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Article ; Online: Clinical decision support for high-cost imaging

Joseph Doyle / Sarah Abraham / Laura Feeney / Sarah Reimer / Amy Finkelstein

PLoS ONE, Vol 14, Iss 3, p e

A randomized clinical trial.

2019 Volume 0213373

Abstract: There is widespread concern over the health risks and healthcare costs from potentially inappropriate high-cost imaging. As a result, the Centers for Medicare and Medicaid Services (CMS) will soon require high-cost imaging orders to be accompanied by ... ...

Abstract	There is widespread concern over the health risks and healthcare costs from potentially inappropriate high-cost imaging. As a result, the Centers for Medicare and Medicaid Services (CMS) will soon require high-cost imaging orders to be accompanied by Clinical Decision Support (CDS): software that provides appropriateness information at the time orders are placed via a best practice alert for targeted (i.e. likely inappropriate) imaging orders, although the impacts of CDS in this context are unclear. In this randomized trial of 3,511 healthcare providers at Aurora Health Care, we study the impacts of CDS on the ordering behavior of providers. We find that CDS reduced targeted imaging orders by a statistically significant 6%, however there was no statistically significant change in the total number of high-cost scans or of low-cost scans. The results suggest that the impending CMS mandate requiring healthcare systems to adopt CDS may modestly increase the appropriateness of high-cost imaging.
Keywords	Medicine ; R ; Science ; Q
Language	English
Publishing date	2019-01-01T00:00:00Z
Publisher	Public Library of Science (PLoS)
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Relative Importance and Knowledge Distribution of Medicinal Plants in a Kichwa Community in the Ecuadorian Amazon

Brian Joseph Doyle / Caroline Michael Asiala / Diana Margot Fernández

Ethnobiology Letters, Vol 8, Iss

2017 Volume 1

Abstract: Traditional knowledge, such as knowledge of the use of plants as medicine, influences how indigenous people manage forest resources. Gender and age-associated differences in traditional knowledge may impact forest resource management because of the ... ...

Abstract	Traditional knowledge, such as knowledge of the use of plants as medicine, influences how indigenous people manage forest resources. Gender and age-associated differences in traditional knowledge may impact forest resource management because of the traditional division of labor. We interviewed 18 men and 18 women between 9 and 74 years old in San José de Payamino, an indigenous community of the Kichwa ethnicity in the Ecuadorian Amazon, to determine if there are gender or age-associated differences in medicinal plant knowledge among the Payamino people and to identify the most important species from a sample of medicinal plants. Individuals were interviewed using a tablet that displayed images of 34 plants, which had been cited by traditional healers in the community. Quantitative analysis provided insight into the relative importance of plants in the sample as well as the distribution of medicinal plant knowledge among members of the community. The most important plants were Tradescantia zanonia and Monolena primuliflora . These plants should be considered candidates for further investigation. There was a positive correlation between age and knowledge of medicinal plants, but no significant difference between genders. Our results suggest that an interview method that relies on digital images can reveal differences in the importance of medicinal plants as well as provide insight into the distribution of traditional medical knowledge. While men and women are likely to manage forest resources similarly, younger members of the community may not have the same regard for forest resources as their elder counterparts.
Keywords	Traditional medicine ; Ethnobotany ; Quichua ; Runa ; Payamino ; Human ecology. Anthropogeography ; GF1-900
Subject code	580
Language	English
Publishing date	2017-01-01T00:00:00Z
Publisher	Society of Ethnobiology
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: The eliminate hepatitis C (EC) experience study

Margaret Hellard / Joseph Doyle / Alisa Pedrana / Peter Higgs / Paul Dietze / Kathleen Ryan / Daniel O’Keefe / Filip Djordjevic / Phoebe Kerr / Judy Gold / Imogen Elsum / Chloe Layton / Kico Chan / Mark A Stoové / Bridget Louise Draper / Jack Gunn

BMJ Open, Vol 13, Iss

baseline characteristics of a cohort of people who inject drugs in Melbourne, Australia

2023 Volume 7

Abstract: Objectives Direct-acting antivirals provide an opportunity to eliminate hepatitis C virus (HCV) as a public health threat in Australia, yet barriers to care remain. In this study, we use baseline data from a longitudinal cohort of people who inject drugs ...

