ePublications Community: A digital repository for managing and storing publications produced by NT Department of Health. This includes annual reports, research and newslettersA digital repository for managing and storing publications produced by NT Department of Health. This includes annual reports, research and newslettershttps://hdl.handle.net/10137/112024-03-19T01:03:55Z2024-03-19T01:03:55ZPublic Health Management of Acute Post-Streptococcal Glomerulonephritis (APSGN)https://hdl.handle.net/10137/4442024-02-20T06:13:42Z2024-02-20T00:00:00ZTitle: Public Health Management of Acute Post-Streptococcal Glomerulonephritis (APSGN)
Abstract: This guideline provides information to support the public health management of Acute Post Streptococcal Glomerulonephritis (APSGN) cases, contacts and outbreaks in the NT.
Description: PRINT WARNING: Content is continually being revised.
ALWAYS refer to the electronic copy for the latest version. Users must ensure that any printed copies of this document are of the latest version.
This guideline has been developed for NT Health practice setting only. Clinical content is intended to guide clinical practice and does not replace clinical judgement. Modification will occur according to internal audit processes and literature review. The rationale for the variation from the guideline must be documented in the clinical record.; First ed. published in December 2002. Second ed. published August 2010.2024-02-20T00:00:00ZTesting the intrinsic mechanisms driving the dynamics of Ross River Virus across Australia.Koolhof ISBeeton NBettiol SCharleston MFirestone SMGibney KNeville PJardine AMarkey PKurucz NWarchot AKrause VOnn MRowe SFranklin LFricker SWilliams CCarver Shttps://hdl.handle.net/10137/126702024-03-06T06:58:05Z2024-02-15T00:00:00ZTitle: Testing the intrinsic mechanisms driving the dynamics of Ross River Virus across Australia.
Authors: Koolhof IS; Beeton N; Bettiol S; Charleston M; Firestone SM; Gibney K; Neville P; Jardine A; Markey P; Kurucz N; Warchot A; Krause V; Onn M; Rowe S; Franklin L; Fricker S; Williams C; Carver S
Abstract: The mechanisms driving dynamics of many epidemiologically important mosquito-borne pathogens are complex, involving combinations of vector and host factors (e.g., species composition and life-history traits), and factors associated with transmission and reporting. Understanding which intrinsic mechanisms contribute most to observed disease dynamics is important, yet often poorly understood. Ross River virus (RRV) is Australia's most important mosquito-borne disease, with variable transmission dynamics across geographic regions. We used deterministic ordinary differential equation models to test mechanisms driving RRV dynamics across major epidemic centers in Brisbane, Darwin, Mandurah, Mildura, Gippsland, Renmark, Murray Bridge, and Coorong. We considered models with up to two vector species (Aedes vigilax, Culex annulirostris, Aedes camptorhynchus, Culex globocoxitus), two reservoir hosts (macropods, possums), seasonal transmission effects, and transmission parameters. We fit models against long-term RRV surveillance data (1991-2017) and used Akaike Information Criterion to select important mechanisms. The combination of two vector species, two reservoir hosts, and seasonal transmission effects explained RRV dynamics best across sites. Estimated vector-human transmission rate (average β = 8.04x10-4per vector per day) was similar despite different dynamics. Models estimate 43% underreporting of RRV infections. Findings enhance understanding of RRV transmission mechanisms, provide disease parameter estimates which can be used to guide future research into public health improvements and offer a basis to evaluate mitigation practices.2024-02-15T00:00:00ZHealth and Wellbeing of Urban and Township Adults in the Northern Territory 2022Zhang, XiaohuaWright, AlysonBurgess, Paulhttps://hdl.handle.net/10137/126522024-03-05T23:16:51Z2024-02-14T00:00:00ZTitle: Health and Wellbeing of Urban and Township Adults in the Northern Territory 2022
Authors: Zhang, Xiaohua; Wright, Alyson; Burgess, Paul
Abstract: This report summarises data from the 2022 Northern Territory Urban and Township Adult Population Health Survey (NTUTAPHS). The survey collected data on socioeconomic and demographic details, self-reported general health status, chronic health conditions, mental health conditions and health risk factors including smoking, physical activity, nutrition and body mass. Eligible participants were NT residents aged 18 and over with a mobile number listed on the Integrated Public Number Database, excluding those living in remote Aboriginal communities (defined by postcodes). The descriptive statistical outcomes in weighted proportion are presented to portray the sampled NT population, as well as for sub-population groups where the results are considered statistically valid.2024-02-14T00:00:00ZAntibiotics to eradicate Streptococcus pyogenes pharyngeal carriage in asymptomatic children and adults: A systematic review.Hung, Te-YuPhuong, LKGrobler, ATong, SYCFreeth, PPelenda, AGibney, KBSteer, AChttps://hdl.handle.net/10137/126682024-03-06T06:54:04Z2024-02-14T00:00:00ZTitle: Antibiotics to eradicate Streptococcus pyogenes pharyngeal carriage in asymptomatic children and adults: A systematic review.
