Background: Manual handling injuries amongst physiotherapists are common and the need to improve our understanding of causal influences is imperative. Objective: The objective was to determine whether intra-shift variations in manual handling task performance occurred in our cohort, which may inform mechanisms underpinning related injuries. Methods: We used motion capture, force plate dynamics and electromyography to identify variations in task performance, loading forces and muscle activity, during the performance of one static and one dynamic standardized manual handling task, pre- and post-shift, by 40 physiotherapists. Participants also rated their pain and fatigue on a visual analogue scale (VAS). Statistical analysis utilised paired samples Student's t tests. Results: Significant differences were seen in the EMG activity in the quadriceps during the static task only. No significant differences were seen for any of the kinematic variables. Significant differences in fatigue (p < 0.005) were seen between the pre- and post-shift sessions. Notably, there were significant differences in pain between the pre- and post-shift sessions in the static (p < 0.01) and dynamic tasks (p < 0.05). This increase in pain was at a level which impacted on function. Conclusion: Whilst significant variations in task performance were not observed, our findings indicate that physiotherapists frequently experience task-related pain towards the end of their shift. Contemporary research indicates that frequent transient low back pain may transition to a chronic disabling condition, as such we posit that the effects of intra-shift pain, and its causative factors, should be more widely considered in a 'whole-of-job' approach to mitigating risk in this demographic.
Background Due to ongoing concerns about Sudden Infant Death Syndrome and Sudden Unexpected Death in Infancy, a safe sleep education blitz was conducted for professional health and care providers in conjunction with the introduction of a safe sleep alternative, the Pepi-Pod program, to Aboriginal families in South Australia. The aim of the study was to explore the effectiveness of the education blitz in building clinical knowledge about safe sleep. Methods Surveys were administered pre and post the education blitz intervention to professional health and care workers. Changes in knowledge pre- and post- intervention were measured to determine campaign effectiveness. The education blitz and surveys were conducted online. Results The pre intervention test knowledge score mean was 8.6 (SD 2.56) and post intervention was 9.5 (SD 1.22), indicating an improvement in knowledge, although not statistically significant. The lowest scores were seen in the ‘other’ category of providers (mean score 6.4), The greatest improvement was seen in the question: What weakens a baby’s arousal response? with improvement from 83% correct to 100% post intervention. Conclusions The education blitz increased safe sleep knowledge and awareness of the Pepi-Pod as a safe sleep alternative. Knowledge among health and care professionals, especially related to the anatomy and physiology of infant arousal and breathing, could be improved by the ongoing availability of the education blitz. This study informs approaches to increasing health and care providers’ knowledge about safe sleep. Despite a high level of health professional knowledge, babies in South Australia continue to die from SIDS and SUDI.
The prevalence of Hospital Acquired Complications (HACs) within major hospitals and intensive care units (ICUs) is often used as an indication of care quality. We performed a retrospective cohort study of acute care separations from four adult public hospitals in the state of South Australia, Australia. Data were derived from the Integrated South Australian Activity Collection (ISAAC) database, subdivided into those admitted to ICU or non-ICU (Ward) in tertiary referral or (other major) metropolitan hospitals. During the five-year study period (1 July 2013 to 30 June 2018), there were 471,934 adult separations with 65,133 HAC events reported in 43,987 (9.32%) at a mean rate of 13.8 (95% confidence interval (CI) 13.7 to 13.9) HAC events per 100 separations and 18.5 (95% CI 18.4 to 18.7) per 1000 bed days. The Ward cohort accounted for the majority (430,583 (91.2%)) of separations, in-hospital deaths (6928 (66.4%)) and HAC events (29,826 (67.8%)). The smaller ICU cohort (41,351 (8.76%)) had a higher mortality rate (8.46% versus 1.61%; P < 0.001), longer length of stay (median 10.0 (interquartile range (IQR) 6.0–18.0) days versus 4.0 (IQR 3.0–8.0) days P < 0.001), and higher HAC prevalence (62.1 (95% CI 61.3 to 62.9) versus 9.16 (95% CI 9.07 to 9.25) per 100 separations P < 0.001). Both ICU and Ward HAC prevalence rates were higher in tertiary referral than major metropolitan hospitals ( P < 0.001). In conclusion, higher HAC prevalence rates in the ICU and tertiary referral cohorts may be due to high-risk patient cohorts, variable provision of care, or both, and warrants urgent clinical investigation and further research.
