Topics

Recent advances in critical care relevant to a broad range of clinicians

Global interest in the management of critically ill patients has increased significantly with the coronavirus disease 2019 (COVID‐19) pandemic. This Perspective article focuses on recent advances in four key aspects of critical care that are relevant to a broad range of clinicians including those who do not practise in an intensive care unit (ICU): intravenous fluid therapy, supplemental oxygen, management of delirium, and follow‐up care of bereaved family members (Box).

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1 University of Melbourne, Melbourne, VIC
2 Royal Melbourne Hospital, Melbourne, VIC
3 Austin Hospital, Melbourne, VIC

Correspondence: yasmine.aliabdelhamid@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 Brianna Tascone and Olivia Gigli for their assistance with the production of the figure.

Competing interests:

No relevant disclosures.

1. Zampieri FG, Machado FR, Biondi RS, et al. Effect of intravenous fluid treatment with a balanced solution vs 0.9% saline solution on mortality in critically ill patients: the BASICS randomized clinical trial. JAMA 2021; 326: 1‐12.
2. SAFE Study Investigators; Australian and New Zealand Intensive Care Society Clinical Trials Group; Australian Red Cross Blood Service; George Institute for International Health; Myburgh J, Cooper DJ, Finfer S, et al. Saline or albumin for fluid resuscitation in patients with traumatic brain injury. N Engl J Med 2007; 357: 874‐884.
3. Zampieri FG, Machado FR, Biondi RS, et al. Association between type of fluid received prior to enrollment, type of admission, and effect of balanced crystalloid in critically ill adults: a secondary exploratory analysis of the BaSICS clinical trial. Am J Resp Crit Care Med 2022; 205: 1419‐1428.
4. Zampieri FG, Machado FR, Biondi RS, et al. Effect of slower vs faster intravenous fluid bolus rates on mortality in critically ill patients: the BASICS randomized clinical trial. JAMA 2021; 326: 830‐838.
5. Finfer S, Micaleff S, Hammond N, et al. Balanced multielectrolyte solution versus saline in critically ill adults. N Engl J Med 2022; 386: 815‐826.
6. Meyhoff TS, Hortrup PB, Wetterslev J, et al. Restriction of intravenous fluid in ICU patients with septic shock. N Engl J Med 2022; 386: 2459‐2470.
7. Lamontagne F, Richards‐Belle A, Thomas K, et al. Effect of reduced exposure to vasopressors on 90‐day mortality in older critically ill patients with vasodilatory hypotension: a randomized clinical trial. JAMA 2020; 323: 938‐949.
8. Kilgannon JH, Jones AE, Shapiro NI, et al. Association between arterial hyperoxia following resuscitation from cardiac arrest and in‐hospital mortality. JAMA 2010; 303: 2165‐2171.
9. Mackle D, Bellomo R, Bailey M, et al. Conservative oxygen therapy during mechanical ventilation in the ICU. N Engl J Med 2020; 382: 989‐998.
10. Schjørring OL, Klitgaard TL, Perner A, et al. Lower or higher oxygenation targets for acute hypoxemic respiratory failure. N Engl J Med 2021; 384: 1301‐1311.
11. Barrot L, Asfar P, Mauny F, et al. Liberal or conservative oxygen therapy for acute respiratory distress syndrome. N Engl J Med 2020; 382: 999‐1008.
12. Singer M, Young PJ, Laffey JG, et al. Dangers of hyperoxia. Crit Care 2021; 25: 440.
13. Pandharipande PP, Girard TD, Jackson JC, et al. Long‐term cognitive impairment after critical illness. N Engl J Med 2013; 369: 1306‐1316.
14. Girard TD, Exline MC, Carson SS, et al. Haloperidol and ziprasidone for treatment of delirium in critical illness. N Engl J Med 2018; 379: 2506‐2516.
15. Page VJ, Casarin A, Ely EW, et al. Evaluation of early administration of simvastatin in the prevention and treatment of delirium in critically ill patients undergoing mechanical ventilation (MODUS): a randomised, double‐blind, placebo‐controlled trial. Lancet Repir Med 2017; 5: 727‐737.
16. Reade MC, Eastwood GM, Bellomo R, et al. Effect of dexmedetomidine added to standard care on ventilator‐free time in patients with agitated delirium: a randomized clinical trial. JAMA 2016; 315: 1460‐1468.
17. Wibrow B, Martinez FE, Myers E, et al. Prophylactic melatonin for delirium in intensive care (Pro‐MEDIC): a randomized controlled trial. Intensive Care Med 2022; 48: 414‐425.
18. Devlin JW, Skrobik Y, Gélinas C, et al. Clinical practice guidelines for the prevention and management of pain, agitation/sedation, delirium, immobility, and sleep disruption in adult patients in the ICU. Crit Care Med 2018; 46: e825‐e873.
19. Kentish‐Barnes N, Chevret S, Champigneulle B, et al. Effect of a condolence letter on grief symptoms among relatives of patients who died in the ICU: a randomized clinical trial. Intensive Care Med 2017; 43: 473‐484.
20. Showler L, Rait L, Chan M, et al. Communication with bereaved family members after death in the ICU: the CATHARTIC randomised clinical trial. Crit Care Resusc 2022; 24: 1161‐1127.
21. Rait LI, Yeo NY, Ali Abdelhamid Y, et al. The impact of bereavement support on psychological distress in family members: a systematic review and meta‐analysis. Crit Care Resusc 2021; 23: 225‐233.
22. Kentish‐Barnes N, Chevret S, Valade S, et al. A three‐step support strategy for relatives of patients dying in the intensive care unit: a cluster randomised trial. Lancet 2022; 399: 656‐664.
23. Writing Committee for the REMAP‐CAP Investigators. Effect of hydrocortisone on mortality and organ support in patients with severe COVID‐19. JAMA 2020; 324: 1317‐1329.
24. REMAP‐CAP, ACTIV‐4a, ATTACC Investigators. Therapeutic anticoagulation with heparin in critically ill patients with COVID‐19. N Engl J Med 2021; 385: 777‐789.

