Western Australian Experience Research Articles

Offshore petroleum regulatory reform: the Western Australian experience—first 12 months in review

On 1 January 2012, a new regulatory framework for the offshore oil and gas industry in Australian Commonwealth waters started. The changes were profound and brought about a single national regulator for safety, environmental management, and well integrity. It also meant that the seven former designated authorities were abolished in favour of a single National Titles Administrator. In the lead up to the reforms, ministers Martin Ferguson and Frederick Moore agreed that officials from their respective departments would implement cooperative working arrangements for the WA adjacent offshore area, to facilitate and ensure a smooth transition for the industry and help achieve the recommendations of the Productivity Commission's review. The authors of this extended abstract reflect on and share the experiences of the past 12 months. An update of the authors' respective agencies' progress beyond the transition phase is also discussed. This extended abstract also outlines projects of interest and how they will benefit the industry and continue to develop the foundations of the cooperative working arrangements between NOPTA and WA-DMP. During the changes and transition program, industry and regulators have strived to engage in the new regime, and the results have been positive. Now is the opportunity for us to come together, ask questions, share information, and examine what has worked and what is yet to come. Several aspects of the arrangements are now evident: the establishment of the National Core Store and Data Repository, the establishment of the National Electronic Approvals and Tracking System (NEATS), and the day-to-day interactions between NOPTA and WA-DMP. The WA-DMP speaker reviews Joint Authority operations for the WA adjacent area since the establishment of NOPTA and NOPSEMA. Bill Tinapple also reviews regulatory framework developments for WA; in particular, changes to provide for shale and tight gas and oil activity, as well as, public engagement to increase confidence in regulatory processes. Coordination of regulatory processes across jurisdictional boundaries are reviewed, including case studies for Gorgon, Wheatstone, and Macedon.

Delayed diagnosis of developmental dislocation of the hip: the Western Australian experience

A delay in the diagnosis of developmental dislocation of the hip has many long-term consequences. This retrospective study was undertaken in order to establish an incidence of late-presenting developmental dislocation of the hip in Western Australia, and investigate possible causes for missed diagnoses. Data were collected retrospectively from 1 January to 31 December 2010. Theatre records were searched for operative descriptions including the words 'arthrogram hip', 'EUA hip', 'closed reduction hip', 'open reduction hip' and 'spica'. Medical records were checked to establish the demographic details and background history of cases identified. Delayed diagnosis of developmental dysplasia of the hip (DDH) was defined as a dislocated hip requiring operative reduction, diagnosed at age greater than 3 months. Seventeen children with 21 dislocated hips were identified. Age at diagnosis ranged from 6 months to 5 years. Girls accounted for 88.2% (15/17) and the left hip was involved two-thirds of the time (14/21). Bilateral dislocations were found in four children. This study has identified an incidence of late-presenting developmental hip dislocation of approximately three times the previously established rate. Possible reasons for this are explored. Additional retrospective audit is now underway, and changes are already in place to ensure that infants with DDH born in Western Australia are identified and treated as early as possible.

Outcomes of Chemoradiotherapy in Cervical Cancer—The Western Australian Experience

A retrospective review of patients with Stage IB1-IVA cervical cancer treated with combined chemoradiotherapy in Western Australia was conducted with the aim of assessing outcomes and patterns of recurrence. Multivariate analysis was performed to identify potential prognostic factors. Patients treated with radical chemoradiotherapy for cervical cancer in Western Australia between June 2005 and November 2008 were analyzed. Treatment consisted of external-beam radiotherapy with concurrent weekly cisplatin (40 mg/m(2)), followed by high-dose-rate brachytherapy. The Kaplan-Meier method was used to determine overall survival and disease-free survival, and Cox regression analysis was used to identify potential prognostic factors. Sixty-nine patients were included in the analysis. All patients completed external-beam radiotherapy; however, only 43.5% of patients completed the planned course of brachytherapy. At a median follow-up of 27 months, 24- and 48-month overall survival were 68.8% and 61.1%, respectively. Disease-free survival at 24 and 48 months was 59.4% and 56.7%, respectively. The 2-year local control rate was 70.1%. Nodal involvement resulted in increased risk of disease recurrence (hazard ratio [HR] 6.26, p= 0.002) and death (HR 5.15, p= 0.013). Pretreatment hemoglobin <120 g/L was a negative prognostic factor for disease recurrence (HR 4.20, p= 0.031) and death (HR 8.19, p= 0.020). Completion of brachytherapy improved overall survival (p= 0.039), with a trend to reducing disease recurrence (p= 0.052). The risk of relapse increased with treatment time over 8 weeks (HR 8.18, p= 0.019), however treatment time did not affect the risk of death (p= 0.245). The overall survival outcomes in this group of women with locally advanced cervical carcinomas treated with chemoradiotherapy are comparable to worldwide data. Despite the use of modern treatment protocols, a significant proportion of women developed locoregional recurrences and distant failures. Many poor prognostic factors have been identified as contributors to this, including pelvic nodal involvement, incomplete brachytherapy, pretreatment hemoglobin <120 g/L, and treatment time over 8 weeks.

