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Chronic non-cancer pain (CNCP) is a leading cause of disability; however, CNCP assessment is limited in those presenting with a primary sleep disorder. This study aimed to (i) measure the prevalence of CNCP in adults undergoing polysomnography (PSG) and (ii) assess the impact of CNCP on sleep architecture. Patients (N = 245, mean age 50 years, 45.7
Importance International guidelines recommend the integration of multidisciplinary rehabilitation into palliative care services but its impact on quality of life across disease types is not well understood. Objective To determine the effect of multidisciplinary palliative rehabilitation on quality of life and healthcare service outcomes for adults with an advanced, life-limiting illness. Data sources Electronic databases CINAHL, EMBASE, MEDLINE and PEDro were searched from the earliest records to February 2024. Study selection Randomised controlled trials examining the effect of multidisciplinary palliative rehabilitation in adults with an advanced, life-limiting illness and reported quality of life were eligible. Data extraction and synthesis Study characteristics, quality of life and health service usage data were extracted, and the methodological quality was assessed using PEDro. Meta-analyses using random effects were completed, and Grades of Recommendation, Assessment, Development and Evaluation criteria were applied. Main outcomes Quality of life and healthcare service outcomes. Results 27 randomised controlled trials (n=3571) were included. Palliative rehabilitation was associated with small improvements in quality of life (standardised mean difference (SMD) 0.40, 95% CI 0.23 to 0.56). These effects were significant across disease types: cancer (SMD 0.22, 95% CI 0.03 to 0.41), heart failure (SMD 0.37, 95% CI 0.61 to 0.05) and non-malignant respiratory diagnoses (SMD 0.77, 95% CI 0.29 to 1.24). Meta-analysis found low-certainty evidence, palliative rehabilitation reduced the length of stay by 1.84 readmission days. Conclusions and relevance Multidisciplinary palliative rehabilitation improves quality of life for adults with an advanced, life-limiting illness and can reduce time spent in hospital without costing more than usual care. Palliative rehabilitation should be incorporated into standard palliative care. PROSPERO registration number CRD42022372951.
BACKGROUND:Approximately 10% of hospitalized patients globally report a penicillin allergy, leading to inappropriate antibiotic prescribing and inferior healthcare outcomes. Evidence supporting the effectiveness and widespread implementation of inpatient penicillin direct oral challenge (DOC) is limited. METHODS:A prospective, multicenter, international type 2 hybrid effectiveness-implementation study was conducted in 40 hospitals across 8 countries between November 2022 and May 2025. Adult inpatients with a penicillin allergy underwent assessment using a digital penicillin allergy toolkit (National Antibiotic Allergy Network [NAAN] App). According to site clinical practice, participants received penicillin DOC (effectiveness intervention) or assessment only. Participating sites received bimonthly audit and feedback at least 3 months after site activation (implementation strategy). Observational data were used to emulate a target trial to examine secondary effectiveness outcomes, including antibiotic prescribing at 90 days in DOC versus non-DOC participants. The primary implementation outcome was adoption of the NAAN App within 6 months of site activation. RESULTS:Among 5121 participants assessed, 1573 (30.7%) underwent DOC, of which 1502 (95.5%) were delabeled. Of 71 (4.5%) participants with a positive DOC, 6 (0.4%) had a serious adverse event. Of 1852 inpatients in the target trial analysis, 892 underwent DOC and 960 underwent assessment only. Participants who underwent DOC were more likely to be prescribed penicillin (risk ratio [RR], 13.25 [95% confidence interval {CI}, 7.82-22.46]), and less likely to be prescribed World Health Organization (WHO) "Watch" or "Reserve" antibiotics (RR, 0.73 [95% CI, .60-.89]) at 90 days post evaluation. Within 6 months of site activation, 77 clinicians adopted the NAAN App. CONCLUSIONS:Multidisciplinary adoption of inpatient penicillin DOC was safe and significantly improved penicillin prescribing and reduced use of WHO restricted antibiotics.
