2023 |
Di Castelnuovo A, Bonaccio M, Costanzo S, McElduff P, Linneberg A, Salomaa V, et al., 'Drinking alcohol in moderation is associated with lower rate of all-cause mortality in individuals with higher rather than lower educational level: findings from the MORGAM project', European Journal of Epidemiology, 38 869-881 (2023) [C1]
The association between socioeconomic status (SES) and alcohol-related diseases has been widely explored. Less is known, however, on whether the association of moderate drinking w... [more]
The association between socioeconomic status (SES) and alcohol-related diseases has been widely explored. Less is known, however, on whether the association of moderate drinking with all-cause mortality is modified by educational level (EL). Using harmonized data from 16 cohorts in the MORGAM Project (N = 142,066) the association of pattern of alcohol intake with hazard of all-cause mortality across EL (lower = primary-school; middle = secondary-school; higher = university/college degree) was assessed using multivariable Cox-regression and spline curves. A total of 16,695 deaths occurred in 11.8¿years (median). In comparison with life-long abstainers, participants drinking 0.1¿10¿g/d of ethanol had 13% (HR = 0.87; 95%CI: 0.74¿1.02), 11% (HR = 0.89; 0.84¿0.95) and 5% (HR = 0.95; 0.89¿1.02) lower rate of death in higher, middle and lower EL, respectively. Conversely, drinkers > 20¿g/d had 1% (HR = 1.01; 0.82¿1.25), 10% (HR = 1.10; 1.02¿1.19) and 17% (HR = 1.17; 1.09¿1.26) higher rate of death. The association of alcohol consumption with all-cause mortality was nonlinear, with a different J-shape by EL levels. It was consistent across both sexes and in various approaches of measuring alcohol consumption, including combining quantity and frequency and it was more evident when the beverage of preference was wine. We observed that drinking in moderation (= 10¿g/d) is associated with lower mortality rate more evidently in individuals with higher EL than in people with lower EL, while heavy drinking is associated with higher mortality rate more evidently in individuals with lower EL than in people with higher EL, suggesting that advice on reducing alcohol intake should especially target individuals of low EL.
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Nova |
2022 |
Bihari S, McElduff P, Pearse J, Cho O, Pilcher D, 'Intensive care unit strain and mortality risk in patients admitted from the ward in Australia and New Zealand', Journal of Critical Care, 68 136-140 (2022) [C1]
Purpose: ICU strain (low number of available beds) may be associated with a delay and altered threshold for ICU admission and adverse patient outcomes. We aimed to investigate the... [more]
Purpose: ICU strain (low number of available beds) may be associated with a delay and altered threshold for ICU admission and adverse patient outcomes. We aimed to investigate the impact of ICU strain on hospital mortality in critically ill patients admitted from wards across Australia and New Zealand. Materials and methods: Ward patient admitted to ICU and ICU bed data at 137 hospitals were accessed between January 2013 and December 2016. ICU strain was classified as low (=0.5 patients admitted per available ICU bed in a 6-h block), medium (0.5 to =1) or high (>1). Logistic regression models were used to examine the relationship between ICU strain and hospital mortality. Results: 57,844 ICU admissions were analysed, with the majority (64.4%) admitted to medium-strain ICUs. Those admitted to high-strain ICUs spent longer in hospital prior to ICU than medium-strain or low-strain ICUs. After adjusting for confounders those admitted to high-strain ICUs [OR 1.24 (95%CI 1.14¿1.35)] or medium-strain ICUs [OR 1.18 (95%CI 1.09¿1.27)], (p < 0.001) had a higher risk of death compared low-strain ICUs. Conclusion: ICU strain is associated with longer times in hospital prior to ICU admission and was associated with increased risk of death in patients admitted from ward.
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Nova |
2022 |
Di Castelnuovo A, Costanzo S, Bonaccio M, McElduff P, Linneberg A, Salomaa V, et al., 'Alcohol intake and total mortality in 142 960 individuals from the MORGAM Project: a population-based study', ADDICTION, 117 312-325 (2022) [C1]
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Nova |
2022 |
Tyagi S, Chan E-C, Barker D, McElduff P, Taylor KA, Riveros C, et al., 'Transcriptomic analysis reveals myometrial topologically associated domains linked to the onset of human term labour.', Mol Hum Reprod, 28 (2022) [C1]
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Nova |
2021 |
Bailey KA, Baker AL, McElduff P, Kay-Lambkin F, Kavanagh DJ, 'Do outcomes of cognitive-behaviour therapy for co-occurring alcohol misuse and depression differ for participants with symptoms of posttraumatic stress?', Journal of Mental Health, 30 12-19 (2021) [C1]
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Nova |
2021 |
Levesque JV, Lambert SD, Girgis A, Turner J, McElduff P, Kayser K, 'Do men with prostate cancer and their partners receive the information they need for optimal illness self-management in the immediate post-diagnostic phase?', ASIA-PACIFIC JOURNAL OF ONCOLOGY NURSING, 2 169-175 (2021)
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2021 |
O'Connell SM, O'Toole NMA, Cronin CN, Saat-Murphy C, McElduff P, King BR, et al., 'Does dietary fat cause a dose dependent glycemic response in youth with type 1 diabetes?', PEDIATRIC DIABETES, 22 1108-1114 (2021) [C1]
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Nova |
2020 |
Richardson A, Pang T, Hitos K, Toh JWT, Johnston E, Morgan G, et al., 'Comparison of administrative data and the American College of Surgeons National Surgical Quality Improvement Program data in a New South Wales Hospital', ANZ Journal of Surgery, 90 734-739 (2020) [C1]
Background: The National Surgical Quality Improvement Program (NSQIP) is widely used in North America for benchmarking. In 2015, NSQIP was introduced to four New South Wales publi... [more]
Background: The National Surgical Quality Improvement Program (NSQIP) is widely used in North America for benchmarking. In 2015, NSQIP was introduced to four New South Wales public hospitals. The aim of this study is to investigate the agreement between NSQIP and administrative data in the Australian setting; to compare the performance of models derived from each data set to predict 30-day outcomes. Methods: The NSQIP and administrative data variables were mapped to select variables available in both data sets where coding may be influenced by interpretation of the clinical information. These were compared for agreement. Logistic regression models were fitted to estimate the probability of adverse outcomes within 30 days. Models derived from NSQIP and administrative data were compared by receiver operating characteristic curve analysis. Results: A total of 2240 procedures over 21 months had matching records. Functional status demonstrated poor agreement (kappa 0.02): administrative data recorded only one (1%) patient with partial- or total-dependence as recorded by NSQIP data. The American Society of Anesthesiologists class demonstrated excellent agreement (kappa 0.91). Other perioperative variables demonstrated poor to fair agreement (kappa 0.12¿0.61). Predictive model based on NSQIP data was excellent at predicting mortality but was less accurate for complications and readmissions. The NSQIP model was better in predicting mortality and complications (receiver operating characteristic curve 0.93 versus 0.87; P = 0.029 and 0.71 versus 0.64; P = 0.027). Conclusions: There is poor agreement between NSQIP data and administrative data. Predictive models associated with NSQIP data were more accurate at predicting surgical outcomes than those from administrative data. To drive quality improvement in surgery, high-quality clinical data are required and we believe that NSQIP fulfils this function.
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Nova |
2020 |
Vaikuntam BP, Middleton JW, McElduff P, Walsh J, Pearse J, Connelly L, Sharwood LN, 'Gap in funding for specialist hospitals treating patients with traumatic spinal cord injury under an activity-based funding model in New South Wales, Australia', Australian Health Review, 44 365-376 (2020)
Objective: The aim of this study was to estimate the difference between treatment costs in acute care settings and the level of funding public hospitals would receive under the ac... [more]
Objective: The aim of this study was to estimate the difference between treatment costs in acute care settings and the level of funding public hospitals would receive under the activity-based funding model. Methods: Patients aged =16 years who had sustained an incident traumatic spinal cord injury (TSCI) between June 2013 and June 2016 in New South Wales were included in the study. Patients were identified from record-linked health data. Costs were estimated using two approaches: (1) using District Network Return (DNR) data; and (2) based on national weighted activity units (NWAU) assigned to activity-based funding activity. The funding gap in acute care treatment costs for TSCI patients was determined as the difference in cost estimates between the two approaches. Results: Over the study period, 534 patients sustained an acute incident TSCI, accounting for 811 acute care hospital separations within index episodes. The total acute care treatment cost was estimated at A$40.5 million and A$29.9 million using the DNR- and NWAU-based methods respectively. The funding gap in total costs was greatest for the specialist spinal cord injury unit (SCIU) colocated with a major trauma service (MTS), at A$4.4 million over the study period. Conclusions: The findings of this study suggest a substantial gap in funding for resource-intensive patients with TSCI in specialist hospitals under current DRG-based funding methods. What is known about the topic?: DRG-based funding methods underestimate the treatment costs at the hospital level for patients with complex resource-intensive needs. This underestimation of true direct costs can lead to under-resourcing of those hospitals providing specialist services. What does this paper add?: This study provides evidence of a difference between true direct costs in acute care settings and the level of funding hospitals would receive if funded according to the National Efficient Price and NWAU for patients with TSCI. The findings provide evidence of a shortfall in the casemix funding to public hospitals under the activity-based funding for resource-intensive care, such as patients with TSCI. Specifically, depending on the classification system, the principal referral hospitals, the SCIU colocated with an MTS and stand-alone SCIU were underfunded, whereas other non-specialist hospitals were overfunded for the acute care treatment of patients with TSCI. What are the implications for practitioners?: Although health care financing mechanisms may vary internationally, the results of this study are applicable to other hospital payment systems based on diagnosis-related groups that describe patients of similar clinical characteristics and resource use. Such evidence is believed to be useful in understanding the adequacy of hospital payments and informing payment reform efforts. These findings may have service redesign policy implications and provide evidence for additional loadings for specialist hospitals treating low-volume, resource-intensive patients.
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2020 |
Newcomb AE, Dignan R, McElduff P, Pearse EJ, Bannon P, 'Bleeding After Cardiac Surgery Is Associated With an Increase in the Total Cost of the Hospital Stay', Annals of Thoracic Surgery, 109 1069-1078 (2020) [C1]
Background: Cardiac surgery results in complications for some patients that lead to a longer hospital stay and higher costs. This study identified the presurgery characteristics o... [more]
Background: Cardiac surgery results in complications for some patients that lead to a longer hospital stay and higher costs. This study identified the presurgery characteristics of patients that were associated with the cost of their hospital stay and estimated how much of that cost could be attributed to a bleeding event, defined as requiring 3 units or more of packed red blood cells or returning to the operating room for bleeding. We also identified the presurgery characteristics that were associated with the bleeding event. Methods: This prospective cohort of patients (n = 1459) underwent cardiac surgery at 3 tertiary referral hospitals in Australia during 2014 and 2015. Clinical data included the variables held by the Australian and New Zealand Society of Cardiac and Thoracic Surgeons registry. Cost data were collected as part of a state-level hospital data collection. Results: Many of the baseline patient characteristics were associated with the total cost of cardiac surgery. After adjusting for these characteristics, the cost of cardiac surgery was 1.76 (confidence interval, 1.64-1.90) times higher for patients who had a bleeding event (P < .001), thus resulting in a median increase in costs (in Australian dollars) of $33,338 (confidence interval, $21,943-$38,415). Several baseline characteristics were strongly associated with a bleeding event. Conclusions: The impact of a bleeding event on the cost of cardiac surgery is substantial. This study identified a set of risk factors for bleeding that could be used to identify patients for discussion at the heart team level, where measures to minimize the risk of transfusion may be initiated.
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Nova |
2020 |
Montalto M, McElduff P, Hardy K, 'Home ward bound: features of hospital in the home use by major Australian hospitals, 2011 2017', Medical Journal of Australia, 213 22-27 (2020) [C1]
Objective: To describe uptake of hospital in the home (HIH) by major Australian hospitals and the characteristics of patients and their HIH admissions; to assess change in HIH adm... [more]
Objective: To describe uptake of hospital in the home (HIH) by major Australian hospitals and the characteristics of patients and their HIH admissions; to assess change in HIH admission numbers relative to total hospital activity. Design: Descriptive, retrospective study of HIH activity, analysing previously collected census data for all multi-day hospital inpatient admissions to included hospitals during the period 1 January 2011 ¿ 31 December 2017. Setting, participants: Nineteen principal referrer hospital members of the Health Roundtable in Australia. Main outcome measures: HIH admissions by diagnosis-related group (DRG); patient and admission characteristics. Results: 80¿167 of 2¿185¿421 admissions to the 19 hospitals included HIH care, or 3.7% (95% CI, 3.6¿3.7%) of all admissions. Median length of stay for admissions including HIH (7.3 days; IQR, 3.1¿14 days) was longer than that for those that did not (2.7 days; IQR, 1.6¿5.1 days). For HIH admissions, the proportion of men was higher (54.4% v 45.9%), the proportion of patients who died in hospital was lower (0.3% v 1.4%), and re-admission within 28 days was less frequent (2.3% v 3.6%). The 50 DRGs with greatest HIH activity encompassed 65¿811 HIH admissions (82.1%), or 8.4% (95% CI, 8.4¿8.5%) of all admissions in these DRGs. HIH admission numbers grew more rapidly than non-HIH admissions, but the difference was not statistically significant. Conclusions: HIH care is most frequently provided to patients requiring hospital treatment related to infections, venous thromboembolism, or post-surgical care. Its use could be expanded in clinical areas where it is currently used, and extended to others where it is not. HIH activity is growing. It should be systematically monitored and reported to allow better overview of its use and outcomes.
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Nova |
2020 |
McInnes E, Dale S, Craig L, Phillips R, Fasugba O, Schadewaldt V, et al., 'Process evaluation of an implementation trial to improve the triage, treatment and transfer of stroke patients in emergency departments (T-3 trial): a qualitative study', IMPLEMENTATION SCIENCE, 15 (2020) [C1]
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Nova |
2019 |
Cheung NW, Campbell LV, Fulcher GR, McElduff P, Depczynski B, Acharya S, et al., 'Routine glucose assessment in the emergency department for detecting unrecognised diabetes: a cluster randomised trial', Medical Journal of Australia, 211 454-459 (2019) [C1]
Objective: To determine whether routine blood glucose assessment of patients admitted to hospital from emergency departments (EDs) results in higher rates of new diagnoses of diab... [more]
Objective: To determine whether routine blood glucose assessment of patients admitted to hospital from emergency departments (EDs) results in higher rates of new diagnoses of diabetes and documentation of follow-up plans. Design, setting: Cluster randomised trial in 18 New South Wales public district and tertiary hospitals, 31 May 2011 ¿ 31 December 2012; outcomes follow-up to 31 March 2016. Participants: Patients aged 18 years or more admitted to hospital from EDs. Intervention: Routine blood glucose assessment at control and intervention hospitals; automatic requests for glycated haemoglobin (HbA1c) assessment and notification of diabetes services about patients at intervention hospitals with blood glucose levels of 14¿mmol/L or more. Main outcome measure: New diagnoses of diabetes and documented follow-up plans for patients with admission blood glucose levels of 14¿mmol/L or more. Results: Blood glucose was measured in 133¿837 patients admitted to hospital from an ED. The numbers of new diabetes diagnoses with documented follow-up plans for patients with blood glucose levels of 14¿mmol/L or more were similar in intervention (83/506 patients, 16%) and control hospitals (73/278, 26%; adjusted odds ratio [aOR], 0.83; 95% CI 0.42¿1.7; P¿=¿0.61), as were new diabetes diagnoses with or without plans (intervention, 157/506, 31%; control, 86/278, 31%; aOR, 1.51; 95% CI, 0.83¿2.80; P¿=¿0.18). 30-day re-admission (31% v 22%; aOR, 1.34; 95% CI, 0.86¿2.09; P¿=¿0.21) and post-hospital mortality rates (24% v 22%; aOR, 1.07; 95% CI, 0.74¿1.55; P¿=¿0.72) were also similar for patients in intervention and control hospitals. Conclusion: Glucose and HbA1c screening of patients admitted to hospital from EDs does not alone increase detection of previously unidentified diabetes. Adequate resourcing and effective management pathways for patients with newly detected hyperglycaemia and diabetes are needed. Trial registration: Australian New Zealand Clinical Trials Registry, ACTRN12611001007921.
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Nova |
2019 |
Vaikuntam BP, Middleton JW, McElduff P, Connelly L, Pearse J, Stanford R, et al., 'Identifying Predictors of Higher Acute Care Costs for Patients with Traumatic Spinal Cord Injury and Modeling Acute Care Pathway Redesign: A Record Linkage Study', Spine, 44 E974-E983 (2019)
Study Design.Record linkage study using healthcare utilization and costs data.Objective.To identify predictors of higher acute-care treatment costs and length of stay for patients... [more]
Study Design.Record linkage study using healthcare utilization and costs data.Objective.To identify predictors of higher acute-care treatment costs and length of stay for patients with traumatic spinal cord injury (TSCI).Summary of Background Data.There are few current or population-based estimates of acute hospitalization costs, length of stay, and other outcomes for people with TSCI, on which to base future planning for specialist SCI health care services.Methods.Record linkage study using healthcare utilization and costs data; all patients aged more than or equal to 16 years with incident TSCI in the Australian state of New South Wales (June 2013-June 2016). Generalized Linear Model regression to identify predictors of higher acute care treatment costs for patients with TSCI. Scenario analysis quantified the proportionate cost impacts of patient pathway modification.Results.Five hundred thirty-four incident cases of TSCI (74% male). Total cost of all acute index episodes approximately AUD$40.5 (95% confidence interval [CI] ±4.5) million; median cost per patient was AUD$45,473 (Interquartile Range: $15,535-$94,612). Patient pathways varied; acute care was less costly for patients admitted directly to a specialist spinal cord injury unit (SCIU) compared with indirect transfer within 24 hours. Over half (53%) of all patients experienced at least one complication during acute admission; their care was less costly if they had been admitted directly to SCIU. Scenario analysis demonstrated that a reduction of indirect transfers to SCIU by 10% yielded overall cost savings of AUD$3.1 million; an average per patient saving of AUD$5,861.Conclusion.Direct transfer to SCIU for patients with acute TSCI resulted in lower treatment costs, shorter length of stay, and less costly complications. Modeling showed that optimizing patient-care pathways can result in significant acute-care cost savings. Reducing potentially preventable complications would further reduce costs and improve longer-term patient outcomes.Level of Evidence: 3.
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2019 |
Middleton S, McElduff P, Drury P, D'Este C, Cadilhac DA, Dale S, et al., 'Vital sign monitoring following stroke associated with 90-day independence: A secondary analysis of the QASC cluster randomized trial', International Journal of Nursing Studies, 89 72-79 (2019) [C1]
Background: The Quality in Acute Stroke Care Trial implemented nurse-initiated protocols to manage fever, hyperglycaemia and swallowing (Fever, Sugar, Swallow clinical protocols) ... [more]
Background: The Quality in Acute Stroke Care Trial implemented nurse-initiated protocols to manage fever, hyperglycaemia and swallowing (Fever, Sugar, Swallow clinical protocols) achieving a 16% absolute improvement in death and dependency 90-day post-stroke. Objective: To examine associations between 90-day death and dependency, and monitoring and treatment processes of in-hospital nursing stroke care targeted in the trial. Design: Secondary data analysis from a single-blind cluster randomised control trial. Setting: 19 acute stroke units in New South Wales, Australia. Participants: English-speakers =18 years with ischaemic stroke or intracerebral haemorrhage arriving at participating stroke units <48 h of stroke onset, excluding those for palliation and without a telephone. Method: Data from patients in the 10 intervention hospitals and the nine control hospitals in the QASC trial post-intervention cohort, who had both hospital process of care data and 90-day outcome data were included. Associations between independence at 90-day (modified Rankin Score =1) and processes of care for fever, hyperglycaemia, and dysphagia screening were examined using multiple logistic regression adjusting for treatment group, sex, age group, premorbid modified Rankin scale, marital status, education, stroke severity and correlation within hospitals. Results: Of 1126 patients in the post-intervention cohort (intervention or control), 970 had both in-hospital processes of care data and 90-day outcome data. Patients had significantly lower odds of 90-day independence if, within the first 72 h of stroke unit admission, they had one or more: febrile event (=37.5 °C) (OR 0.47; 95%CI:0.35-0.61; P < 0.0001), higher mean temperature (OR:0.25; 95%CI:0.14-0.45; P < 0.0001), finger-prick blood glucose reading =11 mmol/L (OR:0.61; 95%CI:0.47-0.79; P = 0.0002), higher mean blood glucose (OR 0.89; 95%CI:0.84-0.95; P = 0.0006), or failed the swallowing screen (OR 0.35; 95%CI:0.22-0.56; P < 0.0001). Patients had greater odds of independence when: venous blood glucose was taken on admission to hospital or within 2 h of stroke unit admission (OR 1.4; 95%CI:1.01¿1.83; P = 0.04); finger-prick blood glucose was measured within 72 h of stroke unit admission (OR 1.3; 95%CI:1.02-1.55; P = 0.03); or when swallowing screening or assessment was performed within 24 h of stroke unit admission (OR 1.8; 95%CI:1.29-2.55; P = 0.0006). Conclusion: We have provided robust evidence of the importance of monitoring patients¿ temperature, blood glucose and swallowing status to improve 90-day stroke outcomes. Routine nursing care can result in significant reduction in death and dependency post-stroke.
