Introduction: In-home treatment of heart failure is a rapidly growing field in Australia, taking many forms. Hospital in the Home (HITH) is one service that may aid in preventing readmissions, and decreasing length of stay (LOS), however to date there are no published data on the current activity and outcomes of HITH in heart failure. Methods: Data were collected on all hospital inpatient admissions across the 19 Australian public principal referrer hospitals that submit inpatient activity data to the Health Round Table. All cases involving a diagnosis of 'heart failure and shock' between 2011 and 2017 were extracted for analysis. Results: Of the 48,891 total cases of heart failure, 1,014 (2.1%) involved an HITH admission. There was no significant difference between HITH and non-HITH groups in baseline characteristics such as age and gender. Average total LOS was longer in HITH 7.2 days vs non-HITH 4.7 days (p < 0.01). Average in-hospital LOS was shorter in HITH 1.8 days vs 4.7 days (p < 0.01). In-hospital mortality was lower in HITH 1.3% vs 4.4% (p < 0.01). There was no difference in patient complexity in HITH 48% vs non-HITH 50.4%, p = 0.76. There were less 28-day readmissions in HITH 6.6% vs non-HITH 9.2% (p = 0.21), however this did not reach statistical significance. The number of episodes involving an HITH admission has risen from 0.8% (2011) to 5.4% (2017). Conclusion: HITH admission is associated with a shorter in-hospital LOS, lower in-hospital mortality rates, and shows a trend towards reduced re-admission rate. Despite this, it is utilised in only 5.4% of current admissions. HITH may be under-utilised in the management of heart failure.

Introduction: Hospital in the Home (HITH) plays an important role in the treatment of infective endocarditis (IE) in Australia. To date, there are no published data on the current activity and outcomes of HITH in IE. Methods: Data was collected on all hospital inpatient admissions in 19 Australian public principal referrer hospitals that submit inpatient activity data to the Health Round Table. All cases involving a diagnosis of IE (DRG F61) between 2011 and 2017 were extracted for analysis. Results: Of the 1,657 total cases of IE, 496 (29.9%) involved a HITH admission. There was no significant difference between HITH and non-HITH groups in baseline characteristics such as age and gender. Average total length of stay (LOS) was longer in HITH 31.8 days vs. non-HITH 11.4 days (p < 0.01). Average in-hospital LOS was shorter in HITH 6.7 days vs 11.4 days (p < 0.01). In-hospital mortality was lower in HITH 1.4% vs 7.0% (p < 0.01). There was no difference in 28-day readmissions; HITH 3.2% vs non-HITH 2.1%, p = 0.16. There were less patients deemed high complexity in HITH 53% vs non-HITH 65%, p < 0.01. Over the time period, the proportion of total episodes of IE involving HITH admission has risen from 15% (2011) to 39.5% (2017). Conclusion: HITH admissions for IE have seen a considerable and steady rise over the past 7 years. In-hospital LOS is reduced when HITH is utilised. HITH admissions reflect selection criteria for lower complexity. HITH is now a recognised provider of acute care for IE.

To estimate and compare the cost consequences to hospitals in Australia of two different active flowable haemostatic matrices (i.e. Floseal and Surgiflo) in cardiac surgery. The potential savings was estimated by modelling the potential difference in adverse outcomes between the two active flowable haemostatic matrices. The prevalences of adverse outcomes, and the incremental costs associated with each outcome, were obtained from patients who underwent cardiac surgery in three Australian hospitals during 2014/15. Differences in adverse outcomes between the two treatments were obtained from a published retrospective comparative effectiveness analysis in patients undergoing cardiac surgery in the US 1. A 95% confidence interval was calculated by simulation, allowing each parameter in the model to varying according to its 95% confidence interval. One-way sensitivity analysis was also conducted. The modelling indicated the potential for a reduction of 200 red blood cell transfusions (from 524 to 324), 63 surgical revisions (from 131 to 68), 104 minor complications (from 299 to 195), and 21 major complications (from 43 to 22) if Floseal was used. The total hospital cost of cardiac surgery for the 1459 patients was $75.5 million. The estimated reduction in total cost by preventing these adverse outcomes is $9.04 million (11.97% of the total cost), with a 95% confidence interval from $6.77 million to $11.23 million. The biggest reduction was due to a reduction in transfusions ($4.99), then surgical revisions ($2.11), minor complications ($1.19.), and major complications ($0.74). The one-way sensitivity analysis indicated the largest source of variation was through the transfusion parameters, however even the most extreme values indicated there would be a substantial cost benefit if these adverse outcomes could be prevented. Using Floseal has the potential to reduce the risk of patients bleeding during cardiac surgery and consequently reduce other adverse outcomes, and total costs.

