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Objectives: To investigate the distribution and prevalence of Japanese encephalitis virus (JEV) antibody (as evidence of past infection) in northern Victoria following the 2022 Japanese encephalitis outbreak, seeking to identify groups of people at particular risk of infection; to investigate the distribution and prevalence of antibodies to two related flaviviruses, Murray Valley encephalitis virus (MVEV) and West Nile virus Kunjin subtype (KUNV). Study design: Cross‐sectional serosurvey (part of a national JEV serosurveillance program). Setting: Three northern Victorian local public health units (Ovens Murray, Goulburn Valley, Loddon Mallee), 8 August – 1 December 2022. Participants: People opportunistically recruited at pathology collection centres and by targeted recruitment through community outreach and advertisements. People vaccinated against or who had been diagnosed with Japanese encephalitis were ineligible for participation, as were those born in countries where JEV is endemic. Main outcome measures: Seroprevalence of JEV IgG antibody, overall and by selected factors of interest (occupations, water body exposure, recreational activities and locations, exposure to animals, protective measures). Results: 813 participants were recruited (median age, 59 years [interquartile range, 42–69 years]; 496 female [61%]); 27 were JEV IgG‐seropositive (3.3%; 95% confidence interval [CI], 2.2–4.8%) (median age, 73 years [interquartile range, 63–78 years]; 13 female [48%]); none were IgM‐seropositive. JEV IgG‐seropositive participants were identified at all recruitment locations, including those without identified cases of Japanese encephalitis. The only risk factors associated with JEV IgG‐seropositivity were age (per year: prevalence odds ratio [POR], 1.07; 95% CI, 1.03–1.10) and exposure to feral pigs (POR, 21; 95% CI, 1.7–190). The seroprevalence of antibody to MVEV was 3.0% (95% CI, 1.9–4.5%; 23 of 760 participants), and of KUNV antibody 3.3% (95% CI, 2.1–4.8%; 25 of 761). Conclusions: People living in northern Victoria are vulnerable to future JEV infection, but few risk factors are consistently associated with infection. Additional prevention strategies, including expanding vaccine eligibility, may be required to protect people in this region from Japanese encephalitis. [ABSTRACT FROM AUTHOR]

Objectives: To explore the views of parents and carers regarding the management of acute otitis media in urban Aboriginal and Torres Strait Islander children who are at low risk of complications living in urban communities. Study design: Qualitative study; semi‐structured interviews and short telephone survey. Setting, participants: Interviews: purposive sample of parents and carers of urban Aboriginal and Torres Strait Islander children (18 months – 16 years old) screened in Aboriginal medical services in Queensland, New South Wales, and Canberra for the WATCH study, a randomised controlled trial that compared immediate antibiotic therapy with watchful waiting for Aboriginal and Torres Strait Islander children with acute otitis media. Survey: parents and carers recruited for the WATCH trial who had completed week two WATCH surveys. Results: We interviewed twenty‐two parents and carers, including ten who had declined participation in or whose children were ineligible for the WATCH trial. Some interviewees preferred antibiotics for managing acute otitis media, others preferred watchful waiting, expressing concerns about side effects and reduced efficacy with overuse of antibiotics. Factors that influenced this preference included the severity, duration, and recurrence of infection, and knowledge about management gained during the trial and from personal and often multigenerational experience of ear disease. Participants highlighted the importance of shared decision making by parents and carers and their doctors. Parents and carers of 165 of 262 WATCH participants completed telephone surveys (63%); 81 were undecided about whether antibiotics should always be used for treating acute otitis media. Open‐ended responses indicated that antibiotic use should be determined by clinical need, support for general practitioners' decisions, and the view that some general practitioners prescribed antibiotics too often. Conclusions: Parents and carers are key partners in managing acute otitis media in urban Aboriginal and Torres Strait Islander children. Our findings support shared decision making informed by the experience of parents and carers, which could also lead to reduced antibiotic use for managing acute otitis media. [ABSTRACT FROM AUTHOR]

