Frankston Hospital

Oral disease remains a global public health concern, disproportionately affecting socioeconomically disadvantaged populations. Adults with disabilities or health conditions face additional barriers to dental care, including physical accessibility, communication challenges, and heightened anxiety. These factors contribute to care avoidance and poorer oral health outcomes. While virtual reality (VR) has shown promise in reducing procedural anxiety in pediatric and private dental settings, its application in adult public dentistry, particularly for people with disabilities, remains underexplored. This study aims to evaluate the feasibility, usability, and acceptability of Smileyscope, a Therapeutic Goods Administration-approved head-mounted VR headset, in reducing dental anxiety and enhancing care experiences for adults with disabilities in public dental clinics. A mixed methods convergent design will be implemented across community dental sites in Victoria, Australia. In total, 50 adult patients and up to 10 dental staff members will be recruited. Primary feasibility indicators include recruitment rate (≥60% consent), completion rate (≥80% System Usability Scale [SUS] completion), and usability threshold (mean SUS ≥68). The primary analysis will be descriptive, with 95% CIs reported. Quantitative data will be collected using the visual analog scale for willingness, the SUS, and the technology acceptance model questionnaire. Qualitative data from semistructured interviews will be thematically analyzed. The study is co-designed with a disability advocate and integrates lived experience throughout all phases, including recruitment, evaluation, and dissemination. The project was funded in 2025, and ethics approval was granted by Peninsula Health Human Research Ethics Committee (project ID 117565). Data collection is scheduled for October 2025 to March 2026 at the participating community dental sites. Primary feasibility estimates and qualitative themes are expected to be submitted for publication in mid‑2026. This protocol outlines a feasibility study that will inform scalable models for VR integration into public dental services. The findings will contribute to improved oral health equity and patient-centered care, advancing the evidence base for inclusive digital health innovation in dentistry. PRR1-10.2196/85916.

Frailty is common among patients undergoing emergency laparotomy and is associated with adverse postoperative outcomes, yet routine frailty assessment remains inconsistently implemented despite international guideline recommendations. This study evaluates the prevalence of frailty using three rapid assessment tools and examines their associations with postoperative outcomes following emergency laparotomy. We conducted a single-centre retrospective cohort study of adults undergoing open emergency laparotomy over a 12-month period. Frailty was assessed retrospectively using the Clinical Frailty Scale (CFS ≥ 5), Emergency Surgery Frailty Index (EmSFI ≥ 7), and five-item Modified Frailty Index (mFI-5 ≥ 2). Primary outcomes were 30- and 90-day mortality. Secondary outcomes included postoperative complications, ICU admission, hospital length of stay, and discharge destination. Unadjusted analyses were descriptive. Multivariable logistic regression models were constructed with frailty measures specified as the primary exposures and adjusted for age, sex, operative indication, and anaesthetist-assigned ASA grade. Among 102 patients (median age 67 years, IQR 54–79; 53% female), frailty prevalence was 26% by CFS, 24% by EmSFI, and 27% by mFI-5, with 37% meeting at least one frailty threshold. In unadjusted analyses, patients living with frailty experienced higher rates of postoperative complications, ICU admission, longer hospital stay, and reduced likelihood of independent discharge home. After adjustment, frailty thresholds were not independently associated with 30- or 90-day mortality, while mFI-5–defined frailty was independently associated with ICU admission. Frailty assessment in emergency laparotomy identifies patients at increased risk of postoperative morbidity, ICU utilisation, and discharge dependence but does not independently predict short-term mortality after adjustment for key clinical factors.

BackgroundDual decline in gait and cognition is associated with an increased risk of dementia, with the strongest association seen between gait speed and delayed memory. However, the underlying brain correlates remain unknown. This study aimed to explore the associations between regional brain volumes and dual decline in gait speed and delayed memory.MethodParticipants over 60 years were randomly selected from the Southern Tasmanian electoral roll (Australia). Baseline brain MRI and three serial gait speed and delayed memory assessments were performed on average 2.5 years apart. Participants were classified into four groups depending on tertiles of annual decline in gait speed and memory: non‐decline, gait only, cognition only, and dual decline. Twenty‐one regional brain volumes (in frontal, parietal, temporal, subcortical, brain stem and cerebellar areas) were preselected based on previous studies of gait and memory. Multinomial logistic regression was used to examine the associations between baseline regional brain volumes and the four groups.ResultThe mean age of participants was 70.9 ± SD 6.7 years (n = 266). Lower volume in six brain regions (superior frontal gyrus, anterior cingulate cortex, middle frontal gyrus, thalamus, orbitofrontal cortex, hippocampus) were associated with a higher risk of dual decline. Lower volumes in the thalamus and cerebellum were associated with a higher risk of gait only and cognitive only decline respectively. However, these associations did not remain significant after correction for multiple comparisons.ConclusionIn this exploratory study regions related to memory, executive function, motor, and sensory motor integration were found to have associations with dual decline. Larger studies investigating a wider range of brain pathologies are required to fully understand the mechanisms underlying dual decline.

