Centre In Sydney Research Articles

Developing spinal cord injury physiotherapy clinical practice guidelines: a qualitative study to determine how physiotherapists and people living with spinal cord injury use evidence.

Generic qualitative design. Australian and New Zealand SCI physiotherapists are developing clinical practice guidelines for the physiotherapy management of people living with spinal cord injury. To guide the development of the guidelines it was important to understand how physiotherapists and people living with spinal cord injury use evidence to choose interventions and the potential barriers and facilitators to the uptake of the clinical practice guidelines. Spinal Cord Injury Centres in Sydney, Australia and New Zealand. Focus groups and interviews with physiotherapists and people living with spinal cord injury were recorded, transcribed, and subjected to thematic analysis. A total of 75 participants took part in the study, 45 physiotherapists and 30 people living with spinal cord injury. Three main themes were identified from the data: (1) Types and sources of evidence that influence treatment choices, (2) the many factors determining treatment choices, and (3) ways in which clinical practice guidelines could influence treatment. Clinical practice guidelines have the potential to reduce the barriers identified by physiotherapists in accessing and interpreting research evidence on interventions for people living with spinal cord injury. Supported implementation of guidelines is required to demonstrate their benefit and encourage physiotherapists to factor in evidence when balancing the multiple factors influencing choice of physiotherapy intervention.

The impact of COVID-19 on spinal cord injuries and trauma at a tertiary referral centre in Sydney.

The coronavirus disease 2019 (COVID-19) pandemic has yielded far-reaching consequences for individual health systems as well as society. Although several studies have investigated epidemiological trends due to the pandemic-associated restrictions in patients requiring surgery for general surgical, trauma and orthopaedic aetiologies, there has been no assessment of the impact on spinal trauma and surgery in Australia. Thus, the aim of this study was to examine these changes at an Australian level one tertiary referral spinal cord injury (SCI) centre. We performed a retrospective cohort study of patients presenting to this institution with spinal injuries requiring surgery, from two time periods [one prior to the pandemic, and one during]. We analysed demographics, injury mechanism and characteristics, and surgical factors to identify significant differences between the cohorts. There were 7.3% fewer spinal operations performed in the COVID-19 affected period. Although patient demographics were unchanged, the total number of emergency operations performed for injuries sustained in a motor vehicle accident decreased by 44% compared to the pre-COVID cohort (P=0.049). The median number of spinal levels affected by injury decreased, and there was a 30% decrease in American Spinal Injury Association (ASIA) type A injuries during the pandemic (P=0.006), with a corresponding increase in ASIA B injuries (P=0.032). The pandemic (and its associated social restrictions) has influenced the patterns of spinal injuries treated at this tertiary level institute during this time. We observed an overall reduction in the volume of emergency procedures performed during the pandemic. There was no change in the proportion of spinal cord injuries when compared to the pre-pandemic period; however, the severity of spinal cord injuries was diminished during the pandemic.

Validation of an Electronic Visual Analog Scale App for Pain Evaluation in Children and Adolescents With Symptomatic Hypermobility: Cross-sectional Study.

Rapid advances in mobile apps for clinical data collection for pain evaluation have resulted in more efficient data handling and analysis than traditional paper-based approaches. As paper-based visual analogue scale (p-VAS) scores are commonly used to assess pain levels, new emerging apps need to be validated prior to clinical application with symptomatic children and adolescents. This study aimed to assess the validity and reliability of an electronic visual analogue scale (e-VAS) method via a mobile health (mHealth) App in children and adolescents diagnosed with hypermobility spectrum disorder/hypermobile Ehlers-Danlos syndrome (HSD/HEDS) in comparison with the traditional p-VAS. Children diagnosed with HSD/HEDS aged 5-18 years were recruited from a sports medicine center in Sydney (New South Wales, Australia). Consenting participants assigned in random order to the e-VAS and p-VAS platforms were asked to indicate their current lower limb pain level and completed pain assessment e-VAS or p-VAS at one time point. Instrument agreement between the 2 methods was determined from the intraclass correlation coefficient (ICC) and through Bland-Altman analysis. In total, 43 children with HSD/HEDS aged 11 (SD 3.8) years were recruited and completed this study. The difference between the 2 VAS platforms of median values was 0.20. Bland-Altman analysis revealed a difference of 0.19 (SD 0.95) with limits of agreement ranging -1.67 to 2.04. An ICC of 0.87 (95% CI 0.78-0.93) indicated good reliability. These findings suggest that the e-VAS mHealth App is a validated tool and a feasible method of collecting pain recording scores when compared with the traditional paper format in children and adolescents with HSD/HEDS. The e-VAS App can be reliably used for pediatric pain evaluation, and it could potentially be introduced into daily clinical practice to improve real-time symptom monitoring. Further research is warranted to investigate the usage of the app for remote support in real clinical settings.

