Australia And New Zealand Research Articles

Ten-year trends in mortality and complications following catheter ablation of atrial fibrillation.

Recent US studies report rising rates of mortality and in-hospital complications following catheter ablation of atrial fibrillation (AF), but whether this is a global phenomenon is uncertain. The aim of this study was to examine trends in 30-day mortality and complications following AF ablation in Australia and New Zealand (ANZ) from 2008 to 2017. We identified 37243 AF (mean age 62.4 ± 11.5years, 29.6% females, 94.5% elective procedures) ablations using national hospitalization data. The primary outcome was occurrence of any complication, including all-cause mortality, within 30days of discharge. Trends were evaluated using logistic regression adjusting for changes in patient characteristics. The annual number of ablations increased from 1359 (2008) to 5115 (2017). Patients' age and rates of heart failure (9.8-10.6%), diabetes (6.8-12.4%), and chronic kidney disease (2.2-4.1%) also increased over time. From 2008 to 2017, the overall rate of complications declined from 7.51% to 5.04% [adjusted odds ratio (aOR) 0.96 (95% confidence interval, CI, 0.94-0.97)/year]. Rates of pericardial effusion [1.69-0.70%, aOR 0.93 (0.89-0.97)], bleeding [4.49-2.74%, aOR 0.94 (0.92-0.96)], and vascular injury [0.52-0.16%, aOR 0.91 (0.85-0.98)] declined, but rates of acute kidney injury [0.15-0.68%, aOR 1.16 (1.08-1.25)] and infection [0.15-0.57%, aOR 1.07 (1.01-1.14)] increased over time. The overall 30-day mortality rate was low (0.11%) and unchanged [0.00-0.16%, aOR 0.99 (0.88-1.11)]. Despite a five-fold increase in AF ablations and the rising risk profile of patients, complications following AF ablation declined by 30% from 2008 to 2017 in ANZ. Procedure-related death was uncommon and occurred in less than 1 in 850 patients.

Inter-Rater Reliability and Agreement of Fetal Echocardiography Measurements Among Investigators From Multiple Sites

Single institutions specialising in fetal cardiology often have too few cases to develop robust prognostic indicators for specific conditions. The Australia and New Zealand (ANZ) Fetal Cardiology Working Group instigated a multicentre study to examine fetal risk factors for early postnatal intervention in Tetralogy of Fallot (ToF). Centralised data analysis was not possible due to COVID-19 travel restrictions and ethical constraints related to sharing of retrospectively acquired images. A study of inter-observer agreement of standardised in utero cardiac measurements was undertaken to assess the feasibility of combining data from multiple centres.

Bi-national survey of ventilation weaning and extubation practices in children

Introduction: International practices for mechanical ventilation (MV) weaning and extubation in children vary, with decisions largely guided by senior medical staff. Recent evidence demonstrates paediatric patients may benefit from a protocolised, collaborative approach to MV weaning with greater nursing, and allied health involvement. In Australia and New Zealand (ANZ) it is not currently understood what role nurses have in MV weaning and extubation practices.

Prolactin Level and Breastmilk Production among Mothers of Low-Birth-Weight Infants Admitted to Level II Neonatal Intensive Care Unit