Learning about knowledge management for improving environmental impact assessment in a government agency: The Western Australian experience

How does knowledge management (KM) by a government agency responsible for environmental impact assessment (EIA) potentially contribute to better environmental assessment and management practice? Staff members at government agencies in charge of the EIA process are knowledge workers who perform judgement-oriented tasks highly reliant on individual expertise, but also grounded on the agency’s knowledge accumulated over the years. Part of an agency’s knowledge can be codified and stored in an organizational memory, but is subject to decay or loss if not properly managed. The EIA agency operating in Western Australia was used as a case study. Its KM initiatives were reviewed, knowledge repositories were identified and staff surveyed to gauge the utilisation and effectiveness of such repositories in enabling them to perform EIA tasks. Key elements of KM are the preparation of substantive guidance and spatial information management. It was found that treatment of cumulative impacts on the environment is very limited and information derived from project follow-up is not properly captured and stored, thus not used to create new knowledge and to improve practice and effectiveness. Other opportunities for improving organizational learning include the use of after-action reviews. The learning about knowledge management in EIA practice gained from Western Australian experience should be of value to agencies worldwide seeking to understand where best to direct their resources for their own knowledge repositories and environmental management practice.

Optional inferior vena cava filter use in surgical patients: a Western Australian experience

The optional filter is gaining ground, supplementing anticoagulation in the management of venous thromboembolism (VTE) in high-risk surgical patients, this despite knowledge gaps relating to its efficacy. We studied the literature and audited our experience with inferior vena cava filters to educate ourselves on this mode of VTE prophylaxis, particularly its practical implications, if any, for the surgeon. A retrospective clinical study on inferior vena cava filter (IVCF)-related events in a Western Australian tertiary centre in 2008 was performed. Literature on IVCFs was reviewed. The 118 IVCF-related events at our centre in 2008, involved either Recovery-G2 75(88%) or Cook-Celect nine (11%). Of these, 78 were insertions and 36 were retrievals with four failed retrievals (10% of the attempts). Major indications for insertion included multi-trauma 32 (38%), prothrombotic state 29 (34%), head injury/intracranial bleeding 16 (19%) and others eight (9%). The mean dwelling time was 100 days (12–349 days). The mean age was 43 and the retrieval rate was 58%. Optional filters have presented both versatility and challenge to the management of VTE in high-risk patients. An underlying concern about the quintessential efficacy of IVCFs lingers on, while the impact of lost follow-ups in young patients is still at large. Class 1 studies on optional filters would add certainty to the use of this generation of filters, be a step forward in relevance from the seminal work of Decousus and garner the willingness needed to engage teamwork and institutional proactiveness against loopholes such as lost follow-ups that can undermine the portrayed benefits of a potentially lifesaving device.

Paired kidney donations to expand the living donor pool: the Western Australian experience

Falling numbers of deceased organ donors and longer kidney transplant waiting lists have increased the emphasis on live kidney donation to meet demand for kidney transplantation. Several new strategies have been introduced to expand live donation beyond the classic direct donation. These include: altruistic donation; paired kidney exchange (PKE); and altruistic donor chains programs. Using incompatible donor-recipient pairs and altruistic donors, the Western Australian PKE program achieved nine successful kidney transplantations between October 2007 and November 2008. If PKE were performed routinely in Australia, the rate of kidney transplants could increase by 7%-10%.

The Western Australian Experience with a Register of Atypical Antibodies.

