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
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.
Abstract We evaluated outcomes by management type for patients with stage IA nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL) in the Global NLPHL One Working Group retrospective database of 2243 patients with stages I to IV disease diagnosed from 1992 to 2021 at 38 international institutions. A total of 779 patients had stage IA disease with median age of 35 years (range, 3-89) and median follow-up of 6.1 years. The 6-year progression-free survival (PFS) and overall survival were 86.3% and 97.7%, respectively. Outcomes were analyzed for the 2 groups: complete resection and unresected disease. Patients with a complete resection and observation alone (n = 99) had a 6-year PFS of 65.5% vs 90.5% for those who received radiotherapy (RT) (n = 53). Patients with unresected disease (n = 627; 80.5%) had a 6-year PFS of 62.0% for rituximab alone (n = 31), 89.6% for RT alone (n = 325), 76.8% for ABVD (doxorubicin, bleomycin, vinblastine, dacarbazine) alone (n = 40), and 94.3% for ABVD plus RT (n = 130). A total of 127 patients relapsed (16.3%), of which 25 (19.7%) had transformation. Our analysis suggests the following: (1) RT improves the PFS in patients with completely resected disease; (2) rituximab or ABVD alone does not appear to achieve a durable response; and (3) chemotherapy was not observed to add additional PFS benefit when used in combination with RT. Thus, for stage IA NLPHL, RT alone is likely sufficient for definitive treatment.
