Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are widely used for the treatment of type 2 diabetes and/or obesity. The physiological actions of endogenous GLP-1, and synthetic GLP-1RAs include inhibition of gastric emptying. This has peri-procedural implications due to the potential increased risk of retained gastric contents which may result in pulmonary aspiration. There is a need for local evidence-based guidelines to best manage patients on GLP-1RAs and dual GLP-1 and glucose-dependent insulinotropic polypeptide receptor co-agonists (GLP-1/GIPRAs) presenting for surgical and medical procedures requiring sedation or anaesthesia. A panel of experts was formed to consider the peri-procedural implications of GLP-1RA and GLP-1/GIPRA use and establish best practice recommendations based on the current evidence.We recommend that all patients should be asked about glucagon-like peptide-1 receptor agonist (GLP-1RA) and dual GLP-1 and glucose-dependent insulinotropic polypeptide receptor co-agonist (GLP-1/GIPRA) use prior to anaesthesia or sedation for surgical and endoscopic procedures and be informed of the benefits and risks. We also recommend that GLP-1RAs and GLP-1/GIPRAs be continued in the peri-procedural period. Preprocedural diet modification with a 24-h clear fluid diet, followed by standard 6-h fasting, should be recommended for all patients receiving GLP-1RAs or GLP-1/GIPRAs. In patients who have not completed or are unable to have a 24-h liquid diet, risk stratification using gastric ultrasound or minimally sedated gastroscopy to assess gastric contents is recommended, as is the use of intravenous erythromycin. We cannot currently recommend using the absence of gastrointestinal symptoms for risk stratification, nor can we recommend an adequate cessation period for GLP-1RAs and GLP-1/GIPRAs to ensure gastric emptying has returned to baseline levels. This clinical guideline, developed by multiple professional bodies, outlines current best practice recommendations for patients taking GLP-1RAs and combined GLP-1/GIPRAs who require general anaesthesia, sedation and/or endoscopic procedures. The guide provides a structure for Australian and New Zealand primary health practitioners, gastroenterologists, surgeons, endocrinologists, anaesthetists and perioperative physicians to support clinical decisions in these patients.

BACKGROUND:Older adults undergoing surgery frequently experience postoperative delirium and postoperative neurocognitive disorders (NCD), but the neuropathophysiology of these conditions remains obscure. A postoperative inflammatory cascade with subsequent neuronal injury is one theory that requires further investigation. We report the incidence of delirium and postoperative NCD using updated nomenclature and investigate changes in inflammatory and neuronal injury biomarkers associated with these conditions. METHODS:We performed a prospective, longitudinal, cohort study with older adults aged 60 years or more undergoing major elective noncardiac surgery. Patients completed cognitive assessments preoperatively and at 3 and 28 months postoperatively, alongside twice-daily delirium assessments during hospital admission. Plasma was obtained before surgical incision and at 30 minutes, 6, 24, and 48 hours postoperatively and assayed for cytokines (interleukin [IL]-6, IL-10, IL-18, tumor necrosis factor [TNF]α) and neuronal injury markers (neurofilament light [NfL], total Tau, and pTau181). RESULTS:We enrolled 79 patients (mean age: 69 [standard deviation {SD}: 6.5]; female: 45.6%). Thirteen patients (15.2%) experienced postoperative delirium. At 3 months, 18 of 63 (28.6%) had postoperative NCD, and at long-term follow-up, 17 of 46 (37.0%) had NCD. IL-6, IL-10, total Tau, p-Tau181, and NfL levels were 10.3, 1.9, 1.3, 1.2, and 1.6 times higher at 48 hours postsurgery compared to baseline (all P <.05). IL-18 levels were 1.1 times lower. TNFα remained unchanged. Linear mixed-effects models revealed that greater elevations in IL-6 levels were associated with increased delirium risk (β = 22.23, standard error {SE} = 9.48, P =.02) and long-term NCD (β = 12.46, SE = 6.02, P =.04). CONCLUSIONS:Using updated nomenclature, postoperative delirium and postoperative NCD affect a third of surgical patients and inflammatory and neuronal injury markers are elevated after surgical intervention. Increases in IL-6 and pTau181 at the time of surgery are associated with postoperative delirium; increases in IL-6 are also associated with long-term NCD. Specific biomarkers follow unique time courses after anesthesia and surgery.

