Background: Historically, collaboration between the Allied Health teams at a Northern Territory cancer care centre and palliative care service was minimal. This initiative aimed to improve collaboration and use the arts to support quality of life and death, focusing on reducing stigma around cancer and palliative care. Methods: Adapted from the UK-based Art Bag Project, the Allied Health teams facilitated a six-month soap carving initiative between June and November, 2024. The project offered an accessible, low-barrier creative activity for patients, families, and staff, promoting self-reflection and connection. Participant demographics and qualitative feedback were collected across two surveys and from an exhibition showcasing the participants' carved creations. Data analysis comprised descriptive statistics and thematic analysis. Results: Survey results revealed 100% of participants expressed interest in more art activities. With 92% reporting enjoyment in the soap carving sessions, highlighting its therapeutic benefits. 100% of exhibition attendees reported enjoyment, with 85% understanding the project’s aims. 100% of participants felt the exhibition successfully destigmatised hospice care. Eight themes from the exhibition feedback survey were identified including: creativity and variety, bringing people together, collaboration between services and the positive atmosphere of the event. Participants shared positive reflections, noting personal growth, such as “testing my patience,” and the communal aspect of the project, “the laughter of fellow carvers.” One participant highlighted the importance of the initiative in fostering “open minds and hearts,” reinforcing its role in building community. Conclusion: The project suggests that creative initiatives can improve quality of life and death, enhance team collaboration, and reduce stigma around palliative and cancer care. By engaging patients and staff in soap carving, the project fostered emotional healing and connection. This initiative has the potential to spark a broader cultural shift in healthcare, encouraging the integration of creativity into patient care, fostering collaboration, and enhancing the patient and family experience across healthcare settings.

General practitioners (GPs) use of imaging for acute low back pain (LBP) is above guideline recommendations, and the reasons for this remain under-researched. We examined the perspectives, expectations and information needs of Australian GPs requesting lumbar spine diagnostic imaging for patients presenting with acute LBP.We completed semi-structured interviews with 12 GPs practising in Victoria, Australia. Transcripts were thematically analysed, and themes compared according to whether or not GPs reported they regularly requested imaging for LBP.We identified four themes. (1) Besides responding to 'red flags', GPs' experiences of uncovering unexpected but serious findings on imaging for LBP as well as perceived external pressures motivated their defensive imaging practices. (2) While most were reluctant to request imaging for LBP, once requested, GPs escalated through imaging modalities and focused on the diagnostic benefit of their findings. (3) GPs supported the inclusion of epidemiological data on imaging reports, but (4) largely opposed imaging reports being written in plain language, believing reports to be clinician-to-clinician communications that patients would misunderstand. All GPs were aware of the limited utility of imaging for diagnosing LBP, and themes were similar between GPs who regularly requested imaging and those who did not. Factors other than knowledge of imaging efficacy for LBP seemed to play an important role in imaging requests.Our study identified key drivers of imaging use for LBP in primary care. The findings underscore that interventions targeting GPs addressing the overuse of imaging for LBP should transcend knowledge deficit models.

No abstract available

To investigate the influence of non-medical social determinants of health on rates of admission and outcomes for children admitted to intensive care units (ICUs) in Australia.Retrospective cohort study; analysis of Australian and New Zealand Paediatric Intensive Care Registry data.Children (18 years or younger) admitted to Australian ICUs during 1 January 2013 - 31 December 2020.Population-standardised ICU admission rates, overall and by residential socio-economic status (Index of Relative Socio-Economic Disadvantage [IRSD] quintile) and Indigenous status; likelihood of mortality in the ICU by residential socio-economic status (continuous, and quintile 1 v quintiles 2-5) and Indigenous status, adjusted for pre-illness, admission, and ICU and hospital factors.Data for 77 233 ICU admissions of children were available. The ICU admission rate for Indigenous children was 1.91 (95% confidence interval [CI], 1.87-1.94), for non-Indigenous children 1.60 (95% CI, 1.57-1.64) per 1000 children per year. The rate was higher for children living in areas in the lowest IRSD quintile (1.93; [95% CI, 1.89-1.96]) than for those living in quintile 5 (1.26 [95% CI, 1.23-1.29] per 1000 children per year). Unadjusted in-ICU mortality was higher for Indigenous than non-Indigenous children (2.5% v 2.1%) and also for children living in the lowest IRSD quintile than in quintiles 2-5 (2.5% v 2.0%). After adjustment for all factors, mortality among Indigenous children was similar to that for non-Indigenous children (adjusted odds ratio [aOR], 1.15; 95% CI, 0.92-1.43); it was higher for children living in the lowest IRSD quintile than for those living in quintiles 2-5 (aOR, 1.18; 95% CI, 1.03-1.36). Remoteness and distance between home and ICU did not influence the likelihood of death in the ICU.The population-standardised ICU admission rate is higher for Indigenous children and children residing in areas of greatest socio-economic disadvantage than for other children in Australia. Adjusted in-ICU mortality was higher for children from areas of greatest socio-economic disadvantage. Advancing health equity will require further investigation of the reasons for these differences.

