Dr Mary Lam is a member of the Health Information Management Association of Australia (HIMAA), a Certified Health Informatician Australasia (CHIA) and a Fellow of Australasian College of Health Informatics (ACHI), with many years of experience in health information management and health data science. After years of practice in the industry, she has developed an academic career with a focus on promoting health information and health data science education at undergraduate and postgraduate levels. She is currently the Acting Director of Studies in Digital Health and Innovation at the University of Technology Sydney. Dr Lam is dedicated to equipping students with the professional attitude, knowledge, and skills to face up to the challenge of a data rich healthcare environment.
Mary’s main research areas are data linkage and analysis, and health informatics education. She is the informatics consultant as well as a key member of the research team in many studies supported by a number of competitive grants including a National Health and Medical Research Council (NHMRC) Program grant. She has also received awards for eHealth and Health Informatics education and research, including the Branko Cesnik and Don Walker Awards at the Health Informatics 2014 and 2016 Conferences respectively.
Dr Mary Lam is a member of the Health Information Management Association of Australia (HIMAA), a Certified Health Informatician Australasia (CHIA) and a Fellow of Australasian College of Health Informatics (ACHI)
Can supervise: YES
The Use of Information Technologies and Health information in the maintenance and advancement of health
Health data science
Health information management
Lam, LT, Rai, A & Lam, MK 2019, 'Attachment problems in childhood and the development of anxiety in adolescents: A systematic review of longitudinal and prospective studies', Mental Health and Prevention, vol. 14.View/Download from: UTS OPUS or Publisher's site
© 2019 Elsevier GmbH The association between early relationships and the experience of infant and mother, and the subsequent development of the child through their life span has long been studied. Attachment, as a most prominent construct in early child development, has been the focal point of investigation since the inception of the theoretical concept by Bowlby. In recent years, research has expanded to examine the effect of attachment on the mental health and socio-emotional development of young children and their on-going adjustment into adolescence. However, most studies in the field concentrated on the relationship of childhood attachment and internalising symptoms as a generic assessment of mental health problems. To provide more precise information on the effect of attachment insecurity on individual mental health problems, a systematic review (the first in a series) of available longitudinal and prospective studies was conducted. 11 studies were identified after an extensive search of the literature in accordance to the PRISMA guidelines. Of these, 4 satisfied all selection criteria and provided sufficient data on the effect of attachment insecurity during infancy or early childhood and anxiety in adolescence. Information was extracted and analysed systematically from each study and tabulated. The overall results obtained from these studies indicated a significant and possible causal relationship between attachment insecurity during infancy or early childhood and the development of anxiety in adolescence. These results were discussed in light of theoretical and practical preventive implications.
Lam, LT, Lam, MK, Benrimoj, C & Cardens, VG 2018, 'Application of the Social Network Analysis to Better Comprehend Relationships in Qualitative Health Data.', Studies in health technology and informatics, vol. 252, pp. 86-91.View/Download from: UTS OPUS or Publisher's site
OBJECTIVE:To explore social network analysis (SNA) as an additional approach to elucidate quantifiable insight from qualitative health-related textual data. METHODS:Key concepts gained from thematic analyses of a set of qualitative health data obtained from an implementation study was analysed using the Excel Add-on module NodeXL. RESULTS:Our results show that SNA provided useful visualisation and quantifiable information of the relationship between key concepts obtained from the thematic analysis. DISCUSSION:SNA is a useful technique for exploring and analysing qualitative data, particularly when the research interest is in complex relationships that may exist among a large number of qualitative variables. In addition to providing a way to visualise the relationship between concepts, SNA provides metric measures that can be further analysed quantitatively. CONCLUSION:The SNA approach allows researchers to explore deeper relationships that may exist among various variables and enable researchers to derive potentially a fuller and more complete appreciation and comprehension of health-related data.
Murphy, M, Curtis, K, Lam, MK, Palmer, CS, Hsu, J & McCloughen, A 2018, 'Simulation-based multidisciplinary team training decreases time to critical operations for trauma patients', Injury, vol. 49, no. 5, pp. 953-958.View/Download from: UTS OPUS or Publisher's site
Clemson, L, Mackenzie, L, Roberts, C, Poulos, R, Tan, A, Lovarini, M, Sherrington, C, Simpson, JM, Willis, K, Lam, M, Tiedemann, A, Pond, D, Peiris, D, Hilmer, S, Pit, SW, Howard, K, Lovitt, L & White, F 2017, 'Integrated solutions for sustainable fall prevention in primary care, the iSOLVE project: A type 2 hybrid effectiveness-implementation design', Implementation Science, vol. 12, no. 1.View/Download from: UTS OPUS or Publisher's site
© 2016 The Author(s). Background: Despite strong evidence giving guidance for effective fall prevention interventions in community-residing older people, there is currently no clear model for engaging general medical practitioners in fall prevention and routine use of allied health professionals in fall prevention has been slow, limiting widespread dissemination. This protocol paper outlines an implementation-effectiveness study of the Integrated Solutions for Sustainable Fall Prevention (iSOLVE) intervention which has developed integrated processes and pathways to identify older people at risk of falls and engage a whole of primary care approach to fall prevention. Methods/design: This protocol paper presents the iSOLVE implementation processes and change strategies and outlines the study design of a blended type 2 hybrid design. The study consists of a two-arm cluster randomized controlled trial in 28 general practices and recruiting 560 patients in Sydney, Australia, to evaluate effectiveness of the iSOLVE intervention in changing general practitioner fall management practices and reducing patient falls and the cost effectiveness from a healthcare funder perspective. Secondary outcomes include change in medications known to increase fall risk. We will simultaneously conduct a multi-methodology evaluation to investigate the workability and utility of the implementation intervention. The implementation evaluation includes in-depth interviews and surveys with general practitioners and allied health professionals to explore acceptability and uptake of the intervention, the coherence of the proposed changes for those in the work setting, and how to facilitate the collective action needed to implement changes in practice; social network mapping will explore professional relationships and influences on referral patterns; and, a survey of GPs in the geographical intervention zone will test diffusion of evidence-based fall prevention practices. The project works in par...
Curtis, K, Van, C, Lam, M, Asha, S, Unsworth, A, Clements, A & Atkins, L 2017, 'Implementation evaluation and refinement of an intervention to improve blunt chest injury management—A mixed-methods study', Journal of Clinical Nursing, vol. 26, no. 23-24, pp. 4506-4518.View/Download from: UTS OPUS or Publisher's site
© 2017 The Authors. Journal of Clinical Nursing Published by John Wiley & Sons Ltd. Aims and objectives: To investigate uptake of a Chest Injury Protocol (ChIP), examine factors influencing its implementation and identify interventions for promoting its use. Background: Failure to treat blunt chest injuries in a timely manner with sufficient analgesia, physiotherapy and respiratory support, can lead to complications such as pneumonia and respiratory failure and/or death. Design: This is a mixed-methods implementation evaluation study. Methods: Two methods were used: (i) identification and review of the characteristics of all patients eligible for the ChIP protocol, and (ii) survey of hospital staff opinions mapped to the Theoretical Domains Framework (TDF) to identify barriers and facilitators to implementation. The characteristics and treatment received between the groups were compared using the chi-square test or Fischer's exact test for proportions, and the Mann–Whitney U-test for continuous data. Quantitative survey data were analysed using descriptive statistics. Qualitative data were coded in NVivo 10 using a coding guide based on the TDF and Behaviour Change Wheel (BCW). Identification of interventions to change target behaviours was sourced from the Behaviour Change Technique Taxonomy Version 1 in consultation with stakeholders. Results: Only 68.4% of eligible patients received ChIP. Fifteen facilitators and 10 barriers were identified to influence the implementation of ChIP in the clinical setting. These themes were mapped to 10 of the 14 TDF domains and corresponded with all nine intervention functions in the BCW. Seven of these intervention functions were selected to address the target behaviours and a multi-faceted relaunch of the revised protocol developed. Following re-launch, uptake increased to 91%. Conclusions: This study demonstrated how the BCW may be used to revise and improve a clinical protocol in the ED context. Relevance to clinical prac...
