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INTRODUCTION: Chronic disease is a leading cause of death and disability that disproportionately burdens culturally and linguistically diverse (CALD) communities. Self-management is a cornerstone of effective chronic disease management. However, research suggests that patients from CALD communities may be less likely to engage with self-management approaches. The Natural Helper Programme aims to facilitate patient engagement with self-management approaches (ie, 'activation') by embedding cultural mentors with lived experience of chronic disease into chronic disease clinics/programmes. The Natural Helper Trial will explore the effect of cultural mentors on patient activation, health self-efficacy, coping efforts and health-related quality of life (HRQoL) while also evaluating the implementation strategy. METHODS AND ANALYSIS: A hybrid type-1 effectiveness-implementation cluster-randomised controlled trial (phase one) and a mixed-method controlled before-and-after cohort extension of the trial (phase 2). Hospital clinics in highly multicultural regions in Australia that provide healthcare for patients with chronic and/or complex conditions, will participate. A minimum of 16 chronic disease clinics (clusters) will be randomised to immediate (active arm) or delayed implementation (control arm). In phase 1, the active arm will receive a multifaceted strategy supporting them to embed cultural mentors in their services while the control arm continues with usual care. Each cluster will recruit an average of 15 patients, assessed at baseline and 6 months (n=240). In phase 2, clusters in the control arm will receive the implementation strategy and evaluate the intervention on an additional 15 patients per cluster, while sustainability in active arm clusters will be assessed qualitatively. Change in activation over 6 months, measured using the Patient Activation Measure will be the primary effectiveness outcome, while secondary effectiveness outcomes will explore changes in ch

Background: Extubation failure is common in extremely preterm (EP, <28 weeks' gestation) infants. Loss of functional residual capacity soon after extubation may contribute. We aimed to evaluate the relationship between pre-extubation mean airway pressure (MAP), post-extubation nasal continuous positive airway pressure (nCPAP) and extubation failure. Method(s): Two centre retrospective audit of the first extubation of EP infants conducted over a 2-year period. Extubation failure was defined as reintubation within 7 days. Result(s): Ninety-six of 204 (48%) infants required reintubation. In a multivariable regression model MAP was the only significant ventilation parameter affecting extubation success. A pre-extubation MAP >8 cm H2O was associated with extubation failure (F [5,198] = 6.9, p < 0.001). We also saw a relationship between pre-extubation MAP and post-extubation nCPAP level. Infants extubated to a pressure lower than the pre-extubation MAP were more likely to have extubation failure. Conclusion(s): In EP infants, it may be prudent use a nCPAP level at least equal to the set MAP on the mechanical ventilator.

Background: Extremely preterm infants born <28 weeks gestation often require invasive mechanical ventilation. To avoid bronchopulmonary dysplasia and other morbidities, clinicians aim to extubate to non-invasive respiratory support as soon as possible. However, extubation failure occurs in up to 60% of extremely preterm infants. Our aim was to compare non-invasive respiratory support modes used post-extubation in extremely preterm infants. Method(s): A systematic review performed according to PRISMA guidelines using Cochrane Neonatal Review Group methods. Data were pooled and analysed using Review Manager v5. Result(s): Five respiratory support modes were identified: nasal continuous positive airway pressure (nCPAP), nasal intermittent positive pressure ventilation (NIPPV), nasal high-flow (nHF), nasal high frequency oscillatory ventilation (nHFOV), and noninvasive neurally-adjusted ventilatory assistance (NI-NAVA). Twenty-three eligible studies were included in the quantitative synthesis. NIPPV delivered using any mode reduced risk of reintubation (RR 0.86 [95% CI 0.79, 0.94]). The effect was more pronounced in a subgroup of trials in which NIPPV was synchronized and delivered by a ventilator (RR 0.22 [95% CI 0.14, 0.37]). Nasal CPAP was superior to nHF in preventing reintubation (RR,-0.04 [95% CI,-0.08,-0.01]). Two small trials compared nCPAP using standard pressures with nHFOV and higher pressure nCPAP; both were underpowered, and no definitive recommendations could be made. No RCTs evaluated NI-NAVA. Conclusion(s): NIPPV when synchronised and ventilator derived may be superior than nCPAP when extubating extremely preterm infants. Promising new modes of respiratory support (nHFOV and NI-NAVA) require further evaluation before widespread use.

INTRODUCTION: Infants born extremely preterm (EP, <28 weeks' gestation) or with extremely low birth weight (ELBW,<1000 g) in the era when surfactant has been available clinically are at high risk of health and developmental problems in childhood and adolescence. However, how their health and well-being may be affected in adulthood is not well known. This study aims to compare between EP/ELBW and normal birthweight (NBW) controls: (1) physical health, mental health and socioemotional functioning at 25 years of age and (2) trajectories of these outcomes from childhood to adulthood. In addition, this study aims to identify risk factors in pregnancy, infancy, childhood and adolescence for poor physical health and well-being in EP/ELBW young adults. METHODS AND ANALYSIS: The Victorian Infant Collaborative Study (VICS) is a prospective geographical cohort of all EP/ELBW survivors to 18 years of age born in the State of Victoria, Australia, from 1 January 1991 to 31 December 1992 (n=297) and contemporaneous term-born/NBW controls (n=262). Participants were recruited at birth and followed up at 2, 5, 8 and 18 years. This 25-year follow-up includes assessments of physical health (cardiovascular, respiratory and musculoskeletal), mental health and socioemotional functioning. Outcomes will be compared between the birth groups using linear and logistic regression, fitted using generalised estimating equations (GEEs). Trajectories of health outcomes from early childhood will be compared between the birth groups using linear mixed-effects models. Risk factors for adult outcomes will be assessed using linear and logistic regression (fitted using GEEs). ETHICS AND DISSEMINATION: This study was approved by the Human Research Ethics Committees of the Royal Women's Hospital, Mercy Hospital for Women, Monash Medical Centre and the Royal Children's Hospital, Melbourne. Study outcomes will be disseminated through conference presentations, peer-reviewed publications, the internet and soci