Northern Sydney Research Articles

Efficacy of an mHealth intervention to support pain self-management and improve analgesia in patients with rib fractures: protocol for a randomised controlled trial

IntroductionIn light of the risks of over-reliance on opioid analgesia during recovery from rib fractures, there is increased interest in the efficacy of non-pharmacological approaches to pain management. This paper...

5-years patency results of Zilver PTX on the femoro-popliteal arterial segment: A Northern Sydney experience.

The burden of peripheral arterial disease is increasing. Treatment of femoro-popliteal lesions remains challenging despite novel endovascular devices. Drug-eluting stents suppress post-treatment inflammation and reducing neo-intimal hyperplasia to reduce in-stent restenosis. A multi-centre retrospective 5-years longitudinal study was undertaken to evaluate freedom from clinically driven target limb revascularisation (FF CD-TLR) and patency of Zilver PTX stents in treating symptomatic femoro-popliteal stenotic lesions. Kaplan-Meier survival curves were used to demonstrate FF CD-TLR, primary, primary assisted and secondary patency. There were 148 patients and 183 lesions treated with a mean age of 80.3years and 52% males. The all-cause 5-years mortality was 25%. FF CD-TLR yearly patencies to 5years were 81%, 67%, 62%, 57% and 52%, respectively, with significantly poorer outcomes for in-stent restenosis, longer stent lengths and lesions at the femoro-popliteal junction. Primary patencies were 63%, 47%, 40%, 34% and 24%, assisted primary patencies were 90%, 75%, 68%, 59% and 48% and secondary patencies were 96%, 94%, 94%, 92% and 92%. Major adverse limb events were 5% at 1-year and cumulative at 5-years was 16%. The clinical outcomes in this study population are comparable to recent publications with smaller cohorts. Our study confirms Zilver PTX has very good primary patency over 5years with no discernible effect on all-cause mortality in an elderly cohort with particularly long treated lesions. Our results are similar to those seen in younger patients with shorter lesions. Nonetheless, longer lesions required more reinterventions to maintain patency. Zilver PTX is a safe and durable drug-eluting stent when utilised in the management of femoro-popliteal stenotic lesions with good long-term patency and limited need for re-intervention.

Petrographic and geochemical signatures of the Upper Permian Gondwana coals: Newcastle Coal Measures, Northern Sydney Basin, Australia

This research presents an integrated approach to organic petrographical and geochemical characteristics of the Upper Permian Newcastle Coal Measures outcropping in the northern Sydney Basin, southeast Australia. Twenty-seven coal, coaly mudstone and mudstone samples were collected and analyzed by using organic petrography (maceral composition and vitrinite reflectance) techniques, Rock–Eval pyrolysis, bitumen extraction and gas chromatography - mass spectrometry (GC–MS). The obtained results indicate that the samples exhibit promising gas-prone source rock potential and contain a predominantly terrestrial in origin organic matter, with limited contribution by marine organisms. The prevalence of terrestrial organic matter is inferred by the presence of collotelinite and sporinite macerals in most of the samples and the ternary plot of C27, C28 and C29 regular steranes. Further, the low C27/C29 ratio, the cross-plots of C27/(C27 + C29) regular steranes vs. Pr/Ph ratio, the C27/C29 vs. Pr/Ph and the C24 tetracyclic/C26 tricyclic terpane ratio point also to the terrestrial origin of the organic matter. The obtained values of vitrinite reflectance, Tmax, OEP27–31 and CPI25–33, along the cross plots of 20S/(20S + 20R) versus ββ/(ββ + αα) suggest that the samples are immature and were subjected to a low burial depth. The examined samples indicate accumulation in a delta-plain environment of deposition, under fluctuating oxic/anoxic conditions, in a humid climatic zone that is characterized by dry periods, interrupting the longer-termed humid climatic regime. This research adds knowledge on the source rock potential in the northern Sydney Basin and on the environmental and climatic setting of a time interval just prior to the major Permian - Triassic climatic crisis.

Addressing diagnostic uncertainty and excellence in emergency care—from multicountry policy analysis to communication practice in Australian emergency departments: a multimethod study protocol

IntroductionCommunication failings may compromise the diagnostic process and pose a risk to quality of care and patient safety. With a focus on emergency care settings, this project aims to examine...

Study protocol for the ROLEX-DUO randomised placebo-controlled trial: ROmosozumab Loaded with EXercise – DUal effects on bone and muscle in postmenopausal Osteoporosis and Osteopenia

IntroductionNovel strategies are needed to address the rising burden of osteoporosis and fragility fractures. High-intensity resistance and impact (HiRIT) exercise has shown benefit in improving bone density in postmenopausal women...

