Medical Journal of Australia最新文献

{"title":"Non-technical errors associated with deaths in surgical care, Australia, 2012-2019, by surgical specialty (Australian and New Zealand Audit of Surgical Mortality): a retrospective cohort study.","authors":"Jesse Ey, Victoria Kollias, Octavia Lee, Kelly Hou, Matheesha Herath, John B North, Ellie Treloar, Suzanne Edwards, Martin Bruening, Adam J Wells, Guy J Maddern","doi":"10.5694/mja2.70055","DOIUrl":"https://doi.org/10.5694/mja2.70055","url":null,"abstract":"<p><strong>Objective: </strong>To compare the frequency of non-technical errors in cases of surgical care-related deaths in Australia, by surgical specialty.</p><p><strong>Study design: </strong>Retrospective cohort study; analysis of Australian and New Zealand Audit of Surgical Mortality (ANZASM) data.</p><p><strong>Setting, participants: </strong>All surgical care-related deaths in Australia (except New South Wales), 1 January 2012 - 31 December 2019, that were flagged in ANZASM as associated with adverse events or areas of concern.</p><p><strong>Main outcome measures: </strong>Proportions of surgical care-related deaths associated with non-technical errors, overall and by domain (communication/teamwork, decision making, situational awareness, leadership); paired comparisons of likelihood of errors by specialty; change in error proportions during 2012-2019; influence of patient and admission factors on likelihood of non-technical errors.</p><p><strong>Results: </strong>Of 30 971 surgical care-related deaths reported to ANZASM during 2012-2019, 3695 were flagged with adverse events or areas of concern, including 3422 cases (92.6%) in five surgical specialties: general surgery (1570 deaths), cardiothoracic surgery (626), orthopaedic surgery (510), vascular surgery (385), and neurosurgery (331). The proportions of surgical care-related deaths associated with non-technical errors differed by specialty (range, 52.2% to 68.5%), as did those errors in the domains decision making (range, 52.6% to 66.3%) and situational awareness errors (range, 44.4% to 62.5%). The probability of any non-technical error was greater for cardiothoracic than orthopaedic surgery (adjusted odds ratio [aOR], 1.76; 95% confidence interval [CI], 1.37-2.28), and for general than orthopaedic surgery (aOR, 1.97, 95% CI, 1.59-2.44) or neurosurgery (aOR, 1.47; 95% CI, 1.14-1.90); the probability was lower for orthopaedic than vascular surgery (aOR, 0.54; 95% CI, 0.41-0.72). The proportion of deaths associated with non-technical errors declined over time for general surgery, but not the other four specialties. Differences by patient and admission characteristics in the proportions of cases including non-technical errors were not statistically significant.</p><p><strong>Conclusion: </strong>At least 50% of surgical care-related deaths in five surgical specialties were associated with non-technical errors, and the proportions did not substantially change during 2012-2019. Differences between specialties in the frequency of fatal non-technical error suggest that targeted improvement strategies are needed, but the persistently high frequency for all specialties indicates that systemwide improvement is crucial.</p>","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":" ","pages":""},"PeriodicalIF":8.5,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145123983","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 epidemiology of acute rheumatic fever and rheumatic heart disease in Queensland, 2017-2021: a population-level cohort study using linked administrative data.","authors":"Carl J Francia Saibai Koedal Awgadhalayg Guda Maluylgal Nation, Leanne M Johnston, Ingrid Stacey, Robert N Justo, John F Fraser, Judith M Katzenellenbogen","doi":"10.5694/mja2.70052","DOIUrl":"https://doi.org/10.5694/mja2.70052","url":null,"abstract":"<p><strong>Objectives: </strong>To determine the incidence and prevalence of acute rheumatic fever (ARF) and rheumatic heart disease (RHD) in Queensland during the period 2017-2021.</p><p><strong>Study design: </strong>Population-level retrospective cohort study using linked administrative data.</p><p><strong>Setting, participants: </strong>Queensland residents aged younger than 45 years for ARF and younger than 55 years for RHD, identified from hospital, emergency department, death and Queensland RHD Register records for the period 1 January 2017 to 31 December 2021.</p><p><strong>Main outcome measures: </strong>Age-specific and age-standardised incidence and prevalence of ARF and RHD; and age-standardised incidence and prevalence ratios comparing Indigenous and non-Indigenous populations.