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Hornby-Turner YC, Russell SG, Quigley R, Matthews V, Larkins S, Hayman N, Lakhan P, Flicker L, Smith K, McKeown D, Cadet-James D, Cass A, Garvey G, LoGiudice D, Miller G, Strivens E. Safeguarding against Dementia in Aboriginal and Torres Strait Islander Communities through the Optimisation of Primary Health Care: A Project Protocol. Methods Protoc 2023; 6:103. [PMID: 37888035 PMCID: PMC10609630 DOI: 10.3390/mps6050103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 09/30/2023] [Accepted: 10/16/2023] [Indexed: 10/28/2023] Open
Abstract
This protocol describes the methodology and methods for a collaborative project with eight Aboriginal and Torres Strait Islander primary health care (PHC) organisations, across three Australian states and one territory, to increase clinical service performance and access to preventive health and health promotion services for preventing, identifying, treating, and managing dementia risk in Aboriginal and Torres Strait Islander communities. Aboriginal participatory action research (APAR) methodology will be the framework for this project, incorporating continuous quality improvement (CQI), informed by research yarning with stakeholder groups, comprising community members and PHC staff and service providers and data collected from the auditing of client health records and the mapping of existing clinical processes and health services at each partnering PHC organisation. The qualitative and quantitative data will be summarised and discussed with stakeholder groups. Priorities will be identified and broken down into tangible PHC organisation deliverable strategies and programs, which will be co-developed with stakeholder groups and implemented cyclically over 24 months using the Plan, Do, Study, Act model of change. Key project outcome measures include increased clinical service performance and availability of preventive health and health promotion services for safeguarding against dementia. Project implementation will be evaluated for quality and transparency from an Indigenous perspective using an appropriate appraisal tool. The project processes, impact, and sustainability will be evaluated using the RE-AIM framework. A dementia safeguarding framework and accompanying tool kit will be developed from this work to support Aboriginal and Torres Strait Islander PHC organisations to identify, implement, and evaluate dementia safeguarding practice and service improvements on a broader scale.
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Affiliation(s)
- Yvonne C. Hornby-Turner
- College of Medicine and Dentistry, James Cook University, Smithfield, QLD 4878, Australia; (S.G.R.); (R.Q.); (E.S.)
| | - Sarah G. Russell
- College of Medicine and Dentistry, James Cook University, Smithfield, QLD 4878, Australia; (S.G.R.); (R.Q.); (E.S.)
| | - Rachel Quigley
- College of Medicine and Dentistry, James Cook University, Smithfield, QLD 4878, Australia; (S.G.R.); (R.Q.); (E.S.)
| | - Veronica Matthews
- University Centre for Rural Health, University of Sydney, Lismore, NSW 2145, Australia
| | - Sarah Larkins
- College of Medicine and Dentistry, James Cook University, Smithfield, QLD 4878, Australia; (S.G.R.); (R.Q.); (E.S.)
| | - Noel Hayman
- Southern Queensland Centre of Excellence in Aboriginal and Torres Strait Islander Primary Health Care, Metro South Hospital and Health Service, Inala, QLD 4077, Australia (P.L.)
| | - Prabha Lakhan
- Southern Queensland Centre of Excellence in Aboriginal and Torres Strait Islander Primary Health Care, Metro South Hospital and Health Service, Inala, QLD 4077, Australia (P.L.)
| | - Leon Flicker
- Western Australian Centre for Health and Ageing, University of Western Australia, Crawley, WA 6009, Australia;
| | - Kate Smith
- Centre for Aboriginal Medical and Dental Health, University of Western Australia, Crawley, WA 6009, Australia
| | | | - Diane Cadet-James
- College of Medicine and Dentistry, James Cook University, Smithfield, QLD 4878, Australia; (S.G.R.); (R.Q.); (E.S.)
| | - Alan Cass
- Menzies School of Health Research, Charles Darwin University, Casuarina, NT 0810, Australia;
| | - Gail Garvey
- School of Public Health, The University of Queensland, Herston, Brisbane, QLD 4006, Australia
| | - Dina LoGiudice
- Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, VIC 3050, Australia
| | - Gavin Miller
- Cairns and Hinterland Hospital and Health Service, Queensland Health, Cairns, QLD 4870, Australia
| | - Edward Strivens
- College of Medicine and Dentistry, James Cook University, Smithfield, QLD 4878, Australia; (S.G.R.); (R.Q.); (E.S.)
