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The Austroads Fitness to Drive Guidelines were updated in 2022. Most of the focus to date has been on Part 2 of the Guidelines, which provide guidance as to specific medical conditions. Less attention has been paid to Part 1 of the Guidelines, which cover a medical practitioner's ethical and legal obligations. This paper addresses the imbalance by considering and amplifying the obligations discussed in Part 1 of the Guidelines. [ABSTRACT FROM AUTHOR]

The outbreak of the COVID‐19 pandemic in late 2019 and in 2020 presented challenges to healthcare workers (HCW) around the world that were unexpected and dramatic. The relentless progress of infection, starting in China and rapidly spreading to Europe, North America and elsewhere gave more remote countries, like Australia, time to prepare but also time for unease. HCW everywhere had to readjust and change their work practices to cope. Further waves of infection and transmission with newer variants pose challenges to HCW and health systems, even after mass vaccination. Respiratory medicine HCW found themselves at the frontline, developing critical care services to support intensive care units and grappling with unanticipated concerns about safety, risk and the need to retrain. Several studies have addressed the need for rapid changes in the healthcare workforce for COVID‐19 and the impact of this preparation on HCW themselves. In this paper, we present a scoping review of the literature on preparing HCW for the pandemic, explore the Australian experience of building the respiratory workforce and propose evidence‐based recommendations to sustain this workforce in an unprecedented high‐risk environment. [ABSTRACT FROM AUTHOR]

Multiple myeloma (MM) is a disease of older people, yet factors relating to comorbidity and frailty may threaten treatment tolerability for many of this heterogenous group. There has been increasing interest in defining specific and clinically relevant frailty assessment tools within the MM population, with the goal of using these frailty scores, not just as a prognostic instrument, but also as a predictive tool to allow for a frailty‐adapted treatment approach. This paper reviews the various frailty assessment frameworks used in the evaluation of patients with MM, including the International Myeloma Working Group Frailty Index (IMWG‐FI), the Mayo Frailty Index and the simplified frailty scale. While the IMWG‐FI remains the most widely accepted tool, the simplified frailty scale is the most user‐friendly in busy day‐to‐day clinics based on its ease of use. This paper summarises the recommendations from the Myeloma Scientific Advisory Group (MSAG) of Myeloma Australia, on the use of frailty assessment tools in clinical practice and proposes a frailty‐stratified treatment algorithm to aid clinicians in tailoring therapy for this highly heterogeneous patient population. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to the National Statement on Ethical Conduct in Human Research, which was published by the Human Research Ethics Committees (HREC) in 2007.

Jack Jumper ant venom allergy is a uniquely Australian medical issue. The stinging ant is a leading cause of insect venom allergy in south‐eastern Australia. An effective venom immunotherapy‐based treatment was successfully developed by the Tasmanian Jack Jumper Allergy Research group. This paper provides a synopsis of our 25 years' research journey in developing this evidence‐based treatment modality. [ABSTRACT FROM AUTHOR]

Background: Spirituality is a fundamental dimension of our human nature that impacts on medical care and yet is relatively neglected by medical education courses in Australia. Aim: This systematic review was conducted to assess the curriculum content currently used to develop medical student understanding of, and engagement with, spirituality in the context of patient care. Methods: Studies published in English from 2010 to the review date were included in order to focus on the most recent curricula. Studies included medical students in undergraduate or postgraduate programmes, doctors in resident training programmes and registrars. Interventions considered for inclusion were curriculum modules on communication skills in spirituality, spiritual needs assessments and holistic care planning. Six databases, including PubMed, Scopus, PsycINFO, Embase, Medline and CINAHL, were searched electronically using the following keywords and MeSH search terms: 'medical students', 'doctor', 'physician', 'spirituality', 'spiritual care', 'religion', 'education', 'history taking' and 'communication skills training' from 2010 to 2020. Results: For 342 articles, three researchers screened the titles and abstracts; disagreements were resolved by discussion. Full-text articles were assessed for eligibility based on study and report characteristics; 17 papers were included in the analysis. Curriculum content of each study was reviewed. The following key features were employed frequently: chaplain shadowing, communications skills training, self-reflection, examining evidence and relationship building. Conclusion: This review has determined the core content, aims and objectives to guide construction of spirituality curricula in Australian medical education. [ABSTRACT FROM AUTHOR]

While many of the maladies of the 20th century are steadily coming under control, the march of neurodegenerative disorders continues largely unchecked. Dementias are an exemplar of such disorders; their incidence and prevalence continue to rise, in large part due to a steadily ageing population worldwide. They represent a group of chronic, progressive and, ultimately, fatal neurodegenerative diseases. Dementia has remained therapeutically recalcitrant. It is not a single disease, and because of that, we cannot expect a single panacea. While primary prevention rightly gains prominence, those with established disease currently require a shift in focus from curative intent towards improved quality of life. Enter palliative care. The sheer number and complexity of needs of patients with dementia, from the physical to the psychosocial and spiritual, necessitates the engagement of a wide range of medical disciplines, nursing and allied health professionals. One of those disciplines, as highlighted in the recent Australian Royal Commission into Aged Care Quality and Safety, is palliative care. This paper shall expand upon that role in the overall context of care for those with dementia. [ABSTRACT FROM AUTHOR]

