Health Services and Economic Impacts of the Limit of Detection in Emergency Department (LEGEND) Rule-Out Strategy in Australian Emergency Departments: A Stepped-Wedge Cluster Randomised Trial.

Objective: This study aimed to describe healthcare utilisation and costs associated with the assessment of suspected acute coronary syndrome (ACS) under standard care and to compare these outcomes with the Limit of Detection in Emergency Department (LEGEND) strategy, an accelerated diagnostic pathway identifying low-risk patients using a single highly sensitive troponin (hs-cTnI).

Method: A stepped-wedge cluster randomised trial was conducted in four Queensland hospitals. Each transitioned from standard care (2016 ACS guidelines) to the LEGEND intervention at randomised intervals.

First direct observations of atmospheric sputtering at Mars.

Billions of years ago, Mars' ability to sustain liquid water waned as the solar wind and radiation began to erode the atmosphere. Sputtering is an atmospheric escape process that may have been dominant during earlier epochs of our Sun according to isotopic evidence, but is difficult to detect under current solar conditions. Using over 9 years of data from the Mars Atmosphere and Volatile Evolution mission, we present the first observations of present-day sputtering in the martian upper atmosphere.

Integrating a Mobile App to Enhance Atrial Fibrillation Care: Key Insights From an Implementation Study Guided by the Consolidated Framework for Implementation Research.

Background: Despite the growing use of mobile health apps in managing chronic heart disease, their integration into routine care remains challenging due to dynamic, context-specific barriers.

Objective: This study aimed to identify the key enablers and challenges of implementing a mobile app for cardiac rehabilitation and healthy lifestyles in patients with atrial fibrillation at an Australian cardiology clinic.

Methods: We interviewed both clinicians and patients to understand their perspectives about the mobile app and what factors affected the implementation.

Preferences for Mobile App Features to Support People Living With Chronic Heart Diseases: Discrete Choice Study.

Background: Using digital health technologies to aid individuals in managing chronic diseases offers a promising solution to overcome health service barriers such as access and affordability. However, their effectiveness depends on adoption and sustained use, influenced by user preferences.

Objectives: This study quantifies the preferences of individuals with chronic heart disease (CHD) for features of a mobile health app to self-navigate their disease condition.

Growth and changing landscape of the cost-utility literature: an Australian perspective, 1992-2022.

Background: Since the introduction of cost-utility analysis (CUA) in the 1990s, its methodologies and applications have evolved significantly in Australia.

Objectives: To provide a comprehensive overview of the volume, trends, and characteristics of the application of CUA in healthcare decision-making.

Methods: Bibliometric analysis of published CUAs identified from the Cost-Effectiveness Analysis Registry, a `1comprehensive source of CUA data between 1992 and 2022.

Evaluating the implementation of adult smoking cessation programs in community settings: a scoping review.

Introduction: Tobacco smoking is a leading contributor to preventable morbidity and premature mortality globally. Although evidence-based smoking cessation programs have been implemented, there is limited evidence on the application of theories, models, and frameworks (TMFs), and implementation strategies to support such programs. This scoping review mapped the evidence for interventions, TMFs, and implementation strategies used for smoking cessation programs in the community.

Economic Evaluation of Enhanced Cleaning and Disinfection of Shared Medical Equipment.

Importance: The economic value of cleaning and disinfection of shared medical equipment is currently unknown.

Objective: To evaluate whether or not better environmental cleaning and disinfection of shared medical equipment would be cost-effective compared with usual care.

Design, Setting, And Participants: This economic evaluation study was a within-trial cost-effectiveness analysis of a stepped-wedge cluster randomized clinical trial: the Cleaning and Enhanced Disinfection (CLEEN) study.

Implementation of a nurse-delivered, community-based liver screening and assessment program for people with metabolic dysfunction-associated steatotic liver disease (LOCATE-NAFLD trial).

Background: With the high burden of Metabolic dysfunction-associated steatotic liver disease (MASLD), (previously known as Non-Alcoholic Fatty Liver Disease - NAFLD) in the community, current models of care that require specialist review for disease risk stratification overwhelm hospital clinic capacity and create inefficiencies in care. The LOCal Assessment and Triage Evaluation of Non-Alcoholic Fatty Liver Disease (LOCATE-NAFLD) randomised trial compared usual care to a community-based nurse delivered liver risk assessment. This study evaluates the implementation strategy of the LOCATE model.

