Northern Sydney Local Health District Research Articles

Experiences of Boosting Inpatient Exercise After HipFracture Surgery Using An Alternative Workforce - A Qualitative Study.

Thrice-daily physiotherapy immediately following surgical repair of hip fracture has been shown to be safe and to reduce total hospital length of stay. However, implementing this is challenging with respect to health service funding and staffing. A novel approach may be to utilize an alternative workforce (allied health staff and student physiotherapists) to deliver two of the three daily treatments. However, how patients and staff may view such an approach is unknown. Thus, the aim of this qualitative study was to explore the views of inpatients with surgical repair of a hip fracture, their carers, health care professionals, and physiotherapy students about the implementation and acceptability of thrice-daily physiotherapy, with two sessions delivered by the alternative workforce (the BOOST study). Semi-structured interviews and focus groups with patients, carers, health professionals and physiotherapy students. All interviews were digitally recorded and transcribed via verbatim. The transcripts were coded, and the data analysed via inductive thematic analysis. A total of 37 interviews (32 one-to-one interviews and five focus group interviews) were analysed. Five main themes were identified: (1) individual perceptions of the intervention: inpatients/carer/staff/student, (2) implementation within the service and organisational context, (3) implementation strategies that were effective, (4) improvements to implementation strategies/barriers to implementation/unsuccessful strategies and (5) future directions of BOOST. The qualitative data revealed that higher frequency physiotherapy was well-received by inpatients and that staff/students involved in providing care perceived it as a safe, acceptable and valuable practice. Implementation of higher daily frequency of physiotherapy using an alternative workforce may feasibly be adopted for inpatients following hip fracture surgery. This study was approved by the Human Research Ethics Committee (HREC) of the Western Sydney Local Health District (2020/ETH02718). Mutual recognition of approval was subsequently obtained from Northern Sydney Local Health District HREC.

P13: Supporting physical health for mental health consumers, in a community setting

Background:Older people with mental illness are likely to have increased difficulty in accessing health services due to social isolation and functional disability. It is well reported that people with mental illness are also more likely to have chronic and complex medical needs, be frail and be socially isolated. They are two times more likely to have respiratory disease, have cardiovascular disease, have metabolic syndrome, have diabetes, six times more likely to have dental problems and more likely to die earlier than the general population.Objective:The physical health program developed by the Northern Sydney Local Health District (NSLHD) community Older Peoples Mental Health Service (OPMHS) was part of a statewide project, facilitated by the Older People's Mental Health Policy Unit, Mental Health Branch, NSW Ministry of Health, where a variety of strategies were developed and implemented, to support the physical health of older mental health consumers using a biopsychosocial approach.Methods:NSLHD focused on providing OPMHS clinicians with the opportunity and resources to support older people with mental illness with their physical health and wellbeing, in particular Cardiometabolic Health, both screening and supporting interventions to address abnormalities and proactively support healthy lifestyle strategies. In each of the three community services, the program was led by a senior clinician who supported their team clinicians to carry out physical health assessments and planning.Results:The program commenced in July 2020, with the percentage of consumers of OPMHS who had regular metabolic monitoring completed, increasing from less than 10% to over 75%. Proactive person centred consideration and discussion including aspects of the consumers physical health and socialisation opportunities took place between clinicians, consumers and carers whilst their reviewing care in the community setting.Conclusion:The improvements have been sustained through a variety of strategies, in particular, capacity building within the multidisciplinary teams and the provision of the necessary resources 2023 IPA International Congress_Lisbon, Portugal Anne Hoolahan to carry out physical health monitoring and health promotion activities. Appropriate pathways were developed to escalate medical support recognised and sustain physical and psychological supports post discharge.Biography:Anne Hoolahan is a clinical nurse consultant in the Northern Sydney Local Health District, Older Peoples Mental Health Service. Anne qualified as a registered nurse in Sydney in 1990. Anne has worked in a variety of inpatient and community roles caring for older people before specialising in older people’s mental health. Anne holds a DipTeach (Ed) | MEd (Adult) | GradDipApSc (Nursing) | GradDipHlthSc (Geront) | GradCertMHlth (Older People).

