21 results on '"Worland T"'
Search Results
2. Serum interleukin-4 is elevated in clinical drug-induced liver injury.
- Author
-
Liu, MN, Au, M., Bishara, M., Worland, T., Con, D., Chew, S., McNiece, A., Gronbaek, H., Sluka, P., and Nicoll, AJ
- Subjects
INTERLEUKIN-4 ,LIVER injuries ,DRUG side effects ,MALIGNANT hyperthermia ,ENZYME-linked immunosorbent assay ,ANTIBODY formation - Abstract
Drug-induced liver injury (DILI) remains a challenging diagnosis due to an absence of specific biomarkers. DILI due to volatile anaesthetics (VA-DILI) is characterised by trifluoroacetyl and CYP2E1 antibodies, but may not be seen for weeks after injury. Interleukin-4 (IL-4) may be involved in the production of these antibodies and may serve as a clinically useful early biomarker of VA-DILI. To prospectively compare serum IL-4 levels between patients who develop VA-DILI and controls following exposure to the volatile anaesthetic. A nested case-control study of patients exposed to VA during surgery was conducted. Thirteen DILI cases were identified from the original cohort, and 26 controls were matched according to age, sex and VA agent. Serum samples were collected before and 48-96 h after VA exposure, and analysed for IL-4 using quantitative enzyme-linked immunosorbent assay techniques. There was a statistically significant difference in serum IL-4 in post-VA samples between DILI cases and controls (control: 0.030 pg/mL, IQR: 0.030 − 0.030 pg/mL vs DILI: 0.044 pg/mL, IQR: 0.030 − 0.061 pg/mL; p = 0.039). A greater proportion of DILI cases had post-VA IL-4 levels above the assay lower limit of detection compared to controls (control: 23% vs DILI: 69%; p = 0.013). IL-4 is a potential biomarker of DILI. Clinical diagnosis and understanding of DILI disease mechanisms may be improved by further investigation of novel biomarkers, and this IL-4 signal in serum is important as proof of concept for prospective study designs. [ABSTRACT FROM AUTHOR]
- Published
- 2023
- Full Text
- View/download PDF
3. Risk stratification in acute upper gastrointestinal bleeding: AIMS65 is superior to Glasgow-Blatchford and Rockall scoring systems in predicting inpatient mortality
- Author
-
ROBERTSON, M, MAJUMDAR, A, BOYAPATI, R, CHUNG, W, TERBAH, R, WORLAND, T, WEI, J, LONTOS, S, and VAUGHAN, R
- Published
- 2014
4. Appendectomy does not appear to confer an increased risk of initial or recurrent Clostridium difficile infection
- Author
-
SKARDOON, G, ROBERTSON, M, and WORLAND, T
- Published
- 2013
5. Surveillance MRI is associated with improved survival in patients with primary sclerosing cholangitis.
- Author
-
Tan N, Ngu N, Worland T, Lee T, Abrahams T, Freeman E, Hannah N, Gazelakis K, Madden RG, Lynch KD, Valaydon Z, Sood S, Dev A, Bell S, Thompson AJ, Ding JN, Nicoll AJ, Liu K, Pandya K, Gow P, Lubel J, Kemp W, Roberts SK, and Majeed A
- Subjects
- Humans, Male, Female, Retrospective Studies, Middle Aged, Australia epidemiology, Adult, Bile Duct Neoplasms mortality, Bile Duct Neoplasms diagnostic imaging, Aged, Cholangitis, Sclerosing mortality, Cholangitis, Sclerosing complications, Cholangitis, Sclerosing diagnostic imaging, Cholangiopancreatography, Magnetic Resonance, Cholangiocarcinoma mortality, Cholangiocarcinoma diagnostic imaging
- Abstract
Background: The benefits of regular surveillance imaging for cholangiocarcinoma in patients with primary sclerosing cholangitis (PSC) are unclear. Hence, we aimed to evaluate the impact of regular magnetic resonance cholangiopancreatography (MRCP) on outcomes of patients with PSC in Australia, where the practice of MRCP surveillance is variable., Methods: The relationship between MRCP surveillance and survival outcomes was assessed in a multicenter, retrospective cohort of patients with PSC from 9 tertiary liver centers in Australia. An inverse probability of treatment weighting approach was used to balance groups across potentially confounding covariates., Results: A total of 298 patients with PSC with 2117 person-years of follow-up were included. Two hundred and twenty patients (73.8%) had undergone MRCP surveillance. Regular surveillance was associated with a 71% reduced risk of death on multivariate weighted Cox analysis (HR: 0.29, 95% CI: 0.14-0.59, p < 0.001) and increased likelihood of having earlier endoscopic retrograde cholangiopancreatography from the date of PSC diagnosis in patients with a dominant stricture (p < 0.001). However, survival posthepatobiliary cancer diagnosis was not significantly different between both groups (p = 0.74). Patients who had surveillance of less than 1 scan a year (n = 41) had comparable survival (HR: 0.46, 95% CI 0.16-1.35, p = 0.16) compared to patients who had surveillance at least yearly (n = 172)., Conclusions: In this multicenter cohort study that employed inverse probability of treatment weighting to minimize selection bias, regular MRCP was associated with improved overall survival in patients with PSC; however, there was no difference in survival after hepatobiliary cancer diagnosis. Further prospective studies are needed to confirm the benefits of regular MRCP and optimal imaging interval in patients with PSC., (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Association for the Study of Liver Diseases.)
