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Research Interests:
Supplemental Material for Contemporary prognosis of transient ischemic attack patients: A systematic review and meta-analysis by Nashwa Najib Parker Magin, Daniel Lasserson, Debbie Quain, John Attia, Christopher Oldmeadow, Carlos... more
Supplemental Material for Contemporary prognosis of transient ischemic attack patients: A systematic review and meta-analysis by Nashwa Najib Parker Magin, Daniel Lasserson, Debbie Quain, John Attia, Christopher Oldmeadow, Carlos Garcia-Esperon and Christopher Levi in International Journal of Stroke
Supplemental Material for The International comparison of Systems of care and patient outcomes In minor Stroke and Tia (InSIST) study: A community-based cohort study by Christopher R Levi, Daniel Lasserson, Debbie Quain, Jose Valderas,... more
Supplemental Material for The International comparison of Systems of care and patient outcomes In minor Stroke and Tia (InSIST) study: A community-based cohort study by Christopher R Levi, Daniel Lasserson, Debbie Quain, Jose Valderas, Helen M Dewey, P Alan Barber, Neil Spratt, Dominique A Cadilhac, Valery Feigin, Hossein Zareie, Carlos Garcia Esperon, Andrew Davey, Nashwa Najib and Parker Magin in International Journal of Stroke
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Rationale Rapid response by health-care systems for transient ischemic attack and minor stroke (TIA/mS) is recommended to maximize the impact of secondary prevention strategies. The applicability of this evidence to Australian... more
Rationale Rapid response by health-care systems for transient ischemic attack and minor stroke (TIA/mS) is recommended to maximize the impact of secondary prevention strategies. The applicability of this evidence to Australian non-hospital-based TIA/mS management is uncertain. Aims Within an Australian community setting we seek to document processes of care, establish determinants of access to care, establish attack rates and determinants of recurrent vascular events and other clinical outcomes, establish the performance of ABC2-risk stratification, and compare the processes of care and outcomes to those in the UK and New Zealand for TIA/mS. Sample size estimates Recruiting practices containing approximately 51 full-time-equivalent general practitioners to recruit 100 TIA/mS per year over a four-year study period will provide sufficient power for each of our outcomes. Methods and design An inception cohort study of patients with possible TIA/mS recruited from 16 general practices in...
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Introduction Anterior cerebral artery flow diversion, measured by transcranial Doppler ultrasound, is correlated with leptomeningeal collateral flow on digital subtraction angiography in the setting of middle cerebral artery occlusion. We... more
Introduction Anterior cerebral artery flow diversion, measured by transcranial Doppler ultrasound, is correlated with leptomeningeal collateral flow on digital subtraction angiography in the setting of middle cerebral artery occlusion. We aimed to assess the influence of flow diversion as a marker of leptomeningeal collateralization on infarct size and penumbral volume. Methods We assessed consecutive patients presenting within six-hours of ischaemic stroke. Anterior cerebral artery flow diversion, defined as ipsilateral mean velocity of at least 30% greater than the contralateral artery, was used as the Doppler index of leptomeningeal collateralization. Multivariable regression analysis was performed to assess the impact of anterior cerebral artery flow diversion, controlling for other important clinical variables. Leptomeningeal collateralization was also graded on computed tomography angiography. Infarct core and penumbral volumes were defined using computed tomography perfusion ...
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... Louise-Anne Jordan, Debbie Quain, Di Marsden, Jenni White, Kathy Bullen, Sally Wright, Renae Galvin, Judith Dunne, Helen Baines Hunter New England Health Page 7. ... British Medical Journal, 331, 1226. Meng, N., Lo, S., Chou, L.,... more
... Louise-Anne Jordan, Debbie Quain, Di Marsden, Jenni White, Kathy Bullen, Sally Wright, Renae Galvin, Judith Dunne, Helen Baines Hunter New England Health Page 7. ... British Medical Journal, 331, 1226. Meng, N., Lo, S., Chou, L., Yang, P., Chang, C. & Chou, E.(2010). ...
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INTRODUCTION Stroke is Australia's most common cause of adult disability and one of the leading causes of death. Annually 53,000 Aus-tralians suffer a stroke. Of these, two people in three will die or be left with permanent... more
INTRODUCTION Stroke is Australia's most common cause of adult disability and one of the leading causes of death. Annually 53,000 Aus-tralians suffer a stroke. Of these, two people in three will die or be left with permanent disability, resulting in a huge soci-etal burden (Hankey, ...
