Thomas Sullivan

University of Adelaide, Tarndarnya, South Australia, Australia

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Publications (52)188.64 Total impact

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    ABSTRACT: Background: The intention-to-treat principle states that all randomised participants should be analysed in their randomised group. The implications of this principle are widely discussed in relation to the analysis, but have received limited attention in the context of handling errors that occur during the randomisation process. The aims of this article are to (1) demonstrate the potential pitfalls of attempting to correct randomisation errors and (2) provide guidance on handling common randomisation errors when they are discovered that maintains the goals of the intention-to-treat principle.
    Clinical Trials 06/2015; DOI:10.1177/1740774515588097 · 1.94 Impact Factor
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    ABSTRACT: Six Year Follow Up of Children at High Hereditary Risk of Allergy, Born To Mothers Supplemented With Docosahexaenoic Acid (DHA) in the DOMInO Trial Best K1,2, Sullivan T6,Gold M1, Kennedy D4,5, Martin J4,5, Palmer D1,7, Makrides M1,2,3 1Women’s & Children’s Health Research Institute, University of Adelaide, North Adelaide, Australia 2School of Paediatrics and Reproductive Health, University of Adelaide, Adelaide, Australia ³Healthy Mothers, Babies and Children, South Australian Health and Medical Research Institute, Adelaide, Australia 4Discipline of Paediatrics, University of Adelaide, Adelaide, Australia 5 Department of Respiratory and Sleep Medicine, Women’s & Children’s Hospital, North Adelaide, Australia 6 School of Population Health, University of Adelaide, Adelaide, Australia 7 School of Paediatrics and Child Health, University of Western Australia, Subiaco, Australia Email: karen.best@adelaide.edu.au Background: Dietary omega-3 (n-3) long chain polyunsaturated fatty acids (LCPUFA) modulate neonatal markers of the immune response but there is uncertainty regarding the effect on clinical allergy outcomes. This double blind, randomised controlled trial aimed to determine whether supplementation with DHA rich fish oil during pregnancy to women with a fetus at high risk of allergic disease, will reduce the risk of allergy in the child. Method: Between 2005 and 2008, pregnant women between 18-21 weeks gestation were randomly assigned to consume capsules containing ~1 g/d of DHA or a blended vegetable oil (no DHA) until birth, the DOMInO trial. From 2012-2014, 603 children (90% of eligible) born to mothers in the DOMInO trial, with a family history of allergic disease completed a six year of age follow up assessment . History of asthma, allergic rhinitis and eczema were assessed, along with food and aero-allergen sensitisation by skin prick testing. Results: Preliminary results show no difference in the overall percentage of children with IgE-mediated allergic disease between the DHA and control groups (75/279 (26.8%) vs 79/263 (30.0%); RR 0.95; 95% CI 0.73,1.23; P=0.69), although there were fewer children with parent reported hay fever in the DHA group (68/314 (21.6%) vs 84/289 (29.1%); RR 0.75; 95%CI 0.57, 0.99; P=0.04) and fewer children were sensitised to house dust mite, D.Farinae, in the DHA group 31/246 (12.6%) vs 49/231 (21.2%) control; RR 0.61 (0.41, 0.92); P=0.019. Conclusions: DHA supplementation in pregnancy did not reduce the overall incidence of IgE-mediated allergies at six years of age although parent reported hay fever and D.Farinae sensitisation were lower.
    Perinatal Society of Australia and New Zealand; 04/2015
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    ABSTRACT: Thirty one infants born less than 30 weeks׳ gestational age were randomised to receive either 40 (n=11), 80 (n=9) or 120 (n=11) mg/kg/day of docosahexaenoic acid (DHA) respectively as an emulsion, via the feeding tube, commenced within 4 days of the first enteral feed. Twenty three infants were enroled in non-randomised reference groups; n=11 who had no supplementary DHA and n=12 who had maternal DHA supplementation. All levels of DHA in the emulsion were well tolerated with no effect on number of days of interrupted feeds or days to full enteral feeds. DHA levels in diets were directly related to blood DHA levels but were unrelated to arachidonic acid (AA) levels. All randomised groups and the maternal supplementation reference group prevented the drop in DHA levels at study end that was evident in infants not receiving supplementation. Australian New Zealand Clinical Trials Registry: ACTRN12610000382077. Copyright © 2015 Elsevier Ltd. All rights reserved.
