Sydney Local Health District

OBJECTIVE: To investigate the effectiveness of intervention strategies for primary and secondary prevention of knee osteoarthritis (OA). DESIGN: Intervention systematic review of randomized controlled trials (RCTs). DATA SOURCES: The Medline, EMBASE, CINAHL, PEDro, and The Cochrane Library databases were searched from inception to June 10, 2025. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: RCTs evaluating interventions for primary/secondary knee OA prevention. Eligible trials targeted populations at-risk of developing knee OA or population with knee OA, and the outcome of interest must not have been present at study entry. Primary outcomes were self-reported knee pain and associated disability. Secondary outcomes included imaging features of knee joint structure and the incidence of knee arthroplasty. Data were synthesized narratively and reported as relative risks (RRs) with 95% Confidence Intervals (CIs). RESULTS: Five published reports from three RCTs (1481 participants) were included. We found evidence that a self-management lifestyle program for community-based women with BMI ≥ 25 kg/m 2 may reduce the risk of developing pain associated with knee OA at 12-months, when compared to a single education session (RR: 0.27, 95%CI: 0.16-0.46). There was uncertain evidence from four reports to draw conclusions about the effects of diet & exercise, glucosamine supplements, diet & exercise plus glucosamine supplements, and intra-articular sprifermin interventions for preventing or reducing Knee OA progression or arthroplasty. CONCLUSION: A self-management lifestyle program may be effective for reducing the risk of developing pain associated with knee OA in women with a BMI ≥ 25 kg/m 2 . Evidence for other preventive interventions remains uncertain.

Carers, including family members and companions, play a crucial role in supporting patients and sharing insights about their care experiences. Their influence is especially important in virtual hospital models, where patients receive remote hospital-level care using digital technologies. However, there is limited evidence examining what carers think about virtual hospitals or how their experiences could be improved. We explored Patient-Reported Experience Measure (PREM) surveys completed by 3047 patients and 235 carers to better understand their experiences with virtual hospitals and suggest insights into how to enhance carer and patient experience from the carer’s perspective. Participants were patients and carers discharged from an acute respiratory model of care within a virtual hospital (from 1st March 2020 to 26th August 2024). We conducted both statistical and qualitative (content) analysis. Mann-Whitney U test was used to compare differences between carer and patient responses to 12 Likert scale questions on their reported experience. Content analysis was applied to two free-text comments (What was the best part of the care you received from the virtual hospital? What part of your care provided by virtual hospital most needs improving?). Keywords from the content analysis of free-text responses were integrated with statistical findings from Likert-scale questions to develop insights. 3047 patients and 235 carers of PREM surveys were analysed. The overall rating of the virtual hospital service was the same between carer and patients, with the mean response of ‘Excellent’. Our service insights from carers highlight how they support patients, shape their care experience, and offer valuable feedback. We identified six key insights that improve patient and carer experience including reassurance, effective communication, consistent availability, supportive healthcare workers, person-centred clinical service, and usable technology. Findings from this study can highlight ways virtual hospital models can be more inclusive and centred around both patients and carers, using data that is already being collected through routine surveys. Carers such as family members and companions play a vital, but often under-recognised role in care by supporting patients emotionally, practically, and through communication. Their influence is especially important in virtual hospital models, where patients receive remote hospital-level care using digital technologies. However, there is limited evidence examining what carers think about virtual hospitals or how their experiences could be improved. In this study, we have explored patient-reported experience measure surveys completed by 3047 patients and 235 carers to better understand their experiences with a virtual hospital service. This study identified service insights from carers that highlight how they support patients, shape their care experience, and offer valuable feedback. We identified six key insights that improve patient and carer experience including reassurance, effective communication, consistent availability, supportive healthcare workers, person-centred clinical service, and usable technology. Findings from this study can help improve virtual hospital models to be more inclusive and centred around both patients and carers, using data that is already being collected as part of standard care.

Flight departure and arrival times contribute to the variability of jetlag duration and can reverse the direction of circadian adaptation post-flight. These dynamics are mainly governed by light exposure and sleep timing during and around flights. Statement of Significance This study provides a quantitative analysis of how flight itineraries interact with circadian and sleep physiology to determine jetlag duration. By simulating over 55,000 flights across all time zone transitions, we reveal systematic patterns linking flight timing with adaptation time and the opportunities to minimise circadian disruption through itinerary design and behaviours during and around flights. These findings advance the mechanistic understanding of jetlag and offer actionable insights for travellers and airlines to reduce jetlag burden through optimised flight schedules and personalised strategies.

The paucity of diagnostic tests for isoniazid-resistant tuberculosis is concerning, given its status as the most common form of drug-resistant tuberculosis and a gateway to multidrug-resistant diseases. Molecular drug-susceptibility testing has improved access to timely diagnosis of rifampicin-resistant tuberculosis, but testing for isoniazid-resistant tuberculosis still remains rare. In this Review, we assessed the characteristics of molecular drug-susceptibility testing for detection of isoniazid-resistant tuberculosis, referencing the WHO target product profiles. 9243 citations were screened to select 238 studies published between 2000 and 2024. The diagnostics options have expanded rapidly since 2020, with 27 nucleic acid amplification tests, eight line probe assays, five DNA microarrays, two targeted next-generation sequencing platforms, and two whole-genome sequencing platforms. Most of the evaluated molecular drug-susceptibility tests met diagnostic performance targets but were often complex and costly. Although a few low-complexity nucleic acid amplification tests met key target product profile criteria, additional field validation and greater efforts are needed to ensure optimal feasibility and affordability for low-resource settings.

