Energy and protein provision for critically ill patients who receive oral nutrition often falls below recommended targets. We compared characteristics and nutrition processes during hospital stay (within and post-intensive care unit [ICU] stay) of those who received oral nutrition as the sole nutrition source to those who first commenced enteral (EN) or parenteral nutrition (PN) within an Australian or New Zealand (ANZ) ICU.Multicentre, observational study of routine nutrition care in 44 hospitals across ANZ, including adult patients within ICU admitted for at least 48 h. Those receiving oral nutrition as the sole source of nutrition (with or without oral nutrition supplements) were included in the 'oral nutrition' group and those who first received EN and/or PN in the ICU as the 'EN/PN group'. The primary outcome was median daily energy delivery in ICU. Data are presented as number (%) or median [interquartile range].Of the 409 patients enroled, median [IQR] age was 64 [51-74] years and 257 patients (62%) were male. APACHE II score, use of invasive ventilation and hospital length of stay (LOS) were all lower in those receiving oral nutrition (n = 200) compared to those receiving EN/PN (n = 209). In ICU, 63 (31.5%) and 169 (81%) (p < 0.001), patients who were receiving oral nutrition and in the EN/PN group received a nutrition assessment, respectively. Oral nutrition supplements were provided for 40 (20%) patients in the oral nutrition group and 31 of 94 (33%) of those receiving oral nutrition in the EN/PN group (p = 0.019). Energy and protein intake in ICU for the oral nutrition group was 716 [597-1069] kcal/day and 37 [19-46] g/day versus 1158 [664-1583] kcal/day and 57 [31-77] g/day for those receiving EN/PN (p = 0.020 energy, p = 0.016 protein). Quantification of oral nutrition was attempted in 78/294 (27%) patients in ICU and completed on 27/78 (36%) occasions. On the ward, attempts were made for 120/273 (44%) patients, with 60/120 (50%) complete.Patients who received oral nutrition as the sole nutrition source in ICU had lower illness severity, rates of nutrition assessment and provision of oral supplements compared to those who first received EN/PN. Quantification of oral nutrition was often incomplete for all patients in ICU and on the ward.

Primary aim was to review severe acute respiratory infections (SARI) hospitalisations caused by respiratory syncytial virus (RSV) in children aged < 2 years in paediatric hospitals in Australia. Secondary aims included RSV subtyping, assessing RSV seasonality and contributing to the World Health Organisation's RSV surveillance programme.We prospectively reviewed the medical records of children (< 2 years of age) with a confirmed SARI who were admitted to one of four major Australian paediatric hospitals and had a respiratory sample analysed by Polymerase Chain Reaction (PCR). A detailed dataset was completed for RSV positive cases.Between 1 January 2021 and 31 December 2022, 2290 RSV (laboratory-confirmed) admissions were identified (53.4% of all SARI admissions). Approximately 50% of all RSV cases were aged 0-6 months. RSV-A predominated in 2021 with peak infections observed in summer while in 2022 RSV-B predominated with peak infections in the more traditional winter months. The median total length of stay (LOS) for RSV positive admissions was 46 h (IQR: 22-82 h). 9% of these children required an ICU admission with a prolonged median LOS 68 h (IQR: 40-112 h). Respiratory support utilisation was consistent over the 2 years. 1.8% required mechanical ventilation; 4.6% continuous positive airway pressure; 23.3% high flow oxygen; and 50.8% low flow oxygen.RSV in children continues to cause a significant disease burden at Australian tertiary paediatric centres. Ongoing hospital surveillance is required to document the impact of RSV preventative therapies that have become available in 2024.

