Western NSW Local Health District

PURPOSE Palbociclib is a cyclin-dependent kinase 4 and 6 inhibitor approved for advanced breast cancer. In the adjuvant setting, the potential value of adding palbociclib to endocrine therapy for hormone receptor–positive breast cancer has not been confirmed. PATIENTS AND METHODS In the prospective, randomized, phase III PALLAS trial, patients with hormone receptor–positive, human epidermal growth factor receptor 2–negative early breast cancer were randomly assigned to receive 2 years of palbociclib (125 mg orally once daily, days 1-21 of a 28-day cycle) with adjuvant endocrine therapy or adjuvant endocrine therapy alone (for at least 5 years). The primary end point of the study was invasive disease-free survival (iDFS); secondary end points were invasive breast cancer–free survival, distant recurrence-free survival, locoregional cancer-free survival, and overall survival. RESULTS Among 5,796 patients enrolled at 406 centers in 21 countries worldwide over 3 years, 5,761 were included in the intention-to-treat population. At the final protocol-defined analysis, at a median follow-up of 31 months, iDFS events occurred in 253 of 2,884 (8.8%) patients who received palbociclib plus endocrine therapy and in 263 of 2,877 (9.1%) patients who received endocrine therapy alone, with similar results between the two treatment groups (iDFS at 4 years: 84.2% v 84.5%; hazard ratio, 0.96; CI, 0.81 to 1.14; P = .65). No significant differences were observed for secondary time-to-event end points, and subgroup analyses did not show any differences by subgroup. There were no new safety signals for palbociclib in this trial. CONCLUSION At this final analysis of the PALLAS trial, the addition of adjuvant palbociclib to standard endocrine therapy did not improve outcomes over endocrine therapy alone in patients with early hormone receptor–positive breast cancer.

New approaches to the prognostic assessment of breast cancer have come from molecular profiling studies. A major feature of this work has been to emphasise the importance of cancer cell proliferation as a key discriminative indicator of recurrence risk for oestrogen receptor positive breast cancer in particular. Mitotic count scoring, as a component of histopathological grade, has long formed part of a routine evaluation of breast cancer biology. However, there is an increasingly compelling case to include a specific proliferation score in breast cancer pathology reports based on expression of the cell cycle regulated protein Ki67. Immunohistochemical staining for Ki67 is a widely available and economical test with good tolerance of pre-analytical variations and staining conditions. However, there is currently no evidence based protocol established to derive a reliable and informative Ki67 score for routine clinical use. In this circumstance, pathologists must establish a standardised framework for scoring Ki67 and communicating results to a multidisciplinary team.

