North Metropolitan Health Service

Arthroscopic surgical takedown and repair of symptomatic partial-thickness rotator cuff tears are commonly undertaken. An alternative approach is the use of a bioinductive collagen implant to augment the rotator cuff tear. To investigate early function and rotator cuff tendon integrity in patients undergoing arthroscopic bioinductive collagen implant augmentation (REG group) versus rotator cuff takedown and repair (RCR group) for high-grade partial-thickness rotator cuff tears. Randomized controlled clinical trial; Level of evidence, 2. Patients 35 to 75 years of age with symptoms >3 months and unresponsive to nonoperative treatment, with high-grade partial-thickness rotator cuff tears confirmed on 3-T magnetic resonance imaging (MRI), were randomly allocated to RCR or REG groups. Exclusion criteria included previous ipsilateral shoulder surgery, multitendon tears/pathology, and concomitant surgery including labral repair, long head of biceps tenodesis, or chondroplasty/microfracture. Patients were assessed preoperatively and at 6 weeks as well as 3, 6, and 12 months postoperatively. The primary study outcome was the Western Ontario Rotator Cuff Index (WORC) at 3 months after surgery. Secondary outcomes included the American Shoulder and Elbow Surgeons (ASES) and Constant scores, and the time taken to return to work and activities of daily living (ADLs). MRI-based rotator cuff repair integrity was assessed using the Sugaya grading system. This study recruited 41 patients (REG n = 21; RCR n = 20). No group differences (P > .05) were observed in mean age (REG 57.1 years; RCR 57.8 years), preoperative duration of symptoms, and previous nonoperative treatments. The REG group reported superior outcomes for the WORC at 6 weeks (P = .001) and 3 months (P = .026) as well as the ASES at 6 weeks (P < .001) and WORC Work, Sport, and Emotions domains at 6 weeks and 3 months (P < .05). There were no group-based differences (P > .05) in patient-reported outcomes at 6 or 12 months after surgery. The REG group was faster (P < .05) to permanently remove the sling, drive a motor vehicle, and return to office duties and moderate-intensity chores. No MRI-based differences were observed, with 19 (90%) and 17 (85%) REG and RCR patients, respectively, graded Sugaya 1 to 2 at 12 months. For symptomatic high-grade partial-thickness rotator cuff tears, bioinductive collagen implant augmentation versus standard rotator cuff repair demonstrated improved early function with equivalent MRI-based healing rates. Australian New Zealand Clinical Trials Register (ACTRN12620000926932p).

The overall goal of this article is to present a fresh entanglement of diverging and converging cross-cultural perspectives on land, wellbeing and people. At times, what we weave is tightly bound, and at other times it frays off because that is life, relationship and research. We word-weave the complexity of our intersecting standpoints like a traditional Barkindji Club Rush emu net. One aim was to amplify and preserve Barkindji ecological and cultural knowledges and define a context-specific framework for conceptualising and practicing wellbeing. This framework builds on the work of others by including the importance of land-based participatory action, the potential for social change through traditional ecological plant knowledge, and highlights the significance of Indigenous women’s roles in this space.