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Nova |
2019 |
Middleton S, Dale S, Cheung NW, Cadilhac DA, Grimshaw JM, Levi C, et al., 'Nurse-Initiated Acute Stroke Care in Emergency Departments: The Triage, Treatment, and Transfer Implementation Cluster Randomized Controlled Trial', Stroke, 50 1346-1355 (2019) [C1]
Background and Purpose-We aimed to evaluate the effectiveness of an intervention to improve triage, treatment, and transfer for patients with acute stroke admitted to the emergenc... [more]
Background and Purpose-We aimed to evaluate the effectiveness of an intervention to improve triage, treatment, and transfer for patients with acute stroke admitted to the emergency department (ED). Methods-A pragmatic, blinded, multicenter, parallel group, cluster randomized controlled trial was conducted between July 2013 and September 2016 in 26 Australian EDs with stroke units and tPA (tissue-type plasminogen activator) protocols. Hospitals, stratified by state and tPA volume, were randomized 1:1 to intervention or usual care by an independent statistician. Eligible ED patients had acute stroke <48 hours from symptom onset and were admitted to the stroke unit via ED. Our nurse-initiated T3 intervention targeted (1) Triage to Australasian Triage Scale category 1 or 2; (2) Treatment: tPA eligibility screening and appropriate administration; clinical protocols for managing fever, hyperglycemia, and swallowing; (3) prompt (<4 hours) stroke unit Transfer. It was implemented using (1) workshops to identify barriers and solutions; (2) face-to-face, online, and written education; (3) national and local clinical opinion leaders; and (4) email, telephone, and site visit follow-up. Outcomes were assessed at the patient level. Primary outcome: 90-day death or dependency (modified Rankin Scale score of =2); secondary outcomes: functional dependency (Barthel Index =95), health status (Short Form [36] Health Survey), and ED quality of care (Australasian Triage Scale; monitoring and management of tPA, fever, hyperglycemia, swallowing; prompt transfer). Intention-to-treat analysis adjusted for preintervention outcomes and ED clustering. Patients, outcome assessors, and statisticians were masked to group allocation. Results-Twenty-six EDs (13 intervention and 13 control) recruited 2242 patients (645 preintervention and 1597 postintervention). There were no statistically significant differences at follow-up for 90-day modified Rankin Scale (intervention: n=400 [53.5%]; control n=266 [48.7%]; P=0.24) or secondary outcomes. Conclusions-This evidence-based, theory-informed implementation trial, previously effective in stroke units, did not change patient outcomes or clinician behavior in the complex ED environment. Implementation trials are warranted to evaluate alternative approaches for improving ED stroke care. Clinical Trial Registration-URL: http://www.anzctr.org.au. Unique identifier: ACTRN12614000939695.
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Nova |
2018 |
Magin P, Tapley A, Morgan S, Davis JS, McElduff P, Yardley L, et al., 'Reducing early career general practitioners' antibiotic prescribing for respiratory tract infections: a pragmatic prospective non-randomised controlled trial.', Family practice, 35 53-60 (2018) [C1]
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Nova |
2018 |
Milton AH, Attia J, Alauddin M, McEvoy M, McElduff P, Hussain S, et al., 'Assessment of nutritional status of infants living in arsenic-contaminated areas in Bangladesh and its association with arsenic exposure', International Journal of Environmental Research and Public Health, 15 (2018) [C1]
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Nova |
2018 |
Milton AH, Vashum KP, McEvoy M, Hussain S, McElduff P, Byles J, Attia J, 'Prospective Study of Dietary Zinc Intake and Risk of Cardiovascular Disease in Women', NUTRIENTS, 10 (2018) [C1]
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Nova |
2018 |
Lopez PE, Evans M, King BR, Jones TW, Bell K, McElduff P, et al., 'A randomized comparison of three prandial insulin dosing algorithms for children and adolescents with Type 1 diabetes', Diabetic Medicine, 35 1440-1447 (2018) [C1]
Aim: To compare systematically the impact of two novel insulin-dosing algorithms (the Pankowska Equation and the Food Insulin Index) with carbohydrate counting on postprandial glu... [more]
Aim: To compare systematically the impact of two novel insulin-dosing algorithms (the Pankowska Equation and the Food Insulin Index) with carbohydrate counting on postprandial glucose excursions following a high fat and a high protein meal. Methods: A randomized, crossover trial at two Paediatric Diabetes centres was conducted. On each day, participants consumed a high protein or high fat meal with similar carbohydrate amounts. Insulin was delivered according to carbohydrate counting, the Pankowska Equation or the Food Insulin Index. Subjects fasted for 5 h following the test meal and physical activity was standardized. Postprandial glycaemia was measured for 300 min using continuous glucose monitoring. Results: 33 children participated in the study. When compared to carbohydrate counting, the Pankowska Equation resulted in lower glycaemic excursion for 90¿240 min after the high protein meal (p < 0.05) and lower peak glycaemic excursion (p < 0.05). The risk of hypoglycaemia was significantly lower for carbohydrate counting and the Food Insulin Index compared to the Pankowska Equation (OR 0.76 carbohydrate counting vs. the Pankowska Equation and 0.81 the Food Insulin Index vs. the Pankowska Equation). There was no significant difference in glycaemic excursions when carbohydrate counting was compared to the Food Insulin Index. Conclusion: The Pankowska Equation resulted in reduced postprandial hyperglycaemia at the expense of an increase in hypoglycaemia. There were no significant differences when carbohydrate counting was compared to the Food Insulin Index. Further research is required to optimize prandial insulin dosing.
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Nova |
2018 |
Vaikuntam BP, Middleton JW, McElduff P, Pearse J, Walsh J, Cameron ID, Sharwood LN, 'Assessing the impact of care pathways on potentially preventable complications and costs for spinal trauma patients: Protocol for a data linkage study using cohort study and administrative data', BMJ Open, 8 (2018)
Introduction Traumatic spinal cord injuries have significant consequences both for the injured individual and the healthcare system, usually resulting in lifelong disability. Evid... [more]
Introduction Traumatic spinal cord injuries have significant consequences both for the injured individual and the healthcare system, usually resulting in lifelong disability. Evidence has shown that timely medical and surgical interventions can lead to better patient outcomes with implicit cost savings. Potentially preventable secondary complications are therefore indicators of the effectiveness of acute care following traumatic injury. The extent to which policy and clinical variation within the healthcare service impact on outcomes and acute care costs for patients with traumatic spinal cord injury (TSCI) in Australia is not well described. Methods and analysis A comprehensive data set will be formed using record linkage to combine patient health and administrative records from seven minimum data collections (including costs), with an existing data set of patients with acute TSCI (Access to Care Study), for the time period June 2013 to June 2016. This person-level data set will be analysed to estimate the acute care treatment costs of TSCI in New South Wales, extrapolated nationally. Subgroup analyses will describe the associated costs of secondary complications and regression analysis will identify drivers of higher treatment costs. Mapping patient care and health service pathways of these patients will enable measurement of deviations from best practice care standards and cost-effectiveness analyses of the different pathways. Ethics and dissemination Ethics approval has been obtained from the New South Wales Population and Health Services Research Ethics Committee. Dissemination strategies include peer-reviewed publications in scientific journals and conference presentations to enable translation of study findings to clinical and policy audiences.
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2018 |
Weigner J, Zardawi I, Braye S, McElduff P, 'Reproducibility of diagnostic criteria associated with atypical breast cytology: A methodological issue', CYTOPATHOLOGY, 29 397-397 (2018)
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2018 |
Johnson NA, Kypri K, Saunders JB, Saitz R, Attia J, Latter J, et al., 'Effect of electronic screening and brief intervention on hazardous or harmful drinking among adults in the hospital outpatient setting: A randomized, double-blind, controlled trial', Drug and Alcohol Dependence, 191 78-85 (2018) [C1]
Background: Most trials of electronic alcohol screening and brief intervention (e-SBI) have been conducted in young people. The aim of this study was to evaluate the effect of e-S... [more]
Background: Most trials of electronic alcohol screening and brief intervention (e-SBI) have been conducted in young people. The aim of this study was to evaluate the effect of e-SBI in adults with hazardous or harmful drinking. Methods: This individually randomized, parallel, two-group, double-blind controlled trial was conducted in the outpatient department of a large public hospital in Australia. Consenting adults who scored 5¿9 on the AUDIT-C (837/3225; 26%) were randomized in a 1:1 ratio by computer to screening alone (442/837; 53%) or to 10 min of assessment and personalized feedback on their alcohol consumption (comparisons with medical guidelines and age and sex-specific norms), peak blood alcohol concentration, expenditure on alcohol, and risk of alcohol dependence (395/837; 47%). The two primary outcomes, assessed six months after randomization, were the number of standard drinks (10 g ethanol) consumed by participants in the last seven days and their AUDIT score. Results: 693/837 (83%) and 635/837 (76%) participants were followed-up at 6 and 12 months, respectively. There was no statistically significant difference between the groups in the median number of standard drinks consumed in the last seven days (intervention: 12; control: 10.5; rate ratio, 1.12 [95% confidence interval, 0.96¿1.31]; P =.17) or in their median AUDIT score (intervention: 7; control: 7; mean difference, 0.28 [-0.42 to 0.98]; P =.44). Conclusion: These results do not support the implementation of an e-SBI program comprising personalized feedback and normative feedback for adults with hazardous or harmful drinking in the hospital outpatient setting.
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Nova |
2018 |
Weigner J, Zardawi I, Braye S, McElduff P, 'Reproducibility of diagnostic criteria associated with atypical breast cytology', Cytopathology, 29 28-34 (2018) [C1]
Objective: The aim of this project was to assess the interobserver and intraobserver variability when identifying cytological criteria, which were found to have a statistically si... [more]
Objective: The aim of this project was to assess the interobserver and intraobserver variability when identifying cytological criteria, which were found to have a statistically significant association with C3 within a workplace environment. Methods: Sixty C3 cases with known endpoints of malignant, benign proliferative or benign non-proliferative diagnoses were blindly and independently screened by seven experienced cytologists to identify previously reported statistically significant criteria associated with the C3 category. The criteria included the presence of myoepithelial cells or bare bipolar nuclei, cohesiveness, cystic background, papillary fragments with fibrovascular cores and tubular structures. Kappa statistics were used to measure interobserver variability. Two cytologists repeated the process 6¿months later to obtain intraobserver data. Results: The interobserver agreement was poor for all criteria except tubules which performed badly. The intraobserver variability for the two cytologists showed that one cytologist achieved moderate intraobserver agreement for all the criteria except cohesion which was poor, whilst the second cytologist showed poor agreement for all criteria. The reasons for the variability are multifactorial and include threshold effects where criteria lack good definition or error in identifying the criteria. Conclusion: Interobserver and intraobserver variability remains a significant challenge for cytologists. Despite attempts to define significant criteria associated with C3, good reproducibility could not be achieved. The C3 category is imprecise and highlights the inadequacy of the current classification reporting categories for breast FNA. The impending review of reporting breast cytology by the International Academy of Cytology is timely and appropriate.
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Nova |
2017 |
Barker D, D'Este C, Campbell MJ, McElduff P, 'Minimum number of clusters and comparison of analysis methods for cross sectional stepped wedge cluster randomised trials with binary outcomes: A simulation study', TRIALS, 18 (2017) [C1]
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Nova |
2017 |
Paterson MA, Smart CEM, Lopez PE, Howley P, McElduff P, Attia J, et al., 'Increasing the protein quantity in a meal results in dose-dependent effects on postprandial glucose levels in individuals with Type 1 diabetes mellitus', Diabetic Medicine, 34 851-854 (2017) [C1]
Aim: To determine the glycaemic impact of increasing protein quantities when consumed with consistent amounts of carbohydrate in individuals with Type 1 diabetes on intensive insu... [more]
Aim: To determine the glycaemic impact of increasing protein quantities when consumed with consistent amounts of carbohydrate in individuals with Type 1 diabetes on intensive insulin therapy. Methods: Participants with Type 1 diabetes [aged 10¿40 years, HbA1c = 64 mmol/mol (8%), BMI = 91st percentile] received a 30-g carbohydrate (negligible fat) test drink daily over 5 days in randomized order. Protein (whey isolate 0 g/kg carbohydrate, 0 g/kg lipid) was added in amounts of 0 (control), 12.5, 25, 50 and 75 g. A standardized dose of insulin was given for the carbohydrate. Postprandial glycaemia was assessed by 5 h of continuous glucose monitoring. Results: Data were collected from 27 participants (15 male). A dose¿response relationship was found with increasing amount of protein. A significant negative relationship between protein dose and mean excursion was seen at the 30- and 60-min time points (P = 0.007 and P = 0.002, respectively). No significant relationship was seen at the 90- and 120-min time points. Thereafter, the dose¿response relationship inverted, such that there was a significant positive relationship for each of the 150¿300-min time points (P < 0.004). Mean glycaemic excursions were significantly greater for all protein-added test drinks from 150 to 300 min (P < 0.005) with the 75-g protein load, resulting in a mean excursion that was 5 mmol/l higher when compared with the control test drink (P < 0.001). Conclusions: Increasing protein quantity in a low-fat meal containing consistent amounts of carbohydrate decreases glucose excursions in the early (0¿60-min) postprandial period and then increases in the later postprandial period in a dose-dependent manner.
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Nova |
2017 |
Lynagh M, Kelly B, Horton G, Walker B, Powis D, Bore M, et al., 'Have we got the selection process right? The validity of selection tools for predicting academic performance in the first year of undergraduate medicine (2017)
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2017 |
Bailey KA, Baker AL, McElduff P, Jones MA, Oldmeadow C, Kavanagh DJ, 'Effects of Assault Type on Cognitive Behaviour Therapy for Coexisting Depression and Alcohol Misuse', JOURNAL OF CLINICAL MEDICINE, 6 (2017) [C1]
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Nova |
2017 |
Demeestere J, Garcia-Esperon C, Garcia-Bermejo P, Ombelet F, Mcelduff P, Bivard A, et al., 'Evaluation of hyperacute infarct volume using ASPECTS and brain CT perfusion core volume', Neurology, 88 2248-2253 (2017) [C1]
Objective: To compare the accuracy of Alberta Stroke Program Early Computed Tomography Score (ASPECTS) and CT perfusion to detect established infarction in acute anterior circulat... [more]
Objective: To compare the accuracy of Alberta Stroke Program Early Computed Tomography Score (ASPECTS) and CT perfusion to detect established infarction in acute anterior circulation stroke. Methods: We performed an observational study in 59 acute anterior circulation ischemic stroke patients who underwent brain noncontrast CT, CT perfusion, and MRI within 100 minutes from CT imaging. ASPECTS scores were calculated by 4 blinded vascular neurologists. The accuracy of ASPECTS and CT perfusion core volume to detect an acute MRI diffusion lesion of =70 mL was evaluated using receiver operating characteristics analysis and optimum cutoff values were calculated using Youden J. Results: Median ASPECTS score was 8 (interquartile range [IQR] 5-9). Median CT perfusion core volume was 22 mL (IQR 10.4-71.9). Median MRI diffusion lesion volume was 24.5 mL (IQR 10-63.9). No significant difference was found between the accuracy of CT perfusion and ASPECTS (c statistic 0.95 vs 0.87, p value for difference = 0.17). The optimum ASPECTS cutoff score to detect a diffusion-weighted imaging lesion =70 mL was <7 (sensitivity 0.74, specificity 0.86, Youden J = 0.60) and the optimum CT perfusion core volume cutoff was =50 mL (sensitivity 0.86, specificity 0.97, Youden J = 0.84). The CT perfusion core lesion covered a median of 100% (IQR 86%-100%) of the acute MRI lesion volume (Pearson R = 0.88; R 2 = 0.77). Conclusions: We found no significant difference between the accuracy of CT perfusion and ASPECTS to predict hyperacute MRI lesion volume in ischemic stroke.
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Nova |
2017 |
Lambert SD, Beatty L, McElduff P, Levesque JV, Lawsin C, Jacobsen P, et al., 'A systematic review and meta-analysis of written self-administered psychosocial interventions among adults with a physical illness.', Patient education and counseling, 100 2200-2217 (2017) [C1]
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Nova |
2017 |
Levi CR, Demeestere J, Garcia-Esperon C, Garcia-Bermejo P, Ombelet F, McElduff P, et al., 'AUTHOR RESPONSE: EVALUATION OF HYPERACUTE INFARCT VOLUME USING ASPECTS AND BRAIN CT PERFUSION CORE VOLUME', NEUROLOGY, 89 2398-2399 (2017)
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2017 |
Britton B, Baker A, Clover K, McElduff P, Wratten C, Carter G, 'Heads Up: a pilot trial of a psychological intervention to improve nutrition in head and neck cancer patients undergoing radiotherapy', EUROPEAN JOURNAL OF CANCER CARE, 26 (2017) [C1]
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Nova |
2017 |
Bivard A, Huang X, McElduff P, Levi CR, Campbell BCV, Cheripelli BK, et al., 'Impact of Computed Tomography Perfusion Imaging on the Response to Tenecteplase in Ischemic Stroke: Analysis of 2 Randomized Controlled Trials', Circulation, 135 440-448 (2017) [C1]
Background: We pooled 2 clinical trials of tenecteplase compared with alteplase for the treatment of acute ischemic stroke, 1 that demonstrated superiority of tenecteplase and the... [more]
Background: We pooled 2 clinical trials of tenecteplase compared with alteplase for the treatment of acute ischemic stroke, 1 that demonstrated superiority of tenecteplase and the other that showed no difference between the treatments in patient clinical outcomes. We tested the hypotheses that reperfusion therapy with tenecteplase would be superior to alteplase in improving functional outcomes in the group of patients with target mismatch as identified with advanced imaging. Methods: We investigated whether tenecteplase-Treated patients had a different 24-hour reduction in the National Institutes of Health Stroke Scale and a favorable odds ratio of a modified Rankin scale score of 0 to 1 versus 2 to 6 compared with alteplase-Treated patients using linear regression to generate odds ratios. Imaging outcomes included rates of vessel recanalization and infarct growth at 24 hours and occurrence of large parenchymal hematoma. Baseline computed tomography perfusion was analyzed to assess whether patients met the target mismatch criteria (absolute mismatch volume >15 mL, mismatch ratio >1.8, baseline ischemic core <70 mL, and volume of severely hypoperfused tissue <100 mL). Patients meeting target mismatch criteria were analyzed as a subgroup to identify whether they had different treatment responses from the pooled group. Results: Of 146 pooled patients, 71 received alteplase and 75 received tenecteplase. Tenecteplase-Treated patients had greater early clinical improvement (median National Institutes of Health Stroke Scale score change: Tenecteplase, 7; alteplase, 2; P=0.018) and less parenchymal hematoma (2 of 75 versus 10 of 71; P=0.02). The pooled group did not show improved patient outcomes when treated with tenecteplase (modified Rankin scale score 0-1: odds ratio, 1.77; 95% confidence interval, 0.89-3.51; P=0.102) compared with alteplase therapy. However, in patients with target mismatch (33 tenecteplase, 35 alteplase), treatment with tenecteplase was associated with greater early clinical improvement (median National Institutes of Health Stroke Scale score change: Tenecteplase, 6; alteplase, 1; P<0.001) and better late independent recovery (modified Rankin scale score 0-1: odds ratio, 2.33; 95% confidence interval, 1.13-5.94; P=0.032) than those treated with alteplase. Conclusions: Tenecteplase may offer an improved efficacy and safety profile compared with alteplase, benefits possibly exaggerated in patients with baseline computed tomography perfusion-defined target mismatch. Clinical Trial Registration: URL: http://www.clinicaltrials.gov. Unique identifier: NCT01472926. URL: https://www.anzctr.org.au. Unique identifier: ACTRN12608000466347.
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Nova |
2017 |
Marsden DL, Dunn A, Callister R, McElduff P, Levi CR, Spratt NJ, 'Interval circuit training for cardiorespiratory fitness is feasible for people after stroke', International Journal of Therapy and Rehabilitation, 24 190-202 (2017) [C1]
Aims: To determine if community-dwelling stroke survivors can achieve exercise intensities sufficient to improve cardiorespiratory fitness during a single session of circuit train... [more]
Aims: To determine if community-dwelling stroke survivors can achieve exercise intensities sufficient to improve cardiorespiratory fitness during a single session of circuit training using an interval training approach. Methods: Thirteen independently ambulant participants within 1 year of stroke were included in this observational study (females=54%; median age=65.6 years; interquartile range=23.9). Exercise intensities were assessed throughout an individually tailored circuit of up to seven 5-minute workstations from a selection of nine functional (e.g. walking, stairs, balance) and three ergometer (upright cycle, rower, treadmill) workstations. The interval durations ranged from 5¿60 seconds. Oxygen consumption (VO2) was recorded continuously using a portable metabolic system. The average VO2 during each 30-second epoch was determined. VO2=10.5 mL/kg/min was categorised as =moderate intensity. Findings: Participants exercised at VO2=10.5 mL/kg/min for the majority of the time on the workstations [functional: 369/472 epochs (78%), ergometer: 170/204 epochs (83%)]. Most (69%) participants exercised for =30 minutes. No serious adverse events occurred. Conclusions: Applying interval training principles to a circuit of functional and ergometer workstations enabled ambulant participants to exercise at an intensity and for a duration that can improve cardiorespiratory fitness. The training approach appears feasible, safe and a promising way to incorporate both cardiorespiratory fitness and functional training into post-stroke management.
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Nova |
2017 |
Kypri K, Davie G, McElduff P, Langley J, Connor J, 'Long-term effects of lowering the alcohol minimum purchasing age on traffic crash injury rates in New Zealand', Drug and Alcohol Review, 36 178-185 (2017) [C1]
Introduction and Aims: In December 1999, New Zealand lowered the alcohol minimum purchasing age from 20 to 18 years. We tested hypotheses that this change was associated with long... [more]
Introduction and Aims: In December 1999, New Zealand lowered the alcohol minimum purchasing age from 20 to 18 years. We tested hypotheses that this change was associated with long-term increases in traffic injury attributable to alcohol-impaired driving among 18- to 19-year-olds (target age group) and 15- to 17-year-olds (affected by ¿trickle-down¿). Design and Methods: We undertook a controlled before-and-after comparison of rates of fatal and non-fatal traffic injury to persons of any age attributable to impaired drivers aged 18¿19 years and 15¿17 years, versus 20- to 21-year-olds. Crash data including assessment of driver alcohol impairment were recorded by New Zealand Police. The pre-change period was 1996¿1999. Post-change periods were 2000¿2003, 2004¿2007 and 2008¿2010. Outcomes were population-based and vehicle travel-based rates. Results: Compared with the change in injury rates attributable to alcohol-impaired 20- to 21-year-old male drivers, injuries attributable to 18- to 19-year-old male drivers increased in all post-change periods and significantly so in the second post-change period (incidence rate ratio [IRR] 1.3, 95% confidence interval [CI] 1.1 to 1.5). For 15- to 17-year-old male drivers, rates increased in all post-change periods compared with 20- to 21-year-olds, and more so in the second (IRR 1.2, 95% CI 1.1 to 1.4) and third (IRR 1.2, 95% CI 1.1 to 1.4) periods. There was a short-term relative increase in harm attributable to 18- to 19-year-old female drivers (IRR 1.5; 1.1 to 2.0). Results were similar for vehicle travel-based rates. Discussion and Conclusions: Reducing the alcohol minimum purchasing age was followed by long-term increases in the incidence of traffic injury attributable to male 15- to 19-year-old alcohol-impaired drivers. [Kypri K, Davie G, McElduff P, Langley J, Connor J. Long-term effects of lowering the alcohol minimum purchasing age on traffic crash injury rates in New Zealand. Drug Alcohol Rev 2017;36:178¿185].
