MJA
MJA

    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

    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

    Please login with your free MJA account to view this article in full

    LOGIN
    CREATE AN ACCOUNT

    Please note: institutional and Research4Life access to the MJA is now provided through Wiley Online Library.

    View on Wiley Online Library
    Online responses are no longer available. Please refer to our instructions for authors page for more information.

      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

      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.

      Please login with your free MJA account to view this article in full

      LOGIN
      CREATE AN ACCOUNT

      Please note: institutional and Research4Life access to the MJA is now provided through Wiley Online Library.

      View on Wiley Online Library

      • 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.

      Online responses are no longer available. Please refer to our instructions for authors page for more information.

        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

        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?

        Please login with your free MJA account to view this article in full

        LOGIN
        CREATE AN ACCOUNT

        Please note: institutional and Research4Life access to the MJA is now provided through Wiley Online Library.

        View on Wiley Online Library

        • 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).

        Online responses are no longer available. Please refer to our instructions for authors page for more information.

          Diagnosis of cystic fibrosis in adults: Australian Cystic Fibrosis Data Registry data, 2000–2019

          Amelia Lin, Keith Wong, Simone K Visser, Helen Jo, Yasmeen Al‐Hindawi, Katrin Kosbab‐Jackson, Molly Cocks, Anastasia Volovets, Paul Haber, Kirsten Hammond, Nicole Taylor, Veronica Yozghatlian, Edmund MT Lau, Nathaniel S Marshall, Tara Aquino‐Salomon and Sheila Sivam
          Med J Aust 2023; 218 (3): . || doi: 10.5694/mja2.51797
          Published online: 16 January 2023

          Cystic fibrosis (CF) is a multisystem disorder characterised by productive cough and recurrent chest infections linked with bronchiectasis; extrapulmonary symptoms may include gastrointestinal reflux, malnutrition associated with pancreatic insufficiency, and chronic sinus disease.1 With multidisciplinary care and improving therapeutic options, the median life expectancy for people with CF is now almost 50 years of age.1 In 2022, highly effective modulator therapy (elexacaftor–tezacaftor–ivacaftor) was made available to all Australians with CF aged 12 years or more with at least one F508del‐CFTR mutation (present in 90% of people with CF),1 with dramatic clinical benefits.2,3

          Please login with your free MJA account to view this article in full

          LOGIN
          CREATE AN ACCOUNT

          Please note: institutional and Research4Life access to the MJA is now provided through Wiley Online Library.

          View on Wiley Online Library

          • 1 Royal Prince Alfred Hospital, Sydney, NSW
          • 2 Sydney School of Health Sciences, the University of Sydney, Sydney, NSW
          • 3 Woolcock Institute of Medical Research, Sydney, NSW


          Acknowledgements: 

          We thank the Australian Cystic Fibrosis Data Registry for supporting this study. We also thank people with cystic fibrosis and their families who participate in the data registry.

          Competing interests:

          No relevant disclosures.

          Online responses are no longer available. Please refer to our instructions for authors page for more information.

            Increasing screening for atrial fibrillation in general practice: the Atrial Fibrillation Self‐Screening, Management And guideline‐Recommended Therapy (AF Self‐SMART) study

            Katrina Giskes, Nicole Lowres, Jessica Orchard, JiaLin Li, Kirsty McKenzie, Charlotte Mary Hespe and Ben Freedman
            Med J Aust 2023; 218 (1): . || doi: 10.5694/mja2.51803
            Published online: 16 January 2023

            Abstract

            Objective: To assess whether atrial fibrillation (AF) self‐screening stations in general practice waiting rooms improve AF screening, diagnosis, and stroke risk management.

            Design, setting: Intervention study (planned duration: twelve weeks) in six New South Wales general practices (two in rural locations, four in greater metropolitan Sydney), undertaken during 28 August 2020 – 5 August 2021.

            Participants: People aged 65 years or more who had not previously been diagnosed with AF, and had appointments for face‐to‐face GP consultations. People with valvular AF were excluded.

            Intervention: AF self‐screening station and software, integrated with practice electronic medical record programs, that identified and invited participation by eligible patients, and exported single‐lead electrocardiograms and automated evaluations to patients’ medical records.

            Main outcome measures: Screening rate; incidence of newly diagnosed AF during intervention and pre‐intervention periods; prescribing of guideline‐recommended anticoagulant medications.

