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1.
Trials ; 23(1): 31, 2022 Jan 12.
Artículo en Inglés | MEDLINE | ID: mdl-35022080

RESUMEN

BACKGROUND: Increasing participation in the Australian National Bowel Cancer Screening Program (NBCSP) is the most efficient and cost-effective way of reducing mortality associated with colorectal cancer by detecting and treating early-stage disease. Currently, only 44% of Australians aged 50-74 years complete the NBCSP. This efficacy trial aims to test whether this SMS intervention is an effective method for increasing participation in the NBCSP. Furthermore, a process evaluation will explore the barriers and facilitators to sending the SMS from general practice. METHODS: We will recruit 20 general practices in the western region of Victoria, Australia to participate in a cluster randomised controlled trial. General practices will be randomly allocated with a 1:1 ratio to either a control or intervention group. Established general practice software will be used to identify patients aged 50 to 60 years old who are due to receive a NBCSP kit in the next month. The SMS intervention includes GP endorsement and links to narrative messages about the benefits of and instructions on how to complete the NBCSP kit. It will be sent from intervention general practices to eligible patients prior to receiving the NBCSP kit. We require 1400 eligible patients to provide 80% power with a two-sided 5% significance level to detect a 10% increase in CRC screening participation in the intervention group compared to the control group. Our primary outcome is the difference in the proportion of eligible patients who completed a faecal occult blood test (FOBT) between the intervention and control group for up to 12 months after the SMS was sent, as recorded in their electronic medical record (EMR). A process evaluation using interview data collected from general practice staff (GP, practice managers, nurses) and patients will explore the feasibility and acceptability of sending and receiving a SMS to prompt completing a NBCSP kit. DISCUSSION: This efficacy trial will provide initial trial evidence of the utility of an SMS narrative intervention to increase participation in the NBCSP. The results will inform decisions about the need for and design of a larger, multi-state trial of this SMS intervention to determine its cost-effectiveness and future implementation. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry ACTRN12620001020976 . Registered on 17 October 2020.


Asunto(s)
Neoplasias Colorrectales , Detección Precoz del Cáncer , Neoplasias Colorrectales/diagnóstico , Humanos , Tamizaje Masivo , Persona de Mediana Edad , Sangre Oculta , Victoria
2.
J Health Organ Manag ; ahead-of-print(ahead-of-print)2022 Jan 06.
Artículo en Inglés | MEDLINE | ID: mdl-34986296

RESUMEN

PURPOSE: The purpose of this study was to examine the concept of value in healthcare through a practical appraisal of the applicability of a conceptual framework, which is aimed at supporting the measurement and realisation of financial benefits from process improvement (PI) activities in a hospital setting. DESIGN/METHODOLOGY/APPROACH: A single case study of a hospital system in Melbourne, Victoria, Australia, was used to assess the applicability of the framework. The study sought to verify the framework's intention, that PI methods could be used to address known wastes that contribute to the cost of providing healthcare. The case study examines the current approach taken by the hospital to measure and realise financial benefits from PI activities and compares these to the components of the Strategy to Balance Cost and Quality in Health Care framework to assess its applicability in practice. FINDINGS: The case study revealed that the steps described in the framework were fundamentally in place albeit with some variation. Importantly, the case study identified an additional step that could be added into the framework to support hospitals to better define their portfolio of initiatives to deliver value. The case study also clarified three types of contributory elements that should be in place for the application of the framework to be successful. PRACTICAL IMPLICATIONS: The Framework to Achieve Value in Healthcare is offered to hospitals as a model by which they can look to reduce expenditure through the removal of non-value adding activities. The modification to the conceptual framework has arisen from a single case study and would benefit from further testing by other hospitals in other policy settings (i.e. other countries). ORIGINALITY/VALUE: This is the first paper to examine and enhance an existing framework to assist hospitals balance cost and quality through PI.


Asunto(s)
Atención a la Salud , Instituciones de Salud , Hospitales , Mejoramiento de la Calidad , Victoria
3.
Sci Total Environ ; 806(Pt 1): 150408, 2022 Feb 01.
Artículo en Inglés | MEDLINE | ID: mdl-34571224

