Stroke is a leading cause of disability and death in Australia. There is a clear benefit in caring for stroke patients in stroke care units. Access to these centres is limited particularly in the rural setting. Certif...Stroke is a leading cause of disability and death in Australia. There is a clear benefit in caring for stroke patients in stroke care units. Access to these centres is limited particularly in the rural setting. Certified stroke care units in the private health care setting are also unheard of. The superiority of these units is thought to be due to better adherence to processes of care (early utility of CT scan, allied health input within 24 hours, neurological observations, DVT prophylaxis and appropriate use of antiplatelet and anticoagulant use). We audited care of 100 patients who presented to the St. John of God Hospital (rural private hospital) over a period of 3 years. This included baseline demographics, adherence of processes of care, utility of appropriate investigations, and outcome measures such as discharge destination, level of function at discharge and complication rates. These data were compared with the national stroke report (AuSCR) and adherence to processes of care was compared with the SCOPE study (the first study to establish the benefit of POC). When compared with data from the AuSCR national report 2012, we found a higher mortality rate, an increased rate of disability on discharge, and a mixed adherence to processes of care. We also found a significant proportion of patients (40%) who were eligible to receive thrombolysis but did not. Overall we found that there were significant strengths to be drawn upon in the rural private healthcare setting and a more organised approach could improve outcomes.展开更多
By providing a means of separating the airborne emissions of patients from the air breathed by healthcare workers(HCWs),vented individual patient(VIP)hoods,a form of local exhaust ventilation(LEV),offer a new approach...By providing a means of separating the airborne emissions of patients from the air breathed by healthcare workers(HCWs),vented individual patient(VIP)hoods,a form of local exhaust ventilation(LEV),offer a new approach to reduce hospital-acquired infection(HAI).Results from recent studies have demonstrated that,for typical patient-emitted aerosols,VIP hoods provide protection at least equivalent to that of an N95 mask.Unlike a mask,hood performance can be easily monitored and HCWs can be alerted to failure by alarms.The appropriate use of these relatively simple devices could both reduce the reliance on personal protective equipment(PPE)for infection control and provide a low-cost and energy-efficient form of protection for hospitals and clinics.Although the development and deployment of VIP hoods has been accelerated by the coronavirus disease 2019(COVID-19)pandemic,these devices are currently an immature technology.In this review,we describe the state of the art of VIP hoods and identify aspects in need of further development,both in terms of device design and the protocols associated with their use.The broader concept of individual patient hoods has the potential to be expanded beyond ventilation to the provision of clean conditions for individual patients and personalized control over other environmental factors such as temperature and humidity.展开更多
Obesity is on the increase worldwide and is a major global public health problem. In an increasingly obesogenic environment, it’s important that health professionals are equipped to identify and address obesity issue...Obesity is on the increase worldwide and is a major global public health problem. In an increasingly obesogenic environment, it’s important that health professionals are equipped to identify and address obesity issues within their clinical practice. As part of the Weight Care Project, the aim of this study was to explore the obesity-related communication issues for primary care and community-based health professionals. The study design was a quantitative survey, which was completed by 382 primary care and community-based health professionals across Northern Ireland and Republic of Ireland working with adults and children. Key findings included that the majority of the health professionals (86%) recognized having a role in giving obesity advice, acknowledged that in clinical practice communication of obesity messages is both complex and challenging (81%), and reported difficulty in sensitively addressing obesity issues (27%). The health professionals surveyed stated that they communicate obesity messages to their patients using a range of different methods, mainly verbally to individuals, leaflets and factsheets. Numerous benefits of communicating obesity messages were reported;the main one was interacting with patients to build trust. Identified barriers to commu nication were: limited time in patient consultations, restricted access to appropriate information, and not sure where to access appropriate resources. Communication needed be reported by the health professionals included provision of greater resources, more information on obesity management and prevention, followed by health communication training, and clear and consistent messages. Significant differences were observed, including significantly much younger health professionals considered their role to provide obesity advice (P = 0.025). It is clear from this study that health professionals view as important the need to be given information on “what” and “how” to communicate with their patients on obesity. This study highlights that health professionals need continued support to enable them to effectively address weight-related issues in a sensitive manner that is acceptable to the patient.展开更多
