ORCID Profile
0000-0003-1939-1761
Current Organisation
Macquarie University
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Public Health and Health Services | Health Information Systems (Incl. Surveillance) | Public Health And Health Services Not Elsewhere Classified |
Publisher: Elsevier BV
Date: 2019
Publisher: MDPI AG
Date: 29-05-2023
Abstract: Cancer is a leading cause of global morbidity and mortality, accounting for 250 Disability-Adjusted Life Years and 10 million deaths in 2019. Minimising unwarranted variation and ensuring appropriate cost-effective treatment across primary and tertiary care to improve health outcomes is a key health priority. There are few studies that have used linked data to explore healthcare utilisation prior to diagnosis in addition to post-diagnosis patterns of care. This protocol outlines the aims of the DaLECC project and key methodological features of the linked dataset. The primary aim of this project is to explore predictors of variations in pre- and post-cancer diagnosis care, and to explore the economic and health impact of any variation. The cohort of patients includes all South Australian residents diagnosed with cancer between 2011 and 2020, who were recorded on the South Australian Cancer Registry. These cancer registry records are being linked with state and national healthcare databases to capture health service utilisation and costs for a minimum of one-year prior to diagnosis and to a maximum of 10 years post-diagnosis. Healthcare utilisation includes state databases for inpatient separations and emergency department presentations and national databases for Medicare services and pharmaceuticals. Our results will identify barriers to timely receipt of care, estimate the impact of variations in the use of health care, and provide evidence to support interventions to improve health outcomes to inform national and local decisions to enhance the access and uptake of health care services.
Publisher: Elsevier BV
Date: 09-2015
DOI: 10.1016/J.AAP.2015.05.023
Abstract: The risk of serious injury or death has been found to be reduced for some front compared to rear seat car passengers in newer vehicles. However, differences in injury severity between car occupants by seating position has not been examined. This study examines the injury severity risk for rear compared to front seat car passengers. A retrospective matched-cohort analysis was conducted of vehicle crashes involving injured rear vs front seat car passengers identified in linked police-reported, hospitalisation and emergency department (ED) presentation records during 2001-2011 in New South Wales (NSW), Australia. Odds ratios were estimated using an ordinal logistic mixed model and logistic mixed models. There were 5419 front and 4588 rear seat passengers in 3681 vehicles. There was a higher odds of sustaining a higher injury severity as a rear-compared to a front seat car passenger, with a higher odds of rear seat passengers sustaining serious injuries compared to minimal injuries. Where the vehicle occupant was older, travelling in a vehicle manufactured between 1990 and 1996 or after 1997, where the airbag deployed, and where the vehicle was driven where the speed limit was ≥70km/h there was a higher odds of the rear passenger sustaining a higher injury severity then a front seated occupant. Rear seat car passengers are sustaining injuries of a higher severity compared to front seat passengers travelling in the same vehicle, as well as when travelling in newer vehicles and where the front seat occupant is shielded by an airbag deployed in the crash. Rear seat occupant protective mechanisms should be examined. Pre-hospital trauma management policies could influence whether an in idual is transported to a hospital ED, thus it would be beneficial to have an objective measure of injury severity routinely available in ED records. Further examination of injury severity between rear and front seat passengers is warranted to examine less severe non-fatal injuries by car seating position and vehicle intrusion.
Publisher: Elsevier BV
Date: 2017
DOI: 10.1016/J.INJURY.2016.09.034
Abstract: Physical injury is a leading cause of death and disability among children worldwide and the largest cause of paediatric hospital admission. Parents of critically injured children are at increased risk of developing mental and emotional distress in the aftermath of child injury. In the Australian context, there is limited evidence on parent experiences of child injury and hospitalisation, and minimal understanding of their support needs. The aim of this investigation was to explore parents' experiences of having a critically injured child during the acute hospitalisation phase of injury, and to determine their support needs during this time. This multi-centre study forms part of a larger longitudinal mixed methods study investigating the experiences, unmet needs and well-being of parents of critically injured children over the two-year period following injury. This paper describes parents' experiences of having a child 0-13 years hospitalised with critical injury in one of four Australian paediatric hospitals. Semi-structured interviews were conducted with forty parents and transcribed verbatim. The data were managed using NVIVO 10 software and thematically analysed. Forty parents (26 mothers and 14 fathers) of 30 children (14 girls and 16 boys aged 1-13 years) from three Australian States participated. The majority of children were Australian born. Three main themes with sub-themes were identified: navigating the crisis of child injury coming to terms with the complexity of child injury and finding ways to meet the family's needs. There is a need for targeted psychological care provision for parents of critically injured children in the acute hospital phase, including psychological first aid and addressing parental blame attribution. Parents and children would benefit from the implementation of anticipatory guidance frameworks informed by a family-centred social ecological approach to prepare them for the trauma journey and for discharge. This approach could inform care delivery throughout the child injury recovery trajectory. The development and implementation of a major trauma family support coordinator in paediatric trauma centres would make a tangible difference to the care of critically injured children and their families.
Publisher: BMJ
Date: 22-07-2011
Publisher: The Sax Institute
Date: 2002
DOI: 10.1071/NB02036
Publisher: BMJ
Date: 09-07-2023
DOI: 10.1136/ARCHDISCHILD-2023-325769
Abstract: This study aimed to compare academic performance and high school completion of young people hospitalised for a burn compared with young people not hospitalised for an injury. A retrospective population-based matched case-comparison cohort study. Young people aged ≤18 years hospitalised for a burn during 2005–2018 in New South Wales, Australia, with age, sex and residential postcode-matched peers not hospitalised for any injury during 1 July 2001 and 31 December 2018. Performance below the national minimum standard (NMS) on the National Assessment Plan for Literacy and Numeracy assessments and not completing high school. Young females hospitalised for a burn had a 72% higher risk of poorer reading compared with their peers (adjusted relative risk (ARR) 1.72 95% CI 1.33 to 2.23), while young males hospitalised with a burn showed no higher risk (ARR 1.14 95% CI 0.91 to 1.43). Young males (ARR 1.05 95% CI 0.81 to 1.35) and females (ARR 1.34 95% CI 0.93 to 1.94) hospitalised with a burn had no higher risk of not reaching the NMS for numeracy compared with peers. Young people hospitalised with a burn had at least twice the risk of not completing year 10 (ARR 3.86 95% CI 1.68 to 8.86), year 11 (ARR 2.45 95% CI 1.89 to 3.18) and year 12 (ARR 2.09 95% CI 1.63 to 2.67) compared with matched counterparts. Young females hospitalised with a burn displayed poorer academic performance for reading compared with matched peers, while males and females were more likely to leave school earlier. Identifying unmet learning support needs of young burn survivors should be investigated.
Publisher: Elsevier BV
Date: 04-2013
DOI: 10.1016/J.AAP.2013.01.005
Abstract: There has been an ongoing debate in Australia and internationally regarding the effectiveness of bicycle helmets in preventing head injury. This study aims to examine the effectiveness of bicycle helmets in preventing head injury amongst cyclists in crashes involving motor vehicles, and to assess the impact of 'risky cycling behaviour' among helmeted and unhelmeted cyclists. This analysis involved a retrospective, case-control study using linked police-reported road crash, hospital admission and mortality data in New South Wales (NSW), Australia during 2001-2009. The study population was cyclist casualties who were involved in a collision with a motor vehicle. Cases were those that sustained a head injury and were admitted to hospital. Controls were those admitted to hospital who did not sustain a head injury, or those not admitted to hospital. Standard multiple variable logistic regression modelling was conducted, with multinomial outcomes of injury severity. There were 6745 cyclist collisions with motor vehicles where helmet use was known. Helmet use was associated with reduced risk of head injury in bicycle collisions with motor vehicles of up to 74%, and the more severe the injury considered, the greater the reduction. This was also found to be true for particular head injuries such as skull fractures, intracranial injury and open head wounds. Around one half of children and adolescents less than 19 years were not wearing a helmet, an issue that needs to be addressed in light of the demonstrated effectiveness of helmets. Non-helmeted cyclists were more likely to display risky riding behaviour, however, were less likely to cycle in risky areas the net result of which was that they were more likely to be involved in more severe crashes.
Publisher: Elsevier BV
Date: 05-2010
DOI: 10.1016/J.JSAMS.2009.04.003
Abstract: Organised sports are a popular form of physical activity, but unfortunately, participation can result in injury. Despite this, there have been surprisingly few studies that have reported the population rate of sports injury. Data from the 2005 New South Wales (NSW, Australia) Population Health Survey were analysed to describe self-reported injury experiences during participation in organised sports activities and the source of treatment for such injuries during a 12-month period in a population representative s le of adults aged 16+ years. At interview, 2414 respondents stated that they had participated in organised sport in the previous 12 months and just under one-third (30.9%) reported that they had been injured during this participation. Half of all injuries required formal treatment from a health or medical practitioner. Physiotherapists most commonly provided treatment for sports injury (26.6% of cases) followed by general practitioners (15.6%). Only 2.8% of all injured sports participants were admitted to hospital for their injury and a further 6.1% received treatment in an emergency department. This corresponds to at most only 8.9% of all treated sports injuries receiving treatment in a hospital setting. Population-based estimates of the rate and burden of sports injuries that rely solely on routine hospital data collections are likely to grossly underestimate the size of the problem, as very few cases are treated in a hospital setting.
Publisher: Informa UK Limited
Date: 14-01-2016
DOI: 10.3109/09638288.2015.1123306
Abstract: For older in iduals who sustain a hip fracture, the presence of dementia can influence their access to hospital-based rehabilitation. This study compares the characteristics and health outcomes of in iduals with and without dementia following a hip fracture and access to, and outcomes following, hospital-based rehabilitation in a population-based cohort. An examination of hip fractures involving in iduals aged 65 years and older with and without dementia using linked hospitalisation, rehabilitation and mortality records during 2009-2013. There were 8785 in iduals with and 23 520 in iduals without dementia who sustained a hip fracture. In iduals with dementia had a higher age-adjusted 30-d mortality rate compared to in iduals without dementia (11.7% versus 5.7%), a lower proportion of age-adjusted 28-d re-admission (17.3% versus 24.4%) and a longer age-adjusted mean length of stay (22.2 versus 21.9 d). Compared to in iduals without dementia, in iduals with dementia had 4.3 times (95% CI: 3.90-4.78) lower odds of receiving hospital-based rehabilitation. However, when they did receive rehabilitation they achieved significant motor functional gain at discharge compared to admission using the Functional Independence Measure, but to a lesser extent than in iduals without dementia. Within a population-based cohort, older in iduals with dementia can benefit from access to, and participation in, rehabilitation activities following a hip fracture. This will ensure that they have the best chance of returning to their pre-fracture physical function and mobility. Implications for Rehabilitation Older in iduals with dementia can benefit from rehabilitation activities following a hip fracture. Early mobilisation of in iduals post-hip fracture surgery, where possible, is advised. Further work is needed on how best to work with in iduals with dementia after a hip fracture in residential aged care to maximise any potential functional gains.
Publisher: SAGE Publications
Date: 23-04-2021
Abstract: Record linkage of health data has been beneficial to inform the design, delivery and evaluation of health care practices, and to improve the quality of clinical care and patient outcomes. We discuss some of the key strengths and limitations of using record linkage as the basis of an evidentiary approach for improved health services, and for conducting health services research. We illustrate the benefits of linking information from disparate administrative data collections, uncovering new knowledge, and influencing health policy or clinical practice, or both. Continued advancement of data methods and models, infrastructure to support research, and, above all, making administrative data accessible, will help ensure more effective delivery of health care services.
Publisher: Wiley
Date: 02-10-2021
DOI: 10.1111/CEA.14022
Abstract: There is inconclusive evidence of the effect of asthma on the academic performance of young people. This study aims to compare scholastic performance and high school completion of young people hospitalized with asthma compared to matched peers not hospitalized with asthma. A population‐based matched case‐comparison cohort study of young people aged ≤18 years hospitalized for asthma during 2005–2018 in New South Wales, Australia using linked birth, health, education and mortality records. The comparison cohort was matched on age, gender and residential postcode. Generalized linear mixed‐modelling examined risk of school performance below the national minimum standard (NMS) and generalized linear regression examined risk of not completing high school for young people hospitalized with asthma compared to matched peers. Young males hospitalized with asthma had a 13% and 15% higher risk of not achieving the NMS for numeracy (95%CI 1.04–1.22) and reading (95%CI 1.07–1.23), respectively, compared to peers. Young males hospitalized with asthma had a 51% (95%CI 1.22–1.86) higher risk of not completing year 10, and around a 20% higher risk of not completing year 11 (ARR: 1.25 95%CI 1.15–1.36) or year 12 (ARR: 1.27 95%CI 1.17–1.39) compared to peers. Young females hospitalized with asthma showed no difference in achieving numeracy or reading NMSs, but did have a 21% higher risk of not completing year 11 (95%CI 1.09–1.36) and a 33% higher risk of not completing year 12 (95%CI 1.19–1.49) compared to peers. Educational attainment is worse for young people hospitalized with asthma compared to matched peers. Early intervention and strategies for better management of asthma symptoms may enhance academic performance for students.
Publisher: Springer Science and Business Media LLC
Date: 08-2017
Publisher: Springer Science and Business Media LLC
Date: 02-02-2017
Publisher: BMJ
Date: 11-2022
DOI: 10.1136/BMJOPEN-2021-059330
Abstract: To address the challenges of rapidly changing healthcare, governments and health services are increasingly emphasising healthcare delivery models that are flexible, person centred, cost-effective and integrate hospital services more closely with primary healthcare and social services. In addition, such models increasingly embed consumer codesign, integration of services, and leverage digital technologies such as telehealth and sophisticated medical records systems. This paper provides a study protocol to describe a method to elicit consumer and healthcare provider needs and expectations for the development of innovative care models. A literature review identified six key models of care, supported by a common theme of consumer-focused care, along with the international evidence supporting the efficacy of these models. A mixed-methods study of the needs and expectations of consumer members and health providers who reside or work in the area of a new hospital catchment will be undertaken. They will complete a community-specific and provider-specific, short demographic questionnaire (delivered during the recruitment process) and be assigned to facilitator-coordinated online workshops comprising small focus groups. Follow-up interviews will be offered. Culturally and linguistically erse members and Aboriginal and Torres Strait Islander Elders and their communities will also be consulted. Data will be analysed thematically (qualitative) and statistically (quantitative), and findings synthesised using a triangulated approach. The results will be actively disseminated through peer-reviewed journals, conference presentations and in a report to stakeholders. This study was reviewed and approved by the relevant Ethics Committee in New South Wales, Australia.
Publisher: Elsevier BV
Date: 2013
DOI: 10.1016/J.INJURY.2011.11.012
Abstract: Paediatric trauma centres seek to optimise the care of injured children. Trends in state-wide paediatric care and outcomes have not been examined in detail in Australia. This study examines temporal trends in paediatric trauma outcomes and factors influencing survival and length of stay. A retrospective review was conducted using data from the NSW Trauma Registry during 2003-2008 for children aged 15 years and younger who were severely injured (injury severity score >15). To examine trauma outcomes descriptive statistics and multivariable logistic and linear regression were conducted. There were 1138 children severely injured. Two-thirds were male. Road trauma and falls were the most common injury mechanisms and over one-third of incidents occurred in the home. Forty-eight percent of violence-related injuries were experienced by infants aged less than 1 year. For the majority of children definitive care was provided at a paediatric trauma centre, but less than one-third of children were taken directly to a paediatric trauma centre post-injury. Children who received definitive treatment at a paediatric trauma centre had between 3 and 6 times higher odds of having a survival advantage than if treated at an adult trauma centre. The number of severe injury presentations to the 14 major trauma centres in NSW remains constant. It is possible that injury prevention measures are having a limited effect on severe injury in NSW. This research provides stimulus for change in the provision and co-ordination in the delivery of trauma care for injured children.
Publisher: Informa UK Limited
Date: 16-06-2016
DOI: 10.1080/15389588.2015.1115025
Abstract: There is a need for routine estimates of injury recovery costs from pedestrian collisions using hospital separation records for economic evaluations. To estimate the cost of injury recovery following pedestrian-vehicle collisions using the personal injury recover cost (PIRC) equation using key demographic and injury characteristics. An estimation of the costs of on-road pedestrian-vehicle collisions involving in iduals who were injured and hospitalized in New South Wales (NSW), Australia, from 2002 to 2011 using the PIRC equation. The PIRC estimates in idual injury recovery costs and does not include costs associated with property damage, vehicle repair, or rescue services. In idual recovery costs associated with severe traumatic brain injury (TBI) were estimated. The injured in idual's mean, median, and total injury recovery costs are described for key demographic, injury, and crash characteristics. There were 9,781 pedestrians who were injured, costing an estimated total of $2.4 billion in personal injury recovery costs, an annual cost of $243 million. Males had a total injury recovery cost 1.7 times higher than females. The median injury recovery cost decreased with increasing age. TBI ($248,491) and spinal cord and vertebral column injuries ($264,103) had the highest median injury recovery costs for the body region of the most severe injury. TBI accounted for 22.6% of the total injury recovery costs for the most severe injury sustained. Just over one third of pedestrians sustained 4 or more injuries, with a median cost of $243,992, which was 1.6 times higher than the cost for a pedestrian who sustained a single injury ($153,682). Personal injury recovery costs following pedestrian-vehicle collisions where a pedestrian is injured are substantial in NSW. The PIRC equation enables the economic cost burden of road traffic injury to be calculated using hospital separation data. The PIRC enables comprehensive personal injury recovery costs to be estimated and would aid in economic evaluations of preventive strategies in road safety.
Publisher: Elsevier BV
Date: 11-2022
Publisher: Elsevier BV
Date: 08-2016
Abstract: This population-based study investigates the influence of geographical location on hospital admissions, utilisation and outcomes for fall-related injury in older adults, adjusting for age, sex and comorbidities. A linked dataset of all admissions of NSW residents aged 65 and older, hospitalised at least once for a fall-related injury between 2003 and 2012, was used to estimate rates of hospitalisations, total lengths-of-stay, 28-day readmissions, and 30-day mortalities. These were standardised for age, sex, comorbidity, and remoteness. Compared to urban residents, rural residents were hospitalised less (p<0.0001) and hospitalisation rates increased at a lower rate (0.8% vs 2.6% per year) from 2003 to 2012. Rural residents had a shorter median total length of stay (5 vs 7 days, p<0.0001), a higher 28-day readmission rate (18.9% vs 17.0%, p<0.0001) and higher 30-day mortality (5.0% vs 4.9%, p=0.0046). Over the study period, rural residents of NSW had lower rates of fall-related injury hospitalisation and a lower annual increase in hospitalisation rates compared to urban residents. When hospitalised, rural residents had a shorter length-of-stay, but higher rates of readmission and mortality. These differences existed following standardisation. This study highlights the need for further research to characterise and explain this variability.
Publisher: SAGE Publications
Date: 03-2015
DOI: 10.1177/183335831504400103
Abstract: Road trauma represents a high proportion of injury-related emergency department presentations. Narrative text recorded in the emergency department could provide useful information to monitor road trauma and to identify crash and injury risk factors by age group. To examine the Public Health Real-time Emergency Department Surveillance System (PHREDSS) to identify road users (i.e. motor vehicle drivers, motor vehicle passengers, motorcyclists, pedal cyclists and pedestrians), and crash (e.g. vehicle speed) and injury risk factors (e.g. non-restraint use) by age group. Narrative text from the PHREDSS in New South wales, Australia, during 1 January 2006 to 31 December 2012 was reviewed. A keyword search of all emergency department presentations potentially identified 388,991 road trauma-related presentations and between 6,420 motorbike crashes to 138,889 motor vehicle accident emergency department presentations. Potential crash and injury risk factors were also identified. This exploratory study demonstrated the capability of information from PHREDSS to be used to support injury prevention efforts in road safety.
Publisher: Elsevier BV
Date: 12-2011
DOI: 10.1016/J.JSR.2011.07.009
Abstract: Projections of the number, rate and cost of fall-related hospitalised injuries for in iduals aged 65 years and older in New South Wales (NSW), Australia were estimated to 2051 for two scenarios: (1) demographic change only using 2008 admission rates and (2) modelled change using negative binominal regression taking into account current trends in admission rates. Based on demographic change alone, the number and cost of fall injury hospitalisations among older people is expected to increase almost three-fold by 2051. Transfers to permanent residential aged care will also increase 3.2 fold. However, if the fall-related hospitalisation rate sustains its current trend, these increases are projected to be more than ten-fold by 2051. Even with demographic change alone, there will be a significant impact on the resources required to care for older people suffering a fall injury hospitalisation over the next forty years in NSW. The impact on the hospital and aged care sectors will be considerable unless significant improvements occur in the prevention and treatment of fall-related injury in older people.
Publisher: No publisher found
Date: 2017
DOI: 10.1016/J.ARCHGER.2017.05.012
Abstract: To identify factors associated with admission to residential aged care (RAC), respite RAC and transitional care (TC) for older in iduals following an injury hospitalisation. A retrospective analysis was conducted of in iduals aged ≥65 years who had an injury hospitalisation and who were admitted to RAC during 1 July 2008 and 30 June 2013 in New South Wales, Australia. Multinominal logistic regression was used to examine the factors associated with admissions to aged care services compared to returning to the community. Of 191,301 injury hospitalisations, 41,085 (21.5%) in iduals either returned or were new admissions to long-term or respite RAC and 3,218 in iduals were admitted to TC. Older in iduals newly admitted to long-term RAC were four times more likely (OR: 4.36 95%CI 4.15-4.57), those admitted to respite RAC were twice as likely (OR: 2.37 95%CI 2.21-2.54) and people admitted to TC were less likely (OR: 0.60 95%CI 0.53-0.68) to have dementia compared to in iduals who returned to the community. Overall, in iduals who were admitted to long-term or respite RAC had a higher likelihood of experiencing limitations associated with their physical, cognitive or social abilities, with in iduals admitted to TC having a higher likelihood of issues with hygiene and mobility, compared to in iduals returning to the community. Understanding the profile and predictive risk factors for injured older in iduals using RAC (long-term, respite or TC services) can inform current and future aged care service resource use needs and can be used to understand factors associated with service use.
Publisher: Elsevier BV
Date: 2011
DOI: 10.1016/J.INJURY.2010.05.004
Abstract: Appropriate triage of the trauma patient is essential to ensure prompt access to definitive care. Many trauma centres use a "tiered" trauma call protocol with the intention of providing a match between the facility's resources and the needs of the patient. This study describes the incidence and impact of undertriage on the trauma patient in the context of an Australian level 1 trauma centre with a tiered trauma call system. This was a retrospective analysis of prospective data collected through the Trauma Registry. Undertriage was defined as sustaining an injury severity score greater than 15 and receiving a non optimal response (i.e., trauma standby call or no call). The level of association between outcome measures (such as LOS in ED, time to OT) and the level of trauma call the patient received was assessed using a general linear model, controlling for injury severity and haemodynamic stability. Between February 2004 and November 2008, 5233 patients meeting trauma criteria presented to the study hospital. There was an undertriage rate of 42% and overtriage rate of 21%. Patients were more likely to be undertriaged if they were older, self-presented, their cause of injury was assault or their head or chest were their most severely injured body region. Undertriaged patients had a significantly longer LOS in the ED (2 h) than appropriately triaged patients. The implementation of a tiered trauma call system resulted in significant undertriage,especially if the patient was older, had been assaulted or had a head/chest injury. Undertriaged patients experienced delay to definitive care. This study has highlighted the importance of compliance with trauma team activation criteria, trauma monitoring and evaluation.
Publisher: Elsevier BV
Date: 02-2018
DOI: 10.1016/J.YEBEH.2017.11.022
Abstract: This study examined the health service utilization and hospital treatment cost of in iduals with epilepsy by age group, mortality within 30days, and surgical outcomes for in iduals with refractory epilepsy in New South Wales (NSW), Australia. A retrospective examination of linked hospitalization and mortality data for in iduals hospitalized with a diagnosis of epilepsy during 2012-2016. Hospitalized incidence rates per 1000 population were calculated, and negative binomial regression was used to examine temporal trends. Mortality within 30days of hospitalization was identified, along with cause of death. There were 44,722 hospitalizations during the five-year period, with a hospitalization rate of 85.6 per 1000 population (95% confidence interval (CI): 84.7-86.4). Total hospital treatment costs were AUD$402.9 million. Children aged ≤17years accounted for 32.0% of hospitalizations. Just over half to two-thirds of hospitalizations for each age group were for a principal diagnosis of epilepsy, with 2976 hospitalizations of in iduals for status epilepticus. The overall mean hospital length of stay (LOS) for epilepsy hospitalizations was 5.1days (standard deviation (SD)=9.0). Thirty-day mortality was highest for in iduals aged ≥65years (6.7%), and epilepsy was identified as the underlying cause of death for 18.2% of deaths. This research has provided insight into the healthcare utilization profiles of in iduals with epilepsy at different ages. Epilepsy hospitalizations constitute a substantial cost to the healthcare system, and better overall management of seizures and comorbid conditions is likely to lead to a reduction in the need for hospitalization.
Publisher: SAGE Publications
Date: 29-12-2016
Abstract: Research has associated some chronic conditions with self-harm and suicide. Quantifying such a relationship in mortality data relies on accurate death records and adequate techniques for identifying these conditions. This study aimed to quantify the impact of identification methods for co-morbid conditions on suicides in in iduals aged 30 years and older in Australia and examined differences by gender. A retrospective examination of mortality records in the National Coronial Information System (NCIS) was conducted. Two different methods for identifying co-morbidities were compared: International Statistical Classification of Diseases and Related Health Problems, 10th Revision (ICD-10) coded data, which are provided to the NCIS by the Australian Bureau of Statistics, and free-text searches of Medical Cause of Death fields. Descriptive statistics and χ 2 tests were used to compare the methods for identifying co-morbidities and look at differences by gender. Results showed inconsistencies between ICD-10 coded and coronial reports in the identification of suicide and chronic conditions, particularly by type (physical or mental). There were also significant differences in the proportion of co-morbid conditions by gender. While ICD-10 coded mortality data more comprehensively identified co-morbidities, discrepancies in the identification of suicide and co-morbid conditions in both systems require further investigation to determine their nature (linkage errors, human subjectivity) and address them. Furthermore, due to the prescriptive coding procedures, the extent to which medico-legal databases may be used to explore potential and previously unrecognised associations between chronic conditions and self-harm deaths remains limited.
Publisher: Informa UK Limited
Date: 26-08-2019
Publisher: BMJ
Date: 19-01-2019
Publisher: Elsevier BV
Date: 07-2003
Publisher: Cambridge University Press (CUP)
Date: 17-09-2015
DOI: 10.1017/S1041610215001581
Abstract: The authors would like to apologise for a typographical error in the abstract of the above mentioned article. In the results section of the abstract on the first page of the article, the first odds ratio that refers to ‘aged care facilities’ should be (OR 5.44 95% CI 4.43–6.67) and the second odds ratio that refers to health service facilities should be (OR 4.56 95%CI 4.06–5.13).
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 05-2019
Publisher: Elsevier BV
Date: 08-2009
DOI: 10.1111/J.1753-6405.2009.00404.X
Abstract: To examine the reliability of work-related activity coding for injury-related hospitalisations in Australia. A random s le of 4,373 injury-related hospital separations from 1 July 2002 to 30 June 2004 were obtained from a stratified random s le of 50 hospitals across four states in Australia. From this s le, cases were identified as work-related if they contained an ICD-10-AM work-related activity code (U73) allocated by either: (i) the original coder (ii) an independent auditor, blinded to the original code or (iii) a research assistant, blinded to both the original and auditor codes, who reviewed narrative text extracted from the medical record. The concordance of activity coding and number of cases identified as work-related using each method were compared. Of the 4,373 cases s led, 318 cases were identified as being work-related using any of the three methods for identification. The original coder identified 217 and the auditor identified 266 work-related cases (68.2% and 83.6% of the total cases identified, respectively). Around 10% of cases were only identified through the text description review. The original coder and auditor agreed on the assignment of work-relatedness for 68.9% of cases. The best estimates of the frequency of hospital admissions for occupational injury underestimate the burden by around 32%. This is a substantial underestimate that has major implications for public policy, and highlights the need for further work on improving the quality and completeness of routine, administrative data sources for a more complete identification of work-related injuries.
