Publications by authors named "Stevens W"

Background: Adolescent hip dysplasia is a condition that often affects hip mechanics, leading to loss of function, pain, and early onset osteoarthritis. Objective literature investigating functional activities remains sparse within this population. A traditional body weight deep squat has translation to everyday tasks, is a clinical screening tool, and is also a common pre/rehabilitation exercise.

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Background: The International Normalized Ratio (INR) monitors anticoagulant treatment but relies on laboratory-based services. This could limit access to rapid monitoring and increase the diagnostic delay, both of which may be addressed by point-of-care testing (POCT). This study investigated the LumiraDx POC platform for INR monitoring.

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Objective: To define the frequency and associations of opioid use in SSc.

Methods: Australian Scleroderma Cohort Study participants meeting ACR/EULAR criteria for SSc were included. Current or previous opioid use was recorded at each visit, with long-term use defined as use on two or more consecutive visits.

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Introduction/objectives: To identify the frequency, correlates and progression of frailty in systemic sclerosis (SSc).

Method: All Australian Scleroderma Cohort Study participants meeting ACR/EULAR criteria with a calculable FRAIL Scale score were included. FRAIL Scale scores were calculated annually and were used to group participants as 'robust', 'pre-frail' or 'frail'.

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Introduction: To ensure there is adequate investment into diagnostics, an understanding of the magnitude of impact and return on investment is necessary. We, therefore, sought to understand the health and economic impacts of the molecular diagnostic programme in South Africa, to deepen the understanding of the broad value of diagnostics and guide future healthcare investments.

Methods: We calculated the 10-year (where data were available) total cost and disability-adjusted life-years (DALYs) averted associated with molecular testing for tuberculosis diagnosis (2013-2022), HIV viral load monitoring (2013-2022), early infant diagnosis of HIV infection (2013-2022) and SARS-CoV-2 testing (2020-2022), based on the actual number of molecular tests conducted in South Africa for the respective time periods.

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Objective: Scleroderma renal crisis (SRC) is associated with high morbidity and mortality and there remain unmet needs regarding early identification and treatment. We aimed to assess risk factors for and the outcomes of SRC at a large Australian tertiary hospital.

Methods: Seventeen incident SRC cases were diagnosed between 2012 and 2022.

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Objective: Organ damage in systemic sclerosis (SSc) in individual organs such as the lungs may be prevented by immunosuppressive drugs (IS). A new measure of global organ damage, the Scleroderma Clinical Trials Consortium Damage Index (SCTC-DI), has allowed us to investigate whether IS may reduce global organ damage accrual in early SSc.

Methods: This was a retrospective study of patients with < 2 years disease duration in Canadian and Australian SSc cohorts.

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Background: Chronic rhinosinusitis with nasal polyps (CRSwNP) is characterized by type 2 (T2) inflammation. Recent studies, including our own, suggest that neutrophils are also elevated in T2 nasal polyps (NP) and that elevated neutrophils display an activated phenotype. However, the actual roles of neutrophils in NP pathogenesis in T2 CRSwNP are still largely unclear.

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Background: Reflexed cryptococcal antigenaemia (CrAg) testing has been offered since 2016 in South Africa, on remnant CD4 specimens, for people with a count < 100 cells/μL. Local guidelines recommended extending testing to 200 cells/μL.

Objectives: This study assessed the cost per result and annual equivalent costs (AEC) for CD4 counts < 100 cells/μL and 100 to 200 cells/μL, as well as determining the cost to find one CrAg-positive case.

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Background: The double-blind, 2 × 2 factorial design, placebo-controlled ASCEND randomized trial compared the effects of 100 mg aspirin daily and, separately, 1 g omega-3 fatty acids (FAs) daily on the primary prevention of cardiovascular disease in 15,480 UK adults with diabetes. We report the effects of these randomized treatment allocations on scores derived from the National Eye Institute's Visual Function Questionnaire-25 (NEI-VFQ-25) in a subset of participants involved in the ASCEND-Eye sub-study.

Methods: Ordinal data from the NEI-VFQ-25 were analyzed using proportional odds regression methods.

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Article Synopsis
  • The study focuses on understanding the risk factors and timing of tuberculosis (TB) recurrence to help reduce its prevalence.
  • Data was analyzed from a large national health database in South Africa, tracking TB episodes from 2013 to 2017, including criteria for defining the beginning and end of TB episodes.
  • Results revealed that 4.7% of individuals with rifampicin-susceptible TB experienced recurrence, particularly among males and people with HIV, with most recurrences happening within the first year after treatment.
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  • The EMPA-KIDNEY trial examined the effects of empagliflozin, an SGLT2 inhibitor, on patients with chronic kidney disease at risk for progression, assessing outcomes during and after the trial.
  • A total of 6609 patients were randomized, with 4891 participating in a follow-up period after the trial where they were observed for an additional 2 years, without trial medication but allowed to use other SGLT2 inhibitors.
  • Results showed that fewer primary outcome events (like kidney disease progression or cardiovascular death) occurred in the empagliflozin group (26.2%) compared to the placebo group (30.3%), suggesting lasting benefits of the drug even after the trial ended. *
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Given the rarity of primary central nervous system lymphoma (PCNSL), evaluations of different high-dose methotrexate-(HD-MTX)-based treatment regimens is sparse. This retrospective, multicenter study evaluates clinical characteristics and outcomes (progression-free, overall and disease-specific survival) after five HD-MTX-based polychemotherapeutic regimens and two consolidation therapies. 346 patients with histologically confirmed PCNSL, treated with ≥ 1 cycle HD-MTX-based strategies (≥3g/m/cycle) were included.