- Cairns and Hinterland Hospital and Health Service, Queensland Health, Cairns, QLD 4870, Australia
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Lakhan P, Cooney A, Palamuthusingam D, Torrens G, Spurling G, Martinez A, Johnson D. Challenges of conducting kidney health checks among patients at risk of chronic kidney disease and attending an urban Aboriginal and Torres Strait Islander primary healthcare service. Aust J Prim Health 2022; 28:371-379. [PMID: 35863762 DOI: 10.1071/py21248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 02/14/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND The increasing incidence of chronic kidney disease (CKD) globally highlights the importance of early targeted screening of at-risk persons in primary healthcare settings. This study investigated the early detection of CKD among Aboriginal and Torres Strait Islander patients attending an urban primary healthcare service. METHODS Routine data extracted for all patients with an active electronic medical record on 7 December 2017 were used to identify patients who were eligible to have a kidney health check (KHC), comprising estimated glomerular filtration rate (eGFR) and urine albumin creatinine ratio (UACR) tests. A subsequent manual search of electronic health records identified the presence of CKD risk factors and follow-up KHCs. RESULTS Of the 1181 eligible patients, 171 (15%) had a complete initial KHC. Of the eight patients with an initial abnormal eGFR, two (25%) had a repeat eGFR assessment within 3 months to confirm the presence of CKD. Of the 30 patients who had an initial abnormal UACR result, three (10%) had at least one repeat UACR measurement within 3 months. In patients with diabetes and/or hypertension and a normal initial KHC, 51% had a repeat eGFR and 36% had UACR within the recommended time frame of 12 months. Similar findings were observed for the recommended time frame of 24 months in patients without diabetes or hypertension. CONCLUSION Accurate documentation of risk factors for CKD and processes to address the barriers to implementation of Kidney Health Australia guidelines will assist in preventing or delaying progression of CKD.
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Affiliation(s)
- Prabha Lakhan
- Southern Queensland Centre of Excellence in Aboriginal and Torres Strait Islander Primary Health Care, Metro South Hospital and Health Service, Inala, Qld 4077, Australia; and The University of Queensland, Poche Centre for Indigenous Health, Brisbane, Qld 4067, Australia
| | - Anna Cooney
- Southern Queensland Centre of Excellence in Aboriginal and Torres Strait Islander Primary Health Care, Metro South Hospital and Health Service, Inala, Qld 4077, Australia
| | - Dharmenaan Palamuthusingam
- Metro North Kidney Health Service, Royal Brisbane and Women's Hospital, Butterfield Street, Herston, Qld 4029, Australia
| | - Gary Torrens
- Princess Alexandra Hospital, 199 Ipswich Road, Woolloongabba, Qld 4102, Australia
| | - Geoffrey Spurling
- Southern Queensland Centre of Excellence in Aboriginal and Torres Strait Islander Primary Health Care, Metro South Hospital and Health Service, Inala, Qld 4077, Australia; and The University of Queensland, Primary Care Clinical Unit, Level 8, Health Sciences Building, Building 16/910, Royal Brisbane and Women's Hospital, Herston, Qld 4029, Australia
| | - Antonio Martinez
- Mount Isa Hospital, 30 Camooweal Street, Mount Isa, Qld 4825, Australia
| | - David Johnson
- Department of Nephrology, Princess Alexandra Hospital, 199 Ipswich Road, Woolloongabba, Qld 4102, Australia; and Centre for Kidney Disease Research, University of Queensland, 199 Ipswich Road, Woolloongabba, Qld 4102, Australia; and Translational Research Institute, 199 Ipswich Road, Woolloongabba, Qld 4102, Australia
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Lakhan P, Osuagwu UL, Askew D, Hayman N, Spurling G. Visual impairment among Aboriginal and Torres Strait Islander patients attending an Australian Indigenous primary health service: a cross-sectional study. Aust J Prim Health 2020; 26:287-292. [PMID: 32654684 DOI: 10.1071/py19119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 04/17/2020] [Indexed: 11/23/2022]
Abstract
This cross-sectional study aimed to identify the period prevalence of visual impairment (VI) and blindness among Aboriginal and Torres Strait Islander people attending an Indigenous urban primary healthcare service, eye care practitioner referrals for those with VI and any opportunities to improve care delivery. Visual acuity (VA) examinations, using a Snellen chart, are performed as part of routine annual health assessments offered to children and adults. This study included patients aged ≥5 years (n=1442) who had a health assessment conducted between 1 January 2015 and 31 December 2016 and provided consent for the use of their health assessment information for research. Of patients with available data, 2.4% (33/1374) experienced VI, defined as presenting VA worse than 6/12 to 6/60 in the better-seeing eye. VI was more common in those aged ≥60 years (14/136; 10.3%) and was significantly associated with increasing age (P<0.001). No patients experienced blindness, defined as presenting VA worse than 6/60 in the better-seeing eye. All patients with VI were aged ≥16 years. Nine (27%) of the 33 patients with VI in the better-seeing eye were referred to an optometrist or an ophthalmologist. The low period prevalence of VI and no blindness in this study are positive findings. The findings also indicate that routine VA testing of older adults, especially those aged ≥60 years, should be conducted to avoid missing those not having an annual health assessment.
