ORCID Profile
0000-0001-7764-4363
Current Organisations
University of Queensland
,
Royal Brisbane and Women's Hospital
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Publisher: Wiley
Date: 05-10-2018
DOI: 10.1111/ANS.14192
Abstract: Infusional 5-fluorouracil (5-FU) has been the standard radiation sensitizer in patients undergoing preoperative long-course chemoradiotherapy (CRT) for locally advanced rectal cancer in Australia. Capecitabine (Xeloda) is an oral 5-FU prodrug of comparable pharmacodynamic activity, currently preferred in place of 5-FU infusion, its established counterpart in neoadjuvant CRT for rectal cancer. The few studies quantifying pathological complete response (pCR) of Xeloda versus 5-FU have produced inconsistent results. We reviewed our own data to determine if the rates of pCR of oral capecitabine were non-inferior to intravenous 5-FU in patients undergoing neoadjuvant CRT for rectal cancer. A retrospective study was performed from a prospectively kept database. Four hundred and fifty-two patients received preoperative CRT from January 2006 to January 2016. Pelvic radiotherapy was delivered concurrently with capecitabine (n = 42) or infusional 5-FU (n = 341). The remaining received different chemotherapy regimens. Surgery was performed 6-12 weeks of CRT completion. Pathological responses were assessed using Dworak regression grading score (0-4). Clinical outcomes were evaluated in terms of local control and recurrence-free survival. The proportion of patients who had a tumour regression score of 4 (pCR) after CRT was 4/42 (9.5%) in the capecitabine group and 71/341 (20%) in the infusional 5-FU group (P = 0.082). pCR was an independent predictor for survival in this group of patients (hazard ratio: 0.002, P = 0.0001, 95% confidence interval: 0.0001-0.027). The use of capecitabine as neoadjuvant chemotherapy in patients with rectal cancer was associated with a reduced rate of pCR. However this difference did not achieve statistical significance.
Publisher: Elsevier BV
Date: 04-2017
DOI: 10.1016/J.JNS.2017.01.050
Abstract: To evaluate a modified extended Timed Up and Go (extended-TUG) assessment against a panel of validated clinical assessments, as an indicator of Parkinson's disease (PD) severity and cognitive impairment. Eighty-seven participants with idiopathic PD were sequentially recruited from a Movement Disorders Clinic. An extended-TUG assessment was employed which required participants to stand from a seated position, walk in a straight line for 7m, turn 180° and then return to the start, in a seated position. The extended-TUG assessment duration was correlated to a panel of clinical assessments, including the Unified Parkinson's Disease Rating Scale (MDS-UPDRS), Quality of Life (PDQ-39), Scales for Outcomes in Parkinson's Disease (SCOPA-Cog), revised Addenbrooke's Cognitive Index (ACE-R) and Barratt's Impulsivity Scale 11 (BIS-11). Extended-TUG time was significantly correlated to MDS-UPDRS III score and to SCOPA-Cog, ACE-R (p<0.001) and PDQ-39 scores (p<0.01). Generalized linear models determined the extended-TUG to be a sole variable in predicting ACE-R or SCOPA-Cog scores. Patients in the fastest extended-TUG tertile were predicted to perform 8.3 and 13.4 points better in the SCOPA-Cog and ACE-R assessments, respectively, than the slowest group. Patients who exceeded the dementia cut-off scores with these instruments exhibited significantly longer extended-TUG times. Extended-TUG performance appears to be a useful indicator of cognition as well as motor function and quality of life in PD, and warrants further evaluation as a first line assessment tool to monitor disease severity and response to treatment. Poor extended-TUG performance may identify patients without overt cognitive impairment form whom cognitive assessment is needed.
