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This case study evaluated the effects of a health package (HP) of a light intensity individualised exercise program and advice on anxiety management and nutrition, on the physical and mental health of people with or without COVID-19, who were quarantined in hotels used as Special Health Accommodation and admitted to the Royal Prince Alfred Virtual Hospital, Sydney during the COVID-19 pandemic. After initial screening and consenting, participants completed three surveys: Depression, Anxiety, Stress Scale; Brief Fatigue Inventory; and the European Quality of Life 5-Dimensions 5-Levels, and were provided with the HP for the duration of their quarantine. The three surveys and a participant reported experience measure were completed prior to discharge. The HP for people in quarantine demonstrated stability of health outcomes and reduction in fatigue. Most participants reported that the HP helped them cope with isolation. Provision of a HP during quarantine could be useful to support physical and mental health. What is known about the topic? Quarantine during the COVID-19 pandemic could negatively impact physical and mental health. What does this paper add? A health package of light intensity exercise, advice on anxiety management and nutritional information demonstrated maintenance of physical and mental health and reduced fatigue in people with and without mild COVID-19 in hotel quarantine. What are the implications for practitioners? Practitioners should consider providing a health package of exercise, anxiety management and nutritional information to help people in quarantine to cope with the physical and mental isolation. Adequate staffing is required to enable implementation. [ABSTRACT FROM AUTHOR]

Objective: To identify baseline factors associated with outcomes from an inpatient multidisciplinary pain management program (PMP) located in a bicultural area of Aotearoa New Zealand. Methods: A prospective cohort study was undertaken involving 164 people with chronic pain who attended the PMP. Demographic, clinical, and psychosocial measures were obtained at baseline, whereas clinical and psychosocial outcome measures were also obtained at program discharge and 3-month follow up (N = 100). Multivariate analyses were used to determine baseline demographic variables that were associated with outcomes at discharge and follow up. Results: Being male and working full-time were associated with poorer outcomes in select measures at discharge. At the 3-month follow up, Māori ethnicity, working full-time, being retired or unemployed, or having chronic widespread pain were associated with poorer outcomes for some measures, whereas those with rheumatoid arthritis had greater self-efficacy. Conclusions: Sex, ethnicity, employment status, and patient condition impact clinical outcomes from the program and in the time from discharge to follow up. Program content and/or delivery should be altered to promote more equitable outcomes for all patients in the long term. What is known about the topic? Multidisciplinary pain management programs (PMPs) are the best treatment for chronic pain, but not everyone benefits from such programs to the same extent. What does this paper add? Ethnicity, employment status, and pain condition are associated with PMP outcomes, but mainly in the long term. What are the implications for practitioners? Program content, delivery, and follow up should be adapted to facilitate equity in long-term outcomes. [ABSTRACT FROM AUTHOR]

