ORCID Profile
0000-0002-9778-0386
Current Organisation
University of New South Wales
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Publisher: Wiley
Date: 25-04-2023
DOI: 10.1111/DAR.13669
Abstract: For people accessing treatment for problems with drugs other than opioids, little is known about the relationship between treatment and mortality risk, nor how mortality risk varies across treatment modalities. We addressed these evidence gaps by determining mortality rates during and after treatment for people accessing a range of treatment modalities for several drugs of concern. We conducted a cohort study using linked data on publicly funded specialist alcohol or other drug treatment service use and mortality for people receiving treatment in New South Wales between January 2012 and December 2018. We calculated and compared during‐treatment and post‐treatment crude mortality rates and age‐ and sex‐standardised mortality rates, separately for each principal drug of concern and modality. Over the study period, 45,026 people accessed treatment for problems with alcohol, 26,407 for hetamine‐type stimulants, 23,047 for cannabinoids and 21,556 for opioids. People treated for alcohol or opioid problems had higher crude mortality rates (1.48, 1.91, 1.09 per 100 person years, respectively) than those with problems with hetamine‐type stimulants or cannabinoids (0.46, 0.30 per 100 person years, respectively). Mortality rates differed according to treatment status and modality only among people with alcohol or opioid problems. The observed variation in mortality rates indicates there is scope to reduce mortality among people accessing treatment with alcohol or opioid problems. Future research on mortality among people accessing drug and alcohol treatment should account for the variation in mortality by drug of concern and treatment modality.
Publisher: Elsevier BV
Date: 09-2022
DOI: 10.1016/J.DRUGALCDEP.2022.109548
Abstract: We aimed to characterise opioid analgesic utilisation over a 16-year period among a cohort of people with a history of opioid dependence, comparing rates of use in and out of opioid agonist treatment (OAT). Retrospective cohort study in New South Wales, Australia, including 28,891 people with documented opioid dependence initiating opioid analgesics between July 2003 and December 2018. Linked administrative records provided data on prescription dispensings, sociodemographics, clinical characteristics, and OAT. Generalised estimating equation models estimated the incidence and adjusted incidence rate ratios (IRR) comparing periods in and out of OAT for the number of opioid analgesic dispensings (overall, for strong opioids, and the most commonly dispensed opioid types) and the amount dispensed in oral morphine equivalent milligrams (OME). At initiation, 43.7% of the cohort were enrolled in OAT. The most commonly initiated opioid was codeine (including combinations with paracetamol 67.8%), and 49.6% of the cohort were dispensed a psychotropic medicine in the previous 90 days. Incidence of all opioid analgesic dispensings was higher during periods out of OAT compared to in OAT (5.8 v. 2.3 dispensings per person-year IRR 0.39, 95% CI 0.38, 0.41), with findings similar when stratified by type. Being in OAT was associated with a lower OME amount dispensed compared to out of OAT (-57.7%, 95% CI-58.8, -56.7). People with opioid dependence had high rates of recent psychotropic medicine utilisation and current OAT enrolment at the time of opioid analgesic initiation. OAT was associated with a significant reduction in opioid analgesic dispensing.
Publisher: Wiley
Date: 30-07-2016
DOI: 10.1111/HIS.12755
Abstract: To compare clinicopathological and immunohistochemical features of polypoid endometriosis (PE) and non-polypoid endometriosis (NPE). Fifteen cases of PE and 20 cases of NPE were assessed. All cases were stained immunohistochemically for CD10 and p16 and the proportion of p16-positive stromal and epithelial cells was estimated. On review, 10 PE cases resembled NPE histologically but occurred at mucosal or serosal surfaces, or within cyst cavities, that permitted polyp formation. These cases had a similar age distribution and immunohistochemical profile to NPE. The remaining five PE cases showed histological similarity to eutopic endometrial polyps these occurred in older patients, and showed significantly greater stromal and epithelial p16 immunoreactivity. There are two main subgroups of PE. The majority of cases in this series showed similar histological features to NPE, but involved anatomical sites that facilitated exophytic or polypoid growth. The remaining PE cases resembled eutopic endometrial polyps histologically and immunophenotypically and they occurred in older patients. These findings suggest that such lesions are 'true' polyps sharing a pathogenetic relationship with similar lesions arising in the endometrium.
Publisher: Informa UK Limited
Date: 05-02-2017
DOI: 10.1080/03007995.2017.1278682
Abstract: The painDETECT questionnaire (PD-Q) has been used widely for the identification of neuropathic pain (NeP) however, the reliability of the English version of the PD-Q has never been investigated. This study aimed to determine the reliability of the PD-Q pre- (T0) and immediately post- (T1) clinical consultation and at one-week follow-up (T2). We recruited 157 patients attending a Neurosurgery Spinal Clinic and Pain Management Department. Minor changes to PD-Q instructions were made to facilitate patient understanding however, no changes to in idual items or scoring were made. Intraclass correlation coefficients (ICCs) were used to assess the reliability of PD-Q total scores between T0-T1 and T0-T2 weighted kappa (κ) was used to assess the agreement of PD-Q classifications (unlikely NeP, ambiguous, likely NeP) between all time-points. To ensure stability of clinical pain, patients scoring ≤2 or ≥6 on the Patient Global Impression Scale (PGIC) at T2 were excluded from the T0-T2 analysis. Accounting for missing data and exclusions (change in PGIC score), data for 136 in iduals (mean [SD] age: 56.8 [15.2] 54% male) was available, of whom n = 129 were included in the T0-T1 and n = 69 in the T0-T2 comparisons. There was almost perfect agreement between the PD-Q total scores at T0-T1 time-points (ICC 0.911 95% CI: 0.882-0.941) and substantial agreement at T0-T2 (ICC 0.792 95% CI: 0.703-0.880). PD-Q classifications demonstrated substantial agreement for T0-T1 (weighted κ: 0.771 95% CI: 0.683-0.858) and for T0-T2 (weighted κ: 0.691 95% CI: 0.553-0.830). Missing data was accounted in 13% of our cohort and over 42% of our patients drew multiple pain areas on the PD-Q body chart. The English version of the PD-Q is reliable as a screening tool for NeP. The validity of the questionnaire is still in question and has to be investigated in future studies.
