone was administered in 39 patients (36%), 10 (9%) were intubated and the median length of stay was 18 h (IQR: 9-30). Thirty-five tapentadol-related deaths were recorded within NCIS between Jan 2015 and Oct 2021 with a median age of 51 years (IQR: 42-61 years). There are increasing tapentadol poisonings and deaths reported to the NSWPIC, three toxicology units, and NCIS in Australia. Most tapentadol poisonings were taken with benzodiazepines and/or other opioids.
Pneumocystis jirovecii pneumonia: still a concern in patients with haematological malignancies and stem cell transplant recipients
Publisher: Oxford University Press (OUP)
Date: 12-05-2016
DOI: 10.1093/JAC/DKW155
Abstract: The risk of patients with ALL and recipients of an allogeneic HSCT developing Pneumocystis jirovecii pneumonia is sufficiently high to warrant guidelines for the laboratory diagnosis, prevention and treatment of the disease. In this issue, the European Conference on Infections in Leukemia (ECIL) presents its recommendations in three companion papers.
Is preference for mHealth intervention delivery platform associated with delivery platform familiarity?
Publisher: Springer Science and Business Media LLC
Date: 22-07-2016
Acetaminophen protein adduct formation following low-dose acetaminophen exposure: Comparison of immediate-release vs extended-release formulations
Publisher: Springer Science and Business Media LLC
Date: 28-09-2013
Effect of age on the severity of chronic lithium poisoning
Publisher: Informa UK Limited
Date: 18-02-2020
Why do men with prostate cancer discontinue active surveillance for definitive treatment? A mixed methods investigation
Publisher: Wiley
Date: 18-05-2022
DOI: 10.1002/PON.5947
Abstract: To explore the personal and/or medical reasons patients on active surveillance (AS) have, or consider having, further definitive treatment for their prostate cancer. Research suggests up to 50% of patients on AS will discontinue within 5 years, though reasons for discontinuation from the patient's perspective is under-explored. Prostate cancer patients who were or had been on AS for at least 6 months were recruited. A questionnaire assessed reasons for receiving/considering definitive treatment and the extent to which reasons were personal or medical. Clinical information was extracted from a state-level population registry. A subset of participants were interviewed to further explore questionnaire responses. One-hundred and-three in iduals completed the survey 33 were also interviewed. Fifty-four survey participants (52%) had discontinued AS for definitive treatment. Common reasons for discontinuation were evidence of disease progression, doctor recommendation, desire to act, and fear of progression. Many participants who considered or had treatment reported weighing medical and personal factors equally in their decision. Interview participants described strongly considering any amount of disease progression and personal factors such as fear of progression, family concerns, and adverse vicarious experiences when deciding whether to pursue treatment. Both medical and personal factors are considered when deciding whether to discontinue AS. Identifying predictors of discontinuation is essential for informing supportive care services to improve AS management.
Overdose with modified-release paracetamol results in delayed and prolonged absorption of paracetamol
Publisher: Wiley
Date: 2010
DOI: 10.1111/J.1445-5994.2009.02096.X
Abstract: A modified-release formulation of paracetamol is currently available in Australasia and marketed under a number of different trade names. These include: Panadol Osteo, Panadol Extend Tablets, and Duatrol SR. We report four cases of intentional overdose with this formulation resulting in delay to peak plasma paracetamol concentrations and prolonged paracetamol absorption. Physicians must be aware that a single plasma paracetamol estimation four or more hours post-ingestion may not be adequate in the risk assessment of patients requiring treatment with N-acetylcysteine (NAC). Current Australasian guidelines for the management of modified-release paracetamol overdose advise empiric commencement of NAC if the suspected ingested dose is greater than 10 grams or 200 mg/kg (whichever is the least), an initial plasma paracetamol concentration should be assayed four or more hours post-ingestion and a second assay should be estimated four hours after the first. Treatment with NAC should continue if either concentration falls above the paracetamol treatment nomogram line. With massive ingestions of this paracetamol formulation (>50 grams) plasma concentrations may be elevated for several days and prolonged treatment with NAC is recommended. When modified-release paracetamol overdose is suspected a clinical toxicologist or Poisons Information Centre should be consulted to help guide management decisions.
