27 research outputs found
Benzodiazepine prescribing in elderly Australian general practice patients
No full textThe definitive version is available at www.blackwell-synergy.comObjective: The use of benzodiazepines by elderly people is of limited therapeutic benefit and increases the risk of adverse events. This study aimed to examine the extent to which benzodiazepines are prescribed for elderly Australians. Methods: Data for 3,970 individuals aged 65 years or more were extracted from a general practice database. Benzodiazepine prescriptions for 2002 were reviewed. Results: Overall, 16% (95% CI 11–21%) of elderly patients had at least one benzodiazepine prescription. Females were almost twice as likely as males to be prescribed a benzodiazepine and prescription prevalence increased with age. Conclusions: Despite risks, benzodiazepines are widely prescribed for the elderly. Limited availability and cost of alternative therapies and pressures on the primary care system in Australia may contribute to their continued overuse. Implications: The prescribing of benzodiazepines for elderly Australians needs to be reduced by better managing sleep and anxiety problems.Alice Windle, Elizabeth Elliot, Katherine Duszynski, Vivienne Moor
Management of clinical data - issues from a research perspective
No full text© Drug Information AssociationThis article examines clinical data management from a research context. It describes the experience of the authors' in the collation and analysis of computerized general practice records. In particular, the authors' examine some of the issues associated with obtaining consent, data deidentification, data quality, ownership, data value, and cost.Don C. Walker, Katherine M. Duszynski, Justin J. Beilby, Nicole L. Pratt and John E. Marle
Use of pharmacotherapies for the management of addictive behaviours in Australian clinical practice
No full textCopyright © 2006 Elsevier Ltd All rights reserved.AIMS: To collect data on the behaviours associated with the prescription of pharmacotherapies (bupropion, acamprosate and naltrexone) for nicotine and alcohol dependence in Australian clinical practice. DESIGN: Self-administered questionnaire. SETTING: Australian clinical practice. PARTICIPANTS: Three specialties, psychiatrists, gastroenterologists and general practitioners (GPs) were defined by the Health Insurance Commission's derived major specialty classification codes and stratified by state (and territory) as well as rural and remote metropolitan area classification. A total of 2680 surveys were sent (670 psychiatrists, 82 gastroenterologists and 1928 GPs) with 1291 surveys used in the final analysis (329 psychiatrists, 37 gastroenterologists and 925 GPs). INTERVENTIONS: A 10-page, 46-item survey was distributed by the HIC. The initial survey was sent in March 2003 and sent a subsequent two times to non-responding physicians. MEASUREMENTS: Characteristics of physicians and their therapeutic preferences in managing patients with nicotine or alcohol dependence. FINDINGS: The majority of physicians identified and provided advice to patients who smoked and consumed alcohol at levels harmful to health. Fourteen percent used a formal alcohol-screening instrument, 4% were familiar with the 5 As' of a smoking cessation strategy and less than a third had undertaken any formal training in providing brief advice. The majority of physicians perceived pharmacotherapies to be an effective treatment strategy and indicated adjuncts improved likelihood of behaviour modification. Predictors of pharmacotherapy prescribing included working in a large clinical practice, having an additional mental health qualification and training in provision of brief advice. CONCLUSIONS: Physicians are in a strong position, and are encouraged to, manage additive disorders. Scope exists to improve prescribing of pharmacotherapies for nicotine and alcohol dependence by enhancing appropriate counselling skills and making explicit the nature of a comprehensive treatment regime as an adjunct to medicines.Christopher M. Doran, Katherine M. Duszynski, Justin J. Beilby and Richard P. Mattickhttp://www.elsevier.com/wps/find/journaldescription.cws_home/471/description#descriptio
The use of citizens' juries in health policy decision-making: a systematic review
