NT Health Research and Publications Online

Welcome to NT Health Research and Publications Online, an open access digital repository that showcases the research projects and output of researchers working for the Northern Territory Department of Health (NT Health), while also collecting and preserving publications and multimedia produced in an official capacity, that represent the department. This service is maintained by NT Health Library Services

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Operative caseload of general surgeons working in a rural hospital in Central Australia.
(2024-12-06)
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Arayne, Aisha Abdulmoeed
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Paredes, Steven
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Barbaro, Antonio
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Elgindy, Yara
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Tran, Steven
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There is limited published data on the caseload of general surgeons in Central Australia. The region has a significant Indigenous population, who often face higher rates of chronic diseases and require more frequent surgical interventions compared to non-Indigenous individuals. This study aims to outline the workload of surgeons at Alice Springs Hospital to determine the necessary skill set and surgical education for future surgeons.A retrospective review of all general surgery operative cases performed in Central Australia, Alice Springs Hospital was conducted between January 2012 and December 2021. The RACS Morbidity Audit and Logbook Tool was used to classify surgical procedures along with Medicare Benefits Schedule item numbers. Tables were created to present the annual and specialty-specific data on the types and volumes of procedures.From January 2012 to December 2021, 35 318 cases were performed, with 92.5% being general surgery, 3% plastics and reconstructive surgery and 2.8% vascular procedures. Indigenous patients received a higher proportion of procedures (50-60%) compared to non-Indigenous patients (30-50%). Common procedures included incision and drainage of abscesses and debridement of wounds, while trends across specialties showed a decline in ENT and plastic surgeries, stable thoracic and vascular cases, and increased numbers of urology operations.General surgeons in rural centres must possess a wide range of skills and be capable of performing a variety of procedures. Trainees should be encouraged to consider practicing in rural areas, and those interested should account for the specific needs of the communities they plan to serve.
Optimising risk stratification in diabetic ketoacidosis: a re-evaluation of acid-base status and hyperosmolarity using observational data.
(2024-12-06)
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Blank, Ruth
Accurate assessment of severity in diabetic ketoacidosis (DKA) can optimise early management and facilitate prioritisation for high acuity care. The primary aim was to evaluate the relationship between severity of acidosis (considering pH, bicarbonate, and anion gap) and hyperosmolarity with hospital mortality. Secondary outcomes included intensive care mortality, mechanical ventilation, vasopressor/inotrope use, and dialysis. A retrospective cohort study was conducted of adults (≥ 16 yr) with DKA admitted to US intensive care units. Data were extracted from the Medical Information Mart for Intensive Care (MIMIC)-IV dataset and eICU Collaborative Research Database. Univariable and multivariable logistic regression analyses were used to evaluate biochemistry obtained within 4 h of admission and the primary and secondary outcomes. We identified 4071 eligible admissions. There was no clear relationship between serum bicarbonate or anion gap and any outcome. Almost half the population did not have blood gas analysis within 4 h of admission; for 2292 patients with blood gases available, pH < 7 and inappropriately high PCO were associated with significant increases in mortality and all secondary outcomes. Osmolarity ≥ 320mosm/L was associated with fourfold increased mortality and higher rates of mechanical ventilation, use of vasopressors/inotropes, and dialysis. Failure of adaptive mechanisms (thirst and hyperventilation) indicating physiological decompensation may be more important for risk stratification in DKA than the degree of acidosis, which was only associated with outcome when severely abnormal. Blood gas analysis is essential to adequately assess disease severity as bicarbonate and anion gap were not predictive of outcome.
Snakebite in Australia: the role of the Venom Detection Kit.
(2004-10-01)
No abstract available
General Practice Sleep Scale - The "GPSS" - A proposed new tool for use in General Practice for risk assessment of Obstructive Sleep Apnoea.
