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Background: Rotational thromboelastometry (ROTEM®) is a point‐of‐care test of coagulation. ROTEM®‐defined hypercoagulability has been identified in pregnant women and in non‐pregnant patients with diabetes mellitus. Pregnancy is known to be a hypercoagulable state, but the influence of gestational diabetes mellitus (GDM) on coagulation is unknown. Aim: The aim of this study was to assess the combined effect of pregnancy and GDM on coagulation using ROTEM® and to compare this to healthy pregnant women presenting for elective caesarean delivery. Materials and Methods: Ethics approval was granted for recruitment of women presenting for elective caesarean delivery. Women with pre‐existing conditions affecting coagulation were excluded. Group N included health pregnant women at term and Group G included pregnant women at term with GDM. Data regarding GDM management and glycaemic control were collected. Poor glycaemic control was defined by markers of accelerated fetal growth and elevated fasting or postprandial blood glucose levels. The ROTEM® parameters (extrinsically activated thromboelastometric test (EXTEM) / fibrin polymerisation test (FIBTEM) amplitude at five minutes, coagulation time, maximum clot firmness and clot formation time) were compared between the two groups using Student's t‐test. Results: There were 75 women in Group N and 21 women in Group G. Mean age and median body mass index values were comparable for both groups. There were no statistical differences found between the EXTEM and FIBTEM parameters analysed for the two groups. Conclusions: There was no association between GDM and increased hypercoagulability as demonstrated by ROTEM® parameters in healthy pregnant women presenting for elective caesarean delivery at term. [ABSTRACT FROM AUTHOR]

Various treatments of keratotic skin lesions and early skin cancers are performed in organ transplant recipients (OTRs) at high risk of skin malignancies but the frequency of their use is unknown. We prospectively assessed the frequency of use of cryotherapy, diathermy, and topical therapies and also investigated their associations with background incidence of histologically-confirmed squamous-cell carcinoma (SCC) and basal cell carcinoma (BCC) in a cohort of OTRs in Queensland, Australia. Median follow-up ranged from 1.7 to 3.2 years across organ transplant groups. Among 285 kidney, 125 lung and 203 liver transplant recipients [382 (62%) male, 380 (62%) immunosuppressed > 5 years, 394 (64%) previously diagnosed with skin cancer], 306 (50%) reported treatment of skin lesions with major types of non-excision therapies during follow-up: 278 (45%) cryotherapy or diathermy; 121 (20%) topical treatments. Of these 306, 150 (49%) developed SCC at double the incidence of those who did not receive these treatments, as assessed by incidence rate ratio (IRR) adjusted for age, sex, type of organ transplant, skin color and history of skin cancer at baseline, calculated by multivariable Poisson regression (IRRadj = 2.1, 95% confidence interval (CI) 1.4–3.1). BCC incidence was not associated with these therapies. Skin lesions in OTRs that are treated with cryotherapy, diathermy, or topical treatment warrant judicious selection and careful follow-up. [ABSTRACT FROM AUTHOR]

Background: Rotational thromboelastometry (ROTEM®) is a point‐of‐care coagulation test which has been used to demonstrate hypercoagulability in pregnant populations and obese populations. Aim: The aim of this study was to assess the combined effect of pregnancy and obesity on coagulation using ROTEM® in healthy pregnant women of varying body mass indices (BMIs) presenting for elective caesarean delivery. Materials and Methods: Ethics approval was granted for recruitment of women presenting for elective caesarean delivery. Women with any condition affecting coagulation were excluded. The ROTEM® parameters of extrinsically activated thromboelastometric test / fibrin polymerisation test (EXTEM/FIBTEM) amplitude at five minutes (A5), coagulation time (CT), maximum clot firmness (MCF) and clot formation time (CFT) were compared between three different groups: normal weight, overweight and obese women. Results: One hundred and eighty‐five women presenting for elective caesarean delivery met inclusion criteria and were divided into three groups; normal weight (BMI < 25 kg/m2, n = 86), overweight (BMI 25–29.9 kg/m2, n = 54) and obese (BMI ≥ 30 kg/m2, n = 45). They had a mean (SD) age of 32.7 ± 5.0 years and the median (interquartile range) BMI of 21.9 kg/m2 (20.5–23.0), 27.0 kg/m2 (26.0–28.5), 36.0 kg/m2 (32.2–41.8) for the normal weight, overweight and obese groups respectively. Forty‐one (22.2%) women were nulliparous. Across the three groups for FIBTEM A5 (P = 0.018), FIBTEM MCF (P = 0.032), FIBTEM CFT (P = 0.047) and EXTEM MCF (P = 0.015) there was evidence of increasing coagulability with increasing BMI. However, following Bonferroni correction, this was no longer significant. Conclusions: There is no association between BMI and ROTEM® parameters in pregnant women presenting for elective caesarean delivery at term. [ABSTRACT FROM AUTHOR]