Abstract	Objectives Direct-acting antivirals provide an opportunity to eliminate hepatitis C virus (HCV) as a public health threat in Australia, yet barriers to care remain. In this study, we use baseline data from a longitudinal cohort of people who inject drugs to understand differences in participant characteristics and explore experiences of stigma, health service utilisation and health literacy between three care cascade groups.Design Cross-sectional.Setting Community and private primary healthcare services in Melbourne, Australia.Participants Participants completed baseline surveys between 19 September 2018 and 15 December 2020. We recruited 288 participants; the median age was 42 years (IQR: 37–49 years) and 198 (69%) were male. At baseline, 103 (36%) self-reported being ‘not engaged in testing’, 127 (44%) had HCV RNA positivity but were ‘not engaged in treatment’ and 58 (20%) were ‘engaged in HCV treatment’.Outcome measures Descriptive statistics were used to present the baseline demographics, health service utilisation and experiences of stigma data. We explored differences in these scales between participant demographics using χ2 test or fisher’s exact tests, and differences between health literacy scores using one-way analysis of variance tests.Results A majority were in regular contact with multiple health services, and most had previously been identified as at-risk of HCV. In the 12 months preceding baseline, 70% reported any experiences of stigma related to injecting drug use. Assessment of health literacy data identified gaps for those ‘not engaged in testing’ and ‘not engaged in treatment’ across two relevant domains: ‘ability to appraise health information’ and ‘ability to actively engage with healthcare providers’.Conclusion In eliminate hepatitis C experience, lower HCV testing and treatment may be explained by experiences of stigmatisation or gaps in health literacy. Enhanced interventions targeting people who inject drugs to promote HCV care are needed.
Keywords	Medicine ; R
Subject code	360
Language	English
Publishing date	2023-07-01T00:00:00Z
Publisher	BMJ Publishing Group
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Hepatitis B and pregnancy

Marvad Ahad / Jack Wallace / Yinzong Xiao / Caroline van Gemert / Gabrielle Bennett / Jonathan Darby / Paul Desmond / Samuel Hall / Jacinta Holmes / Tim Papaluca / Susanne Glasgow / Alexander Thompson / Margaret Hellard / Joseph Doyle / Jessica Howell

BMC Public Health, Vol 22, Iss 1, Pp 1-

understanding the experiences of care among pregnant women and recent mothers in metropolitan Melbourne

2022 Volume 8

Abstract: Abstract Background Pregnant women are a priority group for hepatitis B testing. Guideline-based care during antenatal and post-partum periods aims to prevent mother-to-child transmission of hepatitis B virus and lower the risk of liver complications in ... ...

Abstract	Abstract Background Pregnant women are a priority group for hepatitis B testing. Guideline-based care during antenatal and post-partum periods aims to prevent mother-to-child transmission of hepatitis B virus and lower the risk of liver complications in mothers. This qualitative study explored knowledge of hepatitis B and experiences of hepatitis B related care among pregnant women and mothers. Methods Semi-structured interviews were conducted with thirteen women with hepatitis B who were attending antenatal or post-partum hepatitis B care. The interviews were thematically analysed to assess knowledge and understanding of hepatitis B. Participants were recruited from specialist clinics in metropolitan Melbourne between August 2019 and May 2020. Results Four major themes were identified from interviews: (1) knowledge and understanding of hepatitis B, (2) treatment pathways, (3) accessing hepatitis B related care, and (4) disclosing status to friends. Most participants displayed an understanding of hepatitis B transmission, including mother to child transmission. The main motivator of post-partum attendance was reassurance gained concerning their child’s health. Sources of hepatitis B information included doctors, online information and family. Participants identified parents and siblings as sources of support and reported an unwillingness to disclose hepatitis B status to friends. Conclusions Women attending antenatal or post-partum care reported having overall positive experiences, particularly regarding reassurance of their child’s health, but displayed misconceptions around horizontal transmission. Knowledge gained from these results can contribute to the development of targeted models of care for pregnant women and mothers with young children to ensure their successful linkage to care.
Keywords	Hepatitis B ; Pregnancy ; Healthcare seeking ; Qualitative research ; Public aspects of medicine ; RA1-1270
Subject code	360
Language	English
Publishing date	2022-04-01T00:00:00Z
Publisher	BMC
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Understanding how to live with hepatitis B