Background. Kangaroo mother care (KMC) has been proven by several studies to promote breastfeeding, but many of the studies focus on the success of exclusive breastfeeding, and less on its galactogenic effects.
 Objective. We aim to determine the maternal serum prolactin levels and breastmilk volume of mothers who rendered KMC to their infants.
 Materials and Methods. This is a randomized controlled, open-labeled, interventional study in the Neonatal Intensive Care Unit of a tertiary government hospital. Infants weighing < 2000 grams admitted in NICU Level II, together with medically stable mothers and no contraindication for breastfeeding were simultaneously enrolled. Primary outcome measures were maternal serum prolactin levels and expressed milk volume on day 3 and day 7 postpartum. Two-sample t-test was used to compare groups, and paired t-test to compare within groups. Tests were two-tailed, with a p-value of < 0.05 considered statistically significant.
 Trial Registration. Australia-New Zealand Clinical Trial Registry ID ACTRN12614000218695
 Results. Fifty mother-infant dyads were equally allocated into KMC and control groups (p < 0.001). There was significantly larger milk volume on the third day (29.6 ± 27.8 mL vs 16.3 ± 26.1 mL; p < 0.001) and seventh post-partum day (72.4 ± 62.3 mL vs 47.3 ± 43.8 mL; p < 0.000). There were increased serum prolactin levels compatible with post-partum state. The increase was more evident in the KMC (5244 ± 2702 mIU/L, on the 3rd postpartum day versus 4969 ± 2426 mIU/L, on the 7th postpartum day, p = 0.996) compared to control group (4129 ± 2485 mIU/L on the 3rd postpartum day versus 3705 ± 2731 mIU/L on the 7th postpartum day, p = 0.301).
 Conclusion. We noted a significantly larger milk volume in the KMC group. There was also a greater increase in the prolactin levels in the KMC group, but this did not reach statistical significance. Further studies should be done to determine mechanism of galactogenesis through KMC.

Association of patient-to-intensivist ratio with hospital mortality in Australia and New Zealand

PurposeThe impact of intensivist workload on intensive care unit (ICU) outcomes is incompletely described and assessed across healthcare systems and countries. We sought to examine the association of patient-to-intensivist ratio (PIR) with hospital mortality in Australia/New Zealand (ANZ) ICUs.MethodsWe conducted a retrospective study of adult admissions to ANZ ICUs (August 2016–June 2018) using two cohorts: “narrow”, based on previously used criteria including restriction to ICUs with a single daytime intensivist; and “broad”, refined by individual ICU daytime staffing information. The exposure was average daily PIR and the outcome was hospital mortality. We used summary statistics to describe both cohorts and multilevel multivariable logistic regression models to assess the association of PIR with mortality. In each, PIR was modeled using restricted cubic splines to allow for non-linear associations. The broad cohort model included non-PIR physician and non-physician staffing covariables.ResultsThe narrow cohort of 27,380 patients across 67 ICUs (predicted mortality: median 1.2% [IQR 0.4–1.4%]; mean 5.9% [sd 13.2%]) had a median PIR of 10.1 (IQR 7–14). The broad cohort of 91,206 patients across 73 ICUs (predicted mortality: 1.9% [0.6–6.5%]; 7.6% [14.9%]) had a median PIR of 7.8 (IQR 5.8–10.2). We found no association of PIR with mortality in either the narrow (PIR 1st spline term odds ratio [95% CI]: 1 [0.94, 1.06], Wald testing of spline terms p = 0.61) or the broad (1.02 [0.97, 1.07], p = 0.4) cohort.ConclusionWe found no association of PIR with hospital mortality across ANZ ICUs. The low cohort predicted mortality may limit external validity.Supplementary InformationThe online version contains supplementary material available at 10.1007/s00134-021-06575-z.

Non-home discharge after cardiac surgery in Australia and New Zealand: a cross-sectional study

ObjectiveTo determine the proportion of patients surviving their cardiac surgery who experienced non-home discharge (NHD) over a 16-year period in Australia and New Zealand (ANZ).DesignRetrospective, multicentre, cross-sectional study over the...

Human Rights Education and Social Cohesion in South Asia in times of COVID-19

Globalisations, economic, cultural and social change over the last four decades have affected the nature of the discourse in human rights education. The chapter explores human rights education research and the problematic relationship between human rights education and the state, against the background of globalisation, and economic, political, social and cultural factors. This article aims to link human rights international standards and institutions to grass-roots human rights culture and its impact on social cohesion in South Asia. It begins with an analysis of the nexus between human rights and social cohesion and draws attention to some ideas that complement both. It then analyses how international human rights standards and associated implementation machinery can be used to advance social cohesion around the world. The article critiques current social cohesion trends globally - with some references to Australia and South Asia and focuses on the role of National Human Rights Institutions (NHRIs) in advancing human rights culture.