    Prostaglandins Leukotrienes and Essential Fatty Acids 04/2015; 99. DOI:10.1016/j.plefa.2015.04.003 · 1.98 Impact Factor
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    ABSTRACT: To determine if improvements in cognitive outcome detected at 18 months' corrected age (CA) in infants born <33 weeks' gestation receiving a high-docosahexaenoic acid (DHA) compared with standard-DHA diet were sustained in early childhood. Follow-up of a multicentre randomised controlled trial. Randomisation was stratified for sex, birth weight (<1250 vs ≥1250 g) and hospital. Five Australian tertiary hospitals from 2008 to 2013. 626 of the 657 participants randomised between 2001 and 2005 were eligible to participate. High-DHA (≈1% total fatty acids) enteral feeds compared with standard-DHA (≈0.3% total fatty acids) from age 2-4 days until term CA. Full Scale IQ of the Wechsler Abbreviated Scale of Intelligence (WASI) at 7 years CA. Prespecified subgroup analyses based on the randomisation strata (sex, birth weight) were conducted. 604 (92% of the 657 originally randomised) consented to participate (291 high-DHA, 313 standard-DHA). To address missing data in the 604 consenting participants (22 for primary outcome), multiple imputation was performed. The Full Scale IQ was not significantly different between groups (high-DHA 98.3, SD 14.0, standard-DHA 98.5, SD 14.9; mean difference adjusted for sex, birthweight strata and hospital -0.3, 95% CI -2.9 to 2.2; p=0.79). There were no significant differences in any secondary outcomes. In prespecified subgroup analyses, there was a significant sex by treatment interaction on measures of parent-reported executive function and behaviour. Scores were within the normal range but girls receiving the high-DHA diet scored significantly higher (poorer outcome) compared with girls receiving the standard-DHA diet. Supplementing the diets of preterm infants with a DHA dose of approximately 1% total fatty acids from days 2-4 until term CA showed no evidence of benefit at 7 years' CA. Australian New Zealand Clinical Trials Registry: ACTRN12606000327583. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
    BMJ Open 03/2015; 5(3):e007314. DOI:10.1136/bmjopen-2014-007314 · 2.06 Impact Factor
  • Lisa Nicole Yelland, Thomas Richard Sullivan, Maria Makrides
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    ABSTRACT: Objectives Multiple births are an important subgroup to consider in trials aimed at reducing preterm birth or its consequences. Including multiples results in a unique mixture of independent and clustered data, which has implications for the design, analysis and reporting of the trial. We aimed to determine how multiple births were taken into account in the design and analysis of recent trials involving preterm infants, and whether key information relevant to multiple births was reported. Design We conducted a systematic review of multicentre randomised trials involving preterm infants published between 2008 and 2013. Information relevant to multiple births was extracted. Results Of the 56 trials included in the review, 6 (11%) excluded multiples and 24 (43%) failed to indicate whether multiples were included. Among the 26 trials that reported multiples were included, only one (4%) accounted for clustering in the sample size calculations and eight (31%) took the clustering into account in the analysis of the primary outcome. Of the 20 trials that randomised infants, 12 (60%) failed to report how infants from the same birth were randomised. Conclusions Information on multiple births is often poorly reported in trials involving preterm infants, and clustering due to multiple births is rarely taken into account. Since ignoring clustering could result in inappropriate recommendations for clinical practice, clustering should be taken into account in the design and analysis of future neonatal and perinatal trials including infants from a multiple birth.
