ORCID Profile
0000-0002-8164-8786
Current Organisations
Menzies Centre For Health Policy
,
Concord Repatriation General Hospital
,
University of Sydney Sydney Medical School
,
Sydney Local Health District
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Publications
Virtual Health Care for Community Management of Patients With COVID-19 in Australia: Observational Cohort Study
Publisher: JMIR Publications Inc.
Date: 09-03-2021
DOI: 10.2196/21064
Abstract: Australia has successfully controlled the COVID-19 pandemic. Similar to other high-income countries, Australia has extensively used telehealth services. Virtual health care, including telemedicine in combination with remote patient monitoring, has been implemented in certain settings as part of new models of care that are aimed at managing patients with COVID-19 outside the hospital setting. This study aimed to describe the implementation of and early experience with virtual health care for community management of patients with COVID-19. This observational cohort study was conducted with patients with COVID-19 who availed of a large Australian metropolitan health service with an established virtual health care program capable of monitoring patients remotely. We included patients with COVID-19 who received the health service, could self-isolate safely, did not require immediate admission to an in-patient setting, had no major active comorbid illness, and could be managed at home or at other suitable sites. Skin temperature, pulse rate, and blood oxygen saturation were remotely monitored. The primary outcome measures were care escalation rates, including emergency department presentation, and hospital admission. During March 11-29, 2020, a total of 162 of 173 (93.6%) patients with COVID-19 (median age 38 years, range 11-79 years), who were diagnosed locally, were enrolled in the virtual health care program. For 62 of 162 (38.3%) patients discharged during this period, the median length of stay was 8 (range 1-17) days. The peak of 100 prevalent patients equated to approximately 25 patients per registered nurse per shift. Patients were contacted a median of 16 (range 1-30) times during this period. Video consultations (n=1902, 66.3%) comprised most of the patient contacts, and 132 (81.5%) patients were monitored remotely. Care escalation rates were low, with an ambulance attendance rate of 3% (n=5), emergency department attendance rate of 2.5% (n=4), and hospital admission rate of 1.9% (n=3). No deaths were recorded. Community-based virtual health care is safe for managing most patients with COVID-19 and can be rapidly implemented in an urban Australian setting for pandemic management. Health services implementing virtual health care should anticipate challenges associated with rapid technology deployments and provide adequate support to resolve them, including strategies to support the use of health information technologies among consumers.
Acute interstitial nephritis and nephrogenic diabetes insipidus following treatment with sulfamethoxazole‐trimethoprim and temozolomide
Publisher: Wiley
Date: 05-10-2020
DOI: 10.1111/NEP.13783
Age‐specific risk of renal graft loss from late acute rejection or non‐compliance in the adolescent and young adult period
Publisher: Wiley
Date: 06-2018
DOI: 10.1111/NEP.13067
Abstract: The aims of this study were to identify if an age-specific high-risk window for graft loss is present in Australia and New Zealand and identify the aetiology for such graft loss using the Australia and New Zealand Dialysis and Transplant Registry. Retrospective cohort analysis of all renal transplants were performed in Australia and New Zealand during 1985-2010 in which the graft survived >3 months and the patient spent at least some time aged 10-30 years inclusive while the graft was functioning. Adjusted hazard ratio (aHR) for graft loss according to age, sex, race, cause of end-stage kidney disease, transition, era of transplantation, donor type and human leucocyte antigen mismatch were calculated using an extended Cox proportional hazards model for graft loss from any cause and graft loss from late acute rejection (LAR) or non-compliance. A total of 3289 grafts in 3048 recipients were included. A total of 757 grafts failed including 110 (15 %) from LAR or non-compliance. Age was strongly associated with graft loss from LAR or non-compliance (p < 0.001). Compared with age 10-12 years, the risk of graft loss from LAR or non-compliance was significantly increased from 16-24 years, peaking at 19-21 years (aHR 11.3, 95% confidence interval (CI) 1.5-84.3, p < 0.001). Indigenous race was associated with LAR or non-compliance (aHR 3.5, 95% CI 2.1-5.6) whereas paediatric-to-adult transition with a functioning transplant was not (aHR 1.2, 95% CI 0.4-3.5, p = 0.68). The high risk of graft loss during adolescence and young adulthood is primarily due to LAR or non-compliance. The elevated risk continues well into the 20s and is independent of paediatric-to-adult transition.
