Brisbane Hospital Research Articles

A retrospective audit of audiology encounters in patients undergoing Cisplatin treatment at a large Australian tertiary cancer care centre.

To identify the number and timing of audiology encounters for adult oncology patients in a tertiary care setting in Australia. A retrospective case review was completed for 149 patients who received Cisplatin chemotherapy (CT) at a large, publicly funded tertiary hospital in Brisbane, Queensland, Australia between 1st January and 31st December 2019. Patient data was extracted from the Queensland Oncology Repository (QOR) provided by Cancer Alliance Queensland (CAQ). The number of audiology encounters was low overall with a median of 0 and interquartile range (IQR) of 0-1. Of the entire patient cohort, there was a mean of 1.2 encounters with 56% of patients not engaging with audiology. Where audiology did occur, encounters were most likely before or early in the CT treatment period. This study has demonstrated engagement with audiology services for patients undergoing CT treatment was limited with the few audiology engagements occurring before or early in the CT treatment period. Further research is needed to identify the barriers and facilitators to accessing audiological ototoxic monitoring (OtoM) during chemotherapy treatment in hospitals in Australia. Early identification of ototoxic hearing loss offers the opportunity to minimise further exposure to the ototoxic agent, minimise functional and communication impacts for the patient and provide early opportunity for discussion, education and counselling with patients, carers and their treating team. This, in turn, is expected to improve health related quality of life.

Serving Queensland: reflecting on geographical access to the pelvic exenteration service in Queensland.

Pelvic exenteration for rectal cancer involves a radical multi-visceral resection to improve complete surgical clearance, and access is limited within Queensland. A retrospective review of a prospective database of the referrals to the pelvic exenteration service in the Royal Brisbane and Women's Hospital from 2009 to2023. Geographic, as well as clinical and demographic information was collected. One hundred and seventy six patients were referred to the pelvic exenterations service. In total 93 patients were referred from a major city, 52 from inner regional areas, and 31 from outer regional or remote areas. One hundred and three referred patients (58.5%) proceeded to surgery, significantly more of whom were referred from a major city (P < 0.001). Of the patients referred from outer regional, inner regional, and major cities, a similar proportion of patients proceeded to surgery (55%, 52%, and 63.4%). Patients not proceeding to surgery in major cities and inner regional areas were most commonly unfit to proceed, whereas in outer regional areas most patients decided against surgery (61.5%). In the 14-year period, overall referrals increased, with inner regional referrals increasing the most over time. Overall survival was not significantly impacted by remoteness. Awareness of the pelvic exenteration service in regional Queensland may have resulted in less referrals to the service. It is important to confirm a broad-reaching service to optimize patient care.

SAFE: Safety of procedural sedation and analgesia administration in the fast-track area of the emergency department.

To determine whether undertaking procedural sedation in the low-acuity fast-track area is safe and effective in improving patient flow. A retrospective cohort study reviewed patients who underwent procedural sedation in the Royal Brisbane and Women's Hospital Emergency and Trauma Centre between December 2020 and December 2021. A total of 411 cases were included. Performing sedation in the fast-track area was not associated with increased complication rates but was associated with reduced time to sedation (difference = 44.24 min, P < 0.001) and length of stay (difference = 60.64 min, P < 0.01). The sedation of patients outside a high-acuity area is safe and significantly improves patient flow.

Achievement of international benchmark outcomes for robotic pancreaticoduodenectomy in a low volume country

BackgroundRecently, there has been an increase in the utilisation of the robotic platform to perform minimally invasive pancreaticoduodenectomy in high volume centres, with the goal of reducing morbidity and improving patient outcomes. This study reports the successful implementation of a robotic pancreaticoduodenectomy (RPD) programme in the relatively low volume setting of Australia, measured against established, internationally accepted benchmarks for low-risk open pancreaticoduodenectomy (OPD). MethodsRetrospective review of a prospectively maintained database for consecutive RPD at two Brisbane hospitals was performed, comparing data to internationally established benchmarks for low-risk OPD. A structured RPD programme was implemented by two surgeons across a study period spanning May 2017 to December 2023. ResultsOver the study period, seventy-two consecutive RPDs were performed, with 79 % for malignancy. Perioperative outcomes for transfusions, conversion rate, postoperative fistula rate, morbidity, mortality and oncological outcomes were all within established benchmark cutoffs for low-risk open pancreaticoduodenectomy (OPD), although operative time exceeded the benchmark value by 0.7hrs. ConclusionA carefully implemented RPD programme in the low volume Australian setting is feasible, with high quality outcomes achievable when compared to established benchmarks for low-risk OPD and to reported RPD series published by high volume pioneering centres.