What is the utility of blood beta-hydroxybutyrate measurements in emergency department in patients without diabetes: a systematic review
Publisher: Springer Science and Business Media LLC
Date: 28-04-2023
DOI: 10.1186/S13643-023-02203-7
Abstract: Ketones are synthesised as an alternative fuel source during times of energy restriction. In the absence of a hyperglycemic emergency, ketosis in patients presenting to the emergency department (ED) may indicate reduced carbohydrate intake. In the perioperative setting, excess fasting with ketosis is associated with worse outcomes however, whether ketosis in patients without diabetes presenting to ED is also associated with worse outcomes is unclear. This systematic review aims to examine the evidence for ketosis in predicting the need for hospital admission in patients without diabetes, presenting to the ED. A systematic review was performed using PRISMA guidelines. We searched electronic bases (OVID-Medline, OVID-EMBASE, Scopus and PubMed) up to December 2022. Eligible studies included children or adults without diabetes presenting to the ED where a point-of-care capillary beta-hydroxybutyrate (BHB) was measured and compared to outcomes including the need for admission. Outcome measures included need for admission and length of stay. Content analysis was performed systematically bias and certainty assessed using standard tools. The literature search found 17,133 citations, 14,965 papers were subjected to title and abstract screening. The full text of 62 eligible studies were reviewed. Seven articles met the inclusion criteria. Six studies were conducted solely in the paediatric population, and of these, four were limited to children presenting with gastroenteritis symptoms. Median BHB was higher in children requiring hospital admission with an AUC of 0.64–0.65 across two studies. There was a weak correlation between BHB and dehydration score or duration of symptoms. The single study in adults, limited to stroke presentations, observed no relationship between BHB and neurological deficit at presentation. All studies were at risk of bias using the Newcastle-Ottawa Scale and was assessed of “very low” to “low” quality due to their study design in the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. Heterogeneity amongst selected studies precluded meta-analysis. The evidence for any utility of BHB measurement in the ED in absence of diabetes is limited to the paediatric population, specifically children presenting with symptoms of gastroenteritis. Any role in adults remains unexplored.
Measuring Engagement in eHealth and mHealth Behavior Change Interventions: Viewpoint of Methodologies (Preprint)
Publisher: JMIR Publications Inc.
Date: 15-11-2017
Abstract: ngagement in electronic health (eHealth) and mobile health (mHealth) behavior change interventions is thought to be important for intervention effectiveness, though what constitutes engagement and how it enhances efficacy has been somewhat unclear in the literature. Recently published detailed definitions and conceptual models of engagement have helped to build consensus around a definition of engagement and improve our understanding of how engagement may influence effectiveness. This work has helped to establish a clearer research agenda. However, to test the hypotheses generated by the conceptual modules, we need to know how to measure engagement in a valid and reliable way. The aim of this viewpoint is to provide an overview of engagement measurement options that can be employed in eHealth and mHealth behavior change intervention evaluations, discuss methodological considerations, and provide direction for future research. To identify measures, we used snowball s ling, starting from systematic reviews of engagement research as well as those utilized in studies known to the authors. A wide range of methods to measure engagement were identified, including qualitative measures, self-report questionnaires, ecological momentary assessments, system usage data, sensor data, social media data, and psychophysiological measures. Each measurement method is appraised and ex les are provided to illustrate possible use in eHealth and mHealth behavior change research. Recommendations for future research are provided, based on the limitations of current methods and the heavy reliance on system usage data as the sole assessment of engagement. The validation and adoption of a wider range of engagement measurements and their thoughtful application to the study of engagement are encouraged.