Introduction: Cough is the most common symptom leading to medical consultation. Chronic cough results in significant health care costs, impairs quality of life, and may indicate the presence of a serious underlying condition. Here, we present a summary of an updated position statement on cough management in the clinical consultation. Main recommendations: Assessment of children and adults requires a focused history of chronic cough to identify any red flag cough pointers that may indicate an underlying disease. Further assessment with examination should include a chest x‐ray and spirometry (when age > 6 years). Separate paediatric and adult diagnostic management algorithms should be followed. Management of the underlying condition(s) should follow specific disease guidelines, as well as address adverse environmental exposures and patient/carer concerns. First Nations adults and children should be considered a high risk group. The full statement from the Thoracic Society of Australia and New Zealand and Lung Foundation Australia for managing chronic cough is available at https://lungfoundation.com.au/resources/cicada‐full‐position‐statement. Changes in management as a result of this statement: Algorithms for assessment and diagnosis of adult and paediatric chronic cough are recommended.High quality evidence supports the use of child‐specific chronic cough management algorithms to improve clinical outcomes, but none exist in adults.Red flags that indicate serious underlying conditions requiring investigation or referral should be identified.Early and effective treatment of chronic wet/productive cough in children is critical.Culturally specific strategies for facilitating the management of chronic cough in First Nations populations should be adopted.If the chronic cough does not resolve or is unexplained, the patient should be referred to a respiratory specialist or cough clinic. [ABSTRACT FROM AUTHOR]

Objectives: To examine the clinical characteristics and short term outcomes for children with severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) infections who presented to Australian hospitals during 2020 and 2021. Design, setting: Retrospective case review study in nineteen hospitals of the Paediatric Research in Emergency Departments International Collaborative (PREDICT) network from all Australian states and territories, including seven major paediatric tertiary centres and eight Victorian hospitals. Participants: SARS‐CoV‐2‐positive people under 18 years of age who attended emergency departments or were admitted to hospital during 1 February 2020 – 31 December 2021. Main outcome measures: Epidemiological and clinical characteristics, by hospital care type (emergency department [ED] or inpatient care). Results: A total of 1193 SARS‐CoV‐2‐positive children and adolescents (527 girls, 44%) attended the participating hospitals (107 in 2020, 1086 in 2021). Their median age was 3.8 years (interquartile range [IQR], 0.8–11.4 years); 63 were Aboriginal or Torres Strait Islander people (5%). Other medical conditions were recorded for 293 children (25%), including asthma (86, 7%) and premature birth (68, 6%). Medical interventions were not required during 795 of 1181 ED presentations (67%); children were discharged directly home in 764 cases (65%) and admitted to hospital in 282 (24%; sixteen to intensive care units). The 384 admissions to hospital (including 102 direct admissions) of 341 children (25 infants under one month of age) included 23 to intensive care (6%); the median length of stay was three days (IQR, 1–9 days). Medical interventions were not required during 261 admissions (68%); 44 children received respiratory support (11%) and 21 COVID‐19‐specific treatments, including antiviral and biologic agents (5%). Being under three months of age (v one year to less than six years: odds ratio [OR], 2.6; 95% confidence interval [CI], 1.7–4.0) and pre‐existing medical conditions (OR, 2.5; 95% CI, 1.9–3.2) were the major predictors of hospital admission. Two children died, including one without a known pre‐existing medical condition. Conclusion: During 2020 and 2021, most SARS‐CoV‐2‐positive children and adolescents who presented to participating hospitals could be managed as outpatients. Outcomes were generally good, including for those admitted to hospital. [ABSTRACT FROM AUTHOR]

