49 results on '"Barker AL"'
Search Results
2. Quality and safety indicators for home care recipients in Australia: development and cross-sectional analyses
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Caughey, GE, Lang, CE, Bray, SCE, Sluggett, JK, Whitehead, C, Visvanathan, R, Evans, K, Corlis, M, Cornell, V, Barker, AL, Wesselingh, S, Inacio, MC, Caughey, GE, Lang, CE, Bray, SCE, Sluggett, JK, Whitehead, C, Visvanathan, R, Evans, K, Corlis, M, Cornell, V, Barker, AL, Wesselingh, S, and Inacio, MC
- Abstract
Objectives To develop and examine the prevalence of quality and safety indicators to monitor care of older Australians receiving home care packages (HCPs), a government-funded aged care programme to support individuals to live at home independently. Design Cross-sectional. Setting Home care recipients, Australia. Participants 90 650 older individuals (aged ≥65 years old and ≥50 years old for people of Aboriginal or Torres Strait Islander descent) who received a HCP between 1 January 2016 and 31 December 2016 nationally were included. Primary and secondary outcome measures The Registry of Senior Australians developed 15 quality and safety indicators: antipsychotic use, high sedative load, chronic opioid use, antimicrobial use, premature mortality, home medicines reviews, chronic disease management plan, wait-time for HCP, falls, fractures, medication-related adverse events, weight loss/malnutrition, delirium/dementia-related hospitalisations, emergency department (ED) presentations and pressure injuries. Risk adjusted prevalence (%, 95% CI) and geographical area (statistical level 3) variation during 2016 were examined. Results In 2016, a total of 102 590 HCP episodes were included for 90 650 individuals, with 66.9% (n=68 598) level 1–2 HCP episodes (ie, for basic care needs) and 33.1% (n=33 992) level 3–4 HCP (ie, higher care needs). The most prevalent indicators included: antibiotic use (52.4%, 95% CI 52.0 to 52.7), chronic disease management plans (38.1%, 95% CI 37.8 to 38.4), high sedative load (29.1%, 95% CI 28.8 to 29.4) and ED presentations (26.4%, 95% CI 25.9 to 26.9). HCP median wait time was 134 days (IQR 41–406). Geographical variation was highest in chronic disease management plans and ED presentations (20.7% of areas outside expected range). Conclusion A comprehensive outcome monitoring system to monitor the quality and safety of care and variation for HCP recipients was developed. It provides a pragmatic, efficient and low burden tool to support evidenc
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- 2022
3. Aspirin and fracture risk: a systematic review and exploratory meta-analysis of observational studies
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Barker, AL, Soh, S-E, Sanders, KM, Pasco, J, Khosla, S, Ebeling, PR, Ward, SA, Peeters, G, Talevski, J, Cumming, RG, Seeman, E, McNeil, JJ, Barker, AL, Soh, S-E, Sanders, KM, Pasco, J, Khosla, S, Ebeling, PR, Ward, SA, Peeters, G, Talevski, J, Cumming, RG, Seeman, E, and McNeil, JJ
- Abstract
OBJECTIVES: This review provides insights into the potential for aspirin to preserve bone mineral density (BMD) and reduce fracture risk, building knowledge of the risk-benefit profile of aspirin. METHODS: We conducted a systematic review and exploratory meta-analysis of observational studies. Electronic searches of MEDLINE and Embase, and a manual search of bibliographies was undertaken for studies published to 28 March 2018. Studies were included if: participants were men or women aged ≥18 years; the exposure of interest was aspirin; and relative risks, ORs and 95% CIs for the risk of fracture or difference (percentage or absolute) in BMD (measured by dual energy X-ray absorptiometry) between aspirin users and non-users were presented. Risk of bias was assessed using the Joanna Briggs Institute Critical Appraisal Checklists for observational studies. Pooled ORs for any fracture and standardised mean differences (SMDs) for BMD outcomes were calculated using random-effects models. RESULTS: Twelve studies met the inclusion criteria and were included in the meta-analysis. Aspirin use was associated with a 17% lower odds for any fracture (OR 0.83, 95% CI 0.70 to 0.99; I2=71%; six studies; n=511 390). Aspirin was associated with a higher total hip BMD for women (SMD 0.03, 95% CI -0.02 to 0.07; I2=0%; three studies; n=9686) and men (SMD 0.06, 95% CI -0.02 to 0.13, I2=0%; two studies; n=4137) although these associations were not significant. Similar results were observed for lumbar spine BMD in women (SMD 0.03, 95% CI -0.03 to 0.09; I2=34%; four studies; n=11 330) and men (SMD 0.08; 95% CI -0.01 to 0.18; one study; n=432). CONCLUSIONS: While the benefits of reduced fracture risk and higher BMD from aspirin use may be modest for individuals, if confirmed in prospective controlled trials, they may confer a large population benefit given the common use of aspirin in older people.
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- 2020
4. Physical Therapists' Falls Prevention Knowledge, Beliefs, and Practices in Osteoarthritis Care: A National Cross-Sectional Study
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Ackerman, IN, Soh, S-E, Barker, AL, Ackerman, IN, Soh, S-E, and Barker, AL
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OBJECTIVE: To investigate physical therapists' knowledge, beliefs, and current practices around falls prevention in osteoarthritis (OA) care. METHODS: Currently registered, practicing Australian physical therapists who care for patients with hip and/or knee OA were invited to participate in this cross-sectional study. A comprehensive online survey was used to collect data that were analyzed descriptively or using chi-square tests; free-text responses were classified into key themes for analysis. RESULTS: Complete responses were received from 370 eligible physical therapists, with broad representation across Australian states and practice settings. Participants worked in public and private hospitals, community health centers, private practices, and aged-care facilities. The sample ranged from new graduates to experienced physical therapists (47% had practiced ≥11 years). Despite the majority having specific training or access to educational resources, physical therapists reported only moderate confidence in assessing falls risk (median 7 [interquartile range (IQR) 6-8]; range 0 [not at all confident] to 10 [extremely confident]) and delivering falls prevention care (median 7 [IQR 6-8]). While most participants asked about falls history (88%), only 39% used falls-risk screening tools, and of these, relatively few used appropriate tools. Time constraints (including competing clinical priorities) were the most frequently perceived barrier to including falls prevention activities within OA care. CONCLUSION: This national snapshot of contemporary OA practice has revealed clear opportunities for optimizing clinician confidence and skills to facilitate the uptake of best-practice falls prevention strategies. Improving practice in this area may yield substantial benefits to patients and the health system if more falls can be prevented.
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- 2020
5. A mixed methods process evaluation of a person-centred falls prevention program
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Morris, RL, Hill, KD, Ackerman, IN, Ayton, D, Arendts, G, Brand, C, Cameron, P, Etherton-Beer, CD, Flicker, L, Hill, A-M, Hunter, P, Lowthian, JA, Morello, R, Nyman, SR, Redfern, J, Smit, DV, Barker, AL, Morris, RL, Hill, KD, Ackerman, IN, Ayton, D, Arendts, G, Brand, C, Cameron, P, Etherton-Beer, CD, Flicker, L, Hill, A-M, Hunter, P, Lowthian, JA, Morello, R, Nyman, SR, Redfern, J, Smit, DV, and Barker, AL
- Abstract
BACKGROUND: RESPOND is a telephone-based falls prevention program for older people who present to a hospital emergency department (ED) with a fall. A randomised controlled trial (RCT) found RESPOND to be effective at reducing the rate of falls and fractures, compared with usual care, but not fall injuries or hospitalisations. This process evaluation aimed to determine whether RESPOND was implemented as planned, and identify implementation barriers and facilitators. METHODS: A mixed-methods evaluation was conducted alongside the RCT. Evaluation participants were the RESPOND intervention group (n = 263) and the clinicians delivering RESPOND (n = 7). Evaluation data were collected from participant recruitment and intervention records, hospital administrative records, audio-recordings of intervention sessions, and participant questionnaires. The Rochester Participatory Decision-Making Scale (RPAD) was used to evaluate person-centredness (score range 0 (worst) - 9 (best)). Process factors were compared with pre-specified criteria to determine implementation fidelity. Six focus groups were held with participants (n = 41), and interviews were conducted with RESPOND clinicians (n = 6). Quantitative data were analysed descriptively and qualitative data thematically. Barriers and facilitators to implementation were mapped to the 'Capability, Opportunity, Motivation - Behaviour' (COM-B) behaviour change framework. RESULTS: RESPOND was implemented at a lower dose than the planned 10 h over 6 months, with a median (IQR) of 2.9 h (2.1, 4). The majority (76%) of participants received their first intervention session within 1 month of hospital discharge with a median (IQR) of 18 (12, 30) days. Clinicians delivered the program in a person-centred manner with a median (IQR) RPAD score of 7 (6.5, 7.5) and 87% of questionnaire respondents were satisfied with the program. The reports from participants and clinicians suggested that implementation was facilitated by the use of positive an
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- 2019
6. Parkinson's disease prevalence and the association with rurality and agricultural determinants
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Ayton, D, Ayton, S, Barker, AL, Bush, AI, Warren, N, Ayton, D, Ayton, S, Barker, AL, Bush, AI, and Warren, N
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INTRODUCTION: Parkinson's disease prevalence has been associated with rurality and pesticide use in studies throughout the world. Here, Parkinson's disease (PD) medication usage was used to estimate prevalence in 79 urban and rural localities in Victoria, Australia (5.3 million people). METHODS: An ecological study design was used to determine whether PD medication usage, as a reporter of PD diagnosis, differed between 79 regions in Victoria, and whether variance in PD prevalence was associated with population demographics using multiple regression. Cluster formation probability was calculated using Monte Carlo modelling. The association between agricultural production and PD prevalence was conducted with Bonferroni-adjusted Mann-Whitney-U tests. RESULTS: PD prevalence in Victoria was estimated to be 0.85%, which was greater in rural (1.02%) compared to urban (0.80%) locations; a difference that was abolished when corrected for demographic variables. Four of the highest prevalent regions (regardless of covariate adjustment) were clustered in northwest Victoria; a formation that was unlikely to be due to chance (P = 0.00095). These regions had increased production of pulse crops. CONCLUSIONS: PD prevalence was not associated with rurality, but associated with areas of pulse production. Pulses are plants of the fabaceae family, where many of these species secrete the PD toxin, rotenone, as a natural pesticide, which may underlie increased risk. This study is limited by the data collection method, where people who do not take PD medication for their disease, or take PD-associated medication for other diseases, may impact the estimated prevalence.