- Published
- 2024
- Full Text
- View/download PDF
6. Severe Hepatitis Complicating Olmesartan Enteropathy: A Case Report.
- Author
-
Tan R, Abasszade JH, Dhillon H, Kuan CC, Worland T, and Tabatabai S
- Abstract
Introduction: Olmesartan, an angiotensin II receptor antagonist, is associated with an uncommon complication of enteropathy that presents insidiously, usually months to years after initial commencement of anti-hypertensive therapy which can be dose-dependent. It has a variable spectrum of clinical presentation but commonly presents as a moderate to severe malabsorptive process with potential severe complications related to poor end-organ perfusion. Lymphocytic gastritis and microscopic colitis are often noted in patients presenting with olmesartan-induced enteropathy; however, hepatic involvement has been less frequently observed., Case Presentation: We illustrate a case of a 43-year-old female presenting with 2 weeks of profuse non-bloody diarrhea in the context of olmesartan enteropathy which was complicated by an acute severe ischemic and enteropathic hepatopathy., Conclusion: Our case prompts clinicians to maintain a high index of suspicion in cases presenting with a seronegative enteropathy and concurrent acute liver injury while on olmesartan therapy. Cessation of olmesartan therapy resulted in prompt resolution of diarrheal symptoms and normalization of the acute transaminitis on subsequent three-week follow-up., Competing Interests: The authors declare that there are no conflicts of interest regarding the publication of this article., (© 2024 The Author(s). Published by S. Karger AG, Basel.)
- Published
- 2024
- Full Text
- View/download PDF
7. Testosterone is lower in men with non-alcoholic fatty liver disease and alcohol-related cirrhosis and is associated with adverse clinical outcomes.
- Author
-
Apostolov R, Wong D, Low E, Vaz K, Spurio J, Worland T, Liu D, Chan RK, Gow P, Grossmann M, and Sinclair M
- Subjects
- Male, Humans, Middle Aged, Testosterone, Retrospective Studies, Severity of Illness Index, Liver Cirrhosis, Alcoholic complications, Non-alcoholic Fatty Liver Disease complications, End Stage Liver Disease
- Abstract
Background/aims: Low serum testosterone is common in cirrhotic men, but the impact of disease aetiology remains uncertain. This study compares serum total testosterone (TT) levels by disease aetiology and assesses its prognostic value., Methods: Single-centre retrospective study of cirrhotic men who had TT levels measured between 2002 and 2020. A cut-off of 12 nmol/L was used to define low TT and 230 pmol/L for calculated free testosterone (cFT). Linear and logistic regression used to adjust for variables known to affect testosterone levels and assess for an association between levels and outcomes., Results: Of 766 cirrhotic men, 33.3% had alcohol-related liver disease (ALD) and 11.9% had non-alcoholic fatty liver disease (NAFLD). The median age was 56 years (interquartile range (IQR) 50-61), and the model for end-stage liver disease (MELD) score 14 (IQR 9-20). TT levels were low in 53.3% of patients, (median 11.0 nmol/L; IQR 3.7-19.8) and cFT low in 79.6% (median 122 pmol/L; IQR 48.6-212). Median TT was lower in men with ALD (7.6 nmol/L; IQR 2.1-16.2) and NAFLD (9.8 nmol/L; IQR 2.75-15.6) compared to other aetiologies (11.0 nmol/L; IQR 3.73-19.8) ( p < 0.001 for all), which remained true after adjustment for age and MELD score. TT was inversely associated with 12-month mortality or transplant (381 events, p = 0.02) and liver decompensation (345 events, p = 0.004)., Conclusions: Low serum testosterone is common in cirrhotic men and is associated with adverse clinical outcomes. TT levels are significantly lower in ALD and NAFLD compared to other disease aetiologies. Further large-scale studies are required to assess the potential benefits of testosterone therapy.