Distressing symptoms such as cough, fatigue & breathlessness are highly prevalent in people with interstitial lung disease (ILD), yet treatment is limited & palliative care access is suboptimal. We aimed to explore the knowledge & beliefs of people with ILD & carers about symptom management & palliative care, focusing on barriers & facilitators to accessing supportive care. <bold>Methods:</bold> Qualitative, semi-structured interviews with patients & carers from Australian respiratory clinics were conducted. Data were analysed thematically. <bold>Results:</bold> 4 themes emerged from 15 patient & 2 carer interviews: 1)challenging symptom burden; 2)beliefs & perceptions about opioids & palliative care; 3)informational needs & 4)access to care, trust & continuity. Participants found managing their symptom burden overwhelming due to frightening breathlessness, challenging symptoms, & treatment side effects. Relentless functional decline & variable adherence to self-management were reported. Experiences of opioids based on past episodes of pain were discussed, & opioids & palliative care were linked to end-of-life care. Yet, participants indicated a potential for acceptance of supportive care if reliable information was available with resources about disease & symptom management. Participants noted access to healthcare requires multimodal delivery, digital literacy, timely palliative care referrals, & trust, continuity of care & multidisciplinary collaboration. <bold>Conclusion:</bold> People with ILD lack knowledge about symptom palliation, with misconceptions affecting acceptance. Integrating symptom-directed approaches with multidisciplinary specialist ILD clinics, alongside education resources, is essential.

BackgroundHip fractures are common in older people and are associated with high perioperative mortality. Prompt surgical intervention within the first 48 h of fraction reduces complications; however, surgical urgency often precludes a comprehensive preoperative cardiac evaluation. Preliminary data suggests that performing a focused cardiac ultrasound (FCU) before surgery may reduce postoperative complications. We therefore propose to test the primary hypothesis that FCU reduces a 30-day composite of mortality and serious complications.MethodsWe plan a definitive multicenter pragmatic randomized trial that will enroll 2000 adults with hip fractures. Participants will be randomized before surgery to either receive FCU as part of their preoperative assessment or to routine care without FCU. FCU is a brief, 10-min, goal-directed echocardiography performed at the patient’s bedside. FCU will be conducted by physicians trained in FCU and the information gathered will be shared immediately with all clinicians involved in the patient’s care (anesthesiologists, orthopedic surgeons, geriatricians). The primary outcome will be a 30-day composite of all-cause mortality, hospital readmission, acute kidney injury, cardiac failure, and myocardial injury after noncardiac surgery. Secondary and exploratory outcomes include hospital length of stay, days to return to original residence, postoperative recovery, and quality of life. Additionally, a health cost analysis will be conducted to weigh costs against benefits.DiscussionOur large RCT aims to determine whether preoperative focused ultrasound examinations of hip fracture patients reduce serious postoperative complications, improves the quality of recovery, improves life quality, and is cost-effective.Trial registrationRegistration number: ACTRN12622001546741. Date registered 14/12/2022.

BackgroundA unique feature of inline MRI‐linac prototype systems is the changes to entry surface or skin doses. For the high field (1 T) Australian MRI‐linac prototype, a strong surface dose increase is observed. This is a by‐product of secondary electron contamination being focused down the MRI bore due to the magnetic field being parallel with the x‐ray beam direction. It has been anticipated that future clinical treatments will utilize a 2 cm thick water equivalent bolus layer in air above the patient's skin to absorb the electron contamination that causes the large dose hot spot. However, this will reduce the maximum dose rate of the beam and negate the skin dose‐sparing effect typical of MV x‐ray beams.PurposeTo explore through Monte Carlo (MC) modeling and experimental (Exp) measurements, the skin dose changes when employing a small bespoke permanent magnet electron contamination deflector (ECD) in combination with a helium gas volume (HV) located in the MRI bore. The ECD will purge electron contamination from the beam before it reaches the MRI bore, while the HV minimizes the reintroduction of the contamination above the patient.Methods3D magnetic field models of the Australian MRI‐linac coupled with and without the ECD were created in COMSOL Multiphysics, and the magnetic field maps were imported into Geant4 MC simulations. The Geant4 simulations included the 6 MV linac, multileaf collimator (MLC), ECD, HV and a 30×30×30 cm3 water phantom positioned at the MRI isocenter. Field sizes of 2.4×2.4 cm2, 7.2×7.2 cm2, and 12.4×12.4 cm2 were simulated and surface skin doses were calculated at 70μm depth. Simulations were performed with and without the MRI field, ECD, and HV to characterize the changes introduced by each component. Exp measurements were also performed using real prototypes of the ECD and HV in the identical environment in order to validate our simulation results. Dose measurements were conducted using a MOSkin™ detector and Gafchromic® EBT3 films.ResultsThe skin dose hot spot maximum is measured to be 122.5% (2.4×2.4 cm2), 194.8% (7.2×7.2 cm2), and 260.5% (12.4×12.4 cm2) of the dose at dmax (1.5 cm depth) with no magnetic field (MC MRI off). Introducing the ECD reduced these values by around 30%. As expected, the reintroduction of electron contamination below the ECD was observed due to the beam requiring transport through another 120 m of air before reaching the phantom surface. Finally, including the HV further reduced the skin dose hot spots by approximately 60% of their original values. The latter results also demonstrated a considerable reduction in the cross‐sectional area of the skin dose hot spot.ConclusionsThe inclusion of an ECD coupled with a HV in an inline MRI‐linac prototype system has significantly reduced the intensity of the skin dose increases. It appears to be superior solution over a generic 2 cm water bolus for all field sizes and also will retain some skin dose‐sparing effect. The methods used in this work are expected to be feasible with other inline MRI‐linac designs.