The Australian Commission of Safety and Quality in Health Care mandates the application of the eight National Safety and Quality Health Service Standards to minimise high‐risk adverse events in hospital settings for all Australian patients. It acknowledges that adults with intellectual disability require reasonable adjustments to the application of the standards to optimise the impact of the quality and safety measures for this group. The paper proposes a system whereby reasonable adjustments can be developed for this population. First, particular criteria, items or actions of a standard are selected for the formulation of reasonable adjustments. Second, the adjustments are broken down into categories of alterations to usual knowledge, process, content and organisation involved in compliance with the chosen aspect of the standard. Third, the categories of reasonable adjustments are simultaneously influenced and shaped by aspects of living with intellectual disability, disability supports and a health‐disability sectoral interface. [ABSTRACT FROM AUTHOR]

This position paper provides an overview of the assessment and management of both acute and chronic graft‐versus‐host disease (GvHD). There is a focus on the use of ruxolitinib, a selective inhibitor of Janus kinase (JAK)1 and JAK2, for the treatment of corticosteroid‐refractory and corticosteroid‐dependent GvHD. [ABSTRACT FROM AUTHOR]

Background: Cardiopulmonary resuscitation (CPR) is internationally defined as chest compressions and rescue breaths, and is a subset of resuscitation. First used for out‐of‐hospital cardiac arrest, CPR is now frequently used for in‐hospital cardiac arrest (IHCA) with different causes and outcomes. Aims: This paper aims to describe clinical understanding of the role of in‐hospital CPR and perceived outcomes for IHCA. Methods: An online survey of a secondary care staff involved in resuscitation was conducted, focussing on definitions of CPR, features of do‐not‐attempt‐CPR conversations with patients and clinical case scenarios. Data were analysed using a simple descriptive approach. Results: Of 652 responses, 500 were complete and used for analysis. Two hundred eleven respondents were senior medical staff covering acute medical disciplines. Ninety‐one percent of respondents agreed or strongly agreed that defibrillation is part of CPR, and 96% believed CPR for IHCA included defibrillation. Responses to clinical scenarios were dissonant, with nearly half of respondents demonstrating a pattern of underestimating survival and subsequently showing a desire to offer CPR in similar scenarios with poor outcomes. This was unaffected by seniority and level of resuscitation training. Conclusions: The common use of CPR in hospital reflects the broader definition of resuscitation. Recapturing the CPR definition for clinicians and patients as only chest compressions and rescue breaths may allow clinicians to better discuss individualised resuscitation care to aide meaningful shared decision‐making around patient deterioration. This may involve reframing current in‐hospital algorithms and uncoupling CPR from wider resuscitative measures. [ABSTRACT FROM AUTHOR]

Background: Conversion from paper‐based to electronic medical records (EMR) may affect the quality and timeliness of the completion of Goals‐of‐Care (GOC) documents during hospital admissions and this may have been further impacted by the COVID‐19 pandemic. Aims: To determine the impact of EMR and COVID‐19 on the proper completion of GOC forms and the factors associated with inpatient changes in GOC. Methods: We conducted a cross‐sectional study of adult general medicine admissions (August 2018–September 2020) at Dandenong Hospital (Victoria, Australia). We used interrupted time series to model the changes in the rates of proper GOC completion (adequate documented discussion, completed ≤2 days) after the introduction of EMR and the arrival of COVID‐19. Results: We included a total of 5147 patients. The pre‐EMR GOC proper completion rate was 27.7% (overall completion, 86.5%). There was a decrease in the proper completion rate by 2.21% per month (95% confidence interval (CI): −2.83 to −1.58) after EMR implementation despite an increase in overall completion rates (91.2%). The main reason for the negative trend was a decline in adequate documentation despite improvements in timeliness. COVID‐19 arrival saw a reversal of this negative trend, with proper completion rates increasing by 2.25% per month (95% CI: 1.35 to 3.15) compared with the EMR period, but also resulted in a higher proportion of GOC changes within 2 days of admission. Conclusions: EMR improved the timeliness and overall completion rates of GOC at the cost of a lower quality of documented discussion. COVID‐19 reversed the negative trend in proper GOC completion but increased the number of early revisions. [ABSTRACT FROM AUTHOR]

A biochemical diagnosis of subclinical hypothyroidism (SCH) is defined by an elevated serum thyroid‐stimulating hormone (TSH) with a normal serum free thyroxine (FT4). This paper discusses SCH in the Australian population, the impact of SCH on health‐related quality of life (HRQoL), and the evidence for thyroid hormone therapy as well as exercise therapy to improve HRQoL in SCH. The prevalence of SCH in Australia is approximately 4–5% and is higher in females and the elderly. Current evidence suggests thyroid hormone therapy is not associated with an improvement in HRQoL. However, there does appear to be a subgroup of those with SCH that experience an impairment in HRQoL who may potentially benefit from treatment. Because the majority of research to date has been done in elderly, largely asymptomatic individuals, this may not be representative of the entire SCH population. In addition, alternative treatments, such as exercise therapy, have not been well explored in the literature, despite exercise therapy's effects on HRQoL in other populations. Further research is required to define clearly which individuals with SCH are likely to experience an impaired HRQoL, as well as explore the effects of thyroid hormone therapy and exercise therapy in these individuals. [ABSTRACT FROM AUTHOR]