            Results: Across the six participating practices, 2835 of 7849 eligible patients (36.1%) had face‐to‐face GP appointments during the intervention period, of whom 1127 completed AF self‐screening (39.8%; range by practice: 12–74%). AF was diagnosed in 49 screened patients (4.3%), 44 of whom (90%) had CHA2DS2‐VA scores of 2 or more (high stroke risk). The incidence of newly diagnosed AF during the pre‐intervention period was 11 cases per 1000 eligible patients; during the intervention period, it was 22 per 1000 eligible patients (screen‐detected: 17 per 1000 eligible patients; otherwise detected: 4.6 per 1000 eligible patients). Prescribing of oral anticoagulation therapy for people newly diagnosed with AF and high stroke risk was similar during the pre‐intervention (20 of 24, 83%) and intervention periods (46 of 54, 85%).

            Conclusions: AF self‐screening in general practice waiting rooms is a feasible approach to increasing AF screening and diagnosis rates by reducing time barriers to screening by GPs. AF self‐screening could reduce the number of AF‐related strokes.

            Trial registration: Australian New Zealand Clinical Trials Registry ACTRN12620000233921 (prospective).

            Please login with your free MJA account to view this article in full

            LOGIN
            CREATE AN ACCOUNT

            Please note: institutional and Research4Life access to the MJA is now provided through Wiley Online Library.

            View on Wiley Online Library

            • 1 Heart Research Institute, the University of Sydney, Sydney, NSW
            • 2 The University of Notre Dame Australia, Sydney, NSW
            • 3 Charles Perkins Centre, the University of Sydney, Sydney, NSW
            • 4 Centenary Institute, the University of Sydney, Sydney, NSW


            Correspondence: katrina.giskes@nd.edu.au

            Open access

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

            Acknowledgements: 

            This investigation was supported by an investigator‐initiated research grant to the Heart Research Institute from Bristol‐Myers Squibb/Pfizer Alliance. We gratefully acknowledge the HCF Research Foundation and the Royal Australian College of General Practitioners Foundation for supporting this project. Nicole Lowres was funded by a New South Wales Health Early Career Fellowship (H16/52168). Jessica Orchard is supported by a Postdoctoral Fellowship from the National Heart Foundation of Australia (104809). Publication and open access costs were covered by AFFECT‐EU (http://www.affect‐eu.eu), which received funding from the European Union Horizon 2020 research and innovation program (grant agreement no. 847770).

            We thank Andrew Kay (TOC3 Consulting) for project management advice. We are grateful to Kim Barnett and Bruce Satchwell (Alive Technologies), co‐inventors of Alivecor, for their expertise in developing the software integration. We also thank the general practices, GPs, receptionists, and practice managers involved in the study.

            Competing interests:

            Katrina Giskes and Charlotte Hespe have received honoraria from Pfizer. Ben Freedman has received grants, personal fees, and non‐financial support from Bayer, BMS–Pfizer, Daiichi Sankyo, AliveCor, and Omron.

