Western Australian Experience Research Articles

Informing the management of the post-COVID condition: insights from the Western Australian experience comparing those who tested positive and negative to early COVID-19 strains.

ObjectiveThis study aimed to compare the relative physical recovery and symptoms after SARS-CoV-2 infection between groups confirmed positive or negative to early strains of COVID-19.MethodsA prospective, longitudinal cohort study compared outcomes of metropolitan adults polymerase chain reaction-tested for COVID-19 between March and November 2020 in Western Australia. Control matching was attempted: inpatients (gender, age) and ambulatory clinic (gender, age, asthma, chronic pulmonary disease). One-year follow-up involved three repeated measures: physical function (grip strength and 1-min sit-to-stand) and patient-reported outcomes (Fatigue Severity Scale, modified Medical Research Council dyspnoea scale and Euroqol-5D-5L).ResultsThree hundred and forty-four participants were recruited (154 COVID+, age 54±18years, 75 females [49%]); 190 COVID-, age 52±16years, 67 females [35%]) prior to national vaccination roll-out. No between-group differences in physical function measures were evident at any time point. Fatigue (OR 6.62, 95% CI 2.74-15.97) and dyspnoea (OR 2.21, 95% CI 1.14-4.30) were higher in the COVID+ group at second assessment (T2). On Euroqol-5D-5L, no between-group differences were evident in the physical function domains of self-care, mobility or usual activities at any time point. However, COVID+ participants were less likely to report an absence of anxiety or depression symptoms at T2 (OR 0.41, 95% CI 0.19-0.89).ConclusionsNeither statistical nor clinically meaningful differences in physical function were evident between COVID+ and COVID- participants to 12-months after acute illness. Symptoms of fatigue, dyspnoea, anxiety or depression were more prevalent in the COVID+ group til ~8months after illness with between-group differences no longer evident at 1 year.

Management of Cardiometabolic Risk Factors in Heart Transplant Recipients: The Western Australian Experience

Management of Cardiometabolic Risk Factors in Heart Transplant Recipients: The Western Australian Experience

Collecting routine and timely cancer stage at diagnosis by implementing a cancer staging tiered framework: the Western Australian Cancer Registry experience

BackgroundCurrent processes collecting cancer stage data in population-based cancer registries (PBCRs) lack standardisation, resulting in difficulty utilising diverse data sources and incomplete, low-quality data. Implementing a cancer staging tiered framework aims to improve stage collection and facilitate inter-PBCR benchmarking.ObjectiveDemonstrate the application of a cancer staging tiered framework in the Western Australian Cancer Staging Project to establish a standardised method for collecting cancer stage at diagnosis data in PBCRs.MethodsThe tiered framework, developed in collaboration with a Project Advisory Group and applied to breast, colorectal, and melanoma cancers, provides business rules – procedures for stage collection. Tier 1 represents the highest staging level, involving complete American Joint Committee on Cancer (AJCC) tumour–node–metastasis (TNM) data collection and other critical staging information. Tier 2 (registry-derived stage) relies on supplementary data, including hospital admission data, to make assumptions based on data availability. Tier 3 (pathology stage) solely uses pathology reports.FindingsThe tiered framework promotes flexible utilisation of staging data, recognising various levels of data completeness. Tier 1 is suitable for all purposes, including clinical and epidemiological applications. Tiers 2 and 3 are recommended for epidemiological analysis alone. Lower tiers provide valuable insights into disease patterns, risk factors, and overall disease burden for public health planning and policy decisions. Capture of staging at each tier depends on data availability, with potential shifts to higher tiers as new data sources are acquired.ConclusionsThe tiered framework offers a dynamic approach for PBCRs to record stage at diagnosis, promoting consistency in population-level staging data and enabling practical use for benchmarking across jurisdictions, public health planning, policy development, epidemiological analyses, and assessing cancer outcomes. Evolution with staging classifications and data variable changes will futureproof the tiered framework. Its adaptability fosters continuous refinement of data collection processes and encourages improvements in data quality.

