BackgroundThere is conflicting evidence regarding characteristics of patients most likely to have poor outcomes after referral to a multidisciplinary weight loss clinic. The aim of this study was to identify patient characteristics associated with poor attendance and poor weight outcomes at a weight management clinic based in an Australian tertiary hospital.MethodsPatient characteristics including age, sex, referral source, postcode of residence, weight, body mass index (BMI) and the presence of specific comorbidities were recorded. Outcome measures included questionnaire return following referral (a requirement prior to a first appointment being scheduled), percentage of appointments attended and rate of weight change (kg/month). Continuous variables were expressed as mean ± standard deviation and compared using a t-test. Categorical data were presented as proportions and a chi-squared test was used to test significance. Statistical significance was set as p < 0.05.ResultsOf 502 patients referred to the Comprehensive Metabolic Care Centre (CMCC), 231 (46%) did not return their questionnaire. Patients referred by their GP, compared to those with only internal hospital referrals, were more likely to return their questionnaire (86.0% cf. 77.9%; p = 0.02) as were those who had their BMI recorded in their referral letter (58% cf 45% p = 0.011). 28.1% of patients attended half or less of their scheduled appointments at the CMCC but none of the parameters analysed was associated with attendance. Weight loss was associated with residence in a rural location (p = 0.016) and hypercholesterolaemia (p = 0.03) and weight gain was associated with obstructive sleep apnoea (p = 0.04).ConclusionsA large proportion of the patients referred to a weight management clinic never had an appointment scheduled. Clinicians should not anticipate greater compliance in one patient demographic than another; all groups need focus, particularly at the referral stage, and likely poor compliance must be anticipated and better managed.

BACKGROUND: Sessile serrated adenomas/polyps (SSA/P) are now recognised precursors of colorectal cancer (CRC) including cancers harbouring somatic BRAF (V600E) mutations. While the morphological diagnostic criteria of SSA/P have been established, distinguishing between small/early SSA/P and microvesicular hyperplastic polyps (MVHP) is challenging and may not be possible in routine practice. METHODS: Gene expression profiling of MVHP (n=5, all BRAF V600E wild-type) and SSA/P (n=5, all BRAF V600E mutant) samples was performed. Quantitative reverse transcription–polymerase chain reaction (qRT-PCR) and immunohistochemical analysis was performed to verify the expression of claudin 1 (CLDN1) in MVHP and SSA/P. RESULTS: Gene expression profiling studies conducted between MVHP and SSA/P identified CLDN1 as the most statistically significant differentially expressed gene (p<0.05). Validation with qRT-PCR confirmed an up-regulation of CLDN1 in BRAF V600E mutant polyps regardless of polyp type (p<0.0005). Immunohistochemical analysis of CLDN1 expression in BRAF V600E mutant SSA/Ps (n=53) and MVHPs (n=111) and BRAF wild-type MVHPs (n=58), demonstrated a strong correlation between CLDN1 expression and the BRAF V600E mutation in both SSA/P and MVHP samples when compared to wild-type polyps (p<0.0001). CONCLUSION: This study demonstrates an up regulation of CLDN1 protein in serrated colorectal polyps including MVHP harbouring the BRAF V600E mutation. Our results demonstrated an apparent heterogeneity on the molecular level within the MVHP group and suggest that MVHP with somatic BRAF V600E mutation and up-regulated expression of CLDN1 are closely related to SSA/P and may in fact represent a continuous spectrum of the same neoplastic process within the serrated pathway of colorectal carcinogenesis.

