Calvary Hospital

Over time, kidney supportive care (KSC) - the application of the principles of palliative care to patients with chronic kidney disease - has been recognised as essential to kidney care. To describe the series of recent steps made by the International Society of Nephrology (ISN): endorsing KSC as a core component of integrated kidney care; developing consensus definitions of KSC and conservative kidney management (CKM) and creating an international curriculum on KSC and CKM. Synthesising best evidence and practice, the curriculum provides an invaluable resource for all clinicians, including those working in palliative care. This article charts that journey and summarises the scope and content of the KSC/CKM curriculum.

Interpretation of archaeological geophysics was supported by multiple sources, cartography proves useful but requires considering intentions and errors of authors

Familial hypercholesterolemia (FH) is an under-recognised but common genetic condition resulting in elevated levels of low-density lipoprotein cholesterol (LDL-C) and a high risk of premature coronary disease. The prevalence of FH among younger patients undergoing coronary bypass surgery is unknown, as is their post-surgical prognosis. This was a retrospective analysis of younger patients (aged <60 years) undergoing coronary bypass surgery at an Australian tertiary hospital between 2008 and 2022. A Dutch Lipid Clinical Network Score was calculated to determine the presence of underlying FH for each patient. Outcomes were FH prevalence, pre-surgical attainment of guideline-based secondary prevention LDL-C targets and post-surgical major adverse cardiovascular events. Overall, 590 eligible patients (mean age 53.7 years, 85.6% male) were followed over a median of 7.9 years (interquartile range 4.7-12.1). Eighty (80; 13.6%) patients were categorised as 'FH', 249 (42.2%) 'possible FH' and 261 (44.2%) 'non-FH'. Compared to the non-FH group, patients with FH were less likely to achieve target LDL-C <1.8 mmol/L (15 [18.8%] vs 119 [45.6%]; p<0.001) and had higher rates of adverse cardiovascular events in the years following surgery (adjusted odds ratio 2.52; 95% confidence interval 1.0-6.4; p<0.001). FH is highly prevalent among younger patients undergoing coronary bypass surgery. These patients are less likely to achieve adequate LDL reduction and are at higher risk of further adverse events. Detection and appropriate treatment of FH prior to bypass surgery should be a clinical priority.

Background: Chronic kidney disease (CKD) patients undergoing hemodialysis (HD) often face challenges that can decrease their quality of life. Adherence to medication, including antihypertensive therapy, is crucial in improving patients' quality of life. Objective: This study aims to analyze the relationship between antihypertensive medication adherence and quality of life (QoL) and Quality Adjusted Life Years (QALY) in Chronic Kidney Disease (CKD) patients with hypertension undergoing hemodialysis at RSUD R.T Notopuro Sidoarjo. Methods: Data were prospectively collected from questionnaires, medical records, pharmacy records, and hospital systems between September-November 2024. A total of 73 patients were selected using purposive sampling. Inclusion criteria included CKD patients aged ≥18 years, undergoing HD, completing the questionnaires, and able to communicate effectively. The HillBone questionnaire was used to assess medication adherence, and the EQ5D5L questionnaire was used to measure quality of life. Data were analyzed using Spearman’s Rho correlation, Mann-Whitney, Chi-Square, independent t-test, and One Way Anova. Results: The majority of respondents were male (61.65%) and aged 51-60 years (45.21%). Of the 73 patients, 70 (95.89%) were non-adherent to antihypertensive medication. The average quality of life score was 0.752, QALY was 25.48, and VAS was 71.3. Significant relationships were found between medication adherence and QoL, utility values, and QALY (P=0.002), as well as between adherence and QoL (P=0.033). Conclusion: The majority of hemodialysis patients at RSUD RT. Notopuro Sidoarjo are non-adherent to antihypertensive medication, with a positive correlation between utility values (EQ5D5L) and QALY. Medication adherence affects patients' quality of life.

This study investigated the changes in functional capacity with disease progression in a well-characterised cohort of patients diagnosed with frontotemporal dementia (FTD) and Alzheimer's disease (AD) presentations. We recruited 126 behavioural variant FTD (bvFTD), 40 progressive nonfluent aphasia (PNFA), 64 semantic dementia (SD), 45 logopenic progressive aphasia (LPA), and 115 AD patients. Functional capacity was measured annually over ∼7 years using the Disability Assessment for Dementia. Linear mixed effects models revealed the bvFTD group demonstrated disproportionate functional impairment at baseline and over the study period. Functional capacity among the other syndromes showed a more uniform pattern of decline, with less severe functional impairment at baseline and ∼7%-10% mean annual decline. Baseline correlations indicated different mechanisms supporting basic and complex functional proficiency among the groups. Our findings demonstrate distinct functional profiles across dementia syndromes with disease progression. Identifying progression milestones across syndromes will improve clinical management. bvFTD shows severe functional impairment at baseline and over time.PNFA, SD, LPA, AD: less severe baseline functional impairment; more uniform decline.General cognition is related to IADLs, but not BADLs, in all groups.Behavioural disturbances relate to IADLs and BADLs in bvFTD and SD.Behavioural-ADL relations are more mixed in PNFA, LPA, and AD.

