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    Serum phosphate and mortality in incident dialysis patients in Australia and New Zealand
    Tiong, MK ; Ullah, S ; McDonald, SP ; Tan, S-J ; Lioufas, NM ; Roberts, MA ; Toussaint, ND (WILEY, 2021-06-01)
    AIM: Hyperphosphataemia is associated with increased adverse outcomes, including mortality. Re-examining this association using up-to-date data reflecting current and real-world practices, across different global regions and in both haemodialysis and peritoneal dialysis patients, is important. METHODS: We describe the association between serum phosphate and all-cause and cardiovascular mortality in incident dialysis patients between 2008 and 2018 using the Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry. Time-dependent Cox proportionate hazards models were used. Models were adjusted for available covariates and fitted for the overall cohort, and also each dialysis modality. RESULTS: 31 989 patients were followed over 97 122 person-years at risk (mean age at first dialysis 61 years, 38% female, 67% haemodialysis). We observed a U-shaped association between serum phosphate and all-cause mortality. In the fully adjusted model, categories of serum phosphate above and below 1.25-1.99 mmol/L were associated with progressively higher risk, reaching a hazard ratio of 2.13 (95% CI 1.93-2.36, p < .001) for serum phosphate ≥2.75 mmol/L, and 1.56 (95% CI 1.44-1.69, p < .001) for serum phosphate <1.00 mmol/L. Low and high levels of serum phosphate were also associated with increased risk of cardiovascular mortality, however the association with high serum phosphate was more pronounced ("J-shaped relationship"). The associations were consistent across sub-analyses of patients receiving haemodialysis and peritoneal dialysis treatment. CONCLUSION: In this large contemporary dialysis cohort, both high and low levels of serum phosphate were independently associated with increased risk of mortality. Future studies are required to determine whether treatment of abnormal serum phosphate levels improves mortality.
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    Developing critical thinking skills for delivering optimal care.
    Scott, IA ; Hubbard, RE ; Crock, C ; Campbell, T ; Perera, M (Wiley, 2021-04)
    Healthcare systems across the world are challenged with problems of misdiagnosis, non-beneficial care, unwarranted practice variation and inefficient or unsafe practice. In countering these shortcomings, clinicians must be able to think critically, interpret and assimilate new knowledge, deal with uncertainty and change behaviour in response to compelling new evidence. Three critical thinking skills underpin effective care: clinical reasoning, evidence-informed decision-making and systems thinking. It is important to define these skills explicitly, explain their rationales, describe methods of instruction and provide examples of optimal application. Educational methods for developing and refining these skills must be embedded within all levels of clinician training and continuing professional development.
