Using machine learning models to predict falls in hospitalised adults.

BACKGROUND: Identifying patients at high risk of falling is crucial in implementing effective fall prevention programs. While the integration of information systems is becoming more widespread in the healthcare industry, it poses a significant challenge in analysing vast amounts of data to identify factors that could enhance patient safety. OBJECTIVE: To determine fall-associated factors and develop high-performance prediction tools for at-risk patients in acute and sub-acute care services in Australia. METHODS: A retrospective study of 672,400 patients admitted to acute and sub-acute care services within a large metropolitan tertiary health service in Victoria, Australia, between January 1, 2019, and December 31, 2021. Data were obtained from four sources: the Department of Health Victorian Admitted Episodes Dataset, RiskManTM, electronic health records, and the health workforce dataset. Machine learning techniques, including Random Forest and Deep Neural Network models, were used to analyse the data, predict patient falls, and identify the most important risk factors for falls in this population. Model performance was evaluated using accuracy, F1-score, precision, recall, specificity, Matthew's correlation coefficient, and the area under the receiver operating characteristic curve (AUC). RESULTS: The deep neural network and random forest models were highly accurate in predicting hospital patient falls. The deep neural network model achieved an accuracy of 0.988 and a specificity of 0.999, while the RF achieved an accuracy of 0.989 and a specificity of 1.000. The top 20 variables impacting falls were compared across both models, and 12 common factors were identified. These factors can be broadly classified into three categories: patient-related factors, staffing-related factors, and admission-related factors. Although not all factors are modifiable, they must be considered when planning fall prevention interventions. CONCLUSION: The study demonstrated machine learning's potential to predict falls and identify key risk factors. Further validation across diverse populations and settings is essential for broader applicability.

Investigating the spatial and temporal variation of vape retailer provision in New Zealand: A cross-sectional and nationwide study.

Smoking rates have decreased in Aotearoa New Zealand in recent years however, vaping has shown a dramatic upward trend especially among young people; up to 10% of young New Zealanders are now regular vapers. Importantly, the long-term health consequences for their future life are largely unknown. The accessibility of vape retailers is important, particularly in relation to the youths' daily activities and places such as schools where they spend a considerable amount of time and socialise. Despite this, we know little about the spatial patterning of vape retailers and even less of their socio-spatial patterning around schools. This ecological study utilised data from the New Zealand Specialist Vape Retailers register on nationwide vape retailer locations and combined them with whole-population sociodemographic characteristics and primary and secondary school data. We identified the prevalence of vape retailers and their spatial distribution by area-level deprivation, ethnicity and urban-rural classification by using descriptive statistics and (spatial) statistical modelling on the area-, school- and individual students-level (using disaggregated data on students). We found that almost 97% of all vape retailers are located within 1,600m (∼20-min walk) and 29% within 400m (∼5-min walk) of schools. Our research also identified increasing inequities by deprivation and ethnicity both for the overall population and particularly for students in the most deprived areas who experience a disproportionate presence and increase of new vape store retailers that disadvantage schools and students in these areas. This difference was particularly prominent for Pasifika populations in major urban environments.

Clinical risk prediction model for 30-day all-cause re-hospitalisation or mortality in patients hospitalised with heart failure.

