Medical Journal of Australia最新文献

{"title":"Australian Consensus Statement on the Prevention and Management of Frailty Among Community-Dwelling Older Adults: A Modified Delphi Study.","authors":"Sakshi Chopra, Ida Tornvall, Natasha Reid, Elizabeth Whiting, Sarah N Hilmer, Jenny Job, Anthony Villani, Andrew J Maiorana, Mark Morgan, Sarah Fox, Adrienne Young, Caroline Gibson, Donna M Reidlinger, Elissa Burton, Emily H Gordon, James Baker, Leila Shafiee Hanjani, Lisa Kouladjian O'Donnell, Marc Sim, Michelle Miller, Peta Dampney, Pazit Levinger, Shannon King, Ruth E Hubbard","doi":"10.5694/mja2.70182","DOIUrl":"https://doi.org/10.5694/mja2.70182","url":null,"abstract":"<p><strong>Introduction: </strong>This consensus statement from multidisciplinary experts and consumers across Australia provides comprehensive recommendations on the prevention and management of frailty in community-dwelling older adults.</p><p><strong>Methods: </strong>The study uses a modified Delphi design. Phase I involved iterative discussion among six frailty care working groups, based on current evidence and expert opinion, to draft the statements. Phase II involved validation of each statement across two Delphi rounds conducted to determine level of agreement.</p><p><strong>Main recommendations: </strong>A lifelong approach to health promotion for frailty prevention should focus on raising awareness, annual screening (65+ years) and personalised counselling around accessible health behaviours to manage chronic comorbidities. An individualised, balanced, protein-rich diet is likely to be effective in delaying the onset of frailty. Protein-energy malnutrition and nutritional deficiencies should be identified and treated. A nutrition care plan that considers the relaxation of dietary restrictions aligned with goals of care should be planned for older adults with severe frailty. Progressive, individualised and ongoing exercise should be a combination of aerobic and resistance exercise, and balance and functional training tailored to frailty level and supervised by professionals. Social prescribing for older adults should be co-designed with a link worker to support meaningful, accessible and culturally appropriate activities that foster social engagement, with plans customised to the individual's frailty level. A comprehensive, multidisciplinary medication review tailored to the older adult's health status, preferences and frailty degree helps optimise medication use, minimise harm and support functional independence across all stages of frailty. Older adults with severe frailty need a regularly reviewed, personalised care plan, which involves carers in decision-making, supports advance care planning and ensures high-quality end-of-life care.</p><p><strong>Changes in management informed by this statement: </strong>The consensus statements introduce an integrated, evidence-informed and consumer-focused framework to guide healthcare professionals in delivering personalised and effective care for community-dwelling older adults living with or at risk of frailty.</p>","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"224 5","pages":"e70182"},"PeriodicalIF":8.5,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13139793/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147839699","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":"Advancing Inclusive Design Practice for Queer Youth Using Digital Technologies for Mental Health","authors":"Adam Poulsen,&nbsp;Ian B. Hickie,&nbsp;Samuel J. Hockey,&nbsp;Frank Iorfino,&nbsp;Haley M. LaMonica","doi":"10.5694/mja2.70183","DOIUrl":"https://doi.org/10.5694/mja2.70183","url":null,"abstract":"<p>Youth mental ill health has increased worldwide, and non-inclusive technology design practice risks overlooking queer youth. This article calls for greater inclusivity and equity in the design of digital technologies used by queer youth to access mental health resources, support and service pathways across diverse global contexts, including internet-based tools, digital platforms and digitally enabled therapeutic interventions, such as mobile applications (apps), online services, chatbots and social media. It warns of threats such as persistent invisibility and prejudiced technology design practice markedly affecting mental health equity and access for queer youth. It proposes three key principles to guide practitioners and researchers in designing digital technologies used by queer youth for mental health: (i) partner and design with queer young people; (ii) embed queer theory into research and design; and (iii) design for sustainability. The principles and recommendations presented here are also relevant to other digital health fields and practitioners should consider applying them in their own practice, where appropriate, to advance inclusivity and equity in technology design.