Health map for HealthGap: Defining a geographical catchment to examine cardiovascular risk in Victoria, Australia.

The HealthGap study aimed to understand cardiovascular risk among Indigenous Australians in Victoria using linked administrative data. A key challenge was differing spatial coverages of sources: state-level data for risk factors but cardiovascular outcomes for three hospitals. Catchments were defined based on hospital postcodes to estimate denominator populations for risk modelling: first- and second-order neighbours, and spatial distribution of outcomes ('spatial event distribution'). Catchment coverage was assessed through proportions of patients presenting to study hospitals from catchment postcodes. The spatial event distribution performed best, capturing 82% events overall (first-order:40%; second-order:64%) and 65% Indigenous (27% and 45%). No approach excluded proximal non-study hospitals. Spatial event distributions could help define denominator populations when geographic information on outcome data is available but may not avoid potential misclassification.

The APPRISE Virtual Biobank for Infectious Diseases.

The Australian Partnership for Preparedness Research on InfectiouS disease Emergencies (APPRISE) has developed a virtual biobank to support infectious disease research in Australia. The virtual biobank (https://apprise.biogrid.org.au) integrates access to existing distributed infectious disease biospecimen collections comprising multiple specimen types, including plasma, serum, and peripheral blood mononuclear cells. Through the development of a common data model, multiple collections can be searched simultaneously via a secure web portal. The portal enhances the visibility and searchability of existing collections within their current governance and custodianship arrangements. The portal is easily scalable for integration of additional collections.

Personalised Medicine Possible With Real-Time Integration of Genomic and Clinical Data To Inform Clinical Decision-Making.

Despite widespread use of genomic sequencing in research, there are gaps in our understanding of the performance and provision of genomic sequencing in clinical practice. The Melbourne Genomics Health Alliance (the Alliance), has been established to determine the feasibility, performance and impact of using genomic sequencing as a diagnostic tool. The Alliance has partnered with BioGrid Australia to enable the linkage of genomic sequencing, clinical treatment and outcome data for this project. This integrated dataset of genetic, clinical and patient sourced information will be used by the Alliance to evaluate the potential diagnostic value of genomic sequencing in routine clinical practice. This project will allow the Alliance to provide recommendations to facilitate the integration of genomic sequencing into clinical practice to enable personalised disease treatment.

Development of a pulmonary rehabilitation service for people with COPD: a tiered model of integrated care.

PURPOSE: Pulmonary rehabilitation (PR) services often are used for people with chronic obstructive pulmonary disease (COPD). This study describes the development and evaluation of a tiered service in North Tyneside, United Kingdom, which aimed to increase access to PR without negatively affecting clinical outcomes. METHODS: Data were collected retrospectively. Subjects, identified as having COPD by their general practitioner, based on spirometry, were tiered for PR on the basis of their dyspnea score. Tier 1 (1-2 dyspnea score) patients were prescribed exercise and referred to an exercise program. Those in tier 2 (3-4 dyspnea score) were referred to a specialized "healthy living" exercise and education group run by an exercise health trainer. Those scoring 4 (tier 3) received physiotherapist-led group exercise and education classes. Those scoring 5 were seen at home by trained health care professionals. Scores in the Chronic Respiratory Diseases Questionnaire, COPD assessment test, and 6-minute walk test were recorded at baseline and immediately after rehabilitation. RESULTS: Data were available for 199 cases recruited. Four patients (2.0%) were placed into tier 1, 107 (53.8%) into tier 2, 85 (42.7%) into tier 3, and 3 (1.5%) into tier 4. Because of the small number involved, data for tiers 1 and 4 were not analyzed further. In tiers 2 and 3, there was a significant improvement in performance across all 3 outcome measures. CONCLUSIONS: Tiered PR may be an effective way of increasing access to PR services. Further prospective data are needed to evaluate the service fully with regard to patient throughput and costs.

Doppler-based hemodynamic monitoring: a minimally invasive alternative.

Doppler-based hemodynamic assessment affords a magnitude of diagnostic applications including evaluation of blood flow from the left ventricle. Doppler echocardiography, in the form of transthoracic and transesophageal echocardiography, allows for intermittent evaluation of hemodynamic information including aortic blood flow, global and regional wall motion, and valvular integrity. In the hands of a skilled operator, transthoracic and transesophageal echocardiography provides reliable cardiac output determinations. However, these are not considered routine for hemodynamic monitoring in the critically ill. Neither of the echocardiographic approaches provides the continuously available data needed for ongoing evaluation of response to interventions. In contrast, esophageal Doppler monitoring, a minimally invasive hemodynamic assessment tool, provides the ability for ongoing real-time hemodynamic assessment of the critically ill or compromised patient. This simple-to-use technology requires that a probe, similar in size and shape to a gastric tube, be inserted into the esophagus to obtain measurement of blood flow in the descending aorta. Hemodynamic variables such as cardiac output, preload, afterload, and contractility are measured or derived from the esophageal Doppler monitoring waveform.