Abstract Background Post‐traumatic stress disorder (PTSD) is highly prevalent in children and adolescents who have experienced trauma and has high personal and health costs. Although a wide range of psychological therapies have been used in the treatment of PTSD there are no systematic reviews of these therapies in children and adolescents. Objectives To examine the effectiveness of psychological therapies in treating children and adolescents who have been diagnosed with PTSD. Search methods We searched the Cochrane Depression, Anxiety and Neurosis Review Group's Specialised Register (CCDANCTR) to December 2011. The CCDANCTR includes relevant randomised controlled trials from the following bibliographic databases: CENTRAL (the Cochrane Central Register of Controlled Trials ) (all years), EMBASE (1974 ‐), MEDLINE (1950 ‐) and PsycINFO (1967 ‐). We also checked reference lists of relevant studies and reviews. We applied no date or language restrictions. Selection criteria All randomised controlled trials of psychological therapies compared to a control, pharmacological therapy or other treatments in children or adolescents exposed to a traumatic event or diagnosed with PTSD. Data collection and analysis Two members of the review group independently extracted data. If differences were identified, they were resolved by consensus, or referral to the review team. We calculated the odds ratio (OR) for binary outcomes, the standardised mean difference (SMD) for continuous outcomes, and 95% confidence intervals (CI) for both, using a fixed‐effect model. If heterogeneity was found we used a random‐effects model. Main results Fourteen studies including 758 participants were included in this review. The types of trauma participants had been exposed to included sexual abuse, civil violence, natural disaster, domestic violence and motor vehicle accidents. Most participants were clients of a trauma‐related support service. The psychological therapies used in these studies were cognitive behavioural therapy (CBT), exposure‐based, psychodynamic, narrative, supportive counselling, and eye movement desensitisation and reprocessing (EMDR). Most compared a psychological therapy to a control group. No study compared psychological therapies to pharmacological therapies alone or as an adjunct to a psychological therapy. Across all psychological therapies, improvement was significantly better (three studies, n = 80, OR 4.21, 95% CI 1.12 to 15.85) and symptoms of PTSD (seven studies, n = 271, SMD ‐0.90, 95% CI ‐1.24 to ‐0.42), anxiety (three studies, n = 91, SMD ‐0.57, 95% CI ‐1.00 to ‐0.13) and depression (five studies, n = 156, SMD ‐0.74, 95% CI ‐1.11 to ‐0.36) were significantly lower within a month of completing psychological therapy compared to a control group. The psychological therapy for which there was the best evidence of effectiveness was CBT. Improvement was significantly better for up to a year following treatment (up to one month: two studies, n = 49, OR 8.64, 95% CI 2.01 to 37.14; up to one year: one study, n = 25, OR 8.00, 95% CI 1.21 to 52.69). PTSD symptom scores were also significantly lower for up to one year (up to one month: three studies, n = 98, SMD ‐1.34, 95% CI ‐1.79 to ‐0.89; up to one year: one study, n = 36, SMD ‐0.73, 95% CI ‐1.44 to ‐0.01), and depression scores were lower for up to a month (three studies, n = 98, SMD ‐0.80, 95% CI ‐1.47 to ‐0.13) in the CBT group compared to a control. No adverse effects were identified. No study was rated as a high risk for selection or detection bias but a minority were rated as a high risk for attrition, reporting and other bias. Most included studies were rated as an unclear risk for selection, detection and attrition bias. Authors' conclusions There is evidence for the effectiveness of psychological therapies, particularly CBT, for treating PTSD in children and adolescents for up to a month following treatment. At this stage, there is no clear evidence for the effectiveness of one psychological therapy compared to others. There is also not enough evidence to conclude that children and adolescents with particular types of trauma are more or less likely to respond to psychological therapies than others. The findings of this review are limited by the potential for methodological biases, and the small number and generally small size of identified studies. In addition, there was evidence of substantial heterogeneity in some analyses which could not be explained by subgroup or sensitivity analyses. More evidence is required for the effectiveness of all psychological therapies more than one month after treatment. Much more evidence is needed to demonstrate the relative effectiveness of different psychological therapies or the effectiveness of psychological therapies compared to other treatments. More details are required in future trials in regards to the types of trauma that preceded the diagnosis of PTSD and whether the traumas are single event or ongoing. Future studies should also aim to identify the most valid and reliable measures of PTSD symptoms and ensure that all scores, total and sub‐scores, are consistently reported. Plain Language Summary Psychological therapies for the treatment of post‐traumatic stress disorder in children and adolescents Post‐traumatic stress disorder (PTSD) is highly prevalent in children and adolescents who have experienced trauma and has high personal and health costs. The aim of this review was to examine the effectiveness of all psychological therapies for the treatment of PTSD in children and adolescents. We searched for all randomised controlled trials comparing psychological therapies to a control, other psychological therapies or other therapies for the treatment of PTSD in children and adolescents aged 3 to 18 years. We identified 14 studies with a total of 758 participants. The types of trauma related to the PTSD were sexual abuse, civil violence, natural disaster, domestic violence and motor vehicle accidents. Most participants were clients of a trauma‐related support service. The psychological therapies used in the included studies were cognitive behavioural therapy (CBT), exposure‐based, psychodynamic, narrative, supportive counselling, and eye movement desensitisation and reprocessing (EMDR). Most included studies compared a psychological therapy to a control group. No study compared psychological therapies to medications or medications in combination with a psychological therapy. There was fair evidence for the effectiveness of psychological therapies, particularly CBT, for the treatment of PTSD in children and adolescents for up to a month following treatment. More evidence is required for the effectiveness of psychological therapies in the longer term and to be able to compare the effectiveness of one psychological therapy to another. The findings of this review are limited by the potential for bias in the included studies, possible differences between studies which could not be identified, the small number of identified studies and the low number of participants in most studies.