</p>","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"224 4","pages":""},"PeriodicalIF":8.5,"publicationDate":"2026-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.70183","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147668583","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":"Awareness, Usage and Perceptions of Doxycycline Post-Exposure Prophylaxis (doxyPEP) for Prevention of Sexually Transmitted Infections in Australia: Insights From a National Cross-Sectional Survey","authors":"Phyu Mon Latt,&nbsp;Ei T. Aung,&nbsp;Kate Maddaford,&nbsp;Kai J. Jonas,&nbsp;Christopher K. Fairley,&nbsp;Sarah J. Martin,&nbsp;Carole Khaw,&nbsp;Rick Varma,&nbsp;Caroline Thng,&nbsp;Manoji Gunathilake,&nbsp;Vincent J. Cornelisse,&nbsp;Haoyi Wang,&nbsp;Teralynn Ludwick,&nbsp;Ethan T. Cardwell,&nbsp;Michael W. Traeger,&nbsp;Catriona S. Bradshaw,&nbsp;Dash Heath-Paynter,&nbsp;Benjamin Riley,&nbsp;Daniel Grace,&nbsp;Fabian Y. S. Kong,&nbsp;Eric P. F. Chow,&nbsp;the DoxyAWARE Study Group","doi":"10.5694/mja2.70180","DOIUrl":"https://doi.org/10.5694/mja2.70180","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To examine the awareness, usage and perceptions of doxycycline post-exposure prophylaxis (doxyPEP) for sexually transmitted infection (STI) prevention among gay and bisexual men and transgender (trans) and gender diverse people in Australia.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>Cross-sectional online survey.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting, Participants</h3>\u0000 \u0000 <p>National multi-site survey in Australia from 1 July 2024 to 30 November 2024, recruiting from 13 sexual health and community clinics, 6 general practices, social media, dating applications, and university portals. Gay and bisexual men and trans and gender diverse people aged ≥ 18 years living in Australia were included in the study.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main Outcome Measures</h3>\u0000 \u0000 <p>DoxyPEP awareness, ever use, recent use (past 12 months), dosage regimens, sourcing methods and planned future use.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 2095 participants, half (1080/2095, 51.6%) had heard of doxyPEP. Of those aware, 323/1080 (29.9%) had ever used doxyPEP, and 306/1080 (28.3%) were recent users. DoxyPEP awareness and usage varied by HIV status and pre-exposure prophylaxis (PrEP) use (<i>p</i> &lt; 0.0001). Nearly two-thirds of users had taken the recommended 200 mg within 72 h after sex (205/323, 63.5%). Among recent users, 29/306 (9.5%) reported recent syphilis diagnoses, and 85/306 (27.8%) had ≥ 2 STI diagnoses in the past 12 months. Of those who had ever used doxyPEP, 135/323 (41.8%) obtained prescriptions from clinicians, 17/323 (5.3%) obtained it online, and 28/323 (8.7%) purchased it in person overseas without a prescription. Of those aware of doxyPEP, 490/1080 (45.4%) planned to use doxyPEP in the next 12 months, primarily to prevent chlamydia (460/490, 93.9%), gonorrhoea (422/490, 86.1%) or syphilis (386/490, 78.8%). Some intended to prevent <i>Mycoplasma genitalium</i> (92/490, 18.8%) or mpox (36/490, 7.4%). Among non-users, 306/756 (40.5%) worried about antibiotic resistance.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>DoxyPEP use was happening quickly but often involved non-recommended regimens and unsupervised sourcing. Urgent educational interventions and improved clinical access are needed for safe implementation.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"224 4","pages":""},"PeriodicalIF":8.5,"publicationDate":"2026-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.70180","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147668588","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":"Community Code Blue: The Sydney Jewish Community's Medical Preparations and Response to the Bondi Beach Terror Attack of December 2025","authors":"Aidan Baron,&nbsp;Jesse Lenn,&nbsp;Zachariah Seidman,&nbsp;Matthew N. Lowy,&nbsp;Jeffrey L. Engelman","doi":"10.5694/mja2.70179","DOIUrl":"https://doi.org/10.5694/mja2.70179","url":null,"abstract":"<p>Ethnocultural minority communities may require specialised emergency response frameworks during mass casualty incidents (MCIs). This article describes the Sydney Jewish community's preparation for, and medical response to, the Bondi Beach terror attack of 14 December 2025. We present a timeline of events during the attack and outline the immediate medical response and recovery actions undertaken in the first hours and days following the incident, including first-hand accounts of responders from the scene. Alongside this account, we present a novel response model implemented by the New South Wales Community Health Support (CHS). CHS is a community-operated, not-for-profit emergency medical response organisation that provides telehealth advice and dispatches volunteer community first responders (including health professionals and trained emergency healthcare workers) to urgent and emergency health incidents within the local community. CHS operates alongside statutory emergency services and is embedded within the community it serves. It is hoped that the lessons identified from this incident may be valuable to the broader international medical community, emergency management agencies and policymakers, and that it may serve as an exemplar for other communities seeking to strengthen preparedness, coordination and resilience in the face of future MCIs.