Emergence of Interventional Nephrology in the Asia-Pacific Region – A Report from New Zealand
Publisher: Bentham Science Publishers Ltd.
Date: 08-02-2013
DOI: 10.2174/1874303X01306010010
Abstract: Interventional nephrology is relatively a new field dealing with the procedural aspect of dialysis access. The subspecialty has focused on the nephrologist taking a lead role and learning the procedural skills needed to provide timely care to the end stage renal disease patients on dialysis. The subspecialty has been in existence for over a decade in the United States and is well accepted as a main-stream field. The safety and positive outcomes of nephrologists performing these procedures in the United States are being duplicated across the globe. The growing trend of acceptance of this field is evident in the Asia-Pacific region, which is rapidly embracing this new development. The current report from New Zealand is being presented here in this article.
Antimicrobial Stewardship (AMS) During COVID-19: Eyes and Ears on the AMS Team
Publisher: IOS Press
Date: 22-06-2023
DOI: 10.3233/SHTI230370
Abstract: Antimicrobial stewardship (AMS) programs in hospitals comprise coordinated strategies to optimise antimicrobial use. The COVID-19 pandemic had a significant impact on the healthcare system, including AMS. This study aimed to understand the work processes of AMS teams during COVID-19 hospital restrictions and the role technology played in supporting AMS. Observations and interviews were conducted with AMS teams at two hospitals in Sydney, Australia. Participants reported an increase in antimicrobial use, a loss of resources for AMS activities, and reduced in-person interactions. Meetings were performed through videoconferencing, which resulted in greater access to information but led to poorer communication and impacted interdisciplinary relationships. As COVID-19 restrictions recede, AMS program changes should be evaluated to understand the most effective strategies to facilitate evidence-based AMS practices.
End-stage kidney disease in Fiji
Publisher: Wiley
Date: 04-2019
DOI: 10.1111/IMJ.14108
Abstract: Chronic kidney disease is now a leading cause of death in Fiji. The country lacks even basic statistics about the incidence of end-stage kidney disease (ESKD) and presents significant challenges to conducting clinical research. To estimate the incidence and characteristics of ESKD in Fijian adults. A retrospective cohort study was conducted of patients admitted to Colonial War Memorial Hospital in Suva, Fiji, in 2012. Suspected ESKD cases were identified from laboratory registers of renal function tests and confirmed through medical record review. Population data were from the Fijian Bureau of Statistics. Screening identified 1474 suspected ESKD cases. Following removal of 763 duplicates and cases with discrepant identifiers, 711 unique cases remained. An additional 552 cases met exclusion criteria, including acute kidney injury (247), failure to be admitted (131) and pre-existing ESKD diagnosis (103), leaving 159 cases of confirmed ESKD. Median age was 57 years (interquartile range 47-65). Crude and age-adjusted ESKD incidence rates were 753 per million population (pmp) (95% confidence interval (CI) 636-870) and 793 pmp (95% CI 669-916), respectively, rising to 938 pmp (95% CI 804-1072) if African-American correction was removed. Diabetic nephropathy was the most common cause of ESKD (65.4%). The incidence of ESKD in Fiji is high. This is a substantial public health problem that is likely impacting life expectancy and quality of life. Improving screening, detection and management of kidney disease should be given more prominence in programmes to address non-communicable diseases in Fiji and the Western Pacific.
Relapsed ANCA associated vasculitis following Oxford AstraZeneca ChAdOx1‐S COVID ‐19 vaccination: A case series of two patients
Publisher: Wiley
Date: 09-11-2021
DOI: 10.1111/NEP.13993
Tinzaparin for venous thromboembolism in patients with renal impairment - a single-centre, prospective pilot study.