In moderate-to-high malaria transmission regions, the World Health Organization recommends intermittent preventive treatment in pregnancy (IPTp) with sulfadoxine-pyrimethamine (SP) alongside insecticide-treated bed nets to reduce the adverse consequences of pregnancy-associated malaria. Due to high-grade Plasmodium falciparum resistance to SP, novel treatment regimens need to be evaluated for IPTp, but these increase pill burden and treatment days. The present qualitative study assessed the acceptability of IPTp-SP plus dihydroartemisinin-piperaquine (DP) in Papua New Guinea, where IPTp-SP was implemented in 2009.Individual in-depth interviews (IDIs) and focus group discussions were conducted at health facilities where a clinical trial evaluated IPTp-SP plus DP (three-day regimen) versus IPTp-SP plus DP-placebo. IDIs were conducted with: (1) trial participants at different stages of engagement with ANC and IPTp, e.g. first antenatal clinic visit, subsequent antenatal clinic visits and postpartum; (2) local health workers (nurses, community health workers, midwives, health extension officers, doctors); and (3) representatives of district, provincial and national health authorities involved in programming ANC and IPTp. Focus group discussions comprised pregnant women only, including those engaged in the clinical trial and those receiving routine ANC outside of the trial. All interviews were audio recorded and transcribed. Transcripts were analysed using inductive and deductive thematic analysis applying a framework assessing: affective attitude, burden, ethicality, intervention coherence, opportunity costs, perceived effectiveness, and self-efficacy.Women expressed positive feelings and attitudes towards SP plus DP/DP-placebo; reported limited side effects; and found the size, number, colour, and taste of study medicines acceptable. Health workers and policymakers were concerned that, compared to SP alone, additional tablets, frequency (three-day regimen), and tablet size might be barriers to acceptability for users outside a non-trial setting. There was a high perceived effectiveness of SP plus DP; most women reported that they did not get malaria or felt sick during pregnancy. Broader healthcare benefits received through trial participation and the involvement of health workers, relatives and community members in the clinical trial enabled antenatal clinic attendance and perceived acceptability of this IPTp regimen.In the trial context, IPTp-SP plus DP was acceptable to both users and providers. Healthcare providers were concerned about the realities of acceptability and adherence to SP plus DP outside a clinical trial setting.

No abstract available

Melioidosis is a multisystem infectious disease caused by the environmental bacterium . Osteomyelitis (OM) and septic arthritis (SA) are uncommon primary presentations for melioidosis but important secondary foci, often requiring prolonged therapy and multiple surgeries. We characterized the epidemiology, presentation, treatment, and outcomes of patients from 24 years of the Darwin Prospective Melioidosis Study (DPMS).DPMS patients from October 1, 1999, until September 30, 2023, were included if they had a primary or secondary diagnosis of OM or SA. Epidemiological, risk factor, clinical, and outcome data were retrieved from the DPMS database. Antibiotic and surgical data were collated from patient records.From 1129 consecutive patients with culture-confirmed melioidosis, 122 (10.8%) had OM and/or SA, with 115 evaluable. Ninety-four of 1129 (8.3%) had OM, and 62/1129 (5.5%) had SA, with 41/115 (35.7%) of these having both OM and SA. Many combined infections involved contiguous bone and joints or soft tissue. Fifty-nine (51.3%) were male, and only 4.3% were ≤16 years old. Diabetes mellitus was present in 69.6%, and only 12.2% had no identifiable clinical risk factor. There were 8 deaths (7.0%) and 20 (17.4%) recurrent infections. Seventy-one (61.7%) had operative management, with combined infection associated with more procedures and longer length of stay.The current paradigm of care for osteoarticular melioidosis involves prolonged intravenous antibiotics in conjunction with timely and complete operative management, and in our setting where these are available, outcomes are good. In many melioidosis-endemic regions these resources are limited, and mortality remains high.

The pulmonary valve (PV), although often less emphasized than other heart valves, is crucial for cardiac function and hemodynamics. Historically, the PV has been underrepresented in echocardiographic assessments due to its rare involvement in pathological conditions, particularly in adults. Additionally, the anatomical position of the PV makes it one of the most challenging valves to visualize using conventional echocardiography. Traditional two-dimensional (2D) techniques, while foundational, have limitations in capturing the full spectrum of valve pathology and dynamics. Recent advancements in echocardiography, especially the integration of three-dimensional (3D) imaging, have significantly enhanced the assessment of PV disorders. 3D echocardiography (3DE) offers superior accuracy in visualizing valve morphology and function, overcoming the limitations of angle dependency and suboptimal imaging planes typical of 2D assessments. This evolution in imaging techniques facilitates more precise diagnoses and improved management of conditions such as pulmonary stenosis (PS) and regurgitation (PR). This review explores the transition from conventional echocardiographic methods to advanced approaches that are reshaping our understanding of the PV, emphasizing the importance of incorporating these cutting-edge techniques into routine clinical practice to enhance patient outcomes.