Objective The Prostate Cancer Outcomes Registry for Australian and New Zealand (PCOR-ANZ) aims to monitor population-wide prostate cancer characteristics, treatments, and outcomes. However, long-term follow-up of secondary treatments, disease progression, and side effects is limited. This novel project provides increased utility, enhancing this clinical registry by integrating national and jurisdictional data. ApproachThe Tasmanian and South Australian jurisdictional registries (PCOR-Tas and PCOR-SA) are being treated as pilots for this nationally relevant data linkage project. Each contains descriptive data on clinical characteristics, primary treatments, survival, and patient-reported outcomes for prostate cancer in their jurisdictions. Data linkages include state-based hospital patient records and central cancer registries, with additional linkages to national data on prescribed medicines, procedures, and deaths; refer Figure 1. Authorisation by contributing custodians and ethics committees, and funding from the Movember charity, has enabled the more detailed evaluation of patient follow-up after the initial treatment to examine historical trends, health service utilisation, disparities and gaps, and long-term patient outcomes. ResultsSouth Australian study cohort consists of all men in the SACR (South Australia's central cancer registry) who were diagnosed with prostate cancer [ICD10=C61] as well as any additional men recorded in the PCOR-SA diagnosed from January 2002 to June 2021 (n=25,000). Men who do not have SA addresses recorded in either source are excluded from the South Australian pilot. The Tasmanian cohort is younger (established 2015) and smaller (n=2080), but for comparison is linked with the equivalent local and national datasets The South Australian data linkage is being undertaken by SA NT DataLink, with the Tasmanian linkage undertaken by the Tasmania Data linkage Unit. For both jurisdictions, the national datasets are being linked by the Australian Institute for Health and Welfare (AIHW). Conclusion Since the Australian health system involves components managed at both the State and Federal levels, multijurisdictional data linkage adds additional complexity to linkage projects. Undertaking this project was not without its challenges, but it demonstrates what can be achieved and the value of enhancing high-quality clinical registry data to address important outcomes in prostate cancer.
Funding Acknowledgements Type of funding sources: Other. Main funding source(s): SOLVE CHD Collaboration grant Introduction The burden of cardiovascular disease (CVD) is rapidly increasing, however, access to secondary prevention in rural areas is limited. Moreover, rural and remote CVD patients have limited access to primary care and other health services to receive ongoing support and post-discharge follow-up, and this may predispose them to insufficient secondary prevention in terms of a high risk of uncontrolled blood pressure and consequent life-threatening complications including coronary heart disease. Therefore, reform of secondary prevention in rural and remote areas is required to improve reach and access for patients living in such areas, and consequently improve clinical and other health outcomes. Objective To evaluate the feasibility of an innovative, tailored telehealth education and counselling program to optimise secondary prevention of CVD in patients living in rural areas in South Australia. Methods A quasi experimental study will be conducted by recruiting patients from existing database; country access to cardiac health (CATCH) program. Patients with CVD, aged ≥ 18, enrolled into CATCH program and living in rural and remote South Australia. Sample size is calculated using an online tool and is based on the primary endpoint to detect reduced readmission rate in patients with CVD and cardiac events. Patients with acute coronary syndrome/myocardial infarction, revascularisation procedure, stable and unstable angina, post coronary artery bypass grafting, post cardiac valve replacement surgery, and heart failure will be included. The sample size is calculated using online tool with appropriate statistical assumptions, which gives 113. The intervention of this study consists of two components: 1) delivery of a tailored telehealth counselling and education through telephone by a nurse and 2) use of an iPad application for patient education. Primary outcome is readmission for CVD and cardiac events. Secondary outcomes are knowledge of cardiovascular risk factors, lifestyle modification (e.g. smoking, alcohol, diet and physical exercise), medication adherence, health related quality of life and clinical outcomes such as lipid profile and blood pressure. Conclusion TEACH-RA study will test the feasibility of a tailored telehealth education and counselling program in patients with cardiac conditions living in rural and remote areas.
