Medical Journal of Australia最新文献

{"title":"Healthy ageing","authors":"Michael Skilton, Alison Williams, Wendy Morgan","doi":"10.5694/mja2.70018","DOIUrl":"https://doi.org/10.5694/mja2.70018","url":null,"abstract":"<p>For decades much has been made of Australia's ageing population, particularly how best to manage the arrival of the baby-boomer generation from a health, economic and societal perspective.<span><sup>1</sup></span></p><p>At the same time, the individual people who interact with the aged care system have distinct priorities; for people in aged care this includes maintaining their independence, being treated with respect, and the management of medical conditions.<span><sup>2</sup></span> Addressing the system-wide, indeed society-wide, stressors, while delivering service and health outcomes that align with the expectations of the ageing population remains a key challenge to the Australian health system.</p><p>This Healthy Ageing issue of the <i>MJA</i> contains a series of articles that shine a light on the diverse elements of a modern multifaceted approach to healthy ageing and contribute to the evidence base that will drive the adjustments and changes needed to deliver an effective, efficient and respectful aged care system.</p><p>The Royal Commission into Aged Care Quality and Safety highlighted experiences of substandard care of people accessing residential aged care and home care services.<span><sup>3</sup></span> In a cross-sectional population-based study using data from the Registry of Senior Australians, Eshetie and colleagues<span><sup>4</sup></span> analysed indicators of quality and safety of aged care for older Australians receiving long term residential aged care or home care packages during 2019. Their findings of marked variation in quality of care, particularly regarding antibiotic use, high sedative load, emergency department presentations, home medicines reviews, chronic disease management plans and waiting time for home care services suggest areas that may benefit from targeted quality improvement strategies.</p><p>A narrative review by Inacio and colleagues<span><sup>5</sup></span> discusses recent evidence of aged, community and health care models that may support older people to “age in place”. Evidence for the models supporting ageing in place is limited, although there is evidence for other benefits such as improving wellbeing. Complex multifactorial care interventions have the most compelling evidence for delaying or avoiding entry into long term residential aged care. The authors concluded that “No panacea exists for supporting all people to age in place, but care integration, collaboration among care settings, and multidisciplinary person-centred clinical care that addresses health-related decline and challenges are consistently reported to contribute to its success”.</p><p>As the leading cause of hospitalised injuries and injury deaths among older Australians, falls remain a major public health issue in Australia;<span><sup>6</sup></span> however, strategies to improve mobility and reduce falls in aged care are often limited by under-resourcing of appropriate health services such as physiotherapy. In the era of telehe","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"223 4","pages":""},"PeriodicalIF":8.5,"publicationDate":"2025-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.70018","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144861640","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":"Explaining risk in chronic conditions: the Yolŋu science of signs","authors":"Emma Haynes, Alison Mitchell, Minitja Marawili (Yolŋu), Dawn C Bessarab (Bardi)","doi":"10.5694/mja2.70031","DOIUrl":"10.5694/mja2.70031","url":null,"abstract":"<p>Minitja Marawili is a senior Yolŋu community member residing on her clan-associated country in Northeast Arnhem Land, where our many research experiences occur. She is a critical thinker and, over many years, has initiated reflective conversations with non-Indigenous researchers Alison Mitchell and Emma Haynes, endeavouring to derive new understandings of issues that affect Yolŋu health and wellbeing. These conversations require non-Indigenous colleagues to be slow thinkers, honing deep listening skills, and to be courageous in imagining new ways of thinking that at times may be uncomfortable. Dawn Bessarab is a Bardi woman and a celebrated social science academic. Dawn Bessarab provides insight into our conversations from a contrasting location, yet with similar expertise in critical and reflective thinking. Emma Haynes and Alison Mitchell have many years’ experience in social mixed methods research with Aboriginal colleagues. Their reflective stance is in the role of allyship and learners.</p><p>Since 2016, we have collaborated as Aboriginal and non-Aboriginal social science researchers on primarily qualitative mixed methods projects in remote Homelands in Northeast Arnhem, Northern Territory, related to rheumatic heart disease; training Yolŋu community health researchers and, more recently, Yolŋu Wellbeing.