Research

A 3-year whole-of-hospital clinical service redesign program in a tertiary paediatric hospital in Western Australia finds that the introduction of a 4-hour-rule program for discharge or admission from the emergency department improves timeliness of care for patients throughout the hospital, with no adverse impact on the quality and safety of clinical care.

Liana Maumill RN, BN, PGDip(Paed Nsg) · Mia Zic BHlthSc, MIPH · Amanda A Esson BHlthSc · Gary C Geelhoed MB BS, FRACP, FACEM · Meredith M Borland MB BS, FACEM · Christopher Johnson MB BS, ANZCA · Philip Aylward BBA · Andrew C Martin MB BS, FRACP, MD

A study comparing single-field fundus photography with expert clinical examination finds the former is a valid tool in detecting diabetic retinopathy in Indigenous people in remote communities of Central Australia.

Janice J-Y Ku MB BS · John Landers PhD, FRANZCO · Tim Henderson MB, ChB, FRANZCO · Jamie E Craig DPhil, FRANZCO

A small exploratory study finds that most patients with diabetes attending for routine blood monitoring are willing to undergo non-mydriatic retinal photography administered by pathology collection staff.

Melanie F Larizza BBSc, GradDip(Sec) · Lauren A Hodgson BSc(Hons) · Eva K Fenwick MA, BA(Hons) · Ryo Kawasaki PhD, MD, MPH · Ralph Audehm MB BS · Jie Jin Wang PhD, MB BS, MMed(OphthalPath) · Tien Y Wong PhD, FRCEEd, MMed · Ecosse L Lamoureux PhD, BEd, MApplSci

A retrospective audit of patients referred for venous thromboembolism-related imaging reveals that the availability of new screening and diagnostic tests may have led to overdiagnosis of clinically insignificant pulmonary embolism.

Tatiana Segard MD · William B G Macdonald MB BS, MPH, FRACP

The authors explore the reasons for barriers to discharge from inpatient rehabilitation and whether these can be predicted by demographic or clinical variables.

Peter W New MB BS, MClinEpi, FAFRM(RACP) · Damien J Jolley MSc(Epidemiol), MSc, A Stat · Peter A Cameron MB BS, MD, FACEM · John H Olver MB BS, MD, FAFRM(RACP) · Johannes U Stoelwinder MB BS, MD, FRACMA

In a cohort of 65 boys aged 12–16 years at recruitment, treatment for more than 3 years with stimulant medication was associated with a slower rate of physical development during puberty, compared with boys not taking stimulants.

Alison S Poulton MA, MB BChir, MD · Elaine Melzer RN, RM, OAM · Paul R Tait MB BS, FRACP · Sarah P Garnett BSc, MNutrDiet, PhD · Chris T Cowell MB BS, FRACP · Louise A Baur MB BS, PhD, FRACP · Simon Clarke MB BS, FRACP, FCP

A study of help-seeking behaviours, reproductive disorders and rates of testing for prostate problems in Aboriginal and Torres Strait Islander men from urban, rural and remote communities in the Northern Territory and Queensland.

Michael J Adams BSW, MA, PhD · Veronica R Collins BSc, MSc(Epidemiol), PhD · Michael P Dunne BA(Hons), PhD · David M de Kretser MB BS, MD, FRACP · Carol A Holden BSc(Hons), PhD, MPH

Objectives: To report on the prevalence and implications of overweight and obesity in a rural maternity cohort.Design, setting and participants: A retrospective 6-year cohort of 6138 pregnancies managed in a rural Victorian maternity service from 1 January 2005 to 31 December 2010.Main outcome measures: Maternal body mass index (BMI), prevalence of overweight and obesity, prevalence of pregnancy complications and their association with BMI ...

Chris E Cunningham MSc, BLit, BA · Glyn R Teale MRCP, MRCOG, FRANZCOG

A review of clinical records of patients treated in Canberra and Sydney identified 10 patients who were likely to have suffered “deathcap” mushroom poisoning between 1999 and 2012. Despite treatment according to current standards, including use of the purported antidote silibinin, eight developed significant hepatotoxicity and four died.

Darren M Roberts PhD, FRACP · Michael J Hall FACEM · Morna M Falkland BPharm · Simone I Strasser MD, FRACP · Nick A Buckley MD, FRACP

Objective: To use patient-level data, clinical information and linked Medicare records to assess the distribution of benefits (rebates) across income groups, including benefits relating to chronic conditions such as the Chronic Disease Dental Scheme (CDDS).Design, setting and participants: Nationally representative, cluster-stratified survey (the Australian Hypertension and Absolute Risk Study) involving 322 general practitioners who each collected clinical data on 15–20 patients aged ≥ 55 years ...

