15 results on '"Karnon, Jonathon"'
Search Results
2. Predictors of short-term hospitalization and emergency department presentations in aged care
- Author
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Inacio, Maria C., Jorissen, Robert N., Khadka, Jyoti, Whitehead, Craig, Maddison, John, Bourke, Alice, Pham, Clarabelle T., Karnon, Jonathon, Wesselingh, Steve L., Lynch, Elizabeth, Harvey, Gillian, Caughey, Gillian E., Crotty, Maria, Inacio, Maria C., Jorissen, Robert N., Khadka, Jyoti, Whitehead, Craig, Maddison, John, Bourke, Alice, Pham, Clarabelle T., Karnon, Jonathon, Wesselingh, Steve L., Lynch, Elizabeth, Harvey, Gillian, Caughey, Gillian E., and Crotty, Maria
- Abstract
Objectives: To examine individual, medication, system, and healthcare related predictors of hospitalization and emergency department (ED) presentation within 90 days of entering the aged care sector, and to create risk-profiles associated with these outcomes. Design and setting: Retrospective population-based cohort study using data from the Registry of Senior Australians. Participants: Older people (aged 65 and older) with an aged care eligibility assessment in South Australia between January 1, 2013 and May 31, 2016 (N = 22,130). Measurements: Primary outcomes were unplanned hospitalization and ED presentation within 90 days of assessment. Individual, medication, system, and healthcare related predictors of the outcomes at the time of assessment, within 90 days or 1-year prior. Fine–Gray models were used to calculate subdistribution hazard ratios (sHR) and 95% confidence intervals (CI). Harrell's C-index assessed predictive ability. Results: Four thousand nine-hundred and six (22.2%) individuals were hospitalized and 5028 (22.7%) had an ED presentation within 90 days. Predictors of hospitalization included: being a man (hospitalization sHR = 1.33, 95% CI 1.26–1.42), ≥3 urgent after-hours attendances (hospitalization sHR = 1.21, 95% CI 1.06–1.39), increasing frailty index score (hospitalization sHR = 1.19, 95% CI 1.11–1.28), individuals using glucocorticoids (hospitalization sHR = 1.11, 95% CI 1.02–1.20), sulfonamides (hospitalization sHR = 1.18, 95% CI 1.10–1.27), trimethoprim antibiotics (hospitalization sHR = 1.15, 95% CI 1.03–1.29), unplanned hospitalizations 30 days prior (hospitalization sHR = 1.13, 95% CI 1.04–1.23), and ED presentations 1 year prior (hospitalization sHR = 1.07, 95% CI 1.04–1.10). Similar predictors and hazard estimates were also observed for ED presentations. The hospitalization models out-of-sample predictive ability (C-index = 0.653, 95% CI 0.635–0.670) and ED presentations (C-index = 0.647, 95% CI 0.630–0.663) were moderate. Conclusio
- Published
- 2021
3. Is home-based palliative care cost-effective? An economic evaluation of the Palliative Care Extended Packages at Home (PEACH) pilot
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McCaffrey, Nikki, Agar, Meera, Harlum, Janeane, Karnon, Jonathon, Currow, David, and Eckermann, Simon
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- 2013
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4. Option appraisal of population-based colorectal cancer screening programmes in England
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Tappenden, Paul, Chilcott, James, Eggington, Simon, Patnick, Julietta, Sakai, Hannah, and Karnon, Jonathon
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Colorectal cancer -- Diagnosis ,Sigmoidoscopy -- Economic aspects ,Cost benefit analysis -- Research ,Cancer -- Diagnosis ,Cancer -- Methods ,Occult blood -- Testing ,Occult blood -- Economic aspects ,Cost benefit analysis ,Health - Published
- 2007
5. Effect of a multi-faceted Rapid Response System re-design on repeat calling of the Rapid Response Team
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Chalwin, Richard, primary, Salter, Amy, additional, Karnon, Jonathon, additional, Eaton, Victoria, additional, and Giles, Lynne, additional
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- 2020
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6. Preventing chronic disease in patients with low health literacy using eHealth and teamwork in primary healthcare: protocol for a cluster randomised controlled trial
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Parker, Sharon M, Stocks, Nigel P, Nutbeam, Don, Thomas, Louise, Denney-Wilson, Elizabeth, Zwar, Nicholas Arnold, Karnon, Jonathon, Lloyd, Jane, Noakes, Manny, Liaw, Siaw-teng, Lau, Annie, Osborne, Richard, Harris, Mark Fort, Parker, Sharon M, Stocks, Nigel P, Nutbeam, Don, Thomas, Louise, Denney-Wilson, Elizabeth, Zwar, Nicholas Arnold, Karnon, Jonathon, Lloyd, Jane, Noakes, Manny, Liaw, Siaw-teng, Lau, Annie, Osborne, Richard, and Harris, Mark Fort
