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Background: The COVID‐19 pandemic has been associated with detrimental effects on mental health and psychological well‐being. Although multiple studies have shown decreases in mental health‐related Emergency Department (ED) presentations early in the COVID‐19 pandemic, the medium‐term effects on mental health‐related ED presentations have remained less clear. This study aimed to evaluate the effect of the pandemic on mental health ED presentations by comparing observed presentation numbers to predictions from pre‐pandemic data. Methods: This retrospective cohort study tallied weekly ED presentations associated with mental health disorders from a state‐wide minimum dataset. Three time periods were identified: Pre‐Pandemic (January 1, 2018–March 8, 2020), Statewide Lockdown (March 9, 2020–June 28, 2020), and Restrictions Easing (June 29, 2020–June 27, 2021). Time series analysis was used to generate weekly presentation forecasts using pre‐pandemic data. Observed presentation numbers were compared to these forecasts. Results: Weekly presentation numbers were lower than predicted in 11 out of 16 weeks in the Statewide Lockdown period and 52 out of 52 weeks in the Restrictions Easing period. The largest decrease was seen for anxiety disorders (Statewide Lockdown: 76.8% of forecast; Restrictions Easing: 36.4% of forecast), while an increase was seen in presentations for eating disorders (Statewide Lockdown: 139.5% of forecast; Restrictions Easing: 194.4% of forecast). Conclusions: Overall weekly mental health‐related presentations across Queensland public EDs were lower than expected for the first 16 months of the COVID‐19 pandemic. These findings underline the limitations of emergency department provision of mental health care and the importance of alternate care modalities in the pandemic context. [ABSTRACT FROM AUTHOR]

This article examines the impact of COVID-19 on emergency department (ED) presentations in Queensland, Australia. The study analyzes data from 108 public EDs from January 2018 to June 2021, focusing on three specific groups: First Nations people, residents of remote areas, and children under five years old. During the initial restrictions period (March to June 2020), ED presentations were significantly lower than predicted for all groups. While presentations by First Nations people and residents of remote areas returned to predicted levels by September 2020, presentations by children under five years old remained lower until November 2020. The study suggests that public health responses should consider a community child health approach to address the long-term impact of COVID-19 on children's health. [Extracted from the article]

Objective: To determine the impact of the COVID‐19 state‐wide lockdown on ED presentations for older adults in Queensland, Australia. Methods: A retrospective cohort study pertaining to adults aged 70+ years who presented to Queensland public hospital EDs across three separate time periods; 11 March to 30 June 2018 and 2019 (pre‐pandemic average), 2020 (COVID‐19 state‐wide lockdown) and 2021 (post‐state‐wide lockdown). The primary outcome was change in presentation rates to ED. Secondary outcomes included change in triage category rates, length of stay (LOS), diagnosis and disposition. Results: There was 380 854 older adult presentations. During the COVID‐19 state‐wide lockdown, ED presentation rates decreased by 12.5% (incidence rate ratio 0.875 [95% confidence interval 0.867–0.883]). All triage category presentation rates decreased, as did ED LOS and reasons for presentation, except sepsis and disorders of the nervous system. In the post‐state‐wide lockdown period a 22% (incidence rate ratio 1.22 [95% confidence interval 1.21–1.23]) increase in the presentation rate was observed and presentations in all triage categories increased. ED LOS increased to longer than pre‐pandemic (P < 0.001). Respiratory presentations increased by 346%. Patients who 'did not wait' increased by 212% and ED mortality rose by 42% compared to during the lockdown. Conclusion: There was a significant decrease in presentation rates to EDs during the COVID‐19 state‐wide lockdown for the older population, followed by an increase in presentation rates, longer ED LOS, and an increased ED mortality rate, in the post‐state‐wide lockdown period. It is important to ensure older adults continue to seek appropriate, timely medical care, during a pandemic. [ABSTRACT FROM AUTHOR]

