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: Background: Data on previous alcohol use in surgical patients who died in the Northern Territory (NT) are lacking and have important public health implications. Methods: The prevalence of previous alcohol (ab)use among surgical patients who died (n=560) was assessed in patients within the Northern Territory and the remainder of Australia (n=28,245) over nine years. Results: The likelihood of previous alcohol use (21.4%; 120 of 560), was the outcome measured and was higher in the Northern Territory than outside it (5.9%; 1,660 of 28,245). Factors associated with the outcome of previous alcohol use were: male gender (aOR 1.6); Aboriginal and Torres Strait Islander status (aOR 2.0); liver disease (aOR 7.8); comorbidities (aOR 2.5); and trauma (aOR 1.1), in both the Northern Territory (aOR 11.5) and all Australia (aOR 7.8). In the Northern Territory, alcohol use was high in both Aboriginal and Torres Strait Islander people (31%) and non‐Aboriginal and Torres Strait Islander (16%) people (p=0.316). Conclusion: Of surgical patients who died, the likelihood of being a previous alcohol user was double in the Northern Territory as opposed to other states. Alcohol misuse is widespread across all groups in the Northern Territory. Implications for public health: Previous alcohol (ab)use is a negative factor for survival in any racial group., Previous alcohol use is among the top five risk factors contributing to the burden of disease in Australia,[sup.1] responsible for 4.6% of the total burden of disease and injury in [...]

Background: The causes of death following colorectal resection remain poorly explored. Few studies have addressed whether early post‐operative mortality is predominantly caused by a patient's medical co‐morbidities, or from factors pertaining to the presenting surgical disease process itself. This study analyses data from the Queensland audit of surgical mortality (QASM) to report the causes of in‐hospital death following colorectal resection, identifies whether these were due to either medical or surgical factors, and determines the patient characteristics associated with a medical cause of death. Methods: Through analysis of QASM Surgical Case Forms, the causes of in‐hospital death were determined in 750 patients who died in Queensland following colorectal resection between January 2010 and December 2020. Deaths were attributed to a specific medical or surgical cause, with multivariate analysis used to identify independent risk factors associated with a medical cause of death. Results: In total, 395 patients (52.7%) died due to surgical causes and 355 (47.3%) died due to medical causes. Respiratory co‐morbidities (OR 1.832, 95% CI: 1.267–2.650), advanced malignancy (OR 1.814, 95% CI: 1.262–2.607), neurological co‐morbidities (OR 1.794, 95% CI: 1.168–2.757) and advanced age (OR 1.430, 95% CI: 1.013–2.017) were independent risk factors associated with increased risk of a medical cause of death. Conclusion: Even in the absence of complicating surgical factors, a significant number of patients died in hospital following colorectal resection due to their underlying co‐morbidities. Multi‐disciplinary models of care which allow for the early recognition and treatment of medical complications may reduce post‐operative mortality in these patients. [ABSTRACT FROM AUTHOR]

Background: People with intellectual disability who live in the community often have poor health and healthcare, partly as a consequence of poor communication, recall difficulties and incomplete patient health information. Materials and Methods: A cluster randomized-controlled trial with 2 x 2 factorial design was conducted with adults with intellectual disability to investigate two interventions to enhance interactions among adults with intellectual disability, their care providers and general practitioners (GPs). The interventions were the Comprehensive Health Assessment Program (CHAP), a one-off health review tool, and the "Ask" health diary, designed for ongoing use. Follow-up was for 12 months post-intervention. Evidence of health promotion, disease prevention and case-finding activities were extracted from GPs clinical records. Results: Increased health promotion, disease prevention and case-finding activity were found in the intervention groups using the CHAP. It had a positive impact on "Pneumococcus" vaccination (OR 7.4; 95% CI: 1.5-37.1), hearing testing (4.5; 1.9-10.7), Hepatitis A vaccinations (5.4; 1.8-16.3), vision testing (3.4; 1.4-8.3), and weight measurement (3.1; 1.5-6.4). There were no strong changes in the measured outcomes in the group who used the "Ask" health diary alone. Conclusions: The use of the CHAP increased health promotion, disease prevention and case-finding activity in adults with intellectual disability living in the community and confirms the previously demonstrated benefits of the CHAP can be extended to less formal residential settings. The use of the "Ask" health diary did not improve the measured healthcare activity, at least in the short term, although it may contribute in other ways towards better health.

