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Article ; Online: Fabry-specific treatment in Australia: time to align eligibility criteria with international best practices.

Nicholls, Kathleen / Denaro, Charles / Tchan, Michel / Ellaway, Carolyn / Bratkovic, Drago / Campbell, Sheridan / Fookes, Megan / Thomas, Mark

Internal medicine journal

2024

Abstract: Background: Disease-specific therapy aims to improve symptoms, stabilise current disease and delay progression in patients with Fabry disease. In Australia, treatment access is subject to eligibility criteria initially established in 2004. Patients and ... ...

Abstract	Background: Disease-specific therapy aims to improve symptoms, stabilise current disease and delay progression in patients with Fabry disease. In Australia, treatment access is subject to eligibility criteria initially established in 2004. Patients and their clinicians question why these criteria have remained unchanged despite significant progress in disease understanding. Aims: Appraise the clinical quality of the Australian treatment access criteria. Methods: The Fabry Australia Medical Advisory Committee (N = 6) used the Appraisal of Guidelines for REsearch and Evaluation Global Rating Scale (AGREE II GRS) to assess the clinical quality of the current treatment eligibility criteria. They reviewed the literature, developed 17 clinical statements to help guide reforms of the eligibility criteria and achieved consensus (achievement of ≥75% agreement in the range 5-7 on a 7-point Likert scale) through anonymous voting. The findings were applied to develop proposals for revised classification and treatment initiation criteria. Results: The current treatment eligibility criteria underperformed on the AGREE II GRS. They are pragmatic but out-of-step with contemporary data. Consensus was achieved on all 17 proposed clinical statements. There was strong agreement to differentiate classical male Fabry patients to facilitate timelier access to Fabry-specific treatment. There was also agreement on the value of adopting relevant organ involvement criteria in classical female patients and patients with non-classical disease. Conclusions: Australian access criteria are misaligned with current clinical evidence. The clinical statements and proposed classification and initiation criteria should prompt discussions to support more equitable access to treatment and better align Australian practice with contemporary evidence and international guidelines.
Language	English
Publishing date	2024-01-11
Publishing country	Australia
Document type	Journal Article
ZDB-ID	2045436-3
ISSN	1445-5994 ; 1444-0903
ISSN (online)	1445-5994
ISSN	1444-0903
DOI	10.1111/imj.16327
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Article ; Online: Parkinsonism and prolonged cognitive decline as a manifestation of cryptococcal meningitis in a renal transplant patient.

Nelles, Ricky / Britton, Sumudu / John, George Tharayil / Denaro, Charles

BMJ case reports

2022 Volume 15, Issue 1

Abstract: We report a case of a 67-year-old male recipient of a second renal allograft, presenting with a 9-month history of progressive cognitive and physical decline with features of Parkinsonism. He was HIV-negative. Serum and cerebrospinal fluid (CSF) ... ...

Abstract	We report a case of a 67-year-old male recipient of a second renal allograft, presenting with a 9-month history of progressive cognitive and physical decline with features of Parkinsonism. He was HIV-negative. Serum and cerebrospinal fluid (CSF) cryptococcal antigen was positive though CSF culture was sterile. He had progressive deterioration despite induction and consolidation antifungal treatment. Postmortem brain examination confirmed a large burden of yeast forms in the substantia nigra with widespread chronic meningitis. The significant delay in presentation and diagnosis owing to the atypical, subacute neurocognitive features serves as a timely reminder of the variety of neurological presentations that may be associated with cryptococcal infection in solid organ transplant recipients.
MeSH term(s)	Aged ; Cognitive Dysfunction/diagnosis ; Cognitive Dysfunction/etiology ; Cryptococcosis ; Cryptococcus neoformans ; Fluconazole ; Humans ; Kidney Transplantation/adverse effects ; Male ; Meningitis, Cryptococcal/diagnosis ; Meningitis, Cryptococcal/drug therapy ; Parkinsonian Disorders/etiology
Chemical Substances	Fluconazole (8VZV102JFY)
Language	English
Publishing date	2022-01-19
Publishing country	England
Document type	Case Reports ; Journal Article
ISSN	1757-790X
ISSN (online)	1757-790X
DOI	10.1136/bcr-2021-245788
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Article ; Online: Hydrochar and hydrochar co-compost from OFMSW digestate for soil application: 1. production and chemical characterization.