Summary: Early detection and management of prostate cancer has evolved over the past decade, with a focus now on harm minimisation and reducing overdiagnosis and overtreatment, given the proven improvements in survival from randomised controlled trials.Multiparametric magnetic resonance imaging (mpMRI) is now an important aspect of the diagnostic pathway in prostate cancer, improving the detection of clinically significant prostate cancer, enabling accurate localisation of appropriate sites to biopsy, and reducing unnecessary biopsies in most patients with normal magnetic resonance imaging scans.Biopsies are now performed transperineally, substantially reducing the risk of post‐procedure sepsis.Australian‐led research has shown that prostate‐specific membrane antigen (PSMA) positron emission tomography/computed tomography (PET/CT) has superior accuracy in the staging of prostate cancer than conventional imaging (CT and whole‐body bone scan).Localised prostate cancer that is low risk (International Society for Urological Pathology [ISUP] grade 1, Gleason score 3 + 3 = 6; and ISUP grade group 2, Gleason score 3 + 4 = 7 with less than 10% pattern 4) can be offered active surveillance, reducing harms from overtreatment.Prostatectomy and definitive radiation remain the gold standard for localised intermediate and high risk disease. However, focal therapy is an emerging experimental treatment modality in Australia in carefully selected patients.The management of advanced prostate cancer treatment has evolved to now include several novel agents both in the metastatic hormone‐sensitive and castration‐resistant disease settings. Multimodal therapy with androgen deprivation therapy, additional systemic therapy and radiotherapy are often recommended.PSMA‐based radioligand therapy has emerged as a treatment option for metastatic castration‐resistant prostate cancer and is currently being evaluated in earlier disease states. [ABSTRACT FROM AUTHOR]

Introduction: Chronic obstructive pulmonary disease (COPD) is a treatable and preventable disease characterised by persistent respiratory symptoms and chronic airflow limitation on spirometry. COPD is highly prevalent and is associated with exacerbations and comorbid conditions. "COPD‐X" provides quarterly updates in COPD care and is published by the Lung Foundation Australia and the Thoracic Society of Australia and New Zealand. Main recommendations: The COPD‐X guidelines (version 2.65) encompass 26 recommendations addressing: case finding and confirming diagnosis;optimising function;preventing deterioration;developing a plan of care; andmanaging an exacerbation. Changes in management as a result of these guidelines: Both non‐pharmacological and pharmacological strategies are included within these recommendations, reflecting the importance of a holistic approach to clinical care for people living with COPD to delay disease progression, optimise quality of life and ensure best practice care in the community and hospital settings when managing exacerbations. Several of the new recommendations, if put into practice in the appropriate circumstances, and notwithstanding known variations in the social determinants of health, could improve quality of life and reduce exacerbations, hospitalisations and mortality for people living with COPD. [ABSTRACT FROM AUTHOR]

Objective: To examine associations between area‐level socio‐economic factors and the incidence of severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) infections in Victoria during 2020. Design, setting: Population‐level ecological study of the incidence of SARS‐CoV‐2 infections in Victoria, by postcode, 1 March ‒ 13 August 2020. Main outcome measures: Relationships between the incidence of SARS‐CoV‐2 infections by postcode (Department of Health and Human Services data published on The Age website), and demographic, education level, ethnic background, economic and employment‐related factors, housing‐related factors, and social disadvantage (Australian Bureau of Statistics data for 2014–19), expressed as incidence rate ratios (IRRs). Results: During the study period, 15 482 SARS‐CoV‐2 infections with associated postcodes were recorded in Victoria. Incidence was higher for metropolitan than regional postcodes (418.3 v 62 infections per 100 000 population; IRR, 6.2; 95% CI, 4.6–8.2). In regional postcodes, incidence rose with mean household size (per person: IRR, 7.30; 95% CI, 4.37–12.2), unemployment proportion (per percentage point: IRR, 1.50; 95% CI, 1.33–1.69), and proportions for whom rent (IRR, 1.15; 95% CI, 1.07–1.22) or mortgage repayments (IRR, 1.22; 95% CI, 1.15–1.28) exceeded 30% of household income. In metropolitan areas, incidence increased with unemployment proportion (IRR, 1.14; 95% CI, 1.05–1.23) and proportion without paid leave (IRR, 1.22; 95% CI, 1.02–1.45). Incidence also increased with proportion speaking languages other than English at home (regional: IRR, 1.08; 95% CI, 1.06–1.11; metropolitan: IRR, 1.01; 95% CI, 1.002–1.02) and with Indigenous Australian proportion (metropolitan only: IRR, 1.91; 95% CI, 1.10–2.73). Conclusions: Socio‐economic factors may have contributed to the non‐homogeneous incidence of SARS‐CoV‐2 infections across Victoria during 2020. [ABSTRACT FROM AUTHOR]

