Search

Background and Aim: Obtaining duodenal mucosal biopsy samples during gastroduodenoscopy has long been the gold standard in celiac disease (CeD) diagnosis. However, this paradigm was challenged in 2012 by the release of the European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) non-biopsy criteria. Under the 2020 ESPGHAN guidelines, pediatric patients satisfying the serological criteria may receive a diagnosis of CeD without duodenal biopsy samples and subsequent histological confirmation being obtained. We aimed todetermine the frequency of incidental abnormalities missed by omitting biopsies, in accordance with the 2020 ESPGHAN non-biopsy criteria, in an Australian pediatric population. Method(s): We performed a retrospective case notes review of all patients who had undergone investigation for CeD with subsequent histological diagnosis from 2013 to 2018 at a large tertiary center in Melbourne. Eligible patients were selected on meeting our selection criteria of age < 18 years, anti-tissue transglutaminase IgA > 10 x upper limit of normal (ULN), and deamidated gliadin peptide (DGP) IgA or IgG > 10 x ULN. Our center's pathology database and electronic medical records were consulted to derive the final subset of pediatric patients included in our study. Histopathological reports of all biopsy samples obtained from eligible patients were reviewed, and any incidental abnormalities identified by consultant pathologists were noted. Incidental abnormalities identified were reviewed for clinical significance, which we defined as those potentially requiring further treatment or follow-up. Result(s): During the study period, 252 children were diagnosed with CeD; however, only 44 (17.5%) (25 female, 19 male; median ages, 6 and 7 years, respectively) satisfied our inclusion criteria for non-biopsy diagnosis. A total of 369 biopsy samples were obtained: 260 duodenal (median, 6), 82 gastric (median, 2), and 27 esophageal (median, 2). All patients ha

Background and Aim: Hepatitis C virus (HCV) is now a highly treatable condition. HCV is overrepresented in people with serious mental illness, largely as a consequence of substance misuse. People with serious mental illness are marginalized in terms of access to care. Strengthened community engagement to optimize population HCV management could feasibly reduce overall HCV seroprevalence, while likely reducing disease incidence. As such, we aimed to investigate the prevalence of HCVin a tertiary mental health service and, hence, identify barriers to care and opportunities to optimize community-based HCV management. Method(s): We retrospectively analyzed 4492 people admitted to a multisite mental health service between January 2017 and December 2018. We appraised patterns and rates of HCV screening using medical records, electronic pathology, and ICD-10 coding. Referral pathways were analyzed for people with serious mental illness and potentially treatable HCV. Intensified access to HCV care was prospectively provided to eligible, untreated people within community mental health services. Result(s): HCV seroprevalence was 6.2%, based on pooled serology together with HCV ICD-10 coding. In a sensitivity analysis, 19.1% (35/ 183) of those with identified HCV risk factors remained unscreened. We identified 209 people who required additional HCV work-up or treatment. Multiple opportunity losses were manifest in the care cascade, particularly through lack of referral to treatment (89, 42.6%) and failure to attend specialist outpatient clinics (52, 25.8%). Given this attrition, we identified 48 community-managed patients who were untreated or incompletely worked up for HCV. Of these, 10 people (20.8%) with longstanding mental health service integration achieved a sustained virological response at 12 weeks through bolstered community support. However, 22 people (45.8%) could not be engaged (Fig. 1). Conclusion(s): HCV screening and treatment should be prioritized in people wit

Background and Aim: Primary sclerosing cholangitis (PSC) is a chronic cholestatic liver disease with limited effective medical therapies and a paucity of epidemiological and outcome-based data in Australia. We aimed to retrospectively evaluate the demographics and outcomes of an Australian cohort of patients with PSC. Method(s): We performed a retrospective cohort study of patients with PSC at six tertiary health services, including two liver transplant units. Patients were identified by a computerized search of radiological reports. Predictors of transplant-free survival (need for liver transplantation or death from any cause) were analyzed. Result(s): We identified 405 patients with PSC, of whom 261 patients (64.4%) were known to a liver transplant unit. The median age at diagnosis was 36.2 years (IQR, 23.4-50.9), and 261 patients (64.4%) were male. The median alkaline phosphatase (ALP) level at diagnosis was 251 U/L (IQR, 156-436). During a median follow-up of 7.0 years (IQR, 3.3-12.0), the median ALP level improved to 143 U/L (IQR, 92-278) (P < 0.01). Most patients (247, 61%) were prescribed ursodeoxycholic acid (UDCA) at a median dose of 1000 mg (IQR, 750-1000). Of those treated with UDCA, 91 (36.8%) achieved a > 50% reduction in baseline ALP level during follow-up. An overlap syndrome was identified in 47 patients (15.2%), and a dominant stricture (DS) developed in 122 (30.1%). A total of 191 patients (47.3%) developed cirrhosis, of whom 87 (45.6%) had a decompensation episode. There were 282 patients (71.6%) with concomitant inflammatory bowel disease (IBD): ulcerative colitis (54%), Crohn's disease (16%), or IBD unspecified (2%). One hundred patients (24.7%) underwent liver transplantation, and 51 (12.6%) died (82.3% liver-related death). Gastrointestinal malignancies included cholangiocarcinoma (CCA) (26, 6.4%), hepatocellular carcinoma (HCC) (12, 3.0%), and colorectal cancer (15, 3.8%). The proportion of transplant-free survival was 88.5% at 5 years, 73.8%

Aim: To evaluate the use of rituximab in NS and assess its efficacy maintaining disease remission. Background(s): Rituximab is a chimeric monoclonal antibody that is effective in treating children with nephrotic syndrome (NS) who demonstrate frequent relapses, resistance, or adverse effects to conventional immunosuppression. Method(s): We conducted a single-centre retrospective audit evaluating patients <18 years with NS, who received rituximab between 2010-2020. Patients who achieved complete remission with glucocorticoids alone or calcineurin inhibitors (CNI) but subsequently relapsed or were medicationdependent were included. We assessed the effect of rituximab in maintainingdisease remission, reducing use of other immunosuppressants and any adverse events. Result(s): All 14 patients were in remission and 13 of 14 were taking at least 1 immunosuppressant when they received rituximab. Of these, 10 were steroid-responsive, and 4 achieved remission with the addition of CNI. Prior to rituximab use, patients had a median of 8.0 relapses (range 5-25), and had received treatment with a median of 2 (range 0-3) alternative immunosuppressants. Median number of rituximab doses was 2.5 (range 1-6) over a median duration of 9 months (range 0-57). Adverse events were reported in 2 patients. Rituximab was effective at maintaining remission in 87% of patients at 3 months (n = 14), 86% at 6 months (n = 13), 75% at 12 months (n = 11) and 78% at 24 months (n = 9). After commencing rituximab, 12 of 13 patients ceased all other immunosuppression, within a median of 6 months (range 0-66). Conclusion(s): Rituximab therapy is associated with a prolonged relapse-free period in children with NS over a 2 year follow-up period. Its use could be considered earlier in the treatment course of NS to improve maintenance of disease remission.

Background: Lupus nephritis (LN) is a poor prognostic marker in children with Systemic Lupus Erythematosus (SLE). Treatment strategies are based on adult guidelines, involving multiple immunosuppressive agents. Aim(s): In children with LN at Monash Children's Hospital (MCH), to review induction treatment and immunosuppressive agents used compared to international guidelines, and to describe patient outcomes. Method(s): Retrospective chart review identified children diagnosed with SLE and LN at MCH from January 2002-June 2020. Demographic and clinical data were collected, including relapses or progression of LN and modalities of treatment. Result(s): Over the study period, 17 children with LN were treated at MCH. Data from 16 patients was available. 68.7% were female, with median age at diagnosis 12.5 years (range 8-17). 15 patients had LN at presentation: all had proteinuria (nephrotic range in 7), 14 had haematuria and no patient had renal impairment. All had systemic features, most commonly rash, fever and arthritis. 15 of 16 patients underwent renal biopsy, with proliferative LN in 66.6%. All patients received oral hydroxychloroquine and glucocorticoids. 81.2% received intravenous methylprednisolone and 75% commenced mycophenolate mofetil at induction. 8 of 15 had at least one further kidney biopsy, with a change in LN class observed in five patients. Three patients had progressive LN- requiring treatment with cyclophosphamide, rituximab and ultimately dialysis (median age 15, median time to dialysis 5 years). Excluding the 3 patients with end stage kidney disease, the median eGFR at last follow-up (median 2.25 years) was 108 mL/min/1.73 m2 (2 patients had an eGFR <90 mL/min/1.73 m2). Conclusion(s): Induction treatment of paediatric patients with LN at MCH aligned with recommendations of current international guidelines. End stage kidney disease developed in 18.7% of patients.

Background and Aim: Despite many years since the registry trial of infliximab in Crohn's disease, the strategy of top-down treatment remains controversial for both adults and children. We aimed to compare clinical outcomes and costs for a retrospective pediatric Crohn's disease (pCD) cohort treated with early-use infliximab (EUI) within 12 months, compared with later-use infliximab (LUI). Method(s): We undertook a retrospective review of all children with pCD who commenced infliximab in a tertiary Australian pediatric center. Result(s): We identified pCD progressing to infliximab in 70 children: 38 (54%) in the EUI cohort and 32 (46%) in the LUI cohort. Intestinal surgery had a lower risk of occurring in the EUI group compared with the LUI group (2 [5%] vs 9 [28%]; hazard ratio, 5.67; 95% confidence interval, 1.21-26.38; P = 0.027). No patients in the EUI group underwent intestinal surgery after infliximab commencement, compared with three (9%) in the LUI group (P = 0.09). Escalation of infliximab in luminal Crohn's disease was not significantly different in the EUI group compared with the LUI group (3 [10.3%] vs 9 [39.1%]; P = 0.1). EUI was more frequently used than LUI in 2015-2018 (27 [71%] vs 14 [44%]; P = 0.029), with the inverse occurring in 2010-2014 (11 [29%] vs 18 [56%]). Hospital admissions per person per year in the EUI and LUI groups were 43 (0.23 visits/person/year) and 84 (0.67 visits/person/year), respectively (incidence rate ratio, 2.51; 95% confidence interval, 0.9- 7.01; P = 0.078). Health costs were not significantly different between the cohorts. Conclusion(s): EUI in pCD is associated with an increased likelihood of being diagnosed in more recent years, less intestinal surgery, and a trend towards decreased hospital admissions, compared with LUI.