BACKGROUND: This study aimed to develop a risk prediction model (AUS-HF model) for 30-day all-cause re-hospitalisation or death among patients admitted with acute heart failure (HF) to inform follow-up after hospitalisation. The model uses routinely collected measures at point of care. METHODS: We analyzed pooled individual-level data from two cohort studies on acute HF patients followed for 30-days after discharge in 17 hospitals in Victoria, Australia (2014-2017). A set of 58 candidate predictors, commonly recorded in electronic medical records (EMR) including demographic, medical and social measures were considered. We used backward stepwise selection and LASSO for model development, bootstrap for internal validation, C-statistic for discrimination, and calibration slopes and plots for model calibration. RESULTS: The analysis included 1380 patients, 42.1% female, median age 78.7 years (interquartile range = 16.2), 60.0% experienced previous hospitalisation for HF and 333 (24.1%) were re-hospitalised or died within 30 days post-discharge. The final risk model included 10 variables (admission: eGFR, and prescription of anticoagulants and thiazide diuretics; discharge: length of stay>3 days, systolic BP, heart rate, sodium level (<135 mmol/L), >10 prescribed medications, prescription of angiotensin converting enzyme inhibitors or angiotensin receptor blockers, and anticoagulants prescription. The discrimination of the model was moderate (C-statistic = 0.684, 95%CI 0.653, 0.716; optimism estimate = 0.062) with good calibration. CONCLUSIONS: The AUS-HF model incorporating routinely collected point-of-care data from EMRs enables real-time risk estimation and can be easily implemented by clinicians. It can predict with moderate accuracy risk of 30-day hospitalisation or mortality and inform decisions around the intensity of follow-up after hospital discharge.

Estimating the health loss due to poor engagement with cardiac rehabilitation in Australia.

BACKGROUND: Cardiac rehabilitation (CR) programs are effective in reducing cardiovascular mortality and readmissions. However, most patients are denied the benefits of CR due to low referral rates. Of those patients referred, commencement rates vary from 28.4% to 60%. This paper quantifies the scale of health loss in Australia due to poor engagement with the program, and estimates how much public funding can be justifiably reallocated to address the problem. METHODS: Economic decision modelling was undertaken to estimate the expected lifetime health loss and costs to Medicare. Key parameters were derived from Australian databases, CR registries and meta-analyses. Population health gains associated with uptake rates of 60%, and 85% were calculated. RESULTS: CR was associated with a 99.9% probability of being cost-effective, even at a cost-effectiveness threshold lower than conventionally applied. Importantly, an average of 0.52 years of life expectancy are lost due to national uptake being below 60% achieved in some best performing programs in Australia, equivalent to 0.28 quality adjusted life years. The analysis indicates that $12.9 million/year could be justifiably reallocated from public funds to achieve a national uptake rate of 60%, while maintaining cost-effectiveness of CR due to the large health gains that would be expected. CONCLUSION: CR is a cost-effective service for patients with coronary heart disease. In Australia, less than a third of patients commence CR, potentially resulting in avoidable patient harm. Additional investment in CR is vital and should be a national priority as the health gains for patients far outweigh the costs.

Self-Care Interventions That Reduce Hospital Readmissions in Patients With Heart Failure; Towards the Identification of Change Agents.

Unplanned hospital readmissions are the most important, preventable cost in heart failure (HF) health economics. Current professional guidelines recommend that patient self-care is an important means by which to reduce this burden. Patients with HF should be engaged in their care such as by detecting, monitoring, and managing their symptoms. A variety of educational and behavioural interventions have been designed and implemented by health care providers to encourage and support patient self-care. Meta-analyses support the use of self-care interventions to improve patient self-care and reduce hospital readmissions; however, efficacy is variable. The aim of this review was to explore methods to achieve greater clarity and consistency in the development and reporting of self-care interventions to enable 'change agents' to be identified. We conclude that advancement in this field requires more explicit integration and reporting on the behaviour change theories that inform the design of self-care interventions and the selection of behaviour change techniques. The systematic application of validated checklists, such as the Theory Coding Scheme and the CALO-RE taxonomy, will improve the systematic testing and refinement of interventions to enable 'change agent/s' to be identified and optimised.

Comparison of three commercial serological tests for the detection of Chlamydia abortus infection in ewes.

