Topics

Abstract

Objectives: To evaluate whether an alternative model of care in aged care facilities, including in‐house general practitioners, influenced health outcomes for residents.

Design: Stepped wedge, cluster randomised controlled trial over 90 weeks (31 December 2012 – 21 September 2014), with a 54‐week pre‐trial retrospective data period (start: 19 December 2011) and a 54‐week post‐trial prospective data collection period (to 4 October 2015).

Participants, setting: Fifteen residential aged care facilities operated by Bupa Aged Care in metropolitan and regional cities in four Australian states.

Intervention: Residential aged care facilities sought to recruit general practitioners as staff members; care staff roles were redefined to allow registered nurses greater involvement in care plan development.

Main (primary) outcome measures: Numbers of falls; numbers of unplanned transfers to hospital; polypharmacy.

Results: The new model of care could be implemented in all facilities, but four could not recruit in‐house GPs at any time during the trial period. Intention‐to‐treat analyses found no statistically significant effect of the intervention on the primary outcome measures. Contamination‐adjusted intention‐to‐treat analyses identified that the presence of an in‐house GP was associated with reductions in the numbers of unplanned hospital transfers (incidence rate ratio [IRR], 0.53; 95% CI, 0.43–0.66) and admissions (IRR, 0.52; 95% CI, 0.41–0.64) and of out‐of‐hours GP call‐outs (IRR, 0.54; 95% CI, 0.36–0.80), but also with an increase in the number of reported falls (IRR, 1.37; 95% CI, 1.20–1.58).

Conclusions: Recruiting GPs to work directly in residential aged care facilities is difficult, but may reduce the burden of unplanned presentations to hospitals and increase the reporting of adverse events.

Trial registration: Australia New Zealand Clinical Trial Registry, ACTRN12613000218796 (25 February 2013).

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1 Monash University, Melbourne, VIC
2 Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS
3 Wicking Dementia Research and Education Centre, University of Tasmania, Hobart, TAS
4 Bupa Aged Care Australia, Sydney, NSW

Correspondence: terrence.haines@monash.edu

Acknowledgements:

Terry Haines was supported by a National Health and Medical Research Council Career Development Fellowship.

Competing interests:

This study was funded by the Bupa Health Foundation, and the trial was conducted at Bupa Aged Care facilities. The Bupa Health Foundation had no role in the study design, data collection, analysis or interpretation, reporting or publication. There were no financial relationships with any organisations with an interest in the research question during the preceding three years. Petra Tierney was employed by Bupa Aged Care during the trial but not during manuscript preparation. A copy of the project report was submitted to the Bupa Health Foundation before submitting the manuscript to the MJA.

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Narrative review

Chronic fatigue syndrome: progress and possibilities

Carolina X Sandler and Andrew R Lloyd

Med J Aust 2020; 212 (9): . || doi: 10.5694/mja2.50553
Published online: 6 April 2020

ARTICLE
AUTHORS
REFERENCES

Topics

Infectious diseases

General medicine

Information science

Summary

Chronic fatigue syndrome (CFS) is a prevalent condition affecting about one in 100 patients attending primary care.
There is no diagnostic test, validated biomarker, clear pathophysiology or curative treatment.
The core symptom of fatigue affects both physical and cognitive activities, and features a prolonged post‐activity exacerbation triggered by tasks previously achieved without difficulty.
Although several different diagnostic criteria are proposed, for clinical purposes only three elements are required: recognition of the typical fatigue; history and physical examination to exclude other medical or psychiatric conditions which may explain the symptoms; and a restricted set of laboratory investigations.
Studies of the underlying pathophysiology clearly implicate a range of different acute infections as a trigger for onset in a significant minority of cases, but no other medical or psychological factor has been reproducibly implicated.
There have been numerous small case–control studies seeking to identify the biological basis of the condition. These studies have largely resolved what the condition is not: ongoing infection, immunological disorder, endocrine disorder, primary sleep disorder, or simply attributable to a psychiatric condition.
A growing body of evidence suggests CFS arises from functional (non‐structural) changes in the brain, but of uncertain character and location. Further functional neuroimaging studies are needed.
There is clear evidence for a genetic contribution to CFS from family and twin studies, suggesting that a large scale genome‐wide association study is warranted.
Despite the many unknowns in relation to CFS, there is significant room for improvement in provision of the diagnosis and supportive care. This may be facilitated via clinician education.

