ORCID Profile
0000-0001-7479-9669
Current Organisations
Monash University
,
Eastern Health
,
Alfred Health
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Publisher: Wiley
Date: 2021
DOI: 10.1111/IMJ.14763
Abstract: Delirium is common in elderly inpatients, causing distress, cognitive decline and death. No known intervention improves the course of delirium current treatments are symptomatic, and limited by lack of efficacy and adverse effects. There is an urgent need to find an effective treatment for delirium. To determine the feasibility of a trial of oral melatonin 5 mg nightly for five nights for the treatment of delirium in older medical inpatients, and determine the participants required to demonstrate a clinically and statistically significant decrease in severity of delirium in older medical inpatients treated with melatonin. This was a double blinded, randomised controlled trial in general internal medicine units of a tertiary teaching hospital. Older (≥70 years) inpatients with confusion assessment method positive hyperactive or mixed delirium were suitable for inclusion. Subjects received melatonin 5 mg oral nightly for five nights or matching placebo. The primary outcome was the Memorial Delirium Assessment Scale (MDAS) administered daily. No adverse effects occurred due to melatonin. In the treatment group, the mean change in MDAS from baseline during treatment period was 2.5 ± 5.0 points, in the placebo group, 2.1 ± 4.1 points, a non-significant difference. A power calculation accounting for drop-out (31.0%), suggests 120 participants would be required to demonstrate with 90% power that melatonin 5 mg reduces the severity of delirium by 3 points or more on MDAS. A trial of the hypothesis that 5 mg melatonin nightly for five nights reduces delirium severity in older medical inpatients would require 120 patients, and is feasible.
Publisher: Wiley
Date: 28-06-2021
DOI: 10.1111/APT.16446
Abstract: The healing of the mucosal lesion in patients with coeliac disease is slow. To determine whether concurrent budesonide and gluten‐free diet hasten small bowel healing and symptomatic improvement in patients with newly diagnosed coeliac disease. In a pilot, randomised, double‐blind trial, effects on Marsh grading and quantitative duodenal morphometry of 10 weeks' effervescent budesonide (initially 9 mg/day) or placebo were assessed after 8 and 52 weeks. Multiple clinical measures and adverse events were assessed. Nineteen patients were randomised to budesonide and 18 to placebo. No differences (all P 0.32) were observed for the week‐8 mucosal response (Marsh 0 or 1) (budesonide: 37% vs placebo: 28%), week‐8 remission (Marsh 0) (32% vs 17%), week‐52 response (63% vs 44%) and week‐52 remission (42% vs 33%). Likewise, the improvement from baseline in villous‐height : crypt‐depth ratio was not different for the treatment groups. There were no statistically significant differences in clinical measures or adverse events between the treatment groups. No corticosteroid adverse effects were observed. In a post hoc analysis of all patients, Marsh 3C was present at the diagnostic biopsy in 1/9 achieving mucosal remission at 8 weeks versus 18/23 not ( P 0.001) and mean villous‐height : crypt‐depth ratio was 1.06 (SD: 0.73) versus 0.46 (0.38) ( P = 0.005). In this pilot trial, induction therapy with budesonide had no significant effect on mucosal healing in patients with coeliac disease concurrently initiated on a gluten‐free diet. Mucosal remission at 8 weeks occurred in approximately one in four patients and was associated with less severe histological lesions at diagnosis.
