Medical Education - Research Publications
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ItemNo Preview AvailableCommunity engagement programs and socially accountable medical education(The Australian & New Zealand Association for Health Professional Educators, 2016)
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ItemNo Preview AvailableFactors associated with readmission after chronic obstructive pulmonary disease related hospitalisation(WILEY, 2018-03)Introduction/Aim: Acute exacerbations of Chronic Obstructive Pulmonary Disease (COPD) are associated with increased morbidity and mortality. Readmission within 30 or 60 days of discharge remains common. The purpose of this study was to identify factors in COPD admissions that are associated with readmission at two Melbourne teaching hospitals. Methods: Admissions where COPD was the principal diagnosis between August 1st and December 31st 2016 were retrospectively reviewed through the electronic database of Western Health. Information pertaining to the patient, COPD severity and treatment, as well as to the admission itself was recorded. Admissions were not recorded if they were incomplete, if follow-up was not possible, or if the admission concluded with death. Data was analysed through STATA (v14.2). Results: 211 admissions were included. The outcome 30-day readmission occurred 39 times (19.0%) and the outcome 60-day readmission occurred 60 times (28.4%). Patients who were readmitted were generally older and male. Univariate analysis demonstrated that the risk of 30-day readmissions was higher in patients with more previous COPD or total admissions, lower FEV1, higher bicarbonate levels, abnormal chest x-rays, admissions to Footscray Hospital, higher number of regular medications, and a recent history of pulmonary rehabilitation or Hospital Admission Risk Program participation. Multivariate analysis showed that a higher number of regular medications, a recent COPD admission, a higher white blood cell count, and higher bicarbonate levels on admission were associated with 30-day readmissions (corrected for age, sex, and hospital site). Similar associations were observed for 60-day readmission. Conclusion: Readmission within 30 and 60 days of discharge after admission for AECOPD are common in the Western Health population. Several factors were significantly associated with readmission, in particular those related to COPD severity.
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ItemNo Preview AvailableQuality of communication regarding patient care in the Intermediate Respiratory Care Unit (ircu)(WILEY-BLACKWELL, 2016-04)Introduction/Aim: Intermediate Respiratory Care Units (IRCU) are commonly used to facilitate management of patients in respiratory failure requiring a period of non-invasive ventilation (NIV) who can be managed in the ward (non-intensive care) setting. At Western Health, these patients are admitted under the Respiratory unit or an alternative unit (for example General Medicine). Patients requiring NIV are managed collaboratively by their admitting unit and the Respiratory unit with support from allied health and nursing staff. Clear delineation of responsibility and good communication is essential between those managing IRCU patients to ensure timely decision making and optimal patient care. There is anecdotal evidence that the communication between specialties managing these patients is often suboptimal. An objective assessment of the limitations in understanding and communication will allow delivery of appropriate and meaningful education to those involved in IRCU patient care. Methods: Staff involved in the management of patients admitted to the IRCU at Footscray Hospital were surveyed to assess their understanding of the role of the Unit and their responsibilities with regard to shared management of patients in the unit. Additionally, the inpatient records of all patients admitted to the unit over three non-consecutive months in 2014 were reviewed to assess the quality of written communication between the Respiratory unit, home unit (where applicable), nursing staff and allied health using a standard assessment form. Results: Preliminary review of survey responses reflects a reported good understanding of the role of IRCU and the indications/contraindications for management of patients in IRCU. There was a less satisfactory understanding of appropriate lines of communication and division of responsibility between specialties. We expect in-depth review of the survey responses to elicit clear areas that need further education. Analysis of the inpatient records will provide objective evidence of quality of written communication regarding patient care and decision making. Conclusion: Ongoing analysis of inpatient notes and survey responses will provide a clear picture of areas requiring further education and improvement. This will enable the improvement of current guidelines for the management of patients in IRCU and an education package to improve understanding of staff managing these patients. This will ultimately result in improvement in quality of patient care in the Unit.
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ItemNo Preview AvailablePrevalence of illegal inhalant use among patients undergoing respiratory function tests at Western Health(WILEY, 2017-03)Introduction/Aim: In 2014, 75% of Victorian Illicit Drug Reporting System participants reported recently using methamphetamine (75%), significantly higher than in 2013 (55%, p < 0.001). Cannabis lifetime use was 97%, with 75% recent users and 47% daily users. Lifetime use of E-cigarettes was 27% and recent use was 23%, with a median frequency of use of two days. (IDRS 2014)1 Little is known about the prevalence of illicit inhalant use in Melbourne's Western suburbs. Footscray and Sunshine Hospitals serve the most disadvantaged areas of Melbourne with the highest rates of unemployment. It has been found that the unemployed population is 1.6 times more likely to use cannabis and 2.4 times more likely to use methamphetamines. (AIHW 2014)2 The purpose of this study is to identify the prevalence of illegal inhalant use among patients undergoing respiratory function tests at Western Health. Methods: This study is a prospective audit and involves the completion of an anonymous questionnaire by patients performing respiratory function tests over three months. The questionnaire explores recent and current usage of inhaled methamphetamine, marijuana and tobacco via E-cigarettes and standard cigarettes. The questionnaire is available in multiple languages. The anticipated dataset is 300–500 patients. Voluntary completion of the survey is requested from all adult patients (>18 years) with implied consent. Results: Data collection has commenced across two laboratories. We anticipate the data will corroborate anecdotal reports of high drug use amongst the Western Health patient population. Conclusion: Counselling regarding the use of illicit inhalants represents an important and under-emphasised aim for patients at Western Health. Through demonstrating the prevalence of illicit inhalant use within our population, we hope to increase awareness of this issue amongst our doctors. Concurrent education on topics such as street names and modes of delivery will enable doctors to elicit a more thorough illicit drug history.