Scrinzi, Donato / Bona, Daniela / Denaro, Andrea / Silvestri, Silvia / Andreottola, Gianni / Fiori, Luca

Journal of environmental management

2022 Volume 309, Page(s) 114688

Abstract: ... different temperatures (180 ÷ 220 °C); the wet solid hydrochar obtained after filtration was then co ... in bench-scale bioreactors. The hydrochars and the hydrochar co-composts were suitable for agro-industrial ... into ammonium, and oxidizable organic matter solubilized. The selected hydrochar obtained at 200 °C had mean ...

Abstract	The best available technique (BAT) for managing the organic fraction of municipal solid waste (OFMSW) is represented by anaerobic digestion (AD) and subsequent composting. This research explored a new industrial model in the framework of the C2Land international project, with the insertion of hydrothermal carbonization (HTC) as a post-treatment for OFMSW digestate. The reaction was set for 3 h at three different temperatures (180 ÷ 220 °C); the wet solid hydrochar obtained after filtration was then co-composted with greenery waste as a bulking agent and untreated OFMSW digestate in four different proportions in bench-scale bioreactors. The hydrochars and the hydrochar co-composts were suitable for agro-industrial applications, while the HTC liquors were tested in biochemical methane potential (BMP) for internal recirculation to AD. The scenarios proposed can be beneficial for plant enhancement and increased biogas production. This study reports results connected to the production phase. Mass balances confirmed that, during HTC, phosphorus precipitated into the solid products, organic nitrogen partially mineralized into ammonium, and oxidizable organic matter solubilized. The selected hydrochar obtained at 200 °C had mean (dry) solid, liquid, and gaseous yields equal to 77, 20, and 3 %
MeSH term(s)	Anaerobiosis ; Carbon ; Composting ; Methane ; Soil ; Solid Waste
Chemical Substances	Soil ; Solid Waste ; Carbon (7440-44-0) ; Methane (OP0UW79H66)
Language	English
Publishing date	2022-02-15
Publishing country	England
Document type	Journal Article
ZDB-ID	184882-3
ISSN	1095-8630 ; 0301-4797
ISSN (online)	1095-8630
ISSN	0301-4797
DOI	10.1016/j.jenvman.2022.114688
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Article ; Online: Medication Utilisation Program, Quality Improvement and Research Pharmacist-Implementation Strategies and Preliminary Findings.

Whitfield, Karen / Coombes, Ian / Denaro, Charles / Donovan, Peter

Pharmacy (Basel, Switzerland)

2021 Volume 9, Issue 4

Abstract: Judicious use of medicines that considers evidence-based practice, together with cost-effectiveness, is a priority for all health care organisations. We describe an initiative to lead a Medication Utilisation Program, incorporating medication quality ... ...

Abstract	Judicious use of medicines that considers evidence-based practice, together with cost-effectiveness, is a priority for all health care organisations. We describe an initiative to lead a Medication Utilisation Program, incorporating medication quality improvement and research activities. In August 2020 an advanced pharmacist position was implemented to lead the Program. The purpose was to provide oversight and facilitate initiatives promoting medication optimisation to create sustainable change in practice. A strategic plan was developed with key performance indicators. A governance structure was implemented with relevant reporting mechanisms. Strategic planning and collaboration with medical, nursing and allied health professionals has seen the successful implementation of seven codesigned medication-use evaluations and eight quality improvement projects centred around patient safety, quality and value-based care. Several research studies have been designed with subsequent commencement of pharmacists enrolled in university Research Higher Degree programs. Cost containment initiatives have realised potential savings approximating AUD 250,000. Educational programs included protocol design, ethics approvals and report writing. Key success criteria for a Medication Utilisation Program include dedicated pharmacist resources, structured governance and reporting mechanisms. Alignment of study complexity with staff experience and interdisciplinary collaboration are also critical.
Language	English
Publishing date	2021-11-04
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2737194-3
ISSN	2226-4787 ; 2226-4787
ISSN (online)	2226-4787
ISSN	2226-4787
DOI	10.3390/pharmacy9040182
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Article: The challenge of costly drugs.