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- 2019
7. Symptoms and feelings valued by patients after a percutaneous coronary intervention: a discrete-choice experiment to inform development of a new patient-reported outcome
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Barker, AL, Peeters, G, Morello, RT, Norman, R, Ayton, D, Lefkovits, J, Brennan, A, Evans, SM, Zalcberg, J, Reid, C, Ahern, S, Soh, S-E, Stoelwinder, J, McNeil, JJ, Barker, AL, Peeters, G, Morello, RT, Norman, R, Ayton, D, Lefkovits, J, Brennan, A, Evans, SM, Zalcberg, J, Reid, C, Ahern, S, Soh, S-E, Stoelwinder, J, and McNeil, JJ
- Abstract
OBJECTIVE: To inform the development of a patient-reported outcome measure, the aim of this study was to identify which symptoms and feelings following percutaneous coronary intervention (PCI) are most important to patients. DESIGN: Discrete-choice experiment consisting of two hypothetical scenarios of 10 symptoms and feelings (pain or discomfort; shortness of breath; concern/worry about heart problems; tiredness; confidence to do usual activities; ability to do usual activities; happiness; sleep disturbance; dizziness or light-headedness and bruising) experienced after PCI, described by three levels (never, some of the time, most of the time). Preference weights were estimated using a conditional logit model. SETTING: Four Australian public hospitals that contribute to the Victorian Cardiac Outcomes Registry (VCOR) and a private insurer's claim database. PARTICIPANTS: 138 people aged >18 years who had undergone a PCI in the previous 6 months. MAIN OUTCOME MEASURES: Patient preferences via trade-offs between 10 feelings and symptoms. RESULTS: Of the 138 individuals recruited, 129 (93%) completed all 16 choice sets. Conditional logit parameter estimates were mostly monotonic (eg, moving to worse levels for each individual symptom and feeling made the option less attractive). When comparing the magnitude of the coefficients (based on the coefficient of the worst level relative to best level in each item), feeling unhappy was the symptom or feeling that most influenced perception of a least-preferred PCI outcome (OR 0.42, 95% CI 0.34 to 0.51, p<0.0001) and the least influential was bruising (OR 0.81, 95% CI 0.67 to 0.99, p=0.04). CONCLUSION: This study provides new insights into how patients value symptoms and feelings they experience following a PCI.
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- 2018
8. Exploring patient-reported outcomes following percutaneous coronary intervention: A qualitative study.
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Ayton, DR, Barker, AL, Peeters, GMEE, Berkovic, DE, Lefkovits, J, Brennan, A, Evans, S, Zalcberg, J, Reid, C, Stoelwinder, JJ, McNeil, J, Ayton, DR, Barker, AL, Peeters, GMEE, Berkovic, DE, Lefkovits, J, Brennan, A, Evans, S, Zalcberg, J, Reid, C, Stoelwinder, JJ, and McNeil, J
- Abstract
BACKGROUND: Percutaneous coronary intervention (PCI) is a common cardiac procedure used to treat obstructive coronary artery disease. Patient-centred care is a priority in cardiovascular health having been shown to increase patient satisfaction, engagement with rehabilitation activities and reduce anxiety. Evidence indicates that patient-centred care is best achieved by routine collection of patient-reported outcomes (PROs). However, existing patient-reported outcome measures (PROMs) have limited the patient involvement in their development. AIMS: To identify and explore outcomes, patients perceive as important following PCI. METHODS: A qualitative design was adopted. Eight focus groups and five semi-structured interviews were conducted with 32 patients who had undergone PCI in the previous 6 months. Outcomes were identified and mapped under the U.S. Food and Drug Administration (FDA) patient-reported outcome (PROs) domains of feeling (physical and psychological outcomes), function and evaluation. Inductive and deductive analysis methods were used with open, axial and thematic coding. RESULTS: Consistent with prior studies, patients identified feeling and function outcomes such as reductions in physical and psychological symptoms and the ability to perform usual activities as important. Participants also identified a range of new outcomes, including confidence to return to usual activities and evaluation domains such as adverse effects of medications and the importance of patient communication. CONCLUSION: The findings of this research should be considered in the design of a cardiac PROM for PCI patients. A PROM which adequately assesses these outcomes can provide clinicians and hospital staff with a foundation in which to address these concerns or symptoms.
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- 2018
9. Implementation fidelity of a nurse-led falls prevention program in acute hospitals during the 6-PACK trial
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Morello, RT, Barker, AL, Ayton, DR, Landgren, F, Kamar, J, Hill, KD, Brand, CA, Sherrington, C, Wolfe, R, Rifat, S, Stoelwinder, J, Morello, RT, Barker, AL, Ayton, DR, Landgren, F, Kamar, J, Hill, KD, Brand, CA, Sherrington, C, Wolfe, R, Rifat, S, and Stoelwinder, J
- Abstract
BACKGROUND: When tested in a randomized controlled trial (RCT) of 31,411 patients, the nurse-led 6-PACK falls prevention program did not reduce falls. Poor implementation fidelity (i.e., program not implemented as intended) may explain this result. Despite repeated calls for the examination of implementation fidelity as an essential component of evaluating interventions designed to improve the delivery of care, it has been neglected in prior falls prevention studies. This study examined implementation fidelity of the 6-PACK program during a large multi-site RCT. METHODS: Based on the 6-PACK implementation framework and intervention description, implementation fidelity was examined by quantifying adherence to program components and organizational support. Adherence indicators were: 1) falls-risk tool completion; and for patients classified as high-risk, provision of 2) a 'Falls alert' sign; and 3) at least one additional 6-PACK intervention. Organizational support indicators were: 1) provision of resources (executive sponsorship, site clinical leaders and equipment); 2) implementation activities (modification of patient care plans; training; implementation tailoring; audits, reminders and feedback; and provision of data); and 3) program acceptability. Data were collected from daily bedside observation, medical records, resource utilization diaries and nurse surveys. RESULTS: All seven intervention components were delivered on the 12 intervention wards. Program adherence data were collected from 103,398 observations and medical record audits. The falls-risk tool was completed each day for 75% of patients. Of the 38% of patients classified as high-risk, 79% had a 'Falls alert' sign and 63% were provided with at least one additional 6-PACK intervention, as recommended. All hospitals provided the recommended resources and undertook the nine outlined program implementation activities. Most of the nurses surveyed considered program components important for falls prevention
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- 2017
10. Barriers and enablers to the implementation of the 6-PACK falls prevention program: A pre-implementation study in hospitals participating in a cluster randomised controlled trial
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Foster, AM, Ayton, DR, Barker, AL, Morello, RT, Brand, CA, Talevski, J, Landgren, FS, Melhem, MM, Bian, E, Brauer, SG, Hill, KD, Livingston, PM, Botti, M, Foster, AM, Ayton, DR, Barker, AL, Morello, RT, Brand, CA, Talevski, J, Landgren, FS, Melhem, MM, Bian, E, Brauer, SG, Hill, KD, Livingston, PM, and Botti, M
- Abstract
Evidence for effective falls prevention interventions in acute wards is limited. One reason for this may be suboptimal program implementation. This study aimed to identify perceived barriers and enablers of the implementation of the 6-PACK falls prevention program to inform the implementation in a randomised controlled trial. Strategies to optimise successful implementation of 6-PACK were also sought. A mixed-methods approach was applied in 24 acute wards from 6 Australian hospitals. Participants were nurses working on participating wards and senior hospital staff including Nurse Unit Managers; senior physicians; Directors of Nursing; and senior personnel involved in quality and safety or falls prevention. Information on barriers and enablers of 6-PACK implementation was obtained through surveys, focus groups and interviews. Questions reflected the COM-B framework that includes three behaviour change constructs of: capability, opportunity and motivation. Focus group and interview data were analysed thematically, and survey data descriptively. The survey response rate was 60% (420/702), and 12 focus groups (n = 96 nurses) and 24 interviews with senior staff were conducted. Capability barriers included beliefs that falls could not be prevented; and limited knowledge on falls prevention in patients with complex care needs (e.g. cognitive impairment). Capability enablers included education and training, particularly face to face case study based approaches. Lack of resources was identified as an opportunity barrier. Leadership, champions and using data to drive practice change were recognised as opportunity enablers. Motivation barriers included complacency and lack of ownership in falls prevention efforts. Motivation enablers included senior staff articulating clear goals and a commitment to falls prevention; and use of reminders, audits and feedback. The information gained from this study suggests that regular practical face-to-face education and training for nurses
- Published
- 2017
11. From unicuspid to quadricuspid: the impact of aortic valve morphology on 3D hemodynamics
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Entezari Pegah, Schnell Susanne, Mahadevia Riti J, Rinewalt Daniel, Davarpanah Amir H, Malaisrie SC, McCarthy Patrick, Collins Jeremy, Carr James, Markl Michael, and Barker Alex J
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Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Published
- 2013
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12. Cusp fusion pattern in bicuspid aortic valve disease predicts severity of aortic flow abnormalities
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Bissell Malenka M, Hess Aaron T, Glaze Steffan J, Pitcher Alex, Robson Matthew D, Barker Alex J, Myerson Saul, and Neubauer Stefan
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Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Published
- 2013
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13. Incorporating time-resolved three-dimensional phase contrast (4D flow) MRI in clinical workflow: initial experiences at a large tertiary care medical center
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Allen Bradley D, Barker Alex J, Parekh Keyur, Sommerville Lewis C, Schnell Susanne, Jarvis Kelly B, Carr Maria, Carr James, Collins Jeremy, and Markl Michael
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Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Published
- 2013
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14. Aortic coarctation augments changes in thoracic aortic hemodynamics in pediatric and young adult patients with bicuspid aortic valve
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Allen Bradley D, Barker Alex J, Gabbour Maya, Markl Michael, Rigsby Cynthia, and Robinson Joshua D
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Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Published
- 2013
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15. In vivo quantification of blood mixing in single ventricle patients with Fontan circulation using 4D flow MRI
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Jarvis Kelly B, Schnell Susanne, Gabbour Maya, Barker Alex J, Lorenz Ramona, Carr James, Robinson Joshua D, Popescu Andrada R, de Freitas Roger A, Rigsby Cynthia, and Markl Michael
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Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Published
- 2013
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16. Type of aortic valve replacement influences ascending aortic flow characteristics - a pilot study using 4D flow MRI
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von Knobelsdorff-Brenkenhoff Florian, Trauzeddel Ralf F, Barker Alex J, Gruettner Henriette, Markl Michael, and Schulz-Menger Jeanette
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Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Published
- 2013
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17. 4D flow MRI demonstrates altered aortic hemodynamics in patients with right-left and right-noncoronary bicuspid aortic valve fusion patterns
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Mahadevia Riti J, Schnell Susanne, Entezari Pegah, Rinewalt Daniel, Kansal Preeti, Malaisrie SC, McCarthy Patrick, Collins Jeremy, Carr James, Barker Alex J, and Markl Michael
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Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Published
- 2013
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18. Towards a comprehensive description of relative aortic pressure: insights from 4D flow CMR
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Pitcher Alex, Lamata Pablo, Krittian Sebastian B, Nordslettern David A, Bissell Malenka M, Francis Jane M, Cassar Thomas E, Barker Alex J, Markl Michael, Neubauer Stefan, and Smith Nic
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Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Published
- 2013
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19. 4D flow jet shear layer detection method for the measurement of effective orifice area and assessment of aortic stenosis severity
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Garcia Julio, Barker Alex J, Schnell Susanne, Entezari Pegah, Mahadevia Riti J, Pibarot Philippe, Carr James, and Markl Michael
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Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Published
- 2013
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20. Evaluation of 3D blood flow patterns and wall shear stress in the normal and dilated thoracic aorta using flow-sensitive 4D CMR
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Bürk Jonas, Blanke Philipp, Stankovic Zoran, Barker Alex, Russe Maximilian, Geiger Julia, Frydrychowicz Alex, Langer Mathias, and Markl Michael
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4D flow ,Flow quantification ,Aneurysm of the ascending aorta ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Abstract Background The purpose of this study was to investigate 3D flow patterns and vessel wall parameters in patients with dilated ascending aorta, age-matched subjects, and healthy volunteers. Methods Thoracic time-resolved 3D phase contrast CMR with 3-directional velocity encoding was applied to 33 patients with dilated ascending aorta (diameter ≥40 mm, age=60±16 years), 15 age-matched normal controls (diameter ≤37 mm, age=68±7.5 years) and 15 young healthy volunteers (diameter ≤30 mm, age=23±2 years). 3D blood flow was visualized and flow patterns were graded regarding presence of supra-physiologic-helix and vortex flow using a semi-quantitative 3-point grading scale. Blood flow velocities, regional wall shear stress (WSS), and oscillatory shear index (OSI) were quantified. Results Incidence and strength of supra-physiologic-helix and vortex flow in the ascending aorta (AAo) was significantly higher in patients with dilated AAo (16/33 and 31/33, grade 0.9±1.0 and 1.5±0.6) than in controls (2/15 and 7/15, grade 0.2 ± 0.6 and 0.6 ± 0.7, PPPPPPPP Conclusions Increase in AAo diameter is significantly correlated with the presence and strength of supra-physiologic-helix and vortex formation in the AAo, as well with decrease in systolic WSS and increase in OSI.
