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3. External proficiency testing improves inter-scorer reliability of polysomnography scoring.

Author

Ruehland, Warren R., Rochford, Peter D., Pierce, Robert J., Singh, Parmjit, and Thornton, Andrew T.

Abstract

Purpose: This study evaluated whether or not polysomnography (PSG) inter-scorer reliability (ISR) across sleep centres could be improved by external proficiency testing (EPT), or by EPT combined with method alignment training. Methods: Experienced scorers form 15 sleep centres were randomised to the following: (1) a control group, (2) a group that received a self-directed intervention of EPT reports (EPTPassive) or (3) a group that received an active intervention of method alignment training and EPT reports (EPTActive). Respiratory, arousal and sleep scoring ISR from sixteen PSG fragments were compared between groups across time. Results: Among 30 scorers, there were no ISR changes in controls between baseline (BL) and 6 months (6 m). Both EPT groups showed ISR improvement from BL to 6 m for respiratory, arousal and sleep scoring (p < 0.05). Respiratory scoring back-transformed mean (95CI) proportion of specific agreement (PSA) for the EPTPassive group improved from 0.78 (0.72–0.84) to 0.80 (0.74–0.86) and for the EPTActive group from 0.80 (0.74–0.85) to 0.82 (0.76–0.88). Arousal scoring PSA for the EPTPassive group improved from 0.72 (0.66–0.77) to 0.74 (0.69–0.79) and for the EPTActive group from 0.71 (0.65–0.76) to 0.77 (0.72–0.82). Sleep scoring kappa for the EPTPassive group improved from 0.64 (0.58–0.69) to 0.73 (0.68–0.77) and for the EPTActive group from = 0.75 (0.71–0.80) to 0.80 (0.76–0.85). Overall, poorer performers achieved greater improvement. Conclusion: External proficiency testing produced modest, statistically significant PSG inter-scorer reliability improvements among experienced scorers across sleep centres, with potential to improve clinical management of individual patients and increase research study statistical power. [ABSTRACT FROM AUTHOR]

Published
2023
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4. SMART-COP: A Tool for Predicting the Need for Intensive Respiratory or Vasopressor Support in Community-Acquired Pneumonia

Author

Australian Community-Acquired Pneumonia Study Collaboration, Charles, Patrick G. P., Wolfe, Rory, Whitby, Michael, Fine, Michael J., Fuller, Andrew J., Stirling, Robert, Wright, Alistair A., Ramirez, Julio A., Christiansen, Keryn J., Waterer, Grant W., Pierce, Robert J., Armstrong, John G., Korman, Tony M., Holmes, Peter, Obrosky, D. Scott, Peyrani, Paula, Johnson, Barbara, Hooy, Michelle, and Grayson, M. Lindsay

Published
2008
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5. The Etiology of Community-Acquired Pneumonia in Australia: Why Penicillin Plus Doxycycline or a Macrolide Is the Most Appropriate Therapy

Author

Australian CAP Study Collaboration, Charles, Patrick G. P., Whitby, Michael, Fuller, Andrew J., Stirling, Robert, Wright, Alistair A., Korman, Tony M., Holmes, Peter W., Christiansen, Keryn J., Waterer, Grant W., Pierce, Robert J. P., Mayall, Barrie C., Armstrong, John G., Carton, Michael G., Nimmo, Graeme R., Johnson, Barbara, Hooy, Michelle, and Grayson, M. L.

Published
2008
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6. SMART-COP: a tool for predicting the need for intensive respiratory or vasopressor support in community-acquired pneumonia

Author

Charles, Patrick G.P., Wolfe, Rory, Whitby, Michael, Fine, Michael J., Fuller, Andrew J., Stirling, Robert, Wright, Alistair A., Ramirez, Julio A., Christiansen, Keryn J., Waterer, Grant W., Pierce, Robert J., Armstrong, John G., Korman, Tony M., Holmes, Peter, Obrosky, D. Scott, Peyrani, Paula, Johnson, Barbara, and Hooy, Michelle

Subjects
Bacterial pneumonia -- Care and treatment, Pneumonia -- Care and treatment, Vasoconstrictors -- Dosage and administration, Vasoconstrictors -- Research, Health, Health care industry
Published
2008

23. Clinical spirometry

Author

Pierce, Robert J., Rochford, Peter D., and Johns, David P.