Publisher: Public Library of Science (PLoS)
Date: 05-12-2016
Publisher: Elsevier BV
Date: 02-2020
DOI: 10.1016/J.NEPR.2020.102697
Abstract: It is important to evaluate stakeholder feedback regarding any change to a clinical supervision model to maintain quality. The Quality Practical Experience (QPE) instruments offer both the nurse on the ward involved with supervising student learning and the student nurse the opportunity to evaluate their satisfaction with the supervision model. This paper reports on the evaluation of the construct validity and the reliability of the QPE instruments measuring nurse and nursing student satisfaction with the clinical supervision model. Methodological design for the reliability and validation of a measuring instrument. The nurse and the student QPE instruments were tested with convenience s les of 488 nurses and 1116 student nurses, respectively. Psychometric tests included internal reliability, test-retest reliability and factor analyses. Exploratory factor analysis for both QPEs supported a three-factor solution the nurse QPE explained 48% and student nurse QPE 45% of variance. Internal reliability and test-retest reliability were stable over time (nurse QPE ICC = 0.82 student nurse QPE ICC = 0.71). Both QPE instruments were found to be valid and reliable. Feedback from all stakeholders involved with supporting student nurses during clinical placement is important.
Publisher: American Medical Association (AMA)
Date: 07-2019
Publisher: Elsevier BV
Date: 03-2020
Publisher: Public Library of Science (PLoS)
Date: 29-08-2017
Publisher: Elsevier BV
Date: 07-2020
Publisher: Wiley
Date: 02-02-2018
DOI: 10.1111/ANS.14382
Abstract: Staging of axillary lymph nodes in breast cancer is important for prognostication and planning of adjuvant therapy. The traditional practice of proceeding to axillary lymph node dissection (ALND) if sentinel lymph node biopsy (SLNB) is positive is being challenged and clinical trials are underway. For many centres, this will mean a move away from intra-operative SLNB assessment and utilization of a second procedure to perform ALND. It is sometimes perceived that a delayed ALND results in increased tissue damage and thus increased morbidity. We compared morbidity in those undergoing SLNB only, or ALND as a one- or two-stage procedure. A retrospective review of a prospectively collected institutional database was used to review rates of lymphoedema and shoulder function in women undergoing breast cancer surgery between 2008 and 2012. The overall lymphoedema rate in 745 patients was 8.2% at 12 months. There was no difference in lymphoedema rates between those undergoing immediate or delayed ALND (17.8 and 8.6%, respectively, P = 0.092). Post-operative shoulder elevation, odds ratio (OR) = 0.390, 95% confidence interval (CI) = (0.218, 0.698) and abduction, OR = 0.437 (95% CI = (0.271, 0.705)) were reduced if an ALND was performed although there was no difference between immediate or delayed. ALND remains a risk factor for post-operative morbidity. There is no increased risk of lymphoedema or shoulder function deficit with a positive SLNB and delayed ALND compared to immediate ALND.
Publisher: Wiley
Date: 04-12-2022
DOI: 10.1111/ADD.15736
Abstract: The in idual‐level effectiveness of opioid agonist treatment (OAT) in reducing mortality is well established, but there is less evidence on population‐level benefits. We use modeling informed with linked data from the OAT program in New South Wales (NSW), Australia, to estimate the impact of OAT provision in the community and prisons on mortality and the impact of eliminating excess mortality during OAT initiation/discontinuation. Dynamic modeling. A cohort of 49 359 in iduals who ever received OAT in NSW from 2001 to 2018. Receipt of OAT was represented through five stages: (i) first month on OAT, (ii) short (1–9 months) and (iii) longer (9+ months) duration on OAT, (iv) first month following OAT discontinuation and (v) rest of time following OAT discontinuation. Incarceration was represented as four strata: (i) never or not incarcerated in the past year, (ii) currently incarcerated, (iii) released from prison within the past month and (iv) released from prison 1–12 months ago. The model incorporated elevated mortality post‐release from prison and OAT impact on reducing mortality and incarceration. Among the cohort, mortality was 0.9 per 100 person‐years, OAT coverage and retention remained high ( 50%, 1.74 years/episode). During 2001–20, we estimate that OAT provision reduced overdose and other cause mortality among the cohort by 52.8% [95% credible interval (CrI) = 49.4–56.9%] and 26.6% (95% CrI =22.1–30.5%), respectively. We estimate 1.2 deaths averted and 9.7 life‐years gained per 100 person‐years on OAT. Prison OAT with post‐release OAT‐linkage accounted for 12.4% (95% CrI = 11.5–13.5%) of all deaths averted by the OAT program, primarily through preventing deaths in the first month post‐release. Preventing elevated mortality during OAT initiation and discontinuation could have averted up to 1.4% (95% CrI = 0.8–2.0%) and 3.0% (95% CrI = 2.1–5.3%) of deaths, respectively. The community and prison opioid agonist treatment program in New South Wales, Australia appears to have substantially reduced population‐level overdose and all‐cause mortality in the past 20 years, partially due to high retention.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 04-2020
DOI: 10.1213/ANE.0000000000004070
Abstract: The propensities for the upper airway to collapse during anesthesia and sleep are related, although much of our understanding of this relationship has been inferred from clinical observation and indirect measures such as the apnea–hypopnea index. The aim of this study was to use an identical, rigorous, direct measure of upper airway collapsibility (critical closing pressure of the upper airway) under both conditions to allow the magnitude of upper airway collapsibility in each state to be precisely compared. Ten subjects (8 men and 2 women mean ± SD: age, 40.4 ± 12.1 years body mass index, 28.5 ± 4.0 kg/m 2 ) were studied. Critical closing pressure of the upper airway was measured in each subject on separate days during (1) propofol anesthesia and (2) sleep. Critical closing pressure of the upper airway measurements were obtained in all 10 subjects during nonrapid eye movement sleep and, in 4 of these 10 subjects, also during rapid eye movement sleep. Critical closing pressure of the upper airway during anesthesia was linearly related to critical closing pressure of the upper airway during nonrapid eye movement sleep ( r = 0.64 [95% CI, 0.02–0.91] n = 10 P = .046) with a similar tendency in rapid eye movement sleep ( r = 0.80 [95% CI, −0.70 to 0.99] n = 4 P = .200). However, critical closing pressure of the upper airway during anesthesia was systematically greater (indicating increased collapsibility) than during nonrapid eye movement sleep (2.1 ± 2.2 vs −2.0 ± 3.2 cm H 2 O, respectively, n = 10 within-subject mean difference, 4.1 cm H 2 O [95% CI, 2.32–5.87] P .001) with a similar tendency during rapid eye movement sleep (1.6 ± 2.4 vs −1.9 ± 4.3 cm H 2 O, respectively, n = 4 unadjusted difference, 3.5 cm H 2 O [95% CI, −0.95 to 7.96] P = .087). These results demonstrate that the magnitude of upper airway collapsibility during anesthesia and sleep is directly related. However, the upper airway is systematically more collapsible during anesthesia than sleep, suggesting greater vulnerability to upper airway obstruction in the anesthetized state.