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- 2012
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21. Association of IREB2 and CHRNA3 polymorphisms with airflow obstruction in severe alpha-1 antitrypsin deficiency
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Kim Woo Jin, Wood Alice M, Barker Alan F, Brantly Mark L, Campbell Edward J, Eden Edward, McElvaney Gerard, Rennard Stephen I, Sandhaus Robert A, Stocks James M, Stoller James K, Strange Charlie, Turino Gerard, Silverman Edwin K, Stockley Robert A, and DeMeo Dawn L
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CHRNA3 ,Chronic obstructive pulmonary disease ,Genetic association analysis ,Genetic modifiers ,IREB2 ,Diseases of the respiratory system ,RC705-779 - Abstract
Abstract Background The development of COPD in subjects with alpha-1 antitrypsin (AAT) deficiency is likely to be influenced by modifier genes. Genome-wide association studies and integrative genomics approaches in COPD have demonstrated significant associations with SNPs in the chromosome 15q region that includes CHRNA3 (cholinergic nicotine receptor alpha3) and IREB2 (iron regulatory binding protein 2). We investigated whether SNPs in the chromosome 15q region would be modifiers for lung function and COPD in AAT deficiency. Methods The current analysis included 378 PIZZ subjects in the AAT Genetic Modifiers Study and a replication cohort of 458 subjects from the UK AAT Deficiency National Registry. Nine SNPs in LOC123688, CHRNA3 and IREB2 were selected for genotyping. FEV1 percent of predicted and FEV1/FVC ratio were analyzed as quantitative phenotypes. Family-based association analysis was performed in the AAT Genetic Modifiers Study. In the replication set, general linear models were used for quantitative phenotypes and logistic regression models were used for the presence/absence of emphysema or COPD. Results Three SNPs (rs2568494 in IREB2, rs8034191 in LOC123688, and rs1051730 in CHRNA3) were associated with pre-bronchodilator FEV1 percent of predicted in the AAT Genetic Modifiers Study. Two SNPs (rs2568494 and rs1051730) were associated with the post-bronchodilator FEV1 percent of predicted and pre-bronchodilator FEV1/FVC ratio; SNP-by-gender interactions were observed. In the UK National Registry dataset, rs2568494 was significantly associated with emphysema in the male subgroup; significant SNP-by-smoking interactions were observed. Conclusions IREB2 and CHRNA3 are potential genetic modifiers of COPD phenotypes in individuals with severe AAT deficiency and may be sex-specific in their impact.
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- 2012
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22. Monoallelic deletion of the microRNA biogenesis gene Dgcr8 produces deficits in the development of excitatory synaptic transmission in the prefrontal cortex
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Barker Alison J, Hsu Ruby, Schofield Claude M, Gertz Caitlyn C, Blelloch Robert, and Ullian Erik M
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Neurology. Diseases of the nervous system ,RC346-429 - Abstract
Abstract Background Neuronal phenotypes associated with hemizygosity of individual genes within the 22q11.2 deletion syndrome locus hold potential towards understanding the pathogenesis of schizophrenia and autism. Included among these genes is Dgcr8, which encodes an RNA-binding protein required for microRNA biogenesis. Dgcr8 haploinsufficient mice (Dgcr8+/-) have reduced expression of microRNAs in brain and display cognitive deficits, but how microRNA deficiency affects the development and function of neurons in the cerebral cortex is not fully understood. Results In this study, we show that Dgcr8+/- mice display reduced expression of a subset of microRNAs in the prefrontal cortex, a deficit that emerges over postnatal development. Layer V pyramidal neurons in the medial prefrontal cortex of Dgcr8+/- mice have altered electrical properties, decreased complexity of basal dendrites, and reduced excitatory synaptic transmission. Conclusions These findings demonstrate that precise microRNA expression is critical for the postnatal development of prefrontal cortical circuitry. Similar defects in neuronal maturation resulting from microRNA deficiency could represent endophenotypes of certain neuropsychiatric diseases of developmental onset.
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- 2011
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23. Telecommuter Loses Case For Benefits.
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Barker, Al
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UNEMPLOYMENT , *TELECOMMUTING , *ACTIONS & defenses (Law) , *TELECOMMUNICATION , *UNEMPLOYMENT insurance - Abstract
Reports that a woman who used her laptop computer and a phone line to work in Florida for a company in Long Island, New York is ineligible for New York's unemployment benefits. Decision by the New York Court of Appeals on the new legal front for telecommuting; Ruling that people should seek unemployment benefits from the state where they work, not from the state where their employer is located.
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- 2003
24. Correction: A mixed methods process evaluation of a person-centred falls prevention program.
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Morris RL, Hill KD, Ackerman IN, Ayton D, Arendts G, Brand C, Cameron P, Etherton-Beer CD, Flicker L, Hill AM, Hunter P, Lowthian JA, Morello R, Nyman SR, Redfern J, Smit V, and Barker AL
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- 2023
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25. Longitudinal association between handgrip strength, gait speed and risk of serious falls in a community-dwelling older population.
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Pham T, McNeil JJ, Barker AL, Orchard SG, Newman AB, Robb C, Ernst ME, Espinoza S, Woods RL, Nelson MR, Beilin L, and Hussain SM
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- Male, Female, Humans, Aged, Accidental Falls, Independent Living, Prospective Studies, Obesity, Gait physiology, Hand Strength physiology, Walking Speed
- Abstract
Objective: Both grip strength and gait speed can be used as markers of muscle function, however, no previous study has examined them in the same population with respect to risk of falls., Methods: In this prospective cohort study, utilising data from the ASPirin in Reducing Events in the Elderly (ASPREE) trial and ASPREE-Fracture substudy, we analysed the association of grip strength and gait speed and serious falls in healthy older adults. Grip strength was measured using a handheld dynamometer and gait speed from 3-metre timed walks. Serious falls were confined to those involving hospital presentation. Cox regression was used to calculate hazard ratios (HR) and 95% confidence intervals (CI) for associations with falls., Results: Over an average of 4.0±1.3 years, amongst 16,445 participants, 1,533 had at least one serious fall. After adjustment for age, sex, physical activity, body mass index, Short Form 12 (state of health), chronic kidney disease, polypharmacy and aspirin, each standard deviation (SD) lower grip strength was associated with 27% (HR 1.27, 95% CI 1.17-1.38) higher risk of falls. The results remained the same for males and females. There was a dose-response relationship in the association between grip strength and falls risk. The higher risk of falls was observed in males in all body mass index (BMI) categories, but only in obese females. The association between gait speed and falls risk was weaker than the association between grip strength and falls risk., Conclusions: All males and only obese females with low grip strength appear to be at the greatest risk of serious falls. These findings may assist in early identification of falls., Competing Interests: Dr Hussain is the recipient of National Health and Medical Research Council (NHMRC) Early Career Fellowship (APP1142198), Professor McNeil is supported through an NHMRC Leadership Fellowship (IG 1173690). No other disclosures are reported by the other authors., (Copyright: © 2023 Pham et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)
- Published
- 2023
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26. Variation in Mean Arterial Pressure Increases Falls Risk in Elderly Physically Frail and Prefrail Individuals Treated With Antihypertensive Medication.
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Hussain SM, Ernst ME, Barker AL, Margolis KL, Reid CM, Neumann JT, Tonkin AM, Phuong TLT, Beilin LJ, Pham T, Chowdhury EK, Cicuttini FM, Gilmartin-Thomas JFM, Carr PR, and McNeil JJ
- Subjects
- Aged, Arterial Pressure, Calcium Channel Blockers therapeutic use, Frail Elderly, Geriatric Assessment, Humans, Accidental Falls prevention & control, Antihypertensive Agents therapeutic use
- Abstract
Background: Impaired cerebral blood flow has been associated with an increased risk of falls. Mean arterial pressure (MAP) and variability in MAP have been reported to affect cerebral blood flow but their relationships to the risk of falls have not previously been reported., Methods: Utilising data from the Aspirin in Reducing Events in the Elderly trial participants, we estimated MAP and variability in MAP, defined as within-individual SD of MAP from baseline and first 2 annual visits. The relationship with MAP was studied in 16 703 participants amongst whom 1539 falls were recorded over 7.3 years. Variability in MAP was studied in 14 818 of these participants who experienced 974 falls over 4.1 years. Falls were confined to those involving hospital presentation. Cox regression was used to calculate hazard ratio and 95% CI for associations with falls., Results: Long-term variability in MAP was not associated with falls except amongst frail or prefrail participants using antihypertensive medications. Within this group each 5 mm Hg increase in long-term variability in MAP increased the risk of falls by 16% (hazard ratio, 1.16 [95% CI, 1.02-1.33]). Amongst the antihypertensive drugs studied, beta-blocker monotherapy (hazard ratio, 1.93 [95% CI, 1.17-3.18]) was associated with an increased risk of falls compared with calcium channel blockers., Conclusions: Higher levels of long-term variability in MAP increase the risk of serious falls in older frail and prefrail individuals taking antihypertensive medications. The observation that the relationship was limited to frail and prefrail individuals might explain some of the variability of previous studies linking blood pressure indices and falls.
