General Practice and Primary Care - Research Publications
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ItemThe Victorian Comprehensive Cancer Centre lung cancer clinical audit: collecting the UK National Lung Cancer Audit data from hospitals in Australia(WILEY, 2019-08-01)BACKGROUND: Clinical audit may improve practice in cancer service provision. The UK National Lung Cancer Audit (NLCA) collects data for all new cases of thoracic cancers. AIM: To collect similar data for our Victorian patients from six hospitals within the Victorian Comprehensive Cancer Centre and associated Western and Central Melbourne Integrated Cancer Service. METHODS: We conducted a retrospective audit of all newly diagnosed patients with lung cancer and mesothelioma in 2013 across the six Victorian Comprehensive Cancer Centre/Western and Central Melbourne Integrated Cancer Service hospitals. The objectives were to adapt the NLCA data set for use in the Australian context, to analyse the findings using descriptive statistics and to determine feasibility of implementing a routine, ongoing audit similar to that in the UK. Individual data items were adapted from the NLCA by an expert steering committee. Data were collated from the Victorian Cancer Registry, Victorian Admitted Episodes Dataset and individual hospital databases. Individual medical records were audited for missing data. RESULTS: Eight hundred and forty-five patients were diagnosed across the sites in 2013. Most were aged 65-80 (55%) and were male (62%). Most had non-small-cell lung cancer (81%) with 9% diagnosed with small cell lung cancer and 2% with mesothelioma. Data completeness varied significantly between fields. For those with higher levels of completeness, headline indicators of clinical care were comparable with NLCA data. The Victorian population seem to lack access to specialist lung cancer nurse services. CONCLUSION: Lung cancer care at participating hospitals appeared to be comparable with the UK in 2013. In future, prospective data collection should be harmonised across sites and correlated with survival outcomes. One area of concern was a lack of documented access to specialist nursing services.
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ItemDetection of a soil moisture and groundwater signal in ground-based gravity observations(Conference Organising Committee for the 40th Australian Conference of Economists, 2006)Gravity observations have the potential to provide an exciting new source of remotely sensed data to constrain the water balance in land surface models. This would result in more accurate soil moisture and flux predictions and correspondingly improved numerical weather prediction and global climate forecasts. However before existing or future (GRACE or GOCE) dedicated gravity satellites can be utilised in an operational setting it must be shown that a soil moisture signal is detectable in gravity observations. This is extremely difficult to show directly for the satellite observations due to the massive spatial scale involved (1000 km2or larger depending on accuracy requirements), so a ground-based field study of soil moisture, groundwater and gravity changes is essential in verifying the magnitude of the hydrological signal in gravity observations. This paper presents results from two field sites in the Kyeamba Creek catchment in NSW where soil moisture, groundwater and gravity have been monitored for one year. One is a hillslope site with no groundwater whereas the other is a valley site with a shallow water table. After correcting for earth tides and gravity meter drift, a gravity network adjustment is performed for two time periods chosen to capture the full range of subsurface water storage (autumn and spring). The adjustment improves the precision of the gravity estimates at each site relative to a hydrologically stable bedrock reference site. A t-test is performed on the gravity changes at the two sites and the valley site is found to have a significant change in gravity that corresponds extremely well to the predicted hydrologically induced gravity change. There are many complicating factors in a ground-based study, but nevertheless a hydrological signal (predominantly soil moisture) has been detected in the gravity observations of a valley site with a shallow groundwater table.
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ItemThe Improving Rural Cancer Outcomes Trial: a cluster-randomised controlled trial of a complex intervention to reduce time to diagnosis in rural cancer patients in Western Australia(SPRINGERNATURE, 2017-11-07)BACKGROUND: Rural Australians have poorer survival for most common cancers, due partially to later diagnosis. Internationally, several initiatives to improve cancer outcomes have focused on earlier presentation to healthcare and timely diagnosis. We aimed to measure the effect of community-based symptom awareness and general practice-based educational interventions on the time to diagnosis in rural patients presenting with breast, prostate, colorectal or lung cancer in Western Australia. METHODS: 2 × 2 factorial cluster randomised controlled trial. Community Intervention: cancer symptom awareness campaign tailored for rural Australians. GP intervention: resource card with symptom risk assessment charts and local cancer referral pathways implemented through multiple academic detailing visits. Trial Area A received the community symptom awareness and Trial Area B acted as the community campaign control region. Within both Trial Areas general practices were randomised to the GP intervention or control. PRIMARY OUTCOME: total diagnostic interval (TDI). RESULTS: 1358 people with incident breast, prostate, colorectal or lung cancer were recruited. There were no significant differences in the median or ln mean TDI at either intervention level (community intervention vs control: median TDI 107.5 vs 92 days; ln mean difference 0.08 95% CI -0.06-0.23 P=0.27; GP intervention vs control: median TDI 97 vs 96.5 days; ln mean difference 0.004 95% CI -0.18-0.19 P=0.99). There were no significant differences in the TDI when analysed by factorial design, tumour group or sub-intervals of the TDI. CONCLUSIONS: This is the largest trial to test the effect of community campaign or GP interventions on timeliness of cancer diagnosis. We found no effect of either intervention. This may reflect limited dose of the interventions, or the limited duration of follow-up. Alternatively, these interventions do not have a measurable effect on time to cancer diagnosis.
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ItemBYOD in Hospitals-Security Issues and Mitigation Strategies.(ACM Press, 2019)The demand for using personal devices in hospitals (BYOD) has increased rapidly over the years. However, BYOD also means that healthcare organisations are at great risk of leaking sensitive information assets like Personal Health Information (PHI) of patients, given that personal devices are outside the control of hospital IT management and may lack important security measures. Hence, the aim of this research is to develop a mitigation strategy which can cater to such security issues. A comprehensive literature review was conducted to identify BYOD security issues and mitigation solutions. This was followed by using two existing security frameworks, the BYOD security framework and People Policy Technology (PPT) model to shape a stepwise mitigation strategy. Technical, managerial and social issues were identified which include unsecure user behaviour by hospital employees, lack of security awareness, usability issues, legal requirements and lost devices. The mitigation strategy elucidates that while information and communication technologies allow better enforcement of security measures; policies and training provide the desired guidance to influence positive user behaviour among employees. The paper also discusses the need for a balance between usability and security in the success of BYOD in hospitals and hence provides systematic guidelines to curb BYOD security risks in hospitals.