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Research

Dual‐energy x‐ray absorptiometry assessment of bone health in Australian men with prostate cancer commencing androgen deprivation therapy

Mariya F Hamid, Amy Hayden, Tania Moujaber, Sandra Turner, Howard Gurney, Mathis Grossmann and Peter Wong

Med J Aust 2023; 218 (3): . || doi: 10.5694/mja2.51835
Published online: 20 February 2023

ARTICLE
AUTHORS
REFERENCES

Topics

Musculoskeletal diseases

Urologic diseases

Neoplasms

Endocrine system diseases

General medicine

Men's health

Abstract

Objective: To determine the prevalence in Australia of bone health assessment of men with prostate cancer by dual‐energy x‐ray absorptiometry (DXA), from six months before to twelve months after initiation of androgen deprivation therapy (ADT).

Design, setting: Cross‐sectional national study; linkage of de‐identified Medicare Benefits Schedule (MBS) and Pharmaceutical Benefits Scheme (PBS) data.

Participants: Men (18 years or older) first dispensed PBS‐subsidised ADT during 1 May 2017 – 31 July 2020.

Main outcome measures: Prevalence of MBS‐subsidised DXA assessments undertaken from six months before to twelve months after first ADT prescription.

Results: Of 33 836 men with prostate cancer commencing ADT therapy during 2017–20, 6683 (19.8%) underwent DXA bone heath assessments between six months before and twelve months after commencing ADT; the mean time from first ADT dispensing to DXA scanning was +90 days (standard deviation, 134 days). The proportion of men aged 54 years or younger who had scans (66 of 639, 10%) was smaller than that of men aged 70–84 years (4528 of 19 378, 23.4%; adjusted odds ratio, 0.36; 95% CI, 0.28–0.47).

Conclusions: For about 80% of men with prostate cancer commencing ADT in Australia, therapy initiation was not accompanied by DXA assessment of bone health. Given the excellent long term prognosis for men with prostate cancer and the availability of bone protective therapy, bone health monitoring should be a routine component of prostate cancer care for men receiving ADT.

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1 Westmead Hospital, Sydney, NSW
2 Crown Princess Mary Cancer Centre at Westmead Hospital, Sydney, NSW
3 Western Sydney University, Sydney, NSW
4 Westmead Clinical School, the University of Sydney, Sydney, NSW
5 Macquarie University, Sydney, NSW
6 Austin Health, Melbourne, VIC
7 The University of Melbourne, Melbourne, VIC

Correspondence: mariya.hamid@health.nsw.gov.au

Acknowledgements:

We thank Karen Byth (Research and Education Network, Western Sydney Local Health District) for assisting with the statistical analysis.

