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SWSLHD Research News

Liverpool Hospital staff recent publications

Congratulations to Liverpool Hospital staff on their recently published articles

Featured Research

Brady, B., Sidhu, B., Jennings, M., Boland, R., Hassett, G., Chipchase, L., Tang, C., Yaacoub, S., Pavlovic, N., Sayad, S., Andary, T., Ogul, S., & Naylor, J. (2023). The feasibility of implementing a cultural mentoring program alongside pain management and physical rehabilitation for chronic musculoskeletal conditions: results of a controlled before-and-after pilot study. BMC Musculoskeletal Disorders, 24(1), 47. 

BACKGROUNDCulturally diverse communities face barriers managing chronic musculoskeletal pain conditions including navigation challenges, sub-optimal healthcare provider engagement and difficulty adopting self-management behaviours.OBJECTIVESTo explore the feasibility and trends of effectiveness of implementing a cultural mentoring program alongside clinical service delivery.METHODSThis quasi-experimental controlled before-and-after multiple case study was conducted in three hospital-based services that provide treatment for patients with musculoskeletal pain. Two prospective cohorts, a pre-implementation and a post-implementation cohort, of adults with chronic musculoskeletal pain who attended during the 6-month recruitment phase, were eligible if they self-identified with one of the cultures prioritised for mentoring by the clinic. The pre-implementation cohort received routine care for up to 3-months, while the post-implementation cohort received up to 3-months of cultural mentoring integrated into routine care (3 to 10 sessions), provided by a consumer (n = 6) with lived experience. Feasibility measures (recruitment and completion rates, attendance, satisfaction), and trends of effectiveness (Patient Activation Measure and Health Literacy Questionnaire items one and six) were collated over 3-months for both cohorts. Outcomes were presented descriptively and analysed using Mann-Whitney U-tests for between-group comparisons. Translation and transcription of post-treatment semi-structured interviews allowed both cohorts' perspectives of treatment to be analysed using a Rapid Assessment Process.RESULTSThe cultural mentor program was feasible to implement in clinical services with comparable recruitment rates (66% pre-implementation; 61% post-implementation), adequate treatment attendance (75% pre-implementation; 89% post-implementation), high treatment satisfaction (97% pre-implementation; 96% post-implementation), and minimal participant drop-out (CONCLUSIONParticipant experiences and observations of improved patient activation provide support for the acceptability of the mentoring intervention integrated into routine care. These results support the feasibility of conducting a definitive trial, while also exploring issues of scalability and sustainability.


Quesada, J., Härmä, K., Reid, S., Rao, T., Lo, G., Yang, N., Karia, S., Lee, E., & Borok, N. (2023). Endometriosis: A multimodal imaging review [Review]. European journal of radiology, 158, 110610.

Endometriosis is a chronic inflammatory disorder characterized endometrial-like tissue present outside of the uterus, affecting approximately 10% of reproductive age women. It is associated with abdomino-pelvic pain, infertility and other non - gynecologic symptoms, making it a challenging diagnosis. Several guidelines have been developed by different international societies to diagnose and classify endometriosis, yet areas of controversy and uncertainty remains. Transvaginal ultrasound (TV-US) is the first-line imaging modality used to identify endometriosis due to its accessibility and cost-efficacy. Enhanced sonographic techniques are emerging as a dedicated technique to evaluate deep infiltrating endometriosis (DIE), depending on the expertise of the sonographer as well as the location of the lesions. MRI is an ideal complementary modality to ultrasonography for pre-operative planning as it allows for a larger field-of-view when required and it has high levels of reproducibility and tolerability. Typically, endometriotic lesions appear hypoechoic on ultrasonography. On MRI, classical features include DIE T2 hypointensity, endometrioma T2 hypointensity and T1 hyperintensity, while superficial peritoneal endometriosis (SPE) is described as a small focus of T1 hyperintensity. Imaging has become a critical tool in the diagnosis, surveillance and surgical planning of endometriosis. This literature review is based mostly on studies from the last two decades and aims to provide a detailed overview of the imaging features of endometriosis as well as the advances and usefulness of different imaging modalities for this condition. Copyright © 2022 Elsevier B.V. All rights reserved.



Cho, K., Femia, G., Lee, R., Nageswararajah, D., Doulatram, H., Kadappu, K., & Juergens, C. (2023). Exploration of Cardiology Patient Hospital Presentations, Health Care Utilisation and Cardiovascular Risk Factors During the COVID-19 Pandemic [Article]. Heart Lung and Circulation.

Objectives: COVID-19 and the lockdowns have affected health care provision internationally, including medical procedures and methods of consultation. We aimed to assess the impact of COVID-19 at two Australian hospitals, focussing on cardiovascular hospital admissions, the use of community resources and cardiovascular risk factor control through a mixed methods approach. Methods: Admissions data from the quaternary referral hospital were analysed, and 299 patients were interviewed from July 2020 to December 2021. With the admissions data, the number, complexity and mortality of cardiology hospital admissions, prior to the first COVID-19 lockdown (T0=February 2018–July 2019) were compared to after the introduction of COVID-19 lockdowns (T1=February 2020–July 2021). During interviews, we asked patients about hospital and community health resource use, and their control of cardiovascular risk factors from the first lockdown. Results: Admission data showed a reduction in hospital presentations (T0=138,099 vs T1=128,030) and cardiology admissions after the lockdown period began (T0=4,951 vs T1=4,390). After the COVID-19-related lockdowns began, there was an increased complexity of cardiology admissions (T0=18.7%, 95% CI 17.7%–19.9% vs T1=20.3%, 95% CI 19.1%–21.5%, chi-square test: 4,158.658, p<0.001) and in-hospital mortality (T0=2.3% of total cardiology admissions 95% CI 1.9%–2.8% vs T1=2.8%, 95% CI 2.3%–3.3%, chi-square test: 4,060.217, p<0.001). In addition, 27% of patients delayed presentation due to fears of COVID-19 while several patients reported reducing their general practitioner or pathology/imaging appointments (27% and 11% respectively). Overall, 19% reported more difficulty accessing medical care during the lockdown periods. Patients described changes in their cardiovascular risk factors, including 25% reporting reductions in physical activity. Conclusion: We found a decrease in hospital presentations but with increased complexity after the introduction of COVID-19 lockdowns. Patients reported being fearful about presenting to hospital and experiencing difficulty in accessing community health services. © Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ)


