Topics

Health services administration

Surgical procedures, operative

Summary

Rural surgery is most commonly provided by general surgeons to the 29% of people (7 million) living in rural Australia.
The provision of rural general surgery to enable equitable and safe surgical care for rural Australians is a multifaceted issue concerning recruitment, training, retention, surgical procedures and surgical outcomes.
Sustaining the rural general surgical workforce will be dependent upon growing an increased number of resident rural general surgeons, as well as changed models of care, with a need for ongoing review to track the outcomes of these changes.
To increase recruitment, rural general surgical training must improve to be less stressful for trainees and to be incorporated alongside a rural‐facing generalist curriculum.
Rural general surgical outcomes (excluding some oncology conditions) achieve comparable results to metropolitan centres.
Access to, and outcomes of, surgical oncology services continues to be inequitable for rural Australians and should be a major focus for improved service delivery.

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1 Monash Rural Health — Bendigo, Monash University, Bendigo, VIC
2 Bendigo Health, Bendigo, VIC
3 Monash University, Melbourne, VIC

Correspondence: jess.paynter@monash.edu

Open access:

Open access publishing facilitated by Monash University, as part of the Wiley ‐ Monash University agreement via the Council of Australian University Librarians.

Competing interests:

No relevant disclosures.

1. General Surgeons Australia. About us. Melbourne: GSA, 2022. https://www.generalsurgeons.com.au/about‐us (viewed Feb 2024).
2. Royal Australasian College of Surgeons. Train for Rural: Rural Health Equity Strategy. Melbourne: RACS, 2021. https://www.surgeons.org/‐/media/Project/RACS/surgeons‐org/files/interest‐groups‐sections/Rural‐Surgery/2‐Train‐for‐Rural.pdf?rev=2e53ad7ecb3e4864be9dcc69e0556bb1&hash=6EF8D4FD8F5C13332C8C625D920E42C6 (viewed May 2023).
3. Royal Australasian College of Surgeons. Activities report 2021. Melbourne: RACS, 2022. https://www.surgeons.org/‐/media/Project/RACS/surgeons‐org/files/reports‐guidelines‐publications/workforce‐activities‐census‐reports/2021‐12‐31_RACS_ActivitiesReport_2021_V4_Final.pdf?rev=7dced14774fa449e8a74b1023013998e&hash=528EC8EDAD1B41E0B2757EEECEAC97DF (viewed May 2023).
4. Clancy B. Royal Australasian College of Surgeons Rural Health Equity Strategic Action Plan: excellence through equity. ANZ J Surg 2022; 92: 1990‐1994.
5. Chong A, Kiroff G. Preparing surgeons for rural Australia: the RACS Rural Surgical Training Program. ANZ J Surg 2015; 85: 108‐112.
6. Department of Health and Aged Care. Australian Statistical Geography Standard – Remoteness Area [website]. Canberra: Commonwealth of Australia, 2021. https://www.health.gov.au/topics/rural‐health‐workforce/classifications/asgs‐ra (viewed May 2023).
7. Department of Health and Aged Care. Health Workforce Dataset: Data Tool. Canberra: Commonwealth of Australia, 2020. https://hwd.health.gov.au/datatool/ (viewed May 2023).
8. O'Sullivan B, McGrail M, Russell D. Rural specialists: the nature of their work and professional satisfaction by geographical location of work. Aust J Rural Health 2017; 25: 338‐346.
9. Nelson PG. General surgical manpower, Victoria, Australia. Aust N Z J Surg 1991; 61: 576‐588.
10. Choi MS, van der Mark MA, Hung K. The distribution and composition of colonoscopy providers in Australia. Cureus 2022; 14: e22104.
11. Shanmugakumar S, Playford D, Burkitt T, et al. Is Western Australia's rural surgical workforce going to sustain the future? A quantitative and qualitative analysis. Aust Health Rev 2017; 41: 75‐81.
12. Paynter JA, O'Sullivan B, Qin KR, et al. Characterizing the female general surgery workforce in rural and regional Australia. ANZ J Surg 2023; 93: 2283‐2284.
13. Bruening MH, Maddern GJ. The provision of general surgical services in rural South Australia: a new model for rural surgery. ANZ J Surg 1998; 68: 764‐768.
14. Chittleborough TJ, Lourensz K, Elliott M, et al. Outreach surgical consulting services in North East Victoria. Aust J Rural Health 2013; 21: 325‐328.
15. Gruen RL, Bailie RS, Wang Z, et al. Specialist outreach to isolated and disadvantaged communities: a population‐based study. Lancet 2006; 368: 130‐138.
16. Hughes‐Anderson W, Rankin SL, House J, et al. Open access endoscopy in rural and remote Western Australia: does it work? ANZ J Surg 2002; 72: 699‐703.
17. Maurice AP, Punnasseril JEJ, King SE, Dodd BJ. Improving access to bariatric surgery for rural and remote patients: experiences from a state‐wide bariatric telehealth service in Australia. Obes Surg 2020; 30: 4401‐4410.
18. Hussain R, Maple M, Hunter S, et al. The fly‐in fly‐out and drive‐in drive‐out model of health care service provision for rural and remote Australia: benefits and disadvantages. Rural Remote Health 2015; 15: 3068.
19. Echuca Regional Health. About us. Echuca: Echuca Regional Health, 2021. https://erh.org.au/about/ (viewed May 2023).
20. Venchiarutti RL, Tracy M, Clark JR, et al. Geographic variation in referral practices for patients with suspected head and neck cancer: A survey of general practitioners using a clinical vignette. Aust J Rural Health 2022; 30: 501‐511.
21. Oh D, Wright C, Young CJ. Management of obstetric anal sphincter injury: Colorectal surgeons’ perspectives in Australia and New Zealand. Aust N Z J Obstet Gynaecol 2021; 61: 16‐21.
22. Yeh J, Palamuthusingam P, Cameron D, Avramovic J. Impact of establishing a specialized hepatobiliary unit on liver resections in a non‐specialized tertiary centre in regional Australia. ANZ J Surg 2022; 92: 769‐773.
23. Bishop CV, Drummond KJ. Rural neurotrauma in Australia: implications for surgical training. ANZ J Surg 2006; 76: 53‐59.
24. Brims FJH, Kumarasamy C, Nash J, et al. Hospital‐based multidisciplinary lung cancer care in Australia: a survey of the landscape in 2021. BMJ Open Respir Res 2022; 9: e001157.
25. Underhill C, Bartel R, Goldstein D, et al. Mapping oncology services in regional and rural Australia. Aust J Rural Health 2009; 17: 321‐329.
26. Youl P, Philpot S, Moore J, Theile DE. Population‐based picture of breast reconstruction in Queensland, Australia. ANZ J Surg 2021; 91: 695‐700.
27. Flitcroft K, Brennan M, Costa D, Spillane A. Documenting patterns of breast reconstruction in Australia: the national picture. Breast 2016; 30: 47‐53.
28. Hall SE, Holman CDJ. Inequalities in breast cancer reconstructive surgery according to social and locational status in Western Australia. Eur J Surg Oncol 2003; 29: 519‐525.
29. Flitcroft K, Brennan M, Spillane A. Principles of patient‐centred care and barriers to their implementation: a case study of breast reconstruction in Australia. Support Care Cancer 2020; 28: 1963‐1981.
30. Collins IM, Lum C, Versace VL. Influence of socioeconomic factors and distance to radiotherapy on breast‐conserving surgery rates for early breast cancer in regional Australia; implications of change. Asia Pac J Clin Oncol 2018; 14: e224‐e230.
31. Australian Society of Plastic Surgeons. ASPS Darwin Workforce Project impact report: 2022 — the second year. Sydney: ASPS, 2022. https://plasticsurgery.org.au/wp‐content/uploads/2023/05/Darwin‐second‐year‐impact‐report_FINAL.pdf (viewed May 2023).
32. Bryant K, Dean N. Innovation in rural workforce strategies by a national surgical society: the ASPS experience. Australas J Plast Surg 2021; 4: 3‐5.
33. General Surgeons Australia. Curriculum. Melbourne: GSA, 2022. https://www.generalsurgeons.com.au/education‐and‐training/curriculum (viewed May 2023).
34. Bruening MH, Anthony AA, Maddern GJ. Surgical rotations in provincial South Australia: the trainees’ perspective. ANZ J Surg 2003; 73: 65‐68.
35. Miller FJ, Miller CA, Fox AM, et al. Influence of training on the family. ANZ J Surg 2006; 76: 907‐911.
36. Hippolyte‐Blake D, Dreschler A, Rose A, et al. A qualitative study of the incentives and barriers that influence preferences for rural placements during surgical training in Australia. ANZ J Surg 2022; 92: 341‐345.