</p>","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"224 4","pages":""},"PeriodicalIF":8.5,"publicationDate":"2026-04-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.70179","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147668495","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":"Genomic Newborn Screening: Verdict From an Australian Citizens’ Jury","authors":"Yves Saint James Aquino,&nbsp;Joanne Scarfe,&nbsp;Diana Popic,&nbsp;Lucy Carolan,&nbsp;Chris Degeling,&nbsp;Kathleen Prokopovich,&nbsp;Margaret F. A. Otlowski,&nbsp;Saniya Singh,&nbsp;Belinda Fabrianesi,&nbsp;Kaustuv Bhattacharya,&nbsp;Kristi Jones,&nbsp;Ainsley J. Newson,&nbsp;Patti Shih,&nbsp;Bruce Bennetts,&nbsp;Emma Frost,&nbsp;Zornitza L. Stark,&nbsp;Kristen Nowak,&nbsp;Louise Healy,&nbsp;Sarah Norris,&nbsp;Stacy M. Carter","doi":"10.5694/mja2.70184","DOIUrl":"10.5694/mja2.70184","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To support a nationally representative group of Australians to make informed, reasoned recommendations on the use of genomics in newborn screening programmes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>Hybrid Citizens’ Jury method.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting, Participants</h3>\u0000 \u0000 <p>Thirty Australian adults recruited by random ballot invitation and stratified selection against population-based demographic targets of age, sex, ancestry, highest level of education, location of residence (state/territory, urban/non-urban), experience of disability and parent/non-parent.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main Outcome Measures</h3>\u0000 \u0000 <p>Jury recommendations with reasons.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The jury made 11 recommendations. The jury agreed whole genome sequencing could be used in the programme, but only if conditions were met regarding national consistency, benefit, Australian Government oversight, consent, reporting to parents, data protection, supporting parents and the healthcare system, and parent and public education. All of these conditions were agreed by consensus, except reporting to parents and parent and public education, where there was a supermajority (24/30) in agreement and minority dissent. The jury were split on Recommendation 11: how much genomic data should be extracted and retained. Nine jurors supported whole genome sequencing only if data extraction and retention were limited to interpretable, actionable genetic information; 21 jurors supported a more expansive approach.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>To maintain public trust in Australian newborn screening, programmes should take a more conservative approach to data extraction and storage until concerns are addressed and safeguarding conditions implemented. Jurors' key concerns include identifiability of genomic data, risk of data misuse and potential to undermine trust and participation in newborn screening.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"224 4","pages":""},"PeriodicalIF":8.5,"publicationDate":"2026-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13066916/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147645411","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":"Deprescribing in Older People: A Clinical Practice Guideline Summary","authors":"Hui Wen Quek,&nbsp;Xisco Reus Perello,&nbsp;Kenneth Lee,&nbsp;Atinuke Abraham,&nbsp;Leon A. Adams,&nbsp;Osvaldo P. Almeida,&nbsp;Hend Almutairi,&nbsp;Bree Armstrong,&nbsp;Leanne Boase,&nbsp;Juanita Breen,&nbsp;Lauren J. Brown,&nbsp;Gillian E. Caughey,&nbsp;Lewis W. Chan,&nbsp;Roger Chen,&nbsp;Edward Chew,&nbsp;Antony Clark,&nbsp;Tracy Comans,&nbsp;Deirdre Criddle,&nbsp;Pēteris Dārziņš,&nbsp;Paresh Dawda,&nbsp;Jenny A. Doust,&nbsp;Sue Edwards,&nbsp;Jennifer Gowan,&nbsp;Kerryn Hart,&nbsp;Deborah Hawthorne,&nbsp;Andrew Heredia,&nbsp;Anne-Marie Hill,&nbsp;Jesse Jansen,&nbsp;Lisa Kalisch Ellett,&nbsp;Helen Keen,&nbsp;Erin A. Kelty,&nbsp;Ngaire M. Kerse,&nbsp;Estie Kruger,&nbsp;Susan E. Kurrle,&nbsp;Howard Lance,&nbsp;Adam Livori,&nbsp;Rebecca Livori,&nbsp;Dina C. LoGiudice,&nbsp;Arduino A. Mangoni,&nbsp;Anthony Marinucci,&nbsp;Nilufeur McKay,&nbsp;Allison M. Mckendrick,&nbsp;Andrew J. McLachlan,&nbsp;Treasure