Comparison of general and cardiac care-specific indices of spatial access in Australia

© 2019 Versace et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Objective To identity differences between a general access index (Accessibility/ Remoteness Index of Australia; ARIA+) and a specific acute and aftercare cardiac services access index (Cardiac ARIA). Research design and methods Exploratory descriptive design. ARIA+ (2011) and Cardiac ARIA (2010) were compared using cross-tabulations (chi-square test for independence) and map visualisations. All Australian locations with ARIA+ and Cardiac ARIA values were included in the analysis (n = 20,223). The unit of analysis was Australian locations. Results Of the 20,223 locations, 2757 (14% of total) had the highest level of acute cardiac access coupled with the highest level of general access. There were 1029 locations with the poorest access (5% of total). Approximately two thirds of locations in Australia were classed as having the highest level of cardiac aftercare. Locations in Major Cities, Inner Regional Australia, and Outer Regional Australia accounted for approximately 98% of this category. There were significant associations between ARIA+ and Cardiac ARIA acute (χ2 = 25250.73, df = 28, p<0.001, Cramer’s V = 0.559, p<0.001) and Cardiac ARIA aftercare (χ2 = 17204.38, df = 16, Cramer’s V = 0.461, p<0.001). Conclusions Although there were significant associations between the indices, ARIA+ and Cardiac ARIA are not interchangeable. Systematic differences were apparent which can be attributed largely to the underlying specificity of the Cardiac ARIA (a time critical index that uses distance to the service of interest) compared to general accessibility quantified by the ARIA + model (an index that uses distance to population centre). It is where the differences are located geographically that have a tangible impact upon the communities in these locations–i.e. peri-urban areas of the major capital cities, and around the more remote regional centres. There is a strong case for specific access models to be developed and updated to assist with efficient deployment of resources and targeted service provision. The reasoning behind the differences highlighted will be generalisable to any comparison between general and service-specific access models

Heart failure following blood cancer therapy in pediatric and adult populations

Aim: The link between chemotherapy treatment and cardiotoxicity is well established, particularly for adults with blood cancers. However, it is less clear for children. This analysis aimed to compare the trajectory and mortality of children and adults who received chemotherapy for blood cancers and were subsequently hospitalised for heart failure. Methods: Linked data from the Queensland Cancer Registry, Death Registry and Hospital Administration records for initial chemotherapy and later heart failure were reviewed (1996-2009). Of all identified blood cancer patients (N=23,434); 8,339 received chemotherapy, including 817 children (aged ≤18 years at time of cancer diagnosis) and 7,522 adults. Time-varying Cox proportional hazards regression models were used to compare the characteristics and survival between the two groups. Results: Of those who were subsequently hospitalised for heart failure, 70% of children and 46% of adults had the index admission within 12 months of their cancer diagnosis. Of these, 53% of the pediatric heart failure population and 71% of the adult heart failure population died within the study period. Following adjustment for age, sex and chemotherapy admissions, children with heart failure had an increased mortality risk compared to their non-heart failure counterparts, a difference which was much greater than that between the adult groups. Conclusion: The impact of heart failure on children previously treated for blood cancer is more severe than for adults, with earlier morbidity and greater mortality. Improved strategies are needed for the prevention and management of cardiotoxicity in this population

Exile Vol. XXXVII No. 1

And It Was Sunday by Julie Gruen 1-6 Like a Lady by Grace Mulvihill 7 The Final You by Eric Franzon 8 Joseph\u27s Children by Seneca Murley 9 Ain\u27t the 1950s Anymore by Ellen Stader 10-12 Bonding Women by Shannon salser 13 Ice Man (for mami 1905-1975) by Anne Mulligan 14 The Car Salesman by Tom Ream 15 Cancelling the Bunny by Stewart Engesser 16-17 Richard Brautigan\u27s Body by Michael Payne 18-19 Dinner in Barcelona by Holly Kurtz 20 Untitled by Margaret Strachen 21 Candles by Eric Franzon 22 Summer Rules by Jim Cox 23-31 My Boat by Holly Kurtz 32 Untitled by Michael Payne 33 Half the Birds in the City by Tiffany Richardson 34-35 Down Queen Anne Hill by Julie Gruen 36-37 Your Music by Tim Emrick 38 Zephyrs by Steve Corinth 39-41 Mother by Anne Mulligan 42 As I Look to the Sky, Maize by Shannon Salser 43-45 Close Book before Striking by Sarah Verdon 46-47 Smoked by Tom Ream 48 Driving through Rain by Stewart Engesser 49-50 Contributors 51 Editorial decision is shared equally among the Editorial Board. -i 35th Yea

