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To determine the clinical characteristics, outcomes and longitudinal trends of sepsis occurring in cancer patients. Retrospective study using statewide Victorian Cancer Registry data linked to various administrative datasets. Among 215,763 incident cancer patients, incidence of sepsis within one year of cancer diagnosis was estimated at 6.4%. The incidence of sepsis was higher in men, younger patients, patients diagnosed with haematological malignancies and those with de novo metastatic disease. Of the 13,316 patients with a first admission with sepsis, 55% had one or more organ failures, 29% required care within an intensive care unit and 13% required mechanical ventilation. Treatments associated with the highest sepsis incidence were stem cell/bone marrow transplant (33%), major surgery (4.4%), chemotherapy (1.1%) and radical radiotherapy (0.6%). The incidence of sepsis with organ failure increased between 2008 and 2015, while 90‐day mortality decreased. Sepsis in patients with cancer has high mortality and occurs most frequently in the first year after cancer diagnosis. The number of cancer patients diagnosed with sepsis is expected to increase, causing a substantial burden on patients and the healthcare system.

Background Cancer stage is important to capture within population-based cancer registries (PBCRs) to facilitate recruitment to clinical trials, evaluate prevention programs, assess treatment impact, and forecast cancer service needs. However, capture of cancer stage at diagnosis in many PBCRs is low, stemming from missing data in cancer registrations from health services. This study aims to identify the barriers and facilitators faced by Health Information Managers (HIM)/Clinical Coders (CC) and key multidisciplinary team meeting (MDM) personnel when capturing cancer stage at diagnosis. Method A cross-sectional online survey was conducted with 167 HIM/CC and 58 key MDM personnel employed within Victorian hospitals. The survey included 8 descriptor questions, 12–14 5-point Likert questions and 2–3 free text questions. Free text questions were analysed using the Theoretical Domains Framework, while all other questions were analysed using descriptive statistics, Spearman rank or Kruskall-Wallis tests. Results For HIM/CC, barriers related to the theoretical domains of (i) environmental context and resources, with 87% of participants agreeing required information was not readily available, (ii) knowledge, with 46% of participants agreeing they worry about incorrectly coding stage and (iii) skills, with 42% of participants agreeing they were not confident and 37% feeling they had inadequate training. For key MDM personnel, barriers related to the theoretical domains of (i) environmental context and resources, with 50% of participants agreeing there were time constraints, and required information was not readily available (ii) goals, with 36% of participants agreeing capturing cancer stage is not a priority, and (iii) social/professional role and identity, with 36% of participants agreeing it was not their role to discuss and capture stage. Despite the barriers, over half of participants in both groups agreed recording stage at diagnosis was a vital task. Conclusions Resolving the barriers identified will require enhancing documentation available to, and the training received by, HIM/CC and encouraging MDM Chairs to ensure cancer stage is discussed and recorded adequately for all patients presented.

ObjectiveHospital length of stay (LOS) is a key indicator of hospital efficiency and quality of care, but a reliable metric for benchmarking LOS remains problematic. This report describes a time-to-event methodology to generate a hospital standardised LOS ratio (HSLR).DesignRetrospective observational analysis of LOS from a jurisdictional administrative dataset using a time-to-event (hazard of discharge) analytic approach to generate risk-adjusted LOS (predicted LOS—pLOS), and the HSLR (= (sum observed LOS)/(sum total pLOS)).Setting219 (public and private) acute-care hospitals in the State of Victoria, Australia, adult population 5.28 million.Participants2.73 million adult multiday separations and 15.53 million bed-days from July 2019 to June 2024.InterventionsNil.Outcome measuresDescriptive statistics for annual mean LOS (aLOS), pLOS and HSLR at the hospital level with model fit assessed for calibration (Cox-Snell residuals), classification (aLOS and HSLR results for hospital-years compared to benchmark), variance (intraclass correlation coefficient (ICC) at provider level) and model dispersion (value (φ) and random effect SD (τ)) characteristics.ResultsObserved LOS was markedly right skewed and autocorrelated (p<0.001); population aLOS 5.68±4.98 days, median 3.94 (IQR: 2.48–6.76) days. LOS prediction model included six demographic covariates (age, sex, aged-care residency, emergent, admission source, unplanned transfer) and 12 145 separate principal diagnoses aggregated into nine ranked LOS risk-categories. 572 (61% of 940 hospital-year) aLOS values were outliers (>3 SD of benchmark); whereas 936 (99.5%) HSLR values were inliers (<±3 SD); 98% within ±2 SD. Some overdispersion (φ=14.5 ±1.7, τ=0.09 ±0.001) remained, but ICC at provider level (0.025) was low.ConclusionsaLOS is a simple descriptor but poor comparator. Time-to-event survival analytic models furnish risk-adjusted pLOS and HSLR metrics which indicate that the majority of LOS variation is due to patient-related, not hospital, factors.