Text messaging intervention to support patients with chronic pain during prescription opioid tapering: protocol for a double-blind randomised controlled trial

IntroductionIncreases in pain and interference with quality of life is a common concern among people with chronic non-cancer pain (CNCP) who are tapering opioid medications. Research indicates that access to...

Early and Intensive Motor Training for people with spinal cord injuries (the SCI-MT Trial): protocol of the process evaluation

IntroductionPeople with spinal cord injury receive physical rehabilitation to promote neurological recovery. Physical rehabilitation commences as soon as possible when a person is medically stable. One key component of physical...

Implementation of a frailty intervention in the transition from hospital to home: a realist process evaluation protocol for the FORTRESS trial

IntroductionFrailty in Older people: Rehabilitation, Treatment, Research Examining Separate Settings (the FORTRESS study) is a multisite, hybrid type II, stepped wedge, cluster, randomised trial examining the uptake and outcomes of...

Identifying a more severe emergent COVID-19 variant using Emergency Departments’ routinely collected clinical measures

To determine whether a clinical scoring system (the mPRIEST score) could be used to identify an emerging coronavirus disease 2019 (COVID-19) variant with increased clinical severity. Cross sectional study comparing two time periods (Delta and Omicron waves). Public Emergency Departments in Northern Sydney Local Health District. Patients presenting during August 2021 (Delta wave) and January 2022 (Omicron wave) with confirmed COVID-19. Data on age, gender, temperature, heart rate, systolic blood pressure, respiratory rate, oxygen saturation and mental status were extracted from patients' electronic medical records to assess clinical disease severity at presentation. Modified Pandemic Respiratory Infection Emergency System Triage (mPRIEST) score calculated using routinely collected data. A sample of 262 records of COVID-19 positive patients presenting during the Delta and initial Omicron waves were reviewed with 205 having COVID-19 as their primary diagnosis. During the Delta wave 48.1% had scores above 4 compared to 35.1% for the Omicron wave (p = 0.03). The median score was also significantly higher for the Delta group (4 vs 3; p = 0.01). Hospitalisations, admissions to ICU and deaths during admission were higher among patients presenting during the Delta wave than among those presenting during the Omicron wave. The mPRIEST score was significantly higher for patients for whom the predominant circulating variant was Delta than those for whom the predominant circulating variant was Omicron. This finding is consistent with international reporting of severity measured by hospital admission data and demonstrates the score's possible ability to identify an emergent strain with higher morbidity and mortality.

Work experience in a health library: what’s in it for you?

What do Punch and Judy shows, police balls and egg drives have to do with running a hospital? And why are we reading about such things in JoHILA? The answer lies in a fantastic collaboration between the Northern Sydney Local Health District libraries and TAFE NSW Ultimo, which is giving students a work placement experience like no other.

Online liquor gets audited: a review of regulatory controls and supply practices of online liquor retailers in NSW, Australia.

In New South Wales (NSW), Australia, the number of 'online liquor licences' - packaged liquor licences with conditions restricting the sale of alcohol to online, phone or fax orders - increased from 101 in 2010 to 500 by May 2018. International and national evidence is emerging that this growth in online liquor licences has been accompanied by increased risk of supply to young and intoxicated people. This study aimed to determine the extent to which online liquor retailers in NSW have adopted safeguards to prevent people younger than 18 years purchasing alcohol online; and the supply of alcohol to intoxicated people. It also aimed to assess the regulatory framework in NSW for these licences. We undertook an audit between May and November 2018 of regulatory controls for 213 online liquor retailers in NSW with publicly available websites at the time of auditing. A comparative analysis of the NSW Liquor Act 2007 and the NSW Liquor Regulation 2018 was conducted. Three gaps in the existing legal safeguards for online liquor retailers were identified: inconsistent application of the NSW Liquor Act 2007; the inability of the regulator to complete compliance auditing; and an absence of consistent mandatory signage. The study also identified inconsistencies between the regulation of physical and online liquor retailers. Study findings led to the formulation of recommendations for regulatory change, which were presented to the government oversight agency, Liquor & Gaming NSW, in April 2019 and followed up by written submissions from the research group on behalf of Northern Sydney Local Health District Health Promotion. Several key reforms were subsequently incorporated into the NSW Liquor Amendment (24-hour Economy) Bill 2020. Findings have informed an advocacy approach which has led to improved regulatory reform within NSW.