Exile Vol. XXXVII No. 2

Once and for All by Michael Payne 1 Alone Over The Trees by John Stoddard 2 Caught You by Nancy Booth 3 Mother\u27s Words by Julie Green 4-10 His Token by Donna Marie Voldness 11-12 Global Warming by Eric Franzon 13-14 Amish Mystery by Shannon Salser 15 For Peace by Robin Schneider 16-18 Elvis, the Lizard King, and Me by Stewart Engesser 19-22 Norpell Woods by Brandon Pfeiffer 23 Blue Suit, Red Dog by Jack Beck 24 I Am Without My List of Excusses [sic] by Douglas George 25 Somtimes - Satre Would Not Be Proud by Dana Wells 26 The Flock by Carter Holland 27-33 Dance of Alabaster by Jay Speiden 34 Winter Solstice by K. Lynn Rogers 35-36 Fish Story by Jim Dixon 37-42 Slumming by Stewart Engesser 43 Beached by Chris Dealy 44 The Missing Man by Tom Ream 45-47 Elegy by Scott Dexter 48 Close Range by Jay Speiden 49 No Longer by Shannon Salser 50 In A Bar In Georgetown, Colorado 1990 by John Stoddard 51 untitled by Brian Wills 52 Editorial decision is shared equally among the Editorial Board. -i Cover: Megan Doyle -i NOTE: I Am Without My List of Excusses [sic] by Douglas George 25 is listed as I Am Without My List of Excuses on page 25. The published table of contents is followed here

Discordant identification of pediatric severe sepsis by research and clinical definitions in the SPROUT international point prevalence study

Introduction: Consensus criteria for pediatric severe sepsis have standardized enrollment for research studies. However, the extent to which critically ill children identified by consensus criteria reflect physician diagnosis of severe sepsis, which underlies external validity for pediatric sepsis research, is not known. We sought to determine the agreement between physician diagnosis and consensus criteria to identify pediatric patients with severe sepsis across a network of international pediatric intensive care units (PICUs). Methods: We conducted a point prevalence study involving 128 PICUs in 26 countries across 6 continents. Over the course of 5 study days, 6925 PICU patients <18 years of age were screened, and 706 with severe sepsis defined either by physician diagnosis or on the basis of 2005 International Pediatric Sepsis Consensus Conference consensus criteria were enrolled. The primary endpoint was agreement of pediatric severe sepsis between physician diagnosis and consensus criteria as measured using Cohen's ?. Secondary endpoints included characteristics and clinical outcomes for patients identified using physician diagnosis versus consensus criteria. Results: Of the 706 patients, 301 (42.6 %) met both definitions. The inter-rater agreement (? ± SE) between physician diagnosis and consensus criteria was 0.57 ± 0.02. Of the 438 patients with a physician's diagnosis of severe sepsis, only 69 % (301 of 438) would have been eligible to participate in a clinical trial of pediatric severe sepsis that enrolled patients based on consensus criteria. Patients with physician-diagnosed severe sepsis who did not meet consensus criteria were younger and had lower severity of illness and lower PICU mortality than those meeting consensus criteria or both definitions. After controlling for age, severity of illness, number of comorbid conditions, and treatment in developed versus resource-limited regions, patients identified with severe sepsis by physician diagnosis alone or by consensus criteria alone did not have PICU mortality significantly different from that of patients identified by both physician diagnosis and consensus criteria. Conclusions: Physician diagnosis of pediatric severe sepsis achieved only moderate agreement with consensus criteria, with physicians diagnosing severe sepsis more broadly. Consequently, the results of a research study based on consensus criteria may have limited generalizability to nearly one-third of PICU patients diagnosed with severe sepsis

Obesity, place and environment: the spatial distribution and correlates of weight status in South Australian preschool children.