- Published
- 2023
- Full Text
- View/download PDF
8. A home-based, multidisciplinary liver optimisation programme for the first 28 days after an admission for acute-on-chronic liver failure (LivR well): a study protocol for a randomised controlled trial.
- Author
-
Ngu NL, Saxby E, Worland T, Anderson P, Stothers L, Figredo A, Hunter J, Elford A, Ha P, Hartley I, Roberts A, Seah D, Tambakis G, Liew D, Rogers B, Sievert W, Bell S, and Le S
- Subjects
- Adult, Australia, Hospitalization, Humans, Pandemics, Quality of Life, Randomized Controlled Trials as Topic, Acute-On-Chronic Liver Failure diagnosis, Acute-On-Chronic Liver Failure therapy, COVID-19
- Abstract
Background: Acute-on-chronic liver failure (ACLF) represents a rising global healthcare burden, characterised by increasing prevalence among patients with decompensated cirrhosis who have a 28-day transplantation-free mortality of 33.9%. Due to disease complexity and a high prevalence of socio-economic disadvantage, there are deficits in quality of care and adherence to guideline-based treatment in this cohort. Compared to other chronic conditions such as heart failure, those with liver disease have reduced access to integrated ambulatory care services. The LivR Well programme is a multidisciplinary intervention aimed at improving 28-day mortality and reducing 30-day readmission through a home-based, liver optimisation programme implemented in the first 28 days after an admission with either ACLF or hepatic decompensation. Outcomes from our feasibility study suggest that the intervention is safe and acceptable to patients and carers., Methods: We will recruit adult patients with chronic liver disease from the emergency departments, in-patient admissions, and an ambulatory liver clinic of a multi-site quaternary health service in Melbourne, Australia. A total of 120 patients meeting EF-Clif criteria will be recruited to the ACLF arm, and 320 patients to the hepatic decompensation arm. Participants in each cohort will be randomised to the intervention arm, a 28-day multidisciplinary programme or to standard ambulatory care in a 1:1 ratio. The intervention arm includes access to nursing, pharmacy, physiotherapy, dietetics, social work, and neuropsychiatry clinicians. For the ACLF cohort, the primary outcome is 28-day mortality. For the hepatic decompensation cohort, the primary outcome is 30-day re-admission. Secondary outcomes assess changes in liver disease severity and quality of life. An interim analysis will be performed at 50% recruitment to consider early cessation of the trial if the intervention is superior to the control, as suggested in our feasibility study. A cost-effectiveness analysis will be performed. Patients will be followed up for 12 weeks from randomisation. Three exploratory subgroup analyses will be conducted by (a) source of referral, (b) unplanned hospitalisation, and (c) concurrent COVID-19. The trial has been registered with the Australian New Zealand Clinical Trials Registry., Discussion: This study implements a multidisciplinary intervention for ACLF patients with proven benefits in other chronic diseases with the addition of novel digital health tools to enable remote patient monitoring during the COVID-19 pandemic. Our feasibility study demonstrates safety and acceptability and suggests clinical improvement in a small sample size. An RCT is required to generate robust outcomes in this frail, high healthcare resource utilisation cohort with high readmission and mortality risk. Interventions such as LivR Well are urgently required but also need to be evaluated to ensure feasibility, replicability, and scalability across different healthcare systems. The implications of this trial include the generalisability of the programme for implementation across regional and urban centres., Trial Registration: Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12621001703897 . Registered on 13 December 2021. WHO Trial Registration Data Set. See Appendix 1., (© 2022. The Author(s).)
- Published
- 2022
- Full Text
- View/download PDF
9. An Unexpected Cause of Iron Deficiency Anaemia.
- Author
-
Worland T and Triay J
- Subjects
- Humans, Iron, Anemia, Iron-Deficiency complications, Iron Deficiencies
- Abstract
Competing Interests: Declaration of Competing Interest The authors report no conflicts of interest for this investigator-initiated study.
- Published
- 2022
- Full Text
- View/download PDF
10. Utility and limitations of Hepascore and transient elastography to detect advanced hepatic fibrosis in HFE hemochromatosis.