Defining the temporal dynamics of invasive Streptococcus pyogenes (group A Streptococcus) and differences between hyperendemic and lower-incidence regions provides crucial insights into pathogen evolution and, in turn, informs preventive measures. We aimed to examine the clinical and temporal lineage dynamics of S pyogenes across different disease settings in Australia to improve understanding of drivers of pathogen diversity.In this retrospective, multicentre, clinical and genomic epidemiology study, we identified cases of invasive S pyogenes infection from normally sterile sites between Jan 1, 2011, and Feb 28, 2023. Data were collected from five hospital networks across low-incidence regions in temperate southeast Australia and the hyperendemic, tropical, and largely remote Top End of the Northern Territory of Australia. The crude incidence rate ratio (IRR) of bloodstream S pyogenes infection comparing the Top End and southeast Australia and in First Nations people compared with non-First Nations people was estimated by quasi-Poisson regression. We estimated odds ratios (ORs) of intensive care unit (ICU) admission, in-hospital mortality, and 30-day mortality for the Top End versus southeast Australia using logistic regression. Retrieved and successfully sequenced isolates were assigned lineages at whole-genome resolution. Temporal trends in the composition of co-circulating lineages were compared between the two regions. We used an S pyogenes-specific multistrain simulated transmission model to examine the relationship between host population-specific parameters and observed pathogen lineage dynamics. The prevalence of accessory genes (those present in 5-95% of all genomes) was compared across geographies and temporal periods to investigate genomic drivers of diversity.We identified 500 cases of invasive S pyogenes infection in patients in the Top End and 495 cases in patients in southeast Australia. The crude IRR of bloodstream infection for the Top End compared with southeast Australia was 5·97 (95% CI 4·61-7·73) across the entire study period; in the Top End, infection disproportionately affected First Nations people compared with non-First Nations people (5·41, 4·28-6·89). The odds of in-hospital mortality (OR 0·43, 95% CI 0·26-0·70), 30-day mortality (0·38, 0·23-0·63), and ICU admission (0·42, 0·30-0·59) were lower in the Top End than in southeast Australia. Longitudinal lineage analysis of 642 S pyogenes genomes identified waves of replacement with distinct lineages in the Top End, whereas southeast Australia had a small number of dominant lineages that persisted and cycled in frequency. The transmission model qualitatively reproduced a similar pattern of replacement with distinct lineages when using a high transmission rate, small population size, and high levels of human movement-characteristics similar to those of communities in the hyperendemic Top End. Using a lower transmission rate, larger population size, and lower levels of migration similar to those of communities in urbanised southeast Australia, the transmission model qualitatively reproduced a pattern of dominant lineages that cycled in frequency. Despite distinct circulating lineages, the prevalence of accessory genes in the bacterial population was maintained across geographies and temporal periods.In a hyperendemic setting, the replacement of distinct S pyogenes lineages occurred in waves, which could be linked to the disproportionate burden of disease and sparse human population in this setting. The maintenance of bacterial gene frequency could be consistent with multilocus selection. These findings suggest that lineage-specific interventions-such as vaccines under development-should consider disease setting and, without broad cross-protection, might lead to lineage replacement.National Health and Medical Research Council, and Leducq Foundation.