Introduction & Objectives: Urosepsis from ureteric obstruction is potentially life-threatening condition often requiring admission to intensive care unit (ICU). Gold standard care is emergency decompression with retrograde stenting or nephrostomy. Currently there is no universally accepted predictive tool to predict severity of urosepsis on admission. Our primary aim is to identify clinical factors that predict ICU admission post retrograde stenting. Our research goal is to ultimately develop a reproducible predictive algorithm for urosepsis severity. Material(s) and Method(s): A retrospective cohort study was performed in our institution from 2009 to 2019 of all patients who underwent emergency stent insertion. Data on patient demographics and medical history were extracted, specifically age, gender, weight, body mass index (BMI), diabetes mellitus, stroke, chronic respiratory disease, congestive cardiac failure, ischaemic heart disease, obstructive sleep apnoea, malignancy, immunosuppressive drugs and American Society of Anaesthesiologists (ASA) score. Systemic inflammatory response syndrome data including admission vital signs as well as serum haemoglobin, white cell count (WCC), neutrophils, creatinine, C-reactive protein and time to operation was also collected. Univariate and adjusted multivariate analysis was performed. The primary end point was ICU admission. Result(s): Overall 327 patients received emergency ureteric stent insertion. The mean age, and BMI were 61.3 years and 28.3 respectively. Rates of diabetes mellitus, malignancy and immunosuppressant drugs were 25.4%, 17.1%, 5.3% respectively. ASA score 3, 4, 5 were 42.5%, 11.3%, 0.9% respectively. A total of 75 (22.9%) patients were admitted to ICU post stent insertion. Univariate analysis found patients with ASA 4+5 combined were more likely than patients with ASA 1 to need ICU (OR= 4.5, 95% CI 1.31-15.46, p=0.02). Systolic blood pressure (95% CI 0.95-0.97, p=<0.001), diastolic blood pressure (95% CI 0

Problem: Currently <1% of Australian women give birth at home. Background(s): In Australia there are very few options for women to access public funded homebirth. Aim(s): We aimed to use geo-mapping to identify the number of women eligible for homebirth in Victoria, based on the criteria of uncomplicated pregnancies and residing within 15-25 kms of suitable maternity services, to plan future maternity care options. Method(s): Retrospective study of births between 2015 and 2017 in Victoria, Australia. All women who were identified as having a low risk pregnancy at the beginning of pregnancy were included. The number of women within 15 and 25 km of a suitable Victorian public maternity hospital and catchment boundaries around each hospital were determined. Finding(s): Between 2015 and 2017, 126,830 low risk women gave birth in Victoria, of whom half live within 25 km of seven Victorian hospitals. Currently, 2% of suitable women who live close to the current public homebirth models accessed them. Discussion(s): We present a method to inform the expansion of maternity service options using Victoria as an example. On the basis of the maximum number of low risk women living close by, we have also identified the Victorian maternity services that would be most suitable for creation of public homebirth or low risk continuity of midwifery models. Conclusion(s): This approach could can be used to plan other maternity care services.Copyright © 2021 Australian College of Midwives

Background: Concurrent chemoradiotherapy (CRT) with cisplatin is a widely accepted treatment strategy for patients with LA HNSCC. However, some patients are deemed Cisplatin ineligible for a variety of reasons and offered alternative sensitising agents. There is a paucity of data regarding outcomes in patients treated with non-cisplatin chemotherapy. Patients and Methods: We retrospectively analysed all consecutive adult LA HNSCC patients from January 2016-Feb 2020 treated with chemoradiotherapy in the definitive or adjuvant settings.We collected data on patient and tumour characteristics, chemotherapy regimen, toxicity as well as clinical outcomes including locoregional control and survival. Result(s): Over the 4-year period, a total of 194 patients received CRT for LA HNSCC. Median age was 61 years (range: 22-82) with a male/female ratio of 6:1. Primary tumour site was the oropharynx in 161 (83%), hypopharynx in 12 (6%), oral cavity in 11 (6%) and larynx in 9 (5%) patients. P16 positive tumours accounted for 146 (75%) of all tumours. Most patients (174, 90%) had definitive treatment as opposed to adjuvant therapy (20, 10%). Cisplatin based chemotherapy was employed in 154 (80%) of all patients, and non-cisplatin-based treatment in 44 (20%). Carboplatin plus paclitaxel was used in 21 (11%) and Cetuximab in 15 (8%) of the entire patient cohort. Carboplatin alone in the adjuvant setting was used in 3 (1%) patients. Final survival and toxicity data will be reported at the conference. Conclusion(s):Non-cisplatin-based chemotherapy was used in20%of our patient cohort with LA HNSCC. It is important to ascertain the safety and efficacy data in these two groups of patients treated with radical CRT.

Background and Aim: Vitamin D has been shown to play a role in inflammation in multiple conditions, including inflammatory bowel disease (IBD). Low vitamin D levels have been shown to be associated with active IBD in retrospective studies. Some evidence of an inverse correlation with disease activity and inflammatory markers exists. The current gold-standard inflammatory marker is fecal calprotectin (FC); however, FC testing is not reimbursed in Australia, and sample collection is not as simple as blood testing. We aimed to assess whether serum vitamin D level is useful as a biomarker in real time. Method(s): Quality assurance ethical approval was obtained from the hospital ethics committee. We collected retrospective data via a chart review of the hospital pathology system and medical records. Patients were initially identified using the pathology database to find those who had FC measured in 2019; then, a subset of patients with IBD with both FC and blood tests within 3 months was selected. Demographic data, IBD type, inflammatory markers, and vitamin D levels were obtained from patient records. The vitamin D levels were compared with levels of FC (with a positive FC level being set at 150 mug/g), C-reactive protein (CRP), albumin, hemoglobin, and platelets. Non-parametric tests were used for comparison. Result(s): We identified 616 patients from the initial cohort with FC tests. There were 328 patient episodes with matched FC and blood tests, including vitamin D, CRP, albumin, hemoglobin, and platelets. This subset comprised 101 patients with Crohn's disease (CD) with 198 time points of matched data and 68 patients with ulcerative colitis (UC) with 116 time points of matched data. There were 14 IBD-unspecified episodes. Of the patients with CD, 46% were male, and of the patients with UC, 43% were male. Median disease duration was 8 years (interquartile range, 4-13.5 years) for those with CD and 5.5 years (interquartile range, 3-12.5 years) for those with UC. Over

Purpose: Multiple life-prolonging systemic therapies are now approved for patients with metastatic castrate resistant prostate cancer (mCRPC). However, the optimal treatment strategy following progression through standard treatment lines, including docetaxel, novel anti-androgens abiraterone or enzalutamide and cabazitaxel, remains unclear.We aimed to describe treatment patterns in men with mCRPC following progression on cabazitaxel. Patients andMethods: Patients with mCRPC, who had received treatment with cabazitaxel were identified from the ePAD database (a multicentre mCRPC registry). Clinicopathologic information, treatment and outcome data were extracted. Descriptive statistics were used to report prior and subsequent systemic therapies. T-tests and chi square analyses compared characteristics between those who did and did not receive further therapies. Result(s): Search of the ePAD database identified 106 eligible patients. The median age at commencement of cabazitaxel was 70.8 years. Cabazitaxel was most frequently given as third line treatment (n = 56, 53%). Seventy-nine patients (75%) had previously received both docetaxel and a novel anti-androgen. The median duration of cabazitaxel treatment was 4.1 months, with most patients stopping due to disease progression (n = 61, 58%) or toxicity (n = 14, 13%). Following cabazitaxel, 47 patients (44%) received further systemic therapy. Eighteen patients received a novel anti-androgen, 11 entered a clinical trial and 10 received carboplatin. Other agents included docetaxel (n = 8), cyclophosphamide (n = 6) and mitoxantone (n = 5). Patients who received further systemic therapy were more likely to have better ECOG performance status (P = .0013) but had no difference in median age or comorbidities compared to those who received no further systemic therapy. There was no significant difference in the duration on subsequent systemic therapy. Conclusion(s): This retrospective analysis demonstrates the wide variety of pres

Introduction: Adenotonsillectomy (tonsillectomy and/or adenoidectomy) is the first line treatment for paediatric obstructive sleep apnoea and one of the most common paediatric surgeries. No Australian studies have described the epidemiology of adenotonsillectomy. We aimed to describe the contemporary epidemiology of paediatric adenotonsillectomy in an Australian setting, examine the incidence and surgical indications over 2010-2015, and investigate factors associated with inter-hospital transfer. Method(s): We performed a retrospective population-based study using data from the Victorian Admitted Episodes Dataset. We included all patients aged 0-19 years who underwent tonsillectomy and/or adenoidectomy in Victoria, Australia over 2010-2015. Result(s): Between 2010 and 2015, 59,008 patients underwent 61,281 surgeries, with the highest number performed in males (52.7%), children aged under 10 years (73.5%) and in the higher socioeconomic groups (24.6% in quintile 4, 23.2% in quintile 5). Seventy-five cases (0.12%) resulted in inter-hospital transfer, which was significantly associated with the 0-4 and 5-9 age groups (p < 0.001). Frequency of surgery by hospital was not associated with risk of inter-hospital transfer. The incidence rate of adenotonsillectomy increased over 2010-2015 (p < 0.001), driven by a significant increase in surgery for obstructive symptoms (p < 0.001). Only in 2014/2015 did obstruction surpass infection as an indication. Discussion(s): Adenotonsillectomy rates are rising, with a high proportion being performed in socioeconomically advantaged patients. This raises concerns regarding healthcare access, given low socioeconomic status is a risk factor for obstructive sleep-disordered breathing and sore throat. Obstruction has become the primary reason for adenotonsillectomy, but compared to data from the United States, this shift is delayed by a decade.

Introduction/Aim. To estimate the burden of oral corticosteroid (OCS) use for asthma in Australia, referenced to potentially toxic cumulative thresholds (>=1000 mg prednisolone-equivalent). Methods. This retrospective cohort study used a 10% random sample of the Australian Pharmaceutical Benefits Scheme to identify asthma patients aged >=12 years based on inhaled controller medication dispensing. The primary outcome was cumulative OCS dispensing for asthma over five years. The association between overall dispensing of OCS, with that of diabetes and osteoporosis medication, was examined. The secondary outcome was >=1000 mg prednisolone-equivalent dose dispensing over 12 months, stratified by inhaled controller therapy dose and usage. Results. The national OCS burden can be estimated by multiplying study results by ten. Over five years, 34,580 individuals (27.9%) of the study asthma population were dispensed cumulative prednisoloneequivalent doses of >=1000 mg, and a further 29,532 (23.8%) dispensed doses <1000 mg. Patients on any inhaler accounted for 49.3% of all cumulative dispensing >=1000 mg in the 10% PBS sample. Overall, patients dispensed >=1000 mg prednisolone-equivalent also had higher dispensing rates of diabetes and osteoporosis medication. Over 12 months, 4,633 patients with asthma on high-dose controllers were dispensed >=1000 mg prednisolone-equivalent, more than half of whom had inadequate (<50%) controller therapy usage. Conclusion. Cumulative exposure to OCS in Australia reaches levels associated with toxicity in a quarter of asthma patients on inhaled controller therapy. Potentially toxic OCS use often occurs in patients taking insufficient inhaled controller medication. Better approaches are needed to improve asthma outcomes whilst minimising OCS burden and toxicity.