Few if any sanctions have been imposed on doctors for inappropriate certification of fitness to drive. This paper reviews a recent Tribunal decision on inappropriate certification of fitness to drive. This paper reviews the facts of the case of Medical Board of Australia v Andrew and discusses the legal implications for doctors who certify patients as fit to drive. The paper offers a necessary and timely warning that the Medical Board sought harsh sanctions, more severe than were imposed by the Tribunal, but that the Tribunal also felt compelled to impose 'general deterrence' to prevent inappropriate certification. The paper emphasises the need for scrupulous attention to detail and an absolute need for circumspection when assessing patients who claim to be seizure free, or who minimise impairment from a range of other conditions, insisting on clearance to be able to drive [ABSTRACT FROM AUTHOR]

Background: Australia's Indigenous people suffer from higher cancer mortality than non-Indigenous Australians, a discrepancy partly caused by differences in beliefs about treatment efficacy between Indigenous patients and their non-Indigenous healthcare providers. This paper critically reviews the literature associated with Indigenous beliefs about cancer treatment, both 'bush medicine' and biomedical, in order to provide recommendations to healthcare providers about accommodating Indigenous beliefs when treating cancer. Methods: A search was undertaken of peer-reviewed journal papers using electronic databases and citation snowballing. Papers were selected for inclusion based upon relevance to themes that addressed the research questions. Results: Literature suggests that Indigenous beliefs about treatment efficacy for cancer involve five themes: (i) concerns about the toxicity of treatment; (ii) disconnect with the physician; (iii) fears about absence from home during treatment; (iv) different beliefs about disease aetiology; (v) biomedical cancer treatments failing to address holistic health. Conclusions: Although some information is known about Indigenous Australian healing beliefs and practices associated with cancer treatment, few studies have addressed ways in which Indigenous and biomedical approaches to cancer treatment might be integrated. Some recent work has examined the role of belief in cancer treatment, specifically bush medicine, but more research is required. [ABSTRACT FROM AUTHOR]

The novel Coronavirus disease 2019 (COVID‐19) outbreak has led to rapid and profound changes in healthcare system delivery and society more broadly. Older adults, and those living with chronic or life‐limiting conditions, are at increased risk of experiencing severe or critical symptoms associated with COVID‐19 infection and are more likely to die. They may also experience non‐COVID‐19 related deterioration in their health status during this period. Advance care planning (ACP) is critical for this cohort, yet there is no coordinated strategy for increasing the low rates of ACP uptake in these groups, or more broadly. This paper outlines a number of key reasons why ACP is an urgent priority, and should form a part of the health system's COVID‐19 response strategy. These include reducing the need for rationing, planning for surges in healthcare demand, respecting human rights, enabling proactive care coordination and leveraging societal change. We conclude with key recommendations for policy and practice in the system‐wide implementation of ACP, to enable a more ethical, coordinated and person‐centred response in the COVID‐19 context. [ABSTRACT FROM AUTHOR]

The Australia and New Zealand Musculoskeletal (ANZMUSC) Clinical Trials Network was formed to build capacity and infrastructure for high‐quality musculoskeletal clinical trials in our region. The purpose of this paper is to describe the steps taken in its formation to help others interested in establishing similar networks. In particular, we describe the steps taken to form the collaboration and our progress in achieving our vision and mission. Our aim is to focus on trials of highest importance and quality to provide definitive answers to the most pressing questions in our field. [ABSTRACT FROM AUTHOR]

Despite the increasing use and costs associated with external management consultancy for healthcare improvement, there is a paucity of formal evaluations examining impact. This paper aims to: (i) discuss the potential benefits and disadvantages of external consultancies in addressing complex healthcare challenges and delivering healthcare improvement in Australia; and (ii) explore potential alternative models, including internal consultancy and hybrid models delivered through platforms of collaborative expertise. We propose that the substantive reliance on high cost external management consultancies without demonstrating value or benefit, is unsustainable. An integrative approach that embeds research and capacity building within healthcare services may be of value. [ABSTRACT FROM AUTHOR]

Background: Colorectal cancers result in substantial morbidity and mortality to the Australian society each year. The usual investigation for bowel malignancy is optical colonoscopy (OC), with computed tomography colonography (CTC) used as an alternative investigation. The catharsis and colon insufflation associated with these investigations pose a higher risk in the elderly and frail. Risks include perforation, serum electrolyte disturbance and anaesthesia/sedation risks. Minimal preparation computed tomography colonography (MPCTC) eliminates these risks. Aims: To audit the accuracy of a MPCTC programme for the investigation of colonic masses in symptomatic elderly and frail patients. Methods: This paper audits a 6‐year period of MPCTC in an Australian tertiary referral hospital. A total of 145 patients underwent MPCTC during the study period. Results: There were seven true positives, two false positives and two false negatives. Analysis of this population indicates a sensitivity of 0.78 (95% CI 0.51–1.05), specificity of 0.99 (95% CI 0.97–1.01), positive predictive value (PPV) of 0.78 (95% CI 0.51–1.05) and negative predictive value (NPV) of 0.99 (95% CI 0.97–1.01). These findings are concordant with other published studies. Conclusions: This audit confirms that minimal preparation CT colonography is a reasonable alternative to OC and CTC in detecting colorectal cancer in symptomatic elderly and frail patients, without the procedural risks inherent in more invasive investigations. For most patients, MPCTC ruled out significant colorectal carcinoma with a high NPV. [ABSTRACT FROM AUTHOR]