Competing interests:

Peter Wong is a site investigator in an Amgen‐sponsored post‐marketing trial assessing medication adherence and has received speaking honoraria from Amgen. He is also Honorary Medical Director of Healthy Bones Australia.

1. Australian Institute of Health and Welfare; Cancer Australia. Prostate cancer in Australia statistics. Updated 15 Sept 2022. https://www.canceraustralia.gov.au/cancer‐types/prostate‐cancer/statistics (viewed Sept 2022).
2. Grossmann M, Zajac JD. Management of side effects of androgen deprivation therapy. Endocrinol Metab Clin North Am 2011; 40: 655‐671.
3. Ross RW, Small EJ. Osteoporosis in men treated with androgen deprivation therapy for prostate cancer. J Urol 2002; 167: 1952‐1956.
4. Greenspan SL, Coates P, Sereika SM, et al. Bone loss after initiation of androgen deprivation therapy in patients with prostate cancer. J Clin Endocrinol Metab 2005; 90: 6410‐6417.
5. Morote J, Morin JP, Orsola A, et al. Prevalence of osteoporosis during long‐term androgen deprivation therapy in patients with prostate cancer. Urology 2007; 69: 500‐504.
6. Taylor LG, Canfield SE, Du XL. Review of major adverse effects of androgen‐deprivation therapy in men with prostate cancer. Cancer 2009; 115: 2388‐2399.
7. Smith MR, Eastham J, Gleason DM, et al. Randomized controlled trial of zoledronic acid to prevent bone loss in men receiving androgen deprivation therapy for nonmetastatic prostate cancer. J Urol 2003; 169: 2008‐2012.
8. Ryan CW, Huo D, Demers LM, et al. Zoledronic acid initiated during the first year of androgen deprivation therapy increases bone mineral density in patients with prostate cancer. J Urol 2006; 176: 972‐978.
9. Ryan CW, Huo D, Bylow K, et al. Suppression of bone density loss and bone turnover in patients with hormone‐sensitive prostate cancer and receiving zoledronic acid. BJU Int 2007; 100: 70‐75.
10. Greenspan SL, Nelson JB, Trump DL, Resnick NM. Effect of once‐weekly oral alendronate on bone loss in men receiving androgen deprivation therapy for prostate cancer: a randomized trial. Ann Intern Med 2007; 146: 416‐424.
11. Greenspan SL, Nelson JB, Trump DL, et al. Skeletal health after continuation, withdrawal, or delay of alendronate in men with prostate cancer undergoing androgen‐deprivation therapy. J Clin Oncol 2008; 26: 4426‐4434.
12. Smith MR, Egerdie B, Hernández Toriz N, et al; Denosumab HALT Prostate Cancer Study Group. Denosumab in men receiving androgen‐deprivation therapy for prostate cancer. N Engl J Med 2009; 361: 745‐755.
13. Grossmann M, Gilfillan C, Bolton D, et al. Bone and metabolic health in patients with non‐metastatic prostate cancer who are receiving androgen deprivation therapy. Med J Aust 2011; 194: 301‐306. https://www.mja.com.au/journal/2011/194/6/bone‐and‐metabolic‐health‐patients‐non‐metastatic‐prostate‐cancer‐who‐are
14. Cancer Council Australia Advanced Prostate Cancer Guidelines Working Party. Clinical practice guidelines for the management of locally advanced and metastatic prostate cancer. Updated 2010. https://wiki.cancer.org.au/australia/Guidelines:%20Prostate_cancer/Management/Locally_advanced_and_metastatic (viewed Apr 2022).
15. National Institute for Health and Care Excellence. Prostate cancer: diagnosis and management [Clinical guideline NG131]. Updated 15 Dec 2021. www.nice.org.uk/guidance/ng131 (viewed Apr 2022).
16. Mottet N, Bellmunt J, Bolla M, et al. EAU‐ESTRO‐SIOG guidelines on prostate cancer. Part 1: Screening, diagnosis, and local treatment with curative intent. Eur Urol 2017; 71: 618‐629.
17. Alibhai SMH, Zukotynski K, Walker‐Dilks C, et al; Cancer Care Ontario Genitourinary Cancer Disease Site Group. Bone health and bone‐targeted therapies for prostate cancer: a programme in evidence‐based care. Cancer Care Ontario clinical practice guideline. Clin Oncol (R Coll Radiol) 2017; 29: 348‐355.
18. Saylor PJ, Rumble RB, Tagawa S, et al. Bone health and bone‐targeted therapies for prostate cancer: ASCO endorsement of a Cancer Care Ontario guideline. J Clin Oncol 2020; 38: 1736‐1743.
19. Pan B, Aherne NJ, Shakespeare T, et al. Bone health assessment with dual energy X‐ray absorptiometry in men with high‐risk prostate carcinoma commencing adjuvant androgen deprivation therapy. Rep Pract Oncol Radiother 2022; 27: 677‐683.
20. Alibhai SM, Yun L, Cheung AM, Paszat L. Screening for osteoporosis in men receiving androgen deprivation therapy. JAMA 2012; 307: 255‐256.
21. Suarez‐Almazor ME, Luo R, et al. Low rates of bone mineral density measurement in Medicare beneficiaries with prostate cancer initiating androgen deprivation therapy. Support Care Cancer 2014; 22: 537‐544.
22. Ewald DP, Eisman JA, Ewald BD, et al. Population rates of bone densitometry use in Australia, 2001–2005, by sex and rural versus urban location. Med J Aust 2009; 190: 126‐128. https://www.mja.com.au/journal/2009/190/3/population‐rates‐bone‐densitometry‐use‐australia‐2001‐2005‐sex‐and‐rural‐versus
23. Australian Department of Health. National strategic action plan for osteoporosis 2019. https://www.health.gov.au/sites/default/files/documents/2020/01/national‐strategic‐action‐plan‐for‐osteoporosis‐2019_1.pdf (viewed July 2022).
24. Jones JM, Tsang DS, Zheng S, et al. Implementing and evaluating the impact of BoneRx: a healthy bone prescription for men with prostate cancer initiating androgen deprivation therapy. J Clin Med 2022; 11: 2703.
25. Ito K, Elkin EB, Girotra M, Morris MJ. Cost‐effectiveness of fracture prevention in men who receive androgen deprivation therapy for localized prostate cancer. Ann Intern Med 2010; 152: 621‐629.