What are the problems with the current staging of discontinuous tumour nodules (DTNs) in colorectal carcinoma? Is there a better way?

Discontinuous extramural tumour nodules (DTNs) are deposits of metastatic carcinoma in soft tissue not associated with lymph nodes. Although they are established as an adverse prognostic factor in colorectal carcinoma (CRC), under the AJCC eighth edition staging system their presence does not upstage patients who also have lymph node metastases. Counterintuitively, in some situations the presence of lymph node metastases may in effect downstage a patient with DTNs from pN1c to pN1a/b. Therefore, we sought to critically assess the significance of DTNs in a large unselected single institution cohort of patients undergoing surgical resection for CRC. Of 3822 CRC patients undergoing surgical resection from 2005 to 2021, DTNs were present in 686 (18.0%). In univariate (HR=2.687, 95CI 2.355-3.065; p<0.001) and multivariate analysis (HR=1.805, 95CI 1.529-2.132; p<0.001) in a model including age, gender, stage, grade, location, lymph node ratio and apical lymph node status, DTNs were associated with worse overall survival (OS). N1c patients (DTN present but no nodal metastasis) demonstrated worse OS compared to the current pN1a group (p<0.001) and were least different to the current pN2a group (p=0.571). Within the current N1a (p=0.013), N1b (p=0.004) and N2a (p=0.002) groups, patients who also had DTNs had worse OS. DTNs were associated with worse OS for all stage III CRCs combined (p<0.001), and for stage IIIB (p<0.001) and stage IIIC (p=0.007) individually. We conclude that DTNs are an independent adverse prognostic factor that should be considered in the staging system in a way that is additional to (rather than integrated with) the number of involved lymph nodes. We then assess a simple suggestion for how this could be achieved by increasing the overall stage by one group in the presence of DTNs (requiring the creation of a new stage IIID).

Protocol for a process evaluation: face-to-face physiotherapy compared with a supported home exercise programme for the management of musculoskeletal conditions: the REFORM trial

IntroductionThe REFORM (REhabilitation FOR Musculoskeletal conditions) trial is a non-inferiority randomised controlled trial (n=210) designed to determine whether a supported home exercise programme is as good or better than a...

Predictors and outcomes of quality of life in elderly patients with heart failure

Study objectiveThis study aims to identify predictors of health related quality of life (HRQoL) among patients with heart failure (HF) and assess whether HRQoL was a predictor of rehospitalisation and mortality, and if age influenced the findings. DesignObservational cohort study. SettingSeven hospitals in the Northern Sydney Local Health District, Sydney, Australia. ParticipantsCommunity dwelling patients who completed a Minnesota Living with HF questionnaire (MLHFQ) within 30 days of discharge after a HF hospitalisation. Main outcome measureMultivariable linear regression models were used to identify predictors of MLHFQ scores (higher score = worse HRQoL) and adjusted Cox regression models to assess the impact of MLHFQ scores on one-year rehospitalisation and mortality. Separate analyses were conducted for those aged ≤80 or >80 years. Results1911 patients of mean age 79 years (57 % aged >80 years) were included in this analysis. Among those aged ≤80 years; younger age, lower haemoglobin and presenting symptoms at hospitalisation of exertional dyspnoea, peripheral oedema and fatigue were predictors of worse post-discharge MLHFQ scores. In patients aged >80 years, living alone, chronic kidney disease, exertional dyspnoea and peripheral oedema were predictors of worse MLHFQ scores. Worse MLHFQ scores predicted one-year HF readmissions in those aged >80 years (HR 1.22, 95 % CI 1.07–1.37) but not those aged ≤80 years (HR 0.90 95 % CI 0.71–1.10). ConclusionsIn-hospital predictors can be identified for worse HRQoL post-discharge for HF. These vary according to age, and should be addressed prior to discharge.

