bluuebunny/crossref_metadata_2025_split huggingface dataset:
P066 Long-term outcomes from home invasive mechanical ventilation in Queensland
Authors: Morrison S , Gavey R , Moman A , Kwiatkowski S , Duce B , Hukins C , Ellender C 
Published: December 2024

Abstract
Home invasive mechanical ventilation (HIMV) is an uncommon but life-sustaining therapy for patients with chronic respiratory failure. However, the published literature on patient outcomes is inconsistent, reflecting varied practices. Moreover, local Australian data and detailed therapy outcomes are scarce. A retrospective review of patients treated with HIMV at a single tertiary centre between 01/01/2005 and 18/05/2024 was conducted. The primary outcome was the time from HIMV initiation to cessation or death. Secondary outcomes included diagnostic group, cause of death, number of hospitalisations and length of stay. Patient demographics were recorded.
31 patients were identified, with 26 meeting the inclusion criteria. The median age at injury was 35 years (9-77), with n=15 (57) male. Diagnostic groups included 13 (50%) spinal cord injuries, 4 (15%) brain injuries, 2 (8%) restrictive thoracic, 5 (19%) neuromuscular including 2 motor neuron disease and 2 (8%) other conditions. The mean survival on HIMV therapy was 19.6 years (95th CI 13.8-25.4). There was no significant difference in survival between patients with or without spinal cord injuries. Cause of death was predominantly respiratory failure (36%) and cardiovascular disease (27%). Median hospital encounters per patient-year on HIMV included 1.7 emergency department presentations, 1.4 hospital admissions, and 8.1 days of hospital stay.
This study reported the longest mean survival on HIMV compared with international datasets. This may be due to low sample size, younger population, lower proportions of diagnostic groups with known poorer prognoses and heterogenous prior research.
P071 Legislative and governance pathways to psychologist prescribing of melatonin in the behavioural sleep medicine setting in Queensland
Authors: Sullivan D 
Published: December 2024

Abstract

Introduction
Melatonin can be a beneficial adjunctive therapy alongside behavioural sleep medicine (BSM) interventions for circadian rhythm disorders or other behavioural sleep problems with an element of circadian disruption. Current psychologist scope of practice in Australia is federally regulated and does not include activities with medicines, including prescribing. Authorisation of health professions to prescribe medicines as part of an extended scope of practice, including research or scope of practice trials, is subject to individual state and territory government regulation.

Methods
Queensland legislation and health department procedures were reviewed to outline the mechanisms for psychologists to prescribe melatonin in a public sector BSM setting.

Results
Authority to prescribe medicines is provided by the Medicines and Poisons Act 2019 (Qld) (MPA) and the Medicines and Poisons (Medicines) Regulation 2021 (Qld) (MPMR). This authority may be provided under s75 (General Approval) or s52 (clinical trial) of the MPA without an MPMR amendment. Alternatively, for extended scope models in both public sector and private community settings, an amendment to the MPMR made by the executive branch of government provides authority for a health professional to prescribe medicines alongside an extended practice authority (EPA) by the state health department which specifies the circumstances under which the clinician can execute that authority.

Discussion
Queensland’s medicines legislation enables allied health extended scope of practice models. Implementation of psychologist prescribing of melatonin alongside BSM requires a MPMR amendment and EPA, or General Approval or clinical trial approval which would specify requisite training requirements, formulary, and any other limitations.
P072 Developing Generative AI Products for Sleep Health Support: A Risk-Based Approach
Authors: Deas R , Cotton A , Santizo R , Webb K , Signoroni M , Tjia J , Li M , Au-Yeung G , Lyle A , Silva C , Armitstead J 
Published: December 2024

Abstract

Introduction
Generative AI tools can assist individuals with sleep problems by providing information about sleep disorders, sleep health, and product support. However, it is crucial to mitigate the risks of misinformation and ensure that tools do not unintentionally provide medical advice.