Background: Patterns in oncology phase I clinical trials have changed significantly in recent years due to new classes of therapies, more combination treatments and changing patient demographics. We performed a retrospective review at our institution to examine patient and trial characteristics, screening outcomes and treatment outcomes. Method(s): We analysed all consecutive adult patients with advanced solid organ malignancies who were screened across phase I trials from January 2013 to December 2018 at a single institution. Result(s): During this period, 242 patients were assessed for 28 different trials. Median age was 64 years (range 30-89) with an equal sex distribution. Amongst 257 screening visits, the overall screen failure rate was 18%, resulting in 212 patients being enrolled onto a study. Twenty-six trials (93%) involved immunotherapeutic agents or molecular targeted agents either alone or in combination, with only two trials of cytotoxic agents (7%). Twenty-two (13.4%) of the 209 treated patients experienced a total of 33 grade 3 or higher treatment-related adverse events. There was one treatment-related death (0.5%). Of 190 response-evaluable patients, seven (4%) had a complete response, 34 (18%) a partial response, and 59 (31%) experienced stable disease for a disease control rate of 53%. The overall response rate for immuno-oncology (IO) trials was superior to non-IO trials (28% vs. 14%, P = .022). Furthermore, combination trials yielded a superior ORR than single-agent studies (33% vs. 16%; P = .005) The median overall survival for our cohort was 8.0 (95% CI, 6.8-9.2) months. Conclusion(s): The profile of phase I trials at our institution are consistent with the changing early drug development landscape. Response rates and overall survival in our cohort are superior to historically reported rates and comparable to contemporaneous studies. Severe treatmentrelated toxicity was relatively uncommon, and treatment-related mortality was rare.

Background: Laryngomalacia is a common cause of airway obstruction in infants and may cause obstructive sleep apnoea (OSA). Overnight pulse oximetry has been well documented as a testing modality for paediatric OSA (McGill oximetry score, MOS). There have been few publications that have used the MOS in patients with laryngomalacia as an indication for surgical intervention or as a screening tool for sleep disordered breathing in infants. However, there is no literature that examines MOS for these indications. As central sleep apnoea and periodic breathing may also cause oxygen desaturations in infants, we aimed to determine the applicability of the MOS in determining the presence of OSA in children < 2 years with laryngomalacia. Method(s): Children with laryngomalacia undergoing polysomnography (PSG) from January 2014 to May 2019 were identified. Data collected included clinical and demographic information, oximetry and PSG results. Severity of obstruction was classified as obstructive apnoea-hypopnoea index (OAHI) < 1/hr = normal; OAHI 1-5/hr = mild OSA; OAHI > 5-10/hr = moderate OSA; OAHI > 10/hr = severe OSA. Masimo Radical-7 oximeters were used with a 2-4 second averaging time. The oxygen saturation profile from the PSG was given a MOS by two experienced sleep physicians who were blinded to the PSG results. Inconclusive oximetry results (MOS 1) were divided into normal (normal baseline and no clusters of desaturation) or abnormal (either low baseline or any clusters of desaturation). MOS 2, 3 and 4 were classified as abnormal. Sensitivity, specificity, positive predictive value and negative predictive value were calculated for an abnormal MOS in predicting the presence of moderate or severe OSA (OAHI > 5/hr). Progress to date: 36 patients with laryngomalacia were identified through the sleep laboratory database but 18 patients were excluded: No consent (n = 9); not confirmed to have laryngomalacia (n = 8); previous supraglottoplasty (n = 1). 18 eligible children

Background: Obstructive sleep apnoea (OSA) is a common sleep disorder that can present with a variety of clinical symptoms. Continuous positive airways pressure (CPAP) therapy is the treatment of choice in moderate to severe OSA, however long-term adherence to treatment can be challenging. Recent studies have attempted to identify clinical phenotypes which may aid in guiding treatment and thus improve clinical outcomes. This study's aim was to determine the symptom profile at presentation of a cohort of patients with suspected sleep apnoea and how they relate to treatment choice and adherence. Method(s): Retrospective review of new referrals for suspected obstructive sleep apnoea between July 2017 and June 2018 for 2 physicians. Referral letters, physician review letters, polysomnography results and practice management software data were reviewed to establish presenting symptoms, OSA severity, treatment recommendations and CPAP adherence. We attempted to group patients into the clusters as defined by Keenan et al (Sleep 2018), however patients were not clearly demarcated into the published groups. Adequate CPAP adherence was defined as an average of >=4 hr per night. Progress to date: Data on N = 119 patients were reviewed. Of 119 patients, 15 (12.6%) had no OSA, 27 (22.7%) had mild, 31 (26%) moderate and 46 (38.7%) severe OSA. Mean (+/-SD) age, BMI, ESS and AHI were: 53.8 (+/-14.8) years, 32.9 (+/-8) kg/m2, 8.3 (+/-5.4) and 29.4 (+/-24.3) events/hr respectively. Patients frequently presented with more than one symptom group, with 48 patients reporting one symptom category, 45 with two, 20 with three and 6 with 4 symptom categories. The most common symptom on presentation was loud snoring (n = 65), followed by excessive daytime sleepiness (n = 46) and witnessed apnoeas/gasping (n = 44). Other presenting symptom categories included disturbed sleep, tiredness/fatigue and co-morbid risk factors. CPAP therapy was recommended for 73 patients (61%). 25% of patients prescr

Background/Purpose: Metabolic syndrome (MetS) is a chronic pro-inflammatory and pro-thrombotic state associated with increased atherosclerosis, cardiovascular events and type 2 diabetes. It is diagnosed in the presence of at least 3 of 5 metabolic risk factors (obesity, hypertension, hypertriglyceridemia, low high-density lipoproteins (HDL) and insulin resistance [1]). The pathophysiology of MetS remains incompletely understood, but may share mechanisms with inflammatory states such as SLE. Visceral adiposity is known as a source of pro-inflammatory cytokines by adipocytes, the so-called adipokines. The contribution of glucocorticoids to the development of MetS in SLE is not clear, even though their use is associated with cardiovascular comorbidities [2]. We aim to characterize the prevalence and associations of MetS, including serum levels of adipokines, in a multi-ethnic cohort of patients with SLE. Method(s): Using a standardised protocol, baseline demographics, per visit disease activity (SLEDAI2K) and treatment data, and annual recording of organ damage accrual (SLICC damage index (SDI)) were prospectively captured on SLE patients from a single tertiary centre. The presence of MetS,defined using the updated joint consensus criteria [1], was assessed retrospectively at the last recorded visit. Serum levels of adipokines (resistin, lipocalin-2, TNF, MCP-1) and insulin were measured by Quantibody. Result(s): 116 patients (median (IQR) age at enrolment 39.5 (31.4-51.1) years, median disease duration 6.1 (1.4-12) years) were followed for a median of 6.7 (4.1-8.1) years. 80% of patients were exposed to glucocorticoids (median time-adjusted mean dose 3.7 (0.5-7.0) mg/day and 50% accrued organ damage during follow-up. The prevalence of MetS in this cohort was 29%. The prevalence of the components of MetS included: hypertension (59%), low-HDL (51%), hypertriglyceridemia (32%), obesity (16%) and hyperglycaemia (22%). In univariable analysis, MetS was associated with base

Background and Aim: Sorafenib and lenvatinib are the two oral multikinase inhibitors currently registered in Australia for the treatment of advanced unresectable hepatocellular carcinoma (HCC). We aimed to evaluate the use of these multikinase inhibitors in this setting and to define overall survival, time to progression of disease, and adverse effects associated with therapy. Method(s): We conducted a retrospective cohort study of 71 patients treated with sorafenib (n = 57) and lenvatinib (n = 14) for advanced HCC at a Melbourne tertiary center from 2015 to 2020. Baseline demographic data, tumor characteristics, dosage, adverse effects, and survival from initiation of treatment were collected from medical chart review. Time to radiological and biochemical progression was also recorded. Result(s): In the sorafenib group, 70.18% of patients were classified as Child-Pugh A and 29.82% were classified as Child-Pugh B. A total of 73.68% of patients experienced any adverse effect, and 24.56% of patients experienced a severe grade 3 adverse effect, requiring cessation of therapy. The average number of days to radiological progression was 218.67 (median, 103; range, 21-996), which excluded three outliers who exhibitedspontaneous tumor regression. The average number of days to death from initiation of therapy was 341.86 (median, 196; range, 18-2061). Univariate analysis showed radiological progression was associated with higher Child-Pugh scores (odds ratio [OR], 2.4; P < 0.02), Model for End-Stage Liver Disease scores (OR, 2.96; P < 0.0045), dose reduction of sorafenib (OR, 2.4; P < 0.02), and presence of any adverse effect to therapy (OR, 2.0; P < 0.05). In the lenvatinib group, 50% of treated patients were classified as Child-Pugh B. A total of 85.70% had an adverse event. A subset of 42.85% of patients experienced severe grade 3 adverse effects. The average length of time to radiological progression was 119.14 days (median, 84; range, 24-346), and the average length of t

Background: Anal cancer represented 0.3% of diagnosed cancers globally in 2018,1 with incidence rising in women. Most are squamous cell carcinomas (SCC) and highly associated with human papilloma virus (HPV) infection. Most patients present with localised disease amenable to curative intent chemoradiation. Few patient series with large numbers are reported. Method(s): After ethics approval, a retrospective chart review was performed on adult patients with localised anal SCC treated with definitive chemoradiation atMonash Health between 2009 and 2020. Toxicity was gauged from documentation in medical notes. Result(s): A total of 67 patients were identified; 54 were female and analysed further; 46 having sufficient documentation of toxicity. Median age at diagnosis was 63 years (range: 45-85); median followup was 79 months (1-133). Staging at diagnosis was: T1-2N0: 36%; T3-4N0: 15% and TanyN1 35%. Fourteen patients had documented HPV aetiology, and 13 patients a history of HPV-associated conditions. Median time between diagnosis and treatment commencement was 44 days (14-92). Short-term toxicity included skin reaction (50%), anorectal pain (50%), diarrhoea (39%), nausea/vomiting (30%), mucositis (26%), dysuria (11%) and febrile neutropenia (11%). Severity was grade 3 or 4 in 30%. Long-term toxicities included faecal urgency (19%) and incontinence (15%), diarrhoea (14%), vaginal stenosis (11%) and anorectal pain (8%). PET at 3 and/or 6 months post chemoradiation was utilised in 93% of evaluable patients; 77% had a complete metabolic response (CMR), 20% partial metabolic response and 3% progressive disease. Disease recurrence occurred in 8 patients; only 1 involved distant metastatic disease.Of those with recurrent disease, only 1 patient achieved CMR within 6 months of definitive treatment completion. Conclusion(s): This study provides one of the largest reported series of female patients diagnosed with anal SCC undergoing definitive chemoradiation. Limitations include

