首页 > 最新文献

Medical Journal of Australia最新文献

英文 中文
Defining a core set of research and development priorities for virtual care in the post-pandemic environment: a call to action 为大流行后环境中的虚拟护理确定一套核心研发重点:行动呼吁。
IF 6.7 2区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-12-08 DOI: 10.5694/mja2.52524
Kavisha Shah, Nicki Newton, Emma Charlston, Miranda Shaw, Jagdev Singh, Adam Johnston, Owen Hutchings, Chenyao Yu, Pearl Wang, Aaron Jones, Angus Ritchie, Rebecca Davis, Fiona Robinson, Jennifer A Alison, Melissa T Baysari, Meredith Makeham, Sarah Norris, Liliana Laranjo, Emma Nicholls, Clara K Chow, Tim Shaw
<div> <section> <h3> Objectives</h3> <p>To identify research and development priorities for virtual care following the coronavirus disease 2019 pandemic from the perspective of key stakeholders (patients, clinicians, informaticians and academics).</p> </section> <section> <h3> Design</h3> <p>Qualitative study using a modified nominal group technique.</p> </section> <section> <h3> Setting</h3> <p>Online semi-structured interviews and workshops held in November 2022 and February 2023.</p> </section> <section> <h3> Participants</h3> <p>Health workers involved in delivering virtual care in two metropolitan local health districts and one specialty statewide network, and people who had received care from these sites, were recruited using passive snowball sampling. Research and academic staff from a tertiary institution were also invited to participate.</p> </section> <section> <h3> Main outcome measures</h3> <p>Priorities to support a translational research agenda for virtual care.</p> </section> <section> <h3> Results</h3> <p>Twenty-five individuals participated including 18 innovation deliverers, two innovation recipients and five implementation facilitators. Stakeholders identified several key priorities for developing virtual care models and for sustaining and scaling virtual care services. These included demonstrating the economic and societal value of virtual care, developing a common framework to support evaluation and comparison of virtual care services, ensuring virtual care services integrate acute and primary care, and defining which models of care are most appropriate for virtual care delivery.</p> </section> <section> <h3> Conclusion</h3> <p>As the health system recalibrates with the return of in-person care, there is a growing need to demonstrate the value of virtual care models to patients, the health system, and society at large. Demonstrating this value while also demonstrating improvements to health outcomes will future-proof virtual care, enabling it to be used to address broader challenges of health care delivery. In addition, sustaining virtual care will depend on robust operational structures and workforce training and education. As services evolve, research and development priorities must be revisited to ensure that translational r
目的:从关键利益相关者(患者、临床医生、信息学家和学者)的角度确定2019冠状病毒病大流行后虚拟医疗的研发重点。设计:采用改良的名义群体技术进行定性研究。设置:在线半结构化访谈和研讨会将于2022年11月和2023年2月举行。参与者:采用被动滚雪球抽样方法招募在两个大都市地方卫生区和一个全州专业网络中参与提供虚拟护理的卫生工作者,以及从这些地点接受过护理的人。一所大专院校的研究及学术人员亦获邀参与。主要结果衡量:优先支持虚拟护理的转化研究议程。结果:25人参与,其中创新提供者18人,创新接受者2人,实施促进者5人。利益相关者确定了开发虚拟护理模式以及维持和扩展虚拟护理服务的几个关键优先事项。其中包括展示虚拟护理的经济和社会价值,开发一个共同框架来支持虚拟护理服务的评估和比较,确保虚拟护理服务整合急症和初级保健,并确定哪种护理模式最适合虚拟护理交付。结论:随着卫生系统重新调整面对面护理的回归,越来越需要向患者、卫生系统和整个社会展示虚拟护理模式的价值。在展示这一价值的同时,也展示对健康结果的改善,这将是面向未来的虚拟医疗,使其能够用于应对卫生保健服务的更广泛挑战。此外,维持虚拟护理将取决于健全的业务结构以及劳动力培训和教育。随着服务的发展,必须重新审视研究和开发的优先事项,以确保转化研究与利益相关者的利益保持一致。
{"title":"Defining a core set of research and development priorities for virtual care in the post-pandemic environment: a call to action","authors":"Kavisha Shah,&nbsp;Nicki Newton,&nbsp;Emma Charlston,&nbsp;Miranda Shaw,&nbsp;Jagdev Singh,&nbsp;Adam Johnston,&nbsp;Owen Hutchings,&nbsp;Chenyao Yu,&nbsp;Pearl Wang,&nbsp;Aaron Jones,&nbsp;Angus Ritchie,&nbsp;Rebecca Davis,&nbsp;Fiona Robinson,&nbsp;Jennifer A Alison,&nbsp;Melissa T Baysari,&nbsp;Meredith Makeham,&nbsp;Sarah Norris,&nbsp;Liliana Laranjo,&nbsp;Emma Nicholls,&nbsp;Clara K Chow,&nbsp;Tim Shaw","doi":"10.5694/mja2.52524","DOIUrl":"10.5694/mja2.52524","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 identify research and development priorities for virtual care following the coronavirus disease 2019 pandemic from the perspective of key stakeholders (patients, clinicians, informaticians and academics).&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Design&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Qualitative study using a modified nominal group technique.&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 semi-structured interviews and workshops held in November 2022 and February 2023.&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;Health workers involved in delivering virtual care in two metropolitan local health districts and one specialty statewide network, and people who had received care from these sites, were recruited using passive snowball sampling. Research and academic staff from a tertiary institution were also invited to participate.&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;Priorities to support a translational research agenda for virtual care.&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;Twenty-five individuals participated including 18 innovation deliverers, two innovation recipients and five implementation facilitators. Stakeholders identified several key priorities for developing virtual care models and for sustaining and scaling virtual care services. These included demonstrating the economic and societal value of virtual care, developing a common framework to support evaluation and comparison of virtual care services, ensuring virtual care services integrate acute and primary care, and defining which models of care are most appropriate for virtual care delivery.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Conclusion&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;As the health system recalibrates with the return of in-person care, there is a growing need to demonstrate the value of virtual care models to patients, the health system, and society at large. Demonstrating this value while also demonstrating improvements to health outcomes will future-proof virtual care, enabling it to be used to address broader challenges of health care delivery. In addition, sustaining virtual care will depend on robust operational structures and workforce training and education. As services evolve, research and development priorities must be revisited to ensure that translational r","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"221 S11","pages":"S49-S56"},"PeriodicalIF":6.7,"publicationDate":"2024-12-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.52524","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142794808","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
Barriers, facilitators and next steps for sustaining and scaling virtual hospital services in Australia: a qualitative descriptive study 澳大利亚维持和扩大虚拟医院服务的障碍、促进因素和下一步:一项定性描述性研究。
IF 6.7 2区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-12-08 DOI: 10.5694/mja2.52526
Nicki Newton, Kavisha Shah, Miranda Shaw, Emma Charlston, Melissa T Baysari, Angus Ritchie, Chenyao Yu, Adam Johnston, Jagdev Singh, Meredith Makeham, Sarah Norris, Liliana Laranjo, Clara K Chow, Tim Shaw

Objective

To describe the barriers to and facilitators of implementing and delivering virtual hospital (VH) services, and evidence and practice gaps where further research and policy changes are needed to drive continuous improvement.

Study design

Qualitative descriptive study.

Setting, participants

Online semi-structured interviews and a focus group were conducted between July 2022 and April 2023 with doctors, nurses and leadership staff involved in VH services at three sites in New South Wales, Australia.