    Archives of Disease in Childhood - Fetal and Neonatal Edition 11/2014; 100(2). DOI:10.1136/archdischild-2014-306239 · 3.86 Impact Factor
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    ABSTRACT: OBJECTIVE The origins of cardiovascular and renal disease in type 1 diabetes begin during childhood. We aimed to evaluate carotid (cIMT) and aortic intima-media thickness (aIMT) and their relationship with cardiovascular risk factors and urinary albumin excretion in adolescents with type 1 diabetes in the Adolescent Type 1 Diabetes cardio-renal Intervention Trial (AdDIT). RESEARCH DESIGN AND METHODS A total of 406 adolescents with type 1 diabetes, who were 14.1 +/- 1.9 years old with type 1 diabetes duration of 6.7 +/- 3.7 years, and 57 age-matched control subjects provided clinical and biochemical data and ultrasound measurements of vascular structure (cIMT and aIMT). Vascular endothelial and smooth muscle function was also measured in 123 of 406 with type 1 diabetes and all control subjects. RESULTS In type 1 diabetic subjects, mean/maximal aIMT (P < 0.006; < 0.008), but not mean/maximal cIMT, was greater than in control subjects. Mean/maximal aIMT related to urinary albumin-to-creatinine ratio (multiple regression coefficient [SE], 0.013 [0.006], P = 0.03; 0.023 [0.007], P = 0.002), LDL cholesterol (0.019 [0.008], P = 0.02; 0.025 [0.011], P = 0.02), and age (0.010 [0.004], P = 0.004; 0.012 [0.005], P = 0.01), independent of other variables. Mean/maximal cIMT was greater in males (0.023 [0.006], P = 0.02; 0.029 [0.007], P < 0.0001), and mean cIMT related independently to systolic blood pressure (0.001 [0.001], P = 0.04). Vascular smooth muscle function related to aIMT and cIMT but not to urinary albumin excretion. CONCLUSIONS aIMT may be a more sensitive marker of atherosclerosis than cIMT in type 1 diabetes during mid-adolescence. Higher urinary albumin excretion, even within the normal range, is associated with early atherosclerosis and should direct clinical attention to modifiable cardiovascular risk factors.
    Diabetes Care 07/2014; 37(11). DOI:10.2337/dc14-0700 · 8.57 Impact Factor
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    ABSTRACT: Randomised controlled trials (RCT) examining the effects of fish oil supplementation on cardiac outcomes have yielded varying results over time. Although RCT are placed at the top of the evidence hierarchy, this methodology arose in the framework of pharmaceutical development. RCT with pharmaceuticals differ in important ways from RCT involving fish oil interventions. In particular, in pharmaceutical RCT, the test agent is present only in the intervention group and not in the control group, whereas in fish oil RCT, n-3 fats are present in the diet and in the tissues of both groups. Also, early phase studies with pharmaceuticals determine pharmacokinetics and pharmacodynamics to design the dose of the RCT intervention so that it is in a predicted linear dose-response range. None of this happens in fish oil RCT, and there is evidence that both baseline n-3 intake and tissue levels may be sufficiently high in the dose-response range that it is not possible to demonstrate a clinical effect with a RCT. When these issues are considered, it is possible that the changing pattern of fish consumption and fish oil use over time, especially in cardiac patients, can explain the disparity where benefit was observed in the early fish oil trials but not in the more recent trials.
    British Journal Of Nutrition 06/2014; 112(05):1-9. DOI:10.1017/S0007114514001408 · 3.34 Impact Factor
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    ABSTRACT: -Surviving myocytes within scar may form channels that support ventricular tachycardia (VT) circuits. There is little data on the properties of channels that comprise VT circuits and those which are non-VT supporting channels. -In 22 patients with ischemic cardiomyopathy and VT, high-density mapping was performed with the PentaRay™ catheter and Ensite NavX™ system during sinus rhythm. A channel was defined as a series of matching pace-maps with a stimulus (S) to QRS time of ≥40ms. Sites were determined to be part of a VT channel if there were matching pace-maps to the VT morphology. This was confirmed with entrainment mapping when possible. Of the 238 channels identified, 57 channels corresponded to an inducible VT. Channels that were part of a VT circuit were more commonly located within dense scar than non-VT channels (97% vs 82%, p=0.036). VT supporting channels were of greater length (mean±SEM 53±5 vs 33±4mm), had higher longest S-QRS (130±12 vs 82±12ms), longer conduction time (103±14 vs 43±13ms) and slower conduction velocity (0.87±0.23 vs 1.39±0.21m/s) than non-VT channels (p<0.001). Of all the fractionated, late and very late potentials located in scar, only 21%, 26% and 29% respectively were recorded within VT channels. -High-density mapping shows substantial differences among channels in ventricular scar. Channels supporting VT are more commonly located in dense scar, longer than non-VT channels, and have slower conduction velocity. Only a minority of scar related potentials participate in the VT supporting channels.