37. Chan LS, Scholes NJW, Jones M. Skin excisions: not so simple for the regionally based general surgical trainee. Aust J Rural Health 2011; 19: 205‐210.
38. Wong K, Birks D. Operative experience in the Victorian general surgical training programme. ANZ J Surg 2003; 73: 1036‐1040.
39. O'Grady G, Loveday B, Harper S, et al. Working hours and roster structures of surgical trainees in Australia and New Zealand. ANZ J Surg 2010; 80: 890‐895.
40. Eley DS, Synnott R, Baker PG, Chater AB. A decade of Australian Rural Clinical School graduates — where are they and why? Rural Remote Health 2012; 12: 1937.
41. General Surgeons Australia. Training Committee. Melbourne: GSA, 2023. https://www.generalsurgeons.com.au/training‐committees (viewed May 2023).
42. Monash University. About the hubs. Melbourne: Monash University, 2022. https://www.monash.edu/medicine/rural‐health/hubs/about‐us#:~:text=The%20regional%20training%20hub%20concept,phase%20of%20regional%20medical%20education (viewed May 2023).
43. McGrail MR, Doyle Z, Fuller L, et al. The pathway to more rural doctors: the role of universities. Med J Aust 2023; 219 (Suppl): S8‐S13. https://www.mja.com.au/journal/2023/219/3/pathway‐more‐rural‐doctors‐role‐universities
44. Bappayya S, Chen F, Alderuccio M, Schwalb H. Caseload distribution of general surgeons in regional Australia: is there a role for a rural surgery sub‐specialization? ANZ J Surg 2019; 89: 672‐676.
45. Campbell NA, Kitchen G, Campbell IA. Operative experience of general surgeons in a rural hospital. ANZ J Surg 2011; 81: 601‐603.
46. Campbell NA, Franzi S, Thomas P. Caseload of general surgeons working in a rural hospital with outreach practice. ANZ J Surg 2013; 83: 508‐511.
47. Liu J, Lei C, Reid J, et al. Extended scope of practice needed for Australian rural general surgeons: a review of South Australia's rural general surgical caseload and case mix. ANZ J Surg 2022; 93: 522‐527.
48. Paynter JA, Qin KR, O'Brien A, et al. Rural general surgeon confidence with managing vascular emergencies: a national survey. Aust J Rural Health 2023; 31: 897‐905.
49. Luck T, Treacy PJ, Mathieson M, et al. Emergency neurosurgery in Darwin: still the generalist surgeons’ responsibility. ANZ J Surg 2015; 85: 610‐614.
50. Gilligan J, Reilly P, Pearce A, Taylor D. Management of acute traumatic intracranial haematoma in rural and remote areas of Australia. ANZ J Surg 2017; 87: 80‐85.
51. Udovicich C, Page D, Huq M, Clifforth S. Neck of femur fracture management by general surgeons at a rural hospital. Australas Med J 2015; 8: 154‐160.
52. General Surgeons Australia. PFET Program in Rural Surgery. Melbourne: GSA, 2023. https://www.generalsurgeons.com.au/post‐fellowship‐education‐training/rural‐program (viewed May 2023).
53. Stewart GD, Long G, Tulloh BR. Surgical service centralisation in Australia versus choice and quality of life for rural patients. Med J Aust 2006; 185: 162‐163. https://www.mja.com.au/journal/2006/185/3/surgical‐service‐centralisation‐australia‐versus‐choice‐and‐quality‐life‐rural
54. Liu J, Ting YY, Trochsler M, et al. Analysis of surgical mortality in rural South Australia: a review of four major rural hospital in South Australia. ANZ J Surg 2022; 92: 1681‐1691.
55. Tocaciu S, Thiagarajan J, Maddern GJ, Wichmann MW. Mortality after emergency abdominal surgery in a non‐metropolitan Australian centre. Aust J Rural Health 2018; 26: 408‐415.
56. Swift K, Thompson F, Roeder L, et al. Appendicitis in Far North Queensland: a new take on an old story. ANZ J Surg 2022; 92: 114‐120.
57. Quinn L, Read D. Paediatric surgical services in remote northern Australia: an integrated model of care. ANZ J Surg 2017; 87: 784‐788.
58. Davis SS, Babidge WJ, Kiermeier A, Maddern GJ. Regional versus metropolitan pancreaticoduodenectomy mortality in Australia. ANZ J Surg 2019; 89: 1582‐1586.
59. Davis SS, Noll D, Patel P, et al. Gastrectomy mortality in Australia. ANZ J Surg 2022; 92: 2109‐2114.
60. Gray AD, Petrou G, Rastogi P, et al. Elective hepatic resection is feasible and safe in a regional centre. ANZ J Surg 2018; 88: E147‐E151.
61. van Leeuwen MT, Falster MO, Vajdic CM, et al. Reoperation after breast‐conserving surgery for cancer in Australia: statewide cohort study of linked hospital data. BMJ Open 2018; 8: e020858.
62. Hall S, Holman CDA, Sheiner H, Hendrie D. The influence of socio‐economic and locational disadvantage on survival after a diagnosis of lung or breast cancer in Western Australia. J Health Serv Res Policy 2004; 9 (Suppl): 10‐16.
63. Fox PN, Chatfield MD, Beith JM, et al. Factors delaying chemotherapy for breast cancer in four urban and rural oncology units. ANZ J Surg 2013; 83: 533‐538.
64. Marsh C, Wang J, Kollias J, et al. Disparities in access to breast care nurses for breast surgeons: a National Breast Cancer Audit survey. Breast 2010; 19: 142‐146.
65. Marsh CJ, Boult M, Wang JX, et al. National Breast Cancer Audit: the use of multidisciplinary care teams by breast surgeons in Australia and New Zealand. Med J Aust 2008; 188: 385‐386. https://www.mja.com.au/journal/2008/188/7/national‐breast‐cancer‐audit‐use‐multidisciplinary‐care‐teams‐breast‐surgeons
66. Bergin RJ, Thomas RJS, Whitfield K, White V. Concordance between Optimal Care Pathways and colorectal cancer care: identifying opportunities to improve quality and reduce disparities. J Eval Clin Pract 2020; 26: 918‐926.
67. Watson MM, South Australian Rural Surgical Research Group, Watson DC, et al. Quality of rural colonoscopy outperforms key performance indicators in a multi‐centre prospective clinical study. ANZ J Surg 2022; 93: 528‐533
68. Hoskins W, Taylor P, Jacob A, et al. Colectomies performed at a rural Australian hospital: a 7‐year analysis. Aust J Rural Health 2013; 21: 279‐284.
69. Wichmann MW, McCullough TK, Beukes E, et al. Outcomes of laparoscopic colorectal cancer surgery in a non‐metropolitan Australian hospital: audit of 120 patients with long‐term follow‐up results. ANZ J Surg 2022; 92: 3214‐3218.
70. Wichmann MW, McCullough TK, Beukes E, et al. Colorectal cancer surgery in rural Australia can match outcomes in metropolitan hospitals: a 14‐year study. Med J Aust 2021; 214: 186‐187. https://www.mja.com.au/journal/2021/214/4/colorectal‐cancer‐surgery‐rural‐australia‐can‐match‐outcomes‐metropolitan
71. Udayasiri DK, MacCallum C, Da Silva N, et al. Impact of hospital geographic remoteness on overall survival after colorectal cancer resection using state‐wide administrative data. ANZ J Surg 2020; 90: 1321‐1327.
72. O'Sullivan BG, Worley P. Setting priorities for rural allied health in Australia: a scoping review. Rural Remote Health 2020; 20: 5719.
73. Mannix K. The future of Australia's nursing workforce: COVID‐19 and burnout among nurses. Melbourne: University of Melbourne, 2021. https://www.unimelb.edu.au/__data/assets/pdf_file/0004/4085194/katelyn_mannix_report.pdf (viewed May 2023).
74. Parlier AB, Galvin SL, Thach S, et al. The road to rural primary care: a narrative review of factors that help develop, recruit, and retain rural primary care physicians. Acad Med 2018; 93: 130‐140.
75. Ostini R, McGrail MR, Kondalsamy‐Chennakesavan S, et al. Building a sustainable rural physician workforce. Med J Aust 2021; 215 (Suppl): S1‐S33. https://www.mja.com.au/journal/2021/215/1/building‐sustainable‐rural‐physician‐workforce

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Research

The effectiveness of maternal pertussis vaccination for protecting Aboriginal and Torres Strait Islander infants against infection, 2012–2017: a retrospective cohort study

Lisa McHugh, Heather A D’Antoine, Mohinder Sarna, Michael J Binks, Hannah C Moore, Ross M Andrews, Gavin F Pereira, Christopher C Blyth, Paul Van Buynder, Karin Lust and Annette K Regan

Med J Aust 2024; 220 (4): . || doi: 10.5694/mja2.52220
Published online: 4 March 2024

ARTICLE
AUTHORS
REFERENCES

Topics

Infectious diseases

Women's health

Indigenous health

Environment and public health

Pediatric medicine

Respiratory tract diseases

Abstract

Objectives: To evaluate the effectiveness of maternal pertussis vaccination for preventing pertussis infections in Aboriginal and Torres Strait Islander infants under seven months of age.