Aim: To determine the rate, type and timing of bacterial endotracheal tube (ETT) colonisation in neonates born <32 weeks gestational age (GA); and if bacterial colonisation is associated with chronic lung disease (CLD), septicaemia, length‐of‐stay or mortality. Methods: All intubated newborns born <32 weeks GA were included. Endotracheal aspirates were routinely obtained three times‐per‐week. Cohort was divided into three colonisation groups: no growth, normal respiratory flora only, significant bacteria. Logistic regression was performed to identify if ETT bacterial colonisation was associated with CLD, septicaemia or mortality. A general linear model was fitted for length‐of‐stay. Results: ETT aspirates were sent from 1054 infants: no growth n = 319, only normal respiratory flora n = 357, and significant bacteria n = 378. ETTs became colonised in 70%, most in the first week of life (82%). Most grew normal respiratory flora (642 infants). In those with significant bacteria, 40% grew Gram‐negative species; Klebsiella in 34%. Staphylococcus aureus grew in 104 patients. Adjusted odds ratios for CLD (43% of cohort) compared with no growth were, for normal respiratory flora, 0.58 (95% confidence interval (CI) 0.34–0.99) and, for significant bacteria, 0.48 (95% CI 0.24–0.93). With no overall association between colonisation group and CLD in the adjusted model P = 0.07. The odds of septicaemia (10% of cohort) were 4.50 (95% CI 1.98–10.23, P < 0.001) times greater for significant bacteria compared with no growth. No significant associated was found with mortality or length‐of‐stay. Conclusions: Bacterial colonisation of ETTs is common. It is associated with more septicaemia. There was no significant association with CLD, longer admission or mortality. [ABSTRACT FROM AUTHOR]

Background: Neutropenic fever is a frequently encountered complication when caring for cancer patients and can lead to intensive care admission, with high mortality rates in those patients who require invasive mechanical ventilation (IMV). Although hospital survival in this population has improved, long‐term outcomes of critically ill neutropenic cancer patients have not been well defined. Aims: To evaluate short‐ and long‐term outcomes of neutropenic cancer patients admitted to intensive care, according to requirement for invasive ventilation. Additionally, we aimed to determine predictors of poor clinical outcomes in this group. Methods: A retrospective cohort study of neutropenic cancer patients admitted to our intensive care unit (ICU) from 2008 to 2016. Results: We included 192 cancer patients of whom 100 (52.1%) required IMV. Overall ICU mortality was 29.7% and 12‐month post‐ICU mortality was 61.5%. Patients requiring IMV had significantly higher short‐ and long‐term mortality (P < 0.001). Multivariate analysis determined three variables to be predictors of mortality at ICU discharge in the whole cohort: IMV (OR 13.52), renal replacement therapy (RRT, OR 2.37) and higher APACHE II scores (OR 1.1 for each unit increase). These variables were identical in the subgroup requiring invasive ventilation, with RRT (OR 2.76) and APACHE II scores (OR 1.1 for each unit increase) predicting short‐term mortality. Conclusion: Neutropenic cancer patients admitted to ICU have lower short‐term mortality than previously reported in cohort studies, however their mortality rises significantly following discharge from ICU. Those patients who require IMV are at significantly increased risk of both short‐ and long‐term mortality. [ABSTRACT FROM AUTHOR]