Rachel J Knott BEcon(Hons I), BCom · Alan Cass MB BS, FRACP, PhD · Emma L Heeley BSc(Hons), MSc, PhD · John P Chalmers MD, PhD, FRACP · David P Peiris MB BS, PhD, FRACGP · Philip M Clarke BEc, MEc, PhD

New South Wales data from the 45 and Up study indicate that bariatric surgery for severe obesity is largely available to those who can afford private health insurance and associated out-of-pocket costs, with poor access in populations who are most in need.

Rosemary J Korda PhD · Grace Joshy BSc(Mathematics), MSc(Biostatistics), PhD · Louisa R Jorm BVSc, MSc(Epidemiology), PhD · James RG Butler BEcon, MPolEcon, PhD · Emily Banks MB BS(Hons), PhD, FAFPHM

An analysis of administrative data shows rapid increases in both notifications and substantiated cases of maltreatment in the NT Aboriginal population, suggesting a need for further expansion of services to address both immediate safety and the wider determinants of maltreatment.

Steven L Guthridge MB BS, MTH, FAFPHM · Philip Ryan MB BS, FAFPHM · John R Condon PhD, FAFPHM · Leah M Bromfield BAppSci(Psych)(Hons), PhD · John R Moss MSocSci, MB BS, FPHAA · John W Lynch PhD, MPH

Objectives: To assess notification trends for chlamydia and gonorrhoea infections in Indigenous Australians compared with non-Indigenous Australians in 2000–2009.Design and setting: We assessed trends in national notification rates using univariate Poisson regression and summary rate ratios.Main outcome measures: Crude notification rates and summary rate ratios, by Indigenous status, sex, age and area of residence.Results: Over the 10-year ...

Simon Graham BIS, MAppEpi · Rebecca J Guy BAppSc, MAppEpi, PhD · Basil Donovan MB BS, MD · Hamish McManus BEcon, BAcTS, MBIOS · Jiunn-Yih Su MB, MPH · Carol El-Hayek BSc, MEpi · Kellie S H Kwan BA(Hons), GradCertAppEpi · Amalie Dyda BHSc(Hons), MAppEpi · Handan C Wand MA, MSc, PhD · James S Ward BA

A retrospective study of the extent and management of pelvic inflammatory disease in remote-living Aboriginal women reveals that it occurs frequently, but is underdiagnosed and poorly treated.

Bronwyn J Silver BNurs, GradDipMID, MPH · Janet Knox MMed(STD/HIV), DTM · Kirsty S Smith GDipCommNurs, GDipEd, MPH · James S Ward BA · Jacqueline Boyle FRANZCOG, MPH, PhD · Rebecca J Guy BAppSc, MAppEpid, PhD · John Kaldor PhD · Alice R Rumbold BSc(Hons), MPH, PhD

Objectives: To evaluate the outcomes of preconception screening of Jewish Australians for Tay Sachs disease (TSD) carrier status on Jewish TSD-affected births.Design, participants and setting: Epidemiological observational study involving a complete retrospective audit of infantile and intermediate TSD cases diagnosed in Sydney and Melbourne between 1 January 1995 and 31 December 2011 (Royal Children’s Hospital Melbourne; Pacific Laboratory Medicine Services, Pathology North, NSW Health Pathology, Sydney; ...

Raelia M Lew MB BS(Hons) MMed · Anne L Proos MSc, FFSc(RCPA) · Leslie Burnett MB BS, PhD, FRCPA · Martin Delatycki MB BS, FRACP, PhD · Agnes Bankier MB BS, FRACP · Michael J Fietz PhD

Using a multiplatform approach, the authors identify 156 potentially ineffective and/or unsafe services listed on the Australian Medicare Benefits Schedule that warrant further consideration. Reducing the use of existing services that offer little or no benefit relative to the cost of their public subsidy would allow funding to be reallocated to more beneficial or cost-effective services.

Adam G Elshaug MPH, PhD · Amber M Watt MPH · Linda Mundy MPH · Cameron D Willis PhD

Data collected before and after the H1N1 2009 influenza pandemic indicate significant shifts in public threat perception and anticipated response to a future pandemic. The H1N1 2009 pandemic has altered public perceptions of the probability of a pandemic in the future, but has left the public feeling less vulnerable.