RESUMEN

The identification of nitrogen sources and cycling processes is critical to the management of nitrogen pollution. Here, we used both stable (δ15N-NO3-, δ18O-NO3-, δ15N-NH4+) and radiogenic (222Rn) isotopes together with nitrogen concentrations to evaluate the relative importance of point (i.e. sewage) and diffuse sources (i.e. agricultural-derived NO3- from groundwater, drains and creeks) in driving nitrogen dynamic in a shallow coastal embayment, Port Phillip Bay (PPB) in Victoria, Australia. This study is an exemplar of nitrogen-limited coastal systems around the world where nitrogen contamination is prevalent and where constraining it may be challenging. In addition to surrounding land use, we found that the distributions of NO3- and NH4+ in the bay were closely linked to the presence of drift algae. Highest NO3- and NH4+ concentrations were 315 µmol L-1 and 2140 µmol L-1, respectively. Based on the isotopic signatures of NO3- (δ15N: 0.17 to 21‰; δ18O: 3 to 26‰) and NH4+ (δ15N: 30 to 39‰) in PPB, the high nitrogen concentrations were attributed to three major sources which varied between winter and summer; (1) nitrified sewage effluent and drift algae derived NH4+ mainly during winter, (2) NO3- mixture from atmospheric deposition, drains and creeks predominantly observed during summer and (3) groundwater and sewage derived NO3- during both surveys. The isotopic composition of NO3- also suggested the removal of agriculture-derived NO3- through denitrification was prevalent during transport. This study highlights the role of terrestrial-coastal interactions on nitrogen dynamics and illustrates the importance of submarine groundwater discharge as a prominent pathway of diffuse NO3- inputs. Quantifying the relative contributions of multiple NO3- input pathways, however, require more extensive efforts and is an important avenue for future research.


Asunto(s)
Agua Subterránea , Contaminantes Químicos del Agua , Monitoreo del Ambiente , Nitratos/análisis , Nitrógeno/análisis , Isótopos de Nitrógeno/análisis , Victoria , Contaminantes Químicos del Agua/análisis
4.
J Environ Manage ; 301: 113789, 2022 Jan 01.
Artículo en Inglés | MEDLINE | ID: mdl-34592661

RESUMEN

Wildfire extent and their impacts are increasing around the world. Fire management agencies use fire behaviour simulation models operationally (during a wildfire event) or strategically for risk assessment and treatment. These models provide agencies with increased knowledge of fire potential to improve identification of the best strategies for reducing risk. One of the greatest areas of uncertainty in fire simulations is the data relating to fuel, which are usually based on simplified response trajectories with time since fire within vegetation communities. There is a clear need to better predict relevant fuel variables across landscapes to reduce uncertainties in fire simulations. In this study, we compare the performance of fuel hazard models based on environmental variables (environmental model) with those currently implemented based on a negative exponential relationship with time since fire (NEGEXP) using the state of Victoria in south-eastern Australia as an environmentally diverse case study. The models predicted similar broadscale patterns in fuel hazard but with considerable regional variation. The NEGEXP model was less accurate than the environmental model, which had 41-47% accuracy on an independent data set cf. 24-35% for NEGEXP. Model differences resulted in significant differences in the extent and spatial location of predicted fires with NEGEXP consistently predicting larger fires. Fuel is made up of the live and dead components of vegetation, both of which are influenced by a range of environmental factors. As our study highlights, ignoring environmental factors in simple fuel models based on broad vegetation types (like NEGEXP) will likely compromise the predictive accuracy of fire behaviour models. Only when environmental factors are accounted for can we more accurately predict fuels across landscapes and thereby improve the accuracy of fire behaviour predictions and the estimation of fire risks.


Asunto(s)
Incendios , Incendios Forestales , Modelos Teóricos , Victoria
5.
Health Soc Care Community ; 30(1): 91-101, 2022 01.
Artículo en Inglés | MEDLINE | ID: mdl-33825245

RESUMEN

We have little knowledge of differences in end-of-life care between home settings and residential aged care facilities (RACFs) where people spend most of their last year of life. This study aimed to compare end-of-life care between home settings and RACFs from the perspective of Australian general practitioners (GPs). A descriptive study was conducted with 62 GPs from Western Australia, Queensland and Victoria. Participants were asked to provide reports on end-of-life care of decedents in their practice using a validated clinic-based data collection process developed by our team between September 2018 and August 2019. Of the 213 reported expected deaths, 66.2% mainly lived at home in the last year of life. People living at home were more likely to die at a younger age (median 77 vs. 88, p < 0.001), to be male (51.1% vs. 33.3%, p = 0.01) and to die of cancer (53.9% vs. 4.2%, p < 0.001) compared to those in RACFs. There were no significant differences between the two patient groups for seven out of the eight assessed symptoms, except nausea. GPs' perceived roles in caring for patients and levels of their involvement in provision of common palliative care services were comparable between the two groups. The usual accommodation setting was most frequently considered the preferred place of death in both groups. However, more home residents ended up dying in hospital compared to RACF residents. There were significantly higher frequencies of end-of-life discussions (ORs ranged 5.46-9.82 for all topic comparisons) with GPs associated with people living at home versus RACFs. One opportunity for improved care is through promoting greater involvement of GPs in end-of-life discussions with RACF residents and staff. In general, more Australians could potentially remain at home until death if provided with greater access to essential specialist palliative care services and supportive services in home settings.