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Nova |
2017 |
Gore J, Holmes K, Smith M, Fray L, McElduff P, Weaver N, Wallington C, 'Unpacking the career aspirations of Australian school students: towards an evidence base for university equity initiatives in schools', Higher Education Research and Development, 36 1383-1400 (2017) [C1]
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Nova |
2017 |
Lopez PE, Smart CE, McElduff P, Foskett DC, Price DA, Paterson MA, King BR, 'Optimizing the combination insulin bolus split for a high-fat, high-protein meal in children and adolescents using insulin pump therapy', Diabetic Medicine, 34 1380-1384 (2017) [C1]
Aims: To determine the optimum combination bolus split to maintain postprandial glycaemia with a high-fat and high-protein meal in young people with Type 1 diabetes. Methods: A to... [more]
Aims: To determine the optimum combination bolus split to maintain postprandial glycaemia with a high-fat and high-protein meal in young people with Type 1 diabetes. Methods: A total of 19 young people (mean age 12.9 ± 6.7 years) participated in a randomized, repeated-measures trial comparing postprandial glycaemic control across six study conditions after a high-fat and high-protein meal. A standard bolus and five different combination boluses were delivered over 2 h in the following splits: 70/30 = 70% standard /30% extended bolus; 60/40=60% standard/40% extended bolus; 50/50=50% standard/50% extended bolus; 40/60=40% standard/60% extended bolus; and 30/70=30% standard/70% extended bolus. Insulin dose was determined using the participant's optimized insulin:carbohydrate ratio. Continuous glucose monitoring was used to assess glucose excursions for 6 h after the test meal. Results: Standard bolus and combination boluses 70/30 and 60/40 controlled the glucose excursion up to 120 min. From 240 to 300 min after the meal, the glucose area under the curve was significantly lower for combination bolus 30/70 compared with standard bolus (P=0.004). Conclusions: High-fat and high-protein meals require a =60% insulin:carbohydrate ratio as a standard bolus to control the initial postprandial rise. Additional insulin at an insulin:carbohydrate ratio of up to 70% is needed in the extended bolus for a high fat and protein meal to prevent delayed hyperglycaemia.
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Nova |
2017 |
Middleton S, Coughlan K, Mnatzaganian G, Low Choy N, Dale S, Jammali-Blasi A, et al., 'Mortality Reduction for Fever, Hyperglycemia, and Swallowing Nurse-Initiated Stroke Intervention: QASC Trial (Quality in Acute Stroke Care) Follow-Up', Stroke, 48 1331-1336 (2017) [C1]
Background and Purpose - Implementation of nurse-initiated protocols to manage fever, hyperglycemia, and swallowing dysfunction decreased death and disability 90 days poststroke i... [more]
Background and Purpose - Implementation of nurse-initiated protocols to manage fever, hyperglycemia, and swallowing dysfunction decreased death and disability 90 days poststroke in the QASC trial (Quality in Acute Stroke Care) conducted in 19 Australian acute stroke units (2005-2010). We now examine long-term all-cause mortality. Methods - Mortality was ascertained using Australia's National Death Index. Cox proportional hazards regression compared time to death adjusting for correlation within stroke units using the cluster sandwich (Huber-White estimator) method. Primary analyses included treatment group only unadjusted for covariates. Secondary analysis adjusted for age, sex, marital status, education, and stroke severity using multiple imputation for missing covariates. Results - One thousand and seventy-six participants (intervention n=600; control n=476) were followed for a median of 4.1 years (minimum 0.3 to maximum 70 months), of whom 264 (24.5%) had died. Baseline demographic and clinical characteristics were generally well balanced by group. The QASC intervention group had improved long-term survival (>20%), but this was only statistically significant in adjusted analyses (unadjusted hazard ratio [HR], 0.79; 95% confidence interval [CI], 0.58-1.07; P=0.13; adjusted HR, 0.77; 95% CI, 0.59-0.99; P=0.045). Older age (75-84 years; HR, 4.9; 95% CI, 2.8-8.7; P<0.001) and increasing stroke severity (HR, 1.5; 95% CI, 1.3-1.9; P<0.001) were associated with increased mortality, while being married (HR, 0.70; 95% CI, 0.49-0.99; P=0.042) was associated with increased likelihood of survival. Cardiovascular disease (including stroke) was listed either as the primary or secondary cause of death in 80% (211/264) of all deaths. Conclusions - Our results demonstrate the potential long-term and sustained benefit of nurse-initiated multidisciplinary protocols for management of fever, hyperglycemia, and swallowing dysfunction. These protocols should be a routine part of acute stroke care.
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Nova |
2016 |
Barker D, McElduff P, D'Este C, Campbell MJ, 'Stepped wedge cluster randomised trials: a review of the statistical methodology used and available', BMC MEDICAL RESEARCH METHODOLOGY, 16 (2016) [C1]
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Nova |
2016 |
Bartlem KM, Bowman J, Freund M, Wye PM, Barker D, McElwaine KM, et al., 'Effectiveness of an intervention in increasing the provision of preventive care by community mental health services: a non-randomized, multiple baseline implementation trial', IMPLEMENTATION SCIENCE, 11 (2016) [C1]
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Nova |
2016 |
Hibberd AD, Clark DA, Trevillian PR, Mcelduff P, 'Interaction between castanospermine an immunosuppressant and cyclosporin A in rat cardiac transplantation.', World journal of transplantation, 6 206-214 (2016) [C1]
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Nova |
2016 |
Pearlman J, Morgan S, Van Driel M, Henderson K, Tapley A, McElduff P, et al., 'Continuity of care in general practice vocational training: Prevalence, associations and implications for training', Education for Primary Care, 27 27-36 (2016) [C1]
Continuity of care is a defining characteristic of general practice. Practice structures may limit continuity of care experience for general practice registrars (trainees). This s... [more]
Continuity of care is a defining characteristic of general practice. Practice structures may limit continuity of care experience for general practice registrars (trainees). This study sought to establish prevalence and associations of registrars' continuity of care. We performed an analysis of an ongoing cohort study of Australian registrars' clinical consultations. Primary outcome factors were 'Upstream' continuity (having seen the patient prior to the index consultation) and 'Downstream' continuity (follow-up organised post-index consultation). Independent variables were registrar, practice, patient, consultation and educational factors. 400 registrars recorded 48,114 consultations. 43% of patients had seen the registrar pre-index consultation, and 49% had follow-up organised. 'Upstream' continuity associations included registrar seniority, Australian medical qualification, practice billing policy, smaller practice size, registrar's previous training in the practice, chronic disease and older, female patients (but not registrar full-Time/part-Time status). Associations of 'Downstream' continuity included non-Australian qualification, billing, chronic disease and the patient having seen the registrar previously. Consultations prompting follow-up were more complex: longer duration, involving more problems and generating more learning goals. There was, however, evidence for limited educational utility of this 'continuity'. In our study, continuity of care in Australian registrars' training experience is modest. Associations are complex, but may inform initiatives to increase in-Training continuity.
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Nova |
2016 |
Kypri K, McElduff P, Miller P, 'Night-time assaults in Newcastle 6-7 years after trading hour restrictions', DRUG AND ALCOHOL REVIEW, 35 E1-E2 (2016)
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Nova |
2016 |
Marsden DL, Dunn A, Callister R, McElduff P, Levi CR, Spratt NJ, 'A Home- and Community-Based Physical Activity Program Can Improve the Cardiorespiratory Fitness and Walking Capacity of Stroke Survivors', Journal of Stroke and Cerebrovascular Diseases, 25 2386-2398 (2016) [C1]
Background The cardiorespiratory fitness of stroke survivors is low. Center-based exercise programs that include an aerobic component have been shown to improve poststroke cardior... [more]
Background The cardiorespiratory fitness of stroke survivors is low. Center-based exercise programs that include an aerobic component have been shown to improve poststroke cardiorespiratory fitness. This pilot study aims to determine the feasibility, safety, and preliminary efficacy of an individually tailored home- and community-based exercise program to improve cardiorespiratory fitness and walking capacity in stroke survivors. Methods Independently ambulant, community-dwelling stroke survivors were recruited. The control (n¿=¿10) and intervention (n¿=¿10) groups both received usual care. In addition the intervention group undertook a 12-week, individually tailored, home- and community-based exercise program, including once-weekly telephone or e-mail support. Assessments were conducted at baseline and at 12 weeks. Feasibility was determined by retention and program participation, and safety by adverse events. Efficacy measures included change in cardiorespiratory fitness (peak oxygen consumption [VO2peak]) and distance walked during the Six-Minute Walk Test (6MWT). Analysis of covariance was used for data analysis. Results All participants completed the study with no adverse events. All intervention participants reported undertaking their prescribed program. VO2peak improved more in the intervention group (1.17¿±¿.29¿L/min to 1.35¿±¿.33¿L/min) than the control group (1.24¿±¿.23¿L/min to 1.24¿±¿.33¿L/min, between-group difference¿=¿.18¿L/min, 95% confidence interval [CI]:.01-.36). Distance walked improved more in the intervention group (427¿±¿123¿m to 494¿±¿67m) compared to the control group (456¿±¿101m to 470¿±¿106m, between-group difference¿=¿45¿m, 95% CI:.3-90). Conclusions Our individually tailored approach with once-weekly telephone or e-mail support was feasible and effective in selected stroke survivors. The 16% greater improvement in VO2peak during the 6MWT achieved in the intervention versus control group is comparable to improvements attained in supervised, center-based programs.
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Nova |
2016 |
Xu X, Byles J, Shi Z, McElduff P, Hall J, 'Dietary pattern transitions, and the associations with BMI, waist circumference, weight and hypertension in a 7-year follow-up among the older Chinese population: a longitudinal study', BMC PUBLIC HEALTH, 16 (2016) [C1]
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Nova |
2016 |
Lambert SD, McElduff P, Girgis A, Levesque JV, Regan TW, Turner J, et al., 'A pilot, multisite, randomized controlled trial of a self-directed coping skills training intervention for couples facing prostate cancer: accrual, retention, and data collection issues', Supportive Care in Cancer, 24 711-722 (2016) [C1]
Purpose: To examine the acceptability of the methods used to evaluate Coping-Together, one of the first self-directed coping skill intervention for couples facing cancer, and to c... [more]
Purpose: To examine the acceptability of the methods used to evaluate Coping-Together, one of the first self-directed coping skill intervention for couples facing cancer, and to collect preliminary efficacy data. Methods: Forty-two couples, randomized to a minimal ethical care (MEC) condition or to Coping-Together, completed a survey at baseline and 2¿months after, a cost diary, and a process evaluation phone interview. Results: One hundred seventy patients were referred to the study. However, 57 couples did not meet all eligibility criteria, and 51 refused study participation. On average, two to three couples were randomized per month, and on average it took 26 days to enrol a couple in the study. Two couples withdrew from MEC, none from Coping-Together. Only 44¿% of the cost diaries were completed, and 55¿% of patients and 60¿% of partners found the surveys too long, and this despite the follow-up survey being five pages shorter than the baseline one. Trends in favor of Coping-Together were noted for both patients and their partners. Conclusions: This study identified the challenges of conducting dyadic research, and a number of suggestions were put forward for future studies, including to question whether distress screening was necessary and what kind of control group might be more appropriate in future studies.
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Nova |
2016 |
White J, Magin P, Attia J, Sturm J, McElduff P, Carter G, 'Predictors of health-related quality of life in community-dwelling stroke survivors: A cohort study', Family Practice, 33 382-387 (2016) [C1]
Background. Impaired health-related quality of life (HRQoL) post stroke is common, though prevalence estimates vary considerably. Few longitudinal studies explore post-stroke patt... [more]
Background. Impaired health-related quality of life (HRQoL) post stroke is common, though prevalence estimates vary considerably. Few longitudinal studies explore post-stroke patterns of HRQoL and factors contributing to their change over time. Accurately identifying HRQoL after stroke is essential to understanding the extent of stroke effects. Objectives. This study aimed to assess change in levels of, and identify independent predictors of, HRQoL over the first 12-months post-stroke. Methods. Design. A prospective cohort study. Setting and participants. Community-dwelling stroke survivors in metropolitan Newcastle, New South Wales (NSW), Australia. Consecutively recruited stroke patients (n = 134) participated in face-to-face interviews at baseline, 3, 6, 9 and 12 months. Outcome measure. HRQoL (measured using the Assessment Quality-of-life).Independent measures. Physical and psycho-social functioning, including depression and anxiety (measured via Hospital Anxiety and Depression Scale), disability (Modified Rankin Scale), social support (Multi-dimensional Scale Perceived Social Support) and community participation (Adelaide Activities Profile).Analyses. A linear mixed model was used to establish the predictors of, change in HRQoL over time. Results. On multivariable analysis, HRQOL did not change significantly with time post-stroke. Higher HRQoL scores were independently associated with higher baseline HRQoL (P = 0.03), younger age (P = 0.006), lower disability (P = 0.003), greater community participation (P = 0.001) and no history of depression (P = 0.03). Conclusion. These results contribute to an understanding of HRQoL in the first year post-stroke. Community participation and stroke-related disability are potentially modifiable risk factors affecting post-stroke HRQoL. Interventions aimed at addressing participation and disability post-stroke should be developed and tested.
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Nova |
2016 |
Bailey KA, Baker AL, McElduff P, Kavanagh DJ, 'The Influence of Parental Emotional Neglect on Assault Victims Seeking Treatment for Depressed Mood and Alcohol Misuse: A Pilot Study', JOURNAL OF CLINICAL MEDICINE, 5 (2016) [C1]
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Nova |
2016 |
Magin P, Juratowitch L, Dunbabin J, McElduff P, Goode S, Tapley A, Pond D, 'Attitudes to Alzheimer's disease testing of Australian general practice patients: A cross-sectional questionnaire-based study', International Journal of Geriatric Psychiatry, 31 361-370 (2016) [C1]
Objective In view of proposed screening for presymptomatic Alzheimer's disease (AD) with advanced imaging, and blood and cerebral spinal fluid analysis, we aimed to establish... [more]
Objective In view of proposed screening for presymptomatic Alzheimer's disease (AD) with advanced imaging, and blood and cerebral spinal fluid analysis, we aimed to establish levels, and associations, of acceptance of AD testing modalities by general practice patients. Methods A cross-sectional questionnaire-based study of consecutive patients (aged 50 years and over) of general practices of an Australian practice-based research network was used. The questionnaire elicited demographic data and attitudes to screening for other diseases and included the screening acceptance domain of the Perceptions Regarding Investigational Screening for Memory in Primary Care (PRISM-PC) instrument. This assesses receptivity to modalities of testing for AD: short questionnaire, blood test, cerebral imaging, and annual physician examination. Reflecting speculation of possible future AD diagnostic methods, an item regarding testing cerebral spinal fluid was also included. Associations of PRISM-PC scores were analyzed with multiple linear regression. Results Of 489 participants (response rate 87%), 66.2% would like to know if they had AD. Participants were more accepting of testing modalities that were noninvasive or familiar (questionnaire, physician's examination, and blood test) as opposed to cerebral imaging or lumbar puncture. Attitudes to AD testing are influenced by a positive attitude to disease screening in general. Patients with a self-perceived higher risk of AD were less accepting of testing, as were participants with an educational level of junior high school (10 school years) or less. Conclusions This study demonstrates that a majority of patients would like to know if they have AD. Acceptability of testing modalities, however, varies. Noninvasive, familiar methods are more acceptable.
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Nova |
2016 |
van Driel ML, Morgan S, Tapley A, McArthur L, McElduff P, Yardley L, et al., 'Changing the Antibiotic Prescribing of general practice registrars: the ChAP study protocol for a prospective controlled study of a multimodal educational intervention', BMC FAMILY PRACTICE, 17 (2016)
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2016 |
Chu G, Fogarty GM, Avis LF, Bergin S, McElduff P, Gillies AH, Choi P, 'Low dose heparin lock (1000 U/mL) maintains tunnelled hemodialysis catheter patency when compared with high dose heparin (5000 U/mL): A randomised controlled trial', Hemodialysis International, 20 385-391 (2016) [C1]
Introduction Heparin is commonly used after hemodialysis treatments as a locking solution to prevent catheter thrombosis. The comparative efficacy and safety of different heparin ... [more]
Introduction Heparin is commonly used after hemodialysis treatments as a locking solution to prevent catheter thrombosis. The comparative efficacy and safety of different heparin concentrations to maintain catheter patency has been previously reported in retrospective studies. We conducted a prospective, randomised, controlled study of 1000 U/mL heparin (low dose) versus 5000 U/mL heparin (high dose) locking solution to maintain patency of tunnelled catheters. Methods One hundred patients receiving chronic, unit-based hemodialysis with newly placed tunnelled hemodialysis catheters (less than 1 week) were randomly assigned to either a low dose (n = 48) or high dose heparin (n=52). The primary intention-to-treat analysis examined time to malfunction in both groups over a 90 day period. A secondary analysis compared baseline patient characteristics in relation to catheter malfunction. Findings Overall rate of catheter patency loss was 32% of catheters by 90 days. There was no significant difference in time to malfunction of catheters locked with low dose or high dose heparin (P = 0.5770). Time to catheter malfunction was not associated with diabetic, hypertensive or smoking status. There was no difference in mean delivered blood flow rate, venous and arterial pressure, and dialysis adequacy between low dose and high dose groups. No patient suffered a hemorrhagic complication requiring hospitalisation during the study period. Discussion Low dose heparin is adequate to maintain tunnelled hemodialysis catheter patency when compared with high dose heparin. The study also suggests that there is no relationship between catheter malfunction and diabetic, hypertensive or smoking status.
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Nova |
2016 |
Middleton S, Lydtin A, Comerford D, Cadilhac DA, McElduff P, Dale S, et al., 'From QASC to QASCIP: successful Australian translational scale-up and spread of a proven intervention in acute stroke using a prospective pre-test/post-test study design', BMJ OPEN, 6 (2016) [C1]
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Nova |
2016 |
Vertigan A, Kapela S, Ryan NM, Birring S, McElduff P, Gibson P, 'Pregabalin and speech pathology combination therapy for refractory chronic cough: A randomised controlled trial.', Chest, 149 639-648 (2016) [C1]
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Nova |
2016 |
Paterson MA, Smart CEM, Lopez PE, Mcelduff P, Attia J, Morbey C, King BR, 'Influence of dietary protein on postprandial blood glucose levels in individuals with Type 1 diabetes mellitus using intensive insulin therapy', Diabetic Medicine, 33 592-598 (2016) [C1]
Aim: To determine the effects of protein alone (independent of fat and carbohydrate) on postprandial glycaemia in individuals with Type¿1 diabetes mellitus using intensive insulin... [more]
Aim: To determine the effects of protein alone (independent of fat and carbohydrate) on postprandial glycaemia in individuals with Type¿1 diabetes mellitus using intensive insulin therapy. Methods: Participants with Type¿1 diabetes mellitus aged 7-40¿years consumed six 150¿ml whey isolate protein drinks [0¿g (control), 12.5, 25, 50, 75 and 100] and two 150¿ml glucose drinks (10 and 20¿g) without insulin, in randomized order over 8¿days, 4¿h after the evening meal. Continuous glucose monitoring was used to assess postprandial glycaemia. Results: Data were collected from 27 participants. Protein loads of 12.5 and 50¿g did not result in significant postprandial glycaemic excursions compared with control (water) throughout the 300¿min study period (P¿>¿0.05). Protein loads of 75 and 100¿g resulted in lower glycaemic excursions than control in the 60-120¿min postprandial interval, but higher excursions in the 180-300¿min interval. In comparison with 20¿g glucose, the large protein loads resulted in significantly delayed and sustained glucose excursions, commencing at 180¿min and continuing to 5¿h. Conclusions: Seventy-five grams or more of protein alone significantly increases postprandial glycaemia from 3 to 5¿h in people with Type¿1 diabetes mellitus using intensive insulin therapy. The glycaemic profiles resulting from high protein loads differ significantly from the excursion from glucose in terms of time to peak glucose and duration of the glycaemic excursion. This research supports recommendations for insulin dosing for large amounts of protein.
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Nova |
2016 |
Masson AL, Talseth-Palmer BA, Evans TJ, McElduff P, Spigelman AD, Hannan GN, Scott RJ, 'Copy number variants associated with 18p11.32, DCC and the promoter 1B region of APC in colorectal polyposis patients', Meta Gene, 7 95-104 (2016) [C1]
Familial Adenomatous Polyposis (FAP) is the second most common inherited predisposition to colorectal cancer (CRC) associated with the development of hundreds to thousands of aden... [more]
Familial Adenomatous Polyposis (FAP) is the second most common inherited predisposition to colorectal cancer (CRC) associated with the development of hundreds to thousands of adenomas in the colon and rectum. Mutations in APC are found in ~. 80% polyposis patients with FAP. In the remaining 20% no genetic diagnosis can be provided suggesting other genes or mechanisms that render APC inactive may be responsible. Copy number variants (CNVs) remain to be investigated in FAP and may account for disease in a proportion of polyposis patients. A cohort of 56 polyposis patients and 40 controls were screened for CNVs using the 2.7M microarray (Affymetrix) with data analysed using ChAS (Affymetrix). A total of 142 CNVs were identified unique to the polyposis cohort suggesting their involvement in CRC risk. We specifically identified CNVs in four unrelated polyposis patients among CRC susceptibility genes APC, DCC, MLH1 and CTNNB1 which are likely to have contributed to disease development in these patients. A recurrent deletion was observed at position 18p11.32 in 9% of the patients screened that was of particular interest. Further investigation is necessary to fully understand the role of these variants in CRC risk given the high prevalence among the patients screened.
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Nova |
2016 |
Middleton S, Levi C, Dale S, Cheung NW, McInnes E, Considine J, et al., 'Triage, treatment and transfer of patients with stroke in emergency department trial (the T
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2016 |
Percival E, Bhatia R, Preece K, McElduff P, McEvoy M, Collison A, Mattes J, 'Reproducibility of serum IgE, Ara h2 skin prick testing and fraction of exhaled nitric oxide for predicting clinical peanut allergy in children', ALLERGY ASTHMA AND CLINICAL IMMUNOLOGY, 12 (2016) [C1]
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Nova |
2016 |
Bivard A, Lou M, Levi CR, Krishnamurthy V, Cheng X, Aviv RI, et al., 'Too good to treat? ischemic stroke patients with small computed tomography perfusion lesions may not benefit from thrombolysis', Annals of Neurology, 80 286-293 (2016) [C1]
Objective: Although commonly used in clinical practice, there remains much uncertainty about whether perfusion computed tomography (CTP) should be used to select stroke patients f... [more]
Objective: Although commonly used in clinical practice, there remains much uncertainty about whether perfusion computed tomography (CTP) should be used to select stroke patients for acute reperfusion therapy. In this study, we tested the hypothesis that a small acute perfusion lesion predicts good clinical outcome regardless of thrombolysis administration. Methods: We used a prospectively collected cohort of acute ischemic stroke patients being assessed for treatment with IV-alteplase, who had CTP before a treatment decision. Volumetric CTP was retrospectively analyded to identify patients with a small perfusion lesion (<15ml in volume). The primary analysis was excellent 3-month outcome in patients with a small perfusion lesion who were treated with alteplase compared to those who were not treated. Results: Of 1526 patients, 366 had a perfusion lesion <15ml and were clinically eligible for alteplase (212 being treated and 154 not treated). Median acute National Institutes of Health Stroke Scale score was 8 in each group. Of the 366 patients with a small perfusion lesion, 227 (62%) were modified Rankin Scale (mRS) 0 to 1 at day 90. Alteplase-treated patients were less likely to achieve 90-day mRS 0 to 1 (57%) than untreated patients (69%; relative risk [RR] = 0.83; 95% confidence interval [CI], 0.71¿0.97; p = 0.022) and did not have different rates of mRS 0 to 2 (72% treated patients vs 77% untreated; RR, 0.93; 95% CI, 0.82¿1.95; p = 0.23). Interpretation: This large observational cohort suggests that a portion of ischemic stroke patients clinically eligible for alteplase therapy with a small perfusion lesion have a good natural history and may not benefit from treatment. Ann Neurol 2016;80:286¿293.
