“Everyone should do research”




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Conclusions

3D ultrasound evaluation of renal volumes in neonates is significantly lower than MRI volumes. MRI and 3D ultrasound renal volumes are not comparable in the neonatal population. Repeat volume measurements should use the same radiological modality.


Notes:

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P7


Does extreme prematurity affect kidney volume at term corrected age?


AL Kent1,6, R Jyoti2,6, C Robertson2, L Gonsalves2, S Meskell3,B Shadbolt4,6, MC Falk5.


1Dept of Neonatology, The Canberra Hospital, Canberra, ACT, Australia, 2Dept of Medical Imaging, The Canberra Hospital, Canberra, ACT, Australia,3Clinical Research Nurse, Centre for Newborn Care, 4Clinical Epidemiology Unit, 5Dept of Nephrology, The Canberra Hospital, Canberra, ACT, Australia, 6Australian National University, Canberra, ACT.

alison.kent@act.gov.au


Introduction

Extreme prematurity exposes the neonate to a number of potential renal insults that may result in a reduced number of glomeruli and/or renal size. This may predispose these individuals to cardiovascular disease later in life.


Objective

To determine using Magnetic Resonance Imaging (MRI) whether extreme prematurity results in decreased renal volume.


Methods

Neonates < 29 weeks gestation and term infants undergoing MRI of the brain were enrolled into the study. An MRI was performed at term corrected age in the premature neonate and within the first 4 weeks of life in the term neonate.


Results

17 preterm infants and 13 term infants had MRI’s performed. There was no significant difference in weight and length at the time of MRI (p=0.76, and 0.11 respectively). There was no significant difference in total renal volume or total kidney volume to weight ratio between the preterm and term neonates (p=0.83 and 0.6 respectively).


Conclusions:

At term corrected age extremely premature neonates have the same renal volume as term infants. It is unclear whether renal volume is a good indicator of glomerular number.


Notes:

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P8


INSPIRED HUMIDITY VARIATIONS DURING MECHANICAL VENTILATION WITH THE F&P MR850 HUMIDITY BASE


1DA Todd, 2M Harris, 2C Saville


1Centre for Newborn Care, the Canberra Hospital and ANU Medical School Canberra, ACT, Australia.

2Fisher & Paykel (F&P) Healthcare, East Tamaki, Auckland, New Zealand.

David.Todd@act.gov.au


Background

Inspired humidity during mechanical ventilation with the F&PMR850 set at 40-3 at various humidicrib temperatures is unknown.


Methods

In-vitro measurements of inspired humidity (absolute humidity [AH]) were made at the end of the inspiratory limb (RT235 dual heated circuit and F&PMR290 Auto-feed humidity chamber) with the airway temperature probe (ATP) positioned (1) inside or (2) outside the humidicrib. A Baby Log 8000 ventilator (Drager) delivered pressures of 25/5 cm H2O, X 60 respiratory rate, inspiratory time 0.35 seconds, in air at an inspiratory flow of 10 L/min to a lung model set at 37oC. The humidicrib (Atom V-850) was adjusted to 32, 34.5 and 37oC for 3 sets of measurements.


Results

Significant differences in inspired AH occurred as the humidicrib temperature changed. Only at a humidicrib temperature of 37 oC were there significant differences between positioning the ATP inside or outside the humidicrib (Table).


Humidicrib temperature


32 oC

(n=5)

34.5 oC

(n=5)

37 oC

(n=5)

ANOVA

AH with ATP inside (mgH2O/L)

39.3±1.0*

41.4±0.9**

40.0±1.5#

F=4.15, p<0.05

AH with ATP outside (mgH2O/L)

40.5±0.8

42.3±0.9**

43.7±0.6***

F=20.9, p<0.001




  • * Mean ± 1SD,

  • ** Significantly higher than 32 oC, p<0.05 (Bonferroni [Bon] post hoc)

  • *** Significantly higher than 34.5, p<0.05 and 32 oC, p<0.001 (Bon post hoc)

  • # Significantly lower than ATP outside p<0.05 (paired t-test)


Conclusion

Inspired AH was affected by both humidicrib temperature and ATP position. All measurements were well above the UK or USA minimum standards of 33 and 30 mgH2O/L AH.