INTRODUCTION:Single-injection and continuous brachial plexus block techniques are used widely for postoperative analgesia in patients undergoing shoulder surgery. Although patient-reported outcomes are described in individual studies, their effects have not been synthesised comprehensively using a patient-centred framework. We sought to compare the effects of single-injection vs. continuous brachial plexus block techniques on patient-reported outcomes in adult patients following elective shoulder surgery. METHODS:Databases were searched from inception to October 2025 and randomised controlled trials reporting patient-reported outcomes were included. Co-primary outcomes were postoperative patient-reported pain intensity at rest and during movement at 12 h, 24 h and 48 h post-surgery. Secondary outcomes included nausea and vomiting; sleep quality; patient satisfaction; opioid requests; and functional scores. Random-effects meta-analysis and trial sequential analysis were performed, with risk of bias and quality of patient-reported outcome reporting assessed. RESULTS:Twenty randomised controlled trials that included 1198 patients were analysed. Continuous brachial plexus blocks were associated with lower pain at rest at 12 h, 24 h and 48 h, with mean differences (MD) of -1.96 (95%CI -2.81 to -1.11, p < 0.001), -1.66 (95%CI -2.27 to -1.05, p < 0.001) and - 1.18 (95%CI -1.84 to -0.53, p < 0.001), respectively. Pain on movement could only be pooled at 24 h and 48 h and showed MD -2.04 (95%CI -4.26-0.19, p = 0.07) and - 1.30 (95%CI -3.67-1.07, p = 0.28) respectively. The co-primary outcomes approached or exceeded the predefined minimal clinically important difference for pain scores after shoulder surgery, in favour of continuous techniques. DISCUSSION:Continuous brachial plexus blocks are associated with better pain at rest and other patient-centred outcomes following shoulder surgery, while effects on dynamic pain and long-term functional recovery remain uncertain.

Brain MRI segmentation is required for quantitative PET analysis, in order to derive regional uptake and calculate uptake ratio relative to reference regions. FreeSurfer has been a popular method but is being supplanted by faster and more robust AI-driven methods. The objective of this work is to confirm that the use of Clario’s novel AI segmentation method, whose impact was assessed towards various MRI endpoints, is also valid in the context of PET quantification. 507 subjects from ADNI were selected, including normal controls, subjective memory complainers, early/late MCI and AD subjects. Besides, 210 were selected with available test/re-test data. For each, a pair of good quality 3DT1 MRI and Amyloid PET scans were available. 3DT1 data were segmented with both FreeSurfer v6 (FS) and Clario’s AI method (AI), and registered to PET space for calculation of Standard Uptake Value (SUV) in a set of cortical regions (frontal, posterior cingulate, lateral parietal and lateral temporal) and reference regions (cerebellar grey and whole cerebellum). SUVR (ratio to reference region) was calculated for both. Results were also converted to Centiloid (CL) units. SUV and SUVR values were compared across segmentation methods via Bland-Altmann plots and correlated with Pearson’s coefficient. The ability to distinguish between disease severity stages was assessed by ROC analysis using global AUC. Finally, classification as amyloid (Aβ) positive or negative was assessed by setting a cut-off of 20.1 CL and looking at Cohen’s Kappa. SUV and SUVR values were highly and significantly correlated between FS and AI methods (r>0.99, p<0.001) and for test/re-test, for all regions investigated, with a difference that did not exceed 0.41% on average (SD<1.38%). Global AUC was comparable for both methods and for test/retest (average gAUC=0.62). Aβ classification was near-perfect across methods (κ=0.98) and between test/retest data (κ FS =0.97, κ AI =0.99). Comparing FreeSurfer and Clario’s AI-based MRI segmentation method, no impact was found on subsequent PET analyses and test/retest performance was equivalent. These results support the use of either method for PET quantification. For future trials, the AI method could either be used as the primary method, or as a back-up when traditional FS segmentation fails.