BackgroundThe digital health research field is growing rapidly, and a summary of the available digital tools for triaging musculoskeletal conditions is needed. Effective and safe digital triage tools for musculoskeletal conditions could support patients and clinicians in making informed care decisions and may contribute to reducing emergency department overcrowding and health care costs.ObjectiveThe aim of the study is to identify and describe digital health tools for use by adults to triage musculoskeletal conditions across primary, urgent, or emergency care settings.MethodsOur scoping review was conducted following the Johanna Briggs Institute recommendations for scoping reviews and Arksey and O’Malley’s framework. Systematic searches in MEDLINE (OVID), Embase (OVID), CENTRAL (OVID), CINAHL (EBSCO), Compendex, Web of Science, OpenGrey, Google Scholar, arXiv, medRxiv, and an extensive gray literature search were conducted with a librarian scientist from inception to September 18, 2025. Studies had to recruit adults (aged 18 years and older) with musculoskeletal conditions that identified a digital health tool designed to triage or diagnose in primary, urgent, or emergency care settings and report primary data to be included. In total, 2 reviewer pairs independently screened abstracts and full-text papers. Relevant data were extracted in duplicate, and results were summarized descriptively.ResultsThe search yielded 5695 records, and we screened 189 full-text papers. In total, 34 studies (n=37,509 patients) met the inclusion criteria. The most common musculoskeletal conditions reported were rheumatoid or inflammatory arthritis (13/34, 38%). In total, 19 (19/34, 56%) studies reported on symptom checkers, 13 (13/34, 38%) studies on triage or diagnosis tools, and 2 (2/34, 6%) were studies of diagnostic predictor tools. There were 16 unique digital health tools. A total of 2 tools were built for triaging musculoskeletal conditions and were not publicly available outside the UK National Health Service. Most tools were generic tools designed to screen for general health problems, including musculoskeletal conditions. The most common approach to evaluating performance (eg, accuracy) of the tools was to compare the concordance of the tool to a clinician diagnosis or triage recommendation. Sensitivity and specificity ranged from 39% to 91% and 23% to 80%, respectively. The reported accuracy of the included tools ranged from 33% to 98%.ConclusionsMusculoskeletal conditions remain a blind spot for people designing, implementing, and evaluating digital health for triage: few tools were specifically designed for musculoskeletal conditions, and most existing tools performed poorly when applied to musculoskeletal populations. We recommend health systems and clinicians use a multimodal approach, integrating both digital health tools and clinical decision-making to safely triage and diagnose until a more robust tool for musculoskeletal conditions is available. Future tool developers need to use transparent, standardized processes that prioritize tool safety, clinical value, and trustworthiness when designing for clinicians and patients.

BackgroundNecrotizing fasciitis (NF) is a rapidly progressive, life-threatening infection with significant morbidity and mortality. Rural and remote regions face unique challenges in the timely diagnosis and management of NF.MethodologyThis retrospective study included all patients diagnosed with NF in the Kimberley region, Western Australia, between June 2020 and June 2025. Data were extracted from medical and surgical records, microbiology databases, and theater logs. Demographic, clinical, microbiological, and outcome variables were analyzed descriptively.ResultsIn total, 21 patients were identified during the five-year period. The estimated incidence rate was 12 per 100,000 population. The median age was 49 years (interquartile range = 37-56); 8 (38%) were males, and 13 (62%) were females. Overall, 16 (76%) identified as Aboriginal and/or Torres Strait Islander. Diabetes (76%, 16), obesity (86%, 18), and smoking (62%, 13) were common. The most frequent site of infection was the lower limb, accounting for 52% (11) of cases, followed by the gluteal or buttock in 24% (5). All patients underwent operative management, and 9% (2) of patients died in the hospital.ConclusionsThe incidence of NF in the Kimberley is higher than the national and international average. This presents unique diagnostic and management challenges due to geographic remoteness, workforce shortages, and comorbidity burden. This study contributes valuable insights into the regional epidemiology and the management of NF in rural settings.

Upper tract urothelial carcinoma (UTUC) is a rare but aggressive malignancy where accurate preoperative assessment of tumour grade and stage is essential to guide treatment. Conventional tools such as ureteroscopic biopsy have limited accuracy and procedural risks. This systematic review evaluated the diagnostic and prognostic performance of radiomics models for predicting grade, stage, histotype, muscle invasion, and outcomes in UTUC. Following PRISMA guidelines (PROSPERO Registration ID: CRD420251141966), PubMed, EMBASE, CENTRAL, and grey literature were searched up to 6 September 2025. Eligible studies included radiomics-based analyses in adults with UTUC. Extracted performance metrics (AUC, sensitivity, specificity) were summarised as medians with ranges. Twelve studies (n = 1,685) were included, encompassing 45 distinct radiomics models: 20 for grade, 11 for stage, 10 prognostic, three histotype, and one for muscle invasion. Models predicting high-grade disease demonstrated excellent performance (median AUC 0.876, range 0.675–0.961; sensitivity 0.838; specificity 0.806). Prognostic models achieved a median AUC of 0.854 (range 0.750–0.933) and sensitivity of 0.909, effectively predicting recurrence-free and overall survival. Stage prediction models yielded a median AUC of 0.771 (range 0.711–0.860), while histotype models reported a median AUC of 0.84. The single study assessing muscle invasion achieved an AUC of 0.821. Most studies used CT-based radiomics with machine-learning classifiers, though validation methods and feature selection strategies were heterogeneous. Radiomics demonstrates high diagnostic and prognostic accuracy in UTUC, particularly for tumour grade and survival prediction. These findings support its potential as a non-invasive adjunct for risk stratification and surgical planning, though standardised multicentre validation is required before clinical adoption. The trial was prospectively registered on PROSPERO on 07/09/2025 under ID: CRD420251141966.

