ORCID Profile
0000-0002-9249-8808
Current Organisations
National University of Malaysia
,
HBA Legal (part of Crawford & Company)
,
University of Western Australia
,
Sydney Local Health District
,
Royal Prince Alfred Hospital
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Publications
Telerehabilitation for hip or knee osteoarthritis
Publisher: Wiley
Date: 24-06-2020
Primary care management of non‐specific low back pain: key messages from recent clinical guidelines
Publisher: AMPCo
Date: 04-2018
DOI: 10.5694/MJA17.01152
OASIS—a randomised, placebo-controlled trial of oral glucocorticoids for leg pain in patients with acute sciatica: trial protocol
Publisher: BMJ
Date: 06-2020
DOI: 10.1136/BMJOPEN-2020-040559
Abstract: Sciatica is a lower spine condition characterised by radiating leg pain below the knee. It may be accompanied by motor and sensory loss in the distribution of a spinal nerve. There are few effective treatments for sciatica. Orally administered glucocorticoids have shown some promise, however, any beneficial effects need to be confirmed and weighed against drug safety and cost-effectiveness, in a high-quality, definitive trial. The Oral Steroids In Sciatica (OASIS) trial is a randomised, placebo-controlled, double-blind trial that will evaluate a tapering regimen of oral prednisolone in 200 participants with acute sciatica. Participants will be recruited on presentation to general practice, specialist outpatient clinics or hospital emergency departments and randomised to receive orally administered prednisolone 50 mg per day, up to 3 days then tapering to cessation over 10 days, or placebo, for a maximum of 13 days, in addition to guideline advice. Participants will be followed for 1 year. The primary endpoint will be leg pain intensity at 2 weeks. Secondary outcomes will include back pain intensity, disability, time to recovery, quality of life and treatment success rate. Adverse events will be assessed and a cost-effectiveness analysis will be conducted. Ethical approval has been granted from the Human Research Ethics Committee, The University of Sydney. Trial results will be disseminated by publications and conference presentations and via the media. ACTRN12619001716156.
Scoping review of priority setting of research topics for musculoskeletal conditions
Publisher: BMJ
Date: 12-2018
DOI: 10.1136/BMJOPEN-2018-023962
Abstract: Describe research methods used in priority-setting exercises for musculoskeletal conditions and synthesise the priorities identified. Scoping review. Studies that elicited the research priorities of patients/consumers, clinicians, researchers, policy-makers and/or funders for any musculoskeletal condition were included. We searched MEDLINE and EMBASE from inception to November 2017 and the James Lind Alliance top 10 priorities, Cochrane Priority Setting Methods Group, and Cochrane Musculoskeletal and Back Groups review priority lists. The reported methods and research topics/questions identified were extracted, and a descriptive synthesis conducted. Forty-nine articles fulfilled our inclusion criteria. Methodologies and stakeholders varied widely (26 included a mix of clinicians, consumers and others, 16 included only clinicians, 6 included only consumers or patients and in 1 participants were unclear). Only two (4%) reported any explicit inclusion criteria for priorities. We identified 294 broad research priorities from 37 articles and 246 specific research questions from 17 articles, although only four (24%) of the latter listed questions in an actionable format. Research priorities for osteoarthritis were identified most often (n=7), followed by rheumatoid arthritis (n=4), osteoporosis (n=4) and back pain (n=4). Nearly half of both broad and specific research priorities were focused on treatment interventions (n=116 and 111, respectively), while few were economic (n=8, 2.7% broad and n=1, 0.4% specific), implementation (n=6, 2% broad and n=4, 1.6% specific) or health services and systems research (n=15, 5.1% broad and n=9, 3.7% specific) priorities. While many research priority-setting studies in the musculoskeletal field have been performed, methodological limitations and lack of actionable research questions limit their usefulness. Future studies should ensure they conform to good priority-setting practice to ensure that the generated priorities are of maximum value. CRD42017059250.
Ultrasound of Subtalar Joint Synovitis in Patients with Rheumatoid Arthritis: Results of an OMERACT Reliability Exercise Using Consensual Definitions
Publisher: The Journal of Rheumatology
Date: 11-2018
Abstract: To evaluate the intraobserver and interobserver reliability of the ultrasonographic (US) assessment of subtalar joint (STJ) synovitis in patients with rheumatoid arthritis (RA). Following a Delphi process, 12 sonographers conducted an US reliability exercise on 10 RA patients with hindfoot pain. The anteromedial, posteromedial, and posterolateral STJ was assessed using B-mode and power Doppler (PD) techniques according to an agreed US protocol and using a 4-grade semiquantitative grading score for synovitis [synovial hypertrophy (SH) and signal] and a dichotomous score for the presence of joint effusion (JE). Intraobserver and interobserver reliability were computed by Cohen’s and Light’s κ. Weighted κ coefficients with absolute weighting were computed for B-mode and PD signal. Mean weighted Cohen’s κ for SH, PD, and JE were 0.80 (95% CI 0.62–0.98), 0.61 (95% CI 0.48–0.73), and 0.52 (95% CI 0.36–0.67), respectively. Weighted Cohen’s κ for SH, PD, and JE in the anteromedial, posteromedial, and posterolateral STJ were −0.04 to 0.79, 0.42–0.95, and 0.28–0.77 0.31–1, −0.05 to 0.65, and −0.2 to 0.69 0.66–1, 0.52–1, and 0.42–0.88, respectively. Weighted Light’s κ for SH was 0.67 (95% CI 0.58–0.74), 0.46 (95% CI 0.35–0.59) for PD, and 0.16 (95% CI 0.08–0.27) for JE. Weighted Light’s κ for SH, PD, and JE were 0.63 (95% CI 0.45–0.82), 0.33 (95% CI 0.19–0.42), and 0.09 (95% CI −0.01 to 0.19), for the anteromedial 0.49 (95% CI 0.27–0.64), 0.35 (95% CI 0.27–0.4), and 0.04 (95% CI −0.06 to 0.1) for posteromedial and 0.82 (95% CI 0.75–0.89), 0.66 (95% CI 0.56–0.8), and 0.18 (95% CI 0.04–0.34) for posterolateral STJ, respectively. Using a multisite assessment, US appears to be a reliable tool for assessing synovitis of STJ in RA.
