An electronic medical record reminder is independently associated with improved opportunistic influenza vaccination rates for older inpatients.

BACKGROUND: Influenza vaccination will have added importance this winter given the possibility of further waves of the COVID-19 pandemic. This study examines the impact of an electronic medical record (EMR) reminder on influenza vaccine uptake among eligible hospital inpatients. METHODS: We included a convenience sample of 750 adults (median age 77 years) who are eligible for influenza vaccination (⩾65 years and/or length of stay >30 days). A live electronic dashboard identified patients eligible for vaccination, prompting reminders sent to the clinical teams via the EMR. RESULTS: The EMR reminder was associated with almost a 50% higher likelihood of vaccination after adjusting for other covariates (odds ratio 1.48 (95% confidence interval 1.00-2.20); p = 0.048). DISCUSSION: Reminders sent to the clinical team via the EMR appear to be an effective means of increasing vaccine uptake and should be considered as part of this year's drive to vaccinate eligible patients in hospital.

Post-operative risk factor control following internal carotid artery intervention.

BACKGROUND: Patients who undergo carotid surgical interventions remain at significant risk of further vascular events post-operatively. This study evaluates the level of risk factor monitoring and control being achieved post-operatively for patients who undergo carotid surgical interventions within Southern Health and investigates the significance of patient education and patient insight in this context. METHODS: The study included all patients who underwent successful carotid endarterectomy (CEA) or carotid angioplasty within Southern Health during the 5-year study period. To ascertain the objective risk factor status of participants, the most current reported measurements for the variables of blood pressure, blood lipids and glycosylated hemoglobin were obtained from the participant's usual medical attendants. To ascertain the participant's subjective perceptions of their risk factor status, participants completed a self-administered mail-out questionnaire. RESULTS: A high level of post-operative risk factor monitoring was demonstrated. Post-operative risk factor control was not as commendable. There was a significant discrepancy identified between patient perceptions of current post-operative risk factor status and the objective reality of current post-operative risk factor status. There was a moderate positive linear correlation between level of accurate patient insight into their disease (including their post-operative risk factor control) and the level of postoperative risk factor control being achieved (r = 0.51, P <0.001). CONCLUSION: Future strategy targeted at achieving optimal post-CEA and carotid angioplasty with adjuvant stenting risk factor control should consider incorporating themes that increase the level of accurate patient insight into their disease (particularly their post-operative risk factor control), for instance, patient education and effective doctor-patient communication.

Hospital-admitted eye injury in Victoria, Australia.

BACKGROUND: The public health concern represented by eye injury in Victoria, Australia has been known for a period now approaching 20 years. However, there has been no improvement observed in this public health concern since it was first identified in the 1990s. This study further investigates the epidemiology of eye injury in Victoria, specifically hospital-admitted eye injury. METHODS: The Victorian Admitted Episodes Dataset was surveyed for eye injury coded by the International Classification of Diseases 10th revision during the period spanning 2001-2005, retrieving all cases of hospital-admitted eye injury in Victoria during the surveyed period. RESULTS: During the period surveyed, the average incidence of eye injury requiring hospital admission in Victoria was 53.6 per 100 000 person-years. Sixty-four per cent of patients were male and 36% were female (P < 0.001). Male patients were most commonly middle-aged compared with female patients who were most commonly middle-aged to elderly (P < 0.001). Core patient groups included: elderly women sustaining eye injuries as a result of falls (particularly in residential homes); middle-aged men sustaining eye injuries as a result of assault and in transport-related accidents. CONCLUSION: The incidence of hospital-admitted eye injury in Victoria has increased since it was first identified as a concern in the 1990s. The design and implementation of an effective preventative strategy to reduce the rate of hospital-admitted eye injury in Victoria presents as a difficult task given that the most common causes are represented by falls, assault and transport-related accidents.

Eye injuries in rural Victoria, Australia.