Asunto(s)
Médicos Generales , Cuidado Terminal , Anciano , Humanos , Masculino , Queensland , Victoria , Australia Occidental
6.
Health Soc Care Community ; 30(1): e234-e244, 2022 01.
Artículo en Inglés | MEDLINE | ID: mdl-34322923

RESUMEN

Healthcare staff are in a unique position of understanding client experiences, physiological impacts of client behaviour, the local healthcare system and the physical environment in which the services operate. Their perspectives may provide insights into the feasibility and effectiveness of existing models of diabetes care and suggestions for improvements to models of care (MoC). The objective of this qualitative study was to explore the experiences of healthcare staff delivering care for people with diabetes at the request of an existing healthcare service. Semi-structured interviews were conducted with 21 healthcare staff from three community health centres in one region of Victoria, Australia, in 2018. Interviews were audio-recorded and transcribed verbatim. Data were subject to qualitative content analysis and, subsequently, emerging themes were classified at individual, relationship, community and societal levels of the social-ecological model (SEM). Perceived barriers of access to health services using the current MoC included a lack of public transport, low socioeconomic status, job insecurity (resulting in an inability to take time away from work) and inflexible appointment times, all of which negatively impact diabetes management. Perceived enablers included having a co-located, multidisciplinary team, a holistic approach to diabetes management and motivation resulting from improvement in diabetes-related health outcomes. The findings indicate that there is potential to improve the service in this region by adopting a more integrated, team-focused and accessible MoC.


Asunto(s)
Diabetes Mellitus , Accesibilidad a los Servicios de Salud , Diabetes Mellitus/terapia , Instituciones de Salud , Humanos , Investigación Cualitativa , Victoria
7.
Sci Total Environ ; 802: 149727, 2022 Jan 01.
Artículo en Inglés | MEDLINE | ID: mdl-34461481

RESUMEN

This is the first study to show microplastics contamination in an alluvial sedimentary aquifer that has been capped from the atmosphere. Microplastics are often reported in biotic and abiotic environments, but little is known about their occurrence in groundwater systems. In this study, eight of the most commonly found microplastics in the environment (polyethylene, PE; polystyrene, PS; polypropylene, PP; polyvinyl chloride, PVC; polyethylene terephthalate, PET; polycarbonate, PC; polymethylmethacrylate, PMMA; and polyamide, PA) were analysed in triplicate groundwater samples (n = 21) from five sampling sites across seven capped groundwater monitoring bores from Bacchus Marsh (Victoria, Australia) using Agilent's novel Laser Direct Infra-Red (LDIR) imaging system. Microplastics were detected in all samples, with PE, PP, PS and PVC detected in all seven bores. The average size of the microplastics identified was 89 ± 55 µm (St.Dev.), ranging from 18 to 491 µm. The average number of microplastics detected across all sites was 38 ± 8 microplastics/L, ranging from 16 to 97 particles/L. PE and PVC in total contributed to 59% of the total sum of microplastics detected. PE was consistently detected in all seven bores (average: 11 particles/L), while PVC was more pronounced in a bore adjacent to a meat processor (52 particles/L) compared to that of its overall average of 12 particles/L. A statistically significant positive correlation was observed between PVC and PS (R = 0.934, p ≤0.001). As this study collected samples from capped groundwater bores, the most probable avenue for microplastics was permeation through soil. Therefore, to further understand the fate and transport of microplastics within a groundwater system, it is necessary to analyse a greater range of groundwater bores not only from Australia but throughout the world.


Asunto(s)
Agua Subterránea , Contaminantes Químicos del Agua , Monitoreo del Ambiente , Microplásticos , Plásticos , Victoria , Contaminantes Químicos del Agua/análisis
8.
Nurse Educ Today ; 108: 105181, 2022 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-34715562

RESUMEN

Paramedics provide care in medical emergencies to patients with varying ages and from a range of settings, cultures, backgrounds and experiences. As such, the paramedic needs a very diverse skill set which is difficult to obtain at university. For this reason, undergraduate paramedic students often engage in clinical placements to apply their knowledge to real world experiences. Most of these placements, however, are in hospitals or ambulance settings, but part of the diverse community that paramedics treat are children with special needs, including children with disabilities. This study measured the attitudes of paramedic students to people with disabilities and explored the effectiveness of paramedic student clinical placements in special needs schools. 109 paramedic students enrolled in their first year of the Bachelor of Paramedicine at Monash University undertook placements in special needs schools across Victoria, Australia. These students completed the Interactions with Disabled Persons Scale. Of these students, 5 participated in two focus groups to gain a deeper understanding of their placement experience. The results showed that paramedic students enjoyed their placements and gained a more positive attitude towards special needs students, but also felt challenged and overwhelmed. Also found were four main characteristics that students believed paramedics needed to be effective; empathy, being genuine, the ability to listen to someone even though they are not speaking to you verbally, and the ability to gain the trust of someone quickly where gaining trust is difficult. This study was the first time an entire cohort of paramedic students have undertaken placements at special needs schools. The findings provide a baseline and incentive for further exploration of the benefits of the placement of paramedic students (and student from a variety of healthcare professions) in special needs schools, as well as other marginalised communities.