Is lateral epicondylitis a new indication for botulinum toxin?
Publisher: CMA Joule Inc.
Date: 26-04-2010
DOI: 10.1503/CMAJ.100358
Knee osteoarthritis and role for surgical intervention: Lessons learned from randomized clinical trials and population-based cohorts
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 03-2014
Purinergic mechanisms in the control of gastrointestinal motility
Publisher: Springer Science and Business Media LLC
Date: 06-10-2007
Efficacy and safety of neuromodulators in inflammatory arthritis: a cochrane systematic review
Publisher: The Journal of Rheumatology
Date: 09-2012
Abstract: To determine the efficacy and safety of neuromodulators for pain management in patients with inflammatory arthritis. A Cochrane systematic review was performed as part of the 3e Initiative on pain management in inflammatory arthritis. We searched Medline, Embase, and Cochrane Central for studies to November 2010, and American College of Rheumatology/European League Against Rheumatism meeting abstracts published in 2008-2009. Studies were included if they were randomized or quasirandomized controlled trials that compared any neuromodulator (excluding cannabis) to another therapy (active or placebo, including nonpharmacological therapies) for pain in patients with RA, psoriatic arthritis, ankylosing spondylitis, or spondyloarthritis. Primary outcomes of interest were patient-reported pain relief of 30% or greater and withdrawals due to adverse events. Two authors independently extracted data and assessed methodological quality. A risk of bias assessment was performed using the methods recommended by the Cochrane Collaboration. Three trials, all in RA and all at high risk of bias, were included in this review. Two placebo-controlled trials evaluated nefopam (52 participants) and one placebo-controlled trial evaluated topical capsaicin 0.025% (31 participants). Pooled analysis showed a significant reduction in pain levels favoring nefopam over placebo after 2 weeks [weighted mean difference -21.2, 95% CI -35.6 to -6.7 number needed to treat (NNT) 2, 95% CI 1.4 to 9.5]. However, nefopam was associated with significantly more adverse events (RR 4.1, 95% CI 1.6 to 10.7 number needed to harm 9, 95% CI 2 to 367), predominantly nausea and sweating. In one trial, capsaicin reduced pain more than placebo at 1 and 2 weeks (MD -23.8, 95% CI -44.8 to -2.8 NNT 3, 95% CI 2-47, and -34.4, 95% CI -54.7 to -14.14 NNT 2, 95% CI 1.4 to 6, respectively). Of those who received capsaicin, 44% developed burning at the site of application and 2% withdrew as a result. Based on 3 small trials, which were all at high risk of bias, there is weak evidence that nefopam and capsaicin are superior to placebo in reducing pain in patients with RA, but both are associated with a significant side effect profile. There are no available data for other types of IA or for newer agents such as gabapentin or pregabalin.
Outcome Domains and Measures in Total Joint Replacement Clinical Trials: Can We Harmonize Them? An OMERACT Collaborative Initiative
Publisher: The Journal of Rheumatology
Date: 04-2015
Abstract: To develop a plan for harmonizing outcomes for people undergoing total joint replacement (TJR), to achieve consensus regarding TJR outcome research. The TJR working group met during the 2014 Outcome Measures in Rheumatology (OMERACT) 12 meeting in Budapest, Hungary. Multiple conference calls preceded the face-to-face meeting. Brief presentations were made during a 1.5-h meeting, which included an overview of published systematic reviews of TJR trials and the results of a recent systematic review of TJR clinical trial outcome domains and measures. This was followed by discussion of potential core set areas/domains for TJR clinical trials (as per OMERACT Filter 2.0) as well as the challenges associated with the measurement of these domains. Working group participants discussed which TJR clinical trial outcome domains/areas map to the inner versus outer core for core domain set. Several challenges were identified with TJR outcomes including how to best measure function after TJR, elucidating the source of the pre- and post-TJR joint pain being measured, joint-specific versus generic quality of life instruments and the importance of patient satisfaction and revision surgery as outcomes. A preliminary core domain set for TJR clinical trials was proposed and included pain, function, patient satisfaction, revision, adverse events, and death. This core domain set will be further vetted with a broader audience. An international effort with active collaboration with the orthopedic community to standardize key outcome domains and measures is under way with the TJR working group. This effort will be further developed with new collaborations.
The efficacy and safety of opioids in inflammatory arthritis: a cochrane systematic review
Publisher: The Journal of Rheumatology
Date: 09-2012
Abstract: To determine the efficacy and safety of opioid analgesics in inflammatory arthritis (IA). We searched Medline, Embase, and Central to May 2010. Randomized controlled trials in adults with IA that compared opioids (administered via any route) to another intervention or placebo were included. Studies in the immediate postoperative setting were excluded. Two authors independently extracted data and assessed risk of bias. Primary endpoints were pain and adverse events (AE). Categorical data were pooled using RevMan5 and reported as relative risks (RR) or odds ratios (OR) with 95% confidence intervals (95% CI). Eleven studies were included, all in patients with RA. The risk of bias of all studies was high. No study was longer than 6 weeks in duration and 4 studies used single doses of study drugs. Seven studies were between 1 and 6 weeks in duration and assessed 6 different oral opioids. Only 1 study investigated a strong opioid. Data could be pooled from 4 studies comparing weak opioids to placebo: there was no difference in withdrawals due to inadequate analgesia (RR 0.82, 95% CI 0.34, 2.01), but patient-reported global impression of change was superior with opioids (RR 1.44, 95% CI 1.03, 2.03). Opioids were more likely than placebo to cause AE (OR 3.90, 95% CI 2.31, 6.56). There was no difference between opioids and placebo in net efficacy after adjustment for AE. Based on 11 heterogeneous studies of short duration and high risk of bias, there is weak evidence that opioids are effective analgesics in RA. AE are common and may offset the benefits. The relative risks and benefits of opioids in IA beyond 6 weeks are unknown.
99mTc-labelled glucosamine in the assessment of systemic sclerosis inflammatory lung disease: a novel inexpensive investigative tool with predictive value.
