WA Health Research Articles

Towards bloodless surgery?

There is emerging evidence that blood transfusion is an independent risk factor for adverse patient outcomes, and a lack of evidence for benefit of transfusion in many clinical settings. The launch of the new NHMRC endorsed Patient Blood Management Guidelines for Management of Critical Bleeding and Peri-operative Care from the National Blood Authority encourages clinicians to shift from a focus on product use to a patient orientated approach that seeks to make the best use of all treatment options in the management of the patient’s own blood reserves. WA Health has been promoting this shift in emphasis through a statewide Patient Blood Management (PBM) Program since 2008. This presentation will focus on the perioperative initiatives developed at the Fremantle Hospital and Health Service, the leading site for the WA PBM project. Program initiatives at the hospital will be discussed and the integration of the program across the State will be addressed. The important role of international partnering clinicians and hospitals and the use of the international faculty in the project will be outlined. Critical opportunities and prospects for pathology providers to enhance and facilitate the effective implementation of PBM in Australia will be considered.

Clinical Judgment More Accurate Than CHALICE in Kids With Head Injury

Clinical decision rules can help to determine the need for CT imaging in children with head injuries. We aimed to validate three clinical decision rules (PECARN, CATCH, and CHALICE) in a large sample of children.In this prospective observational study, we included children and adolescents (aged <18 years) with head injuries of any severity who presented to the emergency departments of ten Australian and New Zealand hospitals. We assessed the diagnostic accuracy of PECARN (stratified into children aged <2 years and ≥2 years), CATCH, and CHALICE in predicting each rule-specific outcome measure (clinically important traumatic brain injury [TBI], need for neurological intervention, and clinically significant intracranial injury, respectively). For each calculation we used rule-specific predictor variables in populations that satisfied inclusion and exclusion criteria for each rule (validation cohort). In a secondary analysis, we compiled a comparison cohort of patients with mild head injuries (Glasgow Coma Scale score 13–15) and calculated accuracy using rule-specific predictor variables for the standardised outcome of clinically important TBI. This study is registered with the Australian New Zealand Clinical Trials Registry, number ACTRN12614000463673.Between April 11, 2011, and Nov 30, 2014, we analysed 20 137 children and adolescents attending with head injuries. CTs were obtained for 2106 (10%) patients, 4544 (23%) were admitted, 83 (<1%) underwent neurosurgery, and 15 (<1%) died. PECARN was applicable for 4011 (75%) of 5374 patients younger than 2 years and 11 152 (76%) of 14 763 patients aged 2 years and older. CATCH was applicable for 4957 (25%) patients and CHALICE for 20 029 (99%). The highest point validation sensitivities were shown for PECARN in children younger than 2 years (100·0%, 95% CI 90·7–100·0; 38 patients identified of 38 with outcome [38/38]) and PECARN in children 2 years and older (99·0%, 94·4–100·0; 97/98), followed by CATCH (high-risk predictors only; 95·2%; 76·2–99·9; 20/21; medium-risk and high-risk predictors 88·7%; 82·2–93·4; 125/141) and CHALICE (92·3%, 89·2–94·7; 370/401). In the comparison cohort of 18 913 patients with mild injuries, sensitivities for clinically important TBI were similar. Negative predictive values in both analyses were higher than 99% for all rules.The sensitivities of three clinical decision rules for head injuries in children were high when used as designed. The findings are an important starting point for clinicians considering the introduction of one of the rules.National Health and Medical Research Council, Emergency Medicine Foundation, Perpetual Philanthropic Services, WA Health Targeted Research Funds, Townsville Hospital Private Practice Fund, Auckland Medical Research Foundation, A + Trust.

WA health practitioners and cooking: How well do they mix?

AbstractAim: The aim of the present study was to assess the views and experiences of WA practitioners on the use of cooking as a public health nutrition intervention.Methods: A 39‐point online questionnaire was constructed using Survey Monkey. The questionnaire was distributed via email distribution lists targeting practitioners working in public health nutrition. Questions were focused around four objectives relating to: the value of cooking skills in public health, practitioner cooking skills and training, practitioner views on cooking as a health intervention and practitioner experiences in conducting cooking demonstrations.Results: A total of 84 practitioners completed the questionnaire, of which over half (58%) were employed in dietetic specific positions at the time of the survey. There was overwhelming agreement that cooking skills are an important factor in the prevention of nutrition‐related disease, and that cooking skill interventions have the potential to change dietary intakes. However, only one quarter of practitioners indicated that cooking skill interventions were a significant part of their current role. Over half (58%) of the practitioners surveyed had either conducted or assisted in a cooking demonstration or cooking class in the last 12 months.Conclusions: WA practitioners place a high value on the use of cooking as a public health nutrition intervention. Practitioners felt they have good knowledge and skills in cooking but indicated the need to know more about conducting cooking skill interventions. The findings suggest the need to improve outcome evaluation as a component of cooking skill interventions to assess long‐term behaviour change.

Cost-Shifting of Dialysis Treatment in Western Australia: Winners and Losers

The process of cost-shifting occurs when surplus revenues from one set of services are used to subsidise another set of services or patient group. In Western Australia the call for increased home dialysis in order to reduce the pressure on the WA health system has been suggested to reduce the burden on hospitals. However, when consideration is given to the increased probability of PD peritonitis (especially among the indigenous population), it is possible that hospitalisation rates may increase, offsetting some of the reduced burden. The privatisation of home dialysis in 2006 created divided treatment regimes for dialysis patients such that this group is disadvantaged when they require hospitalisation for any reason, due to the privatisation of PD nurses and resources. Cost-shifting creates winners and losers, therefore, because it will increase rents to the private company that is the monopoly provider of home dialysis equipment and consumables, while reducing the quality of overall care for PD patients in hospitals.

Pandemic (H1N1) 2009 influenza vaccination coverage in Western Australia

To assess pandemic (H1N1) 2009 influenza vaccination coverage in Western Australians, up to 31 January 2010. Vaccination data for Western Australians aged 10 years and older were obtained from two sources: the WA Pandemic Influenza Vaccination Database (PIVD; which collected reports of pandemic influenza vaccinations from vaccination providers statewide) for the period 30 September 2009 to 31 January 2010, and the WA Health and Wellbeing Surveillance System (HWSS; a continuous population-based telephone survey) for the period 1 December 2009 to 31 January 2010. Data from the PIVD was used to input vaccination coverage estimates for at-risk subpopulations not assessed in the HWSS interviews. Vaccination coverage of Western Australians aged 10 years and older and of subgroups targeted by the national pandemic (H1N1) 2009 influenza vaccination campaign. A total of 171,789 pandemic influenza vaccinations were reported to the PIVD by 31 January 2010 and 88% of these were administered by 1 December 2009. Based on HWSS data, vaccination coverage of persons aged 10 years and older was 14.5% (95% CI, 12.6%-16.6%) and of persons aged 18 years and older was 15.3% (95% CI, 13.3%-17.6%). Based on PIVD data, coverage in adults ranged from 10.3% in pregnant women to 52.8% in health care workers. Our estimate of pandemic influenza vaccination coverage in the adult population of WA is comparable to the national estimate of 19%, but it did not reach levels considered sufficient to interrupt community transmission. Future influenza vaccination programs should target groups at increased risk of severe influenza, such as pregnant women.