    Circulation Arrhythmia and Electrophysiology 02/2014; 7(1). DOI:10.1161/CIRCEP.113.000882 · 5.42 Impact Factor
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    ABSTRACT: The safety and nutritional adequacy of goat milk infant formulas have been questioned. The primary aim of the present study was to compare the growth and nutritional status of infants fed a goat milk infant formula with those of infants fed a typical whey-based cow milk infant formula. The secondary aim was to examine a range of health- and allergy-related outcomes. A double-blind, randomised controlled trial with 200 formula-fed term infants randomly assigned to receive either goat or cow milk formula from 2 weeks to at least 4 months of age was conducted. A cohort of 101 breast-fed infants was included for comparison. Weight, length and head circumference were measured at 2 weeks and 1, 2, 3, 4, 6 and 12 months of age. Nutritional status was assessed from serum albumin, urea, creatinine, Hb, ferritin, and folate and plasma amino acid concentrations at 4 months. Z-scores for weight, length, head circumference and weight for length were not different between the two formula-fed groups. There were differences in the values of some amino acids and blood biomarkers between the formula-fed groups, but the mean values for biomarkers were within the normal reference range. There were no differences in the occurrence of serious adverse events, general health, and incidence of dermatitis or medically diagnosed food allergy. The incidence of parentally reported blood-stained stools was higher in the goat milk formula-fed group, although this was a secondary outcome and its importance is unclear. Goat milk formula provided growth and nutritional outcomes in infants that did not differ from those provided by a standard whey-based cow milk formula.
    The British journal of nutrition 02/2014; 111(09):1-11. DOI:10.1017/S0007114513004212 · 3.34 Impact Factor
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    ABSTRACT: BACKGROUND A recent review concluded that general health checks fail to reduce mortality in adults. AIM This review focuses on general practice-based health checks and their effects on both surrogate and final outcomes. DESIGN AND SETTING Systematic search of PubMed, Embase, and the Cochrane Central Register of Controlled Trials. METHOD Relevant data were extracted from randomised trials comparing the health outcomes of general practice-based health checks versus usual care in middle-aged populations. RESULTS Six trials were included. The end-point differences between the intervention and control arms in total cholesterol (TC), systolic and diastolic blood pressure (SBP, DBP), and body mass index (BMI) were -0.13 mmol/l (95% confidence interval [CI] = -0.19 to -0.07), -3.65 mmHg (95% CI = -6.50 to -0.81), -1.79 mmHg (95% CI = -2.93 to -0.64), and -0.45 kg/m(2) (95% CI = -0.66 to -0.24), respectively. The odds of a patient remaining at 'high risk' with elevated TC, SBP, DBP, BMI or continuing smoking were 0.63 (95% CI = 0.50 to 0.79), 0.59 (95% CI = 0.28 to 1.23), 0.63 (95% CI = 0.53 to 0.74), 0.89 (95% CI = 0.81 to 0.98), and 0.91 (95% CI = 0.82 to 1.02), respectively. There was little evidence of a difference in total mortality (OR 1.03, 95% CI = 0.90 to 1.18). Higher CVD mortality was observed in the intervention group (OR 1.30, 95% CI = 1.02 to 1.66). CONCLUSION General practice-based health checks are associated with statistically significant, albeit clinically small, improvements in surrogate outcome control, especially among high-risk patients. Most studies were not originally designed to assess mortality.