INTRODUCTION:Peri-operative neurocognitive disorders are common among older adults presenting for surgery and anaesthesia. Cognitive screening is recommended to identify patients at risk for adverse neurocognitive outcomes, though the most appropriate peri-operative tool remains debated. Remote assessment methods may be advantageous, but they need robust validation. We aimed to examine the feasibility and validity of the Modified Telephone Interview for Cognitive Status (TICS-M) among older adults and provide recommended TICS-M scores to identify those most at risk of poor postoperative cognitive outcomes. METHODS:As part of a prospective longitudinal study with 215 older adults living in the community or scheduled for elective surgery, we conducted the modified, 22-item, 50-point version of the TICS remotely, followed by in-person assessments using two common cognitive screening tools: the Mini-Mental State Examination (MMSE); Alzheimer's Disease Assessment Scale Cognition Subscale (ADAS-Cog); and a comprehensive neuropsychological and functional assessment. RESULTS:The TICS-M was feasible and acceptable, with a completion rate of 86%. TICS-M scores correlated with scores on the MMSE (r = 0.61, p < 0.001) and ADAS-Cog (r = -0.55, p < 0.001) at baseline, and associations remained consistent at 12- and 24-month follow-up. After controlling for age, sex and education, baseline performance on the TICS-M was independently associated with subsequent cognitive impairment at 12 months (OR 0.84, 95% CI 0.77-0.92, p < 0.001) and 24 months (OR 0.84, 95% CI 0.76-0.94, p = 0.001). A TICS-M score of 32.5 was the optimal threshold to identify people with cognitive impairment (0.76, 95% CI 0.70-0.82, p < 0.001). DISCUSSION:The TICS-M is a feasible, valid and reliable remotely administered tool that shows utility in the peri-operative environment. We recommend its implementation into routine clinical practice for remote pre-operative assessment in patients aged ≥ 65 y scheduled for surgery and anaesthesia.

BackgroundData plays a significant role in modern healthcare. Large-scale data systems use healthcare data to improve the design, delivery and review of healthcare. However, these data systems often lack a patient-centered approach. Patient-centered approaches to healthcare improve outcomes. Integrating a patient-centered approach into a large-scale data systems have great promise. Examples such as learning health systems have resulted in many positive healthcare outcomes. However, ethical, legislative and cybersecurity concerns have been stated. Collating the learning and the subsequent insights from reports on patient-centered data systems will further their development in healthcare.ObjectivesA scoping review to identify and collate the guidance, recommendations and examples of good practice of patient-centered data systems from scientific and grey literature.Eligibility criteriaContemporary sources of information (published academic and grey literature) will be included where they make explicit reference to the design, oversight, operation or experience of a national and/or international data system or registry. Similarly, these sources must refer to the patient-centered focus of the national and/or international data system or registry. Where there is no explicit statement that patients were centered in the data system in question, sources are excluded. and/or are involved in the design and/or oversight and/or operation of system. Other reviews and sources not published in English are also excluded.Sources of evidenceA test set of research articles were selected to develop initial search terms, which was then refined into a concept grid. Specific searches will be performed in PubMed, Scopus, CINAHL and Google Scholar, as well as within grey literature. All sources will be collated and stored, prior to an initial screen of title and abstract.Charting MethodsFull text versions of all remaining sources of literature will be screened, with data extraction occurring according to a predefined data extraction framework. Reasons for inclusion and exclusion at each step will be documented, as will any methodological modifications and/or revisions. Data extracted from selected sources will be characterised and summarised in tabular form, with supplementary diagrammatic presentation. Details of the guidance, recommendations and examples of patient-centered data systems will be outlined, alongside a narrative summary description.

A European consensus study in this issue addresses perioperative patient safety recommendations by synthesising multiple patient safety guidelines covering the entire patient journey to provide a single point of reference. In this editorial we address what is considered as evidence and seek inclusion of broader ways of knowing and understanding the complexity of safety in healthcare. We suggest prioritising feasibility could limit improvements to specific clinical practices rather than systems-wide change. Safety is more than a collection of isolated recommendations. Safety interventions should be seen as part of a complex technical sociocultural system. Improvements in care require a change in culture and institutional priorities and a systemic approach to patient safety.