Methods
A set of topics and patient/customer queries were identified to define the use case. Despite not meeting the definition of a medical device in Australia, a multidisciplinary team employed risk management principles to meet user needs while complying with regulatory, legal, and clinical requirements. Key considerations included selecting the LLM and grounding content to create a prototype. The prototype was tested by a multidisciplinary team to evaluate performance and introduce additional requirements via prompt engineering, disclaimers, and topic exclusions. Upon meeting requirements, the product launched with 100% human oversight of customer responses, planning to reduce oversight as the product consistently met all requirements.

Results
The digital assistant has successfully answered over 1000 user inquiries, meeting all requirements. Data sources are regularly updated to align with current information and the risk analysis is continuously updated based on performance, and.

Discussion
The risk-based process used for developing the digital assistant has resulted in a generative AI tool to support people with sleep problems. Collaboration with a multidisciplinary team is crucial to ensure the responsible use of generative AI tools that are fit for the purpose to support people with sleep problems as they look for reliable information about sleep health and sleep disorders.
P074 Design of general practice-delivered models of care for sleep health care: lessons learnt from chronic disease management in general practice
Authors: Grivell N , Brown B , Fuller J , Chai-Coetzer C , McEvoy R , Hoon E 
Published: December 2024

Abstract

Introduction
General practice-delivered models of care for obstructive sleep apnea and insomnia have been developed in response to challenges with access to care. However, despite evidence of effectiveness, these models are not yet integrated into routine practice. Understanding factors influencing implementation can facilitate translation into practice however research exploring the implementation of models of care for sleep health care is scarce. As such, a systematic review exploring the implementation of models of care for chronic disease was conducted to inform models of care for chronic sleep disorders.

Methods
A mixed-methods JBI convergent integrated systematic review. Seventy-two records, published between 1995 and 2022, were included. Framework synthesis was conducted however data that did not fit the chosen conceptual framework was identified, necessitating the development of a new amended framework.

Results
Relationship between general practice staff and specialist services, compatibility with existing work processes, patient-centred care, and an understanding of the benefits of the model of care by clinicians and patients were facilitators to implementation. Lack of transparency and understanding about the roles and responsibilities of team members, inadequate funding, and models of care that restrict individualised patient care limited implementation.

Discussion
This review provides recommendations that can be used to inform the design and implementation of new general practice-delivered models of care for chronic sleep disorders. Establishing relationships, understanding the general practice context, and engagement of patients (co-design) when designing models of care, may facilitate the implementation of models of care that meet the needs of patients and general practice staff.
P075 Use of an innovative tool to screen for sleep disorders in primary care
Authors: Haycock J , Maloney S , Boeselt J , Loffler K , Sweetman A , Hoon E , Lovato N , Catcheside P , Adams R , Reynolds K , Vakulin A 
Published: December 2024

Abstract
Effective screening for sleep problems in primary care is an essential first step in the diagnosis and management of sleep disorders. However, sleep disorders are complex and often overlooked by both primary care clinicians and patients. This pilot project trialled an innovative technological approach to help screen for common sleep disorders and provide treatment decision support recommendations to general practitioners (GPs) and patients in primary care.
This mixed methods study included interviews with GPs to investigate the needs and specifications for a digital sleep health decision support tool in primary care. A pilot study trialled the usefulness and feasibility of an innovative tool to screen for sleep disorders in general practice. Data collected included uptake of the tool, feedback from GP follow-up interviews and patient surveys.
Results from 5 GPs and 23 patients indicate ease of use in primary care and clinical utility are important, and that the decision support tool helped to reinforce clinical decision making and raised the priority of sleep disorders with patients. Issues with workflow, patient motivation and engagement were identified as barriers limiting usage.
With growing interest in the management of sleep disorders in primary care, GPs need streamlined tools to easily identify patients at risk of sleep problems. An innovative decision support tool is useful in primary care to support clinical decision making and encourage patients to seek help for sleep problems. A larger scale trial is warranted to assess the impact of this tool on clinical decisions and patient outcomes in primary care.
P077 Death anxiety, disturbing dreams and nightmare severity in Australian adults
Authors: Dunican I , Turner M , Meaklim H , Cunnington D , Burge M , Menzies R 
Published: December 2024