- Abstract
Introduction Adults with lower levels of health literacy are less likely to engage in health-promoting behaviours. Our trial evaluates the impacts and outcomes of a mobile health-enhanced preventive intervention in primary care for people who are overweight or obese. Methods and analysis A two-arm pragmatic practicelevel cluster randomised trial will be conducted in 40 practices in low socioeconomic areas in Sydney and Adelaide, Australia. Forty patients aged 40-70 years with a body mass index ≥28 kg/m2 will be enrolled per practice. The HeLP-general practitioner (GP) intervention includes a practice-level quality improvement intervention (medical record audit and feedback, staff training and practice facilitation visits) to support practices to implement the clinical intervention for patients. The clinical intervention involves a health check visit with a practice nurse based on the 5As framework (assess, advise, agree, assist and arrange), the use of a purpose-built patientfacing app, my snapp, and referral for telephone coaching. The primary outcomes are change in health literacy, lifestyle behaviours, weight, waist circumference and blood pressure. The study will also evaluate changes in quality of life and health service use to determine the cost-effectiveness of the intervention and examine the experiences of practices in implementing the programme. Ethics and dissemination The study has been approved by the University of New South Wales (UNSW) Human Research Ethics Committee (HC17474) and ratified by the University of Adelaide Human Research Ethics committee. There are no restrictions on publication, and findings of the study will be made available to the public via the Centre for Primary Health Care and Equity website and through conference presentations and research publications. Deidentified data and meta-data will be stored in a repository at UNSW and made available subject to ethics committee approval
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- 2018
7. Measuring the financial and productivity burden of paediatric hospitalisation on the wider family network
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Mumford, Virginia, primary, Baysari, Melissa T, additional, Kalinin, Djala, additional, Raban, Magdalena Z, additional, McCullagh, Cheryl, additional, Karnon, Jonathon, additional, and Westbrook, Johanna I, additional
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- 2018
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8. Frailty prevalence in Australia: Findings from four pooled Australian cohort studies
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Thompson, Mark Q, primary, Theou, Olga, additional, Karnon, Jonathon, additional, Adams, Robert J, additional, and Visvanathan, Renuka, additional
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- 2018
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9. Feasibility, acceptability and diagnostic test accuracy of frailty screening instruments in community-dwelling older people within the Australian general practice setting: a study protocol for a cross-sectional study
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Ambagtsheer, Rachel, primary, Visvanathan, Renuka, additional, Cesari, Matteo, additional, Yu, Solomon, additional, Archibald, Mandy, additional, Schultz, Timothy, additional, Karnon, Jonathon, additional, Kitson, Alison, additional, and Beilby, Justin, additional
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- 2017
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10. Better informing decision making with multiple outcomes cost-effectiveness analysis under uncertainty in cost-disutility space
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McCaffrey, Nikki, Agar, Meera, Harlum, Janeane, Karnon, Jonathon, Currow, David, Eckermann, Simon, McCaffrey, Nikki, Agar, Meera, Harlum, Janeane, Karnon, Jonathon, Currow, David, and Eckermann, Simon
- Abstract