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Editorials

The impact of the COVID‐19 pandemic on emergency department presentations: an opportunity for renewal?

Amith Shetty and Jean‐Frederic Levesque

Med J Aust 2023; 218 (3): . || doi: 10.5694/mja2.51828
Published online: 20 February 2023

ARTICLE
AUTHORS
REFERENCES

Topics

Infectious diseases

Health services administration

Emergency medicine

Health occupations

Health system leaders should integrate alternative models of emergency care that proved useful during the pandemic into care pathways

The coronavirus disease 2019 (COVID‐19) pandemic had a significant impact on health care systems around the world. As well as the large number of people infected and the need for hospital care among those with severe infections, the associated fear and public health responses and restrictions, including mandatory mask‐wearing and lockdowns, also affected health care use.1 For example, a large meta‐analysis found that the pandemic reduced the numbers of emergency department (ED) presentations across all specialities and disease groups, except in countries with large COVID‐19 outbreaks, where ED activity was driven mainly by respiratory illness‐related presentations.2

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1 NSW Health, Sydney, NSW
2 Westmead Clinical School, the University of Sydney, Sydney, NSW
3 Centre for Primary Health Care and Equity, University of New South Wales, Sydney, NSW

Correspondence: amith.shetty@health.nsw.gov.au

Competing interests:

No relevant disclosures.

