搜索结果：Australasian

For many people entering custody, abrupt changes in alcohol or other drug use is associated with the risk of experiencing a withdrawal syndrome. Management of withdrawal from alcohol and other drugs in a custodial setting is complicated by both a limited evidence base and structural barriers to the delivery of best practice healthcare interventions to people in custody. A multidisciplinary expert panel representing all Australian states and territories participated in a modified Delphi process. The process generated 22 recommendations to custodial services, health services and government for the management of withdrawal from alcohol and other drugs in custodial settings across five domains: screening for withdrawal risk; assessment of withdrawal; management of withdrawal; specific considerations for the care of First Nations people; and organisational support. Notable recommendations include using universal and timely assessment for withdrawal at reception to custody; using validated clinical tools and evidence-based interventions to assess and manage withdrawal syndromes; and ensuring that the safest location for withdrawal from alcohol or other drugs is provided. This statement presents best practice standards for the management of withdrawal from alcohol and other drugs in Australian custodial settings, as informed by evidence and expert consensus. Implementing the recommendations set out in this statement will improve the quality and consistency of withdrawal care provided to people entering Australian custodial settings and reduce harms associated with incarceration for people who use alcohol and other drugs. This statement has been endorsed by the Royal Australasian College of Physicians, the Australasian Professional Society on Alcohol and Other Drugs, the National Prisons Hepatitis Network, the Pharmaceutical Society of Australia and the Australian Injecting and Illicit Drug Users League. The statement is also approved as an Accepted Clinical Resource by the Royal Australian College of General Practitioners.

Zinc is an essential trace element, but elevated concentrations from anthropogenic sources, such as stormwater runoff, wastewater effluent, and industrial discharges, can adversely affect marine organisms. Marine water quality guideline values aid management and risk assessment, but Australia and New Zealand values have been outdated. This study aimed to derive updated guideline values using chronic toxicity data relevant to marine species in the Australasian region. Chronic toxicity data were compiled from international and local toxicity databases and regional studies, totaling 350 values for 82 species. Guideline derivation prioritized studies with analytically verified zinc concentrations, low effect concentrations (e.g., EC10 values) and taxa native to or established in Australia and New Zealand, ensuring relevance to Australasian marine ecosystems. There were insufficient high-quality data, so the dataset was supplemented using estimates based on EC50 values, resulting in 16 species from seven taxonomic groups and a guideline value of 8.0 µg/L. Inclusion of nominal data instead resulted in a similar number of species and a slightly lower guideline value. Data gaps remain for key taxonomic groups, including fish, corals, and sponges, highlighting a need for quality toxicity tests using such species to provide more robust water guideline values. Despite ongoing gaps, the updated guideline value provides an improved basis for protection of regional marine ecosystems.

First-trimester sonographic examination remains a fundamental part of antenatal care, providing crucial information for the well-being of both the mother and fetus and leading to the best possible perinatal outcomes. This study aimed to review and compare the most recently published guidelines on first-trimester ultrasound. Therefore, a descriptive review of guidelines from the American Institute of Ultrasound in Medicine (AIUM), the Australasian Society of Ultrasound in Medicine (ASUM), the Association of the Scientific Medical Societies in Germany (AWMF), the International Society of Ultrasound in Obstetrics and Gynecology (ISUOG), the Society of Obstetrician and Gynecologists of Canada (SOGC) and the World Association of Perinatal Medicine (WAPM) regarding first-trimester scans was conducted. There is a consensus regarding the main parameters that should be evaluated, the qualifications of the examiner and specifications of the ultrasound machine, as well as the importance of informed consent. Additionally, the importance of careful visualization of fetal anatomy is discussed, with minor discrepancies regarding the appropriate protocol used. The use of combined first-trimester examination is encouraged by all the reviewed medical societies, although cell-free DNA testing is addressed only by a few, with similar indications. Controversy exists regarding the indications and appropriate gestational age at which the first-trimester scan should be performed, as well as the proper establishment of pregnancy dating. Notably, recommendations regarding fetal growth restriction (FGR) and diagnostic invasive procedures are made only by few medical societies, with the AWMF and SOGC addressing screening for FGR. Furthermore, invasive diagnostic testing is discussed by the AIUM, AWMF and SOGC, with differentiations among them regarding the indications for pursuing such procedures. First-trimester sonographic examination is essential for assessing fetal viability, establishing accurate pregnancy dating, evaluating fetal and maternal anatomy and calculating the risk of various fetal and maternal conditions. The implementation of evidence-based, unified protocols would advance both maternal and fetal outcomes.