</p><p><strong>Results: </strong>736 ARF episodes occurred among 670 people (395 [54%] female participants; 609 [83%] Indigenous). Of 4519 prevalent RHD cases aged < 55 years who were alive on 1 July 2021, 2655 (59%) were female, 2169 (48%) were Indigenous, and 1846 (41%) had severe disease. Previous ARF was recorded for 362 cases (8%). Among RHD cases aged younger than 25 years, 633 of 790 Indigenous individuals (80%) and 133 of 408 non-Indigenous individuals (33%) had RHD Register records. Indigenous age-standardised incidence (< 45 years) was 60.2 times higher (95% CI, 55.6-64.2) than non-Indigenous incidence for first ever ARF, 68.6 times higher (95% CI, 62.3-72.5) for total ARF, and 18.9 times higher (95% CI, 13.5-24.1) for RHD. For Indigenous people aged < 55 years, prevalence was 22.6 times higher (95% CI, 16.2-27.3) for ARF/RHD, 18.4 times higher (95% CI, 12.9-24.1) for RHD, and 12.1 times higher (95% CI, 8.3-15.9) for severe RHD. The overall burden of ARF and RHD was highest in northern Queensland health districts, whereas cases in the non-Indigenous population were concentrated in metropolitan south-east Queensland.</p><p><strong>Conclusions: </strong>The vast disparity in ARF and RHD burden between Indigenous and non-Indigenous Queenslanders indicates an urgent need for targeted, community-led prevention strategies. Under-representation of non-Indigenous youth in the RHD Register suggests improved clinical awareness and reporting is needed. Further investigation is warranted to inform equitable responses.</p>","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":" ","pages":""},"PeriodicalIF":8.5,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145113359","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":"From words to action: time for Australia to take shared decision making implementation seriously","authors":"Tammy C Hoffmann,&nbsp;Kirsten J McCaffery,&nbsp;France Légaré,&nbsp;Mina Bakhit,&nbsp;Marguerite Tracy,&nbsp;the Australian Shared Decision Making Research Network","doi":"10.5694/mja2.70065","DOIUrl":"10.5694/mja2.70065","url":null,"abstract":"&lt;p&gt;Why is embedding shared decision making within the Australian health care system essential and urgent? Shared decision making is a process of engagement and partnership between a patient and their clinician that enables a collaborative decision to be made based on the best evidence, individual circumstances, and what matters most to the patient.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; Patient involvement in making informed health decisions is a fundamental right&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt; and is central to safe and quality health care. Shared decision making represents the highest standard of informed consent&lt;span&gt;&lt;sup&gt;3&lt;/sup&gt;&lt;/span&gt; and is a cornerstone of value-based health care. As well as benefitting individual patients and clinicians, shared decision making also has an important role in addressing unwarranted variations in health care and has the potential to contribute to health system sustainability by reducing the overuse of low-value care (where the benefits do not, or hardly, outweigh the harms) and increasing the uptake of care that is known to be effective but is underutilised.&lt;span&gt;&lt;sup&gt;4, 5&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;Shared decision making can contribute to achieving the quintuple aim of health care improvement,&lt;span&gt;&lt;sup&gt;6&lt;/sup&gt;&lt;/span&gt; by improving patient care experiences, informed decision-making, care efficiency, the wellbeing of clinical teams, and contributing towards reducing health inequities.&lt;span&gt;&lt;sup&gt;7-12&lt;/sup&gt;&lt;/span&gt; However, shared decision making is not widely adopted in practice in Australia and requires urgent scaling up so that more individuals and the health system can benefit from it.&lt;/p&gt;&lt;p&gt;In 2013, the inaugural national Shared Decision Making Symposium was hosted by the Centre for Research in Evidence-Based Practice (now the Institute for Evidence-Based Healthcare) at Bond University, in collaboration with the Australian Commission on Safety and Quality in Health Care (ACSQHC). One outcome of the symposium was identifying that clinicians’ low awareness of shared decision making, misperceptions about it, and limited training opportunities were among the barriers hindering its implementation in Australia. Following the symposium, we published an article in the &lt;i&gt;Medical Journal of Australia&lt;/i&gt;&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; (&lt;i&gt;MJA&lt;/i&gt;) to increase broad awareness about shared decision making, providing a brief explanation and example of the process, and refuting some of the common misperceptions. To address the barrier of limited training opportunities, the ACSQHC developed an online training module in shared decision making for clinicians (Box 1).&lt;/p&gt;&lt;p&gt;The 2014 &lt;i&gt;MJA&lt;/i&gt; article noted that “In the absence of a coordinated national effort, we encourage individual clinicians to begin incorporating shared decision making into their consultations…”.