Box Hill Institute

PurposeTo evaluate the Achieving Clinical Audits with Electronic Records (ACAER) program in supporting primary care providers in quality improvement initiatives across asthma and COPD.Patients and methodsThis observational cohort study included individuals aged ≥12 years with documented diagnosis of asthma or COPD, receiving asthma or COPD therapy, at high risk of exacerbation and hospitalization. Data were derived from the intervention, linked patient questionnaires completed as part of practice evaluation and quality improvement, and routine primary care electronic medical records (EMR) within the Optimum Patient Care Research Database Australia (OPCRDA). Changes in exacerbation rates and maintenance treatment were evaluated.Results7512 asthma and 6526 COPD patients were evaluated with EMR collection. A subset of 1327 asthma patients and 629 COPD patients were classified as active and high-risk. Patient questionnaires and evaluation reports were sent out between 29 October 2019 and 21 September 2021, the intervention period. For those at risk during the entire study period (2018–2023; N=1276), 48.4% and 59.3% of patients in the high-risk asthma and COPD populations, respectively, had maintenance therapy change in the first year post-intervention. Exacerbation rates fell after the intervention period in the high-risk asthma (74.8 to 32.4 per 1000 per month) and COPD (122.9 to 91.2 per 1000 per month) populations. High-risk asthma patients had increasing rates of exacerbations in the 2 years prior to the intervention period (linear trend: 2.79 exacerbations per 1000 per month [1.34, 4.24]; p=0.001), which declined and remained stable after the intervention (p=0.87; up to 2023). Exacerbation rates for high-risk COPD patients were stable pre-intervention (p=0.29). Post-intervention rates initially declined and then showed a marginal non-statistically significant increase (p=0.28).ConclusionOur findings support the potential for the ACAER asthma and COPD program to drive treatment change and improve long-term outcomes in high-risk patients in primary care settings.

ABSTRACTOver 5000 patients are newly diagnosed with Alopecia areata (AA) in Australia each year. AA severity varies from a single small patch to complete loss of scalp hair, body hair including eyelashes and eyebrows. Approximately 40% of affected individuals experience only a single patch and achieve spontaneous, complete and durable remission within 6 months (acute AA). A further 27% develop additional patches but still attain complete remission within 12 months (chronic AA). Chronic persistent AA (CPAA) is defined by an episode duration of > 12 months and occurs in approximately 33% of patients. Without systemic treatment, 55% of individuals with CPAA will have persistent multifocal relapsing and remitting disease, 30% will progress to alopecia totalis (AT) and 15% will ultimately develop alopecia universalis (AU). The physical disfigurement, unpredictable course, social isolation and rejection contribute to the psychological distress attributable to AA. A wide range of topical, intralesional and systemic agents used to treat AA were evaluated in the 2018 Australian expert consensus statement. In 2020, the international Alopecia Areata Consensus of Experts (ACE) publication stated that if reimbursed, Janus Kinase inhibitors (JAKi's) would be an ideal systemic treatment for adults with AA. TGA approval of baricitinib in 2023 and ritlecitinib in 2024 for severe AA is the first step on the pathway for these systemic medications to be reimbursed on the Australian Government Pharmaceutical Benefits Scheme (PBS). Reimbursement would significantly transform the Australian therapeutic landscape for AA. The purpose of this 2025 Update on the Australian Expert Consensus Statement on the treatment of chronic, moderate to severe AA is to augment the 2018 treatment algorithm to include these TGA‐approved medications and to address indications for initiation, continuation and dose titration of systemic JAKi treatment, appropriate choice of agent, satisfactory outcome measures and to provide guidance on when to discontinue successful or unsuccessful treatment.

River systems once safeguarded from water development are being developed. This includes intermittent rivers that annually dry to a series of pools. Describing fish species relationships between abundance and pool depth can help managers set water-take rules that protect fish in dry-season pools. We sampled fish in main-channel and floodplain pools that spanned a gradient of depths and overcame sampling challenges by accounting for interacting effects of species mean length, environmental attributes, and sampling attributes on fish capture probabilities. Fish abundance-depth relationships varied systematically with species mean length, mesohabitat type (main channel, floodplain), water turbidity, and structural complexity, highlighting system complexity and the potential generality of abundance-depth relationships. Similarly, fish length moderated the effects of environmental attributes on capture probability for all sampling methods. We evaluated impacts of hypothetical water-take regulations on fish species’ distributions. Results suggested that water-take rules prohibiting draining of main-channel pools below 1.65 m and reducing floodplain pools by no more than 14% minimises impacts to species’ distributions, promoting conservation of the fish community. Additionally, our approach demonstrates the capacity of species length for predicting distributional and sampling patterns of fish species.