Lam, LT & Lam, MK 2017, 'The association between financial literacy and Problematic Internet Shopping in a multinational sample', Addictive Behaviors Reports, vol. 6, pp. 123-127.View/Download from: UTS OPUS or Publisher's site
© 2017 The Authors Purpose To examine the association between financial literacy and Problematic Internet Shopping in adults. Methods This cross-sectional online survey recruited participants, aged between 18 and 60 years, through an online research facility. The sample consisted of multinational participants from mainly three continents including Europe, North America, and Asia. Problematic Internet Shopping was assessed using the Bergen Shopping Addiction Scale (BSAS). Financial Literacy was measured by the Financial Literacy subscale of the Financial Wellbeing Questionnaire. Multiple linear regression analyses were conducted to elucidate the relationship between the study and outcome variables with adjustment for other potential risk factors. Results Of the total of 997 respondents with an average age of 30.9 (s.d. = 8.8), 135 (13.8%) could be classified as having a high risk of being Problematic Internet Shoppers. Results from the multiple regression analyses suggested a significant and negative relationship between financial literacy and Problematic Internet Shopping with a regression coefficient of − 0.13, after controlling for the effects of potential risk factors such as age, region of birth, employment, income, shopping frequency, self-regulation and anxiety (t = − 6.42, p < 0.001). Conclusions The clinical management of PIS should include a financial counselling as a component of the treatment regime. Enhancement of financial literacy in the general population, particularly among young people, will likely have a positive effect on the occurrence of PIS.
Ng, MC-H, Lau, T-Y, Fan, K, Xu, Q-S, Poon, J, Poon, SK, Lam, MK, Chau, F-T & Sze, DM-Y 2017, 'Prediction of Radix Astragali Immunomodulatory Effect of CD80 Expression from Chromatograms by Quantitative Pattern-Activity Relationship.', BioMed Research International, vol. 2017, pp. 1-11.View/Download from: UTS OPUS or Publisher's site
The current use of a single chemical component as the representative quality control marker of herbal food supplement is inadequate. In this CD80-Quantitative-Pattern-Activity-Relationship (QPAR) study, we built a bioactivity predictive model that can be applicable for complex mixtures. Through integrating the chemical fingerprinting profiles of the immunomodulating herb Radix Astragali (RA) extracts, and their related biological data of immunological marker CD80 expression on dendritic cells, a chemometric model using the Elastic Net Partial Least Square (EN-PLS) algorithm was established. The EN-PLS algorithm increased the biological predictive capability with lower value of RMSEP (11.66) and higher values of Rp2 (0.55) when compared to the standard PLS model. This CD80-QPAR platform provides a useful predictive model for unknown RA extract's bioactivities using the chemical fingerprint inputs. Furthermore, this bioactivity prediction platform facilitates identification of key bioactivity-related chemical components within complex mixtures for future drug discovery and understanding of the batch-to-batch consistency for quality clinical trials.
Tran, V, Lam, MK, Amon, KL, Brunner, M, Hines, M, Penman, M, Lowe, R & Togher, L 2017, 'Interdisciplinary eHealth for the care of people living with traumatic brain injury: A systematic review.', Brain injury, vol. 31, no. 13-14, pp. 1701-1710.View/Download from: UTS OPUS or Publisher's site
To identify literature which discusses the barriers and enablers of eHealth technology and which evaluates its role in facilitating interdisciplinary team work for the care of people with a traumatic brain injury (TBI).Systematic review.Studies were identified by searching CINAHL, Embase, Medline, PsycINFO, Scopus, and Web of Science.Studies included in the review were required to feature an eHealth intervention which assisted interdisciplinary care for people with TBI.Descriptive data for each study described the eHealth intervention, interdisciplinary team, outcomes, and barriers and facilitators in implementing eHealth interventions.The search resulted in 1389 publications, of which 35 were retrieved and scanned in full. Six studies met all the inclusion criteria for the review. Four different eHealth interventions were identified: (i) an electronic goals systems, (ii) telerehabilitation, (iii) videoconferencing, and (iv) a point-of-care team-based information system. Various barriers and facilitators were identified in the use of eHealth.eHealth interventions have been reported to support interdisciplinary teams for the care of TBI. However, there is a substantial gap in existing literature regarding the barriers and enablers which characterize a successful interdisciplinary eHealth model for people with TBI.
Hines, M, Brunner, M, Poon, S, Lam, M, Tran, V, Yu, D, Togher, L, Shaw, T & Power, E 2017, 'Tribes and tribulations: interdisciplinary eHealth in providing services for people with a traumatic brain injury (TBI)', BMC Health Services Research, vol. 17, pp. 1-13.View/Download from: UTS OPUS or Publisher's site
Background eHealth has potential for supporting interdisciplinary care in contemporary traumatic brain injury (TBI) rehabilitation practice, yet little is known about whether this potential is being realised, or what needs to be done to further support its implementation. The purpose of this study was to explore health professionals' experiences of, and attitudes towards eHealth technologies to support interdisciplinary practice within rehabilitation for people after TBI. Methods A qualitative study using narrative analysis was conducted. One individual interview and three focus groups were conducted with health professionals (n = 17) working in TBI rehabilitation in public and private healthcare settings across regional and metropolitan New South Wales, Australia. Results Narrative analysis revealed that participants held largely favourable views about eHealth and its potential to support interdisciplinary practice in TBI rehabilitation. However, participants encountered various issues related to (a) the design of, and access to electronic medical records, (b) technology, (c) eHealth implementation, and (d) information and communication technology processes that disconnected them from the work they needed to accomplish. In response, health professionals attempted to make the most of unsatisfactory eHealth systems and processes, but were still mostly unsuccessful in optimising the quality, efficiency, and client-centredness of their work. Conclusions Attention to sources of disconnection experienced by health professionals, specifically design of, and access to electronic health records, eHealth resourcing, and policies and procedures related to eHealth and interdisciplinary practice are required if the potential of eHealth for supporting interdisciplinary practice is to be realised.
Phillips, J, Poon, SK, Yu, D, Lam, M, Hines, M, Brunner, M, Power, E, Keep, M, Shaw, T & Togher, L 2017, 'A Conceptual Measurement Model for eHealth Readiness: a Team Based Perspective', AMIA ... Annual Symposium proceedings. AMIA Symposium, vol. 2017, pp. 1382-1391.
Despite the shift towards collaborative healthcare and the increase in the use of eHealth technologies, there does not currently exist a model for the measurement of eHealth readiness in interdisciplinary healthcare teams. This research aims to address this gap in the literature through the development of a three phase methodology incorporating qualitative and quantitative methods. We propose a conceptual measurement model consisting of operationalized themes affecting readiness across four factors: (i) Organizational Capabilities, (ii) Team Capabilities, (iii) Patient Capabilities, and (iv) Technology Capabilities. The creation of this model will allow for the measurement of the readiness of interdisciplinary healthcare teams to use eHealth technologies to improve patient outcomes.
Phillips, J, Yu, D, Poon, SK, Lam, M, Hines, M, Brunner, M, Keep, M, Power, E, Shaw, T & Togher, L 2017, 'E-Health Readiness for Teams: A Comprehensive Conceptual Model.', Studies in health technology and informatics, vol. 239, pp. 119-125.View/Download from: UTS OPUS
The use of information technology in the delivery of healthcare services is pervasive but faces many barriers. We propose a four-factor comprehensive conceptual model to provide a measure of interdisciplinary healthcare readiness to provide healthcare services using e-health. We incorporate factors from a series of focus group studies and the wider literature and construct a conceptual model. We utilise the Delphi method to establish content validity and use a series of Q sorts for initial construct validity. This model will improve patient outcomes through healthcare teams identifying barriers to using e-health effectively and efficiently.
Yu, D, Poon, SK, Tran, V, Lam, MK, Hines, M, Brunner, M, Power, E, Shaw, T & Togher, L 2017, 'Enabler for Interdisciplinary eHealthcare: A Qualitative Study.', Studies in Health Technology and Informatics, vol. 239, pp. 160-166.View/Download from: UTS OPUS or Publisher's site
The complex relations between Health Technologies and clinical practices have been the focus of intensive research in recent years. This research represents a shift towards a holistic view where evaluation of health technologies is linked to organisational practices. In this paper, we address the gaps in existing literature regarding the holistic evaluation of e-health in clinical practice. We report the results from a qualitative study conducted to gain insight into e-health in practice within an interdisciplinary healthcare domain. Findings from this qualitative study, provides the foundation for the creation of a generic measurement model that allows for the comparative analysis of health technologies and assist in the decision-making of its stakeholders.
