ORCID Profile
0000-0002-3823-895X
Current Organisations
University of Queensland
,
Peter MacCallum Cancer Centre
,
University of Melbourne
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Publisher: SAGE Publications
Date: 22-06-2020
Abstract: Digital health – the convergence of digital technologies within health and health care to enhance the efficiency of health-care delivery – is fast becoming an integral part of routine medical practice. The integration of digital health into traditional practice brings significant changes. Logic dictates that for medical practitioners to operate in this new digitally enabled environment, they require specific knowledge, skills and competencies relating to digital health. However, very few medical programmes in Australia and globally include digital health within their regular curriculum. This pilot study aimed to explore medical students’ perceptions and expectations of digital health education and training (ET). An online survey and focus groups were used to collect information about medical students’ perceptions and expectations relating to digital health and ET relating to this field within the medical programme at the University of Queensland. Sixty-three students took part in the survey, and 17 students were involved in four focus groups. Most participants had no formal ET in digital health. Most participants ( n = 43 68%) expressed a willingness to learn about digital health as part of their medical programme. Primarily, knowledge- and practice-related factors have motivated students to learn about digital health. The analysis of focus group data identified two superordinate themes: (a) drivers of digital health ET and (b) expectations relating to digital health ET. Students agreed that digital health is a relevant field for their future practice that should be taught as part of their regular curriculum.
Publisher: Springer Science and Business Media LLC
Date: 13-02-2019
DOI: 10.1007/S40263-019-00612-8
Abstract: Clozapine is the most effective medication for treatment-refractory schizophrenia. However, it has a high burden of adverse events, including common adverse events such as sialorrhea. Sialorrhea can lead to severe physical complications such as aspiration pneumonia, as well as psychological complications including embarrassment and low self-esteem. Compromised adherence and treatment discontinuation can occur due to intolerability. There have been no meta-analyses examining strategies to mitigate clozapine-induced sialorrhea. We systematically searched Chinese and Western research databases for randomised controlled trials examining agents for clozapine-induced sialorrhea. No limit to language or date were applied to the search. Where sufficient data for in idual agents was available, pairwise meta-analyses were conducted. Results were provided as risk ratios and number needed to treat. Sensitivity analysis was conducted by study quality. Adverse events were provided as number needed to harm. 19 studies provided data for use in the meta-analysis. Improvement in clozapine-induced sialorrhea was seen in meta-analyses of propantheline (studies = 6, risk ratio [RR] 2.38, 95% confidence interval [CI] 1.52-3.73 number needed to treat [NNT] 3, 95% CI 1.9-2.7), diphenhydramine (studies = 5, RR 3.09, 95% CI 2.36-4.03 NNT 2, 95% CI 1.5-2.0), chlorpheniramine (studies = 2, RR 2.37, 95% CI 1.59-3.55 NNT 3, 95% CI 1.6-3.5), and benzamide derivatives (odds ratio [OR] 6.93, 95% CI 3.03-15.86). When meta-analyses were limited to high-quality studies, all these results remained significant. Single studies of benzhexol, cyproheptadine, doxepin and Kongyan Tang showed promise. Propantheline increased rates of constipation with a number needed to harm (NNH) of 9 (95% CI 4.2-204.1). Clozapine-induced sialorrhea is a potentially serious adverse event. Included studies in this meta-analysis were limited by poor study quality. Diphenhydramine, chlorpheniramine and benzamide derivatives appear to have the best supporting evidence and lowest reported adverse events. Caution should be exercised when using propantheline given its increased risk of constipation.
Publisher: Elsevier BV
Date: 11-2018
Publisher: Wiley
Date: 27-02-2023
Abstract: Balancing disease control and treatment‐related toxicities can be challenging when treating higher‐risk brain metastases (BMs) that are larger in size or eloquent anatomical locations. Hypofractionated stereotactic radiosurgery (hfSRS) is expected to offer superior or equal efficacy with lower toxicity profile compared with single‐fraction SRS (sfSRS). We report the efficacy and toxicity profiles of hfSRS in a consecutive cohort of patients to support this predicted benefit from hfSRS for high‐risk BMs. We retrospectively analysed 185 consecutive in idual lesions from 152 patients with intact BMs treated with hfSRS between 1 July 2016 and 31 October 2019 and followed up to 30 April 2022 with serial brain magnetic resonance imaging (MRI). The primary endpoint was the event of radiation necrosis (RN). Local control (LC) rate and distant brain failure (DBF) were reported as secondary outcomes. Kaplan–Meier method was used to report the cumulative incidence of RN and overall survival and the incidence of DBF. Potential risk factors for RN were assessed using univariable Cox regression analysis. The median follow‐up was 38.0 months, and the median survival post‐SRS was 9.5 months. The cumulative incidence rate of RN was 13.2% (95% CI: 7.0–24.7%), and 18.1% of patients with confirmed RN were symptomatic. Higher mean dose delivered to planning target volume (PTV) (HR 1.22, 95% CI: 1.05–1.42, P = 0.01), higher mean BED 10 (biological equivalent dose assuming a tissue ratio of 10) (HR 1.12, 95% CI: 1.04–1.2, P 0.001), and higher mean BED 2 (HR 1.02, 95% CI: 1–1.04, P = 0.04) delivered to the lesion was associated with increased risk of RN. LC rate was 86% and the cumulative incidence of DBF was 36% with a median onset of 28.4 months. Our results support the predicted radiobiological benefit of the use of hfSRS in high‐risk BMs to limit treatment‐related toxicity with low risk for symptomatic RN comparable with lower risk population receiving sfSRS while achieving satisfactory local disease control.
Publisher: SAGE Publications
Date: 06-05-2018
Abstract: Although clozapine is the most effective medication for treatment refractory schizophrenia, only 40% of people will meet response criteria. We therefore undertook a systematic review and meta-analysis of global literature on clozapine augmentation strategies. We systematically reviewed PubMed, PsycInfo, Embase, Cochrane Database, Chinese Biomedical Literature Service System and China Knowledge Resource Integrated Database for randomised control trials of augmentation strategies for clozapine resistant schizophrenia. We undertook pairwise meta-analyses of within-class interventions and, where possible, frequentist mixed treatment comparisons to differentiate treatment effectiveness We identified 46 studies of 25 interventions. On pairwise meta-analyses, the most effective augmentation agents for total psychosis symptoms were aripiprazole (standardised mean difference: 0.48 95% confidence interval: −0.89 to −0.07) fluoxetine (standardised mean difference: 0.73 95% confidence interval: −0.97 to −0.50) and, sodium valproate (standardised mean difference: 2.36 95% confidence interval: −3.96 to −0.75). Memantine was effective for negative symptoms (standardised mean difference: −0.56 95% confidence interval: −0.93 to −0.20). However, many of these results included poor-quality studies. Single studies of certain antipsychotics (penfluridol), antidepressants (paroxetine, duloxetine), lithium and Ginkgo biloba showed potential, while electroconvulsive therapy was highly promising. Mixed treatment comparisons were only possible for antipsychotics, and these gave similar results to the pairwise meta-analyses. On the basis of the limited data available, the best evidence is for the use of aripiprazole, fluoxetine and sodium valproate as augmentation agents for total psychosis symptoms and memantine for negative symptoms. However, these conclusions are tempered by generally short follow-up periods and poor study quality.
No related grants have been discovered for Qichen Zhang.