Publisher: Wiley
Date: 05-12-2020
DOI: 10.1111/IMJ.15010
Abstract: Background: Low molecular weight heparins (LMWH) are used extensively for prophylaxis and treatment of venous thromboembolism (VTE), bridging therapy for warfarin and standard of care in cancer‐associated VTE (CA‐VTE). Tinzaparin has the highest molecular weight of all LMWH and relies least on renal clearance to Cockcroft‐Gault creatinine clearance (CrCl) of 20 mL/min. Previous pharmacological studies have demonstrated safety and effectiveness in elderly patients. Prospective clinical trials have confirmed these findings to CrCl 20 mL/min and in CA‐VTE. We describe the pilot program developed at Concord Repatriation General Hospital for tinzaparin. Aims: We aim to confirm the deliverability of tinzaparin in patients with renal insufficiency. Methods: Twenty patients were established on tinzaparin as therapeutic anticoagulation with CrCl or CKD‐EPI estimated glomerular filtration rate (eGFR) 20–50 mL/min with an indication for anticoagulation. Tinzaparin was given as a subcutaneous injection at 175 units/kg as a single daily dose, rounded to the nearest vial size. Tinzaparin anti‐Xa levels were tested at Days 2, 7 and 14 (±1 day) and transition to oral anticoagulants were allowed at clinician discretion. Results: No accumulation of tinzaparin was seen into Day 14. Two patients required dose‐adjustment, five patients had bleeding complications (two major, three minor) and four patients died during follow‐up, all attributable to patients' comorbidities. CrCl and body surface area‐standardised CrCl were significantly correlated with tinzaparin anti‐Xa level only on Day 2, and this effect was lost when patients with CrCl mL/min were excluded. Data from our cohort confirm the deliverability of therapeutic tinzaparin in patients with CrCl or CKD‐EPI eGFR 20–50 mL/min. Bleeding and death outcomes were also comparable to other trials using tinzaparin in CA‐VTE. Conclusion: For patients with renal insufficiency, tinzaparin represents an attractive alternative anticoagulant with once‐daily administration in a range of potential indications.
Incidence, treatment patterns and clinical outcomes associated with acute kidney injury in Fiji: a retrospective cohort study
Publisher: Springer Science and Business Media LLC
Date: 24-04-2023
Nationwide survey of adolescents and young adults with end‐stage kidney disease
Publisher: Wiley
Date: 23-07-2012
DOI: 10.1111/J.1440-1797.2012.01610.X
Abstract: To better understand the health-care needs of adolescents and young adults (AYA) with end-stage kidney disease (ESKD), we sought to describe the demographic characteristics of a national cohort. Data were retrieved from the Australia and New Zealand Dialysis and Transplant Registry. We included all patients aged 15-25 years, living in Australia and receiving renal replacement therapy (RRT) on 31 December 2009. Data included race, aetiology of kidney disease, postal code, transition and migration history. A total of 495 AYA were receiving RRT in Australia giving a prevalence of 143 per million age-related population. Sixty-three per cent had a functioning transplant, 24% were receiving haemodialysis and 13% peritoneal dialysis. Median current age was 22 years (interquartile range (IQR) 19-24). The most prevalent cause of ESKD was glomerulonephritis (33%). The majority of patients lived in capital cities. Indigenous patients were more likely to live in more remote areas. Eighty-five per cent of patients were currently receiving care at an adult unit and 35% of these patients had transitioned from a paediatric unit since starting RRT. The median number of patients per adult unit was 5 (IQR 3-10). The majority of Australian AYA with ESKD are managed in adult units however, the number at any one unit is low. As most live in the capital cities there may be an opportunity to establish centralized services designed to cater for the needs of AYA patients. However, the needs of patients living in more remote areas, including a significant proportion of Indigenous patients, may not be met by such a model.
