The Royal North Shore Hospital (RNSH) is a major public teaching hospital in Sydney, Australia, located in St Leonards. It serves as a teaching hospital for Sydney Medical School at the University of Sydney and has approximately 700 beds. It is the referral hospital for Northern Sydney. Its primary referral area accommodates 5.7% of the Australian population or 17% of the NSW population.
Pain is a common public health concern and the primary reason for seeking healthcare. Co-design is a promising approach for developing person-centred pain management interventions. This review aims to explore the characteristics of co-design in pain management interventions and research. This scoping review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guidelines. Systematic searches were conducted in MEDLINE, EMBASE, CINAHL, PsycINFO, Web of Science, and Scopus using key concepts related to pain, co-design, and intervention. Descriptive, thematic, and narrative synthesis were used to present the findings. Forty-seven peer-reviewed articles (n = 44; 94
Patients with groin pain are often referred to hernia surgeons because of imaging-detected inguinal abnormalities, even when no hernia is palpable. Many of these patients have musculoskeletal pathology that would not benefit from surgical intervention. This project aimed to develop a rapid, evidence-informed musculoskeletal screening protocol for use as an adjunct to routine hernia assessment. The protocol was developed in four phases: (1) Structured PubMed search for clinical examination tests relevant to each of the entities defined by the 2016 Doha agreement classification system; (2) QUADAS-2 appraisal and extraction of individual tests based on reliability, diagnostic accuracy, and prevalence; (3) consultation with a sports physiotherapist and a high-volume hernia surgeon; and (4) protocol synthesis. From seven eligible studies, 79 techniques were considered. Thirteen fulfilled our criteria for diagnostic utility and were refined into a six-item protocol. This was titled the Groin Musculoskeletal Assessment Protocol (Groin-MAP). The Groin-MAP screens for adductor-, pubic-, iliopsoas-, and hip-related groin pain. The protocol prioritises low–intra-abdominal-pressure manoeuvres and can be completed in approximately 100 s during simulated testing. Groin-MAP is a fast and simple musculoskeletal screening adjunct to routine hernia assessment. It requires no equipment or pre-requisite knowledge and clearly explains each test and the positioning of the patient and clinician. Prospective validation will be required to determine its diagnostic performance and impact on clinical decision making.
Accurately measuring blood pressure is imperative for diagnosis and control of hypertension. There is a range of devices and methods for measuring blood pressure that each have advantages and limitations. To ensure accuracy of blood pressure measurement and hypertension diagnosis, clinicians and patients should use an accurate and validated blood pressure measurement device, an appropriately sized cuff, and take several measurements rather than only one measurement, using a standardised measurement protocol. Out-of-clinic measurement, using an ambulatory or home blood pressure monitoring device, depending on patient preference, should be used to confirm diagnosis and guide treatment of hypertension. There are emerging new technologies for blood pressure measurement (e.g. wearable technologies) that are yet to be validated and have the potential to improve blood pressure monitoring and patient self-management.
QuestionIn patients at increased risk of pulmonary complications undergoing cardiac surgery, does prophylactic high-flow nasal oxygen therapy (HFNOT) initiated at the time of extubation have important clinical benefits vs the use of standard oxygen therapy (SOT)?FindingsIn this randomized clinical trial that included 1280 adults, HFNOT did not improve clinical outcomes compared with SOT.MeaningThese findings do not support the routine implementation of prophylactic HFNOT for noninvasive respiratory support following cardiac surgery. This randomized clinical trial investigates the use of high-flow nasal oxygen therapy in patients at high risk of pulmonary complications following nonemergent cardiac surgery and assesses the clinical benefits of this technique compared with standard oxygen therapy. ImportanceHigh-flow nasal oxygen therapy (HFNOT) is used for noninvasive respiratory support following cardiac surgery despite uncertainty about its clinical effectiveness or associated costs.ObjectiveTo determine whether prophylactic HFNOT in patients at increased risk of respiratory complications following cardiac surgery has clinical benefits compared with standard oxygen therapy (SOT).Design, Setting, and ParticipantsThis adaptive, parallel group, randomized clinical trial collected and analyzed data from 17 cardiac surgery centers in 3 countries between October 7, 2020, and June 19, 2024. Eligible participants included adults undergoing nonemergent cardiac surgery with any of the following risk factors for pulmonary complications: chronic obstructive pulmonary disease, asthma, lower respiratory tract infection in the last 4 weeks, a body mass index of 35 or greater, or currently or recently smoking for longer than 10 pack-years. Outcome assessors were blinded. A preplanned sample size re-estimation was conducted after 300 participants completed the 90-day follow-up.InterventionParticipants were randomized at a 1:1 ratio with concealed allocation to HFNOT or SOT administered for at least 16 hours immediately after postoperative extubation.Main Outcomes and MeasuresThe primary effectiveness outcome was days alive and at home (DAH) without increased support compared with baseline in the first 90 days (DAH90). Any day of increased support, including at home, would provide a value of 0 for that day. Secondary outcomes included DAH90 without considering the additional support component.ResultsA total of 1280 patients were recruited (mean [SD] age, 62.9 [10.5] years; 892 [69.7%] men; 640 in each group), of whom 1224 (95.6%) had complete DAH90 data. The primary outcome of median DAH90 was 0 (IQR, 0-79) for the HFNOT group and 0 (IQR, 0-87) for the SOT group (median difference, 0 [95% CI, 0-0]; P = .75). Secondary clinical outcomes, including DAH90 without considering whether additional support was required, were similar between groups.Conclusions and RelevanceIn this randomized clinical trial of HFNOT in patients at increased risk of postoperative pulmonary complications after nonemergent cardiac surgery, HFNOT did not improve DAH90 without increased support. These findings do not support the implementation of routine prophylactic HFNOT after cardiac surgery.Trial Registrationisrctn.org Identifier: ISRCTN14092678
INTRODUCTION:Lung cancer is the leading cause of cancer-related mortality worldwide. Immune checkpoint inhibitors (ICIs) are standard first-line therapy for metastatic non-small cell lung cancer (NSCLC), but real-world outcomes in Australia are limited. MATERIALS AND METHODS:We conducted a retrospective, population-based cohort study using the Pharmaceutical Benefits Scheme and National Death Index data, accessed via the Australian Bureau of Statistics DataLab. Adults initiating pembrolizumab with chemotherapy between January 1, 2019, and June 30, 2023, consistent with KEYNOTE-189 and KEYNOTE-407 trial regimens, were included. Overall survival (OS) and time to treatment discontinuation (TTD) were evaluated using Kaplan-Meier methods and multivariable Cox regression. Immune-related adverse events (irAEs) were inferred from incident corticosteroid or levothyroxine prescriptions. Subgroup analyses were conducted by age (18-64 vs. ≥ 65 years) and sex. RESULTS:Among 4782 patients (KEYNOTE-189: n = 3638; KEYNOTE-407: n = 1144), median OS was 13.8 months in the KEYNOTE-189 cohort and 12.0 months in the KEYNOTE-407 cohort. Female patients had significantly longer OS than males in both cohorts. Median TTD did not differ significantly by age or sex. Levothyroxine initiation, used as a proxy for thyroid-related irAEs, was more frequent among female patients across both cohorts. DISCUSSION:In this nationwide cohort, real-world survival with pembrolizumab-chemotherapy was shorter than in clinical trials. Observed sex-based differences in survival and irAE proxies suggest potential biological variation in ICI response and toxicity. These findings highlight the value of population-level data to inform personalised, evidence-based immunotherapy in advanced NSCLC.