Curtis, K, Asha, SE, Unsworth, A, Lam, M, Goldsmith, H, Langcake, M & Dwyer, D 2016, 'ChIP: An early activation protocol for isolated blunt chest injury improves outcomes, a retrospective cohort study', AUSTRALASIAN EMERGENCY NURSING JOURNAL, vol. 19, no. 3, pp. 127-132.View/Download from: UTS OPUS or Publisher's site
Lam, MK 2016, 'An ensemble approach for record matching in data linkage', vol. 227, pp. 113-119.
Nagarajan, S, McAllister, L, McFarlane, L, Hall, M, Schmitz, C, Roots, R, Drynan, D, Avery, L, Murphy, S & Lam, M 2016, 'Telesupervision Benefits for Placements: Allied Health Students' and Supervisors' Perceptions', International journal of practice-based learning in health and social care, pp. 16-27.View/Download from: UTS OPUS or Publisher's site
Telesupervision (TS) uses Information and Communication Technology (ICT) for communication between university-based staff, clinical supervisors and students undertaking placements in the presence or absence of a clinical supervisor onsite. Despite examples of successful implementation (Carlin 2012, Chipchase et al. 2014, Dudding and Justice 2004, Hall 2013) there has been minimal uptake of TS in allied health. This study investigated students' and clinical educators' perceptions of the potential benefits and barriers of TS using readily accessible ICT during placements. During 2014-2015, telesupervision/telesupport was provided to a total of 54 Undergraduate and Graduate Entry Masters students from Speech Language Pathology (SLP), Occupational therapy (OT) and Physical therapy (PT) programs at one Australian and two Canadian universities and Exercise Physiology (EP) students at the Australian university. After receipt of TS, 39 students completed an online survey. Nine participating university-based clinical education coordinators (CECs) were interviewed about their experiences. Survey data were analysed using descriptive statistics and interview data were analysed using thematic analysis. Students valued regular TS contact/communication with their CEC to discuss challenges that arose during their placements. CECs believed students benefitted from the opportunities to discuss their placement experiences through TS sessions used for direct supervision and/or for complementing onsite supervision. Students used TS sessions to debrief and reflect on their placement experiences. CECs gained a better understanding of the students' placement experiences. TS has the potential to develop greater connection between students and CECs and enhance student and supervisor experience of clinical education.
Lam, MK, Hines, M, Lowe, R, Nagarajan, S, Keep, M, Penman, M & Power, E 2016, 'Preparedness for eHealth: Health Sciences Students' knowledge, skills and confidence', Journal of Information Technology Education : Research, vol. 15, pp. 305-334.View/Download from: UTS OPUS
There is increasing recognition of the role eHealth will play in the effective and efficient delivery
of healthcare. This research challenges the assumption that students enter university as digital
natives, able to confidently and competently adapt their use of information and communication
technology (ICT) to new contexts. This study explored health sciences students' preparedness for
working, and leading change, in eHealth-enabled environments. Using a cross-sectional study
design, 420 undergraduate and postgraduate students participated in an online survey investigating
their understanding of and attitude towards eHealth, frequency of online activities and software
usage, confidence learning and using ICTs, and perceived learning needs. Although students
reported that they regularly engaged with a wide range of online activities and software and were
confident learning new ICT skills especially where they have sufficient time or support, their understanding
of eHealth was uncertain or limited. Poor understanding of and difficulty translating
skills learned in personal contexts to the professional context may impair graduates ability to confidently
engage in the eHealth-enabled workplace. These results suggest educators need to scaffold
the learning experience to ensure students build on their ICT knowledge to transfer this to
their future workplaces.
Lam, LT & Lam, MKP 2015, 'Competency of health information acquisition and intention for active health behaviour in children', International Archives of Medicine, vol. 8, no. 1, pp. 1-10.View/Download from: UTS OPUS or Publisher's site
© Under License of Creative Commons Attribution 3.0 License. Objective: To investigate the association between competency of health information acquisition, both online and offline, and the intention for active health behaviour in children. Methods: This study was a population-based cross-sectional health survey utilising a two-stage random cluster sampling design conducted in a major city. Competency of health information acquisition was assessed by a rating scale designed specifically for this study. The intention for active health behaviour was measured by a vignettebased question. Data were analysed using multiple logistic regression modelling techniques with adjustment to the cluster sampling effect and potential confounding factors. Results: After adjusting for potential confounding factors and the cluster sampling effect, intention for active health behaviour was significantly associated with competency of health information acquisition both online (OR=1.06, 95%C.I.=1.01-1.12) and offline (OR=1.08, 95%C.I.=1.02-1.18). Conclusions: Results suggested a positive relationship between competency of health information acquisition, both online and offline, and the intention for active health behaviour which have important public health implications on child health behaviour.
Neville, V, Lam, M & Gordon, CJ 2015, 'The impact of elearning on health professional educators' attitudes to information and communication technology', Journal of Multidisciplinary Healthcare, vol. 8, pp. 75-81.View/Download from: Publisher's site
© 2015 Neville et al. Background: The use of information and communication technology (ICT) in health professional education is increasing rapidly. Health professional educators need to be responsive to health professionals' information and communication technological needs; however, there is a paucity of information about educators' attitudes to, and capabilities with, ICT. Methods: Fifty-two health professional educators, enrolled in health professional education postgraduate studies, participated in an online subject with specific eLearning components requiring the use of ICT. They completed a pre- and postquestionnaire pertaining to ICT attitudes, confidence, and usage. Results: Participants reported significant increases in overall ICT confidence during the subject despite it being high at baseline (mean: 7.0 out of 10; P=0.02). Even with increased ICT confidence, there were decreases in the participants' sense of ICT control when related to health professional education (P=0.002); whereas, the amount of time participants engaged with ICT devices was negatively correlated with the sense of ICT control (P=0.002). The effect of age and health discipline on ICT attitudes and confidence was not significant (P>0.05). Conclusion: This study reports that health professional educators have perceptual deficits toward ICT. The impact of eLearning increased confidence in ICT but caused a reduction in participants' sense of control of ICT. Health professional educators require more ICT training and support to facilitate better ICT integration in health professional education settings.
Wiseman, TA, Curtis, K, Lam, M & Foster, K 2015, 'Incidence of depression, anxiety and stress following traumatic injury: A longitudinal study', Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, vol. 23, no. 1.View/Download from: Publisher's site
© Wiseman et al.; licensee BioMed Central. Traumatic injury and mental health disorders are co-associated. Early identification of depression, anxiety and stress following injury, and subsequent preventive intervention, may reduce the long-term symptoms and negative impacts associated with depression and anxiety. The purpose of the study was to determine the incidence, severity and predictors of depression, anxiety and stress in injured patients in the acute phase of care, and at six months following injury, as well as the effectiveness of an in-hospital screening tool. Methods: This descriptive longitudinal study of trauma patients was conducted at a Level 1 Metropolitan Trauma Centre in Australia over 14 months. Participants were interviewed using the Depression Anxiety Stress Scale short-form version (DASS-21) during hospital admission then at 3 and 6 months after injury. Descriptive statistics were performed to evaluate participant characteristics and incidence of depression, anxiety and stress. Correlations and logistic regression were conducted to investigate the ability of the DASS-21 to predict symptoms of depression, anxiety and stress and to investigate factors associated with depression, anxiety and stress 6 months after injury. Results: 201 participants ranging in age (18-94 years) and injury severity participated in the baseline interview and 109 completed all 3 interviews over 6 months. Over half (54%) reported above normal scores for depression, anxiety and/or stress in at least one of the 3 time points. Intensive care unit admission and high levels of depression, anxiety and stress at 3 months post injury were predictors for high levels of depression, anxiety and stress at 6 months. Low scores for depression, anxiety and stress during admission were correlated with low scores for depression, anxiety and stress at 3 and 6 months. Conclusion: Depression, anxiety and stress in patients hospitalised following injury is common and should be anticipated...