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  • - The study investigated how season, temperature, and humidity affect the severity of Raynaud phenomenon (RP) in patients with systemic sclerosis, utilizing data from the Australian Scleroderma Cohort Study.
  • - Among 1,972 participants, 26.7% experienced worsened RP related to environmental factors such as low temperatures and high humidity, which were linked to poorer health-related quality of life.
  • - The findings suggest that managing RP may benefit from maintaining warmer and drier conditions, highlighting the importance of environmental factors in treating this condition.
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  • Pulmonary arterial hypertension and left ventricular diastolic dysfunction are serious complications in patients with systemic sclerosis, which can lead to high morbidity and mortality rates.
  • A study involving 61 systemic sclerosis patients in Australia assessed the prevalence of these conditions along with their correlation to N-terminal pro-brain natriuretic peptide levels.
  • The findings revealed that 8% of patients had a high likelihood of pulmonary hypertension, and those with either pulmonary hypertension or diastolic dysfunction showed significantly elevated levels of N-terminal pro-brain natriuretic peptide compared to those without these conditions.
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  • * Researchers monitored 47 newly diagnosed adults with HL over 18 months, finding that advanced disease and significant symptoms were prevalent among all participants, regardless of HIV status.
  • * Results indicated that PWH experienced higher early mortality and lower overall survival at one year compared to HIV-negative patients, suggesting a need for better tailored treatments and understanding the factors leading to these poor outcomes.
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  • * Researchers found that NP B cells expressing the extrafollicular marker EBI2 had a higher propensity for autoantibody production and that NP ASCs were more common than those in tonsils.
  • * Analysis showed significant differences in the composition and molecular characteristics of B cells, indicating that NP EBI2+ ASCs produce more total and anti-dsDNA IgG and exhibit traits of mature plasma cells.
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Objective: The gastrointestinal tract (GIT) is the most commonly affected internal organ in systemic sclerosis (SSc). We sought to determine the prevalence and impact of GIT symptoms on survival and patient-reported outcomes.

Methods: A total of 907 consecutive patients from the Australian Scleroderma Cohort Study who had prospectively completed the University of California, Los Angeles, Scleroderma Clinical Trials Consortium Gastrointestinal Tract 2.

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ART scale-up has reduced HIV mortality in South Africa. However, less is known about trends in hospital-based HIV care, which is costly and may indicate HIV-related morbidity. We assessed trends in hospital-based HIV care using the National Health Laboratory Service (NHLS) National HIV Cohort.

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  • * Analysis of 1,965 participants revealed that while PhyGA scores were strongly correlated at visits, changes were discordant 50% of the time, highlighting variations in patient experiences.
  • * Findings indicate that PhyGAs for overall health, activity, and damage relate to distinct SSc features, suggesting a need for a standardized assessment to improve consistency in clinical evaluations.
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Background: This study was designed to evaluate the effect of using maximal cadence criteria cut points established during overground and treadmill walking, on intensity outputs measured during community ambulation. The second aim was to establish the relationship between cardiovascular fitness (predicted VO max capacity) and community ambulation intensity performance, in typically developing individuals.

Research Question: What is the effect on intensity measures when using cadence cut point criteria derived from overground and treadmill walking and does predicted VO max correlate with exercise related community activity in a typically developing population?

Methods: A group of 37 typically developing participants between 8 and 27 years of age, underwent a graded submaximal VO testing protocol followed by a typical week of community ambulation, recorded with a step activity monitor.

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Background: The World Health Organization-approved Xpert MTB/XDR test detects and resistance to isoniazid, fluoroquinolones, ethionamide, and injectable drugs directly in specimens. This pragmatic, laboratory-based study assessed the diagnostic accuracy and feasibility of a reflex testing approach, where Xpert MTB/XDR was performed on residual specimens previously processed for Xpert MTB/RIF Ultra.

Methods: Routine respiratory specimens, processed for Xpert MTB/RIF Ultra, were stored in sample reagent buffer at 2°C-8°C.

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Objectives: To investigate the burden and clinical associations of fatigue in systemic sclerosis (SSc) as measured by FACIT-Fatigue scores.

Methods: Australian Scleroderma Cohort Study participants with ≥1 FACIT-Fatigue score were included. Participants were divided into those with incident SSc (≤5 years SSc duration at recruitment and FACIT-Fatigue score recorded within 5 years of disease onset) or prevalent SSc (first FACIT-Fatigue score recorded >5 years after SSc onset).

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Objectives: To identify the trajectories and clinical associations of functional disability in systemic sclerosis (SSc).

Methods: Australian Scleroderma Cohort Study (ASCS) participants meeting ACR/EULAR criteria for SSc recruited within 5 years of disease onset, with ≥2 Health Assessment Questionnaire-Disability Index (HAQ-DI) scores were included. Group based trajectory modelling (GBTM) was used to identify the number and shape of HAQ-DI trajectories.

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