Absorbed dose determination for therapeutic kilovoltage (kV) x rays is performed following international recommendations to ensure consistency in practice and equivalence in dose delivery for patients worldwide. These recommendations include limits on the variation of ionization chamber calibration coefficients with beam quality. To date, data on energy-dependence have only been published for a limited set of ionization chambers and kV beams, and there are limited guidelines regarding which models of cylindrical ionization chambers are suitable for kV reference dosimetry. To provide cylindrical ionization chamber energy-dependence data with enough beam qualities and chambers to assist medical physicists to assess the compliance of chamber models with protocol recommendations regarding chamber characteristics. Air kerma calibration coefficients for 150 cylindrical ionization chamber calibrations performed between 2017 and 2024 in 59 medium-energy x-ray beam qualities at the Australian Primary Standards Laboratory were analyzed. Chamber response was scrutinized and assessed for compliance with international recommendations on absorbed dose determination for kilovoltage x-ray beams. All chambers showed some degree of energy dependence, with none of the chamber models investigated fully satisfying international recommendations. Chamber response is dominated by filtration (half-value layer), with a weaker dependence on generating potential (kVp); differences of up to ±4.3% were observed for a 100 kVp beam spanning 1.30-6.61mm Al HVL. Distinct differences in response were observed between chamber models, providing rationale for use or exclusion in kV absorbed dose determination. Energy dependence was observed to vary between chambers of the same model type, indicating that calibration coefficients cannot be interchanged between individual chambers of the same model. Cylindrical ionization chambers frequently used for reference dosimetry of kV x-ray beams exhibit different energy dependence based on model type. Some models frequently employed and recommended for use in absorbed dose determination do not satisfy international protocol recommendations regarding energy dependence. International recommendations and protocols for absorbed dose determination for kilovoltage x-rays based solely on kVp should be reviewed and further developed to explicitly account for the effect of filtration (HVL) on chamber response. The results of this work support the adoption or refinement of the recommended chamber types within reference dosimetry protocols.

People with mental health disorders experience disproportionately poor oral health and face persistent barriers to maintaining oral hygiene. This study aimed to assess the feasibility of supporting oral hygiene routines in community-dwelling adults using a self-regulation-based education approach informed by Self-Determination Theory, to identify practical strategies for integrated mental and oral health care. Thirty-nine participants from two community mental health centers received single-session oral health education at baseline (T1). Oral health status was assessed using the Oral Health Assessment Tool and the Silness and Loe Plaque Index. Oral health knowledge and motivation were measured at T1, 4 weeks (T2) and 8 weeks (T3) using a knowledge questionnaire, the Treatment Self-Regulation Questionnaire, the Perceived Competence Scale and the Relative Autonomy Index (RAI). At T2 and T3, participants received plaque feedback, reinforcement of the key message and motivational support. Most participants were aged 50 years or older. At baseline, over half of the participants demonstrated poor oral cleanliness, and fewer than one-third had healthy natural teeth. Plaque scores improved significantly from T1 to T2 (mean reduction 21%, p < 0.001), but plateaued by T3. Oral health knowledge improved across all domains, particularly in understanding oral-systemic links and recognizing oral disease risk factors. Autonomous motivation was modest at T1 (RAI = + 0.15), declined at T2 (RAI = -0.93), and partially recovered at T3 (RAI = -0.57), indicating variability in motivational regulation over time. Single-session oral health education was associated with short-term improvements in knowledge and plaque control; however, sustaining behavior change and motivation likely requires ongoing reinforcement, support and repeated engagement. Visual feedback, structured routines and collaboration between mental health and oral health services may facilitate the integration of oral care into routine community mental health practice.

To review a newly implemented medical staff self-rostering process in a small metropolitan emergency department to ensure sustainability without compromising emergency department safe staffing guidelines. We performed a multi-methods study on the implementation and user experience of a novel rostering process for registrars and CMOs in a small emergency department. Quantitative analysis was performed using a Likert scale to assess operational and implementation success as well as data on hours spent on roster generation, number of sick calls and number of shift swaps. Qualitative structured interviews were also analysed using an inductive process resulting in a thematic analysis. Our implementation outcome scoring showed a median score of 5 for all three domains of the implementation questionnaire including acceptability (IQR 4-5), appropriateness (IQR 4-5) and feasibility (IQR 4-5). Our thematic analysis demonstrated strong themes around flexibility and choice, usability and interface, responsibility for a complete roster, as well as wellbeing and balance. Our analysis of roster metrics showed a large reduction in required shift swaps (29 vs. 163) and time spent on roster development and publication (4 h vs. 20 h) over a 13-week rostering period. While consultant time spent on roster development and publication was reduced, this was accompanied by a redistribution of workload to participating staff, who spent a median of 1.4 h per rostering cycle. We conclude that in a small metropolitan hospital, self-rostering is a feasible and implementable operational intervention with improvements in employee wellbeing.