Since 1980 a register of all blood donors and patients in Western Australia (WA) with clinically significant red cell and platelet antibodies has been maintained by the Blood Group Reference Laboratory, Australian Red Cross Blood Service (ARCBS)-Enterprise. The register is updated by ARCBS daily, and prior to 1999 a microfiche version was sent each month to WA transfusion laboratories. In 1999 ARCBS-Enterprise and the Health Department of WA (HDWA) explored the option of transfusion laboratories in public hospitals obtaining immediate electronic access to the register. A secure telnet radio-link was established between a dedicated stand-alone ARCBS server and the HDWA computer network which allowed password protected enquiry-only access to the database by hospital end-users. All end-users are required to sign an agreement to guarantee proper use of the register. The use of this comprehensive database has been successfully incorporated into the pre-transfusion testing protocols of all transfusion laboratories in WA. The benefits of this system include: • Reduced delay in obtaining phenotyped units for patients with known antibodies. • Reduced chance of delayed transfusion reactions in patients whose antibody level has fallen below detectable levels. • A mechanism for ante-natal monitoring and predicting severity of haemolytic disease of the newborn when patients move between care providers during the pregnancy. ARCBS-Enterprise and end-users are passionate about the continuation of this extremely important resource in the future.

Commentary on the Report of the Health Committee - Inquiry into the Provision of Ambulance Services in New Zealand

The content of this Inquiry has remarkable similarities to the Western Australian experience. As described in the executive summary, unlike most developed countries Western Australia has an ambulance service that are voluntary and contractual i.e. there is no regulation at a state level that refers to the provision of ambulance services or the standards of practice provided by the contract holders. In fact unlike other states that have government administered ambulance services, there is no legislation that refers to what constitutes an ambulance service or an ambulance officer/paramedic. 1

Factors affecting river health and its assessment over broad geographic ranges: The Western Australian experience

AusRivAS is an Australia-wide program that measures river condition using predictive models to compare the macroinvertebrate families occurring at a river site with those expected if the site were in natural condition. Results of assessment of 685 sites across all major rivers in Western Australia are presented. Most rivers were in relatively natural condition in the northern half of the state where the human population is low and pastoralism is the major land use. In the south, where the human population is higher and agriculture is more intensive, rivers were mostly more disturbed. AusRivAS assessment produced some erroneous results in rivers of the south-west cropping zone because of the lack of appropriate reference site groups and biased distribution of sampling sites. Collecting low numbers of animals from many forested streams, because of low stream productivity and samples that were difficult to sort, also affected assessments. Overall, however, AusRivAs assessment identified catchment processes that were inimical to river health. These processes included salinisation, high nutrient and organic loads, erosion and loss of riparian vegetation. River regulation, channel modification and fire were also associated with river degradation. As is the case with other assessment methods, one-off sampling at individual sites using AusRivAS may be misleading. Seasonal drought, in particular, may make it difficult to relate conditions at the time of sampling to longer-term river health. AusRivAS has shown river condition in Western Australia is not markedly different from other parts of Australia which, as a whole, lacks the substantial segments of severely degraded river systems reported in England.

The Western Australian experience of Integra ® use in paediatric patients 1996–2006

The Western Australian experience of Integra ® use in paediatric patients 1996–2006

Breast-Conserving Surgery Versus Mastectomy for Survival from Breast Cancer: the Western Australian Experience

The focus of this study was the relative survival rates of breast cancer patients whose treatment was breast-conserving surgery compared with that of mastectomy, adjusting for tumor size and nodal status because these factors may be intrinsically associated with mastectomy being the treatment of choice. Patient age was also accounted for in the model. By adjusting for these factors, we mitigate them as confounders of treatment choice in assessing effects on survival rates. Data were sourced from linked administrative data from the Western Australian Department of Health Record Linkage Unit. The data consisted of linked records containing the diagnosis, subsequent hospital admission, and death records of about 3000 women diagnosed with cancer in Western Australia between 1 January 1995 and 31 December 1999. Cox proportional hazards regression was used to investigate survival outcomes of breast-conserving surgery compared with that of mastectomy, adjusting for tumor size, nodal status, and subject age. The hazard of death is reduced by a factor of about one half for subjects whose treatment was breast-conserving surgery over treatment by mastectomy. Furthermore, the hazard of death increases substantially for subjects with nodal involvement over subjects for whom there has been no identified spread to regional lymph nodes. Hazard of death increases as both age and tumor size increase. Western Australian breast cancer patients treated with breast-conserving surgery have improved survival outcomes over those treated with mastectomy, after allowing for tumor size, patient age, and lymph node involvement.

