Gold Coast Hospital

The burden of patient harm from unsafe care is disproportionately high in low-income countries, particularly in intensive care units (ICUs). Despite this, there is limited empirical evidence explaining the underlying challenges that make patient safety difficult to achieve in resource-limited ICUs. To explore the barriers to patient safety and incident-reporting in ICUs at Ethiopian university hospital. An exploratory qualitative descriptive study was conducted using in-depth interviews guided by a semi-structured protocol and informed by the Theoretical Domains Framework (TDF). Participants were purposively selected, and sample size was determined based on principles of data sufficiency. Reflexive thematic analysis with inductive orientation was employed following Braun and Clarke's approach. Thirty-nine healthcare professionals participated: 23 (59%) nurses, 13 (33%) physicians, and 3 (8%) clinical pharmacists. The mean age of participants was 32±5 years. Three overarching themes captured the barriers to patient safety and incident reporting in ICUs: (i) Fragile systems: Governance failure and resource constraints; (ii) Normalisation of deviance: teaching-hospital dynamics and clinical oversight, normalised communication lapses, and weak teamwork and relational context; and (iii) Silence trap: Fear in punitive and blame-oriented culture and lack of incident-reporting systems. Patient safety in Ethiopian ICUs is undermined by systemic, operational, and clinician-related obstacles. Structural and cultural barriers further hinder incident-reporting creating a vicious cycle where unsafe care remains hidden and opportunities for learning and improvements are lost. Breaking this cycle requires strong governance, coordinated resource investment, enhancing just culture, strengthening teamwork, establishing robust incident-reporting systems, and ongoing professional development focused on patient safety. Identifying barriers to patient safety and incident reporting in ICUs may enables targeted interventions that reduce preventable harm, improve care quality, and promote incident reporting and learning to sustain safe clinical practice.

Obstructive sleep apnoea (OSA) is common in Australia but underexamined among First Nations peoples. We conducted a retrospective cross-sectional analysis of 1563 adult sleep studies in South East Queensland (2022-2023). Thirty-eight participants (2.4%) identified as First Nations, of whom 74% had OSA. Comorbidities were more frequent among the First Nations cohort, though small sample size limited certainty. These findings reveal both under-identification of First Nations status and a substantial OSA burden, emphasising the need for culturally informed, community-led approaches to OSA care in Queensland.

Haemorrhage and blood product usage are common in venoarterial extracorporeal membrane oxygenation (VA ECMO) and associated with increased mortality. A prospective, investigator-initiated, longitudinal observational cohort study on major haemorrhagic events in 12 ECMO centres from 3 continents for three predefined subgroups (VA ECMO initiated during cardio-pulmonary resuscitation (ECPR), after cardiothoracic surgery (CTS), for cardiogenic shock (CS)). The aim was to describe haemorrhagic complications as well as transfusion practice and anticoagulation for the whole population as well as the subgroups. In addition, independent baseline predictors for red blood cell (RBC) transfusions were evaluated. 545 prospective patients were included between 2019 and 2022 (ECPR 149, CTS 169, CS 227). Hospital mortality was 46%. Over 2796 days 406 major haemorrhage events in 286 (52%) patients were recorded. CTS and ECPR patients had more frequent events occurring earlier in their course. 88% received RBC transfusions (1.27 (95%CI 1.22 – 1.31) units/day) with significantly more transfusions for CTS and ECPR patients. Platelet transfusion rates were highest in the CTS group (0.58 (95%CI 0.53–0.64) units/day). Haemoglobin and platelet count prior to transfusion were independent of subgroups and averaged (78 g/L (IQR 73, 84), 58 × 10^9/L (IQR 37, 85), respectively). However, platelet count prior transfusion was only marginally higher on days with major haemorrhage (74 × 10^9/L (IQR 50, 104). Systemic anticoagulation was started within the first 24 h in 83% (95% CI 80–87%) of patients, most frequently in CS patients (90%, CI 85–95%). Independent baseline predictors for RBC transfusion were ECPR (IRR 1.50, 95%CI 1.19–1.89) and prior use of antiplatelets (IRR: 1.43, 95%CI 1.13–1.80). Myocarditis and pulmonary embolism were associated with a lower rate of transfusion when compared to myocardial infarct (IRR: 0.57 (0.37–0.89), IRR: 0.67 (0.45–1.00, respectively). Haemorrhagic complications differ in clinical subgroups and RBC transfusion exposure is by far higher than in other critically unwell populations. We identified ECPR and antiplatelet therapy as additional predictors. Transfusion practice for RBC and platelets is variable and does not always follow international guidelines.

To map the current literature on the characteristics of nurse-related medication errors in perioperative healthcare settings. A scoping review. This scoping review used the five-stage framework developed by Arksey and O'Malley (2005). The five stages are: (1) Identifying the Research Question; (2) Identifying Relevant Studies; (3) Study Selection; (4) Charting the Data; and (5) Collating, Summarising, and Reporting the Results. Findings were synthesised using the PAGER framework. An Ishikawa diagram was used to illustrate contributing factors of nurse-related medication errors. In October 2024, using key search terms, five databases (Scopus, EBSCO Cumulative Index to Nursing and Allied Health Literature, OVID Embase, EBSCO Medline, EBSCO PsycInfo) and two grey literature platforms (opengrey, Policy commons) were searched. The articles were imported to the Covidence database from Endnote after removing duplicate literature. Selected article titles and abstracts, and subsequently full-text articles, were screened by two trained reviewers based on a priori inclusion and exclusion criteria. Data were extracted from the included full-text articles by one author, checked by another, and analysed descriptively. Of the 967 articles identified through the searches, 7 full-text articles were included. The incidence of nurse-related medication errors in perioperative settings ranged from 6.4% to 33.7%, with errors including incorrect medication routes, missed or delayed doses, and miscommunication-related overdoses. Contributing factors were multifaceted, involving workload pressures, communication failures, system flaws, and organisational influences such as leadership and safety culture. Medication errors in the perioperative setting pose a significant threat to patient safety yet remain underexplored compared to other healthcare contexts. A holistic approach incorporating human factors frameworks, improved communication, workload management, and leadership can help address the complex causes of these errors and guide targeted interventions to enhance perioperative safety and patient outcomes. Scoping Reviews (PRISMA-ScR) checklist. No Patient or Public Contribution. Open science Framework Website. Registration DOI https://doi.org/10.17605/OSF.IO/EXT8C.