Young adult outcomes following premature birth: A Western Australian experience

BackgroundChildhood outcomes following preterm birth are widely published, however long-term adult outcomes are less well described. We aimed to determine the quality of life and burden of co-morbidities experienced by preterm-born young adults in Western Australia. MethodsA retrospective observational study was conducted. Participants born at 23–33 weeks gestation cared for at King Edward Memorial Hospital during 1990 and 1991 were recruited from a historical birth cohort. Participants completed general, medical and reproductive health questionnaires. Results were compared with contemporaneous cohort data and/or population statistics. ResultsQuestionnaires were received from 73 young adults aged 28 to 30 years. The majority of respondents completed high school (94.5 %), were employed fulltime (74.0 %) and had close friends and family relationships. Almost all the participants considered their health to be good (94.0 %) and participated in light exercise (90.0 %). Increased hypertension, hypercholesterolaemia, asthma, neuropsychiatric conditions and visual impairment were reported. Depression Anxiety and Stress Scale (DASS-21) scoring identified increased mild anxiety. Increased consultation with healthcare workers and use of prescription medications were reported. ConclusionThe group of preterm-born adults surveyed reported a good quality of life, supportive interpersonal relationships and they provided significant contributions to society. They did report increased medical and psychological conditions than the general population.

The Western Australian experience of COVID-19 after the borders reopened: evaluation of public health modelling predictions.

Western Australia (WA) serves as a unique global case study on the impact of coronavirus disease 2019 (COVID-19) on an isolated, prepared and highly vaccinated population. This study builds upon the study performed by House et al. through an extended data set. To examine the impact of COVID-19 at the only quaternary hospital in WA following the border opening from 3 March to 17 July 2022. A total of 257 adults were admitted with COVID-19 under either respiratory or the intensive care unit (ICU). Admission numbers, disease severity, ICU admission, prevalence of COVID-19 deterioration risk factors, length of stay and mortality. A total of 257 patients were admitted with COVID-19, under respiratory (81.7%) and ICU (18.3%). COVID-19 was the primary reason for admission for 67.7%. Ten patients died during the study, with seven deaths attributed to COVID pneumonitis. COVID-19 severity was 37.4% mild, 37.0% moderate, 18.3% severe and 7.4% critical. Risk factors for requiring ICU included incomplete immunisation status (P = 0.011), chronic kidney disease (P = 0.008) and Aboriginal and Torres Strait Islander (ATSI) ethnicity. The WA Department of Health predicted that the number of hospitalisations and ICU cases were significantly higher than the actual number of cases. The number of hospitalisations and ICU COVID-19 cases were significantly less than predicted, likely due to high population vaccination rates prior to border opening. The main risk factors for COVID-19 severity were incomplete immunisation and ATSI ethnicity.

Left ventricular assist devices for treatment of refractory advanced heart failure: the Western Australian experience.

Left ventricular (LV) assist devices (LVADs) can prolong survival and improve quality of life in end-stage heart failure. Review outcomes of the Western Australian LVAD programme. Retrospective database and medical record review. One hundred forty-seven LVADs have been implanted in 23 years, of which 95 were newer-generation devices (HeartWare HVAD [HW], HeartMate II and HeartMate 3). Presented data refer to these devices only. Most patients (94%) were classed as bridge-to-transplant or -candidacy/decision, with the remainder classed as 'destination therapy' (DT). Mean LV ejection fraction was 20%, and 36% had severe right ventricular dysfunction. Sixty-two percent of patients had a nonischaemic cardiomyopathy. Following LVAD implant, the median length of stay in intensive care was 2 days, and in the hospital overall was 23 days. Ninety-six percent of patients survived to hospital discharge, and, following discharge, 98% of days with LVAD were spent as an outpatient. The median number of hospital readmissions was 1.5 per patient per year. LVAD-associated infection requiring admission or intravenous antibiotics at any time after implant occurred in 36%, significant gastrointestinal bleeding in 19% and stroke in 11%. The percentage of patients alive with LVAD still in situ at 1, 2 and 5 years was 94%, 88% and 62% respectively, which exceeds current international registry outcomes. All DT patients survived at least 4 years, spending 97% of days with LVAD as an outpatient. The two longest-surviving HW DT patients worldwide (11.3 and 10.5 years) are among this cohort. Excellent outcomes can be achieved with LVADs in appropriately selected patients.