<span><sup>1-11</sup></span> This perspective article aggregates our learnings regarding use of the term “risk” across many projects, the details of ethics approvals (Menzies Human Research Ethics Committee [HREC] 2016_2678 and West Australian Aboriginal Health Ethics Committee HREC 1112), and research methods are provided in the references.<span><sup>1-11</sup></span> The quotes included here are drawn from this previous research. For this article, we completed the CONSIDER reporting criteria checklist for health research involving Indigenous peoples (Supporting Information).<span><sup>12</sup></span></p><p>Over time we have observed that well intentioned health communication often causes Aboriginal people who use English as a second language unexpected harm. This arises from the preferencing of biomedical information over local knowledge and inattention to social communicative norms.<span><sup>6, 9, 13</sup></span> For instance, simplified messages during the COVID-19 pandemic pierced the foundations of Yolŋu existence, in particular <i>gurrutu</i> (foundational kin relationships). Health directives, such as prohibiting funeral attendance to maintain social distance, led to distress, with some Yolŋu expressing that they would rather die than comply. This clash between biomedical and Yolŋu cultural worldviews demonstrates the impact of power differences and the need to provide conceptually clear information that respects cultural norms and contexts.<span><sup>14</sup></span></p><p>Despite these challenges, Yolŋu consistently advocate for collaborative effort to improve everyone's wellbeing.<span><sup>3</sup></span> This cultural strength","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"223 6","pages":"289-291"},"PeriodicalIF":8.5,"publicationDate":"2025-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.70031","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144873905","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":"Voluntary assisted dying: challenges in Northern Territory remote Aboriginal communities","authors":"Geetanjali Lamba, Kane Vellar, C Paul Burgess, Camille La Brooy, Paul A Komesaroff","doi":"10.5694/mja2.70023","DOIUrl":"10.5694/mja2.70023","url":null,"abstract":"<p>Voluntary assisted dying (VAD) legislation has now been passed in all Australian jurisdictions, except for the Northern Territory.<span><sup>1, 2</sup></span> The Voluntary Assisted Dying Independent Expert Advisory Panel led public consultations in the NT to inform development of NT VAD legislation, submitting their report to the Chief Minister in July 2024, which has been publicly released.<span><sup>3</sup></span> This perspective article reflects on the VAD implementation challenges highlighted in this public report. We discuss the unique demographics of the NT, including a significant Aboriginal population living in remote areas coupled with a high burden of chronic disease, which poses difficulties for equitable access to end-of-life services (respecting NT cultural protocols, “First Nations” in this perspective article are referred to as “Aboriginal peoples”, which is inclusive of Torres Strait Islanders).<span><sup>3</sup></span> “Cultural safety” is critical for Aboriginal peoples but application is contextual. Telehealth, which may help increase access, also presents challenges.</p><p>About 30% of the NT population identifies as Aboriginal, with 75% of NT Aboriginal peoples living in remote or very remote areas, compared with 15.4% nationally.<span><sup>4</sup></span> In contrast, 24% of non-Indigenous people in the NT live in remote or very remote areas.<span><sup>5, 6</sup></span> The NT has a 77% higher burden of disease than the national average, with NT Aboriginal peoples experiencing a disproportionate disease burden that is 3.6 times higher than that of non-Indigenous people in the NT.<span><sup>7</sup></span> Remoteness is also associated with reduced access to health care, potentially including VAD services.</p><p>The Northern Territory Government health department, NT Health, manages six public hospitals and 39 remote primary health care (PHC) centres, and supports 133 clinics or services operated by Aboriginal Controlled Community Health Organisations.<span><sup>8</sup></span> In addition to vast distances, the health system is beleaguered by workforce shortages, a high workforce turnover, cross-cultural challenges, and profound socio-economic disadvantage.<span><sup>9, 10</sup></span> Thus, equitable access to culturally safe health services, particularly for palliative and end-of-life care, including VAD, will require both policy and resource commitments.</p><p>The NT was the first Australian jurisdiction to legalise VAD in 1995 before losing this right under a federal government in 1997. The Restoring Territory Rights Bill 2022<span><sup>11</sup></span> lifted this restriction.</p><p>The Commonwealth <i>Criminal Code Act 1995</i> prohibits the use of carrier services (telephone, email or internet communications) to disseminate suicide-related materials.