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Affiliation(s)
- Prabha Lakhan
- Southern Queensland Centre of Excellence in Aboriginal and Torres Strait Islander Primary Healthcare, PO Box 52, Inala, Qld 4077, Australia; and Corresponding author.
| | - Uchechukwu L Osuagwu
- Diabetes, Obesity and Metabolism Translational Research Unit (DOMTRU), School of Medicine, Western Sydney University, Level 2, Macarthur Clinical School Building, Parkside Crescent, Campbelltown, NSW 2560, Australia
| | - Deborah Askew
- Southern Queensland Centre of Excellence in Aboriginal and Torres Strait Islander Primary Healthcare, PO Box 52, Inala, Qld 4077, Australia; and Primary Care Clinical Unit, The University of Queensland, Level 8, Health Sciences Building, Building 16/910, Royal Brisbane and Women's Hospital, Herston, Qld 4029, Australia
| | - Noel Hayman
- Southern Queensland Centre of Excellence in Aboriginal and Torres Strait Islander Primary Healthcare, PO Box 52, Inala, Qld 4077, Australia; and School of Medicine, Griffith University, Parklands Drive, Southport, Qld 4222, Australia
| | - Geoffrey Spurling
- Southern Queensland Centre of Excellence in Aboriginal and Torres Strait Islander Primary Healthcare, PO Box 52, Inala, Qld 4077, Australia; and Primary Care Clinical Unit, The University of Queensland, Level 8, Health Sciences Building, Building 16/910, Royal Brisbane and Women's Hospital, Herston, Qld 4029, Australia
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Lakhan P, Askew D, Hayman N, Pokino LA, Sendall C, Clark PJ. Optimising Hepatitis C care in an urban Aboriginal and Torres Strait Islander primary health care clinic. Aust N Z J Public Health 2019; 43:228-235. [PMID: 30908846 DOI: 10.1111/1753-6405.12888] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Revised: 02/01/2018] [Accepted: 02/01/2019] [Indexed: 01/31/2023] Open
Abstract
OBJECTIVE Describe the sociodemographic and clinical characteristics of patients with Hepatitis C Virus (HCV) attending an urban Indigenous primary health clinic (IPHC) in Brisbane, Australia. METHODS A retrospective chart review of sociodemographic characteristics, presence of liver disease and treatments, lifestyle behaviours and comorbidities in patients with a HCV infection was conducted between October 2015 and March 2016. RESULTS One hundred and thirteen patients with confirmed HCV infection were aged between seven and 63 years; 66% were male, and 84% were Indigenous. Sixty-nine per cent had been incarcerated; 41% had experienced conflict or domestic violence; 47% were injecting drugs; 72% had depression; and 61% had anxiety. Cirrhosis was present in 7/95 patients with adequate data and associated with age (p=0.02). Eleven patients had commenced direct acting antiviral (DAA) therapy in the 18 months that it had been available. CONCLUSIONS The study highlights the opportunities for enhancing treatment of patients with HCV infection. Opportunities to improve treatment rates in an Indigenous primary healthcare include optimising diagnostic pathways, improving patient engagement, and general practitioner and peer worker participation. Implications for public health: HCV poses a serious threat to public health in Australia and IPHCs are key sites to addressing this for Indigenous people. Optimising care of patients with HCV attending IPHC requires recognition of the complex health needs and social context, to reduce the incidence and consequences of HCV infection.
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Affiliation(s)
- Prabha Lakhan
- Southern Queensland Centre of Excellence in Aboriginal and Torres Strait Islander Primary Health Care, Queensland
| | - Deborah Askew
- Southern Queensland Centre of Excellence in Aboriginal and Torres Strait Islander Primary Health Care, Queensland.,The University of Queensland, Primary Care Clinical Unit, Royal Brisbane and Women's Hospital, Queensland
| | - Noel Hayman
- Southern Queensland Centre of Excellence in Aboriginal and Torres Strait Islander Primary Health Care, Queensland
| | - Leigh-Anne Pokino
- Southern Queensland Centre of Excellence in Aboriginal and Torres Strait Islander Primary Health Care, Queensland
| | - Cheryl Sendall
- Southern Queensland Centre of Excellence in Aboriginal and Torres Strait Islander Primary Health Care, Queensland
| | - Paul J Clark
- Southern Queensland Centre of Excellence in Aboriginal and Torres Strait Islander Primary Health Care, Queensland.,Faculty of Medicine, The University of Queensland.,Department of Gastroenterology, The Princess Alexandra and Mater Hospitals, Queensland
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Brousseau AA, Dent E, Hubbard R, Melady D, Émond M, Mercier É, Costa AP, Gray LC, Hirdes JP, Dey AB, Jonsson PV, Lakhan P, Ljunggren G, Singler K, Sjostrand F, Swoboda W, Wellens NIH. Identification of older adults with frailty in the Emergency Department using a frailty index: results from a multinational study. Age Ageing 2018; 47:242-248. [PMID: 29165543 DOI: 10.1093/ageing/afx168] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Accepted: 10/16/2017] [Indexed: 01/08/2023] Open
