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In Research Link Australia (RLA), "Research Topics" refer to ANZSRC FOR and SEO codes. These topics are either sourced from ANZSRC FOR and SEO codes listed in researchers' related grants or generated by a large language model (LLM) based on their publications.
Epidemiology | Population Trends and Policies | Public Health and Health Services | Health and Community Services
Social Structure and Health | Aboriginal and Torres Strait Islander Development and Welfare | Families and Family Services |
Publisher: Wiley
Date: 21-11-2014
DOI: 10.1111/JAN.12572
Abstract: To compare characteristics of hospitalizations with and without complications and examine the impact of nurse staffing on inpatient complications across different unit types. Studies investigating the relationship between nurse staffing and inpatient complications have not shown consistent results. Methodological limitations have been cited as the basis for this lack of uniformity. Our study was designed to address some of these limitations. Retrospective longitudinal hospitalization-level study. Adult hospitalizations to high intensity, general medical and general surgical units at three metropolitan tertiary hospitals were included. Data were sourced from Western Australian Department of Health administrative data collections from 2004-2008. We estimated the impact of nurse staffing on inpatient complications adjusted for patient and hospital characteristics and accounted for patients with multiple hospitalizations. The study included 256,984 hospitalizations across 58 inpatient units. Hospitalizations with complications had significantly different demographic characteristics compared with those without. The direction of the association between nurse staffing and inpatient complications was not consistent for different inpatient complications, nurse skill mix groups or for hospitalizations with different unit movement patterns. Our study design addressed limitations noted in the field, but our results did not support the widely held assumption that improved nurse staffing levels are associated with decreased patient complication rates. Despite a strong international focus on improving nurse staffing to reduce inpatient complications, our results suggest that adding more nurses is not a panacea for reducing inpatient complications to zero.
Publisher: Elsevier BV
Date: 07-2014
DOI: 10.1016/J.JACL.2014.05.008
Abstract: Familial hypercholesterolemia (FH) imposes significant burden of premature coronary heart disease (CHD). This study aimed to determine the cost-effectiveness of FH detection based on genetic testing, supplemented with the measurement of plasma low-density lipoprotein cholesterol concentration, and treatment with statins. A Markov model with a 10-year time horizon was constructed to simulate the onset of first-ever CHD and death in close relatives of probands with genetically confirmed FH. The model comprised of 3 health states: "alive without CHD," "alive with CHD," and "dead." Decision-analysis compared the clinical consequences and costs of cascade-screening vs no-screening from an Australian health care perspective. The annual risk of CHD and benefits of treatment was estimated from a cohort study. The underlying prevalence of FH, sensitivity, specificity, cost of screening, treatment, and clinic follow-up visits were derived from a cascade screening service for FH in Western Australia. An annual discount rate of 5% was applied to costs and benefits. The model estimated that screening for FH would reduce the 10-year incidence of CHD from 50.0% to 25.0% among people with FH. Of every 100 people screened, there was an overall gain of 24.95 life-years and 29.07 quality-adjusted life years (discounted). The incremental cost-effectiveness ratio was in Australian dollars, $4155 per years of life saved and $3565 per quality-adjusted life years gained. This analysis within an Australian context, demonstrates that cascade screening for FH, using genetic testing supplemented with the measurement of plasma low-density lipoprotein cholesterol concentrations and treatment with statins, is a cost-effective means of preventing CHD in families at risk of FH.
Publisher: Informa UK Limited
Date: 11-2019
DOI: 10.2147/CLEP.S224621
Publisher: Elsevier BV
Date: 12-1996
Publisher: Springer Science and Business Media LLC
Date: 22-06-2016
DOI: 10.1038/EJHG.2016.69
Publisher: Springer Science and Business Media LLC
Date: 12-08-2015
Publisher: Elsevier BV
Date: 04-2014
DOI: 10.1016/J.IJCARD.2014.02.020
Abstract: To compare the incidence of first heart failure (HF) hospitalisation, antecedent risk factors and 1-year mortality between Aboriginal and non-Aboriginal populations in Western Australia (2000-2009). A population-based cohort aged 20-84 years comprising Aboriginal (n=1013 mean 54±14 years) and non-Aboriginal patients (n=16,366 mean 71±11 years) with first HF hospitalisation was evaluated. Age and sex-specific incidence rates and HF antecedents were compared between subpopulations. Regression models were used to examine 30-day and 1-year (in 30-day survivors) mortality. Aboriginal patients were younger, more likely to reside in rural/remote areas (76% vs 23%) and to be women (50.6% vs 41.7%, all p<0.001). Aboriginal (versus non-Aboriginal) HF incidence rates were 11-fold higher in men and 23-fold in women aged 20-39 years, declining to about 2-fold in patients aged 70-84 years. Ischaemic and rheumatic heart diseases were more common antecedents of HF in younger (<55 years) Aboriginal versus non-Aboriginal patients (p =3) were also more prevalent in younger and older Aboriginal patients (p<0.001). Although 30-day mortality was similar in both subpopulations, Aboriginal patients aged<55 years had a 1.9 risk-adjusted hazard ratio (HR) for 1-year mortality (p=0.015). Aboriginal people had substantially higher age and sex-specific HF incidence rate and prevalence of HF antecedents than their non-Aboriginal counterparts. HR for 1-year mortality was also significantly worse at younger ages, highlighting the urgent need for enhanced primary and secondary prevention of HF in this population.
Publisher: Wiley
Date: 17-07-2017
Abstract: Between 2009 and 2012, This analysis was based on retrospective clinical data from 95 The median imaging time for an
Publisher: Wiley
Date: 12-06-2019
Abstract: To quantify the direct cost of alcohol-related presentations to Royal Perth Hospital ED, as part of the binational Alcohol Harm in Emergency Departments study. Secondary analysis of a prospective observational study of all ED presentations over a 168-h period in December 2014. Direct costs for health service usage were based on activity-based costing methodologies from the Royal Perth Hospital Business Intelligence Unit. Patients were classified as either alcohol positive or alcohol negative (using predetermined criteria) to determine the direct cost of these presentations. Of the 213 alcohol-positive presentations in the original study, 206 had costing data available. Direct cost of care in the ED for alcohol-positive patients was $121 619 across all age groups during the study week (annual estimate $6.3 million). This cost was largely driven by injuries. On average, the direct cost of care in the ED was $590 per alcohol-positive and $575 per alcohol-negative patient. Costs of care provided in the ED were largely attributable to ED (72%) and radiology (17%) services. Extrapolation using mean costs for the patients without costing data, the study week cost was $144 629, with the annual estimate $7.5 million. Alcohol-related presentations to the ED are a significant public health burden. If the study week is representative, the annual cost is substantial. Although the direct mean cost of presentations to the ED is similar between alcohol-positive and alcohol-negative patients, these presentations would not have occurred without the influence of alcohol.
Publisher: SAGE Publications
Date: 15-02-2011
DOI: 10.1345/APH.1P514
Abstract: Community pharmacies are at the forefront of primary care providers and have an important role in the referral of patients to a medical practitioner for review when necessary. Chronic cough is a common disorder in the community and requires medical assessment. The proficiency of community pharmacy staff to refer patients with chronic cough is currently unknown. To assess the ability of community pharmacy staff to recognize and medically refer patients with a chronic nonproductive cough. Following ethics approval, a simulated patient study of 156 community pharmacies in Perth, Western Australia, was conducted over a 3-month period. Simulated patients presented to the pharmacy requesting treatment for a cough. The simulated patient required a referral based on a designated scenario. Demographic details, assessment questions, and advice provided were recorded by the simulated patient immediately postvisit. A logistic regression analysis was performed, with referral for medical assessment as the dependent variable. Of the 155 community pharmacies included in the analysis, 38% provided appropriate medical referral. Cough suppressants were provided as therapy in 72% of all visits. Predictors of medical referral were assessment of symptom duration, medical history, current medications being taken, frequency of reliever use, and the position of the pharmacy staff member conducting the consultation. A third of community pharmacies provided appropriate primary care by recommending medical referral advice to patients with chronic cough. The majority of pharmacy staff members acquired information from the patient that suggested a need for medical referral, yet did not provide referral advice. Appropriate medical referral is more likely when adequate assessment is undertaken and when a pharmacist is directly involved in the consultation. This highlights the need for pharmacies to ensure that processes are in place for patients to access the pharmacist.
