Sleep disorders are highly-prevalent, chronic conditions which present challenges to public health and productivity. The Big Sleep ACT project aims to support better sleep health and affine research by curating a large-size clinical data collection that includes both high-quality polysomnography (PSG) and, uniquely, detailed longitudinal patient health records. Our CHARM presentation will update the community on progress on data availability, as well as key methodological learnings on clinical data extraction and organisation from the first 12 months of the project.

Affiliation: ANU School of Engineering, college of Engineering Computing and Cybernetics 

Background
Ethnicity is an important factor when attempting to identify and address drivers of health inequalities. The Australian Population Census lacks a specific question about ethnicity and there is currently no agreement on how to use existing variables (such as ancestry) to describe ethnicity for the purposes of public health research. 

 

Aims
This report aims to describe the processes and outcomes of a series of expert panel meetings convened to determine how best to use existing Census data to accurately describe Australia’s complex ethnic diversity.  

Methods
Panel members were selected for their professional and academic expertise in fields such as population health, biostatistics, epidemiology, and demography. A combined theoretical- and data-driven approach was applied to develop a series of questions to initiate panel discussions, which continued until consensus was reached.   

 

While potential risks and limitations were acknowledged, consensus was reached that it would be reasonable to: 

·         Present greater granularity of data than current approaches by presenting results for the 50 most populous groups with the addition of smaller key groups where possible. 

·         Group people with more than one reported ancestry into relevant multi-ethnic categories.  

·         Create an ‘Anglo-Celtic’ category combining Australian, English, Welsh, Scottish and Irish ancestries. 

·         Recategorize responses listing Australian plus another ethnicity by removing ‘Australian’.

 

A pathway has been forged to better use existing Census data for research on ethnicity and health in Australia. This will improve identification of inequalities and inform public health policy. 

 

Fiona Stanaway1, Bree McDonald2
 
 

1.     University of Sydney, Camperdown, NSW, 2006

2.     Canberra Health Services, Garran, ACT 2605

Introduction: Rapid Response System (RRS) was implemented worldwide to limit or prevent intrahospital cardiac arrests as many are preceded by signs of instability. After-hour care remain a concern in healthcare. RRS was implemented in 2010 at our hospital.  

Aims: To determine the effectiveness and sustainability of RRS implementation to the intra-hospital cardiac arrest rates over 10-year period after giving time for the system to mature.

Methods: Retrospective observational study of a prospectively collected data on all RRS calls activated between January 1, 2013, to December 31, 2022. We included all in-patients with age >16 years who had an RRS-call activated and suffered cardiac arrest during their hospitalization. RRS-calls with pre-exiting not for resuscitation (NFR) orders, non-admitted patients, in intensive care unit or emergency department were excluded.  We investigated their frequency, initial rhythm noted, time, total duration and all cause in-hospital mortality of these calls.

Results: 20399 RRS-calls were recorded in the study period. The number significantly increased from 1570 calls/year in 2013 to 2564 calls/year in 2022 . The proportion of concurrent RRS-calls also more than doubled. We excluded 4004 RRS-call episodes from analysis. The median age was 69 years, 47.47% were females. The cardiac arrest occurred more during the after-hours. The proportion of cardiac arrest each year steadily reduced from 3.2% in 2013 to 1.4% in 2021 and 1.8% in 2022. Overall, the mortality for non-shockable rhythms was high. 

Conclusion: Our study confirmed despite there is significant increase in the frequency of RRS calls, there was a steady decrease in number of intrahospital cardiac arrest rates.

Significance: This indicated effective implementation and sustainability of the mature RRS. 

 
Dr Manoj Y Singh, Kristen Douglass, Jo Lindbek, Anil Ramnani, Tina Xu,  Krishna Karpe

Canberra Health Services, Garran, ACT, 2605

Lymphoma in adolescents and young adults (AYA) accounts for 20-25% of cancer diagnosis in this age group. Historically, AYAs had inferior outcomes compared to paediatric and adults. Recent studies have demonstrated different disease features unique to AYA, though paucity in AYA cancer research remains. 

To investigate lymphoma epidemiology in AYA in Australia and report on disease features, therapeutic approaches, and outcome differences between AYA and older adults. 

Data from the LaRDR registry was retrospectively analysed to compare differences between AYA (aged 18-39) and adults (aged 40-60). We focussed on those diagnosed with classical Hodgkin lymphoma (cHL), DLBCL, PMBCL and Burkitt lymphoma between 2016 and April 2023.

cHL was the most common lymphoma diagnosis in AYA (68%), compared with 70% of adults affected with DLBCL (p<0.001). AYA patients with cHL had more favourable prognostic features, with majority of the AYAs having early-stage disease (p=0.003) and lower prognostic scores (HL-IPS) (p<0.001). In DLBCL, both AYA and adult patients had predominantly germinal-centre B cell lymphoma (GCB), with advance stages representing majority of the 2 populations (57% vs 60%, p>0.05). Overall survival (OS) was significantly better among AYA than in adult patients (p<0.001), and AYA had better 36-month progress-free survival (PFS) compared to adults (0.82 vs 0.73, p<0.001). 