<span><sup>12</sup></span> Significant legal barriers remain in the use of telehealth for VAD, confirmed with a recent federal court decision that the <i>Criminal Code Ac","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"223 6","pages":"292-295"},"PeriodicalIF":8.5,"publicationDate":"2025-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.70023","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144855728","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":"The contribution of evidence-based practice and the practice-based evidence approaches to contemporary Australian psychology: implications for culturally safe practice","authors":"Paul Gray (Wiradjuri), Dawn Darlaston-Jones, Pat Dudgeon AM (Bardi), Kate Derry, Joanna Alexi, William Smith (Wiradjuri and Wemba Wemba), Tanja Hirvonen (Jaru and Bunuba), David Badcock, Shraddha Kashyap, Belle Selkirk (Noongar)","doi":"10.5694/mja2.70028","DOIUrl":"10.5694/mja2.70028","url":null,"abstract":"<p>Psychological practice emphasises the importance of using the best available evidence to ensure accountability and promote positive outcomes for individuals and communities.<span><sup>1</sup></span> These expectations are critical for community trust; however, without adequate consideration of broader processes of knowledge production, this focus can marginalise populations and perpetuate health inequities, such as those experienced by Aboriginal and Torres Strait Islander communities. Considering new professional practice expectations in psychology,<span><sup>1, 2</sup></span> this article examines the foundations of these standards and how they might be effectively implemented. We present a conceptual exploration of empirical and constructionist perspectives on evidence and introduce guidelines for practice-based evidence (PBE), including theoretical and practical implications to yield the best available evidence<span><sup>1</sup></span> that guides culturally safe practice when working with Aboriginal and Torres Strait Islander peoples.<span><sup>3</sup></span></p><p>Although the authorship team is situated within the discipline of psychology, the arguments can be extrapolated to other health disciplines. Medicine, for example, is situated within both the pure science and social science realms. Its foundation exists within the laboratory and empirical clinical trials, but it operates in the context and complexity of human patients and the cultural, historical and political milieu they inhabit. Medicine has been a pioneer in requiring students and graduates to acknowledge the diverse experiences of Aboriginal and Torres Strait Islander peoples and was among the first disciplines to include this in its curriculum. The arguments within this article enhance the foundation work provided by Indigenous leaders such as Professor Gregory Phillips.<span><sup>4</sup></span></p><p>Associate Professor Paul Gray is a Wiradjuri researcher and child protection advocate, focused on promoting the safety, welfare and wellbeing of Aboriginal children, families and communities through self-determination and reasserting Aboriginal systems and practices.</p><p>Dr Dawn Darlaston-Jones is a non-Indigenous woman (she/her) of British descent, who lives and works on Whadjuk Noongar Boodja as a researcher and educator. She has over 20 years’ experience in developing psychology curricula within a decolonial framework.</p><p>Professor Pat Dudgeon AM, from the Bardi people, is a psychologist, researcher and leader in Aboriginal and Torres Strait Islander mental health and wellbeing. Her area of research includes social and emotional wellbeing, Indigenous psychology, and suicide prevention.</p><p>Dr Kate Derry is cisgender (she/her), born and raised on unceded Wadjuk Noongar Boodja. She is of Burmese immigrant and Irish/English settler heritage. Her research focus on social and emotional wellbeing has challenged her to decolonise her worldview and research approach.</p><p>","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"223 6","pages":"282-288"},"PeriodicalIF":8.5,"publicationDate":"2025-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.70028","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144855727","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":"Treatment outcomes for people with hepatitis C referred to tertiary care in Victoria, 2021–22: a retrospective observational study","authors":"Elly Layton, Nicole Matthews, Brendan Quinn, Nasra Higgins, Gabrielle Lindeman, Mielle Abbott, Jennifer MacLachlan, Elizabeth Birbilis, Margaret E Hellard, Joseph Doyle, Benjamin C Cowie, Mark Stoové","doi":"10.5694/mja2.70017","DOIUrl":"https://doi.org/10.5694/mja2.70017","url":null,"abstract":"<p>In Australia, an estimated 68 890 people were living with chronic hepatitis C virus (HCV) infections at the end of 2023.<span><sup>1</sup></span> An overwhelming majority of incident HCV infections in Australia are in people who inject drugs.