Objectives: To report differences in neonatal health outcomes for a community‐based antenatal program, the Aboriginal Maternity Group Practice Program (AMGPP; the intervention group), compared with two matched control groups eligible for standard antenatal care. Design: Non‐randomised intervention study using data from the Western Australian Midwives Notification System. Regression models were used to report adjusted odds ratios (aORs) for defined neonatal health outcomes. Setting: The AMGPP employed Aboriginal grandmothers, Aboriginal Health Officers, and midwives working in partnership with existing antenatal services to provide care for pregnant Aboriginal women residing in south metropolitan Perth. Participants: 343 women (with 350 pregnancies) who participated in the AMGPP and gave birth between 1 July 2011 and 31 December 2012; historical and contemporary control groups of pregnant Aboriginal women (each including 350 pregnancies), frequency matched for maternal age and gravidity. Main outcome measures: Preterm births, birthweight, neonatal resuscitation, neonatal hospital length of stay longer than 5 days. Results: Babies born to AMGPP participants were significantly less likely to be born preterm (AMGPP, 9.1% v historical controls, 15.9% [aOR, 0.56; 95% CI, 0.35–0.92]; v contemporary controls, 15.3% [aOR, 0.75; 95% CI, 0.58–0.95]); to require resuscitation at birth (AMGPP, 17.8% v historical controls, 24.4% [aOR, 0.68; 95% CI, 0.47–0.98]; v contemporary controls, 31.2% [aOR, 0.71; 95% CI, 0.60–0.85]), or to have a hospital length of stay of more than 5 days (AMGPP, 4.0% v historical controls, 11.3% [aOR, 0.34; 95% CI, 0.18–0.64]; v contemporary controls, 11.6% [aOR, 0.56; 95% CI, 0.41–0.77]). Conclusion: Participation in the AMGPP in south metropolitan Perth was associated with significantly improved neonatal health outcomes.
A 39-year-old woman with no medical history or medication use was brought by ambulance to the ED in status epilepticus. The patient had called her neighbour for help as she was feeling weak and had vomited several times. Prior to ambulance arrival she collapsed in the toilet and did not regain consciousness. En route to hospital and in ED she was noted to have tonic posturing, jaw trismus, limb rigidity and tonic eye deviation. Despite temporary improvement in seizure activity following boluses of midazolam, she remained comatose and had recurrent seizure activity for approximately 40 min. She was hypothermic (34.5°C), tachycardic (HR 115/min) and normotensive. Rapid sequence intubation was performed with thiopentone, fentanyl and suxamethonium, and she was admitted to the ICU.The initial arterial blood gas showed a severe lactic metabolic acidosis (pH 6.61, bicarbonate 4 mmol/L, base excess −29 mmol/L, AG 31 mmol/L, lactate 26 mmol/L) and hyperglycaemia (blood sugar level of 20.6 mmol/ L). Alcohol, paracetamol, salicylate and ketone levels were negative, and iron studies were normal. Carbon monoxide and cyanide were considered unlikely causes given that no exposure was identified at the time. Head CT, MRI and lumbar puncture were normal and EEG post extubation was unremarkable.Lactate levels normalised after 6 h ( Fig. 1), metabolic acidosis resolved over 16 h and the patient was extubated 24 h after presentation.On outpatient follow up, the patient mentioned that she routinely consumed a quarter of a teaspoon of ground apricot kernels daily as a dietary supplement and had commenced a new packet of a new brand of kernels the day prior to admission. This information, combined with the clinical presentation, suggested a diagnosis of acute cyanide toxicity.OzFoodNet and the Environmental Health Directorate (Department of Health, Western Australia) were notified. A second bag of the same brand of apricot kernels were tested, returning a cyanide concentration above the upper limit of calibration (over 3000 mg/kg). As a result of the high cyanide assay and clinically compatible toxicity, the product was recalled by the manufacturer. To better quantify their cyanide content, 6 weeks later other kernels from the same packet were retested twice by a second laboratory, yielding levels of 530 mg/ kg and 780 mg/kg. These levels were probably lower because the total cyanogenic potential of apricot kernels degrades over time.Cyanogenic glycosides occur naturally in many plants including apricot kernels, which contain up to 6% amygdalin and are the food most likely to cause acute cyanide toxicity. 1 Amygdalin is hydrolysed by two enzymes (amygdalin hydrolase and prunasin hydrolase), most effectively in crushed, moistened kernels, resulting in the formation of hydrogen cyanide (HCN) and glucose. 2 Figure 1. Serum lactate level over time.bs_bs_banner CASE LETTERS 491
IntroductionDespite global concerns about the safety and quality of health care, population-wide studies of hospital outcomes are uncommon. The SAFety, Effectiveness of care and Resource use among Australian Hospitals (SAFER Hospitals) study seeks to estimate the incidence of serious adverse events, mortality, unplanned rehospitalisations and direct costs following hospital encounters using nationwide data, and to assess the variation and trends in these outcomes.Methods and analysisSAFER Hospitals is a cohort study with retrospective and prospective components. The retrospective component uses data from 2012 to 2018 on all hospitalised patients age ≥18 years included in each State and Territories’ Admitted Patient Collections. These routinely collected datasets record every hospital encounter from all public and most private hospitals using a standardised set of variables including patient demographics, primary and secondary diagnoses, procedures and patient status at discharge. The study outcomes are deaths, adverse events, readmissions and emergency care visits. Hospitalisation data will be linked to subsequent hospitalisations and each region’s Emergency Department Data Collections and Death Registries to assess readmissions, emergency care encounters and deaths after discharge. Direct hospital costs associated with adverse outcomes will be estimated using data from the National Cost Data Collection. Variation in these outcomes among hospitals will be assessed adjusting for differences in hospitals’ case-mix. The prospective component of the study will evaluate the temporal change in outcomes every 4 years from 2019 until 2030.Ethics and disseminationHuman Research Ethics Committees of the respective Australian states and territories provided ethical approval to conduct this study. A waiver of informed consent was granted for the use of de-identified patient data. Study findings will be disseminated via presentations at conferences and publications in peer-reviewed journals.
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