Authors: Hung, Te-Yu; Phuong, LK; Grobler, A; Tong, SYC; Freeth, P; Pelenda, A; Gibney, KB; Steer, AC
Abstract: Streptococcus pyogenes (S. pyogenes) is a Gram-positive bacteria which causes a spectrum of diseases ranging from asymptomatic infection to life-threatening sepsis. Studies report up to 2000 times greater risk of invasive S. pyogenes disease in close contacts of index cases within 30-days of symptom onset. Despite this, there is variability in the management of asymptomatic carriage of S. pyogenes and those at risk of secondary cases of invasive S. pyogenes infection. OBJECTIVE: Our systematic review assessed the efficacy of different antibiotic regimens used for eradication of S. pyogenes from the pharynx in asymptomatic individuals. METHODS: We searched Pubmed, EMBASE (1974-), OVID Medline (1948-) and the Cochrane CENTRAL registry. We included randomised controlled trials (RCTs) with asymptomatic participants with >50% with pharyngeal cultures positive with S. pyogenes at baseline. Only studies with microbiological methods including culture (+/- polymerase chain reaction, PCR) were included. We included studies published in English. Each included study was assessed by two independent reviewers for data extraction and risk of bias. RESULTS: Of 1166 unique records identified, three RCTs were included in the review. Two of the three included RCTs found oral clindamycin for 10-days was the most efficacious regimen, compared to intramuscular benzathine penicillin G followed by 4 days of oral rifampicin, or monotherapy using benzathine penicillin, phenoxymethylpenicillin or erythromycin. Two RCTs were assessed as being at high risk of bias, with the third study demonstrating low/some risk of bias. CONCLUSIONS: Current available evidence for the optimal antibiotic in eradicating pharyngeal S. pyogenes carriage is limited. Future RCTs should include penicillin, first-generation cephalosporins, rifampicin, macrolides (such as azithromycin) and clindamycin.2024-02-14T00:00:00Z'I mean, I wouldn't say I was sober': Exploring the psychosocial impact of e-scooter injuries and aligning a collaborative public health response.Piatkowski, TimothyMoran, JamesCanty, RuthWright, Cassandra J Chttps://hdl.handle.net/10137/126552024-02-14T03:53:31Z2024-02-02T00:00:00ZTitle: 'I mean, I wouldn't say I was sober': Exploring the psychosocial impact of e-scooter injuries and aligning a collaborative public health response.
Authors: Piatkowski, Timothy; Moran, James; Canty, Ruth; Wright, Cassandra J C
Abstract: ISSUE ADDRESSED: E-scooters are sought after for their cost-effectiveness, sustainability, and efficiency in urban transportation. However, this popularity has been accompanied by a surge in injuries, prompting a deeper investigation into the factors influencing risk perceptions among e-scooter users. METHODS: Using a qualitative approach, we conducted 19 interviews with those who attended an emergency department as a result of e-scooter injury. We aimed to understand the psychosocial effects of these incidents and employed thematic analysis to discern recurrent patterns in participants' experiences, focusing on alterations in daily life, community response, perception shifts, and avenues to enhance safety awareness. RESULTS: The findings underscored significant disruptions to daily life due to injuries, demonstrating enduring impacts on lifestyle and wellbeing. Participants exhibited a perceptual shift, transitioning from perceiving e-scooters as enjoyable to viewing them as dangerous. Recommendations for enhancing safety awareness included accessible and clear safety education, pre-ride briefings, real-time safety guidance, temporal rental restrictions, and mandatory breathalysers before e-scooter use. CONCLUSIONS: The study underscores the importance of considering not only the individual experiences and perceptions of e-scooter injuries but also the broader social context, including the night-time economy. Leveraging peer narratives and community engagement is vital to reshape risk perceptions and promote harm reduction messages. SO WHAT?: A comprehensive approach through proactive interventions and robust educational strategies is essential to foster responsible e-scooter usage and prioritise public safety.2024-02-02T00:00:00ZA pilot study using hospital surveillance and a birth cohort to investigate enteric pathogens and malnutrition in children, Dili, Timor-Leste.Cribb, Danielle MSarmento, NevioMoniz, AlmerioFancourt, Nicholas S SGlass, KathrynDraper, Anthony D KFrancis, Joshua RLay Dos Santos, Milena MSoares da Silva, EndangPolkinghorne, Benjamin Gde Lourdes da Conceiҫão, Virginiada Conceiҫão, Felicianoda Silva, PaulinoJong, JoanitaKirk, Martyn DColquhoun, Samanthahttps://hdl.handle.net/10137/126562024-02-14T03:54:23Z2024-02-01T00:00:00ZTitle: A pilot study using hospital surveillance and a birth cohort to investigate enteric pathogens and malnutrition in children, Dili, Timor-Leste.