Anaplastic thyroid cancer (ATC) is a rare and aggressive malignancy with limited treatment options and a poor prognosis. This study evaluates the outcomes of patients with locally advanced or metastatic ATC treated at two tertiary centres, focusing on the efficacy of pembrolizumab and lenvatinib, and the impact of BRAF status. A retrospective review of 16 ATC patients treated between January 2018 and June 2024 at two tertiary Australian hospitals was conducted. Pathological confirmation was required for inclusion. Clinical data, including treatment regimens, response rates assessed by Response Evaluation Criteria in Solid Tumours version 1.1 (RECIST 1.1), progression-free survival (PFS), and overall survival (OS), were analysed. Fifteen out of 16 patients (94%) had metastatic disease. Five patients (31%) had a BRAFV600E mutation, with four receiving first-line (1L) dabrafenib/trametinib, achieving a 75% (3/4) objective response rate. Eleven patients (50%) were BRAF wildtype, and eight received pembrolizumab and lenvatinib as both 1L and second-line (2L) settings, with an objective response rate of 75% (6/8) in both 1L and 2L settings, including three complete responses. Programmed death-ligand 1 tumour proportional score ≥50% was found in 64% (9/14) of patients, correlating with better outcomes. Median time on treatment for the pembrolizumab and lenvatinib group was not reached, with the longest survival exceeding 12 months at the time of data cut-off. This case series highlights promising outcomes with systemic treatment options in ATC, but the analysis is limited by a small sample size, emphasising the need for further research and collaboration to improve clinical outcomes.

Chronic and intractable hiccups are a debilitating symptom in palliative care, yet the evidence for their pharmacological management is sparse and of low certainty, as certain study designs are frequently excluded from traditional systematic reviews. To synthesize all available quantitative and qualitative evidence for the pharmacological management of chronic and intractable hiccups in adults receiving palliative care. We conducted a mixed methods systematic review, including a rapid umbrella review, following a registered PROSPERO protocol (CRD42024514442) in accordance to the PRISMA and SWiM guidelines. Seven electronic databases, trial registries and grey literature sources were searched from inception until August 2025 for studies of any design and systematic reviews. Quantitative data on hiccup reduction or cessation following pharmacological use, and qualitative phenomena of interest on patient and clinician experiences were extracted. Studies were critically appraised via JBI and AMSTAR-2 tools, synthesized separately using a convergent segregated approach, and then integrated narratively. This was performed independently by two reviewers. A total of 88 primary studies (85 quantitative, two qualitative and one mixed methods) and six systematic reviews were included. The quantitative synthesis, comprising 156 patients, identified gabapentin and baclofen as the most frequently reported effective agents, alongside various dopamine antagonists, benzodiazepines, medication rotation, combination therapies and novel approaches. The qualitative synthesis revealed four themes: the profound psychosocial impact of hiccups, perceived treatment ineffectiveness, a disconnect between patient experience and clinical awareness, and a patient preference for symptom management over cure. The evidence for management of chronic and intractable hiccups in palliative care is of very low certainty and likely subject to significant publication bias. Clinical goals should be reframed from cure to "palliative control", prioritizing functional improvement and a reduction in symptom burden.