Factors influencing prosthesis selection and variation: a survey of orthopaedic surgeons in Australia.

Background: There is increasing demand for knee and hip arthroplasty with considerable health system cost implications. Despite the high surgical costs relating to the prosthesis used, little is known about which factors are most influential in prosthesis choice, nor is it clear what level of variation may be warranted for clinical reasons.

Objectives: This study had dual objectives: (1) identify factors influencing prosthesis selection for total hip arthroplasty (THA) and total knee arthroplasty (TKA) and (2) develop a working definition for unwarranted variation in THA and TKA implant selection.

Recovery trajectories after a serious injury or illness: a longitudinal evaluation of health-related quality of life in an Australian cohort.

Purpose: Serious injuries or illnesses impose a significant burden on the affected individuals. This study examined the long-term recovery of health-related quality of life (HRQoL) after a serious injury or illness and quantified the economic costs attributable to the quality-adjusted life-years (QALYs) lost to serious injury or illness.

Methods: Data were sourced from the Household, Income and Labour Dynamics in Australia (HILDA) database.

Improving our understanding of the longitudinal relationship between health-related quality of life and multimorbidity: The role of personality traits.

It is well known that multimorbidity negatively impacts health-related quality of life (HRQoL). However, how psychosocial factors moderate this relationship remains unclear. The present study investigated the moderating effects of personality traits on the relationship between multimorbidity and HRQoL.

Parallel randomised trial testing community fibrosis assessment for suspected non-alcoholic fatty liver disease: outcomes from LOCATE-NAFLD.

Objective: Non-alcoholic fatty liver disease (NAFLD) is estimated to affect a third of Australian adults, and its prevalence is predicted to rise, increasing the burden on the healthcare system. The LOCal Assessment and Triage Evaluation of Non-Alcoholic Fatty Liver Disease (LOCATE-NAFLD) trialled a community-based fibrosis assessment service using FibroScan to reduce the time to diagnosis of high-risk NAFLD and improve patient outcomes.

Methods: We conducted a 1:1 parallel randomised trial to compare two alternative models of care for NAFLD diagnosis and assessment.

Cost-effectiveness analysis of microwave ablation versus robot-assisted partial nephrectomy for patients with small renal masses in Australia.

Objectives: Microwave ablation (MWA) has gained attention as a minimally invasive and safe alternative to surgical intervention for patients with small renal masses; however, its cost-effectiveness in Australia remains unclear. This study conducted a cost-effectiveness analysis to evaluate the relative clinical and economic merits of MWA compared to robotic-assisted partial nephrectomy (RA-PN) in the treatment of small renal masses.

Methods: A Markov state-transition model was constructed to simulate the progression of Australian patients with small renal masses treated with MWA versus RA-PN over a 10-year horizon.

Investigating the effect of enhanced cleaning and disinfection of shared medical equipment on health-care-associated infections in Australia (CLEEN): a stepped-wedge, cluster randomised, controlled trial.

Background: There is a paucity of high-quality evidence based on clinical endpoints for routine cleaning of shared medical equipment. We assessed the effect of enhanced cleaning and disinfection of shared medical equipment on health-care-associated infections (HAIs) in hospitalised patients.

Methods: We conducted a stepped-wedge, cluster randomised, controlled trial in ten wards of a single hospital located on the central coast of New South Wales, Australia.

Cancer survivor preferences for breast cancer follow-up care: a discrete choice experiment.

Purpose: To identify the key attributes of breast cancer follow-up care models preferred by cancer survivors in Australia.

Methods: A discrete choice experiment (DCE) was conducted to elicit preferences for attributes of breast cancer follow-up care. Respondents were presented with two hypothetical scenarios, known as choice sets, and asked to select a preference.

How digital health translational research is prioritised: a qualitative stakeholder-driven approach to decision support evaluation.