Endometrial cancer is the second leading cause of malignancy in women worldwide. Risk of recurrence and treatment depends on tumour grade, stage and more recently, molecular classification. This case details an atypical presentation of endometrial cancer recurrence. A postmenopausal woman presented to hospital in septic shock with anterior abdominal wall necrotising fasciitis. She was 5 years into her surveillance for FIGO (International Federation of Gynaecology and Obstetrics) Grade III, Stage IIIA mixed endometrioid and clear cell endometrial adenocarcinoma, treated by total abdominal hysterectomy, bilateral salpingo-oophorectomy, vaginal brachytherapy, radiotherapy and chemotherapy. Necrotising fasciitis was localised to a fluid collection associated with biological mesh on the anterior abdominal wall. Histopathology and cytology of the fluid collection revealed high-grade serous endometrial carcinoma. Recurrence in the incision has previously been described in the literature, however not as a fluid collection in association with biological mesh nor causing necrotising fasciitis of the anterior abdominal wall.

No abstract available

Staphylococcus pseudintermedius is a common commensal and opportunistic canine pathogen with emerging pathogenicity in humans. We describe the first case of invasive S. pseudintermedius infection causing aortitis and mycotic aneurysm in an 83-year-old patient, treated successfully with flucloxacillin. This case highlights the potential for S. pseudintermedius to cause serious endovascular infection in humans.

Pelvic fractures are prevalent in polytrauma patients who have sustained injury from high-energy mechanisms. They are associated with major haemorrhage, shock and other organ injuries. In the absence of standards for practice, clinical algorithms serve to guide the resuscitative, surgical and radiological interventions to manage haemodynamically stable and unstable pelvic trauma. High morbidity and mortality are associated with pelvic trauma, highlighting the importance of integrated trauma care, which has been demonstrated to improve patient outcomes. Aims: We aim to present the characteristics, acute management and outcomes of pelvic trauma from a Top End Regional Trauma Centre perspective. Methods: We conducted a retrospective analysis of adult (>18 years) pelvic trauma patients presenting to the Royal Darwin Hospital, a level II Trauma Centre, between 2018 and 2023. Results: Statistical analysis is in progress. Conclusion: Our findings will provide visibility of pelvic trauma, its management and corresponding outcomes from a Top End perspective. We anticipate identifying opportunities for quality improvement to optimise pelvic trauma outcomes in the Top End, Northern Territory.

Coronary heart disease (CHD) is the primary cause of mortality in Australia and the largest contributor to the 'gap' in cardiovascular disease deaths between Aboriginal and Torres Strait Islander (First Nations) people and non-indigenous Australians. To assess secondary prevention of CHD in First Nations people in primary care in Australia. Retrospective cohort study of patients with CHD under active primary care management using electronic medical records from 406 general practices across Australia. Ultimately, 50 088 people with CHD were included in the study, and 3.5% of those were First Nations people. After 5.9 years (standard deviation 5.0) in primary care adjusting for gender, age, remoteness, comorbidities, smoking status and continuity of care, First Nations peoples received equal statin (adjusted odds ratio (aOR): 0.9; 95% CI:0.8-1.1, P = 0.28), angiotensin-converting enzyme inhibitors/angiotensin II receptor antagonists (aOR:1.0; 95% CI:0.9-1.2, P = 0.85) and beta blockers (aOR:0.9;95% CI:0.8-1.1, P = 0.41) prescriptions. First Nations peoples were more likely to achieve BP <1.8 in similar proportions (35.2% vs 36.9%, P = 0.16) but less likely to have HDL-C >1.0 mmol/L (57.5% vs 73.7%, P < 0.001), triglycerides<2.0 mmol/L (61.7% vs 76.0%, P < 0.001) and HbA1C ≤ 53 mmol/mol (7.0%) (67.7% vs 82.1%, P < 0.001). A higher proportion of First Nations people had HbA1c measured (75.7% vs 66.6%, P < 0.001). First Nations peoples with CHD under active primary care management received similar secondary prevention medications and achieved BP and LDL-C targets as frequently as non-indigenous Australians. A focus on easier access to facilitate attending primary care is needed to close the gap as well as addressing social determinants of health and structural inequities.