Main outcome measures

Barriers to and facilitators of implementing and delivering VH services in sites with differing operating structures and levels of maturity, and evidence and practice gaps relating to VH services.

Results

A total of 22 individuals took part in the study. Barriers, facilitators, and evidence and practice gaps emerged within five major themes: scope and structure of VH services; development and implementation of VH models of care; delivery of VH models of care; evaluation of VHs and VH models of care; and sustainment and scalability of VH services. Facilitators of VH success included hybrid approaches to care, partnerships with external services, and skills of the VH workforce. Barriers and gaps in evidence and practice included technical challenges, the need to define the role of VH services, the need to evaluate the tangible impact of VH care models and technologies, and the need to develop funding models that support VH care delivery. Participants also highlighted the perceived impacts and benefits of VH services on the workforce (within and beyond the VH setting), consumers, and the health care system.

Conclusions

Our findings can help inform the development of new VH services and the improvement of existing VH services. As VH services become more mainstream, gaps in evidence and practice must be addressed by future research and policy changes to maximise the benefits.

目的:描述实施和提供虚拟医院(VH)服务的障碍和促进因素,以及需要进一步研究和政策变革以推动持续改进的证据和实践差距。研究设计:定性描述性研究。环境、参与者:在2022年7月至2023年4月期间,在澳大利亚新南威尔士州的三个地点,对参与VH服务的医生、护士和领导人员进行了在线半结构化访谈和焦点小组。主要成果衡量标准:在运营结构和成熟度不同的地点实施和提供VH服务的障碍和促进因素,以及与VH服务有关的证据和实践差距。结果:共有22人参加了这项研究。五大主题中出现了障碍、促进因素以及证据和实践差距:卫生保健服务的范围和结构;制定和实施卫生保健模式;提供卫生保健模式;VH和VH护理模式的评价;以及VH服务的可持续性和可扩展性。促进VH成功的因素包括混合护理方法、与外部服务机构的伙伴关系以及VH工作人员的技能。证据和实践方面的障碍和差距包括技术挑战,需要确定VH服务的作用,需要评估VH护理模式和技术的实际影响,以及需要制定支持VH护理提供的筹资模式。与会者还强调了VH服务对劳动力(在VH环境内外)、消费者和卫生保健系统的影响和好处。结论:我们的研究结果可以为新的VH服务的开发和现有VH服务的改进提供信息。随着VH服务日益成为主流,必须通过未来的研究和政策变革来解决证据和实践方面的差距,以最大限度地发挥其效益。
{"title":"Barriers, facilitators and next steps for sustaining and scaling virtual hospital services in Australia: a qualitative descriptive study","authors":"Nicki Newton,&nbsp;Kavisha Shah,&nbsp;Miranda Shaw,&nbsp;Emma Charlston,&nbsp;Melissa T Baysari,&nbsp;Angus Ritchie,&nbsp;Chenyao Yu,&nbsp;Adam Johnston,&nbsp;Jagdev Singh,&nbsp;Meredith Makeham,&nbsp;Sarah Norris,&nbsp;Liliana Laranjo,&nbsp;Clara K Chow,&nbsp;Tim Shaw","doi":"10.5694/mja2.52526","DOIUrl":"10.5694/mja2.52526","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To describe the barriers to and facilitators of implementing and delivering virtual hospital (VH) services, and evidence and practice gaps where further research and policy changes are needed to drive continuous improvement.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Study design</h3>\u0000 \u0000 <p>Qualitative descriptive study.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting, participants</h3>\u0000 \u0000 <p>Online semi-structured interviews and a focus group were conducted between July 2022 and April 2023 with doctors, nurses and leadership staff involved in VH services at three sites in New South Wales, Australia.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main outcome measures</h3>\u0000 \u0000 <p>Barriers to and facilitators of implementing and delivering VH services in sites with differing operating structures and levels of maturity, and evidence and practice gaps relating to VH services.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 22 individuals took part in the study. Barriers, facilitators, and evidence and practice gaps emerged within five major themes: scope and structure of VH services; development and implementation of VH models of care; delivery of VH models of care; evaluation of VHs and VH models of care; and sustainment and scalability of VH services. Facilitators of VH success included hybrid approaches to care, partnerships with external services, and skills of the VH workforce. Barriers and gaps in evidence and practice included technical challenges, the need to define the role of VH services, the need to evaluate the tangible impact of VH care models and technologies, and the need to develop funding models that support VH care delivery. Participants also highlighted the perceived impacts and benefits of VH services on the workforce (within and beyond the VH setting), consumers, and the health care system.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Our findings can help inform the development of new VH services and the improvement of existing VH services. As VH services become more mainstream, gaps in evidence and practice must be addressed by future research and policy changes to maximise the benefits.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"221 S11","pages":"S37-S48"},"PeriodicalIF":6.7,"publicationDate":"2024-12-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.52526","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142794784","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
Ethical challenges of multiple organ transplant in cystic fibrosis 囊性纤维化多器官移植的伦理挑战。
IF 6.7 2区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-12-04 DOI: 10.5694/mja2.52547
Mark R Oliver, John Massie, Miranda Paraskeva, Avik Majumdar, Lynn H Gillam, Dominic JC Wilkinson
<p>Effective treatment in the form of cystic fibrosis transmembrane regulator (CFTR) modulator therapy targeting the most common gene mutations is now available for over 90% of people with cystic fibrosis over the age of 2 years. This treatment results in improvement of lung function and nutritional status.<span><sup>1</sup></span> However, it is not known whether these effects will be sustained or have a wider influence on the multiple organs affected by cystic fibrosis if introduced early in life. Hence, many Australian people with cystic fibrosis will continue to live with the possibility of organ failure, albeit fewer than in previous generations. There is agreement that single organ transplantation in a patient with organ failure is medically appropriate and ethically justifiable. However, cystic fibrosis can result in the insidious failure of several organs simultaneously, such that single organ transplant is neither possible nor life prolonging. In such circumstances, multiple organ transplant would be considered. However, there are several complex medical factors that transplant teams need to consider, such as feasibility (infrastructure and centralisation of services) and benefit to the patient (usefulness) along with the ethical consideration of organ rationing when donors are limited. Due to recent treatment improvements, the need for multiple organ transplants in people with cystic fibrosis is decreasing; however, we still need to ensure equity regarding decision making. In this article, we explore the ethical principles associated with multiple organ transplant in people with cystic fibrosis in the current setting, using a fictional patient representative of a typical patient with cystic fibrosis.</p><p>A referral is received from the local cystic fibrosis service for a 22-year-old man (Box 1) for consideration of a combined lung and liver transplant. He has a forced expiratory volume in one second (FEV<sub>1</sub>) of less than 30%, life-threatening haemoptysis and worsening nutrition despite full supplemental feeding. His genotype (<i>G543X</i> and <i>N1303K</i>) was not responsive to CFTR modulator therapy.<span><sup>2</sup></span> In addition, he has portal hypertension because of advanced cystic fibrosis-related liver disease and has suffered life-threatening variceal bleeding. He has read about multiple organ transplant in cystic fibrosis and has discussed this with his team, who agree that this is an option to explore, given a substantially diminished quality of life and poor survival with severe dual organ disease. But is it ethically appropriate to list him for transplantation?</p><p>Multiple organ transplant in people with cystic fibrosis has been accepted as a treatment option globally (North America, Europe, England, Australia and New Zealand) and increasing numbers are being performed.<span><sup>3-6</sup></span> Multiple organ transplant has been demonstrated to provide a significant advantage to recipients including sur
{"title":"Ethical challenges of multiple organ transplant in cystic fibrosis","authors":"Mark R Oliver,&nbsp;John Massie,&nbsp;Miranda Paraskeva,&nbsp;Avik Majumdar,&nbsp;Lynn H Gillam,&nbsp;Dominic JC Wilkinson","doi":"10.5694/mja2.52547","DOIUrl":"10.5694/mja2.52547","url":null,"abstract":"&lt;p&gt;Effective treatment in the form of cystic fibrosis transmembrane regulator (CFTR) modulator therapy targeting the most common gene mutations is now available for over 90% of people with cystic fibrosis over the age of 2 years. This treatment results in improvement of lung function and nutritional status.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; However, it is not known whether these effects will be sustained or have a wider influence on the multiple organs affected by cystic fibrosis if introduced early in life. Hence, many Australian people with cystic fibrosis will continue to live with the possibility of organ failure, albeit fewer than in previous generations. There is agreement that single organ transplantation in a patient with organ failure is medically appropriate and ethically justifiable. However, cystic fibrosis can result in the insidious failure of several organs simultaneously, such that single organ transplant is neither possible nor life prolonging. In such circumstances, multiple organ transplant would be considered. However, there are several complex medical factors that transplant teams need to consider, such as feasibility (infrastructure and centralisation of services) and benefit to the patient (usefulness) along with the ethical consideration of organ rationing when donors are limited. Due to recent treatment improvements, the need for multiple organ transplants in people with cystic fibrosis is decreasing; however, we still need to ensure equity regarding decision making. In this article, we explore the ethical principles associated with multiple organ transplant in people with cystic fibrosis in the current setting, using a fictional patient representative of a typical patient with cystic fibrosis.&lt;/p&gt;&lt;p&gt;A referral is received from the local cystic fibrosis service for a 22-year-old man (Box 1) for consideration of a combined lung and liver transplant. He has a forced expiratory volume in one second (FEV&lt;sub&gt;1&lt;/sub&gt;) of less than 30%, life-threatening haemoptysis and worsening nutrition despite full supplemental feeding. His genotype (&lt;i&gt;G543X&lt;/i&gt; and &lt;i&gt;N1303K&lt;/i&gt;) was not responsive to CFTR modulator therapy.&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt; In addition, he has portal hypertension because of advanced cystic fibrosis-related liver disease and has suffered life-threatening variceal bleeding. He has read about multiple organ transplant in cystic fibrosis and has discussed this with his team, who agree that this is an option to explore, given a substantially diminished quality of life and poor survival with severe dual organ disease. But is it ethically appropriate to list him for transplantation?&lt;/p&gt;&lt;p&gt;Multiple organ transplant in people with cystic fibrosis has been accepted as a treatment option globally (North America, Europe, England, Australia and New Zealand) and increasing numbers are being performed.&lt;span&gt;&lt;sup&gt;3-6&lt;/sup&gt;&lt;/span&gt; Multiple organ transplant has been demonstrated to provide a significant advantage to recipients including sur","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"222 1","pages":"20-22"},"PeriodicalIF":6.7,"publicationDate":"2024-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.52547","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142780617","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
National Hypertension Taskforce of Australia: a roadmap to achieve 70% blood pressure control in Australia by 2030 澳大利亚国家高血压工作组:到2030年在澳大利亚实现70%血压控制的路线图
IF 6.7 2区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-12-03 DOI: 10.5694/mja2.52553
Madeleine M Cosgrave, Catherine A Brumby, Matthew A Roberts, Lawrence P McMahon

