ORCID Profile
0000-0001-6339-0374
Current Organisation
Queensland University of Technology
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Public Health and Health Services | Artificial Intelligence and Image Processing | Epidemiology | Environmental and Occupational Health and Safety | Neural, Evolutionary and Fuzzy Computation | Pattern Recognition and Data Mining | Information and Computing Sciences not elsewhere classified |
Environmentally Sustainable Information and Communication Services not elsewhere classified | Urban and Industrial Water Management | Climate Change Adaptation Measures | Social Ethics | Environmental Health | Occupational Health
Publisher: American Chemical Society (ACS)
Date: 10-10-2017
Abstract: Exposure to traffic related nitrogen dioxide (NO
Publisher: Frontiers Media SA
Date: 02-02-2016
Publisher: AMPCo
Date: 27-10-2019
DOI: 10.5694/MJA2.50372
Publisher: Institute of Electrical and Electronics Engineers (IEEE)
Date: 2005
Publisher: BMJ
Date: 12-2018
DOI: 10.1136/BMJOPEN-2018-023127
Abstract: Long-stay patients in acute hospitals commonly present with complex psychosocial needs and use high levels of hospital resources. To determine whether a specialist social worker-led model of care was associated with a reduction in length of stay for medically stable patients with complex psychosocial needs who were at risk of long stay, and to determine the economic value of this model relative to the decision makers’ willingness to pay for bed days released. A prospective, matched cohort study with historical controls. A large, tertiary teaching and referral hospital in metropolitan Southeast Queensland, Australia. Length of hospital stay for a cohort of patients seen under the specialist social worker-led model of care was compared with a matched control group of patients admitted to the hospital prior to the introduction of the new model of care using a multistate model with the social worker model of care as an intermediate event. Costs associated with the model of care were calculated and an estimate of the ‘cost per bed day’ was produced. The model of care reduced mean length of stay by 33 days. This translated to 9999 bed days released over 12 months. The cost to achieve this was estimated to be $A229 000 over 12 months. The cost per bed day released was $23, which is below estimates of hospital decision makers’ willingness to pay for a bed day to be released for an alternate use. The specialist social worker-led model of care was associated with a reduced length of stay at a relatively low cost. This is likely to represent a cost-effective use of hospital resources. The limitations of our historic control cohort selection mean that results should be interpreted with caution. Further research is needed to confirm these findings.
Publisher: Elsevier BV
Date: 06-2005
DOI: 10.1016/J.ATHEROSCLEROSIS.2004.12.005
Abstract: Indigenous Australians are at high risk for cardiovascular disease and type 2 diabetes. Carotid artery intimal medial thickness (CIMT) and brachial artery flow-mediated vasodilation (FMD) are ultrasound imaging based surrogate markers of cardiovascular risk. This study examines the relative contributions of traditional cardiovascular risk factors on CIMT and FMD in adult Indigenous Australians with and without type 2 diabetes mellitus. One hundred and nineteen Indigenous Australians were recruited. Physical and biochemical markers of cardiovascular risk, together with CIMT and FMD were measured for all subjects. Fifty-three Indigenous Australians subjects (45%) had type 2 diabetes mellitus. There was a significantly greater mean CIMT in diabetic versus non-diabetic subjects (p=0.049). In the non-diabetic group with non-parametric analyses, there were significant correlations between CIMT and: age (r=0.64, p<0.001), systolic blood pressure (r=0.47, p<0.001) and non-smokers (r=-0.30, p=0.018). In the diabetic group, non-parametric analysis showed correlations between CIMT, age (r=0.36, p=0.009) and duration of diabetes (r=0.30, p=0.035) only. Adjusting for age, sex, smoking and history of cardiovascular disease, Hb(A1c) became the sole significant correlate of CIMT (r=0.35, p=0.01) in the diabetic group. In non-parametric analysis, age was the sole significant correlate of FMD (r=-0.31, p=0.013), and only in non-diabetic subjects. Linear regression analysis showed significant associations between CIMT and age (t=4.6, p<0.001), systolic blood pressure (t=2.6, p=0.010) and Hb(A1c) (t=2.6, p=0.012), smoking (t=2.1, p=0.04) and fasting LDL-cholesterol (t=2.1, p=0.04). There were no significant associations between FMD and examined cardiovascular risk factors with linear regression analysis CIMT appears to be a useful surrogate marker of cardiovascular risk in this s le of Indigenous Australian subjects, correlating better than FMD with established cardiovascular risk factors. A lifestyle intervention programme may alleviate the burden of cardiovascular disease in Indigenous Australians by reducing central obesity, lowering blood pressure, correcting dyslipidaemia and improving glycaemic control. CIMT may prove to be a useful tool to assess efficacy of such an intervention programme.
Publisher: Elsevier BV
Date: 03-2023
Publisher: BMJ
Date: 02-2016
Publisher: Springer Science and Business Media LLC
Date: 15-04-2019
DOI: 10.1038/S41370-019-0138-1
Abstract: Heatwaves have potential health and safety implications for many workers, and heatwaves are predicted to increase in frequency and intensity with climate change. There is currently a lack of comparative evidence for the effects of heatwaves on workers' health and safety in different climates (sub-tropical and temperate). This study examined the relationship between heatwave severity (as defined by the Excess Heat Factor) and workers' compensation claims, to define impacts and identify workers at higher risk. Workers' compensation claims data from Australian cities with temperate (Melbourne and Perth) and subtropical (Brisbane) climates for the years 2006-2016 were analysed in relation to heatwave severity categories (low and moderate/high severity) using time-stratified case-crossover models. Consistent impacts of heatwaves were observed in each city with either a protective or null effect during heatwaves of low-intensity while claims increased during moderate/high-severity heatwaves compared with non-heatwave days. The highest effect during moderate/high-severity heatwaves was in Brisbane (RR 1.45, 95% CI: 1.42-1.48). Vulnerable worker subgroups identified across the three cities included: males, workers aged under 34 years, apprentice/trainee workers, labour hire workers, those employed in medium and heavy strength occupations, and workers from outdoor and indoor industrial sectors. These findings show that work-related injuries and illnesses increase during moderate/high-severity heatwaves in both sub-tropical and temperate climates. Heatwave forecasts should signal the need for heightened heat awareness and preventive measures to minimise the risks to workers.
Publisher: Springer Science and Business Media LLC
Date: 08-02-2022
Publisher: Elsevier BV
Date: 05-2018
DOI: 10.1016/J.ENVRES.2018.01.046
Abstract: Assessing historical exposure to air pollution in epidemiological studies is often problematic because of limited spatial and temporal measurement coverage. Several methods for modelling historical exposures have been described, including land-use regression (LUR). Satellite-based LUR is a recent technique that seeks to improve predictive ability and spatial coverage of traditional LUR models by using satellite observations of pollutants as inputs to LUR. Few studies have explored its validity for assessing historical exposures, reflecting the absence of historical observations from popular satellite platforms like Aura (launched mid-2004). We investigated whether contemporary satellite-based LUR models for Australia, developed longitudinally for 2006-2011, could capture nitrogen dioxide (NO
Publisher: Cambridge University Press (CUP)
Date: 13-08-2013
DOI: 10.1017/S0950268812001379
Abstract: Few studies have formally examined the relationship between meteorological factors and the incidence of child pneumonia in the tropics, despite the fact that most child pneumonia deaths occur there. We examined the association between four meteorological exposures (rainy days, sunshine, relative humidity, temperature) and the incidence of clinical pneumonia in young children in the Philippines using three time-series methods: correlation of seasonal patterns, distributed lag regression, and case-crossover. Lack of sunshine was most strongly associated with pneumonia in both lagged regression [overall relative risk over the following 60 days for a 1-h increase in sunshine per day was 0·67 (95% confidence interval (CI) 0·51–0·87)] and case-crossover analysis [odds ratio for a 1-h increase in mean daily sunshine 8–14 days earlier was 0·95 (95% CI 0·91–1·00)]. This association is well known in temperate settings but has not been noted previously in the tropics. Further research to assess causality is needed.
Publisher: Elsevier BV
Date: 03-2019
DOI: 10.1016/J.ENVRES.2018.12.024
Abstract: The thermal environment can directly affect workers' occupational health and safety, and act as a contributing factor to injury or illness. However, the literature addressing risks posed by varying temperatures on work-related injuries and illnesses is limited. To examine the occupational injury and illness risk profiles for hot and cold conditions. Daily numbers of workers' compensation claims in Adelaide, South Australia from 2003 to 2013 (n = 224,631) were sourced together with daily weather data. The impacts of maximum daily temperature on the risk of work-related injuries and illnesses was assessed using a time-stratified case-crossover study design combined with a distributed lag non-linear model. The minimum number of workers' compensation claims occurred when the maximum daily temperature was 25 °C. Compared with this optimal temperature, extremely hot temperatures (99th percentile) were associated with an increase in overall claims (RR: 1.30, 95%CI: 1.18-1.44) whereas a non-significant increase was observed with extremely cold temperatures (1st percentile, RR: 1.10 (95%CI: 0.99-1.21). Heat exposure had an acute effect on workers' injuries whereas cold conditions resulted in delayed effects. Moderate temperatures were associated with a greater injury burden than extreme temperatures. Days of very high temperatures were associated with the greatest risks of occupational injuries whereas moderate temperatures, which occur more commonly, have the greatest burden. These findings suggest that the broader range of thermal conditions should be considered in workplace injury and illness prevention strategies.
Publisher: Informa UK Limited
Date: 26-08-2016
DOI: 10.1080/02699052.2016.1199894
Abstract: Cerebral microcirculation after head injury is heterogeneous and temporally variable. Regions at risk of infarction such as peri-contusional areas are vulnerable to anaemia. However, direct quantification of the cerebral microcirculation is clinically not feasible. This study describes a novel experimental head injury model correlating cerebral microcirculation with histopathology analysis. To test the hypothesis that cerebral microcirculation at the ischaemic penumbrae is reduced over time when compared with non-injured regions. Merino sheep were instrumented using a transeptal catheter to inject coded microspheres into the left cardiac atrium, ensuring systemic distribution. After a blunt impact over the left parietal region, cytometric analyses quantified cerebral microcirculation and amyloid precursor protein staining identified axonal injury in pre-defined anatomical regions. A mixed effect regression model assessed the hourly blood flow results during 4 hours after injury. Cerebral microcirculation showed temporal reductions with minimal amyloid staining except for the ipsilateral thalamus and medulla. The spatial heterogeneity and temporal reduction of cerebral microcirculation in ovine models occur early, even after mild head injury, independent of the intracranial pressure and the level of haemoglobin. Alternate approaches to ensure recovery of regions with reversible injury require a targeted assessment of cerebral microcirculation.
Publisher: Elsevier BV
Date: 08-2018
DOI: 10.1016/J.ANNEPIDEM.2018.04.004
Abstract: Road safety is a major public health concern in China. However, the effectiveness of traffic laws in China is not known. We investigated the effect of traffic legislation on traffic deaths using data in Ningbo, China. We obtained traffic fatality data from 2002 to 2014 from the Ningbo Municipal Center for Disease Control and Prevention. An interrupted time series was used to look for change points in fatalities over time. We first used multiple change-point analysis to identify whether change points existed. Then, we checked if the identified change points corresponded to major changes in traffic legislation. Finally, we used a generalized additive model to examine the magnitude of those changes on fatalities. A total of 12,412 traffic fatalities occurred in the study period. We detected two change points in traffic fatalities, which corresponded to the road safety law in 2004 and the Criminal Law Amendment criminalizing risky driving in 2011. The fatalities showed an 18.9% reduction (relative risk = 0.81, 95% confidence interval, 0.74-0.89) after the first change point and a further 19.2% reduction (relative risk = 0.80, 95% confidence interval, 0.74-0.89) after the second change point. Traffic legislation might improve road safety by spurring behavioral changes that reduce traffic deaths in China. These laws may provide a sound model for other similar countries.
Publisher: eLife Sciences Publications, Ltd
Date: 23-07-2020
DOI: 10.7554/ELIFE.60080
Abstract: Some acronyms are useful and are widely understood, but many of the acronyms used in scientific papers hinder understanding and contribute to the increasing fragmentation of science. Here we report the results of an analysis of more than 24 million article titles and 18 million article abstracts published between 1950 and 2019. There was at least one acronym in 19% of the titles and 73% of the abstracts. Acronym use has also increased over time, but the re-use of acronyms has declined. We found that from more than one million unique acronyms in our data, just over 2,000 (0.2%) were used regularly, and most acronyms (79%) appeared fewer than 10 times. Acronyms are not the biggest current problem in science communication, but reducing their use is a simple change that would help readers and potentially increase the value of science.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 11-2009
Publisher: Springer Science and Business Media LLC
Date: 22-02-2011
Publisher: Public Library of Science (PLoS)
Date: 25-09-2009
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 2019
Publisher: Elsevier BV
Date: 05-2014
DOI: 10.1016/J.ENVINT.2014.01.029
Abstract: Air pollution is a persistent problem in urban areas, and traffic emissions are a major cause of poor air quality. Policies to curb pollution levels often involve raising the price of using private vehicles, for ex le, congestion charges. We were interested in whether higher fuel prices were associated with decreased air pollution levels. We examined an association between diesel and petrol prices and four traffic-related pollutants in Brisbane from 2010 to 2013. We used a regression model and examined pollution levels up to 16 days after the price change. Higher diesel prices were associated with statistically significant short-term reductions in carbon monoxide and nitrogen oxides. Changes in petrol prices had no impact on air pollution. Raising diesel taxes in Australia could be justified as a public health measure. As raising taxes is politically unpopular, an alternative political approach would be to remove schemes that put a downward pressure on fuel prices, such as industry subsidies and shopping vouchers that give fuel discounts.
Publisher: Springer Science and Business Media LLC
Date: 03-02-2012
DOI: 10.1007/S12350-012-9517-X
Abstract: This prospective study investigated the effects of caffeine ingestion on the extent of adenosine-induced perfusion abnormalities during myocardial perfusion imaging (MPI). Thirty patients with inducible perfusion abnormalities on standard (caffeineabstinent) adenosine MPI underwent repeat testing with supplementary coffee intake. Baseline and test MPIs were assessed for stress percent defect, rest percent defect, and percent defect reversibility. Plasma levels of caffeine and metabolites were assessed on both occasions and correlated with MPI findings. Despite significant increases in caffeine [mean difference 3,106 μg/L (95% CI 2,460 to 3,752 μg/L P < .001)] and metabolite concentrations over a wide range, there was no statistically significant change in stress percent defect and percent defect reversibility between the baseline and test scans. The increase in caffeine concentration between the baseline and the test phases did not affect percent defect reversibility (average change -0.003 for every 100 μg/L increase 95% CI -0.17 to 0.16 P = .97). There was no significant relationship between the extent of adenosine-induced coronary flow heterogeneity and the serum concentration of caffeine or its principal metabolites. Hence, the stringent requirements for prolonged abstinence from caffeine before adenosine MPI - based on limited studies - appear ill-founded.
Publisher: Springer Science and Business Media LLC
Date: 03-2013
DOI: 10.1038/495314D
Publisher: BMJ
Date: 12-2020
DOI: 10.1136/BMJOPEN-2020-041417
Abstract: There is a paucity of data that can be used to guide the management of critically ill patients with COVID-19. In response, a research and data-sharing collaborative—The COVID-19 Critical Care Consortium—has been assembled to harness the cumulative experience of intensive care units (ICUs) worldwide. The resulting observational study provides a platform to rapidly disseminate detailed data and insights crucial to improving outcomes. This is an international, multicentre, observational study of patients with confirmed or suspected SARS-CoV-2 infection admitted to ICUs. This is an evolving, open-ended study that commenced on 1 January 2020 and currently includes sites in over 48 countries. The study enrols patients at the time of ICU admission and follows them to the time of death, hospital discharge or 28 days post-ICU admission, whichever occurs last. Key data, collected via an electronic case report form devised in collaboration with the International Severe Acute Respiratory and Emerging Infection Consortium/Short Period Incidence Study of Severe Acute Respiratory Illness networks, include: patient demographic data and risk factors, clinical features, severity of illness and respiratory failure, need for non-invasive and/or mechanical ventilation and/or extracorporeal membrane oxygenation and associated complications, as well as data on adjunctive therapies. Local principal investigators will ensure that the study adheres to all relevant national regulations, and that the necessary approvals are in place before a site may contribute data. In jurisdictions where a waiver of consent is deemed insufficient, prospective, representative or retrospective consent will be obtained, as appropriate. A web-based dashboard has been developed to provide relevant data and descriptive statistics to international collaborators in real-time. It is anticipated that, following study completion, all de-identified data will be made open access. ACTRN12620000421932 ( anzctr.org.au/ACTRN12620000421932.aspx ).
Publisher: Elsevier BV
Date: 02-2011
Publisher: Elsevier BV
Date: 09-2022
DOI: 10.1016/J.JVAL.2022.01.017
Abstract: The EuroQoL 3-level version of EQ-5D and 5-level version of EQ-5D questionnaires are often used to quantify health states. They include ordinal responses across 5 health dimensions (EQ-5D index) and an EQ-visual analog scale (EQ-VAS) overall health rating. We investigated the value of incorporating the EQ-VAS to update health utility estimates using a Bayesian framework. We created a joint bivariate normal EQ-VAS and EQ-5D index utility model and compared this to a univariate normal EQ-5D index utility model. We tested these models for 1026 Sri Lankan patients with chronic kidney disease and 94 Australian patients with wounds. We validated our approach by simulating EQ-VAS and EQ-5D index responses and applying our Bayesian model and then comparing the modeled estimates to our observed data. The combined model showed a reduction in estimate uncertainty for all respondents. Compared with the EQ-5D index-only model, the mean utility for Sri Lankan respondents dropped from 0.556 (0.534-0.579) to 0.540 (0.521-0.559) in men and increased from 0.489 (0.461-0.518) to 0.528 (0.506-0.550) in women, with reduced credible interval width by 13% and 23%, respectively. The mean utility in Australian respondents moved from 0.715 (0.633-0.800) to 0.716 (0.652-0.782) in men, and 0.652 (0.581-0.723) to 0.652 (0.593-0.711) in women, with reduced credible interval width by 23% and 17%, respectively. The credible interval width for simulated data also narrowed, ranging from 8.3 to 8.5%. Including the EQ-VAS through Bayesian methods can add value by reducing requisite s le sizes and decision uncertainty using small amounts of additional data that is often collected but rarely used.
Publisher: Public Library of Science (PLoS)
Date: 10-03-2009
Publisher: Elsevier BV
Date: 02-2011
Publisher: John Wiley & Sons, Ltd
Date: 14-11-2012
Publisher: Elsevier BV
Date: 09-2019
DOI: 10.1016/J.SCITOTENV.2019.05.145
Abstract: A paradigm shift to the use of indoor rather than outdoor temperature to estimate the exposure risk of low and high temperatures is vital for better prediction of temperature health effects and timely health warnings, and will also assist in understanding the influence of temperature on energy consumption and comfort. This study aimed to quantify the percentage of hours during the year that indoor temperature (living room) was in the extended comfort band (18-28 °C) of a subtropical climate, and identify the diurnal pattern of indoor temperatures in different seasons. Data used was collected in a previous study on the association between indoor and outdoor temperature. A k-shape cluster analysis resulted in two clusters of indoor temperature patterns for both weekdays and weekends. A bimodal pattern was identified during the cool season and a flat top pattern for the warm season, with many variations at weekends. These patterns can be attributed to the influence of cooling and heating processes depending on the season as well as occupancy, occupants' interference, and building materials. During the intermediate season, a sinusoidal pattern was observed for both weekdays and weekends because occupants likely relied on outdoor temperature conditions which were similar to those expected indoors without heating or cooling devices. The percentage of hours in which the indoor temperature of the houses ranged within the extended comfort band was 72-97% throughout the year, but for the coldest and hottest months it was 50-75%. These findings show that Brisbane residents are at possible risk of exposure to cold and hot temperatures due to the poor thermal performance of houses, and confirm that there is no standard indoor temperature pattern for all houses.
Publisher: Elsevier BV
Date: 10-2019
DOI: 10.1016/J.SCITOTENV.2019.06.098
Abstract: The thermal working environment can have direct and in-direct effects on health and safety. Ambient temperatures have been associated with an increased risk of occupational injuries but it is unknown how the relationship can vary by weather, location and climate. To examine the relationship between ambient temperatures and work-related injury and illness compensation claims in three Australian cities: Melbourne and Perth (temperate climate) and Brisbane (subtropical climate) in order to determine how hot and cold weather influences the risk of occupational injury in Australia. Workers' compensation claims from each city for the period 2005 to 2016 were merged with local daily weather data. A time-stratified case-crossover design combined with a distributed lag non-linear model was used to quantify the impacts of daily maximum temperature (T Compared to the median maximum temperature (T The relationship between injury and ambient temperature appears to be variable depending on location and climate. In general, work-related injuries and illnesses appear to be more common at higher temperatures than lower temperatures. Adopting adaptation and prevention measures could reduce the social and economic burden of injury, and formulating effective measures for dealing with high temperatures should be prioritised given the predicted increase in the frequency and intensity of hot weather.
Publisher: BMJ
Date: 11-01-2021
DOI: 10.1136/MEDETHICS-2020-106785
Abstract: We conducted a survey to identify what types of health/medical research could be exempt from research ethics reviews in Australia. We surveyed Australian health/medical researchers and Human Research Ethics Committee (HREC) members. The survey asked whether respondents had previously changed or abandoned a project anticipating difficulties obtaining ethics approval, and presented eight research scenarios, asking whether these scenarios should or should not be exempt from ethics review, and to provide (optional) comments. Qualitative data were analysed thematically quantitative data in R. We received 514 responses. Forty-three per cent of respondents to whom the question applied, reported changing projects in anticipation of obstacles from the ethics review process 25% reported abandoning projects for this reason. Research scenarios asking professional staff to provide views in their area of expertise were most commonly exempted from ethics review (to prioritise systematic review topics 84%, on software strengths/weaknesses 85%) scenarios involving surplus s les (82%) and N-of-1 (single case) studies (76%) were most commonly required to undergo ethics review. HREC members were 26% more likely than researchers to require ethics review. Need for independent oversight, and low risk, were most frequently cited in support of decisions to require or exempt from ethics review, respectively. Considerable differences exist between researchers and HREC members, about when to exempt from review the research that ultimately serves the interests of patients and the public. It is widely accepted that evaluative research should be used to reduce clinical uncertainties—the same principle should apply to ethics reviews.
Publisher: SAGE Publications
Date: 03-2017
DOI: 10.1177/0310057X1704500214
Abstract: The reproducibility of the regional distribution of ventilation and the timing of onset of regional filling as measured by electrical impedance tomography lacks evidence. This study investigated whether electrical impedance tomography measurements in healthy males were reproducible when electrodes were replaced between measurements. Part 1: Recordings of five volunteers lying supine were made using electrical impedance tomography and a pneumotachometer. Measurements were repeated at least three hours later. Skin marking ensured accurate replacement of electrodes. No stabilisation period was allowed. Part 2: Electrical impedance tomography recordings of ten volunteers a 15 minute stabilisation period, extra skin markings, and time-averaging were incorporated to improve the reproducibility. Reproducibility was determined using the Bland–Altman method. To judge the transferability of the limits of agreement, a Pearson correlation was used for electrical impedance tomography tidal variation and tidal volume. Tidal variation was judged to be reproducible due to the significant correlation between tidal variation and tidal volume (r 2 = 0.93). The ventilation distribution was not reproducible. A stabilisation period, extra skin markings and time-averaging did not improve the outcome. The timing of regional onset of filling was reproducible and could prove clinically valuable. The reproducibility of the tidal variation indicates that non-reproducibility of the ventilation distribution was probably a biological difference and not measurement error. Other causes of variability such as electrode placement variability or lack of stabilisation when accounted for did not improve the reproducibility of the ventilation distribution.
Publisher: Springer Science and Business Media LLC
Date: 26-02-2014
DOI: 10.1038/NCLIMATE2146
Publisher: Public Library of Science (PLoS)
Date: 30-04-2009
Publisher: F1000 Research Ltd
Date: 27-09-2018
DOI: 10.12688/F1000RESEARCH.15522.2
Abstract: Background: Clinical trials might be larger than needed because arbitrary levels of statistical confidence are sought in the results. Traditional s le size calculations ignore the marginal value of the information collected for decision making. The statistical hypothesis testing objective is misaligned with the goal of generating information necessary for decision-making. The aim of the present study was to show that for a case study clinical trial designed to test a prior hypothesis against an arbitrary threshold of confidence more participants were recruited than needed to make a good decision about adoption. Methods: We used data from a recent RCT powered for traditional rules of statistical significance. The data were also used for an economic analysis to show the intervention led to cost-savings and improved health outcomes. Adoption represented a sensible investment for decision-makers. We examined the effect of reducing the trial’s s le size on the results of the statistical hypothesis-testing analysis and the conclusions that would be drawn by decision-makers reading the economic analysis. Results: As the s le size reduced it became more likely that the null hypothesis of no difference in the primary outcome between groups would fail to be rejected. For decision-makers reading the economic analysis, reducing the s le size had little effect on the conclusion about whether to adopt the intervention. There was always high probability the intervention reduced costs and improved health. Conclusions: Decision makers managing health services are largely invariant to the s le size of the primary trial and the arbitrary p-value of 0.05. If the goal is to make a good decision about whether the intervention should be adopted widely, then that could have been achieved with a much smaller trial. It is plausible that hundreds of millions of research dollars are wasted each year recruiting more participants than required for RCTs.
Publisher: F1000 Research Ltd
Date: 02-08-2018
DOI: 10.12688/F1000RESEARCH.15522.1
Abstract: Background: Clinical trials might be larger than needed because arbitrary high levels of statistical confidence are sought in the results. Traditional s le size calculations ignore the marginal value of the information collected for decision making. The statistical hypothesis testing objective is misaligned with the goal of generating information necessary for decision-making. The aim of the present study was to show that a clinical trial designed to test a prior hypothesis against an arbitrary threshold of confidence may recruit too many participants, wasting scarce research dollars and exposing participants to research unnecessarily. Methods: We used data from a recent RCT powered for traditional rules of statistical significance. The data were also used for an economic analysis to show the intervention led to cost savings and improved health outcomes. Adoption represented a good investment for decision-makers. We examined the effect of reducing the trial’s s le size on the results of the statistical hypothesis-testing analysis and the conclusions that would be drawn by decision-makers reading the economic analysis. Results: As the s le size reduced it became more likely that the null hypothesis of no difference in the primary outcome between groups would fail to be rejected. For decision-makers reading the economic analysis, reducing the s le size had little effect on the conclusion about whether to adopt the intervention. There was always high probability the intervention reduced costs and improved health. Conclusions: Decision makers managing health services are largely invariant to the s le size of the primary trial and the arbitrary p-value of 0.05. If the goal is to make a good decision about whether the intervention should be adopted widely, then that could have been achieved with a much smaller trial. It is plausible that hundreds of millions of research dollars are wasted each year recruiting more participants than required for RCTs.
Publisher: Public Library of Science (PLoS)
Date: 10-10-2018
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 06-2007
Publisher: No publisher found
Date: 2015
Publisher: BMJ
Date: 07-2015
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 08-2019
DOI: 10.1097/ALN.0000000000002752
Abstract: Nebulized antibiotics may be used to treat ventilator-associated pneumonia. In previous pharmacokinetic studies, lung interstitial space fluid concentrations have never been reported. The aim of the study was to compare intravenous and nebulized tobramycin concentrations in the lung interstitial space fluid, epithelial lining fluid, and plasma in mechanically ventilated sheep with healthy lungs. Ten anesthetized and mechanically ventilated healthy ewes underwent surgical insertion of microdialysis catheters in upper and lower lobes of both lungs and the jugular vein. Five ewes were given intravenous tobramycin 400 mg, and five were given nebulized tobramycin 400 mg. Microdialysis s les were collected every 20 min for 8 h. Bronchoalveolar lavage was performed at 1 and 6 h. The peak lung interstitial space fluid concentrations were lower with intravenous tobramycin 20.2 mg/l (interquartile range, 12 mg/l, 26.2 mg/l) versus the nebulized route 48.3 mg/l (interquartile range, 8.7 mg/l, 513 mg/l), P = 0.002. For nebulized tobramycin, the median epithelial lining fluid concentrations were higher than the interstitial space fluid concentrations at 1 h (1,637 interquartile range, 650, 1,781, vs. 16 mg/l, interquartile range, 7, 86, P & 0.001) and 6 h (48, interquartile range, 17, 93, vs. 4 mg/l, interquartile range, 2, 9, P & 0.001). For intravenous tobramycin, the median epithelial lining fluid concentrations were lower than the interstitial space fluid concentrations at 1 h (0.19, interquartile range, 0.11, 0.31, vs. 18.5 mg/l, interquartile range, 9.8, 23.4, P & 0.001) and 6 h (0.34, interquartile range, 0.2, 0.48, vs. 3.2 mg/l, interquartile range, 0.9, 4.4, P & 0.001). Compared with intravenous tobramycin, nebulized tobramycin achieved higher lung interstitial fluid and epithelial lining fluid concentrations without increasing systemic concentrations.
Publisher: BMJ
Date: 03-2017
Publisher: Springer Science and Business Media LLC
Date: 06-03-2014
DOI: 10.1007/S12519-014-0469-X
Abstract: Heatwaves have a significant impact on population health including both morbidity and mortality. In this study we examined the association between heatwaves and emergency hospital admissions (EHAs) for renal diseases in children (aged 0-14 years) in Brisbane, Australia. Daily data on EHAs for renal diseases in children and exposure to temperature and air pollution were obtained for Brisbane city from January 1, 1996 to December 31, 2005. A time-stratified case-crossover design was used to compare the risks for renal diseases between heatwave and non-heatwave periods. There were 1565 EHAs for renal diseases in children during the study period. Heatwaves exhibited a significant impact on EHAs for renal diseases in children after adjusting for confounding factors (odds ratio: 3.6 95% confidence interval: 1.4-9.5). The risk estimates differed with lags and the use of different heatwave definitions. There was a significant increase in EHAs for renal diseases in children during heatwaves in Brisbane, a subtropical city where people are well accustomed to warm weather. This finding may have significant implications for pediatric renal care, particularly in subtropical and tropical regions.