Publisher: Research Square Platform LLC
Date: 31-10-2022
DOI: 10.21203/RS.3.RS-2209418/V1
Abstract: Background The human gastrointestinal tract harbours a complex multi-kingdom community known as the microb\\iome. Dysbiosis refers to its disruption and is reportedly extreme in acute critical illness, yet its clinical implications are unresolved. The review systematically evaluates the relationship between gut dysbiosis and clinical outcomes of patients early in critical illness. Methods Following PRISMA guidelines, a prospectively registered search was undertaken of MEDLINE and Cochrane databases for observational studies undertaking metagenomic sequencing of the lower gastrointestinal tract of critically ill adults and children within 72hours of admission. Eligible studies reported an alpha ersity metric and one or more of the primary outcome, all cause mortality, or secondary clinical outcomes. After aggregate data was requested, meta-analysis was performed for 4 studies with mortality stratified to high or low Shannon index. Results The search identified 26 studies for systematic review and 4 had suitable data for meta-analysis. No effect of alpha ersity was seen on mortality after binary transformation of Shannon index (odds ratio 0.52, CI 0.12–4.98, I 2 = 0.64) however certainty of evidence is low. Pathogen dominance and commensal depletion were each more frequently associated with mortality, adverse clinical and ecological sequalae, particularly overabundance of Enterococcus . Conclusions There is a paucity of large, rigorous observational studies in this population. Globally, alpha ersity was dynamically reduced in early ICU admission and was not associated with in-hospital mortality. The abundance of taxa such as Enterococcus spp. appear to offer greater predictive capacity for important clinical and ecological outcomes.
Publisher: Sciedu Press
Date: 12-01-2016
Publisher: Springer Science and Business Media LLC
Date: 03-02-2023
DOI: 10.1186/S40635-022-00486-Z
Abstract: The human gastrointestinal tract harbours a complex multi-kingdom community known as the microbiome. Dysbiosis refers to its disruption and is reportedly extreme in acute critical illness yet its clinical implications are unresolved. The review systematically evaluates the association between gut dysbiosis and clinical outcomes of patients early in critical illness. Following PRISMA guidelines, a prospectively registered search was undertaken of MEDLINE and Cochrane databases for observational studies undertaking metagenomic sequencing of the lower gastrointestinal tract of critically ill adults and children within 72 h of admission. Eligible studies reported an alpha ersity metric and one or more of the primary outcome, in-hospital mortality, or secondary clinical outcomes. After aggregate data were requested, meta-analysis was performed for four studies with in-hospital mortality stratified to high or low Shannon index. The search identified 26 studies for systematic review and 4 had suitable data for meta-analysis. No effect of alpha ersity was seen on in-hospital mortality after binary transformation of Shannon index (odds ratio 0.52, CI 0.12–4.98, I 2 = 0.64) however certainty of evidence is low. Pathogen dominance and commensal depletion were each more frequently associated with in-hospital mortality, adverse clinical and ecological sequelae, particularly overabundance of Enterococcus . There is a paucity of large, rigorous observational studies in this population. Globally, alpha ersity was dynamically reduced in early ICU admission in adults and children and was not associated with in-hospital mortality. The abundance of taxa such as Enterococcus spp. appears to offer greater predictive capacity for important clinical and ecological outcomes.