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Nova |
2015 |
Johnson NA, Kypri K, Latter J, McElduff P, Attia J, Saitz R, et al., 'Effect of telephone follow-up on retention and balance in an alcohol intervention trial', Preventive Medicine Reports, 2 746-749 (2015) [C1]
Objectives: Telephone follow-up is not currently recommended as a strategy to improve retention in randomized trials. The aims of this study were to estimate the effect of telepho... [more]
Objectives: Telephone follow-up is not currently recommended as a strategy to improve retention in randomized trials. The aims of this study were to estimate the effect of telephone follow-up on retention, identify participant characteristics predictive of questionnaire completion during or after telephone follow-up, and estimate the effect of including participants who provided follow-up data during or after telephone follow-up on balance between randomly allocated groups in a trial estimating the effect of electronic alcohol screening and brief intervention on alcohol consumption in hospital outpatients with hazardous or harmful drinking. Method: Trial participants were followed up 6. months after randomization (June-December 2013) using e-mails containing a hyperlink to a web-based questionnaire when possible and by post otherwise. Telephone follow-up was attempted after two written reminders and participants were invited to complete the questionnaire by telephone when contact was made. Results: Retention before telephone follow-up was 62.1% (520/837) and 82.8% (693/837) afterward: an increase of 20.7% (173/837). Therefore, 55% (95% CI 49%-60%) of the 317 participants who had not responded after two written reminders responded during or after the follow-up telephone call. Age. <. 55. years, a higher AUDIT-C score and provision of a mobile/cell phone number were predictive of questionnaire completion during or after telephone follow-up. Balance between randomly allocated groups was present before and after inclusion of participants who completed the questionnaire during or after telephone follow-up. Conclusion: Telephone follow-up improved retention in this randomized trial without affecting balance between the randomly allocated groups.
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Nova |
2015 |
Jones J, Wyse R, Finch M, Lecathelinais C, Wiggers J, Marshall J, et al., 'Effectiveness of an intervention to facilitate the implementation of healthy eating and physical activity policies and practices in childcare services: a randomised controlled trial', IMPLEMENTATION SCIENCE, 10 (2015) [C1]
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Nova |
2015 |
Berthon BS, Gibson PG, Mcelduff P, Macdonald-Wicks LK, Wood LG, 'Effects of short-term oral corticosteroid intake on dietary intake, body weight and body composition in adults with asthma - a randomized controlled trial', Clinical and Experimental Allergy, 45 908-919 (2015) [C1]
Background: Oral corticosteroids (OCS) are an efficacious treatment for asthma exacerbations, yet risk of adverse effects may decrease patient adherence to therapy. In particular,... [more]
Background: Oral corticosteroids (OCS) are an efficacious treatment for asthma exacerbations, yet risk of adverse effects may decrease patient adherence to therapy. In particular, changes in appetite and dietary intake, which lead to weight gain and changes in body composition, are considered undesirable. Objective: To determine whether 10-day OCS therapy in adults with asthma causes changes in leptin, appetite, dietary intake, body weight and body composition. Methods: Double-blinded, placebo-controlled randomized cross-over trial of 10 days prednisolone (50 mg) in adults with stable asthma (n = 55) (ACTRN12611000562976). Pre- and post-assessment included spirometry, body weight, body composition measured by dual-energy X-ray absorptiometry and bioelectrical impedance analysis, appetite measured using a validated visual analogue scale (VAS) and dietary intake assessed using 4-day food records. Leptin was measured as a biomarker of appetite and eosinophils as an adherence biomarker. Outcomes were analysed by generalized linear mixed models. Results: Subject adherence was confirmed by a significant decrease in blood eosinophils (× 109/L) following prednisolone compared to placebo [Coef. -0.29, 95% CI: (-0.39, -0.19) P < 0.001]. There was no difference in serum leptin (ng/mL) [Coef. 0.13, 95% CI: (-3.47, 3.72) P = 0.945] or appetite measured by VAS (mm) [Coef. -4.93, 95% CI: (-13.64, 3.79) P = 0.267] following prednisolone vs. placebo. There was no difference in dietary intake (kJ/day) [Coef. 255, 95% CI: (-380, 891) P = 0.431], body weight (kg) [Coef. -0.38, 95% CI: (-0.81, 0.05) P = 0.083] or body fat (%) [Coef. -0.31, 95% CI: (-0.81, 0.20) P = 0.230]. Symptoms including sleep and gastrointestinal disturbance were reported significantly more often during prednisolone vs. placebo. Conclusions and Clinical Relevance: Short-term OCS in stable asthma did not induce significant changes in appetite, dietary intake, body weight or composition, although other adverse effects may require medical management. This evidence may assist in increasing medication adherence of asthmatics prescribed OCS for exacerbations.
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Nova |
2015 |
Weigner J, Zardawi I, Braye S, McElduff P, 'The Conundrum of Papillary Breast Lesions within the C3 Category', Acta Cytologica, 59 289-297 (2015) [C1]
Objectives: To identify features that could define papillary ductal cell proliferation within the C3 category and to subcategorise papillary lesions into benign papillomas which c... [more]
Objectives: To identify features that could define papillary ductal cell proliferation within the C3 category and to subcategorise papillary lesions into benign papillomas which can be managed conservatively and atypical/malignant papillary neoplasms which require surgical intervention. Study Design: A blind microscopic rescreen of all C3 cases was conducted. The corresponding histological outcome was compared with the cytology. Statistical analysis was performed using papillary versus non-papillary outcomes and benign versus atypical/malignant papillary lesions. In addition, macropapillary lesions (papilloma and encysted papillary carcinoma) were plotted against micropapillary ductal carcinoma in situ. Results: Two hundred thirty FNA cases reported as C3 included 72 papillary neoplasms (52 benign papillomas and 20 atypical/malignant papillary lesions). Features specific to papillary lesions within C3 include macropapillary fragments, complex sheets, palisading strips, cystic background, cohesion and a decreased nuclear-to-cytoplasmic ratio. Features favouring atypical/malignant papillary lesions include decreased numbers of bare bipolar nuclei, discohesion and a non-cystic background. These features are common to most breast malignancies; however, identification of papillary features often results in a downgraded diagnosis from C5. Conclusions: This study supports the ability to reliably identify papillary ductal cell proliferation within C3. Certain features can distinguish papillary lesions from other C3 pathologies. This separation is likely to be clinically useful as papillary lesions may require a different management approach.
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Nova |
2015 |
Marquez J, van Vliet P, Mcelduff P, Lagopoulos J, Parsons M, 'Transcranial direct current stimulation (tDCS): Does it have merit in stroke rehabilitation? A systematic review', International Journal of Stroke, 10 306-316 (2015) [C1]
Transcranial direct current stimulation has been gaining increasing interest as a potential therapeutic treatment in stroke recovery. We performed a systematic review with meta-an... [more]
Transcranial direct current stimulation has been gaining increasing interest as a potential therapeutic treatment in stroke recovery. We performed a systematic review with meta-analysis of randomized controlled trials to collate the available evidence in adults with residual motor impairments as a result of stroke. The primary outcome was change in motor function or impairment as a result of transcranial direct current stimulation, using any reported electrode montage, with or without adjunct physical therapy. The search yielded 15 relevant studies comprising 315 subjects. Compared with sham, cortical stimulation did not produce statistically significant improvements in motor performance when measured immediately after the intervention (anodal stimulation: facilitation of the affected cortex: standardized mean difference=0·05, P=0·71; cathodal stimulation: inhibition of the nonaffected cortex: standardized mean difference=0·39, P=0·08; bihemispheric stimulation: standardized mean difference=0·24, P=0·39). When the data were analyzed according to stroke characteristics, statistically significant improvements were evident for those with chronic stroke (standardized mean difference=0·45, P=0·01) and subjects with mild-to-moderate stroke impairments (standardized mean difference=0·37, P=0·02). Transcranial direct current stimulation is likely to be effective in enhancing motor performance in the short term when applied selectively to patients with stroke. Given the range of stimulation variables and heterogeneous nature of stroke, this modality is still experimental and further research is required to determine its clinical merit in stroke rehabilitation.
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Nova |
2015 |
Levesque JV, Lambert SD, Girgis A, Turner J, McElduff P, Kayser K, 'Do men with prostate cancer and their partners receive the information they need for optimal illness self-management in the immediate post-diagnostic phase?', ASIA-PACIFIC JOURNAL OF ONCOLOGY NURSING, 2 169-175 (2015)
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2015 |
Kypri K, Davie G, Mcelduff P, Langley J, Connor J, 'Effects of lowering the alcohol minimum purchasing age on weekend hospitalised assaults of young Maori in New Zealand', Drug and Alcohol Review, 34 299-303 (2015) [C1]
Introduction and Aims: We examine the association between reducing the alcohol minimum purchasing age from 20 to 18 years in December 1999 and rates of weekend assault hospitalisa... [more]
Introduction and Aims: We examine the association between reducing the alcohol minimum purchasing age from 20 to 18 years in December 1999 and rates of weekend assault hospitalisation among young Maori in the following 12 years. Our previous work showed deleterious effects for young people overall. In keeping with Treaty of Waitangi principles, we sought to determine whether the policy was similarly detrimental for Maori. Design and Methods: We used Poisson regression to examine data from 1995 to 2011 on Maori hospitalised on Friday-Sunday following assault, separately by gender among 15- to 17-year-olds and 18- to 19-year-olds, versus 20- to 21-year-olds as a control for changes in economic and environmental factors. Results: There was no evidence to suggest weekend assault hospitalisations increased significantly more among 15- to 17-year-old or 18- to 19-year-old Maori males in the post-change periods (incidence rate ratios varied between 0.83 and 1.13; P values >0.25) compared with increases observed in 20- to 21-year-old Maori males. For Maori females, estimates were more variable, but overall, there was no evidence of the hypothesised effect (incidence rate ratios between 0.60 and 1.09; P values >0.07). Discussion and Conclusions: Overall, we find no evidence that lowering the minimum alcohol purchasing age increased weekend hospitalised assaults among young Maori. Inferences are compromised by lack of statistical power which underlines the importance of planning for evaluation of important policies well before they are implemented, particularly with a view to meeting obligations to Maori arising from the Treaty of Waitangi.
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Nova |
2015 |
Luque-Fernandez MA, Ananth CV, Jaddoe VWV, Gaillard R, Albert PS, Schomaker M, et al., 'Is the fetoplacental ratio a differential marker of fetal growth restriction in small for gestational age infants?', European Journal of Epidemiology, 30 331-341 (2015) [C1]
Higher placental weight relative to birthweight has been described as an adaptive mechanism to fetal hypoxia in small for gestational age (SGA) infants. However, placental weight ... [more]
Higher placental weight relative to birthweight has been described as an adaptive mechanism to fetal hypoxia in small for gestational age (SGA) infants. However, placental weight alone may not be a good marker reflecting intrauterine growth restriction. We hypothesized that fetoplacental ratio (FPR)¿the ratio between birthweight and placental weight¿may serve as a good marker of SGA after adjustment for surrogates of fetal hypoxemia (maternal iron deficiency anemia, smoking and choriodecidual necrosis). We conducted a within-sibling analysis using data from the US National Collaborative Perinatal Project (1959¿1966) of 1,803 women who delivered their first two (or more) consecutive infants at term (n¿=¿3,494). We used variance-component fixed-effect linear regression models to explore the effect of observed time-varying factors on placental weight and conditional logistic regression to estimate the effects of the tertiles of FPRs (1st small, 2nd normal and 3rd large) on the odds of SGA infants. We found placental weights to be 15¿g [95¿% confidence interval (CI) 8, 23] higher and -7¿g (95¿% CI -13, -2) lower among women that had anemia and choriodecidual necrosis, respectively. After multivariable adjustment, newborns with a small FPR (1st-tertile =7) had twofold higher odds of being SGA (OR 2.0, 95¿% CI 1.2, 3.5) than their siblings with a large FPR (3nd-tertile =9). A small FPR was associated with higher odds of SGA, suggesting that small FPR may serve as an indicator suggestive of adverse intrauterine environment. This observation may help to distinguish pathological from constitutional SGA.
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Nova |
2015 |
Kingsland M, Wolfenden L, Tindall J, Rowland B, Sidey M, Mcelduff P, Wiggers JH, 'Improving the implementation of responsible alcohol management practices by community sporting clubs: A randomised controlled trial', Drug and Alcohol Review, 34 447-457 (2015) [C1]
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Nova |
2015 |
Ribbons KA, McElduff P, Boz C, Trojano M, Izquierdo G, Duquette P, et al., 'Male sex is independently associated with faster disability accumulation in relapse-onset MS but not in primary progressive MS', PLoS ONE, 10 (2015) [C1]
Background: Multiple Sclerosis is more common in women than men and females have more relapses than men. In a large international cohort we have evaluated the effect of gender on ... [more]
Background: Multiple Sclerosis is more common in women than men and females have more relapses than men. In a large international cohort we have evaluated the effect of gender on disability accumulation and disease progression to determine if male MS patients have a worse clinical outcome than females. Methods: Using the MSBase Registry, data from 15,826 MS patients from 25 countries was analysed. Changes in the severity of MS (EDSS) were compared between sexes using a repeated measures analysis in generalised linear mixed models. Kaplan-Meier analysis was used to test for sex difference in the time to reach EDSS milestones 3 and 6 and the secondary progressive MS. Results: In relapse onset MS patients (n = 14,453), males progressed significantly faster in their EDSS than females (0.133 vs 0.112 per year, P<0.001,). Females had a reduced risk of secondary progressive MS (HR (95% CI) = 0.77 (0.67 to 0.90) P = 0.001). In primary progressive MS (n = 1,373), there was a significant increase in EDSS over time in males and females (P<0.001) but there was no significant sex effect on the annualized rate of EDSS change. Conclusion: Among registrants of MSBase, male relapse-onset patients accumulate disability faster than female patients. In contrast, the rate of disability accumulation between male and female patients with primary progressive MS is similar.
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Nova |
2015 |
Kingsland M, Wolfenden L, Tindall J, Rowland BC, Lecathelinais C, Gillham KE, et al., 'Tackling risky alcohol consumption in sport: A cluster randomised controlled trial of an alcohol management intervention with community football clubs', Journal of Epidemiology and Community Health, (2015) [C1]
Background An increased prevalence of risky alcohol consumption and alcohol-related harm has been reported for members of sporting groups and at sporting venues compared with non-... [more]
Background An increased prevalence of risky alcohol consumption and alcohol-related harm has been reported for members of sporting groups and at sporting venues compared with non-sporting populations. While sports clubs and venues represent opportune settings to implement strategies to reduce such risks, no controlled trials have been reported. The purpose of the study was to examine the effectiveness of an alcohol management intervention in reducing risky alcohol consumption and the risk of alcohol-related harm among community football club members. Method A cluster randomised controlled trial of an alcohol management intervention was undertaken with non-elite, community football clubs and their members in New South Wales, Australia. Risky alcohol consumption (5+ drinks) at the club and risk of alcohol-related harm using the Alcohol Use Disorders Identification Test (AUDIT) were measured at baseline and postintervention. Results Eighty-eight clubs participated in the trial (n=43, Intervention; n=45, Control) and separate cross-sectional samples of club members completed the baseline (N=1411) and postintervention (N=1143) surveys. Postintervention, a significantly lower proportion of intervention club members reported: risky alcohol consumption at the club (Intervention: 19%; Control: 24%; OR: 0.63 (95% CI 0.40 to 1.00); p=0.05); risk of alcohol-related harm (Intervention: 38%; Control: 45%; OR: 0.58 (95% CI 0.38 to 0.87); p<0.01); alcohol consumption risk (Intervention: 47%; Control: 55%; OR: 0.60 (95% CI 0.41 to 0.87); p<0.01) and possible alcohol dependence (Intervention: 1%; Control: 4%; OR: 0.20 (95% CI 0.06 to 0.65); p<0.01). Conclusions With large numbers of people worldwide playing, watching and sports officiating, enhancing club-based alcohol management interventions could make a substantial contribution to reducing the burden of alcohol misuse in communities.
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Nova |
2015 |
Bivard A, Levi C, Krishnamurthy V, McElduff P, Miteff F, Spratt NJ, et al., 'Perfusion computed tomography to assist decision making for stroke thrombolysis', Brain, 138 1919-1931 (2015) [C1]
The use of perfusion imaging to guide selection of patients for stroke thrombolysis remains controversial because of lack of supportive phase three clinical trial evidence. We aim... [more]
The use of perfusion imaging to guide selection of patients for stroke thrombolysis remains controversial because of lack of supportive phase three clinical trial evidence. We aimed to measure the outcomes for patients treated with intravenous recombinant tissue plasminogen activator (rtPA) at a comprehensive stroke care facility where perfusion computed tomography was routinely used for thrombolysis eligibility decision assistance. Our overall hypothesis was that patients with 'target' mismatch on perfusion computed tomography would have improved outcomes with rtPA. This was a prospective cohort study of consecutive ischaemic stroke patients who fulfilled standard clinical/non-contrast computed tomography eligibility criteria for treatment with intravenous rtPA, but for whom perfusion computed tomography was used to guide the final treatment decision. The 'real-time' perfusion computed tomography assessments were qualitative; a large perfusion computed tomography ischaemic core, or lack of significant perfusion lesion-core mismatch were considered relative exclusion criteria for thrombolysis. Specific volumetric perfusion computed tomography criteria were not used for the treatment decision. The primary analysis compared 3-month modified Rankin Scale in treated versus untreated patients after 'off-line' (post-treatment) quantitative volumetric perfusion computed tomography eligibility assessment based on presence or absence of 'target' perfusion lesion-core mismatch (mismatch ratio >1.8 and volume >15 ml, core <70 ml). In a second analysis, we compared outcomes of the perfusion computed tomography-selected rtPA-treated patients to an Australian historical cohort of non-contrast computed tomography-selected rtPA-treated patients. Of 635 patients with acute ischaemic stroke eligible for rtPA by standard criteria, thrombolysis was given to 366 patients, with 269 excluded based on visual real-time perfusion computed tomography assessment. After off-line quantitative perfusion computed tomography classification: 253 treated patients and 83 untreated patients had 'target' mismatch, 56 treated and 31 untreated patients had a large ischaemic core, and 57 treated and 155 untreated patients had no target mismatch. In the primary analysis, only in the target mismatch subgroup did rtPA-treated patients have significantly better outcomes (odds ratio for 3-month, modified Rankin Scale 0-2 = 13.8, P < 0.001). With respect to the perfusion computed tomography selected rtPA-treated patients (n = 366) versus the clinical/non-contrast computed tomography selected rtPA-treated patients (n = 396), the perfusion computed tomography selected group had higher adjusted odds of excellent outcome (modified Rankin Scale 0-1 odds ratio 1.59, P = 0.009) and lower mortality (odds ratio 0.56, P = 0.021). Although based on observational data sets, our analyses provide support for the hypothesis that perfusion computed tomography improves the identification of patients likely to respond to thrombolysis, and also those in whom natural history may be difficult to modify with treatment.
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Nova |
2015 |
Tapley A, Magin P, Morgan S, Henderson K, Scott J, Thomson A, et al., 'Test ordering in an evidence free zone: Rates and associations of Australian general practice trainees' Vitamin D test ordering', Journal of Evaluation in Clinical Practice, 21 1151-1156 (2015) [C1]
Rationale, aims and objectives Indiscriminate health screening is increasingly seen as being problematic. In particular, Vitamin D testing rates are increasing rapidly despite rec... [more]
Rationale, aims and objectives Indiscriminate health screening is increasingly seen as being problematic. In particular, Vitamin D testing rates are increasing rapidly despite recommendations against population screening. The purpose of this study was to determine the level of Vitamin D testing among family practice/general practitioner (GP) trainees and to establish associations of this testing. Methods Cross-sectional analysis of data from the ReCEnT (Registrars Clinical Encounters in Training) cohort study. The setting was GP practices in four Australian states. Data from 60 consecutive consultations per trainee were recorded each 6-month training term (up to four terms). Results Vitamin D tests were ordered in 726 (1.0%) of encounters (n = 69 412). Vitamin D test ordering was significantly associated with patients being older, female and non-English speaking. Trainees were more likely to test if they worked in a completely bulk-billing practice (i.e. a practice without any patient payment), if more problems were dealt with, more pathology tests were ordered in the consultation and if a lipid profile was ordered. They were less likely to test if they sought in-consultation advice or information. The most common reasons for testing were 'check-up' and 'health maintenance'. Conclusions In this first report of associations of Vitamin D testing in the GP setting, we found that non-targeted Vitamin D testing (testing inconsistent with current guidelines) is widespread in GP trainees' practice. Adoption of more rational testing approaches is needed.
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Nova |
2015 |
Noble N, Paul C, Conigrave K, Lee K, Blunden S, Turon H, et al., 'Does a retrospective seven-day alcohol diary reflect usual alcohol intake for a predominantly disadvantaged Australian aboriginal population', Substance Use and Misuse, 50 308-319 (2015) [C1]
Background: Alcohol disproportionately affects socially disadvantaged groups including Aboriginal and Torres Strait Islander Australians. Methods to assess alcohol intake for disa... [more]
Background: Alcohol disproportionately affects socially disadvantaged groups including Aboriginal and Torres Strait Islander Australians. Methods to assess alcohol intake for disadvantaged communities need to be able to capture variable or episodic drinking. The ability of a seven-day diary to capture typical consumption for a predominantly Aboriginal sample has not been assessed. Objective: One aim of this paper was to examine agreement between a seven-day retrospective diary and 'usual' drinking assessed by a modified version of the Alcohol Use Disorders Identification Test question 3 (AUDIT-3m; two questions). Other aims were to describe drinking patterns as reported in the seven-day diary. Method: In 2012, consecutive adults attending an Aboriginal Community Controlled Health Service completed a cross-sectional health risk survey on a touch screen laptop (n = 188). Alcohol consumption questions included the retrospective diary and AUDIT-3m. Agreement was assessed using weighted kappa analysis. Results: There was good agreement between the two measures of consumption; however, the AUDIT-3m questions identified more current drinkers. Respondents who were drinkers (54%) tended to consume large amounts per drinking occasion: almost half (46%) of diary completers reported nine or more standard drinks on at least one occasion in the last week. Conclusions: The seven-day diary did not adequately capture variability in alcohol consumption common among this sample. Although the AUDIT-3m appeared acceptable, alternative approaches to assess usual or risky alcohol consumption, such as asking about specific drinking occasions, or allowing participants to respond in non-standard drink sizes, also need to be considered for indigenous and other disadvantaged communities.
