Medical Journal of Australia最新文献_第3页

The potential of maternal and child health service data in Australia: how lessons from the COVID-19 pandemic can accelerate data-informed decision making.

IF 6.7 2区医学

Medical Journal of Australia Pub Date : 2025-03-16 DOI: 10.5694/mja2.52630

Ashleigh Shipton, Meredith O'Connor, Melissa Wake, Sharon Goldfeld, Helen Lees, Catina Adams, Kristina Edvardsson, Leesa Hooker, Jatender Mohal, Rhiannon M Pilkington, Fiona K Mensah

引用次数: 0

Dismantling barriers to research and clinical care for individuals with a vision impairment

IF 6.7 2区医学

Medical Journal of Australia Pub Date : 2025-03-16 DOI: 10.5694/mja2.52627

Eden G Robertson, Kate Hetherington, Meredith Prain, Julia Hall, Leighton Boyd AM, Rosemary Boyd OAM, Emily Shepard, Hollie Feller, Sally Karandrews, Fleur O'Hare, Kanae Yamamoto, Matthew P Simunovic, Robyn V Jamieson, Alan Ma, Lauren Ayton AM, Anai Gonzalez-Cordero

{"title":"Dismantling barriers to research and clinical care for individuals with a vision impairment","authors":"Eden G Robertson, Kate Hetherington, Meredith Prain, Julia Hall, Leighton Boyd AM, Rosemary Boyd OAM, Emily Shepard, Hollie Feller, Sally Karandrews, Fleur O'Hare, Kanae Yamamoto, Matthew P Simunovic, Robyn V Jamieson, Alan Ma, Lauren Ayton AM, Anai Gonzalez-Cordero","doi":"10.5694/mja2.52627","DOIUrl":"10.5694/mja2.52627","url":null,"abstract":"In Australia, little prevalence data around vision impairment exist. However, self-reported data from the Australian Bureau of Statistics 2017–18 National Health Survey1 suggest that around 800 000 people have a vision impairment or are blind (excluding uncorrected refractive errors).2 The leading cause of vision impairment in working-age adults are inherited retinal diseases (IRDs)3 — a group of genetic conditions that primarily affect the retina. Other than one particular gene therapy for biallelic RPE65-associated retinal dystrophy, there are no other clinically available treatments to safely prevent vision loss or restore vision for someone with an IRD.4With no universally accepted definition of vision impairment,5 we use “vision impairment” in this article to refer to a significant reduction in vision that causes individuals to rely on visual substitution skills for daily living.6 Understanding the perspectives of individuals who have a vision impairment is necessary to develop meaningful interventions, policies and practices. However, too often these individuals have limited access to research opportunities and health information due to the inaccessibility of information.7-9 Resources, such as the Web content accessibility guidelines, provide useful guidance for how to make digital information more accessible.10, 11 However, a lack of awareness and integration of these guidelines across national policy and professional code results in little uptake. Challenges around feasibility and capacity also arise for researchers and clinicians when embedding such practices.In 2023–2024, we undertook a James Lind Alliance Priority Setting Partnership (PSP) to identify the top research priorities for IRDs in Australia, from the perspectives of individuals with lived experience and health professionals.12, 13 As a first step of the PSP, we established a 14-member steering group consisting of people with lived experience (individuals with an IRD or other vision impairment, and caregivers), community organisations representatives, health professionals (clinical geneticists, ophthalmologists, speech pathologist, optometrist), and researchers. The steering group met ten times over 18 months to guide the PSP, which included two national surveys and online workshops with the IRD community.12Here, we share our learnings from undertaking the PSP surveys and hosting an in-person educational event for the IRD community. This article has been co-written with our PSP steering group, including seven co-authors who have lived experience of vision impairment. By providing these co-developed recommendations, summarised in the Box, our aim is to provide feasible strategies for researchers and clini","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"222 7","pages":"324-326"},"PeriodicalIF":6.7,"publicationDate":"2025-03-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.52627","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143649640","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}

引用次数: 0

Platypus envenomation.

