Charley Budgeon

Background: Low‐dose colchicine reduces cardiovascular events in patients with chronic coronary disease. However, side effects may compromise compliance and lead to discontinuation of treatment. Therefore, we aimed to assess the incidence of side effects leading to discontinuation of treatment in the LoDoCo2 (Low‐Dose Colchicine 2) trial. Methods: The LoDoCo2 trial was a randomized controlled trial evaluating colchicine versus placebo in patients with chronic coronary disease. Participants entered a 30‐day open‐label run‐in phase during which all participants received colchicine 0.5 mg once daily, followed by randomization to colchicine or placebo. Tolerability‐related side effects leading to treatment discontinuation were evaluated at the end of the 30‐day run‐in phase and during the randomized phase (median follow‐up, 29.5 [interquartile range, 21.6–47.4] months). Cumulative incidence of side effects was presented using Kaplan–Meier curves and compared by treatment arm using Cox proportional hazards models. Results: During the 30‐day run‐in phase, 618 of 6519 (9.5%) participants reported side effects. Women had a higher risk of side effects than men during the 30‐day run‐in phase (odds ratio, 1.53 [95% CI, 1.23–1.89]). After randomization, 114 participants (4.2%) in the colchicine group and 120 (4.4%) in the placebo group discontinued treatment due to side effects (hazard ratio [HR], 0.95 [95% CI, 0.73–1.22]). Gastrointestinal symptoms were most common (colchicine 2.0% versus placebo 1.7%) followed by myalgia (colchicine 1.2% versus placebo 1.6%). No differences in the risk of side effects between colchicine and placebo were seen for any of the subgroups. Women did have a higher risk of reporting side effects compared with men, regardless of assigned treatment (HR, 1.66 [95% CI, 1.22–2.25]). Conclusions: In patients with chronic coronary disease that tolerated initial treatment with low‐dose colchicine, long‐term discontinuation due to side effects was uncommon and did not differ between colchicine and placebo. Registration: URL: https://www.anzctr.org/au ; Unique identifier: ACTRN12614000093684.

Introduction: Medication-related readmissions are a significant and preventable cause of patient harm. Patients living in rural and remote areas may face inequitable access to healthcare and fragmented continuity of care, increasing their vulnerability to medication-related harm. Despite this, the burden and drivers of medication-related readmissions in these settings remain poorly understood. Determining the current burden and identifying factors associated with medication-related readmissions is essential to inform targeted strategies to improve medication safety. Aim: To determine the proportion of adult patients with a medication-related readmission within 30 days of discharge from rural and remote hospitals, and to identify factors potentially associated with these readmissions. Method: A retrospective cohort study was conducted using medical records of adults admitted to rural and remote hospitals in New South Wales, Australia, between June 1, 2022 and August 31, 2023. Readmissions within 30 days were assessed for medication-related causes using the AT-HARM10, a validated 10-item tool based on admission notes, medication lists, inpatient pathology results, and discharge summaries. Patient demographics, comorbidities and admission details were extracted. Comorbidity burden was calculated using the Charlson Comorbidity Index (CCI). Medication lists were based on medications charted 12 h before discharge. Univariable logistic regression was performed to explore factors associated with 30-day medication-related readmissions, with results reported as unadjusted odds ratios (uOR). Results: Of the 2220 patients admitted during the study period, 6% (n = 133) experienced a 30-day readmission, of which 22.5% (n = 30) were medication-related. Overall, 1.4% of all admitted patients experienced a 30-day medication-related readmission. Older age (uOR 1.04; 95% CI 1.01–1.07), higher CCI (uOR 1.22; 95% CI 1.04–1.44), a greater number of regular medications (uOR 1.07 per additional medication; 95% CI 1.01–1.14), and insulin use (uOR 2.80; 95% CI 1.06–7.42) were associated with medication-related readmission. Conclusion: In rural and remote hospitals, a small but clinically important proportion of patients experienced a medication-related readmission within 30 days of discharge. Unadjusted analysis identified that older age, multimorbidity, polypharmacy and insulin use were associated with increased risk. Larger studies are needed to validate these findings and evaluate strategies to reduce medication-related harm in rural and remote populations.