Background Smoking is disproportionately prevalent among Aboriginal and Torres Strait Islander Australian peoples, with 39% of Indigenous Australians aged over 15 years smoking daily. Efforts to reduce the prevalence include culturally focused media campaigns, designed through community consultation, that highlight the need to determine how such health messaging is perceived by smokers. This study aimed to examine Indigenous Australian smokers’ reactions to a culturally focused anti-smoking mass media campaign. Methods Intercept surveying across health services and events recorded demographics, smoking status, quit attempts, smoking health effects, anti-smoking campaign recall, social support, and campaign reactions. Participants rated four different campaign images in five domains: (1) whether it made them stop and think; (2) personal relevance; (3) believability of design and message; (4) prompting concern about smoking; and (5) motivation towards quitting. Cluster analysis was used to identify smoker types. Results Smoking health effects knowledge was high, and did not differ by quit readiness, attempts, or social support. Cessation support access was higher among those with greater readiness to quit. Social smoking behaviour and confidence to support others quitting did not significantly differ between participants, however importance of others quitting did. Quit readiness, attempts, and social support were associated with reaction to campaign design, but not message recall. Four types of smokers were identified using smoking characteristics, who differed in campaign message reactions. Conclusions Culturally focused anti-smoking media can benefit from exploring how smoker types can be used to differentiate messaging by smokers’ profile characteristics, to support mass media smoking cessation efforts.
Background: The association between temperatures and respiratory diseases has been extensively reported. However, the associated healthcare costs and attributable fractions due to temperature have scarcely been explored. The aims of this study were to estimate respiratory disease hospitalization costs attributable to non-optimum ambient temperature, to quantify the attributable fraction from cold and hot temperatures, and to estimate the future hospitalization costs in two Australian cities. Methods: The associations between daily hospitalization costs for respiratory diseases and temperatures in Sydney and Perth over the study period of 2010-2016 were analyzed using distributed lag non-linear models. Future hospitalization costs for respiratory diseases were estimated based on three predicted climate change scenarios - RCP2.6, RCP4.5 and RCP8.5. Results: The estimated respiratory disease hospitalization costs attributable to non-optimum ambient temperatures increased from 493.2 million Australian dollars (AUD) in 2010s to more than 700 million AUD in 2050s in Sydney, and from 98.0 million AUD to about 150 million AUD during the same period in Perth, in large part due to population growth. In the context of climate change, the current cold attributable fraction in Sydney (23.7%) and Perth (11.2%) is estimated to decline by the middle of this century to (18.1-20.1%) and (5.1-6.6%) respectively, while the heat-attributable fraction for respiratory disease is expected to gradually increase from 2.6% up to 5.5% in Perth. Conclusions: This study found both cold and hot temperatures increased the overall hospitalization costs for respiratory diseases in two major Australian cities, although the attributable fractions varied. The largest contributor was cold temperatures. While respiratory disease hospitalization costs will increase in the future, climate change will result in a decrease in the cold attributable fraction and an increase in the heat attributable fraction, depending on the location.