Subjects
Spirometry -- Usage, Respiratory tract diseases -- Diagnosis, Health
Abstract

Clinical spirometry, which should be routine for Australian patients with respiratory symptoms, is discussed, and procedures are described. Indications for use of the tests are described and common pitfalls, equipment standards and quality assurance aspects are covered in this guide for medical practitioners and other involved staff.

Published
1997

25. Positive airway pressure for sleep-disordered breathing in acute quadriplegia: a randomised controlled trial

Author

Berlowitz, David J, primary, Schembri, Rachel, additional, Graco, Marnie, additional, Ross, Jacqueline M, additional, Ayas, Najib, additional, Gordon, Ian, additional, Lee, Bonne, additional, Graham, Allison, additional, Cross, Susan V, additional, McClelland, Martin, additional, Kennedy, Paul, additional, Thumbikat, Pradeep, additional, Bennett, Cynthia, additional, Townson, Andrea, additional, Geraghty, Timothy J, additional, Pieri-Davies, Sue, additional, Singhal, Raj, additional, Marshall, Karen, additional, Short, Deborah, additional, Nunn, Andrew, additional, Mortimer, Duncan, additional, Brown, Doug, additional, Pierce, Robert J, additional, and Cistulli, Peter A, additional

Published
2018
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28. Should medical students be routinely offered BCG vaccination?

Author

Johnson, Paul D., Pierce, Robert J., Howley, Tanya M., and Graham, Maryza

Subjects
Australia -- Health policy, BCG vaccination -- Health aspects, BCG vaccination -- Usage, Medical students -- Health aspects, Cross infection -- Risk factors, Cross infection -- Drug therapy, Nosocomial infections -- Risk factors, Nosocomial infections -- Drug therapy, Tuberculosis -- Prevention, Health
Abstract

BCG vaccination for students and surveillance for tuberculosis (TB) infection during the medical training are implemented variously in Australian medical schools, with BCG vaccination not offered routinely to medical students in Victoria. Since exposure to TB is an occupational hazard for Australian health care workers, a standard approach is recommended for all Australian medical schools that includes offering BCG vaccination to all students even if they test negative to tuberculin skin and TB blood testing.

Published
2006

29. Positive airway pressure for sleep-disordered breathing in acute quadriplegia: a randomised controlled trial

Author

Berlowitz, David J, Schembri, Rachel, Graco, Marnie, Ross, Jacqueline M, Ayas, Najib, Gordon, Ian, Lee, Bonne, Graham, Allison, Cross, Susan V, McClelland, Martin, Kennedy, Paul, Thumbikat, Pradeep, Bennett, Cynthia, Townson, Andrea, Geraghty, Timothy J, Pieri-Davies, Sue, Singhal, Raj, Marshall, Karen, Short, Deborah, Nunn, Andrew, Mortimer, Duncan, Brown, Doug, Pierce, Robert J, and Cistulli, Peter A

Abstract

RationaleHighly prevalent and severe sleep-disordered breathing caused by acute cervical spinal cord injury (quadriplegia) is associated with neurocognitive dysfunction and sleepiness and is likely to impair rehabilitation.ObjectiveTo determine whether 3 months of autotitrating CPAP would improve neurocognitive function, sleepiness, quality of life, anxiety and depression more than usual care in acute quadriplegia.Methods and measurementsMultinational, randomised controlled trial (11 centres) from July 2009 to October 2015. The primary outcome was neurocognitive (attention and information processing as measure with the Paced Auditory Serial Addition Task). Daytime sleepiness (Karolinska Sleepiness Scale) was a prioriidentified as the most important secondary outcome.Main results1810 incident cases were screened. 332 underwent full, portable polysomnography, 273 of whom had an apnoea hypopnoea index greater than 10. 160 tolerated at least 4 hours of CPAP during a 3-day run-in and were randomised. 149 participants (134 men, age 46±34 years, 81±57 days postinjury) completed the trial. CPAP use averaged 2.9±2.3 hours per night with 21% fully ‘adherent’ (at least 4 hours use on 5 days per week). Intention-to-treat analyses revealed no significant differences between groups in the Paced Auditory Serial Addition Task (mean improvement of 2.28, 95% CI −7.09 to 11.6; p=0.63). Controlling for premorbid intelligence, age and obstructive sleep apnoea severity (group effect −1.15, 95% CI −10 to 7.7) did not alter this finding. Sleepiness was significantly improved by CPAP on intention-to-treat analysis (mean difference −1.26, 95% CI −2.2 to –0.32; p=0.01).ConclusionCPAP did not improve Paced Auditory Serial Addition Task scores but significantly reduced sleepiness after acute quadriplegia.Trial registration numberACTRN12605000799651.