Publisher: Wiley
Date: 2020
DOI: 10.1111/IMJ.14329
Abstract: Patients with anorexia nervosa (AN) are vulnerable to physiological decompensation and often require inpatient management by an eating disorders unit. Patients admitted to an Australian tertiary medical centre for medical stabilisation of AN were assessed as part of quality assurance. Analysis included: (i) medical complications during acute inpatient stabilisation (ii) predictors of refeeding syndrome (iii) predictors governing length of stay (LOS) and (iv) outcomes pre- and post-implementation of multidisciplinary treatment guidelines. A retrosepctive analysis of 95 consecutive admissions (60 in idual patients) between November 2011 and August 2017 was performed. Patients had a median LOS of 9.6 days (interquartile range 5.8-19.7) and a mean weight gain of 1.4 kg (standard deviation 2.9). Medical complications included the following: hypoglycaemia (11.6%) and refeeding electrolyte derangement (26.3%). Advancing age (odds ratio (OR) 1.06 per year, P = 0.019), nasogastric tube requirement (OR 3.4, P = 0.014) and Code Grey(s) (security calls) (OR 7.1, P = 0.010) were associated with refeeding electrolyte derangement. Parameters associated with increased LOS included the following: lower body mass index (P = 0.029), Code Grey(s) (P = 0.029) and tachycardia (P = 0.013). Following multivariate analysis, the post-guidelines implementation group required less intravenous fluid and electrolyte replacement, though had lower rates of refeeding electrolyte derangement (OR 0.33 (0.11-0.99)). Patients with moderate to severe AN are at risk of dangerous medical complications, and older patients may have heightened predisposition to refeeding electrolyte derangement. Early identification of medically high-risk patients is imperative to implement timely, life-saving interventions.
Publisher: Wiley
Date: 2019
DOI: 10.1111/IMJ.13800
Abstract: Epidemic thunderstorm asthma (ETSA) refers to large-scale acute bronchospasm events associated with thunderstorm. The most serious episode ever recorded occurred in Melbourne, Australia, in November 2016, where more than 3500 patients were treated in hospitals and 10 died. Previous work has been focused primarily on patient presentations to emergency departments. The prevalence of in iduals with milder, non-emergent symptoms and who may be at risk of more serious episodes in the future has not previously been explored. To characterise the nature and extent of respiratory symptoms in healthcare workers during the Melbourne ETSA event. A survey was conducted among staff and volunteers across Eastern Health, distributed on the intranet homepage, by email and by word of mouth. Anonymous survey questions were constructed to assess prior and current diagnoses of relevance, symptoms, and demography. There were 515 participants (80% female, n = 411) of approximately 9000 potential respondents (~6% response rate) who completed the survey 132 (25.6%) had symptoms suggestive of asthma during the Melbourne ETSA event, the majority of whom did not seek professional medical help. Notably, of those with ETSA-like symptoms, only 58 (43.9%) had a history of asthma, while 97 (73.5%) had a history of allergic rhinitis. Specifically, a history of allergic rhinitis (OR 2.77, P < 0.001), a history of asthma (OR 1.67, P = 0.037) and being of self-identified Asian ethnicity (OR 3.24, P < 0.001) were all strong predictors of ETSA-like symptoms. Being predominantly indoors was not protective. Our study provides evidence of the presence of a large cohort of sufferers during the Melbourne ETSA event of 2016 that did not come to the attention of medical services, implying a potentially hidden and significant susceptible population. Further research should help clarify the true prevalence of vulnerability in the general population, with important public health implications.
Publisher: Wiley
Date: 02-2023
DOI: 10.1111/IMJ.16010
Publisher: Wiley
Date: 18-04-2023
DOI: 10.1111/IMJ.16055
Abstract: Non‐alcoholic fatty liver disease (NAFLD) is a major healthcare burden. Real‐world outcomes in dedicated tertiary care settings in Australia remain unknown. To evaluate the initial outcomes of patients referred to a dedicated multidisciplinary tertiary care NAFLD clinic. Retrospective review of all adult patients with NAFLD who attended a dedicated tertiary care NAFLD clinic between January 2018 and February 2020 and who had two clinic visits and FibroScans at least 12 months apart. Demographic and health‐related clinical and laboratory data were extracted from electronic medical records. Key outcome measures were serum liver chemistries, liver stiffness measurement (LSM) and weight control at 12 months. A total of 137 patients with NAFLD were included. Median (interquartile range (IQR)) follow‐up time was 392 days (343–497 days). One hundred and eleven patients (81%) achieved weight control (i.e. weight loss or stability). Markers of liver disease activity were significantly improved, including median (IQR) serum alanine aminotransferase (48 (33–76) vs 41 (26–60) U/L, P = 0.009) and aspartate aminotransferase (35 (26–54) vs 32 (25–53) U/L, P = 0.020). Median (IQR) LSM across the whole cohort was significantly improved (8.4 (5.3–11.8) vs 7.0 (4.9–10.1) kPa, P = 0.001). No significant reduction was observed in mean body weight or the frequency of metabolic risk factors. This study highlights a new model of care for patients with NAFLD and demonstrates promising initial outcomes in relation to significant reductions in markers of liver disease severity. Although most patients achieved weight control, further refinements are needed to achieve significant weight reduction including more frequent and structured dietetic and/or pharmacotherapeutic interventions.