Publisher: Elsevier BV
Date: 04-2013
DOI: 10.1016/J.IJCARD.2011.06.122
Abstract: The prevalence of hospitalised atherothrombotic disease affecting the coronary, cerebrovascular and peripheral vasculature is expected to increase due to improving survival, ageing and changing risk factor profiles. This study determined sex, age-standardised and age-specific (35-54, 55-69, 70-84years) prevalence of atherothrombotic disease and its association with diabetes and chronic kidney disease in Western Australian residents from 2000 to 2007. In a cross-sectional and longitudinal study, person-linked hospitalisations for atherothrombotic disease were obtained using records from 1985. From 2000 to 2007, total and vasculature-specific prevalence of atherothrombotic disease (as a principal diagnosis) was calculated using a 15-year lead-in to determine prior disease and comorbidity. In 2007, 45,916 (8.6%) men and 22,782 (4.3%) women in Western Australia had established atherothrombotic disease and about 25% had diabetes, 10% had chronic kidney disease, and 5% had both. From 2000 to 2007 the estimated average annual change in age-standardised atherothrombotic disease prevalence was -0.6%/year (95% CI -0.8, -0.4) in men and -0.7%/year (95% CI -1.0, -0.4) in women. Similar modest declines were seen in age-standardised prevalence of monovascular and polyvascular atherothrombotic disease. The proportion of cases with diabetes increased by about 5%/year, the proportion having chronic kidney disease increased slowly in women (1.5%/year) and was stable in men, and the proportion with both comorbidities increased at about 9%/year. The age-standardised prevalence of atherothrombotic disease requiring hospitalisation has been in marginal decline in Western Australia this decade, despite the proportion of affected persons with diabetes and/or chronic kidney disease steadily rising.
Publisher: Elsevier BV
Date: 10-2011
DOI: 10.1016/J.ATHEROSCLEROSISSUP.2011.06.001
Abstract: Familial hypercholesterolaemia (FH) is a dominantly inherited disorder present from birth that causes marked elevation in plasma cholesterol and premature coronary heart disease. There are at least 45,000 people with FH in Australia and New Zealand, but the vast majority remains undetected and those diagnosed with the condition are inadequately treated. To bridge this major gap in coronary prevention the FH Australasia Network (Australian Atherosclerosis Society) has developed a consensus model of care (MoC) for FH. The MoC is based on clinical experience, expert opinion, published evidence and consultations with a wide spectrum of stakeholders, and has been developed for use primarily by specialist centres intending starting a clinical service for FH. This MoC aims to provide a standardised, high-quality and cost-effective system of care that is likely to have the highest impact on patient outcomes. The MoC for FH is presented as a series of recommendations and algorithms focusing on the standards required for the detection, diagnosis, assessment and management of FH in adults and children. The process involved in cascade screening and risk notification, the backbone for detecting new cases of FH, is detailed. Guidance on treatment is based on risk stratifying patients, management of non-cholesterol risk factors, safe and effective use of statins, and a rational approach to follow-up of patients. Clinical and laboratory recommendations are given for genetic testing. An integrative system for providing best clinical care is described. This MoC for FH is not prescriptive and needs to be complemented by good clinical judgment and adjusted for local needs and resources. After initial implementation, the MoC will require critical evaluation, development and appropriate modification.
Publisher: BMJ
Date: 07-2017
Publisher: Elsevier BV
Date: 09-2017
DOI: 10.1016/J.JVAL.2017.04.023
Abstract: Concerns about pathology testing such as the value provided by new tests and the potential for inappropriate utilization have led to a greater need to assess costs and benefits. Economic evaluations are a formal method of analyzing costs and benefits, yet for pathology tests, questions remain about the scope and quality of the economic evidence. To describe the extent and quality of published evidence provided by economic evaluations of pathology tests from 2010 to 2015. Economic evaluations relating to pathology tests from 2010 to 2015 were reviewed. Eight databases were searched for published studies, and details recorded for the country, clinical focus, type of testing, and consideration of sensitivity, specificity, and false test results. The reporting quality of studies was assessed using the Consolidated Health Economic Evaluation Reporting Standards checklist and cost-effectiveness ratios were analyzed for publication bias. We found 356 economic evaluations of pathology tests, most of which regarded developed countries. The most common economic evaluations were cost-utility analyses and the most common clinical focus was infectious diseases. More than half of the studies considered sensitivity and specificity, but few studies considered the impact of false test results. The average Consolidated Health Economic Evaluation Reporting Standards checklist score was 17 out of 24. Cost-utility ratios were commonly less than $10,000/quality-adjusted life-year or more than $200,000/quality-adjusted life-year. The number of economic evaluations of pathology tests has increased in recent years, but the rate of increase has plateaued. Furthermore, the quality of studies in the past 5 years was highly variable, and there is some question of publication bias in reporting cost-effectiveness ratios.
Publisher: Springer Science and Business Media LLC
Date: 27-04-2018
DOI: 10.1007/S00198-018-4526-5
Abstract: Fracture liaison service linked to an emergency department database effectively identifies patients with OP, improves best practice care, reduces recurrent fractures, and improves quality of life (QoL). The next step is to establish cost-effectiveness. This should be seen as the standard model of care. The Western Australian Osteoporosis Model of Care recommends implementation of a fracture liaison service (FLS) to manage patients with minimal trauma fractures (MTFs). This study evaluates the efficacy of a FLS linked to a tertiary hospital emergency department information system (EDIS) in reducing recurrent fractures. Patients aged ≥ 50 years with MTF identified from EDIS were invited to the FLS. Patient outcomes were compared to routine care (retrospective group-same hospital, and prospective group-other hospital) at 3- and 12-month follow-up. Two hundred forty-one of 376 (64.1%) eligible patients participated in the FLS with 12 months of follow-up. Absolute risk of recurrent MTF at 12 months was reduced by 9.2 and 10.2% compared with the prospective and retrospective controls, respectively. After age/sex adjustment, FLS participants had less MTF at 12 months vs. the retrospective controls, OR 0.38 (95%CI 0.18-0.79), but not the prospective controls, OR 0.40 (95%CI 0.16-1.01). FLS patients were more likely to receive the 'best practice' care, i.e. awareness of osteoporosis, investigations, and treatment (all p < 0.05). 'Fallers' (OR 0.48 (95%CI 0.24, 0.96)) and fall rates were lower in the FLS (p = 0.001) compared to the prospective control. FLS experienced the largest improvement in QoL from 3 to 12 months as measured by the EuroQoL 5-domain (EQ-5D) UK weighted score (+ 15 vs. - 11 vs. - 16%, p < 0.001) and EQ-5D Health State visual analogue scale (+ 29 vs. - 2 vs. + 1%, p < 0.001). Patients managed in a linked EDIS-FLS were more likely to receive the 'best practice' care and had lower recurrent MTF and improved QoL.
Publisher: BMJ
Date: 04-2021
DOI: 10.1136/BMJOPEN-2020-041695
Abstract: The current diagnostic pathways for cognitive impairment rarely identify babies at risk before 2 years of age. Very early detection and timely targeted intervention has potential to improve outcomes for these children and support them to reach their full life potential. Early Moves aims to identify early biomarkers, including general movements (GMs), for babies at risk of cognitive impairment, allowing early intervention within critical developmental windows to enable these children to have the best possible start to life. Early Moves is a double-masked prospective cohort study that will recruit 3000 term and preterm babies from a secondary care setting. Early Moves will determine the diagnostic value of abnormal GMs (at writhing and fidgety age) for mild, moderate and severe cognitive delay at 2 years measured by the Bayley-4. Parents will use the Baby Moves smartphone application to video their babies’ GMs. Trained GMs assessors will be masked to any risk factors and assessors of the primary outcome will be masked to the GMs result. Automated scoring of GMs will be developed through applying machine-based learning to the data and the predictive value for an abnormal GM will be investigated. Screening algorithms for identification of children at risk of cognitive impairment, using the GM assessment (GMA), and routinely collected social and environmental profile data will be developed to allow more accurate prediction of cognitive outcome at 2 years. A cost evaluation for GMA implementation in preparation for national implementation will be undertaken including exploring the relationship between cognitive status and healthcare utilisation, medical costs, health-related quality of life and caregiver burden. Ethics approval has been granted by the Medical Research Ethics Committee of Joondalup Health Services and the Health Service Human Research Ethics Committee (1902) of Curtin University (HRE2019-0739). ACTRN12619001422112.
