Accuracy and completeness of patient pathways – the benefits of national data linkage in Australia

Background - The technical challenges associated with national data linkage, and the extent of cross-border population movements, are explored as part of a pioneering research project. The project involved linking state-based hospital admission records and death registrations across Australia for a national study of hospital related deaths. Methods - The project linked over 44 million morbidity and mortality records from four Australian states between 1st July 1999 and 31st December 2009 using probabilistic methods. The accuracy of the linkage was measured through a comparison with jurisdictional keys sourced from individual states. The extent of cross-border population movement between these states was also assessed. Results - Data matching identified almost twelve million individuals across the four Australian states. The percentage of individuals from one state with records found in another ranged from 3-5 %. Using jurisdictional keys to measure linkage quality, results indicate a high matching efficiency (F measure 97 to 99 %), with linkage processing taking only a matter of days. Conclusions - The results demonstrate the feasibility and accuracy of undertaking cross jurisdictional linkage for national research. The benefits are substantial, particularly in relation to capturing the full complement of records in patient pathways as a result of cross-border population movements. The project identified a sizeable ‘mobile’ population with hospital records in more than one state. Research studies that focus on a single jurisdiction will under-enumerate the extent of hospital usage by individuals in the population. It is important that researchers understand and are aware of the impact of this missing hospital activity on their studies. The project highlights the need for an efficient and accurate data linkage system to support national research across Australia

Intraperitoneal drain placement and outcomes after elective colorectal surgery: international matched, prospective, cohort study

Despite current guidelines, intraperitoneal drain placement after elective colorectal surgery remains widespread. Drains were not associated with earlier detection of intraperitoneal collections, but were associated with prolonged hospital stay and increased risk of surgical-site infections.Background Many surgeons routinely place intraperitoneal drains after elective colorectal surgery. However, enhanced recovery after surgery guidelines recommend against their routine use owing to a lack of clear clinical benefit. This study aimed to describe international variation in intraperitoneal drain placement and the safety of this practice. Methods COMPASS (COMPlicAted intra-abdominal collectionS after colorectal Surgery) was a prospective, international, cohort study which enrolled consecutive adults undergoing elective colorectal surgery (February to March 2020). The primary outcome was the rate of intraperitoneal drain placement. Secondary outcomes included: rate and time to diagnosis of postoperative intraperitoneal collections; rate of surgical site infections (SSIs); time to discharge; and 30-day major postoperative complications (Clavien-Dindo grade at least III). After propensity score matching, multivariable logistic regression and Cox proportional hazards regression were used to estimate the independent association of the secondary outcomes with drain placement. Results Overall, 1805 patients from 22 countries were included (798 women, 44.2 per cent; median age 67.0 years). The drain insertion rate was 51.9 per cent (937 patients). After matching, drains were not associated with reduced rates (odds ratio (OR) 1.33, 95 per cent c.i. 0.79 to 2.23; P = 0.287) or earlier detection (hazard ratio (HR) 0.87, 0.33 to 2.31; P = 0.780) of collections. Although not associated with worse major postoperative complications (OR 1.09, 0.68 to 1.75; P = 0.709), drains were associated with delayed hospital discharge (HR 0.58, 0.52 to 0.66; P < 0.001) and an increased risk of SSIs (OR 2.47, 1.50 to 4.05; P < 0.001). Conclusion Intraperitoneal drain placement after elective colorectal surgery is not associated with earlier detection of postoperative collections, but prolongs hospital stay and increases SSI risk

Mapping children’s neighborhood perceptions: Implications for child indicators

Abstract A growing literature on small-area effects has linked neighborhood conditions with indicators of child well-being. This paper addresses some of the challenges in identifying and understanding these linkages, with a focus on children's definitions and perceptions of their neighborhood geographies. The study included 60 children aged 7 to 11 and one of their parents in five neighborhoods (census tracts). Neighborhood maps were elicited from both children and parents. Child and parent maps showed only a modest correlation, suggesting that children have their own conceptions of their neighborhoods. Also, home range was not equated with children's definitions of neighborhood boundaries. Accurate and meaningful measures of neighborhood, including child-centered measures, are needed. Child-centered neighborhood indicators are an important complement to the measures that are increasingly available for standard neighborhood units. The neighborhood is a potentially important context for improving child well-being by developing area-based programs to address spatial inequality in child well-being