Bolusing IV Administration Sets With Monoclonal Antibodies Reduces Cost and Chair Time: A Randomized Controlled Trial.

Monoclonal antibodies are widely used anticancer therapies. Increasing demand for ambulatory care necessitates exploration of efficiency measures. The primary objective was to evaluate the impacts on chair time and associated cost of priming IV administration sets with a bolus of the prescribed monoclonal antibody drugs. A secondary objective was to assess the associated incidence of hypersensitivity reactions. A large tertiary hospital in Brisbane, Australia, conducted a randomized controlled trial (N = 128) with a two-arm design. Included monoclonal antibodies were daratumumab, obinutuzumab, pembrolizumab, and nivolumab. There was a statistically significant reduction in chair time for obinutuzumab, pembrolizumab, and nivolumab compared with the control. Findings suggest that this priming intervention reduces chair time and cost for some monoclonal antibody drugs. Future research could assess this practice in other oncology therapies.

Self-Determination, Optimism, Social Support, Knowledge, and Skills Have a Positive Influence on the Oral Intake of Long-Stay Acute Patients: A Qualitative Study

BackgroundAlthough previous research has attempted to understand the barriers and enablers of oral intake in hospitalized patients, these studies have mainly focused on short-stay inpatients and lacked a theory-driven examination of the determinants that influence dietary behavior in the hospital. ObjectiveTo explore and compare the factors influencing adequate and poor oral intake in long-stay acute patients (admitted >14 days). DesignA qualitative descriptive study with semistructured interviews. Participants/settingTwenty-one adult inpatients (13 men, 8 women) admitted to 2 medical and 2 surgical wards at a tertiary hospital in Brisbane, Australia, during 2022, stratified by the Subjective Global Assessment. Analysis performed Transcripts were initially deductively analyzed against the Theoretical Domains Framework, and a reflexive thematic approach was used to create overall themes. ResultsOf the 21 included patients (median age = 68.0 years, IQR 34 years), 11 had adequate/improved intake and 10 poor/decreased intake. Six themes were identified to have influenced oral intake in long-stay patients: self-determination to eat; nutrition impact symptoms; foodservice characteristics and processes; nutrition-related knowledge and skills; social support; and optimism, emotions, and emotion regulation. Patients with adequate/improved oral intake were characterized by an autonomous motivation to eat. They had increased awareness about their nutritional status, knowledge, and skills about food for recovery, were more optimistic, and social support was an important enabler to eating. In contrast, patients with poor/decreased oral intake perceived nutrition impact symptoms and dislike of meals as the main barriers to eating in the hospital; however, they also expressed more negative emotions, reduced coping strategies, and decreased knowledge, skills, intrinsic motivation, and capabilities to eat. Social support was present but did not enable oral intake in this patient group. ConclusionsThis study provides novel insights into the factors that influenced oral intake in long-stay acute patients, highlighting the importance of patient-centered nutrition care, encompassing motivational interviewing techniques and collaboration from the multidisciplinary team to create a supportive environment that fosters autonomy and empowers patients to actively participate in their own nutrition and recovery.

Utilizing technology for diet and exercise change in complex chronic conditions across diverse environments (U-DECIDE): feasibility randomised controlled trial

