Gold Coast Health Research Articles

Relationship between parathyroid adenoma size, weight and histological subtypes with perioperative serum levels

AimsThis study aims to identify associations between parathyroid adenoma (PTA) characteristics (histology, weight and size) with the change in parathyroid hormone (PTH) and calcium levels.MethodsA historical cohort study was conducted...

Implementation of the Gold Coast Health aphasia peer support volunteer program

Implementation of the Gold Coast Health aphasia peer support volunteer program

Implementation of an Electronic, Web-Based, Customisable Inpatient Admission and Consult Handover List in the Gold Coast Health Cardiology Service

Implementation of an Electronic, Web-Based, Customisable Inpatient Admission and Consult Handover List in the Gold Coast Health Cardiology Service

Cardiac Rapid Access Service—A New Gold Coast Health Initiative

Cardiac Rapid Access Service—A New Gold Coast Health Initiative

Testing for Mycoplasma genitalium in pelvic inflammatory disease: A clinical audit.

The records of women attending Gold Coast health hospital sites were retrospectively analysed to determine if women diagnosed with pelvic inflammatory disease (PID) were being tested for Mycoplasma genitalium (MG). Only 11.4% of 299 women were tested for MG despite 74.2% being tested for Chlamydia trichomonas (CT) and Neisseria gonorrhoeae (NG). Only 9% of the women were treated with antibiotics which would treat macrolide-sensitive MG infection. Increasing education and awareness of MG and utilising reflex macrolide testing for MG will help direct effective antibiotic therapy and prevent the long-term sequalae of PID.

Do patients discharged from the physiotherapy-led pelvic health clinic re-present to the urogynaecology service?

The physiotherapy-led pelvic health clinic (PLPHC) is an advanced practice clinic that manages women from the urogynaecology waitlist with pelvic organ prolapse (POP) and/or urinary incontinence (UI) at Gold Coast Health, Australia. This study was aimed at determining re-referral rates and reasons for re-presentation of women previously managed and discharged from the PLPHC. We hypothesised that there would be low representation rates for the same condition within 12months of discharge. A retrospective audit was undertaken of all (n = 209) patients discharged between 1 January and 31 December 2017. Re-presentation rates and reasons for re-referral for women seen in the PLPHC and discharged without requiring urogynaecology medical specialist review were analysed and descriptive analysis performed. Of the 209 patients, 67 were referred to, or had, urogynaecology medical specialist review after their initial physiotherapy care and were removed from further analysis. Of the remaining 142 patients, who were initially managed by physiotherapy only, 10 (7.1%) women were re-referred to specialist medical outpatient gynaecology and urology out-patient departments, for management of a different diagnosis, and 10 (7.1%) for their original diagnoses, within 12months of discharge. Of the latter, 1 patient required further physiotherapy and urogynaecologist management; 7 patients required ongoing pessary management; 1 patient continued with urologist medical management; and 1 failed to attend. This study presents novel data on low re-presentation rates in the 12months following discharge for patients with POP or UI managed in a PLPHC; and provides further support for advanced scope of practice physiotherapy gynaecological service models.

Evaluating the provision of Further Enabling Care at Home (FECH+) for informal caregivers of older adults discharged home from hospital: protocol for a multicentre randomised controlled trial

IntroductionThere are personal and societal benefits from caregiving; however, caregiving can jeopardise caregivers’ health. The Further Enabling Care at Home (FECH+) programme provides structured nurse support, through telephone outreach, to...

Virtual models of chronic disease management: lessons from the experiences of virtual care during the COVID-19 response.