Objective The aim of this project was to assess the interobserver and intraobserver variability when identifying cytological criteria, which were found to have a statistically significant association with C3 within a workplace environment. Methods Sixty C3 cases with known endpoints of malignant, benign proliferative or benign non‐proliferative diagnoses were blindly and independently screened by seven experienced cytologists to identify previously reported statistically significant criteria associated with the C3 category. The criteria included the presence of myoepithelial cells or bare bipolar nuclei, cohesiveness, cystic background, papillary fragments with fibrovascular cores and tubular structures. Kappa statistics were used to measure interobserver variability. Two cytologists repeated the process 6 months later to obtain intraobserver data. Results The interobserver agreement was poor for all criteria except tubules which performed badly. The intraobserver variability for the two cytologists showed that one cytologist achieved moderate intraobserver agreement for all the criteria except cohesion which was poor, whilst the second cytologist showed poor agreement for all criteria. The reasons for the variability are multifactorial and include threshold effects where criteria lack good definition or error in identifying the criteria. Conclusion Interobserver and intraobserver variability remains a significant challenge for cytologists. Despite attempts to define significant criteria associated with C3, good reproducibility could not be achieved. The C3 category is imprecise and highlights the inadequacy of the current classification reporting categories for breast FNA . The impending review of reporting breast cytology by the International Academy of Cytology is timely and appropriate.

Background: Previous reviews have focussed on the rationale for employing the stepped wedge design (SWD), the areas of research to which the design has been applied and the general characteristics of the design. However these did not focus on the statistical methods nor addressed the appropriateness of sample size methods used. This was a review of the literature of the statistical methodology used in stepped wedge cluster randomised trials.Methods: Literature Review. The Medline, Embase, PsycINFO, CINAHL and Cochrane databases were searched for methodological guides and RCTs which employed the stepped wedge design.Results: This review identified 102 trials which employed the stepped wedge design compared to 37 from the most recent review by Beard et al. 2015. Forty six trials were cohort designs and 45 % (n = 46) had fewer than 10 clusters. Of the 42 articles discussing the design methodology 10 covered analysis and seven covered sample size. For cohort stepped wedge designs there was only one paper considering analysis and one considering sample size methods. Most trials employed either a GEE or mixed model approach to analysis (n = 77) but only 22 trials (22 %) estimated sample size in a way which accounted for the stepped wedge design that was subsequently used.Conclusions: Many studies which employ the stepped wedge design have few clusters but use methods of analysis which may require more clusters for unbiased and efficient intervention effect estimates. There is the need for research on the minimum number of clusters required for both types of stepped wedge design. Researchers should distinguish in the sample size calculation between cohort and cross sectional stepped wedge designs. Further research is needed on the effect of adjusting for the potential confounding of time on the study power.

Malnutrition in head and neck cancer (HNC) patients is common and associated with poorer radiotherapy outcomes including increased mortality. This pilot trial investigates the feasibility and effectiveness of a psychological intervention to improve nutritional status, depression and mortality in HNC patients undergoing radiotherapy. Fifty-nine intervention patients received motivational interviewing and cognitive behavioural therapy compared to 70 historical controls who received treatment as usual. Participants were assessed for nutrition, depression and mortality. There were no significant differences between groups in nutritional status, depression or mortality. Subgroup analyses among patients at greater nutritional risk (cancers of the oral cavity, pharynx, larynx) revealed a potentially clinically important reduction on the PG-SGA and lower mortality (31% of controls vs. 16% intervention; P = 0.03) in favour of the intervention condition. Potential benefits in nutritional status and in mortality in this pilot trial of a psychological intervention among HNC patients at high nutritional risk suggest that a larger randomised controlled trial is warranted.