Background: The COVID-19 pandemic has changed the way people are accessing healthcare. The aim of... more Background: The COVID-19 pandemic has changed the way people are accessing healthcare. The aim of this study was to examine the impact of coronavirus (COVID-19) on emergency department (ED) attendance for frequent attenders and to explore potential reasons for changes in attendance. Methods: This convergent parallel mixed methods study comprised two parts. An interrupted time-series analysis evaluated changes in ED presentation rates; interviews investigated reasons for changes for frequent ED users in a culturally and linguistically diverse setting. Findings: Interrupted time series analysis from 4868 eligible participants showed an instantaneous decrease in weekly ED presentations by 36% (p<0.001), with reduction between 45% and 66% across emergency triage categories. 200 patients were interviewed, mean age 66 years (range 23-99). 32% did not know they could leave home to seek care with differences seen in English versus non-English speakers (p<0.001). 35% reported postponing medical care. There was a high fear about the health system becoming overloaded (mean 4.2 (±2) on 6-point scale). Four key themes emerged influencing health seeking behaviour: Fear and/or avoidance of hospital care; Use of telehealth for remote assessment; No fear or avoidance of hospital care; Not leaving the house for any reason. Interpretation: This study demonstrated reduced emergency department use by a vulnerable population of previously frequent attenders. COVID-19 has resulted in some fear and avoidance of hospitals, but has also offered new opportunity for alternative care through telehealth. Funding: Northern Health Foundation; Inner North West, Health West and Hume Whittlesea Primary Care Partnerships; La Trobe University. Declaration of Interests: All authors have completed the Unified Competing Interest form (available on request from the corresponding author) and declare: no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three year, no other relationships or activities that could appear to have influenced the submitted work. Ethics Approval Statement: This project was reviewed by an ethics committee that included consumer representatives that were able to provide feedback on methods (including interview questions). All participants were patients of Northern Health.
ObjectiveThis study determined the economic impact of 16 ‘high-priority’ hospital-acquired compli... more ObjectiveThis study determined the economic impact of 16 ‘high-priority’ hospital-acquired complications (HACs), as defined by the Australian Commission on Safety and Quality in Health Care, from the perspective of an individual Australian health service. MethodsA retrospective cohort study was performed using a deidentified patient dataset containing 93056 in-patient separations in Northern Health (Victoria, Australia) from 1 July 2016 to 30 June 2017. Two log-linked generalised linear regression models were used to obtain additional costs and additional length of stay (LOS) for 16 different HACs, with the main outcome measures being the additional cost and LOS for all 16 HACs. ResultsIn all, 1700 separations involving HACs (1.83%) were identified. The most common HAC was health care-associated infections. Most HACs were associated with a statistically significant risk of increased cost (15/16 HACs) and LOS (11/16 HACs). HACs involving falls resulting in fracture or other intracran...
This study determined the proficiencies of laboratories measuring human immunodeficiency virus ty... more This study determined the proficiencies of laboratories measuring human immunodeficiency virus type 1 (HIV-1) viral loads and the accuracies of two assays used for HIV-1 viral load measurement in Australia and investigated the variability of the new versions of these assays. Quality assessment program panels containing (i) dilutions of HIV-1 subtype B, (ii) replicates of identical samples of HIV-1 subtype B, and (iii) samples of subtype E and B were tested by laboratories. Total variability (within and between laboratories) was tested with quality control samples. The coefficients of variation (CVs) for the Roche AMPLICOR HIV-1 MONITOR version (v) 1.0 and Chiron Quantiplex bDNA 2.0 assays ranged from 53 to 87% and 22 to 31%, respectively. The widespread occurrence of invalid runs with the AMPLICOR HIV-1 MONITOR 1.0 assay was identified. The CVs of the new versions of the assays were 82 to 86% for the AMPLICOR HIV-1 MONITOR v 1.5 assay and 16 to 23% for the Quantiplex bDNA 3.0 assay....