Research Interests: Medicine()
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Research Interests: Stroke()
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are in a stroke unit improves longterm outcomes for stroke patients, underpinning the enhanced organisation of stroke services now underway across Australia.
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To assess the effectiveness of the PAST (Pre-hospital Acute Stroke Triage) protocol in reducing pre-hospital and emergency department (ED) delays to patients receiving organised acute stroke care, thereby increasing access to thrombolytic... more
To assess the effectiveness of the PAST (Pre-hospital Acute Stroke Triage) protocol in reducing pre-hospital and emergency department (ED) delays to patients receiving organised acute stroke care, thereby increasing access to thrombolytic therapy. Prospective cohort study using historical controls. Hunter Region of New South Wales, September 2005 to March 2006 (pre-intervention) and September 2006 to March 2007 (post-intervention). Consecutive patients presenting with acute stroke to a regional, tertiary referral hospital. PAST protocol, comprising a pre-hospital stroke assessment tool for ambulance officers, an ambulance protocol for hospital bypass for potentially thrombolysis-eligible patients, and pre-hospital notification of the acute stroke team. Proportion of patients who received intravenous tissue plasminogen activator (tPA), process of care time points (symptom onset to ED arrival, ED arrival to tPA treatment, and ED transit time), and clinical outcomes of patients treated...
Research Interests: Accessibility, Treatment, Emergency Medical Services, Stroke, Humans, and 15 moreTriage, Female, Male, Care, Emergency, Young Adult, New South Wales, Clinical Sciences, Aged, Middle Aged, Adult, Public health systems and services research, Tissue Plasminogen Activator, Clinical Protocols, and Health Services Accessibility
Research Interests: Medicine()
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INTRODUCTION Over-prescription of antibiotics for common infective conditions is an important health issue. Infective conjunctivitis represents one of the most common eye-related complaints in general practice. Despite its self-limiting... more
INTRODUCTION Over-prescription of antibiotics for common infective conditions is an important health issue. Infective conjunctivitis represents one of the most common eye-related complaints in general practice. Despite its self-limiting nature, there is evidence of frequent general practitioner (GP) antibiotic prescribing for this condition, which is inconsistent with evidence-based guidelines. AIM To investigate the prevalence and associations of GP registrars' (trainees') prescription of antibiotics for infective conjunctivitis. METHODS We performed a cross-sectional analysis of the Registrar Encounters in Clinical Training (ReCEnT) ongoing prospective cohort study, which documents GP registrars' clinical consultations (involving collection of information from 60 consecutive consultations, at three points during registrar training). The outcome of the analyses was antibiotic prescription for a new diagnosis of conjunctivitis. Patient, registrar, practice and consultati...
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Research Interests:
Introduction: It is crucial to enhance timely treatment and secondary prevention following a transient ischaemic attack (TIA) and one way to ensure this is to improve the accuracy and promptness of diagnosis. Unfortunately, initiating... more
Introduction: It is crucial to enhance timely treatment and secondary prevention following a transient ischaemic attack (TIA) and one way to ensure this is to improve the accuracy and promptness of diagnosis. Unfortunately, initiating timely treatment can be difficult due to patients’ lack of knowledge of symptoms and their need for urgency, and difficulties in obtaining this diagnosis. Understanding the TIA event from the patient’s perceptive may open the door to a better understanding of TIA symptomology and improve current difficulties with diagnosis. Method: Narratives of 123 participants, adjudicated to have experienced a TIA, were selected from a TIA/minor stroke cohort assembled by the International Study of Systems of Care in Minor Stroke and TIA [InSiST] study. This National Health and Medical Research Council (NHMRC) funded study is currently underway in NSW, Australia. The participants’ TIA experiences were transcribed into narratives, and using constructivist thematic an...
Deprescribing is the health‐professional‐supervised process of withdrawal of an inappropriate medication to manage polypharmacy and improve patient outcomes. Given the harms of polypharmacy and associated inappropriate medicines,... more
Deprescribing is the health‐professional‐supervised process of withdrawal of an inappropriate medication to manage polypharmacy and improve patient outcomes. Given the harms of polypharmacy and associated inappropriate medicines, practitioners, especially general practitioners (GPs), are encouraged to take a proactive role in deprescribing in older patients. While trial evidence for benefits of deprescribing is accumulating, there is currently little epidemiologic evidence of clinicians’ (including GPs’) deprescribing behaviours. We aimed to establish the prevalence and explore associations of deprescribing of inappropriate medicines by early‐career GPs.