2004 Lowbury Lecture: the Western Australian experience with vancomycin-resistant enterococci – from disaster to ongoing control

The first hospital outbreak of a vancomycin-resistant enterococcus (VRE) in Western Australia (WA) started in the Royal Perth Hospital in July 2001 and initially involved the Intensive Care Unit (ICU) and the Nephrology and Dialysis Units. The outbreak was caused by vancomycin-resistant Enterococcus faecium (VREF) of the vanB genotype. Pulsed-field gel electrophoresis and plasmid analysis of the isolates demonstrated a single-strain outbreak. Despite the isolation of carriers and implementation of all the additional precautions recommended to control VRE, VREF spread rapidly. Two months after the index patient was detected, the epidemic strain had spread to 22 wards and units and one outpatient unit (Satellite Dialysis). Four patients were infected and 64 were colonized. A Hospital VRE Executive Group, which included the Chief Executive and Directors of Clinical Services and Nursing, was formed to eradicate the outbreak and to prevent the epidemic strain from becoming endemic in the hospital. The WA Department of Health agreed to provide substantial extra funding to enable the hospital to use expensive enhanced infection control practices, as follows. Control was handicapped by the slowness of conventional laboratory methods, which took four to five days to identify VRE and allowed environmental contamination and nosocomial transmission to occur before carriers were detected and isolated. A laboratory procedure to make rapid provisional identification of VRE within 30-48h was developed by performing multiplex polymerase chain reaction (PCR) for vanA and vanB genes directly on 24-h selective enrichment broth cultures. On average, four rectal swabs, each collected on separate days, were needed to detect >90% of carriers. In total, 1977 ward contacts were screened after discharge from hospital and 54 (2.73%) were found to be carrying VREF. The electronic labelling and active follow-up of ward contacts resulted in a significant number of carriers being detected who otherwise posed a risk of initiating further outbreaks in hospital if they were re-admitted. The outbreak was terminated after five months and the cost of the enhanced infection control practices was 2,700 000 Australian dollars (1,000,000 pounds sterlings). Ongoing control has been facilitated by targeted active surveillance cultures: on admission to high-risk units (ICU, Burns, Nephrology, Haematology, Bone Marrow Transplant Unit), on transfer out of the ICU to other hospital units, by monthly screening of patients regularly attending Dialysis Units, and by opportunistic laboratory screening of inpatient faecal specimens submitted for Clostridium difficile culture and toxin. Vigilance needs to be maintained as the epidemic strain of VREF remains in the Perth community. Ward contacts of the first outbreak have caused small outbreaks in two hospitals, and seven to 19 sporadic new carriers have been detected annually since the first outbreak. The key elements of the VRE control programme are as follows: To date, this programme has prevented VRE from becoming established in any WA hospital.

Is Surgical Ligation of Patent Ductus Arteriosus Necessary: The Western Australian Experience of Conservative Management

Is Surgical Ligation of Patent Ductus Arteriosus Necessary: The Western Australian Experience of Conservative Management

Long-term effects of the Meniett device in Ménière’s disease: the Western Australian experience

Transtympanic pressure has been shown to influence endolymphatic hydrops. As endolymphatic hydrops plays a key role in Ménière's disease, a few studies, undertaken by the inventors, manufacturers and associates of the Meniett device, have demonstrated positive short-term effects of transtympanic pressure treatment via the Meniett device in medically intractable Ménière's disease. The aim of our study was to independently investigate the long-term efficacy and safety of transtympanic pressure treatment in the management of recalcitrant vertigo in Ménière's disease. Cross-sectional case study. Tertiary referral centre. Eighteen patients with Ménière's disease, suffering from medically intractable symptoms. All patients in the study had Ménière's disease according to the criteria of the Committee on Hearing and Equilibrium of the American Academy of Otolaryngology, Head & Neck Surgery. Outcome and severity of symptoms were assessed, using the six-point functional scale and the vertigo visual analogue scale (VAS), as recommended by the Committee on Hearing and Equilibrium of the American Academy of Otolaryngology, Head & Neck Surgery. Changes of pure tone average thresholds and vestibular calorics before and during treatment with the Meniett device were recorded. The mean follow-up time was 18 months. Twelve out of 18 patients showed significant improvement in the functional score and in the VAS. Five patients displayed an audiometric improvement, out of which three patients showed a pertaining significant hearing gain of more than 10 dB; the remainder had stable hearing levels. Of six patients without any improvement, four had previous invasive surgery for their Ménière's disease and two had previous vestibular ablation with gentamicin. No changes in vestibular function were noted. There were no complications during the treatment with the Meniett device. According to this independent study, the Meniett device seems to be a minimally invasive, non-destructive treatment tool, which can reduce vertigo and associated functional handicap in Ménière's disease. These effects are maintained up to 18 months after treatment so far. Previous surgical or chemical vestibular ablation procedures may adversely influence the effect of the Meniett device.