Publisher: Springer Science and Business Media LLC
Date: 05-03-2007
Abstract: Providing ongoing family centred support is an integral part of childhood cancer care. For families living in regional and remote areas, opportunities to receive specialist support are limited by the availability of health care professionals and accessibility, which is often reduced due to distance, time, cost and transport. The primary aim of this work is to investigate the cost-effectiveness of videotelephony to support regional and remote families returning home for the first time with a child newly diagnosed with cancer We will recruit 162 paediatric oncology patients and their families to a single centre randomised controlled trial. Patients from regional and remote areas, classified by Accessibility/Remoteness Index of Australia (ARIA+) greater than 0.2, will be randomised to a videotelephone support intervention or a usual support control group. Metropolitan families (ARIA+ ≤ 0.2) will be recruited as an additional usual support control group. Families allocated to the videotelephone support intervention will have access to usual support plus education, communication, counselling and monitoring with specialist multidisciplinary team members via a videotelephone service for a 12-week period following first discharge home. Families in the usual support control group will receive standard care i.e., specialist multidisciplinary team members provide support either face-to-face during inpatient stays, outpatient clinic visits or home visits, or via telephone for families who live far away from the hospital. The primary outcome measure is parental health related quality of life as measured using the Medical Outcome Survey (MOS) Short Form SF-12 measured at baseline, 4 weeks, 8 weeks and 12 weeks. The secondary outcome measures are: parental informational and emotional support parental perceived stress, parent reported patient quality of life and parent reported sibling quality of life, parental satisfaction with care, cost of providing improved support, health care utilisation and financial burden for families. This investigation will establish the feasibility, acceptability and cost-effectiveness of using videotelephony to improve the clinical and psychosocial support provided to regional and remote paediatric oncology patients and their families.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 06-1999
DOI: 10.1097/00007632-199906010-00010
Abstract: Postal questionnaire to in iduals with back pain. To assess the acceptability, validity, and reliability of two existing back pain outcome measures, the Roland-Morris Questionnaire and the Von Korff scales, modified to measure the preceding 4 weeks. The ideal outcome measure for studies of low back pain and disability remains elusive. Most existing measures assess current pain and disability. Measuring these factors over a preceding 4-week period may be more appropriate. In iduals with back pain identified in a community survey were asked to complete the modified questionnaires. Validity was assessed by comparison with the Medical Outcome Study Short Form 36 and two general comparator questions on self-reported pain and disability. Repeatability was assessed using retest questionnaires. Completed questionnaires were returned by 95 in iduals with chronic back pain. The modified Roland-Morris Questionnaire and Von Korff pain and Von Korff disability scales were completed satisfactorily by 83 (87%), 89 (94%), and 87 (92%) participants, respectively. Mean scores of the modified measures changed significantly and in a predictable manner with increasing ratings of pain and disability. They also correlated with aspects of the Medical Outcome Study Short Form 36 questionnaire. Retest data suggest that these measures are repeatable. The modified Roland-Morris Questionnaire provided adequate analyzable data only if missing values were imputed, and it explained less of the variance in the comparator questions than the modified Von Korff scales. The modified Von Korff scales were completed easily and appear to be valid and repeatable in this format.
Publisher: MDPI AG
Date: 28-04-2016
Publisher: Oxford University Press (OUP)
Date: 04-2010
DOI: 10.1086/651110
Abstract: Monetary valuations of the economic cost of health care-associated infections (HAIs) are important for decision making and should be estimated accurately. Erroneously high estimates of costs, designed to jolt decision makers into action, may do more harm than good in the struggle to attract funding for infection control. Expectations among policy makers might be raised, and then they are disappointed when the reduction in the number of HAIs does not yield the anticipated cost saving. For this article, we critically review the field and discuss 3 questions. Why measure the cost of an HAI? What outcome should be used to measure the cost of an HAI? What is the best method for making this measurement? The aim is to encourage researchers to collect and then disseminate information that accurately guides decisions about the economic value of expanding or changing current infection control activities.
Publisher: BMJ
Date: 12-2021
DOI: 10.1136/BMJOPEN-2021-053377
Abstract: To investigate differences between target and actual s le sizes, and what study characteristics were associated with s le sizes. Observational study. The large trial registries of clinicaltrials.gov (starting in 1999) and ANZCTR (starting in 2005) through to 2021. Over 280 000 interventional studies excluding studies that were withheld, terminated for safety reasons or were expanded access. The actual and target s le sizes, and the within-study ratio of the actual to target s le size. Most studies were small: the median actual s le sizes in the two databases were 60 and 52. There was a decrease over time in the target s le size of 9%–10% per 5 years, and a larger decrease of 18%–21% per 5 years for the actual s le size. The actual-to-target s le size ratio was 4.1% lower per 5 years, meaning more studies (on average) failed to hit their target s le size. Registered studies are more often under-recruited than over-recruited and worryingly both target and actual s le sizes appear to have decreased over time, as has the within-study gap between the target and actual s le size. Declining s le sizes and ongoing concerns about underpowered studies mean more research is needed into barriers and facilitators for improving recruitment and accessing data.
Publisher: Frontiers Media SA
Date: 08-09-2021
Abstract: Background: In a disease that has only existed for 18 months, it is difficult to be fully informed of the long-term sequelae of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection. Evidence is growing that most organ systems can be affected by the virus, causing severe disabilities in survivors. The extent of the aftermath will declare itself over the next 5–10 years, but it is likely to be substantial with profound socio-economic impact on society. Methods: This is an international multi-center, prospective long-term follow-up study of patients who developed severe coronavirus disease-2019 (COVID-19) and were admitted to Intensive Care Units (ICUs). The study will be conducted at international tertiary hospitals. Patients will be monitored from time of ICU discharge up to 24 months. Information will be collected on demographics, co-existing illnesses before ICU admission, severity of illness during ICU admission and post-ICU quality of life as well as organ dysfunction and recovery. Statistical analysis will consist of patient trajectories over time for the key variables of quality of life and organ function. Using latent class analysis, we will determine if there are distinct patterns of patients in terms of recovery. Multivariable regression analyses will be used to examine associations between baseline characteristics and severity variables upon admission and discharge in the ICU, and how these impact outcomes at all follow-up time points up to 2 years. Ethics and Dissemination: The core study team and local principal investigators will ensure that the study adheres to all relevant national and local regulations, and that the necessary approvals are in place before a site may enroll patients. Clinical Trial Registration: anzctr.org.au : ACTRN12620000799954.
Publisher: Springer Science and Business Media LLC
Date: 26-07-2012
DOI: 10.1007/S00484-011-0473-Y
Abstract: In September 2009 an enormous dust storm swept across eastern Australia. Dust is potentially hazardous to health as it interferes with breathing, and previous dust storms have been linked to increased risks of asthma and even death. We examined whether the 2009 Australian dust storm changed the volume or characteristics of emergency admissions to hospital. We used an observational study design, using time series analyses to examine changes in the number of admissions, and case-only analyses to examine changes in the characteristics of admissions. The admission data were from the Prince Charles Hospital, Brisbane, between 1 January 2009 and 31 October 2009. There was a 39% increase in emergency admissions associated with the storm (95% confidence interval: 5, 81%), which lasted for just 1 day. The health effects of the storm could not be detected using particulate matter levels. We found no significant change in the characteristics of admissions during the storm specifically, there was no increase in respiratory admissions. The dust storm had a short-lived impact on emergency hospital admissions. This may be because the public took effective avoidance measures, or because the dust was simply not toxic, being composed mainly of soil. Emergency departments should be prepared for a short-term increase in admissions during dust storms.
Publisher: SAGE Publications
Date: 03-2004
DOI: 10.1597/02-102
Abstract: This study was designed to determine whether velar surgery was worthwhile for submucous cleft palate (SMCP) and evaluate whether results were dependent on the degree of the anatomical abnormality. A prospective study of a consecutive series of patients fulfilling the entry criteria, assessed blindly from records arranged randomly. Fifty-eight patients diagnosed with SMCP and operated on by a single surgeon between June 1991 and April 1997 were reviewed. Forty patients fulfilled the entry criteria. Minimum follow-up was 6 years. Radical reconstruction of the soft palate musculature was performed by one surgeon using the operating microscope. A scoring system was devised for grading the anatomical severity of submucous cleft (SMCP score). Postoperative hypernasality and nasal emission scores and the degrees of improvement were considered the primary outcome measures, and the degree of velopharyngeal closure was also assessed. There were highly significant improvements in hypernasality, nasal emission, and velopharyngeal closure. A preoperative gap size of more than 13 mm was associated with less satisfactory outcomes, but gap size was not predictive of improvement. Severity of the SMCP did not correlate with the degree of preoperative speech abnormality but was a significant predictor of outcome of surgery, with the less severe (total SMCP score of 0 to 3) having less satisfactory end results and lesser degrees of improvement. Patients with less abnormal muscle anatomy had lesser degrees of improvement. Repair of the muscle abnormality in SMCP is recommended as the first line of treatment in most cases.
Publisher: Proceedings of the National Academy of Sciences
Date: 15-09-2021
Abstract: How to allocate COVID-19 vaccines is one of the most important decisions currently facing governments. With limited supplies, what is most pressing is deciding who gets priority in the vaccine allocation rollout. Some governments are exploring allowing private purchases of COVID-19 vaccines. Many countries are debating whether COVID-19 vaccines should be mandated. There is little evidence on what policies are preferred by the global public. Our survey of 15,536 adults in 13 countries confirms that priority should be given to health workers and those at high risk but also, to a broad range of key workers and those with lower incomes. The public favors allocating COVID-19 vaccines solely via government programs but was polarized in some countries on mandatory vaccinations.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 30-11-2021
Publisher: Wiley
Date: 11-11-2008
DOI: 10.1111/J.1600-0528.2008.00431.X
Abstract: While there is good evidence of caries-preventive benefits of fluoride in drinking water among children and adolescents, there is little information about effectiveness of water fluoridation among adults. To determine whether exposure to fluoride in drinking water is associated with caries experience in Australian Defence Force (ADF) personnel. Cross-sectional study of 876 deployable ADF personnel aged 17-56 years. At each person's mandatory annual dental examination, military dentists recorded the number of decayed, missing and filled teeth (DMFT) using visual, tactile and radiographic criteria. Participants also completed a questionnaire, listing residential locations in each year from 1964 to 2003. People were classified into four categories according to the percentage of their lifetime living in places with fluoridated water: <10%, 10% to <50%, 50% to or =90%. Mean DMFT was compared among those categories of fluoridation exposure and the association was evaluated statistically using analysis of variance to adjust for age, sex, years of service and rank. Without adjustment for confounders, the mean DMFT (+/-95% confidence interval) was 6.3 +/- 0.8 for <10% fluoridation exposure, 7.8 +/- 0.8 for 10% to <50% exposure, 7.5 +/- 0.7 for 50% to or =90% exposure (P < 0.01). However, age was inversely associated with mean DMFT and in the <10% exposure group, 91% of people were aged or =50% exposure compared with the <10% exposure group. Degree of lifetime exposure to fluoridated drinking water was inversely associated with DMFT in a dose-response manner among this adult military population.
Publisher: BMJ
Date: 2013
Publisher: American Thoracic Society
Date: 06-2005
Publisher: Springer Science and Business Media LLC
Date: 12-03-2010
Publisher: Elsevier BV
Date: 12-2018
Publisher: Environmental Health Perspectives
Date: 04-2013
DOI: 10.1289/EHP.1206025
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 08-2010
Publisher: Wiley
Date: 25-10-2004
DOI: 10.1002/SIM.1927
Abstract: We present two methods of estimating the trend, seasonality and noise in time series of coronary heart disease events. In contrast to previous work we use a non-linear trend, allow multiple seasonal components, and carefully examine the residuals from the fitted model. We show the importance of estimating these three aspects of the observed data to aid insight of the underlying process, although our major focus is on the seasonal components. For one method we allow the seasonal effects to vary over time and show how this helps the understanding of the association between coronary heart disease and varying temperature patterns.
Publisher: BMJ
Date: 10-2015
Publisher: Elsevier BV
Date: 06-2018
DOI: 10.1016/J.PUHE.2018.03.004
Abstract: Obesity has become a global issue with abundant evidence to indicate that the prevalence of obesity in many nations has increased over time. The literature also reports a strong association between obesity and economic development, but the trend that obesity growth rates may converge over time has not been examined. We propose a conceptual framework and conduct an ecological analysis on the relationship between economic development and weight gain. We also test the hypothesis that weight gain converges among countries over time and examine determinants of weight gains. This is a longitudinal study of 34 Organisation for Economic Cooperation and Development (OECD) countries in the years 1980-2008 using publicly available data. We apply a dynamic economic growth model to test the hypothesis that the rate of weight gains across countries may converge over time. We also investigate the determinants of weight gains using a longitudinal regression tree analysis. We do not find evidence that the growth rates of body weight across countries converged for all countries. However, there were groups of countries in which the growth rates of body weight converge, with five groups for males and seven groups for females. The predicted growth rates of body weight peak when gross domestic product (GDP) per capita reaches US$47,000 for males and US$37,000 for females in OECD countries. National levels of consumption of sugar, fat and alcohol were the most important contributors to national weight gains. National weight gains follow an inverse U-shape curve with economic development. Excessive calorie intake is the main contributor to weight gains.
Publisher: Elsevier BV
Date: 06-2020
Publisher: Cambridge University Press (CUP)
Date: 15-07-2020
DOI: 10.1017/ICE.2020.304
Abstract: Methods that include the time-varying nature of healthcare-associated infections (HAIs) avoid biases when estimating increased risk of death and excess length of stay. We determined the excess mortality risk and length of stay associated with HAIs among inpatients in Singapore using a multistate model that accommodates the timing of key events. Analysis of existing prospective cohort study data. Seven public acute-care hospitals in Singapore. Inpatients reviewed in a HAI point-prevalence survey (PPS) conducted between June 2015 and February 2016. We modeled each patient’s admission over time using 4 states: susceptible with no HAI, infected, died, and discharged alive. We estimated the excess mortality risk and length of stay associated with HAIs, with adjustment for the baseline characteristics between the groups for mortality risk. We included 4,428 patients, of whom 469 had ≥1 HAI. Using a multistate model, the expected excess length of stay due to any HAI was 1.68 days (95% confidence interval [CI], 1.15–2.21 days). Surgical site infections were associated with the longest excess length of stay of 4.68 days (95% CI, 2.60–6.76 days). After adjusting for baseline differences, HAIs were associated with increased hazards of in-hospital mortality (adjusted hazard ratio [aHR], 1.32 95% CI, 1.09–1.65) and decreased hazards in being discharged (aHR, 0.75 95% CI, 0.67–0.84). HAIs are associated with increased length of hospital stay and mortality in hospitalized patients. Avoiding nosocomial infections can improve patient outcomes and free valuable bed days.
Publisher: Elsevier BV
Date: 2015
DOI: 10.1016/J.ENVRES.2014.08.046
Abstract: Seasonal patterns in mortality have been recognised for decades, with a marked excess of deaths in winter, yet our understanding of the causes of this phenomenon is not yet complete. Research has shown that low and high temperatures are associated with increased mortality independently of season however, the impact of unseasonal weather on mortality has been less studied. In this study, we aimed to determine if unseasonal patterns in weather were associated with unseasonal patterns in mortality. We obtained daily temperature, humidity and mortality data from 1988 to 2009 for five major Australian cities with a range of climates. We split the seasonal patterns in temperature, humidity and mortality into their stationary and non-stationary parts. A stationary seasonal pattern is consistent from year-to-year, and a non-stationary pattern varies from year-to-year. We used Poisson regression to investigate associations between unseasonal weather and an unusual number of deaths. We found that deaths rates in Australia were 20-30% higher in winter than summer. The seasonal pattern of mortality was non-stationary, with much larger peaks in some winters. Winters that were colder or drier than a typical winter had significantly increased death risks in most cities. Conversely summers that were warmer or more humid than average showed no increase in death risks. Better understanding the occurrence and cause of seasonal variations in mortality will help with disease prevention and save lives.
Publisher: BMJ
Date: 16-01-2015
Publisher: Springer Science and Business Media LLC
Date: 05-10-2010
Publisher: BMJ
Date: 10-2013
Publisher: Elsevier BV
Date: 12-2009
Publisher: Elsevier BV
Date: 10-2008
DOI: 10.1111/J.1753-6405.2008.00270.X
Abstract: To examine the seasonal pattern in heart failure (HF) and cardiovascular disease (CVD) by climate and cause of death in Australia. A retrospective analysis of a national database of deaths in the eight Australian State and Territory capitals between January 1997 and November 2004. We examined the seasonal pattern in HF and CVD deaths, we identified variations in the pattern by: sex, age, time, climate and cause of death (for total CVD using seven groups determined by ICD-10 code). Deaths in all seven groups of CVD significantly increased in winter. The largest increase in mortality rates was 23.5% observed for HF. The magnitude of this increase varied greatly between cities, with the lowest winter mortality rates in the coldest (Hobart) and warmest (Darwin) cities. The pattern in CVD deaths showed a clearer correlation with climate than HF deaths. Winters in Australia are mild but winter increases in HF and CVD are a significant problem. Increased blood pressure and lack of vitamin D in winter are the most likely causes of the increase. Reducing exposure to cold, particularly in the elderly, should reduce the number of winter CVD deaths in Australia.
Publisher: Wiley
Date: 18-04-2018
DOI: 10.1111/AJO.12816
Abstract: Gestational diabetes mellitus (GDM) is one of the most common pregnancy disorders however, if well managed, women with GDM experience similar pregnancy outcomes to those without. Currently, there is limited evidence on actual management practices across Australia or how multidisciplinary teams interact to optimise care. To examine the current screening, diagnostic, task and role perceptions and management practices, as reported by members of the GDM multidisciplinary team. A 64-item electronic survey containing multiple choice, Likert scale and open-ended questions was developed for this cross-sectional observational study and advertised through health professional organisations and Queensland Health facilities in May and June, 2017. The 183 survey respondents included 45 diabetes educators, 43 dietitians, 21 endocrinologists/diabetes specialists, 14 obstetricians and 21 midwives. Although almost 90% reported using updated diagnostic guidelines, less than two-thirds used GDM management guidelines. While 68% reported using the same blood glucose targets for GDM management, there was variation to what criteria prompted the commencement of medication to control blood glucose levels. There was a good consensus concerning the health professional responsible for tasks such as medical nutrition therapy, gestational weight gain and self-blood glucose monitoring education and ultrasound use. Other tasks appeared to be the role of almost any member of the GDM multidisciplinary team. The survey results indicate there is a need for consistent evidence on how to best manage GDM and that role identity, access to specialist knowledge and best practice need to be clearly defined within GDM models of care.
Publisher: Elsevier BV
Date: 05-2016
DOI: 10.1016/J.JHIN.2016.01.012
Abstract: The emergence of antimicrobial resistance is of particular concern with respect to urinary tract infections, since the majority of causative agents are Gram-negative bacteria. Healthcare-associated urinary tract infections (HAUTIs) are frequently associated with instrumentation of the urinary tract, specifically with indwelling catheters. To evaluate the current incidence, mortality, and length of hospital stay associated with HAUTIs. A non-concurrent cohort study design was used, conducted between January 1st, 2010 and June 30th, 2014. All patients admitted to one of the eight participating Australian hospitals and who were hospitalized for more than two days were included. The primary outcome measures were the incidence, mortality, and excess length of stay associated with HAUTIs. From 162,503 patient admissions, 1.73% [95% confidence interval (CI): 1.67-1.80] of admitted patients acquired a HAUTI. Using a multi-state model, the expected extra length of stay due to HAUTI was four days (95% CI: 3.1-5.0 days). Using a Cox regression model, infection significantly reduced the rate of discharge (hazard ratio: 0.78 95% CI: 0.73-0.83). Women were less likely to die (0.71 0.66-0.75), whereas older patients were more likely to die (1.40 1.38-1.43). Death was rarer in a tertiary referral hospital compared to other hospitals, after adjusting for age and sex (0.74 0.69-0.78). This study is the first to explore the burden of HAUTIs in hospitals using appropriate statistical methods in a developed country. Our study indicates that the incidence of HAUTI, in addition to its associated extra length of stay in hospital, presents a burden to the hospital system. With increasing incidence of UTI due to antimicrobial-resistant organisms, surveillance and interventions to reduce the incidence of HAUTI are required.
Publisher: Elsevier BV
Date: 02-2012
DOI: 10.1016/J.SCITOTENV.2011.09.027
Abstract: Although ambient air pollution exposure has been linked with poor health in many parts of the world, no previous study has investigated the effect on morbidity in the city of Adelaide, South Australia. To explore the association between particulate matter (PM) and hospitalisations, including respiratory and cardiovascular admissions in Adelaide, South Australia. For the study period September 2001 to October 2007, daily counts of all-cause, cardiovascular and respiratory hospital admissions were collected, as well as daily air quality data including concentrations of particulates, ozone and nitrogen dioxide. Visibility codes for present weather conditions identified days when airborne dust or smoke was observed. The associations between PM and hospitalisations were estimated using time-stratified case-crossover analyses controlling for covariates including temperature, relative humidity, other pollutants, day of the week and public holidays. Mean PM(10) concentrations were higher in the warm season, whereas PM(2.5) concentrations were higher in the cool season. Hospital admissions were associated with PM(10) in the cool season and with PM(2.5) in both seasons. No significant effect of PM on all-age respiratory admissions was detected, however cardiovascular admissions were associated with both PM(2.5) and PM(10) in the cool season with the highest effects for PM(2.5) (4.48%, 95% CI: 0.74%, 8.36% increase per 10μg/m(3) increase in PM(2.5)). These findings suggest that despite the city's relatively low levels of air pollution, PM concentrations are associated with increases in morbidity in Adelaide. Further studies are needed to investigate the sources of PM which may be contributing to the higher cool season effects.
Publisher: Elsevier BV
Date: 2010
DOI: 10.1016/J.SCITOTENV.2016.10.019
Abstract: Although many in idual studies have examined the association between temperature and blood pressure (BP), they used different methods and also their results were somewhat inconsistent. The aims of this study are to quantitatively summarize previous studies and to systematically assess the methodological issues to make recommendations for future research. We searched relevant empirical studies published before January 2016 concerning temperature and BP among adults using the MEDLINE, Embase and PubMed databases. Mean changes in systolic (SBP) and diastolic blood pressure (DBP) per 1°C reduction in temperature were pooled using a random-effects meta-analysis. Of 23 studies included, 14 were used for meta-analysis. Consistent, statistically significant, inverse associations were observed between ambient temperature (mean, maximum, minimum outdoor temperature and indoor temperature) and BP. An 1°C decrease in mean daily outdoor temperature was associated with an increase in SBP and DBP of 0.26mmHg (95% CI: 0.18-0.33) and 0.13 (95% CI: 0.11-0.16), respectively. The increase was greater in people with conditions related to cardiovascular disease. An 1°C decrease in indoor temperature was associated with 0.38mmHg (0.18-0.58) increase in SBP, while the effects on DBP were not estimated due to limited studies. Among the previous studies on temperature-BP relationship, temperature and BP measurements are not accurate enough and statistical methods need to be improved. Lower ambient temperatures seem to increase adults' BP and people with conditions related to cardiovascular disease are more susceptible to drops in temperature. Indoor temperature appeared to have a stronger effect on BP than outdoor temperature. To understand temperature-BP relationship well, a study combining repeated personal temperature exposure and ambulatory BP monitoring, applying improved statistical methods to examine potential non-linear relationship is warranted.
Publisher: Springer Science and Business Media LLC
Date: 30-03-2021
Publisher: Springer Science and Business Media LLC
Date: 23-01-2020
Publisher: Hindawi Limited
Date: 2013
DOI: 10.1155/2013/595838
Abstract: The use of microspheres for the determination of regional microvascular blood flow (RMBF) has previously used different approaches. This study presents for the first time the intracardiac injection of microspheres using transeptal puncture under intracardiac echocardiography guidance. Five Merino sheep were instrumented and cardiovascularly supported according to local guidelines. Two catheter sheaths into the internal jugular vein facilitated the introduction of an intracardiac probe and transeptal catheter, respectively. Five million colour coded microspheres were injected into the left atrium via this catheter. After euthanasia the brain was used as proof of principle and the endpoint for determination of microcirculation at different time points. Homogeneous allocation of microspheres to different regions of the brain was found over time. Alternate slices from both hemispheres showed the following flow ranges: for slice 02 0.57–1.02 mL/min/g, slice 04 0.45–1.42 mL/min/g, slice 06 0.35–1.87 mL/min/g, slice 08 0.46–1.77 mL/min/g, slice 10 0.34–1.28 mL/min/g. A mixed effect regression model demonstrated that the confidence interval did include zero suggesting that the apparent variability intra- and intersubject was not statistically significant, supporting the stability and reproducibility of the injection technique. This study demonstrates the feasibility of the transeptal injection of microspheres, showing a homogeneous distribution of blood flow through the brain unchanged over time and has established a new interventional model for the measurement of RMBF in ovine models.
Publisher: F1000 Research Ltd
Date: 19-01-2018
DOI: 10.12688/F1000RESEARCH.13477.1
Abstract: Background : Reproducible research includes sharing data and code. The reproducibility policy at the journal Biostatistics rewards articles with badges for data and code sharing. This study investigates the effect of badges at increasing reproducible research, specifically, data and code sharing, at Biostatistics . Methods : The setting of this observational study is the Biostatistics and Statistics in Medicine (control journal) online research archives. The data consisted of 240 randomly s led articles from 2006 to 2013 (30 articles per year) per journal, a total s le of 480 articles. Data analyses included: plotting probability of data and code sharing by article submission date, and Bayesian logistic regression modelling to test for a difference in the probability of making data and code available after the introduction of badges at Biostatistics . Results : The probability of data sharing was higher at Biostatistics than the control journal but the probability of code sharing was comparable for both journals. The probability of data sharing increased by 3.5 times (95% credible interval: 1.4 to 7.4 times, p-value probability that sharing increased: 0.996) after badges were introduced at Biostatistics . On an absolute scale, however, this difference was only a 7.3% increase in data sharing (95% CI: 2 to 14%, p-value: 0.996). Badges did not have an impact on code sharing at the journal (mean increase: 1.1 times, 95% credible interval: 0.45 to 2.14 times, p-value probability that sharing increased: 0.549). Conclusions: The effect of badges at Biostatistics was a 7.3% increase in the data sharing rate, 5 times less than the effect of badges on data sharing at Psychological Science (37.9% badge effect). Though the effect of badges at Biostatistics did not impact code sharing, and was associated with only a moderate effect on data sharing, badges are an interesting step that journals are taking to incentivise and promote reproducible research.
Publisher: Springer Science and Business Media LLC
Date: 23-03-2017
Publisher: F1000 Research Ltd
Date: 07-03-2018
DOI: 10.12688/F1000RESEARCH.13477.2
Abstract: Background : The reproducibility policy at the journal Biostatistics rewards articles with badges for data and code sharing. This study investigates the effect of badges at increasing reproducible research. Methods : The setting of this observational study is the Biostatistics and Statistics in Medicine (control journal) online research archives. The data consisted of 240 randomly s led articles from 2006 to 2013 (30 articles per year) per journal. Data analyses included: plotting probability of data and code sharing by article submission date, and Bayesian logistic regression modelling. Results : The probability of data sharing was higher at Biostatistics than the control journal but the probability of code sharing was comparable for both journals. The probability of data sharing increased by 3.9 times (95% credible interval: 1.5 to 8.44 times, p-value probability that sharing increased: 0.998) after badges were introduced at Biostatistics . On an absolute scale, this difference was only a 7.6% increase in data sharing (95% CI: 2 to 15%, p-value: 0.998). Badges did not have an impact on code sharing at the journal (mean increase: 1 time, 95% credible interval: 0.03 to 3.58 times, p-value probability that sharing increased: 0.378). 64% of articles at Biostatistics that provide data/code had broken links, and at Statistics in Medicine , 40% assuming these links worked only slightly changed the effect of badges on data (mean increase: 6.7%, 95% CI: 0.0% to 17.0%, p-value: 0.974) and on code (mean increase: -2%, 95% CI: -10.0 to 7.0%, p-value: 0.286). Conclusions: The effect of badges at Biostatistics was a 7.6% increase in the data sharing rate, 5 times less than the effect of badges at Psychological Science . Though badges at Biostatistics did not impact code sharing, and had a moderate effect on data sharing, badges are an interesting step that journals are taking to incentivise and promote reproducible research.
Publisher: Springer Science and Business Media LLC
Date: 04-09-2023
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 2009
Publisher: Elsevier BV
Date: 09-2012
DOI: 10.1016/J.SSTE.2012.02.010
Abstract: The health effects of environmental hazards are often examined using time series of the association between a daily response variable (e.g., death) and a daily level of exposure (e.g., temperature). Exposures are usually the average from a network of stations. This gives each station equal importance, and negates the opportunity for some stations to be better measures of exposure. We used a Bayesian hierarchical model that weighted stations using random variables between zero and one. We compared the weighted estimates to the standard model using data on health outcomes (deaths and hospital admissions) and exposures (air pollution and temperature) in Brisbane, Australia. The improvements in model fit were relatively small, and the estimated health effects of pollution were similar using either the standard or weighted estimates. Spatial weighted exposures would be probably more worthwhile when there is either greater spatial detail in the health outcome, or a greater spatial variation in exposure.
Publisher: Elsevier BV
Date: 12-2020
Publisher: The Open Journal
Date: 05-04-2023
DOI: 10.21105/JOSS.05328
Publisher: Springer Science and Business Media LLC
Date: 11-07-2018
Publisher: Oxford University Press (OUP)
Date: 27-08-2005
DOI: 10.1093/IJE/DYH299
Publisher: Elsevier BV
Date: 12-2014
DOI: 10.1071/HI14033
Publisher: Springer Science and Business Media LLC
Date: 02-08-2021
DOI: 10.1186/S41073-021-00113-7
Abstract: Australian health and medical research funders support substantial research efforts, and incentives within grant funding schemes influence researcher behaviour. We aimed to determine to what extent Australian health and medical funders incentivise responsible research practices. We conducted an audit of instructions from research grant and fellowship schemes. Eight national research grants and fellowships were purposively s led to select schemes that awarded the largest amount of funds. The funding scheme instructions were assessed against 9 criteria to determine to what extent they incentivised these responsible research and reporting practices: (1) publicly register study protocols before starting data collection, (2) register analysis protocols before starting data analysis, (3) make study data openly available, (4) make analysis code openly available, (5) make research materials openly available, (6) discourage use of publication metrics, (7) conduct quality research (e.g. adhere to reporting guidelines), (8) collaborate with a statistician, and (9) adhere to other responsible research practices. Each criterion was answered using one of the following responses: “Instructed”, “Encouraged”, or “No mention”. Across the 8 schemes from 5 funders, applicants were instructed or encouraged to address a median of 4 (range 0 to 5) of the 9 criteria. Three criteria received no mention in any scheme (register analysis protocols, make analysis code open, collaborate with a statistician). Importantly, most incentives did not seem strong as applicants were only instructed to register study protocols, discourage use of publication metrics and conduct quality research. Other criteria were encouraged but were not required. Funders could strengthen the incentives for responsible research practices by requiring grant and fellowship applicants to implement these practices in their proposals. Administering institutions could be required to implement these practices to be eligible for funding. Strongly rewarding researchers for implementing robust research practices could lead to sustained improvements in the quality of health and medical research.
Publisher: Elsevier BV
Date: 06-2018
Publisher: IOP Publishing
Date: 20-07-2011
DOI: 10.1088/0967-3334/32/9/001
Abstract: Biological signals often exhibit self-similar or fractal scaling characteristics which may reflect intrinsic adaptability to their underlying physiological system. This study analysed fractal dynamics of cerebral blood flow in patients supported with ventricular assist devices (VAD) to ascertain if sustained modifications of blood pressure waveform affect cerebral blood flow fractality. Simultaneous recordings of arterial blood pressure and cerebral blood flow velocity using transcranial Doppler were obtained from five cardiogenic shock patients supported by VAD, five matched control patients and five healthy subjects. Computation of a fractal scaling exponent (α) at the low-frequency time scale by detrended fluctuation analysis showed that cerebral blood flow velocity exhibited 1/f fractal scaling in both patient groups (α = 0.95 ± 0.09 and 0.97 ± 0.12, respectively) as well as in the healthy subjects (α = 0.86 ± 0.07). In contrast, fluctuation in blood pressure was similar to non-fractal white noise in both patient groups (α = 0.53 ± 0.11 and 0.52 ± 0.09, respectively) but exhibited 1/f scaling in the healthy subjects (α = 0.87 ± 0.04, P < 0.05 compared with the patient groups). The preservation of fractality in cerebral blood flow of VAD patients suggests that normal cardiac pulsation and central perfusion pressure changes are not the integral sources of cerebral blood flow fractality and that intrinsic vascular properties such as cerebral autoregulation may be involved. However, there is a clear difference in the fractal scaling properties of arterial blood pressure between the cardiogenic shock patients and the healthy subjects.