Publisher: SAGE Publications
Date: 18-08-2009
DOI: 10.1345/APH.1M086
Abstract: Over one quarter of asthma reliever medications are provided without prescription by community pharmacies in Australia. Evidence that community pharmacies provide these medications with sufficient patient assessment and medication counseling to ensure compliance with the government's Quality Use of Medicines principles is currently tacking. To assess current practice when asthma reliever medication is provided in the community pharmacy setting and to identify factors that correlate with assessment of asthma control. Researchers posing as patients visited a s le of Perth metropolitan community pharmacies in May 2007. During the visit, the simulated patient enacted a standardized scenario of someone with moderately controlled asthma who wished to purchase a salbutamol (albuterol) inhaler without prescription. Results of the encounter were recorded immediately after the visit. Regression analysis was performed, with medication use frequency (a marker of asthma control) as the dependent variable. One hundred sixty community pharmacies in the Perth metropolitan area were visited in May 2007. Pharmacists and/or pharmacy assistants provided some form of assessment in 84% of the visits. Counseling was provided to the simulated patients in 24% of the visits. Only 4 pharmacy staff members asked whether the simulated patient knew how to use the inhaler. Significant correlation was found between assessment and/or counseling of reliever use frequency and 3 independent variables: visit length (p 0.001), number of assessment questions asked (p 0.001), and the simulated patient who conducted the visit (p 0.02). Both patient assessment and medication counseling were suboptimal compared with recommended practice when nonprescription asthma reliever medication was supplied in the community pharmacy setting. Pharmacy and pharmacist demographic variables do not appear to affect assessment of asthma control. This research indicates the need for substantial improvements in practice in order to provide reliever medication in line with Quality Use of Medication principles of ensuring safe and effective use of medication.
Publisher: Elsevier BV
Date: 07-2012
DOI: 10.1016/J.IJCARD.2011.01.061
Abstract: It is uncertain if improvements in long-term cardiovascular (CV) mortality have occurred in both men and women with ischemic and non-ischemic forms of heart failure (HF). The Western Australia Hospital Morbidity Database was used to identify all index (first-ever) hospitalizations for HF between 1990 and 2005. Patients were followed until death attributed to cardiovascular causes or censored on December 31, 2006 to determine 5-year survival. Cox proportional hazards models were used to compare the adjusted mortality hazard ratio (HR) during the study follow-up (4-year periods). A total of 21,507 patients (mean age 73.9 years, 49.1% women) were identified. Women were significantly older than men, and less likely to have ischemic HF (38.8% versus 46.1%). Over the period, age-standardized incidence of first HF hospitalization declined but with the least decline in women with non-ischemic HF (-13.3%) compared to other subgroups. Risk-adjusted 5-year CV mortality declined over the study period, with HR 0.64 (95% CI 0.60-0.68) for patients admitted in 1998-2001 compared to 1990-1993, with significant improvement in both forms of HF, and in both sexes and across age groups. However, overall total HF hospitalizations increased (+26.7%) over the period, particularly for non-ischemic HF (+43.7%), of which elderly women formed the predominant group. Risk-adjusted long-term survival improved similarly in men and women, including the elderly, with ischemic and non-ischemic forms of HF during 1990-2005 in Western Australia. However, there was a growing burden of HF hospitalizations particularly for HF of non-ischemic aetiology.
Publisher: Elsevier BV
Date: 10-1970
DOI: 10.1016/J.YPMED.2014.07.041
Abstract: This study investigated the cost-effectiveness of installing sidewalks to increase levels of transport-walking. Secondary analysis using logistic regression established the association of sidewalks with transport-walking using two transport-walking thresholds of 150 and 60 min/week using Western Australian data (n=1394) from 1995 to 2000. Minimum, moderate and maximum interventions were defined, associated respectively with one sidewalk, at least one sidewalk and sidewalks on both sides of the street. Costs, average and incremental cost-effectiveness ratios were calculated for each intervention and expressed as 'the cost per person who walks for transport for more than 150 min/week (60 min/week) after the installation of new sidewalks'. A sensitivity analysis examined the robustness of the incremental cost-effectiveness ratios to varying model inputs. Costs are in 2012 Australian dollars. A positive relationship was found between the presence of sidewalks and transport-walking for both transport-walking thresholds of 150 and 60 min/week. The minimum intervention was found to be the most cost-effective at $2330 erson and $674 erson for the 150 and 60 min/week transport-walking thresholds respectively. Increasing the proportion of people transport-walking and increasing population density by 50% improved the cost-effectiveness of installing side-walks to $346 erson. To increase levels of transport-walking, retrofitting streets with one sidewalk is most cost-effective.
Publisher: BMJ
Date: 05-2014
Publisher: American Academy of Pediatrics (AAP)
Date: 10-2010
Abstract: The goal was to examine the associations between dose, pattern, and timing of prenatal alcohol exposure (PAE) and birth defects. Data from a randomly selected, population-based cohort of nonindigenous women who gave birth to a live infant in Western Australia (WA) between 1995 and 1997 (N = 4714) were linked to WA Midwives Notification System and WA Birth Defects Registry data. We assessed the associations of PAE before pregnancy, in the first trimester, and in late pregnancy with any birth defect and with birth defects classified as alcohol-related birth defects (ARBDs) by the Institute of Medicine (IOM), by using logistic regression. The prevalence of birth defects classified as ARBDs by the IOM was low. Compared with abstinence, heavy PAE in the first trimester was associated with increased odds of birth defects classified as ARBDs (adjusted odds ratio: 4.6 [95% confidence interval: 1.5–14.3]), with similar findings after validation through bootstrap analysis. There was no association between low or moderate PAE and birth defects. A fourfold increased risk of birth defects classified as ARBDs was observed after heavy PAE in the first trimester. Many in idual birth defects included in the IOM classification for ARBDs either were not present in this cohort or were not associated with PAE. Large, population-based studies are needed to strengthen the evidence base for ARBDs.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 03-2017
Abstract: Rheumatic heart disease ( RHD ) remains a leading cause of cardiovascular morbidity and mortality in children and young adults in disadvantaged populations. The emergence of echocardiographic screening provides the opportunity for early disease detection and intervention. Using our own multistate model of RHD progression derived from Australian RHD register data, we performed a cost–utility analysis of echocardiographic screening in indigenous Australian children, with the dual aims of informing policy decisions in Australia and providing a model that could be adapted in other countries. We simulated the outcomes of 2 screening strategies, assuming that RHD could be detected 1, 2, or 3 years earlier by screening. Outcomes included reductions in heart failure, surgery, mortality, disability‐adjusted life‐years, and corresponding costs. Only a strategy of screening all indigenous 5‐ to 12‐year‐olds in half of their communities in alternate years was found to be cost‐effective (incremental cost‐effectiveness ratio less than AU$50 000 per disability‐adjusted life‐year averted), assuming that RHD can be detected at least 2 years earlier by screening however, this result was sensitive to a number of assumptions. Additional modeling of improved adherence to secondary prophylaxis alone resulted in dramatic reductions in heart failure, surgery, and death these outcomes improved even further when combined with screening. Echocardiographic screening for RHD is cost‐effective in our context, assuming that RHD can be detected ≥2 years earlier by screening. Our model can be adapted to any other setting but will require local data or acceptable assumptions for model parameters.
Publisher: The Royal Australian College of General Practitioners
Date: 04-2018
Publisher: Springer Science and Business Media LLC
Date: 30-03-2018
Publisher: BMJ
Date: 18-09-2014
Publisher: Elsevier BV
Date: 08-2006
DOI: 10.1111/J.1467-842X.2006.TB00851.X
Abstract: To estimate the number of neural tube defects that could be prevented in Australia and New Zealand by increasing levels of folic acid intake. Available data on prevalence of neural tube defects in Australia and New Zealand, folic acid supplement use and serum folate were used in a published model to estimate the number of neural tube defects that could be prevented in Australia and New Zealand for increments of folic acid intake from 0.1 mg daily to 1 mg daily. An increase of 0.2 mg folic acid per day was estimated to result in the prevention of 49 (95% CI 27-84) neural tube defects per year in Australia and 11 (95% CI 6-18) in New Zealand. A separate estimation for Indigenous Australians found that 0.2 mg of folic acid daily could prevent 7 (95% CI 4-11) neural tube defects in Indigenous infants per year. These data should be useful in considering primary preventive strategies for neural tube defects, including the possible introduction of mandatory fortification of food with folic acid. The estimates are imprecise because of limitations in the data used in the model. More representative and precise data on neural tube defects, serum folate levels and use of folic acid supplements from all Australian States and New Zealand are needed to refine the output from the model and to provide a baseline assessment of folate status against which to measure the effects of any future interventions to prevent neural tube defects.
Publisher: Wiley
Date: 11-2005
DOI: 10.1111/J.1440-1754.2005.00725.X
Abstract: To evaluate the costs and benefits of neonatal screening for phenylketonuria (PKU) and congenital hypothyroidism (CH). Neonatal screening for PKU and CH is common throughout the developed world. It represents a model of preventive care in that the screening procedure is simple and intellectual disability is otherwise irreversible. Changes in treatment and care, and in particular the advent of maternal PKU, require regular evaluation of a programme that also impacts on a large healthy population. Costs of screening were based on the programme provided within Western Australia. Costs averted were derived using patterns of care currently adopted in Western Australia and applied according to historical patterns of intellectual disability for each condition. A net saving of dollar A2.9 million is attributable to the programme annually. The economic benefits derive from the prevention of intellectual disability which otherwise incurs costs throughout the life of the affected in idual. Maternal PKU represented a minor proportion of overall costs. Sensitivity analysis showed that the cost savings were robust, given changes in the levels of intellectual disability, but varied according to the discount rate. The result of a net saving was evident under all assumptions. Neonatal screening for PKU and CH is a cost saving use of resources and the emergence of maternal PKU has not had a significant effect on the economic outcomes.