Abstract
Objective frailty is a central concept in geriatric medicine, yet its utility in the Emergency Department (ED) is not well understood nor well utilised. Our objectives were to develop an ED frailty index (FI-ED), using the Rockwood cumulative deficits model and to evaluate its association with adverse outcomes. Method this was a large multinational prospective cohort study using data from the interRAI Multinational Emergency Department Study. The FI-ED was developed from the Canadian cohort and validated in the multinational cohort. All patients aged ≥75 years presenting to an ED were included. The FI-ED was created using 24 variables included in the interRAI ED-Contact Assessment tool. Results there were 2,153 participants in the Canadian cohort and 1,750 in the multinational cohort. The distribution of the FI-ED was similar to previous frailty indices. The mean FI-ED was 0.26 (Canadian cohort) and 0.32 (multinational cohort) and the 99th percentile was 0.71 and 0.81, respectively. In the Canadian cohort, a 0.1 unit increase in the FI-ED was significantly associated with admission (odds ratio (OR) = 1.43 [95% CI: 1.34-1.52]); death at 28 days (OR = 1.55 [1.38-1.73]); prolonged hospital stay (OR = 1.37 [1.22-1.54]); discharge to long-term care (OR = 1.30 [1.16-1.47]); and need for Comprehensive geriatric Assessment (OR = 1.51 [1.41-1.60]). The multinational cohort showed similar associations. Conclusion the FI-ED conformed to characteristics previously reported. A FI, developed and validated from a brief geriatric assessment tool could be used to identify ED patients at higher risk of adverse events.
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Affiliation(s)
- Audrey-Anne Brousseau
- Department of Family and Community Medicine, University of Toronto, Canada
- Schwartz-Reisman Emergency Medicine Institute, Mount Sinai Hospital, Toronto, Canada
| | - Elsa Dent
- Centre for Research in Geriatric Medicine, The School of Medicine, The University of Queensland, Brisbane, Australia
| | - Ruth Hubbard
- Centre for Research in Geriatric Medicine, The School of Medicine, The University of Queensland, Brisbane, Australia
| | - Don Melady
- Department of Family and Community Medicine, University of Toronto, Canada
- Schwartz-Reisman Emergency Medicine Institute, Mount Sinai Hospital, Toronto, Canada
| | - Marcel Émond
- Axe Sante des Populations et Pratiques Optimales en Sante, Centre de recherche du CHU de Quebec, Canada
- Universite Laval, Quebec, Canada
- Centre d'excellence sur le Vieillissement de Quebec, Canada
| | - Éric Mercier
- Axe Sante des Populations et Pratiques Optimales en Sante, Centre de recherche du CHU de Quebec, Canada
- Universite Laval, Quebec, Canada
- Department of Epidemiology and Preventive Medicine, Monash University, Australia
| | - Andrew P Costa
- Department of Clinical Epidemiology and Biostatistics and Department of Medicine, McMaster University, Hamilton, Canada
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Lakhan P, Askew D, Harris MF, Kirk C, Hayman N. Understanding health talk in an urban Aboriginal and Torres Strait Islander primary healthcare service: a cross-sectional study. Aust J Prim Health 2017; 23:335-341. [DOI: 10.1071/py16162] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Accepted: 03/15/2017] [Indexed: 11/23/2022]
Abstract
Health literacy is an important determinant of health status. This cross-sectional study aimed to describe the prevalence of adequate health literacy among Aboriginal and Torres Strait Islander patients or their carers including parents of sick children attending an urban primary healthcare clinic in Australia, and their experiences of communication with General Practitioners (GPs). A questionnaire, including questions from the Brief Health Literacy Screen (BHLS) and questions from the Consumer Assessment of Healthcare Providers and Systems (CAHPS): Communication with Provider, was administered to 427 participants. Descriptive statistics, Pearson’s Chi-Square test and logistic regression analysis were used to describe the prevalence and risk factors associated with health literacy and any associations between the CAHPS questions and health literacy. In total, 72% of participants had adequate health literacy. An age of ≥50 years was independently associated with inadequate health literacy, and completion of secondary or post-secondary schooling was protective. Communication questions that identified areas for improvement included less use of incomprehensible medical words and more frequent use of visual aids. The study provides useful information on health literacy among Aboriginal and Torres Strait Islander patients, or their carers, and their experiences of communication with GPs. Further population-based research is required to investigate the effect of health literacy on health outcomes of Aboriginal and Torres Strait Islander patients.