Publisher: Elsevier BV
Date: 08-2017
DOI: 10.1016/J.INJURY.2017.06.002
Abstract: The prevalence of chronic health conditions such as diabetes among young people is increasing. Limited information is known about the impact of these conditions on young people who have been traumatically injured. Injury is the global leading cause of death and disability in young people. The aim of this study is to compare health outcomes for injured young people with and without chronic health conditions. A retrospective examination of injury in young people aged≤25years with and without a chronic health condition using linked hospitalisation and mortality records during 1 January 2010 to 30 June 2014 in New South Wales, Australia. Health outcomes, including hospital length of stay (LOS), 28-day unplanned hospital readmission, hospital treatment costs, and 30-day and 12-month mortality were examined. A 1:1 matched design was used to determine excess mean hospital LOS and cost for young people with a chronic health conditions versus no health condition. There were 184,819 injury-related hospitalisations of young people 13.8% had a chronic health condition. Compared to young people who did not have a chronic health condition, those with one were found to have double the mean hospital cost, higher unplanned hospital readmission, and a higher rate of mortality. Injured young people had a three times higher likelihood of having a prolonged LOS if they had a chronic health condition (Adjusted odds ratio: 3.89 95% CI: 3.69-4.11). Renal conditions, anaemia, coagulation defects, hypertension, and mental health conditions had the highest excess LOS and anaemia, hypertension, coagulation defects and renal conditions had the highest excess mean cost for matched injured in iduals with and without the health condition. Health outcomes following injury are worse for young people with a chronic health condition. The increasing prevalence of young people with a chronic health condition has implications for treatment, resource use, provision of support services, and survival following traumatic injury.
Publisher: Wiley
Date: 12-2004
DOI: 10.1111/J.1440-1854.2004.00628.X
Abstract: To describe the types of aquatic locations attended by residents of rural and remote New South Wales (NSW), to record self-reported water safety-related behaviour, and identify preferred communication mediums for water safety messages. A stratified random telephone survey was conducted of 500 NSW residents aged greater than 15 years residing in moderately accessible, remote and very remote locations in NSW. Results indicate that around two-thirds of respondents had been in or on the water at a pool, beach, lake, river or dam in the past 6 months. The most common type of aquatic facilities used were rivers, creeks or streams (53.5%), beaches (45.7%), public pools (45.5%), private pools (40.7%), dams (40.6%) and lakes (27.0%). Time spent at each of these locations and time of day each location was visited varied. Overall, the majority of respondents reported practicing water-related safe behaviour. Preferred communication mediums for water safety messages included television, schools and newspapers. Water safety education, especially in relation to beach conditions, remains just as important a topic for public health authorities and key water safety agencies in regional and remote NSW as it is in coastal suburbs. Responses from the survey, along with key stakeholder advice, will be used to inform the development of appropriate strategies aimed to reduce drowning deaths in rural and remote locations in NSW.
Publisher: Elsevier BV
Date: 2015
DOI: 10.1016/J.AAP.2014.06.002
Abstract: Collisions with fixed objects in the roadway environment account for a substantial proportion of motorcyclist fatalities. Many studies have identified in idual roadway environment and/or motorcyclist characteristics that are associated with the severity of the injury outcome, including the presence of roadside barriers, helmet use, alcohol use and speeding. However, no studies have reported the cumulative benefit of such characteristics on motorcycling safety. The safe system approach recognises that the system must work as a whole to reduce the net injury risk to road users to an acceptable level, including the four system cornerstone areas of roadways, speeds, vehicles and people. The aim of the present paper is to consider these cornerstone areas concomitantly, and quantitatively assess the serious injury risk of motorcyclists in fixed object collisions using this holistic approach. A total of 1006 Australian and 15,727 (weighted) United States motorcyclist-fixed object collisions were collected retrospectively, and the serious injury risks associated with roadside barriers, helmet use, alcohol use and speeding were assessed both in idually and concomitantly. The results indicate that if safety efforts are made in each of the safe system cornerstone areas, the combined effect is to substantially reduce the serious injury risk of fixed hazards to motorcyclists. The holistic approach is shown to reduce the serious injury risk considerably more than each of the safety efforts considered in idually. These results promote the use of a safe system approach to motorcycling safety.
Publisher: SAGE Publications
Date: 31-12-2018
Abstract: Objective. Assault is a global public health issue that affects in iduals of all ages. This study describes the epidemiological profile of assault-related hospitalization and health outcomes across different age groups in New South Wales, Australia. Methods. Population-based linked hospitalization and mortality data from January 1, 2010, to June 30, 2014, were used to identify assault-related hospitalizations. Age-standardized rates were calculated and health outcomes were examined by age group. Results. There were 22 579 hospitalizations due to assault, with an age-standardized rate of 55.9 per 100 000 population (95% confidence interval = 55.2 to 56.70). Assault by bodily force (63.1%) and by sharp or blunt objects (21.6%) were the most common injury mechanisms. In iduals above 60 years had the highest mean hospital length of stay at 7.3 days, 30- and 90-day mortality, and average hospitalization costs at $9757. Conclusion. The findings have important implications in informing the development and strategies to reduce assault-related incidents in the community.
Publisher: Wiley
Date: 06-2017
DOI: 10.1111/AJAG.12422
Abstract: To compare trends, causes, and outcomes of fall-related traumatic brain injury (TBI) between community-dwelling (CD) in iduals and residential aged care facility (RACF) residents. Hospitalisation and RACF administrative data for 6635 in iduals aged ≥65 years admitted to all NSW hospitals for fall-related TBI from 2008-2009 to 2012-2013 were linked. Of the 6944 hospitalisations, 20.8% were for RACF residents. Age-standardised hospitalisation rates were almost fourfold higher for RACF residents than CD in iduals (standardised rate ratio 3.7 95% CI 3.4-4.1) but increased at a similar annual rate of 9.2% (95% CI 0.3-19.0) and 7.2% (95% CI 5.6-8.9), respectively. Compared to CD in iduals: a higher proportion of falls in RACF residents were furniture-related (21.4% vs 9.9%) resulted in haemorrhage (82.5% vs 73.7%) and death (23.1% vs 14.9%). Overall, 7.7% of hospitalisations for CD in iduals resulted in new permanent RACF placement. Residential aged care facility residents have higher hospitalisation rates and poorer health outcomes than their CD counterparts.
Publisher: Elsevier BV
Date: 04-2011
Publisher: Wiley
Date: 24-07-2002
DOI: 10.1046/J.1440-1584.2002.00449.X
Abstract: This paper describes the types of, and circumstances surrounding, unintentional farm-related fatal injuries involving young and older adults in Australia. Information was obtained from an inspection of coronial files for the period 1989-1992. Around 14% of all farm-related fatalities in Australia during 1989-1992 were of young adults aged 15-24 years and approximately one-quarter were of older adults aged > or = 55 years. Young adults were commonly fatally injured in motor vehicle incidents and in incidents involving firearms. Tractors were the most common agent involved in fatal incidents involving older adults. Intervention measures to prevent fatalities of older adults in agriculture should focus on the safe use of tractors, while for young adults it appears prevention efforts should centre around safe use of firearms and operation of motor vehicles on the farm. Ways to overcome barriers to the use of injury prevention measures in rural Australia should be further explored.
Publisher: Wiley
Date: 27-02-2022
DOI: 10.5694/MJA2.51440
Publisher: JMIR Publications Inc.
Date: 06-01-2022
DOI: 10.2196/30027
Abstract: Emerging adulthood is a distinct segment of an in idual’s life course. The defining features of this transitional period include identity exploration, instability, future possibilities, self-focus, and feeling in-between, all of which are thought to affect quality of life, health, and well-being. A longitudinal cohort study with a comprehensive set of measures would be a valuable resource for improving the understanding of the multifaceted elements and unique challenges that contribute to the health and well-being of emerging adults. The main aim of this pilot study was to evaluate the feasibility and acceptability of recruiting university graduates to establish a longitudinal cohort study to inform the understanding of emerging adulthood. This pilot study was conducted among graduates at a large university. It involved collecting web-based survey data at baseline (ie, graduation) and 12 months post baseline, and linking survey responses to health records from administrative data collections. The feasibility outcome measures of interest included the recruitment rate, response rate, retention rate, data linkage opt-out rate, and availability of linked health records. Descriptive statistics were used to evaluate the representativeness of the s le, completeness of the survey responses, and data linkage characteristics. Only 2.8% of invited graduates (238/8532) agreed to participate in this pilot cohort study, of whom 59.7% (142/238) responded to the baseline survey. The retention rate between the baseline and follow-up surveys was 69.7% (99/142). The completeness of the surveys was excellent, with the proportion of answered questions in each survey domain ranging from 87.3% to 100% in both the baseline and follow-up surveys. The data linkage opt-out rate was 32.4% (77/238). The overall recruitment rate was poor, while the completeness of survey responses among respondents ranged from good to excellent. There was reasonable acceptability for conducting data linkage of health records from administrative data collections and survey responses. This pilot study offers insights and recommendations for future research aiming to establish a longitudinal cohort study to investigate health and well-being in emerging adults. Australian New Zealand Clinical Trials Registry number ACTRN12618001364268 eec8wh RR2-10.2196/16108
Publisher: Elsevier BV
Date: 11-2015
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 07-2011
Publisher: Elsevier BV
Date: 2016
DOI: 10.1016/J.APERGO.2015.07.018
Abstract: This study aimed to identify temporal precursor and associated contributing factors for adverse clinical incidents in a hospital setting using the Human Factors Classification Framework (HFCF) for patient safety. A random s le of 498 clinical incidents were reviewed. The framework identified key precursor events (PE), contributing factors (CF) and the prime causes of incidents. Descriptive statistics and correspondence analysis were used to examine incident characteristics. Staff action was the most common type of PE identified. Correspondence analysis for all PEs that involved staff action by error type showed that rule-based errors were strongly related to performing medical or monitoring tasks or the administration of medication. Skill-based errors were strongly related to misdiagnoses. Factors relating to the organisation (66.9%) or the patient (53.2%) were the most commonly identified CFs. The HFCF for patient safety was able to identify patterns of causation for the clinical incidents, highlighting the need for targeted preventive approaches, based on an understanding of how and why incidents occur.
Publisher: Elsevier BV
Date: 09-2011
DOI: 10.1016/J.BODYIM.2011.07.001
Abstract: The present study evaluated whether the strength of relationship between contextual cues (presence of company and mood) and state body dissatisfaction varied as a function of in idual differences in key trait measures (body shame, body surveillance tendencies, internalization of appearance standards, and trait affect) which have been linked to trait body dissatisfaction. Fifty-five undergraduate women completed a questionnaire containing the trait-based measures and then carried a Personal Digital Assistant (PDA) for a 7-day period. The PDA prompted participants six times daily to self-report their current mood and state body dissatisfaction. Multi-level modeling revealed that in idual differences in body shame predicted inter-in idual variability in the strength of the relationships between presence of company and state body dissatisfaction, and positive mood and state body dissatisfaction. Trait positive affect also explained variance in the positive mood state-body dissatisfaction relationship. The implications of the findings for prevention of body image disturbances are discussed.
Publisher: Wiley
Date: 13-08-2018
DOI: 10.1002/HPJA.186
Abstract: Child head injuries can cause life-long disability and are a major cause of mortality globally. The incidence and impact of child head injuries in Australia is unknown. This study aimed to quantify the incidence, characteristics and treatment cost and to identify factors associated with the severity of hospitalisations of head injuries in Australian children. Linked hospitalisation and mortality data were used to retrospectively examine hospitalisation trends for head injury in children aged ≤16 years and associated factors, in Australia, from 1 July 2002 to 30 June 2012. There were 164 126 hospitalisations of children for head injury during the 10-year period, commonly male (65.5%), or aged ≤5 years (48.3%). The incidence among children aged <1 year and 1-5 years significantly increased by 1.7% (95% CI 0.9-2.6 P < 0.0001) and 1.5% (95% CI 1.1-1.9 P < 0.0001) annually during the study period, respectively. The most common injury mechanisms across all age groups were falls (45.2%) and road trauma (16.0%). Head injury hospitalisations cost $468.9 million, with the higher costs found for children aged 11-16 years, and for the most severe injuries. Head injury hospitalisations cost the Australian health system close to half a billion dollars over a 10-year period, with the most serious injuries resulting in lifelong health implications. SO WHAT?: Targeted health promotion strategies such as the promotion of helmet wearing during scooter use, the introduction of cycleways, and impact absorbing surfaces on playgrounds, need to be implemented to reduce the occurrence of head injuries in children.
Publisher: Elsevier BV
Date: 03-2021
Publisher: Informa UK Limited
Date: 07-01-2016
DOI: 10.1080/17457300.2014.992353
Abstract: Identifying quad-bike-related injuries in administrative data collections can be problematic. This study sought to determine whether quad-bike-related injuries could be identified in routinely collected administrative data collections in New South Wales (NSW), Australia, and to determine the information recorded according to World Health Organization (WHO) injury surveillance guidelines that could assist injury prevention efforts. Five routinely collected administrative data collections in NSW in the period 2000-2012 were reviewed. The WHO core minimum data items recorded in each of the five data collections ranged from 37.5% to 75.0%. Age and sex of the injured in idual were the only data items that were recorded in all data collections. The data collections did not contain detailed information on the circumstances of quad bike incidents. Major improvements are needed in the information collected in these data-sets, if their value is to be increased and used for injury prevention purposes.
Publisher: Cambridge University Press (CUP)
Date: 04-08-2015
DOI: 10.1017/S1041610215001258
Abstract: Medicinal substances have been identified as common agents of both unintentional and intentional poisoning among older people, including those with dementia. This study aims to compare the characteristics of poisoning resulting in hospitalization in older people with and without dementia and their clinical outcomes. A retrospective cohort study involving an examination of poisoning by intent involving in iduals aged 50+ years with and without dementia using linked hospitalization and mortality records during 2003–2012. In iduals who had dementia were identified from hospital diagnoses and unintentional and intentional poisoning was identified using external cause classifications. The epidemiological profile (i.e. in idual and incident characteristics) of poisoning by intent and dementia status was compared, along with clinical outcomes of hospital length of stay (LOS), 28-day readmission and 30-day mortality. The hospitalization rate for unintentional and intentional poisoning for in iduals with dementia was double and 1.5 times higher than the rates for in iduals without dementia (69.5 and 31.6 per 100,000) and (56.4 and 32.5 per 1,00,000). The home was the most common location of poisoning. Unintentional poisoning was more likely to involve in iduals residing in aged care facilities (OR 2.12 95%CI 1.70–2.63) or health service facilities (OR 3.91 95%CI 3.45–4.42). There were higher mortality rates and longer LOS for unintentional poisoning for in iduals with dementia. Clinicians need to be aware of the risks of poisoning for in iduals with dementia and care is required in appropriate prescription, safe administration, and potential for self-harm with commonly used medications, such as anticholinesterase medications, antihypertensive drugs, and laxatives.
Publisher: Springer Science and Business Media LLC
Date: 25-09-2021
DOI: 10.1186/S12887-021-02891-X
Abstract: Exploring the impact of injury and injury severity on academic outcomes could assist to identify characteristics of young people likely to require learning support services. This study aims to compare scholastic performance and high school completion of young people hospitalised for an injury compared to young people not hospitalised for an injury by injury severity and to examine factors influencing scholastic performance and school completion. A population-based matched case-comparison cohort study of young people aged ≤18 years hospitalised for an injury during 2005–2018 in New South Wales, Australia using linked birth, health, education and mortality records. The comparison cohort was matched on age, gender and residential postcode. Generalised linear mixed modelling examined risk of performance below the national minimum standard (NMS) on the National Assessment Plan for Literacy and Numeracy (NAPLAN) and generalised linear regression examined risk of not completing high school for injured young people compared to matched peers. Injured young people had a higher risk of not achieving the NMS compared to their matched peers for numeracy (ARR: 1.12 95%CI 1.06–1.17), reading (ARR: 1.09 95%CI 1.04–1.13), spelling (ARR: 1.13 95%CI 1.09–1.18), grammar (ARR: 1.11 95%CI 1.06–1.15), and writing (ARR: 1.07 95%CI 1.04–1.11). As injury severity increased from minor to serious, the risk of not achieving the NMS generally increased for injured young people compared to matched peers. Injured young people had almost twice the risk of not completing high school at year 10 (ARR: 2.17 95%CI 1.73–2.72), year 11 (ARR: 1.95 95%CI 1.78–2.14) or year 12 (ARR: 1.93 95%CI 1.78–2.08) compared to matched peers. The identification of characteristics of young people most likely to encounter problems in the academic environment after sustaining an injury is important to facilitate the potential need for learning support. Assessing learning needs and monitoring return-to-school progress post-injury may aid identification of any ongoing learning support requirements.
Publisher: Elsevier BV
Date: 12-2022
DOI: 10.1016/J.JSAMS.2022.09.165
Abstract: To synthesise competition and training injury data in amateur boxing. Systematic review and meta-analysis. Pooled estimates of competition injury incidence rates per 1000 athlete-exposures (IIR MEDLINE, Embase, AMED, AUSPORT, and SPORTDiscus databases were searched from inception to 27 May 2022. Cohort studies with prospectively collected injury and exposure data from amateur boxing competition or training published in peer-reviewed journals were eligible for inclusion. Seventeen studies were eligible for inclusion. The competition IIR Amateur boxing athletes sustain, on average, 1 injury every 2.5 h of competition and every 772 h of training. There is a need for identifying injury mechanisms and modifiable risk factors that can be targeted by preventive measures to reduce the burden of injury in amateur boxing.
Publisher: Springer Science and Business Media LLC
Date: 06-09-2016
Publisher: Elsevier BV
Date: 2022
DOI: 10.1016/J.INJURY.2021.02.036
Abstract: Timely definitive paediatric trauma care influences patient and parental physical and emotional outcomes. New South Wales (NSW) covers a large geographical area with all three NSW paediatric trauma centres (PTC) located in two approximated major cities, meaning it is inevitable that some injured children receive initial treatment locally and then require transfer. Little is known about the factors that then impact timely arrival of injured children to definitive care. This included children admitted between July 2015 and September 2016, 2) between transferred and directly transported cohorts. There were significant differences in mechanism of injury between the two groups (χ Clinicians caring for paediatric trauma patients in facilities outside trauma centres require the capability and opportunity to identify and notify early those requiring transfer for ongoing management. The provision of a streamlined referral and transfer process for all paediatric trauma patients requiring treatment in NSW PTCs would reduce the burden on the referring facility, reduce variation amongst transport providers and improve time to definitive care.
Publisher: Elsevier BV
Date: 10-2020
Publisher: BMJ
Date: 06-2019
DOI: 10.1136/BMJOPEN-2019-030988
Abstract: The aged population is increasing rapidly across the world and this is expected to continue. People living in residential aged care facilities (RACFs) represent amongst the sickest and frailest cohort of the aged population, with a high prevalence of chronic conditions and complex comorbidities. Given the vulnerability of RACF residents and the demands on the system, there is a need to determine the extent that care is delivered in line with best practice (‘appropriate care’) in RACFs. There is also a recognition that systems should provide care that optimises quality of life (QoL), which includes support for physical and psychological well-being, independence, social relationships, personal beliefs and a caring external environment. The aims of CareTrack Aged are to develop sets of indicators for appropriate care and processes of care for commonly managed conditions, and then assess the appropriateness of care delivered and QoL of residents in RACFs in Australia. We will extract recommendations from clinical practice guidelines and, using expert review, convert these into sets of indicators for 15 common conditions and processes of care for people living in RACFs. We will recruit RACFs in three Australian states, and residents within these RACFs, using a stratified multistage s ling method. Experienced nurses, trained in the CareTrack Aged methods (‘surveyors’), will review care records of recruited residents within a 1-month period in 2019 and 2020, and assess the care documented against the indicators of appropriate care. Surveyors will concurrently assess residents’ QoL using validated questionnaires. The study has been reviewed and approved by the Human Research Ethics Committee of Macquarie University (5201800386). The research findings will be published in international and national journals and disseminated through conferences and presentations to interested stakeholder groups, including consumers, national agencies, healthcare professionals, policymakers and researchers.
Publisher: SAGE Publications
Date: 06-10-2011
Abstract: This article compares the epidemiological profile of injury-related hospitalized morbidity of international tourists in New South Wales (NSW) with the hospitalized injury profile of NSW residents. Injury-related hospitalizations were identified from the NSW Admitted Patients Data Collection during 1 July 2000 to 30 June 2009. Injuries were identified using a principal diagnosis code of injury (ie, ICD-10-AM range S00-T98) and the presence of an external cause code (ie, ICD-10-AM range V00-Y98). Overseas tourists were more likely to be hospitalized for an injury following air and water transport, near-drowning, and pedestrian-related injuries. Sport or leisure-related activities were the most common activity conducted at the time of the incident. International tourists are at a higher risk of experiencing injuries particularly following recreational pursuits, while as a pedestrian, in vehicle crashes for older age groups, as a result of interpersonal violence for young males, and following a poisoning or cut ierce injury for young females. Prevention measures should be undertaken to limit the incidence of injury among international tourists, particularly during active recreational activities and while using the roadways.
Publisher: The Sax Institute
Date: 2002
DOI: 10.1071/NB02042
Publisher: BMJ Publishing Group Ltd
Date: 20-09-2018
Publisher: BMJ
Date: 03-2003
DOI: 10.1136/IP.9.1.15
Abstract: Unpaid work in and around the home is a common and potentially high risk activity, yet there is limited information about the circumstances surrounding resulting injuries. This study aimed to describe circumstances surrounding fatal injuries resulting from home duties activities, in order to identify and prioritise areas for prevention. Coroners' reports on all unintentional deaths in Australia from 1989-92 inclusive were inspected to identify deaths of interest. Rates were calculated using population data and incorporating measures of time engaged in particular home duties activities. There were 296 home duties deaths over the four year period. Most (83%) deaths were of males, and males had 10 times the risk of fatal injury compared with females. The most common activities resulting in fatal injuries were home repairs, gardening, and car care. The highest risk activities (deaths per million persons per year per hour of activity) were home repairs (49), car care (20), home improvements (18), and gardening (16). Being hit by inadequately braced vehicles during car maintenance, falls from inadequately braced ladders, contact with fire and flames while cooking, and contact with electricity during maintenance were the most common injury scenarios. Fatal injury of persons engaged in unpaid domestic work activities is a significant cause of death. Use of activity specific denominator data allows appropriate assessment of the degree of risk associated with each activity. The recurrence of similar circumstances surrounding many independent fatal incidents indicates areas where preventative interventions might be usefully targeted.
Publisher: AMPCo
Date: 10-2014
DOI: 10.5694/MJA14.00055
Abstract: To examine the impact of orthogeriatric services on 30-day mortality and length of stay (LOS) for hip fracture patients undergoing surgery in public hospitals in New South Wales. A retrospective analysis of patients aged 65 years and older who had a fractured hip and received surgical intervention between 1 July 2009 and 30 June 2011 at one of the 37 NSW public hospitals operating on hip fracture patients. 30-day mortality and LOS. During the study period, there were 9601 hip fracture cases for which surgery was done. Mean age, sex and comorbidity distribution were similar for hip fracture patients treated in hospitals with an orthogeriatric service compared with those treated in hospitals without an orthogeriatric service. There were 706 deaths within 30 days of hip fracture surgery, and the overall unadjusted 30-day mortality rate was 7.4%. The median adjusted 30-day mortality rate for hospitals with an orthogeriatric service was significantly lower than that for hospitals without an orthogeriatric service (6.2% v 8.4% P < 0.002). Median total LOS was longer at hospitals with an orthogeriatric service compared with hospitals that did not have an orthogeriatric service (26 days v 22 days P < 0.001). The presence of an orthogeriatric service was associated with a reduction in 30-day mortality but a longer LOS. More research is required to understand the key aspects of care that determine health outcomes. The recently launched Australian and New Zealand Hip Fracture Registry will provide data that will enable improvements in care.
Publisher: Springer Science and Business Media LLC
Date: 16-08-2011
Publisher: BMJ
Date: 03-2003
DOI: 10.1136/OEM.60.3.195
Abstract: To determine the levels of coverage of work related traumatic deaths by official occupational health and safety (OHS) and compensation agencies in Australia, to allow better understanding and interpretation of officially available statistics. The analysis was part of a much larger study of all work related fatalities that occurred in Australia during the four year period 1989 to 1992 inclusive and which was based on information from coroners' files. For the current study, State, Territory, and Commonwealth OHS and compensation agencies were asked to supply unit record information for all deaths identified by the jurisdictions as being due to non-suicide traumatic causes and which were identified by them as being work related, using whatever definitions the agencies were using at the relevant time. This information was matched to cases identified during the main study. The percentage of working deaths not covered by any agency was 34%. Only 35% of working deaths were covered by an OHS agency, while 57% were covered by a compensation agency. The OHS agencies had minimal coverage of work related deaths that occurred on the road (to workers (8%) or commuters (3%)), whereas the compensation system covered these deaths better than those of workers in incidents that occurred in a workplace (65% versus 53%). There was virtually no coverage of bystanders (less than 8%) by either type of agency. There was marked variation in the level of coverage depending on the industry, occupation, and employment status of the workers, and the type of injury event involved in the incident. When using data from official sources, the significant limitations in coverage identified in this paper need to be taken into account. Future surveillance, arising from a computerised National Coroners Information System, should result in improved coverage of work related traumatic deaths in Australia.
Publisher: Elsevier BV
Date: 2000
DOI: 10.1016/S0003-6870(99)00025-3
Abstract: Several studies exist that have conducted research into the effects of different shiftwork patterns on the in idual, especially regarding 8 and 12 h rosters. The findings of these studies have been largely supportive of longer shifts, however, the effects on work performance are not as clear cut. This study aimed to examine the changeover from an 8 h roster to a 12 h roster in a power station via monitoring on-shift performance, general health and well-being, sleep and mood behaviour, as well as absence and accident data. Results suggest that the domestic and social life of workers was markedly improved under the 12 h roster. Improvements in physical health, sleeping behaviour and mood state of employees were also documented. On-shift performance measures showed an increase in error rates at the end of a 12 h shift. Ways of reducing the risk of error towards the end of a 12 h shift should be explored. The results of this study suggest that 12 h shifts are a valid alternative to 8 h shifts in this particular workplace, although tasks that require error-free activities should not be performed towards the end of a 12 h shift.
Publisher: Elsevier BV
Date: 2014
DOI: 10.1016/J.AAP.2013.10.009
Abstract: In many countries increased on-road motorcycling participation has contributed to increased motorcyclist morbidity and mortality over recent decades. Improved helmet technologies and increased helmet wearing rates have contributed to reductions in serious head injuries, to the point where in many regions thoracic injury is now the most frequently occurring serious injury. However, few advances have been made in reducing the severity of motorcyclist thoracic injury. The aim of the present study is to provide needed information regarding serious motorcyclist thoracic trauma, to assist motorcycling groups, road safety advocates and road authorities develop and prioritise counter-measures and ultimately reduce the rising trauma burden. For this purpose, a data collection of linked police-reported and hospital data was established, and considerable attention was given to establishing a weighting procedure to estimate hospital cases not reported to police and fatal cases not admitted to hospital. The resulting data collection of an estimated 19,979 hospitalised motorcyclists is used to provide detailed information on the nature, incidence and risk factors for thoracic trauma. Over the last decade the incidence of motorcyclist serious thoracic injury has more than doubled in the population considered, and by 2011 while motorcycles comprised 3.2% of the registered vehicle fleet, one quarter of road traffic-related serious thoracic trauma cases treated in hospitals were motorcyclists. Motor-vehicle collisions, fixed object collisions and non-collision crashes were fairly evenly represented amongst these cases, while older motorcyclists were over-represented. Several prevention strategies are identified and discussed.
Publisher: Elsevier BV
Date: 09-2017
DOI: 10.1016/J.ARCHGER.2017.06.006
Abstract: Delirium is common in older hip fracture patients, yet its association with mortality after hip fracture remains uncertain. This study aimed to determine whether delirium was associated with all-cause one-year mortality after hip fracture in older patients and whether the effect of delirium was independent of dementia status. A retrospective analysis of linked hospitalisation and mortality data for patients aged ≥65 years with a hip fracture during 1 January 2010 to 30 June 2014 in New South Wales, Australia. The association between delirium and mortality after a hip fracture was assessed using Cox proportional hazard regression. There were 4,065 (14.6%) of 27,888 hip fracture hospitalisations identified with delirium during hospitalisation. In iduals with delirium had a higher age-adjusted rate of all-cause one-year mortality after hip fracture compared to in iduals without delirium (35.3% versus 23.9%). After adjusting for covariates, the risk of all-cause mortality was increased at one-year post-admission for older in iduals compared to those aged 65-69 years, for in iduals with multiple comorbidities, dementia (Hazard Ratio (HR): 1.14 95%CI:1.08-1.20), delirium (HR: 1.19 95%CI:1.12-1.26), and who had an Intensive Care Unit admission (HR: 1.44 95%CI:1.31-1.59). Comorbid delirium did not add additional mortality risk for in iduals with a hip fracture who have dementia. Delirium identified in hospital was associated with all-cause one-year mortality after hip fracture in older Australians without dementia. As delirium is potentially preventable, better systematic assessment and documentation of a hip fracture patient's cognitive state is warranted to select the most effective strategies to prevent and manage delirium.