In colorectal cancer (CRC), circulating tumour cells (CTCs) employ genetic alterations to dodge the body's immune system. These alterations occur in specific "driver" genes, including KRAS, BRAF, p53, MYC, APC and PTEN. Changes in these genes can control how the tumour interacts with the immune system and influence the expression of immune checkpoint molecules such as PD-1, PD-L1, PD-L2, CTLA-4 and CD47. These molecules help suppress the immune system's response against the tumour, thus promoting tumour growth. However, the precise relationship between driver gene mutations and the expression of immune checkpoint molecules in CTCs, along with their clinical significance, remains incompletely understood. By studying these genetic changes and how they affect the behaviour of CTCs, researchers can gain critical insights into the development and progression of CRC, especially the roles of CTCs, which could improve CTCs' implications in liquid biopsy. Moreover, understanding these alterations can also highlight potential therapeutic targets. This may pave the way for more effective, targeted therapies to delay or prevent CRC progression. Therefore, investigating the genetic alterations in CTCs and their role in immune escape mechanisms is a significant area of study in CRC research.

Obesity is a modifiable risk factor for atrial fibrillation (AF); however, its influence on recurrence and mortality remains controversial. This study aimed to compare clinical characteristics and 12-month outcomes between obese and non-obese patients with AF and to identify predictors of recurrence and mortality. A retrospective analysis was conducted on 225 patients hospitalized for AF, classified according to obesity (BMI ≥30kg/m2). The primary outcome was AF-related rehospitalization within 12 months, and the secondary outcome was all-cause mortality. Clinical, biochemical, and sociodemographic data were collected. Obesity was present in 43% of patients and was associated with younger age, a higher prevalence of sleep apnea, and hypertriglyceridemia. At 12 months, 24.9% of patients were rehospitalized and 14.0% experienced AF recurrence. Obesity (OR 2.84; 95% CI 1.17-6.90; p=0.021) and excessive alcohol consumption (OR 3.49; 95% CI 1.07-11.41; p=0.039) independently predicted AF recurrence. Advanced age, low socioeconomic status, and hypokalaemia were associated with higher mortality, whereas obesity was linked to a lower risk (OR 0.38; 95% CI 0.16-0.95; p=0.038). In this cohort, obesity was associated with increased AF recurrence but reduced mortality, supporting the "obesity paradox." Excessive alcohol intake and low socioeconomic status also influenced outcomes, underscoring the need for individualized management strategies.

The clinical application of acoustic swallowing sound parameters collected from digital cervical auscultation is limited because of the time-consuming manual segmentation required by trained experts. The automated identification of swallowing sounds in children and adults from swallowing sound audio wavefiles using machine learning have accuracies between 76-95%. No data exists in preterm neonates. To determine if applying automated machine learning using a transfer learning approach could accurately identify and segment swallows from swallowing sounds collected in preterm neonates. Thin fluid swallow sounds were collected from 78 preterm neonates, median birth age 34weeks gestation (range 25-36weeks, 52.6% males) across 3 Australian special care nurseries. For the base machine learning model, a deep convolutional neural network (DCNN) pre-trained for audio event classification was used. With raw swallow audio data as input, embedding vectors from the base DCNN were generated and used to train a feedforward neural network to determine the presence of a swallow within an audio segment. The model showed high overall accuracy (94%) in identifying preterm swallows. Better model performance on bottle feeding swallows (Sensitivity, 95%; and specificity, 96%) was seen compared with breastfeeding swallows (sensitivity, 95%, specificity 92%). Interpretation: Our novel study demonstrates the successful use of transfer learning to accurately identify and segment digital swallowing sounds in preterm neonates. Application of this model could support the development of a digital CA app to automatically classify swallow sounds and improve objectivity for CA use in clinical practice within special care nurseries.

Mechanical thrombectomy (MT), in combination with intravenous thrombolysis, have been widely accepted as effective therapies for acute ischemic stroke (AIS) secondary to large vessel occlusion. However, the presence of calcified cerebral emboli (CCE) has been associated with worse angiographic and clinical outcomes. Therefore, this systematic review aimed to evaluate the efficacy and safety of MT in the management of AIS secondary to CCE. Asystematic review was registered and conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (CRD420251031539). PubMed, Ovid Medline, SCOPUS, The Cochrane Library and EMBASE were searched for publications until 13th April 2025. The search yielded 2102 publications. 14studies met inclusion criteria (160 patients with AIS due to CCE). Two multi-centre studies reported recanalisation rates of only 57.5% and 57% respectively across 75participants. Only 11.1-28.0% of patients in the included case series and cohort studies had amodified rankin score 2at 3months, suggesting that most patients did not regain functional independence following MT for CCE. MT for CCE was also associated with a3-month mortality rate of 0-62.5%. Haemorrhagic complications were the most common adverse effect associated with MT. The available evidence from 14studies elucidated poor recanalisation rates and functional outcomes when MT was used in the management of AIS secondary to CCE. However, the available evidence is primarily low-level evidence from observational studies, hence the conclusions should be interpreted with caution.