<span><sup>2</sup></span> In alignment with World Health Organization targets, the Australian government has committed to eliminating HCV as a public health threat by 2030.<span><sup>3</sup></span> In 2016, Australia became one of the first countries in which direct-acting antiviral (DAA) medications were broadly available for the treatment of HCV infections, including through primary care clinicians, and HCV elimination strategies emphasise the importance of general practitioner prescribing.<span><sup>3</sup></span> However, current treatment rates are slowing progress to elimination;<span><sup>4</sup></span> in 2023, treatment was initiated for only 5499 people living with HCV infection.<span><sup>1</sup></span> The declining initiation of treatment by specialist medical practitioners has not been offset by initiations by general practitioners and nurse practitioners.<span><sup>1</sup></span></p><p>In the Coordinated Hepatitis response to Enhance the Cascade of Care (CHECCS) project, public health officers followed up clinicians to support their care for people they diagnosed with HCV infections and notified to the Victorian Department of Health during 1 September 2021 – 31 March 2022.<span><sup>5</sup></span> Despite HCV-related strategic priorities that encourage treatment in primary care, diagnosing clinicians reported referring 50 of the 117 people positive for HCV RNA during the study period (43%) to specialist care (ie, not general practitioners).<span><sup>5</sup></span> This finding was consistent with the national pattern of HCV treatment prescribing.<span><sup>6</sup></span></p><p>Little is known about the clinical outcomes of DAA treatment not initiated by general practitioners.<span><sup>7</sup></span> We therefore assessed treatment uptake by the 50 HCV RNA-positive people referred to tertiary care clinics during the CHECCS project. During 26 July – 26 September 2024, we contacted the tertiary care clinics to which people had been referred to ascertain their appointment attendance, treatment, and whether sustained virological response (SVR) had been achieved. We also describe the demographic characteristics and HCV infection risk factors for people who were treated after referral. Our study was approved by the Alfred Hospital Ethics Committee (project 61/24).</p><p>Of the 50 people referred to tertiary specialist clinics, 44 had been diagnosed with HCV infections in general practices and six in hospitals. We could follow up tertiary care for 45 people; their median age was 53 years (interquartile range [IQR], 39–64 years), and 29 were men. Scheduled appointments were recorded for 37 people; of the eight people without scheduled appointments, three had been referred but were eventually treate","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"223 5","pages":"265-267"},"PeriodicalIF":8.5,"publicationDate":"2025-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.70017","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144923478","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":"Country revealing the way: evaluating Elder-governed cultural therapy for Aboriginal and Torres Strait Islander young people with mental health conditions","authors":"Alasdair Vance, Janet McGaw, Jo Winther, Naomi Tootell, Herb Patten, Sandra Eades","doi":"10.5694/mja2.70019","DOIUrl":"10.5694/mja2.70019","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To assess the effectiveness of an Elder-governed cultural therapy program for Aboriginal and Torres Strait Islander young people with mental health conditions.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Study design</h3>\u0000 \u0000 <p>A cultural therapy program for Aboriginal and Torres Strait Islander young people was designed, delivered and qualitatively evaluated.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting</h3>\u0000 \u0000 <p>The cultural therapy was conducted in two locations: Royal Park, a traditional camping area for members of the Kulin Nation adjacent to the Royal Children's Hospital Melbourne; and a psychology and animal-assisted therapy practice located on a rural property 50 km north-west of Melbourne.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Participants</h3>\u0000 \u0000 <p>Twenty Aboriginal and Torres Strait Islander young people aged 7–18 years with mental health conditions completed the cultural therapy program between October 2021 and April 2024.