Middlemore Hospital

BackgroundInformed choice is of the highest importance in health care. However, confusion and challenges remain toward how it is conceptualized and measured.PurposeThis umbrella review aimed to establish how informed choice is operationalized in health care and the characteristics and performance of the most commonly used measurement instruments.Data SourcesFour electronic databases (Ovid MEDLINE, Ovid EMBASE, APA PsycINFO, and Cochrane Library) were searched up to January 29, 2024. Reference lists of included studies were hand searched for further relevant publications.Study SelectionAfter the titles and abstracts of 10,434 articles were screened by one reviewer and 10% were screened by a second reviewer for consistency, 2 reviewers independently screened 60 full-text articles for inclusion. Key eligibility criteria included systematic reviews in adult health care settings where the aim included an evaluation of measures of informed choice. Sixteen articles were included.Data ExtractionData were independently extracted by 2 reviewers using a standardized template. Data Synthesis. Data were synthesized using the summarization technique with systematic reviews as the main unit of analysis and additional subanalysis of primary measurement instruments identified.LimitationsHeterogeneous definitions complicate search strategies, and eligibility criteria may limit external validity. The ROBIS appraisal identified many reviews as high risk of bias, limiting the conclusions drawn. Due to heterogeneity, meta-analysis was not possible, and conclusions were limited to narrative reviews.ConclusionsThere remains no consensus on how informed choice should be conceptualized and measured within health care. This review attempts to bridge these gaps by presenting available concepts and instruments for clinicians, researchers, and policy makers. Future recommendations include achieving consistent definitions of informed choice and related concepts, followed by the use of standardized, validated, multidimensional instruments informed by theory in diverse populations.HighlightsInformed choice is of key importance and increasingly emphasized across health care.Despite this importance, confusion and challenges remain regarding how informed choice is conceptualized and measured in health care.Consistent definitions and the use of standardized, validated, multidimensional instruments, informed by theory and patients themselves, in diverse populations should be the first steps to improve this.These recommendations apply to all in health care, including health professionals, researchers, and policy makers.

Hospital discharge codes can be used to identify possible Adverse Events of Special Interest (AESI) following COVID-19 vaccinations. We sought to estimate the positive predictive value (PPV) and level of certainty of ICD-10-AM and SNOMED coding for meeting Brighton Collaboration case definitions of AESIs in Aotearoa, New Zealand. Our expert panel identified 24 ICD-10-AM codes and 2 SNOMED codes expected to identify 9 AESIs. We sought codes likely to be specific rather than sensitive. Medical record reviews were conducted by an experienced coder, adjudicated by medical specialists, for the level of certainty that each case met the target case definition. Admissions coded to an explicit alternative diagnosis were classified as Not a Case. Our data covered over 3 million people. Reviews were conducted on 761 medical records, randomly selected from admissions principally in calendar years 2016 to 2019. We report the PPV of each code with respect to its level of certainty of meeting the case definition. Only Guillain-Barré had a single code specific to a single AESI. Several neurological conditions had overlapping codes, conditions and case definitions. PPVs for individual codes to meet case definitions ranged from 11% to 100%. Level of certainty of each code and PPV are specified. PPVs of codes for each AESI need to be assessed on a case-by-case basis. Many codes are arguably insufficiently 'accurate' to identify a target AESI. We did not assess PPVs for combinations of codes. Our method did not allow us to estimate the number of cases missed by the coding.

only be accomplished through critical synergies between academia, clinicians, industry, government, and community.Conclusions The roadmap represents a comprehensive landscape of the lupus biomarker field and can be used by the research community as a guide for identifying gaps and opportunities.It can also serve as a template for strategic analyses of other areas of lupus research.Ultimately, it positions LRA to lead a coordinated, patient-centered effort that bridges discovery and clinical application, ensuring that biomarker research delivers tangible benefits to people living with lupus.