To the Editor: It was most welcome to see hypertension receive due attention in the timely roadmap of the National Hypertension Taskforce of Australia.1 The authors described the pillars of “prevent”, “detect” and “treat effectively” and listed the appropriate high risk groups. However, one group, women with hypertensive disorders of pregnancy (HDP), was curiously omitted.

All women are screened for hypertension in pregnancy, and each year 5–10% are diagnosed with HDP. These women have a lifelong increased risk of cardiovascular disease (CVD). It is not merely a concern for older age groups. Disturbingly, there is a doubling in risk of cardiovascular events in the first ten years following pregnancy. The risk is multiplied by five times if the HDP was early onset.2 The ramifications are often unrecognised as blood pressure usually normalises within weeks of delivery and the needs of the newborn quickly supersede those of the mother.

An additional concern is that many women are not aware of the elevated risks of HDP. A New South Wales survey of 105 women with prior HDP found that only 18 (17%) knew of their increased cardiovascular risk.3 General practitioners need to be informed of their patient's HDP diagnosis to manage their long term cardiovascular risks. Lack of patient awareness and inaccurate or incomplete discharge summaries can hamper the general practitioner's awareness and subsequent treatment.

Women are already disadvantaged when it comes to cardiovascular health: appraisal of their risk factors is less likely, and prescription of evidence-based therapies is less common in young women (aged 35–54 years) compared with their male counterparts with the same risk of CVD.4 It was heartening to see relevant information on HDP added to the Australian CVD Risk Calculator5 in 2023, but there is a long way to go.

Pregnancy is an opportunity to detect, treat and educate women of childbearing age regarding hypertension. All women with HDP and their respective general practitioners should be informed of their diagnosis and increased CVD risk. In line with current national guidelines,6 all women with HDP should have an annual review of blood pressure and cardiovascular risk factors to facilitate early detection and treatment of hypertension — Pillars B and C of the roadmap. For the National Hypertension Taskforce of Australia roadmap to achieve its goal, this at-risk group should be included in the roadmap.

No relevant disclosures.

{"title":"National Hypertension Taskforce of Australia: a roadmap to achieve 70% blood pressure control in Australia by 2030","authors":"Madeleine M Cosgrave,&nbsp;Catherine A Brumby,&nbsp;Matthew A Roberts,&nbsp;Lawrence P McMahon","doi":"10.5694/mja2.52553","DOIUrl":"10.5694/mja2.52553","url":null,"abstract":"<p><span>To the Editor:</span> It was most welcome to see hypertension receive due attention in the timely roadmap of the National Hypertension Taskforce of Australia.<span><sup>1</sup></span> The authors described the pillars of “prevent”, “detect” and “treat effectively” and listed the appropriate high risk groups. However, one group, women with hypertensive disorders of pregnancy (HDP), was curiously omitted.</p><p>All women are screened for hypertension in pregnancy, and each year 5–10% are diagnosed with HDP. These women have a lifelong increased risk of cardiovascular disease (CVD). It is not merely a concern for older age groups. Disturbingly, there is a doubling in risk of cardiovascular events in the first ten years following pregnancy. The risk is multiplied by five times if the HDP was early onset.<span><sup>2</sup></span> The ramifications are often unrecognised as blood pressure usually normalises within weeks of delivery and the needs of the newborn quickly supersede those of the mother.</p><p>An additional concern is that many women are not aware of the elevated risks of HDP. A New South Wales survey of 105 women with prior HDP found that only 18 (17%) knew of their increased cardiovascular risk.<span><sup>3</sup></span> General practitioners need to be informed of their patient's HDP diagnosis to manage their long term cardiovascular risks. Lack of patient awareness and inaccurate or incomplete discharge summaries can hamper the general practitioner's awareness and subsequent treatment.</p><p>Women are already disadvantaged when it comes to cardiovascular health: appraisal of their risk factors is less likely, and prescription of evidence-based therapies is less common in young women (aged 35–54 years) compared with their male counterparts with the same risk of CVD.<span><sup>4</sup></span> It was heartening to see relevant information on HDP added to the Australian CVD Risk Calculator<span><sup>5</sup></span> in 2023, but there is a long way to go.</p><p>Pregnancy is an opportunity to detect, treat and educate women of childbearing age regarding hypertension. All women with HDP and their respective general practitioners should be informed of their diagnosis and increased CVD risk. In line with current national guidelines,<span><sup>6</sup></span> all women with HDP should have an annual review of blood pressure and cardiovascular risk factors to facilitate early detection and treatment of hypertension — Pillars B and C of the roadmap. For the National Hypertension Taskforce of Australia roadmap to achieve its goal, this at-risk group should be included in the roadmap.</p><p>No relevant disclosures.</p>","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"222 2","pages":"104"},"PeriodicalIF":6.7,"publicationDate":"2024-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.52553","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142770174","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
National Hypertension Taskforce of Australia: a roadmap to achieve 70% blood pressure control in Australia by 2030 澳大利亚国家高血压工作组:到2030年在澳大利亚实现70%血压控制的路线图
IF 6.7 2区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-12-03 DOI: 10.5694/mja2.52554
Aletta E Schutte, Markus Schlaich