Publisher: Oxford University Press (OUP)
Date: 08-2023
Abstract: Perioperative interventions could enhance early mobilisation and physical function after hip fracture surgery. Determine the effectiveness of perioperative interventions on early mobilisation and physical function after hip fracture. Ovid MEDLINE, CINAHL, Embase, Scopus and Web of Science were searched from January 2000 to March 2022. English language experimental and quasi-experimental studies were included if patients were hospitalised for a fractured proximal femur with a mean age 65 years or older and reported measures of early mobilisation and physical function during the acute hospital admission. Data were pooled using a random effect meta-analysis. Twenty-eight studies were included from 1,327 citations. Studies were conducted in 26 countries on 8,192 participants with a mean age of 80 years. Pathways and models of care may provide a small increase in early mobilisation (standardised mean difference [SMD]: 0.20, 95% confidence interval [CI]: 0.01–0.39, I2 = 73%) and physical function (SMD: 0.07, 95% CI 0.00 to 0.15, I2 = 0%) and transcutaneous electrical nerve stimulation analgesia may provide a moderate improvement in function (SMD: 0.65, 95% CI: 0.24–1.05, I2 = 96%). The benefit of pre-operative mobilisation, multidisciplinary rehabilitation, recumbent cycling and clinical supervision on mobilisation and function remains uncertain. Evidence of no effect on mobilisation or function was identified for pre-emptive analgesia, intraoperative periarticular injections, continuous postoperative epidural infusion analgesia, occupational therapy training or nutritional supplements. Perioperative interventions may improve early mobilisation and physical function after hip fracture surgery. Future studies are needed to model the causal mechanisms of perioperative interventions on mobilisation and function after hip fracture.
Publisher: SAGE Publications
Date: 07-12-2022
DOI: 10.1177/00048674211061684
Abstract: Young people with a mental disorder often perform poorly at school and can fail to complete high school. This study aims to compare scholastic performance and high school completion of young people hospitalised with a mental disorder compared to young people not hospitalised for a mental disorder health condition by gender. A population-based matched case-comparison cohort study of young people aged ⩽18 years hospitalised for a mental disorder during 2005–2018 in New South Wales, Australia using linked birth, health, education and mortality records. The comparison cohort was matched on age, gender and residential postcode. Generalised linear mixed modelling examined risk of school performance below the national minimum standard and generalised linear regression examined risk of not completing high school for young people with a mental disorder compared to matched peers. Young males with a mental disorder had over a 1.7 times higher risk of not achieving the national minimum standard for numeracy (adjusted relative risk: 1.71 95% confidence interval: [1.35, 2.15]) and reading (adjusted relative risk: 1.99 95% confidence interval: [1.80, 2.20]) compared to matched peers. Young females with a mental disorder had around 1.5 times higher risk of not achieving the national minimum standard for numeracy (adjusted relative risk: 1.50 95% confidence interval: [1.14, 1.96]) compared to matched peers. Both young males and females with a disorder had around a three times higher risk of not completing high school compared to peers. Young males with multiple disorders had up to a sixfold increased risk and young females with multiple disorders had up to an eightfold increased risk of not completing high school compared to peers. Early recognition and support could improve school performance and educational outcomes for young people who were hospitalised with a mental disorder. This support should be provided in conjunction with access to mental health services and school involvement and assistance.
Publisher: Elsevier BV
Date: 06-2020
DOI: 10.1016/J.AUEC.2019.09.004
Abstract: Injury remains the leading cause of death and disability for Australian children. There is known variability in the quality of care delivered to injured children in Australia. This study prioritises recommendations developed from an expert review of paediatric trauma cases, for implementation with the aim of improving health service delivery to children sustaining severe injury. A modified-Delphi study was conducted between October 2018 and February 2019. Two rounds of an online survey to rank the suitability and importance of each of the 26 recommendations was conducted. Final decisions on the priorities for change in the paediatric trauma system was determined by a consensus of ≥80% for importance and/or suitability. One hundred and one participants completed Round 1, and 60 participants completed Round 2 of the modified-Delphi. In Round 1, 13 recommendations reached ≥80% and in round 2, 11 recommendations reached ≥80%. Those ranked highest focussed on pre-hospital airway management, streamlining retrieval and transfer processes, improving hospital nursing ratios and radiology reporting. This modified-Delphi study identified the priority areas for recommended change to the NSW paediatric trauma system. Work to address these areas has the potential to provide more coordinated and timely care to children sustaining severe injury.
Publisher: AMPCo
Date: 11-2016
DOI: 10.5694/MJA16.00406
Abstract: To determine trends in crude and risk-adjusted mortality for major trauma patients injured in rural or metropolitan New South Wales, 2009-2014. A retrospective analysis of NSW statewide trauma registry data. Adult patients (aged 16 years or more) who presented with major trauma (Injury Severity Scores greater than 15) to a NSW hospital during 2009-2014. The main covariate of interest was geographic location of injury (metropolitan v rural/regional areas). Inpatient mortality was analysed by multivariable logistic regression. Data for 11 423 eligible patients were analysed. Inpatient mortality for those injured in metropolitan locations was 14.7% in 2009 and 16.1% in 2014 (P = 0.45). In rural locations, there was a statistically significant decline in in-hospital mortality over the study period, from 12.1% in 2009 to 8.7% in 2014 (P = 0.004). Risk-adjusted mortality for those injured in a rural location was lower in 2013 than during 2009, but remained stable for those injured in metropolitan locations. Crude and risk-adjusted mortality after major trauma have remained stable in those injured in metropolitan areas of NSW between 2009 and 2014. The apparent downward trend in mortality associated with severe trauma in rural/regional locations requires further analysis.
Publisher: Elsevier BV
Date: 09-2004
Publisher: Informa UK Limited
Date: 15-10-2017
DOI: 10.1080/13607863.2015.1099610
Abstract: With population ageing, self-harm injuries among older people are increasing. Further examination of the association of physical illness and self-harm among older people is warranted. This research aims to identify the association of physical illness with hospitalisations following self-harm compared to non-self-harm injury among older people. A population-based cohort study of in iduals aged 50+ years admitted to hospital either for a self-harm or a non-self-harm injury using linked hospital admission and mortality records during 2003-2012 in New South Wales, Australia was conducted. Logistic regression and survival plots were used to examine the association of 21 physical illnesses and mortality at 12 months by injury intent, respectively. Age-adjusted health outcomes, including length of stay, readmission and mortality were examined by injury intent. There were 12,111 hospitalisations as a result of self-harm and 474,158 hospitalisations as a result of non-self-harm injury. Self-harm compared to non-self-harm hospitalised injury was associated with higher odds of mental health conditions (i.e. depression, schizophrenia, bipolar and anxiety disorders), neurological disorders (excluding dementia), other disorders of the nervous system, diabetes, chronic lower respiratory disease, liver disease, tinnitus and pain. Tinnitus, pain, malignancies and diabetes all had a higher likelihood of occurrence for self-harm compared to non-self-harm hospitalisations even after adjusting for mental health conditions, number of comorbidities and alcohol and drug dependency. Older people who are experiencing chronic health conditions, particularly tinnitus, malignancies, diabetes and chronic pain may be at risk of self-harm. Targeted screening may assist in identifying older people at risk of self-harm.
Publisher: Elsevier BV
Date: 05-2019
DOI: 10.1016/J.INJURY.2018.12.011
Abstract: Paediatric injury impacts the entire family. Many parents experience stress and anxiety following paediatric injury, but little is known about factors that support parents' wellbeing and how they successfully manage the adversity of child injury during acute hospitalisation. To explore parent experiences and resilience-promoting factors that facilitate the wellbeing of parents with severely injured children during the acute hospitalisation period. A qualitative inquiry conducted across four major Australian paediatric trauma services. Semi-structured interviews were conducted with a purposive s le of 40 parents of 30 severely injured children aged 0-12 years during the acute post-injury hospitalisation period. Interviews explored parents' experiences and how parents had managed the stress of their child's injury during the acute hospitalisation period. Data were analysed using directed content analysis. Parents identified a range of in idual characteristics and resources, and those of their children and families, communities, and the hospital environment, which facilitated their wellbeing during the initial post-injury period. Three themes were derived from analysis: Drawing on inner strengths Having positive and supportive relationships Being in a safe place with the right help. Resilience-promoting factors for parents of injured children can be used to inform development of brief online intervention modules to enhance parent resilience. Routine screening and targeted psychological first aid for parental distress are recommended.
Publisher: BMJ
Date: 04-2016
Publisher: Springer Science and Business Media LLC
Date: 07-06-2023
DOI: 10.1186/S12913-023-09614-1
Abstract: Unprofessional behaviour among hospital staff is common. Such behaviour negatively impacts on staff wellbeing and patient outcomes. Professional accountability programs collect information about unprofessional staff behaviour from colleagues or patients, providing this as informal feedback to raise awareness, promote reflection, and change behaviour. Despite increased adoption, studies have not assessed the implementation of these programs utilising implementation theory. This study aims to (1) identify factors influencing the implementation of a whole-of-hospital professional accountability and culture change program, Ethos , implemented in eight hospitals within a large healthcare provider group, and (2) examine whether expert recommended implementation strategies were intuitively used during implementation, and the degree to which they were operationalised to address identified barriers. Data relating to implementation of Ethos from organisational documents, interviews with senior and middle management, and surveys of hospital staff and peer messengers were obtained and coded in NVivo using the Consolidated Framework for Implementation Research (CFIR). Implementation strategies to address identified barriers were generated using Expert Recommendations for Implementing Change (ERIC) strategies and used in a second round of targeted coding, then assessed for degree of alignment to contextual barriers. Four enablers, seven barriers, and three mixed factors were found, including perceived limitations in the confidential nature of the online messaging tool (‘Design quality and packaging’), which had downstream challenges for the capacity to provide feedback about utilisation of Ethos (‘Goals and Feedback’, ‘Access to Knowledge and Information’). Fourteen recommended implementation strategies were used, however, only four of these were operationalised to completely address contextual barriers. Aspects of the inner setting (e.g., ‘Leadership Engagement’, ‘Tension for Change’) had the greatest influence on implementation and should be considered prior to the implementation of future professional accountability programs. Theory can improve understanding of factors affecting implementation, and support strategies to address them.
Publisher: BMJ
Date: 12-2020
DOI: 10.1136/BMJOPEN-2020-044049
Abstract: Value-based healthcare delivery models have emerged to address the unprecedented pressure on long-term health system performance and sustainability and to respond to the changing needs and expectations of patients. Implementing and scaling the benefits from these care delivery models to achieve large-system transformation are challenging and require consideration of complexity and context. Realist studies enable researchers to explore factors beyond ‘what works’ towards more nuanced understanding of ‘what tends to work for whom under which circumstances’. This research proposes a realist study of the implementation approach for seven large-system, value-based healthcare initiatives in New South Wales, Australia, to elucidate how different implementation strategies and processes stimulate the uptake, adoption, fidelity and adherence of initiatives to achieve sustainable impacts across a variety of contexts. This exploratory, sequential, mixed methods realist study followed RAMESES II (Realist And Meta-narrative Evidence Syntheses: Evolving Standards) reporting standards for realist studies. Stage 1 will formulate initial programme theories from review of existing literature, analysis of programme documents and qualitative interviews with programme designers, implementation support staff and evaluators. Stage 2 envisages testing and refining these hypothesised programme theories through qualitative interviews with local hospital network staff running initiatives, and analyses of quantitative data from the programme evaluation, hospital administrative systems and an implementation outcome survey. Stage 3 proposes to produce generalisable middle-range theories by synthesising data from context–mechanism–outcome configurations across initiatives. Qualitative data will be analysed retroductively and quantitative data will be analysed to identify relationships between the implementation strategies and processes, and implementation and programme outcomes. Mixed methods triangulation will be performed. Ethical approval has been granted by Macquarie University (Project ID 23816) and Hunter New England (Project ID 2020/ETH02186) Human Research Ethics Committees. The findings will be published in peer-reviewed journals. Results will be fed back to partner organisations and roundtable discussions with other health jurisdictions will be held, to share learnings.
Publisher: SAGE Publications
Date: 06-2013
DOI: 10.1177/183335831304200201
Abstract: The introduction of Systematized Nomenclature of Medicine - Clinical Terms (SNOMED CT) for diagnosis coding in emergency departments (EDs) in New South Wales (NSW) has implications for injury surveillance abilities. This study aimed to assess the consequences of its introduction, as implemented as part of the ED information system in NSW, for identifying road trauma-related injuries in EDs. It involved a retrospective analysis of road trauma-related injuries identified in linked police, ED and mortality records during March 2007 to December 2009. Of all SNOMED CT codes in the principal provisional diagnosis field, between 53.7% and 78.4% referred to the type of injury or symptom experienced by the in idual. Of the road users identified by police, 3.2% of vehicle occupants, 6% of motorcyclists, 10.0% of pedal cyclists and 5.2% of pedestrians were identified using SNOMED CT codes in the principal provisional diagnosis field. The introduction of SNOMED CT may provide flexible terminologies for clinicians. However, unless carefully implemented in information systems, its flexibility can lead to mismatches between the intention and actual use of defined data fields. Choices available in SNOMED CT to indicate symptoms, diagnoses, or injury mechanisms need to be controlled and these three concepts need to be retained in separate data fields to ensure a clear distinction between their classifications in the ED.
Publisher: Elsevier BV
Date: 02-1997
Publisher: Informa UK Limited
Date: 04-07-2014
DOI: 10.1080/00140139.2014.933886
Abstract: Various human factors classification frameworks have been used to identified causal factors for clinical adverse events. A systematic review was conducted to identify human factors classification frameworks that identified the causal factors (including human error) of adverse events in a hospital setting. Six electronic databases were searched, identifying 1997 articles and 38 of these met inclusion criteria. Most studies included causal contributing factors as well as error and error type, but the nature of coding varied considerably between studies. The ability of human factors classification frameworks to provide information on specific causal factors for an adverse event enables the focus of preventive attention on areas where improvements are most needed. This review highlighted some areas needing considerable improvement in order to meet this need, including better definition of terms, more emphasis on assessing reliability of coding and greater sophistication in analysis of results of the classification. Practitioner Summary: Human factors classification frameworks can be used to identify causal factors of clinical adverse events. However, this review suggests that existing frameworks are erse, limited in their identification of the context of human error and have poor reliability when used by different in iduals.
Publisher: AMPCo
Date: 07-2017
DOI: 10.5694/MJA16.01173
Abstract: To compare the socio-demographic characteristics and type of injury sustained, the use of hospital resources and rates of hospitalisation by injury type, and survival following fall injuries to older Aboriginal people and non-Indigenous Australian people hospitalised for fall-related injuries. Population-based retrospective cohort data linkage study. Setting, participants: New South Wales residents aged 50 years or more admitted to a public or private NSW hospital for a fall-related injury during 1 January 2003 - 31 December 2012. Proportions of patients with defined injury types, mean hospital length of stay (LOS), 30-day mortality, age-standardised hospitalisation rates and age-adjusted rate ratios, 28-day re-admission rates. There were 312 758 fall-related injury hospitalisations for 234 979 in iduals 2660 admissions (0.85%) were of Aboriginal people. The proportion of hospitalisations for fall-related fracture injuries was lower for Aboriginal than for non-Indigenous Australians (49% v 60% of fall-related hospitalisations P < 0.001). The major injury type for Aboriginal patients was non-fracture injury to head or neck (19% of hospitalisations) for non-Indigenous patients it was hip fractures (18%). Age-adjusted LOS was lower for Aboriginal than for non-Indigenous patients (9.1 v 14.0 days P < 0.001), as was 30-day mortality (2.9% v 4.2% P < 0.001). For Aboriginal people, fall injury hospitalisations increased at an annual rate of 5.8% (95% CI, 4.0-7.7% P < 0.001) for non-Indigenous patients, the mean annual increase was 2.5% (95% CI, 2.1-3.0 P < 0.001). The patterns of injury and outcomes of fall injury hospitalisations were different for older Aboriginal people and other older Australians, suggesting that different approaches are required to prevent and treat fall injuries.
Publisher: Elsevier BV
Date: 09-2022
DOI: 10.1016/J.INJURY.2022.04.024
Abstract: Blunt chest injury in older adults, aged 65 years and older, leads to significant morbidity and mortality. The aim of this study was to evaluate the effect of a multidisciplinary chest injury care bundle (ChIP) on patient and health service outcomes in older adults with blunt chest injury. ChIP comprised multidimensional implementation guidance in three key pillars of care for blunt chest injury: respiratory support, analgesia, and complication prevention. Implementation was guided using the Behaviour Change Wheel. This proof-of-concept controlled pre- and post-test study with two intervention and two control sites in Australia was conducted from July 2015 to June 2019. The primary outcomes were non-invasive ventilation (NIV) use, unplanned Intensive Care Unit (ICU) admissions, and in-hospital mortality. Secondary outcomes were health service and costing outcomes. There were 1122 patients included in the analysis, with 673 at intervention sites (331 pre-test and 342 post-test) and 449 at control sites (256 pre-test and 193 post-test). ChIP was associated with unplanned ICU admissions and in NIV use with a reduction of the odds in the post vs the pre periods in the intervention sites when compared to the controls (ratio of OR=0.13, 95%CI=0.03-0.55) and (ratio of OR=0.14, 95%CI=0.02-0.98) respectively. There was no significant change in mortality. Implementing ChIP was also associated with health service team reviews with an increased odds in the post vs pre periods in the intervention sites in comparison to the controls for surgical review (ratio of OR =6.93, 95%CI=4.70-10.28), ICU doctor (ratio of OR =5.06, 95%CI=2.26-9.25), ICU liaison (ratio of OR =14.14, 95%CI=3.15-63.31), and pain (ratio of OR =5.59, 95%CI=3.25-9.29). ChIP was also related to incentive spirometry (ratio of OR=6.35, 95%CI= 3.15-12.82) and overall costs (ratio of mean ratio=1.34, 95%CI=1.09-1.66) with a higher ratio for intervention sites. Implementation of ChIP using the Behaviour Change Wheel was associated with reduced unplanned ICU admissions and NIV use and improved health care delivery. ANZCTR: ACTRN12618001548224, approved 17/09/2018.
Publisher: Wiley
Date: 19-04-2018
DOI: 10.1111/AJR.12408
Abstract: To compare differences in injury characteristics, health outcomes and treatment costs between urban and rural residents who were hospitalised following an injury. A retrospective examination of injury-linked hospitalisation and mortality data in New South Wales from 1 January 2010 to 30 June 2014. Urban (496 325) and rural (213 139) residents who were hospitalised following an injury. Demographic and injury characteristics, injury severity, hospital length of stay, 28-day hospital readmission, 90-day mortality and treatment cost. Rural residents had an increased likelihood of being hospitalised for injuries from motorcycles, vehicles, animate causes, venomous animals or plants and assault compared to urban residents. Rural residents were less likely to be readmitted to hospital within 28 days and had a lower length of stay and age-adjusted length of stay than urban residents. Injury-related hospitalisations for urban and rural residents cost $4.4 billion and $1.7 billion, respectively. Annually, acute injury treatment ($1.1 billion), rehabilitation ($130 million) and subacute non-acute patient care ($57 million) cost $1.3 billion ($990 million for urban and $384 million for rural residents) in New South Wales. Fall-related injuries and transport incidents were the costliest injury mechanisms for both urban and rural residents. Injuries contribute substantially to hospitalised morbidity and its cost. The development and implementation of injury prevention strategies targeting the most common injuries for urban and rural residents will go some way towards reducing hospitalised injury and its cost.
Publisher: Wiley
Date: 31-05-2022
DOI: 10.1111/JPC.16028
Abstract: This study aims to identify the hospitalised morbidity associated with three common chronic health conditions among young people using a population‐based matched cohort. A population‐level matched case‐comparison retrospective cohort study of young people aged ≤18 years hospitalised with asthma, type 1 diabetes (T1D) or epilepsy during 2005–2018 in New South Wales, Australia using linked birth, health and mortality records. The comparison cohort was matched on age, sex and residential postcode. Adjusted rate ratios (ARR) were calculated by sex and age group. There were 65 055 young people hospitalised with asthma, 6648 with epilepsy, and 2209 with T1D. Young people with epilepsy (ARR 10.95 95% confidence interval (CI) 9.98–12.02), T1D (ARR 8.64 95% CI 7.72–9.67) or asthma (ARR 4.39 95% CI 4.26–4.53) all had a higher risk of hospitalisation than matched peers. Admission risk was highest for males (ARR 11.00 95% CI 9.64–12.56) and females with epilepsy (ARR 10.83 95% CI 9.54–12.29) compared to peers. The highest admission risk by age group was for young people aged 10–14 years (ARR 5.50 95% CI 4.77–6.34) living with asthma, children aged ≤4 years (ARR 12.68 95% CI 11.35–14.17) for those living with epilepsy, and children aged 5–9 years (ARR 9.12 95% CI 7.69–10.81) for those living with T1D compared to peers. The results will guide health service planning and highlight opportunities for better management of chronic health conditions, such as further care integration between acute, primary and community health services for young people.
Publisher: Springer Science and Business Media LLC
Date: 08-08-2018
Publisher: Springer Science and Business Media LLC
Date: 26-08-2021
DOI: 10.1186/S12883-021-02355-W
Abstract: Spinal cord injury (SCI) is associated with autonomic imbalance and significant secondary conditions, including cardiac and brain dysfunction that adversely impact health and wellbeing. This study will investigate the effectiveness (intention-to-treat) of a neuro-cardiac self-regulation therapy to improve autonomic and neural/brain activity in adults with SCI living in the community. A two-arm parallel, randomised controlled trial in which adults with SCI living in the community post-rehabilitation will be randomly assigned to a treatment or control group. The treatment group ( N = 60) aged 18–70 years with a chronic traumatic or non-traumatic SCI, will receive intervention sessions once per week for 10 weeks, designed to regulate autonomic activity using computer-based feedback of heart rate variability and controlled breathing (called HRV-F). Comprehensive neurophysiological and psychological assessment will occur at baseline, immediate post-treatment, and 6 and 12-months post-treatment. Primary outcome measures include electrocardiography/heart rate variability (to assess autonomic nervous system function) and transcranial doppler sonography (to assess cerebral blood circulation in basal cerebral arteries). Secondary outcomes measures include continuous blood pressure, electroencephalography, functional near-infrared spectroscopy, respiration/breath rate, electrooculography, cognitive capacity, psychological status, pain, fatigue, sleep and quality of life. Controls ( N = 60) will receive usual community care, reading material and a brief telephone call once per week for 10 weeks and be similarly assessed over the same time period as the HRV-F group. Linear mixed model analysis with repeated measures will determine effectiveness of HRV-F and latent class mixture modelling used to determine trajectories for primary and selected secondary outcomes of interest. Treatments for improving autonomic function after SCI are limited. It is therefore important to establish whether a neuro-cardiac self-regulation therapy can result in improved autonomic functioning post-SCI, as well as whether HRV-F is associated with better outcomes for secondary conditions such as cardiovascular health, cognitive capacity and mental health. The study has been prospectively registered with the Australian and New Zealand Clinical Trial Registry ( ACTRN12621000870853 .aspx). Date of Registration: 6th July 2021. Trial Sponsor: The University of Sydney, NSW 2006. Protocol version: 22/07/2021.
Publisher: JMIR Publications Inc.
Date: 03-05-2021
Abstract: merging adulthood is a distinct segment of an in idual’s life course. The defining features of this transitional period include identity exploration, instability, future possibilities, self-focus, and feeling in-between, all of which are thought to affect quality of life, health, and well-being. A longitudinal cohort study with a comprehensive set of measures would be a valuable resource for improving the understanding of the multifaceted elements and unique challenges that contribute to the health and well-being of emerging adults. he main aim of this pilot study was to evaluate the feasibility and acceptability of recruiting university graduates to establish a longitudinal cohort study to inform the understanding of emerging adulthood. his pilot study was conducted among graduates at a large university. It involved collecting web-based survey data at baseline (ie, graduation) and 12 months post baseline, and linking survey responses to health records from administrative data collections. The feasibility outcome measures of interest included the recruitment rate, response rate, retention rate, data linkage opt-out rate, and availability of linked health records. Descriptive statistics were used to evaluate the representativeness of the s le, completeness of the survey responses, and data linkage characteristics. nly 2.8% of invited graduates (238/8532) agreed to participate in this pilot cohort study, of whom 59.7% (142/238) responded to the baseline survey. The retention rate between the baseline and follow-up surveys was 69.7% (99/142). The completeness of the surveys was excellent, with the proportion of answered questions in each survey domain ranging from 87.3% to 100% in both the baseline and follow-up surveys. The data linkage opt-out rate was 32.4% (77/238). he overall recruitment rate was poor, while the completeness of survey responses among respondents ranged from good to excellent. There was reasonable acceptability for conducting data linkage of health records from administrative data collections and survey responses. This pilot study offers insights and recommendations for future research aiming to establish a longitudinal cohort study to investigate health and well-being in emerging adults. ustralian New Zealand Clinical Trials Registry number ACTRN12618001364268 eec8wh R2-10.2196/16108
Publisher: AMPCo
Date: 08-2012
DOI: 10.5694/MJA11.11351
Abstract: To examine trends in mechanism and outcome of major traumatic injury in adults since the implementation of the New South Wales trauma monitoring program, and to identify factors associated with mortality. Retrospective review of NSW Trauma Registry data from 1 January 2003 to 31 December 2007, including patient demographics, year of injury, and level of trauma centre where definitive treatment was provided. 9769 people aged ≥ 15 years hospitalised for trauma, with an injury severity score (ISS) > 15. The NSW Trauma Registry outcome measures included were overall hospital length of stay, length of stay in an intensive care unit and in ospital mortality. There was a decreasing trend in severe trauma presentations in the age group 16-34 years, and an increasing trend in presentations of older people, particularly those aged ≥ 75 years. Road trauma and falls were consistently the commonest injury mechanisms. There were 1328 inhospital deaths (13.6%). Year of injury, level of trauma centre, ISS, head/neck injury and age were all independent predictors of mortality. The odds of mortality was significantly higher among patients receiving definitive care at regional trauma centres compared with Level I centres (odds ratio, 1.34 95% CI, 1.10-1.63). Deaths from major trauma in NSW trauma centres have declined since 2003, and definitive care at a Level 1 trauma centre was associated with a survival benefit. More comprehensive trauma data collection with timely analysis will improve injury surveillance and better inform health policy in NSW.
Publisher: Elsevier BV
Date: 08-2005
Publisher: Springer Science and Business Media LLC
Date: 12-2018
Publisher: Springer Science and Business Media LLC
Date: 23-07-2009
Publisher: Elsevier BV
Date: 08-2015
DOI: 10.1016/J.AAP.2015.04.039
Abstract: To examine the circumstances of passenger vehicle crashes for novice licenced drivers aged 17-25 years and to compare the crash circumstances of the most common crash types for novices to a s le of full-licence drivers aged 40-49 years. A retrospective analysis was conducted of passenger vehicle crashes involving novice and full-licenced drivers during 1 January 2001 to 31 December 2011 in New South Wales (NSW), Australia. There were 4113 injurious crashes of novice drivers. Almost half the novice driver crashes involved a single vehicle. Vehicle speed (33.2%), fatigue (15.6%) and alcohol (12.6%) were identified risk factors in novice driver crashes. Correspondence analysis for 4 common crash types for novice drivers revealed that the crash characteristics between novice and full-licenced drivers were similar. Similarities exist between novice driver and full-licenced driver crash risk for common crash types. Preventive strategies aimed at crash risk reduction for novice drivers may also benefit all drivers.
Publisher: Taylor & Francis
Date: 21-03-2013
DOI: 10.1201/B13826-60
Publisher: Wiley
Date: 02-06-2023
DOI: 10.1002/CBM.2298
Abstract: There are not many longitudinal studies examining people experiencing homelessness and interacting with the criminal justice system over time. To describe the type of criminal offences committed, court outcomes, identify probable predictors of reoffending, and estimate the criminal justice costs in a cohort of homeless hostel clinic attendees. A retrospective cohort study of 1646 people attending a homeless clinic who had had contact with the criminal justice system (CJS) in New South Wales (NSW), Australia, using linked clinic, criminal offence, health and mortality data from 1 July 2008 to 30 June 2021. Initial comparisons were made with the 852 clinic attendees without CJS contact in the period. Multivariable logistic regression was used to identify predictors of reci ism. There were 16,840 offending episodes, giving an offence rate of 87.8 per 100 person‐years (95%CI: 86.5–89.1). The most common index offences were acts intended to cause injury (22%), illicit drug (17%) and theft‐related (12%) offences. Most people (83%) were found guilty of the index offence and received a fine (37%) or community‐based sentence (29%). Total court finalisation costs were AUD $11.3 million. Three‐quarters of those convicted reoffended within 24 months. Offenders were more likely to be younger, have a diagnosis of personality disorder (AOR: 1.31 95% CI: 1.04–1.67), a substance use disorder (AOR: 1.60 95% CI 1.14–2.23) and/or to have a previous charge dismissed on mental health grounds (AOR: 1.79 95% CI: 1.31–2.46). Within the offending cohort, reoffenders had almost twice the odds of having theft‐related offences as their principal index offence (AOR: 1.85 95% CI: 1.29–2.66). This longitudinal study finding of not only a high rate of criminal justice contact, but also a high rate of reci ism among people who have been homeless, lends support to a need for strategies both to address the root causes of homelessness and to provide a comprehensive systems‐based response to reduce reci ism, that includes secure housing as well as mental health and substance use treatment programmes for homeless offenders.