Extract, transform, load framework for the conversion of health databases to OMOP
Publisher: Public Library of Science (PLoS)
Date: 11-04-2022
DOI: 10.1371/JOURNAL.PONE.0266911
Abstract: Common data models standardize the structures and semantics of health datasets, enabling reproducibility and large-scale studies that leverage the data from multiple locations and settings. The Observational Medical Outcomes Partnership Common Data Model (OMOP CDM) is one of the leading common data models. While there is a strong incentive to convert datasets to OMOP, the conversion is time and resource-intensive, leaving the research community in need of tools for mapping data to OMOP. We propose an extract, transform, load (ETL) framework that is metadata-driven and generic across source datasets. The ETL framework uses a new data manipulation language (DML) that organizes SQL snippets in YAML. Our framework includes a compiler that converts YAML files with mapping logic into an ETL script. Access to the ETL framework is available via a web application, allowing users to upload and edit YAML files via web editor and obtain an ETL SQL script for use in development environments. The structure of the DML maximizes readability, refactoring, and maintainability, while minimizing technical debt and standardizing the writing of ETL operations for mapping to OMOP. Our framework also supports transparency of the mapping process and reuse by different institutions.
A Survey of Current Procedural Practices of Australian and New Zealand Nephrologists
Publisher: Wiley
Date: 05-03-2013
DOI: 10.1111/SDI.12072
Abstract: The aim of this study was to describe the range and extent of current procedural practices of Nephrologists and trainees in Australia and New Zealand with a specific focus on renal biopsy. A web-based survey was constructed based on a 2009 pilot survey conducted by the authors. The survey was distributed by email. A total of 118 responses were received from 60 centers, including six pediatric centers Nephrologists or trainees performed the following procedures: urine microscopy 36.4% diagnostic ultrasound 10.2% renal biopsy 93.2% simple vascath insertion 64.4% cuffed vascath insertion 22% peritoneal catheter insertion 16.9% fistula ultrasound 20.3% and fistulography 5%. Trainees performed most renal biopsies (67.8% of respondents) and real-time ultrasound was the commonest technique (97%). The majority of respondents believe that renal biopsy is an essential skill for trainees (78.8%) 10-25 biopsies are required for trainee proficiency (59.3%) an online training module would assist in teaching renal biopsies (67.8%). Cuffed catheter insertion and fistulography were more often performed in nonmetropolitan than in metropolitan centers. Procedures are part of Australian and New Zealand Nephrology, including specialized procedures in a minority of centers. Vascular access procedures are more common in nonmetropolitan centers. Renal biopsy is an important skill, considered essential for trainees by most.
Angiotensin receptor blockers for the treatment of covid-19: pragmatic, adaptive, multicentre, phase 3, randomised controlled trial
Publisher: BMJ
Date: 16-11-2022
Abstract: To determine whether disrupting the renin angiotensin system with angiotensin receptor blockers will improve clinical outcomes in people with covid-19. CLARITY was a pragmatic, adaptive, multicentre, phase 3, randomised controlled trial. 17 hospital sites in India and Australia. Participants were at least 18 years old, previously untreated with angiotensin receptor blockers, with a laboratory confirmed diagnosis of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection who had been admitted to hospital for management of covid-19. Oral angiotensin receptor blockers (telmisartan in India) or placebo (1:1) for 28 days. The primary endpoint was covid-19 disease severity using a modified World Health Organization Clinical Progression Scale (WHO scale) at day 14. Secondary outcomes were WHO scale scores at day 28, mortality, intensive care unit admission, and respiratory failure. Analyses were evaluated on an ordinal scale in the intention-to-treat population. Between 3 May 2020 and 13 November 2021, 2930 people were screened for eligibility, with 393 randomly assigned to angiotensin receptor blockers (of which 388 (98.7%) to telmisartan 40 mg/day) and 394 to the control group. 787 participants were randomised: 778 (98.9%) from India and nine (1.1%) from Australia. The median WHO scale score at day 14 was 1 (interquartile range 1-1) in 384 participants assigned angiotensin receptor blockers and 1 (1-1) in 382 participants assigned placebo (adjusted odds ratio 1.51 (95% credible interval 1.02 to 2.23), probability of an odds ratio of (Pr(OR )=0.98). WHO scale scores at day 28 showed little evidence of difference between groups (1.02 (0.55 to 1.87), Pr(OR )=0.53). The trial was stopped when a prespecified futility rule was met. In patients admitted to hospital for covid-19, mostly with mild disease, not requiring oxygen, no evidence of benefit, based on disease severity score, was found for treatment with angiotensin receptor blockers, using predominantly 40 mg/day of telmisartan. ClinicalTrials.gov NCT04394117 .
