Geelong Hospital

Staphylococcus aureus bacteraemia is a severe infection with potential sex-based disparities. While males have higher infection rates, females may experience poorer clinical outcomes. This study examines sex-based differences in the clinical characteristics, management approaches, and outcomes of community-onset S. aureus bacteraemia (COSAB) within a single-centre cohort. We conducted a single-centre retrospective study of 279 COSAB cases (2015–2020) at University Hospital Geelong, Australia. Clinical characteristics, diagnostic testing, and 30-day all-cause mortality were compared by sex using univariable binomial logistic regression models. Analysis of 279 COSAB cases (58.4% males, 41.6% females) showed a higher, though not statistically significant association between 30-day mortality rate in females (21.6%) compared to males (17.2%) (p = 0.36). There was no significant difference of age between the sexes (p = 0.38) or Charlson Age Comorbidity Index (p = 0.71). Males had longer median hospital stay (26 days, IQR: 33.25 compared to females (18 days, IQR: 34). Transoesophageal echocardiography (TOE) was performed less frequently in females than males (OR: 0.58, 95% CI 0.35–0.97; p = 0.04), despite comparable rates of infective endocarditis. Females were also associated with a methicillin-susceptible Staphylococcus aureus (MSSA) infection (OR: 2.10, 95% CI: 1.13–3.97, p = 0.02). This study identified sex-based differences in the management of COSAB, particularly the lower frequency of TOE performed in females. While there was no significant difference in 30-day mortality between sexes in this underpowered study, these disparities warrant further investigation. Understanding the underlying causes of these differences could help improve clinical practices and ensure equitable management for all patients.

Current surgical planning relies on conventional two-dimensional (2D) imaging, but this is limited by its inability to fully represent three-dimensional (3D) anatomical relationships. This limitation is particularly evident in thoracic surgery, where accurate visualization of the pulmonary bronchovascular anatomy is essential for planning lung resections in a surgical field that has high anatomical variations and dynamic deformation during surgery. Although 3D reconstruction techniques have been explored to address these limitations, their adoption into routine clinical practice has been constrained by reliance on expensive proprietary software and a lack of detailed, efficient, reproducible workflows. Here, we describe a novel, practical imaging-based approach for generating patient-specific 3D reconstructions of pulmonary anatomy from computed tomography (CT) data using 3D Slicer, an open-source platform for imaging segmentation and 3D modelling. A reproducible step-by-step workflow is presented, detailing segmentation of pulmonary arteries, veins, bronchi, tumour localization, and resection margin assessment, together with common pitfalls, troubleshooting strategies, and factors influencing accuracy and efficiency. The workflow is designed to be intuitive and time-feasible, with model generation achievable within routine pre-operative planning timeframes. The process is demonstrated through two representative cases in which 3D reconstruction altered surgical planning by clarifying ambiguous anatomy, enabling precise pulmonary tumour localization and accurate resection. With the use of 3D reconstruction technology, anatomical understanding and operative precision can be enhanced, supporting more informed surgical decision-making and potentially improving patient outcomes.

Coxiella burnetii, the causative agent of Q fever, is a highly infectious zoonotic bacterium presenting significant biosafety challenges, particularly in laboratory environments. Due to its low infectious dose, environmental resilience, and potential for aerosol transmission, C. burnetii has been classified as a Risk Group 3 pathogen and Category B biothreat agent. This review evaluates the biosafety practices required for safe handling, including adherence to Biosafety Level 3 (BSL-3) containment for propagative work and BSL-2 standards for diagnostic activities. Strategies such as vaccination, personal protective equipment (PPE), environmental controls, and rigorous decontamination protocols are critical to mitigate laboratory-acquired infections (LAIs). Historical reports highlight C. burnetii as a leading cause of LAIs, underscoring the importance of implementing risk-based biosafety frameworks outlined by the World Health Organization. However, gaps remain in disinfection efficacy data, vaccine accessibility, and consistent application of biosafety measures, particularly in resource-limited settings. Addressing these challenges through enhanced surveillance, interdisciplinary research, and improved access to preventive tools can reduce C. burnetii-associated risks. This review emphasises the need for adaptive, sustainable practices to ensure global laboratory safety and highlights the integration of evidence-based strategies for C. burnetii research.

