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  • 1
    In: Scientific Reports, Springer Science and Business Media LLC, Vol. 13, No. 1 ( 2023-02-27)
    Abstract: Frailty and pain in hospitalised patients are associated with adverse clinical outcomes. However, there is limited data on the associations between frailty and pain in this group of patients. Understanding the prevalence, distribution and interaction of frailty and pain in hospitals will help to determine the magnitude of this association and assist health care professionals to target interventions and develop resources to improve patient outcomes. This study reports the point prevalence concurrence of frailty and pain in adult patients in an acute hospital. A point prevalence, observational study of frailty and pain was conducted. All adult inpatients (excluding high dependency units) at an acute, private, 860-bed metropolitan hospital were eligible to participate. Frailty was assessed using the self-report modified Reported Edmonton Frail Scale. Current pain and worst pain in the last 24 h were self-reported using the standard 0–10 numeric rating scale. Pain scores were categorised by severity (none, mild, moderate, severe). Demographic and clinical information including admitting services (medical, mental health, rehabilitation, surgical) were collected. The STROBE checklist was followed. Data were collected from 251 participants (54.9% of eligible). The prevalence of frailty was 26.7%, prevalence of current pain was 68.1% and prevalence of pain in the last 24 h was 81.3%. After adjusting for age, sex, admitting service and pain severity, admitting services medical (AOR: 13.5 95% CI 5.7–32.8), mental health (AOR: 6.3, 95% CI 1. 9–20.9) and rehabilitation (AOR: 8.1, 95% CI 2.4–37.1) and moderate pain (AOR: 3.9, 95% CI 1. 6–9.8) were associated with increased frailty. The number of older patients identified in this study who were frail has implications for managing this group in a hospital setting. This indicates a need to focus on developing strategies including frailty assessment on admission, and the development of interventions to meet the care needs of these patients. The findings also highlight the need for increased pain assessment, particularly in those who are frail, for more effective pain management. Trial registration: The study was prospectively registered (ACTRN12620000904976; 14th September 2020).
    Type of Medium: Online Resource
    ISSN: 2045-2322
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2023
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  • 2
    In: BMJ Open, BMJ, Vol. 7, No. 6 ( 2017-06), p. e013691-
    Type of Medium: Online Resource
    ISSN: 2044-6055 , 2044-6055
    Language: English
    Publisher: BMJ
    Publication Date: 2017
    detail.hit.zdb_id: 2599832-8
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  • 3
    In: BMJ Open, BMJ, Vol. 9, No. 3 ( 2019-03), p. e026662-
    Abstract: Osteoradionecrosis (ORN) of the mandible is a painful and debilitating condition occurring after radiotherapy to the head and neck to treat cancer. For decades, hyperbaric oxygen (HBO) has formed the mainstay of the early management of ORN. Literature about the efficacy of HBO is contentious. Recently, Oral and Maxillofacial surgical units in France and UK have trialled a combination of medications to treat ORN, also known as PENTOCLO (PENtoxifylline+TOcopherol±CLOdronate). This regime has shown promising results to date however randomised controlled trials in the area comparing HBO against PENTOCLO are lacking and there are no current trials registered in Europe, UK, Australia and the USA. The purpose of this pilot study is to generate a hypothesis that can be tested in large multi-centre controlled trials. Methods and analysis For this pilot study we will recruit 16 patients who will be randomly allocated to one of either HBO or PENTOCLO. After a 4 week period of uniform ‘pre-treatment’ medication patients will be commenced on their allocated treatment. Standard follow-up examination, imaging and photographs will be taken and de-identified and then presented to two Oral and Maxillofacial surgeons for allocation of a Notani & Lyons classification score. Data for each patient will be tracked over the 18 months of treatment and follow-up. The results will then be analysed using descriptive statistics and all patients included in an intention to treat analysis. Ethics and dissemination Ethical approval for this study has been granted by the South Metropolitan Health Service HREC (PRN RGS0000001193). Data generated by conducting this study will be uploaded to an open access repository in a de-identified form. Results from this study will be disseminated at national and international conferences as well as peer reviewed medical publications. Trial registration number ACTRN12618001099213; Pre-results.
