Tasman Medical Journal

ISSN:  2652-1881

Volume - Issue 2021.

Life AfTER covid-19 (LATER-19): a protocol for a prospective, longitudinal, cohort study of symptoms, physical function and psychological outcomes in the context of a pandemic

Dale W Edgar, Paul Gittings, Lisa van der Lee, Louise Naylor, Andrew Maiorana, Angela Jacques and Vinicius Cavalheri


Introduction (COVID-19) disease can present with respiratory tract infection and influenza-like symptoms. Although increased symptoms during physical exertion and impairments in lung function have been recently reported as some of the negative effects of COVID-19, no study has defined the recovery trajectories during and following the acute phase of the disease from a symptomatic, physical or psychological perspective. The proposed study will aim primarily to provide a multidimensional analysis of the 12-month recovery of symptoms, physical function, health-related quality of life (HRQoL), and psychological function in adults following a diagnosis of COVID-19.

Methods This report describes the method for a prospective, longitudinal, single-area multi-centre cohort study. Possible international extension is envisaged. Eligibility criteria are patients > 18 years old with a confirmed diagnosis of COVID-19, who provide informed consent. Exclusion criteria include those with pre-existing neuromuscular disorders likely to affect the measures of physical function, diagnosed pre-existing mental illness and significant cognitive impairment likely to affect responses to self-report measures. The study assessment protocol is in two parts. Part A will be undertaken by inpatients, who will undergo added clinical and symptom assessments every 48 hours during the admission. At discharge, participants will be eligible for Part B, incorporating assessments at four time points: on discharge and 3, 6, and 12 months from hospital admission. Assessments will include: symptoms (fatigue and shortness of breath), physical function (functional capacity and peripheral muscle force), HRQoL and psychological (feelings of anxiety and depression, and posttraumatic stress) function. Associations of patient and clinical characteristics predictors with longitudinal in-hospital clinical and symptomatic outcomes will be examined using generalised linear mixed models (GLMM) with random subject effects. Corresponding associations of patient characteristic, clinical pathway and rehabilitation pathway predictors with recovery trajectories will also be examined.


An audit of clinical service delivery and outcomes in diffuse idiopathic skeletal hyperostosis – preliminary evidence for efficacy of tumour necrosis factor inhibition therapy

Andrew J Lim, William H Breidahl, Swithin J Song, William M Dewing, Sophie Coleman, Justin Bui and Graeme J Carroll


Objectives Diffuse idiopathic skeletal hyperostosis (DISH) is a common spinal disorder for which there is no specific drug treatment. The aim of this data audit was to determine the outcome of therapy with tumour necrosis factor inhibition (TNFi) in painful DISH.

Methods We performed a retrospective audit of patients with DISH followed from 2006 to 2020. Twelve patients with painful DISH who had a Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) of 6 or higher at outset, who had been treated empirically with a TNFi after failed treatment with exercise, NSAID/Coxibs and/or non-opiate analgesics were compared with 7 patients with DISH (BASDAI < 6 at onset) observed whilst receiving standard of care, but not TNFi.

Results One TNFi-treated patient was intolerant of TNFi. Eight patients had a 2-point or greater reduction in disease activity in the BASDAI measure. This is similar to the clinical response observed in patients with TNFi-treated ankylosing spondylitis in clinical trials. Based on intention to treat, the response rate was 67%. In contrast, only 1 of the 7 untreated DISH patients had a 2-point improvement in BASDAI (14%).

Conclusions These results support the efficacy of TNF inhibition in painful DISH. Based on these uncontrolled results we conclude that a formal prospective trial of the safety and efficacy of TNFi in DISH is justified.

Tasman Medical Journal 2021: 3 (1); 11-16.


Trends in acute myeloid leukaemia in Western Australia over time: Improved outcomes with contemporary management

Shane A Gangatharan, Michael F Leahy, Julie Crawford, Matthew Wright and Annalise M Martin


Introduction: Real-world survival in acute myeloid leukaemia (AML) is poor, and there has been little change to the intensive induction and consolidative chemotherapy regimens over 30 years. Despite this, there have been developments in therapeutic agents for patients unfit for intensive therapy, supportive care, risk stratification and allogenic stem cell transplant. We report outcomes of these patients with AML treated using contemporary care standards in Western Australia (WA) and compare this with a historical cohort.

