Why is there such a difference in outcome between Australian intensive care units and others?

PURPOSE OF REVIEW: The aim of this article is to assess the data on clinical outcomes for critically ill patients admitted to Australian and New Zealand intensive care units in comparison to information available for similar patients in other counties RECENT FINDINGS: Australia and New Zealand have been collecting standardized data intensive care unit admissions for over a decade. The Australian and New Zealand Intensive Care Society Database Management Committee has developed a high quality database of close to 600 000 adult intensive care unit admissions. Although comparisons suffer from significant methodological, case-mix and process differences, which make their findings easily subject to criticism, interrogation of this database and of data from clusters of intensive care units within this system consistently yields patient outcomes, which are better than outcomes reported from other nations or international studies for similar patients. In addition, Australia and New Zealand has now achieved the highest rate of patient enrollment in an investigator-initiated multicentre randomized controlled trials. SUMMARY: Although comparisons in outcome between Australia and New Zealand intensive care units and other units worldwide may not have sufficient scientific rigour to truly reflect better national outcomes, many features of Australian and New Zealand units are unique and worthy of consideration by other national systems as they consider their strategic national goals for the next decade.

Improved outcomes from acute severe asthma in Australian intensive care units (1996 2003).

BACKGROUND: There is limited information on changes in the epidemiology and outcome of patients with asthma admitted to intensive care units (ICUs) in the last decade. A database sampling intensive care activity in hospitals throughout Australia offers the opportunity to examine these changes. METHODS: The Australian and New Zealand Intensive Care Society Adult Patient Database was examined for all patients with asthma admitted to ICUs from 1996 to 2003. Demographic, physiological and outcome information was obtained and analysed from 22 hospitals which had submitted data continuously over this period. RESULTS: ICU admissions with the primary diagnosis of asthma represented 1899 (1.5%) of 126 906 admissions during the 8-year period. 36.1% received mechanical ventilation during the first 24 h. The overall incidence of admission to ICU fell from 1.9% in 1996 to 1.1% in 2003 (p<0.001). Overall hospital mortality was 3.2%. There was a significant decline in mortality from a peak of 4.7% in 1997 to 1.1% in 2003 (p = 0.014). This was despite increasing severity of illness (as evidenced by an increasing predicted risk of death derived from the APACHE II score) over the 8-year period (p = 0.002). CONCLUSIONS: There has been a significant decline in the incidence of asthma requiring ICU admission between 1996 and 2003 among units sampled by the Australian and New Zealand Intensive Care Society Adult Patient Database. The mortality of these patients has also decreased over time and is lower than reported in other studies.

Development and implementation of a high-quality clinical database: the Australian and New Zealand Intensive Care Society Adult Patient Database.

OBJECTIVE: To describe the development of a binational intensive care database. SETTING: One hundred thirty-eight intensive care units (ICUs) in Australia and New Zealand. METHODS: A structure was developed to enable ICUs to submit data for central and local analysis. Reports were developed to allow comparison with similar ICU types and against published mortality prediction models. The database was evaluated according to (a) the criteria of the Directory of Clinical Databases (DoCDat) and (b) a proposed framework for data quality assurance in medical registries. RESULTS: Between January 1987 and December 2003, 444,147 data sets were collected from 121 (72.5%) of 167 Australian and 10 (37.0%) of 27 New Zealand ICUs. Data sets from more than 60000 ICU admissions were submitted in 2003. Overall hospital mortality was 14.5%. The mean quality level achieved according to DoCDat criteria was high as was performance against a proposed framework for data quality. The provision of no-cost software has been vitally important to the success of the database. CONCLUSION: A high-quality ICU database has successfully been implemented in Australia and New Zealand and is now used as a routine quality assurance and peer review tool. Similar developments may be both possible and desirable in other countries.

EMLA cream in the treatment of post-herpetic neuralgia. Efficacy and pharmacokinetic profile.

The analgesic efficacy of 5% of EMLA cream (5 or 10 g) when applied for 24 h periods was evaluated in 5 female and 7 male patients (mean age 69 years, range 50-85 years) with refractory post-herpetic neuralgia (PHN). Mean visual analogue pain intensity scores for all patients were significantly improved 6 h after application (P less than 0.05). In a subgroup of patients with facial PHN receiving EMLA cream, 5 g (n = 4), there were significant improvements in pain intensity scores at 6 h (P less than 0.05). 8 h (P less than 0.01) and 10 h (P less than 0.01) after application. Plasma lignocaine and plasma prilocaine concentrations were well below potentially toxic levels in all patients after application.