There is substantial evidence supporting the need for effective intervention for children and families living with parental mental illness. However, translation of this knowledge into mental health workforce practice remains variable, with a range of clinical practices and models of care evident. Nurses, who constitute the majority of the mental health workforce, are in prime positions to support children and families and provide preventative measures, identify those at risk, and intervene early. In this paper, we provide a framework for practice for nurses working with consumer parents. We contend that traditional models of nursing practice concentrating on the consumer are insufficient in meeting the needs of children and families living with parental mental illness. A focus on families needs to be core business for mental health nurses. A family-focused approach can be used to prevent problems for children and their families, and identify their strengths as well as vulnerabilities. Family-focused care is a useful framework from which to support families and address the challenges that might arise from parental mental illness, and to build individual and family resilience.

AIMS AND OBJECTIVES: This article reviews the available literature that supports implementing bedside clinical handover in nursing clinical practice and then seeks to identify key issues if any. BACKGROUND: Clinical handover practices are recognised as being an essential component in the effective transfer of clinical care between health practitioners. It is recognised that the point where a patient is 'handed over' from one clinician to another is significant in maintaining continuity of care and that doing this poorly can have significant safety issues for the patient. DESIGN: An integrated literature review. METHOD: A literature review of 45 articles was undertaken to understand bedside clinical handover and the issues related to the implementation of this process. RESULTS: It was identified that there are a number of clinical handover mnemonics available that provide structure to the process and that areas such as confidentiality, inclusion of the patient/carer and involving the multidisciplinary team remain topical issues for practitioners in implementing good clinical handover practices. CONCLUSIONS: This literature review identified a lack of literature available about the transfer of responsibility and accountability during clinical handover and auditing practices of the clinical handover process. The nurses were more concerned about confidentiality issues than were patients. The use of a structured tool was strongly supported; however, no one singular tool was considered suitable for all clinical areas. RELEVANCE TO CLINICAL PRACTICE: Nursing clinicians seeking to implement best practice within their professional speciality should consider some of the issues raised within this article and seek to address these issues by developing strategies to overcome them.

Abstract Objective Epidemiological studies have indicated that dietary patterns during pregnancy are associated with adverse pregnancy and birth outcomes such as hypertensive disorders of pregnancy (HDP), gestational diabetes mellitus (GDM), preterm birth (PTB) and low birth weight (LBW). However, the results of these studies are varied and inconsistent. The present study aimed to assess the association between dietary patterns and the risk of adverse pregnancy and birth outcomes. Design Systematic review and meta-analysis. Seven databases were searched for articles. Two reviewers performed the study selection and data extraction. A random-effects model was used to estimate pooled effect sizes of eligible studies. Setting Studies conducted all over the world were incorporated. Subjects The review focused on pregnant women. Results A total of twenty-one studies were identified. Adherence to a healthy dietary pattern (intake of vegetables, fruits, legumes, whole grains) was significantly associated with lower odds (OR; 95 % CI) of pre-eclampsia (0·78; 0·70, 0·86; I 2 =39·0 %, P =0·178), GDM (0·78; 0·56, 0·99; I 2 =68·6 %, P =0·013) and PTB (0·75; 0·57, 0·93; I 2 =89·6 %, P =0·0001). Conclusions Our review suggests that dietary patterns with a higher intake of fruits, vegetables, legumes, whole grains and fish are associated with a decreased likelihood of adverse pregnancy and birth outcomes. Further research should be conducted in low-income countries to understand the impact of limited resources on dietary intake and adverse pregnancy and birth outcomes.

OBJECTIVES: (i) To determine the prevalence of multiple sclerosis (MS) in New South Wales and South Australia; (ii) to compare these prevalences with those in other areas of Australia and to determine the relationship between prevalence and latitude; (iii) to examine the relative contribution of genetic and environmental factors in the aetiology of the disease in Australia; and (iv) to ascertain whether there had been a change in the frequency of the disease since 1961. RESULTS: The crude prevalence of MS in New South Wales on prevalence day (National Census Day, 30 June 1981) was 37.2/100,000 and the age-standardised prevalence 36.6/100,000. The female:male ratio was 2.3:1. The crude prevalence in South Australia was 29.4/100,000 and the age-standardised prevalence 28.8/100,000. The female:male ratio was 2.4:1. No Aborigines or Torres Strait Islanders with MS were identified. There was a significant increase in the prevalence with increasing south latitude in Australia, MS being about seven times more frequent in Hobart than in tropical Queensland, but no genetic differences were found in the surveyed population in different parts of Australia. A significant increase in the prevalence of MS occurred in most areas of Australia between 1961 and 1981, but this may not reflect a true increase in incidence. CONCLUSION: The increasing prevalence with increasing south latitude cannot readily be explained by genetic susceptibility, and suggests that environmental factors are important for expression of the disease.