- Published
- 2022
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27. CT Pulmonary Vessels and MRI Ventilation in Chronic Obstructive Pulmonary Disease: Relationship with worsening FEV 1 in the TINCan cohort study.
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Barker AL, Eddy RL, MacNeil JL, McCormack DG, Kirby M, and Parraga G
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- Cohort Studies, Forced Expiratory Volume, Humans, Lung diagnostic imaging, Magnetic Resonance Imaging, Tomography, X-Ray Computed, Helium, Pulmonary Disease, Chronic Obstructive diagnostic imaging
- Abstract
Rationale and Objectives: The relationships between computed tomography (CT) pulmonary vascularity and MRI ventilation is not well-understood in chronic obstructive pulmonary disease (COPD) patients. Our objective was to evaluate CT pulmonary vascular and MRI ventilation measurements in ex-smokers and to investigate their associations and how such measurements change over time., Materials and Methods: Ninety ex-smokers (n = 41 without COPD 71 ± 10 years and n = 49 COPD 71 ± 8 years) provided written informed-consent to an ethics-board approved protocol and underwent imaging and pulmonary-function-tests twice, 31 ± 7 months apart.
3 He MRI was acquired to generate ventilation-defect-percent (VDP). CT measurements of the relative area-of-the-lung with attenuation <-950 Hounsfield units (RA950 ), pulmonary vascular total-blood-volume (TBV) and percent of vessels with radius < one voxel (PV1 ) were evaluated., Results: At baseline, there were significant differences in RA950 (p = 0.0001), VDP (p = 0.0001), total-blood-volume (p = 0.0001) and PV1 (p = 0.01) between ex-smokers and COPD participants as well as for VDP (p = 0.0001) in COPD participants with and without emphysema. The annual FEV1 change (-40 ± 93 mL/year) was not different among participant subgroups (p = 0.87), but the annual RA950 (p = 0.01) and PV1 (p = 0.007) changes were significantly different in participants with an accelerated annual FEV1 decline as compared to participants with a diminished annual FEV1 decline. There were significant but weak relationships for PV1 with FEV1%pred (p = 0.02), FEV1 /FVC (p = 0.001), and log RA950 (p = 0.0001), but not VDP (p=0.20). The mean change in PV1 was also weakly but significantly related to the change in RA950 (p = 0.02)., Conclusion: CT pulmonary vascular measurements were significantly different in ex-smokers and participants with COPD and related to RA950 but not VDP worsening over 2.5 years., (Copyright © 2020 The Association of University Radiologists. Published by Elsevier Inc. All rights reserved.)- Published
- 2021
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28. Conformation of the Intermediates in the Reaction Catalyzed by Protoporphyrinogen Oxidase: An In Silico Analysis.
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Barker AL, Barnes H, and Dayan FE
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- Catalysis, Computer Simulation, Protoporphyrinogen Oxidase chemistry, Protoporphyrins chemistry, Tetrapyrroles chemistry, Protoporphyrinogen Oxidase metabolism
- Abstract
Protoporphyrinogen oxidase (PPO) is a critical enzyme across life as the last common step in the synthesis of many metalloporphyrins. The reaction mechanism of PPO was assessed in silico and the unstructured loop near the binding pocket was investigated. The substrate, intermediates, and product were docked in the catalytic domain of PPO using a modified Autodock method, introducing flexibility in the macrocycles. Sixteen PPO protein sequences across phyla were aligned and analyzed with Phyre2 and ProteinPredict to study the unstructured loop from residue 204-210 in the H. sapiens structure. Docking of the substrate, intermediates, and product all resulted in negative binding energies, though the substrate had a lower energy than the others by 40%. The α-H of C10 was found to be 1.4 angstroms closer to FAD than the β-H, explaining previous reports of the reaction occurring on the meso face of the substrate. A lack of homology in sequence or length in the unstructured loop indicates a lack of function for the protein reaction. This docking study supports a reaction mechanism proposed previously whereby all hydride abstractions occur on the C10 of the tetrapyrrole followed by tautomeric rearrangement to prepare the intermediate for the next reaction.
- Published
- 2020
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29. Physical Therapists' Falls Prevention Knowledge, Beliefs, and Practices in Osteoarthritis Care: A National Cross-Sectional Study.
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Ackerman IN, Soh SE, and Barker AL
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- Adult, Attitude of Health Personnel, Australia, Cross-Sectional Studies, Female, Humans, Male, Osteoarthritis psychology, Physical Therapists statistics & numerical data, Surveys and Questionnaires, Accidental Falls prevention & control, Health Knowledge, Attitudes, Practice, Osteoarthritis therapy, Physical Therapists psychology, Physical Therapy Specialty statistics & numerical data
- Abstract
Objective: To investigate physical therapists' knowledge, beliefs, and current practices around falls prevention in osteoarthritis (OA) care., Methods: Currently registered, practicing Australian physical therapists who care for patients with hip and/or knee OA were invited to participate in this cross-sectional study. A comprehensive online survey was used to collect data that were analyzed descriptively or using chi-square tests; free-text responses were classified into key themes for analysis., Results: Complete responses were received from 370 eligible physical therapists, with broad representation across Australian states and practice settings. Participants worked in public and private hospitals, community health centers, private practices, and aged-care facilities. The sample ranged from new graduates to experienced physical therapists (47% had practiced ≥11 years). Despite the majority having specific training or access to educational resources, physical therapists reported only moderate confidence in assessing falls risk (median 7 [interquartile range (IQR) 6-8]; range 0 [not at all confident] to 10 [extremely confident]) and delivering falls prevention care (median 7 [IQR 6-8]). While most participants asked about falls history (88%), only 39% used falls-risk screening tools, and of these, relatively few used appropriate tools. Time constraints (including competing clinical priorities) were the most frequently perceived barrier to including falls prevention activities within OA care., Conclusion: This national snapshot of contemporary OA practice has revealed clear opportunities for optimizing clinician confidence and skills to facilitate the uptake of best-practice falls prevention strategies. Improving practice in this area may yield substantial benefits to patients and the health system if more falls can be prevented., (© 2019, American College of Rheumatology.)
- Published
- 2020
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30. Pulmonary Imaging Phenotypes of Chronic Obstructive Pulmonary Disease Using Multiparametric Response Maps.
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MacNeil JL, Capaldi DPI, Westcott AR, Eddy RL, Barker AL, McCormack DG, Kirby M, and Parraga G
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- Aged, Female, Forced Expiratory Volume, Helium, Humans, Isotopes, Male, Middle Aged, Phenotype, Prospective Studies, Pulmonary Disease, Chronic Obstructive genetics, Pulmonary Disease, Chronic Obstructive physiopathology, Lung diagnostic imaging, Magnetic Resonance Imaging methods, Pulmonary Disease, Chronic Obstructive diagnostic imaging, Tomography, X-Ray Computed methods
- Abstract
Background Pulmonary imaging of chronic obstructive pulmonary disease (COPD) has focused on CT or MRI measurements, but these have not been evaluated in combination. Purpose To generate multiparametric response map (mPRM) measurements in ex-smokers with or without COPD by using volume-matched CT and hyperpolarized helium 3 (
3 He) MRI. Materials and Methods In this prospective study ( https://clinicaltrials.gov , NCT02279329), participants underwent MRI and CT and completed pulmonary function tests, questionnaires, and the 6-minute walk test between December 2010 and January 2019. Disease status was determined by using Global initiative for chronic Obstructive Lung Disease (GOLD) criteria. The mPRM voxel values were generated by using co-registered MRI and CT labels. Kruskal-Wallis and Bonferroni tests were used to determine differences across disease severity, and correlations were determined by using Spearman coefficients. Results A total of 175 ex-smokers (mean age, 69 years ± 9 [standard deviation], 108 men) with or without COPD were evaluated. Ex-smokers without COPD had a larger fraction of normal mPRM voxels (60% vs 37%, 20%, and 7% for GOLD I, II, and III/IV disease, respectively; all P ≤ .001) and a smaller fraction of abnormal voxels, including small airways disease (normal CT, not ventilated: 5% vs 6% [not significant], 11%, and 19% [ P ≤ .001 for both] for GOLD I, II, and III/IV disease, respectively) and mild emphysema (normal CT, abnormal apparent diffusion coefficient [ADC]: 33% vs 54%, 56%, and 54% for GOLD I, II, and III/IV disease respectively; all P ≤ .001). Normal mPRM measurements were positively correlated with forced expiratory volume in 1 second (FEV1 ) ( r = 0.65, P < .001), the FEV1 -to-forced vital capacity ratio ( r = 0.81, P < .001), and diffusing capacity ( r = 0.75, P < .001) and were negatively correlated with worse quality of life ( r = -0.48, P < .001). Abnormal mPRM measurements of small airways disease (normal CT, not ventilated) and mild emphysema (normal CT, abnormal ADC) were negatively correlated with FEV1 ( r = -0.65 and -0.42, respectively; P < .001) and diffusing capacity ( r = -0.53 and -0.60, respectively; P < .001) and were positively correlated with worse quality of life ( r = 0.45 and r = 0.33, respectively; P < .001), both of which were present in ex-smokers without COPD. Conclusion Multiparametric response maps revealed two abnormal structure-function results related to emphysema and small airways disease, both of which were unexpectedly present in ex-smokers with normal spirometry and CT findings. © RSNA, 2020 Online supplemental material is available for this article.- Published
- 2020
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31. Applying the International Classification of Functioning, Disability and Health framework to determine the predictors of falls and fractures in people with osteoarthritis or at high risk of developing osteoarthritis: data from the Osteoarthritis Initiative.