Background: Non-traumatic lower limb amputation rates are rising worldwide, resulting in increased hospitalisations and use of rehabilitation services. This study aimed to identify key comorbidities associated with prolonged length of stay or decreased functional gain for episodes receiving inpatient rehabilitation following non-traumatic lower limb amputation. Methods: Prospectively collected data submitted to the Australasian Rehabilitation Outcomes Centre were analysed. The cohort comprised episodes for patients (aged ≥18 years) discharged from inpatient rehabilitation between 1 July 2013 and 30 June 2018 following a non-traumatic lower limb amputation. Results: The cohort included 5074 episodes with an average age of 66.3 years and the majority being male (71.7%). Comorbidities affecting the ability to participate in rehabilitation were reported for 65.4% of episodes, most commonly diabetes mellitus (50.3%), cardiac disease (33.5%), and respiratory disease (10.1%). These comorbidities were associated with a prolonged length of stay and reduced functional improvement. Conclusion: This study showed comorbidities contribute to prolonged length of stay and poorer functional outcomes among those undergoing inpatient rehabilitation following non-traumatic lower limb amputation. Future research should focus on strategies to address these comorbidities to help improve patient outcomes and reduce healthcare costs. What is known about the topic? It is known that the presence of comorbidities contributes to lower limb amputation; however, the effect that comorbidities have on inpatient rehabilitation outcomes is not well reported. What does this paper add? This study identified five comorbidities (diabetes mellitus, cardiac disease, respiratory disease, renal failure with dialysis, and mental health problems) associated with prolonged length of stay and decreased functional outcomes following inpatient rehabilitation for non-traumatic lower limb amputation. What are the implications for practitioners? Our findings suggest practitioners should focus on strategies to address these comorbidities to help improve functional outcomes, reduce length of stay, and reduce healthcare costs. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to estimate the public hospital costs associated with primary liver cancer (PLC) in the first and second years following the cancer diagnosis. Methods: This study linked administrative datasets of patients diagnosed with PLC in Victoria, Australia, from January 2008 to December 2015. The health system perspective was adopted to estimate the direct healthcare costs associated with PLC, based on inpatient and emergency costs. Costs were estimated for the first 12 months and 12–24 months after the PLC diagnosis and expressed in 2017 Australian dollars (A$). The cost estimated was then extrapolated nationally. The linear mixed model with a Box–Cox transformation of the costs was used to explore the relationship between costs and patients' sociodemographic and clinical characteristics. Results: For the first 12 months, the total and annual per-patient cost was A$211.4 million and A$63 664, respectively. Costs for the subsequent year were A$49.7 million and A$46 751, respectively. Regarding the cost extrapolation to Australia, the total cost was A$137 million for the first 12 months after notification and A$42.6 million for the period from 12 to 24 months. Higher costs per episode of care were mostly associated with older age, hepatocellular carcinoma type of PLC, metropolitan hospitals, and Asian birth region. Conclusion: This study showed the public hospital admission and emergency costs associated with PLC and the substantial economic burden this cancer has placed on the Australian health system. What is known about the topic? There are limited data on the economic burden of primary liver cancer in Australia. What does this paper add? This study showed the cost in the second year after cancer diagnosis was substantially lower than that of the first year. Higher costs per episode of care were mostly associated with older age, metropolitan hospitals, and Asian birth region. What are the implications for practitioners? Results from this study can be used as a baseline for comparison with other initiatives to mitigate cancer risk factors or inputs for future economic evaluations of cancer surveillance. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to compare robotic versus laparoscopic colorectal operations for clinical outcomes, safety and cost. Methods: A retrospective cohort study was performed of 213 elective colorectal operations (59 robotic, 154 laparoscopic), matched by surgeon and operation type. Results: No differences in age, body mass index, median American Society of Anesthesiologists score or presence of cancer were observed between the laparoscopic or robotic surgery groups. However, patients undergoing robotic colorectal surgery were more frequently male (P = 0.004) with earlier T stage tumours (P = 0.02) if cancer present. Procedures took longer in cases of robotic surgery (302 vs 130 min; P < 0.001), and patients in this group were more frequently admitted to intensive care units (P < 0.001). Overall length of stay was longer (7 vs 5 days; P = 0.03) and consumable cost was A$2728 higher per patient in the robotic surgery group. Conclusion: Robotic colorectal surgery appears to be safe compared with current laparoscopic techniques, albeit with longer procedure times and overall length of stay, more frequent intensive care admissions and higher consumables cost. What is known about the topic?: Robotic surgery is an emerging alternative to traditional laparoscopic approaches in colorectal surgery. International trials suggest the two techniques are equivalent in safety. What does this paper add?: This is an original cohort study examining clinical outcomes in Australian colorectal robotic surgery. The data suggest it may be safe, but this paper demonstrates key issues in the implementation and audit of novel surgical technologies in relatively low-volume centres. What are implications for practitioners?: In our study, patients undergoing robotic colorectal surgery at a single centre in Australia had equivalent measured clinical outcomes to those undergoing laparoscopic surgery. However, practitioners may counsel patients that robotic procedures are typically longer and more expensive, with a longer overall hospital admission and a higher likelihood of intensive care admission. [ABSTRACT FROM AUTHOR]