1 UNSW Fatigue Clinic, UNSW, Sydney, NSW
2 Queensland University of Technology, Brisbane, QLD
3 Kirby Institute for Infection and Immunity in Society, UNSW, Sydney, NSW
4 UNSW Medicine, Sydney, NSW

Correspondence: a.lloyd@unsw.edu.au

Acknowledgements:

Andrew Lloyd is supported by a National Health and Medical Research Council Practitioner Fellowship (1041897). We are grateful for the review of the manuscript by Phillip Peterson MD.

Competing interests:

No relevant disclosures.

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Letters

Time to recognise gout as a chronic disease

Helen I Keen, Philip C Robinson, Nicola Dalbeth and Catherine Hill

Med J Aust 2020; 212 (6): . || doi: 10.5694/mja2.50512
Published online: 6 April 2020

ARTICLE
AUTHORS
REFERENCES

Topics

Musculoskeletal diseases

To the Editor: In August 2019, the Australian Institute of Health and Welfare (AIHW) released a report on chronic musculoskeletal conditions in Australia.1

1 Fiona Stanley Hospital, Perth, WA
2 Royal Perth Hospital, Perth, WA
3 University of Western Australia, Perth, WA
4 Centre for Neurogenetics and Statistical Genomics, Diamantina Institute, University of Queensland, Brisbane, QLD
5 Royal Brisbane and Women's Hospital, Brisbane, QLD
6 University of Auckland, Auckland, Auckland, New Zealand
7 Queen Elizabeth Hospital, Adelaide, SA
8 Royal Adelaide Hospital, Adelaide, SA

Correspondence: helen.keen@uwa.edu.au

Competing interests:

Nicola Dalbeth reports grants and personal fees from AstraZeneca, grants from Amgen, and personal fees from Dyve, Hengrui, Horizon, Abbvie, Pfizer, and Janssen outside the submitted work. Helen Keen reports personal fees from Abbvie, Cornerstones, Roche, and Pfizer outside of the submitted work.

1. Australian Institute of Health and Welfare. Arthritis [Cat. No. PHE 234]. Canberra: AIHW, 2019. https://www.aihw.gov.au/reports/chronic-musculoskeletal-conditions/arthritis/related-material (viewed Jan 2019).
2. Pisaniello HL, Lester S, Gonzalez‐Chica D, et al. Gout prevalence and predictors of urate‐lowering therapy use: results from a population‐based study. Arthritis Res Ther 2018; 20: 143.
3. Rai SK, Choi HK, Choi SHJ, et al. Key barriers to gout care: a systematic review and thematic synthesis of qualitative studies. Rheumatology (Oxford) 2018; 57: 1282–1292.
4. Bursill D, Taylor WJ, Terkeltaub R, et al. Gout, Hyperuricaemia and Crystal‐Associated Disease Network (G‐CAN) consensus statement regarding labels and definitions of disease states of gout. Ann Rheum Dis 2019; 78: 1592–1600.
5. Dalbeth N, Schumacher HR, Fransen J, et al. Survey definitions of gout for epidemiologic studies: comparison with crystal identification as the gold standard. Arthritis Care Res (Hoboken) 2016; 68: 1894–1898.

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Letters

The hidden slaves of medicine

Sharon Sitters

Med J Aust 2020; 212 (6): . || doi: 10.5694/mja2.50510
Published online: 6 April 2020

ARTICLE
AUTHORS
REFERENCES

Topics

Global health

Ethics and law

Social determinants of health

To the Editor: Nearly all industries profit from today's 25 million slaves and 150 million child labourers.1 The results of their work, including medical disposables, are sold worldwide. Unfortunately, there is not a comprehensive analysis identifying exactly where slaves are involved in the medical products supply chain.

Unitec Institute of Technology, Auckland, New Zealand

Correspondence: ssitters@unitec.ac.nz

Competing interests:

No relevant disclosures.