A Child Girl Has Severe Case of Pediatric Atopic Dermatitis: Treatment with Terbinafine Hydrochloride

Atopic dermatitis in early childhood accounts for 20% of all atopic dermatitis occurrences, with similar atopic dermatitis symptomology of red pustules or scales characteristic. The potential causation of atopic dermatitis varies, may be hereditary in some cases. Combination topical therapies are used to treat patients with a compromised skin barrier. There are few safe and regulated pharmacotherapeutic atopic dermatitis therapies for pediatric use, and current treatment satisfaction is low. Here we provide details of the successful treatment of a pediatric patient with pustular atopic dermatitis using topical application of terbinafine hydrochloride in tandem with maternal diet control on July 22, 2020 at AYA Medical Center in Sydney, Australia. After a six-month follow-up, the patient's symptoms had fully recovered. Thus, Terbinafine hydrochloride may be useful in the treatment of atopic dermatitis in children.

Pregnancy outcomes in women with gestational diabetes mellitus by models of care: a retrospective cohort study

ObjectiveTo compare birth outcomes of women with gestational diabetes mellitus (GDM) with background obstetric population, stratified by models of care.DesignRetrospective cohort study.SettingA tertiary referral centre in Sydney, Australia.ParticipantsAll births 1...

O13 - Introduction of the London Measure of Unplanned Pregnancy at the booking visit and the midwives’ perspective

Pregnancy planning and preconception care benefit women, their children, and future generations. The London Measure of Unplanned Pregnancy (LMUP) is a tool that can be used in antenatal care to identify women with unintended pregnancies, who require improved access to such services. This tool has recently been implemented into routine antenatal care in two Sydney Maternity centres. To explore midwives’ attitudes to the LMUP and their understanding of its application to their scope of practice following 12 months after it was introduced into the booking visit. A qualitative study using in-depth semi structured interviews with midwives from the two maternity care centres in Sydney, New South Wales, Australia. All midwives performing antenatal booking visits were eligible to take part. Interviews were transcribed, analysed, and coded to define key themes. Recruitment ceased when thematic saturation was reached. Ten midwives from the two maternity centres were interviewed. Midwives support the inclusion of the LMUP into the booking visit and felt it was in their scope of practice to be using the tool. Time constraints, the impact of COVID-19 and lack of structured referral pathways were identified barriers to the implementation of the LMUP in routine care. Midwives support the inclusion of the LMUP into the antenatal booking visit and see that it falls within their scope of practice. Service barriers were identified at the individual, organisational and external context levels. These need to be addressed to enhance the potential of this tool.

Interview with Emily Crawford

Emily Crawford is an Associate Professor at the University of Sydney Law School, where she teaches and researches in international law, international humanitarian law and international criminal law. She has published widely in the field of international humanitarian law, including three monographs (The Treatment of Combatants and Insurgents under the Law of Armed Conflict (Oxford University Press, 2010), Identifying the Enemy: Civilian Participation in Hostilities (Oxford University Press, 2015) and Non-Binding Norms in International Humanitarian Law (Oxford University Press, 2021)), and a textbook (International Humanitarian Law (with Alison Pert, 2nd edition, Cambridge University Press, 2020)). She is an associate of the Sydney Centre for International Law, and a co-editor of the Journal of International Humanitarian Studies.

Collecting the History of the Church in Australia

Collecting the History of the Church in Australia

Preferences for Biologic Treatment in Patients With Psoriatic Arthritis: A Discrete Choice Experiment.