1. Sutherland K, Chessman J, Zhao J, et al. Impact of COVID‐19 on healthcare activity in NSW, Australia. Public Health Res Pract 2020; 30: 3042030.
2. Moynihan R, Sanders S, Michaleff ZA, et al. Impact of COVID‐19 pandemic on utilisation of healthcare services: a systematic review. BMJ Open 2021; 11: e045343.
3. Sweeny AL, Keijzers GB, Marshall A, et al. Emergency department presentations during the COVID‐19 pandemic in Queensland (to June 2021): interrupted time series analysis. Med J Aust 2023; 218: 120‐125.
4. Sara G, Wu J, Uesi J, et al. Growth in emergency department self‐harm or suicidal ideation presentations in young people: comparing trends before and since the COVID‐19 first wave in New South Wales, Australia. Aust N Z J Psychiatry 2022; doi: https://doi.org/10.1177/00048674221082518 [online ahead of print].
5. Ng RW, Emmerig D, Salter MD, et al. Toxicology presentations to a tertiary unit in New South Wales during the COVID‐19 pandemic first wave: a retrospective comparison study. Emerg Med Australas 2022; doi: https://doi.org/10.1111/1742‐6723.14070 [online ahead of print].
6. Stamenova V, Chu C, Pang A, et al. Virtual care use during the COVID‐19 pandemic and its impact on healthcare utilization in patients with chronic disease: a population‐based repeated cross‐sectional study. PLoS One 2022; 17: e0267218.
7. Weiner JP, Bandeian S, Hatef E, et al. In‐person and telehealth ambulatory contacts and costs in a large US insured cohort before and during the COVID‐19 pandemic. JAMA Netw Open 2021; 4: e212618.
8. Baum A, Schwartz MD. Admissions to Veterans Affairs hospitals for emergency conditions during the COVID‐19 pandemic. JAMA 2020; 324: 96‐99.
9. Maringe C, Spicer J, Morris M, et al. The impact of the COVID‐19 pandemic on cancer deaths due to delays in diagnosis in England, UK: a national, population‐based, modelling study. Lancet Oncol 2020; 21: 1023‐1034.
10. Australia Institute of Health and Welfare. Australia's health 2022: data insights (Cat. no. AUS 240; Australia's health series number 18). 7 July 2022. https://www.aihw.gov.au/reports/australias‐health/australias‐health‐2022‐data‐insights/summary (viewed Nov 2022).

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Editorials

Gender diversity of clinical practice guideline panels in Australia: important opportunities for progress

Cheryl Carcel and Mark Woodward

Med J Aust 2023; 218 (2): . || doi: 10.5694/mja2.51832
Published online: 6 February 2023

ARTICLE
AUTHORS
REFERENCES

Topics

Social determinants of health

General medicine

Gender balance can lead to more focused recommendations and better health outcomes for everyone

The George Institute for Global Health, University of New South Wales, Sydney, NSW

Correspondence: ccarcel@georgeinstitute.org.au

Competing interests:

No relevant disclosures.

1. Sciarra E. The importance of practice guidelines in clinical care. Dimens Crit Care Nurs 2012; 31: 84‐85.
2. Woolf SH, Grol R, Hutchinson A, et al. Clinical guidelines: potential benefits, limitations, and harms of clinical guidelines. BMJ 1999; 318: 527‐530.
3. Lerchenmüller C, Lerchenmueller MJ, Sorenson O. Long‐term analysis of sex differences in prestigious authorships in cardiovascular research supported by the National Institutes of Health. Circulation 2018; 137: 880‐882.
4. Pinho‐Gomes AC, Vassallo A, Thompson K, et al. Representation of women among editors in chief of leading medical journals. JAMA Netw Open 2021; 4: e2123026.
5. Carcel C, Harris K, Peters SA, et al. Representation of women in stroke clinical trials: a review of 281 trials involving more than 500 000 participants. Neurology 2021; 97: e1768‐e1774.
6. Shalit A, Vallely L, Nguyen R, et al. The representation of women on Australian clinical practice guideline panels, 2010–2020. Med J Aust 2023; 218: 84‐88.
7. Merman E, Pincus D, Bell C, et al. Differences in clinical practice guideline authorship by gender. Lancet 2018; 392: 1626‐1628.
8. Australian Bureau of Statistics. Standard for sex, gender, variations of sex characteristics and sexual orientation variables, reference period 2020. 14 Jan 2021. https://www.abs.gov.au/statistics/standards/standard‐sex‐gender‐variations‐sex‐characteristics‐and‐sexual‐orientation‐variables/2020 (viewed Dec 2022).
9. Mousa M, Boyle J, Skouteris H, et al. Advancing women in healthcare leadership: A systematic review and meta‐synthesis of multi‐sector evidence on organisational interventions. EClinicalMedicine 2021; 39: 101084.
10. Bohren MA, Javadi D, Vogel JP. Gender balance in WHO panels for guidelines published from 2008 to 2018. Bull World Health Organ 2019; 97: 477‐485.
11. Pinho‐Gomes AC, Vassallo A, Carcel C, et al. Gender equality and the gender gap in life expectancy in the European Union. BMJ Glob Health 2022; 7: e008278.
12. Nielsen MW, Andersen JP, Schiebinger L, Schneider JW. One and a half million medical papers reveal a link between author gender and attention to gender and sex analysis. Nat Hum Behav 2017; 1: 791‐796.