Objective This study examined Gold Coast staff and patient experiences with the rapid expansion of a virtual model of chronic disease management during the COVID-19 pandemic. Methods The study undertook a survey of enrolled patients (n=24) and focus groups with clinical and administrative staff (n=44) delivering chronic disease programs at Gold Coast Health in Queensland. The study also examined routinely collected activity data for the chronic disease programs before COVID (January-February 2020) and for the first 3 months of the COVID-19 response (March-May 2020). Results Chronic disease programs continued to provide similar numbers of appointments over the COVID-19 response period, but there was a marked increase in the proportion of appointments that were delivered virtually, either by telephone or video conference. Most patients were satisfied with their virtual care experiences and felt that their health care needs were met. Conclusions The COVID-19 response provided an opportunity to learn and further develop models of virtual care. Staff and patients were generally supportive of continuing to include virtual appointments in the future. Ongoing concerns were predominantly around the support available to patients and staff to ensure they are trained and equipped to manage the technology and new mode of communicating. What is known about the topic? Emerging evidence suggests that virtual models of health care delivery, such as telephone and video consultations and remote patient monitoring, can be safe and cost-effective alternatives to traditional face-to-face chronic disease management programs. Virtual care is associated with equal or improved clinical outcomes, as well as efficiency improvements, such as reduced failure to attend rates. What does this paper add? The increasing burden of chronic disease across Australia, as well as the need to minimise the risk of vulnerable patient groups attending in-hospital appointments where it is safe and appropriate to do so, means that expanding the delivery of virtual chronic disease management will become increasingly necessary. The results of this study provide an opportunity to learn from a rapid rollout of virtual care for these staff and patient groups and will help inform advances in this area. What are the implications for practitioners? Existing evidence, demographic pressures and the COVID-19 pandemic response all point to virtual care as a viable and safe alternative to traditional models of chronic disease management. The lessons presented here provide more detailed guidance on the support that staff and patients require to ensure virtual care is a seamless and safe alternative or adjunct to traditional chronic disease management programs.

Changes in older adults' impairment, activity, participation and wellbeing as measured by the AusTOMs following participation in a Transition Care Program.

Maintaining a continuum of care is vital to ensure adequate health among older adults, particularly during periods of care transitions, when they are vulnerable and at risk of poor health outcomes. The Transition Care Program in Australia is designed to support older adults following the conclusion of a hospital episode. Using the Australian Therapy Outcome Measures for Occupational Therapy (AusTOMs-OT), this study aimed to understand how the Transition Care Program impacts an older adult's occupational performance during care transitions. Data were collected as a part of usual occupational therapy care from March 2016 to August 2017 from clients admitted to a Gold Coast Health Transition Care Program. Data from 110 clients were analysed on 5 AusTOMs-OT scales: functional walking and mobility, upper limb use, self care, domestic life-home, and community life/recreation/leisure/play. Change data from these scales were analysed using the Wilcoxon Signed Ranks Test. Clients in the Transition Care Program experienced statistically and clinically significant improvements in all AusTOMs-OT scales analysed as well as in each domain of impairment, activity limitation, participation restriction and distress/wellbeing. These results are meaningful for clients, occupational therapists and Australian Transition Care Programs. Clients demonstrated progress towards their goals, indicating maintenance or improvements in their occupational performance, confirming for occupational therapists that the provision of services is promoting goal achievement and leading to improved occupational performance. The study also highlighted the benefits for the use of outcome measures such as the AusTOMs-OT to quantify and validate client change.

MON-139 SODIUM THIOSULPHATE IN CALCIPHYLAXIS; A SINGLE-CENTRE AUDIT

Calciphylaxis is a rare and debilitating disease caused by progressive microvascular necrosis of skin resulting in ulcers. The pathophysiology is unclear but mural calcification is central to the disease process. Patients are usually hyperphosphataemic, have hyperparathyroidism and an elevated plasma calcium and phosphate product. Prognosis is poor with one-year survival estimated between 45-80%.There is little evidence to guide treatment; parathyroidectomy and vitamin K2 supplementation have been used with some success. One of the most commonly used treatment strategies is intravenous sodium thiosulphate, an agent thought to dissolve the intramural calcium and thus reduce inflammation. The aim of this audit is to examine the prescribing practices and patterns in the Gold Coast Health Service haemodialysis population. An audit of the Gold Coast Health Service pharmacy dispensing of intravenous sodium thiosulphate was conducted between 2014-2018. Patients with end-stage renal disease, defined as being established on haemodialysis or planned to commence within 6 months, were included. Nine patients were identified and their demographic, dialysis history, duration of treatment, biochemistry and mortality data was collated from electronic health records. One third of the patients were female. The average age at time of diagnosis was 63 years. The average time from start of dialysis to diagnosis was 3.51 years (range 22-3869 days). The average treatment duration was 131 days. Time from diagnosis to death averaged 217 days. Three patients had complete resolution of lesions and treatment was discontinued. The mean calcium phosphate product was 3.92 mmol2/L2 at time of diagnosis and mean PTH was 50.78 micromol/L. Sodium thiosulphate may slow, and in some cases cure, an otherwise aggressive and debilitating syndrome. Delay in administering this medication may be to the detriment of patients, however prospective, randomised data is required.