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ItemNo Preview AvailablePrescribing oxygen: An audit of prescribing and delivery practices at two tertiary hospitals in Melbourne, Australia(Wiley Online Library, 2021)Background and Aims: Over-oxygenation in COPD patients can result in adverse outcomes. The use of specific oxygen saturation targets in COPD has been associated with less acidosis, a lower requirement for assisted ventilation, and reduced mortality. Our study reviews current practices of both oxygen prescription and delivery for patients admitted at two tertiary hospitals with an exacerbation of COPD. Methods: This retrospective audit included all admissions at two tertiary hospitals with a primary diagnosis of exacerbation of COPD over 6 months (April to September 2020). Medical records were reviewed to determine how many had documented target SpO2 ranges and how concordant these were with the Thoracic Society of Australia and New Zealand guidelines (SpO2 range 88% to 92% in COPD). For those with documented SpO2 ranges, we determined the percentage of recorded SpO2 levels that were below, above and within the target range. Results: 312 admissions for exacerbation of COPD were reviewed. Target SpO2 goals were documented for 57% of admissions (N=178), of which 77% (N=137) were consistent with current guidelines. Of those with a documented SpO2 range, only 75.4% of recorded SpO2 readings were within range, with 2.3% falling below and 22.3% above range. Conclusions: Our results highlight underutilisation of SpO2 targets in patients with COPD, as well as frequent over-oxygenation despite documented targets.
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ItemNo Preview AvailableUtility of the stop and stop-bang questionnaires in a pre-screened population presenting for overnight polysomnography(Wiley, 2009)Obstructive Sleep Apnoea (OSA) is a common condition, the diagnosis of which is often delayed by prolonged waiting lists at the point of referral or in the sleep laboratory. Clinical prediction tools may become useful in triaging assessment and management of this condition.Recent publications have proposed and validated two new pre-opera-tive screening tools for Obstructive Sleep Apnoea (OSA) in surgical patients (STOP and STOP-BANG). These screening tools have not been examined in a general sleep population.Methods: All patients attending for in-laboratory polysomnography at Box Hill Hospital during the study period were asked to complete the STOP questionnaire, and sleep scientists recorded the biometric data required for the BANG component. Polysomnography proceeded with sleep staging and event scoring performed according to the Chicago Criteria.Risk stratification by the STOP and STOP-BANG tools was combined with total Respiratory Disturbance Index from polysomnogram reports.Results: 69 patients have been recruited, although data continues to be collected. As expected, there is a predominance of moderate and severe OSA in this cohort (45/69, 65%).The STOP-BANG tool maintains higher sensitivity, negative predic-tive value and odds ratios than the STOP tool at each degree of OSA severity examined. Receiver operating characteristic curves demonstrate superiority of the STOP-BANG tool for RDI > 15, when compared with STOP-BANG for RDI > 30 and STOP at both RDI cut-offs.Conclusions: With ongoing data collection we hope to confirm trends seen in predictive values with these tools. Removal of less discrimina-tory criteria may improve their statistical usefulness, perhaps allowing development into risk stratification tools that will assist in triaging investigation and management of patients with suspected OSA.
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ItemRecommendations from The Medical Education Editor(WILEY, 2022-10)
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ItemBilirubin as a new antioxidant in melasma(WILEY, 2022-11)BACKGROUND: Oxidative stress and its role in the pathogenesis of cutaneous diseases have been widely investigated. However, there are few studies that have solely assessed the contribution of intracellular antioxidants in the etiopathology of melasma. Furthermore, there are convincing reports about antioxidant properties of bilirubin (Bil) and uric acid (UA) in some skin disorders but not melasma. OBJECTIVE: This study aimed to determine serum levels of two major extracellular antioxidants (Bil and UA) levels in patients with melasma and their correlation with the severity and extent of the disease. METHODS: In this case-control study, the serum levels of bilirubin and uric acid of 50 melasma patients were compared with 50 healthy controls. Moreover, the correlation of serum concentrations of these antioxidants with the extent and severity of the disease were assessed. RESULTS: The serum concentration of Bil was significantly higher in the case group (p < 0.05). Furthermore, serum Bil level had a positive correlation with the extent of the melasma (correlation coefficient, +0.3; p < 0.05). No significant difference was found between the serum concentrations of UA between the study and control group. Neither Bil nor UA had a significant correlation with the severity of the disease. CONCLUSION: Oxidative stress may play a major role in the etiopathology of melasma and bilirubin, as an antioxidant, could be involved in the process of oxidative stress.
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ItemInsulin antibodies are prevalent in adults with type 1 diabetes referred for islet cell transplantation and are modified by islet transplantation and immunosuppression: an Australian experience(WILEY, 2022-08)We have analysed insulin antibodies in 149 adults with type 1 diabetes and 2859 people without diabetes. We have determined that insulin antibody levels are higher in adults with, versus without, diabetes and that the levels are falling, and more patients are becoming antibody-negative post islet cell transplantation.