Notes:

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P9


ASSESSMENT OF CARDIAC OUTPUT USING THE ULTRASONIC CARDIAC OUTPUT MONITORING (USCOM) DEVICE IN THE NEONATAL INTENSIVE CARE UNIT (NICU)


1DA Todd, 1S Meyer, 2B Shadbolt


1Centre for Newborn Care, 2 Department of Epidemiology, the Canberra Hospital, Woden, ACT 2606 and the ANU Medical School, Canberra

David.Todd@act.gov.au


Background

Cardiac output (CO) measurements using 2D continuous wave Doppler may become a useful tool in the NICU.


Method

In a pilot study using the USCOM device (USCOM Pty Ltd Australia), we have determined 1) the inter operator (rater) agreement and 2) the Aortic and Pulmonary CO in neonates admitted to the NICU during the first 8 days of life. We first compared results by operator and then combined the results from the 2 operators for an average for each neonate.


Results

Twelve neonates were enrolled in the study and their gestational age was 34.1±3.7 weeks, birthweight 2.268±0.872 Kg with a male:female ratio of 8:4. There was very strong absolute agreement between the two operators (table 1). However, the Pulmonary CO was significantly higher than the Aortic (Systemic) CO (table 2).

Table 1: Inter-rater agreement used intraclass correlations with absolute agreement

Measure

Intraclass correlation (95% CI)

p value

Aortic

0.90 (0.80, 0.95)

< 0.0001

Pulmonary

0.92 (0.85, 0.96)

< 0.0001

Total

0.93 (0.86, 0.97)

< 0.0001

Average measures, n = 35 (readings)


Table 2: General linear mixed model was used to examine the difference between averaged rater assessment of Aortic and Pulmonary CO.

Measure

Mean (95% CI)

Aortic (mL/Kg/min)

228.3 (202.1, 254.5)

Pulmonary (mL/Kg/min)

282.3 (256.0, 308.5)

F test = 8.75, df = 1, 34, p =0.006, n = 12 (neonates)


Conclusion:

Although there was a good correlation between operators, further investigations with greater numbers are required to study the discrepancy between Aortic (Systemic) and Pulmonary CO in this population.


Notes:

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P10


EXPERIENCES OF MOTHERS WITH 2-YEAR OLD INFANTS:

EMOTIONAL HEALTH, REASONS FOR DISTRESS AND ACCESS TO TREATMENT & SUPPORT.


1R Reay, 2S Matthey, 3D Ellwood


1Academic Unit of Psychological Medicine, ANU Medical School, Canberra, 2606

2 Sydney South West Area Health Service, Sydney, 1871

3School of Clinical Medicine, ANU Medical School, Canberra, 2606

rebecca.reay@act.gov.au


Introduction

The National beyondblue Postnatal Depression Program was implemented in the ACT to assist in the early detection and referral for treatment of mothers affected by perinatal depression. However, few screening programs have documented the outcomes beyond the first few months. We assessed the effectiveness of the program by examining the incidence of ‘probable depression’, uptake of treatments, perceived helpfulness and obstacles to treatment and support over the course of 2 years.


Methods

During April – December 2004, 984 women from the ACT were assessed for symptoms of depression in pregnancy and 6-8 weeks postpartum. At 2 years postpartum, all the participants who were screened as probably depressed were invited to participate. An equivalent random sample of mothers who screened as ‘not depressed’ were also invited to participate.


Results

99 ‘probably depressed’ and 102 ‘not depressed’ mothers completed and returned the questionnaire package. The most notable finding was a more than three fold increase in the rates of depression at 2 years for mothers detected as ‘probably depressed’. Despite the fact that maternal depression was detected and effective, helpful treatments were available, 41% of depressed mothers did not access treatment. 2/3 of these women identified their own reluctance as the major obstacle to accepting treatment above practical or systems barriers.


