Research

A promising model of collaboration between orthopaedic teams and geriatricians

Justin Zeltzer BCom(Econometrics), LLB · Rebecca J Mitchell MA(Psych), MOHS, PhD · Barbara Toson BStatEc · Ian A Harris MB BS, MMed(ClinEpi), PhD · Laura Ahmad MD, PhD, FRACP · Jacqui Close MD, FRCP, FRACP

This effective form of contraception has less uptake among the more disadvantaged

Philip Goldstone MB BS(Hons) · Yachna H Mehta MB BS · Kevin McGeechan MBiostat, PhD · Katherine Francis BE(Electrical), MB BS · Kirsten I Black MB BS, FRANZCOG, PhD

Online mental health programs have the potential to reduce absenteeism

Anna Mackenzie MPH · Samuel Harvey MRCPsych, FRANZCP, PhD · Louise Mewton BA(Hons), PhD · Gavin Andrews MD, FRANZCP

Declines in HCV incidence suggest increased treatment uptake and a reduction in the population of injecting drug users

Bethany White PhD, MPH · Gregory J Dore MB BS, FRACP, PhD · Andrew R Lloyd MB BS, MD, FRACP · William D Rawlinson MB BS, PhD, FRACP · Lisa Maher PhD

There is a need to protect against risks considered unacceptable in Australian practice

Martyn A Stafford-Bell MB BS, FRCOG, FRANZCOG · Sam G Everingham BSc, MA, MPH · Karin Hammarberg RN, BSc, PhD

Appropriate identification and management of diabetes and its comorbid conditions can reduce costs of preventable complications

Leon A Bach MB BS, PhD, FRACP · Elif I Ekinci MB BS, FRACP, PhD · Dennis Engler MD, FRACP · Chris Gilfillan MB BS, PhD, FRACP · P Shane Hamblin MB BS(Hons), FRACP · Richard J MacIsaac PhD, MB BS, FRACP · Georgia Soldatos MB BS, FRACP, PhD · Cheryl Steele RN, RM, CDE · Glenn M Ward MB BS, FRACP, DPhil(Oxon) · Sue Wyatt RN, GradCertDiabEd

High levels of active infection and susceptibility suggest routine HBV testing and vaccination could be beneficial in this population

Mary E Harrod PhD · Sophia Couzos FRACGP, FACRRM, FAFPHM · Dea Delaney-Thiele MPH · Gregory J Dore MPH, PhD, FRACP · Belinda Hammond · Mark Saunders · Mary Belfrage MB BS, DRANZCOG, MRACGP · Sidney Williams AdvDipMgt · John M Kaldor PhD · James Ward BA

High-risk children need ongoing surveillance and follow-up

Emma Griffiths MB BS, MPHTM, FRACGP · Carole Reeve FRACGP, FACRRM, FAFPHM · Julia V Marley PGDipSc, PGDipPolSt, PhD,

A first step towards understanding how Australia’s notifiable conduct law is working

Marie M Bismark MB ChB, LLB, MBHL · Matthew J Spittal PhD, MBio · Tessa M Plueckhahn BA(Hons), JD · David M Studdert LLB, ScD, MPH

Smoking cessation or reduction should be made a clear priority for improving pregnancy outcomes

Nicolette A Hodyl PhD, GradCert(Biostats) · Luke E Grzeskowiak PhD, BPharm(Hons), GCertClinEpid · Michael J Stark PhD, MB ChB · Wendy Scheil MB BS · Vicki L Clifton PhD

Concerns that women may not continue to participate in screening appear to be warranted

Alison C Budd PhD · Julia M L Brotherton BMed(Hons), MPH(Hons), FAFPHM · Dorota M Gertig MB BS(Hons), ScD, FAFPHM · Theresa Chau BPsychSc · Kelly T Drennan BHlthSc, PGCertCommDev · Marion Saville MB ChB, FIAC, GradDipMed(ClinEpi)

Reasons behind geographic and socioeconomic differences in survival warrant further investigation

Satyamurthy Anuradha MB BS, FRCS, PhD · Penelope M Webb MA, DPhil · Penny Blomfield MB BS, FRANZCOG, CGO · Alison H Brand MD, FRANZCOG, CGO · Michael Friedlander FRACP · Yee Leung MB BS, FRANZCOG, CGO · Andreas Obermair MD, FRANZCOG, CGO · Martin K Oehler MD, FRANZCOG, CGO · Michael Quinn MB ChB, FRANZCOG, CGO · Christopher Steer MB BS, FRACP · Susan J Jordan MB BS, FRACGP, PhD