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Editorials

Beyond the intensive care unit: ensuring the long term health of critically ill Indigenous people

Dianne P Stephens

Med J Aust 2023; 218 (2): . || doi: 10.5694/mja2.51818
Published online: 6 February 2023

ARTICLE
AUTHORS
REFERENCES

Topics

Indigenous health

Anesthesia, analgesia and pain

An important aim after critically ill Indigenous people return home is to avoid the need for re‐admission to hospital

Evidence is growing that an episode of critical illness which requires admission to an intensive care unit (ICU) affects longer term health outcomes. More advanced age, chronic disease, and severity of the critical illness all influence long term outcomes, and the challenge is to identify modifiable factors and to design interventions that improve these outcomes.1 Identifying who is at risk of poorer long term outcomes would facilitate better targeting of surveillance and intervention after discharge from the ICU. Indigenous Australians have generally poorer health outcomes than non‐Indigenous Australians, their median age at presentation with critical illness is lower, and have a greater burden of chronic disease, but their ICU and hospital outcomes are similar to those of non‐Indigenous Australians.2,3 However, longer term outcomes after ICU care have not previously been investigated in detail.

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1 Charles Darwin University, Darwin, NT
2 National Critical Care and Trauma Response Centre, Darwin, NT

Correspondence: dianne.stephens@cdu.edu.au

Competing interests:

No relevant disclosures.

1. Gayat E, Cariou A, Deye N, et al. Determinants of long‐term outcome in ICU survivors: results from the FROG‐ICU study. Crit Care 2018; 22: 8.
2. Stephens D. Critical illness and its impact on the Aboriginal people of the top end of the Northern Territory, Australia. Anaesth Intensive Care 2003; 31: 294‐299.
3. Ho KM, Finn J, Dobb GJ, Webb SAR. The outcome of critically ill Indigenous patients. Med J Aust 2006; 184: 496‐499. https://www.mja.com.au/journal/2006/184/10/outcome‐critically‐ill‐indigenous‐patients
4. Secombe PJ, Brown A, Bailey MJ, et al. Twelve‐month mortality outcomes for Indigenous and non‐Indigenous people admitted to intensive care units in Australia: a registry‐based data linkage study. Med J Aust 2023; 218: 77‐83.
5. Hughes JT, Majoni SW, Barzi F, et al. Incident haemodialysis and outcomes in the Top End of Australia. Aust Health Re 2020: 44: 234‐240.
6. Morrisey J. Exploring the outcomes of Indigenous patients from critical care environments [thesis]. Charles Darwin University, Darwin; Nov 2021. https://researchers.cdu.edu.au/en/studentTheses/exploring‐the‐outcomes‐of‐indigenous‐patients‐from‐critical‐care‐ (viewed Nov 2022).
7. Secombe P, Brown A, McAnulty G, Pilcher D. Aboriginal and Torres Strait Islander patients requiring critical care: characteristics, resource use, and outcomes. Crit Care Resusc 2019; 21: 200‐211.
8. Doherty Z, Kippen R, Bevan D, et al. Long‐term outcomes of hospital survivors following an ICU stay: a multi‐centre retrospective cohort study. PLoS One 2022; 17: e0266038.
9. Cuthbertson B, Wunsch H. Long‐term outcomes after critical illness. The best predictor of the future is the past. Am J Respir Crit Care Med 2016; 194: 132‐134.
10. Coffey A, Leahy‐Warren P, Savage E, et al. Interventions to promote early discharge and avoid inappropriate hospital (re)admission: a systematic review. Int J Environ Res Public Health 2019; 16: 2457.
11. Secombe PJ, Stewart P. Long‐term morbidity and mortality in survivors of critical illness: a 5‐year observational follow‐up study. Rural Remote Health 2017; 17: 3908.