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Nova |
2015 |
Britton B, McCarter K, Baker A, Wolfenden L, Wratten C, Bauer J, et al., 'Eating As Treatment (EAT) study protocol: a stepped-wedge, randomised controlled trial of a health behaviour change intervention provided by dietitians to improve nutrition in patients with head and neck cancer undergoing radiotherapy.', BMJ open, 5 e008921 (2015) [C3]
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2015 |
Tzelepis F, Paul CL, Wiggers J, Kypri K, Bonevski B, McElduff P, et al., 'Targeting multiple health risk behaviours among vocational education students using electronic feedback and online and telephone support: Protocol for a cluster randomised trial Health behavior, health promotion and society', BMC Public Health, 15 (2015) [C3]
Background: Technical and Further Education (TAFE) colleges are the primary provider of vocational education in Australia. Most TAFE students are young adults, a period when healt... [more]
Background: Technical and Further Education (TAFE) colleges are the primary provider of vocational education in Australia. Most TAFE students are young adults, a period when health risk behaviours become established. Furthermore, high rates of smoking, risky alcohol consumption, inadequate fruit and vegetable intake and insufficient physical activity have been reported in TAFE students. There have been no intervention studies targeting multiple health risk behaviours simultaneously in this population. The proposed trial will examine the effectiveness of providing TAFE students with electronic feedback regarding health risk behaviours and referral to a suite of existing online and telephone services addressing smoking, risky alcohol consumption, fruit and vegetable intake, and physical activity levels. Methods/Design: A two arm, parallel, cluster randomised trial will be conducted within TAFE campuses in New South Wales (NSW), Australia. TAFE classes will be randomly allocated to an intervention or control condition (50 classes per condition). To be eligible, students must be: enrolled in a course that runs for more than 6 months; aged 16 years or older; and not meet Australian health guideline recommendations for at least one of the following: smoking, alcohol consumption, fruit and/or vegetable intake, or physical activity. Students attending intervention classes, will undertake via a computer tablet a risk assessment for health risk behaviours, and for behaviours not meeting Australian guidelines be provided with electronic feedback about these behaviours and referral to evidence-based online programs and telephone services. Students in control classes will not receive any intervention. Primary outcome measures that will be assessed via online surveys at baseline and 6 months post-recruitment are: 1) daily tobacco smoking; 2) standard drinks of alcohol consumed per week; 3) serves of fruit consumed daily; 4) serves of vegetables consumed daily; and 5) metabolic equivalent minutes of physical activity per week. Discussion: Proactive enrolment to existing online and telephone services has the potential to address modifiable determinants of disease. This trial will be the first to examine a potentially scalable intervention targeting multiple health risk behaviours among students in the vocational training setting.
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Nova |
2015 |
Tzelepis F, Paul CL, Knight J, Duncan SL, McElduff P, Wiggers J, 'Improving the continuity of smoking cessation care delivered by quitline services', Patient Education and Counseling, 98 1643-1648 (2015) [C1]
Objectives: This study identified smokers' intended use of new quitline features aimed at improving smoking cessation such as having the same quitline advisor for each call, ... [more]
Objectives: This study identified smokers' intended use of new quitline features aimed at improving smoking cessation such as having the same quitline advisor for each call, longer-term telephone counselling and provision of additional cessation treatments. Methods: Smokers who had previously used quitline counselling completed a computer-assisted telephone interview examining intended use of potential quitline enhancements. Results: The majority of smokers (61.1%) thought their chances of quitting would have increased a lot/moderately if they had the same quitline advisor for each call. Most smokers reported likely use of longer-term quitline telephone support after a failed (58.3%) or successful (60%) quit attempt. Smokers were likely to use quitline support long-term (mean = 9.9 months). Most smokers would be likely to use free or subsidised nicotine replacement therapy (NRT) (74.9%) if offered by quitlines. Younger smokers had greater odds of being likely to use text messages, whereas less educated smokers had greater odds of being likely to use free or subsidised NRT. Conclusions: Smokers appear interested in quitlines offering longer-term telephone support, increased continuity of care and additional effective quitting strategies. Practice implications: Quitlines could adopt a stepped care model that involves increasingly intensive treatments and extended telephone counselling delivered by the same quitline advisor.
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Nova |
2015 |
Hubbard IJ, Carey LM, Budd TW, Levi C, McElduff P, Hudson S, et al., 'A Randomized Controlled Trial of the Effect of Early Upper-Limb Training on Stroke Recovery and Brain Activation', Neurorehabilitation and Neural Repair, 29 703-713 (2015) [C1]
Background. Upper-limb (UL) dysfunction is experienced by up to 75% of patients poststroke. The greatest potential for functional improvement is in the first month. Following repe... [more]
Background. Upper-limb (UL) dysfunction is experienced by up to 75% of patients poststroke. The greatest potential for functional improvement is in the first month. Following reperfusion, evidence indicates that neuroplasticity is the mechanism that supports this recovery. Objective. This preliminary study hypothesized increased activation of putative motor areas in those receiving intensive, task-specific UL training in the first month poststroke compared with those receiving standard care. Methods. This was a single-blinded, longitudinal, randomized controlled trial in adult patients with an acute, first-ever ischemic stroke; 23 participants were randomized to standard care (n = 12) or an additional 30 hours of task-specific UL training in the first month poststroke beginning week 1. Patients were assessed at 1 week, 1 month, and 3 months poststroke. The primary outcome was change in brain activation as measured by functional magnetic resonance imaging. Results. When compared with the standard-care group, the intensive-training group had increased brain activation in the anterior cingulate and ipsilesional supplementary motor areas and a greater reduction in the extent of activation (P =.02) in the contralesional cerebellum. Intensive training was associated with a smaller deviation from mean recovery at 1 month (Pr>F0 = 0.017) and 3 months (Pr>F = 0.006), indicating more consistent and predictable improvement in motor outcomes. Conclusion. Early, more-intensive, UL training was associated with greater changes in activation in putative motor (supplementary motor area and cerebellum) and attention (anterior cingulate) regions, providing support for the role of these regions and functions in early recovery poststroke.
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Nova |
2014 |
Vashum KP, McEvoy M, Milton AH, McElduff P, Hure A, Byles J, Attia J, 'Dietary zinc is associated with a lower incidence of depression: findings from two Australian cohorts.', J Affect Disord, 166 249-257 (2014) [C1]
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Nova |
2014 |
Ewald B, Attia J, McElduff P, 'How many steps are enough? Dose-response curves for pedometer steps and multiple health markers in a community-based sample of older australians.', J Phys Act Health, 11 509-518 (2014)
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Nova |
2014 |
Regan TW, Lambert SD, Kelly B, McElduff P, Girgis A, Kayser K, Turner J, 'Cross-sectional relationships between dyadic coping and anxiety, depression, and relationship satisfaction for patients with prostate cancer and their spouses.', Patient Educ Couns, 96 120-127 (2014) [C1]
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Nova |
2014 |
Weigner J, Zardawi I, Braye S, McElduff P, 'The microscopic complexities of C3 in breast cytology', Acta Cytologica, 58 335-336 (2014) [C1]
Background: Fine-needle aspiration (FNA) of difficult breast lesions often results in an atypical (C3) report. The assortment of outcomes generated by C3 reports varies widely, an... [more]
Background: Fine-needle aspiration (FNA) of difficult breast lesions often results in an atypical (C3) report. The assortment of outcomes generated by C3 reports varies widely, and this has given rise to different clinical management pathways. Objective: To identify and objectively assess microscopic features associated with atypical/C3 breast FNA cases. Materials and Methods: A total of 230 atypical breast FNAs were subjected to a blind microscopic rescreen using a range of robust qualitative and quantitative cytological criteria including cellularity, architectural qualities, cytomorphology and background features. A logistic regression with a receiver operating characteristic (ROC) curve and the resultant forward stepwise analysis were conducted to assess the results. This statistical testing was measured against malignant, benign proliferative and benign non-proliferative outcomes. Results: The malignant and benign proliferative outcomes showed a mixture of opposing protective and predictive individual cytological criteria. The stepwise analysis produced models demonstrating the best combination of individual cytological criteria for malignancy, proliferative and benign non-proliferative entities. In the malignancy model, discohesion, nuclear crowding within sheets, diminished numbers of bare bipolar nuclei and myoepithelial cells, the presence of tubules or necrosis and the absence of a cystic background were important features. The benign proliferative model suggested the same criteria but with the opposite implication and with the addition of several others, such as the presence of apocrine metaplasia, retained polarity and a speckled or coarse chromatin pattern. Age was a significant factor in malignant and proliferative outcomes. The benign non-proliferative stepwise analysis produced a model with fewer criteria (complex sheets, bare bipolar nuclei and a cystic background) limiting clinical application. Conclusion: Atypical/C3 breast cytology remains a legitimate reporting category. However, it is associated with a number of different histological outcomes. The incidence of the C3 category can be significantly reduced by controlling extrinsic factors and understanding the associated microscopic features.
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Nova |
2014 |
Williamson A, Redman S, Mcelduff P, D' Este C, Dadds M, Raphael B, et al., 'The Construct Validity of the Strengths and Difficulties Questionnaire for Aboriginal Children Living in Urban New South Wales, Australia', Australian Psychologist, (2014) [C1]
The current study explores the construct validity of the standard Strengths and Difficulties Questionnaire (SDQ) for Aboriginal children living in urban communities in New South W... [more]
The current study explores the construct validity of the standard Strengths and Difficulties Questionnaire (SDQ) for Aboriginal children living in urban communities in New South Wales, Australia. Parent report SDQ data from the first 717 Aboriginal children aged 4-17 years who participated in the baseline survey of the Study of Environment on Aboriginal Resilience and Child Health were analysed. The overall construct validity of the SDQ in our sample was acceptable but not "good." The internal consistency reliability was excellent overall and good for all subscales with the exception of peer problems, a concept that may have a different significance for urban Aboriginal parents. Removing the peer relationships subscale, however, did not improve the fit of the model. The convergent validity of the SDQ was good. The prosocial behaviours scale and both the peer and conduct problems scales were highly correlated suggesting Aboriginal parents conceptualise these differently and that prosocial behaviours may be considered a key indicator of well-being for Aboriginal children. Overall, the SDQ is a promising tool for urban Aboriginal children in New South Wales. Those working with Aboriginal young people should focus on the SDQ total difficulties score and limit their reliance on the peer relationships subscale. © 2014 The Australian Psychological Society.
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Nova |
2014 |
Kypri K, Davie G, McElduff P, Connor J, Langley J, 'Effects of lowering the minimum alcohol purchasing age on weekend assaults resulting in hospitalization in New Zealand', American Journal of Public Health, 104 1396-1401 (2014) [C1]
Objectives. We estimated the effects on assault rates of lowering the minimum alcohol purchasing age in New Zealand from 20 to 18 years. We hypothesized that the law change would ... [more]
Objectives. We estimated the effects on assault rates of lowering the minimum alcohol purchasing age in New Zealand from 20 to 18 years. We hypothesized that the law change would increase assaults among young people aged 18 to 19 years (the target group) and those aged 15 to 17 years via illegal sales or alcohol supplied by older friends or family members. Methods. Using Poisson regression, we examined weekend assaults resulting in hospitalization from 1995 to 2011. Outcomes were assessed separately by gender among young people aged 15 to 17 years and those aged 18 to 19 years, with those aged 20 and 21 years included as a control group. Results. Relative to young men aged 20 to 21 years, assaults increased significantly among young men aged 18 to 19 years between 1995 and 1999 (the period before the law change), as well as the postchange periods 2003 to 2007 (incidence rate ratio [IRR] = 1.21; 95% confidence interval [CI] = 1.05, 1.39) and 2008 to 2011 (IRR = 1.20; 95% CI = 1.05, 1.37). Among boys aged 15 to 17 years, assaults increased during the postchange periods 1999 to 2003 (IRR = 1.28; 95% CI = 1.10, 1.49) and 2004 to 2007 (IRR = 1.25; 95% CI = 1.08, 1.45). There were no statistically significant effects among girls and young women. Conclusions. Lowering the minimum alcohol purchasing age increased weekend assaults resulting in hospitalization among young males 15 to 19 years of age.
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Nova |
2014 |
Wolfenden L, Wyse R, Nichols M, Allender S, Millar L, McElduff P, 'A systematic review and meta-analysis of whole of community interventions to prevent excessive population weight gain', PREVENTIVE MEDICINE, 62 193-200 (2014) [C1]
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Nova |
2014 |
Vishram JKK, Borglykke A, Andreasen AH, Jeppesen J, Ibsen H, Jørgensen T, et al., 'Do other cardiovascular risk factors influence the impact of age on the association between blood pressure and mortality? the MORGAM Project', Journal of Hypertension, 32 1025-1033 (2014) [C1]
OBJECTIVE: To investigate age-related shifts in the relative importance of SBP and DBP as predictors of cardiovascular mortality and all-cause mortality and whether these relation... [more]
OBJECTIVE: To investigate age-related shifts in the relative importance of SBP and DBP as predictors of cardiovascular mortality and all-cause mortality and whether these relations are influenced by other cardiovascular risk factors. METHODS: Using 42 cohorts from the MORGAM Project with baseline between 1982 and 1997, 85772 apparently healthy Europeans and Australians aged 19-78 years were included. During 13.3 years of follow-up, 9.2% died (of whom 7.2% died due to stroke and 21.1% due to coronary heart disease, CHD). RESULTS: Mortality risk was analyzed using hazard ratios per 10-mmHg/5-mmHg increase in SBP/DBP by multivariate-adjusted Cox regressions, including SBP and DBP simultaneously. Because of nonlinearity, SBP and DBP were analyzed separately for blood pressure (BP) values above and below a cut-point wherein mortality risk was the lowest. For the total population, significantly positive associations were found between stroke mortality and SBP [hazard ratio=1.19 (1.13-1.25)] and DBP at least 78mmHg [hazard ratio=1.08 (1.02-1.14)], CHD mortality and SBP at least 116mmHg [1.20 (1.16-1.24)], and all-cause mortality and SBP at least 120mmHg [1.09 (1.08-1.11)] and DBP at least 82mmHg [1.03 (1.02-1.05)]. BP values below the cut-points were inversely related to mortality risk. Taking into account the age×BP interaction, there was a gradual shift from DBP (19-26 years) to both DBP and SBP (27-62 years) and to SBP (63-78 years) as risk factors for stroke mortality and all-cause mortality, but not CHD mortality. The age at which the importance of SBP exceeded DBP was for stroke mortality influenced by sex, cholesterol, and country risk. CONCLUSION: Age-related shifts to the superiority of SBP exist for stroke mortality and all-cause mortality, and for stroke mortality was this shift influenced by other cardiovascular risk factors. © 2014 Wolters Kluwer Health / Lippincott Williams & Wilkins.
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Nova |
2014 |
Janssen H, Ada L, Bernhardt J, McElduff P, Pollack M, Nilsson M, Spratt N, 'Physical, cognitive and social activity levels of stroke patients undergoing rehabilitation within a mixed rehabilitation unit', Clinical Rehabilitation, 28 91-101 (2014) [C1]
Objective: To determine physical, cognitive and social activity levels of stroke patients undergoing rehabilitation, and whether these changed over time. Design: Observational stu... [more]
Objective: To determine physical, cognitive and social activity levels of stroke patients undergoing rehabilitation, and whether these changed over time. Design: Observational study using behavioural mapping techniques to record patient activity over 12 hours on one weekday and one weekend day at baseline (week 1) and again two weeks later (week 2). Setting: A 20-bed mixed rehabilitation unit. Subjects: Fourteen stroke patients. Interventions: None. Main measures: Percentage of day spent in any activity or physical, cognitive and social activities. Level of independence using the Functional Independence Measure (FIM) and mood using the Patient Health Questionniare-9 (PHQ-9). Results: The stroke patients performed any activity for 49%, social activity for 32%, physical activity for 23% and cognitive activity for 4% of the day. Two weeks later, physical activity levels had increased by 4% (95% confidence interval (CI) 1 to 8), but levels of any activity or social and cognitive activities had not changed significantly. There was a significant: (i) positive correlation between change in physical activity and change in FIM score (r = 0.80), and (ii) negative correlation between change in social activity and change in PHQ-9 score (r = -0.72). The majority of activity was performed by the bedside (37%), and most physical (47%) and cognitive (54%) activities performed when alone. Patients undertook 5% (95% CI 2 to 9) less physical activity on the weekends compared with the weekdays. Conclusions: Levels of physical, cognitive and social activity of stroke patients were low and remained so even though level of independence and mood improved. These findings suggest the need to explore strategies to stimulate activity within rehabilitation environments. © The Author(s) 2013.
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Nova |
2014 |
Baker AL, Kavanagh DJ, Kay-Lambkin FJ, Hunt SA, Lewin TJ, Carr VJ, McElduff P, 'Randomized controlled trial of MICBT for co-existing alcohol misuse and depression: Outcomes to 36-months', Journal of Substance Abuse Treatment, 46 281-290 (2014) [C1]
Integrated psychological treatment addressing co-existing alcohol misuse and depression has not been compared with single-focused treatment. This trial evaluates changes over 36. ... [more]
Integrated psychological treatment addressing co-existing alcohol misuse and depression has not been compared with single-focused treatment. This trial evaluates changes over 36. months following randomization of 284 outpatients to one of four motivational interviewing and cognitive-behavior therapy (MICBT) based interventions: (1) brief integrated intervention (BI); or BI plus 9 further sessions with (2) an integrated-, (3) alcohol-, or (4) depression-focus. Outcome measures included changes in alcohol consumption, depression (BDI-II: Beck Depression Inventory) and functioning (GAF: Global Assessment of Functioning), with average improvements from baseline of 21.8 drinks per week, 12.6 BDI-II units and 8.2 GAF units. Longer interventions tended to be more effective in reducing depression and improving functioning in the long-term, and in improving alcohol consumption in the short-term. Integrated treatment was at least as good as single-focused MICBT. Alcohol-focused treatment was as effective as depression-focused treatment at reducing depression and more effective in reducing alcohol misuse. The best approach seems to be an initial focus on both conditions followed by additional integrated- or alcohol-focused sessions. © 2014 Elsevier Inc.
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2014 |
McElwaine KM, Freund M, Campbell EM, Knight J, Bowman JA, Wolfenden L, et al., 'Increasing preventive care by primary care nursing and allied health clinicians a non-randomized controlled trial', American Journal of Preventive Medicine, 47 424-434 (2014) [C1]
Background: Although primary care nurse and allied health clinician consultations represent key opportunities for the provision of preventive care, it is provided suboptimally. Pu... [more]
Background: Although primary care nurse and allied health clinician consultations represent key opportunities for the provision of preventive care, it is provided suboptimally. Purpose: To assess the effectiveness of a practice change intervention in increasing primary care nursing and allied health clinician provision of preventive care for four health risks. Design: Two-group (intervention versus control), non-randomized controlled study assessing the effectiveness of the intervention in increasing clinician provision of preventive care. Setting/participants: Randomly selected clients from 17 primary healthcare facilities participated in telephone surveys that assessed their receipt of preventive care prior to (September 2009-2010, n=876) and following intervention (October 2011-2012, n=1,113). Intervention: The intervention involved local leadership and consensus processes, electronic medical record system modification, educational meetings and outreach, provision of practice change resources and support, and performance monitoring and feedback. Main outcome measures: The primary outcome was differential change in client-reported receipt of three elements of preventive care (assessment, brief advice, referral/follow-up) for each of four behavioral risks individually (smoking, inadequate fruit and vegetable consumption, alcohol overconsumption, physical inactivity) and combined. Logistic regression assessed intervention effectiveness. Results: Analyses conducted in 2013 indicated significant improvements in preventive care delivery in the intervention compared to the control group from baseline to follow-up for assessment of fruit and vegetable consumption (+23.8% vs -1.5%); physical activity (+11.1% vs -0.3%); all four risks combined (+16.9% vs -1.0%) and for brief advice for inadequate fruit and vegetable consumption (+19.3% vs -2.0%); alcohol overconsumption (+14.5% vs -8.9%); and all four risks combined (+14.3% vs +2.2%). The intervention was ineffective in increasing the provision of the remaining forms of preventive care. Conclusions: The intervention's impact on the provision of preventive care varied by both care element and risk type. Further intervention is required to increase the consistent provision of preventive care, particularly referral/follow-up.
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Nova |
2014 |
Preece K, Bhatia R, Belcher J, Patchett K, McElduff P, Collison A, Mattes J, 'The fraction of exhaled nitric oxide improves prediction of clinical allergic reaction to peanut challenge in children', CLINICAL AND EXPERIMENTAL ALLERGY, 44 371-380 (2014) [C1]
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Nova |
2014 |
Kypri K, Mcelduff P, Miller P, 'Restrictions in pub closing times and lockouts in Newcastle, Australia five years on', Drug and Alcohol Review, 33 323-326 (2014) [C1]
Introduction and Aims.: In 2008 pub closing times were restricted from 5am to 3:30am in the central business district (CBD) of Newcastle, Australia. A previous study showed a one-... [more]
Introduction and Aims.: In 2008 pub closing times were restricted from 5am to 3:30am in the central business district (CBD) of Newcastle, Australia. A previous study showed a one-third reduction in assaults in the 18 months following the restriction. We assessed whether the assault rate remained lower over the following 3.5 years and whether the introduction of a 'lockout' in nearby Hamilton was associated with a reduction in assaults there. Design and Methods.: We used a pre-post design with comparison against two post-change periods. The setting was Greater Newcastle (population 530 000) and subjects were persons apprehended for assault in the CBD and nearby Hamilton, an area with late trading pubs where a lockout and other strategies were implemented in 2010. Cases were police-recorded assault apprehensions occurring from 10pm to 6am in one pre-change period: January 2001 to March 2008, and two post-change periods: (i) April 2008 to September 2009 and (ii) October 2009 to March 2013. Negative binomial regression with terms for secular trend and seasonal effects was used to estimate Post1: Pre and Post2: Pre Incidence Rate Ratios and confidence intervals. Results.: In the CBD recorded assaults fell from 99/quarter before the restriction to 68/quarter in the first post-change period [incidence rate ratio (IRR) 0.67, 95% confidence interval (CI) 0.55-0.82] and 71/quarter (IRR: 0.68, 95% CI: 0.55-0.85) in the later post-change period. In the same periods in Hamilton, assault rates were 23, 24, and 22 per quarter respectively. Discussion and Conclusions.: The restriction in closing time was associated with a sustained lower assault rate in the Newcastle CBD. We find no evidence that lockouts and other outlet management strategies were effective in Hamilton. [Kypri K, McElduff P, Miller P. Restrictions in pub closing times and lockouts in Newcastle Australia 5 years on. Drug Alcohol Rev. © 2014 Australasian Professional Society on Alcohol and other Drugs.