The built environment plays a key role in shaping children’s opportunities to be physically active; however, few studies have integrated objective and parent-perceived built environment measures to derive data-driven neighbourhood typologies and examine longitudinal associations with device-measured movement behaviours across developmental stages.Longitudinal associations between movement behaviours and neighbourhood typologies across early to middle childhood were examined using data from the PLAYCE (Play Spaces and Environments for Children’s Physical Activity) cohort (n=569; aged 2-10 years). Movement behaviours were measured using accelerometers and classified using a machine-learning model. Six neighbourhood physical environment profiles identified in a previous study using latent profile analysis were applied.Across all profiles, most movement behaviours showed non-linear age trajectories except for walking. Differences between physical environment profiles were consistent across ages and sexes. Children living in ‘semi-rural’ neighbourhoods accumulated more walking time than those in other profiles, and more total daily physical activity and light-intensity play than all profiles except those characterised by higher access to blue space. Profiles characterised by higher residential density, greater traffic exposure, and limited private yard space were associated with lower levels of energetic play and walking, despite relatively good access to public transport and destinations.Neighbourhoods offering access to private outdoor space, natural environments, and lower traffic exposure appear to support physical activity across early to middle childhood. Urban planning and housing policies should prioritise child-friendly design features, such as access to play space, nature, and low traffic exposure, to promote opportunities for physical activity from early life.

Hospital admission is high risk for medication harm due to transfer errors, delays, and charting mistakes. Up to 70% of admission medication lists contain errors, 59% potentially harmful, highlighting the need for safety strategies. The aim of the study is to systematically review the effectiveness of strategies for medication management at hospital admission. Following PRISMA guideline, three databases were searched for RCTs. Subgroup analyses assessed outcomes including mortality, readmissions/Emergency Department (ED) visits, length of stay (LOS), medication errors, and adverse drug events (ADEs), with meta‐analysis where possible. Nineteen RCTs were included. The strategies were classified into five categories: medication reconciliation, supported medication review, collaborative model of medication review, Partnered Pharmacist Medication Charting (PPMC), and real‐time health information exchange (HIE) tools. Medication reconciliation alone showed limited effectiveness in reducing medication errors and ADEs while combining with other strategies was more effective in minimizing ADEs. The meta‐analysis showed that PPMC can be considered a potential strategy to reduce medication errors and ADEs. Outcomes such as readmission, ED visits, mortality, and LOS were reported as secondary outcomes, and the strategies showed no significant effect in improving them. Overall admission strategies can reduce medication‐related outcomes such as medication errors and ADEs; however, stronger evidence is needed to confirm their impact on other outcomes. Future research should focus on integrating Clinical Decision Support (CDS) and stratification tools into electronic medical records to enhance the efficiency of these tools.

Aims: Bioprosthetic valves are increasingly used for surgical aortic valve replacement (SAVR) in patients ≤ 70 years though the relative benefits compared to mechanical valve replacement remain uncertain. This study aims to compare mortality and other outcomes by prosthesis type for patients aged 50–70 years who received SAVR in a well-characterized Australian cohort. Methods and results: Data were prospectively collected at the time of heart valve surgery and linked administrative outcome data. This analysis includes all patients aged 50–70 years who had SAVR in Western Australian public hospitals between 2010 and 2020. The primary endpoint was all-cause mortality. Secondary endpoints were cardiovascular mortality, separately and combined with admission for either non-fatal myocardial infarction or for non-fatal stroke (MACE), major bleeding, and days alive and out of hospital (DAOH). Outcomes, categorized by prosthesis type (mechanical or bioprosthetic), were compared using propensity matching. Within the initial cohort of 706 patients undergoing SAVR (mean age 62.5 years, SD 6), propensity score matching identified 149 patients each with mechanical or bioprosthetic valves. After adjustment, patients who received mechanical valves had lower all-cause mortality [adjusted hazard ratio (aHR) 0.51; 95% confidence interval (CI) 0.27–0.98; P = 0.04] and MACE (aHR 0.53; 95% CI 0.30–0.95; P = 0.03) during median follow-up of 3.6 years. Mechanical valves were associated with increased risk of major bleeding (aHR3.40; 95% CI 1.32–8.77; P = 0.01). There was no difference in risk of cardiovascular mortality, admissions for non-fatal MI, non-fatal stroke, or DAOH by prosthesis type. Conclusion: Patients aged 50–70 years who underwent mechanical valve SAVR had lower risk of all-cause mortality and MACE compared with those who received a bioprosthesis, despite higher bleeding risk. Randomized comparisons are necessary to confirm these findings.