- Author
-
Ong SY, Khoo T, Nicoll AJ, Gurrin L, Worland T, Pateria P, Ramm LE, Testro A, Anderson GJ, Skoien R, Powell LW, Ramm GA, Olynyk JK, and Delatycki MB
- Subjects
- Adult, Aspartate Aminotransferases blood, Biomarkers blood, Biopsy, Cohort Studies, Disease Progression, Female, Hemochromatosis complications, Hemochromatosis genetics, Hemochromatosis pathology, Hemochromatosis Protein genetics, Humans, Liver diagnostic imaging, Liver pathology, Liver Cirrhosis etiology, Liver Cirrhosis pathology, Male, Middle Aged, Platelet Count, Predictive Value of Tests, Reproducibility of Results, Sensitivity and Specificity, Elasticity Imaging Techniques methods, Hemochromatosis diagnosis, Liver Cirrhosis diagnosis
- Abstract
Aspartate aminotransferase-to-platelet ratio index (APRI) and Fibrosis-4 Index (Fib4) have been validated against liver biopsy for detecting advanced hepatic fibrosis in HFE hemochromatosis. We determined the diagnostic utility for advanced hepatic fibrosis of Hepascore and transient elastography compared with APRI and Fib4 in 134 newly diagnosed HFE hemochromatosis subjects with serum ferritin levels > 300 µg/L using area under the receiver operator characteristic curve (AUROC) analysis and APRI- (> 0.44) or Fib4- (> 1.1) cut-offs for AHF, or a combination of both. Compared with APRI, Hepascore demonstrated an AUROC for advanced fibrosis of 0.69 (95% CI 0.56-0.83; sensitivity = 69%, specificity = 65%; P = 0.01) at a cut-off of 0.22. Using a combination of APRI and Fib4, the AUROC for Hepascore for advanced fibrosis was 0.70 (95% CI 0.54-0.86, P = 0.02). Hepascore was not diagnostic for detection of advanced fibrosis using the Fib4 cut-off. Elastography was not diagnostic using either APRI or Fib4 cut-offs. Hepascore and elastography detected significantly fewer true positive or true negative cases of advanced fibrosis compared with APRI and Fib4, except in subjects with serum ferritin levels > 1000 µg/L. In comparison with APRI or Fib4, Hepascore or elastography may underdiagnose advanced fibrosis in HFE Hemochromatosis, except in individuals with serum ferritin levels > 1000 µg/L., (© 2021. The Author(s).)
- Published
- 2021
- Full Text
- View/download PDF
11. An Unusual Case of Small Bowel Obstruction.
- Author
-
Worland T, Bloom A, and Robertson M
- Subjects
- Aorta, Abdominal surgery, Endoscopy, Gastrointestinal, Female, Femoral Artery surgery, Humans, Middle Aged, Polyethylene Terephthalates, Tomography, X-Ray Computed, Blood Vessel Prosthesis adverse effects, Duodenal Diseases diagnostic imaging, Duodenal Diseases etiology, Intestinal Obstruction diagnostic imaging, Intestinal Obstruction etiology
- Published
- 2021
- Full Text
- View/download PDF
12. Resolution of metastatic hepatocellular carcinoma with sour cherry intake.
- Author
-
Worland T, O'Neill P, and Rusli F
- Subjects
- Aged, Antioxidants, Humans, Male, Remission Induction, Carcinoma, Hepatocellular diet therapy, Liver Neoplasms diet therapy, Prunus avium
- Published
- 2021
- Full Text
- View/download PDF
13. A retrospective case-controlled cohort study of inpatient drug induced liver injury: the RIDDLE study.
- Author
-
Worland T, Chin KL, Rodrigues B, and Nicoll A
- Abstract
Background: Identification of risk factors for drug-induced liver injury (DILI) has been hindered by the unpredictable incidence and idiosyncratic nature of DILI. The aim of this study was to identify characteristic host risk factors for DILI., Methods: A retrospective cohort study was performed examining all patients admitted with a diagnosis of DILI over a 5.5-year period. Cases were compared to a control group non-exposed to DILI using propensity score-derived inverse probability weights. Patients with DILI due to alcohol or paracetamol were excluded from analysis., Results: Seventy-two cases of DILI admitted to hospital were identified. Antimicrobials caused 56.9% of cases, with amoxicillin-clavulanate the single most common agent, responsible for 13.9% of cases. DILI cohort median age (50.2±36 years) was significantly younger than controls (65.0±38 years) (P<0.001). Pre-existing chronic liver disease (OR, 3.44; 95% CI, 1.38-8.59; P=0.008), length of stay (P<0.001) and in-hospital death (P=0.009) were more likely to be associated with DILI cases. There was no correlation with sex (OR male, 0.92; 95% CI, 0.50-1.67; P=0.78), presence of comorbid autoimmune disease (OR, 1.44; 95% CI, 0.68-3.05; P=0.35), past drug allergies (OR, 1.71; 95% CI, 0.92-3.16; P=0.09), or atopy (OR, 0.87; 95% CI, 0.42-1.82; P=0.72)., Conclusions: Younger age and presence of chronic liver disease were associated with an admission with DILI; however, it remains difficult to predict the population at risk of DILI on clinical grounds and putative risk factors such as female gender, and history of other drug allergies and autoimmunity, were not demonstrated in this study., Competing Interests: Conflicts of Interest: The authors have no conflicts of interest to declare., (2020 Translational Gastroenterology and Hepatology. All rights reserved.)