Publisher: Wiley
Date: 08-02-2015
DOI: 10.1111/HIS.12620
Abstract: The significance and pathogenesis of irregular or asynchronous maturation within endometrial glands remains uncertain. The aim of this study was to investigate differences in epithelial hormone receptor immunoreactivity and stromal cell calretinin, CD34 and p16 expression in morphologically normal secretory endometrium and in asynchronous (non-secretory) endometrial glands (AEGs). Nineteen consecutive endometrial specimens showing AEGs were examined. The mean age of the patients was 42.8 years, and the most common presenting symptom was menorrhagia. Immunohistological expression of oestrogen receptor (ER) α, of ERβ and of progesterone receptor (PR) were compared in normal secretory glands and in AEGs. Stromal cell expression of calretinin, CD34 and p16 was also investigated. In contrast to normal secretory glands, the epithelial cells lining AEGs were usually ERα/PR-positive and showed significantly increased ERβ expression. Altered calretinin and CD34 expression within functional layer stromal cells was seen in five and two cases, respectively, but there were no differences in stromal cell immunoreactivity around AEGs. The most common clinical symptom associated with AEGs in this study was menorrhagia. Aberrant hormone receptor expression in AEGs suggests a localized, possibly clonal, defect in epithelial maturation. There were no immunophenotypic changes to suggest that AEGs are related to a primary endometrial stromal deficiency.
Publisher: Elsevier BV
Date: 03-2022
DOI: 10.1016/J.DRUGALCDEP.2022.109310
Abstract: Identifying solutions to the continued rise in overdose deaths is a public health priority. However, there is evidence of change in recent substance type associated with morbidity and mortality. To better understand the continued rise in overdose deaths, in particular those attributed to opioid and stimulant use disorders, increased knowledge of patterns of use is needed. Retrospective cohort study of Veterans diagnosed with an opioid or stimulant use disorder between 2005 and 2019. The outcome of interest was diagnosis of substance use disorders, specifically examining combinations of opioid and stimulant use disorders among this population. A total of 1932,188 Veterans were diagnosed with at least one substance use disorder (SUD) during the study period, 2005 through 2019. While the annual prevalence of opioid use disorder (OUD) diagnoses increased more than 155%, OUD diagnoses absent of any other SUD diagnosis increased by an average of 6.9% (95% CI, 6.4, 7.5) per year between 2005 and 2019. Between 2011 and 2019, diagnoses of co-morbid meth hetamine use disorder (MUD) and OUD increased at a higher rate than other SUD combinations. The prevalence of comorbid SUD, in particular co-occurring opioid and meth hetamine use disorder, increased at a higher rate than other combinations between 2005 and 2019. These findings underscore the urgent need to offer patients a combination of evidence-based treatments for each co-morbid SUD, such MOUD and contingency management for persons with comorbid opioid and meth hetamine use disorders.
Publisher: Elsevier BV
Date: 02-2015
Publisher: Wiley
Date: 09-12-2019
DOI: 10.1111/ADD.14482
Publisher: Informa UK Limited
Date: 10-05-2019
Publisher: Informa UK Limited
Date: 13-01-2019
Publisher: Elsevier BV
Date: 10-2016
DOI: 10.1016/J.PATHOL.2016.06.006
Abstract: The distinction between partial hydatidiform mole (PHM) and trisomy gestation is not always straightforward histologically and it is unclear which morphological features, alone or in combination, provide the greatest diagnostic accuracy. We performed a comparative review of 89 products of conception (POC) specimens including 54 PHMs and 35 trisomy gestations, assessing the following in each case: trophoblastic atypia, cistern formation, multifocal trophoblast proliferation, lace-like trophoblast, villous enlargement, large trophoblast inclusions, scalloped villous shape, stromal apoptosis, small round villous inclusions, and fibrillary stromal collagen. There was a significant difference in the presence of trophoblast atypia, cistern formation, multifocal trophoblast proliferation, lace-like trophoblast, large trophoblastic inclusions, small round villous inclusions, fibrillary collagen (all p<0.01), and apoptosis (p=0.028), between PHM and trisomy cases. Fibrillary collagen was more common in trisomy specimens whereas the other features were more common in PHMs. There was no significant difference in villous enlargement or scalloped villous shape between the two groups. The combination of cistern formation, multifocal trophoblast proliferation and large trophoblast inclusions correctly classified 83 (93.3%) of cases where the presence of at least two features was considered diagnostic of PHM. While cytogenetic analysis is arguably the gold standard for diagnosis, this study demonstrates that histological assessment permits accurate distinction of PHM and trisomic gestations in the great majority of cases.