BACKGROUND:Postoperative delirium (POD) is a common and serious complication in older surgical populations. Intraoperative EEG may help identify those at risk. Proprietary processed EEG (pEEG) devices were not developed to identify POD risk and studies utilising such devices may confound attempts to identify non-proprietary EEG-derived measures associated with POD. We performed a systematic review of non-proprietary intraoperative EEG-derived measures and their association with POD including a secondary analysis excluding studies that utilised pEEG-guided anaesthesia. METHODS:This review followed PRISMA guidelines and the Population, Index test, Target outcome (PIT) framework. The protocol was prospectively registered with PROSPERO (ID: CRD42024564983). Seven databases were searched up to May 30, 2025. Eligible studies reported intraoperative EEG-derived measures and POD incidence. Meta-analysis was performed for measures reported in three or more studies. Risk of bias was assessed using the Quality in Prognostic Studies tool. RESULTS:Forty-two studies (13115 patients) were included, and the mean incidence of POD was 18.8%. Forty-nine EEG-derived measures were identified including time domain, frequency domain, and functional connectivity measures. Meta-analyses identified that lower intraoperative alpha and delta mean power, lower alpha peak frequency, and lower spectral edge frequency were significantly associated with POD. Delta mean power was not significantly associated with POD in non-pEEG-guided studies. Both the presence and duration of burst suppression were associated with POD. CONCLUSIONS:Alpha oscillation and burst suppression measures appear to be robust indicators of POD vulnerability, even in the presence of pEEG-guided anaesthesia. The use of pEEG-guided anaesthesia did not eliminate the associations between these measures and POD. SYSTEMATIC REVIEW PROTOCOL:PROSPERO (CRD42024564983).

Background Residual disease following cytoreductive surgery in patients with ovarian cancer has been associated with poorer survival outcomes compared with no residual disease. We performed a meta-analysis to assess the impact of varying levels of residual disease status on survival outcomes in patients with ovarian cancer who have undergone primary cytoreductive surgery or interval cytoreductive surgery in the setting of new therapies for this disease. Methods Medline, Embase, and Cochrane databases (January 2011 – July 2020) and grey literature, bibliographic and key conference proceedings, were searched for eligible studies. Fixed and random-effects meta-analyses compared progression and survival by residual disease level across studies. Heterogeneity between comparisons was explored via type of surgery, disease stage, and type of adjuvant chemotherapy. Results Of 2832 database and 16 supplementary search articles screened, 50 studies were selected; most were observational studies. The meta-analysis showed that median progression-free survival and overall survival decreased progressively with increasing residual disease (residual disease categories of 0 cm, > 0–1 cm and > 1 cm). Compared with no residual disease, hazard ratios (HR) for disease progression increased with increasing residual disease category (1.75 [95% confidence interval: 1.42, 2.16] for residual disease > 0–1 cm and 2.14 [1.34, 3.39] for residual disease > 1 cm), and also for reduced survival (HR versus no residual disease, 1.75 [ 1.62, 1.90] for residual disease > 0–1 cm and 2.32 [1.97, 2.72] for residual disease > 1 cm). All comparisons were significant ( p < 0.05). Subgroup analyses showed an association between residual disease and disease progression/reduced survival irrespective of type of surgery, disease stage, or type of adjuvant chemotherapy. Conclusions This meta-analysis provided an update on the impact of residual disease following primary or interval cytoreductive surgery, and demonstrated that residual disease was still highly predictive of progression-free survival and overall survival in adults with ovarian cancer despite changes in ovarian cancer therapy over the last decade. Higher numerical categories of residual disease were associated with reduced survival than lower categories.