Is surgical ligation of patent ductus arteriosus necessary? The Western Australian experience of conservative management

Background: Surgical ligation of patent ductus arteriosus (PDA) is widely practised in preterm infants despite no clear evidence that this improves outcomes. Geographical isolation meant that ductal ligation was not...

241 Patent Ductus Arteriosus – Is Surgical Ligation Necessary? The Western Australian Experience

Patent ductus arteriosus (PDA) with a significant left-right shunt is associated with chronic lung disease (CLD), intraventricular haemorrhage (IVH) and necrotising enterocolitis (NEC). Surgical ligation is reserved for PDA refractory to medical treatment, however there is no clear evidence that this improves outcome. WCHS is the only tertiary perinatal/paediatric centre in Western Australia. Geographical isolation from the nearest cardiac surgical centre (3,500kms) has meant that ductal ligation has not been an option until recently. A retrospective data analysis was undertaken to test the hypothesis that outcomes of infants with persistent PDA were no worse than that of those with a closed duct. Patients and Methods: Infants born 1.4 or a ductal diameter of > 1.5 mm with a left-to-right shunt. Continuous data is summarised as median (IQR) and analysed with Mann-Whitney and Kruskal-Wallis tests. Duration of ventilation, oxygen and hospital stay were estimated using Kaplan-meier probability estimates and analysed using Cox proportional hazards regression model Results Total 284 infants <28 weeks gestation were included and 32 excluded. Twenty-four (10%) infants died at median (IQR) 15.5 (9–35) days. Relative to Group 1, the infants in Group 3 were at increased risk of death (adjusted OR = 4.01 (95% CI 1.12–14.51) p= 0.033). Deaths: Group1= 6/154; Group2= 7/65; Group3: deaths= 11/33. There was no significant difference between groups in the incidence of CLD, CLD or death, NEC, IVH, duration of oxygen or hospital stay but duration of ventilation tended to be longer in Group 3 (adjusted HR 0.66 (95% CI 0.41–1.06) p=0.082.

The Health Information Manager in a Division of General Practice: A Western Australian Experience.

The Health Information Manager in a Division of General Practice: A Western Australian Experience.

The Renewable Portfolio Standard in Western Australia — Performance in the Face of Institutional Constraints

The Renewable Portfolio Standard (RPS) is a popular method of increasing the portion of renewable energy generation in electricity supplies. The Australian Federal Government introduced a RPS that, in addition to accelerating the uptake of renewable energy, is designed to provide an ongoing base for the development of commercially competitive renewable energy and contribute to the development of an internationally competitive renewable energy industry. The design parameters of the RPS and the existing electricity market framework within which it operates are important considerations in determining the success of this policy initiative in meeting all its objectives. On the basis of the Western Australian experience, this paper argues that while conceptually the RPS may be a useful tool for increasing the portion of electricity generated by renewable resources, and supporting the development of a competitive renewable energy industry, its effectiveness depends upon the policy framework within which it operates.

The Western Australian Experience of the Use of en Bloc Resection of Ovarian Cancer with Concomitant Rectosigmoid Colectomy

Objectives. The aim of this study was to assess the technique of en bloc resection of ovarian cancer with concomitant rectosigmoid colectomy, in relation to perioperative complication rates, and its impact on survival following the procedure.Methods. A retrospective review was performed of the case notes of 129 consecutive procedures performed between 1989 and 2000 in a regional cancer center.Results. Overall, 48.8% of patients suffered a major or minor complication. Complications relating to bowel anastomosis occurred in 2.4%. Perioperative mortality was 3.1%. Median survival for the group as a whole was 30.6 months. Patients who were optimally debulked had a significantly longer median survival time.Conclusion. En bloc resection of ovarian cancer with concomitant rectosigmoid colectomy allows a high rate of optimal debulking with acceptable morbidity, mortality, and survival.

564 Outcome of prenatally diagnosed congenital cystic adenomatoid malformation: The contemporary western Australian experience

564 Outcome of prenatally diagnosed congenital cystic adenomatoid malformation: The contemporary western Australian experience