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Abstract
BACKGROUND Mid- to late-stage dementia is often characterized by behavioural and psychological symptoms, including, but not limited to physical and verbal aggression. INTRODUCTION Although there is a considerable research about the prevalence, aetiology, and management of behavioural and psychological symptoms of dementia, there is limited research about the experience of caring for people with such symptoms in long-term aged care facilities. AIM The aims of the study were to describe: (i) nurses' experiences of caring for people with behavioural and psychological symptoms of dementia in long-term aged care facilities, and (ii) strategies nurses used to deal with these symptoms. METHODS A qualitative exploratory and descriptive design, involving focus group interviews with 30 nurses from three long-term aged care units in Australia. The transcripts were analysed using inductive content analysis. RESULTS The findings revealed five interrelated themes: (i) working under difficult conditions, (ii) behavioural and psychological symptoms of dementia: an everyday encounter, (iii) making sense of behavioural and psychological symptoms of dementia, (iv) attempting to manage behavioural and psychological symptoms of dementia, and (v) feeling undervalued. CONCLUSION This study highlighted the difficult conditions under which nurses worked and the complexity of caring for individuals who have behavioural and psychological symptoms of dementia. IMPLICATIONS FOR NURSING AND HEALTH POLICY Organizational efforts to enhance the quality of care for individuals with behavioural and psychological symptoms of dementia in long-term aged care facilities should extend beyond staff education to heed nurses' concerns about organizational barriers to interpersonal care.
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Affiliation(s)
- J Ostaszkiewicz
- Centre for Quality and Patient Safety Research, School of Nursing and Midwifery, Deakin University, Melbourne, Vic., Australia
| | - P Lakhan
- Centre for Research in Geriatric Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - B O'Connell
- Faculty of Nursing, University of Manitoba, Winnipeg, Manitoba, Canada
| | - M Hawkins
- School of Nursing and Midwifery, Deakin University, Melbourne, Vic., Australia
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Si D, Rajmokan M, Lakhan P, Marquess J, Coulter C, Paterson D. Surgical site infections following coronary artery bypass graft procedures: 10 years of surveillance data. BMC Infect Dis 2014; 14:318. [PMID: 24916690 PMCID: PMC4061097 DOI: 10.1186/1471-2334-14-318] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2014] [Accepted: 05/30/2014] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Surgical site infections following coronary artery bypass graft (CABG) procedures pose substantial burden on patients and healthcare systems. This study aims to describe the incidence of surgical site infections and causative pathogens following CABG surgery over the period 2003-2012, and to identify risk factors for complex sternal site infections. METHODS Routine computerised surveillance data were collected from three public hospitals in Queensland, Australia in which CABG surgery was performed between 2003 and 2012. Surgical site infection rates were calculated by types of infection (superficial/complex) and incision sites (sternal/harvest sites). Patient and procedural characteristics were evaluated as risk factors for complex sternal site infections using a logistic regression model. RESULTS There were 1,702 surgical site infections (518 at sternal sites and 1,184 at harvest sites) following 14,546 CABG procedures performed. Among 732 pathogens isolated, Methicillin-sensitive Staphylococcus aureus accounted for 28.3% of the isolates, Pseudomonas aeruginosa 18.3%, methicillin-resistant Staphylococcus aureus 14.6%, and Enterobacter species 6.7%. Proportions of Gram-negative bacteria elevated from 37.8% in 2003 to 61.8% in 2009, followed by a reduction to 42.4% in 2012. Crude rates of complex sternal site infections increased over the reporting period, ranging from 0.7% in 2004 to 2.6% in 2011. Two factors associated with increased risk of complex sternal site infections were identified: patients with an ASA (American Society of Anaesthesiologists) score of 4 or 5 (reference score of 3, OR 1.83, 95% CI 1.36-2.47) and absence of documentation of antibiotic prophylaxis (OR 2.03, 95% CI 1.12-3.69). CONCLUSIONS Compared with previous studies, our data indicate the importance of Gram-negative organisms as causative agents for surgical site infections following CABG surgery. An increase in complex sternal site infection rates can be partially explained by the increasing proportion of patients with more severe underlying disease.
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Affiliation(s)
- Damin Si
- Centre for Healthcare Related Infection Surveillance and Prevention, Queensland Health, Brisbane, Australia.