Curtis, K, Chan, DL, Lam, MK, Mitchell, R, King, K, Leonard, L, D'Amours, S & Black, D 2014, 'The injury profile and acute treatment costs of major trauma in older people in New South Wales', Australasian Journal on Ageing, vol. 33, no. 4, pp. 264-270.View/Download from: Publisher's site
© 2013 ACOTA. Aims: To Describe injury profile and costs of older person trauma in New South Wales; quantify variations with peer group costs; and identify predictors of higher costs. Methods: Nine level 1 New South Wales trauma centres provided data on major traumas (aged ≥55 years) during 2008-2009 financial year. Trauma register and financial data of each institution were linked. Treatment costs were compared with peer group Australian Refined Diagnostic Related Groups costs, on which hospital funding is based. Variables examined through multivariate analyses. Results: Six thousand two hundred and eighty-nine patients were admitted for trauma. Most common injury mechanism was falls (74.8%) then road trauma (14.9%). Median patient cost was $7044 (Q1-3: $3405-13 930) and total treatment costs $76 694 252. Treatment costs were $5 813 975 above peer group average. Intensive care unit admission, age, injury severity score, length of stay and traumatic brain injury were independent predictors of increased costs. Conclusion: Older person trauma attracts greater costs and length of stay. Cost increases with age and injury severity. Hospital financial information and trauma registry data provides accurate cost information that may inform future funding.
Curtis, K, Lam, M, Mitchell, R, Black, D, Taylor, C, Dickson, C, Jan, S, Palmer, CS, Langcake, M & Myburgh, J 2014, 'Acute costs and predictors of higher treatment costs of trauma in New South Wales, Australia', Injury, vol. 45, no. 1, pp. 279-284.View/Download from: Publisher's site
Background: Accurate economic data are fundamental for improving current funding models and ultimately in promoting the efficient delivery of services. The financial burden of a high trauma casemix to designated trauma centres in Australia has not been previously determined, and there is some evidence that the episode funding model used in Australia results in the underfunding of trauma. Aim: To describe the costs of acute trauma admissions in trauma centres, identify predictors of higher treatment costs and cost variance in New South Wales (NSW), Australia. Materials and methods: Data linkage of admitted trauma patient and financial data provided by 12 Level 1 NSW trauma centres for the 08/09 financial year was performed. Demographic, injury details and injury scores were obtained from trauma registries. Individual patient general ledger costs (actual trauma patient costs), Australian Refined Diagnostic Related Groups (AR-DRG) and state-wide average costs (which form the basis of funding) were obtained. The actual costs incurred by the hospital were then compared with the state-wide AR-DRG average costs. Multivariable multiple linear regression was used for identifying predictors of costs. Results: There were 17,522 patients, the average per patient cost was $10,603 and the median was $4628 (interquartile range: $2179-10,148). The actual costs incurred by trauma centres were on average $134 per bed day above AR-DRG costs-determined costs. Falls, road trauma and violence were the highest causes of total cost. Motor cyclists and pedestrians had higher median costs than motor vehicle occupants. As a result of greater numbers, patients with minor injury had comparable total costs with those generated by patients with severe injury. However the median cost of severely injured patients was nearly four times greater. The count of body regions injured, sex, length of stay, serious traumatic brain injury and admission to the Intensive Care Unit were significantly associa...
Curtis, K, Lam, M, Mitchell, R, Dickson, C & McDonnell, K 2014, 'Major trauma: The unseen financial burden to trauma centres, a descriptive multicentre analysis', Australian Health Review, vol. 38, no. 1, pp. 30-37.View/Download from: Publisher's site
Objective This research examines the existing funding model for in-hospital trauma patient episodes in New South Wales (NSW), Australia and identifies factors that cause above-average treatment costs. Accurate information on the treatment costs of injury is needed to guide health-funding strategy and prevent inadvertent underfunding of specialist trauma centres, which treat a high trauma casemix. Methods Admitted trauma patient data provided by 12 trauma centres were linked with financial data for 2008-09. Actual costs incurred by each hospital were compared with state-wide Australian Refined Diagnostic Related Groups (AR-DRG) average costs. Patient episodes where actual cost was higher than AR-DRG cost allocation were examined. Results There were 16693 patients at a total cost of AU$178.7million. The total costs incurred by trauma centres were $14.7million above the NSW peer-group average cost estimates. There were 10 AR-DRG where the total cost variance was greater than $500000. The AR-DRG with the largest proportion of patients were the upper limb injury categories, many of whom had multiple body regions injured and/or a traumatic brain injury (P<0.001). Conclusions AR-DRG classifications do not adequately describe the trauma patient episode and are not commensurate with the expense of trauma treatment. A revision of AR-DRG used for trauma is needed. What is known about this topic? Severely injured trauma patients often have multiple injuries, in more than one body region and the determination of appropriate AR-DRG can be difficult. Pilot research suggests that the AR-DRG do not accurately represent the care that is required for these patients. What does this paper add? This is the first multicentre analysis of treatment costs and coding variance for major trauma in Australia. This research identifies the limitations of the current AR-DRGS and those that are particularly problematic. The value of linking trauma registry and financial data within each trauma ce...
Lam, MK, Nguyen, M, Lowe, R, Nagarajan, SV & Lincoln, M 2014, '"I can do it": Does confidence and perceived ability in learning new ICT skills predict pre-service health professionals' attitude towards engaging in e-healthcare?', Studies in Health Technology and Informatics, vol. 204, pp. 60-66.View/Download from: Publisher's site
© 2014 The authors and IOS Press. Background: There are many factors affecting health professionals' willingness to engage in e-health. One of these factors is whether health professionals perceive themselves to be able to learn new skills, and have the confidence in mastering these new Information and Communication Technology (ICT) skills. Objective: This study examined how health students' confidence and perceived ability for learning new ICT skills affect their attitude towards engaging in e-health. Methods: A survey was conducted to explore students' attitude towards using e-health and their perceived self-efficacy and confidence to learn new ICT skills. Multiple regression analysis was used to examine the relationship between confidence and self-efficacy, and attitude towards engaging in e-health controlling for participants' age, gender, and prior IT learning experience. Results: The three scales measuring attitude, confidence and self-efficacy showed good internal consistency with respective Cronbach's Alpha scores of 0.835, 0.761 and 0.762. Multiple regression analysis showed a significant relationship between confidence, self-efficacy and prior IT learning experiences with attitude towards e-health after adjusting for the effect of each other (F3,350=17.20,p<0.001). Conclusion: Self-efficacy and confidence in learning new ICT skills together with previous ICT training either at or outside their university studies are significant factors associated with students' attitude towards using e-health. Enhancing students' level of self-efficacy in learning new ICT skills may be the key to the success of implementation of e-health initiatives.
Ogilvie, R, Curtis, K, Lam, M, McCloughen, A & Foster, K 2014, 'The burden of youth: major traumatic injury in adolescents and young adults managed in the Australian Capital Territory', Journal of trauma nursing : the official journal of the Society of Trauma Nurses, vol. 21, no. 5, pp. 218-227.View/Download from: Publisher's site
To determine the incidence, characteristics, and factors associated with mortality after major traumatic injury in adolescent and young people in the Australian Capital Territory (ACT). A combined retrospective analysis of the National Coroners Information System and ACT Level 1 Trauma Centre registry data from July 2007 to June 2012 was conducted. Inclusion criteria were age 16 to 24 years, injury occurring within the ACT or surrounding region of responsibility, Injury Severity Score of more than 15, intensive care unit admission, hospital stay of more than 3 days, penetrating injury, or death. There were 714 adolescent and young adults recorded in the TCH trauma registry and National Coroners Information System. Injury rates remained consistent over the 5-year study period. Over half the injuries occurred in the districts surrounding the ACT. The largest subset represented was 18 to 21 years (47.8%). Road trauma was the most prevalent injury mechanism overall (58.4%), reaching statistical significance within the 18- to 21-year subset (39.9%). Other dominant injury mechanisms overall were recreation (15.4%) and violence (15.3%); self-inflicted violence constituted 45.8% within the larger violence group. Variables associated with mortality included those injured within the ACT (odds ratio [OR], 0.4; 95% confidence interval [CI], 0.23-0.76) and the injury categories of severe (OR, 52.27; 95% CI, 24.71-110.58) and critically injured (OR, 770.73; 95% CI, 267.37-2221.73). The largest demographic affected by major trauma in the ACT and surrounds is young people aged 16 to 24 years. The focus of injury prevention may benefit from targeting young people involved in multiple risk behaviors that contribute to road trauma, interpersonal and self-inflicted violence, as well as high-risk recreation activities. Further research examining the complexity and relationship between these risk factors is required, as well as the long-term burden associated with caring for injured p...