Background The coronavirus disease 2019(COVID-19)pandemic has had a profound and prolonged impact on healthcare services and healthcare workers.Aims The Australian COVID-19 Frontline Healthcare Workers Study aimed to ...Background The coronavirus disease 2019(COVID-19)pandemic has had a profound and prolonged impact on healthcare services and healthcare workers.Aims The Australian COVID-19 Frontline Healthcare Workers Study aimed to investigate the severity and prevalence of mental health issues,as well as the social,workplace and financial disruptions experienced by Australian healthcare workers during the COVID-19 pandemic.Methods A nationwide,voluntary,anonymous,single timepoint,online survey was conducted between 27 August and 23 October 2020.Individuals self-identifying as frontline healthcare workers in secondary or primary care were invited to participate.Participants were recruited through health organisations,professional associations or colleges,universities,government contacts and national media.Demographics,home and work situation,health and psychological well-being data were collected.Results A total of 9518 survey responses were received;of the 9518 participants,7846(82.4%)participants reported complete data.With regard to age,4110(52.4%)participants were younger than 40 years;6344(80.9%)participants were women.Participants were nurses(n=3088,39.4%),doctors(n=2436,31.1%),allied health staff(n=1314,16.7%)or in other roles(n=523,6.7%).In addition,1250(15.9%)participants worked in primary care.Objectively measured mental health symptoms were common:mild to severe anxiety(n=4694,59.8%),moderate to severe burnout(n=5458,70.9%)and mild to severe depression(n=4495,57.3%).Participants were highly resilient(mean(SD)=3.2(0.66)).Predictors for worse outcomes on all scales included female gender;younger age;pre-existing psychiatric condition;experiencing relationship problems;nursing,allied health or other roles;frontline area;being worried about being blamed by colleagues and working with patients with COVID-19.Conclusions The COVID-19 pandemic is associated with significant mental health symptoms in frontline healthcare workers.Crisis preparedness together with policies and practices addressing psychological well-being are needed.展开更多
When microdissection testicular sperm extraction(micro-TESE)fails,a redo procedure may be the only option for patients who want a biological child.However,there are many gaps of knowledge surrounding the procedure,whi...When microdissection testicular sperm extraction(micro-TESE)fails,a redo procedure may be the only option for patients who want a biological child.However,there are many gaps of knowledge surrounding the procedure,which need to be addressed to help clinicians and patients make informed decisions.This review explores redo micro-TESE in the context of nonobstructive azoospermia(NOA).Literature was searched using Google Scholar,Medline,and PubMed.Search terms were“NOA”AND“second microdissection testicular sperm extractions”AND“redo microdissection testicles sperm extraction”AND“repeat microdissection testicular sperm extractions”AND“failed microdissection testicular sperm extractions”AND“salvage microdissection testicular sperm extractions”.Only original articles in English were included.A total of nine articles were included,consisting of four retrospective and five prospective studies.The time gap between the first and second micro-TESE varied from 6 months to 24 months.Most of the included studies reported successful surgical sperm retrieval(SSR)in the second micro-TESE in the range of 10%–21%,except in one study where it reached 42%.It has not been presented any definitive information about the use of hormonal treatment or the benefit of varicocelectomy prior to the second micro-TESE.Patients with hypospermatogenesis and Klinefelter syndrome(KS)had the highest chance of success in redo surgery.In conclusion,redo micro-TESE following a negative procedure can lead to sperm recovery in 10%–21%.Patients with hypospermatogenesis and KS have a higher chance of success.There is no enough evidence to conclude which is the best hormonal stimulation if any before a redo surgery.展开更多