Websites promoting emerging breast imaging devices overpromise on safety and effectiveness

Thomas D Vreugdenburg BHSc(Hons) · Caroline O Laurence BA(Hons), MHSM, PhD · Cameron D Willis BPhysio(Hons), PhD · Linda Mundy BSc, MPH · Janet E Hiller BA, MPH, PhD

Middle-aged patients with multiple risk factors appear to be well managed, but other age groups may be missing out

Leon A Simons MD, FRACP · Eric Chung BE(Comp), MBA

Publicly funded surgery is as effective as that performed in the private sector; improved access can reduce health inequities for those in need

Natalie Lukas MB BS(Hons), BPhty · Janet Franklin BMedSci(Hons), MNutr/Diet, PhD · Crystal M Y Lee PhD, MIPH, BMedSc(Hons) · Craig J Taylor MB BS(Hons), FRACS · David J Martin MB BS, FRACS · Nic Kormas MB BS(Hons), FRACP · Ian D Caterson MB BS(Hons), PhD, FRACP · Tania P Markovic MB BS(Hons), PhD, FRACP

Good outcomes for the few who can stay on pharmacotherapy

Sandra L Neoh FRACP, MB BS(Hons), BMedSci · Priya Sumithran MB BS(Hons), FRACP, PhD · Cilla J Haywood MB BS(Hons), FRACP · Christine A Houlihan MB BS, FRACP · Fiona T H Lee MB BS, FRACP, MD · Joseph Proietto MB BS, FRACP, PhD

Objectives: To investigate the characteristics of parents and intended parents and their current and planned behaviour in relation to surrogacy arrangements. Design, setting and participants: Members of two Australian parenting support forums who were considering surrogacy or were currently or previously in a surrogacy arrangement were invited to complete an online survey during July 2013. Main outcome measures: Sociodemographic characteristics; proportions engaging in domestic uncompensated and overseas compensated arrangements; countries used; costs incurred; and impact on behaviour of state laws criminalising compensated surrogacy. Results: Of 1135 potential participants, 312 (27%) commenced the survey. Of these, 24 did not fulfil inclusion criteria and 29 did not complete the survey. Eighty-nine respondents were considering surrogacy and 170 had commenced or completed surrogacy. Many respondents (53%) considered both overseas and domestic surrogacy. Among those who only considered one option, overseas surrogacy was considered significantly more often than domestic surrogacy (92% v 8%; P < 0.05). Only 22 respondents (8%) commenced with a surrogate in Australia. The most common countries used for compensated surrogacy were India and the United States, and average total estimated costs were $69 212 for India and $172 347 for the US. Barriers discouraging domestic surrogacy included concern that the surrogate might keep the child (75%), belief that it was too long and complicated a process (68%) and having no one of the right age or life stage to ask (61%). Few intended parents (9%) were deterred by state laws criminalising compensated surrogacy. Conclusions: Most Australian intended parents via surrogacy consider or use overseas compensated arrangements. Laws banning compensated surrogacy do not appear to deter those seeking surrogacy arrangements.

Sam G Everingham BSc, MA, MPH · Martyn A Stafford-Bell MB BS, FRCOG, FRANZCOG · Karin Hammarberg RN, BSc, PhD

Objectives: To examine doctors' level of knowledge of the law on withholding and withdrawing life-sustaining treatment from adults who lack decision-making capacity, and factors associated with a higher level of knowledge. Design, setting and participants: Postal survey of all specialists in emergency medicine, geriatric medicine, intensive care, medical oncology, palliative medicine, renal medicine and respiratory medicine on the AMPCo Direct database in New South Wales, Victoria and Queensland. Survey initially posted to participants on 18 July 2012 and closed on 31 January 2013. Main outcome measures: Medical specialists' levels of knowledge about the law, based on their responses to two survey questions. Results: Overall response rate was 32%. For the seven statements contained in the two questions about the law, the mean knowledge score was 3.26 out of 7. State and specialty were the strongest predictors of legal knowledge. Conclusions: Among doctors who practise in the end-of-life field, there are some significant knowledge gaps about the law on withholding and withdrawing life-sustaining treatment from adults who lack decision-making capacity. Significant consequences for both patients and doctors can flow from a failure to comply with the law. Steps should be taken to improve doctors' legal knowledge in this area and to harmonise the law across Australia.

