An algorithm for augmenting cancer registry data for epidemiological research applied to oesophageal cancers

Oesophageal cancer is an important cancer with short survival, but the relationship between pre-diagnosis health behaviour and post-diagnosis survival remains poorly understood. Cancer registries can provide a high quality census of cancer cases but do not record pre-diagnosis exposures. The aim of this thesis is to document relationships between pre-diagnosis health behaviours on post-diagnosis survival times in oesophageal cancer, developing new methods as required. A systematic review and meta-analysis conducted in 2014, and updated in 2021, to investigate the association between pre-diagnosis health behaviours and oesophageal cancer. Visualising health behaviour variables as part of the cancer registry data set, with 100% missing data, led to the development of new approaches for augmenting US oesophageal cancer registry data with health behaviour data from a US national health survey Firstly, the health survey data were used to create logistic regression models of the probability of each behaviour relative to demographic characteristics and then these models were applied to cancer cases to estimate their probability of each behaviour. Secondly, cold-deck imputation such that two randomly selected but demographically similar health survey respondents both donated their health behaviour to the matching cancer case. The agreement between these two imputed values was used as an estimate of the misclassification and corrected for during the analyses. The logistic regression imputation-based analyses returned accurate point estimates, with wide confidence intervals, if the behaviour occurred in more than approximately 5% of cases. Our reviews and analyses confirmed that pre-diagnosis smoking decreased survival in oesophageal cancer (hazard ratio (HR) 1.08, 95% confidence interval (CI) 1.00-1.17) particularly squamous cell carcinoma when comparing highest to lowest lifetime exposure ( and HR 1.55, 95%CI 1.25-1.94); with similar associations for alcohol consumption. Pre-diagnosis leisure time physical activity was found to be associated with reduced hazard (HR 0.25, 95%CI 0.03,0.81) overall. Findings from these analyses can assist in modelling the impact of current changes in community health behaviour, as well as informing prognosis and treatment decisions at the individual level. This novel method of augmenting cancer registry data with pre-diagnosis variables appears to be effective and will benefit from further validation. This thesis has significantly progressed both issues and identified future opportunities for research and development

The Toowoomba adult trauma triage tool

Since the introduction of the Australasian Triage Scale (ATS) there has been considerable variation in its application. Improved uniformity in the application of the ATS by triage nurses is required. A reproducible, reliable and valid method to classify the illness acuity of Emergency Department patients so that a triage category 3 by one nurse means the same as a triage category 3 by another, not only in the same ED but also in another institution would be of considerable value to emergency nurses. This has been the driving motivation behind developing the Toowoomba Adult Trauma Triage Tool (TATTT). It is hoped the TATTT will support emergency nurses working in this challenging area by promoting standardisation and decreasing subjectivity in the triage decision process

Duolingo to Improve Linguistics of the Medical Resident

Purpose: Create an attainable Spanish language education program within a medical residency program to increase the quality, efficiency, and equality of healthcare received by patients. Description: Free DuoLingo language education application was chosen for the program due to being easily accessible, offering the ability to break down lessons into small timeframes, being user-friendly, and game format design. User’s learning goals can be tracked on this application. The duration of the QI Project was 4 months, and the population size was 3 residents. Each were requested to complete 10 minutes per day or 70 min per week (on average) for Spanish education on DuoLingo. Participants linked accounts with the project lead to allow monitoring throughout the study. The goal was to see if this time requirement was feasible for medical residents to meet. Results/Looking Ahead: The results concluded that it was not feasible. Average time spent a week was 7.4 mins a week. One subject did not participate at all and one resident averaged 98 minutes per week. The main problem with adherence appears to be the time length requirements were too long for residents who have limited time during training. The next phase of the QI project would be to decrease the time requirement to 40 min per week to see if this time requirement is more feasible to be achieved. Once feasibility is determined, the next step would be to determine the efficacy of using DuoLingo to learn Spanish

Vol. 2 Ch. 8 Moving Beyond the Question: Were the Hopewell Really Farmers? Evidence from the Hocking Valley, Ohio

https://ideaexchange.uakron.edu/encountering_hopewell/1018/thumbnail.jp

Key issues in rural health: perspectives of health service providers in Queensland