    British Journal of General Practice 01/2014; 64(618):e47-53. DOI:10.3399/bjgp14X676456 · 2.36 Impact Factor
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    ABSTRACT: Partial weight bearing is often prescribed for patients with orthopedic injuries. Patients’ ability to accurately reproduce partial weight bearing orders is variable, and its impact on clinical outcomes is unknown. This observational study measured patients’ ability to reproduce partial weight bearing orders, factors influencing this, patients’ and physiotherapists’ ability to gauge partial weight bearing accuracy, and the effect of partial weight bearing accuracy on long-term clinical outcomes. Fifty-one orthopedic inpatients prescribed partial weight bearing were included. All received standard medical/nursing/physiotherapy care. Physiotherapists instructed patients in partial weight bearing using the hand-under-foot, bathroom scales, and/or verbal methods of instruction. Weight bearing was measured on up to 3 occasions during hospitalization using a force-sensitive insole. Factors that had the potential to influence partial weight bearing accuracy were recorded. Patients and their physiotherapists rated their perception of partial weight bearing accuracy. Three-month clinical follow-up data were retrieved from medical records. The majority of patients (72% or more) exceeded their target load, with mean peak weight bearing as high as 19.3 kg over target load (285% of target load). Weight bearing significantly increased over the 3 measurement occasions (P<.001) and was significantly associated with greater body weight (P=.04). Patients and physiotherapists were unable to accurately gauge partial weight bearing accuracy. The incidence of clinically important complications at 3 months was 9% and not significantly associated with partial weight bearing accuracy during hospitalization (P≥.45). Patients are unable to accurately reproduce partial weight bearing orders when trained with the hand-under-foot, bathroom scales, or verbal methods of instruction.
    Orthopedics 01/2014; 37(1):e10-8. DOI:10.3928/01477447-20131219-10 · 0.98 Impact Factor
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    ABSTRACT: (1) To investigate the association between temperature and work-related injuries and (2) to identify groups of workers at high risk of work-related injuries in hot environments in Adelaide, South Australia. Workers' compensation claims in Adelaide, South Australia for 2001-2010 were used. The relationship between temperature and daily injury claims was estimated using a generalised estimating equation model. A piecewise linear spline function was used to quantify the effect of temperature on injury claims below and above thresholds. Overall, a 1°C increase in maximum temperature between 14.2°C and 37.7°C was associated with a 0.2% increase in daily injury claims. Specifically, the incidence rate ratios (IRRs) for male workers and young workers aged ≤24 were (1.004, 95% CI 1.002 to 1.006) and (1.005, 95% CI 1.002 to 1.008), respectively. Significant associations were also found for labourers (IRR 1.005, 95% CI 1.001 to 1.010), intermediate production and transport workers (IRR 1.003, 95% CI 1.001 to 1.005) and tradespersons (IRR 1.002, 95% CI 1.001 to 1.005). Industries at risk were agriculture, forestry and fishing (IRR 1.007, 95% CI 1.001 to 1.013), construction (IRR 1.006, 95% CI 1.002 to 1.011), and electricity, gas and water (IRR 1.029, 95% CI 1.002 to 1.058). There is a significant association between injury claims and temperature in Adelaide, South Australia, for certain industries and groups. Relevant adaptation and prevention measures are required at both policy and practice levels to address occupational exposure to high temperatures.
    Occupational and environmental medicine 12/2013; DOI:10.1136/oemed-2013-101584 · 3.23 Impact Factor
  • Helen Marshall, Michelle Clarke, Thomas Sullivan
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    ABSTRACT: A new meningococcal serogroup B (Men B) vaccine has been licensed in the European Union (EU) and Australia. This study aimed to assess community and parental attitudes to introduction of new Men B vaccines and identify facilitators and barriers to vaccine implementation. Cross-sectional survey including face-to-face interviews with adolescents, parents and adults from randomly selected households in South Australia in 2012. Survey data were weighted to the age, gender and geographical area profile of the population. 3055 interviews were conducted with individuals aged 15-97 years, including 966 parents. Participation rate was 66.4%. 82.5% (95% CI 79.7-85.4) of parents (797/966) wanted their child to receive the Men B vaccine, with 12.2% (9.7-14.7) (118/966) unsure. Main parental concerns included potential side effects (41.3% (26.7-46.0)) and adequate vaccine testing (11.7% (9.4-14.1)). Potential for an extra injection at an immunisation visit resulted in 15.7% (12.8-18.5) of parents (n=152/966) less likely to have their child immunised. Potential redness/swelling at the injection site or mild/moderate fever resulted in only 8.5% (6.3-10.7) and 10.8% (8.5-13.2) of parents, respectively, less likely to have their child immunised. Children being up to date with vaccinations and recommendation from family physician were the strongest independent predictors of parents agreeing their children should be immunised with Men B vaccine (OR=6.58; p=0.006 and OR=4.15; p<0.001, respectively). Only 16.4% (14.9-17.9) of adults (501/3055) stated that they would not want to receive a Men B vaccine, with family physician recommendation the strongest independent predictor of acceptance (OR=3.81; p<0.001). There is strong community support for introduction of Men B vaccines, with parental willingness to have children immunised, impacted more by number of injections than potential for adverse events such as local reactions or fever.