Publisher: Springer Science and Business Media LLC
Date: 28-07-2021
DOI: 10.1007/S12149-021-01653-0
Abstract: To evaluate the role of In this prospective pilot study, glucosamine scanning (GS) was performed in 15 SSc patients, with and without ILD. Collected data included patient disease characteristics, autoantibody profile, GS results, high-resolution computerised tomography [HRCT], pulmonary function tests [PFT], and transthoracic echocardiogram [TTE]. Glucosamine results were correlated with patient clinical profile, HRCT, and PFT's findings. Lung uptake of Increased
Why a dearth of sports and exercise medicine/physiotherapy research using hospital electronic medical records? A success story and template for researchers
Publisher: BMJ
Date: 21-05-2020
Marine oil supplements for rheumatoid arthritis
Publisher: Wiley
Date: 18-12-2019
Pedra Branca: Story of the Unheard Cases by S Jayakumar, Tommy Koh and Lionel Yee
Publisher: Bond University
Date: 25-06-2020
DOI: 10.53300/001C.13473
Abstract: Book Review
Is Mediation a Process of ‘Law’? A Hart-Ian Perspective
Publisher: Penerbit Universiti Kebangsaan Malaysia (UKM Press)
Date: 02-04-2021
Abstract: Mediation, as a form of dispute resolution, is widely practiced. Nations across the world recognize it as an increasingly appropriate form of dispute resolution. But the existential question remains. Can we rightly ascribe the word ‘law’ to the processes of mediation? This article makes one qualified proposition. Mediation is an extra-legal process, unless it is used to realize the law (and justice). This is for two reasons. First, mediation’s processes and mediated outcomes do not in themselves cause judges’ obeisance and adherence. Mediated settlements must rely on the law of contract for its validity and efficacy. Second, even if mediation is legislated to form part of our law, it is extra-legal. It does not comport with the minimum content of natural law in that it does not guarantee the realization of the law and access to justice. If we are to regard mediation as law, mediation must be used to realize the law and guarantee access to justice.
The efficacy and safety of antidepressants in inflammatory arthritis: a cochrane systematic review
Publisher: The Journal of Rheumatology
Date: 09-2012
Abstract: To determine the efficacy and safety of antidepressants in pain management in patients with inflammatory arthritis (IA). We searched the Cochrane Central Register of Controlled Trials, Medline, Embase, and PsychINFO for randomized controlled trials in adults with IA that compared any antidepressants (administered via any route) to another analgesic intervention or placebo. We also searched the 2008-2009 American College of Rheumatology and European League Against Rheumatism abstracts and performed a hand search of reference lists of relevant articles. Primary outcomes were patient-reported pain relief ≥ 30% and withdrawals due to adverse events. Two authors independently assessed methodological quality and extracted data. A risk of bias assessment was performed using methods recommended by the Cochrane Collaboration. Eight trials (652 participants) in patients with rheumatoid arthritis (RA) and 1 trial in patients with ankylosing spondylitis (100 participants) were included in this review. The majority of studies were published in the late 1980s in patients with active disease receiving minimal disease-modifying antirheumatic drug therapy. All trials evaluated tricyclic antidepressants (TCA) and 2 studies included a selective serotonin uptake inhibitor. Seven of the 9 trials had high risk of bias, 2 were unclear, and metaanalysis was not performed due to trial heterogeneity. RA trials with short-term outcome ( 6 wks) benefits on pain. One trial in depressed patients with RA showed no significant difference between amitriptyline and paroxetine given for 8 weeks (65% vs 56% much or very much improved RR 1.2, 95% CI 0.9 to 1.5). One trial found that amitriptyline was no better than placebo in reducing pain in patients with active AS over 2 weeks (MD -0.2, 95% CI -1.2 to 0.8). From 5 trials, withdrawals due to adverse events were not significantly different from placebo. However, there were significantly more minor adverse events in patients receiving TCA compared with those receiving a placebo (RR 2.3, 95% CI 1.2 to 4.4). These included somnolence, dizziness, dry mouth, and nausea. Based upon 9 trials of high or unclear risk of bias, it is not possible to draw firm conclusions about the efficacy of TCA as analgesics for patients with IA. The use of these agents may be associated with adverse events that are generally mild and do not lead to cessation of treatment. High-quality trials are needed in this area.
Efficacy and harms of orally, intramuscularly or intravenously administered glucocorticoids for sciatica: A systematic review and meta-analysis.
Publisher: Wiley
Date: 30-01-2020
DOI: 10.1002/EJP.1505
Abstract: Sciatica can be a debilitating condition and there is limited guidance on the use of glucocorticoids administered via the oral, intramuscular or intravenous route for this condition. These represent viable treatment options in the primary care setting. To evaluate the evidence on efficacy and harms of oral, IM and IV glucocorticoid administration for sciatica. MEDLINE, EMBASE, CENTRAL, CINAHL, PsycINFO (inception to October 2018) were searched for randomised placebo-controlled trials evaluating oral, IV or IM glucocorticoid administration for sciatica. Two authors extracted outcomes data. Continuous pain and disability outcomes were converted to a 0 (no pain/disability) to 100 (worst pain/disability) scale. Data were pooled using a random effects model. Overall quality of evidence was assessed using GRADE. Primary outcomes were leg pain and disability. Primary follow-up period was the immediate-term (<2 weeks from administration). We also considered adverse events. Nine trials were eligible. One study [n = 27] provided low quality evidence of a small reduction in disability with early administration of oral prednisone (within 1 week) MD -13.4 [-23.3, -3.5] but not for pain MD -2.5 [-16.9, 11.9]. There was low quality evidence from one study [n = 78] of moderate reduction in disability and small reduction in pain with early (within 72 hr of symptom onset) single intramuscular administration of methylprednisolone acetate MD -24.5 [-38.8, -10.2] and -14.0 [-27.4, -0.6], respectively. There were no immediate-term benefits with IV administration. The effects of glucocorticoids on immediate-term leg pain or disability are uncertain. Future large high quality trials are needed to resolve this uncertainty.
Australian and New Zealand evidence‐based recommendations for pain management by pharmacotherapy in adult patients with inflammatory arthritis
Publisher: Wiley
Date: 30-05-2014
Text Messaging and Web-Based Survey System to Recruit Patients With Low Back Pain and Collect Outcomes in the Emergency Department: Observational Study (Preprint)
Publisher: JMIR Publications Inc.
