المؤلفون: Seng Khee Gan, Roslyn J. Francis, Gerald F. Watts, Joshua R. Lewis, William Macdonald, Alistair Vickery, Michael Phillips, Gerard T. Chew, Carl Schultz, Sing Ching Lee, Jamie W Bellinge

المصدر: Journal of Nuclear Cardiology. 29:1855-1866

مصطلحات موضوعية: medicine.medical_specialty, business.industry, Type 2 diabetes, 030204 cardiovascular system & hematology, medicine.disease, Placebo, Gastroenterology, 030218 nuclear medicine & medical imaging, law.invention, 03 medical and health sciences, chemistry.chemical_compound, Arterial calcification, 0302 clinical medicine, chemistry, Randomized controlled trial, law, Diabetes mellitus, Internal medicine, Medicine, Colchicine, Radiology, Nuclear Medicine and imaging, Cardiology and Cardiovascular Medicine, business, Adverse effect, Calcification

الوصف: There is currently no treatment for attenuating progression of arterial calcification. 18F-sodium fluoride positron emission tomography (18F-NaF PET) locates regions of calcification activity. We tested whether vitamin-K1 or colchicine affected arterial calcification activity. 154 patients with diabetes mellitus and coronary calcification, as detected using computed tomography (CT), were randomized to one of four treatment groups (placebo/placebo, vitamin-K1 [10 mg/day]/placebo, colchicine [0.5 mg/day]/placebo, vitamin-K1 [10 mg/day]/ colchicine [0.5 mg/day]) in a double-blind, placebo-controlled 2x2 factorial trial of three months duration. Change in coronary calcification activity was estimated as a change in coronary maximum tissue-to-background ratio (TBRmax) on 18F-NaF PET. 149 subjects completed follow-up (vitamin-K1: placebo = 73:76 and colchicine: placebo = 73:76). Neither vitamin-K1 nor colchicine had a statistically significant effect on the coronary TBRmax compared with placebo (mean difference for treatment groups 0·00 ± 0·16 and 0·01 ± 0·17, respectively, p > 0.05). There were no serious adverse effects reported with colchicine or vitamin-K1. In patients with type 2 diabetes, neither vitamin-K1 nor colchicine significantly decreases coronary calcification activity, as estimated by 18F-NaF PET, over a period of 3 months. Clinical trial registration: ACTRN12616000024448.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_________::42453e20b80449847ccbd8cfc20f7db0Test
https://doi.org/10.1007/s12350-021-02589-8Test

المؤلفون: Phillip M. Finch, Alistair Vickery

المصدر: Internal Medicine Journal. 50:1326-1332

مصطلحات موضوعية: medicine.medical_specialty, Cannabinoid receptor, medicine.medical_treatment, 030204 cardiovascular system & hematology, 03 medical and health sciences, 0302 clinical medicine, Internal Medicine, medicine, Cannabidiol, Humans, Dronabinol, 030212 general & internal medicine, Child, Adverse effect, Intensive care medicine, Cannabis, biology, Cannabinoids, business.industry, Australia, Chronic pain, medicine.disease, biology.organism_classification, Anxiety, Cannabinoid, Chronic Pain, medicine.symptom, business, medicine.drug, Chemotherapy-induced nausea and vomiting