Long term outcomes of hepatic resection: A western australian experience

Long term outcomes of hepatic resection: A western australian experience

Mechanical Versus Bioprosthetic Aortic Valve Replacement in Middle-Aged Adults: Western Australian Experience

Selection of the type of prosthesis for middle-aged patients undergoing aortic valve replacement (AVR) is complex, where several patient and prosthesis factors must be considered. A large cohort of Western Australian (WA) patients undergoing AVR was studied and long-term survival between patients receiving bioprosthetic valves (BV) and mechanical valves (MV) was compared.

Total neoadjuvant therapy for locally advanced rectal cancer: A western Australian experience.

e15582 Background: Despite the widespread application of standard chemoradiotherapy (CRT) followed by total mesorectal excision with adjuvant chemotherapy, the mortality reduction for locally advanced rectal cancer (LARC) has slowed in recent years. Total neoadjuvant therapy (TNT) is a novel therapeutic strategy in LARC which incorporates both systemic chemotherapy and neoadjuvant CRT prior to surgery. Recent studies have associated TNT with better treatment adherence, decreased toxicity, improved complete clinical response and anal sphincter preservation rates. However, real-world experience with TNT in the management of LARC remains limited. Methods: Records from patents with LARC who underwent TNT at two oncology centres in Western Australia since 2018 were screened. Patient demographics, diagnostic workup, treatment regimens, surgical, pathological reports, post-operative surveillance scans and adverse effects’ documentation were reviewed. TNT regimens included neoadjuvant chemotherapy (NAC) with oxaliplatin in combination with either 5-FU (FOLFOX) or capecitabine (CAPOX) with chemoradiation given prior or after NAC, which is then followed by surgery. Patients who had radiological complete response (rCR) were given the option of “watch and wait (W&W)” instead of proceeding to surgery. Outcomes assessed included radiological complete response (rCR), pathological complete response (pCR) rate, proportion of patients with progressive disease, type of surgery, rate of R0 resection, proportion of patients who completed planned cycles of chemotherapy and radiotherapy and treatment-related adverse effects. Results: 29 patients with LARC have thus far have completed TNT followed by surgery. The mean age was 59 years (range 34-84), 58% and 42% of patients were male and female respectively. 11 (38%), 16 (55%) and 2 (7%) patients were ECOG 0, 1 and 2 respectively. The majority of patients were stage 3 (90%), with the remaining 3 patients at stage 1, 2 and 4 at time of presentation. 3 (10%) and 7 (24%) patients had pCR and rCR respectively, of which 4 opted for W&W approach. Treatment was well-tolerated with 86% and 96% of patients completing the planned total course of chemotherapy and radiotherapy respectively although dose reductions and/or delay were required for many. Common adverse effects included neuropathy, neutropenia, anaemia and fatigue, most of which were grade 1. Of the 22 patients who underwent surgery, 19 (82%) and 4 (18%) patients had R0 resection and R1 resection respectively. Majority of the patients who underwent surgery had an anterior resection with temporary loop ileostomy (64%) while the remaining had an abdominoperineal resection (36%). After a median follow up time of 27 months, 10 (34%) patients had progressive disease. Conclusions: TNT is a well-tolerated, effective and promising strategy for the management of LARC. Further data is needed to determine the standard TNT protocol.

The Frozen Elephant Trunk Technique With the Thoraflex Device: A Western Australian Experience

The frozen elephant trunk (FET) technique has enabled synergy between cardiac and vascular surgery in the operative management of aortic disease in the arch and into the descending thoracic aorta. Its best usage in clinical practice is still being established.

Vacuum-assisted excision biopsy for definitive diagnosis of breast lesions of uncertain malignant potential (B3 lesions) on core biopsy - A single centre Western Australian experience.

