Royal Prince Alfred Hospital

BackgroundPsychotic symptoms are common in patients with Parkinson's Disease Dementia and Dementia with Lewy Bodies, known collectively as the Lewy Body Dementias (LBD). It is important to identify these symptoms early and accurately. However, these symptoms are challenging to identify and quantify in clinical practice. The Psychosis and Hallucinations Questionnaire (PsycH-Q) was developed as a self-report tool using patient-friendly language to assess hallucinations and related phenomena and has been previously validated in Parkinson's Disease patients without dementia and their caregivers.ObjectivesThis study aimed to evaluate the utility of the PsycH-Q in patients diagnosed with a Lewy Body Dementia.MethodsA total of 33 LBD patients, assisted by their caregivers, completed the PsycH-Q, along with the Scales for Outcomes in Parkinson's Disease-Psychiatric Complications (SCOPA-PC) and the Movement Disorder Society Unified Parkinson's Disease Rating Scale (MDS-UPDRS). Items relating to hallucinations and psychotic phenomena from the SCOPA-PC and MDS-UPDRS were then compared with analogous ratings on the PsycH-Q.ResultsScores on the PsycH-Q were significantly correlated with SCOPA-PC Questions 1 and 3, as well as the MDS-UPDRS question 1.2 (Spearman's rho of 0.65, 0.73, and 0.47, respectively; p < 0.01 for all three correlations).ConclusionsThese results support the PsycH-Q as a patient-friendly questionnaire that accurately identifies hallucinatory phenomena and their features in LBD patients via self-report completed by patients with their caregivers. Future use of the PsycH-Q in clinical practice and research could improve early detection of psychotic symptoms in LBD patients, leading to improved management.

There are no evidence-based guidelines concerning reprocessing of positive airway pressure (PAP) devices between users. Consequently, current practices are based on local policies and interpretation of manufacturer instructions. As many PAP users start with loaned equipment, understanding PAP device hygiene is a priority. Little is known about PAP device reprocessing procedures or clinician confidence in reprocessing procedures across Australia. An online anonymous survey was administered to clinicians involved in reprocessing PAP devices between users. This survey was sent to both targeted clinicians known to provide non-invasive ventilation (NIV) and openly circulated to any clinician managing PAP devices via mailing lists, to understand current practices. There was a response rate of 41 % (20/49) for targeted respondents with a total of 66 completed responses. 53 % of respondents had >10 years of experience with 86 % providing NIV. Confidence in NIV machine reprocessing in institutions was 81 mm (IQR 70-90.5 mm) on a 100 mm visual analogue scale. Less than 30 % of respondents described specific cleaning processes for multi-resistant organisms (MROs). A device isolation period before reissue occurred at 26 % of sites providing home NIV. Thematic analysis identified waste concerns due to mandated single use items, uncertainty about MROs and evolving requirements for tracking of equipment. This is the first known survey investigating PAP reprocessing practices by experienced clinicians, showing limited procedural variability with variable confidence in procedures used. Evidence-based guidelines are needed to reduce uncertainty and practice variability with consideration of risk mitigation and principles of sustainable healthcare.

During epidemics, emergency department (ED) syndromic surveillance of patient arrivals provides timely but nonvirus-specific assessment of epidemic intensity. Surveillance of severe infection outcomes (intensive care admission or death) is less timely because outcomes can take weeks to occur. Time series models can be used to estimate the frequency of severe infection outcomes due to viruses. We developed and evaluated daily time series modeling applied to linked ED, infection, and outcomes data from Australia to better predict population and health system burden during acute respiratory virus epidemics. In retrospective daily surveillance emulation, generalized additive models nowcasted (short-term forecast) the frequency of ED arrivals attributable to each of influenza and COVID-19 that will have a severe infection outcome within 28days. Daily nowcasts spanned days -29 to -4 from each date for which surveillance was emulated. To validate the method, nowcasts were compared with subsequently observed severe infection outcome frequencies for December 2021 through February 2023. During this period, the mean daily day-4 nowcast error was 2.7 (34.2%), compared with 3.5 (43.8%) if outcomes known at day-1 were used. With increasing real-world data availability, this method could improve rapid, automated epidemic assessment for timely public health action.

By Marissa Guan, Sonia Sinclair & 2 more. The authors present a novel surgical technique for breast augmentation in the massive weight loss population. It addresses skin laxity and mitigates the risk of implant displacement.

Haemorrhage and blood product usage are common in venoarterial extracorporeal membrane oxygenation (VA ECMO) and associated with increased mortality. A prospective, investigator-initiated, longitudinal observational cohort study on major haemorrhagic events in 12 ECMO centres from 3 continents for three predefined subgroups (VA ECMO initiated during cardio-pulmonary resuscitation (ECPR), after cardiothoracic surgery (CTS), for cardiogenic shock (CS)). The aim was to describe haemorrhagic complications as well as transfusion practice and anticoagulation for the whole population as well as the subgroups. In addition, independent baseline predictors for red blood cell (RBC) transfusions were evaluated. 545 prospective patients were included between 2019 and 2022 (ECPR 149, CTS 169, CS 227). Hospital mortality was 46%. Over 2796 days 406 major haemorrhage events in 286 (52%) patients were recorded. CTS and ECPR patients had more frequent events occurring earlier in their course. 88% received RBC transfusions (1.27 (95%CI 1.22 – 1.31) units/day) with significantly more transfusions for CTS and ECPR patients. Platelet transfusion rates were highest in the CTS group (0.58 (95%CI 0.53–0.64) units/day). Haemoglobin and platelet count prior to transfusion were independent of subgroups and averaged (78 g/L (IQR 73, 84), 58 × 10^9/L (IQR 37, 85), respectively). However, platelet count prior transfusion was only marginally higher on days with major haemorrhage (74 × 10^9/L (IQR 50, 104). Systemic anticoagulation was started within the first 24 h in 83% (95% CI 80–87%) of patients, most frequently in CS patients (90%, CI 85–95%). Independent baseline predictors for RBC transfusion were ECPR (IRR 1.50, 95%CI 1.19–1.89) and prior use of antiplatelets (IRR: 1.43, 95%CI 1.13–1.80). Myocarditis and pulmonary embolism were associated with a lower rate of transfusion when compared to myocardial infarct (IRR: 0.57 (0.37–0.89), IRR: 0.67 (0.45–1.00, respectively). Haemorrhagic complications differ in clinical subgroups and RBC transfusion exposure is by far higher than in other critically unwell populations. We identified ECPR and antiplatelet therapy as additional predictors. Transfusion practice for RBC and platelets is variable and does not always follow international guidelines.