No full textDeliberative inclusive approaches, such as citizen juries, have been used to engage citizens on a range of issues in health care and public health. Researchers engaging with the public to inform policy and practice have adapted the citizen jury method in a variety of ways. The nature and impact of these adaptations has not been evaluated. We systematically searched Medline (PubMED), CINAHL and Scopus databases to identify deliberative inclusive methods, particularly citizens' juries and their adaptations, deployed in health research. Identified studies were evaluated focussing on principles associated with deliberative democracy: inclusivity, deliberation and active citizenship. We examined overall process, recruitment, evidence presentation, documentation and outputs in empirical studies, and the relationship of these elements to theoretical explications of deliberative inclusive methods. The search yielded 37 papers describing 66 citizens' juries. The review demonstrated that the citizens' jury model has been extensively adapted. Inclusivity has been operationalised with sampling strategies that aim to recruit representative juries, although these efforts have produced mixed results. Deliberation has been supported through use of steering committees and facilitators to promote fair interaction between jurors. Many juries were shorter duration than originally recommended, limiting opportunity for constructive dialogue. With respect to citizenship, few juries' rulings were considered by decision-making bodies thereby limiting transfer into policy and practice. Constraints in public policy process may preclude use of the ‘ideal’ citizens' jury with potential loss of an effective method for informed community engagement. Adapted citizens' jury models provide an alternative: however, this review demonstrates that special attention should be paid to recruitment, independent oversight, jury duration and moderation.Jackie Street, Katherine Duszynski, Stephanie Krawczyk, Annette Braunack-Maye
A randomised controlled trial to compare opt-in and opt-out parental consent for childhood vaccine safety surveillance using data linkage: study protocol
No full textExtent: 10p.Background: The Vaccine Assessment using Linked Data (VALiD) trial compared opt-in and opt-out parental consent for a population-based childhood vaccine safety surveillance program using data linkage. A subsequent telephone interview of all households enrolled in the trial elicited parental intent regarding the return or non-return of reply forms for opt-in and opt-out consent. This paper describes the rationale for the trial and provides an overview of the design and methods. Methods/Design: Single-centre, single-blind, randomised controlled trial (RCT) stratified by firstborn status. Mothers who gave birth at one tertiary South Australian hospital were randomised at six weeks post-partum to receive an opt-in or opt-out reply form, along with information explaining data linkage. The primary outcome at 10 weeks post-partum was parental participation in each arm, as indicated by the respective return or non-return of a reply form (or via telephone or email response). A subsequent telephone interview at 10 weeks post-partum elicited parental intent regarding the return or non-return of the reply form, and attitudes and knowledge about data linkage, vaccine safety, consent preferences and vaccination practices. Enrolment began in July 2009 and 1,129 households were recruited in a three-month period. Analysis has not yet been undertaken. The participation rate and selection bias for each method of consent will be compared when the data are analysed. Discussion: The VALiD RCT represents the first trial of opt-in versus opt-out consent for a data linkage study that assesses consent preferences and intent compared with actual opting in or opting out behaviour, and socioeconomic factors. The limitations to generalisability are discussed.Jesia G Berry, Philip Ryan, Annette J Braunack-Mayer, Katherine M Duszynski, Vicki Xafis, Michael S Gold, the Vaccine Assessment Using Linked Data (VALiD) Working Grou
Public perspectives on consent for the linkage of data to evaluate vaccine safety
No full textData source: Supplementary information, https://doi-org/10.1016/j.vaccine.2012.04.056Introduction: We sought community opinion on consent alternatives when linking childhood immunisation and hospital attendance records for the purpose of vaccine safety surveillance.
Methods: We conducted computer-assisted telephone interviewing (CATI) of a sample of rural and metropolitan residents of South Australia in 2011.
Results: Of 2002 households interviewed (response rate 55.6%), 96.4% supported data linkage for postmarketing surveillance of vaccines; very few were completely opposed (1.5%) or undecided (2.2%). The majority (75.3%) trusted the privacy protections used in data linkage and most wished to have minimal or no direct involvement, preferring either opt-out consent (40.4%) or no consent (30.6%). A quarter of respondents (24.6%) favoured opt-in consent, but their preferences were divergent; half requested consent be sought prior to every use (11.4%) while the remainder preferred to give broad consent just once (3.4%) or renewed at periodic intervals (9.8%).