M. McGuire,&nbsp;Stewart Mearns,&nbsp;Mark Morgan,&nbsp;Saba Nabi,&nbsp;Vasi Naganathan,&nbsp;Elaine Newman,&nbsp;Christopher A. C. M. Ng,&nbsp;Maz Osborne,&nbsp;Ray Parkin,&nbsp;Kevan R. Polkinghorne,&nbsp;Constance Dimity Pond,&nbsp;Kathleen Potter,&nbsp;Debbie Rigby,&nbsp;Debra Rowett,&nbsp;Amina Schipp,&nbsp;Veronika Seda,&nbsp;Jessica Seeto,&nbsp;Sepehr Shakib,&nbsp;Angela Shiu,&nbsp;Andrew C. Stafford,&nbsp;Irene J. Tan,&nbsp;Marc Tennant,&nbsp;Leanne Teoh,&nbsp;Stephen Tucker,&nbsp;John D. G. Watson,&nbsp;Donna Wellins,&nbsp;Tim Whitmore,&nbsp;Christopher Etherton-Beer,&nbsp;Amy T. Page","doi":"10.5694/mja2.70174","DOIUrl":"10.5694/mja2.70174","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Older people face higher risks of medicine-related harm due to polypharmacy and the use of potentially inappropriate medicines. Current treatment guidelines rarely specify when to stop medicines, leading to medicines often being continued indefinitely without a clear deprescribing plan. While deprescribing guidelines exist for some medicine classes, limited guidance is a major barrier to deprescribing. These new guidelines address this gap by providing structured recommendations that complement more detailed drug-specific deprescribing guidance, disease-specific therapeutic guidelines and non-pharmacological management resources. These guidelines were developed by a team of 72 experts, including consumer representatives, and were further shaped by feedback from public consultation and independent reviewers.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main Recommendations</h3>\u0000 \u0000 <p>The guidelines are intended for all healthcare professionals involved in prescribing, dispensing or administering medicines to older people. The guidelines specifically address polypharmacy and medicines commonly dispensed for regular use in people aged ≥ 65 years, as well as other medicines where there is evidence to consider deprescribing in this cohort. The guidelines provide 185 consensus-based recommendations and 70 good practice statements, covering both specific medicine categories and general deprescribing principles. The guidelines are structured into four areas: (1) when to deprescribe; (2) ongoing treatment needs; (3) how to deprescribe; and (4) monitoring requirements.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Changes in Care as a Result of the Guideline</h3>\u0000 \u0000 <p>This guideline emphasises deprescribing as an integral part of the prescribing continuum. Applying a deprescribing approach encourages prescribers to consider the ongoing need for a medicine each time a prescription is re-issued, to balance benefits and harms as they evolve over time, and to ensure treatment decisions reflect an individual's goals through shared decision-making. The guideline was developed based on currently available evidence for deprescribing and expert multidisciplinary and consumer input. It supports health professionals in reviewing regular medicines, minimising harm and planning ongoing treatment or monitoring. The detailed guideline is available at https://deprescribing.com.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"224 4","pages":""},"PeriodicalIF":8.5,"publicationDate":"2026-04-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13054209/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147628149","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":"Reflex Testing for Hepatitis D Infection: A Unique Opportunity to Reduce Hepatitis D-Related Chronic Liver Disease Deaths in Australia","authors":"Jessica Howell,&nbsp;Lauren Andersson,&nbsp;Miriam T. Levy,&nbsp;James O'Beirne,&nbsp;Leon Adams,&nbsp;Katharine Irvine,&nbsp;Avik Majumdar,&nbsp;Golo Ahlenstiel,&nbsp;Kathy Jackson,&nbsp;Krispin Hajkowicz,&nbsp;Joseph Doyle,&nbsp;Jane Davies,&nbsp;Sarah Cherian,&nbsp;Wayne Dimech,&nbsp;Alexander J. Thompson","doi":"10.5694/mja2.70170","DOIUrl":"10.5694/mja2.70170","url":null,"abstract":"<p>Chronic hepatitis D virus (HDV) infection always occurs as a coinfection with hepatitis B virus (HBV) and is the most severe form of viral hepatitis, associated with a high risk of cirrhosis, liver cancer and death. Effective treatment is now available for HDV–HBV coinfection and HDV screening is recommended for all people living with HBV, yet most people in Australia with HDV–HBV are diagnosed too late to prevent complications. This article calls for an urgent change in HDV testing policy and funding to implement reflex HDV antibody (anti-HDV) testing for all people diagnosed with HBV infection, thus enabling timely diagnosis of HDV–HBV coinfection and rapid access to life-saving treatment.