الوصف: Cannabis has been used as a medicine for millennia. Prohibition in the mid-20th century precluded early scientific investigation. 'Cannabis' describes three separate forms - herbal cannabis, 'hemp' products, pharmaceutical-grade regulated cannabinoid-based medical products (CBMP). In Australia, CBMP became available for prescription in November 2016. Herbal cannabis with Δ9-tetrahydrocannabinol (THC), which is illegal, and cannabidiol (CBD) in herbal extracts, are both unregulated and unreliable sources of cannabinoids. The endocannabinoid system (ECS), delineated in the late 1990s, has increased the understanding and interest in research for appropriate clinical indications. The ubiquitous ECS has homeostatic and anti-inflammatory effects and comprises cannabinoid receptors, endocannabinoids and degrading enzymes. Phytocannabinoids are partial agonists of the ECS. In pre-clinical studies, THC and CBD produce beneficial effects in chronic pain, anxiety, sleep and inflammation. Systematic reviews often conflate herbal cannabis and CBMP, confusing the evidence. Currently large randomised controlled trials are unlikely to be achieved. Other methodologies with quality end-points are required. Rich, valuable high-quality real-world evidence for the safe and effective use of CBMP provides an opportunity to examine benefits and potential harms. Evidence demonstrates benefit of CBMP in multiple sclerosis, chronic neuropathic pain, chemotherapy induced nausea and vomiting, resistant paediatric epilepsy, anxiety and insomnia. CBMP are well tolerated with few serious adverse events. Additional clinical benefits are promising in many other resistant chronic conditions. Pharmaceutical grade prescribed CBMP has proven clinical benefits and provides another clinical option in the physician's pharmacopeia.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::4beff1bde335dc5834f72c1c7bd3faf5Test
https://doi.org/10.1111/imj.15052Test

المؤلفون: Tiew-Hwa Katherine Teng, Matthew Knuiman, Judith M. Katzenellenbogen, Joseph Hung, Frank M Sanfilippo, Alistair Vickery, Qun Mai, Sandra C. Thompson, Elizabeth Geelhoed, Anthony S. Gunnell

المصدر: International Journal for Equity in Health, Vol 17, Iss 1, Pp 1-11 (2018)
International Journal for Equity in Health

مصطلحات موضوعية: Adult, Male, medicine.medical_specialty, Native Hawaiian or Other Pacific Islander, Health care disparity, Population, Myocardial Ischemia, Aboriginal health, 030204 cardiovascular system & hematology, Medicare, Health Services Accessibility, 03 medical and health sciences, 0302 clinical medicine, Health care, medicine, Humans, 030212 general & internal medicine, education, Referral and Consultation, Health policy, Aged, Primary health care, education.field_of_study, Ischaemic heart disease, Shared care, business.industry, Health Policy, Public health, Research, lcsh:Public aspects of medicine, Public Health, Environmental and Occupational Health, Health services research, Australia, lcsh:RA1-1270, Emergency department, Middle Aged, medicine.disease, United States, 3. Good health, Administrative datasets, Hospitalization, Emergency medicine, Female, business, Kidney disease, Indigenous health services

الوصف: Background Ischaemic heart disease (IHD) remains the leading cause of morbidity and mortality for both Aboriginal and non-Aboriginal Australians. Patterns of primary and specialist care in patients leading up to the first hospitalisation for IHD potentially impact on prevention and subsequent outcomes. We investigated the differences in general practice (GP), specialist and emergency department (ED) consultations, and associated resource use in Aboriginal and non-Aboriginal people in the two years preceding hospitalisation for IHD. Methods Linked-data were used to identify first IHD admissions for Western Australians aged 25–74 years in 2002–2007. Person-linked GP, specialist and ED consultations were obtained from the Medicare Benefits Schedule (MBS) and ED records to assess health care access and costs for the preceding 2 years. Results Aboriginal people constituted 4.7% of 27,230 IHD patients, 3.5% of 1,348,238 MBS records, and 14% of 33,170 ED presentations. Aboriginal (vs. non-Aboriginal) people were younger (mean 50.2 vs 60.5 years), more commonly women (45.2% vs 28.4%), had more comorbidities [Charlson index≥1, 35.2% vs 26.3%], were more likely to have had GP visits (adjusted rate-ratio 1.07, 95% CI 1.02–1.12), long/prolonged (16.0% vs 11.9%) consults and non-vocationally registered GP consults (17.1% vs 3.2%), but less likely to received specialist consults (mean 1.0 vs 4.1). Mean number of urgent/semi-urgent ED presentations in the year preceding the IHD admission was higher in Aboriginal people (2.9 vs 1.9). Aboriginal people incurred 2.7% of total associated MBS expenditure (estimated at $59.7 million). Mean total cost per person was 43.3% lower in Aboriginal patients, with cost differentials being greatest in diabetic and chronic kidney disease patients. Conclusions Despite being over-represented in urgent/semi-urgent ED presentations and admissions for IHD, Aboriginal people were under-resourced compared with the rest of the population, particularly in terms of specialist care prior to first IHD hospitalisation. The findings underscore the need for better primary and specialist shared care delivery models particularly for Aboriginal people.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::e5f7cafb62ae78e73f75074b9110dea5Test
http://link.springer.com/article/10.1186/s12939-018-0826-9Test