- Published
- 2020
- Full Text
- View/download PDF
14. Hepatitis B virus activity is not associated with degree of liver steatosis in patients with hepatitis B-related chronic liver disease.
- Author
-
Worland T, Apostolov R, Asadi K, and Leung C
- Subjects
- Cohort Studies, Hepatitis B virus, Humans, Liver, Liver Cirrhosis, Hepatitis B, Hepatitis B, Chronic, Non-alcoholic Fatty Liver Disease
- Abstract
Background & Aims: The recently published manuscript by Zhu and colleagues "Hepatitis B virus infection and risk of non-alcoholic fatty liver disease: A population-based cohort study" found no correlation between presence of chronic HBV and presence of common risk factors for non-alcoholic fatty liver disease on primary analysis. A limitation to this study, like most population based research, is the absence of liver histology, which is considered gold standard for assessment of non-alcoholic fatty liver disease., Methods: Our group studied the association between hepatitis B viral activity and non-alcoholic fatty liver disease activity as measured by grade of steatohepatitis/fibrosis on liver biopsy by analysing consecutive liver histology samples from patients with chronic hepatitis B at a single quaternary liver transplant centre., Results: Linear regression modelling for active viral hepatitis on histological examination against degree of steatohepatitis showed no correlation (r
2 = .018, all P> .1). Linear regression of degree of steatohepatitis vs hepatitis B viral load also showed no correlation., Conclusions: Our work is concordant with the manuscript from Zhu et al; we found no significant correlation between hepatitis B viral activity and degree of steatohepatitis., (© 2020 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)- Published
- 2020
- Full Text
- View/download PDF
15. Prognostic significance of hepatic encephalopathy in patients with cirrhosis treated with current standards of care.
- Author
-
Bohra A, Worland T, Hui S, Terbah R, Farrell A, and Robertson M
- Subjects
- Aged, Clinical Decision-Making, Female, Follow-Up Studies, Hepatic Encephalopathy drug therapy, Hepatic Encephalopathy etiology, Humans, Kaplan-Meier Estimate, Lactulose therapeutic use, Liver Cirrhosis complications, Liver Cirrhosis diagnosis, Liver Cirrhosis mortality, Male, Middle Aged, Patient Selection, Prognosis, Retrospective Studies, Rifaximin therapeutic use, Severity of Illness Index, Standard of Care, Treatment Outcome, Hepatic Encephalopathy mortality, Liver Cirrhosis therapy, Liver Transplantation standards
- Abstract
Background: Hepatic encephalopathy (HE) is a reversible neuropsychiatric complication of liver cirrhosis and occurs in up to 50% of cirrhotic patients. Studies examining the prognostic significance of HE are limited despite the high prevalence in cirrhosis., Aim: To define the clinical outcomes of patients after an episode of HE treated with current standards-of-care., Methods: All patients hospitalised with HE requiring Rifaximin to 3 tertiary centres over 46-mo (2012-2016) were identified via pharmacy dispensing records. Patients with hepatocellular carcinoma and those prescribed Rifaximin prior to admission were excluded. Medical records were reviewed to determine baseline characteristics and survival. The Kaplan-Meier method was used to calculate survival probability. Univariate survival analysis was performed with variables reaching statistical significance included in a multivariate analysis. The primary outcome was 12-mo mortality following commencement of Rifaximin., Results: 188 patients were included. Median age was 57 years (IQR 50-65), 71% were male and median model for end stage liver disease and Child Pugh scores were 25 (IQR 18-31) and 11 (IQR 9-12) respectively. The most common causes of cirrhosis were alcohol (62%), hepatitis C (31%) and non-alcoholic fatty liver disease (20%). A precipitating cause for HE was found in 92% patients with infection (43%), GI bleeding (16%), medication non-compliance (15%) and electrolyte imbalance (14%) the most common. During a mean follow up period of 12 ± 13 mo 107 (57%) patients died and 32 (17%) received orthotopic liver transplantation. The most common causes of death were decompensated chronic liver disease (57%) and sepsis (19%). The probability of survival was 44% and 35% at 12- and 24-mo respectively. At multivariate analysis a model for end stage liver disease > 15 and international normalised ratio reached statistical significance in predicting mortality., Conclusion: Despite advances made in the management of HE patients continue to have poor survival. Thus, in all patients presenting with HE the appropriateness of orthotopic liver transplantation should be considered., Competing Interests: Conflict-of-interest statement: We have no financial relationships to disclose., (©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.)