Abstract

Introduction
In recent years, death anxiety has been identified as a transdiagnostic risk factor for many mental health conditions and potentially for disturbing sleep and nightmares. In this cross-sectional study, we aimed to identify the prevalence and predictors of death anxiety and examine its relationship to disturbing dreams and nightmares in Australian adults.

Methods
Participants completed a series of questionnaires as part of a larger study, including measures of death anxiety with the Death Anxiety Beliefs and Behaviour Scale (DABBS), nightmare severity with the Disturbing Dream and Nightmare Severity Index (DDNSI), and dream content with the Typical Dreams Questionnaire (TDQ).

Results
432 (47% female) Australian participants completed the study, with an average age of 45±18 years. Overall, 10% reported a sleep disorder diagnosis, and 47% reported a mental health diagnosis. Overall, DABBS scores were significantly higher in females than in males aged 18-30 (p&lt;0.001). Similarly, DDNSI was significantly higher in females compared with males between ages 31-44 years (p&lt;0.02). Typical themes for most people’s dreams included being chased or pursued. Those with a mental health disorder also had significantly higher DABBS scores (p&lt;0.001). Importantly, DABBS scores were significantly and positively related to DDNSI (p&lt;0.003, R2 0.006).

Discussion
These findings indicate that gender differences in death anxiety appear largest in young adults. Importantly, death anxiety was significantly associated with nightmare severity. In particular, the most reported dream themes revolved around threat (i.e., being chased). These results highlight the potential benefits of treating death anxiety to improve nightmare severity.
P079 Words matter: Dream content may predict psychological distress
Authors: Burge M , Meaklim H , Turner M , Dunican I , Menzies R , Cunnington D 
Published: December 2024

Abstract

Introduction
Dream content analysis is not a routine part of a clinical sleep assessment. However, dreams are an important part of the sleep experience and may provide insights into other health domains. This study investigated the relationship between descriptions of dream content and psychological distress.

Methods
The study cohort consisted of 217 participants (149 female, age range: 19-83) who completed the Depression Anxiety Stress Scale 21 (DASS-21) and described their last remembered dream. Dream content was analysed using 26 categories from the Linguistic Inquiry and Word Count 22, including emotion, pro-social vs. conflict, lifestyle, health, drives, and perception language. Principal components analysis (PCA) identified 18 principle components (PC) that explained 90% of the variance in these categories. These components were used to predict severe and higher scores of depression and anxiety and moderate and higher scores of stress through logistic regression models. Stepwise regression using the backward method, based on Akaike Information Criterion scores, was employed to select the best models.

Results
The analysis found no significant predictors for depression. However, a PC high in frequencies of visual and auditory perception, motion, and space language and a PC high in frequencies of substances, sexual, food, and motion language significantly increased the odds of severe and higher anxiety (Tjur R² = 0.04) and moderate and higher stress (Tjur R² = 0.09).

Discussion
These findings suggest specific words used to describe dream content are associated with higher levels of anxiety and stress. Reviewing dream content may provide additional insights for clinicians.
P081 Sleep health in community-dwelling midlife women and associations with menopausal symptoms: a cross-sectional study
Authors: Noll J , Metse A , Gardiner P , Pernoud L , Scott J , Schaumberg M 
Published: December 2024

Abstract

Introduction
Sleep health or, ‘healthy sleep’, is a multidimensional construct, more than the absence of a sleep disorder. Menopausal women often experience sleep disturbances, yet the impact of menopausal symptoms on the likelihood of poorer sleep health remains unclear. This study examined how domains of menopausal symptoms (vasomotor, psychosocial, physical and sexual) relate to sleep health in Australian middle-aged women.

