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Background: Electronic health record datasets have been used to determine the prevalence of musculoskeletal complaints in general practice but not to examine the associated characteristics and healthcare utilisation at the primary care level. Aim: To describe the prevalence and characteristics of patients presenting to general practitioners with musculoskeletal complaints. Design and setting: A five-year analysis within three Primary Health Networks (PHNs) in Victoria, Australia. Method: We included patients with at least one face-to-face consultation 2014 to 2018 inclusive and a low back (≥ 18 years), and/or neck, shoulder or knee (≥ 45 years) complaint determined by SNOMED codes derived from diagnostic text within the medical record. We determined prevalence, socio-demographic characteristics and diagnostic codes for patients with an eligible diagnosis; and number of consultations within one year of diagnosis. Results: 324,793/1,294,021 (25%) presented with at least one musculoskeletal diagnosis, of whom 41% (n = 133,279) fulfilled our inclusion criteria. There were slightly more females (n = 73,428, 55%), two-thirds (n = 88,043) were of working age (18–64 years) and 83,816 (63%) had at least one comorbidity. Over half had a low back diagnosis (n = 76,504, 57%) followed by knee (n = 33,438, 25%), shoulder (n = 26,335, 20%) and neck (n = 14,492, 11%). Most codes included 'pain' and/or 'ache' (low back: 58%, neck: 41%, shoulder: 32%, knee 26%). Median (IQR) all-cause consultations per patient within one year of diagnosis was 7 (4–12). Conclusion: The burden of MSK complaints at the primary care level is high as evidenced by the prevalence of people with musculoskeletal complaints presenting to a general practitioner, the preponderance of comorbidities and the numerous consultations per year. Identification and evaluation of strategies to reduce this burden are needed. [ABSTRACT FROM AUTHOR]

The rapid evolution and wide applicability of genomic testing means that medical practitioners outside the field are not appropriately skilled to understand the utility of genomics for their patients. Rotating junior doctors through genomic medicine provides them with the hands‐on experience necessary to understand the complexities in this field. In this study, we analysed the training experience of 12 hospital medical officers who rotated through genomic medicine at the Royal Melbourne Hospital. Here, we demonstrate that immersion in clinical genomics aids in mainstreaming genomics knowledge. [ABSTRACT FROM AUTHOR]

Background: Universal screening of pregnant women at 35–37 weeks gestation is recommended for detection of anogenital group B streptococcus carriage. Intrapartum chemoprophylaxis is prescribed to carriers to prevent transmission to babies, reducing early‐onset neonatal group B streptococcal sepsis. Aims: To review compliance with, and the effects of education on group B streptococcus screening and intrapartum chemoprophylaxis practices at The Royal Women's Hospital, Melbourne, Australia. Materials and Methods: A retrospective audit of women delivering in February 2016 and February–March 2017 was conducted. In February 2017, updated early‐onset group B streptococcal disease prevention guidelines were released and promoted with targeted education of clinical staff. Compliance was considered appropriate if practices followed up‐to‐date local protocols. Results: Screening rate for group B streptococcus was 84.4% (599/710) and carriage rate 19.5% (109/558), while intrapartum antibiotic prophylaxis was optimal in 83% of those labouring greater than four hours (39/47). There was no significant difference in compliance between 2016 and 2017. Of 113 women with unknown group B streptococcal status at delivery, only five of 33 (15%) with clinical risk factors for early‐onset neonatal disease received intrapartum prophylaxis. Conclusions: Compliance remained stable, with no change during or after implementation of new protocols. Compliance with protocols was low for cases with unknown group B streptococcal status at delivery but with the presence of one or more clinical risk factors for early‐onset group B streptococcal sepsis. [ABSTRACT FROM AUTHOR]