BACKGROUND: Eye injury causes significant morbidity and is a leading cause of blindness worldwide. This study investigates the incidence, spectrum and patterns of eye injury presenting to a rural hospital in Victoria, Australia. METHODS: A retrospective review of the medical records of all patients presenting with eye injury to the emergency department of Mildura Base Hospital, Victoria, Australia in year 2004 was conducted. As the emergency department of Mildura Base Hospital also acts as the outpatient department for this hospital, the series included all patients treated for eye injury at Mildura Base Hospital in year 2004, including admissions. RESULTS: There were 435 patients present to Mildura Base Hospital emergency department for eye injury in 2004, which represented approximately 1% of the population of Mildura. The majority of eye injuries were superficial. Fifty-six (13%) patients required specialist attention. Most patients were male (83%) and were middle-aged. The most common locations where eye injuries took place were residential homes (47%) and workplaces (32%). The most common causes of eye injuries were trade tools and machinery (47%), followed by chemicals (12%) and branches/sticks/twigs (11%). Of particular concern for Mildura is that approximately one-quarter of the patients treated at Mildura Base Hospital for eye injury in 2004 had been treated at Mildura Base Hospital for a separate episode of eye injury in the past. CONCLUSION: Eye injuries represent a significant socioeconomic burden. This research contributes to the knowledge required for the design and implementation of effective preventative strategy.

Comparing ultrasound biometry with partial coherence interferometry for intraocular lens power calculations: a randomized study.

PURPOSE: To determine whether intraocular lens (IOL) power calculations for cataract surgery as measured by postoperative refractive error using partial coherence interferometry (PCI) are more accurate in improving postoperative outcomes than applanation ultrasound biometry (AUS). METHODS: A double-blind randomized controlled trial consisting of 205 patients was undertaken by the Southern Health Ophthalmology Unit, Victoria, Australia. Mean absolute postoperative refractive error (MAE) represented the dependent variable; the biometric technique (PCI; AUS) used to determine the IOL power to be implanted in the surgical eye represented the independent variable. An intention-to-treat analysis was used to prevent loss of randomization caused by the effects of crossover and drop-out. RESULTS: The MAE in patients with implanted PCI-calculated IOLs was 0.40 +/- 0.37 D (SD; 95% confidence interval [CI], 0.32-0.48 D) compared with 0.45 +/- 0.41 D (SD; 95% CI, 0.36-0.54 D) for patients with implanted AUS-calculated IOLs. There was no statistically significant difference between MAE in patients with implanted PCI-calculated IOLs and that in patients with AUS-calculated IOLs in analysis of best possible outcomes (t(167) = 1.0, P = 0.315). CONCLUSIONS: The results of this trial demonstrated that the calculation of IOL power based on ocular axial length measurement with PCI technology provided no clinical advantage over conventional applanation ultrasound, as measured by postoperative refractive outcome (anzctr.org.au number, ACTRN12608000077369).

Lawn mower injuries in children: a 30-year experience.

BACKGROUND: Lawn mowers cause severe injuries that are particularly devastating to children. This study analyses the patterns and trends in lawn mower injuries involving children referred to Victoria's principal children's hospital. METHODS: A retrospective review of the patient medical records at the Royal Children's Hospital (Melbourne) Victoria, Australia was carried out. The series included all patients admitted for lawn mower injury during the 30-year period spanning 1975-2004. RESULTS: Lawn mower injuries treated at Royal Children's Hospital were severe and included partially amputated limbs. Overall, admissions for lawn mower injury generally decreased over time from n = 26 in the 1975-1979 interval to n = 14 in the 2000-2004 interval. However, the frequency of admission for injuries caused by ride-on mowers contradicted the overall trend and generally increased over time from n = 5 in the 1975-1979 interval to n = 11 in the 2000-2004 interval. This is of particular concern. Ride-on lawn mowers caused significantly more severe injuries requiring longer periods of admission and more operations during admission in comparison to standard mowers. Rural location at the time of injury was a risk factor associated with requiring longer periods of admission and more operations during admission. Children injured while operating mowers were generally older than children injured as bystanders. CONCLUSION: Lawn mower injuries are a significant cause of morbidity. These injuries are particularly devastating to children. The tragedy is keenly felt in the realization that these devastating injuries to children could all be prevented. Strategic preventative measures should be developed through partnership between the medical profession, the media, industry specialists and the wider community.