Authors: Cribb, Danielle M; Sarmento, Nevio; Moniz, Almerio; Fancourt, Nicholas S S; Glass, Kathryn; Draper, Anthony D K; Francis, Joshua R; Lay Dos Santos, Milena M; Soares da Silva, Endang; Polkinghorne, Benjamin G; de Lourdes da Conceiҫão, Virginia; da Conceiҫão, Feliciano; da Silva, Paulino; Jong, Joanita; Kirk, Martyn D; Colquhoun, Samantha
Abstract: In low-to-middle-income countries (LMICs), enteric pathogens contribute to child malnutrition, affecting nutrient absorption, inducing inflammation, and causing diarrhoea. This is a substantial problem in LMICs due to high disease burden, poor sanitation and nutritional status, and the cyclical nature of pathogen infection and malnutrition. This relationship remains understudied in Timor-Leste. In our pilot study of enteric pathogens and malnutrition in Dili, Timor-Leste (July 2019-October 2020), we recruited 60 infants in a birth cohort from Hospital Nacional Guido Valadares (HNGV) with up to four home visits. We collected faecal samples and details of demographics, anthropometrics, diet and food practices, and animal husbandry. Additionally, we collected faecal samples, diagnostics, and anthropometrics from 160 children admitted to HNGV with a clinical diagnosis of severe diarrhoea or severe acute malnutrition (SAM). We tested faeces using the BioFire® FilmArray® Gastrointestinal Panel. We detected high prevalence of enteric pathogens in 68.8% (95%CI 60.4-76.2%) of infants at home, 88.6% of SAM cases (95%CI 81.7-93.3%) and 93.8% of severe diarrhoea cases (95%CI 67.7-99.7%). Diarrhoeagenic Escherichia coli and Campylobacter spp. were most frequently detected. Pathogen presence did not significantly differ in birth cohort diarrhoeal stool, but hospital data indicated associations between Salmonella and Shigella and diarrhoea. We observed wasting in 18.4% (95%CI 9.2-32.5%) to 30.8% (95%CI 17.5-47.7%) of infants across home visits, 57.9% (95%CI 34.0-78.9%) of severe diarrhoea cases, and 92.5% (95%CI 86.4-96.2%) of SAM cases. We associated bottle feeding with increased odds of pathogen detection when compared with exclusive breastfeeding at home (OR 8.3, 95%CI 1.1-62.7). We detected high prevalence of enteric pathogens and signs of malnutrition in children in Dili. Our pilot is proof of concept for a study to fully explore the risk factors and associations between enteric pathogens and malnutrition in Timor-Leste.2024-02-01T00:00:00ZEchocardiography Does not Reduce Mortality in Sepsis: A Re-Evaluation Using the Medical Information Mart for Intensive Care IV Dataset.Blank, Sebastiaan PBlank, Ruth Mhttps://hdl.handle.net/10137/126572024-02-14T03:55:07Z2024-02-01T00:00:00ZTitle: Echocardiography Does not Reduce Mortality in Sepsis: A Re-Evaluation Using the Medical Information Mart for Intensive Care IV Dataset.
Authors: Blank, Sebastiaan P; Blank, Ruth M
Abstract: OBJECTIVES: Echocardiography is commonly used for hemodynamic assessment in sepsis, but data regarding its association with outcome are conflicting. The aim of this study was to evaluate the association between echocardiography and outcomes in patients with septic shock using the Medical Information Mart for Intensive Care IV database. DESIGN: Retrospective cohort study comparing patients who did or did not undergo transthoracic echocardiography within the first 5 days of admission for the primary outcome of 28-day mortality. SETTING: Admissions to the Beth Israel Deaconess Medical Center intensive care from 2008 to 2019. PATIENTS: Adults 16 years old or older with septic shock requiring vasopressor support within 48 hours of admission. Readmissions and patients admitted to the coronary care unit or cardiovascular intensive care were excluded, as well as patients with ST-elevation myocardial infarction or cardiac arrest. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Echocardiography was performed in 1,515 (27%) of 5,697 eligible admissions. The primary outcome was analyzed using a marginal structural model and rolling entry matching to adjust for baseline and time-varying confounders. Patients who underwent echocardiography showed no significant difference in 28-day mortality (adjusted hazard ratio 1.09; 95% CI, 0.95-1.25; p = 0.24). This was consistent across multiple sensitivity analyses. Secondary outcomes were changes in management instituted within 4 hours of imaging. Treatment changes occurred in 493 patients (33%) compared with 431 matched controls (29%), with the most common intervention being the administration of a fluid bolus. CONCLUSIONS: Echocardiography in sepsis was not associated with a reduction in 28-day mortality based on observational data. These findings do not negate the utility of echo in cases of diagnostic uncertainty or inadequate response to initial treatment.2024-02-01T00:00:00ZAssociation between perinatal and early life exposures and lung function in Australian Indigenous young adults: The Aboriginal Birth Cohort study.Navaratnam, VidyaForrester, Douglas LChang, Anne BDharmage, Shyamali CSingh, Gurmeet Rhttps://hdl.handle.net/10137/126502024-02-13T07:25:09Z2024-02-01T00:00:00ZTitle: Association between perinatal and early life exposures and lung function in Australian Indigenous young adults: The Aboriginal Birth Cohort study.