Background/objectives: Cardiovascular disease (CVD) is a major cause of mortality and morbidity globally. Results from previous studies are inconsistent and it remains unclear whether low-serum 25 OHD levels are associated with an increased risk of CVD. These associations have been little studied in young women. The aim of this study was to assess the relationship between serum 25 OHD and obesity, body composition, metabolic profiles and blood pressure in young women.Subjects/methods: Women aged 16-25 years living in Victoria, Australia, were recruited through Facebook advertising in this cross-sectional study. Participants completed an online survey and attended a site visit in a fasted state, where parameters, including blood pressure, anthropometry, metabolic profiles, serum 25 OHD levels and body composition (using dual energy X-ray absorptiometry) were measured.Results: A total of 557 participants were recruited into this study. Multiple linear regression analysis showed that after adjusting for visceral fat, season, smoking, physical activity, age, alcohol intake, oral contraceptive use, country of birth, taking multivitamins and taking vitamin D supplement, a 10 nmol/L increase in 25 OHD levels was associated with 0.65% greater HDL levels (p = 0.016) and 0.92% greater triglyceride levels (p = 0.003). It was also associated with 0.48% lower BMI (p < 0.001), 0.50% lower total fat percentage (p < 0.001), 0.09% lower visceral fat percentage (p < 0.001), 0.14% lower visceral fat to total fat ratio (p < 0.001) and 0.36% lower trunk fat to total fat ratio (p < 0.001), after adjustment for season, smoking, physical activity, age, alcohol intake, oral contraceptive use, country of birth, taking multivitamins and taking vitamin D supplements. Although these associations were statistically significant, they were very small in magnitude and of uncertain clinical significance.Conclusions: These findings may help to explain an association between 25 OHD levels and CVD risk factors through associations with HDL, BMI, total body and visceral fat mass. Possible underlying mechanisms warrant further investigation. [ABSTRACT FROM AUTHOR]

Background Bone turnover markers (BTMs) may provide insight into bone health in young women, but have been little studied in this demographic. We aimed to explore the association between body composition, hormonal contraception, bone mineral density and biochemical parameters and BTMs in young women. Methods Participants were community-dwelling females aged 16-25 years, living in Victoria, Australia. Carboxy-terminal cross-linking telopeptide of type 1 collagen (CTX) and total procollagen type 1 N-propeptide (P1NP) were analysed on the Roche Elecsys automated analyzer. A total of 305 were evaluated, after excluding participants with medical conditions or medications (except hormonal contraceptives), which may affect bone metabolism. Results Median (Q1, Q3) BTM values were 540 (410, 690) ng/L for CTX and 61.7 (46.2, 83.7) µg/L for P1NP. Serum CTX and P1NP were inversely associated with chronological age ( P < 0.001), transferrin ( P < 0.020) and serum dehydroepiandrosterone sulphate concentration ( P < 0.001). BTM values were up to 22% lower in combined oral contraceptive (COC) pill users ( P < 0.001). Serum CTX was inversely associated with per cent body fat ( P = 0.009) and tibial cortical volumetric bone mineral density (vBMD; P = 0.003). Serum P1NP concentrations were 23  µg/L higher in participants who reported using an osteopath in the previous year ( P = 0.007). Conclusions These data suggest that BTMs are influenced by age, COC use, body composition, iron status and hormonal profiles. Higher CTX values were associated with lower tibial cortical vBMD. Examining BTMs in relation to interventions aimed at improving bone health in young women is warranted. [ABSTRACT FROM AUTHOR]

Background: Polycystic ovarian syndrome (PCOS) is the most common condition among reproductive‐aged women. However, its exact prevalence is unknown. Aims: To determine the prevalence of PCOS in Australian women aged 16–29 years using the National Institutes of Health (NIH) criteria compared to self‐reported PCOS, to compare co‐morbidities between the groups and to determine the most distressing aspect of a diagnosis of PCOS for these young women. Materials and Methods: Participants were recruited from the Young Female Health Initiative (YFHI) and Safe‐D studies. Participants completed questionnaires, physical examinations and blood tests from 2012 to 2016. In March 2016, two supplementary questionnaires were distributed: the first, comprising questions on reproductive health and impact of diagnosis, was sent to participants who self‐reported having PCOS in the original studies. The second, comprising general reproductive health questions, was sent to the remainder. Results: The prevalence of PCOS, according to the NIH criteria, was 12% (31/254), while the prevalence of self‐reported PCOS was 8% (23/300). Only 35% (8/23) of those with self‐reported PCOS actually fulfilled the NIH criteria for PCOS. Comorbidities were relatively similar among groups. Finally, approximately 65% (15/23) were unhappy or worried about their initial PCOS diagnosis, with 72% (13/18) stating fertility concerns were the most distressing aspect of their diagnosis. Conclusions: The lack of consistent and accurate diagnosis of PCOS in young women potentially leads to over‐diagnosis. This creates unnecessary fears of health complications, particularly infertility. Therefore, we recommend the development of standardised criteria with set parameters that allow for better diagnosis of PCOS. [ABSTRACT FROM AUTHOR]