In reply: On behalf of the National Hypertension Taskforce of Australia, we welcome the above comment from Cosgrove and colleagues1 on our roadmap2 and fully appreciate the importance of hypertensive disorders of pregnancy (HDP) as a high risk condition for future development of established hypertension and cardiovascular disease (CVD).3 While not specifically mentioned as a high risk group in the roadmap, risk-based management of CVD is a critical component of the HEARTS package to be adopted and tailored to the Australian circumstances to diagnose and treat hypertension effectively, including HDP (Pillar C).2 Team-based and patient-centred care is another essential aspect and will allow implementation of systematic blood pressure screening and monitoring, delivered by general practitioners, physicians and, importantly, by obstetricians, as mentioned in the roadmap (Pillar B).2

Continuous monitoring of blood pressure postpartum seems particularly relevant in view of recent evidence indicating a 2.4-fold increased risk of hypertension ten years after the occurrence of HDP.4 Indeed, observed differences in non-invasive measures of CVD risk were predominantly driven by the hypertension diagnosis, regardless of HDP history, suggesting that the known long term risk of CVD after HDP may primarily be a consequence of hypertension development and uncontrolled blood pressure levels.4

Adding further to the complexity is the observation that both HDP and associated CVD disproportionally affect black women, as shown in an American study predominantly including women who self-identified as black. This highlights possible racial disparities4 and the need for further research and exploration of the underlying mechanisms.

Another important group of patients not mentioned specifically in the roadmap is adolescents, a cohort frequently lost in transition from paediatric to adult physician care.5 To remedy this, a call for Australian clinical practice guidelines for paediatric hypertension (including adolescents) has recently been published6 and development is underway.

While it was beyond the scope of the roadmap to address specific aspects of all patient groups affected, the guidance provided in the document under the principal pillars of prevent, detect and treat effectively, combined with adequate and timely implementation of the required framework, should allow us to substantially improve blood pressure control rates for all Australians and curb the enormous burden of hypertension on our society.

No relevant disclosures.