1|Introduction Theranostics is quickly establishing itself as a key component in the field of cancer diagnosis and treatment^([1]).It is now considered the fifth pillar of contemporary oncology manage-ment alongside s...1|Introduction Theranostics is quickly establishing itself as a key component in the field of cancer diagnosis and treatment^([1]).It is now considered the fifth pillar of contemporary oncology manage-ment alongside surgery,chemotherapy,radiotherapy,and immunotherapy^([2]).As theranostics continues to evolve,it is essential for clinicians and radiologists to be aware of the cur-rent landscape and trends in the field^([3-5]).This article aims to highlight the importance for global radiology training colleges to formally introduce theranostics into their training curricula.This is to ensure that their trainees will gain adequate exposure to this growing branch of precision medicine and to enable them to contribute effectively to the field of oncology.展开更多
Hepatic hydrothorax(HH)is an uncommon yet severe manifestation of portal hypertension which develops in 5%-10%of patients with liver cirrhosis.It typically presents as a unilateral,right-sided pleural effusion and in ...Hepatic hydrothorax(HH)is an uncommon yet severe manifestation of portal hypertension which develops in 5%-10%of patients with liver cirrhosis.It typically presents as a unilateral,right-sided pleural effusion and in the context of end-stage liver disease and concomitant ascites.The most widely accepted explanatory model for HH accumulation is the formation of small diaphragmatic defects(pleuroperitoneal connections)facilitating migration of ascitic fluid from the peritoneal cavity directly to the pleural cavity.Medical management involves sodium restriction and diuretic therapy,with thoracentesis also offering symptomatic relief.In cases of refractory HH,a transjugular intrahepatic portosystemic shunt is considered either as definitive treatment or as a bridge to liver transplantation,which remains the only curative treatment option.HH refractory to medical therapy presents a challenging clinical dilemma,particularly in those who are ineligible for liver transplantation.In this mini-review,we aim to highlight the pathophysiology,clinical presentation,diagnosis and management of HH.Additionally,we discuss and appraise novel therapeutic options and offer future directions.展开更多
Detection of high-grade squamous intraepithelial lesions(HSILs)is key for the prevention of human papillomavirus(HPV)-related cancers.In this study,we aimed to identify and consolidate the existing evidence on the dia...Detection of high-grade squamous intraepithelial lesions(HSILs)is key for the prevention of human papillomavirus(HPV)-related cancers.In this study,we aimed to identify and consolidate the existing evidence on the diagnostic performances of artificial intelligence(AI)-assisted tools for HPV-related HSILs.We followed the Cochrane Handbook for Systematic Reviews of Diagnostic Test Accuracy and the Preferred Reporting Items for a Systematic Review and Meta-analysis of Diagnostic Test Accuracy guidelines and systematically searched PubMed,Embase,Web of Science,IEEE,and the Cochrane Library for eligible studies published between 2000 and January 2024.Studies on AI-assisted colposcopy used to facilitate the diagnosis of cervical or anal HSILs and cancers were included.The revised Quality Assessment of Diagnostic Studies 2 and AI checklists were used to assess the risk of bias.With random-effect models,meta-analyses were performed on performance indicators,including accuracy,sensitivity,specificity,and area under the receiver-operating characteristic curves(AUC).Subgroup and meta-regression analyses were performed to identify the sources of heterogeneity.Twenty-five studies,comprising 21 studies focused on cervical cancer and 4 on anal cancer,were included in the meta-analysis.When differentiating from individuals with<cervical intraepithelial neoplasia grade 2(CIN2)/low-grade squamous intraepithelial lesion(LSIL)−(lesion grade<CIN2 or≤LSIL),the AI-assisted diagnostic tools identified individuals with CIN2+/HSIL+(lesion grade≥CIN2 or≥HSIL)at a pooled accuracy of 0.84(95%confidence interval[CI]:0.81-0.88),sensitivity of 0.87(0.81-0.93),specificity of 0.85(0.81-0.89),and AUC of 0.94(0.91-0.96).For anal cancer,the AI-assisted diagnostic tools differentiated individuals with anal intraepithelial neoplasia grade 2(AIN2)+/HSIL+(≥AIN2 or≥HSIL)from those with<AIN2/LSIL−(lesion grade<AIN2 or≤LSIL)at a pooled accuracy of 0.90(95%CI:0.88-0.93),sensitivity of 0.94(0.87-0.99),specificity of 0.88(0.71-0.98),and AUC of 0.97(0.95-0.98).All meta-analysis results demonstrated high heterogeneity(I^(2)>90%),but the meta-regression analysis did not reveal any significant contributing sources of heterogeneity.Based on this systematic review and meta-analysis of existing literature,we concluded that AI-assisted diagnostic tools have demonstrated promising predictive performance in diagnosing HPV-related cervical and anal precancerous lesions and cancers.展开更多