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Objectives Psychological distress is common among palliative care patients. Despite this, little is known about the availability of psychological services to support palliative care patients within Australia. This study aimed to determine the level of psychological support services available within Australian Palliative Care Services. The study was based on a similar study in Australia by Crawford in 1999, allowing differences over time to be examined. Methods A 12-item online survey was distributed to adult Palliative Care Services throughout Australia from November 2021 to January 2022. Quantitative and qualitative analysis of responses was conducted, with comparisons made with the 1999 study using a 2-proportions z-test. Results Social workers were the most available professionals delivering psychological care (prevalence of 94.1%), followed by spiritual care workers (62.5%), creative therapists (43.8%), counselors (36.4%), psychiatrists (31.3%), complementary therapists (28.1%), and psychologists (25.0%). Nearly 60% of services had no access to a psychiatrist or a psychologist. The proportion of Palliative Care Services that had access to a psychiatrist, psychologist, or counselor was significantly less in 2021/22 compared to 1999, with differences of 29.4% (p = 0.002), 23.4% (p = 0.015), and 26.1% (p = 0.006), respectively. Significance of results Lack of access to psychiatrists, psychologists, and counselors in Australian Palliative Care Services remains a significant issue and has become more prevalent since 1999. Ongoing advocacy and increased government funding to enable psychological health professionals to be readily employed in Palliative Care Services is vital.

Introduction: Atrial fibrillation (AF) is significantly more prevalent in men than in women. Significant differences in left atrial (LA) and pulmonary vein (PV) electrophysiology that may predispose to AF have been demonstrated in animal studies but there are few data regarding gender-based differences in human electrophysiology.Methods: Detailed studies of LA and PV electrophysiology were undertaken in 66 consecutive patients with AF undergoing ablation. ERP was measured at 3 LA and 2 PV sites at two cycle lengths. The LA was divided into six anatomic regions (appendage, roof, floor, septum, lateral and posterior). Activation time (AT) and voltage were analysed globally and regionally. PV sleeve length was measured from PV electrogram extent and AT was corrected for length as a marker of conduction. Data were analysed for the presence of systematic differences between male and female patients.Results: Male (n = 53) and female groups (n = 13) were well matched for age (58 vs 62 years, p = ns), LVEF (59 vs 60%, p = ns) and LA diameter (4.4 vs 4.1 cm, p = ns). No consistent differences were observed for any parameter. Representative data are presented: Heart, Lung and Circulation CSANZ 2012 Abstracts 2012;21:S1-S142 (b) history of embolism (including stroke/TIA), (c) renal failure, (d) malignancy, (e) hemodynamic instability and (f) AF associated with another medical reason necessitating admission (e.g. underlying infection).Results: Seventy-one percent (n = 175) of patient presenting to the ED were admitted to hospital, with a consequent median length of stay of 2 [1-4] days. Older age (p = 0.01), clinical history of hypertension (p = 0.006) and out of hours presentation time (p = 0.02) were significant predictors of hospital admission, whilst the presence of diabetes mellitus (p = 0.10), impaired renal function (p = 0.08) and congestive heart failure (p = 0.16) trended toward predicting hospital admission. Nineteen percent of the patients admitted to hospital were considered to be low risk.Conclusion: Older age, out of hours presentation time and hypertension predicted hospitalisation for acute AF; however, ∼1 in 5 hospitalisations were for low risk patients. Treating a low risk patient in the ED could save ∼$2000 per presentation, which extrapolates to ∼13 million dollar saving Australia wide every year. http://dx.

