Austin Health Research Online

Unintended consequences of a cautious approach to e-cigarette laws.

2019-02-18T05:07:12Z

Title: Unintended consequences of a cautious approach to e-cigarette laws. Authors: Catalano, Christian; Cranswick, Noel E; Robinson, Jeffrey; Grindlay, Joanne; Creati, Mick; Danchin, Margie H; Williams, Nicola; Gwee, Amanda

Diagnostic accuracy of noncontrast CT imaging markers in cerebral venous thrombosis.

2019-02-19T05:17:33Z

Title: Diagnostic accuracy of noncontrast CT imaging markers in cerebral venous thrombosis. Authors: Buyck, Pieter-Jan; Zuurbier, Susanna M; Garcia-Esperon, Carlos; Barboza, Miguel A; Costa, Paolo; Escudero, Irene; Renard, Dimitri; Lemmens, Robin; Hinteregger, Nicole; Fazekas, Franz; Conde, Jordi Jimenez; Giralt-Steinhauer, Eva; Hiltunen, Sini; Arauz, Antonio; Pezzini, Alessandro; Montaner, Joan; Putaala, Jukka; Weimar, Christian; Churilov, Leonid; Gattringer, Thomas; Asadi, Hamed; Tatlisumak, Turgut; Coutinho, Jonathan M; Demaerel, Philippe; Thijs, Vincent N Abstract: To assess the added diagnostic value of semiquantitative imaging markers on noncontrast CT scans in cerebral venous thrombosis (CVT). In a retrospective, multicenter, blinded, case-control study of patients with recent onset (<2 weeks) CVT, 3 readers assessed (1) the accuracy of the visual impression of CVT based on a combination of direct and indirect signs, (2) the accuracy of attenuation values of the venous sinuses in Hounsfield units (with adjustment for hematocrit levels), and (3) the accuracy of attenuation ratios of affected vs unaffected sinuses in comparison with reference standard MRI or CT angiography. Controls were age-matched patients with (sub)acute neurologic presentations. We enrolled 285 patients with CVT and 303 controls from 10 international centers. Sensitivity of visual impression of thrombosis ranged from 41% to 73% and specificity ranged from 97% to 100%. Attenuation measurement had an area under the curve (AUC) of 0.78 (95% confidence interval [CI] 0.74-0.81). After adjustment for hematocrit, the AUC remained 0.78 (95% CI 0.74-0.81). The analysis of attenuation ratios of affected vs unaffected sinuses had AUC of 0.83 (95% CI 0.8-0.86). Adding this imaging marker significantly improved discrimination, but sensitivity when tolerating a false-positive rate of 20% was not higher than 76% (95% CI 0.70-0.81). Semiquantitative analysis of attenuation values for diagnosis of CVT increased sensitivity but still failed to identify 1 out of 4 CVT. This study provides Class II evidence that visual analysis of plain CT with or without attenuation measurements has high specificity but only moderate sensitivity for CVT.

The Australasian Resuscitation In Sepsis Evaluation: FLUid or vasopressors In Emergency Department Sepsis, a multicentre observational study (ARISE FLUIDS observational study): Rationale, methods and analysis plan.

2019-02-06T05:15:07Z

Title: The Australasian Resuscitation In Sepsis Evaluation: FLUid or vasopressors In Emergency Department Sepsis, a multicentre observational study (ARISE FLUIDS observational study): Rationale, methods and analysis plan. Authors: Keijzers, Gerben; Macdonald, Stephen Pj; Udy, Andrew A; Arendts, Glenn; Bailey, Michael; Bellomo, Rinaldo; Blecher, Gabriel E; Burcham, Jonathon; Delaney, Anthony; Coggins, Andrew R; Fatovich, Daniel M; Fraser, John F; Harley, Amanda; Jones, Peter; Kinnear, Fran; May, Katya; Peake, Sandra; Taylor, David McD; Williams, Julian; Williams, Patricia Abstract: There is uncertainty about the optimal i.v. fluid volume and timing of vasopressor commencement in the resuscitation of patients with sepsis and hypotension. We aim to study current resuscitation practices in EDs in Australia and New Zealand (the Australasian Resuscitation In Sepsis Evaluation: FLUid or vasopressors In Emergency Department Sepsis [ARISE FLUIDS] observational study). ARISE FLUIDS is a prospective, multicentre observational study in 71 hospitals in Australia and New Zealand. It will include adult patients presenting to the ED during a 30 day period with suspected sepsis and hypotension (systolic blood pressure <100 mmHg) despite at least 1000 mL fluid resuscitation. We will obtain data on baseline demographics, clinical and laboratory variables, all i.v. fluid given in the first 24 h, vasopressor use, time to antimicrobial administration, admission to intensive care, organ failure and in-hospital mortality. We will specifically describe (i) the volume of fluid administered at the following time points: when meeting eligibility criteria, in the first 6 h, at 24 h and prior to vasopressor commencement and (ii) the frequency and timing of vasopressor use in the first 6 h and at 24 h. Screening logs will provide reliable estimates of the proportion of ED patients meeting eligibility criteria for a subsequent randomised controlled trial. This multicentre, observational study will provide insight into current haemodynamic resuscitation practices in patients with sepsis and hypotension as well as estimates of practice variation and patient outcomes. The results will inform the design and feasibility of a multicentre phase III trial of early haemodynamic resuscitation in patients presenting to ED with sepsis and hypotension.

Is Exercise Prescription in Cardiac Rehabilitation Influenced by physical capacity or Cardiac Intervention?

2019-02-18T05:30:10Z

Title: Is Exercise Prescription in Cardiac Rehabilitation Influenced by physical capacity or Cardiac Intervention? Authors: Price, Kym Joanne; Gordon, Brett A; Gray, Kim; Gergely, Kerri; Bird, Stephen Richard; Benson, Amanda Clare Abstract: This study investigated the influence of cardiac intervention and physical capacity of individuals attending an Australian outpatient cardiac rehabilitation program on the initial exercise prescription. Eighty-five patients commencing outpatient cardiac rehabilitation at a major metropolitan hospital had their physical capacity assessed by an incremental shuttle walk test, and the initial aerobic exercise intensity and resistance training load prescribed were recorded. Physical capacity was lower in surgical patients than non-surgical patients. While physical capacity was higher in younger compared with older surgical patients, there was no difference between younger and older non-surgical patients. The initial exercise intensity did not differ between surgical and non-surgical patients. This study highlights the importance of pre-program exercise testing to enable exercise prescription to be individualised according to actual physical capacity, rather than symptoms, comorbidities and age, in order to maximise the benefit of cardiac rehabilitation.