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Costa AP, Hirdes JP, Heckman GA, Dey AB, Jonsson PV, Lakhan P, Ljunggren G, Singler K, Sjostrand F, Swoboda W, Wellens NI, Gray LC. Geriatric syndromes predict postdischarge outcomes among older emergency department patients: findings from the interRAI Multinational Emergency Department Study. Acad Emerg Med 2014; 21:422-33. [PMID: 24730405 DOI: 10.1111/acem.12353] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2013] [Revised: 09/22/2013] [Accepted: 10/26/2013] [Indexed: 12/20/2022]
Abstract
OBJECTIVES Identifying older emergency department (ED) patients with clinical features associated with adverse postdischarge outcomes may lead to improved clinical reasoning and better targeting for preventative interventions. Previous studies have used single-country samples to identify limited sets of determinants for a limited number of proxy outcomes. The objective of this study was to identify and compare geriatric syndromes that influence the probability of postdischarge outcomes among older ED patients from a multinational context. METHODS A multinational prospective cohort study of ED patients aged 75 years or older was conducted. A total of 13 ED sites from Australia, Belgium, Canada, Germany, Iceland, India, and Sweden participated. Patients who were expected to die within 24 hours or did not speak the native language were excluded. Of the 2,475 patients approached for inclusion, 2,282 (92.2%) were enrolled. Patients were assessed at ED admission with the interRAI ED Contact Assessment, a geriatric ED assessment. Outcomes were examined for patients admitted to a hospital ward (62.9%, n=1,436) or discharged to a community setting (34.0%, n=775) after an ED visit. Overall, 3% of patients were lost to follow-up. Hospital length of stay (LOS) and discharge to higher level of care was recorded for patients admitted to a hospital ward. Any ED or hospital use within 28 days of discharge was recorded for patients discharged to a community setting. Unadjusted and adjusted odds ratios (ORs) were used to describe determinants using standard and multilevel logistic regression. RESULTS A multi-country model including living alone (OR=1.78, p≤0.01), informal caregiver distress (OR=1.69, p=0.02), deficits in ambulation (OR=1.94, p≤0.01), poor self-report (OR = 1.84, p≤0.01), and traumatic injury (OR=2.18, p≤0.01) best described older patients at risk of longer hospital lengths of stay. A model including recent ED visits (OR=2.10, p≤0.01), baseline functional impairment (OR=1.68, p≤0.01), and anhedonia (OR=1.73, p≤0.01) best described older patients at risk of proximate repeat hospital use. A sufficiently accurate and generalizable model to describe the risk of discharge to higher levels of care among admitted patients was not achieved. CONCLUSIONS Despite markedly different health care systems, the probability of long hospital lengths of stay and repeat hospital use among older ED patients is detectable at the multinational level with moderate accuracy. This study demonstrates the potential utility of incorporating common geriatric clinical features in routine clinical examination and disposition planning for older patients in EDs.
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Affiliation(s)
- Andrew P. Costa
- The Institute for Clinical Evaluative Sciences; Toronto Ontario Canada
- The Department of Medicine; McMaster University; Hamilton Ontario Canada
- The School of Public Health and Health Systems; University of Waterloo; Waterloo Ontario Canada
| | - John P. Hirdes
- The School of Public Health and Health Systems; University of Waterloo; Waterloo Ontario Canada
| | - George A. Heckman
- The Department of Medicine; McMaster University; Hamilton Ontario Canada
- The School of Public Health and Health Systems; University of Waterloo; Waterloo Ontario Canada
| | - Aparajit B. Dey
- The Department of Geriatric Medicine; All India Institute of Medical Sciences; New Delhi India
| | - Palmi V. Jonsson
- The Department of Geriatrics; Landspitali University Hospital; Faculty of Medicine; University of Iceland; Reykjavik Iceland
| | - Prabha Lakhan
- The Centre for Research in Geriatric Medicine; The University of Queensland; Brisbane Queensland Australia
| | - Gunnar Ljunggren
- The Medical Management Centre; Department of Learning, Informatics; Management and Ethics; Karolinska Institutet; Stockholm Sweden
| | - Katrin Singler
- The Institute for Biomedicine of Aging; University of Erlangen-Nuremberg; Klinikum Nuremberg Germany
| | - Fredrik Sjostrand
- Karolinska Institutet; Department of Clinical Science and Education; Södersjukhuset, and the Section of Emergency Medicine; Södersjukhuset AB Stockholm Sweden
| | - Walter Swoboda
- The Institute for Biomedicine of Aging; University of Erlangen-Nuremberg; Klinikum Nuremberg Germany
| | - Nathalie I.H. Wellens
- The Department of Public Health; Centre for Health Services and Nursing Research; KU Leuven Belgium
- The Geriatrics Center and Institute of Gerontology; University of Michigan; Ann Arbor MI
| | - Leonard C. Gray
- The Centre for Research in Geriatric Medicine; The University of Queensland; Brisbane Queensland Australia
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Lakhan P, Jones M, Wilson A, Gray LC. The Higher Care At Discharge Index (HCDI): Identifying older patients at risk of requiring a higher level of care at discharge. Arch Gerontol Geriatr 2013; 57:184-91. [DOI: 10.1016/j.archger.2013.04.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2012] [Revised: 04/08/2013] [Accepted: 04/10/2013] [Indexed: 11/25/2022]
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Lakhan P, Faoagali J, Steinhardt R, Olesen D. Shelf life of sterilized packaged items stored in acute care hospital settings: factors for consideration. ACTA ACUST UNITED AC 2013. [DOI: 10.1071/hi13002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Gray LC, Peel NM, Costa AP, Burkett E, Dey AB, Jonsson PV, Lakhan P, Ljunggren G, Sjostrand F, Swoboda W, Wellens NIH, Hirdes J. Profiles of older patients in the emergency department: findings from the interRAI Multinational Emergency Department Study. Ann Emerg Med 2013; 62:467-474. [PMID: 23809229 DOI: 10.1016/j.annemergmed.2013.05.008] [Citation(s) in RCA: 81] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2013] [Revised: 05/07/2013] [Accepted: 05/14/2013] [Indexed: 11/17/2022]
Abstract
STUDY OBJECTIVE We examine functional profiles and presence of geriatric syndromes among older patients attending 13 emergency departments (EDs) in 7 nations. METHODS This was a prospective observational study of a convenience sample of patients, aged 75 years and older, recruited sequentially and mainly during normal working hours. Clinical observations were drawn from the interRAI Emergency Department Screener, with assessments performed by trained nurses. RESULTS A sample of 2,282 patients (range 98 to 549 patients across nations) was recruited. Before becoming unwell, 46% were dependent on others in one or more aspects of personal activities of daily living. This proportion increased to 67% at presentation to the ED. In the ED, 26% exhibited evidence of cognitive impairment, and 49% could not walk without supervision. Recent falls were common (37%). Overall, at least 48% had a geriatric syndrome before becoming unwell, increasing to 78% at presentation to the ED. This pattern was consistent across nations. CONCLUSION Functional problems and geriatric syndromes affect the majority of older patients attending the ED, which may have important implications for clinical protocols and design of EDs.