Ogilvie, R, Curtis, K, Palmer, C, Lam, M, Mccloughen, A & Foster, K 2014, 'Incidence and outcomes of major trauma patients managed in the australian capital territory', ANZ Journal of Surgery, vol. 84, no. 6, pp. 433-437.View/Download from: Publisher's site
Background: To determine the incidence and characteristics of major traumatic injury treated in the Australian Capital Territory (ACT) over a 5-year period. Methods: A retrospective analysis of ACT Level 1 Trauma Centre registry data from July 2007 to June 2012 was conducted. Inclusion criteria were: major trauma (Injury Severity Score (ISS) >15), intensive care unit admission, hospital stay >3 days or penetrating injury. Results: There were 931 patients with an ISS >15, a 12.5% increase over the 5-year period (P = 0.003). Unadjusted mortality rates in the ISS >15 group remained stable at 9.9%. About half of all injuries occurred outside the ACT. The largest age group represented was 16-24 years. Road trauma was the most prevalent injury mechanism, but its incidence reduced over the 5-year period (52.2-40.3% [P = 0.005]). There was a 3.1% increase in admissions following violence. Conclusion: The largest demographic affected by major trauma in the ACT and surrounds is young people. Injury prevention should remain focused on road trauma but also target violence and high-risk recreation activities. Further investigation around the circumstances of major traumatic injury in young people is required. Funding and cross-border agreements should be reviewed to minimize financial disadvantage to the ACT. © 2014 Royal Australasian College of Surgeons.
Lam, MK, Nguyen, M & Campbell, AJ 2013, 'E-health as a life long learning process: How to prepare health professionals for this journey', Studies in Health Technology and Informatics, vol. 188, pp. 72-78.View/Download from: Publisher's site
Background: The e-health environment is a rapidly changing one. To effectively engage with technology for healthcare delivery, health professionals must be able to adapt to this constantly evolving environment very quickly. Learning and adapting to new e-health technologies is a life-long learning process. Objective: This study examined the effectiveness of incorporating self-directed and transformative learning approaches to introduce health sciences students to e-health concepts and skills. Methods: Two surveys were conducted to measure students' e-health knowledge and their perceived self-efficacy in using commonly available software to complete tasks required for an assessment in the unit of study. These surveys were conducted at the beginning and the end of the semester. Paired t-tests with Bonferroni adjustment were used to examine the effect of the teaching approach on students' self-perceived efficacy. Results: It was found that students showed significant improvement in their knowledge of, and perceived efficacy in using, commonly available software to carry out spreadsheet, database and data manipulation operations after intervention. Conclusion: This study shows that the combined self-directed and transformative teaching and learning approach is effective in helping students to identify their learning needs and develop skills to seek out resources that enable them to learn new e-health skills and concepts in a self-directed manner. © 2013 The authors and IOS Press. All rights reserved.
Georgiou, A, Lam, M, Allardice, J, Hart, GK & Westbrook, JI 2012, 'Troponin testing in the emergency department: A longitudinal study to assess the impact and sustainability of decision support strategies', Journal of Clinical Pathology, vol. 65, no. 6, pp. 546-550.View/Download from: Publisher's site
Aim: To evaluate the impact of decision support on the proportion of troponin I (cTnI) tests and associated costs over the period 2000-7 for patients presenting with chest pain in an emergency department (ED) setting. Methods: A longitudinal study using linked data for patients presenting with chest pain from the ED and laboratory information systems of a metropolitan teaching hospital in Melbourne, Australia. The study period was divided into a pre-intervention period (2000-2), which contained no decision support; an initial post period (2003-4) after the introduction of a quality improvement initiative (utilising a paper-based guideline, education, audit and feedback) about cTnI test ordering and the incorporation of the guideline as a decision support feature of the computerised provider order entry system; followed by a post-modification period (2005-7) after the electronic decision support feature was modified to allow clinicians to bypass viewing the complete guideline. Results: There was a significant fall in the proportion of cTnI tests ordered per patient presentation across the three periodsdpre (2000-2), post (2003-4) and postmodification (2005-7)dfrom 7.3% to 4.1% and 2.8%, respectively. Analysis of costs showed significant reductions in the mean costs for cTnI tests per patient presentation from $A9.28 to $A8.54 and $A8.18, respectively, which amounted to a modest saving of $A13 251 since the initiation of decision support in 2003. Conclusions: Decision support systems are often part of multifaceted implementations undertaken over time. They require continuous monitoring and modifications to ensure optimal performance.
Lam, MK & Lam, LT 2012, 'Health information-seeking behaviour on the Internet and health literacy among older Australians', ELECTRONIC JOURNAL OF HEALTH INFORMATICS, vol. 7, no. 2.View/Download from: UTS OPUS
Lam, MK, Amon, KL, Nguyen, M, Campbell, AJ & Neville, V 2012, 'The effect of e-health contents on health science students' attitude toward the efficiency of health ICT in care provision', Studies in Health Technology and Informatics, vol. 178, pp. 99-104.View/Download from: Publisher's site
Objective: This study aimed to examine the effects of e-health education content on the attitude of undergraduate health science students towards the efficiency of health ICT in healthcare provision. Methods: A cross-sectional survey design was used. Participants were Health Sciences students attending The University of Sydney. Students were divided into three groups: junior students enrolled in a subject with non e-health content; senior students enrolled in a subject with non e-health content; and students enrolled in a subject with e-health content. Students' attitude towards the efficiency of ICT in healthcare provision was measured by a modified version of the Information Technology Attitude Scales for Health (ITASH). Results: Students enrolled in the subject with e-health content had a significantly higher average baseline attitude score than the other two groups (T198=-3.47, p=0.001; T 93=-2.43, p=0.017). The repeat measures analysis yielded a result with significant interaction between survey time and student group (F 2, 267=4.99, p=0.007) suggesting that changes of score was dependent on student group status. Conclusion: Subjects rich in e-health content significantly enhanced student attitudes, even with a group of students with a rather positive initial attitude. To facilitate the uptake and utilisation of health ICT by the future health workforce, it is important for tertiary educational institutes to provide students with sufficient exposure to specific health-related ICT training, via specifically designed subjects delivering both generic and specific e-health content. © 2012 The authors and IOS Press. All rights reserved.
Steinbeck, K, Hazell, P, Cumming, RG, Skinner, SR, Ivers, R, Booy, R, Fulcher, G, Handelsman, DJ, Martin, AJ, Morgan, G, Starling, J, Bauman, A, Rawsthorne, ML, Bennett, DL, Chow, CM, Lam, MK, Kelly, P, Brown, NJ, Paxton, K & Hawke, C 2012, 'The study design and methodology for the ARCHER study - adolescent rural cohort study of hormones, health, education, environments and relationships', BMC Pediatrics, vol. 12.View/Download from: Publisher's site
Background: Adolescence is characterized by marked psychosocial, behavioural and biological changes and represents a critical life transition through which adult health and well-being are established. Substantial research confirms the role of psycho-social and environmental influences on this transition, but objective research examining the role of puberty hormones, testosterone in males and oestradiol in females (as biomarkers of puberty) on adolescent events is lacking. Neither has the tempo of puberty, the time from onset to completion of puberty within an individual been studied, nor the interaction between age of onset and tempo. This study has been designed to provide evidence on the relationship between reproductive hormones and the tempo of their rise to adult levels, and adolescent behaviour, health and wellbeing.Methods/Design: The ARCHER study is a multidisciplinary, prospective, longitudinal cohort study in 400 adolescents to be conducted in two centres in regional Australia in the State of New South Wales. The overall aim is to determine how changes over time in puberty hormones independently affect the study endpoints which describe universal and risk behaviours, mental health and physical status in adolescents. Recruitment will commence in school grades 5, 6 and 7 (10-12 years of age). Data collection includes participant and parent questionnaires, anthropometry, blood and urine collection and geocoding. Data analysis will include testing the reliability and validity of the chosen measures of puberty for subsequent statistical modeling to assess the impact over time of tempo and onset of puberty (and their interaction) and mean-level repeated measures analyses to explore for significant upward and downward shifts on target outcomes as a function of main effects.Discussion: The strengths of this study include enrollment starting in the earliest stages of puberty, the use of frequent urine samples in addition to annual blood samples to measure pubert...