Raptors are high-trophic-level predators and scavengers that are sensitive to habitat alteration, human disturbance, and climate variability, yet province-wide assessments of their habitat suitability and climate-change responses remain limited in subtropical China. Hunan Province, located along the inland section of the East Asian-Australasian Flyway, contains complex mountain systems, plains, wetlands, and land-use mosaics that may support diverse raptor assemblages. Based on raptor survey records collected across Hunan from January 2022 to July 2023, we used biomod2 ensemble species distribution models to assess current habitat suitability, identify key environmental predictors, and project future changes under the SSP2-4.5 and SSP5-8.5 scenarios for the 2050s and 2090s. We recorded 39 raptor species and retained 3637 valid geographic locations and 4855 observed individuals after data cleaning. Nine representative species were further selected to construct 22 species-season combinations covering resident species, summer visitors, winter visitors, and four phenological stages. The EMwmean weighted ensemble model consistently outperformed the best single models, increasing mean AUC from 0.882 to 0.970 and the mean TSS from 0.611 to 0.845. Temperature seasonality (BIO4), the Human Footprint Index (HFP), precipitation in the driest month (BIO14), and the Normalized Difference Vegetation Index (NDVI) were the dominant predictors, although their relative importance varied among residency types and phenological stages. Under current conditions, highly suitable and most suitable habitats covered 65,259.67 km2, accounting for 30.81% of Hunan Province, and were mainly concentrated in western, southern, and eastern mountain regions. Future projections indicated a marked contraction of high-suitability habitats, especially under SSP5-8.5, with no HSI > 0.6 habitat identified by the 2090s. High-suitability habitats also became increasingly concentrated at higher elevations. These findings identify mountain regions as key conservation priorities and provide a spatial framework for climate-adaptive raptor conservation in Hunan Province.

The prognosis in pancreatic ductal adenocarcinoma (PDAC) remains poor with 2-year recurrence rates around 80% despite curative-intent surgery. This study evaluated factors associated with early recurrence in a contemporary, multi-center, Australasian population. A better understanding of patients at risk of early recurrence (ER) could improve selection of operative candidates. De-identified data were extracted from 23 hospitals participating in the PURPLE pancreatic cancer registry between 2016 and 2024. Clinicopathological features, treatment, recurrence patterns, and survival were examined. ER was defined as cancer recurrence within 12 months of surgery. Of 3041 patients identified, 539 completed curative intent surgery. At a median follow-up of 21.8 months, 74% of resected cases had recurred. The median recurrence free survival was 14.3 months. ER occurred in 41% of patients and was associated with advanced age (P =&#xa0;0.04), worse performance status (P <&#xa0;0.01), T3-T4 stage (P =&#xa0;0.01), CA19-9&#xa0;>&#xa0;300 U/ml (P <&#xa0;0.01), involvement of more than two lymph nodes (P <&#xa0;0.01), lymphovascular invasion (P =&#xa0;0.01), and no neoadjuvant and/or adjuvant treatment (P <&#xa0;0.01). There was a significant association between the primary tumor location and recurrence site (P =&#xa0;0.046). The median OS of those with isolated lung (31.4 months) and locoregional (29.2 months) recurrences was longer than those with liver (21.3 months) or peritoneal (20.7 months) recurrences (P =&#xa0;0.01). The use of neoadjuvant and adjuvant therapy was associated with lower ER rates (P <&#xa0;0.01). A high proportion of resected PDAC patients experienced ER. Multiple pathological factors can predict ER. Primary tumor location was associated with site of recurrence. Neoadjuvant and adjuvant therapy significantly reduced ER and increased OS.