Denaro, Charles / Martin, Jennifer

Australian prescriber

2016 Volume 39, Issue 3, Page(s) 72–74

Language	English
Publishing date	2016-06-01
Publishing country	Australia
Document type	Journal Article
ZDB-ID	1075442-8
ISSN	0312-8008
ISSN	0312-8008
DOI	10.18773/austprescr.2016.037
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Article: Hydrochar and hydrochar co-compost from OFMSW digestate for soil application: 1. production and chemical characterization

Scrinzi, Donato / Bona, Daniela / Denaro, Andrea / Silvestri, Silvia / Andreottola, Gianni / Fiori, Luca

Journal of environmental management. 2022 May 01, v. 309

2022

Abstract	The best available technique (BAT) for managing the organic fraction of municipal solid waste (OFMSW) is represented by anaerobic digestion (AD) and subsequent composting. This research explored a new industrial model in the framework of the C2Land international project, with the insertion of hydrothermal carbonization (HTC) as a post-treatment for OFMSW digestate. The reaction was set for 3 h at three different temperatures (180 ÷ 220 °C); the wet solid hydrochar obtained after filtration was then co-composted with greenery waste as a bulking agent and untreated OFMSW digestate in four different proportions in bench-scale bioreactors. The hydrochars and the hydrochar co-composts were suitable for agro-industrial applications, while the HTC liquors were tested in biochemical methane potential (BMP) for internal recirculation to AD. The scenarios proposed can be beneficial for plant enhancement and increased biogas production. This study reports results connected to the production phase. Mass balances confirmed that, during HTC, phosphorus precipitated into the solid products, organic nitrogen partially mineralized into ammonium, and oxidizable organic matter solubilized. The selected hydrochar obtained at 200 °C had mean (dry) solid, liquid, and gaseous yields equal to 77, 20, and 3 %db, respectively. The dynamic respirometric index (DRI) confirmed that the reproduced BAT for the composting process was effective in producing high-quality hydrochar co-composts in terms of biological stability. The BMP tests on HTC liquors showed some inhibitory effects, suggesting the need for future studies with inoculum adaptation and co-digestion, to dilute toxic compounds and enhance biogas production. Part 2 of this study describes the agro-environmental properties of hydrochars and hydrochar co-composts, including the beneficial effect of composting on hydrochars phytotoxicity.
Keywords	ammonium ; anaerobic digestion ; bioreactors ; filtration ; gas production (biological) ; hydrochars ; hydrothermal carbonization ; inoculum ; liquids ; methane ; models ; municipal solid waste ; organic nitrogen ; phosphorus ; phytotoxicity ; soil treatment ; vegetation
Language	English
Dates of publication	2022-0501
Publishing place	Elsevier Ltd
Document type	Article
ZDB-ID	184882-3
ISSN	1095-8630 ; 0301-4797
ISSN (online)	1095-8630
ISSN	0301-4797
DOI	10.1016/j.jenvman.2022.114688
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Article: Access block: it's all about available beds.

Denaro, Charles P

The Medical journal of Australia

2009 Volume 191, Issue 5, Page(s) 292

MeSH term(s)	Australia ; Emergency Service, Hospital ; Health Services Accessibility ; Hospital Bed Capacity ; Humans ; Patient Transfer
Language	English
Publishing date	2009-09-01
Publishing country	Australia
Document type	Comment ; Letter
ZDB-ID	186082-3
ISSN	1326-5377 ; 0025-729X
ISSN (online)	1326-5377
ISSN	0025-729X
DOI	10.5694/j.1326-5377.2009.tb02795.x
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Article ; Online: The prevalence of Fabry disease in a statewide chronic kidney disease cohort - Outcomes of the aCQuiRE (Ckd.Qld fabRy Epidemiology) study.