Lesser Sac Haematoma – Meliodosis: A Surgical Surprise

ABSTRACT
 Meliodosis, a potentially fatal disease endemic in south east asia and northern Australia is caused by Burkholderia pseudomallei, a motile ,aerobic , non spore forming gram negative bacillus. It can present with asymptomatic infections to localized abscesses to fulminating diseases with multi organ involvement and eventual death. Mycotic aneurysm is a very rare presentation of meliodosis. Although isolation of

Impact of FTA on Trade in ASEAN and Australia Using Customs Level Data

This study examines the impact of the Association of Southeast Asian Nations (ASEAN)-Australia-New Zealand Free Trade Agreement (AANZFTA) on Australian trade with a particular focus on imports from ASEAN member countries to Australia. We examine the AANZFTA’s utilization by ten ASEAN countries at the six-digit trade classification level from 2012 to 2016 using Australian customs data. We implement Ando and Urata’s (2018) and Hayakawa et al.’s (2014) framework of free trade agreement (FTA) utilization based on preferential tariff margins. We also account for overlapping FTAs that are likely to impact the AANZFTA’s utilization. The results indicate that preferential tariff margins positively impact FTA utilization. However, the results also indicate that the AANZFTA’s utilization rate across ASEAN countries is low relative to Australia’s bilateral FTAs with Malaysia, Thailand, and Singapore. We also find evidence that co-sharing rules of origin positively impact FTA utilization.

“Winning the women’s world cup”: gender, branding, and the Australia/New Zealand As One 2023 social media strategy for the FIFA Women’s World Cup 2023™

In this article we critically explore the social media strategy of the successful Australia-New Zealand ‘As One’ joint bid for the FIFA Women’s World Cup 2023™. We explore how the As One bid harnessed Twitter to communicate a hosting vision that appealed to multiple audiences while strategically, and successfully, resonating with contemporary FIFA politics. We adopt quantitative and qualitative content analysis methods to develop the constructed presence and narrative patterns from the As One bid’s Twitter activity. Our findings suggest content relied on two primary ‘legacy’ narratives which both conformed to current FIFA strategy and broader social and regional politics: growing football participation among women and girls and strengthening cultural, economic, and political relations in the Asia-Pacific. Ultimately, we argue the use of Twitter was strategic and targeted, deliberately appropriating popular FIFA narratives to build an emotive ‘legacy’ vision to gain support from voting members of the FIFA Council.

Assessment of knowledge, attitude and practices of people toward Japanese Encephalitis in endemic areas of Nepal

Japanese encephalitis is a serious vector borne viral zoonotic disease, particularly in Asia and Northern Australia. In Nepal, JE cases were reported in 63 out of 75 districts up until the year 2005. The aim of this study was to assess the level of knowledge, attitude and practices (KAP) toward JE and associated factors. A structured questionnaire was used to gather information on the KAP of people in endemic areas. Accordingly, 397 respondents demonstrated a desirable attitude, while half of the population exhibited desirable knowledge and practices. Age was found to be a significant factor for knowledge, wherein the senior population had better awareness of the vectors of JE. Moreover, education and occupation were found to be significant factors for KAP scores with an increase in level of education leading to an increase in desirable characteristics. This study determined that the characteristics of the surrounding environment were prominent factors. A significant number of people were not aware of the JE vaccine even though the government has made it available to most of the population of Nepal. Thus, more effective awareness programs should be implemented to increase the KAP of the population with regard to JE.

"The odds were stacked against me": a qualitative study of underrepresented minorities in surgical training.