None available.

The pharmacokinetics (PK) of piperacillin/tazobactam (PIP/TAZ) is highly variable across different patient populations and there are controversies regarding non-linear elimination as well as the fraction unbound of PIP (f). This has led to a plethora of subgroup-specific models, increasing the risk of misusing published models when optimising dosing regimens. In this study, we aimed to develop a single model to simultaneously describe the PK of PIP/TAZ in diverse patient populations and evaluate the current dosing recommendations by predicting the PK/pharmacodynamics (PD) target attainment throughout life.Population PK models were separately built for PIP and TAZ based on data from 13 studies in various patient populations. In the development of those single-drug models, postnatal age (PNA), postmenstrual age (PMA), total body weight (TBW), height, and serum creatinine (SCR) were tested as covariates. Subsequently, a combined population PK model was established and the correlations between the PK of PIP and TAZ were tested. Monte Carlo simulations were performed based on the final combined model to evaluate the current dosing recommendations.The final combined model for PIP/TAZ consisted of four compartments (two for each drug), with covariates including TBW, PMA, and SCR. For a 70-kg, 35-year-old patient with SCR of 0.83 mg L, the PIP values for V, CL, V and Q were 10.4 L, 10.6 L h, 11.6 L and 15.2 L h, respectively, and the TAZ values were 10.5 L, 9.58 L h, 13.7 L and 16.8 L h, respectively. The CL for both drugs show maturation in early life, reaching 50% at 54.2 weeks PMA. With advancing age, CL of TAZ declines to 50% at 61.6 years PMA, whereas CL of PIP declines more slowly, reaching 50% at 89.1 years PMA. The f was estimated as 64.5% and non-linear elimination was not supported by our data. The simulation results indicated considerable differences in PK/PD target attainment for different patient populations under current recommended dosing regimens.We developed a combined population PK model for PIP/TAZ across a broad range of patients covering the extremes of patient characteristics. This model can be used as a robust a priori model for Bayesian forecasting to achieve individualised dosing. The simulations indicate that adjustments based on the allometric theory as well as maturation and decline of CL of PIP may help the current dosing recommendations to provide consistent target attainment across patient populations.

TRK-inhibitors have demonstrated efficacy across several cancers with NTRK fusions. Their activity in cancers with NTRK overexpression remains unclear.This trial enrolled patients with advanced cancers harboring NTRK fusions or extreme mRNA overexpression, defined as NTRK1/2/3 expression by RNA profiling >5 SDs for a given cancer type. The primary endpoint was objective response rate (ORR), with secondary endpoints including time-to-progression (TTP) ratio [TTP on study to TTP on previous systemic therapy (TTP1)], progression-free survival (PFS), and overall survival (OS). Initially planned for 2 non-comparator groups: primary central nervous system (CNS) and non-CNS tumours with NTRK fusions, the protocol was amended to permit NTRK overexpression.Seventeen patients were treated with larotrectinib: one glioblastoma with a SPECC1L::NTRK2 fusion (group 1), and a peripheral nerve sheath tumor with a TPM3::NTRK1 fusion and 15 patients with overexpression (group 2). The ORR was 6%. An additional 3 of 12 (25%) TTP1-evaluable patients achieved a TTP ratio ≥1.3 and 2 of 5 without an evaluable TTP1 had a PFS >6 months. Median PFS and OS were 3.5 (95% CI, 1.4-6.0) and 15.9 months (95% CI, 6.4-NR), respectively.Unlike its efficacy in NTRK-fusion positive cancers, larotrectinib did not demonstrate a signal of efficacy among tumors with NTRK overexpression.