            • 1. Freedman B, Camm J, Calkins H, et al; AF‐Screen Collaborators. Screening for atrial fibrillation: a report of the AF‐SCREEN international collaboration. Circulation 2017; 135: 1851‐1867.
            • 2. Freedman SB, Lowres N. Asymptomatic atrial fibrillation: the case for screening to prevent stroke. JAMA 2015; 314: 1911‐1912.
            • 3. NHFA CSANZ Atrial Fibrillation Guideline Working Group. National Heart Foundation of Australia and the Cardiac Society of Australia and New Zealand: Australian Clinical guidelines for the diagnosis and management of atrial fibrillation 2018. Heart Lung Circ 2018; 27: 1209‐1266.
            • 4. Hindricks G, Potpara T, Dagres N, et al; ESC Scientific Document Group. 2020 ESC guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio‐Thoracic Surgery (EACTS). Eur Heart J 2021; 42: 373‐498.
            • 5. Royal Australian College of General Practitioners. General practice: health of the nation 2018. Melbourne: RACGP, 2018. https://www.racgp.org.au/download/Documents/Publications/Health‐of‐the‐Nation‐2018‐Report.pdf (viewed June 2022).
            • 6. The Economist Intelligence Unit. Preventing stroke: uneven progress. A global policy research program. 2017. https://impact.economist.com/perspectives/sites/default/files/Preventing%20Stroke_Uneven%20Progress.pdf (viewed June 2022).
            • 7. Orchard J, Neubeck L, Freedman B, et al. eHealth tools to provide structured assistance for atrial fibrillation screening, management, and guideline‐recommended therapy in metropolitan general practice: The AF‐SMART Study. J Am Heart Assoc 2019; 8: e010959.
            • 8. Orchard J, Li J, Freedman B, et al. Atrial fibrillation screen, management, and guideline‐recommended therapy in the rural primary care setting: a cross‐sectional study and cost‐effectiveness analysis of ehealth tools to support all stages of screening. J Am Heart Assoc 2020; 9: e017080.
            • 9. Orchard J, Li J, Gallagher R, et al. Uptake of a primary care atrial fibrillation screening program (AF‐SMART): a realist evaluation of implementation in metropolitan and rural general practice. BMC Fam Pract 2019; 20: 170.
            • 10. Kaasenbrood F, Hollander M, Rutten FH, et al. Yield of screening for atrial fibrillation in primary care with a hand‐held, single‐lead electrocardiogram device during influenza vaccination. Europace 2016; 18: 1514‐1520.
            • 11. Kaasenbrood F, Hollander M, de Bruijn SHM, et al. Opportunistic screening versus usual care for diagnosing atrial fibrillation in general practice: a cluster randomised controlled trial. Br J Gen Pract 2020; 70: e427‐e433.
            • 12. Giskes K, Lowres N, Li J, et al. Atrial fibrillation self screening, management and guideline recommended therapy (AF SELF SMART): a protocol for atrial fibrillation self‐screening in general practice. Int J Cardiol Heart Vasc 2021; 32: 100683.
            • 13. Orchard J, Lowres N, Freedman SB, et al. Screening for atrial fibrillation during influenza vaccinations by primary care nurses using a smartphone electrocardiograph (iECG): a feasibility study. Eur J Prev Cardiol 2016; 23: 13‐20.
            • 14. Crockford C, Mitchell A, Kaba R, et al. SAFE2SCREEN: can patient initiated kiosk‐based self‐screening provide an opportunity to identify atrial fibrillation within a GP waiting room environment? [abstract: Heart Rhythm Congress, Birmingham, UK, 1–4 October 2017]. Europace 2017; 19 (Suppl 1): i5.
            • 15. Crockford C. When med‐tech is just a few years ahead of its intended audience. 2 Oct 2017. https://www.linkedin.com/pulse/when‐med‐tech‐just‐few‐years‐ahead‐its‐intended‐chris‐crockford (viewed Dec 2021).
            • 16. Sanders C, Rogers A, Bowen R, et al. Exploring barriers to participation and adoption of telehealth and telecare within the Whole System Demonstrator trial: a qualitative study. BMC Health Serv Res 2012; 12: 220.
            • 17. Tompson A, Fleming S, Lee MM, et al. Mixed‐methods feasibility study of blood pressure self‐screening for hypertension detection. BMJ Open 2019; 9: e027986.
            • 18. McKenzie K, Lowres N, Orchard J, et al. Staff acceptability and patient usability of a self‐screening kiosk for atrial fibrillation in general practice waiting rooms. Cardiovasc Digit Health J 2022; 3: 212‐219.
            • 19. Whitton AE, Hardy R, Cope K, et al. Mental health screening in general practices as a means for enhancing uptake of digital mental health interventions: observational cohort study. J Med Internet Res 2021; 23: e28369.
            • 20. Royal Australian College of General Practitioners. Guidelines for preventive activities in general practice. 9th ed. Melbourne: RACGP, 2016. https://www.racgp.org.au/download/Documents/Guidelines/Redbook9/17048‐Red‐Book‐9th‐Edition.pdf (viewed June 2022).
            • 21. Proudfoot J, Gale N, O'Moore K, et al. Implementation of an augmented stepped mental health care service in Australian primary care: a mixed method study. Adv Mental Health 2019; 19: 75‐93.
            • 22. Tompson AC, Grant S, Greenfield SM, et al. Patient use of blood pressure self‐screening facilities in general practice waiting rooms: a qualitative study in the UK. Br J Gen Pract 2017; 67: e467‐e73.
            • 23. AliveCor. FDA clears first of its kind algorithm suite for personal ECG [media release]. 23 Nov 2020. https://www.alivecor.com/press/press_release/fda‐clears‐first‐of‐its‐kind‐algorithm‐suite‐for‐personal‐ecg (viewed Nov 2022).
            • 24. Orchard J, Lowres N, Neubeck L, Freedman B. Atrial fibrillation: is there enough evidence to recommend opportunistic or systematic screening? Int J Epidemiol 2018; 47: 1372‐1378.
            • 25. Orchard JJ, Neubeck L, Orchard JW, et al. ECG‐based cardiac screening programs: legal, ethical, and logistical considerations. Heart Rhythm 2019; 16: 1584‐1591.
            Online responses are no longer available. Please refer to our instructions for authors page for more information.