In Australia, a policy of deferring donors who have lived in the UK for longer than 6 months betw... more In Australia, a policy of deferring donors who have lived in the UK for longer than 6 months between 1980 and 1996 has been instituted to reduce the theoretical risk of transmitting variant Creutzfeldt-Jakob disease (vCJD) through the blood supply. The objective of this report was to refine estimates of the possible risks and benefits of donor-deferral strategies that are aimed at avoiding transmission of vCJD. Estimates of the effect of donor deferral on the blood supply in Australia were based on a 1998 survey of blood donors. The number of donations from donors potentially infected with vCJD and excluded by donor deferral was estimated based on published estimates of the size of the vCJD epidemic in the UK and assuming that the risk of vCJD in Australian blood donors was proportional to the time lived in the UK between 1980 and 1996. The possible increased number of blood donations that were infected with human immunodeficiency virus (HIV), hepatitis C virus (HCV) or hepatitis B virus (HBV) and made during a window period (as a result of increased donations from first-time donors) was estimated using published methods. A strategy of deferring donations in Australia from people who have lived in the UK for 6 months or longer, between 1980 and 1996, was estimated to result in exclusion of 5.3% of all blood donations, corresponding to 50 100 donations in 1998. It was estimated that the annual number of blood donations made by donors potentially infected with vCJD is 1.15 (range 0.02--31.1, based on the uncertainty in the UK prevalence estimate). Donor deferral was estimated to remove 0.92 (range 0.02--25.1) of these donations. Replacement of 33%, 50% and 100% of excluded donations by donations from first-time donors, was estimated to result in an increase of 0.0010, 0.0019 and 0.0044, respectively, of HIV-infected donations per year donated during the window period; in an increase of 0.021, 0.038 and 0.089, respectively, of HCV-infected donations per year; and in an increase of 0.18, 0.33 and 0.76, respectively, of HBV-infected donations per year. The large uncertainties involved in these analyses mean that estimates must be interpreted cautiously, but the data does suggest that donor deferral may exclude more donations from donors potentially infected with vCJD than the corresponding increase, caused by donor replacement, of window-period donations possibly infected with HIV, HCV or HBV.
Journal of Molecular and Cellular Cardiology, 1992
The effects of n-3 fatty acids on human arterial smooth muscle reactivity were studied in In tivo... more The effects of n-3 fatty acids on human arterial smooth muscle reactivity were studied in In tivo and in v/fro preparations. Male subjects were given maxEPA (elcosapentaenolc add 0.176 g/g; docosahexaenolc acid 0.125 g/g) lOg/dey for 28 dayr. Forearm vascular responses lo the vasoconstiiciors noradrenallne (NA) and anglolensin II (All) and the dllalors acetylchollne (ACh), sodlum nltroprusslde (SNP) and post-ischaemlc hyperaemla were determined both before and after treatment uslng venous occlusion plelhysmography. When analysed as area under the dose-response curve, maxEPA signffkanliy suppressed responses to NA and All by 63% and 67% respectively but had no effect on vasodllation induced either pharmaculoglcaliy or endogenously. Responses to ellher constrictor were unaltered in subjects receiving mixed oil placebo. The supressive effects of maxEPA were blocked by Indomethacln. In a separate series of experiments buttock skln blopsies were performed on day 29 of the treatment regimen. Subcufaneous resistance arteries (~250 pm 1.d.) were removed and mounted in myographs. Full concentration-response curves obtained lo various pharmacological stimuli revealed a potentiatfng effect of maxEPA on All (maxEPA vs placebo: net loo EC50: 8.36 f 0.07 vs 7.91 f 0.06: P<O.O5) but no effect on dilation Induced by Substance P, Adh or SNP (&EPA vs placebo; neg log IC50: 7.19 f 0.24 vs 7.27 f 0.45; P~&05). We conclude that marlne oils suppress vascular reactMy h viva in man by an lndomethadn-sensltke mechanism. This suppressive effect is, however, no longer epparenl when the vessels are removed from the in viva environment.
