Anatomy and Neuroscience - Research Publications

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Author: Irving, Louis × Author: Smallwood, Natasha × End date: 2021 × Start date: 2020 ×

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    Burden of diagnostic investigations at the end of life for people with chronic obstructive pulmonary disease
    Ross, L ; Taverner, J ; John, J ; Baisch, A ; Irving, L ; Philip, J ; Smallwood, N (WILEY, 2021-11)
    BACKGROUND: Chronic obstructive pulmonary disease (COPD) is an incurable, chronic condition that leads to significant morbidity and mortality, with most patients dying in hospital. While diagnostic tests are important for actively managing patients during hospital admissions, the balance between benefit and harm should always be considered. This is particularly important when patients reach the end of life, when the focus is to reduce burdensome interventions. AIMS: To examine the use of diagnostic testing in a cohort of people with COPD who died in hospital. METHODS: Retrospective medical record audits were completed at two Australian hospitals (Royal Melbourne Hospital and Northeast Health Wangaratta), with all patients who died from COPD over 12 years between 1 January 2004 and 31 December 2015 included. RESULTS: Three hundred and forty-three patients were included, with a median of 11 diagnostic testing episodes per patient. Undergoing higher numbers of diagnostic tests was associated with younger age, intensive care unit admission and non-invasive ventilation use. Reduced testing was associated with recent hospital admission for COPD, domiciliary oxygen use and a prior admission with documentation limiting medical treatment. Most patients underwent diagnostic tests in the last 2 days of life, and 12% of patients had ongoing diagnostic tests performed after a documented decision was made to change the goal of care to provide comfort care only. CONCLUSION: There were missed opportunities to reduce the burden of diagnostic tests and focus on comfort at the end of life. Increased physician education regarding communication and end-of-life care, including recognising active dying may address these issues.
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    Australian childcare centres are too close to car parks exposing children with developing lungs to high levels of traffic pollution
    Birch, H ; Walter, C ; Irving, L ; Dharmage, SC ; Smallwood, N (WILEY, 2020-12)
    OBJECTIVE: To examine the co-location of childcare centres and their outdoor play spaces with car parks in Melbourne and Sydney, Australia. METHODS: The co-location of childcare centre outdoor play spaces and car parks was examined through measurement of horizontal and vertical distances using Google Earth Pro satellite imagery. RESULTS: One hundred and forty-two childcare centres were studied in Melbourne, with 133 accompanying car parks identified. Eighty-one (57.0%) centres had a significant size car park within 150 m and 43.7% had a car park within 100 m. Twenty car parks (15.0%) were found within 10 metres of childcare centres, of which 12 (9.0%) had more than 100 spaces. Twenty centres were examined in Sydney, with 31 associated car parks identified. Eighteen childcare centres (90.0%) had car parks within 150 m and 17 (85.0%) had car parks within 100 m. CONCLUSION: Australian childcare centres are located too close to car parks exposing children to pollution and likely impacting the development of chronic respiratory disease. Traffic pollution is an avoidable risk that must be considered when planning childcare centre location. Implications for public health: The co-location of childcare centres with large-scale car parks may have long-term impacts on the respiratory health of Australian children under the age of five.