              Learning from the past to prepare for the future

              Douglas Johnson and Megan Anne Rees
              Med J Aust 2023; 218 (1): . || doi: 10.5694/mja2.51800
              Published online: 16 January 2023

              Lessons from the COVID‐19 experience can minimise the morbidity, mortality and social disruption of future pandemics

              Our society and health care systems have experienced significant challenges and undergone major changes as a consequence of the coronavirus disease 2019 (COVID‐19) pandemic: from the dramatic early days, with high rates of morbidity and mortality overseas,1,2 and the long, difficult lockdowns in several Australian states to incredible advances in medical knowledge in terms of both vaccination and treatment.

              Please login with your free MJA account to view this article in full

              LOGIN
              CREATE AN ACCOUNT

              Please note: institutional and Research4Life access to the MJA is now provided through Wiley Online Library.

              View on Wiley Online Library

              • 1 The University of Melbourne, Melbourne, VIC
              • 2 The Royal Melbourne Hospital, Melbourne, VIC


              Correspondence: douglas.f.johnson@mh.org.au
              Competing interests:

              No relevant disclosures.

              Online responses are no longer available. Please refer to our instructions for authors page for more information.

                Welcoming the new MJA Editor‐in‐Chief, and the top ten original research articles in the MJA in 2022

                Nicholas J Talley
                Med J Aust 2023; 218 (1): . || doi: 10.5694/mja2.51801
                Published online: 16 January 2023

                It has been a privilege to lead the Journal through challenging times, but it is time to pass the baton

                From 23 January 2023, I hand over responsibility for the MJA to the new Editor‐in‐Chief, Professor Virginia (Ginny) Barbour. Professor Barbour is eminently qualified to lead the MJA, having been a Senior Editor at The Lancet and one of the founding editors and the first Chief Editor of PLOS Medicine. She completed her undergraduate immunology and medical degrees at Cambridge University, trained in haematology in the United Kingdom (including at University College London and the Royal Free Hospital), and was awarded her DPhil degree by Oxford University for her investigation of human α‐globin gene regulation. Open access for all medical journals is the future, and Professor Barbour is an internationally recognised expert in innovative scholarly communication, open access, and research integrity. In 2021, she was an expert advisor with the Australian delegation to the intergovernmental meeting of experts on the UNESCO Open Science Recommendation, and she has been involved in many international initiatives, including as vice‐chair of the Declaration on Research Assessment (DORA) steering committee and as a Plan S ambassador. Professor Barbour is based at the Queensland University of Technology, where she is co‐lead of the Office for Scholarly Communication and director of Open Access Australasia; she is also a member of the NHMRC Research Quality Steering Committee, and during the COVID‐19 pandemic was an editorial advisor to the medRxiv preprint server. I congratulate Professor Barbour on her appointment and wish her and the entire MJA team every success in the years to come. I know the Journal will be in very good hands!

                Please login with your free MJA account to view this article in full

                LOGIN
                CREATE AN ACCOUNT

                Please note: institutional and Research4Life access to the MJA is now provided through Wiley Online Library.

                View on Wiley Online Library

                • Editor‐in‐Chief, the Medical Journal of Australia


                Correspondence: ntalley@mja.com.au

                Competing interests:

                A complete list of disclosures is available at https://www.mja.com.au/journal/staff/editor‐chief‐professor‐nick‐talley.

                Online responses are no longer available. Please refer to our instructions for authors page for more information.