Objective: The management of low-risk febrile neutropenia (FN) patients through ambulatory programs has demonstrated comparative safety and effectiveness to in-patient strategies. However, there is limited evidence of benefits of changing practice, particularly on a national scale. The aim of this study was to estimate costs and benefits of the program over a 10-year time horizon. Methods: A comparative cost analysis from a health system perspective was performed, comparing costs and length of stay (LOS) of patients enrolled in an ambulatory program to a historical cohort who did not receive the program. Generalised linear models were used for analysis and bootstrapped to account for uncertainty. National data of identified FN admissions were used to inform future projections, with varying proportions of low-risk patients and eligibility for the ambulatory program. Results: The overall LOS for patients in ambulatory cohort was 1.9 days shorter (95% confidence interval (CI) 1.0–2.8 days), a 50% reduction in in-patient bed-days. Although patients in the ambulatory cohort incurred additional costs due to care received outside hospital (mean (± s.d.) A$828.03 ± 124.30), the mean total cost incurred remained substantially lower than that of the historical cohort (A$2979 lower; 95% CI A$772–5391). On a national scale, this could translate into A$62.7 million in costs averted and 41 347 bed-days saved over 10 years if the low-risk prediction rate and eligibility for ambulatory programs remained at currently observed rates. Conclusions: The wider implementation of a safe and effective ambulatory program to manage low-risk FN patients can result in significant return-on-investment for the healthcare system by eliminating avoidable costs due to unnecessary lengthy hospital admissions. What is known about the topic?: There is strong evidence demonstrating out-patient treatment of low-risk FN patients to be an effective and cost-effective strategy compared with continued in-patient hospitalisation. What does this paper add?: This study demonstrates the sustainability of the ambulatory program in ensuring cost benefits and in-patient beds through real-life implementation data. It also provides evidence of the substantial cost and bed-days potentially averted when the cost savings and difference in LOS are estimated on a national scale over a 10-year time horizon. What are the implications for practitioners?: The management of low-risk FN patients through ambulatory or out-patient programs is a safe and effective approach. There is strong evidence demonstrating the likely cost savings and considerable bed-days saved, which can be reallocated to meet other medical demands. [ABSTRACT FROM AUTHOR]

Objective. This study aimed to assess and compare the psychological wellbeing of Australian hospital clinical staff at three timepoints during the coronavirus disease 2019 (COVID-19) pandemic. Methods. An anonymous, online, cross-sectional survey was conducted at three timepoints during the COVID-19 pandemic (T1: May–June 2020; T2: October–December 2020; T3: November 2021–January 2022). The surveys were completed by nurses, midwives, doctors and allied health staff employed at a large metropolitan tertiary health service located in Melbourne, Australia. The Depression, Anxiety and Stress Scale (DASS-21) assessed respondents’ psychological wellbeing in the past week. General linear models were used to measure the effects of survey timepoint on DASS-21 subscale scores, adjusting for selected sociodemographic and health characteristics. Results. A total of 1470 hospital clinical staff completed at least one survey (T1: 668 (14.7%), T2: 358 (7.9%) and T3: 444 (9.8%)). Respondents’ sociodemographic characteristics were similar across the three timepoints and within professional discipline groups. Respondents’ psychological wellbeing was worse at T3 compared to the earlier survey timepoints. Adjusting for respondent characteristics, depression, anxiety and stress scores were significantly higher for respondents of the third survey compared to the first (P < 0.001). Conclusions. There was a significant and persistent negative impact on the psychological wellbeing of hospital clinical staff in Australia across waves of the COVID-19 pandemic. Hospital clinical staff would benefit from ongoing and continued wellbeing support during and after pandemic waves. [ABSTRACT FROM AUTHOR]

