Topics

Health professionals must be prepared to address the health risks and impacts of climate change

Between 2030 and 2050, climate change is expected to cause about 250 000 additional deaths per year.1 This does not include deaths from pollution, mental illness, extreme weather events and resultant migration and conflict, all of which carry significant morbidity and mortality risks. The medical profession has a responsibility to prepare practitioners and the health system for the escalating challenges of this health crisis.

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1 University of Melbourne, Melbourne, VIC
2 Centre for Health Policy, Melbourne School of Population and Global Health, Melbourne, VIC

Correspondence: burchh@unimelb.edu.au

Open access

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

Acknowledgements:

We thank the members of Doctors for the Environment Australia (DEA) for their clinical and research expertise, and the organisation for its graphic support to produce our final curriculum mapping resource.

Competing interests:

No relevant disclosures.

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20. Burch H, Watson B, Simpson G, et al. Mapping climate change and health into the medical curriculum: co‐development of a “planetary health–organ system map” for graduate medical education. Melbourne: Doctors for the Environment Australia, 2021. https://dea.org.au/wp‐content/uploads/2022/03/Mapping‐Climate‐Change‐FINAL‐v3‐compressed.pdf (viewed Apr 2021).
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Editorials

Feticide and late termination of pregnancy: an essential component of reproductive health care

Caroline M Costa

Med J Aust 2022; 217 (8): . || doi: 10.5694/mja2.51727
Published online: 17 October 2022

ARTICLE
AUTHORS
REFERENCES

Topics

Health occupations

Women's health

Decisions about late abortion and care for women and their families are supported by sensitive and professional care

Most pregnant women in Australia undergo some form of antenatal screening for fetal anomalies. This includes ultrasound scanning for fetal structural anomalies and combined first trimester screening, which is largely publicly funded, and non‐invasive prenatal screening for certain chromosomal or genetic conditions, currently available only at private expense.1

The Cairns Institute, James Cook University, Cairns, QLD

Correspondence: caroline.decosta@jcu.edu.au

Competing interests:

No relevant disclosures.

1. Hui L, Edwards L. First and second trimester screening for fetal structural anomalies. Semin Fetal Neonatal Med 2018; 23: 102‐111.
2. Down Syndrome Australia. Submission to Disability Royal Commission Health: Health issues paper (cited here: p. 9). Mar 2020. https://disability.royalcommission.gov.au/system/files/submission/ISS.001.00149_2.PDF (viewed Aug 2022).
3. National Institute for Health and Care Excellence. Abortion care (NICE guideline NG140). Sept 2019. https://www.nice.org.uk/guidance/ng140 (viewed July 2022).
4. Lou S, Castersen K, Petersen O, et al. Termination of pregnancy following a prenatal diagnosis of Down syndrome: a qualitative study of the decision‐making process of pregnant couples. Acta Obstet Gynecol Scand 2018; 97: 1228‐1236.
5. Pasquini l, Pontello V, Kumar S. Intra‐cardiac injection of potassium chloride as a method of feticide: experience from a single UK tertiary centre. BJOG 2008; 115: 528‐531.
6. Rosser S, Sekar R, Laporte J, et al. Late termination of pregnancy at a major Queensland tertiary hospital, 2010–2020. Med J Aust 2022; 217: 410‐414.
7. Graham D, Mason K, Rankin J, Robson SC. The role of feticide in the context of late termination of pregnancy: a qualitative study of health professionals’ and parents’ views. Prenat Diagn 2009; 29: 875‐881.
8. Janiak E, Freeman S, Maurer R, et al. Relationship of job role and clinic type to perceived stigma and occupational stress among abortion workers. Contraception 2018; 98: 517‐521.
9. Fitzsimmons C. What overturning Roe v Wade means for Australia. Sydney Morning Herald, 25 June 2022. https://www.smh.com.au/national/what‐overturning‐roe‐v‐wade‐means‐for‐australia‐20220625‐p5awk9.html (viewed July 2022).
10. Barratt A, McGeechan K, Black K, et al. Knowledge of current abortion law and views on abortion law reform: a community survey of NSW residents. Aust N Z J Public Health 2019; 43: 88‐93.