Background: People with intellectual disability often have poor health which may be improved through better health advocacy and enhanced communication with their general practitioner. To this end, we examined the use of the Comprehensive Health Assessment Program (CHAP) and the "Ask" health diary previously developed for adults with intellectual disability and trialled their use in adolescents attending a Special School. Materials and methods: A CHAP health review completed by both carers and General Practitioners was used to collect information about adolescents' health. An "Ask" health diary was used in school to learn health advocacy and communication skills. Thirty students, their parents and their eight teachers participated in the trial. Results: The CHAP health review resulted in a mean of 5.2 health conditions being found, and 1.4 planned actions by the general practitioner per adolescent. The "Ask" health diary was highly accepted by the students and teachers. There did not appear to be any increase in communication skills of the students after using the diary in the school for one term. Conclusion: The CHAP health review and "Ask" health diary have the potential to improve the health of adolescents with intellectual disability.

Background: Surgical mortality audit is an important tool for quality assurance and professional development but little is known about the impact of such activity on professional practice at the individual surgeon level. This paper reports the findings of a survey conducted with a self-selected cohort of surgeons in Queensland, Australia, on their experience of participating in the audit and its impact on their professional practice, as well as implications for hospital systems.Methods: The study used a descriptive cross-sectional survey design. All surgeons registered in Queensland in 2015 (n = 919) were invited to complete an anonymous online questionnaire between September and October 2015. 184 surgeons completed and returned the questionnaire at a response rate of 20%.Results: Thirty-nine percent of the participants reported that involvement in the audit process affected their clinical practice. This was particularly the case for surgeons whose participation included being an assessor. Thirteen percent of the participants had perceived improvement to hospital practices or advancement in patient care and safety as a result of audit recommendations. Analysis of the open-ended responses suggested the audit experience had led surgeons to become more cautious, reflective in action and with increased confidence in best practice, and recognise the importance of effective communication and clear documentation.Conclusions: This is the first study to examine the impact of participation in a mortality audit process on the professional practice of surgeons. The findings offer evidence for surgical mortality audit as an effective strategy for continuous professional development and for improving patient safety initiatives. [ABSTRACT FROM AUTHOR]

Background Surgical audits provide constructive feedback to individual surgeons, hospitals and other healthcare sector professionals. Audits identify deficiencies in treatment processes, evaluate practice trends and detect practice gaps. The credibility and validity of the Queensland Audit of Surgical Mortality ( QASM) relies on the accuracy of its data. Methods To determine the validity of routine reporting of surgical information to QASM, surgical case forms were compared against medical records (considered the gold standard). Data were extracted by a trained medical research assistant. QASM forensically reviewed 896 of a total of 5636 deaths in 20 Queensland public hospitals between 2008 and 2013. Concordance between the surgical case form and the relevant medical record was determined for 27 objective items. Results Overall concordance was 98.2%. The median concordance was 100% (interquartile range 87-100%). Cases with discordance were few and in these, most had only one discordant item. Discordances were mainly omissions. Conclusion The QASM surgical case form is a reliable data collection tool that provides high-quality data. QASM objective data can be confidently regarded as accurate and therefore reliable for use in publications, reports and case studies. [ABSTRACT FROM AUTHOR]

Objectives: It is assumed that increased age signifies increased surgical care. Few surgical studies describe the differences in care provided to older patients compared with younger patients. We aimed to examine the relationships between increasing age, preoperative factors and markers of postoperative care in adults who died in-hospital after surgery in Australia. Design: This retrospective cross-sectional study extracted data from a national surgical mortality audit--an independent, peer-reviewed process. Setting: From January 2009 to December 2012, 111 public and 61 private Australian hospitals notified the audit of in-hospital deaths after general anaesthetic surgery or if the patient was admitted under a surgeon. Participants: Notified deaths totalled 19 723. We excluded deaths if patients were brain dead, younger than 17 years or never had an operation (n=11 376). From this baseline population, we divided 11 201 deaths into three patient age groups: youngest (17-64 years), medium (65-79 years) and oldest (≥80 years). Outcome measures: Univariable and multivariable logistic regression analyses determined the relationships between increasing age and the measured preoperative factors and postoperative variables. Results: The baseline population's median age was 78 years (IQR 66-85), 43.7% (4892/11 201) were 80 years or older and 83.4% (9319/11 173) had emergency admissions. The oldest group had increased trauma and emergency admissions than the medium and youngest age groups. Seven of the eight measured markers of postoperative care demonstrate strong and significant relationships with increasing age. The oldest group compared with the medium group had decreased rates of: unplanned returns to theatre (11.2% (526/4709) vs 20.2% (726/3586)), unplanned intensive care admissions (16.3% (545/3350) vs 24.0% (601/2504)) and treatment in intensive care units (59.7% (2689/4507) vs 76.7% (2754/3590)). Conclusions: The oldest patients received lower levels of care than the medium and youngest age groups. [ABSTRACT FROM AUTHOR]