Abstract Background Chemsex, the intentional combining of sex with the use of particular psychoactive substances typically crys- tal methamphetamine, gamma-hydroxybutyrate(GHB)/gamma butyrolactone(GBL), mephedrone, and ketamine has been reported among men who have sex with men (MSM). Chemsex is more common among MSM than in the general population. We aimed to determine the prevalence and factors associated with chemsex in a sample of MSM attending three clinical settings in South Australia (SA). Methods MSM attending three urban clinics in South Australia between 1 February 2017 and 31 August 2017 were invited to complete questionnaires reporting socio-demographic information, sexual practices, drug use, and HIV/STI status. We determined the proportion of respondents reporting chemsex and evaluated factors associated with this practice using unad- justed and adjusted logistic regression. Results Chemsex was reported by 29% of this sample and was associated with being Australian-born (APR = 1.45; 95%CI: 1.02–2.06), engaging in group sex once/a few times (APR = 1.86; 95%CI 1.35–2.57) or at least monthly (APR = 2.30; 95%CI 1.23–4.29), hooking-up for sex online and on mobile phone applications (APR = 1.70; 95%CI 1.19–2.43), being HIV posi- tive (APR = 2.46; 95%CI 1.62–3.73) and taking PrEP (APR = 1.85; 95%CI 1.06–3.23). Condom-less anal sex (CAS) was significantly associated with chemsex (APR = 1.44; 95%CI 1.04–1.99). Conclusion The practice of chemsex in MSM in our clinical settings was associated with HIV-positive status and with cer- tain sexual practices. This practice by HIV-negative and HIV-positive men may play a role in STI and HIV transmission. There is a need to better understand this practice and our findings may inform the development of clinically based STI/HIV prevention and health promotion interventions for MSM in similar settings.
Background In Australia, the notification rate for hepatitis C is five times greater among Aboriginal and Torres Strait Islander peoples than nonIndigenous populations. Infection with Hepatitis C virus is associated with increased morbidity, mortality and health-related costs. However simple, tolerable and short-duration HCV therapies with extremely high efficacy are available. Methods Overall, this project aims to identify inequities in hepatitis C healthcare for Aboriginal and Torres Strait Islander peoples across South Australia (SA) and Northern Territory (NT). By using 19 routinely collected health administration datasets, we will evaluate hepatitis C diagnoses, treatment uptake, and treatment outcomes, with focus on identifying patterns in healthcare access among Aboriginal and Torres Strait Islander people in SA since 1992 or in NT since 1999 using probabilistic data linkage methodology in a secured online environment. Results The study population includes all hepatitis C notifications recorded in SA and NT, totaling more than 25,000 cases. Preliminary findings will be reported including incidence of hospitalisation, mortality, and morbidity by Aboriginal and Torres Strait Islander status. Conclusions Now that highly effective direct acting anti-viral treatments are available, it is crucial to ensure key affected populations, including Aboriginal and Torres Strait Islander people, have access to these novel biomedical approaches. Key messages This project is of national importance to address hepatitis C related morbidity and mortality in Australia, particularly among Aboriginal and Torres Strait Islander peoples. Findings will underpin future policy to reduce the burden of hepatitis C across SA and NT populations.
This brief communication reports what appears to be the first case of an interaction between an inferior vena cava filter and a patent foramen ovale closure device. During removal of the inferior vena cava filter, the patent foramen ovale closure device was unintentionally removed. This case report serves to highlight the possible interaction of these two devices.
Introduction In Australia, the notification rate for hepatitis C is 5 times greater among Aboriginal and Torres Strait Islander peoples than non‑Indigenous populations (164 vs. 35 per 100,000). Infection with Hepatitis C virus is associated with increased morbidity, mortality and health-related costs. Recently, the use of simple, tolerable and short-duration HCV therapies with extremely high efficacy (cure rates >90%) became available through the Pharmaceutical Benefits Scheme (PBS) on 1 March 2016. Objectives and Approach Overall, this project aims to identify inequities in hepatitis C healthcare for Aboriginal and Torres Strait Islander peoples across SA and NT. By using 19 routinely collected health administration datasets, we will evaluate hepatitis C diagnoses, treatment uptake, and treatment outcomes, with focus on identifying patterns in healthcare access among Aboriginal and Torres Strait Islander people. The study links state-based and federal datasets, including Medicare, Pharmaceutical Benefits Scheme, and National Mortality Database, to hepatitis C notifications reported in SA since 1992 or in NT since 1999 using probabilistic data linkage methodology in a secured online environment. Results The study population includes all hepatitis C notifications recorded in SA and NT, totalling more than 25,000 cases. Preliminary findings will be reported including incidence of hospitalisation, mortality, and morbidity by Aboriginal and Torres Strait Islander status. Conclusion / Implications This project is of national importance to address hepatitis C related morbidity and mortality in Australia, particularly among Aboriginal and Torres Strait Islander peoples. Now that highly effective direct acting anti-viral treatments are available, it is crucial to ensure key affected populations, including Aboriginal and Torres Strait Islander people, have access to these novel biomedical approaches. Findings will underpin future policy to reduce the burden of hepatitis C across SA and NT populations.