文摘Stroke is a leading cause of disability and death in Australia. There is a clear benefit in caring for stroke patients in stroke care units. Access to these centres is limited particularly in the rural setting. Certified stroke care units in the private health care setting are also unheard of. The superiority of these units is thought to be due to better adherence to processes of care (early utility of CT scan, allied health input within 24 hours, neurological observations, DVT prophylaxis and appropriate use of antiplatelet and anticoagulant use). We audited care of 100 patients who presented to the St. John of God Hospital (rural private hospital) over a period of 3 years. This included baseline demographics, adherence of processes of care, utility of appropriate investigations, and outcome measures such as discharge destination, level of function at discharge and complication rates. These data were compared with the national stroke report (AuSCR) and adherence to processes of care was compared with the SCOPE study (the first study to establish the benefit of POC). When compared with data from the AuSCR national report 2012, we found a higher mortality rate, an increased rate of disability on discharge, and a mixed adherence to processes of care. We also found a significant proportion of patients (40%) who were eligible to receive thrombolysis but did not. Overall we found that there were significant strengths to be drawn upon in the rural private healthcare setting and a more organised approach could improve outcomes.
文摘By providing a means of separating the airborne emissions of patients from the air breathed by healthcare workers(HCWs),vented individual patient(VIP)hoods,a form of local exhaust ventilation(LEV),offer a new approach to reduce hospital-acquired infection(HAI).Results from recent studies have demonstrated that,for typical patient-emitted aerosols,VIP hoods provide protection at least equivalent to that of an N95 mask.Unlike a mask,hood performance can be easily monitored and HCWs can be alerted to failure by alarms.The appropriate use of these relatively simple devices could both reduce the reliance on personal protective equipment(PPE)for infection control and provide a low-cost and energy-efficient form of protection for hospitals and clinics.Although the development and deployment of VIP hoods has been accelerated by the coronavirus disease 2019(COVID-19)pandemic,these devices are currently an immature technology.In this review,we describe the state of the art of VIP hoods and identify aspects in need of further development,both in terms of device design and the protocols associated with their use.The broader concept of individual patient hoods has the potential to be expanded beyond ventilation to the provision of clean conditions for individual patients and personalized control over other environmental factors such as temperature and humidity.
文摘Obesity is on the increase worldwide and is a major global public health problem. In an increasingly obesogenic environment, it’s important that health professionals are equipped to identify and address obesity issues within their clinical practice. As part of the Weight Care Project, the aim of this study was to explore the obesity-related communication issues for primary care and community-based health professionals. The study design was a quantitative survey, which was completed by 382 primary care and community-based health professionals across Northern Ireland and Republic of Ireland working with adults and children. Key findings included that the majority of the health professionals (86%) recognized having a role in giving obesity advice, acknowledged that in clinical practice communication of obesity messages is both complex and challenging (81%), and reported difficulty in sensitively addressing obesity issues (27%). The health professionals surveyed stated that they communicate obesity messages to their patients using a range of different methods, mainly verbally to individuals, leaflets and factsheets. Numerous benefits of communicating obesity messages were reported;the main one was interacting with patients to build trust. Identified barriers to commu nication were: limited time in patient consultations, restricted access to appropriate information, and not sure where to access appropriate resources. Communication needed be reported by the health professionals included provision of greater resources, more information on obesity management and prevention, followed by health communication training, and clear and consistent messages. Significant differences were observed, including significantly much younger health professionals considered their role to provide obesity advice (P = 0.025). It is clear from this study that health professionals view as important the need to be given information on “what” and “how” to communicate with their patients on obesity. This study highlights that health professionals need continued support to enable them to effectively address weight-related issues in a sensitive manner that is acceptable to the patient.