Methods: AML diagnosed between 2009-2018 in WA were identified by discharge diagnosis at 3 tertiary public hospitals in Perth and the database of the state reference cytogenetic laboratory at Pathwest. Medical and laboratory records were reviewed retrospectively for characteristics and outcomes. Comparison was made with a historical cohort diagnosed 1991-2015 and analysed with t-test and Kaplan-Meier methods.

Results: 734 patients were identified in the contemporary period. Median age was 64.4 years and 70% were primary/de novo AML. 61% were managed with intensive chemotherapy and 16.9% of these under the age of 60 proceeded to allogeneic stem cell transplant in first remission. There were no significant differences in the rates of intensive therapy or allogenic transplantation compared with the historical cohort. 98.8% of patients had successful cytogenetic studies performed. Of those with a normal karyotype, molecular studies were performed in 57%. Median overall survival in patients treated intensively was 56.6 months for age 60 or less, and 10 months in patients age over 60. Cytogenetic risk group predicted survival (p<0.0001). Survival was significantly improved in both groups treated intensively and non-intensively compared with the historical cohort; 18.7 vs 13.2 months (HR 1.348, 95% CI 1.157-1.571) and 3.1 vs 1.6 months (HR 1.431, 95% CI 1.1223-1.674) respectively.

Conclusion: Survival has improved in all patients with AML in WA over time despite no significant change to intensive chemotherapy regimens. This may be explained by improved risk stratification, supportive care, non-intensive therapy options, and allogeneic donor selection and transplantation techniques.
Tasman Medical Journal 2020; 3(1): 17-22.


An evaluation of research capacity and culture in a sample of Western Australian Allied Health professionals

Janine Matus, Jessica E Tearne, Kellie Blyth, Stephanie Coates, Sara Pearson and Vinicius Cavalheri


Background: The aim of the present study was to measure perceived Allied Health research capacity and culture within the South Metropolitan Health Service (SMHS) and describe strengths, barriers and motivators to undertaking research.

Method: Cross-sectional survey. Allied Health professionals within SMHS were invited to complete the Research Capacity and Culture (RCC) tool. The tool consists of 52 questions examining self-reported success or skill in a range of areas related to research capacity or culture across three domains: (i) the organisation; (ii) the team (i.e. professional group); and (iii) the individual. Each question uses a 10-point numeric rating scale where 10 is the highest possible level of skill or success. Scores for items were categorised as “low” (median <4), “moderate” (median ≥4 and ≤6.9) and “high” (median ≥7) level of skill or success. Data were collected electronically via Survey Monkey for five weeks in February and March 2020.

Results: 320 Allied Health professionals (37% of the SMHS workforce) responded to the survey. Overall, respondents considered their organisation and professional group to be moderately successful in supporting and valuing research. On an individual level, common strengths were in finding relevant literature, critically reviewing the literature and integrating research findings into practice. Areas of weakness included securing research funding, writing ethics application and manuscripts. Motivators for engaging in research were to develop skills, address gaps in clinical practice, increase job satisfaction and provide opportunities for career advancement. Enablers included having dedicated time for research, access to research mentors and encouragement from managers. The most commonly reported barriers to engaging in research included a lack of time, funding and suitable backfill, other work roles taking priority, and a lack of research skills.

Conclusions: In order to increase research culture and capacity of the Allied Health professionals at SMHS, ongoing support and investment of resources is paramount. Initiatives should focus on strengthening existing motivators and mitigating key barriers to research engagement.
Tasman Medical Journal 2021; 3(1): 17-23


Outcomes from the first five years of allogeneic haemopoietic progenitor cell transplantation at Fiona Stanley Hospital

Min-Hi Han, Andrew P Hutchison, Gemma L White, Diane Sutherland, Celeste Hill, Paul Chiappini, Julian P Cooney, Paul K Cannell, Matthew PF Wright and Duncan Purtill


