Medical Journal of Australia最新文献

{"title":"The transformative potential of remote patient monitoring in health care.","authors":"Tuan Duong, Wenyong Wang, Clair Sullivan","doi":"10.5694/mja2.52686","DOIUrl":"https://doi.org/10.5694/mja2.52686","url":null,"abstract":"","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":" ","pages":""},"PeriodicalIF":6.7,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144159436","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"No silver lining with health misinformation: argyria caused by intentional silver consumption.","authors":"Luke Collins, Logesh Palanikumar, Stephen Bacchi","doi":"10.5694/mja2.52687","DOIUrl":"https://doi.org/10.5694/mja2.52687","url":null,"abstract":"","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":" ","pages":""},"PeriodicalIF":6.7,"publicationDate":"2025-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144151149","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implementing voluntary assisted dying in New South Wales correctional settings.","authors":"Diya Ahluwalia, Leigh Haysom","doi":"10.5694/mja2.52688","DOIUrl":"https://doi.org/10.5694/mja2.52688","url":null,"abstract":"","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":" ","pages":""},"PeriodicalIF":6.7,"publicationDate":"2025-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144142525","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Remote patient monitoring for managing acute COVID-19, and mortality and hospital use in Sydney, New South Wales, 2021-22: a retrospective observational cohort study.","authors":"Myong Gyu Kim, Phuong Thao Phan, Cambell McMaster, Praveen Indraratna, Jennifer Yu, Allison Martin, Rebecca Pinheiro, Lisa Altman, Guenter Schreier, Benjamin Kwan, Pamela Konecny, Jeffrey J Post, Nigel Lovell, Sze-Yuan Ooi, Kristen Overton","doi":"10.5694/mja2.52685","DOIUrl":"https://doi.org/10.5694/mja2.52685","url":null,"abstract":"<p><strong>Objectives: </strong>To evaluate the influence of remote patient monitoring (RPM) for managing people with acute coronavirus disease 2019 (COVID-19) on 28-day mortality and hospital use in Australia.</p><p><strong>Study design: </strong>Retrospective observational cohort study; analysis of deterministically linked NSW Notifiable Conditions Information Management System and hospital, emergency department, and non-admitted patient data.</p><p><strong>Setting, participants: </strong>South Eastern Sydney Local Health District catchment area residents aged 15 years or older for whom positive severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) test results (polymerase chain reaction or rapid antigen testing) during 26 November 2021 - 30 June 2022 were recorded.</p><p><strong>Main outcome measures: </strong>Primary outcome: All-cause mortality within 28 days of positive SARS-CoV-2 test result.</p><p><strong>Secondary outcomes: </strong>Hospital length of stay, and numbers of emergency department presentations, hospital admissions, and intensive care unit admissions within 14 days of positive test results. All analyses were undertaken for the unadjusted data (original cohort analysis) and after propensity score matching and inverse probability treatment weighting.</p><p><strong>Results: </strong>Of 276 236 people aged 15 years or older with positive SARS-CoV-2 test results and complete demographic information, 4399 (1.6%) participated in RPM. Twenty-eight-day mortality was lower for the RPM group than the usual care group (propensity score-matched: adjusted odds ratio [aOR], 0.19; 95% confidence interval [CI], 0.08-0.43; inverse probability treatment-weighted: aOR, 0.21; 95% CI, 0.10-0.46). The 14-day likelihood of intensive care unit admission and emergency department presentation was similar for both groups; the likelihood of hospital admission was higher for the RPM group (propensity score-matched: aOR, 1.42; 95% CI, 1.12-1.78; inverse probability treatment-weighted: aOR, 1.51; 95% CI, 1.28-1.78), but the mean hospital length of stay was shorter (adjusted mean difference, original cohort: -2.01 [95% CI, -2.81 to -1.21] days; propensity score-matched: -3.54 [95% CI, -6.39 to -0.69] days; inverse probability treatment-weighted: -3.26 [95% CI, -6.01 to -0.50] days).</p><p><strong>Conclusion: </strong>RPM was associated with greater 14-day likelihood of hospital admission, but also with shorter mean length of stay and lower 28-day mortality, which may indicate that clinical deterioration was detected and treated earlier than with usual care. The benefit of RPM for managing other acute health conditions in the community, particularly infectious diseases, should be examined.