Date: 22-07-2020
Abstract: ow back pain (LBP) is a frequent reason for emergency department (ED) presentations, with a global prevalence of 4.4%. Despite being common, the number of clinical trials investigating LBP in the ED is low. Recruitment of patients in EDs can be challenging because of the fast-paced and demanding ED environment. he aim of this study is to describe the recruitment and response rates using an SMS text messaging and web-based survey system supplemented by telephone calls to recruit patients with LBP and collect health outcomes in the ED. n automated SMS text messaging system was integrated into Research Electronic Data Capture and used to collect patient-reported outcomes for an implementation trial in Sydney, Australia. We invited patients with nonserious LBP who presented to participating EDs at 1, 2, and 4 weeks after ED discharge. Patients who did not respond to the initial SMS text message invitation were sent a reminder SMS text message or contacted via telephone. The recruitment rate was measured as the proportion of patients who agreed to participate, and the response rate was measured as the proportion of participants completing the follow-up surveys at weeks 2 and 4. Regression analyses were used to explore factors associated with response rates. n total, 807 patients with nonserious LBP were invited to participate and 425 (53.0%) agreed to participate. The week 1 survey was completed by 51.5% (416/807) of participants. At week 2, the response rate was 86.5% (360/416), and at week 4, it was 84.4% (351/416). Overall, 60% of the surveys were completed via SMS text messaging and on the web and 40% were completed via telephone. Younger participants and those from less socioeconomically disadvantaged areas were more likely to respond to the survey via the SMS text messaging and web-based system. sing an SMS text messaging and web-based survey system supplemented by telephone calls is a viable method for recruiting patients with LBP and collecting health outcomes in the ED. This hybrid system could potentially reduce the costs of using traditional recruitment and data collection methods (eg, face-to-face, telephone calls only). R2-10.1136/bmjopen-2017-019052
The OMERACT Core Domain Set for Clinical Trials of Shoulder Disorders
Publisher: The Journal of Rheumatology
Date: 02-2019
Abstract: To reach consensus on the core domains to be included in a core domain set for clinical trials of shoulder disorders using the Outcome Measures in Rheumatology (OMERACT) Filter 2.1 Core Domain Set process. At OMERACT 2018, the OMERACT Shoulder Working Group conducted a workshop that presented the OMERACT 2016 preliminary core domain set and its rationale based upon a systematic review of domains measured in shoulder trials and international Delphi sessions involving patients, clinicians, and researchers, as well as a new systematic review of qualitative studies on the experiences of people with shoulder disorders. After discussions in breakout groups, the OMERACT core domain set for clinical trials of shoulder disorders was presented for endorsement by OMERACT 2018 participants. The qualitative review (n = 8) identified all domains included in the preliminary core set. An additional domain, cognitive dysfunction, was also identified, but confidence that this represents a core domain was very low. The core domain set that was endorsed by the OMERACT participants, with 71% agreement, includes 4 “mandatory” trial domains: pain, function, patient global — shoulder, and adverse events including death and 4 “important but optional” domains: participation (recreation/work), sleep, emotional well-being, and condition-specific pathophysiological manifestations. Cognitive dysfunction was voted out of the core domain set. OMERACT 2018 delegates endorsed a core domain set for clinical trials of shoulder disorders. The next step includes identification of a core outcome measurement set that passes the OMERACT 2.1 Filter for measuring each domain.
A Critique of the Strata Management Act's 'Social Legislation' Purpose Identified in Innab Salil v Verve Suites Mont' Kiara [2020] 12 MLJ 16 (FC)
Publisher: IIUM Press
Date: 16-05-2023
DOI: 10.31436/IIUMLJ.V31I1.786
Abstract: This case note provides a critique of the ‘Social Legislation’ purpose of the Strata Management Act 2013 identified in Innab Salil & Ors v Verve Suites Mont’ Kiara [2020] 12 MLJ 16 (‘Verve Suites’). This case note suggests that the ‘social legislation’ purpose identified in Verve Suites achieved two purposes. First, it identified the Act’s broad legislative purpose and guided its statutory interpretation. Second, it provided a normative rationale which justified why it should be read as taking precedence over other legislation. However, it is suggested that the words ‘social legislation’ applied to the Strata Management Act 2013 may be a misnomer. It is proposed that the Federal Court should reconsider a restatement of its findings on the ‘social legislation’ purpose of the Strata Management Act 2013.
A Preliminary Core Domain Set for Clinical Trials of Shoulder Disorders: A Report from the OMERACT 2016 Shoulder Core Outcome Set Special Interest Group
Publisher: The Journal of Rheumatology
Date: 15-01-2017
Abstract: The Outcome Measures in Rheumatology (OMERACT) Shoulder Core Outcome Set Special Interest Group (SIG) was established to develop a core outcome set (COS) for clinical trials of shoulder disorders. In preparation for OMERACT 2016, we systematically examined all outcome domains and measurement instruments reported in 409 randomized trials of interventions for shoulder disorders published between 1954 and 2015. Informed by these data, we conducted an international Delphi consensus study including shoulder trial experts, clinicians, and patients to identify key domains that should be included in a shoulder disorder COS. Findings were discussed at a stakeholder premeeting of OMERACT. At OMERACT 2016, we sought consensus on a preliminary core domain set and input into next steps. There were 13 and 15 participants at the premeeting and the OMERACT 2016 SIG meeting, respectively (9 attended both meetings). Consensus was reached on a preliminary core domain set consisting of an inner core of 4 domains: pain, physical function/activity, global perceived effect, and adverse events including death. A middle core consisted of 3 domains: emotional well-being, sleep, and participation (recreation and work). An outer core of research required to inform the final COS was also formulated. Our next steps are to (1) analyze whether participation (recreation and work) should be in the inner core, (2) conduct a third Delphi round to finalize definitions and wording of domains and reach final endorsement for the domains, and (3) determine which instruments fulfill the OMERACT criteria for measuring each domain.