Jack Wallace / Yinzong Xiao / Jess Howell / Alex Thompson / Nicole Allard / Emily Adamson / Jacqui Richmond / Behzad Hajarizadeh / Melanie Eagle / Joseph Doyle / Margaret Hellard

BMC Public Health, Vol 22, Iss 1, Pp 1-

a qualitative investigation of peer advice for Chinese people living with hepatitis B in Australia

2022 Volume 8

Abstract: Abstract Background Hepatitis B is a chronic viral infection, a leading cause of primary liver cancer and identified as a major public health priority by the World Health Organization. Despite a high proportion of people in Australia who have been ... ...

Abstract	Abstract Background Hepatitis B is a chronic viral infection, a leading cause of primary liver cancer and identified as a major public health priority by the World Health Organization. Despite a high proportion of people in Australia who have been diagnosed with hepatitis B, significant gaps remain in health care access and in accurate knowledge about hepatitis B. Most people with hepatitis B in Australia were born in China, where the infection has an intergenerational impact with significant social implications resulting from the infection. Understanding how people of Chinese ethnicity with hepatitis B understand and respond to hepatitis B is imperative for reducing morbidity, mortality, and the personal and social impact of the infection. Methods Qualitative semi-structured interviews with people with hepatitis B of Chinese ethnicity recruited through a specialist service identified the advice people with hepatitis B thought was important enough to inform the experience of people newly diagnosed with hepatitis B. A thematic analysis of the data privileged the lived experience of participants and their personal, rather than clinical, explanations of the virus. Results Hepatitis B infection had psychological and physical consequences that were informed by cultural norms, and to which people had responded to with significant behavioural change. Despite this cohort being engaged with specialist clinical services with access to the most recent, comprehensive, and expert information, much of the advice people with hepatitis B identified as important for living with hepatitis B was not based on biomedical understandings. Key suggestions from people with hepatitis B were to form sustainable clinical relationships, develop emotional resilience, make dietary changes, regulate energy, and issues related to disclosure. Conclusions The study highlights conflicts between biomedical and public health explanations and the lived experience of hepatitis B among people of Chinese ethnicity in Australia. Beliefs about hepatitis B ...
Keywords	Hepatitis B virus ; Health beliefs ; China ; Diagnosis ; Health information ; Public aspects of medicine ; RA1-1270
Subject code	360 ; 306
Language	English
Publishing date	2022-03-01T00:00:00Z
Publisher	BMC
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Cost-effectiveness of transplanting lungs and kidneys from donors with potential hepatitis C exposure or infection

Nick Scott / Greg Snell / Glen Westall / David Pilcher / Michelle Raggatt / Rowan G. Walker / Margaret Hellard / Anton Y. Peleg / Joseph Doyle

Scientific Reports, Vol 10, Iss 1, Pp 1-

2020 Volume 11

Abstract: Abstract Organ transplant guidelines in many settings recommend that people with potential hepatitis C virus (HCV) exposure or infection are deemed ineligible to donate. The recent availability of highly-effective treatments for HCV means that this may ... ...