Methods
A total of 150 healthy women, aged 40-64 years, participated in this cross-sectional study. Sleep health was measured using the Ru-SATED questionnaire (scores ranging from 0 [poor sleep health] to 12 [good sleep health]), and sleep duration and efficiency were collected with actigraphy. Recommended sleep duration and efficiency were based on National Sleep Foundation (NSF) guidelines. Domains of menopausal symptoms were assessed with the Menopause-specific Quality of Life (MENQOL) questionnaire. Data were analysed through ordinal and binomial regression.

Results
The average Ru-SATED score was 9.2±2.2. According to NSF guidelines, only 20.0% of participants slept the recommended 7 to 9 hours, and 31.3% had the recommended sleep efficiency (≥85.0%). After adjusting for covariates, greater psychosocial symptoms were significantly associated with poorer sleep health (β=-0.437, p=0.002). Menopausal symptoms were not significantly associated with actigraphy measured sleep duration or efficiency.

Discussion
Most midlife women in this study did not meet the NSF sleep health recommendations. Psychosocial symptoms were associated with poorer sleep health in midlife women, consistent with research in other populations. Further research into factors beyond menopausal symptoms contributing to the likelihood of poor sleep health in middle-aged women is warranted.
P084 General practitioner training on obstructive sleep apnoea and long-term care: a pilot study
Authors: Abbas S , Liaw S , Marks G , Buchanan P , Williamson J , Johnson A , Tam M , Garden F , Chung Y , Vedam H 
Published: December 2024

Abstract

General practitioner training on obstructive sleep apnoea and long-term care: a pilot study

Introduction
Obstructive sleep apnoea (OSA) can be treated using continuous positive airway pressure (CPAP) therapy; however, many patients experience difficulties acclimatising and persisting with this treatment. In view of the increasing prevalence of OSA, evidence-based models of care not limited to sleep physicians are urgently required. A pilot study was conducted on the feasibility of implementing an education session for general practitioners (GPs) on OSA and its long-term care.

Methods
Fourteen GPs from a university practice-based research network participated in a 1-hour education session on the chronic nature and management of OSA, aiming to develop a format for structured follow-up. Quizzes were administered to assess knowledge before and after the sessions, with pre and post-session data compared using McNemar’s test. Prior to these sessions, surveys were sent to GPs to identify areas they wanted to cover to maximise engagement.

Results
Twelve GPs completed both pre and post-session questionnaires. Key areas demonstrating an improvement in knowledge were awareness of established treatment measures for OSA (p=0.008), compliance data parameters to assess CPAP use (p=0.014) and assessment of leak (p=0.014). All participants found sessions to be either “helpful” or “very helpful”.

Discussion
This study demonstrated that a focused education session for GPs on OSA and CPAP therapy is feasible, implementable, and led to improved knowledge and confidence in providing structured follow-up. Further work is required to determine potential benefits for patients and access to health services.
P085 Case report of direct diaphragmatic pacing in a child
Authors: Abosh D , Jarvis S , Karpelowsky J , Waters K 
Published: December 2024

Abstract

Background
We present the case of an 8-year-old boy who was diagnosed with acute flaccid myelitis at the age of 5 subsequent to an enterovirus infection. His course was complicated by near complete paralysis of the diaphragm and ventilatory failure necessitating tracheostomy. He has subsequently required full time ventilation via tracheostomy despite gaining sufficient motor function for walking. We describe the concept, indications, and contraindications of diaphragm pacing in ventilator-dependent paediatric populations and compare its use to similar adult populations.

Methods
Direct diaphragmatic pacing is an alternative to phrenic nerve pacing, and it has gained popularity in recent years. The majority of reported cases are in adults with paralysis secondary to spinal cord injury. This is a prospective interventional case report of the use of diaphragm pacing in a ventilator-dependent paediatric patient with a tracheostomy, because he represents a unique clinical scenario for this surgery, including potential sensation of the pacing.