Publisher: Informa UK Limited
Date: 12-2019
DOI: 10.2147/CIA.S211424
Publisher: Elsevier BV
Date: 09-2019
Publisher: Wiley
Date: 30-11-2022
DOI: 10.1002/PDS.5567
Abstract: Pharmaceutical claims data are often used as the primary information source to define medicine exposure periods in pharmacoepidemiological studies. However, often critical information on directions for use and the intended duration of medicine supply are not available. In the absence of this information, alternative approaches are needed to support the assignment of exposure periods. This study summarises the key methods commonly used to estimate medicine exposure periods and dose from pharmaceutical claims data and describes a method using in idualised dispensing patterns to define time‐dependent estimates of medicine exposure and dose. This method extends on important features of existing methods and also accounts for recent changes in an in idual's medicine use. Specifically, this method constructs medicine exposure periods and estimates the dose used by considering characteristics from an in idual's prior dispensings, accounting for the time between prior dispensings and the amount supplied at prior dispensings. Guidance on the practical applications of this method is also provided. Although developed primarily for application to databases, which do not contain duration of supply or dose information, use of this method may also facilitate investigations when such information is available and there is a need to consider in idualised and/or changing dosing regimens. By shifting the reliance on prescribed duration and dose to determine exposure and dose estimates, in idualised dispensing information is used to estimate patterns of exposure and dose for an in idual. Reflecting real‐world in idualised use of medicines with complex and variable dosing regimens, this method offers a pragmatic approach that can be applied to all medicine classes.
Publisher: BMJ
Date: 02-2016
Publisher: Springer Science and Business Media LLC
Date: 19-03-2019
DOI: 10.1007/S11325-018-1653-3
Abstract: To determine the effect of temazepam on assessment of the severity of obstructive sleep apnea (OSA) by polysomnography (PSG). Analysis of diagnostic laboratory-PSG studies was performed in OSA patients who were administered temazepam (10 mg) to facilitate sleep ("temazepam group", n = 73) and in OSA patients (matched for age, gender, body mass index and study date) in whom temazepam was not administered ("control group", n = 73). Sleep- and respiratory-related variables were compared between the groups for the (i) first 3 h of study following temazepam in the temazepam group (when peak blood concentration is expected) or following lights out in the control group, and (ii) entire study duration. Within the first 3 h, no differences in sleep-related variables were observed between the groups. Over the entire study duration, the temazepam group had a reduced total sleep time compared to the control group, likely due to the overnight sleep difficulties that led to its use. Whether measured during the first 3 h of study or over the entire study duration, no significant differences were detected between the groups for any respiratory-related variable, including apnea hypopnea index, arousal index, oxygen desaturation, apnea index, hypopnea index, and event duration. When patients were considered in terms of OSA severity, decreased arousal index was noted in the temazepam group over the entire study duration, but only in those with severe OSA. Oral administration of 10 mg of temazepam during the course of PSG does not systematically affect assessment of the severity of OSA by PSG.
Publisher: Wiley
Date: 02-06-2019
DOI: 10.1111/ADD.14599
Publisher: Elsevier BV
Date: 02-2021
Publisher: Socidrogalcohol
Date: 20-12-2018
Abstract: To examine the potential impact of prevalence of alcohol use in a birth-sex cohort on subsequent initiation and progression of alcohol use in the PEGASUS-Murcia project, a cross-sectional survey of a representative s le of non-institutionalized adults in Murcia (Spain). Data on lifetime history of alcohol use, DSM-IV use disorders, and remission were collected from 1,459 adults using face-to-face interviewers based on the Composite International Diagnostic Interview (CIDI 3.0). Life-table estimates based on survival functions for alcohol use age-of-onset and remission were used as time-varying predictors of subsequent in idual-level alcohol use in discrete-time survival models. Nearly nine out of ten adults had a lifetime alcohol use history at time of interview. Of these lifetime users, 84.3% became regular users (>12 drinks a year) and 5.5-1.6% went on to meet criteria for DSM-IV alcohol abuse or dependence, respectively. By the age of 18, 70.9% of respondents had used alcohol, and one half (50.2%) had used regularly. Regular use sharply increased during early adulthood to reach 90.8% by age 22. Birth-sex cohort alcohol use was significantly and positively associated with increased odds of all subsequent transitions examined except for the transition from use to abuse. The findings highlight sensitive periods with rapid transitions to higher levels of alcohol use and emphasize the importance of cohort experiences in the full spectrum of stages of alcohol use. These results may contribute to predicting population-levels trends in alcohol-related problems in Spain.
Publisher: Walter de Gruyter GmbH
Date: 22-03-2019
Abstract: The painDETECT questionnaire (PD-Q) has been widely used as a screening tool for the identification of neuropathic pain (NeP) as well as a tool for the characterization of patients’ pain profile. In contrast to other NeP screening tools, the PD-Q is the only screening tool with weighted sensory descriptors. It is possible that responses to the PD-Q sensory descriptors are influenced by psychological factors, such as catastrophizing or anxiety, which potentially might contribute to an overall higher score of PD-Q and a false positive identification of NeP. This study aimed to explore (i) the relationship between psychological factors (catastrophizing, anxiety, depression and stress) and the total PD-Q score and (ii) if psychological factors are associated with false positive identifications of NeP on the PD-Q compared to clinically diagnosed NeP. The study was a retrospective review of 1,101 patients attending an outpatient pain centre. Patients were asked to complete the PD-Q, the Pain Catastrophizing Scale (PCS), the Depression, Anxiety and Stress Scale (DASS) and the Brief Pain Inventory (BPI). For patients who were identified by PD-Q as having NeP, their medical records were reviewed to establish if they had a clinical diagnosis of NeP. Accounting for missing data, complete datasets of 652 patients (mean age 51 (SD14) years, range 18–88 57% females) were available for analysis. Based on PD-Q scoring, NeP was likely present in 285 (44%) patients. Depression, anxiety, stress, catastrophizing, BPI pain and BPI interference were all significantly related to each other ( p 0.0001) and patients displaying these traits were significantly more likely to have a positive PD-Q score ( p 0.0001). For patients classified by PD-Q as having NeP, only 50% of patients had a clinical diagnosis of NeP. Anxiety was significantly associated with a false positive classification of NeP on PD-Q ( p = 0.0036). Our retrospective study showed that psychological factors including catastrophizing, depression, anxiety, and stress were all influential in producing a higher score on the PD-Q. We observed a high rate of false positive NeP classification which was associated with the presence of anxiety. Clinicians and researchers should be aware that a patient’s psychological state may influence the responses to PD-Q and consequently the final PD-Q score and its NeP classification.