Abstract	Abstract Organ transplant guidelines in many settings recommend that people with potential hepatitis C virus (HCV) exposure or infection are deemed ineligible to donate. The recent availability of highly-effective treatments for HCV means that this may no longer be necessary. We used a mathematical model to estimate the expected difference in healthcare costs, difference in disability-adjusted life years (DALYs) and cost-effectiveness of removing HCV restrictions for lung and kidney donations in Australia. Our model suggests that allowing organ donations from people who inject drugs, people with a history of incarceration and people who are HCV antibody-positive could lead to an estimated 10% increase in organ supply, population-level improvements in health (reduction in DALYs), and on average save AU$2,399 (95%CI AU$1,155-3,352) and AU$2,611 (95%CI AU$1,835-3,869) per person requiring a lung and kidney transplant respectively. These findings are likely to hold for international settings, since this policy change remained cost saving with positive health gains regardless of HCV prevalence, HCV treatment cost and waiting list survival probabilities. This study suggests that guidelines on organ donation should be revisited in light of recent changes to clinical outcomes for people with HCV.
Keywords	Medicine ; R ; Science ; Q
Subject code	360
Language	English
Publishing date	2020-01-01T00:00:00Z
Publisher	Nature Publishing Group
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Epidemiology and Management of invasive infections among people who Use drugs (EMU)

BMJ Open, Vol 13, Iss

protocol for a prospective, multicentre cohort study

2023 Volume 4

Abstract: Introduction People who inject drugs (PWID) are at risk of invasive infections such as bloodstream infections, endocarditis, osteomyelitis and septic arthritis. Such infections require prolonged antibiotic therapy, but there is limited evidence about the ...

Abstract	Introduction People who inject drugs (PWID) are at risk of invasive infections such as bloodstream infections, endocarditis, osteomyelitis and septic arthritis. Such infections require prolonged antibiotic therapy, but there is limited evidence about the optimal care model to deliver to this population. The Epidemiology and Management of invasive infections among people who Use drugs (EMU) study aims to (1) describe the current burden, clinical spectrum, management and outcomes of invasive infections in PWID; (2) determine the impact of currently available models of care on completion of planned antimicrobials for PWID admitted to hospital with invasive infections and (3) determine postdischarge outcomes of PWID admitted with invasive infections at 30 and 90 days.Methods and analysis EMU is a prospective multicentre cohort study of Australian public hospitals who provide care to PWIDs with invasive infections. All patients who have injected drugs in the previous six months and are admitted to a participating site for management of an invasive infection are eligible. EMU has two components: (1) EMU-Audit will collect information from medical records, including demographics, clinical presentation, management and outcomes; (2) EMU-Cohort will augment this with interviews at baseline, 30 and 90 days post-discharge, and data linkage examining readmission rates and mortality. The primary exposure is antimicrobial treatment modality, categorised as inpatient intravenous antimicrobials, outpatient antimicrobial therapy, early oral antibiotics or lipoglycopeptide. The primary outcome is confirmed completion of planned antimicrobials. We aim to recruit 146 participants over a 2-year period.Ethics and dissemination EMU has been approved by the Alfred Hospital Human Research Ethics Committee (Project number 78815.) EMU-Audit will collect non-identifiable data with a waiver of consent. EMU-Cohort will collect identifiable data with informed consent. Findings will be presented at scientific conferences and disseminated by ...
Keywords	Medicine ; R
Subject code	170
Language	English
Publishing date	2023-04-01T00:00:00Z
Publisher	BMJ Publishing Group
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Heterogeneity in hepatitis C treatment prescribing and uptake in Australia

Nick Scott / Samuel W. Hainsworth / Rachel Sacks-Davis / Alisa Pedrana / Joseph Doyle / Amanda Wade / Margaret Hellard

Journal of Virus Eradication, Vol 4, Iss 2, Pp 108-

a geospatial analysis of a year of unrestricted treatment access

2018 Volume 114

Abstract: Background and aim: Direct-acting antiviral (DAA) treatments became available for all people living with hepatitis C virus (HCV) in Australia in March 2016. We assess variations in treatment rates and prescribing patterns across Australia's 338 ... ...