We describe analytically confirmed opioid-related presentations to emergency departments (EDs) in Australia. Presentations with analytically confirmed opioid exposure, between January 2021 and December 2024, were identified from the Emerging Drugs Network of Australia (EDNA) Clinical Registry. Demographic data, clinical features, outcomes, naloxone dosing, and analytical toxicology results were extracted. Opioids were detected in 793 ED presentations. The majority were male (568, 71.6%) with a median age of 40&#x2009;years (Q1-Q3: 30-48&#x2009;years). Patients were unwell (Australasian Triage Score 1 or 2&#x2009;=&#x2009;700, 88.3%). Suicidal intent was noted in 55 (6.9%) presentations. Mono-opioid detections occurred in 550 (69.4%) presentations, most frequently heroin exposures (162, 29.5%). Novel opioids including nitazenes and U-Class synthetic opioids were uncommon (21, 2.6%). Illicit co-detections were common (547, 69.0%) especially with methylamphetamine (512, 64.6%), gamma-hydroxybutyrate (108, 13.6%), and diazepam (341, 43%). Naloxone was used in 498 (62.8%) presentations: median dose 400&#x2009;&#x3bc;g (IQR: 200-600&#x2009;&#x3bc;g). There was no difference in median naloxone dose for heroin (median 320&#x2009;&#x3bc;g) and novel opioids (median 500&#x2009;&#x3bc;g, p&#x2009;=&#x2009;0.25). Intubation was more likely to occur in patients with novel opioids compared to heroin (8/21, 26/162, p&#x2009;=&#x2009;0.020). Heroin was the most common analytically confirmed illicit opioid detected among opioid-related ED presentations. Novel opioids were uncommon with no difference in median naloxone dose used. There were higher intubation rates for novel opioids. Polydrug exposure is common, complicating the clinical picture. Increased awareness of the national Take Home Naloxone program, particularly by emergency physicians, is a key element of harm reduction.

Pathology testing accounts for over half of non-labour costs in Australian Emergency Departments (EDs), yet up to one-fifth of tests are unnecessary. Despite national guidance from the Australasian College for Emergency Medicine (ACEM) and the Royal College of Pathologists of Australasia (RCPA), variation in test ordering persists across departments and across clinical presentations. The Unnecessary Tests in Emergency (UNTIE) study aims to evaluate whether audit and feedback using a novel indicator can reduce unnecessary pathology testing. UNTIE is a multicentre, stepped-wedge cluster randomised trial conducted across five metropolitan EDs in New South Wales, Australia. All adult ED presentations that fall within the 29 clinical conditions covered by the 2023 ACEM-RCPA guideline will be included. Presentations were identified using routinely collected ED triage diagnoses. Because the ACEM-RCPA pathology guideline specifies clinical presentations rather than diagnostic codes, a mapping process was developed to align triage terms used in the electronic medical record with the guideline categories. Approximately 100 common triage diagnoses were reviewed by a panel of emergency physicians and mapped to the 29 eligible presentations. This mapping dictionary was used to automatically classify all ED encounters during data extraction. Ambiguous or unmapped triage terms were reviewed and assigned by consensus.The intervention comprises a multifaceted audit-feedback programme-combining local champions, education sessions, visual prompts and electronic dashboards. Two automated indicators will be generated for every eligible ED encounter: UNTIE-U (Unnecessary Testing Index) representing the proportion of tests performed but not recommended and UNTIE-N (Necessary Testing Index) representing the proportion of guideline-recommended tests performed. The primary outcome is change in UNTIE-U before and after intervention; the secondary outcome is change in UNTIE-N. Ethics approval has been granted by the Western Sydney Local Health District Human Research Ethics Committee (HREC/17/WMEAD/274, 2022/STE03249). All analyses will use de-identified data. Findings will be disseminated through peer-reviewed publication, conference presentation and feedback to participating EDs. Australian New Zealand Clinical Trials Registry: ACTRN12623001130651, UTN: U1111-1297-0386.