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Soh SE, Barker AL, Morello RT, and Ackerman IN
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- Age Factors, Aged, Clinical Decision-Making methods, Disability Evaluation, Female, Fractures, Bone etiology, Fractures, Bone prevention & control, Humans, Life Style, Longitudinal Studies, Male, Medical History Taking, Middle Aged, Osteoarthritis, Hip complications, Retrospective Studies, Risk Assessment methods, Risk Factors, Self Report statistics & numerical data, Sex Factors, Accidental Falls statistics & numerical data, Fractures, Bone epidemiology, International Classification of Functioning, Disability and Health, Osteoarthritis, Hip diagnosis
- Abstract
Background: Falls are a major cause of injury and death among older people. Evidence suggests that people with osteoarthritis (OA) are at a higher risk of falls and fall-related injuries including fractures. While studies demonstrate a link between OA and falls, little is known about the pathways that link falls with demographic factors, OA impairments, activity limitations and participation restrictions. The aim of this study was to identify risk factors for falls and fractures among people with OA or at high risk of developing OA using the International Classification of Functioning, Disability and Health (ICF) framework., Methods: A longitudinal analysis of data from the Osteoarthritis Initiative (OAI) dataset was undertaken. Participants were considered to have OA if they reported they had been diagnosed with knee or hip OA by a medical practitioner. Outcomes were self-reported falls and fractures. Potential predictors were classified using the ICF framework. Poisson regression models were used to determine the risk factors for falls and fractures., Results: Of the 4796 participants, 2270 (47%) were diagnosed with knee and/or hip OA. A higher proportion of participants with OA reported having had falls (72% vs 63%; p < 0.0001) and fractures (17% vs 14%; p = 0.012) than those without OA. Personal factors were found to be stronger predictors of falls and fractures compared to OA impairments, activity limitations and participation restrictions in this sample of participants. After adjusting for potential covariates, self-reported history of falls was a significant predictor of both increased falls (incidence rate ratio [IRR] 1.50; 95% confidence interval [CI] 1.40, 4.60) and fracture risk (IRR 1.38; 95% CI 1.13, 1.69)., Conclusions: By applying the ICF framework, we have shown that personal factors were more likely to predict falls and fractures rather than OA impairments, environmental factors, activity limitations and participation restrictions in people with OA or at high risk of developing OA. This highlights the importance of questioning patients about their previous falls and past medical history, and using this information to focus our assessment and clinical decision-making processes.
- Published
- 2020
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32. Aspirin and fracture risk: a systematic review and exploratory meta-analysis of observational studies.
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Barker AL, Soh SE, Sanders KM, Pasco J, Khosla S, Ebeling PR, Ward SA, Peeters G, Talevski J, Cumming RG, Seeman E, and McNeil JJ
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- Anti-Inflammatory Agents, Non-Steroidal pharmacology, Bone Density Conservation Agents pharmacology, Humans, Risk Assessment, Aspirin pharmacology, Bone Density drug effects, Fractures, Bone prevention & control
- Abstract
Objectives: This review provides insights into the potential for aspirin to preserve bone mineral density (BMD) and reduce fracture risk, building knowledge of the risk-benefit profile of aspirin., Methods: We conducted a systematic review and exploratory meta-analysis of observational studies. Electronic searches of MEDLINE and Embase, and a manual search of bibliographies was undertaken for studies published to 28 March 2018. Studies were included if: participants were men or women aged ≥18 years; the exposure of interest was aspirin; and relative risks, ORs and 95% CIs for the risk of fracture or difference (percentage or absolute) in BMD (measured by dual energy X-ray absorptiometry) between aspirin users and non-users were presented. Risk of bias was assessed using the Joanna Briggs Institute Critical Appraisal Checklists for observational studies. Pooled ORs for any fracture and standardised mean differences (SMDs) for BMD outcomes were calculated using random-effects models., Results: Twelve studies met the inclusion criteria and were included in the meta-analysis. Aspirin use was associated with a 17% lower odds for any fracture (OR 0.83, 95% CI 0.70 to 0.99; I
2 =71%; six studies; n=511 390). Aspirin was associated with a higher total hip BMD for women (SMD 0.03, 95% CI -0.02 to 0.07; I2 =0%; three studies; n=9686) and men (SMD 0.06, 95% CI -0.02 to 0.13, I2 =0%; two studies; n=4137) although these associations were not significant. Similar results were observed for lumbar spine BMD in women (SMD 0.03, 95% CI -0.03 to 0.09; I2 =34%; four studies; n=11 330) and men (SMD 0.08; 95% CI -0.01 to 0.18; one study; n=432)., Conclusions: While the benefits of reduced fracture risk and higher BMD from aspirin use may be modest for individuals, if confirmed in prospective controlled trials, they may confer a large population benefit given the common use of aspirin in older people., Competing Interests: Competing interests: ALB, KS, JP, SK, PE, SAW, RGC, ES and JJM are the members of the investigator group for the ASPREE-Fracture substudy., (© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)- Published
- 2020
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33. A mixed methods process evaluation of a person-centred falls prevention program.
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Morris RL, Hill KD, Ackerman IN, Ayton D, Arendts G, Brand C, Cameron P, Etherton-Beer CD, Flicker L, Hill AM, Hunter P, Lowthian JA, Morello R, Nyman SR, Redfern J, Smit V, and Barker AL
- Subjects
- Aged, Aged, 80 and over, Evaluation Studies as Topic, Female, Focus Groups, Humans, Male, Program Evaluation, Telephone, Accident Prevention, Accidental Falls prevention & control, Patient-Centered Care methods
- Abstract
Background: RESPOND is a telephone-based falls prevention program for older people who present to a hospital emergency department (ED) with a fall. A randomised controlled trial (RCT) found RESPOND to be effective at reducing the rate of falls and fractures, compared with usual care, but not fall injuries or hospitalisations. This process evaluation aimed to determine whether RESPOND was implemented as planned, and identify implementation barriers and facilitators., Methods: A mixed-methods evaluation was conducted alongside the RCT. Evaluation participants were the RESPOND intervention group (n = 263) and the clinicians delivering RESPOND (n = 7). Evaluation data were collected from participant recruitment and intervention records, hospital administrative records, audio-recordings of intervention sessions, and participant questionnaires. The Rochester Participatory Decision-Making Scale (RPAD) was used to evaluate person-centredness (score range 0 (worst) - 9 (best)). Process factors were compared with pre-specified criteria to determine implementation fidelity. Six focus groups were held with participants (n = 41), and interviews were conducted with RESPOND clinicians (n = 6). Quantitative data were analysed descriptively and qualitative data thematically. Barriers and facilitators to implementation were mapped to the 'Capability, Opportunity, Motivation - Behaviour' (COM-B) behaviour change framework., Results: RESPOND was implemented at a lower dose than the planned 10 h over 6 months, with a median (IQR) of 2.9 h (2.1, 4). The majority (76%) of participants received their first intervention session within 1 month of hospital discharge with a median (IQR) of 18 (12, 30) days. Clinicians delivered the program in a person-centred manner with a median (IQR) RPAD score of 7 (6.5, 7.5) and 87% of questionnaire respondents were satisfied with the program. The reports from participants and clinicians suggested that implementation was facilitated by the use of positive and personally relevant health messages. Complex health and social issues were the main barriers to implementation., Conclusions: RESPOND was person-centred and reduced falls and fractures at a substantially lower dose, using fewer resources, than anticipated. However, the low dose delivered may account for the lack of effect on falls injuries and hospitalisations. The results from this evaluation provide detailed information to guide future implementation of RESPOND or similar programs., Trial Registration: This study was registered with the Australian New Zealand Clinical Trials Registry, number ACTRN12614000336684 (27 March 2014).
- Published
- 2019
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34. What matters most to patients following percutaneous coronary interventions? A new patient-reported outcome measure developed using Rasch analysis.
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Soh SE, Barker AL, Ayton DR, Ahern S, Morello R, Lefkovits J, Brennan AL, Evans S, Zalcberg JR, Reid CM, and McNeil JJ
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- Aged, Female, Humans, Male, Middle Aged, Psychometrics, Reproducibility of Results, Surveys and Questionnaires, Patient Reported Outcome Measures, Patient Satisfaction, Percutaneous Coronary Intervention
- Abstract
Introduction: Measuring patient reported outcomes can improve the quality and effectiveness of healthcare interventions. The aim of this study was to identify the final set of items that can be included in a patient-reported outcome measure to assess recovery of patients following percutaneous coronary interventions., Methods: A consecutive sample of 200 patients registered in the Victorian Cardiac Outcomes Registry participated in a telephone survey 30 days following their percutaneous cardiac procedure. Rasch analysis was used to select the best set of items to form a concise and psychometrically sound patient-reported outcome measure. Key measurement properties assessed included overall fit to the Rasch measurement model, unidimensionality, response formats (thresholds), targeting, internal consistency and measurement invariance., Results: Five items were identified as being reliable and valid measures of patient-reported outcomes: pain or discomfort, shortness of breath, confidence in performing usual activities, feeling unhappy and having trouble sleeping. Data showed overall fit to a Rasch model of expected item functioning (χ2 16.99; p = 0.07) and all items demonstrated unidimensionality (t-test less than 0.05 threshold value). Internal consistency was acceptable (equivalent Cronbach's α 0.65) given there are only five items, but there was a ceiling effect (mean logit score -1.24) with compromised score precision for patients with better recovery., Conclusions: We identified a succinct set of items that can be used in a patient-reported outcome measure following percutaneous coronary interventions. This patient-report outcome measure has good structural validity and acceptable internal consistency. While further psychometric evaluations are recommended, the items identified capture the patient's perspective of their recovery following a percutaneous coronary intervention., Competing Interests: The authors have declared that no competing interests exist.
- Published
- 2019
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35. Symptoms and feelings valued by patients after a percutaneous coronary intervention: a discrete-choice experiment to inform development of a new patient-reported outcome.
