Royal Brisbane and Women's Hospital

Bloodstream infections (BSIs) are an important complication among injured patients, yet existing studies have focused on selected populations or specific settings, limiting the generalisability of the findings. In this study, we conducted a population-based study to examine the incidence, demographic and clinical variation of injury-related BSIs. The study population consisted of all residents of Queensland, Australia, who developed an injury-related BSI identified between 1 January 2000 and 31 December 2019. The linked data used for this study consisted of three statewide databases of all public and private hospital admissions, public pathology data and deaths. ICD-10 AM codes for injuries (S00-T75 and T79) were used to identify hospitalisations for index injuries. Incidence rates were calculated by age, sex, geographic remoteness and socio-economic status using estimated residential population data and aggregated acute injury hospital episodes. Across 20 years, a total of 3205 injury-related BSI episodes occurred among 3188 individuals. The median age of this cohort was 63 years, with males accounting for 65 % of the population. The overall 30-day case-fatality rate was 13 %. During the study period, age-standardised rates increased from 2.47 to 4.62 per 100,000 population, with males experiencing higher rates than females. Patients from remote areas in Queensland had significantly higher rates compared to those from other regions. Additionally, age-specific rates increased with advancing age. Approximately two-thirds of the injury-related BSI episodes were hospital-onset. The most commonly identified pathogens among these patients were Staphylococcus aureus and Escherichia coli. This world-first population-based study on injury-related BSIs provides a comprehensive understanding of the incidence and variation by demographic and clinical characteristics. Injury-related BSIs differed across subgroups: males, remote area residents and older people had higher rates than females, urban/regional area residents and younger individuals. These findings provide a foundation for further work to target treatment and interventions to minimise the burden of injury-related BSIs.

Despite the availability of extensive research evidence, many patients do not receive evidence-based care, which underscores the need to bridge the evidence-practice gap. Clinicians often report a lack of confidence and knowledge to translate evidence into practice. While most evidence-based practice programs focus on research skills, fewer address the practical application of evidence in clinical settings, leaving a critical gap in implementation capabilities. This study evaluated the HELIX 4 implementation capacity-building program (HELIX 4 program) in two metropolitan health services in Queensland, Australia. The HELIX 4 program was conducted over 12 months in 2023 and included interdisciplinary teams, hands-on implementation training (Stage 1), coaching, and expert support (Stage 2). The program was evaluated using surveys and interviews, with analysis informed by the Kirkpatrick Model: Reaction, Learning, Behavior, and Impact. Participants reported high satisfaction with the program, with 100% expressing satisfaction with the coaching and mentorship in Stage 2. Knowledge and confidence significantly improved, with knowledge scores increasing from 3.4 to 4.3 and confidence from 3.6 to 4.2 ( p < 0.05). Participants demonstrated significant improvements in their ability to implement evidence-based changes, although some faced challenges balancing clinical duties with project responsibilities. Organizational support for evidence-based practice improved, with significant gains in leadership recognition of implementation efforts ( p = 0.030). Participants reported early project successes and increased organizational commitment to sustaining changes. The HELIX 4 program enhanced participants' knowledge, confidence, and organizational support for evidence implementation. The pilot provides a foundation for future iterations of the program, with a focus on addressing long-term sustainability and time management challenges. http://links.lww.com/IJEBH/A359.

Patients with aneurysmal subarachnoid haemorrrhage (aSAH) represent a cohort with limited evidence to guide mobilization practices. The objective was to describe acute mobilization practices, outcomes, and barriers to mobilization in patients following aSAH. The design of the study was a single-centre prospective, observational study. This study was conducted in the acute ward and intensive care unit of a tertiary neurosurgical referral centre. Participants were adult (≥18 years) patients post-aSAH with secured aneurysms. Mobilization practices were delivered during physical therapist sessions up to 14 days post-aneurysm repair. Severity was classified using the World Federation of Neurological Surgeons (WFNS) scale, dichotomizing into "good" (Grade I to II) and "poor" (Grade III to V) clinical status. Mobilization outcomes were measured using the Mobility Scale for Acute Stroke (MSAS), with independent walking assessed. A total of 102 patients participated with 69 (67.6%) classified as "good" grade and 90 (88.2%) of patients mobilized within the first 14 days. Data were collected from 603 planned mobilization sessions, with barriers to mobilization encountered in 193 (32.0%) of these sessions, primarily due to neurological instability (n = 80, 41.5%) and haemodynamic instability (n = 43, 22.3%). Overall, the highest median MSAS score achieved was 32 (IQR = 10 to 36). By 2 weeks, 65.2% of patients with a "good" clinical status walked independently versus 12.9% in the "poor" group. While most patients mobilized, physiological instability commonly prevented mobilization activities. Independent walking by 2 weeks was significantly more common in patients with "good" clinical status. These findings underline the importance of careful screening and monitoring during mobilization in the acute period. This study underscores the need for further research into optimal mobilization strategies for improving outcomes in patients with aSAH.