INTRODUCTION: Comparing multiple, diverse outcomes with cost-effectiveness analysis (CEA) is important, yet challenging in areas like palliative care where domains are unamenable to integration with survival. Generic multi-attribute utility values exclude important domains and non-health outcomes, while partial analyses-where outcomes are considered separately, with their joint relationship under uncertainty ignored-lead to incorrect inference regarding preferred strategies. OBJECTIVE: The objective of this paper is to consider whether such decision making can be better informed with alternative presentation and summary measures, extending methods previously shown to have advantages in multiple strategy comparison. METHODS: Multiple outcomes CEA of a home-based palliative care model (PEACH) relative to usual care is undertaken in cost disutility (CDU) space and compared with analysis on the cost-effectiveness plane. Summary measures developed for comparing strategies across potential threshold values for multiple outcomes include: expected net loss (ENL) planes quantifying differences in expected net benefit; the ENL contour identifying preferred strategies minimising ENL and their expected value of perfect information; and cost-effectiveness acceptability planes showing probability of strategies minimising ENL. RESULTS: Conventional analysis suggests PEACH is cost-effective when the threshold value per additional day at home ( 1) exceeds $1,068 or dominated by usual care when only the proportion of home deaths is considered. In contrast, neither alternative dominate in CDU space where cost and outcomes are jointly considered, with the optimal strategy depending on threshold values. For example, PEACH minimises ENL when 1=$2,000 and 2=$2,000 (threshold value for dying at home), with a 51.6% chance of PEACH being cost-effective. CONCLUSION: Comparison in CDU space and associated summary measures have distinct advantages
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- 2015
11. Better Informing Decision Making with Multiple Outcomes Cost-Effectiveness Analysis under Uncertainty in Cost-Disutility Space
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McCaffrey, Nikki, primary, Agar, Meera, additional, Harlum, Janeane, additional, Karnon, Jonathon, additional, Currow, David, additional, and Eckermann, Simon, additional
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- 2015
- Full Text
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12. What sort of follow-up services would Australian breast cancer survivors prefer if we could no longer offer long-term specialist-based care? A discrete choice experiment
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Bessen, Taryn, Chen, G, Street, Jacqueline M, Eliott, Jaklin, Karnon, Jonathon, Keefe, Dorothy, Ratcliffe, Julie, Bessen, Taryn, Chen, G, Street, Jacqueline M, Eliott, Jaklin, Karnon, Jonathon, Keefe, Dorothy, and Ratcliffe, Julie
- Abstract
Background:Early diagnosis and improved treatment outcomes have increased breast cancer survival rates that, in turn, have led to increased numbers of women undergoing follow-up after completion of primary treatment. The current workload growth is unsustainable for breast cancer specialists who also provide care for women newly diagnosed or with a recurrence. Appropriate and acceptable follow-up care is important; yet, currently we know little about patient preferences. The aim of this study was to explore the preferences of Australian breast cancer survivors for alternative modes of delivery of follow-up services.Methods:A self-administered questionnaire (online or paper) was developed. The questionnaire contained a discrete choice experiment (DCE) designed to explore patient preferences with respect to provider, location, frequency and method of delivery of routine follow-up care in years 3, 4 and 5 after diagnosis, as well as the perceived value of 'drop-in' clinics providing additional support. Participants were recruited throughout Australia over a 6-month period from May to October 2012. Preference scores and choice probabilities were used to rank the top 10 most preferred follow-up scenarios for respondents.Results:A total of 836 women participated in the study, of whom 722 (86.4%) completed the DCE. In the absence of specialist follow-up, the 10 most valued surveillance scenarios all included a Breast Physician as the provider of follow-up care. The most preferred scenario is a face-to-face local breast cancer follow-up clinic held every 6 months and led by a Breast Physician, where additional clinics focused on the side effects of treatment are also provided.Conclusion:Beyond the first 2 years from diagnosis, in the absence of a specialist led follow-up, women prefer to have their routine breast cancer follow-up by a Breast Physician (or a Breast Cancer Nurse) in a dedicated local breast cancer clinic, rather than with their local General Practitioner. Drop
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- 2014