The Royal Australasian College of Surgeons (RACS) is expected to provide surgical care to a diverse patient population across Australia and New Zealand (ANZ). To improve the quality-of-care individuals receive, the surgical workforce must reflect the population it serves. Achieving diversity within RACS will strengthen therapeutic relationships with patients and promote an inclusive culture. This study investigates the perspectives of underrepresented minority (URM) trainees to highlight barriers for the selection and completion of the RACS Surgical Education and Training (SET) program. This qualitative study used online, semi-structured, in-depth interviews of URM trainees. Participants were recruited by self-identification and were invited to participate based on inclusion criterion. Interviews took place between August and October 2020, were transcribed and de-identified. Framework analysis was used to identify themes. Eight participants from four surgical specialities were interviewed, six from Australia and two from New Zealand. There were six female and two male participants. The findings identified barriers that were grouped into eight broad areas: discouragement; structural racism, discrimination and unconscious bias; language barriers; policies and procedures; lack of role models; homophobia; sexual harassment and women in surgery. The findings offer guidance to RACS and the surgical community to explore new strategies to improve the experience of URM SET trainees. While on a small scale, the study draws directly on the URMs' experiences to inform strategies addressing equity, diversity and inclusion. The aim is to produce a diverse surgical workforce that better delivers healthcare services to a diverse population.

Use of parenteral nutrition in term and late preterm infants: an Australian and New Zealand survey.

There is limited information regarding the use of parenteral nutrition (PN) in term and late preterm infants. We conducted a survey to study the current clinical practices within Australia and New Zealand (ANZ). A fifteen-question online survey was distributed to 232 neonatologists and fifty-five paediatric intensivists across ANZ between September and November 2019. At least one neonatologist from twenty-seven out of thirty tertiary neonatal intensive care units responded (90 %). Responses were received from sixty-nine neonatologists (30 %) and seven paediatric intensivists (13 %). The overall response rate was 26 % (76/287). Thirty-three percent (25/76) commenced PN within 24 h of admission, 27 % (20/75) between 24 and 48 h, 24 % (18/75) between 48 and 72 h, 9 % (7/75) between 72 and 96 h and 4 % (3/75) between 96 h and 7 days. None of the respondents commenced PN after 7 d of admission. Sixty-one percent (46/75) aimed for 1·5-3 g/kg per d of parenteral amino acids, whereas 27 % (20/75) aimed for 2-3 g/kg per d. Renal failure (59 %; 38/64) and high plasma urea (44 %; 28/64) were the major indications for withholding/decreasing the amino acid intake. Eighty-three percent (63/76) aimed for a dose of 2·5g-3·5 g/kg per d of parenteral lipids; about 9 % (7/76) targeted a dose of 1-2·5 g/kg per d and 4 % (3/76) for > 3·5 g/kg per d. Thirty-two percent (24/74) reported that they would withhold/decrease the dose of parenteral lipids in infants with sepsis. The variations in clinicians' practices with respect to the use of PN in term and late preterm infants highlight the need for high-quality research in this population.

Commonwealth Responsibility and Cold War Solidarity: Australia in Asia, 1944–74

Commonwealth Responsibility and Cold War Solidarity: Australia in Asia, 1944–74

Family visitation policies, facilities, and support in Australia and New Zealand intensive care units: A multicentre, registry-linked survey

ObjectiveThe objective of this study was to describe family visitation policies, facilities, and support in Australia and New Zealand (ANZ) intensive care units (ICUs). MethodsA survey was distributed to all Australian and New Zealand ICUs reporting to the Australian and New Zealand Intensive Care Society Centre for Outcomes and Resources Evaluation Critical Care Resources (CCR) Registry in 2018. Data were obtained from the survey and from data reported to the CCR Registry. For this study, open visiting (OV) was defined as allowing visitors for more than 14 h per day. Setting and participantsThis study included all Australian and New Zealand ICUs reporting to CCR in 2018. Main outcome measuresThe main outcome measures were family access to the ICU and visiting hours, characteristics of the ICU waiting area, and information provided to and collected from the relatives. FindingsFifty-six percent (95/170) of ICUs contributing to CCR responded, representing 44% of ANZ ICUs and a range of rural, metropolitan, tertiary, and private ICUs. Visiting hours ranged from 1.5 to 24 h per day, with 68 (72%) respondent ICUs reporting an OV policy, of which 64 (67%) ICUs were open to visitors 24 h a day. A waiting room was part of the ICU for 77 (81%) respondent ICUs, 74 (78%) reported a separate dedicated room for family meetings, and 83 (87%) reported available social worker services. Most ICUs reported facilities for sleeping within or near the hospital. An information booklet was provided by 64 (67%) ICUs. Only six (6%) ICUs required personal protective equipment for all visitors, and 76 (80%) required personal protective equipment for patients with airborne precautions. ConclusionsIn 2018, the majority of ANZ ICUs reported liberal visiting policies, with substantial facilities and family support.