1. International Labour Organization. Modern slavery and child labour: 40 million in modern slavery and 152 million in child labour around the world. International Labour Organization, 2017. https://www.ilo.org/global/about-the-ilo/newsroom/news/WCMS_574717/lang-en/index.htm (viewed June 2019).
2. Bhutta MF. Time for a global response to labour rights violations in the manufacture of health‐care goods. Bull World Health Organ 2017; 95: 314–314A.
3. Bureau of International Labor Affairs. US Department of Labor's 2018 list of goods produced by child labor or forced labor. US Department of Labor, 2018. https://www.dol.gov/sites/dolgov/files/ILAB/ListofGoods.pdf (viewed June 2019).
4. Khadem N. Ansell says worker rights abuse in its supply chain under investigation. ABC News 2019, 11 Mar. https://www.abc.net.au/news/2019-01-04/ansell-investigating-claims-worker-rights-abuse-in-supply-chain/10685124 (viewed June 2019).
5. Boersma M. Do no harm? Procurement of medical goods by Australian companies and government. Australian Nursing and Midwifery Federation, Australia Institute, 2017. http://www.anmf.org.au/documents/Do_No_Harm_Report.pdf (viewed June 2019).
6. Nestlé. Tackling child labour — 2017 report. Nestlé, 2017. https://www.nestle.com/asset-library/documents/creating-shared-value/responsible-sourcing/nestle-cocoa-plan-child-labour-2017-report.pdf (viewed June 2019).
7. King B, Payne C, Melsom R. The tobacco free portfolios story [website]. Tobacco Free Portfolios, 2019. www.tobaccofreeportfolios.org/who-we-are/ (viewed Oct 2019).

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Research

Optimising epilepsy management with a smartphone application: a randomised controlled trial

Yang Si, Xiaoqiang Xiao, Cai Xia, Jiang Guo, Qiukui Hao, Qianning Mo, Yulong Niu and Hongbin Sun

Med J Aust 2020; 212 (6): . || doi: 10.5694/mja2.50520
Published online: 6 April 2020

ARTICLE
AUTHORS
REFERENCES

Topics

Nervous system diseases

Health services administration

Information science

Abstract

Objective: To assess whether a practical intervention based upon a smartphone application (app) would improve self‐management and seizure control in adults with epilepsy.

Design, setting: Randomised, controlled trial in western China, December 2017 to August 2018.

Participants: 380 eligible people with epilepsy were recruited; 327 completed the 6‐month follow‐up (176 in the app group, 151 in the control group).

Main outcome measures: Self‐management of epilepsy (measured with the validated Chinese Epilepsy Self‐Management Scale, C‐ESMS) and self‐reported seizure frequency.

Results: In the intention‐to‐treat analysis, the mean C‐ESMS score increased significantly in the app group between baseline and the 6‐month evaluation (from 121.7 [SD, 12.1] to 144.4 [SD, 10.0]; P < 0.001); improvements on the information management, medication management, and safety management subscales were also statistically significant. At 6 months, the mean overall C‐ESMS score for the app group was significantly higher than that for the control group (125.4 [SD, 1.5]; P < 0.001). The proportion of patients who were seizure‐free at the 6‐month follow‐up was larger for the app than the control group (54 of 190, 28% v 22 of 190, 12%), as was the proportion with reductions in frequency of between 75 and 100% (22 of 190, 12% v 8 of 190, 4%). Changes in C‐ESMS score were not statistically associated with seizure frequency.

Conclusions: Using a smartphone app improved epilepsy self‐management scores in people in western China. It should be further tested in larger populations in other areas. Our preliminary investigation of building digital communities for people with epilepsy should encourage similar approaches to managing other chronic diseases.

Trial registration: Chinese Clinical Trial Registry, ChiCTR1900026864, 24 October 2019.

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1 Sichuan Academy of Medical Sciences and Sichuan People's Hospital, Chengdu, Sichuan, China
2 University of Electronic Science and Technology of China, Chengdu, Sichuan, China
3 Sichuan Provincial Center for Mental Health, Sichuan Academy of Medical Sciences and Sichuan People's Hospital, Chengdu, Sichuan, China
4 National Clinical Research Center for Geriatrics, Sichuan University West China Hospital, Chengdu, Sichuan, China
5 Key Laboratory of Bio‐Resource and Eco‐Environment, College of Life Sciences, Sichuan University, Chengdu, Sichuan, China

Correspondence:

yulong.niu@hotmail.com, sndxgl@163.com

Acknowledgements:

This investigation was supported by the National Natural Science Foundation of China (NSFC, 81701269).

Competing interests:

No relevant disclosures.

