BackgroundThe number of elderly people over the age of 65 commencing dialysis in NZ has increased by almost 400% in the past decade. Few data are available about health related outcomes and survival on dialysis in the elderly to help the individual, their family, clinicians and health planners with decision-making.Methods/designThis study will provide the first comprehensive longitudinal survey of health-related quality of life (HRQOL) and other patient centred outcomes for individuals aged ≥65 years on, or eligible for, dialysis therapy and will link these data to survival outcomes. Data collected by yearly structured interviews with participants will be linked to co-morbidity data, health service use, and laboratory information collected from health records, and analysed with respect to HRQOL and survival. The information obtained will inform the delivery of dialysis services in New Zealand and facilitate improved decision-making by individuals, their family and clinicians, about the appropriateness and impact of dialysis therapy on subsequent health and survival.DiscussionResults from this study will make possible more informed decision-making by future elderly patients and their families as they contemplate renal replacement therapy. Results will also allow health professionals to more accurately describe the impact of dialysis therapy on quality of life and outcomes for patients.Trial registrationACTRN12611000024943.

A role for Ga-PSMA-I&T PET/CT in primary PCa staging of high-grade disease (GS 8 or more and PSA >10 ng/ml) has been shown. There was a low rate of detection of PSMA-avid metastases in low-grade disease (GS 7 or less and PSA <5 ng/ml), suggesting that there is a limited role for this modality in such cases.

Background Diphtheria is a potentially fatal respiratory disease caused by toxigenic Corynebacterium diphtheriae. Although resistance to erythromycin has been recognised, β-lactam resistance in toxigenic diphtheria has not been described. Here, we report a case of fatal respiratory diphtheria caused by toxigenic C. diphtheriae resistant to penicillin and all other β-lactam antibiotics and describe a novel mechanism of inducible carbapenem resistance associated with the acquisition of a mobile resistance element. Methods Long-read whole genome sequencing was performed using Pacific Biosciences SMRT sequencing to determine the genome sequence of C. diphtheriae BQ11 and mechanism of β-lactam resistance. To investigate phenotypic inducibility of meropenem resistance, short read sequencing was performed using an Illumina NextSeq500 sequencer on the strain with and without exposure to meropenem. Results BQ11 demonstrated high-level resistance to penicillin (benzylpenicillin MIC ≥ 256 μg/ml), β-lactam/β-lactamase inhibitors and cephalosporins (amoxicillin/clavulanic acid MIC ≥ 256 μg/mL; ceftriaxone MIC ≥ 8 μg/L). Genomic analysis of BQ11 identified acquisition of a novel transposon carrying the penicillin binding protein Pbp2c, responsible for resistance to penicillin and cephalosporins. When strain BQ11 was exposed to meropenem, selective pressure drove amplification of the transposon in a tandem array and led to a corresponding change from a low level to high level meropenem resistant phenotype. Conclusions We have identified a novel mechanism of inducible antibiotic resistance whereby isolates that appear to be carbapenem susceptible on initial testing can develop in vivo resistance to carbapenems with repeated exposure. This phenomenon could have significant implications for treatment of C. diphtheriae infection and may lead to clinical failure.

Background Despite an increasing number of older people commencing dialysis the impact of dialysis on their quality of life and survival, remains unclear. The Dialysis Outcomes in those aged over 65 years or older study is an accelerated prospective cohort longitudinal design study, designed to obtain sufficient health related quality of life data, linked to clinical data, to inform clinicians’ and patients’ decision-making with respect to end stage kidney disease (ESKD), outcomes, and options for management in New Zealand (NZ). Methods The study has an accelerated prospective cohort longitudinal design, comprised of cross-sectional and longitudinal components. We report the baseline data on the 225 participants enrolled in the study. Dialysis duration was grouped in tertiles from less than one year (incident patients), 1–3 years and greater than 3 years. Health related quality of life data was obtained from self-reported questionnaires including KDQoL-36, EQ-5D-3 L, FACIT, WHODAS II, and the Personal Well-being Score. Results The median age of the cohort was 71 years and two thirds were male. Three quarters of the participants were on dialysis at the baseline, with 42% of those on home dialysis (haemodialysis or peritoneal dialysis). Māori and Pacific people were over represented (20% Māori and 24% Pacific) in the sample, when compared to the general NZ population of the same age group (where 5% are Māori and 2% are Pacific). At baseline, there were no differences observed in sociodemographic, quality of life or health characteristics between the dialysis groups either by modality or duration of dialysis. Conclusions We report the baseline characteristics of participants enrolled prospectively into a longitudinal cohort observational study examining health related quality of life factors with clinical characteristics on dialysis outcomes in a group of New Zealanders aged 65 years or older who are either on dialysis or have been educated about dialysis (BMC Nephrol 14:175, 2013). Subsequent publications are planned, analysing the prospective longitudinal data to identify key factors that determine both outcome and quality of life for individuals of this age group. Trial registration ACTRN12611000024943 .