Study design: Retrospective cohort study; analysis of linked administrative health data.

Setting, participants: Mother–infant cohort (Links2HealthierBubs) including all pregnant women who gave birth to live infants (gestational age ≥ 20 weeks, birthweight ≥ 400 g) in the Northern Territory, Queensland, and Western Australia during 1 January 2012 – 31 December 2017.

Main outcome measures: Proportions of women vaccinated against pertussis during pregnancy, rates of pertussis infections among infants under seven months of age, and estimated effectiveness of maternal vaccination for protecting infants against pertussis infection, each by Indigenous status.

Results: Of the 19 892 Aboriginal and Torres Strait Islander women who gave birth to live infants during 2012–2017, 7398 (37.2%) received pertussis vaccine doses during their pregnancy, as had 137 034 of 259 526 non‐Indigenous women (52.8%; Indigenous v non‐Indigenous: adjusted odds ratio, 0.66; 95% confidence interval [CI], 0.62–0.70). The annual incidence of notified pertussis infections in non‐Indigenous infants declined from 16.8 (95% CI, 9.9–29) in 2012 to 1.4 (95% CI, 0.3–8.0) cases per 10 000 births in 2017; among Aboriginal and Torres Strait Islander infants, it declined from 47.6 (95% CI, 16.2–139) to 38.6 (95% CI, 10.6–140) cases per 10 000 births. The effectiveness of maternal vaccination for protecting non‐Indigenous infants under seven months of age against pertussis infection during 2014–17 was 68.2% (95% CI, 51.8–79.0%); protection of Aboriginal and Torres Strait Islander infants was not statistically significant (36.1%; 95% CI, –41.3% to 71.1%).

Conclusions: During 2015–17, maternal pertussis vaccination did not protect Aboriginal and Torres Strait Islander infants in the NT, Queensland, and WA against infection. Increasing the pertussis vaccination rate among pregnant Aboriginal and Torres Strait Islander women requires culturally appropriate, innovative strategies co‐designed in partnership with Indigenous organisations and communities.

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1 The University of Queensland, Brisbane, QLD
2 National Aboriginal and Torres Strait Islander Research Network, University of Queensland, Brisbane, QLD
3 Curtin University, Perth, WA
4 Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, WA
5 Menzies School of Health Research, Darwin, NT
6 Telethon Institute for Child Health Research, University of Western Australia, Perth, WA
7 Office of the Chief Health Officer, Queensland Health, Brisbane, QLD
8 Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
9 The University of Western Australia, Perth, WA
10 Griffith University, Gold Coast, QLD
11 Royal Brisbane and Woman's Hospital Health Service District, Brisbane, QLD
12 University of San Francisco, San Francisco, CA, United States of America

Correspondence: l.mchugh@uq.edu.au

Open access:

Open access publishing facilitated by The University of Queensland, as part of the Wiley – The University of Queensland agreement via the Council of Australian University Librarians.

Acknowledgements:

This investigation was supported by a National Health and Medical Research Council (NHMRC) Project Grant (GNT1141510) and operational funds provided by the Western Australia Department of Health. Lisa McHugh is supported by an NHMRC EL1 Investigator Grant (GNT2016407) at the University of Queensland. Annette K Regan was supported by an NHMRC Early Career Fellowship (GNT1138425). Hannah C Moore was supported by a Stan Perron Charitable Foundation People Fellowship. Christopher C Blyth was supported by an NHMRC Career Development Fellowship (GNT1111596) and NHMRC Investigator award (APP1173163). Michael J Binks was supported by an NHMRC Early Career Fellowship (GNT1088733) and an NHMRC‐funded Hot North (Improving Health Outcomes in the Tropical North) Fellowship (1131932). Gavin F Pereira was supported by NHMRC Project (GNT1099655) and Investigator Grants (GNT1173991), and by the Research Council of Norway through its Centres of Excellence funding scheme (GNT262700). The funding sources had no role in the planning, study design, data collection, analysis or interpretation, reporting or publication.

We thank the Linkages Services Branch of Queensland Health and the data custodians of the Perinatal, Notifications and Other Communicable Infectious Diseases, and Immunisation Data collections; the Linkage and Client Services Teams at the Data Linkage Branch of the Western Australia Department of Health and the data custodians of the Midwives Notification System, the WA Antenatal Vaccination Database, and the WA Notifiable Infectious Diseases Database; and SA‐NT DataLink and the NT Centre for Disease Control, and the data custodians of the NT Perinatal Trends, Communicable Infectious Diseases, and Immunisation Databases.

Competing interests:

No relevant disclosures.

1. Yeung KHT, Duclos P, Nelson EAS, Hutubessy RCW. An update of the global burden of pertussis in children younger than 5 years: a modelling study. Lancet Infect Dis 2017; 17: 974‐980.
2. Australian Department of Health and Aged Care. National Immunisation Program Schedule. Updated 12 July 2023. https://beta.health.gov.au/health‐topics/immunisation/immunisation‐throughout‐life/national‐immunisation‐program‐schedule (viewed Nov 2023).
3. Wiley KE, Zuo Y, Macartney KK, McIntyre PB. Sources of pertussis infection in young infants: a review of key evidence informing targeting of the cocoon strategy. Vaccine 2013; 31: 618‐625.
4. Bertilone C, Wallace T, Selvey LA. Finding the “who” in whooping cough: vaccinated siblings are important pertussis sources in infants 6 months of age and under. Commun Dis Intell Q Rep 2014; 38: E195‐E200.
5. Regan AK, Moore HC, Binks MJ, et al. Maternal pertussis vaccination, infant immunization, and risk of pertussis. Pediatrics 2023; 152: e2023062664.
6. Amirthalingam G, Andrews N, Campbell H, et al. Effectiveness of maternal pertussis vaccination in England: an observational study. Lancet 2014; 384: 1521‐1528.
7. Beard FH. Pertussis immunisation in pregnancy: a summary of funded Australian state and territory programs. Commun Dis Intell Q Rep 2015; 39: E329‐E336.
8. McHugh L, Van Buynder P, Sarna M, et al. Timing and temporal trends of influenza and pertussis vaccinations during pregnancy in three Australian jurisdictions: the Links2HealthierBubs population‐based linked cohort study, 2012–17. Aust N Z J Obstet Gynaecol 2023; 63: 27‐33.
9. McRae JE, McHugh L, King C, et al. Influenza and pertussis vaccine coverage in pregnancy in Australia, 2016–2021. Med J Aust 2023; 218: 528‐541. https://www.mja.com.au/journal/2023/218/11/influenza‐and‐pertussis‐vaccine‐coverage‐pregnancy‐australia‐2016‐2021
10. McHugh L, Viney KA, Andrews RM, Lambert SB. Pertussis epidemiology prior to the introduction of a maternal vaccination program, Queensland Australia. Epidemiol Infect 2017; 146: 207‐217.
11. Joseph T, Menzies R, Sinclair M. Vaccination for our mob, 2006–2010. Summary report of Vaccine preventable diseases and vaccination coverage in Aboriginal and Torres Strait Islander people, Australia, 2006 to 2010. Sydney: National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases, 2014; pp. 27‐29. https://nacchocommunique.com/wp‐content/uploads/2017/04/vaccination‐for‐our‐mob‐2006‐2010.pdf (viewed Dec 2023).
12. Quinn HE, Comeau JL, Marshall HS, et al. Pertussis disease and antenatal vaccine effectiveness in Australian children. Pediatr Infect Dis J 2021; 41: 180‐185.
13. Saul N, Wang K, Bag S, et al. Effectiveness of maternal pertussis vaccination in preventing infection and disease in infants: the NSW public health network case–control study. Vaccine 2018; 36: 1887‐1892.
14. Sarna M, Andrews RM, Moore H, et al. “Links2HealthierBubs” cohort study: protocol for a record linkage study on the safety, uptake and effectiveness of influenza and pertussis vaccines among pregnant Australian women. BMJ Open 2019; 9: e030277.
15. Christensen D, Davis G, Draper G, et al. Evidence for the use of an algorithm in resolving inconsistent and missing Indigenous status in administrative data collections. Aust J Soc Issues 2014; 49: 423‐443.
16. Australian Bureau of Statistics. Australian Statistical Geography Standard (ASGS): Volume 5. Remoteness structure, July 2016 (1270.0.55.005). 16 Mar 2018. https://www.abs.gov.au/ausstats/abs@.nsf/mf/1270.0.55.005 (viewed Dec 2023).
17. Australian Bureau of Statistics. IRSAD. In: Census of Population and Housing: Socio‐Economic Indexes for Areas (SEIFA), Australia, 2016 (2033.0.55.001). 27 Mar 2018. https://www.abs.gov.au/statistics/people/people‐and‐communities/socio‐economic‐indexes‐areas‐seifa‐australia/latest‐release#index‐of‐relative‐socio‐economic‐advantage‐and‐disadvantage‐irsad‐ (viewed Dec 2023).
18. McHugh L, Regan AK, Sarna M, et al. Inequity of antenatal influenza and pertussis vaccine coverage in Australia: the Links2HealthierBubs record linkage cohort study, 2012–2017. [Cited here: supplementary figure 1 and table 2]. BMC Pregnancy Childbirth 2023; 23: 314.
19. Vygen‐Bonnet S, Hellenbrand W, Garbe E, et al. Safety and effectiveness of acellular pertussis vaccination during pregnancy: a systematic review. BMC Infect Dis 2020; 20: 136.
20. Rowe SL, Leder K, Perrett KP, et al. Maternal vaccination and infant influenza and pertussis. Pediatrics 2021; 148: e2021051076.
21. Queensland Department of Health. First Nations COVID‐19 vaccination training. 2022. https://clinicalexcellence.qld.gov.au/showcase/events/showcase‐2022/care‐for‐mob/covid‐vaccination‐training.html (viewed Nov 2023).