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; In the eleven years since the article’s publication, numerous initiatives led by local champions across Australia have promoted and facilitated implementation of shared","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"223 8","pages":"391-396"},"PeriodicalIF":8.5,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.70065","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145113343","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":"Clinical practice guidelines for hepatocellular carcinoma surveillance for people at high risk in Australia: summary of recommendations","authors":"Jacob George,&nbsp;Nicole L Allard,&nbsp;Stuart K Roberts,&nbsp;Leon A Adams,&nbsp;Jane Davies,&nbsp;Behzad Hajarizadeh,&nbsp;Jennifer H MacLachlan,&nbsp;Suzanne E Mahady,&nbsp;Rosalie Altus,&nbsp;Catherine Brown,&nbsp;David C Fry,&nbsp;Belinda Greenwood-Smith,&nbsp;Natali Smud,&nbsp;Patricia C Valery,&nbsp;Nafisa Yussf,&nbsp;Kate Broun,&nbsp;Denise Campbell,&nbsp;Karen Canfell,&nbsp;Chelsea Carle Harrison,&nbsp;Victoria Freeman,&nbsp;Paul Grogan,&nbsp;Catherine Holliday,&nbsp;Suzanne Hughes,&nbsp;Anna Kelly,&nbsp;Cathelijne van Kemenade,&nbsp;Claire Latumahina,&nbsp;Amanda McAtamney,&nbsp;Megan Varlow,&nbsp;Joachim Worthington,&nbsp;Susan Yuill,&nbsp;Eleonora Feletto","doi":"10.5694/mja2.70061","DOIUrl":"10.5694/mja2.70061","url":null,"abstract":"&lt;div&gt;\u0000 \u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Introduction&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Hepatocellular carcinoma (HCC) is the most common form of primary liver cancer, the sixth most common cause of cancer death in Australia. With shifting aetiologies and a growing at-risk population, consistent routine surveillance recommendations are key to early detection of HCC and improved survival. We developed new evidence-based HCC surveillance guidelines for people at high risk in Australia due to liver disease and/or other risk factors. These guidelines were developed by a working group of experts in liver cancer control and included evidence reviews, synthesis and adaptation of existing guidelines for the Australian context, and predictive modelling.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Main recommendations&lt;/h3&gt;\u0000 \u0000 &lt;div&gt;\u0000 \u0000 &lt;ul&gt;\u0000 \u0000 \u0000 &lt;li&gt;This article summarises the recommendations and practice points for key population subgroups who were identified as potentially benefitting from routine HCC surveillance in the form of six-monthly ultrasound scans, with or without α-fetoprotein testing.&lt;/li&gt;\u0000 \u0000 \u0000 &lt;li&gt;People with liver cirrhosis and a non-HCC-related life expectancy of greater than six months are recommended to receive routine HCC surveillance.&lt;/li&gt;\u0000 \u0000 \u0000 &lt;li&gt;People with chronic hepatitis B virus infection who do not have liver cirrhosis are recommended to receive routine HCC surveillance if they have a family history of HCC, are Aboriginal or Torres Strait Islander peoples, or have an Asian, Pacific, or sub-Saharan African background, with varying start ages recommended for each group.&lt;/li&gt;\u0000 \u0000 \u0000 &lt;li&gt;People with stage 3 non-cirrhotic liver fibrosis (F3) may be recommended to receive routine HCC surveillance based on individual risk assessment, or otherwise monitored for progression to cirrhosis.&lt;/li&gt;\u0000 &lt;/ul&gt;\u0000 &lt;/div&gt;\u0000 \u0000 &lt;p&gt;The final guidelines were approved by the National Health and Medical Research Council (NHMRC) in April 2023.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Changes in management as a result of the guideline&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;The updated guidelines formalise recommendations for people with cirrhosis, identify other patient groups who are recommended for surveillance, and highlight gaps in evidence where the benefit of surveillance is unclear. These guidelines were accompanied by the &lt;i&gt;Roadmap to liver cancer control&lt;/i&gt;, a coordinated ten-year plan for advancing liver cancer prevention a","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"223 8","pages":"426-436"},"PeriodicalIF":8.5,"publicationDate":"2025-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.70061","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145112975","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":"A future for the hospital-in-the-home (HITH) deteriorating patient: shifting the paradigm","authors":"Davide R Tomassoni,&nbsp;Iftah Amith","doi":"10.5694/mja2.70060","DOIUrl":"10.5694/mja2.70060","url":null,"abstract":"","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"223 8","pages":""},"PeriodicalIF":8.5,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145086464","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":"Sex differences in management and outcomes of people with ST-elevation myocardial infarction, New South Wales, 2011–2020: a retrospective cohort study","authors":"Samia Kazi,&nbsp;Simone Marschner,&nbsp;Haeri Min,&nbsp;Desi Quintans,&nbsp;James JH Chong,&nbsp;Ehsan Khan,&nbsp;David B Brieger,&nbsp;Clara K Chow","doi":"10.5694/mja2.70048","DOIUrl":"10.5694/mja2.70048","url":null,"abstract":"&lt;div&gt;\u0000 \u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Objectives&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;To examine whether sex differences in cardiovascular disease care and outcomes for people hospitalised with ST-elevation myocardial infarction (STEMI) in New South Wales have declined during 2011–2020.