Introduction/Aim: The aim of this study is to assess the effects of a service model change in the Alice Springs Hospital Respiratory Service intended to reduce the time from referral to treatment for lung cancer patients in Central Australia. A key component of the service model change is the appointment of an onsite resident respiratory specialist. Additional changes include increased access to bronchoscopic procedures, enhanced collaboration with the multidisciplinary lung cancer team, and developing a clinical care pathway for patients who are initially suspected and have been diagnosed to have lung cancer. Methods: A retrospective cohort design will measure primary care intervals (IPC) or the time lapsed from when general practitioners have seen the patient to referral to a respiratory specialist, referral intervals (IR) or the time taken from being referred to a specialist to a confirmed diagnosis, and treatment intervals (IT) or the time from diagnosis to treatment. The data will encompass 4 years before the service model change has been introduced and a year after its introduction. The availability of a Multidisciplinary Team (MDT) meeting document will also be included. Results: Preliminary results indicate an improvement in the service delivery in terms of primary care interval (IPC), referral intervals (IR), treatment intervals (IT), diagnostic intervals (ID) and health care intervals (IHC), with the general trend indicating shorter time lapses in between intervals. MDT notes have also been provided ever since the service model change. Conclusion: The appointment of an on-site respiratory specialist, complemented by access to diagnostic procedures, and increased collaboration with the MDT will enable provision of care that is comparative with national benchmarks complying with guidelines set by the Cancer Council in terms of time required from referral to treatment for lung cancer patients.

Familial hypercholesterolemia (FH) is a common and treatable inherited condition of cholesterol metabolism that increases cardiovascular health risk. Less than 10% of people with FH have been detected and few receive recommended treatment.We report on the development of a national implementation strategy for enhancing the detection of FH in Australia.A modified intervention mapping study was conducted, through workshops to identify barriers and facilitators of FH detection, models for detection and their objectives. Practical implementation strategies were selected using a constructivist analysis and summaries of the strategies were disseminated for feedback. A case study showcase was used to monitor strategy implementation.Potential models for FH detection were identified, including (1) use of pathology lab reports and recall; (2) screening in general practice, pharmacy, and Aboriginal Community Controlled Health Organizations; (3) screening in cardiovascular inpatients, outpatients, and rehabilitation; (4) universal screening; and (5) centralized coordination of primary-tertiary shared care. Implementation strategies were selected for each model to support their operationalization into routine care. A list of general implementation strategies was also produced that could support multiple models for FH detection.We identified multiple FH detection models and strategies that would support implementation across Australia. Centralized coordination of a primary-tertiary shared care model was described as a promising approach for integrating index case detection with family cascade testing. We provide a set of implementation recommendations for policy and practice to enhance the detection of FH in Australia.

Aboriginal and Torres Strait Islander women experience a disproportionate burden of hyperglycaemia in pregnancy. A multi-component health systems intervention aiming to improve antenatal and postpartum care was implemented across Australia's Northern Territory (NT) and Far North Queensland (FNQ) between 2016 and 2019. Components included clinician education, improving recall systems, enhancing policies and guidelines, and embedding Diabetes in Pregnancy (DIP) Clinical Registers in systems of care. This program was evaluated to determine impacts on clinical practice and maternal health.Data for women with hyperglycaemia in pregnancy from primary care clinical records and the DIP Clinical Registers were analysed to assess changes in: antenatal and postpartum diabetes testing; HbA1c/glucose levels; medication use; weight checks performed, weight and body mass index; and postpartum contraception, smoking and breastfeeding.Clinical practice in the NT improved, including increased uptake of the recommended first trimester 75 g oral glucose tolerance test among women with hyperglycaemia risk factors (Aboriginal and Torres Strait Islander women 11.7% to 26.5%, p < 0.001; non-Indigenous women 6.2% to 19.3%, p < 0.001). In the NT, postpartum diabetes monitoring (56% to 68%, p = 0.039) and contraceptive use (41% to 60%, p = 0.001) increased among Aboriginal and Torres Strait Islander women. In FNQ, postpartum glucose monitoring increased among women with T2D (26% to 68% Aboriginal and Torres Strait Islander, p = 0.002; 50% to 100% non-Indigenous, p = 0.008), although there were no improvements in antenatal care indicators.Aspects of care for women with hyperglycaemia in pregnancy improved in the NT and FNQ following a multi-component health systems intervention.This study is funded by the Australian National Health and Medical Research Council (NHMRC) Global Alliance for Chronic Diseases Grant 1092968.