Evaluating acceptability and feasibility of a mobile health intervention to improve self-efficacy in prescription opioid tapering in patients with chronic pain: protocol for a pilot randomised, single-blind, controlled trial

IntroductionOpioid medications are no longer recommended as long-term therapy for chronic non-cancer pain, and many patients are advised to reduce or discontinue opioid medications. Many patients report difficulties in tapering...

Obesity Class Impacts Adverse Maternal and Neonatal Outcomes Independent of Diabetes.

IntroductionObesity in pregnancy is a known risk factor for adverse maternal and neonatal outcomes. Few studies have compared adverse pregnancy-related outcomes according to obesity severity. Hence, we aimed to examine the impact of obesity class on maternal and perinatal outcomes.MethodsWe retrospectively analysed data from all singleton births from mothers with obesity from 2013-2017 in Northern Sydney Local Health District in Sydney, Australia. Women were categorised into obesity class I (BMI 30-34.9kg/m2), class II (BMI 35-39.9 kg/m2) or class III (BMI 40+ kg/m2). Across BMI classes, we compared maternal outcomes including mode of delivery, gestational diabetes mellitus (GDM), and preeclampsia, and neonatal outcomes including large- and small-for-gestational age (SGA, LGA), neonatal hypoglycaemia, birth defects and timing of birth. Logistic analyses were performed to explore the impact of maternal obesity class on these outcomes, adjusting for maternal age, country of birth, parity, diabetes (both pre-existing and gestational) and hypertension.ResultsThere were 2466 births to women with obesity, class (69.1%), class II (21.8%), and class III (9.2%). 42.5% delivered by Caesarean section, 22.3% developed GDM and 11.2% had a hypertensive disorder in pregnancy, and Caesarean section and GDM were more common in women with higher class obesity. LGA occurred in 27.3% and SGA occurred in 4.0% of women across all classes of obesity. LGA rates were 49% more likely in women with class III compared to women with class I obesity (OR=1.49, CI 1.06-2.09, p=0.02). The presence of diabetes in the index pregnancy did not significantly impact risk of neonatal LGA between maternal obesity classes. Other neonatal adverse outcomes such as stillbirth and birth defects were more common in women with higher class obesity. SGA, neonatal hypoglycaemia, gestational age at delivery, APGAR 5-minute score and NICU admissions were similar across obesity classes, after adjustment for covariates.ConclusionsObesity class increases the risk of many adverse maternal and neonatal outcomes. Obesity class is independently associated with LGA incidence in the neonate, independent of maternal factors including GDM. Ongoing efforts must be made to reduce obesity incidence in women of reproductive age to circumvent the adverse perinatal outcomes associated with obesity.

Implementation of a novel stratified PAthway of CarE for common musculoskeletal (MSK) conditions in primary care: protocol for a multicentre pragmatic randomised controlled trial (the PACE MSK trial)

IntroductionMusculoskeletal (MSK) conditions constitute the highest burden of disease globally, with healthcare services often utilised inappropriately and overburdened. The aim of this trial is to evaluate the effectiveness of a...

Clinical characteristics and outcomes of COVID-19 in a low-prevalence, well resourced setting, Sydney, Australia.

BackgroundThe Northern Sydney Local Health District was one of the first health regions to be affected by COVID‐19 in Australia.AimsTo describe the clinical characteristics, risk factors and outcomes in our low‐prevalence Australian population.MethodsThis is a retrospective analysis of 517 laboratory‐confirmed COVID‐19 cases between January and June 2020. Patient information was collected as part of routine care within the COVID‐19 Virtual Hospital system. Outcomes examined were death, recovery at 30 days and intensive care unit (ICU) admission.ResultsThe case fatality rate was 1.8%. Multivariate analysis showed factors independently associated with death, composite outcome of death/ICU admission or incomplete recovery at 30 days were age >80 years and presence of two or more comorbidities. Most cases acquired COVID‐19 through international (50.9%) or cruise ship travel (9.1%). Healthcare workers comprised 12.8% of the cohort and represented a disproportionately high percentage of the ‘unknown’ source group (27.6%). The median incubation period was 5 days (interquartile range 3–8); one patient had an incubation period of 15 days. Hospitalisation was required in 11.8%, ICU admission in 2.1% and ventilation in 1.4%. A Radiographic Assessment of Lung Oedema score on chest X‐ray of >10 was independently associated with death.ConclusionsIn this low prevalence, well resourced Australian setting, we report an overall low mortality. Factors associated with adverse patient outcomes on multivariate analysis were age greater than 80 and the presence of two or more comorbidities. These data can assist in early risk stratification of COVID‐19 patients, and in surge capacity planning for hospitals.