Abstract: Assessing fitness to drive in applicants with a historical or current substance use disorder presents a specific clinical challenge. The Australian guidelines require evidence of remission and absence of cognitive change when considering applications for re‐licensing driver or individuals applying to reengage in safety‐sensitive work. This paper reviews some of the clinical and biochemical indicators that determine whether a particular person is in ‘remission’ and meets the criteria for return to driving or other safety‐sensitive occupation. It provides an overview of the challenges in establishing an evidence‐based approach to determining fitness for safety critical activities. There is no internationally accepted definition of ‘remission’. Review of the literature and examination of assessment protocols from other national jurisdictions are available for alcohol and the more important drugs of interest in road safety. Assessing fitness to drive when there is a history of substance misuse and/or substance use disorders is a complex issue that requires assessment of biomarkers, clinical findings and clinical assessment before the person returns to driving. We propose that hair testing provides a reliable and reproducible way to demonstrate remission and provide cost‐effective monitoring. Standardised psychological tests could provide a reproducible assessment of the cognitive effects of drug use and suitability to resume driving. We recommend that AustRoads amend the national guidelines to reflect an evidence‐based approach to assessing fitness to drive after conviction for offences related to alcohol and drug use. [ABSTRACT FROM AUTHOR]

Abstract: Climate change has been described as the biggest global health threat of the 21st century. The atmospheric concentrations of greenhouse gases, such as carbon dioxide, methane and nitrous oxide, have increased significantly since the start of the Industrial Era around 1750, with much of this increase occurring over just the last 50 years or so. This is resulting in warming of the climate system as well as changes in precipitation and weather and climate extremes. These changes in climate are having wide‐ranging impacts on the Earth’s physical, biological and human systems, including human health. It is these impacts of climate change on human health that are the focus of this paper, particularly the impacts on allergens and allergic diseases. Such impacts are particularly significant in many countries where the prevalence of such diseases is high and/or increasing. There is now compelling evidence that rising air temperatures and carbon dioxide concentrations are, in some plant species, resulting in increased pollen production and allergenicity and advancement and lengthening of the pollen season. Changes in extreme events, such as thunderstorms and tropical cyclones, will also have impacts on allergic diseases, with, for example, the flooding associated with tropical cyclones leading to proliferation of mould growth in damp homes. The article also considers a range of responses to these health threats, including greenhouse gas mitigation, and adaptation strategies, such as enhanced environmental monitoring and health surveillance and adequate planning for the future medical workforce. [ABSTRACT FROM AUTHOR]

Abstract: Background: Rituximab, an anti‐CD20 B‐cell depleting monoclonal antibody, is increasingly prescribed off‐label for a range of autoimmune diseases. There has not previously been an audit of off‐label rituximab use in the Northern Territory, where the majority of patients are Aboriginal. Aims: To evaluate retrospectively off‐label rituximab use in autoimmune diseases in the Top End of the Northern Territory. Methods: We performed a retrospective audit of 8 years of off‐label rituximab use at the Royal Darwin Hospital, the sole tertiary referral centre for the Darwin, Katherine and East Arnhem regions. Electronic and paper records were reviewed for demographic information, diagnosis/indication for rituximab, doses, previous/concomitant immunosuppression, clinical outcomes and specific adverse events. Results: Rituximab was prescribed off‐label to 66 patients for 24 autoimmune diseases. The majority of patients (62.1%) were Aboriginal and 60.6% female. The most common indications were refractory/relapsing disease despite standard therapies (68.7%) or severe disease with rituximab incorporated into an induction immunosuppressive regimen (19.4%). Systemic lupus erythematosus was the underlying diagnosis in 28.8% of cases. A clinically significant response was demonstrated in 74.2% of cases overall. There were 18 clinically significant infections; however, 13 were in patients receiving concurrent immunosuppressive therapy. There was a total of nine deaths from any cause. Conclusion: Rituximab has been used off‐label for a range of autoimmune diseases in this population with a high proportion of Aboriginal patients successfully and safely in the majority of cases. [ABSTRACT FROM AUTHOR]

Background The perceptions of those called on to make decisions on behalf of patients who lack capacity at the end of life must accurately reflect patient preferences. Aims To establish the extent to which the views of medical oncology outpatients are understood by their support persons, specifically with regards to (i) preferred type and location of end-of-life care, (ii) preferred level of involvement in end-of-life decision-making and (iii) whether the patient has completed an advance care plan or appointed an enduring guardian. Methods Adults with a confirmed cancer diagnosis and their nominated support persons were approached between September 2015 and January 2016 in the waiting room of an Australian tertiary referral clinic. Consenting participants completed a pen-and-paper survey. Nominated support persons answered the same questions from the patient's perspective. Results In total, 208 participants (39% of eligible dyads) participated. Observed agreement across the five outcomes ranged from 54% to 84%. Kappa values for concordance between patient-support person responses were fair to moderate (0.24-0.47) for enduring guardian, decision-making, advance care plan and care location outcomes. A slight level of concordance ( k = 0.15; 95% confidence interval: −0.02, 0.32) was found for the type of care outcome. Conclusion Relying on support persons' views does not guarantee that patients' actual preferences will be followed. Strategies that make patient preferences known to healthcare providers and support persons while they still have the capacity to do so is a critical next step in improving quality cancer care. [ABSTRACT FROM AUTHOR]

Empiric antibiotic therapy in suspected prosthetic joint infection should cover likely pathogens while avoiding overly broad‐spectrum antibiotics. We analysed individual patient data from a large prospective cohort study (Prosthetic Joint Infection in Australia and New Zealand, Observational (PIANO)) and found that causative organisms vary with the presentation type, with early post‐operative infections more likely to be polymicrobial (41%) compared with late acute infections (10%). We thus propose empirical regimens tailored to the presentation type and presence or absence of sepsis. [ABSTRACT FROM AUTHOR]

The author reflects on the challenging regulation of complementary medicines to clinicians. He cites the study by Cohen et al. that notes the difficulties in assessing the effectiveness of complex but self-medication products. The author believes that Australia would globally lead in developing evidence-based ingredients and products to help consumers and health professionals.