</p>","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":" ","pages":""},"PeriodicalIF":6.7,"publicationDate":"2025-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144151169","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Respiratory syncytial virus preventives for children in Australia: current landscape and future directions.","authors":"Sam T Barnett, Jane Tuckerman, Ian G Barr, Nigel W Crawford, Danielle F Wurzel","doi":"10.5694/mja2.52671","DOIUrl":"https://doi.org/10.5694/mja2.52671","url":null,"abstract":"<p><p>Respiratory syncytial virus (RSV) is a major cause of acute lower respiratory tract infections, and a leading cause of hospitalisation in children under 6 months of age. Previously, palivizumab, a costly, short-acting monoclonal antibody, was the primary preventive option. The recent introductions of nirsevimab (Beyfortus), a long-acting monoclonal antibody, and Abrysvo, a maternal RSV vaccine, have brought about significant advances in RSV prevention for children. Western Australia, Queensland and New South Wales launched state-managed nirsevimab programs targeting infants and high risk groups for the 2024 RSV season. International data support nirsevimab's effectiveness in reducing RSV-related hospitalisations and severity of disease in real-world settings. In 2025, Australia's national RSV prevention program includes free maternal vaccination with Abrysvo and targeted infant protection with nirsevimab for high risk or newborns whose mothers did not receive Abrysvo at least 2 weeks before delivery, funded by individual jurisdictions. Real-world efficacy data derived from Australian states and territories and the national prevention program will be pivotal in evaluating and refining the integration of maternal immunisation with Abrysvo and infant passive immunisation with nirsevimab. Key logistical considerations include ensuring timely access and equitable distribution, particularly for First Nations populations who face increased risk from RSV infection. Coordinated efforts are essential to overcome health care disparities and deliver effective prevention strategies to these prioritised groups.</p>","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":" ","pages":""},"PeriodicalIF":6.7,"publicationDate":"2025-05-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144142531","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Motivations, barriers and enablers for medical and forensic examiners in New South Wales sexual assault services: a qualitative interview study.","authors":"Natalie Edmiston, Sam Sperring, Rosalie Power, Samantha Ryan, Kathryn Evans, Jane Ussher, Ellie Freedman","doi":"10.5694/mja2.52679","DOIUrl":"https://doi.org/10.5694/mja2.52679","url":null,"abstract":"<p><strong>Objectives: </strong>To understand the motivations, barriers and enablers for doctors and nurses to work as medical and forensic examiners in New South Wales sexual assault services.</p><p><strong>Design: </strong>Qualitative interview study using semi-structured interviews.</p><p><strong>Setting: </strong>Interviews were conducted from 1 May to 31 August 2023 in NSW, Australia.</p><p><strong>Participants: </strong>Thirty-one participants (27 female; 23 doctors, 8 nurses) - who were currently working as examiners in a NSW Health sexual assault service, had left the role within the previous 3 years, or had undertaken training for this role within the previous 3 years but were not working in this capacity - were recruited by email invitation from the NSW Health Education Centre Against Violence.</p><p><strong>Main outcome measures: </strong>Key themes affecting workforce participation.</p><p><strong>Results: </strong>Using inductive thematic analysis, we determined four key themes affecting workforce participation: the responsibility burden, on-call challenges, high expectations of medicolegal expertise, and inadequate human resources affecting supervisor and peer support. The workforce was highly motivated and, in the absence of sufficient organisational support, this became a responsibility burden. For many participants, the most challenging aspect of their role was being predominantly on call, which made them feel isolated, invaded their personal time, and affected their preferred mechanisms for managing the traumatic aspects of the work, which were peer support and compartmentalisation. Medicolegal responsibilities were motivating for some participants but represented a significant barrier for many due to high expectations and unfamiliarity. Adequate staffing, opportunities for workplace-based education, and more supervisor and peer support were desired.</p><p><strong>Conclusion: </strong>Additional support for medical and forensic examiners can overcome barriers, particularly regarding the medicolegal aspects of the role. Employers should ensure the work conditions of examiners enable them to participate in the workforce safely, ensuring that the strong motivations to participate are not undone by organisational factors.</p>","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":" ","pages":""},"PeriodicalIF":6.7,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144128102","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The first live term birth following uterus transplantation in Australia.","authors":"Rebecca Deans, Brigitte Gerstl, Antonia W Shand, Sarah Lyons, Aaron Budden, Helen L Barrett, Grant Luxton, Mangalee Fernando, Kenneth Yong, Karen Keung, Kaushalya Arulpragasam, Henry Pleass, King Man Wan, Eva Kehag, Jana-Emily Pittman, Mianna Lotz, Maria Fenn, Erin Nesbitt-Hawes, Lily Byun, Katrina Tang, Mats Brannstrom, Jason Abbott","doi":"10.5694/mja2.52682","DOIUrl":"https://doi.org/10.5694/mja2.52682","url":null,"abstract":"<p><strong>Objective: </strong>To report the first live birth following uterus transplantation in Australia.