Melanoma represents a significant burden on the Australian healthcare system and early detection is crucial to improve patient and health system outcomes. Experts suggest that targeted screening for high-risk individuals could lead to more efficient use of healthcare resources. Integrated risk scores combine polygenic risk scores (PRS) and non-genetic risk factors to offer the best performance for melanoma risk stratification. However, the feasibility of using integrated risk scores on a population basis to identify those at highest risk has yet to be evaluated. This narrative review aimed to identify evidence gaps and key issues to be addressed to support implementation of melanoma integrated risk scores on a population-based scale in Australia. Findings highlighted the following research and infrastructure needs: understand the progression rate of melanoma in situ to invasive disease; define who should be offered integrated risk scores; address performance issues across ancestries; develop clearly defined risk thresholds and corresponding clinical advice; and investigate clinical utility and impact of receiving integrated risk scores. Furthermore, screening programmes will require: equitable access to post-screening care; guidelines and quality standards for generating PRS and integrated risk scores; healthcare rebates for PRS testing; infrastructure for computational and data storage needs; workforce training and clinical decision support resources; clearer protections around PRS use in risk-rated insurances; and clear plans for programme quality and performance management. In conclusion, integrated risk scores have potential to facilitate targeted high-risk melanoma screening in Australia. However, there are significant evidence and infrastructure gaps that must be addressed before programme implementation.
Objective: To explore the characteristics of ambulance ramping and its association with access block before, during and after the first wave of the coronavirus disease 2019 (COVID-19) pandemic.
Design: Retrospective observational study.
Setting: Exploratory data analysis and statistical modelling covering the ambulance-emergency department (ED) interface of the 25 largest public hospitals in Queensland between 1 January 2018 and 31 December 2022.
Main outcome measures: Primary outcome: The association between ramping, assessed as the ambulance performance target patient off-stretcher time (POST) and access block, and how COVID-19 affected these time-sensitive processes.
Secondary outcomes: The association between POST and ambulance response time and between ramping and ED length of stay.
Results: A significant decline in POST performance was observed across the study period, with the mean difference between pre- and post-COVID-19 periods being 13.1 min (95% CI, 12.9-13.3 min) and 8.9 min (95% CI, 8.7-9.1 min) for Priority 1 and Priority 2 responses, respectively. POST compliance within 30 min dropped from 74% (718,912) pre-COVID-19 to 66% (694,633) during the first wave of COVID-19 and 57% (309,815) post-COVID-19, all below the 90% target. The proportion of patients experiencing access block increased from 10% (91,168) to 17% (87,757) over this same time period. Regression analyses revealed a positive relationship between POST and access block, response time and POST, and ramping and ED length of stay. Before COVID-19, no significant relationship existed between POST and access block for triage category 1 patients, but longer POST was linked to a higher likelihood of access block for categories 2-5. This trend increased across all categories during and post-COVID-19.
Conclusion: Achieving the POST target of transferring 90% of patients within 30 min is becoming more difficult, with performance declining. The strong association of POST with access block suggests that access block is driving ramping increases. To reduce delays, efforts should focus on improving access to ward beds and managing hospital capacity issues.
Hereditary pancreatitis causes severe early-onset pain and hospitalisation. In 15 Australian patients undergoing total pancreatectomy and islet auto transplantation (TPIAT), we observed a marked reduction in hospital admissions, inpatient days and emergency visits, complete analgesic cessation by 24 months and durable insulin independence in nearly half of the patients. These findings highlight TPIAT’s potential to improve quality of life and reduce healthcare burden. Our programme aims to build evidence to support public funding and ensure equitable access to this procedure.
In a population cohort of 44,216 adolescent girls, about 73.5% of those who became pregnant were known to child protection services. Exposure to higher levels of child protection response was associated with increased cumulative incidence and an earlier age of pregnancy.
A man aged in his 40s, recently returned from Uganda, was hospitalised with Plasmodium falciparum malaria, with hyperparasitaemia of ~1.5 × 106 parasites/μL (26%). He received intravenous artesunate followed by artemether–lumefantrine. However, parasite clearance was delayed, and despite a negative blood film following treatment, the patient was readmitted 3 weeks later with recurrent parasitaemia. Further testing for drug-resistant phenotypes and genotypes demonstrated reduced susceptibility to lumefantrine, an A675V mutation in the pfk13 gene and increased ring-stage survival, consistent with partial artemisinin resistance. The case highlights the high risk of P. falciparum treatment failure in patients with hyperparasitaemia and partial drug resistance.
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