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Editorials

Equitable access to abortion care is still not a reality in Australia

Asvini K Subasinghe and Seema Deb

Med J Aust 2024; 220 (3): . || doi: 10.5694/mja2.52210
Published online: 19 February 2024

ARTICLE
AUTHORS
REFERENCES

Topics

Women's health

Social determinants of health

General medicine

Health services administration

Health occupations

The 2023 Senate inquiry into universal access to reproductive health care identified major structural barriers to abortion care in Australia.1 However, in the absence of a national abortion registry, it is unclear whether access is equitable and what factors influence the provision of abortion care. In two articles published in this issue of the MJA, researchers report large population‐based studies that investigated these questions in Victoria.

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1 Monash University, Melbourne, VIC
2 Eastern Health, Box Hill Hospital, Melbourne, VIC

Correspondence: asvini.subasinghe@monash.edu

Competing interests:

No relevant disclosures.

1. Community Affairs References Committee. Ending the postcode lottery: addressing barriers to sexual, maternity and reproductive healthcare in Australia. May 2023. https://parlinfo.aph.gov.au/parlInfo/download/committees/reportsen/RB000075/toc_pdf/EndingthepostcodelotteryAddressingbarrierstosexual,maternityandreproductivehealthcareinAustralia.pdf (viewed June 2023).
2. Marzan M, Johnson E, Moore P, et al. Changes in the numbers of hospital‐based abortions and outpatient early medical abortions in Victoria, 2012–22: a retrospective cohort study. Med J Aust 2024; 220: 145‐153.
3. Subasinghe AK, Mogharbel C, Hill D, Mazza D. Changes in women's health service seeking behaviours and the impact of telehealth during COVID‐19: Insights from the 1800MyOptions service. Aust N Z J Obstet Gynaecol 2021; 61: E26‐E27.
4. Edvardsson K, Black KI, Bateson D. et al. The prevalence of and factors associated with prior induced abortion among women who gave birth in Victoria, 2010–2019. Med J Aust 2024; 220: 138‐144.
5. Grzeskowiak LE, Rumbold AR, Subasinghe A, et al. Long‐acting reversible contraception use after medical abortion is associated with reduced likelihood of a second medical abortion. Med J Aust 2022; 216: 476‐477. https://www.mja.com.au/journal/2022/216/9/long‐acting‐reversible‐contraception‐use‐after‐medical‐abortion‐associated
6. Rowe H, Holton S, Kirkman M, et al. Prevalence and distribution of unintended pregnancy: the understanding fertility management in Australia national survey. Aust N Z J Public Health 2016;40:104‐109.
7. Therapeutic Goods Administration. Amendments to restrictions for prescribing of MS‐2 Step (mifepristone and misoprostol). 11 July 2023. https://www.tga.gov.au/news/media‐releases/amendments‐restrictions‐prescribing‐ms‐2‐step‐mifepristone‐and‐misoprostol (viewed Oct 2023).
8. Australian Department of Health and Aged Care. Continuing MBS telehealth – video and phone services. Updated 22 Dec 2023. https://www.mbsonline.gov.au/internet/mbsonline/publishing.nsf/content/38CA335B16BB8661CA25897300829588/$File/PDF%20Version%20Factsheet%20Medical%20Practitioners%20in%20general%20practice%201%20January%202024%20final.pdf (viewed Dec 2023).
9. ACT Government. No cost abortions now available in ACT [media release]. 20 Apr 2023. https://www.cmtedd.act.gov.au/open_government/inform/act_government_media_releases/yvette‐berry‐mla‐media‐releases/2023/no‐cost‐abortions‐now‐available‐in‐the‐act (viewed Dec 2023).
10. Royal Australian and New Zealand College of Obstetricians and Gynaecologists. Clinical guidelines for abortion care: an evidence‐based guideline on abortion care in Australia and Aotearoa New Zealand. Melbourne: RANZCOG, 2023. https://ranzcog.edu.au/news/clinical‐guideline‐for‐abortion‐care (viewed Dec 2023).
11. Royal Australian and New Zealand College of Obstetricians and Gynaecologists. Clinical Guideline for abortion care: an evidence‐based guideline on abortion care in Australia and Aotearoa New Zealand. 31 Oct 2023. https://ranzcog.edu.au/resources/abortion‐guideline (viewed Dec 2023).
12. Minister for Health (Victoria). Improving abortion access across Melbourne [media release] 29 Nov 2023. https://www.premier.vic.gov.au/sites/default/files/2023‐11/231129‐Improving‐Abortion‐Access‐Across‐Melbourne.pdf (viewed Jan 2024).
13. Mazza D. Reimagining medical abortion in Australia: what do we need to do to meet women's needs and ensure ongoing access? Med J Aust 2023; 218: 496‐498. https://www.mja.com.au/journal/2023/218/11/reimagining‐medical‐abortion‐australia‐what‐do‐we‐need‐do‐meet‐womens‐needs‐and
14. Moulton JE, Mazza D, Tomnay J, et al. Co‐design of a nurse‐led model of care to increase access to medical abortion and contraception in rural and regional general practice: a protocol. Aust J Rural Health 2022; 30: 876‐883.
15. Subasinghe AK, McGeechan K, Moulton JE, et al. Early medical abortion services provided in Australian primary care. Med J Aust 2021; 215: 366‐370. https://www.mja.com.au/journal/2021/215/8/early‐medical‐abortion‐services‐provided‐australian‐primary‐care
16. Singh R, Mazza D, Moloney L, et al. General practitioner experiences in delivering early medical abortion services to women from culturally and linguistically diverse backgrounds: a qualitative‐descriptive study. Aust J Gen Pract 2023; 52: 557‐564.

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Scoping review

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The participation of Aboriginal and Torres Strait Islander parents in Australian trials of parenting programs for improving children's health: a scoping review

Jake MacDonald, Myles Young, Briana Barclay, Stacey McMullen, James Knox and Philip Morgan

Med J Aust || doi: 10.5694/mja2.52198
Published online: 12 February 2024

ARTICLE
AUTHORS
REFERENCES

Topics

Pediatric medicine

Indigenous health

Mental disorders

Abstract

Objectives: To assess the inclusion of Aboriginal and Torres Strait Islander parents in trials of parenting programs in Australia; the involvement of Indigenous fathers in such studies; and whether parenting programs are designed to be culturally appropriate for Aboriginal and Torres Strait Islander people.

Study design: Scoping review of peer‐reviewed journal publications that report quantitative outcomes for Australian randomised control trials of parenting programs in which the participants were parents or caregivers of children under 18 years of age, and with at least one outcome related to children's health, health behaviour, or wellbeing.

Data sources: MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and Scopus databases.