BackgroundDiet and exercise are important components of treatment for complex chronic conditions, however access to allied health support is limited. When available, support is often siloed and fragmented. Digital health incorporating patient choice may help to align health care services with preferences and goals. This study evaluated the implementation of a ubiquitously accessible patient-centred digital health diet and exercise service.MethodsU-DECIDE was a single-centre, 26-week randomised controlled trial set in kidney and liver disease clinics in a tertiary hospital in Brisbane, Australia. Participants were adults with a complex chronic condition referred for dietetic consultation with at least one feature of the metabolic syndrome. All participants received a dietary consultation, an activity monitor and usual care. Intervention participants were offered one text message per week and access to additional digital health options (increased text message frequency, nutrition app, exercise app, group-based diet and/or exercise video consultations). The primary outcome of feasibility was determined by safety (study-related serious adverse events: SRSAEs), recruitment (≥ 50% eligible patients), retention (≥ 70%), exposure uptake (≥ 75% of intervention group had greater access to health professional contact than comparator) and video consultation adherence (≥ 80% attendance). Secondary outcomes included process evaluation metrics and clinical outcomes.ResultsOf 67 participants (intervention n = 33, comparator n = 34), 37 (55%) were men, median (IQR) age was 51 (41–58) years. The most chosen digital health options were the nutrition app (n = 29, 88%) and exercise video consultations (n = 26, 79%). Only one participant chose no additional digital health options. The intervention group had no SRSAEs. The study exceeded targets for recruitment (52%), retention (81%) and exposure uptake (94%). Video consultation adherence was 42%. Engagement across digital health options was inconsistent.ConclusionsDigital health options incorporating patient choice were feasible and can be offered to people with complex chronic disease as a service model option.Trial registrationAustralia and New Zealand Trials Register: Trial Registration Number: ACTRN12620001282976. Registered 27th November 2020.

Pregnancy and stomas: a 9-year retrospective series at a major metropolitan hospital in Brisbane Queensland.

Over 42 000 Australians live with a stoma, and this number increases annually. Pregnancy in stoma patients is a rare but complex condition and there is limited published literature regarding surgical and obstetric complications in pregnant stoma patients. The aim of this paper was to review stoma outcomes, perinatal morbidity and mortality, and early postpartum period in pregnant stoma patients. Data was retrospectively obtained on women of childbearing age, with a stoma, who had been pregnant and birthed in the last nine years at the Royal Brisbane and Women's Hospital between January 2014 to December 2022. Data recorded included patient demographics, type of stoma, indication for stoma, need for additional abdominal surgeries, method of conception, pregnancy complications, length of stay, neonatal outcomes and post pregnancy stomal complications. In total, there were 16 births from 13 mothers with stomas. Of 10 births to IBD patients, 40% experienced a serious stomal complication. Caesarean section (CS) rate was 90% for IBD and 83% for non-IBD. In-vitro fertilisation rates were 40% in IBD patients and 0% in non-IBD patients. The average gestational age at delivery was 36 weeks in IBD and 35 weeks in non-IBD patients. Neonates delivered to IBD mothers had a birth weight under 2500g in 40% of cases and in non IBD mothers at 33.3% (p = 0.62). Of the sixteen births there was five complications (31.25%) associated with the stoma either during pregnancy or during the sixty-day postpartum period. Pregnancy in stoma patients is a rare occurrence and appears to be associated with high rates of CS, preterm delivery, low birth weight and stomal complication.

Direct to psychology for sleep disorders: Innovating models of care in the hospital and health service.

A 'Direct to Psychology Insomnia' pathway was developed for implementation within a multidisciplinary sleep disorders service in a tertiary hospital in Brisbane, Australia. The project was informed by implementation science principles and methodology to re-design the model of care (MoC). A consensus group workshop using the Nominal Group Technique (NGT) with 12 multidisciplinary staff was undertaken to develop the new MoC. The workshop explored inclusion and exclusion criteria for a Direct to Psychology pathway including patient flow and enablers. The team endorsed a MoC that was acceptable to stakeholders and addressed service-level imperatives. The findings highlighted that patient inclusion or exclusion should be overseen by the Sleep Physician team and an Advanced Psychologist with behavioural sleep medicine expertise. Continuum of care for patients referred via primary care providers was considered. Barriers and risks to the MoC changes were identified which informed the refinement of the MoC.

Exploring the potential impact of adding upper limit single trigger MET thresholds to a paediatric early warning scoring tool at a tertiary children's hospital: a retrospective review.

This study aims to determine the impact of incorporating upper threshold vital sign triggers into the digital Children's Early Warning Tool (CEWT) on the number of medical emergency team (MET) alerts. De-identified vital set data from the Cerner Millennium Integrated Electronic Medical Records were obtained for all paediatric patients aged ≤16 years at a tertiary children's hospital in Brisbane over a 12-month period in 2022. Patients in the paediatric intensive care unit, post-anaesthetic care unit, or the emergency department were excluded as they would not trigger MET alerts in these locations. Microsoft Excel scripts were used to tabulate and graph the data to compare the number of MET alerts in the current system vs. the system with proposed upper thresholds for heart rate, respiratory rate, systolic blood pressure, and severe respiratory distress. A total of 389,352 vital sets were used for analysis after exclusions. Total cumulative MET alerts increased by 229% from 1,707 to 5,623. The number of increased alerts was inversely proportional to the age group. Respiratory rate and systolic blood pressure were the vital signs most associated with increased alerts. The largest number of new alerts came from patients with lower CEWT scores, while the largest proportional increase in alerts came from those with higher CEWT scores. Incorporating upper threshold vital sign triggers into the digital CEWT leads to a substantial increase in MET alerts. The consequent workload is not justified, given the lack of evidence suggesting a failure of the current CEWT system in recognising deteriorating patients.