Authors: Navaratnam, Vidya; Forrester, Douglas L; Chang, Anne B; Dharmage, Shyamali C; Singh, Gurmeet R
Abstract: BACKGROUND AND OBJECTIVE: Despite the high burden of respiratory disease amongst Indigenous populations, prevalence data on spirometric deficits and its determinants are limited. We estimated the prevalence of abnormal spirometry in young Indigenous adults and determined its relationship with perinatal and early life factors. METHODS: We used prospectively collected data from the Australian Aboriginal Birth Cohort, a birth cohort of 686 Indigenous Australian singletons. We calculated the proportion with abnormal spirometry (z-score <-1.64) and FEV(1) below the population mean (FEV(1) % predicted 0 to -2SD) measured in young adulthood. We evaluated the association between perinatal and early life exposures with spirometry indices using linear regression. RESULTS: Fifty-nine people (39.9%, 95%CI 31.9, 48.2) had abnormal spirometry; 72 (49.3%, 95%CI 40.9, 57.7) had a FEV(1) below the population mean. Pre-school hospitalisations for respiratory infections, younger maternal age, being overweight in early childhood and being born remotely were associated with reduced FEV(1) and FVC (absolute, %predicted and z-score). The association between maternal age and FEV(1) and FVC were stronger in women, as was hospitalization for respiratory infections before age 5. Being born remotely had a stronger association with reduced FEV(1) and FVC in men. Participants born in a remote community were over 6 times more likely to have a FEV(1) below the population mean (odds ratio [OR] 6.30, 95%CI 1.93, 20.59). CONCLUSION: Young Indigenous adults have a high prevalence of impaired lung function associated with several perinatal and early life factors, some of which are modifiable with feasible interventions.2024-02-01T00:00:00ZNorthern Territory population movement in the COVID-19 pandemic - Results from 2021Morris, Libbyhttps://hdl.handle.net/10137/126452024-02-12T06:47:07Z2024-02-01T00:00:00ZTitle: Northern Territory population movement in the COVID-19 pandemic - Results from 2021
Authors: Morris, Libby
Abstract: Interstate migration has consistently detracted from population growth in the Northern Territory (NT), with more people leaving the NT than arriving. In the NT, this population loss is usually offset by natural increase (greater births than deaths). However, the COVID-19 pandemic may have resulted in inbound and outbound migration changes. The 2021 Census of Population and Housing was conducted in the midst of COVID-19 pandemic restrictions, including closed borders both domestically and internationally. Analysis of Census data will help to inform migration patterns in the NT observed during this time.2024-02-01T00:00:00Z"Putting the power back into community": A mixed methods evaluation of a chronic hepatitis B training course for the Aboriginal health workforce of Australia's Northern Territory.Hosking, KellyDe Santis, TeresaVintour-Cesar, EmilyWilson, Phillip MerrdiBunn, LindaGarambaka Gurruwiwi, GeorgeWurrawilya, ShiralineBukulatjpi, Sarah MariyalawuyNelson, SandraRoss, CherylStuart-Carter, Kelly-AnneNgurruwuthun, TereseDhagapan, AmandaBinks, PaulaSullivan, RichardWard, LindaSchroder, PhoebeTate-Baker, JaclynDavis, Joshua SConnors, ChristineDavies, Janehttps://hdl.handle.net/10137/126542024-02-14T03:53:05Z2024-01-24T00:00:00ZTitle: "Putting the power back into community": A mixed methods evaluation of a chronic hepatitis B training course for the Aboriginal health workforce of Australia's Northern Territory.
Authors: Hosking, Kelly; De Santis, Teresa; Vintour-Cesar, Emily; Wilson, Phillip Merrdi; Bunn, Linda; Garambaka Gurruwiwi, George; Wurrawilya, Shiraline; Bukulatjpi, Sarah Mariyalawuy; Nelson, Sandra; Ross, Cheryl; Stuart-Carter, Kelly-Anne; Ngurruwuthun, Terese; Dhagapan, Amanda; Binks, Paula; Sullivan, Richard; Ward, Linda; Schroder, Phoebe; Tate-Baker, Jaclyn; Davis, Joshua S; Connors, Christine; Davies, Jane
Abstract: BACKGROUND: Chronic hepatitis B (CHB) is endemic in the Aboriginal and Torres Strait Islander population of Australia's Northern Territory. Progression to liver disease can be prevented if holistic care is provided. Low health literacy amongst health professionals is a known barrier to caring for people living with CHB. We co-designed and delivered a culturally safe "Managing hepatitis B" training course for the Aboriginal health workforce. Here, we present an evaluation of the course. OBJECTIVES: 1. To improve course participants CHB-related knowledge, attitudes, and clinical practice. 2. To evaluate the "Managing hepatitis B" training course. 3. To enable participants to have the skills and confidence to be part of the care team. METHODS: We used participatory action research and culturally safe principles. We used purpose-built quantitative and qualitative evaluation tools to evaluate our "Managing hepatitis B" training course. We integrated the two forms of data, deductively analysing codes, grouped into categories, and assessed pedagogical outcomes against Kirkpatrick's training evaluation framework. RESULTS: Eight courses were delivered between 2019 and 2023, with 130 participants from 32 communities. Pre- and post-course questionnaires demonstrated statistically significant improvements in all domains, p<0.001 on 93 matched pairs. Thematic network analysis demonstrated high levels of course acceptability and significant knowledge acquisition. Other themes identified include cultural safety, shame, previous misinformation, and misconceptions about transmission. Observations demonstrate improvements in post-course engagement, a deep understanding of CHB as well as increased participation in clinical care teams. CONCLUSIONS: The "Managing hepatitis B" training course led to a sustained improvement in the knowledge and attitudes of the Aboriginal health workforce, resulting in improved care and treatment uptake for people living with CHB. Important non-clinical outcomes included strengthening teaching and leadership skills, and empowerment.2024-01-24T00:00:00ZEvaluating the impact of 'Ask the Specialist Plus': a training program for improving cultural safety and communication in hospital-based healthcare.Kerrigan, VickiMcGrath, Stuart YiwarrDoig, CassandraHerdman, Rarrtjiwuy MelanieDaly, ShannonPuruntatameri, PirrawayingiLee, BilawaraHefler, MaritaRalph, Anna Phttps://hdl.handle.net/10137/126222024-01-24T07:26:31Z2024-01-22T00:00:00ZTitle: Evaluating the impact of 'Ask the Specialist Plus': a training program for improving cultural safety and communication in hospital-based healthcare.