Effect of leflunomide on the peripheral nerves in rheumatoid arthritis
Publisher: Wiley
Date: 16-01-2007
DOI: 10.1111/J.1445-5994.2007.01266.X
Abstract: The objective of this study was to determine the neurophysiological effects of leflunomide on peripheral nerves in rheumatoid arthritis. We conducted a prospective cohort trial of 32 patients with rheumatoid arthritis with 16 patients receiving leflunomide treatment and 16 receiving other disease-modifying anti-rheumatic drug therapies. Clinical, laboratory and neurophysiological measurements were used to determine the presence of a peripheral neuropathy in these patients at study entry and then after a further 3 and 6 months. Fifty-four per cent of the leflunomide group and 8% of the control group had an increase in their neuropathy symptom score 6 months into the study (P = 0.01). No correlation was found between the electrophysiological findings and the clinical symptoms. There was no significant difference between the two groups in upper and lower limb sensory and motor litudes and conduction velocities recorded at 3 and 6 months. One patient developed both clinical and neurophysiological evidence of a peripheral neuropathy 5 months into the study that improved after cessation of leflunomide therapy and cholestyramine washout. After 6 months of exposure we found that leflunomide was associated with an apparent increase in the clinical symptoms of peripheral neuropathy in patients with rheumatoid arthritis. These symptoms did not correlate with neurophysiological studies.
The OMERACT Ultrasound Group: A Report from the OMERACT 2016 Meeting and Perspectives
Publisher: The Journal of Rheumatology
Date: 02-2017
Abstract: To provide an update from the Outcome Measures in Rheumatology (OMERACT) Ultrasound Working Group on the progress for defining ultrasound (US) minimal disease activity threshold at joint level in rheumatoid arthritis (RA) and for standardization of US application in juvenile idiopathic arthritis (JIA). For minimal disease activity, healthy controls (HC) and patients with early arthritis (EA) who were naive to disease-modifying antirheumatic drugs were recruited from 2 centers. US was performed of the hands and feet, and scored semiquantitatively (0–3) for synovial hypertrophy (SH) and power Doppler (PD). Synovial effusion (SE) was scored a binary variable. For JIA, a Delphi approach and subsequent validation in static images and patient-based exercises were used to developed preliminary definitions for synovitis and a scoring system. For minimal disease activity, 7% HC had at least 1 joint abnormality versus 30% in the EA group. In HC, the findings of SH and PD were predominantly grade 1 whereas all grades were seen in the EA cohort, but SE was rare. In JIA, synovitis can be diagnosed based on B-mode findings alone because of the presence of physiological vascularization. A semiquantitative scoring system (0–3) for synovitis for both B-mode and Doppler were developed in which the cutoff between Doppler grade 2 and grade 3 was 30%. The first step has been taken to define the threshold for minimal disease activity in RA by US and to define and develop a scoring system for synovitis in JIA. Further steps are planned for the continuous validation of US in these areas.
Text Messaging and Web-Based Survey System to Recruit Patients With Low Back Pain and Collect Outcomes in the Emergency Department: Observational Study
Publisher: JMIR Publications Inc.
Date: 04-03-2021
DOI: 10.2196/22732
Abstract: Low back pain (LBP) is a frequent reason for emergency department (ED) presentations, with a global prevalence of 4.4%. Despite being common, the number of clinical trials investigating LBP in the ED is low. Recruitment of patients in EDs can be challenging because of the fast-paced and demanding ED environment. The aim of this study is to describe the recruitment and response rates using an SMS text messaging and web-based survey system supplemented by telephone calls to recruit patients with LBP and collect health outcomes in the ED. An automated SMS text messaging system was integrated into Research Electronic Data Capture and used to collect patient-reported outcomes for an implementation trial in Sydney, Australia. We invited patients with nonserious LBP who presented to participating EDs at 1, 2, and 4 weeks after ED discharge. Patients who did not respond to the initial SMS text message invitation were sent a reminder SMS text message or contacted via telephone. The recruitment rate was measured as the proportion of patients who agreed to participate, and the response rate was measured as the proportion of participants completing the follow-up surveys at weeks 2 and 4. Regression analyses were used to explore factors associated with response rates. In total, 807 patients with nonserious LBP were invited to participate and 425 (53.0%) agreed to participate. The week 1 survey was completed by 51.5% (416/807) of participants. At week 2, the response rate was 86.5% (360/416), and at week 4, it was 84.4% (351/416). Overall, 60% of the surveys were completed via SMS text messaging and on the web and 40% were completed via telephone. Younger participants and those from less socioeconomically disadvantaged areas were more likely to respond to the survey via the SMS text messaging and web-based system. Using an SMS text messaging and web-based survey system supplemented by telephone calls is a viable method for recruiting patients with LBP and collecting health outcomes in the ED. This hybrid system could potentially reduce the costs of using traditional recruitment and data collection methods (eg, face-to-face, telephone calls only). RR2-10.1136/bmjopen-2017-019052
Design and implementation of flexible advanced training in rheumatology: report of a pilot programme
Publisher: Wiley
Date: 02-06-2022
DOI: 10.1111/IMJ.15403
Abstract: Training in medicine is highly demanding and coincides with critical life tasks including relationship development, childbearing and rearing. The rigid requirements of training programmes risk precluding successful achievement of these extracurricular roles, forcing choices between work and other life commitments. Flexible employment structures that facilitate the development of high‐quality physicians are needed. To assess the outcomes of 2 novel flexible training positions in Rheumatology. The clinical department, trainees and senior administration designed flexible, part‐time advanced training positions in rheumatology. We sought to deliver excellent training, supervision and support while ensuring safe, efficient clinical service delivery within existing systems and cultures. Barriers to implementation were actively identified. We rejected job share arrangements in favour of independent part‐time positions anchored to departmental education, clinical and trainee needs. The outcomes of these positions have been determined through regular trainee meetings, clinic activity and costs. Trainees achieved all training requirements, reported high levels of job satisfaction, strong professional development, improved work−life balance and reduction of stress. Outpatient events increased and waiting times have decreased. We estimate that increased rebatable outpatient services have rendered the positions cost neutral. Flexible training positions can enhance clinical departments while enabling high‐quality training for junior doctors. Further work should consider longer term outcomes and application to different clinical and training settings.