Asunto(s)
Técnicos Medios en Salud , Auxiliares de Urgencia , Niño , Humanos , Estudiantes , Universidades , Victoria
9.
BMC Health Serv Res ; 21(1): 1340, 2021 Dec 14.
Artículo en Inglés | MEDLINE | ID: mdl-34906126

RESUMEN

BACKGROUND: Invasive Group A Streptococcal (iGAS) disease exerts an important burden among Australian children. No Australian hospitalisation cost estimates for treating children with iGAS disease exist, so the financial impact of this condition is unknown. AIM: To determine the minimum annual healthcare cost for children (< 18 years) hospitalised with iGAS disease in Australia from a healthcare sector perspective. METHODS: A cost analysis including children with laboratory-confirmed iGAS disease hospitalised at the Royal Children's Hospital (Victoria, Australia; July 2016 to June 2019) was performed. Results were extrapolated against the national minimum iGAS disease incidence. This analysis included healthcare cost from the 7 days prior to the index admission via General Practitioner (GP) and Emergency Department (ED) consultations; the index admission itself; and the 6 months post index admission via rehabilitation admissions, acute re-admissions and outpatient consultations. Additional extrapolations of national cost data by age group, Aboriginal and Torres Strait Islander ethnicity and jurisdiction were performed. RESULTS: Of the 65 included children, 35% (n = 23) were female, 5% (n = 3) were Aboriginal and Torres Strait Islander, and the average age was 4.4 years (SD 4.6; 65% aged 0-4). The iGAS disease related healthcare cost per child was $67,799 (SD $92,410). These costs were distributed across the 7 days prior to the index admission via GP and ED consultations (0.2 and 1.1% of total costs, respectively), the index admission itself (88.7% of the total costs); and the 6 months post index admission via rehabilitation admissions, acute re-admissions and outpatient consultations (5.3, 4.5 and 0.1% of total costs, respectively). Based on a national minimum paediatric incidence estimation of 1.63 per 100,000 children aged < 18 (95%CI: 1.11-2.32), the total annual healthcare cost for children with iGAS in 2019 was $6,200,862. The financial burden reflects the overrepresentation of Aboriginal and Torres Strait Islander people in the occurrence of iGAS disease. Costs were concentrated among children aged 0-4 years (62%). CONCLUSION: As these cost estimations were based on a minimum incidence, true costs may be higher. Strengthening of surveillance and control of iGAS disease, including a mandate for national notification of iGAS disease, is warranted. TRIAL REGISTRATION: The current study is a part of ongoing iGAS surveillance work across seven paediatric health services in Australia. As this is not a clinical trial, it has not undergone trial registration.


Asunto(s)
Costos de la Atención en Salud , Niño , Preescolar , Femenino , Hospitalización , Humanos , Incidencia , Victoria
10.
J Law Med ; 28(4): 913-930, 2021 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-34907676

RESUMEN

Community attitudes towards mandated vaccinations against COVID-19 vary significantly from country to country. Views on the issue are strongly held. However, in Australia opposition to vaccination is at low levels according to a leading public opinion poll, although there has been vocal opposition to "no jab, no work" directives from some. There is relative consistency in the framing of directives that designated categories of workers across a number of Australian States are required to be vaccinated to continue in their employment, especially in the health care sector. A number of challenges against such directives have been commenced in five States in Australia. However, decisions from the Fair Work Commission, the Queensland Industrial Relations Commission and the New South Wales Supreme Court have given a clear indication that in most scenarios such directives are likely to be found lawful, with precedence being given to the public health rights of the community over individual assertions of rights, in the difficult circumstances of a country still emerging from the COVID-19 pandemic, at a time when numbers of infections in New South Wales, the Australian Capital Territory and Victoria remain significant, and when Australia has not yet opened up to the world.