Published
2019
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30. The effect of sleep onset on upper airway muscle activity in patients with sleep apnoea versus controls

Author

Fogel, Robert B, Trinder, John, White, David P, Malhotra, Atul, Raneri, Jill, Schory, Karen, Kleverlaan, Darci, and Pierce, Robert J

Subjects
Adult, Male, Adolescent, Continuous Positive Airway Pressure, Electromyography, Airway Resistance, Middle Aged, Tissue, System and Organ Physiology, Respiratory Muscles, nervous system diseases, respiratory tract diseases, Sleep Apnea Syndromes, Humans, Pharynx, Sleep Stages, Pulmonary Ventilation, Aged
Abstract

Pharyngeal dilator muscles are important in the pathophysiology of obstructive sleep apnoea syndrome (OSA). We have previously shown that during wakefulness, the activity of both the genioglossus (GGEMG) and tensor palatini (TPEMG) is greater in patients with OSA compared with controls. Further, EMG activity decreases at sleep onset, and the decrement is greater in apnoea patients than in healthy controls. In addition, it is known that the prevalence of OSA is greater in middle-aged compared with younger men. Thus, we had two goals in this study. First we compared upper airway muscle activity between young and middle-aged healthy men compared with men with OSA. We also explored the mechanisms responsible for the decrement in muscle activity at sleep onset in these groups. We investigated muscle activity, ventilation , and upper airway resistance (UAR) during wakefulness and sleep onset (transition from α to θ EEG activity) in all three groups. Measurements were obtained during basal breathing (BB) and nasal continuous positive airway pressure (CPAP) was applied to reduce negative pressure-mediated muscle activation). We found that during wakefulness there was a gradation of GGEMG and UAR (younger < older < OSA) and that muscle activity was reduced by the application of nasal CPAP (to a greater degree in the OSA patients). Although CPAP eliminated differences in UAR during wakefulness and sleep, GGEMG remained greater in the OSA patients. During sleep onset, a greater initial fall in GGEMG was seen in the OSA patients followed by subsequent muscle recruitment in the third to fifth breaths following the α to θ transition. On the CPAP night, and GGEMG still fell further in the OSA patients compared with control subjects. CPAP prevented the rise in UAR at sleep onset along with the associated recruitment in GGEMG. Differences in TPEMG among the groups were not significant. These data suggest that the middle-aged men had upper airway function midway between that of young normal men and the abnormal airway of those with OSA. Furthermore it suggests that the initial sleep onset reduction in upper airway muscle activity is due to loss of a ‘wakefulness’ stimulus, rather than to loss of responsiveness to negative pressure, and that this wakefulness stimulus may be greater in the OSA patient than in healthy controls.

Published
2005

32. Auto-titrating continuous positive airway pressure treatment for obstructive sleep apnoea after acute quadriplegia (COSAQ): study protocol for a randomized controlled trial

Author

Berlowitz, David J, primary, Ayas, Najib, additional, Barnes, Maree, additional, Brown, Douglas J, additional, Cistulli, Peter A, additional, Geraghty, Tim, additional, Graham, Alison, additional, Lee, Bonsan, additional, Morris, Meg, additional, O’Donoghue, Fergal, additional, Rochford, Peter D, additional, Ross, Jack, additional, Singhal, Balraj, additional, Spong, Jo, additional, Wadsworth, Brooke, additional, and Pierce, Robert J, additional

Published
2013
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33. Pilot Study of Remote Telemonitoring in COPD

Author

Antoniades, Nick C., primary, Rochford, Peter D., additional, Pretto, Jeffrey J., additional, Pierce, Robert J., additional, Gogler, Janette, additional, Steinkrug, Julie, additional, Sharpe, Ken, additional, and McDonald, Christine F., additional

Published
2012
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41. Percutaneous versus surgical tracheostomy: A randomized controlled study with long-term follow-up*

Author

Silvester, William, primary, Goldsmith, Donna, additional, Uchino, Shige, additional, Bellomo, Rinaldo, additional, Knight, Simon, additional, Seevanayagam, Siven, additional, Brazzale, Danny, additional, McMahon, Marcus, additional, Buckmaster, Jon, additional, Hart, Graeme K., additional, Opdam, Helen, additional, Pierce, Robert J., additional, and Gutteridge, Geoff A., additional

Published
2006
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42. Long-term ventilatory support at home: any progress?