Objective: To determine age-specific and age-standardised incidence trends of acute rheumatic fever (ARF) or rheumatic heart disease (RHD) among Indigenous Western Australians aged less than 35 years of age. Design: A population-based retrospective cohort study with linked data analysis. Setting: Western Australian hospital admissions (1996–2022) and RHD notifications to the state-based register (2011–2015). Participants: Patients, both Indigenous and non-Indigenous aged <35 years at diagnosis with incident ARF or RHD. Results: Of 1746 incident ARF/RHD cases, 1526 (87%) were Indigenous peoples, with the highest rates observed in patients aged 5–14 years, with an annual estimated increase of 4.3% (95% CI 3.2% to 5.2%). The 0–4 years age group experienced an annual increase in incidence rates of 4.8% (95% CI 1.4% to 8.2%). Overall, Indigenous patients experienced an annual increase of 1.9% (95% CI 1.3% to 2.6%) from 1996 to 2022. However, most cases (n=894) were identified after multiple significant policy developments (2011–2022) with an annual increase of 5.7% (95% CI 3.7% to 7.5%) for this period. Conclusion: Increasing trends of incident ARF/RHD were observed in Indigenous patients aged under 15 years, with the greatest annual increments observed after policy implementation for disease reporting and awareness in the period from 2011 to 2022. Improvement in case ascertainment of ARF/RHD may be contributing towards increasing trends with improved reporting and monitoring of incident cases in very young Indigenous Australians more recently.

This review explored the use of linked administrative data to study outcomes associated with adverse childhood experiences (ACEs), which are traumatic events during childhood. A search of Medline, PsycINFO, Embase, ERIC, Education Source, and CINAHL Plus identified studies published from 1998 to 2023. To be included, studies had to use linked administrative data to determine ACE exposure in individuals aged 0 to 18 years, focusing on outcomes categorized as Health, Education, Welfare, or Justice. Following deduplication, title and abstract screening, and a full text review, a total of 309 studies met the inclusion criteria. The review summarized study characteristics such as publication year, geographic location, sample size, age of participants, type of ACE exposure, and outcome studied. An increasing trend in ACE-related publications over the review period was evident, with sample sizes most commonly ranging from 5,001 to 50,000 individuals. The majority of studies utilized data sourced in Australia and the USA, and the participants were predominantly aged 0 to 2 years, with fewer studies involving older children. Over half of the included studies focused on single ACE exposures, particularly sexual abuse, either as a standalone factor or part of broader child maltreatment reports. ACE exposure was most often identified at the level of the “parent/carer,” with mothers more likely to be included when a single parent only was analyzed. Health outcomes were the most frequently studied. While linked administrative data provides a powerful tool for examining multiple exposures and outcomes, the review found a potential under-utilization of its full potential, with fewer studies addressing multiple exposures and outcomes simultaneously.

