The Prince Charles Hospital (TPCH) is a major teaching and tertiary referral hospital in the northern suburb of Chermside in Brisbane, Australia. TPCH is a public hospital operated by Metro North Health, the largest health service in Queensland Health. The hospital is described to be the "leading cardiothoracic hospital in Australia", and provides services to patients in Queensland and northern New South Wales. The Prince Charles Hospital employs 3,390 staff, including 635 doctors and 2,150 nursing staff, and provides around 340,000 episodes of care each year. Beyond cardiothoracic care, The Prince Charles Hospital also provides general surgical and medical services, including both a paediatric and adult emergency medicine department, and specialist outpatient, rehabilitation, and palliative care services. The hospital is actively involved in medical research, and has research partnerships with the University of Queensland, the Queensland University of Technology, and the Australian Catholic University.
BACKGROUND:Preclinical data indicate that inhaled treprostinil may be useful for the treatment of idiopathic pulmonary fibrosis (IPF) through an antifibrotic mechanism, a premise that is supported by clinical observation. METHODS:In this phase 3, double-blind trial, we randomly assigned patients with IPF to receive inhaled treprostinil or placebo (12 breaths four times daily) over a period of 52 weeks. The primary end point was the change from baseline in the absolute forced vital capacity (FVC) at week 52. Secondary end points, which were analyzed in a prespecified order to control for multiplicity, were clinical worsening and acute exacerbation of IPF (each assessed in a time-to-event analysis), death by week 52, and the change from baseline in the percentage of predicted FVC, quality of life, and the diffusing capacity of the lungs for carbon monoxide by week 52. Safety was also assessed. RESULTS:A total of 593 patients underwent randomization and received at least one dose of treprostinil (298 patients) or placebo (295 patients). Of these, 463 patients (224 in the treprostinil group and 239 in the placebo group) completed the trial assessments through week 52. The mean age of the patients was 71.7 years, 80.1% were men, the mean FVC at baseline was 76.8%, and 75.4% of the patients were receiving background antifibrotic therapy. The median change in FVC at week 52 was -49.9 ml (95% confidence interval [CI], -79.2 to -19.5) in the treprostinil group and -136.4 ml (95% CI, -172.5 to -104.0) in the placebo group; the between-group difference in the change in FVC was 95.6 ml (95% CI, 52.2 to 139.0; P<0.001). Clinical worsening occurred in 81 patients (27.2%) in the treprostinil group and 115 patients (39.0%) in the placebo group (hazard ratio, 0.71; 95% CI, 0.53 to 0.95; P = 0.02). No substantial between-group difference in the time to IPF exacerbation was observed, and so no further inferences with regard to subsequent secondary end points were made. The most common adverse event was cough, reported in 48.3% of the patients in the treprostinil group and 24.1% of those in the placebo group. Discontinuation of treprostinil or placebo occurred in 33.6% and 24.7%, respectively, with approximately half these patients citing adverse events as the primary reason for discontinuation. CONCLUSIONS:In patients with IPF, inhaled treprostinil was associated with a smaller decline in FVC and fewer clinical-worsening events than placebo over a period of 52 weeks. (Funded by United Therapeutics; TETON-2 ClinicalTrials.gov number, NCT05255991.).
BACKGROUND:Cystic fibrosis (CF) is a genetic disease with increasing life expectancy due to advances in treatment. However, this increased life expectancy has led to new health challenges, especially diabetes. Nearly 25% of adults with CF develop diabetes, but only a minority receive endocrinology care. OBJECTIVE:This study aimed to co-design, implement, and evaluate a nested diabetes model of care (MOC) for adults with CF and diabetes in a single tertiary adult CF center in Australia. METHODS:We used several implementation frameworks to co-design the MOC with consumer and provider end-users. Following MOC implementation, we used database-driven analytics to evaluate changes in the primary clinical outcome (HbA1c) pre and post study at 1 year. A mixed methods approach was used to evaluate secondary clinical and non-clinical outcomes. RESULTS:The MOC promoted multidisciplinary collaboration and streamlined patient journeys, leading to high engagement. Thus, 76.7% of the entire CF cohort with confirmed diabetes was reviewed within the first year of operationalization. Engagement with the MOC was associated with a statistically significant decline in HbA1c (-0.54% vs +0.33%, p- value 0.004) and a 0.22% [95% CI 0.19 -0.32] per month increment in percent predicted forced expiratory volume (ppFEV1). CONCLUSION:Our co-designed MOC demonstrated high engagement as well as improving glycemic management and lung function in adults with CF and diabetes. Our approach to CF diabetes care may reduce the treatment burden in the order of initiating a new diabetes medication while concurrently enhancing end-user experiences of health care. SPANISH ABSTRACT:http://links.lww.com/IJEBH/A473.