Objectives: Digital health is now routinely being applied in clinical care, and with a variety of clinician-facing systems available, healthcare organisations are increasingly required to make decisions about technology implementation and evaluation. However, few studies have examined how digital health research is prioritised, particularly research focused on clinician-facing decision support systems. This study aimed to identify criteria for prioritising digital health research, examine how these differ from criteria for prioritising traditional health research and determine priority decision support use cases for a collaborative implementation research programme.

Cost-effectiveness of left atrial appendage closure for stroke prevention in atrial fibrillation: a systematic review appraising the methodological quality.

Background: The increasing global prevalence of atrial fibrillation (AF) has led to a growing demand for stroke prevention strategies, resulting in higher healthcare costs. High-quality economic evaluations of stroke prevention strategies can play a crucial role in maximising efficient allocation of resources. In this systematic review, we assessed the methodological quality of such economic evaluations.

A discrete choice experiment to elicit preferences for a liver screening programme in Queensland, Australia: a mixed methods study to select attributes and levels.

Background: In Australia, the overall prevalence of liver disease is increasing. Maximising uptake of community screening programmes by understanding patient preferences is integral to developing consumer-centred care models for liver disease. Discrete choice experiments (DCEs) are widely used to elicit preferences for various healthcare services.

Global, regional, and national burden of heart failure associated with atrial fibrillation.

Background: Heart failure is a leading cause of mortality and morbidity worldwide, and Atrial fibrillation (AF) is among many modifiable risk factors for heart failure. No estimates are available on the magnitude of the burden of heart failure associated with AF, and this study estimated the global, regional, and national burdens associated with AF.

Methods: We used the comparative risk assessment method to estimate the disease burden in terms of prevalence and years lived with disability (YLD).

Global and regional burden of ischemic stroke associated with atrial fibrillation, 2009-2019.

The extent of the preventable burden of ischaemic stroke associated with atrial fibrillation (AF) remains uncertain to date. To address this knowledge gap, we utilised the comparative risk assessment methodology to estimate the burden of ischaemic stroke associated with AF at both global and regional levels. The population attributable fraction for ischaemic stroke and AF was obtained from published literature, while data on the prevalence, incidence, deaths, and disability-adjusted life years (DALY) associated with ischaemic stroke were sourced from the Global Burden of Disease study database.

Cancer Survivor Preferences for Models of Breast Cancer Follow-Up Care: Selecting Attributes for Inclusion in a Discrete Choice Experiment.

Background And Objective: It is critical to evaluate cancer survivors' preferences when developing follow-up care models to better address the needs of cancer survivors. This study was conducted to understand the key attributes of breast cancer follow-up care for use in a future discrete choice experiment (DCE) survey.

Methods: Key attributes of breast cancer follow-up care models were generated using a multi-stage, mixed-methods approach.

Cost-Effectiveness of Screening to Identify Patients With Atrial Fibrillation: A Systematic Review.

Background: Screening for Atrial Fibrillation (AF) is recommended for people aged above 65 years. Screening for AF in asymptomatic individuals can be beneficial by enabling earlier diagnosis and the commencement of interventions to reduce the risk of early events, thus improving patient outcomes. This study systematically reviews the literature about the cost-effectiveness of various screening methods for previously undiagnosed AF.

Evaluating the costs and consequences of computerized clinical decision support systems in hospitals: a scoping review and recommendations for future practice.

Objective: Sustainable investment in computerized decision support systems (CDSS) requires robust evaluation of their economic impacts compared with current clinical workflows. We reviewed current approaches used to evaluate the costs and consequences of CDSS in hospital settings and presented recommendations to improve the generalizability of future evaluations.

Materials And Methods: A scoping review of peer-reviewed research articles published since 2010.

A randomised controlled trial investigating the effect of improving the cleaning and disinfection of shared medical equipment on healthcare-associated infections: the CLEaning and Enhanced disiNfection (CLEEN) study.

Background: Healthcare-associated infections (HAIs) are a common, costly, yet largely preventable complication impacting patients in healthcare settings globally. Improving routine cleaning and disinfection of the hospital environment has been shown to reduce the risk of HAI. Contaminated shared medical equipment presents a primary transmission route for infectious pathogens, yet is rarely studied.