Publisher: Elsevier BV
Date: 10-2008
DOI: 10.1111/J.1753-6405.2008.00269.X
Abstract: To determine the accuracy of the hospital discharge coding of heart failure (HF) in the Western Australian (WA) Hospital Morbidity Data (HMD). A retrospective medical chart review of a s le of 1,006 patients with a principal diagnosis code indicating HF in the WA HMD was undertaken. Validation was reported against a written diagnosis of HF in the medical chart and using Boston criteria score as a gold standard. The positive predictive value (PPV) of the HMD coding of HF as the principal diagnosis was 99.5% when compared to the medical chart diagnosis and 92.4% when compared to the Boston score criteria for 'definite' HF and 98.8% for a combined 'possible' and 'definite' HF Boston score. With the high predictive accuracy, the WA HMD can be used with confidence to monitor trends in the epidemiology of in-hospital HF patients.
Publisher: BMJ
Date: 10-2014
DOI: 10.1136/BMJOPEN-2014-006337
Abstract: Coronary artery bypass grafting (CABG) and percutaneous coronary interventions (PCI) are procedures commonly performed on patients with significant obstructive coronary artery disease to relieve symptoms of ischaemia, improve survival or both. Although the efficacy of both procedures at the in idual level has been established, the impact of advances in coronary artery revascularisation procedures (CARP) on long-term outcomes and cost-effectiveness at the population level are yet to be assessed. Our aim is to evaluate a minimum of 6-year outcomes and costs for the total population of patients who had CARP in Western Australia (WA) in 2000–2005. This retrospective population cohort study will link clinical and administrative health data for a previously defined cohort including all patients in WA who had a CARP in the period 2000–2005. The cohort consists of 19 014 patients who had 21 175 procedures (15 429 PCI and 5746 CABG). We are now collecting a minimum of 6 years follow-up of morbidity and mortality data for the cohort using the WA Data Linkage System, clinical registries and hospital records, with 12 years follow-up for cases in the year 2000. Comparison of long-term outcomes for different CARP will be reported (PCI vs CABG bare metal stents vs drug-eluting stents vs CABG). Cost-effectiveness analysis of CARP from the perspective of the healthcare sector will be performed using in idual level cost data and average costs from Australian Refined Diagnosis Related Groups. This study has received ethics approval from the University of Western Australia, the Western Australian Department of Health and all participating hospitals. Being a large population cohort study, approval included a waiver of informed consent. All findings will be presented at local, national and international healthcare/academic conferences and published in peer-reviewed journals.
Publisher: Springer Science and Business Media LLC
Date: 28-08-2012
Publisher: Elsevier BV
Date: 10-2016
Publisher: Wiley
Date: 09-05-2016
DOI: 10.1002/MUS.24965
Abstract: Duchenne muscular dystrophy (DMD) is an incurable neuromuscular disorder of childhood. Healthcare, caregiving, and other resource needs of affected in iduals are thought to be substantial however, the economic burden associated with DMD has not yet been assessed specifically in Australia. Australian households with a child with DMD were asked to complete a cross-sectional survey. Data were collected on annual resource utilization including hospital and medical services, equipment, home modifications, informal care, and working days lost. Mean healthcare costs were found to be $10,046 Australian dollars per affected in idual and were markedly higher than average Australian health expenditures at each age group. The mean total cost was $46,700 (median $32,300), with healthcare costs contributing 22% of total costs. The annual economic cost of DMD was found to be high, reflecting a significant socioeconomic burden, especially in boys who reach adulthood, where household resource use and caregiving burden is highest. Muscle Nerve 53: 877-884, 2016.
Publisher: Elsevier BV
Date: 03-2014
DOI: 10.1016/J.IJNURSTU.2013.06.006
Abstract: Nursing sensitive outcomes are adverse patient health outcomes that have been shown to be associated with nursing care. Researchers have developed specific algorithms to identify nursing sensitive outcomes using administrative data sources, although contention still surrounds the ability to adjust for pre-existing conditions. Existing nursing sensitive outcome detection methods could be improved by using look-back periods that incorporate relevant health information from patient's previous hospitalisations. Retrospective cohort study at three tertiary metropolitan hospitals in Perth, Western Australia. The objective of this research was to explore the effect of using linked hospitalisation data on estimated incidence rates of eleven adverse nursing sensitive outcomes by retrospectively extending the timeframe during which relevant patient disease information may be identified. The research also explored whether patient demographics and/or the characteristics of their hospitalisations were associated with nursing sensitive outcomes. During the 5 year study period there were 356,948 hospitalisation episodes involving 189,240 patients for a total of 2,493,654 inpatient days at the three tertiary metropolitan hospitals. There was a reduction in estimated rates for all nursing sensitive outcomes when a look-back period was applied to identify relevant health information from earlier hospitalisations within the preceding 2 years. Survival analysis demonstrates that the majority of relevant patient disease information is identified within approximately 2 years of the baseline nursing sensitive outcomes hospitalisation. Compared to patients without, patients with nursing sensitive outcomes were significantly more likely to be older (70 versus 58 years), female, have Charleson comorbidities, be direct transfers from another hospital, have a longer inpatient stay and spend time in intensive care units (p≤0.001). The results of this research suggest that nursing sensitive outcome rates may be over-estimated using current detection methods. Linked hospitalisation data enables the use of look-back periods to identify clinically relevant diagnosis codes recorded prior to the hospitalisation in which a nursing sensitive outcome is detected. Using linked hospitalisation data to incorporate look-back periods offers an opportunity to increase the accuracy of nursing sensitive outcome detection when using administrative data sources.
Publisher: Elsevier BV
Date: 12-1996
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 05-2008
Publisher: Springer Science and Business Media LLC
Date: 02-08-2018
Publisher: Elsevier BV
Date: 10-2012
DOI: 10.1111/J.1753-6405.2012.00887.X
Abstract: To determine the effects on cardiovascular outcomes and costs of a delay in subsidising statins for Australian normolipidaemic diabetics aged 60-79 years that occurred between 2002 and 2006. The Australian normolipidaemic diabetic population aged 60-79 with no history of coronary heart disease (CHD) or stroke was estimated from the Australian Bureau of Statistics (National Health Survey 2001 and 2002 population estimates). The number of CHD and stroke events expected to have occurred between 2002 and 2006 were estimated from the United Kingdom Prospective Diabetes Study Risk Engine. The proportion of these events that may have been prevented by the use of statins in this population was estimated using risk reduction values from the Heart Protection Study. The target population was estimated as 186,501. In this population, 3,205 (95% confidence interval (CI) 2567, 4003) CHD events, of which 1,456 (95% CI 908, 2334) would have been fatal, could have been prevented if all patients had been treated with statins. In addition, 2,150 (95% CI 1515, 3052) ischaemic strokes could have been prevented. The net cost to the government would have been about $136 million per year over the four-year period. Delays in the adoption of statins on the Pharmaceutical Benefits Scheme based on evidence available at the time for specific populations may have led to preventable morbidity and mortality. Implications The effects of delays in translating new evidence into public subsidies for drugs are measurable and are likely to be significant.
Publisher: Elsevier BV
Date: 02-2006
Publisher: Massachusetts Medical Society
Date: 25-07-2019
Publisher: Springer Science and Business Media LLC
Date: 2012
Publisher: Springer Science and Business Media LLC
Date: 15-03-2018
DOI: 10.1007/S00701-018-3514-Z
Abstract: To compare the long-term outcomes of patients who had been randomly allocated to receive primary titanium cranioplasty or autologous bone graft following decompressive craniectomy. Sixty-four patients had been previously enrolled and randomised to receive either their own bone graft or a primary titanium cranioplasty. Functional and cosmetic outcomes had previously been assessed at 1-year following the cranioplasty procedure. Hospital records and the Picture Archiving communication system were reviewed to determine how many patients had cranioplasty failure or associated complications such as seizures beyond 1 year-with a minimum of 24-month follow-up. Amongst the 31 patients in the titanium group (one patient had died), no patients had a partial or complete cranioplasty failure at 12 months follow-up and there had been no failures beyond 12 months. Amongst the 31 patients who had an autologous cranioplasty (one patient had died), 7 patients had complete resorption of the autologous bone such that it was adjudged a complete failure at 12-month follow-up. Five of these patients had had titanium augmentation and two patients declined further surgery. Both of these patients requested cranial augmentation for functional and cosmetic reasons subsequent to the 12-month follow-up. Another patient who had previously been noted to have moderate resorption at 12 months presented 1 year later with progressive bone flap resorption and also required subsequent augmentation for functional and cosmetic reasons. When follow-up was extended to a minimum of 24 months, use of titanium instead of autologous bone for primary cranioplasty resulted in a significant reduction in the number of patients who required rescue cranioplasty (0 vs 25%, 95% confidence interval [CI] 9.1-42.1% p = 0.001). In addition, there were significantly less total hospital healthcare costs in those patients randomised to the titanium arm of the trial (difference = A$9999, 95%CI 2231-17,768 p = 0.015). Bone resorption continued to occur beyond 12 months after autologous cranioplasty use of primary titanium cranioplasty after decompressive craniectomy reduced the number of reoperations needed and the associated long-term total hospital costs.