Dietary supplementation with marine oils attenuates the responses to noradrenaline and angiotensi... more Dietary supplementation with marine oils attenuates the responses to noradrenaline and angiotensin II in human forearm resistance arteries. The mechanisms underlying these effects were the subject of the present study. Twenty-two normal male adults were allocated to one of three groups. The first group (n = 11) received 10 g/day marine oil capsules (maxEPA) for 28 days. The second group (n = 7) received maxEPA plus 25 mg indomethacin three times a day on days 28 and 29. The third group (n = 4) received 10 g/day mixed-oil placebo capsules for 28 days, plus indomethacin on days 28 and 29 as in group 2. Forearm venous occlusion plethysmography was performed before and immediately after each treatment period. Responses to acetylcholine, sodium nitroprusside or reactive hyperaemia (area under the time-response curve: pre-maxEPA 14,850 +/- 3502, post-maxEPA 17,118 +/- 4576 units) were unaffected by maxEPA. The suppressive effect of maxEPA on responses to noradrenaline and angiotensin II (from group 1) was no longer apparent in the group receiving indomethacin in addition to maxEPA. Indomethacin, in subjects on placebo capsules, had no effect on the responses to either agonist. We conclude that the suppressive effects of maxEPA result from alterations to in vivo prostanoid profiles.
We report the results from 57 Australian diagnostic laboratories testing two external quality ass... more We report the results from 57 Australian diagnostic laboratories testing two external quality assessment panels using either the Roche Amplicor Chlamydia trachomatis test (R-PCR) or the Abbott LCx Chlamydia trachomatis assay (A-ligase chain reaction [LCR]). Panel samples were either normal urine spiked with Chlamydia trachomatis antigen or clinical urine specimens. There was no significant difference between laboratories or between assays in detection of C. trachomatis- positive clinical samples. Only at the lower limit of detection of the assays did the R-PCR demonstrate increased sensitivity over the A-LCR in the detection of C. trachomatis antigen. However, it was found that single-sample testing could lead to decreased test sensitivity. Detection of the presence of inhibitors of nucleic acid amplification differed between laboratories.
Anti-HIV testing is the most regulated area of laboratory medicine in Australia. These regulation... more Anti-HIV testing is the most regulated area of laboratory medicine in Australia. These regulations have placed the National Serology Reference Laboratory, Australia (NRL) in a unique position to implement a comprehensive quality assurance (QA) program for HIV testing. The elements of our QA program include pre-market evaluation of assays, external quality assessment schemes (EQAS), quality control, specificity monitoring, consultations, and training workshops. The results of the NRL EQAS for Australian laboratories were compared with those of a program developed by the NRL for reference laboratories in the Southeast Asian and Western Pacific (SEAWP) regions. For laboratories authorized to use tests for HIV in Australia, participation in the entire QA program is mandatory, whereas the SEAWP EQAS program is voluntary. While the overall percentage of discrepant results for these programs are similar, the percentage of false negatives, variation in laboratory results, and choice of assay differ. These differences have decreased with time with improvements in assays and laboratory testing practices. The educational component of both EQAS, which comprises workshops, laboratory questionnaires, consultancies, and newsletters, has had a critical impact on the testing practices of laboratories.
The effects of dietary supplementation with marine oils on vascular reactivity in human forearm r... more The effects of dietary supplementation with marine oils on vascular reactivity in human forearm resistance arteries were studied. Healthy male adults (six to nine subjects per group) were given either maxEPA capsules (content: eicosapentaenoic acid, 0.178 g/g; docosahexaenoic acid, 0.116 g/g) at doses of 20, 10, or 5 g/day or placebo capsules at 20 g/day for 28 days. Capsule compliance was confirmed by measurement of platelet membrane incorporation of n-3 fatty acids. Blood pressure was not affected by either maxEPA or placebo. The influence of treatment interventions on forearm vasoconstrictive responses to local infusions of angiotensin II and norepinephrine was examined using venous occlusion plethysmography before and after treatment. Responses to both agonists were significantly suppressed by 20 g/day maxEPA (slopes before and after maxEPA, respectively: angiotensin II, 3.34 and 0.89; norepinephrine, 0.91 and 0.41). When analyzed as difference in area under the dose-response cu...