Vitamin D deficiency is a global public health concern. Studies of serum 25-hydroxyvitamin D (25(OH)D) determinants in young women are limited and few include objective covariates. Our aims were to define the prevalence of vitamin D deficiency and examine serum 25(OH)D correlates in an exploratory study of women aged 16-25 years. We studied 348 healthy females living in Victoria, Australia, recruited through Facebook. Data collected included serum 25(OH)D assayed by liquid chromatography-tandem MS, relevant serum biochemistry, soft tissue composition by dual-energy X-ray absorptiometry, skin melanin density, Fitzpatrick skin type, sun exposure using UV dosimeters and lifestyle factors. Mean serum 25(OH)D was 68 (SD 27) nmol/l and 26% were vitamin D deficient (25(OH)D <50nmol/l). The final model explained 56% of 25(OH)D variance. Serum sex hormone-binding globulin levels, creatinine levels, sun exposure measured by UV dosimeters, a positive attitude towards sun tanning, typically spending >2 h in the sun in summer daily, holidaying in the most recent summer period, serum Fe levels, height and multivitamin use were positively associated with 25(OH)D. Fat mass and a blood draw in any season except summer was inversely associated with 25(OH)D. Vitamin D deficiency is common in young women. Factors such as hormonal contraception, sun exposure and sunrelated attitudes, as well as dietary supplement use are essential to consider when assessing vitamin D status. Further investigation into methods to safely optimise vitamin D status and to improve understanding of the impact of vitamin D status on long-term health outcomes is required. [ABSTRACT FROM AUTHOR]

Background Gorlin syndrome (nevoid basal cell carcinoma syndrome) is a rare genetic predisposition to basal cell carcinomas ( BCC), keratocysts of the jaw and calcification of the falx cerebri among other clinical features. With the advent of sonic hedgehog inhibitors for the treatment of BCC, it is timely to establish a cohort of individuals with Gorlin syndrome and collect standardised phenotypic information on these individuals. Moreover, the health-related quality of life ( QoL) in individuals with Gorlin syndrome is not well studied. Aim To establish a Victorian cohort of Gorlin syndrome and study the QoL in these individuals. Methods Phenotypic data were obtained by reviewing medical records of individuals attending two major tertiary/quaternary genetic referral centres in Victoria, followed by telephone or face-to-face interviews where possible. QoL information was obtained utilising the AQoL-6D quality of life survey form. Results The median number of BCC in the 19 individuals studied was 17.5 (interquartile range 3-70). The number of patients with ≥100 BCC in this group was similar to a previously described national cohort (22.2 vs 27% respectively). A total of 58% of referrals to the genetics clinics originated from maxillofacial surgeons and 42% from dermatologists. Individuals with ≥100 BCC had worse median QoL scores compared to those with <100 BCC (36 vs 29, P-value of 0.031). Conclusion The clinical features in our cohort were congruent with those previously described in Australia. The QoL is adversely correlated with increased BCC burden. [ABSTRACT FROM AUTHOR]

Background. Increasing pressure on the emergency department (ED) throughout the world has meant the introduction of innovative ways of working. One such innovation is the advanced practice physical therapist (APP) acting as a primary contact practitioner. There has been little research into the role beyond identifying patient satisfaction with management, cost-effectiveness, and time efficiency. In order to give further support and assist in development of an APP service in the ED, an increased exploration of patient caseload demographics, resource utilization, and management outcomes is needed. Objectives. The purpose of this study was to provide quantitative data regarding patient demographics, time efficiency, resource utilization, and management outcomes to examine the APP role in the ED. Design. This was a prospective observational study of practice. Setting. The study was conducted in a single ED in Melbourne, Australia. Method. Data collection was conducted over a 6-month period. Patient demographics and diagnoses, assessment times, hospital resource utilization, and discharge destinations were recorded. Results. One thousand seventeen patients (45% female; median age=34 years, interquartile range=25-52) were managed by the APPs; 89% had conditions triaged as not serious or life threatening, and 97% had musculoskeletal pathologies, with the most common diagnosis being fracture or dislocation. Four-hour length-of-stay targets were met in 95% of the patients. Forty-six percent of the patients seen were managed independently, without any support from medical colleagues. The most frequent discharge destination was a referral back to the primary care physician or to hospital outpatient clinics. When comparing similar diagnostic groups, the APPs were significantly more time-efficient than ED physicians in their patient management. Conclusions. This study described in detail the caseload managed by the APP in the ED and identified the role as a valuable asset to an ED, managing a great deal of their caseload independently, safely, and time efficiently. [ABSTRACT FROM AUTHOR]