    Type of Medium: Online Resource
    ISSN: 2044-6055 , 2044-6055
    Language: English
    Publisher: BMJ
    Publication Date: 2019
    detail.hit.zdb_id: 2599832-8
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  • 4
    In: International Journal of Population Data Science, Swansea University, Vol. 5, No. 5 ( 2020-12-07)
    Abstract: IntroductionIn January 2005, the Australian Government increased the consumer medication co-payment by 21%. Previous research found that this affected population-level utilisation of statins, which fell by 5% following the co-payment increase. The subsequent health impact on individuals reducing or ceasing use of statins is unknown. Objectives and ApproachTo explore the two-year risk of acute coronary syndrome (ACS) or stroke-related hospitalisation among individuals who discontinued, reduced or continued statin medicines after the 2005 PBS co-payments increase. This was achieved through a retrospective cohort study using linked administrative Commonwealth and State datasets for the Western Australian population. Outcomes were assessed using the Fine and Gray competing risks method, with death as the competing risk, adjusting for demographics, comorbidities and medication history. ResultsThere were 207,066 individuals identified as using statins before the co-payment increase. After the increase, adherence reduced in 12.5% of this cohort, and 3.3% ceased use. There were 4,343 ACS and stroke-related hospitalisations for the cohort in the follow-up period. Multivariate analysis indicated ceasing statins increased the risk of hospitalisation for ACS or stroke-related events by 18% (95%CI=0.1-40%) compared to continuing therapy. The risk was greatest for males 〈 70 years. No differences existed for women or older men who discontinued statins. There was no difference in hospitalisation risk for those who reduced statins compared to those who continued. Conclusion / ImplicationsYounger men ceasing statins after the 2005 co-payments increase had a higher risk of ACS and stroke hospitalisations compared to individuals who continued using statins. The findings highlight the importance of continued adherence to prescribed statin medication, and that discontinuing therapy for non-clinical reasons (such as cost) can have negative consequences. Additionally, it demonstrates to policymakers that substantial increases in consumer co-payments can result in adverse health outcomes.
    Type of Medium: Online Resource
    ISSN: 2399-4908
    Language: Unknown
    Publisher: Swansea University
    Publication Date: 2020
    detail.hit.zdb_id: 2892786-2
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  • 5
    In: BMJ Open, BMJ, Vol. 11, No. 5 ( 2021-05), p. e040600-
    Abstract: To retrospectively assess a cohort of mothers for characteristics of injuries that they have suffered as a result of family and domestic violence (FDV) and which have required admission to a hospital during both the intrapartum and postpartum periods. Design and setting Retrospective, whole-population linked data study of FDV in Western Australia using the Western Australia birth registry from 1990 to 2009 and Hospital Morbidity Data System records from 1970 to 2013. Main outcome measures Number of hospitalisations, and mode, location and type of injuries recorded, with particular focus on the head and neck area. Results There were 11 546 hospitalisations for mothers due to FDV. 8193 hospitalisations recorded an injury code to the head and/or neck region. The upper and middle thirds of the face and scalp were areas most likely to receive superficial injuries (58.7% or 4158 admissions), followed by the mouth and oral cavity (9.7% or 687 admissions). Fracture to the mandible accounted for 479 (4.2%) admissions and was almost equal to the sum of the next three most common facial fractures (nasal, maxillary and orbital floor). Mothers more likely to be hospitalised due to a head injury from FDV included those with more than one child (OR=1.17, 95% CI 1.03 to 1.30) and those with infants ( 〈 1 year old) (OR=1.40, 95% CI 1.04 to 1.90) and young children ( 〈 7 years old) (OR=1.15, 95% CI 1.01 to 1.30). Conclusions FDV is a serious and ongoing problem and front-line clinicians are in need of evidence-based guidelines to recognise and assist victims of FDV. Mothers with children in their care are a particularly vulnerable group.
    Type of Medium: Online Resource
    ISSN: 2044-6055 , 2044-6055
    Language: English
    Publisher: BMJ
    Publication Date: 2021
    detail.hit.zdb_id: 2599832-8
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  • 6
    In: BMJ Open, BMJ, Vol. 11, No. 3 ( 2021-03), p. e046138-
    Abstract: Frailty and pain are associated with adverse patient clinical outcomes and healthcare system costs. Frailty and pain can interact, such that symptoms of frailty can make pain assessment difficult and pain can exacerbate the progression of frailty. The prevalence of frailty and pain and their concurrence in hospital settings are not well understood, and patients with cognitive impairment are often excluded from pain prevalence studies due to difficulties assessing their pain. The aim of this study is to determine the prevalence of frailty and pain in adult inpatients, including those with cognitive impairment, in an acute care private metropolitan hospital in Western Australia. Methods and analysis A prospective, observational, single-day point prevalence, cross-sectional study of frailty and pain intensity of all inpatients (excluding day surgery and critical care units) will be undertaken. Frailty will be assessed using the modified Reported Edmonton Frail Scale. Current pain intensity will be assessed using the PainChek smart-device application enabling pain assessment in people unable to report pain due to cognitive impairment. Participants will also provide a numerical rating of the intensity of current pain and the worst pain experienced in the previous 24 hours. Demographic and clinical information will be collected from patient files. The overall response rate of the survey will be reported, as well as the percentage prevalence of frailty and of pain in the sample (separately for PainChek scores and numerical ratings). Additional statistical modelling will be conducted comparing frailty scores with pain scores, adjusting for covariates including age, gender, ward type and reason for admission. Ethics and dissemination Ethical approval has been granted by Ramsay Health Care Human Research Ethics Committee WA/SA (reference: 2038) and Edith Cowan University Human Research Ethics Committee (reference: 2020–02008-SAUNDERS). Findings will be widely disseminated through conference presentations, peer-reviewed publications and social media. Trial registration number ACTRN12620000904976.