Rheumatoid leptomeningitis presenting with an acute neuropsychiatric disorder
Publisher: BMJ
Date: 10-08-2019
DOI: 10.1136/PRACTNEUROL-2018-001978
Abstract: Leptomeningitis is a rare central nervous system manifestation of rheumatoid arthritis, generally in patients with established chronic rheumatoid disease. We report a 41-year-old man without previous rheumatoid arthritis or psychiatric disorder who presented with an acute neuropsychiatric disturbance and polyarthralgia. His MR scan of brain showed asymmetric bifrontal leptomeningitis, confirmed on (18F)-fluoro-D-glucose-positron emission tomography. Other investigations showed highly positive serum and cerebrospinal fluid anti-cyclic citrullinated peptide. A leptomeningeal biopsy showed necrotising leptomeningeal inflammation with ill-defined granulomas and lymphoplasmacytic infiltrate without organisms. Prolonged high-dose corticosteroids and then rituximab resulted in recovery. Chronic leptomeningitis can present with an acute neuropsychiatric disorder. We highlight that early rheumatoid disease can, rarely, cause a chronic leptomeningitis, reversible with immunotherapy.
Epidemiology of large-vessel vasculidities
Publisher: Elsevier BV
Date: 12-2010
DOI: 10.1016/J.BERH.2010.10.008
Abstract: The systemic vasculitides are multisystem disorders characterised by the inflammation of blood vessels and tissue necrosis. Classified by the size of the vessels affected, the large vessel vasculitides include giant cell arteritis (GCA) and Takayasu's arteritis (TA). These are anatomically, epidemiologically and clinically distinct conditions. They are often associated with considerable morbidity and mortality. The classification of vasculitis has been an area of controversy for many years and current classification criteria remain suboptimal. Although intensive efforts are under way to improve them, a further understanding of the aetiology and pathogenesis of these diseases is required to develop more sensitive and specific diagnostic tests. These efforts, however, have been h ered by the low prevalence of these diseases. The establishment of national and international registries is encouraged to enhance valuable data collection. These are anatomically, epidemiologically and clinically distinct conditions. This article summarises the current classification systems for systemic vasculitis and their limitations. We also review the presently known epidemiology, risk factors and morbidity and mortality associated with GCA and TA.
The OMERACT Ultrasound Working Group 10 Years On: Update at OMERACT 12
Publisher: The Journal of Rheumatology
Date: 15-03-2015
Abstract: Musculoskeletal ultrasound (US) now thrives as an established imaging modality for the investigation and management of chronic inflammatory arthritis. We summarize here results of the Outcome Measures in Rheumatology (OMERACT) US working group (WG) projects of the last 2 years. These results were reported at the OMERACT 12 meeting at the plenary session and discussed during breakout sessions. Topics included standardization of US use in rheumatic disease over the last decade and its contribution to understanding musculoskeletal diseases. This is the first update report of WG activities in validating US as an outcome measure in musculoskeletal inflammatory and degenerative diseases, including pediatric arthritis, since the OMERACT 11 meeting.
Introduction
Publisher: The Journal of Rheumatology
Date: 08-2019
Active women over 50: study protocol for RCT of a low-dose information and support program to promote physical activity behaviour change
Publisher: Springer Science and Business Media LLC
Date: 04-09-2019
Do outcomes reported in randomised controlled trials of joint replacement surgery fulfil the OMERACT 2.0 Filter? A review of the 2008 and 2013 literature
Publisher: Springer Science and Business Media LLC
Date: 30-05-2017
Outcome measures used in arthroplasty trials: Systematic review of the 2008 and 2013 literature
Publisher: The Journal of Rheumatology
Date: 15-05-2017
Abstract: Previously published literature assessing the reporting of outcome measures used in joint replacement randomized controlled trials (RCT) has revealed disappointing results. It remains unknown whether international initiatives have led to any improvement in the quality of reporting and/or a reduction in the heterogeneity of outcome measures used. Our objective was to systematically assess and compare primary outcome measures and the risk of bias in joint replacement RCT published in 2008 and 2013. We searched MEDLINE, EMBASE, and CENTRAL for RCT investigating adult patients undergoing joint replacement surgery. Two authors independently identified eligible trials, extracted data, and assessed risk of bias using the Cochrane tool. Seventy RCT (30 in 2008, 40 in 2013) met the eligibility criteria. There was no significant difference in the number of trials judged to be at low overall risk of bias (n = 6, 20%) in 2008 compared with 2013 [6 (15%) chi-square = 0.302, p = 0.75]. Significantly more trials published in 2008 did not specify a primary outcome measure (n = 25, 83%) compared with 18 trials (45%) in 2013 (chi-square = 10.6316, p = 0.001). When specified, there was significant heterogeneity in the measures used to assess primary outcomes. While less than a quarter of trials published in both 2008 and 2013 were judged to be at low overall risk of bias, significantly more trials published in 2013 specified a primary outcome. Although this might represent a temporal trend toward improvement, the overall frequency of primary outcome reporting and the wide heterogeneity in primary outcomes reported remain suboptimal.
Improving Benefit-harm Assessment of Therapies from the Patient Perspective: OMERACT Premeeting Toward Consensus on Core Sets for Randomized Controlled Trials
Publisher: The Journal of Rheumatology
Date: 15-01-2019
Abstract: Outcome Measures in Rheumatology (OMERACT) convened a premeeting in 2018 to bring together patients, regulators, researchers, clinicians, and consumers to build upon previous OMERACT drug safety work, with patients fully engaged throughout all phases. Day 1 included a brief introduction to the history of OMERACT and methodology, and an overview of current efforts within and outside OMERACT to identify patient-reported medication safety concerns. On Day 2, two working groups presented results after each, breakout groups were assembled to discuss findings. Five themes pertaining to drug safety measurement emerged. Current approaches have failed to include data from the patient’s perspective. A better understanding of how in iduals with rheumatic diseases view potential benefits and harms of therapies is essential.
Personalised yoga for burnout and traumatic stress in junior doctors.
