The Royal Hobart Hospital is a public hospital in the Hobart CBD, Tasmania, Australia. The hospital also functions as a teaching hospital in co-operation with the University of Tasmania. The hospital's research facilities are known as the Royal Hobart Hospital Research Foundation. Also close to the hospital site is the Menzies Research Institute.The hospital is run by the Tasmanian Government as part of the Department of Health and Human Services and is the largest hospital, and the largest employer, in Tasmania. The hospital provides services for all of southern Tasmania and has capacity for 400 patients. Many statewide services such as cardiothoracic surgery, neurosurgery, major trauma, high-risk obstetrics, hyperbaric medicine, and neonatal intensive care are based at the hospital, with referrals coming in from the north and northwest.The main entrance underwent construction for a new underground emergency department. This began operation in early 2007 with surrounding construction ongoing. A more recent hospital redevelopment project was initiated with A$565 million in funding, including a new women's and children's precinct, cancer service, intensive care unit, and day surgery facility.
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
BACKGROUND AND AIMS:A hypertensive response to exercise is independently associated with cardiovascular disease (CVD), but clinical interpretation may be confounded by aerobic capacity (fitness). The aim of this study was to determine the relationship between exercise blood pressure (BP) relative to fitness and CVD events. METHODS:Clinical exercise test records were analysed from 12 743 people (aged 53 ± 13 years, 60% male) who completed a standard exercise stress test (Bruce treadmill protocol, stages 1-4) at six Australian hospitals. Records were linked to administrative datasets (hospital and emergency admissions, death register) to define clinical characteristics and the primary outcome of fatal/non-fatal CVD events. Exercise systolic BP relative to fitness was calculated from the quotient of systolic BP and peak METs (SBP/METPeak). Competing risks regression was undertaken to compare events across quartiles, at the 90th percentile, and at various thresholds of SBP/METPeak. RESULTS:Over a median follow-up of 51 months (interquartile range: 32-75 months), 1349 events occurred. Exercise systolic BP without consideration of fitness was not associated with cardiovascular events (P > .05). In models adjusted for age, sex, and pre-exercise systolic BP, there was a stepwise increase in cardiovascular events across SBP/METPeak quartiles at stages 1-3 and peak (fourth quarter hazard ratios [HR]: stage 1 HR 2.54, 95% confidence interval [CI] 2.08-3.12; stage 2 HR 2.05, 95% CI 1.64-2.57; stage 3 HR 1.60, 95% CI 1.22-2.10; peak HR 2.43, 95% CI 1.99-2.98). SBP/METPeak ≥90th percentile was associated with a 55-94% increased risk of cardiovascular events vs < 90th percentile (stages 1-3 and peak, P < .001). Thresholds from 15 to 24 mmHg/METPeak were associated with cardiovascular events in both males and females (P < .001, stages 1-3 and peak). Results persisted in those without CVD, normal pre-exercise BP, and in those on BP-lowering medication. CONCLUSIONS:Exercise systolic BP relative to fitness is associated with increased risk for cardiovascular events and could provide a clinically actionable marker to prompt targeted intervention to lower hypertension-related cardiovascular risk.
BACKGROUND:Contrast-induced encephalopathy (CIE) is an increasingly observed complication following neurointervention, but remains poorly defined with limited evidence for clinical decision-making. We sought to characterize the stereotypical clinical features of CIE in a nationwide, multicenter cohort. METHODS:A multicenter cohort study was conducted between 10 neurovascular sites across Australia. Patients were screened according to the previously proposed Australian diagnostic criteria. Descriptive analysis was conducted to characterize the clinical course and outcomes of CIE, and associations between clinical and radiological variables on patient outcomes were analyzed using Fisher's exact and χ2 tests. RESULTS:A total of 56 patients (median age 65 years) were included. The median contrast volume was 170 mL (IQR 140-229). Median time to symptom onset was 6 hours (IQR 1-12), with frequent symptoms including motor deficit (55.4%), dysphasia (39.3%), and confusion (35.7%). Common radiological findings included sulcal effacement (45.5%) and subarachnoid contrast staining (30.9%) on CT. Hemianopia (p=0.001) and cortical blindness (p=0.018) were associated with posterior circulation interventions, while motor deficit was correlated with anterior circulation interventions (p=0.001). At discharge, 87.5% of patients achieved complete resolution of symptoms, of which 69.4% achieved complete recovery within 72 hours. CONCLUSION:CIE is a recognized complication of neurointervention. Symptoms occur within hours of contrast administration and correlate with the territory of contrast administration. Most patients achieve complete symptom resolution. Ongoing investigation is required to further define CIE as a clinical entity.
Background Bordetella pertussis continues to circulate globally despite widespread vaccination, with a notable epidemic in 2024. Its resurgence is confounded by the emergence of pertactin-deficient, macrolide-resistant B pertussis strains in Asia and Europe, which are under-recognised by conventional diagnostics. We aimed to apply targeted culture-independent next-generation sequencing (tNGS) of respiratory specimens to improve global B pertussis diagnostic capability and genomic surveillance. Methods We did a nationwide genomic epidemiology study of B pertussis RT-PCR-positive respiratory specimens that were retrospectively and prospectively collected by diagnostic and public health laboratories in six of seven states and territories of Australia. Specimens underwent tNGS and macrolide-resistant B pertussis-specific PCR, and an opportunistic subset from New South Wales and Queensland were cultured for confirmatory susceptibility testing and whole-genome sequencing. Sequencing data were analysed for genome recovery, virulence profiles, and macrolide resistance mutations, and were compared with international macrolide-resistant B pertussis genomes and ancestral Australian genomes. The performance of the tNGS approach was assessed with logistic regression relative to RT-PCR cycle threshold values, and sensitivity and specificity values were calculated. Findings 255 respiratory specimens positive for B pertussis were included in the study. 64 (25%) were retrospectively collected between Jan 12, 2012, and Dec 31, 2023, and 191 (75%) were prospectively collected between Jan 1 and Oct 28, 2024. Of these 255 specimens, 148 (58%) yielded near-complete B pertussis genomes through tNGS. Seven co-circulating lineages of B pertussis were documented, including two associated with macrolide-resistance. Eight epidemiologically unrelated and geographically dispersed cases of macrolide-resistant B pertussis with a 23S rRNA 2037A→G mutation were identified by tNGS and confirmed by whole-genome sequencing. Three of these were further validated by phenotypic testing. The estimated prevalence of macrolide resistance among Australian cases positive for B pertussis was 4% (eight of 188). Interpretation tNGS can recover near-complete B pertussis genomes directly from clinical specimens, enabling identification of macrolide resistance mutations and high-resolution phylogenetic analysis. These findings show that tNGS complements PCR-based surveillance by providing genome-wide assessment of resistance, virulence, and genomic diversity in a single workflow. Funding NSW Health Prevention Research Support Program.
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