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    Complicated diverticular disease presenting as recurrent epididymo-orchitis: a case report
    Tay, JYI ; Hayes, I ; Fisher, T ; McMullin, R (WILEY, 2021-03-18)
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    Diagnostic dilemma for an adrenal mass: perivascular epithelioid cell neoplasm versus adrenocortical carcinoma
    Liew, AN ; Naqash, N ; Arachchi, A ; Simpson, I ; Slavin, J (WILEY, 2021-02-06)
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    Miliary EGFR mutated non-small cell lung cancer
    Nguyen, MM ; Moore, MM (WILEY, 2021-01-18)
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    Impact of COVID-19 Pandemic on Cardiovascular Testing in Asia
    Kudo, T ; Lahey, R ; Hirschfeld, CB ; Williams, MC ; Lu, B ; Alasnag, M ; Bhatia, M ; Henry Bom, H-S ; Dautov, T ; Fazel, R ; Karthikeyan, G ; Keng, FYJ ; Rubinshtein, R ; Better, N ; Cerci, RJ ; Dorbala, S ; Raggi, P ; Shaw, LJ ; Villines, TC ; Vitola, JV ; Choi, AD ; Malkovskiy, E ; Goebel, B ; Cohen, YA ; Randazzo, M ; Pascual, TNB ; Pynda, Y ; Dondi, M ; Paez, D ; Einstein, AJ ; Einstein, AJ ; Paez, D ; Dondi, M ; Better, N ; Cerci, R ; Dorbala, S ; Pascual, TNB ; Raggi, P ; Shaw, LJ ; Villines, TC ; Vitola, JV ; Williams, MC ; Pynda, Y ; Hinterleitner, G ; Lu, Y ; Morozova, O ; Xu, Z ; Hirschfeld, CB ; Cohen, Y ; Goebel, B ; Malkovskiy, E ; Randazzo, M ; Choi, A ; Lopez-Mattei, J ; Parwani, P ; Nasery, MN ; Goda, A ; Shirka, E ; Benlabgaa, R ; Bouyoucef, S ; Medjahedi, A ; Nailli, Q ; Agolti, M ; Aguero, RN ; Alak, MDC ; Alberguina, LG ; Arroñada, G ; Astesiano, A ; Astesiano, A ; Norton, CB ; Benteo, P ; Blanco, J ; Bonelli, JM ; Bustos, JJ ; Cabrejas, R ; Cachero, J ; Campisi, R ; Canderoli, A ; Carames, S ; Carrascosa, P ; Castro, R ; Cendoya, O ; Cognigni, LM ; Collaud, C ; Collaud, C ; Cortes, C ; Courtis, J ; Cragnolino, D ; Daicz, M ; De La Vega, A ; De Maria, ST ; Del Riego, H ; Dettori, F ; Deviggiano, A ; Dragonetti, L ; Embon, M ; Enriquez, RE ; Ensinas, J ; Faccio, F ; Facello, A ; Garofalo, D ; Geronazzo, R ; Gonza, N ; Gutierrez, L ; Guzzo, MA ; Guzzo, MA ; Hasbani, V ; Huerin, M ; Jäger, V ; Lewkowicz, JM ; López De Munaín, MNA ; Lotti, JM ; Marquez, A ; Masoli, O ; Masoli, OH ; Mastrovito, E ; Mayoraz, M ; Melado, GE ; Mele, A ; Merani, MF ; Meretta, AH ; Molteni, S ; Montecinos, M ; Noguera, E ; Novoa, C ; Sueldo, CP ; Ascani, SP ; Pollono, P ; Pujol, MP ; Radzinschi, A ; Raimondi, G ; Redruello, M ; Rodríguez, M ; Rodríguez, M ; Romero, RL ; Acuña, AR ; Rovaletti, F ; San Miguel, L ; Solari, L ; Strada, B ; Traverso, S ; Traverzo, SS ; Espeche, MDHV ; Weihmuller, JS ; Wolcan, J ; Zeffiro, S ; Sakanyan, M ; Beuzeville, S ; Boktor, R ; Butler, P ; Calcott, J ; Carr, L ; Chan, V ; Chao, C ; Chong, W ; Dobson, M ; Downie, D ; Dwivedi, G ; Elison, B ; Engela, J ; Francis, R ; Gaikwad, A ; Basavaraj, AG ; Goodwin, B ; Greenough, R ; Hamilton-Craig, C ; Hsieh, V ; Joshi, S ; Lederer, K ; Lee, K ; Lee, J ; Magnussen, J ; Mai, N ; Mander, G ; Murton, F ; Nandurkar, D ; Neill, J ; O'Rourke, E ; O'Sullivan, P ; Pandos, G ; Pathmaraj, K ; Pitman, A ; Poulter, R ; Premaratne, M ; Prior, D ; Ridley, L ; Rutherford, N ; Salehi, H ; Saunders, C ; Scarlett, L ; Seneviratne, S ; Shetty, D ; Shrestha, G ; Shulman, J ; Solanki, V ; Stanton, T ; Stuart, M ; Stubbs, M ; Swainson, I ; Taubman, K ; Taylor, A ; Thomas, P ; Unger, S ; Upton, A ; Vamadevan, S ; Van Gaal, W ; Verjans, J ; Voutnis, D ; Wayne, V ; Wilson, P ; Wong, D ; Wong, K ; Younger, J ; Feuchtner, G ; Mirzaei, S ; Weiss, K ; Maroz-Vadalazhskaya, N ; Gheysens, O ; Homans, F ; Moreno-Reyes, R ; Pasquet, A ; Roelants, V ; Van De Heyning, CM ; Ríos, RA ; Soldat-Stankovic, V ; Stankovic, S ; Albernaz Siqueira, MH ; Almeida, A ; Alves Togni, PH ; Andrade, JH ; Andrade, L ; Anselmi, C ; Araújo, R ; Azevedo, G ; Bezerra, S ; Biancardi, R ; Grossman, GB ; Brandão, S ; Pianta, DB ; Carreira, L ; Castro, B ; Chang, T ; Cunali, F ; Cury, R ; Dantas, R ; de Amorim Fernandes, F ; De Lorenzo, A ; De Macedo Filho, R ; Erthal, F ; Fernandes, F ; Fernandes, J ; Fernandes, F ; De Souza, TF ; Alves, WF ; Ghini, B ; Goncalves, L ; Gottlieb, I ; Hadlich, M ; Kameoka, V ; Lima, R ; Lima, A ; Lopes, RW ; Machado e Silva, R ; Magalhães, T ; Silva, FM ; Mastrocola, LE ; Medeiros, F ; Meneghetti, JC ; Naue, V ; Naves, D ; Nolasco, R ; Nomura, C ; Oliveira, JB ; Paixao, E ; De Carvalho, FP ; Pinto, I ; Possetti, P ; Quinta, M ; Nogueira Ramos, RR ; Rocha, R ; Rodrigues, A ; Rodrigues, C ; Romantini, L ; Sanches, A ; Santana, S ; Sara da Silva, L ; Schvartzman, P ; Matushita, CS ; Senra, T ; Shiozaki, A ; Menezes de Siqueira, ME ; Siqueira, C ; Smanio, P ; Soares, CE ; Junior, JS ; Bittencourt, MS ; Spiro, B ; Mesquita, CT ; Torreao, J ; Torres, R ; Uellendahl, M ; Monte, GU ; Veríssimo, O ; Cabeda, EV ; Pedras, FV ; Waltrick, R ; Zapparoli, M ; Naseer, H ; Garcheva-Tsacheva, M ; Kostadinova, I ; Theng, Y ; Abikhzer, G ; Barette, R ; Chow, B ; Dabreo, D ; Friedrich, M ; Garg, R ; Hafez, MN ; Johnson, C ; Kiess, M ; Leipsic, J ; Leung, E ; Miller, R ; Oikonomou, A ; Probst, S ; Roifman, I ; Small, G ; Tandon, V ; Trivedi, A ; White, J ; Zukotynski, K ; Canessa, J ; Muñoz, GC ; Concha, C ; Hidalgo, P ; Lovera, C ; Massardo, T ; Vargas, LS ; Abad, P ; Arturo, H ; Ayala, S ; Benitez, L ; Cadena, A ; Caicedo, C ; Moncayo, AC ; Moncayo, AC ; Gomez, S ; Gutierrez Villamil, CT ; Jaimes, C ; Londoño, J ; Londoño Blair, JL ; Pabon, L ; Pineda, M ; Rojas, JC ; Ruiz, D ; Escobar, MV ; Vasquez, A ; Vergel, D ; Zuluaga, A ; Gamboa, IB ; Castro, G ; González, U ; Baric, A ; Batinic, T ; Franceschi, M ; Paar, MH ; Jukic, M ; Medakovic, P ; Persic, V ; Prpic, M ; Punda, A ; Batista, JF ; Gómez Lauchy, JM ; Gutierrez, YM ; Gutierrez, YM ; Menéndez, R ; Peix, A ; Rochela, L ; Panagidis, C ; Petrou, I ; Engelmann, V ; Kaminek, M ; Kincl, V ; Lang, O ; Simanek, M ; Abdulla, J ; Bøttcher, M ; Christensen, M ; Gormsen, LC ; Hasbak, P ; Hess, S ; Holdgaard, P ; Johansen, A ; Kyhl, K ; Norgaard, BL ; Øvrehus, KA ; Rønnow Sand, NP ; Steffensen, R ; Thomassen, A ; Zerahn, B ; Perez, A ; Escorza Velez, GA ; Velez, MS ; Abdel Aziz, IS ; Abougabal, M ; Ahmed, T ; Allam, A ; Asfour, A ; Hassan, M ; Hassan, A ; Ibrahim, A ; Kaffas, S ; Kandeel, A ; Ali, MM ; Mansy, A ; Maurice, H ; Nabil, S ; Shaaban, M ; Flores, AC ; Poksi, A ; Knuuti, J ; Kokkonen, V ; Larikka, M ; Uusitalo, V ; Bailly, M ; Burg, S ; Deux, J-F ; Habouzit, V ; Hyafil, F ; Lairez, O ; Proffit, F ; Regaieg, H ; Sarda-Mantel, L ; Tacher, V ; Schneider, RP ; Ayetey, H ; Angelidis, G ; Archontaki, A ; Chatziioannou, S ; Datseris, I ; Fragkaki, C ; Georgoulias, P ; Koukouraki, S ; Koutelou, M ; Kyrozi, E ; Repasos, E ; Stavrou, P ; Valsamaki, P ; Gonzalez, C ; Gutierrez, G ; Maldonado, A ; Buga, K ; Garai, I ; Maurovich-Horvat, P ; Schmidt, E ; Szilveszter, B ; Várady, E ; Banthia, N ; Bhagat, JK ; Bhargava, R ; Bhat, V ; Bhatia, M ; Choudhury, P ; Chowdekar, VS ; Irodi, A ; Jain, S ; Joseph, E ; Kumar, S ; Girijanandan Mahapatra, PD ; Mitra, D ; Mittal, BR ; Ozair, A ; Patel, C ; Patel, T ; Patel, R ; Patel, S ; Saxena, S ; Sengupta, S ; Singh, S ; Singh, B ; Sood, A ; Verma, A ; Affandi, E ; Alam, PS ; Edison, E ; Gunawan, G ; Hapkido, H ; Hidayat, B ; Huda, A ; Mukti, AP ; Prawiro, D ; Soeriadi, EA ; Syawaluddin, H ; Albadr, A ; Assadi, M ; Emami, F ; Houshmand, G ; Maleki, M ; Rostami, MT ; Zakavi, SR ; Zaid, EA ; Agranovich, S ; Arnson, Y ; Bar-Shalom, R ; Frenkel, A ; Knafo, G ; Lugassi, R ; Maor Moalem, IS ; Mor, M ; Muskal, N ; Ranser, S ; Shalev, A ; Albano, D ; Alongi, P ; Arnone, G ; Bagatin, E ; Baldari, S ; Bauckneht, M ; Bertelli, P ; Bianco, F ; Bonfiglioli, R ; Boni, R ; Bruno, A ; Bruno, I ; Busnardo, E ; Califaretti, E ; Camoni, L ; Carnevale, A ; Casoni, R ; Cavallo, AU ; Cavenaghi, G ; Chierichetti, F ; Chiocchi, M ; Cittanti, C ; Colletta, M ; Conti, U ; Cossu, A ; Cuocolo, A ; Cuzzocrea, M ; De Rimini, ML ; De Vincentis, G ; Del Giudice, E ; Del Torto, A ; Della Tommasina, V ; Durmo, R ; Erba, PA ; Evangelista, L ; Faletti, R ; Faragasso, E ; Farsad, M ; Ferro, P ; Florimonte, L ; Frantellizzi, V ; Fringuelli, FM ; Gatti, M ; Gaudiano, A ; Gimelli, A ; Giubbini, R ; Giuffrida, F ; Ialuna, S ; Laudicella, R ; Leccisotti, L ; Leva, L ; Liga, R ; Liguori, C ; Longo, G ; Maffione, M ; Mancini, ME ; Marcassa, C ; Milan, E ; Nardi, B ; Pacella, S ; Pepe, G ; Pontone, G ; Pulizzi, S ; Quartuccio, N ; Rampin, L ; Ricci, F ; Rossini, P ; Rubini, G ; Russo, V ; Sacchetti, GM ; Sambuceti, G ; Scarano, M ; Sciagrà, R ; Sperandio, M ; Stefanelli, A ; Ventroni, G ; Zoboli, S ; Baugh, D ; Chambers, D ; Madu, E ; Nunura, F ; Asano, H ; Chimura, CM ; Fujimoto, S ; Fujisue, K ; Fukunaga, T ; Fukushima, Y ; Fukuyama, K ; Hashimoto, J ; Ichikawa, Y ; Iguchi, N ; Imai, M ; Inaki, A ; Ishimura, H ; Isobe, S ; Kadokami, T ; Kato, T ; Kudo, T ; Kumita, S ; Maruno, H ; Mataki, H ; Miyagawa, M ; Morimoto, R ; Moroi, M ; Nagamachi, S ; Nakajima, K ; Nakata, T ; Nakazato, R ; Nanasato, M ; Naya, M ; Norikane, T ; Ohta, Y ; Okayama, S ; Okizaki, A ; Otomi, Y ; Otsuka, H ; Saito, M ; Sakata, SY ; Sarai, M ; Sato, D ; Shiraishi, S ; Suwa, Y ; Takanami, K ; Takehana, K ; Taki, J ; Tamaki, N ; Taniguchi, Y ; Teragawa, H ; Tomizawa, N ; Tsujita, K ; Umeji, K ; Wakabayashi, Y ; Yamada, S ; Yamazaki, S ; Yoneyama, T ; Rawashdeh, M ; Batyrkhanov, D ; Dautov, T ; Makhdomi, K ; Ombati, K ; Alkandari, F ; Garashi, M ; Coie, TL ; Rajvong, S ; Kalinin, A ; Kalnina, M ; Haidar, M ; Komiagiene, R ; Kviecinskiene, G ; Mataciunas, M ; Vajauskas, D ; Picard, C ; Karim, NKA ; Reichmuth, L ; Samuel, A ; Allarakha, MA ; Naojee, AS ; Alexanderson-Rosas, E ; Barragan, E ; González-Montecinos, AB ; Cabada, M ; Rodriguez, DC ; Carvajal-Juarez, I ; Cortés, V ; Cortés, F ; De La Peña, E ; Gama-Moreno, M ; González, L ; Ramírez, NG ; Jiménez-Santos, M ; Matos, L ; Monroy, E ; Morelos, M ; Ornelas, M ; Ortga Ramirez, JA ; Preciado-Anaya, A ; Preciado-Gutiérrez, ÓU ; Barragan, AP ; Rosales Uvera, SG ; Sandoval, S ; Tomas, MS ; Sierra-Galan, LM ; Sierra-Galan, LM ; Siu, S ; Vallejo, E ; Valles, M ; Faraggi, M ; Sereegotov, E ; Ilic, S ; Ben-Rais, N ; Alaoui, NI ; Taleb, S ; Pa Myo, KP ; Thu, PS ; Ghimire, RK ; Rajbanshi, B ; Barneveld, P ; Glaudemans, A ; Habets, J ; Koopmans, KP ; Manders, J ; Pool, S ; Scholte, A ; Scholtens, A ; Slart, R ; Thimister, P ; Van Asperen, E-J ; Veltman, N ; Verschure, D ; Wagenaar, N ; Edmond, J ; Ellis, C ; Johnson, K ; Keenan, R ; Kueh, SHA ; Occleshaw, C ; Sasse, A ; To, A ; Van Pelt, N ; Young, C ; Cuadra, T ; Roque Vanegas, HB ; Soli, IA ; Issoufou, DM ; Ayodele, T ; Madu, C ; Onimode, Y ; Efros-Monsen, E ; Forsdahl, SH ; Hildre Dimmen, J-M ; Jørgensen, A ; Krohn, I ; Løvhaugen, P ; Bråten, AT ; Al Dhuhli, H ; Al Kindi, F ; Al-Bulushi, N ; Jawa, Z ; Tag, N ; Afzal, MS ; Fatima, S ; Younis, MN ; Riaz, M ; Saadullah, M ; Herrera, Y ; Lenturut-Katal, D ; Vázquez, MC ; Ortellado, J ; Akhter, A ; Cao, D ; Cheung, S ; Dai, X ; Gong, L ; Han, D ; Hou, Y ; Li, C ; Li, T ; Li, D ; Li, S ; Liu, J ; Liu, H ; Lu, B ; Ng, MY ; Sun, K ; Tang, G ; Wang, J ; Wang, X ; Wang, Z-Q ; Wang, Y ; Wang, Y ; Wu, J ; Wu, Z ; Xia, L ; Xiao, J ; Xu, L ; Yang, Y ; Yin, W ; Yu, J ; Yuan, L ; Zhang, T ; Zhang, L ; Zhang, Y-G ; Zhang, X ; Zhu, L ; Alfaro, A ; Abrihan, P ; Barroso, A ; Cruz, E ; Gomez, MR ; Magboo, VP ; Medina, JM ; Obaldo, J ; Pastrana, D ; Pawhay, CM ; Quinon, A ; Tang, JM ; Tecson, B ; Uson, KJ ; Uy, M ; Kostkiewicz, M ; Kunikowska, J ; Bettencourt, N ; Cantinho, G ; Ferreira, A ; Syed, G ; Arnous, S ; Atyani, S ; Byrne, A ; Gleeson, T ; Kerins, D ; Meehan, C ; Murphy, D ; Murphy, M ; Murray, J ; O'Brien, J ; Bang, J-I ; Bom, H ; Cho, S-G ; Hong, CM ; Jang, SJ ; Jeong, YH ; Kang, WJ ; Kim, J-Y ; Lee, J ; Namgung, CK ; So, Y ; Won, KS ; Majstorov, V ; Vavlukis, M ; Salobir, BG ; Štalc, M ; Benedek, T ; Benedek, I ; Mititelu, R ; Stan, CA ; Ansheles, A ; Dariy, O ; Drozdova, O ; Gagarina, N ; Gulyaev, VM ; Itskovich, I ; Karalkin, A ; Kokov, A ; Migunova, E ; Pospelov, V ; Ryzhkova, D ; Saifullina, G ; Sazonova, S ; Sergienko, V ; Shurupova, I ; Trifonova, T ; Ussov, WY ; Vakhromeeva, M ; Valiullina, N ; Zavadovsky, K ; Zhuravlev, K ; Alasnag, M ; Okarvi, S ; Saranovic, DS ; Keng, F ; Jason See, JH ; Sekar, R ; Yew, MS ; Vondrak, A ; Bejai, S ; Bennie, G ; Bester, R ; Engelbrecht, G ; Evbuomwan, O ; Gongxeka, H ; Vuuren, MJ ; Kaplan, M ; Khushica, P ; Lakhi, H ; Louw, L ; Malan, N ; Milos, K ; Modiselle, M ; More, S ; Naidoo, M ; Scholtz, L ; Vangu, M ; Aguadé-Bruix, S ; Blanco, I ; Cabrera, A ; Camarero, A ; Casáns-Tormo, I ; Cuellar-Calabria, H ; Flotats, A ; Fuentes Cañamero, ME ; García, ME ; Jimenez-Heffernan, A ; Leta, R ; Diaz, JL ; Lumbreras, L ; Marquez-Cabeza, JJ ; Martin, F ; Martinez de Alegria, A ; Medina, F ; Canal, MP ; Peiro, V ; Pubul-Nuñez, V ; Rayo Madrid, JI ; Rey, CR ; Perez, RR ; Ruiz, J ; Hernández, GS ; Sevilla, A ; Zeidán, N ; Nanayakkara, D ; Udugama, C ; Simonsson, M ; Alkadhi, H ; Buechel, RR ; Burger, P ; Ceriani, L ; De Boeck, B ; Gräni, C ; Juillet de Saint Lager Lucas, A ; Kamani, CH ; Kawel-Boehm, N ; Manka, R ; Prior, JO ; Rominger, A ; Vallée, J-P ; Khiewvan, B ; Premprabha, T ; Thientunyakit, T ; Sellem, A ; Kir, KM ; Sayman, H ; Sebikali, MJ ; Muyinda, Z ; Kmetyuk, Y ; Korol, P ; Mykhalchenko, O ; Pliatsek, V ; Satyr, M ; Albalooshi, B ; Ahmed Hassan, MI ; Anderson, J ; Bedi, P ; Biggans, T ; Bularga, A ; Bull, R ; Burgul, R ; Carpenter, J-P ; Coles, D ; Cusack, D ; Deshpande, A ; Dougan, J ; Fairbairn, T ; Farrugia, A ; Gopalan, D ; Gummow, A ; Ramkumar, PG ; Hamilton, M ; Harbinson, M ; Hartley, T ; Hudson, B ; Joshi, N ; Kay, M ; Kelion, A ; Khokhar, A ; Kitt, J ; Lee, K ; Low, C ; Mak, SM ; Marousa, N ; Martin, J ; Mcalindon, E ; Menezes, L ; Morgan-Hughes, G ; Moss, A ; Murray, A ; Nicol, E ; Patel, D ; Peebles, C ; Pugliese, F ; Luis Rodrigues, JC ; Rofe, C ; Sabharwal, N ; Schofield, R ; Semple, T ; Sharma, N ; Strouhal, P ; Subedi, D ; Topping, W ; Tweed, K ; Weir-Mccall, J ; Abbara, S ; Abbasi, T ; Abbott, B ; Abohashem, S ; Abramson, S ; Al-Abboud, T ; Al-Mallah, M ; Almousalli, O ; Ananthasubramaniam, K ; Kumar, MA ; Askew, J ; Attanasio, L ; Balmer-Swain, M ; Bayer, RR ; Bernheim, A ; Bhatti, S ; Bieging, E ; Blankstein, R ; Bloom, S ; Blue, S ; Bluemke, D ; Borges, A ; Branch, K ; Bravo, P ; Brothers, J ; Budoff, M ; Bullock-Palmer, R ; Burandt, A ; Burke, FW ; Bush, K ; Candela, C ; Capasso, E ; Cavalcante, J ; Chang, D ; Chatterjee, S ; Chatzizisis, Y ; Cheezum, M ; Chen, T ; Chen, J ; Chen, M ; Choi, A ; Clarcq, J ; Cordero, A ; Crim, M ; Danciu, S ; Decter, B ; Dhruva, N ; Doherty, N ; Doukky, R ; Dunbar, A ; Duvall, W ; Edwards, R ; Esquitin, K ; Farah, H ; Fentanes, E ; Ferencik, M ; Fisher, D ; Fitzpatrick, D ; Foster, C ; Fuisz, T ; Gannon, M ; Gastner, L ; Gerson, M ; Ghoshhajra, B ; Goldberg, A ; Goldner, B ; Gonzalez, J ; Gore, R ; Gracia-López, S ; Hage, F ; Haider, A ; Haider, S ; Hamirani, Y ; Hassen, K ; Hatfield, M ; Hawkins, C ; Hawthorne, K ; Heath, N ; Hendel, R ; Hernandez, P ; Hill, G ; Horgan, S ; Huffman, J ; Hurwitz, L ; Iskandrian, A ; Janardhanan, R ; Jellis, C ; Jerome, S ; Kalra, D ; Kaviratne, S ; Kay, F ; Kelly, F ; Khalique, O ; Kinkhabwala, M ; Iii, GK ; Kircher, J ; Kirkbride, R ; Kontos, M ; Kottam, A ; Krepp, J ; Layer, J ; Lee, SH ; Leppo, J ; Lesser, J ; Leung, S ; Lewin, H ; Litmanovich, D ; Liu, Y ; Lopez-Mattei, J ; Magurany, K ; Markowitz, J ; Marn, A ; Matis, SE ; Mckenna, M ; Mcrae, T ; Mendoza, F ; Merhige, M ; Min, D ; Moffitt, C ; Moncher, K ; Moore, W ; Morayati, S ; Morris, M ; Mossa-Basha, M ; Mrsic, Z ; Murthy, V ; Nagpal, P ; Napier, K ; Nelson, K ; Nijjar, P ; Osman, M ; Parwani, P ; Passen, E ; Patel, A ; Patil, P ; Paul, R ; Phillips, L ; Polsani, V ; Poludasu, R ; Pomerantz, B ; Porter, T ; Prentice, R ; Pursnani, A ; Rabbat, M ; Ramamurti, S ; Rich, F ; Luna, HR ; Robinson, A ; Robles, K ; Rodríguez, C ; Rorie, M ; Rumberger, J ; Russell, R ; Sabra, P ; Sadler, D ; Schemmer, M ; Schoepf, UJ ; Shah, S ; Shah, N ; Shanbhag, S ; Sharma, G ; Shayani, S ; Shirani, J ; Shivaram, P ; Sigman, S ; Simon, M ; Slim, A ; Smith, D ; Smith, A ; Soman, P ; Sood, A ; Srichai-Parsia, MB ; Streeter, J ; T, A ; Tawakol, A ; Thomas, D ; Thompson, R ; Torbet, T ; Trinidad, D ; Ullery, S ; Unzek, S ; Uretsky, S ; Vallurupalli, S ; Verma, V ; Waller, A ; Wang, E ; Ward, P ; Weissman, G ; Wesbey, G ; White, K ; Winchester, D ; Wolinsky, D ; Yost, S ; Zgaljardic, M ; Alonso, O ; Beretta, M ; Ferrando, R ; Kapitan, M ; Mut, F ; Djuraev, O ; Rozikhodjaeva, G ; Le Ngoc, H ; Mai, SH ; Nguyen, XC (Elsevier BV, 2021-09)
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    Defining ICD-10 surrogate variables to estimate the modified frailty index: a Delphi-based approach.
    Subramaniam, A ; Ueno, R ; Tiruvoipati, R ; Darvall, J ; Srikanth, V ; Bailey, M ; Pilcher, D ; Bellomo, R (Springer Science and Business Media LLC, 2022-05-13)
    BACKGROUND: There are currently no validated globally and freely available tools to estimate the modified frailty index (mFI). The widely available and non-proprietary International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) coding could be used as a surrogate for the mFI. We aimed to establish an appropriate set of the ICD-10 codes for comorbidities to be used to estimate the eleven-variable mFI. METHODS: A three-stage, web-based, Delphi consensus-building process among a panel of intensivists and geriatricians using iterative rounds of an online survey, was conducted between March and July 2021. The consensus was set a priori at 75% overall agreement. Additionally, we assessed if survey responses differed between intensivists and geriatricians. Finally, we ascertained the level of agreement. RESULTS: A total of 21 clinicians participated in all 3 Delphi surveys. Most (86%, 18/21) had more than 5-years' experience as specialists. The agreement proportionately increased with every Delphi survey. After the third survey, the panel had reached 75% consensus in 87.5% (112/128) of ICD-10 codes. The initially included 128 ICD-10 variables were narrowed down to 54 at the end of the 3 surveys. The inter-rater agreements between intensivists and geriatricians were moderate for surveys 1 and 3 (κ = 0.728, κ = 0.780) respectively, and strong for survey 2 (κ = 0.811). CONCLUSIONS: This quantitative Delphi survey of a panel of experienced intensivists and geriatricians achieved consensus for appropriate ICD-10 codes to estimate the mFI. Future studies should focus on validating the mFI estimated from these ICD-10 codes. TRIAL REGISTRATION: Not applicable.
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    Feasibility of a refurbished shipping container as a transportable laboratory for rapid SARS-CoV-2 diagnostics.