Over half of the respondents gave higher priority to rapid vaccine safety surveillance (56.5%) rather than first seeking parental consent (26.6%) and one in seven was undecided (14.5%). Although 91.6% of respondents believed childhood vaccines are safe, over half (53.1%) were very or somewhat concerned that a vaccine could cause a serious reaction. Nevertheless, 92.4% of the parents in the sample (556/601) reported every child in their care as being fully immunised according to the National Immunisation Program schedule. Only 3.7% of parents (22/601) reported one or more children as under immunised, and 3.9% (23/601) reported that none of their children were immunised.
Conclusions: This survey demonstrates that data linkage for vaccine safety surveillance has substantial community support and that a system utilising opt-out consent or no consent was preferred to one using opt-in consent. These findings should inform public health policy and practice; data linkage should be established where feasible to address limitations in passive surveillance systemsJesia G. Berry, Michael S. Gold, Philip Ryan, Katherine M. Duszynski and Annette J. Braunack-Maye
Privacy considerations in the context of an Australian observational database
No full textCopyright © 2001 John Wiley & Sons, Ltd.Observational databases are increasingly acknowledged for their value in clinical investigation. Australian general practice in particular presents an exciting opportunity to examine treatment in a natural setting. The paper explores issues such as privacy and confidentiality--foremost considerations when conducting this form of pharmacoepidemiological research. Australian legislation is currently addressing these exact issues in order to establish clear directives regarding ethical concerns. The development of a pharmacoepidemiological database arising from the integration of computerized Australian general practice records is described in addition, to the challenges associated with creating a database which considers patient privacy. The database known as 'Medic-GP', presently contains more than 950,000 clinical notes (including consultations, pathology, diagnostic imaging and adverse reactions) over a 5-year time period and relates to 55,000 patients. The paper then details a retrospective study which utilized the database to examine the interaction between antibiotic prescribing and patient outcomes from a community perspective, following a policy intervention. This study illustrates the application of computerized general practice records in research.Katherine M. Duszynski, Justin J. Beilby, John E. Marley, Don C. Walker and Nicole L. Prat
The effect of soil texture and vegetation on carbon accrual in restored grasslands
No full textSettlement of the Midwest, with the subsequent conversion of tallgrass prairie to agricultural fields, has led to a drastic reduction of soil carbon (C). As agricultural fields are returned to grasslands, it is important to understand the factors influencing rates of C and nitrogen (N) accrual in order to better predict C storage rate and capacity. In this study, we first evaluated the effect of soil texture, plant productivity, species richness and C4 grass-legume complementarity on soil C and N. In addition, we used a chronosequence approach to estimate the rate of soil C and N accrual. Soil samples were collected at depths up to 90 cm from remnant prairies, high-diversity prairie restorations, medium and low-diversity plantings enrolled in the Conservation Reserve Program (CRP), and crop fields in Newton County, IN and Lee County, IL. Vegetation surveys and biomass collections were conducted in the prairie and conservation areas to estimate plant species richness, functional group abundance, and productivity. We found that soil silt + clay content was the most important predictor for soil C and N content, in Newton and Lee Counties. Difference among field treatments fell along lines of soil texture, as fields with high silt + clay content were the first to be converted to agriculture due to their greater productivity compared to the sandy prairie remnants. As predicted, soil C and N increased with plant productivity. However, we found soil C and N decreased with species richness. There was no effect of legumes on soil C and N content in C4 grass dominated grasslands. In our chronosequence study, soil C and N increased with time since restoration, however the pattern was not significant over the initial chronosequence when remnant prairies were excluded. After omitting remnant prairies, the relationship between C and time since restoration was strengthened when