    Vaccine 11/2013; 32(3). DOI:10.1016/j.vaccine.2013.11.042 · 3.49 Impact Factor
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    ABSTRACT: -Atrial fibrillation (AF) ablation is an established therapy; however, limited data is available on associated complications. This systematic review determines the incidence and potential predictors of acute complications. -Electronic searches were conducted in MEDLINE and EMBASE for English scientific literature up to the 18(th) June 2012. 2065-references were retrieved and evaluated for relevance. Reference lists of retrieved studies and review articles were examined to ensure all relevant studies were included. Data was extracted from 192-studies, total of 83,236-patients. The incidence of peri-procedural complications for catheter ablation of AF was 2.9% (95%CI, 2.6-3.2). There was a significant decrease in the acute complication rate in 2007-2012 compared to 2000-2006 (2.6% versus 4.0%, P=0.003). The complication rates reported were higher in prospective studies compared to those that retrospectively described complications (3.5% vs 2.7%, P= 0.03). There were no significant associations between procedure duration, ablation time, or ablation strategy, and acute complication rate. -Catheter ablation of AF has a low incidence of peri-procedural complications. The acute complication rate has decreased significantly in recent years. This may reflect improved catheter technology and experience. The use of different strategies across centers worldwide appears to be safe with no established relationship between procedural variables and complication rate.
    Circulation Arrhythmia and Electrophysiology 11/2013; 6(6). DOI:10.1161/CIRCEP.113.000768 · 5.42 Impact Factor
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    ABSTRACT: Background/objectives:Randomised controlled trials (RCTs) evaluating the effect of fish oil supplementation on postoperative atrial fibrillation (POAF) following cardiac surgery have produced mixed results. In this study, we examined relationships between levels of red blood cell (RBC) n-3 long-chain polyunsaturated fatty acids (LC-PUFAs) and the incidence of POAF.Subjects/methods:We used combined data (n=355) from RCTs conducted in Australia and Iceland. The primary end point was defined as POAF lasting >10 min in the first 6 days following surgery. The odds ratios (ORs) for POAF were compared between quintiles of preoperative RBC n-3 LC-PUFA levels by multivariable logistic regression.Results:Subjects with RBC docosahexaenoic acid (DHA) in the fourth quintile, comprising a RBC DHA range of 7.0-7.9%, had the lowest incidence of POAF. Subjects in the lowest and highest quintiles had significantly higher risk of developing POAF compared with those in the fourth quintile (OR=2.36: 95% CI; 1.07-5.24 and OR=2.45: 95% CI; 1.16-5.17, respectively). There was no association between RBC eicosapentaenoic acid levels and POAF incidence.Conclusions:The results suggest a 'U-shaped' relationship between RBC DHA levels and POAF incidence. The possibility of increased risk of POAF at high levels of DHA suggests an upper limit for n-3 LC-PUFAs in certain conditions.European Journal of Clinical Nutrition advance online publication, 30 October 2013; doi:10.1038/ejcn.2013.215.