Publisher: Elsevier BV
Date: 05-2015
DOI: 10.1016/J.INJURY.2015.02.006
Abstract: Road trauma is one of the most common causes of injury for children. Yet risk factors associated with different levels of injury severity for childhood road trauma have not been examined in-depth. This study identifies crash and injury risk factors associated with the severity of non-fatal injury outcome for paediatric road trauma. A retrospective analysis was conducted of paediatric road trauma identified in linked police-reported and hospitalisation records during 1 January 2001 to 31 December 2011 in New South Wales (NSW), Australia. The linkage rate was 54%. Injury severity was calculated from diagnosis classifications in hospital records using the International Classification of Disease Injury Severity Score. Univariate and multi-variable logistic regression was conducted. There were 2412 car occupants, 1701 pedestrians and 612 pedal cyclists hospitalised where their hospital record linked to a police report. For car occupants, unauthorised vehicle drivers had twice the odds (OR: 2.21, 95%CI 1.47-3.34) and learner rovisional drivers had one and a half times higher odds (OR: 1.54, 95%CI 1.15-2.07) of a child car occupant sustaining a serious injury compared to a minor injury. For pedal cyclists and pedestrians, there were lower odds of a crash occurring during school commuting time and higher odds of a crash occurring during the weekend or on a dry road for children who sustained a serious versus a minor injury. Injury prevention initiatives, such as restraint and helmet use, that should reduce injury and/or crash severity are advocated.
Publisher: Wiley
Date: 25-01-2021
DOI: 10.1111/AJAG.12905
Abstract: To compare demographics, treatment and health outcomes for in iduals hospitalised with a hip fracture and examine predictors of postacute discharge destination. A retrospective analysis of data from the Australian and New Zealand Hip Fracture Registry of in iduals aged ≥50 years hospitalised with a hip fracture from 2015 to 2018 (n = 29 881). Multinominal logistic regression was used to examine factors associated with discharge destination for in iduals from private residences. Advancing age, impaired cognition, reduced walking ability and poorer pre‐operative health were predictors for discharge to residential aged care. The odds of discharge to a rehabilitation unit were higher for in iduals with extracapsular fractures, treated at major trauma centres or at hospitals with home‐based rehabilitation. In iduals in rural areas had higher odds of discharge to another hospital or ward. In addition to well‐known demographics, injury and treatment factors, non‐clinical factors including geographic area of residence also affect discharge destination.
Publisher: Wiley
Date: 05-02-2021
DOI: 10.1111/AJAG.12906
Abstract: To compare the health system utilisation patterns and health outcomes of residential aged care facility (RACF) residents reviewed by a hospital avoidance program to those of RACF residents who received usual care. A retrospective evaluation of a hospital avoidance program provided by a hospital‐based medical and nursing outreach team. Residents reviewed by the program were randomly matched 1:1 to comparison group residents based on age group, sex and number of co‐morbidities. Number of hospital admissions, excess hospital length of stay and excess hospital treatment costs were compared. Residents reviewed by the program spent an average 9‐10 days fewer in hospital with AUD$2,091 to $8,014 lower hospital treatment costs compared to comparison group residents. Rapid provision of outreach services for the management of acute care of RACF residents may reduce the number of days residents spend in hospital, as well as reducing the associated hospital treatment costs.
Publisher: Elsevier BV
Date: 06-2020
DOI: 10.1016/J.SPINEE.2020.01.002
Abstract: Despite its potential to cause serious and life-long disability or death, population-based data on traumatic spinal injury in pediatric populations is scarce. To quantify and describe the incidence and cost of hospitalizations for traumatic spinal injury among Australian children, and to examine the trend over a 10-year period. Population-based retrospective cohort study. Children aged ≤16 years who were hospitalized for traumatic spinal injury in Australia during 1 July 2002 to 30 June 2012. Age-standardized hospital admission rates. This study used linked hospitalization and mortality data. Age-standardized hospitalization rates were calculated with 95% confidence intervals (CIs). Negative binomial regression was used to examine change in temporal trends in hospitalization rates. There were 4,360 hospitalizations for pediatric traumatic spinal injury during the 10-year study period. Males and older children were more frequently hospitalized, and falls and road trauma accounted for almost three-quarters of hospitalizations. The average overall annual hospitalization rate was 9.43 (95% CI: 9.15-9.72) per 100,000 population, with an annual percent change of 1.2% (95% CI: -0.1% to 2.4%). There was an increase in the annual hospitalization rate for spinal dislocations, sprains, and strains (3.0% [95% CI: 0.8%-5.3%]) and among female children (1.7% [95% CI: 0.0%-3.4%]). The estimated total hospital treatment costs were AUD$43 million over the 10-year study period, with an estimated mean cost per child of AUD$9,867. Pediatric traumatic spinal injury is associated with significant morbidity and mortality. The burden of hospitalized pediatric traumatic spinal injury in Australia is rising, in particular spinal dislocations, sprains, and strains among female children. Targeted prevention strategies are needed to reduce the burden of pediatric traumatic spinal injury. It is recommended that a coordinated national strategy for preventing childhood traumatic spinal injury is developed and implemented in Australia.
Publisher: Elsevier BV
Date: 10-2013
Publisher: AMPCo
Date: 11-05-2021
DOI: 10.5694/MJA2.51083
Publisher: Springer Science and Business Media LLC
Date: 18-11-2022
Publisher: Elsevier BV
Date: 10-2018
DOI: 10.1016/J.INJURY.2018.07.009
Abstract: Injury is a leading cause of death and disability among children and young people. Recovery may be negatively affected by unwarranted clinical variation such as representation to an emergency department (ED), readmission to a hospital, and mortality. The aim of this study was to examine unwarranted clinical variation across providers of care of children and young people who were hospitalised for injury in New South Wales (NSW). Retrospective population-based cohort study using linked ED, hospital, and mortality data of all children and young people aged ≤25 years who were injured and hospitalised during 1 January 2010-30 June 2014 in NSW. Unwarranted clinical variation across providers was examined using three indicators. That is, for each hospital that treated ≥100 cases per year, risk standardised ratios were calculated with 95% and 99.8% confidence limits using the number of observed and expected events of (1) representations to ED within 72 h, (2) unplanned readmissions to hospital within 28 days, and (3) all-cause mortality within 30 days. There were 189,990 injury-related hospitalisations of children and young people. Of these, 4.4% represented to an ED, 8.7% were readmitted to hospital, and 0.2% died. Of the 45 public hospitals that treated ≥100 cases per year, higher than expected rates of ED representations, hospital readmissions, and mortality were observed in eleven, six, and two hospitals, respectively. The rates of ED representations, hospital readmissions, and mortality among children and young people hospitalised for injury in NSW were similar to the rates reported in other countries. However, unwarranted clinical variation across public hospitals was observed for all three indicators. These findings suggest that by improving routine follow-up support services post-discharge for children and young people and their families, it may be possible to reduce unwarranted clinical variation and improve health outcomes.
Publisher: CSIRO Publishing
Date: 2013
DOI: 10.1071/AH12031
Abstract: Background Falls are the leading cause of injury in older people. Rehabilitation services can assist in iduals to improve mobility and function after sustaining a fall-related injury. However, the true effect of fall-related injury resulting in hospitalisation is often underestimated because of failure to consider sub-acute and non-acute care provided following the acute hospitalisation episode. Aim This study aims to describe the sub-acute and non-acute health service use of in iduals hospitalised in New South Wales (NSW), Australia for a fall-related injury during 2000–01 to 2008–09, to examine the burden of fall-related inpatient rehabilitation hospital admissions from 1998–99 to 2010–11 and to estimate future demand for fall-related inpatient rehabilitation admissions in NSW to 2020. Method Retrospective review of sub-acute and non-acute records linked to hospital admission records during 2001–02 to 2008–09 in NSW. Analysis of temporal trends from 1998–99 to 2010–11 and projections to 2020 for rehabilitation-related (ICD-10-AM: Z47, Z48, Z50, Z75.1) inpatient hospital admissions. Results There were 4317 in iduals with a fall-related injury admitted to hospital and subsequently admitted for sub-acute and non-acute care 84% of these were aged 65+ years 70.4% were female and 27.2% had femur fractures. For the rehabilitation-related admissions, total mean functional independence measure (FIM) scores improved significantly (from 78.4 to 94.6 P 0.0001) between admission and discharge. Fall-related inpatient rehabilitation episodes increased by 9.1% each year between 1998 and 2011 for in iduals aged 65 years and older and are projected to rise to 50 000 admissions annually by 2020. Conclusion This is the first study to provide an epidemiological profile of in iduals using sub-acute and non-acute care in NSW using linked data. Improvements in data validity and reliability would enhance the quality of the sub-acute and non-acute care data and its ability to be used to inform resource use in this sector. The examination of temporal trends using only the inpatient hospital admissions provides a guide for resource implications for inpatient rehabilitation services. What is known about this topic? Fall-related injuries that result in inpatient hospital admissions are increasing in Australia. However, the extent of the effect of fall-related injuries in the sub-acute and non-acute sector remains unknown, due to data limitations. What does this paper add? Provides the first epidemiological profile of in iduals who fall and go on to use sub-acute and non-acute care in NSW using linked data. It highlights where improvements in data quality in the sub-acute and non-acute care data could be made to improve their usefulness to inform resource use in this sector. What are the implications for clinicians? Fall injury prevention and healthy ageing strategies for older in iduals remain a priority for clinicians. The current and projected future resource implications for inpatient rehabilitation and follow-up services provide an indication for clinicians of future demand in this area as the population ages. However, data quality needs to improve to provide clinicians with strongly relevant guidance to inform clinical practice.
Publisher: Oxford University Press (OUP)
Date: 04-2022
Abstract: People who live in aged care homes have high rates of illness and frailty. Providing evidence-based care to this population is vital to ensure the highest possible quality of life. In this study (CareTrack Aged, CT Aged), we aimed to develop a comprehensive set of clinical indicators for guideline-adherent, appropriate care of commonly managed conditions and processes in aged care. Indicators were formulated from recommendations found through systematic searches of Australian and international clinical practice guidelines (CPGs). Experts reviewed the indicators using a multiround modified Delphi process to develop a consensus on what constitutes appropriate care. From 139 CPGs, 5609 recommendations were used to draft 630 indicators. Clinical experts (n = 41) reviewed the indicators over two rounds. A final set of 236 indicators resulted, mapped to 16 conditions and processes of care. The conditions and processes were admission assessment bladder and bowel problems cognitive impairment depression dysphagia and aspiration end of life alliative care hearing and vision infection medication mobility and falls nutrition and hydration oral and dental care pain restraint use skin integrity and sleep. The suite of CT Aged clinical indicators can be used for research and assessment of the quality of care in in idual facilities and across organizations to guide improvement and to supplement regulation or accreditation of the aged care sector. They are a step forward for Australian and international aged care sectors, helping to improve transparency so that the level of care delivered to aged care consumers can be rigorously monitored and continuously improved.
Publisher: Informa UK Limited
Date: 14-08-2013
DOI: 10.1080/15389588.2012.752077
Abstract: Roadside barriers are often deployed between road users and fixed hazards to protect users from injury. However, the United States and Australian Roadside Design Guides do not consider motorcyclists in the risk-based decision process for the deployment of a barrier, because the severity indices for barriers and fixed hazards were developed for passenger vehicles. The aim of the present article is to quantify the protective effect of barriers with regards to motorcyclist injury and to thereby inform the Roadside Design Guides as to the relative severity of roadside hazards and infrastructure for motorcyclists. A retrospective case series study, using linked police-reported road crash and hospital admission data in New South Wales, Australia, from 2001 to 2009 was performed. Crude and adjusted relative risks of motorcyclist serious injury were determined for various fixed objects compared to barriers, using serious injury rates and multiple variable logistic regression. Calculated relative risks compared with guardrail for motorcyclists were compared with those determined from the United States and Australian Roadside Design Guides for passenger vehicle occupants. The study identified 1364 motorcyclists injured as a result of single-vehicle collisions with roadside barriers, trees, utility poles, and other fixed roadside infrastructure. Trees, posts, and utility poles were shown to provide significantly higher risks of serious injury to motorcyclists compared to barriers. This was also found to be true for serious injuries to particular body regions, such as the head, spine, and torso. The results for motorcyclists were in reasonable agreement with those derived from severity indices in the United States and Australian Roadside Design Guides for passenger vehicle occupants. Roadside barriers provide a significant reduction in the risk of serious injury to motorcyclists compared to various roadside hazards. The provisions in the United States and Australian Roadside Design Guides for passenger vehicle occupants are generally applicable to motorcyclists and support the prior and ongoing use of such guides for designing roadsides that reduce the risk of injury to motorcyclists. However, a more realistic estimation might be derived by increasing the severity indices for barriers by around 25 percent for motorcyclists.
Publisher: The Sax Institute
Date: 2017
DOI: 10.17061/PHRP2741734
Abstract: Injury is one of the most common reasons why a child is hospitalised. Information gained from injury surveillance activities provides an estimate of the injury burden, describes injury event circumstances, can be used to monitor injury trends over time, and is used to design and evaluate injury prevention activities. This perspective article provides an overview of child injury surveillance capabilities within New South Wales (NSW), Australia, following a stocktake of population-based injury-related data collections using the Evaluation Framework for Injury Surveillance Systems. Information about childhood injury in NSW is obtained from multiple administrative data collections that were not specifically designed to conduct injury surveillance. Obtaining good information for child injury surveillance in NSW will involve better coordination of information from agencies that record information about childhood injury. Regular reporting about childhood injury to provide a comprehensive profile of injuries of children and young people in the state should be considered, along with the provision and/or linkage of child injury information from multiple data collections. This could support the development of a suite of injury performance indicators to monitor childhood injury reduction strategies across NSW.
Publisher: Informa UK Limited
Date: 17-12-2014
Publisher: BMJ
Date: 10-2022
DOI: 10.1136/BMJOPEN-2022-065567
Abstract: While the majority of adults with severe-to-profound hearing loss and poor speech perception outcomes with hearing aids benefit from receiving a cochlear implant, the long-term health and social benefits for implant recipients are yet to be explored. The objective of the ARCHS research is to provide a better understanding of the health and social factors that play a role in the lives of adults with a cochlear implant up to 10 years after the procedure. This research will involve conducting two retrospective cohort studies of adults aged ≥18 years who received a cochlear implant during 2011–2021 using linked administrative data first within New South Wales (NSW) and second Australia-wide. It will examine health service use and compare health and social outcomes for younger (18–64 years) and older (≥65 years) cochlear implant recipients. Ethical approval was received from the NSW Population Health Services Research Ethics Committee for the NSW cohort study (Reference: 2022/ETH00382/2022.07) and from the Macquarie University ethics committee for the national cohort study (Reference: 520221151437084). Research findings will be published in peer-reviewed journals and presented at scientific conferences.
Publisher: Informa UK Limited
Date: 07-07-2020
Publisher: Springer Science and Business Media LLC
Date: 13-05-2016
Publisher: Elsevier BV
Date: 06-2018
DOI: 10.1016/J.YEBEH.2018.03.028
Abstract: Adult patients with refractory epilepsy who are potential candidates for resective surgery undergo a period of presurgical investigation in tertiary epilepsy centers (TECs), where they engage extensively with healthcare professionals and receive a range of treatment-related information. This qualitative study aimed to examine the experiences of adult patients with refractory epilepsy leading up to and during presurgical investigation and how their perceptions of resective surgery are shaped. In-depth interviews with 12 patients and six epilepsy specialist clinicians and 12 observations of routine patient-clinician consultations took place at two TECs in Sydney, Australia. Data were thematically analyzed via group work. Patients reflected on prior experiences of poor seizure control and inadequate antiepileptic drug management and a lack of clarity about their condition before referral to tertiary care. Poor continuity of care and disrupted care transitions affected patients from regional locations. Tertiary referral increased engagement with personalized information about refractory epilepsy, which intensified during presurgical assessments with additional hospital visits and consultations. Experiential information, such as testimonials of other patients, influenced perceptions of surgery and fostered more trust and confidence towards healthcare professionals. Qualitative inquiry detailed multifaceted effects of information on patients' overall treatment trajectory and experience of healthcare. Earlier patient identification for surgical assessments should be accompanied by access to good quality information at primary and community care levels and strengthened referral processes.
Publisher: Elsevier BV
Date: 07-2022
DOI: 10.1016/J.SEIZURE.2022.05.014
Abstract: To compare academic performance and high school completion of young people admitted to hospital with epilepsy and matched peers from the general population not admitted to hospital with epilepsy during the study period. A population-based matched case-comparison cohort study of young people aged ≤18 years hospitalised with epilepsy during 2005-2018 in New South Wales, Australia, using linked birth, health, education, and mortality records. The comparison cohort was matched on age, sex, and residential postcode. Generalised linear mixed modelling examined risk of school performance below the national minimum standard (NMS), and generalised linear regression examined risk of not completing high school for young people hospitalised with epilepsy compared to matched peers not hospitalised with epilepsy during the study period. Adjusted relative risks (ARRs) with 95% confidence intervals (CIs) were derived from the final models. Young people hospitalised with epilepsy had more than 3 times higher risk of not achieving the NMS for numeracy (ARR: 3.40 95%CI 2.76‒4.18) and reading (ARR: 3.15 95%CI 2.60‒3.82), compared to matched peers. Young people hospitalised with epilepsy had a 78% higher risk of not completing year 10 (ARR: 1.78 95%CI 1.14‒2.79), 18% higher risk of not completing year 11 (ARR: 1.18 95%CI 0.97‒1.45), and 38% higher risk of not completing year 12 (ARR: 1.38 95%CI 1.14‒1.67), compared to matched counterparts. Young people hospitalised with epilepsy have higher risk of not achieving minimum standards for numeracy and reading and not completing high school compared to matched peers. There is a need for effective strategies and interventions (e.g., early seizure control and improved multidisciplinary management and care coordination) to minimise the potential adverse effect of epilepsy on education and its sequelae such as early school leaving, unemployment and poverty in adulthood.
Publisher: Wiley
Date: 07-11-2017
DOI: 10.1111/JPC.13777
Abstract: To describe the epidemiological profile and cost of hospitalised injuries caused by playground equipment falls of children aged 0-14 years, in New South Wales, Australia. Linked New South Wales hospitalisation data from 1 January 2010 to 30 June 2014 were used to describe the incidence of hospitalisation for playground falls, the age-standardised rate of hospitalisation per year, age group and gender, the characteristics of the injured children and the injury incident. Health outcomes, such as length of stay in hospital, and the hospital costs associated with the injuries were examined by age group. Negative binomial regression assessed the trend in hospitalisation rates over time. There were 7795 hospitalisations of children for playground fall injuries. The highest hospitalisation rate was for the 5-9 year olds (220.7 per 100 000 population) and was higher in males than females (234.2 and 206.3 per 100 000 population, respectively). The majority of these injuries occurred in schools (17.1%) and homes (14.6%), and were as a result of falls from tr olines (34.3%) and climbing apparatuses (28.2%). Over half the playground falls led to fractures of the elbow and wrist (54.7%). The total hospital cost of playground fall-related injuries was $18 million. Rates of hospitalisation of children for playground fall injuries remain high despite implementation of national playground safety standards in Australia. This research highlights where interventions should be targeted to reduce the incidence and burden of injuries following falls from playground equipment.
Publisher: Elsevier BV
Date: 02-2014
Abstract: To determine whether overweight and obese in iduals have higher reported fall and fall injury risk than in iduals of healthy weight, and to examine the influence of BMI on health, quality of life and lifestyle characteristics of fallers. A representative s le of community-based in iduals aged 65 years and older in New South Wales was surveyed regarding their history of falls, height, weight, lifestyle and general health within a 12-month period. Obese in iduals had a 31% higher risk of having fallen, but no higher risk of a fall-related injury compared to healthy-weight in iduals. Obese fallers also had a 57% higher risk of believing nothing could be done to prevent falls a 41% higher risk of using four or more medications a 30% higher risk of experiencing moderate or extreme pain or discomfort were 26% less likely have walked for two or more hours in the last week and were less likely to think they were doing enough physical activity. Older obese in iduals have an increased risk of falls and obese fallers have a higher prevalence of pain and inactivity than fallers of a healthy weight. A decrease in sedentary lifestyle and regular weight-bearing exercise may reduce fall risk in older obese in iduals.
Publisher: The Sax Institute
Date: 2002
DOI: 10.1071/NB02004
Publisher: Elsevier BV
Date: 2015
DOI: 10.1016/J.ARCHGER.2014.09.006
Abstract: Obesity has been associated with an increased risk of falls among older people. However, it is not certain whether factors commonly associated with falls and/or obesity mediate this risk. This research examines whether specific diseases, sedentary behavior, mood, pain, and medication use mediate the association between obesity and falls. A representative s le of community-living in iduals aged 65+ years in New South Wales (NSW), Australia were surveyed regarding their experience of falls, height, weight, lifestyle and general health within a 12 month period. Intervening variable effects were examined using Freedman and Schatzkin's difference in coefficients tests and regression analyses were used to estimate relative risks. Obesity was associated with a 25% higher risk (95%confidence interval (CI) 1.11-1.41 p<0.0003) of having fallen in the previous 12 months compared to non-obese in iduals. The strongest mediators of the association between obesity and falls were sleeping tablets (t=-5.452 p<0.0001), sitting for more than 8h per day on weekdays (t=5.178 p<0.0001), heart disease/angina (t=3.526 p<0.0001), anti-depressant use (t=3.102 p=0.002), moderate/extreme anxiety or depression (t=3.038 p=0.002), and diabetes (t=3.032 p=0.002). Sedentary behavior, chronic health conditions and medication use were identified as mediators for the association between obesity and falls in community living older people. Interventions aimed at weight reduction and increased activity may have benefits not only for fall prevention, but also for the mediating health, mood and lifestyle factors identified here.
Publisher: BMJ
Date: 08-2017
DOI: 10.1136/BMJOPEN-2017-017148
Abstract: One-third of patients with refractory epilepsy may be candidates for resective surgery, which can lead to positive clinical outcomes if efficiently managed. In Australia, there is currently between a 6-month and 2-year delay for patients who are candidates for respective epilepsy surgery from the point of referral for surgical assessment to the eventual surgical intervention. This is a major challenge for implementation of effective treatment for in iduals who could potentially benefit from surgery. This study examines implications of delays following the point of eligibility for surgery, in the assessment and treatment of patients, and the factors causing treatment delays. Mixed methods design: Observations of qualitative consultations, patient and healthcare professional interviews, and health-related quality of life assessments for a group of 10 patients and six healthcare professionals (group 1) quantitative retrospective medical records’ reviews examining longitudinal outcomes for 50 patients assessed for, or undergoing, resective surgery between 2014 and 2016 (group 2) retrospective epidemiological study of all in iduals hospitalised with a diagnosis of epilepsy in New South Wales (NSW) in the last 5 years (2012–2016 approximately 11 000 hospitalisations per year, total 55 000), examining health services’ use and treatment for in iduals with epilepsy, including refractory surgery outcomes (group 3). Ethical approval has been granted by the North Sydney Local Health District Human Research Ethics Committee (HREC/17/HAWKE/22) and the NSW Population & Health Services Research Ethics Committee (HREC/16/CIPHS/1). Results will be disseminated through publications, reports and conference presentations to patients and families, health professionals and researchers.
Publisher: CSIRO Publishing
Date: 19-03-2021
DOI: 10.1071/AH20032
Abstract: Hip fracture is a common injury in older adults that causes significant morbidity and mortality. Older adults who sustain a hip fracture are at a higher risk of institutionalisation, reduced mobility and subsequent falls and, consequently, have increased rates of morbidity and mortality. Quality improvement strategies that address gaps in hip fracture care are needed to ensure best practice and improve health outcomes for older adults. This case study describes the development of a state-based hip fracture registry and incentive payment scheme in Western Australia (WA), which were designed to drive quality improvement. The registry monitored best practice in hip fracture care criteria across three tertiary hospitals in WA, and the incentive program provided premium payments to these hospitals for meeting six criteria in best practice clinical quality. The fracture registry commenced in 2011, and by 2014 all participating hospitals were eligible for payments. From 2014 to 2016, the proportion of patients who were operated on within 36 hours increased from 60% to 79%. This case study illustrates how a hip fracture registry in conjunction with small premium payments improved well-described process measures in hip fracture care. What is known about the topic? Hip fracture is a common among older adults, usually resulting from a fall. International clinical quality registries have been shown to help drive quality improvements in patient care processes and outcomes. What does this paper add? This paper adds an Australian perspective to the existing literature on the efficacy of hip fracture clinical quality registries. It offers an ex le of how a Western Australian hip fracture registry with an associated incentive payment program drove clinical care and process change to improve care provision and patient outcomes. What are the implications for practitioners? This case study suggests regular monitoring and reporting on hip fracture care processes and patient outcomes can lead to improvements in both of these measures. Because incentive payments may have contributed to the best practice improvements noted in this case study, practitioners involved in designing future monitoring and reporting programs should consider the merits of incorporating financial incentives.
Publisher: Elsevier BV
Date: 05-2019
DOI: 10.1016/J.INJURY.2019.01.004
Abstract: Parents of critically injured children can experience high levels of psychological distress post-injury, however little is known about their experiences and needs following injury. This study aimed to explore parent experiences and psychosocial support needs in the six months following child critical injury. An interpretive qualitative design was used. Semi-structured interviews were conducted with 30 parents of 23 critically injured children. Interviews explored parent experiences and psychosocial support needs. Qualitative data were managed using NVIVO 10 and analysed thematically. Four themes were identified: integrating back into home life adjusting mentally and emotionally to injury coping with injury as a family and navigating resources to meet family needs. Parents and families experienced substantial ongoing emotional impacts at 6 months following child injury. Parents were unprepared for the negative changes in their child's psychological wellbeing and behaviour post injury, and parents' mental health was negatively impacted, with mothers more likely to seek emotional support than fathers. Parents reported receiving no psychosocial follow-up from the hospital and limited information about community services and accessing local community resources on returning home. There is a need to include all family members in discharge planning, and to use a family-centred continuity-of-care approach from the time of child injury through to post-discharge recovery. To strengthen parent and family wellbeing, a biopsychosocial holistic approach is recommended, including cognitive-behavioural and other psychological strategies to help reduce distress for parents and all family members and strengthen their coping capacity. A dedicated family support coordinator role to facilitate care over the child recovery trajectory, and development of accessible online and e-psychosocial support resources for parents and families are recommended.
Publisher: Informa UK Limited
Date: 03-2009
DOI: 10.1080/17457300802434015
Abstract: Geographical information system (GIS) technology is a potentially useful tool for policy makers to identify priority areas for the prevention of injuries in the home environment. An analysis of hospitalised injuries in New South Wales (NSW), Australia, that occurred in the home environment was conducted using Bayesian methods to calculate the expected relative home injury risk for common injury mechanisms. The results show geographic differences in the mechanism of home injuries. The risk of hospitalised fall-related injuries for people aged 75 years and over and poisoning of children four years of age or less was spread over NSW, while cut ierce and struck by/struck against injuries showed less extensive areas of risk. This study shows that the use of geographic mapping and spatial statistics can provide a useful means of estimating home injury risk, eliminating the instability of estimates, while showing overall geographic patterns. In the future, geographical mapping of injury locations, coupled with satellite imagery, are likely to provide an additional level of detail for injury surveillance within a defined area.
Publisher: Wiley
Date: 22-12-2016
DOI: 10.1111/JAN.13224
Abstract: The aim of this study was to determine which tasks unregulated nursing support staff spend their work time undertaking and to determine differences between the work undertaken by licensed/regulated nurses on units which have nursing support workers and those on units which do not. Acute hospital nursing teams often include nursing support staff little is known about what kinds of tasks these unregulated support workers do and how it affects the work tasks of their licensed/regulated team members. Cross-sectional analysis of nurse work s ling data. Data collection took place between March-October 2013. The proportion of time spent on 25 work activities by nursing support staff and licensed/regulated nursing staff was compared. Logistic regression models estimated whether nursing support staff or licensed/regulated nurses were more likely to conduct direct and indirect patient care tasks and whether licensed/regulated nurses on units with nursing support staff were more likely to conduct direct or indirect tasks compared with those on units without nursing support workers. Nursing support staff spent the majority of their time engaged in direct care tasks, e.g. admission and assessment, hygiene and mobility. Although licensed/regulated nurses were less likely to undertake direct care tasks compared with support workers, those who worked on units with support workers undertook more direct care compared with those who worked on units without support workers. Nursing support workers were given tasks that required substantial amounts of patient interaction. These staff may be associated with an increase in direct care tasks for licensed/regulated nurses, who may duplicate the direct care done by nursing support workers.
Publisher: SAGE Publications
Date: 21-05-2023
DOI: 10.1177/10398562231176734
Abstract: To report on the rate and causes of mortality, and associations with premature mortality among the homeless in inner city Sydney. Retrospective cohort study of 2,498 people who attended a psychiatric clinic conducted at the three main homeless hostels between 17 February 2008 and 19 May 2020. Cox’s proportional hazards regression was used to identify factors associated with mortality. A total of 324 of the 2498 (13.0%) clinic attenders were found to have died in the follow-up period, with a mean age at death of 50.7 years. Unnatural causes of death (119/324, 36.7%) included drug overdose (24.1%), suicide (6.8%) and other injuries (5.9%), at a younger age (44.4 years) than those who died from natural causes (54.4 years). There were 142 (43.8%) deaths from natural causes and 63 (19.4%) in which the cause of death was not determined. The study confirms the high mortality of homeless clinic attenders in Sydney found in a study from 30 years earlier. The lower mortality among regular attenders supports the provision of accessible services to address the physical health needs of homeless people, as well as ready access to mental health and substance use services.