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main outcome measures</h3>\u0000 \u0000 <p>Yarns were conducted with the young people, their parent or carer and the cultural therapist before, immediately after and 3 months following completion of the therapy. In addition, fieldnotes and photographs were used to record the sessions. Effectiveness of the cultural therapy was assessed based on participation and engagement of the young person in the cultural therapy; their social and emotional wellbeing over the course of the cultural therapy; and their social and emotional wellbeing 3 months after completion of the cultural therapy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>All participants willingly attended and actively engaged in the cultural therapy. Social and emotional wellbeing of participants improved over the course of the cultural therapy, and 3-month follow-up sessions revealed these improvements to be lasting. Centring Aboriginal ways of knowing, doing and being and actively engaging Country as a co-therapist were key to the effectiveness of the therapy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The cultural therapy was found to be beneficial for Aboriginal and Torres Strait Islander young people with mental health conditions and should be offered alongside but separate from Western mental health management.</p>\u0000 ","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"223 6","pages":"304-311"},"PeriodicalIF":8.5,"publicationDate":"2025-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.70019","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144821947","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":"Alison Bush memorial oration: supporting First Nations community-designed and led maternal health initiatives","authors":"Karel Williams","doi":"10.5694/mja2.70024","DOIUrl":"10.5694/mja2.70024","url":null,"abstract":"<p>As a Palawa woman, my standpoint is grounded in my cultural identity, community obligations and lived experience. This work is informed by the teachings of my Elders and the responsibilities I hold to my family, Country and community. My positionality shapes the questions I ask, the way I engage with knowledge, and how I share it, guided by the principle that research must be accountable to the people and places it represents. By writing from a First Nations standpoint, I seek to centre First Nations voices and ways of knowing, challenge colonial narratives, and contribute to scholarship that supports and honours First Nations priorities and futures.</p><p>I never met Sister Alison Bush, but she is as present today in the lives of First Nations midwives, as she was during her trailblazing career in the fields of nursing and midwifery, and more generally in advocating for improvements in First Nations peoples' health.</p><p>Like Sister Bush, I am a First Nations woman, a midwife, an advocate for improving the perinatal outcomes of First Nations women and babies, and an advocate for the empowerment of First Nations women.</p><p>First Nations women have multiple voices — we do not just hold voice for ourselves, but for our children, our families and our communities, and we demand that our voices be heard.</p><p>Today, 14 October 2024, is a significant day for many First Nations Australians. One year ago, a referendum that proposed enshrining an Indigenous Voice to Parliament in the Australian Constitution was defeated. Unlike our sister states, the nation of Australia was not built on the notion of equality, there were no treaties, no acknowledgement of our rights, or even of our right to exist. Instead, the nation began with genocidal acts that sought to erase our peoples, that stole our children and that stole our land. Genocidal acts that denied cultural knowledge, denied cultural practices, and denied us the use of our languages — all justified under Acts of the State and inhumane policies of protectionism and assimilation.</p><p>At the time of the nation's federation in 1901 and the enactment of the Australian Constitution, not only were First Nations people explicitly excluded from it, we were also not entitled to vote for or against it. This right, to vote in federal elections or referenda, did not extend to us until 1962.</p><p>Section 51, paragraph xxvi, of the Australian Constitution, known as the Race Power, gave the Australian Parliament the authority to make laws for “the people of any race, other than the aboriginal [sic] race…for whom it is deemed necessary to make special laws”.<span><sup>1</sup></span> This section's wide scope and lack of restrictions were deliberate choices of the drafters of the Constitution and, many have argued, were firmly embedded in their desire to uphold a “white” image.</p><p>The Constitution also, at Section 127, expressly excluded Aboriginal people from being counted in the national census. It was as ","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"223 6","pages":"299-301"},"PeriodicalIF":8.5,"publicationDate":"2025-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.70024","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144789524","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":"Ante-mortem interventions for deceased donation: legal barriers and uncertainty in Australia's decision-making frameworks","authors":"Shih-Ning Then, Dominique E Martin, Helen I Opdam","doi":"10.5694/mja2.70020","DOIUrl":"10.5694/mja2.70020","url":null,"abstract":"<p>Definitive decision making about deceased donation of organs and tissues usually occurs towards the end of a person's life. If possible, pathways to organ donation will depend on the clinical circumstances: donation after neurological determination of death (“brain death”), or donation after circulatory determination of death (DCDD). DCDD typically applies when ceasing life-sustaining interventions is planned, and when death is expected within a timeframe permitting recovery of organs for transplantation (ie, controlled DCDD).