Authors: Kerrigan, Vicki; McGrath, Stuart Yiwarr; Doig, Cassandra; Herdman, Rarrtjiwuy Melanie; Daly, Shannon; Puruntatameri, Pirrawayingi; Lee, Bilawara; Hefler, Marita; Ralph, Anna P
Abstract: BACKGROUND: First Nations peoples in colonised countries often feel culturally unsafe in hospitals, leading to high self-discharge rates, psychological distress and premature death. To address racism in healthcare, institutions have promised to deliver cultural safety training but there is limited evidence on how to teach cultural safety. To that end, we created Ask the Specialist Plus: a training program that focuses on improving healthcare providers intercultural communication skills to improve cultural safety. Our aim is to describe training implementation and to evaluate the training according to participants. METHODS: Inspired by cultural safety, Critical Race Theory and Freirean pedagogy, Ask the Specialist Plus was piloted at Royal Darwin Hospital in Australia's Northern Territory in 2021. The format combined listening to an episode of a podcast called Ask the Specialist with weekly, one-hour face-to-face discussions with First Nations Specialists outside the clinical environment over 7 to 8 weeks. Weekly surveys evaluated teaching domains using five-point Likert scales and via free text comments. Quantitative data were collated in Excel and comments were collated in NVivo12. Results were presented following Kirkpatrick's evaluation model. RESULTS: Fifteen sessions of Ask the Specialist Plus training were delivered. 90% of participants found the training valuable. Attendees enjoyed the unique format including use of the podcast as a catalyst for discussions. Delivery over two months allowed for flexibility to accommodate clinical demands and shift work. Students through to senior staff learnt new skills, discussed institutionally racist systems and committed to behaviour change. Considering racism is commonly denied in healthcare, the receptiveness of staff to discussing racism was noteworthy. The pilot also contributed to evidence that cultural safety should be co-taught by educators who represent racial and gender differences. CONCLUSION: The Ask the Specialist Plus training program provides an effective model for cultural safety training with high potential to achieve behaviour change among diverse healthcare providers. The training provided practical information on how to improve communication and fostered critical consciousness among healthcare providers. The program demonstrated that training delivered weekly over two months to clinical departments can lead to positive changes through cycles of learning, action, and reflection.2024-01-22T00:00:00ZThree-Dimensional Echocardiography: A Promising Tool for the Diagnosis of Quadricuspid Pulmonary Valve and Pulmonary Artery Aneurysm.Kavalerchyk, VladyslavAslan, UtkuKemaloğlu Öz, Tuğbahttps://hdl.handle.net/10137/126292024-01-24T07:29:35Z2024-01-22T00:00:00ZTitle: Three-Dimensional Echocardiography: A Promising Tool for the Diagnosis of Quadricuspid Pulmonary Valve and Pulmonary Artery Aneurysm.
Authors: Kavalerchyk, Vladyslav; Aslan, Utku; Kemaloğlu Öz, Tuğba2024-01-22T00:00:00ZIndigenous art-themed personalised theatre caps improve patient perioperative experience and perceived staff communication in the operating theatre: a quality improvement project at Royal Darwin Hospital in Australia.Peake, BenjaminSmirk, AlexanderDebelak, Guyhttps://hdl.handle.net/10137/126182024-01-24T07:23:15Z2024-01-21T00:00:00ZTitle: Indigenous art-themed personalised theatre caps improve patient perioperative experience and perceived staff communication in the operating theatre: a quality improvement project at Royal Darwin Hospital in Australia.
Authors: Peake, Benjamin; Smirk, Alexander; Debelak, Guy
Abstract: BACKGROUND: Personalised theatre caps have been shown to improve staff communication in the operating theatre. The impact of these caps on the patient perioperative experience, particularly in Indigenous Australian patients, has not been well established. METHODOLOGY: Surgical patients and operating theatre staff at Royal Darwin Hospital in Australia were surveyed before and after the introduction of Indigenous art-themed personalised (name and role) theatre caps in October 2021 and January 2022. Staff name and role visibility in operating theatres was also audited. RESULTS: A total of 223 staff and patients completed surveys. Most patients reported the theatre caps to be helpful (90%, 95% confidence interval [CI] 81-99) and felt more comfortable because staff were wearing them (91%, 95% CI 82-100). These results were consistent across Indigenous and non-Indigenous patients. The majority of staff agreed that personalised name and role theatre caps improved staff communication (89%, 95% CI 81-97), improved the staff-patient interaction (77%, 95% CI 67-87), and made it easier to use staff names (100%). Staff name and role visibility increased from 8 to 51% (p < 0.001) after the introduction of personalised theatre caps. CONCLUSIONS: The introduction of Indigenous art-themed personalised theatre caps for operating theatre staff at Royal Darwin Hospital improved perceived staff communication and the patient perioperative experience.2024-01-21T00:00:00ZIs tropical pus in the hand special? A retrospective study comparing hand infection cases in Darwin and Adelaide.Baxter, Claire RBurnett, NikkiAlatrash, MonaSires, Jamesvan Essen, PhillipaDean, Nicola Rhttps://hdl.handle.net/10137/126262024-01-24T07:28:17Z2024-01-19T00:00:00ZTitle: Is tropical pus in the hand special? A retrospective study comparing hand infection cases in Darwin and Adelaide.