Depressive symptoms associated with psychological correlates of physical activity and perceived helpfulness of intervention features
Publisher: Elsevier BV
Date: 10-2015
Poisonings from hydrocarbon inhalant misuse in Australia
Publisher: Wiley
Date: 27-02-2023
DOI: 10.1111/ADD.16166
Abstract: Inhalational misuse of volatile substances has been a significant public health concern because of the risk of sudden death and associated chronic complications such as encephalopathy. The Australian Government released a Consensus‐based clinical practice guideline in 2011 on the management of volatile substance use in Australia, which noted a lack of available data particularly on harms. This study aimed to measure (1) the number of calls received by the New South Wales Poisons Information Centre (NSWPIC) regarding inhalational hydrocarbon exposures or poisonings and (2) the number of unintentional deaths reported to the National Coronial Information System (NCIS) in Australia. We performed a retrospective review of all recreational inhalational hydrocarbon exposure calls to the NSWPIC between 1 January 2010 and 31 December 2020. A search was made of the NCIS database in all states and territories over the same period to determine the number of non‐intentional inhalational hydrocarbon‐related deaths in Australia. Between January 2010 and December 2020, there were 752 primary calls made to the NSWPIC regarding hydrocarbon use or exposure. Age or age bracket was recorded in 748 cases, with 508 (67%) calls involving children or adolescents. Over the same time, there were 58 unintentional deaths involving the recreational use of inhalational hydrocarbons. The median age at death was 23 years (interquartile range = 15–30 years), and 72% (42 cases) were male. Cause of death was predominately acute suffocation/asphyxia, encephalopathy related to chronic use, cardiac arrest likely from sudden sniffing syndrome or thermal injuries secondary to unintentional fires sparked by the volatile agents. Although death and cardiac arrest are uncommon among people in Australia who misuse hydrocarbons for recreational use, the deaths and cardiac arrests tend to occur in adolescents.
The Significance of an Increased Beta-Hydroxybutyrate at Presentation to the Emergency Department in Patients with Diabetes in the Absence of a Hyperglycemic Emergency.
Publisher: Hindawi Limited
Date: 10-10-2019
DOI: 10.1155/2019/7387128
Abstract: The significance of hyperketonemia in adults with diabetes presenting to the emergency department with acute illness, not due to a diabetic hyperglycemic emergency, has not been well characterized. Adult patients with diabetes presenting to the emergency department who had venous blood gas and beta-hydroxybutyrate levels measured whilst in the emergency department were retrospectively evaluated for the relationship between BHB and clinical outcomes. Over 6 months, 404 patients with diabetes had at least one beta-hydroxybutyrate level measured in the emergency department. There were 23 admissions for diabetic ketoacidosis (DKA) or hyperosmolar state. Of the remainder, 58 patients had a beta- hydroxybutyrate ≥ 1 mmol / L this group had a higher glucose at presentation (19.0 (8.8) versus 10.4 (9.9) mmol/L), higher HbA1c (8.8 (5.4) versus 8.0 (3.3)%), lower bicarbonate (22.6 (6.2) versus 24.8 (4.7) mmol/L), and higher anion gap (14.8 (6.1) versus 12.6 (4.2)) than had those with BHB 1 mmol / L . There was no association between the presence of ketosis and the length of stay (4.2 (7.3) versus (3.0) (7.2) days). Acute illness in those with diabetes associated with ketosis in the absence of DKA is associated with worse glycaemic control than in those without ketosis. Ketosis may represent an intermediate state of metabolic dysregulation rather than being associated with a more severe acute illness, as suggested by no relationship between BHB and length of stay.
A comparison of correlates associated with adult physical activity behavior in major cities and regional settings.
Publisher: American Psychological Association (APA)
Date: 2014
DOI: 10.1037/HEA0000027
Abstract: People living outside of urban areas are at higher risk for physical inactivity. Understanding physical activity correlates in different settings is important for understanding this risk. This study compared psychological, demographic, and health-related correlates of activity among adults living in major cities (urban areas) and regional (low-population density) towns and whether there were significant differences in how these potential determinants related to physical activity. Participants (n = 756) were male and female adults who were members of the Australian Health and Social Science panel. Participant characteristics and physical activity were assessed using standardized measures via an online survey. Differences in the strength of the relation between the physical activity correlates were tested using equality of regression coefficient tests. Few differences in physical activity determinants between major cities and regional settings were observed. For major city and regional areas, self-efficacy and outcome expectations were the most strongly related correlates to physical activity. The strength of associations between the correlates and physical activity did not differ between areas, with the exception of working status. Not working was associated with lower odds of meeting physical activity guidelines for major city residents but not for regional residents. Physical activity correlates were generally similar for people living in major city and regional areas. This suggests that physical activity interventions targeting personal factors do not need to tailor to a person's level of urbanization. Studies examining the interaction between psychological correlates of physical activity and environmental factors are needed.