Publisher: Elsevier BV
Date: 09-2016
DOI: 10.1016/J.JSE.2016.01.025
Abstract: Reverse total shoulder arthroplasty (RTSA) is increasingly being performed. Many patients may wish to return to high levels of sporting activity. This study aimed to evaluate the correlation of isokinetic shoulder strength with level of participation in sport and recreation after RTSA. We surveyed 51 patients at a mean of 29.5 months (range, 12-60 months) after surgery. Mean age was 74.1 years. Patient-reported sporting activity was classified as low, medium, or high demand. All patients completed the shortened Disabilities of the Arm, Shoulder, and Hand questionnaire and the Oxford Shoulder Score and underwent Biodex dynamometer testing of the RTSA evaluating isokinetic shoulder strength in flexion and extension, abduction and adduction, and internal and external rotation. Reported sporting activity was high demand in 35% and moderate demand in 43%. There was a large variation in shoulder isokinetic strength parameters especially for internal and external rotation. With the exception of abduction, a significant correlation was noted between strength and the level of sports participation that patients reported (P < .03). A significant correlation was also noted between strength and patient-reported outcome measures for internal rotation and arm flexion and abduction (P < .05). Most patients reported returning to moderate- or high-level sporting activity in the short term after RTSA. Isokinetic shoulder strength, especially in internal rotation and arm flexion, positively correlates with both patient-reported level of participation in sports and recreation and daily function.
Publisher: Elsevier BV
Date: 11-2021
DOI: 10.1016/J.DRUGALCDEP.2021.109091
Abstract: Longer retention in opioid agonist treatment (OAT) is associated with improved treatment outcomes but 12-month retention rates are often low. Innovative approaches are needed to strengthen retention in OAT. We develop and compare traditional and deep learning-extensions of Cox regression to examine the potential for predicting time in OAT at in iduals' first episode entry. Retrospective cohort study in New South Wales, Australia including 16,576 people entering OAT for the first time between January 2006 and December 2017. We develop 12-month OAT cessation prediction models using traditional and deep learning-extensions of the Cox regression algorithm with predictors evaluated from linked administrative datasets. Proportion of explained variation, calibration, and discrimination are compared using 5 × 2 cross-validation. Twelve-month cessation rate was 58.4%. The largest hazard ratios for earlier cessation from the deep learning model were observed for treatment factors, including private dosing points (HR=1.54, 95% CI=1.49-1.60) and buprenorphine medication (HR=1.43, 95% CI=1.39-1.46). Diagnostic codes for homelessness (HR=1.09, 95% CI=1.04-1.13), outpatient treatment for drug use disorders (HR=1.10, 95% CI=1.06-1.15), and occupant of vehicle accident (HR=1.04, 95% CI=1.01-1.07) from past-year health service presentations were identified as significant predictors of retention. We observed no improvement in performance of the deep learning model over traditional Cox regression. Deep learning may be more useful in identifying novel risk factors of OAT retention from administrative data than evaluating in idual-level risk. An increased focus on addressing structural issues at the population level and considering alternate models of care may be more effective at improving retention than delivering fully personalised OAT.
Publisher: Elsevier BV
Date: 07-2019
Publisher: Informa UK Limited
Date: 04-04-2017
Publisher: Oxford University Press (OUP)
Date: 27-09-2018
Publisher: Wiley
Date: 05-03-2018
DOI: 10.1111/DAR.12679
Publisher: South African Medical Association NPC
Date: 13-12-2018
Publisher: SAGE Publications
Date: 26-11-2017
Abstract: Cox proportional hazards modelling is a widely used technique for determining relationships between observed data and the risk of asset failure when model performance is satisfactory. Cox proportional hazards models possess good explanatory power and are used by asset managers to gain insight into factors influencing asset life. However, validation of Cox proportional hazards models is not straightforward and is seldom considered in the maintenance literature. A comprehensive validation process is a necessary foundation to build trust in the failure models that underpin remaining useful life prediction. This article describes data splitting, model discrimination, misspecification and fit methods necessary to build trust in the ability of a Cox proportional hazards model to predict failures on out-of-s le assets. Specifically, we consider (1) Prognostic Index comparison for training and test sets, (2) Kaplan–Meier curves for different risk bands, (3) hazard ratios across different risk bands and (4) calibration of predictions using cross-validation. A Cox proportional hazards model on an industry data set of water pipe assets is used for illustrative purposes. Furthermore, because we are dealing with a non-statistical managerial audience, we demonstrate how graphical techniques, such as forest plots and nomograms, can be used to present prediction results in an easy to interpret way.
Publisher: Wiley
Date: 12-05-2021
DOI: 10.1111/ADD.15514
Abstract: There is limited evidence on the relationship between retention in opioid agonist treatment for opioid dependence and characteristics of treatment prescribers. This study estimated retention in buprenorphine and methadone treatment and its relationship with person, treatment and prescriber characteristics. Retrospective longitudinal study. New South Wales, Australia. People entering the opioid agonist treatment programme for the first time between August 2001 and December 2015. Time in opioid agonist treatment (primary outcome) was modelled using a generalized estimating equation model to estimate associations with person, treatment and prescriber characteristics. The impact of medication type on opioid agonist treatment retention reduced over time the risk of leaving treatment when on buprenorphine compared with methadone was higher among those who entered treatment earlier [e.g. 2001–03: odds ratio (OR) = 1.59, 95% confidence interval (CI) = 1.45–1.75] and lowest among those who entered most recently (2013–15: OR = 1.23, 95% CI = 1.11–1.36). In adjusted analyses, risk of leaving was reduced among people whose prescriber had longer tenure of prescribing (e.g. 3 versus 8 years: OR = 0.94, 95% CI = 0.93–0.95) compared with prescribers with shorter tenure. Aboriginal and Torres Strait Islander people, being of younger age, past‐year psychosis disorder and having been convicted of more criminal charges in the year prior to treatment entry were associated with increased risk of leaving treatment. In New South Wales, Australia, retention in buprenorphine treatment for opioid dependence, compared with methadone, has improved over time since its introduction in 2001. Opioid agonist treatment retention is affected not only by characteristics of the person and his or her treatment, but also of the prescriber, with those of longer prescribing tenure associated with increased retention of people in opioid agonist treatment.