</p><p><strong>Study design: </strong>Case report.</p><p><strong>Setting, participant: </strong>The first participant in the uterus transplantation research study program at the Royal Hospital for Women, the Prince of Wales Hospital, and Westmead Hospital in Sydney.</p><p><strong>Main outcome measures: </strong>Clinical course after uterus transplantation; course of the subsequent pregnancy until delivery.</p><p><strong>Results: </strong>The immunosuppression regimen following uterus transplantation on 10 January 2023 was similar to that used for low immunologic risk kidney transplantation. It included induction therapy (basiliximab on days 0 and 4, methylprednisolone on days 0 and 1), followed by maintenance therapy with oral tacrolimus, prednisolone, and mycophenolate mofetil (MMF). The prednisolone dose was steadily tapered over twelve weeks to a low maintenance dose (from 25 mg to 5 mg daily); MMF was replaced with azathioprine during week 9, and tacrolimus was continued throughout the pregnancy. There was no evidence of rejection. A frozen grade 1 blastocyst was transferred during a natural ovulatory cycle 101 days (fifteen weeks) after transplantation; clinical pregnancy was successfully initiated. The woman developed gestational diabetes at 20 weeks and was treated with insulin. A healthy boy was born by planned caesarean delivery at 37 weeks; he weighed 2990 g, with Apgar scores of 7 at one minute and 9 at five minutes. Intrapartum haemorrhage (estimated 2500 mL) led to iron infusion after delivery. The woman and her infant were discharged from the hospital five days after the birth. The infant was breastfed, but the woman experienced recurrent episodes of mastitis that were managed with oral antibiotics, and intravenous antibiotics during two hospital admissions. Eight weeks after birth she commenced weaning the infant. Neither the woman nor her infant experienced serious complications.</p><p><strong>Conclusion: </strong>The first live birth following uterus transplantation in Australia indicates that the procedure could be adopted here as an assisted reproductive technology for women with uterine factor infertility.</p><p><strong>Trial registration: </strong>Australian and New Zealand Clinical Trials registry, ACTRN12622000917730.</p>","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":" ","pages":""},"PeriodicalIF":6.7,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144128145","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ending nuclear weapons, before they end us.","authors":"Kamran Abbasi, Parveen Ali, Virginia Barbour, Marion Birch, Inga Blum, Peter Doherty, Andy Haines, Ira Helfand, Richard C Horton, Kati Juva, José Florencio F Lapeña, Robert Mash, Olga Mironova, Arun Mitra, Carlos A Monteiro, Elena N Naumova, David Onazi, Tilman A Ruff, Peush Sahni, James Tumwine, Carlos Umaña, Paul Yonga, Chris Zielinski","doi":"10.5694/mja2.52676","DOIUrl":"https://doi.org/10.5694/mja2.52676","url":null,"abstract":"","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":" ","pages":""},"PeriodicalIF":6.7,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144102227","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"General practice in the era of funding reform","authors":"Aajuli Shukla","doi":"10.5694/mja2.52669","DOIUrl":"https://doi.org/10.5694/mja2.52669","url":null,"abstract":"&lt;p&gt;How we fund our health system to achieve the most effective, efficient and equitable outcomes is high on the political agenda. Australia has just experienced a federal election dubbed “the health election” for one of the largest funding boosts to Medicare promised by both major parties.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; This issue of the &lt;i&gt;MJA&lt;/i&gt; is dedicated to general practice — the bedrock of the health system that has arguably been in crisis for several years.&lt;/p&gt;&lt;p&gt;A centrepiece of Labor's campaign on health was a pledge to build more bulk-billing urgent care centres around the country. These centres aim to bridge the gap for urgent illnesses when patients cannot see their general practitioner and reduce pressure on emergency departments (EDs).