Maternal perception of decreased fetal movements is independent of infant size.

Fetal movements are often used as a surrogate for fetal wellbeing. Previous research suggests a link between maternal perception of decreased fetal movements (DFM) and small for gestational age (SGA) infants. The aim of this study was to investigate the association between maternal presentation with DFM and birthweight centile categories at a large Australian perinatal center. This was a 5-year cohort study (January 2016 to October 2020) of non-anomalous singleton infants born at the Mater Mothers' Hospital in Brisbane, Australia at 28+0 weeks gestation or later. The primary outcome for this study was the rate of DFM by birthweight centile categories. Maternal demographics included age, body mass index, ethnicity, parity, medical conditions, and previous stillbirths. The effect of decreased fetal movements on birthweight centile was evaluated with adjusted multinomial regression models. Adjusted logistic regression models were then used to evaluate whether decreased fetal movements resulted in birthweight centiles <5 and <10. Robust standard errors were used to account for clustering at the patient level. Wald tests, Hosmer and Lemeshow's goodness of fit tests, Akaike's and Bayesian Information Criteria were used to evaluate models. Over the 5-year study period, 45042 women met the inclusion criteria. Of these, 6690 (14.9%) women presented with DFM. Of the DFM cohort, 80.9% (5411/6690) had only one presentation with DFM, whilst 19.1% (1279/6690) had >2 presentations. The overall stillbirth rate was similar in women with DFM (0.1%, 8/6690) and without DFM (0.1%, 50/38352). There was no difference in rates of DFM (either single or multiple) vs. no DFM and infant birthweight centile categories. There was no association between DFM (either single or multiple) and infant birth weight centile. The results of this study suggest that presentation with DFM is not associated with infant size. Clinicians should consider additional risk factors and the overall clinical context in deciding appropriate management. DFM is not necessarily an indication for an immediate or urgent ultrasound scan to assess fetal size. This article is protected by copyright. All rights reserved.

Qualitative Evaluation of a Novel Security Role to Reduce Occupational Violence in Inpatient Hospital Settings.

Background: Occupational violence (OV) is a priority issue that significantly affects the safety of nurses, leading to staff burnout and poor retention issues. Security personnel are common in inpatient settings, yet there is limited research on their role, function, and impacts. The study aims to qualitatively evaluate a novel security role to reduce OV in inpatient settings. Methods: This qualitative study was conducted in a tertiary hospital in Brisbane, Queensland. A novel security role (Ambassador) was piloted in three inpatient wards over 6 months in 2020 to mitigate OV risk. Semi-structured in-depth interviews were conducted. All interviews were audio recorded. Interview transcripts were transcribed. Deductive analysis based on the Consolidated Framework for Implementation Research (CFIR) was used to identify the experiences and perceptions of the participants. Findings: 17 participants were interviewed. Five themes were identified including program characteristics, internal drivers, external drivers, individual experience, and implementation process. An Ambassador proactively engages with patients and visitors and employs behavioral strategies to de-escalate or redirect persons of concern. Participants considered Ambassadors to be important members of the health care team who supported the provision of patient and family-centered care. Successful implementation was said to require collaboration between clinical and security services and a small agile project team with authority and autonomy. Conclusion/Application to practice: This study provides many insights into the successful implementation of a novel security role in acute hospital settings. More research is needed on the effectiveness, appropriateness, feasibility, and cost of different security models.

No safe time window in malrotation and volvulus: A consecutive cohort study.