Publisher: Informa UK Limited
Date: 30-09-2017
Publisher: Wiley
Date: 04-05-2023
DOI: 10.1111/ADD.16200
Abstract: Studies often rely upon self‐report and biological testing methods for measuring illicit drug use, although evidence for their agreement is limited to specific populations and self‐report instruments. We aimed to examine comprehensively the evidence for agreement between self‐reported and biologically measured illicit drug use among all major illicit drug classes, biological indicators, populations and settings. We systematically searched peer‐reviewed databases (Medline, Embase and PsycINFO) and grey literature. Included studies reported 2 × 2 table counts or agreement estimates comparing self‐reported and biologically measured use published up to March 2022. With biological results considered to be the reference standard and use of random‐effect regression models, we evaluated pooled estimates for overall agreement (primary outcome), sensitivity, specificity, false omission rates (proportion reporting no use that test positive) and false discovery rates (proportion reporting use that test negative) by drug class, potential consequences attached to self‐report (i.e. work, legal or treatment impacts) and time‐frame of use. Heterogeneity was assessed by inspecting forest plots. From 7924 studies, we extracted data from 207 eligible studies. Overall agreement ranged from good to excellent ( 0.79). False omission rates were generally low, while false discovery rates varied by setting. Specificity was generally high but sensitivity varied by drug, s le type and setting. Self‐report in clinical trials and situations of no consequences was generally reliable. For urine, recent (i.e. past 1–4 days) self‐report produced lower sensitivity and false discovery rates than past month. Agreement was higher in studies that informed participants biological testing would occur (diagnostic odds ratio = 2.91, 95% confidence interval = 1.25–6.78). The main source of bias was biological assessments (51% studies). While there are limitations associated with self‐report and biological testing to measure illicit drug use, overall agreement between the two methods is high, suggesting both provide good measures of illicit drug use. Recommended methods of biological testing are more likely to provide reliable measures of recent use if there are problems with self‐disclosure.
Publisher: Wiley
Date: 07-05-2022
DOI: 10.1002/WPS.20971
Abstract: Patient‐reported helpfulness of treatment is an important indicator of quality in patient‐centered care. We examined its pathways and predictors among respondents to household surveys who reported ever receiving treatment for major depression, generalized anxiety disorder, social phobia, specific phobia, post‐traumatic stress disorder, bipolar disorder, or alcohol use disorder. Data came from 30 community epidemiological surveys – 17 in high‐income countries (HICs) and 13 in low‐ and middle‐income countries (LMICs) – carried out as part of the World Health Organization (WHO)’s World Mental Health (WMH) Surveys. Respondents were asked whether treatment of each disorder was ever helpful and, if so, the number of professionals seen before receiving helpful treatment. Across all surveys and diagnostic categories, 26.1% of patients (N=10,035) reported being helped by the very first professional they saw. Persisting to a second professional after a first unhelpful treatment brought the cumulative probability of receiving helpful treatment to 51.2%. If patients persisted with up through eight professionals, the cumulative probability rose to 90.6%. However, only an estimated 22.8% of patients would have persisted in seeing these many professionals after repeatedly receiving treatments they considered not helpful. Although the proportion of in iduals with disorders who sought treatment was higher and they were more persistent in HICs than LMICs, proportional helpfulness among treated cases was no different between HICs and LMICs. A wide range of predictors of perceived treatment helpfulness were found, some of them consistent across diagnostic categories and others unique to specific disorders. These results provide novel information about patient evaluations of treatment across diagnoses and countries varying in income level, and suggest that a critical issue in improving the quality of care for mental disorders should be fostering persistence in professional help‐seeking if earlier treatments are not helpful.
Publisher: Walter de Gruyter GmbH
Date: 2020
Abstract: The aim of the present study was to investigate the long-term efficacy of rapid maxillary expansion (RME) and facemask (FM) therapy in the treatment of Class III malocclusions by comparing Class III subjects treated by RME/FM mechanics with untreated Class III controls at the Western Australian public dental hospital. The lateral cephalograms of 42 (26 males, 16 females) Class III patients treated by RME/FM therapy were analysed and compared with a control s le comprised of 23 (14 males, 9 females) untreated Class III patients. Evaluations were carried out prior to facemask therapy and at a long-term follow-up period of approximately eight to nine years post-treatment. Statistical comparisons were performed using t -tests for unpaired data. At long-term follow-up, there were no statistically significant differences between the treated and control groups except in overjet, which was greater in the treated group ( p 0.05). These results suggest that the short-term effects on the maxilla in RME/FM therapy are not maintained in the long term. Success in treatment is largely dependent on the patient’s skeletal growth pattern.
Publisher: Elsevier BV
Date: 11-2022
DOI: 10.1016/J.DRUGALCDEP.2022.109574
Abstract: Exposure to traumatic events (TEs) is associated with substance use disorders (SUDs). However, most studies focus on a single TE, and are limited to single countries, rather than across countries with variation in economic, social and cultural characteristics. We used cross-national data to examine associations of erse TEs with SUD onset, and variation in associations over time. Data come from World Mental Health surveys across 22 countries. Adults (n = 65,165) retrospectively reported exposure to 29 TEs in six categories: "exposure to organised violence" "participation in organised violence" "interpersonal violence" "sexual-relationship violence" "other life-threatening events" and those involving loved ones ("network traumas"). Discrete-time survival analyses were used to examine associations with subsequent first SUD onset. Most (71.0%) reported experiencing at least one TE, with network traumas (38.8%) most common and exposure to organised violence (9.5%) least. One in five (20.3%) had been exposed to sexual-relationship violence and 26.6% to interpersonal violence. Among the TE exposed, lifetime SUD prevalence was 14.5% compared to 5.1% with no trauma exposure. Most TE categories (except organised violence) were associated with increased odds of SUD. Increased odds of SUD were also found following interpersonal violence exposure across all age ranges (ORs from 1.56 to 1.78), and sexual-relationship violence exposure during adulthood (ORs from 1.33 to 1.44), with associations persisting even after >11 years. Sexual and interpersonal violence have the most consistent associations with progression to SUD increased risk remains for many years post-exposure. These need to be considered when working with people exposed to such traumas.