Publisher: Oxford University Press (OUP)
Date: 16-04-2020
DOI: 10.1136/POSTGRADMEDJ-2019-137413
Abstract: Junior doctors are frequently exposed to occupational and traumatic stress, sometimes with tragic consequences. Mindfulness-based and fitness interventions are increasingly used to mitigate this, but have not been compared. We conducted a randomised, controlled pilot trial to assess the feasibility, acceptability and effectiveness of these interventions in junior doctors. We randomised participants (n=21) to weekly 1-hour sessions of personalised, trauma-informed yoga (n=10), with a 4-hour workshop, and eHealth homework or group-format fitness (n=8) in an existing wellness programme, MDOK. Burnout, traumatic stress and suicidality were measured at baseline and 8 weeks. Both interventions reduced burnout, and yoga increased compassion satisfaction within group on the Professional Quality of Life scale, without difference between groups on this measure. Personalised yoga significantly reduced depersonalisation (z=−1.99, p=0.05) compared with group fitness on the Maslach Burnout Inventory (MBI-HSS (MP)) and showed greater flexibility changes. Both interventions increased MBI Personal Accomplishment, with no changes in other self-report psychological or physiological metrics, including breath-counting. Participants doing one-to-one yoga rated it more highly overall (p=0.02) than group fitness, and reported it comparatively more beneficial for mental (p=0.01) and physical health (p=0.05). Face-to-face weekly sessions were 100% attended in yoga, but only 45% in fitness. In this pilot trial, both yoga and fitness improved burnout, but trauma-informed yoga reduced depersonalisation in junior doctors more than group-format fitness. One-to-one yoga was better adhered than fitness, but was more resource intensive. Junior doctors need larger-scale comparative research of the effectiveness and implementation of in idual, organisational and systemic mental health interventions. ANZCTR 12618001467224.
Polyarteritis nodosa presenting with bilateral testicular swelling and complicated by unilateral facial nerve palsy
Publisher: The Korean Urological Association
Date: 2011
Implementation of an evidence-based model of care for low back pain in emergency departments: protocol for the Sydney Health Partners Emergency Department (SHaPED) trial.
Publisher: BMJ
Date: 04-2018
Multinational evidence-based recommendations for pain management by pharmacotherapy in inflammatory arthritis: integrating systematic literature research and expert opinion of a broad panel of rheumat
Publisher: Oxford University Press (OUP)
Date: 24-03-2012
The OMERACT emerging leaders program: The good, the bad, and the future
Publisher: The Journal of Rheumatology
Date: 03-2019
Abstract: To describe the experience of the first OMERACT Emerging Leaders Program (ELP). A Delphi process identified positive aspects, areas for improvement, and future directions. Core items were defined as essential if they received ≥ 70% ratings. Participants valued relatable/accessible mentors (100%), including an OMERACT Executive mentor (100%), and a support network of peers (90%). Key items for future development were funding support (100%) and developing knowledge about OMERACT processes (90%) and politics (80%). The ELP has the potential to provide targeted training for early career researchers to develop relevant skills for future leadership roles within OMERACT.
TOWARDS ENFORCEABLE STANDARDS, RULES AND RIGHTS IN STRATA MANAGEMENT: AN ANALYSIS
Publisher: IIUM Press
Date: 19-12-2019
DOI: 10.31436/IIUMLJ.V27I2.433
Abstract: The Strata Management Act 2013 (Act 757) and the Strata Titles Act 1985 (Act 318) confer broad powers on strata communities to self-manage and self-regulate through body corporates (termed Strata Management Bodies). The policy behind these legislations promotes maximum autonomy and self-regulatory powers for Strata Management Bodies to, through their internal rule-making and decision-making processes, govern themselves in ways that best suit their needs and interests. Consequently, judicial and administrative recognition of Strata Management Bodies’ autonomy has left a lacuna of matters which are not justiciable by the Courts and/or the Strata Management Tribunal. This adversely affects homeowners’ ability to access substantive justice. This article, through doctrinal analyses of key Malaysian and Western Australian cases, sheds light on a selection of strata disputes illustrating the inadequacies of the law on strata title and strata management, and the lack of enforceable standards of good management practices. The article also explores how the apathetic application of general principles of company law to strata management bodies has left a lacuna of non-justiciability. Consequently, this article argues the case for strata law reform. It advocates for law reform that promulgate standards, rules and rights of good strata management as enforceable law, rather than mere general, high-level, unenforceable and unjusticiable principles.
The scope, funding and publication of musculoskeletal clinical trials performed in Australia
Publisher: AMPCo
Date: 02-2014
DOI: 10.5694/MJA13.10907
Abstract: Musculoskeletal conditions are the leading contributors to disability burden globally and account for 27.4% of total disability burden in Australia. Timely research that addresses important questions relevant to consumers, clinicians and policymakers is critical for reducing the burden associated with these conditions. Clinical trials are particularly important for providing information about whether interventions are effective and safe. They are also needed to test strategies for reducing the sizeable delays in translating evidence into practice. A review of the current scope of musculoskeletal clinical trials in Australia found that National Health and Medical Research Council funding is disproportionally low compared with the burden of these conditions (averaging 5.8 new trials per year through the project grant scheme over the past 5 years, representing 0.8% of all project grants and funding, and 5% of NHMRC clinical trial funding). In the past 2 years, 128 Australian-initiated trials were registered in a trial registry, while about one in 20 randomised trials published in 37 leading general medical and musculoskeletal-specific journals was initiated in Australia. None were implementation trials. Relative to the burden of musculoskeletal conditions in Australia, investment in clinical trials is not ideal. While Australian musculoskeletal trialists are productive and internationally competitive, we may not be addressing the most critical issues. There is an urgent need for Australian researchers, clinicians, policymakers and consumers to work collaboratively to prioritise the most important questions, secure appropriate research funding, and undertake well designed trials to ensure we deliver best evidence-informed care and optimal outcomes for people with musculoskeletal conditions.