Malrotation and volvulus classically present with bilious vomiting. It is more common earlier in life, but there are other causes of bile-stained vomiting. This leads some clinicians to 'watch and wait'. In the presence of a volvulus, this is potentially a fatal decision. It is not clear from the literature if there is a safe time window in which children can be observed in the hope of avoiding transfers or radiological investigations. To determine whether time to identification and management of midgut volvulus correlated with morbidity and mortality; and whether there were patterns to transition of care. Multicentre, retrospective review of all children with malrotation ± volvulus at two tertiary children's hospitals in Brisbane from 2000 to 2012. Data collected included age at presentation, timing between symptom onset and presentation, radiological findings, and definitive surgical management. Outcomes included patient length of stay (LOS), total parenteral nutrition (TPN) duration, re-operations and death. There were 96 cases of malrotation identified, with 23 excluded (elective operation, insufficient data). Neonates made up 66% of included cases. Only 14% of cases were over 12 months old. Bilious vomiting or bile-stained aspirates were the presenting symptoms in 71% (52). Overall mortality was 5.56%. Time from symptom onset to presentation or management was not significantly associated with morbidity or mortality. More than half (53%, 39/73) of patients received total parenteral nutrition; 20/39 for more than 10 days. Neonates and infants had a significantly higher rate of TPN compared with older children (P < 0.001). Those requiring TPN post-operatively had a significantly higher mortality compared with those who did not (P = 0.02). Time from symptom onset to presentation or definitive management was not significantly associated with LOS, TPN duration, or need for re-operation. Malrotation remains a time-critical diagnosis to secure and treat. Even a short duration of symptoms can be associated with high morbidity or mortality. There is no place for 'watch and wait' for such patients, and malrotation/volvulus should be emergently actively excluded with contrast studies.

Placental growth factor and fetoplacental Doppler indices in combination predict preterm birth reliably in pregnancies complicated by fetal growth restriction.

To assess the association between placental biomarkers (placental growth factor (PlGF) and soluble fms-like tyrosine kinase-1 (sFlt-1)/PlGF ratio) and fetoplacental Doppler indices (umbilical artery (UA) pulsatility index (PI) and uterine artery (UtA) PI) in various combinations for predicting preterm birth (PTB) in pregnancies complicated by fetal growth restriction (FGR). This was a prospective observational cohort study, performed at Mater Mother's Hospital in Brisbane, Queensland, Australia, from May 2022 to June 2023, of pregnancies complicated by FGR and appropriate-for-gestational-age (AGA) pregnancies. Maternal serum PlGF levels, sFlt-1/PlGF ratio, UA-PI and UtA-PI were measured at 2-4-weekly intervals from recruitment until delivery. Harrell's concordance statistic (Harrell's C) was used to evaluate multivariable Cox proportional hazards regression models featuring various combinations of placental biomarkers and fetoplacental Doppler indices to ascertain the best combination to predict PTB (< 37 weeks). Multivariable Cox regression models were used with biomarkers as time-varying covariates. The study cohort included 320 singleton pregnancies, comprising 179 (55.9%) affected by FGR, defined according to a Delphi consensus, and 141 (44.1%) with an AGA fetus. In the FGR cohort, both low PlGF levels and elevated sFlt-1/PlGF ratio were associated with significantly shorter time to PTB. Low PlGF was a better predictor of PTB than was either sFlt-1/PlGF ratio or a combination of PlGF and sFlt-1/PlGF ratio (Harrell's C, 0.81, 0.78 and 0.79, respectively). Although both Doppler indices were significantly associated with time to PTB, in combination they were better predictors of PTB than was either UA-PI > 95th centile or UtA-PI > 95th centile alone (Harrell's C, 0.82, 0.75 and 0.76, respectively). Predictive utility for PTB was best when PlGF < 100 ng/L, UA-PI > 95th centile and UtA-PI > 95th centile were combined (Harrell's C, 0.88) (hazard ratio, 32.99; 95% CI, 10.74-101.32). Low maternal serum PlGF level (< 100 ng/L) and abnormal fetoplacental Doppler indices (UA-PI > 95th centile and UtA-PI > 95th centile) in combination have the greatest predictive utility for PTB in pregnancies complicated by FGR. Their assessment may help guide clinical management of these complex pregnancies. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

Admissions for psychosis following agency-notified child maltreatment at 40-year-follow-up: Results from the Childhood Adversity and Lifetime Morbidity (CALM) cohort