Publisher: Elsevier BV
Date: 12-2021
DOI: 10.1016/J.DRUGALCDEP.2021.109158
Abstract: We examined prevalence and factors associated with receiving perceived helpful alcohol use disorder (AUD) treatment, and persistence in help-seeking after earlier unhelpful treatment. Data came from 27 community epidemiologic surveys of adults in 24 countries using the World Health Organization World Mental Health surveys (n = 93,843). Participants with a lifetime history of treated AUD were asked if they ever received helpful AUD treatment, and how many professionals they had talked to up to and including the first time they received helpful treatment (or how many ever, if they had not received helpful treatment). 11.8% of respondents with lifetime AUD reported ever obtaining treatment (n = 9378) of these, 44% reported that treatment was helpful. The probability of obtaining helpful treatment from the first professional seen was 21.8% the conditional probability of subsequent professionals being helpful after earlier unhelpful treatment tended to decrease as more professionals were seen. The cumulative probability of receiving helpful treatment at least once increased from 21.8% after the first professional to 79.7% after the seventh professional seen, following earlier unhelpful treatment. However, the cumulative probability of persisting with up to seven professionals in the face of prior treatments being unhelpful was only 13.2%. Fewer than half of people with AUDs who sought treatment found treatment helpful the most important factor was persistence in seeking further treatment if a previous professional had not helped. Future research should examine how to increase the likelihood that AUD treatment is found to be helpful on any given contact.
Publisher: Wiley
Date: 31-01-2023
DOI: 10.1111/ADD.16122
Abstract: Likelihood of alcohol dependence (AD) is increased among people who transition to greater levels of alcohol involvement at a younger age. Indicated interventions delivered early may be effective in reducing risk, but could be costly. One way to increase cost‐effectiveness would be to develop a prediction model that targeted interventions to the subset of youth with early alcohol use who are at highest risk of subsequent AD. A prediction model was developed for DSM‐IV AD onset by age 25 years using an ensemble machine‐learning algorithm known as ‘Super Learner’. Shapley additive explanations (SHAP) assessed variable importance. Respondents reporting early onset of regular alcohol use (i.e. by 17 years of age) who were aged 25 years or older at interview from 14 representative community surveys conducted in 13 countries as part of WHO's World Mental Health Surveys. The primary outcome to be predicted was onset of life‐time DSM‐IV AD by age 25 as measured using the Composite International Diagnostic Interview, a fully structured diagnostic interview. AD prevalence by age 25 was 5.1% among the 10 687 in iduals who reported drinking alcohol regularly by age 17. The prediction model achieved an external area under the curve [0.78 95% confidence interval (CI) = 0.74–0.81] higher than any in idual candidate risk model (0.73–0.77) and an area under the precision‐recall curve of 0.22. Overall calibration was good [integrated calibration index (ICI) = 1.05%] however, miscalibration was observed at the extreme ends of the distribution of predicted probabilities. Interventions provided to the 20% of people with highest risk would identify 49% of AD cases and require treating four people without AD to reach one with AD. Important predictors of increased risk included younger onset of alcohol use, males, higher cohort alcohol use and more mental disorders. A risk algorithm can be created using data collected at the onset of regular alcohol use to target youth at highest risk of alcohol dependence by early adulthood. Important considerations remain for advancing the development and practical implementation of such models.
Publisher: Wiley
Date: 18-04-2021
DOI: 10.1002/PPUL.25398
Abstract: Transfer from pediatric to adult services could lead to clinical deterioration, few studies have examined this. We sought to examine the clinical impact of a structured in idualized transition and transfer process in patients with cystic fibrosis (CF). Medical records of all patients with CF in Western Australia who transferred from a pediatric center (Princess Margaret Hospital for Children) to an adult CF center (Sir Charles Gairdner Hospital) between 2008 and 2012 were reviewed. Data were extracted for 2 years before and after transfer. The number of CF outpatient visits, inpatient days, and home intravenous antibiotic therapy (HIVT) days were recorded at yearly intervals before and after transfer. Sputum culture results at transfer were collected. All respiratory function and anthropometric data over the 4 years were extracted. Forty‐two patients with CF were transferred between 2008 and 2012. The mean age at transfer was 18.9 years (range 17–22). Compared to 1‐year pre‐transfer, the frequency of outpatient visits at 1‐ and 2‐year post‐transfer increased. After transfer, there was no change in BMI, HIVT days, or inpatient days, and no acceleration in the expected decline in FEV1. This study found that transfer from a pediatric to an adult CF center using a structured, in idualized transition and transfer process was not associated with accelerated clinical deterioration.
Publisher: SAGE Publications
Date: 05-2019
Abstract: We compared the cost of continuous renal replacement therapy (CRRT) in critically ill patients using two different anticoagulation strategies: regional citrate and low-dose systemic heparin in a single-centre, prospective observational study in an adult Australian tertiary intensive care unit (ICU). All patients receiving CRRT between October 2015 and May 2016 were included in the study. Costs were modelled using the number of filter sets, number of dialysis bags, amount of citrate, heparin and calcium replacement required, and cost of monitoring the anticoagulation. The primary outcome was cost associated with CRRT per patient per day. The secondary outcome was efficacy of CRRT. In total, 66 patients were commenced on dialysis that required anticoagulation. Twenty-four patients were commenced on regional citrate anticoagulation and 42 patients commenced on systemic low-dose heparin anticoagulation. Median filter life, though not statistically significant, was longer in the citrate group by 7.7 hours ( P=0.152), however the median cost of anticoagulation was AUD$317.91 higher in the citrate than the heparin group per patient per day ( P=0.0020). While regional citrate anticoagulation may prolong filter life, it is also more expensive than low-dose systemic heparin. Choice of anticoagulation in CRRT should include cost as one of the variables that clinicians consider.