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Research Interests:
Cerebral autoregulation can be impaired after ischemic stroke, with potential adverse effects on cerebral blood flow during early rehabilitation. The objective of this study was to assess changes in cerebral blood flow velocity with... more
Cerebral autoregulation can be impaired after ischemic stroke, with potential adverse effects on cerebral blood flow during early rehabilitation. The objective of this study was to assess changes in cerebral blood flow velocity with orthostatic variation at 24 hours after stroke. This investigation was an observational study comparing mean flow velocities (MFVs) at 30, 15, and 0 degrees of elevation of the head of the bed (HOB). Eight participants underwent bilateral middle cerebral artery (MCA) transcranial Doppler monitoring during orthostatic variation at 24 hours after ischemic stroke. Computed tomography angiography separated participants into recanalized (artery completely reopened) and incompletely recanalized groups. Friedman tests were used to determine MFVs at the various HOB angles. Mann-Whitney U tests were used to compare the change in MFV (from 30° to 0°) between groups and between hemispheres within groups. For stroke-affected MCAs in the incompletely recanalized grou...
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To assess the effectiveness of the PAST (Pre-hospital Acute Stroke Triage) protocol in reducing pre-hospital and emergency department (ED) delays to patients receiving organised acute stroke care, thereby increasing access to thrombolytic... more
To assess the effectiveness of the PAST (Pre-hospital Acute Stroke Triage) protocol in reducing pre-hospital and emergency department (ED) delays to patients receiving organised acute stroke care, thereby increasing access to thrombolytic therapy. Prospective cohort study using historical controls. Hunter Region of New South Wales, September 2005 to March 2006 (pre-intervention) and September 2006 to March 2007 (post-intervention). Consecutive patients presenting with acute stroke to a regional, tertiary referral hospital. PAST protocol, comprising a pre-hospital stroke assessment tool for ambulance officers, an ambulance protocol for hospital bypass for potentially thrombolysis-eligible patients, and pre-hospital notification of the acute stroke team. Proportion of patients who received intravenous tissue plasminogen activator (tPA), process of care time points (symptom onset to ED arrival, ED arrival to tPA treatment, and ED transit time), and clinical outcomes of patients treated...
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Transient ischaemic attacks (TIA) and minor strokes (TIAMS) have the same pathophysiological mechanism as stroke and carry a high risk of recurrent ischaemic events. Diagnosis of TIAMS can be challenging and often occurs in general... more
Transient ischaemic attacks (TIA) and minor strokes (TIAMS) have the same pathophysiological mechanism as stroke and carry a high risk of recurrent ischaemic events. Diagnosis of TIAMS can be challenging and often occurs in general practice. Absolute cardiovascular risk (ACVR) is recommended as the basis for vascular risk management. Consideration of cardiovascular risk in TIAMS diagnosis has been recommended but its utility is not established. Firstly, to document the ACVR of patients with incident TIAMS and with TIAMS-mimics. Secondly, to evaluate the utility of ACVR calculation in informing the initial diagnosis of TIAMS. The International comparison of Systems of care and patient outcomes in minor Stroke and TIA (InSiST) study is an inception cohort study of patients of 17 Australian general practices presenting as possible TIAMS. An expert panel determines whether participants have had TIAMS or TIAMS-mimics. ACVR was calculated at baseline for each participating patient. In this cross-sectional baseline analysis, ACVR of TIAMS and TIAMS-mimics were compared univariately and, also, when adjusted for age and sex. The diagnostic utility of ACVR was evaluated via receiver operating characteristic (ROC) curves. Of 179 participants, 87 were adjudicated as TIAMS. The presence of motor and speech symptoms and body mass index were associated with a diagnosis of TIAMS. ACVR was associated with TIAMS diagnosis on univariate analysis, but not when age- and sex-adjusted. ACVR did not significantly improve area under ROC curves beyond that of age and sex. In patients presenting with transient or minor neurological symptoms, calculation of ACVR did not improve diagnostic accuracy for TIAMS beyond that of age and sex.