Phased implementation of pathogen-reduced platelets in a health system facilitates increased manufacturing at the blood center.

BACKGROUND: Pathogen reduction treatment (PRT) reduces the risk of transfusion-transmitted infections from established and emerging organisms. Manufacturing, however, is complex. In our university health system, we phased in pathogen-reduced platelets (PR PLTs) by patient population. We then assessed the implementation strategy and investigated factors in the supply chain that prevented us from meeting the goal of providing greater than 90% PR PLTs within 6 months. STUDY DESIGN AND METHODS: In Phase 1, PR PLTs were provided in the outpatient cancer center. Phase 2 added inpatients undergoing bone marrow transplantation, and Phase 3 included all patients. In Phase 4, the blood center implemented manufacturing optimization strategies. Product supply and usage during the first 23 months after implementation were evaluated. Investigation of the supply chain included analysis of (1) the number of in-state hospitals receiving PR PLTs; (2) the fraction of products eligible for PRT before and after manufacturing improvements. RESULTS: During Phases 1 and 2, PR products comprised 44% and 53% of PLTs transfused in the phased-in areas. At 6 months, 41% of PLTs were PR, and at 23 months, 92%. The fraction of PR PLTs transfused in our system correlated logarithmically with the number of in-state hospitals receiving them (R2 = 0.71) and the number of PR PLTs sold to those hospitals (R2 = 0.80). CONCLUSION: Phased implementation is a practical and ethical way to introduce PR PLTs in a health system and facilitates scalability at the blood center. Widespread availability of PR products may require collective action and can be increased by optimization strategies during manufacturing.

Community outreach midwifery-led model improves antenatal access in a disadvantaged population.

OBJECTIVE: This study aimed to assess the impact of a new model of antenatal care for women living in a very remote area. DESIGN: This is a retrospective 2-year evaluation of antenatal care. SETTING AND PARTICIPANTS: Two hundred thirteen pregnant women in Aboriginal communities in the Fitzroy Valley of Western Australia participated in this study. INTERVENTION: The implementation of a midwifery-led interdisciplinary model of antenatal outreach care. MAIN OUTCOME MEASURES: The indicators measured were numbers of antenatal visits, their location and quality care indicators (presentation in first trimester, alcohol and smoking, ultrasound and blood-borne virus screening) and outcome indicators (birth weight, prematurity, in utero deaths and mode of delivery). RESULTS: There was an increase in access to antenatal care and improvements in quality-of-care indicators. The proportion of visits provided in local Aboriginal communities increased from 10% to 24%. There were statistically significant increases in women presenting in the first trimester (40-58%), screening for alcohol and smoking (48-93%) and having an ultrasound in pregnancy (59-94%). There were no significant improvements in neonatal outcome indicators. CONCLUSION: There is a large disparity in maternal and child health outcomes between Aboriginal and Torres Strait Islander (Indigenous) and non-Indigenous Australians thought to be due to decreased access to antenatal care, poorer socioeconomic status and the associated risk factors. The change in model of care resulted in earlier presentation for antenatal care, increased numbers of antenatal visits and increased screening for risk factors. Regular auditing of services enables the identification of opportunity for improvement with the goal of improving health outcomes.

Prevalence of airflow obstruction and reduced forced vital capacity in an Aboriginal Australian population: The cross-sectional BOLD study.