Publisher: Elsevier BV
Date: 05-2016
DOI: 10.1016/J.AUCC.2016.07.003
Abstract: To provide a snapshot of the prevalence of abnormal body mass index (BMI) in a s le of intensive care unit (ICU) patients to identify if any medical specialty was associated with abnormal BMI and to explore associations between BMI and ICU-related outcomes. Obesity is an escalating public health issue across developed nations but there is little data pertaining to critically ill patients who require care that is expensive. Retrospective observational audit of 735 adult patients (median age 58 years) admitted to the Sir Charles Gairdner Hospital 23 bed tertiary ICU between November 2012 and June 2014. Primary outcome measure was patient BMI: underweight (<18.5kg/m Compared to the general population there was a higher proportion of obese patients within the cohort with the majority of patients overweight (33.9%) or obese (36.5%) and median BMI of 27.9 (IQR 7.9). There were no significant differences between specialties for BMI (p=0.103) and abnormal BMI was not found to impact negatively on mortality (ICU, p=0.373 hospital, p=0.330). Normal BMI patients had shorter length of MV than other BMI categories and the impact of BMI on ICU LOS was dependent on length of MV. Overweight patients ventilated for five days or more had a shorter LOS, and extremely obese non-ventilated patients had a longer LOS, compared to normal weight patients. Although the obesity-disease relationship is increasingly complex and data presented reflects categorical BMI for patients admitted to a single ICU site it may be important to consider the cost implications of caring for this cohort especially with regard to MV and LOS.
Publisher: Wiley
Date: 20-12-2017
DOI: 10.1002/JMRS.202
Publisher: American Medical Association (AMA)
Date: 09-2021
DOI: 10.1001/JAMAPSYCHIATRY.2021.0976
Abstract: Mortality among people with opioid dependence is higher than that of the general population. Opioid agonist treatment (OAT) is an effective treatment for opioid dependence however, there has not yet been a systematic review on the relationship between OAT and specific causes of mortality. To estimate the association of time receiving OAT with mortality. The Embase, MEDLINE, and PsycINFO databases were searched through February 18, 2020, including clinical trial registries and previous Cochrane reviews. All observational studies that collected data on all-cause or cause-specific mortality among people with opioid dependence while receiving and not receiving OAT were included. Randomized clinical trials (RCTs) were also included. This systematic review and meta-analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Data on study, participant, and treatment characteristics were extracted person-years, all-cause mortality, and cause-specific mortality were calculated. Crude mortality rates and rate ratios (RRs) were pooled using random-effects meta-analyses. Overall all-cause and cause-specific mortality both by setting and by participant characteristics. Methadone and buprenorphine OAT were evaluated specifically. Fifteen RCTs including 3852 participants and 36 primary cohort studies including 749 634 participants were analyzed. Among the cohort studies, the rate of all-cause mortality during OAT was more than half of the rate seen during time out of OAT (RR, 0.47 95% CI, 0.42-0.53). This association was consistent regardless of patient sex, age, geographic location, HIV status, and hepatitis C virus status and whether drugs were taken through injection. Associations were not different for methadone (RR, 0.47 95% CI, 0.41-0.54) vs buprenorphine (RR, 0.34 95% CI, 0.26-0.45). There was lower risk of suicide (RR, 0.48 95% CI, 0.37-0.61), cancer (RR, 0.72 95% CI, 0.54-0.98), drug-related (RR, 0.41 95% CI, 0.33-0.52), alcohol-related (RR, 0.59 95% CI, 0.49-0.72), and cardiovascular-related (RR, 0.69 95% CI, 0.60-0.79) mortality during OAT. In the first 4 weeks of methadone treatment, rates of all-cause mortality and drug-related poisoning were more than double the rates during the remainder of OAT (RR, 2.81 95% CI, 1.55-5.09) but not for buprenorphine (RR, 0.58 95% CI, 0.18-1.85). All-cause mortality was 6 times higher in the 4 weeks after OAT cessation (RR, 6.01 95% CI, 4.32-8.36), remaining double the rate for the remainder of time not receiving OAT (RR, 1.81 95% CI, 1.50-2.18). Opioid agonist treatment was associated with a lower risk of mortality during incarceration (RR, 0.06 95% CI, 0.01-0.46) and after release from incarceration (RR, 0.09 95% CI, 0.02-0.56). This systematic review and meta-analysis found that OAT was associated with lower rates of mortality. However, access to OAT remains limited, and coverage of OAT remains low. Work to improve access globally may have important population-level benefits.
Publisher: Wiley
Date: 08-03-2017
DOI: 10.1002/JMRS.205
Publisher: Research Square Platform LLC
Date: 13-04-2022
DOI: 10.21203/RS.3.RS-1534962/V1
Abstract: Background: Major Depressive Disorder (MDD) contributes to a significant proportion of disease burden, disability, economic losses, and impact on need of treatment and health care in Brazil, but systematic information about its treatment coverage is scarce. This paper aims to estimate the gap in treatment coverage for MDD and identify key bottlenecks in obtaining adequate treatment among adult residents in the São Paulo Metropolitan area, Brazil. Methods: A representative face-to-face household survey was conducted among 2,942 respondents aged 18+ years to assess 12-month MDD, characteristics of 12-month treatment received, and bottlenecks to deliver care through the World Mental Health Composite International Diagnostic Interview. Results: Among those with MDD (n=491), 164 (33.3% [SE, 1.9]) were seen in health services, with an overall 66.7% treatment gap, and only 25.2% [SE, 4.2] received effective treatment coverage, which represents 8.5% of those in need, with a 91.5% gap in adequate care (66.4% due to lack of utilization and 25.1% due to inadequate quality and adherence). Critical service bottlenecks identified were: use of psychotropic medication (12.2 percentage points drop), use of antidepressants (6.5), adequate medication control (6.8), receiving psychotherapy (19.8). Conclusions: This is the first study demonstrating the huge treatment gaps for MDD in Brazil, considering not only overall coverage, but also identifying specific quality- and user-adjusted bottlenecks in delivering pharmacological and psychotherapeutic care. These results call for urgent combined actions focused in reducing effective treatment gaps within services utilization, as well as in reducing gaps in availability and accessibility of services, and acceptability of care for those in need.
Publisher: Frontiers Media SA
Date: 16-06-2020
Publisher: Elsevier BV
Date: 06-2021
Location: Australia
No related grants have been discovered for Chrianna I Bharat.