Abstract Introduction Sedative medications are commonly prescribed for older adults; these include neuroleptics, benzodiazepines, opioids, ‘z’ drugs and trazadone. The prevalence of sedative drug prescriptions is increasing (1). Nursing home residents are three times more likely to be prescribed benzodiazepines (2). Regular medication review and education have been shown to reduce rates of sedative use in nursing homes (3). We previously demonstrated a significant reduction in prescription of these target medications at an Irish nursing home with specific focus, within scheduled medication reviews, on reduction or discontinuation of the target drugs in combination with education on management of Behavioural and Psychological symptoms (BPSD). This audit examines the prescribing patterns 3 years on from the initial audit. Methods Point prevalence study of sedative prescriptions and BPSD of all 95 nursing home residents on 6/5/21. Comparison with data from two previous audits in the same unit. All data was anonymised. Data analysed with SPSS statistical software. Results Sustained significant drop in quetiapine use from 30% of residents to 14% post-intervention in 2018 and three-year follow-up (p = 0.06). Borderline significant reduction in overall neuroleptics (from 39% to 25%, p = 0.06). Significant rise in ‘z’ drug prescription (from 8% to 17%, p = 0.03). BPSD reported in 33%, compared to 49% pre-intervention. Conclusion Regularly scheduled medication reviews can effectively rationalise sedative prescription rates in nursing home residents. Increasing ‘z’ drug prescription likely represents the appropriate replacement of neuroleptics. Reduced BPSD may be due to reporting bias of staff since regular education has been introduced or changing cohort of residents. References numbered above not included given limited word count.

This review aims to understand how Australia compares internationally in the practice of teledermatology for the diagnosis and management of skin cancer, and in the process, ascertain the robustness of the evidence for teledermatology, as well as identify its limitations and current difficulties for its adoption in Australia. Diagnostic and treatment concordance, time to detection and action, as well as expected cost in Australia were comparable with international studies. Earlier detection of skin cancer and convenience such as reduced travel are main reasons supportive of teledermatology. Potential limitations of teledermatology are seen in high-risk melanoma patients, the older population, and those with multiple co-morbidities requiring reviews by various specialties. Image documentation and storage on personal devices are ongoing issues despite existing guidelines. Australia remains a pioneer in the research of teledermatology, while collaborating with international groups to advocate quality research and its practical use, with a focus on patient-led mobile teledermoscopy.

For patients with locally advanced, resectable gastric or gastro-oesophageal junction adenocarcinoma, peri-operative chemotherapy with Fluorouracil/Leucovorin, Oxaliplatin, and Docetaxel (FLOT) is associated with a significant overall survival benefit and improved pathological response when compared with Epirubicin, Cisplatin, and Fluorouracil (ECF), as published in the Lancet Journal, May 2019. In the West of Scotland, delivery of peri-operative FLOT chemotherapy has been implemented since 2018 with the addition of prophylactic GCSF. Here we present our real-world experience with particular focus on pathological outcomes and tolerability of treatment. Chemocare was used to identify patients across the West of Scotland, treated over 2 surgical centres, receiving peri-operative FLOT chemotherapy between January 2018 and September 2019. Data were collected from Chemocare and electronic case records and collated on Microsoft Excel. There were 46 patients (78% male (n=36) and 22% female (n=10)) with a median age 64 (range 28 - 74) identified receiving FLOT chemotherapy between 9th May 2018 and 20th September 2019. All patients had performance status 0 (59%) or 1 (41%). Two patients were excluded from analysis as they were initially suspected, and with subsequent investigations, confirmed to have metastatic disease. Forty-three patients (98%) received a minimum of 4 cycles of neoadjuvant chemotherapy. Dose reductions were made in 19 patients (43%) and a delay in subsequent neoadjuvant chemotherapy cycles was required in 14 patients (32%). Grade 3 toxicities occurred in 6 patients (14%): neutropenia (n=3; of which 1 had neutropenic sepsis), diarrhoea (n=2) and laryngospasm (n=1). Thirty-three patients (75%) underwent definitive resectional surgery. Reasons for not proceeding included: not fit (n=3), progressive disease pre-operatively (n=6) and progressive disease at the time of operation (n=4). Median time from the last cycle of FLOT to surgery was 47 days (range 31 – 75). Pathological response was recorded and the majority demonstrated some response to neoadjuvant FLOT chemotherapy (25/33; 76%). 15% had a complete pathological response (n=5). The R0 resection rate was 27/33 patients (82%), with the remaining patients (n=6) having a R1 resection. There were no in-hospital or 30 day mortalities. Adjuvant FLOT was delivered to 21 patients (64%). Two thirds (14/21) of these patients received 4 cycles. Treatment was stopped in 5 patients due to toxicities and 2 patients were censored during data collection. 13 of 21 patients required a dose reduction (62%) and 5 patients experienced a delay due to toxicity (24%). One patient experienced grade 3 toxicity: nausea. Rates of R0 resection and complete pathological response are excellent within this non-trial population at 82% and 15% respectively.

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Lung cancer is the leading cause of cancer mortality worldwide. Culturally and Linguistically Diverse (CALD) patients are especially vulnerable, with poorer outcomes than non-immigrant patients. The LEAD (Lung cancer diagnostic and treatment pathways: A comparison between CALD and Anglo-Australian patients) study aimed to measure and compare the lung cancer diagnostic and treatment pathways between CALD and Anglo-Australian patients. LEAD is a mixed-method, observational cohort study. The presentation reports findings from the quantitative arm comprising a patient questionnaire and reviews of patients’ hospital and general practice records. A total of 577 (407 Anglo-Australian and 170 CALD) patients were recruited from Melbourne, Sydney and Brisbane, and their hospital records were reviewed. The questionnaire was returned by 189 patients (135 Anglo-Australian and 54 CALD) and a record review was completed by the General Practitioners (GPs) of 99 patients (76 Anglo-Australian and 23 CALD). Survival and Cox regression analyses were conducted to examine differences in time intervals between the two groups. LEAD is funded by Cancer Council Australia with the assistance of Cancer Australia. CALD patients reported longer time intervals from referral to diagnosis (Median = 30 days, 95% CI = 26 - 34) than Anglo-Australian patients (Median = 17, 95% CI = 14 - 20), p =. 003, Exp (B) = 1.32. This difference persisted after the impact of relevant factors, such as age and stage of lung cancer, was taken into consideration. CALD patients also reported longer time in five other intervals, including from 1) symptom notification to GP presentation, 2) GP presentation to referral, 3) referral to treatment, 4) symptom notification to treatment, and 5) symptom notification to diagnosis. However, the differences in these five intervals failed to reach significance. LEAD is the first Australian study to comprehensively measure and compare the time intervals along the lung cancer pathways amongst CALD and Anglo-Australian patients. It found that CALD patients have longer time intervals from referral to diagnosis than Anglo-Australian patients.

Purpose: Development of acute kidney injury (AKI) in patients undergoing cardiac surgery leads to worse outcomes. Emerging biomarkers of AKI, such as cystatin C (CysC) and neutrophil gelatinase-associated lipocalin (NGAL) can only predict AKI, at best, 1–2 hours after surgery. Monitoring of intraoperative urinary PO2 (UPO2) may predict AKI earlier than available biomarkers. This may facilitate intervention to prevent postoperative AKI. Thus, we compared UPO2 with several emerging biomarkers of AKI in adult patients undergoing on-pump cardiac surgery.