In Australia, the usual approach to breast lesions where core biopsy returns an uncertain result ("B3" breast lesion) is to perform surgical diagnostic open biopsy (DOB). This is associated with patient time off work, costs of hospital admission, risks of general anaesthesia and surgical complications. The majority of B3 lesions return benign results following surgery. Vacuum assisted excision biopsy (VAEB) is a less invasive, lower cost alternative, and is standard of care for selected B3 lesions in the United Kingdom. Similar use of VAEB in Australia, could save many women unnecessary surgery. The aim of this study was to document our experience during the introduction of VAEB as an alternative to DOB for diagnosis of selected B3 lesions. The multidisciplinary team developed an agreed VAEB pathway for selected B3 lesions. Technically accessible papillary lesions, mucocele-like lesions and radial scars without atypia measuring ≤ 15mm were selected. Over a 7 month period, 18 women with 20 B3 lesions were offered VAEB. 16 women (18 lesions) chose VAEB over DOB. Papillomas were the commonest lesion type. All lesions were successfully sampled: 17/18 were benign. One lesion (6%) was upgraded to malignancy (ductal carcinoma insitu on VAEB, invasive ductal carcinoma at surgery). No major complications occurred. Patient satisfaction was high: 15/16 respondents would again choose VAEB over surgery. VAEB is a patient-preferred, safe, well-tolerated, lower-cost alternative to DOB for definitive diagnosis of selected B3 breast lesions.

Neonatal Staphylococcus Aureus Sepsis: a 20-year Western Australian experience

ObjectivesThe purpose of this study was to characterise neonatal Staphylococcus aureus (SA) sepsis in Western Australia (WA) between 2001 and 2020 at the sole tertiary neonatal intensive care unit (NICU), examine risk factors for sepsis in the cohort, and compare short- and long-term outcomes to control infants without any sepsis.MethodsRetrospective cohort study at the Neonatal Directorate at King Edward Memorial Hospital (KEMH) and Perth Children’s Hospital, using electronic databases and patient medical records.ResultsThe overall incidence of SA sepsis was 0.10 per 1000 live births (62/614207). From 2001 to 2010 the incidence was 0.13/1000 live births, reducing to 0.07/1000 live births from 2011 to 2020. SA was most frequently isolated from endotracheal aspirates, and infants with SA sepsis had longer median duration of ventilatory support than those without any sepsis (31 days vs 18 days respectively, p < 0.001). In our cohort, SA sepsis was associated with worse neurodevelopmental outcomes compared to infants without any sepsis.ConclusionsThe incidence of neonatal SA sepsis has reduced over the last 20 years, suggesting potential effectiveness of the preventative interventions implemented. Endotracheal tube (ETT) colonisation and prolonged ventilation may be under-recognised as potential sources of SA infection. Our study suggests SA sepsis may negatively impact neurodevelopmental outcomes.

LVADs: The Western Australian Experience

<h3>Purpose</h3> Review outcomes of the Western Australian (WA) LVAD program. <h3>Methods</h3> Retrospective review of medical records and local databases. <h3>Results</h3> In 23 years, 140 LVADs (no RVAD/BIVADs) have been inserted in WA: 46 HeartWare HVAD (HW), 26 HeartMate III (HM3), 16 HeartMate II (HM2), and 52 earlier generation devices. Abstract data refers to HW/HM2/HM3. Insertion indications were non-ischaemic cardiomyopathy (60%) and ischaemic (40%). 89% were inotrope dependant pre-implant, with median LV ejection fraction 20%. 34% had severe right ventricular (RV) dysfunction on echo, and on right heart catheterisation median cardiac index was 1.7L/min/m². We aggressively and pre-emptively manage for RV failure (RVF): early RVF (requirement for inotropes >14 days) occurred in only 7% and no patients required RVAD. 64% received ≥5 days of early inhaled pulmonary vasodilators, and 88% were discharged on sildenafil (median daily dose 150mg). Median ICU length of stay (LOS) was 2 days. 95% of patients survived to hospital discharge (median LOS 23 days). Following discharge, median percentage of days with LVAD spent as an outpatient was 98%, and median number of hospital readmissions was 1.8 per patient years. LVAD-associated infection requiring admission or intravenous antibiotics occurred in 36%, gastrointestinal bleeding in 16%, and stroke in 11%. The percentage of patients alive with LVAD at 1, 2, and 5 years was 93%, 87%, and 63%, respectively, which betters current international INTERMACS survival. 93% of patients were implanted as bridge-to-transplant/candidacy, with median transplant wait time 9 months. Of our six destination therapy patients there have been no deaths before 5 years, and our centre holds the world record for the 2 longest surviving HW patients at 11.3 and 10.5 years. All aspects of VAD management including anticoagulation and driveline care are performed exclusively by our service in Perth (the nearest VAD centre is 1700 miles away). <h3>Conclusion</h3> Excellent outcomes can be achieved with single-centre care despite geographical isolation.

