Risk of cardiovascular events from current, recent, and cumulative exposure to abacavir among persons living with HIV who were receiving antiretroviral therapy in the United States: a cohort study

Abstract Background There is ongoing controversy regarding abacavir use in the treatment of HIV infection and the risk of subsequent development of cardiovascular disease. It is unclear how the risk varies as exposure accumulates. Methods Using an administrative health-plan dataset, risk of cardiovascular disease events (CVDe), defined as the first episode of an acute myocardial infarction or a coronary intervention procedure, associated with abacavir exposure was assessed among HIV-infected individuals receiving antiretroviral therapy across the U.S. from October 2009 through December 2014. The data were longitudinal, and analyzed using marginal structural models. Results Over 114,470 person-years (n = 72,733) of ART exposure, 714 CVDe occurred at an incidence rate (IR) (95% CI) of 6·23 (5·80, 6·71)/1000 person-years. Individuals exposed to abacavir had a higher IR of CVDe of 9·74 (8·24, 11·52)/1000 person-years as compared to 5·75 (5·30, 6·24)/1000 person-years for those exposed to other antiretroviral agents. The hazard (HR; 95% CI) of CVDe was increased for current (1·43; 1·18, 1·73), recent (1·41; 1·16, 1·70), and cumulative [(1·18; 1·06, 1·31) per year] exposure to abacavir. The risk for cumulative exposure followed a bell-shaped dose-response curve peaking at 24-months of exposure. Risk was similarly elevated among participants free of pre-existing heart disease or history of illicit substance use at baseline. Conclusion Current, recent, and cumulative use of abacavir was associated with an increased risk of CVDe. The findings were consistent irrespective of underlying cardiovascular risk factors

Survey of quasi-judicial decision-makers in NSW and the national registration scheme for health practitioners

© 2018 Thomson Head Office. This study is part of a larger, Australian Research Council-funded project studying comparative analyses of complaints and notification handling between the NSW system and National Registration and Accreditation Scheme (2010). This article explores the assessments and decisions made by Tribunal and other quasi-judicial decision-makers involved in the two schemes, including the key decision-management stages during a disciplinary process. Respondents recruited from both systems completed an online questionnaire comprising a series of closed and open-ended questions to case vignettes. While we found no significant difference between jurisdictions in relation to their decision-making processes in this case, the article provides insights into the rationales for their decisions and the outcomes or "sanctions" selected by decision-makers as being appropriate to the circumstances presented

National Registration of Health Practitioners: A Comparative Study of the Complaints and Notification System Under the National System and in New South Wales – Decision Makers who Handle Complaints/Notifications About Regulated Health Practitioners in Australia

© 2017 Institute of Public Administration Australia When the National Registration and Accreditation Scheme (NRAS) for health practitioners commenced in Australia in 2010, all jurisdictions joined the scheme for the registration and accreditation of health practitioners, but NSW retained its existing co-regulatory complaint-handling system. We sought to compare the new National notifications and the NSW complaints handling processes, as NSW has an independent investigative and prosecutory body to manage serious complaints. Decision makers from both the National and NSW schemes, who handled notifications/complaints at assessment, were invited to participate in a survey consisting of case studies. A qualitative thematic approach was used to determine and compare contributing factors to decision makers’ priorities when assessing a notification/complaint for the National and NSW schemes. The 123 completed surveys comprised 50 NSW respondents and 73 National respondents from the other jurisdictions. No consistent differences in contributory factors when assessing a complaint/notification were observed between the two schemes. This evidence points towards national consistency in decisions about assessment of complaints and notifications in Australia