Nontuberculous mycobacterial (NTM) infections are difficult to treat and are associated with significant morbidity and mortality. Reported success rates with guideline-based therapy vary depending on NTM species and up to 70
BACKGROUND:Although robotic arm-assisted total hip arthroplasty (RA-THA) has been increasing in popularity, the outcomes following its use are still uncertain. METHODS:We performed a propensity-matched prospective cohort study comparing all-cause revision, odds of instability/dislocation, odds of periprosthetic joint infection, and hospital length of stay (HLOS) between patients receiving an RA-THA versus a conventional THA (CO-THA). Consecutive patients undergoing a primary elective THA via a posterior approach at our institution between January 2019 and February 2024 were included. Those who received a bilateral simultaneous THA were excluded. We successfully matched 268 pairs of hips. RESULTS:There was no difference in all-cause revision risk between the RA-THA and CO-THA groups (hazard ratio = 1.00; P = 1.000). Furthermore, there was also no significant difference in the odds of instability/dislocation (odds ratio = 1.00; P = 1.000) and the odds of periprosthetic joint infection (odds ratio = 0.75; P = 0.704). The HLOS was significantly shorter in the RA-THA cohort by 0.49 days (P = 0.044). The median follow-up duration was 3.46 years (interquartile range: 1.92 to 4.64). CONCLUSIONS:Although there was no difference in short-term revision risk in patients receiving an RA-THA versus a CO-THA, likely, the benefits from improved implant positioning are yet to be realized. This study is underpowered, and results should be interpreted with caution. The shorter HLOS observed in the RA-THA group may help offset the increase in consumable costs incurred. Further studies with long-term follow-up, alongside a cost-effectiveness analysis, are required.
BACKGROUND:Mobile health (mHealth) is a novel model of care that may overcome barriers to pulmonary rehabilitation (PR) access. This study determined if mHealth PR was equivalent to centre-based PR (CB-PR) in improving exercise capacity and health status in people with chronic obstructive pulmonary disease (COPD). METHOD:Single-blinded, multicentre, randomised controlled equivalence trial using an intention-to-treat analysis. Participants completed 8 weeks of either mHealth PR, using the mobile PR (m-PR) application and supported by telephone calls, or CB-PR. Co-primary outcomes, measured at baseline and end-intervention, were change in 6 minute walk distance (6MWD) and COPD assessment test (CAT) score, with an equivalence margin of 30 m and 2 points, respectively. RESULTS:90 participants were randomised (mean (SD), m-PR n = 44: age 75 (7) years; forced expiratory volume in one second (FEV1) 58 (15) % predicted; CB-PR n = 46: age 75 (6) years; FEV1 55 (14) % predicted) with 38 m-PR participants and 42 CB-PR participants completing at least one primary outcome. At end-intervention, there was no between-group difference in 6MWD (mean difference (MD) 13 m, 95% CI -6 to 31), indicating equivalence of m-PR to CB-PR. There was a significant between-group difference in CAT score (MD -4.9 points, 95% CI -7.2 to -2.6), with both limits of the CI exceeding the equivalence margin, indicating superiority of m-PR. CONCLUSION:An mHealth PR programme resulted in equivalent improvements in exercise capacity and superior improvements in health status when compared with CB-PR in people with COPD. mHealth PR could be effective as a management option for people with COPD with adequate digital literacy. TRIAL REGISTRATION NUMBER:ACTRN12619001253190.
