Modbury Hospital

Background: As the burden of Alzheimer’s disease (AD) escalates with an ageing population, the demand for early and accessible diagnostic methods becomes increasingly urgent. Saliva, with its non-invasive and cost-effective nature, presents a promising alternative to cerebrospinal fluid and plasma for biomarker discovery. Methods: In this study, we conducted a comprehensive multi-omics analysis of saliva samples (n = 20 mild cognitive impairment (MCI), n = 20 Alzheimer’s disease and age- and n = 40 gender-matched cognitively normal individuals), from the South Australian Neurodegenerative Disease (SAND) cohort, integrating proteomics, metabolomics, and microbiome data with plasma measurements, including pTau181. Results: Among the most promising findings, the protein Stratifin emerged as a top candidate, showing a strong negative correlation with plasma pTau181 (r = −0.49, p < 0.001) and achieving an AUC of 0.95 in distinguishing AD and MCI combined from controls. In the metabolomics analysis, 3-chlorotyrosine and L-tyrosine exhibited high correlations with disease severity progression, with AUCs of 0.93 and 0.96, respectively. Pathway analysis revealed significant alterations in vitamin B12 metabolism, with Transcobalamin-1 levels decreasing in saliva as AD progressed despite an increase in serum vitamin B12 levels (p = 0.008). Microbiome analysis identified shifts in bacterial composition, with a microbiome cluster containing species such as Lautropia mirabilis showing a significant decrease in abundance in MCI and AD samples. The overall findings were reinforced by weighted correlation network analysis, which identified key hubs and enriched pathways associated with AD. Conclusions: Collectively, these data highlight the potential of saliva as a powerful medium for early AD diagnosis, offering a practical solution for large-scale screening and monitoring.

Global warming caused by increased greenhouse gas (GHG) emissions has a direct impact on human health. Gastrointestinal (GI) endoscopy contributes significantly to GHG emissions due to energy consumption, reprocessing of endoscopes and accessories, production of equipment, safe disposal of biohazardous waste, and travel by patients. Moreover, GHGs are also generated in histopathology through tissue processing and the production of biopsy specimen bottles. The reduction in unnecessary surveillance endoscopies and biopsies is a practical approach to decrease GHG emissions without affecting disease outcomes. This narrative review explores the role of precision medicine in GI endoscopy, such as image-enhanced endoscopy and artificial intelligence, with a focus on decreasing unnecessary endoscopic procedures and biopsies in the surveillance and diagnosis of premalignant lesions in the esophagus, stomach, and colon. This review offers strategies to minimize unnecessary endoscopic procedures and biopsies, decrease GHG emissions, and maintain high-quality patient care, thereby contributing to sustainable healthcare practices.

ABSTRACTBackground and Aims:Epidural catheter migration is a well-described complication in the obstetric population, though its significance in the non-obstetric surgical population is not known. The purpose of this study was to explore the incidence of epidural catheter migration in a non-obstetric adult surgical cohort, assess the factors associated with migration and analyse complications among patients with and without catheter migration.Methods:In this single-centre, prospective, observational study, the acute pain services team collected data over 12 months on consecutive, adult non-obstetric surgical patients who received an epidural catheter for postoperative pain management. Details of epidural catheter insertion, fixation, migration and complications were collected from the first to the fourth postoperative day.Results:Of the 510 patients recruited, epidural catheter migration was noted in 233 patients (45.7%), of which 152 (65.2%) migrated outwards and the rest migrated inwards. Also, 72 (30.9%) and 86 (31.05%) complications were noted in the groups with and without catheter migration, respectively. The most frequent complications noted were inadequate analgesia, unilateral sensory block, motor block and hypotension in both groups. We did not find any correlation between the frequency of epidural catheter migration and demographic factors.Conclusions:Epidural catheter migration is a sizeable postoperative occurrence in non-obstetric surgical patients. Factors that might play a role in catheter migration could not be established in this study. There is an almost similar frequency of complications noted among patients with and without catheter migration, with the most common being inadequate analgesia in both groups.

Gallbladder agenesis is a very rare condition, majority of which are normally diagnosed intraoperatively because of low index of suspicion and high rate of false positive results for cholecystitis on ultrasound imaging. We present a case of a 25-year-old man who presented with a right upper quadrant pain, whose ultrasound suggests a contracted gallbladder with gallstones. He was treated as an acute on chronic cholecystitis and booked for laparoscopic cholecystectomy. Intraoperatively, there was no gallbladder to be seen and decision was made to abandon procedure and avoid further exploration. Post-operative magnetic resonance cholangiopancreatography confirmed the congenital agenesis of gallbladder. It is important to have awareness of this condition, and possible further imaging modalities should be used if the ultrasound suggests a shrunken or contracted gallbladder that is not easily visible to avoid the risk of undergoing an unwarranted surgery.

