Association between Malnutrition and Delirium in Older Chronic Kidney Disease Patients Admitted to Intensive Care Units: A Data Linkage Study.

BACKGROUND: Independently, malnutrition and delirium in older hospitalised adults is prevalent. However, there is limited evidence on the association between these two conditions in older hospitalised adults with chronic kidney disease (CKD). OBJECTIVES: To determine the association between malnutrition and delirium in older CKD patients admitted to intensive care units (ICU). METHODS: This data linkage study utilised administrative data from New South Wales (NSW) hospitals in Australia between 2017 and 2020.Admitted patient data was linked with Cause of Death Unit Record File, and NSW Registry of Deaths (RBD). The study population comprised all CKD patients aged 65 and over admitted to ICUs. Descriptive statistics were used to summarise patient characteristics. Binary logistic tested for association between malnutrition and delirium. RESULTS: The study population included 748 CKD patients with a total 948 admissions in the study period. The International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) was used to code for all outcomes and comorbidities. The incidence of delirium was 15.5% (n=141) and malnutrition was recorded in 11.3% (n=103) across all admissions. The adjusted odds ratio (OR) of a delirium diagnosis was 2.07 (95% CI: 1.27-3.39) for CKD patients that were malnourished compared to non-malnourished CKD patients. CONCLUSIONS: This study showed a significant association between delirium and malnutrition in older CKD patients admitted to ICU. Management of malnutrition could be critical in reducing the risk of delirium in older hospitalized patients with CKD. Additionally, more education and awareness around delirium and its association with malnutrition are needed in clinical practice.

Driving, dementia and Australian physicians: primum non nocere?

Older Australians are increasingly reliant on automobiles as their sole form of transport. As our population is ageing and the prevalence of dementia is increasing, it is anticipated that the number of drivers with dementia will rise over time. Much of the literature relating to driving and dementia focuses on safety rather than mobility. The objective of this paper is to highlight several topical ethical issues that pertain to Australian drivers with dementia. It is recommended that future research, policy and practice should centre on the crucial mobility and transport needs of our senior citizens.

Privacy impact assessment in the design of transnational public health information systems: the BIRO project.

OBJECTIVES: To foster the development of a privacy-protective, sustainable cross-border information system in the framework of a European public health project. MATERIALS AND METHODS: A targeted privacy impact assessment was implemented to identify the best architecture for a European information system for diabetes directly tapping into clinical registries. Four steps were used to provide input to software designers and developers: a structured literature search, analysis of data flow scenarios or options, creation of an ad hoc questionnaire and conduction of a Delphi procedure. RESULTS: The literature search identified a core set of relevant papers on privacy (n = 11). Technicians envisaged three candidate system architectures, with associated data flows, to source an information flow questionnaire that was submitted to the Delphi panel for the selection of the best architecture. A detailed scheme envisaging an "aggregation by group of patients" was finally chosen, based upon the exchange of finely tuned summary tables. CONCLUSIONS: Public health information systems should be carefully engineered only after a clear strategy for privacy protection has been planned, to avoid breaching current regulations and future concerns and to optimise the development of statistical routines. The BIRO (Best Information Through Regional Outcomes) project delivers a specific method of privacy impact assessment that can be conveniently used in similar situations across Europe.

Do divisions of general practice have a role in and the capacity to tackle health inequalities?

BACKGROUND: General practitioners are concerned with improving the health of the community, and Divisions are an important structure through which this can be achieved. Any focus on health outcomes needs to consider what general practice and Divisions can do to reduce inequalities in health outcomes. METHOD: We analysed 2000-2002 strategic and business plans from 78% of Divisions in NSW and Victoria, to see how Divisions were developing capacity to address health inequalities in the community through appropriate needs assessments, allocation of resources and partnership approaches. RESULTS: Thirty percent of Divisions discussed socioeconomic barriers to people accessing health care within their community. None used equity as a needs priority. Thirty percent specifically committed resources through programs for disadvantaged groups. Thirty-six percent used partnership approaches to improve access, although only 11% used a broad advocacy role. DISCUSSIONS: Divisions see socioeconomic disadvantage as an important issue, and some are developing significant multilevel strategies to address them, although significant gaps exist in the capacity of Divisions to undertake this work.

The formation of professional and consumer solutions: ethics in the general practice setting.

A general practice research project on ethics is underway at the University of New South Wales, funded by GPEP (General Practice Evaluation Program, Commonwealth Department of Human Services and Health, GPEP 386). Ethical issues, as defined and explored by general practitioners and consumers, are being examined across four areas of Sydney. So far, telephone interviews have been conducted (64% response rate) with a random sample of general practitioners (GPs). Face-to-face interviews have been conducted with 107 consumers, randomly sampled using ABS collection district information. Focus groups have been formed to discuss acceptable solutions to GP and consumer identified ethical issues. This report will report on some preliminary findings to date and will explore professional and consumer roles in the formation of ethical solutions.

Immunisation in general practice. Results from the Australian Morbidity and Treatment Survey, 1990-1991.

Immunisation is the sixth most commonly managed problem in general practice in Australia. This paper provides an overview of its management in general practice.

Menopause: its management in general practice.

Menopause is managed in over 10% of general practice consultations with women aged between 45 and 54 years, yet there is little information about its symptomotology and its management by GPs. This paper investigates these issues in a secondary analysis of data from the Australian Morbidity and Treatment Survey 1990-1991.

The management of arthritis in general practice. Results from the Australian morbidity and treatment survey, 1990-1991.

Arthritis is the ninth most commonly managed problem in general practice in Australia. This paper provides an overview of its management in general practice and draws some comparisons with an earlier study.

The management of asthma in general practice. Results from the Australian Morbidity and Treatment Survey, 1990-1991.

Asthma is the third most commonly managed problem in general practice in Australia. This paper provides an overview of its management in general practice.

The management of osteoarthritis in general practice. Results from the Australian Morbidity and Treatment Survey, 1990-1991.

Osteoarthritis is the fourth most commonly managed problem in general practice in Australia. This paper provides an overview of its management in general practice.

The management of sprains and strains in general practice. Results from the Australian Morbidity and Treatment Survey, 1990-1991.

Sprains and strains were the eighth most commonly managed problem in general practice in Australia. This paper provides an overview of their management in general practice.

The management of acute bronchitis in general practice: results from the Australian Morbidity and Treatment Survey, 1990-1991.

Acute bronchitis is the fifth most commonly managed problem in general practice in Australia. This paper provides an overview of its management in general practice and compares the results with those of an earlier study.

A comparison of country and metropolitan general practice.

This paper is a summary of a report of a comparison of country and metropolitan general practice undertaken by the Family Medicine Research Unit, University of Sydney, and published as a supplement to the Medical Journal of Australia. The identified differences were not consistent across small medium and large country towns. The morbidity patterns were similar between all areas, but country GPs were generally busier and undertook more hospital and procedural work.

The management of hypertension in general practice. Results from the Australian Morbidity and Treatment Survey, 1990-1991.

Hypertension is the most frequently managed problem in general practice in Australia. This paper provides an overview of its management in general practice and draws some comparisons with an earlier study.

The diagnostic difficulties of abdominal pain.

When the patient presents with the words, "I've got a pain in the gut", what are the most common diagnoses and how often does the problem remain undiagnosed? This paper describes what usually happens at encounters initiated by patient presentation of abdominal pain and is based on the results of the Australian Morbidity and Treatment Survey 1990-1991.