Publisher: Wiley
Date: 12-11-2016
Abstract: Describe the dispensing patterns for guideline-recommended medications during 2008 in people with acute coronary syndrome (ACS) and how dispensing varies by gender and time since last ACS hospitalization. A descriptive cohort spanning 20 years of people alive post-ACS in 2008. We extracted all ACS hospitalizations and deaths in Western Australia (1989-2008), and all person-linked Pharmaceutical Benefits Scheme claims nationally for 2008. Participants were 23 642 men and women (36.8%), alive and aged 65-89 years in mid-2008 who were hospitalized for ACS between 1989 and 2008. Main outcome was the proportion of the study cohort (in 2008) dispensed guideline-recommended cardiovascular medications in that year. Adjusted odds ratios estimating the association between type (and number) of guideline-recommended medications and time since last ACS hospitalization. Medications most commonly dispensed in 2008 were statins (79.6% of study cohort) and then angiotensin-converting enzyme inhibitors or angiotensin-receptor blockers (ACEi/ARBs) (71.1%), aspirin or clopidogrel (59.4%), and β-blockers (54.6%). Only 51.8% of the cohort was dispensed three or more of these drug types in 2008. Women with ACS were 18% less likely to be dispensed statins (adjusted odds ratio (OR)=0.82 95% CI 0.76-0.88). Overall, for each incremental year since last ACS admission, there was an 8% increased odds (adjusted OR=1.08 95% CI 1.07-1.08) of being dispensed fewer of the recommended drug regimen in 2008. Longer time since last ACS admission was associated with dispensing fewer medications types and combinations in 2008. Interventions are warranted to improve dispensing long term and any apparent gender inequality in the drug class filled.
Publisher: Journal of Neurosurgery Publishing Group (JNSPG)
Date: 2017
DOI: 10.3171/2015.12.JNS152004
Abstract: Autologous bone is usually used to reconstruct skull defects following decompressive surgery. However, it is associated with a high failure rate due to infection and resorption. The aim of this study was to see whether it would be cost-effective to use titanium as a primary reconstructive material. Sixty-four patients were enrolled and randomized to receive either their own bone or a primary titanium cranioplasty. All surgical procedures were performed by the senior surgeon. Primary and secondary outcome measures were assessed at 1 year after cranioplasty. There were no primary infections in either arm of the trial. There was one secondary infection of a titanium cranioplasty that had replaced a resorbed autologous cranioplasty. In the titanium group, no patient was considered to have partial or complete cranioplasty failure at 12 months of follow-up (p = 0.002) and none needed revision (p = 0.053). There were 2 deaths unrelated to the cranioplasty, one in each arm of the trial. Among the 31 patients who had an autologous cranioplasty, 7 patients (22%) had complete resorption of the autologous bone such that it was deemed a complete failure. Partial or complete autologous bone resorption appeared to be more common among young patients than older patients (32 vs 45 years old, p = 0.013). The total cumulative cost between the 2 groups was not significantly different (mean difference A$3281, 95% CI $−9869 to $3308 p = 0.327). Primary titanium cranioplasty should be seriously considered for young patients who require reconstruction of the skull vault following decompressive craniectomy. Clinical trial registration no.: ACTRN12612000353897 ( anzctr.org.au )
Publisher: SAGE Publications
Date: 22-06-2010
DOI: 10.1345/APH.1P142
Abstract: Earlier work established an evidence practice gap during provision of nonprescription salbutamol (albuterol). Pharmacist interns are hypothesized to be in a position to improve professional practice in the community pharmacy setting. To explore the potential of intern pharmacists to improve the professional practice of community pharmacy staff in the provision of nonprescription salbutamol. Intern pharmacists (n = 157) delivered an asthma intervention in 136 pharmacies consisting of an educational activity to pharmacy staff and a health promotion c aign to consumers. Post-intervention, simulated patients presented to 100 intervention and 100 control community pharmacies with a request for salbutamol. The appropriate outcome was medical referral for poor asthma contral and correction of poor inhaler technique. Incidence and quantity of patient assessment and counseling provided during the visit were also assessed. Logistic regression was used to determine the predictors of medical referral. A doubling in the rate of medical referral was seen in the intervention group (19% vs 40% p = 0.001). Assessment of reliever use frequency was the main predictor of medical referral (OR = 22.7 95% CI 9.06 to 56.9). Correction of poor inhaler technique did not improve however, a reduction in salbutamol supplied without patient assessment (23% vs 8% p = 0.009) or counseling (75% vs 48% p 0.001) was noted. A doubling in the rate of medical referral showed a clear improvement in professional practice during the provision of nonprescription salbutamol. The improved patient outcome in the intervention group was due to increased assessment of reliever use frequency. Identification of poor inhaler technique remained near zero in both groups, which suggests that intern pharmacists were able to improve the current practice of community pharmacies yet were unable to establish a new practice behavior. This study provides evidence that intern pharmacists can act as change agents to improve pharmacy practice.
Publisher: Wiley
Date: 08-2019
DOI: 10.1111/IMJ.14231
Abstract: Preliminary studies have reported promising results for the utility of gallium-68 (Ga-68) citrate positron emission tomography-computed tomography (PET-CT) for infection imaging. This technique offers reduced radiation dose to patients, shorter time between injection and imaging and reduced time for image acquisition compared to the 'gold standard' nuclear imaging technique: gallium-67 (Ga-67) citrate scintigraphy. To compare the two imaging modalities to ascertain whether Ga-68 citrate PET-CT is of equivalent diagnostic efficacy for bone and joint infection or pyrexia of unknown origin (PUO) and to assess image quality and reporter confidence. Patients with PUO and suspected bone or joint infection underwent Ga-67 citrate scintigraphy and Ga-68 citrate PET-CT. Participants were followed up for 3 months to record subsequent treatment, investigations and outcome. 60 patients were recruited to this multicentre prospective study: 32 for bone and joint infection, 28 for PUO. The results show a sensitivity of 81% for Ga-67 citrate scintigraphy and 69% for Ga-68 citrate PET-CT, a specificity of 79% for Ga-67 citrate and 67% for Ga-68 citrate and were concordant for 76% of the participants. The reporting physician confidence was significantly lower for Ga-68 citrate (P < 0.05), frequently due to prominent physiologic blood pool activity adjacent to the site of infection. The sensitivity and specificity of Ga-68 citrate PET-CT were found to be consistently lower than Ga-67 citrate scintigraphy. Additionally, due to the insufficient level of confidence of the reporting physicians for the Ga-68 citrate PET-CT, this modality could not currently be recommended to replace Ga-67 citrate scintigraphy for routine clinical use.
Publisher: CSIRO Publishing
Date: 2013
DOI: 10.1071/AH13083
Abstract: Objective. This study of equity and access characterises admissions for coronary, cerebrovascular and peripheral arterial disease by hospital type (rural, tertiary and non-tertiary metropolitan) in a representative Australian population. Methods. We conducted a descriptive analysis using data linkage of all residents aged 35–84 years hospitalised in Western Australia with a primary diagnosis for an atherothrombotic event in 2007. We compared sociodemographic and clinical features by atherothrombotic territory and hospital type. Results. There were 11670 index admissions for atherothrombotic disease in 2007 of which 46% were in tertiary hospitals, 41% were in non-tertiary metropolitan hospitals and 13% were in rural hospitals. Coronary heart disease comprised 72% of admissions, followed by cerebrovascular disease (19%) and peripheral arterial disease (9%). Comparisons of socioeconomic disadvantage reveal that for those admitted to rural hospitals, more than one-third were in the most disadvantaged quintile, compared with one-fifth to any metropolitan hospital. Conclusions. Significant differences in demographic characteristics were evident between Western Australian tertiary and non-tertiary hospitals for patients hospitalised for atherothrombotic disease. Notably, the differences among tertiary, non-tertiary metropolitan and rural hospitals were related to socioeconomic disadvantage. This has implications for atherothrombotic healthcare provision and the generalisation of research findings from studies conducted exclusively in the tertiary metropolitan hospitals. What is known about the topic? Equity and access to hospital care for atherothrombotic disease in a geographically erse population is poorly characterised. National data show that both fatal and non-fatal coronary heart disease and non-fatal stroke hospitalisations increase with remoteness. Fatal in-hospital stroke is greatest in major cities, whereas peripheral arterial disease hospitalisations are greatest in the inner and outer regional areas. What does this paper add? This study demonstrates that around 13% of atherothrombotic events were treated in rural hospitals with in-hospital case fatality higher than in tertiary and non-tertiary metropolitan hospitals. A greater proportion of atherothrombotic disease cases treated in rural hospitals were in the most disadvantaged Socioeconomic Indices For Area group. What are the implications for practitioners? It is important to consider differences in disadvantage when generalising results of studies generated from tertiary hospital data to non-tertiary metropolitan and rural patients.
