Background Marginal and multilevel logistic regression methods can estimate associations between hospital-level factors and patient-level 30-day mortality outcomes after cardiac surgery. However, it is not widely understood how the interpretation of hospital-level effects differs between these methods. Methods The Australasian Society of Cardiac and Thoracic Surgeons (ASCTS) registry provided data on 32,354 patients undergoing cardiac surgery in 18 hospitals from 2001 to 2009. The logistic regression methods related 30-day mortality after surgery to hospital characteristics with concurrent adjustment for patient characteristics. Results Hospital-level mortality rates varied from 1.0% to 4.1% of patients. Ordinary, marginal and multilevel regression methods differed with regard to point estimates and conclusions on statistical significance for hospital-level risk factors; ordinary logistic regression giving inappropriately narrow confidence intervals. The median odds ratio, MOR, from the multilevel model was 1.2 whereas ORs for most patient-level characteristics were of greater magnitude suggesting that unexplained between-hospital variation was not as relevant as patient-level characteristics for understanding mortality rates. For hospital-level characteristics in the multilevel model, 80% interval ORs, IOR-80%, supplemented the usual ORs from the logistic regression. The IOR-80% was (0.8 to 1.8) for academic affiliation and (0.6 to 1.3) for the median annual number of cardiac surgery procedures. The width of these intervals reflected the unexplained variation between hospitals in mortality rates; the inclusion of one in each interval suggested an inability to add meaningfully to explaining variation in mortality rates. Conclusions Marginal and multilevel models take different approaches to account for correlation between patients within hospitals and they lead to different interpretations for hospital-level odds ratios.

Acute kidney injury after cardiac surgery can be predicted using preoperative risk factors alone or, with greater accuracy, using pre-, peri-, and early postoperative risk factors. The ability to identify high-risk individuals can be useful in preoperative patient management and for recruitment of appropriate patients to clinical trials. Prediction in the early stages of postoperative care can guide subsequent intensive care of patients and could also be the basis of a retrospective performance audit tool.

CCT is inversely correlated to optic disc area. Although thicker corneas have been recognised to cause slight overestimation of true intraocular pressure (IOP), they may also indicate the presence of a substantially smaller, and thus more robust, optic nerve head. People with thinner corneas which slightly underestimate the true IOP may also have larger and more deformable optic discs.

Background and aim: To assess the Farsi (Persian) translated and modified version of the questionnaire of the American Board of Internal Medicine (ABIM) for measuring professionalism, and also, measuring the professional attitudes and behaviors associated with the medical residency training environment in Iran. Methods: After a pilot study, a 17-item questionnaire was distributed to 282 medical residents of two major universities of Iran, from December 2006 through February 2007. Results: Of the 282 distributed questionnaires, 259 (95.2%) were used in the analysis. Based on the analyses, two items were omitted and 15 items were retained for further analysis. The mean score was 106 (Standard Deviation (SD), 22.4) out of maximum 150, whereas the item mean was 6.12 (SD, 0.37) out of maximum 10. Corrected item-to-total correlations ranged from low to moderate. The internal reliability of the scale, based on Cronbach's alpha, meets Nunnally's minimal requirement. A factor analysis was performed, based on principal components and varimax rotation. The solution identified three factors (subscales) including excellence, honor/integrity and altruism/respect. Together these factors represented 58.8% of the common variance. Conclusion: This study showed the content validity and internal reliability of the Farsi version of the ABIM questionnaire. Therefore, it can be considered as an encouraging step toward developing a short, reliable and valid instrument for measuring professionalism in medical environments.

Introduction In 2018, ARPANSA published updated national DRLs for adult CT, which were first published in 2012, and augmented the national DRL categories. This paper presents the updated national DRLs and describes the process by which they were produced. Methods Examine patient survey data submitted to the Australian Radiation Protection and Nuclear Safety Agency (ARPANSA) National Diagnostic Reference Level Service (NDRLS). Determine the quartiles of the distributions of median survey dose metrics with categorisation by procedure type. Engage a liaison panel representing the radiology professions to review procedure categories and recommend revised national DRLs. The revised NDRL procedure categories are: head (non‐contrast brain (trauma/headache)), cervical spine (Non‐contrast (trauma)), soft‐tissue neck (post‐contrast (oncology)), chest (post‐contrast (oncology)), abdomen–pelvis (post‐contrast (oncology)), kidney–ureter–bladder (non‐contrast (suspected renal colic)), chest–abdomen–pelvis (post‐contrast (oncology)) and lumbar spine (non‐contrast (degenerative pain)). Results The existing six procedure categories were revised and refined. Updated Australian national diagnostic reference levels for adult CT were recommended and endorsed for eight procedure categories: head (52 mGy/880 mGycm), cervical spine (23 mGy/470 mGycm),soft‐tissue neck (17 mGy/450 mGycm), chest (10 mGy/390 mGycm), abdomen–pelvis (13 mGy/600 mGycm), kidney–ureter–bladder (13 mGy/600 mGycm), chest–abdomen–pelvis (11 mGy/940 mGycm) and lumbar spine (26 mGy/670 mGycm). The updated national DRLs are between 12 and 26% lower than the previous DRLs for dose‐length product and between 13 and 63% lower for volume computed tomography dose index. Conclusions Australian national DRLs for adult CT have been reviewed and revised. The revised national DRLs are lower, better reflecting current practice among imaging facilities in Australia. The revised Australian national DRLs are similar to those in other developed countries.