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Research letter

Online first

Distress and career regret among Australian orthopaedic surgical trainees

Carrie Kollias, Chris Conyard, Melissa Frances Formosa, Richard Page and Ian Incoll

Med J Aust || doi: 10.5694/mja2.51823
Published online: 30 January 2023

ARTICLE
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REFERENCES

Topics

General medicine

Medical education

Health occupations

Physician burnout has negative effects on patient safety and quality of care, and may contribute to medical errors.1 There is a growing literature on wellbeing in specific medical and surgical specialties overseas, but information about specialty‐specific wellbeing in Australia is limited.2,3

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1 Royal Children's Hospital, Melbourne, VIC
2 Murdoch Children's Research Institute, Melbourne, VIC
3 Queen Elizabeth II Jubilee Hospital, Brisbane, QLD
4 Griffith University, Brisbane, QLD
5 Deakin University, Geelong, VIC
6 Barwon Health, Geelong, VIC
7 The University of Newcastle, Newcastle, NSW
8 The University of Melbourne, Melbourne, VIC

Correspondence: carrie.kollias@rch.org.au

Competing interests:

No relevant disclosures.

1. Lu DW, Dresden S, McCloskey C, et al. Impact of burnout on self‐reported patient care among emergency physicians. West J Emerg Med 2015; 16: 996‐1001.
2. Arora M, Diwan AD, Harris IA. Prevalence and factors of burnout among Australian orthopaedic trainees: a cross‐sectional study. J Orthop Surg (Hong Kong) 2014; 22: 374‐377.
3. Raftopulos M, Wong EH, Stewart TE, et al. Occupational burnout among otolaryngology‐head and neck surgery trainees in Australia. Otolaryngol Head Neck Surg 2019; 160: 472‐479.
4. Dyrbye LN, Satele D, Sloan J, Shanafelt TD. Ability of the physician well‐being index to identify residents in distress. J Grad Med Educ 2014; 6: 78‐84.

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Research

The cost‐effectiveness of universal hepatitis B screening for reaching WHO diagnosis targets in Australia by 2030

Yinzong Xiao, Margaret E Hellard, Alexander J Thompson, Christopher Seaman, Jess Howell and Nick Scott

Med J Aust 2023; 218 (4): . || doi: 10.5694/mja2.51825
Published online: 30 January 2023

ARTICLE
AUTHORS
REFERENCES

Topics

Digestive system diseases

Health services administration

Environment and public health

Infectious diseases

Abstract

Objectives: To assess the impact on diagnosis targets, cost, and cost‐effectiveness of universal hepatitis B screening in Australia.

Design: Markov model simulation of disease and care cascade progression for people with chronic hepatitis B in Australia.

Setting: Three scenarios were compared: 1. no change to current hepatitis B virus (HBV) testing practice; 2. universal screening strategy, with the aim of achieving the WHO diagnosis target by 2030 (90% of people with chronic hepatitis B diagnosed), based on opportunistic (general practitioner‐initiated) screening for HBsAg; 3. universal screening strategy, and also ensuring that 50% of people with chronic hepatitis B are receiving appropriate clinical management by 2030.

Main outcome measures: Projected care cascade for people with chronic hepatitis B, cumulative number of HBV‐related deaths, intervention costs, and health utility (quality‐adjusted life‐years [QALYs] gained during 2020–2030). An incremental cost‐effectiveness ratio (ICER) threshold (v scenario 1) of $50 000 per QALY gained was applied.

Results: Compared with scenario 1, 80 HBV‐related deaths (interquartile range [IQR], 41–127 deaths) were averted during 2020–2030 in scenario 2, 315 HBV‐related deaths (IQR, 211–454 deaths) in scenario 3. Scenario 2 cost $84 million (IQR, $41–106 million) more than scenario 1 during 2020–2030 (+8%), yielding an ICER of $104 921 (IQR, $49 587–107 952) per QALY gained. Scenario 3 cost $263 million (IQR, $214–316 million) more than scenario 1 during 2020–2030 (+24%), yielding an ICER of $47 341 (IQR, $32 643–58 200) per QALY gained. Scenario 3 remained cost‐effective if the test positivity rate was higher than 0.35% or the additional costs per person tested did not exceed $4.02.