This Ankle Arthroplasty Supplementary Report is based on the analysis of 4,646 ankle procedures with a procedure date from 2006 up to and including 31 December 2022. This Report is one of 16 supplementary reports to complete the AOANJRR Annual Report for 2023. Information on the background, purpose, aims, benefits and governance of the Registry can be found in the Introductory chapter of the 2023 Hip, Knee and Shoulder Arthroplasty Annual Report. The Registry data quality processes including data collection, validation and outcomes assessment, are provided in detail in the Data Quality section of the introductory chapter of the 2023 Hip, Knee and Shoulder Arthroplasty Annual Report: https://aoanjrr.sahmri.com/annual-reports-2023.

Early prediction of delayed healing for venous leg ulcers could improve management outcomes by enabling earlier initiation of adjuvant therapies. In this paper, we propose a framework for computerised prediction of healing for venous leg ulcers assessed in home settings using thermal images of the 0 week. Wound data of 56 older participants over 12 weeks were used for the study. Thermal images of the wounds were collected in their homes and labelled as healed or unhealed at the 12th week follow up. Textural information of the thermal images at week 0 was extracted. Thermal images of unhealed wounds had a higher variation of grey tones distribution. We demonstrated that the first three principal components of the textural features from one timepoint can be used as an input to a Bayesian neural network to discriminate between healed and unhealed wounds. Using the optimal Bayesian neural network, the classification results showed 78.57% sensitivity and 60.00% specificity. This non-contact method, incorporating machine learning, can provide a computerised prediction of this delay in the first assessment (week 0) in participants’ homes compared to the current method that is able to do this in 3rd week and requires contact digital planimetry.

Older Australians may live up to 10 years in ill health, most likely chronic disease-related. Those with multimorbidity report more healthcare visits, poorer health and take more medications compared with people with a single chronic disease. They are also at higher risk of hospital admission and poor quality of life. People living with multimorbidity are considered to have "complex care" needs. A person-centred approach to healthcare has led to increasing use of in-home nursing support, enabling older people to receive care at home. Our prospective observational study describes the profile and management of home-based care for older people with complex care needs and examines changes in their quality of life over 12 months. Routinely collected data were analysed, including demographics, medical history, medications and the visit activity of staff providing care to participants. Additional health-related quality of life and hospitalisation data were collected via quarterly surveys and analysed. Fifty-two participants (mean age 76.6 years, 54% female) with an average of eight diagnosed health conditions, received an average of four home care visits per week. Almost half the participants were hospitalised once during the 12-month period and experienced a significant decline in overall quality of life and in the dimensions measuring independent living and relationships over the study period. If ageing in place with good quality of life is to be realised by older adults with multimorbidity, support services including home nursing need to consider both the biomedical and social determinants perspectives when addressing health and social care needs.

Abstract Economic forecasts, such as the Survey of Professional Forecasters (SPF), are revised multiple times before realization of the target. This paper studies the sources of forecast revisions. By decomposing the fixed‐event forecast error into a rational component due to unanticipated future shocks and an irrational component due to measurement error in acquired information or forecasters' reactions, we derive the conditions under which fixed‐event forecasts that contain an irrational forecast error can still possess the second moment properties of rational forecasts. We show that internal consistency of fixed‐event forecasts depends on the magnitude of the rational and irrational components in the revisions. As such, fixed‐event forecasts subject to irrational error may still be internally consistent, although they are not rational, as evidence in many empirical studies. We illustrate our methodology with the SPF inflation forecasts data. Our results show evidence of a sizeable and heterogeneous irrational forecast error component across forecast horizons and a high irrational‐to‐news ratio for most forecasters. This finding also provides insight into why forecast revision effort is not always fully compensated by revision reward.