IF 6.7 2区医学

Medical Journal of Australia Pub Date : 2025-03-13 DOI: 10.5694/mja2.52632

Irene M Moyer de Miguel, Jennifer C Jamieson, Lori Coulson, Ingrid Berling

引用次数: 0

The Fossil Fuel Non-Proliferation Treaty: what it is, its importance for health, and why Australia should endorse it

IF 6.7 2区医学

Medical Journal of Australia Pub Date : 2025-03-13 DOI: 10.5694/mja2.52610

Philomena Colagiuri, Jake TW Williams, Paul J Beggs, Ying Zhang

{"title":"The Fossil Fuel Non-Proliferation Treaty: what it is, its importance for health, and why Australia should endorse it","authors":"Philomena Colagiuri, Jake TW Williams, Paul J Beggs, Ying Zhang","doi":"10.5694/mja2.52610","DOIUrl":"10.5694/mja2.52610","url":null,"abstract":"Climate change — driven primarily by the extraction and burning of fossil fuels — is profoundly affecting our health. Some impacts are direct and immediate, such as from worsening heatwaves and extreme weather events.1 Others are indirect and more complex, including changes to the social determinants of health and the distribution of infectious diseases, and increased water and food insecurity. The risks associated with climate change are not being felt equally, and it is the most disadvantaged people and countries (who have generally contributed the least to climate change) that are disproportionately exposed and vulnerable.2The 29th Conference of the Parties to the United Nations Framework Convention on Climate Change (UNFCCC), COP29, was recently held in Baku, Azerbaijan. COP is the UNFCCC's decision-making body, most notably responsible for the Paris Agreement, which aims to limit global warming to 1.5°C or well below 2°C.3 Azerbaijan is a major oil and gas producer with plans for expansion, which contradicts the urgent need to phase out fossil fuels in accordance with the Paris Agreement.4 This is the third consecutive year that COP has been hosted by a country with significant fossil fuel interests, and fossil fuel lobbyists at COP29 outnumbered delegates from the ten most climate-vulnerable countries combined.5 Given the prominence of fossil fuel producers in the UNFCCC process, a further mechanism is needed to manage the phasing out of fossil fuels.Achieving the goals of the Paris Agreement requires rapid reductions in greenhouse gas (GHG) emissions in all sectors.6 However, current mitigation plans make it likely that warming will exceed 1.5°C this century.6 To prevent the most devastating and inequitable health impacts, we must rapidly reduce GHG emissions — and phase out fossil fuels.Based on the extensive evidence of the health impacts of climate change, and the health benefits of phasing out fossil fuel extraction and use, this perspective article argues that Australia should endorse the Fossil Fuel Non-Proliferation Treaty (FFNPT) as an act of public health. We outline the health impacts of climate change, discuss what the FFNPT seeks to achieve, its alignment with public health, and how Australia's support for the treaty could strengthen its bid to host COP31.The world is not on track to meet the goals of the Paris Agreement. The sixth assessment report of the Intergovernmental Panel on Climate Change, released in 2023, found that GHG emissions are the highest they have ever been and that, in the last decade (2011–2020), the mean global surface temperature reached 1.1°C above the 1850–1900 baseline.6 The 2023 annual mean temperature hit a record high of 1.45°C above pre-industrial times.7<","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"222 6","pages":"297-299"},"PeriodicalIF":6.7,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.52610","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143625259","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}

引用次数: 0

Using patient-reported outcome measures in clinical trials: perspectives for and against a modular approach

IF 6.7 2区医学

Medical Journal of Australia Pub Date : 2025-03-11 DOI: 10.5694/mja2.52629

Carrie-Anne Ng, Jessica Roydhouse, Tim Luckett, Richard De Abreu Lourenco, Brendan Mulhern