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Barker AL, Peeters G, Morello RT, Norman R, Ayton D, Lefkovits J, Brennan A, Evans SM, Zalcberg J, Reid C, Ahern S, Soh SE, Stoelwinder J, and McNeil JJ
- Subjects
- Activities of Daily Living, Adult, Age Factors, Aged, Anxiety epidemiology, Anxiety etiology, Dyspnea epidemiology, Dyspnea etiology, Fatigue epidemiology, Fatigue etiology, Female, Humans, Male, Middle Aged, Pain, Postoperative epidemiology, Pain, Postoperative etiology, Reproducibility of Results, Sleep Wake Disorders epidemiology, Sleep Wake Disorders etiology, Surveys and Questionnaires, Young Adult, Patient Reported Outcome Measures, Percutaneous Coronary Intervention adverse effects, Percutaneous Coronary Intervention psychology, Percutaneous Coronary Intervention statistics & numerical data
- Abstract
Objective: To inform the development of a patient-reported outcome measure, the aim of this study was to identify which symptoms and feelings following percutaneous coronary intervention (PCI) are most important to patients., Design: Discrete-choice experiment consisting of two hypothetical scenarios of 10 symptoms and feelings (pain or discomfort; shortness of breath; concern/worry about heart problems; tiredness; confidence to do usual activities; ability to do usual activities; happiness; sleep disturbance; dizziness or light-headedness and bruising) experienced after PCI, described by three levels (never, some of the time, most of the time). Preference weights were estimated using a conditional logit model., Setting: Four Australian public hospitals that contribute to the Victorian Cardiac Outcomes Registry (VCOR) and a private insurer's claim database., Participants: 138 people aged >18 years who had undergone a PCI in the previous 6 months., Main Outcome Measures: Patient preferences via trade-offs between 10 feelings and symptoms., Results: Of the 138 individuals recruited, 129 (93%) completed all 16 choice sets. Conditional logit parameter estimates were mostly monotonic (eg, moving to worse levels for each individual symptom and feeling made the option less attractive). When comparing the magnitude of the coefficients (based on the coefficient of the worst level relative to best level in each item), feeling unhappy was the symptom or feeling that most influenced perception of a least-preferred PCI outcome (OR 0.42, 95% CI 0.34 to 0.51, p<0.0001) and the least influential was bruising (OR 0.81, 95% CI 0.67 to 0.99, p=0.04)., Conclusion: This study provides new insights into how patients value symptoms and feelings they experience following a PCI., Competing Interests: Competing interests: ALB is currently the Head of Member Health Innovation at Medibank Private Ltd., (© Author(s) (or their employer(s)) 2018. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
- Published
- 2018
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36. Potential Effect Modifiers of the Association Between Physical Activity Patterns and Joint Symptoms in Middle-Aged Women.
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Peeters G, Edwards KL, Brown WJ, Barker AL, Arden N, Redmond AC, Conaghan PG, Cicuttini F, and Mishra GD
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- Aged, Arthralgia diagnosis, Australia epidemiology, Effect Modifier, Epidemiologic, Female, Health Surveys methods, Humans, Longitudinal Studies, Menopause physiology, Middle Aged, Prospective Studies, Arthralgia epidemiology, Arthralgia prevention & control, Body Mass Index, Exercise physiology, Health Surveys trends, Women's Health trends
- Abstract
Objective: To examine whether body mass index (BMI), menopausal status, and hormone therapy (HT) use modify the association between physical activity (PA) patterns throughout middle age and the incidence and prevalence of joint symptoms in women in later middle age., Methods: Data were from 6,661 participants (born 1946-1951) in the Australian Longitudinal Study on Women's Health. Surveys, with questions on joint pain and stiffness, PA, height and weight, menopausal symptoms, and HT use, were completed every 3 years from 1998 to 2010. PA patterns were defined as none or low, low or meeting guidelines, fluctuating, or meeting guidelines at all times (reference pattern). Logistic regression was used to examine the association between PA patterns and prevalent (in 2010) and cumulative incident (1998-2010) joint symptoms and effect modification by patterns in BMI, menopausal status, and HT., Results: The groups representing fluctuating PA (odds ratio [OR] 1.34 [99% confidence interval (99% CI) 1.04-1.72]) and no or low PA (OR 1.60 [99% CI 1.08-2.35]) had higher odds of incident joint symptoms than those described as meeting guidelines at all times. Stratification by BMI showed that this association was statistically significant in the obese group only. No evidence for effect modification by menopausal status or HT use was found. The findings were similar for prevalent joint symptoms., Conclusion: Maintaining at least low levels of PA throughout middle age was associated with a lower prevalence and incidence of joint symptoms later in life. This apparent protective effect of PA on joint symptoms was stronger in obese women than in under- or normal-weight women, and not related to menopause or HT status., (© 2017, The Authors. Arthritis Care & Research published by Wiley Periodicals, Inc. on behalf of American College of Rheumatology.)
- Published
- 2018
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37. Opportunities for cross-disciplinary care partnerships in physiotherapy.
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Ackerman IN, Soh SE, and Barker AL
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- Humans, Accidental Falls prevention & control, Cooperative Behavior, Osteoarthritis rehabilitation, Patient Care Team, Physical Therapy Specialty, Professional Role
- Published
- 2018
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38. Exploring patient-reported outcomes following percutaneous coronary intervention: A qualitative study.
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Ayton DR, Barker AL, Peeters GMEE, Berkovic DE, Lefkovits J, Brennan A, Evans S, Zalcberg J, Reid C, Stoelwinder JJ, and McNeil J
- Subjects
- Aged, Aged, 80 and over, Female, Focus Groups, Humans, Male, Middle Aged, Patient-Centered Care, Qualitative Research, United States, United States Food and Drug Administration, Victoria, Attitude to Health, Patient Reported Outcome Measures, Patient Satisfaction, Patients psychology, Percutaneous Coronary Intervention psychology
- Abstract
Background: Percutaneous coronary intervention (PCI) is a common cardiac procedure used to treat obstructive coronary artery disease. Patient-centred care is a priority in cardiovascular health having been shown to increase patient satisfaction, engagement with rehabilitation activities and reduce anxiety. Evidence indicates that patient-centred care is best achieved by routine collection of patient-reported outcomes (PROs). However, existing patient-reported outcome measures (PROMs) have limited the patient involvement in their development., Aims: To identify and explore outcomes, patients perceive as important following PCI., Methods: A qualitative design was adopted. Eight focus groups and five semi-structured interviews were conducted with 32 patients who had undergone PCI in the previous 6 months. Outcomes were identified and mapped under the U.S. Food and Drug Administration (FDA) patient-reported outcome (PROs) domains of feeling (physical and psychological outcomes), function and evaluation. Inductive and deductive analysis methods were used with open, axial and thematic coding., Results: Consistent with prior studies, patients identified feeling and function outcomes such as reductions in physical and psychological symptoms and the ability to perform usual activities as important. Participants also identified a range of new outcomes, including confidence to return to usual activities and evaluation domains such as adverse effects of medications and the importance of patient communication., Conclusion: The findings of this research should be considered in the design of a cardiac PROM for PCI patients. A PROM which adequately assesses these outcomes can provide clinicians and hospital staff with a foundation in which to address these concerns or symptoms., (© 2017 The Authors Health Expectations Published by John Wiley & Sons Ltd.)
- Published
- 2018
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39. Measurement properties of the Health Literacy Questionnaire (HLQ) among older adults who present to the emergency department after a fall: a Rasch analysis.
- Author
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Morris RL, Soh SE, Hill KD, Buchbinder R, Lowthian JA, Redfern J, Etherton-Beer CD, Hill AM, Osborne RH, Arendts G, and Barker AL
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- Aged, Aged, 80 and over, Australia, Emergency Service, Hospital, Female, Humans, Male, Middle Aged, Preventive Health Services, Randomized Controlled Trials as Topic, Reproducibility of Results, Accidental Falls, Health Literacy statistics & numerical data, Surveys and Questionnaires
- Abstract
Background: Health literacy is an important concept associated with participation in preventive health initiatives, such as falls prevention programs. A comprehensive health literacy measurement tool, appropriate for this population, is required. The aim of this study was to evaluate the measurement properties of the Health Literacy Questionnaire (HLQ) in a cohort of older adults who presented to a hospital emergency department (ED) after a fall., Methods: Older adults who presented to an ED after a fall had their health literacy assessed using the HLQ (n = 433). Data were collected as part of a multi-centre randomised controlled trial of a falls prevention program. Measurement properties of the HLQ were assessed using Rasch analysis., Results: All nine scales of the HLQ were unidimensional, with good internal consistency reliability. No item bias was found for most items (43 of 44). A degree of overall misfit to the Rasch model was evident for six of the nine HLQ scales. The majority of misfit indicated content overlap between some items and does not compromise measurement. A measurement gap was identified for this cohort at mid to high HLQ score., Conclusions: The HLQ demonstrated good measurement properties in a cohort of older adults who presented to an ED after a fall. The summation of the HLQ items within each scale, providing unbiased information on nine separate areas of health literacy, is supported. Clinicians, researchers and policy makers may have confidence using the HLQ scale scores to gain information about health literacy in older people presenting to the ED after a fall., Trial Registration: This study was registered with the Australian New Zealand Clinical Trials Registry, number ACTRN12614000336684 (27 March 2014).
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- 2017
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40. Implementation fidelity of a nurse-led falls prevention program in acute hospitals during the 6-PACK trial.
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Morello RT, Barker AL, Ayton DR, Landgren F, Kamar J, Hill KD, Brand CA, Sherrington C, Wolfe R, Rifat S, and Stoelwinder J
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- Australia, Health Care Surveys, Humans, Medical Audit, Observation, Outcome Assessment, Health Care, Program Evaluation, Randomized Controlled Trials as Topic, Accidental Falls prevention & control, Hospitals, Nursing Staff, Program Development
- Abstract
Background: When tested in a randomized controlled trial (RCT) of 31,411 patients, the nurse-led 6-PACK falls prevention program did not reduce falls. Poor implementation fidelity (i.e., program not implemented as intended) may explain this result. Despite repeated calls for the examination of implementation fidelity as an essential component of evaluating interventions designed to improve the delivery of care, it has been neglected in prior falls prevention studies. This study examined implementation fidelity of the 6-PACK program during a large multi-site RCT., Methods: Based on the 6-PACK implementation framework and intervention description, implementation fidelity was examined by quantifying adherence to program components and organizational support. Adherence indicators were: 1) falls-risk tool completion; and for patients classified as high-risk, provision of 2) a 'Falls alert' sign; and 3) at least one additional 6-PACK intervention. Organizational support indicators were: 1) provision of resources (executive sponsorship, site clinical leaders and equipment); 2) implementation activities (modification of patient care plans; training; implementation tailoring; audits, reminders and feedback; and provision of data); and 3) program acceptability. Data were collected from daily bedside observation, medical records, resource utilization diaries and nurse surveys., Results: All seven intervention components were delivered on the 12 intervention wards. Program adherence data were collected from 103,398 observations and medical record audits. The falls-risk tool was completed each day for 75% of patients. Of the 38% of patients classified as high-risk, 79% had a 'Falls alert' sign and 63% were provided with at least one additional 6-PACK intervention, as recommended. All hospitals provided the recommended resources and undertook the nine outlined program implementation activities. Most of the nurses surveyed considered program components important for falls prevention., Conclusions: While implementation fidelity was variable across wards, overall it was found to be acceptable during the RCT. Implementation failure is unlikely to be a key factor for the observed lack of program effectiveness in the 6-PACK trial., Trial Registration: The 6-PACK cluster RCT is registered with the Australian New Zealand Clinical Trials Registry, number ACTRN12611000332921 (29 March 2011).
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- 2017
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41. Barriers and enablers to the implementation of the 6-PACK falls prevention program: A pre-implementation study in hospitals participating in a cluster randomised controlled trial.