Approach Bias Modification (ApBM) is a recommended adjunctive intervention during residential treatment for Alcohol Use Disorder (AUD), and there are also promising findings for ApBM as an adjunctive intervention for people in outpatient treatment. ApBM can be delivered via smartphone apps, yet little is known about how people interact with and interpret ApBM apps. We adopted an ‘evidence-making intervention’ approach to qualitatively explore experiences of an AUD ApBM app, to guide implementation in real-world settings. Whilst evidence-based research is mostly concerned with whether trials show that ApBM reduces approach bias and relapse/alcohol use, evidence-making research is concerned with how things like trial design, measures, contexts, and narratives of participants shape our understanding of ApBM’s effectiveness. 20 participants (12 men, 8 women; mean age 52.1 years) from two randomised controlled trials of a personalised and gamified ApBM app (10 outpatient, 10 residential rehabilitation) completed semi-structured phone interviews exploring their experiences with the app, its perceived effects, and its alignment with other treatment options. Common themes were identified using thematic analysis. Participants engaged with the app in several ways, with four primary themes identified. The first, context and structure of app use (part of daily routines), with preferred times of day and locations for use, to support habit formation. Second, gendered responses to gamification elements shaped participant engagement with the intervention, with male participants framing it more as a game, and females tending to describe it as monotonous. The third theme encompassed participants’ multiple perceptions of how the app works, including as: a craving distraction tool; reinforcing recovery goals and life beyond alcohol use; assisting with countering the effects of environmental alcohol-related triggers; and affecting subconscious processes. The fourth theme related to participants’ feelings that the app was complementary to other addiction treatment and support. Participants interpreted and applied ApBM in ways that went beyond the primary intentions of the app, with most perceiving it as a useful supplement to other forms of AUD support. These findings highlight the importance of exploring user experiences and incorporating consumer feedback in future app design to improve the implementation of this brief, convenient, low-cost intervention. The Outpatient project was prospectively registered with ClinicalTrials.gov on November 11, 2021, registration number NCT05120856 https://clinicaltrials.gov/ct2/show/NCT05120856. The Rehabilitation project was prospectively registered with the Australian New Zealand Clinical Trials Registry on September 15 2022, registration number ACTRN12622001245785 https://anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12622001245785.
586 Background: Active surveillance (AS) remains a preferred option for clinical stage 1 (CS1) TGCT. Biomarkers to predict recurrence are limited by poor accuracy. Circulating miR-371 has high sensitivity and specificity for TGCT, and as a marker of MRD post-orchiectomy (orch), is a promising biomarker for predicting recurrence. Initial results from CLIMATE examine the discriminatory accuracy of baseline post-orch miR-371 in predicting recurrence in patients with CS1 TGCT undergoing AS. Methods: Patients from 12 sites in Australia and New Zealand, aged ≥18y, with histologically confirmed CS1 TGCT, no evidence of metastases and planned for AS, were enrolled ≤6w post-orch. Plasma and serum were collected at baseline (≤6w post-orch) and every 3mo for 24mo and at recurrence. Clinical and outcome data were recorded in iTestis, Australia’s TGCT registry. miR-371 was assessed using a qPCR assay based upon published methodology (Murray et al.) and deemed detectable if the mean of triplicate qPCR Ct was ≤40. Results: CLIMATE enrolled 200 patients from 2021 to 2025. 196 patients had assays run on baseline samples prior to data cutoff and were included in this analysis. Orch histology included 117 (60%) pure seminoma and 79 (40%) non-seminoma. With median follow-up (F/U) 18.9mo, there were 40 recurrences. miR-371 was detected at baseline in 42 (21%) plasma and 34 (17%) serum samples. Assays using plasma performed better than serum (AUC 0.77 v 0.69) and are reported hereafter. In predicting recurrence, baseline miR-371 demonstrated positive predictive value (PPV) 62%, negative predictive value (NPV) 91%. Detectable baseline miR-371 was associated with significantly poorer Recurrence Free Survival (RFS) compared to undetectable miR-371 (HR 10.28, p<0.001; 24mo RFS 32% v 89%). miR-371 outperformed existing biomarkers for predicting recurrence. For seminoma, with 10 (8%) recurrences and median F/U 18.4mo, miR-371 had superior discriminatory accuracy for recurrence compared to tumour size >4cm (AUC 0.86 v 0.57, p=0.02) and Boorman risk group (AUC 0.86 v 0.61, p=0.03). For non-seminoma, with 30 (38%) recurrences and median F/U 20.8mo, miR-371 had superior discriminatory accuracy for recurrence compared to presence of lymphovascular invasion (AUC 0.73 v 0.58, p=0.04), or embryonal carcinoma (AUC 0.73 v 0.53, p<0.001). Sensitivity analysis of 84 (43%) pts with recurrence or >24mo F/U supported high discriminatory accuracy of miR-371 (AUC 0.80, PPV 90%, NPV 67%) and significant difference in RFS (HR 8.59, p<0.001, 24mo RFS 7% v 75%). Conclusions: In this initial analysis of CLIMATE, detectable post-orch miR-371 in CS1 TGCT is a marker of MRD with superior discriminatory accuracy for predicting recurrence. Its utility in guiding use of adjuvant chemotherapy warrants exploration. Clinical trial information: ACTRN12622000247774.