Data synthesis: Of 109 eligible publications, nine reported how many participants were Aboriginal or Torres Strait Islander people; three specified whether they were Aboriginal, Torres Strait Islander, or both. Two publications described specific interventions for Aboriginal and Torres Strait Islander children; both reported consultation with Indigenous people regarding program design. Of the 15 559 participating parents in all included publications, 93 were identified as Aboriginal or Torres Strait Islander people. No publications noted as study limitations the absence of consultation with Indigenous people or the low participation rate of Aboriginal and Torres Strait Islander families.

Conclusions: The specific needs and interests of Aboriginal and Torres Strait Islander families have not generally been considered in Australian trials of parenting programs that aim to improve the mental and physical health of children. Further, Indigenous people are rarely involved in the planning and implementation of the interventions, few of which are designed to be culturally appropriate for Indigenous people. If parenting research in Australia is to support Aboriginal and Torres Strait Islander families, it must include consultation with local communities, adapt interventions and research methods to the needs of the participating parents and their communities, and improve the recruitment and retention of Aboriginal and Torres Strait Islander participants.

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1 Office of Indigenous Strategy and Leadership, University of Newcastle, Newcastle, NSW
2 The University of Newcastle, Newcastle, NSW
3 Centre for Active Living and Learning, University of Newcastle, Newcastle, NSW

Correspondence: jake.macdonald@newcastle.edu.au

Open access:

Open access publishing facilitated by The University of Newcastle, as part of the Wiley ‐ The University of Newcastle agreement via the Council of Australian University Librarians.

Competing interests:

No relevant disclosures.

1. Bailey EL, van der Zwan R, Phelan TW, Brooks A. The 1‐2‐3 magic program: implementation outcomes of an Australian pilot evaluation with school‐aged children. Child Fam Behav Ther 2012; 34: 53‐69.
2. Stevens J, Binns A, Morgan B, Egger G. Meaninglessness, alienation, and loss of culture/identity (MAL) as determinants of chronic disease. In: Egger G, Binns A, Rössner S, Sagner M, editors. Lifestyle medicine; third edition. London: Academic Press, 2017; pp. 317‐325.
3. Australian Bureau of Statistics. National Aboriginal and Torres Strait Islander health survey. Reference period 2018–19 financial year. 11 Dec 2019. https//www.abs.gov.au/statistics/people/aboriginal‐and‐torres‐strait‐islander‐peoples/national‐aboriginal‐and‐torres‐strait‐islander‐health‐survey/latest‐release (viewed Sept 2023).
4. Canuto K, Harfield SG, Canuto KJ, Brown A. Aboriginal and Torres Strait Islander men and parenting: a scoping review. Aust J Primary Health 2019; 26: 1‐9.
5. Stuart G, May C, Hammond C. Engaging Aboriginal fathers. Developing Practice 2015; 42: 4‐17.
6. Bessarab D, Ng'andu B. Yarning about yarning as a legitimate method in Indigenous research. International Journal of Critical Indigenous Studies 2010; 3: 37–51.
7. Reilly L, Rees SJ. Fatherhood in Australian Aboriginal and Torres Strait Islander communities: an examination of barriers and opportunities to strengthen the male parenting role. Am J Mens Health 2018; 12: 420‐430.
8. Ryan F. Kanyininpa (holding): a way of nurturing children in Aboriginal Australia. Aust Social Work 2011; 64: 183‐197.
9. Central Australian Aboriginal Congress. Aboriginal male health summit 2008 [draft report]. 20 July 2008. https://nacchocommunique.com/wp‐content/uploads/2018/06/2008‐national‐male‐health‐summit‐of‐reports‐1‐and‐2.pdf (viewed Sept 2023).
10. Tricco AC, Lillie E, Zarin W, et al. PRISMA extension for scoping reviews (PRISMA‐ScR): checklist and explanation. Ann Intern Med 2018; 169: 467‐473.
11. Morgan PJ, Young MD, Lloyd, AB, et al. Involvement of fathers in pediatric obesity treatment and prevention trials: a systematic review. Pediatrics 2017; 139: e20162635.
12. Turner KMT, Richards M, Sanders MR. Randomised clinical trial of a group parent education programme for Australian Indigenous families. J Paediatr Child Health 2007; 3: 429‐437.
13. Pineda J, Dadds MR. Family intervention for adolescents with suicidal behavior: a randomized controlled trial and mediation analysis. J Am Acad Child Adolesc Psychiatry 2013; 52: 851‐862.
14. Hammersley ML, Okely AD, Batterham MJ, Jones RA. An internet‐based childhood obesity prevention program (Time2bHealthy) for parents of preschool‐aged children: randomized controlled trial. J Med Internet Res 2019; 21: e11964.
15. Tonge B, Brereton A, Kiomall M, et al. A randomised group comparison controlled trial of “preschoolers with autism”: a parent education and skills training intervention for young children with autistic disorder. Autism 2014; 18: 166‐177.
16. Duncanson K, Burrows T, Collins C. Effect of a low‐intensity parent‐focused nutrition intervention on dietary intake of 2‐to 5‐year olds. J Pediatr Gastroenterol Nutr 2013; 57: 728‐734.
17. Thomas R, Zimmer‐Gembeck MJ. Parent–child interaction therapy: an evidence‐based treatment for child maltreatment. Child Maltreat 2012; 17: 253‐266.
18. Fraser JA, Armstrong KL, Morris JP, Dadds MR. Home visiting intervention for vulnerable families with newborns: follow‐up results of a randomized controlled trial. Child Abuse Negl 2000; 24: 1399‐1429.
19. Hart LM, Damiano SR, Paxton SJ. Confident body, confident child: a randomized controlled trial evaluation of a parenting resource for promoting healthy body image and eating patterns in 2‐to 6‐year old children. Int J Eat Disord 2016; 49: 458‐472.
20. Wyse R, Wolfenden L, Campbell E, et al. A cluster randomized controlled trial of a telephone‐based parent intervention to increase preschoolers’ fruit and vegetable consumption. Am J Clin Nutr 2012; 96: 102‐110.
21. Slade GD, Bailie RS, Roberts‐Thomson K, et al. Effect of health promotion and fluoride varnish on dental caries among Australian Aboriginal children: results from a community‐randomized controlled trial. Community Dent Oral Epidemiol 2011; 39: 29‐43.
22. Young MD, Morgan PJ. Paternal physical activity: an important target to improve the health of fathers and their children. Am J Lifestyle Med 2017; 11: 212‐215.
23. Jia T. Indigenous young fathers’ support group. Aboriginal Isl Health Work J 2000; 24: 18‐20.

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Perspectives

Baby steps in lobbying reform: opportunities and challenges in Queensland

Jennifer Lacy‐Nichols and Katherine B Cullerton

Med J Aust 2024; 220 (2): . || doi: 10.5694/mja2.52187
Published online: 5 February 2024

ARTICLE
AUTHORS
REFERENCES

Topics

Environment and public health

Health services administration

Information science

Australia is lacklustre in its political transparency. This makes it challenging to see if commercial actors have undue influence over policy decisions, which is a risk for public health.

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1 University of Melbourne, Melbourne, VIC
2 University of Queensland, Brisbane, QLD

Correspondence: jennifer.lacy@unimelb.edu.au

Acknowledgements:

Jennifer Lacy‐Nichols is the recipient of a fellowship to research the commercial determinants of health from the Victorian Health Promotion Foundation (VicHealth). VicHealth had no role in the planning, writing or publication of the work.

Competing interests:

No relevant disclosures.