We aimed to assess patient preferences for the characteristics and outcomes of biologic and targeted synthetic disease-modifying antirheumatic drugs (DMARDs) to manage psoriatic arthritis. We conducted a discrete choice experiment in patients with psoriatic arthritis from 3 rheumatology centers in Sydney, Australia. We assessed preferences for different attributes of biologic medications. The route and frequency of medications had a range of 5 levels, and the following 7 attributes had a range of 3 levels: the ability to attend to normal activities, improvements in joint pain, enthesitis and skin disease, chance of disease remission, risk of infection, and risk of severe adverse events. Multinomial logit models including a latent class model were used to calculate preferences. Of the 150 participants, 58.3% were female, with a median age of 53.5 years. The attributes in order of preference using the β coefficient in absolute values (95% confidence interval [95% CI]) were as follows: oral route compared to subcutaneous and intravenous routes (β coefficient 1.00 [fixed parameter]), avoiding severe side effects (β coefficient 0.72 [95% CI 0.50, 0.95]), increasing ability to attend to normal activities (β coefficient 0.66 [95% CI 0.36, 0.96]), avoiding infections (β coefficient 0.38 [95% CI 0.23, 0.53]), improvement in enthesitis pain (β coefficient 0.28 [95% CI 0.20, 0.36]), improvement in psoriasis (β coefficient 0.28 [95% CI 0.20, 0.36]), increasing chance of remission (β coefficient 0.27 [95% CI 0.19, 0.36]), and improvement in joint pain (β coefficient 0.26 [95% CI 0.00, 0.52]). When choosing biologic medications, patients with psoriatic arthritis preferred oral medications. Patients prioritized avoiding severe complications, maintaining the ability to attend to work and normal activities, and avoiding infection over clinical measures of efficacy.

Use of a hybrid teledermatology model in an Australian tertiary hospital during the COVID-19 pandemic

To the Editor: The COVID-19 pandemic has led to the adoption of teledermatology by health services across the world. There is increasing support for the use of teledermatology in the outpatient setting; however, its role in inpatient and emergency settings is less established. We reported the use of teledermatology in inpatient and emergency settings at the Dermatology Department, St George Hospital, a tertiary center in Sydney, Australia. Inpatient and emergency consultations are conducted at our institution by 1 of 2 staff dermatologists per day and 1 hospital-based dermatology resident. A hybrid model of inpatient teledermatology consultations was established prior to the COVID-19 pandemic. All referrals would be seen face to face by the dermatology resident to ensure relevant history, and high-quality clinical and dermatoscopic photographs would be taken. The referrals would then be summarized and sent to the on-call dermatologist, who would provide an impression and plan for the resident to enact. For severe or life-threatening cases, the on-call dermatologist would also attend the face-to-face consultation. This system involved both synchronous and asynchronous models depending on the triaging of consultations performed by the dermatology resident. To avoid the exposure of the on-call dermatologists to COVID-19, which would subsequently shut down the provision of dermatology services to both outpatient and inpatient or emergency services, this hybrid model of inpatient teledermatology was maintained during the pandemic, and outpatient clinics were converted to teledermatology for large proportions of 2020 and 2021. Using this hybrid approach, our dermatology service avoided any shut down periods due to the exposure of the 2 on-call dermatologists to COVID-19. The main exposure site for COVID-19 was the emergency department, and this was the main source of inpatient referrals (Fig 1). There was no statistically significant difference (P > 0.05, Student t test) in the number of inpatient consultations seen between pre-COVID-19 2019 (n = 295; mean, 27 consultations per month; SD, 10.9) and 2020 (n = 305; mean, 25 consultations per month; SD, 6.3) or 2021 (n = 323; mean, 27 consultations per month; SD, 8.1).1Ho G. Blake S.C. Sheriff T. Daniel B.S. Murrell D.F. Impact of COVID-19 on inpatient dermatology consults in an Australian tertiary hospital.Australas J Dermatol. 2021; 62: 427-428Crossref PubMed Scopus (3) Google Scholar This may have been due to the establishment of the hybrid model of inpatient teledermatology. In 2021, 70% of inpatient consultations had a treatment plan provided to the referring team within the same day of referral. The role of teledermatology to increase the efficiency of inpatient consultations was described prior to the COVID-19 pandemic, with reduction in the time taken for inpatient medical teams to receive advice from dermatology consultants.2Sharma P. Kovarik C.L. Lipoff J.B. Teledermatology as a means to improve access to inpatient dermatology care.J Telemed Telecare. 2016; 22: 304-310Crossref PubMed Scopus (25) Google Scholar Concordance in investigations and treatment plans between teleconsultations and face-to-face consultations has also been described.3Keller J.J. Johnson J.P. Latour E. Inpatient teledermatology: diagnostic and therapeutic concordance among a hospitalist, dermatologist and teledermatologist using store-and-forward teledermatology.J Am Acad Dermatol. 2020; 82: 1262-1267Abstract Full Text Full Text PDF PubMed Scopus (22) Google Scholar,4Gabel C.K. Nguyen E. Karmouta R. Liu K.J. Zhou G. Alloo A. Use of teledermatology by dermatology hospitalists is effective in the diagnosis and management of inpatient disease.J Am Acad Dermatol. 2021; 84: 1547-1553Abstract Full Text Full Text PDF PubMed Scopus (17) Google Scholar The COVID-19 pandemic has seen wider adoption of teledermatology services.5Loh C.H. Tam S.Y. Oh C.C. Teledermatology in the COVID-19 pandemic: a systematic review.JAAD Int. 2021; 5: 54-64Abstract Full Text Full Text PDF PubMed Scopus (13) Google Scholar The experience of our department supports the use of teledermatology for efficient delivery of care that has been stable throughout the COVID-19 pandemic. Our experience supports use of a hybrid model of teledermatology rather than a virtual model and can be applied in other parts of the world. None disclosed.