An audit for the inpatient management of patients with severe hypertension without acute end-organ damage at the Northern Sydney Local Health District.

Severe hypertension without acute end-organ damage is commonly encountered in inpatients. Despite this, there is a lack of international guidelines to manage this disorder. We conducted an audit to investigate the local practices within our health district. Current practices favour the use of rapidly acting antihypertensive drugs, which have been associated with iatrogenic injury.

Improving health system responses when patients are harmed: a protocol for a multistage mixed-methods study

IntroductionAt least 10% of hospital admissions in high-income countries, including Australia, are associated with patient safety incidents, which contribute to patient harm (‘adverse events’). When a patient is seriously harmed,...

Response to the detection of Rugonectria castaneicola and Rugonectria wingfieldii sp. nov. on Quercus in Australia.

Here we report on the detection and surveillance response to two Rugonectria species found in Sydney, Australia, in 2015. Both Rugonectria castaneicola and R. wingfieldii sp. nov. were found in association with cankers on Quercus robur (English oak). The fungi were initially found to be localised on amenity trees in northern Sydney, New South Wales, and as they were new detections for Australia, eradication was considered. Ongoing surveillance across the Sydney basin, regional New South Wales, and the Australian Capital Territory, however, indicated that they were already well established. Species identities were confirmed through morphological examination and molecular barcoding, with the subsequent analysis undertaken to classify R. wingfieldii sp. nov. This study provides the first records of Rugonectria found in association with canker on Oak trees in Australia. Citation: Trollip C, Carnegie AJ, Anderson C, Priest MJ, Gorrie B, Daly A (2024). Response to the detection of Rugonectria castaneicola and Rugonectria wingfieldii sp. nov. on Quercus in Australia. Fungal Systematics and Evolution 13: 123-130. doi: 10.3114/fuse.2024.13.06.

Data-driven collaborative QUality improvement in Cardiac Rehabilitation (QUICR) to increase program completion: protocol for a cluster randomized controlled trial

BackgroundCoronary heart disease (CHD) is the leading cause of deaths and disability worldwide. Cardiac rehabilitation (CR) effectively reduces the risk of future cardiac events and is strongly recommended in international clinical guidelines. However, CR program quality is highly variable with divergent data systems, which, when combined, potentially contribute to persistently low completion rates. The QUality Improvement in Cardiac Rehabilitation (QUICR) trial aims to determine whether a data-driven collaborative quality improvement intervention delivered at the program level over 12 months: (1) increases CR program completion in eligible patients with CHD (primary outcome), (2) reduces hospital admissions, emergency department presentations and deaths, and costs, (3) improves the proportion of patients receiving guideline-indicated CR according to national and international benchmarks, and (4) is feasible and sustainable for CR staff to implement routinely.MethodsQUICR is a multi-centre, type-2, hybrid effectiveness-implementation cluster-randomized controlled trial (cRCT) with 12-month follow-up. Eligible CR programs (n = 40) and the individual patient data within them (n ~ 2,000) recruited from two Australian states (New South Wales and Victoria) are randomized 1:1 to the intervention (collaborative quality improvement intervention that uses data to identify and manage gaps in care) or control (usual care with data collection only). This sample size is required to achieve 80% power to detect a difference in completion rate of 22%. Outcomes will be assessed using intention-to-treat principles. Mixed-effects linear and logistic regression models accounting for clusters within allocated groupings will be applied to analyse primary and secondary outcomes.DiscussionAddressing poor participation in CR by patients with CHD has been a longstanding challenge that needs innovative strategies to change the status-quo. This trial will harness the collaborative power of CR programs working simultaneously on common problem areas and using local data to drive performance. The use of data linkage for collection of outcomes offers an efficient way to evaluate this intervention and support the improvement of health service delivery.EthicsPrimary ethical approval was obtained from the Northern Sydney Local Health District Human Research Ethics Committee (2023/ETH01093), along with site-specific governance approvals.Trial registrationAustralian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12623001239651 (30/11/2023) (https://anzctr.org.au/Trial/Registration/TrialReview.aspx?id=386540&isReview=true).

Meniscal Transplant surgery or Optimised Rehabilitation full randomised trial (MeTeOR2): a study protocol

IntroductionPain and disability after meniscectomy can be a substantial lifelong problem. There are few treatment options, especially for young people. Non-surgical management (rehabilitation) is an option but increasingly surgeons are...

