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Exploring the role of urine drug screening in opioid agonist therapy.
IF 6.7 2区 医学 Q1 MEDICINE, GENERAL & INTERNAL 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
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引用次数: 0
Accountability, ambition, and quantifiable action in the carbon emission reduction plans of the ten largest pharmaceutical companies in Australia: a cross-sectional analysis. 澳大利亚十大制药公司碳减排计划中的责任、雄心和可量化行动:横截面分析。
IF 6.7 2区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2025-03-04 DOI: 10.5694/mja2.52621
Hayden Burch, Georgia Brown, Oliver Adler, Jason Wong, Kenneth D Winkel

Objectives: To assess the commitment of the ten largest pharmaceutical companies operating in Australia to achieving net zero emissions by evaluating their accountability metrics, ambitions, and quantifiable actions taken.

Study design: Cross-sectional study; analysis of publicly available company reports published during 12 December 2015 - 31 December 2023.

Setting, participants: Ten largest pharmaceutical companies operating in Australia, defined by total pharmaceutical costs (to patients and Pharmaceutical Benefits Scheme) for PBS-subsidised medications, as reported in PBS expenditure and prescriptions reports for 2020-21 and 2022-23.

Main outcome measures: Content analysis of publicly available documents for the ten companies using modified criteria from the PricewaterhouseCoopers Building blocks for net zero transformation framework, with three domains: accountability, ambition, and action; the Carbon Disclosure Project (CDP) grading; the Science Based Targets initiative (SBTi) approval system. We focused on measurement, target setting, and achievement of emission reductions, and ranked the environmental sustainability of companies using a points and colour coding system.

Results: Three groups could be defined by evidence of their commitment to emissions reductions. The first - companies leading emissions reduction efforts, with SBTi-approved near term targets, consistent emissions monitoring, well defined commitments, and quantified evidence of action - includes AstraZeneca, Novartis, Johnson & Johnson, Bayer, and Merck & Co. The second group - companies that had made commitments to SBTi-approved targets but their disclosure records are limited - includes AbbVie and Roche. The third group - without public commitments to achieving net zero emissions, minimal or no SBTi-approved targets, and minimal disclosure or monitoring of emissions - includes Viatris, Vertex, and Arrotex.

Conclusions: The ten largest pharmaceutical companies in Australia are moving towards net zero greenhouse gas emissions at different rates. Gaps in standardised reporting processes should be closed, and further qualitative research on industry-wide environmental sustainability policy and practice is needed.

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引用次数: 0
National consensus statement on opioid agonist treatment in custodial settings
IF 6.7 2区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2025-03-02 DOI: 10.5694/mja2.52603
Jocelyn Chan, Jon Cook, Michael Curtis, Adrian J Dunlop, Ele Morrison, Suzanne Nielsen, Rebecca J Winter, Thileepan Naren

Introduction

Opioid use and dependence are prevalent among incarcerated people, contributing to elevated rates of overdose and other harms in this population. Opioid agonist treatment (OAT) has been shown to be an effective intervention to mitigate these risks. However, challenges to health care implementation in the custodial sector result in suboptimal and variable access to OAT in prisons nationally.

Main recommendations

Among a national multidisciplinary expert panel, we conducted a modified Delphi study that yielded 19 recommendations to government, relevant health authorities and custodial health services. These recommendations cover five core domains: induction or continuation of OAT, OAT options and administration, transition of care to the community, special populations, and organisational support. Key recommendations include prompt recognition and treatment of opioid withdrawal, active linkage to community-based OAT providers upon release, and ensuring appropriate organisational support through local protocols, adequate funding, and monitoring of key program indicators.

Changes in management as a result of this statement

This consensus statement addresses a significant gap in national policy on OAT in Australian prisons. The recommendations, finalised in July 2024, set forth best practice standards grounded in evidence and expert consensus. We expect that implementing these recommendations will enhance the quality, consistency and continuity of OAT both within prison and upon release. Optimising OAT provision is crucial for improving health outcomes and addressing the risk of overdose, which is the leading cause of death among people released from prison.