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Ayton DR, Barker AL, Morello RT, Brand CA, Talevski J, Landgren FS, Melhem MM, Bian E, Brauer SG, Hill KD, Livingston PM, and Botti M
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- Australia, Cluster Analysis, Hospitals, Humans, Accident Prevention methods, Accidental Falls prevention & control, Health Plan Implementation, Outcome Assessment, Health Care, Practice Guidelines as Topic standards, Preventive Health Services statistics & numerical data, Wounds and Injuries prevention & control
- Abstract
Evidence for effective falls prevention interventions in acute wards is limited. One reason for this may be suboptimal program implementation. This study aimed to identify perceived barriers and enablers of the implementation of the 6-PACK falls prevention program to inform the implementation in a randomised controlled trial. Strategies to optimise successful implementation of 6-PACK were also sought. A mixed-methods approach was applied in 24 acute wards from 6 Australian hospitals. Participants were nurses working on participating wards and senior hospital staff including Nurse Unit Managers; senior physicians; Directors of Nursing; and senior personnel involved in quality and safety or falls prevention. Information on barriers and enablers of 6-PACK implementation was obtained through surveys, focus groups and interviews. Questions reflected the COM-B framework that includes three behaviour change constructs of: capability, opportunity and motivation. Focus group and interview data were analysed thematically, and survey data descriptively. The survey response rate was 60% (420/702), and 12 focus groups (n = 96 nurses) and 24 interviews with senior staff were conducted. Capability barriers included beliefs that falls could not be prevented; and limited knowledge on falls prevention in patients with complex care needs (e.g. cognitive impairment). Capability enablers included education and training, particularly face to face case study based approaches. Lack of resources was identified as an opportunity barrier. Leadership, champions and using data to drive practice change were recognised as opportunity enablers. Motivation barriers included complacency and lack of ownership in falls prevention efforts. Motivation enablers included senior staff articulating clear goals and a commitment to falls prevention; and use of reminders, audits and feedback. The information gained from this study suggests that regular practical face-to-face education and training for nurses; provision of equipment; audit, reminders and feedback; leadership and champions; and the provision of falls data is key to successful falls prevention program implementation in acute hospitals.
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- 2017
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42. Acceptability of the 6-PACK falls prevention program: A pre-implementation study in hospitals participating in a cluster randomized controlled trial.
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Barker AL, Morello RT, Ayton DR, Hill KD, Brand CA, Livingston PM, and Botti M
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- Focus Groups, Hospitals, Humans, Interviews as Topic, Nurses psychology, Patient Safety standards, Randomized Controlled Trials as Topic, Surveys and Questionnaires, Accidental Falls prevention & control, Health Personnel psychology, Program Evaluation
- Abstract
There is limited evidence to support the effectiveness of falls prevention interventions in the acute hospital setting. The 6-PACK falls prevention program includes a fall-risk tool; 'falls alert' signs; supervision of patients in the bathroom; ensuring patients' walking aids are within reach; toileting regimes; low-low beds; and bed/chair alarms. This study explored the acceptability of the 6-PACK program from the perspective of nurses and senior staff prior to its implementation in a randomised controlled trial. A mixed-methods approach was applied involving 24 acute wards from six Australian hospitals. Participants were nurses working on participating wards and senior hospital staff including: Nurse Unit Managers; senior physicians; Directors of Nursing; and senior personnel involved in quality and safety or falls prevention. Information on program acceptability (suitability, practicality and benefits) was obtained by surveys, focus groups and interviews. Survey data were analysed descriptively, and focus group and interview data thematically. The survey response rate was 60%. Twelve focus groups (n = 96 nurses) and 24 interviews with senior staff were conducted. Falls were identified as a priority patient safety issue and nurses as key players in falls prevention. The 6-PACK program was perceived to offer practical benefits compared to current practice. Nurses agreed fall-risk tools, low-low beds and alert signs were useful for preventing falls (>70%). Views were mixed regarding positioning patients' walking aid within reach. Practical issues raised included access to equipment; and risk of staff injury with low-low bed use. Bathroom supervision was seen to be beneficial, however not always practical. Views on the program appropriateness and benefits were consistent across nurses and senior staff. Staff perceived the 6-PACK program as suitable, practical and beneficial, and were open to adopting the program. Some practical concerns were raised highlighting issues to be addressed by the implementation plan.
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- 2017
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43. EPSPS Gene Copy Number and Whole-Plant Glyphosate Resistance Level in Kochia scoparia.
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Gaines TA, Barker AL, Patterson EL, Westra P, Westra EP, Wilson RG, Jha P, Kumar V, and Kniss AR
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- Gene Amplification, Gene Expression Regulation, Enzymologic, Gene Expression Regulation, Plant, Glycine pharmacology, Herbicides pharmacology, Glyphosate, 3-Phosphoshikimate 1-Carboxyvinyltransferase genetics, Bassia scoparia drug effects, Bassia scoparia genetics, Gene Dosage, Glycine analogs & derivatives, Herbicide Resistance genetics
- Abstract
Glyphosate-resistant (GR) Kochia scoparia has evolved in dryland chemical fallow systems throughout North America and the mechanism of resistance involves 5-enolpyruvylshikimate-3-phosphate synthase (EPSPS) gene duplication. Agricultural fields in four states were surveyed for K. scoparia in 2013 and tested for glyphosate-resistance level and EPSPS gene copy number. Glyphosate resistance was confirmed in K. scoparia populations collected from sugarbeet fields in Colorado, Wyoming, and Nebraska, and Montana. Glyphosate resistance was also confirmed in K. scoparia accessions collected from wheat-fallow fields in Montana. All GR samples had increased EPSPS gene copy number, with median population values up to 11 from sugarbeet fields and up to 13 in Montana wheat-fallow fields. The results indicate that glyphosate susceptibility can be accurately diagnosed using EPSPS gene copy number., Competing Interests: Funding has been provided to the University of Wyoming from the following organizations in support of ARK's research and education program, either through unrestricted gifts, research contracts, or grants: Arysta LifeScience, BASF, Bayer CropScience, Dow AgroSciences, DuPont, FMC, Hatch Act Funds – USDA, Loveland Industries, Monsanto, NovaSource, Repar Corporation, StateLine Bean Cooperative, Syngenta, USDA National Institute for Food and Agriculture, University of Wyoming Department of Plant Sciences, University of Wyoming School of Energy Resources, Valent, Western Sugar Cooperative, Winfield Solutions, Wyoming Agricultural Experiment Station, Wyoming Crop Improvement Association, Wyoming Department of Agriculture, and Wyoming Seed Certification. ARK currently serves on the Board of Directors for the Weed Science Society of America. ARK currently serves on the Farming Systems Trial Advisory Panel for the Rodale Institute. Funding has been provided to the Montana State University-Bozeman from the following organizations in support of PJ’s research and education program, either through unrestricted gifts, research contracts, or grants: Arysta LifeScience, BASF, Bayer CropScience, Dow AgroSciences, DuPont, FMC, Hatch Act Funds – USDA, Montana Wheat and Barley Committee, Montana Agricultural Experiment Station, Montana Department of Agriculture, Montana Fertilizer Committee, Montana Noxious Weed Trust, NovaSource, USDA National Institute for Food and Agriculture, Valent, Western Sugar Cooperative, Winfield Solutions. PJ currently serves on the Board of Directors for the Western Society of Weed Science and Associate Editor for Weed Technology journal. PJ currently serves on the education committee of Montana Ari-Business Association. Funding has been provided to Colorado State University from the following organizations in support of TG's research and education program, either through unrestricted gifts, research contracts, or grants: Aquatic Plant Management Society, BASF, Bayer CropScience, Biotechnology and Biological Sciences Research Council, Colorado Agricultural Experiment Station, Colorado Wheat Administrative Committee, Colorado Wheat Research Foundation, Dow AgroSciences, Hatch Act Funds – USDA, National Science Foundation (I/UCRC), United Sorghum Checkoff Program, United Phosphorus, Inc., and Western Sugar Cooperative. TG currently serves as the scientific chair and conference organizer for the Global Herbicide Resistance Challenge conference. TG has received travel grants to speak at meetings from the following organizations: AGRO division of American Chemical Society, Bayer CropScience, The Scotts Company, Canadian Weed Science Society, Limagrain Cereal Seeds, Brazilian Society of Weed Science, Tennessee Weed Science Society, and Crop Science Society of America. Funding has been provided to Colorado State University from the following organizations in support of PW’s research and education program, either through unrestricted gifts, research contracts, or grants: BASF, Bayer CropScience, Colorado Agricultural Experiment Station, Colorado Wheat Administrative Committee, Colorado Wheat Research Foundation, Dow AgroSciences, DuPont, FMC, Hatch Act Funds – USDA, Loveland Industries, Monsanto, Syngenta, United Sorghum Checkoff Program, USDA National Institute for Food and Agriculture, Western Sugar Cooperative, and Winfield Solutions. This does not alter the authors' adherence to PLOS ONE policies on sharing data and materials.
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- 2016
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44. Unplanned early return to the emergency department by older patients: the Safe Elderly Emergency Department Discharge (SEED) project.
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Lowthian J, Straney LD, Brand CA, Barker AL, Smit Pde V, Newnham H, Hunter P, Smith C, and Cameron PA
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- Affect, Age Factors, Aged, Aged, 80 and over, Chi-Square Distribution, Cognition, Comorbidity, Female, Geriatric Assessment, Health Services Needs and Demand, Health Services Research, Humans, Logistic Models, Male, Multivariate Analysis, Needs Assessment, Prognosis, Prospective Studies, Risk Assessment, Risk Factors, Tertiary Care Centers, Time Factors, Victoria, Aging psychology, Emergency Service, Hospital, Health Services for the Aged, Patient Discharge, Process Assessment, Health Care
- Abstract
Background: an emergency department (ED) visit is a sentinel event for an older person, with increased likelihood of adverse outcomes post-discharge including early re-presentation., Objectives: to determine factors associated with early re-presentation., Methods: prospective cohort study conducted in the ED of a large acute Melbourne tertiary hospital. Community-dwelling patients ≥65 years were interviewed including comprehensive assessment of cognitive and functional status, and mood. Logistic regression was used to identify risk factors for return within 30 days., Results: nine hundred and fifty-nine patients, median age 77 years, were recruited. One hundred and forty patients (14.6%) re-presented within 30 days, including 22 patients (2.3%) on ≥2 occasions and 75 patients (7.8%) within 7 days. Risk factors for re-presentation included depressive symptoms, cognitive impairment, co-morbidity, triaged as less urgent (ATS 4) and attendance in the previous 12 months, with a decline in risk after 85 years of age. Logistic regression identified chronic obstructive pulmonary disease (OR 1.78, 95% CI 1.02-3.11), moderate cognitive impairment (OR 2.07, 95% CI 1.09-3.90), previous ED visit (OR 2.11, 95% CI 1.43-3.12) and ATS 4 (OR 2.34, 95% CI 1.10-4.99) as independent risk factors for re-presentation. Age ≥85 years was associated with reduced risk (OR 0.81, 95% CI 0.70-0.93)., Conclusion: older discharged patients had a high rate of early re-presentation. Previously identified risk factors-increased age, living alone, functional dependence and polypharmacy-were not associated with early return in this study. It is not clear whether these inconsistencies represent a change in patient case-mix or strategies implemented to reduce re-attendance. This remains an important area for future research., (© The Author 2016. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For Permissions, please email: journals.permissions@oup.com.)