المؤلفون: Caroline Bulsara, Amanda Timler, Jim Codde, Alistair Vickery, Max Bulsara, Jill Smith

المصدر: Trials
Trials, Vol 21, Iss 1, Pp 1-11 (2020)

مصطلحات موضوعية: Quality of life, Male, medicine.medical_specialty, Next of kin, Population, Medicine (miscellaneous), Pain, Medical Marijuana, 03 medical and health sciences, Study Protocol, 0302 clinical medicine, Double-Blind Method, Medicine, Dementia, Medicinal cannabis, Humans, Plant Oils, Pharmacology (medical), 030212 general & internal medicine, Functional ability, education, Aged, Pain Measurement, Randomized Controlled Trials as Topic, lcsh:R5-920, education.field_of_study, Cross-Over Studies, business.industry, Cannabinoids, Pain scale, medicine.disease, Crossover trial, Mental Status and Dementia Tests, Behavioural and neuropsychiatric symptoms of dementia (BPSD), Nursing Homes, Clinical trial, Treatment Outcome, Physical therapy, Female, lcsh:Medicine (General), business, 030217 neurology & neurosurgery, Neuropsychiatric Inventory Questionnaire

الوصف: Background Dementia is a neurological condition that affects the cognitive and functional ability of the brain and is the leading cause of disability among those aged 65 years and above. More effective ways to manage dementia symptoms are needed because current treatment options (antidepressants and antipsychotics) can be ineffective and are associated with substantial side effects, including increased rate of mortality. Cannabinoid-based medicine (CBM) has shown an ability to inhibit some symptoms associated with dementia, and the adverse effects are often minimal; yet, little research has explored the use of CBM among this population. Aim To monitor the safety of a purified dose of CBM oil (3:2 delta-9-tetrahydrocannabinol:cannabidiol) on behaviour symptoms, quality of life and discomfort caused by pain. Methods/design We will carry out an 18-week, randomised, double-blind crossover trial that consists of a 2-week eligibility period, two 6-week treatment cycles, and two 2-week washout periods (between both cycles and after the second treatment cycle). We aim to recruit 50 participants with dementia who are living in residential aged-care facilities. The participants will be randomised into two groups and will receive a dose of either CBM oil or placebo for the first treatment cycle and the opposite medication for the second. Data will be collected using the Neuropsychiatric Inventory Questionnaire, the Cohen-Mansfield Agitation Inventory, the Quality of Life in Alzheimer’s Disease questionnaire, and the Abbey Pain Scale on seven occasions. These will be completed by the participants, aged-care staff, and nominated next of kin or family members. The participants’ heart rate and blood pressure will be monitored weekly, and their body composition and weight will be monitored fortnightly by a research nurse, to assess individual dose response and frailty. In addition, pre- and post-surveys will be administered to aged-care staff and family members to understand their perceptions of CBM and to inform proposed focus groups consisting of the aged-care staff and next of kin. Discussion The study design has been informed by medical professionals and key stakeholders, including those working in the residential aged-care industry to ensure patient safety, collection of non-invasive measures, and methodological rigor and study feasibility. Trial registration Australian New Zealand Clinical Trials Registry, ACTRN12619000474156. Registered on 21 March 2019