Introduction: The Australian Technical Advisory Group on Immunisation and New Zealand Ministry of Health recommend all children aged ≥ 5 years receive either of the two mRNA COVID‐19 vaccines: Comirnaty (Pfizer), available in both Australia and New Zealand, or Spikevax (Moderna), available in Australia only. Both vaccines are efficacious and safe in the general population, including children. Children and adolescents undergoing treatment for cancer and immunosuppressive therapy for non‐malignant haematological conditions are particularly vulnerable, with an increased risk of severe or fatal COVID‐19. There remains a paucity of data regarding the immune response to COVID‐19 vaccines in immunosuppressed paediatric populations, with data suggestive of reduced immunogenicity of the vaccine in immunocompromised adults. Recommendations: Considering the safety profile of mRNA COVID‐19 vaccines and the increased risk of severe COVID‐19 in immunocompromised children and adolescents, COVID‐19 vaccination is strongly recommended for this at‐risk population. We provide a number of recommendations regarding COVID‐19 vaccination in this population where immunosuppressive, chemotherapeutic and/or targeted biological agents are used. These include the timing of vaccination in patients undergoing active treatment, management of specific situations where vaccination is contraindicated or recommended under special precautions, and additional vaccination recommendations for severely immunocompromised patients. Finally, we stress the importance of upcoming clinical trials to identify the safest and most efficacious vaccination regimen for this population. Changes in management as a result of this statement: This consensus statement provides recommendations for COVID‐19 vaccination in children and adolescents aged ≥ 5 years with cancer and immunocompromising non‐malignant haematological conditions, based on evidence, national and international guidelines and expert opinion. Endorsed by: The Australian and New Zealand Children's Haematology/Oncology Group. [ABSTRACT FROM AUTHOR]

Objectives: To examine the epidemiological and clinical characteristics of SARS-CoV-2-positive children in Australia during 2020.Design, Setting: Multicentre retrospective study in 16 hospitals of the Paediatric Research in Emergency Departments International Collaborative (PREDICT) network; eleven in Victoria, five in four other Australian states.Participants: Children aged 0-17 years who presented to hospital-based COVID-19 testing clinics, hospital wards, or emergency departments during 1 February - 30 September 2020 and who were positive for SARS-CoV-2.Main Outcome Measures: Epidemiological and clinical characteristics of children positive for SARS-CoV-2.Results: A total of 393 SARS-CoV-2-positive children (181 girls, 46%) presented to the participating hospitals (426 presentations, including 131 to emergency departments [31%]), the first on 3 February 2020. Thirty-three children presented more than once (8%), including two who were transferred to participating tertiary centres (0.5%). The median age of the children was 5.3 years (IQR, 1.9-12.0 years; range, 10 days to 17.9 years). Hospital admissions followed 51 of 426 presentations (12%; 44 children), including 17 patients who were managed remotely by hospital in the home. Only 16 of the 426 presentations led to hospital medical interventions (4%). Two children (0.5%) were diagnosed with the paediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 (PIMS-TS).Conclusion: The clinical course for most SARS-CoV-2-positive children who presented to Australian hospitals was mild, and did not require medical intervention. [ABSTRACT FROM AUTHOR]

Even if ultimately unfounded, providing raw data to those who request it reciprocates the participants' contribution to research and builds empowerment.9 Implications for clinicians Clinicians who treat patients and recruit them to genomic research studies will increasingly field requests for raw data. Clinicians who recruit their patients to genomic research studies are often provided with a summary report interpreting clinically relevant results they may choose to share with patients. Keywords: Ethics; Legislation, medical; Medicolegal; Clinical decision-making; Delivery of healthcare; Medical records; Genetic testing; Sequence analysis; Patient rights EN Ethics Legislation, medical Medicolegal Clinical decision-making Delivery of healthcare Medical records Genetic testing Sequence analysis Patient rights 550 552 3 06/21/22 20220615 NES 220615 As the number of requests for raw genomic data increases, policies and protocols reflecting the perspectives of clinicians, patients, researchers and research participants are required Next generation sequencing technologies generate vast quantities of genomic data and can identify significant molecular markers associated with disease development and its response to treatments. [Extracted from the article]