ABSTRACTAimSalivary microvesicles (MVs) are nanosized extracellular vesicles from the host and microbiota whose cargo may mirror the biological state of their parent cells. This cross‐sectional study aimed to explore the diagnostic power of host methylome and microbiome profiles of MVs in various periodontal disease states.Materials and MethodsThis exploratory study recruited 20 healthy, 16 gingivitis and 26 stage III/IV periodontitis cases. The origins of salivary host‐MVs were identified using a multiplex extracellular vesicle (EV) kit. The microbiome and host methylome profiles of MV DNA were analysed using 16S rRNA sequencing and methylated DNA immunoprecipitation sequencing (MeDIP‐seq), respectively.ResultsThe periodontitis group showed increased CD63+, CD45+, CD29+ and CD24+ MV subpopulations (AUC > 0.7), along with significantly higher bacterial outer membrane vesicles (AUC > 0.89) from Treponema, Fretibacterium and Treponema denticola, compared to both healthy and gingivitis groups, as well as the non‐periodontitis (combining healthy and gingivitis) group. MeDIP‐seq identified 1196 differentially methylated regions across 3′ UTRs, CDS, introns and intergenic regions (AUC > 0.9), distinguishing periodontitis from the other groups. These methylated genes were enriched in inflammation‐related pathways, including AMP‐activated protein kinase (AMPK) and Toll‐like receptor 4 (TLR4) pathways.ConclusionThis exploratory study found that host methylome and microbiome profiles in salivary MVs reflect periodontal disease status, and hence supports their potential as non‐invasive liquid biopsy biomarkers for periodontitis.

Genetic nephrology has emerged as a distinct subspecialty within nephrology with growing evidence supporting its clinical utility and cost-effectiveness across diagnostic, prognostic, and management pathways. Yet significant implementation gaps such as undefined clinic models and outcomes, limited use of implementation science frameworks, ad hoc strategy development, and a narrow focus on diagnostic yield and clinical utility hinder its routine adoption and integration. This research programme aims to systematically design, implement, and evaluate a multidisciplinary kidney genetics clinic model, using a theory-informed and stakeholder-engaged implementation science approach, to translate genomic advances into improved service, patient-reported, and implementation outcomes, and to inform sustainable and scalable kidney genomics care policy. Using a interconnected four-part, mixed-methods, multi-frameworks design underpinned by implementation science theory, the research programme will (1) review global kidney genetics clinic models, outcomes, determinants of successful implementation, and implementation strategies; (2) assess local stakeholder perceptions, priorities and contextual determinants using Consolidated Framework for Implementation Research (CFIR)-guided qualitative inquiry; (3) co-design and refine tailored implementation strategies via Consolidated Framework for Implementation Research-Expert Recommendations for Implementing Change (CFIR-ERIC) mapping and hybrid participatory methods; and (4) evaluate the clinic’s service, patients, and implementation outcomes in a prospective effectiveness-implementation hybrid type 2 quasi-experimental interrupted time-series study design. Outcomes assessed include (1) service outcomes (diagnostic yield, clinical utility, and timeliness of care); (2) patient-reported outcomes (personal utility, patient-reported outcome measures); and (3) Proctor-defined implementation outcomes (acceptability, appropriateness, readiness, feasibility, and fidelity, and penetration). We will measure outcomes longitudinally across pre-implementation, implementation, and post-implementation phases, and analyse data using segmented regression analysis to assess changes in outcomes over time. The Implementation Research Logic Model (IRLM) will guide evaluation and adaptation throughout. This programme is designed to address critical implementation gaps between genomic evidence and clinical practice. Through four sequential studies, the programme will generate standardised kidney genetics clinic models and care pathways, evidence-informed implementation determinants, and context-tailored, co-designed implementation strategies. Taken together, this programme will establish a policy-relevant genetic nephrology care model with improved service, patient-reported, and implementation outcomes for the benefit of patients and families living with genetic kidney disease.

Traumatic brain injury (TBI) often leads to long-term disability, including persistent mental health issues and lower health-related quality of life (HRQoL). Early interventions can improve recovery, but because resources limit routine monitoring of all patients, trauma care remains largely symptom-driven. The combination of long-term disability and limited capacity for routine follow-up highlights the need for risk-stratified follow-up care and reliable evidence on early prognostic factors. However, the existing literature is sparse and methodologically heterogeneous, limiting the clinical applicability of findings. We therefore conducted a systematic review and meta-analysis to identify early risk factors for poorer long-term mental health and HRQoL outcomes. A systematic search of seven electronic databases identified studies of adult patients with TBI, with outcomes assessed at least 6 months postdischarge. Two authors independently screened the studies, assessed the risk of bias, and extracted the data. We pooled effect estimates using a random-effects meta-analysis and calculated 95% prediction intervals. A narrative synthesis was applied when meta-analysis was not feasible. The review was registered with PROSPERO (CRD42024576912) and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Of the 8,104 articles screened, 64 studies met the inclusion criteria (n = 334,672). Most studies (58%) had a low risk of bias. Female sex, socioeconomic disadvantage, psychiatric history, assaultive-related injuries, and previous TBI were consistently associated with worse long-term outcomes. Across meta-analyses, assault-related injuries more than doubled the odds of post-traumatic stress disorder (odds ratio [OR] = 2.72; 95% confidence interval [CI]: 2.01-3.66, I2 = 0%). Higher odds were also observed among females (OR = 1.33; 95% CI: 1.11-1.59, I2 = 0%), individuals with prior TBI (OR = 1.56; 95% CI: 1.07-2.27, I2 = 0%), and those with psychiatric history (OR = 2.38; 95% CI: 1.83-3.10, I2 = 48%). We found that female sex (OR = 1.72; 95% CI: 1.38-2.16, I2 = 58%), prior TBI (OR = 1.52; 95% CI: 1.25-1.85, I2 = 0%), and psychiatric history (OR = 3.25; 95%CI: 1.86-5.69, I2 = 98%) were associated with higher odds of depression. Furthermore, higher pooled anxiety scores were observed in females and in individuals with a psychiatric history. The study identified several readily available factors present before or at discharge that are associated with poor long-term HRQoL and mental health outcomes. Leveraging these factors in follow-up protocols, prediction modeling, and clinical decision support systems may facilitate risk-stratified postdischarge care for TBI patients.