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引用次数: 0
International Women’s Day and the right to health: a view from the clinical frontline
IF 6.7 2区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2025-03-02 DOI: 10.5694/mja2.52609
Aajuli Shukla
<p>As this issue of the <i>MJA</i> is published, the world will be celebrating International Women's Day on 8 March 2025 and the rights of women continue to be critical to health. As a general practitioner working in the sphere of women's health for several years now, I have seen the gradual shift towards a more conservative view of women's health and a lack of equity around the management of chronic health issues. Hormone replacement therapy to treat menopause, for instance, continues to be out of reach for many due to high costs and poor access. More broadly, women continue to have experiences with a health system that is often invalidating and traumatic. The impacts of these are especially worse for women from socially disadvantaged backgrounds, Indigenous women, immigrants and refugees, and women with disabilities.</p><p>Menstrual issues are a common presentation in primary care and, despite their high prevalence and impact on daily functioning, they continue to be under-reported and undermanaged. In this issue of the <i>MJA</i>, Wilson and colleagues (https://doi.org/10.5694/mja2.52596) report on heavy menstrual bleeding in a cohort of women participating in the Australian Longitudinal Study on Women's Health from young adulthood to midlife. The prevalence of heavy menstrual bleeding increased from 17.6% at age 22 years to 32.1% at 48 years. Almost a third of the cohort reported heavy menstrual bleeding by middle age that has a significant impact on mood and social and physical functioning. Mean health-related quality of life scores for women who reported heavy menstrual bleeding were lower in all domains and for the summary mental health and physical health scores than for women who reported never or rarely experiencing the condition; the differences were greater for women who often experienced heavy menstrual bleeding. Although the study was unable to examine conditions such as a history of fibroids or adenomyosis as a cause for heavy menstrual bleeding, most middle-aged women in Australia struggle to access progesterone-producing implants due to the cost and lack of access to the service (https://www.bayer.com.au/en/womens-health-collaboration). Worse, if the condition fails to respond to hormonal measures, as noted by my colleagues and I, women struggle to access gynaecological care for further treatment in the current cost-of-living crisis.</p><p>Kirkman and colleagues (https://doi.org/10.5694/mja2.52602), in their research article in this issue of the <i>MJA</i>, found that of the 80 clinical guidelines in Australia they examined, there were varied levels of inclusiveness in dealing with sex and gender matters in health care and most guidelines were at the lower end of the inclusiveness scale. The majority of the 80 guidelines (46 of them) made no mention of clinical practice concerning gender. Only 12 developed ideas of gender in any detail, including discussion of topics such as gender inequality, transgender health and intersectiona
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引用次数: 0
Updating the diagnosis and management of elevated serum ferritin levels in the era of routine ferritin testing of blood donors by Australian Red Cross Lifeblood.
IF 6.7 2区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2025-02-27 DOI: 10.5694/mja2.52618
Gary D Zhang, James Chen, Daniel M Johnstone, Martin B Delatycki, Katie Allen, John K Olynyk
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引用次数: 0
Tick tock: the travelling time bomb.
IF 6.7 2区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2025-02-25 DOI: 10.5694/mja2.52615
Matthew Ak Martin, Maxwell E Olenski
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引用次数: 0
Mandatory research projects by medical specialist trainees: suboptimal today, world-leading tomorrow?
IF 6.7 2区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2025-02-25 DOI: 10.5694/mja2.52612
Nicholas J Talley AC
<p>In Australia, the medical colleges have a monopoly on the training of specialists. If you want to be a registered gastroenterologist, a cardiothoracic surgeon, or a general practitioner, you must complete the relevant college training (or an equivalent training program) and meet the minimum expected standards, which are high in this country. Australian specialists are internationally recognised as clinically first rate, as indicated by overall health outcomes,<span><sup>2</sup></span> a testament to our college clinical training programs.</p><p>At most colleges in Australia and in specialty training programs in similar countries, completing a research project during training is mandatory. In this issue of the <i>MJA</i>, Stehlik and colleagues report the results of their cross-sectional survey of research project activity during training in Australia and New Zealand. The survey was sent to college trainees in eleven specialties,<span><sup>3</sup></span> including the Royal Australasian College of Physicians (RACP), which alone has more than 4400 advanced trainees in 2025 (personal communication). A total of 371 responses were obtained, a rather low number. The survey results are consequently not necessarily generalisable, but the results are still sobering. Almost 80% of survey respondents developed their research questions in isolation or on the basis of clinical discussions, more than 50% received little input from others regarding the study design, 85% of projects were not part of ongoing high quality research, most trainees undertook the research in their own time, and 85% of the evaluable studies submitted to the authors of the study had a moderate to high risk of bias, suggesting research waste. On the positive side, half of the projects were published, usually with the trainee as first author, almost 50% of respondents felt that the effort involved was worthwhile, and since completing their fellowships more than 70% had considered initiating new research.<span><sup>3</sup></span></p><p>If producing excellent clinicians is the goal of specialty training, why should we care about the quality of research during training? One could argue that the minority with serious academic interests can pursue these after specialisation by, for example, completing a PhD or equivalent training, although most never do. Indeed, for 40 years it has been recognised that interest in careers as clinician–scientists has been steadily falling in the United States<span><sup>4</sup></span> and Australia.<span><sup>5</sup></span></p><p>Why then should colleges retain mandatory trainee research projects? One compelling reason is that medical knowledge is growing so rapidly that keeping up is challenging.<span><sup>6</sup></span> Evidence-based practice is more important than ever, but this requires critical thinking and analytic skills, including how to read the literature expertly and translate new information into best practice. Arguably, unless you have had appro
