Background: Neonatal respiratory distress (NRDS) and other neonatal manifestations are reported c... more Background: Neonatal respiratory distress (NRDS) and other neonatal manifestations are reported commonly in patients with Primary Ciliary Dyskinesia (PCD): Despite this, most patients remain undiagnosed until much later in life. We calculated the prevalence of neonatal manifestations in a large multinational dataset and assessed if they were associated with earlier PCD diagnosis. Methods: We included 13 datasets from the international PCD (iPCD) cohort, with almost complete information on the neonatal period. We calculated the prevalence of reported NRDS and separately the prevalence of any reported neonatal manifestation (including any of the following: NRDS, rhinitis, cough, pneumonia, admission to NICU, mechanical ventilation, need of oxygen, hydrocephalus). Further, we compared age of diagnosis in patients with and without neonatal manifestations using poisson regression models. Results: We included 1175 patients with information on NRDS and 1053 with information on any neonatal manifestation. Prevalence of NRDS was 40% (469/1175) and of any neonatal manifestation 66% (696/1053). After adjusting for sex and laterality, mean age of diagnosis was lower in patients who reported neonatal symptoms (12 versus 14 years, p Conclusion: PCD patients who reported neonatal manifestations were diagnosed younger, however age of diagnosis was still high. Increased awareness and close collaboration with neonatologists is needed to diagnose PCD earlier in patients with early life symptoms. Funding: FP7 grant 305404, SNF 320030_173044, COST BM1407
Introduction: Bronchiectasis is characterised by bacterial airway colonisation. The role of virus... more Introduction: Bronchiectasis is characterised by bacterial airway colonisation. The role of viruses in the aetiology of bronchiectasis, progression of airway inflammation and exacerbations is less clear. Exacerbations are strongly associated with symptom burden, disease progression and loss of lung function. Aim: This study aimed to investigate how frequently, common respiratory viruses could be identified in patients with stable non CF-bronchiectasis. Methods: Adult patients (n=13) diagnosed with clinically stable bronchiectasis were recruited, alongside healthy controls (n=10) who completed spirometry and provided a nasal washing or sputum sample. We looked for four common viruses (human rhinovirus, respiratory syncytial virus, influenza A and influenza B) in respiratory secretions and exhaled breath collected in filters from spirometry mouthpieces, using RT-PCR. Results: 92% (12/13) of patients with bronchiectasis, compared with 70% (7/10) of healthy controls had detectable virus in either exhaled breath or nasal washing/sputum samples. The bronchiectasis group had significantly higher detection rates of rhinovirus and influenza A compared with controls (p Discussion: In this cross–sectional study we found asymptomatic viral infections occur frequently in patients with bronchiectasis. We speculate that chronic infection may be the result of a dysfunctional innate immune response in bronchiectasis.
With the current epidemic of obesity in Australia, bariatric surgery has become increasingly acce... more With the current epidemic of obesity in Australia, bariatric surgery has become increasingly accessible for patients with a body mass index above 35 kg/m². Laparoscopic adjustable gastric banding (LAGB) is currently the weight loss surgery of choice for its perceived simplicity and its low peri-operative complication and mortality rates. The short term complications and long term benefits of sustained weight loss with LAGB are well described but the medium term respiratory complications are less clearly appreciated. We report three cases with LAGB who presented with significant respiratory tract symptoms to the Nepean Hospital in New South Wales, a teaching hospital with a busy LAGB service, during the period from January to March 2012.
Background: Poor growth is a common problem in children with severe chronic respiratory disease, ... more Background: Poor growth is a common problem in children with severe chronic respiratory disease, but little is known for PCD. In the EU project BESTCILIA, we assessed height and body mass index (BMI) in a multinational PCD dataset, compared to WHO reference values. Methods: We analysed 2633 measurements of height and weight from 296 paediatric and adult PCD patients from 6 centres (Australia, Belgium, Cyprus, Denmark, UK and Switzerland). We used World Health Organization (WHO) growth reference data to calculate z-scores for height and BMI. To account for repeated measurements we used a multilevel model, adjusting for age, sex and study centre. Results: The mean age of patients at the time of measurement was 20 years (range 0-72). We found a mean height z-score of 0.07 (SD=1.11) and a mean BMI z-score of 0.93 (3.41). 17/296 (5.74%) patients had BMI z-score Conclusions: In our study, we found higher BMI z-scores compared to WHO growth reference data. This suggests that undernutrition might be a minor problem in our population. In a next step, we will compare the data also to national reference values, determine patient characteristics associated with growth, especially level of lung function and evaluate changes over time. Funding: FP7 grant 305404, Lungenliga Bern, Lungenliga St.Gallen.