AYA lymphoma patients displayed different disease subtypes, prognosis and outcomes, and this is consistent with other lymphoma studies acknowledging AYA as a distinct population. 

Utilising treatment regimens used in treating paediatric and adult lymphoma patients may be suboptimal for AYA patients. Mature long-term data are required to evaluate long-term toxicity.

 

Evangeline EW Wong1, Cameron CW Wellard2, Kirsty KR Rady1, Dipti DT Talaulikar1
 
 

1.     Department of Haematology, Canberra Health Services, Garran, ACT, 2605

2.     School of Public Health and Preventive Medicine, Monash University, Victoria, 3800

Australia has a high rate of antibiotic use. Government policy interventions are one strategy to optimise the use of antibiotics. On 1 April 2020, the Australian Government Department of Health introduced a policy intervention to increase the quality use of four antibiotics.

 

To assess if the government policy intervention improved the appropriate supply of the four antibiotics amoxicillin, amoxicillin-clavulanic acid, cefalexin and roxithromycin.

 

This study employed a retrospective cohort study design comparing a 10% sample (n = 345,018) of four antibiotics prescribed and dispensed in Australia during a three-month period (May, June, July) in 2019, and again in 2020 (after the policy intervention). The 10% sample of PBS data was obtained from the Australian Government Department of Health. Descriptive statistics, bivariate and multivariable logistic regression analysis were carried out. 

 

The results suggest the policy change improved the appropriate supply of original prescriptions in 2020 compared to 2019 OR = 1.75 (95% CI = 1.68-1.82, p<0.001), and appropriate supply of repeat prescriptions OR = 1.56 (95% CI = 1.25-1.96, p<0.001). In 2020, the proportion of appropriate supply of original prescriptions increased by an absolute difference of 1.8% (95% CI = 1.6-1.9%; P<0.001), and appropriate supply of repeat prescriptions increased by 3.9% (95% CI = 2.2-5.5%; P<0.001). 

 

The study provides evidence for the impact of a government policy intervention to improve the appropriate supply of antibiotics, although some of the reduction in antibiotic use was likely due to the concomitant COVID-19 pandemic. 

 

This supports the use of government policy interventions as an effective antimicrobial stewardship intervention.

 

 
Juliet Contreras1, Victor Oguoma2, Lyn Todd1, Mark Naunton1, Peter Collignon3,4, Mary Bushell1
 
 

1.     Faculty of Pharmacy, University of Canberra, Bruce, ACT, 2617

2.     Health Research Institute, University of Canberra, Bruce, ACT, 2617

3.     ANU Medical School, ANU College of Health & Medicine, The Australian National University, Canberra, ACT, 2601

4.     Australian Capital Territory Pathology, Canberra Hospital, Garran, Canberra, ACT, 2605

Injury is a leading cause of death and major contributor to physical disability and psychological trauma for children and young people. 

 

The aim of this study was to examine the epidemiology of serious injury hospitalisations. The analysis was undertaken at the request of the ACT Child & Young People Death Review Committee. 

 

This research involved an analysis of ACT resident young people aged 0–24 years hospitalised in the ACT for an injury between 2000 and 2020. 

Injury severity classifications were based on survival risk ratios (SRRs)1. The survival risk ratios were used to categorise injuries into mild, moderate and severe categories.

 

Over the 20-year study period, 63.5% of injury related hospitalisations for young Canberrans aged 0–24 years were for males and 36.5% were for females. 

Age-standardised rates for both males and females increased over the 20-year period. Rates for males increased by an average of 2.8% per year, while female rates increased by 4.8% per year.

Most hospital-related injuries were classified as minor. However, the proportion of injury-related hospitalisations classified as moderate or serious increased with age.

The leading nature of injury for all age-groups was injuries to the head. 

 

This research provides a detailed understanding of the burden and severity of hospitalised childhood injury in the ACT. It can help shape injury prevention strategies, policy prioritisation and resource allocation in the ACT.

1. Mitchell, R. & Ting, H. P. Survival risk ratios for ICD-10-AM injury diagnosis classifications for children. Macquarie University.

 

Pollock Z, Draper G, Freebairn L
 
 

1.     ACT Health Directorate, Phillip, ACT, 2606