Medical Journal of Australia最新文献

{"title":"Advancing Gender Equality in Australian Healthcare Leadership: Why National Targets Matter and What It Means for Healthcare Employers","authors":"Belinda Garth,&nbsp;Nicole Pope,&nbsp;Jenny Proimos,&nbsp;Helena J. Teede","doi":"10.5694/mja2.70300","DOIUrl":"https://doi.org/10.5694/mja2.70300","url":null,"abstract":"<p>Women comprise the majority of Australia's healthcare workforce yet remain underrepresented in leadership. This structural inequity has direct consequences for workforce sustainability and patient outcomes. Australia's new gender equality target-setting requirements, which create binding obligations for large employers, including major healthcare services, offer a timely mechanism to address this structural inequity. In this article, we explain why gender equality targets matter for healthcare, outline who must comply and what is required and describe how health services and training settings can embed targets within governance, clinical accountability and workforce systems. We introduce the Monash Learning Health System Maturity Matrix as a practical tool for aligning targets with organisational maturity and argue that, when implemented well, gender equality targets go beyond compliance, building the institutional resilience and culture that retains talent and delivers better care.</p>","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"224 9","pages":""},"PeriodicalIF":6.8,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.70300","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148994094","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":"Centring Aboriginal and Torres Strait Islander Voices: A Framework for Culturally Safe and Racism-Free Healthcare","authors":"Elissa Elvidge,&nbsp;Roianne West,&nbsp;Kalkadunga, Djkunde,&nbsp;Karen Nicholls,&nbsp;Boigu,&nbsp;Kiara Harvey,&nbsp;Gamilaroi,&nbsp;Yeena Thompson,&nbsp;Gamilaraay,&nbsp;Geraint B. Rogers,&nbsp;Yin Paradies,&nbsp;Wakaya","doi":"10.5694/mja2.70295","DOIUrl":"10.5694/mja2.70295","url":null,"abstract":"<p>Culturally safe, racism-free healthcare is essential in Australia, yet Aboriginal and Torres Strait Islander people continue to face inequitable access, experiences and outcomes. Although cultural safety is widely cited, implementation remains shallow and disconnected from patients' realities. We argue that meaningful cultural safety requires Aboriginal and Torres Strait Islander governance, robust measurement and institutional accountability. Evidence shows that culturally unsafe care, including racism, creates psychological distress, leads to care avoidance and results in poorer outcomes, whereas Indigenous-led models perform considerably better. We propose a framework to strengthen cultural safety through Aboriginal and Torres Strait Islander community-governed assessment, greater accountability, data sovereignty and mandated cultural safety and anti-racism standards.</p>","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"224 9","pages":""},"PeriodicalIF":6.8,"publicationDate":"2026-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13573042/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148963477","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":"Sex Differences in Management and Outcomes of People With ST-Elevation Myocardial Infarction, New South Wales, 2011–2020: A Retrospective Cohort Study","authors":"Adam C. Livori,&nbsp;Jedidiah I. Morton,&nbsp;Dianna J. Magliano,&nbsp;Jonathan E. Shaw","doi":"10.5694/mja2.70286","DOIUrl":"10.5694/mja2.70286","url":null,"abstract":"","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"224 9","pages":""},"PeriodicalIF":6.8,"publicationDate":"2026-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148963480","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":"Rethinking Rheumatic Fever Diagnosis: Progress, Pitfalls and the Path Towards a Definitive Test","authors":"Anna P. Ralph,&nbsp;Rachel Webb,&nbsp;Tom Parks,&nbsp;Nicole J. Moreland,&nbsp;Asha C. Bowen,&nbsp;Benjamin Jones,&nbsp;Emma Ndagire,&nbsp;Andrea Z. Beaton","doi":"10.5694/mja2.70296","DOIUrl":"10.5694/mja2.70296","url":null,"abstract":"<div>\u0000 \u0000 <p>Elimination of rheumatic heart disease (RHD) as a public health problem requires a multifaceted approach, including better primordial and primary prevention and early case detection and treatment of rheumatic fever, the autoimmune precursor to RHD. Here, we reflect on progress made in the decade since the 2015 revision of the Jones Criteria for rheumatic fever diagnosis. Advances in understanding rheumatic fever pathophysiology, the identification of potential biomarkers and improved clinical insights are bringing us closer to a diagnostic test for rheumatic fever and to targeted treatments that could prevent progression to RHD.