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Affiliation(s)
- Leonard C Gray
- Centre for Research in Geriatric Medicine, the University of Queensland, Brisbane, Queensland, Australia
| | - Nancye M Peel
- Centre for Research in Geriatric Medicine, the University of Queensland, Brisbane, Queensland, Australia.
| | - Andrew P Costa
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada; Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Ellen Burkett
- Princess Alexandra Hospital Emergency Department, Brisbane, Queensland, Australia
| | - Aparajit B Dey
- Department of Geriatric Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Palmi V Jonsson
- Department of Geriatrics, Landspitali University Hospital and Faculty of Medicine, University of Iceland, Reykjavic, Iceland
| | - Prabha Lakhan
- Centre for Research in Geriatric Medicine, the University of Queensland, Brisbane, Queensland, Australia
| | - Gunnar Ljunggren
- Public Healthcare Services Committee Administration, Stockholm County Council, Stockholm, Sweden; Medical Management Centre, Department of Learning, Informatics, Management and Ethics, Stockholm, Sweden; Karolinska Institutet, Stockholm, Sweden
| | - Fredrik Sjostrand
- Karolinska Institutet, Stockholm, Sweden; Department of Clinical Science and Education, Södersjukhuset and Section of Emergency Medicine, Södersjukhuset AB, Stockholm, Sweden
| | - Walter Swoboda
- Institute for Biomedicine of Aging, University of Erlangen Nuremberg, Klinikum Nuremberg, Germany
| | - Nathalie I H Wellens
- Department of Public Health, Centre for Health Services and Nursing Research, KU Leuven, Belgium
| | - John Hirdes
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
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Islam T, O'Connell B, Lakhan P. Hospital readmission among older adults with congestive heart failure. AUST HEALTH REV 2013; 37:362-8. [DOI: 10.1071/ah12042] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2012] [Accepted: 01/30/2013] [Indexed: 11/23/2022]
Abstract
Introduction.
To examine the factors associated with unplanned readmission among older adults with congestive heart failure (CHF) within 28 days of discharge from an index admission, within a large Australian health service.
Methods.
Using a comparative cohort design, a multivariate logistic regression model was used to compare readmitted patients with non-readmitted patients and identify risk factors associated with readmission.
Results.
Significant risk factors identified were male gender, numerous diagnoses, length of stay 3 days or longer and patients being admitted from acute, subacute or aged-care facilities.
Conclusions.
The high risk of patients being readmitted from acute, subacute and aged-care services requires further review as these readmissions may be avoidable. It may also be useful to develop a readmission risk screening tool so that patients at risk of readmission can be identified.
What is known about this topic?
Older adults with CHF are likely to experience multiple readmissions to hospital. There have been several studies conducted on hospital readmissions; however, generalising the findings is problematic due to the use of variable definitions of what constitutes a readmission.
What does this paper add?
This paper addresses the absence of Australian research comparing groups of older patients with CHF who are readmitted to hospital with those who are not readmitted. It also adopts one of the more frequently used definitions of readmission to aid in future comparability of research.
What are the implications for practice?
Further work is necessary to improve discharge planning and effectively manage chronic illnesses such as CHF in patients’ homes. It may be useful to develop a readmission risk screening tool for staff of inpatient medical wards so that these at-risk patients can be identified before discharge.