Ben White LLB(Hons), DPhil · Lindy Willmott BCom LLB, LLM, PhD · Colleen Cartwright PhD, MPH, BSW(Hons) · Malcolm H Parker MB BS, MHMedLaw, MD · Gail Williams MSc, MSc(Lond), PhD

Less time in emergency department, but with what outcomes and at what cost?

Thomas P Y Yip MB BS(Hons), FRACP, FCSANZ · Heather M Pascoe MB BS(Hons), BMedSci · Stephen E Lane BSc(Hons), PhD

Expanding data sources for surveillance offers hope for improving child protection

Steven L Guthridge MB BS, MTH, FAFPHM · Philip Ryan MB BS, BSc, FAFPHM · John R Condon MB BS, PhD, FAFPHM · John R Moss MSocSci, MB BS, BEc · John Lynch PhD, MPH

Objectives: To understand the changes in the population incidence of inhospital cardiopulmonary arrest (IHCA) and mortality associated with the introduction of rapid response systems (RRSs). Design, setting and participants: Population-based study of 9 221 138 hospital admissions in 82 public acute hospitals in New South Wales, using data linked to a death registry, from 1 Jan 2002 to 31 Dec 2009. Main outcome measures: Changes in IHCA, IHCA-related mortality, hospital mortality and proportion of IHCA patients surviving to hospital discharge. Results: RRS uptake increased from 32% in 2002 to 74% in 2009. This increase was associated with a 52% decrease in IHCA rate, a 55% decrease in IHCA-related mortality rate, a 23% decrease in hospital mortality rate and a 15% increase in survival to discharge after an IHCA (all P < 0.01). The adjusted absolute reductions in IHCA-related mortality and hospital mortality were 1.49 (95% CI, 1.30–1.68) and 4.05 (95% CI, 3.17–4.76) patients per 1000 admissions, respectively. The decrease in IHCA incidence rate accounted for 95% of the reduction in IHCA-related mortality. In contrast, the increase in IHCA survival accounted for only 5% of the reduction in IHCA-related mortality. Conclusions: During nearly a decade, as RRSs were progressively introduced, there was a coincidental reduction in IHCA, IHCA-related deaths and hospital mortality and an increased survival to hospital discharge after an IHCA. Reduced IHCA incidence, rather than improved postcardiac arrest survival, was the main contributor to the reduction in IHCA mortality.

Jack Chen MB BS, PhD, MBA(Exec) · Lixin Ou MBA, MPH, PhD · Kenneth M Hillman MD, FRCA, FCICM · Arthas Flabouris MD, FCICM, FANZCA · Rinaldo Bellomo MD, FCICM, FRACP · Stephanie J Hollis BSc, MMedSc, PhD · Hassan Assareh PhD, MEng, MSc(Manag)

Health care providers identify barriers to optimal antibiotic prescribing in nursing homes

Ching Jou Lim BPharm(Hons) · Megan W-L Kwong MB BS, BMedSci · Rhonda L Stuart MB BS, FRACP, PhD · Kirsty L Buising MPH, MD, FRACP · N Deborah Friedman FRACP, MD, MPH · Noleen J Bennett PhD, MPH · Allen C Cheng FRACP, MPH, PhD · Anton Y Peleg MB BS, PhD, FRACP · Caroline Marshall FRACP, PhD, GradDipClinEpi · David C M Kong BPharm, MPharm, PhD

Selling the bush: 3 weeks' rural experience left students with positive feelings about rural health care

Julian R Wright MD, FRCP(UK), FAcadMEd · Lisa Bourke BSc, MSc, PhD · Catherine J Waite BA(Hons), MPhil · Thom A Holden BA(Hons), PhD · Jenni M Goodwin BA · Anne L Marmo BA(Hons), GradDipEdSec · Maxine L Wilson · Helen E Malcolm BSc, MB BS, FRACGP · David Pierce MB BS, MD, FRACGP

Seasonal monitoring provided by general practitioners is effective

Sheena G Sullivan MPH, PhD · Monique B-N Chilver BSc, GradDipPubHealth · Geoff Higgins MB BS, PhD, FRCPA · Allen C Cheng MPH, PhD, FRACP · Nigel P Stocks MD, FRACGP, FAFPHM