</p>","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"224 4","pages":""},"PeriodicalIF":8.5,"publicationDate":"2026-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13050674/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147623311","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":"Cost-Effectiveness of Donanemab for Early Alzheimer Disease in Australia.","authors":"Lan Gao, Rosie Watson, Nawaf Yassi","doi":"10.5694/mja2.70186","DOIUrl":"https://doi.org/10.5694/mja2.70186","url":null,"abstract":"<p><strong>Objectives: </strong>To evaluate the cost-effectiveness of donanemab, an anti-amyloid-β monoclonal antibody recently approved in Australia, for treating early-stage Alzheimer disease with confirmed amyloid-β pathology from healthcare system and societal perspectives.</p><p><strong>Design: </strong>A Markov microsimulation model simulating long-term Alzheimer disease progression, treatment costs and health outcomes for donanemab compared with standard care.</p><p><strong>Setting, participants: </strong>Australian healthcare context, applying published clinical and economic inputs. A hypothetical cohort of people with early symptomatic Alzheimer disease, consistent with TRAILBLAZER-ALZ eligibility criteria: mean age 75 years, amyloid-β-positive, with mild cognitive impairment or mild dementia because of Alzheimer disease and excluding individuals with APOEE4 homozygotes, in line with the Australian labelling. Donanemab administered every 4 weeks with magnetic resonance imaging (MRI)-based amyloid-β-related imaging abnormalities monitoring and treatment suspension upon amyloid-β clearance or progression to severe Alzheimer disease, compared with standard care.</p><p><strong>Main outcome measures: </strong>Incremental costs, quality-adjusted life years (QALYs) and incremental cost-effectiveness ratios (ICERs). Secondary analyses included sensitivity and distributional equity analyses.</p><p><strong>Results: </strong>Donanemab increased total healthcare costs ($300,689 vs. $178,121) and societal costs ($389,113 vs. $283,618) compared with standard care per capita, while improving health outcomes (4.38 vs. 4.01 QALYs) per capita. The ICER was $342,424 per QALY from the healthcare perspective and $294,701 per QALY from the societal perspective, exceeding frequently cited Australian willingness-to-pay thresholds. Sensitivity analyses identified drug cost and efficacy as key drivers of uncertainty. Distributional analysis suggested inequitable health gains by remoteness because of differences in diagnostic and treatment infrastructure.</p><p><strong>Conclusion: </strong>Donanemab provides clinical benefits but is unlikely to be cost-effective under current Australian thresholds. Policymakers should balance economic evidence with unmet need, equity considerations and healthcare sustainability when making reimbursement decisions. Further research using real-world evidence and disaggregated analyses by geography and socioeconomic status is warranted.</p>","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"224 4","pages":"e70186"},"PeriodicalIF":8.5,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13100693/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147775788","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":"Organ Donation After Oral Ingestion of a Voluntary Assisted Dying Substance.","authors":"Joanne Kantianis, Helen I Opdam, Rohit L D'Costa","doi":"10.5694/mja2.70193","DOIUrl":"https://doi.org/10.5694/mja2.70193","url":null,"abstract":"<p><p>Organ donation after voluntary assisted dying (VAD) is increasingly undertaken in jurisdictions where it is legally permissible, including Australia, although previously all reported cases involved intravenous administration of the life-ending substance. A 55-year-old woman in Victoria has become the first known person to have successfully donated organs and tissues after self-administration of an oral substance, despite initial uncertainty about feasibility due to the unpredictable time to death (agonal phase). With Victorian legislation requiring self-administration as the default, this case provides a precedent, opening the possibility of donation for others in this majority VAD cohort where oral administration is obligatory.</p>","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"224 4","pages":"e70193"},"PeriodicalIF":8.5,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13102989/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147775772","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":"Equity, Diversity and Inclusion From the Start: Reforming Australia's Research Infrastructure for Inclusive Participation.","authors":"Danielle M Muscat, Kirsten J McCaffery, Heather L Shepherd, Marguerite Tracy","doi":"10.5694/mja2.70185","DOIUrl":"10.5694/mja2.70185","url":null,"abstract":"","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"224 4","pages":"e70185"},"PeriodicalIF":8.5,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147723355","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}