We are finished competing. The cauldron will be extinguished tonight and the flag passed on to the Australians for 2000. Undoubtedly, there are many people in the world who will be happy not to hear the word ``Olympic'' for at least four years. I lay awake thinking about them last night. The athletic competition that went on in Atlanta attracted sponsors and media alike years before it took place because of what they knew it would be: incredible instances of raw emotion, struggle, and triumph -- all happening live. The Olympics are fabulous drama because they are completely un-scripted. This is the essence of the Olympics and no matter how many commercials or complaints accompany it, it will not change.

Polygenic risk score analyses on embryos (PGT-P) are being marketed by some private testing companies to parents using in vitro fertilisation as being useful in selecting the embryos that carry the least risk of disease in later life. It appears that at least one child has been born after such a procedure. But the utility of a PRS in this respect is severely limited, and to date, no clinical research has been performed to assess its diagnostic effectiveness in embryos. Patients need to be properly informed on the limitations of this use of PRSs, and a societal debate, focused on what would be considered acceptable with regard to the selection of individual traits, should take place before any further implementation of the technique in this population.

To sustain or repair cooperation during a social exchange, adaptive creatures must understand social gestures and the consequences when shared expectations about fair exchange are violated by accident or intent. We recruited 55 individuals afflicted with borderline personality disorder (BPD) to play a multiround economic exchange game with healthy partners. Behaviorally, individuals with BPD showed a profound incapacity to maintain cooperation, and were impaired in their ability to repair broken cooperation on the basis of a quantitative measure of coaxing. Neurally, activity in the anterior insula, a region known to respond to norm violations across affective, interoceptive, economic, and social dimensions, strongly differentiated healthy participants from individuals with BPD. Healthy subjects showed a strong linear relation between anterior insula response and both magnitude of monetary offer received from their partner (input) and the amount of money repaid to their partner (output). In stark contrast, activity in the anterior insula of BPD participants was related only to the magnitude of repayment sent back to their partner (output), not to the magnitude of offers received (input). These neural and behavioral data suggest that norms used in perception of social gestures are pathologically perturbed or missing altogether among individuals with BPD. This game-theoretic approach to psychopathology may open doors to new ways of characterizing and studying a range of mental illnesses.

This study evaluated HCV treatment initiation among people who inject drugs (PWID) following an intervention of campaign days involving peer connection, point-of-care HCV RNA testing, and linkage to nursing support. ETHOS Engage is an observational cohort study of PWID attending 25 drug treatment clinics and needle and syringe programs in Australia (May 2018–September 2019). Point-of-care results were provided to the nurse, facilitating confirmatory testing and treatment. The study aimed to evaluate treatment uptake and factors associated with treatment at 24 months post-enrolment. There were 317 people with current HCV infection and eligible for treatment (median age 43, 65% male, 15% homeless, 69% receiving opioid agonist treatment, 70% injected in last month). Overall, 15% (47/317), 27% (85/317), 38% (120/317), and 49% (155/317) of people with current HCV infection had initiated treatment at 3-, 6-, 12-, and 24-months following testing, respectively. Homelessness (adjusted hazard ratio (aHR): 0.40; 95% confidence interval: 0.23, 0.71) and incarceration in the past 12 months (vs. never, aHR:0.46; 0.28, 0.76) were associated with decreased treatment initiation in the 24 months post-enrolment. This testing campaign intervention facilitated HCV treatment uptake among PWID. Further interventions are needed to achieve HCV elimination among people experiencing homelessness or incarceration.