</p>\u0000 </div>","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"224 9","pages":""},"PeriodicalIF":6.8,"publicationDate":"2026-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148963527","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 AUstralian-CLimate and Health Attitudes, RIsk and Trust in the sYstem (AU-CLARITY) Study: A National, Representative Survey","authors":"Jeffrey Braithwaite,&nbsp;Carolynn L. Smith,&nbsp;Yvonne A. Zurynski,&nbsp;Louise A. Ellis,&nbsp;Georgia Fisher,&nbsp;Kate Churruca,&nbsp;Lisa Pagano,&nbsp;Samantha Spanos,&nbsp;Janet C. Long,&nbsp;Christina Rojas,&nbsp;S. Bruce Dowton","doi":"10.5694/mja2.70293","DOIUrl":"10.5694/mja2.70293","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;Climate change, associated with heat spikes, floods, wildfires and changing patterns of vector-borne diseases, is a major determinant of health, and health system functioning. Understanding public perceptions of climate-related health risks and system preparedness can support equitable policy responses and effective health messaging.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Study Type&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Cross-sectional.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Setting&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Online survey from 20 June to 27 August 2025.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Participants&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;6030 adults, aged ≥ 18 years, broadly representative of the Australian population.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Main Outcome Measures&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;The AUstralian-CLimate and Health Attitudes, RIsk and Trust in the sYstem (AU-CLARITY) survey collected data on demographics, health status, experiences of climate-related events, and views on climate change and health system preparedness.&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;Respondents (65%, 3910/6030) were concerned about climate change, yet only 45% (2735/6030) perceived it as a serious risk to their own health. Personal risk perception declined with age (odds ratio [OR] = 0.98; 95% confidence interval [CI], 0.98–0.98) and was higher among females (OR = 1.28; 95% CI, 1.15–1.43), First Nations people (OR = 1.44; 95% CI, 1.22–1.71), multilingual individuals (OR = 1.44; 95% CI, 1.22–1.71) and those with higher education (OR = 1.28; 95% CI, 1.12–1.46). Personal experience of a climate-related event increased perceived risk (OR = 1.97; 95% CI, 1.73–2.24). Regional and remote residents were less likely to perceive health risk (OR = 0.76; 95% CI, 0.65–0.89). A third (37%; 2209/6030) of respondents believed that the healthcare system was prepared for climate change. Being female (OR = 2.35; 95% CI, 2.10–2.65), having a chronic condition (OR = 1.47; 95% CI, 1.28–1.68) and older age (OR = 1.01; 95% CI, 1.01–1.01) increased perceptions that the system was unprepared. Those with higher education, who had been personally impacted, or identified as First Nations had more confidence in the system's preparedness.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Conclusions&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Many Australians recognise climate change as a health challenge; personal ri","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"224 9","pages":""},"PeriodicalIF":6.8,"publicationDate":"2026-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.70293","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148930667","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 Summary for Non-Psychiatrists of the Australian and New Zealand Journal of Psychiatry Grading of Recommendations, Assessment, Development and Evaluations (GRADE) Guidelines for the Management of Schizophrenia","authors":"Shuichi Suetani,&nbsp;Frances Dark,&nbsp;Susanna Every-Palmer,&nbsp;Cherrie Galletly,&nbsp;Brian O'Donoghue,&nbsp;Sean Halstead,&nbsp;Dolores Keating,&nbsp;Steve Kisely,&nbsp;Nicole Korman,&nbsp;Julia Lappin,&nbsp;Sharon Lawn,&nbsp;Andrew Thompson,&nbsp;Nicola Warren,&nbsp;Dan J. Siskind","doi":"10.5694/mja2.70287","DOIUrl":"10.5694/mja2.70287","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;This article summarises the recently published ‘&lt;i&gt;Australian and New Zealand Journal of Psychiatry&lt;/i&gt; (&lt;i&gt;ANZJP&lt;/i&gt;) Grading of Recommendations, Assessment, Development and Evaluations (GRADE) Guidelines for the Management of Schizophrenia in Australia and Aotearoa New Zealand’ (https://journals.sagepub.com/doi/10.1177/00048674251406058).&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Methods&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;We used the GRADE approach to evaluate the certainty of existing evidence and the strength of the recommendation was determined by the panel. The Guidelines are organised into seven sections: (1) physical health assessment; (2) pharmacological treatment; (3) psychological and psychosocial interventions; (4) family, whānau and carer involvement; (5) psychiatric comorbidities; (6) physical health and lifestyle interventions; and (7) special populations.&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;A comprehensive yet tailored clinical assessment should be undertaken to identify treatable physical health comorbidities early, particularly for people with early psychosis.