Mallett, Andrew / Kearey, Phoebe Jane / Cameron, Anne / Healy, Helen G / Denaro, Charles / Thomas, Mark / Lee, Vincent W / Stark, Samantha Louise / Fuller, Maria / Wang, Zaimin / Hoy, Wendy E

BMC nephrology

2022 Volume 23, Issue 1, Page(s) 169

Abstract: Background: Prevalence of Fabry disease amongst Chronic Kidney Disease (CKD) patients on haemodialysis has been shown to be approximately 0.2%.: Methods: We undertook a cross-sectional study employing a cascade screening strategy for Fabry Disease ... ...

Abstract	Background: Prevalence of Fabry disease amongst Chronic Kidney Disease (CKD) patients on haemodialysis has been shown to be approximately 0.2%. Methods: We undertook a cross-sectional study employing a cascade screening strategy for Fabry Disease amongst 3000 adult, male and female patients affected by CKD stage 1-5D/T at public, specialty renal practices within participating Queensland Hospital and Health Services from October 2017 to August 2019. A multi-tiered FD screening strategy, utilising a combination of dried blood spot (DBS) enzymatic testing, and if low, then lyso-GB3 testing and DNA sequencing, was used. Results: Mean (SD) age was 64.0 (15.8) years (n = 2992), and 57.9% were male. Eight participants withrew out of the 3000 who consented. Of 2992 screened, 6 (0.20%) received a diagnosis of FD, 2902 (96.99%) did not have FD, and 84 (2.81%) received inconclusive results. Of the patients diagnosed with FD, mean age was 48.5 years; 5 were male (0.29%) and 1 was female (0.08%); 4 were on kidney replacement therapy (2 dialysis and 2 transplant); 3 were new diagnoses. Conclusions: Estimated overall FD prevalence was 0.20%. Screening of the broader CKD population may be beneficial in identifying cases of FD. Trial registration: The aCQuiRE Study has been prospectively registered with the Queensland Health Database of Research Activity (DORA, https://dora.health.qld.gov.au ) as pj09946 (Registered 3rd July 2017).
MeSH term(s)	Adult ; Cross-Sectional Studies ; Fabry Disease/diagnosis ; Fabry Disease/epidemiology ; Fabry Disease/genetics ; Female ; Humans ; Male ; Middle Aged ; Prevalence ; Renal Dialysis ; Renal Insufficiency, Chronic/epidemiology ; Renal Insufficiency, Chronic/therapy
Language	English
Publishing date	2022-05-04
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2041348-8
ISSN	1471-2369 ; 1471-2369
ISSN (online)	1471-2369
ISSN	1471-2369
DOI	10.1186/s12882-022-02805-8
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Article ; Online: Prescribing and up-titration in recently hospitalized heart failure patients attending a disease management program.

Carroll, Robert / Mudge, Alison / Suna, Jessica / Denaro, Charles / Atherton, John

International journal of cardiology

2016 Volume 216, Page(s) 121–127

Abstract: Background: Heart failure (HF) medications improve clinical outcomes, with optimal doses defined in clinical trials. Patient, provider and system barriers may limit achievement of optimal doses in real life settings, although disease management programs ...

