Liverpool Hospital is located in the South Western Sydney suburb of Liverpool, New South Wales, Australia and is a 50-minute drive from the Sydney CBD. It is the second largest hospital in New South Wales (behind Westmead Hospital) and one of the leading trauma centres in Australia.It has a maximum capacity of 960 beds, 23 operating rooms and 60 critical care beds, diagnostic and imaging services, emergency and trauma care, maternity, paediatric, cancer care, mental health, ambulatory care, allied health and medical and surgical services from birth to aged care.The hospital is the major health service for South Western Sydney, providing services to the local government area of Liverpool City Council as well as district services to residents and visitors in the area. It also provides a range of statewide services in areas such as critical care and trauma, neonatal intensive care and brain injury rehabilitation.Liverpool Hospital sits within an education and health precinct which includes the Ingham Institute of Applied Medical Research, Clinical Schools of the University of New South Wales and Western Sydney University, South West Private Hospital and South Western Sydney TAFE.It is a principal teaching hospital of the University of New South Wales and the Western Sydney University and continues to have an active education programme for medical practitioners, nurses and health professionals, with a range of clinical placements available for students from universities around Australia..
Trans-radial access (TRA) offers advantages in elective settings, but its safety and feasibility in emergencies remain understudied. This study compares TRA and trans-femoral access (TFA) in emergency embolizations at a Level 1 trauma center. Ethical approval was obtained for this retrospective analysis. A total of 421 emergency embolizations performed on 389 patients were included. TRA (n = 95, including 44 distal radial) and TFA (n = 326) were compared for technical success rate, procedural success rate, and access-site complications. Multivariate analysis was used to identify independent predictors of complications. TRA patients were younger (median 58 vs. 66 years; p = 0.044) with less hypertension (33.7
BACKGROUND:Although cardiovascular disease is common in patients with chronic obstructive pulmonary disease (COPD), the efficacy and safety of β blockers in reducing cardiac events and mortality is uncertain. This study was designed to assess whether the cardioselective β blocker, bisoprolol, improves cardiorespiratory outcomes when added to usual COPD care. METHODS:This double-blind, randomised, controlled, phase 3 trial was done across 22 hospital and research institute sites selected by research experience and resources to conduct the study in Australia, India, New Zealand, and Sri Lanka. Participants aged 40-85 years with COPD, post-bronchodilator FEV1 30-70% predicted, and at least one COPD exacerbation in the previous 2 years were randomly assigned to receive bisoprolol (1·25-5 mg) or matched placebo, orally, once daily, for 2 years, with both groups continuing to receive usual COPD care. Randomisation was with a concealed, computer-generated sequence, stratified by site, smoking status, and previous diagnosis of cardiovascular disease requiring treatment. Participants, site personnel, and investigators remained masked to study treatment throughout the trial. The primary outcome was a composite of cardiac and respiratory effects, starting with the most important outcome (death), then cardiac or respiratory hospital admissions, exacerbations, quality-of-life measures, and FEV1. Analysis was by intention-to-treat (ITT) in all randomly assigned patients, using a country-stratified win ratio. Adverse events were analysed from the ITT population using all available data. Missing data were not used to determine wins, but regarded as a tie on that level of the hierarchy. The trial was prospectively registered on ClinicalTrials.gov (NCT03917914), Clinical Trial Registry - India (CTRI/2020/08/027322), and the Sri Lanka Clinical Trials Registry (SLCTR/2021/033). The study is complete. FINDINGS:Of 360 participants screened for eligibility between June 30, 2020, and March 20, 2023, 280 were randomly assigned to bisoprolol (n=143) or placebo (n=137), with 249 completing 2 years of follow-up. 233 patients (83%) were male and 47 (17%) were female; mean age was 68 years (SD 8). Mean post-bronchodilator FEV1 was 45% (SD 11) predicted at baseline. According to the hierarchy of outcomes, bisoprolol was associated with better cardiorespiratory health for 3041 (45%) of 6763 comparisons and placebo for 3240 (48%), with 482 (7%) showing no difference, giving a win ratio of 0·95 (95% CI 0·72 to 1·25, p=0·72) and a net benefit of -2% (95% CI -15 to 10) with bisoprolol. No significant differences were seen between bisoprolol and placebo in all-cause mortality, cardiorespiratory hospitalisations, major adverse cardiac events, or moderate or severe COPD exacerbations. Additionally, no significant differences were seen in FEV1, COPD symptoms, or quality of life, or adverse events. The most common adverse events were COPD exacerbations, occuring in 83 (58%) participants in the bisoprolol group and 87 (64%) in the placebo group. 15 (10%) participants in the bisoprolol group and 11 (8%) in the placebo group died. None of these deaths were attributed to the treatment. INTERPRETATION:In patients with moderately severe COPD, treatment with bisoprolol made no difference to overall cardiorespiratory health, all-cause mortality, or serious cardiorespiratory events. FUNDING:National Health and Medical Research Council of Australia and the Health Research Council of New Zealand.