- Published
- 2020
- Full Text
- View/download PDF
16. Retrospective study of idiosyncratic drug-induced liver injury from infliximab in an inflammatory bowel disease cohort: the IDLE study.
- Author
-
Worland T, Chin KL, van Langenberg D, Garg M, and Nicoll A
- Abstract
Background: Infliximab therapy may be associated with drug-induced liver injury (DILI), often resembling a drug-induced autoimmune hepatitis. However, the prevalence of DILI in patients receiving infliximab is unclear. Abnormal liver biochemistry is common in patients with inflammatory bowel disease (IBD) and definitive diagnosis may be difficult. The aim of this study was to describe the patterns of abnormal liver biochemistry in an IBD cohort., Methods: In a retrospective cohort study of adult patients with IBD treated with infliximab through a single institution we used the Roussel Uclaf Causality Assessment Method (RUCAM) to evaluate liver biochemistry and possible DILI. All cases of abnormal liver biochemistry were ascribed a presumptive diagnosis from the electronic medical record., Results: Fifty-seven of the 175 patients (149 Crohn's disease, 26 ulcerative colitis) had abnormal liver biochemistry. Of the 57 cases, one had highly probable, and 10 possible DILI due to infliximab. There were no significant differences regarding demographics, concomitant therapy/disease, indication for infliximab or outcomes between patients with normal and abnormal liver biochemistry, except for higher baseline alanine transaminase and alkaline phosphatase in the abnormal biochemistry group (P<0.001). Multivariate logistic regression showed male sex (odds ratio [OR] 2.49, 95% confidence interval [CI] 1.22-5.09; P=0.01) and background liver disease (OR 15.09, 95%CI 4.09-55.69; P<0.001) to be associated with the abnormal liver biochemistry group., Conclusions: Abnormal liver biochemistry is common in IBD patients on infliximab. Patients who are male, or have abnormal pre-therapy liver biochemistry or background liver disease, are more likely to develop worsening liver biochemistry during infliximab therapy. RUCAM scoring may help identify true cases of DILI., Competing Interests: Conflict of Interest: None, (Copyright: © Hellenic Society of Gastroenterology.)
- Published
- 2020
- Full Text
- View/download PDF
17. Clinical and financial impacts of introducing an endoscopic mucosal resection service for treatment of patients with large colonic polyps into a regional tertiary hospital.
- Author
-
Worland T, Cronin O, Harrison B, Alexander L, Ding N, Ting A, Dimopoulos S, Sykes R, and Alexander S
- Abstract
Background and study aims Endoscopic mucosal resection (EMR) of large sessile or laterally spreading colonic lesions is a safe alternative to surgery. We assessed reductions in Surgical Resection (SR) rates and associated clinical and financial benefits following the introduction of an EMR service to a large regional center. Patients and methods Ongoing prospective intention-to-treat analysis of EMR was undertaken from time of service inception in 2009 to 2017. Retrospective data for SR of large sessile/laterally spreading colonic lesions were collected for the period 4 years before commencement of the EMR service (2005 - 2008) and 9 years after its introduction (2009 - 2017). Results From 2005 to 2008, 32 surgical procedures were performed for non-malignant colonic neoplasia (50 % male, median age 68 years, median Length of Stay (LoS) 10 days). Following the introduction of the EMR service, there was a 56 % reduction in the number of patients referred for surgery (32 surgical procedures, 47 % male, median age 70 years, median LoS 8.5 days). During this period, EMR was successfully performed in 183 patients with 216 lesions resected (60 % male, median age 68 years, median LoS 1 day). Compared to the SR group, the EMR cohort had a lower peri-procedural complication rate (7.7 % vs 54.7 %, P < 0.0001), and shorter average LoS (1 vs 9 days, P < 0.0001). A cost saving of AUD $ 19 543.5 was seen per lesion removed with EMR compared to SR. Conclusions The introduction of a dedicated EMR service into a large regional center as an alternative to SR can lead to a substantial decrease in unnecessary surgery with subsequent clinical and financial benefits.