Publisher: Elsevier BV
Date: 12-2014
Abstract: To examine the age-specific population prevalence and predictors of uptake of home modifications and exercise to prevent falls in the NSW older population. A total of 5,681 respondents were asked questions on fall prevention activities as part of the 2009 NSW Falls Prevention Survey. RESULTS were weighted to represent the NSW population. Regression analysis was used to determine factors associated with uptake of interventions. Overall, 28.9% of the older population have modified their home, and 35.1% increased exercise to prevent falls. Main predictors of home modification were being aged 85+ (RR 2.04, 95% CI 1.76-2.35) and physiotherapy/occupational therapy intervention (RR 1.57, 95% CI 1.22-2.01). Main predictors of increasing exercise were physiotherapy/OT intervention (RR 2.12, 95% CI 1.86-2.42) and medical advice (RR 1.45, 95% CI1.32-1.60). Older respondents (RR 0.68, 95% CI 0.57-0.81) and those with fair oor health (RR 0.86, 95% CI 0.77-0.96) were less likely to report increased exercise. More than one-quarter of the older population of NSW report having made modifications to their home and one-third increased exercise to prevent falls. There was a clear gradient of increased uptake of home modifications with increasing age, with the reverse trend for increased exercise. Although fall prevention initiatives are having an impact at the population level, targeted strategies for high-risk groups are still required.
Publisher: Springer Science and Business Media LLC
Date: 28-02-2017
Publisher: CSIRO Publishing
Date: 2014
DOI: 10.1071/AH13061
Abstract: Objective This research examines the existing funding model for in-hospital trauma patient episodes in New South Wales (NSW), Australia and identifies factors that cause above-average treatment costs. Accurate information on the treatment costs of injury is needed to guide health-funding strategy and prevent inadvertent underfunding of specialist trauma centres, which treat a high trauma casemix. Methods Admitted trauma patient data provided by 12 trauma centres were linked with financial data for 2008–09. Actual costs incurred by each hospital were compared with state-wide Australian Refined Diagnostic Related Groups (AR-DRG) average costs. Patient episodes where actual cost was higher than AR-DRG cost allocation were examined. Results There were 16 693 patients at a total cost of AU$178.7 million. The total costs incurred by trauma centres were $14.7 million above the NSW peer-group average cost estimates. There were 10 AR-DRG where the total cost variance was greater than $500 000. The AR-DRG with the largest proportion of patients were the upper limb injury categories, many of whom had multiple body regions injured and/or a traumatic brain injury (P 0.001). Conclusions AR-DRG classifications do not adequately describe the trauma patient episode and are not commensurate with the expense of trauma treatment. A revision of AR-DRG used for trauma is needed. What is known about this topic? Severely injured trauma patients often have multiple injuries, in more than one body region and the determination of appropriate AR-DRG can be difficult. Pilot research suggests that the AR-DRG do not accurately represent the care that is required for these patients. What does this paper add? This is the first multicentre analysis of treatment costs and coding variance for major trauma in Australia. This research identifies the limitations of the current AR-DRGS and those that are particularly problematic. The value of linking trauma registry and financial data within each trauma centre is demonstrated. What are the implications for practitioners? Further work should be conducted between trauma services, clinical coding and finance departments to improve the accuracy of clinical coding, review funding models and ensure that AR-DRG allocation is commensurate with the expense of trauma treatment.
Publisher: Elsevier BV
Date: 08-2020
Publisher: Inderscience Publishers
Date: 2014
Publisher: Elsevier BV
Date: 05-2022
DOI: 10.1016/J.CHIABU.2022.105586
Abstract: The effect of potential protective factors and stressors faced by carers on their well-being and ability to provide care for children in out-of-home-care (OOHC) needs examination. To explore the impact of child and placement characteristics, carer resources, perceptions and stressors on caregiving and well-being and identify carer group-based trajectories over time. Longitudinal study of up to 1143 carers caring for 1359 children in OOHC in Australia. Carers completed questionnaires at 4 waves across 2011-2018 regarding their demographics, various potential stressors, resource availability and support. A composite indicator of caregiving quality was generated. Caseworkers, who manage child placements with carers, and administrative data provided information on placement characteristics, child demographics and history in OOHC. Multilevel modelling and group-based trajectory analyses were conducted, and carer views examined. Potential concern for carer well-being and caregiving was flagged for 12-20% of carers. Increased odds of concern were found for carers in employment, with placements provided by a non-government organisation, and caring for >1 child in OOHC. Odds were lower for carers satisfied with caseworker assistance. Carer responses illuminated how these resources and stressors interact to impact caregiving. Four trajectory groups were identified: Minimal concern (12.7%), No concern (74.5%), Ongoing concern (6.2%) and Fluctuating concern (6.5%). Effective support for carers is essential to ensuring that children and young people in OOHC can be placed with capable, resilient, and responsive carers. Without adequate support, carers are likely to experience decreased well-being and have difficulty adequately performing their caregiving role.
Publisher: Elsevier BV
Date: 05-2020
DOI: 10.1016/J.INJURY.2020.01.017
Abstract: To provide effective care and promote wellbeing and positive outcomes for parents and families following paediatric critical injury there is a need to understand parent experiences and psychosocial support needs. This study explores parent experiences two years following their child's critical injury. This multi-centre study used an interpretive qualitative design. Parent participants were recruited from four paediatric hospitals in Australia. Semi-structured interviews were audio recorded and transcribed verbatim. Qualitative data were thematically analysed and managed using NVivo 11. Twenty-two parents participated. Three themes were identified through analysis: Recovering from child injury Managing the emotional impact of child injury Being resilient and finding ways to adapt. A long-term dedicated trauma family support role is required to ensure continuity of care, integration of support and early targeted intervention to prevent long-term adverse outcomes for critically injured children and their families. Early and ongoing psychosocial intervention would help strengthen parental adaptation and address families' psychosocial support needs following child injury.
Publisher: Elsevier BV
Date: 12-2014
Abstract: To examine rock fishing-related fatalities and hospitalisations, identify initiatives aimed at improving safety and survey key rock fishing stakeholders about the strengths and limitations of each initiative. This research obtained information from mortality and hospitalisation statistics, the published literature and key stakeholders for opinions on the strengths, limitations and improvements for rock fishing safety initiatives. Injury patterns involving rock fishers have largely remained unchanged over time. The literature revealed that many rock fishing safety initiatives focused on awareness raising and engineering initiatives, but ignored the development of guidelines and the use of enforcement strategies. There had been limited evaluations conducted of any of the initiatives reviewed. It is likely that a combination of evidence-based, standard-focused and education initiatives would be useful in improving rock fishing safety in NSW, provided that the impact of these initiatives were routinely evaluated. Information from this research will be used to inform preventive strategies aimed at improving rock fishing safety through better coordination of the role of evidence in informing standards and practices and the continued evaluation of these initiatives.
Publisher: Wiley
Date: 24-03-2017
DOI: 10.1111/JPC.13514
Abstract: Whether treatment at paediatric trauma centres (PTCs) provides a survival advantage for injured children over treatment at adult trauma centres (ATCs) remains inconclusive. This study examines the association between trauma centre type and in-hospital mortality for severely injured paediatric trauma patients in New South Wales, Australia. A retrospective examination of paediatric patient characteristics (aged ≤15 years), treatment and injury outcome was conducted using data from the New South Wales Trauma Registry for 2009-2014. Logistic regression was used to examine the association of in-hospital mortality and type of trauma centre. There were 1230 children who were severely injured (i.e. Injury Severity Score ISS > 12) and 81.0% received definitive care at a PTC. Two-thirds were male, 37.8% were aged 11-15 years and falls represented 32.0% of the injuries. Almost half (48.9%) the injured children had an ISS between 16 and 24, 31.9% between 25 and 39 and 3.8% an ISS between 40 and 75. The mean and median hospital length of stay was 17.5 and 5 days, respectively. Fifty percent of children that received definitive care at a PTC were admitted to an ICU compared to 23.9% at a Level 1 ATC. There were 119 (9.7%) in-hospital deaths. Children aged ≤15 years who were treated at a Level 1 ATC had 6.1 times higher odds of not surviving their injuries than if treated at a PTC. Children who received definitive care at a PTC had a survival advantage compared to those treated at a Level 1 ATC. Prospectively examining the processes of care for severely injured children may assist in identification of quality and system changes required to ensure optimal trauma care within the health-care system.
Publisher: Springer Science and Business Media LLC
Date: 16-12-2010
DOI: 10.1007/S00198-010-1511-Z
Abstract: Despite advances in prevention, fall-related hospitalisation rates among older people are still increasing. Rates between 1998/1999 and 2008/2009 for non-facture-related injuries increased by 6.1% while fracture injuries declined by -0.4%. Varying trends in rates of different injury types makes it difficult to provide a definitive explanation for these changes. Despite advances in fall prevention research and practice, the rate of fall-related hospitalisations continues to increase. However, hip fracture rates appear to be declining. An examination of trends in types of injuries that contribute to the overall fall injury rate is required to establish which injuries are driving the falls admission rate. The aim of this paper is to examine trends in fall-related injury hospital admissions by injury type in New South Wales (NSW), Australia. A retrospective review of fall-related injury hospitalisations in NSW among in iduals aged 65+ years, by injury type, was conducted from 1 July 1998 to 30 June 2009. Direct age-standardised admission rates were calculated. Negative binomial regression was used to examine the statistical significance of changes in trend over time of different hospitalised fall-related injuries. The fall-related hospitalisation rate increased by 1.7% each year (p < 0.0001 95% confidence interval (CI), 1.3-2.1%). However, the rate of fracture declined by -0.4% (p < 0.03 95% CI, -0.8-0.0%) whereas, the non-fracture rate increased by 6.1% (p < 0.0001 95% CI, 5.5-6.7%) annually. Rates for severe head injuries, rib and pelvic fracture increased while those for hip and forearm fracture declined. It appears that while fall prevention efforts in NSW are not yet affecting the overall rate of injury hospitalisation, there has been a significant decline in the rates of some fractures. Opposing trends in the rates of other fracture admissions and a significant increase in the rate of non-fracture injuries associated with falls makes a definitive explanation for these changes difficult.
Publisher: Elsevier BV
Date: 04-2023
Publisher: BMJ
Date: 08-2010
Abstract: To estimate the rate of unintentional drowning mortality and hospitalised morbidity using population-based, population-risk and person-time denominator data and to compare the estimates obtained. To then compare exposure-based rates for drowning with road traffic death rates. Retrospective analysis of unintentional drowning mortality and hospitalised morbidity of New South Wales (NSW, Australia) residents 16+ years of age during 1 January to 31 December 2005. Information on population-risk and person-time risk was obtained from the 2005 NSW Population Health Survey. Analysis of road traffic death data from NSW and population and person-time risk estimates from the Survey of Vehicle Use, Household Travel Surveys and Roads and Traffic Authority Speed Surveys in 2005. Estimated drowning mortality and hospitalised morbidity rates for adults were higher using population-risk and person-time risk exposures compared to a population-based exposure. Population-based estimates of road traffic mortality were four times higher than drowning mortality rates. In contrast, exposure adjusted person-time estimates for drowning were 200 times higher than road traffic fatalities. Many injury risks are underestimated when the total age-specific population is used to calculate an injury rate instead of actual population-risk or person-time exposure. This can result in the identification of misleading priorities for injury prevention. Drowning risk is strikingly higher than previously thought based on population-based estimates. This information is important for decision-making and policy development as it provides a basis for comparing the inherent risk in exposure to hazards with potential to cause injury.
Publisher: Wiley
Date: 20-04-2021
DOI: 10.1111/ANS.16867
Abstract: Provision of quality care can help to reduce adverse health outcomes following hip fracture. While surgical management by either a consultant or junior surgeon has shown inconclusive differences in patient outcomes, consultant presence is often recommended, yet little is known about the factors that influence whether a consultant surgeon is present during hip fracture surgery. The aim of this study is to examine patient, surgical and hospital factors associated with having a consultant surgeon present during hip fracture surgery. An examination of hip fracture surgeries of adults aged ≥ 50 years admitted to hospitals in Australia and New Zealand between 1 January 2015 and 31 December 2018 using data from the Australia and New Zealand Hip Fracture Registry was conducted. Multivariable logistic regression was used to examine factors associated with the presence of a consultant surgeon during hip fracture surgery. There were 29 530 hip fracture surgeries 58.1% had a consultant surgeon present (range 8.5–100% by hospital). Patients were more likely to have a consultant surgeon present during surgery if they had private health insurance, were operated on after hours, required total hip replacements or were operated on in hospitals that conducted ≤150 surgeries per year. There is variation in the presence of consultant surgeons within Australia and New Zealand during hip fracture surgery, potentially associated with the complexity of surgery and hospital factors. However, further research is needed to determine the optimum level of supervision required based on patient factors and surgical complexity.
Publisher: Elsevier BV
Date: 04-2020
Publisher: Elsevier BV
Date: 2012
DOI: 10.1016/J.INJURY.2011.01.006
Abstract: Injuries represent a significant health burden in Australia. In New South Wales (NSW), no routine follow-up of post-injury health outcomes is conducted. This article describes the development of a protocol and the conduct of a pilot study to collect information on trauma outcomes at 3 months post-injury at two trauma centres. A modified Victorian model of trauma outcomes monitoring was adopted, with potential participants required to 'opt in' to the collection. Fifty-three percent of in iduals contacted consented to opt in, with 75% of these completing an interview. The data items collected were able to provide an indicator of the impact of trauma on in iduals. This study has highlighted that there are important methodological issues to be addressed in terms of recruitment in establishing long-term trauma outcomes data collections that are representative of the trauma population. Ultimately, information from a long-term trauma outcomes collection could be linked to data collections to conduct research across the injury continuum.
Publisher: Inter-Research Science Center
Date: 24-09-2014
DOI: 10.3354/MEPS10935
Publisher: JMIR Publications Inc.
Date: 23-04-2020
DOI: 10.2196/16108
Abstract: Emerging adulthood is a unique segment of an in idual’s life course. The defining features of this transitional period include identity exploration, instability, future possibilities, self-focus, and feeling in-between adolescence and adulthood, all of which are thought to affect quality of life, health, and well-being. A longitudinal cohort study with a comprehensive set of measures would be a unique and valuable resource for improving the understanding of the multi-faceted elements and unique challenges that contribute to the health and well-being of emerging adults. The main aim of this pilot study is to evaluate the feasibility and acceptability of recruiting university graduates to establish a longitudinal cohort study to inform our understanding of emerging adulthood. This is a pilot longitudinal cohort study of Australian university graduates. It will involve collecting information via online surveys (baseline and 12-month follow-up) and data linkage with health records. Recruitment, response, and retention rates will be calculated. Descriptive analysis of the representativeness of recruited participants and completeness of survey responses will be conducted. Participant recruitment was completed in October 2018, and data collection for the baseline and follow-up surveys was completed in November 2019. As of April 2020, the process of acquiring health records from administrative data collections has commenced. The findings from this pilot study will identify areas for improvement and inform the development of a future longitudinal cohort study of emerging adults. Australian New Zealand Clinical Trials Registry ACTRN12618001364268 eec8wh DERR1-10.2196/16108
Publisher: BMJ
Date: 12-2016
Publisher: Springer Science and Business Media LLC
Date: 02-01-2020
DOI: 10.1007/S00198-019-05260-8
Abstract: This study examined hip fracture hospitalisation trends and predictors of access to rehabilitation for adults aged ≥ 65 years living with and without dementia. The hospitalisation rate was 2.5 times higher for adults living with dementia and adults who lived in aged care were between 4.8 and 9.3 times less likely to receive rehabilitation. To examine hip fracture hospitalisation temporal trends, health outcomes, and predictors of access to in-hospital rehabilitation for older adults living with and without dementia. A population-based retrospective cohort study of adults aged ≥ 65 years hospitalised with a hip fracture during 2007-2017 in New South Wales, Australia. Of the 69,370 hip fracture hospitalisations, 27.1% were adults living with dementia. The hip fracture hospitalisation rate was 2.5 times higher for adults living with dementia compared with adults with no dementia (1186.6 vs 492.9 per 100,000 population). The rate declined by 6.1% per year (95%CI - 6.6 to - 5.5) for adults living with dementia and increased by 1.0% per year (95%CI 0.5-1.5) for adults with no dementia. Multivariable associations identified that adults living with dementia who experienced high frailty and increasing age were between 1.6 and 1.8 times less likely to receive in-hospital rehabilitation. Adults who were living in long-term aged care facilities were between 4.8 and 9.3 times less likely to receive in-hospital rehabilitation which varied by the presence of dementia or delirium. Consistent criteria should be applied to determine rehabilitation access, and rehabilitation services designed for older adults living with dementia or in aged care are needed. • Adults living with dementia were able to make functional gains following hip fracture rehabilitation. • Need to determine consistent criteria to determine access to hip fracture rehabilitation. • Rehabilitation services specifically designed for adults living with dementia or in aged care are needed.
Publisher: Springer Science and Business Media LLC
Date: 19-07-2017
DOI: 10.1007/S11657-017-0359-7
Abstract: With an ageing population, the burden of hip fractures is expected to increase in the coming decades. Older in iduals with hip fracture are more than 3.5 times more likely to die within 12 months compared to non-injured in iduals. The main priority for reducing mortality should be prevention of hip fracture. The aim of this study is to quantify and describe the 12-month mortality of older persons presenting to hospitals in Australia with a hip fracture. Population-based matched cohort study using linked hospital and mortality data from four Australian states (New South Wales, Queensland, South Australia, and Tasmania). In iduals aged 65 years and older who had a hospital admission with a primary diagnosis of hip fracture in 2009 (n = 9748) and a matched comparison cohort of non-injured in idual were selected from the electoral roll (n = 9748). The comparison group was matched 1:1 on age, sex, and postcode of residence. Adjusted mortality rate ratios (MRR) and attributable risk percent were calculated. Cox proportional hazard regression was used to examine the effect of risk factors on survival. The hip fracture cohort experienced significantly worse survival at the 12-month post-fracture hospitalisation (P < 0.0001). In iduals with hip fracture were more than 3.5 times more likely to die within 12 months compared to their non-injured counterparts (MRR 3.62 [95%CI 3.23-4.05]). Hip fracture was likely to be a contributory factor in 72% of mortality within 12 months after the index hospital admission. Excess mortality risk at 12 months was higher in males than that in females and in the 65-74-year age group. With an ageing population in Australia, the burden of hip fractures is expected to increase in the coming decades. Because incident hip fracture is the main predictor of subsequent mortality, the main priority for reducing excess mortality after hip fracture is primary and secondary prevention of hip fracture.
Publisher: Revista Cientifica Pesquisa Agropecuaria Gaucha (PAG)
Date: 02-03-2020
DOI: 10.36812/PAG.202026146-54
Abstract: The main objective of this study was to develop a freely available mobile software application and education platform in health and safety for aquaculture workers and managers. The application, called AquaSafe, was created in Portuguese and English for the Android system using the Java 8 programming language and the Android Studio development environment. AquaSafe content focusses on the identification of hazards and health risks, hazardous sources and preventive measures for occupational health and safety in the aquaculture sector. It has three predominantly interactive user interfaces to reinforce the main messages, which include games in the form of compliance checklists, quizzes and question-answer tools. The software is designed to act as a platform for assessment and management of occupational hazards, guide decision making on simple techniques or measures to prevent injuries, diseases and fatalities during aquaculture activities. It is envisaged that the AquaSafe mobile software will contribute to the prevention of occupational injuries and diseases in aquaculture.
Publisher: Hindawi Limited
Date: 30-11-2022
DOI: 10.1111/HSC.13665
Abstract: People with disabilities are often subject to intersecting layers of social and economic disadvantage and other barriers that drive health inequity. As a result, they frequently experience worse health than people without disabilities, beyond the direct effects of their health condition or impairment. The aim of this overview of systematic reviews was to summarise the evidence on the impact of socio-environmental factors (i.e. social, physical or attitudinal) on the health outcomes of disabled people. A systematic search of five databases (MEDLINE, PsycINFO, Embase, CINAHL and Scopus) for English-language articles from January 2000 to April 2021 was conducted. Abstracts were screened by two reviewers and reviews were critically appraised. Key data were extracted by topic, population, disability type, critical appraisal method, socio-environmental themes and health outcomes. There were 23 systematic reviews identified examining adult (60.9%) or child and young (8.7%) disabled people, with 30.4% not specifying an age range. Reviews examined people with neurological or physical (39.1%), intellectual (17.4%), sensory (8.7%) or a range of (34.8%) disabilities. Three key health outcomes (i.e. access to healthcare, health-promoting behaviour and care quality) and several recurring socio-environmental themes related to the health outcomes of disabled people were identified. Disabled people encounter common social, physical and attitudinal factors that hinder their health outcomes in terms of access to services and quality healthcare. Many preventive health services were identified as either inaccessible or not meeting the needs of disabled people. Greater involvement of disabled people in service design and awareness raising is essential.
Publisher: BMJ
Date: 18-11-2020
DOI: 10.1136/OEMED-2019-105753
Abstract: A scoping project was funded by the Food and Agriculture Organization in 2017 on the health and safety of aquaculture workers. This project developed a template covering basic types of aquaculture production, health and safety hazards and risks, and related data on injuries and occupational ill health, regulations, social welfare conditions, and labour and industry activity in the sector. Profiles using the template were then produced for key aquaculture regions and nations across the globe where information could be obtained. These revealed both the scale and depth of occupational safety and health (OSH) challenges in terms of data gaps, a lack of or poor risk assessment and management, inadequate monitoring and regulation, and limited information generally about aquaculture OSH. Risks are especially high for offshore/marine aquaculture workers. Good practice as well as barriers to improving aquaculture OSH were noted. The findings from the profiles were brought together in an analysis of current knowledge on injury and work-related ill health, standards and regulation, non-work socioeconomic factors affecting aquaculture OSH, and the role of labour and industry in dealing with aquaculture OSH challenges. Some ex les of governmental and labour, industry and non-governmental organisation good practice were identified. Some databases on injury and disease in the sector and research initiatives that solved problems were noted. However, there are many challenges especially in rural and remote areas across Asia but also in the northern hemisphere that need to be addressed. Action now is possible based on the knowledge available, with further research an important but secondary objective.
Publisher: Elsevier BV
Date: 05-2019
DOI: 10.1016/J.INJURY.2019.01.028
Abstract: There is known variability in the quality of care delivered to injured children. Identifying where care improvement can be made is critical. This study aimed to review paediatric trauma cases across the most populous Australian State to identify factors contributing to clinical incidents. Medical records from three New South Wales Paediatric Trauma Centres were reviewed for children <16 years requiring intensive care with an injury severity score of ≥9, or who died following injury between July 2015 and September 2016. Records were peer-reviewed by nurse surveyors who identified cases that might not meet the expected standard of care or where the child died following the injury. A multidisciplinary panel conducted the peer-review using a major trauma peer-review tool. Records were reviewed independently, then discussed to establish consensus. A total 535 records were reviewed and 41 cases were peer-reviewed. The median (IQR) age was 7 (2-12) years, the median ISS was 25 (IQR 16-30). The peer-review identified a combination of clinical (85%), systems (51%) and communication (12%) problems that contributed to difficulties in care delivery. In 85% of records, staff actions were identified to contribute to events with medical task failure the most frequently identified cause (89%). The peer-review of paediatric trauma cases assisted in the identification of contributing factors to clinical incidents in trauma care resulting in 26 recommendations for change. The prioritisation and implementation of these recommendations, alongside a uniform State-wide trauma case review process with consistent criteria (definitions), performance indicators, monitoring and reporting would facilitate improvement in health service delivery to children sustaining severe injury.
Publisher: Hindawi Limited
Date: 03-02-2022
DOI: 10.1111/PEDI.13317
Abstract: The impact of type 1 diabetes mellitus (T1D) on academic performance is inconclusive. This study aims to compare scholastic performance and high-school completion in young people hospitalized with T1D compared to matched peers not hospitalized with diabetes. Retrospective case-comparison cohort study. A population-level matched case-comparison study of people aged ≤18 hospitalized with T1D during 2005-2018 in New South Wales, Australia using linked health-related and education records. The comparison cohort was matched on age, gender, and residential postcode. Generalized linear mixed modeling examined risk of school performance below the national minimum standard (NMS) and generalized linear regression examined risk of not completing high school for young people hospitalized with T1D compared to peers. Adjusted relative risks (ARR) were calculated. Young females and males hospitalized with T1D did not have a higher risk of not achieving the NMS compared to peers for numeracy (ARR: 1.19 95%CI 0.77-1.84 and ARR: 0.74 95%CI 0.46-1.19) or reading (ARR: 0.98 95%CI 0.63-1.50 and ARR: 0.85 95%CI 0.58-1.24), respectively. Young T1D hospitalized females had a higher risk of not completing year 11 (ARR: 1.73 95%CI 1.19-2.53) or 12 (ARR: 1.65 95%CI 1.17-2.33) compared to peers, while hospitalized T1D males did not. There was no difference in academic performance in youth hospitalized with T1D compared to peers. Improved glucose control and T1D management may explain the absence of school performance decrements in students with T1D. However, females hospitalized with T1D had a higher risk of not completing high school. Potential associations of this increased risk, with attention to T1D and psycho-social management, should be investigated.
Publisher: No publisher found
Date: 2012
DOI: 10.1016/J.AAP.2012.01.021
Abstract: Work-related vehicle crashes are a common cause of occupational injury. Yet, there are few studies that investigate management practices used for light vehicle fleets (i.e. vehicles less than 4.5 tonnes). One of the impediments to obtaining and sharing information on effective fleet safety management is the lack of an evidence-based, standardised measurement tool. This article describes the initial development of an audit tool to assess fleet safety management practices in light vehicle fleets. The audit tool was developed by triangulating information from a review of the literature on fleet safety management practices and from semi-structured interviews with 15 fleet managers and 21 fleet drivers. A preliminary useability assessment was conducted with 5 organisations. The audit tool assesses the management of fleet safety against five core categories: (1) management, systems and processes (2) monitoring and assessment (3) employee recruitment, training and education (4) vehicle technology, selection and maintenance and (5) vehicle journeys. Each of these core categories has between 1 and 3 sub-categories. Organisations are rated at one of 4 levels on each sub-category. The fleet safety management audit tool is designed to identify the extent to which fleet safety is managed in an organisation against best practice. It is intended that the audit tool be used to conduct audits within an organisation to provide an indicator of progress in managing fleet safety and to consistently benchmark performance against other organisations. Application of the tool by fleet safety researchers is now needed to inform its further development and refinement and to permit psychometric evaluation.
Publisher: Elsevier BV
Date: 2022
DOI: 10.1016/J.JSAMS.2021.08.002
Abstract: To quantify and describe boxing-related deaths in Australia. Retrospective analysis of news media reports of all boxing-related fatalities in Australia during 1832 to 2020. Australia and New Zealand Newsstream, Factiva, Informit, Google News, Fairfax Media Archive, and Trove were searched from inception to December 31, 2020. News media articles reporting all-cause boxing-related mortality were included for analysis. There were 163 boxing-related fatalities in Australia during 1832 to 2020, including 122 (74.8%) professional and 40 (24.5%) amateur athletes. The most common causes of death were traumatic brain injury (n = 121 74.2%) and cardiac arrest (n = 11 6.7%). Boxing-related deaths occurred most frequently during the decades from 1910 to 1930. The fatality rate remained relatively steady from the 1870s through the 1930s, and then declined precipitously until the 1980s. Since legislation to regulate boxing started being introduced in the mid-1970s, there were a total of eleven deaths, of which all but one were caused by traumatic brain injury. Participation in boxing is associated with risk of death, in particular death caused by traumatic brain injury. The boxing-related fatality rate declined precipitously prior to government legislation to regulate boxing started being introduced, with no discernible further reduction in fatalities since. Given that a main purpose of government regulation of boxing is to protect the health and safety of athletes, the findings herein suggest that current regulations are either inadequate or not effectively implemented.