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2. Wang WZ, Wu JZ, Wang DS, et al. The prevalence and treatment gap in epilepsy in China: an ILAE/IBE/WHO study. Neurology 2003; 60: 1544–1545.
3. Briesacher BA, Andrade SE, Fouayzi H, Chan KA. Comparison of drug adherence rates among patients with seven different medical conditions. Pharmacotherapy 2008; 28: 437–443.
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11. Liu X, Wang R, Zhou D, Hong Z. Smartphone applications for seizure care and management in children and adolescents with epilepsy: feasibility and acceptability assessment among caregivers in China. Epilepsy Res 2016; 127: 1–5.
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13. Xiao X, Si Y, Mo Q, et al. Development and validation of the Chinese version of the Adult Epilepsy Self‐Management Scale (C‐ESMS) in western China. Epilepsy Res 2018; 144: 43–48.
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Editorials

Monitoring changes in infant feeding practices after changes to guidelines for food allergy prevention

Rachel L Peters and Kirsten P Perrett

Med J Aust 2020; 212 (6): . || doi: 10.5694/mja2.50535
Published online: 6 April 2020

ARTICLE
AUTHORS
REFERENCES

Topics

Immune system diseases

It may soon be possible to reverse the increase in food allergy of the past few decades

IgE‐mediated food allergy is a significant public health problem in many countries, and its prevalence in Australia is the highest of any country.1 As no curative treatments are available in routine practice, effective prevention strategies are essential for managing the increasing burden. Modifying infant feeding practices has emerged as a key approach.

1 Murdoch Children's Research Institute, Melbourne, VIC
2 The University of Melbourne, Melbourne, VIC
3 Royal Children's Hospital, Melbourne, VIC

Correspondence: rachel.peters@mcri.edu.au

Competing interests:

No relevant disclosures.

1. Peters RL, Koplin JJ, Gurrin LC, et al; HealthNuts Study. The prevalence of food allergy and other allergic diseases in early childhood in a population‐based study: HealthNuts age 4‐year follow‐up. J Allergy Clin Immunol 2017; 140: 145–153.e8.
2. Netting MJ, Campbell DE, Koplin JJ, et al. An Australian consensus on infant feeding guidelines to prevent food allergy: outcomes from the Australian Infant Feeding Summit. J Allergy Clin Immunol Pract 2017; 5: 1617–1624.
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5. O'Sullivan M, Vale S, Loh RKS, et al. SmartStartAllergy: a novel tool for monitoring food allergen introduction in infants. Med J Aust 2020; 212: 271–275.
6. Tey D, Allen KJ, Peters RL, et al; HealthNuts study investigators. Population response to change in infant feeding guidelines for allergy prevention. J Allergy Clin Immunol 2014; 133: 476–484.
7. Soriano VX, Peters RL, Ponsonby AL, et al. Earlier ingestion of peanut following changes to infant feeding guidelines: the EarlyNuts Study. J Allergy Clin Immunol 2019; 144: 1327–1335.e5.
8. Koplin JJ, Peters RL, Dharmage SC, et al; HealthNuts study investigators. Understanding the feasibility and implications of implementing early peanut introduction for prevention of peanut allergy. J Allergy Clin Immunol 2016; 138: 1131–1141 e2.
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10. Lowe AJ, Su JC, Allen KJ, et al. A randomized trial of a barrier lipid replacement strategy for the prevention of atopic dermatitis and allergic sensitization: the PEBBLES pilot study. Br J Dermatol 2018; 178: e19–e21.

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Editorials

Testing the effect of discharge destination on outcomes for people with isolated lower limb fractures

Ian D Cameron

Med J Aust 2020; 212 (6): . || doi: 10.5694/mja2.50540
Published online: 6 April 2020

ARTICLE
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REFERENCES

Topics

Rehabilitation

Environment and public health

Some patients may not benefit from inpatient rehabilitation, but numerous factors must be considered

In this issue of the MJA, Kimmel and her co‐authors report analysing data from the Victorian Orthopaedic Trauma Outcomes Registry (VOTOR)1 with the aim of determining whether inpatient rehabilitation after isolated lower extremity fracture in working age people might be associated with poorer long term outcomes. For those of us in the rehabilitation services, this investigation further develops a familiar theme, doubt about the value of inpatient rehabilitation services.