BACKGROUND: 20.9% of diagnosable abortions in Ireland in 2015 were caused by Chlamydia abortus infection. Abortion usually occurs in the last 2-3 weeks of gestation, and up to 30% of ewes may be affected in naïve flocks. Serological diagnosis of EAE in flocks using LPS or whole bacteria as antigens is often hindered by cross reactions with C. pecorum. Although the complement fixation test is the official test for diagnosis of EAE, more sensitive and specific ELISA based tests have been developed. This study aimed to compare three commercial ELISA kits to detect C. abortus antibodies in ewes and to determine which of the kits had the highest sensitivity. The IDvet kit utilises a MOMP peptide antigen, the MVD-Enfer kit is based on a POMP90-3 antigen while the LSI kit plates are coated with chlamydial LPS. The study also aimed to examine the potential of these ELISAs to distinguish infected animals that go on to abort compared to those that have live lambs. Ewes were vaccinated with either a commercial live vaccine (n = 10) or Tris-buffer sham inoculation (n = 9) 5 months prior to gestation, these ewes were then challenged with C. abortus (1 × 106 IFU/ml) on day 90 of gestation. Sera were collected at pre-vaccination, 14 days post vaccination, 35 days post vaccination, pre-challenge, 35 days post challenge and 3 weeks post lambing/abortion (~ 70 days post challenge) and tested using the 3 aforementioned ELISAs to determine if one ELISA was more sensitive at detecting circulating anti-chlamydial antibodies. RESULTS: Sensitivity was highest with the LSI test kit at 94.74%, followed by the MVD-Enfer and IDvet kits, at 78.95 and 73.68% respectively. Ewes vaccinated with Enzovax became seropositive at 14 days post vaccination with all kits. Following challenge at day 90 of gestation, antibody titres steadily rose in all groups of ewes. With all ELISA kits, antibody levels were higher in ewes that aborted compared to ewes that had live lambs at 35 days post challenge and three weeks post lambing, and statistically significantly higher antibody levels were recorded in ewes that aborted compared to ewes that had live lambs using the MVD-ENFER ELISA at three weeks post lambing (P = 0.0482). CONCLUSIONS: The LSI assay was the most sensitive out of the three kits tested in this study, when sera were tested at three weeks post lambing. As the LPS used in this kit is cross-reactive with all chlamydia, it is good for identifying flocks infected with any chlamydial species, but it is not considered specific for C. abortus. Furthermore, antibody levels were higher in ewes that aborted compared to ewes that had live lambs, at both 35 days post challenge and at three weeks post lambing. Future work should include evaluation of a larger number of sera at a wider range of time-points as well as an estimation of the specificity of commercially available assays.

Draft Genome Sequences of Six Different Staphylococcus epidermidis Clones, Isolated Individually from Preterm Neonates Presenting with Sepsis at Edinburgh's Royal Infirmary.

Herein, we report the draft genome sequences of six individual Staphylococcus epidermidis clones, cultivated from blood taken from different preterm neonatal sepsis patients at the Royal Infirmary, Edinburgh, Scotland, United Kingdom.

Clinical pregnancy following pre-implantation genetic diagnosis for cystic fibrosis.

Pre-implantation genetic diagnosis (PGD) is an established alternative to prenatal testing for couples at risk of transmitting genetic disorders such as cystic fibrosis (CF).PGD screens pre-implantation embryos, allowing the safe transfer of those identified as unaffected. Awareness of CF carrier status in Ireland is increasing following the introduction of neonatal screening in 2011. PGD is the most acceptable reproductive strategy for many at risk Irish couples but until now the treatment necessitated travelling abroad. In 2012, the Irish Medicines Board licenced two Irish fertility clinics to carry out embryo biopsy for PGD. This is the first reported clinical pregnancy following PGD carried out in Ireland.

Draft Genome Sequence of a Pantoea sp. Isolated from a Preterm Neonatal Blood Sepsis Patient.

Herein, we report the draft genome sequence of Pantoea sp. ED-NGS-1003, cultivated from a blood sample taken from a neonatal sepsis patient at the Royal Infirmary, Edinburgh, Scotland, United Kingdom.

Draft Genome Sequence of a Staphylococcus aureus Isolate Taken from the Blood of a Preterm Neonatal Blood Sepsis Patient.

Herein, we report the draft genome sequence of Staphylococcus aureus ED-NGS-1006, cultivated from a blood sample taken from a neonatal sepsis patient at the Royal Infirmary in Edinburgh, Scotland, United Kingdom.