Rapid Access Palliative Radiation Therapy Clinics: The Evidence Is There, but Where Are the Clinics? An Australian and New Zealand Perspective

First developed in Canada in the 1990s, Rapid Access Palliative Radiation Therapy (RAPRT) clinics have subsequently spread internationally to expedite treatment for near end-of-life patients, sparing them the need for multiple visits to the department. A "classical" RAPRT clinic is herein defined as "a dedicated clinic specifically established to enable (ideally) same day consultation, planning for, and delivery of palliative radiation treatment." The aim of this work was to determine the current status of these clinics in Australia and New Zealand (ANZ). A phone survey of all 100 Australian and 10 NZ radiation therapy centers was conducted in March and April 2021. The Chief Medical Officers of the 2 large private practices (GenesisCare and Icon) also approved the survey and answered on behalf of their 57 centers. A single page questionnaire was used, seeking information on the logistics and clinical details of past and present RAPRT clinics, and reasons why other centers do not have one. The survey response rate was 100%. There are only 3 current RAPRT clinics (2.7%). The dominant treatment indication is bone metastases (85%-90%), with most patients receiving single fractions (60%-90%), but commencement on the same day is variable (35%-90%). Five other clinics (4.5%) closed after 4 months to 7 years, but the clinical features were similar. By far, the most common reason (95%) given by the 107 centers without a current RAPRT clinic was that these patients are accommodated using existing resources. Classical RAPRT clinics have not been widely embraced in ANZ. There are alternative strategies such as the Advanced Practice Radiation Therapist model and techniques to avoid the conventional computed tomography-simulation step, which may also expedite treatment for palliative patients.

Development of clinical practice guidelines for allied health and nursing assessment and management of Duchenne muscular dystrophy

Purpose To provide evidence-based guidance specific to allied health and nursing practice for the assessment and management of individuals with Duchenne muscular dystrophy (DMD). Materials and methods Thirteen key focus areas were identified in consultation with health professionals and consumer advocacy groups. A series of systematic literature reviews were conducted to identify assessment and management strategies for each key focus area. A consensus process using modified Delphi methodology, including an Australia-New Zealand expert consensus meeting, was conducted. Recommendations underwent consultative review with key groups before being finalised and prepared for dissemination. Results This clinical practice guideline (CPG) generated 19 evidence-based recommendations, 117 consensus-based recommendations and five research recommendations across the 13 focus areas to inform allied health assessment and management of individuals with DMD. Conclusions The resulting recommendations can be used in conjunction with existing medical CPGs to improve, standardise and advocate for allied health and rehabilitation care in DMD. The process used here may be useful for the development of CPGs in other rare diseases. Implications for rehabilitation Implementation-ready evidence-based statements to guide clinical care of individuals with DMD are provided with the potential to improve participation, function in the community and quality of life. A model for developing best practice statements for other rare neurological diseases is described. Allied health and nursing health professionals should focus research efforts to generate quality evidence to support rehabilitation practice.

Clinicians' perceptions around discectomy surgery for lumbar disc herniation: a survey of orthopaedic and neuro-surgeons in Australia and New Zealand.