Curtis, K, Mitchell, R, Dickson, C, Black, D & Lam, M 2011, 'Do AR-DRGs adequately describe the trauma patient episode in New South Wales, Australia?', Health Information Management Journal, vol. 40, no. 1, pp. 7-13.View/Download from: Publisher's site
The use of Diagnosis Related Groups (DRGs) may not be an accurate tool to provide reimbursement for trauma services. This study aimed to determine whether Australian Refined Diagnosis Related Groups (AR-DRGs) adequately describe the trauma patient episode and to identify AR-DRG groupings where reimbursement was not commensurate with actual cost. The AR-DRG allocated costs and actual costs of a sample of 206 trauma patient episodes were reviewed during a three-month period. Of the AR-DRG groups identified in the patient episodes, 62.8% were not commensurate with actual cost incurred, equating to an overall loss of $113,921 from under-funded acute trauma patient episodes over a three-month period. Assault-related penetrating trauma, traffic-related and sport-related incidents were all inadequately reimbursed using AR-DRGs compared with the actual cost of treatment. Cases involving female patients, patients aged 45 years or less and those with moderate injuries were similarly underfunded. AR-DRGs are not adequate to describe the extent of injuries experienced by trauma patients and there is a need to investigate alternative funding models for trauma services.
Jonas, E, Thomson, PC, Hall, EJS, McGill, D, Lam, MK & Raadsma, HW 2011, 'Mapping quantitative trait loci (QTL) in sheep. IV. Analysis of lactation persistency and extended lactation traits in sheep', Genetics Selection Evolution, vol. 43, no. 1.View/Download from: Publisher's site
Background: In sheep dairy production, total lactation performance, and length of lactation of lactation are of economic significance. A more persistent lactation has been associated with improved udder health. An extended lactation is defined by a longer period of milkability. This study is the first investigation to examine the presence of quantitative trait loci (QTL) for extended lactation and lactation persistency in sheep. Methods. An (Awassi × Merino) × Merino single-sire backcross family with 172 ewes was used to map QTL for lactation persistency and extended lactation traits on a framework map of 189 loci across all autosomes. The Wood model was fitted to data from multiple lactations to estimate parameters of ovine lactation curves, and these estimates were used to derive measures of lactation persistency and extended lactation traits of milk, protein, fat, lactose, useful yield, and somatic cell score. These derived traits were subjected to QTL analyses using maximum likelihood estimation and regression analysis. Results: Overall, one highly significant (LOD > 3.0), four significant (2.0 < LOD < 3.0) and five suggestive (1.7 < LOD < 2.0) QTL were detected across all traits in common by both mapping methods. One additional suggestive QTL was identified using maximum likelihood estimation, and four suggestive (0.01 < P < 0.05) and two significant (P < 0.01) QTL using the regression approach only. All detected QTL had effect sizes in the range of 0.48 to 0.64 SD, corresponding to QTL heritabilities of 3.1 to 8.9%. The comparison of the detected QTL with results in cattle showed conserved linkage regions. Most of the QTL identified for lactation persistency and extended lactation did not coincide. This suggests that persistency and extended lactation for the same as well as different milk yield and component traits are not controlled by the same genes. Conclusion: This study identified ten novel QTL for lactation persistency and extended lactation in sheep...
Lam, MK 2011, 'How good is New South Wales admitted patient data collection in recording births?', Health Information Management Journal, vol. 40, no. 3, pp. 12-19.View/Download from: Publisher's site
This record linkage study aims to examine the coding concordance of delivery outcome and discharge status between the New South Wales (NSW) Midwives Data Collection (MDC) and Admitted Patients Data Collection (APDC) as well as factors that contribute to hospital births not being recorded in the APDC. Births recorded in the APDC and MDC datasets for the calendar year 2005 were used for analysis. Births registered in the NSW Registry of Births Deaths and Marriages for the same period were used as validation. Descriptive analysis was used to examine coding concordance between the APDC and MDC datasets for matched records, and logistic regression analyses were used to identify factors associated with hospital births not being included in the APDC. A total of 90,585 unique births were recorded in the MDC for the calendar year 2005. A total of 79,173 confirmed hospital births were matched to corresponding records in the APDC; 2,249 (3%) confirmed hospital births were not found in the APDC. For unmatched records, logistic regression analyses showed that the level of obstetric hospital in which babies were born was a significant factor associated with information not being recorded in the APDC. As compared with local, small isolated, and small metropolitan hospitals (Levels 1 to 3 hospitals), larger tertiary hospitals (Levels 4 to 6) and private hospitals had decreased odds of hospital births not being recorded in the APDC. For matched records, 95% and 99% of records were found to be coded consistently between the APDC and MDC datasets for outcome of delivery and discharge status respectively. With a high level of coding concordance between the APDC and MDC datasets and only a small percentage of hospital births not being recorded in the APDC, the obstetrics subset of the APDC dataset was found to be of good quality.
Lam, L & Lam, M 2009, 'The use of information technology and mental health among older care-givers in Australia', AGING & MENTAL HEALTH, vol. 13, no. 4, pp. 557-562.View/Download from: Publisher's site
Raadsma, H, Jonas, E, McGill, D, Hobbs, M, Lam, M & Thomson, P 2009, 'Mapping quantitative trait loci (QTL) in sheep. II. Meta-assembly and identification of novel QTL for milk production traits in sheep', Genetics Selection Evolution, vol. 41, no. 1.View/Download from: Publisher's site
An (Awassi × Merino) × Merino backcross family of 172 ewes was used to map quantitative trait loci (QTL) for different milk production traits on a framework map of 200 loci across all autosomes. From five previously proposed mathematical models describing lactation curves, the Wood model was considered the most appropriate due to its simplicity and its ability to determine ovine lactation curve characteristics. Derived milk traits for milk, fat, protein and lactose yield, as well as percentage composition and somatic cell score were used for single and two-QTL approaches using maximum likelihood estimation and regression analysis. A total of 15 significant (P < 0.01) and additional 25 suggestive (P < 0.05) QTL were detected across both single QTL methods and all traits. In preparation of a meta-analysis, all QTL results were compared with a meta-assembly of QTL for milk production traits in dairy ewes from various public domain sources and can be found on the ReproGen ovine gbrowser http://crcidp.vetsci.usyd.edu.au/cgi-bin/gbrowse/oaries-genome/. Many of the QTL for milk production traits have been reported on chromosomes 1, 3, 6, 16 and 20. Those on chromosomes 3 and 20 are in strong agreement with the results reported here. In addition, novel QTL were found on chromosomes 7, 8, 9, 14, 22 and 24. In a cross-species comparison, we extended the meta-assembly by comparing QTL regions of sheep and cattle, which provided strong evidence for synteny conservation of QTL regions for milk, fat, protein and somatic cell score data between cattle and sheep. © 2009Raadsma et al.
Raadsma, HW, Thomson, PC, Zenger, KR, Cavanagh, C, Lam, MK, Jonas, E, Jones, M, Attard, G, Palmer, D & Nicholas, FW 2009, 'Mapping quantitative trait loci (QTL) in sheep. I. A new male framework linkage map and QTL for growth rate and body weight', Genetics Selection Evolution, vol. 41, no. 1.View/Download from: Publisher's site
A male sheep linkage map comprising 191 microsatellites was generated from a single family of 510 Awassi-Merino backcross progeny. Except for ovine chromosomes 1, 2, 10 and 17, all other chromosomes yielded a LOD score difference greater than 3.0 between the best and second-best map order. The map is on average 11% longer than the Sheep Linkage Map v4.7 male-specific map. This map was employed in quantitative trait loci (QTL) analyses on body-weight and growth-rate traits between birth and 98 weeks of age. A custom maximum likelihood program was developed to map QTL in half-sib families for non-inbred strains (QTL-MLE) and is freely available on request. The new analysis package offers the advantage of enabling QTL × fixed effect interactions to be included in the model. Fifty-four putative QTL were identified on nine chromosomes. Significant QTL with sex-specific effects (i.e. QTL × sex interaction) in the range of 0.4 to 0.7 SD were found on ovine chromosomes 1, 3, 6, 11, 21, 23, 24 and 26. © 2009 Raadsma et al.