Authors: Baxter, Claire R; Burnett, Nikki; Alatrash, Mona; Sires, James; van Essen, Phillipa; Dean, Nicola R
Abstract: BACKGROUND: Hand infections are a common reason for presenting to hospital and can be associated with significant morbidity and prolonged antibiotic use. Factors recognized to influence patient outcomes include resistant organisms and delayed presentation. Surgeons working around Australia may assume that hand infections and appropriate treatment algorithms will be similar between sites. This is the first study to examine differences between hand infections presenting in Darwin (with its tropical climate) vs. those in a more temperate city (Adelaide). METHODS: This is a two-site retrospective study, where diagnostic discharge codes were used to identify cases for a 12-month period and patient age, sex and rurality, duration of hospital stay, microbiology results and subsequent trips to theatre were reviewed. RESULTS: Despite significant differences in rurality between FMC and RDH patients, there was no significant difference in length of hospital stay, duration of intravenous antibiotics or return trips to theatre across the two sites. RDH reported a 25% rate of MRSA, compared to 18% at FMC, as well as a statistically significant increase in uncommon microbes, with 30% compared to 12% of patients growing microbes that may not be covered by antibiotics routinely administered in metropolitan areas. A limitation of this study was that compliance with antibiotics and hospital stay were not accounted for. CONCLUSION: It is often our training years that determine our norms of everyday practice, but fewer Australian surgical training posts are located in tropical centres. The results of this study highlight the importance of not assuming that the spectrum of organisms causing hand infections are the same as that in the surgeons' state of origin.2024-01-19T00:00:00ZCarfilzomib, thalidomide, and dexamethasone is safe and effective in relapsed and/or refractory multiple myeloma: final report of the single arm, multicenter phase II ALLG MM018/AMN002 study.Ninkovic, SlavisaHarrison, Simon JLee, Je-JungMurphy, NickLee, Jae HoonEstell, JaneChen, Vivien MHorvath, NoemiKim, KihuynEek, RichardAugustson, BradleyBang, Soo-MeeHuang, Shang-YiRajagopal, RajeevSzabo, FerencEngeler, DanielButcher, Belinda EMollee, PeterDurie, BrianChng, Wee JooQuach, Hanghttps://hdl.handle.net/10137/126212024-01-24T07:24:42Z2024-01-18T00:00:00ZTitle: Carfilzomib, thalidomide, and dexamethasone is safe and effective in relapsed and/or refractory multiple myeloma: final report of the single arm, multicenter phase II ALLG MM018/AMN002 study.
Authors: Ninkovic, Slavisa; Harrison, Simon J; Lee, Je-Jung; Murphy, Nick; Lee, Jae Hoon; Estell, Jane; Chen, Vivien M; Horvath, Noemi; Kim, Kihuyn; Eek, Richard; Augustson, Bradley; Bang, Soo-Mee; Huang, Shang-Yi; Rajagopal, Rajeev; Szabo, Ferenc; Engeler, Daniel; Butcher, Belinda E; Mollee, Peter; Durie, Brian; Chng, Wee Joo; Quach, Hang
Abstract: This multicentre, phase II study of the Australian Lymphoma and Leukaemia Group (ALLG) and the Asian Myeloma Network (AMN) investigated fixed-duration (18-month) treatment with carfilzomib (K), thalidomide (T), and dexamethasone (d; KTd) in patients with relapsed and/or refractory multiple myeloma and 1-3 prior lines of therapy. Patients received induction with up to twelve 28-day cycles of K [20mg/m2 IV cycle 1 day 1 and 2, 56mg/m2 (36mg/m2 for patients ≥75 years) from day 8 onwards), T 100mg PO nocte and weekly dexamethasone 40mg (20mg for patients ≥75 years). During maintenance T was omitted, while K continued on days 1,2,15,16 with fortnightly dexamethasone. The primary endpoint was progression free survival (PFS). Secondary endpoints were overall response rate, overall survival (OS), duration of response, safety, and tolerability. Ninety-three patients (median age 66.3 years (41.9 - 84.5)) were enrolled with a median follow-up of 26.4 (1.6 - 54.6) months. The median PFS was 22.3 months (95% CI 15.7 - 25.6) with a 46.3% (95% CI 35.1 - 52.8) 2-year PFS. Median OS was not reached and was 73.8% (95% CI 62.9 - 81.9) at 2 years. The overall response rate was 88% (≥ VGPR 73%). There was no difference in the depth of response, PFS or OS comparing Asian and Non-Asian cohorts (p=0.61). The safety profile for KTd was consistent with each individual drug. KTd is well tolerated and effective in patients with RRMM irrespective of Asian or non-Asian ethnicity and provides an alternative option particularly where use of KRd is limited by access, cost, or renal impairment.2024-01-18T00:00:00ZBronchiectasis among Indigenous adults in the Top End of the Northern Territory, 2011-2020: a retrospective cohort study.Gibbs, ClaireHowarth, TimothyTicoalu, AdrianaChen, WinnieFord, Payi LAbeyaratne, AsangaJayaram, LataMcCallum, GabrielleHeraganahally, Subash Shttps://hdl.handle.net/10137/126192024-01-24T07:23:40Z2024-01-15T00:00:00ZTitle: Bronchiectasis among Indigenous adults in the Top End of the Northern Territory, 2011-2020: a retrospective cohort study.