Background: The COVID-19 pandemic has changed the way people are accessing healthcare. The aim of... more Background: The COVID-19 pandemic has changed the way people are accessing healthcare. The aim of this study was to examine the impact of coronavirus (COVID-19) on emergency department (ED) attendance for frequent attenders and to explore potential reasons for changes in attendance. Methods: This convergent parallel mixed methods study comprised two parts. An interrupted time-series analysis evaluated changes in ED presentation rates; interviews investigated reasons for changes for frequent ED users in a culturally and linguistically diverse setting. Findings: Interrupted time series analysis from 4868 eligible participants showed an instantaneous decrease in weekly ED presentations by 36% (p<0.001), with reduction between 45% and 66% across emergency triage categories. 200 patients were interviewed, mean age 66 years (range 23-99). 32% did not know they could leave home to seek care with differences seen in English versus non-English speakers (p<0.001). 35% reported postponing medical care. There was a high fear about the health system becoming overloaded (mean 4.2 (±2) on 6-point scale). Four key themes emerged influencing health seeking behaviour: Fear and/or avoidance of hospital care; Use of telehealth for remote assessment; No fear or avoidance of hospital care; Not leaving the house for any reason. Interpretation: This study demonstrated reduced emergency department use by a vulnerable population of previously frequent attenders. COVID-19 has resulted in some fear and avoidance of hospitals, but has also offered new opportunity for alternative care through telehealth. Funding: Northern Health Foundation; Inner North West, Health West and Hume Whittlesea Primary Care Partnerships; La Trobe University. Declaration of Interests: All authors have completed the Unified Competing Interest form (available on request from the corresponding author) and declare: no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three year, no other relationships or activities that could appear to have influenced the submitted work. Ethics Approval Statement: This project was reviewed by an ethics committee that included consumer representatives that were able to provide feedback on methods (including interview questions). All participants were patients of Northern Health.
ObjectiveThis study determined the economic impact of 16 ‘high-priority’ hospital-acquired compli... more ObjectiveThis study determined the economic impact of 16 ‘high-priority’ hospital-acquired complications (HACs), as defined by the Australian Commission on Safety and Quality in Health Care, from the perspective of an individual Australian health service. MethodsA retrospective cohort study was performed using a deidentified patient dataset containing 93056 in-patient separations in Northern Health (Victoria, Australia) from 1 July 2016 to 30 June 2017. Two log-linked generalised linear regression models were used to obtain additional costs and additional length of stay (LOS) for 16 different HACs, with the main outcome measures being the additional cost and LOS for all 16 HACs. ResultsIn all, 1700 separations involving HACs (1.83%) were identified. The most common HAC was health care-associated infections. Most HACs were associated with a statistically significant risk of increased cost (15/16 HACs) and LOS (11/16 HACs). HACs involving falls resulting in fracture or other intracran...
This study determined the proficiencies of laboratories measuring human immunodeficiency virus ty... more This study determined the proficiencies of laboratories measuring human immunodeficiency virus type 1 (HIV-1) viral loads and the accuracies of two assays used for HIV-1 viral load measurement in Australia and investigated the variability of the new versions of these assays. Quality assessment program panels containing (i) dilutions of HIV-1 subtype B, (ii) replicates of identical samples of HIV-1 subtype B, and (iii) samples of subtype E and B were tested by laboratories. Total variability (within and between laboratories) was tested with quality control samples. The coefficients of variation (CVs) for the Roche AMPLICOR HIV-1 MONITOR version (v) 1.0 and Chiron Quantiplex bDNA 2.0 assays ranged from 53 to 87% and 22 to 31%, respectively. The widespread occurrence of invalid runs with the AMPLICOR HIV-1 MONITOR 1.0 assay was identified. The CVs of the new versions of the assays were 82 to 86% for the AMPLICOR HIV-1 MONITOR v 1.5 assay and 16 to 23% for the Quantiplex bDNA 3.0 assay....
