Australian Capital Territory Health Research Articles

‘Joining the Dots: Linking Prenatal Drug Exposure to Childhood and Adolescence’ – research protocol of a population cohort study

IntroductionPrenatal drug exposure (PDE) is one of the most important causes of child harm, but comprehensive information about the long-term outcomes of the families is difficult to ascertain. The Joining...

203 Clinical Significance of Haemorrhagic Cholecystitis: Retrospective Case Series

Abstract Aim Hemorrhagic cholecystitis (HC) is a rare entity of acute cholecystitis. HC is hard to detect clinically as its symptoms are easily confused with acute calculus or acalculus cholecystitis. Although it is rare the purpose of this study is that early recognition may prevent possible life-threatening complications. Method A retrospective review of HC patients diagnosed by histopathology from 2010 to 2021 at the Australian Capital Territory health hospitals. A search of the histopathology database, patients’ medical records, laboratory results and imaging were conducted. Results Thirty-five patients (1%) were diagnosed on the histopathology report from approximately 3500 patients with cholecystectomies. Thirty-one Patients (88.6%) were presented to emergency, four patients (11.4%) had elective surgery. Twenty-one patients (60%) were female, fifteen patients (40%) were male. The median age was 51 years. All patients had laparoscopic cholecystectomy, four patients (11.4%) were converted to open, and five patients (14.2%) required ERCP. Two patients (5.7%) were on anti-coagulation. Twenty-three (65.7%) had ultrasound, twelve patients (34.2 %) had CT just one was reported as HC. Three patients (8.5%) had MRCP. Intraoperative findings were 8 patients with mucocele (22.8%), 6 patients had gangrenous gall bladder (17.1%),4 patients had empyema of gall bladder (11.4%) and 2 patients had perforated gall bladder (5.7%). Conclusions Our results revealed that all patients with HC were treated with surgical removal of gall bladder and had no post-operative complications. This shows diagnosing HC not effecting the overall clinical outcome for patients.

Long-term protection from HIV infection with oral HIV pre-exposure prophylaxis in gay and bisexual men: findings from the expanded and extended EPIC-NSW prospective implementation study.

Daily pre-exposure prophylaxis (PrEP) is effective in preventing HIV, but few long-term data are available on effectiveness and adherence in real-world settings. Here, we report trends in HIV incidence over 3 years in individuals at high risk who were prescribed PrEP in New South Wales (NSW), as well as adherence before the transition to subsidised PrEP. Expanded PrEP Implementation in Communities-New South Wales (EPIC-NSW) was a pragmatic, prospective, single-arm, implementation study of daily, oral PrEP in 31 sites (sexual health clinics, general practices, and a hospital) in NSW, Australia. Eligible participants were HIV-negative adults (aged ≥18 years) who were at high risk of HIV infection as defined in local PrEP guidelines. Participants were prescribed coformulated (once-daily, oral tablet) tenofovir disoproxil fumarate (300 mg) and emtricitabine (200 mg) as HIV PrEP and were followed up with HIV testing, sexually transmitted infection testing, and PrEP dispensing. Originally planned for 3700 participants followed for 1 year, the study was expanded so that all eligible participants in the state could obtain PrEP and extended until publicly subsidised PrEP became available in Australia. The primary outcome was new HIV infection among all participants who were dispensed PrEP at least once and had at least one follow-up HIV test result. Adherence was estimated by medication possession ratio (MPR), defined as the proportion of PrEP pills dispensed in 90 days, assuming daily dosing. This study is registered with ClinicalTrials.gov, NCT02870790. Between March 1, 2016, and April 30, 2018, we enrolled 9709 participants. 9596 participants were dispensed PrEP, of whom 9448 (98·3%) were gay or bisexual men. Participants were followed up until March 31, 2019, with at least one follow-up HIV test available in 9520 (99·2%) participants. Mean MPR declined from 0·93 to 0·64 from the first to the ninth quarter. There were 30 HIV seroconversions over 18 628 person-years, an incidence of 1·61 per 1000 person-years (95% CI 1·13-2·30). Being younger, living in a postcode with fewer gay men, reporting more risk behaviours at baseline, and having an MPR of less than 0·6 were each univariately associated with increased HIV incidence. In the final year of follow-up, when PrEP was mostly purchased rather than provided free by the study, HIV incidence remained low at 2·24 per 1000 person-years (1·46-3·44). HIV incidence remained low over up to 3 years of follow-up, including during a transition from study-provided to publicly subsidised PrEP. In a setting of affordable PrEP and associated health-care services, very low HIV incidence of 1 to 2 per 1000 person-years can be maintained in gay and bisexual men who were previously at high risk. New South Wales Ministry of Health, Australian Capital Territory Health Directorate, Gilead Sciences.

