Western Health is the governing body for healthcare regulation in an area of the Canadian province of Newfoundland and Labrador.
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: Hepatocellular carcinoma (HCC) poses a significant public health challenge in Australia, with poorer survival observed in non-metropolitan populations. This study investigated whether survival disparities persist between non-metropolitan and metropolitan patients if only those with early-stage HCC treated at metropolitan tertiary referral centres are considered. Methods: We performed a retrospective cohort study across ten Australian tertiary centres involving patients with a new diagnosis of Barcelona Clinic Liver Cancer (BCLC) stage 0 or A, recorded from 1 January 2016 to 31 December 2020. Residential postcodes were entered using the Modified Monash (MM) model to define metropolitan versus non-metropolitan residence. The primary endpoint was adjusted for all-cause mortality. Results: Our study included 854 patients (metropolitan n = 612, and non-metropolitan n = 242) with a median follow-up of 42.6 months. We found no significant survival or mortality differences between the two groups with the unadjusted Kaplan–Meier survival analysis (log-rank test p = 0.612) and with the Cox proportional hazards regression analysis (adjusted HR 0.93, 95% CI 0.64–1.34, p = 0.690). As expected, tumour burden, Child–Pugh Score, and Charlson Comorbidity Index (CCI) were significant predictors of mortality. Conclusions: Our findings suggest that previously observed survival disparities may stem from delayed diagnosis and reduced access to tertiary care in non-metropolitan regions and highlight the need for improved HCC surveillance and referral pathways, particularly for rural and Indigenous communities, to mitigate geographic inequities.
BACKGROUND:Approximately 10% of hospitalized patients globally report a penicillin allergy, leading to inappropriate antibiotic prescribing and inferior healthcare outcomes. Evidence supporting the effectiveness and widespread implementation of inpatient penicillin direct oral challenge (DOC) is limited. METHODS:A prospective, multicenter, international type 2 hybrid effectiveness-implementation study was conducted in 40 hospitals across 8 countries between November 2022 and May 2025. Adult inpatients with a penicillin allergy underwent assessment using a digital penicillin allergy toolkit (National Antibiotic Allergy Network [NAAN] App). According to site clinical practice, participants received penicillin DOC (effectiveness intervention) or assessment only. Participating sites received bimonthly audit and feedback at least 3 months after site activation (implementation strategy). Observational data were used to emulate a target trial to examine secondary effectiveness outcomes, including antibiotic prescribing at 90 days in DOC versus non-DOC participants. The primary implementation outcome was adoption of the NAAN App within 6 months of site activation. RESULTS:Among 5121 participants assessed, 1573 (30.7%) underwent DOC, of which 1502 (95.5%) were delabeled. Of 71 (4.5%) participants with a positive DOC, 6 (0.4%) had a serious adverse event. Of 1852 inpatients in the target trial analysis, 892 underwent DOC and 960 underwent assessment only. Participants who underwent DOC were more likely to be prescribed penicillin (risk ratio [RR], 13.25 [95% confidence interval {CI}, 7.82-22.46]), and less likely to be prescribed World Health Organization (WHO) "Watch" or "Reserve" antibiotics (RR, 0.73 [95% CI, .60-.89]) at 90 days post evaluation. Within 6 months of site activation, 77 clinicians adopted the NAAN App. CONCLUSIONS:Multidisciplinary adoption of inpatient penicillin DOC was safe and significantly improved penicillin prescribing and reduced use of WHO restricted antibiotics.
People from ethnically diverse backgrounds are underrepresented in clinical trials, reinforcing healthcare inequity. Co-production involves users of research (knowledge users) as partners in the research process. A premise of co-production is that it enhances ethicality of research by responding to the needs and preferences of those it is designed for while facilitating adoption and impact. Research reporting co-production in ethnically diverse communities is emerging; however, reporting of specific strategies to support effective co-production remains sparse, particularly when designing interventions for clinical trials. We draw on our experience of co-production with ethnically diverse communities to address this gap in the research literature using the exemplar, MOVE Together: Reduce falls, a co-produced intervention to support people aged over 65 years from ethnically diverse communities to develop exercise habits and reduce their risk of falls. Utilizing an integrated knowledge translation (IKT) approach to co-production, our team of 24 partners, including people aged over 65 years from ethnically diverse communities, representatives from ethnically diverse community groups and service providers developed our intervention over five stages. Two stages engaged 75 participants including 63 (84
BACKGROUND:Reduced preoperative fasting times are beneficial for patients, have negligible aspiration risk and minimise intravenous fluid (IVF) use. For over 15 years the national anaesthetic guidelines in Australia have recommended solid food until 6 h prior to surgery and unlimited clear fluids until 2 h prior to surgery. In 2024 an additional recommendation was added: sips of clear fluids (typically water) up to 200 mL/h until sent to theatres. Nonetheless, 'fast from midnight' (FFM) and 'nil by mouth' (NBM) are commonly used. METHODS:This study was conducted on patients in a single, tertiary, metropolitan hospital. Baseline preoperative fasting data were retrospectively collected from 21/08/2024 to 18/09/2024. A staff education campaign and an EMR smart phrase (".FAST") were then introduced. Post implementation data were prospectively collected from 28/10/2025 to 20/01/2025. Data were analysed for fasting protocol type, total fasting time (TFT), and preoperative IVF use. Data modelling was used to calculate the projected impact of the .FAST protocol. RESULTS:Uptake of best practice fasting guidelines increased from 1% to 47% (p < 0.001). This was associated with a marked IVF use reduction-from 41% to 17% of patients (p < 0.001)-and a decrease in median fasting time from 9 to 2 h (p < 0.001). Median total time on IVF reduced from 8 to 0 h (p < 0.001). Projected annual savings in EGS with 100% uptake of the .FAST protocol were projected to be 23 doctor workdays and 46 nurse workdays (assuming an 8 h workday), and $2460 in IVF cost. CONCLUSIONS:Implementation of a simple to use, contemporary preoperative fasting protocol in EGS through staff education and an EMR smart phrase led to decreased time fasted for patients and IVF use. No patients fasted with .FAST had surgery cancelled due to inadequate fasting.