European Heart Journal - Quality of Care and Clinical Outcomes, May 10, 2016
Acute coronary syndrome (ACS) is a costly condition for health service provision yet variation in... more Acute coronary syndrome (ACS) is a costly condition for health service provision yet variation in the delivery of care between hospitals persists. A composite measure of adherence with evidence-based clinical-process indicators (CPIs) could better inform hospital performance reporting and clinical outcomes in the management of ACS. Data on 7444 ACS patients from 39 Australian hospitals were used to derive a hospital-specific composite quality score by calculating mean adherence to 14 evidence-based CPIs. Using the generalized estimating equation to account for clustering of patients within hospitals and the GRACE risk score to adjust for differences in presenting risk, we evaluated associations between the hospital-specific composite quality score, in-hospital major adverse events, in-hospital mortality and mortality and readmission for ACS at 6 months. Hospitals had a mean adherence of 68.3% (SD 21.7) with the composite quality score. There was significant variation between hospital adherence tertile 1 (79%) and tertile 3 (56%), P < 0.0001. With risk adjustment, there was an association between hospitals with a higher composite quality score and reduced in-hospital adverse events (OR: 0.85, CI: 0.71-0.99) and survival at hospital discharge (OR: 0.47; 95% CI: 0.28-0.77). There was trending improvement in survival at 6 months (OR 0.48; CI: 0.20-1.16) and fewer readmissions to hospital for ACS at 6 months (OR 0.79; CI 0.60-1.05). The association between the quality composite score and reduced in-hospital events and survival at hospital discharge supports the utility of reporting CPIs in routine hospital performance reporting on the management of ACS. CONCORDANCE Registry ACTRN12614000887673.
Introduction: Respiratory viruses are a major cause of exacerbations for patients with chronic re... more Introduction: Respiratory viruses are a major cause of exacerbations for patients with chronic respiratory disease. Many studies have investigated the incidence of viruses in patients experiencing exacerbation using traditional sampling methods which are invasive, difficult to collect, and are unsuitable for repetitive measurements. Aim: To utilise the disposable electret filters used during routine spirometry testing as a virus collection system. Methods: Patients with COPD, asthma and bronchiectasis were recruited during their routine outpatient visit during a local influenza epidemic. They completed spirometry and provided a nasal washing or sputum sample. We looked for four common viruses (human rhinovirus, respiratory syncytial virus, influenza A and influenza B) in the secretion sample and in exhaled breath collected in electret spirometry filters, using RT-PCR. Results: 53 participants were recruited (COPD n=13; asthma n=17; bronchiectasis n=13) and 10 healthy volunteers (n=10). Virus was identified in the filters in 56% of participants, and of these, 81% had the same virus type in sputum/nasal washing samples. 77% of participants with COPD, 88% with asthma, and 92% with bronchiectasis, compared with 70% of healthy controls tested viral positive in at least one sample. Conclusion: Virus was detected more frequently in patients with chronic respiratory disease than healthy controls. Virus identified in electret filters correlated well with virus identified in sputum/nasal lavage. Detection and identification of virus obtained from exhaled breath collected in the electret filters may be a novel way to assess viral incidence in large populations or as part of routine clinical management.
Abstract A 66-year-old male smoker with a history of peptic ulcer disease had hemoptysis and weig... more Abstract A 66-year-old male smoker with a history of peptic ulcer disease had hemoptysis and weight loss. Bronchoscopy revealed a tumor in the right main bronchus. Thoracic CT scan showed a right hilar mass with tumor extension into the esophagus. Biopsy of the ...