Soo, IHY, Lam, MK, Rust, J & Madden, R 2009, 'Do we have enough information? How ICD-10-am activity codes measure up', Health Information Management Journal, vol. 38, no. 1, pp. 22-34.View/Download from: Publisher's site
This research explored the usage of activity codes introduced into the International Statistical Classification of Diseases and Related Health Problems, Tenth revision, Australian Modification (ICD-10-AM) Third Edition and examined the data quality of activity coding, explicitly, completeness and specificity. Injury separations for years 2001/02 to 2005/06 specifying a 'true injury' were extracted for descriptive analyses. Part A investigated the usage of activity codes and compared the usage of the 236 activity codes available in the Activity block (U50-U73) present in the ICD-10-AM Third Edition against the 16 codes present in the second edition. Part B examined the level of completeness of external cause coding and the degree of activity coding specificity in the 2005/06 dataset. It was found that the additional activity codes were used extensively with only 46 codes seldom assigned. Codes present in the second edition were extensively used in the third and fourth editions and the new additional activity codes represent 10% of all activity codes assigned per year. All five datasets demonstrated high levels of completeness, recording completeness levels greater than 97%, where missing activity codes attributed to the majority of missing codes. Fourteen out of the 24 activity categories demonstrated a strong reliance on non-specific codes and Team ball sports and Wheeled non-motor sports illustrated that activity codes assigned lacked detail in the code. Clinicians and coders need to acknowledge the importance of quality clinical documentation for research and policy-making purposes so that circumstances surrounding injury events can be coded to the highest level of specificity to improve injury prevention and control activities. Missing activity codes and the abundance of non-specific coding hinders the usefulness of the data.
Lam, M & Lam, L 2008, 'Access and the use of information technology in the older Australian population: A comparison among the healthy, chronically ill, and people with disability with and without limitation to core functioning', Journal on Information Technology in Healthcare, vol. 6, no. 4, pp. 261-272.
Objective: To examine the access and usage of information technology in Australia among various groups of older people including healthy, chronically ill, and disabled people with and without limitations to core functional activities. Methods: Cross-sectional population-based national health survey with stratified random sampling from the total population of people with disability, aged 60 years or older and carers of people with disability. Data were analysed using logistic regression analyses with bootstrapping resampling (a statistical method for estimating the sampling distribution of an estimator by sampling with replacement from the original sample) and estimation statistical techniques. Results: After adjusting for demographic variables there was no significant association between health conditions and access to Internet except for those who were disabled with both physical and communication limitations. In terms of the use of the Internet a 50% reduction of odds (Odds Ratio (OR) = 0.5, 95% Confidence Intervals (CI) = 0.11-0.89) were found for this group when compared to the healthy group. A significant result was found for the disability with physical limitation only group with a 30% reduction (OR = 0.73, 95%CI = 0.50-0.95). Conclusions: Disabled people with physical and communication limitations are more disadvantaged in terms of using the Internet. More attention should be paid to the design of computer devices for physically restricted people. © The Journal on Information Technology in Healthcare.
Lam, MK, Innes, K, Soad, P, Rust, J, Dimitropoulos, V & Cumerlato, M 2008, 'An evaluation of the quality of obstetric morbidity coding using an objective assessment tool, the Performance Indicators for Coding Quality (PICQ)', HEALTH INFORMATION MANAGEMENT JOURNAL, vol. 37, no. 2, pp. 19-29.View/Download from: Publisher's site
Lam, LT & Lam, MKP 2005, 'The association between sudden illness and motor vehicle crash mortality and injury among older drivers in NSW, Australia', ACCIDENT ANALYSIS AND PREVENTION, vol. 37, no. 3, pp. 563-567.View/Download from: Publisher's site
Belov, K, Lam, MKP & Colgan, DJ 2004, 'Marsupial MHC class II β genes are not orthologous to the eutherian β gene families', Journal of Heredity, vol. 95, no. 4, pp. 338-345.View/Download from: Publisher's site
The major histocompatibility complex (MHC) class II DRB, DQB, DPB, and DOB gene clusters are shared by different eutherian orders. Such an orthologous relationship is not seen between the β genes of birds and eutherians. A high degree of uncertainty surrounds the evolutionary relationship of marsupial class II β sequences with eutherian β gene families. In particular, it has been suggested that marsupials utilize the DRB gene cluster. A cDNA encoding an MHC class II β molecule was isolated from a brushtail possum mesenteric lymph node cDNA library. This clone is most similar to Macropus rufogriseus DBB. Our analysis suggests that all known marsupial β-chain genes, excluding DMB, fall into two separate clades, which are distinct from the eutherian DRB, DQB, DPB, or DOB gene clusters. We recommend that the DAB and DBB nomenclature be reinstated. DAB and DBB orthologs are not present in eutherians. It appears that the marsupial and eutherian lineages have retained different gene clusters following gene duplication events early in mammalian evolution.
Taylor, AC, Cowan, PE, Fricke, BL, Geddes, S, Hansen, BD, Lam, M & Cooper, DW 2004, 'High microsatellite diversity and differential structuring among populations of the introduced common brushtail possum, Trichosurus vulpecula, in New Zealand', Genetical Research, vol. 83, no. 2, pp. 101-111.View/Download from: Publisher's site
An understanding of genetic variation and structure of pest populations has the potential to improve the efficiency of measures to control them. Genetic analysis was undertaken at five microsatellite loci in four native Australian and 14 introduced New Zealand populations of the common brushtail possum Trichosurus vulpecula in order to document these parameters. Genetic variation in New Zealand populations, and phylogenetic relationships among Australian and New Zealand populations, were largely predicted by the recorded introduction history. Populations on the two main islands of New Zealand had only slightly lower genetic diversity than did Australian populations, except that allelic richness on the South Is. was significantly lower. Diversity was higher in North Is. than in South Is. populations (although not significantly so) and mainland New Zealand populations as a group were significantly more diverse than offshore islands that represented secondary population size bottlenecks. In phylogenetic analyses South Is. and offshore island populations grouped with Tasmania, while North Is. populations grouped either with mainland Australia or were intermediate between the two Australian sources. This scheme was supported by admixture coefficients showing that North and South Is./offshore island populations were largely mainland Australian and Tasmanian in origin, respectively. Population structure differed markedly between the North and South Islands: populations were typically more genetically differentiated on the former than the latter, which also showed significant isolation-by-distance. Substantial linkage disequilibrium in most sampled New Zealand but no Australian population between microsatellite loci Tv16 and Tv27 suggests they may be physically linked. © 2004 Cambridge University Press.
Belov, K, Lam, MKP, Hellman, L & Colgan, DJ 2003, 'Evolution of the major histocompatibility complex: Isolation of class II β cDNAs from two monotremes, the platypus and the short-beaked echidna', Immunogenetics, vol. 55, no. 6, pp. 402-411.View/Download from: Publisher's site
Extant mammals are composed of three lineages: the eutherians, the marsupials and the monotremes. The majority of the mammalian major histocompatibility complex (MHC) data is based on the eutherian mammals, which generally have three classical MHC class II β chain gene clusters - DRB, DQB and DPB, as well as the non-classical DMB and DOB. Marsupial DMB, DAB and DBB have been characterised. Confusion still surrounds the relationship of the marsupial DAB and DBB genes with the classical eutherian class II clusters. Here we present the first monotreme MHC class II β chain sequences. Four MHC class II β chain sequences were isolated from a spleen cDNA library from the short-beaked echidna, and one from a spleen cDNA library from platypus using a brushtail possum DAB probe. Given the non-orthologous relationship of the monotreme sequences with marsupial and eutherian β chain clusters, we recommend that the five new monotreme sequences be assigned the nomenclature 'DZB', signifying the description of a new mammalian β chain cluster. Our analysis suggests that all mammalian β chain sequences (except DMB) evolved from a common ancestor. Maximum likelihood analysis places the monotreme β chain sequences at the base of the mammalian clade, indicating their ancestral status. However, within the mammalian clade, monophyletic clades are not robust, and elucidation of the order of gene duplication that gave rise to the present-day gene clusters is not yet possible.
