Craig Antony McBride

Circuit thrombosis and mechanical failure are important complications during extracorporeal membrane oxygenation (ECMO), but expected circuit duration and predictors of circuit failure remain poorly defined. We performed a retrospective analysis of the Extracorporeal Life Support Organization (ELSO) Registry, including patients aged less than 18 years supported with ECMO between January 2020 and December 2024. Circuit failure was defined as a mechanical complication requiring circuit or component replacement. Time to failure was analyzed using Cox proportional hazards models, and associations with mortality were analyzed using logistic regression and propensity score matching. A total of 20,124 patients with 21,294 runs and 26,318 circuits were included. Circuit failure occurred in 5,052 circuits (19.2%), with at least one replacement in 15.3% of runs. Median time to failure was 129.5 hours (interquartile range [IQR]: 55.0–262.5). Neonatal age, weight less than 3 kg, and higher center volume were associated with increased circuit failure, whereas older age was associated with lower risk. Extracorporeal membrane oxygenation pump flow was not associated with circuit failure. Circuit failure was associated with higher mortality (49.0% vs. 34.1%). In propensity score matching, circuit failure increased absolute mortality risk by 6.1 percentage points ( p < 0.001), with the strongest effect in neonates. Circuit life warrants evaluation as a potential endpoint for future hemocompatibility and anticoagulation studies.

Background: There are studies on parent, patient and child preferences regarding hospital staff attire, but no corresponding studies on staff preferences. The COVID‐19 pandemic in Australia coincided with a rapid change to scrubs as standard staff attire on hospital wards. These are often at staff choice, whereas theatre scrubs are typically mandated and supplied by the hospital. There is therefore choice outside theatre, but no choice for theatre staff. Objectives: Survey staff preferences regarding two styles and colours of hospital‐provided scrubs, along with reasons underpinning staff preferences. Methods: Anonymous survey of all in‐theatre staff in response to a recent change in scrub uniforms. Mixture of survey and free‐text responses to questions. Results: A total of 267 staff responded, with the majority completing the survey. There were ~20 000 words of free‐text responses to analyse. There was a clear choice for dark colour, elastic waistband and trouser‐style pockets over the alternative. Reasons fell into seven major categories: Comfort/fit/availability, professionalism, functionality/practicality, dignity/self‐esteem, modesty/privacy, stains/sweat/dirt and safety. There was no clear preference for own scrubs vs. supplied scrubs, or for multiple options vs. everyone looking the same. Female staff particularly did not like lighter scrubs, with their risk of strikethrough menstrual bleeding. Interpretation: Staff have clear reasons for scrub preferences. Poorly designed scrubs present a hazard to physical safety and well‐being. Light colours show stains, sweat and blood more. Underwear can be visible through poorly designed or light‐coloured scrubs. There is a pride which comes from wearing well‐fitting and functional theatre attire.