Abstract Primary central nervous system lymphoma (PCNSL) is a rare aggressive B-cell non-Hodgkin lymphoma confined to the central nervous system, without systemic involvement. The incidence has increased over the past 3 decades. The prognosis has improved in patients up to 70 years old, and this type of lymphoma can be potentially cured. The gold standard of diagnosing PCNSL is histological, usually on a brain biopsy specimen via a neurosurgical procedure. Recent developments in both imaging and laboratory analyses of the cerebrospinal fluid, can be helpful in narrowing the differential diagnosis, diagnosing PCNSL itself, and in follow-up after treatment. This narrative review gives an overview of the epidemiology, diagnosis, and treatment of PCNSL, with an emphasis on recent developments in diagnostic techniques and treatment.

The data that support the findings of this study are available from the corresponding author upon reasonable request. Data S1. Supporting Information. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.

Pulsed Field Ablation (PFA) has been rapidly adopted as a method of Pulmonary Vein Isolation (PVI) for patients with atrial fibrillation (AF). As a non-thermal, tissue-selective technique it may reduce or eliminate some of the complications observed with radiofrequency or cryo-ablation including oesophageal fistula formation and phrenic nerve palsy. It appears to be as efficacious and safer than thermal based ablations. We evaluated the first 100 patients who underwent ablation using the PulseSelect PFA system (Medtronic, Minneapolis, USA) at our centre. All patients who underwent AF ablation using the PulseSelect PFA system between May 2024 and February 2025 were identified from our local, prospective registry. Primary outcome was successful intra-procedural PVI. Secondary outcomes included adverse events, procedure duration, fluoroscopy time and same-day discharge. All of the patients achieved PVI. Additional non-PV target ablations were performed in 39 patients (22 radiofrequency CTI line ablations, 18 other targets). Five (5%) had procedural complications, two of which related to vascular access. Median procedural time was 85min for all procedures, and 70min for PVI-only, with improved times as user experience increased. Median fluoroscopy time was 20min. Same-day discharge was achieved in 49 patients. PFA using Medtronic's PulseSelect System is an effective and safe method of achieving PVI. Our data would suggest it is a quicker procedure than thermal based ablation, which rapidly improved with user experience. The long-term durability of PVI requires further follow-up.

The data from the Myeloma and Related Diseases Registry that support the findings of this study are available on request and following approval from the corresponding author and the registry. The data are not publicly available due to privacy and ethical restrictions. The data access policy is available at www.mrdr.net.au.

Grommet insertion is one of the most common surgeries in childhood. While post-operative care has been traditionally provided by Ear, Nose and Throat (ENT) specialists, workforce capacity challenges have led to the delegation of care to alternate workforces, including audiology. This study aims to evaluate safety and effectiveness of audiology-led post-grommet services and to compare costs of audiology-led models with traditional medical and simulated nurse-led models. A retrospective cohort study was conducted in a regional New Zealand public hospital including all 247 children attending an audiology-led post-grommet clinic from 2019 to 2025. Patient outcomes and pathways through post-grommet services were mapped and costs to the healthcare system and patient/families were calculated. 42.5% of children required an ENT assessment following the implementation of an audiology-led post-grommet model. At the first post-operative visit (median 184 days) 57.5% of grommets were nonfunctional. There were no adverse events reported over the six-year study period. Average healthcare system cost per patient was $NZ130.40 for the audiology-led model representing a 12% cost-savings compared to the standard ENT model ($NZ147.85). The simulated nurse-led model was more costly compared to the audiology-led and ENT models. Cost-savings for patients were achieved through salary differences and fewer clinic visits required under the audiology-led model compared to standard care. Audiology-led post-grommet models are a clinically appropriate and cost-efficient approach to optimise service delivery in resource-limited settings.

RSV remains a severe infection in infants and children. In this report, data on the activity of clesrovimab, a long-lasting RSV monoclonal antibody, are described as compared with palivizumab.