Transanal total mesorectal excision (TaTME) offers advantages for resection of low rectal tumours in patients with challenging access to the pelvis, but the functional outcomes relative to the conventional transabdominal approach are poorly understood. Patients undergoing TaTME for cancer between 2009 and 2018 at nine sites across Australia and New Zealand were eligible. Patients with a stoma or recurrent disease were excluded. Outcomes were compared to a matched cohort of patients who underwent transabdominal (laparoscopic or open) total mesorectal excision as part of the ALaCaRT trial. Patients were surveyed regarding bowel, urinary and overall function using the low anterior resection syndrome (LARS), International Prostate Symptom Score (IPSS) and the European Organisation for Research and Treatment of Cancer (EORTC) CR29 validated scoring tools. In the TaTME group, 200 eligible patients were invited to participate, with 100 patients enrolled (survey response rate 50%). Major LARS was reported in 69.3% of patients. Mahalanobis distance matching was used to compare functional outcomes in interventional and control groups (83 patients in each group), showing poorer outcomes in the TaTME group regarding faecal incontinence (median EORTC CR29 score 28.5 vs. 18.8, p = 0.005), blood and mucus in stool (8.03 vs. 4.02, p = 0.04) and flatulence (42.6 vs. 32.5, p = 0.01). There were no significant differences in other domains. No difference was observed in urinary function (median IPSS score 6.38 vs. 6.22, p = 0.87). While it affords advantages when pelvic access is challenging, TaTME may compromise functional outcomes relative to the transabdominal approach, particularly regarding faecal incontinence.

ABSTRACTIntroductionThere is currently limited guidance on how to codesign digital mental health programs in collaboration with end‐users. As a result, common barriers often prevent codesign initiatives from achieving their full potential in enhancing the effectiveness of digital mental health supports. These barriers include the exclusion of end‐users from the early stages of design, a lack of attention to diversity in user experiences and needs, failure to use tools that facilitate creative and egalitarian collaboration, and prioritisation of usability over robust research methods. To address this gap, this article aims to present a novel conceptual framework, called ‘Design Mapping’, for developing digital mental health programs.MethodsThe Design Mapping framework was developed through a three‐stage process. First, industry experts were consulted, and a review of relevant literature was conducted to identify current best practices for user collaboration in product/service development. Second, the initial conceptual development framework was created, drawing on the strengths of different approaches. Third, the framework was applied to develop a novel early childhood parenting program (called ‘Active Play’), enabling the approach to be tested and refined.ResultsDesign Mapping is a three‐phase framework that integrates tools from Design Thinking that emphasise meaningful and creative user collaboration, within a robust and systematic methodology inspired by Intervention Mapping. The framework also considers factors pertinent when developing both mental health and digital support programs. Preliminary findings from pilot testing of the Active Play program suggest that Design Thinking may support the development of programs that are feasible, effective and engaging.ConclusionDesign Mapping offers a novel conceptual codesign methodology for developing robust, evidence‐based support programs that are responsive to diverse user needs and preferences. The next step is to evaluate its effectiveness in comparison to existing methodologies.Public ContributionThis article presents Design Mapping, a novel conceptual framework that offers a systematic approach to developing evidence‐based digital mental health programs, emphasising meaningful and creative collaboration with end‐users throughout. The primary aim of this article is to explore and address current limitations in codesign practices in the healthcare industry, consider best practice for user collaboration in the development of digital mental health programs, and provide clear and pragmatic descriptions of suggested methods, with sufficient detail to support real‐world utilisation. The Design Mapping framework was conceptualised, tested and refined via the development of a novel early‐childhood parenting support smartphone‐app, called ‘Daily Growth’ (Figure 2). End‐users were involved throughout the development of Daily Growth, from initial program inception through to prototype testing and refinement. This article presents an overview of the development of Daily Growth to illustrate the application of Design Mapping, with other publications providing an in‐depth account of the methodology.