Caladenia is very unusual in that it contains species that attract pollinators by two different strategies, food and sexual deception. Among the sexually deceptive species, baiting for pollinators has shown that within populations orchid species are typically pollinated by a single species of thynnine wasp. However, some wasp species can be pollinators of more than one species of orchid usually when their ranges do not overlap. There is a trend for closely related orchids to exploit wasps from the same genus, with different lineages of orchids often pollinated by different genera. Very little is known about pollination of food-deceptive Caladenia species, although it is evident they attract a suite of generalist food-seeking insects. Food-deceptive species have a higher pollination rate than do sexually deceptive species. Studies of population genetics and pollen movements are few, although they suggest a pattern of fine-scale genetic structuring within populations, owing to predominantly restricted seed dispersal and low genetic differentiation among populations as a consequence of rare long-distance seed-dispersal events. Both evolutionary and ecological research of Caladenia will greatly benefit from a better understanding of the insect species involved in pollination, their ecological requirements and the ecological and genetic consequences of food and sexual deception.

Geophagy, the ingestion of soil, has been reported for birds and other animals from many regions, but its functions remain debated. We report geophagy for the first time for New Guinea birds: four or five parrot species, two or three pigeon species, one hornbill species, one crow species and possibly one cassowary species. These species ate soil at an area of bare ground created by a landslide on a steep mountain slope. Parrots visited the site in the early morning, pigeons in the late afternoon, flying in from considerable distances. All 11 of these species are frugivores. In the vicinity, we recorded 133 other bird species (including 37 other frugivore species) that were not observed to visit the site. Within each taxonomic group of frugivores, those practising geophagy tended to be the largest species of their guild. To test hypotheses regarding the functions of geophagy, we carried out chemical and physical analyses of soil samples from the site. The ingested soil was much too fine‐grained to be useful as grit; it contained only modest levels of all 14 minerals analysed; it lacked buffering capacity; and there was no evidence that it protected against diarrhoea. Instead, the soil's high measured cation‐exchange capacity, high content of cation‐binding minerals and binding of large quantities of tannic acid and quinine suggest a different hypothesis: that geophagy in this case served to bind poisonous and/or bitter‐tasting secondary compounds in ingested fruits and seeds. Geophagy thus represents one weapon in the escalating biological warfare between plants and animal consumers‐an evolutionary arms race at which parrots excel. We discuss five unsolved problems posed by geophagy.

OBJECTIVE: We evaluated the use of MDCT in the diagnosis and management of lower gastrointestinal bleeding (hematochezia). CONCLUSION: MDCT is proposed as an alternative first-line investigation to locate lower gastrointestinal bleeding before placing the patient under observation or performing embolization or surgery.

OBJECTIVE: The aim of this study was to assess the spatial distribution and determinant factors of anaemia among reproductive age women in Ethiopia. METHODS: An in-depth analysis of the 2016 Ethiopian Demographic and Health Survey data was undertaken. Getis-Ord Gi* statistics were used to identify the hot and cold spot areas for anaemia among women of reproductive age. A multilevel logistic regression model was used to identify independent predictors of anaemia among women of reproductive age. RESULTS: Older age (adjusted OR [AOR]=0.75; 95% CI 0.64 to 0.96), no education (AOR=1.37; 95% CI 1.102 to 1.72), lowest wealth quantile (AOR=1.29; 95% CI 1.014 to 1.60), currently pregnant (AOR=1.28; 95% CI 1.10 to 1.51, currently breast feeding (AOR=1.09; 95% CI 1.025 to 1.28), high gravidity (AOR=1.39; 95% CI 1.13 to 1.69) and HIV positive (AOR=2.11; 95% CI 1.59 to 2.79) are individual factors associated with the occurrence of anaemia. Likewise, living in a rural area (AOR=1.29; 95% CI 1.02 to 1.63) and availability of unimproved latrine facilities (AOR=1.18; 95% CI 1.01 to 1.39) are community-level factors associated with higher odds of anaemia. The spatial analysis indicated that statistically high hotspots of anaemia were observed in the eastern (Somali, Dire Dawa and Harari regions) and north-eastern (Afar) parts of the country. CONCLUSION: The prevalence rate of anaemia among women of reproductive age varied across the country. Significant hotspots/high prevalence of anaemia was observed in the eastern and north-eastern parts of Ethiopia. Anaemia prevention strategies need to be targeted on rural residents, women with limited to no education, women who are breast feeding, areas with poor latrine facilities and women who are HIV positive.