Asunto(s)
COVID-19 , Pandemias , Accesibilidad a los Servicios de Salud , Derechos Humanos , Humanos , SARS-CoV-2 , Vacunación , Victoria
11.
JAMA Netw Open ; 4(12): e2138228, 2021 12 01.
Artículo en Inglés | MEDLINE | ID: mdl-34932107

RESUMEN

Importance: There are accumulating data about the utility of diagnostic multiorgan focused clinical ultrasonography (FCU) in the assessment of patients admitted with cardiopulmonary symptoms. Objective: To determine whether adding multiorgan FCU to the initial clinical evaluation of patients admitted with cardiopulmonary symptoms reduces hospital length of stay, hospital readmissions, and in-hospital costs. Design, Setting, and Participants: This is a prospective, parallel-group, superiority, randomized clinical trial with a 1:1 allocation ratio. The study was conducted at The Royal Melbourne Hospital, a tertiary public hospital located in Melbourne, Victoria, Australia. Adults aged 18 years or older admitted to the internal medicine ward with a cardiopulmonary diagnosis were enrolled between September 2018 and December 2019 and were followed up until hospital discharge. Data analysis was performed from August 2020 to January 2021. Interventions: The intervention involved an internal medicine physician-performed heart, lung, and 2-point vein compression FCU in addition to standard clinical evaluation. Main Outcomes and Measures: The primary outcome was the difference in the mean length of hospital stay, defined as the number of hours from admission to the internal medicine ward to hospital discharge. A difference of 24 hours was defined as clinically important. Secondary outcomes included hospital readmissions at 30 days and hospital care costs. Results: A total of 250 participants were enrolled and 2 were excluded, leaving 248 participants (mean [SD] age, 80.1 [11.0] years; 121 women [48.7%]) in the final analysis. There were 124 patients in the intervention group and 124 patients in the control group. The most common initial diagnoses were acute decompensated heart failure (113 patients [45.5%]), pneumonia (45 patients [18.1%]), and exacerbated chronic pulmonary disease (32 patients [12.9%]). The length of hospital stay was 113.4 hours (95% CI, 91.7-135.1 hours) in the FCU group and 125.3 hours (95% CI, 101.7-148.8 hours) in the control group (P = .53). The 30-day readmission rate was not different between groups (FCU vs control, 20 of 124 patients [16.1%] vs 15 of 124 patients [12.0%]), nor were total in-hospital costs (FCU vs control, A$7831.1 [95% CI, A$5586.1-A$10 076.1] vs A$7895.7 [95% CI, A$6385.9-A$9.405.5]). Conclusions and Relevance: In this randomized clinical trial, adult patients admitted to an internal medicine ward with a cardiopulmonary diagnosis, who underwent multiorgan FCU of the heart, lungs, and lower extremities veins during their initial clinical assessment, did not have a shorter hospital length of stay by more than 24 hours, compared with patients who received standard care. Trial Registration: Australian New Zealand Clinical Trials Registry Identifier: ACTRN12618001442291.


Asunto(s)
Cardiopatías/diagnóstico por imagen , Costos de Hospital/estadística & datos numéricos , Tiempo de Internación/economía , Enfermedades Pulmonares/diagnóstico por imagen , Admisión del Paciente/economía , Ultrasonografía/métodos , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Tiempo de Internación/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Admisión del Paciente/estadística & datos numéricos , Estudios Prospectivos , Victoria
12.
Scand J Immunol ; 94(5): e13100, 2021 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-34940992

RESUMEN

The SARS-CoV-2 epidemic infections in Australia during 2020 were small in number in epidemiological terms and are well described. The SARS-CoV-2 genomic sequence data of many infected patients have been largely curated in a number of publicly available databases, including the corresponding epidemiological data made available by the Victorian Department of Health and Human Services. We have critically analysed the available SARS-CoV-2 haplotypes and genomic sequences in the context of putative deficits in innate immune APOBEC and ADAR deaminase anti-viral responses. It is now known that immune impaired elderly co-morbid patients display clear deficits in interferon type 1 (α/ß) and III (λ) stimulated innate immune gene cascades, of which APOBEC and ADAR induced expression are part. These deficiencies may help explain some of the clear genetic patterns in SARS-CoV-2 genomes isolated in Victoria, Australia, during the 2nd Wave (June-September, 2020). We tested the hypothesis that predicted lowered innate immune APOBEC and ADAR anti-viral deaminase responses in a significant proportion of elderly patients would be consistent with/reflected in a low level of observed mutagenesis in many isolated SARS-CoV-2 genomes. Our findings are consistent with this expectation. The analysis also supports the conclusions of the Victorian government's Department of Health that essentially one variant or haplotype infected Victorian aged care facilities where the great majority (79%) of all 820 SARS-CoV-2 associated deaths occurred. The implications of our data analysis for other localized epidemics and efficient coronavirus vaccine design and delivery are discussed.