Angiotensin axis antagonists increase the incidence of haemodynamic instability in dihydropyridine calcium channel blocker poisoning
Publisher: Informa UK Limited
Date: 06-10-2020
A systematic review of the unmet supportive care needs of men on active surveillance for prostate cancer
Publisher: Wiley
Date: 06-11-2019
DOI: 10.1002/PON.5262
Abstract: Understanding the unmet supportive care needs of men on active surveillance for prostate cancer may enable researchers and health professionals to better support men and prevent discontinuation when there is no evidence of disease progression. This review aimed to identify the specific unmet supportive care needs of men on active surveillance. A systematic review following PRISMA guidelines was conducted. Databases (Pubmed, Embase, PsycINFO, and CINAHL) were searched to identify qualitative and/or quantitative studies that reported unmet needs specific to men on active surveillance. Quality appraisals were conducted before results were narratively synthesised. Of the 3613 unique records identified, only eight articles were eligible (five qualitative and three cross-sectional studies). Unmet Informational, Emotional/Psychological, Social, and "Other" needs were identified. Only three studies had a primary aim of investigating unmet supportive care needs. Small active surveillance s les, use of nonvalidated measures, and minimal reporting of author reflexivity in qualitative studies were the main quality issues identified. The unmet needs of men on active surveillance is an underresearched area. Preliminary evidence suggests the information available and provided to men during active surveillance is perceived as inadequate and inconsistent. Men may also be experiencing unmet psychological/emotional, social, and other needs however, further representative, high-quality research is required to understand the magnitude of this issue. Reporting results specific to treatment type and utilising relevant theories/models (such as the social ecological model [SEM]) is recommended to ensure factors that may facilitate unmet needs are appropriately considered and reported.
Acetaminophen Poisoning
Publisher: Elsevier BV
Date: 07-2021
Cue Consistency Associated with Physical Activity Automaticity and Behavior
Publisher: Informa UK Limited
Date: 25-07-2015
DOI: 10.1080/08964289.2015.1017549
Abstract: Physical activity is partly regulated by automatic processes such as habits (ie, well-learned responses to cues), but it remains unclear what cues trigger these processes. This study examined the relations of physical activity automaticity and behavior with the consistency of people, activity, routine, location, time, and mood cues present upon initiation of physical activity behavior. Australian adults (N = 1,244, 627 female, M age = 55 years) reported their physical activity automaticity, behavior, and the degree of consistency of these cues each time they start a physical activity behavior. Multiple regression models, which accounted for gender and age, revealed that more consistent routine and mood cues were linked to more physical activity automaticity whereas more consistent time and people cues were linked to more physical activity behavior. Interventions may more effectively translate into long-lasting physical activity habits if they draw people's attention to the salient cues of time, people, routine, and mood.
Physical Activity, Sedentary Behavior, and Diet-Related eHealth and mHealth Research: Bibliometric Analysis
Publisher: JMIR Publications Inc.
Date: 18-04-2018
DOI: 10.2196/JMIR.8954
Past, Present, and Future of eHealth and mHealth Research to Improve Physical Activity and Dietary Behaviors
Publisher: Elsevier BV
Date: 03-2016
DOI: 10.1016/J.JNEB.2015.12.006
Abstract: Because physical inactivity and unhealthy diets are highly prevalent, there is a need for cost-effective interventions that can reach large populations. Electronic health (eHealth) and mobile health (mHealth) solutions have shown promising outcomes and have expanded rapidly in the past decade. The purpose of this report is to provide an overview of the state of the evidence for the use of eHealth and mHealth in improving physical activity and nutrition behaviors in general and special populations. The role of theory in eHealth and mHealth interventions is addressed, as are methodological issues. Key recommendations for future research in the field of eHealth and mHealth are provided.