Does the cytomegalovirus infection cause kidney transplant rejection in Erbil city patients, Kurdistan region of Iraq?

Does the cytomegalovirus infection cause kidney transplant rejection in Erbil city patients, Kurdistan region of Iraq?

Outcomes in extremely low birth weight (≤500 g) preterm infants: A Western Australian experience

Background and aimExtremely preterm (EP) infant survival has significantly improved with advanced neonatal care; however outcomes of infants born with birth weight (BW) ≤500 g remain poor. We aimed to review outcomes of this cohort in our institution. MethodsRetrospective study of all inborn preterm infants born at ≥22 weeks gestational age (GA) and weighing ≤500 g between January 2001–December 2017. Outcomes included short-term morbidity, mortality, neurodevelopmental impairment and growth up to five years of age. ResultsOf a total 438 eligible infants, 92 livebirths were admitted to intensive care [median (range) GA: 24 (22−30) weeks; median (IQR) BW: 427.5 (380–499) grams]. Majority [78/92 (84.7%)] were small for gestational age (SGA). In 50% of non-survivors, median (IQR) age of death was 3.5 (1–17.5) days with no late deaths. Medical morbidities were common. Follow-up, including standardised cognitive assessments, was available for 41/46 (89%) infants. At a median age of 5.06 years, 17/41 (41.5%) had moderate-severe disability; non-statistically higher in SGA compared to appropriate for gestational age/AGA (48.6% vs. 33.3%) group. Cerebral palsy (4/41; 10%), deafness needing amplification (1/41; 2.4%) were noted. Weight (32/41, 78%) and height (27/41, 66%) of most children remained at >2 SD below normal. ConclusionsIn a cohort of preterm infants weighing ≤500 g at birth, 50% survived after admission to intensive care. Medical morbidities were common and 54% were free from moderate to severe disability at five years. SGA infants had higher rates (48.6%) of moderate to severe disability. Ongoing suboptimal growth in childhood is common.

Prevalence of Frailty and Prehabilition Uptake Amongst Waitlisted Cardiac Transplant Patients: A Western Australian Single Centre Experience

Frailty is a novel risk factor which is associated with prolonged hospitalisation and death post cardiac transplantation [1–2]. Recent data suggest at least partial reversibility of pre-transplant frailty [1]. Prehabilitation programs may help reduce frailty prior to surgery and prevent post-operative complications [3]. We report the burden of frailty and uptake of prehabilitation in a contemporary Australian cohort.

Controlling the rainbow lorikeet in Tasmania: is it too late?

ABSTRACT Throughout the world, many parrot species have established wild populations outside their natural range through accidental escapes and deliberate releases from captivity. The Rainbow Lorikeet (Trichoglossus moluccanus), native to coastal northern and eastern continental Australia, has established viable populations in Western Australia and New Zealand from escaped or released pets and more recently have established in Tasmania. The Western Australian experience with introduced Rainbow Lorikeets, clearly shows that significant costs and impacts to agriculture, the environment and human amenities can be expected if this species is not controlled in the early stages of population increase, while in New Zealand, early intervention has proven successful in removing the species from the wild. This study examines sighting records of Rainbow Lorikeets in Tasmania which have gradually established over 20 years and we present a model to assist in determining likely population trajectories under various scenarios of control. Modelling indicates that the removal of 200 birds per year from each of the three Tasmanian sub-populations would decrease numbers to near-zero within 4.6 years. This demonstrates the opportunity to effectively control the Rainbow Lorikeet in Tasmania still exists and substantial damage to agriculture and impacts to conservation values can be avoided, resulting in significant cost savings to the Tasmanian community.