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Nova |
2014 |
Janssen H, Ada L, Bernhardt J, McElduff P, Pollack M, Nilsson M, Spratt NJ, 'An enriched environment increases activity in stroke patients undergoing rehabilitation in a mixed rehabilitation unit: a pilot non-randomized controlled trial', DISABILITY AND REHABILITATION, 36 255-262 (2014) [C1]
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Nova |
2014 |
McCambridge J, Kypri K, McElduff P, 'Regression to the mean and alcohol consumption: A cohort study exploring implications for the interpretation of change in control groups in brief intervention trials', Drug and Alcohol Dependence, 135 156-159 (2014) [C1]
Background: Reductions in drinking among individuals randomised to control groups in brief alcohol intervention trials are common and suggest that asking study participants about ... [more]
Background: Reductions in drinking among individuals randomised to control groups in brief alcohol intervention trials are common and suggest that asking study participants about their drinking may itself cause them to reduce their consumption. We sought to test the hypothesis that the statistical artefact regression to the mean (RTM) explains part of the reduction in such studies. Methods: 967 participants in a cohort study of alcohol consumption in New Zealand provided data at baseline and again six months later. We use graphical methods and apply thresholds of 8, 12, 16 and 20 in AUDIT scores to explore RTM. Results: There was a negative association between baseline AUDIT scores and change in AUDIT scores from baseline to six months, which in the absence of bias and confounding, is RTM. Students with lower baseline scores tended to have higher follow-up scores and conversely, those with higher baseline scores tended to have lower follow-up scores. When a threshold score of 8 was used to select a subgroup, the observed mean change was approximately half of that observed without a threshold. The application of higher thresholds produced greater apparent reductions in alcohol consumption. Conclusions: Part of the reduction seen in the control groups of brief alcohol intervention trials is likely to be due to RTM and the amount of change is likely to be greater as the threshold for entry to the trial increases. Quantification of RTM warrants further study and should assist understanding assessment and other research participation effects. © 2013 The Authors.
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Nova |
2014 |
Gilligan C, Toumbourou JW, Kypri K, McElduff P, 'Factors Associated With Parental Rules for Adolescent Alcohol Use', SUBSTANCE USE & MISUSE, 49 145-153 (2014) [C1]
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Nova |
2014 |
Denham JW, Nowitz M, Joseph D, Duchesne G, Spry NA, Lamb DS, et al., 'Impact of androgen suppression and zoledronic acid on bone mineral density and fractures in the Trans-Tasman Radiation Oncology Group (TROG) 03.04 Randomised Androgen Deprivation and Radiotherapy (RADAR) randomized controlled trial for locally advanced prostate cancer', BJU International, 114 344-353 (2014) [C1]
Objective To study the influence of adjuvant androgen suppression and bisphosphonates on incident vertebral and non-spinal fracture rates and bone mineral density (BMD) in men wit... [more]
Objective To study the influence of adjuvant androgen suppression and bisphosphonates on incident vertebral and non-spinal fracture rates and bone mineral density (BMD) in men with locally advanced prostate cancer. Patients and Methods Between 2003 and 2007, 1071 men with locally advanced prostate cancer were randomly allocated, using a 2 × 2 trial design, to 6 months i.m. leuprorelin (androgen suppression [AS]) before radiotherapy alone ± 12 months additional leuprorelin ± 18 months zoledronic acid (ZdA), commencing at randomization. The main endpoint was incident thoraco-lumbar vertebral fractures, which were assessed radiographically at randomization and at 3 years, then reassessed by centralized review. Subsidiary endpoints included incident non-spinal fractures, which were documented throughout follow-up, and BMD, which was measured in 222 subjects at baseline, 2 years and 4 years. Results Incident vertebral fractures at 3 years were observed in 132 subjects. Their occurrence was not increased by 18 months' AS, nor reduced by ZdA. Incident non-spinal fractures occurred in 72 subjects and were significantly related to AS duration but not to ZdA. Osteopenia and osteoporosis prevalence rates at baseline were 23.4 and 1.4%, respectively, at the hip. Treatment for 6 and 18 months with AS caused significant reductions in hip BMD at 2 and 4 years (P < 0.01) and ZdA prevented these losses at both time points. Conclusion In an AS-naïve population, 18 months of ZdA treatment prevented the sustained BMD losses caused by 18 months of AS treatment; however, the study power was insufficient to show that AS duration or ZdA influenced vertebral fracture rates. © 2013 The Authors. BJU International © 2013 BJU International.
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2014 |
Bivard A, Krishnamurthy V, Levi C, McElduff P, Miteff F, Spratt N, et al., 'Stroke thrombolysis: Tissue is more important than time.', CEREBROVASCULAR DISEASES, 37 154-154 (2014)
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2014 |
Bivard A, Krishnamurthy V, Levi C, McElduff P, Miteff F, Spratt N, et al., 'Does the presence of CTP mismatch predict better outcomes in thrombolysis-treated patients?', CEREBROVASCULAR DISEASES, 37 344-344 (2014)
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2014 |
Bivard A, Levi C, Krishnamurthy V, McElduff P, Miteff F, Spratt N, et al., 'Better stroke outcomes despite worse baseline stroke severity - the value of a combined clinical and advanced CT selection approach to thrombolysis.', CEREBROVASCULAR DISEASES, 37 701-701 (2014)
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2014 |
Magin P, Morgan S, Henderson K, Tapley A, McElduff P, Pearlman J, et al., 'Family medicine trainees' clinical experience of chronic disease during training: a cross-sectional analysis from the registrars' clinical encounters in training study', BMC MEDICAL EDUCATION, 14 (2014) [C1]
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2014 |
Islam MR, Attia J, Alauddin M, McEvoy M, McElduff P, Slater C, et al., 'Availability of arsenic in human milk in women and its correlation with arsenic in urine of breastfed children living in arsenic contaminated areas in Bangladesh.', Environmental Health: A Global Access Science Source, 13 1-10 (2014) [C1]
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2014 |
Johnson NA, Kypri K, Latter J, McElduff P, Saunders JB, Saitz R, et al., 'Prevalence of unhealthy alcohol use in hospital outpatients', Drug and Alcohol Dependence, 144 270-273 (2014) [C1]
Background: Few studies have examined the prevalence of unhealthy alcohol use in the hospital outpatient setting. Our aim was to estimate the prevalence of unhealthy alcohol use a... [more]
Background: Few studies have examined the prevalence of unhealthy alcohol use in the hospital outpatient setting. Our aim was to estimate the prevalence of unhealthy alcohol use among patients attending a broad range of outpatient clinics at a large public hospital in Australia. Methods: Adult hospital outpatients were invited to complete the Alcohol Use Disorders Identification Test Consumption questions (AUDIT-C) using an iPad as part of a randomised trial testing the efficacy of alcohol electronic screening and brief intervention. Unhealthy alcohol use was defined as an AUDIT-C score =5 among men and =4 among women. Results: Sixty percent (3616/6070) of invited hospital outpatients consented, of whom 89% (3206/3616) provided information on their alcohol consumption (either reported they had not consumed any alcohol in the last 12 months or completed the AUDIT-C). The prevalence of unhealthy alcohol use was 34.7% (95% confidence interval [CI]: 33.0-36.3%). The prevalence among men aged 18-24 years, 25-39 years, 40-59 years and 60 years and older, was 74.4% (95% CI: 68.4-80.4%), 54.3% (95% CI: 48.7-59.8%), 44.1% (95% CI: 39.9-48.3%), and 27.0% (95% CI: 23.6-30.4%), respectively (43.1% overall; 95% CI: 40.8-45.5%). The prevalence among women aged 18-24 years, 25-39 years, 40-59 years, and 60 years and older, was 48.6% (95% CI: 39.2-58.1%), 36.9% (95% CI: 31.2-42.6%), 25.2% (95% CI: 21.5-29.0%) and 14.5% (95% CI: 11.7-17.3%), respectively (24.9% overall; 95% CI: 22.7-27.1%). Conclusion: A large number of hospital outpatients who are not currently seeking treatment for their drinking could benefit from effective intervention in this setting.
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Nova |
2014 |
Ewald B, Attia J, McElduff P, 'How many steps are enough? dose-response curves for pedometer steps and multiple health markers in a community-based sample of older Australians', Journal of Physical Activity and Health, 11 509-518 (2014) [C1]
Background: Although an overall public health target of 10,000 steps per day has been advocated, the dose-response relationship for each health benefit of physical activity may di... [more]
Background: Although an overall public health target of 10,000 steps per day has been advocated, the dose-response relationship for each health benefit of physical activity may differ. Methods: A representative community sample of 2458 Australian residents aged 55-85 wore a pedometer for a week in 2005-2007 and completed a health assessment. Age-standardized steps per day were compared with multiple markers of health using locally weighted regression to produce smoothed dose-response curves and then to select the steps per day matching 60% or 80% of the range in each health marker. Results: There is a linear relationship between activity level and markers of inflammation throughout the range of steps per day; this is also true for BMI in women and high density lipoprotein in men. For other markers, including waist:hip ratio, fasting glucose, depression, and SF-36 scores, the benefit of physical activity is mostly in the lower half of the distribution. Conclusions: Older adults have no plateau in the curve for some health outcomes, even beyond 12,000 steps per day. For other markers, however, there is a threshold effect, indicating that most of the benefit is achieved by 8000 steps per day, supporting this as a suitable public health target for older adults. © 2014 Human Kinetics, Inc.
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2014 |
Drury P, Levi C, McInnes E, Hardy J, Ward J, Grimshaw JM, et al., 'Management of fever, hyperglycemia, and swallowing dysfunction following hospital admission for acute stroke in New South Wales, Australia', INTERNATIONAL JOURNAL OF STROKE, 9 23-31 (2014) [C1]
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2014 |
Drury P, Levi C, D'Este C, Mcelduff P, Mcinnes E, Hardy J, et al., 'Quality in Acute Stroke Care (QASC): Process evaluation of an intervention to improve the management of fever, hyperglycemia, and swallowing dysfunction following acute stroke', International Journal of Stroke, 9 766-776 (2014) [C1]
Background: Our randomized controlled trial of a multifaceted evidence-based intervention for improving the inpatient management of fever, hyperglycemia, and swallowing dysfunctio... [more]
Background: Our randomized controlled trial of a multifaceted evidence-based intervention for improving the inpatient management of fever, hyperglycemia, and swallowing dysfunction in the first three-days following stroke improved outcomes at 90 days by 15%. We designed a quantitative process evaluation to further explain and illuminate this finding. Methods: Blinded retrospective medical record audits were undertaken for patients from 19 stroke units prior to and following the implementation of three multidisciplinary evidence-based protocols (supported by team-building workshops, and site-based education and support) for the management of fever (temperature =37·5°C), hyperglycemia (glucose >11mmol/l), and swallowing dysfunction in intervention stroke units. Results: Data from 1804 patients (718 preintervention; 1086 postintervention) showed that significantly more patients admitted to hospitals allocated to the intervention group received care according to the fever (n=186 of 603, 31% vs. n=74 of 483, 15%, P<0·001), hyperglycemia (n=22 of 603, 3·7% vs. n=3 of 483, 0·6%, P=0·01), and swallowing dysfunction protocols (n=241 of 603, 40% vs. n=19 of 483, 4·0%, P=0·001). Significantly more patients in these intervention stroke units received four-hourly temperature monitoring (n=222 of 603, 37% vs. n=90 of 483, 19%, P<0·001) and six-hourly glucose monitoring (194 of 603, 32% vs. 46 of 483, 9·5%, P<0·001) within 72 hours of admission to a stroke unit, and a swallowing screen (242 of 522, 46% vs. 24 of 350, 6·8%, P=0·0001) within the first 24 hours of admission to hospital. There was no difference between the groups in the treatment of patients with fever with paracetamol (22 of 105, 21% vs. 38 of 131, 29%, P=0·78) or their hyperglycemia with insulin (40 of 100, 40% vs. 17 of 57, 30%, P=0·49). Interpretation: Our intervention resulted in better protocol adherence in intervention stroke units, which explains our main trial findings of improved patient 90-day outcomes. Although monitoring practices significantly improved, there was no difference between the groups in the treatment of fever and hyperglycemia following acute stroke. A significant link between improved treatment practices and improved outcomes would have explained further the success of our intervention, and we are still unable to explain definitively the large improvements in death and dependency found in the main trial results. One potential explanation is that improved monitoring may have led to better overall surveillance of deteriorating patients and faster initiation of treatments not measured as part of the main trial. © 2013 World Stroke Organization.
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2014 |
White AE, Edelman JJB, Lott N, Bannon PG, McElduff P, Curnow JL, Balogh ZJ, 'Characterization of the hypercoagulable state following severe orthopedic trauma', JOURNAL OF TRAUMA AND ACUTE CARE SURGERY, 77 231-237 (2014) [C1]
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2014 |
James S, Perry L, Gallagher R, Lowe J, Dunbabin J, McElduff P, et al., 'Service usage and vascular complications in young adults with type 1 diabetes', BMC Endocrine Disorders, 14 (2014) [C1]
Background: Few studies have examined young adults with type 1 diabetes use of health services and the development of vascular complications. As part of the Youth Outreach for Dia... [more]
Background: Few studies have examined young adults with type 1 diabetes use of health services and the development of vascular complications. As part of the Youth Outreach for Diabetes (YOuR-Diabetes) project, this study identified health service usage, the prevalence and factors predictive of development of vascular complications (hypertension, retinopathy and nephropathy) in a cohort of young adults (aged 16-30 years) with type 1 diabetes in Hunter New England and the Lower Mid-North Coast area of New South Wales, Australia. Methods: A cross-sectional retrospective documentation survey was undertaken of case notes of young adults with type 1 diabetes accessing Hunter New England Local Health District public health services in 2010 and 2011, identified through ambulatory care clinic records, hospital attendances and other clinical records. Details of service usage, complications screening and evidence of vascular complications were extracted. Independent predictors were modelled using linear and logistic regression analyses. Results: A cohort of 707 patients were reviewed; mean (SD) age was 23.0 (3.7) years, with mean diabetes duration of 10.2 (5.8, range 0.2 - 28.3) years; 42.4% lived/ 23.1% accessed services in non-metropolitan areas.Routine preventative service usage was low and unplanned contacts high; both deteriorated with increasing age. Low levels of complications screening were found. Where documented, hypertension, particularly, was common, affecting 48.4% across the study period. Diabetes duration was a strong predictor of vascular complications along with glycaemic control; hypertension was linked with renal dysfunction.Conclusion: Findings indicate a need to better understand young people's drivers and achievements when accessing services, and how services can be reconfigured or delivered differently to better meet their needs and achieve better outcomes. Regular screening is required using current best practice guidelines as this affords the greatest chance for early complication detection, treatment initiation and secondary prevention. © 2014 James et al.; licensee BioMed Central Ltd.
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2014 |
James EL, Ewald B, Johnson N, Brown W, Stacey FG, Mcelduff P, et al., 'Efficacy of GP referral of insufficiently active patients for expert physical activity counseling: protocol for a pragmatic randomized trial (The NewCOACH trial)', BMC FAMILY PRACTICE, 15 (2014) [C3]
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2014 |
Jones J, Wolfenden L, Wyse R, Finch M, Yoong SL, Dodds P, et al., 'A randomised controlled trial of an intervention to facilitate the implementation of healthy eating and physical activity policies and practices in childcare services.', BMJ Open, 4 e005312 (2014) [C3]
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2014 |
Lopez P, Smart C, Morbey C, McElduff P, Paterson M, King BR, 'Extended insulin boluses cannot control postprandial glycemia as well as a standard bolus in children and adults using insulin pump therapy.', BMJ Open Diabetes Research & Care, 2 1-6 (2014) [C1]
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2014 |
Clarey J, Lasserson D, Levi C, Parsons M, Dewey H, Barber PA, et al., 'Absolute cardiovascular risk and GP decision making in TIA and minor stroke.', Fam Pract, 31 664-669 (2014) [C1]
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2013 |
Johnson NA, Kypri K, Saunders JB, Saitz R, Attia J, Dunlop A, et al., 'The hospital outpatient alcohol project (HOAP): protocol for an individually randomized, parallel-group superiority trial of electronic alcohol screening and brief intervention versus screening alone for unhealthy alcohol use.', Addict Sci Clin Pract, 8 14 (2013) [C3]
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2013 |
Paul CL, Turon H, Bonevski B, Bryant J, McElduff P, 'A cross-sectional survey of experts' opinions about the relative effectiveness of tobacco control strategies for the general population versus disadvantaged groups: What do we choose in the absence of evidence?', BMC Public Health, 13 (2013) [C1]
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2013 |
Lambert SD, Girgis A, McElduff P, Turner J, Levesque JV, Kayser K, et al., 'A parallel-group, randomised controlled trial of a multimedia, self-directed, coping skills training intervention for patients with cancer and their partners: Design and rationale', BMJ Open, 3 (2013) [C2]
Introduction: Coping skills training interventions have been found to be efficacious in helping both patients and their partners manage the physical and emotional challenges they ... [more]
Introduction: Coping skills training interventions have been found to be efficacious in helping both patients and their partners manage the physical and emotional challenges they face following a cancer diagnosis. However, many of these interventions are costly and not sustainable. To overcome these issues, a self-directed format is increasingly used. The efficacy of self-directed interventions for patients has been supported; however, no study has reported on the outcomes for their partners. This study will test the efficacy of Coping-Together - a multimedia, self-directed, coping skills training intervention for patients with cancer and their partners. Methods and analysis: The proposed three-group, parallel, randomised controlled trial will recruit patients diagnosed in the past 4 months with breast, prostate, colorectal cancer or melanoma through their treating clinician. Patients and their partners will be randomised to (1) a minimal ethical care (MEC) condition - selected Cancer Council New South Wales booklets and a brochure for the Cancer Council Helpline, (2) Coping-Together generic - MEC materials, the six Coping-Together booklets and DVD, the Cancer Council Queensland relaxation audio CD and login to the Coping-Together website or (3) Coping-Together tailored - MEC materials, the Coping-Together DVD, the login to the website and only those Coping-Together booklet sections that pertain to their direct concerns. Anxiety (primary outcome), distress, depression, dyadic adjustment, quality of life, illness or caregiving appraisal, self-efficacy and dyadic and individual coping will be assessed before receiving the study material (ie, baseline) and again at 3, 6 and 12 months postbaseline. Intention-to-treat and per protocol analysis will be conducted. Ethics and dissemination: This study has been approved by the relevant local area health and University ethics committees. Study findings will be disseminated not only through peer-reviewed publications and conference presentations but also through educational outreach visits, publication of lay research summaries in consumer newsletters and publications targeting clinicians.
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2013 |
Turner A, Hambridge J, Baker A, Bowman J, McElduff P, 'Randomised controlled trial of group cognitive behaviour therapy versus brief intervention for depression in cardiac patients', AUSTRALIAN AND NEW ZEALAND JOURNAL OF PSYCHIATRY, 47 235-243 (2013) [C1]
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2013 |
Smart CEM, Evans M, O'Connell SM, McElduff P, Lopez PE, Jones TW, et al., 'Both Dietary Protein and Fat Increase Postprandial Glucose Excursions in Children With Type 1 Diabetes, and the Effect Is Additive', DIABETES CARE, 36 3897-3902 (2013) [C1]
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2013 |
Morgan PJ, Callister R, Collins CE, Plotnikoff RC, Young MD, Berry N, et al., 'The SHED-IT Community Trial: A Randomized Controlled Trial of Internet- and Paper-Based Weight Loss Programs Tailored for Overweight and Obese Men', ANNALS OF BEHAVIORAL MEDICINE, 45 139-152 (2013) [C1]
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2013 |
Girgis A, Lambert SD, McElduff P, Bonevski B, Lecathelinais C, Boyes A, Stacey F, 'Some things change, some things stay the same: a longitudinal analysis of cancer caregivers' unmet supportive care needs', PSYCHO-ONCOLOGY, 22 1557-1564 (2013) [C1]
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Nova |
2013 |
Robertson J, McElduff P, Pearson S-A, Henry DA, Inder KJ, Attia JR, 'The health services burden of heart failure: an analysis using linked population health data-sets (vol 12, pg 103, 2012)', BMC HEALTH SERVICES RESEARCH, 13 (2013) [O1]
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2013 |
Fletcher A, Wolfenden L, Wyse R, Bowman J, McElduff P, Duncan S, 'A randomised controlled trial and mediation analysis of the 'Healthy Habits', telephone-based dietary intervention for preschool children', INTERNATIONAL JOURNAL OF BEHAVIORAL NUTRITION AND PHYSICAL ACTIVITY, 10 (2013) [C1]
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2013 |
Janssen H, Speare S, Spratt NJ, Sena ES, Ada L, Hannan AJ, et al., 'Exploring the Efficacy of Constraint in Animal Models of Stroke: Meta-analysis and Systematic Review of the Current Evidence', NEUROREHABILITATION AND NEURAL REPAIR, 27 3-12 (2013) [C1]
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2013 |
Zareie H, Quain DA, Parsons M, Inder KJ, McElduff P, Miteff F, et al., 'The influence of anterior cerebral artery flow diversion measured by transcranial Doppler on acute infarct volume and clinical outcome in anterior circulation stroke', INTERNATIONAL JOURNAL OF STROKE, 8 228-234 (2013) [C1]
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2013 |
Magin P, Lasserson D, Parsons M, Spratt N, Evans M, Russell M, et al., 'Referral and triage of patients with transient ischemic attacks to an acute access clinic: Risk stratification in an Australian setting', International Journal of Stroke, 8 81-89 (2013) [C1]
Background: Transient ischemic attacks and minor stroke entail considerable risk of completed stroke but this risk is reduced by prompt assessment and treatment. Risk can be strat... [more]
Background: Transient ischemic attacks and minor stroke entail considerable risk of completed stroke but this risk is reduced by prompt assessment and treatment. Risk can be stratified according to the ABCD2 prediction score. Current guidelines suggest specialist assessment and treatment within 24h for high-risk event (ABCD2 score 4-7) and seven-days for low-risk event (ABCD2 score =3). Aims: The study aims to establish paths to care and outcomes for patients referred by general practitioners and emergency departments to an Australian acute access transient ischemic attack service. Methods: This is a prospective audit. Primary outcomes were time from event to referral, from referral to clinic appointment, and from event to appointment. ABCD2 score was calculated for each event. Time from event was modeled using Cox proportional hazards regression. Results: There were 231 clinic attendees (general practitioner: 127; emergency department: 104). Mean time from event to referral was 9·2 days (SD 23·7, median 2), from referral to being seen in the clinic was 13·6 days (SD 19·0, median 7), and from event to being seen in the clinic was 17·2 days (SD 27·1, median 10). Of low-risk patients, 38·5% were seen within seven-days of event. Of high-risk patients, 36·7% were seen within one-day. ABCD2 score was not a significant predictor of any time interval from event to clinic attendance. There were no completed strokes prior to clinic attendance. Conclusions: Times from event to clinic assessment were in excess of current recommendations and risk stratification was suboptimal, though short-term outcomes were good. Improvements in referral mechanisms may enhance risk-stratification and triage. © 2013 World Stroke Organization.