Abstract	Background and aim: Direct-acting antiviral (DAA) treatments became available for all people living with hepatitis C virus (HCV) in Australia in March 2016. We assess variations in treatment rates and prescribing patterns across Australia's 338 Statistical Area 3 (SA3) geographical units. Methods: Geocoded DAA treatment initiation data were analysed for the period 1 March 2016 to 30 June 2017. Regression models tested associations between the population demographics and healthcare service coverage of geographical areas and (a) their treatment rates; and (b) the proportion of prescriptions written by specialists compared to non-specialists. Results: Across the 320 areas (95%) recording treatments, a median 76 (interquartile range [IQR] 35–207, range 4–3834) per 100,000 were initiated, corresponding to an estimated median 7.9% (IQR 2.9–23.6%, range 0–100%) treatment uptake. Major cities, areas of socioeconomic advantage and areas with lower proportions of the population born overseas had the highest per capita treatment rates. Non-specialists prescribed 46% (20,323/44,382) of treatment initiations. Prescriptions were written by non-specialists only in 163 areas (51%), while in other areas a median 40.0% (IQR 21.8–62.5%) of prescriptions were written by non-specialists. Non-specialist prescribing was higher in regional areas, as well as areas that had greater proportions of Indigenous Australians. Conclusions: High national-level treatment uptake of 20% in Australia masks underlying health system limitations; more than half of geographical areas may have treated less than 8% of people living with HCV. Areas of socioeconomic disadvantage and areas with a higher proportion of the population born overseas may need targeting with interventions to improve treatment uptake.
Keywords	direct-acting antivirals ; elimination ; geospatial analysis ; hepatitis C virus ; Microbiology ; QR1-502 ; Public aspects of medicine ; RA1-1270
Subject code	310
Language	English
Publishing date	2018-04-01T00:00:00Z
Publisher	Elsevier
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Assessing the feasibility, acceptability and impacts of an education program on hepatitis B testing uptake among ethnic Chinese in Australia

Yinzong Xiao / Jack Wallace / Marvad Ahad / Caroline van Gemert / Alexander J. Thompson / Joseph Doyle / Ho Yin Lam / Kico Chan / Gabrielle Bennett / Emily Adamson / Nafisa Yussf / Aurora Tang / Alisa Pedrana / Mark Stoove / Margaret Hellard / Jessica Howell

BMC Public Health, Vol 21, Iss 1, Pp 1-

results of a randomised controlled pilot study

2021 Volume 13

Abstract: Abstract Background In Australia, Chinese migrants are among the populations most affected by hepatitis B virus (HBV) infection but often experience late diagnosis or access to clinical care. This study aims to explore approaches to increase HBV testing ... ...

Abstract	Abstract Background In Australia, Chinese migrants are among the populations most affected by hepatitis B virus (HBV) infection but often experience late diagnosis or access to clinical care. This study aims to explore approaches to increase HBV testing in Australia’s Chinese community and inform evaluation planning, specifically to i) assess the feasibility and acceptability of HBV educational programs, and ii) compare HBV testing uptake in people receiving a tailored education resource focussing on liver cancer prevention compared with a standard HBV education package. Methods This is a pre-post mixed-methods pilot and feasibility study. People of Chinese ethnicity and unsure of their HBV infection or immunity status were recruited from ten community sites in Melbourne, Australia in 2019–2020. Participants were randomised to receive an education package (comprised of a leaflet and in-person one-on-one educational session) with a focus on either 1) standard HBV-related information, or 2) liver cancer prevention. Participants completed a baseline questionnaire prior to receiving the intervention and were followed up at 6 months’ time for a questionnaire and an opt-in semi-structured interview. Primary study outcomes included feasibility of study procedures, measured by recruitment, participation, and retention rates; acceptability of the education program assessed by acceptability scores; and HBV testing uptake rate in each arm. Secondary outcomes include HBV-related knowledge change, assessed by pre-post comparison; and factors affecting participants’ testing behaviour analysed using qualitative data. Results Fifty-four participants received an education package; baseline and follow-up data from 33 (61%) were available. The study procedures of recruitment and retention were feasible; the acceptability of the education program was moderate with improved HBV-related knowledge observed. Four participants self-reported being tested: one (1/15, 7%) in the standard HBV information group and three (3/18, 17%) in the ...
Keywords	HBV testing ; Community-based program ; Chinese community ; Feasibility ; Acceptability ; Efficacy ; Public aspects of medicine ; RA1-1270
Subject code	306
Language	English
Publishing date	2021-10-01T00:00:00Z
Publisher	BMC
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Redo aortic valve replacement vs valve-in-valve trans-catheter aortic valve implantation