Lam, LT & Lam, MK 2003, 'Associations between social, economic resources and mental, physical illnesses in a population of older people in New South Wales, Australia', Journal of Mental Health and Aging, vol. 9, no. 4, pp. 223-232.
This cross-sectional study aims to investigate the association between social and economic resources and the likelihood of being diagnosed with mental and physical illnesses in a well defined population of older people, aged 60 or above, who are referred to an aged care assessment program. The likelihood of being diagnosed with mental illness was increased by 40% for older people who were socially isolated (OR = 1.44, 95% CI = 1.12-1.85), and about 50% for those who stayed in care providing facilities (OR = 1.51, 95% CI = 1.06-2.15), as compared to those who were not isolated and staying with spouse/relatives. A nearly 50% reduction of likelihood for mental illness diagnosis for those who lived in the nonmetropolitan areas (OR = 0.52, 95% CI = 0.41-0.67) as compared to those staying in metropolitan areas. The likelihood of being diagnosed with both mental and physical illnesses was increased for older people who were economically more disadvantaged (mental: OR = 1.50, 95% CI = 1.12-2.00; physical: OR = 1.42, 95% CI = 1.09-1.83). Results from this study shed light on possible community health strategies for older people.
Ramsey, D, Spencer, N, Caley, P, Efford, M, Hansen, K, Lam, M & Cooper, D 2002, 'The effects of reducing population density on contact rates between brushtail possums: Implications for transmission of bovine tuberculosis', Journal of Applied Ecology, vol. 39, no. 5, pp. 806-818.View/Download from: Publisher's site
1. Interactions during mating are thought to be an important mechanism for transmission of tuberculosis (Tb) Mycobacterium bovis in the brushtail possum Trichosurus vulpecula. However, little information is available on the frequency of contacts between males and females in oestrus during the breeding season, and the relationship between mating contacts and population density. 2. We used radio-telemetry to record contacts between male and oestrous and non-oestrous female possums, and determined paternity of offspring using DNA analysis. This was repeated following the removal of c. 70% of the resident possums to determine the effect of reducing density on the contact rate. 3. We could not detect any significant differences in the contact rate between oestrous and non-oestrous females and males, either before or after the density reduction, even when paternity was positively identified from DNA analysis. This suggests that actual mating contacts could not be distinguished from other agonistic or affiliative contact behaviours. 4. Despite this, the relationships between male-female and male-male contact rates and population density were non-linear convex-up, implying that the contact rate during the breeding season did not decrease in proportion to reductions in density. This appeared to be driven by the enlargement of male ranges and a corresponding increase in male overlap of female ranges following the density reduction. 5. The form of the contact rate function will influence predictions of disease spread in epidemiological models for Tb in wildlife. This has major implications for the development of tactical approaches to disease management based on such models.
Lam, MKP, Belov, K, Harrison, GA & Cooper, DW 2001, 'An Mhc class I gene in the Australian brushtail possum (Trichosurus vulpecula)', Immunogenetics, vol. 53, no. 5, pp. 430-433.View/Download from: Publisher's site
Lam, MKP, Belov, K, Harrison, GA & Cooper, DW 2001, 'Cloning of the MHC class II DRB cDNA from the brushtail possum (Trichosurus vulpecula)', Immunology Letters, vol. 76, no. 1, pp. 31-36.View/Download from: Publisher's site
The cell-surface glycoproteins encoded by the major histocompatibility complex (MHC) bind to processed foreign antigens and present them to T lymphocytes. Two classes of MHC molecules and their corresponding gene sequences have been extensively studied in eutherian mammals and birds, but data on the marsupial MHC are limited. Marsupials split from eutherian mammals about 125 million years ago and represent a distinct branch in mammalian evolution. Here the cDNA cloning of MHC class II genes of the brushtail possums (Trichosurus vulpecula) is reported. The sequences obtained were found to be relatively conserved when compared to the red-necked wallaby (Macropus rufogriseus) and an South American marsupial, Monodelphis domestica. The T. vulpecula sequence shared an average overall sequence identity of 75.4% at the deduced amino acid level with M. rufogriseus and M. domestica, respectively. © 2001 Elsevier Science B.V.
Lam, MKP, Homewood, J, Taylor, AJ & Mazurski, EJ 2000, 'Second generation effects of maternal alcohol consumption during pregnancy in rats', Progress in Neuro-Psychopharmacology and Biological Psychiatry, vol. 24, no. 4, pp. 619-631.View/Download from: Publisher's site
1. Previous studies have shown that when female rats are administered alcohol during pregnancy there are adverse effects on their progeny, including decreased birth weight and delayed neuromotor development. Evidence from several sources suggests alcohol exposure may contribute to cytogenetic abnormalities, suggesting the possibility of cross generational effects from prenatal exposure. 2. On day 1 of gestation female rats were randomly allocated to the Alcohol group, which received a liquid diet containing 5% (v/v) ethanol solution until parturition, the Sucrose control group, which received an identical diet, except that sucrose had been isocalorically substituted for ethanol, or the Chow control, which received standard laboratory chow. 3. When the offspring of these rats reached adulthood they were mated with drug-free rats and the development of their offspring was monitored. 4. In comparison with female pups whose sires had been exposed to alcohol in utero, the weight of pups descended from fetally-exposed dams increased more slowly from day 1 to day 7. 5. At five days of age, significant differences favouring the two control groups were found in latency to right for pups descended from fetally-exposed dams. 6. These data suggest that the effects of prenatal exposure to alcohol are more pervasive than previously thought and affect female pups to a greater extent than males.
Lam, M 2016, 'An ensemble data linkage technique', HIC 2016, Melbourne, Australia.
Lam, MK 2016, 'The iSOLVE Fall Prevention Assessment Tool', HIC 2016, Melbourne, Australia.
Poon, SK, Poon, J, Lam, MK, Yin, Q, Sze, DM-Y, Wu, JCY, Mok, VCT, Ching, JYL, Chan, K-L, Cheung, WHN & Lau, AY 2016, 'An Ensemble Approach for Record Matching in Data Linkage.', Studies in health technology and informatics - Digital Health Innovation for Consumers, Clinicians, Connectivity and Community, Australian National Health Informatics Conference, IOS, Melbourne, Australia, pp. 113-119.View/Download from: UTS OPUS or Publisher's site
To develop and test an optimal ensemble configuration of two complementary probabilistic data matching techniques namely Fellegi-Sunter (FS) and Jaro-Wrinkler (JW) with the goal of improving record matching accuracy.Experiments and comparative analyses were carried out to compare matching performance amongst the ensemble configurations combining FS and JW against the two techniques independently.Our results show that an improvement can be achieved when FS technique is applied to the remaining unsure and unmatched records after the JW technique has been applied.Whilst all data matching techniques rely on the quality of a diverse set of demographic data, FS technique focuses on the aggregating matching accuracy from a number of useful variables and JW looks closer into matching the data content (spelling in this case) of each field. Hence, these two techniques are shown to be complementary. In addition, the sequence of applying these two techniques is critical.We have demonstrated a useful ensemble approach that has potential to improve data matching accuracy, particularly when the number of demographic variables is limited. This ensemble technique is particularly useful when there are multiple acceptable spellings in the fields, such as names and addresses.
Westbrook, JI, Georgiou, A & Lam, M 2009, 'Does computerised provider order entry reduce test turnaround times? A before-and-after study at four hospitals', Studies in Health Technology and Informatics, pp. 527-531.View/Download from: Publisher's site
Few multi-centre studies of the impact of computerised provider order entry (CPOE) systems on health care efficiency and effectiveness exist. Further, demonstrating a link between system use and improvements in patient outcomes is challenging. An often neglected step is to characterise the nature of the problem prior to CPOE introduction to ensure that the 'problem' being addressed has a demonstrated impact on the outcome of interest. We undertook a two-staged project to i) investigate the link between test turnaround time (TAT) and length of stay for emergency department patients prior to CPOE; ii) to measure the impact of CPOE on TAT in four Australian hospitals to examine the consistency of findings. We found TAT is a significant contributor to length of stay. All four hospitals experienced a significant reduction in TAT following CPOE. This study presents evidence that TAT is directly related to length of stay and that CPOE systems are effective at reducing TAT. These results add weight to the hypothesis that the introduction of CPOE may positively impact upon patient outcomes. © 2009 European Federation for Medical Informatics.