A smartphone app for sedentary behaviour change in cardiac rehabilitation and the effect on hospital admissions: the ToDo-CR randomised controlled trial study protocol

IntroductionCardiac rehabilitation (CR) is recommended for secondary prevention of cardiovascular disease and reducing the risk of repeat cardiac events. Physical activity is a core component of CR; however, studies show...

Free range eggs does not mean safe eggs: an outbreak of Salmonella Typhimurium linked to free range eggs

An outbreak of Salmonella enterica serovar Typhimurium with closely related Multiple Locus Variable-number Tandem Repeat Analysis (MLVA) patterns was detected by routine surveillance by the Australian Capital Territory Health Protection Service in May 2018. The outbreak consisted of three cases in 2018 (MLVA 03-10-10-09-496) and one in 2016 (MLVA 03-10-09-09-496), who reported eating home-cooked eggs from the same local producer. Environmental investigations found significant problems with egg cleaning, hand hygiene and documentation of food safety procedures on farm. Environmental samples collected from the farm were found to have the same MLVA pattern as the 2018 cases. Although poor farm practices most likely led to contamination of the eggs, this outbreak highlights the need for consumer education about safe handling of eggs in the home.

A four-year, systems-wide intervention promoting interprofessional collaboration

BackgroundA four-year action research study was conducted across the Australian Capital Territory health system to strengthen interprofessional collaboration (IPC) though multiple intervention activities.MethodsWe developed 272 substantial IPC intervention activities involving 2,407 face-to-face encounters with health system personnel. Staff attitudes toward IPC were surveyed yearly using Heinemann et al's Attitudes toward Health Care Teams and Parsell and Bligh's Readiness for Interprofessional Learning scales (RIPLS). At study's end staff assessed whether project goals were achieved.ResultsOf the improvement projects, 76 exhibited progress, and 57 made considerable gains in IPC. Educational workshops and feedback sessions were well received and stimulated interprofessional activities. Over time staff scores on Heinemann's Quality of Interprofessional Care subscale did not change significantly and scores on the Doctor Centrality subscale increased, contrary to predictions. Scores on the RIPLS subscales of Teamwork & Collaboration and Professional Identity did not alter. On average for the assessment items 33% of staff agreed that goals had been achieved, 10% disagreed, and 57% checked neutral. There was most agreement that the study had resulted in increased sharing of knowledge between professions and improved quality of patient care, and least agreement that between-professional rivalries had lessened and communication and trust between professions improved.ConclusionsOur longitudinal interventional study of IPC involving multiple activities supporting increased IPC achieved many project-specific goals. However, improvements in attitudes over time were not demonstrated and neutral assessments predominated, highlighting the difficulties faced by studies targeting change at the systems level and over extended periods.

A review of Australian health privacy regulation regarding the use and disclosure of identified data to conduct data linkage

To review Australian legislation about privacy, focusing on provisions within the regulations to conduct health research using identified data and lobby for regulatory change in the ACT. A systematic review of Commonwealth and jurisdiction health privacy regulation. Australia has a number of regulations for the protection of privacy of health information. In addition to Commonwealth privacy laws, there are jurisdictional regulations concerning protection of health information. These range from no specific legislation in Western Australia, to a code of practice in South Australia, and Commonwealth legislation that deals with use and disclosure of identified health information to conduct health research (Sections 95 and 95A of the Privacy Act 1988). At the time of this review, all but one jurisdiction, the Australian Capital Territory (ACT), had provisions for disclosing identified health information for health research. The ACT's Health Records (Privacy and Access) Act was inconsistent with the other Australian regulation concerning the use of identified health data in health research. The information from the review was used to inform the ACT Government that the health privacy regulations in place were inconsistent with the rest of Australia and resulted in regulatory change in the ACT. ACT legislation was amended to include provisions for the disclosure of identified health information for health research under controlled circumstances. The amendments were passed in December 2005, facilitating future health research involving data linkage in the ACT.