Background: The use of electronic medical records (EMRs) and clinical registries has transformed health care delivery by improving data management, care coordination, and research capacity. However, the full potential of these technologies can only be realized through effective interoperability, thereby reducing the burden of manual data entry and enhancing the use of real-world clinical data. Objective: This review examines technologies that enable automated data extraction and transfer, which promote interoperability between EMRs and clinical registries. Methods: A search of PubMed, CINAHL, Embase, and Web of Science, including studies published between January 2013 and April 2025, was registered with Open Science Framework a priori and involved three key concepts: (1) “registry,” (2) “electronic medical records,” and (3) “interoperability.” A 2-phase screen identified studies evaluating technologies that facilitate automated data extraction or interoperability. Automation was defined as fully automated, where data are extracted and transferred without human intervention, or semiautomated, where extraction or transfer is predominantly automated but may include manual validation. Only technologies supporting ongoing database integration were eligible for inclusion. Screening, data extraction, and synthesis were conducted by multiple independent reviewers. Technology experts provided extensive input and guidance throughout to ensure the accuracy and relevance of the extracted information. Results: Overall, 36 studies met the inclusion criteria, representing 12 countries across 5 continents and addressing a wide range of acute and chronic health conditions. Epic was the most frequently reported EMR system, while the most common registry platforms were REDCap (Research Electronic Data Capture; Vanderbilt University), structured query language (SQL) server database, and EMR-embedded solutions. Most approaches centered around extracting data from structured formats (n=18), or a combination of both structured and unstructured formats (n=10), emphasizing the central role of structured EMR data in current automated extraction approaches. Conclusions: This review advances understanding of interoperability between EMRs and clinical registries by uniquely examining automated and sustainable solutions for data exchange, extending beyond prior work that has largely focused on technologies designed for isolated systems or study-specific data extraction. A novel contribution of this review is the synthesis of context-specific considerations derived from reported implementations, providing a comprehensive overview of how technology selection and implementation are shaped by the context in which they are deployed. While these advancements have reduced reliance on inefficient, error-prone, and resource-intensive manual processes, ongoing challenges in data standardization, seamless integration, and long-term sustainability are compounded by poor and inconsistent reporting across studies. Future efforts should follow comprehensive reporting guidelines, adhere to robust governance principles, and incorporate implementation science frameworks, to not only enable meaningful comparison and synthesis in future research, but also to ensure that technologies can be effectively, feasibly, and sustainably integrated within health care contexts, while upholding the ethical and equitable use of health care data.

Aim: To evaluate whether, in children treated in paediatric intensive care units (PICU) with peripheral venous access devices (PVADs) receiving intermediate‐ or high‐risk peripheral intravenous medications, the use of a tissue‐infiltration biosensor (ivWatch), compared to standard care, reduces extravasation injuries. Methods: A superiority, parallel group randomised controlled trial conducted in a single Queensland quaternary hospital PICU from September 2020 to July 2022. Children with PVADs inserted in the distal half of the limb and receiving intermediate‐ to high‐risk infusates for ≥ 24 h were randomly allocated in a 1:1 ratio to biosensor (ivWatch monitor applied within 10–15 mm of the PVAD tip) plus standard clinical observation, or standard observation alone. Primary outcome was extravasation severity on the 4‐point Cincinnati Children's Hospital Medical Centre Extravasation Harm Scale. Injuries were compared between treatment groups using ordinal logistic regression. Results: A total of 175 children were enrolled, 88 to biosensor and 87 to standard care. Extravasation severity was similar between groups, with no, mild and moderate injury occurring in 56 (69%), 25 (30%) and 2 (2%) participants in the biosensor group and 61 (70%), 24 (28%) and 2 (2%) in the standard care group (proportional odds ratio = 1.13; 95% CI: 0.59, 2.15, p = 0.71). No statistically significant between‐group differences in extravasation severity, volume, treatment sequelae, PVADs used or dwell time were observed. The biosensor was acceptable to nurses. Conclusions: In this PICU population, biosensor monitoring in addition to standard care did not significantly reduce extravasation injuries. The technology was acceptable to bedside nursing staff. Trial Registration: ACTRN12620000317998

BACKGROUND The use of electronic medical records (EMRs) and clinical registries has transformed healthcare delivery by improving data management, care coordination, and research capacity. However, the full potential of these technologies can only be realized through effective interoperability, thereby reducing the burden of manual data entry and enhancing the utility of real-world clinical data. OBJECTIVE This review explores existing technologies used to facilitate automatic data capture and transfer methods which promote interoperability between patient EMRs and clinical registries. METHODS A search of PubMed, CINAHL, Embase and Web of Science involved three key concepts: (1) “registry”, (2) “electronic medical records”, and (3) “interoperability”. A two-phase screen identified studies utilizing technologies to facilitate automatic data extraction or interoperability within a health context. RESULTS Thirty-five studies met inclusion criteria and were included in the final review. Twelve countries over five continents were represented, addressing a wide range of acute and chronic health conditions. Epic was the most frequently used electronic medical record system, while the most used registry platforms were REDCap, SQL Server Database and EMR-embedded solutions. Various technologies were employed to facilitate automated extraction and transfer of data from the EMR onto clinical registries, with approaches often tailored to align with data formats and institutional requirements. CONCLUSIONS The findings highlight the growing global adoption of technological solutions to support data interoperability between EMRs and clinical registries. The selection and subsequent implementation of technologies were consistently shaped by contextual factors, highlighting the need for tailored approaches. While these advancements have reduced reliance on inefficient, error-prone, and resource-intensive manual processes, ongoing challenges in data standardization, seamless integration, and long-term sustainability are compounded by poor and inconsistent reporting across studies. Many studies lacked the methodological detail required for replication or meaningful comparison, and the limited application of implementation science frameworks further hindered the ability to assess real-world effectiveness, feasibility and scalability. To maximize the full potential of EMR-linked registries in driving high-quality research to improve patient outcomes, future initiatives must not only adhere to robust governance frameworks that uphold data security, patient privacy, and regulatory compliance, but also address existing gaps through co-designed, context-sensitive approaches to improve data quality, interoperability, and equitable adoption across healthcare settings.