John Walsh Centre for Rehabilitation Research, University of Sydney, Sydney, NSW

Correspondence: ian.cameron@sydney.edu.au

Acknowledgements:

I am supported by a National Health and Medical Research Council (NHMRC) Practitioner Fellowship, the NSW State Insurance Regulatory Authority, and Insurance and Care (icare) NSW.

Competing interests:

I have received grants from the NHMRC, the Australian Research Council, the New South Wales State Insurance Regulatory Authority, and icare NSW.

1. Kimmel LA, Simpson PM, Holland AE, et al. Discharge destination and patient‐reported outcomes after inpatient treatment for isolated lower limb fractures. Med J Aust 2020; 212: 263–270.
2. Naylor JM, Hart A, Mittal R, et al. The value of inpatient rehabilitation after uncomplicated knee arthroplasty: a propensity score analysis. Med J Aust 2017; 207: 250–255. https://www.mja.com.au/journal/2017/207/6/value-inpatient-rehabilitation-after-uncomplicated-knee-arthroplasty-propensity
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8. Levin HS, Boake C, Song J, et al. Validity and sensitivity to change of the extended Glasgow Outcome Scale in mild to moderate traumatic brain injury. J Neurotrauma 2001; 18: 575–584.

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Perspective

Citation metrics for appraising scientists: misuse, gaming and proper use

John PA Ioannidis and Kevin W Boyack

Med J Aust 2020; 212 (6): . || doi: 10.5694/mja2.50493
Published online: 6 April 2020

ARTICLE
AUTHORS
REFERENCES

Topics

Statistics, epidemiology and research design

Information science

We need informative citation metrics that will be less prone to misuse and gaming

Citation and other metrics are widely misused, but when properly used, they can be valuable. Science itself thrives on quantitative measurement. Quantitative indicators aim to provide objective data instead of biased beliefs. Here, we focus on citation metrics in appraising scientists1 for hiring, promotion, tenure, funding, selection for some award, recognition or bonus, or other reasons. Many tricks exist to game citation metrics (Box); however, proper use of metrics may overcome these deficiencies. Generic challenges that we describe here may partly apply also to larger, more composite entities such as the appraisal of journals, institutions or large research portfolios, for example, at a national level.

1 Stanford Prevention Research Center, Stanford University, Stanford, CA, United States
2 SciTech Strategies, Albuquerque, NM, United States

Correspondence: jioannid@stanford.edu

Competing interests:

No relevant disclosures.

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15. Sauermann H, Haeussler C. Authorship and contribution disclosures. Sci Adv 2017; 3: e1700404.

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A new model of care and in‐house general practitioners for residential aged care facilities: a stepped wedge, cluster randomised trial

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Abstract

Author

Chronic fatigue syndrome: progress and possibilities

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Summary

Author

Time to recognise gout as a chronic disease

Topics

Author

The hidden slaves of medicine

Topics

Author

Optimising epilepsy management with a smartphone application: a randomised controlled trial

Topics

Abstract

Author

Monitoring changes in infant feeding practices after changes to guidelines for food allergy prevention

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Author

Testing the effect of discharge destination on outcomes for people with isolated lower limb fractures

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Author

Citation metrics for appraising scientists: misuse, gaming and proper use

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Author

Cardiovascular disease risk assessment for Aboriginal and Torres Strait Islander adults aged under 35 years: a consensus statement

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Summary

Author

Ending cheap alcohol gets promising results

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Author

A new model of care and in‐house general practitioners for residential aged care facilities: a stepped wedge, cluster randomised trial

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Abstract

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Comment

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Chronic fatigue syndrome: progress and possibilities

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Time to recognise gout as a chronic disease

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The hidden slaves of medicine

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Optimising epilepsy management with a smartphone application: a randomised controlled trial

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Monitoring changes in infant feeding practices after changes to guidelines for food allergy prevention

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Testing the effect of discharge destination on outcomes for people with isolated lower limb fractures

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Author

Comment

Do you have any competing interests to declare? *

Citation metrics for appraising scientists: misuse, gaming and proper use

Topics

Author

Comment

Do you have any competing interests to declare? *

Cardiovascular disease risk assessment for Aboriginal and Torres Strait Islander adults aged under 35 years: a consensus statement

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Comment

Do you have any competing interests to declare? *

Ending cheap alcohol gets promising results

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Pagination