Background/Aim To evaluate the frequency and geographical variation in knee arthroscopy for adults (>25 years) with a concomitant diagnosis of osteoarthritis. Methods This was a retrospective cohort study of hospital separations involving an elective knee arthroscopy in public and private hospitals in Victoria, Australia. Participants included patients receiving knee arthroscopies with a diagnosis code indicating osteoarthritis ( OA) from 1 July 2008 to 30 June 2009. Records were excluded if the patient was under 25 years or their arthroscopy involved a ligament reconstruction. Crude rates per 100 000 population and negative binomial regression offset by total knee arthroscopy volume were used to analyse differences by region. Results There were 9620 arthroscopic procedures meeting the inclusion criteria. There were 5500 (57.2%) admissions where the principal diagnosis was knee OA (gonarthrosis) and 3510 (36.5%) where the principal diagnosis indicated a mechanical derangement and there was a primary or associated diagnosis of OA. When we examined the incidence rate ratios ( IRR) by region, after adjustment for relevant factors and accounting for the total knee arthroscopy volume within each region, we identified significant variation in knee arthroscopy rates for patients with OA. The region with the highest adjusted IRR was Barwon South Western ( IRR: 1.26, 95% confidence interval ( CI): 1.16-1.36) and the region with lowest adjusted incidence rate ratio was the Gippsland region ( IRR: 0.89, 95% CI: 0.80-0.98). Conclusions We identified considerable geographical variation in arthroscopies for people with OA across Victoria. Further investigation is needed to understand whether this variation is a reflection of differences in OA prevalence, clinical decision-making or access. [ABSTRACT FROM AUTHOR]

Background Primary angiitis of the central nervous system is a rare condition, which is often difficult to diagnose and is associated with significant morbidity and mortality. There is no standardised treatment protocol or randomised clinical trial evidence to guide management. Aim To describe the clinical features, diagnostic modalities, treatment and outcomes in an Australian hospital population-based series of primary cerebral angiitis. Methods Data were collected via retrospective medical record review of patients with primary angiitis of the central nervous system for the period 1 July 1998 to 30 June 2009, using previously published diagnostic criteria. Eligible patient records were identified in two ways; from routinely collected hospital episode data, coded using the ICD-10- AM coding standard and by review of cerebral biopsy data. Results Ten of 12 included patients had a positive cerebral biopsy, with two patients diagnosed by angiography. Mean age at diagnosis was 47.2 years (range 18-73 years), with a female predominance of 5:1. Headache was the most common symptom experienced. Seventy per cent of the biopsy specimens showed a lymphocytic vasculitis. All patients received treatment with either steroids alone or a combination of steroids and cyclophosphamide, the latter treatment being initiated for those with a higher modified Rankin score of disability. Nine (75%) responded to treatment. There was one in-hospital death, and two patients had no documented response to treatment. Conclusion This study presents the first Australian case series data of primary cerebral angiitis. Better understanding of management and outcomes of this rare condition would be gained through multicentre studies. [ABSTRACT FROM AUTHOR]