Publisher: Wiley
Date: 22-07-2007
DOI: 10.1111/J.1742-6723.2007.00981.X
Abstract: The present study aimed to determine which parameter is the most reliable predictor of bacteraemia in children aged 3-36 months and to develop a simple tool to assess risk of bacteraemia. A retrospective review was performed on patients aged 3-36 months who presented to a paediatric ED between July 1999 and April 2004. Children with a febrile illness who had a blood culture and full blood count performed were included in the study. Data were collected from the pathology database (AUSLAB) and Emergency Department Information System (EDIS). Variables examined were age, sex, temperature at presentation, white cell count, neutrophil count and blood culture result. Multiple regression analysis was used to determine the independent predictors of bacteraemia. Non-linear regression analysis was applied to explore alternative patterns of bacteraemia risk. Of the 1488 patients in the dataset, 43 were bacteraemic (2.9%). The most common organism was pneumococcus (74.4%). Sex was evenly distributed (male 52.4%, female 47.6%). Mean temperature at presentation was 38.8 degrees C (95% confidence interval 35.5-41.4 degrees C). The optimal logistic regression model identified neutrophil count as the variable most predictive of bacteraemia, with the odds of bacteraemia increasing by 1.11 for each one-unit increase in neutrophil count. Neutrophil count is the strongest predictor of bacteraemia in febrile children aged 3-36 months. Based on this, a simple prediction tool can be used to risk stratify this population, and assist in clinical decision making.
Publisher: Public Library of Science (PLoS)
Date: 07-02-2018
Publisher: Springer Science and Business Media LLC
Date: 29-06-2011
Publisher: Springer Science and Business Media LLC
Date: 07-04-2022
DOI: 10.1186/S12877-022-02999-4
Abstract: Increasing numbers of older adults with complex health deficits presenting to emergency departments has prompted the development of innovative models of care. One such model designed to reduce poor outcomes associated with acute healthcare, is the Geriatric Emergency Department Intervention. This intervention is a nurse-led, physician-ch ioned, Emergency Department intervention that improves the health outcomes for frail older adults in the emergency department. This quantitative cohort study aimed to evaluate the healthcare outcomes and costs associated with the implementation of the Geriatric Emergency Department Intervention (GEDI) for adults aged 70 years and over at two hospital sites that implemented the model using the integrated-Promoting Action on Research Implementation in Health Services (i-PARHIS) framework. Hospital A was large teaching hospital located in the tropical north of Australia. Hospital B was a medium sized teaching hospital near Brisbane, Queensland Australia. The effect of the intervention was examined in two ways. Outcomes were compared between: 1) all patients in the pre- and post- implementation periods, and 2) patients seen or not seen by the Geriatric Emergency Department Intervention team in the post-implementation period. The outcomes measured were disposition (discharged home, admitted) emergency department length of stay hospital length of stay all cause in-hospital mortality within 28 days time to re-presentation up to 28 days post-discharge emergency department and in-hospital costs. Survival analyses were used for the primary and secondary outcome variables and a Cox survival model was used to estimate the associations between variables and outcomes. Multiple regression models were used to examine other secondary outcomes whilst controlling for a range of confounders. The Geriatric Emergency Department Intervention was successfully translated into two different emergency departments. Both demonstrated an increased likelihood of discharge, decreased emergency department length of stay, decreased hospital costs for those who were admitted, with an associated reduction in risk of mortality, for adults aged 70 years and over. The Geriatric Emergency Department Intervention was successfully translated into new sites that adapted the model design. Improvement in healthcare outcomes for older adults presenting to the emergency department was demonstrated, although this was more subtle than in the original model setting.
Publisher: BMJ
Date: 29-04-2015
Publisher: Oxford University Press (OUP)
Date: 13-12-2012
DOI: 10.1093/AJE/KWR404
Abstract: Almost 10% of all births are preterm, and 2.2% are stillbirths. Recent research has suggested that environmental factors may be a contributory cause of these adverse birth outcomes. The authors examined the relation between ambient temperature and preterm birth and stillbirth in Brisbane, Australia, between 2005 and 2009 (n = 101,870). They used a Cox proportional hazards model with livebirth and stillbirth as competing risks. They also examined whether there were periods in pregnancy where exposure to high temperatures had a greater effect. Higher ambient temperatures in the last 4 weeks of the pregnancy increased the risk of stillbirth. The hazard ratio for stillbirth was 0.3 at 12°C relative to the reference temperature of 21°C. The temperature effect was greatest at less than 36 weeks of gestation. There was an association between higher temperature and shorter gestation, as the hazard ratio for livebirth was 0.96 at 15°C and 1.02 at 25°C. This effect was greatest at later gestational ages. These results provide strong evidence of an association between increased temperature and increased risk of stillbirth and shorter gestation.
Publisher: Oxford University Press (OUP)
Date: 13-12-2012
DOI: 10.1093/AJE/KWR407
Publisher: Springer Berlin Heidelberg
Date: 2010
Publisher: Elsevier BV
Date: 10-2010
DOI: 10.1016/J.SOCSCIMED.2010.07.018
Abstract: For young people with refugee backgrounds, establishing a sense of belonging to their family and community, and to their country of resettlement is essential for wellbeing. This paper describes the psychosocial factors associated with subjective health and wellbeing outcomes among a cohort of 97 refugee youth (aged 11-19) during their first three years in Melbourne, Australia. The findings reported here are drawn from the Good Starts Study, a longitudinal investigation of settlement and wellbeing among refugee youth conducted between 2004 and 2008. The overall aim of Good Starts was to identify the psychosocial factors that assist youth with refugee backgrounds in making a good start in their new country. A particular focus was on key transitions: from pre-arrival to Australia, from the language school to mainstream school, and from mainstream school to higher education or to the workforce. Good Starts used a mix of both method and theory from anthropology and social epidemiology. Using standardized measures of wellbeing and generalised estimating equations to model the predictors of wellbeing over time, this paper reports that key factors strongly associated with wellbeing outcomes are those that can be described as indicators of belonging - the most important being subjective social status in the broader Australian community, perceived discrimination and bullying. We argue that settlement specific policies and programs can ultimately be effective if embedded within a broader socially inclusive society - one that offers real opportunities for youth with refugee backgrounds to flourish.
Publisher: Environmental Health Perspectives
Date: 07-2006
DOI: 10.1289/EHP.8674
Abstract: The goal of this study was to estimate the associations between outdoor air pollution and cardiovascular hospital admissions for the elderly. Associations were assessed using the case-crossover method for seven cities: Auckland and Christchurch, New Zealand and Brisbane, Canberra, Melbourne, Perth, and Sydney Australia. Results were combined across cities using a random-effects meta-analysis and stratified for two adult age groups: 15-64 years and >/= 65 years of age (elderly). Pollutants considered were nitrogen dioxide, carbon monoxide, daily measures of particulate matter (PM) and ozone. Where multiple pollutant associations were found, a matched case-control analysis was used to identify the most consistent association. In the elderly, all pollutants except O3 were significantly associated with five categories of cardiovascular disease admissions. No associations were found for arrhythmia and stroke. For a 0.9-ppm increase in CO, there were significant increases in elderly hospital admissions for total cardiovascular disease (2.2%) , all cardiac disease (2.8%), cardiac failure (6.0%), ischemic heart disease (2.3%), and myocardial infarction (2.9%). There was some heterogeneity between cities, possibly due to differences in humidity and the percentage of elderly people. In matched analyses, CO had the most consistent association. The results suggest that air pollution arising from common emission sources for CO, NO2, and PM (e.g., motor vehicle exhausts) has significant associations with adult cardiovascular hospital admissions, especially in the elderly, at air pollution concentrations below normal health guidelines. Relevance to clinical and professional practice: Elderly populations in Australia need to be protected from air pollution arising from outdoor sources to reduce cardiovascular disease.
Publisher: Springer Science and Business Media LLC
Date: 16-11-2022
DOI: 10.1186/S12877-022-03554-X
Abstract: Hospitalisation rates for older people are increasing, with end-of-life care becoming a more medicalised experience. Innovative approaches are warranted to support early identification of the end-of-life phase, communicate prognosis, provide care consistent with people’s preferences, and improve the use of healthcare resources. The Intervention for Appropriate Care and Treatment (InterACT) trial aimed to increase appropriate care and treatment decisions for older people at the end of life, through implementation of a prospective feedback loop. This paper reports on the care review outcomes. A stepped-wedge randomised controlled trial was conducted in three large acute hospitals in Queensland, Australia between May 2020 and June 2021. The trial identified older people nearing the end of life using two validated tools for detecting deterioration and short-term death. Admitting clinical teams were provided with details of patients identified as at-risk with the goal of increasing awareness that end of life was approaching to facilitate appropriate patient centred care and avoid non-beneficial treatment. We examined the time between when the patient was identified as ‘at-risk’ and three outcomes: clinician-led care review discussions, review of care directive measures and palliative care referrals. These were considered useful indicators of appropriate care at the end of life. In two hospitals there was a reduction in the review of care directive measures during the intervention compared with usual care at 21 days (reduced probability of − 0.08 95% CI: − 0.12 to − 0.04 and − 0.14 95% CI: − 0.21 to − 0.06). In one hospital there was a large reduction in clinician-led care review discussions at 21 days during the intervention (reduced probability of − 0.20 95% CI: − 0.28 to − 0.13). There was little change in palliative care referrals in any hospital, with average probability differences at 21 days of − 0.01, 0.02 and 0.04. The results are disappointing as an intervention designed to improve care of hospitalised older people appeared to have the opposite effect on care review outcomes. The reasons for this may be a combination of the intervention design and health system challenges due to the pandemic that highlight the complexity of providing more appropriate care at the end of life. Australia New Zealand Clinical Trial Registry, ACTRN12619000675123 (registered 6 May 2019).
Publisher: BMJ
Date: 05-10-2011
DOI: 10.1136/BMJ.D5694
Publisher: Elsevier BV
Date: 03-2018
DOI: 10.1016/J.IDH.2017.11.002
Abstract: Drug resistant "superbugs" are on the rise and pose a considerable threat. Little is known of their impact on health outcomes and costs to health services at a country-level. Local and relevant estimates that are realistic and derived with a transparent method can stimulate and inform policy responses. We describe an innovative online open-access tool, ResImpact that provides estimates of the national cost of common drug-resistant infections in Australia. Users are able to modify the proportion of five resistant organisms and be presented with an estimate of the associated healthcare costs. By translating complex economic data into a practical and user-friendly output, policy makers and other health professionals can improve their policy response for the Australian healthcare system.
Publisher: SAGE Publications
Date: 07-2012
DOI: 10.1177/0310057X1204000411
Abstract: Critically ill patients receiving extracorporeal membrane oxygenation (ECMO) are often noted to have increased sedation requirements. However, data related to sedation in this complex group of patients is limited. The aim of our study was to characterise the sedation requirements in adult patients receiving ECMO for cardiorespiratory failure. A retrospective chart review was performed to collect sedation data for 30 consecutive patients who received venovenous or venoarterial ECMO between April 2009 and March 2011. To test for a difference in doses over time we used a regression model. The dose of midazolam received on ECMO support increased by an average of 18 mg per day (95% confidence interval 8, 29 mg, P=0.001), while the dose of morphine increased by 29 mg per day (95% confidence interval 4, 53 mg, P=0.021) The venovenous group received a daily midazolam dose that was 157 mg higher than the venoarterial group (95% confidence interval 53, 261 mg, P=0.005). We did not observe any significant increase in fentanyl doses over time (95% confidence interval 1269, 4337 μg, P=0.94). There is a significant increase in dose requirement for morphine and midazolam during ECMO. Patients on venovenous ECMO received higher sedative doses as compared to patients on venoarterial ECMO. Future research should focus on mechanisms behind these changes and also identify drugs that are most suitable for sedation during ECMO.
Publisher: Elsevier BV
Date: 09-2010
DOI: 10.1016/J.SCITOTENV.2010.06.042
Abstract: A number of epidemiological studies have examined the adverse effect of air pollution on mortality and morbidity. Also, several studies have investigated the associations between air pollution and specific-cause diseases including arrhythmia, myocardial infarction, and heart failure. However, little is known about the relationship between air pollution and the onset of hypertension. To explore the risk effect of particulate matter air pollution on the emergency hospital visits (EHVs) for hypertension in Beijing, China. We gathered data on daily EHVs for hypertension, fine particulate matter less than 2.5 microm in aerodynamic diameter (PM(2.5)), particulate matter less than 10 microm in aerodynamic diameter (PM(10)), sulfur dioxide, and nitrogen dioxide in Beijing, China during 2007. A time-stratified case-crossover design with distributed lag model was used to evaluate associations between ambient air pollutants and hypertension. Daily mean temperature and relative humidity were controlled in all models. There were 1,491 EHVs for hypertension during the study period. In single pollutant models, an increase in 10 microg/m(3) in PM(2.5) and PM(10) was associated with EHVs for hypertension with odds ratios (overall effect of five days) of 1.084 (95% confidence interval (CI): 1.028, 1.139) and 1.060% (95% CI: 1.020, 1.101), respectively. Elevated levels of ambient particulate matters are associated with an increase in EHVs for hypertension in Beijing, China.
Publisher: Springer Science and Business Media LLC
Date: 15-10-2007
Publisher: Springer Science and Business Media LLC
Date: 24-11-2015
Publisher: Springer Science and Business Media LLC
Date: 09-06-2009
DOI: 10.1007/S00484-009-0241-4
Abstract: Stroke is a leading cause of disability and death. This study evaluated the association between temperature variation and emergency admissions for stroke in Brisbane, Australia. Daily emergency admissions for stroke, meteorologic and air pollution data were obtained for the period of January 1996 to December 2005. The relative risk of emergency admissions for stroke was estimated with a generalized estimating equations (GEE) model. For primary intracerebral hemorrhage (PIH) emergency admissions, the average daily PIH for the group aged or = 65 decreased by 3% (95% CI: -6, 0%) for a 1 degrees C increase in daily maximum temperature in winter after adjustment for confounding factors. Temperature variation was significantly associated with emergency admissions for stroke, and its impact varied with different type of stroke. Health authorities should pay greater attention to possible increasing emergency care for strokes when temperature changes, in both summer and winter.
Publisher: Springer Science and Business Media LLC
Date: 03-09-2202
Publisher: Springer Science and Business Media LLC
Date: 11-06-2022
DOI: 10.1186/S13104-022-06080-6
Abstract: The rising rate of preprints and publications, combined with persistent inadequate reporting practices and problems with study design and execution, have strained the traditional peer review system. Automated screening tools could potentially enhance peer review by helping authors, journal editors, and reviewers to identify beneficial practices and common problems in preprints or submitted manuscripts. Tools can screen many papers quickly, and may be particularly helpful in assessing compliance with journal policies and with straightforward items in reporting guidelines. However, existing tools cannot understand or interpret the paper in the context of the scientific literature. Tools cannot yet determine whether the methods used are suitable to answer the research question, or whether the data support the authors’ conclusions. Editors and peer reviewers are essential for assessing journal fit and the overall quality of a paper, including the experimental design, the soundness of the study’s conclusions, potential impact and innovation. Automated screening tools cannot replace peer review, but may aid authors, reviewers, and editors in improving scientific papers. Strategies for responsible use of automated tools in peer review may include setting performance criteria for tools, transparently reporting tool performance and use, and training users to interpret reports.
Publisher: Oxford University Press (OUP)
Date: 06-2001
Abstract: The benefit of folic acid is a simple health promotion message of proven effectiveness that is particularly pertinent to a young population with a high birth rate. The aim of the present study was to compare the uptake of a folic acid health message in two different ethnic groups. Community antenatal teams in Tower Hamlets were asked to recruit women attending for a booking between October 1997 and July 1998 to the study. Tower Hamlets, in east London, is one of the poorest areas in England and Wales, with an ethnically erse population. A questionnaire enquiring about age, employment, level of education, use of folic acid in their current pregnancy, understanding of the benefits of folic acid and self-described ethnic group was administered verbally immediately before the booking appointment to those women who agreed to participate. Completed questionnaires were received on 249 women. Univariate analysis showed that white women were 5.7 [95% confidence interval (CI) 2.5, 13.2] times more likely to have taken folic acid supplements before conception than Bangladeshi women. Having controlled for the variables, age, school leaving age, social class, parity, planned pregnancy and 'heard of folic acid', ethnic status remained a significant predictor of taking folic acid, with the odds ratio dropping to 5.2 with a 95% CI (1.1, 25.2). The Bangladeshi community in the UK have been shown to have poor access to health information sources, which is consistent with the results of this survey, which shows that a simple and important message has not been acted upon equally by white and Bangladeshi women in east London. This survey lends support to the view that resources and innovative forms of health promotion are needed to ensure that ethnic minority groups have adequate access to health promotion messages.
Publisher: Elsevier BV
Date: 12-2017
Publisher: SAGE Publications
Date: 26-06-2016
Abstract: Winning research funding is one of the most difficult challenges faced by researchers, especially with falling success rates and shrinking budgets. Telemedicine researchers can find it especially hard to win funding as they are often researching small changes to the health system that whilst important for patient care are often not as competitive as proposals that promise to cure diseases. In a climate of both tight health funding and tight research funding, telemedicine researchers should emphasise the potential for their research to add value and lower costs in order to increase their chances of winning funding.
Publisher: Elsevier BV
Date: 2005
Publisher: Environmental Health Perspectives
Date: 10-0009
DOI: 10.1289/EHP.1103885
Publisher: SAGE Publications
Date: 09-2008
Abstract: As part of the preparation for a randomized controlled trial, we conducted a pilot study to investigate the feasibility of providing videotelephone-based support to a s le of families ( n = 8) with a child diagnosed with cancer, returning home for the first time after diagnosis and initial treatment. Seven of these families received support via videotelephone over a three-month period. Twenty videotelephone calls were made totalling 400 minutes (median 21 min, IQR 16–24). All videotelephone calls involved the specialist nurse providing support to mothers (85%) or fathers (15%) and involved communicating directly with the patient in most of the calls (55%). Social workers were involved in three calls (15%). All families expressed satisfaction with services delivered in this way. There were few technical problems. The use of a hybrid approach to providing videotelephony, using the family home computer and Internet connection for video and the home telephone line for full-duplex audio, was less costly than the custom-made device used in past studies.
Publisher: Elsevier BV
Date: 2022
Publisher: Springer Science and Business Media LLC
Date: 12-2013
Publisher: Elsevier BV
Date: 04-2019
Publisher: BMJ
Date: 10-2017
DOI: 10.1136/BMJOPEN-2017-017284
Abstract: To examine whether respondents to a survey of health and physical activity and potential determinants could be grouped according to the questions they missed, known as ‘item missing’. Observational study of longitudinal data. Residents of Brisbane, Australia. 6901 people aged 40–65 years in 2007. We used a latent class model with a mixture of multinomial distributions and chose the number of classes using the Bayesian information criterion. We used logistic regression to examine if participants’ characteristics were associated with their modal latent class. We used logistic regression to examine whether the amount of item missing in a survey predicted wave missing in the following survey. Four per cent of participants missed almost one-fifth of the questions, and this group missed more questions in the middle of the survey. Eighty-three per cent of participants completed almost every question, but had a relatively high missing probability for a question on sleep time, a question which had an inconsistent presentation compared with the rest of the survey. Participants who completed almost every question were generally younger and more educated. Participants who completed more questions were less likely to miss the next longitudinal wave. Examining patterns in item missing data has improved our understanding of how missing data were generated and has informed future survey design to help reduce missing data.
Publisher: Elsevier BV
Date: 02-2005
DOI: 10.1016/J.YPMED.2004.05.026
Abstract: Adolescents' intentions to smoke are generally regarded as a valid and reliable predictor of subsequent smoking. This association is largely based on research with adults and needs a more detailed analysis for adolescents. Data on intentions and smoking status were collected as part of a longitudinal, birth-cohort study when the study members were 9, 11, 13, 15, 18, and 21 years of age. The results showed that intention to smoke only had an important predictive power in the subgroup of previous nonsmokers. Among those already smoking (on a monthly basis or greater), previous level of smoking was a more important predictor of future behavior than intention to smoke. In addition, the effect of positive intention to smoke was nonlinear over age and had the greatest effect at age 15. The results indicated that in adolescence, measurement of intentions to smoke or not smoke cannot be assumed to be a general predictor of behavior at a later age for all groups of adolescents.
Publisher: Springer Science and Business Media LLC
Date: 28-04-2020
Publisher: BMJ
Date: 03-2014
Publisher: Elsevier BV
Date: 02-2009
DOI: 10.1016/J.AMEPRE.2008.09.042
Abstract: The delivery of effective interventions to assist patients to improve their physical activity and dietary behaviors is a challenge in the busy primary care setting. Cluster RCT with practices randomized to telephone counseling intervention or usual care. Data collection took place from February 2005 to November 2007, with analysis from December 2007 to April 2008. Four-hundred thirty-four adult patients with type 2 diabetes or hypertension (mean age=58.2 [SD=11.8] 61% female mean BMI=31.1 [SD=6.8]) from a disadvantaged community were recruited from ten primary care practices. Twelve-month telephone counseling intervention. Physical activity and dietary intake were assessed by self-report at baseline, 4, and 12 months. At 12 months, patients in both groups increased moderate-to-vigorous physical activity by a mean of 78 minutes per week (SE=10). Significant intervention effects (telephone counseling minus usual care) were observed for: calories from total fat (decrease of 1.17% p<0.007), energy from saturated fat (decrease of 0.97% p<0.007), vegetable intake (increase of 0.71 servings p<0.039), fruit intake (increase of 0.30 servings p<0.001), and grams of fiber (increase of 2.23 g p<0.001). The study targeted a challenging primary care patient s le and, using a telephone-delivered intervention, demonstrated modest improvements in diet and in physical activity. Results suggest that telephone counseling is a feasible means of delivering lifestyle intervention to primary care patients with chronic conditions-patients whose need for ongoing support for lifestyle change is often beyond the capacity of primary healthcare practitioners.
Publisher: Public Library of Science (PLoS)
Date: 09-03-2022
DOI: 10.1371/JOURNAL.PONE.0264360
Abstract: Appropriate descriptions of statistical methods are essential for evaluating research quality and reproducibility. Despite continued efforts to improve reporting in publications, inadequate descriptions of statistical methods persist. At times, reading statistical methods sections can conjure feelings of dèjá vu , with content resembling cut-and-pasted or “boilerplate text” from already published work. Instances of boilerplate text suggest a mechanistic approach to statistical analysis, where the same default methods are being used and described using standardized text. To investigate the extent of this practice, we analyzed text extracted from published statistical methods sections from PLOS ONE and the Australian and New Zealand Clinical Trials Registry (ANZCTR). Topic modeling was applied to analyze data from 111,731 papers published in PLOS ONE and 9,523 studies registered with the ANZCTR. PLOS ONE topics emphasized definitions of statistical significance, software and descriptive statistics. One in three PLOS ONE papers contained at least 1 sentence that was a direct copy from another paper. 12,675 papers (11%) closely matched to the sentence “a p-value 0.05 was considered statistically significant”. Common topics across ANZCTR studies differentiated between study designs and analysis methods, with matching text found in approximately 3% of sections. Our findings quantify a serious problem affecting the reporting of statistical methods and shed light on perceptions about the communication of statistics as part of the scientific process. Results further emphasize the importance of rigorous statistical review to ensure that adequate descriptions of methods are prioritized over relatively minor details such as p-values and software when reporting research outcomes.
Publisher: Elsevier BV
Date: 10-2014
Publisher: Springer Science and Business Media LLC
Date: 15-01-2012
DOI: 10.1038/NCLIMATE1369
Publisher: BMJ
Date: 04-05-2022
Abstract: To estimate the effect of extracorporeal membrane oxygenation (ECMO) compared with conventional mechanical ventilation on outcomes of patients with covid-19 associated respiratory failure. Observational study. 30 countries across five continents, 3 January 2020 to 29 August 2021. 7345 adults admitted to the intensive care unit with clinically suspected or laboratory confirmed SARS-CoV-2 infection. ECMO in patients with a partial pressure of arterial oxygen to fraction of inspired oxygen (PaO 2 /FiO 2 ) ratio mm Hg compared with conventional mechanical ventilation without ECMO. The primary outcome was hospital mortality within 60 days of admission to the intensive care unit. Adherence adjusted estimates were calculated using marginal structural models with inverse probability weighting, accounting for competing events and for baseline and time varying confounding. 844 of 7345 eligible patients (11.5%) received ECMO at any time point during follow-up. Adherence adjusted mortality was 26.0% (95% confidence interval 24.5% to 27.5%) for a treatment strategy that included ECMO if the PaO 2 /FiO 2 ratio decreased mm Hg compared with 33.2% (31.8% to 34.6%) had patients received conventional treatment without ECMO (risk difference –7.1%, 95% confidence interval –8.2% to –6.1% risk ratio 0.78, 95% confidence interval 0.75 to 0.82). In secondary analyses, ECMO was most effective in patients aged years and with a PaO 2 /FiO 2 mm Hg or with driving pressures cmH 2 O during the first 10 days of mechanical ventilation. ECMO was associated with a reduction in mortality in selected adults with covid-19 associated respiratory failure. Age, severity of hypoxaemia, and duration and intensity of mechanical ventilation were found to be modifiers of treatment effectiveness and should be considered when deciding to initiate ECMO in patients with covid-19.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 11-2005
DOI: 10.1097/01.PRS.0000187147.73963.A5
Abstract: How a scar is managed postoperatively influences its cosmetic outcome. After suture removal, scars are susceptible to skin tension, which may be the trigger for hypertrophic scarring. Paper tape to support the scar may reduce multidirectional forces and prevent hypertrophic scarring. Seventy patients who had undergone cesarean section at the Royal Brisbane and Women's Hospital were randomized to treatment and control groups. Patients in the control group received no postoperative intervention. Patients in the treatment group applied paper tape to their scars for 12 weeks. Scars were assessed at 6 weeks, 12 weeks, and 6 months after surgery using ultrasound to measure intradermal scar volume. Scars were also assessed using the International Clinical Recommendations. Paper tape significantly decreased scar volume by a mean of 0.16 cm3, (95 percent confidence interval, 0.00 to 0.29 cm3). At 12 weeks after surgery, 41 percent of the control group developed hypertrophic scars compared with none in the treatment group (exact test, p = 0.003). In the treatment group, one patient developed a hypertrophic scar and four developed stretched scars only after the tape was removed. The odds of developing a hypertrophic scar were 13.6 times greater in the control than in the treatment group (95 percent confidence interval, 3.6 to 66.9). Of the 70 patients randomized, 39 completed the study. Four patients in the treatment group developed a localized red rash beneath the tape. These reactions were minor and transient and resolved without medical intervention. The development of hypertrophic and stretched scars in the treatment group only after the tape was removed suggests that tension acting on a scar is the trigger for hypertrophic scarring. Paper tape is likely to be an effective modality for the prevention of hypertrophic scarring through its ability to eliminate scar tension.
Publisher: Elsevier BV
Date: 02-2013
DOI: 10.1016/J.AUCC.2012.05.001
Abstract: Early recognition of deteriorating patients results in better patient outcomes. Modified early warning scores (MEWS) attempt to identify deteriorating patients early so timely interventions can occur thus reducing serious adverse events. We compared frequencies of vital sign recording 24h post-ICU discharge and 24h preceding unplanned ICU admission before and after a new observation chart using MEWS and an associated educational programme was implemented into an Australian Tertiary referral hospital in Brisbane. Prospective before-and-after intervention study, using a convenience s le of ICU patients who have been discharged to the hospital wards, and in patients with an unplanned ICU admission, during November 2009 (before implementation n=69) and February 2010 (after implementation n=70). Any change in a full set or in idual vital sign frequency before-and-after the new MEWS observation chart and associated education programme was implemented. A full set of vital signs included Blood pressure (BP), heart rate (HR), temperature (T°), oxygen saturation (SaO2) respiratory rate (RR) and urine output (UO). After the MEWS observation chart implementation, we identified a statistically significant increase (210%) in overall frequency of full vital sign set documentation during the first 24h post-ICU discharge (95% CI 148, 288%, p value <0.001). Frequency of all in idual vital sign recordings increased after the MEWS observation chart was implemented. In particular, T° recordings increased by 26% (95% CI 8, 46%, p value=0.003). An increased frequency of full vital sign set recordings for unplanned ICU admissions were found (44%, 95% CI 2, 102%, p value=0.035). The only statistically significant improvement in in idual vital sign recordings was urine output, demonstrating a 27% increase (95% CI 3, 57%, p value=0.029). The implementation of a new MEWS observation chart plus a supporting educational programme was associated with statistically significant increases in frequency of combined and in idual vital sign set recordings during the first 24h post-ICU discharge. There were no significant changes to frequency of in idual vital sign recordings in unplanned admissions to ICU after the MEWS observation chart was implemented, except for urine output. Overall increases in the frequency of full vital sign sets were seen.
Publisher: BMJ
Date: 06-09-2011
Publisher: Oxford University Press (OUP)
Date: 10-02-2015
DOI: 10.1093/AJE/KWU342
Abstract: Suicide is a serious public health issue worldwide, with multiple risk factors, such as severe mental illness, alcohol abuse, a painful loss, exposure to violence, or social isolation. Environmental factors, particularly chemical and meteorological variables, have been examined as risk factors for suicide, but less evidence is available on whether air pollution is related to suicide. In this issue of the Journal, Bakian et al. ( publish findings from a study that found a short-term increased risk of suicide associated with increased air pollution. This study bolsters a small body of research linking air pollution exposure to suicide risk. If the association between air pollution and suicide is confirmed, it would broaden the scope of the already large disease burden associated with air pollution.
Publisher: Wiley
Date: 11-01-2011
DOI: 10.1111/J.1423-0410.2010.01381.X
Abstract: Even with the introduction of specific risk-reduction strategies, transfusion-related acute lung injury (TRALI) continues to be a leading cause of transfusion-related morbidity and mortality. Existing small animal models have not yet investigated TRALI resulting from the infusion of heat-treated supernatant from whole blood platelet concentrates. In this study, our objective was the development of a novel in vivo two-event model of TRALI in sheep. Lipopolysaccharide (LPS 15 μg/kg) as a first event, modelled clinical infection. Transfusion (estimated at 10% of total blood volume) of heat-treated pooled supernatant from date-of-expire human whole blood platelet concentrates (d5-PLT-S/N) was used as a second event. TRALI was defined by both hypoxaemia that developed either during the transfusion or within two hours of its completion and post-mortem histological evidence of pulmonary oedema. LPS infusion did not cause lung injury itself, but did result in decreased circulating levels of lymphocytes and neutrophils with evidence of the latter becoming sequestered in the lungs. Sheep that received LPS (first event) followed by d5-PLT-S/N (second event) displayed decreased pulmonary compliance, decreased end tidal CO(2) and increased arterial partial pressure of CO(2) relative to control sheep, and 80% of these sheep developed TRALI. This novel ovine two-event TRALI model presents a new tool for the investigation of TRALI pathogenesis. It represents the first description of an in vivo large animal model of TRALI and the first description of TRALI caused by transfusion with heat-treated pooled supernatant from human whole blood platelet concentrates.