Blackwater fever is a haemolytic syndrome associated with malaria that coincided with the use of quinine chemoprophylaxis. Once quinine was no longer chronically used to prevent malaria, blackwater fever largely disappeared and its aetiology remains poorly understood. Blackwater fever is representative of classical tropical medicine and its history was reflected in Australia's colonial development of Papua New Guinea particularly as reported in the Australian medical literature. [ABSTRACT FROM AUTHOR]

Despite clear priority and high costs of leadership capability programmes in healthcare, and significant investments into improving clinical leadership, there remains a prominent gap around evidence of effectiveness or impact on patient outcomes in Australia. We aimed to conduct a systematic review on postgraduate clinical leadership programmes to gather learnings on the processes, theoretical underpinnings, and impact of such programmes for medical and other health professionals. Our search included empirical, peer‐reviewed evaluations of Australian clinical leadership development programmes published between November 2008 and March 2019 and yielded 3284 records. Four studies met criteria. Findings revealed that currently, little value is placed on formal evaluations and peer‐reviewed publication including assessment of individual, organisational or system level impacts of clinical leadership development programmes, with limited evidence available on effective approaches to clinical leadership development in the Australian healthcare system. [ABSTRACT FROM AUTHOR]

Data from the Australasian Bone Marrow Transplant Recipient Registry show a steady increase in the number of allogeneic haemopoietic stem cell transplantations (HSCT) performed annually in Australia and New Zealand. In 2012, 629 allogeneic HSCT were performed. Allogeneic HSCT is associated with numerous potential complications, including chronic graft-versus-host disease (cGVHD). The oral cavity is one of the most frequent sites affected by cGvHD, often leading to significant disability and reduced quality of life. Management strategies are often complex, of variable efficacy and influenced by the availability of various therapeutic agents, access to compounding pharmacies and associated costs. This paper summarises the current status of allogeneic HSCT in Australia and New Zealand with a focus on oral cGvHD and the associated challenges in its management. [ABSTRACT FROM AUTHOR]

Background Antimicrobial stewardship programmes aim to optimise use of antibiotics and are now mandatory in all Australian hospitals. Aim We aimed to identify barriers to and enablers of appropriate antimicrobial prescribing among hospital doctors. Methods Two paper-based and one web-based surveys were administered at three Australian university teaching hospitals from March 2010 to May 2011. The 18-item questionnaire recorded doctors' level of experience, their knowledge regarding the use of common antimicrobials and their attitudes regarding antimicrobial prescribing. Local survey modifications allowed inclusion of specific questions on: infections in intensive care unit patients, clinical microbiology and use of local guidelines. Results The respondents ( n = 272) were comprised of 96 (35%) registrars, 67 (25%) residents, 57 (21%) interns and 47 (17%) consultant hospital doctors. Forty-one per cent were working in a medical specialty. Identified barriers included: gaps in antimicrobial prescribing knowledge (especially among interns), a lack of awareness about which antimicrobials were restricted and a reliance on senior colleagues to make antimicrobial prescribing decisions. Enablers of optimal prescribing included: an acknowledgement of the need for assistance in prescribing and reported readiness to consult national prescribing guidelines. These results were used to help guide and prioritise interventions to improve prescribing practices. Conclusion A transferable knowledge and attitudes survey tool can be used to highlight barriers and facilitators to optimal hospital antimicrobial prescribing in order to inform tailored antimicrobial stewardship interventions. [ABSTRACT FROM AUTHOR]

Despite a drive to increase research in healthcare settings, clinician participation in research remains infrequent. This paper describes an online survey comparing attitudes with research participation among clinicians (doctors, nurses and allied health professionals) at an Australian tertiary children's hospital. Differences between professional groups support the existence of different professional cultures surrounding research, suggesting that multiple strategies are required to improve participation in research. [ABSTRACT FROM AUTHOR]

Older Australians are increasingly reliant on automobiles as their sole form of transport. As our population is ageing and the prevalence of dementia is increasing, it is anticipated that the number of drivers with dementia will rise over time. Much of the literature relating to driving and dementia focuses on safety rather than mobility. The objective of this paper is to highlight several topical ethical issues that pertain to Australian drivers with dementia. It is recommended that future research, policy and practice should centre on the crucial mobility and transport needs of our senior citizens. [ABSTRACT FROM AUTHOR]

No published data exist following the changes in lipid profile during and after an episode of acute illness for the Australian Indigenous population. This paper presents data focusing on lipid profiles and inflammatory markers in a group of survivors of critical illness in Central Australia, prospectively recruited to a larger trial exploring the medium-term sequelae of an intensive care unit admission. This data confirm that lipid profiles in acute illness are deranged, and that recovery may differ between indigenous and non-indigenous populations. [ABSTRACT FROM AUTHOR]