Long-Term Peritoneal Indwelling Catheters for Malignant Ascites: A Retrospective Case Series of PleurX and Peritoneal Port.

Objectives: To compare outcomes of PleurX and peritoneal port for malignant ascites. Design: Retrospective review of medical records was conducted. Setting/Subjects: Subjects were consecutive patients receiving PleurX or peritoneal port for malignant ascites in a center in Sydney, Australia. Measurements: Demographic data, complication rates, hospitalization rates, and survival were measured. Results: Sixteen cases were analyzed: 6 had peritoneal port (170 catheter days) and 10 had PleurX (477 catheter days). Complication rates were low with both drainage systems. Cellulitis rate was 33% (1.2 events/100 catheter days) for peritoneal port and 10% (0.2 events/100 catheter days) for PleurX. Hospital admission days were 27 days/100 catheter days for peritoneal port and 5.2 days/100 catheter days for PleurX. Conclusions: Both PleurX and peritoneal port seem feasible options in draining malignant ascites. Further research is needed to ascertain whether there are true differences in cellulitis/admission rates. Patient quality of life, experience, and preference should be included in future studies.

Bisphosphonates and bone mineral density in patients with end-stage kidney disease and renal transplants: A 15-year single-centre experience

Chronic Kidney Disease Stage 5 (CKD-5) imparts a 4-fold increase in minimal trauma fracture with a substantial increase in mortality following hip fracture. Bone disease in CKD is complex, characterised by abnormal levels of PTH, calcium, phosphate, ALP, and vitamin D, manifesting as a condition known as CKD-Mineral and Bone Disorder (CKD-MBD). While bisphosphonates (BPs) are widely used in the management of osteoporosis, their therapeutic role when end-stage renal function and bone disease co-exist remains unclear. This 15-year retrospective cohort study examines the long-term use of BPs in CKD-4 and -5 patients receiving no renal replacement therapy, haemodialysis and renal transplant in a tertiary centre in Sydney, Australia. In multivariate regression adjusting for age, baseline bone mineral density (BMD) and history of fracture, BP use was associated with net gain in lumbar spine bone density in renal transplant recipients over a mean treatment period of 3.5 years (net annual BMD gain of 0.039 g/cm2, p = 0.005). No such benefit was seen in hip BMD in CKD subjects. Regardless of transplant status, CKD patients treated with BPs had no improvement in hip BMD with a general decline in hip BMD across both groups during the study period (hip BMD: transplant recipients decline 0.024 ± 0.81 g/cm2, non-transplant CKD patients decline 0.055 ± 0.84 g/cm2). BP therapy did not result in significant changes in biochemical parameters (ALP, PTH, and phosphate) and no serious adverse effects were detected in association with BP use. In particular, kidney function was not affected by BPs post-transplant (eGFR = 43 ± 29 ml/min/1.73 m2, p = 0.80). BPs preserved lumbar spine bone density in kidney transplant recipients but did not prevent declines in hip bone mineral density in either transplant patients or those with CKD-4 and -5. SummaryThere remains a lack of clarity of the risks vs. benefits of bone-sparing pharmacotherapy in chronic kidney disease Stages 4 and 5. This single-centre 15-year retrospective data analysis showed that bisphosphonates are not associated with any detectable serious adverse effects in CKD-4 and -5 and effective at mitigating lumbar spine bone loss in kidney transplant patients.