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::b5d1a0df1c6c5031614154c9cfda19d4Test
http://europepmc.org/articles/PMC7023743Test

المؤلفون: Alistair Vickery, Suzanna Allen, Thinh Nguyen, Yvonne Hauck, Jacqueline Frayne, Helena Liira

المساهمون: Department of General Practice and Primary Health Care, University Management, University of Helsinki

مصطلحات موضوعية: Adult, medicine.medical_specialty, Time Factors, PRETERM BIRTH, NEONATAL OUTCOMES, Population, Prenatal care, Antenatal care, Cohort Studies, 03 medical and health sciences, Young Adult, 0302 clinical medicine, 3123 Gynaecology and paediatrics, Severe mental illness, SCHIZOPHRENIA, Medicine, Humans, COHORT, education, Retrospective Studies, RISK, education.field_of_study, Pregnancy, COMPLICATIONS, 030219 obstetrics & reproductive medicine, business.industry, Obstetrics, Mental Disorders, Attendance, Obstetrics and Gynecology, Retrospective cohort study, General Medicine, medicine.disease, Delivery, Obstetric, Comorbidity, 3. Good health, Gestational diabetes, Pregnancy Complications, PRENATAL-CARE, PREGNANCY, 030220 oncology & carcinogenesis, Bipolar, Female, business, Psychosocial

الوصف: Purpose This study aims to describe 10 years of antenatal care and outcomes for women with a severe mental illness (SMI). Methods A retrospective cohort study of 420 completed pregnancy records over the last 10 years (2007-2017). Findings were compared to the Western Australian (WA) pregnancy data. Antenatal attendance, demographic, obstetric, neonatal and psychosocial variables were analysed using t tests, chi(2)(,) ANOVA and odds ratio (OR). Results Overall, women with a SMI had high rates of comorbidity (47%), antenatal complications, and preterm birth at 12.6% compared to WA mothers (p

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::942924ec279fba39743c63456e1a48f3Test
http://hdl.handle.net/10138/320959Test

المؤلفون: Alistair Vickery, Matthew Tuson, Berwin A. Turlach, David Whyatt

المصدر: American Journal of Epidemiology. 187:170-179

مصطلحات موضوعية: Adult, Male, Point prevalence survey, Biometry, Adolescent, Epidemiology, Statistics as Topic, Population, Health outcomes, 01 natural sciences, Young Adult, 010104 statistics & probability, 03 medical and health sciences, 0302 clinical medicine, Outcome Assessment, Health Care, Statistics, Humans, Medicine, Computer Simulation, 030212 general & internal medicine, 0101 mathematics, Child, education, Aged, Estimation, Likelihood Functions, education.field_of_study, business.industry, Infant, Newborn, Nonparametric statistics, Infant, Reproducibility of Results, Western Australia, Middle Aged, medicine.disease, Confidence interval, Logistic Models, Child, Preschool, Multivariate Analysis, Attributable risk, Cohort, Female, Medical emergency, business

الوصف: The aim of this study was to reconcile 3 approaches to calculating population attributable fractions and attributable burden percentage: the approach of Bruzzi et al. (Am J Epidemiol. 1985;122(5):904-914.), the maximum-likelihood method of Greenland and Drescher (Biometrics. 1993;49(3):865-872.), and the multivariable method of Tanuseputro et al. (Popul Health Metr. 2015;13:5.). Using data from a statewide point prevalence survey (Western Australian Point Prevalence Survey, 2014) linked to an administrative database, we compared estimates of attributable burden percentage obtained using the contrasting methods in 6 logistic models of health outcomes from the survey, estimating 95% confidence intervals using nonparametric and weighted bootstrap approaches. Our results show that instability can arise from the fundamental algebraic construction of Bruzzi's formula, and that this instability may substantially influence the calculation of attributable burden percentage and associated confidence intervals. These observations were confirmed in a simulation study. The algebraic reduction of Bruzzi's formula to the 2 alternative methods resulted in markedly more stable estimates for population attributable fraction and attributable burden percentage in cross-sectional studies and cohort designs with fixed follow-up time. We advocate the widespread implementation of the maximum-likelihood approach and the multivariable method.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::7d2955d78d0b25e9c609ce9c15f2aec0Test
https://doi.org/10.1093/aje/kwx200Test

