Moore JK, Rayner C, Skinner SR
… +13 more, Wynne K, Cavve BS, Fraser B, Ganti U, McAllister C, Meyerowitz-Katz G, Nguyen T, Ravine A, Ross B, Russell DB, Saunders LA, Siafarikas A, Pang KC
OBJECTIVES: To quantify the cost of hospital separations attributable to environmental risk factors in the Northern Territory, including for Indigenous and remote subgroups. STUDY DESIGN: A retrospective cross-sectional...OBJECTIVES: To quantify the cost of hospital separations attributable to environmental risk factors in the Northern Territory, including for Indigenous and remote subgroups. STUDY DESIGN: A retrospective cross-sectional secondary data analysis of hospital separations data. Data collection, analysis and presentation were guided by our Indigenous Steering Committee. SETTING AND PARTICIPANTS: All episodes of care from 1 July 2021 to 30 June 2022 with an inpatient separation (discharge, transfer, death) from NT public hospitals were included. Non-inpatient episodes of care (outpatient, emergency department and primary care presentations) were excluded. MAJOR OUTCOME MEASURES: Individual hospital separations were classified as environmentally attributable if the International statistical classification of diseases and related health problems, 10th revision, Australian modification (ICD-10-AM) code for their primary diagnosis matched an included disease. Included diseases were based on environmental attributable fractions previously generated for the Kimberley region, contextualised to the NT. Costs were assigned to individual hospital separations based on activity-based funding allocations. RESULTS: Environmental risk factors contributed more than $72 million to inpatient hospital costs in the NT over 1 year. Environmental risks disproportionately affected children aged 0-4 years ($10.9 million), Indigenous people ($47.2 million) and those in remote areas ($41.7 million). Skin disease made up the largest contribution by a single disease ($26.4 million). The two largest categories of environmental risk were "water quality, sanitation and hygiene" and "home condition", together contributing $37.3 million in costs. CONCLUSIONS: Quantifying the economic impact of preventable environmental risk in the NT bolsters the argument for strengthening environmental health initiatives. Health disparities between groups reflect the interconnectedness of environmental, social and cultural determinants of health. Targeted interventions to reduce inequities in housing, sanitation and water quality are needed. Delivering on existing environmental health commitments through meaningful partnerships and coordinated action across sectors such as housing and education is essential, particularly within the Northern Territory Implementation Plan on Closing the Gap.
OBJECTIVES: To understand whether and how breast magnetic resonance imaging (MRI) at cancer diagnosis influences treatment planning, and whether subpopulations of patients with newly diagnosed breast cancer benefit in te...OBJECTIVES: To understand whether and how breast magnetic resonance imaging (MRI) at cancer diagnosis influences treatment planning, and whether subpopulations of patients with newly diagnosed breast cancer benefit in terms of most appropriate management. DESIGN: Multicentre prospective observational study. SETTING: Seven centres across New South Wales, Victoria and Western Australia during the period 15 September 2020 to 14 July 2022. PARTICIPANTS: Patients with newly diagnosed early breast cancer meeting predefined criteria for whom multidisciplinary team normal practice deemed MRI would aid treatment planning. INTERVENTION: Preoperative contrast-enhanced MRI. MAIN OUTCOME MEASURES: Reasons for requesting MRI; pre-MRI versus post-MRI changes in treatment plans; changes justified by pathology findings. RESULTS: 387 eligible participants were enrolled. MRI was most frequently requested for dense breasts (252 [65%]), clinical and/or radiological size discrepancy (161 [42%]), multifocality (108 [28%]) and young age (105 [27%]). Change in treatment plan after MRI occurred for 198 participants (51% [95% CI, 46-56%]), including a change in breast surgery plan for 119 participants (31% [95% CI, 26-36%]). More mastectomies were planned after MRI (15% v 28%; absolute risk difference [RD], 13 percentage points [95% CI, 9-17]; P < 0.001), including unilateral mastectomy (14% v 24%; RD, 10 percentage points [95% CI, 6-14]; P < 0.001) and bilateral mastectomy (1% v 4%; RD, 3 percentage points [95% CI, 1-5]; P < 0.001). No increases in planned mastectomies occurred for women aged ≥ 70 years (RD, -3 percentage points [95% CI, -15 to 9]; or in those for whom neoadjuvant therapy was planned (RD, 2 percentage points [95% CI, -11 to 14]). Change in surgery was deemed justified by pathology findings in 75 of 88 women who experienced a change (85% [95% CI, 75-91%]). CONCLUSIONS: Preoperative MRI findings led to changes in surgical management for a third of selected women with early breast cancer, increasing the mastectomy rate. In most cases, the changes were deemed appropriate. MRI findings did not change planned mastectomy in those aged ≥ 70 years, indicating that these women may not experience changes in surgical plans after such testing.