Background Chronic hepatitis B ( HBV) and cirrhosis are major risk factors for hepatocellular carcinoma ( HCC). The proportion and characteristics of cases with cirrhosis are not well documented. Aim Our aim was to compare demographic, viral and tumour characteristics of HBV-associated HCC in an Australian cohort, in patients with and without cirrhosis. Methods Existing HCC databases at six Melbourne teaching hospitals were reviewed for cases associated with HBV. Patient demographics, HBV viral characteristics, presence of cirrhosis, serum alpha-fetoprotein and tumour size were assessed. Mode of diagnosis was recorded through surveillance or symptoms, and treatment was either palliative, percutaneous or surgical. Results We identified 197 cases of HBV-related HCC. The mean age was 57.9 ± 12.9 years; 83% were male, and 55.3% and 35.3% were of Asian and European descent respectively. Of 168 patient with available data, 146 (87%) had cirrhosis versus 22 (13%) without. Patients with cirrhosis tended to be older (median 60 vs 52 years, P = 0.078). Asian patients were more likely to have HCC without cirrhosis than Europeans (17% vs 6%, P = 0.04). There were no other differences identified between cirrhotic and non-cirrhotic patients. Thirty-four per cent of patients had tumours greater than 5 cm at diagnosis, and 47% were diagnosed after presenting with symptoms. Twelve patients with HBV-HCC were outside current screening guidelines. Conclusion Most patients in Melbourne with HBV-associated HCC have cirrhosis. HCC characteristics in non-cirrhotic and cirrhotic patients were similar. The large number of patients detected through symptoms and with large tumours reinforces the need for vigilance in screening. [ABSTRACT FROM AUTHOR]

williams a., manias e., walker r. & gorelik a. (2012) A multifactorial intervention to improve blood pressure control in co-existing diabetes and kidney disease: a pilot randomized controlled trial. Journal of Advanced Nursing 68(11), 2515-2525. Abstract Aims. The aim of this study was to test the feasibility and impact of an intervention consisting of self-monitored blood pressure, medicine review, a Digital Versatile Disc, and motivational interviewing telephone calls to help people with diabetes and kidney disease improve their blood pressure control and adherence to prescribed medications. Background. People with co-existing diabetes, kidney disease and hypertension require multiple medications to manage their health. About 50% of people are non-adherent to their prescribed medications with non-adherence increasing in the presence of chronic conditions. Design. Randomized controlled trial. Methods. Patients aged ≥18 years with diabetes, chronic kidney disease and systolic hypertension were recruited from nephrology and diabetes outpatients' clinics of an Australian metropolitan hospital between 2008-2009. Participants were randomly allocated on a 1:1 basis to one of two groups in a randomized controlled trial: the intervention delivered over 3 months ( n = 39) and usual care ( n = 41), with follow-up at 3, 6 and 9 months postintervention. People collecting data and assessing outcomes were blinded to group assignment. Results. Seventy-five participants completed the study. The intervention was acceptable and feasible for this cohort. There were no statistically significant differences between groups, although the mean systolic blood pressure reduction in the intervention group ( n = 36) was −6·9 mmHg 95% CI (−13·8, −0·02) at 9 months postintervention. Conclusion. The study was feasible and statistically significant differences may be determinable in a larger sample to overcome the variability between groups, paying attention to recommendations for further research. Trial registration. The trial was prospectively registered with the Australian and New Zealand Clinical Trials Register (ACTRN12607000044426). [ABSTRACT FROM AUTHOR]

The determination of healing rate in the diabetic foot wound is an important assessment parameter that is part of the overall clinical decision-making process in wound treatment. A number of methods that have been used to calculate healing, ranging from length and width measurement, surface area measure changes expressed as a function of time and linear advancement of the wound edge. The objective of this study was to compare surface area measures to linear advancement of the wound edge in 228 diabetic foot ulcers. Each wound was measured using the two methods and analyzed using linear regression to determine the best modeling of the healing process in these wounds. Results indicated that the total surface area change per day was superior to the linear advancement parameter in this group of wounds and that the area measurement was significantly more likely to predict the healing trajectory in the subgroup of wounds that took more than 28 days to heal. Contrary to expectations, the linear advancement method was correlated to initial wound size in the longer duration wounds suggesting that in these chronic wounds, differing healing phases render the surface area calculation method superior to the linear advancement parameter. [ABSTRACT FROM AUTHOR]