Conclusions

Programs need to develop more effective ways to address mothers’ internal restraints on accepting help if they want to improve treatment uptake rates for high risk women.


Notes:

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P11


Comparison of Two Tail Cuff Systems to Measure SYSTOLIC BLOOD pressure in rats


JJ Vickers, Y Zhang, JA Whitworth.

The High Blood Pressure Research Unit, The John Curtin School of Medical Research, The Australian National University, Canberra, 2601

Janine.vickers@anu.edu.au


Introduction

Accurate and ethical measurement of systolic blood pressure (SBP) in experimental rats is of prime importance in blood pressure research. The aim of this study was to validate the IITC device (Life Sciences, Woodland, CA, USA) and compare it with the SDR (Narco Biosystems, Houston, TX, USA) tail cuff system in SBP measurement in adrenocorticosteroid hormone (ACTH) and sham (saline) treated rats.


Method

Male Sprague-Dawley rats were randomly divided into two groups: (i) ACTH-treated (0.2mg/kg/day sc. n=10) or (ii) sham-treated controls (0.9% saline 1ml/kg/day sc. n=10). SBP was measured using alternate systems on alternate days.


Results

There was no significant difference in SBP readings in saline-treated (IITC 117±3 vs SDR 119±2 mmHg) or ACTH-treated rats (IITC 126±3 vs SDR 135±2 mmHg). However the SDR system showed significant SBP increase in the ACTH-treated rats compared with saline-treated (Saline 119±2 mmHg, ACTH 135±2 mmHg, =0.008), but with the IITC system SBP increase was not significant (Saline 117±3 mmHg vs ACTH 126±3 mmHg, =ns). Ordinary Least Products regression analysis (Model II) indicated both proportional and fixed bias with small linear association and wide scatter. The coefficient of determination (r2) showed only 8% predictive value.


Conclusion

This study suggests the IITC gives statistically valid SBP measurements but it was not as sensitive as the SDR system in detecting ACTH induced increases. The SDR system was easier to use, allowed clearer view of the rats, appeared less stressful to them, and was more sensitive in detecting changes in SBP in this model.


Notes:

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P12

The role of ARGINASE IN Dexamethasone-INDUCED HYPERTENSION IN RATS


Y Zhang, YK Tan, JA Whitworth.

The High Blood Pressure Research Unit, The John Curtin School of Medical Research, The Australian National University, Canberra, ACT 0200


Introduction

Dexamethasone (Dex)-induced hypertension is associated with nitric oxide (NO) deficiency. Arginase is the largest consumer of L-arginine and co-localises with NO synthase, thus, inhibition of arginase could increase bioavailability of L-arginine and NO. We have shown that the arginase inhibitor α-difluoromethylornithine (DFMO) partially prevented adrenocorticotropic hormone (ACTH)-induced hypertension in rats. In this study, we investigated the effects of DFMO on Dex-induced hypertension in rats.


Methods

Male Sprague-Dawley rats were randomly divided into 8 groups (n=8-10 in each group). In the prevention study, DFMO (30mg/kg in the drinking water) was given for four days prior to and 9 days during concurrent treatment with saline (0.1 ml/rat/day) or with Dex (10 μg/rat/day). In the reversal study, daily injections of Dex or saline began 8 days before administration of DFMO and co-treatment for 7 days. Systolic blood pressure (SBP) was measured on alternate days, using a tail-cuff system. Thymus weight was measured as a marker of glucocorticoid activity.