13. Feasibility, acceptability and diagnostic test accuracy of frailty screening instruments in community-dwelling older people within the Australian general practice setting: a study protocol for a cross-sectional study
- Author
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Ambagtsheer, Rachel, Visvanathan, Renuka, Cesari, Matteo, Yu, Solomon, Archibald, Mandy, Schultz, Timothy, Karnon, Jonathon, Kitson, Alison, and Beilby, Justin
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100402 Medical Biotechnology Diagnostics (incl. Biosensors) ,111702 Aged Health Care ,FOS: Health sciences ,16. Peace & justice ,FOS: Medical biotechnology ,3. Good health - Abstract
IntroductionFrailty is one of the most challenging aspects of population ageing due to its association with increased risk of poor health outcomes and quality of life. General practice provides an ideal setting for the prevention and management of frailty via the implementation of preventive measures such as early identification through screening.Methods and analysisOur study will evaluate the feasibility, acceptability and diagnostic test accuracy of several screening instruments in diagnosing frailty among community-dwelling Australians aged 75+ years who have recently made an appointment to see their general practitioner (GP). We will recruit 240 participants across 2 general practice sites within South Australia. We will invite eligible patients to participate and consent to the study via mail. Consenting participants will attend a screening appointment to undertake the index tests: 2 self-reported (Reported Edmonton Frail Scale and Kihon Checklist) and 5 (Frail Scale, Groningen Frailty Index, Program on Research for Integrating Services for the Maintenance of Autonomy (PRISMA-7), Edmonton Frail Scale and Gait Speed Test) administered by a practice nurse (a Registered Nurse working in general practice). We will randomise test order to reduce bias. Psychosocial measures will also be collected via questionnaire at the appointment. A blinded researcher will then administer two reference standards (the Frailty Phenotype and Adelaide Frailty Index). We will determine frailty by a cut-point of 3 of 5 criteria for the Phenotype and 9 of 42 items for the AFI. We will determine accuracy by analysis of sensitivity, specificity, predictive values and likelihood ratios. We will assess feasibility and acceptability by: 1) collecting data about the instruments prior to collection; 2) interviewing screeners after data collection; 3) conducting a pilot survey with a 10% sample of participants.BMJ Open 2017;7:e016663
14. Predictors of short‐term hospitalization and emergency department presentations in aged care
- Author
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Maria Crotty, Alice Bourke, Elizabeth A Lynch, Jyoti Khadka, Steven Lodewyk Wesselingh, Gillian E. Caughey, John Maddison, Jonathon Karnon, Maria C.S. Inacio, Clarabelle T. Pham, Craig Whitehead, Gillian Harvey, Robert N. Jorissen, Inacio, Maria C, Jorissen, Robert N, Khadka, Jyoti, Whitehead, Craig, Maddison, John, Bourke, Alice, Pham, Clarabelle T, Karnon, Jonathon, Wesselingh, Steve L, Lynch, Elizabeth, Harvey, Gillian, Caughey, Gillian E, and Crotty, Maria
- Subjects
Male ,medicine.medical_specialty ,Time Factors ,aged care ,Population ,Residential Facilities ,Medication Adherence ,03 medical and health sciences ,Sex Factors ,0302 clinical medicine ,Risk Factors ,South Australia ,Health care ,Humans ,Medicine ,Registries ,030212 general & internal medicine ,Aged care ,education ,Geriatric Assessment ,Glucocorticoids ,Aged ,Retrospective Studies ,Sulfonamides ,education.field_of_study ,business.industry ,030503 health policy & services ,Emergency department ,Confidence interval ,Anti-Bacterial Agents ,emergency department presentation ,Hospitalization ,predictors ,Emergency medicine ,Delirium ,Female ,Geriatrics and Gerontology ,medicine.symptom ,Emergency Service, Hospital ,0305 other medical science ,business ,Older people ,hospitalization ,Cohort study - Abstract