Background: Atrial fibrillation (AF) is associated with increased thromboembolic stroke risk. The effect of rapid atrial rates on thrombogenesis in the human left atrium (LA) remains unknown.Methods: Twelve patients with AF undergoing catheter ablation in sinus rhythm (SR) and eight with supraventricular tachycardia (SVT) due to left-sided accessory pathways were studied with rapid atrial pacing at 150 bpm. Eight patients with AF in SR served as controls. Blood was sampled from the LA, right atrium (RA) and femoral vein (FV) at baseline and 15 min after pacing or in controls. Platelet activation (platelet P-selectin), thrombin generation [thrombin-antithrombin-complex (TAT)] endothelial dysfunction [asymmetric dimethylarginine (ADMA)] and platelet-derived inflammation [soluble-CD40-ligand (sCD40L)] were measured by flow cytometry and ELISA.Results: With rapid atrial pacing, thrombin generation increased significantly in the AF group (log TAT 1.29 ± 0.56 mcg/L at 15 min vs. 1.05 ± 0.34 at baseline; p < 0.01), specifically in the LA and RA compared to the FV. This was markedly observed in patients with AV dyssynchrony (p < 0.01). In contrast, thrombin generation decreased in the SVT group (p < 0.01) and control group (p < 0.01). Platelet activation increased in AF patients with pacing (log P-selectin 1.27 ± 0.10% vs. 1.14 ± 0.17%; p < 0.01), was unchanged in the SVT group (p = 0.8) and decreased in controls (p < 0.01). ADMA and sCD40L were unchanged in all three groups.Conclusion: Rapid atrial rates increase LA thrombin generation and platelet activation in patients with AF. This effect is accentuated with AV dyssynchrony. However, rapid atrial rates did not result in abnormal markers in SVT patients, suggesting the additional role of abnormal substrate in AF patients. http://dx. Aim: To assess the usefulness of seven-day event monitoring in evaluating symptoms suggestive of cardiac arrhythmias when ECG and 24 h Holter monitoring are non-diagnostic.Methods: All patients undergoing seven day event monitoring from January 2011 to February 2012 were included in the analysis. Indications included: palpitations (70%); atrial fibrillation/flutter (15%); pre-syncope (10%); syncope (2%). Prior ECG and 24 h Holter monitors were non-diagnostic.Results: Eighty-four patients were included (mean age 51 ± 17 years, 76% female). Referral sources were: cardiologists 86% (53% electrophysiologists); emergency physicians and general practitioners 14%. 360 events in total were recorded by 69 (82%) patients (maximum possible 15 per patient). Symptoms were: palpitations (55%); irregular heart beat (21%); pre-syncope (15%). Fiftyeight percent of patients had a defined symptom-related arrhythmia, including: atrial fibrillation/flutter (5%); supraventricular tachycardia > 10 s (6%); atrial runs < 10 beats (10%); ventricular ectopics (26%); atrial ectopics (35%); sinus pause > 3 s (1%); sinus tachycardia > 120 bpm at rest (10%). In the remaining 24% of symptomatic patients, sinus rhythm only was recorded.Conclusions: Seven-day event monitor...

b) history of embolism (including stroke/TIA), (c) renal failure, (d) malignancy, (e) hemodynamic instability and (f) AF associated with another medical reason necessitating admission (e.g. underlying infection).Results: Seventy-one percent (n = 175) of patient presenting to the ED were admitted to hospital, with a consequent median length of stay of 2 [1-4] days. Older age (p = 0.01), clinical history of hypertension (p = 0.006) and out of hours presentation time (p = 0.02) were significant predictors of hospital admission, whilst the presence of diabetes mellitus (p = 0.10), impaired renal function (p = 0.08) and congestive heart failure (p = 0.16) trended toward predicting hospital admission. Nineteen percent of the patients admitted to hospital were considered to be low risk.Conclusion: Older age, out of hours presentation time and hypertension predicted hospitalisation for acute AF; however, ∼1 in 5 hospitalisations were for low risk patients. Treating a low risk patient in the ED could save ∼$2000 per presentation, which extrapolates to ∼13 million dollar saving Australia wide every year. http://dx.

dATP appears to be the major purine metabolite implicated in ADA deficiency.In spite of an important decrease of erythrocyte dATP levels, closely related to a marked clinical improvement, no significant restoration of immune function was observed. Thus red cell transfusion appears to be not a sufficiently effective therapy in ADA deficiency. REFERENCESBoulieu, R., Bory, C. and Gonnet, C. High performance liquid chromatographic method for the analysis of purine and pyrimidine bases, ribonucleosides and deoxyribonucleosides in biological fluids. J. Chromatogr. 339 (1985a) 380-387 Boulieu, R., Bory, C. and Gonnet, C. Liquid chromatographic measurement of purine nucleotides in blood cells. Clin. Chem. 31 (1985b) 727-731 Hirschhorn, R. Inherited enzyme deficiencies and immunodeficiency: adenosine deaminase (ADA) and purine nucleoside phosphorylase (PNP) deficiencies.