BACKGROUND:Peri-operative neurocognitive disorders are one of the most common complications affecting older adults after anaesthesia and surgery. It is not clear how exposure to surgery and anaesthesia contributes to the prevalence of long-term neurocognitive disorders. This study aimed to report the prevalence of neurocognitive disorders, and explore pre-operative factors associated with neurocognitive disorders 5 years after elective orthopaedic surgery. METHODS:A prospective, 5-year longitudinal, cohort study was performed recruiting patients (aged ≥ 60 y) undergoing elective orthopaedic surgery and a contemporaneous non-surgical control group. Neurocognitive disorder was evaluated and classified at baseline and 5-year review incorporating: self- and informant-reported cognition; functional participation; and performance on neuropsychological tests. RESULTS:Recruitment at 5-year follow-up included 195 patients and 21 control participants. In the patient cohort the prevalence of neurocognitive disorder was 38.1% (n = 75), with 61 (30.1%) meeting the criteria for mild neurocognitive disorder and 14 (7.1%) for major neurocognitive disorder. At 5-year follow-up, 121 (61.4%) patients were classified with a neurocognitive disorder, with 88 (44.7%) characterised with mild neurocognitive disorder and 33 (16.8%) with major neurocognitive disorder. Age (odds ratio (95%CI) 1.07 (1.02-1.13); p = 0.01) and baseline cognitive impairment (odds ratio (95%CI) 2.1 (1.06-4.15); p = 0.03) were significant predictors of neurocognitive disorder 5 years after surgery. CONCLUSION:More than half of older adult patients had some form of neurocognitive disorder 5 years after elective orthopaedic surgery. Surgery and anaesthesia may be associated with the trajectory of cognitive decline in at-risk older adults, including those with pre-operative cognitive impairment. Cognitive screening should be factored into pre-operative assessments of older adults to inform subsequent care.

Spinal muscular atrophy (SMA) is a severe genetic neuromuscular disease characterized by a loss of motor neurons and progressive muscle weakness. Children with untreated type 1 SMA never sit independently and require increasing levels of ventilatory support as the disease progresses. Without intervention, and lacking ventilatory support, death typically occurs before the age of 2 years. There are currently no head-to-head trials comparing available treatments in SMA. Indirect treatment comparisons are therefore needed to provide information on the relative efficacy and safety of SMA treatments for healthcare decision-making. The long-term efficacy and safety of risdiplam versus nusinersen in children with type 1 SMA was evaluated using indirect treatment comparison methodology to adjust for differences between population baseline characteristics, to reduce any potential bias in the comparative analysis. An unanchored matching-adjusted indirect comparison was conducted using risdiplam data from 58 children in FIREFISH (NCT02913482) and published aggregate nusinersen data from 81 children obtained from the ENDEAR (NCT02193074) and SHINE (NCT02594124) clinical trials with at least 36 months of follow-up. Children with type 1 SMA treated with risdiplam had a 78 Risdiplam and nusinersen are two approved treatments for patients with type 1 spinal muscular atrophy (SMA). There are currently no head-to-head trials that compare the outcomes of these treatments in patients. This study conducted a statistical comparison of the efficacy and safety of risdiplam and nusinersen in children with type 1 SMA who received treatment for at least 36 months. Risdiplam data were collected from 58 children who participated in the FIREFISH trial (NCT02913482). Published combined data were collected from 81 children treated with nusinersen who participated in the ENDEAR (NCT02193074) and SHINE (NCT02594124) trials. Outcomes from the two studies were compared using matching-adjusted indirect comparison (MAIC) methodology. MAIC adjusts for differences in baseline characteristics between patients in two trials to make the populations more similar and reduce bias in the comparison. Results suggested that children with type 1 SMA treated with risdiplam had a 78