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Editorials

Breast cancer metastasis: mapping long term outcomes in Australia

Andrew Redfern and Hilary Martin

Med J Aust 2022; 217 (8): . || doi: 10.5694/mja2.51728
Published online: 17 October 2022

ARTICLE
AUTHORS
REFERENCES

Topics

Neoplasms

Statistics, epidemiology and research design

Characterising the ongoing but changing risk of relapse after breast cancer diagnosis improves surveillance planning and patient care

The high incidence of breast cancer and the enduring risk of relapse are major burdens for oncology care. Defining individual recurrence risk profiles would help optimise resource use when managing patients with breast cancer, but population‐based outcomes datasets are unfortunately scarce.

1 The University of Western Australia, Perth, WA
2 Fiona Stanley Hospital, Perth, WA

Correspondence: andrew.redfern@health.wa.gov.au

Competing interests:

No relevant disclosures.

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4. Mejri N, Boussen H, Labidi S, et al. Relapse profile of early breast cancer according to immunohistochemical subtypes: guidance for patient’s follow up? Ther Adv Med Oncol 2015; 7: 144‐152.
5. Luen SJ. Clinical implications of genomic driver alterations in hormone receptor‐positive, human epidermal growth factor receptor (HER) 2‐negative early breast cancer [doctoral thesis]. University of Melbourne, 2021. https://minerva‐access.unimelb.edu.au/items/97a5fd05‐1fe2‐5f6d‐9fcb‐b4ff5d944857 (viewed Aug 2022).
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9. Dawson G, Madsen LT, Dains JE. Interventions to manage uncertainty and fear of recurrence in female breast cancer survivors: a review of the literature. Clin J Oncol Nurs 2016; 20: E155‐E161.

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Medical education
Lessons from practice

Mycobacterium haemophilum in a patient with inflammatory bowel disease

Fleur W Kong, David Wong, Kendall Sharpe, Louis Pool and James Muir

Med J Aust 2022; 217 (8): . || doi: 10.5694/mja2.51720
Published online: 17 October 2022

ARTICLE
AUTHORS
REFERENCES

Topics

Infectious diseases

Anatomy and physiology

Digestive system diseases

A 38‐year‐old woman with longstanding Crohn’s disease presented with 7 months of a non‐healing widespread rash. Examination revealed indurated and ulcerated papulonodular lesions on the abdomen and extremities (Box 1). Medications included adalimumab, 6‐mercaptopurine, allopurinol and an oral contraceptive pill. There were no other significant medical conditions. The main differentials considered were cutaneous/metastatic Crohn’s disease or a disseminated atypical infection such as atypical mycobacterium or deep fungal. The lesions were too numerous for a skin malignancy.

1 Princess Alexandra Hospital, Brisbane, QLD
2 Mater Hospital, Brisbane, QLD
3 Sullivan Nicolaides Pathology, Brisbane, QLD
4 University of Queensland, Brisbane, QLD

Correspondence: fleur.kong@health.qld.gov.au

Competing interests:

No relevant disclosures.

1. Burns T, Breathnach S, Cox N, Griffiths C. Rook’s textbook of dermatology. 8th ed. Wiley‐Blackwell, 2010.
2. Lindeboom JA, Bruijnesteijn van Coppenraet LE, van Soolingen D, et al. Clinical manifestations, diagnosis, and treatment of Mycobacterium haemophilum infections. Clin Microbiol Rev 2011; 24: 701‐717.
3. Bao F, Yu C, Pan Q, et al. Cutaneous Mycobacterium haemophilum infection in an immunocompetent patient. J Dtsch Dermatol Ges 2020; 18: 1186‐1188.
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8. Hashash JG, Kane S. Pregnancy and inflammatory bowel disease. Gastroenterol Hepatol (N Y) 2015; 11: 96‐102.
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11. Bothamley G. Drug treatment for tuberculosis during pregnancy: safety considerations. Drug Saf 2001; 24: 553‐565.