Publisher: Elsevier BV
Date: 2019
Publisher: Elsevier BV
Date: 09-2018
Publisher: Wiley
Date: 07-07-2023
DOI: 10.1111/AJO.13555
Abstract: Maternal preference for warm water immersion (WWI) and waterbirth is increasing, but adoption into obstetric guidelines and clinical practice remains limited. Concerns regarding safety and a paucity of evidence have been cited as reasons for the limited adoption and uptake. The aim was to investigate maternal and neonatal outcomes after WWI and/or waterbirth compared with land birth. A prospective cohort study was conducted in an Australian public maternity hospital between 2019 and 2020. Maternal and neonatal outcomes for 1665 women who had a vaginal birth were studied. Primary outcome was admission to the neonatal unit (NNU). Secondary outcomes included neonatal antibiotic administration, maternal intrapartum fever, epidural use and perineal injury. Multivariate logistical regression analyses compared the outcomes between three groups: waterbirth, WWI only and land birth. NNU admissions for a suspected infectious condition were significantly higher in the land birth group ( P = 0.035). After accounting for labour duration, epidural use and previous birth mode, no significant difference was detected between groups in the odds of NNU admission ( P = 0.167). No babies were admitted to NNU with water inhalation or drowning. Women birthing on land were more likely to be febrile (2 vs 0% P = 0.007) obstetric anal sphincter injury and postpartum haemorrhage were similar between groups. Regional analgesia use was significantly lower in the WWI group compared to the land birth group (21.02 vs 38.58% P = .001). There was one cord avulsion in the waterbirth group (0.41%). Maternal and neonatal outcomes were similar between groups, with no increased risk evident in the waterbirth and WWI groups.
Publisher: Wiley
Date: 03-03-2023
DOI: 10.1111/AJO.13654
Abstract: Obstructive sleep apnoea (OSA) occurs in 15–20% of pregnant women living with obesity. As global obesity prevalence increases, OSA in pregnancy is concurrently increasing, yet remains under‐diagnosed. The effects of treating OSA in pregnancy are under‐investigated. A systematic review was conducted to determine whether treating pregnant women with OSA using continuous positive airway pressure (CPAP) will improve maternal or fetal outcomes, compared with no treatment or delayed treatment. Original studies in English published until May 2022 were included. Searches were conducted in Medline, PubMed, Scopus, the Cochrane Library and clinicaltrials.org . Maternal and neonatal outcome data were extracted, and quality of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach (PROSPERO registration: CRD42019127754). Seven trials met inclusion criteria. Use of CPAP in pregnancy appears to be well tolerated with reasonable adherence. Use of CPAP in pregnancy may be associated with both a reduction in blood pressure and pre‐ecl sia. Birthweight may be increased by maternal CPAP treatment, and preterm birth may be reduced by treatment with CPAP in pregnancy. Treatment of OSA with CPAP in pregnancy may reduce hypertension and, preterm birth, and may increase neonatal birthweight. However, more rigorous definitive trial evidence is required to adequately assess the indication, efficacy, and applications of CPAP treatment in pregnancy.
Publisher: Hindawi Limited
Date: 10-2019
DOI: 10.1155/2019/2672075
Abstract: Introduction . Patients with Parkinson’s disease (PD) commonly experience cognitive deficits and some also develop impulse control disorders (ICDs) however, the relationship between impulsivity and cognitive dysfunction remains unclear. This study investigated whether trait impulsivity associates with mild cognitive impairment (MCI), or is altered in a PD patient cohort with MCI. Methods . A total of 302 patients with idiopathic PD were recruited sequentially from three Australian Movement Disorder clinics. Based on cognitive scores, participants were ided into two groups, one defined as having mild cognitive impairment (PD-MCI n = 113) and the other with normal cognitive function (PD-C n = 189). Trait impulsivity was evaluated using the Barrett Impulsiveness Scale 11 (BIS-11). Total impulsivity scores, as well as subscale scores, were compared between PD-C and PD-MCI groups. Results . The PD-MCI cohort had significantly lower scores in all cognitive domains, and mirrored expected clinical differences in medication, motor symptoms, and disease duration, when compared to the PD-C cohort. Self-reported impulsivity was not significantly different between groups, nor was there a difference within first-order subscale scores: attention p = 0.137 , cognitive instability p = 0.787 , self-control p = 0.503 , cognitive complexity p = 0.157 , motor impulsivity p = 0.559 , or perseverance p = 0.734 between the PD-MCI and PD-C groups. Conclusions . These findings suggest that impulsive traits and behaviors are independent of changes in cognitive state and are not altered in PD patients with mild cognitive impairment.
Location: Australia
No related grants have been discovered for Tess Evans.