Progress to date
The patient is planned for pacing surgery in August 2024. Consent has been obtained from the family to report the case, thus permitting preparation of the manuscript while plans for surgery are underway.

Intended outcome and impact
The expectation is that with direct diaphragmatic pacing the patient will become less dependent on mechanical ventilation, enabling him to have more freedom in his activities. If successful this intervention will provide an opportunity for future utilisation in other carefully selected cohorts, to replace mechanical ventilation and improve quality of life.
P086 Taking a Comprehensive Approach to Investigating Screen Time and Sleep in Preschoolers With and Without Autism
Authors: Axelsson E 
Published: December 2024

Abstract
Children’s screen time has increased, and the majority of children exceed recommended screen time limits. Relationships between screen time and development are reportedly mixed, but children who meet recommended guidelines for screen time, physical activity, and sleep, perform better on cognitive measures (Walsh et al., 2018). It is therefore important to incorporate sleep into investigations of screen time and child development. Sleep is important for children’s learning, memory, and behaviour, and screen time evidently disrupts sleep. Children with developmental disorders have greater sleep difficulties (Halstead et al., 2021) and longer screen times than typically developing children (Aishworiya et al., 2018) and both could compound existing developmental difficulties. We take a comprehensive approach to investigating preschoolers’ screen time and relationships with sleep, cognition, language, and behaviour. There are limited findings with preschoolers and in particular preschoolers with autism. Caregivers of typically developing children and children with or at risk for autism complete a screen time diary that incorporates content type (entertainment, educational, relaxing), engagement type (passive/interactive; with someone/solo), and time of day; and questionnaires on their child’s sleep quality, development, and behaviour. We also administer direct measures of executive function, language, and memory. Sleep is measured objectively using actigraphy and a sleep diary. If screen time disrupts sleep, does it also interact with children’s memory for new words, their cognitive and behavioural development? We present an overview of the study and the challenges faced recruiting preschoolers and some preliminary descriptive data.
P090 Assessment of the seal, comfort, usability and performance of an ultra-compact full-face PAP mask in comparison to a competitor mask
Authors: Bindra J , Ghamedi S , Camacho L , Banodkar N , Deas R , Zhu X , Sert Kuniyoshi F , Dauphin B , Uhles M 
Published: December 2024

Abstract

Introduction
Positive Airway Pressure (PAP) is the standard treatment for Obstructive Sleep Apnoea (OSA), with a well-fitting mask crucial for adherence. The Oran Park (OP) mask combines full-face performance with an ultra-compact design, featuring a soft, adaptable silicone cushion for all-night comfort. This study assessed the efficacy and subjective ratings of the OP mask in the home environment, compared to a competitor mask and participants’ own masks.

Methods
PAP users with cloud-connected devices tested the OP and competitor masks for up to 7 nights each in randomised order, completing questionnaires on an 11-point Likert Scale. Objective PAP therapy data (Apnoea-Hypopnoea Index (AHI), leak, pressure, usage) was obtained from their PAP devices. Data were analysed using appropriate statistical methods.

Results
57 participants completed the study. The OP mask received significantly better median scores than the competitor for ease of adjustment (8 vs. 7), ease of use (9 vs. 8), softness and comfort (9 vs. 8), noise (9 vs. 8), venting (10 vs. 8), sleep position freedom (8 vs. 7), and confidence about continuing therapy (8 vs. 7). The OP mask was rated significantly better than own mask for facial markings. PAP therapy data showed no significant differences across all masks, with acceptable objective leak values.

Discussion
This clinical study demonstrates the efficacy of the OP mask with PAP therapy, evidenced by low residual AHI and superior subjective results for cushion softness/comfort and sleep position freedom. Further research could explore the long-term effects of the OP mask on PAP adherence and outcomes.