    European journal of clinical nutrition 10/2013; 68(1). DOI:10.1038/ejcn.2013.215 · 2.95 Impact Factor
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    ABSTRACT: Stereotactic radiosurgery (SRS) is a well established, minimally invasive treatment option for patients diagnosed with cerebral arteriovenous malformations (AVM). We present the experience in linear accelerator-based SRS for cerebral AVM treated over 14years. We prospectively followed 67 patients with 69 AVM treated with SRS from 1994 to 2008, inclusive. The mean patient age was 37years (range 7-69) with 36 women and 31 men. The median AVM size, as defined by maximal diameter, was 2.5cm (range 0.5-4.6cm) and the median marginal dose was 18Gy in one fraction. The crude angiographic obliteration rate was 55% with a 3 and 5year actuarial rate of 39% and 65%, respectively. Median time to obliteration was 4.2years. Higher treatment dose (p<0.0001) and smaller maximal AVM diameter (p=0.002) were associated with an increased obliteration rate. There were no deaths from treatment. Post-treatment neurological complications occurred in 10 patients (15%) including hemorrhage in two. Twelve patients (18%) required a second SRS procedure. Larger AVM diameter was associated with increased odds of requiring re-treatment (p=0.02). Radiosurgery for intracerebral AVM is a non-invasive therapeutic option with low morbidity and a reasonable likelihood of nidus obliteration. Treatment dose and AVM diameter are the main determinants of obliteration.
    Journal of Clinical Neuroscience 10/2013; 21(2). DOI:10.1016/j.jocn.2013.03.040 · 1.32 Impact Factor
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    ABSTRACT: The effects of fish oil (FO) in rheumatoid arthritis (RA) have not been examined in the context of contemporary treatment of early RA. This study examined the effects of high versus low dose FO in early RA employing a 'treat-to-target' protocol of combination disease-modifying anti-rheumatic drugs (DMARDs). Patients with RA <12 months' duration and who were DMARD-naïve were enrolled and randomised 2:1 to FO at a high dose or low dose (for masking). These groups, designated FO and control, were given 5.5 or 0.4 g/day, respectively, of the omega-3 fats, eicosapentaenoic acid + docosahexaenoic acid. All patients received methotrexate (MTX), sulphasalazine and hydroxychloroquine, and DMARD doses were adjusted according to an algorithm taking disease activity and toxicity into account. DAS28-erythrocyte sedimentation rate, modified Health Assessment Questionnaire (mHAQ) and remission were assessed three monthly. The primary outcome measure was failure of triple DMARD therapy. In the FO group, failure of triple DMARD therapy was lower (HR=0.28 (95% CI 0.12 to 0.63; p=0.002) unadjusted and 0.24 (95% CI 0.10 to 0.54; p=0.0006) following adjustment for smoking history, shared epitope and baseline anti-cyclic citrullinated peptide. The rate of first American College of Rheumatology (ACR) remission was significantly greater in the FO compared with the control group (HRs=2.17 (95% CI 1.07 to 4.42; p=0.03) unadjusted and 2.09 (95% CI 1.02 to 4.30; p=0.04) adjusted). There were no differences between groups in MTX dose, DAS28 or mHAQ scores, or adverse events. FO was associated with benefits additional to those achieved by combination 'treat-to-target' DMARDs with similar MTX use. These included reduced triple DMARD failure and a higher rate of ACR remission.
    Annals of the rheumatic diseases 09/2013; 74(1). DOI:10.1136/annrheumdis-2013-204145 · 9.27 Impact Factor
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    ABSTRACT: QT variability (QTV) signifies repolarization lability and increased QTV is a risk predictor for sudden cardiac death. The aim of this study was to investigate the role of autonomic nervous system activity on QTV. The study was performed in 29 subjects: 10 heart failure patients with spontaneous ventricular tachycardia [HFVT(+)], 10 heart failure patients without spontaneous VT [HFVT(-)], 9 subjects with structurally normal hearts (HNorm). Beat-to-beat QT interval was measured on 3-minutes records of surface ECG at baseline and during interventions [atrial pacing, esmolol, isoprenaline and atropine infusion]. Variability in QT intervals was expressed as standard deviation of all QT intervals (SDQT). The ratio of SDQT to SDRR was calculated as an index of QTV normalized to heart rate variability. There was a trend towards higher baseline SDQT/SDRR in the HFVT(+) group compared to the HFVT(-) and HNorm groups (p=0.09). SDQT increased significantly in the HFVT(+) and HFVT(-) groups compared to HNorm patients during fixed rate atrial pacing (p=0.008). Compared to baseline, isoprenaline increased SDQT in the HNorm group (p=0.02), but not in HF patients. SDQT remained elevated in the HFVT(+) group relative to the HNorm group despite acute beta-adrenoceptor blockade with esmolol (p= 0.02). In conclusion, patients with HF and spontaneous VT have larger fluctuations in beat-to-beat QT intervals. This appears to be a genuine effect that is not solely a consequence of heart rate variation. The effect of acute autonomic nervous system modulation on QTV appears to be limited in HF patients.