Results

SBP was increased with Dex treatment (Saline 108±1 vs Dex 146±1 mmHg, P΄<0.001) DFMO alone did not alter SBP. However, DFMO prevented (SBP DFMO+Dex: 113±1 mmHg, <0.01) and partially reversed (SBP Dex+DFMO: 123±1 mmHg, P′<0.01) Dex-induced hypertension. Thymus weight decreased in Dex-treated rats compared to saline-treated rats (Dex 59±2 vs saline 171±6 g/100g body weight, P′<0.001). DFMO slightly decreased thymus weight in saline-treated rats (saline+DFMO 151±8 g/100g body weight, P′<0.05 vs saline alone treated rats) but not Dex-treated rats (Thymus weight in Dex+DFMO 56±2 g/100g body weight, P′<0.001 vs saline+DFMO treated rats).


Conclusion

Arginase inhibition by DFMO prevented and reversed Dex-induced hypertension. Arginase activity may play a role in glucocorticoid-induced hypertension.


Notes:

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P13


CARDIOVASCULAR LOAD AND WHOLE BODY ACCELERATIONS IN INDIVIDUALS 65 YEARS AND OVER WALKING ON THREE OUTDOOR TRACKS IN THE ACT REGION


1G Waddington, 1T Dickson, 1S Trathen, 2R Adams.


1University of Canberra, 2University of Sydney.

Gordon.waddington@canberra.edu.au


Introduction

Exercising at levels of whole body accelerations exceeding 3.9g have been shown to have positive effects on cardiovascular fitness, bone density and balance. This pilot research project evaluated the whole body accelerations and cardiovascular challenge provided by selected walks in the ACT region to determine if walks could be ranked according to potential level of impact on both cardiovascular fitness and bone health.


Methods

Nine participants (3 male 6 female 75+/-9 years), who described themselves as walking at least 3km, 3 times a week, wore a data logging device (SPI Elite GPSports) recording heart rate, acceleration and GPS position while walking on three randomly selected outdoor tracks; the AIS athletics track, the Mount Ainsley Walk and the Narrabundah Community Walk. Data from the logging device was downloaded to a laptop and proprietary software (Team AMS GPSports) was used to compare steady state exercise performance between each of the three walks.


Results

There was a significant difference (p<0.05) for heart rate, distribution of whole body accelerations and average walking speed between the Mount Ainsley Walk and both the AIS track and Narrabundah walks. The participants experienced higher ranges of accelerations and higher levels of cardiovascular challenge ranging from lowest, the AIS track, then the Narrabundah Community Walk and then the Mt Ainsley Walk.


Conclusion

The AIS athletics track and the Narrabundah Community Walk provide a moderate exercise challenge and the Mt Ainsley Walk, providing progressively greater vertical height challenge, resulted in an increased exercise challenge. However, when compared to published data, no participant effectively exceeded the threshold for achieving a positive impact on femoral bone density (100 or more accelerations/day >3.9g) on the AIS track and only two of the nine participants achieved the threshold on the Narrabundah Community Walk or the Mt Ainsley Walk.


Notes:

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P14


ADMISSION ANAEMIA IN OLDER HIP FRACTURE (HF) PATIENTS:

PREVALENCE, ASSOCIATIONS AND SIGNIFICANCE


1,2AA Fisher, 1W Srikusalanukul, 1SL Goh, 1,2MW Davis.

1Department of Geriatric Medicine, Canberra Hospital, PO Box 11, Woden ACT 2606 and 2Australian National University Medical School.

wichat.srikusalanukul@act.gov.au


ntroduction

Reduced haemoglobin (Hb) levels are associated with poor outcomes after surgery. Deficiencies of vitamin B12 and folate are associated with risk of osteoporosis and fractures. We determined the prevalence and type of admission anaemia in older (≥60 years) HF patients and its effect on outcomes.


Methods

We prospectively studied 557 HF patients (mean age 82.4 +/-8.6 years, 74.1% women) including 321 (57.6%) with cervical and 236 (42.4%) with trochanteric fractures. Patients were classified as having anaemia according to WHO criteria (Hb <130g/L for men and <120 g/L for women). Plasma concentrations of vitamin B12, folate and iron metabolism parameters were measured.