Understanding practice-based differences in treatment of lumbar disc herniations (LDHs) is vital for reducing unwarranted variation in the delivery of spine surgical health care. Identifying factors that influence surgeons' decision-making will offer useful insights for developing the most cost-effective and safest surgical strategy as well as developing surgeon education materials for common lumbar pathologies. This study was to capture any variation in techniques used by surgeons in Australia and New Zealand (ANZ) region, and perceived complications of different surgical procedures for primary and recurrent LDH (rLDH). Web-based survey study was emailed to orthopaedic and neurosurgeons who routinely performed spinal surgery in ANZ from Decmber 20, 2018 to February 20, 2020. The response data were analyzed to assess for differences based on geography, practice setting, speciality, practice experience, practice length, and operative volume. Invitations were sent to 150 surgeons; 96 (64%) responded. Most surgeons reported microdiscectomy as their surgical technique of choice for primary LDH (73%) and the first rLDH (72%). For the second rLDH, the preferred choice for most surgeons was fusion surgery (82%). A surgeon's practice setting (academic/private/hybrid) was a statistically significant factor in what surgical procedure was chosen for the first rLDH (P = 0.014). When stratifying based on surgeon experience, there were statisfically significant differences based on the annual volume of spine surgeries performed (perceived reherniation rates following primary discectomy, P = 0.013; perceived reherniation rates following revision surgeries, P = 0.017; perceived intraoperative complications rates following revision surgeries, P = 0.016) and based on the annual volume of lumbar discectomies performed (perceived reherniation rates following revision surgeries, P = 0.022; perceived intraoperative complications rates following revision surgeries, P = 0.036; perceived durotomy rates following primary discectomy, P = 0.023). Surgeons' annual practice volume and practice setting have significant influences in the selection of surgical procedures and the perception of surgical complications when treating LDHs.

Examining national planning principles for animals in Australian disaster response

Australia’s summer bushfires of 2019–20 were a reminder that animals are increasingly exposed to risks from changing climate conditions. In Australia, differing organisational approaches to managing owned animals in disasters can lead to different welfare and safety outcomes for animals and the people responsible for them. The need for consistency was reinforced by recent Australian royal commission findings. In 2014, the Australia-New Zealand Emergency Management Committee endorsed the National Planning Principles for Animals in Disasters, a tool supporting best practice in emergency planning and policy for animal welfare. This study examines current planning for animals in disasters in relation to the principles and describes their implementation in the Australian context. A national survey of organisation representatives with a stake in animal management in disasters (n=137) and addressing the national principles implementation was conducted from July to October 2020. Findings show moderate awareness of the principles by respondents and low to moderate implementation of these in planning processes and arrangements for animal welfare. Implementation of specific principles is described from the perspectives of stakeholders. Greater awareness of the national principles and attention to specific principles promotes consistency in animal welfare planning arrangements.

Cross-National Outcomes of a Digital Weight Loss Intervention in the United States, Canada, United Kingdom and Ireland, and Australia and New Zealand: A Retrospective Analysis.

Mobile health (mHealth) interventions are ubiquitous and effective treatment options for obesity. There is a widespread assumption that the mHealth interventions will be equally effective in other locations. In an initial test of this assumption, this retrospective study assesses weight loss and engagement with an mHealth behavior change weight loss intervention developed in the United States (US) in four English-speaking regions: the US, Australia and New Zealand (AU/NZ), Canada (CA), and the United Kingdom and Ireland (UK/IE). Data for 18,459 participants were extracted from the database of Noom's Healthy Weight Program. Self-reported weight was collected every week until program end (week 16). Engagement was measured using user-logged and automatically recorded actions. Linear mixed models were used to evaluate change in weight over time, and ANOVAs evaluated differences in engagement. In all regions, 27.2–33.2% of participants achieved at least 5% weight loss by week 16, with an average of 3–3.7% weight loss. Linear mixed models revealed similar weight outcomes in each region compared to the US, with a few differences. Engagement, however, significantly differed across regions (P < 0.001 on 5 of 6 factors). Depending on the level of engagement, the rate of weight loss over time differed for AU/NZ and UK/IE compared to the US. Our findings have important implications for the use and understanding of digital weight loss interventions worldwide. Future research should investigate the determinants of cross-country engagement differences and their long-term effects on intervention outcomes.