Experiences and needs of people with haematological cancers during the COVID-19 pandemic: A qualitative study
Publisher: Wiley
Date: 09-09-2022
DOI: 10.1002/PON.5819
Abstract: Haematological cancer patients are particularly vulnerable to the effects of COVID‐19. In addition to being immunocompromised, pandemic‐related travel restrictions have impacted access to treatments and overseas stem cell donations for patients requiring transplantation. Given this vulnerability, people with haematological cancers are at risk of experiencing heightened distress during the pandemic. This study aimed to explore haematological cancer patients' experiences and needs. Twenty‐four Australian haematological cancer patients completed semi‐structured interviews exploring their concerns and worries during the pandemic, impact of pandemic on management of disease, access to information and support, lifestyle changes, and attitudes towards emerging models of healthcare during the pandemic. Interview transcripts were thematically analysed. Four themes reflecting the experiences of haematological cancer patients during the pandemic were identified: ‘Fears about contracting COVID‐19' (behaviour changes to protect health, impact on daily routine and habits, annoyance at dismissive attitude of others toward COVID‐19) ‘Reduced sense of connection and support’ (reduced social support and access to external support services) ‘New challenges’ (increased financial hardship, worsened health), and ‘Underlying system and communication issues' (access to trusted information, satisfaction/dissatisfaction with care, navigating telehealth). Participants expressed a need for improved access to support services and trusted information. The findings emphasise the additional challenges experienced by haematological cancer patients during the COVID‐19 pandemic and their impact on daily life. Results point to the importance of validation of increased distress during periods of uncertainty reinforcing recommendations about high‐quality sources of information and facilitating access to support services when face‐to‐face care is limited.
Characteristics of Adopters of an Online Social Networking Physical Activity Mobile Phone App: Cluster Analysis
Publisher: JMIR Publications Inc.
Date: 03-06-2019
DOI: 10.2196/12484
Associations between occupational indicators and total, work-based and leisure-time sitting: A cross-sectional study
Publisher: Springer Science and Business Media LLC
Date: 12-2013
Efficacy of a two bag acetylcysteine regimen to treat paracetamol overdose (2NAC study).
Publisher: Elsevier BV
Date: 03-2020
Quality, Features, and Presence of Behavior Change Techniques in Mobile Apps Designed to Improve Physical Activity in Pregnant Women: Systematic Search and Content Analysis
Publisher: JMIR Publications Inc.
Date: 07-04-2021
DOI: 10.2196/23649
Abstract: Physical activity during pregnancy is associated with several health benefits for the mother and child. However, very few women participate in regular physical activity during pregnancy. eHealth platforms (internet and mobile apps) have become an important information source for pregnant women. Although the use of pregnancy-related apps has significantly increased among pregnant women, very little is known about their theoretical underpinnings, including their utilization of behavior change techniques (BCTs). This is despite research suggesting that inclusion of BCTs in eHealth interventions are important for promoting healthy behaviors, including physical activity. The aim of this study was to conduct a systematic search and content analysis of app quality, features, and the presence of BCTs in apps designed to promote physical activity among pregnant women. A systematic search in the Australian App Store and Google Play store using search terms relating to exercise and pregnancy was performed. App quality and features were assessed using the 19-item Mobile App Rating Scale (MARS), and a taxonomy of BCTs was used to determine the presence of BCTs (26 items). BCTs previously demonstrating efficacy in behavior changes during pregnancy were also identified from a literature review. Spearman correlations were used to investigate the relationships between app quality, app features, and number of BCTs identified. Nineteen exercise apps were deemed eligible for this review and they were accessed via Google Play (n=13) or App Store (n=6). The MARS overall quality scores indicated moderate app quality (mean 3.5 [SD 0.52]). Functionality was the highest scoring MARS domain (mean 4.2 [SD 0.5]), followed by aesthetics (mean 3.7 [SD 0.6]) and information quality (mean 3.16 [SD 0.42]). Subjective app quality (mean 2.54 [SD 0.64]) and likelihood for behavioral impact (mean 2.5 [SD 0.6]) were the lowest scoring MARS domains. All 19 apps were found to incorporate at least two BCTs (mean 4.74, SD 2.51 range 2-10). However, only 11 apps included BCTs that previously demonstrated efficacy for behavior change during pregnancy, the most common being provide opportunities for social comparison (n=8) and prompt self-monitoring of behavior (n=7). There was a significant positive correlation between the number of BCTs with engagement and aesthetics scores, but the number of BCTs was not significantly correlated with functionality, information quality, total MARS quality, or subjective quality. Our findings showed that apps designed to promote physical activity among pregnant women were functional and aesthetically pleasing, with overall moderate quality. However, the incorporation of BCTs was low, with limited prevalence of BCTs previously demonstrating efficacy in behavior change during pregnancy. Future app development should identify and adopt factors that enhance and encourage user engagement, including the use of BCTs, especially those that have demonstrated efficacy for promoting physical activity behavior change among pregnant women.