Author

Campbell, Donald A. and Pierce, Robert J.

Subjects
Home care -- Innovations, Artificial respiration -- Health aspects, Home care -- Evaluation, Health
Abstract

There is urgent need in Australia for a program to assist patients who require long-term ventilator support after discharge from a hospital. The advent of portable ventilators and noninvasive nasal and face masks have broadened the range of clinical conditions that benefit from mechanical ventilation. Patients with restrictive chest-wall disease, neuromuscular diseases, spinal cord injury, and nocturnal breathing problems desire ventilator support in the home. To accomplish this, a program to provide the financial and caregiver support required for success is needed.

Published
1998

43. Cerebral Structural Changes in Severe Obstructive Sleep Apnea

Author

O'Donoghue, Fergal J., primary, Briellmann, Regula S., additional, Rochford, Peter D., additional, Abbott, David F., additional, Pell, Gaby S., additional, Chan, Chow Huat Patrick, additional, Tarquinio, Natalie, additional, Jackson, Graeme D., additional, and Pierce, Robert J., additional

Published
2005
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48. Nebuhaler versus wet aerosol for domiciliary bronchodilator therapy: A multi‐centre clinical comparison

Author

Pierce, Robert J, primary, McDonald, Christine F, additional, Landau, Louis I, additional, Le Souef, Peter N, additional, Armstrong, John G, additional, Mitchell, Charles A, additional, Francis, Paul W, additional, Martin, A James, additional, Musk, A William, additional, Antic, Ral, additional, Clark, Elizabeth, additional, and Ryder, Elizabeth, additional

Published
1992
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50. The Etiology of Community-Acquired Pneumonia in Australia: Why Penicillin plus Doxycycline or a Macrolide Is the Most Appropriate Therapy.

Author

Charles, Patrick G. P., Whitby, Michael, Fuller, Andrew J., Stirling, Robert, Wright, Alistair A., Korman, Tony M., Holmes, Peter W., Christiansen, Keryn J., Waterer, Grant W., Pierce, Robert J. P., Mayall, Barrie C., Armstrong, John G., Catton, Michael G., Nimmo, Graeme R., Johnson, Barbara, Hooy, Michelle, and Grayson, M. L.

Subjects
COMMUNITY-acquired pneumonia, BETA lactam antibiotics, PNEUMONIA, LUNG diseases, ASPIRATION pneumonia, COMMUNITY-acquired infections, ETIOLOGY of diseases, ANTIBACTERIAL agents
Abstract

Background. Available data on the etiology of community-acquired pneumonia (CAP) in Australia are very limited. Local treatment guidelines promote the use of combination therapy with agents such as penicillin or amoxycillin combined with either doxycycline or a macrolide. Methods. The Australian CAP Study (ACAPS) was a prospective, multicenter study of 885 episodes of CAP in which all patients underwent detailed assessment for bacterial and viral pathogens (cultures, urinary antigen testing, serological methods, and polymerase chain reaction). Antibiotic agents and relevant clinical outcomes were recorded. Results. The etiology was identified in 404 (45.6%) of 885 episodes, with the most frequent causes being Streptococcus pneumoniae (14%), Mycoplasma pneumoniae (9%), and respiratory viruses (15%; influenza, picornavirus, respiratory syncytial virus, parainfluenza virus, and adenovirus). Antibiotic-resistant pathogens were rare: only 5.4% of patients had an infection for which therapy with penicillin plus doxycycline would potentially fail. Concordance with local antibiotic recommendations was high (82.4%), with the most commonly prescribed regimens being a penicillin plus either doxycycline or a macrolide (55.8%) or ceftriaxone plus either doxycycline or a macrolide (36.8%). The 30-day mortality rate was 5.6% (50 of 885 episodes), and mechanical ventilation or vasopressor support were required in 94 episodes (10.6%). Outcomes were not compromised by receipt of narrowerspectrum β-lactams, and they did not differ on the basis of whether a pathogen was identified. Conclusions. The vast majority of patients with CAP can be treated successfully with narrow-spectrum β-lactam treatment, such as penicillin combined with doxycycline or a macrolide. Greater use of such therapy could potentially reduce the emergence of antibiotic resistance among common bacterial pathogens. [ABSTRACT FROM AUTHOR]

Published
2008
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