Response\u2014A Critical Response to \u201cDiscourse Communities and the Discourse of Experience\u201d

In their article Little, Jordens, and Sayers developed the notion of “discourse communities”—as groups of people who share an ideology and common “language”—with the support of seminal ideas from M.M. Bakhtin. Such communities provide benefits although they may also impose constraints. An ethical community would open to others’ discourse and be committed to critique. Those commitments may counter the limitations of discourse communities. Since their paper was published in 2003, the notion of “discourse communities” has been widely adopted and applied in healthcare and beyond. Their ideas were influential in the founding of an ethics centre in Sydney and contributed to articulating the values which underpin this journal. This commentary notes that an ethical community is fragile in responding to current onslaughts on truth and meaning—potencies inherent in discourse communities. The essay takes Bakhtin’s ideas further to explore intrinsic forces at play in dialogue, language, and art. This leads to discussing the centrality of ethics in Bakhtin’s thought. For him, the essence of discourse is a dialogic exchange which comprises both art and ethics. It is art in that self and other are created in the exchange. It is ethical in that “I” am answerable to the other, as a phenomenological reality, in the moment of intersubjectivity.

A Spatial-Contextual Indoor Trajectory Prediction Approach via Hidden Markov Models

Unlike outdoor trajectory prediction that has been studied many years, predicting the movement of a large number of users in indoor space like shopping mall has just been a hot and challenging issue due to the ubiquitous emerging of mobile devices and free Wi-Fi services in shopping centers in recent years. Aimed at solving the indoor trajectory prediction problem, in this paper, a hybrid method based on Hidden Markov approach is proposed. The proposed approach clusters Wi-Fi access points according to their similarities first; then, a frequent subtrajectory based HMM which captures the moving patterns of users has been investigated. In addition, we assume that a customer’s visiting history has certain patterns; thus, we integrate trajectory prediction with shop category prediction into a unified framework which further improves the predicting ability. Comprehensive performance evaluation using a large-scale real dataset collected between September 2012 and October 2013 from over 120,000 anonymized, opt-in consumers in a large shopping center in Sydney was conducted; the experimental results show that the proposed method outperforms the traditional HMM and perform well enough to be usable in practice.

Cardiac Catheter Laboratory Utilisation Following Introduction of an Extracorporeal Membrane Oxygenation Cardiopulmonary Resuscitation (e-CPR) Programme for Out-of-Hospital Cardiac Arrest

Refractory out-of-hospital cardiac arrest (r-OHCA) is associated with globally poor outcomes. Highly selected r-OHCA cases may be suitable for invasive, resource intensive interventions such as extracorporeal membrane oxygenation cardiopulmonary resuscitation (ECPR). We sought to further understand whether ECPR implementation would have unintended effects on cardiac catheterisation laboratory (CCL) utilisation. This was an analysis of a prospective adult OHCA registry and Utstein-based outcome reporting with two distinct ‘pre’ and ‘post’ cohorts. The setting was a tertiary centre in Sydney, Australia. The pre-ECPR cohort comprised consecutive OHCA patients between 2016 and 2019 (prior to an ECPR program), and the post-ECPR cohort from mid-2020 and mid-2021 (post implementation of an ECPR program). There were 248 patients in the pre-ECPR cohort and 51 in the post-ECPR cohort. The groups had similar baseline characteristics. Sustained return of spontaneous circulation (ROSC) was obtained in 61 (24.6%) (pre) and 12 (23.5%) (post) OHCAs, respectively (p=0.86). Pre-ECPR, 47 (77%) received CCL during admission versus 8 (67%) post-ECPR (p=0.55). Early CCL (<24 h) was performed in 34 (56%) pre-ECPR patients versus 8 (67%) post-ECPR (p=0.57). In patients receiving early CCL, time from OHCA to CCL arrival was 188.38 min (SD 176.6) for pre-ECPR versus 130.38 min (SD 91.9) for the post-ECPR cohort (p=0.38). ECPR was attempted in 6/51 OHCA cases but only 1 patient survived to CCL. ECPR implementation did not appear to lead to unintended delayed to CCL interventions. All patients attending CCL post-ECPR implementation did so within 24 hours [[1]Yannopoulos D. Bartos J. Raveendran G. Walser E. Connett J. Murray T.A. et al.Advanced reperfusion strategies for patients with out-of-hospital cardiac arrest and refractory ventricular fibrillation (ARREST): a phase 2, single centre, open-label, randomised controlled trial.Lancet. 2020; 396: 1807-1816Abstract Full Text Full Text PDF PubMed Scopus (155) Google Scholar].

