172 research outputs found
Reducing perinatal mortality among Indigenous babies in Queensland: should the first priority be better primary health care or better access to hospital care during confinement?
No full textThe perinatal mortality rate among Indigenous Australians is still double that of the rest of the community. In this study Trisha Johnston and Michael Coory set out to estimate the extent to which increased risk of low birthweight and preterm birth among Indigenous babies in Queensland account for their continuing mortality excess. Their results show that priority should be given to primary health care initiatives aimed at reducing the prevalence of low birth weight and preterm birth
Beyond the headlines: Fetal movement awareness is an important stillbirth prevention strategy
No full textVicki Flenady, David Ellwood, Billie Bradford, Michael Coory, Philippa Middleton, Glenn Gardener ... et al
Anticipated behaviors of emergency prehospital medical care providers during an influenza pandemic
No full textVivienne C. Tippett, Kerrianne Watt, Steven G. Raven, Heath A. Kelly, Michael Coory, Frank Archer, Konrad Jamrozi
SUPPLEMENTARY_MATERIAL_-_S_Table_1 – Supplemental material for The role of renal mass biopsy in the management of small renal masses – patterns of use and surgeon opinion
No full textSupplemental material, SUPPLEMENTARY_MATERIAL_-_S_Table_1 for The role of renal mass biopsy in the management of small renal masses – patterns of use and surgeon opinion by Melinda M Protani, Andre Joshi, Victoria White, David JT Marco, Rachel E Neale, Michael D Coory, Graham G Giles, Damien M Bolton, Ian D Davis, Simon Wood and Susan J Jordan in Journal of Clinical Urology</p
My Baby's Movements: An assessment of the effectiveness of the My Baby's Movements phone program in reducing late‐gestation stillbirth rates
No full textBackground: Delayed reporting of decreased fetal movements (DFM) could repre- sent a missed opportunity to prevent stillbirth. Mobile phone applications (apps) have the potential to improve maternal awareness and reporting of DFM and con- tribute to stillbirth prevention. Aims: To evaluate the effectiveness of the My Baby's Movements (MBM) app on late-gestation stillbirth rates. Materials and Methods: The MBM trial evaluated a multifaceted fetal movements awareness package across 26 maternity services in Australia and New Zealand be- tween 2016 and 2019. In this secondary analysis, generalised linear mixed models were used to compare rates of late-gestation stillbirth, obstetric interventions, and neonatal outcomes between app users and non-app users including calendar time, cluster, primiparity and other potential confounders as fixed effects, and hospital as a random effect. Results: Of 140 052 women included, app users comprised 9.8% (n = 13 780). The stillbirth rate was not significantly lower among app users (1.67/1000 vs 2.29/1000) (adjusted odds ratio (aOR) 0.79; 95% CI 0.51–1.23). App users were less likely to have a preterm birth (aOR 0.81; 0.75–0.88) or a composite adverse neonatal out- come (aOR 0.87; 0.81–0.93); however, they had higher rates of induction of labour (IOL) (aOR 1.27; 1.22–1.32) and early term birth (aOR 1.08; 1.04–1.12). Conclusions: The MBM app had low uptake and its use was not associated with stillbirth rates but was associated with some neonatal benefit, and higher rates of IOL and early term birth. Use and acceptability of tools designed to promote fetal movement awareness is an important knowledge gap. The implications of increased IOL and early term births warrant consideration in future studies.Sarah Skalecki, Harriet Lawford, Glenn Gardener, Michael Coory, Billie Bradford, Kara Warrilow, Aleena M. Wojcieszek, Tionie Newth, Megan Weller, Joanne M. Said, Fran M. Boyle, Christine East, Adrienne Gordon, Philippa Middleton, David Ellwood and Vicki Flenad
Attitudes to living and working in pandemic conditions among emergency prehospital medical care personnel
No full textKerrianne Watt, Vivienne C. Tippett, Steven G. Raven, Konrad Jamrozik, Michael Coory, Frank Archer, Heath A. Kell
Evaluation of Pregnancy Outcomes among Women with Decreased Fetal Movements
No full textImportance: Stillbirth is a devastating pregnancy outcome with far-reaching economic and psychosocial consequences, but despite significant investment, a screening tool for identifying those fetuses at risk for stillbirth remains elusive. Maternal reporting of decreased fetal movements (DFM) has been found to be associated with stillbirth and other adverse perinatal outcomes. Objective: To examine pregnancy outcomes of women presenting with DFM in the third trimester at a tertiary Australian center with a clear clinical management algorithm. Design, Setting, and Participants: This cohort study used data on all births meeting the inclusion criteria from 2009 through 2019 at Mater Mothers' Hospital in Brisbane, Australia. This is a tertiary center and Australia's largest maternity hospital. All singleton births without a known congenital anomaly after 28 weeks' gestation were included. Among 203071 potential participants identified from the hospital database, 101597 individuals met the eligibility criteria. Data analysis was performed from May through September 2020. Exposure: Presentation to hospital with DFM after 28 weeks gestation. Main Outcomes and Measures: The primary outcome of this study was the incidence of stillbirth. Multivariate analysis was undertaken to determine the association between DFM and stillbirth, obstetric intervention, and other adverse outcomes, including being born small for gestational age (SGA) and a composite adverse perinatal outcome (at least 1 of the following: neonatal intensive care unit admission, severe acidosis [ie, umbilical artery pH <7.0 or base excess -12.0 mmol/L or less], 5-minute Apgar score <4, or stillbirth or neonatal death). The hypothesis being tested was formulated prior to data collection. Results: Among 101597 women with pregnancies that met the inclusion criteria, 8821 (8.7%) presented at least once with DFM and 92776 women (91.3%) did not present with DFM (ie, the control population). Women presenting with DFM, compared with those presenting without DFM, were younger (mean [SD] age, 30.4 [5.4] years vs 31.5 [5.2] years; P <.001), more likely to be nulliparous (4845 women [54.9%] vs 42210 women [45.5%]; P <.001) and have a previous stillbirth (189 women [2.1%] vs 1156 women [1.2%]; P <.001), and less likely to have a previous cesarean delivery (1199 women [13.6%] vs 17444 women [18.8%]; P <.001). During the study period, the stillbirth rate was 2.0 per 1000 births after 28 weeks' gestation. Presenting with DFM was not associated with higher odds of stillbirth (9 women [0.1%] vs 185 women [0.2%]; adjusted odds ratio [aOR], 0.54; 95% CI, 0.23-1.26, P =.16). However, presenting with DFM was associated with higher odds of a fetus being born SGA (aOR, 1.14; 95% CI, 1.03-1.27; P =.01) and the composite adverse perinatal outcome (aOR, 1.14; 95% CI, 1.02-1.27; P =.02). Presenting with DFM was also associated with higher odds of planned early term birth (aOR, 1.26; 95% CI, 1.15-1.38; P <.001), induction of labor (aOR, 1.63; 95% CI, 1.53-1.74; P <.001), and emergency cesarean delivery (aOR, 1.18; 95% CI, 1.09-1.28; P <.001). Conclusions and Relevance: The presence of DFM is a marker associated with increased risk for a fetus. This study's findings of a nonsignificantly lower rate of stillbirth among women with DFM may be reflective of increased community awareness of timely presentation to their obstetric care clinician when concerned about fetal movements and the benefits of tertiary level care guided by a clear clinical management protocol. However, DFM was associated with increased odds of an infant being born SGA, obstetric intervention, early term birth, and a composite of adverse perinatal outcomes.Full Tex
Why we need a population-based approach to clinical indicators for cancer: A case study using microscopic confirmation of lung cancer in Queensland
No full textAn important function of clinical cancer registries is to provide feedback to clinicians on various performance measures. To date, most clinical cancer registries in Australia are located in tertiary academic hospitals, where adherence to guidelines is probably already high. Microscopic confirmation is an important process measure for lung cancer care. We found that the proportion of patients with lung cancer without microscopic confirmation was much higher in regional public hospitals (27.1%) than in tertiary hospitals (7.5%), and this disparity remained after adjusting for age, sex and comorbidities. The percentage was also higher in the private than in the public sector. This case study shows that we need a population-based approach to measuring clinical indicators that includes regional public hospitals as a matter of priority and should ideally include the private sector
Hospital admissions of overseas visitors involved in motor vehicle crashes in Queensland, Australia
No full textDuring the financial year 1997/98, 132 overseas visitors were admitted to Queensland hospitals as a result of motor vehicle crashes. The main conditions treated were fracture/ dislocation (29.5%), laceration/contusion/abrasion (18.2%), chest/abdominal trauma (10.6%) and minor head injury (10.6%). The median length-of-stay was two days, with 49% of patients staying only one day in hospital. Overall, overseas visitors admitted to hospital following a motor vehicle crash occupied 725 bed days. The estimated total cost of these admissions was $239,904.00. While overseas visitors represent only a small proportion of the state's road toll, they can be a substantial financial and resource burden to rural and regional hospitals. It is suggested that profiling tourists admitted to hospital as a result of motor vehicle crashes will provide valuable information to guide road safety initiatives
Prospective cohort study: Causes of stillbirth in Australia 2013–2018
No full textBackground: Stillbirth is a major public health problem that is slow to improve in Australia. Understanding the causes of stillbirth through appropriate investigation is the cornerstone of prevention and important for parents to understand why their baby died. Aim: The aim of this study is to assess compliance with the Perinatal Society of Australia and New Zealand (PSANZ) Perinatal Mortality Clinical Practice Guidelines (2009) for stillbirths. Methods: This is a prospective multi-centred cohort study of stillbirths at participating hospitals (2013–2018). Data were recorded into a purpose-built database. The frequency of the recommended core investigations was calculated, and χ² test was performed for subgroup analyses by gestational age groups and timing of fetal death. A 70% compliance threshold was defined for investigations. The cause of death categories was provided according to PSANZ Perinatal Death Classification. Results: Among 697 reported total stillbirths, 562 (81%) were antepartum, and 101 (15%) were intrapartum. The most common cause of death categories were ‘congenital abnormality’ (12.5%), ‘specific perinatal conditions’ (12.2%) and ‘unexplained antepartum death’ (29%). According to 2009 guidelines, there were no stillbirths where all recommended investigations were performed (including or excluding autopsy). A compliance of 70% was observed for comprehensive history (82%), full blood count (94%), cytomegalovirus (71%), toxoplasmosis (70%), renal function (75%), liver function (79%), external examination (86%), post-mortem examination (84%) and placental histopathology (92%). The overall autopsy rate was 52%. Conclusions: Compliance with recommended investigations for stillbirth was suboptimal, and many stillbirths remain unexplained. Education on the value of investigations for stillbirth is needed. Future studies should focus on understanding the yield and value of investigations and service delivery gaps that impact compliance.Jessica K. Sexton, Kassam Mahomed, Tania Marsden, Michael Coory, Glenn Gardener, David Ellwood, Adrienne Gordon, Antonia W. Shand, Teck Yee Khong, Louisa G. Gordon, and Vicki Flenad
- …