Introduction: Australia is an ageing multicultural society with an increased prevalence of chronic conditions. The rise of coexisting diabetes, kidney disease and hypertension is placing a significant and increasing demand on Australian health services. Prescribed medications are a key component of reducing the disease burden of these coexisting conditions, and successful treatment is largely dependent on self-management of medications. Culturally and linguistically diverse (CALD) groups have an increased risk of medication mismanagement and are often excluded from intervention studies. We examined an intervention in this group and report on some of the difficulties and resource issues involved with studying CALD groups. Methods: Patients aged >18 years of age with chronic kidney disease, diabetes and cardiovascular disease whose preference it was to speak Greek, Italian or Vietnamese were recruited from nephrology outpatients' clinics of two Australian metropolitan hospitals in 2009. A translated, multifactorial intervention, consisting of a medication review, a short PowerPoint presentation and motivational interviewing designed to improve medication self-efficacy and adherence, was tested in a randomised controlled trial (RCT) with 12 months follow-up post-baseline. People collecting data and assessing outcomes were blinded to group assignment. Results: Seventy-eight participants were recruited and 29 participants completed the study. There were no significant differences in medication self-efficacy or adherence between the intervention and control groups at three, six and 12 months post-baseline. Conclusion: The pilot study was not feasible due to high attrition rates. This work has highlighted difficulties with conducting research into CALD groups using interpreting services and health literacy issues affecting medicine self-management in this group. Trial registration: The trial was prospectively registered with the Australian and New Zealand Clinical Trials Register (ACTRN126080000313336). [ABSTRACT FROM AUTHOR]

Background: While there is evidence linking vitamin D status with mood, this association and its clinical significance remain uncertain. Moreover, few studies have focused on young, community-dwelling females. The Safe-D study examined the association between serum 25-hydroxyvitamin D (25OHD) levels and mental health in young women.Methods: Participants completed an online questionnaire, wore a UV dosimeter to measure personal sun exposure and underwent a comprehensive health assessment. Serum 25OHD was measured by liquid chromatography-tandem mass spectrometry in 353 healthy women aged 16-25 years, living in Victoria, Australia. Mental health measures included: Patient Health Questionnaire (PHQ-9), 7-item Generalized Anxiety Disorder Scale (GAD-7), Kessler psychological distress scale (K10) and 12-item short-form health survey (SF-12), plus any self-reported mental disorder diagnoses or medication use.Results: The prevalence of self-reported mental disorder was 26% and of vitamin D deficiency 27%. The median (Q1, Q3) scores for the PHQ-9, GAD-7, K10 and SF-12 MCS were 6 (3, 9), 5 (2, 8), 19 (15, 25) and 43 (34, 49), respectively. Serum 25OHD levels were not associated with mental health scores. Vitamin D status was not associated with a reported diagnosis of depression or anxiety.Limitations: There was a low prevalence of severe vitamin D deficiency and mental health symptoms, which may reduce study power.Conclusion: Our findings do not support an association between serum 25OHD levels and mental health status in young women. Longitudinal studies and randomized clinical trials investigating vitamin D and mood in young women are needed to confirm and extend these results. [ABSTRACT FROM AUTHOR]

Background: Guideline-based strategies for evaluation of solitary pulmonary nodules are tailored to the likelihood of malignancy. Surveillance, biopsy, and resection are all reasonable approaches in fit individuals when the likelihood of malignancy is intermediate. Given the paucity of data demonstrating superior outcomes and important trade-offs among strategies, guidelines emphasize the importance of eliciting patient preferences and engaging in shared decision making; however, there is little literature on what patient preferences actually are., Methods: This study conducted a cross-sectional, interview-administered questionnaire survey in 100 adults recruited from a metropolitan teaching hospital (The Royal Melbourne Hospital, Parkville, Victoria, Australia). The questionnaire used a hypothetical scenario designed to elicit patient preferences for different management strategies of solitary pulmonary nodules with a probability of malignancy between 10% and 70%., Results: The mean age of participants was 62 years (range, 45 to 80 years), 56% were male, and 94% were current smokers or ex-smokers. Ninety-four percent completed all questions. At 10% probability of malignancy, 36.3% preferred surveillance, 42.4% preferred needle biopsy, and 21.2% preferred surgical resection. Preference for surgical resection increased to 53.5% and 86.2% when the probability of malignancy was 30% and 70%, respectively. Changes in the diagnostic yield of computed tomography biopsy significantly altered preferences when the probability of malignancy was 10% or 30%., Conclusions: The majority of participants surveyed expressed a preference for some type of biopsy over observation at all levels of solitary pulmonary nodule probability of malignancy evaluated. In an era of increasing solitary pulmonary nodule detection and patient-centered care, if confirmed in broader studies, these findings have considerable implications for processes of care and resource allocation., (Copyright © 2022 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)