Background/Objectives: This study aims to provide a comprehensive understanding of the current mental health workforce and the factors influencing its distribution within adult community mental health services in Western Australia’s North Metropolitan Health Service. Methods: Mental health workforce supply across North Metropolitan Statistical Area Level 2 (SA2-Australian Statistical Geography Standard) was estimated using the Geographically-adjusted Index of Relative Supply (GIRS) and categorised as low (0–3) or moderate-to-high (4–8) for analysis and testing associations with multiple covariates. Population, clinic, and individual-level data were analysed using principal component analysis and logistic regression to identify the factors associated with workforce distribution. Results: Of the 68 SA2s analysed, 25 SA2s (representing 45 suburbs) were identified as having a low workforce supply, defined by a GIRS score of ≤3. These areas were compared to those with a moderate-to-high supply (GIRS > 3) to assess the differences in service performance. A principal component analysis identified three key components within the data: service usage, health service providers, and service efficiency. A logistic regression analysis revealed that areas with a low workforce supply were significantly more likely to experience reduced service usage (OR = 3.3, p = 0.037, CI [0.09–0.92]), indicating fewer patient interactions and lower engagement with mental health services. In addition, these areas demonstrated a lower service efficiency as evidenced by longer wait times (OR = 3.7, p = 0.002, CI [1.62–8.50]), suggesting that workforce shortages directly impact timely access to health care. Conclusions: The findings revealed disparities in workforce supply across different urban locations, with low-supply areas facing tangible challenges in service accessibility and operational efficiency. These findings highlight the need for targeted mental health workforce planning. Developing and implementing best practice guidelines is essential to effectively manage service demands and reduce waitlists.

BackgroundPharmacogenetics (PGx) is the study of how interindividual genetic variation can alter drug metabolism and the response to medication. By evaluating common genetic markers in genes encoding drug-metabolising enzymes, PGx testing has demonstrated the potential to individualise pharmacotherapy, offering a more personalised treatment plan to improve drug efficacy and tolerability. In clinical use, PGx testing has been shown to reduce the process of medication trial-and-error. However, in Australian psychiatric care, PGx testing is seldom used to personalise antidepressant treatment plans for people with depression and/or anxiety. With the rising prevalence of depression and anxiety in young Australians, coupled with the limitations of conventional antidepressant treatment, PGx testing has shown promise in optimising medication selection. Given the drive for further clinical integration of PGx testing in youth psychiatric care, it is essential to first understand the perspectives and concerns of key stakeholders regarding its implementation.Aims & ObjectivesThis study aimed to assess the attitudes of young adults towards PGx testing for guiding antidepressant treatment, focusing on their perceived advantages, concerns, and anticipated barriers to its clinical adoption.MethodSemi-structured focus groups and interviews were employed, engaging with participants aged 18–24 years who had prior or current antidepressant experience. Sessions were recorded and transcribed verbatim. Reflexive thematic analysis was conducted to code, refine, and identify prevalent themes, encompassing perspectives on current treatment, views on PGx, and clinical integration barriers.ResultsSaturation was reached after nine sessions with a total of 17 participants. Three primary themes emerged from the analysis: (1) attitudes towards current antidepressant prescription practices, (2) perspectives and concerns towards PGx testing, and (3) perceived barriers to PGx implementation. Participants appreciated PGx’s potential to reduce the trial-and-error approach, improve medication selection, and potentially minimise medication-related side effects. However, concerns included the high perceived cost of PGx testing, anticipated delays in treatment initiation, and scepticism regarding the efficacy of such genetically guided treatment. Furthermore, participants believed that GPs’ awareness, willingness, and knowledge to incorporate PGx results in treatment plans would act as a key barrier to PGx implementation.Discussion & ConclusionsThis study highlights significant gaps in youth mental health treatment, including the limited involvement of youth patients in medication decision-making. Participants viewed PGx testing as a promising step toward personalised treatment, provided concerns around cost, accessibility, and testing accuracy are addressed. Furthermore, education and awareness campaigns around PGx testing were viewed as necessary for both patients and healthcare providers to facilitate integration into clinical use. The findings from this study highlight the importance of recognising patient perspectives when integrating medical practices into healthcare, ensuring that the implementation of PGx testing in Australian psychiatric practices remains patient-focused, upholding the needs and expectations of those receiving care. Furthermore, these findings have helped to inform the design and outcomes of an ongoing pilot randomised controlled trial aimed at evaluating the efficacy and tolerability of PGx-guided antidepressant pharmacotherapy in youth. This trial, conducted at the Perron Institute for Neurological and Translational Science, aims to address the youth concerns expressed in this qualitative study.