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2013 |
Paul CL, Piterman L, Shaw J, Kirby C, Sanson-Fisher RW, Carey ML, et al., 'Diabetes in rural towns: effectiveness of continuing education and feedback for healthcare providers in altering diabetes outcomes at a population level: protocol for a cluster randomised controlled trial', IMPLEMENTATION SCIENCE, 8 (2013) [C3]
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2013 |
Bartlem K, Bowman J, Freund M, Wye P, McElwaine K, Knight J, et al., 'Evaluating the effectiveness of a clinical practice change intervention in increasing clinician provision of preventive care in a network of community-based mental health services: a study protocol of a non-randomized, multiple baseline trial', IMPLEMENTATION SCIENCE, 8 (2013) [C3]
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2013 |
Mcdonald VM, Simpson JL, Mcelduff P, Gibson PG, 'Older peoples' perception of tests used in the assessment and management of COPD and asthma', Clinical Respiratory Journal, 7 367-374 (2013) [C1]
Objectives: Outcome assessment is an important part of the management of airways disease, yet older adults may have difficulty with the burden of testing. This study evaluated the... [more]
Objectives: Outcome assessment is an important part of the management of airways disease, yet older adults may have difficulty with the burden of testing. This study evaluated the patient perception of tests used for the assessment of airways disease in older people. Data Source: Older adults (>55 years) with obstructive airway disease and healthy controls (N=56) underwent inhaler technique assessment, skin allergy testing, venepuncture, fractional exhaled nitric oxide (FENO) and gas diffusion measurement, exercise testing, sputum induction, and questionnaire assessment. They then completed an assessment burden questionnaire across five domains: difficulty, discomfort, pain, symptoms and test duration. Results: Test perception was generally favourable. Induced sputum had the greatest test burden perceived as being more difficult (mean 0.83, P=0.001), associated with more discomfort (mean 1.3, P<0.001), more painful (0.46, P=0.019), longer test duration (0.84, P<0.001) and worsening symptoms (0.55, P=0.001) than the questionnaires. FENO had a more favourable assessment but was assessed to be difficult to perform. Inhaler technique received the most favourable assessment. Conclusions: Older adults hold favourable perceptions to a range of tests that they might encounter in the course of their care for airway disease. The newer tests of sputum induction and FENO have some observed difficulties, in particular sputum induction. The results of this study can inform current practice by including details of the test and its associated adverse effects when conducting the test, as well as providing clear explanations of the utility of tests and how the results might aid in patient care. © 2013 John Wiley & Sons Ltd.
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2013 |
Islam MR, Arslan I, Attia J, McEvoy M, McElduff P, Basher A, et al., 'Is Serum Zinc Level Associated with Prediabetes and Diabetes?: A Cross-Sectional Study from Bangladesh', PLOS ONE, 8 (2013) [C1]
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2013 |
Holliday EG, Smith AV, Cornes BK, Buitendijk GHS, Jensen RA, Sim X, et al., 'Insights into the genetic architecture of early stage age-related macular degeneration: A genome-wide association study meta-analysis', PLoS One, 8 (2013) [C1]
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2012 |
Parsons MW, Spratt NJ, Bivard A, Campbell B, Chung K, Miteff F, et al., 'A randomized trial of tenecteplase versus alteplase for acute ischemic stroke', New England Journal of Medicine, 366 1099-1107 (2012) [C1]
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Nova |
2012 |
Denham J, Wilcox C, Lamb DS, Spry NA, Duchesne G, Atkinson C, et al., 'Rectal and urinary dysfunction in the TROG 03.04 RADAR trial for locally advanced prostate cancer', Radiotherapy and Oncology, 105 184-192 (2012) [C1]
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Nova |
2012 |
Smart CE, King BR, McElduff P, Collins CE, 'In children using intensive insulin therapy, a 20-g variation in carbohydrate amount significantly impacts on postprandial glycaemia', Diabetic Medicine, 29 E21-E24 (2012) [C1]
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Nova |
2012 |
Magee CA, Kritharides L, Attia JR, McElduff P, Banks E, 'Short and long sleep duration are associated with prevalent cardiovascular disease in Australian adults', Journal of Sleep Research, 21 441-447 (2012) [C1]
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2012 |
Carter GL, Britton B, Clover K, Rogers K, Adams CA, McElduff P, 'Effectiveness of QUICATOUCH: A computerised touch screen evaluation for pain and distress in ambulatory oncology patients in Newcastle, Australia', Psycho-Oncology, 21 1149-1157 (2012) [C1]
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Nova |
2012 |
Dassanayake WM, Jones AL, Michie PT, Carter GL, McElduff P, Stokes BJ, Whyte IM, 'Risk of road traffic accidents in patients discharged following treatment for psychotropic drug overdose: A self-controlled case series study in Australia', CNS Drugs, 26 269-276 (2012) [C1]
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Nova |
2012 |
Wolfenden L, Wyse RJ, Britton BI, Campbell KJ, Hodder RK, Stacey FG, et al., 'Interventions for increasing fruit and vegetable consumption in children aged 5 years and under', COCHRANE DATABASE OF SYSTEMATIC REVIEWS, (2012) [C1]
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2012 |
Denham J, Wilcox C, Joseph D, Spry NA, Lamb DS, Tai K-H, et al., 'Quality of life in men with locally advanced prostate cancer treated with leuprorelin and radiotherapy with or without zoledronic acid (TROG 03.04 RADAR): Secondary endpoints from a randomised phase 3 factorial trial', Lancet Oncology, 13 1260-1270 (2012) [C1]
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Nova |
2012 |
Short CE, James EL, Girgis A, McElduff P, Plotnikoff RC, 'Move more for life: The protocol for a randomised efficacy trial of a tailored-print physical activity intervention for post-treatment breast cancer survivors', BMC Cancer, 12 172 (2012) [C3]
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Nova |
2012 |
Robertson J, McElduff P, Pearson S-A, Henry DA, Inder KJ, Attia JR, 'The health services burden of heart failure: An analysis using linked population health data-sets', BMC Health Services Research, 12 1-11 (2012) [C1]
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2012 |
Lambert SD, Girgis A, Turner J, McElduff P, Kayser K, Vallentine P, 'A pilot randomized controlled trial of the feasibility of a self-directed coping skills intervention for couples facing prostate cancer: Rationale and design', Health and Quality of Life Outcomes, 10 119 (2012) [C3]
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2012 |
Janssen H, Ada L, Karayanidis F, Drysdale K, McElduff P, Pollack MR, et al., 'Translating the use of an enriched environment poststroke from bench to bedside: study design and protocol used to test the feasibility of environmental enrichment on stroke patients in rehabilitation', International Journal of Stroke, 7 521-526 (2012) [C3]
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2012 |
Mate KE, Pond CD, Magin PJ, Goode SM, McElduff P, Stocks NP, 'Diagnosis and disclosure of a memory problem is associated with quality of life in community based older Australians with dementia', International Psychogeriatrics, 24 1962-1971 (2012) [C1]
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2012 |
Hibberd A, Trevillian PR, Clark DA, McElduff P, Cowden WB, 'The effects of Castanospermine, an oligosaccharide processing inhibitor, on mononuclear/endothelial cell binding and the expression of cell adhesion molecules', Transplant Immunology, 27 39-47 (2012) [C1]
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Nova |
2012 |
Middleton S, McElduff P, Ward J, Grimshaw JM, Dale S, D'Este C, et al., 'Implementation of evidence-based treatment protocols to manage fever, hyperglycaemia, and swallowing dysfunction in acute stroke (QASC): A cluster randomised controlled trial', Dysphagia, 27 441 (2012)
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2011 |
McElwaine KM, Freund MA, Campbell EM, Knight JJ, Slattery C, Doherty E, et al., 'The effectiveness of an intervention in increasing community health clinician provision of preventive care: A study protocol of a non-randomised, multiple-baseline trial', BMC Health Services Research, 11 354 (2011) [C3]
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2011 |
Kingsland M, Wolfenden L, Rowland BC, Tindall J, Gillham KE, McElduff P, et al., 'A cluster randomised controlled trial of a comprehensive accreditation intervention to reduce alcohol consumption at community sports clubs: Study protocol', BMJ Open, 1 e000328 (2011) [C3]
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2011 |
Tzelepis F, Paul CL, Walsh RA, McElduff P, Knight JJ, 'Proactive telephone counseling for smoking cessation: Meta-analyses by recruitment channel and methodological quality', Journal of the National Cancer Institute, 103 922-941 (2011) [C1]
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Nova |
2011 |
Middleton S, McElduff P, Ward J, Grimshaw JM, Dale S, D'Este CA, et al., 'Implementation of evidence-based treatment protocols to manage fever, hyperglycaemia, and swallowing dysfunction in acute stroke (QASC): A cluster randomised controlled trial', The Lancet, 378 1699-1706 (2011) [C1]
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Nova |
2011 |
Magin PJ, May J, McElduff P, Goode SM, Adams J, Cotter GL, 'Occupational violence in general practice: A whole-of-practice problem. Results of a cross-sectional study', Australian Health Review, 35 75-80 (2011) [C1]
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2011 |
Osmotherly PG, McElduff P, Attia JR, 'Factor Structure of the Neck Disability Index RESPONSE', SPINE, 36 1816-1816 (2011) [C3]
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2011 |
Pickering PM, Osmotherly PG, Attia JR, McElduff P, 'An examination of outcome measures for pain and dysfunction in the cervical spine: A factor analysis', Spine, 36 581-588 (2011) [C1]
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2011 |
Osmotherly PG, McElduff P, Attia JR, 'In response: Factor structure of the Neck Disability Index', Spine, 36 1816 (2011) [C3]
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2011 |
Kypri K, Jones C, McElduff P, Barker DJ, 'Effects of restricting pub closing times on night-time assaults in an Australian city', Addiction, 106 303-310 (2011) [C1]
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Nova |
2011 |
Bryant JL, Bonevski B, Paul CL, McElduff P, Attia JR, 'A systematic review and meta-analysis of the effectiveness of behavioural smoking cessation interventions in selected disadvantaged groups', Addiction, 106 1568-1585 (2011) [C1]
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2011 |
Parsons MW, Bivard A, McElduff P, Spratt NJ, Levi CR, 'Defining the extent of irreversible brain ischemia using perfusion computed tomography', Cerebrovascular Diseases, 31 238-245 (2011) [C1]
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Nova |
2011 |
McGettigan P, Lincz L, Attia JR, McElduff P, Bissett L, Peel R, et al., 'The risk of coronary thrombosis with cyclo-oxygenase-2 inhibitors does not vary with polymorphisms in two regions of the cyclo-oxygenase-2 gene', British Journal of Clinical Pharmacology, 72 707-714 (2011) [C1]
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2011 |
Middleton S, Levi CR, Ward J, Grimshaw J, Griffiths R, D'Este CA, et al., 'Death, dependency and health status 90 days following hospital admission for acute stroke in NSW', Internal Medicine Journal, 41 736-743 (2011) [C1]
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2011 |
Ranasinghe WKB, Wright TA, Attia JR, McElduff P, Doyle T, Bartholomew M, et al., 'Effects of bariatric surgery on urinary and sexual function', BJU International, 107 88-94 (2011) [C1]
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2010 |
Attia JR, Thakkinstian A, McElduff P, Milne E, Dawson S, Scott R, et al., 'Detecting genotyping error using measures of degree of Hardy-Weinberg disequilibrium', Statistical Applications in Genetics and Molecular Biology, 9 17 (2010) [C1]
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Nova |
2010 |
Janssen H, Bernhardt J, Collier JM, Sena ES, McElduff P, Attia JR, et al., 'An enriched environment improves sensorimotor function post-ischemic stroke', Neurorehabilitation and Neural Repair, 24 802-813 (2010) [C1]
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Nova |
2010 |
Wilson AJ, Robertson J, McElduff P, Jones AL, Henry DA, 'Does it matter who writes medical news stories?', PLoS Medicine, 7 1-5 (2010) [C1]
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Nova |
2010 |
Day RO, Liauw W, Tozer LMR, McElduff P, Beckett RJ, Williams KM, 'A double-blind, placebo-controlled study of the short term effects of a spring water supplemented with magnesium bicarbonate on acid/base balance, bone metabolism and cardiovascular risk factors in postmenopausal women', BMC Research Notes, 3 (2010)
Background. A number of health benefits including improvements in acid/base balance, bone metabolism, and cardiovascular risk factors have been attributed to the intake of magnesi... [more]
Background. A number of health benefits including improvements in acid/base balance, bone metabolism, and cardiovascular risk factors have been attributed to the intake of magnesium rich alkaline mineral water. This study was designed to investigate the effects of the regular consumption of magnesium bicarbonate supplemented spring water on pH, biochemical parameters of bone metabolism, lipid profile and blood pressure in postmenopausal women. Findings. In this double-blind, placebo-controlled, parallel-group, study, 67 postmenopausal women were randomised to receive between 1500 mL and 1800 mL daily of magnesium bicarbonate supplemented spring water (650 mg/L bicarbonate, 120 mg/L magnesium, pH 8.3-8.5) (supplemented water group) or spring water without supplements (control water group) over 84 days. Over this period biomarkers of bone turnover (serum parathyroid hormone (PTH), 1,25-dihydroxyvitamin D, osteocalcin, urinary telopeptides and hydroxyproline), serum lipids (total cholesterol, HDL-cholesterol, LDL-cholesterol and triglycerides), venous and urinary pH were measured together with measurements of standard biochemistry, haematology and urine examinations. Serum magnesium concentrations and urinary pH in subjects consuming the magnesium bicarbonate supplemented water increased significantly at Day 84 compared to subjects consuming the spring water control (magnesium - p = 0.03; pH - p = 0.018). The consumption of spring water led to a trend for an increase in parathyroid hormone (PTH) concentrations while the PTH concentrations remained stable with the intake of the supplemented spring water. However there were no significant effects of magnesium bicarbonate supplementation in changes to biomarkers of bone mineral metabolism (n-telopeptides, hydroxyproline, osteocalcin and 1,25-dihydroxyvitamin D) or serum lipids or blood pressure in postmenopausal women from Day 0 to Day 84. Conclusions. Short term regular ingestion of magnesium bicarbonate supplemented water provides a source of orally available magnesium. Long term clinical studies are required to investigate any health benefits. Trial registration. © 2010 Tozer et al; licensee BioMed Central Ltd.
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2010 |
Marsden D, Quinn R, Pond N, Golledge R, Neilson C, White J, et al., 'A multidisciplinary group programme in rural settings for community-dwelling chronic stroke survivors and their carers: A pilot randomized controlled trial', Clinical Rehabilitation, 24 328-341 (2010) [C1]
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Nova |
2010 |
Parsons MW, Christensen S, McElduff P, Levi CR, Butcher KS, De Silva DA, et al., 'Pretreatment diffusion- and perfusion-MR lesion volumes have a crucial influence on clinical response to stroke thrombolysis', Journal of Cerebral Blood Flow and Metabolism, 30 1214-1225 (2010) [C1]
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Nova |
2010 |
Wolfenden L, Wyse R, Britton B, Campbell K, Hodder R, Stacey FJ, et al., 'Interventions for increasing fruit and vegetable consumption in preschool aged children', Cochrane Database of Systematic Reviews, 1-11 (2010)
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2010 |
Smart CE, Ross K, Edge JA, King BR, McElduff P, Collins CE, 'Can children with Type 1 diabetes and their caregivers estimate the carbohydrate content of meals and snacks?', Diabetic Medicine, 27 348-353 (2010) [C1]
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Nova |
2010 |
Wood LG, Attia JR, McElduff P, McEvoy MA, Gibson PG, 'Assessment of dietary fat intake and innate immune activation as risk factors for impaired lung function', European Journal of Clinical Nutrition, 64 818-825 (2010) [C1]
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Nova |
2010 |
Hiew C, Williams T, Hatton R, Narasimhan S, O'Connor S, Baker F, et al., 'Influence of age on long-term outcome after emergent percutaneous coronary intervention for ST-elevation myocardial infarction', Journal of Invasive Cardiology, 22 273-277 (2010) [C1]
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Nova |
2010 |
Morgan PJ, Collins CE, Plotnikoff RC, McElduff P, Burrows TL, Warren JM, et al., 'The SHED-IT community trial study protocol: A randomised controlled trial of weight loss programs for overweight and obese men', BMC Public Health, 10 1-11 (2010) [C1]
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Nova |
2010 |
Collins CE, Morgan PJ, Jones P, Fletcher K, Martin JE, Aguiar EJ, et al., 'Evaluation of a commercial web-based weight loss and weight loss maintenance program in overweight and obese adults: A randomized controlled trial', BMC Public Health, 10 669 (2010) [C1]
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Nova |
2010 |
Loten C, Attia JR, Hullick C, Marley J, McElduff P, 'Point of care troponin decreases time in the emergency department for patients with possible acute coronary syndrome: A randomised controlled trial', Emergency Medicine Journal, 27 194-198 (2010) [C1]
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Nova |
2009 |
Loten C, Attia JR, Hullick C, Marley J, McElduff P, 'Validation of a point of care troponin assay in real life emergency department conditions', Emergency Medicine Australasia, 21 286-292 (2009) [C1]
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Nova |
2009 |
Loten C, Isbister GK, Jamcotchian MA, Hullick C, McElduff P, Attia JR, Marley J, 'Adverse outcomes following emergency department discharge of patients with possible acute coronary syndrome', Emergency Medicine Australasia, 21 455-464 (2009) [C1]
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Nova |
2009 |
Levi CR, Bateman GA, Spratt NJ, McElduff P, Parsons MW, Miteff F, 'The independent predictive utility of computed tomography angiographic collateral status in acute ischaemic stroke', Brain, 132 2231-2238 (2009) [C1]
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Nova |
2009 |
Smith R, Smith JI, Shen XB, Engel PJ, Bowman M, McGrath SA, et al., 'Patterns of plasma corticotropin-releasing hormone, progesterone, estradiol, and estriol change and the onset of human labor', Journal of Clinical Endocrinology & Metabolism, 94 2066-2074 (2009) [C1]
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Nova |
2009 |
Simpson JL, McElduff P, Gibson PG, 'Assessment and reproducibility of non-eosinophilic asthma using induced sputum', Respiration, 79 147-151 (2009) [C1]
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Nova |
2009 |
Lowe J, Mensch M, McElduff P, Fitzgerald M, Attia JR, 'Does an advanced insulin education programme improve outcomes and health service use for people with Type 2 diabetes? A 5-year follow-up of the Newcastle Empowerment course', Diabetic Medicine, 26 1277-1281 (2009) [C1]
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Nova |
2009 |
Reeves SG, Meldrum C, Groombridge C, Spigelman AD, Suchy J, Kurzawski G, et al., 'MTHFR 677 C\T and 1298 A\C polymorphisms and the age of onset of colorectal cancer in hereditary nonpolyposis colorectal cancer', European Journal of Human Genetics, 17 629-635 (2009) [C1]
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Nova |
2009 |
Clover K, Carter G, Adams C, McElduff P, Rogers K, 'Reduced pain and distress among oncology outpatients following the introduction of routine screening with QUICATOUCH.', Asia-Pacific Journal of Clinical Oncology, A146-A146 (2009)
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2009 |
Freund MA, Campbell EM, Paul CL, Sakrouge R, McElduff P, Walsh RA, et al., 'Increasing smoking cessation care provision in hospitals: A meta-analysis of intervention effect', Nicotine & Tobacco Research, 11 650-662 (2009) [C1]
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Nova |
2008 |
Freund MA, Campbell EM, Paul CL, McElduff P, Walsh RA, Sakrouge R, et al., 'Smoking care provision in hospitals: A review of prevalence', Nicotine & Tobacco Research, 10 757-774 (2008) [C1]
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Nova |
2008 |
Kwok S, McElduff P, Ashton DW, Lowe GDO, Wood D, Humphries SE, et al., 'Indices of Obesity and Cardiovascular Risk Factors in British Women', Obesity Facts, 1 190-195 (2008) [C1]
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Nova |
2008 |
Quain DA, Parsons MW, Loudfoot AR, Spratt NJ, Evans MK, Russell ML, et al., 'Improving access to acute stroke therapies: A controlled trial of organised pre-hospital and emergency care', Medical Journal of Australia, 189 429-433 (2008) [C1]
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Nova |
2008 |
Clifton-Bligh RJ, McElduff P, McElduff E, 'Maternal vitamin D deficiency, ethnicity and gestational diabetes', Diabetic Medicine, 25 378-384 (2008) [C1]
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Nova |
2007 |
O Dwyer DT, McElduff P, Peterson PR, Perheentupa J, Crock PA, 'Pituitary autoantibodies in autoimmune polyendocrinopathy - candidiasis - ectodermal dystrophy (APECED)', Acta Bio Medica, 78 248-254 (2007) [C1]
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2007 |
Edwards R, McElduff P, Jenner D, Heller RF, Langley J, 'Smoking, smoking cessation, and use of smoking cessation aids and support services in South Derbyshire, England', Public Health, 121 321-332 (2007) [C1]
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2007 |
Koudsi A, Oldroyd J, McElduff P, Banerjee M, Vyas A, Cruickshank JK, 'Maternal and Neonatal Influences on, and Reproducibility of, Neonatal Aortic Pulse Wave Velocity', Hypertension, 49 225-231 (2007) [C1]
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2006 |
Mackness B, Hine D, McElduff P, Mackness M, 'High C-reactive protein and low paraoxonasel in diabetes as risk factors for coronary heart disease', Atherosclerosis, 186 396-401 (2006) [C1]
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2006 |
Bansal N, Charlton-Menys V, Pemberton P, McElduff P, Oldroyd J, Vyas A, et al., 'Adiponectin in Umbilical Cord Blood Is inversely Related to Low-Density Lipoprotein Cholesterol But not Ethnicity', journal of Clinical Endocrinology & Metabolism, 6 2244-2250 (2006) [C1]
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2006 |
Edwards R, McElduff P, Harrison RA, Watson K, Butler G, Elton P, 'Pleasure or Pain? A profile of smokers in Northern England', Public Health, 120 760-768 (2006) [C1]
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2006 |
Harrison RA, McElduff P, Edwards R, 'Planning to win: Health and lifestyles associated with physical activity amongst 15,423 adults', Public Health, 120 206-212 (2006) [C1]
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2006 |
Meier PS, Donmall MC, McElduff P, Barrowclough C, Heller RF, 'The role of the early therapeutic alliance in predicting drug treatment dropout', Drug and Alcohol Dependence, 83 57-64 (2006) [C1]
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2006 |
Bansal N, McElduff P, Gemmell I, Vyas A, Pemberton P, Charlton-Menys V, et al., 'Maternal and early life determinants of serum adiponectin from birth to 4 years in a multi-ethnic population: the Manchester Children's Cardiovascular Health Study', EARLY HUMAN DEVELOPMENT, 82 505-505 (2006) |