Publisher: Elsevier BV
Date: 04-2011
DOI: 10.1016/J.ENVRES.2011.01.023
Abstract: Seasonal patterns of birth outcomes, such as low birth weight, preterm birth and stillbirth, have been found around the world. As a result, there has been an increasing interest in evaluating short-term exposure to ambient temperature as a determinant of adverse birth outcomes. This paper reviews the epidemiological evidence on seasonality of birth outcomes and the impact of prenatal exposure to ambient temperature on birth outcomes. We identified 20 studies that investigated seasonality of birth outcomes, and reported statistically significant seasonal patterns. Most of the studies found peaks of preterm birth, stillbirth and low birth weight in winter, summer or both, which indicates the extremes of temperature may be an important determinant of poor birth outcomes. We identified 13 studies that investigated the influence of exposure to ambient temperature on birth weight and preterm birth (none examined stillbirth). The evidence for an adverse effect of high temperatures was stronger for birth weight than for preterm birth. More research is needed to clarify whether high temperatures have a causal effect on fetal health.
Publisher: Springer Science and Business Media LLC
Date: 2012
DOI: 10.1186/CC11178
Publisher: Elsevier BV
Date: 12-2012
Publisher: F1000 Research Ltd
Date: 30-05-2023
DOI: 10.12688/F1000RESEARCH.123002.2
Abstract: Background : Papers describing the results of a randomised trial should include a baseline table that compares the characteristics of randomised groups. Researchers who fraudulently generate trials often unwittingly create baseline tables that are implausibly similar (under-dispersed) or have large differences between groups (over-dispersed). I aimed to create an automated algorithm to screen for under- and over-dispersion in the baseline tables of randomised trials. Methods : Using a cross-sectional study I examined 2,245 randomised controlled trials published in health and medical journals on PubMed Central . I estimated the probability that a trial's baseline summary statistics were under- or over-dispersed using a Bayesian model that examined the distribution of t-statistics for the between-group differences, and compared this with an expected distribution without dispersion. I used a simulation study to test the ability of the model to find under- or over-dispersion and compared its performance with an existing test of dispersion based on a uniform test of p-values. My model combined categorical and continuous summary statistics, whereas the uniform test used only continuous statistics. Results : The algorithm had a relatively good accuracy for extracting the data from baseline tables, matching well on the size of the tables and s le size. Using t-statistics in the Bayesian model out-performed the uniform test of p-values, which had many false positives for skewed, categorical and rounded data that were not under- or over-dispersed. For trials published on PubMed Central , some tables appeared under- or over-dispersed because they had an atypical presentation or had reporting errors. Some trials flagged as under-dispersed had groups with strikingly similar summary statistics. Conclusions : Automated screening for fraud of all submitted trials is challenging due to the widely varying presentation of baseline tables. The Bayesian model could be useful in targeted checks of suspected trials or authors.
Publisher: F1000 Research Ltd
Date: 12-07-2022
DOI: 10.12688/F1000RESEARCH.123002.1
Abstract: Background : Papers describing the results of a randomised trial should include a baseline table that compares the characteristics of randomised groups. Researchers who fraudulently generate trials often unwittingly create baseline tables that are implausibly similar (under-dispersed) or have large differences between groups (over-dispersed). I aimed to create an automated algorithm to screen for under- and over-dispersion in the baseline tables of randomised trials. Methods : Using a cross-sectional study I examined 2,245 randomised controlled trials published in health and medical journals on PubMed Central . I estimated the probability that a trial's baseline summary statistics were under- or over-dispersed using a Bayesian model that examined the distribution of t-statistics for the between-group differences, and compared this with an expected distribution without dispersion. I used a simulation study to test the ability of the model to find under- or over-dispersion and compared its performance with an existing test of dispersion based on a uniform test of p-values. My model combined categorical and continuous summary statistics, whereas the uniform uniform test used only continuous statistics. Results : The algorithm had a relatively good accuracy for extracting the data from baseline tables, matching well on the size of the tables and s le size. Using t-statistics in the Bayesian model out-performed the uniform test of p-values, which had many false positives for skewed, categorical and rounded data that were not under- or over-dispersed. For trials published on PubMed Central , some tables appeared under- or over-dispersed because they had an atypical presentation or had reporting errors. Some trials flagged as under-dispersed had groups with strikingly similar summary statistics. Conclusions : Automated screening for fraud of all submitted trials is challenging due to the widely varying presentation of baseline tables. The Bayesian model could be useful in targeted checks of suspected trials or authors.
Publisher: F1000 Research Ltd
Date: 29-04-2019
DOI: 10.12688/F1000RESEARCH.18453.1
Abstract: Background: Universities closely watch international league tables because these tables influence governments, donors and students. Achieving a high ranking in a table, or an annual rise in ranking, allows universities to promote their achievements using an externally validated measure. However, league tables predominantly reward measures of research output, such as publications and citations, and may therefore be promoting poor research practices by encouraging the “publish or perish” mentality. Methods: We examined whether a league table could be created based on good research practice. We rewarded researchers who cited a reporting guideline, which help researchers report their research completely, accurately and transparently, and were created to reduce the waste of poorly described research. We used the EQUATOR guidelines, which means our tables are mostly relevant to health and medical research. Results: Our cross-sectional tables for the years 2016 and 2017 included 14,408 papers with 47,876 author affiliations. We ranked universities and included a bootstrap measure of uncertainty. We clustered universities in five similar groups in an effort to avoid over-interpreting small differences in ranks. Conclusions: We believe there is merit in considering more socially responsible criteria for ranking universities, and this could encourage better research practice internationally if such tables become as valued as the current quantity-focused tables.
Publisher: Public Library of Science (PLoS)
Date: 03-01-2018
Publisher: Informa UK Limited
Date: 23-04-2021
Publisher: SAGE Publications
Date: 27-02-2009
Abstract: Videotelephony (real-time audio-visual communication) has been used successfully in adult palliative home care. This paper describes two attempts to complete an RCT (both of which were abandoned following difficulties with family recruitment), designed to investigate the use of videotelephony with families receiving palliative care from a tertiary paediatric oncology service in Brisbane, Australia. To investigate whether providing videotelephone-based support was acceptable to these families, a 12-month non-randomised acceptability trial was completed. Seventeen palliative care families were offered access to a videotelephone support service in addition to the 24 hours ‘on-call’ service already offered. A 92% participation rate in this study provided some reassurance that the use of videotelephones themselves was not a factor in poor RCT participation rates. The next phase of research is to investigate the integration of videotelephone-based support from the time of diagnosis, through outpatient care and support, and for palliative care rather than for palliative care in isolation. Trial registration ACTRN 12606000311550
Publisher: Wiley
Date: 07-10-2023
DOI: 10.1111/JPC.16242
Abstract: To determine if the timing of manuscript submissions to The Journal of Paediatrics and Child Health (JPCH) changed following the onset of the COVID‐19 pandemic and to determine if the timing of manuscript submissions influenced editorial decisions. A retrospective observational study of submissions to JPCH from 1 January 2015 to 1 August 2022 was performed. Regression models were used to explore the change over time. Editorial decisions were examined using a multinomial regression model with the three‐category ordinal outcome of reject, revise and accept. All statistical models were fitted using a Bayesian approach and show 95% credible intervals (CI). The analyses included 11 499 manuscript submissions between 2015 and 2022. The mean number of manuscript submissions increased by 17 papers per month (CI 15–19), with a larger 4‐month long increase after the COVID‐19 pandemic was declared of 86 submissions per month (CI 67–103). There was no clear effect of the pandemic on weekend submissions, mean difference in probability 0.003 (CI –0.021 to 0.026). Throughout the study period, the peak submission time was later in the day and was shifted +37 min later post‐March 2020 (CI +22 to +52 min). Throughout the study period, submissions out‐of‐hours and on weekends were less likely to get an editorial decision of ‘accept’ or ‘revise’: odds ratio weekend versus weekday 0.87 (CI 0.78–0.97). The COVID‐19 pandemic had a limited effect on the timing of manuscript submissions to JPCH. However, the timing of manuscript submission impacted the likelihood of a more positive editorial decision. While the time of manuscript submission is only one part of the research process, it is postulated that it may be associated with research quality.
Publisher: F1000 Research Ltd
Date: 29-07-2019
DOI: 10.12688/F1000RESEARCH.18453.2
Abstract: Background: Universities closely watch international league tables because these tables influence governments, donors and students. Achieving a high ranking in a table, or an annual rise in ranking, allows universities to promote their achievements using an externally validated measure. However, league tables predominantly reward measures of research output, such as publications and citations, and may therefore be promoting poor research practices by encouraging the “publish or perish” mentality. Methods: We examined whether a league table could be created based on good research practice. We rewarded researchers who cited a reporting guideline, which help researchers report their research completely, accurately and transparently, and were created to reduce the waste of poorly described research. We used the EQUATOR guidelines, which means our tables are mostly relevant to health and medical research. We used Scopus to identify the citations. Results: Our cross-sectional tables for the years 2016 and 2017 included 14,408 papers with 47,876 author affiliations. We ranked universities and included a bootstrap measure of uncertainty. We clustered universities in five similar groups in an effort to avoid over-interpreting small differences in ranks. Conclusions: We believe there is merit in considering more socially responsible criteria for ranking universities, and this could encourage better research practice internationally if such tables become as valued as the current quantity-focused tables.
Publisher: Elsevier BV
Date: 04-2015
DOI: 10.1016/J.SSTE.2015.03.001
Abstract: Identifying inequalities in air pollution levels across population groups can help address environmental justice concerns. We were interested in assessing these inequalities across major urban areas in Australia. We used a land-use regression model to predict ambient nitrogen dioxide (NO2) levels and sought the best socio-economic and population predictor variables. We used a generalised least squares model that accounted for spatial correlation in NO2 levels to examine the associations between the variables. We found that the best model included the index of economic resources (IER) score as a non-linear variable and the percentage of non-Indigenous persons as a linear variable. NO2 levels decreased with increasing IER scores (higher scores indicate less disadvantage) in almost all major urban areas, and NO2 also decreased slightly as the percentage of non-Indigenous persons increased. However, the magnitude of differences in NO2 levels was small and may not translate into substantive differences in health.
Publisher: Elsevier BV
Date: 05-2019
Publisher: AMPCo
Date: 06-2018
DOI: 10.5694/MJA17.00171
Publisher: Public Library of Science (PLoS)
Date: 12-06-2009
Publisher: BMJ
Date: 10-2017
DOI: 10.1136/BMJOPEN-2017-017393
Abstract: In-bed cycling with patients with critical illness has been shown to be safe and feasible, and improves physical function outcomes at hospital discharge. The effects of early in-bed cycling on reducing the rate of skeletal muscle atrophy, and associations with physical and cognitive function are unknown. A single-centre randomised controlled trial in a mixed medical-surgical intensive care unit (ICU) will be conducted. Adult patients (n=68) who are expected to be mechanically ventilated for more than 48 hours and remain in ICU for a further 48 hours from recruitment will be randomly allocated into either (1) a usual care group or (2) a group that receives usual care and additional in-bed cycling sessions. The primary outcome is change in rectus femoris cross-sectional area at day 10 in comparison to baseline measured by blinded assessors. Secondary outcome measures include muscle strength, incidence of ICU-acquired weakness, handgrip strength, time to achieve functional milestones (sitting out of bed, walking), Functional Status Score in ICU, ICU Mobility Scale, 6 min walk test 1 week post-ICU discharge, incidence of delirium and quality of life (EuroQol Five Dimensions questionnaire Five Levels scale). Quality of life assessments will be conducted post-ICU admission at day 10, 3 and 6 months after acute hospital discharge. Participants in the intervention group will complete an acceptability of intervention questionnaire. Appropriate ethical approval from Metro South Health Human Research Ethics Committee has been attained. Results will be published in peer-reviewed publications and presented at scientific conferences to assist planning of future multicentre randomised controlled trials (if indicated) that will test in-bed cycling as an intervention to improve the physical, cognitive and health-related quality of life outcomes of patients with critical illness. This trial has been prospectively registered on the Australian and New Zealand Clinical Trial Registry (ACTRN12616000948493) Pre-results.
Publisher: Elsevier BV
Date: 07-2023
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 27-09-2022
DOI: 10.1097/CCM.0000000000005296
Abstract: The study investigated the impact of prone positioning during venovenous extracorporeal membrane oxygenation support for coronavirus disease 2019 acute respiratory failure on the patient outcome. An observational study of venovenous extracorporeal membrane oxygenation patients. We used a multistate survival model to compare the outcomes of patients treated with or without prone positioning during extracorporeal membrane oxygenation, which incorporates the dynamic nature of prone positioning and adjusts for potential confounders. Seventy-two international institutions participating in the Coronavirus Disease 2019 Critical Care Consortium international registry. Coronavirus disease 2019 patients who were supported by venovenous extracorporeal membrane oxygenation during the study period. None. There were 232 coronavirus disease 2019 patients at 72 participating institutions who were supported with venovenous extracorporeal membrane oxygenation during the study period from February 16, 2020, to October 31, 2020. Proning was used in 176 patients (76%) before initiation of extracorporeal membrane oxygenation and in 67 patients (29%) during extracorporeal membrane oxygenation. Survival to hospital discharge was 33% in the extracorporeal membrane oxygenation prone group versus 22% in the extracorporeal membrane oxygenation supine group. Prone positioning during extracorporeal membrane oxygenation support was associated with reduced mortality (hazard ratio, 0.31 95% CI, 0.14–0.68). Our study highlights that prone positioning during venovenous extracorporeal membrane oxygenation support for refractory coronavirus disease 2019-related acute respiratory distress syndrome is associated with reduced mortality. Given the observational nature of the study, a randomized controlled trial of prone positioning on venovenous extracorporeal membrane oxygenation is needed to confirm these findings.
Publisher: Pensoft Publishers
Date: 02-2017
DOI: 10.3897/RIO.3.E11931
Publisher: Springer Science and Business Media LLC
Date: 18-04-2011
Abstract: Many previous studies have found seasonal patterns in birth outcomes, but with little agreement about which season poses the highest risk. Some of the heterogeneity between studies may be explained by a previously unknown bias. The bias occurs in retrospective cohorts which include all births occurring within a fixed start and end date, which means shorter pregnancies are missed at the start of the study, and longer pregnancies are missed at the end. Our objective was to show the potential size of this bias and how to avoid it. To demonstrate the bias we simulated a retrospective birth cohort with no seasonal pattern in gestation and used a range of cohort end dates. As a real ex le, we used a cohort of 114,063 singleton births in Brisbane between 1 July 2005 and 30 June 2009 and examined the bias when estimating changes in gestation length associated with season (using month of conception) and a seasonal exposure (temperature). We used survival analyses with temperature as a time-dependent variable. We found strong artificial seasonal patterns in gestation length by month of conception, which depended on the end date of the study. The bias was avoided when the day and month of the start date was just before the day and month of the end date (regardless of year), so that the longer gestations at the start of the study were balanced by the shorter gestations at the end. After removing the fixed cohort bias there was a noticeable change in the effect of temperature on gestation length. The adjusted hazard ratios were flatter at the extremes of temperature but steeper between 15 and 25°C. Studies using retrospective birth cohorts should account for the fixed cohort bias by removing selected births to get unbiased estimates of seasonal health effects.
Publisher: Wiley
Date: 26-11-2020
Abstract: As the population of Australia ages, EDs will experience an increasing frequency of presentations of older adults from residential aged care facilities (RACFs). These presentations are often complex and time consuming in the chaotic and potentially hazardous ED environment. The Geriatric Emergency Department Intervention (GEDI) model was developed to optimise the care of frail older adults, especially RACF residents, in the ED. The aim of the present study was to evaluate the effectiveness of the GEDI model on the primary outcomes of disposition (admission, discharge or death) and ED length of stay for residents of RACFs, presenting to an ED in regional Queensland, Australia. GEDI is a nurse-led, physician-ch ioned, innovative model delivered by advanced practice nurses with expertise in gerontology. This quasi-experimental pragmatic study compared outcomes for RACF residents who presented to a regional Queensland ED during three time periods: pre-GEDI, interim GEDI and post-GEDI implementation of the GEDI model. Outcomes included disposition, ED length of stay, ED re-presentation and mortality. A significant increase in the likelihood of discharge from ED (hazard ratio 1.15, 95% confidence interval 1.05-1.26) and reductions in ED length of stay (hazard ratio 1.49, 95% confidence interval 1.24-1.78) were evident for RACF residents following the implementation of the GEDI intervention. There were no differences in mortality, ED re-presentation or in-hospital length of stay between the three time periods. There is a paucity of evidence to support the implementation of nurse-led teams in EDs designed to target older adults living in RACFs. The GEDI model was effective in reducing ED length of stay while increasing the likelihood of safe discharge for RACF residents.
Publisher: Elsevier BV
Date: 12-2012
DOI: 10.1016/J.JCRC.2012.08.019
Abstract: Endotracheal suctioning causes significant lung derecruitment. Closed suction (CS) minimizes lung volume loss during suction, and therefore, volumes are presumed to recover more quickly postsuctioning. Conflicting evidence exists regarding this. We examined the effects of open suction (OS) and CS on lung volume loss during suctioning, and recovery of end-expiratory lung volume (EELV) up to 30 minutes postsuction. Randomized crossover study examining 20 patients postcardiac surgery. CS and OS were performed in random order, 30 minutes apart. Lung impedance was measured during suction, and end-expiratory lung impedance was measured at baseline and postsuctioning using electrical impedance tomography. Oximetry, partial pressure of oxygen in the alveoli/fraction of inspired oxygen ratio and compliance were collected. Reductions in lung impedance during suctioning were less for CS than for OS (mean difference, -905 impedance units 95% confidence interval [CI], -1234 to -587 P < .001). However, at all points postsuctioning, EELV recovered more slowly after CS than after OS. There were no statistically significant differences in the other respiratory parameters. Closed suctioning minimized lung volume loss during suctioning but, counterintuitively, resulted in slower recovery of EELV postsuction compared with OS. Therefore, the use of CS cannot be assumed to be protective of lung volumes postsuctioning. Consideration should be given to restoring EELV after either suction method via a recruitment maneuver.
Publisher: Springer Science and Business Media LLC
Date: 09-2011
DOI: 10.1038/477538A
Publisher: Springer Science and Business Media LLC
Date: 18-06-2018
Publisher: BMJ
Date: 02-2021
DOI: 10.1136/BMJOPEN-2020-044054
Abstract: To evaluate the cost-effectiveness of percutaneous coronary intervention (PCI) compared with placebo in patients with single-vessel coronary artery disease and angina despite anti-anginal therapy. A cost-effectiveness analysis comparing PCI with placebo. A Markov model was used to measure incremental cost-effectiveness, in cost per quality-adjusted life-years (QALYs) gained, over 12 months. Health utility weights were estimated using responses to the EuroQol 5-level questionnaire, from the Objective Randomised Blinded Investigation with optimal medical Therapy of Angioplasty in stable angina trial and UK preference weights. Costs of procedures and follow-up consultations were derived from Healthcare Resource Group reference costs and drug costs from the National Health Service (NHS) drug tariff. Probabilistic sensitivity analysis was undertaken to test the robustness of results to parameter uncertainty. Scenario analyses were performed to test the effect on results of reduced pharmaceutical costs in patients undergoing PCI, and the effect of patients crossing over from placebo to PCI due to refractory angina within 12 months. Five UK NHS hospitals. 200 adult patients with stable angina and angiographically severe single-vessel coronary artery disease on anti-anginal therapy. At recruitment, patients received 6 weeks of optimisation of medical therapy for angina after which they were randomised to PCI or a placebo procedure. Incremental cost-effectiveness ratio (ICER) expressed as cost (in £) per QALY gained for PCI compared with placebo. The estimated ICER is £90 218/QALY gained when using PCI compared with placebo in patients receiving medical treatment for angina due to single-vessel coronary artery disease. Results were robust under sensitivity analyses. The ICER for PCI compared with placebo, in patients with single-vessel coronary artery disease and angina on anti-anginal medication, exceeds the threshold of £30 000 used by the National Institute of Health and Care Excellence when undertaking health technology assessment for the NHS context. Trial registration: The ORBITA study is registered with ClinicalTrials.gov, number NCT02062593 .
Publisher: BMJ
Date: 10-2016
DOI: 10.1136/BMJOPEN-2016-011784
Abstract: To quantify data sharing trends and data sharing policy compliance at the British Medical Journal (BMJ) by analysing the rate of data sharing practices, and investigate attitudes and examine barriers towards data sharing. Observational study. The BMJ research archive. 160 randomly s led BMJ research articles from 2009 to 2015, excluding meta-analysis and systematic reviews. Percentages of research articles that indicated the availability of their raw data sets in their data sharing statements, and those that easily made their data sets available on request. 3 articles contained the data in the article. 50 out of 157 (32%) remaining articles indicated the availability of their data sets. 12 used publicly available data and the remaining 38 were sent email requests to access their data sets. Only 1 publicly available data set could be accessed and only 6 out of 38 shared their data via email. So only 7/157 research articles shared their data sets, 4.5% (95% CI 1.8% to 9%). For 21 clinical trials bound by the BMJ data sharing policy, the per cent shared was 24% (8% to 47%). Despite the BMJ 's strong data sharing policy, sharing rates are low. Possible explanations for low data sharing rates could be: the wording of the BMJ data sharing policy, which leaves room for in idual interpretation and possible loopholes that our email requests ended up in researchers spam folders and that researchers are not rewarded for sharing their data. It might be time for a more effective data sharing policy and better incentives for health and medical researchers to share their data.
Publisher: Elsevier BV
Date: 10-2008
DOI: 10.1016/J.JPEDS.2008.04.023
Abstract: To determine the accuracy of C-reactive protein (CRP) for diagnosing serious bacterial and bacterial infections in infants and children presenting with fever. Systematic review of diagnostic accuracy studies. We included studies comparing the diagnostic accuracy of CRP with microbiologic confirmation of (a) serious bacterial and (b) bacterial infection. For differentiating between serious bacterial infection and benign or nonbacterial infection (6 studies), the pooled estimate of sensitivity was 0.77 (95% CI, 0.68, 0.83) specificity, 0.79 (95% CI, 0.74, 0.83) positive likelihood ratio, 3.64 (95% CI, 2.99, 4.43) and negative likelihood ratio, 0.29 (95% CI, 0.22, 0.40). In multivariate analysis, CRP is an independent predictor of serious bacterial infection. 3 studies investigating the accuracy of CRP for diagnosing bacterial infection could not be pooled, but all showed a lower sensitivity compared with studies using serious bacterial infection as the reference diagnosis. CRP provides moderate and independent information for both ruling in and ruling out serious bacterial infection in children with fever at first presentation. Poor sensitivity means that CRP cannot be used to exclude all bacterial infection.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 04-2016
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 09-2004
DOI: 10.1097/01.EDE.0000129521.22687.C0
Abstract: The aim of this article was to investigate the size and possible causes of the reported excess in coronary events on Mondays. We conducted a metaanalysis of data from the World Health Organization (WHO) MONICA Project, which monitored trends and determinants in cardiovascular disease. The MONICA Project was undertaken in 21 countries from 1980 to 1995. We found a small overall excess rate of coronary events on Mondays. In a population experiencing 100 events per week, we estimate there would be approximately 1 more event on Monday than on any other day. Hierarchical logistic regression showed that the Monday excess was greater in centers with less thorough data collection procedures. The excess of coronary events on Mondays is probably an artifact resulting from events with uncertain dates being coded as taking place on Mondays.
Publisher: Elsevier BV
Date: 02-2019
DOI: 10.1016/J.AMJCARD.2018.10.022
Abstract: Magnetic resonance imaging (MRI) studies have consistently identified a high incidence of silent brain infarction (SBI) after cardiac intervention. The frequent occurrence, objective measurement and clinical sequelae of SBI have seen interest in their detection for both research and clinical purposes. However, MRI is expensive, time-consuming, unsafe in acutely-ill patients, and not always available, limiting its use as a routine screening tool. For this purpose, a blood biomarker of SBI would be the "Holy Grail." By performing targeted profiling of serologic biomarkers this study aimed to assess their potential as screening tools for perioperative SBI. This is a nested case-control study of 20 prospectively recruited patients undergoing transcatheter aortic valve implantation under general anesthesia. Clinical and diffusion-weighted MRI assessments were performed at baseline and on day 3 postprocedure to identify the presence (cases) or absence (controls) of new SBI. Blood was collected at baseline and 24, 48, and 72 hours postprocedure and analyzed for S100 calcium-binding protein B, neuron specific enolase (NSE), matrix metalloproteinase 9 (MMP 9), and glial fibrillary acidic protein. Best-fit polynomial curves using a smoothing model were generated for each biomarker and inferential testing at a predefined 24-hour postprocedure timepoint detected a significant difference for MMP 9 (72,435 SEM: 25,030 p = 0.027). Longitudinal regression revealed a statistically significant case-control difference for both NSE (mean: 10,747 SEM: 3,114) and MMP 9 (63,842 SEM: 16,173). In conclusion, NSE and MMP 9 are present in higher levels following SBI and warrant further investigation for their utility as screening tools.
Publisher: Elsevier BV
Date: 09-2021
Publisher: Informa UK Limited
Date: 28-02-2018
DOI: 10.1080/15389588.2018.1426911
Abstract: This study used medicolegal data to investigate fatal older road user (ORU) crash circumstances and risk factors relating to four key components of the Safe System approach (e.g., roads and roadsides, vehicles, road users, and speeds) to identify areas of priority for targeted prevention activity. The Coroners Court of Victoria's Surveillance Database was searched to identify coronial records with at least one deceased ORU in the state of Victoria, Australia, for 2013-2014. Information relating to the ORU, crash characteristics and circumstances, and risk factors was extracted and analyzed. The average rate of fatal ORU crashes per 100,000 population was 8.1 (95% confidence interval [CI] 6.0-10.2), which was more than double the average rate of fatal middle-aged road user crashes (3.6, 95% CI 2.5-4.6). There was a significant relationship between age group and deceased road user type (χ Road user error was the most significant risk factor identified in fatal ORU crashes, which suggests that there is a limited capacity of the Victorian road system to fully accommodate road user errors. Initiatives related to safer roads and roadsides, vehicles, and speed zones, as well as behavioral approaches, are key areas of priority for targeted activity to prevent fatal older road user crashes in the future.
Publisher: Public Library of Science (PLoS)
Date: 29-06-2023
DOI: 10.1371/JOURNAL.PONE.0287470
Abstract: Up to 80% of Intensive Care Unit patients experience physical, cognitive, and/or psychological complications post-discharge, known as ‘Post Intensive Care Syndrome’ (PICS). Early diagnosis and intervention are a priority, but while current post-intensive care follow-up processes endorse a multidisciplinary model, incorporating a psychiatric consultation has not been studied. A pilot, open-label randomised controlled trial was developed by a multidisciplinary team to evaluate the feasibility and acceptability of incorporating a psychiatric review into an existing post-ICU clinic. The study will run for 12 months and aim to recruit 30 participants. Inclusion criteria for participants: a) ICU admission greater than 48 hours, b) no cognitive impairment that prevents participation, c) ≥ 18 years old, d) residing in Australia, e) fluent in English, f) able to provide GP information, and g) likely to be contactable in 6 months. Patient recruitment will be at Redcliffe Hospital, Queensland, Australia, and will involve patients attending the Redcliffe post intensive care clinic. Participants will be allocated to intervention or control using block randomisation and allocation concealment. Participants allocated to the control arm will receive the standard cares provided by the clinic, which involves an unstructured interview about their ICU experience and a battery of surveys about their psychological, cognitive, and physical function. Those allocated to the intervention arm will receive these same cares as well as an appointment with a psychiatrist for a single session intervention. The psychiatric intervention will involve a comprehensive review, including comorbid disorders, substance use, suicidal ideation, psychosocial stressors, social/emotional supports. Psychoeducation and initial treatment will be provided as indicated and recommendations given to the patient and their GP about how to access ongoing care. In addition to surveys conducted as part of standard clinic cares, all participants will complete additional questionnaires about their history, hospital experience, mental and physical health as well as employment circumstances. All participants will be followed up 6 months after their appointment and will be invited to complete follow-up questionnaires about their mental and physical health, as well as health service use and employment circumstances. The trial has been registered with ANZCTR (ACTRN12622000894796). To evaluate the feasibility and acceptability of the intervention to the patient population. Differences between groups will be assessed using an independent s les t-test. Resource requirements to administer the intervention will be evaluated by reporting the mean duration of the EPARIS assessment and approximate cost per patient to provide this service. To estimate the effect size of any treatment effects, changes in secondary outcome measures between baseline and 6 months will be compared between intervention and control groups using Analysis of Covariance regression. As this is a pilot, we will not use p-values or test a null hypothesis, but will give confidence intervals. This protocol provides a pragmatic evaluation of the acceptability of introducing early psychiatric assessment into an existing post-ICU follow-up process, and if considered acceptable will inform future research into the efficacy and generalisability of the intervention. The strengths of EPARIS are the prospective, longitudinal design with a control population, and its use of validated post-ICU outcome measures.
Publisher: Springer Science and Business Media LLC
Date: 12-2018
Publisher: Elsevier BV
Date: 06-2018
DOI: 10.1016/J.PUPT.2018.04.006
Abstract: Preservative-free tobramycin is commonly used as aerosolized therapy for ventilator associated pneumonia. The comparative delivery profile of the formulations of two different concentrations (100 mg/ml and 40 mg/ml) is unknown. This study aims to evaluate the aerosol characteristics of these tobramycin formulations in a simulated adult mechanical ventilation model. Simulated adult mechanical ventilation set up and optimal settings were used in the study. Inhaled mass study was performed using bacterial/viral filters at the tip of the tracheal tube and in the expiratory limb of circuit. Laser diffractometer was used for characterising particle size distribution. The physicochemical characteristics of the formulations were described and nebulization characteristics compared using two airways, an endotracheal tube (ET) and a tracheostomy tube (TT). For each type of tube, three internal tube diameters were studied, 7 mm, 8 mm and 9 mm. The lung dose was significantly higher for 100 mg/ml solution (mean 121.3 mg vs 41.3 mg). Viscosity was different (2.11cp vs 1.58cp) for 100 mg/ml vs 40 mg/ml respectively but surface tension was similar. For tobramycin 100 mg/ml vs 40 mg/ml, the volume median diameter (2.02 vs 1.9 μm) was comparable. The fine particle fraction (98.5 vs 85.4%) was higher and geometric standard deviation (1.36 vs 1.62 μm) was significantly lower for 100 mg/ml concentration. Nebulization duration was longer for 100 mg/ml solution (16.9 vs 10.1 min). The inhaled dose percent was similar (30%) but the exhaled dose was higher for 100 mg/ml solution (18.9 vs 10.4%). The differences in results were non-significant for type of tube or size except for a small but statistically significant reduction in inhaled mass with TT compared to ET (0.06%). Aerosolized tobramycin 100 mg/ml solution delivered higher lung dose compared to tobramycin 40 mg/ml solution. Tracheal tube type or size did not influence the aerosol characteristics and delivery parameters.