Melanie R Taylor BSc(Hons), PhD, CPsychol · Garry J Stevens BSc(Hons), MClinPsych · Kingsley E Agho MSc, MPH, PhD · Sheree A Kable BMed, PhD · Beverley Raphael MB BS, MD, FRANZCP

Non-melanoma skin cancer treatments increased by 86% between 1997 and 2010. The authors anticipate that the number and the total cost without inflation of non-melanoma skin cancer treatments will increase by a further 22% between 2010 and 2015.

Marloes Fransen MB BS · Amalia Karahalios BSc, MPH · Niyati Sharma MB BS · Dallas R English BSc, MSc, PhD · Graham G Giles BSc, MSc, PhD · Rodney D Sinclair MB BS, MD, FACD

Objectives: To measure the frequency and content of electronic handover before and after implementation of the Blue BARRWUE handover system, and to measure its effect on patient safety and hospital efficiency over weekends.Design, setting and participants: Point-prevalence study comparing outcomes for general medical inpatients present over weekends before implementation (1 May 2008 to 30 April 2009) and after implementation (1 May 2009 to 30 April 2010) of ...

Boloor S Rao MB BS, DNB · Gail O Lowe RN, BN, MHA · Andrew J Hughes MB BS, FRACP

H1N1-containing vaccines were not statistically associated with Guillain-Barré syndrome, but this study could not exclude smaller increases in the relative incidence. Active surveillance of adverse events following immunisation is required to maintain public and health care professional confidence in mass vaccine implementation programs.

Nigel W Crawford MB BS, MPH, PhD · Allen Cheng MPH, PhD, FRACP · Nick Andrews MSc · Patrick G Charles MB BS, PhD, FRACP · Hazel J Clothier MAppEpid, MscID, FIBMS · Bruce Day MB BS · Timothy Day MB BS · Peter Gates MB BS · Richard Macdonell MB BS · Les Roberts MB BS · Victoria Rodriguez-Casero MB BS · Tissa Wijeratne MB BS · Lynette Kiers MB BS

Using cases as their own controls potentially provides stronger evidence for analysing adverse events following vaccinationMMaintaining public confidence in vaccines requires having effective postmarketing vaccine safety surveillance systems in place to rapidly address emerging concerns about vaccine safety. However, conducting studies of vaccine safety presents several challenges for traditional observational study designs. Important differences may exist between vaccinated and unvaccinated individuals that could confound the ...

Steven Hawken MSc · Kumanan R Wilson MD

GP referrals had the highest level of appropriateness, and healthdirect- and self-referrals had similar levels of appropriateness. More than half the healthdirect-referred patients attended the ED despite a contrary recommendation, probably due to difficulty accessing after-hours health services.

Joseph Y Ng MB BS, FANZCA · Daniel M Fatovich MB BS, FACEM, PhD · Valendar F Turner MB BS, FRACS, FACEM · Jennifer A Wurmel RN · Sally A Skevington BWS(Hons) · Michael R Phillips BSc(Hons), MMedSci

Together with reports of the decreasing prevalence of smoking among Indigenous people, this first report of a significant reduction in heavy smoking by Indigenous smokers is good news. Reducing smoking intensity and prevalence will lead to fewer deaths and less illness due to smoking. Reducing the number of heavy smokers will also assist smoking cessation among Indigenous people. These changes in smoking intensity occurred before the recent increase in attention to and investment in tobacco control in Indigenous communities, but at a time of significant mainstream anti-tobacco public health activity. Similar trends in smoking intensity have been reported in the total Australian population.

David P Thomas MB BS, PhD, FAFPHM

There is a mismatch between the high proportion of registered trials in advanced colorectal cancer and the areas of priority identified. The development of specific trials in these priority areas depends on the availability of funding and the existence of plausible interventions likely to improve patient outcomes.

Rachel F Dear MB BS, PhD, FRACP · Alexandra L Barratt MB BS, MPH, PhD · Alison Evans PhD · John Simes MD, PhD · John Newsom BA · Dan Kent GDM · Sally Crossing BEc · Catherine Holliday PhD · Eva Segelov MB BS, FRACP, PhD · George Hruby MB ChB · Martin HN Tattersall MD

Objective: To determine whether international medical graduates (IMGs) have more complaints made against them to medical boards and experience more adverse disciplinary findings than Australian-trained doctors.Design and setting: Data on all complaints made against doctors to medical boards in Victoria and Western Australia over 7.5 years and 5.25 years, respectively, were extracted and linked with information on all doctors registered in those states over the ...

Katie Elkin LLB, BSc · Matthew J Spittal PhD, MBio · David M Studdert LLB, ScD, MPH