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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 AvailableUse of collaborative request model was highly correlated with organ donation consent.(LIPPINCOTT WILLIAMS & WILKINS, 2019-11)Background: There continues to be a disconnect between Australian’s self-reported support for organ donation and formal end-of-life family consent rates. In 2015, a multi-site Australian study by Lewis et al. demonstrated that consent rates were optimised by involving a clinician who had specific training in donation conversations, and in addition, was independent of the treating team. This approach is known as “Collaborative requesting” in Australia. The aim of the study was to report our single institution’s experience in introducing and augmenting the collaborative request model. Methods: The Royal Melbourne Hospital (RMH), is one of two adult tertiary trauma centres for the city of Melbourne, Australia. Additionally, the hospital has specialist neurosurgical and stroke services. Australia permits organ donation via both brain death and controlled circulatory death pathways. The hospital co-employs 4 embedded Donation Specialist Nursing Coordinators, and 3 fractionally appointed Medical Donation Specialists. Both craft groups have specialist communication training, and in addition, nursing coordinators have detailed end-to-end case donation management experience. Over a three-year period, the RMH progressively implemented the request model. Rather than using “any” independent clinician with donation communication training (the Lewis Model), the unit promoted the use of embedded Donation Specialist Nursing Coordinators as the collaborative requestors (the augmented collaborative model). Results: From January 2016 to June 2018 there were 135 donation requests raised by staff. Donation conversations raised by the family were excluded from analysis, as they have a consent rate at our hospital of over 90%. During the study period collaborative requesting increased from 50% (Jan 2016) to 96% (Jun 2018). Over the 3 study years (2016, 2017 and first half of 2018), the consent rate was highly positively correlated with the increased use of a collaborative model (r2=0.984). Conclusions: Since the introduction of embedded donation specialist nursing coordinators in RMH ICU, the hospital has seen both a clinically and statistically significant improvement in organ donation consent rates.
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ItemNo Preview AvailableEndoscopic features of buried Barrett's mucosa: visible to the trained eye?(Wiley, 2019-12-01)
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ItemNo Preview AvailableFemale genital cosmetic surgery toolkit for general practitioners and other health professionals(BMJ PUBLISHING GROUP, 2015)
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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)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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ItemFemale Reproductive and Hormonal Factors and Incidence of Primary Total Knee Arthroplasty Due to Osteoarthritis(WILEY, 2018-07)OBJECTIVE: To examine the associations of female reproductive and hormonal factors with incidence of total knee arthroplasty (TKA) for osteoarthritis (OA), and to determine whether the associations differ according to overweight/obesity status. METHODS: This study included 22,289 women in the Melbourne Collaborative Cohort Study. Data on age at menarche, pregnancy, parity, years of menstruation, oral contraceptive (OC) use, menopausal status, and hormone replacement therapy (HRT) were collected in 1990-1994. Incidence of TKA during 2001-2013 was determined by linking cohort records to the Australian Orthopaedic Association National Joint Replacement Registry. All analyses were adjusted for age, body mass index (BMI) at midlife, change in BMI (from early reproductive age to midlife), country of birth, physical activity, smoking, and education level. RESULTS: Over the course of 12.7 years, 1,208 TKAs for OA were identified. Ever being pregnant was associated with increased risk of TKA (hazard ratio [HR] 1.32 [95% confidence interval (95% CI) 1.06-1.63]). Parity was positively associated with risk of TKA (P for trend = 0.003). OC users had increased risk of TKA compared with non-users (for OC use of <5 years, HR 1.25 [95% CI 1.08-1.45]; for OC use of ≥5 years, HR 1.17 [95% CI 1.00-1.37]). A 1-year increase in menstruation was associated with a 1% decrease in risk of TKA (HR 0.99 [95% CI 0.97-0.99]). These associations remained significant only in women of normal weight at early reproductive age. Current HRT users had increased risk of TKA compared with non-users (HR 1.37 [95% CI 1.14-1.64]); the association was significant only in non-obese women at midlife. CONCLUSION: Reproductive and hormonal factors were associated with risk of knee OA. These associations remained significant in women of normal weight at early reproductive age and in non-obese women at midlife. Further work is needed to understand the complex effect of these factors on knee OA.
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ItemAssociation between metformin use and disease progression in obese people with knee osteoarthritis: data from the Osteoarthritis Initiativea prospective cohort study(BMC, 2019-05-24)OBJECTIVE: To examine whether metformin use was associated with knee cartilage volume loss over 4 years and risk of total knee replacement over 6 years in obese individuals with knee osteoarthritis. METHODS: This study analysed the Osteoarthritis Initiative participants with radiographic knee osteoarthritis (Kellgren-Lawrence grade ≥ 2) who were obese (body mass index [BMI] ≥ 30 kg/m2). Participants were classified as metformin users if they self-reported regular metformin use at baseline, 1-year and 2-year follow-up (n = 56). Non-users of metformin were defined as participants who did not report the use of metformin at any visit from baseline to 4-year follow-up (n = 762). Medial and lateral cartilage volume (femoral condyle and tibial plateau) were assessed using magnetic resonance imaging at baseline and 4 years. Total knee replacement over 6 years was assessed. General linear model and binary logistic regression were used for statistical analyses. RESULTS: The rate of medial cartilage volume loss was lower in metformin users compared with non-users (0.71% vs. 1.57% per annum), with a difference of - 0.86% per annum (95% CI - 1.58% to - 0.15%, p = 0.02), after adjustment for age, gender, BMI, pain score, Kellgren-Lawrence grade, self-reported diabetes, and weight change over 4 years. Metformin use was associated with a trend towards a significant reduction in risk of total knee replacement over 6 years (odds ratio 0.30, 95% CI 0.07-1.30, p = 0.11), after adjustment for age, gender, BMI, Kellgren-Lawrence grade, pain score, and self-reported diabetes. CONCLUSIONS: These data suggest that metformin use may have a beneficial effect on long-term knee joint outcomes in those with knee osteoarthritis and obesity. Randomised controlled trials are needed to confirm these findings and determine whether metformin would be a potential disease-modifying drug for knee osteoarthritis with the obese phenotype.