ORCID Profile
0000-0001-7503-0317
Current Organisation
Fiona Stanley Hospital
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Publisher: Wiley
Date: 05-2017
DOI: 10.1111/IMJ.13410
Publisher: Wiley
Date: 04-09-2022
DOI: 10.1111/IMJ.15700
Abstract: Guidelines advocate for intensive lipid-lowering in patients with atherosclerotic cardiovascular disease (ASCVD). In May 2020, evolocumab, a proprotein convertase subtilisin-kexin type 9 (PCSK9) inhibitor, became government subsidised in Australia for patients with ASCVD requiring further low-density lipoprotein cholesterol (LDL-C) lowering. To identify barriers to prescribing PCSK9 inhibitors in hospitalised patients with ASCVD. A retrospective 3-month, single-site, observational analysis was conducted in consecutive patients undergoing percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG) surgery. Lipid-lowering therapy prescriptions, including PSCK9 inhibitors, were assessed using electronic medical records, compared against the Australian Pharmaceutical Benefits eligibility criteria, and barriers to PCSK9 inhibitor use identified. Of 331 patients, 244 (73.7%) underwent PCI and 87 (26.3%) underwent CABG surgery. A lipid profile during or within 8 weeks of admission was measured for 202 (82.8%) patients undergoing PCI and 59 (67.8%) undergoing CABG surgery. In patients taking high-intensity statins on admission (n = 109), LDL-C ≥1.4, ≥1.8 and >2.6mmol/L was seen in 64 (58.7%), 44 (40.4%) and 19 (17.4%) patients respectively. High-intensity statin prescribing at discharge was high (>80%) however, ezetimibe was initiated in zero patients with LDL-C ≥1.4 mmol/L. There was variable advice given by clinicians for LDL-C targets. No patients met the criteria for subsidised PSCK9 inhibitor therapy, largely due to lack of qualifying lipid levels following combined statin and ezetimibe therapy. Prescribing of non-statin LDL-C-lowering therapies remains low in patients with ASCVD. Underprescribing of ezetimibe and suboptimal lipid testing rates are barriers to accessing subsidised PCSK9i therapy using current Australian eligibility criteria.
Publisher: Wiley
Date: 05-2015
DOI: 10.1111/IMJ.12743
Publisher: Wiley
Date: 30-12-2017
DOI: 10.1111/PAPR.12538
Abstract: The occurrence of bone metastases is common in patients with advanced cancer. The literature supports percutaneous vertebroplasty and kyphoplasty as minimally invasive procedures to relieve pain and improve quality of life for selected patients with disabling pain from pathological vertebral fractures secondary to bone metastases. We describe a case of a 71-year-old patient with castrate-resistant metastatic prostate cancer who underwent sacroplasty for painful sacral metastases. The patient had previously been treated with maximally tolerated analgesics and anticancer therapies including systemic anticancer treatments and local radiotherapy. After sacroplasty, he experienced significant pain reduction and improvement in mobility and function. This case and recent literature demonstrate positive outcomes of sacroplasty in terms of pain reduction and improved mobility. Further research is warranted to establish the role of such minimally invasive percutaneous procedures for pain management in cancer patients.
Publisher: Wiley
Date: 23-05-2022
DOI: 10.1111/IMJ.15393
Abstract: Guidelines advocate multifactorial cardiovascular risk management in patients with diabetes and atherosclerotic cardiovascular disease. In hospitalised patients with diabetes following coronary artery bypass graft (CABG), we aimed to evaluate the impacts of decision-support algorithms for optimising glycaemia and lipid-lowering. We also assessed the safety of initiating sodium-glucose cotransporter 2 (SGLT2) inhibitors near time of hospital discharge. This was a single-site, pre- and post-intervention analysis of glucose and lipid management in consecutive hospitalised patients with diabetes undergoing CABG surgery. The intervention involved education and decision-support algorithms designed by a multidisciplinary committee to guide cardiac surgery unit clinicians. A total of 200 patients were included in the study. The pre- and post-intervention groups had similar baseline characteristics (HbA1c 7.9 ± 1.9% vs 8.1 ± 1.8%). Of 4092 blood glucose measurements, the incidence of levels between 5 and 10 mmol/L was not different post-intervention (55.5% vs 57.0% P = 0.441). Fewer endocrinology consultations occurred (59.0% vs 45.0% P = 0.048) and rates of hypoglycaemia remained low. High-intensity statin was prescribed in >90% pre- and post-intervention, although non-statin lipid-lowering agents remained <10% despite patients not achieving LDL-C targets. No 30-day readmissions for diabetic ketoacidosis occurred in patients prescribed SGLT2 inhibitors. The intervention did not improve inpatient glycaemia or increase non-statin lipid-lowering prescriptions in patients with diabetes following CABG surgery but did reduce reliance on specialty input. Initiation of SGLT2 inhibitor therapy near time of hospital discharge was not associated with safety concerns. Alternative interventions or strategies are required to optimise glycaemia and non-statin lipid-lowering therapy prescribing in this setting.