- Published
- 2019
- Full Text
- View/download PDF
18. Development of Acute Decompensated Heart Failure Among Hospital Inpatients: Incidence, Causes and Outcomes.
- Author
-
Plant LD, Taylor DM, Worland T, Puri A, Ugoni A, Patel SK, Johnson DF, and Burrell LM
- Subjects
- Acute Disease, Aged, Disease Progression, Female, Follow-Up Studies, Heart Failure etiology, Heart Failure physiopathology, Hospital Mortality trends, Humans, Incidence, Male, Prognosis, Retrospective Studies, Survival Rate trends, Time Factors, Victoria epidemiology, Heart Failure epidemiology, Inpatients, Myocardial Ischemia complications, Risk Assessment methods
- Abstract
Background: We aimed to investigate the incidence, precipitants, and outcomes of acute decompensated heart failure (ADHF) that develops during the inpatient stay., Methods: We undertook a case-control study in the medical, oncology, surgical, and orthopaedic wards of a tertiary referral hospital (February-May, 2016). Patients aged ≥18 years who developed ADHF during their inpatient stay were enrolled as cases. One control patient was matched to each case by age, gender, presenting complaint/surgery performed and co-morbidities. Multivariate regression was employed to determine variables associated with ADHF., Results: The incidence of ADHF was 1.0% of patients. Eighty cases were well-matched to 80 controls (p>0.05). ADHF precipitants comprised infection (30%), inappropriate intravenous (IV) fluid and medication management (23.8% and 8.8%, respectively), tachyarrhythmia (12.5%), ischaemic heart disease (8.8%), renal failure (1.3%), and other/unclear causes (15%). Three variables were associated with ADHF: not having English as the preferred language (OR 3.5, 95%CI 1.2-9.8), a history of ischaemic heart disease (OR 3.3, 95%CI 1.2-9.1), and the administration of >2000ml of IV fluid on the day before the ADHF (OR 8.3, 95%CI 1.5-48.0). The day before the ADHF, cases were administered significantly more IV fluids than controls (median 2,757.5 versus 975ml, p=0.001). Medication errors mostly related to failure to restart regular diuretics. Cases had significantly greater length of stay (median 15 versus 6 days, p<0.001) and mortality (12.5% versus 1.3%, p=0.01)., Conclusions: New onset ADHF is common and a substantial proportion of cases are iatrogenic. Cases experience significantly increased length of hospital stay, morbidity, and mortality., (Copyright © 2017 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.)
- Published
- 2019
- Full Text
- View/download PDF
19. Hepatocellular Carcinoma Screening Utilising Serum Alpha-Fetoprotein Measurement and Abdominal Ultrasound Is More Effective than Ultrasound Alone in Patients with Non-viral Cirrhosis.
- Author
-
Worland T, Harrison B, Delmenico L, and Dowling D
- Subjects
- Adult, Aged, Biopsy, Carcinoma, Hepatocellular blood, Carcinoma, Hepatocellular pathology, Disease Progression, Female, Humans, Liver diagnostic imaging, Liver pathology, Liver Cirrhosis diagnostic imaging, Liver Cirrhosis pathology, Liver Neoplasms blood, Liver Neoplasms pathology, Male, Middle Aged, Retrospective Studies, Sensitivity and Specificity, Ultrasonography, Young Adult, Carcinoma, Hepatocellular diagnosis, Early Detection of Cancer methods, Liver Cirrhosis blood, Liver Neoplasms diagnosis, alpha-Fetoproteins analysis
- Abstract
Purpose: This study is aimed to determine the performance of alpha-fetoprotein (AFP) as part of hepatocellular carcinoma (HCC) screening in a non-viral cirrhosis population., Methods: A retrospective audit was conducted of patients with non-viral cirrhosis over a 13 year period managed at a single centre. All patients were investigated routinely for evidence of viral hepatitis; patients with positive results were excluded from analysis. Cirrhosis was defined on basis of clinical, biochemical, and radiological investigations and examinations. All patients underwent HCC screening with 6-monthly AFP measurement and 6-12-monthly upper abdominal ultrasound (US). Diagnosis of HCC was confirmed by biopsy, definitive imaging, or natural disease progression., Results: Sixty-seven patients were included (49 males, average age 58.7 years). Of 14 patients who developed HCC during the study period, 12 patients had HCC detected via screening. Of the screening diagnosed HCC cases, four (33%) patients had a normal AFP with abnormal surveillance US, three (25%) had raised AFP with normal surveillance US, and five (42%) had concurrent AFP elevation and US abnormality. Patients with raised AFP and normal surveillance US had HCC diagnosed after a progressive rise in AFP precipitated imaging with alternative modalities. Within the 53 patients who remained free of HCC, a raised AFP precipitated additional imaging on 10 occasions. HCC was diagnosed in 12 out of 64 patients over a total of 4292 screening months giving an annual incidence of 3.35%., Conclusions: Twenty-five percent of HCC occurring in non-viral cirrhosis will be detected earlier using a surveillance program incorporating both AFP and US compared to imaging alone programs.