Rat lungworm, Cryptosporidium and other zoonotic pathogens of Rattus rattus and native wildlife on Sydney's Northern beaches

ABSTRACT Urbanisation is disrupting natural habitats and potentially causing spillover of zoonotic diseases from animals common in highly populated areas to natural environments and native wildlife. The black rat (Rattus rattus) is a common commensal species abundant in urban areas and nearby bushland in Australia and globally. It can be a major reservoir of pathogens and vectors for diseases that affect humans, pets, and wildlife. We examined pathogen prevalence in black rats and native wildlife in peri-urban northern Sydney. We trapped rats and native wildlife at eight 1-ha bushland sites and sampled for a range of internal pathogens from necropsied individuals (n=85 rats) and animal/trap swabs (n=54 native individuals). We detected a high prevalence of rat lungworm (Angiostrongylus spp.) in black rats (67%) as well as native wildlife including long-nosed bandicoots (Perameles nasuta; 43%; previously undetected) and bush rats (R. fuscipes; 33%). Incidence of detection tended to be more frequent where rat activity was greatest. Non-zoonotic Cryptosporidium spp. was also recorded in 17% of black rats and Salmonella spp. in 21% of bandicoots. Our findings suggest black rats may be facilitating spill-over of disease into native wildlife. The detected prevalence of Angiostrongylus spp. suggests an increasing occurrence in this natural system. These data provide valuable insight for disease management highlighting important reservoirs of disease which could be targeted to reduce disease burden in humans, pets, and wildlife.

Feasibility study comparing synthesized mammography with digital breast tomosynthesis and digital mammography for simulated first round screening in a single BreastScreen NSW centre.

While digital breast tomosynthesis (DBT) has proven to enhance cancer detection and reduce recall rates (RR), its integration into BreastScreen Australia for screening has been limited, in part due to perceived cost implications. This study aims to assess the cost effectiveness of digital mammography (DM) compared with synthesized mammography and DBT (SM + DBT) in a first round screening context for short-term outcomes. Clients recalled for nonspecific density (NSD) as a single lesion by both readers at the Northern Sydney Central Coast BreastScreen service in 2019 were included. Prior images were excluded to simulate first-round screening. Eleven radiologists read DM and synthesized mammography with DBT (SM + DBT) images 4 weeks apart. Recall rates (RR), reading time, and diagnostic parameters were measured, and costs for screen reading and assessment were calculated. Among 65 clients studied, 13 were diagnosed with cancer, with concordant cancer recalls. SM + DBT reduced recall rates (RR), increased reading time, maintained cancer detection sensitivity, and significantly improved other diagnostic parameters, particularly false positive rates. Benign biopsy recalls remained equivalent. While SM + DBT screen reading cost was significantly higher than DM (DM AU$890 ± 186 vs SM + DBT AU$1279 ± 265; P < 0.001), the assessment cost (DM AU$29,504 ± 9427 vs SM + DBT AU$18,021 ± 5606; P < 0.001), and combined screen reading and assessment costs were significantly lower (DM AU$30,394 ± 9508 vs SM + DBT AU$19,300 ± 5721; P = 0.001). SM + DBT screen reading and assessment of 65 patients resulted in noteworthy cost savings (AU$11,094), equivalent to assessing 12 additional clients. In first round screening, DBT yields significant cost savings by effectively reducing unnecessary recalls to assessment while maintaining diagnostic efficacy.

Antibiotics administered as continuous intravenous infusion over 24 hours by elastomeric devices to patients treated at home: a study of infusion efficiency

AbstractBackgroundElastomeric infusion devices or ‘Infusors’ are commonly used to administer 24‐h continuous intravenous infusions to hospital patients at home, a service which can increase hospital capacity.AimThis study sought to determine Infusor efficiency by measuring infusion lengths administered by Infusors to patients in the community setting and reviewing any impacting factors on varying infusion rates, if observed.MethodPatients and nurses completed data collection forms daily over a 12‐month period. The following information was recorded: time Infusor attached to patient, time Infusor emptied, Infusor ‘empty’ or ‘not empty’ when removed, volume of antibiotic solution remaining, Infusor storage details, antibiotic solution and dose, indication for treatment, and date (season). Statistical analyses was conducted using Stata. Data were analysed using descriptive statistics, including median and range for continuous variables, and frequency counts and percentages for categorical variables. Ethical approval was granted by Northern Sydney Local Health District (NSLHD) Research Office (Reference no: RESP/14/184), the Human Research Ethics Committee (HREC) (Reference no: LNR/14/HAWKE/265) and the study conforms to the Australian National Statement on Ethical Conduct in Human Research. Informed consent was obtained from all participants via a study information leaflet that was provided with the patient questionnaire and patients were informed that their participation in the study was optional. Patients indicated their consent by completing the data collection form for each day of treatment.ResultsA significant number of Infusors (27%) emptied outside the expected infusion duration of 24 h ± 10% (21.6–26.4 h) and Infusors were removed ‘not empty’ when the nurse visited &gt;24 h on 35% of occasions. Infusors were more likely to empty &gt;24 h if they contained piperacillin‐tazobactam 13.5 g (predicted probability = 1.0), in winter (predicted probability = 0.83), and in cooler overnight storage locations (predicted probability = 0.64). Infusors were more likely to empty &lt;24 h if they contained vancomycin (predicted probability = 0.12).ConclusionInfusors delivering 24‐h continuous intravenous infusions in the home setting may empty at unpredictable times and may be affected by temperature or solutions with varying doses. Outpatient parenteral antimicrobial therapy clinicians should be aware of possible unfinished infusions from Infusors.