Retrospective cohort study on preparation regimens for frozen embryo transfer.

The objective of this study was to examine the pregnancy outcomes from frozen embryo transfer (FET) cycles using different endometrial preparation regimens, compared to ovulation induction with letrozole (letrozole OI). A retrospective cohort study was conducted at a fertility centre in Sydney, Australia, on 6060 FET cycles. The cycles were stratified into one of four ways to achieve endometrial preparation. These were either a natural, letrozole OI, OI with follicle-stimulating hormone (FSH OI) or a programmed cycle. The primary outcome was live birth rate (LBR) per embryo transfer. Secondary outcomes included clinical pregnancy and biochemical pregnancy rates, adverse events including miscarriage, ectopic pregnancy, stillbirth, neonatal death and multiple births. Ovarian stimulation parameters were also analysed including the time taken to reach the luteal phase and the number of blood or urine tests required for monitoring the cycle. The results of the study showed that the LBR following letrozole OI cycles was higher when compared to natural cycles (odds ratio (OR): 1.27 (1.07–1.49)) and programmed cycles (OR: 2.36 (1.67–3.34)). There was no significant difference between letrozole OI and FSH OI LBR (OR: 0.99 (0.76–1.28)). An improved LBR with letrozole OI compared to natural cycles was maintained when only women with a normal length cycle were considered (OR: 1.44 (1.10–1.89)). There was a significant reduction in miscarriage rates when letrozole OI was compared to programmed cycles (OR: 0.46 (0.26–0.83)). It was therefore concluded that the use of letrozole OI for endometrial preparation in an FET cycle may be associated with higher LBR and lower miscarriage rate, compared to using a programmed cycle.Lay summaryCouples suffering from infertility frequently try to conceive following the transfer of an embryo which has been frozen during an in vitro fertilisation cycle. Embryos will only lead to a pregnancy if the woman’s womb lining has particular characteristics that allow it to accept the embryo. Despite the thousands of frozen embryo transfer cycles carried out across the world, it is not known how best to prepare a woman’s lining so it has these particular characteristics. This study looked at the pregnancy outcomes of 6060 cycles to compare four different ways to prepare a woman’s womb lining. These included relying on a woman’s natural menstrual cycle, or using an oral medication called letrozole, or injectable medicine called follicle-stimulating hormone, or oestrogen and progesterone hormonal medications. The comparison found that using letrozole before transfer of a frozen embryo may be associated with higher rates of a live birth for some women.

Infant educators’ use of mental-state talk in Australia and China: a cross-cultural comparative study

ABSTRACT This study compares the mental-state talk of infant educators in Australia and China in order to determine the nuanced differences in the ways that they use this talk with the infants in their room. Participants are 44 native English-speaking Australian educators from centres in Sydney, Australia and 30 native Chinese-speaking infant educators recruited from centres in and around Hangzhou, China. Twenty-minute samples of each educators’ naturally occurring play interactions with infants during play were coded to determine the frequency of their desire, emotion, perception, cognition and modulation of assertion talk. Each mental-state term was also coded according to the referent of that mental-state. We examined the extent to which Australian and Chinese educators’ use mental-state talk and how the referents of such talk differed by mental-state talk type and culture. Australian educators used significantly more mental-state talk than their Chinese counterparts. Different patterns of referent use across cultural cohorts and mental-state talk types were identified. Findings have implications for the socialisation of very young children into culturally specific ways of talking and thinking about the mind.