In Australia, a policy of deferring donors who have lived in the UK for longer than 6 months betw... more In Australia, a policy of deferring donors who have lived in the UK for longer than 6 months between 1980 and 1996 has been instituted to reduce the theoretical risk of transmitting variant Creutzfeldt-Jakob disease (vCJD) through the blood supply. The objective of this report was to refine estimates of the possible risks and benefits of donor-deferral strategies that are aimed at avoiding transmission of vCJD. Estimates of the effect of donor deferral on the blood supply in Australia were based on a 1998 survey of blood donors. The number of donations from donors potentially infected with vCJD and excluded by donor deferral was estimated based on published estimates of the size of the vCJD epidemic in the UK and assuming that the risk of vCJD in Australian blood donors was proportional to the time lived in the UK between 1980 and 1996. The possible increased number of blood donations that were infected with human immunodeficiency virus (HIV), hepatitis C virus (HCV) or hepatitis B virus (HBV) and made during a window period (as a result of increased donations from first-time donors) was estimated using published methods. A strategy of deferring donations in Australia from people who have lived in the UK for 6 months or longer, between 1980 and 1996, was estimated to result in exclusion of 5.3% of all blood donations, corresponding to 50 100 donations in 1998. It was estimated that the annual number of blood donations made by donors potentially infected with vCJD is 1.15 (range 0.02--31.1, based on the uncertainty in the UK prevalence estimate). Donor deferral was estimated to remove 0.92 (range 0.02--25.1) of these donations. Replacement of 33%, 50% and 100% of excluded donations by donations from first-time donors, was estimated to result in an increase of 0.0010, 0.0019 and 0.0044, respectively, of HIV-infected donations per year donated during the window period; in an increase of 0.021, 0.038 and 0.089, respectively, of HCV-infected donations per year; and in an increase of 0.18, 0.33 and 0.76, respectively, of HBV-infected donations per year. The large uncertainties involved in these analyses mean that estimates must be interpreted cautiously, but the data does suggest that donor deferral may exclude more donations from donors potentially infected with vCJD than the corresponding increase, caused by donor replacement, of window-period donations possibly infected with HIV, HCV or HBV.
Journal of Molecular and Cellular Cardiology, 1992
The effects of n-3 fatty acids on human arterial smooth muscle reactivity were studied in In tivo... more The effects of n-3 fatty acids on human arterial smooth muscle reactivity were studied in In tivo and in v/fro preparations. Male subjects were given maxEPA (elcosapentaenolc add 0.176 g/g; docosahexaenolc acid 0.125 g/g) lOg/dey for 28 dayr. Forearm vascular responses lo the vasoconstiiciors noradrenallne (NA) and anglolensin II (All) and the dllalors acetylchollne (ACh), sodlum nltroprusslde (SNP) and post-ischaemlc hyperaemla were determined both before and after treatment uslng venous occlusion plelhysmography. When analysed as area under the dose-response curve, maxEPA signffkanliy suppressed responses to NA and All by 63% and 67% respectively but had no effect on vasodllation induced either pharmaculoglcaliy or endogenously. Responses to ellher constrictor were unaltered in subjects receiving mixed oil placebo. The supressive effects of maxEPA were blocked by Indomethacln. In a separate series of experiments buttock skln blopsies were performed on day 29 of the treatment regimen. Subcufaneous resistance arteries (~250 pm 1.d.) were removed and mounted in myographs. Full concentration-response curves obtained lo various pharmacological stimuli revealed a potentiatfng effect of maxEPA on All (maxEPA vs placebo: net loo EC50: 8.36 f 0.07 vs 7.91 f 0.06: P<O.O5) but no effect on dilation Induced by Substance P, Adh or SNP (&EPA vs placebo; neg log IC50: 7.19 f 0.24 vs 7.27 f 0.45; P~&05). We conclude that marlne oils suppress vascular reactMy h viva in man by an lndomethadn-sensltke mechanism. This suppressive effect is, however, no longer epparenl when the vessels are removed from the in viva environment.