The impact of digital interventions on antimicrobial stewardship in hospitals: A qualitative synthesis of systematic reviews (Preprint)
Publisher: JMIR Publications Inc.
Date: 15-02-2021
Abstract: ntimicrobial stewardship (AMS) programs aim to optimize antimicrobial use by utilizing a suite of coordinated strategies. With the increased use of health information technology in hospitals, AMS processes that were traditionally paper-based are becoming computerized and streamlined. A number of reviews on digital interventions supporting AMS have been performed, so we performed a review of reviews to consolidate findings o provide a systematic overview and synthesis of evidence on the effectiveness of digital interventions to improve antimicrobial prescribing and monitoring in hospitals. atabases: Medline, Embase, Scopus, CINAHL and the Cochrane Database of Systematic Reviews were searched from 2010 onwards. Papers were eligible if they included studies that examined the effectiveness of digital health interventions related to antimicrobial prescribing and monitoring, in an inpatient hospital setting. Papers were excluded if they did not include a clearly defined search strategy, if they were limited to a pediatric setting, or they were not in English. even systematic reviews were included for data extraction. Five reviews were of moderate quality and two of low quality. A large number of digital interventions were evaluated, with a strong focus on clinical decision support. There was a large variability in outcome measures used. Six reviews reported that digital interventions reduced antimicrobial use and improved antimicrobial appropriateness. The impact of digital interventions on clinical outcomes was inconsistent. he results of this review indicate digital interventions, regardless of type, reduce antimicrobial use and improve antimicrobial appropriateness in hospitals. We recommend hospitals consider implementing one or more digital interventions to facilitate AMS programs. >
Educating Junior Doctors to Reduce Requests for Laboratory Investigations: Opportunities and Challenges
Publisher: Springer Science and Business Media LLC
Date: 10-04-2014
PROTEINURIA IN PREECLAMPSIA: FROM BENCH TO BEDSIDE
Publisher: Cambridge University Press (CUP)
Date: 12-01-2010
DOI: 10.1017/S0965539509990167
Abstract: Pre-ecl sia (PE) remains the leading cause of maternal and fetal mortality in the developed world and parts of the developing world. Morbidity and mortality from PE is increased in the developing world compared to the developed world, as availability and access to antenatal care and pathology services are limited.
Virtual health care for community management of patients with COVID-19.
Publisher: Cold Spring Harbor Laboratory
Date: 15-05-2020
DOI: 10.1101/2020.05.11.20082396
Abstract: Objectives: To describe the implementation and early experience of virtual health care for community management of patients with COVID-19. Design: observational cohort study. Setting: large Australian metropolitan health service with established virtual health care program and remote patient monitoring capability. Participants: patients with COVID-19 living within the health service who can self-isolate safely, do not require immediate admission to an inpatient setting, have no major active comorbid illness and can be managed at home or other suitable accommodation. Main outcome measures: care escalation rates, including hospital admission. Results: between 11-29 March 2020, 162/173 (93.6%) locally diagnosed patients with COVID-19 were accepted to the virtual health care program, median age 38y (range 11-79). For the 62 patients discharged during this period the median length of stay was 8 days (range 1-17). The peak of 100 prevalent patients equated to approximately 25 patients per Registered Nurse per shift. Patients were contacted a median of 16 times (range 1-30) during this period, with video consultations used 66.3% of the time 132/162 (81.5%) patients were monitored remotely. Care escalation rates were low: ambulance attendance, 5 (3%) ED attendance, 4 (2.5%) hospital admission, 3 (1.9%). There were no deaths. Conclusions: community-based virtual health care is feasible for managing most patients with COVID-19 and can be rapidly implemented in an urban Australian context for pandemic management. Health services implementing virtual health care should anticipate challenges with rapid technology deployments and provide adequate support to resolve them including strategies supporting consumer use of health information technologies.