Publisher: BMJ
Date: 02-2005
Publisher: Elsevier BV
Date: 2019
Publisher: Wiley
Date: 13-11-2019
DOI: 10.1111/JGS.15662
Publisher: Wiley
Date: 04-2015
DOI: 10.1071/HE14059
Publisher: Springer Science and Business Media LLC
Date: 2013
DOI: 10.1186/CC12843
Publisher: Oxford University Press (OUP)
Date: 12-2020
Abstract: To avoid arguments over disappointing results, Adrian Barnett suggests scrambling your statistics before sharing the final report
Publisher: Elsevier BV
Date: 2012
DOI: 10.1016/J.ENVRES.2011.12.010
Abstract: Extreme cold and heat waves, characterized by a number of cold or hot days in succession, place a strain on people's cardiovascular and respiratory systems. The increase in deaths due to these waves may be greater than that predicted by extreme temperatures alone. We examined cold and heat waves in 99 US cities for 14 years (1987-2000) and investigated how the risk of death depended on the temperature threshold used to define a wave, and a wave's timing, duration and intensity. We defined cold and heat waves using temperatures above and below cold and heat thresholds for two or more days. We tried five cold thresholds using the first to fifth percentiles of temperature, and five heat thresholds using the 95-99 percentiles. The extra wave effects were estimated using a two-stage model to ensure that their effects were estimated after removing the general effects of temperature. The increases in deaths associated with cold waves were generally small and not statistically significant, and there was even evidence of a decreased risk during the coldest waves. Heat waves generally increased the risk of death, particularly for the hottest heat threshold. Cold waves of a colder intensity or longer duration were not more dangerous. Cold waves earlier in the cool season were more dangerous, as were heat waves earlier in the warm season. In general there was no increased risk of death during cold waves above the known increased risk associated with cold temperatures. Cold or heat waves earlier in the cool or warm season may be more dangerous because of a build up in the susceptible pool or a lack of preparedness for extreme temperatures.
Publisher: Cambridge University Press (CUP)
Date: 04-2013
DOI: 10.1086/669862
Publisher: American Society for Microbiology
Date: 07-09-2016
Publisher: Environmental Health Perspectives
Date: 12-2011
DOI: 10.1289/EHP.1103456
Publisher: Frontiers Media SA
Date: 07-05-2018
Publisher: Springer Science and Business Media LLC
Date: 29-07-2020
DOI: 10.1186/S12877-020-01660-2
Abstract: Hospitalisation rates for the older population have been increasing with end-of-life care becoming a more medicalised and costly experience. There is evidence that some of these patients received non-beneficial treatment during their final hospitalisation with a third of the non-beneficial treatment duration spent in intensive care units. This study aims to increase appropriate care and treatment decisions and pathways for older patients at the end of life in Australia. This study will implement and evaluate a prospective feedback loop and tailored clinical response intervention at three hospitals in Queensland, Australia. A stepped-wedge cluster randomised trial will be conducted with up to 21 clinical teams in three acute hospitals over 70 weeks. The study involves clinical teams providing care to patients aged 75 years or older, who are prospectively identified to be at risk of non-beneficial treatment using two validated tools for detecting death and deterioration risks. The intervention’s feedback loop will provide the teams with a summary of these patients’ risk profiles as a stimulus for a tailored clinical response in the intervention phase. The Consolidated Framework for Implementation Research will be used to inform the intervention’s implementation and process evaluation. The study will determine the impact of the intervention on patient outcomes related to appropriate care and treatment at the end of life in hospitals, as well as the associated healthcare resource use and costs. The primary outcome is the proportion of patients who are admitted to intensive care units. A process evaluation will be carried out to assess the implementation, mechanisms of impact, and contextual barriers and enablers of the intervention. This intervention is expected to have a positive impact on the care of older patients near the end of life, specifically to improve clinical decision-making about treatment pathways and what constitutes appropriate care for these patients. These will reduce the incidence of non-beneficial treatment, and improve the efficiency of hospital resources and quality of care. The process evaluation results will be useful to inform subsequent intervention implementation at other hospitals. Australia New Zealand Clinical Trial Registry (ANZCTR), ACTRN12619000675123p (approved 6 May 2019),
Publisher: Elsevier BV
Date: 02-2019
DOI: 10.1016/J.JCRC.2018.10.015
Abstract: Endotracheal suctioning (ES) of mechanically ventilated patients decreases end-expiratory lung volume (EELV). Manual hyperinflation (MHI) and ventilator hyperinflation (VHI) may restore EELV post-ES but it remains unknown which method is most effective. The primary aim was to compare the efficacy of MHI and VHI in restoring EELV post-ES. ES was performed on mechanically ventilated intensive care patients, followed by MHI or VHI, in a randomised crossover design. The washout period between interventions was 1 h. End-expiratory lung impedance (EELI), measured by electrical impedance tomography, was recorded at baseline, during ES, during hyperinflation and 1, 5, 15 and 30 min post-hyperinflation. Nine participants were studied. ES decreased EELI by 1672z (95% CI, 1204 to 2140) from baseline. From baseline, MHI increased EELI by 1154z (95% CI, 977 to 1330) while VHI increased EELI by 769z (95% CI, 457 to 1080). Five minutes post-VHI, EELI remained 528z (95% CI, 4 to 1053) above baseline. Fifteen minutes post-MHI, EELI remained 351z (95% CI, 111 to 592) above baseline. At subsequent time-points, EELI returned to baseline. MHI and VHI effectively restore EELV above baseline post-ES and should be considered post suctioning.
Publisher: SAGE Publications
Date: 2015
DOI: 10.1177/0310057X1504300113
Abstract: Electrical impedance tomography is a novel technology capable of quantifying ventilation distribution in the lung in real time during various therapeutic manoeuvres. The technique requires changes to the patient's position to place the electrical impedance tomography electrodes circumferentially around the thorax. The impact of these position changes on the time taken to stabilise the regional distribution of ventilation determined by electrical impedance tomography is unknown. This study aimed to determine the time taken for the regional distribution of ventilation determined by electrical impedance tomography to stabilise after changing position. Eight healthy, male volunteers were connected to electrical impedance tomography and a pneumotachometer. After 30 minutes stabilisation supine, participants were moved into 60 degrees Fowler's position and then returned to supine. Thirty minutes was spent in each position. Concurrent readings of ventilation distribution and tidal volumes were taken every five minutes. A mixed regression model with a random intercept was used to compare the positions and changes over time. The anterior-posterior distribution stabilised after ten minutes in Fowler's position and ten minutes after returning to supine. Left-right stabilisation was achieved after 15 minutes in Fowler's position and supine. A minimum of 15 minutes of stabilisation should be allowed for spontaneously breathing in iduals when assessing ventilation distribution. This time allows stabilisation to occur in the anterior-posterior direction as well as the left-right direction.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 03-2008
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 11-2009
Publisher: F1000 Research Ltd
Date: 29-10-2019
DOI: 10.12688/F1000RESEARCH.20661.1
Abstract: Background: A mechanism to predict graft failure before the actual kidney transplantation occurs is crucial to clinical management of chronic kidney disease patients. Several kidney graft outcome prediction models, developed using machine learning methods, are available in the literature. However, most of those models used small datasets and none of the machine learning-based prediction models available in the medical literature modelled time-to-event (survival) information, but instead used the binary outcome of failure or not. The objective of this study is to develop two separate machine learning-based predictive models to predict graft failure following live and deceased donor kidney transplant, using time-to-event data in a large national dataset from Australia. Methods: The dataset provided by the Australia and New Zealand Dialysis and Transplant Registry will be used for the analysis. This retrospective dataset contains the cohort of patients who underwent a kidney transplant in Australia from January 1 st , 2007, to December 31 st , 2017. This included 3,758 live donor transplants and 7,365 deceased donor transplants. Three machine learning methods (survival tree, random survival forest and survival support vector machine) and one traditional regression method, Cox proportional regression, will be used to develop the two predictive models. The best predictive model will be selected based on the model’s performance. Discussion: This protocol describes the development of two separate machine learning-based predictive models to predict graft failure following live and deceased donor kidney transplant, using a large national dataset from Australia. Furthermore, these two models will be the most comprehensive kidney graft failure predictive models that have used survival data to model using machine learning techniques. Thus, these models are expected to provide valuable insight into the complex interactions between graft failure and donor and recipient characteristics.
Publisher: Cambridge University Press (CUP)
Date: 21-06-2019
DOI: 10.1017/ICE.2019.114
Abstract: Multisite intervention studies have become increasingly common in infection control, for ex le, looking for a change in hospital infection rates after a regional policy change. The design of these studies can take various forms, from pre–post observational studies to randomized trials, in which sites are randomly assigned to the intervention or in which the intervention is sequentially introduced to different sites over time. Data collected under these settings are clustered by hospital and/or ward, consist of repeated measurements and, in some cases, exhibit temporal and/or seasonal patterns. Failure to account for these features in data analysis could well result in biased estimates of intervention effectiveness and impact on the generalizability of model results.
Publisher: F1000 Research Ltd
Date: 09-03-2020
DOI: 10.12688/F1000RESEARCH.20661.2
Abstract: Background: A mechanism to predict graft failure before the actual kidney transplantation occurs is crucial to clinical management of chronic kidney disease patients. Several kidney graft outcome prediction models, developed using machine learning methods, are available in the literature. However, most of those models used small datasets and none of the machine learning-based prediction models available in the medical literature modelled time-to-event (survival) information, but instead used the binary outcome of failure or not. The objective of this study is to develop two separate machine learning-based predictive models to predict graft failure following live and deceased donor kidney transplant, using time-to-event data in a large national dataset from Australia. Methods: The dataset provided by the Australia and New Zealand Dialysis and Transplant Registry will be used for the analysis. This retrospective dataset contains the cohort of patients who underwent a kidney transplant in Australia from January 1 st , 2007, to December 31 st , 2017. This included 3,758 live donor transplants and 7,365 deceased donor transplants. Three machine learning methods (survival tree, random survival forest and survival support vector machine) and one traditional regression method, Cox proportional regression, will be used to develop the two predictive models (for live donor and deceased donor transplants). The best predictive model will be selected based on the model’s performance. Discussion: This protocol describes the development of two separate machine learning-based predictive models to predict graft failure following live and deceased donor kidney transplant, using a large national dataset from Australia. Furthermore, these two models will be the most comprehensive kidney graft failure predictive models that have used survival data to model using machine learning techniques. Thus, these models are expected to provide valuable insight into the complex interactions between graft failure and donor and recipient characteristics.
Publisher: Springer Science and Business Media LLC
Date: 21-04-2020
DOI: 10.1186/S12913-020-05233-2
Abstract: Non-alcoholic fatty liver disease (NAFLD) is the most common type of chronic liver disease in Australia and its recent increase mirrors the obesity and type 2 diabetes epidemics. Currently, many patients who present to primary care with abnormal liver function tests or steatosis on liver ultrasound are referred for assessment in secondary care. Due to the large number of patients with NAFLD, this results in long waits for clinical and fibrosis assessment, placing unnecessary burden on the public hospital system. We will conduct a 1:1 parallel randomised trial to compare two alternative models of care for NAFLD. Participants will be randomised to usual care or the LOCal Assessment and Triage Evaluation (LOCATE) model of care and followed for 1 year. We will recruit patients from the non-neighbouring Sunshine Coast and Metro South Hospital and Health Services (HHSs) in Queensland, Australia. Our primary outcome of interest is time to diagnosis of high-risk NAFLD, based on the number of participants in each arm of the study who receive a diagnosis of clinically significant fibrosis. Two hundred and 34 participants will give us a 95% power to detect a 50% reduction in the primary outcome of time to diagnosis of high-risk disease. We will also conduct an economic evaluation, evaluating the cost-effectiveness of the new model of care. We will also evaluate the implementation of the new model of care. It is anticipated that the results of this study will provide valuable new information regarding the management of NAFLD in the Australian setting. A relatively simple change to care could result in earlier identification of patients with significant liver disease and lower overall costs for the health system. Results will be directly disseminated to key staff for further distribution to consumers, policy- and decision-makers in the form of evidence briefs, plain language summaries and policy recommendations. The trial was registered on 30 January, 2020 and can be found via ANZCTR - number ACTRN12620000158965 .
Publisher: The Royal Society
Date: 03-2020
DOI: 10.1098/RSOS.191818
Abstract: Sharing data and code are important components of reproducible research. Data sharing in research is widely discussed in the literature however, there are no well-established evidence-based incentives that reward data sharing, nor randomized studies that demonstrate the effectiveness of data sharing policies at increasing data sharing. A simple incentive, such as an Open Data Badge, might provide the change needed to increase data sharing in health and medical research. This study was a parallel group randomized controlled trial (protocol registration: doi:10.17605/OSF.IO/PXWZQ ) with two groups, control and intervention, with 80 research articles published in BMJ Open per group, with a total of 160 research articles. The intervention group received an email offer for an Open Data Badge if they shared their data along with their final publication and the control group received an email with no offer of a badge if they shared their data with their final publication. The primary outcome was the data sharing rate. Badges did not noticeably motivate researchers who published in BMJ Open to share their data the odds of awarding badges were nearly equal in the intervention and control groups (odds ratio = 0.9, 95% CI [0.1, 9.0]). Data sharing rates were low in both groups, with just two datasets shared in each of the intervention and control groups. The global movement towards open science has made significant gains with the development of numerous data sharing policies and tools. What remains to be established is an effective incentive that motivates researchers to take up such tools to share their data.
Publisher: Elsevier BV
Date: 05-2020
Publisher: Wiley
Date: 08-05-2015
DOI: 10.1111/IMIG.12099
Publisher: American Chemical Society (ACS)
Date: 02-10-2018
Abstract: Australia has relatively erse sources and low concentrations of ambient fine particulate matter (<2.5 μm, PM
Publisher: SAGE Publications
Date: 08-02-2023
DOI: 10.1177/02676591231156487
Abstract: Introduction: Obesity is associated with a worse prognosis in COVID-19 patients with acute respiratory distress syndrome (ARDS). Veno-venous (V-V) Extracorporeal Membrane Oxygenation (ECMO) can be a rescue option, however, the direct impact of morbid obesity in this select group of patients remains unclear. Methods: This is an observational study of critically ill adults with COVID-19 and ARDS supported by V-V ECMO. Data are from 82 institutions participating in the COVID-19 Critical Care Consortium international registry. Patients were admitted between 12 January 2020 to 27 April 2021. They were stratified based on Body Mass Index (BMI) at 40 kg/m 2 . The endpoint was survival to hospital discharge. Results: Complete data available on 354 of 401 patients supported on V-V ECMO. The characteristics of the high BMI ( kg/m 2 ) and lower BMI (≤40 kg/m 2 ) groups were statistically similar. However, the ‘high BMI’ group were comparatively younger and had a lower APACHE II score. Using survival analysis, older age (Hazard Ratio, HR 1.49 per-10-years, CI 1.25–1.79) and higher BMI (HR 1.15 per-5 kg/m 2 increase, CI 1.03–1.28) were associated with a decreased patient survival. A safe BMI threshold above which V-V ECMO would be prohibitive was not apparent and instead, the risk of an adverse outcome increased linearly with BMI. Conclusion: In COVID-19 patients with severe ARDS who require V-V ECMO, there is an increased risk of death associated with age and BMI. The risk is linear and there is no BMI threshold beyond which the risk for death greatly increases.
Publisher: BMJ
Date: 02-2016
Publisher: Environmental Health Perspectives
Date: 10-2008
DOI: 10.1289/EHP.11804
Publisher: Elsevier BV
Date: 2013
DOI: 10.1016/J.ENVRES.2012.09.001
Abstract: Most studies examining the temperature-mortality association in a city used temperatures from one site or the average from a network of sites. This may cause measurement error as temperature varies across a city due to effects such as urban heat islands. We examined whether spatiotemporal models using spatially resolved temperatures produced different associations between temperature and mortality compared with time series models that used non-spatial temperatures. We obtained daily mortality data in 163 areas across Brisbane city, Australia from 2000 to 2004. We used ordinary kriging to interpolate spatial temperature variation across the city based on 19 monitoring sites. We used a spatiotemporal model to examine the impact of spatially resolved temperatures on mortality. Also, we used a time series model to examine non-spatial temperatures using a single site and the average temperature from three sites. We used squared Pearson scaled residuals to compare model fit. We found that kriged temperatures were consistent with observed temperatures. Spatiotemporal models using kriged temperature data yielded slightly better model fit than time series models using a single site or the average of three sites' data. Despite this better fit, spatiotemporal and time series models produced similar associations between temperature and mortality. In conclusion, time series models using non-spatial temperatures were equally good at estimating the city-wide association between temperature and mortality as spatiotemporal models.
Publisher: BMJ
Date: 20-12-2011
DOI: 10.1136/BMJ.D7799
Publisher: BMJ
Date: 11-2019
DOI: 10.1136/BMJOPEN-2019-032506
Abstract: Previous research has shown clear biases in the distribution of published p values, with an excess below the 0.05 threshold due to a combination of p-hacking and publication bias. We aimed to examine the bias for statistical significance using published confidence intervals. Observational study. Papers published in Medline since 1976. Over 968 000 confidence intervals extracted from abstracts and over 350 000 intervals extracted from the full-text. Cumulative distributions of lower and upper confidence interval limits for ratio estimates. We found an excess of statistically significant results with a glut of lower intervals just above one and upper intervals just below 1. These excesses have not improved in recent years. The excesses did not appear in a set of over 100 000 confidence intervals that were not subject to p-hacking or publication bias. The huge excesses of published confidence intervals that are just below the statistically significant threshold are not statistically plausible. Large improvements in research practice are needed to provide more results that better reflect the truth.
Publisher: SAGE Publications
Date: 2018
Publisher: Springer Science and Business Media LLC
Date: 15-09-2017
Publisher: Daedalus Enterprises
Date: 20-05-2014
Abstract: Head-of-bed elevation (HOBE) has been shown to assist in reducing respiratory complications associated with mechanical ventilation however, there is minimal research describing changes in end-expiratory lung volume. This study aims to investigate changes in end-expiratory lung volume in a supine position and 2 levels of HOBE. Twenty postoperative cardiac surgery subjects were examined using electrical impedance tomography. End-expiratory lung impedance (EELI) was recorded as a surrogate measurement of end-expiratory lung volume in a supine position and at 20° and then 30°. Significant increases in end-expiratory lung volume were seen at both 20° and 30° HOBE in all lung regions, except the anterior, with the largest changes from baseline (supine) seen at 30°. From baseline to 30° HOBE, global EELI increased by 1,327 impedance units (95% CI 1,080-1,573, P < .001). EELI increased by 1,007 units (95% CI 880-1,134, P < .001) in the left lung region and by 320 impedance units (95% CI 188-451, P < .001) in the right lung. Posterior increases of 1,544 impedance units (95% CI 1,405-1,682, P < .001) were also seen. EELI decreased anteriorly, with the largest decreases occurring at 30° (-335 impedance units, 95% CI -486 to -183, P < .001). HOBE significantly increases global and regional end-expiratory lung volume therefore, unless contraindicated, all mechanically ventilated patients should be positioned with HOBE.
Publisher: Elsevier BV
Date: 12-2020
DOI: 10.1016/J.PHYSIO.2019.06.011
Abstract: This study aims to (i) describe the time to exercise commencement (sitting and upright activities) relative to ICU admission and relative to achievement of initial neurological, respiratory and cardiovascular stability (ii) examine factors associated with whether sitting and upright activities occurred in ICU and (iii) examine factors associated with time taken to commence these activities after stability has been achieved. Five-year historical cohort study. An Australian tertiary mixed medical, surgical, trauma ICU. The cohort (n=3222, mean (SD) age 54 (18) years, 67% male) included consecutive ICU patients with length of stay over 48hours admitted to a tertiary ICU who achieved stability. Time from stability to patients' first completed sitting and upright activities was calculated. Logistic regression (and Cox proportional hazard models) examined whether sitting and upright activities in ICU occurred (and time to these events). None. For patients who completed exercise interventions (n=1845/3222, 57%), this commenced a median (IQR) 2.3 (1.3-4.4) days after stability for upright activities and 2.7 (1.5-5.7) days for sitting. A large proportion of patients did not complete exercise interventions despite achieving stability (n=1377/3222, 43%). Elective surgical admissions, lower illness severity and older age were associated with completion (and earlier completion) of sitting and upright activity (P<0.01). Many stable patients did not commence sitting or upright activity in ICU despite known benefits, or commencement was somewhat delayed. Opportunities may exist to improve patient outcomes through timely implementation of exercise-based interventions.
Publisher: BMJ
Date: 2013
Publisher: Elsevier BV
Date: 11-0004
DOI: 10.1016/J.ENVRES.2014.09.011
Abstract: Land-use regression (LUR) is a technique that can improve the accuracy of air pollution exposure assessment in epidemiological studies. Most LUR models are developed for single cities, which places limitations on their applicability to other locations. We sought to develop a model to predict nitrogen dioxide (NO2) concentrations with national coverage of Australia by using satellite observations of tropospheric NO2 columns combined with other predictor variables. We used a generalised estimating equation (GEE) model to predict annual and monthly average ambient NO2 concentrations measured by a national monitoring network from 2006 through 2011. The best annual model explained 81% of spatial variation in NO2 (absolute RMS error=1.4 ppb), while the best monthly model explained 76% (absolute RMS error=1.9 ppb). We applied our models to predict NO2 concentrations at the ~350,000 census mesh blocks across the country (a mesh block is the smallest spatial unit in the Australian census). National population-weighted average concentrations ranged from 7.3 ppb (2006) to 6.3 ppb (2011). We found that a simple approach using tropospheric NO2 column data yielded models with slightly better predictive ability than those produced using a more involved approach that required simulation of surface-to-column ratios. The models were capable of capturing within-urban variability in NO2, and offer the ability to estimate ambient NO2 concentrations at monthly and annual time scales across Australia from 2006-2011. We are making our model predictions freely available for research.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 05-2007
Publisher: Springer Science and Business Media LLC
Date: 24-01-2022
DOI: 10.1007/S11136-022-03079-1
Abstract: This study describes the reporting of the preference-based health-related quality-of-life (HRQOL) instrument, the EQ-5D, and proposes strategies to improve reporting and reduce research waste. The EQ-5D is a validated instrument widely used for health economic evaluation and is useful for informing health policy. As part of a systematic review of papers reporting EQ-5D utility weights in patients with coronary artery disease, we noted the reasons data from some papers could not be reused in a meta-analysis, including whether health utility weights and sufficient statistical details were reported. Research waste was quantified using: (1) the percentage of papers and s le size excluded, and (2) researcher time and cost reviewing poorly reported papers. Our search strategy found 5942 papers. At title and abstract screening 93% were excluded. Of the 379 full text papers screened, 130 papers reported using EQ-5D. Only 46% (60/130) of those studies reported utility weights and/or statistical properties enabling meta-analysis. Only 67% of included papers had reported EQ-5D in the title or abstract. A total s le size of 133,298 was excluded because of poor reporting. The cost of researcher time wasted estimated to be between $3816 and $13,279 for our review. Poor reporting of EQ-5D data creates research waste where potentially useful data are excluded from meta-analyses and economic evaluations. Poor reporting of HRQOL instruments also creates waste due to additional time spent reviewing papers for systematic reviews that are subsequently excluded. Studies using the EQ-5D should report utility weights with appropriate summary statistics to enable reuse in meta-analysis and more robust evidence for health policy. We recommend authors report the HRQOL instrument in the title or abstract in line with current reporting guidelines (CONSORT-PRO and SPIRIT-PRO Extensions) to make it easier for other researchers to find. Validated instruments should also be listed in the Medical Subject Headings (MeSH) to improve cataloguing and retrieval of previous research.
Publisher: SAGE Publications
Date: 27-10-2017
Abstract: When designing quantitative trials and evaluation of telehealth interventions, researchers should think ahead to the intended way that the intervention could be implemented in routine care and consider how trial participants with similar characteristics to the target population can be included. The telehealth intervention and the context in which it is placed should be clearly described, and consideration given to conducting pragmatic trials in order to show the effect of telehealth in complex environments with rapidly changing technology. Types of research designs, comparators and outcome measures are discussed and common statistical issues are introduced.
Publisher: Springer Science and Business Media LLC
Date: 2008
DOI: 10.1186/CC6840
Publisher: Elsevier BV
Date: 12-2011
DOI: 10.1093/BJA/AER265
Abstract: High-flow nasal cannulae (HFNCs) create positive oropharyngeal airway pressure, but it is unclear how their use affects lung volume. Electrical impedance tomography allows the assessment of changes in lung volume by measuring changes in lung impedance. Primary objectives were to investigate the effects of HFNC on airway pressure (P(aw)) and end-expiratory lung volume (EELV) and to identify any correlation between the two. Secondary objectives were to investigate the effects of HFNC on respiratory rate, dyspnoea, tidal volume, and oxygenation and the interaction between BMI and EELV. Twenty patients prescribed HFNC post-cardiac surgery were investigated. Impedance measures, P(aw), ratio, respiratory rate, and modified Borg scores were recorded first on low-flow oxygen and then on HFNC. A strong and significant correlation existed between P(aw) and end-expiratory lung impedance (EELI) (r=0.7, P<0.001). Compared with low-flow oxygen, HFNC significantly increased EELI by 25.6% [95% confidence interval (CI) 24.3, 26.9] and P(aw) by 3.0 cm H(2)O (95% CI 2.4, 3.7). Respiratory rate reduced by 3.4 bpm (95% CI 1.7, 5.2) with HFNC use, tidal impedance variation increased by 10.5% (95% CI 6.1, 18.3), and ratio improved by 30.6 mm Hg (95% CI 17.9, 43.3). A trend towards HFNC improving subjective dyspnoea scoring (P=0.023) was found. Increases in EELI were significantly influenced by BMI, with larger increases associated with higher BMIs (P<0.001). This study suggests that HFNCs reduce respiratory rate and improve oxygenation by increasing both EELV and tidal volume and are most beneficial in patients with higher BMIs.
Publisher: Elsevier BV
Date: 2018
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 05-2012
Publisher: MDPI AG
Date: 30-08-2012
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 09-2012
DOI: 10.1161/CIRCOUTCOMES.112.965707
Abstract: Extreme temperatures are associated with cardiovascular disease (CVD) deaths. Previous studies have investigated the relative CVD mortality risk of temperature, but this risk is heavily influenced by deaths in frail elderly people. To better estimate the burden of extreme temperatures, we estimated their effects on years of life lost due to CVD. The data were daily observations on weather and CVD mortality for Brisbane, Australia, between 1996 and 2004. We estimated the association between daily mean temperature and years of life lost due to CVD, after adjusting for trend, season, day of the week, and humidity. To examine the nonlinear and delayed effects of temperature, a distributed lag nonlinear model was used. The model’s residuals were examined to investigate whether there were any added effects due to cold spells and heat waves. The exposure–response curve between temperature and years of life lost was U-shaped, with the lowest years of life lost at 24°C. The curve had a sharper rise at extremes of heat than of cold. The effect of cold peaked 2 days after exposure, whereas the greatest effect of heat occurred on the day of exposure. There were significantly added effects of heat waves on years of life lost. Increased years of life lost due to CVD are associated with both cold and hot temperatures. Research on specific interventions is needed to reduce temperature-related years of life lost from CVD deaths.
Publisher: Springer Science and Business Media LLC
Date: 05-04-2014
Publisher: Springer Science and Business Media LLC
Date: 23-10-2023
Publisher: Wiley
Date: 18-01-2010
Publisher: Environmental Health Perspectives
Date: 03-2008
DOI: 10.1289/EHP.10720
Publisher: Elsevier BV
Date: 03-2018
DOI: 10.1016/J.AHJ.2017.12.008
Abstract: Transcatheter aortic valve implantation (TAVI) is associated with a high incidence of cerebrovascular injury. As these injuries are thought to be primarily embolic, neuroprotection strategies have focused on embolic protection devices. However, the topographical distribution of cerebral emboli and how this impacts on the effectiveness of these devices have not been thoroughly assessed. Here, we evaluated the anatomical characteristics of magnetic resonance imaging (MRI)-defined cerebral ischemic lesions occurring secondary to TAVI to enhance our understanding of the distribution of cardioembolic phenomena. Forty patients undergoing transfemoral TAVI with an Edwards SAPIEN-XT valve under general anesthesia were enrolled prospectively in this observational study. Participants underwent brain MRI preprocedure, and 3 ± 1 days and 6 ± 1 months postprocedure. Mean ± SD participant age was 82 ± 7 years. Patients had an intermediate to high surgical risk, with a mean Society of Thoracic Surgeons score of 6.3 ± 3.5 and EuroSCORE of 18.1 ± 10.6. Post-TAVI, there were no clinically apparent cerebrovascular events, but MRI assessments identified 83 new lesions across 19 of 31 (61%) participants, with a median ± interquartile range number and volume of 1 ± 2.8 lesions and 20 ± 190 μL per patient. By volume, 80% of the infarcts were cortical, 90% in the posterior circulation and 81% in the right hemisphere. The distribution of lesions that we detected suggests that cortical gray matter, the posterior circulation, and the right hemisphere are all particularly vulnerable to perioperative cerebrovascular injury. This finding has implications for the use of intraoperative cerebral embolic protection devices, particularly those that leave the left subclavian and, therefore, left vertebral artery unprotected.
Publisher: Springer Science and Business Media LLC
Date: 31-07-2009
Publisher: Environmental Health Perspectives
Date: 12-2011
DOI: 10.1289/EHP.1103598
Publisher: Springer Science and Business Media LLC
Date: 2011
DOI: 10.1038/469299C
Publisher: Springer Science and Business Media LLC
Date: 02-2017
DOI: 10.1038/NCLIMATE3182
Publisher: BMJ
Date: 03-2014
Publisher: Springer Science and Business Media LLC
Date: 12-2015
DOI: 10.1186/S13054-015-1151-Y
Abstract: Ex vivo experiments in extracorporeal membrane oxygenation (ECMO) circuits have identified octanol-water partition coefficient (logP, a marker of lipophilicity) and protein binding (PB) as key drug factors affecting pharmacokinetics (PK) during ECMO. Using ovine models, in this study we investigated whether these drug properties can be used to predict PK alterations of antimicrobial drugs during ECMO. Single-dose PK s ling was performed in healthy sheep (HS, n = 7), healthy sheep on ECMO (E24H, n = 7) and sheep with smoke inhalation acute lung injury on ECMO (SE24H, n = 6). The sheep received eight study antimicrobials (ceftriaxone, gentamicin, meropenem, vancomycin, doripenem, ciprofloxacin, fluconazole, caspofungin) that exhibit varying degrees of logP and PB. Plasma drug concentrations were determined using validated chromatographic techniques. PK data obtained from a non-compartmental analysis were used in a linear regression model to predict PK parameters based on logP and PB. We found statistically significant differences in pH, haemodynamics, fluid balance and plasma proteins between the E24H and SE24H groups ( p 0.001). logP had a strong positive linear relationship with steady-state volume of distribution (V ss ) in both the E24H and SE24H groups ( p 0.001) but not in the HS group ( p = 0.9) and no relationship with clearance (CL) in all study groups. Although we observed an increase in CL for highly PB drugs in ECMO sheep, PB exhibited a weaker negative linear relationship with both CL (HS, p = 0.01 E24H, p 0.001 SE24H, p 0.001) and V ss (HS, p = 0.01 E24H, p = 0.004 SE24H, p =0.05) in the final model. Lipophilic antimicrobials are likely to have an increased V ss and decreased CL during ECMO. Protein-bound antimicrobial agents are likely to have reductions both in CL and V ss during ECMO. The strong relationship between lipophilicity and V ss seen in both the E24H and SE24H groups indicates circuit sequestration of lipophilic drugs. These findings highlight the importance of drug factors in predicting antimicrobial drug PK during ECMO and should be a consideration when performing and interpreting population PK studies.
Publisher: F1000 Research Ltd
Date: 09-07-2018
DOI: 10.12688/F1000RESEARCH.15479.1
Abstract: Background: Decisions about which applications to fund are generally based on the mean scores of a panel of peer reviewers. As well as the mean, a large disagreement between peer reviewers may also be worth considering, as it may indicate a high-risk application with a high return. Methods: We examined the peer reviewers' scores for 227 funded applications submitted to the American Institute of Biological Sciences between 1999 and 2006. We examined the mean score and two measures of reviewer disagreement: the standard deviation and range. The outcome variable was the relative citation ratio, which is the number of citations from all publications associated with the application, standardised by field and publication year. Results: There was a clear increase in relative citations for applications with a higher mean. There was no association between relative citations and either of the two measures of disagreement. Conclusions: We found no evidence that reviewer disagreement was able to identify applications with a higher than average return. However, this is the first study to empirically examine this association, and it would be useful to examine whether reviewer disagreement is associated with research impact in other funding schemes and in larger s le sizes.