My Baby's Movements: A Stepped-Wedge Cluster-Randomised Controlled Trial of a Fetal Movement Awareness Intervention to Reduce Stillbirths

Background: Maternal perception of decreased fetal movements (DFM) is associated with stillbirth. The My Baby’s Movements (MBM) trial aimed to evaluate the impact on stillbirth rates of a multifaceted awareness package for women and clinicians. Methods: A stepped wedge cluster randomised controlled trial was undertaken with 8 groups of 3-5 hospitals in Australia and New Zealand at four-monthly intervals, targeting women with a singleton pregnancy without major fetal anomaly at ≥28 weeks’ gestation. The primary outcome was stillbirth at ≥28 weeks’ gestation. Secondary outcomes included obstetric and neonatal outcomes. Analysis was undertaken using generalised linear mixed models controlling for calendar time, clustering, and hospital effects. Findings: From August 2016 to May 2019 there were 304,853 births with 290,219 meeting inclusion criteria: 150,079 in control and 140,140 in intervention periods. The stillbirth rate during the intervention was lower than the control period, although not statistically significant (2·2/1000 births versus 2·4, odds ratio [OR] 0·91, 95% Confidence Intervals [CI] 0·78-1·06, p=0·22). The decrease was larger across calendar time with 2·7/1000 in the first 18 months versus 2·0/1000 in the last 18 months (OR 0·74; 95% CI 0·63-0·86; p≤0·01). Adjusting for calendar time, stillbirth rates between the control and intervention periods were not significantly different: (aOR 1·18, 95% CI 0·93-1·50; p=0·18). No increase in obstetric intervention or adverse neonatal outcome was evident. Interpretation: The MBM intervention did not reduce stillbirths beyond the downward trend over time, suggesting hospitals may have implemented best practice in DFM management outside their randomisation schedule. Based on these findings, the role of interventions for raising awareness of DFM remains unclear. Trial Registration: ACTRN12614000291684. Funding Statement: National Health and Medical Research Council (NHMRC) Project Grant Application (APP1067363). Stillbirth Foundation Australia provided funding to develop the MBM application. Dr Glenn Gardener was provided a Betty McGrath Fellowship through the Mater Research Institute. Additional support was provided by Mater Foundation and the NHMRC Stillbirth Centre of Research Excellence. Declaration of Interests: The authors declare that they have no competing interests. Ethics Approval Statement: Primary ethics approval was obtained from Mater Misericordiae Ltd Human Research Ethics Committee (EC00332) (MML HREC) in 2015. Further jurisdictional ethics approval was obtained from seven participating HRECs include the ACT Health, Northern Sydney Local Health District (NSLHD), Northern Territory Department of Health and Menzies School of Health Research, The Central Health and Disability Ethics Committee (NZ), Melbourne Health, and the Mercy Health. Governance clearance was obtained from all 26 sites involved in the trial.

These are not normal times…Implementing a customer relations management system during a pandemic

Northern Sydney Local Health District (NSLHD) located on the north shore of Sydney Harbour, has a workforce of more than 10,000 staff. The workforce include nurses, allied health, medical professionals and health service managers, serving a community of over 900,000 people. NSLHD Libraries consists of five hospital libraries as well as a well-developed online service. NSLHD Libraries support the NSLHD Strategic Plan 2017 -2022, in particular, three of the key themes: Evidence Based Decision Making, Responsive &amp; Adaptable Organisation and an Engaged and Empowered Workforce. Patient care and supporting clinicians and health professionals in carrying out this care stand at the forefront of all NSLHD Libraries services and activities.&#x0D; To maintain sustainability and innovate, NSLHD Libraries sought a technology solution in the form of a customer relationship management (CRM) system. It needed to support our client-centred approach to services, as well as capture operational data. We needed to identify and implement a system, a single source of truth, that would support multiple purposes including evaluating services, reporting operational statistics and managing a client’s needs.