BACKGROUND AND OBJECTIVE: Mortality and hospital separation data suggest a higher burden of chronic obstructive pulmonary disease (COPD) in indigenous than non-indigenous subpopulations of high-income countries. This study sought to accurately measure the true prevalence of post-bronchodilator airflow obstruction and forced vital capacity reduction in representative samples of Indigenous and non-Indigenous Australians. METHODS: This study applies cross-sectional population-based survey of Aboriginal and non-Indigenous residents of the Kimberley region of Western Australia aged 40 years or older, following the international Burden Of Lung Disease (BOLD) protocol. Quality-controlled spirometry was conducted before and after bronchodilator. COPD was defined as Global initiative for chronic Obstructive Lung Disease (GOLD) Stage 2 and above (post-bronchodilator forced expiratory volume in 1 s/forced vital capacity (FEV1 /FVC) ratio <0.7 and FEV1 < 80% predicted). RESULTS: Complete data were available for 704 participants. The prevalence of COPD, adjusted for age, gender and body weight in Aboriginal participants (7.2%, 95% confidence interval (CI) 3.9 to 10.4) was similar to that seen in non-Indigenous Kimberley participants (8.2%, 95% CI 5.7 to 10.7) and non-Indigenous residents of the remainder of Australia (7.1%, 95% CI 6.1 to 8.0). The prevalence of low FVC (<80% predicted) was substantially higher in Aboriginal compared with non-Indigenous participants (74.0%, 95% CI 69.1 to 78.8, vs 9.7%, 95% CI 7.1 to 12.4). CONCLUSIONS: Low FVC, rather than airflow obstruction, characterizes the impact of chronic lung disease previously attributed to COPD in this population subject to significant social and economic disadvantage. Environmental risk factors other than smoking as well as developmental factors must be considered. These findings require further investigation and have implications for future prevention of chronic lung disease in similar populations.

Evaluation of an ear health pathway in remote communities: improvements in ear health access.

OBJECTIVE: Reduce long waiting lists for ear, nose and throat (ENT) specialist review and improve primary ear health care. DESIGN: A retrospective evaluation of ear health care after the implementation of an ear health program (EHP). SETTING AND PARTICIPANTS: School children in Aboriginal communities in the Fitzroy Valley of Western Australia. KEY MEASURES FOR IMPROVEMENT: Access number of children screened for ear disease, effectiveness-referral letter completeness (history, otoscopy, tympanometry, audiometry), patient management and waiting time until first ENT contact. INTERVENTIONS: EHP--an electronic referral template, ear health nurse, ear health educator and telehealth ENT specialist review. MAIN OUTCOME MEASURES: Screening rates, timely ENT review and improved primary care management. RESULTS: Number of children screened increased from 148 per 18 months to 710. Nearly twofold increase in numbers of patients referred to ENT (32, 66). A reduction in median waiting time from 141 days to 22 days for ENT review using telehealth. Content of referral letters showed an increase in essential information--otoscopy, audiometry and tympanometry. Primary care management in accordance with guidelines improved. CONCLUSIONS: The addition of an ear health team increased access to appropriate primary care management and the time to contact with ENT was reduced by using an electronic template and telehealth sessions.

Short communication: a simple method for performing worm-egg counts on sodium acetate formaldehyde-preserved samples.

The Kato Katz method is the most common way of performing worm-egg counts on human faecal samples, but it must be done in the field using freshly collected samples. This makes it difficult to use in remote, poorly accessible situations. This paper describes a simple method for egg counts on preserved samples collected in the field and sent to a central location for further processing.

Predicting respiratory syncytial virus hospitalisation in Australian children.

BACKGROUND: There is limited information on respiratory syncytial virus infections among Australians, particularly those of Indigenous descent. AIM: This study identifies groups of infants at risk of hospitalisation with respiratory syncytial virus-positive lower respiratory tract infection who may be targeted for prevention with palivizumab. METHODS: Case control study: the case notes of 271 children with cases of respiratory syncytial virus-positive lower respiratory tract infection admitted to The Townsville Hospital were studied for risk factors. Controls were chosen randomly from babies born in The Townsville Hospital during that period. Multiple logistic regression analysis and classification and regression tree analysis were used to identify risk factors. RESULTS: Multiple logistic regression analysis identified birthweight <2500 g, maternal parity and marital status to be independent predictors of hospitalisation with respiratory syncytial virus-positive lower respiratory tract infection. Classification and regression tree analysis identified babies born weighing <2500 g who possessed older siblings to be at highest risk. Single mothers and smoking were additional risk factors. Indigenous babies were significantly more likely to be exposed to all of the identified risk factors. CONCLUSION: Babies born weighing <2500 g (especially with siblings) could be targeted for prevention. All Indigenous babies should be considered at high risk because of their exposure to multiple risk factors.