Valgus osteotomy is a femoral head-preserving surgery to treat femoral neck non-union in young, active patients. The traditional approach, however, causes medialisation of the femoral shaft during valgus correction, which alters femoral anatomy and complicates conversion to total hip arthroplasty if head osteosynthesis fails. This study aims to outline a novel surgical technique, medial opening wedge valgus intertrochanteric osteotomy (VITO), and evaluate its clinical and radiographic outcomes, focusing on restoring hip biomechanics and improving union rates.Between 2007 and 2022, this technique was used in 18 cases (mean age 39; range 16-51 years). There were 14 males and 4 females. Non-union was due to failed internal fixation in 10 cases, while in 8 cases was due to neglected fractures. Treatment outcomes were evaluated by assessing union, pre- and postoperative neck-shaft angle (NSA) correction and functional outcomes by the Harris Hip Score (HHS).16 out of 18 patients were available for follow-up. The average duration of nonunion was 10.7 (range 1-60) months and the mean follow-up was 64 (range 24-140) months. All achieved successful union, with an average neck shaft angle correction of 16°. 3 patients were converted to total hip arthroplasty (THA) due to implant failure. Complications included 3 cases of avascular necrosis (AVN). Despite these complications, 62% of patients had excellent HHS, and 19% had good HHS. The mean improvement in HHS was 92 (postoperative) from 46 (preoperative).The medial opening wedge VITO is an effective technique for restoring hip biomechanics and achieving high union rates in patients with femoral neck non-union. This technique preserves the proximal femoral anatomy, facilitating easier conversion to THA when necessary.

Sputum microbiology is an integral aspect of managing patients with bronchiectasis. Adult Aboriginal Australians have a high bronchiectasis disease burden; however, as yet there is sparce literature detailing the sputum microbiology profile in this population.To assess the sputum microbiology profile among Aboriginal patients aged ≥18 years with chest computed tomography-confirmed bronchiectasis in the Top End Northern Territory of Australia.All available sputum samples processed in a single laboratory service with established protocols for examining and reporting sputum microbiology results between 2011 through 2020 were assessed in relation to demographics, lung function parameters, chest radiology, inhaled pharmacotherapy, hospital admissions restricted to respiratory conditions and all-cause mortality.Four hundred twenty-eight patients (median age 47 years, 56% female) had sputum cultures available to assess. Haemophilus spp. was the most common (64%), followed by yeast/Candida spp. (53%) and Pseudomonas spp. (36%). Polymicrobial cultures were noted in 92% of patients. There were significant geographic differences on a region-wise and community-wise basis. Patients with yeast/Candida spp. and Pseudomonas spp. recorded more hospitalisations (median 7 (interquartile range (IQR) 3-14) and 8 (IQR 4-16)). In multivariate models, both yeast/Candida spp. (odds ratio (OR) 2.63 (95% confidence interval (CI) 1.68-4.14)) and Pseudomonas spp. (OR 1.95 (95% CI 1.25-3.04)) were associated with increased odds for mortality. Other than higher Pseudomonas spp. isolated with the use of inhaled corticosteroids, no significant association was observed either with lung function or chest radiology.Adult Aboriginal Australians with bronchiectasis harbour a significant microorganism load that may play a role in overall morbidity and mortality.

Second contralateral hip fractures (SCHF) are relatively uncommon. The overall prevalence of this is poorly reported in literature.We performed a single centre retrospective cohort study in patients >50 years old who sustained a SCHF between 1st of January 2005 and 30th of April 2023. A systematic search of the literature was then performed by searching PubMed, Embase, and Web of Science from the date of inception of each database through to the 22nd of February 2024. A meta-analysis was conducted to estimate the prevalence of SCHF and hip fracture pattern symmetry, incorporating both our results and that previously reported in literature.Our cohort study showed a period prevalence of 1.7 % within 1 year and 2.8 % within 2 years following a hip fracture. 65 studies were identified using our search strategy. The overall prevalence of SCHF was 7.3 % [95 % CI: 6.3-8.4]. Meta-regression suggested that studies conducted in Europe and North America showed higher prevalence than studies conducted in Asia. A similar fracture pattern was seen in 72.1 % [95 % CI: 69.7-74.4] of patients with SCHF.SCHF are relatively uncommon. When they do occur, it is usually within 2 years of the index fracture. Asian populations had lower prevalence of SCHF when compared to their European and North American counterparts. Hip fracture pattern is symmetrical in most patients with a SCHF.