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Lakhan P, Jones M, Wilson A, Gray LC. The decline in Activities of Daily Living at Discharge (DADLD) index: stratifying patients at lower and higher risk. J Nutr Health Aging 2012; 16:919-24. [PMID: 23208033 DOI: 10.1007/s12603-012-0092-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND Decreased ability to perform Activities of Daily Living (ADLs) during hospitalisation has negative consequences for patients and health service delivery. OBJECTIVE To develop an Index to stratify patients at lower and higher risk of a significant decline in ability to perform ADLs at discharge. DESIGN Prospective two cohort study comprising a derivation (n=389; mean age 82.3 years; SD± 7.1) and a validation cohort (n=153; mean age 81.5 years; SD± 6.1). PATIENTS AND SETTING General medical patients aged ≥ 70 years admitted to three university-affiliated acute care hospitals in Brisbane, Australia. MEASUREMENT AND MAIN RESULTS The short ADL Scale was used to identify a significant decline in ability to perform ADLs from premorbid to discharge. In the derivation cohort, 77 patients (19.8%) experienced a significant decline. Four significant factors were identified for patients independent at baseline: 'requiring moderate assistance to being totally dependent on others with bathing'; 'difficulty understanding others (frequently or all the time)'; 'requiring moderate assistance to being totally dependent on others with performing housework'; a 'history of experiencing at least one fall in the previous 90 days prior to hospital admission' in addition to 'independent at baseline', which was protective against decline at discharge. 'Difficulty understanding others (frequently or all the time)' and 'requiring moderate assistance to being totally dependent on others with performing housework' were also predictors for patients dependent in ADLs at baseline. Sensitivity, specificity, Positive Predictive Value (PPV), and Negative Predictive Value (NPV) of the DADLD dichotomised risk scores were: 83.1% (95% CI 72.8; 90.7); 60.5% (95% CI 54.8; 65.9); 34.2% (95% CI 27.5; 41.5); 93.5% (95% CI 89.2; 96.5). In the validation cohort, 47 patients (30.7%) experienced a significant decline. Sensitivity, specificity, PPV and NPV of the DADLD were: 78.7% (95% CI 64.3; 89.3); 69.8% (95% CI 60.1, 78.3); 53.6% (95% CI 41.2; 65.7); 88.1% (95% CI 79.2; 94.1). CONCLUSIONS The DADLD Index is a useful tool for identifying patients at higher risk of decline in ability to perform ADLs at discharge.
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Affiliation(s)
- P Lakhan
- The University of Queensland, Brisbane, Australia
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Abstract
OBJECTIVES To develop and validate a screening strategy for delirium within the inter RAI acute care comprehensive assessment system. DESIGN Prospective validation cohort study. SETTING Acute general medical wards in two acute care metropolitan hospitals in Brisbane, Australia. PARTICIPANTS Two hundreds thirty-nine subjects with and without delirium, aged 70 and older. MEASUREMENTS Trained research nurses assessed subjects within 36 hours of hospital admission using the inter-RAI acute care (AC) system which includes four observational delirium items: Acute change mental status from baseline (ACMS), mental function varies over the course of the day (MFV), episode of disorganised speech (EDS), and easily distracted (ED). Geriatricians assessed subjects face to face within 4 hours of nurses' assessment using the Diagnostic and statistical manual of mental disorders (DSM IV) criteria and clinical judgement to determine delirium presence. Based on the performance of each delirium feature and to achieve highest predictive accuracy, a combination algorithm of either ACMS or MFV was developed and compared with the reference standard diagnosis determined by geriatricians. RESULTS Geriatricians diagnosed delirium in 52 of 239 (21.7%) subjects aged 70-102 years. The area under the receiver operator characteristics (AUC) for interRAI-AC delirium screener algorithm was 0.87 (95% CI; 0.80, 0.93), sensitivity 82%, specificity 91%, positive and negative predictive value of 0.72% and 95%, and likelihood ratio of 9.6 achieving the highest predictive accuracy of all possible combination of 4 delirium features. Underlying pre-morbid cognitive impairment did not undermine validity of the screening strategy, AUC 0.85 (95% CI; 0.74, 0.95), sensitivity 90% and specificity 69%. CONCLUSION The interRAI AC delirium screening strategy is a valid measure of delirium in older subjects in acute medical wards.
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Affiliation(s)
- S A Salih
- Centre for research in Geriatric Medicine, The University of Queensland, Woolloongabba, Brisbane, Australia.
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Lakhan P, Jones M, Wilson A, Courtney M, Hirdes J, Gray LC. A Prospective Cohort Study of Geriatric Syndromes Among Older Medical Patients Admitted to Acute Care Hospitals. J Am Geriatr Soc 2011; 59:2001-8. [DOI: 10.1111/j.1532-5415.2011.03663.x] [Citation(s) in RCA: 99] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
| | | | - Andrew Wilson
- Faculty of Health; Queensland University of Technology; Brisbane; Australia
| | | | | | - Leonard C. Gray
- Centre for Research in Geriatric Medicine; The University of Queensland
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Lakhan P, Doherty J, Jones M, Clements A. A systematic review of maternal intrinsic risk factors associated with surgical site infection following Caesarean sections. ACTA ACUST UNITED AC 2010. [DOI: 10.1071/hi10001] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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