Background Although socioeconomic status (SES) has been reported to be associated with health inequities, there are limited studies exploring the association between SES and secondary prevention of acute coronary syndrome (ACS) in countries with universal health cover. Purpose The aim is to examine whether SES has an impact on the secondary prevention of ACS in Australia. Methods Australian SNAPSHOT ACS data (2012) and its 18-month follow-up data were linked to admissions data from 6 jurisdictions covering all states and territories, national death index and Medicare Pharmaceutical Benefits Scheme data covering up to 3 years post-discharge. The five SES groups (lowest in Group 1 and highest in Group 5) were derived from the Australian Bureau of Statistics Socio-Economic Indexes for Areas (SEIFA) using the residential postcode at baseline. Outcomes were cardiac rehabilitation (CR) participation and smoking rate at 18 months post discharge as well as the use of ≥3 of the 4 indicated medications, all-cause death and cardiovascular disease (CVD) rates by 36 months of discharge. Outcomes were compared between the groups using the multilevel logistic regression with covariates of SES (5 groups), sex, GRACE risk score (4 groups), ACS diagnosis (STEMI/NSTEMI/UA) and the jurisdictions where the admissions data were linked. Results Of 1655 patients with ACS (mean age 68±13.5 yrs, 65% were male), who were discharged from hospital alive and had linked data available, 353 (21%) were in SES Group 1 (lowest SES), 369 (22%) in Group 2, 382 (23%) in Group 3, 296 (18%) in Group 4 and 255 (15%) in Group 5 (highest SES). Baseline clinical characteristics were comparable across the five SES groups. At 18-month after discharge, 1014 (61%) patients were followed-up with comparable loss to follow-up in each group. After adjustment, fewer patients in the lower SES groups (Groups 1 and 2) had participated in CR than those in the highest SES group (Group 5) (OR (95% CI): 0.60 (0.36, 0.99) and 0.56 (0.35, 0.91), respectively). Moreover, the odds of smoking was greater in Group 3 than Group 5 (2.60 (1.15, 5.89)) but no trend was found across the groups. By 36 months of discharge after adjustment, there was no difference in the odds of using ≥3 out of 4 medications between the SES groups. Despite this, patients in Groups 1 and 2 were significantly more likely to die than those in the highest SES group (1.96 (1.19, 3.21) and 1.91 (1.19, 3.07), respectively). The odds of CVD readmission did not differ across SES groups. Conclusion This study suggests that patients with low SES were less likely to participate in CR programs and more likely to die than those with high SES. Smoking rates varied between patients with intermediate and high SES but no trend was found across the groups. Despite the universal health cover available, inequity between the SES groups still exist. Future research is needed to further explore strategies to help close the evidence-practice gaps. Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): Australian National Heart Foundation Postdoctoral Fellowship
Information and knowledge represent important organisational assets. In healthcare environments, patient wellbeing depends on effective management of these assets. This paper describes junior doctors’ perspectives of adverse consequences of ineffective information and knowledge management (IKM) practices. The research for this phenomenological study consisted of semi-structured interviews with ten junior doctors in public hospitals in Adelaide, South Australia. The reasons for ineffective IKM include limited access to information, inadequate clinical handover, inappropriate use of information systems, and incomplete documentation. Adverse medical events resulting from ineffective IKM practices include medication errors, delays in patient care or discharge, poor post-discharge care, confidentiality breaches, acting against patient wishes, disability or even death. Junior doctors regard health information systems and access to electronic patient medical records as important for improving IKM. Behaviour of staff often results in ineffective IKM and the paper suggests that an IKM-focused culture should be driven by hospital management.
