includes Epworth’s scholarly publications http://hdl.handle.net/11434/1 2026-07-11T09:29:32Z 2026-07-11T09:29:32Z Subramaniam, Ashwin http://hdl.handle.net/11434/2435 2026-07-10T04:51:53Z 2026-06-01T00:00:00Z

Title: From size to function: moving beyond body mass index to frailty and central adiposity phenotypes. Epworth Authors: Subramaniam, Ashwin Abstract: The burden of critical illness is higher than generally appreciated and is expected to increase as the population ages. A key goal of critical care is to provide accurate short- and long-term prognostication, reflected in the development of numerous condition-specific prediction scores across diverse critical illnesses.

2026-06-01T00:00:00Z Subramaniam, Ashwin http://hdl.handle.net/11434/2434 2026-07-10T11:02:09Z 2026-06-01T00:00:00Z

Title: The cost analysis of remifentanil and fentanyl for analgosedation in mechanically ventilated patients in intensive care: Post hoc analysis of an open-labelled pilot randomised controlled study. Epworth Authors: Subramaniam, Ashwin Abstract: Objective: To compare total hospital costs associated with remifentanil versus fentanyl for analgosedation in mechanically ventilated intensive care unit (ICU) patients, given increasing interest in remifentanil as a feasible alternative, but limited economic evidence. Design: Cost analysis of a single-centre, prospective, randomised controlled trial (remi-fent1 RCT). Setting: Nepean Hospital ICU, New South Wales, Australia. Patients: Adult patients admitted between June 2020 and August 2021 requiring invasive mechanical ventilation (IMV) who were randomised to receive remifentanil or fentanyl as part of their analgosedation regimen. Main outcome measures: The primary outcome was total hospital bed-day costs (Australian Dollars), estimated from a healthcare payer perspective using the Australian Independent Hospital Pricing Authority National Pricing Model for the financial year 2020-2021. Health-related quality of life (HRQoL) at 6 months was measured using the generic EuroQoL 5-dimension 5-level (EQ-5D-5L) instrument. Pre-specified subgroup analyses examined age (arbitrary cut-off 65 years) and duration of IMV (arbitrary cut-off 72 h). Results: A total of 210 patients were analysed (remifentanil n = 104; fentanyl n = 106). Opioid acquisition costs were comparable between groups. Total mean hospital bed-day costs were lower in the remifentanil group compared with the fentanyl ($48,301 [$38,644-$57,958] vs. $37,012 [95% confidence interval {CI}: $27,834-$46,191]; p = 0.006). The remifentanil group was associated with lower total hospital costs in older patients (≥65 years) and in those ventilated for ≤72 h. At 6 months, 110 patients were alive, with 7 lost to follow-up, (61/103 remifentanil [59.2%] vs. 59/100 fentanyl [59.0%]; p = 0.80). Among survivors, remifentanil continued to demonstrate lower overall hospital costs, but 6-month HRQoL remained similar between groups (EQ-5D-5L index 0.83 vs. 0.87; p = 0.24). Conclusion: Remifentanil was associated with lower total hospital costs than fentanyl, without differences in survival or HRQoL at 6 months, suggesting that remifentanil may be a lower-cost alternative for analgosedation. However, the results are exploratory and require confirmation in larger, adequately powered multicentre phase-2 trials.

2026-06-01T00:00:00Z Hill, Bridget Williams, Gavin Banky, Megan http://hdl.handle.net/11434/2430 2026-05-08T11:02:09Z 2025-12-01T00:00:00Z

Title: Development of a core outcome set for the assessment of spasticity in adults: a study protocol. Epworth Authors: Hill, Bridget; Williams, Gavin; Banky, Megan Abstract: Background: Muscle spasticity is common in adult-onset neurological conditions such as stroke, traumatic brain injury, multiple sclerosis, and spinal cord injury. Although effective interventions exist, studies evaluating interventions to improve rehabilitation or management outcomes for those with spasticity are methodologically heterogeneous, making meta-analysis impossible. This paper reports a protocol to develop a spasticity core outcome set (COS) to standardise the reporting of clinical trials and enable better evidence synthesis in future studies. Further, a spasticity COS may facilitate better patient assessment, guide treatment planning and goal setting, and further support evaluation of treatment outcomes in clinical practice. Methods: This protocol has been developed according to the Core Outcome Measures in Effectiveness Trial (COMET) initiative guidelines. It has been prospectively registered on the COMET website. Outcome measures for inclusion in the COS will be based on COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN). The study will adhere to the minimum standards for the design of a COS study (Core Outcome Set-Standards for Development [COS-STAD]). This project involves four phases. Phase 1 involves semi-structured interviews of people with a lived experience of spasticity to determine important areas for outcome evaluation. Phase 2 is a Delphi survey with experts in spasticity, together with people with lived experience, to select the outcome domains for inclusion in the COS. Phase 3 consists of systematic reviews of the literature to identify outcome measures specific to each of the domains selected in phase 2 and their psychometric properties. Phase 4 is a second Delphi survey with the spasticity experts, conducted to obtain consensus on outcome measures included in the COS. Discussion: This proposal represents the first spasticity COS to improve the consistency in outcome measurement selection and reporting in clinical trials to enable future meta-analyses and reduce research waste. It will also provide clinicians with a resource for documenting and reporting patient outcomes that can be used for benchmarking and optimising care. Trial registration: https://www.comet-initiative.org/Studies/Details/3345 . 31st January, 2025.

2025-12-01T00:00:00Z Carll, Jonathon Lawrentschuk, Nathan http://hdl.handle.net/11434/2429 2026-05-08T11:02:17Z 2026-04-01T00:00:00Z

Title: Guideline of guidelines: pelvic lymph node dissection at time of radical prostatectomy. Epworth Authors: Carll, Jonathon; Lawrentschuk, Nathan Abstract: Objective: To provide a comprehensive review, analysis and critique of guidelines from various oncological and urological organisations regarding the use pelvic lymph node dissection (PLND) in men undergoing radical prostatectomy (RP) for primary treatment of prostate cancer (PCa). Methods: PubMed, Google Scholar and the official webpages of major urological and oncological societies were searched for PCa guidelines. Guidelines were assessed for recommendations and opinions regarding the use of PLND. A total of 15 guidelines were identified and included for this review. Results: There is consensus amongst guidelines that an extended template (ePLND), is the preferred templated when PLND is to be undertaken. The majority of guidelines acknowledge the lack of proven oncological benefit from PLND, and that the largest benefit is from improved staging information. However, there is significant divergence between the guidelines about which patients should undergo PLND. Some guidelines advocate for the abandonment of PLND altogether, whilst others adopt a risk-stratified approach, suggesting that patients should be offered PLND based on nomograms or clinical risk stratification. Conclusion: Whilst ePLND is recommended by some guidelines for select patients undergoing RP, it remains a contentious topic with significant discordance between guidelines regarding patient selection. Given the lack of proven oncological benefit and significant morbidity from the procedure, careful selection is required. It is uncertain as to how pathological findings on PLND will change management given recent trends towards salvage rather than adjuvant radiotherapy, and improved preoperative staging with prostate-specific membrane antigen-positron emission tomography/computed tomography.

2026-04-01T00:00:00Z