- Published
- 2018
- Full Text
- View/download PDF
20. Antibiotic Allergy Labels in a Liver Transplant Recipient Study.
- Author
-
Khumra S, Chan J, Urbancic K, Worland T, Angus P, Jones R, Grayson ML, and Trubiano JA
- Subjects
- Anti-Bacterial Agents therapeutic use, Australia epidemiology, Cephalosporins therapeutic use, Clostridioides difficile drug effects, Clostridioides difficile genetics, Clostridioides difficile isolation & purification, Clostridium Infections drug therapy, Clostridium Infections mortality, Drug Resistance, Multiple, Bacterial genetics, Female, Humans, Male, Nitroimidazoles therapeutic use, Penicillins therapeutic use, Retrospective Studies, Trimethoprim, Sulfamethoxazole Drug Combination therapeutic use, Anti-Bacterial Agents adverse effects, Drug Hypersensitivity epidemiology, Liver Transplantation
- Published
- 2017
- Full Text
- View/download PDF
21. Risk stratification in acute upper GI bleeding: comparison of the AIMS65 score with the Glasgow-Blatchford and Rockall scoring systems.
- Author
-
Robertson M, Majumdar A, Boyapati R, Chung W, Worland T, Terbah R, Wei J, Lontos S, Angus P, and Vaughan R
- Subjects
- Age Factors, Aged, Aged, 80 and over, Area Under Curve, Blood Pressure, Blood Transfusion statistics & numerical data, Blood Urea Nitrogen, Comorbidity, Endoscopy, Digestive System, Esophageal Diseases therapy, Female, Gastrointestinal Hemorrhage therapy, Hemoglobins metabolism, Hospitalization, Humans, Intensive Care Units, International Normalized Ratio, Length of Stay, Male, Middle Aged, Prognosis, ROC Curve, Recurrence, Serum Albumin metabolism, Severity of Illness Index, Stomach Diseases therapy, Esophageal Diseases mortality, Gastrointestinal Hemorrhage mortality, Hospital Mortality, Risk Assessment, Stomach Diseases mortality
- Abstract
Background and Aims: The American College of Gastroenterology recommends early risk stratification in patients presenting with upper GI bleeding (UGIB). The AIMS65 score is a risk stratification score previously validated to predict inpatient mortality. The aim of this study was to validate the AIMS65 score as a predictor of inpatient mortality in patients with acute UGIB and to compare it with established pre- and postendoscopy risk scores., Methods: ICD-10 (International Classification of Diseases, Tenth Revision) codes identified patients presenting with UGIB requiring endoscopy. All patients were risk stratified by using the AIMS65, Glasgow-Blatchford score (GBS), pre-endoscopy Rockall, and full Rockall scores. The primary outcome was inpatient mortality. Secondary outcomes were a composite endpoint of inpatient mortality, rebleeding, and endoscopic, radiologic, or surgical intervention; blood transfusion requirement; intensive care unit (ICU) admission; rebleeding; and hospital length of stay. The area under the receiver-operating characteristic curve (AUROC) was calculated for each score., Results: Of the 424 study patients, 18 (4.2%) died and 69 (16%) achieved the composite endpoint. The AIMS65 score was superior to both the GBS (AUROC, 0.80 vs 0.76, P < .027) and the pre-endoscopy Rockall score (0.74, P = .001) and equivalent to the full Rockall score (0.78, P = .18) in predicting inpatient mortality. The AIMS65 score was superior to all other scores in predicting the need for ICU admission and length of hospital stay. AIMS65, GBS, and full Rockall scores were equivalent (AUROCs, 0.63 vs 0.62 vs 0.63, respectively) and superior to pre-endoscopy Rockall (AUROC, 0.55) in predicting the composite endpoint. GBS was superior to all other scores for predicting blood transfusion., Conclusion: The AIMS65 score is a simple risk stratification score for UGIB with accuracy superior to that of GBS and pre-endoscopy Rockall scores in predicting in-hospital mortality and the need for ICU admission., (Crown Copyright © 2016. Published by Elsevier Inc. All rights reserved.)
- Published
- 2016
- Full Text
- View/download PDF
Catalog
Discovery Service for Jio Institute Digital Library
For full access to our library's resources, please sign in.