Introduction/Aim. Despite the widespread usage of oxygen, inappropriate administration may lead to adverse events. TSANZ guidelines provide guidance on oxygen prescription and administration, specifically identifying patients with COPD as a group at risk of adverse events. The aim of this study was to assess the adherence to TSANZ oxygen prescription and oxygen saturation aims in admitted patients with COPD. Methods. We conducted a retrospective chart review of patients admitted to Monash Health between the 1/1/2018 and 30/6/2018. Patients were identified from a coding search of relevant categories. Records were reviewed for oxygen prescription and administration with regards to TSANZ guidance. Adverse events possibly due to oxygen toxicity were recorded. Results. 557 episodes were reviewed. Mean (+/-SD) age was 74.1 (+/-11.4), 281 (50.4%) were male, 101 (18.1%) used home oxygen and 85 (15.1%) lived in residential care. Most patients were admitted for an exacerbation of airways disease: 180 (32.3%) non-infective and 170 (30.5%) infective. 521 patients presented through the emergency department with only 78 (14.9%) having a correctly documented oxygen prescription. 469 patients required admission to hospital, with only 166 (35.3%) having a documented oxygen prescription which was TSANZ adherent. Complications possibly related to inappropriate oxygen administration occurred in 48 patients (8.6%). Conclusion. Rates of documentation of an appropriate oxygen prescription adherent to guidelines were low both in the emergency department and during ward admission. However complications due to over oxygenation were infrequent. This study supports the implementation of measures to improve clinician prescribing of oxygen.

Objective: Maternal obesity is a major challenge to safe obstetric practice with higher rates of intrapartum complications, failed induction of labour (IOL) and emergency caesarean delivery (CD). We investigated the impact of obesity on labour outcomes and interventions. Study Design: Class III obese (BMI >40 Kg/m2) and normal BMI (<25 Kg/m2) patients who delivered from 2015-2018 were matched (1:1) based on age, gestational age, parity, onset of labour, and birth weight. Patients with previous CD, IOL < 37 weeks, maternal age <18 years or stillbirth were excluded. The primary outcome was CD. Secondary outcomes were instrumental delivery, cervical dilation at decision for CD, dilation rate prior to decision for CD for labour progress, oxytocin augmentation, and intrapartum interventions (epidural analgesia, fetal scalp electrode (FSE), intrauterine pressure catheter (IUPC), fetal scalp lactate, terbutaline use). Result(s): Of 600 matched patients, 50% were primigravidae (PG). Half of both PG and multigravidae groups underwent IOL. CD rate was higher for obese (oBMI) patients (19.3%) than the normal BMI (nBMI) cohort (13.3%, RR 1.45, CI 1.00-2.09, p = 0.049). Instrumental deliveries occurred less in oBMI (16.7%) than with nBMI (24.0%, RR 0.89, CI 0.50-0.96, p = 0.027). Median cervical dilation at CD was lower for oBMI (4 cm) than nBMI (6 cm), even when comparing only CD for poor progress (5 cm vs 7 cm). Rate of dilation prior to CD for poor progress was lower in oBMI (0.04cm/hr) than nBMI (0.16cm/hr). In CD patients, oxytocin was used less often for oBMI (75.8% vs 85.0%, RR 0.89, CI 0.73-1.08, p = 0.253) but with a higher mean total dose (12.3 IU vs 11.9 IU). Rates of intrapartum intervention were higher for oBMI, particularly FSE (72.7% vs 22.7%, RR 3.21, CI 2.52-3.99, p < 0.001) and IUPC (55% vs 0%, p < 0.001). Conclusion(s): Obesity increased the risk of CD, and CD for poor progress occurred at a lower cervical dilation in the obese cohort, with a slower rate of di

Introduction &objectives: Some forms of epidermolysis bullosa (EB), notably severe generalized recessive dystrophic EB (RDEB-SG), are associated with an increased risk of developing mucocutaneous squamous cell carcinomas (SCCs) which behave aggressively and are the major cause of mortality in early to midadulthood. We report our centres' experience of EB-associated SCCs over the last 28 years. Materials &methods: An observational, retrospective, double institution case record review of EB patients diagnosed with SCC between July 1991-June 2019. Result(s): Forty-four EB patients with SCC were identified with a total of 221 primary SCCs. They comprised: 31 (70%) with RDEB-SG, 1 (2.3%) with RDEB-pruriginosa, 1 with RDEBinversa (2.3%), 2 (4.5%) with RDEB-generalised intermediate, 3 (6.8%) with junctional EB generalised intermediate (JEB-GI), 5 (11.4%) with dominant dystrophic EB, and 1 (2.3%) with Kindler syndrome. Diagnosis of first SCC was earlier in the RDEB-SG group (median 29.5 years (range 13-52 years)) compared to other groups collectively (median 47.1 years (range 30-89 years)). Most SCCs occurred in the RDEB-SG group, and the majority had multiple tumours (mean 5.8 (range 1-44)). SCC-associated mortality was high in this group (64.5%), with a median survival after diagnosis of first SCC of 2.4 years (range 0.5-12.6 years). Most SCCs were well-differentiated (53.4%) and located on the extremities. Wide local excision was undertaken for the majority of tumours (86.4%). Metastatic disease occurred in 16 of 31 (51.6%) RDEB-SG patients and 1 with JEB-GI. Treatments for metastatic disease included lymph node dissection (n = 6), radiotherapy (n= 5), chemotherapy (n=3), electrochemotherapy (n= 2), and targeted cancer therapies erlotinib (n=1), cetuximab (n =2) and cemiplimab (n= 1). Treatments were generally welltolerated, however were limited in response with the exception of cemiplimab. Conclusion(s): EB-associated SCCs differ from those in the general population: th

Background: 68Gallium-labelled prostate-specific membrane antigen positron emission tomography (68Ga-PSMA-11 PET) is a valuable staging tool, but its utility in characterising primary prostate cancer remains unclear. The maximum standardised uptake value (SUVmax) is a quantification measure of highest radiotracer uptake within PET-avid lesions. Objective(s): To assess the utility of SUVmax in detecting clinically significant prostate cancer (csPCa) on biopsy alone and in combination with multiparametric magnetic resonance imaging (mpMRI). Design, setting, and participants: This was a retrospective analysis of 200 men who underwent 68Ga-PSMA-11 PET/CT, mpMRI, and transperineal template prostate biopsy between 2016 and 2018. Outcome measurements and statistical analysis: The primary and secondary outcomes were detection of grade group (GG) 3-5 and GG 2-5 prostate cancer, respectively. We used the Mann-Whitney U test to compare SUVmax by GG, and calculated sensitivity and specificity for csPCa detection via 68Ga-PSMA-11 PET/CT, mpMRI, and both. Multivariable logistic regression analyses were used to identify predictors of csPCa on biopsy. Results and limitations: The median SUVmax was greater for GG 3-5 tumours (6.40, interquartile range [IQR] 4.47-11.0) than for benign and GG 1-2 tumours (3.14, IQR 2.55-3.91; p < 0.001). The median SUVmax was greater for GG 3 (5.70, IQR 3.68-8.67) than for GG 2 (3.47, IQR 2.70-4.74; p < 0.001). For GG 3-5 disease, sensitivity was 86.5%, 95.9%, and 98.6%, and the negative predictive value (NPV) was 88.4%, 88.5%, and 93.3% using SUVmax >=4, a Prostate Imaging-Reporting and Data System (PI-RADS) score of 3-5, and both, respectively. This combined model detected more GG 3-5 disease than mpMRI alone (98.6% vs 95.9%; p = 0.04). SUVmax was an independent predictor of csPCa for GG 3-5 disease only (odds ratio 1.27 per unit, 95% confidence interval 1.13-1.45). Our results are limited by the retrospective study design. Conclusion(s): Greater SU

Misuse of prescription opioids is a significant public health issue in Australia. There has been a rapid rise in prescription opioid use over the past 20 years, with an associated increase in overdose and death.1 In the United States (USA), hospital emergency departments (ED) have been recognised as a significant source of opioid prescriptions, often provided for inappropriate indications on discharge from hospital.2 There is anecdotal concern that a similar prescribing practice may exist in Australian EDs, which could be contributing to a growing national opioid crisis. There is however limited Australian literature studying opioid prescribing in local EDs. Aim(s): Our study primarily aimed to quantify the volume of opioids prescribed on discharge from an Australian ED. As a secondary outcome, we aimed to identify any trends in prescribing behaviour. Method(s): We performed an observational, retrospective data analysis of all oral schedule 8 opioid prescriptions provided on discharge from a single-centre metropolitan ED. Data was collected for a three-year period from MerlinMapVR electronic prescribing software. Result(s): During the 2017 calendar year, 5.6% of patients presenting to the ED were discharged back into the community with a prescription for an opioid. Oxycodone immediate-release (IR) 5mg was the most frequently ordered, however there were also 303 prescriptions (8.1%) for slow-release (SR) opioids. 77.7% of opioid prescriptions allowed for a maximum quantity of tablets. The annual volume of discharge opioid prescriptions has increased over a three-year period, reaching 3, 758 prescriptions in 2017 A concerningly large number of opioids were prescribed on discharge from the ED. Oxycodone has an important role in the management of severe acute pain, however this high prevalence suggests an inappropriate overuse of this medication, especially in SR formulation. The high quantities of tablets provided per prescription may also put patients at risk of harm

Introduction: AK104 is a recombinant humanized IgG1 bispecific antibody that simultaneously binds to programmed cell death-1 (PD-1) and cytotoxic T-lymphocyte-associated antigen-4 (CTLA-4). Large cell neuroendocrine carcinoma (LCNEC) is a rare and aggressive tumor that accounts for about 3% of lung cancers. Currently, there are limited systemic therapy options for advanced or metastatic LCNEC; and immunotherapy is not standard, with a recent retrospective study reporting that only 37 out of 661 eligible patients had received it [1]. To date, the largest prospective study of LCNEC treated with immune checkpoint inhibitors after failure of first-line chemotherapy demonstrated an overall response rate (ORR) of 33%, with a complete response (CR) rate of 11 % and median progression-free survival (PFS) of 4.2months [2]. Here we report a CR to AK104 in a patient with metastatic LCNEC of the lung. Method(s): The patient was a 64-year-old, non-smoker, male subject enrolled in a dose escalation cohort of Study AK104-101 (NCT03261011) - a first-in-human, Phase 1a/1b, open-label, single-arm dose-escalation and dose-expansion study of AK104 to evaluate the safety, tolerability, PK, immunogenicity, pharmacodynamic and antitumor activity in adult subjects with advanced solid tumors that are refractory/relapsed to standard therapies, or for which no effective standard therapy is available. A 3+3+3 dose escalation design was used. The patient presented with large axillary lymphadenopathy and chest wall disease. He then underwent a left-sided mastectomy and left axillary node dissection. Further imaging demonstrated bilateral lung lesions. Histopathology from the axillary lymph node confirmed a metastatic, high grade LCNEC (Ki67 proliferation index = 50%). No malignancy was found in the mastectomy specimen. He had no treatment for the LCNEC prior to receiving AK104. At study entry, he was assessed to have Stage IV disease and a Performance Status of ECOG 0. The patient received 6mg/k