Background Repeated admission to hospital can be a stressful and negative experience for older people and their families and puts additional pressure on the health care system. While there is evidence about strategies to better integrate care and improve older patients' experiences at transitions of care, thus helping to reduce hospital readmissions, implementing these strategies at scale is challenging. The objective of this project is to improve the pathways of care for older people after discharge from hospital by leveraging existing large datasets and an established collaborative network of clinicians, consumers, academics, and aged care providers. Methods The project will be undertaken in the state of South Australia and focuses on people aged 65 and over. A mixed methods approach will be adopted, with three inter-linked work packages that aim to: analyse existing registry data to profile individuals at high risk of emergency department encounters and hospital admissions; evaluate the effectiveness and cost-effectiveness of existing ‘out-of-hospital’ programs provided within the state; implement and evaluate a statewide quality improvement collaborative to tackle key interventions likely to improve older people’s care at points of transitions. The study is underpinned by an integrated approach to knowledge translation, with active engagement of a broad range of stakeholders throughout, to optimize the relevance and sustainability of the changes that are introduced. DiscussionThis project highlights the uniqueness and potential value of a multi-faceted approach (risk profiling; evaluation framework; implementation and evaluation) to improving health services. The project aims to develop a practical and scalable solution to a challenging health service problem for frail older people and service providers.Trial registrationNot applicable.
Background To assess the effects of consumer engagement in health care policy, research and services. Methods We updated a review published in 2006 and 2009 and revised the previous search strategies for key databases (The Cochrane Central Register of Controlled Trials; MEDLINE; EMBASE; PsycINFO; CINAHL; Web of Science) up to February 2020. Selection criteria included randomised controlled trials assessing consumer engagement in developing health care policy, research, or health services. The International Association for Public Participation, Spectrum of Public Participation was used to identify, describe, compare and analyse consumer engagement. Outcome measures were effects on people; effects on the policy/research/health care services; or process outcomes. Results We included 23 randomised controlled trials with a moderate or high risk of bias, involving 136,265 participants. Most consumer engagement strategies adopted a consultative approach during the development phase of interventions, targeted to health services. Based on four large cluster-randomised controlled trials, there is evidence that consumer engagement in the development and delivery of health services to enhance the care of pregnant women results in a reduction in neonatal, but not maternal, mortality. From other trials, there is evidence that involving consumers in developing patient information material results in material that is more relevant, readable and understandable for patients, and can improve knowledge. Mixed effects are reported of consumer-engagement on the development and/or implementation of health professional training. There is some evidence that using consumer interviewers instead of staff in satisfaction surveys can have a small influence on the results. There is some evidence that consumers may have a role in identifying broader range of health care priorities that are complementary to those from professionals. There is some evidence that consumer engagement in monitoring and evaluating health services may impact perceptions of patient safety or quality of life. Conclusions There is growing evidence from randomised controlled trials of the effects of consumer engagement on the relevance and positive outcomes of health policy, research and services. Health care consumers, providers, researchers and funders should continue to employ evidence-informed consumer engagement in their jurisdictions, with embedded evaluation.
