Extremely long Australian paediatric outpatient waiting lists have resulted in large numbers of children waiting to see a paediatrician. Analyses of the patient referrals suggest that a large proportion of children ma...Extremely long Australian paediatric outpatient waiting lists have resulted in large numbers of children waiting to see a paediatrician. Analyses of the patient referrals suggest that a large proportion of children may benefit from allied health input, in addition to being seen by the paediatrician. This paper provides an organisational strategy that involves streamlining Allied Health clinical services in an effort to assist with bringing down a Paediatric Out-patient waitlist. The paper describes principles to guide the formation of a Paediatric Allied Health Multi-Disciplinary team that proposes assessment and brief interventions. The service would focus on supporting the paediatricians through the use of structured procedures, telephone intakes, multidisciplinary triage, shared and standardised assessments, collaborative formulations and reports, brief interventions, clinical-community linkages, and allied health student support. A variety of additional important organisational principles are proposed to facilitate patient flow from the perspective of streamlining administrative processes, having adequate administrative support, shared responsibilities, teamwork, flexibility, carrying out intake assessments, determining which referrals were appropriate for allied health, and working closely with medical staff.展开更多
BACKGROUND Limited data currently exists on the clinical utility of Artificial Intelligence Assisted Colonoscopy(AIAC)outside of clinical trials.AIM To evaluate the impact of AIAC on key markers of colonoscopy quality...BACKGROUND Limited data currently exists on the clinical utility of Artificial Intelligence Assisted Colonoscopy(AIAC)outside of clinical trials.AIM To evaluate the impact of AIAC on key markers of colonoscopy quality compared to conventional colonoscopy(CC).METHODS This single-centre retrospective observational cohort study included all patients undergoing colonoscopy at a secondary centre in Brisbane,Australia.CC outcomes between October 2021 and October 2022 were compared with AIAC outcomes after the introduction of the Olympus Endo-AID module from October 2022 to January 2023.Endoscopists who conducted over 50 procedures before and after AIAC introduction were included.Procedures for surveillance of inflammatory bowel disease were excluded.Patient demographics,proceduralist specialisation,indication for colonoscopy,and colonoscopy quality metrics were collected.Adenoma detection rate(ADR)and sessile serrated lesion detection rate(SSLDR)were calculated for both AIAC and CC.RESULTS The study included 746 AIAC procedures and 2162 CC procedures performed by seven endoscopists.Baseline patient demographics were similar,with median age of 60 years with a slight female predominance(52.1%).Procedure indications,bowel preparation quality,and caecal intubation rates were comparable between groups.AIAC had a slightly longer withdrawal time compared to CC,but the difference was not statistically significant.The introduction of AIAC did not significantly change ADR(52.1%for AIAC vs 52.6%for CC,P=0.91)or SSLDR(17.4%for AIAC vs 18.1%for CC,P=0.44).CONCLUSION The implementation of AIAC failed to improve key markers of colonoscopy quality,including ADR,SSLDR and withdrawal time.Further research is required to assess the utility and cost-efficiency of AIAC for high performing endoscopists.展开更多
BACKGROUND Drug shortages are common yet their impact on patient care and their commercial ramifications has not been adequately researched.In Australia a shortage of balsalazide(2012-2013)necessitated substitution wi...BACKGROUND Drug shortages are common yet their impact on patient care and their commercial ramifications has not been adequately researched.In Australia a shortage of balsalazide(2012-2013)necessitated substitution with alternative 5-aminosalicylate(5-ASA)formulations for ulcerative colitis(UC).AIM To assess and compare the clinical and commercial sequelae of non-medical switching from balsalazide to another 5-ASA and/or return to balsalazide once supply resumed.METHODS A prospective cohort study of patients on balsalazide for mild-moderate UC was conducted where,strictly due to the national shortage(November 2012-January 2013),were switched to alternative 5-ASA and/or then returned to balsalazide once supply resumed.Clinical(Partial Mayo),endoscopic(Mayo score)activity,adverse effects(to alternative 5-ASA)and percentage market share(of continuous 5-ASA users)from baseline(i.e.,time of switching due to shortage)through to five years were assessed.RESULTS Of 31 patients switched due to the shortage,12(38.7%)resumed balsalazide immediately once supply resumed,8(25.8%)prompted by adverse effects to the alternative 5-ASA used.Three patients(9.7%)had documented symptomatic improvement,15(48.4%)were unchanged and 13(41.9%)had symptomatic worsening vs baseline(P<0.01),after switching to an alternative 5-ASA.At 3 and 5y post switch,overall 26/31(83.9%)and 23/31(74.2%)had remained continuously on any 5-ASA therapy respectively.Twelve(38.7%)and 11(35.5%)patients remained on balsalazide continuously at three and five years respectively after drug supply returned,equating to a loss of market share(within 5-ASA class)of 45.2%and 38.7%respectively.CONCLUSION This study of a balsalazide shortage in UC patients exemplifies the detrimental impact of a drug shortage on long term patient,disease and commercial outcomes.展开更多
文摘Extremely long Australian paediatric outpatient waiting lists have resulted in large numbers of children waiting to see a paediatrician. Analyses of the patient referrals suggest that a large proportion of children may benefit from allied health input, in addition to being seen by the paediatrician. This paper provides an organisational strategy that involves streamlining Allied Health clinical services in an effort to assist with bringing down a Paediatric Out-patient waitlist. The paper describes principles to guide the formation of a Paediatric Allied Health Multi-Disciplinary team that proposes assessment and brief interventions. The service would focus on supporting the paediatricians through the use of structured procedures, telephone intakes, multidisciplinary triage, shared and standardised assessments, collaborative formulations and reports, brief interventions, clinical-community linkages, and allied health student support. A variety of additional important organisational principles are proposed to facilitate patient flow from the perspective of streamlining administrative processes, having adequate administrative support, shared responsibilities, teamwork, flexibility, carrying out intake assessments, determining which referrals were appropriate for allied health, and working closely with medical staff.