Objective. To estimate the risk of an emergency department (ED)/inpatient visit due to complications in people with diabetes and compare them to their non-diabetes counterparts. Methods. This matched retrospective cohort study used a linked dataset in Tasmania, Australia for the 2004–17 period. People with diabetes (n = 45 378) were matched on age, sex and geographical regions with people without diabetes (n = 90 756) based on propensity score matching. The risk of an ED/inpatient visit related to each complication was estimated using negative binomial regression. Results. In people with diabetes, the combined ED and admission rates per 10 000 person-years were considerable, especially for macrovascular complications (ranging from 31.8 (lower extremity amputation) to 205.2 (heart failure)). The adjusted incidence rate ratios of ED/inpatient visits were: retinopathy 59.1 (confidence interval 25.8, 135.7), lower extremity amputation 11.1 (8.8, 14.1), foot ulcer/gangrene 9.5 (8.1, 11.2), nephropathy 7.4 (5.4, 10.1), dialysis 6.5 (3.8, 10.9), transplant 6.3 (2.2, 17.8), vitreous haemorrhage 6.0 (3.7, 9.8), fatal myocardial infarction 3.4 (2.3, 5.1), kidney failure 3.3 (2.3, 4.5), heart failure 2.9 (2.7, 3.1), angina pectoris 2.1 (2.0, 2.3), ischaemic heart disease 2.1 (1.9, 2.3), neuropathy 1.9 (1.7, 2.0), non-fatal myocardial infarction 1.7 (1.6, 1.8), blindness/low vision 1.4 (0.8, 2.5), non-fatal stroke 1.4 (1.3, 1.6), fatal stroke 1.3 (0.9, 2.1) and transient ischaemic attack 1.1 (1.0, 1.2). Conclusions. Our results demonstrated the high demand on hospital services due to diabetes complications (especially macrovascular complications) and highlighted the importance of preventing and properly managing microvascular complications. These findings will support future resource allocation to reduce the increasing burden of diabetes in Australia [ABSTRACT FROM AUTHOR]

Objective. To explore measures of potentially avoidable general practitioner (PAGP)-type presentations to the emergency department (ED) of a large regional hospital in northern Queensland. Methods. Linkage of an ED administrative dataset to a face-to-face patient survey of local residents (n = 1000); calculation of Australian Institute of Health and Welfare (AIHW) and Australasian College of Emergency Medicine (ACEM) measures of PAGP-type presentations to the ED; and exploration of these measures with patient-perspective linked data. Results. PAGP-type presenters to the ED were younger in age (median age in years: total cohort: 49; AIHW 38, P, 0.001; ACEM 36, P, 0.001); with the odds of having a chronic condition being less likely for AIHW PAGP-type presenters than other ED presenters (OR (95% CI) 0.54 (0.38-0.77): P = 0.001)) after adjustment for age. PAGP-type presenters nominated reasons of convenience rather than urgency as their rationale for attending the ED, irrespective of measure. The number of PAGP-type presentations to the ED identified by the AIHW measure was more than three-fold higher than the ACEM measure (AIHW: n = 227; ACEM: n = 67). Influencing factors include the low proportion of ED attendees who had a medical consultation time of ,1 h at this hospital site (1-month survey period: 17.8%); and differences between the patient self-report and EDadministrative record for 'self-referral to the ED' (Self-referred: Survey 71% vs EDIS 93%, P, 0.001). Conclusions. Identification of PAGP-type presentations to the ED could be enhanced with improvements to the quality of administrative processes when recording patient 'self-referral to the ED', along with further consideration of hospital site variation for the length of medical consultation time. [ABSTRACT FROM AUTHOR]

Objectives. The aims of the present study were to identify predictors of admission and describe outcomes for patients who arrived via ambulance to three Australian public emergency departments (EDs), before and after the opening of 41 additional ED beds within the area. Methods. The present study was a retrospective comparative cohort study using deterministically linked health data collected between 3 September 2006 and 2 September 2008. Data included ambulance offload delay, time to see doctor, ED length of stay (LOS), admission requirement, access block, hospital LOS and in-hospital mortality. Logistic regression analysis was undertaken to identify predictors of hospital admission. Results. Almost one-third of all 286 037 ED presentations were via ambulance (n = 79 196) and 40.3% required admission. After increasing emergency capacity, the only outcome measure to improve was in-hospital mortality. Ambulance offload delay, time to see doctor, ED LOS, admission requirement, access block and hospital LOS did not improve. Strong predictors of admission before and after increased capacity included age >65 years, Australian Triage Scale (ATS) Category 1-3, diagnoses of circulatory or respiratory conditions and ED LOS >4 h. With additional capacity, the odds ratios for these predictors increased for age >65 years and ED LOS >4 h, and decreased for ATS category and ED diagnoses. Conclusions. Expanding ED capacity from 81 to 122 beds within a health service area impacted favourably on mortality outcomes, but not on time-related service outcomes such as ambulance offload time, time to see doctor and ED LOS. To improve all service outcomes, when altering (increasing or decreasing) ED bed numbers, the whole healthcare system needs to be considered. [ABSTRACT FROM AUTHOR]