Abstract	Background: Heart failure (HF) medications improve clinical outcomes, with optimal doses defined in clinical trials. Patient, provider and system barriers may limit achievement of optimal doses in real life settings, although disease management programs (HF-DMPs) can facilitate up-titration. Methods and results: Secondary analysis of a prospective cohort of 216 participants recently hospitalized with systolic HF, attending 5 HF-DMPs in Queensland, Australia. Medication history at baseline (6weeks after discharge) and 6months provided data to describe prescription rates, dosage and optimal titration of HF medications, and associations with patient and system factors were explored. At baseline, 94% were on an angiotensin converting enzyme inhibitor/angiotensin II receptor blocker (ACEI/ARB), 94% on a beta-blocker (BB) and 42% on a mineralocorticoid receptor antagonist (MRA). The proportion of participants on optimal doses of ACEI/ARB increased from 38% (baseline) to 52% (6months, p=0.001) and on optimal BB dose from 23% to 49% (p<0.001). Significant barriers to ACEI/ARB up-titration were body mass index (BMI)<25, female gender, polypharmacy, previously diagnosed HF, and tertiary hospital. Significant barriers for BB up-titration were BMI<25, previously diagnosed HF and non-cardiologist care. Conclusions: Effective up-titration in HF DMPs is influenced by patient, disease and service factors. Better understanding of barriers to effective up-titration in women, normal weight, and established HF patients may help provide targeted strategies for improving outcomes in these groups.
MeSH term(s)	Adrenergic beta-Antagonists/therapeutic use ; Adult ; Aged ; Aged, 80 and over ; Angiotensin Receptor Antagonists/therapeutic use ; Drug Dosage Calculations ; Drug Prescriptions/statistics & numerical data ; Female ; Guideline Adherence ; Heart Failure/drug therapy ; Hospitalization ; Humans ; Male ; Middle Aged ; Mineralocorticoid Receptor Antagonists/therapeutic use ; Practice Guidelines as Topic ; Prospective Studies ; Queensland
Chemical Substances	Adrenergic beta-Antagonists ; Angiotensin Receptor Antagonists ; Mineralocorticoid Receptor Antagonists
Language	English
Publishing date	2016-08-01
Publishing country	Netherlands
Document type	Journal Article ; Multicenter Study
ZDB-ID	779519-1
ISSN	1874-1754 ; 0167-5273
ISSN (online)	1874-1754
ISSN	0167-5273
DOI	10.1016/j.ijcard.2016.04.084
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Article: Exploring beliefs about heart failure treatment in adherent and nonadherent patients: use of the repertory grid technique.

Cottrell, William Neil / Denaro, Charles P / Emmerton, Lynne

Patient preference and adherence

2013 Volume 7, Page(s) 141–150

Abstract: Purpose: Beliefs about medicines impact on adherence, but eliciting core beliefs about medicines in individual patients is difficult. One method that has the potential to elicit individual core beliefs is the "repertory grid technique." This study ... ...

Abstract	Purpose: Beliefs about medicines impact on adherence, but eliciting core beliefs about medicines in individual patients is difficult. One method that has the potential to elicit individual core beliefs is the "repertory grid technique." This study utilized the repertory grid technique to elicit individuals' beliefs about their heart failure treatment and to investigate whether generated constructs were different between adherent and nonadherent patients. Methods: Ninety-two patients with heart failure were interviewed using a structured questionnaire that applied the repertory grid technique. Patients were asked to compare and contrast their medicines and self-care activities for their heart failure. This lead to the generation of individual constructs (perceptions towards medicines), and from these, beliefs were elicited about their heart failure treatment, resulting in the generation of a repertory grid. Adherence was measured using the Medication Adherence Report Scale (MARS). Patients with a MARS score ≥ 23 were categorized as "adherent" and those with a score ≤ 22 as "nonadherent." The generated grids were analyzed descriptively and constructs from all grids themed and the frequency of these constructs compared between adherent and nonadherent patients. Results: Individual grids provided insight into the different beliefs that patients held about their heart failure treatment. The themed constructs "related to water," "affect the heart," "related to weight," and "benefit to the heart" occurred more frequently in adherent patients compared with nonadherent patients. Conclusion: The repertory grid technique elicited beliefs of individual participants about the treatment of their heart failure. Constructs from self-reported adherent patients were more likely to reflect that their medicines and self-care activities were related to water and weight, and affect and benefit to the heart. Providing clinicians with better insight into individuals' beliefs about their treatment may facilitate the development of tailored interventions to improve adherence.
Language	English
Publishing date	2013-02-18
Publishing country	New Zealand
Document type	Journal Article
ZDB-ID	2455848-5
ISSN	1177-889X
ISSN	1177-889X
DOI	10.2147/PPA.S40725
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