المؤلفون: Berwin A. Turlach, Alistair Vickery, M. J. Yap, David Whyatt, Elizabeth Geelhoed, Bryan Boruff, Mei Ruu Kok, Matthew Tuson

المصدر: International Journal of Population Data Science. 1

مصطلحات موضوعية: Information Systems and Management, Event (computing), Service delivery framework, business.industry, Psychological intervention, Health Informatics, Context (language use), Emergency department, medicine.disease, Mental health, Intervention (counseling), Health care, medicine, Medical emergency, business, Information Systems, Demography

الوصف: ObjectivesThe objectives of this project are to identify patients that can be recruited into specific interventions and the optimisation of the delivery of such interventions, in order to improve access to health services, equity of service delivery, and patient outcomes.ApproachThe entire linked Western Australian Data Collections from 2002-2015 (including population-wide hospital admissions, emergency department presentations, cancer registry records, mental health care, maternity records, and mortality records) were examined. To identify patients at risk, a definition of a ‘PEAC’ event was developed. This acronym reflects the following criteria for such events. First, the event should ‘predictable’, i.e. either able to be easily predicted, or able to predict subsequent poor patient outcomes (for example, death). Second, the event should be ‘expensive’, i.e. be associated with significantly increased levels of individual healthcare utilisation and/or mortality. Third, the impact of the event should be ‘avoidable’, i.e. an evidence-based intervention should exist that may delay or completely avoid the event, or reduce its sequelae. Fourth, the event should be ‘cardinal’, which in this context indicates that the event should be clearly and unambiguously defined and recognisable, and specific enough to assign an effective intervention. Once PEAC events were identified, geospatial and predictive modelling of future events were then used to inform clinical service delivery, alongside appropriate return-on-investment analysis to support intervention. Finally, the entire process was embedded within a learning health system, linking research, policy, and practice, to drive ongoing improvement.ResultsExemplar PEAC events will be described, including hospital admission events associated with chronic disease, mental health, and dental/oral health. The predictability of such events in individuals using statistical models fitted to the available administrative datasets will be presented, along with the sequelae of such events in terms of healthcare use and mortality. The optimisation of delivering interventions targeting PEAC events will be described, along with the process of translating findings into policy and practice within the context of a learning health system.ConclusionThe identification of PEAC events allows for targeted delivery of healthcare interventions in a manner that not only optimises access, equity, and outcomes, but also permits ongoing improvement of the health system.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_________::1188f95203d219875135083f0e46e8eeTest
https://doi.org/10.23889/ijpds.v1i1.229Test

المؤلفون: Gerald F. Watts, Jing Pang, Alistair Vickery

المصدر: Advances in Dyslipidemia. :18-41

مصطلحات موضوعية: medicine.medical_specialty, Bridging (networking), business.industry, Family medicine, Health care, Medicine, Familial hypercholesterolemia, business, medicine.disease

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_________::0daebc5bb788639db53a0a35137f399cTest
https://doi.org/10.2217/fmeb2013.13.24Test

المؤلفون: Raji Tenneti, Glenn Pearson, Alistair Vickery, David Whyatt, M. J. Yap

المصدر: Emergency medicine Australasia : EMA. 29(5)