There is substantial evidence of an association between self-reported child maltreatment (CM) and subsequent psychosis in retrospective data. Such findings may be affected by recall bias. Prospective studies of notifications to statutory agencies address recall bias but are less common and subject to attrition bias. These studies may therefore be underpowered to detect significant associations for some CM types such as sexual abuse. This study therefore linked administrative health data to a large birth cohort that included notifications to child protection agencies. We assessed psychiatric outcomes of CM as measured by inpatient admissions for non-affective psychoses (ICD10 codes F20-F29) to both public and private hospitals in Brisbane, Australia. Follow-up was up to 40 years old. There were 6087 cohort participants whose data could be linked to the administrative health data. Of these, 10.1 % had been the subject of a CM notification. Seventy-two participants (1.2 %) had been admitted for non-affective psychosis by 40-year follow-up. On adjusted analysis, all notified and substantiated types of CM were associated with admissions for non-affective psychosis. This included neglect, physical, sexual or emotional abuse, as well as notifications for multiple CM types. For instance, there was a 2.72-fold increase in admissions following any agency notification (95 % CI = 1.53–4.85). All maltreatment types therefore show a significant association with subsequent admissions for psychosis up to the age of 40. Screening for CM in individuals who present with psychosis is, therefore, indicated, as well as greater awareness that survivors of CM may be at higher risk of developing psychotic symptoms.

Surgical Resection and Reconstruction of Ameloblastoma: A 13-Year Retrospective Review

Ameloblastoma is a locally aggressive, benign tumor presenting in the maxilla and mandible prone to recurrence. Resection greatly limits recurrence; however, reconstruction becomes critical to preserve patients' functionality and esthetics. The aim of this study was to describe surgical resection and reconstructive approaches in the treatment of ameloblastoma and compare clinical outcomes to conservative methods of treatment. A retrospective case series was completed through analysis of patient records. The study population was composed of patients treated for ameloblastoma at the Royal Brisbane Hospital (Queensland, Australia) in the Oral and Maxillofacial Surgery Unit from January 1, 2008, to December 31, 2020. Patients without histological confirmation of intraosseous ameloblastoma were excluded from the study sample. Not applicable. The primary outcome variable was time to recurrence. Secondary outcome variables included any surgical complications incurred. The covariate variables collected included age at diagnosis/treatment, gender, ethnicity, location of lesion and site(s) of involvement, tumor extent, alveolar expansion, histopathological growth pattern, and soft tissue involvement. Descriptive statistics were computed for each study variable. A total of 48 cases of histologically confirmed ameloblastoma were identified (41 mandibular, 7 maxillary) involving 50 excisional operations (44 resections, 6 enucleations). Of these cases, 44 were followed up>12months, with a mean length of follow-up time of 65.6months. No recurrence was detected for resected lesions. One enucleated lesion recurred at 25months. Thirty-seven reconstructive procedures were undertaken, including 32 immediate free flaps. All reconstructive flaps and grafts survived, and no major complications were recorded. Resection of ameloblastoma limits recurrence and should be considered curative. Immediate microvascular free flap reconstruction of maxillary and mandibular defects from resection of ameloblastoma is safe and predictable.

Incidence and outcomes of in-hospital nutritional decline: A prospective observational cohort study in adult patients

Background and AimsHospital malnutrition is associated with higher healthcare costs and worse outcomes. Only a few prospective studies have evaluated trends in nutritional status during an acute stay, but these studies were limited by the short timeframe between nutrition assessments. The aim of this study was to investigate changes in nutritional status, incidence of hospital-acquired malnutrition (HAM), and the associated risk factors and outcomes in acute adult patients admitted for >14 days. MethodsA prospective observational cohort study was conducted in two medical and two surgical wards in a tertiary hospital in Brisbane, Australia. Nutrition assessments were performed using the Subjective Global Assessment at baseline (day eight) and weekly until discharge. Nutritional decline was defined as a change from well-nourished to moderate/severe malnutrition (HAM) or from moderate to severe malnutrition (further decline) >14 days after admission. ResultsOne hundred and thirty patients were included in this study (58.5% male; median age 67.0 years (IQR 24.4), median length of stay 23.5 days (IQR 14)). At baseline, 70.8% (92/130) of patients were well-nourished. Nutritional decline occurred in 23.8% (31/130), with 28.3% (26/92) experiencing HAM. Of the patients with moderate malnutrition on admission (n = 30), 16% (5/30) continued to decline to severe malnutrition. Improvement in nutritional status from moderate and severe malnutrition to well-nourished was 18.4% (7/38). Not being prescribed the correct nutrition care plan within the first week of admission was an independent predictor of in-hospital nutritional decline or remaining malnourished (OR 2.3 (95% CI 1.0–5.1), p = 0.039). In-hospital nutritional decline was significantly associated with other hospital-acquired complications (OR 3.07 (95% CI 1.1–8.9), p = 0.04) and longer length of stay (HR 0.63 (95% CI 0.4–0.9), p=0.044). ConclusionThis study found a high rate of nutritional decline in acute patients, highlighting the importance of repeated nutrition screening and assessments during hospital admission and proactive interdisciplinary nutrition care to treat or prevent further nutritional decline.