Draft Genome Sequence of an Enterococcus faecalis Strain Isolated from a Neonatal Blood Sepsis Patient.

Herein, we report the draft genome sequence of Enterococcus faecalis ED-NGS-1009, cultivated from a blood sample taken from a neonatal sepsis patient at the Royal Infirmary in Edinburgh, Scotland, United Kingdom.

Draft Genome Sequence of a Serratia marcescens Strain Isolated from a Preterm Neonatal Blood Sepsis Patient at the Royal Infirmary, Edinburgh, Scotland, United Kingdom.

Herein, we report the draft genome sequence for isolate ED-NGS-1015 of Serratia marcescens, cultivated from a blood sample obtained from a neonatal sepsis patient at the Royal Infirmary in Edinburgh, Scotland, United Kingdom.

Draft Genome Sequence of a Streptococcus agalactiae Strain Isolated from a Preterm Neonate Blood Sepsis Patient at the Royal Infirmary, Edinburgh, Scotland.

Herein, we report the draft genome sequence of Streptococcus agalactiae ED-NGS-1000, cultivated from a blood sample taken from a preterm neonate blood sepsis patient at the Royal Infirmary, Edinburgh, Scotland, United Kingdom.

Draft Genome Sequence of a Staphylococcus warneri Strain Isolated from a Preterm Neonate Blood Sepsis Patient at the Royal Infirmary, Edinburgh, Scotland.

Herein, we report the draft genome sequence of Staphylococcus warneri ED-NGS-1001, cultivated from a blood sample taken from a preterm neonate blood sepsis patient at the Royal Infirmary, Edinburgh, Scotland, United Kingdom.

Prevention of HPV-related oral cancer: assessing dentists' readiness.

OBJECTIVES: Epidemiological research indicates an association between the Human Papillomavirus (HPV) with a subset of oral cancers (OC). Dentists may play a role in primary prevention of HPV-related OC by discussing the HPV vaccine with patients. This study assessed dentists' readiness to discuss the HPV vaccine with female patients. STUDY DESIGN: Cross-sectional web-based survey. METHODS: A web-based survey based on the Transtheoretical Model was administered among Florida dentists (n = 210). RESULTS: The majority of participants (97%) fell into the precontemplation and contemplation stages of readiness to discuss the HPV vaccine with patients. Perceived role and liability were determined to be predictive of dentists in contemplation stage as opposed to those in precontemplation (P < 0.05). CONCLUSIONS: Findings suggest liability and perceived role as processes of change necessary to guide dentists to primary prevention of HPV-related OC despite high levels of knowledge. As public awareness of HPV-related OC increases, dentists may become more involved in primary prevention. Results of the current study may assist in developing intervention strategies for engaging dentists in discussing the HPV vaccine with patients.

Reducing risk in coronary artery disease. Are Australian patients in general practice achieving targets? The Coronary Artery Disease in general practice study (CADENCE).

BACKGROUND: The benefits of secondary preventive measures for stable coronary artery disease are well established and risk factor treatment targets are defined. AIM: The aim of this study was to examine Australian general practitioners' (GP) perception and management of risk factors in chronic stable angina patients in primary care. METHODS: Using a cluster-stratified design, 2031 consecutive stable angina patients were recruited between October 2006 and March 2007 by 207 GP who documented their risk factors and reported if they were optimally controlled. RESULTS: Among the patients, 93% had objective evidence of coronary artery disease and 63% were male, and mean age was 71 ± 11 years. Based upon national guidelines, recommended targets were achieved in: 60% for blood pressure, 24% for body mass index, 23% for waist circumference, 17% for lipid profiles (low-density lipoprotein cholesterol, high-density lipoprotein cholesterol and triglycerides) and 54% of diabetics for haemoglobin A1c . However, GP perceived risk factors to be 'optimally controlled' in: 86% for blood pressure (kappa statistic (κ) = 0.37), 44% for weight (κ = 0.3), 70% for lipids (κ = 0.20) and 60% for haemoglobin A1c (κ = 0.74). CONCLUSIONS: In this representative cohort of chronic stable angina patients attending GP, cardiovascular risk factor control was frequently suboptimal despite being perceived as satisfactory by the clinicians. New strategies that raise awareness and address this treatment gap need to be implemented.