Objectives: To examine individual, medication, system, and healthcare related predictors of hospitalization and emergency department (ED) presentation within 90 days of entering the aged care sector, and to create risk-profiles associated with these outcomes. Design and setting: Retrospective population-based cohort study using data from the Registry of Senior Australians. Participants: Older people (aged 65 and older) with an aged care eligibility assessment in South Australia between January 1, 2013 and May 31, 2016 (N = 22,130). Measurements: Primary outcomes were unplanned hospitalization and ED presentation within 90 days of assessment. Individual, medication, system, and healthcare related predictors of the outcomes at the time of assessment, within 90 days or 1-year prior. Fine–Gray models were used to calculate subdistribution hazard ratios (sHR) and 95% confidence intervals (CI). Harrell's C-index assessed predictive ability. Results: Four thousand nine-hundred and six (22.2%) individuals were hospitalized and 5028 (22.7%) had an ED presentation within 90 days. Predictors of hospitalization included: being a man (hospitalization sHR = 1.33, 95% CI 1.26–1.42), ≥3 urgent after-hours attendances (hospitalization sHR = 1.21, 95% CI 1.06–1.39), increasing frailty index score (hospitalization sHR = 1.19, 95% CI 1.11–1.28), individuals using glucocorticoids (hospitalization sHR = 1.11, 95% CI 1.02–1.20), sulfonamides (hospitalization sHR = 1.18, 95% CI 1.10–1.27), trimethoprim antibiotics (hospitalization sHR = 1.15, 95% CI 1.03–1.29), unplanned hospitalizations 30 days prior (hospitalization sHR = 1.13, 95% CI 1.04–1.23), and ED presentations 1 year prior (hospitalization sHR = 1.07, 95% CI 1.04–1.10). Similar predictors and hazard estimates were also observed for ED presentations. The hospitalization models out-of-sample predictive ability (C-index = 0.653, 95% CI 0.635–0.670) and ED presentations (C-index = 0.647, 95% CI 0.630–0.663) were moderate. Conclusions: One in five individuals with aged care eligibility assessments had unplanned hospitalizations and/or ED presentation within 90 days with several predictors identified at the time of aged care eligibility assessment. This is an actionable period for targeting at-risk individuals to reduce hospitalizations. Refereed/Peer-reviewed
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- 2021
15. Does one size fit all? Cost utility analyses of alternative mammographic follow-up schedules, by risk of recurrence
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Jonathan Karnon, Dorothy M. K. Keefe, Taryn Bessen, Bessen, Taryn, Keefe, Dorothy MK, and Karnon, Jonathon
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Oncology ,medicine.medical_specialty ,Time Factors ,Cost effectiveness ,Cost-Benefit Analysis ,mammography ,Aftercare ,Breast Neoplasms ,Risk Assessment ,law.invention ,Breast cancer ,Randomized controlled trial ,law ,Internal medicine ,South Australia ,follow-up ,Medicine ,Mammography ,Humans ,Stage (cooking) ,Neoplasm Metastasis ,early breast cancer ,cost-effectiveness ,Early breast cancer ,Aged ,Retrospective Studies ,Gynecology ,Models, Statistical ,medicine.diagnostic_test ,business.industry ,Health Policy ,Age Factors ,Middle Aged ,medicine.disease ,Prognosis ,Primary tumor ,Postmenopause ,Models, Economic ,Nottingham Prognostic Index ,Female ,Neoplasm Recurrence, Local ,business - Abstract
Objectives: International guidelines recommend annual mammography after early breast cancer, but there is no randomized controlled trial evidence to support this schedule over any other. Given that not all women have the same risk of recurrence, it is possible that, by defining different risk profiles, we could tailor mammographic schedules that are more effective and efficient.Methods: A discrete event simulation model was developed to describe the progression of early breast cancer after completion of primary treatment. Retrospective data for 1,100 postmenopausal women diagnosed with early breast cancer in South Australia from 2000 to 2008 were used to calibrate the model. Women were divided into four prognostic subgroups based on the Nottingham Prognostic Index of their primary tumor. For each subgroup, we compared the cost-effectiveness of three different mammographic schedules for two different age groups.Results: Annual mammographic follow-up was not cost-effective for most postmenopausal women. Two yearly mammography was cost-effective for all women with excellent prognosis tumors; and for women with good prognosis tumors if high compliance rates can be achieved. Annual mammography for 5 years and 2 yearly surveillance thereafter (a mixed schedule) may be cost-effective for 50- to 69-year-old women with moderate prognosis tumors, and for women aged 70–79 years with poor prognosis tumors. For younger women with poor prognosis tumors, annual mammography is potentially cost-effective.Conclusions: Our results suggest that mammographic follow-up could be tailored according to risk of recurrence. If validated with larger datasets, this could potentially set the stage for personalized mammographic follow-up after breast cancer.
- Published
- 2015
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