Aim: Evidence‐based guidelines do not recommend imaging in cryptorchidism, but anecdotally most referrals include an ultrasound report. We aimed to assess the frequency, utility and burden of imaging in children referred with presumptive disorders of testicular descent, and to assess trends over a 7‐year period before and after local and international guidelines have been introduced.Methods: This was a prospective cohort study of children referred to the Queensland Children's Hospital for anomalies of testicular descent between 2015–2017 and 2023–2024. Data were collected regarding demographics, referral details, imaging performed and surgical diagnosis.Results: A total of 268 children were recruited. Ultrasound frequency has not significantly changed over time (72.8%, 2015–2017; 63.6% 2023–2024; P = 0.11). Currently, 17.6% of families are charged, and 31.9% need to take time off work, for the ultrasound. This is a significant increase from the 2015–2017 cohort. Parents report concern and anxiety, and find it traumatic for their child. Following review, the majority (65.7%) had physiologically normal testes, while 4.9% and 22.4% were diagnosed with bilateral or unilateral cryptorchidism, respectively, and 7.0% had other diagnoses. Ultrasound was concordant with the surgical diagnosis in 25.0% (2015–2017) and 30.7% (2023–2024). Ultrasound did not contribute to diagnosis nor management in any patient.Conclusions: Despite international and local guidelines, cryptorchid children continue to undergo ultrasound prior to referral. Such ultrasounds do not provide utility, or value for cost. We recommend avoiding their routine use for suspicion of testicular maldescent and working together to improve strategies for translating evidence‐based guidelines into clinical practice.

Background Paediatric donor site wounds are often complicated by dyspigmentation following a split-thickness skin graft. These easily identifiable scars can potentially never return to normal pigmentation. A Regenerative Epidermal Suspension (RES) has been shown to improve pigmentation in patients with vitiligo, and in adult patients following a burn injury. Very little is known regarding the efficacy of RES for the management of donor site scars in children. Methods and analysis A pilot randomised controlled trial of 40 children allocated to two groups (RES or no RES) standard dressing applied to donor site wounds will be conducted. All children aged 16 years or younger requiring a split thickness skin graft will be screened for eligibility. The primary outcome is donor site scar pigmentation 12 months after skin grafting. Secondary outcomes include re-epithelialisation time, pain, itch, dressing application ease, treatment satisfaction, scar thickness and health-related quality of life. Commencing 7 days after the skin graft, the dressing will be changed every 3–5 days until the donor site is ≥ 95% re-epithelialised. Data will be collected at each dressing change and 3, 6 and 12 months post skin graft. Ethics and dissemination Ethics approval was confirmed on 11 February 2019 by the study site Human Research Ethics Committee (HREC) (HREC/18/QCHQ/45807). Study findings will be published in peer-reviewed journals and presented at national and international conferences. This study was prospectively registered on the Australian New Zealand Clinical Trials Registry (available at https://anzctr.org.au/ACTRN12620000227998.aspx). Trial registration number Australian New Zealand Clinical Trials Registry [Available at https://anzctr.org.au/ACTRN12620000227998.aspx]