Publisher: Elsevier BV
Date: 12-2019
Publisher: Wiley
Date: 28-09-2020
DOI: 10.1002/JPPR.1682
Publisher: SAGE Publications
Date: 29-01-2015
Abstract: Approximately one-third of rapid response team consultations involve issues of end-of-life care. We postulate a greater occurrence in patients with a life-limiting illness, in whom the opportunity for advance care planning and palliative care involvement should be offered. We aim to review the characteristics and compare outcomes of rapid response team consultations on patients with and without a life-limiting illness. A 3-month retrospective cohort study of all rapid response team consultations was conducted. The s le population included all adult inpatients in a major teaching hospital network. We identified 351 patients – including 139 with a life-limiting illness – receiving a total of 456 rapid response team consultations. The median time from admission to the first rapid response team consultation was 3 days. Patients with a life-limiting illness had a significantly higher mortality rate (41.7% vs 13.2%), were older (72.6 vs 63.5 years), more likely to come from a residential aged-care facility (29.5% vs 4.1%) and had a shorter hospital stay (10 vs 13 days). Rapid response team consultations resulted in a change to more palliative goals of care in 28.5% of patients, of whom two-thirds had a life-limiting illness. Patients with a life-limiting illness had worse outcomes post–rapid response team consultation. Our findings suggest that a routine clarification of goals of care for this cohort, within 3 days of hospital admission, may be advantageous. These discussions may provide clarity of purpose to treating teams, reduce the burden of unnecessary interventions and promote patient-centred care agreed upon in advance of any deterioration.
Publisher: Wiley
Date: 03-2021
DOI: 10.1111/IMJ.15245
Publisher: Wiley
Date: 11-2020
DOI: 10.1111/IMJ.15055
Publisher: Elsevier BV
Date: 08-2018
Publisher: Elsevier BV
Date: 07-2020
Publisher: Elsevier BV
Date: 12-2021
DOI: 10.1016/J.JDIACOMP.2021.108057
Abstract: In this real-world study, the main barriers for not initiating SGLT2 inhibitor therapy early after an acute cardiac event are prescribing criteria around glycated haemoglobin and renal function. Initiation of SGLT2 inhibitors near to, or at, hospital discharge following the cardiac event was not associated with 30-day diabetic ketoacidosis readmissions.
Publisher: Elsevier BV
Date: 04-2014
Publisher: Elsevier BV
Date: 02-2019
Publisher: American Society of Clinical Oncology (ASCO)
Date: 20-02-2014
Publisher: Wiley
Date: 06-2015
DOI: 10.1111/BCP.12614
Publisher: SAGE Publications
Date: 03-08-2018
Abstract: In geriatric inpatient rehabilitation settings, where the goal is to optimise function, providing end-of-life care can be challenging. The aim of this study is to explore how end-of-life care goals and decision-making are communicated in a geriatric inpatient rehabilitation setting. The design is a qualitative descriptive design using semi-structured in idual and group interviews. This study was conducted in a 154-bed facility in metropolitan Melbourne, Australia, providing geriatric inpatient rehabilitation for older patients medical, nursing and allied health clinicians, who had cared for an inpatient who died, were recruited. Participants were interviewed using a conversational approach, guided by an ‘aide memoire’. A total of 19 clinicians participated in this study, with 12 interviewed in idually and the remaining 7 clinicians participating in group interviews. The typical patient was described as older, frail and with complex needs. Clinicians described the challenge of identifying patients who were deteriorating towards death, with some relying on others to inform them. How patient deterioration and decision-making was communicated among the team varied. Communication with the patient/family about dying was expected but did not always occur, nor was it always documented. Some clinicians relied on documentation, such as commencement of a dying care pathway to indicate when a patient was dying. Clinicians reported difficulties recognising patient deterioration towards death. Uncertainty and inconsistent communication among clinicians about patient deterioration negatively impacted team understanding, decision-making, and patient and family communication. Further education for all members of the multidisciplinary team focusing on how to recognise and communicate impending death will aid multidisciplinary teams to provide quality end-of-life care when required.
Publisher: Springer Science and Business Media LLC
Date: 30-05-2020
Publisher: Wiley
Date: 07-2018
DOI: 10.1111/IMJ.13939
Abstract: A survey of cancer treatment providers at our institution exploring their perspectives regarding voluntary assisted dying in Victoria and the imminent legislation showed that while almost all were aware of the Bill (92%), reported knowledge and understanding of it was much less (38%). As many clinicians supported the Bill as opposed it (28%) 44% were uncertain of their stance. Most were unwilling to directly provide voluntary assisted dying if they did, would refer to palliative care services for ongoing support.
Publisher: The Royal Australian College of General Practitioners
Date: 11-2018
No related grants have been discovered for Sarah Hitchen.