Danger Signs: Ethnicity, Relationship Status and Lethal Threats Associated with Intimate Partner Violence

This paper identifies groupings of women who experience dangerous levels of intimate partner violence. Data from a survey of two hundred and twenty seven Perth women, who were clients of two services, were systematically analysed using SPSS Version 17. The results confirm that specific groupings of women experienced various illegal, potentially lethal forms of violence. The severity of the threats to Aboriginal and separated women suggests that these women are at risk of serious injury and possibly homicide. Their experiences expose a gap between laws outlawing violence and cultural norms that support intimate partner violence. These findings serve also as a warning to service providers that intervention is warranted

The Influence of Neighborhood Violent Crime on Child-Rearing: Integrating Neighborhood Ecologies and Stratified Reproduction Approaches

While relationships between neighborhood violent crime and adverse child outcomes are well-established, less is known about how neighborhood violent crime influences child-rearing strategies. To address this gap, we blend neighborhood ecologies and stratified reproduction frameworks and examine interview data collected in 2014–2015 from 107 adult caregivers residing in three low and three elevated violent crime neighborhoods in Cleveland, OH, USA. Our objective is to examine how perceptions of neighborhood violent crime and its relationship to self-reported child-rearing practices vary by level of neighborhood violence. We find that, although caregivers in low and elevated violent crime neighborhoods shared the perception of neighborhood violent crime as a concern, their narratives of child-rearing practices differed. Caregivers in elevated violent crime neighborhoods were more likely than their low violent crime counterparts to describe in experience-near terms how violent crime threatened their children’s well-being. To protect children, caregivers in elevated violent crime neighborhoods reported engaging in severely constrained child-rearing strategies. These constraints have unintended consequences. While they may protect children in the short-term, they may also reproduce inequities by reducing family quality of life in other ways. These findings advance understanding of how neighborhood violent crime differentially affects child-rearing. We integrate neighborhood ecologies and stratified reproduction frameworks to capture how social inequities interact in neighborhood settings to constrain child-rearing and perpetuate inequities over time

Risk of high-grade cervical dysplasia and gynaecological malignancies following the cytologic diagnosis of atypical endocervical cells of undetermined significance: A retrospective study of a state-wide screening population in Western Australia

Background: In 2006, Australia adopted a revised cervical cytology terminology system, known as the Australian Modified Bethesda System (AMBS). One substantial change in the AMBS was the introduction of the diagnostic category of atypical endocervical cells (AEC) of undetermined significance. Aim: The aim of this study was to investigate the incidence of histologically confirmed high-grade cervical dysplasia (cervical intra-epithelial neoplasia (CIN) grades 2 and 3 and adenocarcinoma in situ (ACIS)), cervical carcinoma and endometrial carcinoma in women presenting with AEC on cervical cytology. Methods: A seven-year retrospective study examining clinical outcomes of women with AEC on a screening cervical smear. Cytology and histology results were extracted from the Western Australia Cervical Screening Registry, and time-to-event analysis was used to predict the odds of having or developing in situ and invasive neoplasia.Results: AEC was reported in index smears from 0.093% (584/622754) women during the study period. No follow-up was available in 35 AEC cases. Sixty-five of the remaining 549 women (11.8%) had, or developed, high-grade cervical dysplasia within five years of their index AEC diagnosis. Endometrial cancer was diagnosed in 21 women and cervical cancer in four women during the follow-up period. Conclusion: Cytologic demonstration of AEC requires careful gynaecologic evaluation, particularly in younger women who may be found to have either high-grade squamous (CIN) or glandular (ACIS) lesions, while in older women, the possibility of endometrial neoplasia needs to be considered