    Type of Medium: Online Resource
    ISSN: 2044-6055 , 2044-6055
    Language: English
    Publisher: BMJ
    Publication Date: 2021
    detail.hit.zdb_id: 2599832-8
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  • 7
    In: Australian Health Review, CSIRO Publishing, Vol. 44, No. 3 ( 2020), p. 377-
    Abstract: ObjectiveThis study assessed the effect of the frequency of general practitioner (GP) visitation in the 12 months before a 21% consumer copayment increase in the Pharmaceutical Benefits Scheme (PBS; January 2005) on the reduction or discontinuation of statin dispensing for tertiary prevention. MethodsThe study used routinely collected, whole-population linked PBS, Medicare, mortality and hospital data from Western Australia. From 2004 to 2005, individuals were classified as having discontinued, reduced or continued their use of statins in the first six months of 2005 following the 21% consumer copayment increase on 1 January 2005. The frequency of GP visits was calculated in 2004 from Medicare data. Multivariate logistic regression models were used to determine the association between GP visits and statin use following the copayment increase. ResultsIn December 2004, there were 22495 stable statin users for tertiary prevention of prior coronary heart disease, prior stroke or prior coronary artery revascularisation procedure. Following the copayment increase, patients either discontinued (3%), reduced (12%) or continued (85%) their statins. Individuals who visited a GP three or more times in 2004 were 47% less likely to discontinue their statins in 2005 than people attending only once. Subgroup analysis showed the effect was apparent in men, and long-term or new statin users. The frequency of GP visits did not affect the proportion of patients reducing their statin therapy. ConclusionsPatients who visited their GP at least three times per year had a lower risk of ceasing their statins in the year following the copayment increase. GPs can help patients maintain treatment following rises in medicines costs. What is known about the topic?Following the 21% increase in medication copayment in 2005, individuals discontinued or reduced their statin usage, including for tertiary prevention. What does this paper add?Patients who visited their GP at least three times per year were less likely to discontinue their statin therapy for tertiary prevention following a large copayment increase. What are the implications for practitioners?This paper identifies the important role that GPs have in maintaining the continued use of important medications following rises in medicines costs.
    Type of Medium: Online Resource
    ISSN: 0156-5788
    Language: English
    Publisher: CSIRO Publishing
    Publication Date: 2020
    detail.hit.zdb_id: 2082451-8
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  • 8
    In: BMJ Open, BMJ, Vol. 12, No. 6 ( 2022-06), p. e059388-
    Abstract: Hospitalised older adults are prone to functional deterioration, which is more evident in frail older patients and can be further exacerbated by pain. Two interventions that have the potential to prevent progression of frailty and improve patient outcomes in hospitalised older adults but have yet to be subject to clinical trials are nurse-led volunteer support and technology-driven assessment of pain. Methods and analysis This single-centre, prospective, non-blinded, cluster randomised controlled trial will compare the efficacy of nurse-led volunteer support, technology-driven pain assessment and the combination of the two interventions to usual care for hospitalised older adults. Prior to commencing recruitment, the intervention and control conditions will be randomised across four wards. Recruitment will continue for 12 months. Data will be collected on admission, at discharge and at 30 days post discharge, with additional data collected during hospitalisation comprising records of pain assessment and volunteer support activity. The primary outcome of this study will be the change in frailty between both admission and discharge, and admission and 30 days, and secondary outcomes include length of stay, adverse events, discharge destination, quality of life, depression, cognitive function, functional independence, pain scores, pain management intervention (type and frequency) and unplanned 30-day readmissions. Stakeholder evaluation and an economic analysis of the interventions will also be conducted. Ethics and dissemination Ethical approval has been granted by Human Research Ethics Committees at Ramsay Health Care WA|SA (number: 2057) and Edith Cowan University (number: 2021-02210-SAUNDERS). The findings will be disseminated through conference presentations, peer-reviewed publications and social media. Trial registration number ACTRN12620001173987.
    Type of Medium: Online Resource
    ISSN: 2044-6055 , 2044-6055
    Language: English
    Publisher: BMJ
    Publication Date: 2022
    detail.hit.zdb_id: 2599832-8
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  • 9
    In: Journal of Aging & Social Policy, Informa UK Limited
    Type of Medium: Online Resource
    ISSN: 0895-9420 , 1545-0821
    Language: English
    Publisher: Informa UK Limited
    Publication Date: 2021
    detail.hit.zdb_id: 2069274-2
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  • 10
    In: Medical Journal of Australia, Wiley, Vol. 181, No. 4 ( 2004-08), p. 191-194
    Type of Medium: Online Resource
    ISSN: 0025-729X , 1326-5377
    URL: Issue
    Language: English
    Publisher: Wiley
    Publication Date: 2004
    detail.hit.zdb_id: 2035730-8
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