Objectives: To assess emergency department (ED) presentation numbers in Queensland during the coronavirus disease 2019 (COVID‐19) pandemic to mid‐2021, a period of relatively low COVID‐19 case numbers. Design: Interrupted time series analysis. Setting: All 105 Queensland public hospital EDs. Main outcome measures: Numbers of ED presentations during the COVID‐19 lockdown period (11 March 2020 – 30 June 2020) and the period of easing restrictions (1 July 2020 – 30 June 2021), compared with pre‐pandemic period (1 January 2018 – 10 March 2020), overall (daily numbers) and by Australasian Triage Scale (ATS; daily numbers) and selected diagnostic categories (cardiac, respiratory, mental health, injury‐related conditions) and conditions (stroke, sepsis) (weekly numbers). Results: During the lockdown period, the mean number of ED presentations was 19.4% lower (95% confidence interval, –20.9% to –17.9%) than during the pre‐pandemic period (predicted mean number: 5935; actual number: 4786 presentations). The magnitudes of the decline and the time to return to predicted levels varied by ATS category and diagnostic group; changes in presentation numbers were least marked for ATS 1 and 2 (most urgent) presentations, and for presentations with cardiac conditions or stroke. Numbers remained below predicted levels during the 12‐month post‐lockdown period for ATS 5 (least urgent) presentations and presentations with mental health problems, respiratory conditions, or sepsis. Conclusions: The COVID‐19 pandemic and related public restrictions were associated with profound changes in health care use. Pandemic plans should include advice about continuing to seek care for serious health conditions and health emergencies, and support alternative sources of care for less urgent health care needs. [ABSTRACT FROM AUTHOR]

Spinal cord injury (SCI) represents an urgent unmet need for clinical reparative therapy due to its largely irreversible and devastating effects on patients, and the tremendous socioeconomic burden to the community. While different approaches are being explored, therapy to restore the lost function remains unavailable. Olfactory ensheathing cell (OEC) transplantation is a promising approach in terms of feasibility, safety, and limited efficacy; however, high variability in reported clinical outcomes prevent its translation despite several clinical trials. The aims of this position paper are to present an in-depth analysis of previous OEC transplantation-based clinical trials, identify existing challenges and gaps, and finally propose strategies to improve standardization of OEC therapies. We have reviewed the study design and protocols of clinical trials using OEC transplantation for SCI repair to investigate how and why the outcomes show variability. With this knowledge and our experience as a team of biologists and clinicians with active experience in the field of OEC research, we provide recommendations regarding cell source, cell purity and characterisation, transplantation dosage and format, and rehabilitation. Ultimately, this position paper is intended to serve as a roadmap to design an effective clinical trial with OEC transplantation-based therapy for SCI repair. [ABSTRACT FROM AUTHOR]

Advancements in technology and communication have revolutionised the twenty-first century with the introduction of mobile phones and smartphones. These phones are known to be platforms harbouring microbes with recent research shedding light on the abundance and broad spectrum of organisms they harbour. Mobile phone use in the community and in professional sectors including health care settings is a potential source of microbial dissemination. To identify the diversity of microbial genetic signature present on mobile phones owned by hospital medical staff. Twenty-six mobile phones of health care staff were swabbed. DNA extraction for downstream next generation sequencing shotgun metagenomic microbial profiling was performed. Survey questionnaires were handed to the staff to collect information on mobile phone usage and users' behaviours. Each of the 26 mobile phones of this study was contaminated with microbes with the detection of antibiotic resistance and virulent factors. Taken together the sum of microbes and genes added together across all 26 mobile phones totalised 11,163 organisms (5714 bacteria, 675 fungi, 93 protists, 228 viruses, 4453 bacteriophages) and 2096 genes coding for antibiotic resistance and virulent factors. The survey of medical staff showed that 46% (12/26) of the participants used their mobile phones in the bathroom. Mobile phones are vectors of microbes and can contribute to microbial dissemination and nosocomial diseases worldwide. As fomites, mobile phones that are not decontaminated may pose serious risks for public health and biosecurity. [ABSTRACT FROM AUTHOR]

The United Nations Convention on the Rights of Persons with Disabilities and the Sendai Framework for Disaster Risk Management establish the importance of ensuring the equitable protection of human rights in disaster planning, relief, and recovery. However, internationally and within Australia, the reality is one of indignity, human rights violations, and corruption. Australia is living in a perpetual state of crisis, following 3years of environmental and health disaster events. Vulnerable Australian citizens, especially people with disability, are at a great risk of human rights violations and may have restricted access to resilience-building resources that would enable them to recover. Embedding dignity into disaster management and recovery can safeguard human rights and improve outcomes for people with disability. What is known about this topic? People with disability are more vulnerable to the negative impacts of disaster and are marginalised and excluded in recovery efforts. What does this paper add? The paper focuses on embedding dignity into disaster planning, response and recovery to conserve human rights of people with disability and improve outcomes. What are the implications for practitioners? Health practitioners are important front-line responders to both health and environmental disasters and should consider how dignity can improve service for people with disability and increase positive outcomes to build back better. [ABSTRACT FROM AUTHOR]