Introduction: General practice is integral to the Australian healthcare system. Outcome Health's POpulation Level Analysis and Reporting (POLAR) database uses de-identified electronic health records to analyse general practice data in Australia. Previous studies using routinely collected health data for research have not consistently reported the codes and algorithms used to describe the population, exposures, interventions and outcomes in sufficient detail to allow replication. This paper reports a study protocol investigating patterns of care for people presenting with musculoskeletal conditions to general practice in Victoria, Australia. Its focus is on the systematic approach used to classify and select eligible records from the POLAR database to facilitate replication. This will be useful for other researchers using routinely collected health data for research., Methods and Analysis: This is a retrospective cohort study. Patient-related data will be obtained through electronic health records from a subset of general practices across three primary health networks (PHN) in southeastern Victoria. Data for patients with a low back, neck, shoulder and/or knee condition and who received at least one general practitioner (GP) face-to-face consultation between 1 January 2014 and 31 December 2018 will be included. Data quality checks will be conducted to exclude patients with poor data recording and/or non-continuous follow-up. Relational data files with eligible and valid records will be merged to select the study cohort and the GP care received (consultations, imaging requests, prescriptions and referrals) between diagnosis and 31 December 2018. Number and characteristics of patients and GPs, and number, type and timing of imaging requests, prescriptions for pain relief and referrals to other health providers will be investigated., Ethics and Dissemination: Ethics approval was obtained from the Cabrini and Monash University Human Research Ethics Committees (Reference Numbers 02-21-01-19 and 16975, respectively). Study findings will be reported to Outcome Health, participating PHNs, disseminated in academic journals and presented in conferences., Competing Interests: Competing interests: RH, DAO’C, RB and DM report grants from Arthritis Australia (not-for-profit organisation), during the conduct of the study. CP is an employee of Outcome Health, the not-for-profit organisation that developed the POLAR database and chairs the Product improvement group of the Australian Digital Health Agency. It has no relationship with the research, but has provided grant funding to Outcome Health. LB reports consultancy fees paid to Monash University from Charite Medical University Berlin, Jesuit Social Services Victoria and Swinburne University of Technology, outside the submitted work., (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Objective: To estimate the lifetime risk of total knee replacement (TKR) and examine temporal trends in TKR incidence in the state of Victoria, Australia., Methods: We performed a retrospective analysis of a population-based longitudinal cohort of patients (ages ≥40 years) who received a primary TKR in Victoria from 1999-2008. Hospital separations and life tables were used to estimate lifetime risk. Temporal changes in TKR incidence were examined according to health care setting (public versus private), socioeconomic status (SES), and geographic location (regional versus metropolitan)., Results: There were 43,570 incidents of primary TKRs identified over the study period. In 2008, the lifetime risk of surgery was 10.4% (95% confidence interval [95% CI] 10.13-10.64%) for men and 11.9% (95% CI 11.63-12.13%) for women. TKRs increased steadily over the study period in private hospitals (overall increase of 90%) with a smaller growth in procedure numbers for public hospitals (overall increase of 40%). From 2002-2003 onward, the low SES tertile showed a lower incidence of TKR compared to the middle and high SES groups, with incidence rates of 1.09 (95% CI 1.04-1.15), 1.22 (95% CI 1.17-1.28), and 1.20 (95% CI 1.16-1.25) per 1,000 population, respectively (based on 2007-2008 figures). Increased numbers of TKRs were also found to be occurring among people residing in regional areas of Victoria (from 1.12 [95% CI 1.04-1.31] to 1.84 [95% CI 1.72-2.02] per 1,000 population)., Conclusion: Increases in lifetime risk of TKR were evident. Although improved access to TKR for those living in regional areas was observed, sustained disparities relating to health care setting and SES warrant further investigation., (Copyright © 2014 by the American College of Rheumatology.)