Background and Aims: Limited evidence exists on clinical management and longer-term survival after aneurysmal subarachnoid hemorrhage (aSAH) including sex differences. We aimed to determine sex differences in the association of optimal evidence-based care with survival. Method(s): We established a retrospective cohort (2010-2016) of all consecutive aSAH cases admitted to two comprehensive cerebrovascular centers in Australia. Survival at one year was obtained by linking cases with the National Death Index. We documented 4 indicators of evidence-based aSAH processes of care: (1) imaging (CTwith CTA/DSA), (2) nimodipine, (3) aneurysm treatment (coiling/clipping) and, (4) antihypertensives in subset with systolic blood pressure (SBP) >=150mmHg and, we calculated 'optimal care' (e.g. received all eligible processes of care).We estimated (1) sex differences in processes of care using t-test/chi-square (2) association between processes of care and sex with 1-year mortality using cox-proportional hazard model adjusting for age, severity, co-morbidities and hospital network. Result(s): Among 575 participants (69% women), only 40% of patients received optimal care. There were no sex differences in processes of care. One-year mortality was 28% with no sex difference. Treatment of the aneurysm, receiving nimodipine and antihypertensive and, receiving 'optimal care' was associated with a lesser hazard of death at 12 months with no differences by sex when adjusted for age, comorbidities and hospital network (fig-1). Conclusion(s): Many people with aSAH do not receive evidence-based care, and this lack of optimal care may impact on their survival.

Background and Aim: Immune activation associated with immune checkpoint inhibitors can cause inflammatory side effects known as immune-related adverse events (irAEs), which can include hepatitis and colitis. The rate of immune-mediated hepatitis has previously been shown in registration trials to be as low as 0.7% for pembrolizumab, up to 13% in combination ipilimumab and nivolumab. Interestingly, the incidence in subsequent observational studies has been higher, with rates of up to 7.8% with monotherapy. We aimed to determine the incidence of immune-related hepatitis in a real-world cohort of patients receiving immune checkpoint inhibitors and to assess their subsequent management. Method(s): We performed a retrospective cohort study of patients receiving immune checkpoint inhibitors to determine the incidence, severity, and management of immune checkpoint inhibitor-induced hepatitis. We included any adults who had received at least one dose of either ipilimumab (CTLA-4 inhibitor), nivolumab (PD-1 inhibitor), or pembrolizumab (PD-1 inhibitor) between January 2017 and April 2020. Pharmacy, medical, and pathology records were used to identify patients, and data were obtained pertaining to their demographics, malignancy type, hepatitis complications, and management. We defined immune-mediated hepatitis according to the Common Terminology Criteria for Adverse Events (CTCAE). Result(s): A total of 198 patients met our inclusion criteria. There were 50 patients (25.2%) who experienced immune-mediated hepatitis, with the highest incidence in those receiving combination ipilimumab-nivolumab (43.8%) (Table 1). No patients in our cohort received monotherapy with ipilimumab. None of the patients were investigated with liver biopsy. Therewere four cases of grade 2 hepatitis (2%) and seven cases of grade 3-4 hepatitis (3.5%). Seven patients in total received corticosteroids, of whom two received intravenous administration. There was no use of other immunosuppressant drugs. Conc

Introduction: A low-arousal threshold (ArTH) is one of several key endotypes identified that contribute to the pathogenesis of obstructive sleep apnoea (OSA). As such, it has emerged as a potential 'druggable' target (i.e. sedatives) to help treat OSA. However, in order to identify OSA patients with a low ArTH we need simplified and clinically accessible methods available. Notably, we recently developed a non-invasive, clinical screening tool to identify OSA patients with low ArTH based on three predictive variables obtained from standard polysomnography (PSG): 1) nadir oxygen saturation (SpO2-nadir) > 82.5%; 2) Apnoea-hypopnoea-index (AHI) < 30; and 3) fraction of respiratory events that are hypopnoeas (F-hypopnoea) > 58.3%. A point was given for each variable that exceeded the set threshold and a score of >= 2 correctly predicted low ArTH in 84% of OSA patients. However, a key limitation of this tool is that it was developed using hypopnoea scoring rules from the older Chicago scoring criteria which has since been updated to the current AASM "Recommended" (2012Rec) and "Acceptable" (2012Acc) criteria. While it is known that differing scoring criteria will impact the reported AHI and F-hypopnoea values, we do not know whether these changes will impact the predictive utility of the ArTH score. Therefore, the aim of the study was to examine the impact that the AASM 2012 hypopnoea scoring criteria has on the performance of our tool. Method(s): A single investigator retrospectively analysed the scored PSG data of 101 OSA patients from the original ArTH score development study. Hypopnoea's that did not meet the AASM 2012Rec criteria were removed. A separate analysis then reanalysed the 2012Rec data and further removed hypopnoea's that did not meet the stricter AASM 2012Acc criteria. General linear modelling assessed differences in AHI and F-hypopnoea between scoring criteria. Receiver Operating Characteristic (ROC) curve analysis was used to compare the sensitivity and

Background and Aim: Peroral endoscopic myotomy (POEM) is an emerging minimally invasive technique for the management of achalasia. Previously, treatment options consisted of endoscopic pneumatic dilatation or laparoscopic Heller myotomy with Dor fundoplication (LHM). We aimed to compare differences in length of stay, costs incurred, and clinical outcomes among patients with achalasia who underwent a POEM or LHM in a single tertiary center. Method(s): We performed a retrospective audit of all patients who underwent POEM or LHM for diagnosed achalasia at our center between July 2016 and June 2020. All patients had data on their demographics, length of inpatient admission, cost of inpatient admission, theater costs, theater time, and weighted inlier equivalent separation (WIES) funding recorded. The two-sample Wilcoxon rank-sum (Mann-Whitney) test and Shapiro-Wilk W test were used to compare patient demographics and procedural characteristics between the two groups. Costs were in Australian dollars. Clinical success was defined as no need for further intervention, either endoscopic or surgical. Given the small sample sizes, statisticalsignificance was based on the calculation of exact P values. Statistics were calculated using Stata (StataCorp). Result(s): During the period of July 2016 to June 2020, 18 patients underwent POEM, and 14 patients underwent LHM. The average age of patients overall was 55.1 years (POEM, 63.1 years; LHM, 45 years). There were eight men and 10 women who underwent POEM, and nine women and five men who underwent LHM. The mean follow-up time was 7.97 months (SD, 5.23) for POEM patients and 9.14 months (SD 8.84) for LHM patients. Mean length of stay for POEM was 1.72 days (SD, 1.07), compared with 3.29 days (SD, 1.64) days for LHM (P = 0.0009). The median total cost of admission for LHM was $8363.02 (IQR, $7354.64 to $9803.32), compared with $10 472.12 (IQR, $8950.29 to $14 167.95) for POEM (P = 0.0229). Mean total costs less theater consumables

Dermatological conditions make up a small component of the patients who present to the emergency department (ED). Although skin conditions may cause physical and psychological distress to the patient, most are not emergencies and are routinely managed in the general practice or outpatient setting. We present a retrospective case-note review of the dermatological presentations to the emergency departments within a major multi-site Victorian hospital network in the month of June 2019. Of a total 20209 presentations to the ED, 527 (2.6%) had a dermatology related presenting complaint or diagnosis, of which 131 (24.9%) were attributed to cellulitis or abscess. Only 47 (14.9%) of the 316 presentations excluding cellulitis, abscess, trauma and non-dermatological final diagnoses were admitted, resulting in a discharge rate of 85%, compared with the Victorian state average of 62% for all emergency presentations (1). We discuss the implications of these ED presentations in relation to the services provided by dermatologists, general practitioners, emergency physicians and the cost to the community.

Aims: To review the Victorian increased viral risk donor (IVRD) program 22 months post-implementation. Background(s): IVRDs with at-risk behaviours for blood borne virus infection and negative nucleic acid testing (NAT) have a low absolute risk of window period infection but were historically under-utilised. A new system of allocation of these donors (defined by Public Health Service [PHS] 2013 criteria and open window periods) to pre-consented recipients was developed. Method(s): We retrospectively examined the characteristics of IVRDs (July 31 2018-May 31, 2020). Data for comparison with non-IVRDs was available for the first 7 months. Continuous data was expressed as median (IQR). Result(s): 40% of waitlisted recipients were pre-consented to accept IVRD kidneys. Thirty-two IVRDs (58 kidneys) were utilised, comprising 13.5% of all kidney donors. Only 9% of allocated IVRDs had neither kidney accepted. Injecting drug use (59%) was the commonest at-risk behaviour. NAT was performed 3 (2-4) days post-admission. 9 (28%) IVRDs had positive HCV Ab but negative NAT. 50% of recipients of these 9 IVRDs developed abnormal HCV serology, but no viraemia was detected in any IVRD recipients to date at 1 and 3 months post-transplantation. 3-month eGFR (CKD-EPI) was 65 (53-79) mL/min/1.73 m2. Compared with non-IVRDs, IVRDs were younger (37 (30-44) vs 51 (35-61) years; P < 0.01), with lower kidney donor profile index (KDPI) (26 (17-40) vs 59 (25-78); P < 0.001), and none had a KDPI >80% (0% vs 19%; P < 0.05). Waiting time was significantly shorter for blood group O IVRD vs non-IVRD recipients (26 (18-29) vs 38 (34-42) months; P = 0.001). Conclusion(s): IVRDs appear to offer better quality kidneys and may reduce waiting time with no transmission to date. Increasing the pre-consent rate may improve utilisation and benefit more waitlisted recipients.