Importance: During pandemics Agent Based Models (ABMs) can model complex, fine-grained behavioural interactions occurring in social networks, that contribute to disease transmission by novel viruses such as SARS-CoV-2. Objective: We present a new agent-based model (ABM) called the Discrete-Event, Simulated Social Agent based Network Transmission model (DESSABNeT) and demonstrate its ability to model the spread of COVID-19 in large cities like Sydney, Melbourne and Gold Coast. Our aim was to validate the model with its disease dynamics and underlying social network. Design: DESSABNeT relies on disease transmission within simulated social networks. It employs an epidemiological SEIRD+M (Susceptible, exposed, infected, recovered, died and managed) structure. One hundred simulations were run for each city, with simulated social restrictions closely modelling real restrictions imposed in each location. Main outcome(s) and measure(s): The mean predicted daily incidence of COVID-19 cases were compared to real case incidence data for each city. Reff and health service utilisation outputs were compared to the literature, or for the Gold Coast with daily incidence of hospitalisation. Results: DESSABNeT modelled multiple physical distancing restrictions and predicted epidemiological outcomes of Sydney, Melbourne and the Gold Coast, validating this model for future simulation work. Conclusions and relevance: DESSABNeT is a valid platform to model the spread of COVID-19 in large cities in Australia and potentially internationally. The platform is suitable to model different combinations of social restrictions, or to model contact tracing, predict, and plan for, the impact on hospital and ICU admissions, and deaths; and also the rollout of COVID-19 vaccines and optimal social restrictions during vaccination. [ABSTRACT FROM AUTHOR]

Some people with disabilities may have greater risk of contracting COVID-19 or experiencing worse outcomes if infected. Although COVID-19 is a genuine threat for people with disabilities, they also fear decisions that might limit lifesaving treatment should they contract the virus. During a pandemic, health systems must manage excess demand for treatment, and governments must enact heavy restrictions on their citizens to prevent transmission. Both actions can have a negative impact on people with disabilities. Ironically, the sociotechnical advances prompted by this pandemic could also revolutionize quality of life and participation for people with disabilities. Preparation for future disasters requires careful consideration. [ABSTRACT FROM AUTHOR]

The article discusses the need for the Royal Australasian College of Physicians (RACP) to include doctors with disabilities. It highlights employment disparities and discrimination, emphasizes workplace inclusion, legal protections, and calls on the RACP to prioritize the inclusion of doctors with disabilities for the sake of health equity.

Concurrent stimulation and reinforcement of motor and sensory pathways has been proposed as an effective approach to restoring function after developmental or acquired neurotrauma. This can be achieved by applying multimodal rehabilitation regimens, such as thought-controlled exoskeletons or epidural electrical stimulation to recover motor pattern generation in individuals with spinal cord injury (SCI). However, the human neuromusculoskeletal (NMS) system has often been oversimplified in designing rehabilitative and assistive devices. As a result, the neuromechanics of the muscles is seldom considered when modeling the relationship between electrical stimulation, mechanical assistance from exoskeletons, and final joint movement. A powerful way to enhance current neurorehabilitation is to develop the next generation prostheses incorporating personalized NMS models of patients. This strategy will enable an individual voluntary interfacing with multiple electromechanical rehabilitation devices targeting key afferent and efferent systems for functional improvement. This narrative review discusses how real-time NMS models can be integrated with finite element (FE) of musculoskeletal tissues and interface multiple assistive and robotic devices with individuals with SCI to promote neural restoration. In particular, the utility of NMS models for optimizing muscle stimulation patterns, tracking functional improvement, monitoring safety, and providing augmented feedback during exercise-based rehabilitation are discussed. [ABSTRACT FROM AUTHOR]