Following the decision in the Gillet Case it may no longer be safe to rely on the Austroads guidelines when considering fitness to drive. This paper examines the case and its implications. Although the Guidelines claimed ‘... the identification and application of world best-practice...’, they were disregarded by the court in Gillet. Both expert witnesses testified that on disclosure of epilepsy the accused would have been endorsed as fit for a licence application to the Roads & Traffic Authority, on the basis of 10 years of only nocturnal seizures, in accordance with the guidelines. The Court rejected this evidence and interpreted failure to disclose epilepsy as recognition of perceived risk and the previously undiagnosed sleep apnoea as the basis for that risk, despite being diagnosed after the accident. There needs to be greater certainty in the application of the guidelines, with legislative intervention and licenses should display a bold statement advising drivers of their responsibility to notify authorities of illnesses that could potentially affect driving. [ABSTRACT FROM AUTHOR]

Introduction: Austroads Guidelines for fitness to drive were promulgated in 2003. Epilepsy was one of the conditions included and this paper reports results of a survey of Australian neurologists regarding opinions and practices relevant to the guidelines. Methods: The survey was developed, piloted and Human Research Ethics Committee approved. Members of the Australian Association of Neurologists received three mailings and results were analysed. Results: Almost 70% of 236 surveyed indicated assessment of epilepsy and driving with <9% not doing so – establishing ∼77% response for eligible neurologists. Most questions achieved 90% response. Almost 90% respondents assessed epilepsy and 70% found the guidelines helpful. Seventy-seven per cent endorsed doctor assessors although half discounted General Practitioners as insufficiently knowledgeable and half advocated that only neurologists evaluate potential drivers with epilepsy. Most respondents supported reporting recalcitrant patients; yet only <30% did so. Three-quarters favoured licences carrying a warning to self-report and two-thirds felt that product information should identify driving implications. Although many questions attracted expected responses, the surprise was the large undecided numbers, which were greater than expected. Neurologists were more lenient than prescribed by the guidelines with neither consensus for controlled epilepsy nor mandatory driving restrictions. Conclusion: Respondents supplied predictable answers regarding ideal circumstances; yet most did not report recalcitrant patients. Most claimed to adhere to the guidelines and yet advocated more lenient driving restrictions that may allow preventable accidents. There was agreement between neurologists and guidelines for more rigourous restrictions for commercial drivers although again neurologists were more lenient. There is need for prospective research on epilepsy and driving. [ABSTRACT FROM AUTHOR]

The article offers information on challenges faced by researchers wishing to access Australian linked data. It mentions that legal and ethical frameworks in which data intensive research must be conducted are complicated and overlapping; and waiver of consent to link the data approved by a human research ethics committee.

Abstract Despite scorpions being locally abundant in many parts of Australia, scorpion sting is a poorly defined clinical condition in Australia. Many health-care workers are unaware of the effects of their stings and scorpions are often feared based on their international reputation. Five scorpion stings that occurred in different parts of Australia where the scorpion was caught at the time of the sting and identified by a professional arachnologist are reported in the present paper. The spectrum of clinical effects of scorpion stings in Australia and the potential for significant effects are discussed. These cases and recent prospective case series demonstrate that in ­Australia scorpion stings cause only minor effects. The main effect is localized pain lasting for several hours, associated less commonly with systemic effects, local numbness and paraesthesia. Most stings are from smaller scorpions from the family Buthidae and often occur indoors at night. The stings from Australian buthid scorpions cause more severe effects than from the larger species in the families Urodacidae (genus Urodacus) and Liochelidae (genus Liocheles). (Intern Med J 2004; 34: 427−430) [ABSTRACT FROM AUTHOR]

Abstract In the 1980s Australia experienced an epidemic of medically certified claims for non-specific arm symptoms described as repetitive strain injury. Although a number of factors were mooted as causal of the epidemic, no single factor emerged as a compelling putative candidate. The present paper discusses the results of research which was published only after the epidemic had waned. It provides possible insights into the rise and fall of repetitive strain injury. (Intern Med J 2004; 34: 416−419) [ABSTRACT FROM AUTHOR]

Abstract Asthma remains a major cause of morbidity in the Australian community, despite enhanced strategies and interventions for achieving optimal outcomes. Although there is some evidence of over use of high doses of inhaled corticosteroids (ICS), there is also evidence for under use of ICS, despite long-term data demonstrating clear benefits of low doses. The present paper briefly discusses some of the issues that are pertinent to the development of sensitization and atopic disease, but focuses mainly on the current understanding of best clinical practice for adults with asthma and the optimal approach to management. A clear definition of asthma control and a systematic approach to down-titration to minimize ICS doses is crucial to achieving better outcomes. Patient self-management education and optimal therapy are the keys to achieving better outcomes, although uncertainty remains about recommendations for mild asthma, despite new data. (Intern Med J 2003; 33: 365-371). [ABSTRACT FROM AUTHOR]

Highlights the issues confronting journal editors when dealing with industry-sponsored research, especially in the area of pharmacoeconomics. Overview of an industry-sponsored economic analysis of the use of ramipril in Australia; Bias in industry-sponsored pharmacoeconomics analyses; Concerns on the ability of journals to referee pharmacoeconomic models.

The article offers information related to the Internal Medicine Society of Australia and New Zealand (IMSANZ) 2023 conference set to be held from September.