Child and family health nursing: A workforce profile.

To develop a profile of registered nurses working in Child and Family Health services across the Northern Sydney Local Health District to inform workforce strategic planning. Child and family health nurses (CFHNs) are registered nurses holding recognized qualifications in child and family health. To date, information regarding Child and family health nurses has been very limited. The survey was conducted using a self-administrated online questionnaire between March-June 2017. Just over 75% of the respondents were aged over 50years. Job satisfaction and feeling valued are enablers for remaining in current positions and not feeling valued can contribute to leaving employment. Nearly, one-third of respondents are currently a carer. This study provides an insight into the demographics of Child and family health nurses in Northern Sydney Local Health District, including roles as carers. It also examines factors influencing Child and family health nurses to remain or leave current positions. This survey has drawn attention to the need for managers to urgently develop strategies, for example succession planning, to ensure that shortages of these experienced Child and family health nurses do not occur. The inability to staff Child and Family Health could potentially impact on the ability to provide services and meet key performance indicators.

1374TiP - PRIME002: Early phase II study of azacitidine and carboplatin priming for avelumab in patients with advanced melanoma who are resistant to immunotherapy

BackgroundMelanoma patients with disease progression on immunotherapy have very limited treatment options. Low-dose azacitidine results in demethylation and increase in neoantigen expression and carboplatin increases DNA-damage and cellular stress. This trial is testing if sequential treatment with azacitidine and carboplatin “primes” for immunotherapy rechallenge with anti-PDL1 antibody Avelumab, via a decrease in the disease burden and re-establishment of immune sensitivity. Primary Objective: Quantify complete response (CR), partial response (PR), stable disease (SD), overall response rate (ORR) and clinical benefit rate (CBR) after 2 cycles of priming (1 cycle= azacitidine x 5 days followed by Carboplatin Day 8/28 days) according to RECIST 1.1 and 6 cycles of immunotherapy (1 cycle= 1 dose of Avelumab/14 days) according to irRECIST criteria. Secondary Objectives: 1. Determine DNA methylation levels before, and immediately after priming with azacitidine and carboplatin treatment i.e. at study entry and after 2 months; 2. Quantify immune-response markers (PDL-1, PD-1, CD4/CD8, and CD68) in blood, tumour and microenvironment and immune response in blood before treatment, after 2 priming cycles and after 6 immunotherapy cycles. Trial designInterventional early phase II study that consists of 2 cycles of azacitidine 40mg/m2 IV/day for 5 days followed by Carboplatin AUC 4.5 IV on D8/ 28day cycle and RECIST1.1 after completion of priming; followed by Avelumab 10mg/kg IV/14day cycle until disease progression according to irRECIST. A favourable or stable response in 20% patients and no grade 4 or persistent (>4 weeks) grade 3 treatment-related adverse events (TRAEs) is required for continuation of the trial. This early phase II study will assess the feasibility and determine outcome measures required to calculate sample sizes and develop a statistical plan for multi-centre Phase II study. This study has been approved by the Northern Sydney Local Health District HREC, reference number HREC/17/HAWKE/55’. Clinical trial identificationACTRN12618000053224; registered 16th January 2018. Legal entity responsible for the studyAndre van der Westhuizen. FundingRamaciotti Foundation and Hunter Medical Research Institute, Australia. DisclosureAll authors have declared no conflicts of interest.

Design and rationale of the MyHeartMate study: a randomised controlled trial of a game-based app to promote behaviour change in patients with cardiovascular disease

IntroductionRecurrence of cardiac events is common after a first event, leading to hospitalisations and increased health burden. Patients have difficulties achieving the lifestyle changes required for secondary prevention and access...