Publisher: Springer Science and Business Media LLC
Date: 12-11-2018
Publisher: Wiley
Date: 18-11-2018
DOI: 10.1002/HPJA.213
Abstract: As injuries are preventable, understanding the age profile of specific injury mechanisms is critical for developing injury prevention strategies. This study examined the profile and temporal trends of injury mortality of young people aged ≤24 years in Australia across developmental life stages. A retrospective analysis of injury deaths of young people aged ≤24 years was conducted using closed cases from the National Coronial Information System during 2001-2013. Negative binomial regression was used to examine temporal trends in mortality rates by age group. There were 7749 injury deaths of young people in Australia. The mortality rates were estimated to decline each year for young people aged 0-4 years (by 3.4% 95% CI: -5.10 to -1.67), 10-14 years (by 3.7% 95% CI: -6.29 to -1.09), 15-19 years (by 4.4% 95% CI: -5.90 to -2.85) and 20-24 years (by 4.5% 95% CI: -5.61 to -3.37). Motor vehicle incidents were a frequent mechanism of fatal injury for all ages. For children aged ≤9 years, drowning and submersion and other threats to breathing were also frequent mechanisms of fatal injury. Young people aged 15-24 years were also frequently fatally injured as a motorcyclist or a pedestrian. The age-specific injury mortality profiles reflect the changing vulnerabilities of young people influenced by physical, cognitive and social characteristics associated with different stages of their development. By focusing on different ages, targeted injury prevention interventions can be developed. SO WHAT?: While policies play a key role in reducing injury mortality, secondary interventions that aim to shift attitudes to injury prevention activities will also be critical to influence positive behaviour change.
Publisher: Elsevier BV
Date: 11-2020
Publisher: Elsevier BV
Date: 10-2019
DOI: 10.1016/J.INJURY.2019.05.003
Abstract: The psychological distress and risk of mental health problems for parents of children with critical injury is well-established. There has been little exploration, however, of parent experiences and psychosocial trajectories over time following child critical injury. To address this knowledge gap, a longitudinal qualitative study was conducted to explore parent experiences and support needs and identify parent psychosocial trajectories in the 12 months following child critical injury. Semi- structured in-depth interviews were conducted with 27 parents at three time points over a 12 month period: the immediate hospital period post-child injury, and 6 and 12 months following injury, resulting in a total of 81 interviews. Data were analysed using a longitudinal within and across-case thematic analysis of patterns emerging over time. Three parent trajectory patterns were identified: resilient trajectory where parents were temporarily disrupted by the child's injury and hospitalisation, but recovered their mental and emotional wellbeing quickly, which was maintained over time recovering trajectory where parents were initially disrupted at the time of injury but their mental and emotional wellbeing fluctuated over time and had not been fully restored by 12 months and distressed trajectory where parents experienced significant psychosocial disruption due to their child's injury and struggled to adapt and regain their wellbeing over time, remaining emotionally distressed about the circumstances and impacts of the injury on their child and family. Illustrative narratives that represent each trajectory are presented. This is the first qualitative study to report the psychosocial trajectories of parents of critically injured children. Clinical application of insights provided by these trajectories can assist clinicians to use targeted strategies to help strengthen parental adaptation and prevent adverse mental health outcomes, and address families' psychosocial support needs following child injury. Screening for parent psychological distress and post-traumatic stress disorder is needed from the time of the child's admission, and a dedicated trauma support role can facilitate an integrated care approach for children and families with complex needs across the care continuum.
Publisher: Springer Science and Business Media LLC
Date: 16-11-2022
DOI: 10.1186/S12913-022-08789-3
Abstract: To inform healthcare planning and resourcing, population-level information is required on the use of health services among young people with a mental disorder. This study aims to identify the health service use associated with mental disorders among young people using a population-level matched cohort. A population-based matched case-comparison retrospective cohort study of young people aged ≤ 18 years hospitalised for a mental disorder during 2005–2018 in New South Wales, Australia was conducted using linked birth, health, and mortality records. The comparison cohort was matched on age, sex and residential postcode. Adjusted rate ratios (ARR) were calculated for key demographics and mental disorder type by sex. Emergency department visits, hospital admissions and ambulatory mental health service contacts were all higher for males and females with a mental disorder than matched peers. Further hospitalisation risk was over 10-fold higher for males with psychotic (ARR 13.69 95%CI 8.95–20.94) and anxiety (ARR 11.44 95%CI 8.70-15.04) disorders, and for both males and females with cognitive and behavioural delays (ARR 10.79 95%CI 9.30-12.53 and ARR 14.62 95%CI 11.20-19.08, respectively), intellectual disability (ARR 10.47 95%CI 8.04–13.64 and ARR 11.35 95%CI 7.83–16.45, respectively), and mood disorders (ARR 10.23 95%CI 8.17–12.80 and ARR 10.12 95%CI 8.58–11.93, respectively) compared to peers. The high healthcare utilisation of young people with mental disorder supports the need for the development of community and hospital-based services that both prevent unnecessary hospital admissions in childhood and adolescence that can potentially reduce the burden and loss arising from mental disorders in adult life.
Publisher: Swansea University
Date: 25-08-2022
Abstract: ObjectivesTo compare scholastic performance and high school completion of young people hospitalised with a mental disorder compared to young people not hospitalised for a mental disorder by sex. ApproachA population-based matched case-comparison cohort study of young people aged ≤18 years hospitalised for a mental disorder during 2005-2018 in New South Wales, Australia using linked birth, health, education and mortality records. The comparison cohort was matched on age, sex and residential postcode. Generalised linear mixed modelling examined risk of school performance below the national minimum standard (NMS) and generalised linear regression examined risk of not completing high school for young people with a mental disorder compared to matched peers. ResultsYoung males with a mental disorder had over a 1.7 times higher risk of not achieving the NMS for numeracy (ARR: 1.71 95%CI 1.35-2.15) and reading (ARR: 1.99 95%CI 1.80-2.20) compared to matched peers. Young females with a mental disorder had around 1.5 times higher risk of not achieving the NMS for numeracy (ARR: 1.50 95%CI 1.14-1.96) compared to matched peers. Both young males and females with a disorder had around a three times higher risk of not completing high school compared to peers. Young males with multiple disorders had up to a six-fold increased risk and young females with multiple disorders had up to an eight-fold increased risk of not completing high school compared to peers. ConclusionsEarly recognition and support could improve school performance and educational outcomes for young people who were hospitalised with a mental disorder. This support should be provided in conjunction with access to mental health services and school involvement and assistance.
Publisher: Public Library of Science (PLoS)
Date: 07-10-2021
DOI: 10.1371/JOURNAL.PONE.0256027
Abstract: Blunt chest injury leads to significant morbidity and mortality. The aim of this study was to evaluate the effect of a multidisciplinary chest injury care bundle (ChIP) on patient and health service outcomes. ChIP provides guidance in three key pillars of care for blunt chest injury—respiratory support, analgesia and complication prevention. ChIP was implemented using a multi-faceted implementation plan developed using the Behaviour Change Wheel. This controlled pre-and post-test study (two intervention and two non-intervention sites) was conducted from July 2015 to June 2019. The primary outcome measures were unplanned Intensive Care Unit (ICU) admissions, non-invasive ventilation use and mortality. There were 1790 patients included. The intervention sites had a 58% decrease in non-invasive ventilation use in the post- period compared to the pre-period (95% CI 0.18–0.96). ChIP was associated with 90% decreased odds of unplanned ICU admissions (95% CI 0.04–0.29) at the intervention sites compared to the control groups in the post- period. There was no significant change in mortality. There were higher odds of health service team reviews (surgical OR 6.6 (95% CI 4.61–9.45), physiotherapy OR 2.17 (95% CI 1.52–3.11), ICU doctor OR 6.13 (95% CI 3.94–9.55), ICU liaison OR 55.75 (95% CI 17.48–177.75), pain team OR 8.15 (95% CI 5.52 –-12.03), analgesia (e.g. patient controlled analgesia OR 2.6 (95% CI 1.64–3.94) and regional analgesia OR 8.8 (95% CI 3.39–22.79), incentive spirometry OR 8.3 (95% CI 4.49–15.37) and, high flow nasal oxygen OR 22.1 (95% CI 12.43–39.2) in the intervention group compared to the control group in the post- period. The implementation of a chest injury care bundle using behaviour change theory was associated with a sustained improvement in evidence-based practice resulting in reduced unplanned ICU admissions and non-invasive ventilation requirement. ANZCTR: ACTRN12618001548224 , approved 17/09/2018
Publisher: Elsevier BV
Date: 2013
DOI: 10.1016/J.JSAMS.2012.05.009
Abstract: To describe the epidemiology of competition and training-based surf sport-related injury in Australia in the years 2003-2011. A retrospective epidemiological review. Information on surf sport-related injuries was obtained from Surf Life Saving Australia's SurfGuard Incident Reporting Database during 1 January 2003 to 20 August 2011. There were 2645 surf sport-related competition or training-related incidents. Males and females experienced similar proportions of injury by activity type, with older in iduals experiencing a higher proportion of injuries during training than younger in iduals. Minor first aid was required for 54.5% of the competition and 43.7% of the training-related incidents, with major first aid required in just over 10% of both incident types. Overall, inflatable rescue boats, beach flags, and surf boats were the most common activities performed at the time of the incident, with returning to shore and negotiating the break the most common possible contributing factors to surf boat incidents. Bruises/contusions, strains, inflammation/swelling, and sprains were the most common types of injuries that occurred during both competition and training. RICE--Rest-Ice-Compression-Elevation--was the most common form of initial treatment for the injury during both competition and training. Participation in surf sports is not without risk of injury. Information from this study will inform injury prevention efforts for surf sport and act as a guide for future research in this area, and towards improved injury surveillance for surf sport-related injuries.
Publisher: Bristol University Press
Date: 15-06-2023
DOI: 10.1332/239788221X16825359407198
Abstract: Despite widespread acknowledgement of challenges endured by unpaid caregivers, there is still a paucity of studies attempting to elucidate factors that necessitate resilience in caregiving. This integrative review aimed to identify facilitators and barriers to unpaid caregivers’ resilience. Four databases (Medline, PsycINFO, Cumulative Index of Nursing and Allied Health Literature [CINAHL] and Scopus) were searched for English-language articles (January 2000–August 2021) that considered facilitators and barriers to caregiving resilience among the carer population. A total of 22 articles were identified. Facilitators included carers receiving adequate social support and personal time, and remaining positive barriers included lack of social support, adopting a negative outlook, experiencing family conflict and financial instability.
Publisher: Elsevier BV
Date: 11-2018
Publisher: Springer Science and Business Media LLC
Date: 06-2022
DOI: 10.1186/S40814-022-01077-1
Abstract: Commercial delivery cyclists represent a uniquely vulnerable and poorly understood road user. The primary aim of this study was to pilot whether cycling injuries could be categorised as either commercial or non-commercial using documentation entered into routine hospital medical records, in order to determine the feasibility of conducting a large cohort study of commercial cycling injuries in the future. A secondary aim was to determine which key demographic, incident and injury characteristics were associated with commercial versus non-commercial cycling injuries in emergency. Pilot retrospective cohort study of adults presenting to an acute public hospital emergency department between May 2019 and April 2020 after sustaining a cycling-related injury. Multinomial logistic regression was used to examine the demographic, incident and injury characteristics associated with commercial compared to non-commercial cycling. Of the 368 people presenting to the emergency department with a cycling-related injury, we were able to categorise 43 (11.7%) as commercial delivery cyclists, 153 (41.6%) as non-commercial cyclists and the working status of 172 (46.7%) was unable to be confirmed. Both commercial and unconfirmed cyclists were more likely to be younger than non-commercial cyclists. Compared to non-commercial cyclists, commercial cyclists were 11 times more likely to speak a language other than English (AOR 11.3 95% CI 4.07–31.30 p .001), less likely to be injured from non-collision incidents than vehicle collisions (AOR 0.36 95% CI 0.15–0.91 p =0.030) and were over 13 times more likely to present to the emergency department between 8.00pm and 12.00am compared to the early morning hours (12.00 to 8.00am) (AOR 13.43 95% CI 2.20–82.10 p =0.005). The growth of commercial cycling, particularly through online food delivery services, has raised concern regarding commercial cyclist safety. Improvements in the recording of cycling injury commercial status is required to enable ongoing surveillance of commercial cyclist injuries and establish the extent and risk factors associated with commercial cycling.
Publisher: CSIRO Publishing
Date: 2023
DOI: 10.1071/AH23197
Publisher: Australasian College of Road Safety
Date: 02-2020
Abstract: Introduction: Certain cognitive and physical conditions have been associated with increased risk of injury, particularly risk of vehicle crashes among older car drivers. This study aims to examine the association of seven select medical conditions among hospitalised road users compared to other hospitalised injuries, and to estimate the hospitalised injury rates of car drivers, car passengers and pedestrians with these medical conditions. Method: An examination of road transport and nonroad transport hospitalised injury involving adults aged ≥50 years identified during 2003-2012 in New South Wales, Australia was conducted. Medical conditions were identified from hospital diagnosis records. Conditional fixed effects logistic regression conditioned on the matched cases and comparison-cohort estimated odds ratios for each medical condition by road user type. Results: There were 35,134 road transport injuries (10,664 car drivers and 4,907 pedestrians) and 447,858 nonroad transport injuries. In iduals with vision disorders, cardiovascular disease including stroke, diabetes, and osteoarthritis had higher odds of hospitalisation for an injury as a car driver compared to all other hospitalised injuries. In iduals with diagnoses of dementia or alcohol dependence had a lower odds of an injury hospital admission as a road user (excluding pedestrians) compared to all other hospitalised injuries. Conclusions: As the population ages, there are likely to be more older road users with comorbidities that may affect their ability to drive or safely cross the road. Community mobility strategies need to take into account the influence of comorbid health conditions for older adults.
Publisher: Springer Science and Business Media LLC
Date: 23-10-2006
Publisher: Elsevier BV
Date: 2024
Publisher: Springer Science and Business Media LLC
Date: 30-08-2023
DOI: 10.1186/S12913-023-09900-Y
Abstract: Hearing loss can have a negative impact on in iduals’ health and engagement with social activities. Integrated approaches that tackle barriers and social outcomes could mitigate some of these effects for cochlear implants (CI) users. This review aims to synthesise the evidence of the impact of a CI on adults’ health service utilisation and social outcomes. Five databases (MEDLINE, Scopus, ERIC, CINAHL and PsychINFO) were searched from 1st January 2000 to 16 January 2023 and May 2023. Articles that reported on health service utilisation or social outcomes post-CI in adults aged ≥ 18 years were included. Health service utilisation includes hospital admissions, emergency department (ED) presentations, general practitioner (GP) visits, CI revision surgery and pharmaceutical use. Social outcomes include education, autonomy, social participation, training, disability, social housing, social welfare benefits, occupation, employment, income level, anxiety, depression, quality of life (QoL), communication and cognition. Searched articles were screened in two stages ̶̶̶ by going through the title and abstract then full text. Information extracted from the included studies was narratively synthesised. There were 44 studies included in this review, with 20 (45.5%) cohort studies, 18 (40.9%) cross-sectional and six (13.6%) qualitative studies. Nine studies (20.5%) reported on health service utilisation and 35 (79.5%) on social outcomes. Five out of nine studies showed benefits of CI in improving adults’ health service utilisation including reduced use of prescription medication, reduced number of surgical and audiological visits. Most of the studies 27 (77.1%) revealed improvements for at least one social outcome, such as work or employment 18 (85.7%), social participation 14 (93.3%), autonomy 8 (88.9%), education (all nine studies), perceived hearing disability (five out of six studies) and income (all three studies) post-CI. None of the included studies had a low risk of bias. This review identified beneficial impacts of CI in improving adults’ health service utilisation and social outcomes. Improvement in hearing enhanced social interactions and working lives. There is a need for large scale, well-designed epidemiological studies examining health and social outcomes post-CI.
Publisher: Informa UK Limited
Date: 06-2006
Publisher: Elsevier BV
Date: 06-2013
DOI: 10.1016/J.JSR.2012.11.005
Abstract: Fall-related injuries among older people is a significant public health issue. To identify medical, general health and lifestyle factors associated with falls and multiple falls in older persons, a representative s le of people aged 65+ years living in the community in New South Wales (NSW) Australia were surveyed regarding their falls experience, lifestyle and general health. One-quarter of respondents indicated they had fallen in the past 12 months. People who fell were more likely to be aged 85+ years, have cataracts, musculoskeletal system and connective tissue disorders, major diseases of the circulatory, respiratory and nervous systems, use four or more medications, use a mobility aid and be overweight than non-fallers. In iduals aged 85+ years and those who experienced circulatory diseases, used four or more medications and used mobility aids were more likely to experience multiple falls. This representative population-based survey reinforces the multi-factorial nature of falls and the complex interaction of risk factors that increase the likelihood of in iduals having a fall or multiple falls. Agencies focused on community-based fall prevention strategies should adopt a systematic, integrated approach to reduce the burden of fall injury at the population-level and should have mechanisms in place at the population-level to monitor the success of fall reduction strategies.
Publisher: Wiley
Date: 12-07-2010
DOI: 10.1111/J.1741-6612.2010.00413.X
Abstract: To examine fall-related hospitalised morbidity in New South Wales (NSW) and to describe the pattern of fall-related major trauma presentations at a Level 1 Trauma Centre in NSW for younger and older fallers. Fall-related injuries were identified in the NSW Admitted Patients Data Collection during 1 July 1999-30 June 2008 and the trauma registry of the NSW St George Public Hospital during 1 January 2006-6 December 2008. There were 434 138 hospitalisations and 862 fall-related trauma presentations. Older fallers had a higher incidence of hospitalisation, being more likely to fall on the same level during general activities at home, injuring their hip or thigh. Older fallers were also more likely to have an Injury Severity Score > 9, undergo physiotherapy and stay in hospital for >1 day than younger fallers. Falls, particularly for older in iduals, are an important cause of serious injury, representing a considerable burden in terms of hospitalised morbidity.
Publisher: Elsevier BV
Date: 06-2014
Abstract: To outline some of the key issues for injury-related data linkage studies in Australia and describe potential applications of data linkage for injury surveillance and research. Narrative review of data linkage capacity and injury-related data collection quality in Australia. The establishment of national and state-based data linkage centres in Australia has been a great leap forward for data linkage capacity for injury research. However, there are still limitations of using data linkage for injury surveillance and research. These are highlighted in the form of key perils and pitfalls, with ex les provided. There is still much to be gained for injury research by using data linkage techniques to enhance the information available across the injury continuum, but data quality issues should always be acknowledged. Obtaining authorisation to link injury data collections for national research remains cumbersome. Streamlining of the application process is needed to ensure that injury research is able to be conducted in a timely fashion. Data quality and data linkage rates need to be considered when interpreting research findings. Streamlining of the application process for research that involves linking data collections would help ensure that research is conducted in a timely fashion.
Publisher: Wiley
Date: 20-05-2016
DOI: 10.1111/JPC.13189
Abstract: This study describes clinical staff opinions on the availability and suitability of resources to provide trauma care to children and their families and any perceived strengths, gaps and potential interventions to strengthen care. A mixed-method study was conducted in five Australian paediatric trauma centres. The trauma coordinator at each site participated in a structured interview to determine models of care and trauma activity at their site. This informed the development of an electronic survey, which sought staff opinion on child and family access to services and perceived gaps in care. Five trauma coordinators were interviewed, and 214 clinicians (medical, nursing, allied health) from New South Wales, Victoria, South Australia and Queensland completed the survey. Each site had a trauma director and coordinator, and there was variance in resource availability. Almost all survey participants (92.5%) considered their hospital met the physical needs of injured children, 68.2% thought that the psychosocial needs of children were met and 82.1% thought that the needs of families were met. The least accessible services reported were clinical psychology/family counselling, mental health and behaviour management services. No routine follow-up support services post-discharge for the child or their families were identified. Staff providing care for injured children report that physical needs are better met than psychosocial needs. There is variability in resource levels across paediatric trauma centres. A coordinated model of care that provides psychosocial care both during hospitalisation and post-discharge could reduce this gap in care for injured children and their families.
Publisher: BMJ
Date: 09-2019
DOI: 10.1136/BMJPO-2019-000530
Abstract: Children who have sustained a serious injury or who have a chronic health condition, such as diabetes or epilepsy, may have their school performance adversely impacted by the condition, treatment of the condition and/or time away from school. Examining the potential adverse impact requires the identification of children most likely to be affected and the use of objective measures of education performance. This may highlight educational disparities that could be addressed with learning support. This study aims to examine education performance, school completion and health outcomes of children in New South Wales (NSW), Australia, who were hospitalised with an injury or a chronic health condition compared with children who have not been hospitalised for these conditions. This research will be a retrospective population-level case-comparison study of hospitalised injured or chronically ill children (ie, diabetes, epilepsy, asthma or mental health conditions) aged ≤18 years in NSW, Australia, using linked health and education administrative data collections. It will examine the education performance, school completion and health outcomes of children who have been hospitalised in NSW with an injury or a chronic health condition compared with children randomly drawn from the NSW population (matched on gender, age and residential postcode) who have not been hospitalised for these conditions. The study received ethics approval from the NSW Population Health Services Research Ethics Committee (2018HRE0904). Findings from the research will be published in peer-reviewed journals and presented at scientific conferences.
Publisher: Elsevier BV
Date: 2014
DOI: 10.1016/J.INJURY.2013.02.024
Abstract: No Australian population-based studies have examined temporal trends in the incidence of fracture of the first or second cervical vertebra (C1 or C2 fractures), their aetiology, treatment and outcome for younger (15-64 years) compared to older (65+ years) in iduals. The aim of this research is to examine the circumstances, treatment and outcomes including mortality for C1 or C2 fractures without associated spinal cord injury by age group in New South Wales (NSW), Australia. A retrospective review of C1 or C2 vertebra fractures in in iduals aged 15 years and over in the NSW Admitted Patient Data Collection from 1 July 1998 to 30 June 2010. Direct age standardised admission rates were calculated by cervical fracture type and by age group. Negative binomial regression was used to examine the statistical significance of changes in trend over time of hospitalised cervical fractures by age group. The annual rate of hospitalised C1 and C2 fractures without associated spinal cord injury for in iduals aged 15 years and over in NSW was 2.3 per 100,000 population, with the rate estimated to increase by 5.3% each year. Those aged 85+ years had the highest rates of hospitalisation. For those aged 15-64 years, road trauma was the most common mechanism of injury, while for those aged 65+ years, a fall was the dominant mechanism of injury. The in-hospital mortality for in iduals aged 65+ years was 11.8% compared to 0.7% for those aged 15-64 years. This study identified an estimated increasing trend in C1 and C2 fractures over time, particularly for older in iduals. While younger in iduals are commonly injured in road traffic accidents, older in iduals are predominantly injured following a fall. Injury prevention strategies should be targeted to the different age groups and injury mechanisms. Implementation of effective falls prevention strategies is likely to reduce these injuries in older people whilst road and vehicle safety including vehicle rollover protection standards may improve rates in younger people.
Publisher: Elsevier BV
Date: 07-2017
DOI: 10.1016/J.INJURY.2017.04.014
Abstract: Healthcare use by traumatically injured in iduals prior to and subsequent to their injury are not often explored for different types of injuries. This study aims to describe health care use 12 months preceding and 12 months following a traumatic injury by injury type and injury severity. Hospital and mortality data from three Australian states were linked in a population-based matched cohort study. In iduals ≥18 years who had an injury-related hospital admission in 2009 were identified as the injured cohort. A comparison cohort of non-injured people, matched 1:1 on age, gender and postcode of residence, was randomly selected from the electoral roll. Twelve-month pre- and post-index injury health service use was examined. Rates, adjusted rate ratios and attributable risk proportions were calculated by injury type and severity. The injury cohort experienced higher 12-month pre- and post-injury hospital admissions than the non-injured group. By 6 to 7 months post-injury, the injury cohort had largely returned to their pre-injury health service use levels, except for injuries involving dislocations, sprains and strains and injury to nerves and spinal cord. Hip fracture (17.69 per 100 person-months) and poisoning (16.09 per 100 person-months) had the highest rates of post-injury hospitalisation in the injured cohort. The adjusted rate ratios (ARR) for post-injury hospitalisation were highest for poisoning (ARR: 3.77 95% CI: 3.38-4.21) and injury to nerves and spinal cord (ARR: 2.73 95% CI: 2.27-3.28). Poisoning also had the highest ARR for post-injury LOS (ARR: 5.31 95% CI: 4.51-6.27). After sustaining a traumatic injury, many in iduals are readmitted to hospital and require ongoing care up to 12 months post-injury. That injured in iduals post-injury largely return to their pre-index injury hospital use by 6 to 7 months could imply a return to pre-injury function and/or that other measures of health service use should be explored. Trauma services should consider long-term follow-up and support services for seriously injured patients post-hospital discharge.
Publisher: Springer Berlin Heidelberg
Date: 2006
Publisher: Elsevier BV
Date: 07-2018
DOI: 10.1016/J.SPINEE.2017.11.013
Abstract: Traumatic spinal injuries are often associated with both long-term disability, higher frequency of hospital readmissions, and high medical costs for in iduals of all ages. Age differences in terms of injury profile and health outcomes among those who sustain a spinal cord injury have been identified. However, factors that may influence health outcomes among those with a spinal injury have not been extensively examined at a population level. The present study aims to describe the characteristics of traumatic spinal injury, identify factors predictive of mortality, and estimate the cost of hospital treatment for younger and older people. This is a population-based retrospective epidemiological study using linked hospitalization and mortality records during January 1, 2010 to June 30, 2014 in New South Wales, Australia. The present study included 13,429 hospitalizations. Mortality within 30 and 90 days of hospitalization, hospital length of stay (LOS), and hospitalization costs were determined. Hospitalizations with a principal diagnosis of spinal cord injury or spinal fractures were used to identify traumatic spinal injuries. Age-standardized incidence rates were calculated and negative binomial regression was used to examine statistical significant changes over time. Cox proportional hazard regression was used to examine the effect of risk factors on survival at 90 days. There were 13,429 hospitalizations, with 52.4% of in iduals aged ≥65 years. The hospitalization rates for in iduals aged ≤64 and ≥65 years were both estimated to significantly increase per year by 3.3% (95% confidence interval [CI] 0.97-5.79, p<.006) and 3.3% (95% CI 1.02-5.71, p=.005), respectively. For in iduals aged ≥65 years, there were a higher proportion of women injured, comorbid conditions, injuries after a fall in the home or aged care facility, a longer hospital LOS, unplanned hospital admissions, and deaths than in idual aged ≤64 years. The average cost per index hospitalization was AUD$23,808 for in iduals aged ≤64 years and AUD$31,187 for in iduals aged ≥65 years with a total estimated cost of AUD$371 million. Mortality risk at 90 days was increased for in iduals who had one or more comorbidities, a higher injury severity score, and if their injury occurred in the home or an aged care facility. Spinal injury represents a substantial cost and results in debilitating injuries, particularly for older in iduals. Spinal injury prevention efforts for older people should focus on the implementation of fall injury prevention, whereas for younger in iduals, prevention measures should target road safety.
Publisher: Elsevier BV
Date: 09-2020
Publisher: Springer Science and Business Media LLC
Date: 19-02-2019
Publisher: Wiley
Date: 03-09-2021
DOI: 10.1111/AJAG.12847
Publisher: Informa UK Limited
Date: 09-2009
DOI: 10.1080/17457300903024178
Abstract: Narrative text can be a useful means of identifying injury in routine data collections. An analysis of data from a near real-time emergency department surveillance system (NREDSS) in New South Wales (NSW, Australia) was conducted to determine if sports injuries can be identified from routine narrative text recorded in emergency departments. Around one-third of all emergency department (ED) presentations during 1 September 2003 to 15 February 2007 were identified as injury-related. Narrative text searching of triage nursing assessments using keywords identified between 282 (i.e. football) and 26,944 (i.e. play) potential sports injury presentations depending on the selected sports-related keyword used. Routine narrative text descriptions from triage nurse assessments show promise for the identification of sports injury presentations to EDs. Further work is required regarding in-depth assessment of case detection capabilities and the likelihood of improving the quality of narrative text recorded.
Publisher: Elsevier BV
Date: 03-2016
DOI: 10.1016/J.BURNS.2015.10.023
Abstract: Older people are disproportionately at risk of burn and have a high risk of dementia however the impact of dementia on risk of burn is unknown. Linked hospitalisation and death records for in iduals aged 65 years and older admitted to a NSW hospital for a burn over the ten year period 2003-2012 were analysed. Demographic and burn characteristics and health outcomes were compared for people with and without dementia. Incidence rates were calculated per 100,000 population and negative binomial regression was used to examine temporal trends. Of the 1535 older people hospitalised for a burn, 11.0% had a record of dementia. The age-standardised incidence rate for people with dementia was 22.7 per 100,000, and for people without dementia was 14.2 per 100,000 population, an incident rate ratio (IRR) of 1.6 (95%CI 1.3-2.0, p<0.0001). There was no significant change in rates over time. People with dementia were more likely to be admitted with burns to the trunk and have greater than 20% total body surface area (TBSA) burn. Mean length of stay (LOS) was more than double (24 vs 12 days) and 30-day mortality three times higher (15.4% vs 5.1%) for people with dementia. Adjusting for differences in age, sex, TBSA, inhalation injury, comorbidities and complications eliminated the increased mortality but not the difference in LOS. People with dementia were more likely to have been burnt by hot tap water (RR 2.3 95%CI 1.8-2.8, p<0.0001) and ignition of clothing/nightwear (RR 2.6 95% CI 1.2-5.4, p=0.0149) and to have sustained the burn in residential aged care (20.0%). Burns in people with dementia are significant injuries, which have not decreased over the past ten years despite prevention efforts to reduce burns in older people. Targeted prevention education in the home and residential aged care facilities is warranted.