基金The Royal Melbourne Hospital Foundation and the Lord Mayor’s Charitable Foundation kindly provided financial support for this study.
文摘Background The coronavirus disease 2019(COVID-19)pandemic has had a profound and prolonged impact on healthcare services and healthcare workers.Aims The Australian COVID-19 Frontline Healthcare Workers Study aimed to investigate the severity and prevalence of mental health issues,as well as the social,workplace and financial disruptions experienced by Australian healthcare workers during the COVID-19 pandemic.Methods A nationwide,voluntary,anonymous,single timepoint,online survey was conducted between 27 August and 23 October 2020.Individuals self-identifying as frontline healthcare workers in secondary or primary care were invited to participate.Participants were recruited through health organisations,professional associations or colleges,universities,government contacts and national media.Demographics,home and work situation,health and psychological well-being data were collected.Results A total of 9518 survey responses were received;of the 9518 participants,7846(82.4%)participants reported complete data.With regard to age,4110(52.4%)participants were younger than 40 years;6344(80.9%)participants were women.Participants were nurses(n=3088,39.4%),doctors(n=2436,31.1%),allied health staff(n=1314,16.7%)or in other roles(n=523,6.7%).In addition,1250(15.9%)participants worked in primary care.Objectively measured mental health symptoms were common:mild to severe anxiety(n=4694,59.8%),moderate to severe burnout(n=5458,70.9%)and mild to severe depression(n=4495,57.3%).Participants were highly resilient(mean(SD)=3.2(0.66)).Predictors for worse outcomes on all scales included female gender;younger age;pre-existing psychiatric condition;experiencing relationship problems;nursing,allied health or other roles;frontline area;being worried about being blamed by colleagues and working with patients with COVID-19.Conclusions The COVID-19 pandemic is associated with significant mental health symptoms in frontline healthcare workers.Crisis preparedness together with policies and practices addressing psychological well-being are needed.
文摘When microdissection testicular sperm extraction(micro-TESE)fails,a redo procedure may be the only option for patients who want a biological child.However,there are many gaps of knowledge surrounding the procedure,which need to be addressed to help clinicians and patients make informed decisions.This review explores redo micro-TESE in the context of nonobstructive azoospermia(NOA).Literature was searched using Google Scholar,Medline,and PubMed.Search terms were“NOA”AND“second microdissection testicular sperm extractions”AND“redo microdissection testicles sperm extraction”AND“repeat microdissection testicular sperm extractions”AND“failed microdissection testicular sperm extractions”AND“salvage microdissection testicular sperm extractions”.Only original articles in English were included.A total of nine articles were included,consisting of four retrospective and five prospective studies.The time gap between the first and second micro-TESE varied from 6 months to 24 months.Most of the included studies reported successful surgical sperm retrieval(SSR)in the second micro-TESE in the range of 10%–21%,except in one study where it reached 42%.It has not been presented any definitive information about the use of hormonal treatment or the benefit of varicocelectomy prior to the second micro-TESE.Patients with hypospermatogenesis and Klinefelter syndrome(KS)had the highest chance of success in redo surgery.In conclusion,redo micro-TESE following a negative procedure can lead to sperm recovery in 10%–21%.Patients with hypospermatogenesis and KS have a higher chance of success.There is no enough evidence to conclude which is the best hormonal stimulation if any before a redo surgery.