Results

Overall, 213 (38.2%) patients were anaemic. The prevalence of anaemia was higher in men than women (50% vs 34.1%, p = 0.001) and occurred more often in patients with trochanteric than cervical fractures (67.8% vs 37.7%, p <0.001 in men; 42.1% vs 28.0%, p=0.003 in women). Low plasma vitamin B12 (<250pmol/L) was present in 34.0%, vitamin B12 deficiency (<139pmol/L) in 4.3%, low folate (<11nmol/L) in 13.9%, folate deficiency (<7mmol/L) in 6.9%, hypoferrinaemia (<9μmol/L) in 76.5%, low transferrin (<1.5g/L) in 30.0% and low transferrin saturation (<13%) in 55.7% of patients. Men were more likely to have low cobalamin (53.1% vs 33.5%, p = 0.003) and transferrin levels (39.7% vs 26.6%, p < 0.05). Hb levels significantly and positively correlated with serum albumin (r = 0.342, p < 0.001), lymphocyte count (r = 0.158, p = 0.014) and glomerular filtration rate (r = 0.232, p = 0.001) and negatively with age (r = -0.136, p = 0.034), bone-specific alkaline phosphatase (r = -0.134, p = 0.039), cardiac troponin (r = -0.132, p = 0.050) and urine excretion of deoxypyridinoline (r = -0.374, p = 0.004). Hb <115 g/L was associated with peri-operative myocardial injury (40% vs 24%, p = 0.035). Anaemia was not associated with in-hospital mortality, prolonged hospital stay or institutionalisation, provided that it was properly controlled.


Conclusion

A substantial proportion of HF patients on admission are anaemic with subnormal levels of cobalamin, folate and iron parameters, especially men and patients with trochanteric fractures. A link between anaemia and advanced age, nutritional status, bone turnover markers and developing peri-operative myocardial injury indicates a need for adequate corrective therapy. Admission anaemia does not predict short-term outcomes after HF surgery.


Notes:

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P15


WHAT IS ENOUGH TO KNOW? DISCREPANCIES BETWEEN HEALTH CARE CONSUMERS' AND PROVIDERS' PERCEPTIONS OF AN ADEQUATE LEVEL OF HEALTH LITERACY.


C Pearce-Brown1, T Jowsey1, Y-H Jeon1, L Yen1, M Mirzaei2, B Essue2, T Usherwood2, N Glasgow1, S R Leeder2, J Gillespie2 and the SCIPPS team.


1Australian Primary Health Care Research Institute, The Australian National University, Canberra, ACT 0200 Australia, 2Menzies Centre for Health Policy, University of Sydney NSW 2006.

Carmen.Pearce-Brown@anu.edu.au


Introduction

This poster aims to provide a new perspective on health literacy and self management discourses by reporting on health care consumers’ (i.e. patients and carers) perception that they "know enough" about the management of their condition, and how that contrasts with health care providers' (HCPs) perception that they do not "know enough".


Method

As part of the Serious and Continuing Illness Policy and Practice Study, qualitative research was conducted using 66 in-depth interviews with patients and carers from the ACT and Sydney West who had been affected by diabetes, chronic heart failure and chronic obstructive pulmonary disease. Content analysis of the data (using NVivo 7) revealed health literacy as a key issue impacting their self-management. Based on the preliminary analysis eight focus groups with HCPs (n=63) were conducted to explore the health literacy issue further, identify gaps and inform policy options.


Results

More than half of the participants stated that they perceived they “know enough” (n=34) to manage their condition. Elements of health literacy discussed included the disease process, medications, co-morbidities and their impact on management of the index condition, associated lifestyle factors, the support services available, and the financial impact of the condition. They expressed that they learn by over time, by the experience of trial and error, and as the need arises. In the interim, some patients consider themselves as having an adequate level of knowledge to manage their condition for that point in time. For the most part, HCPs expect patients and carers to obtain high health related knowledge levels, which equates to knowledge in all of the aforementioned fields.