Publisher: F1000 Research Ltd
Date: 15-10-2018
DOI: 10.12688/F1000RESEARCH.15479.2
Abstract: Background : Decisions about which applications to fund are generally based on the mean scores of a panel of peer reviewers. As well as the mean, a large disagreement between peer reviewers may also be worth considering, as it may indicate a high-risk application with a high return. Methods : We examined the peer reviewers' scores for 227 funded applications submitted to the American Institute of Biological Sciences between 1999 and 2006. We examined the mean score and two measures of reviewer disagreement: the standard deviation and range. The outcome variable was the relative citation ratio, which is the number of citations from all publications associated with the application, standardised by field and publication year. Results : There was a clear increase in relative citations for applications with a better mean. There was no association between relative citations and either of the two measures of disagreement. Conclusions : We found no evidence that reviewer disagreement was able to identify applications with a higher than average return. However, this is the first study to empirically examine this association, and it would be useful to examine whether reviewer disagreement is associated with research impact in other funding schemes and in larger s le sizes.
Publisher: Elsevier BV
Date: 03-2019
DOI: 10.1016/J.ENVPOL.2018.12.061
Abstract: Epidemiological studies on the impact of outdoor temperature to human health have demonstrated the capability of humans to adapt to local climate. However, there is limited information on the association between indoor temperature and human health, despite people spending most of their time indoors. The problem stems from the lack of sufficient indoor temperature measurement in the population. To overcome this obstacle, this paper presents an indirect epidemiological approach to evaluate the impact of high indoor temperature on mortality. The relationships between indoor-outdoor temperatures in different climate zones identified in the literature were combined with the outdoor temperature-mortality curves of the same locations to obtain the local indoor minimum mortality temperatures (iMMT), the temperature at which mortality is lowest, which by implication is the temperature at which the population is most comfortable on average. We show that the iMMT varies and has a weak linear relationship with the distance to the equator, which provides evidence of human adaptation to local indoor temperatures. These findings reinforce the adaptive comfort theory, which states that people can adapt to local indoor environment and establish their thermal comfort. Recognising the human adaptability to local climate will direct flexible and optimized policy to protect public health against extreme temperature events. This will also help reduce energy consumption for regulating indoor temperature without compromising the occupants' health.
Publisher: Elsevier BV
Date: 11-2014
DOI: 10.1016/J.JHIN.2014.06.005
Abstract: The Australian National Hand Hygiene Initiative (NHHI) is a major patient safety programme co-ordinated by Hand Hygiene Australia (HHA) and funded by the Australian Commission for Safety and Quality in Health Care. The annual costs of running this programme need to be understood to know the cost-effectiveness of a decision to sustain it as part of health services. To estimate the annual health services cost of running the NHHI the set-up costs are excluded. A health services perspective was adopted for the costing and collected data from the 50 largest public hospitals in Australia that implemented the initiative, covering all states and territories. The costs of HHA, the costs to the state-level infection-prevention groups, the costs incurred by each acute hospital, and the costs for additional alcohol-based hand rub are all included. The programme cost AU$5.56 million each year (US$5.76, £3.63 million). Most of the cost is incurred at the hospital level (65%) and arose from the extra time taken for auditing hand hygiene compliance and doing education and training. On average, each infection control practitioner spent 5h per week on the NHHI, and the running cost per annum to their hospital was approximately AU$120,000 in 2012 (US$124,000, £78,000). Good estimates of the total costs of this programme are fundamental to understanding the cost-effectiveness of implementing the NHHI. This paper reports transparent costing methods, and the results include their uncertainty.
Publisher: Springer Science and Business Media LLC
Date: 05-02-2021
Publisher: Springer Science and Business Media LLC
Date: 03-08-2010
Publisher: Springer Science and Business Media LLC
Date: 08-11-2018
Publisher: Springer Science and Business Media LLC
Date: 08-04-2015
DOI: 10.1007/S00134-015-3765-6
Abstract: Patients with a body mass index (BMI) ≥30 kg/m(2) experience more severe atelectasis following cardiac surgery than those with normal BMI and its resolution is slower. This study aimed to compare extubation of patients post-cardiac surgery with a BMI ≥30 kg/m(2) onto high-flow nasal cannulae (HFNC) with standard care to determine whether HFNC could assist in minimising post-operative atelectasis and improve respiratory function. In this randomised controlled trial, patients received HFNC or standard oxygen therapy post-extubation. The primary outcome was atelectasis on chest X-ray. Secondary outcomes included oxygenation, respiratory rate (RR), subjective dyspnoea, and failure of allocated treatment. One hundred and fifty-five patients were randomised, 74 to control, 81 to HFNC. No difference was seen between groups in atelectasis scores on Days 1 or 5 (median scores = 2, p = 0.70 and p = 0.15, respectively). In the 24-h post-extubation, there was no difference in mean PaO2/FiO2 ratio (HFNC 227.9, control 253.3, p = 0.08), or RR (HFNC 17.2, control 16.7, p = 0.17). However, low dyspnoea levels were observed in each group at 8 h post-extubation, median (IQR) scores were 0 (0-1) for control and 1 (0-3) for HFNC (p = 0.008). Five patients failed allocated treatment in the control group compared with three in the treatment group [Odds ratio 0.53, (95 % CI 0.11, 2.24), p = 0.40]. In this study, prophylactic extubation onto HFNC post-cardiac surgery in patients with a BMI ≥30 kg/m(2) did not lead to improvements in respiratory function. Larger studies assessing the role of HFNC in preventing worsening of respiratory function and intubation are required.
Publisher: Oxford University Press (OUP)
Date: 17-09-2009
DOI: 10.1093/AJE/KWP249
Abstract: Health-care-associated methicillin-resistant Staphylococcus aureus (MRSA) infection may cause increased hospital stay, or sometimes death. Quantifying this effect is complicated because the exposure is time dependent: infection may prolong hospital stay, while longer stays increase infection risk. In this paper, the authors overcome these problems by using a multinomial longitudinal model to estimate the daily probability of death and discharge. They then extend the basic model to estimate how the effect of MRSA infection varies over time and to quantify number of excess days in the intensive care unit due to infection. They found that infection decreased the relative risk of discharge (relative risk ratio = 0.68, 95% credible interval: 0.54, 0.82). Infection on the first day of admission resulted in a mean extra stay of 0.3 days (95% credible interval: 0.1, 0.5) for a patient with an Acute Physiology and Chronic Health Evaluation II score of 10 and 1.2 days (95% credible interval: 0.5, 2.0) for a patient with a score of 30. The decrease in the relative risk of discharge remained fairly constant with day of MRSA infection but was slightly stronger closer to the start of infection. Results confirm the importance of MRSA infection in increasing stay in an intensive care unit but suggest that previous work may have systematically overestimated the effect size.
Publisher: Elsevier BV
Date: 07-1999
DOI: 10.1016/S0002-9378(99)70448-5
Abstract: Maternal serum inhibin A concentration is elevated in established preecl sia. The aim of this study was to investigate whether this relationship antedates the appearance of the classic signs of preecl sia. A retrospective analysis was performed on trisomy 21 screening data from 685 women at between 15 and 19 weeks' gestation. The main outcome measures were preecl sia and small for gestational age ( 2.0 multiples of the median were significantly more likely to acquire preecl sia (P <.00001) and to be delivered of a small for gestational age infant (<5th percentile, P <.00001) than were women with inhibin A concentration </=2.0 multiples of the median. The odds ratios were 9.4 (95% confidence interval 4.6-19.3) for development of preecl sia and 18.2 (95% confidence interval 6. 0-54.8) for preecl sia necessitating delivery at <37 weeks' gestation. The association remained statistically significant for nulliparous women. Elevated maternal inhibin A concentration in the second trimester was strongly associated with a subsequent risk of preecl sia. The potential role of second trimester inhibin A measurement in a screening strategy for preecl sia needs to be investigated further.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 19-12-2016
Abstract: A “Christmas holiday effect” showing elevated cardiovascular mortality over the Christmas holidays (December 25 to January 7) was demonstrated previously in study from the United States. To separate the effect of seasonality from any holiday effect, a matching analysis was conducted for New Zealand, where the Christmas holiday period falls within the summer season. New Zealand mortality data for a 25‐year period (1988–2013) was analyzed based on the same methodology used in the previous study. Locally weighted smoothing was used to calculate an “expected” number of deaths for each day of the year. The expected value was compared with the actual number of deaths. In addition, mean age at death was estimated and used to assess the life‐years lost due to excess mortality. There were 738 409 deaths (197 109 coded as cardiac deaths) during the period. We found evidence of a Christmas holiday effect in our of medical facility's cardiac deaths, with an excess event rate of 4.2% (95% CI 0.7–7.7%) leading to ≈4 additional deaths per annum. The average age of those with fatal cardiac deaths was 76.8 years ( SD 13.5) during the Christmas holiday period, resulting in 148 to 222 years of life lost per annum. Cardiac mortality is elevated during the Christmas holiday period relative to surrounding time periods. Our findings are consistent with a previously reported study conducted in the United States , suggesting that cardiac mortality does not take a “summer break.”
Publisher: Springer Science and Business Media LLC
Date: 14-02-2017
Publisher: Hindawi Limited
Date: 2016
DOI: 10.1155/2016/2471207
Abstract: Background . Lung transplantation is the optimal treatment for end stage lung disease. Donor shortage necessitates single-lung transplants (SLT), yet minimal data exists regarding regional ventilation in diseased versus transplanted lung measured by Electrical Impedance Tomography (EIT). Method . We aimed to determine regional ventilation in six SLT outpatients using EIT. We assessed end expiratory volume and tidal volumes. End expiratory lung impedance (EELI) and Global Tidal Variation of Impedance were assessed in supine, right lateral, left lateral, sitting, and standing positions in transplanted and diseased lungs. A mixed model with random intercept per subject was used for statistical analysis. Results . EELI was significantly altered between diseased and transplanted lungs whilst lying on right and left side. One patient demonstrated pendelluft between lungs and was therefore excluded for further comparison of tidal variation. Tidal variation was significantly higher in the transplanted lung for the remaining five patients in all positions, except when lying on the right side. Conclusion . Ventilation to transplanted lung is better than diseased lung, especially in lateral positions. Positioning in patients with active unilateral lung pathologies will be implicated. This is the first study demonstrating changes in regional ventilation, associated with changes of position between transplanted and diseased lung.
Publisher: Elsevier BV
Date: 10-2009
DOI: 10.1016/J.IJNURSTU.2009.03.013
Abstract: The accurate measurement of Cardiac output (CO) is vital in guiding the treatment of critically ill patients. Invasive or minimally invasive measurement of CO is not without inherent risks to the patient. Skilled Intensive Care Unit (ICU) nursing staff are in an ideal position to assess changes in CO following therapeutic measures. The USCOM (Ultrasonic Cardiac Output Monitor) device is a non-invasive CO monitor whose clinical utility and ease of use requires testing. To compare cardiac output measurement using a non-invasive ultrasonic device (USCOM) operated by a non-echocardiograhically trained ICU Registered Nurse (RN), with the conventional pulmonary artery catheter (PAC) using both thermodilution and Fick methods. Prospective observational study. Between April 2006 and March 2007, we evaluated 30 spontaneously breathing patients requiring PAC for assessment of heart failure and/or pulmonary hypertension at a tertiary level cardiothoracic hospital. SCOM CO was compared with thermodilution measurements via PAC and CO estimated using a modified Fick equation. This catheter was inserted by a medical officer, and all USCOM measurements by a senior ICU nurse. Mean values, bias and precision, and mean percentage difference between measures were determined to compare methods. The Intra-Class Correlation statistic was also used to assess agreement. The USCOM time to measure was recorded to assess the learning curve for USCOM use performed by an ICU RN and a line of best fit demonstrated to describe the operator learning curve. In 24 of 30 (80%) patients studied, CO measures were obtained. In 6 of 30 (20%) patients, an adequate USCOM signal was not achieved. The mean difference (+/-standard deviation) between USCOM and PAC, USCOM and Fick, and Fick and PAC CO were small, -0.34+/-0.52 L/min, -0.33+/-0.90 L/min and -0.25+/-0.63 L/min respectively across a range of outputs from 2.6L/min to 7.2L/min. The percent limits of agreement (LOA) for all measures were -34.6% to 17.8% for USCOM and PAC, -49.8% to 34.1% for USCOM and Fick and -36.4% to 23.7% for PAC and Fick. Signal acquisition time reduced on average by 0.6 min per measure to less than 10 min at the end of the study. In 80% of our cohort, USCOM, PAC and Fick measures of CO all showed clinically acceptable agreement and the learning curve for operation of the non-invasive USCOM device by an ICU RN was found to be satisfactorily short. Further work is required in patients receiving positive pressure ventilation.
Publisher: Springer Science and Business Media LLC
Date: 12-2016
Publisher: Elsevier BV
Date: 02-2014
DOI: 10.1016/J.AJIC.2013.07.006
Abstract: Clostridium difficile infection (CDI) possibly extends hospital length of stay (LOS) however, the current evidence does not account for the time-dependent bias, ie, when infection is incorrectly analyzed as a baseline covariate. The aim of this study was to determine whether CDI increases LOS after managing this bias. We examined the estimated extra LOS because of CDI using a multistate model. Data from all persons hospitalized >48 hours over 4 years in a tertiary hospital in Australia were analyzed. Persons with health care-associated CDIs were identified. Cox proportional hazards models were applied together with multistate modeling. One hundred fifty-eight of 58,942 admissions examined had CDI. The mean extra LOS because of infection was 0.9 days (95% confidence interval: -1.8 to 3.6 days, P = .51) when a multistate model was applied. The hazard of discharge was lower in persons who had CDI (adjusted hazard ratio, 0.42 P < .001) when a Cox proportional hazard model was applied. This study is the first to use multistate models to determine the extra LOS because of CDI. Results suggest CDI does not significantly contribute to hospital LOS, contradicting findings published elsewhere. Conversely, when methods prone to result in time-dependent bias were applied to the data, the hazard of discharge significantly increased. These findings contribute to discussion on methods used to evaluate LOS and health care-associated infections.
Publisher: Springer Science and Business Media LLC
Date: 05-09-2023
Publisher: Springer Science and Business Media LLC
Date: 29-11-2022
Publisher: SAGE Publications
Date: 05-2018
DOI: 10.1177/0310057X1804600309
Abstract: Unnecessary pathology tests performed in intensive care units (ICU) might lead to increased costs of care and potential patient harm due to unnecessary phlebotomy. We hypothesised that a multimodal intervention program could result in a safe and effective reduction in the pathology tests ordered in our ICU. We conducted a single-centre pre- and post-study using multimodal interventions to address commonly ordered routine tests. The study was performed during the same six month period (August to February) over three years: 2012 to 2013 (pre-intervention), 2013 to 2014 (intervention) and 2014 to 2015 (post-intervention). Interventions consisted of staff education, designing new pathology forms, consultant-led pathology test ordering and intensive monitoring for a six-month period. The results of the study showed that there was a net savings of over A$213,000 in the intervention period and A$175,000 in the post-intervention period compared to the pre-intervention period. There was a 28% reduction in the tests performed in the intervention period (P .0001 compared to pre-intervention period) and 26% in the post-intervention period (P .0001 compared to pre-intervention period). There were no ICU or hospital mortality differences between the groups. There were no significant haemoglobin differences between the groups. A multimodal intervention safely reduced pathology test ordering in the ICU, resulting in substantial cost savings.
Publisher: Wiley
Date: 16-10-2023
DOI: 10.5694/MJA2.52129
Publisher: Elsevier BV
Date: 08-2010
DOI: 10.1016/J.ENVRES.2010.05.006
Abstract: Hot and cold temperatures significantly increase mortality rates around the world, but which measure of temperature is the best predictor of mortality is not known. We used mortality data from 107 US cities for the years 1987-2000 and examined the association between temperature and mortality using Poisson regression and modelled a non-linear temperature effect and a non-linear lag structure. We examined mean, minimum and maximum temperature with and without humidity, and apparent temperature and the Humidex. The best measure was defined as that with the minimum cross-validated residual. We found large differences in the best temperature measure between age groups, seasons and cities, and there was no one temperature measure that was superior to the others. The strong correlation between different measures of temperature means that, on average, they have the same predictive ability. The best temperature measure for new studies can be chosen based on practical concerns, such as choosing the measure with the least amount of missing data.
Publisher: Springer Science and Business Media LLC
Date: 22-11-2014
DOI: 10.1186/S40635-014-0029-7
Abstract: Extracorporeal membrane oxygenation (ECMO) circuits have been shown to sequester circulating blood compounds such as drugs based on their physicochemical properties. This study aimed to describe the disposition of macro- and micronutrients in simulated ECMO circuits. Following baseline s ling, known quantities of macro- and micronutrients were injected post oxygenator into ex vivo ECMO circuits primed with the fresh human whole blood and maintained under standard physiologic conditions. Serial blood s les were then obtained at 1, 30 and 60 min and at 6, 12 and 24 h after the addition of nutrients, to measure the concentrations of study compounds using validated assays. Twenty-one s les were tested for thirty-one nutrient compounds. There were significant reductions ( p 0.05) in circuit concentrations of some amino acids [alanine (10%), arginine (95%), cysteine (14%), glutamine (25%) and isoleucine (7%)], vitamins [A (42%) and E (6%)] and glucose (42%) over 24 h. Significant increases in circuit concentrations ( p 0.05) were observed over time for many amino acids, zinc and vitamin C. There were no significant reductions in total proteins, triglycerides, total cholesterol, selenium, copper, manganese and vitamin D concentrations within the ECMO circuit over a 24-h period. No clear correlation could be established between physicochemical properties and circuit behaviour of tested nutrients. Significant alterations in macro- and micronutrient concentrations were observed in this single-dose ex vivo circuit study. Most significantly, there is potential for circuit loss of essential amino acid isoleucine and lipid soluble vitamins (A and E) in the ECMO circuit, and the mechanisms for this need further exploration. While the reductions in glucose concentrations and an increase in other macro- and micronutrient concentrations probably reflect cellular metabolism and breakdown, the decrement in arginine and glutamine concentrations may be attributed to their enzymatic conversion to ornithine and glutamate, respectively. While the results are generally reassuring from a macronutrient perspective, prospective studies in clinical subjects are indicated to further evaluate the influence of ECMO circuit on micronutrient concentrations and clinical outcomes.
Publisher: BMJ
Date: 11-2019
DOI: 10.1136/BMJOPEN-2019-029360
Abstract: We aimed to estimate the annual pharmaceutical costs for patients with stable coronary artery disease, using Australian administrative data, comparing patients who had undergone interventional treatment with those had not. We also aimed to compare the duration of dual antiplatelet therapy (DAPT) prescription in the real-world, with recommended guidelines. An observational study using administrative data. We used data from the QSkin study, a population-based prospective study assessing skin cancer risk. Participants were invited from the Queensland population, not based on perceived skin cancer risk, and had consented to future use of their data for approved research projects. We calculated 12-month costs of pharmaceutical therapy for coronary artery disease for patients in each of three clinically relevant groups: medical therapy only, following coronary stent implantation and following coronary artery bypass graft surgery. We measured the duration of DAPT following stent implantation and total duration of DAPT, where it was prescribed, in the medical therapy only group. Estimated mean annual pharmaceutical costs were highest in the stent group at AUD$1920, compared with AUD$1481 in the medical therapy group, and AUD$881 in the coronary artery bypass group. There were similar rates of prescriptions of symptom relief drugs following stent insertion, compared with the medical therapy only group. The median duration of DAPT in the stent group was 16, and 31 months in the medical therapy group. Our results suggest that despite the common expectation that the burden of medical therapy is reduced following coronary stent insertion for stable coronary artery disease, this does not occur in practice. Many patients also appear to continue DAPT longer than guidelines recommend, which may put them at unnecessarily elevated risk of bleeding events.
Publisher: Springer Science and Business Media LLC
Date: 03-2017
DOI: 10.1038/543S29A
Publisher: Wiley
Date: 05-2022
DOI: 10.1111/AOR.14269
Abstract: To identify clinical and biochemical markers associated with nutrition adequacy and gastrointestinal and liver dysfunction in adults on extracorporeal membrane oxygenation (ECMO). A retrospective, observational, study was conducted at 2 centres in Australia. Adult patients who received ECMO from July 2011 to June 2015 were included. Mode of ECMO used, fluid balance, number of systemic inflammatory response syndrome (SIRS) criteria present, vasoactive‐inotropic scores (VIS) and liver function tests (LFTs) were collected for the duration of ECMO until 7 days after ECMO cessation. Multiple regression models were used to determine if the collected variables were associated with nutrition adequacy. The mean LFTs during ECMO were also compared to mean LFTs post ECMO cessation. During the first 5 days of ECMO commencement, mean nutrition adequacy was 10% higher in the veno‐venous (VV) ECMO group than in the veno‐arterial (VA) group (95% confidence interval [CI], 2% to 17%). For every 5000 ml increase of fluid balance, an associated decrease in nutrition adequacy was observed (−8%, 95% CI: −15% to −2%). A doubling of bilirubin and VIS were associated with a mean reduction in nutrition adequacy of −5% (95% CI –8% to −2%) and − 2% (95% CI: −3% to −1%), respectively. In the first 5 days of ECMO commencement, higher nutrition adequacy was associated with the VV mode of ECMO and reduced nutrition adequacy with increased fluid balance, more vasopressor and inotropic support and raised bilirubin. Prospective investigation is required to confirm whether these associations have a causal relationship.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 05-2012
Publisher: Elsevier BV
Date: 2016
DOI: 10.1016/J.JCLINEPI.2015.04.010
Abstract: Funding for early career researchers in Australia's largest medical research funding scheme is determined by a competitive peer-review process using a panel of four reviewers. The purpose of this experiment was to appraise the reliability of funding by duplicating applications that were considered by separate grant review panels. Sixty duplicate applications were considered by two independent grant review panels that were awarding funding for Australia's National Health and Medical Research Council. Panel members were blinded to which applications were included in the experiment and to whether it was the original or duplicate application. Scores were compared across panels using Bland-Altman plots to determine measures of agreement, including whether agreement would have impacted on actual funding. Twenty-three percent of the applicants were funded by both panels and 60 percent were not funded by both, giving an overall agreement of 83 percent [95% confidence interval (CI): 73%, 92%]. The chance-adjusted agreement was 0.75 (95% CI: 0.58, 0.92). There was a comparatively high level of agreement when compared with other types of funding schemes. Further experimental research could be used to determine if this higher agreement is due to nature of the application, the composition of the assessment panel, or the characteristics of the applicants.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 26-10-2016
Abstract: The application of transcatheter aortic valve implantation ( TAVI ) to intermediate‐risk patients is a controversial issue. Of concern, neurological injury in this group remains poorly defined. Among high‐risk and inoperable patients, subclinical injury is reported on average in 75% undergoing the procedure. Although this attendant risk may be acceptable in higher‐risk patients, it may not be so in those of lower risk. Forty patients undergoing TAVI with the Edwards SAPIEN ‐ XT ™ prosthesis were prospectively studied. Patients were of intermediate surgical risk, with a mean±standard deviation Society of Thoracic Surgeons score of 5.1±2.5% and a Euro SCORE II of 4.8±2.4% participant age was 82±7 years. Clinically apparent injury was assessed by serial National Institutes of Health Stroke Scale assessments, Montreal Cognitive Assessments (Mo CA ), and with the Confusion Assessment Method. These identified 1 (2.5%) minor stroke, 1 (2.5%) episode of postoperative delirium, and 2 patients (5%) with significant postoperative cognitive dysfunction. Subclinical neurological injury was assessed using brain magnetic resonance imaging, including diffusion‐weighted imaging ( DWI ) sequences preprocedure and at 3±1 days postprocedure. This identified 68 new DWI lesions present in 60% of participants, with a median±interquartile range of 1±3 lesions atient and volumes of infarction of 24±19 μL/lesion and 89±218 μL atient. DWI lesions were associated with a statistically significant reduction in early cognition (mean ΔMo CA −3.5±1.7) without effect on cognition, quality of life, or functional capacity at 6 months. Objectively measured subclinical neurological injuries remain a concern in intermediate‐risk patients undergoing TAVI and are likely to manifest with early neurocognitive changes. URL : www.anzctr.org.au . Australian & New Zealand Clinical Trials Registry: ACTRN 12613000083796.
Publisher: Springer Science and Business Media LLC
Date: 09-11-2012
DOI: 10.1038/SREP00830
Publisher: Springer Science and Business Media LLC
Date: 28-11-2012
Publisher: Springer Science and Business Media LLC
Date: 13-02-2015
Publisher: Springer Science and Business Media LLC
Date: 12-2017
Publisher: Springer Science and Business Media LLC
Date: 15-04-2021
DOI: 10.1186/S13561-021-00312-4
Abstract: Economic-evaluations using decision analytic models such as Markov-models (MM), and discrete-event-simulations (DES) are high value adds in allocating resources. The choice of modelling method is critical because an inappropriate model yields results that could lead to flawed decision making. The aim of this study was to compare cost-effectiveness when MM and DES were used to model results of transplanting a lower-quality kidney versus remaining waitlisted for a kidney. Cost-effectiveness was assessed using MM and DES. We used parametric survival models to estimate the time-dependent transition probabilities of MM and distribution of time-to-event in DES. MMs were simulated in 12 and 6 monthly cycles, out to five and 20-year time horizon. DES model output had a close fit to the actual data. Irrespective of the modelling method, the cycle length of MM or the time horizon, transplanting a low-quality kidney as compared to remaining waitlisted was the dominant strategy. However, there were discrepancies in costs, effectiveness and net monetary benefit (NMB) among different modelling methods. The incremental NMB of the MM in the 6-months cycle lengths was a closer fit to the incremental NMB of the DES. The gap in the fit of the two cycle lengths to DES output reduced as the time horizon increased. Different modelling methods were unlikely to influence the decision to accept a lower quality kidney transplant or remain waitlisted on dialysis. Both models produced similar results when time-dependant transition probabilities are used, most notable with shorter cycle lengths and longer time-horizons.
Publisher: Cambridge University Press (CUP)
Date: 08-2014
DOI: 10.1086/677160
Abstract: Interventions that prevent healthcare-associated infection should lead to fewer deaths and shorter hospital stays. Cleaning hands (with soap or alcohol) is an effective way to prevent the transmission of organisms, but rates of compliance with hand hygiene are sometimes disappointingly low. The National Hand Hygiene Initiative in Australia aimed to improve hand hygiene compliance among healthcare workers, with the goal of reducing rates of healthcare-associated infection. We examined whether the introduction of the National Hand Hygiene Initiative was associated with a change in infection rates. Monthly infection rates for healthcare-associated Staphylococcus aureus bloodstream infections were examined in 38 Australian hospitals across 6 states. We used Poisson regression and examined 12 possible patterns of change, with the best fitting pattern chosen using the Akaike information criterion. Monthly bed-days were included to control for increased hospital use over time. The National Hand Hygiene Initiative was associated with a reduction in infection rates in 4 of the 6 states studied. Two states showed an immediate reduction in rates of 17% and 28%, 2 states showed a linear decrease in rates of 8% and 11% per year, and 2 showed no change in infection rates. The intervention was associated with reduced infection rates in most states. The failure in 2 states may have been because those states already had effective initiatives before the national initiative’s introduction or because infection rates were already low and could not be further reduced.
Publisher: Springer Science and Business Media LLC
Date: 2012
DOI: 10.1186/CC11679
Publisher: Springer Science and Business Media LLC
Date: 03-02-2020
DOI: 10.1186/S41073-019-0089-Z
Abstract: The Health Research Council of New Zealand is the first major government funding agency to use a lottery to allocate research funding for their Explorer Grant scheme. This is a somewhat controversial approach because, despite the documented problems of peer review, many researchers believe that funding should be allocated solely using peer review, and peer review is used almost ubiquitously by funding agencies around the world. Given the rarity of alternative funding schemes, there is interest in hearing from the first cohort of researchers to ever experience a lottery. Additionally, the Health Research Council of New Zealand wanted to hear from applicants about the acceptability of the randomisation process and anonymity of applicants. This paper presents the results of a survey of Health Research Council applicants from 2013 to 2019. The survey asked about the acceptability of using a lottery and if the lottery meant researchers took a different approach to their application. The overall response rate was 39% (126 of 325 invites), with 30% (76 of 251) from applicants in the years 2013 to 2018, and 68% (50 of 74) for those in the year 2019 who were not aware of the funding result. There was agreement that randomisation is an acceptable method for allocating Explorer Grant funds with 63% ( n = 79) in favour and 25% ( n = 32) against. There was less support for allocating funds randomly for other grant types with only 40% ( n = 50) in favour and 37% ( n = 46) against. Support for a lottery was higher amongst those that had won funding. Multiple respondents stated that they supported a lottery when ineligible applications had been excluded and outstanding applications funded, so that the remaining applications were truly equal. Most applicants reported that the lottery did not change the time they spent preparing their application. The Health Research Council’s experience through the Explorer Grant scheme supports further uptake of a modified lottery.
Publisher: Springer Science and Business Media LLC
Date: 09-10-2020
DOI: 10.1186/S12913-020-05736-Y
Abstract: Matching survival of a donor kidney with that of the recipient (longevity matching), is used in some kidney allocation systems to maximize graft-life years. It is not part of the allocation algorithm for Australia. Given the growing evidence of survival benefit due to longevity matching based allocation algorithms, development of a similar kidney allocation system for Australia is currently underway. The aim of this research is to estimate the impact that changes to costs and health outcomes arising from ‘longevity matching’ on the Australian healthcare system. A decision analytic model to estimate cost-effectiveness was developed using a Markov process. Four plausible competing allocation options were compared to the current kidney allocation practice. Models were simulated in one-year cycles for a 20-year time horizon, with transitions through distinct health states relevant to the kidney recipient. Willingness to pay was considered as AUD 28000. Base case analysis indicated that allocating the worst 20% of Kidney Donor Risk Index (KDRI) donor kidneys to the worst 20% of estimated post-transplant survival (EPTS) recipients (option 2) and allocating the oldest 25% of donor kidneys to the oldest 25% of recipients are both cost saving and more effective compared to the current Australian allocation practice. Option 2, returned the lowest costs, greatest health benefits and largest gain to net monetary benefits (NMB). Allocating the best 20% of KDRI donor kidneys to the best 20% of EPTS recipients had the lowest expected incremental NMB. Of the four longevity-based kidney allocation practices considered, transplanting the lowest quality kidneys to the worst kidney recipients (option 2), was estimated to return the best value for money for the Australian health system.
Publisher: F1000 Research Ltd
Date: 10-08-2018
DOI: 10.12688/F1000RESEARCH.14488.3
Abstract: Background : The scientific literature is growing in volume and reducing in readability. Poorly presented numbers decrease readability by either fatiguing the reader with too many decimal places, or confusing the reader by not using enough decimal places, and so making it difficult to comprehend differences between numbers. There are guidelines for the ideal number of decimal places, and in this paper I examine how often percents meet these guidelines. Methods : Percents were extracted from the abstracts of research articles published in 2017 in 23 selected journals. Percents were excluded if they referred to a statistical interval, typically a 95% confidence interval. Counts and percents were calculated for the number of percents using too few or too many decimal places, and these percents were compared between journals. Results : The s le had over 43,000 percents from around 9,500 abstracts. Only 55% of the percents were presented according to the guidelines. The most common issue was using too many decimal places (33%), rather than too few (12%). There was a wide variation in presentation between journals, with the range of ideal presentation from a low of 53% ( JAMA ) to a high of 80% ( Lancet Planetary Health ). Conclusions : Many percents did not adhere to the guidelines on using decimal places. Using the recommended number of decimal places would make papers easier to read and reduce the burden on readers, and potentially improve comprehension. It should be possible to provide automated feedback to authors on which numbers could be better presented.