Objective Central venous access device (CVAD) insertion is a routine procedure in intensive care units (ICUs); however, it is associated with procedural risks. While structured training enhances safety, significant variability exists in training, supervision, and competency assessment across ICUs. Standardised education and assessment frameworks are recommended to improve procedural safety and patient outcomes. This study aimed to evaluate ICU trainees’ experiences with CVAD insertion training, identify any significant variation in current educational frameworks, and gather recommendations for enhancing training and assessment. Design A web-based survey was distributed to ICU trainees across Australia, New Zealand, Singapore, and Hong Kong. Data were analysed using descriptive statistics and regression models. Main outcome measures Key outcomes included trainee's perceptions of training disparities, accreditation processes, and practice variations across ICUs, informing the development of a standardised CVAD training framework. Results Among 237 respondents, 199 responses were analysed. Fewer than two-thirds of trainees in tertiary and metropolitan ICUs and only 17% in regional and private ICUs, reported access to structured multimodal CVAD training, while 15.3% indicated no formal training was available. Fewer than a quarter (23.1%) of less experienced trainees reported having undergone competency assessments in the past 12 months. Commonly perceived challenges included coordinating ultrasound guidance and manipulating the guidewire and catheter. Most trainees (52.3%) recommended six to ten supervised insertions and competency across multiple insertion sites (∼60%) for accreditation. Conclusions These findings highlight trainees' perceptions of critical gaps in CVAD training, emphasising the need for structured multimodal education, standardised competency assessments, and improved access to training resources across diverse ICU settings.
Introduction:The phase 3 REFLECT trial demonstrated the efficacy and safety of lenvatinib versus sorafenib in the first-line treatment of patients with unresectable hepatocellular carcinoma (uHCC). We report results from STELLAR, a non-interventional post-marketing study. The primary objectives were to characterize hepatotoxicity and overall safety of lenvatinib in patients from Western regions with uHCC. Methods:STELLAR was a prospective, open-label, observational, phase 4 study of patients treated with lenvatinib (n = 193). A cohort of sorafenib-treated patients (n = 123) was included as an internal reference group. The treating physician made the decision to treat patients with lenvatinib or sorafenib before enrollment. Study drugs were administered according to the Summary of Product Characteristics guidelines. Safety and efficacy evaluations were performed according to standard clinical practice at each site. The primary endpoint was safety. Secondary endpoints included treatment exposure and overall survival. Results:The median duration of treatment with lenvatinib or sorafenib was 6.5 months (range, 0.2-33.1 months) and 4.4 months (range, 0.5-30.7 months), respectively. Hepatotoxicity treatment-emergent adverse events (TEAEs) were observed in 26.9% of lenvatinib-treated patients and 33.3% of sorafenib-treated patients. The most frequently reported hepatotoxicity TEAEs were hepatic encephalopathy (7.8%; lenvatinib cohort) and ascites (11.4%; sorafenib cohort), respectively. Overall, 85.0% of lenvatinib-treated patients and 84.6% of sorafenib-treated patients experienced ≥1 TEAE. Median overall survival (95% CI) was 16.9 months (14.1-not estimable) in lenvatinib-treated patients. Conclusion:Our findings support the established safety and efficacy of lenvatinib in first-line patients with uHCC.
Background and objective:Recent observational data suggest that cardioselective β-blockers like bisoprolol are safe and beneficial for patients with COPD. However, the acute effects of bisoprolol on lung and cardiovascular function in these patients is unclear, a gap that this study aimed to address. Methods:This was a subanalysis of pre-randomisation screening visit data from the ongoing Preventing Adverse Cardiac Events (PACE) in COPD randomised controlled trial. If all other eligibility criteria were met, participants were orally administered an unblinded 1.25 mg tablet of bisoprolol. Post-bronchodilator spirometry, heart rate and blood pressure were monitored at 0, 30 (cardiovascular parameters only), 60 and 120 min. For this subanalysis, respiratory intolerance was defined as a decrease in forced expiratory volume in 1 s (FEV1) (L) ≥200 mL and ≥12% from the 0-min FEV1 (L) value; and cardiovascular intolerance was defined as systolic blood pressure (SBP) falling below 100 mmHg at 1 or 2 h. Results:Of 359 consented participants, 292 conducted the test-dose procedure. 13 (4.5%) were respiratory intolerant and six (2.1%) were cardiovascular intolerant at 1 or 2 h. No participant was intolerant for both. There was no significant difference in FEV1 (L) or SBP at baseline At 120 min the intolerant group's mean FEV1 had significantly decreased to 1.05 L (95% CI 0.86-1.25 L; p<0.0001); the tolerant group experienced no change (1.10, 1.05-1.14 L; p=0.33). Conclusion:The administration of 1.25 mg bisoprolol was acutely well tolerated in >95% of COPD patients.