(2024-11-21)
Howarth, Timothy
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Hedger, Joe
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Chen, Winnie
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Garg, Himanshu
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This pilot study investigated a new simplified OSA screening tool that could be used in primary care/GP settings - the "GPSS" tool - "General Practice Sleep Scale" and compared against common existing OSA screening tools.A convenience sample of patients attending the respiratory and sleep clinic in the Northern Territory of Australia were included if they completed the GPSS prior to undergoing a diagnostic polysomnography. The GPSS contained 9 questions to provide information on: sex, age, body mass index, neck circumference, snoring, witnessed apnoeas, morning tiredness, daytime sleepiness and presence of hypertension/diabetes/heart disease/depression. Presence of OSA was defined as an apnoea-hypopnoea index of ≥15/hour. The GPSS scoring was developed via log odds of regression predictions for each GPSS question upon OSA.159 patients (65 % male, median age 45 years) were enrolled. A minimum score of 1 was assigned to GPSS questions, up to 5 for the strongest predictor (neck circumference). The median total GPSS score was 13 (IQR 9, 16) (maximum 22) and correlated strongly with OSA (AUC 0.812 (95 % CI 0.744, 0.881)). Categorised into low (0-7), moderate (8-13) or high risk (>13), a moderate or severe score had sensitivity 100, specificity 34.9 %. The GPSS significantly outperformed the Epworth Sleepiness Scale, Berlin questionnaire and OSA-50, and was comparable but slightly improved against the STOP-Bang.The proposed GPSS tool could be of use in general practice settings. Further prospective research is warranted to test the applicability and adaptability of the GPSS tool in wider population settings.
Aeromedical retrieval for suspected preterm labour or rupture of membranes in the Northern Territory, Australia: may some cases be safely not retrieved?
(2024-11-30)
Langston-Cox, Annie
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Warton, Emily
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Tipping, Nadine
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Odgers, Harrison L
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Goni, Sherihan
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Suspected preterm labour (PTL) and prelabour rupture of membranes (PPROM) are common indications for aeromedical retrieval in the Top End, Northern Territory, Australia, where many women reside remotely and preterm birth (< 37 completed weeks of gestation) is common. The primary objective of this study was to determine rate of delivery during the index admission following aeromedical transfers from remote clinics to Royal Darwin Hospital for suspected PTL/PPROM.A retrospective cohort study of aeromedical transfers for suspected PTL/PPROM from 1 January 2020 to 31 July 2022 was undertaken. Transfers were identified through CareFlight, the regional air ambulance service, and complemented with data from hospital records. Clinical and sociodemographic characteristics were compared by delivery status during the index (post-retrieval) admission using parametric and non-parametric tests and multivariable linear regression analysis.238 women with singleton pregnancies were retrieved for suspected PPROM (n = 77, 32.4%) or PTL (n = 161, 67.6%), together accounting for 49.2% of all obstetric transfers (n = 483). Of 77 patients transferred for suspected PPROM, 47 (61.0%) had ruptured membranes confirmed on arrival, and 45 (95.7%) of them delivered during the index admission. None of the 30 women transferred for suspected PPROM with intact membranes on arrival delivered during the index admission. Of 161 patients transferred for suspected PTL, 13 (8.1%) had ruptured membranes confirmed on arrival, and 12 (92.3%) of them delivered during the index admission. Amongst women transferred for suspected PTL with intact membranes confirmed on arrival, 14.9% (22/149) delivered during the index admission. Prior to arrival, 120 women (50.4%) had a documented speculum examination, and 15 (6.3%) and 9 (3.8%) had cervicovaginal swab tests to assess their risks of a PPROM and PTL, respectively. Half of women who did not deliver during the index admission had received antenatal corticosteroids (n = 76).Many aeromedical retrievals for suspected PTL/PPROM did not result in delivery during the index admission. Women retrieved for suspected PPROM with intact membranes on arrival were less likely to deliver. Upskilling remote clinic staff and better point-of-care testing may reduce retrievals and unnecessary interventions. Prospective cohort studies designed to enable accurate prediction of which cases can be safely not retrieved are required.Not applicable.