{"title":"Using patient-reported outcome measures in clinical trials: perspectives for and against a modular approach","authors":"Carrie-Anne Ng, Jessica Roydhouse, Tim Luckett, Richard De Abreu Lourenco, Brendan Mulhern","doi":"10.5694/mja2.52629","DOIUrl":"10.5694/mja2.52629","url":null,"abstract":"There is growing acknowledgement among international stakeholders, including regulators, health technology assessment (HTA) bodies and professional societies, that the inclusion of patient-reported outcome measures (PROMs) in clinical trials should be guided by clear rationales.1 In this regard, existing PROMs may overreach or fall short in measuring domains most relevant for a specific study's context, population, treatments and stakeholders.In response to the need for flexibility in assessing specific health-related quality of life (HRQoL) domains and regulatory recommendations,1 PROM developers and stakeholders have provided guidance on a modular approach.2-4 Although most guidance has focused on cancer clinical trials, the same principles are applicable to any context where PROMs are used (eg, clinical practice). In trials, the modular approach has been defined as the selection and assessment of specific patient-relevant and clinically relevant domains of interest, purposefully selected from multidomain PROMs, and then independently scored and interpreted.3, 4Selection of the most relevant disease- and treatment-specific domains can be based on previous research, consumer advice and clinical experience. Stakeholders have also recommended using conceptual frameworks and core patient-reported outcome (PROs) sets to guide the selection of PROM domains.5 HRQoL concepts identified as primary or key secondary outcomes should ideally be assessed using the most valid, reliable and dedicated measures, which are often more in-depth than domains in multidomain PROMs used to provide a broad overview. For example, if pain is a primary outcome in a trial investigating an anti-cancer treatment, the Brief Pain Inventory might be a comprehensive substitution for the two-item domain of pain from the widely used cancer-specific HRQoL PROM, the European Organisation for Research and Treatment of Cancer Quality of Life Core Questionnaire (EORTC QLQ-C30).6 Secondary outcomes, such as appetite loss and constipation, might be adequately assessed by the QLQ-C30's single-item domains for these outcomes. Thus, we propose three possible applications of the modular approach (Box 1): (i) using a study-specific conceptual framework, incorporating dedicated PROMs or domains to measure relevant HRQoL concepts; (ii) using a full-length PROM, removing domains less relevant to the study context or not covered by a core PRO set; or (iii) using a full-length PROM, substituting domains that are primary or key secondary outcomes with dedicated PROMs or domains.Box 2 presents the cases for and against the use of a modular approach. In this perspective article, we discuss some of these arguments in the context of assessing clinical efficacy and conducting economic evaluations.A modular approach can address respo","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"222 7","pages":"327-330"},"PeriodicalIF":6.7,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.52629","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143605395","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}

引用次数: 0

Early cardiovascular collapse after envenoming by snakes in Australia, 2005–2020: an observational study (ASP-31)

IF 6.7 2区医学

Medical Journal of Australia Pub Date : 2025-03-09 DOI: 10.5694/mja2.52622

Geoffrey K Isbister, Katherine Z Isoardi, Angela L Chiew, Shane Jenkins, Nicholas A Buckley

{"title":"Early cardiovascular collapse after envenoming by snakes in Australia, 2005–2020: an observational study (ASP-31)","authors":"Geoffrey K Isbister, Katherine Z Isoardi, Angela L Chiew, Shane Jenkins, Nicholas A Buckley","doi":"10.5694/mja2.52622","DOIUrl":"10.5694/mja2.52622","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 To investigate the frequency, timing, and characteristics of cardiovascular collapse after snakebite in Australia, and the complications of collapse following envenoming.\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Study design</h3>\u0000 \u0000 Observational study; analysis of prospectively collected demographic and clinical data.\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting, participants</h3>\u0000 \u0000 People with confirmed snake envenoming recruited to the Australian Snakebite Project at one of 200 participating Australian hospitals, 1 July 2005 – 30 June 2020.\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main outcome measures</h3>\u0000 \u0000 Time from snakebite to collapse; post-collapse complications (cardiac arrest, seizures, death).\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 Of 1259 envenomed people, 157 (12%) collapsed within 24 hours of the snakebite; venom-induced consumption coagulopathy (VICC) was determined in all 156 people for whom coagulation testing could be performed. The exact time between bite and collapse was known for 149 people (median, 20 min; interquartile range, 15–30 min; range, 5–115 min); the time exceeded 60 minutes for only two people, each after releasing tight bandages 60 minutes after the bite. The collapse preceded hospital arrival in 132 cases (84%). Brown snake (Pseudonaja spp.) envenoming was the leading cause of collapse (103 cases, 66%). Forty-two collapses (27%) were followed by cardiac arrest, 49 (31%) by seizures (33 without cardiac arrest), and five by apnoea; collapse was associated with hypotension in all 24 people whose blood pressure could be measured at or close to the time of collapse. Twenty-five people who collapsed died (16%), and seven of the envenomed people who did not collapse (0.6%; difference: 15 percentage points; 95% confidence interval, 8–21 percentage points). The deaths of 21 of the 25 people who collapsed were immediately associated with the cardiac arrest that followed the collapse; three people who did not have cardiac arrests died later of intracranial haemorrhage, and one of hyperthermia. The proportion of people who had collapsed before reaching hospital was larger for people who died of post-collapse cardiac arrest (13 of 21, 62%) than for those who survived (6 of 21, 28%).\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 Collapse after Australian snake envenoming almost always occurred wi","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"222 6","pages":"313-317"},"PeriodicalIF":6.7,"publicationDate":"2025-03-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.52622","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143586129","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}