There is a high prevalence of type 2 diabetes (T2D) in First Nations populations worldwide, increasingly at younger ages. This review aims to identify interventions for the prevention of T2D in First Nations children and young people aged 4-25 years.A systematic search of both published and unpublished literature until March 2024 was performed using 15 electronic databases, including MEDLINE, CINAHL, EMBASE, Scopus, Cochrane Library, ATSIHealth, OpenGrey and specific First Nations databases. Eligible studies included First Nations participants aged 4-25 years without T2D, exploring interventions to prevent T2D. Outcomes included knowledge of diabetes, anthropometry and physiology, diet and nutrition, physical activity, glycemic indicators and psychosocial indicators.Fourteen pre-post exposure non-controlled studies were included, evaluating nine programs. Programs were culturally adapted and primarily school-based, focusing on individual-level behaviour modification in nutrition and physical activity. Most studies assessing knowledge outcomes reported improvement. There were inconsistent findings regarding impacts on dietary intake and glycemia. One home-based program achieved improvements across a range of outcomes, including body mass index, physical activity and psychosocial scores.Despite the increasing prevalence of T2D in First Nations children and young people, evidence of effective preventive strategies within these populations remains limited.

Spontaneous coronary artery dissection (SCAD) is an increasingly recognized cause of acute coronary syndrome (ACS). Recent data suggest a harmful association of dual antiplatelet therapy compared with single antiplatelet therapy following SCAD. This study investigated independent predictors of major adverse cardiovascular events (MACEs) and recurrence in patients with SCAD.This multicentre cohort study involving 23 Australian and New Zealand sites included patients aged ≥18 years with an ACS due to SCAD confirmed on core laboratory adjudication. Multivariable Cox proportional hazard models analysed predictors for the primary MACE outcome.Among 586 patients, 505 (150 prospective, 355 retrospective) with SCAD confirmed by core laboratory adjudication, mean age was 52.2 ± 10.6 years, 88.6% were female, and 74.5% were Caucasian. At long-term follow-up (median 21 months), MACE and SCAD recurrence occurred in 8.6% and 3.6% of patients, respectively. Oral anticoagulation on discharge [adjusted hazard ratio (aHR) 3.8, 95% confidence interval (CI) 1.6-9.3, P = .003], ticagrelor combined with aspirin (aHR 1.8, 95% CI 1.04-3.2, P = .037), fibromuscular dysplasia (aHR 2.2, 95% CI 1.05-4.5, P = .037), and history of stroke (aHR 3.8, 95% CI 1.2-12.2, P = .03) were independently associated with higher MACE. Fibromuscular dysplasia (aHR 3.9, 95% CI 1.5-26.5, P = .01), ticagrelor combined with aspirin (aHR 2.6, 95% CI 2.1-5.3, P = .01), and history of stroke (aHR 6.2, 95% CI 1.8-9.5, P = .01) were also associated with higher SCAD recurrence.The findings support the hypothesis that SCAD is primarily caused by intramural bleeding, with a harmful association of more potent antiplatelet therapy and anticoagulation with adverse cardiovascular outcomes.

Melioidosis is an endemic tropical disease caused by . It typically causes pulmonary disease and bacteraemia but can disseminate to cause multi-organ disease. 18-F FDG PET/CT has an evolving role in diagnosing other infectious diseases, especially where the pathogen or extent of infection is challenging to elucidate clinically and with conventional imaging (CT, US and MRI). We present a case series of patients diagnosed with melioidosis who also underwent 18-F FDG PET/CT from December 18th 2018 to September 30th 2022. Indications for imaging were categorised and analysed as to whether 18-F FDG PET/CT changed management over conventional imaging. Twenty-one 18-F FDG PET/CT scans were performed for sixteen patients. Two scans (9.5%) performed for pyrexia of unknown origin changed management in both cases. Twelve scans (57.1%) performed to ascertain the extent of dissemination of melioidosis changed management in only three (25%) cases. Five scans (23.8%) performed to monitor the response to treatment of known foci changed management in all five cases. Five scans (23.8%) performed for suspected or known malignancy changed management in three (60%) cases. 18-F FDG PET/CT is an emerging tool which improves diagnosis and changes the management of melioidosis when applied judiciously and for well-selected indications.

No abstract available