Dietary supplementation with marine oils attenuates the responses to noradrenaline and angiotensi... more Dietary supplementation with marine oils attenuates the responses to noradrenaline and angiotensin II in human forearm resistance arteries. The mechanisms underlying these effects were the subject of the present study. Twenty-two normal male adults were allocated to one of three groups. The first group (n = 11) received 10 g/day marine oil capsules (maxEPA) for 28 days. The second group (n = 7) received maxEPA plus 25 mg indomethacin three times a day on days 28 and 29. The third group (n = 4) received 10 g/day mixed-oil placebo capsules for 28 days, plus indomethacin on days 28 and 29 as in group 2. Forearm venous occlusion plethysmography was performed before and immediately after each treatment period. Responses to acetylcholine, sodium nitroprusside or reactive hyperaemia (area under the time-response curve: pre-maxEPA 14,850 +/- 3502, post-maxEPA 17,118 +/- 4576 units) were unaffected by maxEPA. The suppressive effect of maxEPA on responses to noradrenaline and angiotensin II (from group 1) was no longer apparent in the group receiving indomethacin in addition to maxEPA. Indomethacin, in subjects on placebo capsules, had no effect on the responses to either agonist. We conclude that the suppressive effects of maxEPA result from alterations to in vivo prostanoid profiles.
We report the results from 57 Australian diagnostic laboratories testing two external quality ass... more We report the results from 57 Australian diagnostic laboratories testing two external quality assessment panels using either the Roche Amplicor Chlamydia trachomatis test (R-PCR) or the Abbott LCx Chlamydia trachomatis assay (A-ligase chain reaction [LCR]). Panel samples were either normal urine spiked with Chlamydia trachomatis antigen or clinical urine specimens. There was no significant difference between laboratories or between assays in detection of C. trachomatis- positive clinical samples. Only at the lower limit of detection of the assays did the R-PCR demonstrate increased sensitivity over the A-LCR in the detection of C. trachomatis antigen. However, it was found that single-sample testing could lead to decreased test sensitivity. Detection of the presence of inhibitors of nucleic acid amplification differed between laboratories.
Anti-HIV testing is the most regulated area of laboratory medicine in Australia. These regulation... more Anti-HIV testing is the most regulated area of laboratory medicine in Australia. These regulations have placed the National Serology Reference Laboratory, Australia (NRL) in a unique position to implement a comprehensive quality assurance (QA) program for HIV testing. The elements of our QA program include pre-market evaluation of assays, external quality assessment schemes (EQAS), quality control, specificity monitoring, consultations, and training workshops. The results of the NRL EQAS for Australian laboratories were compared with those of a program developed by the NRL for reference laboratories in the Southeast Asian and Western Pacific (SEAWP) regions. For laboratories authorized to use tests for HIV in Australia, participation in the entire QA program is mandatory, whereas the SEAWP EQAS program is voluntary. While the overall percentage of discrepant results for these programs are similar, the percentage of false negatives, variation in laboratory results, and choice of assay differ. These differences have decreased with time with improvements in assays and laboratory testing practices. The educational component of both EQAS, which comprises workshops, laboratory questionnaires, consultancies, and newsletters, has had a critical impact on the testing practices of laboratories.
The effects of dietary supplementation with marine oils on vascular reactivity in human forearm r... more The effects of dietary supplementation with marine oils on vascular reactivity in human forearm resistance arteries were studied. Healthy male adults (six to nine subjects per group) were given either maxEPA capsules (content: eicosapentaenoic acid, 0.178 g/g; docosahexaenoic acid, 0.116 g/g) at doses of 20, 10, or 5 g/day or placebo capsules at 20 g/day for 28 days. Capsule compliance was confirmed by measurement of platelet membrane incorporation of n-3 fatty acids. Blood pressure was not affected by either maxEPA or placebo. The influence of treatment interventions on forearm vasoconstrictive responses to local infusions of angiotensin II and norepinephrine was examined using venous occlusion plethysmography before and after treatment. Responses to both agonists were significantly suppressed by 20 g/day maxEPA (slopes before and after maxEPA, respectively: angiotensin II, 3.34 and 0.89; norepinephrine, 0.91 and 0.41). When analyzed as difference in area under the dose-response cu...
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