Logan Hospital

Diabetic ketoacidosis (DKA) remains a life-threatening complication of diabetes mellitus with suboptimal outcomes despite standard management. Emerging evidence suggests that thiamine (vitamin B1) deficiency may play an under-recognized role in DKA pathophysiology and clinical course. This narrative review synthesizes current evidence regarding thiamine deficiency in diabetes and DKA, examining molecular mechanisms, clinical implications, and the rationale for thiamine supplementation as adjunctive therapy. Thiamine deficiency is highly prevalent in diabetes, with plasma concentrations reduced by approximately 75% compared to healthy controls. In DKA specifically, 25–35% of patients present with thiamine deficiency, which often worsens during insulin therapy. The primary mechanism involves hyperglycemia-induced downregulation of renal thiamine transporters (THTR-1 and THTR-2), resulting in 16–24-fold increased renal clearance and massive urinary losses. Thiamine pyrophosphate serves as an essential cofactor for three critical enzymes in glucose metabolism: pyruvate dehydrogenase, α-ketoglutarate dehydrogenase, and transketolase. Deficiency impairs these pathways, causing pyruvate accumulation with conversion to lactate (resulting in lactic acidosis), compromised TCA cycle function (reducing ATP production by 40–48%), and decreased NADPH generation (increasing oxidative stress). Clinical manifestations include persistent metabolic acidosis despite standard therapy, myocardial dysfunction with elevated cardiac biomarkers, neurological impairment, and prolonged recovery times. Cellular studies demonstrate that thiamine supplementation significantly improves mitochondrial oxygen consumption in DKA patients. The high prevalence of thiamine deficiency in DKA, compelling biochemical rationale, excellent safety profile, and preliminary mechanistic evidence support the urgent need for large-scale randomized controlled trials examining thiamine supplementation to definitively establish efficacy, optimal dosing, and patient selection criteria.

Obesity increases the risk of complications in colorectal cancer surgery. While preoperative very low calorie diet (VLCD) interventions may provide weight loss prior to various surgeries, no data on preoperative VLCD in colorectal cancer surgery exist. This retrospective cohort study therefore aimed to evaluate the efficacy and safety of a dietitian-led preoperative VLCD clinic for adults with obesity prior to colorectal cancer surgery. Patients who received the VLCD clinic intervention between 2017 and 2023 were matched 1:1 with adults who did not receive VLCD clinic intervention (controls). Primary outcome was efficacy, measured as ≥ 3% weight change from baseline to surgery. Secondary outcome was safety, measured via occurrence of adverse and serious adverse events during VLCD clinic intervention. Descriptive and clinical data were collected from medical charts. Chi-squared, Fisher's exact and nonparametric tests were used to compare data between groups. Thirteen VLCD and 13 controls were recruited (age (median(IQR) 63(59-69)years, 65% male). Baseline descriptors were similar, including planned surgical procedure, age and co-morbidities (p > 0.05). However, VLCD participants were ~9 kg heavier (median(IQR) 114.1(104.5-131.7)kg) at baseline than controls (p < 0.05). The VLCD group lost median 4.75 kg (3.8%) (p < 0.05), with 67% achieving ≥ 3% body weight loss from baseline to surgery (median(IQR) 30(18-47) days). No VLCD-related adverse events occurred. The VLCD and control groups experienced eight and 15 surgical complications, respectively. A dietitian-led preoperative VLCD clinic intervention achieved weight loss and appears safe. This novel approach may be useful for the preoperative optimisation of colorectal cancer patients with obesity.

Data sharing is not applicable to this article as no datasets were generated or analyzed during the current study.