Introduction: Hyperbaric oxygen therapy (HBOT) is widely used for the treatment of the late effects of radiation therapy. We report a prospective observational cohort study of 51 patients designed to examine the effectiveness of hyperbaric oxygen treatment (HBOT) for xerostomia following radiotherapy.Methods: Objective (saliva volume) and subjective (quality of life scoring and visual analogue scale (VAS) of discomfort) measurements associated with xerostomia were compared prior to commencement of HBOT, after 30 sessions (over 6 weeks) of HBOT at 243 kPa for 90 minutes daily for five days per week and at 6-week review (12 weeks from commencement).Results: One hundred and one courses of treatment in 99 patients were examined. For 53 (53%) courses in 51 patients, data were recorded before and after HBOT and so could be included in the analysis. Thirty-four (34%) of these patients had complete data for all three time points. The unit of study was per treatment course, not per person. There were no major complications to HBOT. There was a statistically significant difference in saliva volume following HBOT (P = 0.016). The mean saliva volume increase was 0.9 mL over a 5-min collection period (95% CI 0.2-1.5). There was also a statistically significant improvement in discomfort after HBOT (P < 0.001) and QOL (P < 0.001). The mean visual analogue scale for discomfort (VAS on a 0-10 scale) score decreased by 1.4 units (95% CI 0.7-2.1), whilst the mean QOL score was 10 points lower after treatment (95% CI 5.9-14.4).Conclusion: Hyperbaric oxygen therapy may be a safe and effective treatment for symptoms of xerostomia after radiation therapy and should be considered when available. [ABSTRACT FROM AUTHOR]

Introduction: Central nervous system oxygen toxicity (CNS-OT) is an uncommon complication of hyperbaric oxygen treatment (HBOT). Different facilities have developed local protocols in an attempt to reduce the risk of CNS-OT. This audit was performed to elucidate which protocols might be of benefit in mitigating CNS-OT and to open discussion on adopting a common protocol for Treatment Table 14 (TT14) to enable future multicentre clinical trials. Methods: Audit of CNS-OT events between units using different compression profiles for TT14, performed at 243 kPa with variable durations of oxygen breathing and 'air breaks', to assess whether there is a statistical diference between protocols. Data were collected retrospectively from public and private hyperbaric facilities in Australia and New Zealand between 01 January 2010 and 31 December 2014. Results: Eight of 15 units approached participated. During the five-year period 5,193 patients received 96,670 treatments. There were a total of 38 seizures in 33 patients when all treatment pressures were examined. In the group of patients treated at 243 kPa there were a total of 26 seizures in 23 patients. The incidence of seizure per treatment was 0.024% (2.4 per 10,000 treatments) at 243 kPa and the risk per patient was 0.45% (4.5 in 1,000 patients). There were no statistically significant differences between the incidences of CNS-OT using different TT14 protocols in this analysis. Conclusion: HBOT is safe and CNS-OT is uncommon. The risk of CNS-OT per patient at 243 kPa was 1 in 222 (0.45%; range 0-1%) and the overall risk irrespective of treatment table was 0.6% (range 0.31-1.8%). These figures are higher than previously reported as they represent individual patient risk as opposed to risk per treatment. The wide disparity of facility protocols for a 243 kPa table without discernible influence on the incidence of CNS-OT rates should facilitate a national approach to consensus. [ABSTRACT FROM AUTHOR]

Background: Preterm breech delivery is associated with a higher perinatal mortality rate compared with preterm vertex delivery, and some studies suggest caesarean section leads to lower mortality rates. Few studies include infants delivered less than 26 weeks gestation, and where included, results are often not stratified by gestational age. There is also a lack of consistent reporting on neonatal and maternal morbidity outcome measures. Aims: To determine if mode of delivery for singleton extreme preterm breech fetuses is associated with a difference in perinatal mortality, neonatal and maternal morbidity. Materials and Methods: Retrospective cohort study of breech deliveries from 23 + 0 to 27 + 6 weeks gestation (extreme preterm) between 2005 and 2014 at a tertiary obstetric facility. Results: One hundred and fifty deliveries met the selection criteria. Perinatal mortality was reduced in the caesarean section group (20% vs 55.5% P < 0.001). Apgar scores ≥ 7 (P = 0.008) and cord pH ≥7.1 (P = 0.025) were more likely for neonates delivered by caesarean section, with lower rates of birth trauma (P = 0.003). Caesarean section was associated with higher nursery admission rates (P < 0.001), longer intensive care nursery admission (P = 0.006), continuous positive airway pressure times (P = 0.008) and increased use of surfactant (P < 0.001). Maternal morbidity was increased with caesarean section including longer hospital stay (P < 0.001), higher postpartum haemorrhage (P < 0.001) and wound infection rates (P = 0.034). Conclusion: Caesarean section for singleton extreme preterm breech delivery is associated with reduced perinatal mortality, improved neonatal condition at delivery, and increased short‐term maternal morbidity. [ABSTRACT FROM AUTHOR]