Authors: Gibbs, Claire; Howarth, Timothy; Ticoalu, Adriana; Chen, Winnie; Ford, Payi L; Abeyaratne, Asanga; Jayaram, Lata; McCallum, Gabrielle; Heraganahally, Subash S
Abstract: OBJECTIVES: To assess the prevalence of bronchiectasis among Aboriginal and Torres Strait Islander (Indigenous) adults in the Top End of the Northern Territory, and mortality among Indigenous adults with bronchiectasis. STUDY DESIGN: Retrospective cohort study. SETTING, PARTICIPANTS: Aboriginal and Torres Strait Islander adults (18 years or older) living in the Top End Health Service region of the NT in whom bronchiectasis was confirmed by chest computed tomography (CT) during 1 January 2011 - 31 December 2020. MAIN OUTCOME MEASURES: Prevalence of bronchiectasis, and all-cause mortality among Indigenous adults with CT-confirmed bronchiectasis - overall, by sex, and by health district - based on 2011 population numbers (census data). RESULTS: A total of 23 722 Indigenous adults lived in the Top End Health Service region in 2011; during 2011-2020, 459 people received chest CT-confirmed diagnoses of bronchiectasis. Their median age was 47.5 years (interquartile range [IQR], 39.9-56.8 years), 254 were women (55.3%), and 425 lived in areas classified as remote (93.0%). The estimated prevalence of bronchiectasis was 19.4 per 1000 residents (20.6 per 1000 women; 18.0 per 1000 men). The age-adjusted prevalence of bronchiectasis was 5.0 (95% CI, 1.4-8.5) cases per 1000 people in the Darwin Urban health area, and 18-36 cases per 1000 people in the three non-urban health areas. By 30 April 2023, 195 people with bronchiectasis had died (42.5%), at a median age of 60.3 years (IQR, 50.3-68.9 years). CONCLUSION: The prevalence of bronchiectasis burden among Indigenous adults in the Top End of the NT is high, but differed by health district, as is all-cause mortality among adults with bronchiectasis. The socio-demographic and other factors that contribute to the high prevalence of bronchiectasis among Indigenous Australians should be investigated so that interventions for reducing its burden can be developed.2024-01-15T00:00:00ZAutoimmune rheumatic disease in Australian Aboriginal and Torres Strait Islander Peoples: What do we know?Eades, Laura ESines, JasonHoi, Alberta YLiddle, RuaidhriKandane-Rathnayake, RangiMorand, Eric FBrady, StephenRischmueller, MaureenVincent, Fabien Bhttps://hdl.handle.net/10137/126232024-01-24T07:26:51Z2024-01-14T00:00:00ZTitle: Autoimmune rheumatic disease in Australian Aboriginal and Torres Strait Islander Peoples: What do we know?
Authors: Eades, Laura E; Sines, Jason; Hoi, Alberta Y; Liddle, Ruaidhri; Kandane-Rathnayake, Rangi; Morand, Eric F; Brady, Stephen; Rischmueller, Maureen; Vincent, Fabien B
Abstract: Autoimmune rheumatic disease (AIRD) is a collective term, which comprises a group of multisystem inflammatory autoimmune diseases, including connective tissue disease, chronic inflammatory arthritis, sarcoidosis and systemic vasculitis. Some AIRD are prevalent in the general population, and all can cause significant morbidity and reduced quality of life, with some increasing the risk of premature mortality, such as systemic lupus erythematosus (SLE), a connective tissue disease that is more prevalent and severe in Australian Aboriginal and Torres Strait Islander Peoples with high mortality rates. To ensure that management of AIRD can be optimised for all Australians, it is important that we understand the prevalence and potential phenotypic variations of AIRD across the Australian population. However, to date there have been few described cases of AIRD other than SLE in Aboriginal and Torres Strait Islander Peoples. In this review, we summarise what is known about AIRD other than SLE in Aboriginal and Torres Strait Islander Peoples, particularly with regards to prevalence, phenotype and disease outcomes, and highlight the current gaps in knowledge.2024-01-14T00:00:00ZSepsis epidemiology in Australian and New Zealand children (SENTINEL): protocol for a multicountry prospective observational study.Long, ElliotBorland, Meredith LGeorge, ShaneJani, ShefaliTan, EuniciaNeutze, JocelynPhillips, NatalieKochar, AmitCraig, SimonLithgow, AnnaRao, ArjunDalziel, StuartOakley, EdHearps, StephenSingh, SoniaGelbart, BenMcNab, SarahBalamuth, FranWeiss, ScottKuppermann, NathanWilliams, AmandaBabl, Franz Ehttps://hdl.handle.net/10137/126252024-01-24T07:27:37Z2024-01-12T00:00:00ZTitle: Sepsis epidemiology in Australian and New Zealand children (SENTINEL): protocol for a multicountry prospective observational study.