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Guideline summary

Care for adults with COVID‐19: living guidelines from the National COVID‐19 Clinical Evidence Taskforce

Heath White, Steve J McDonald, Bridget Barber, Joshua Davis, Lucy Burr, Priya Nair, Sutapa Mukherjee, Britta Tendal, Julian Elliott, Steven McGloughlin and Tari Turner

Med J Aust 2022; 217 (7): . || doi: 10.5694/mja2.51718
Published online: 3 October 2022

ARTICLE
AUTHORS
REFERENCES

Topics

Environment and public health

Health services administration

Infectious diseases

Pharmaceutical preparations

Statistics, epidemiology and research design

Abstract

Introduction: The Australian National COVID‐19 Clinical Evidence Taskforce was established in March 2020 to maintain up‐to‐date recommendations for the treatment of people with coronavirus disease 2019 (COVID‐19). The original guideline (April 2020) has been continuously updated and expanded from nine to 176 recommendations, facilitated by the rapid identification, appraisal, and analysis of clinical trial findings and subsequent review by expert panels.

Main recommendations: In this article, we describe the recommendations for treating non‐pregnant adults with COVID‐19, as current on 1 August 2022 (version 61.0). The Taskforce has made specific recommendations for adults with severe/critical or mild disease, including definitions of disease severity, recommendations for therapy, COVID‐19 prophylaxis, respiratory support, and supportive care.

Changes in management as a result of the guideline: The Taskforce currently recommends eight drug treatments for people with COVID‐19 who do not require supplemental oxygen (inhaled corticosteroids, casirivimab/imdevimab, molnupiravir, nirmatrelvir/ritonavir, regdanvimab, remdesivir, sotrovimab, tixagevimab/cilgavimab) and six for those who require supplemental oxygen (systemic corticosteroids, remdesivir, tocilizumab, sarilumab, baricitinib, casirivimab/imdevimab). Based on evidence of their achieving no or only limited benefit, ten drug treatments or treatment combinations are not recommended; an additional 42 drug treatments should only be used in the context of randomised trials. Additional recommendations include support for the use of continuous positive airway pressure, prone positioning, and endotracheal intubation in patients whose condition is deteriorating, and prophylactic anticoagulation for preventing venous thromboembolism. The latest updates and full recommendations are available at www.covid19evidence.net.au.

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1 Cochrane Australia, Monash University, Melbourne, VIC
2 QIMR Berghofer Medical Research Institute, Brisbane, QLD
3 John Hunter Hospital, Newcastle, NSW
4 The University of Newcastle, Newcastle, NSW
5 Mater Hospital Brisbane, Brisbane, QLD
6 Mater Research Institute, University of Queensland, Brisbane, QLD
7 St Vincent's Hospital Sydney, Sydney, NSW
8 Adelaide Institute for Sleep Health, Adelaide, SA
9 The Alfred Hospital, Melbourne, VIC
10 Monash University, Melbourne, VIC

Correspondence: heath.white@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.

Acknowledgements:

The National COVID‐19 Clinical Evidence Taskforce is funded by the Australian Department of Health, the Victorian Department of Health and Human Services, the Ian Potter Foundation and the Walter Cottman Endowment Fund (managed by Equity Trustees), and the Lord Mayors’ Charitable Foundation. We thank all members of the National COVID‐19 Clinical Evidence Taskforce for their magnificent contributions to the work described in this article, and acknowledge the Taskforce member organisations and our partners (complete list included in the Supporting Information).

Competing interests:

No relevant disclosures.