<span><sup>1</sup></span> People undergoing voluntary assisted dying may also choose to pursue DCDD.<span><sup>2</sup></span></p><p>Although decisions are often interconnected and discussed contemporaneously, legal frameworks underpinning decision making for these decisions have developed separately and are often ill-suited to integrated decision making at the bedside.<span><sup>3</sup></span> This presents a barrier to implementation of important strategies — proven or currently experimental — to expand the pool of potential donors, and to ensure that organs recovered are successfully transplanted.</p><p>Specific clinical interventions that are initiated before death (ie, ante-mortem interventions [AMIs]) may help preserve opportunities for donation or improve the outcomes of transplantation. Interventions range from blood tests to invasive procedures, such as elective non-therapeutic intubation and ventilation; and risks and burdens can vary substantially.<span><sup>3, 4</sup></span> Complicating ethical decision making, across Australia there is uncertainty about the legality of, and consent requirements for, AMIs and no agreed definition.<span><sup>5</sup></span> This uncertainty particularly affects health care workers caring for potential donors, and may discourage or delay time-critical decisions about the use of AMIs.</p><p>Ethical and clinical guidance is currently limited. The Australian and New Zealand Intensive Care Society (ANZICS) statement on death and organ donation,<span><sup>6</sup></span> for example, notes that where the use of AMIs is lawful, consent should be obtained from the individual or their family. It does not clarify how decisions should be made or who may have legal authority for decision making. Consequently, uncertainty and disagreements are common at the local level. Hospital staff and executives, together with donation agency staff may face questions about cases such as Arwen's (Box 1), where substitute decision making about use of AMIs is required.</p><p>In Australia, medical decision making for adults lacking decision-making capacity is governed by legislation (ie, guardianship, substitute decision-making, or medical decision-making legislation). However, at the end of life, when deceased donation may be considered, other legal frameworks may become relevant, and potential mismatches between frameworks within states and territories and across Australia become problematic. Box 2 shows st","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"223 5","pages":"236-240"},"PeriodicalIF":8.5,"publicationDate":"2025-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.70020","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144789525","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":"Important updates for clinical practice and health policy","authors":"Aajuli Shukla","doi":"10.5694/mja2.70011","DOIUrl":"https://doi.org/10.5694/mja2.70011","url":null,"abstract":"<p>This issue of the <i>MJA</i> features several articles that provide new guidelines and insights into the management and consequences of important clinical conditions.</p><p>Updated guidelines on the management of gestational diabetes are now published.<span><sup>1</sup></span> The 2025 consensus recommendations from the Australasian Diabetes in Pregnancy Society (ADIPS) update the guidance for the screening, diagnosis and classification of hyperglycaemia in pregnancy based on available evidence and stakeholder consultation.<span><sup>2</sup></span> These consensus recommendations, from Sweeting and colleagues, are important; the last time these guidelines were updated was in 2014.<span><sup>1</sup></span> These updated recommendations raise the diagnostic glucose thresholds for gestational diabetes mellitus and clarify approaches to early pregnancy screening for women with risk factors for hyperglycaemia in pregnancy. An HbA<sub>1C</sub> measurement is now recommended with first trimester antenatal blood tests to assist practitioners with risk stratification. There is also guidance on considerations that need to be made for early oral glucose tolerance testing in high risk women. As rates of gestational diabetes continue to rise, diagnosis and management of this condition are likely to be within the scope of practice for most generalist medical practitioners, especially in regional and remote areas with poor access to specialist teams. These recommendations are a welcome update for medical practitioners.