Asunto(s)
Desaminasas APOBEC/genética , Adenosina Desaminasa/genética , Vacunas contra la COVID-19/inmunología , COVID-19/inmunología , Proteínas de Unión al ARN/genética , SARS-CoV-2/fisiología , Desaminasas APOBEC/metabolismo , Adenosina Desaminasa/metabolismo , Factores de Edad , Anciano de 80 o más Años , COVID-19/epidemiología , COVID-19/virología , Femenino , Redes Reguladoras de Genes , Haplotipos , Humanos , Inmunidad Innata , Síndromes de Inmunodeficiencia , Interferón Tipo I/genética , Masculino , Proteínas de Unión al ARN/metabolismo , Victoria/epidemiología
13.
Nat Commun ; 12(1): 6266, 2021 11 01.
Artículo en Inglés | MEDLINE | ID: mdl-34725323

RESUMEN

During 2020, Victoria was the Australian state hardest hit by COVID-19, but was successful in controlling its second wave through aggressive policy interventions. We calibrated a detailed compartmental model of Victoria's second wave to multiple geographically-structured epidemic time-series indicators. We achieved a good fit overall and for individual health services through a combination of time-varying processes, including case detection, population mobility, school closures, physical distancing and face covering usage. Estimates of the risk of death in those aged ≥75 and of hospitalisation were higher than international estimates, reflecting concentration of cases in high-risk settings. We estimated significant effects for each of the calibrated time-varying processes, with estimates for the individual-level effect of physical distancing of 37.4% (95%CrI 7.2-56.4%) and of face coverings of 45.9% (95%CrI 32.9-55.6%). That the multi-faceted interventions led to the dramatic reversal in the epidemic trajectory is supported by our results, with face coverings likely particularly important.


Asunto(s)
COVID-19/epidemiología , COVID-19/prevención & control , Epidemias , Adolescente , Adulto , COVID-19/transmisión , Hospitalización , Humanos , Persona de Mediana Edad , Modelos Teóricos , Distanciamiento Físico , SARS-CoV-2 , Instituciones Académicas , Victoria , Adulto Joven
14.
J Telemed Telecare ; 27(10): 674-679, 2021 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-34726995

RESUMEN

Telehealth can effectively increase access to specialist care and reduce the need for travel. The Geri-Connect service was established in 2017 to support people living in residential aged care facilities in regional Victoria, Australia. Using the Model for the Assessment of Telemedicine, an evaluation of the Geri-Connect service identified service activity patterns and factors associated with uptake. Service activity from 2017 to 2020 and 10 semi-structured, key stakeholder interviews were captured and analysed. Between 2017 and 2020, video consultations were provided to 53 residential aged care facilities. Sustained growth (over 178%) and strong stakeholder acceptance highlight the effectiveness of this telegeriatric service. Four recommendations provide opportunities to further enhance service delivery including: implementation of an integrated health information system; systematic evaluation of service impact on stakeholders and residents, auditing and subsequent provision of targeted training; and regular auditing of software and hardware. Additionally, the need to augment fixed room hardware with mobile telehealth systems would increase access for residents with mobility problems. Dedicated personnel of the centralised team are best suited to implementing the recommendations. Whilst the provision of routine telehealth services into residential aged care facilities is challenging, the Geri-Connect service demonstrates that telehealth can be effectively provided to residential aged care facility residents needing specialist geriatric care.


Asunto(s)
Geriatría , Telemedicina , Anciano , Humanos , Derivación y Consulta , Especialización , Victoria
15.
Artículo en Inglés | MEDLINE | ID: mdl-34769631

RESUMEN

BACKGROUND: In Australia, Indian immigrants are one of the fastest-growing communities. Since oral cancer is widespread in India, the indulgence of Indians in customs of areca (betel) nut use in Australia may be linked to the recent rise in oral cancer cases. Since GPs (general practitioners) are primary healthcare providers, it is pivotal to ensure the oral cancer awareness of GPs. This study aimed to explore oral cancer risk-related knowledge, beliefs, and clinical practices of GPs in Australia. METHODS: Fourteen semi-structured interviews were conducted with GPs practicing across New South Wales and Victoria. Purposive and snowball sampling were used for recruitment. Data were analysed through a directed content analysis approach. RESULTS: All GPs were knowledgeable of major oral cancer causative factors including tobacco and alcohol, but some had limited understanding about the risks associated with areca nut preparations. Positive attitudes were evident, with all participants acknowledging the importance of oral cancer risk assessment. Most GPs recalled not performing oral cancer routine check-ups. CONCLUSION: GPs presented good oral cancer knowledge except for emerging risk factors such as areca nut use. Varied beliefs and inconsistent clinical practices relating to oral cancer screening is concerning. Accessible oral cancer training around emerging risk factors may benefit GPs.