PTB increases the risk of health problems such as chronic renal disease and diabetes in later life and adverse impacts are inversely correlated with gestational age at birth. Rates of PTB in the Northern Territory (NT) of Australia are amongst the highest nationally and globally, with First Nations babies most affected. This study assessed the magnitude and potential drivers of intergenerational PTB recurrence in the NT.A retrospective intergenerational cohort study (1986-2017) was conducted amongst 5,366 mothers born singleton who had 9,571 singleton live births (7,673 First Nations, and 1,898 non-First Nations babies). Maternal and offspring PTB was categorised as early (< 34 weeks) and late (34-36 gestational weeks). Modified Poisson regression was used to estimate the relative risk (RR) of PTB associated with maternal PTB, adjusting for moderators such as receipt of antenatal care prior to the offspring PTB. Secondary analyses assessed the impact of additional adjustment for conditions with a familial component, or that PTB predisposes to, on the risk estimate. Mediation analysis assessed the degree of mediation of maternal-offspring PTB relationships by these conditions.Overall, First Nations women born preterm (< 37 weeks) had an increased risk of delivering before 37 gestational weeks (aRR 1.28; 95%CI 1.08, 1.51). Women born preterm had a higher risk of delivering early (< 34 gestational weeks) but not late preterm (34-36 weeks): the risk of early offspring PTB was increased amongst women themselves born early preterm (aRR 1.95, 95%CI 1.17, 3.24) or late preterm (aRR 1.41, 95%CI 1.01, 1.97). Adjustment for pre-eclampsia, intrauterine growth restriction, and hypertensive renal disease attenuated the observed intergenerational PTB associations. Mediation analysis suggested these conditions may mediate up to 26% of the observed intergenerational PTB recurrence. Similar trends were observed when first-time mothers were considered only. Maternal PTB status was not associated with PTB amongst non-First Nations women.First Nations women born preterm have an increased risk of early PTB. This association is in part driven by pre-eclampsia and hypertensive renal disease. Routine inquiry of maternal birth status may be a useful tool to identify NT First Nations women who may benefit from preventative measures.

Constipation is found in individuals with intellectual disabilities, autism, and cerebral palsy. Although generally a benign condition, it may lead to life-threatening intestinal obstruction, with or without volvulus, or to stercoral ulceration with enteritis and/or perforation. Two unusual cases of lethal chronic constipation are reported to demonstrate other very rare fatal mechanisms that may occur. Case 1: A 17-year-old male with cerebral palsy and autism was found deceased in bed. Death was due to pulmonary thromboembolism arising from compression of pelvic veins by acquired megacolon due to constipation (fecal mass 4.6 kg). Case 2: A second 17-year-old male with intellectual disability, global developmental delay, attention deficit disorder, seizures, and hypotonia collapsed and died during a medical evacuation from a remote community. Death was due to abdominal compartment syndrome in the context of medical air transport (medical retrieval), chronic constipation with acquired megacolon and megarectum (fecal mass 6.5 kg), global developmental delay, intellectual disability, and a suspected underlying genetic syndrome. These cases demonstrate that individuals with constipation may present for medicolegal assessment following sudden collapse/death and that pulmonary thromboembolism and abdominal compartment syndrome should be considered as rare possibilities in the evaluation of vulnerable individuals.

The Northern Territory (NT) of Australia has the highest rates of alcohol consumption and injury in the country. We aimed to: (i) describe the epidemiology of alcohol-related injury (ARI) hospitalisations in the NT; (ii) estimate the proportion of alcohol involvement in injury hospitalisations; and (iii) consider the influence of alcohol policies on ARI hospitalisation trends.We conducted a retrospective time-series study using coded hospitalisation data from NT public hospitals between 2007 and 2022. ARI hospitalisation was defined combining indicators for injury and acute alcohol use. We undertook descriptive analyses and calculated alcohol involvement against all injury hospitalisations. Annual percent changes (APC) were computed using joinpoint regression to examine the influence of alcohol policies on ARI hospitalisation trends by NT geographical regions (Central Australia and Top End).Alcohol use was associated with 22.6% of all injury hospitalisations. The most common cause of ARI hospitalisations was assault (46%). In Central Australia, a significant trend decline (APC -12.2; p = 0.011) was observed after 2017 following alcohol policies implemented between 2017 and 2018 (Banned Drinkers Register v2; Minimum Unit Price; and Police Auxiliary Liquor Inspectors). Consecutive years with the greatest decrease in Central Australia were 2013-2014 (APC -25.8) and 2018-2019 (APC -35.1); likely influenced by alcohol policies in effect at the time. In the Top End, a non-significant trend decline (APC -26.1; p = 0.186) was observed after 2020.Alcohol policies implemented between 2017 and 2018 were associated with reduced ARI hospitalisations in Central Australia. Alcohol policies that demonstrated reduced harm should be sustained.