Background and Aims: To determine the incidence of inflammatory bowel disease (IBD) in the Mackay‐Isaac‐Whitsunday region in Northern Queensland (−21.14° S) and to allow a comparison with Southern Australian and New Zealand data (Geelong, Australia −38.14° S; Tasmania −41.43° S and −42.88° S (Launceston and Hobart) and Canterbury, New Zealand −43.46 °S). Design: A prospective observational community population‐based IBD study was conducted between 1 June 2017 and 31 May 2018. Outcome measures: Primary includes the crude annual incidence rate of IBD, Crohn's disease (CD), ulcerative colitis (UC) and inflammatory bowel disease‐unclassified (IBDU), while secondary includes disease phenotype and behaviour. Results: Fifty‐six new cases of IBD were identified. Twenty‐three were CD, 30 were UC and 3 were IBDU. The crude annual incidence rate per 100 000 for IBD, CD, UC and IBDU were 32.2 (95% confidence interval (CI): 24.78–41.84), 13.23 (95% CI: 8.79–19.90), 17.25 (95% CI: 12.06–24.67) and 1.73 (95% CI: 0.56–5.35). When directly age‐standardised to the World Health Organisation Standard Population Distribution, the overall CD, UC and IBDU incidence were 13.19, 17.34 and 1.85 per 100 000, with an overall age‐standardised IBD incidence of 32.38. Conclusions: This is the first study to define the incidence of IBD in a Northern Australian cohort and to allow a comparison between North and Southern Australia. The IBD crude is the highest reported in Australia. Like others, we found a high and low incidence of upper gastrointestinal Crohn's disease and complicated disease at diagnosis respectively, likely reflective of the increased availability and early uptake of endoscopic procedures. [ABSTRACT FROM AUTHOR]

Background: Cancer‐related fatigue (CRF) is a common debilitating condition. International evidence supports an exercise prescription for CRF. The majority of Australians with cancer do not meet recommended exercise targets. Aims: To analyse the effects of a guideline‐based supervised exercise programme on CRF among a representative private hospital cancer patient sample (n = 268). Methods: We collected data from 268 patients recruited from haematology and oncology over a 5‐year period. Participants underwent a 3‐month CRF exercise programme based on internationally recognised exercise guidelines. The programme, conducted by a multidisciplinary team, operated twice weekly sessions of 2 h duration comprising aerobic, resistance and balance exercises; hydrotherapy and condition counselling; fatigue management; and dietetic, speech pathology and swallowing education (head and neck cancers). The effect of the programme was measured in relation to the following outcomes: Functional Assessment of Chronic Illness Therapy, Fatigue (self‐reported fatigue); Functional Assessment of Cancer Therapy, general quality of life (health‐related quality of life in cancer); six‐minute walk test; and Lawton's Instrumental Activities of Daily Living Scale. Results: Multivariate outcomes showed statistically significant improvements in all four major outcome measures, plus a programme effect of greater than 0.7 for each outcome variable. The programme treatment outcomes were consistent over the 5 years of the programme. Conclusions: The outcomes of this programme contribute to exercise guidelines in Australia. Currently only position statements exist on the subject, but there are no programme guidelines. An exercise prescription is critical to cancer outcomes. This programme is likely to benefit cancer survivors experiencing CRF across private and public hospitals in Australia. [ABSTRACT FROM AUTHOR]

Background: Childhood maltreatment (CM) is associated with both dietary fat intake and obesity in later life. There is less information on associations with metabolic risk factors and specific types of CM such as physical, sexual and emotional abuse, as well as neglect. Aims: To assess the association between five types of self‐reported CM and a range of obesity and metabolic indicators in a subsample of a birth cohort. Methods: This was a study of 1689 adults born in a major metropolitan maternity hospital in Australia and followed up 30 years later. Body mass index, bioimpedance and fasting lipid levels/insulin resistance were measured. Details on self‐reported CM were collected using the Child Trauma Questionnaire. We adjusted for birth weight, parental income and relationship at participants' birth, as well as maternal age and alcohol or tobacco use. We also adjusted for participants' smoking, depression, educational level, marital and employment status at follow up. Results: One‐fifth reported maltreatment (n = 362), most commonly emotional neglect (n = 175), followed by emotional abuse (n = 128), physical neglect (n = 123), sexual (n = 121) and physical abuse (n = 116). On adjusted analyses, there were significant associations for CM, particularly neglect or emotional abuse, and one or more of the following outcomes: obesity, the total cholesterol/high‐density lipoprotein cholesterol (TC/HDL‐C) ratio and HDL levels. Results for other outcomes were more equivocal. Conclusions: Of child maltreatment types, emotional abuse and neglect show the strongest associations with obesity and several cardiometabolic risk factors, therefore highlighting the public health importance of early intervention to reduce childhood adversity. [ABSTRACT FROM AUTHOR]

Background: Bronchiectasis has been observed in association with systemic sclerosis (SSc). Theorised aetiology includes aspiration related to oesophageal dysmotility, immunosuppressant medication use and the direct effect of collagen deposition on airway calibre. Aims: To detail bronchiectasis prevalence in an SSc population who have had a high‐resolution computed tomography (HRCT) of the thorax. We assessed whether oesophageal dysmotility, demographic variables, SSc duration or subclass were associated with bronchiectasis. Methods: Participants in the Australian Scleroderma Cohort Study (ASCS) with a HRCT were included. The ASCS provided demographic and clinical data. HRCT studies were reviewed for bronchiectasis, oesophageal dilatation and interstitial lung disease (ILD). Traction bronchiectasis associated with ILD was recorded as a separate entity to bronchiectasis. Oesophageal dysmotility was defined by symptoms and/or oesophageal dilatation. Results: Of the 256 participants, 16.4% (n = 42) had bronchiectasis. Logistic regression analysis revealed no significant association between bronchiectasis and oesophageal dysmotility (observed in 95.7%), any demographic variable, SSc duration or subclass. A negative association between bronchiectasis and ILD was observed (P = 0.009; odds ratio 0.322; 95% confidence intervals 0.137–0.756). Conclusion: Those with SSc appear to have an increased risk for bronchiectasis. Since bronchiectasis was not more frequent in participants with a longer duration of SSc, we hypothesise that its development is not related to immunosuppression alone. Oesophageal dysmotility was almost universal in our population such that its effect on bronchiectasis development could not be concluded. A negative association between bronchiectasis and ILD reflects that bronchiectasis occurring alongside ILD was recorded as a separate entity. [ABSTRACT FROM AUTHOR]

