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Background: Ventral hernia repair is a common elective surgical procedure lacking strong evidence for specific operative approaches. This study aimed to evaluate the outcomes of primary suture repair or polypropylene sandwich mesh repair for ventral hernias. The main outcome measures were the rate of hernia recurrence, and evaluation of long-term complications and patient-reported outcomes., Methods: This retrospective cohort study evaluated patient perceived recurrence and pain in patients who had undergone a primary ventral hernia (epigastric, supraumbilical, or umbilical) repair or small (≤20 mm) midline incisional hernia repair 10 years after the procedure. Short-term follow-up occurred up to 6 weeks after the initial operation, while long-term follow-up included patients who were reviewed clinically or interviewed via telephone at or beyond 3 years after the procedure., Results: Most (75/100, 75.0%) patients had an extra-peritoneal sandwich mesh repair. Short-term follow-up showed minimal pain and normal activities for all patients (97/97, 100%). Long-term follow-up (median 12 years [IQR 11-13]) was achieved in 95.9% (93/97) of patients with only a small number reporting a slight bulge (5/93, 5.4%) and intermittent mild discomfort (8/93, 8.6%). Nine patients (9/97, 9.3%) experienced hernia recurrence, diagnosed at a median of 26 months [interquartile range, IQR, 7-58] post-operatively., Conclusions: These findings suggest that an open sandwich mesh technique is a safe and effective method for repairing primary ventral hernias and small midline incisional hernias and is associated with favourable long-term patient-reported outcomes., (© 2024 The Author(s). ANZ Journal of Surgery published by John Wiley & Sons Australia, Ltd on behalf of Royal Australasian College of Surgeons.)

Background: Several recent reports have identified significant variations in discharge practices following umbilical hernia repair (UHR). The primary aim of this paper is to determine Australian UHR same day discharge (SDD) rates over the past two decades. Secondary aims are to analyse factors which may contribute to variation in discharge practices, compare Australian UHR SDD rates internationally and determine LOS trends., Methods: A retrospective, population-based cohort study was conducted using de-identified data from the Australian Institute of Health and Welfare (1 July 1998 to 30 June 2019). SDD rates and LOS were calculated for age, gender and complexity. Negative binomial models were used to investigate associations between characteristics., Results: The overall mean UHR SDD rate was 41.2% with a modest improvement over the study period (36.5% to 44.4%, P < 0.0001). The mean LOS was 3.4 days, and this decreased over the study period (P = 0.01). Males had a higher rate of SDD (42.1% vs. 39.4%, P < 0.0001) and shorter LOS (3.0 vs. 3.7 days, P < 0.0001) compared with females. Increased age was associated with decreased SDD (P < 0.0001) and increased LOS (P < 0.0001). Australia's SDD rate was lower than in both New Zealand and the United Kingdom., Conclusion: While SDD and LOS following UHR improved across the study period, SDD rates remain below the RACS recommendation and compare unfavourably internationally. Advancing age and female gender were associated with decreased SDD and increased LOS demonstrating potential areas for improvement. Multiple strategies are discussed to address the persistently low rates of SDD after UHR., (© 2022 Royal Australasian College of Surgeons.)

Background: There is a global concern that physician-researchers are 'a dying breed'. Recent studies of clinical career choices of Australian medical students and doctors have signalled the rising age of medical graduates, generational shifts in work-life attitudes and increased proportion of female graduates. There are scant data regarding Australian physician-researchers., Aims: To develop and utilise a questionnaire determining respondent characteristics and 'push' and 'pull' factors for medical graduates to incorporate research into their careers., Methods: We developed and administered an 88-item online survey, including quantitative and qualitative questions, to medical students, faculty and alumni of Sydney Medical School, The University of Sydney, asking about their medical career, research experience and interest and reasons for doing or not doing medical research. Responses to all 74 quantitative questions are reported here., Results: Data from 427 respondents (44% female; mean ± standard deviation age 38 ± 13 years; 56% completed or undertaking a PhD) were analysed. Attractions of research included a desire to improve human health, intellectual stimulation and career diversity. Barriers included low funding rates, job insecurity and low salaries. Although few were prepared to undertake or recommend full-time research, 71% would recommend part-time research. Respondents perceived a smaller-than-actual gap between clinical and research salaries, and if comparable (75-100% of a clinician's) salaries were available, 89% would like to spend 21-60% of their work time undertaking research., Conclusion: Many Australian medical students and doctors are interested in research, especially part time. Perceived obstacles include job insecurity, low funding rates and salary. Respondents underestimated clinical and research salary differences., (© 2019 Royal Australasian College of Physicians.)

Background: Clinicians vary in their ability to elicit and interpret hallucinatory symptoms in patients with Parkinson's disease (PD). There is limited evidence for informant-report measures of PD hallucinations as adjuncts to clinician-rated scales., Objectives: To determine the utility of an informant version of the validated Psychosis and Hallucinations Questionnaire (PsycH-Q) for assessing the presence and severity of hallucinations in PD; and, to evaluate accuracy of clinician judgements by comparison with informant report and self-report., Methods: One hundred sixty-three PD patient-informant dyads completed self- and informant-report versions of PsycH-Q and three common questionnaire measures: Neuropsychiatric Inventory Questionnaire; Parkinson's Psychosis Questionnaire; and Scales for Outcomes in Parkinson's disease-Psychiatric Complications. We compared self-ratings and informant ratings across analogous subscales for the presence of hallucinations with clinician interview ratings on MDS-UPDRS as a diagnostic standard., Results: There was a low level of agreement between dyads (average κ = 0.39; κ range = 0.32-0.47; P  < 0.001), and patients indicated the highest prevalence of hallucinations compared to informant or clinician estimates. Clinician interview missed 32% of PsycH-Q hallucinators identified by dyads. Relative to the sample, 22 patients with exclusively clinician-appraised hallucinations had poorer overall quality of life measured by the Parkinson's Disease Questionnaire., Conclusions: The sole use of clinician-rated scales may underestimate prevalence of PD hallucinations, and there is room for introducing self- and informant-report tools. Nonetheless, clinician appraisals are critical in cases when informant and patient insight might be affected by the impact of illness on quality of life.

People diagnosed with Parkinson's disease (PD) frequently experience visual and non-visual hallucinations often with comorbid psychosis, however, there is currently no gold standard tool for accurately assessing these symptoms. To address this problem, we designed a novel questionnaire to evaluate the presence of hallucinatory and psychotic symptoms in PD, as well as related symptoms, such as attentional dysfunction and sleep disturbance. We administered the 20-item Psychosis and Hallucinations Questionnaire (PsycH-Q) and three common questionnaire measures in a large cohort of 197 patients with idiopathic PD via a postal survey. We established concurrent validity, convergent validity, and internal consistency of the questionnaire and then assessed test-retest reliability in a subcohort of 44 patients. PsycH-Q was found to be a valid instrument when analogous items were compared across three other existing tools (Spearman's rho range: 0.34-0.64; P  < 0.01). PsycH-Q demonstrated a strong relationship between self-reported hallucinations and psychosis and symptoms of the broader hallucinatory phenotype (Kendall's tau = 0.41; P  <   0.01; positive predictive value = 0.97). PsycH-Q also displayed a high level of internal consistency (Cronbach's alpha = 0.900; range, 0.696-0.923) and reproducibility (intraclass correlation coefficient = 0.928). PsycH-Q is a simple, valid, self-completed instrument that reliably identifies hallucinations and psychosis in PD and has the ability to characterize related patterns of attentional and sleep impairments. As such, PsycH-Q is a highly valuable tool for use in both clinical and research settings.