Introduction: The Royal Australian and New Zealand College of Radiology (RANZCR) recognised the importance of experience in on-call and emergency radiology for first-year registrars by introducing 'Key conditions in Year 1 training'. This list of common radiological pathologies can help to focus preparations for new registrars as they prepare for after-hours duties.Methods: The Royal Brisbane and Women's Hospital (RBWH) implemented a 12-week formal training programme, based on this curriculum, for new registrars prior to commencing after-hours work. Its impact was assessed by an image recognition and interpretation examination that was administered to registrars before and after training.Results: Examination results revealed that the prescribed training programme significantly increased both the rate and accuracy of reporting, and that improvements in speed were not at the expense of accuracy. Furthermore, it showed that a 12-week training programme was able to improve novice radiology registrars' ability to detect radiological abnormalities above that of experienced emergency department clinicians. Performances of consultant radiologists were used as a 'gold standard' control.Conclusion: This research demonstrates the value of a formal training programme in preparing registrars for extended after-hours reporting duties and contributing to important departmental service provision. [ABSTRACT FROM AUTHOR]

Background The purpose of this study was to determine if p16 status, chemotherapy regimen, or other nutrition markers could improve protocol accuracy in predicting proactive gastrostomy in patients with head and neck cancer. Methods Patients who received curative treatment from July 2010 to June 2011 were included ( n = 269). Associations among dependent variables (age, sex, tumor site, staging, treatment, p16 status, albumin, and Malnutrition Screening Tool [MST] score), the protocol risk rating, and requirement for proactive gastrostomy were examined. Results Current protocol correctly identified 81 of 88 high-risk patients (92%) for gastrostomy, but incorrectly classified 32 of 181 low-risk patients (18%). Analysis of low-risk patients with oral or oropharyngeal cancers, found p16-positive disease had 4.4 times greater odds ( p = .049), and those at risk of malnutrition had 4.5 times greater odds ( p = .019) of requiring gastrostomy. Conclusion Malnutrition risk and p16 status could be used to identify further patients who may benefit from proactive gastrostomy. © 2017 Wiley Periodicals, Inc. Head Neck 39: 868-875, 2017 [ABSTRACT FROM AUTHOR]

Background: Thyroid autoimmunity (TAI) – the presence of anti-thyroid peroxidase and/or anti-thyroglobulin antibodies – affects 8–14% of reproductively-aged women. It is hotly debated whether TAI adversely affects IVF/ICSI outcomes. This systematic review and meta-analysis evaluated the relationship between thyroid autoimmunity (TAI) and IVF/ICSI outcomes, both overall and amongst euthyroid women of known age using strict criteria for grouping pregnancy outcomes. Methods: The review was registered with PROSPERO: CRD42019120947. Searches were undertaken in MEDLINE, EMBASE, Web of Science and Cochrane Database from Inception-March 2020. Primary outcomes were clinical pregnancy rate, clinical miscarriage rate, biochemical pregnancy loss, livebirth rate per-cycle and live birth rate per clinical pregnancy (CP). Results: 14 studies were included in the meta-analysis. Compared with women who tested negative for thyroid autoantibodies (TAI-), there was no significant difference in clinical pregnancy rate overall (OR 0.86; 95%CI [0.70, 1.05]; P = 0.14; 11 studies; I2 = 29.0%), or in euthyroid women (OR 0.88; 95%CI [0.69, 1.12]; P = 0.29; 10 studies; I2 = 32.0%). There was also no significant difference in clinical miscarriage rate overall (OR 1.04; 95%CI [0.52, 2.07]; P = 0.908; 8 studies; I2 = 53%), or in euthyroid women (OR 1.18; 95%CI [0.52, 2.64]; P = 0.69; 7 studies; I2 = 54%). There was no significant difference in biochemical pregnancy loss (OR 1.14; 95%CI [0.48, 2.72]; P = 0.769; 4 studies; I2 = 0.0%), live birth rate per cycle (OR 0.84; 95%CI [0.67, 1.06]; P = 0.145; I2 = 1.7%), live birth rate per clinical pregnancy (OR 0.67; 95%CI [0.28, 1.60]; P = 0.369; I2 = 69.2%), both overall and in euthyroid women as all studies included consisted of euthyroid women only. There was also no significant difference in number of embryos transferred, number of oocytes retrieved, mean maternal age or TSH levels overall or in euthyroid women. Conclusion: The findings of the present study suggest that thyroid autoimmunity has no effect on pregnancy outcomes in euthyroid women alone, or in euthyroid women and women with subclinical hypothyroidism. [ABSTRACT FROM AUTHOR]