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- 2016
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45. Discharging older patients from the emergency department effectively: a systematic review and meta-analysis.
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Lowthian JA, McGinnes RA, Brand CA, Barker AL, and Cameron PA
- Subjects
- Age Factors, Aged, Chi-Square Distribution, Community Health Services, Geriatric Assessment, Health Services for the Aged, Homes for the Aged, Hospital Mortality, Humans, Nursing Homes, Odds Ratio, Patient Admission, Risk Factors, Time Factors, Continuity of Patient Care, Emergency Service, Hospital, Geriatrics, Patient Discharge
- Abstract
Background: a decline in health state and re-attendance are common in people aged ≥65 years following emergency department (ED) discharge. Diverse care models have been implemented to support safe community transition. This review examined ED community transition strategies (ED-CTS) and evaluated their effectiveness., Methods: a systematic review and meta-analysis using multiple databases up to December 2013 was conducted. We assessed eligibility, methodological quality, risk of bias and extracted published data and then conducted random effects meta-analyses. Outcomes were unplanned ED representation or hospitalisation, functional decline, nursing-care home admission and mortality., Results: five experimental and four observational studies were identified for qualitative synthesis. ED-CTS included geriatric assessment with referral for post-discharge community-based assistance, with differences apparent in components and delivery methods. Four studies were included in meta-analysis. Compared with usual care, the evidence indicates no appreciable benefit for ED-CTS for unplanned ED re-attendance up to 30 days (odds ratio (OR) 1.32, 95% confidence interval (CI) 0.99-1.76; n = 1,389), unplanned hospital admission up to 30 days (OR 0.90, 95% CI 0.70-1.16; n = 1,389) or mortality up to 18 months (OR 1.04, 95% CI 0.83-1.29; n = 1,794). Variability between studies precluded analysis of the impact of ED-CTS on functional decline and nursing-care home admission., Conclusions: there is limited high-quality data to guide confident recommendations about optimal ED community transition strategies, highlighting a need to encourage better integration of researchers and clinicians in the design and evaluation process, and increased reporting, including appropriate robust evaluation of efficacy and effectiveness of these innovative models of care., (© The Author 2015. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For Permissions, please email: journals.permissions@oup.com.)
- Published
- 2015
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46. Implementation of pressure ulcer prevention best practice recommendations in acute care: an observational study.
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Barker AL, Kamar J, Tyndall TJ, White L, Hutchinson A, Klopfer N, and Weller C
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- Aged, Aged, 80 and over, Critical Care, Female, Follow-Up Studies, Humans, Male, Middle Aged, New South Wales epidemiology, Pressure Ulcer diagnosis, Pressure Ulcer epidemiology, Prevalence, Prospective Studies, Reproducibility of Results, Practice Guidelines as Topic, Pressure Ulcer prevention & control, Risk Assessment methods
- Abstract
Pressure ulcers are a common but preventable problem in hospitals. Implementation of best practice guideline recommendations can prevent ulcers from occurring. This 9-year cohort study reports prevalence data from point prevalence surveys during the observation period, and three practice metrics to assess implementation of best practice guideline recommendations: (i) nurse compliance with use of a validated pressure ulcer risk assessment and intervention checklist; (ii) accuracy of risk assessment scoring in usual-care nurses and experienced injury prevention nurses; and (iii) use of pressure ulcer prevention strategies. The prevalence of hospital-acquired pressure ulcers decreased following implementation of an evidence-based prevention programme from 12·6% (2 years preprogramme implementation) to 2·6% (6 years postprogramme implementation) (P < 0·001). Audits between 2003 and 2011 of 4368 patient medical records identified compliance with pressure ulcer prevention documentation according to best practice guidelines was high (>84%). A sample of 270 patients formed the sample for the study of risk assessment scoring accuracy and use of prevention strategies. It was found usual-care nurses under-estimated patients' risk of pressure ulcer development and under-utilised prevention strategies compared with experienced injury prevention nurses. Despite a significant reduction in prevalence of hospital-acquired pressure ulcers and high documentation compliance, use of prevention strategies could further be improved to achieve better patient outcomes. Barriers to the use of prevention strategies by nurses in the acute hospital setting require further examination. This study provides important insights into the knowledge translation of pressure ulcer prevention best practice guideline recommendations at The Northern Hospital., (© 2012 The Authors. International Wound Journal © 2012 John Wiley & Sons Ltd and Medicalhelplines.com Inc.)
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- 2013
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47. A review of hospital characteristics associated with improved performance.
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Brand CA, Barker AL, Morello RT, Vitale MR, Evans SM, Scott IA, Stoelwinder JU, and Cameron PA
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- Environment, Humans, Information Systems, Leadership, Organizational Culture, Organizational Innovation, Outcome and Process Assessment, Health Care, Hospital Administration, Quality Improvement organization & administration, Quality Indicators, Health Care
- Abstract
Purpose: The objective of this review was to critically appraise the literature relating to associations between high-level structural and operational hospital characteristics and improved performance., Data Sources: The Cochrane Library, MEDLINE (Ovid), CINAHL, proQuest and PsychINFO were searched for articles published between January 1996 and May 2010. Reference lists of included articles were reviewed and key journals were hand searched for relevant articles., Study Selection: and data extraction Studies were included if they were systematic reviews or meta-analyses, randomized controlled trials, controlled before and after studies or observational studies (cohort and cross-sectional) that were multicentre, comparative performance studies. Two reviewers independently extracted data, assigned grades of evidence according to the Australian National Health and Medical Research Council guidelines and critically appraised the included articles. Data synthesis Fifty-seven studies were reported within 12 systematic reviews and 47 observational articles. There was heterogeneity in use and definition of performance outcomes. Hospital characteristics investigated were environment (incentives, market characteristics), structure (network membership, ownership, teaching status, geographical setting, service size) and operational design (innovativeness, leadership, organizational culture, public reporting and patient safety practices, information technology systems and decision support, service activity and planning, workforce design, staff training and education). The strongest evidence for an association with overall performance was identified for computerized physician order entry systems. Some evidence supported the associations with workforce design, use of financial incentives, nursing leadership and hospital volume., Conclusion: There is limited, mainly low-quality evidence, supporting the associations between hospital characteristics and healthcare performance. Further characteristic-specific systematic reviews are indicated.
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- 2012
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48. Mobility has a non-linear association with falls risk among people in residential aged care: an observational study.
- Author
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Barker AL, Nitz JC, Low Choy NL, and Haines TP
- Subjects
- Aged, Aged, 80 and over, Cohort Studies, Confidence Intervals, Female, Frail Elderly, Geriatric Assessment, Homes for the Aged, Humans, Male, Odds Ratio, Prospective Studies, Accidental Falls prevention & control, Exercise, Gait, Mobility Limitation, Walking
- Abstract
Questions: What is the association between mobility and falls risk for people living in residential aged care? Can the Physical Mobility Scale discriminate between residents at risk of falling and those not at risk?, Design: Prospective longitudinal observational study., Setting: Six residential aged care facilities in Australia., Participants: Eighty-seven high- and low-level care permanent residents., Outcome Measures: The primary outcome measure was the number of falls in the six months after the initial mobility assessment. Mobility of all participants was assessed using the Physical Mobility Scale, which includes nine mobility items assessed on a 0-5 scale yielding a total score out of 45., Results: During the six-month study period, 131 falls were reported. Residents with mild mobility impairment (Physical Mobility Scale total score 28-36) had the highest fall risk (hazard ratio = 1.98, 95% CI 1.30 to 3.03). Residents with fully dependent mobility (Physical Mobility Scale total score 0-9) had the lowest risk for falls (HR=0.05, 95% CI 0.01 to 0.32)., Conclusion: Aged care residents with mild mobility impairment are at increased risk of falls and are an appropriate target for falls prevention strategies. Although improving the mobility of residents with moderate to severe mobility impairment may enhance their independence and reduce their burden on staff, paradoxically this may also increase their risk of falls. When these residents improve enough to progress into a higher category of mobility, physiotherapists should be aware that this may increase the risk of falls and should consider instituting appropriate falls prevention strategies., (Copyright © 2012 Australian Physiotherapy Association. Published by .. All rights reserved.)
- Published
- 2012
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49. Scanning electrochemical microscopy as a local probe of oxygen permeability in cartilage.
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Gonsalves M, Barker AL, Macpherson JV, Unwin PR, O'Hare D, and Winlove CP
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- Animals, Cartilage, Articular cytology, Cartilage, Articular ultrastructure, Cattle, Electrochemistry instrumentation, Electrochemistry methods, Indicators and Reagents, Metacarpophalangeal Joint, Microscopy, Atomic Force, Microscopy, Electron, Scanning instrumentation, Microscopy, Electron, Scanning methods, Models, Biological, Models, Theoretical, Oxygen metabolism, Permeability, Cartilage, Articular physiology
- Abstract
The use of scanning electrochemical microscopy, a high-resolution chemical imaging technique, to probe the distribution and mobility of solutes in articular cartilage is described. In this application, a mobile ultramicroelectrode is positioned close ( approximately 1 microm) to the cartilage sample surface, which has been equilibrated in a bathing solution containing the solute of interest. The solute is electrolyzed at a diffusion-limited rate, and the current response measured as the ultramicroelectrode is scanned across the sample surface. The topography of the samples was determined using Ru(CN)(6)(4-), a solute to which the cartilage matrix was impermeable. This revealed a number of pit-like depressions corresponding to the distribution of chondrocytes, which were also observed by atomic force and light microscopy. Subsequent imaging of the same area of the cartilage sample for the diffusion-limited reduction of oxygen indicated enhanced, but heterogeneous, permeability of oxygen across the cartilage surface. In particular, areas of high permeability were observed in the cellular and pericellular regions. This is the first time that inhomogeneities in the permeability of cartilage toward simple solutes, such as oxygen, have been observed on a micrometer scale.
- Published
- 2000
- Full Text
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