https://dora.health.qld.gov.au/qldresearchjspui/handle/1/858 2026-05-17T20:58:07Z https://dora.health.qld.gov.au/qldresearchjspui/handle/1/7598 Title: Intramedullary Screw Fixation of Proximal Phalangeal Fractures: Short- to Medium-term Outcomes Authors: Abbot, Hagen; George, Adam R.; McCarron, Luke; Graham, David J.; Sivakumar, Brahman Abstract: Background: Intramedullary screw fixation of phalangeal and metacarpal fractures has gained popularity as a method of providing rigid internal fixation with minimum tendon disturbance, allowing early mobilization and rehabilitation. Despite this, the literature on outcomes using this technique is limited. Thus, the aim of this study was to assess the short-term to medium-term outcomes of intramedullary screw fixation for proximal phalangeal fracture fixation in an Australian setting.; Methods: A retrospective analysis of consecutive patients with a fracture(s) of the proximal phalanx fixated using intramedullary screws between January 2020 and March 2023 was conducted via telehealth.; Results: Forty-six phalangeal fractures from 37 patients were included in this study. Mean Quick Disabilities of the Arm, Shoulder, and Hand score of 6.2 (range: 0-61.4, median: 0), mean pain visual analogue scale score of 1.8 (range: 1-7, median: 1), and mean total active motion of 231° (range: 132-282) were noted. A total of 4.4% of fractures sustained a major complication, and 94.6% of patients reported willingness to undergo intramedullary screw fixation again.; Conclusion: This study concurs with the prior literature that intramedullary screw fixation is a safe and effective method of stabilizing extra-articular proximal phalangeal fractures in the short to medium term. Superior clinical outcomes, as well as cost-effectiveness and time-effectiveness, render it a viable alternative to plate fixation in this setting.; Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. 2024-01-01T00:00:00Z https://dora.health.qld.gov.au/qldresearchjspui/handle/1/7597 Title: Neurodevelopmental follow-up care pathways and processes for children with congenital heart disease in Australia Authors: Abell, Bridget; Rodwell, David; Eagleson, Karen J.; Auld, Ben; Bora, Samudragupta; Kasparian, Nadine A.; Justo, Robert; Parsonage, William; McPhail, Steven M. Abstract: Background: International consensus exists for neurodevelopmental follow-up care of children with congenital heart disease (CHD) to support timely intervention for developmental delays. Yet, documentation of how this care is implemented in Australia is lacking. This study aimed to identify, categorise, and understand care pathways and services supporting neurodevelopmental follow-up of Australian children with CHD.; Methods: A qualitative study, using semi-structured virtual interviews with healthcare professionals across Australia involved in neurodevelopmental care of children with CHD (n = 52) was conducted. Data was analysed using a rapid qualitative approach including structured templates, data reduction, and inductive-deductive analysis of matrices to synthesise data.; Results: Most neurodevelopmental follow-up was delivered as pathways through existing healthcare services rather than centre-based cardiac programmes. Service availability and accessibility varied across the country. Community-based primary care services, paediatric clinics, child development services, neonatal follow-up programmes, and allied health providers were commonly accessed pathway components. However, participants reported a lack of formal structures to coordinate care pathways.; Conclusions: The study identifies how cardiac neurodevelopmental follow-up in Australia can be embedded into existing services and adapted to meet local needs and contexts. Future approaches will benefit from integrating, leveraging, and growing existing services, although adoption of new models may be needed.; Impact: This study found neurodevelopmental follow-up care for children with CHD in Australia to be delivered as pathways through existing services rather than the centre-based cardiac follow-up programmes common in North America. Our study describes alternate options, including providers in community settings, that can be used for follow-up care delivery and how these can adapted to local context. Future approaches will benefit from integrating, leveraging, and growing existing services, although adoption of new models may be needed. Greater systematic coordination of care pathways is still required to optimise service delivery, inform planning, and support implementation of national standards of care.; Competing Interests: Competing interests: The authors declare no competing interests. Consent statement: Consistent with our ethical approval, informed verbal consent was obtained from every participant prior to starting each interview. (© 2024. The Author(s).) 