Commentary: The Gold Coast Health and Knowledge Precinct

Commentary

Implementation of Periop Disaster Response Exercise Program at Gold Coast Health

Introduction:With the move into Gold Coast University Hospital, a new disaster plan was developed in 2017. To assess preparedness for the Commonwealth Games (April 2018), a number of mass casualty exercises were conducted, including a large multi-agency exercise with Queensland Police and Ambulance Services. During this preparation phase, senior clinicians from the perioperative area clarified their sub-plans and developed a novel model of periop response.Aim:This study assesses this model of response and evaluates it within the context of periop disaster exercises.Methods:The periop response model evolved through multi-disciplinary key stakeholder engagement into a defined model of surgical, anesthetic, and periop nursing responses with dedicated roles and parallel communication streams from ED to OR by the respective specialties. Throughout different disaster exercises, this model of response was tested, refined, and evaluated by formal post-exercise debriefs and group meetings.Results:Since May 2017, seven different mass casualty exercises with periop response were performed; firstly, a table-top (EmergoTrainSystem) format was used, which revealed communication and logistical deficiencies. After model refinement, further exercises were accomplished, all within the clinical environment, including movements of mock patients from ED to OR. These exercises generated improvements in communication, coordination, and logistics. Every exercise was also used to test more detailed information, communication, and organizational tasks of the various involved craft groups, such as notification, call-in lists, whiteboard structure, transport facilitation, and many more. Overall, our newly developed periop response model proved to be robust and successful, even with rotating personnel through different roles.Discussion:Apart from the success of the periop response model, other hospital areas (ICU, bed and ward management) became involved. With growing interest and staff turn-over a regular periop disaster response exercise program has now been established. This model of periop response has potential for use in other health systems.

Surfing-related renal trauma

Objectives:The objective of this study was to describe the prevalence and mechanisms of surfing-related renal trauma in a coastal town, which have not previously been published in the literature.Subjects/patients and methods:A 3 year retrospective review was completed of all renal trauma patients presenting to the Gold Coast Health Service.Results:Five injuries were identified and their mechanisms described, with three directly related to surfboard riding, one secondary to paddle boarding and one secondary to windsurfing. Surfing-related injuries accounted for 6% of the total renal trauma injuries in the study period. Injuries ranged from American Association for the Surgery of Trauma grade I–IV and were all managed non-operatively. One case was complicated by a urinoma, which resolved on interval follow-up imaging. All injuries were in males, and left-sided.Conclusion:Surfing-related activities have the potential to cause high-grade renal injuries. Diagnosis of renal trauma secondary to surfing-related activities requires a high index of clinical suspicion.Level of evidence:Level IV Evidence

Evaluation of the research capacity and culture of allied health professionals in a large regional public health service.