{"title":"National Hypertension Taskforce of Australia: a roadmap to achieve 70% blood pressure control in Australia by 2030","authors":"Aletta E Schutte,&nbsp;Markus Schlaich","doi":"10.5694/mja2.52554","DOIUrl":"10.5694/mja2.52554","url":null,"abstract":"<p><b><i><span>In reply</span></i></b>: On behalf of the National Hypertension Taskforce of Australia, we welcome the above comment from Cosgrove and colleagues<span><sup>1</sup></span> on our roadmap<span><sup>2</sup></span> and fully appreciate the importance of hypertensive disorders of pregnancy (HDP) as a high risk condition for future development of established hypertension and cardiovascular disease (CVD).<span><sup>3</sup></span> While not specifically mentioned as a high risk group in the roadmap, risk-based management of CVD is a critical component of the HEARTS package to be adopted and tailored to the Australian circumstances to diagnose and treat hypertension effectively, including HDP (Pillar C).<span><sup>2</sup></span> Team-based and patient-centred care is another essential aspect and will allow implementation of systematic blood pressure screening and monitoring, delivered by general practitioners, physicians and, importantly, by obstetricians, as mentioned in the roadmap (Pillar B).<span><sup>2</sup></span></p><p>Continuous monitoring of blood pressure postpartum seems particularly relevant in view of recent evidence indicating a 2.4-fold increased risk of hypertension ten years after the occurrence of HDP.<span><sup>4</sup></span> Indeed, observed differences in non-invasive measures of CVD risk were predominantly driven by the hypertension diagnosis, regardless of HDP history, suggesting that the known long term risk of CVD after HDP may primarily be a consequence of hypertension development and uncontrolled blood pressure levels.<span><sup>4</sup></span></p><p>Adding further to the complexity is the observation that both HDP and associated CVD disproportionally affect black women, as shown in an American study predominantly including women who self-identified as black. This highlights possible racial disparities<span><sup>4</sup></span> and the need for further research and exploration of the underlying mechanisms.</p><p>Another important group of patients not mentioned specifically in the roadmap is adolescents, a cohort frequently lost in transition from paediatric to adult physician care.<span><sup>5</sup></span> To remedy this, a call for Australian clinical practice guidelines for paediatric hypertension (including adolescents) has recently been published<span><sup>6</sup></span> and development is underway.</p><p>While it was beyond the scope of the roadmap to address specific aspects of all patient groups affected, the guidance provided in the document under the principal pillars of prevent, detect and treat effectively, combined with adequate and timely implementation of the required framework, should allow us to substantially improve blood pressure control rates for all Australians and curb the enormous burden of hypertension on our society.</p><p>No relevant disclosures.</p>","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"222 2","pages":"104-105"},"PeriodicalIF":6.7,"publicationDate":"2024-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.52554","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142770306","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
Intrinsic capacity and ageing well for Aboriginal people in remote Western Australia: a longitudinal cohort study 西澳大利亚偏远地区土著人的内在能力和老龄化:一项纵向队列研究。
IF 6.7 2区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-12-02 DOI: 10.5694/mja2.52544
Zoë Hyde, Kate Smith, Roslyn Malay, Dina C LoGiudice, Dawn C Bessarab, David N Atkinson, Edward Strivens, Leon Flicker
<div> <section> <h3> Objective</h3> <p>To assess intrinsic capacity, an important component of ageing well, in older Aboriginal people living in remote Western Australia.</p> </section> <section> <h3> Study design</h3> <p>Longitudinal cohort study; secondary analysis of survey and clinical assessment data.</p> </section> <section> <h3> Setting</h3> <p>Kimberley region of Western Australia (six remote communities, and the town of Derby).</p> </section> <section> <h3> Participants</h3> <p>Aboriginal people aged 45 years or older, initially recruited 15 July 2004 – 17 November 2006.</p> </section> <section> <h3> Main outcome measures</h3> <p>Intrinsic capacity (assessed in each participant by questionnaire and review by a consultant specialist), overall and by domain, and presence of core activity limitations, at baseline and follow-up (8 February 2011 – 6 June 2013); risk of death by follow-up; preservation of intrinsic capacity at follow-up.</p> </section> <section> <h3> Results</h3> <p>The mean age of the 345 participants at baseline was 60.2 years (standard deviation [SD], 11.6 years; range, 45–96 years); 152 were men (44.1%) and 193 were women (55.9%). Intrinsic capacity was unimpaired in all five domains for 55 participants (15.9%; 95% confidence interval [CI], 12.4–20.2%). Capacity in the vitality domain was unimpaired in 325 respondents (94.2%), in the psychological/mood domain in 318 (92.2%), and in the cognition domain in 289 people (83.8%); the locomotion domain was unimpaired in 174 people (50.4%), and the sensory domain in 117 people (33.9%). The proportion of men with full capacity in all five domains (32 of 152, 21.1%) was larger than for women (23 of 193, 11.9%). Of the 274 people included in follow-up analyses, intrinsic capacity was lower than at baseline for 66 people (24.1%), it was unchanged or improved in 111 participants (40.5%; 95% CI, 34.8–46.5%), and 97 people had died (35.4%). Thirty-seven of the 177 surviving participants for whom complete data were available had full capacity in all domains (20.9%; 95% CI, 15.5–27.6%). After adjustment for age, the number of unimpaired intrinsic capacity domains at baseline was inversely associated with having a core activity limitation at baseline (per domain: adjusted prevalence ratio, 0.43; 95% CI, 0.34–0.55) and follow-up (adjusted risk ratio, 0.62; 95% CI, 0.44–0.88), and with risk of
目的:评估内在能力,老龄化的一个重要组成部分,在老年土著居民生活在偏远的西澳大利亚州。研究设计:纵向队列研究;对调查和临床评价资料进行二次分析。环境:西澳大利亚的金伯利地区(六个偏远社区和德比镇)。参与者:45岁以上的原住民,2004年7月15日至2006年11月17日首次招募。主要结果测量指标:基线和随访(2011年2月8日至2013年6月6日)时,总体和按领域划分的内在能力(每位参与者通过问卷调查和顾问专家的审查进行评估);随访造成的死亡风险;保留后续行动的内在能力。结果:345名参与者基线时的平均年龄为60.2岁(标准差[SD], 11.6岁;范围:45-96岁);男性152例(44.1%),女性193例(55.9%)。55名参与者的内在能力在所有五个领域均未受损(15.9%;95%可信区间[CI], 12.4-20.2%)。325人(94.2%)在活力领域的能力未受损,318人(92.2%)在心理/情绪领域,289人(83.8%)在认知领域;174人(50.4%)运动区未受损,117人(33.9%)感觉区未受损。在所有五个领域都具备全部能力的男性比例(152人中32人,21.1%)大于女性(193人中23人,11.9%)。在随访分析的274人中,有66人(24.1%)的内在能力低于基线,111人(40.5%)的内在能力保持不变或有所改善;95% CI, 34.8-46.5%),死亡97人(35.4%)。177名幸存的参与者中,有37人在所有领域都有完全的能力(20.9%;95% ci, 15.5-27.6%)。在年龄调整后,基线时未受损的内在能力域的数量与基线时核心活动受限呈负相关(每个域:调整患病率比,0.43;95% CI, 0.34-0.55)和随访(调整风险比,0.62;95% CI, 0.44-0.88),随访死亡风险(校正风险比,0.83;95% ci, 0.71-0.96)。结论:居住在金伯利的老年土著居民的内在能力受损在感觉和运动领域最为常见。在这些方面能力下降的人可以通过治疗来确保老年人能够继续参加对生活质量很重要的活动。