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Editorials

Practice and system improvements for better physical health and longer lives for people living with serious mental illness

Rosemary V Calder, James A Dunbar and Maximilian P Courten

Med J Aust 2022; 217 (7): . || doi: 10.5694/mja2.51713
Published online: 3 October 2022

ARTICLE
AUTHORS
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Topics

General medicine

Health services administration

Mental disorders

Health occupations

The Being Equally Well policy roadmap seeks to end the neglect of physical health for people living with serious mental illness

People living with serious mental illness die up to 20 years prematurely from chronic physical health conditions.1 Most of these early deaths are from preventable health conditions including cardiovascular disease, smoking‐related respiratory illness, diabetes, and cancer.2 Primary care is not organised to provide this group with screening for cardiometabolic risk factors.

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1 Mitchell Institute, Victoria University, Melbourne, VIC
2 Deakin University, Warrnambool, VIC

Correspondence: rosemary.calder@vu.edu.au

Acknowledgements:

The Being Equally Well project has been partially supported by grant funding from the Australian Government Department of Health and Aged Care to the Mitchell Institute at Victoria University for the Australian Health Policy Collaboration, a network of chronic disease and population health academics, clinicians, experts, and advocates who have participated in this project. The supplement accompanying this issue of the MJA was financially supported by the Mitchell Institute, Victoria University, and by grant funding from the Australian Government Department of Health and Aged Care for the Australian Health Policy Collaboration. The authors acknowledge and thank all participants in and contributors to the Being Equally Well project for their expert commitment to the project and its potential impacts on health care for people living with serious mental illness.

Competing interests:

No relevant disclosures.

1. Australian Institute of Health Welfare. Physical health of people with mental illness. Canberra: AIHW, 2020. https://www.aihw.gov.au/reports/australias‐health/physical‐health‐of‐people‐with‐mental‐illness (viewed July 2022).
2. Roberts R. The physical health of people living with mental illness: a narrative literature review. Charles Sturt University, 2019. https://www.equallywell.org.au/wp‐content/uploads/2019/06/Literature‐review‐EquallyWell.pdf (viewed July 2022).
3. Morgan M, Peters D, Hopwood M, et al. Being Equally Well: a national policy roadmap to better physical health care and longer lives for people living with serious mental illness. Melbourne: Mitchell Institute, Victoria University, 2021. https://www.vu.edu.au/sites/default/files/being‐equally‐well‐policy‐roadmap‐mitchell‐institute.pdf (viewed July 2022).
4. Nelson EC, Batalden PB, Godfrey MM. Quality by design: a clinical microsystems approach. San Francisco: Jossey‐Bass, 2007.
5. Morgan M, Hopwood M, Dunbar JA. Shared guidelines and protocols to achieve better health outcomes for people living with serious mental illness. Med J Aust 2022; 217 (7 Suppl): S34‐S35.
6. Mc Namara K, Rosenbaum S, Rocks T, et al. Workforce development for better management of physical comorbidities among people with severe mental illness. Med J Aust 2022; 217 (7 Suppl): S39‐S42.
7. Coles AS, Maksyutynska K, Knezevic D, et al. Peer‐facilitated interventions for physical health outcomes in individuals with schizophrenia spectrum disorders. Med J Aust 2022; 217 (7 Suppl): S22‐S28.
8. Mc Namara K, Jamza AZ, Murry M, et al. Should antidiabetic medicines be considered to reduce cardiometabolic risk in patients with serious mental illness? Med J Aust 2022; 217 (7 Suppl): S29‐S33.
9. Sharma S, Buckhalter S, Siskind S, Castle D. Clozapine shared care: mental health services and GPs working together for better outcomes for people with schizophrenia. Med J Aust 2022; 217 (7 Suppl): S36‐S38.
10. Rocks T, Teasdale SB, Fehily C, et al. The role of dietary intervention for the management of physical health conditions in individuals with serious mental illness: a systematic review and meta‐analysis. Med J Aust 2022; 217 (7 Suppl): S7‐S21.