Idiopathic granulomatous mastitis: case series and clinical review.

Idiopathic granulomatous mastitis is a chronic inflammatory breast disorder that typically affects young, parous women, often following lactation. Patients present with tender, erythematous breast lesions with histological evidence of non-caseating granulomata and an inflammatory cell infiltrate. An immune-mediated pathophysiology is hypothesised and an association with lipophilic Corynebacterium species is observed. Initial diagnosis is often delayed due to lack of awareness of the condition and management of refractory disease can be challenging. We present an extensive case series of patients collaboratively managed by subspecialty physicians and surgeons at a single centre in Sydney, Australia. The accompanying review expands on features of this condition and supports the utility of a multidisciplinary approach.

Patient satisfaction with telehealth consultations in medical oncology clinics: A cross-sectional study at a metropolitan centre during the COVID-19 pandemic

Introduction The coronavirus disease 2019 (COVID-19) pandemic has resulted in a widespread adoption of telehealth (phone and video consultations) in cancer care worldwide. The aim of this study was to determine patient satisfaction with telehealth consultations with their medical oncologist at a tertiary cancer centre in Sydney, Australia. Methods Patients who attended a routine telehealth appointment at the medical oncology outpatient clinic were recruited to complete a questionnaire containing 16 items, each on a 5-point Likert scale regarding satisfaction levels in various aspects of telehealth and their willingness to continue telehealth after the pandemic. Patients were also invited to provide suggestions for improvement. Results In total, 150 patients were invited to participate, and 103 valid questionnaires were returned. Median age was 63 years (range: 25–90), 49% of patients were male, 63% of patients had advanced cancer and 81% were on active treatment. In total, 95% of participants indicated that they were satisfied (score ≥4) with telehealth. 82% of participants preferred to continue telehealth consultations after the coronavirus disease 2019 pandemic, but ideally with a mix of telehealth and in-person consultations. Phone appointments (vs. video, p < 0.002), patients with advanced cancer (vs. early, p < 0.036) and pre-chemotherapy/immunotherapy/targeted therapy treatment reviews (vs. follow-up appointments, p < 0.001) were significantly associated with a willingness to continue telehealth. Discussion Patients were overwhelmingly satisfied with telehealth during the study period and were willing to continue telehealth for some appointments beyond the coronavirus disease 2019 pandemic. More research into the effectiveness, safety and implementation of telehealth to compliment traditional face-to-face services for patient-centred cancer care is required.

Real world outcomes of neoadjuvant chemotherapy and radiotherapy for borderline resectable pancreatic cancer: a multicentre observational study.

Neoadjuvant therapy may increase the likelihood of complete (R0) resection for borderline resectable pancreatic cancer. The optimal approach is unknown and differs amongst treatment centres. We identified patients with biopsy-proven borderline resectable pancreatic adenocarcinoma who commenced neoadjuvant therapy between January 2012 and June 2019 at three centres in Sydney, Australia. Patterns of care and outcomes of varying approaches were examined. Forty-eight patients were identified. Median age was 66 years (range: 41-84). Staging included endoscopic ultrasound in 98%, PET-CT scan in 77%, laparoscopy in 46%. Neoadjuvant regimens used were a combination of chemotherapy and chemo-radiation (58%), chemotherapy alone (13%) and chemoradiation alone (29%). Radiologic complete or partial response occurred in 33% and progression in 25%. Complete macroscopic surgical resection was achieved in 50%, and R0 resection in 38%. At median follow-up of 15 months, the 1-year and 2-year overall survival was 75% and 63% respectively, and the 1-year and 2-year progression-free survival was 50% and 29% respectively. Significant predictors of macroscopic resectability were radiologic response (p= 0.005) but not addition of radiotherapy to chemotherapy (OR 0.87, p= 0.81). Predictors of overall survival included baseline Ca19.9 level (p= 0.04) and a trend to the use of systemic chemotherapy (HR 0.51, p= 0.07), but not use of radiotherapy (HR 0.70, p= 0.47). There is high variability in staging and neoadjuvant approaches for borderline resectable pancreas cancer. Despite aggressive neoadjuvant therapies, R0 resection and prolonged survival are uncommon. The incremental benefit of neoadjuvant radiotherapy after neoadjuvant chemotherapy was not demonstrated in this observational study.