    Muhi, S ; Tayler, N ; Hoang, T ; Prestedge, J ; Lee, JYH ; Ballard, SA ; Isles, N ; Wlodek, A ; Greenhalgh, A ; Williamson, DA ; Howden, BP ; Stinear, TP (Microbiology Society, 2022)
    Background: Australia's response to the coronavirus disease 2019 (COVID-19) pandemic relies on widespread availability of rapid, accurate testing and reporting of results to facilitate contact tracing. The extensive geographical area of Australia presents a logistical challenge, with many of the population located distant from a laboratory capable of robust severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) detection. A strategy to address this is the deployment of a mobile facility utilizing novel diagnostic platforms. This study aimed to evaluate the feasibility of a fully contained transportable SARS-CoV-2 testing laboratory using a range of rapid point-of-care tests. Method: A 20 ft (6.1 m) shipping container was refurbished (GeneWorks, Adelaide, South Australia) with climate controls, laboratory benches, hand-wash station and a class II biosafety cabinet. Portable marquees situated adjacent to the container served as stations for registration, sample acquisition and personal protective equipment for staff. Specimens were collected and tested on-site utilizing either the Abbott ID NOW or Abbott Panbio rapid tests. SARS-CoV-2 positive results from the rapid platforms or any participants reporting symptoms consistent with COVID-19 were tested on-site by GeneXpert Xpress RT-PCR. All samples were tested in parallel with a standard-of-care RT-PCR test (Panther Fusion SARS-CoV-2 assay) performed at the public health reference laboratory. In-laboratory environmental conditions and data management-related factors were also recorded. Results: Over a 3 week period, 415 participants were recruited for point-of-care SARS-CoV-2 testing. From time of enrolment, the median result turnaround time was 26 min for the Abbott ID NOW, 32 min for the Abbott Panbio and 75 min for the Xpert Xpress. The environmental conditions of the refurbished shipping container were found to be suitable for all platforms tested, although humidity may have produced condensation within the container. Available software enabled turnaround times to be recorded, although technical malfunction resulted in incomplete data capture. Conclusion: Transportable container laboratories can enable rapid COVID-19 results at the point of care and may be useful during outbreak settings, particularly in environments that are physically distant from centralized laboratories. They may also be appropriate in resource-limited settings. The results of this pilot study confirm feasibility, although larger trials to validate individual rapid point-of-care testing platforms in this environment are required.
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    Whole genome sequencing and molecular epidemiology of paediatric Staphylococcus aureus bacteraemia.
    Campbell, AJ ; Mowlaboccus, S ; Coombs, GW ; Daley, DA ; Al Yazidi, LS ; Phuong, LK ; Leung, C ; Best, EJ ; Webb, RH ; Voss, L ; Athan, E ; Britton, PN ; Bryant, PA ; Butters, CT ; Carapetis, JR ; Ching, NS ; Francis, J ; Hung, T-Y ; Nourse, C ; Ojaimi, S ; Tai, A ; Vasilunas, N ; McMullan, B ; Bowen, AC ; Blyth, CC ; Australian and New Zealand Pediatric Infectious Diseases (ANZPID) clinical research network (CRN) of the Australasian Society of Infectious Diseases (ASID) and the Australian Group on Antimicrobial Resistance (AGAR), (Elsevier BV, 2022-06)
    OBJECTIVES: The role Staphylococcus aureus antimicrobial resistance genes and toxins play in disease severity, management and outcome in childhood is an emerging field requiring further exploration. METHODS: A prospective multisite study of Australian and New Zealand children hospitalised with S. aureus bacteraemia (SAB) occurred over 24 months (2017-2018). Whole genome sequencing (WGS) data were paired with clinical information from the ISAIAH cohort. RESULTS: 353 SAB isolates were sequenced; 85% methicillin-susceptible S. aureus ([MSSA], 301/353) and 15% methicillin-resistant S. aureus ([MRSA], 52/353). There were 92 sequence types (STs), most commonly ST5 (18%) and ST30 (8%), grouped into 23 clonal complexes (CCs), most frequently CC5 (21%) and CC30 (12%). MSSA comprised the majority of healthcare-associated SAB (87%, 109/125), with principal clones CC15 (48%, 11/21) and CC8 (33%, 7/21). Panton-Valentine leukocidin (PVL)-positive SAB occurred in 22% (76/353); predominantly MSSA (59%, 45/76), community-onset (92%, 70/76) infections. For community-onset SAB, the only microbiological independent predictor of poor outcomes was PVL positivity (aOR 2.6 [CI 1.0-6.2]). CONCLUSION: From this WGS paediatric SAB data, we demonstrate the previously under-recognized role MSSA has in harbouring genetic virulence and causing healthcare-associated infections. PVL positivity was the only molecular independent predictor of poor outcomes in children. These findings underscore the need for further research to define the potential implications PVL-producing strains may have on approaches to S. aureus clinical management.