The umbilical cord is a helical and tubular blood conduit connecting the foetus to the placenta. The umbilical cord achieves its final form by the 12th week of gestation and normally contains two arteries and a single vein, all embedded in Wharton's jelly. The structure of the umbilical cord receives only a cursory glance during many obstetric ultrasound examinations: with imaging limited to documenting the number of vessels within the cord and the insertion sites at the foetus and placenta. Extensive research into blood flow characteristics of the umbilical cord arteries has been undertaken and is now widely applied in contemporary ultrasound practice. In contrast, investigation of umbilical vein blood flow is only instigated in instances of foetal compromise when the spectral waveform of the ductus venosus and pulsations in the vein are scrutinised. The current level of ultrasound imaging of the umbilical vein demonstrates a lack of appreciation and knowledge about a structure that is crucial to sustaining foetal life. The goal of this review is to increase awareness of the importance of the umbilical cord. In addition, this review will provide an information platform for undertaking and critically analysing research into the umbilical cord by providing a summary of cord embryology, structure, foetal venous circulation and mechanisms of blood flow within the umbilical cord vein.

AIMS: To identify the challenges associated with using journaling as a method of data collection and to offer strategies for effectively managing those challenges. BACKGROUND: While journaling can be used for a variety of reasons, in the context of this paper, journaling refers to the process of participants sharing thoughts, ideas, feelings and experiences through writing and/or other media. Journaling is used in phenomenological research studies to record participant experiences in their natural contexts. DATA SOURCES: The findings are based on the experiences of the researchers during a qualitative study that explored the experiences of lesbian mothers and used journaling as one method of data collection. REVIEW METHODS: This is a methodological paper. DISCUSSION: Three main challenges affect journaling as a method of data collection: poor participation, feeling exposed and staying on track. Six strategies to promote participation in journaling are: coaching participants, limiting the journaling period, providing follow-up contact, promoting comfort, ensuring safety and providing clear content expectations. Each strategy is discussed and methods of implementing the strategies are offered. CONCLUSION: Journaling as a method of data collection has long been accepted as a valid method of accessing rich qualitative data. By acknowledging the common challenges associated with the process of journaling that are experienced by the participants, researchers employing this data collection method can promote constructive and valuable participation. IMPLICATIONS FOR FUTURE RESEARCH: Further research examining participants' experiences of journaling as a method of qualitative data collection would be useful in determining challenges, barriers and benefits of the method.

AIMS: To review the impact of prenatal alcohol exposure on the outcomes of the mother and child. DESIGN: Narrative review. SETTING: Review of literature. PARTICIPANTS: Mothers and infants affected by prenatal alcohol use. MEASUREMENTS: Outcomes of mothers and children. FINDINGS: Prenatal alcohol exposure is one of the most important causes of preventable cognitive impairment in the world. The developing neurological system is exquisitely sensitive to harm from alcohol and there is now also substantial evidence that alcohol-related harm can extend beyond the individual person, leading to epigenetic changes and intergenerational vulnerability and disadvantage. There is no known safe level or timing of drinking for pregnant or lactating women and binge drinking (> four drinks within 2 hours for women) is the most harmful. Alcohol-exposure increases the risk of congenital problems, including Fetal Alcohol Spectrum Disorder (FASD) and its most severe form, Fetal Alcohol Syndrome (FAS). CONCLUSION: The impact of FASD and FAS is enduring and life-long with no current treatment or cure. Emerging therapeutic options may mitigate the worst impact of alcohol exposure but significant knowledge gaps remain. This review discusses the history, epidemiology and clinical presentations of prenatal alcohol exposure, focusing on FASD and FAS, and the impact of evidence on future research, practice and policy directions.