Publisher: BMJ
Date: 08-2018
DOI: 10.1136/BMJOPEN-2017-020275
Abstract: Automated insulin delivery (also known as closed loop, or artificial pancreas) has shown potential to improve glycaemic control and quality of life in people with type 1 diabetes (T1D). Automated insulin delivery devices incorporate an insulin pump with continuous glucose monitoring(CGM) and an algorithm, and adjust insulin in real time. This study aims to establish the safety and efficacy of a hybrid closed-loop (HCL) system in a long-term outpatient trial in people with T1D aged 12 – years of age, and compare outcomes with standard therapy for T1D as used in the contemporary community. This is an open-label, multicentre, 6-month, randomised controlled home trial to test the MiniMed Medtronic 670G system (HCL) in people with T1D aged 12 – years, and compare it to standard care (multiple daily injections or continuous subcutaneous insulin infusion (CSII), with or without CGM). Following a run-in period including diabetes and carbohydrate counting education, dosage optimisation and baseline glucose control data collection, participants are randomised to either HCL or to continue on their current treatment regimen. The primary aim of the study is to compare the proportion of time spent in target sensor glucose range (3.9–10.0 mmol/L) on HCL versus standard therapy. Secondary aims include a range of glucose control parameters, psychosocial measures, health economic measures, biomarker status, user/technology interactions and healthcare professional expectations. Analysis will be intention to treat. A study in adults with an aligned design is being conducted in parallel to this trial. Ethics committee permissions were gained from respective institutional review boards. The findings of the study will provide high-quality evidence on the role of HCL in clinical practice.
Publisher: BMJ
Date: 21-07-2012
DOI: 10.1136/HEARTJNL-2012-302181
Abstract: To examine temporal trends in the incidence and recurrence of hospitalised coronary heart disease (CHD), cerebrovascular disease (CeVD) and peripheral arterial disease (PAD) separately and combined, and by the history of all forms of atherothrombotic disease (ATD). Population-based longitudinal data linkage study. Western Australia. All patients aged 35-84 years hospitalised in Western Australia for CHD, CeVD or PAD from 2000 to 2007. Age-standardised incidence and recurrence rates of CHD, CeVD and PAD stratified by ATD history, sex and age. 107 576 events (65.9% men) were identified 70% of all admissions were for CHD. In patients without a history of any ATD, incidence rates declined significantly in all groups, although the reduction in incident CHD in women was marginal (-0.7%/year, 95% CI -1.5 to +0.1%). The largest annual reductions in incidence rates were for PAD (men, -6.4%/year, 95% CI -7.7 to -5.0% women, -5.4%/year, 95% CI -7.2 to -3.6%) and CeVD in women (-4.0%/year, 95% CI -5.0 to -3.0%). Falls in overall recurrence rates were greatest for CeVD (men, -3.2%/year, 95% CI -4.7 to -1.6% women -4.6%/year, 95% CI -6.4 to -2.7%). Trends across all categories of polyvascular ATD were generally downward, although not all changes were statistically significant. The incidence and recurrence rates of hospitalised ATD have decreased over time, including in patients with disease involving multiple vascular territories. This implies that primary and secondary prevention strategies have been broadly effective. However, high absolute rates of recurrence and limited reduction in 35-54-year-old in iduals highlight patient groups to target to reduce further the burden of ATD.
Publisher: Elsevier BV
Date: 08-2016
DOI: 10.1016/J.DRUGALCDEP.2016.06.005
Abstract: Alcohol and other drug (AOD) use are significant cause of disease burden and costs among adolescents. We conducted a randomized trial in hospital emergency departments (ED) following an AOD-related presentation, comparing usual care with brief advice and referral to link adolescents aged 12-19 years with external AOD services. Subsequently, we used health data linkage to assemble data on mortality, hospital admissions, ED attendances, out-patient mental health and use of opiate pharmacotherapies in the next 10 years. From these, treatment costs and rates of events were estimated and compared using generalized linear models. Those who received the intervention had lower costs ($22 versus $227: z=3.16, p=0.002) and rates (0.03 versus 0.25: z=2.57, p=0.010) of ED mental health AOD presentations. However, the intervention did not significantly reduce overall mean health costs per patient (intervention $58746 versus control $64833, p=0.800). Similarly, there was no significant difference in the costs associated with hospitalizations ($48920 versus $50911 p=0.924), overall ED presentations ($4266 versus $4150, p=0.916), out-patient mental health services ($4494 versus $7717, p=0.282), or opiate pharmacotherapies ($1013 versus $2054, p=0.209). Injecting drug use was a significant baseline predictor of subsequent costs in the cohort (z=2.64, p=0.008). An ED delivered intervention may reduce direct ED costs and subsequent ED AOD attendances. There was also some indication that overall costs may be impacted, with economically large but non-significant differences between the groups. The high costs and morbidity incurred by some of this cohort illustrate the importance of targeting high-risk adolescents.
Publisher: Springer Science and Business Media LLC
Date: 21-03-2017
Publisher: Microbiology Society
Date: 2016
DOI: 10.1099/JMM.0.000194
Abstract: Rapid identification of bacteria isolated from blood cultures by direct matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) is now in wide spread use in major centres but is not yet feasible in smaller hospital laboratories. A FilmArray multiplex PCR panel for blood culture isolate identification (BCID) provides an alternative approach to near point-of-care microbial identification in regional hospitals. We assessed the accuracy and time to identification of the BCID FilmArray in a consecutive series of 149 blood cultures from 143 patients in a teaching hospital and smaller regional hospitals, currently identified by direct MALDI-TOF and proprietary molecular methods. The BCID FilmArray contained 18 of 34 species and 20 of 23 species isolated from teaching and regional hospital, respectively. Overall, 85 % of the teaching hospital and 100 % of the regional hospital monomicrobial blood cultures were identified, compared with 60 and 68 %, respectively, for direct MALDI-TOF on the same cultures. There were no incorrect results from blood cultures containing Staphylococcus aureus, streptococci, Pseudomonas aeruginosa or Enterobacteriaceae. The three discrepant results were all in mixed cultures. The mean reduction in time to identification of blood culture isolates was 53 h, which did not include the time required to transport cultures from regional centres to a central laboratory. The overall performance of the BCID FilmArray is stronger in blood cultures from smaller regional hospitals that encounter a narrower range of bacterial species dominated by the commonest species. This approach is more suited to smaller clinical laboratories than the MALDI-TOF direct method.
Publisher: SAGE Publications
Date: 03-02-2011
Abstract: The objective was to evaluate the Alcohol and Pregnancy Project that provided health professionals in Western Australia (WA) with educational resources to inform them about prevention of prenatal alcohol exposure and fetal alcohol spectrum disorder (FASD). The authors developed, produced, and distributed educational resources to 3,348 health professionals in WA. Six months later, they surveyed 1,483 of these health professionals. The authors used the RE-AIM framework (reach, effectiveness, adoption, implementation, and maintenance) to evaluate the project. The educational resources were effective in producing a 31% increase in the proportion of health professionals who routinely provided pregnant women with information about the consequences of drinking alcohol during pregnancy. One hundred percent of the settings adopted the project, it reached 96.3% of the target population, it was implemented as intended, and the resources were maintained (www.ichr.uwa.edu.au/alcoholandpregnancy). The educational resources for health professionals have potential to contribute to reducing prenatal alcohol exposure and FASD.