Background: Neonatal respiratory distress (NRDS) and other neonatal manifestations are reported c... more Background: Neonatal respiratory distress (NRDS) and other neonatal manifestations are reported commonly in patients with Primary Ciliary Dyskinesia (PCD): Despite this, most patients remain undiagnosed until much later in life. We calculated the prevalence of neonatal manifestations in a large multinational dataset and assessed if they were associated with earlier PCD diagnosis. Methods: We included 13 datasets from the international PCD (iPCD) cohort, with almost complete information on the neonatal period. We calculated the prevalence of reported NRDS and separately the prevalence of any reported neonatal manifestation (including any of the following: NRDS, rhinitis, cough, pneumonia, admission to NICU, mechanical ventilation, need of oxygen, hydrocephalus). Further, we compared age of diagnosis in patients with and without neonatal manifestations using poisson regression models. Results: We included 1175 patients with information on NRDS and 1053 with information on any neonatal manifestation. Prevalence of NRDS was 40% (469/1175) and of any neonatal manifestation 66% (696/1053). After adjusting for sex and laterality, mean age of diagnosis was lower in patients who reported neonatal symptoms (12 versus 14 years, p Conclusion: PCD patients who reported neonatal manifestations were diagnosed younger, however age of diagnosis was still high. Increased awareness and close collaboration with neonatologists is needed to diagnose PCD earlier in patients with early life symptoms. Funding: FP7 grant 305404, SNF 320030_173044, COST BM1407
Introduction: Bronchiectasis is characterised by bacterial airway colonisation. The role of virus... more Introduction: Bronchiectasis is characterised by bacterial airway colonisation. The role of viruses in the aetiology of bronchiectasis, progression of airway inflammation and exacerbations is less clear. Exacerbations are strongly associated with symptom burden, disease progression and loss of lung function. Aim: This study aimed to investigate how frequently, common respiratory viruses could be identified in patients with stable non CF-bronchiectasis. Methods: Adult patients (n=13) diagnosed with clinically stable bronchiectasis were recruited, alongside healthy controls (n=10) who completed spirometry and provided a nasal washing or sputum sample. We looked for four common viruses (human rhinovirus, respiratory syncytial virus, influenza A and influenza B) in respiratory secretions and exhaled breath collected in filters from spirometry mouthpieces, using RT-PCR. Results: 92% (12/13) of patients with bronchiectasis, compared with 70% (7/10) of healthy controls had detectable virus in either exhaled breath or nasal washing/sputum samples. The bronchiectasis group had significantly higher detection rates of rhinovirus and influenza A compared with controls (p Discussion: In this cross–sectional study we found asymptomatic viral infections occur frequently in patients with bronchiectasis. We speculate that chronic infection may be the result of a dysfunctional innate immune response in bronchiectasis.
With the current epidemic of obesity in Australia, bariatric surgery has become increasingly acce... more With the current epidemic of obesity in Australia, bariatric surgery has become increasingly accessible for patients with a body mass index above 35 kg/m². Laparoscopic adjustable gastric banding (LAGB) is currently the weight loss surgery of choice for its perceived simplicity and its low peri-operative complication and mortality rates. The short term complications and long term benefits of sustained weight loss with LAGB are well described but the medium term respiratory complications are less clearly appreciated. We report three cases with LAGB who presented with significant respiratory tract symptoms to the Nepean Hospital in New South Wales, a teaching hospital with a busy LAGB service, during the period from January to March 2012.
Background: Poor growth is a common problem in children with severe chronic respiratory disease, ... more Background: Poor growth is a common problem in children with severe chronic respiratory disease, but little is known for PCD. In the EU project BESTCILIA, we assessed height and body mass index (BMI) in a multinational PCD dataset, compared to WHO reference values. Methods: We analysed 2633 measurements of height and weight from 296 paediatric and adult PCD patients from 6 centres (Australia, Belgium, Cyprus, Denmark, UK and Switzerland). We used World Health Organization (WHO) growth reference data to calculate z-scores for height and BMI. To account for repeated measurements we used a multilevel model, adjusting for age, sex and study centre. Results: The mean age of patients at the time of measurement was 20 years (range 0-72). We found a mean height z-score of 0.07 (SD=1.11) and a mean BMI z-score of 0.93 (3.41). 17/296 (5.74%) patients had BMI z-score Conclusions: In our study, we found higher BMI z-scores compared to WHO growth reference data. This suggests that undernutrition might be a minor problem in our population. In a next step, we will compare the data also to national reference values, determine patient characteristics associated with growth, especially level of lung function and evaluate changes over time. Funding: FP7 grant 305404, Lungenliga Bern, Lungenliga St.Gallen.