Abstract Background Allied health professionals (AHPs) are pivotal to delivering safe, effective, and collaborative healthcare. Yet, there is limited empirical insight into their current training priorities across core domains of professional practice. In an increasingly digital, team-based health system, identifying profession-specific and shared training needs is essential for designing development strategies that retain and grow a future-ready workforce. This study aimed to map training needs across the Australian AHP workforce and explore whether demographic factors predict perceived gaps between the importance and performance of key professional tasks, both within and across professional groups. Methods A national cross-sectional survey of AHPs was conducted using the WHO-endorsed Hennessy Hicks Training Needs Analysis Questionnaire. Participants self-rated 30 core and 10 emerging tasks by perceived importance and current performance. Gap scores (importance minus performance) were analysed and visualised using an Importance-Performance matrix to highlight priority areas. Descriptive statistics, multiple regression models and multivariate analysis explored whether variation existed between profession and other demographic variables across seven domains of practice. Results From 2,436 valid responses, a clear and consistent pattern emerged: AHPs rated all tasks as more important than their current performance, highlighting significant perceived capability gaps. The most pronounced needs were found in leadership/continuous improvement, and digital health domains. Emerging tasks such as managing work-life balance, achieving efficient results and identifying opportunities for quality improvement also ranked highly, reflecting the current landscape of AHP practice. While significant demographic differences including level of experience, highest qualification, profession and regionality were observed across domains, effect sizes were uniformly small, suggesting limited practical significance. Conclusion This study provides the first national snapshot of AHP needs and provides compelling evidence that the future of allied health workforce development lies in shifting from siloed, discipline-specific training to capability-building that supports interdisciplinary, digitally enabled healthcare. Interprofessional education models are particularly implicated to address shared training needs in leadership, digital transformation, and system improvement, particularly for early-career professionals and those in remote roles. These findings offer a practical and timely roadmap for aligning training with the evolving demands of healthcare delivery.

Sensory augmentation or "neurofeedback" devices have been used in balance rehabilitation to provide additional sensory information to complement natural sensory inputs and enhance sensory reweighting. The VertiGuard RT vibrotactile neurofeedback balance training system records body sway (direction, amplitude, and acceleration) via a wearable sensor and provides feedback to the wearer in real time via vibrotactile sensory feedback. This study aimed to explore the feasibility and usability of VertiGuard RT vibrotactile neurofeedback balance training in older adults with hearing loss and describe the participants' overall perspectives of the device and training. A mixed-methods design was used, including qualitative semistructured interviews analyzed using thematic analysis and the System Usability Scale for quantitative analysis. A subset of participants from a larger trial of the VertiGuard RT device (N = 14) of older adults with mild-to-profound hearing loss was recruited. Participants found the VertiGuard RT training feasible; however, usability varied, with a number of challenges, including technical issues, challenge level of the exercises, and degree of feedback. This study provides suggestions for improving future iterations of the VertiGuard RT system and the design of technology-enhanced balance training systems for older adults. https://doi.org/10.23641/asha.29289926.

PurposeSodium bicarbonate is commonly administered to treat metabolic acidosis in intensive care units (ICUs). There is limited evidence from randomized trials to support this practice, and observational studies show conflicting results. Our aim was to perform a target trial emulation evaluating the effect of bicarbonate therapy on mortality.MethodsRetrospective cohort study using data from 12 Australian ICUs. Inclusion criteria were adults with pH < 7.3 and PCO2 ≤ 45 mmHg within the first three days. We excluded repeat admissions, toxicology, diabetic ketoacidosis, and pre-existing end-stage renal failure. The treatment intervention was sodium-bicarbonate administration, and the primary outcome was 30-day ICU mortality with ICU discharge as a competing event. We evaluated multiple subgroups, including patients with acute kidney injury, requirement for vasoactive therapy, and pH < 7.2. The primary model utilized a parametric g-computation and rolling entry matching was performed as a sensitivity analysis.ResultsWe identified 6157 eligible admissions, of which 1764 (29%) received sodium bicarbonate. Bicarbonate therapy was associated with a 1.9% absolute mortality reduction for the primary analysis [risk ratio 0.86, 95% confidence interval (CI) 0.80 to 0.91], and significant benefits were seen across all subgroups evaluated. A similar point estimate of 2.1% was observed in the sensitivity analysis, with a sustained mortality reduction seen at 30 days.ConclusionIn this target trial emulation, bicarbonate administration was associated with a small but statistically significant reduction in mortality for patients with metabolic acidosis. Large sample sizes would be required to demonstrate this effect in a randomized trial.