Introduction PARP inhibitors (PARPi) have changed the management landscape for patients with epithelial ovarian cancer (EOC). However, as with many targeted therapies, treatment resistance is common. The response to treatment post-PARPi has not been well described in trials. Data is needed to better understand disease course, and guide treatment decisions. The primary aim is to describe the treatment patterns post-PARPi. Secondary aims are to describe patient characteristics who received chemotherapy post-PARPi and DoR to chemotherapy. Methods Retrospective analysis of women with EOC treated with PARPi either in the maintenance or treatment setting and via government-funded or clinical trial access at six gynaecological oncology centres. Between 2007-2019 eligible women were identified via clinics, trial databases and pharmacy dispensing logs. Information regarding clinico-pathological characteristics and treatment outcomes were collated from medical records. Results Eighty-five women with EOC were identified. 90.6% received chemotherapy post-PARPi, with 72.7% receiving platinum- based chemotherapy. Clinicopathological characteristics in table 1. Best responses observed were 5.2% CR, 19.5% PR, 19.5% SD, and 55.8% PD. Median DOR was 7.0 months (range, 0.2 - 20.4 months) in 77 patients receiving chemotherapy post- PARPi. Eight patients did not receive further systemic therapy due to poor performance status. Women who received platinum doublet chemotherapy post-PARPi had a longer mPFS than those receiving platinum single agent or non-platinum chemotherapy (9.1 months vs 3.3 months vs 5.0 months, respectively p=0.0004). Conclusion Most patients received-platinum based chemotherapy post-PARPi with a modest response rate. Potential overlapping mechanisms of resistance to PARPi and platinum require further study to improve patient outcomes.

Background and Aim: Endoscopic retrograde cholangiopancreatography (ERCP) remains the gold standard for drainage in malignant biliary obstruction. However, ERCP is not always successful, due to difficulties with selective biliary cannulation or gastroduodenal obstruction preventing access to the ampulla of Vater. Although percutaneous transhepatic biliary drainage has traditionally been the preferred approach in these circumstances, endoscopic ultrasound-guided biliary drainage (EUS-BD), using a novel lumen-apposing metal stent (LAMS) with an electrocautery-enhanced delivery system, has shown a technical success rate of 95% in overseas studies. This multicenter study aimed to evaluate the efficacy and safety of EUS-BD using LAMS (Hot AXIOS; Boston Scientific) in an Australian cohort. Method(s): Patients in whom a LAMS was used for biliary drainage across 11 tertiary Australian hospitals from October 2016 to June 2020 were retrospectively identified. Patient and procedural data were collected from the electronic medical records of each hospital. The primary outcome measure was technical success, defined as successful EUS-BD. Secondary outcomes included adverse events and 30-day mortality. Result(s): A total of 41 patients (median age, 72 years [range, 45-94]; 22 [54%] male) had attempted EUS-BD across the 11 hospitals. Etiology of biliary obstruction included pancreatic adenocarcinoma (n = 30), ampullary carcinoma (n = 3), cholangiocarcinoma (n = 1), duodenal cancer (n = 1), and metastatic disease (n = 6). Initial ERCP drainage failed due to inability to access the papilla as a result of malignant duodenal obstruction (n = 8), inability to locate the papilla due to tumor infiltration (n = 11), and failed cannulation (n = 22). The median common bile duct (CBD) diameter was 18 mm (IQR, 16-19.5), with access obtained through the duodenum in all but two procedures (95%), in which the stent was inserted through the gastric antrum. Fluoroscopic guidance was used in two-thi

Background: Lupus nephritis (LN) is a poor prognostic marker in children with Systemic Lupus Erythematosus (SLE). Treatment strategies are based on adult guidelines, involving multiple immunosuppressive agents. Aim(s): In children with LN at Monash Children's Hospital (MCH), to review induction treatment and immunosuppressive agents used compared to international guidelines, and to describe patient outcomes. Method(s): Retrospective chart review identified children diagnosed with SLE and LN at MCH from January 2002-June 2020. Demographic and clinical data were collected, including relapses or progression of LN and modalities of treatment. Result(s): Over the study period, 17 children with LN were treated at MCH. Data from 16 patients was available. 68.7% were female, with median age at diagnosis 12.5 years (range 8-17). 15 patients had LN at presentation: all had proteinuria (nephrotic range in 7), 14 had haematuria and no patient had renal impairment. All had systemic features, most commonly rash, fever and arthritis. 15 of 16 patients underwent renal biopsy, with proliferative LN in 66.6%. All patients received oral hydroxychloroquine and glucocorticoids. 81.2% received intravenous methylprednisolone and 75% commenced mycophenolate mofetil at induction. 8 of 15 had at least one further kidney biopsy, with a change in LN class observed in five patients. Three patients had progressive LN- requiring treatment with cyclophosphamide, rituximab and ultimately dialysis (median age 15, median time to dialysis 5 years). Excluding the 3 patients with end stage kidney disease, the median eGFR at last follow-up (median 2.25 years) was 108 mL/min/1.73 m2 (2 patients had an eGFR <90 mL/min/1.73 m2). Conclusion(s): Induction treatment of paediatric patients with LN at MCH aligned with recommendations of current international guidelines. End stage kidney disease developed in 18.7% of patients.

Background and Aim: Primary sclerosing cholangitis (PSC) is a chronic cholestatic liver disease with limited effective medical therapies and a paucity of epidemiological and outcome-based data in Australia. We aimed to retrospectively evaluate the demographics and outcomes of an Australian cohort of patients with PSC. Method(s): We performed a retrospective cohort study of patients with PSC at six tertiary health services, including two liver transplant units. Patients were identified by a computerized search of radiological reports. Predictors of transplant-free survival (need for liver transplantation or death from any cause) were analyzed. Result(s): We identified 405 patients with PSC, of whom 261 patients (64.4%) were known to a liver transplant unit. The median age at diagnosis was 36.2 years (IQR, 23.4-50.9), and 261 patients (64.4%) were male. The median alkaline phosphatase (ALP) level at diagnosis was 251 U/L (IQR, 156-436). During a median follow-up of 7.0 years (IQR, 3.3-12.0), the median ALP level improved to 143 U/L (IQR, 92-278) (P < 0.01). Most patients (247, 61%) were prescribed ursodeoxycholic acid (UDCA) at a median dose of 1000 mg (IQR, 750-1000). Of those treated with UDCA, 91 (36.8%) achieved a > 50% reduction in baseline ALP level during follow-up. An overlap syndrome was identified in 47 patients (15.2%), and a dominant stricture (DS) developed in 122 (30.1%). A total of 191 patients (47.3%) developed cirrhosis, of whom 87 (45.6%) had a decompensation episode. There were 282 patients (71.6%) with concomitant inflammatory bowel disease (IBD): ulcerative colitis (54%), Crohn's disease (16%), or IBD unspecified (2%). One hundred patients (24.7%) underwent liver transplantation, and 51 (12.6%) died (82.3% liver-related death). Gastrointestinal malignancies included cholangiocarcinoma (CCA) (26, 6.4%), hepatocellular carcinoma (HCC) (12, 3.0%), and colorectal cancer (15, 3.8%). The proportion of transplant-free survival was 88.5% at 5 years, 73.8%

Background and Aim: Peroral endoscopic myotomy (POEM) is an emerging minimally invasive technique for the management of achalasia. Previously, treatment options consisted of endoscopic pneumatic dilatation or laparoscopic Heller myotomy with Dor fundoplication (LHM). We aimed to compare differences in length of stay, costs incurred, and clinical outcomes among patients with achalasia who underwent a POEM or LHM in a single tertiary center. Method(s): We performed a retrospective audit of all patients who underwent POEM or LHM for diagnosed achalasia at our center between July 2016 and June 2020. All patients had data on their demographics, length of inpatient admission, cost of inpatient admission, theater costs, theater time, and weighted inlier equivalent separation (WIES) funding recorded. The two-sample Wilcoxon rank-sum (Mann-Whitney) test and Shapiro-Wilk W test were used to compare patient demographics and procedural characteristics between the two groups. Costs were in Australian dollars. Clinical success was defined as no need for further intervention, either endoscopic or surgical. Given the small sample sizes, statisticalsignificance was based on the calculation of exact P values. Statistics were calculated using Stata (StataCorp). Result(s): During the period of July 2016 to June 2020, 18 patients underwent POEM, and 14 patients underwent LHM. The average age of patients overall was 55.1 years (POEM, 63.1 years; LHM, 45 years). There were eight men and 10 women who underwent POEM, and nine women and five men who underwent LHM. The mean follow-up time was 7.97 months (SD, 5.23) for POEM patients and 9.14 months (SD 8.84) for LHM patients. Mean length of stay for POEM was 1.72 days (SD, 1.07), compared with 3.29 days (SD, 1.64) days for LHM (P = 0.0009). The median total cost of admission for LHM was $8363.02 (IQR, $7354.64 to $9803.32), compared with $10 472.12 (IQR, $8950.29 to $14 167.95) for POEM (P = 0.0229). Mean total costs less theater consumables

Problem: Currently <1% of Australian women give birth at home. Background(s): In Australia there are very few options for women to access public funded homebirth. Aim(s): We aimed to use geo-mapping to identify the number of women eligible for homebirth in Victoria, based on the criteria of uncomplicated pregnancies and residing within 15-25 kms of suitable maternity services, to plan future maternity care options. Method(s): Retrospective study of births between 2015 and 2017 in Victoria, Australia. All women who were identified as having a low risk pregnancy at the beginning of pregnancy were included. The number of women within 15 and 25 km of a suitable Victorian public maternity hospital and catchment boundaries around each hospital were determined. Finding(s): Between 2015 and 2017, 126,830 low risk women gave birth in Victoria, of whom half live within 25 km of seven Victorian hospitals. Currently, 2% of suitable women who live close to the current public homebirth models accessed them. Discussion(s): We present a method to inform the expansion of maternity service options using Victoria as an example. On the basis of the maximum number of low risk women living close by, we have also identified the Victorian maternity services that would be most suitable for creation of public homebirth or low risk continuity of midwifery models. Conclusion(s): This approach could can be used to plan other maternity care services.Copyright © 2021 Australian College of Midwives

Aim: To evaluate the use of rituximab in NS and assess its efficacy maintaining disease remission. Background(s): Rituximab is a chimeric monoclonal antibody that is effective in treating children with nephrotic syndrome (NS) who demonstrate frequent relapses, resistance, or adverse effects to conventional immunosuppression. Method(s): We conducted a single-centre retrospective audit evaluating patients <18 years with NS, who received rituximab between 2010-2020. Patients who achieved complete remission with glucocorticoids alone or calcineurin inhibitors (CNI) but subsequently relapsed or were medicationdependent were included. We assessed the effect of rituximab in maintainingdisease remission, reducing use of other immunosuppressants and any adverse events. Result(s): All 14 patients were in remission and 13 of 14 were taking at least 1 immunosuppressant when they received rituximab. Of these, 10 were steroid-responsive, and 4 achieved remission with the addition of CNI. Prior to rituximab use, patients had a median of 8.0 relapses (range 5-25), and had received treatment with a median of 2 (range 0-3) alternative immunosuppressants. Median number of rituximab doses was 2.5 (range 1-6) over a median duration of 9 months (range 0-57). Adverse events were reported in 2 patients. Rituximab was effective at maintaining remission in 87% of patients at 3 months (n = 14), 86% at 6 months (n = 13), 75% at 12 months (n = 11) and 78% at 24 months (n = 9). After commencing rituximab, 12 of 13 patients ceased all other immunosuppression, within a median of 6 months (range 0-66). Conclusion(s): Rituximab therapy is associated with a prolonged relapse-free period in children with NS over a 2 year follow-up period. Its use could be considered earlier in the treatment course of NS to improve maintenance of disease remission.