مصطلحات موضوعية: Adult, Male, Longitudinal study, medicine.medical_specialty, Native Hawaiian or Other Pacific Islander, Psychological intervention, Type 2 diabetes, Cohort Studies, 03 medical and health sciences, Pulmonary Disease, Chronic Obstructive, 0302 clinical medicine, Life Expectancy, medicine, Humans, 030212 general & internal medicine, Hospital use, Aged, Heart Failure, business.industry, 030503 health policy & services, Type 2 Diabetes Mellitus, Western Australia, Middle Aged, medicine.disease, Hospitals, Chronic disease, Diabetes Mellitus, Type 2, Heart failure, Family medicine, Chronic Disease, Emergency Medicine, Female, Age of onset, 0305 other medical science, business

الوصف: OBJECTIVE The objective of this study was to compare rates of hospital utilisation in Aboriginal and non-Aboriginal peoples before and after hospital admission for chronic obstructive pulmonary disease, heart failure and/or type 2 diabetes mellitus. METHODS This was a longitudinal cohort study from 2002 to 2014, which was conducted in all hospitals in Western Australia. The participants of this study were Aboriginal and non-Aboriginal patients with a principal diagnosis of heart failure, type 2 diabetes or chronic obstructive pulmonary disease, on admission to hospital, where such an event had not occurred in the previous 3 years. Inpatient days and ED presentations were the main outcome measures. RESULTS Among the patients with chronic disease, Aboriginal people have similar inpatient days for all causes compared to non-Aboriginal people. However, they have much higher ED presentations in comparison. Age of onset of cardinal events occurs 15-20 years earlier in Aboriginal patients with chronic disease. Although age has little influence on ED presentations in non-Aboriginal chronic disease patients, younger Aboriginal people with chronic disease present far more often to ED than older Aboriginal people. CONCLUSIONS Aboriginal people use health services in a different manner when compared to non-Aboriginal people. In a subset of patients with chronic disease, high use may be reduced with better access to primary healthcare. Policy-makers and healthcare providers should examine healthcare use from primary to tertiary care among the Aboriginal population, with a particular focus on ED presentations; investigate the underlying causes driving specific patterns of health service utilisation among Aboriginal people; and develop interventions to reduce potential deleterious impacts, and enhance the potential benefits, of specific patterns of healthcare use.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::a0548b61e804e2e9ac87c56edce74c5bTest
https://pubmed.ncbi.nlm.nih.gov/28419735Test

المؤلفون: Gerald F. Watts, Tom Brett, Damon A. Bell, Alistair Vickery, Diane Arnold-Reed, Jacquie Garton-Smith, Jacqueline D.M. Ryan, Jing Pang

المصدر: Expert review of cardiovascular therapy. 13(10)

مصطلحات موضوعية: Pediatrics, medicine.medical_specialty, Cascade testing, medicine.diagnostic_test, business.industry, Care perspective, General Medicine, Primary care, Familial hypercholesterolemia, Cholesterol, LDL, medicine.disease, Hyperlipoproteinemia Type II, Family medicine, Internal Medicine, medicine, Humans, Young adult, Cardiology and Cardiovascular Medicine, business, Index case, Lipid clinic, Genetic testing

الوصف: Familial hyperchoelsterolaemia (FH) remains under-diagnosed and under-treated in the community setting. Earlier evidence suggested a prevalence of 1:500 worldwide but newer evidence suggests it is more common. Less than 15% of FH patients are ever diagnosed, with children and young adults rarely tested despite having the most to gain given their lifetime exposure. Increasing awareness among primary care teams is critical to improve the detection profile for FH. Cascade testing in the community setting needs a sustainable approach to be developed to facilitate family tracing of index cases. The use of the Dutch Lipid Clinic Network Criteria score to facilitate a phenotypic diagnosis is the preferred approach adopted in Australia and eliminates the need to undertake genetic testing for all suspected FH cases.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::da3482e5ccc4b0ff48e679ef839ba380Test
https://pubmed.ncbi.nlm.nih.gov/26313701Test