Emotional support for patients is critical for achieving person-centered care. However, the literature evidences an ongoing challenge in embedding emotional support within current health services. This study aimed to investigate the strategies to embed emotional support from the perspectives of patients and clinicians. This is an exploratory qualitative study that collected data through focus group discussions (FGDs) and interviews from 11 patients, 2 carers, and 7 clinicians in the multi-disciplinary care teams in an outpatient complex and chronic care setting in New South Wales, Australia. The FGDs and interviews were recorded, transcribed, and thematically analyzed. Three main themes emerged from the experience of both the patients and clinicians: (1) warmth and kindness, (2) deep listening, and (3) social connection in the process of treatment. Clinicians' and patients' shared experience of these themes was key to embed emotional support in care. Practical strategies including promoting shared understanding of emotional support, enhancing provider's capability to deliver emotional support, and building patient's networking opportunities in treatment processes were discussed to facilitate emotional support in patient care and health services.

During the recent coronavirus disease (COVID-19) pandemic, telehealth has received greater attention due to its role in reducing hospital visits from patients with COVID-19 or other conditions, while supporting home isolation in patients with mild symptoms. The needs of patients with chronic diseases tend to be overlooked during the pandemic. With reduced opportunities for routine clinic visits, these patients are adopting various telehealth services such as video consultation and remote monitoring. We advocate for more innovative designs to be considered to enhance patients' feelings of "copresence"-a sense of connection with another interactant via digital technology-with their health care providers during this time. The copresence-enhanced design has been shown to reduce patients' anxiety and increase their confidence in managing their chronic disease condition. It has the potential to reduce the patient's need to reach out to their health care provider during a time when health care resources are being stretched.

AIM: To critically synthesise the literature that explores the experiences of workplace gender discrimination from the perspective of registered nurses. DESIGN: Integrative review. REVIEW METHODS: Primary research articles reporting on the experience of workplace gender discrimination towards registered nurses in any setting were eligible for inclusion. Studies were critically appraised for methodological quality using a modified Critical Appraisal Skills Program list. The six phases of thematic analysis proposed by Braun and Clarke (2006) were used to guide the analysis. Data were extracted and coded, and themes were identified according to the review aims and significant findings of each study. DATA SOURCES: CINAHL, MEDLINE, SCOPUS, Cochrane Library, published between January 2012 and June 2022. RESULTS: Twenty studies met the inclusion criteria. Major themes identified were (1) career progression, (2) career interruption, (3) positioning of men in nursing and (4) positioning of women in nursing. CONCLUSION: This review shows that both men and women in nursing experience workplace gender discrimination; however, the forms and consequences of this discrimination differ substantially by gender. IMPLICATIONS FOR THE PROFESSION: It is important that the pursuit of greater numerical representation of men in nursing does not result in further reinforcing patriarchal advantage. Professional development for nurse leaders in managing gender issues is recommended. IMPACT: This integrative review presents current issues on workplace gender discrimination for men and women in nursing. The findings suggest gender roles and norms have an effect on the careers of both men and women in nursing. The time has come to alter restrictive gender norms and to challenge notions of hegemonic masculinity and femininity. REPORTING METHOD: We have adhered to relevant EQUATOR guidelines-PRISMA. NO PATIENT OR PUBLIC CONTRIBUTION: For this literature review on workplace gender discrimination for registered nurses, we did not engage members of the patient population, nor the general public.

INTRODUCTION: The coronavirus 2019 disease (COVID-19) pandemic is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Pre-existing cardiovascular disease (CVD) increases the morbidity and mortality of COVID-19, and COVID-19 itself causes serious cardiac sequelae. Strategies to minimise the risk of viral transmission to health care workers and uninfected cardiac patients while prioritising high quality cardiac care are urgently needed. We conducted a rapid literature appraisal and review of key documents identified by the Cardiac Society of Australia and New Zealand Board and Council members, the Australian and New Zealand Society of Cardiac and Thoracic Surgeons, and key cardiology, surgical and public health opinion leaders. MAIN RECOMMENDATIONS: Common acute cardiac manifestations of COVID-19 include left ventricular dysfunction, heart failure, arrhythmias and acute coronary syndromes. The presence of underlying CVD confers a five- to tenfold higher case fatality rate with COVID-19 disease. Special precautions are needed to avoid viral transmission to this population at risk. Adaptive health care delivery models and resource allocation are required throughout the health care system to address this need. CHANGES IN MANAGEMENT AS A RESULT OF THIS STATEMENT: Cardiovascular health services and cardiovascular health care providers need to recognise the increased risk of COVID-19 among CVD patients, upskill in the management of COVID-19 cardiac manifestations, and reorganise and innovate in service delivery models to meet demands. This consensus statement, endorsed by the Cardiac Society of Australia and New Zealand, the Australian and New Zealand Society of Cardiac and Thoracic Surgeons, the National Heart Foundation of Australia and the High Blood Pressure Research Council of Australia summarises important issues and proposes practical approaches to cardiovascular health care delivery to patients with and without SARS-CoV-2 infection.