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2006 |
Bansal N, McElduff P, Gemmell I, Charlton-Menys V, Oldroyd J, Clayton PE, et al., 'Maternal and early life determinants of serum lipids in infancy and early childhood: the Manchester Children's Cardiovascular Health Study', EARLY HUMAN DEVELOPMENT, 82 505-505 (2006) |
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2006 |
Kwok S, Charlton-Menys V, Pemberton P, McElduff P, Durrington PN, 'Effects of dydrogesterone and norethisterone, in combination with oestradiol, on lipoproteins and inflammatory markers in postmenopausal women', Maturitas, 53 439-446 (2006) [C1]
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2006 |
McElduff A, Hitchman R, McElduff P, 'Is sex hormone-building globulin associated with glucose tolerance?', Diabetic Medicine, 23 306-312 (2006) [C1]
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2006 |
Middleton RJ, Foley RN, Hegarty J, Cheung CM, McElduff P, Gibson JM, et al., 'Is the diagnosis of chronic kidney disease missed in diabetic women? Reply', NEPHROLOGY DIALYSIS TRANSPLANTATION, 21 1733-1734 (2006)
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2006 |
Middleton RJ, Foley RN, Hegarty J, Cheung CM, McElduff P, Gibson M, et al., 'The unrecognized prevalence of chronic kidney disease in diabetes', Nephrology Dialysis Transplantation, 21 88-92 (2006) [C1]
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2006 |
Gee IL, Watson AFR, Carrington J, Edwards PR, Van Tongeren M, McElduff P, Edwards RE, 'Second-hand smoke levels in UK pubs and bars: do the English Public Health White Paper proposals go far enough?', Journal of Public Health, 28 17-23 (2006) [C1]
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Nova |
2006 |
Gary C, John D, Singh M, McElduff P, 'Readmission after hysterectomy and prophylactic low molecular weight heparin: retrospective case-control study', BMJ, 332 819-820 (2006) [C1]
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2006 |
McElduff P, Jaefarnezhad M, Pn D, 'American, British and European recommendations for statins in the primary prevention of cardiovascular disease applied to British men studied prospectively', Heart, 92 1213-1218 (2006) [C1]
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2006 |
Lyratzopoulos G, Rf H, McElduff P, Hanily M, Lewis P, 'Deprivation and trends in blood pressure, cholesterol, body mass index and smoking among participants of a UK primary care-based cardiovascular risk factor screening programme: both narrowing and widening in cardiovascular risk factor inequalities', Heart, 92 1198-1206 (2006) [C1]
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2006 |
Boyes AW, Newell SA, Girgis A, McElduff P, Sanson-Fisher RW, 'Does routine assessment and real-time feedback improve cancer patients' psychosocial well-being?', European Journal of Cancer Care, 15 163-171 (2006) [C1]
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Nova |
2005 |
Gemmell I, Heller RF, McElduff P, Payne K, Butler G, Edwards R, et al., 'Population impact of stricter adherence to recommendations for pharmacological and lifestyle interventions over one year in patients with coronary heart disease', Journal of Epidemiology and Community Health, 59 1041-1046 (2005) [C1]
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2005 |
Stephens RH, McElduff P, Heald AH, New JP, Worthington J, Ollier WE, Gibson M, 'Polymorphisms in IGF-binding protein 1 are associated with impaired renal function in type 2 diabetes', Diabetes, 54 3547-3553 (2005) [C1]
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2005 |
McElduff A, McElduff P, Wiley V, Wilcken B, 'Neonatal Thyrotropin as Measured in a Congenital Hypothyroidism Screening Program: Influence of the Mode of Delivery', Journal of Clinical Endocrinology and Metabolism, 90 6361-6363 (2005) [C1]
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2005 |
McElduff P, Edwards R, Burns JA, Young RJ, Heller R, Long B, et al., 'Comparison of processes and intermediate outcomes between South Asian and European patients with diabetes in Blackburn, north-west England', Diabetic Medicine, 22 1226-1233 (2005) [C1]
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2005 |
Mackness B, McElduff P, Mackness MI, 'The paraoxonase-2-310 polymorphism is associated with the presence of microvascular complications in diabetes mellitus', Journal of Internal Medicine, 258 363-368 (2005) [C1]
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2005 |
Bansal N, Cruidshank JK, McElduff P, Durrington PN, 'Cord blood lipoproteins and prenatal influences', Current Opinion in Lipidology, 16 400-408 (2005) [C1]
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2005 |
Meier PS, Donmall MC, Barrowclough C, McElduff P, Heller RF, 'Predicting the early therapeutic alliance in the treatment of drug misuse', Addiction, 100 500-511 (2005) [C1]
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2005 |
Thakkinstian A, McElduff P, D'Este CA, Duffy D, Attia JR, 'A method for meta-analysis of molecular association studies', Statistics in Medicine, 24 1291-1306 (2005) [C1]
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Nova |
2005 |
Cook G, Taylor D, France M, Burrows G, Manning E, Lyratzopoulos G, et al., 'Survival among hospital in-patients with troponin T elevation below levels defining myocardial infarction', QJM: an international journal of medicine, 98 275-282 (2005) [C1]
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2005 |
Lyratzopoulos G, McElduff P, Heller RF, Hanily M, Lewis PS, 'Comparative levels and time trends in blood pressure, total cholesterol, Body Mass Index and smoking Caucasian and South-Asian participants of a UK primary-care based cardiovascular risk factor sreening programme', BMC Public Health, 5 125-134 (2005) [C1]
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2005 |
Lyratzopoulos G, McElduff P, Heller RF, Hanily M, Lewis PS, 'Mid-term Body Mass Index increase among obese and non-obese individuals in middle life and deprivation status: A cohort study', BMC Public Health, 5 32-43 (2005) [C1]
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2005 |
Barnett AG, Dobson AJ, McElduff P, Salomaa V, Kuulasmaa K, Sans S, 'Cold periods and coronary events: an analysis of populations worldwide', JOURNAL OF EPIDEMIOLOGY AND COMMUNITY HEALTH, 59 551-557 (2005) [C1]
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2004 |
Xu L, McElduff P, D'Este CA, Attia JR, 'Does dietary calcium have a protective effect on bone fractures in women? A meta-analysis of observational studies', The British Journal of Nutrition, 91 625-634 (2004) [C1]
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2004 |
Lyratzopoulos G, Cook GA, McElduff P, Havely D, Edwards R, Heller RF, 'Assessing the impact of heart failure specialist services on patient populations', BMC health services research, 4 10 (2004)
BACKGROUND: The assessment of the impact of healthcare interventions may help commissioners of healthcare services to make optimal decisions. This can be particularly the case if ... [more]
BACKGROUND: The assessment of the impact of healthcare interventions may help commissioners of healthcare services to make optimal decisions. This can be particularly the case if the impact assessment relates to specific patient populations and uses timely local data. We examined the potential impact on readmissions and mortality of specialist heart failure services capable of delivering treatments such as b-blockers and Nurse-Led Educational Intervention (N-LEI). METHODS: Statistical modelling of prevented or postponed events among previously hospitalised patients, using estimates of: treatment uptake and contraindications (based on local audit data); treatment effectiveness and intolerance (based on literature); and annual number of hospitalization per patient and annual risk of death (based on routine data). RESULTS: Optimal treatment uptake among eligible but untreated patients would over one year prevent or postpone 11% of all expected readmissions and 18% of all expected deaths for spironolactone, 13% of all expected readmisisons and 22% of all expected deaths for b-blockers (carvedilol) and 20% of all expected readmissions and an uncertain number of deaths for N-LEI. Optimal combined treatment uptake for all three interventions during one year among all eligible but untreated patients would prevent or postpone 37% of all expected readmissions and a minimum of 36% of all expected deaths. CONCLUSION: In a population of previously hospitalised patients with low previous uptake of b-blockers and no uptake of N-LEI, optimal combined uptake of interventions through specialist heart failure services can potentially help prevent or postpone approximately four times as many readmissions and a minimum of twice as many deaths compared with simply optimising uptake of spironolactone (not necessarily requiring specialist services). Examination of the impact of different heart failure interventions can inform rational planning of relevant healthcare services.
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2004 |
Heller RF, Sandars JE, Patterson L, McElduff P, 'GPs'and physicians'interpretation of risks, benefits and diagnostic test results', Family Practice, 21 155-159 (2004) [C1]
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2004 |
Kwok S, Selby PL, McElduff P, Laing I, Mackness B, Mackness MI, et al., 'Progestogens of varying androgenicity and cardiovascular risk factors in postmenopausal women receiving oestrogen replacement therapy', Clinical Endocrinology, 61 760-767 (2004) [C1]
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2004 |
Meier PS, Donmall MC, McElduff P, 'Characteristics of drug users who do or do not have care of their children', Addiction, 99 955-961 (2004) [C1]
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2004 |
McElduff P, Edwards R, Arvanitis AP, Holloway J, 'An evidence-based audit of coronary heart disease clinics', British Journal of Cardiology, 11 323-325 (2004)
The National Service Framework (NSF) for Coronary Heart Disease (CHD) requires practices to establish registers of patients with CHD and to implement audits of care for these pati... [more]
The National Service Framework (NSF) for Coronary Heart Disease (CHD) requires practices to establish registers of patients with CHD and to implement audits of care for these patients. Little is known about the potential health impact of registers and audits. We therefore looked at the impact of establishing such systems on patients with CHD at Cleveleys Group Practice. All patients with CHD are recorded on a computerised register that is used to recall patients for an annual review to nurse-led clinics. Data from annual audits are used to estimate the number of adverse events prevented in the practice by the use of effective medications. We found that the use of effective treatments was estimated to save approximately 27 lives and prevent 30 non-fatal myocardial infarctions each year. The increased use of effective treatments after the introduction of the register coincided with a reduction in average levels of systolic blood pressure and total cholesterol, preventing two deaths and three non-fatal myocardial infarctions each year. Based on the best available evidence from randomised controlled trials, the benefit of this care to a practice population is substantial.
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2004 |
Lyratzopoulos G, Sheridan GF, Michie HR, McElduff P, Hobbiss JH, 'Absence of socioeconomic variation in survival from colorectal cancer in patients receiving surgical treatment in one helath district: cohort study', Colorectal Disease, 6 512-517 (2004) [C1]
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2004 |
Lyratzopoulos G, Cook GA, McElduff P, Havely D, Edwards R, Heller RF, 'Assessing the impact of heart failure specialist services on patient populations', BMC Health Services Research, 4 10-10 (2004) [C1]
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2004 |
McElduff P, Lyratzopoulos G, Edwards R, Heller RF, Shekelle P, Roland M, 'Will changes in primary care improve health outcomes? Modelling the impact of financial incentives introduced to improve quality of care in the UK', Quality and Safety in Health Care, 13 191-197 (2004) [C1]
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2004 |
Mahonen MS, McElduff P, Dobson AJ, Kuulasmaa KA, Evans AE, 'Current smoking and the risk of non-fatal myocardial infarction in the WHO MONICA Project populations', TOBACCO CONTROL, 13 244-250 (2004) [C1]
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2003 |
Wong PKK, Spencer DG, McElduff P, Manolios N, Larcos G, Howe GB, 'Secondary screening for osteoporosis in patients admitted with minimal-trauma fracture to a major teaching hospital', Internal Medicine Journal, 33 505-510 (2003) [C1]
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2003 |
France MW, Kwok S, McElduff P, Seneviratne CJ, 'Ethnic trends in lipid tests in general practice', QJM: an international journal of medicine, 96 919-923 (2003) [C1]
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2003 |
Heller RF, Edwards R, McElduff P, 'Implementing guidelines in primary care: can population impact measures help?', BMC Public Health, 3 1-7 (2003) [C1]
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2003 |
Heller RF, Buchan I, Edwards R, Lyratzopoulos G, McElduff P, St Leger S, 'Communicating risks at the population level: application of population impact numbers 1162-1165 (2003) [C1]
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2003 |
Buchan I, Hooper L, McElduff P, Freemantle N, Martin D, 'Primary coronary angioplasty versus thrombolysis for acute myocardial infarction.', Lancet, 361 (2003)
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2003 |
Mackness B, Durrington P, McElduff P, Yarnell J, Azam N, Watt M, Mackness M, 'Low Paraoxonase Activity Predicts Coronary Events in the Caerphilly Prospective Study', Circulation, 107 2775-2779 (2003) [C1]
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2003 |
Edwards R, Burns JA, McElduff P, Young RJ, New JP, 'Variations in process and outcomes of diabetes care by socio-economic status in Salford, UK', Diabetologia, 46 750-759 (2003) [C1]
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2003 |
Wark PA, Hensley MJ, Saltos N, Boyle MJ, Toneguzzi R, Simpson JL, et al., 'Anti-inflammatory effect of itraconazole in stable allergic bronchopulmonary aspergillosis: A randomized controlled trial', The Journal of Allergy and Clinical Immunology, 111 952-957 (2003) [C1]
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2003 |
Buchan I, Hooper L, McElduff P, Freemantle N, Martin D, 'Primary coronary angioplasty versus thrombolysis for acute myocardial infarction', Lancet, 361 1304-1305 (2003) [C1]
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2003 |
McElduff P, 'Apportionment of disease in individuals: reply', JOURNAL OF CLINICAL EPIDEMIOLOGY, 56 291-291 (2003)
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2003 |
Tyson MJ, McElduff P, 'Self-blood-pressure-monitoring - a questionnaire study: response, requirement, training, support-group popularity and recommendations', Journal of Human Hypertension, 17 51-61 (2003) [C1]
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2003 |
Cockburn JD, Paul CL, Tzelepis F, McElduff P, Byles JE, 'Delay in seeking advice for symptoms that potentially indicate bowel cancer', American Journal of Health Behavior, 27 401-407 (2003) [C1]
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2003 |
Girgis A, Tzelepis F, Paul CL, Walsh RA, McElduff P, McKenzie J, 'Australians' use of fake tanning lotions: another piece of the puzzle', Promoting Health, 27 529-532 (2003) [C1]
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2002 |
McElduff A, McElduff P, Gunton JE, Hams G, Wiley V, Wilcken BM, 'Neonatal thyroid-stimulating hormone concentrations in northern Sydney: further indications of mild iodine deficiency?', MEDICAL JOURNAL OF AUSTRALIA, 176 317-320 (2002)
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2002 |
McElduff P, Attia JR, Ewald BD, Cockburn JD, Heller R, 'Estimating the contribution of individual risk factors to disease in a person with more than one risk factor', The Journal of Clinical Epidemiology, 55 588-592 (2002) [C1]
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2002 |
Heller RF, McElduff P, Edwards R, 'Impact of upward social mobility on population mortality: analysis with routine data', BMJ-BRITISH MEDICAL JOURNAL, 325 134-136A (2002)
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2002 |
Cockburn JD, Paul CL, Tzelepis F, McElduff P, Byles JE, 'Screening for bowel cancer among NSW adults with varying levels of risk: a community survey', Australian and New Zealand Journal of Public Health, 26(3) 236-241 (2002) [C1]
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2001 |
McElduff P, Dobson A, 'Case fatality after an acute cardiac event: the effect of smoking and alcohol consumption', Journal of Clinical Epidemiology, 54 58-67 (2001) [C1]
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2001 |
McElduff P, Dobson AJ, Jamrozik K, Hobbs MST, 'Opportunities for control of coronary heart disease in Australia', AUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH, 25 24-30 (2001)
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2001 |
Walsh RA, Paul CL, McElduff P, 'Smoking rates may be declining', Medical Journal of Australia, 175 339 (2001) [C3]
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2001 |
Nicholls S, McElduff P, Dobson A, Jamrozik K, Hobbs M, Leitch J, 'Underuse of beta-blockers following myocardial infarction: a tale of two cities', Internal Medicine Journal, 31 391-396 (2001) [C1]
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2000 |
Chiarelli P, Brown W, McElduff P, 'Constipation in Australian women: prevalence and associated factors', International Urogynecology Journal & Pelvic Floor Dysfunction, 11 71-78 (2000) [C1]
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2000 |
McElduff P, Leitch JW, Dobson AJ, Heller R, 'Postinfarction calcium antagonism versus beta blockade', Cardiology Review, 17 25-31 (2000) |
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2000 |
McElduff P, Dobson AJ, 'Trends in coronary heart disease - has the socio-economic diffeerential changed?', Australian and New Zealand Journal of Public Health, 24 465-473 (2000) [C1]
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1999 |
Higginbotham HN, Heading G, McElduff P, Dobson A, Heller RF, 'Reducing Coronary Heart Disease in the Australian Coalfields: Evaluation of a Ten-Year Community Intervention', Social Science and Medicine, 48 683-692 (1999) [C1]
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1999 |
Chiarelli P, Brown WJ, McElduff P, 'Leaking Urine: Prevalence And Associated Factors In Australian Women', NEUROUROLOGY AND URODYNAMICS, 18 567-577 (1999) [C1]
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1999 |
Dobson AJ, McElduff P, Heller R, Alexander H, Colley P, D'Este K, 'Changing patterns of coronary heart disease in the Hunter Region of New South Wales, Australia', Journal of Clinical Epidemiology, 52 761-771 (1999) [C1]
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1998 |
McElduff P, Dobson AJ, Beaglehole R, Jackson R, 'Rapid reduction in coronary risk for those who quit cigarette smoking', Australian and New Zealand Journal of Public Health, 22 787-791 (1998) [C1]
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1998 |
Leitch J, McElduff P, Dobson AJ, Heller R, 'Outcome With Calcium Channel Antagonists After Myocardial Infarction: A Community-Based Study', Journal of the American College of Cardiology, 31 111-117 (1998) [C1]
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1998 |
McElduff P, Dobson AJ, Jackson R, Beaglehole R, Heller RF, Lay-Yee R, 'Coronary events and exposure to environmental tobacco smoke: a case-control study from Australia and New Zealand', Tobacco Control, 7 41-46 (1998) [C1] |
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1998 |
McElduf P, Dobson A, Jackson R, Beaglehole R, Heller RF, Lay-Yee R, 'Coronary events and exposure to environmental tobacco smoke: a case-control study from Australia and New Zealand', Tobacco Control, 9 41-46 (1998) [C1]
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1997 |
Dobson A, Porteous J, McElduff P, Alexander H, 'Whose diet has changed?', AUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH, 21 147-154 (1997)
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1997 |
Beaglehole R, Stewart AW, Jackson R, Dobson AJ, McElduff P, DEste K, et al., 'Declining rates of coronary heart disease in New Zealand and Australia, 1983-1993', AMERICAN JOURNAL OF EPIDEMIOLOGY, 145 707-713 (1997)
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1997 |
McElduff P, Dobson AJ, 'How much alcohol and how often? Population based case-control study of alcohol consumption and risk of a major coronary event', Pneumologie, 51 867 (1997) |
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1997 |
McElduff SP, 'Determining priorities for change in primary care: The value of practice-based needs assessment', British Journal of General Practice, 47 353-357 (1997)
Background. Primary care is being expected to expand the range of services it provides, and to take on many of the tasks traditionally provided in secondary care. At the same time... [more]
Background. Primary care is being expected to expand the range of services it provides, and to take on many of the tasks traditionally provided in secondary care. At the same time, general practitioners (GPs) will become increasingly responsible for assessing their patients' health care needs and commissioning care from other providers. This article describes an approach taken in one general practice to meet these difficult challenges. Aim. To examine whether information on health and health care needs, when used as the basis for a priority setting exercise, can provide a useful first step in planning primary care provision within a practice. Method. A three-stage process of information-gathering from a number of sources, including continuous data recording of patient contacts and a postal survey of all adults registered with the practice, identification of key findings and discussion of associated issues, and priority setting of proposals for practice development using the nominal group technique. Results. Continuous data recording of patient contacts with GPs and the practice nurse provided data on 4489 GP contacts with 2027 patients, 1000 district nurse contacts with 101 patients, and 361 health visitor contacts with 172 clients. More than 70% of patient records had been computerized, with 600 diagnostic READ codes identified and 11,500 separate entries made. The socioeconomic and health survey questionnaire achieved an 84% response rate. Following the priority-setting exercise, 28 proposed practice developments were identified. These were reduced to a final list of eight. Conclusion. A comprehensive method of practice-based needs assessment, when used as the basis for some form of priority setting has great potential in helping to plan primary care services within a practice. The success of such initiatives will require a substantial investment of resources in primary care and fundamental changes to the way in which primary care is funded.
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1997 |
Leitch J, McElduff P, Dobson A, Heller R, 'A population based study of outcome with calcium channel antagonist use after myocardial infarction', JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 29 7872-7872 (1997) |
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1997 |
Dobson A, Porteous J, McElduff P, Alexander H, 'Dietary trends: Estimates from food supply and survey data', EUROPEAN JOURNAL OF CLINICAL NUTRITION, 51 193-198 (1997)
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1997 |
McElduff P, Dobson AJ, 'How much alcohol and how often? Population based case-control study of alcohol consumption and risk of a major coronary event', BRITISH MEDICAL JOURNAL, 314 1159-1164 (1997)
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1996 |
Kinlay S, Dobson AJ, Heller RF, McElduff P, Alexander H, Dickeson J, 'Risk of primary and recurrent acute myocardial infarction from lipoprotein(a) in men and women', JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 28 870-875 (1996)
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