Background: Nationally, Indigenous Australians are more likely to have diabetes and diabetic retinopathy (DR) than non‐Indigenous Australians. However, the prevalence of DR and impaired vision in regional primary care settings is unclear. Aim: To describe the prevalence and severity of DR and presenting vision level among Indigenous Australian adults with diabetes attending an indigenous primary care clinic in regional Australia. Methods: Participants underwent nurse‐led retinal imaging and DR screening with offsite retinal grading in the integrated Diabetes Education and Eye Screening (iDEES) project implemented at a regional indigenous primary healthcare setting between January 2018 and March 2020. Results: Of 172 eligible adults, 135 (79%) were recruited and screened for DR and vision level. The median age was 56 (46–67) years, 130 (96%) had type 2 diabetes of median (interquartile range) duration 6 (2–12) years and 48 (36%) were male. Images from 132 (97.8%) participants were gradable. DR was present in 38 (29%) participants: mild non‐proliferative in 33 (25%); moderate–severe in three (2.5%); and sight‐threatening two (1.5%). Subnormal presenting vision was present in 33%. Conclusions: A nurse‐led model of care integrating diabetes eye screening and education at a single visit was successful at recruiting Indigenous Australian adults with diabetes, screening their vision and acquiring a high rate of gradable images. Even for a short duration of known diabetes, DR was present in three out of 10 patients screened. [ABSTRACT FROM AUTHOR]

The article offers information on the Annual Scientific Meeting of the Australian & New Zealand Society of Nuclear Medicine to be held in Melbourne, Victoria from April 21-24, 2018.

Background: Obtaining accurate medication histories at transitions of care is challenging, but important for patient safety. Prescription exchange services (PES) securely transfer electronic prescription and dispensing records between prescribers and pharmacies, which is potentially useful data for determining medication histories. Aim: To evaluate the accuracy of PES‐derived medication histories. Methods: Prospective observational study, at two Australian tertiary‐referral health services. A convenience sample of adult inpatients was recruited. The main outcome measure was: proportion of patients with ≥1 errors in their PES‐derived pre‐admission medication histories, compared with gold‐standard best‐possible medication histories, including prescribed and non‐prescribed medications, obtained by pharmacists using multiple sources including patient/carer interview. Results: Of 154 patients (median age 76 years; interquartile range (IQR) 64–84 years; median 10.0 pre‐admission medications; IQR 6.0–14.0), 153 (99.4%) had ≥1 errors in their PES‐derived medication history (median 6.0 errors per patient; IQR 4.0–9.0). Excluding when‐required medications, 146 (94.8%) patients had >1 errors (median 4.0 errors per patient; IQR 2.0–6.0). Omission was the most common error, affecting 549 (33.3%) of 1648 current medications (median 3.0; IQR 1.0–5.0 per patient); 396 (72.1%) omissions were over‐the‐counter medicines. Dose‐regimen errors affected 276 (25.1%) of 1099 current medications captured in PES‐derived medication histories (median 1.0 error per patient; IQR 0.0–3.0). Commission errors (medications in PES‐derived histories that were not current) affected 224 (16.9%) of 1323 medications (median 1.0 error per patient; IQR 1.0–2.0). Conclusions: Medication histories derived solely from a cloud‐based medication record repository had a high error rate compared with patients' actual medication use. Like all medication history sources, data from cloud‐based repositories need to be verified with additional sources including the patient and/or their carer. [ABSTRACT FROM AUTHOR]

We explored post–pulmonary embolism (post‐PE) follow‐up at a large Australian regional city hospital health service. Over a 12‐month period, we identified 195 (49% male) patients with a median age of 62 years. Post‐PE follow‐up was not organised for 23 patients and delayed for seven patients. Post‐PE complication occurred in 21% of all patients reviewed in the clinic after discharge. Follow‐up imaging was arranged in 28% of patients. To deliver high‐quality care, we recommend implementing a local post‐PE follow‐up pathway, which balances individual physician preference with available resources and expert recommendations. [ABSTRACT FROM AUTHOR]

Background: The Northern Territory (NT) of Australia is currently experiencing a syphilis epidemic. Neurosyphilis is commonly considered in the differential diagnosis for patients presenting with neurologic conditions such as dementia and stroke in the NT. Aims: To explore the local epidemiologic, diagnostic and treatment complexities of neurosyphilis in the NT and produce a guideline for clinical practice. Methods: A database search was undertaken and local and global neurosyphilis guidelines were analysed. A guideline was created based on findings of the critical review and consultation with local multidisciplinary experts. Results: Neurosyphilis is frequently encountered in the NT but studies suggest it is often undertreated. Dementia is the most common clinical presentation locally. Establishing a diagnosis of neurosyphilis is complex and requires stepwise evaluation of clinical, laboratory and radiological findings. Conclusions: A clinical guideline and algorithm have been developed for the diagnosis and management of patients with neurosyphilis. [ABSTRACT FROM AUTHOR]