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Study design&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Retrospective cohort study; analysis of linked New South Wales Admitted Patient Data Collection and Registry of Births, Deaths and Marriages data.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Setting, participants&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Adults (18 years or older) admitted to public or private hospitals in New South Wales with STEMI for the first time during 1 January 2011 – 31 December 2020.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Major outcome measures&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Proportions of people who received coronary angiography or percutaneous coronary intervention (PCI) within seven days of first STEMI admission, by year and sex; proportions of STEMI admissions followed by major adverse cardiovascular events (MACE) or death (any cause) within twelve months, by year and sex; rate of change in these parameters, adjusted for age group, intensive care unit admission, and Charlson Comorbidity Index score.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Results&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;We identified 29 435 initial STEMI hospital admissions during 2011–2020; the mean age at admission was 66.1 years (standard deviation, 14.2 years), 8475 patients were women (28.8%) and 20 960 were men (71.2%). The proportions of female patients who underwent angiography (71.9% &lt;i&gt;v&lt;/i&gt; 85.1%) or PCI (54.4% &lt;i&gt;v&lt;/i&gt; 70.0%) were smaller than those of male patients. During 2011–2020, the increase in the angiography proportion was greater for female than for male patients (2.7 [95% confidence interval {CI}, 2.5–2.9] &lt;i&gt;v&lt;/i&gt; 1.5 [95% CI, 1.4–1.6] percentage points per year), as was the change in PCI proportion (3.2 [95% CI, 2.9–3.6] &lt;i&gt;v&lt;/i&gt; 2.5 [95% CI, 2.3–2.7] percentage points per year). The proportions of admissions followed by MACE (18.4% &lt;i&gt;v&lt;/i&gt; 15.0%) or death of any cause (14.7% &lt;i&gt;v&lt;/i&gt; 8.5%) were larger for female than male patients. The decline in the MACE proportion during 2011–2020 was similar for female and male patients (0.8 [95% CI, 0.5–1.1] &lt;i&gt;v&lt;/i&gt; 0.5 [95% CI, 0.3–0.7] percentage points per year); the decline in all-cause mortality was greater for female than male patients (1.0 [95% CI, 0.8–1.1] &lt;i&gt;v&lt;/i&gt; 0.6 [95% CI, 0.5–0.7] percentage points per year).&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt;","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"223 7","pages":"351-358"},"PeriodicalIF":8.5,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.70048","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145081208","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":"Systemic challenges for meaningful partnerships in Aboriginal and Torres Strait Islander health and medical research grant applications: a critical reflection","authors":"Heather McCormack,&nbsp;Troy Combo,&nbsp;Bridget G Haire","doi":"10.5694/mja2.70025","DOIUrl":"https://doi.org/10.5694/mja2.70025","url":null,"abstract":"&lt;p&gt;The authors of this article are three Chief Investigators on a recent application to an Indigenous-specific funding round of the Medical Research Future Fund (MRFF). The first author, Dr Heather McCormack, is a Wiradjuri woman with family connections to central-west New South Wales and the second author, Mr Troy Combo, is a Bundjalung man from northern NSW. The final author, Assoc. Prof. Bridget Haire, is a non-Indigenous senior researcher. All three authors had significant industry careers in the bloodborne virus and not-for-profit sectors before making the transition to academia, with Mr Combo and Dr McCormack holding leadership positions in Aboriginal health. As such, we position ourselves in relation to this perspective article as being aware of the challenges raised within it both from the academic perspective and that of potential community partners.&lt;/p&gt;&lt;p&gt;Health and medical research in Australia is primarily funded by two key schemes: the National Health and Medical Research Council (NHMRC) and the MRFF, with the latter providing targeted funding for research topics identified by the Australian Government as national priorities.