The issue of overweight and obesity in childhood has received a great deal of recent attention in both the academic literature and popular media. These discussions have tended to concentrate on individual responses to behavioural and nutritional choices, with limited exploration of how the wider social and economic environment might influence weight outcomes. However there is a growing body of research which has identified area level effects on health outcomes, and this suggests that location should be an important consideration in obesity research. Currently, very little formal investigation of weight status has been conducted among children of preschool age and location is not routinely considered in obesity research, especially at the small area level and particularly with reference to children. Given that childhood overweight is known to persist into adulthood and that behavioural change may be easier to effect in preschoolers, it is appropriate to focus research attention on this age group. This study explores an administrative data set containing over 120 000 individual records collected over ten years and supplied by the South Australian Children, Youth and Women‟s Health Service. Geographical Information Systems (GIS) are used to determine the prevalence, distribution and area-level correlates of obesity in South Australian four year old children between 1995 and 2003. It aims to determine if there has been significant variation in the spatial distribution of obesity prevalence between different communities over this time period, and to detect relationships between weight status, socio-economic variables and environmental attributes at a small scale which may be able to explain some of the discrepancy. These are investigated in conjunction with the data items available for the individual children in this data set. A univariate analysis approach using cross-tabulation and chi square testing has been used to explore the relationships between the obesity prevalence of the study population and selected socio-demographic and environmental variables at a small area level. The Australian Census of Population and Housing is the primary source of socio-demographic data, but other variables including housing characteristics, proximity to fast food outlets, proximity to recreational areas and the walkability of neighbourhoods have also been examined. Analysis of this data set reveals an increase in obesity prevalence over time, in line with national and international trends. For individual children, birth weight, ethnicity and breastfeeding history appear to be particularly influential in the development of overweight at four years of age, but there is nevertheless a distinct spatial patterning of obesity prevalence throughout the state, and also within the metropolitan Adelaide area. While there is generally a positive association between socio-economic status and obesity, these relationships are not necessarily straightforward and the area-level physical and social environmental variables actually show a varying relationship with obesity prevalence in different communities. This study has clearly identified neighbourhood characteristics as an important component in the complex etiology of obesity development in even very young children. It has shown that aspects of environment such as ethnicity and disadvantage should be taken into account when targeting and tailoring public health initiatives to combat the development of obesity in these populations. The exploration of this unique, administrative data set with reference to location has illustrated the complexity of the relationship between biology and environment in the development of overweight and obesity in young children. This has implications for policy development across many spheres of government.Thesis (Ph.D.) -- University of Adelaide, School of Social Sciences, 201

Role of the pharmacist for improving self-care and outcomes in heart failure

The final publication is available at Springer via http://dx.doi.org/10.1007/s11897-017-0323-2 This author accepted manuscript is made available following 12 month embargo from date of publication (Feb 2017) in accordance with the publisher’s archiving policyPurpose of Review This review highlights the current and emerging approaches for the role of the pharmacist for improving self-care and outcomes in heart failure management. Recent Findings Pharmacists are contributing to heart failure management in a variety of settings, including hospitals, clinics, and communities. Different interventions which may be mediated by the pharmacist include drug adherence, discharge counseling, medication reconciliation, telephone follow-up, and recommendation of evidence-based medicines. Summary Pharmacist engagement in heart failure management has demonstrated improved drug adherence, readmission rates, medication management, self-care ability, patient satisfaction, and heart failure knowledge. Some findings are mixed, especially for readmission rates. Improved medication management was reported in nearly all studies, despite significant heterogeneity in the models of care, patient populations, and study designs. This review highlights the requirement for large randomized trials with extended follow-up to confirm the impact of the role of the pharmacist in HF self-care, particularly through multidisciplinary-based interventions