Background: We investigated treatment and survival by clinical and sociodemographic characteristics in South Australia for service evaluation using linked data. Method: Data on invasive female breast cancers (n=13494) from the South Australian Cancer Registry (2000-2014 diagnoses) were linked to hospital inpatient, radiotherapy, and universal health insurance data. Treatments <12 months from diagnosis and survival were analysed, using adjusted odds ratios (aORs) from logistic regression, and adjusted sub-hazard ratios (aSHRs) from competing risk regression. Results: Five-year disease-specific survival increased to 91% for 2010-2014. Survival was lower for: ages 70+ years, and lowest for 80+ years (aSHR 2.04, 95%CI 1.69-2.47), compared with ages <50 years; and in the presence of comorbidity (aSHR 2.00, 95%CI 1.06-3.78), higher TNM stage and higher grade. Differences in aSHRs were not found by birth country or residential remoteness, but survival was higher in the least disadvantaged areas (aSHR 0.77, 95%CI 0.65-0.92). Most women had breast surgery (90%) (breast conserving surgery (56%), mastectomy (26%), and both surgery types (9%)), systemic therapy (72%) and radiotherapy (60%). Less treatment applied for ages 80+ vs <50 years (aOR 0.10, 95%CI 0.05-0.20) and TNM stage IV vs stage I (aOR 0.13, 95%CI 0.08-0.22). Surgical treatment increased during the study period. More women from least disadvantaged areas had systemic therapy (aOR 1.43, 95%CI 1.26-1.63). Radiotherapy was less common in outer regional/remote residents compared with major city residents (aOR 0.88, 95%CI 0.78-0.99). Conclusions: High survival from breast cancer in South Australia was comparable to the Australia-wide rate and did not differ by residential remoteness and country of birth. Surgical treatment within 12 months after cancer diagnosis increased during the study period and strongly predicted higher survival. Patients aged 70+ years had lower survival and less treatment, and more trial evidence is needed to optimize trade-offs between benefits and harms in this older age range. Systemic therapy was less for residents from most disadvantaged areas, while radiotherapy was less for residents of outer regional and remote areas.
Background Tacrolimus, a post-transplant immunosuppressive drug with a narrow therapeutic window requires close monitoring of levels to avoid under-immunosuppression or toxicity. Top End Renal Services in the Northern Territory (NT) refer to South Australia (SA) for drug levels as there was no local service. We aimed to evaluate the Abbott ARCHITECTi2000 immunoassay against the liquid chemistry tandem mass spectroscopy (LC-MS/MS) used in SA for measuring tacrolimus levels to provide on-site service in NT. Methods 465 specimens were collected over 5 months and analyzed over several reagent lots. We used Passing-Bablok regression plots and Bland–Altman plots to assess the agreement between tacrolimus levels on both platforms. Results The Passing-Bablok regression plot demonstrated a slope of 1.172 (CI 1.136 to 1.207) with an intercept of 0.262 (CI 0.040 to 0.472). In Deming analysis, the slope was 1.095 (CI 1.074 to 1.116) with an intercept of 0.773 (CI 0.592 to 0.955), correlation coefficient (r) was 0.9782. Bland-Altman plot demonstrated positive bias for Abbott ARCHITECT results. The mean absolute bias was 1.494 ug/L and the mean percentage bias was 18.78%. Within run imprecision, Co-efficient of Variation (%) was 5.1, 2.7, 4.3, 3.4 and 3.5 at tacrolimus concentration levels of 4.2, 6.5, 9.5, 17.2 and 24.4 µg/L. Results turnaround time improved by 80%. Conclusion The results demonstrate that Abbott ARCHITECT i2000 is an acceptable method to monitor levels of tacrolimus. The positive bias could be justifiable if the drug levels are initially based and then monitored on results from the same platform.
The dramatic rescue of a youth soccer team from Tham Luang cave in 2018 offered important lessons in the care of patients with hypothermia.
Objectives State governments often face capped budgets that can restrict expenditure on health technologies and their evaluation, yet many technologies are introduced to practice through state‐funded institutions such as hospitals, rather than through national evaluation mechanisms. This research aimed to identify the criteria, evidence, and standards used by South Australian committee members to recommend funding for high‐cost health technologies. Methods We undertook 8 semi‐structured interviews and 2 meeting observations with members of state‐wide committees that have a mandate to consider the safety, effectiveness, and cost‐effectiveness of high‐cost health technologies. Results Safety and effectiveness were fundamental criteria for decision makers, who were also concerned with increasing consistency in care and equitable access to technologies. Committee members often consider evidence that is limited in quantity and quality; however, they perceive evaluations to be rigorous and sufficient for decision making. Precise standards for safety, effective, and cost‐effectiveness could not be identified. Conclusions Consideration of new technologies at the state level is grounded in the desire to improve health outcomes and equity of access for patients. High quality evidence is often limited. The impact funding decisions have on population health is unclear due to limited use of cost‐effectiveness analysis and unclear cost‐effectiveness standards.
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