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; The MRFF was introduced as part of the 2014–15 federal Budget and represented a considerable investment in health and medical research by the Australian Government. The fund achieved its $20 billion target through contributions from the health budget in 2020, growing to $23 billion in 2023.&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt; The MRFF finances health and medical research projects via grants paid from the net interest on the perpetual investment of the fund. The introduction of the Indigenous Health Research Fund (hereafter referred to as MRFF Indigenous) in 2018 saw the Australian Government commit $160 million over 11 years from the MRFF to research focused on Aboriginal and Torres Strait Islander people.&lt;span&gt;&lt;sup&gt;3&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;Aboriginal and Torres Strait Islander health and medical research has historically faced structural and system-wide impediments. These have included short term funding cycles, lack of genuine partnerships and misalignment with community-identified priorities, underinvestment in capacity building of the Aboriginal and Torres Strait Islander research workforce, and failures to translate research findings into policy, practice and appropriate service delivery.&lt;span&gt;&lt;sup&gt;4&lt;/sup&gt;&lt;/span&gt; Targeted schemes that respond to identified research priorities within Aboriginal and Torres Strait Islander health have potential for significant impact.&lt;span&gt;&lt;sup&gt;5&lt;/sup&gt;&lt;/span&gt; Alignment of research funding priorities with priorities outlined in the National Agreement on Closing the Gap&lt;span&gt;&lt;sup&gt;6&lt;/sup&gt;&lt;/span&gt; and the National Aboriginal and Torres Strait Islander Health Plan&lt;span&gt;&lt;sup&gt;7&lt;/sup&gt;&lt;/span&gt; can help these funding schemes to play a critical role in addressing the particular health needs of Aboriginal and Torres Strait Islander populations.&lt;span&gt;&lt;sup&gt;4&lt;/sup&gt;&lt;/span&gt; However, to","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"223 6","pages":"296-298"},"PeriodicalIF":8.5,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.70025","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145062729","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":"Beyond endorsement: reflecting on the 18th anniversary of the United Nations Declaration on the Rights of Indigenous Peoples","authors":"Sophie Pitt","doi":"10.5694/mja2.70029","DOIUrl":"https://doi.org/10.5694/mja2.70029","url":null,"abstract":"&lt;p&gt;The United Nations Declaration on the Rights of Indigenous Peoples (UNDRIP) stands as the most comprehensive international charter for Indigenous rights.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; The 18th anniversary of the adoption of UNDRIP by the United Nations (UN) General Assembly (13 September 2007) provides an opportunity for reflection and a renewed commitment to its application to realise health equity.&lt;/p&gt;&lt;p&gt;UNDRIP affirms the collective and individual rights of Indigenous Peoples, including the fundamental right to self-determination (Article 3).&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; This is not just a political ideal; but the foundation on which health equity must be built. Article 24 states that “Indigenous Peoples have the right to their traditional medicines and to maintain their health practices” and “Indigenous individuals have an equal right to the enjoyment of the highest attainable standard of physical and mental health.”&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; Critically, UNDRIP must be read holistically, recognising that health is not merely an individual right, but an inherent collective and community right that cannot be separated from self-determination.&lt;/p&gt;&lt;p&gt;Self-determination shifts the power dynamics from colonial control to Indigenous agency and leadership. Self-determination recognises that Aboriginal and Torres Strait Islander Peoples, as bearers of vast cultural knowledge and custodians of Country, are best placed to define their own health priorities, design their own services, and lead initiatives that genuinely address the complex determinants of their wellbeing. Top-down approaches have proven to be inadequate, disempowering communities via colonial domination.&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt; Self-determination, however, enables communities to reclaim sovereignty, to make decisions about their lives, lands and institutions, including their health care systems, thereby promoting health and healing. Genuine wellbeing is directly linked to self-determination.&lt;/p&gt;&lt;p&gt;Australia's adoption and endorsement of UNDRIP was laborious. Initially, Australia was one of four nations that refused to endorse UNDRIP, citing concerns over provisions related to self-determination, land rights and the status of customary law, and co-led efforts to weaken its original text.