Publisher: Springer Science and Business Media LLC
Date: 11-03-2022
DOI: 10.1007/S00068-022-01937-8
Abstract: To synthesise the evidence on the impact of pre-operative direct oral anticoagulants (DOACs) on health outcomes for patients who sustain a hip fracture. A rapid systematic review of three databases (MEDLINE, Embase and Scopus) for English-language articles from January 2000 to August 2021 was conducted. Abstracts and full text were screened by two reviewers and articles were critically appraised. Data synthesis was undertaken to summarise health outcomes examined for DOAC users versus a no anticoagulant group. Key information was extracted for study type, country and time frame, population and s le size, type of DOACs, comparator population(s), key definitions, health outcome(s), and summary study findings. There were 21 articles identified. Of the 18 studies that examined time to surgery, 12 (57.1%) found DOAC users had a longer time to surgery than in iduals not using anticoagulants. Five (83.3%) of six studies identified that DOAC users had a lower proportion of surgery conducted within 48 h Four (40.0%) of ten studies reporting hospital length of stay (LOS) identified a higher LOS for DOAC users. Where reported, DOAC users did not have increased mortality, blood loss, transfusion rates, complication rates of stroke, re-operation or readmissions compared to in iduals not using anticoagulants. The effect of DOAC use on hip fracture patient health was mixed, although patients on DOACs had a longer time to surgery. The review highlights the need for consistent measurement of health outcomes in patients with a hip fracture to determine the most appropriate management of patients with a hip fracture taking DOACs.
Publisher: Elsevier BV
Date: 2014
DOI: 10.1016/J.INJURY.2012.10.002
Abstract: Accurate economic data are fundamental for improving current funding models and ultimately in promoting the efficient delivery of services. The financial burden of a high trauma casemix to designated trauma centres in Australia has not been previously determined, and there is some evidence that the episode funding model used in Australia results in the underfunding of trauma. To describe the costs of acute trauma admissions in trauma centres, identify predictors of higher treatment costs and cost variance in New South Wales (NSW), Australia. Data linkage of admitted trauma patient and financial data provided by 12 Level 1 NSW trauma centres for the 08/09 financial year was performed. Demographic, injury details and injury scores were obtained from trauma registries. In idual patient general ledger costs (actual trauma patient costs), Australian Refined Diagnostic Related Groups (AR-DRG) and state-wide average costs (which form the basis of funding) were obtained. The actual costs incurred by the hospital were then compared with the state-wide AR-DRG average costs. Multivariable multiple linear regression was used for identifying predictors of costs. There were 17,522 patients, the average per patient cost was $10,603 and the median was $4628 (interquartile range: $2179-10,148). The actual costs incurred by trauma centres were on average $134 per bed day above AR-DRG costs-determined costs. Falls, road trauma and violence were the highest causes of total cost. Motor cyclists and pedestrians had higher median costs than motor vehicle occupants. As a result of greater numbers, patients with minor injury had comparable total costs with those generated by patients with severe injury. However the median cost of severely injured patients was nearly four times greater. The count of body regions injured, sex, length of stay, serious traumatic brain injury and admission to the Intensive Care Unit were significantly associated with increased costs (p<0.001). This multicentre trauma costing study demonstrated the feasibility of trauma registry and financial data linkage. Discrepancies between the observed costs of care in these 12 trauma centres and the NSW average AR-DRG costs suggest that trauma care is currently underfunded in NSW.
Publisher: BMJ
Date: 07-2023
DOI: 10.1136/BMJOPEN-2023-072908
Abstract: Emergency department (ED) care must adapt to meet current and future demands. In Australia, ED quality measures (eg, prolonged length of stay, re-presentations or patient experience) are worse for older adults with multiple comorbidities, people who have a disability, those who present with a mental health condition, Indigenous Australians, and those with a culturally and linguistically erse (CALD) background. Strengthened ED performance relies on understanding the social and systemic barriers and preferences for care of these different cohorts, and identifying viable solutions that may result in sustained improvement by service providers. A collaborative 5-year project (MyED) aims to codesign, with ED users and providers, new or adapted models of care that improve ED performance, improve patient outcomes and improve patient experience for these five cohorts. Experience-based codesign using mixed methods, set in three hospitals in one health district in Australia. This protocol introduces the staged and incremental approach to the whole project, and details the first research elements: ethnographic observations at the ED care interface, interviews with providers and interviews with two patient cohorts—older adults and adults with a CALD background. We aim to s le a erse range of participants, carefully tailoring recruitment and support. Ethics approval has been obtained from the Western Sydney Local Health District Human Research Ethics Committee (2022/PID02749-2022/ETH02447). Prior informed written consent will be obtained from all research participants. Findings from each stage of the project will be submitted for peer-reviewed publication. Project outputs will be disseminated for implementation more widely across New South Wales, Australia.
Publisher: Wiley
Date: 08-05-2018
DOI: 10.1111/ANS.14507
Abstract: To quantify the incidence and timing of second hip fracture, and to evaluate the relative impact of comorbidities on risk of second hip fracture. Hospitalization records for in iduals aged ≥65, admitted to a New South Wales hospital for fall-related hip fracture between 1 January 2005 and 31 December 2009 were linked. Comorbidities were identified from the records using a 1-year look-back period. To calculate second hip fracture rates, in iduals were followed until death, fracture or end of study period (31 December 2012). Time-dependent competing-risk hazards regression was used to assess the relative contribution of each comorbidity to fracture risk, adjusting for age and sex. Of the 24 500 in iduals who sustained at least one hip fracture, 2.9% experienced a second within a year, 6.1% within 3 years and 9.4% within 8 years. Malnutrition/cachexia (hazard ratio (HR): 2.47 99.9% confidence interval (CI): 1.87-3.26), dementia (HR: 2.15 99.9% CI: 1.80-2.57), congestive heart failure (HR: 1.62 99.9% CI: 1.30-2.04), Parkinson's disease (HR: 1.51 99.9% CI: 1.08-2.10), cerebrovascular disease (HR: 1.41 99.9% CI: 1.06-1.89) and osteoporosis (HR: 1.36 99.9% CI: 1.11-1.67) were associated with increased risk of second hip fracture within 3 years. Mortality was high with 26% of in iduals dying within a year, 44.9% within 3 years and 70.2% within 8 years. One in 11 older in iduals with an initial hip fracture sustained a second hip fracture. While the priority is to prevent the first hip fracture, those that have sustained a hip fracture should be seen as a high risk population and be targeted for future falls and fracture prevention strategies.
Publisher: Elsevier BV
Date: 10-2022
DOI: 10.1016/J.INJURY.2022.07.005
Abstract: While comorbidities and types of road users are known to influence survival in people hospitalised with injury, few studies have examined the association between comorbidities and survival in people injured in road traffic crashes. Further, few studies have examined outcomes across different types of road users with different types of pre-existing comorbidities. This study aims to examine differences in survival within 30 days of admission among different road user types with and without different pre-existing comorbidities. Retrospective cohort study using data for all major road trauma cases were extracted from the NSW Trauma Registry Minimum Dataset (1 January 2013 - 31 July 2019) and linked to the NSW Admitted Patient Data Collection, and the NSW Registry of Births, Deaths and Marriages - death dataset. Pre-existing comorbidities and road user types were identified by the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Australian Modification (ICD-10-AM) codes and Charlson Comorbidity Index in the Trauma Registry, hospital admission, and death datasets. Logistic regression was used to assess the associations between six types of road users (pedestrian, pedal cycle, two- and three-wheel motorcycle, car and pick-up truck, heavy vehicle and bus, and other types of vehicle) and death within 30 days of hospital admission while controlling for comorbidities. All models used 'car and pick-up truck driver assenger' as the road user reference group and adjusted for demographic variables, injury severity, and level of impaired consciousness. Within 6253 traffic injury person-records (all aged ≥15 years old, ISS>12), and in final models, injured road users with major trauma who had a history of cardiovascular diseases (including stroke), diabetes mellitus, and higher Charlson Comorbidity Index score, were more likely to die, than those without pre-existing comorbidities. Furthermore, in final models, pedestrians were more likely to die than car occupants (OR: 1.68 - 1.77, 95CI%: 1.26 - 2.29 depending on comorbidity type). This study highlights the need to prioritize enhanced management of trauma patients with comorbidities, given the increasing prevalence of chronic medical conditions globally, together with actions to prevent pedestrian crashes in strategies to reach Vision Zero.
Publisher: Elsevier BV
Date: 08-2017
Abstract: To examine gender differences in the characteristics, treatment costs and health outcomes of farm injuries resulting in hospitalisation of New South Wales (NSW) residents. A population-based study of in iduals injured on a farm and admitted to hospital using linked hospital admission and mortality records from 1 January 2010 to 30 June 2014 in NSW. Health outcomes, including injury severity, hospital length of stay (LOS), 28-day readmission and 30-day mortality were examined by gender. A total of 6,270 hospitalisations were identified, with males having a higher proportion of work-related injuries and injuries involving motorbikes compared to females. Females had a higher proportion of equestrian-related injuries. There were no differences in injury severity, with around 20% serious injuries, in mean LOS or 28-day hospital re-admission. Treatment costs totalled $42.7 million, with males accounting for just under 80% of the total. There are some gender differences in the characteristics of farm injury-related hospitalisations. Farm injury imposes modest, but nonetheless relatively considerable, financial costs on hospital services in NSW. Implications for public health: Continued efforts to ameliorate these injuries in a farm environment, which are mainly preventable, will have personal and societal benefits.
Publisher: Springer Science and Business Media LLC
Date: 17-08-2021
DOI: 10.1007/S11657-021-00966-X
Abstract: Hip fracture trajectories have not been examined for older adults in aged care or living in the community. Trajectories of health care use were defined by distinct predictive factors. These results can inform the development of targeted strategies to reduce health service use following hip fracture. To examine hospital service use trajectories of older adults who were hospitalised for hip fracture and living in a residential aged care facility (RACF) or the community, and to identify factors predictive of trajectory group membership. These findings may inform future programmes aimed at reducing unexpected hospitalisations and subsequently reduce health care costs. A group-based trajectory analysis of hospitalisations was conducted for adults aged ≥ 65 years hospitalised for hip fracture during 2008-2009 in New South Wales, Australia. Linked hospitalisation and RACF data were examined for a 5-year period. Group-based trajectory models were derived for RACF and community-dwelling older adults based on the number of subsequent hospital admissions following the index hip fracture. Multinomial logistic regression examined predictors of trajectory group membership for subsequent hospital admissions. There were 5752 hip fracture hospitalisations, with two-thirds of hip fractures occurring in community-dwellers. Key predictors of trajectory group membership for both RACF residents and community-dwellers were age group, sex, hospital length of stay and cognitive impairment. Assistance with activities of daily living and complex health care needs were also predictive of group membership in RACF residents. Location of residence and time to move to a RACF were additional predictors of group membership for community-dwellers. Health service use trajectories differed for RACF residents and community-dwellers however, there were similar patient characteristics that defined trajectory group membership. Low users of hospital services living in RACFs or the community included older adults with generally unfavourable health conditions, potentially indicating that palliative care or advanced care directives and community-care initiatives, respectively, have played a part in the lowered frequency of rehospitalisation.
Publisher: Elsevier BV
Date: 08-2021
Publisher: Elsevier BV
Date: 12-2006
DOI: 10.1016/J.JSAMS.2006.05.005
Abstract: The usefulness of New South Wales (NSW) hospitalisation data for the identification of prevention measures for sport- or leisure-related injury hospitalisations for one common injury mechanism, struck by/struck against injuries, is illustrated. Sport- or leisure-related hospitalisations were identified during 1999-2000 to 2003-2004 from the NSW hospitalisation data using activity and place of occurrence information. Struck by/struck against injury hospitalisations were identified using the International Classification of Disease, 10th Revision, Australian Modified (ICD-10-AM) codes W20-W23 and W50-W52. Information regarding the number of hospitalisations for basic demographic descriptors (such as age and sex), the type of injury experienced, the injury mechanism, the activity, and the place of occurrence of the injury event are available from NSW hospitalisation data. Additional information than what is currently available would be required for the identification of targeted injury prevention strategies for sport- or leisure-related struck by/struck against injuries leading to hospitalisation. Assessing the feasibility of collecting information regarding the object or agent of injury, the phase of activity at the time of the injury, the collection of narrative text and the date of injury are all recommended. These recommendations have national and international implications as ICD-10 is widely used to classify hospitalised morbidity data.
Publisher: BMJ
Date: 11-2020
Publisher: Elsevier BV
Date: 07-2019
DOI: 10.1016/J.ARCHGER.2019.03.028
Abstract: To describe the injury profile, hospitalisation rates and health outcomes for older people with cognitive impairment and to determine whether these differ from those with normal cognition. Participants were 867 community-dwelling 70-90 year olds enrolled in the population-based longitudinal Sydney Memory and Ageing Study (MAS). Participant's cognitive status was classified as normal, mild cognitive impairment (MCI) and dementia at baseline, then 2, 4 and 6 years' follow-up. MAS records were linked to hospital and death records to identify injury-related hospitalisations for the 2-year period following each assessment. There were 335 injury-related hospitalisations for participants 222 (25.6%) participants had at least one injury-related hospitalisation. The injury-related hospitalisation rate for participants with MCI (63.0 [95%CI 51.6-74.4] per 1000 person-years) was higher than for people with normal cognition (39.3 [95%CI 32.4-46.1] per 1000 person-years) but lower than people with dementia (137.1 [95%CI 87.2-186.9] per 1000 person-years). Upper limb fractures (22.1%) were the most common injuries for participants with normal cognition, and non-fracture head injuries for participants with MCI and dementia (25.9% and 23.3% respectively). Participants with dementia had a higher proportion of hip fractures (20.0%, p = 0.0483) than participants with normal cognition. There was no difference in 30-day mortality between participants with normal cognition, MCI and dementia (3.9%, 1.7%, 3.3% respectively). Older people with objectively defined MCI are at higher risk of injury-related hospitalisation than their cognitively intact peers, but lower risk than people with dementia. Falls-risk screening and fall prevention initiatives may be indicated for older people with MCI.
Publisher: Elsevier BV
Date: 07-2020
DOI: 10.1016/J.GERINURSE.2019.02.001
Abstract: Care transitions for older people moving from residential aged care facilities (RACFs) to hospital services are associated with greater challenges and poorer outcomes. An integrative review was conducted to investigate models of care designed to avoid or improve transitions for older people residing in RACFs to hospital settings. Twenty-one studies were included in the final analysis. Models of care aimed to either improve or avoid transitions of residents through enhanced primary care in RACFs, promoting quality improvement in RACFs, instilling comprehensive hospital care, conducting outreach services, transferring information, or involved a combination of outreach services and comprehensive hospital care. As standalone interventions, standardised communication tools may improve information transfer between RACFs and hospital services. For more complex models, providing quality improvement and outreach to RACFs may prevent some types of hospital admissions.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 04-2012
Publisher: Elsevier BV
Date: 12-2015
DOI: 10.1016/J.AAP.2015.09.013
Abstract: Road crashes result in substantial trauma and costs to societies around the world. Robust costing methods are an important tool to estimate costs associated with road trauma, and are key inputs into policy development and cost-benefit analysis for road safety programmes and infrastructure projects. With an expanding focus on seriously injured road crash casualties, in addition to the long standing focus on fatalities, methods for costing seriously injured casualties are becoming increasingly important. Some road safety agencies are defining a seriously injured casualty as an in idual that was admitted to hospital following a road crash, and as a result, hospital separation data provide substantial potential for estimating the costs associated with seriously injured road crash casualties. The aim of this study is to establish techniques for estimating the human recovery costs of (non-fatal) seriously injured road crash casualties directly from hospital separation data. An in iduals' road crash-related hospitalisation record and their personal injury insurance claim were linked for road crashes that occurred in New South Wales, Australia. These records provided the means for estimating all of the costs to the casualty directly related to their recovery from their injuries. A total of 10,897 seriously injured road crash casualties were identified and four methods for estimating their recovery costs were examined, using either unit record or aggregated hospital separation data. The methods are shown to provide robust techniques for estimating the human recovery costs of seriously injured road crash casualties, that may prove useful for identifying, implementing and evaluating safety programmes intended to reduce the incidence of road crash-related serious injuries.
Publisher: Elsevier BV
Date: 10-2011
DOI: 10.1016/J.JSR.2011.06.007
Abstract: Information from hospital trauma registries is increasingly being used to support injury surveillance efforts. This research examines the potential of using trauma registry data for road traffic injury surveillance for different types of road users in terms of both the information collected and how representative trauma data are compared to two population-based road traffic injury data collections. The three data collections were assessed against recommended variables to be collected for injury surveillance purposes and the representativeness of the distribution of road traffic-related injury data from the trauma registry was compared to hospital admission and road traffic authority data collections. Data from the trauma registry was largely not representative of the distribution of age groups or activities compared to the two population-based collections, but was representative for gender for some road user groups to at least one population-based data collection. Trauma data could be used to supplement information from population-based data collections to inform road safety efforts. Road safety policy makers should be aware of the potential and the limitations of using trauma registry data for road traffic injury surveillance.
Publisher: Elsevier BV
Date: 2011
DOI: 10.1016/J.JSAMS.2010.03.009
Abstract: Sport/leisure injuries are a population health issue in Australia. Over 2003-2004 to 2007-2008, the rate of sport/leisure injury NSW hospitalisations was 195.5/100,000 residents. Males and children/young people had consistently highest rates of hospitalisation. There was no significant decline in rates over this period and no change in the profiles of the types of sport/leisure injuries. The extent to which effective preventive programs have been developed and implemented needs to be determined as current programs do not seem to be impacting on hospitalisation rates. Medical/health promotion agencies and sports bodies need to jointly formulate and implement policies to reduce sport/leisure injuries. This is one of the most significant challenges facing sports medicine professionals today.
Publisher: Elsevier BV
Date: 11-2018
Publisher: Informa UK Limited
Date: 03-2007
Publisher: Elsevier BV
Date: 2020
DOI: 10.1016/J.APERGO.2019.102920
Abstract: This study aimed to operationalise and use the World Health Organisation's International Classification for Patient Safety (ICPS) to identify incident characteristics and contributing factors of deaths involving complications of medical or surgical care in Australia. A s le of 500 coronial findings related to patient deaths following complications of surgical or medical care in Australia were reviewed using a modified-ICPS (mICPS). Over two-thirds (69.0%) of incidents occurred during treatment and 27.4% occurred in the operating theatre. Clinical process and procedures (55.9%), medication/IV fluids (11.2%) and healthcare-associated infection/complications (10.4%) were the most common incident types. Coroners made recommendations in 44.0% of deaths and organisations undertook preventive actions in 40.0% of deaths. This study demonstrated that the ICPS was able to be modified for practical use as a human factors taxonomy to identify sequences of incident types and contributing factors for patient deaths. Further testing of the mICPS is warranted.
Publisher: Elsevier BV
Date: 12-2022
Abstract: To describe the characteristics and cost of health service use of a cohort of 2,140 people attending homeless hostel clinics, and identify predictors of high health service use and time to readmission. A retrospective cohort study of 2,140 adults who attended a homeless hostel clinic and were hospitalised in New South Wales (NSW) using linked clinic, health and mortality data from 1 July 2008 to 30 June 2021. Multivariable logistic regression examined predictors of high health service users. There were 27,466 hospital admissions, with a median cost of A$81,481 per person, and a total cost of A$548.2 million. Twenty per cent of the cohort were readmitted within 28 days and 27.4% were classified as high users of health services. Factors associated with high use were age ≥45 years, female (AOR: 1.52 95%CI 1.05-2.22), the presence of a mental disorder, substance use disorder (AOR: 1.36 95%CI: 1.03-1.82), or if the person had been homeless for >1 year (AOR: 1.31 95%CI: 1.06-1.62). Conclusions and implications for public health: The high health costs generated by homeless adults confirm the need to develop models of supported housing with a focus on integrated care, improved referral pathways and better coordination with community-based support agencies.
Publisher: Wiley
Date: 27-05-2014
DOI: 10.1111/ANS.12671
Abstract: Guidelines for hip fracture care suggest that patients with hip fracture should undergo surgery on the day of or day after admission to hospital. This study examined factors affecting time to surgery for hip fracture extracted from existing administrative datasets in New South Wales (NSW), Australia. A retrospective analysis of patients with hip fracture aged 65 years and over undergoing surgical intervention in NSW public hospitals between 1 July 2000 and 30 June 2011. A multinomial logistic model was used to identify factors impacting on time to surgery from 1 July 2006 to 30 June 2011. A total of 49,317 hip fracture procedures were recorded during 2000-2001 to 2010-2011. Sixty-four per cent of patients received operative treatment on the day of or day after admission. Co-morbidity, type of surgical procedure and day of presentation all impacted significantly on time to surgery. Fourteen per cent required an inter-hospital transfer prior to receiving operative intervention. Transferred patients were 2.6 (95% confidence interval (CI): 2.31-2.85) times more likely to wait 2-4 days and 3.2 times more likely to wait 5 or more days (95% CI: 2.77-3.76) for surgery compared with patients presenting to an operating hospital. Significant variation exists between hospitals in the time to surgery that is not solely explained by measures of case mix or geography. Opportunities exist to consider other factors contributing to this variation and to ensure timely access to surgical intervention in the future.
Publisher: Springer International Publishing
Date: 2017
Publisher: Elsevier BV
Date: 08-2022
Publisher: Wiley
Date: 30-06-2017
DOI: 10.1002/GPS.4542
Abstract: Characteristics of older people with and without dementia who are hospitalised following self-harm remains largely unexplored. This research compares the characteristics of older people with and without dementia who self-harm, compares associations of mental health-related diagnoses with those hospitalised for a self-harm and a non-self-harm injury and examines mortality by injury intent. A population-based study of in iduals aged 50+ years with and without dementia admitted to hospital for a self-harm injury (and those with other injuries) using linked hospital admission and mortality records during 2003-2012 in New South Wales (NSW), Australia. Health outcomes, including hospital length of stay (LOS), 28-day readmission and 30-day and 12-month mortality were examined by dementia status. There were 427 hospitalisations of in iduals with dementia and 11,684 hospitalisations of in iduals without dementia following self-harm. The hospitalisation rate for self-harm for in iduals with dementia aged 60+ years was double the rate for in iduals without dementia (72.2 and 37.5 per 100,000). For both older people with and without dementia, those who self-harmed were more likely to have co-existent mental health and alcohol use disorders than in iduals who had a non-self-harm injury. In iduals with dementia had higher 12-month mortality rates, 28-day readmission and longer LOS than in iduals without dementia. Dementia is associated with an increased risk of hospitalisation for self-harm in older people and worse outcomes. The high rate of coexistent mental health conditions suggests that interventions which reduce behavioural and psychological symptoms of dementia might reduce self-harm in people with dementia. Copyright © 2016 John Wiley & Sons, Ltd.
Publisher: Springer Science and Business Media LLC
Date: 24-07-2019
DOI: 10.1007/S00198-019-05096-2
Abstract: This study identified group-based trajectories of hospitalisation for older adults who were living in residential aged care facilities (RACF) or the community for up to 4 years after an index fall injury hospitalisation. Greater than 3 subsequent fall injury hospitalisations and time until move to a RACF were key predictors of RACF and community-living trajectory group memberships, respectively. To examine hospital service use trajectories of people aged ≥ 65 years who had a fall injury hospitalisation and were either living in a residential aged care facility (RACF) or the community at the time of the index fall and to identify factors predictive of their trajectory group membership. A group-based trajectory analysis of hospitalisations of people aged ≥ 65 years who had a fall injury hospitalisation during 2008-2009 in New South Wales, Australia, was conducted. Linked hospitalisation and RACF data were examined for a 5-year period. Group-based trajectory models were derived based on number of subsequent hospital admissions following the index fall injury hospitalisation. Multinominal logistic regression examined predictors of trajectory group membership. There were 24,729 fall injury hospitalisations 78.8% of fallers were living in the community and 21.2% in a RACF. Five distinct trajectory groups were identified for community-living and four trajectory groups for RACF residents. Key predictors of trajectory group membership for both community-living and RACF residents were age group, number of comorbidities and dementia status. For RACF residents, depression, assistance with activities of daily living and number of subsequent fall injury admissions were also predictors of group membership, with time to move to a RACF a predictor of group membership for community living. Identifying trajectories of ongoing hospital use informs targeting of strategies to reduce hospital admissions and design of services to allow community-living in iduals to remain as long as possible within their own residence.
Publisher: Springer Science and Business Media LLC
Date: 22-04-2022
DOI: 10.1186/S12874-022-01586-W
Abstract: With the increasing use of mobile technology, ecological momentary assessments (EMAs) may enable routine monitoring of patient health outcomes and patient experiences of care by health agencies. This rapid review aims to synthesise the evidence on the use of EMAs to monitor health outcomes after traumatic unintentional injury. A rapid systematic review of nine databases (MEDLINE, Web of Science, Embase, CINAHL, Academic Search Premier, PsychINFO, Psychology and Behavioural Sciences Collection, Scopus, SportDiscus) for English-language articles from January 2010–September 2021 was conducted. Abstracts and full-text were screened by two reviewers and each article critically appraised. Key information was extracted by population characteristics, age and s le size, follow-up time period(s), type of EMA tools, physical health or pain outcome(s), psychological health outcome(s), general health or social outcome(s), and facilitators or barriers of EMA methods. Narrative synthesis was undertaken to identify key EMA facilitator and barrier themes. There were 29 articles using data from 25 unique studies. Almost all (84.0%) were prospective cohort studies and 11 (44.0%) were EMA feasibility trials with an injured cohort. Traumatic and acquired brain injuries and concussion (64.0%) were the most common injuries examined. The most common EMA type was interval (40.0%). There were 10 key facilitator themes (e.g. feasibility, ecological validity, compliance) and 10 key barrier themes (e.g. complex technology, response consistency, ability to capture a participant’s full experience, compliance decline) identified in studies using EMA to examine health outcomes post-injury. This review highlighted the usefulness of EMA to capture ecologically valid participant responses of their experiences post-injury. EMAs have the potential to assist in routine follow-up of the health outcomes of patients post-injury and their use should be further explored.
Publisher: BMJ
Date: 27-07-2018
DOI: 10.1136/INJURYPREV-2017-042451
Abstract: Childhood injury is a leading cause of hospitalisation, yet there has been no comprehensive examination of child injury and survival over time in Australia. To examine the characteristics, temporal trend and survival for children who were hospitalised as a result of injury in Australia. A retrospective examination of linked hospitalisation and mortality data for injured children aged 16 years or less during 1 July 2001 to 30 June 2012. Negative binomial regression examined change in injury hospitalisation trends. Cox proportional hazard regression examined the association of risk factors on 30-day survival. There were 6 86 409 injury hospitalisations, with an age-standardised rate of 1489 per 1 00 000 population (95% CI 1485.3 to 1492.4) in Australia. Child injury hospitalisation rates did not change over the 10-year period. For every severely injured child, there are at least 13 children hospitalised with minor or moderate injuries. The total cost of child injury hospitalisations was $A2.1 billion (annually $A212 million). Falls (38.4%) were the most common injury mechanism. Factors associated with a higher risk of 30-day mortality were: child was aged ≤10 years, higher injury severity, head injury, injured in a transport incident or following drowning and submersion or other threats to breathing, during self-harm and usual residence was regional/remote Australia. Childhood injury hospitalisation rates have not reduced in 10 years. Children’s patterns of injury change with age, and priorities for injury prevention alter according to developmental stages. The development of a national multisectorial childhood injury monitoring and prevention strategy in Australia is long overdue.
Publisher: BMJ
Date: 09-2010
Publisher: Wiley
Date: 08-06-2021
Abstract: Presentations to EDs for major paediatric injury are considerably lower than for adults. International studies report lower levels of critical intervention, including intubation, required in injured children. A New South Wales study demonstrated an adverse event rate of 7.6% in children with major injury. Little is known about the care and interventions received by children presenting to Australian EDs with major injury. The ED care of injured children years who ultimately received definitive care at a New South Wales Paediatric Trauma Centre between July 2015 and September 2016, and had an Injury Severity Score ≥9, required intensive care admission or died were included. There were 491 injured children who received treatment at 64 EDs, half (49.4%, n = 243) were treated initially in a Paediatric Trauma Centre. One third (32.8%) sustained an Injury Severity Score , more than half ( n = 251, 51.1%) of children were classified as a triage category 1 or 2, and 38.3% received trauma team activation. Critical intervention was infrequent. Intubation was documented in 9.2% ( n = 45), needle thoracostomy and activation of massive transfusion protocol in two (0.4%) and eight (1.6%) had intraosseous access established. Only a small proportion (14.7%, n = 63) had two or more observations outside the normal range. A small proportion of children arriving in the ED post‐major trauma have deranged clinical observations and receive critical interventions. The limited exposure in the management of trauma in paediatric patients requires measures to ensure clinicians have adequate training, skills and confidence to manage these clinical presentations in all EDs.