OBJECTIVE: To compare the frequency of non-technical errors in cases of surgical care-related deaths in Australia, by surgical specialty. STUDY DESIGN: Retrospective cohort study; analysis of Australian and New Zealand A...OBJECTIVE: To compare the frequency of non-technical errors in cases of surgical care-related deaths in Australia, by surgical specialty. STUDY DESIGN: Retrospective cohort study; analysis of Australian and New Zealand Audit of Surgical Mortality (ANZASM) data. SETTING, PARTICIPANTS: All surgical care-related deaths in Australia (except New South Wales), 1 January 2012 - 31 December 2019, that were flagged in ANZASM as associated with adverse events or areas of concern. MAIN OUTCOME MEASURES: Proportions of surgical care-related deaths associated with non-technical errors, overall and by domain (communication/teamwork, decision making, situational awareness, leadership); paired comparisons of likelihood of errors by specialty; change in error proportions during 2012-2019; influence of patient and admission factors on likelihood of non-technical errors. RESULTS: Of 30 971 surgical care-related deaths reported to ANZASM during 2012-2019, 3695 were flagged with adverse events or areas of concern, including 3422 cases (92.6%) in five surgical specialties: general surgery (1570 deaths), cardiothoracic surgery (626), orthopaedic surgery (510), vascular surgery (385), and neurosurgery (331). The proportions of surgical care-related deaths associated with non-technical errors differed by specialty (range, 52.2% to 68.5%), as did those errors in the domains decision making (range, 52.6% to 66.3%) and situational awareness errors (range, 44.4% to 62.5%). The probability of any non-technical error was greater for cardiothoracic than orthopaedic surgery (adjusted odds ratio [aOR], 1.76; 95% confidence interval [CI], 1.37-2.28), and for general than orthopaedic surgery (aOR, 1.97, 95% CI, 1.59-2.44) or neurosurgery (aOR, 1.47; 95% CI, 1.14-1.90); the probability was lower for orthopaedic than vascular surgery (aOR, 0.54; 95% CI, 0.41-0.72). The proportion of deaths associated with non-technical errors declined over time for general surgery, but not the other four specialties. Differences by patient and admission characteristics in the proportions of cases including non-technical errors were not statistically significant. CONCLUSION: At least 50% of surgical care-related deaths in five surgical specialties were associated with non-technical errors, and the proportions did not substantially change during 2012-2019. Differences between specialties in the frequency of fatal non-technical error suggest that targeted improvement strategies are needed, but the persistently high frequency for all specialties indicates that systemwide improvement is crucial.
OBJECTIVES: To determine the incidence and prevalence of acute rheumatic fever (ARF) and rheumatic heart disease (RHD) in Queensland during the period 2017-2021. STUDY DESIGN: Population-level retrospective cohort study...OBJECTIVES: To determine the incidence and prevalence of acute rheumatic fever (ARF) and rheumatic heart disease (RHD) in Queensland during the period 2017-2021. STUDY DESIGN: Population-level retrospective cohort study using linked administrative data. SETTING, PARTICIPANTS: Queensland residents aged younger than 45 years for ARF and younger than 55 years for RHD, identified from hospital, emergency department, death and Queensland RHD Register records for the period 1 January 2017 to 31 December 2021. MAIN OUTCOME MEASURES: Age-specific and age-standardised incidence and prevalence of ARF and RHD; and age-standardised incidence and prevalence ratios comparing Indigenous and non-Indigenous populations. RESULTS: 736 ARF episodes occurred among 670 people (395 [54%] female participants; 609 [83%] Indigenous). Of 4519 prevalent RHD cases aged < 55 years who were alive on 1 July 2021, 2655 (59%) were female, 2169 (48%) were Indigenous, and 1846 (41%) had severe disease. Previous ARF was recorded for 362 cases (8%). Among RHD cases aged younger than 25 years, 633 of 790 Indigenous individuals (80%) and 133 of 408 non-Indigenous individuals (33%) had RHD Register records. Indigenous age-standardised incidence (< 45 years) was 60.2 times higher (95% CI, 55.6-64.2) than non-Indigenous incidence for first ever ARF, 68.6 times higher (95% CI, 62.3-72.5) for total ARF, and 18.9 times higher (95% CI, 13.5-24.1) for RHD. For Indigenous people aged < 55 years, prevalence was 22.6 times higher (95% CI, 16.2-27.3) for ARF/RHD, 18.4 times higher (95% CI, 12.9-24.1) for RHD, and 12.1 times higher (95% CI, 8.3-15.9) for severe RHD. The overall burden of ARF and RHD was highest in northern Queensland health districts, whereas cases in the non-Indigenous population were concentrated in metropolitan south-east Queensland. CONCLUSIONS: The vast disparity in ARF and RHD burden between Indigenous and non-Indigenous Queenslanders indicates an urgent need for targeted, community-led prevention strategies. Under-representation of non-Indigenous youth in the RHD Register suggests improved clinical awareness and reporting is needed. Further investigation is warranted to inform equitable responses.