ObjectiveSome studies have reported increasing trends in certain brain tumours and a possible link with mobile phone use has been suggested. We examined the incidence time trends of brain tumour in Australia for three distinct time periods to ascertain the influence of improved diagnostic technologies and increase in mobile phone use on the incidence of brain tumours.DesignIn a population-based ecological study, we examined trends of brain tumour over the periods 1982–1992, 1993–2002 and 2003–2013. We further compared the observed incidence during the period of substantial mobile phone use (2003–2013) with predicted (modelled) incidence for the same period by applying various relative risks, latency periods and mobile phone use scenarios.SettingNational Australian incidence registration data on primary cancers of the brain diagnosed between 1982 and 2013.Population16 825 eligible brain cancer cases aged 20–59 from all of Australia (10 083 males and 6742 females).Main outcome measuresAnnual percentage change (APC) in brain tumour incidence based on Poisson regression analysis.ResultsThe overall brain tumour rates remained stable during all three periods. There was an increase in glioblastoma during 1993–2002 (APC 2.3, 95% CI 0.8 to 3.7) which was likely due to advances in the use of MRI during that period. There were no increases in any brain tumour types, including glioma (−0.6, –1.4 to 0.2) and glioblastoma (0.8, –0.4 to 2.0), during the period of substantial mobile phone use from 2003 to 2013. During that period, there was also no increase in glioma of the temporal lobe (0.5, –1.3 to 2.3), which is the location most exposed when using a mobile phone. Predicted incidence rates were higher than the observed rates for latency periods up to 15 years.ConclusionsIn Australia, there has been no increase in any brain tumour histological type or glioma location that can be attributed to mobile phones.

We conducted a randomised double-blind, placebo-controlled trial to assess whether a bolus dose of lidocaine during the induction of general anaesthesia would reduce postoperative pain over 24 h. Level of satisfaction with pain control at 48 h after surgery and Apgar score were also examined. A total of 100 women aged 20-35 years, who were candidates for elective caesarean section (CS) were randomised to receive either 1.5 mg/kg lidocaine or placebo during the induction of general anaesthesia. Results showed that lidocaine decreased pain intensity over 24 h after surgery (p < .001), and decreased postoperative morphine consumption from median (range) of 3.79 (0-9) mg in the placebo group to 0 (0-12) mg and in the lidocaine group (p <.001). Lidocaine was not associated with postoperative nausea and vomiting or any side effects in women and newborn babies. We conclude that a small bolus dose of lidocaine attenuates postoperative pain, thus reducing the requirement for opioid consumption in the postoperative period. Impact statement • With its anti-inflammatory, anti-hyperalgesic and analgesic properties, intravenous perioperative lidocaine infusion (IVLI) has been used for optimal postoperative care in different surgeries. Limited evidence suggests that IVLI may be a useful adjuvant during general anaesthesia. There is a report of a positive effect on several outcomes after surgery including postoperative pain over 24 h after laparoscopic abdominal surgery or open abdominal surgery. However, there was a paucity of information regarding the efficacy of a bolus dose of lidocaine in patients undergoing caesarean section (CS). In this randomized, placebo-controlled trial the use of a bolus dose of 1.5 mg/kg lidocaine 2%, compared with placebo, during the induction of general anaesthesia for elective CS resulted in a significant decrease in postoperative pain score as well as decreased postoperative morphine consumption over 24 h. Lidocaine use was not associated with any side effect in participants and newborns. • This study provides the first evidence that a bolus dose of lidocaine may be a safe and simple alternative therapeutic intervention for enhanced postoperative recovery in terms of pain and postoperative opioid consumption. Future studies are needed to examine pain reducing effect of perioperative bolus dose of lidocaine after CS under spinal or epidural anesthesia.

The generalizability of a prediction model from North America for incident nosocomial pneumonia following coronary artery bypass graft surgery was assessed for 23247 patients on the Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) registry. The performance of the North American model was evaluated using measures of calibration and discrimination. The model had reasonable discrimination (area under the receiver-operating characteristic curve, AUC=0·69), but unsatisfactory calibration (Hosmer-Lemeshow test, P<0·001) in the ANZSCTS patients. An update of the model coefficients yielded a model with AUC=0·71 and good calibration (P=0·46).