Cutajar, L., Dahlen, H. G., Leechburch Auwers, A., Vir, S., Berberovic, B., Jedrzejewski, T., & Burns, E. S. (2023). Model of care matters: An integrative review. Women and Birth. 


Background: Pregnant women are entitled to quality care during pregnancy. Some health districts offer a variety of maternity care models but, not all women are aware of what is available and there is limited research on the experiences of women within their chosen or allocated model of care.

Aim: The aim of this integrative review is to explore the available literature on women’s experiences of the model of care accessed during pregnancy.

Method: A database search of CINAHL, MEDLINE, SCOPUS, OVID, JBI and Cochrane Database was conducted to identify original research articles published in English between 2011 and 2021. In total, 20 articles met the inclusion criteria.

Findings: The included papers came from nine different countries and reported on eight different models of care. Following analysis of the articles one overarching theme ‘Model of care matters’, and six sub themes were identified: 1.‘Choosing a model’, 2.‘Learning about pregnancy and birth’, 3.‘Being known’, 4.‘Making social and emotional connections’, 5.‘Receiving enabling or disabling care’ and 6.‘Integrated care is best’. Some women disclosed that they had no choice in the model they were allocated, while others stated they were not provided with information about all available models of care.

Conclusion: A lack of integrated care between medical and midwifery models led to feelings of dissatisfaction and distress during pregnancy. Positive experiences were reported when women developed a connection with the care provider. The development of a well-informed decision aid could alleviate deficits of information, and clarify the subtle differences that occur within various models.


Kovai, V., Mahjabeen, Z., Jalaludin, B. et al. Towards an effective collaboration between the South Western Sydney Local Health District and local councils: insights from a qualitative study. Health Res Policy Sys 20, 47 (2022).


Introduction: Creutzfeldt-Jakob disease (CJD), a spongiform encephalopathy, caused by a transmissible misfolded cellular prion protein, is a rapidly progressive, debilitating neurodegenerative disorder with no effective treatment. The estimated global incidence is at 1/million inhabitants. This retrospective study examined the incidence of CJD in South Western Sydney Local Health District (SWSLHD) from 2014 to 2020. Background: SWSLHD had an estimated population of 1,038,534 in 2020, with CJD data being limited. Methods: The New South Wales (NSW) Health Information Exchange (HIE) database, for all admissions with CJD diagnoses in SWSLHD, between 2014 and 2020, was reviewed according to the WHO diagnostic criteria, consistent with the Australian national CJD registry. Only probable CJD cases were included. Incidence was calculated based on the projected SWSLHD population. Results: Thirty-five patients, diagnosed with CJD, were identified. Each was evaluated by 2 independent investigators, including clinical presentation, MRI, EEGs, 14-3-3, and RT-QuIC results, before assigning CJD-probable status. Four failed the CJD criteria and were excluded. Of the 31 CJD-probable cases, most (59%) were male and older (37%, range 61–70 years). The incidence rate peaked at 9/million in 2017 and was above 2/million, throughout the 7 years, with an average of 4.859/million/year. Conclusions: The incidence of CJD, in SWSLHD, exceeds the national average of 1/million. Cost-effective, adequate diagnostic and screening tools, implementable over a large population, will become increasingly essential.


N. Moore, A. Abid, S. Ren, K. Robinson and P. Middleton. (2022). "Multicultural emergency medicine epidemiology: A health economic analysis of patient visits." Emergency Medicine Australasia. DOI: 10.1111/1742-6723.14085

    OBJECTIVE: There is growing evidence to suggest that culturally and linguistically diverse (CALD) patients cost the health system more than non-CALD patients because of a higher burden of disease and increased resource consumption. The present study aimed to compare the ED resource utilisation of CALD and non-CALD patients at a tertiary hospital in Sydney, Australia. METHODS: The total ED resource utilisation was calculated by separating each visit into diagnostic test cost and time spent in ED components. The time component was calculated using the product of the total length of stay and a resource cost per unit time measure. Diagnostic tests were costed using the Australian Medicare Benefit Schedule. A generalised additive model was developed to estimate the isolated effect of CALD status on the resource utilisation during an ED visit. RESULTS: CALD patients had a higher median resource utilisation than non-CALD patients ($736.93 vs $701.36, P < 0.0001); however, the generalised additive model demonstrated that CALD status was not independently associated with increased resource utilisation. CONCLUSION: CALD status is not an independent influence on ED resource utilisation but other explanatory variables such as increased age and altered case-mix appear to have a much greater influence. There may, however, be other reasons to consider CALD loading such as equity in healthcare and to address poorer overall health outcomes for CALD patients.