Publisher: Elsevier BV
Date: 2011
Publisher: F1000 Research Ltd
Date: 23-07-2018
DOI: 10.12688/F1000RESEARCH.14488.2
Abstract: Background: The scientific literature is growing in volume and reducing in readability. Poorly presented numbers decrease readability by either fatiguing the reader with too many decimal places, or confusing the reader by not using enough decimal places, and so making it difficult to comprehend differences between numbers. There are guidelines for the ideal number of decimal places, and in this paper I examine how often percents meet these guidelines. Methods: Percents were extracted from the abstracts of research articles published in 2017 in 23 selected journals. Percents were excluded if they referred to a statistical interval, typically a 95% confidence interval. Counts and percents were calculated for the number of percents using too few or too many decimal places, and these percents were compared between journals. Results: The s le had over 43,000 percents from around 9,500 abstracts. Only 55% of the percents were presented according to the guidelines. The most common issue was using too many decimal places (33%), rather than too few (12%). There was a wide variation in presentation between journals, with the range of ideal presentation from a low of 53% (JAMA) to a high of 80% (Lancet Planetary Health). Conclusions: Many percents did not adhere to the guidelines on using decimal places. Using the recommended number of decimal places would make papers easier to read and reduce the burden on readers, and potentially improve comprehension. It should be possible to provide automated feedback to authors on which numbers could be better presented.
Publisher: Elsevier BV
Date: 15-12-2010
DOI: 10.1016/J.SCITOTENV.2010.10.013
Abstract: Many studies have illustrated that ambient air pollution negatively impacts on health. However, little evidence is available for the effects of air pollution on cardiovascular mortality (CVM) in Tianjin, China. Also, no study has examined which strata length for the time-stratified case-crossover analysis gives estimates that most closely match the estimates from time series analysis. The purpose of this study was to estimate the effects of air pollutants on CVM in Tianjin, China, and compare time-stratified case-crossover and time series analyses. A time-stratified case-crossover and generalized additive model (time series) were applied to examine the impact of air pollution on CVM from 2005 to 2007. Four time-stratified case-crossover analyses were used by varying the stratum length (Calendar month, 28, 21 or 14 days). Jackknifing was used to compare the methods. Residual analysis was used to check whether the models fitted well. Both case-crossover and time series analyses show that air pollutants (PM(10), SO(2) and NO(2)) were positively associated with CVM. The estimates from the time-stratified case-crossover varied greatly with changing strata length. The estimates from the time series analyses varied slightly with changing degrees of freedom per year for time. The residuals from the time series analyses had less autocorrelation than those from the case-crossover analyses indicating a better fit. Air pollution was associated with an increased risk of CVM in Tianjin, China. Time series analyses performed better than the time-stratified case-crossover analyses in terms of residual checking.
Publisher: F1000 Research Ltd
Date: 11-04-2018
DOI: 10.12688/F1000RESEARCH.14488.1
Abstract: Background: The scientific literature is growing in volume and reducing in readability. Poorly presented numbers decrease readability by either fatiguing the reader with too many decimal places, or confusing the reader by not using enough decimal places, and so making it difficult to comprehend differences between numbers. There are guidelines for the ideal number of decimal places, and in this paper I examine how often percents meet these guidelines. Methods: Percents were extracted from the abstracts of research articles published in 2017 in 23 selected journals. Percents were excluded if they referred to a statistical interval, typically a 95% confidence interval. Counts and percents were calculated for the number of percents using too few or too many decimal places, and these percents were compared between journals. Results: The s le had over 43,000 percents from around 9,500 abstracts. Only 55% of the percents were presented according to the guidelines. The most common issue was using too many decimal places (33%), rather than too few (12%). There was a wide variation in presentation between journals, with the range of ideal presentation from a low of 53% (JAMA) to a high of 80% (Lancet Planetary Health). Conclusions: Many percents did not adhere to the guidelines on using decimal places. Using the recommended number of decimal places would make papers easier to read and reduce the burden on readers, and potentially improve comprehension. It should be possible to provide automated feedback to authors on which numbers could be better presented.
Publisher: F1000 Research Ltd
Date: 03-07-2018
DOI: 10.12688/F1000RESEARCH.13616.2
Abstract: Background : Cardiovascular disease remains the primary cause of death among Australians, despite dramatic improvements in overall cardiovascular health since the 1980s. Treating cardiovascular disease continues to place a significant economic strain on the Australian health care system, with direct healthcare costs exceeding those of any other disease. Coronary artery disease accounts for nearly one third of these costs and spending continues to rise. A range of treatments is available for coronary artery disease yet evidence of cost-effectiveness is missing, particularly for the Australian context. Cost-effectiveness evidence can signal waste and inefficiency and so is essential for an efficient allocation of healthcare resources. Methods: We used systematic review methods to search the literature across several electronic databases for economic evaluations of treatments for stable coronary artery disease. We critically appraised the literature found in searches, both against the CHEERS statement for quality reporting of economic evaluations and in terms of its usefulness for policy and decision-makers. Results: We retrieved a total of 308 references, 229 once duplicates were removed. Of these, 26 were excluded as they were not full papers (letters, editorials etc.), 55 were review papers, 50 were not cost-effectiveness analyses and 93 related to a highly specific patient sub-group or did not consider all treatment options. This left five papers to be reviewed in full. Conclusions: The current cost-effectiveness evidence does not support the increased use of PCI that has been seen in Australia and internationally. Due to problems with accessibility, clarity and relevance to policy and decision-makers, some otherwise very scientifically rigorous analyses have failed to generate any policy changes.
Publisher: F1000 Research Ltd
Date: 17-01-2018
DOI: 10.12688/F1000RESEARCH.13616.1
Abstract: Background : Cardiovascular disease remains the primary cause of death among Australians, despite dramatic improvements in overall cardiovascular health since the 1980s. Treating cardiovascular disease continues to place a significant economic strain on the Australian health care system, with direct healthcare costs exceeding those of any other disease. Coronary artery disease accounts for nearly one third of these costs and spending continues to rise. A range of treatments is available for coronary artery disease yet evidence of cost-effectiveness is missing, particularly for the Australian context. Cost-effectiveness evidence can signal waste and inefficiency and so is essential for an efficient allocation of healthcare resources. Methods: We used systematic review methods to search the literature across several electronic databases for economic evaluations of treatments for coronary artery disease. We critically appraised the literature found in searches, both against the CHEERS statement for quality reporting of economic evaluations and in terms of its usefulness for policy and decision-makers. Results: We retrieved a total of 308 references, 229 once duplicates were removed. Of these, 26 were excluded as they were not full papers (letters, editorials etc.), 55 were review papers, 50 were not cost-effectiveness analyses and 93 related to a highly specific patient sub-group or did not consider all treatment options. This left five papers to be reviewed in full. Conclusions: The current cost-effectiveness evidence does not support the increased use of PCI that has been seen in Australia and internationally. Due to problems with accessibility, clarity and relevance to policy and decision-makers, some otherwise very scientifically rigorous analyses have failed to generate any policy changes.
Publisher: Springer Science and Business Media LLC
Date: 23-06-2022
DOI: 10.1007/S10654-022-00885-2
Abstract: This study aims to compare the mortality rate and life expectancy of politicians with those of the age and gender-matched general populations. This was an observational analysis of mortality rates of politicians (i.e. members of national parliaments with available data on dates of birth, death and election, gender, and life tables) in 11 developed countries. Politicians were followed from date of first election until either death or the last available year with life table data. Relative mortality differences were estimated using standardised mortality ratios (SMRs). Absolute inequalities were quantified as the difference in survival by deducting a population’s remaining life expectancy from politicians’ remaining life expectancy at age 45, estimated using Gompertz parametric proportional hazards models. We included 57,561 politicians (with follow-up ranging from 1816–2016 for France to 1949–2017 for Germany). In almost all countries politicians had similar rates of mortality to the general population in the early part of the twentieth century. Relative mortality and survival differences (favouring politicians) increased considerably over the course of the twentieth century, with recent SMRs ranging from 0.45 (95%CI 0.41–0.50) in Italy to 0.82 (95%CI 0.69–0.95) in New Zealand. The peak life expectancy gaps ranged from 4.4 (95% CI, 3.5–5.4) years in the Netherlands to 7.8 (95% CI, 7.2–8.4) years in the US. Our results show large relative and absolute inequalities favouring politicians in every country. In some countries, such as the US, relative inequalities are at the greatest level in over 150 years.
Publisher: Environmental Health Perspectives
Date: 21-12-2017
DOI: 10.1289/EHP1370
Publisher: Wiley
Date: 26-11-2014
DOI: 10.1111/ANS.12446
Abstract: There is a well-established link between exposure to hot and cold temperatures and an increased risk of cardiovascular hospitalization or death. There is also contrasting evidence of a seasonal increase in aortic ruptures related to atmospheric pressure, but an association with environmental temperature has never been formally modelled. Using a prospective database, we identified 295 patients who were operated in a single centre for ruptured abdominal aortic aneurysm in south-east Queensland between 1990 and 2010. We matched patients to their nearest weather station to estimate their exposure to temperature and air pressure in the days leading up to their rupture. We used the case-crossover method to estimate the risks of temperature, which we allowed to be non-linear (increased risks at high and low temperatures) and delayed by up to 25 days. There was an immediate increase in risk after exposure to cold, and a delayed risk after exposure to heat. An increased risk after exposure to high pressures disappeared after adjusting for temperature. At a mean temperature of 19°C (66°F), the odds ratio for rupture was 1.73 (95% confidence interval: 1.09, 2.76) compared with the reference temperature of 24°C. This is the first study to demonstrate an association between temperature and risk of aortic aneurysm rupture in the Southern Hemisphere. The physiological changes caused by thermoregulation may be a trigger for those people with a fragile aneurysm.
Publisher: Elsevier BV
Date: 04-2016
DOI: 10.1016/J.JPAINSYMMAN.2015.11.022
Abstract: Audits have been proposed for estimating possible recruitment rates to randomized controlled trials (RCTs), but few studies have compared audit data with subsequent recruitment rates. To compare the accuracy of estimates of potential recruitment from a retrospective consecutive cohort audit of actual participating sites and recruitment to four Phase III multisite clinical RCTs. The proportion of potentially eligible study participants estimated from an inpatient chart review of people with life-limiting illnesses referred to six Australian specialist palliative care services was compared with recruitment data extracted from study prescreening information from three sites that participated fully in four Palliative Care Clinical Studies Collaborative RCTs. The predominant reasons for ineligibility in the audit and RCTs were analyzed. The audit overestimated the proportion of people referred to the palliative care services who could participate in the RCTs (pain 17.7% vs. 1.2%, delirium 5.8% vs. 0.6%, anorexia 5.1% vs. 0.8%, and bowel obstruction 2.8% vs. 0.5%). Approximately 2% of the referral base was potentially eligible for these effectiveness studies. Ineligibility for general criteria (language, cognition, and geographic proximity) varied between studies, whereas the reasons for exclusion were similar between the audit and pain and anorexia studies but not for delirium or bowel obstruction. The retrospective consecutive case note audit in participating sites did not predict realistic recruitment rates, mostly underestimating the impact of study-specific inclusion criteria. These findings have implications for the applicability of the results of RCTs. Prospective pilot studies are more likely to predict actual recruitment.
Publisher: SAGE Publications
Date: 12-10-2022
DOI: 10.1177/15562646211048268
Abstract: We created a petition for a national inquiry into the Australian system of research ethics and governance, to inform the politicians about the problems with the existing system. We analyzed the reasons that signatories offered for why signing the petition was important to them. A total of 409 comments (by 805 signatories) focused on five major themes: (1) views on previous changes to the system of research ethics and governance (2) drawbacks of the existing system (3) suggested changes to the system (4) anticipated impacts of changing the system and (5) miscellaneous/other comments. Comments ranged from several words to over 400 words in length, and most often focused on the procedural aspects, and commented on theme 2: drawbacks of the existing system.
Publisher: Cambridge University Press (CUP)
Date: 11-2010
DOI: 10.1086/656593
Abstract: To estimate the excess length of stay in an intensive care unit (ICU) due to a central line-associated bloodstream infection (CLABSI), using a multistate model that accounts for the timing of infection. A cohort of 3,560 patients followed up for 36,806 days in ICUs. Eleven ICUs in 3 Latin American countries: Argentina, Brazil, and Mexico. All patients admitted to the ICU during a defined time period with a central line in place for more than 24 hours. The average excess length of stay due to a CLABSI increased in 10 of 11 ICUs and varied from -1.23 days to 4.69 days. A reduction in length of stay in Mexico was probably caused by an increased risk of death due to CLABSI, leading to shorter times to death. Adjusting for patient age and Average Severity of Illness Score tended to increase the estimated excess length of stays due to CLABSI. CLABSIs are associated with an excess length of ICU stay. The average excess length of stay varies between ICUs, most likely because of the case-mix of admissions and differences in the ways that hospitals deal with infections.
Publisher: Public Library of Science (PLoS)
Date: 21-03-2019
Publisher: Elsevier BV
Date: 02-2015
Publisher: Elsevier BV
Date: 07-2013
DOI: 10.1016/J.JHIN.2013.03.006
Abstract: Previous attempts at costing infection control programmes have tended to focus on accounting costs rather than economic costs. For studies using economic costs, estimates tend to be quite crude and probably underestimate the true cost. One of the largest costs of any intervention is staff time, but this cost is difficult to quantify and has been largely ignored in previous attempts. To design and evaluate the costs of hospital-based infection control interventions or programmes. This article also discusses several issues to consider when costing interventions, and suggests strategies for overcoming these issues. Previous literature and techniques in both health economics and psychology are reviewed and synthesized. This article provides a set of generic, transferable costing guidelines. Key principles such as definition of study scope and focus on large costs, as well as pitfalls (e.g. overconfidence and uncertainty), are discussed. These new guidelines can be used by hospital staff and other researchers to cost their infection control programmes and interventions more accurately.
Publisher: Elsevier BV
Date: 2016
DOI: 10.1016/J.ENVRES.2015.11.004
Abstract: China is experiencing more and more days of serious air pollution recently, and has the highest lung cancer burden in the world. To examine the associations between lung cancer incidence and fine particles (PM2.5) and ozone in China. We used 75 communities' data of lung cancer incidence from the National Cancer Registration of China from 1990 to 2009. The annual concentrations of fine particles (PM2.5) and ozone at 0.1°×0.1° spatial resolution were generated by combing remote sensing, global chemical transport models, and improvements in coverage of surface measurements. A spatial age-period-cohort model was used to examine the relative risks of lung cancer incidence associated with the air pollutants, after adjusting for impacts of age, period, and birth cohort, sex, and community type (rural and urban) as well as the spatial variation on lung cancer incidence. The relative risks of lung cancer incidence related to a 10 µg/m(3) increase in 2-year average PM2.5 were 1.055 (95% confidence interval (CI): 1.038, 1.072) for men, 1.149 (1.120, 1.178) for women, 1.060 (1.044, 1.075) for an urban communities, 1.037 (0.998, 1.078) for a rural population, 1.074 (1.052, 1.096) for people aged 30-65 years, and 1.111 (1.077, 1.146) for those aged over 75 years. Ozone also had a significant association with lung cancer incidence. The increased risks of lung cancer incidence were associated with PM2.5 and ozone air pollution. Control measures to reduce air pollution would likely lower the future incidence of lung cancer.
Publisher: CSIRO Publishing
Date: 2011
DOI: 10.1071/PY10051
Abstract: Approximately one-third of refugee and humanitarian entrants to Australia are adult men. Many of these men and their families settle in regional areas. Little is known about the health status of refugee men and the use of health services, and whether or not there are differences between those living in urban and regional areas. This paper reports on the cross-sectional differences in health status and use of health services among a group of 233 recently arrived refugee men living in urban and regional areas of South-east Queensland. Overall, participants reported good levels of subjective health status, moderate to good levels of well-being, and low prevalence of mental illness. Men living in urban areas were more likely to have a long-standing illness and report poorer health status than those settled in regional areas. In contrast, men living in regional areas reported poorer levels of well-being in the environment domain and were more likely to visit hospital emergency departments. Targeted health promotion programs will ensure that refugee men remain healthy and develop their full potential as members of the Australian community. Programs that facilitate refugees’ access to primary health care in regional areas may promote more appropriate use of hospital emergency departments by these communities.
Publisher: Wiley
Date: 12-08-2022
DOI: 10.1111/AJO.13600
Abstract: Consumer perspectives are a cornerstone of value‐based healthcare. Screening and diagnosis of gestational diabetes mellitus (GDM) were among many of the rapid changes to health care recommended during the COVID‐19 pandemic. The changes provided a unique opportunity to add information about women's perspectives on the debate on GDM screening. The aim of this qualitative study was to explore women's perspectives and understanding of GDM screening and diagnosis comparing the modified COVID‐19 recommendations to standard GDM screening and diagnostic practices. Women who had experienced both the standard and modified GDM screening and diagnostic processes were recruited for telephone interviews. Data analysis used inductive reflexive thematic analysis. Online surveys were disseminated to any registrant not included in interviews to provide an opportunity for all interested participants to provide their perspective. Twenty‐nine telephone interviews were conducted and 19 survey responses were received. Seven themes were determined: (1) information provision from clinicians (2) acceptability of GDM screening (3) in idualisation of GDM screening methods (4) safety nets to avoid a missed diagnosis (5) informed decision making (6) women want information and evidence and (7) preferred GDM screening methods for the future. Overall, women preferred the modified GDM screening recommendations put in place due to the COVID‐19 pandemic. However, their preference was influenced by their prior screening experience and perception of personal risk profile. Women expressed a strong need for clear communication from health professionals and the opportunity to be active participants in decision making.
Publisher: Elsevier BV
Date: 2020
Publisher: SAGE Publications
Date: 07-07-2016
Abstract: Developmental defects of the enamel (DDE) commonly occur in the primary dentition. Although several cross-sectional studies have shown the association of DDE with caries, there is a paucity of longitudinal studies demonstrating that teeth with DDE are at greater risk of caries than are normal teeth. Therefore, the aim of the present study was to longitudinally track a total of 14,220 primary teeth in 725 children from a large birth cohort study, who were interviewed by telephone or home visits at 6-mo intervals. There were 74 children with at least 1 tooth with DDE. We compared teeth with and without DDE by calculating hazard ratios for caries using a Cox proportional hazards model and by plotting caries-free probabilities by child’s age for DDE categories in a Kaplan-Meier plot. Our results show that teeth with DDE had a much higher risk for caries and developed caries earlier than did teeth without DDE. The hazard ratios (95% confidence intervals) for caries were 6.0 (2.4 to 14.6 P 0.001) for pits, 5.5 (3.8 to 7.8 P 0.001) for missing enamel, and 4.5 (1.8 to 11.3 P 0.002) for hypoplasia occurring with yellow-brown opacities. Kaplan-Meier survival plots of caries-free probabilities by age, depending on DDE type, suggest that all types of enamel hypoplasia are associated with a statistically significant increased risk for caries. The study provides longitudinal evidence that DDE are a strong determinant for caries in the primary dentition (ACTRN No. 012606000356561). Knowledge Transfer Statement: The study provides longitudinal evidence that developmental defects of enamel of the primary dentition are strongly associated with increased risk of early childhood caries.
Publisher: Springer Science and Business Media LLC
Date: 09-01-2017
Publisher: Wiley
Date: 17-09-2020
DOI: 10.1002/SIM.8701
Publisher: Springer Science and Business Media LLC
Date: 16-05-2021
Publisher: Public Library of Science (PLoS)
Date: 12-04-2018
Publisher: Public Library of Science (PLoS)
Date: 26-10-2022
DOI: 10.1371/JOURNAL.PONE.0276761
Abstract: Diabetes is on the rise as the worldwide population ages. While physical activity can help protect against diabetes, ageing is commonly associated with reduced physical activity. This study aimed to examine if physical activity differs by diabetes status in mid-aged adults, how this association changes over time, and whether physical activity-related sociodemographic factors and health indicators differ in those with and without diabetes. Data came from four waves of the How Areas in Brisbane Influence HealTh and AcTivity (HABITAT), a longitudinal study of mid-age adults living in Brisbane, Australia. Random effects/Expectation-maximisation (RE-EM) regression trees were used to identify factors affecting physical activity among those with and without diabetes, both separately and combined. At study entry, those with diabetes had a higher median age of 58 years (95% CI: 57–60) and a lower median physical activity of 699 MET.min/week (95% CI: 599–799) than people without diabetes (53 years (95% CI: 53–53) and 849 MET.min/week (95% CI: 799–899)). However, the strongest factors influencing physical activity were BMI and gender, not diabetes status. It is vital to promote physical activity among adults, in particular among those with high BMI and women, as well as those with and at high risk of diseases like diabetes.
Publisher: Springer Science and Business Media LLC
Date: 07-02-2015
Publisher: Wiley
Date: 19-11-2009
DOI: 10.1002/PON.1435
Abstract: This paper explores the effects of perceived stage of cancer (PSOC) on carers' anxiety and depression during the patients' final year. A consecutive s le of patients and carers (N=98) were surveyed at regular intervals regarding PSOC, and anxiety and depression using the Hospital Anxiety and Depression Scale. Means were compared by gender using the Mann-Whitney U-test. The chi-square was used to analyse categorical data. Agreement between carers' and patients' PSOC was estimated using kappa statistics. Correlations between carers' PSOC and their anxiety and depression were calculated using the Spearman's rank correlation. Over time, an increasing proportion of carers reported that the cancer was advanced, culminating at 43% near death. Agreement regarding PSOC was fair (kappa=0.29-0.34) until near death (kappa=0.21). Carers' anxiety increased over the year depression increased in the final 6 months. Females were more anxious (p=0.049, 6 months p=0.009, 3 months) than males, and more depressed until 1 month to death. The proportion of carers reporting moderate-severe anxiety almost doubled over the year to 27%, with more females in this category at 6 months (p=0.05). Carers with moderate-severe depression increased from 6 to 15% over the year. Increased PSOC was weakly correlated with increased anxiety and depression. Carers' anxiety exceeded depression in severity during advanced cancer. Females generally experienced greater anxiety and depression. Carers were more realistic than patients regarding the ultimate outcome, which was reflected in their declining mental health, particularly near the end.
Publisher: Oxford University Press (OUP)
Date: 12-08-2015
DOI: 10.1093/IJE/DYV161
Publisher: BMJ
Date: 19-12-2019
DOI: 10.1136/BMJ.L6460
Abstract: To determine whether researchers are submitting manuscripts and peer reviews to BMJ journals out of hours and whether this has changed over time. Observational study of research manuscripts and peer reviews submitted between 2012 and 2019 for which an author’s address could be geocoded. Online BMJ submission systems for two large general medical journals. Manuscript and peer review submissions on weekends, on national holidays, and by hour of day (to determine early mornings and late nights). Logistic regression was used to estimate the probability of manuscript and peer review submissions on weekends or holidays. The analyses included more than 49 000 manuscript submissions and 76 000 peer reviews. Little change over time was seen in the average probability of manuscript or peer review submissions occurring on weekends or holidays. The levels of out of hours work were high, with average probabilities of 0.14 to 0.18 for work on the weekends and 0.08 to 0.13 for work on holidays compared with days in the same week. Clear and consistent differences were seen between countries. Chinese researchers most often worked at weekends and at midnight, whereas researchers in Scandinavian countries were among the most likely to submit during the week and the middle of the day. The differences between countries that are persistent over time show that a “culture of overwork” is a literal thing, not just a figure of speech.
Publisher: Informa UK Limited
Date: 27-07-2023
Publisher: Elsevier BV
Date: 06-2014
DOI: 10.1016/J.JCRC.2014.01.020
Abstract: This study investigated the significance of baseline cortisol levels and adrenal response to corticotropin in shocked patients after acute myocardial infarction (AMI). A short corticotropin stimulation test was performed in 35 patients with cardiogenic shock after AMI by intravenously injecting of 250 μg of tetracosactrin (Synacthen). Blood s les were obtained at baseline (T0) before and at 30 (T30) and 60 (T60) minutes after the test to determine plasma total cortisol (TC) and free cortisol concentrations. The main outcome measure was in-hospital mortality and its association with T0 TC and maximum response to corticotropin (maximum difference [Δ max] in cortisol levels between T0 and the highest value between T30 and T60). The in-hospital mortality was 37%, and the median time to death was 4 days (interquartile range, 3-9 days). There was some evidence of an increased mortality in patients with T0 TC concentrations greater than 34 μg/dL (P=.07). Maximum difference by itself was not an independent predictor of death. Patients with a T0 TC 34 μg/dL or less and Δ max greater than 9 μg/dL appeared to have the most favorable survival (91%) when compared with the other 2 groups: T0 34 μg/dL or less and Δ max 9 μg/dL or less or T0 34 μg/dL or higher and Δ max greater than 9 μg/dL (75% P=.8) and T0 greater than 34 μg/dL and Δ max 9 μg/dL or less (60% P=.02). Corticosteroid therapy was associated with an increased mortality (P=.03). There was a strong correlation between plasma TC and free cortisol (r=0.85). A high baseline plasma TC was associated with a trend toward increased mortality in patients with cardiogenic shock post-AMI. Patients with lower baseline TC, but with an inducible adrenal response, appeared to have a survival benefit. A prognostic system based on basal TC and Δ max similar to that described in septic shock appears feasible in this cohort. Corticosteroid therapy was associated with adverse outcomes. These findings require further validation in larger studies.
Publisher: American Diabetes Association
Date: 06-2007
DOI: 10.2337/DC06-2187
Abstract: OBJECTIVE—Although there is consensus that excess adiposity is strongly associated with type 2 diabetes, its relationship with weight change is less clear. This study investigates the relative impact of BMI at baseline and short-term (2- or 3-year) weight changes on the incidence of diabetes. RESEARCH DESIGN AND METHODS—Prospective data were collected from a population-based cohort of middle-aged women participating in the Australian Longitudinal Study on Women's Health (n = 7,239 for this report). To date, participants have completed four mailed surveys (S1, 1996 S2, 1998 S3, 2001 and S4, 2004). Generalized estimating equations were used to model binary repeated-measures data to assess the impact of BMI at S1 and weight change (S1 to S2 S2 to S3) on 3-year incidence of diabetes at S3 and S4, respectively, adjusting for sociodemographic and lifestyle factors. RESULTS—BMI at S1 was strongly associated with the development of diabetes by S3 or S4. Compared with women who had a BMI & kg/m2, those with BMI ≥25 kg/m2 had higher incidence of diabetes (P & 0.0001), with odd ratios reaching 12.1 (95% CI 7.6–19.3) for women in the very obese group (BMI ≥35 kg/m2). There was no association between shorter-term weight gain or weight loss on first-reported diagnosis of diabetes (P = 0.08). CONCLUSIONS—Because women's risk of developing type 2 diabetes in midlife is more closely related to their initial BMI (when aged 45–50 years) than to subsequent short-term weight change, public health initiatives should target the prevention of weight gain before and during early adulthood.
Publisher: Public Library of Science (PLoS)
Date: 09-02-2016
Publisher: Wiley
Date: 10-07-2019
DOI: 10.1111/AJO.13032
Abstract: In 2014, updated screening and diagnostic criteria for gestational diabetes (GDM) were introduced across Australia. Many states including Queensland introduced clinical guidelines to include these changes and other recommendations for GDM management. While it is understood that GDM diagnosis has increased, it is unknown whether resources or service delivery have changed, or whether health services have implemented the guidelines. To understand the staff resourcing, models of care, level of guideline implementation and barriers and enablers to implementing the guideline across Queensland Health GDM services. A 22-item electronic survey containing multiple choice and open-ended questions was disseminated to healthcare professionals involved in GDM care across 14 Hospital and Health Services (HHS) in Queensland between August and October 2017. Fifty-three surveys were included for analysis. Between 2014 and 2016, Queensland GDM diagnosis increased by an average of 33%, yet only eight out of 14 HHS reported increases to staff resourcing. Full implementation of the GDM guideline was reported by 41% of metropolitan compared with 29% for regional and 25% for rural/remote services. Guideline recommendations were inconsistently delivered for physical activity advice, minimum schedule of dietetics appointments and psychosocial support. The most common barrier to guideline implementation was staff resourcing (85%), whereas enablers included staff/teamwork (42%), staff resourcing (21%), local protocols (21%) and staff education/knowledge (15%). Increased staff funding as well as an implementation science-driven process for guideline implementation is required to ensure that the increasing number of women with GDM can receive evidence-based care.
Publisher: BMJ
Date: 27-09-2011
DOI: 10.1136/BMJ.D4797
Publisher: BMJ
Date: 10-2016
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 07-2012
Publisher: Environmental Health Perspectives
Date: 02-2019
DOI: 10.1289/EHP2207
Publisher: Springer Science and Business Media LLC
Date: 05-04-2016
DOI: 10.1007/S11136-016-1282-X
Abstract: Factors that predict the health-related quality of life (HRQoL) of people with complex chronic diseases have not been investigated to date. Determining the impact of disease on daily activities is a factor that is particularly important with this group of people. This study examined the influence of a range of predictors (including the impact of chronic diseases on daily activities), on HRQoL in patients with complex chronic diseases over a 12-month period. A longitudinal cohort study was conducted with outcomes measured at baseline, 3, 6 and 12 months post-baseline. Adults attending an Australian community-based rehabilitation service were included. HRQoL was measured using the SF-36 and corresponding preference-based health utility. Predictor variables included sociodemographic factors, disease factors (e.g. impact of diseases on daily activities), intervention factors, psychosocial factors and HRQoL components that were not included as the dependent variable. Linear mixed-effects regression was used to examine the relationship between predictor variables and HRQoL. Data from 351 participants were included. The impact of chronic disease on daily activities was the most frequent significant predictor of HRQoL outcomes. Other significant predictors included the impact of chronic back pain or sciatica on daily activities, the number of comorbidities, general health functioning and psychological distress. Models of health care for people with complex chronic disease may be enhanced by greater focus on patients' daily activities during assessment and intervention delivery. The range of significant predictors highlights the importance of an interdisciplinary team for managing complex chronic disease or targeted intervention strategies.
Publisher: Springer Science and Business Media LLC
Date: 11-05-2009
Publisher: Elsevier BV
Date: 05-2020
Publisher: Elsevier BV
Date: 05-2020
Publisher: Public Library of Science (PLoS)
Date: 13-08-2010
Publisher: Informa UK Limited
Date: 12-2005
DOI: 10.1080/02699050500110785
Abstract: To quantify time caring, burden and health status in carers of stroke patients after discharge from rehabilitation to identify the potentially modifiable sociodemographic and clinical characteristics associated with these outcomes. Patients and carers prospectively interviewed 6 (n=71) and 12 (n=57) months after discharge. Relationships of carer and patient variables with burden, health status and time analysed by Gaussian and Poisson regression. Carers showed considerable burden at 6 and 12 months. Carers spent 4.6 and 3.6 hours per day assisting patients with daily activities at 6 and 12 months, respectively. Improved patient motor and cognitive function were associated with reductions of up to 20 minutes per day in time spent in daily activities. Better patient mental health and cognitive function were associated with better carer mental health. Potentially modifiable factors such as these may be able to be targeted by caregiver training, support and education programmes and outpatient therapy for patients.