Background: Australian clinical guidelines recommend further investigation in females with postmenopausal bleeding (PMB) and endometrial thickness (ET) of ≥4 mm on transvaginal ultrasound (TVUS). However, the literature indicates that an ET of ≥3 mm as an upper limit is a more sensitive predictor of endometrial malignancy (EM) in females with PMB. Aims: To assess whether Australian guidelines for PMB with an upper limit of 4 mm ET on ultrasound investigation, is sensitive enough for malignancy detection. Material and Methods: A retrospective study was performed on tissue results in PMB presentations to the Gold Coast Hospital and Health Service between 2011 and 2015. Results: Twenty point nine percent of women with PMB had a malignancy. With an upper limit of 4 mm in ET on ultrasound, malignancy was present in 22% of participants. [Correction added on 10 July 2020, after first online publication: percentage of women with PMB that had a malignancy has been amended to twenty point nine percent.] Conclusions: A limit of 3 mm for ET in PMB, along with office endometrial biopsy, should be considered to ensure timely diagnoses. [ABSTRACT FROM AUTHOR]

Asking a patient how they feel about a proposed treatment may delight a well-informed patient, yet signal incompetence to a patient who may expect and accept that their doctor knows best. While we need well-educated doctors, they are more comfortable with medical jargon than most patients, and using medical jargon has been shown to inhibit good communication and even harm patients.[12] This problem is aggravated further if the patient's first language is not English. RELATIVE LACK OF HEALTHCARE PRACTITIONER DIVERSITY The relative lack of diversity among healthcare practitioners could exacerbate the challenge to empathy posed by increasingly diverse patients. [Extracted from the article]

The article discusses that organisations have cropped up to advocate and support doctors with disabilities. With Australia's investment in disability and the National Disability Insurance Scheme's budget approaching comparison to the Medicare budget and schemes like Job Access funding a great deal of equipment for doctors wanting to enter or return to work, it is important for disability inclusion in medicine to become a national movement.

Spinal cord injuries (SCIs) present distinct physiological and social considerations for the emergency physician. During the COVID‐19 pandemic, these considerations may generate unique challenges for emergency physicians managing patients with SCIs. Physiological disruptions may alter the way SCI patients present with COVID‐19. The same disruptions can affect management of this vulnerable patient group, perhaps warranting early aggressive treatment. The medical picture will often be complicated by unique social characteristics. The reliance on caregivers for activities of daily living can, as an example, increase the human resource requirement of an ED. Considering the vulnerabilities and complexities of patients with SCI, the community should prioritise prevention of COVID‐19 infections in this group. In the event that they do present to an ED, planning for and understanding their complexities will facilitate optimal management. [ABSTRACT FROM AUTHOR]

Keywords: Doctors' health; Physician-patient relations; Disability evaluation; Disabled persons; Education; Medical; Premedical; Graduate EN Doctors' health Physician-patient relations Disability evaluation Disabled persons Education Medical Premedical Graduate 249 249 1 09/21/21 20210915 NES 210915 Medical students with disabilities bring lived experience as patients, with a positive impact on school culture and learning In 2015, Dinesh Palipana was readmitted to the third year of the Griffith University School of Medicine (GUSOM) medical program, 5 years after sustaining traumatic quadriplegia. Education, Graduate, Doctors' health, Physician-patient relations, Disability evaluation, Disabled persons, Medical, Premedical. [Extracted from the article]

Society is currently facing unprecedented technological advances that simultaneously create opportunities and risks. Technology has the potential to revolutionize rehabilitation and redefine the way we think about disability. As more advanced technology becomes available, impairments and the environmental barriers that engender disability can be significantly mitigated. The opportunity to apply technology to rehabilitation following serious injuries or illnesses is becoming more evident. However, the translation of these innovations into practice remains limited and often inequitable. This situation is exacerbated by the fact that not all relevant parties are involved in the decision-making process. Our solution was to create a sociotechnical system, known as HabITec, where people with disabilities, practitioners, funders, researchers, designers and developers can work together and co-create new solutions. Sociotechnical thinking is collaborative, interdisciplinary, adaptive, problem-solving and focused on a shared set of goals. By applying a sociotechnical approach to the healthcare sector, we aimed to minimize the lag in translating new technologies into rehabilitation practice. This collaborative co-design process supports innovation and ensures that technological solutions are practical and meaningful, ethical, sustainable and contextualized. In this conceptual paper, we presented the HabITec model along with the empirical evidence and theories on which it has been built. [ABSTRACT FROM AUTHOR]