Many deaths after colorectal resection may be preventable, but administrative datasets provide limited insights into the clinical processes leading to mortality. We used the Australian and New Zealand Audit of Surgical Mortality (ANZASM) to quantify potentially preventable deaths after colorectal surgery and describe modifiable clinical management issues (CMI) in contemporary Australasian practice. Retrospective cohort study of prospectively collected ANZASM data. Adults who died after elective or emergency colorectal resection between 2010 and 2023 were included. Potentially preventable mortality was defined as at least one CMI assessed as definitely or potentially preventable and contributing to death. CMIs were summarised by phase of care and thematically analysed. Among 1058 deaths after colorectal resection, 321 (30.3%) were classified as potentially preventable. Potentially preventable deaths were more frequent after elective than emergency surgery (35.3 vs. 27.8%, p&#x2009;=&#x2009;0.01). Leading causes of death were sepsis, multiorgan failure and aspiration/pneumonia. Anastomotic leak was the most common postoperative complication, implicated in 19.6% of deaths. Preventable mortality was independently associated with lower estimated operative risk, postoperative complications, unplanned ICU admission and rural hospital care. Common themes included suboptimal patient selection, physiological optimisation, anastomotic decision-making and delayed recognition or escalation of deterioration. Nearly one third of audited deaths after colorectal surgery were potentially preventable, most arising from failures of selection, optimisation or rescue rather than technical errors. Strengthening preoperative triage, multidisciplinary decision-making and improving postoperative surveillance and escalation systems offer the greatest opportunities to reduce preventable mortality in colorectal surgery.

Idiopathic multicentric Castleman disease (iMCD) is a rare condition. The pathogenesis is incompletely understood; however, interleukin-6 (IL-6) is a major mediator. The clinical presentation is heterogeneous, from mild constitutional symptoms to severe multi-organ failure. The diagnosis is challenging, as it incorporates clinicopathologic criteria and requires careful evaluation to exclude various systemic disorders. Targeting IL-6 activity forms the cornerstone of modern therapy for iMCD, with siltuximab recommended as first-line therapy. Rituximab-based regimens are recommended for second-line therapy. However, many patients do not achieve adequate responses with limited evidence to guide further therapy. In the context of these substantial challenges, herein we provide a multidisciplinary Australasian clinical practice guideline to characterise clinical and pathological features, summarise treatment pathways and discuss clinical outcomes of the condition. The objective is to develop a multidisciplinary clinical practice guideline in the diagnosis and management of iMCD in Australia.

Social media is frequently used by clinicians to establish their professional identity, but engagement remains dubious. A 2015 study of Australian and New Zealand urologists demonstrated widespread use of social media, though no follow-up study has been conducted. Cross-sectional study of urologists identified on the Royal Australasian College of Surgeons 'Find a Surgeon' page or on a group practice website. A thorough search on 'Google' and individual platforms (LinkedIn, X, Facebook, Instagram, YouTube, TikTok) was performed to identify professional websites and social media accounts associated with each urologist. Amongst 516 urologists identified across Australia and New Zealand, most had a business website (79.0%). The mean number of social media accounts per individual was 1.72. LinkedIn (60.9%) was the most popular social media platform. Facebook (34.3%) and X (31.4%) were also commonly used by urologists. Few personal accounts on X (26.8%), Facebook (11.5%) and Instagram (21.8%) were active. Video-based platforms had the poorest uptake, with 8.3% of urologists identifiable on YouTube and 1.2% on TikTok. Academic urologists were significantly more likely to have a social media presence. There was a parabolic decline in social media use with more years since medical qualification, most notable on Facebook and X. The number of urologists with a professional website has increased substantially in the past decade, with a moderate rise in overall social media use. Most social media accounts are inactive. Unlike their international counterparts, ANZ urologists appear to have retreated to conservative digital platforms.

Candidates awaiting repeat kidney transplantation face substantial immunological barriers due to prior human leukocyte antigen (HLA) allo-sensitisation. Re-exposure to previously mismatched HLA antigens may increase the risk of acute rejection and premature graft loss. Although avoidance of repeat HLA mismatches (RMM) has been standard practice, emerging evidence suggests this risk varies according to the specific HLA allelic RMM and anti-HLA antibody profile to the RMM. Here we describe the protocol for a retrospective registry-based cohort study that aims to determine the differences in graft outcome between recipients who received kidney transplants with and without RMM, and to examine the immunogenicity of RMM that are associated with allo-sensitisation. Using linked data between the Australia and New Zealand Dialysis and Transplant Registry (ANZDATA) and Australian organ waitlisting and matching system (2012-2023), we will evaluate the association between Class I and II HLA RMM and the risk of acute rejection and graft loss using Cox regression and competing risk models in recipients who have received repeat kidney transplants in Australia. Epitope analysis of each RMM will be examined. This study will improve understanding of the impact of RMM on kidney transplant outcomes and identify higher immunological risk RMM associated with poorer graft outcomes.