Background and Aim: Hepatitis C virus (HCV) is now a highly treatable condition. HCV is overrepresented in people with serious mental illness, largely as a consequence of substance misuse. People with serious mental illness are marginalized in terms of access to care. Strengthened community engagement to optimize population HCV management could feasibly reduce overall HCV seroprevalence, while likely reducing disease incidence. As such, we aimed to investigate the prevalence of HCVin a tertiary mental health service and, hence, identify barriers to care and opportunities to optimize community-based HCV management. Method(s): We retrospectively analyzed 4492 people admitted to a multisite mental health service between January 2017 and December 2018. We appraised patterns and rates of HCV screening using medical records, electronic pathology, and ICD-10 coding. Referral pathways were analyzed for people with serious mental illness and potentially treatable HCV. Intensified access to HCV care was prospectively provided to eligible, untreated people within community mental health services. Result(s): HCV seroprevalence was 6.2%, based on pooled serology together with HCV ICD-10 coding. In a sensitivity analysis, 19.1% (35/ 183) of those with identified HCV risk factors remained unscreened. We identified 209 people who required additional HCV work-up or treatment. Multiple opportunity losses were manifest in the care cascade, particularly through lack of referral to treatment (89, 42.6%) and failure to attend specialist outpatient clinics (52, 25.8%). Given this attrition, we identified 48 community-managed patients who were untreated or incompletely worked up for HCV. Of these, 10 people (20.8%) with longstanding mental health service integration achieved a sustained virological response at 12 weeks through bolstered community support. However, 22 people (45.8%) could not be engaged (Fig. 1). Conclusion(s): HCV screening and treatment should be prioritized in people wit

Background and Aim: Obtaining duodenal mucosal biopsy samples during gastroduodenoscopy has long been the gold standard in celiac disease (CeD) diagnosis. However, this paradigm was challenged in 2012 by the release of the European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) non-biopsy criteria. Under the 2020 ESPGHAN guidelines, pediatric patients satisfying the serological criteria may receive a diagnosis of CeD without duodenal biopsy samples and subsequent histological confirmation being obtained. We aimed todetermine the frequency of incidental abnormalities missed by omitting biopsies, in accordance with the 2020 ESPGHAN non-biopsy criteria, in an Australian pediatric population. Method(s): We performed a retrospective case notes review of all patients who had undergone investigation for CeD with subsequent histological diagnosis from 2013 to 2018 at a large tertiary center in Melbourne. Eligible patients were selected on meeting our selection criteria of age < 18 years, anti-tissue transglutaminase IgA > 10 x upper limit of normal (ULN), and deamidated gliadin peptide (DGP) IgA or IgG > 10 x ULN. Our center's pathology database and electronic medical records were consulted to derive the final subset of pediatric patients included in our study. Histopathological reports of all biopsy samples obtained from eligible patients were reviewed, and any incidental abnormalities identified by consultant pathologists were noted. Incidental abnormalities identified were reviewed for clinical significance, which we defined as those potentially requiring further treatment or follow-up. Result(s): During the study period, 252 children were diagnosed with CeD; however, only 44 (17.5%) (25 female, 19 male; median ages, 6 and 7 years, respectively) satisfied our inclusion criteria for non-biopsy diagnosis. A total of 369 biopsy samples were obtained: 260 duodenal (median, 6), 82 gastric (median, 2), and 27 esophageal (median, 2). All patients ha

Background and Aim: Percutaneous cholecystostomy tube (PC) drainage of the gall bladder (GB) has long been the preferred alternative to laparoscopic cholecystectomy in patients who are deemed too high risk or not appropriate for surgical intervention. Although PC has proven effective in resolving acute sepsis, reintervention for tube dysfunction is required in up to 28% of cases. Recently, endoscopic ultrasound (EUS)-guided transluminal drainage using a novel lumen-apposing metal stent (LAMS) with an electrocautery-enhanced delivery system has gained favor as another means of providing GB drainage. A meta-analysis of the overseas literature demonstrated a technical success rate of 95.2% and a procedure mortality rate of 0.02%. This multicenter study aimed to evaluate the efficacy and safety of EUS-guided GB drainage using LAMS (Hot AXIOS; Boston Scientific) in an Australian cohort. Method(s): Patients in whom a LAMS was used for GB drainage across eight tertiary Australian hospitals from October 2016 to June 2020 were retrospectively identified. Patient and procedural data were collected from the electronic medical records of each respective hospital. Primary outcome measures were technical success, defined as successful initial deployment of the LAMS, and clinical success, defined as resolution of symptoms at 72 h after the procedure. Secondary outcomes included adverse events and 30-day mortality. Result(s): A total of 37 patients (median age, 76 years [range, 39-94]; 26 [70%] male) across the eight hospitals had attempted EUS-guided GB drainage. Indications for proceeding to cholecystostomy drainage, as opposed to surgical management, included advanced age and comorbidities (n = 18), incurable malignancy (n = 13), poor functional state (n = 4), and clinically significant portal hypertension (n = 2). Visible GB calculi were seen in 24 patients (65%), with the remaining patients having acalculous cholecystitis, largely due to malignant obstruction. Most patients (9

Background and Aim: Despite many years since the registry trial of infliximab in Crohn's disease, the strategy of top-down treatment remains controversial for both adults and children. We aimed to compare clinical outcomes and costs for a retrospective pediatric Crohn's disease (pCD) cohort treated with early-use infliximab (EUI) within 12 months, compared with later-use infliximab (LUI). Method(s): We undertook a retrospective review of all children with pCD who commenced infliximab in a tertiary Australian pediatric center. Result(s): We identified pCD progressing to infliximab in 70 children: 38 (54%) in the EUI cohort and 32 (46%) in the LUI cohort. Intestinal surgery had a lower risk of occurring in the EUI group compared with the LUI group (2 [5%] vs 9 [28%]; hazard ratio, 5.67; 95% confidence interval, 1.21-26.38; P = 0.027). No patients in the EUI group underwent intestinal surgery after infliximab commencement, compared with three (9%) in the LUI group (P = 0.09). Escalation of infliximab in luminal Crohn's disease was not significantly different in the EUI group compared with the LUI group (3 [10.3%] vs 9 [39.1%]; P = 0.1). EUI was more frequently used than LUI in 2015-2018 (27 [71%] vs 14 [44%]; P = 0.029), with the inverse occurring in 2010-2014 (11 [29%] vs 18 [56%]). Hospital admissions per person per year in the EUI and LUI groups were 43 (0.23 visits/person/year) and 84 (0.67 visits/person/year), respectively (incidence rate ratio, 2.51; 95% confidence interval, 0.9- 7.01; P = 0.078). Health costs were not significantly different between the cohorts. Conclusion(s): EUI in pCD is associated with an increased likelihood of being diagnosed in more recent years, less intestinal surgery, and a trend towards decreased hospital admissions, compared with LUI.

Introduction & Objectives: Urosepsis from ureteric obstruction is potentially life-threatening condition often requiring admission to intensive care unit (ICU). Gold standard care is emergency decompression with retrograde stenting or nephrostomy. Currently there is no universally accepted predictive tool to predict severity of urosepsis on admission. Our primary aim is to identify clinical factors that predict ICU admission post retrograde stenting. Our research goal is to ultimately develop a reproducible predictive algorithm for urosepsis severity. Material(s) and Method(s): A retrospective cohort study was performed in our institution from 2009 to 2019 of all patients who underwent emergency stent insertion. Data on patient demographics and medical history were extracted, specifically age, gender, weight, body mass index (BMI), diabetes mellitus, stroke, chronic respiratory disease, congestive cardiac failure, ischaemic heart disease, obstructive sleep apnoea, malignancy, immunosuppressive drugs and American Society of Anaesthesiologists (ASA) score. Systemic inflammatory response syndrome data including admission vital signs as well as serum haemoglobin, white cell count (WCC), neutrophils, creatinine, C-reactive protein and time to operation was also collected. Univariate and adjusted multivariate analysis was performed. The primary end point was ICU admission. Result(s): Overall 327 patients received emergency ureteric stent insertion. The mean age, and BMI were 61.3 years and 28.3 respectively. Rates of diabetes mellitus, malignancy and immunosuppressant drugs were 25.4%, 17.1%, 5.3% respectively. ASA score 3, 4, 5 were 42.5%, 11.3%, 0.9% respectively. A total of 75 (22.9%) patients were admitted to ICU post stent insertion. Univariate analysis found patients with ASA 4+5 combined were more likely than patients with ASA 1 to need ICU (OR= 4.5, 95% CI 1.31-15.46, p=0.02). Systolic blood pressure (95% CI 0.95-0.97, p=<0.001), diastolic blood pressure (95% CI 0

Background and Aim: Vitamin D has been shown to play a role in inflammation in multiple conditions, including inflammatory bowel disease (IBD). Low vitamin D levels have been shown to be associated with active IBD in retrospective studies. Some evidence of an inverse correlation with disease activity and inflammatory markers exists. The current gold-standard inflammatory marker is fecal calprotectin (FC); however, FC testing is not reimbursed in Australia, and sample collection is not as simple as blood testing. We aimed to assess whether serum vitamin D level is useful as a biomarker in real time. Method(s): Quality assurance ethical approval was obtained from the hospital ethics committee. We collected retrospective data via a chart review of the hospital pathology system and medical records. Patients were initially identified using the pathology database to find those who had FC measured in 2019; then, a subset of patients with IBD with both FC and blood tests within 3 months was selected. Demographic data, IBD type, inflammatory markers, and vitamin D levels were obtained from patient records. The vitamin D levels were compared with levels of FC (with a positive FC level being set at 150 mug/g), C-reactive protein (CRP), albumin, hemoglobin, and platelets. Non-parametric tests were used for comparison. Result(s): We identified 616 patients from the initial cohort with FC tests. There were 328 patient episodes with matched FC and blood tests, including vitamin D, CRP, albumin, hemoglobin, and platelets. This subset comprised 101 patients with Crohn's disease (CD) with 198 time points of matched data and 68 patients with ulcerative colitis (UC) with 116 time points of matched data. There were 14 IBD-unspecified episodes. Of the patients with CD, 46% were male, and of the patients with UC, 43% were male. Median disease duration was 8 years (interquartile range, 4-13.5 years) for those with CD and 5.5 years (interquartile range, 3-12.5 years) for those with UC. Over