&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;In this issue of the &lt;i&gt;MJA&lt;/i&gt;, Savira and colleagues&lt;span&gt;&lt;sup&gt;3&lt;/sup&gt;&lt;/span&gt; conducted a scoping review to examine the effectiveness of urgent care centres. They examined studies conducted in clinics in the UK, Europe and the United States and found that the results with respect to reduction in ED visits were mixed. While some studies reported that the introduction of these clinics was associated with a reduction in ED visits, others often showed no changes or an increase in presentation to ED minor injury units. Importantly, most studies examined showed a reduction in hospital admission rates in places where urgent care clinics had been set up. Although most patients in consumer surveys examined were happy with the service, continuity of care was a concern expressed by both patients and practitioners. Even though the review was limited by the high heterogeneity of methodologies examined, it provides a warning about relying on a model without adequate governance and formal assessment of cost effectiveness. Indeed, a recent interim report by the Department of Health and Aged Care found that although the cost of seeing a doctor in an urgent care clinic is lower than in an emergency department, this cost is at least five times that of seeing a general practitioner for a standard consult.&lt;span&gt;&lt;sup&gt;4&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;Continuity of care has been an ongoing issue in primary health care for several years. Unlike the UK and New Zealand, where patients are often enrolled into their local primary care clinics for care, in Australia most people can visit any general practitioner anywhere for care, which often leads to a significant amount of fragmentation of care and over ordering of investigations.&lt;span&gt;&lt;sup&gt;5&lt;/sup&gt;&lt;/span&gt; The MyMedicare initiative that has been recently rolled out in Australia attempts to correct this.&lt;/p&gt;&lt;p&gt;Bates and colleagues&lt;span&gt;&lt;sup&gt;6&lt;/sup&gt;&lt;/span&gt; in their scoping review for this issue examined enrolment models in other countries to elucidate their impacts on continuity of care. They found little evidence that enrolment improved continuity of care; however, study populations had high levels of pre-existing patient engagement with a usual general practition","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"222 9","pages":""},"PeriodicalIF":6.7,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.52669","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144091574","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Smartphone-activated volunteer responders and survival to discharge after out-of-hospital cardiac arrests in Victoria, 2018-23: an observational cohort study.","authors":"Belinda Delardes, Mads Christian Tofte Gregers, Emily Nehme, Michael Ray, Dylan Hall, Tony Walker, David Anderson, Daniel Okyere, Ashanti Dantanarayana, Ziad Nehme","doi":"10.5694/mja2.52673","DOIUrl":"https://doi.org/10.5694/mja2.52673","url":null,"abstract":"<p><strong>Objectives: </strong>To compare the likelihood of patient survival to discharge and of bystander cardiopulmonary resuscitation (CPR) and defibrillation for cases of out-of-hospital cardiac arrest in which at least one smartphone-activated volunteer responder (SAVR) arrived before emergency medical services (EMS) with cases in which EMS arrived first.</p><p><strong>Study design: </strong>Population-based observational cohort study; analysis of Victorian Ambulance Cardiac Arrest Registry (VACAR) data.</p><p><strong>Setting: </strong>Victoria, 12 February 2018 - 31 August 2023.</p><p><strong>Participants: </strong>All cases of out-of-hospital cardiac arrest not witnessed by EMS personnel, except events in residential aged care facilities, in which EMS personnel did not attempt resuscitation, or for which the EMS dispatch code was ineligible for SAVR activation; events during coronavirus disease 2019 pandemic lockdowns were also excluded (SAVR program pause: rural areas: 23 March 2020 - 16 October 2020; metropolitan areas: 23 March 2020 - 9 November 2020).</p><p><strong>Main outcome measures: </strong>Primary outcome: survival to hospital discharge.</p><p><strong>Secondary outcomes: </strong>bystander CPR, bystander defibrillation, any return of spontaneous circulation.</p><p><strong>Results: </strong>Of 9196 cases of out-of-hospital cardiac arrest included in our analysis, 1158 (12.6%) had been attended by SAVRs: before EMS arrival in 564 cases (48.7%) and after EMS arrival in 594 cases (51.3%). The risk-adjusted odds of patient survival to hospital discharge were higher for events in which SAVRs arrived before EMS than for those not attended by SAVRs (adjusted odds ratio [aOR], 1.37; 95% confidence interval [CI], 1.02-1.85), as were those of bystander CPR (aOR, 7.59; 95% CI, 4.97-11.6) and bystander defibrillation (aOR, 16.0; 95% CI, 9.23-27.7); the likelihood of return of spontaneous circulation was similar for the two event groups. SAVRs arriving after EMS did not influence any of the assessed outcomes.</p><p><strong>Conclusion: </strong>The arrival of SAVRs before EMS personnel was associated with greater likelihood of patient survival to hospital discharge and of bystander CPR and defibrillation.</p>","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":" ","pages":""},"PeriodicalIF":6.7,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144094313","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}