European Heart Journal - Quality of Care and Clinical Outcomes, May 10, 2016
Acute coronary syndrome (ACS) is a costly condition for health service provision yet variation in... more Acute coronary syndrome (ACS) is a costly condition for health service provision yet variation in the delivery of care between hospitals persists. A composite measure of adherence with evidence-based clinical-process indicators (CPIs) could better inform hospital performance reporting and clinical outcomes in the management of ACS. Data on 7444 ACS patients from 39 Australian hospitals were used to derive a hospital-specific composite quality score by calculating mean adherence to 14 evidence-based CPIs. Using the generalized estimating equation to account for clustering of patients within hospitals and the GRACE risk score to adjust for differences in presenting risk, we evaluated associations between the hospital-specific composite quality score, in-hospital major adverse events, in-hospital mortality and mortality and readmission for ACS at 6 months. Hospitals had a mean adherence of 68.3% (SD 21.7) with the composite quality score. There was significant variation between hospital adherence tertile 1 (79%) and tertile 3 (56%), P < 0.0001. With risk adjustment, there was an association between hospitals with a higher composite quality score and reduced in-hospital adverse events (OR: 0.85, CI: 0.71-0.99) and survival at hospital discharge (OR: 0.47; 95% CI: 0.28-0.77). There was trending improvement in survival at 6 months (OR 0.48; CI: 0.20-1.16) and fewer readmissions to hospital for ACS at 6 months (OR 0.79; CI 0.60-1.05). The association between the quality composite score and reduced in-hospital events and survival at hospital discharge supports the utility of reporting CPIs in routine hospital performance reporting on the management of ACS. CONCORDANCE Registry ACTRN12614000887673.
Introduction: Respiratory viruses are a major cause of exacerbations for patients with chronic re... more Introduction: Respiratory viruses are a major cause of exacerbations for patients with chronic respiratory disease. Many studies have investigated the incidence of viruses in patients experiencing exacerbation using traditional sampling methods which are invasive, difficult to collect, and are unsuitable for repetitive measurements. Aim: To utilise the disposable electret filters used during routine spirometry testing as a virus collection system. Methods: Patients with COPD, asthma and bronchiectasis were recruited during their routine outpatient visit during a local influenza epidemic. They completed spirometry and provided a nasal washing or sputum sample. We looked for four common viruses (human rhinovirus, respiratory syncytial virus, influenza A and influenza B) in the secretion sample and in exhaled breath collected in electret spirometry filters, using RT-PCR. Results: 53 participants were recruited (COPD n=13; asthma n=17; bronchiectasis n=13) and 10 healthy volunteers (n=10). Virus was identified in the filters in 56% of participants, and of these, 81% had the same virus type in sputum/nasal washing samples. 77% of participants with COPD, 88% with asthma, and 92% with bronchiectasis, compared with 70% of healthy controls tested viral positive in at least one sample. Conclusion: Virus was detected more frequently in patients with chronic respiratory disease than healthy controls. Virus identified in electret filters correlated well with virus identified in sputum/nasal lavage. Detection and identification of virus obtained from exhaled breath collected in the electret filters may be a novel way to assess viral incidence in large populations or as part of routine clinical management.
Abstract A 66-year-old male smoker with a history of peptic ulcer disease had hemoptysis and weig... more Abstract A 66-year-old male smoker with a history of peptic ulcer disease had hemoptysis and weight loss. Bronchoscopy revealed a tumor in the right main bronchus. Thoracic CT scan showed a right hilar mass with tumor extension into the esophagus. Biopsy of the ...
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