Conclusions: Universal screening for hepatitis B will be cost‐effective only if the cost of testing is kept low and people receive appropriate clinical management.

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1 The Burnet Institute, Melbourne, VIC
2 The Alfred Hospital, Melbourne, VIC
3 St Vincent's Hospital, Melbourne, VIC
4 The University of Melbourne, Melbourne, VIC
5 Monash University, Melbourne, VIC

Correspondence: yinzong.xiao@burnet.edu.au

Acknowledgements:

We acknowledge support from the Victorian Operational Infrastructure Support Program received by the Burnet Institute. Margaret Hellard is supported by a National Health and Medical Research Council (NHMRC) Investigator Grant (GNT1194322) and an NHMRC program grant (GNT1132902). Alexander J Thompson has received an NHMRC program grant (GNT1132902) and MRFF Practitioner Fellowship (1142976). Jessica Howell is supported by a University of Melbourne CR Roper Faculty Fellowship and an NHMRC Program Grant. Nick Scott holds an NHMRC fellowship (GNT2009408). Christopher Seaman is supported by an Australian Government Research Training Program scholarship.

Competing interests:

Margaret Hellard receives funding from Gilead Sciences and Abbvie for investigator‐initiated research. Margaret Hellard, Alexander J Thompson, and Jess Howell have received unrelated investigator‐initiated research grants from Gilead Sciences, AbbVie, Merck/MSD, and Bristol Myers Squibb. Alexander J Thompson has received consulting fees from Gilead, Abbvie, Roche, BMS, Merck, Immunocore, Janssen, Assembly Biosciences, Arbutus, Eisai, Ipsen and Bayer, speaker fees from Gilead Sciences, and investigator‐initiated grants from Gilead Sciences. Jess Howell has received speaker fees and investigator‐initiated grants from Gilead Sciences. Nick Scott has received unrelated research grants from Gilead Sciences.

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Editorials

Centering the Medical Journal of Australia in the landscape of medical information in 2023

Virginia Barbour

Med J Aust 2023; 218 (2): . || doi: 10.5694/mja2.51817
Published online: 23 January 2023

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Information science

The MJA has a unique responsibility and opportunity to report, reflect, and be an advocate for health priorities across Australia and our region

As 2023 begins, no‐one would argue that we are short of medical information. Sifting and assessing the daily tide of information — and misinformation — to obtain actionable and reliable evidence that can influence and inform health care has become one of the key problems for both medical professionals and the general public. Health care faces many challenges, and the need for high quality evidence has never been greater. These challenges include the increasing burden of chronic disease on an already strained health system, even as we continue to navigate the COVID‐19 pandemic, and prepare for whatever epidemics lie ahead. And, as evidenced by the recent devastation in our region, the increasing significance of climate change as a major risk to human health is ever more apparent. What should be the priorities of the MJA now?

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Editor‐in‐Chief, the Medical Journal of Australia

Correspondence: vbarbour@mja.com.au

Competing interests:

I am the director of Open Access Australasia, a paid position. I am a member of the National Health and Medical research Council Research Quality Steering Committee. I am an unpaid advisor to a number of national and international open access and research quality and integrity organisations, including cOAlition S (https://www.coalition‐s.org), the San Francisco Declaration on Research Assessment (DORA; https://sfdora.org), the Confederation of Open Access Repositories (COAR; https://www.coar‐repositories.org), and Cochrane (https://www.cochrane.org).

1. United Nations. United Nations Declaration on the Rights of Indigenous Peoples. 13 Sept 2007. https://www.un.org/development/desa/indigenouspeoples/wp‐content/uploads/sites/19/2018/11/UNDRIP_E_web.pdf (viewed Dec 2022).
2. National Agreement on Closing the Gap. July 2020. https://www.closingthegap.gov.au/national‐agreement (viewed 2022).

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Do you have any competing interests to declare? *

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Do you have any competing interests to declare? *

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Do you have any competing interests to declare? *

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Do you have any competing interests to declare? *

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