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引用次数: 0
The impact of pay-for-performance incentives for stroke unit access on public hospital costs and use, Queensland, 2012–17: interrupted time series analysis
IF 6.7 2区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2025-02-25 DOI: 10.5694/mja2.52607
Rohan Grimley, Joosup Kim, Helen M Dewey, Nadine E Andrew, Taya A Collyer, Eleanor S Horton, Greg Cadigan, Dominique A Cadilhac
<div> <section> <h3> Objectives</h3> <p>To assess the impact of pay-for-performance financial incentives for improving stroke unit access in Queensland public hospitals on hospital costs and use.</p> </section> <section> <h3> Study design</h3> <p>Population-based longitudinal study; interrupted time series analysis of linked hospital admissions, emergency department, and hospital costs data.</p> </section> <section> <h3> Setting, participants</h3> <p>First admissions with stroke or myocardial infarction of adult Queensland residents (18 years or older) to public hospitals for more than one day during 1 July 2009 – 31 December 2011 (pre-incentive period), 1 January 2012 – 31 December 2012 (intervention implementation period), and 1 January 2013 – 30 June 2017 (intervention period). Admissions to neurosurgical wards of people with intracerebral haemorrhage were excluded.</p> </section> <section> <h3> Intervention</h3> <p>Queensland Health pay-for-performance program: Quality Improvement Payments (QIP). Initial three years: payments to hospitals contingent on progressively increasing targets for the proportion of people with stroke admitted to acute stroke units. Subsequent years: 10% loading on Diagnosis Related Group-based payments for the care of patients with primary diagnoses of stroke admitted to stroke units.</p> </section> <section> <h3> Main outcome measures</h3> <p>Changes in level and rates of change of outcomes (hospital length of stay, patient-attributed hospital costs, non-elective hospital re-admissions) for admissions of people with stroke or myocardial infarction (as control condition) before and after the introduction of the QIP.</p> </section> <section> <h3> Results</h3> <p>We analysed data for 23 572 people admitted with stroke and 39 511 admitted with myocardial infarction. The median acute length of stay did not change significantly during the implementation year for either patient group; and pre-intervention downward trends declined to near zero for both groups. The difference between the pre-incentive and implementation periods in median total hospital costs per patient with stroke was not statistically significant (–$1692; interquartile range [IQR], –$4440 to $1056), in contrast to the difference for patients with myocardial infarction (–$4278; IQR, –$5280 to –$3275). The proportion of non-elective hospital re-admissions was c
{"title":"The impact of pay-for-performance incentives for stroke unit access on public hospital costs and use, Queensland, 2012–17: interrupted time series analysis","authors":"Rohan Grimley,&nbsp;Joosup Kim,&nbsp;Helen M Dewey,&nbsp;Nadine E Andrew,&nbsp;Taya A Collyer,&nbsp;Eleanor S Horton,&nbsp;Greg Cadigan,&nbsp;Dominique A Cadilhac","doi":"10.5694/mja2.52607","DOIUrl":"10.5694/mja2.52607","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 assess the impact of pay-for-performance financial incentives for improving stroke unit access in Queensland public hospitals on hospital costs and use.&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;Population-based longitudinal study; interrupted time series analysis of linked hospital admissions, emergency department, and hospital costs 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;First admissions with stroke or myocardial infarction of adult Queensland residents (18 years or older) to public hospitals for more than one day during 1 July 2009 – 31 December 2011 (pre-incentive period), 1 January 2012 – 31 December 2012 (intervention implementation period), and 1 January 2013 – 30 June 2017 (intervention period). Admissions to neurosurgical wards of people with intracerebral haemorrhage were excluded.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Intervention&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Queensland Health pay-for-performance program: Quality Improvement Payments (QIP). Initial three years: payments to hospitals contingent on progressively increasing targets for the proportion of people with stroke admitted to acute stroke units. Subsequent years: 10% loading on Diagnosis Related Group-based payments for the care of patients with primary diagnoses of stroke admitted to stroke units.&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;Changes in level and rates of change of outcomes (hospital length of stay, patient-attributed hospital costs, non-elective hospital re-admissions) for admissions of people with stroke or myocardial infarction (as control condition) before and after the introduction of the QIP.&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 analysed data for 23 572 people admitted with stroke and 39 511 admitted with myocardial infarction. The median acute length of stay did not change significantly during the implementation year for either patient group; and pre-intervention downward trends declined to near zero for both groups. The difference between the pre-incentive and implementation periods in median total hospital costs per patient with stroke was not statistically significant (–$1692; interquartile range [IQR], –$4440 to $1056), in contrast to the difference for patients with myocardial infarction (–$4278; IQR, –$5280 to –$3275). The proportion of non-elective hospital re-admissions was c","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"222 5","pages":"249-258"},"PeriodicalIF":6.7,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.52607","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143492194","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
Mandatory research projects during medical specialist training in Australia and New Zealand: a survey of trainees’ experiences and reports
IF 6.7 2区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2025-02-25 DOI: 10.5694/mja2.52611