Gastric dilatation and volvulus in a 10‐week‐old Pembroke Welsh Corgi with renal dysplasia

AbstractA 10‐week‐old Pembroke Welsh Corgi was presented for unproductive retching and abdominal distension to a referral hospital in Brisbane, Australia. The puppy had a history of polydipsia and was reported to have been drinking excessively prior to presentation. A 360° gastric dilatation and volvulus (GDV) was diagnosed radiographically. The puppy underwent surgery for gastric derotation and incisional gastropexy. Follow‐up testing was consistent with congenital renal dysplasia. To the author's knowledge, there are no previous case reports of a GDV in a medium‐breed puppy. Overindulgence of water has not previously been identified as a risk factor for GDV in the literature.

Celebrating Australian native foods through hospital foodservices: Engaging patients, staff and the broader community

Objective: The modern Australian diet is largely characterised by too few fruits and vegetables and too many discretionary foods. This is very different to how Indigenous Australians ate prior to colonisation. Native plants and seeds like bush tomatoes, warrigal greens, Kakadu plum and wattleseed are not common features of the contemporary Australian diet. We developed an initiative to incorporate native plants and seeds into a hospital inpatient menu to normalise their use and provide nutrition education to patients, staff and the community of the nutrition and sustainability benefits of native ingredients. Design: Between May and August 2022, the Chef’s Special menu (for privately funded patients) featured Australian native ingredients in all dishes. The nutritional benefits of native foods were communicated to patients through a printed brochure delivered with the menu, to foodservices staff through in-service training, and to the broader community through social media. Setting: Urban hospital in Brisbane, Australia. Method: Data were collected on acceptability, engagement and reach of the education initiative. Results: The initiative was successfully delivered, with more than 8,000 patient brochures distributed, 45 staff attending training, and social media reaching approximately 10,000 people. The most frequently ordered main meal on the menu was grilled snapper (fish) with macadamia Asian herb salad and finger lime. Conclusion: The work highlighted how the patient menu in hospital can serve as a useful tool to communicate nutrition education to patients, staff and the broader community. In addition, we reflect on the many opportunities to continue to celebrate the nutritional benefits of Australian native foods in healthcare settings.

A cost-effectiveness evaluation of a dietitian-delivered telephone coaching program during pregnancy for preventing gestational diabetes mellitus

BackgroundThis study aimed to evaluate the cost-effectiveness of a telehealth coaching intervention to prevent gestational diabetes mellitus (GDM) and to calculate the breakeven point of preventing GDM.MethodsData to inform the economic evaluation model was sourced directly from the large quaternary hospital in Brisbane, where the Living Well during Pregnancy (LWdP) program was implemented, and further supplemented with literature-based estimates where data had not been directly collected in the trial. A cost-effectiveness model was developed using a decision tree framework to estimate the potential for cost savings and quality of life improvement. A total of 1,315 pregnant women (49% with a BMI 25-29.9, and 51% with a BMI ≥ 30) were included in the analyses.ResultsThe costs of providing routine care and routine care plus LWdP coaching intervention to pregnant women were calculated to be AUD 20,933 and AUD 20,828, respectively. The effectiveness of the LWdP coaching program (0.894 utility) was slightly higher compared to routine care (0.893). Therefore, the value of the incremental cost-effectiveness ratio (ICER) was negative, and it indicates that the LWdP coaching program is a dominant strategy to prevent GDM in pregnant women. We also performed a probabilistic sensitivity analysis using Monte Carlo simulation through 1,000 simulations. The ICE scatter plot showed that the LWdP coaching intervention was dominant over routine care in 93.60% of the trials using a willingness to pay threshold of AUD 50,000.ConclusionFindings support consideration by healthcare policy and decision makers of telehealth and broad-reach delivery of structured lifestyle interventions during pregnancy to lower short-term costs associated with GDM to the health system.