Introduction Cardiac rehabilitation after type 1 myocardial infarction (type 1 MI) is an effective but underutilised method of preventing new cardiac events. This study aims to determine whether a programme of personalised cardiac rehabilitation achieves better completion rates compared with a routine outpatient rehabilitation model post-type 1 MI. A secondary aim is to determine any differences in rates of major adverse cardiovascular events at 12 months. Methods and analysis Secondary prevention for all in need (SPAN) is a prospective multisite single-blind comparative effectiveness randomised trial of personalised versus standard outpatient rehabilitation. Five hundred and thirty-two patients with a recent type 1 MI diagnosis will be randomised to either a personalised model of rehabilitation which includes flexibility in the components of rehabilitation and the time and location of contacts, or the standard outpatient model. Exclusion criteria include conditions associated with higher clinical risk to the participant, which introduce confounding to the study or interfere with a participant’s ability to comply. The primary study endpoint is the proportion of patients who complete the assigned rehabilitation model. Completion of rehabilitation is defined as participation in ≥80% of all scheduled sessions, in either treatment arm. Assuming a power of 90% and an overall type 1 error of 5%, we expect that 50% of those randomised to usual care will meet the primary endpoint compared with 65% of those on personalised rehabilitation. To detect this difference of 15%, we require a sample size of 478 participants (239 per arm). Accounting for a conservative attrition rate of 10%, the total sample size required is 532. Ethics and dissemination The trial received ethical approval from the Southern Adelaide Clinical Human Research Ethics Committee (ref. 2022/HRE00071) in September 2022, with an opt-out approach. The findings will be disseminated through peer-reviewed journals. Trial registration number ACTRN12622000316707.

Introduction Transition of care from hospital is a period when the risks of medication errors and adverse events are high, with 50% of adults discharged having at least one medication-related problem. Pharmacist-led medication reviews can reduce medication errors and unplanned readmission when completed promptly post-discharge; however, they are underutilised. A Transition of Care Stewardship pharmacist has been proposed to facilitate and coordinate a patient’s discharge process and facilitate a timely post-discharge medication review. Access to pharmacist medication review in rural and regional areas can be limited. This protocol describes a randomised controlled trial (RCT) to determine whether a virtual Transition of Care Stewardship pharmacist reduces medication-related harm in rural and regional Australia. Method and analysis Multicentre RCT involving patients at high risk of medication-related harm discharged from regional and rural hospitals to a domiciliary residence. Eligible patients must be aged≥18 years, admitted under a medical specialty, be discharged to a domiciliary setting, have a regular general practitioner (GP) or be willing to visit a GP or an Aboriginal Medical Service after discharge for medical follow-up, have a Medicare card and be at high risk of readmission. High risk of readmission is defined as either a previous admission to the hospital or Emergency Department (ED) presentation in the past 6 months AND≥three regular medications OR on at least ONE high-risk medication. A total of 922 participants will be recruited into the study. Enrolled participants will be randomised to the intervention or control (usual care). The intervention will include a virtual Transition Of Care Stewardship pharmacist to ensure that patients receive discharge medication reconciliation, medication counselling, medication list and communicate directly with primary care providers to facilitate a timely post-discharge medication review. Usual care will include informing the patient’s clinical inpatient treating team that the patient is at high risk of medication misadventure and may benefit from a post-discharge Home Medicines Review (a GP-referred pharmacist medication review funded by the Australian Government). Data analysis will be performed on a modified intent-to-treat basis. The primary outcome assessed is a composite of a first unplanned medication-related hospitalisation or ED presentation within 30 days of hospital discharge. Comparisons between the intervention and usual care groups for the primary outcome will be made using a mixed-effects logistic regression model, adjusting for site-level clustering as a random effect. Ethics and dissemination This study is approved to be conducted at the Western New South Wales Local Health District via the Research Ethics and Governance Information System (approval number: 2023/ETH00978). To ensure the needs of Aboriginal and Torres Strait Islander patients are appropriately addressed, ethics for this study were submitted and approved by the Aboriginal Health and Medical Research Council (approval number: 2148/23). Manuscripts resulting from this trial will be submitted to peer-reviewed journals. Results may also be disseminated at scientific conferences and meetings with key stakeholders. Trial registration number ACTRN12623000727640.