Publisher: Informa UK Limited
Date: 06-2012
DOI: 10.5172/CONU.2012.41.2.190
Abstract: The aim of this research was to explore registered nurses' perceptions of the relationship between nursing care and clinical outcomes. We conducted an exploratory survey using a convenience s le of nurses attending a 3 day nursing practice conference. Nurses with postgraduate degrees and those with a clinical main work role had higher mean scores for the impact of nursing care on patient outcomes. Nurses reported that pressure ulcers and surgical wound infection were most affected by nursing care. Falls, medication errors, pain management, and patient education were some of the clinical indicators suggested as additional appropriate measures of nursing care. Our results suggest that nurses' educational background and work role may influence their perception of the impact of nursing care on patient outcomes.
Publisher: Wiley
Date: 06-03-2013
DOI: 10.1111/JAN.12109
Abstract: To assess the economic impact of increased nursing hours of care on health outcomes in adult teaching hospitals in Perth, Western Australia. Advancing technology and increased availability of treatment interventions are increasing demand for health care while the downturn in world economies has increased demand for greater efficiency. Nurse managers must balance nurse staffing to optimize care and provide efficiencies. This longitudinal study involved the retrospective analysis of a cohort of multi-day stay patients admitted to adult teaching hospitals. Hospital morbidity and staffing data from September 2000 until June 2004, obtained in 2010 from a previous study, were used to analyse nursing-sensitive outcomes pre- and post-implementation of the Nurse Hours per Patient Day staffing method, which remains in place today. The cost of the intervention comprised increased nursing hours following implementation of the staffing method. The number of nursing-sensitive outcomes was 1357 less than expected post-implementation and included 155 fewer 'failure to rescue' events. The 1202 other nursing-sensitive outcomes prevented were 'surgical wound infection', 'pulmonary failure', 'ulcer, gastritis', 'upper gastrointestinal bleed', and 'cardiac arrest'. One outcome, pneumonia, showed an increase of 493. Analysis of life years gained was based on the failure to rescue events prevented and the total life years gained was 1088. The cost per life year gained was AUD$8907. The implementation of the Nurse Hours per Patient Day staffing method was cost-effective when compared with thresholds of interventions commonly accepted in Australia.
Publisher: Elsevier BV
Date: 08-2017
Publisher: Springer Science and Business Media LLC
Date: 12-02-2016
Publisher: Wiley
Date: 06-2016
Abstract: ED chest pain assessments can be challenging, lengthy and contribute to overcrowding. Rapid accurate risk stratification strategies should improve ED length of stay (EDLOS). Emergency, Biochemistry and Cardiology implemented new guidelines using paired (<3 h) multiple cardiac markers to stratify patients. The intervention would reduce chest pain EDLOS. We observed for safety and disposition effects. This is a single-site, prospective observational, before and after intervention study. In December 2009, paired multiple cardiac markers, the second at least 4 h from pain, replaced late troponins. The 4 h rule (ED flow improvement) started in April 2009 (unplanned confounder). Demographics, clinical features, risk assessment and disposition preferably prospective. Administrative datasets provided disposition outcomes, 4 months pre- ost-intervention. Follow up with partially blinded adjudications assessed for 45 day major adverse cardiac events (MACE). Before intervention, consecutive patients were enrolled with mixed prospective/retrospective data. After, s ling occurred whenever prospective data were collected. Adjudicated patients were n = 1029 (14.2% MI, 14.9% MACE), 426 before, 603 after. EDLOS reduced 87 min (416-329 P < 0.001), similar to triage 2 patients without chest pain. Possibly, avoidable MACE occurred in five of 598 discharges (0.8%, CI 0.3-1.8%) with non-significant decreases (0.5%, CI 0.1-1.8%) post-intervention. Disposition changes included greater observation ward use (3.8-12.3% P < 0.001), more discharges (47.4-52.9%, P = 0.002), less transfers (9.3-6.9%, P = 0.014) and less late inpatient discharge decisions (15.2-8.7%, P = 0.001). Paired cardiac markers performed adequately for avoidable MACE, and disposition improved significantly. A confounding system change meant the reduced EDLOS (primary outcome) was unable to be associated with the intervention.
Publisher: Microbiology Society
Date: 05-2018
DOI: 10.1099/JMM.0.000714
Publisher: Springer Science and Business Media LLC
Date: 19-09-2017
DOI: 10.1038/BJC.2017.310
Publisher: S. Karger AG
Date: 2006
DOI: 10.1159/000091487
Abstract: i Aim: /i To evaluate costs and outcomes of genetic testing for familial colorectal cancer through services provided by Genetic Services of Western Australia (GSWA). i Methods: /i Costs and outcomes of predictive DNA-based testing for inherited colorectal cancers (CRC) were assessed, specifically for familial adenomatous polyposis (FAP) and hereditary non-polyposis CRC (HNPCC) using a decision-analysis model. Costs were assigned according to standards of care in Western Australia (WA). Cancer risks and the efficacy of surveillance on long-term outcomes were derived from the published literature. i Results: /i The cost-effectiveness of genetic testing was compared in first-degree relatives of known mutation carriers who have a 50% risk of carrying the mutated gene (intervention group) to in iduals with the same risk but who do not undergo a genetic test (control subjects). Compared with control subjects undergoing the same high-level surveillance and surgery, the FAP and HNPCC intervention groups provided total savings of $ 13,390 and 14,783–15,460 per person (males-females), respectively. HPNCC mutation carriers also gained 1 CRC-free year. Compared to control subjects having only population surveillance, in iduals in the FAP intervention group delayed the onset of CRC by 40 years for a net cost of $ 9,042. In iduals in the HNPCC intervention group delayed the onset of CRC by 8 years at a net cost of $ 12,141 for males and $ 12,596 for females. i Conclusions: /i Genetic testing for familial CRC in WA allows targeted surveillance for mutation carriers, which ensures the efficient use of resources and reduces cancer-related morbidity, if clinical recommendations for intervention are adopted.
Publisher: Wiley
Date: 09-02-2022
Abstract: Early childhood investment decisions represent critical policy frameworks that ideally reflect a strong evidence base. This review seeks to assess early childhood intervention priorities based on return on investment without limitation by health, education or social science sector. A systematic search of peer‐reviewed literature identified 858 eligible papers relating to economic evaluations of intervention in early childhood (0–4 years). Data for this narrative review was provided by 34 papers. The capacity to rank interventions and to compare relevance across disciplines is limited by the degree of heterogeneity across studies and the potential to compare published studies based on journal indices.
Publisher: Public Library of Science (PLoS)
Date: 15-02-2012
Publisher: Elsevier BV
Date: 08-2012
Abstract: Patients with malignant pleural effusion (MPE) have limited prognoses. They require long-lasting symptom relief with minimal hospitalization. Indwelling pleural catheters (IPCs) and talc pleurodesis are approved treatments for MPE. Establishing the implications of IPC and talc pleurodesis on subsequent hospital stay will influence patient choice of treatment. Therefore, our objective was to compare patients with MPE treated with IPC vs pleurodesis in terms of hospital bed days (from procedure to death or end of follow-up) and safety. In this prospective, 12-month, multicenter study, patients with MPE were treated with IPC or talc pleurodesis, based on patient choice. Key end points were hospital bed days from procedure to death (total and effusion-related). Complications, including infection and protein depletion, were monitored longitudinally. One hundred sixty patients with MPE were recruited, and 65 required definitive fluid control 34 chose IPCs and 31 pleurodesis. Total hospital bed days (from any causes) were significantly fewer in patients with IPCs (median, 6.5 days interquartile range [IQR] = 3.75-13.0 vs pleurodesis, mean, 18.0 IQR, 8.0-26.0 P = .002). Effusion-related hospital bed days were significantly fewer with IPCs (median, 3.0 days IQR, 1.8-8.3 vs pleurodesis, median, 10.0 days IQR, 6.0-18.0 P < .001). Patients with IPCs spent significantly fewer of their remaining days of life in hospital (8.0% vs 11.2%, P < .001, χ(2) = 28.25). Fewer patients with IPCs required further pleural procedures (13.5% vs 32.3% in pleurodesis group). There was no difference in rates of pleural infection (P = .68) and protein (P = .65) or albumin loss (P = .22). More patients treated with IPC reported immediate (within 7 days) improvements in quality of life and dyspnea. Patients treated with IPCs required significantly fewer days in hospital and fewer additional pleural procedures than those who received pleurodesis. Safety profiles and symptom control were comparable.