Paulina Stehlik, Caitlyn Withers, Rachel C Bourke, Adrian G Barnett, Caitlin Brandenburg, Christy Noble, Alexandra Bannach-Brown, Gerben B Keijzers, Ian A Scott, Paul P Glasziou, Emma C Veysey, Sharon Mickan, Mark Morgan, Hitesh Joshi, Kirsty Forrest, Thomas G Campbell, David A Henry
<div> <section> <h3> Objective</h3> <p>To determine how many specialist trainees are required to conduct research projects, how they conduct these studies, and their views on the value of these activities; to assess the design and reporting quality of their research reports.</p> </section> <section> <h3> Study design</h3> <p>Online, anonymous survey.</p> </section> <section> <h3> Setting, participants</h3> <p>Current and recent trainees (past five years) at Australian and New Zealand specialist colleges, recruited through eleven colleges and snowballing; survey was available 31 March – 31 December 2021.</p> </section> <section> <h3> Main outcome measures</h3> <p>Whether trainees were required to conduct research as part of specialty training; how they conducted their projects; the skills mix of the project team and access to relevant expertise and supervision; trainee views on mandatory research during specialty training; research engagement after training. Respondents were invited to submit project reports for reporting and methodological quality evaluation.</p> </section> <section> <h3> Results</h3> <p>A total of 371 people commenced the survey; 361 respondents provided answers about mandatory research projects during specialist training, including 311 (86%) who had been required to complete projects. Seventy-six of 177 people who had completed projects (43%) provided information about 92 projects and submitted 34 project reports for evaluation. Thirty-eight projects (41%) investigated questions developed by the trainees alone; in 48 cases (52%) trainees had planned their projects with little outside input; of the 69 study protocols developed (75% of projects), 60 were developed by the trainees. The median proportion of time devoted to the research project exceeded 50% for trainees in ten of twelve colleges. Respondents typically worked in non-collaborative teams, restricted to members of their own specialty, and additional expertise was limited to statisticians, allied health professionals, and nurses. Eighty-seven of 174 participants who had completed projects (50%) felt that doing so was very or moderately important for their clinical careers; 36 of 67 respondents (54%) supported the requirement for scholarly projects during specialty training; 33 of 61 respondents (54%) had participated in research after completing training, and 44 (72%) had considered doing so. Twenty-five of 34 available reports had been published; in 27 assessable reports,
{"title":"Mandatory research projects during medical specialist training in Australia and New Zealand: a survey of trainees’ experiences and reports","authors":"Paulina Stehlik,&nbsp;Caitlyn Withers,&nbsp;Rachel C Bourke,&nbsp;Adrian G Barnett,&nbsp;Caitlin Brandenburg,&nbsp;Christy Noble,&nbsp;Alexandra Bannach-Brown,&nbsp;Gerben B Keijzers,&nbsp;Ian A Scott,&nbsp;Paul P Glasziou,&nbsp;Emma C Veysey,&nbsp;Sharon Mickan,&nbsp;Mark Morgan,&nbsp;Hitesh Joshi,&nbsp;Kirsty Forrest,&nbsp;Thomas G Campbell,&nbsp;David A Henry","doi":"10.5694/mja2.52611","DOIUrl":"10.5694/mja2.52611","url":null,"abstract":"&lt;div&gt;\u0000 \u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Objective&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;To determine how many specialist trainees are required to conduct research projects, how they conduct these studies, and their views on the value of these activities; to assess the design and reporting quality of their research reports.&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;Online, anonymous survey.&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;Current and recent trainees (past five years) at Australian and New Zealand specialist colleges, recruited through eleven colleges and snowballing; survey was available 31 March – 31 December 2021.&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;Whether trainees were required to conduct research as part of specialty training; how they conducted their projects; the skills mix of the project team and access to relevant expertise and supervision; trainee views on mandatory research during specialty training; research engagement after training. Respondents were invited to submit project reports for reporting and methodological quality evaluation.&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;A total of 371 people commenced the survey; 361 respondents provided answers about mandatory research projects during specialist training, including 311 (86%) who had been required to complete projects. Seventy-six of 177 people who had completed projects (43%) provided information about 92 projects and submitted 34 project reports for evaluation. Thirty-eight projects (41%) investigated questions developed by the trainees alone; in 48 cases (52%) trainees had planned their projects with little outside input; of the 69 study protocols developed (75% of projects), 60 were developed by the trainees. The median proportion of time devoted to the research project exceeded 50% for trainees in ten of twelve colleges. Respondents typically worked in non-collaborative teams, restricted to members of their own specialty, and additional expertise was limited to statisticians, allied health professionals, and nurses. Eighty-seven of 174 participants who had completed projects (50%) felt that doing so was very or moderately important for their clinical careers; 36 of 67 respondents (54%) supported the requirement for scholarly projects during specialty training; 33 of 61 respondents (54%) had participated in research after completing training, and 44 (72%) had considered doing so. Twenty-five of 34 available reports had been published; in 27 assessable reports,","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"222 5","pages":"231-239"},"PeriodicalIF":6.7,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.52611","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143501938","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
Management of Mycobacterium ulcerans infection (Buruli ulcer) in Australia: consensus statement.
IF 6.7 2区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2025-02-23 DOI: 10.5694/mja2.52591
Stephen Muhi, Victoria Rv Cox, Matthew O'Brien, Jonathan T Priestley, Jodie Hill, Adrian Murrie, Anthony McDonald, Peter Callan, Grant A Jenkin, N Deborah Friedman, Kasha P Singh, Callum Maggs, Peter Kelley, Eugene Athan, Paul Dr Johnson, Daniel P O'Brien