Accurate assessment of severity in diabetic ketoacidosis (DKA) can optimise early management and facilitate prioritisation for high acuity care. The primary aim was to evaluate the relationship between severity of acidosis (considering pH, bicarbonate, and anion gap) and hyperosmolarity with hospital mortality. Secondary outcomes included intensive care mortality, mechanical ventilation, vasopressor/inotrope use, and dialysis. A retrospective cohort study was conducted of adults (≥ 16 yr) with DKA admitted to US intensive care units. Data were extracted from the Medical Information Mart for Intensive Care (MIMIC)-IV dataset and eICU Collaborative Research Database. Univariable and multivariable logistic regression analyses were used to evaluate biochemistry obtained within 4 h of admission and the primary and secondary outcomes. We identified 4071 eligible admissions. There was no clear relationship between serum bicarbonate or anion gap and any outcome. Almost half the population did not have blood gas analysis within 4 h of admission; for 2292 patients with blood gases available, pH < 7 and inappropriately high PCO were associated with significant increases in mortality and all secondary outcomes. Osmolarity ≥ 320mosm/L was associated with fourfold increased mortality and higher rates of mechanical ventilation, use of vasopressors/inotropes, and dialysis. Failure of adaptive mechanisms (thirst and hyperventilation) indicating physiological decompensation may be more important for risk stratification in DKA than the degree of acidosis, which was only associated with outcome when severely abnormal. Blood gas analysis is essential to adequately assess disease severity as bicarbonate and anion gap were not predictive of outcome.

There is limited published data on the caseload of general surgeons in Central Australia. The region has a significant Indigenous population, who often face higher rates of chronic diseases and require more frequent surgical interventions compared to non-Indigenous individuals. This study aims to outline the workload of surgeons at Alice Springs Hospital to determine the necessary skill set and surgical education for future surgeons.A retrospective review of all general surgery operative cases performed in Central Australia, Alice Springs Hospital was conducted between January 2012 and December 2021. The RACS Morbidity Audit and Logbook Tool was used to classify surgical procedures along with Medicare Benefits Schedule item numbers. Tables were created to present the annual and specialty-specific data on the types and volumes of procedures.From January 2012 to December 2021, 35 318 cases were performed, with 92.5% being general surgery, 3% plastics and reconstructive surgery and 2.8% vascular procedures. Indigenous patients received a higher proportion of procedures (50-60%) compared to non-Indigenous patients (30-50%). Common procedures included incision and drainage of abscesses and debridement of wounds, while trends across specialties showed a decline in ENT and plastic surgeries, stable thoracic and vascular cases, and increased numbers of urology operations.General surgeons in rural centres must possess a wide range of skills and be capable of performing a variety of procedures. Trainees should be encouraged to consider practicing in rural areas, and those interested should account for the specific needs of the communities they plan to serve.