    AJP Heart and Circulatory Physiology 08/2013; 305(8). DOI:10.1152/ajpheart.00448.2013 · 4.01 Impact Factor
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    ABSTRACT: Cardiovascular disease is the leading cause of mortality in Type 1 diabetes (T1D). Vascular dysfunction is an early and critical event in the development of cardiovascular disease. Children with T1D have vascular dysfunction therefore early interventions to improve vascular health are essential to reduce cardiovascular mortality in T1D. Metformin is an insulin sensitising agent which is known to improve vascular health outcomes in type 2 diabetes (T2D) and other individuals with insulin resistance. It has been used safely in children and adolescents with T2D for over 10 years. This study aims to assess the effect of metformin on vascular health in children with T1D.Methods/designThis study is a 12 month, double blind, randomised, placebo controlled trial to determine the effect of metformin on vascular health in children (age 8--18) with T1D. The sample size is 76 with 38 children in the metformin group and 38 children in the placebo group. Vascular health and biochemical markers will be measured at baseline, 3, 6 and 12 months. Vascular function will be measured using flow mediated dilatation and glyceryl trinitrate mediated dilatation of the brachial artery and vascular structure will be measured with carotid and aortic intima media thickness, using standardised protocols. This study will be the first to investigate the effect of metformin on vascular health in children with T1D. It will provide important information on a potential intervention to improve cardiovascular morbidity and mortality in this population at high risk from cardiovascular disease.Trial registrationAustralia New Zealand Clinical Trials Registry ACTRN12611000148976.
    BMC Pediatrics 07/2013; 13(1):108. DOI:10.1186/1471-2431-13-108 · 1.92 Impact Factor
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    ABSTRACT: BACKGROUND: Implantable Cardioverter Defibrillators (ICDs) have been demonstrated to reduce mortality in survivors of life-threatening arrhythmias (secondary prevention) and in patients at increased risk of sudden cardiac death (primary prevention). Other nations have reported significant increases in ICD use in recent years. We examined Australian nationwide trends of ICD procedures over a 10-year period (2000-2009). METHODS: A retrospective analysis of the Australian Institute of Health and Welfare's National Hospital Morbidity Database was performed to determine the annual number of ICD implantation and replacement procedures between 2000-2009. Rates were calculated using Australian Bureau of Statistics data on the annual estimated population. Time trends in the yearly procedure number and rate were analysed using negative binomial regression models with comparisons made by age and sex. RESULTS: The number of new ICD implantations increased from 708 to 3198 procedures between 2000-2009. Replacement procedures increased from 290 to 1378. The implantation rate (per million) increased from 37.0 to 145.6 and the replacement rate from 15.1 to 62.7. When rates were adjusted for age and sex, the implantation rate increased annually by 15.8% and the replacement rate by 16.6% (p<0.0001). Procedures occurred most commonly in men (implantations: 80.1%; replacements: 78.0%) between ages 70-79. CONCLUSIONS: ICD procedures increased significantly in Australia between 2000-2009. Despite these increases, other studies have suggested ICD devices are currently under-utilised. During the study period, males accounted for the majority of ICD procedures. While there are numerous reasons for this, it is not known if device under-use is more common in females.
    Internal Medicine Journal 06/2013; 43(8). DOI:10.1111/imj.12201 · 1.70 Impact Factor

Publication Stats

465 Citations
188.64 Total Impact Points

Institutions

  • 2008–2014
    • University of Adelaide
      • • Data Management and Analysis Centre
      • • Discipline of Public Health
      Tarndarnya, South Australia, Australia
  • 2012
    • Elsevier B.V.
      Philadelphia, Pennsylvania, United States
  • 2010–2012
    • Royal Adelaide Hospital
      • • Centre for Heart Rhythm Disorders
      • • Department of Cardiology
      Tarndarnya, South Australia, Australia