Introduction: Buruli ulcer, caused by Mycobacterium ulcerans, is increasing in incidence and spreading to new areas in southeast Australia. With increasing experience and emerging evidence, this consensus statement considers contemporary data to provide up-to-date recommendations to clinicians who may encounter this disease. The emergence of Buruli ulcer in previously non-endemic areas highlights the importance of increasing clinician and community awareness of this disease. Main recommendations and changes in management as a result of this consensus statement: Buruli ulcer is a notifiable disease in Victoria, the Northern Territory and Queensland. Cases identified in other states or territories should be discussed with relevant health authorities. We call for Buruli ulcer to be made nationally notifiable to monitor for its potential emergence in non-endemic regions. Diagnosis using polymerase chain reaction is sensitive and specific if performed correctly; a dry swab under the undermined edge of ulcers or a tissue sample via punch biopsy if the lesion is not ulcerated is recommended. If swabs are incorrectly performed or performed on non-ulcerated skin, they can give a false negative result. There is high quality evidence to support treatment of eight weeks' duration using rifampicin-based dual oral antibiotic therapy, in combination with clarithromycin or a fluoroquinolone; relapse is very rare but can occur in people with risk factors. There is emerging evidence for shorter durations of treatment (six weeks) in individuals with small lesions who are at low risk of relapse and in those who have undergone surgical excision of the lesion (four weeks). Patients should be warned that ulcers typically enlarge with antibiotic treatment, will not have healed by completion of antibiotics, and take a median of four to five months to heal. Surgical management is usually not required, but may be beneficial to reduce healing times, avoid or reduce the duration of antibiotics, and manage paradoxical reactions. Early identification and treatment of paradoxical reactions is important, as they are associated with increased tissue necrosis and delayed wound healing. Good wound care is critical in successful treatment of Buruli ulcer, as it enhances healing and prevents secondary bacterial infection. Compared with adults, children have a higher proportion of non-ulcerative and severe lesions, are less likely to experience adverse antibiotic effects, but have higher rates of paradoxical reactions; specialist referral is recommended.

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引用次数: 0
期刊
Medical Journal of Australia
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