Francesca Gatta / Yama Haqzad / George Gradinariu / Pietro Giorgio Malvindi / Zubair Khalid / Rona L. Suelo-Calanao / Nader Moawad / Aladdin Bashir / Luke J. Rogers / Clinton Lloyd / Bao Nguyen / Karen Booth / Lu Wang / Nawwar Al-Attar / Neil McDowall / Stuart Watkins / Rana Sayeed / Saleh Baghdadi / Andrea D'Alessio /

Maria Monteagudo-vela / Jasmina Djordjevic / Matej Goricar / Solveig Hoppe / Charlotte Bocking / Azar Hussain / Betsy Evans / Salman Arif / Christopher Malkin / Mark Field / Kully Sandhu / Amer Harky / Ahmed Torky / Mauin Uddin / Muhammad Abdulhakeem / Ayman Kenawy / John Massey / Neil Cartwright / Nathan Tyson / Niki Nicou / Kamran Baig / Mark Jones / Firas Aljanadi / Colum G. Owens / Tunde Oyebanji / Joseph Doyle / Mark S. Spence / Paul F. Brennan / Ganesh Manoharan / Taha Ramadan / Sunil Ohri / Mahmoud Loubani

Monaldi Archives for Chest Disease (2023)

a UK propensity-matched analysis

2023

Abstract: This study sought to compare the morbidity and mortality of redo aortic valve replacement (redo-AVR) versus valve-in-valve trans-catheter aortic valve implantation (valve-in-valve TAVI) for patients with a failing bioprosthetic valve. A multicentre UK ... ...

Abstract	This study sought to compare the morbidity and mortality of redo aortic valve replacement (redo-AVR) versus valve-in-valve trans-catheter aortic valve implantation (valve-in-valve TAVI) for patients with a failing bioprosthetic valve. A multicentre UK retrospective study of redo-AVR or valve-in-valve TAVI for patients referred for redo aortic valve intervention due to a degenerated aortic bioprosthesis. Propensity score matching was performed for confounding factors. From July 2005 to April 2021, 911 patients underwent redo-AVR and 411 patients valve-in-valve TAVI. There were 125 pairs for analysis after propensity score matching. Mean age was 75.2±8.5 years. In-hospital mortality was 7.2% (n=9) for redo-AVR vs 0 for valve-in-valve TAVI, p=0.002. Surgical patients suffered more post-operative complications, including IABP support (p=0.02), early re-operation (p<0.001), arrhythmias (p<0.001), respiratory and neurological complications (p=0.02 and p=0.03) and multi-organ failure (p=0.01). The valve-in-valve TAVI group had a shorter intensive care unit and hospital stay (p <0.001 for both). However, moderate aortic regurgitation at discharge and higher post-procedural gradients were more common after valve-in-valve TAVI (p<0.001 for both). Survival probabilities in patients who were successfully discharged from hospital were similar after valve-in-valve TAVI and redo-AVR over the 6-year follow-up (log-rank p=0.26). In elderly patients with a degenerated aortic bioprosthesis, valve-in-valve trans-catheter aortic valve implantation provides better early outcomes, as opposed to redo surgical aortic valve replacement, although there was no difference in mid-term survival in patients successfully discharged from hospital.
Keywords	redo aortic valve replacement ; valve-in-valve TAVI ; aortic valve ; Medicine ; R
Language	English
Publishing date	2023-04-01T00:00:00Z
Publisher	PAGEPress Publications
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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