</p><p>Diabetes features in an article by Zhang and colleagues, which examined information from Diabetic Foot Services and linked it to Queensland Hospital Admitted Patient Data to assess the incidence, risk factors and length of stay for hospitalisations, with and without amputations, of people with diabetes-related foot ulcers (DFU).<span><sup>3</sup></span> This is again an increasingly common condition in the population as rates of diabetes and its related complications increase. The incidence of DFU-related hospitalisations among people with DFU was high, although most did not involve amputations. The risk of DFU-related hospitalisation was higher for people with deep ulcers or severe peripheral artery disease. The authors argue that these findings could assist services determine which people with DFU would benefit most from intensive interventions, potentially averting large numbers of diabetes-related hospitalisations.</p><p>In another clinically focused article in this issue, Seeley and colleagues analysed data from the Australian postural orthostatic tachycardia syndrome (POTS) Patient Registry to assess the symptom burden, quality of life, and diagnosis history of people with POTS in South Australia.<span><sup>4</sup></span> This is the first Australian study based on data from a registry of people with physician-confirmed POTS. The key findings were long delays between symptom onset and diagnosis despite seeing several physicians, re","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"223 3","pages":""},"PeriodicalIF":8.5,"publicationDate":"2025-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.70011","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144767539","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":"Silicosis research priorities for health care, research, and health and safety professionals, and for people exposed to silica in Australia: a research priority setting exercise","authors":"Hayley Barnes, Sharna Mathieu, Deborah C Glass, Malcolm R Sim, Lin Fritschi, Joanne L Dickinson, Daniel C Chambers, Tim R Driscoll, Graeme Edwards, Nikky LaBranche, Catherine Jones, Jane E Bourke, Ryan F Hoy, Christine R Jenkins, Simon Apte, Anne Holland, Gabriella Tikellis","doi":"10.5694/mja2.70013","DOIUrl":"10.5694/mja2.70013","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To identify the silicosis research priorities of people living with silicosis, workers at risk of silicosis, their partners and caregivers, and of health professionals and researchers.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Study design</h3>\u0000 \u0000 <p>Research priority setting exercise; modified James Lind Alliance framework for research priority setting partnerships, comprising an online survey followed by two forums in which thematic analysis and nominal group analysis were used to establish a list of research priorities.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting, participants</h3>\u0000 \u0000 <p>People with or at risk of silicosis, their partners or caregivers (survey, online forum) and health care professionals, researchers, health and safety professionals (survey, in-person forum), recruited 14 April – 19 December 2023.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main outcome measures</h3>\u0000 \u0000 <p>Research priorities in four pre-identified areas: prevention, screening and diagnosis, treatment, and living with and managing the impact of silicosis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 164 survey respondents (105 medical or research professionals, 34 workers currently or formerly at risk of silicosis, eleven people with confirmed silicosis, and fourteen partners or caregivers) identified 47 key research topics. Fifty-three health care professionals and thirteen people with or at risk of silicosis and their caregivers then ranked the research topics and developed research questions at the two forums. The highest ranked research priorities were research into assessment and optimisation of the hierarchy of controls, compliance and regulation, establishing minimum standards and developing innovative screening methods, early diagnosis, development of effective treatments, identification of biomarkers for risk of progression, developing an optimal care model that includes mental health care, and estimating the economic impact of silicosis. Both participant groups agreed that research into workplace controls is important, as is improving education and awareness, compliance with preventive measures, and screening and diagnosis, including nationally consistent screening and diagnosis practices. The professional participants rated research into silicosis pathogenesis and biomarkers and technological considerations higher than workers and their carers, who focused more on the barriers for and attitudes of workers, specific treatments, and managing ","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"223 5","pages":"257-264"},"PeriodicalIF":8.5,"publicationDate":"2025-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.70013","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144742441","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}