BACKGROUND AND OBJECTIVES:Sensitive, reliable, and scalable biomarkers are needed to accelerate the development of therapies for Parkinson disease (PD). In this study, we evaluate the biomarkers of early PD diagnosis, disease progression, and treatment effect collected in the SPARK. METHODS:Cinpanemab is a human-derived monoclonal antibody binding preferentially to aggregated forms of extracellular α-synuclein. SPARK was a randomized, double-blind, placebo-controlled, phase 2 multicenter trial evaluating 3 cinpanemab doses administered intravenously every 4 weeks for 52 weeks with an active treatment dose-blind extension period for up to 112 weeks. SPARK enrolled 357 participants diagnosed with PD within 3 years, aged 40-80 years, ≤2.5 on the modified Hoehn and Yahr scale, and with evidence of striatal dopaminergic deficit. The primary outcome was change from baseline in the Movement Disorder Society-Sponsored Revision of the Unified Parkinson's Disease Rating Scale total score. Secondary and exploratory biomarker outcomes evaluated change from baseline at week 52 relative to placebo. Dopamine transporter SPECT and MRI were used to quantify changes in the nigrostriatal dopamine pathway and regional atrophy. CSF and plasma samples were used to assess change in total α-synuclein levels, α-synuclein seeding, and neurofilament light chain levels. SPARK was conducted from January 2018 to April 2021 and terminated due to lack of efficacy. RESULTS:Approximately 3.8% (15/398) of SPECT-imaged participants did not have evidence of dopaminergic deficit and were screen-failed. Binary classification of α-synuclein seeding designated 93% (110/118) of the enrolled CSF subgroup as positive for α-synuclein seeds at baseline. Clinical disease progression was observed, with no statistically significant difference in cinpanemab groups compared with that in placebo. Ninety-nine percent of participants with positive α-synuclein seeding remained positive through week 52. No statistically significant changes from baseline were observed between treatment groups and placebo across biomarker measures. Broadly, there was minimal annual change with high interindividual variability across biomarkers-with striatal binding ratios of the ipsilateral putamen showing the greatest mean change/SD over time. DISCUSSION:Biomarker results indicated enrollment of the intended population with early PD, but there was no significant correlation with disease progression or clear evidence of a cinpanemab treatment effect on biomarker measures. Suitable biomarkers for evaluating disease severity and progression in early PD trials are still needed. TRIAL REGISTRATION INFORMATION:NCT03318523 (clinicaltrials.gov/ct2/show/NCT03318523); Submitted October 24, 2017; First patient enrolled January 2018.

Background and ObjectivesSensitive, reliable, and scalable biomarkers are needed to accelerate the development of therapies for Parkinson disease (PD). In this study, we evaluate the biomarkers of early PD diagnosis, disease progression, and treatment effect collected in the SPARK.MethodsCinpanemab is a human-derived monoclonal antibody binding preferentially to aggregated forms of extracellular alpha-synuclein. SPARK was a randomized, double-blind, placebo-controlled, phase 2 multicenter trial evaluating 3 cinpanemab doses administered intravenously every 4 weeks for 52 weeks with an active treatment dose-blind extension period for up to 112 weeks. SPARK enrolled 357 participants diagnosed with PD within 3 years, aged 40-80 years, <= 2.5 on the modified Hoehn and Yahr scale, and with evidence of striatal dopaminergic deficit. The primary outcome was change from baseline in the Movement Disorder Society-Sponsored Revision of the Unified Parkinson's Disease Rating Scale total score. Secondary and exploratory biomarker outcomes evaluated change from baseline at week 52 relative to placebo. Dopamine transporter SPECT and MRI were used to quantify changes in the nigrostriatal dopamine pathway and regional atrophy. CSF and plasma samples were used to assess change in total alpha-synuclein levels, alpha-synuclein seeding, and neurofilament light chain levels. SPARK was conducted from January 2018 to April 2021 and terminated due to lack of efficacy.ResultsApproximately 3.8% (15/398) of SPECT-imaged participants did not have evidence of dopaminergic deficit and were screen-failed. Binary classification of alpha-synuclein seeding designated 93% (110/118) of the enrolled CSF subgroup as positive for alpha-synuclein seeds at baseline. Clinical disease progression was observed, with no statistically significant difference in cinpanemab groups compared with that in placebo. Ninety-nine percent of participants with positive alpha-synuclein seeding remained positive through week 52. No statistically significant changes from baseline were observed between treatment groups and placebo across biomarker measures. Broadly, there was minimal annual change with high interindividual variability across biomarkers-with striatal binding ratios of the ipsilateral putamen showing the greatest mean change/SD over time.DiscussionBiomarker results indicated enrollment of the intended population with early PD, but there was no significant correlation with disease progression or clear evidence of a cinpanemab treatment effect on biomarker measures. Suitable biomarkers for evaluating disease severity and progression in early PD trials are still needed.Trial Registration InformationNCT03318523 (clinicaltrials.gov/ct2/show/NCT03318523); Submitted October 24, 2017; First patient enrolled January 2018.