Box Hill Hospital is a teaching hospital in Melbourne. It is one of the seven hospitals that are governed within the Eastern Health network which provides health care services across the Eastern metropolitan area of Victoria.Established in 1956, Box Hill Hospital is a large acute hospital in the Melbourne suburb of Box Hill, which admits over 48,000 patients each year.The hospital provides a wide range of healthcare services including: emergency care, general and specialist medicine, intensive care, mental health services for children, adolescents and adults, maternity services, post-acute care programs, surgery, teaching and research.Box Hill Hospital is a university teaching hospital affiliated with Monash, La Trobe and Deakin Universities.In 2016 Box Hill Hospital celebrated its 60th anniversary with a staff event.
To compare perioperative, oncological, and survival outcomes of total gastrectomy (TG) versus subtotal gastrectomy (SG) in patients with locally advanced distal diffuse gastric adenocarcinoma treated with perioperative 5-fluorouracil, leucovorin, oxaliplatin and docetaxel (FLOT) chemotherapy. Diffuse distal gastric cancer is characterized by infiltrative growth patterns and early nodal metastasis. Whilst radical resection remains the cornerstone of curative treatment, the optimal extent of surgery with TG or SG, remains debated. This international multicenter cohort study analyzed data from patients with histologically confirmed diffuse gastric adenocarcinoma, located > 5 cm from the gastroesophageal junction. Endpoints included surgical margin status, nodal yield, perioperative morbidity, recurrence patterns, time-to-recurrence (TTR), and overall survival (OS). Outcomes were compared using multivariate analyses. In total, 188 (39.0
This update and revision of the international guideline for urticaria was developed in accordance with the methods recommended by Cochrane and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) working group. It is an initiative of the Global Allergy and Asthma Excellence Network (GA(2)LEN) and its Urticaria and Angioedema Centers of Reference and Excellence (UCAREs and ACAREs), with the participation of 210 delegates from 107 national and international societies, from 59 countries. The consensus conference was held on December 6th, 2024. This guideline was acknowledged and accepted by the European Union of Medical Specialists (UEMS). Urticaria is a frequent, mast cell-driven disease, defined by a rapid appearance of wheals, angioedema, or both. The lifetime prevalence of acute urticaria is estimated to be approximately 20%. Chronic urticaria, categorized as either chronic spontaneous urticaria or chronic inducible urticaria, is disabling, impairs quality of life, and affects performance at work and school, however, novel therapies are available. This updated version of the international guideline for urticaria covers the definition and classification of urticaria and outlines expert-guided and evidence-based diagnostic and therapeutic approaches for the different subtypes of urticaria.
Predicting disease progression at the individual level is essential for personalized medicine. We previously developed machine-learning tools to estimate 5-year progression risk in people with multiple sclerosis (PwMS). Such models should account for disease-modifying therapy (DMT) and objective outcome definitions. In a retrospective multicenter case–control study, we evaluated adults with relapsing–remitting multiple sclerosis (RRMS) at baseline. Using machine-learning, we developed two complementary tools for individualized 5-year risk estimation: DAAE-M, optimized for transparency, software-neutral use, and mitigation of indication bias, and ELIE, optimized for dynamic landmark-based modeling, complex treatment histories, and mitigation of immortal-time bias. Disease progression was defined using both a clinical outcome (RRMS-to-progressive MS) and an objective outcome (late-stage confirmed progression independent of relapse activity). Among 34,510 people with RRMS (72.6
Providing high-quality reproductive health information for pregnant women will promote health literacy, improve postpartum maternal health and optimise preconception health before future pregnancies. We analysed antenatal data from 314 women attending a Victorian Hospital for pregnancy services, and co-designed and evaluated a culturally responsive interconception health tool for inclusion in the baby bundle provided to women attending this service. Information around family planning, nutrition and physical activity, lactation, common conditions in pregnancy, mental health and support networks was included in the tool. Women reported that combining an interconception resource with the standard midwifery-led discharge consultation would be optimal.
BackgroundThe role of rituximab in the treatment of myasthenia gravis (MG) remains uncertain due to limited randomized controlled evidence and heterogeneous observational data. While rituximab is often used in refractory MG, its comparative effectiveness against other non-steroidal immunosuppressive therapies (NSISTs) has yet to be fully clarified.ObjectiveTo evaluate the effectiveness of rituximab compared to a second NSIST in achieving a composite clinical outcome in acetylcholine-receptor-antibody (AChR-Ab) positive MG patients using causal inference methods to adjust for confounding.MethodsWe conducted a retrospective cohort study of AChR-Ab positive MG patients treated with rituximab or a second NSIST. The primary outcome was time to achieving a composite clinical endpoint representing a patient acceptable symptom state (PASS): Myasthenia Gravis Composite (MGC) score ≤ 3, daily corticosteroid dose ≤ 5 mg prednisolone equivalent, and no rescue therapy use in the preceding month. To reduce confounding by indication and improve causal comparability between treatment groups, inverse probability of treatment weighting (IPTW) based on propensity scores was used to balance baseline covariates. Cox proportional hazards models were applied to estimate the effect of treatment on time to outcome.Results169 patients entered into the time-to-event analysis, and after IPTW adjustment, baseline characteristics between treatment groups were balanced. There was no statistical difference in the hazard ratio between Rituximab compared to a second NSIST in achieving the composite clinical outcome (HR = 1.27, 95% CI 0.66–2.45, p = 0.48).ConclusionIn this IPTW-adjusted analysis, rituximab did not improve the time-to-improvement compared to a second NSIST in AChR-Ab-positive MG.