PurposeThe first aim of this study was to evaluate the current research capacity and culture among allied health professionals (AHPs) working in a large regional health service. The second aim of this study was to undertake principal component analyses (PCAs) to determine key components influencing our research capacity and culture.Patients and methodsAs part of a cross-sectional observational study, the Research Capacity and Culture (RCC) tool was administered to AHPs working in Gold Coast Health to measure self-reported research capacity and culture across Organization, Team, and Individual domains, including barriers to and motivators for performing research. An exploratory PCA was performed to identify key components influencing research capacity and culture in each of the three domains, and the results were compared with the findings of a previous study performed in a large metropolitan health district.ResultsThis study found moderate levels of research capacity and culture across all domains, with higher scores (median, IQR) reported for the Organization domain (7,5–8) compared to the Team (6,3–8) and Individual domains (5,2–7). Two components were identified in each domain. Components in the Organization domain included “research culture” and “research infrastructure”; components in the Team domain included “valuing and sharing research” and “supporting research”; and components in the Individual domain included “skills for conducting research” and “skills for searching and critiquing the literature”. These components were found to be highly correlated with each other, with correlations between components within each domain ranging from 0.459 to 0.702.ConclusionThe results of this study reinforce the need for an integrated “whole of system” approach to research capacity building. Ongoing investment in tailored support and infrastructure is required to maintain current areas of strengths and build on identified areas of weakness at the level of organizations, teams, and individual AHPs, and consideration should also be given as to how support across these three levels is integrated.

Risk Factors Associated with Lower Urinary Tract Injuries in Traumatic Pelvic Fractures

Background: Bladder and urethral injuries associated with pelvic fractures are uncommon and are missed at initial assessment in up to 23% of cases. Missed lower urinary tract injuries have a significant impact on patient morbidity, if not identified early. This study aims to associate mechanisms of traumatic pelvic ring fractures with bladder and/or urethral injuries to determine factors that may increase odds of injury. Methods: In a retrospective cohort study, all patients 13 years and older admitted to Gold Coast Health Service from 2010 to 2016 with traumatic pelvic injuries and lower urinary tract injuries were identified. Mechanism of injury and types of pelvic fractures were evaluated and clinical symptoms and treatment analysed. Results: 333 patients with pelvic fractures were identified: seven sustained urethral injuries, three bladder injuries and one with both. Common mechanisms included crush injuries (40%) with a statistical significant correlation (p=0.47), falls from height (30%) and road traffic accidents (30%). Associated types of pelvic fractures comprised of lateral compression (40%), anterior-posterior compression (40%) and vertical shear (20%). Conclusion: As identified in this retrospective study, concomitant lower urinary tract injuries and pelvic fractures are rare. Although a significant correlation with types of pelvic fracture could not be determined, there is a clear association with high-energy trauma. Therefore, it is important to actively look for and exclude bladder and urethral injuries in this patient group. Further research with a larger prospective study could provide a greater insight into correlations.

Epidemiological Analysis of Infective Endocarditis at the Gold Coast Health Service

Epidemiological Analysis of Infective Endocarditis at the Gold Coast Health Service

Histopathological evaluation of parotid gland neoplasms in Queensland, Australia

Parotid gland tumours are complex neoplasms with a broad histological range. The parotid gland is also a common site of face and scalp skin cancer metastases. Parotidectomies performed by ENT department in the Gold Coast health district from 2006 to 2013. A total of 158 specimens were examined. Of these, 53.80 per cent were benign and 46.20 per cent were malignant. Pleomorphic adenoma was the most common tumour (29.11 per cent), followed by cutaneous squamous cell carcinoma (23.42 per cent) and Warthin's tumour (12.03 per cent). Metastatic squamous cell carcinoma accounted for a large proportion of parotid masses in our case series, reflecting the high prevalence of non-melanoma skin cancer in Australia. Primary parotid neoplasms had similar incidence rates to other studies.

Erratum: Corrigendum to: The 2q23.1 microdeletion syndrome: clinical and behavioural phenotype

Correction to: European Journal of Human Genetics advance online publication 7 October 2009; doi: 10.1038/ejhg.2009.152 Since the publication of the above paper, the authors noticed a co-author was missing from the authors’ list: Dr Susan Moloney, and her affiliation is MBBS FRACP, Department of Paediatrics, Gold Coast Health Service District, Southport, Gold Coast, Queensland, Australia.

Methylphenidate and Psychotic Depression

Aged Care Mental Health Robina Campus Gold Coast Health Service District and Faculty of Health Sciences and Medicine Bond University Queensland, Australia [email protected]