George J, Allard NL, Roberts SK
… +28 more, Adams LA, Davies J, Hajarizadeh B, MacLachlan JH, Mahady SE, Altus R, Brown C, Fry DC, Greenwood-Smith B, Smud N, Valery PC, Yussf N, Broun K, Campbell D, Canfell K, Harrison CC, Freeman V, Grogan P, Holliday C, Hughes S, Kelly A, van Kemenade C, Latumahina C, McAtamney A, Varlow M, Worthington J, Yuill S, Feletto E
INTRODUCTION: Hepatocellular carcinoma (HCC) is the most common form of primary liver cancer, the sixth most common cause of cancer death in Australia. With shifting aetiologies and a growing at-risk population, consiste...INTRODUCTION: Hepatocellular carcinoma (HCC) is the most common form of primary liver cancer, the sixth most common cause of cancer death in Australia. With shifting aetiologies and a growing at-risk population, consistent routine surveillance recommendations are key to early detection of HCC and improved survival. We developed new evidence-based HCC surveillance guidelines for people at high risk in Australia due to liver disease and/or other risk factors. These guidelines were developed by a working group of experts in liver cancer control and included evidence reviews, synthesis and adaptation of existing guidelines for the Australian context, and predictive modelling. MAIN RECOMMENDATIONS: This article summarises the recommendations and practice points for key population subgroups who were identified as potentially benefitting from routine HCC surveillance in the form of six-monthly ultrasound scans, with or without α-fetoprotein testing. People with liver cirrhosis and a non-HCC-related life expectancy of greater than six months are recommended to receive routine HCC surveillance. People with chronic hepatitis B virus infection who do not have liver cirrhosis are recommended to receive routine HCC surveillance if they have a family history of HCC, are Aboriginal or Torres Strait Islander peoples, or have an Asian, Pacific, or sub-Saharan African background, with varying start ages recommended for each group. People with stage 3 non-cirrhotic liver fibrosis (F3) may be recommended to receive routine HCC surveillance based on individual risk assessment, or otherwise monitored for progression to cirrhosis. The final guidelines were approved by the National Health and Medical Research Council (NHMRC) in April 2023. CHANGES IN MANAGEMENT AS A RESULT OF THE GUIDELINE: The updated guidelines formalise recommendations for people with cirrhosis, identify other patient groups who are recommended for surveillance, and highlight gaps in evidence where the benefit of surveillance is unclear. These guidelines were accompanied by the Roadmap to liver cancer control, a coordinated ten-year plan for advancing liver cancer prevention and early detection in Australia. The full guidelines can be accessed at https://cancer.org.au/clinical-guidelines/liver-cancer/hepatocellular-carcinoma.
OBJECTIVES: To examine whether sex differences in cardiovascular disease care and outcomes for people hospitalised with ST-elevation myocardial infarction (STEMI) in New South Wales have declined during 2011-2020. STUDY...OBJECTIVES: To examine whether sex differences in cardiovascular disease care and outcomes for people hospitalised with ST-elevation myocardial infarction (STEMI) in New South Wales have declined during 2011-2020. STUDY DESIGN: Retrospective cohort study; analysis of linked New South Wales Admitted Patient Data Collection and Registry of Births, Deaths and Marriages data. SETTING, PARTICIPANTS: Adults (18 years or older) admitted to public or private hospitals in New South Wales with STEMI for the first time during 1 January 2011 - 31 December 2020. MAJOR OUTCOME MEASURES: Proportions of people who received coronary angiography or percutaneous coronary intervention (PCI) within seven days of first STEMI admission, by year and sex; proportions of STEMI admissions followed by major adverse cardiovascular events (MACE) or death (any cause) within twelve months, by year and sex; rate of change in these parameters, adjusted for age group, intensive care unit admission, and Charlson Comorbidity Index score. RESULTS: We identified 29 435 initial STEMI hospital admissions during 2011-2020; the mean age at admission was 66.1 years (standard deviation, 14.2 years), 8475 patients were women (28.8%) and 20 960 were men (71.2%). The proportions of female patients who underwent angiography (71.9% v 85.1%) or PCI (54.4% v 70.0%) were smaller than those of male patients. During 2011-2020, the increase in the angiography proportion was greater for female than for male patients (2.7 [95% confidence interval {CI}, 2.5-2.9] v 1.5 [95% CI, 1.4-1.6] percentage points per year), as was the change in PCI proportion (3.2 [95% CI, 2.9-3.6] v 2.5 [95% CI, 2.3-2.7] percentage points per year). The proportions of admissions followed by MACE (18.4% v 15.0%) or death of any cause (14.7% v 8.5%) were larger for female than male patients. The decline in the MACE proportion during 2011-2020 was similar for female and male patients (0.8 [95% CI, 0.5-1.1] v 0.5 [95% CI, 0.3-0.7] percentage points per year); the decline in all-cause mortality was greater for female than male patients (1.0 [95% CI, 0.8-1.1] v 0.6 [95% CI, 0.5-0.7] percentage points per year). CONCLUSION: The increase in the proportions of patients with STEMI who underwent timely angiography and PCI was more rapid during 2011-2020 for female than male patients, and the decline in all-cause mortality was also greater. Sex differences in treatment and outcomes for people with STEMI are declining but will not be eliminated during the next ten years.