Publisher: Wiley
Date: 04-11-2022
DOI: 10.1111/JGH.15723
Abstract: Clinical and public health implications of the recent redefining of non-alcoholic fatty liver disease (NAFLD) to metabolic-associated fatty liver disease (MAFLD) remain unclear. We sought to determine the prevalence and compare MAFLD with NAFLD in a well-defined cohort. A cross-sectional study was conducted in regional Victoria with participants from randomly selected households. Demographic and health-related clinical and laboratory data were obtained. Fatty liver was defined as a fatty liver index ≥ 60 with MAFLD defined according to recent international expert consensus. A total of 722 participants were included. Mean age was 59.3 ± 16 years, and 55.3% were women with a median body mass index of 27.8 kg/m Metabolic-associated fatty liver disease is a highly prevalent condition within this large community cohort. Application of the MAFLD definition increased prevalence of fatty liver disease by including people with dual etiologies of liver disease.
Publisher: Springer Science and Business Media LLC
Date: 29-02-2016
Publisher: Wiley
Date: 03-2016
DOI: 10.1111/IMJ.13000
Publisher: Elsevier BV
Date: 11-2021
Publisher: Wiley
Date: 02-09-2022
DOI: 10.1002/JGH3.12814
Abstract: Pulmonary tumor thrombotic microangiopathy (PTTM) is a rare manifestation of malignancy. Pulmonary tumor emboli and associated fibrous intimal hyperplasia cause widespread pulmonary vascular stenosis/occlusion, which in turn increase pulmonary vascular resistance and lead to pulmonary hypertension. Gastric cancer is the most common underlying malignancy that leads to PTTM, and patients may present with dyspnea or other features of pulmonary hypertension prior to the diagnosis of cancer. In this short report, we describe a case of pulmonary hypertension due to gastric cancer associated PTTM. Endoscopic and histopathologic findings are shown, and a brief review of the literature is presented.
Publisher: MDPI AG
Date: 29-01-2023
DOI: 10.3390/NU15030687
Abstract: While non-alcoholic fatty liver disease (NAFLD) is a prevalent and frequent cause of liver-related morbidity and mortality, it is also strongly associated with cardiovascular disease-related morbidity and mortality, likely driven by its associations with insulin resistance and other manifestations of metabolic dysregulation. However, few satisfactory pharmacological treatments are available for NAFLD due in part to its complex pathophysiology, and challenges remain in stratifying in idual patient’s risk for liver and cardiovascular disease related outcomes. In this review, we describe the development and progression of NAFLD, including its pathophysiology and outcomes. We also describe different tools for identifying patients with NAFLD who are most at risk of liver-related and cardiovascular-related complications, as well as current and emerging treatment options, and future directions for research.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 23-06-2022
DOI: 10.1002/HEP.32572
Publisher: Wiley
Date: 12-09-2023
DOI: 10.1111/LIV.15725
Publisher: MDPI AG
Date: 27-06-2023
DOI: 10.3390/NU15132908
Abstract: Thank you for your interesting comment [...]
Publisher: Elsevier BV
Date: 07-2021
No related grants have been discovered for Daniel Clayton-Chubb.