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Perspectives

Australia needs to implement a national health strategy for doctors

Chanaka Wijeratne, Margaret P Kay, Mark H Arnold and Jeffrey CL Looi

Med J Aust 2022; 217 (7): . || doi: 10.5694/mja2.51714
Published online: 3 October 2022

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Topics

General medicine

Health services administration

Medical education

Coordinated systemic change and enhanced access to care are needed to improve doctors’ wellbeing

Over the past decade, there has been growing recognition of the prevalence of psychological distress across the medical profession and that practitioner wellbeing has significant implications for patient safety. The fact that burnout, anxiety, depression, suicidal ideation, and completed suicide are higher in doctors than in the general population1,2 is a problem requiring urgent and novel interventions.

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1 University of Notre Dame Australia, Sydney, NSW
2 UNSW Sydney, Sydney, NSW
3 University of Queensland, Brisbane, QLD
4 School of Rural Health, University of Sydney, Dubbo, NSW
5 University of Sydney, Sydney, NSW
6 Australian National University, Canberra, ACT

Correspondence: chanaka.wijeratne@health.nsw.gov.au

Open access

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

Competing interests:

Chanaka Wijeratne is a Medical Council of New South Wales Directed Health Assessor. Margaret Kay is a member of the Management Committee, Queensland Doctors’ Health Advisory Service. Mark Arnold is a member of the Medical Council of New South Wales.

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Guidelines

Urological Society of Australia and New Zealand (USANZ) and Australasian Chapter of Sexual Health Medicine (AChSHM) for the Royal Australasian College of Physicians (RACP) clinical guidelines on the management of erectile dysfunction

Eric Chung, Michael Lowy, Michael Gillman, Chris Love, Darren Katz and Graham Neilsen

Med J Aust 2022; 217 (6): . || doi: 10.5694/mja2.51694
Published online: 19 September 2022

Correction(s) for this article:

Erratum | Published online: 21 November 2022

ARTICLE
AUTHORS
REFERENCES

Topics

Men's health

Sexual health

Urologic diseases

Abstract

Introduction: These clinical practice recommendations by the Urological Society of Australia and New Zealand (USANZ) and the Australasian Chapter of Sexual Health Medicine (AChSHM) for the Royal Australasian College of Physicians (RACP) provide evidence‐based clinical guidelines on the management of erectile dysfunction (ED) in Australia.

Main recommendations:

A comprehensive clinical history and a tailored physical examination are essential (Level of evidence [LoE] 3; GRADE B).
Laboratory testing should include fasting glucose, lipid profile and total testosterone level (LoE 3; GRADE A).
Specialised diagnostic tests are recommended in selected cases and the patient should be counselled accordingly (LoE 4; GRADE B).
Lifestyle changes and optimisation of existing medical conditions should accompany all ED treatment regimens (LoE 1; GRADE A).
Oral phosphodiesterase type 5 inhibitor (PDE5i) is an effective first line medical therapy (LoE 1; GRADE A).
Intracavernosal injections and vacuum erection devices are recommended as second line therapy (LoE 1; GRADE B).
A penile prosthesis implant can be considered in men who are medically refractory or unable to tolerate the side effects of medical therapy (LoE 4; GRADE B).
Pro‐erectile regenerative therapy remains largely experimental (LoE 3; GRADE B).

Changes in management as a result of these guidelines: Modification of lifestyle behaviour, management of reversible risk factors and optimisation of existing medical conditions remain pivotal, and existing standard ED therapies are often effective and safe following cardiovascular risk stratification. Caution should be exercised on the use of regenerative technology in ED due to unknown long term outcomes.

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1 Princess Alexandra Hospital, Brisbane, QLD
2 University of Queensland, Brisbane, QLD
3 AndroUrology Centre, Brisbane, QLD
4 Male Clinic, Sydney, NSW
5 Men’s Health Doctor, Brisbane, QLD
6 Urology South, Melbourne, VIC
7 Men’s Health Melbourne, Melbourne, VIC
8 Stonewall Medical Centre, Brisbane, QLD

Correspondence: ericchg@hotmail.com

Competing interests:

No relevant disclosures.

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Pagination