Publisher: Elsevier BV
Date: 11-2018
DOI: 10.1016/J.VACCINE.2018.10.001
Abstract: Group A streptococcus (GAS) causes an exceptionally erse range of diseases, raising questions about the optimal product characteristics of a commercially viable vaccine. The objectives of this study were to (1) estimate the current health and economic burdens caused by 24 diseases attributable to GAS each year in Australia and (2) use these estimates to explore the value of a GAS vaccine for different clinical indications, age schedules, and population groups. For objective 1, we estimated the population heath and economic burdens by synthesising data from administrative databases, nationally representative surveys, literature reviews, public reimbursement schedules, and expert opinion. For objective 2, we modelled the prospective lifetime burden of GAS for all infants from birth, for children from 5 years of age, and for adults from 65 years of age. A vaccine was assumed to reduce each GAS disease by 70% for a period of 10 years, and the difference in outcomes between vaccinated and non-vaccinated cohorts were used to calculate the cost-effective value of vaccination. The annual health and economic burdens of GAS diseases totalled 23,528 disability-adjusted life years and AU$185.1 million in healthcare costs respectively approximately half of each measure was due to cellulitis, followed by other skin infections and throat infections. Reducing the incidence of throat infections, skin infections, and cellulitis in non-Indigenous cohorts resulted in 30%, 33%, and 28% of the total vaccine value for an infant schedule (cost-effective vaccine price AU$260 per course) 47%, 26%, and 22% of the value for a child schedule (AU$289) and 2%, 15% and 74% for an adult schedule (AU$489). A vaccine that prevents GAS cellulitis and other skin infections, in addition to throat infections, would maximise its value and commercial viability, with a cost-effective price in line with other recently-licensed and funded vaccines in Australia.
Publisher: Wiley
Date: 25-07-2023
DOI: 10.1111/DMCN.15714
Abstract: To establish the burden of respiratory illness in cerebral palsy (CP) on the Western Australian health care system by quantifying the costs of respiratory hospitalizations in children with CP, compared with non‐respiratory hospitalizations. A 2‐year (2014–2015) retrospective study using linked hospital data (excluding emergency department visits), in a population of children with CP in Western Australia aged 18 years and under (median age at hospitalization 7 years interquartile range 5–12 years). In 671 in iduals (57% male) there were 726 emergency hospitalizations, and 1631 elective hospitalizations. Although there were more elective hospitalizations, emergency hospitalizations were associated with longer stays in hospital, and more days in an intensive care unit, resulting in a higher total cost of emergency hospitalizations than elective hospitalizations (total costs: emergency AU$7 748 718 vs elective AU$6 738 187). ‘Respiratory’ was the leading cause of emergency hospitalizations, contributing to 36% of all emergency admission costs. For a group of high‐cost inpatient users (top 5% of in iduals with the highest total inpatient costs) the most common reason for hospitalization was ‘respiratory’. Where non‐respiratory admissions were complicated by an additional respiratory diagnosis, length of stay was greater. Respiratory hospitalizations in CP are a significant driver of health care costs. In the paediatric group, they are a burden for a subgroup of children with CP.
Publisher: BMJ
Date: 17-09-2014
Publisher: Springer Science and Business Media LLC
Date: 08-08-2014
Publisher: Wiley
Date: 12-02-2010
DOI: 10.1111/J.1753-6405.1994.TB00217.X
Abstract: We compared the cost-effectiveness of interventions to prevent osteoporosis using a decision analytic model for a hypothetical cohort of 100,000 healthy perimenopausal women. The interventions were: oestrogen from age 50 for life, oestrogen from age 50 for 15 years, oestrogen from age 65 years for life, and a lifestyle regime of calcium supplements and exercise. The four interventions were compared with the case of no intervention by examining the effects on medical and nursing home costs, life years gained, quality-adjusted life years (QALYs) gained and costs per QALY gained. Lifetime oestrogen therapy from age 65 years achieved the lowest cost per life year gained and the lowest cost per QALY gained. The lifestyle intervention was the most expensive intervention by all measures but was sensitive to the cost of exercise and to the effects of exercise on cardiovascular mortality. Conventionally, oestrogen therapy begins at the menopause to avoid the rapid decline in bone mass that occurs with normally decreasing oestrogen levels. These results indicate that there is evidence, both in terms of fracture prevention and cost, to justify introduction of treatment at a later age. If a lifestyle intervention regimen can reduce cardiovascular mortality as well as hip fracture, this may provide an alternative means of reducing osteoporotic hip fracture at a reasonable cost.
Publisher: BMJ
Date: 08-2020
DOI: 10.1136/BMJOPEN-2019-036647
Abstract: Investment in early childhood produces positive returns: for the child, the family and the community. Benefits have been shown to be significant within certain parameters, but a systematic review of the economic evidence across multiple sectors including health, education and social welfare will have the capacity to inform policy relative to the full range of social determinants. This review will take a broad approach, encompassing a range of costs and benefits to enable the identification of the most beneficial investments in early childhood and to highlight gaps in current research. Economic evaluations incorporating both costs and long-term outcomes of early childhood interventions and programmes will be included. Outcomes may be valued in monetary units or quantified non-monetary units (eg, quality-adjusted life years (QALY), disability-adjusted life years (DALY)). Results will be expressed as a ratio according to the outcome with monetary outcomes expressed as cost-benefit ratios or return on investment, and non-monetary outcomes expressed as cost per QALY or DALY. The target population is children aged 0–5 years. Extensive database searches across sectors will be undertaken. The review will involve five phases: defining the research question, identifying relevant studies, selecting studies, extracting and collating data, and summarising and reporting results. The search commenced in 2019 and the expected end date is December 2020. The findings of this review will inform policymakers and practitioners in public health, education, social welfare and primary care settings. The publication plan includes a series of academic publications, and policy papers prepared and disseminated through Telethon Kids Institute networks. Exemption from ethics approval was granted by the University of Western Australia Human Ethics Office (RA/4/20/5677). CRD42020145901.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 02-2011
Publisher: Wiley
Date: 26-09-2018
DOI: 10.1111/JEP.13041
Abstract: There is considerable uncertainty around the cost-effectiveness of interventions for preventing secondary falls in older people presenting to emergency departments (ED). The objective was to complete an economic evaluation of a brief educational ED intervention aimed at preventing falls in older people post discharge. A net cost analysis was completed from the health system perspective, using data from a controlled clinical trial, where an education intervention was compared to standard care. Patients aged 65 and older presenting to the ED with any diagnosis were enrolled. The costs, using Australian dollars (A$) at 2015 values, included resources required for the intervention and any health care cost incurred in the 6-month follow-up period (time horizon). Cost data were sourced through institutional billing records and liaison with the patient and their general practitioner. Mean costs and differences were analysed through nonparametric bootstrapping. The total costs in the control group (n = 201) were A$1 576 496 compared to A$1 292 130 in the intervention group (n = 211). The mean net cost per patient was A$7749 and A$6187 (P = 0.68) respectively resulting in a mean difference of A$1580 per patient in the intervention group (95% CI: A$-2806 to A$6150). Patients who presented to the ED with a fall diagnosis were reviewed through subgroup analysis. Total costs for patients who presented with a fall in the control group (n = 69) were A$708 995 compared to A$512 874 in the intervention group (n = 97). The mean net cost per patient was A$10 326 and A$5343 respectively (P = 0.33) with an overall saving of A$4624 per patient in the intervention group (95% CI: A$-2868 to A$15 426). A brief intervention had no net cost benefit across the whole study population, but is more cost effective in older people presenting to the ED with a fall.
Publisher: Elsevier BV
Date: 04-2017
DOI: 10.1038/GIM.2016.130
Abstract: Increasingly, women newly diagnosed with breast cancer are being offered treatment-focused genetic testing (TFGT). As the demand for TFGT increases, streamlined methods of genetic education are needed. In this noninferiority trial, women aged <50 years with either a strong family history (FH+) or other features suggestive of a germ-line mutation (FH-) were randomized before definitive breast cancer surgery to receive TFGT education either as brief written materials (intervention group (IG)) or during a genetic counseling session at a familial cancer clinic (usual-care group (UCG)). Women completed self-report questionnaires at four time points over 12 months. A total of 135 women were included in the analysis, all of whom opted for TFGT. Decisional conflict about TFGT choice (primary outcome) was not inferior in the IG compared with the UCG (noninferiority margin of -10 mean difference = 2.45 95% confidence interval -2.87-7.76 P = 0.36). Costs per woman counseled in the IG were significantly lower (AUD$89) compared with the UCG (AUD$173 t(115) = 6.02 P < 0.001). A streamlined model of educating women newly diagnosed with breast cancer about TFGT seems to be a cost-effective way of delivering education while ensuring that women feel informed and supported in their decision making, thus freeing resources for other women to access TFGT.Genet Med 19 4, 448-456.
No related organisations have been discovered for Elizabeth Geelhoed.
Start Date: 2007
End Date: 2013
Funder: National Health and Medical Research Council
View Funded ActivityStart Date: 2018
End Date: 2020
Funder: National Health and Medical Research Council
View Funded ActivityStart Date: 2016
End Date: 2021
Funder: National Health and Medical Research Council
View Funded ActivityStart Date: 12-2020
End Date: 12-2025
Amount: $1,357,136.00
Funder: Australian Research Council
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