The prevalence of bronchiectasis is significantly higher among adult Aboriginal Australians (the Indigenous peoples of Australia) compared to non-Aboriginal Australians. Currently, there is no well-established tool to assess bronchiectasis severity specific to Indigenous peoples. Nor has the applicability and validity of the two well-established bronchiectasis severity assessment tools - The "Bronchiectasis Severity Index" (BSI) and "FACED" scale been vigorously tested in an Indigenous population. This retrospective study evaluated the validity of the BSI and FACED amongst an adult Aboriginal Australian cohort with bronchiectasis in the Top End Northern Territory (NT) of Australia.Patients with CT confirmed bronchiectasis identified between 2011 and 2020, residing in the Top End of the NT were eligible to be enrolled. The primary endpoint of 4-year mortality was assessed via hospital records, and sensitivity and specificity of the BSI and FACED assessed against this using area under the curve (AUC) receiver operating characteristics analysis. For patients with missing data, a relative BSI / FACED score was used which divided the score recorded for that patient by the total potential score based on their available clinical data.A total of 456 adult Aboriginal Australian patients >18 years of age were included (55.5% female, median age 49 years). According to the BSI score 43.4% of patients were assessed to have mild, 30.5% moderate and 26.1% severe bronchiectasis (median score 4 (IQR 2, 8)). According to the FACED 80.9% were assessed to have mild, 17.8% moderate and 1.3% severe (median score of 1 (IQR 0, 2)). Four-year mortality was 11.2% (median age of death 55.6 years). Sensitivity and specificity of the BSI combining moderate and severe were 86.3 and 47.2% respectively, and for severe alone 51% and 77%. Sensitivity and specificity of the FACED combining moderate and severe were 21.6% and 81.2%, respectively, and for severe alone 2% and 98.8%. The AUC for the continuous total BSI was 0.703, and the FACED 0.515. Utilising a relative score, based only on data available for patients with missing data (ie lung function or BMI) resulted in slightly improved AUCs for both the BSI (0.717) and FACED (0.571).Both BSI and FACED bronchiectasis assessment tools may not be ideal in an Indigenous/Aboriginal people's context. However, it may be reasonable to utilise the relative BSI score in this population until Indigenous people's specific bronchiectasis severity assessment tools are developed.Adult Indigenous people globally have a higher prevalence of chronic respiratory disorders, and bronchiectasis is no exception. To assess the bronchiectasis severity and to predict future mortality, there are well-established assessment tools. However, the existing bronchiectasis assessment tools are developed predominately from data gathered from non-Indigenous population cohorts. To date, it is unclear if these existing bronchiectasis assessment tools are appropriate or applicable for Indigenous people. Therefore, this study assessed how existing bronchiectasis tools, namely the “Bronchiectasis Severity Index” (BSI) and “FACED” [Forced expiratory volume in 1 s, Age, Chronic colonization, Extension, and Dyspnea] fit for an adult Indigenous/ Aboriginal Australian cohort diagnosed to have bronchiectasis. The results of the study showed that both BSI and FACED assessment tools may not be ideal in the Australian Indigenous/Aboriginal population, due to population demographics and other social determinants, including geographical isolation. Hence, further research is warranted in developing Indigenous/Aboriginal specific bronchiectasis assessment tools.

Out-of-school adolescent girls (OoSGs) can lack education on menstrual, sexual, reproductive, and mental health (SRMH) and be more vulnerable to SRMH harms. Targeted interventions could reduce these risks. We assessed interventions and their effectiveness among OoSGs globally.Six online databases were searched for interventional studies targeting SRMH problems in OoSGs. Two coders independently abstracted data from each eligible study, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We summarized results using forest plots.A total of 1,244 studies were screened; eight studies with sufficient information on SRMH outcomes were included (9,084 OoSGs, range 100-3,026 per study, overall study quality low-to-moderate). Six were educational programmes, and two were cash interventions; no study was directed at mental health. Participants were recruited through village census, outreach workers, and work locations. Some improvements were seen in indicators of SRMH knowledge (four studies), attitudes (one study), and risky sexual behaviors (four studies); however, no reduction was seen in human immunodeficiency virus or herpes simplex virus-2 incidence (two studies).This review suggests that programmes can improve OosG's SRMH knowledge, attitudes, and practices and can be delivered in low resource contexts. Effective interventions are needed to support OoSGs, including interventions focusing on SRMH support incorporating elements of cash-transfer, and comprehensive sexual education, and to aid local policy and programming.

Respiratory viral infection may increase infection with progressing to clinical disease (melioidosis). This data linkage study evaluated associations between melioidosis and SARS-CoV-2 or influenza. Among 160 melioidosis cases, there was no difference in risk factors, vaccine status, or disease severity between 17 with viral co-infection and 143 without.