1. Access Info Europe, Open Knowledge, Sunlight Foundation, Transparency International. International Standards for Lobbying Regulation. Access Info Europe, Open Knowledge, Sunlight Foundation, Transparency International; 2015. https://lobbyingtransparency.net/lobbyingtransparency.pdf (viewed Nov 2023).
2. Chapman S. Public health advocacy and tobacco control: making smoking history. John Wiley and Sons, 2007.
3. Daube M, Maddox R. Impossible until implemented: New Zealand shows the way. Tob Control 2021; 30: 361‐362.
4. Sainsbury E, Magnusson R, Thow AM, Colagiuri S. Explaining resistance to regulatory interventions to prevent obesity and improve nutrition: a case‐study of a sugar‐sweetened beverages tax in Australia. Food Policy 2020; 93: 101904.
5. Heenan M, Shanthosh J, Cullerton K, Jan S. Influencing and implementing mandatory alcohol pregnancy warning labels in Australia and New Zealand. Health Promot Int 2023; 38: daac022.
6. Pettigrew S, Coyle D, McKenzie B, et al. A review of front‐of‐pack nutrition labelling in Southeast Asia: Industry interference, lessons learned, and future directions. Lancet Reg Health Southeast Asia 2022; 3: 100017.
7. Lacy‐Nichols J, Cullerton K. A proposal for systematic monitoring of the commercial determinants of health: a pilot study assessing the feasibility of monitoring lobbying and political donations in Australia. Global Health 2023; 19: 2.
8. Johnson M, Livingstone C. Measuring influence: an analysis of Australian gambling industry political donations and policy decisions. Addict Res Theory 2021; 29: 196‐204.
9. Robertson NM, Sacks G, Miller PG. The revolving door between government and the alcohol, food and gambling industries in Australia. Public Health Res Pract 2019; 29: 2931921.
10. Tham JC. Democracy before dollars: the problems with money in Australian politics and how to fix them. AQ: Australian Quarterly 2019; 90: 20‐32.
11. Halpin D, Warhurst J. Commercial lobbying in Australia: exploring the Australian Lobby Register. Australian Journal of Public Administration 2016; 75: 100‐111.
12. Lacy‐Nichols J, Johnson M, Cullerton K. Commercial lobbying and political contributions: an Australian scoping review. Aust N Z J Public Health 2023; 47: 100073.
13. Lacy‐Nichols J, Christie S, Cullerton K. Lobbying by omission: what is known and unknown about harmful industry lobbyists in Australia. Health Promot Int 2023; 38: daad134.
14. Brown A, Ankamah S, Coghill K, et al. Australia's National Integrity System: the blueprint for action. Gold Coast: Griffith University, 2020. https://transparency.org.au/australias‐national‐integrity‐system/ (viewed Aug 2023).
15. Knaus C, Evershed N. “In the family”: majority of Australia's lobbyists are former political insiders. The Guardian 2018; 17 Sept. https://www.theguardian.com/australia‐news/2018/sep/16/in‐the‐family‐majority‐of‐australias‐lobbyists‐are‐former‐political‐insiders (viewed Mar 2023).
16. Wood D, Griffiths K. Who's in the room? Access and influence in Australian politics. Melbourne: Grattan Institute, 2018. https://grattan.edu.au/report/whos‐in‐the‐room/ (viewed Aug 2023).
17. Queensland Integrity Commission. Lobbying Register. Brisbane: State of Queensland, 2023. https://lobbyists.integrity.qld.gov.au/Lobbying‐Register/ (viewed Nov 2023).
18. Queensland Integrity Commissioner. Lobbyists’ Code of Conduct. Brisbane: State of Queensland, 2023. https://www.integrity.qld.gov.au/assets/document/catalogue/general/lobbyists_code_of_conduct_Sept_2013.pdf (viewed Dec 2023).
19. Global Data Barometer. First edition report — Global Data Barometer. IL‐DA, 2022. https://globaldatabarometer.org/wp‐content/uploads/2022/05/GDB‐Report‐English.pdf (viewed Aug 2023).
20. Organisation for Economic Co‐operation and Development. Lobbying in the 21st century: transparency, integrity and access. Paris: OECD Publishing, 2021.
21. Jones SC, Hall S, Kypri K. Should I drink responsibly, safely or properly? Confusing messages about reducing alcohol‐related harm. PLoS One 2017; 12: e0184705.
22. Jones SC, Wyatt A, Daube M. Smokescreens and beer goggles: how alcohol industry CSM protects the industry. Social Marketing Quarterly 2015; 22: 264‐279.
23. Chari R, Hogan J, Murphy G, Crepaz M. Regulating lobbying: a global comparison, 2nd ed. Manchester: Manchester University Press, 2020.
24. Laboutková Š, Vymětal P. A black box assessment of institutional quality: the challenge of evaluating lobbying transparency. Policy Studies 2023; 44: 336‐355.

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Perspectives

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Why clinical artificial intelligence is (almost) non‐existent in Australian hospitals and how to fix it

Anton van der Vegt, Victoria Campbell and Guido Zuccon

Med J Aust || doi: 10.5694/mja2.52195
Published online: 5 February 2024

ARTICLE
AUTHORS
REFERENCES

Topics

General medicine

Information science

Health services administration

In‐hospital clinical artificial intelligence (AI) encompasses learning algorithms that use real‐time electronic medical record (EMR) data to support clinicians in making treatment, prognostic or diagnostic decisions. In the United States, the implementation of hospital‐based clinical AI, such as sepsis or deterioration prediction, has accelerated over the past five years,1 while in Australia, outside of digital imaging‐based AI products, nearly all hospitals remain clinical AI‐free zones. Some would argue this is a good thing, both prudent and sensibly cautious given the wide ranging ethical, privacy and safety concerns;2,3 others contend our consumers are missing out on important interventions that save lives and improve care.4,5 In this perspective article, we argue that in‐hospital clinical AI excluding imaging‐based products (herein referred to as “clinical AI”) can improve care and we examine what is preventing clinical AI uptake in Australia and how to start to remedy it.

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1 Centre for Health Services Research, University of Queensland, Brisbane, QLD
2 Sunshine Coast University Hospital, Sunshine Coast, QLD
3 University of Queensland, Brisbane, QLD

Correspondence: a.vandervegt@uq.edu.au

Open access:

Open access publishing facilitated by The University of Queensland, as part of the Wiley ‐ The University of Queensland agreement via the Council of Australian University Librarians.

Acknowledgements:

Anton van der Vegt is supported by the Advance Queensland Industry Research Fellowship granted by the Queensland Government. The funder played no role in the writing or publication of this study.

Competing interests:

No relevant disclosures.

1. Lee D, Yoon SN. Application of artificial intelligence‐based technologies in the healthcare industry: opportunities and challenges. Int J Environ Res Public Health 2021; 18: 1‐18.
2. Harrison S, Despotou G, Arvanitis TN. Hazards for the implementation and use of artificial intelligence enabled digital health interventions, a UK perspective. Stud Health Technol Inform 2022; 289: 14‐17.
3. Rajkomar A, Hardt M, Howell MD, et al. Ensuring fairness in machine learning to advance health equity. Ann Intern Med 2018; 169: 866‐872.
4. Herasevich S, Lipatov K, Pinevich Y, et al. The impact of health information technology for early detection of patient deterioration on mortality and length of stay in the hospital acute care setting: systematic review and meta‐analysis. Crit Care Med 2022; 50: 1198‐1209.
5. van der Vegt AH, Scott IA, Dermawan K, et al. Deployment of machine learning algorithms to predict sepsis: systematic review and application of the SALIENT clinical AI implementation framework. J Am Med Inform Assoc 2023; 30: 1349‐1361.
6. Schootman M, Wiskow C, Loux T, et al. Evaluation of the effectiveness of an automated sepsis predictive tool on patient outcomes. J Crit Care 2022; 71: 154061.
7. Wong A, Otles E, Donnelly JP, et al. External validation of a widely implemented proprietary sepsis prediction model in hospitalized patients. JAMA Intern Med 2021; 181: 1065‐1070.
8. Beede E, Baylor E, Hersch F, et al. A human‐centered evaluation of a deep learning system deployed in clinics for the detection of diabetic retinopathy. Proceedings of the Conference on Human Factors in Computing Systems; Honolulu (USA), 25–30 April 2020. New York (NY): Association for Computing Machinery, 2020. https://dl.acm.org/doi/abs/10.1145/3313831.3376718 (viewed Nov 2023).
9. Daneshjou R, Vodrahalli K, Novoa RA, et al. Disparities in dermatology AI performance on a diverse, curated clinical image set. Sci Adv 2022; 8: eabq6147.
10. Lohr S. What ever happened to IBM's Watson? The New York Times 2021; 16 July. https://www.nytimes.com/2021/07/16/technology/what‐happened‐ibm‐watson.html#:~:text=Watsonstruggledtodecipherdoctors,Andersonshutdowntheproject (viewed May 2023).
11. OECD.AI Policy Observatory. AI and health [website]. Organisation for Economic Co‐operation and Development, 2023 https://oecd.ai/en/dashboards/policy‐areas/PA11 (viewed May 2023).
12. van der Vegt AH, Campbell V, Mitchell I, et al. Systematic review and longitudinal analysis of implementing Artificial Intelligence to predict clinical deterioration in adult hospitals: what is known and what remains uncertain. Journal of the American Medical Informatics Association 2023; https://doi.org/10.1093/jamia/ocad220.
13. Isbanner S, O'Shaughnessy P, Steel D, et al. The adoption of artificial intelligence in health care and social services in Australia: findings from a methodologically innovative national survey of values and attitudes (the AVA‐AI study). J Med Internet Res 2022; 24: e37611.
14. Hashiguchi TCO, Oderkirk J, Slawomirski L. Fulfilling the Promise of Artificial Intelligence in the Health Sector: Let's Get Real. Value Health 2022; 25: 368‐373.
15. World Health Organization. WHO calls for safe and ethical AI for health [news release]. 16 May 2023 https://www.who.int/news/item/16‐05‐2023‐who‐calls‐for‐safe‐and‐ethical‐ai‐for‐health (viewed May 2023).
16. van der Vegt A, Scott IA, Dermawan K, et al. Implementation frameworks for end‐to‐end clinical AI: derivation of the SALIENT framework. J Am Med Inform Assoc 2023; 30: 1503‐1515.
17. Moons KGM, Altman DG, Reitsma JB, et al. Transparent reporting of a multivariable prediction model for individual prognosis or diagnosis (TRIPOD): explanation and elaboration. Ann Intern Med 2015; 162: W1‐W73.
18. Vasey B, Nagendran M, Campbell B, et al. Reporting guideline for the early stage clinical evaluation of decision support systems driven by artificial intelligence: DECIDE‐AI. BMJ 2022; 377: e070904.
19. Liu X, Rivera SC, Moher D, et al. Reporting guidelines for clinical trial reports for interventions involving artificial intelligence: the CONSORT‐AI extension. BMJ 2020; 370: 1364‐1374.
20. Callahan A, Ashley E, Datta S, et al. The Stanford Medicine data science ecosystem for clinical and translational research. JAMIA Open 2023; 6: ooad054.