暂无摘要（点击查看详情）

暂无摘要（点击查看详情）

Background: Near-infrared spectroscopy (NIRS) enables non-invasive assessment of regional tissue oxygenation (StO2). Although impaired skeletal muscle oxygenation during stress is well documented in heart failure (HF), the reproducibility of resting StO2 and its potential utility for clinical monitoring remain unclear. Methods: Twenty adults (ten healthy; ten chronic HF) underwent StO2 assessment using the Medtronic INVOSTM 7100 system at five sites: pectoralis major, deltoid, biceps, flexor carpi, and rectus femoris. Duplicate measurements were obtained over one minute with sensor repositioning between recordings. Effects of time and group were evaluated using general linear models. Reproducibility was assessed using intraclass correlation coefficients (ICCs) and Bland-Altman analyses (p<0.05). Results: Resting StO2 was similar between healthy participants and those with HF across all anatomical sites (pectoralis major: p=0.73; deltoid: p=0.71; biceps: p=0.12; flexor carpi: p=0.20; rectus femoris: p=0.32). No significant effects of time, group, or group-by-time interactions were observed (all p > 0.10), except for a small increase in biceps StO2 in HF (p=0.04). Reproducibility remained high following sensor repositioning, with strong ICCs across all sites (all > 0.84; p < 0.001) and minimal bias on Bland-Altman analyses. Conclusion: Resting skeletal muscle StO2 measured by NIRS is preserved and highly reproducible across anatomical sites in stable HF, despite inherent microvascular and oxygen delivery abnormalities. These findings support the feasibility of NIRS for longitudinal StO2 monitoring. However, resting StO2 alone do not discriminate HF status, suggesting that NIRS may may have greater clinical utility for detecting dynamic changes during physiological stress or acute HF decompensation.

Aboriginal and Torres Strait Islander children are the future custodians of country, culture and community for the world's oldest living cultures. However, they continue to experience significant disadvantage as a legacy of British colonisation. Failure to address the systemic inequities experienced by Aboriginal and Torres Strait Islander children infringes on their rights to health, education, safety and cultural identity. Despite this, there has been limited focus on recognising and measuring the cultural and personal strengths that support their well-being. This study aims to co-design a culturally grounded, illustrated self-report well-being measure for Aboriginal and Torres Strait Islander children aged 5-11 years, focusing on the aspects of life that nurture their strength and well-being. The project will employ a five-phase mixed methods design, guided by principles of co-design and best practices to develop culturally and developmentally responsive measures with Aboriginal and Torres Strait Islander children. Extending existing methods, we will pioneer a new approach to develop measures enhanced with culturally-responsive pictures co-designed with Aboriginal and Torres Strait Islander communities. Ethics approvals have been obtained from the University of Queensland Human Research Ethics Committee (2023/HE000607), Western Australian Aboriginal Health Ethics Committee (WAHREC1260), Far North Queensland Human Research Ethics Committee (2023/QCH/99346), Aboriginal Health and Medical Research Council of New South Wales (2140/23), Aboriginal Health Council of South Australia (04-23-1063), Menzies School of Health Research and Northern Territory Department of Health Human Research Ethics Committee (HREC 2023-4608) and the Australian National University Human Research Ethics Committee (H/2024/0914), as well as relevant Departments of Education. The final WM2K (What Matters 2 Kids) results will be published in peer-reviewed journals, presented at conferences and disseminated to partner organisations and the broader sector via strategic networks with Aboriginal and Torres Strait Islander organisations, government bodies and non-government agencies. Children will receive study communications via partner organisations in age-appropriate formats.