文摘1|Introduction Theranostics is quickly establishing itself as a key component in the field of cancer diagnosis and treatment^([1]).It is now considered the fifth pillar of contemporary oncology manage-ment alongside surgery,chemotherapy,radiotherapy,and immunotherapy^([2]).As theranostics continues to evolve,it is essential for clinicians and radiologists to be aware of the cur-rent landscape and trends in the field^([3-5]).This article aims to highlight the importance for global radiology training colleges to formally introduce theranostics into their training curricula.This is to ensure that their trainees will gain adequate exposure to this growing branch of precision medicine and to enable them to contribute effectively to the field of oncology.
文摘Hepatic hydrothorax(HH)is an uncommon yet severe manifestation of portal hypertension which develops in 5%-10%of patients with liver cirrhosis.It typically presents as a unilateral,right-sided pleural effusion and in the context of end-stage liver disease and concomitant ascites.The most widely accepted explanatory model for HH accumulation is the formation of small diaphragmatic defects(pleuroperitoneal connections)facilitating migration of ascitic fluid from the peritoneal cavity directly to the pleural cavity.Medical management involves sodium restriction and diuretic therapy,with thoracentesis also offering symptomatic relief.In cases of refractory HH,a transjugular intrahepatic portosystemic shunt is considered either as definitive treatment or as a bridge to liver transplantation,which remains the only curative treatment option.HH refractory to medical therapy presents a challenging clinical dilemma,particularly in those who are ineligible for liver transplantation.In this mini-review,we aim to highlight the pathophysiology,clinical presentation,diagnosis and management of HH.Additionally,we discuss and appraise novel therapeutic options and offer future directions.
文摘Detection of high-grade squamous intraepithelial lesions(HSILs)is key for the prevention of human papillomavirus(HPV)-related cancers.In this study,we aimed to identify and consolidate the existing evidence on the diagnostic performances of artificial intelligence(AI)-assisted tools for HPV-related HSILs.We followed the Cochrane Handbook for Systematic Reviews of Diagnostic Test Accuracy and the Preferred Reporting Items for a Systematic Review and Meta-analysis of Diagnostic Test Accuracy guidelines and systematically searched PubMed,Embase,Web of Science,IEEE,and the Cochrane Library for eligible studies published between 2000 and January 2024.Studies on AI-assisted colposcopy used to facilitate the diagnosis of cervical or anal HSILs and cancers were included.The revised Quality Assessment of Diagnostic Studies 2 and AI checklists were used to assess the risk of bias.With random-effect models,meta-analyses were performed on performance indicators,including accuracy,sensitivity,specificity,and area under the receiver-operating characteristic curves(AUC).Subgroup and meta-regression analyses were performed to identify the sources of heterogeneity.Twenty-five studies,comprising 21 studies focused on cervical cancer and 4 on anal cancer,were included in the meta-analysis.When differentiating from individuals with<cervical intraepithelial neoplasia grade 2(CIN2)/low-grade squamous intraepithelial lesion(LSIL)−(lesion grade<CIN2 or≤LSIL),the AI-assisted diagnostic tools identified individuals with CIN2+/HSIL+(lesion grade≥CIN2 or≥HSIL)at a pooled accuracy of 0.84(95%confidence interval[CI]:0.81-0.88),sensitivity of 0.87(0.81-0.93),specificity of 0.85(0.81-0.89),and AUC of 0.94(0.91-0.96).For anal cancer,the AI-assisted diagnostic tools differentiated individuals with anal intraepithelial neoplasia grade 2(AIN2)+/HSIL+(≥AIN2 or≥HSIL)from those with<AIN2/LSIL−(lesion grade<AIN2 or≤LSIL)at a pooled accuracy of 0.90(95%CI:0.88-0.93),sensitivity of 0.94(0.87-0.99),specificity of 0.88(0.71-0.98),and AUC of 0.97(0.95-0.98).All meta-analysis results demonstrated high heterogeneity(I^(2)>90%),but the meta-regression analysis did not reveal any significant contributing sources of heterogeneity.Based on this systematic review and meta-analysis of existing literature,we concluded that AI-assisted diagnostic tools have demonstrated promising predictive performance in diagnosing HPV-related cervical and anal precancerous lesions and cancers.