variance due to silt + clay content was accounted for in the Newton County MD and LD restorations and Lee County low silt + clay restoration chronosequence, through residual analysis. Standardized multiple linear regression (MLR) showed soil C and N increased with silt + clay content both counties, and decreased with species richness, particularly in Lee County. Standardized MLR showed C and N to increase with field age in Newton County, but decrease with field age in Lee County. This may be due to leaching of C and N because the oldest restorations were located in areas with greater slope and well-drained soils. Labile soil C decreased slightly with time since restoration in both Newton and Lee Counties
Comparative effectiveness and safety of low-strength and high-strength direct oral anticoagulants compared with warfarin: a sequential cohort study
No full textOBJECTIVES:The aim of this study was to compare effectiveness and safety of low-strength and high-strength direct oral anticoagulants (DOACs) with warfarin in the Australian Veteran population. DESIGN:Sequential cohort study using inverse probability of treatment weighting (IPTW) and propensity score matching. Initiators of high-strength (apixaban 5 mg, dabigatran 150 mg, rivaroxaban 20 mg) and low-strength DOACS (apixaban 2.5 mg, dabigatran 110 mg, rivaroxaban 15 mg) were compared with warfarin initiators. SETTING:Australian Government Department of Veterans' Affairs claims database. PARTICIPANTS:4836 patients who initiated oral anticoagulants (45.8%, 26.0% and 28.2% on low-strength, high-strength DOACs and warfarin, respectively) between August 2013 and March 2015. Mean age was 85, 75 and 83 years for low-strength, high-strength DOACs and warfarin initiators, respectively. MAIN OUTCOME MEASURES:One-year risk of hospitalisation for ischaemic stroke, any bleeding event or haemorrhagic stroke. Secondary outcomes were 1-year risk of hospitalisation for myocardial infarction and death. RESULTS:Using the IPTW method, no difference in risk of ischaemic stroke or bleeding was found with low-strength DOACs compared with warfarin. As a class, no increased risk of myocardial infarction was found for low-strength DOACs, however, risk was elevated for apixaban (HR 2.25, 95% CI 1.23 to 4.13). For high-strength DOACs, no difference was found for ischaemic stroke compared with warfarin, however, there was a significant reduction in risk of bleeding events (HR 0.63, 95% CI 0.44 to 0.89) and death (HR 0.40, 95% CI 0.28 to 0.58). Propensity score matching showed no difference in risk of ischaemic stroke or bleeding. CONCLUSION:We found that in the practice setting both DOAC formulations were similar to warfarin with regard to effectiveness and had no increased risk of bleeding.Nicole L Pratt, Emmae Ramsay, Lisa M Kalisch Ellett, Katherine Duszynski, Sepehr Shakib, Mhairi Kerr, Gillian Caughey, Elizabeth Ellen Roughea
MMWR. Morbidity and Mortality Weekly Report, Vol. 69, No. 26, July 3, 2020
No full textEstimated County-Level Prevalence of Selected Underlying Medical Conditions Associated with Increased Risk for Severe COVID-19 Illness \u2014 United States, 2018 / Hilda Razzaghi; Yan Wang; Hua Lu; Katherine E. Marshall et al.Identification of Substance-Exposed Newborns and Neonatal Abstinence Syndrome Using ICD-10-CM \u2014 15 Hospitals, Massachusetts, 2017 / Sonal Goyal; Katherine C. Saunders; Chiara S. Moore; Katherine T. Fillo \u2014 Evaluation of Online Risk Assessment To Identify Rabies Exposures Among Health Care Workers \u2014 Utah, 2019 / Erin R. Whitehouse; Dallin Peterson; Keegan McCaffrey; Amit Eichenbaum et al.Population Point Prevalence of SARS-CoV-2 Infection Based on a Statewide Random Sample \u2014 Indiana, April 25\u201329, 2020 / Nir Menachemi; Constantin T. Yiannoutsos; Brian E. Dixon; Thomas J. Duszynski et al.Estimated Community Seroprevalence of SARS-CoV-2 Antibodies \u2014 Two Georgia Counties, April 28\u2013May 3, 2020 / Holly M. Biggs; Jennifer B. Harris; Lucy Breakwell; F. Scott Dahlgren et al.Notes from the Field: Effects of the COVID-19 Response on Tuberculosis Prevention and Control Efforts \u2014 United States, March\u2013April 2020 / Ann M. Cronin; Shanica Railey; Diana Fortune; Donna Hope Wegener et al.Notes from the Field: Characteristics of Tetrahydrocannabinol\u2013 Containing E-cigarette, or Vaping, Products Used by Adults \u2014 Illinois, September\u2013October 2019 / Livia Navon; Isaac Ghinai; Jennifer LaydenQuickStats: Percentage of Adults Aged 50\u201375 Years Who Received Colorectal Cancer Screening, by Poverty Status and Year \u2014 National Health Interview Survey, United States, 2010 and 2018