Acute pancreatitis following liver resection: report of three fatal cases and a review of the literature
Publisher: Wiley
Date: 08-2004
Virtual Health Care for Community Management of Patients With COVID-19 in Australia: Observational Cohort Study (Preprint)
Publisher: JMIR Publications Inc.
Date: 05-06-2020
Abstract: ustralia has successfully controlled the COVID-19 pandemic. Similar to other high-income countries, Australia has extensively used telehealth services. Virtual health care, including telemedicine in combination with remote patient monitoring, has been implemented in certain settings as part of new models of care that are aimed at managing patients with COVID-19 outside the hospital setting. his study aimed to describe the implementation of and early experience with virtual health care for community management of patients with COVID-19. his observational cohort study was conducted with patients with COVID-19 who availed of a large Australian metropolitan health service with an established virtual health care program capable of monitoring patients remotely. We included patients with COVID-19 who received the health service, could self-isolate safely, did not require immediate admission to an in-patient setting, had no major active comorbid illness, and could be managed at home or at other suitable sites. Skin temperature, pulse rate, and blood oxygen saturation were remotely monitored. The primary outcome measures were care escalation rates, including emergency department presentation, and hospital admission. uring March 11-29, 2020, a total of 162 of 173 (93.6%) patients with COVID-19 (median age 38 years, range 11-79 years), who were diagnosed locally, were enrolled in the virtual health care program. For 62 of 162 (38.3%) patients discharged during this period, the median length of stay was 8 (range 1-17) days. The peak of 100 prevalent patients equated to approximately 25 patients per registered nurse per shift. Patients were contacted a median of 16 (range 1-30) times during this period. Video consultations (n=1902, 66.3%) comprised most of the patient contacts, and 132 (81.5%) patients were monitored remotely. Care escalation rates were low, with an ambulance attendance rate of 3% (n=5), emergency department attendance rate of 2.5% (n=4), and hospital admission rate of 1.9% (n=3). No deaths were recorded. ommunity-based virtual health care is safe for managing most patients with COVID-19 and can be rapidly implemented in an urban Australian setting for pandemic management. Health services implementing virtual health care should anticipate challenges associated with rapid technology deployments and provide adequate support to resolve them, including strategies to support the use of health information technologies among consumers.
Extract, Transform, Load Framework for the Conversion of Health Databases to OMOP
Publisher: Cold Spring Harbor Laboratory
Date: 13-04-2021
DOI: 10.1101/2021.04.08.21255178
Abstract: Develop an extract, transform, load (ETL) framework for the conversion of health databases to the Observational Medical Outcomes Partnership Common Data Model (OMOP CDM) that supports transparency of the mapping process, readability, refactoring, and maintainability. We propose an ETL framework that is metadata-driven and generic across source datasets. The ETL framework reads mapping logic for OMOP tables from YAML files, which organize SQL snippets in key-value pairs that define the extract and transform logic to populate OMOP columns. We developed a data manipulation language (DML) for writing the mapping logic from health datasets to OMOP, which defines mapping operations on a column-by-column basis. A core ETL pipeline converts the DML in YAML files and generates an ETL script. We provide access to our ETL framework via a web application, allowing users to upload and edit YAML files and obtain an ETL SQL script that can be used in development environments. The structure of the DML and the mapping operations defined in column-by-column operations maximizes readability, refactoring, and maintainability, while minimizing technical debt, and standardizes the writing of ETL operations for mapping to OMOP. Our web application allows institutions and teams to reuse the ETL pipeline by writing their own rules using our DML. The research community needs tools that reduce the cost and time effort needed to map datasets to OMOP. These tools must support transparency of the mapping process for mapping efforts to be reused by different institutions.
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Related Funding Activities
No related grants have been discovered for Angus Ritchie.