Background: 68Gallium-labelled prostate-specific membrane antigen positron emission tomography (68Ga-PSMA-11 PET) is a valuable staging tool, but its utility in characterising primary prostate cancer remains unclear. The maximum standardised uptake value (SUVmax) is a quantification measure of highest radiotracer uptake within PET-avid lesions. Objective(s): To assess the utility of SUVmax in detecting clinically significant prostate cancer (csPCa) on biopsy alone and in combination with multiparametric magnetic resonance imaging (mpMRI). Design, setting, and participants: This was a retrospective analysis of 200 men who underwent 68Ga-PSMA-11 PET/CT, mpMRI, and transperineal template prostate biopsy between 2016 and 2018. Outcome measurements and statistical analysis: The primary and secondary outcomes were detection of grade group (GG) 3-5 and GG 2-5 prostate cancer, respectively. We used the Mann-Whitney U test to compare SUVmax by GG, and calculated sensitivity and specificity for csPCa detection via 68Ga-PSMA-11 PET/CT, mpMRI, and both. Multivariable logistic regression analyses were used to identify predictors of csPCa on biopsy. Results and limitations: The median SUVmax was greater for GG 3-5 tumours (6.40, interquartile range [IQR] 4.47-11.0) than for benign and GG 1-2 tumours (3.14, IQR 2.55-3.91; p < 0.001). The median SUVmax was greater for GG 3 (5.70, IQR 3.68-8.67) than for GG 2 (3.47, IQR 2.70-4.74; p < 0.001). For GG 3-5 disease, sensitivity was 86.5%, 95.9%, and 98.6%, and the negative predictive value (NPV) was 88.4%, 88.5%, and 93.3% using SUVmax >=4, a Prostate Imaging-Reporting and Data System (PI-RADS) score of 3-5, and both, respectively. This combined model detected more GG 3-5 disease than mpMRI alone (98.6% vs 95.9%; p = 0.04). SUVmax was an independent predictor of csPCa for GG 3-5 disease only (odds ratio 1.27 per unit, 95% confidence interval 1.13-1.45). Our results are limited by the retrospective study design. Conclusion(s): Greater SU

Background: Concurrent chemoradiotherapy (CRT) with cisplatin is a widely accepted treatment strategy for patients with LA HNSCC. However, some patients are deemed Cisplatin ineligible for a variety of reasons and offered alternative sensitising agents. There is a paucity of data regarding outcomes in patients treated with non-cisplatin chemotherapy. Patients and Methods: We retrospectively analysed all consecutive adult LA HNSCC patients from January 2016-Feb 2020 treated with chemoradiotherapy in the definitive or adjuvant settings.We collected data on patient and tumour characteristics, chemotherapy regimen, toxicity as well as clinical outcomes including locoregional control and survival. Result(s): Over the 4-year period, a total of 194 patients received CRT for LA HNSCC. Median age was 61 years (range: 22-82) with a male/female ratio of 6:1. Primary tumour site was the oropharynx in 161 (83%), hypopharynx in 12 (6%), oral cavity in 11 (6%) and larynx in 9 (5%) patients. P16 positive tumours accounted for 146 (75%) of all tumours. Most patients (174, 90%) had definitive treatment as opposed to adjuvant therapy (20, 10%). Cisplatin based chemotherapy was employed in 154 (80%) of all patients, and non-cisplatin-based treatment in 44 (20%). Carboplatin plus paclitaxel was used in 21 (11%) and Cetuximab in 15 (8%) of the entire patient cohort. Carboplatin alone in the adjuvant setting was used in 3 (1%) patients. Final survival and toxicity data will be reported at the conference. Conclusion(s):Non-cisplatin-based chemotherapy was used in20%of our patient cohort with LA HNSCC. It is important to ascertain the safety and efficacy data in these two groups of patients treated with radical CRT.

Purpose: Multiple life-prolonging systemic therapies are now approved for patients with metastatic castrate resistant prostate cancer (mCRPC). However, the optimal treatment strategy following progression through standard treatment lines, including docetaxel, novel anti-androgens abiraterone or enzalutamide and cabazitaxel, remains unclear.We aimed to describe treatment patterns in men with mCRPC following progression on cabazitaxel. Patients andMethods: Patients with mCRPC, who had received treatment with cabazitaxel were identified from the ePAD database (a multicentre mCRPC registry). Clinicopathologic information, treatment and outcome data were extracted. Descriptive statistics were used to report prior and subsequent systemic therapies. T-tests and chi square analyses compared characteristics between those who did and did not receive further therapies. Result(s): Search of the ePAD database identified 106 eligible patients. The median age at commencement of cabazitaxel was 70.8 years. Cabazitaxel was most frequently given as third line treatment (n = 56, 53%). Seventy-nine patients (75%) had previously received both docetaxel and a novel anti-androgen. The median duration of cabazitaxel treatment was 4.1 months, with most patients stopping due to disease progression (n = 61, 58%) or toxicity (n = 14, 13%). Following cabazitaxel, 47 patients (44%) received further systemic therapy. Eighteen patients received a novel anti-androgen, 11 entered a clinical trial and 10 received carboplatin. Other agents included docetaxel (n = 8), cyclophosphamide (n = 6) and mitoxantone (n = 5). Patients who received further systemic therapy were more likely to have better ECOG performance status (P = .0013) but had no difference in median age or comorbidities compared to those who received no further systemic therapy. There was no significant difference in the duration on subsequent systemic therapy. Conclusion(s): This retrospective analysis demonstrates the wide variety of pres

Introduction/Aim. To estimate the burden of oral corticosteroid (OCS) use for asthma in Australia, referenced to potentially toxic cumulative thresholds (>=1000 mg prednisolone-equivalent). Methods. This retrospective cohort study used a 10% random sample of the Australian Pharmaceutical Benefits Scheme to identify asthma patients aged >=12 years based on inhaled controller medication dispensing. The primary outcome was cumulative OCS dispensing for asthma over five years. The association between overall dispensing of OCS, with that of diabetes and osteoporosis medication, was examined. The secondary outcome was >=1000 mg prednisolone-equivalent dose dispensing over 12 months, stratified by inhaled controller therapy dose and usage. Results. The national OCS burden can be estimated by multiplying study results by ten. Over five years, 34,580 individuals (27.9%) of the study asthma population were dispensed cumulative prednisoloneequivalent doses of >=1000 mg, and a further 29,532 (23.8%) dispensed doses <1000 mg. Patients on any inhaler accounted for 49.3% of all cumulative dispensing >=1000 mg in the 10% PBS sample. Overall, patients dispensed >=1000 mg prednisolone-equivalent also had higher dispensing rates of diabetes and osteoporosis medication. Over 12 months, 4,633 patients with asthma on high-dose controllers were dispensed >=1000 mg prednisolone-equivalent, more than half of whom had inadequate (<50%) controller therapy usage. Conclusion. Cumulative exposure to OCS in Australia reaches levels associated with toxicity in a quarter of asthma patients on inhaled controller therapy. Potentially toxic OCS use often occurs in patients taking insufficient inhaled controller medication. Better approaches are needed to improve asthma outcomes whilst minimising OCS burden and toxicity.

Background: Laryngomalacia is a common cause of airway obstruction in infants and may cause obstructive sleep apnoea (OSA). Overnight pulse oximetry has been well documented as a testing modality for paediatric OSA (McGill oximetry score, MOS). There have been few publications that have used the MOS in patients with laryngomalacia as an indication for surgical intervention or as a screening tool for sleep disordered breathing in infants. However, there is no literature that examines MOS for these indications. As central sleep apnoea and periodic breathing may also cause oxygen desaturations in infants, we aimed to determine the applicability of the MOS in determining the presence of OSA in children < 2 years with laryngomalacia. Method(s): Children with laryngomalacia undergoing polysomnography (PSG) from January 2014 to May 2019 were identified. Data collected included clinical and demographic information, oximetry and PSG results. Severity of obstruction was classified as obstructive apnoea-hypopnoea index (OAHI) < 1/hr = normal; OAHI 1-5/hr = mild OSA; OAHI > 5-10/hr = moderate OSA; OAHI > 10/hr = severe OSA. Masimo Radical-7 oximeters were used with a 2-4 second averaging time. The oxygen saturation profile from the PSG was given a MOS by two experienced sleep physicians who were blinded to the PSG results. Inconclusive oximetry results (MOS 1) were divided into normal (normal baseline and no clusters of desaturation) or abnormal (either low baseline or any clusters of desaturation). MOS 2, 3 and 4 were classified as abnormal. Sensitivity, specificity, positive predictive value and negative predictive value were calculated for an abnormal MOS in predicting the presence of moderate or severe OSA (OAHI > 5/hr). Progress to date: 36 patients with laryngomalacia were identified through the sleep laboratory database but 18 patients were excluded: No consent (n = 9); not confirmed to have laryngomalacia (n = 8); previous supraglottoplasty (n = 1). 18 eligible children

Introduction: Adenotonsillectomy (tonsillectomy and/or adenoidectomy) is the first line treatment for paediatric obstructive sleep apnoea and one of the most common paediatric surgeries. No Australian studies have described the epidemiology of adenotonsillectomy. We aimed to describe the contemporary epidemiology of paediatric adenotonsillectomy in an Australian setting, examine the incidence and surgical indications over 2010-2015, and investigate factors associated with inter-hospital transfer. Method(s): We performed a retrospective population-based study using data from the Victorian Admitted Episodes Dataset. We included all patients aged 0-19 years who underwent tonsillectomy and/or adenoidectomy in Victoria, Australia over 2010-2015. Result(s): Between 2010 and 2015, 59,008 patients underwent 61,281 surgeries, with the highest number performed in males (52.7%), children aged under 10 years (73.5%) and in the higher socioeconomic groups (24.6% in quintile 4, 23.2% in quintile 5). Seventy-five cases (0.12%) resulted in inter-hospital transfer, which was significantly associated with the 0-4 and 5-9 age groups (p < 0.001). Frequency of surgery by hospital was not associated with risk of inter-hospital transfer. The incidence rate of adenotonsillectomy increased over 2010-2015 (p < 0.001), driven by a significant increase in surgery for obstructive symptoms (p < 0.001). Only in 2014/2015 did obstruction surpass infection as an indication. Discussion(s): Adenotonsillectomy rates are rising, with a high proportion being performed in socioeconomically advantaged patients. This raises concerns regarding healthcare access, given low socioeconomic status is a risk factor for obstructive sleep-disordered breathing and sore throat. Obstruction has become the primary reason for adenotonsillectomy, but compared to data from the United States, this shift is delayed by a decade.