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Contemporary management of advanced colorectal cancer: the Australian experience

Kilian GM Brown, Nabila Ansari and Michael J Solomon

Med J Aust || doi: 10.5694/mja2.52218
Published online: 5 February 2024

ARTICLE
AUTHORS
REFERENCES

Topics

Surgical procedures, operative

Neoplasms

Colorectal cancer (CRC) is the third most common cancer in Australia, with almost 16 000 new cases in 2022 accounting for 10% of new cancer diagnoses and 11% of cancer‐related deaths.1 There has been a well documented increase in the incidence of CRC in people under the age of 50 years in Australia in recent decades, while the incidence in those older than 50 years has decreased over the same period.2 Treatment of CRC has evolved dramatically in the 21st century, particularly for patients with advanced disease. Advances in medical imaging and peri‐operative medicine, as well as refinement of surgical techniques, have facilitated radical resection in selected patients with advanced or recurrent local disease, as well as those with limited metastases, who would otherwise be considered incurable. Improvements in systemic therapy mean that, in contemporary practice, many patients with metastatic (stage IV) CRC who historically had few systemic treatment options and a poor anticipated survival may now be afforded durable disease control and have a life expectancy measured in years rather than months. CRC is increasingly understood to be a biologically heterogenous disease. As the behaviour of individual tumours is better characterised by their molecular profiles, targeted systematic therapy combined with ablative techniques and radical surgery in selected patients can be expected to further improve outcomes. This article describes recent developments in the management of advanced CRC and how these advances are reflected in contemporary Australian practice.

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1 Royal Prince Alfred Hospital, Sydney, NSW
2 Surgical Outcomes Research Centre, Royal Prince Alfred Hospital and University of Sydney, Sydney, NSW

Correspondence: professor.solomon@sydney.edu.au

Open access:

Open access publishing facilitated by The University of Sydney, as part of the Wiley – The University of Sydney agreement via the Council of Australian University Librarians.

Competing interests:

No relevant disclosures.

1. Cancer Australia. Bowel cancer (colorectal cancer) in Australia statistics. Updated 31 Aug 2022. https://bowel‐cancer.canceraustralia.gov.au/statistics (viewed June 2023).
2. Feletto E, Yu XQ, Lew JB, et al. Trends in colon and rectal cancer incidence in Australia from 1982 to 2014: analysis of data on over 375,000 cases. Cancer Epidemiol Biomarkers Prev 2019; 28: 83‐90.
3. Temmink SJD, Peeters KCMJ, Bahadoer RR, et al. Watch and wait after neoadjuvant treatment in rectal cancer: comparison of outcomes in patients with and without a complete response at first reassessment in the International Watch & Wait Database (IWWD). Br J Surg 2023; 110: 676‐684,
4. Brown KGM, Solomon MJ, Heriot A, Frizelle F. Treatment of locally advanced and recurrent rectal cancer in Australia and New Zealand: recent progress and future challenges. ANZ J Surg 2023; 93: 2291‐2292.
5. Steffens D, Solomon MJ, Lee P, et al. Surgical, survival and quality of life outcomes in over 1000 pelvic exenterations: lessons learned from a large Australian case series. ANZ J Surg 2023; 93: 1232‐1241.
6. Kong JC, Peacock O, Waters PS, et al. Predictors of overall survival following extended radical resections for locally advanced and recurrent pelvic malignancies. Langenbecks Arch Surg 2020; 405: 491‐502.
7. Johnstone P, Okonta L, Aitken K, et al. A multicentre retrospective review of SABR reirradiation in rectal cancer recurrence. Radiother Oncol 2021; 162: 1‐6.
8. Nordlinger B, Sorbye H, Glimelius B, et al. Perioperative FOLFOX4 chemotherapy and surgery versus surgery alone for resectable liver metastases from colorectal cancer (EORTC 40983): long‐term results of a randomised, controlled, phase 3 trial. Lancet Oncol 2013; 14: 1208‐1215.
9. Zabaleta J, Iida T, Falcoz PE, et al. Individual data meta‐analysis for the study of survival after pulmonary metastasectomy in colorectal cancer patients: a history of resected liver metastases worsens the prognosis. Eur J Surg Oncol 2018; 44: 1006‐1012.
10. Jayne DG, Fook S, Loi C, Seow‐Choen F. Peritoneal carcinomatosis from colorectal cancer. Br J Surg 2002; 89: 1545‐1550.
11. Verwaal VJ, van Ruth S, de Bree E, et al. Randomized trial of cytoreduction and hyperthermic intraperitoneal chemotherapy versus systemic chemotherapy and palliative surgery in patients with peritoneal carcinomatosis of colorectal cancer. J Clin Oncol 2003; 21: 3737‐3743.
12. Flood M, Narasimhan V, Waters P, et al. Survival after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for colorectal peritoneal metastases: a systematic review and discussion of latest controversies. Surgeon 2021; 19: 310‐320.
13. Quenet F, Elias D, Roca L, et al. Cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy versus cytoreductive surgery alone for colorectal peritoneal metastases (PRODIGE 7): a multicentre, randomised, open‐label, phase 3 trial. Lancet Oncol 2021; 22: 256‐266.
14. Koh CE, Ansari N, Morris D, et al. Beware mis‐representation of PRODIGE 7: danger of throwing out the cytoreductive surgery baby with the hyperthermic intraperitoneal chemotherapy bathwater. ANZ J Surg 2019; 89: 992‐994.
15. Raoof M, Whelan RL, Sullivan KM, et al. Safety and efficacy of oxaliplatin pressurized intraperitoneal aerosolized chemotherapy (PIPAC) in colorectal and appendiceal cancer with peritoneal metastases: results of a multicenter phase I trial in the USA. Ann Surg Oncol 2023; 30: 7814‐7824.
16. Cercek A, Lumish M, Sinopoli J, et al. PD‐1 blockade in mismatch repair‐deficient, locally advanced rectal cancer. N Engl J Med 2022; 386: 2363‐2376.
17. Chalabi M, Verschoor YL, van den Berg J, et al. Neoadjuvant immune checkpoint inhibition in locally advanced MMR‐deficient colon cancer: the NICHE‐2 study [abstract]. Ann Oncol 2022; 33 (S7): S1389.
18. Kopetz S, Grothey A, Yaeger R, et al. Encorafenib, binimetinib, and cetuximab in BRAF V600E‐mutated colorectal cancer. N Engl J Med 2019; 381: 1632‐1643.

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Sexual and reproductive health and rights in Australia: we have much to celebrate but must not be complacent

Catriona Melville and Bonney Corbin

Med J Aust || doi: 10.5694/mja2.52194
Published online: 29 January 2024

ARTICLE
AUTHORS
REFERENCES

Topics

Women's health

Social determinants of health

Ethics and law

In a world where sexual and reproductive injustice continues, Australia has been quietly making changes for the better. Australian sexual and reproductive health law reforms have been prodigious in recent years: we have seen more changes in the past six years than in the previous 60. Alongside Australia's progression, however, sexual and reproductive rights have been considerably eroded in other countries. How does the global context of reproductive rights affect Australia? And how can we protect not only our hard‐fought liberties but also ensure they are equitable and clinically fit for purpose?