Asunto(s)
Emigrantes e Inmigrantes , Médicos Generales , Neoplasias de la Boca , Actitud del Personal de Salud , Humanos , Neoplasias de la Boca/epidemiología , Neoplasias de la Boca/etiología , Percepción , Factores de Riesgo , Victoria
16.
Vaccine ; 39(48): 7052-7057, 2021 11 26.
Artículo en Inglés | MEDLINE | ID: mdl-34756770

RESUMEN

Emerging evidence suggest a possible association between immune thrombocytopenia (ITP) and some formulations of COVID-19 vaccine. We conducted a retrospective case series of ITP following vaccination with Vaxzevria ChadOx1-S (AstraZeneca) and mRNA Comirnaty BNT162b2 COVID-19 (Pfizer-BioNTech) vaccines and compare the incidence to expected background rates for Victoria during the first six months of the Australian COVID-19 vaccination roll-out in 2021. Cases were identified by reports to the Victorian state vaccine safety service, SAEFVIC, of individuals aged 18 years or older presenting with thrombocytopenia following COVID-19 vaccination without evidence of thrombosis. Twenty-one confirmed or probable cases of ITP were identified following receipt of AstraZeneca (n = 17) or Pfizer-BioNTech (n = 4) vaccines. This translates to an observed incidence of 8 per million doses for AstraZeneca vaccine, twice the expected background rate of 4.1 per million. The observed rate for Pfizer-BioNTech was consistent with the expected background rate. The median time to onset for the cases post AstraZeneca vaccination was 10 days (range 1-78) and median platelet nadir 5 × 109/L (range 0-67 × 109/L). Hospital presentations or admissions for management of symptoms such as bleeding occurred in 18 (86%) of the cases. The majority of cases (n = 11) required intervention with at least 2 therapy modalities. In conclusion, we observed a substantially higher than expected rate of ITP following AstraZeneca vaccination. ITP is the second haematological adverse event, distinct from that of thrombosis with thrombocytopenia syndrome (TTS), observed following AstraZeneca vaccination.


Asunto(s)
COVID-19 , Púrpura Trombocitopénica Idiopática , Trombocitopenia , Vacunas , Vacunas contra la COVID-19 , Humanos , Púrpura Trombocitopénica Idiopática/inducido químicamente , Púrpura Trombocitopénica Idiopática/epidemiología , Estudios Retrospectivos , SARS-CoV-2 , Vacunación , Victoria/epidemiología
17.
Artículo en Inglés | MEDLINE | ID: mdl-34769922

RESUMEN

Road trauma remains a significant public health problem. We aimed to identify sub-groups of motor vehicle collisions in Victoria, Australia, and the association between collision characteristics and outcomes up to 24 months post-injury. Data were extracted from the Victorian State Trauma Registry for injured drivers aged ≥16 years, from 2010 to 2016, with a compensation claim who survived ≥12 months post-injury. People with intentional or severe head injury were excluded, resulting in 2735 cases. Latent class analysis was used to identify collision classes for driver fault and blood alcohol concentration (BAC), day and time of collision, weather conditions, single vs. multi-vehicle and regional vs. metropolitan injury location. Five classes were identified: (1) daytime multi-vehicle collisions, no other at fault; (2) daytime single-vehicle predominantly weekday collisions; (3) evening single-vehicle collisions, no other at fault, 36% with BAC ≥ 0.05; (4) sunrise or sunset weekday collisions; and (5) dusk and evening multi-vehicle in metropolitan areas with BAC < 0.05. Mixed linear and logistic regression analyses examined associations between collision class and return to work, health (EQ-5D-3L summary score) and independent function Glasgow Outcome Scale - Extended at 6, 12 and 24 months. After adjusting for demographic, health and injury characteristics, collision class was not associated with outcomes. Rather, risk of poor outcomes was associated with age, sex and socioeconomic disadvantage, education, pre-injury health and injury severity. People at risk of poor recovery may be identified from factors available during the hospital admission and may benefit from clinical assessment and targeted referrals and treatments.


Asunto(s)
Nivel de Alcohol en Sangre , Heridas y Lesiones , Accidentes de Tránsito , Humanos , Vehículos a Motor , Sobrevivientes , Victoria/epidemiología , Heridas y Lesiones/epidemiología
18.
Artículo en Inglés | MEDLINE | ID: mdl-34711144