Publisher: Elsevier BV
Date: 05-2016
DOI: 10.1016/J.PEDN.2015.11.009
Abstract: Critical illness in children is a life changing event for the child, their parents, caregivers and wider family. There is a need to design and evaluate models of care that aim to implement family-centred care to support more positive outcomes for critically ill children and their families. Due to a gap in knowledge on the impact of such models, the present review was conducted. Primary research articles written in English that focused on children hospitalised for an acute, unexpected, sudden critical illness, such as that requiring an intensive care admission and addressed the implementation of a model of care in a paediatric acute care hospital setting. Thirteen studies met the inclusion criteria. The models of care implemented were associated with positive changes such as reduced parental anxiety and improved communication between parents/caregivers and health professionals. However, no model provided intervention throughout each phase of care to (or post) hospital discharge. Models of care applying family-centred care principles targeting critically ill children and their families can create positive changes in care delivery for the family. However a model which provides continuity across the span of care is required. There is need to describe how best to design, implement and sustain models of care for critically ill children and their families. The success of any intervention implementation will be dependent on the comprehensiveness of the strategy for implementation, the relevance to the context and setting, and engagement with key stakeholders.
Publisher: BMJ
Date: 04-2008
Abstract: Identifying work-related injuries from hospitalization data is not straightforward. How a work-related injury, either acute or non-acute, is defined will affect injury enumeration, injury burden estimates, and subsequent priority setting for prevention activity. To examine the effect of different case identification criteria on the number and rate of hospitalized work-related injuries and to identify the type of pathologies that are recorded for work-related admissions that have an external cause code. Identified work-related hospitalization admissions from 1 July 2000 to 30 June 2005 were analysed according to different injury case-selection criteria (ie, a principal diagnosis in the ICD-10-AM range S00-T98 and/or an external cause code in the ICD-10-AM range V01-Y98) and different admission restrictions (ie, exclusion of: transfers and type changes re-admissions within 28 days or day-only admissions). The principal diagnosis recorded for work-related admissions that had an external cause code were examined. The incidence of identified work-related hospitalized injuries varied widely, from 289 to 611 per 100,000 workers depending on the identification criteria adopted. The exclusion of day-only stays reduced the identified work-related injury admissions by about one-third for each definitional condition. Where only an external cause code was used to identify an injury, the principal diagnoses codes were predominantly injuries, poisoning, and certain other consequences of external causes (74.6%) and diseases of the musculoskeletal system and connective tissue (15.5%). Case-selection criteria adopted to identify work-related hospitalized injuries should be carefully considered. It is recommended that inclusion of certain musculoskeletal conditions that are likely to arise from repetitive minor trauma over time (ie non-acute injuries) should be considered in calculating the estimate of the burden of all work-related hospitalized injuries.
Publisher: Wiley
Date: 18-12-2018
DOI: 10.1111/JPC.14337
Abstract: Readmission of paediatric trauma patients is associated with increased hospital length of stay, additional operative procedures and significant costs to the health-care system. The rates and causes of readmission of paediatric trauma patients are not well reported outside of the USA or single centres. This nation-wide study is the first in Australia to examine the readmission rates, costs and characteristics of Australian paediatric trauma patients. This was a retrospective examination of linked hospitalisation and mortality data for injured children aged 16 or younger from 1 July 2001 to 30 June 2012, readmitted to hospital within 28 days of discharge. Data including injury severity, nature of injury, episodes of care and costs were extracted from hospitalisation data. There were 37 603 injury children aged ≤16 years readmitted to hospital within 28 days during the 10-year period, a readmission rate of 5.5%. The most common principal injury requiring readmission was fracture (52.6%) and burns (19.3%). A total of 66% of all patients had a readmission diagnosis of injury, complication of their initial injury or complication of surgical and medical care 30% were readmitted for a specific procedure or follow-up care. The total cost of readmissions was AU$108 million. Hospital readmission rates of paediatric trauma patients in Australia are due to injury or a complication of injury and are associated with significant costs. Early identification of at-risk patients and the prevention of complications are needed to prevent the ongoing burden of readmission.
Publisher: Informa UK Limited
Date: 23-07-2019
DOI: 10.1080/09638288.2019.1643418
Abstract: To enhance understanding of access to rehabilitation services in Australian and New Zealand acute care facilities for older adults living with dementia and/or living in residential aged care facilities (RACFs) following a hip fracture. Information on hip fracture rehabilitation was obtained from an online survey of 40 health professionals who were members of the Australian and New Zealand Hip Fracture Registry Network. This information was supplemented with key informant interviews with five geriatricians and five rehabilitation physicians. Availability of hip fracture rehabilitation services differed by region and country. Around one in 10 respondents indicated that their facility had specific rehabilitation protocols for people living in RACFs or who were living with dementia. Barriers to providing hip fracture rehabilitation were commonly related to availability of resources. Rehabilitation pathways were determined according to in idual patient characteristics and perceived potential benefit. Decision making was mainly informed by the patient's pre-fracture morbidity and residence. Three key themes and nine sub-themes emerged from the interviews. The development of consistent decision criteria and pathways for access to hip fracture rehabilitation could provide a standard approach to access to rehabilitation, particularly for patients with cognitive impairment and/or who reside in RACFs.IMPLICATIONS FOR REHABILITATIONNeed to establish evidence-based criteria for patients who will benefit from hip fracture rehabilitation.Consistent decision criteria for access to hip fracture rehabilitation will assist in guiding a standard approach to providing rehabilitation, particularly for patients with cognitive impairment and/or who reside in RACFs.There is a need to ensure the availability of physiotherapy services in RACFs to assist with rehabilitation provision.Rehabilitation provided to patients with cognitive impairment and/or who are living in RACFs should be tailored to their physical and mental ability.
Publisher: Informa UK Limited
Date: 08-2013
Publisher: Elsevier BV
Date: 10-2014
Publisher: Elsevier BV
Date: 06-2018
Abstract: To examine the magnitude, 10-year temporal trends and treatment cost of intentional injury hospitalisations of children aged ≤16 years in Australia. A retrospective examination of linked hospitalisation and mortality data for children aged ≤16 years during 1 July 2001 to 30 June 2012 with self-harm or assault injuries. Negative binomial regression examined temporal trends. There were 18,223 self-harm and 13,877 assault hospitalisations, with a treatment cost of $64 million and $60.6 million, respectively. The self-harm hospitalisation rate was 59.8 per 100,000 population (95%CI 58.96-60.71) with no annual decrease. The assault hospitalisation rate was 29.9 per 100,000 population (95%CI 29.39-30.39) with a 4.2% annual decrease (95%CI -6.14- -2.31, p<0.0001). Poisoning was the most common method of self-harm. Other maltreatment syndromes were common for children ≤5 years of age. Assault by bodily force was common for children aged 6-16 years. Health professionals can play a key role in identifying and preventing the recurrence of intentional injury. Psychosocial care and access to support services are essential for self-harmers. Parental education interventions to reduce assaults of children and training in conflict de-escalation to reduce child peer-assaults are recommended. Implications for public health: Australia needs a whole-of-government and community approach to prevent intentional injury.
Publisher: Elsevier BV
Date: 05-2022
DOI: 10.1016/J.INJURY.2021.12.057
Abstract: The majority of paediatric injury outcomes studies focus on mortality rather than the impact on long-term quality of life, health care use and other health-related outcomes. This study sought to determine predictors of 12-month functional and psychosocial outcomes for children sustaining major injury in NSW. The study included all children < 16 years requiring intensive care or an injury severity score (ISS) ≥ 9 treated in NSW at a paediatric trauma centre (PTC). Children were identified through the three PTCs and NSW Trauma Registry. The paediatric Quality of Life Inventory (PedsQL) and EuroQol five-dimensional EQ-5D-Y were used to measure HRQoL post-injury, completed via parent/carer proxy recruited through NSW PTCs. There were 510 children treated at the three NSW PTCs during the 15-month study period. The mean (SD) age was 6.7 (6.0) years, with a median NISS (New Injury Severity Score) of 11 (IQR: 9-18). Regression analysis showed worse psychosocial health at twelve months was associated with hospital length of stay (LoS) and number of body regions injured (F Hospital length of stay and polytrauma are independent factors that negatively influence psychological and physical outcomes of children with major injuries. Early intervention to enable emotional well-being, discharge home and long-term follow up such as dedicated family support and rehabilitation at home could reduce preventable poor outcomes.
Publisher: SAGE Publications
Date: 04-07-2018
Abstract: Prior and repeated self-harm hospitalisations are common risk factors for suicide. However, few studies have accounted for pre-existing comorbidities and prior hospital use when quantifying the burden of self-harm. The aim is to quantify hospitalisation in the 12 months preceding and re-hospitalisation and mortality risk in the 12 months post a self-harm hospitalisation. A population-based matched cohort using linked hospital and mortality data for in iduals ⩾18 years from four Australian jurisdictions. A non-injured comparison cohort was matched on age, gender and residential postcode. Twelve-month pre- and post-index self-harm hospitalisations and mortality were examined. The 11,597 in iduals who were hospitalised following self-harm in 2009 experienced 21% higher health service use in the 12 months pre and post the index admission and a higher mortality rate (2.9% vs 0.3%) than their matched counterparts. There were 133 (39.0%) deaths within 2 weeks of hospital discharge and 342 deaths within 12 months of the index hospitalisation in the self-harm cohort. Adjusted rate ratios for hospital readmission were highest for females (2.86 95% confidence interval: [2.33, 2.52]) and in iduals aged 55–64 years (3.96 95% confidence interval: [2.79, 5.64]). Improved quantification of the burden of self-harm-related hospital use can inform resource allocation for intervention and after-care services for in iduals at risk of repeated self-harm. Better assessment of at-risk self-harm behaviour, appropriate referrals and improved post-discharge care, focusing on care continuity, are needed.
Publisher: Future Medicine Ltd
Date: 09-2023
Abstract: Aim: To examine the impact of concussion on objective measures of school performance. Materials & methods: Population-based matched cohort study using linked health and education records of young people aged ≤18 years hospitalized with concussion in New South Wales, Australia, during 2005–2018, and matched comparisons not hospitalized with any injury. Results: Young people with concussion had higher risk of not achieving the national minimum standards for literacy and numeracy assessments, ranging from 30% for numeracy to 43% for spelling, and not completing high school, ranging from 29% for year 10 to 77% for year 12, compared with matched peers. Conclusion: Young people hospitalized with concussion have impaired school performance compared with uninjured matched peers.
Publisher: Elsevier BV
Date: 11-2021
Publisher: Elsevier BV
Date: 02-2019
DOI: 10.1016/J.JSAMS.2018.07.010
Abstract: To quantify and describe the incidence, cost, and temporal trends of sports injury-related hospitalisations in Australian children over a 10-year period. Retrospective population-based cohort study. This study used linked hospitalisation and mortality data of children aged ≤16 years who were hospitalised for sports-related injury in Australia from 1 July 2002 to 30 June 2012. Age-standardised incidence rates were calculated with 95% confidence intervals (CI). Negative binomial regression was used to examine change in temporal trends in incidence rates. There were 130,167 sports injury-related hospitalisations during the 10-year study period. The overall annual incidence rate was 281.0 (95%CI: 279.5, 282.6) per 100,000 population. Males and older children were more frequently hospitalised than their female and younger counterparts. The most common sports activities resulting in hospitalisation were team ball sports (43.1%) and wheeled non-motor sport (22.3%). There was no significant annual decline in the overall incidence rate during the 10-year study period (-1.0% [95%CI: -3.0%, 1.0%]). The estimated total hospital treatment cost was $396 million, with an estimated mean cost per injured child of $3058. There has been no significant decline in sports injury-related hospitalisation rates among Australian children during 2002-03 to 2011-12. This may suggest that sports injury prevention initiatives in Australia to date have been inadequate to produce population-level reduction in sports injury-related hospitalisations. It is recommended that a national injury prevention strategy to reduce the burden of sports injuries among Australian children is developed and implemented.
Publisher: Elsevier BV
Date: 2016
DOI: 10.1016/J.INJURY.2015.09.021
Abstract: Injury is the most common reason for admission to hospital in people with dementia in Australia. However relatively little is known about the temporal trends and the hospital experience of people with dementia hospitalised for an injury. This population-based data linkage study compared the causes, temporal trends and health outcomes for injury-related hospitalisations in people with and without dementia. Hospitalisation and death data for 235,612 in iduals aged 65 years and over admitted to hospital for an injury over the ten year period (2003-2012) in New South Wales, Australia were probabilistically linked. Descriptive statistics including chi square tests, observed and age-standardised admission rates and rate ratios (RRs) were calculated. Trends over time were analysed using negative binomial regression. There were 331,432 injury-related hospitalisations over the study period. Both the observed (RR 3.16 95% CI 3.13-3.19) and age-standardised admission rate ratios (RR 1.78 95% CI 1.77-1.79) were higher for people with dementia. Age-standardised rates increased by 3.5% (95% CI 3.1-3.9) per annum over the study period for people without dementia. In contrast, for people with dementia, rates increased by 2.4% (95% CI 1.8-3.1) per annum until 2007 and then decreased by 3.1% (95% CI -4.4 to -1.7) per annum from 2007 onwards. Compared to people without dementia, a higher proportion of people with dementia were hospitalised as a result of a fall (90.9% vs 75.2%, p<0.0001), sustained a fracture (57.2% vs 52.1%, p<0.0001), notably hip fracture (30.7% vs 14.7%, p<0.0001), had longer mean hospital lengths of stay (LOS) (16.5 vs 13.6 days), and higher 30-day mortality (8.7% vs 3.6% p<0.0001), although this pattern was not consistent across all injury types. People with dementia are disproportionately represented in injury-related hospitalisations, experience longer hospital LOS and have poorer outcomes. Ninety percent of hospitalisations for people with dementia were as a result of a fall, highlighting the importance of developing and implementing effective fall-related preventive strategies in this high risk population.
Publisher: Wiley
Date: 12-06-2013
DOI: 10.1111/JPC.12280
Abstract: To describe the costs of acute trauma admissions for children aged ≤15 years in trauma centres to identify predictors of higher treatment costs and quantify differences in actual and state-wide average cost in New South Wales (NSW), Australia. Admitted trauma patient data provided by 12 trauma centres was linked with financial data for 2008-2009. Demographic, injury details and injury severity scores (ISS) were obtained from trauma registries. In idual patient costs, Australian Refined Diagnostic Related Groups (AR-DRG) and state-wide average costs were obtained. Actual costs incurred by each hospital were compared with state-wide AR-DRG average costs. Multivariate multiple linear regression identified predictors of cost. There were 3493 patients with a total cost of AUD$20.2 million. Falls (AUD$6.7 million) and road trauma (AUD$4.4 million) had the highest total expenditure. The reduction in cost between ISS 12 was significant (P < 0.0001). The median cost of injury increased with every additional body region injured (P < 0.0001). For each additional day spent in hospital, there was an increased cost of AUD$1898 and patients admitted to an intensive care unit (ICU) cost AUD$7358 more than patients not admitted to ICU. The total costs incurred by trauma centres were AUD$1.4 million above the NSW peer group average cost estimates. The high financial cost of paediatric patient treatment highlights the need to ensure prevention remains a priority in Australia. Hospitals tasked with providing trauma care should be appropriately funded and future funding models should consider trauma severity.
Publisher: Elsevier BV
Date: 11-2020
Publisher: Elsevier BV
Date: 07-1998
Publisher: Wiley
Date: 12-12-2018
DOI: 10.1111/JPC.14347
Abstract: Globally, burns remain a significant public health issue that disproportionately affect young children. The current study examines the 10-year epidemiological profile of burn hospitalisations, hospital treatment cost and health outcomes by age group for children ≤16 years in Australia. National, population-based, linked hospital and mortality data from 1 July 2002 to 30 June 2012 were used to identify burn-related hospitalisations. Age-standardised hospitalisation rates and hospital treatment costs were estimated. There were 25 098 children aged ≤16 years hospitalised after sustaining a burn. The age-standardised hospitalisation rate was 54.4 per 100 000 (95% confidence interval (CI): 53.7-55.1). Children aged 1-5 years had the highest burn hospitalisation rate (105.6 per 100 000 95% CI: 103.8-107.3). The burn hospitalisation rate of infants <1 year declined by 3.1% per annum (95% CI: -4.84, -1.37, P < 0.001). Contact with heat and other substances, hot drinks, food, fats and cooking oils was the most common burn mechanism, and the home was the most common place of occurrence for children ≤10 years. Exposure to the ignition of highly flammable material was the most common burn mechanism for children aged 11-16 years. There were 7260 hospital readmissions within 28 days and 11 deaths within 30 days of the index burn hospitalisation. Total hospital treatment costs were estimated at $168 million. Childhood burns continue to account for a large proportion of hospitalised morbidity. To assist in reducing burn hospitalisations, the development, implementation and resourcing of national multi-sectorial childhood injury prevention is needed in Australia.
Publisher: SAGE Publications
Date: 03-2011
DOI: 10.1177/183335831104000102
Abstract: The use of Diagnosis Related Groups (DRGs) may not be an accurate tool to provide reimbursement for trauma services. This study aimed to determine whether Australian Refined Diagnosis Related Groups (AR-DRGs) adequately describe the trauma patient episode and to identify AR-DRG groupings where reimbursement was not commensurate with actual cost. The AR-DRG allocated costs and actual costs of a s le of 206 trauma patient episodes were reviewed during a three-month period. Of the AR-DRG groups identified in the patient episodes, 62.8% were not commensurate with actual cost incurred, equating to an overall loss of $113,921 from under-funded acute trauma patient episodes over a three-month period. Assault-related penetrating trauma, traffic-related and sport-related incidents were all inadequately reimbursed using AR-DRGs compared with the actual cost of treatment. Cases involving female patients, patients aged 45 years or less and those with moderate injuries were similarly underfunded. AR-DRGs are not adequate to describe the extent of injuries experienced by trauma patients and there is a need to investigate alternative funding models for trauma services.
Publisher: Elsevier BV
Date: 08-2015
Abstract: To describe the practical issues that need to be overcome to conduct national data linkage projects in Australia and propose recommendations to improve efficiency. Review of the processes, documentation and applications required to conduct national data linkage in Australia. The establishment of state and national data linkage centres in Australia has placed Australia at the forefront of research linking health-related administrative data collections. However, improvements are needed to reduce the clerical burden on researchers, simplify the process of obtaining ethics approval, improve data accessibility, and thus improve the efficiency of data linkage research. While a sound state and national data linkage infrastructure is in place, the current complexity, duplication and lack of cohesion undermines any attempts to conduct research involving national record linkage in a timely manner. Data linkage applications and Human Research Ethics Committee approval processes need to be streamlined and duplication removed, in order to reduce the administrative and financial burden on researchers if national data linkage research is to be viable.
Publisher: Springer Science and Business Media LLC
Date: 12-12-2022
Publisher: Wiley
Date: 17-06-2014
DOI: 10.1111/AJAG.12059
Abstract: To Describe injury profile and costs of older person trauma in New South Wales quantify variations with peer group costs and identify predictors of higher costs. Nine level 1 New South Wales trauma centres provided data on major traumas (aged ≥ 55 years) during 2008-2009 financial year. Trauma register and financial data of each institution were linked. Treatment costs were compared with peer group Australian Refined Diagnostic Related Groups costs, on which hospital funding is based. Variables examined through multivariate analyses. Six thousand two hundred and eighty-nine patients were admitted for trauma. Most common injury mechanism was falls (74.8%) then road trauma (14.9%). Median patient cost was $7044 (Q1-3: $3405-13 930) and total treatment costs $76 694 252. Treatment costs were $5 813 975 above peer group average. Intensive care unit admission, age, injury severity score, length of stay and traumatic brain injury were independent predictors of increased costs. Older person trauma attracts greater costs and length of stay. Cost increases with age and injury severity. Hospital financial information and trauma registry data provides accurate cost information that may inform future funding.
Publisher: Elsevier BV
Date: 08-2001
DOI: 10.1111/J.1467-842X.2001.TB00585.X
Abstract: To describe the types of and circumstances surrounding unintentional farm-related fatal injuries involving children aged less than 15 years in Australia. Information concerning 115 deaths were obtained from inspection of coronial files for the period 1989-92. Children less than 15 years made up 20% of all unintentional farm-related fatalities in Australia, with children less than 5 years representing 63% of all child fatalities. The majority of children were fatally injured while bystanders to farm work and equipment used on the farm (including dams), with drowning the most common mechanism of the fatal incident for children aged both 5 years or less and 5-9 years. Vehicle accidents were common for children aged 10-14 years. Children are exposed to various hazards in the farming environment and as such are at risk of being injured. This study has highlighted a number of particular hazards for children on farms, with drowning, transport and tractor-related injuries of particular concern. A national strategy for child safety on farms has been developed by Farmsafe Australia aimed at providing a nationally co-ordinated plan for improving child safety on farms.
Publisher: Elsevier BV
Date: 11-2016
DOI: 10.1016/J.ARCHGER.2016.06.014
Abstract: To explore the impact of dementia on the trends in fall-related fracture and non-fracture injuries for older people. In iduals aged ≥65years who were admitted to a NSW hospital for at least an over-night stay for a fall-related injury from 2003 to 2012 were identified. Age-standardised hospitalisation rates, length of stay, access to in-hospital rehabilitation, 30-day and 1-year mortality were examined. Annual percentage change (PAC) over time was calculated using negative binomial regression. Of the 228,628 fall-related injury hospitalisations, 20.6% were for people with dementia. People with dementia were more likely to be admitted with a hip fracture, and less likely to be admitted with a fracture of the forearm/wrist, and received less in-hospital rehabilitation than people without dementia. Fall-related hip-fracture rates for people with dementia decreased by 4.2% (95%CI -5.6 to -2.7, p<0.001) per annum there was no change over time for people without dementia (PAC-0.2% 95%CI -0.8 to 0.5, p=0.643). Rates for other fractures decreased by 1.2% (95%CI -1.9 to -0.5, p<0.001) per annum in people with dementia, while rates increased by 2.2% (95%CI 1.9-2.5, p<0.001) for people without dementia. By contrast, non-fracture injuries including traumatic brain injury increased significantly for both people with and without dementia. Rates of fall-related fracture and non-fracture hospitalisations for people with dementia remain higher than for those without dementia. However, fall-related fracture hospitalisation rates have decreased for people with dementia, while there has not been a corresponding decrease in people without dementia.
Publisher: Elsevier BV
Date: 03-2022
DOI: 10.1016/J.AUCC.2021.04.003
Abstract: Ineffective intervention for patients with blunt chest wall injury results in high rates of morbidity and mortality. To address this, a blunt chest injury care bundle protocol (ChIP) was developed, and a multifaceted plan was implemented using the Behaviour Change Wheel. The purpose of this study was to evaluate the reach, fidelity, and dose of the ChIP intervention to discern if it was activated and delivered to patients as intended at two regional Australian hospitals. This is a pretest and post-test implementation evaluation study. The proportion of ChIP activations and adherence to ChIP components received by eligible patients were compared before and after intervention over a 4-year period. S le medians were compared using the nonparametric median test, with 95% confidence intervals. Differences in proportions for categorical data were compared using the two-s le z-test. Over the 19-month postimplementation period, 97.1% (n = 440) of eligible patients received ChIP (reach). The median activation time was 134 min there was no difference in time to activation between business hours and after-hours time to activation was not associated with comorbidities and injury severity score. Compared with the preimplementation group, the postimplementation group were more likely to receive evidence-based treatments (dose), including high-flow nasal cannula use (odds ratio [OR] = 6.8 [95% confidence interval {CI} = 4.8-9.6]), incentive spirometry in the emergency department (OR = 7.5, [95% CI = 3.2-17.6]), regular analgesia (OR = 2.4 [95% CI = 1.5-3.8]), regional analgesia (OR = 2.8 [95% CI = 1.5-5.3]), patient-controlled analgesia (OR = 1.8 [95% CI = 1.3-2.4]), and multiple specialist team reviews, e.g., surgical review (OR = 9.9 [95% CI = 6.1-16.1]). High fidelity of delivery was achieved and sustained over 19 months for implementation of a complex intervention in the acute context through a robust implementation plan based on theoretical frameworks. There were significant and sustained improvements in care practices known to result in better patient outcomes. Findings from this evaluation can inform future implementation programs such as ChIP and other multidisciplinary interventions in an emergency or acute care context.
Publisher: Springer Science and Business Media LLC
Date: 19-12-2019
DOI: 10.1007/S00198-018-4800-6
Abstract: This study compared hip fracture rates and health outcomes of older people living in residential aged care facilities (RACFs) to the community. The RACF resident age-standardised hospitalisation rate was five times higher than the community rate and declining. RACF residents experience overall worse health outcomes and survival post-hip fracture. To compare hospitalisation trends, characteristics and health outcomes following a fall-related hip fracture of older people living in residential aged care facilities (RACFs) to older people living in the community. A retrospective analysis of fall-related hip fracture hospitalisations of people aged ≥ 65 years during 1 July 2008 and 30 June 2013 in New South Wales (NSW), Australia's largest populated state. Linked hospitalisation, RACF and Aged Care Assessment Appraisal data collections were examined. Negative binomial regression examined the significance of hospitalisation temporal trends. There were 28,897 hip fracture hospitalisations. One-third were of older people living in RACFs. The hospitalisation rate was 2180 per 100,000 (95%CI: 2097.0-2263.7) for RACF residents and 390 per 100,000 (95%CI 384.8-395.8) for older people living in the community. The hospitalisation rate for RACF residents was estimated to decline by 2.9% annually (95%CI: - 4.3 to - 1.5). Hospital treatment cost for hip fractures was AUD$958.5 million. Compared to older people living in the community, a higher proportion of RACF residents were aged ≥ 90 years (36.1% vs 17.2%), were female (75.3% vs 71.8%), had > 1 Charlson comorbidity (37.6% vs 35.6%) and 58.2% had dementia (vs 14.4%). RACF residents had fewer in-hospital rehabilitation episodes (18.7% vs 60.9%) and a higher proportion of unplanned readmissions (10.6% vs 9.1%) and in-hospital mortality (5.9% vs 3.3%) compared to older people living in the community. RACF residents are a vulnerable cohort of older people who experience worse health outcomes and survival post-hip fracture than older people living in the community. Whether access to in idualised hip fracture rehabilitation for RACF residents could improve their health outcomes should be examined.
Publisher: Elsevier BV
Date: 11-2021
Publisher: Wiley
Date: 12-2009
DOI: 10.1111/J.1440-1754.2007.01157.X
Abstract: To describe the trend of unintentional hospitalised injury in children aged 0-14 years in New South Wales (NSW), Australia during 1993-1994 to 2004-2005 and to estimate future projections of common child injury hospitalisations from 2006 to 2021. NSW hospitalisation data were used to describe injury trends of children aged 14 years or less who were residents of NSW (1993-1994 to 2004-2005). Projected injury-related hospitalisations of children for 2006-2021 were estimated assuming that the current observed rate of change in childhood injury hospitalisation rates continued to 2021. During 1993-1994 to 2004-2005, there were 238 093 injury-related hospitalisations of children aged 14 years or less in NSW. Assuming the rate of change in injury hospitalisation observed between 1993-1994 and 2004-2005 continued into the future, the all hospitalised injury incidence rate for children aged 14 years or less is projected to decrease by 1.0% each year to 2021. Injury mechanisms such as burns and scalds, swimming pool non-fatal drowning and poisoning are all projected to decrease in the future, although not for all age groups. Falls (excluding those from playground equipment) and falls from playground equipment hospitalisations (excluding children less than 1 year) are projected to increase. Although the incidence of hospitalisation for some common child-related injury mechanisms is projected to decrease over the coming years, others are projected to increase. It is possible that advocacy efforts might benefit from using projected injury trends. Co-ordinated cross-government action is needed to successfully implement child injury prevention strategies, particularly in the playground environment.
Publisher: Springer Science and Business Media LLC
Date: 24-06-2021
DOI: 10.1186/S12913-021-06575-1
Abstract: An existing hospital avoidance program, the Aged Care Rapid Response Team (ARRT), rapidly delivers geriatric outreach services to acutely unwell or older people with declining health at risk of hospitalisation. The aim of the current study was to explore health professionals’ perspectives on the factors impacting ARRT utilisation in the care of acutely unwell residential aged care facility residents. Semi-structured interviews were conducted with two Geriatricians, two ARRT Clinical Nurse Consultants, an ED-based Clinical Nurse Specialist, and an Extended Care Paramedic. Interview questions elicited views on key factors regarding care decisions and care transitions for acutely unwell residential aged care facility residents. Thematic analysis was undertaken to identify themes and sub-themes from interviews. Analysis of interviews identified five overarching themes affecting ARRT utilisation in the care of acutely unwell residents: (1) resident care needs (2) family factors (3) enabling factors (4) barriers and (5) adaptability and responsiveness to the COVID-19 pandemic. Various factors impact on hospital avoidance program utilisation in the care of acutely unwell older aged care facility residents. This information provides additional context to existing quantitative evaluations of hospital avoidance programs, as well as informing the design of future hospital avoidance programs.
Start Date: 05-2009
End Date: 05-2012
Amount: $285,000.00
Funder: Australian Research Council
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