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MSI Australia, Melbourne, VIC

Correspondence: catriona.melville@msiaustralia.org.au

Competing interests:

No relevant disclosures.

1. United Nations Women. The Beijing Declaration and Platform for Action. New York (NY): United Nations, 1995. https://www.un.org/womenwatch/daw/beijing/pdf/BDPfA%20E.pdf (viewed Dec 2023).
2. United Nations. The Cairo Declaration on Population and Development, Cairo: United Nations, 1994. https://www.unfpa.org/resources/cairo‐declaration‐population‐development (viewed Dec 2023).
3. Starrs AM, Ezeh AC, Barker G, et al. Accelerate progress — sexual and reproductive health and rights for all: report of the Guttmacher–Lancet Commission. Lancet 2018; 391: 2642‐2692.
4. UNFPA, Danish Institute for Human Rights, United Nations Human Rights Office of the High Commissioner. Reproductive rights are human rights: a handbook for national human rights institutions. New York (NY): United Nations, 2014. https://www.ohchr.org/sites/default/files/NHRIHandbook.pdf (viewed July 2023).
5. Guttmacher Institute. Global and regional estimates of unintended pregnancy and abortion [website]. Guttmacher Institute, 2022. https://www.guttmacher.org/fact‐sheet/induced‐abortion‐worldwide (viewed July 2023).
6. Bolnga JW, Lufele E, Teno M, et al. Incidence of self‐induced abortion with misoprostol, admitted to a provincial hospital in Papua New Guinea: a prospective observational study. Aust N Z J Obstet Gynaecol 2021; 61: 955‐960.
7. Chan A, Sage LC. Estimating Australia's abortion rates 1985–2003. Med J Aust 2005; 182: 447‐452. https://www.mja.com.au/journal/2005/182/9/estimating‐australias‐abortion‐rates‐1985‐2003#:~:text=The%20estimated%20national%20abortion%20rate,an%20estimated%2084%20460%20abortions
8. Venegas M. Relationships and sex education in the age of anti‐gender movements: what challenges for democracy? Sex Education 2022; 22: 481‐495.
9. Orofino E, Allchorn W, editors. Routledge handbook of non‐violent extremism: groups, perspectives and new debates. Taylor and Francis, 2023.
10. Kováts E. The emergence of powerful anti‐gender movements in Europe and the crisis of liberal democracy. In: Köttig M, Bitzan R, Petö A; editors. Gender and far right politics in Europe. Gender and politics. Palgrave Macmillan, 2017; pp. 175‐189.
11. Baird B. Abortion care is health care. Melbourne: Melbourne University Press, 2003; p 232.
12. Penovic T. The fall of Roe v Wade, the US anti‐abortion movement and its influence in Australia. Alternative Law Journal 2022; 47: 253‐260.
13. MSI Australia. Safe access zones in Australia: legislative considerations. Melbourne: MSI Australia, 2021. https://resources.msiaustralia.org.au/Safe‐Access‐Zones‐in‐Australia.pdf (viewed July 2023).
14. Parliament of Australia. Ending the postcode lottery: addressing barriers to sexual, maternity and reproductive healthcare in Australia. Canberra: Commonwealth of Australia, 2023. https://www.aph.gov.au/Parliamentary_Business/Committees/Senate/Community_Affairs/ReproductiveHealthcare/Report (viewed July 2023).
15. Workman A. National push to safeguard abortion access. The Australian 2022; 18 July. https://www.msiaustralia.org.au/wp‐content/uploads/220718.‐Walker‐The‐Australian.‐National‐Plan‐to‐safeguard‐abortion‐access.pdf (viewed Dec 2023).
16. O'Rourke A. A legal and political assessment of challenges to abortion laws by anti‐choice activists in Australia and the progression of abortion law in Australia and the United States. American Journal of Comparative Law 2022; 70: 162‐204.
17. Millar E. COVID hurting abortion access nationwide [website]. Melbourne: La Trobe University, 2020. https://www.latrobe.edu.au/news/articles/2020/opinion/covid‐hurting‐abortion‐access‐nationwide (viewed Oct 2023).
18. Corbin B. “Disinformation”: Australia reaches critical reproductive rights “tipping point”. News.com 2023; 28 June. https://www.news.com.au/lifestyle/health/disinformation‐australia‐reaches‐critical‐reproductive‐rights‐tipping‐point/news‐story/94995aeed4a17c15f334c08e059fac9d (viewed July 2023).
19. Parliament of Australia. National Human Rights (Children Born Alive) Protection Bill 2022. https://www.aph.gov.au/Parliamentary_Business/Bills_Legislation/Bills_Search_Results/Result?bId=s1359 (viewed Dec 2023).
20. Parliament of New South Wales. New South Wales Crimes Amendment (Zoe's Law) Bill 2019. https://www.parliament.nsw.gov.au/bills/Pages/bill‐details.aspx?pk=3660 (viewed Dec 2023).
21. Women's Legal Service NSW. Foetal Personhood Bill (“Zoe's Law”). https://www.wlsnsw.org.au/law‐reform/past‐campaigns/zoes‐law/ (viewed Dec 2023).
22. Human Rights Law Centre. Explainer: responding to abortion and sex selection claims in WA. Melbourne: Human Rights Law Centre, 2023. https://www.hrlc.org.au/reports‐news‐commentary/9/14/wa‐abortion (viewed Dec 2023).
23. Royal Australian and New Zealand College of Obstetricians and Gynaecologists. Clinical guideline for abortion care: an evidence‐based guideline on abortion care in Australia and Aotearoa New Zealand. Melbourne: RANZCOG, 2023. https://ranzcog.edu.au/resources/abortion‐guideline/ (viewed Nov 2023).
24. Haining C, Willmott L, Keogh LA, White BP. Abortion law in Australia: conscientious objection and implications for access. Melbourne: Monash University, 2022. https://bridges.monash.edu/articles/journal_contribution/Abortion_Law_in_Australia_Conscientious_Objection_and_Implications_for_Access/21606360 (viewed Nov 2023).
25. Australian Government Department of Health and Aged Care; Pharmaceutical Benefits Advisory Committee. Items recommended out of session between ordinary meetings (March 2023 – July 2023), recommendation three. Canberra: Commonwealth of Australia, 2023. https://www.pbs.gov.au/industry/listing/elements/pbac‐meetings/pbac‐outcomes/out‐of‐session/items‐recommended‐between‐meetings‐OOS‐Mar23‐Jul23‐v2.pdf (viewed Aug 2023).
26. Fix L, Seymour JW, Sandhu MV, et al. At‐home telemedicine for medical abortion in Australia: a qualitative study of patient experiences and recommendations. BMJ Sex Reprod Health 2020; 46: 172‐176.
27. Parliament of Tasmania. House of Assembly — Estimates B, Hon Sarah Courtney MP [23 Nov 2020; pp 125‐126]. https://www.msiaustralia.org.au/wp‐content/uploads/HA‐Estimates‐B‐Monday‐23‐November‐Courtney.pdf (viewed Dec 2023).
28. ACT Government. No cost abortions now available in the ACT [media release]. 20 April 2023. https://www.act.gov.au/our‐canberra/latest‐news/2023/april/no‐cost‐abortions‐now‐available‐in‐the‐act (viewed July 2023).
29. Sifris R. Abortion in Australia: law, policy and the advancement of reproductive rights. In: Ziegler M; editor. Research handbook on international abortion law. Edward Elgar Publishing, 2023; pp. 124‐140.

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The provision of general surgery in rural Australia: a narrative review

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The Australian Government's new vaping policy should be part of a larger plan towards a tobacco endgame

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The provision of general surgery in rural Australia: a narrative review

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Do you have any competing interests to declare? *

The effectiveness of maternal pertussis vaccination for protecting Aboriginal and Torres Strait Islander infants against infection, 2012–2017: a retrospective cohort study

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Abstract

Author

Comment

Do you have any competing interests to declare? *

Equitable access to abortion care is still not a reality in Australia

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The participation of Aboriginal and Torres Strait Islander parents in Australian trials of parenting programs for improving children's health: a scoping review

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Comment

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Baby steps in lobbying reform: opportunities and challenges in Queensland

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Comment

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Why clinical artificial intelligence is (almost) non‐existent in Australian hospitals and how to fix it

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Comment

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Contemporary management of advanced colorectal cancer: the Australian experience

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Comment

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Sexual and reproductive health and rights in Australia: we have much to celebrate but must not be complacent

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Comment

Do you have any competing interests to declare? *

Socio‐economic status and access to fluoridated water in Queensland: an ecological data linkage study

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The Australian Government's new vaping policy should be part of a larger plan towards a tobacco endgame

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Pagination