Alcohol industry arguments for putting profit before health in the midst of a pandemic: The Western Australian experience.

In an effort to limit the impact of alcohol on the Western Australian (WA) health system during the coronavirus disease (COVID‐19) pandemic, the WA Government introduced temporary restrictions on takeaway alcohol purchases for several weeks in March and April 2020. In response, alcohol industry representatives encouraged the WA Government to remove the restrictions and replace them with a voluntary alcohol industry initiative. We looked at alcohol industry representatives' comments in media and online publications during this period. We found that the industry framed alcohol as an essential product, focused on the impact of the restrictions on WA businesses and framed the restrictions as complex and ineffective. The themes and arguments we identified are commonly used by the alcohol industry and are not unique to the pandemic. The alcohol industry's response to the COVID‐19 restrictions in Australia provides a unique case study of how the alcohol industry attempts to interfere in public health policy.

Unprecedented times – The state library of Western Australia’s COVID-19 experience

The State Library of Western Australia was forced to close to the public under a declared State of Emergency due to the COVID-19 pandemic. During the 56 days of full closure, the Library quickly adapted services to meet restrictions, collected COVID-19 related material, transitioned some staff to working from home and undertook collection-related projects and minor refurbishment works. The Library had maintained a current pandemic plan, but significant decisions about service closure, risks and responses and strategic human resource considerations were made at the highest levels of government. Although not considered essential services enabling them to remain open to the community, the State Library and public libraries in Western Australia were among the first services to reopen within strict protocols under a staged lifting of restrictions. Social media was an essential tool in staying connected with the community, providing advice about service changes, delivering online services and engaging the community to secure donations of COVID-19-related material for the Library’s collections. Difficulties in collecting material efficiently and quickly about the Western Australian experience of an event of global significance were highlighted. Transitioning some staff to working from home arrangements presented policy and technology challenges and highlighted a digital divide for Library staff including their lack of access to appropriate technology at home. Although the pandemic is ongoing and uncertainty still exists, the COVID-19 experience is informing collection development policy, digital service delivery direction, human resource policies and advocacy.

Repeat transurethral resection is still an essential tool in treating non-muscle invasive bladder cancer: the Western Australian experience.

OBJECTIVESTo determine the rate of residual disease and under-staging after primary transurethral resection (TUR) of bladder tumors (TURBT) in tertiary hospitals in Western Australia.METHODSA retrospective study was performed evaluating all patients with TaHG (stage Ta, high-grade), T1LG (stage T1, low-grade) or T1HG (stage T1, high-grade) bladder cancer on primary TURBT conducted between January 1, 2012 and December 31, 2017 at the four largest metropolitan public hospitals in Western Australia. Only patients who underwent repeat resection within 3 months from initial resection were included. Those with previous history of bladder cancer, incomplete follow-up data and visibly incomplete initial resection were excluded. Baseline patient demographics, macroscopic clearance at initial resection, and disease data at initial and repeat resections were recorded.RESULTSSixty-seven patients with a median age of 71 years were included in this study. At initial resection, T1HG was the most common disease stage (64.2%) and detrusor muscle was present in 82.1% of initial resections. At repeat resection, 41.8% of cases had residual disease. The rate of upstaging to muscle-invasive bladder cancer was 3.0%. Patients treated by operators with five or less years of formal training did not have a significantly different rate of residual disease from patients treated by operators with more than five years of experience.CONCLUSIONSRepeat TUR should remain an essential practice due to high rates of residual disease and a small risk of tumor under-staging. The presence of detrusor muscle and macroscopic clearance should not be used as surrogates for adequacy of resection or consideration of avoiding a repeat TUR, even for TaHG disease.