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...

Provenance of a Late Permian retroarc foreland basin along the eastern Gondwanan margin: northern Sydney Basin, eastern Australia

Abstract The Upper Permian sedimentary successions in the northern Sydney Basin have been the subject of several stratigraphic, sedimentological and coal petrographic studies, and recently, extensive U-Pb zircon dating has been carried out on tuffs in the Newcastle Coal Measures. However, detailed petrographic and geochemical studies of these successions are lacking. These are important because a major change in tectonic setting occurred prior to the Late Permian because of the Hunter-Bowen Orogeny that caused the uplift of the Carboniferous and Devonian successions in the Tamworth Group and Tablelands Complex adjacent to the Sydney Basin. This should be reflected in the detrital makeup of the Upper Permian rocks. This study provides data that confirms major changes did take place at this time. Petrographic analysis indicates that the source area is composed of sedimentary, felsic volcanic and plutonic and low-grade metamorphic rocks. Conglomerate clast composition analysis confirms these results, revealing a source region that is composed of felsic volcanics, cherts, mudstones and sandstones. Geochemical analysis suggests that the sediments are geochemically mature and have undergone a moderate degree of weathering. The provenance data presented in this paper indicate that the southern New England Orogen is the principal source of detritus in the basin. Discrimination diagrams confirm that the source rocks derive from an arc-related, contractional setting and agree with the provenance analyses that indicate sediment deposition in a retroarc foreland basin. This study offers new insights on the provenance and tectonic setting of the Northern Sydney Basin, eastern Australia.

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...

Increasing prevalence of gonorrhoea and chlamydia among female sex workers in northern Sydney, 2005-2019.

Recent reports indicate increasing gonorrhoea and chlamydia among female sex workers (FSWs) in Australia, with decreasing condom use for oral sex. We determined trends in prevalence and positivity of gonorrhoea and chlamydia among FSWs attending our clinic from 2005 to 2019, by analysing data from medical and pathology records. We conducted a sensitivity analysis by using an alternative prevalence definition of first test result only per calendar year. Prevalence of gonorrhoea (all sites: pharynx, genital, rectal) increased from 1/130 (0.8%) in 2005 to 14/166 (8.4%) in 2012, to 31/257 (12.1%) in 2019; rate ratio (RR) 1.19, 95%CI 1.14-1.24, ptrend < 0.001. There were rising trends for pharyngeal (RR 1.11, 95% CI 1.05-1.17, ptrend = 0.001) and genital gonorrhoea (RR 1.17, 95% CI 1.08-1.26, ptrend < 0.001). Prevalence of chlamydia (all sites) increased from 4/130 (3.1%) in 2005 to 8/166 (4.8%) in 2012, to 20/257 (7.8%) in 2019; RR 1.05, 95%CI 1.01-1.09, ptrend = 0.006. This rise reflected predominately pharyngeal chlamydia (RR 1.16, 95%CI 1.04-1.29, ptrend = 0.004). Qualitatively similar trends with similar significant results, were seen for gonococcal and chlamydial infections in the sensitivity analyses, indicating robustness of results to potential changes in testing frequency. Gonorrhoea and chlamydia were significantly associated with FSWs born in China. Chlamydia was significantly associated with age group 18-25. In the 2015-2019 period, of 89 women with gonococcal infections, 56 (62.9%) were pharyngeal-only; of 93 with chlamydial infections, 32 (34.4%) were pharyngeal-only infections. FSWs require screening for pharyngeal as well as genital infections. Enhanced and sustainable health promotion is required.

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...