Conclusion

Health care consumers have different perceptions of what is adequate health related knowledge levels at different stages throughout the disease continuum. These understandings are, in most cases, vastly different from that perceived by HCPs as adequate.


Notes:

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P16


PATIENT ROLE IN REDUCING ED CROWDING


P Habib, DB Richardson


Australian National University Medical School, Canberra Hospital, Garran, ACT, 2605

u4288623@anu.edu.au


Aim

This retrospective study aims to evaluate whether subsequent visits to the TCH ED for the same condition could be avoided if patients followed the advice given by their physician during their initial visit.


Methods

During 10-17 February 2007, 985 patients presented to the ED. ANU medical students took histories from 604 consenting patients. After 2 months, 371 were successfully followed up by telephone about subsequent visits to the ED, whether they had followed any advice given during their initial visit and whether any changes were made to prevent future visits to the ED. The Chi-square test was used for statistical analysis and age was divided into 8 categories for ages 0-75.


Results

The number of subsequent ED visits increased when advice given by ED physicians was not followed (p-value= 0.008). Men were more likely not to return to the ED despite not following the advice given compared to women. However, age and gender nullified these relationships due to a small sample size (p-value age = 0.11; gender when advice followed = 0.42; when advice not followed = 0.58).


Conclusion

Patients following the advice given to them by their treating physician did not significantly prevent subsequent visits to the ED.


Notes:

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P17


QUALITY OF LIFE IN THE ELDERLY 1 YEAR AFTER ED VISIT


DB Richardson, E Corley, LK Nguyen


Australian National University Medical School, Canberra Hospital, Garran, ACT, 2605

Drew.richardson@act.gov.au


Aim

Elderly patients presenting to the ED are known to have an increased risk of death or dependency. This study aimed to quantify quality of life in patients aged over 65 years 1 year after ED presentation.


Methods

Prospective descriptive study of patients presenting to a mixed adult/paediatric tertiary ED during a single week. Patients were interviewed and enrolled for telephone follow-up. At 1 year, patients aged 65 years and over at enrolment were contacted by telephone, interviewed about their current living situation and were administered the SF-12, a validated quality of life scale. Patients aged under and over 75 years at enrolment were compared using chi-square and t-test.


Results

Of 985 presentations to the ED, 84 patients aged 65 years or over consented and were enrolled. At 1 year, 13 (20%) were known to have died, and 64 were successfully contacted and interviewed, 32 in each age range. There was no significant difference in death rate (7 aged over 75 and 6 under 75), but more of the patients aged over 75 reported an increased need for support as defined by a different home situation or admission to a nursing home (41% vs 19%, P=0.05). The differences between mean SF 12 scores did not reach statistical significance (Over 75: -11.8 (95% CI -16.2, -7.04), under 75: -8.4 (-12.3,-4.5).


Conclusions

This study confirms a high rate of increasing dependency after ED visit, and indicates the level of reported quality of life. ED presentation is a major risk factor for both death and dependency in patients aged over 65.


Notes:

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P18


SELF-REPORTED “REGULAR GP” AND ED VISITS OVER 12 MONTHS


D Richardson, S Robison, V Hughes, D Ameratunga, J Moran


Australian National University Medical School, Canberra Hospital, Garran, ACT, 2605

Drew.richardson@act.gov.au


Aims

To compare self-reported ED visits and relationship with a regular General Practitioner (GP) over a 12 month period in an ED patient population.


Methods

Prospective observational 12 month telephone follow-up of patients enrolled on presentation to an ED over one week in March 2005. Patients (or carers) who consented were asked “Do you (or does the patient) have a regular GP?” at enrolment and at 12 months and asked to report their number of visits to any ED in the last year.


Results

89 % of the surviving consented cohort of 518 was contacted. 88% reported a regular GP at the start and 90% at the end of 12 months, and 33.7% reported one or more ED visits in the year (range 0-15). 29.8% of those without a regular GP at the start reported an ED visit, compared to 34.3% of those with a GP (P=NS), but only 10.9% of those without a regular GP at the end reported an ED visit compared to 36.3% of those with a GP (P=0.0005). There was no relationship between patients reporting contact with their GP before the index ED visit and subsequent visits, but all those reporting more than 2 ED visits had a GP at both the start and the end (P=0.005).