Authors: Long, Elliot; Borland, Meredith L; George, Shane; Jani, Shefali; Tan, Eunicia; Neutze, Jocelyn; Phillips, Natalie; Kochar, Amit; Craig, Simon; Lithgow, Anna; Rao, Arjun; Dalziel, Stuart; Oakley, Ed; Hearps, Stephen; Singh, Sonia; Gelbart, Ben; McNab, Sarah; Balamuth, Fran; Weiss, Scott; Kuppermann, Nathan; Williams, Amanda; Babl, Franz E
Abstract: INTRODUCTION: Sepsis affects 25.2 million children per year globally and causes 3.4 million deaths, with an annual cost of hospitalisation in the USA of US$7.3 billion. Despite being common, severe and expensive, therapies and outcomes from sepsis have not substantially changed in decades. Variable case definitions, lack of a reference standard for diagnosis and broad spectrum of disease hamper efforts to evaluate therapies that may improve sepsis outcomes. This landscape analysis of community-acquired childhood sepsis in Australia and New Zealand will characterise the burden of disease, including incidence, severity, outcomes and cost. Sepsis diagnostic criteria and risk stratification tools will be prospectively evaluated. Sepsis therapies, quality of care, parental awareness and understanding of sepsis and parent-reported outcome measures will be described. Understanding these aspects of sepsis care is fundamental for the design and conduct of interventional trials to improve childhood sepsis outcomes. METHODS AND ANALYSIS: This prospective observational study will include children up to 18 years of age presenting to 12 emergency departments with suspected sepsis within the Paediatric Research in Emergency Departments International Collaborative network in Australia and New Zealand. Presenting characteristics, management and outcomes will be collected. These will include vital signs, serum biomarkers, clinician assessment of severity of disease, intravenous fluid administration for the first 24 hours of hospitalisation, organ support therapies delivered, antimicrobial use, microbiological diagnoses, hospital and intensive care unit length-of-stay, mortality censored at hospital discharge or 30 days from enrolment (whichever comes first) and parent-reported outcomes 90 days from enrolment. We will use these data to determine sepsis epidemiology based on existing and novel diagnostic criteria. We will also validate existing and novel sepsis risk stratification criteria, characterise antimicrobial stewardship, guideline adherence, cost and report parental awareness and understanding of sepsis and parent-reported outcome measures. ETHICS AND DISSEMINATION: Ethics approval was received from the Royal Children's Hospital of Melbourne, Australia Human Research Ethics Committee (HREC/69948/RCHM-2021). This included incorporated informed consent for follow-up. The findings will be disseminated in a peer-reviewed journal and at academic conferences. TRIAL REGISTRATION NUMBER: ACTRN12621000920897; Pre-results.2024-01-12T00:00:00ZPerioperative Exercise Testing in Pregnant and Non-Pregnant Women of Reproductive Age: A Systematic Review.Spicer, Madeleine GDennis, Alicia Thttps://hdl.handle.net/10137/126242024-01-24T07:27:11Z2024-01-11T00:00:00ZTitle: Perioperative Exercise Testing in Pregnant and Non-Pregnant Women of Reproductive Age: A Systematic Review.
Authors: Spicer, Madeleine G; Dennis, Alicia T
Abstract: BACKGROUND: Women have classically been excluded from the development of normal data and reference ranges, with pregnant women experiencing further neglect. The incidence of Caesarean section in pregnant women, and of general operative management in young women (both pregnant and non-pregnant), necessitates the formal development of healthy baseline data in these cohorts to optimise their perioperative management. This systematic review assesses the representation of young women in existing reference ranges for several functional exercise tests in common use to facilitate functional assessment in this cohort. METHODS: Existing reference range data for the exercise tests the Six Minute Walk Test (6MWT), the Incremental Shuttle Walk Test (ISWT) and Cardiopulmonary Exercise Testing (CPET) in young women of reproductive age were assessed using the MEDLINE (Ovid) database, last searched December 2023. Results were comparatively tabulated but not statistically analysed given underlying variances in data. RESULTS: The role of exercise testing in the perioperative period as an assessment tool, as well as its safety during pregnancy, was evaluated using 65 studies which met inclusion criteria. CONCLUSION: There is a significant lack of baseline data regarding these tests in this population, especially amongst the pregnant cohort, which limits the application of exercise testing clinically.2024-01-11T00:00:00ZA retrospective, longitudinal cohort study of trends and risk factors for preterm birth in the Northern Territory, Australia.Brown, KiarnaCotaru, CarinaBinks, Michaelhttps://hdl.handle.net/10137/126202024-01-24T07:24:18Z2024-01-05T00:00:00ZTitle: A retrospective, longitudinal cohort study of trends and risk factors for preterm birth in the Northern Territory, Australia.
Authors: Brown, Kiarna; Cotaru, Carina; Binks, Michael
Abstract: BACKGROUND: Preterm birth (PTB) is the single most important cause of perinatal mortality and morbidity in high income countries. In Australia, 8.6% of babies are born preterm but substantial variability exists between States and Territories. Previous reports suggest PTB rates are highest in the Northern Territory (NT), but comprehensive analysis of trends and risk factors are lacking in this region. The objective of this study was to characterise temporal trends in PTB among First Nations and non-First Nations mothers in the Top End of the NT over a 10-year period and to identify perinatal factors associated with the risk of PTB. METHODS: This was a retrospective population-based cohort study of all births in the Top End of the NT over the 10-year period from January 1st, 2008, to December 31st, 2017. We described maternal characteristics, obstetric complications, birth characteristics and annual trends in PTB. The association between the characteristics and the risk of PTB was determined using univariate and multivariate generalised linear models producing crude risk ratios (cRR) and adjusted risk ratios (aRR). Data were analysed overall, in First Nations and non-First Nations women. RESULTS: During the decade ending in 2017, annual rates of PTB in the Top End of the NT remained consistently close to 10% of all live births. However, First Nations women experienced more than twice the risk of PTB (16%) compared to other women (7%). Leading risk factors for PTB among First Nations women as compared to other women included premature rupture of membranes (RR 12.33; 95% CI 11.78, 12.90), multiple pregnancy (RR 7.24; 95% CI 6.68, 7.83), antepartum haemorrhage (RR 4.36; 95% CI 3.93, 4.84) and pre-existing diabetes (RR 4.18; 95% CI 3.67, 4.76). CONCLUSIONS: First Nations women experience some of the highest PTB rates globally. Addressing specific pregnancy complications provides avenues for intervention, but the story is complex and deeper exploration is warranted. A holistic approach that also acknowledges the influence of socio-demographic influences, such as remote dwelling and disadvantage on disease burden, will be required to improve perinatal outcomes.2024-01-05T00:00:00Z