{"title":"Intrinsic capacity and ageing well for Aboriginal people in remote Western Australia: a longitudinal cohort study","authors":"Zoë Hyde,&nbsp;Kate Smith,&nbsp;Roslyn Malay,&nbsp;Dina C LoGiudice,&nbsp;Dawn C Bessarab,&nbsp;David N Atkinson,&nbsp;Edward Strivens,&nbsp;Leon Flicker","doi":"10.5694/mja2.52544","DOIUrl":"10.5694/mja2.52544","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 assess intrinsic capacity, an important component of ageing well, in older Aboriginal people living in remote Western Australia.&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;Longitudinal cohort study; secondary analysis of survey and clinical assessment data.&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;Kimberley region of Western Australia (six remote communities, and the town of Derby).&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;Aboriginal people aged 45 years or older, initially recruited 15 July 2004 – 17 November 2006.&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;Intrinsic capacity (assessed in each participant by questionnaire and review by a consultant specialist), overall and by domain, and presence of core activity limitations, at baseline and follow-up (8 February 2011 – 6 June 2013); risk of death by follow-up; preservation of intrinsic capacity at follow-up.&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;The mean age of the 345 participants at baseline was 60.2 years (standard deviation [SD], 11.6 years; range, 45–96 years); 152 were men (44.1%) and 193 were women (55.9%). Intrinsic capacity was unimpaired in all five domains for 55 participants (15.9%; 95% confidence interval [CI], 12.4–20.2%). Capacity in the vitality domain was unimpaired in 325 respondents (94.2%), in the psychological/mood domain in 318 (92.2%), and in the cognition domain in 289 people (83.8%); the locomotion domain was unimpaired in 174 people (50.4%), and the sensory domain in 117 people (33.9%). The proportion of men with full capacity in all five domains (32 of 152, 21.1%) was larger than for women (23 of 193, 11.9%). Of the 274 people included in follow-up analyses, intrinsic capacity was lower than at baseline for 66 people (24.1%), it was unchanged or improved in 111 participants (40.5%; 95% CI, 34.8–46.5%), and 97 people had died (35.4%). Thirty-seven of the 177 surviving participants for whom complete data were available had full capacity in all domains (20.9%; 95% CI, 15.5–27.6%). After adjustment for age, the number of unimpaired intrinsic capacity domains at baseline was inversely associated with having a core activity limitation at baseline (per domain: adjusted prevalence ratio, 0.43; 95% CI, 0.34–0.55) and follow-up (adjusted risk ratio, 0.62; 95% CI, 0.44–0.88), and with risk of","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"222 1","pages":"38-46"},"PeriodicalIF":6.7,"publicationDate":"2024-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.52544","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142769947","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
Castleman disease following post-coronavirus disease 2019 multisystem inflammatory syndrome in adults 成人冠状病毒病后多系统炎症综合征后Castleman病
IF 6.7 2区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-12-01 DOI: 10.5694/mja2.52546
Katherine J Punshon, Anugrah Chrispal
<p>A 50-year-old man presented with one week of progressive dyspnoea, abdominal pain and malaise, together with one month of enlarging capillary haemangiomas. His medical history reported post-coronavirus disease 2019 (COVID-19) multisystem inflammatory syndrome in adults (MIS-A), diagnosed 18 months prior with dyspnoea and abdominal pain, and associated with progressive kidney injury, liver function derangements, pancytopenias and mediastinal lymphadenopathy. MIS-A was diagnosed clinically after non-diagnostic mediastinal lymph node and liver biopsies. He was treated with corticosteroids, which were weaned only five months before the current presentation.</p><p>On presentation, his vital signs and initial examination were unremarkable. Blood results showed anaemia, inflammation, acute kidney injury and cholestatic liver derangement (Box 1). A chest x-ray showed small bilateral pleural effusions, further evaluated with computed tomography pulmonary angiography, which revealed mediastinal and axillary adenopathy. Serological workup revealed unremarkable infectious, autoimmune and haematologic screens (Box 2).</p><p>A positron emission tomography scan showed innumerable mildly to moderately fludeoxyglucose (FDG)-avid enlarged and non-enlarged lymph nodes above and below the diaphragm, and increased splenic and bone marrow activity (Box 3). Biopsy samples were taken from the most FDG-avid axillary and mediastinal lymph nodes, but were non-diagnostic. The results from one biopsy showed non-caseating granulomas; however, results from the second biopsy did not. An excisional lymph node biopsy was subsequently taken, with the results meeting histopathologic criteria for Castleman disease (Box 4). These criteria included depleted germinal centres, concentric rimming of small B lymphocytes in a “onion skin” appearance, and vascularity with vessels extending into the germinal centre.<span><sup>1</sup></span></p><p>The patient was diagnosed with multicentric Castleman disease, and commenced on high dose prednisolone and interleukin-6 inhibitor siltuximab. At the time of writing, he was in incomplete remission.</p><p>The 50-year-old-patient presented with exuberant multisystem inflammation. With a history of MIS-A, a relapse was initially considered; however, there are no documented cases of relapsed MIS-A. Thus, alternative causes were considered, especially in the context of extensive lymphadenopathy.</p><p>Core lymph node biopsy results revealed non-caseating granulomas, initially suspicious of sarcoidosis. However, non-caseating granulomas may also indicate many viral, bacterial or fungal infections, vasculitides, occupational diseases and haematological disorders.<span><sup>2</sup></span> Core lymph node biopsies can provide definitive diagnosis in more than 92% of cases. However, they have an increased rate of incorrect and non-conclusive diagnosis compared to an excisional lymph node biopsy.<span><sup>3</sup></span> Excisional lymph node biopsies shou
{"title":"Castleman disease following post-coronavirus disease 2019 multisystem inflammatory syndrome in adults","authors":"Katherine J Punshon,&nbsp;Anugrah Chrispal","doi":"10.5694/mja2.52546","DOIUrl":"10.5694/mja2.52546","url":null,"abstract":"&lt;p&gt;A 50-year-old man presented with one week of progressive dyspnoea, abdominal pain and malaise, together with one month of enlarging capillary haemangiomas. His medical history reported post-coronavirus disease 2019 (COVID-19) multisystem inflammatory syndrome in adults (MIS-A), diagnosed 18 months prior with dyspnoea and abdominal pain, and associated with progressive kidney injury, liver function derangements, pancytopenias and mediastinal lymphadenopathy. MIS-A was diagnosed clinically after non-diagnostic mediastinal lymph node and liver biopsies. He was treated with corticosteroids, which were weaned only five months before the current presentation.&lt;/p&gt;&lt;p&gt;On presentation, his vital signs and initial examination were unremarkable. Blood results showed anaemia, inflammation, acute kidney injury and cholestatic liver derangement (Box 1). A chest x-ray showed small bilateral pleural effusions, further evaluated with computed tomography pulmonary angiography, which revealed mediastinal and axillary adenopathy. Serological workup revealed unremarkable infectious, autoimmune and haematologic screens (Box 2).&lt;/p&gt;&lt;p&gt;A positron emission tomography scan showed innumerable mildly to moderately fludeoxyglucose (FDG)-avid enlarged and non-enlarged lymph nodes above and below the diaphragm, and increased splenic and bone marrow activity (Box 3). Biopsy samples were taken from the most FDG-avid axillary and mediastinal lymph nodes, but were non-diagnostic. The results from one biopsy showed non-caseating granulomas; however, results from the second biopsy did not. An excisional lymph node biopsy was subsequently taken, with the results meeting histopathologic criteria for Castleman disease (Box 4). These criteria included depleted germinal centres, concentric rimming of small B lymphocytes in a “onion skin” appearance, and vascularity with vessels extending into the germinal centre.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;The patient was diagnosed with multicentric Castleman disease, and commenced on high dose prednisolone and interleukin-6 inhibitor siltuximab. At the time of writing, he was in incomplete remission.&lt;/p&gt;&lt;p&gt;The 50-year-old-patient presented with exuberant multisystem inflammation. With a history of MIS-A, a relapse was initially considered; however, there are no documented cases of relapsed MIS-A. Thus, alternative causes were considered, especially in the context of extensive lymphadenopathy.&lt;/p&gt;&lt;p&gt;Core lymph node biopsy results revealed non-caseating granulomas, initially suspicious of sarcoidosis. However, non-caseating granulomas may also indicate many viral, bacterial or fungal infections, vasculitides, occupational diseases and haematological disorders.&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt; Core lymph node biopsies can provide definitive diagnosis in more than 92% of cases. However, they have an increased rate of incorrect and non-conclusive diagnosis compared to an excisional lymph node biopsy.&lt;span&gt;&lt;sup&gt;3&lt;/sup&gt;&lt;/span&gt; Excisional lymph node biopsies shou","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"222 1","pages":"17-19"},"PeriodicalIF":6.7,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.52546","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142769972","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
