BackgroundThere is conflicting evidence regarding characteristics of patients most likely to have poor outcomes after referral to a multidisciplinary weight loss clinic. The aim of this study was to identify patient characteristics associated with poor attendance and poor weight outcomes at a weight management clinic based in an Australian tertiary hospital.MethodsPatient characteristics including age, sex, referral source, postcode of residence, weight, body mass index (BMI) and the presence of specific comorbidities were recorded. Outcome measures included questionnaire return following referral (a requirement prior to a first appointment being scheduled), percentage of appointments attended and rate of weight change (kg/month). Continuous variables were expressed as mean ± standard deviation and compared using a t-test. Categorical data were presented as proportions and a chi-squared test was used to test significance. Statistical significance was set as p < 0.05.ResultsOf 502 patients referred to the Comprehensive Metabolic Care Centre (CMCC), 231 (46%) did not return their questionnaire. Patients referred by their GP, compared to those with only internal hospital referrals, were more likely to return their questionnaire (86.0% cf. 77.9%; p = 0.02) as were those who had their BMI recorded in their referral letter (58% cf 45% p = 0.011). 28.1% of patients attended half or less of their scheduled appointments at the CMCC but none of the parameters analysed was associated with attendance. Weight loss was associated with residence in a rural location (p = 0.016) and hypercholesterolaemia (p = 0.03) and weight gain was associated with obstructive sleep apnoea (p = 0.04).ConclusionsA large proportion of the patients referred to a weight management clinic never had an appointment scheduled. Clinicians should not anticipate greater compliance in one patient demographic than another; all groups need focus, particularly at the referral stage, and likely poor compliance must be anticipated and better managed.

BACKGROUND: Sessile serrated adenomas/polyps (SSA/P) are now recognised precursors of colorectal cancer (CRC) including cancers harbouring somatic BRAF (V600E) mutations. While the morphological diagnostic criteria of SSA/P have been established, distinguishing between small/early SSA/P and microvesicular hyperplastic polyps (MVHP) is challenging and may not be possible in routine practice. METHODS: Gene expression profiling of MVHP (n=5, all BRAF V600E wild-type) and SSA/P (n=5, all BRAF V600E mutant) samples was performed. Quantitative reverse transcription–polymerase chain reaction (qRT-PCR) and immunohistochemical analysis was performed to verify the expression of claudin 1 (CLDN1) in MVHP and SSA/P. RESULTS: Gene expression profiling studies conducted between MVHP and SSA/P identified CLDN1 as the most statistically significant differentially expressed gene (p<0.05). Validation with qRT-PCR confirmed an up-regulation of CLDN1 in BRAF V600E mutant polyps regardless of polyp type (p<0.0005). Immunohistochemical analysis of CLDN1 expression in BRAF V600E mutant SSA/Ps (n=53) and MVHPs (n=111) and BRAF wild-type MVHPs (n=58), demonstrated a strong correlation between CLDN1 expression and the BRAF V600E mutation in both SSA/P and MVHP samples when compared to wild-type polyps (p<0.0001). CONCLUSION: This study demonstrates an up regulation of CLDN1 protein in serrated colorectal polyps including MVHP harbouring the BRAF V600E mutation. Our results demonstrated an apparent heterogeneity on the molecular level within the MVHP group and suggest that MVHP with somatic BRAF V600E mutation and up-regulated expression of CLDN1 are closely related to SSA/P and may in fact represent a continuous spectrum of the same neoplastic process within the serrated pathway of colorectal carcinogenesis.

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Objectives Psychological distress is common among palliative care patients. Despite this, little is known about the availability of psychological services to support palliative care patients within Australia. This study aimed to determine the level of psychological support services available within Australian Palliative Care Services. The study was based on a similar study in Australia by Crawford in 1999, allowing differences over time to be examined. Methods A 12-item online survey was distributed to adult Palliative Care Services throughout Australia from November 2021 to January 2022. Quantitative and qualitative analysis of responses was conducted, with comparisons made with the 1999 study using a 2-proportions z-test. Results Social workers were the most available professionals delivering psychological care (prevalence of 94.1%), followed by spiritual care workers (62.5%), creative therapists (43.8%), counselors (36.4%), psychiatrists (31.3%), complementary therapists (28.1%), and psychologists (25.0%). Nearly 60% of services had no access to a psychiatrist or a psychologist. The proportion of Palliative Care Services that had access to a psychiatrist, psychologist, or counselor was significantly less in 2021/22 compared to 1999, with differences of 29.4% (p = 0.002), 23.4% (p = 0.015), and 26.1% (p = 0.006), respectively. Significance of results Lack of access to psychiatrists, psychologists, and counselors in Australian Palliative Care Services remains a significant issue and has become more prevalent since 1999. Ongoing advocacy and increased government funding to enable psychological health professionals to be readily employed in Palliative Care Services is vital.

dATP appears to be the major purine metabolite implicated in ADA deficiency.In spite of an important decrease of erythrocyte dATP levels, closely related to a marked clinical improvement, no significant restoration of immune function was observed. Thus red cell transfusion appears to be not a sufficiently effective therapy in ADA deficiency. REFERENCESBoulieu, R., Bory, C. and Gonnet, C. High performance liquid chromatographic method for the analysis of purine and pyrimidine bases, ribonucleosides and deoxyribonucleosides in biological fluids. J. Chromatogr. 339 (1985a) 380-387 Boulieu, R., Bory, C. and Gonnet, C. Liquid chromatographic measurement of purine nucleotides in blood cells. Clin. Chem. 31 (1985b) 727-731 Hirschhorn, R. Inherited enzyme deficiencies and immunodeficiency: adenosine deaminase (ADA) and purine nucleoside phosphorylase (PNP) deficiencies.