RESUMEN

Abstract: The Australian Gonococcal Surveillance Programme (AGSP), established in 1981, has continuously monitored antimicrobial resistance in clinical isolates of Neisseria gonorrhoeae for more than 40 years. In 2020, a total of 7,222 clinical isolates of gonococci from patients in the public and private sectors, in all jurisdictions, were tested for in vitro antimicrobial susceptibility by standardised methods. Current treatment recommendations for gonorrhoea, for the majority of Australia, continues to be dual therapy with ceftriaxone and azithromycin. In 2020, decreased susceptibility (DS) to ceftriaxone (minimum inhibitory concentration [MIC] value ≥ 0.06 mg/L) was found nationally in 0.9% of isolates. There was one isolate, reported from Victoria in 2020, that was resistant to ceftriaxone (MIC value ≥ 0.25 mg/L). Resistance to azithromycin (MIC value ≥ 1.0 mg/L) was found nationally in 3.9% of N. gonorrhoeae isolates, continuing a downward trend observed and reported since 2017. Isolates with high-level resistance to azithromycin (MIC value ≥ 256 mg/L) are identified sporadically in Australia; in 2020, there was one such isolate reported in Queensland. In 2020, penicillin resistance was found in 27% of gonococcal isolates nationally, and ciprofloxacin resistance in 36%; however, there is considerable variation by jurisdiction. In some remote settings, penicillin resistance remains low, and this drug continues to be recommended as part of an empiric therapy strategy. In 2020, in remote Northern Territory, no penicillin resistance was reported, and in remote Western Australia 5/116 of gonococcal isolates (4.3%) were penicillin resistant. There was one ciprofloxacin-resistant isolate reported from remote Northern Territory, and ciprofloxacin resistance rates remain comparatively low in remote Western Australia (4/116; 3.4%).


Asunto(s)
Gonorrea , Antibacterianos/farmacología , Antibacterianos/uso terapéutico , Gonorrea/tratamiento farmacológico , Gonorrea/epidemiología , Humanos , Pruebas de Sensibilidad Microbiana , Neisseria gonorrhoeae , Victoria
19.
Artículo en Inglés | MEDLINE | ID: mdl-34711148

RESUMEN

Background: Health care workers are at increased risk of SARS-CoV-2 infection due to potential exposure to patients or staff in health care settings. Australian health care services and health care workers experienced intense pressure to prepare for and respond to SARS-CoV-2 infections. We summarise national data on health care worker infections and associated outbreaks during 2020. Methods: We collected aggregated data on infected health care workers and outbreaks in health care facilities from all jurisdictions. Health care workers working solely in residential aged care and outbreaks in residential aged care facilities were excluded. Jurisdictions provided data on the number of health care setting outbreaks, confirmed cases, hospitalisation, source of infection, and health care worker role. We analysed data for two periods that aligned with two distinct peaks in the epidemic relative to 1 June 2020, referred to here as the first wave (23 January - 31 May 2020) and the second wave (1 June - 18 September 2020). Results: Jurisdictions reported a total of 2,163 health care worker infections with SARS-CoV-2 during the surveillance period. Source of acquisition was known for 81.0% of cases (1,667/2,059). The majority of cases in the first wave were acquired overseas, shifting to locally-acquired cases in the second wave. The odds of infection in the second wave compared to the first wave were higher for nurses/midwives (odds ratio, OR: 1.61; 95% confidence interval (95% CI): 1.32-2.00), lower for medical practitioners (OR: 0.36; 95% CI: 0.28-0.47) and did not differ for 'other' health care workers (OR: 1.07; 95% CI: 0. 87-1.32). The odds of infection in the second wave were higher in a health care setting (OR: 1.76; 95% CI: 1.28-2.41) than in the community. There were 120 outbreaks in health care settings with 1,428 cases, of which 56.7% (809/1,428) were health care workers. The majority (88/120; 73.8%) of outbreaks in health care settings occurred in the second wave of the epidemic, with 90.9% of these (80/88) occurring in Victoria. Conclusions: In the second wave of the epidemic, when there was heightened community transmission, health care workers were more likely to be infected in the workplace. Throughout the epidemic, nurses were more likely to be infected than staff in other roles.


Asunto(s)
COVID-19 , Anciano , Brotes de Enfermedades , Personal de Salud , Humanos , SARS-CoV-2 , Victoria
20.
Rural Remote Health ; 21(4): 7043, 2021 10.
Artículo en Inglés | MEDLINE | ID: mdl-34619974

RESUMEN

The COVID-19 pandemic has devastated communities throughout the world and has required rapid paradigm changes in the manner in which health care is administered. Previous health models and practices have been modified and changed at a rapid pace. This commentary provides the experiences of a regional Victorian Aboriginal Community Controlled Organisation in a COVID-19 vaccination program led and managed by Aboriginal Health Practitioners.


Asunto(s)
Vacunas contra la COVID-19 , Servicios de Salud Comunitaria , Servicios de Salud del Indígena , Rol del Médico , Vacunación , COVID-19/etnología , COVID-19/prevención & control , Vacunas contra la COVID-19/administración & dosificación , Servicios de Salud Comunitaria/organización & administración , Servicios de Salud del Indígena/organización & administración , Humanos , Pandemias/prevención & control , Vacunación/estadística & datos numéricos , Victoria/epidemiología
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