The Centre for Rural and Remote Area Health (CRRAH) held interactive research workshops in eight towns in Southern Queensland. The purpose of the workshops was to determine what health providers considered were major issues affecting their service and for these results to inform future research strategy of CRRAH. Over 150 organisations identified as either providing health services or having a significant interest in health provision in one or more of the targeted towns were invited to attend. The workshops used the nominal group technique to identify what the participants considered were key health issues in the geographical area in which they worked. These issues were then prioritised by the participants. Thematic analysis of the issues generated a ranking of themes by importance. Results were compared with a similar exercise undertaken in 2003. Participants from organisation directly involved with health care were complemented at the workshops by representatives from local government, the police service and church groups. A total of 85 participants representing 47 services and 41 different organisations attended the eight workshops. Issues generated by the participants were pooled into seventeen themes. Workforce issues were by far the major concern of health providers. Recruitment and retention of health workers were a major concern. The other four highest ranked themes across all workshops were mental health, access to health services, perceptions and expectations of consumers of health services and interagency cooperation. Aged care was an additional theme that generated a lot of concern at several of the workshops. The workshops provided important information to CRRAH for developing research strategy. Additionally, several new alliances among health providers were developed which will support sharing of information and resources. The workshops enabled rural and remote organisations to meet and identify the key health issues and supported research planning. Much need alliances among health providers were forged and collaborative research avenues are being explored. The workshop forum is an excellent means of information exchange

A suggested sampling algorithm for use with ATP testing in cleanliness measurement

Introduction: Rapid Adenosine Triphosphate (ATP) testing is becoming a commonly used method to measure cleanliness on reusable medical devices and healthcare environmental surfaces. Unfortunately, ATP testing devices suffer from inherent variability from a number of sources including imprecision in ATP measurement. Method: This paper proposes a new sampling algorithm which reduces the impact of inherent variability and thus improves decision making when using ATP testing. Conclusion: This algorithm can be applied across a variety of applications to provide more reliable data on measurable cleanliness standards for both medical devices and environmental surfaces. Formal trials using the new ATP sampling algorithm are required

Using a simplified ATP algorithm to improve data reliability and improve cleanliness standards for surface and medical device hygiene

Background: An algorithm has been improved to mitigate variability in cleanliness measurements of various surfaces using rapid Adenosine Triphosphate (ATP) testing. A cleaning intervention step (CIS) verifies the cleanability of those surfaces. Methods: ATP testing was performed on surfaces which were pre-approved as “clean” and ready for re-use. Adjacent (duplicate) ATP sampling was undertaken on 421 environmental surfaces, medical devices and other implements. The CIS was conducted on 270 surfaces using an aseptic technique and disposable cleaning wipes. Results: The two initial ATP results were plotted against each other with a 100 RLU threshold grading the results as clean (2x 100RLU) or equivocal (1x 100RLU). Of the surfaces sampled, 68.5 % were clean (288/421), 13.5 % were dirty (57/421) and 18 % were equivocal (76/421). The duplicate testing demonstrated a false negative rate of 10 % (44/421) where the first swab was 100 RLU. For the equivocal group, the gap between the two swabs was >100 RLU for 7.5 % of surfaces (33/421). The CIS was conducted on 270 of the surfaces tested and showed that cleaning could be improved (P=<0.001) on 88.5 % of surfaces (239/270). Conclusion: The simplified ATP testing algorithm provides real-time discrimination between surface cleanliness levels and improved certainty over surface hygiene. The duplicate swab sampling approach mitigates uncontrolled variability in the results and the CIS provides a nuanced understanding of the measurable cleanliness of any surface

A randomised clinical trial comparing outcomes of a single digit volar plate injury : buddy loops versus dorsal thermoplastic orthosis in a neutral position : study protocol

Background Volar plate injuries are a common hand injury and complications associated with this injury such as a fixed flexion deformity, persistent pain and oedema can have a significant impact on a person’s function. The literature reports these injuries are treated using various splinting materials such as thermoplastic, in varying degrees of proximal interphalangeal joint flexion or buddy loops. Despite volar plate injuries being reported as common, optimal non-surgical treatment of these injuries remains unclear. This study aims to investigate whether a dorsal blocking orthosis in a neutral position (00) is more effective than buddy loops for a volar plate injury to the proximal interphalangeal joint in preventing a fixed flexion deformity, reducing pain, managing oedema, and promoting function. Methods This study is a single-centre, prospective parallel-group, single blinded (assessor), randomised clinical trial. Patients between 18–65 years, who have sustained a volar plate injury to a single digit, have adequate cognitive functioning and give written informed consent will be invited to participate in this study. Patients will be randomised to either the control group where they will be fitted with buddy loops and commence early active motion exercises or the experimental group where they will receive a dorsal thermoplastic orthosis in a neutral position and commence early active motion exercises. The primary outcome measure is passive proximal interphalangeal joint extension and secondary outcome measures include passive range of motion, total passive motion, active range of motion, total active motion, grip strength, oedema, pain, function and adherence to treatment. Assessments will be completed until 8 weeks following commencement of treatment. The sample size calculation indicates that 23 patients is required in each group. With an expected dropout rate of 25% a total of 32 patients will be enrolled in each group. Discussion This study will assist in trying to improve treatment of volar plate injuries and assist in reducing complications associated with volar plate injuries, potentially reducing the need for prolonged hand therapy. Trial registration This trial has been registered with the Australian New Zealand Clinical Trials Registry (ACTRN12622001425785p). Ethical approval has been granted by the South Eastern Sydney Local Health District ethical committee (2022/ETH01697)