Triage to electrocardiogram sign‐off time in patients with acute coronary syndrome at a metropolitan Sydney hospital
Publisher: Wiley
Date: 16-02-2023
Abstract: To compare the time from triage to ECG sign‐off in patients with acute coronary syndrome, before and after the introduction of an electronic medical record‐integrated ECG workflow system (Epiphany). Additionally, to assess for any correlation between patient characteristics and ECG sign‐off times. A retrospective, single‐centre cohort study was performed at Prince of Wales Hospital, Sydney. Patients were included if they were over 18 years, presented to Prince of Wales Hospital ED during 2021, had an ED diagnosis code of ‘ACS’, ‘UA’, ‘NSTEMI’ or ‘STEMI’ and were subsequently admitted under the cardiology team. ECG sign‐off times and demographic data were compared between patients presenting prior to 29 June (pre‐Epiphany group) and those presenting after (post‐Epiphany group). Those without ECGs signed‐off were excluded. There were 200 patients (100 each group) included in the statistical analysis. There was a significant decrease in the median triage to ECG sign‐off time, from 35 min (IQR 18–69) pre‐Epiphany, to 21 min (IQR 13–37) post‐Epiphany. There were only 10 (5%) patients in the pre‐Epiphany group and 16 (8%) in the post‐Epiphany group, who had ECG sign‐off times less than the 10‐min. There was no correlation between gender, triage category, age or time of shift with triage to ECG sign‐off time. The introduction of the Epiphany system has significantly reduced the triage to ECG sign‐off time in the ED. Despite this, there remains a large proportion of patients with acute coronary syndrome who do not have an ECG signed‐off within the guideline‐recommended 10 min.
Factors associated with higher sitting time in general, chronic disease, and psychologically-distressed, adult populations: Findings from the 45 & up Study
Publisher: Public Library of Science (PLoS)
Date: 03-06-2015
The comparative pharmacokinetics of modified-release and immediate-release paracetamol in a simulated overdose model
Publisher: Wiley
Date: 12-2010
DOI: 10.1111/J.1742-6723.2010.01354.X
Abstract: Panadol Extend (PEx) is an over-the-counter, modified-release formulation of paracetamol. Each 665 mg tablet contains 69% slow-release and 31% immediate-release paracetamol. In simulated human overdose, PEx exhibits lower and later peak serum concentrations and a lower area-under-the-curve (AUC) than comparable doses of immediate-release paracetamol (APAP-IR). The lower AUC might result from incomplete absorption of paracetamol or simultaneous metabolism with absorption. Do differences in pharmacokinetics (PK) between PEx and APAP-IR result from incomplete absorption or simultaneous absorption and metabolism of paracetamol? Cross-over study of 80 mg/kg of PEx or APAP-IR in nine volunteers. Serial plasma paracetamol, glucuronide, sulphate and cysteine metabolite estimates performed over 24 h. Peak plasma concentration (Cmax), AUC((0-∞),) time to peak concentration (Tmax) and elimination half-life (t(1/2) ) were compared. PEx exhibited significantly lower paracetamol Cmax (252.33 µmol/L vs 565.56 µmol/L, P= 0.0421), AUC((0-∞)) (2133 µmol/h/L vs 2637 µmol/h/L, P= 0.0004) and delayed Tmax (2.889 h vs 1.389 h, P= 0.0189) than APAP-IR. Sulphate metabolite PK parameters for both preparations, PEx vs APAP-IR, showed similar AUC((0-∞)) (1369 µmol/h/L vs 1089 µmol/h/L), Tmax (3.889 h vs 4.444 h), Cmax (95.889 µmol/L vs 95.889 µmol/L) and t(1/2) (3.895 h vs 3.810 h). Glucuronide metabolite concentrations revealed that PEx produced a lower Cmax (257.44 µmol/L vs 335.22 µmol/L, P= 0.0239) than APAP-IR. All other pharmacokinetic parameters were similar. Cysteine metabolite was not detected. There were minor differences between the PK parameters of the two major paracetamol metabolites of these two preparations in simulated overdose. The variability in paracetamol AUC seen between the two preparations in moderate overdose might be explained by concurrent metabolism of paracetamol during slower absorption with PEx.
Related Organisations
Prince Of Wales Hospital And Community Health Services
Location: Australia
Related Funding Activities
No related grants have been discovered for Angela L Chiew.