&lt;/li&gt;\u0000 \u0000 \u0000 &lt;li&gt;Pharmacotherapy should aim for the lowest effective dose with a tolerable and manageable adverse-effect profile (e.g., first-line pharmacotherapy with aripiprazole, brexpiprazole, cariprazine or lurasidone).&lt;/li&gt;\u0000 \u0000 \u0000 &lt;li&gt;Lifestyle interventions, particularly physical activity and multimodal lifestyle programmes, should be routinely offered to people with schizophrenia.&lt;/li&gt;\u0000 \u0000 \u0000 &lt;li&gt;Psychological and psychosocial interventions are essential components of care for people with schizophrenia, especially during the maintenance phase of illness.&lt;/li&gt;\u0000 \u0000 \u0000 &lt;li&gt;Clinicians should actively involve people with schizophrenia and their family, whānau and carers in shared decision-making.&lt;/li&gt;\u0000 \u0000 \u0000 &lt;li&gt;Comorbid psychiatric symptoms and conditions should be assessed and managed according to standard treatment approaches until more robust evidence base specific to schizophrenia becomes available.&lt;/li&gt;\u0000 &lt;/ul&gt;\u0000 &lt;/div&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Changes in Assessment and Management as a Result of the Guidelines&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;The &lt;i&gt;ANZJP&lt;/i&gt; GRADE Guidelines synthesise the current evidence base across key domains relevant to the management of people with schizophr","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"224 9","pages":""},"PeriodicalIF":6.8,"publicationDate":"2026-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148920130","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":"Why Parity is Not the Goal: Increasing Aboriginal and Torres Strait Islander Representation in Non-General Practice Specialties","authors":"Ryan Dashwood","doi":"10.5694/mja2.70291","DOIUrl":"10.5694/mja2.70291","url":null,"abstract":"<p>Aboriginal and Torres Strait Islander doctors remain under-represented in non-general practice specialties. Although parity is often used as a benchmark for workforce reform, targets alone cannot address the structural challenges that constrain entry, progression and retention. Specialist training systems must be redesigned through Indigenous leadership, shared authority, culturally safe workplaces, protected mentorship and recognition of cultural labour. Parity is not the goal; it is the consequence of systems that are equitable, accountable and grounded in Aboriginal and Torres Strait Islander self-determination. Building such systems will strengthen specialist care and improve outcomes for Aboriginal and Torres Strait Islander patients and communities.</p>","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"224 9","pages":""},"PeriodicalIF":6.8,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.70291","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148912893","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":"Medical Colleges Have an Obligation to Ensure Full Participation in Clinical Quality Registries","authors":"Robert J. Aitken,&nbsp;Julian A. Smith,&nbsp;Guy J. Maddern","doi":"10.5694/mja2.70274","DOIUrl":"10.5694/mja2.70274","url":null,"abstract":"","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"224 9","pages":""},"PeriodicalIF":6.8,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148912822","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;Clara K. Chow","doi":"10.5694/mja2.70290","DOIUrl":"10.5694/mja2.70290","url":null,"abstract":"<p>In Reply: The aim of our article was to examine whether sex differences in care and outcomes for people with ST-elevation myocardial infarction (STEMI) had declined through analysis of the New South Wales Admitted Patient Data Collection from 2011 to 2020 [<span>1</span>]. This found that care and outcomes had improved over time among patients with STEMI and that this improvement was steeper in females compared with males and, thus, the gap by sex had narrowed over time.</p><p>In summary, our study focussed on changes in trends of treatment and outcomes over time in each of the sexes; age adjustment did not change our conclusion that the steepness of the trend to improvement is greater in females compared with males.</p><p><b>Samia Kazi:</b> writing (original draft). <b>Simone Marschner:</b> writing (original draft). <b>Clara K. Chow:</b> writing (original draft).</p><p>Clara K. Chow holds a National Health and Medical Research Council Investigator grant (APP1195326).</p><p>The authors declare no conflicts of interest.</p><p>The authors have nothing to report.</p>","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"224 9","pages":""},"PeriodicalIF":6.8,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13551382/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148906530","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":"Medical Colleges Have an Obligation to Ensure Full Participation in Clinical Quality Registries","authors":"Thomas J. Hugh","doi":"10.5694/mja2.70273","DOIUrl":"10.5694/mja2.70273","url":null,"abstract":"","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"224 9","pages":""},"PeriodicalIF":6.8,"publicationDate":"2026-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148906515","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}