Chronic respiratory disorders in the adult Aboriginal and Torres Strait Islander population are common, but there is a sparsity of literature detailing an approach to clinical management.This paper describes a clinical approach to chronic respiratory disorders for clinicians working with Aboriginal and Torres Strait Islander people, particularly in the remote Australian context.There are significant differences in the way chronic respiratory diseases manifest in Aboriginal and Torres Strait Islander people compared with non-Indigenous Australians. Chronic obstructive pulmonary disease (COPD), bronchiectasis and asthma often overlap in clinical features, and can be present concurrently. Restrictive impairment on spirometry is common. The presence of bronchodilator response might indicate asthma, but can also be observed in patients with asthma/COPD/bronchiectasis overlap. Because the management of each of these conditions differs, accurate diagnosis and disease severity classification are important, particularly in the prescribing of guideline-recommended inhaled pharmacotherapy.

Government mandated quarantine outside the home was implemented to mitigate COVID-19 in some countries. Individual studies report that this can result in psychological distress. Investigating levels of distress and associated risk factors across different settings would inform public health models of care during future pandemics. However, no previous systematic reviews have been conducted on the topic. Therefore, we systematically reviewed international research on the prevalence and risk factors of psychological distress within supervised quarantine facilities during the COVID-19 pandemic.A systematic review of the literature was conducted using Medline, Psychological and Behavioural Sciences, Psych Info, Cochrane databases and Google Scholar from January 2020 until June 2023. Relevant quantitative studies published in English were included.13 studies (pooled participants = 4366) were included in this review. The prevalence of psychological distress varied widely across the included studies (depression 4%-63%; anxiety 4%-100%; stress 1%-68%). Associated risk factors identified were also heterogeneous between studies and facilities.In future pandemics, the benefits of infection mitigation need to be weighed against the risk of psychological distress. Models of care utilising specifically designed facilities, with greater freedoms, increased comfort and ease of access to mental health services may limit psychological distress.

Suspected preterm labour (PTL) and prelabour rupture of membranes (PPROM) are common indications for aeromedical retrieval in the Top End, Northern Territory, Australia, where many women reside remotely and preterm birth (< 37 completed weeks of gestation) is common. The primary objective of this study was to determine rate of delivery during the index admission following aeromedical transfers from remote clinics to Royal Darwin Hospital for suspected PTL/PPROM.A retrospective cohort study of aeromedical transfers for suspected PTL/PPROM from 1 January 2020 to 31 July 2022 was undertaken. Transfers were identified through CareFlight, the regional air ambulance service, and complemented with data from hospital records. Clinical and sociodemographic characteristics were compared by delivery status during the index (post-retrieval) admission using parametric and non-parametric tests and multivariable linear regression analysis.238 women with singleton pregnancies were retrieved for suspected PPROM (n = 77, 32.4%) or PTL (n = 161, 67.6%), together accounting for 49.2% of all obstetric transfers (n = 483). Of 77 patients transferred for suspected PPROM, 47 (61.0%) had ruptured membranes confirmed on arrival, and 45 (95.7%) of them delivered during the index admission. None of the 30 women transferred for suspected PPROM with intact membranes on arrival delivered during the index admission. Of 161 patients transferred for suspected PTL, 13 (8.1%) had ruptured membranes confirmed on arrival, and 12 (92.3%) of them delivered during the index admission. Amongst women transferred for suspected PTL with intact membranes confirmed on arrival, 14.9% (22/149) delivered during the index admission. Prior to arrival, 120 women (50.4%) had a documented speculum examination, and 15 (6.3%) and 9 (3.8%) had cervicovaginal swab tests to assess their risks of a PPROM and PTL, respectively. Half of women who did not deliver during the index admission had received antenatal corticosteroids (n = 76).Many aeromedical retrievals for suspected PTL/PPROM did not result in delivery during the index admission. Women retrieved for suspected PPROM with intact membranes on arrival were less likely to deliver. Upskilling remote clinic staff and better point-of-care testing may reduce retrievals and unnecessary interventions. Prospective cohort studies designed to enable accurate prediction of which cases can be safely not retrieved are required.Not applicable.