Objectives: Frailty denotes a vulnerability to poor outcomes and is a common risk factor for mortality in older persons. The Vulnerable Elders Survey (VES) is an easy to administer validated screening tool to detect a frail population. Assessment of frailty has the potential to aid in prognostication for the older community dwelling palliative population. This study seeks to evaluate the relationship of the VES to prognosis in this population., Methods: Prospective cohort study of patients over 65 years old admitted to a community palliative care service. The VES was performed in addition to the usual assessments of physical function. Comorbidity was assessed using the Charlson Comorbidity Index (CCI). Physical function and CCI were assessed to determine whether they improved the prognostic power of the VES. Patients were followed-up for 8 months with the primary endpoint of survival., Results: 197 patients completed the study with a high proportion of malignant diagnoses (87.5%); 98% of patients died during the study with a median survival of 61 days; 93.4% of patients were vulnerable on the VES and high risk scores predicted death within 100 days., Conclusions: In this study the VES demonstrated high rates of vulnerability and has the potential to improve the accuracy of prognosis in older palliative community dwelling patients. Improving prognostication has potential clinical benefits, including aiding clinical communication and determining the best use of community services. The limitations of this study and the evolving understanding of frailty suggest that further work in this area is required.

Our ageing population creates challenges for palliative care, including accuracy of prognostication. This study highlights this by profiling the outcomes of an Australian, community-based palliative service over 6 months with collection of epidemiological, comorbidity and physical function data. Most patients had cancer, comorbidities and died during the study. Low scores on the Australian-modified Karnofsky Performance Scale and the presence of congestive cardiac failure were predictive of shorter survival., (© 2012 The Authors. Internal Medicine Journal © 2012 Royal Australasian College of Physicians.)

Objective: To determine injuries significantly associated with traumatic thoracic spine (T-spine) fractures, Methods: This was a case-control study undertaken in an adult trauma centre. Cases were patients admitted with a traumatic T-spine fracture between January 1999 and August 2007. Each case had two controls matched for sex, age (+/-5 years) and injury severity classification (major/minor). Data were collected from patient medical records and the trauma service database. Multivariate logistic regression was used to determine injuries significantly associated with T-spine fracture., Results: Two hundred and sixty-one cases and 512 controls were enrolled. In both groups, mean age was 41 years and 70% of patients were male. Univariate analysis revealed a range of injuries that were significantly more common among the cases, especially cervical and lumbar spine injuries, sternal/scapular/clavicular/rib fractures, pneumo/haemothorax and pulmonary contusions (P < 0.01). Skull fractures and lower limb injuries were significantly more common among the controls (P < 0.01). Logistic regression analysis revealed that only cervical and lumbar spine injuries and rib fractures were positively associated with T-spine fracture (P < 0.001). Skull fractures and lower limb injuries were negatively associated with T-spine injury (P < 0.001)., Conclusion: Cervical and lumbar spine injuries and rib fractures are significantly associated with T-spine fracture. The presence of these injuries should raise suspicion of concomitant T-spine injury.

Objective: Despite delirium being common in older hospitalized people, little is known about its management. The aims of this study are (1) to describe the pharmacological management of delirium in an acute care setting as a baseline measure prior to the implementation of newly developed Australian guidelines; and (2) to determine what areas of delirium pharmacological management need to be targeted for future practical guideline implementation and quality improvement activities., Methods: A medical record audit was conducted using a structured audit form. All patients aged 65 years and over who were admitted to a general medical or orthopaedic unit of the Royal Melbourne Hospital between 1 March 2006 and 28 February 2007 and coded with delirium were included. Data on the use of antipsychotic medications for the management of delirium in relation to best practice recommendations were assessed., Results: Overall 174 episodes of care were included in the analysis. Antipsychotic medications were used for the management of most patients with severe behavioral and or emotional disturbance associated with delirium. There was variation in the prescribing patterns of antipsychotic agents and the documentation of medication management plans. Less than a quarter of patients prescribed antipsychotic medication were started on a low dose and very few were reviewed on a regular basis., Conclusion: A wide range of practice is seen in the use of antipsychotic agents to manage older patients with severe symptoms associated with delirium. The findings highlight the need to implement evidence-based guideline recommendations with a focus on improving the consistency in the pharmacological management and documentation processes.