Inclusivity in Australian population surveys: missed opportunities to understand the health experiences of culturally and linguistically diverse populations 澳大利亚人口调查的包容性:错过了了解文化和语言多样化人口健康经历的机会。
IF 6.7 2区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-11-28 DOI: 10.5694/mja2.52545
Humaira Maheen, Tania King
<p>Population surveys are crucial to public health research, offering critical information on morbidity at a population level, health service use, and attitudes and intentions regarding health outcomes and behaviours. In Australia, population surveys are widely used to identify emerging health needs and their determinants and are vital in informing health policies and programs. Despite their geographic representation, these surveys often fail to adequately represent the diversity within Australia's culturally and linguistically diverse (CALD) populations. This impedes understanding of health patterning among these populations. It prevents the identification of unique disease patterns, predictive risk factors, preferences for engaging with health services, and barriers to care that these communities encounter,<span><sup>1</sup></span> and potentially obscures our understanding of health inequalities among different groups.<span><sup>2</sup></span> In this perspective, we highlight the imperative for population surveys to improve their inclusivity and thereby enable more comprehensive understanding of the needs of CALD groups. We discuss the implications of the non-inclusiveness of CALD populations and propose a way forward to ensure better representation and inclusion in these surveys.</p><p>The term “CALD communities” is unique to the Australian context. In 1996, it was first used to describe the diversity within the Australian population, replacing the term “non-English speaking backgrounds”, which was criticised for being non-inclusive.<span><sup>3</sup></span> The Australian Bureau of Statistics (ABS) defines the CALD population using a set of minimum core cultural and language indicators (four items) and 12 standard indicators (including the four core items) representing diversity within these groups (Box 1).<span><sup>9</sup></span> Most Australian surveys comply with the minimum core data, with very few reporting all 12 standard indicators, noting that some report “country of birth” and “language spoken at home” with aggregate, broad categories rather than specific countries or languages. English language proficiency and Indigenous status are part of the minimum core data reported in all surveys (Box 1).</p><p>There are two principal ways by which population surveys miss opportunities to adequately capture the experiences of CALD populations: (i) under-representation of vulnerable groups and (ii) overlooking critical diversity indicators. The lack of inclusion of CALD populations in clinical trials and other research designs has garnered significant attention in recent years.<span><sup>10-12</sup></span> Two studies<span><sup>13, 14</sup></span> shed light on how diverse population groups are often excluded in academic research at the design stage, and when these groups are sampled, analysis is rarely stratified by CALD groups to enable meaningful insights into the experiences of these groups. We argue that such issues extend to Australian
{"title":"Inclusivity in Australian population surveys: missed opportunities to understand the health experiences of culturally and linguistically diverse populations","authors":"Humaira Maheen,&nbsp;Tania King","doi":"10.5694/mja2.52545","DOIUrl":"10.5694/mja2.52545","url":null,"abstract":"&lt;p&gt;Population surveys are crucial to public health research, offering critical information on morbidity at a population level, health service use, and attitudes and intentions regarding health outcomes and behaviours. In Australia, population surveys are widely used to identify emerging health needs and their determinants and are vital in informing health policies and programs. Despite their geographic representation, these surveys often fail to adequately represent the diversity within Australia's culturally and linguistically diverse (CALD) populations. This impedes understanding of health patterning among these populations. It prevents the identification of unique disease patterns, predictive risk factors, preferences for engaging with health services, and barriers to care that these communities encounter,&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; and potentially obscures our understanding of health inequalities among different groups.&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt; In this perspective, we highlight the imperative for population surveys to improve their inclusivity and thereby enable more comprehensive understanding of the needs of CALD groups. We discuss the implications of the non-inclusiveness of CALD populations and propose a way forward to ensure better representation and inclusion in these surveys.&lt;/p&gt;&lt;p&gt;The term “CALD communities” is unique to the Australian context. In 1996, it was first used to describe the diversity within the Australian population, replacing the term “non-English speaking backgrounds”, which was criticised for being non-inclusive.&lt;span&gt;&lt;sup&gt;3&lt;/sup&gt;&lt;/span&gt; The Australian Bureau of Statistics (ABS) defines the CALD population using a set of minimum core cultural and language indicators (four items) and 12 standard indicators (including the four core items) representing diversity within these groups (Box 1).&lt;span&gt;&lt;sup&gt;9&lt;/sup&gt;&lt;/span&gt; Most Australian surveys comply with the minimum core data, with very few reporting all 12 standard indicators, noting that some report “country of birth” and “language spoken at home” with aggregate, broad categories rather than specific countries or languages. English language proficiency and Indigenous status are part of the minimum core data reported in all surveys (Box 1).&lt;/p&gt;&lt;p&gt;There are two principal ways by which population surveys miss opportunities to adequately capture the experiences of CALD populations: (i) under-representation of vulnerable groups and (ii) overlooking critical diversity indicators. The lack of inclusion of CALD populations in clinical trials and other research designs has garnered significant attention in recent years.&lt;span&gt;&lt;sup&gt;10-12&lt;/sup&gt;&lt;/span&gt; Two studies&lt;span&gt;&lt;sup&gt;13, 14&lt;/sup&gt;&lt;/span&gt; shed light on how diverse population groups are often excluded in academic research at the design stage, and when these groups are sampled, analysis is rarely stratified by CALD groups to enable meaningful insights into the experiences of these groups. We argue that such issues extend to Australian ","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"222 1","pages":"13-16"},"PeriodicalIF":6.7,"publicationDate":"2024-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.52545","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142751335","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
Updated recommendations for warfarin reversal in the setting of four-factor prothrombin complex concentrate 在使用四因子凝血酶原复合物浓缩物的情况下进行华法林逆转治疗的最新建议。
IF 6.7 2区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-11-25 DOI: 10.5694/mja2.52538
Danielle Robinson, James McFadyen, Eileen Merriman, Chee Wee Tan, Ross Baker, Huyen Tran