Factors associated with commencing and ceasing opioid therapy in patients with rheumatoid arthritis
Publisher: Elsevier BV
Date: 12-2019
DOI: 10.1016/J.SEMARTHRIT.2019.06.003
Abstract: To determine factors associated with opioid use in rheumatoid arthritis (RA) patients. Adult RA patients (n = 3225, 73% female, mean age 57 years, median follow-up 54 months) were recruited into the Australian Rheumatology Association Database (ARAD) between 2001-2015. A logistic regression examining both within- and between-patient effect sizes for time-varying covariates, and transition-state analysis for covariates associated with opioid commencement or cessation were used to examine determinants of current opioid use. The population-averaged prevalence of any opioid use was 33% (95%CI 32-34), 9% (95% CI 8, 10) for high potency opioid use, and 62% (95% 60, 64) of patients reported opioid ever-use after five years of follow-up. Opioid use was higher in females and decreased with older baseline age. Within-patients opioid use was associated with higher self-reported pain and HAQ scores (p < 0.001), and NSAID (OR 1.88 1.67-2.10), oral glucocorticoid (2.23 .93-2.58), csDMARD (2.08 .78-2.44) and bDMARD (1.22 .06-1.40) treatment. Younger baseline age, higher pain scores, HAQ scores and oral GC use were important determinants of change in opioid use, associated with both a higher probability of commencing opioid use, and a lower probability of cessation. Paradoxically, NSAID and DMARD treatments were associated with both a lower probability of commencing opioids, and a lower probability of cessation. There was a high prevalence of opioid use among RA patients, which was associated with pain, function and GC treatment. NSAID, and DMARD treatments obviate the need for opioids in some, but not all, patients.
Comparison of People With ABI Living in Two Accommodation Settings: Shared Supported Accommodation and Residential Aged Care
Publisher: Cambridge University Press (CUP)
Date: 12-2010
Abstract: Background: People with severe acquired brain injury (ABI) often require high and ongoing levels of paid support, which is sometimes provided within a shared supported accommodation service (SSA). In Victoria there are more than 140 people with severe ABI living in shared supported accommodation services who have a similar level of disability as young people with ABI in residential aged care (RAC). Objectives: The aims of this article are twofold: (1) to describe the characteristics, support needs and level of community inclusion of people with an ABI living in shared SSA in Victoria and (2) to compare the characteristics, support needs, social contact, community integration and leisure participation of this group with a group of people with ABI under 50 years old living in RAC reported in a previous study. Participants: Information was obtained from SSA managers on 128 residents with an ABI, aged under 60 years, who were living in shared supported accommodation. Measures: Questionnaires were used to obtain information about the characteristics, support needs and occupational participation of participants. Support needs were measured utilising the Care and Needs Scale (CANS). Method: Questionnaires were sent to and completed by SSA managers. Results: Of the 39 SSA managers contacted, 32 provided information about the characteristics of 128 residents with ABI living in their facilities. While 72% of SSA residents accessed the community almost everyday or more often, 40% of this s le received a visit from a friend less often than once per year. Results of the CANS indicated that the SSA group required a similar level of support to the comparison group of people with ABI living in RAC, but went outside, participated in community based leisure activities, and visited friends significantly more often. There was no significant difference between the two groups in the frequency of visits to the facility from relatives or friends. Conclusion: Although the relationship between client outcomes and accommodation is a complex one, this study suggests that the type of accommodation and support has a significant impact on the frequency of community participation experienced people with ABI and high care needs.
Early development of the Australia and New Zealand Musculoskeletal Clinical Trials Network
Publisher: Wiley
Date: 2020
DOI: 10.1111/IMJ.14191
Abstract: The Australia and New Zealand Musculoskeletal (ANZMUSC) Clinical Trials Network was formed to build capacity and infrastructure for high-quality musculoskeletal clinical trials in our region. The purpose of this paper is to describe the steps taken in its formation to help others interested in establishing similar networks. In particular, we describe the steps taken to form the collaboration and our progress in achieving our vision and mission. Our aim is to focus on trials of highest importance and quality to provide definitive answers to the most pressing questions in our field.
Avascular necrosis in a HIV patient receiving ritonavir and inhaled fluticasone.
Publisher: SAGE Publications
Date: 28-11-2013
Abstract: We report a case of severe bilateral knee avascular necrosis in a HIV-positive man receiving ritonavir and inhaled fluticasone. This case highlights the need for a thorough medication history in patients on ritonavir-based antiretroviral therapy, especially where multiple prescribers are involved in the patient's care.
Opioid analgesics for rheumatoid arthritis pain
Publisher: American Medical Association (AMA)
Date: 06-02-2013
Abstract: CLINICAL QUESTION Do the benefits of opioid analgesics outweigh the risks in patients with persistent pain due to rheumatoid arthritis? BOTTOM LINE Weak opioids (such as codeine, dextropropoxyphene, and tramadol) may be effective in the short-term management of rheumatoid arthritis pain, but adverse effects are common and may outweigh the benefits alternative analgesics should be considered first.
NO ONE IS TOO SMALL TO MAKE A DIFFERENCE BY GRETA THUNBERG
Publisher: IIUM Press
Date: 28-12-2020
Enemies of the People: How Judges Shape Society
Publisher: No publisher found
Date: 2021
Management of low back pain in Australian emergency departments
Publisher: BMJ
Date: 04-06-2019
DOI: 10.1136/BMJQS-2019-009383
Abstract: To describe the diagnoses of people who present to the emergency department (ED) with low back pain (LBP), the proportion of people with a lumbar spine condition who arrived by ambulance, received imaging, opioids and were admitted to hospital and to explore factors associated with these four outcomes. In this retrospective study, we analysed electronic medical records for all adults presenting with LBP at three Australian EDs from January 2016 to June 2018. Outcomes included discharge diagnoses and key aspects of care (ambulance transport, lumbar spine imaging, provision of opioids, admission). We explored factors associated with these care outcomes using multilevel mixed-effects logistic regression models and reported data as ORs. There were 14 024 presentations with a ‘visit reason’ for low back pain, of which 6393 (45.6%) had a diagnosis of a lumbar spine condition. Of these, 31.4% arrived by ambulance, 23.6% received lumbar imaging, 69.6% received opioids and 17.6% were admitted to hospital. Older patients (OR 1.79, 95% CI 1.56 to 2.04) were more likely to be imaged. Opioids were less used during working hours (OR 0.81, 95% CI 0.67 to 0.98) and in patients with non-serious LBP compared with patients with serious spinal pathology (OR 1.65, 95% CI 1.07 to 2.55). Hospital admission was more likely to occur during working hours (OR 1.74, 95% CI 1.48 to 2.05) and for those who arrived by ambulance (OR 2.98, 95% CI 2.53 to 3.51). Many ED presentations of LBP were not due to a lumbar spine condition. Of those that were, we noted relatively high rates of lumbar imaging, opioid use and hospital admission.
Related Organisations
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No related grants have been discovered for Bethan Richards.