Suboptimal management of cardiovascular risk factors in coronary heart disease patients in primary care occurs particularly in women.

BACKGROUND: Patients with established coronary heart disease (CHD) are at the highest risk of further events. Despite proven therapies, secondary prevention is often suboptimal. General practitioners (GPs) are in an ideal position to improve secondary prevention. AIM: To contrast management of cardiovascular risk factors in patients with established CHD in primary care to those in clinical guidelines and according to gender. METHODS: GPs throughout Australia were approached to participate in a programme incorporating a disease management software (mdCare) program. Participating practitioners (1258 GPs) recruited individual patients whose cardiovascular risk factor levels were measured. RESULTS: The mdCare programme included 12,509 patients (58% male) diagnosed with CHD. Their mean age was 71.7years (intra-quartile range 66-78) for men and 74years (intra-quartile range 68-80) for women. Low-density-lipoprotein cholesterol was above target levels in 69% (2032) of women compared with 58% (2487) in men (P < 0.0001). There was also a higher proportion of women with total cholesterol above target levels (76%, 3592) compared with men (57%, 3787) (P < 0.0001). In patients who were prescribed lipid-lowering medication, 53% (2504) of men and 72% (2285) of women continued to have a total cholesterol higher than recommended target levels (P < 0.0001). Overall, over half (52%, 6538) had at least five cardiovascular risk factors (55% (2914) in women and 50% (3624) in men, P < 0.0001). CONCLUSION: This study found less intensive management of cardiovascular risk factors in CHD patients, particularly among women, despite equivalent cardiovascular risk. This study has shown that these patients have multiple risk factors where gender also plays a role.

Evidence-based chronic heart-failure management programmes: reality or myth?

BACKGROUND: Chronic heart-failure management programmes (CHF-MPs) have become part of standard care for patients with chronic heart failure (CHF). OBJECTIVE: To investigate whether programmes had applied evidence-based expert clinical guidelines to optimise patient outcomes. DESIGN: A prospective cross-sectional survey was used to conduct a national audit. SETTING: Community setting of CHF-MPs for patients postdischarge. SAMPLE: All CHF-MPs operating during 2005-2006 (n=55). Also 10-50 consecutive patients from 48 programmes were recruited (n=1157). MAIN OUTCOME MEASURES: (1) Characteristics and interventions used within each CHF-MP; and (2) characteristics of patients enrolled into these programmes. RESULTS: Overall, there was a disproportionate distribution of CHF-MPs across Australia. Only 6.3% of hospitals nationally provided a CHF-MP. A total of 8000 postdischarge CHF patients (median: 126; IQR: 26-260) were managed via CHF-MPs, representing only 20% of the potential national case load. Significantly, 16% of the caseload comprised patients in functional New York Heart Association Class I with no evidence of these patients having had previous echocardiography to confirm a diagnosis of CHF. Heterogeneity of CHF-MPs in applied models of care was evident, with 70% of CHF-MPs offering a hybrid model (a combination of heart-failure outpatient clinics and home visits), 20% conducting home visits and 16% conducting an extended rehabilitation model of care. Less than half (44%) allowed heart-failure nurses to titrate medications. The main medications that were titrated in these programmes were diuretics (n=23, 96%), ß-blockers (n=17, 71%), ACE inhibitors (ACEIs) (n=14, 58%) and spironolactone (n=9, 38%). CONCLUSION: CHF-MPs are being implemented rapidly throughout Australia. However, many of these programmes do not adhere to expert clinical guidelines for the management of patients with CHF. This poor translation of evidence into practice highlights the inconsistency and questions the quality of health-related outcomes for these patients.