Arthritis involving the knees is common[[2], [5]] and was the initial presentation in our patient. Keywords: Cardiovascular infections; Cardiac surgery; Occupational diseases; Zoonoses; Heart valve diseases EN Cardiovascular infections Cardiac surgery Occupational diseases Zoonoses Heart valve diseases 584 585 2 12/09/22 20221201 NES 221201 Clinical record A 44-year-old man presented to the emergency department with left knee monoarthritis; he had a history of tobacco dependence and no known cardiac disease. Additionally, its growth is inhibited by polyanethol sulfonate, which is present in many commercial blood culture bottles.[[2], [6]] Fortunately, in our patient, positive blood cultures were obtained, which greatly assisted in timely diagnosis, and appropriate antimicrobial and subsequent surgical management. [Extracted from the article]

Objective: To evaluate the impact of an acute assessment unit (AAU) on length of hospital stay (LOS), emergency department (ED) waiting times, direct discharge rate, unplanned readmission rate and all-cause hospital mortality of general medical patients.Design and Setting: Retrospective comparison of data for general medical patients admitted to a tertiary teaching hospital in Adelaide, South Australia, before and after the establishment of an AAU (reference years, 2003 [before] and 2006 [after]).Main Outcome Measures: Mean LOS, ED waiting times and all-cause hospital mortality during calendar years 2003 (pre-establishment) and 2006 (post-establishment).Results: Following the establishment of an AAU, the mean LOS shortened (from 6.8 days in 2003 to 5.7 days in 2006; P < 0.001) despite a 50.5% increase in the number of admissions (from 2652 to 3992). The number of admitted patients waiting in the ED more than 8 hours for a hospital bed decreased (from 28.7% to 17.9%; P < 0.001), as did the number waiting more than 12 hours (from 20.2% to 10.4%; P < 0.001). The rates of unplanned readmission within 7 and 28 days did not change. The all-cause hospital mortality for general medical admissions was 4.6% in 2003 v 3.7% in 2006 (P = 0.056).Conclusion: The establishment of an AAU within the general medical service coincided with decreases in both LOS and ED waiting times, despite a 50% increase in admissions. This structural reform in the process of acute medical care may have contributed to the improvement in these key health care performance indices without compromising the quality of patient care. [ABSTRACT FROM AUTHOR]

The article discusses the case of an 82-year-old woman who presented with a probable stroke with left-side symptoms. The physical examination conducted on the patient are detailed. The National Institutes of Health Stroke Scale (NIHSS) is the most commonly used structured grading system to assess the severity of neurological deficit in acute stroke. The clinical characteristics of major strokes are cited.

The article presents a study which examines haemopoietic stem cell transplantation (HSCT) activity and trends among pediatric patients in Australia and New Zealand. Conducted on behalf of the Australasian Bone Marrow Transplant Recipient Registry and the Australian and New Zealand Children's Haematology Oncology Group from 1998-2006, the study cited the most common indications for allogenic HSCT. The study found that HSCT is a vital procedure for children with a number of life-threatening illnesses.

As survival rates improve for children and young adults with cancer, there is emerging awareness of the pervading physical, emotional and psychological tolls on survivors of a childhood cancer diagnosis and treatment. As the incidence of paediatric cancer rises, challenges for the future include minimising the late effects of disease and its treatment, and further developing personalised approaches to cancer therapy. Risk, risk factors, and surveillance of subsequent malignant neoplasms in survivors of childhood cancer: a review. [Extracted from the article]

The article focuses on potential risks for infections associated with the use of multidose vials (MDV) in Australia. According to the author, the decision of the Australian Government Department of Health and Ageing (DoHA) to distribute vaccines against H1N1 influenza in 2009 using MDVs was met by criticisms from various sectors of the country. The reaction prompted the agency to distribute the vaccines accompanied by consent forms and information sheets. He advises patients to weigh in the risks of using MDVs before giving their consent.

The article offers information on a forum held at the Children's Hospital at Westmead, New South Wales, sponsored by Doctors for the Environment Australia, where professor Ben Marais who argued to reimagine the traditional framework of medical ethics and safeguard the rights of future generations.

The article focuses on the Pharmaceutical Benefits Scheme (PBS) urgently needs to update anti-epileptic drug prescribing restrictions that put patients and prescribers at risk; and mentions the three latest drugs listed on the PBS for third line use include perampanel, lacosamide and brivaracetam.