Objective Consumer and community engagement (CCE) in research is increasingly valued in a contemporary healthcare environment that seeks to genuinely partner with consumers and the wider community. Although there is widespread agreement at research governance levels as to the benefits of CCE in research, there is little available research-based guidance as to how best to proceed with CCE organisationally and how to manage and overcome barriers. The aim of this narrative review was to draw together the available research, review findings and relevant governance-related material and to discuss these in light of a case series among research-engaged consumers in order to chart a practical way forward. Methods A narrative literature review about CCE in research was conducted. Following this, a case series among seven consumers who had been engaged as partners in health research was conducted. Finally, the lived experience of these consumers was explored against the findings of the narrative review. Results In all, 121 papers were identified and reviewed, 37 of which were used to inform the content of this paper. The most important benefits of CCE to both consumers and healthcare researchers were related to improvements in trust between consumer and researchers, and the increased relevance and ethics of research agendas ultimately pursued. Barriers to CCE were found to be pragmatic, attitudinal and organisational. Enabling factors that capitalise on the benefits and help address the barriers to meaningful CCE are outlined and discussed in light of a case series conducted among research-engaged consumers in Australia and internationally. Conclusion Best practice standards, organisational commitments and resources are needed to improve the status quo in Australia and to provide health research end-users with research outcomes that better align with their priorities and needs. What is known about the topic? Consumer and community engagement (CCE) in research is increasing in prevalence and is likely to be beneficial to both consumers and healthcare providers and researchers. What does this paper add? Following review of the available research findings and governance statements about CCE, enabling strategies are presented in light of a case series among Sydney-based research-engaged consumers. What are the implications for practitioners? Barriers to consumer and community engagement can be overcome if well understood and tackled organisationally. The potential benefits of shifting to a fully consumer- or community-engaged healthcare research environment are multifactorial and represent a paradigm shift in favour of evidence-based patient and family-centred care.

AIM: Multidisciplinary care is advocated as best practice in cancer care. Relatively little is documented about multidisciplinary team (MDT) meeting functioning, decision making and the use of evidence to support decision making in Australia. This descriptive study aimed to examine team functioning, the role of team meetings and evidence use in MDTs whose institutions are members of Sydney Catalyst Translational Cancer Research Centre. METHODS: We designed a structured 40-item survey instrument about topics that included meeting purpose, organization, resources and documentation; caseload estimates; use of evidence and quality assurance; patient involvement and supportive care needs; and open-ended items about the MDTs strengths and weaknesses. Participants were invited to participate via email and the survey was administered online. Data were analyzed using descriptive and comparative statistics. RESULTS: Thirty-seven MDTs from seven hospitals participated (100% response) and represented common (70%) and rare tumor groups (30%). MDT meeting purpose was reported as treatment (100%) or diagnostic decision making (88%), or for education purposes (70%). Most MDTs based treatment decisions on group consensus (92%), adherence to clinical practice guidelines (57%) or other evidence-based medicine sources (33%). The majority of MDTs discussed only a proportion of new patients at each meeting emphasizing the importance of educational aspects for other cases. Barriers exist in the availability of data to enable audit and reflection on evidence-based practice. MDT strengths included collaboration and quality discussion about patients. CONCLUSIONS: MDT meetings focus on treatment decision making, with group consensus playing a significant role in translating research evidence from guidelines into clinical decision making. With a varying proportion of patients discussed in each MDT meeting, a wider audit of multidisciplinary care would enable more accurate assessments of whether treatment recommendations are in accordance with best-practice evidence.