Introduction

Warfarin (vitamin K antagonist) remains an established anticoagulant for patients at high risk of arterial and venous thromboembolism. The prompt reversal of the anticoagulant effect of warfarin is necessary in the context of major bleeding or emergency surgery because of its extended inhibition of vitamin K-dependent coagulation factors for days. The mainstay of urgent warfarin reversal has been vitamin K administration, and infusion of a three-factor prothrombin complex concentrate (3FPCC) and the option for the addition of fresh frozen plasma as a source of factor VII. With the upcoming introduction in Australia and New Zealand of a four-factor prothrombin complex concentrate (4FPCC), which replaces all the vitamin K-dependent clotting factors, this article updates the previously published warfarin reversal guidelines.

Main recommendations

For urgent warfarin reversal, 4FPCC should be used instead of 3FPCC, using the same suggested dose. Vitamin K co-administration is still recommended for more sustained reversal.

Changes in management as a result of this statement

The use of 4FPCC for urgent warfarin reversal obviates the need for co-administration of fresh frozen plasma.

简介华法林(维生素 K 拮抗剂)仍然是动脉和静脉血栓栓塞高危患者的首选抗凝剂。由于华法林对维生素 K 依赖性凝血因子的抑制作用可持续数天,因此在大出血或急诊手术中必须及时逆转华法林的抗凝作用。紧急逆转华法林的主要方法是服用维生素 K、输注三因子凝血酶原复合物浓缩物(3FCC)以及添加新鲜冰冻血浆作为 VII 因子来源。澳大利亚和新西兰即将引入四因子凝血酶原复合物浓缩物(4FCC),该浓缩物可替代所有依赖维生素 K 的凝血因子,因此本文对之前发布的华法林逆转指南进行了更新:主要建议:对于紧急华法林逆转,应使用 4FPCC 代替 3FCC,建议剂量相同。仍建议联合应用维生素 K 以获得更持久的逆转效果:使用 4FPCC 进行紧急华法林逆转时,无需联合应用新鲜冰冻血浆。
{"title":"Updated recommendations for warfarin reversal in the setting of four-factor prothrombin complex concentrate","authors":"Danielle Robinson,&nbsp;James McFadyen,&nbsp;Eileen Merriman,&nbsp;Chee Wee Tan,&nbsp;Ross Baker,&nbsp;Huyen Tran","doi":"10.5694/mja2.52538","DOIUrl":"10.5694/mja2.52538","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Warfarin (vitamin K antagonist) remains an established anticoagulant for patients at high risk of arterial and venous thromboembolism. The prompt reversal of the anticoagulant effect of warfarin is necessary in the context of major bleeding or emergency surgery because of its extended inhibition of vitamin K-dependent coagulation factors for days. The mainstay of urgent warfarin reversal has been vitamin K administration, and infusion of a three-factor prothrombin complex concentrate (3FPCC) and the option for the addition of fresh frozen plasma as a source of factor VII. With the upcoming introduction in Australia and New Zealand of a four-factor prothrombin complex concentrate (4FPCC), which replaces all the vitamin K-dependent clotting factors, this article updates the previously published warfarin reversal guidelines.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main recommendations</h3>\u0000 \u0000 <p>For urgent warfarin reversal, 4FPCC should be used instead of 3FPCC, using the same suggested dose. Vitamin K co-administration is still recommended for more sustained reversal.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Changes in management as a result of this statement</h3>\u0000 \u0000 <p>The use of 4FPCC for urgent warfarin reversal obviates the need for co-administration of fresh frozen plasma.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"222 1","pages":"49-51"},"PeriodicalIF":6.7,"publicationDate":"2024-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.52538","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142716516","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
Is the term bulk-billing still relevant in today's landscape of health policy reform? 在医疗政策改革的今天,批量计费一词是否仍然适用?
IF 6.7 2区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-11-25 DOI: 10.5694/mja2.52543
Michael Wright, May Chin
<p>As Medicare enters its 40th year and we reflect on its achievements, it is timely to assess the usefulness and relevance of a term that is closely associated with it: bulk-billing.</p><p>The term bulk-billing originated when Medicare was first introduced in 1984, and it referred to the manual process where a medical practitioner would submit collected paper receipts in bulk to Medicare. Although the practice of physically sending bulk receipts to Medicare has long since disappeared, the term bulk-billing has persisted.</p><p>The state of the Australian health system looks very different now than it did 40 years ago when Medicare was first introduced. In that time, the term bulk-billing has become synonymous with marker of access to general practice and in the delivery of health care with zero cost to the patient. This is in part due to current and past governments using the bulk-billing rate as a political indicator of health policy successes and as an indictment by opposition parties on the government of the day's commitment to health care access and equity. For example, in 2021, the former Minister for Health, the Hon Greg Hunt, used bulk-billing rates to demonstrate the then Coalition government's firm commitment to Medicare, despite also being the government responsible for extending the freeze on the Medicare indexation.<span><sup>1</sup></span> Similarly, the current Minister for Health, the Hon Mark Butler, also used increases in the bulk-billing rate as evidence of the success of the 2023 Budget initiatives to triple the bulk-billing incentives for Australians with concession cards and those aged under 16 years.<span><sup>2</sup></span></p><p>At the time of its introduction, Medicare was designed to ensure all Australians have access to affordable health care by subsidising 85% of the cost of general practice services, increasing to 100% in 2004. Since then, Medicare rebates have not kept pace with increasing inflation nor the costs of care. From 1995 to 2022, increases in Medicare rebates averaged just over 1.1% annually,<span><sup>3</sup></span> compared with general inflation reaching up to 7.3% during the same period.<span><sup>4</sup></span></p><p>Although the bulk-billing rate has been used as metric for general practice access, there is no standardised definition or interpretation. The bulk-billing rate typically quoted by politicians reflects the reported percentage of subsidised services that are bulk billed — the <i>volume</i> of bulk billed general practice services — and provides little insight into patient access to general practice.</p><p>Organisations such as Cubiko and Cleanbill have attempted to further interpret the bulk-billing rate with key differences. Cubiko, in their 2023 Touchstone report refers to the bulk-billing rate as “the percentage of invoices [that are bulk billed]” recognising that multiple Medicare services can be provided at one time distorting bulk-billing metrics.<span><sup>5</sup></span> Cubiko als
{"title":"Is the term bulk-billing still relevant in today's landscape of health policy reform?","authors":"Michael Wright,&nbsp;May Chin","doi":"10.5694/mja2.52543","DOIUrl":"10.5694/mja2.52543","url":null,"abstract":"&lt;p&gt;As Medicare enters its 40th year and we reflect on its achievements, it is timely to assess the usefulness and relevance of a term that is closely associated with it: bulk-billing.&lt;/p&gt;&lt;p&gt;The term bulk-billing originated when Medicare was first introduced in 1984, and it referred to the manual process where a medical practitioner would submit collected paper receipts in bulk to Medicare. Although the practice of physically sending bulk receipts to Medicare has long since disappeared, the term bulk-billing has persisted.&lt;/p&gt;&lt;p&gt;The state of the Australian health system looks very different now than it did 40 years ago when Medicare was first introduced. In that time, the term bulk-billing has become synonymous with marker of access to general practice and in the delivery of health care with zero cost to the patient. This is in part due to current and past governments using the bulk-billing rate as a political indicator of health policy successes and as an indictment by opposition parties on the government of the day's commitment to health care access and equity. For example, in 2021, the former Minister for Health, the Hon Greg Hunt, used bulk-billing rates to demonstrate the then Coalition government's firm commitment to Medicare, despite also being the government responsible for extending the freeze on the Medicare indexation.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; Similarly, the current Minister for Health, the Hon Mark Butler, also used increases in the bulk-billing rate as evidence of the success of the 2023 Budget initiatives to triple the bulk-billing incentives for Australians with concession cards and those aged under 16 years.&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;At the time of its introduction, Medicare was designed to ensure all Australians have access to affordable health care by subsidising 85% of the cost of general practice services, increasing to 100% in 2004. Since then, Medicare rebates have not kept pace with increasing inflation nor the costs of care. From 1995 to 2022, increases in Medicare rebates averaged just over 1.1% annually,&lt;span&gt;&lt;sup&gt;3&lt;/sup&gt;&lt;/span&gt; compared with general inflation reaching up to 7.3% during the same period.&lt;span&gt;&lt;sup&gt;4&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;Although the bulk-billing rate has been used as metric for general practice access, there is no standardised definition or interpretation. The bulk-billing rate typically quoted by politicians reflects the reported percentage of subsidised services that are bulk billed — the &lt;i&gt;volume&lt;/i&gt; of bulk billed general practice services — and provides little insight into patient access to general practice.&lt;/p&gt;&lt;p&gt;Organisations such as Cubiko and Cleanbill have attempted to further interpret the bulk-billing rate with key differences. Cubiko, in their 2023 Touchstone report refers to the bulk-billing rate as “the percentage of invoices [that are bulk billed]” recognising that multiple Medicare services can be provided at one time distorting bulk-billing metrics.&lt;span&gt;&lt;sup&gt;5&lt;/sup&gt;&lt;/span&gt; Cubiko als","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"222 2","pages":"66-68"},"PeriodicalIF":6.7,"publicationDate":"2024-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.52543","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142716512","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
期刊
Medical Journal of Australia
全部 Acc. Chem. Res. ACS Applied Bio Materials ACS Appl. Electron. Mater. ACS Appl. Energy Mater. ACS Appl. Mater. Interfaces ACS Appl. Nano Mater. ACS Appl. Polym. Mater. ACS BIOMATER-SCI ENG ACS Catal. ACS Cent. Sci. ACS Chem. Biol. ACS Chemical Health & Safety ACS Chem. Neurosci. ACS Comb. Sci. ACS Earth Space Chem. ACS Energy Lett. ACS Infect. Dis. ACS Macro Lett. ACS Mater. Lett. ACS Med. Chem. Lett. ACS Nano ACS Omega ACS Photonics ACS Sens. ACS Sustainable Chem. Eng. ACS Synth. Biol. Anal. Chem. BIOCHEMISTRY-US Bioconjugate Chem. BIOMACROMOLECULES Chem. Res. Toxicol. Chem. Rev. Chem. Mater. CRYST GROWTH DES ENERG FUEL Environ. Sci. Technol. Environ. Sci. Technol. Lett. Eur. J. Inorg. Chem. IND ENG CHEM RES Inorg. Chem. J. Agric. Food. Chem. J. Chem. Eng. Data J. Chem. Educ. J. Chem. Inf. Model. J. Chem. Theory Comput. J. Med. Chem. J. Nat. Prod. J PROTEOME RES J. Am. Chem. Soc. LANGMUIR MACROMOLECULES Mol. Pharmaceutics Nano Lett. Org. Lett. ORG PROCESS RES DEV ORGANOMETALLICS J. Org. Chem. J. Phys. Chem. J. Phys. Chem. A J. Phys. Chem. B J. Phys. Chem. C J. Phys. Chem. Lett. Analyst Anal. Methods Biomater. Sci. Catal. Sci. Technol. Chem. Commun. Chem. Soc. Rev. CHEM EDUC RES PRACT CRYSTENGCOMM Dalton Trans. Energy Environ. Sci. ENVIRON SCI-NANO ENVIRON SCI-PROC IMP ENVIRON SCI-WAT RES Faraday Discuss. Food Funct. Green Chem. Inorg. Chem. Front. Integr. Biol. J. Anal. At. Spectrom. J. Mater. Chem. A J. Mater. Chem. B J. Mater. Chem. C Lab Chip Mater. Chem. Front. Mater. Horiz. MEDCHEMCOMM Metallomics Mol. Biosyst. Mol. Syst. Des. Eng. Nanoscale Nanoscale Horiz. Nat. Prod. Rep. New J. Chem. Org. Biomol. Chem. Org. Chem. Front. PHOTOCH PHOTOBIO SCI PCCP Polym. Chem.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
0
微信
客服QQ
Book学术公众号 扫码关注我们
反馈
×
意见反馈
请填写您的意见或建议
请填写您的手机或邮箱
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
现在去查看 取消
×
提示
确定
Book学术官方微信
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术
文献互助 智能选刊 最新文献 互助须知 联系我们:info@booksci.cn
Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。
Copyright © 2023 Book学术 All rights reserved.
ghs 京公网安备 11010802042870号 京ICP备2023020795号-1