文摘BACKGROUND Limited data currently exists on the clinical utility of Artificial Intelligence Assisted Colonoscopy(AIAC)outside of clinical trials.AIM To evaluate the impact of AIAC on key markers of colonoscopy quality compared to conventional colonoscopy(CC).METHODS This single-centre retrospective observational cohort study included all patients undergoing colonoscopy at a secondary centre in Brisbane,Australia.CC outcomes between October 2021 and October 2022 were compared with AIAC outcomes after the introduction of the Olympus Endo-AID module from October 2022 to January 2023.Endoscopists who conducted over 50 procedures before and after AIAC introduction were included.Procedures for surveillance of inflammatory bowel disease were excluded.Patient demographics,proceduralist specialisation,indication for colonoscopy,and colonoscopy quality metrics were collected.Adenoma detection rate(ADR)and sessile serrated lesion detection rate(SSLDR)were calculated for both AIAC and CC.RESULTS The study included 746 AIAC procedures and 2162 CC procedures performed by seven endoscopists.Baseline patient demographics were similar,with median age of 60 years with a slight female predominance(52.1%).Procedure indications,bowel preparation quality,and caecal intubation rates were comparable between groups.AIAC had a slightly longer withdrawal time compared to CC,but the difference was not statistically significant.The introduction of AIAC did not significantly change ADR(52.1%for AIAC vs 52.6%for CC,P=0.91)or SSLDR(17.4%for AIAC vs 18.1%for CC,P=0.44).CONCLUSION The implementation of AIAC failed to improve key markers of colonoscopy quality,including ADR,SSLDR and withdrawal time.Further research is required to assess the utility and cost-efficiency of AIAC for high performing endoscopists.
文摘BACKGROUND Drug shortages are common yet their impact on patient care and their commercial ramifications has not been adequately researched.In Australia a shortage of balsalazide(2012-2013)necessitated substitution with alternative 5-aminosalicylate(5-ASA)formulations for ulcerative colitis(UC).AIM To assess and compare the clinical and commercial sequelae of non-medical switching from balsalazide to another 5-ASA and/or return to balsalazide once supply resumed.METHODS A prospective cohort study of patients on balsalazide for mild-moderate UC was conducted where,strictly due to the national shortage(November 2012-January 2013),were switched to alternative 5-ASA and/or then returned to balsalazide once supply resumed.Clinical(Partial Mayo),endoscopic(Mayo score)activity,adverse effects(to alternative 5-ASA)and percentage market share(of continuous 5-ASA users)from baseline(i.e.,time of switching due to shortage)through to five years were assessed.RESULTS Of 31 patients switched due to the shortage,12(38.7%)resumed balsalazide immediately once supply resumed,8(25.8%)prompted by adverse effects to the alternative 5-ASA used.Three patients(9.7%)had documented symptomatic improvement,15(48.4%)were unchanged and 13(41.9%)had symptomatic worsening vs baseline(P<0.01),after switching to an alternative 5-ASA.At 3 and 5y post switch,overall 26/31(83.9%)and 23/31(74.2%)had remained continuously on any 5-ASA therapy respectively.Twelve(38.7%)and 11(35.5%)patients remained on balsalazide continuously at three and five years respectively after drug supply returned,equating to a loss of market share(within 5-ASA class)of 45.2%and 38.7%respectively.CONCLUSION This study of a balsalazide shortage in UC patients exemplifies the detrimental impact of a drug shortage on long term patient,disease and commercial outcomes.
