Steve Quinn

Relationship between glycaemia and length of hospital stay during an acute exacerbation of chronic obstructive pulmonary disease

We have assessed whether glucose concentration and patient outcome are related in hospitalised patients when glycaemia is quantified in detail. Continuous glucose monitoring was performed on 47 consecutive subjects with an acute exacerbation of chronic obstructive pulmonary disease. Length of hospital stay increased by 10% for each mmol/L increase in mean glucose (P = 0.01). In a multivariable analysis, mean glucose was independently associated with length of hospital stay (P = 0.02). These data add weight to evidence that hyperglycaemia may adversely affect patient outcomes in hospitalised patients.

Implementing practice change in chronic cancer pain management: clinician response to a phase III study of ketamine

An adequately powered, double‐blind, multisite, randomised controlled trial has shown no net clinical benefit for subcutaneous ketamine over placebo in the management of cancer pain refractory to combination opioid and co‐analgesic therapy. The results of the trial were disseminated widely both nationally and internationally.

Is use of the Nintendo Wii Fit in physiotherapy as effective as conventional physiotherapy training for hospitalised older adults

While there has been wide uptake of the Nintendo Wii Fit as a therapy tool in hospital and aged care settings there is a lack of evidence regarding the effectiveness and safety of this approach when used with older people. This pilot study compared the effect of a physiotherapist providing activities from the Wii Fit with conventional therapy on mobility, activities of daily living and safety. The study used a randomized controlled design with masked outcome assessment. A total of 44 participants were recruited from a Geriatric Evaluation and Management (GEM) Unit and randomized to either therapy using the Wii Fit (n=22) or conventional physiotherapy (n=22). Therapy sessions were 25 minutes per workday for the duration of the participants stay on the unit. Assessment measures were taken at baseline, post intervention (on discharge from the unit) and one month after discharge. The primary outcome used was the Timed Up and Go Test and additional measures included balance and activities of daily living function. Adverse events were recorded. Preliminary analyses of results showed that both groups improved however there was a small significant difference between groups on balance and the Timed Up and Go Test with the Wii Fit appearing to be a more effective approach to balance and mobility training in hospitalized older people.

Methicillin‐resistant Staphylococcus aureus in children with atopic dermatitis from 1999 to 2014: A longitudinal study

With the increase in rates of methicillin‐resistant Staphylococcus aureus (MRSA) skin infections in the general population, there may be a similar increase of such infections in patients with atopic dermatitis (AD). There are few studies on MRSA prevalence in the AD population, and no previous studies in Australia. This study investigated the prevalence of MRSA and other organisms in the paediatric AD population over the previous 15 years.

A cluster randomized trial of objective risk assessment versus standard care for acute coronary syndromes: Rationale and design of the Australian GRACE Risk score Intervention Study (AGRIS)

BACKGROUND Assessing risk and weighing the potential benefits from evidence-based therapies are essential in the clinical decision making process of optimizing care and outcomes for patients presenting with acute coronary syndromes (ACS). Such practices are advocated in international clinical guidelines of ACS care. While the GRACE risk score (GRS) is a guideline advocated, well-validated risk stratification tool, its utility in improving care and outcomes remains unproven, and its application has been limited in routine clinical practice. OBJECTIVE This study will assess the effectiveness using the GRS tool and treatment recommendations during patient assessment on improving the application of guideline-recommended therapies in ACS care. DESIGN This study employs a PROBE (prospective cluster [hospital-level] randomized open-label, blinded endpoint) design to evaluate objective measures of hospital performance, with clinical events adjudicated by a blinded event committee. This randomized study is nested within the established CONCORDANCE registry of ACS patients, with existing methods for data collection and monitoring of care and clinical outcomes. The hospital-level intervention is the integration of the GRS into routine ACS patient assessment process. The study will assess the use of early invasive management, prescription of guideline recommended pharmacology and referral to cardiac rehabilitation by hospital discharge; with the key composite clinical endpoint of cardiovascular death, new or recurrent myocardial infarction, in-hospital heart failure or cardiovascular readmission at 12 months. Health economic impacts of risk stratification implementation will also be evaluated. The study will recruit 3000 patients from 30 hospitals. SUMMARY The AGRIS trial will establish the effect of routine objective risk stratification using the GRACE risk score on ACS care and clinical outcomes.

Impact of the new national health standard for rail safety workers on ischaemic heart disease risk factors in train drivers

In 2004, a compulsory National Standard for the Australian rail industry was introduced outlining health standards that drivers must meet to be deemed fit to drive.

Investigating the adverse respiratory effects of beta‐blocker treatment: six years of prospective longitudinal data in a cohort with cardiac disease

Background:  Globally, cardiovascular disease (CVD) is the leading cause of death. Beta‐blocker medications have well‐established survival benefit for myocardial infarction and heart failure. However, CVD frequently coexists with chronic obstructive airways disease (COPD), a disease in which beta‐blockers are traditionally avoided.

Moving on: Factors associated with caregivers’ bereavement adjustment using a random population-based face-to-face survey

Background: Providing care at end of life has consequences for caregivers’ bereavement experience. ‘Difficulty moving on with life’ is an informative and unbiased symptom of prolonged grief disorder. Predictors of bereaved caregivers’ ability to ‘move on’ have not been examined across the population. Aim: To identify the characteristics of bereaved hands-on caregivers who were, and were not, able to ‘move on’ 13–60 months after the ‘expected’ death of someone close. Design: The South Australian Health Omnibus is an annual, random, cross-sectional community survey. From 2000 to 2007, respondents were asked about providing care for someone terminally ill and their subsequent ability to ‘move on’. Multivariable logistic regression models explored the characteristics moving on and not moving on. Setting: Respondents were aged ⩾15 years and lived in households within South Australia. They had provided care to someone who had died of terminal illness in the preceding 5 years. Results: A total of 922 people provided hands-on care. In all, 80% of caregivers (745) had been able to ‘move on’. Closeness of relationship to the deceased, increasing caregiver age, caregiver report of needs met, increasing time since loss, sex and English-speaking background were significantly associated with ‘moving on’. A closer relationship to the deceased, socioeconomic disadvantage and being male were significantly associated with not ‘moving on’. Conclusion: These results support the relevance of ‘moving on’ as an indicator of caregivers’ bereavement adjustment. Following the outcomes of bereaved caregivers longitudinally is essential if effective interventions are to be developed to minimise the risk of prolonged grief disorder.

Phase III randomised double-blind controlled trial of oral risperidone, haloperidol or placebo with rescue subcutaneous midazolam for delirium management in palliative care

Results: At baseline, 676 (16.1%) men were frail, as defined by having ≥3 deficits (FRAIL scale ≥ 3). In multivariate cross-sectional analysis, low vitamin D status, defined by the lowest quartile of 25(OH)D values (<52.9 nmol/l), was associated with increased prevalent frailty (odds ratio [OR] 1.96, 95% confidence interval [CI] 1.52 to 2.52) in comparison to the highest quartile of 25(OH)D values (>81.6 nmol/l). After a mean period of 5.3 years, the adjusted OR of being frail at follow-up for men with low vitamin D and having zero deficit at baseline (FRAIL scale = 0) was 1.56 (95% CI 1.07 to 2.27). Low vitamin D also predicted all-cause mortality over a period of up to 9.2 years (hazards ratio 1.20, 95% CI 1.02 to 1.42), independent of baseline frailty and other covariates.