Background Allogeneic haemopoietic progenitor cell transplantation (alloHPCT, previously known as ‘stem cell transplantation’) is the only curative procedure for many haematological malignancies (for example, acute leukaemia), and non-malignant conditions such as bone marrow failure and myelodysplasia. Fiona Stanley Hospital (FSH), a new tertiary metropolitan hospital in Perth Western Australia opened in 2015. A Blood and Marrow Transplant Programme (BMTP) was established and replaced the previous State service at Royal Perth Hospital. We describe here the patient demographics and outcomes of alloHPCT at FSH BMTP since its establishment in 2015.
Methods One hundred and ninety-three consecutive adult patients who had alloHPCT were identified retrospectively from 1 February 2015 to 31 December 2019. Pre-transplant, transplant and clinical outcome characteristics were analysed.
Results Acute myeloid leukaemia (AML) was the most common indication for transplant (n = 82, 42.5%) followed by myelodysplasia (16.1%). The median time from diagnosis to alloHPCT in patients with AML in first complete remission was 5.7 m (range, 2.4 – 28.4). The cumulative incidence of grade III-IV aGVHD at 6 months was 10.4% (95% CI 6.5 – 15.4%) and the cumulative incidence of severe cGVHD at 2 years was 10.2% (95% CI 5.7 – 16.3%).  The median follow-up was 24.3 m (range, 5.9 – 62.1).  Overall survival at 1and 2 years was 73.7% (95% CI 70.1 – 77.3%) and 65.0% (95% CI 61.2 – 68.8%) respectively. Progression-free survival at 2-years was 62.9% (95% CI 59.6 – 66.2%). The cumulative risk of transplant-related mortality at 2-years was 17.8% (95% CI 12.6 – 23.7%), and disease relapse at 2-years was 19.3% (95% CI 13.8 – 25.6%).
Conclusions Clinical outcomes of allogeneic transplantation at the FSH BMTP appear acceptable and are comparable to those reported elsewhere within Australia and overseas. This information is valuable for transplant physicians, referrers and patients in Western Australia and will inform future practice improvement activities in this high risk and complex medical procedure.
Tasman Medical Journal 2020; 3(1): 37-43.


Impact of ‘Can’t Intubate Can’t Oxygenate’ (CICO) kit ergonomic design on the timed responses of participants in simulated CICO crises: A randomised, crossover pilot study

Justin SS Ti, Sean P Dwyer, Claire N McTernan, Brendon K Dunlop and Martin J Firth


Background: The ‘Can’t Intubate Can’t Oxygenate’ (CICO) crisis is a rare but life-threatening airway emergency. Multiple factors have been implicated in poor outcomes for CICO management. A key modifiable factor is the availability, accessibility and strategic layout of CICO equipment. The ergonomic implications of selective equipment packaging and CICO kit design on clinical practice are yet to be studied. This pilot study aims to investigate the clinical implications of CICO kit ergonomic design on the timed responses of participants within simulated CICO crises at Fiona Stanley Hospital (FSH).

Methods: Paired participants were allocated randomly to either an ergonomically designed kit (Princess Alexandra Hospital modified kit; PAH-M) or to institutionally packaged equipment (FSH kit) within simulated CICO crises, with a crossover design. The primary aim was to compare timed events between CICO kit groups including time to completion of infraglottic rescue technique, oxygenation, ventilation and timing between predetermined participant actions. A secondary objective was to examine whether a difference in heart rate and physiological stress parameters existed between the CICO kit groups.

Results: The PAH-M kit demonstrated a time advantage across the majority of primary timed events. A learning model that factored in carry over effects due to the crossover design demonstrated a time benefit for the PAH-M kit in terms of time to retrieval of equipment (6.5 seconds), infraglottic rescue performance (9.0 seconds) and oxygenation (20.4seconds). An order of effects model also demonstrated the PAH-M kit to have a faster time to oxygenation compared to our institutionally packaged FSH kit (p=0.049). Heart rate variability did not differ between CICO kit groups.

Conclusion: This study highlights CICO kit design and its ergonomic utility as being important factors that may influence time-critical outcomes in simulated CICO crises.