2024-01-01T00:00:00Z https://dora.health.qld.gov.au/qldresearchjspui/handle/1/7594 Title: Success and Feasibility of Multiple Breath Washout: Prospective Multi-center Results From the Transpire Study Authors: Abts, M. F.; Silva Carmona, M. D.; Allen, J. L.; Robinson, P. D.; Doherty, E. E.; Baker, K. S.; MacMillan, M. L.; Genatassio, A.; Lacher, P.; Griffin, T.; Tekmen, M.; Ballard, S.; Azamian, M. S.; Schimelpfenig, B.; Koo, J.; Edwards, S. L.; Woods, J. C.; Davies, S. M.; Goldfarb, S. B. Abstract: Rationale: Pulmonary complications, e.g., pulmonary chronic graft vs host disease and bronchiolitis obliterans, are major causes of morbidity and mortality following hematopoietic stem cell transplant. Pulmonary function testing is insensitive for detecting changes in small airways. Multiple breath nitrogen washout (MBW) is a technique used to detect ventilation heterogeneity. Primary outcome of MBW testing is lung clearance index (LCI), lung turnovers required to clear an inert gas (N2). Utilization of LCI as a marker for early disease may allow for early diagnosis. Methods: TRANSPIRE is a prospective cohort study of lung injury after pediatric HSCT. Eligible participants undergo repeated pulmonary evaluations that include PFTs, 6MWT, IOS, MBW, and 129Xe MRI. This descriptive report aims to evaluate the feasibility and success of surveillance MBW in this cohort. Subjects ≥6 years of age across 3/7 participating centers were eligible for MBW testing. Data were reviewed through Sept 14, 2023. Results: 49 participants across 3 centers were eligible for MBW. Thirty-one (63.3%) subjects attempted at least 1 MBW test completing 56 unique results. Mean age for those performing MBW was 14.01 years (6.33 - 24.8). There were more males (18/31, 58.1%). Malignancy was the most common primary diagnosis (22, 71.0%), followed by benign hematologic conditions (3), immune deficiencies (2), marrow failure (2), and genetic/metabolic causes (2). Three eligible subjects were unable to produce acceptable results due to poor technique or intolerance of testing conditions. The remainder of missing data was secondary to missed appointments, intercurrent illnesses, or refusal to participate. 22/31 (71.0%) participants with at least 1 MBW attempt have pretransplant baseline data. Eight (36.4%) of these subjects also have at least one additional post-transplant data point (Figure 1A). The mean baseline LCI2.5 was 6.50 +/-0.99 SD (range 5.35 - 9.79, ULN 7.9) (Figure 1). For pre-transplant baseline data, only one had an abnormal LCI2.5 above the upper limit of normal. Twenty-nine percent (9/31) had abnormal spirometry prior to transplant. DLCO uncorrected for hemoglobin was abnormal in 29% (6/21) at baseline and 54% (7/13) at day 100. Thirty-eight documented pulmonary events occurred in 31 participants. Two subjects registered an abnormal LCI2.5 at any timepoint. Conclusions: MBW is a feasible test that can be reliably done in patients as young as 6 years of age, regardless of primary disease or baseline pulmonary status. The relevance and applicability of outcome variables such as LCI have yet to be determined given our small sample size to date. 2024-01-01T00:00:00Z https://dora.health.qld.gov.au/qldresearchjspui/handle/1/7596 Title: "It's more than just a conversation about the heart": exploring barriers, enablers, and opportunities for improving the delivery and uptake of cardiac neurodevelopmental follow-up care Authors: Abell, Bridget; Rodwell, David; Eagleson, Karen J.; Parsonage, William; Auld, Ben; Bora, Samudragupta; Kasparian, Nadine A.; Justo, Robert; McPhail, Steven M. Abstract: Introduction: Surveillance, screening, and evaluation for neurodevelopmental delays is a pivotal component of post-surgical care for children with congenital heart disease (CHD). However, challenges exist in implementing such neurodevelopmental follow-up care in international practice. This study aimed to characterise key barriers, enablers, and opportunities for implementing and delivering outpatient cardiac neurodevelopmental follow-up care in Australia.; Methods: an exploratory descriptive qualitative study was conducted with healthcare professionals across Australia who had lived experience of designing, implementing, or delivering neurodevelopmental care for children with CHD. Online semi-structured interviews were conducted using a guide informed by the Consolidated Framework for Implementation Research to explore contextual influences. Interview transcripts were analysed using a rapid qualitative approach including templated summaries and hybrid deductive-inductive matrix analysis.; Results: fifty-two participants were interviewed. Perceived barriers and enablers were organised into six higher-order themes: factors in the broader environmental, economic, and political context; healthcare system factors; organisational-level factors; provider factors; patient and family factors; and care model factors. The largest number of barriers occurred at the healthcare system level (service accessibility, fragmentation, funding, workforce), while service providers demonstrated the most enabling factors (interprofessional relationships, skilled teams, personal characteristics). Strategies to improve practice included building partnerships; generating evidence; increasing funding; adapting for family-centred care; and integrating systems and data.; Discussion: Australia shares many similar barriers and enablers to cardiac neurodevelopmental care with other international contexts. However, due to unique geographical and health-system factors, care models and implementation strategies will require adaption to the local context to improve service provision.; Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. (© 2024 Abell, Rodwell, Eagleson, Parsonage, Auld, Bora, Kasparian, Justo and McPhail.) 2024-01-01T00:00:00Z