引用次数: 0

Long COVID in a highly vaccinated but largely unexposed Australian population following the 2022 SARS-CoV-2 Omicron wave

IF 6.7 2区医学

Medical Journal of Australia Pub Date : 2025-03-09 DOI: 10.5694/mja2.52620

Mulu Woldegiorgis, Rosemary J Korda, Paul V Effler

引用次数: 0

Long COVID in a highly vaccinated but largely unexposed Australian population following the 2022 SARS-CoV-2 Omicron wave

IF 6.7 2区医学

Medical Journal of Australia Pub Date : 2025-03-09 DOI: 10.5694/mja2.52619

Nigel Curtis

引用次数: 0

Pills, profits, and pollution: accountability for pharmaceuticals-related greenhouse gas emissions

IF 6.7 2区医学

Medical Journal of Australia Pub Date : 2025-03-06 DOI: 10.5694/mja2.52623

Angie Bone, Nick Watts

{"title":"Pills, profits, and pollution: accountability for pharmaceuticals-related greenhouse gas emissions","authors":"Angie Bone, Nick Watts","doi":"10.5694/mja2.52623","DOIUrl":"10.5694/mja2.52623","url":null,"abstract":"Pharmaceuticals have improved the length and quality of life for millions, if not billions, of people worldwide. However, Big Pharma has also faced claims that the industry puts profits before patient and population health.1, 2 Further, there is increasing concern about the environmental harm associated with pharmaceuticals, from bench to bedside to bin, including their contributing 20–25% of health sector greenhouse gas emissions.3, 4The imperative for Big Pharma to demonstrate its environmental, social, and governance sustainability credentials is increasingly clear. Voluntary initiatives, such as the Sustainable Markets Initiative health systems taskforce established in 2021,5 have been accompanied by increasing expectations and requirements by procurers and regulators.In England, the National Health Service has taken the procurement lead by gradually increasing requirements for their suppliers to work toward net zero greenhouse gas emissions, including by publicly reporting emissions, emissions reduction targets, and carbon reduction plans.6 Australia has joined international initiatives to reduce emissions associated with pharmaceuticals, including a United Kingdom-led multi-country collaboration to align their health care procurement requirements, and another to harmonise measurement standards for the environmental impact of health technologies.7Governments around the world are introducing mandatory public disclosure of corporate environmental, social, and governance sustainability performance. In Australia, mandatory climate-related financial disclosure reporting based on international standards began on 1 January 2025.8 The phased introduction starts with large enterprises (based on assets, revenue, or number of employees), and will include the large pharmaceutical companies operating in Australia.The study by Burch and colleagues reported in this issue of the MJA provides a useful first analysis of the self-reported emissions reduction targets, plans, actions, and performance during 2015–23 of the ten largest pharmaceutical companies in Australia according to Pharmaceutical Benefits Scheme expenditure. The authors assessed publicly available documents, and used an evaluation framework developed from internationally recognised tools.9The authors identified a range of levels of commitment, with the three leading companies scoring 28 to 30 of a possible 32 points, and six others 12 to 27 points. The definite laggard was Arrotex Pharmaceuticals, the only Australian and the only privately owned company of the ten assessed, which scored zero points. As Burch and colleagues note, interpretation of an analysis based on voluntary reports is necessarily limited; relevant information may not be publicly available, or may have been presente","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"222 6","pages":"303-304"},"PeriodicalIF":6.7,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.52623","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143572925","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}

引用次数: 0

Exploring the role of urine drug screening in opioid agonist therapy.

IF 6.7 2区医学

Medical Journal of Australia Pub Date : 2025-03-05 DOI: 10.5694/mja2.52628

Grace FitzGerald, Sione Crawford, Adrian J Dunlop, Jon Cook, Dean Membrey, Paul MacCartney, Thileepan Naren

引用次数: 0