The Australian-led 2023 International evidence-based guideline for the assessment and management of polycystic ovary syndrome was based on best available evidence, clinical expertise and consumer preference. It followed best practice, involved extensive evidence synthesis and applied relevant frameworks across evidence quality, feasibility, acceptability, cost and implementation. Thirty-nine societies and organisations covering 71 countries were engaged. The evidence in the assessment and management of polycystic ovary syndrome (PCOS) has generally improved in the past five years, but remains of low to moderate quality. The technical evidence report, 52 systematic reviews and analyses (approximately 6000 pages) underpin 77 evidence-based and 54 consensus recommendations, with 123 practice points. Changes include: refinement of individual diagnostic criteria, a simplified diagnostic algorithm and inclusion of anti-Müllerian hormone levels as an alternative to ultrasound in adults only, and differentiation of adolescent and adult criteria; strengthening the recognition of broad features of PCOS including metabolic effects, cardiovascular disease, dermatological symptoms, sleep apnoea, a high prevalence of psychological features and a high risk of adverse pregnancy outcomes; emphasising the poorly recognised, diverse burden of disease, the vital need for greater health professional education, evidence-based patient information, improved models of care, shared decision making and research efforts to improve patient experience; maintained emphasis on healthy lifestyle, emotional wellbeing and quality of life, with awareness and consideration of weight stigma; and emphasising evidence-based medical therapy and cheaper and safer fertility management. The 2023 guideline is approved by the National Health and Medical Research Council and provides clinicians and patients with clear advice on best practice in a common and neglected condition, based on the best available evidence, expert multidisciplinary input and consumer preferences. It provides vital, extensive patient and provider resources to enhance evidence-based care. The full guideline is available at www.monash.edu/medicine/mchri/pcos/guideline.

To describe the implementation and evaluation of a hospital-initiated, community-based, digital prehabilitation program (My PreHab Program: MPP) for adults referred for elective joint replacement. MPP was implemented July 2022 and comprises a personalised digital health screen that guides the provision of self-management resources. Adults (>18years) referred and accepted, or already waitlisted, for total knee/hip replacement surgery were eligible. Individuals requiring category 1 (urgent) or emergency surgery and those without a mobile phone were excluded. Implementation and intervention outcome measures (program adoption, equity of reach, fidelity, acceptability, appropriateness, feasibility, engagement, preliminary surgical outcomes) were explored via study-specific measures and hospital records. Of those invited (N = 689), 77.8% participated. Participants and non-participants were similar in key demographic variables except regional invitees were more likely to participate than metropolitan (88.0% vs 75.4%, p = .002) and non-participants tended to be older (median age = 69.0 vs 64.0, p = .005). Participants reported on average four modifiable risk factors: most commonly chronic pain (79.1%), obesity (57.3%), and frailty (40.9%). Most participants (80.4%) reviewed all resources provided and reported action/intention to address issues identified (90.9%). Participants perceived MPP as acceptable (3.2/5), appropriate (3.3/5), and feasible (3.4/5). Early trends for participants progressing to surgery (n = 33) show a reduced length of stay (MPP = 4.3, baseline = 5.3 days). MPP demonstrated high adoption, fidelity, and participant engagement. It is acceptable, appropriate and feasible and has the potential to be scaled-up digitally at low-cost. Modifiable risk factors were prevalent and early indications suggest this preoperative intervention may benefit both patients and the healthcare system.

ResumenEl artículo desarrolla la figura de la prostitución, analizando sus elementos negativos que el sistema neoliberal invisibiliza con el fin de legitimar una de las industrias más lucrativas del mundo.Pese a la argumentación liberal de que la prostitución constituye un trabajo como cualquier otro, esta es fruto de la cultura patriarcal y una forma de instrumentalización del cuerpo femenino que reproduce las desigualdades de género.Para evidenciar lo anterior, se efectúa un estudio crítico mediante la revisión bibliográfica, acerca del contenido y fines de esta figura, como también su regulación legal en los países elegidos, con especial atención al debate teórico contemporáneo que divide el movimiento feminista.Finalmente, se constata que la prostitución afecta la igualdad entre mujeres y hombres, y la regulación legal abolicionista de esta figura que

Mild cognitive impairment (MCI) is a known risk factor for the development of dementia. The potential benefits on cognition from non-pharmacological measures such as art-based interventions are of increasing interest. This systematic review examines the evidence for the impact of one form of art-based intervention, visual art therapy (VAT), on the cognition and psychological wellbeing of older people with MCI. Randomised controlled and quasi-experimental trials evaluating the efficacy of VAT in older persons aged over 60years with MCI were included. A search was performed on electronic databases: MEDLINE, CINAHL, Embase and PsycINFO. Joanna Briggs Institute critical appraisal and extraction tools were utilised for risk of bias assessment and data extraction, respectively. A narrative descriptive approach was used to outline the findings. Seven studies were identified from 4311 articles screened. Improvement in cognition was reported in five studies, with two of these reporting sustained improvement at 6-9months, while the remaining three studies showed improvement only at the immediate post-intervention period. A positive impact was reported in four of six studies that examined the effect of VAT on participant psychological wellbeing. The overall methodological quality of the studies ranged from moderate in four of five RCTs, to high in the quasi-experimental studies and one RCT. However, the low study power in the context of small sample sizes limits the applicability of these studies to the population of interest. VAT is potentially an effective non-pharmacological intervention that may enhance cognition and provide benefits for psychological wellbeing in older persons with MCI. Given the limited studies available, with the majority emerging over the last 5years, further research is required to confirm these reported benefits, as well as to determine whether VAT impacts on the progression of cognitive decline in MCI.