Conclusions

This study suggests that a self-reported relationship with a GP is not “protective” against ED visits, but rather associated with increased ED visits, probably because of ongoing need for medical care.


Notes:

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P19


LONG-TERM OUTCOME OF PATIENTS PRESENTING TO AN EMERGENCY DEPARTMENT: PREDICTORS OF POOR HEALTH OUTCOME.


V Hughes, D Richardson.


Australian National University Medical School, Canberra Hospital, Garran, ACT, 2605

Drew.richardson@act.gov.au


Aims

To describe the 12 month health outcome of a sample of adult patients presenting to an ED and to identify possible predictive factors.


Methods

Prospective observational 12 month telephone follow-up of patients enrolled on presentation to an ED over one week in March 2005. Recorded responses at follow-up included functional status before and after ED visit, having a regular GP, polypharmacy (> 3 prescription medications), revisits to an ED or hospitalization during the 12 months. A “poor outcome” was defined as a patient who died during the period or at follow up self-reported the need for “more help than usual to take care of” themselves.


Results

90% of the 373 consenting patients (age15-96 yrs) were followed-up. 3.2% had died, and 37% of survivors reported an ED visit and 28% a hospitalisation in the 12 months. Poor outcome was reported in 13.7% of patients and was associated with age >65 (P=2.66 x 10 –8, Chi-square), having a regular GP (P=0.018), arriving by ambulance (P=0.0001) and being admitted/transferred from the ED (P=0.00015) at the initial presentation. In the surviving patients, need for “more help” was associated with self-reported polypharmacy (P=6.24 x 10 -7) and report of functional decline prior to ED visit (P=0.0004).


Conclusions

This study suggests that many patients at risk of poor long-term health outcomes could be identified based on factors present at the time of the ED visit. Identifying at-risk patients might allow appropriate interventions as part of long-term management aiming to prevent further decline in health status.


Notes:

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P20


HIGH LEVEL OF HEALTH SYSTEM USAGE BY ED PATIENTS


K Bird, D Richardson.

Australian National University Medical School, Canberra Hospital, Garran, ACT, 2605

Drew.richardson@act.gov.au


Aims

To compare the recent self-reported health service usage of a population of tertiary ED patients with the National Health survey (NHS). Previous studies have concentrated on recurrent attenders or on usage immediately around the ED visit.


Methods

Prospective observational 12 month telephone follow-up of patients enrolled on presentation to an ED over one week in March 2005. Health resource usage in the past 2 weeks was determined via the use of health questions developed in concordance with the NHS (2001). The responses were then age-adjusted to the Australian population and compared with the NHS population data (2004/2005 results).


Results

89 % of the surviving consented cohort of 518 were contacted. They reported significantly higher age-adjusted usage of health services in the last two weeks than the national population: 3.7% (95% CI 2.2-6.0) were admitted to hospital (NHS 0.8%), 5.9% (4.0-8.5) visited an ED (NHS 0.9%), 7.3% (4.9-9.8) visited an outpatient department (NHS 1.9%) and 33.8% (29.6-38.4) visited a GP or specialist (NHS 22.8%). There was no difference in reported visits to day clinics or other health practitioners.


Conclusions

Even one year after initial ED visit, this cohort reported much higher usage of health services, particularly hospital services, than the general population. Findings suggest a high level of health needs, and limited potential for health resource substitution strategies to address ED overcrowding. Further studies are warranted exploring the underlying reasons and the potential for preventative strategies.


Notes:

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P21


MEASUREMENT OF THE THORACIC SPINE WITH THE FLEXIBLE ELECTROGONIOMETER.


Perriman, DM; Scarvell, JM; Hughes, A; Lueck, CJ; Ashman, B; Smith, P.
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