Publisher: Elsevier BV
Date: 02-2016
Publisher: Public Library of Science (PLoS)
Date: 22-12-2070
Publisher: Public Library of Science (PLoS)
Date: 02-02-2021
Publisher: Oxford University Press (OUP)
Date: 09-2021
Abstract: Diabetes-related foot disease is the leading cause of lower limb utations in Queensland. Amputations can be either minor (below the ankle joint) or major (above the ankle joint). Minor utations may be performed to prevent major utations prophylactically, but how these forms of utations interrelate, and where their interrelationships are weakest and strongest, is unknown. Knowledge of small-area variation in interrelations between minor and major utations is relevant to prevention and improved management of foot disease. Data on lower limb utations performed between 2014 and 2018 on patients aged 20+ years with diabetes were obtained from the Queensland Hospital Admitted Patient Data Collection. Rates were calculated using the number of people, rather than the number of utation procedures. A Bayesian hierarchical spatial multivariate model was used to examine patterns over 516 populated statistical areas 2 in Queensland. During 2014 to 2018, 3,548 Queenslanders had at least one minor utation, and 1,114 had at least one major utation. Modelled utation rates varied markedly across the State (standardised morbidity ratio (SMR) IQR: 0.67 to 1.22), with areas in far north Queensland having extremely high rates. There was consistently high area-level correlation between minor and major utation rates. The highest SMRs for both minor and major utations were in the Northern Peninsula. Elevated rates of minor and major utations in areas in Queensland, most noticeably the far north, indicate an urgent need for greater support for people with diabetes-related foot disease. Text: Large differences in minor and major utation rates across Queensland indicate that certain regions require greater assistance in managing diabetes-related foot disease.
Publisher: Springer Science and Business Media LLC
Date: 21-06-2021
DOI: 10.1186/S12874-021-01319-5
Abstract: Kidney graft failure risk prediction models assist evidence-based medical decision-making in clinical practice. Our objective was to develop and validate statistical and machine learning predictive models to predict death-censored graft failure following deceased donor kidney transplant, using time-to-event (survival) data in a large national dataset from Australia. Data included donor and recipient characteristics (n = 98) of 7,365 deceased donor transplants from January 1st, 2007 to December 31st, 2017 conducted in Australia. Seven variable selection methods were used to identify the most important independent variables included in the model. Predictive models were developed using: survival tree, random survival forest, survival support vector machine and Cox proportional regression. The models were trained using 70% of the data and validated using the rest of the data (30%). The model with best discriminatory power, assessed using concordance index (C-index) was chosen as the best model. Two models, developed using cox regression and random survival forest, had the highest C-index (0.67) in discriminating death-censored graft failure. The best fitting Cox model used seven independent variables and showed moderate level of prediction accuracy (calibration). This index displays sufficient robustness to be used in pre-transplant decision making and may perform better than currently available tools.
Publisher: BMJ
Date: 02-08-2013
Abstract: Seasonal changes in cardiovascular disease (CVD) risk factors may be due to exposure to seasonal environmental variables like temperature and acute infections or seasonal behavioural patterns in physical activity and diet. Investigating the seasonal pattern of risk factors should help determine the causes of the seasonal pattern in CVD. Few studies have investigated the seasonal variation in risk factors using repeated measurements from the same in idual, which is important as in idual and population seasonal patterns may differ. The authors investigated the seasonal pattern in systolic and diastolic blood pressure, heart rate, body weight, total cholesterol, triglycerides, high-density lipoprotein cholesterol, C reactive protein and fibrinogen. Measurements came from 38 037 participants in the population-based cohort, the Tromsø Study, examined up to eight times from 1979 to 2008. In idual and population seasonal patterns were estimated using a cosinor in a mixed model. All risk factors had a highly statistically significant seasonal pattern with a peak time in winter, except for triglycerides (peak in autumn), C reactive protein and fibrinogen (peak in spring). The sizes of the seasonal variations were clinically modest. Although the authors found highly statistically significant in idual seasonal patterns for all risk factors, the sizes of the changes were modest, probably because this subarctic population is well adapted to a harsh climate. Better protection against seasonal risk factors like cold weather could help reduce the winter excess in CVD observed in milder climates.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 2015
Publisher: Environmental Health Perspectives
Date: 08-2014
DOI: 10.1289/EHP.1307496
Publisher: Proceedings of the National Academy of Sciences
Date: 28-11-2011
Abstract: Globally, inadequate water supply, sanitation, and hygiene (WASH) are major contributors to mortality and burden of disease. We aimed to quantify the role of WASH in the risk of Schistosoma hematobium , Schistosoma mansoni , and hookworm infection in school-aged children to estimate the population attributable fraction (PAF) of helminth infection due to WASH and to spatially predict the risk of infection. We generated predictive maps of areas in West Africa without piped water, toilet facilities, and improved household floor types, using spatial risk models. Our maps identified areas in West Africa where the millennium development goal for water and sanitation is lagging behind. There was a generally better geographical coverage for toilets and improved household floor types compared with water supply. These predictions, and their uncertainty, were then used as covariates in Bayesian geostatistical models for the three helminth species. We estimated a smaller attributable fraction for water supply in S. mansoni (PAF 47%) compared with S. hematobium (PAF 71%). The attributable fraction of S. hematobium infection due to natural floor type (PAF 21%) was comparable to that of S. mansoni (PAF 16%), but was significantly higher for hookworm infection (PAF 86%). Five percent of hookworm cases could have been prevented if improved toilet facilities had been available. Mapping the distribution of infection risk adjusted for WASH allowed the identification of communities in West Africa where preventive chemotherapy integrated with interventions to improve WASH will yield the greatest health benefits.
Publisher: Springer Science and Business Media LLC
Date: 11-10-2013
Abstract: Rates of chronic disease are escalating around the world. To date health service evaluations have focused on interventions for single chronic diseases. However, evaluations of the effectiveness of new intervention strategies that target single chronic diseases as well as multimorbidity are required, particularly in areas outside major metropolitan centres where access to services, such as specialist care, is difficult and where the retention and recruitment of health professionals affects service provision. This study is a longitudinal investigation with a baseline and three follow-up assessments comparing the health and health costs of people with chronic disease before and after intervention at a chronic disease clinic, in regional Australia. The clinic is led by students under the supervision of health professionals. The study will provide preliminary evidence regarding the effectiveness of the intervention, and evaluate the influence of a range of factors on the health outcomes and costs of the patients attending the clinic. Patients will be evaluated at baseline (intake to the service), and at 3-, 6-, and 12-months after intake to the service. Health will be measured using the SF-36 and health costs will be measured using government and medical record sources. The intervention involves students and health professionals from multiple professions working together to treat patients with programs that include education and exercise therapy programs for back pain, and Healthy Lifestyle programs as well as in idual consultations involving single professions. Understanding the effect of a range of factors on the health state and health costs of people attending an interdisciplinary clinic will inform health service provision for this clinical group and will determine which factors need to be controlled for in future observational studies. Preliminary evidence regarding changes in health and health costs associated with the intervention will be a platform for future clinical trials of intervention effectiveness. The results will be of interest to teams investigating new chronic disease programs particularly for people with multimorbidity, and in areas outside major metropolitan centres. Australia and New Zealand Clinical Trials Registry: ACTRN12611000724976
Publisher: Springer Science and Business Media LLC
Date: 03-11-2020
DOI: 10.1186/S12884-020-03352-6
Abstract: There is strong evidence that women with gestational diabetes mellitus (GDM) who receive a minimum of three appointments with a dietitian may require medication less often. The aim of this study was to evaluate the impact of a dietitian-led model of care on clinical outcomes and to understand the utility of the integrated Promoting Action on Research Implementation in Health Services ( i -PARIHS) framework as a prospective tool for implementation. This was a pre-post intervention study measuring outcomes before-and-after changing a gestational diabetes (GDM) model of care and included women with GDM managed at a large, regional hospital in Queensland, Australia. The i -PARIHS framework was used to develop, implement and evaluate a dietitian-led model of care which increased dietetic input for women with GDM to a minimum of one initial education and two review appointments. The outcomes were adherence to the schedule of appointments, clinician perspective of the implementation process, pharmacotherapy use, gestational age at commencement of pharmacotherapy and birth weight. Pre- and post- comparisons of outcomes were made using t-tests and chi-squared tests. Adherence to the dietetic schedule of appointments was significantly increased from 29 to 82% ( p 0.001) but pharmacotherapy use also increased by 10% ( p = 0.10). There were significantly more women in the post-intervention group who were diagnosed with GDM prior to 24 weeks gestation, a strong independent predictor of pharmacotherapy use. Infant birthweight remained unchanged. The i -PARIHS framework was used as a diagnostic tool and checklist in the model of care development phase a facilitation tool during the implementation phase and during the evaluation phase was used as a reflection tool to identify how the i- PARIHS constructs and their interactions that may have impacted on clinical outcomes. The i -PARIHS framework was found to be useful in the development, implementation and evaluation of a dietitian-led model of care which saw almost 90% of women with GDM meet the minimum schedule of dietetic appointments.
Publisher: Springer Science and Business Media LLC
Date: 13-07-2016
Abstract: Post-operative atrial fibrillation (POAF) is a frequent complication of cardiac surgery. Oxidative stress and reduced antioxidant function have major roles in its development. Selenium is a key to normal antioxidant function, and levels are often low before cardiac surgery. This study investigated whether low preoperative selenium levels were associated with POAF in cardiac surgical patients. Using the Society of Thoracic Surgeons (STS) Mortality risk score, 50 patients having primary coronary artery bypass grafts (CABG) surgery were ided into two groups: (i) low-risk group (STS ⩽0.5% n=26) and (ii) intermediate-risk group (STS ⩾2.0% n=24). Plasma levels of selenium, glutathione peroxidase (GPx) and malondialdehyde (MDA) were measured in all patients at anaesthetic induction, after aortic cross-cl removal, 3 h post cardiopulmonary bypass and on post-operative days 1 and 5. Multiple logistic regression was used to assess whether selenium levels were associated with POAF development. Seventeen patients developed POAF (14 patients in the intermediate-risk group and 3 patients in the low-risk group). Preoperative selenium was lower in patients who developed POAF compared with those with normal sinus rhythm (0.73±0.16 vs 0.89±0.13 μmol/l, P=0.005), and this was independently associated with POAF (PR 0.32 95% confidence credible interval (95%cI) 0.06-0.85, P=0.016). Regardless of POAF, preoperative selenium was lower in the intermediate-risk patients than in the low-risk patients (0.77±0.15 vs 0.89±0.14 μmol/l P=0.004). Intermediate-risk patients with low preoperative selenium levels may be at a greater risk of developing POAF following CABG. This raises the question of whether selenium supplementation in select cardiac surgical patients may reduce their POAF risk.
Publisher: Wiley
Date: 16-04-2008
DOI: 10.1111/J.1365-3156.2008.02048.X
Abstract: To characterize age-gender prevalence profiles of urinary schistosomiasis according to the questionnaire responses, compare the profiles to field survey data from selected regions, and determine if the profiles varied spatially throughout Tanzania. In 2004, a national school-based questionnaire survey for self-reported schistosomiasis and blood in urine (BIU) was conducted in all regions of mainland Tanzania, to assist targeted mass distribution of praziquantel. Field survey data were collected in six north-western and five coastal regions using microscopic examination of urine s les for the presence of Schistosoma haematobium eggs and assessment of micro-haematuria with chemical reagent strips. Bayesian logistic regression models were created to calculate age-gender profiles adjusted for demographic and ecological covariates and spatial correlation in the questionnaire data. Separate odds ratios (OR) for age-gender effects were calculated in each administrative area. Data were obtained from > 2.5 million schoolchildren. Boys had higher prevalence of self-reported schistosomiasis and BIU than girls. In boys, prevalence according to the questionnaire and field surveys followed similar age profiles. However, in girls, prevalence according to the field surveys increased in older age groups, but flattened out or decreased according to the questionnaire, indicating the latter underestimated prevalence in older girls. In the models, little spatial correlation was evident in the OR for the age-gender effects, suggesting that these did not vary spatially. Age-gender patterns of urinary schistosomiasis were consistent in different geographical areas of Tanzania. Because the questionnaire underestimated prevalence in older girls, we propose that upward calibration of observed prevalence is done for older females only.
Publisher: Zenodo
Date: 2020
Publisher: Oxford University Press (OUP)
Date: 20-11-2015
DOI: 10.1093/HER/CYV057
Abstract: Hand hygiene is the primary measure in hospitals to reduce the spread of infections, with nurses experiencing the greatest frequency of patient contact. The '5 critical moments' of hand hygiene initiative has been implemented in hospitals across Australia, accompanied by awareness-raising, staff training and auditing. The aim of this study was to understand the determinants of nurses' hand hygiene decisions, using an extension of a common health decision-making model, the theory of planned behaviour (TPB), to inform future health education strategies to increase compliance. Nurses from 50 Australian hospitals (n = 2378) completed standard TPB measures (attitude, subjective norm, perceived behavioural control [PBC], intention) and the extended variables of group norm, risk perceptions (susceptibility, severity) and knowledge (subjective, objective) at Time 1, while a sub-s le (n = 797) reported their hand hygiene behaviour 2 weeks later. Regression analyses identified subjective norm, PBC, group norm, subjective knowledge and risk susceptibility as the significant predictors of nurses' hand hygiene intentions, with intention and PBC predicting their compliance behaviour. Rather than targeting attitudes which are already very favourable among nurses, health education strategies should focus on normative influences and perceptions of control and risk in efforts to encourage hand hygiene adherence.
Publisher: Elsevier BV
Date: 03-2022
DOI: 10.1016/J.IJHEH.2021.113899
Abstract: Environmental chemicals have been implicated in the etiology of impaired fetal growth. However, few studies have assessed the effects of chemical mixtures or considered the possibility of non-monotonic exposure-response relationships for chemicals that act through the endocrine system. We assessed exposure to polybrominated diphenyl ethers, organochlorine pesticides, metals, and perfluorinated alkyl substances in blood and urine s les collected approximately two weeks prior to delivery in 166 non-smoking pregnant women, and subsequent birth weight, length, and head circumference of neonates who were part of the Australian Maternal Exposures to Toxic Substances (AMETS) study. We used Bayesian structured additive regression models with spike-slab priors to estimate mixture effects, identify important exposures, and model non-linearity in exposure-response relationships. Mixtures of polybrominated diphenyl ethers, organochlorine pesticides, metals, and perfluorinated alkyl substances were not associated with fetal growth outcomes. Estimated change in fetal growth outcomes for an increase in exposure from the 25th to 75th percentile suggested no meaningful associations the strongest evidence was for a small inverse association between birth weight and cesium exposure measured in whole blood (-124 g, 90% credible interval: -240 to -3 g). We identified several chemicals that may be associated with fetal growth non-linearly however, 90% credible intervals contained small values consistent with no meaningful association. Using a Bayesian penalized regression method, we assessed the shapes of exposure-response relationships, controlled for confounding by co-exposure, and estimated the single and combined effects of a large mixture of correlated environmental chemicals on fetal growth. Our findings, based on a small s le of mother-neonate pairs, suggest that mixtures of persistent chemicals are not associated with birth weight, length, and head circumference. The potential for non-monotonic relationships between environmental chemicals and fetal growth outcomes warrants further study.
Publisher: Springer Science and Business Media LLC
Date: 05-05-2017
Publisher: Cold Spring Harbor Laboratory
Date: 28-07-2021
DOI: 10.1101/2021.07.26.21250865
Abstract: Governments are considering financial incentives to increase vaccine uptake to end the COVID-19 pandemic. Incentives being offered include cash-equivalents such as vouchers or being entered into lotteries. Our experiment involved random assignment of 1,628 unvaccinated participants in the United States to one of three 45 second informational videos promoting vaccination with messages about: (a) health benefits of COVID-19 vaccines (control) (b) being entered into lotteries or (c) receiving cash equivalent vouchers. After seeing the control health information video, 16% of in iduals wanted information on where to get vaccinated. This compared with 14% of those assigned to the lottery video (odds ratio of 0.82 relative to control: 95% credible interval 0.57-1.17) and 22% of those assigned to the cash voucher video (odds ratio of 1.53 relative to control: 95% credible interval 1.11-2.11). These results support greater use of cash vouchers to promote COVID-19 vaccine uptake and do not support the use of lottery incentives.
Publisher: Elsevier BV
Date: 03-2019
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 28-07-2021
DOI: 10.1097/CCM.0000000000005209
Abstract: Stroke has been reported in observational series as a frequent complication of coronavirus disease 2019, but more information is needed regarding stroke prevalence and outcomes. We explored the prevalence and outcomes of acute stroke in an international cohort of patients with coronavirus disease 2019 who required ICU admission. Retrospective analysis of prospectively collected database. A registry of coronavirus disease 2019 patients admitted to ICUs at over 370 international sites was reviewed for patients diagnosed with acute stroke during their stay. Patients older than 18 years old with acute coronavirus disease 2019 infection in ICU. None. Of 2,699 patients identified (median age 59 yr male 65%), 59 (2.2%) experienced acute stroke: 0.7% ischemic, 1.0% hemorrhagic, and 0.5% unspecified type. Systemic anticoagulant use was not associated with any stroke type. The frequency of diabetes, hypertension, and smoking was higher in patients with ischemic stroke than in stroke-free and hemorrhagic stroke patients. Extracorporeal membrane oxygenation support was more common among patients with hemorrhagic (56%) and ischemic stroke (16%) than in those without stroke (10%). Extracorporeal membrane oxygenation patients had higher cumulative 90-day probabilities of hemorrhagic (relative risk = 10.5) and ischemic stroke (relative risk = 1.7) versus nonextracorporeal membrane oxygenation patients. Hemorrhagic stroke increased the hazard of death (hazard ratio = 2.74), but ischemic stroke did not—similar to the effects of these stroke types seen in noncoronavirus disease 2019 ICU patients. In an international registry of ICU patients with coronavirus disease 2019, stroke was infrequent. Hemorrhagic stroke, but not ischemic stroke, was associated with increased mortality. Further, both hemorrhagic stroke and ischemic stroke were associated with traditional vascular risk factors. Extracorporeal membrane oxygenation use was strongly associated with both stroke and death.
Publisher: Oxford University Press (OUP)
Date: 30-07-2020
DOI: 10.1093/CID/CIZ717
Abstract: Healthcare-associated infections (HAIs) remain a significant patient safety issue, with point prevalence estimates being ~5% in high-income countries. In 2016–2017, the Researching Effective Approaches to Cleaning in Hospitals (REACH) study implemented an environmental cleaning bundle targeting communication, staff training, improved cleaning technique, product use, and audit of frequent touch-point cleaning. This study evaluates the cost-effectiveness of the environmental cleaning bundle for reducing the incidence of HAIs. A stepped-wedge, cluster-randomized trial was conducted in 11 hospitals recruited from 6 Australian states and territories. Bundle effectiveness was measured by the numbers of Staphylococcus aureus bacteremia, Clostridium difficile infection, and vancomycin-resistant enterococci infections prevented in the intervention phase based on estimated reductions in the relative risk of infection. Changes to costs were defined as the cost of implementing the bundle minus cost savings from fewer infections. Health benefits gained from fewer infections were measured in quality-adjusted life-years (QALYs). Cost-effectiveness was evaluated using the incremental cost-effectiveness ratio and net monetary benefit of adopting the cleaning bundle over existing hospital cleaning practices. Implementing the cleaning bundle cost $349 000 Australian dollars (AUD) and generated AUD$147 500 in cost savings. Infections prevented under the cleaning bundle returned a net monetary benefit of AUD$1.02 million and an incremental cost-effectiveness ratio of $4684 per QALY gained. There was an 86% chance that the bundle was cost-effective compared with existing hospital cleaning practices. A bundled, evidence-based approach to improving hospital cleaning is a cost-effective intervention for reducing the incidence of HAIs.
Publisher: Elsevier BV
Date: 10-2012
Publisher: Springer Science and Business Media LLC
Date: 12-2015
Publisher: Elsevier BV
Date: 10-2020
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 05-2020
DOI: 10.1097/AOG.0000000000003790
Abstract: To evaluate the effects of updated gestational diabetes mellitus (GDM) screening and diagnostic criteria on selected perinatal outcomes in Queensland, Australia. This was a pre–post comparison study using perinatal data the year before (2014) and after (2016) the screening and diagnostic criteria for GDM was changed in Queensland, Australia. In 2015, Queensland adopted the one-step screening and diagnostic criteria based on the International Association of the Diabetes and Pregnancy Study Groups' recommendations. The data from 62,517 women in 2014 and 61,600 women in 2016 who gave birth from 24 weeks of gestation were analyzed in three groups in each year: women with GDM women without diagnosed GDM and total population. The outcome measures were gestational hypertension, cesarean birth, gestational age at delivery, birth weight, preterm delivery, large-for-gestational age (LGA) neonates, small-for-gestational-age (SGA) neonates, neonatal hypoglycemia, and respiratory distress. The diagnosis of GDM increased from 8.7% (n=5,462) to 11.9% (n=7,317). After changing the diagnostic criteria, the changes to outcomes, odds ratios (OR), and adjusted odds ratios (aOR) (95% CI) for outcomes with statistically significant differences for the total population were: gestational hypertension 4.6% vs 5.0%, OR 1.09 (1.03–1.15), aOR 1.07 (1.02–1.13) preterm birth 7.6% vs 8.0%, OR 1.05 (1.01–1.09), aOR 1.06 (1.02–1.10) neonatal hypoglycemia 5.3% vs 6.8%, OR 1.31 (1.25–1.37), aOR 1.32 (1.25–1.38) and respiratory distress 6.2% vs 6.0%, OR 0.96 (0.91–1.00), aOR 0.94 (0.89–0.99). There was no change to cesarean births or LGA or SGA neonates for women with or without diagnosed GDM or the total population. Except for a very small decrease in respiratory distress, changing the diagnostic criteria has resulted in more GDM diagnoses with no observed changes to measured perinatal outcomes for women with and without diagnosed GDM.
Publisher: Informa UK Limited
Date: 2005
DOI: 10.1080/03014460500154699
Abstract: Birth weight is known to fluctuate with month of birth and with latitude however the mechanisms underlying these gradients remain unclear. The study examined within-year fluctuations in birth weight across four regions in Australia. We obtained the birth weight of singleton births of at least 37 weeks gestation from four regions: (a) southeast Queensland, (b) Sydney and surrounding districts, (c) Victoria, and (d) Tasmania. Seasonal fluctuations were examined after long-term trends had been removed. The litude, timing and variability of seasonal fluctuations were examined and compared across regions. Each of the four regions had prominent annual periodicity with the peak birth weight occurring in spring. The litude of this signal ranged from 1.4 g (Victoria) to 7.7 g (southeast Queensland). There was no significant correlation between the litude of these fluctuations and the latitude of four regions. In addition, a second smaller autumn peak was identified. Environmental factors that have regular within-year variation influence birth weight in Australia. The evidence suggests that at least two distinguishable seasonal processes contribute to the findings. Identifying the factors underlying these seasonal fluctuations could have implications from a public health perspective.
Publisher: BMJ
Date: 07-2005
Publisher: Springer Science and Business Media LLC
Date: 10-04-2012
Publisher: Elsevier BV
Date: 08-2010
Publisher: Informa UK Limited
Date: 09-2020
DOI: 10.2147/CLEP.S256735
Publisher: eLife Sciences Publications, Ltd
Date: 04-04-2022
DOI: 10.7554/ELIFE.76123
Abstract: When researchers’ careers are disrupted by life events – such as illness or childbirth – they often need to take extended time off. This creates a gap in their research output that can reduce their chances of winning funding. In Australia, applicants can disclose their career disruptions and peer reviewers are instructed to make appropriate adjustments. However, it is not clear if and how applicants use career disruption sections or how reviewers adjust and if they do it consistently. To examine career disruption, we used surveys of the Australian health and medical research community. We used both a random s le of Australian authors on PubMed and a non-random convenience s le. Respondents expressed concerns that sharing information on career disruption would harm their chances of being funded, with 13% saying they have medical or social circumstances but would not include it in their application, with concerns about appearing ‘weak’. Women were more reluctant to include disruption. There was inconsistency in how disruption was adjusted for, with less time given for those with depression compared with caring responsibilities, and less time given for those who did not provide medical details of their disruption. The current system is likely not adequately adjusting for career disruption and this may help explain the ongoing funding gap for senior women in Australia. National Health and Medical Research Council Senior Research Fellowship (Barnett).
Publisher: Wiley
Date: 20-02-2022
DOI: 10.1111/NICC.12613
Abstract: Critically ill patients are more likely to survive intensive care than ever before due to advances in treatment. However, a proportion subsequently experiences post‐intensive care syndrome (PICS) incurring substantial personal, social, and economic costs. PICS is a debilitating set of physical, psychological, and cognitive sequelae but the size and characteristics of the affected population have been difficult to describe, impeding progress in intensive care rehabilitation. The aim of this protocol is to describe recovery after admission to intensive care unit (ICU) and the predictors, correlates, and patient‐reported outcomes for those experiencing PICS. The study will support the development of screening, diagnostic, and outcome measures to improve post‐ICU recovery. A prospective, multi‐site observational study in three ICUs in Brisbane, Australia. Following consent, data will be collected from clinical records and using validated self‐report instruments from 300 patients, followed up at 6 weeks and 6 months post ICU discharge. TOPIC is a prospective, multi‐site observational study using self‐report and clinical data on risk factors, including comorbidities, and outcomes. Data will be collected with consent from hospital records and participants 6 weeks and 6months post ICU discharge. The main outcome measures will be self‐reported physical, cognitive, and psychological function 6 weeks and 6 months post‐ICU discharge. This protocol provides a methodological framework to measure recovery and understand PICS. Data analysis will describe characteristics associated with recovery and PICS. The subsequent prediction and screening tools developed then aim to improve the effectiveness of post‐ICU prevention and rehabilitation through more targeted screening and prediction and found a program of research developing a more tailored approach to PICS.
Publisher: National Institute for Health and Care Research
Date: 07-2016
DOI: 10.3310/HTA20540
Abstract: A deep infection of the surgical site is reported in 0.7% of all cases of total hip arthroplasty (THA). This often leads to revision surgery that is invasive, painful and costly. A range of strategies is employed in NHS hospitals to reduce risk, yet no economic analysis has been undertaken to compare the value for money of competing prevention strategies. To compare the costs and health benefits of strategies that reduce the risk of deep infection following THA in NHS hospitals. To make recommendations to decision-makers about the cost-effectiveness of the alternatives. The study comprised a systematic review and cost-effectiveness decision analysis. 77,321 patients who had a primary hip arthroplasty in NHS hospitals in 2012. Nine different treatment strategies including antibiotic prophylaxis, antibiotic-impregnated cement and ventilation systems used in the operating theatre. Change in the number of deep infections, change in the total costs and change in the total health benefits in quality-adjusted life-years (QALYs). Literature searches using MEDLINE, EMBASE, Cumulative Index to Nursing and Allied Health Literature and the Cochrane Central Register of Controlled Trials were undertaken to cover the period 1966–2012 to identify infection prevention strategies. Relevant journals, conference proceedings and bibliographies of retrieved papers were hand-searched. Orthopaedic surgeons and infection prevention experts were also consulted. English-language papers only. The selection of evidence was by two independent reviewers. Studies were included if they were interventions that reported THA-related deep surgical site infection (SSI) as an outcome. Mixed-treatment comparisons were made to produce estimates of the relative effects of competing infection control strategies. Twelve studies, six randomised controlled trials and six observational studies, involving 123,788 total hip replacements (THRs) and nine infection control strategies, were identified. The quality of the evidence was judged against four categories developed by the National Institute for Health and Care Excellence Methods for Development of NICE Public Health Guidance ( publications.nice.org.uk/methods-for-the-development-of-nice-public-health-guidance-third-edition-pmg4 ), accessed March 2012. All evidence was found to fit the two highest categories of 1 and 2. Nine competing infection control interventions [treatments (Ts) 1–9] were used in a cohort simulation model of 77,321 patients who had a primary THR in 2012. Predictions were made for cases of deep infection and total costs, and QALY outcomes. Compared with a baseline of T1 (no systemic antibiotics, plain cement and conventional ventilation) all other treatment strategies reduced risk. T6 was the most effective (systemic antibiotics, antibiotic-impregnated cement and conventional ventilation) and prevented a further 1481 cases of deep infection, and led to the largest annual cost savings and the greatest gains to QALYs. The additional uses of laminar airflow and body exhaust suits indicate higher costs and worse health outcomes. T6 is an optimal strategy for reducing the risk of SSI following THA. The other strategies that are commonly used among NHS hospitals lead to higher cost and worse QALY outcomes. Policy-makers, therefore, have an opportunity to save resources and improve health outcomes. The effects of laminar air flow and body exhaust suits might be further studied if policy-makers are to consider disinvesting in these technologies. A wide range of evidence sources was synthesised and there is large uncertainty in the conclusions. The National Institute for Health Research Health Technology Assessment programme and the Queensland Health Quality Improvement and Enhancement Programme (grant number 2008001769).
Publisher: Elsevier BV
Date: 03-2012
DOI: 10.1071/HI12003
Publisher: Elsevier BV
Date: 02-2021
Publisher: Elsevier
Date: 2018
Publisher: Elsevier BV
Date: 08-2010
DOI: 10.1016/J.ENVRES.2010.06.005
Abstract: The association between extreme temperatures and health outcomes has been frequently investigated during the last few years. This assessment is usually based on a time series design, a framework which has gained a substantial development in the last two decades. In this contribution we offer an overview of the recent methodological advancements which provide new statistical tools to examine the health effects of temperature in a time series setting, highlighting at the same time the main limitations that still affect this research area.
Publisher: BMJ
Date: 10-2017
DOI: 10.1136/BMJOPEN-2017-017661
Abstract: To estimate the incidence, duration and cost of futile treatment for end-of-life hospital admissions. Retrospective multicentre cohort study involving a clinical audit of hospital admissions. Three Australian public-sector tertiary hospitals. Adult patients who died while admitted to one of the study hospitals over a 6-month period in 2012. Incidences of futile treatment among end-of-life admissions length of stay in both ward and intensive care settings for the duration that patients received futile treatments health system costs associated with futile treatments monetary valuation of bed days associated with futile treatment. The incidence rate of futile treatment in end-of-life admissions was 12.1% across the three study hospitals (range 6.0%–19.6%). For admissions involving futile treatment, the mean length of stay following the onset of futile treatment was 15 days, with 5.25 of these days in the intensive care unit. The cost associated with futile bed days was estimated to be $AA12.4 million for the three study hospitals using health system costs, and $A988 000 when using a decision maker’s willingness to pay for bed days. This was extrapolated to an annual national health system cost of $A153.1 million and a decision maker’s willingness to pay of $A12.3 million. The incidence rate and cost of futile treatment in end-of-life admissions varied between hospitals. The overall impact was substantial in terms of both the bed days and cost incurred. An increased awareness of these economic costs may generate support for interventions designed to reduce futile treatments. We did not include emotional hardship or pain and suffering, which represent additional costs.
Location: United Kingdom of Great Britain and Northern Ireland
Start Date: 2017
End Date: 2021
Funder: National Health and Medical Research Council
View Funded ActivityStart Date: 2012
End Date: 2013
Funder: National Health and Medical Research Council
View Funded ActivityStart Date: 07-2020
End Date: 07-2024
Amount: $390,000.00
Funder: Australian Research Council
View Funded ActivityStart Date: 2016
End Date: 07-2019
Amount: $295,156.00
Funder: Australian Research Council
View Funded Activity