BackgroundIn Australia during the COVID‐19 pandemic new funding models were introduced to support telehealth consultations, resulting in their widescale adoption in palliative care service delivery. Clarity around the clinical circumstances and patient populations that might be most appropriate for telehealth models was required.AimsTo evaluate patient and physician satisfaction, acceptability and utility of outpatient palliative care provision through telehealth.MethodsThis is a multi‐site prospective, cross‐sectional, observational study conducted during a time of significant public health restrictions. A survey was used to collect matched patient‐ and physician‐reported perceptions of palliative care telehealth consultations across three metropolitan hospitals in Victoria, Australia.ResultsThere were 127 matched patient–physician data of telehealth consultations and a further 812 physician‐only assessments. Telehealth was generally acceptable and satisfactory, with patients providing greater positive scores than clinicians. Telehealth incorporating both audio and video were more acceptable and satisfactory, particularly with the presence of a carer, and during routine reviews. Physicians were less satisfied using telehealth when there was increasing symptom complexity across all domains (pain, psychological, and other symptoms).ConclusionsTelehealth has high utility in palliative care practice. A future hybrid model of care comprising both face‐to‐face and telehealth consultations seems favoured by patients and physicians but must be accompanied by targeted support for specific patient groups to ensure equitable healthcare access. Further evaluation of telehealth during a time of fewer public health emergency measures and lower community anxiety is required to fully understand its ongoing role.

BackgroundCurrent international consensus is that ‘early’ referral to palliative care services improves cancer patient and family carer outcomes. In practice, however, these referrals are not routine. An approach which directly addresses identified barriers to early integration of palliative care is required. This protocol details a trial of a standardized model of early palliative care (Care Plus) introduced at key defined, disease-specific times or transition points in the illness for people with cancer. Introduced as a ‘whole of system’ practice change for identified advanced cancers, the key outcomes of interest are population health service use change.The aims of the study are to examine the effect of Care Plus implementation on (1) acute hospitalisation days in the last 3 months of life; (2) timeliness of access to palliative care; (3) quality and (4) costs of end of life care; and (5) the acceptability of services for people with advanced cancer.MethodsMulti-site stepped wedge implementation trial testing usual care (control) versus Care Plus (practice change). The design stipulates ‘control’ periods when usual care is observed, and the process of implementing Care Plus which includes phases of planning, engagement, practice change and evaluation. During the practice change phase, all patients with targeted advanced cancers reaching the transition point will, by default, receive Care Plus.Health service utilization and unit costs before and after implementation will be collated from hospital records, and state and national health service administrative datasets. Qualitative data from patients, consumers and clinicians before and after practice change will be gathered through interviews and focus groups.DiscussionThe study outcomes will detail the impact and acceptability of the standardized integration of palliative care as a practice change, including recommendations for ongoing sustainability and broader implementation.Trial registrationAustralian New Zealand Clinical Trials Registry ACTRN 12619001703190. Registered 04 December 2019.

Giant cell arteritis is a medical emergency because of the high risk of irreversible blindness and cerebrovascular accidents. While elevated inflammatory markers, temporal artery biopsy and modern imaging modalities are useful diagnostic aids, thorough history taking and clinical acumen still remain key elements in establishing a timely diagnosis. Glucocorticoids are the cornerstone of treatment but are associated with high relapse rates and side effects. Targeted biologic agents may open up new treatment approaches in the future.

Abstract Objective:To synthesise the current best evidence on both pharmacological and non-pharmacological behaviour management interventions for adult patients in the acute hospital setting with traumatic brain injury (TBI) or post-traumatic amnesia (PTA).Data Sources:A comprehensive search of 10 electronic databases was completed.Study Selection:Systematic reviews (SRs) published in English before September 2018 were included. Initial search resulted in 4604 citations, 2916 for title and abstract screening with duplicates removed, and 2909 articles failed to meet the inclusion criteria leaving seven reviews for inclusion. Five reporting pharmacological management approaches, two reporting non-pharmacological management approaches, and one reporting both pharmacological and non-pharmacological management approaches.Data Extraction:Methodological quality was assessed independently by two reviewers using the Critical Appraisal Skills Programme Tool for SRs. Data were extracted from the studies based on the recommendations of the Joanna Briggs Institute (JBI) Methodology for JBI Umbrella Reviews.Data Synthesis:The SRs were of low-to-moderate quality overall. High-quality SRs were characterised by low numbers of studies and significant biases. The evidence relating to pharmacological interventions demonstrates low level and variable quality. The evidence relating to non-pharmacological interventions was limited and of low quality.Conclusions:The current evidence for the management of challenging behaviours in patients with acute TBI/PTA is generally equivocal, potentially reflecting the heterogeneity of patients with TBI and their clinical behaviours. More studies with rigorous methodologies are required to investigate the most suitable pharmacological and non-pharmacological behavioural interventions for the acute phase of TBI or PTA.

Evaluating and comparing the efficacy of intratympanic high dose dexamethasone (24 mg/mL) and high dose methylprednisolone (125 mg/mL) as a primary and salvage treatment for idiopathic sudden sensorineural hearing loss