&lt;span&gt;&lt;sup&gt;3&lt;/sup&gt;&lt;/span&gt; Although formal endorsement came on 3 April 2009, indicating a commitment to upholding Aboriginal and Torres Strait Islander rights, a critical paradox remains: Australia has not incorporated or implemented UNDRIP directly into domestic law. This stands in stark contrast to the nation's commitments made in multilateral forums to democratic principles and human rights, creating dissonance between international posture and domestic action, particularly regarding the right of Indigenous Peoples to self-determination.&lt;/p&gt;&lt;p&gt;Despite a lack of legal integration, the implementation of UNDRIP in Australia has been a subject of significant interest and discussion, driven by Aboriginal and Torres","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"223 6","pages":"302-303"},"PeriodicalIF":8.5,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.70029","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145062728","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":"A case of Lyme carditis in a returned traveller: a rare cause of reversible heart block in Australia","authors":"Eunice Chuah,&nbsp;Hari Sritharan,&nbsp;Zachariah Seidman,&nbsp;Avedis A Ekmejian,&nbsp;Karin Chia","doi":"10.5694/mja2.70059","DOIUrl":"10.5694/mja2.70059","url":null,"abstract":"","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"223 8","pages":"397-399"},"PeriodicalIF":8.5,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145069970","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":"Land, culture, rights and self-determination: foundations of Indigenous health","authors":"Virginia Barbour","doi":"10.5694/mja2.70040","DOIUrl":"https://doi.org/10.5694/mja2.70040","url":null,"abstract":"<p>This issue of the <i>MJA</i> is the second of this year with a specific focus on Aboriginal and Torres Strait Islander health. It includes three articles that were originally selected by the Guest Editors for the NAIDOC week Special Issue, which was published in July, 2025.<span>^{1, 2}</span> We were in the fortunate position of having too many accepted articles for that issue, so we are delighted to now publish them, alongside other articles on Indigenous health that went through regular <i>MJA</i> editorial processes.</p><p>Two of the articles previously selected are research articles: a study by Alasdair Vance and colleagues evaluates Elder-governed cultural therapy for Aboriginal and Torres Strait Islander young people with mental health conditions,<span>³</span> and Karrina DeMasi and colleagues describe the development of an Aboriginal women-led maternal and child health model when cardiometabolic complications are experienced in pregnancy.<span>⁴</span> The third article is a perspective from Paul Gray and colleagues that discusses the need to move towards epistemic pluralism, cultural safety, and critical reflexivity in Australian psychology.<span>⁵</span> Together, these articles reflect the depth and strength of Aboriginal and Torres Islander-led research and community, strength-based approaches. These values are also reflected in the other articles of this issue, which demonstrate a huge diversity of Aboriginal and Torres Strait Islander research and critical thought, ranging from voluntary assisted dying in remote Aboriginal communities in the Northern Territory, to exploring the need for meaningful partnerships in health and medical research grant applications.</p><p>This issue was timed for the 18th anniversary of the United Nations Declaration on the Rights of Indigenous Peoples — an important international resolution. The editorial for this issue reflects on the Declaration and, despite endorsing it, the failure of successive Australian governments to incorporate it into national law. As the editorial concludes “The 18th anniversary of UNDRIP is a historical marker but serves as a powerful call to action. It reminds us that health is inextricably linked to human rights, self-determination and cultural integrity”.</p><p>The cover for this issue of the <i>MJA</i> features an image of Mer Island in the Torres Strait. Sophie Pitt, who authored the editorial, explains the how this image calls us to recognise the links between the escalating climate crisis, Indigenous rights, and health, as it represents “both a celebration of the enduring connection to Country and a reminder of what can be lost” (Box).</p><p>For this issue, as for the previous NAIDOC week issue, we are very grateful for all the expertise and wisdom generously provided by the Guest Editors, and the care they took in assessing and selecting papers for these two Indigenous health issues.</p>","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"223 6","pages":""},"PeriodicalIF":8.5,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.70040","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145062797","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}