                  The Paediatric Aussie Chocolate Poo Scale

                  Guy D Eslick and Eloise G Eslick
                  Med J Aust 2022; 217 (11): . || doi: 10.5694/mja2.51779
                  Published online: 12 December 2022

                  The Bristol Stool Scale (BSS) was developed 30 years ago, with the aim of determining the range of bowel habits including stool types in the adult population.1 We conducted a PubMed search (All Fields), which identified more than 600 published papers associated with the BSS. The BSS is currently the gold standard to classify stool consistency in adults. In its present form, it has been useful in assessing intestinal transit time;2 the longer the time, the lower the stool number (eg, type 1 has the slowest transit time [constipation]; type 7 has the fastest transit time [diarrhoea]) (Box 1). The form of the stool strongly influences the act of defecation. The need to strain increases as the type number goes down, and the feeling of urgency increases as the type number rises.1 Feelings of incomplete evacuation occur quite often in normal individuals if their stool is at either end of the scale, but rarely if the stool is type 3 or 4.

                  Please login with your free MJA account to view this article in full

                  LOGIN
                  CREATE AN ACCOUNT

                  Please note: institutional and Research4Life access to the MJA is now provided through Wiley Online Library.

                  View on Wiley Online Library

                  • 1 Centre for Research Excellence in Digestive Health, Hunter Medical Research Institute, University of Newcastle, Newcastle, NSW
                  • 2 Clued (Clinical Links using Evidence‐based Data), Sydney, NSW


                  Correspondence: guy.eslick@sydney.edu.au
                  Competing interests:

                  No relevant disclosures.

                  • 1. Heaton KW, Radvan J, Cripps H, et al. Defecation frequency and timing, and stool form in the general population: a prospective study. Gut 1992; 33: 818‐824.
                  • 2. Lewis SJ, Heaton KW. Stool form scale as a useful guide to intestinal transit time. Scand J Gastroenterol 1997; 32: 920‐924.
                  • 3. Jadrešin O, Hojsak I, Mišak Z, et al. Lactobacillus reuteri DSM 17938 in the treatment of functional abdominal pain in children: RCT study. J Pediatr Gastroenterol Nutr 2017; 64: 925‐929.
                  • 4. Bekkali N, Hamers SL, Reitsma JB, et al. Infant stool form scale: development and results. J Pediatr 2009; 154: 521‐526.
                  • 5. Velasco‐Benitez CA, Llanos‐Chea A, Saps M. Utility of the Brussels Infant and Toddler Stool Scale (BITSS) and Bristol Stool Scale in non‐toilet‐trained children: a large comparative study. Neurogastroenterol Motil 2021; 33: e14015.
                  Online responses are no longer available. Please refer to our instructions for authors page for more information.

                    Clinical staging of clinicians

                    Gordon B Parker
                    Med J Aust 2022; 217 (11): . || doi: 10.5694/mja2.51780
                    Published online: 12 December 2022

                    Medical practice weights clinical staging models, so why not a staging model for medical practitioners themselves?

                    Clinical staging models are relevant to managing many medical conditions and have the potential to determine prognosis and phase‐specific interventions. Reflecting this age of personalised medicine, a staging model for personalising clinicians (henceforth, personalised to “you”) is now offered.

                    Please login with your free MJA account to view this article in full

                    LOGIN
                    CREATE AN ACCOUNT

                    Please note: institutional and Research4Life access to the MJA is now provided through Wiley Online Library.

                    View on Wiley Online Library

                    • University of New South Wales, Sydney, NSW


                    Correspondence: g.parker@unsw.edu.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:

                    No relevant disclosures.

                    Online responses are no longer available. Please refer to our instructions for authors page for more information.

                      From meals, movies and microbes to a new chocolate yuk scale, mortality among wizards, and medical career staging: season's greetings!

                      Nicholas J Talley
                      Med J Aust 2022; 217 (11): . || doi: 10.5694/mja2.51783
                      Published online: 12 December 2022

                      Time to celebrate another successful year in difficult times, but we are mindful of the challenges that remain

                      Welcome to the final MJA issue of 2022! As most Australians take well earned Christmas–New Year breaks, many health professionals across Australia continue to serve their communities, staff our hospitals and clinics, and provide outstanding health care 24 hours a day. We at the MJA thank everyone working in health and medicine for all you do every day, during the holiday season and throughout the year, and hope that you too will find time for a break.

                      Please login with your free MJA account to view this article in full

                      LOGIN
                      CREATE AN ACCOUNT

                      Please note: institutional and Research4Life access to the MJA is now provided through Wiley Online Library.

                      View on Wiley Online Library

                      • Editor‐in‐Chief, the Medical Journal of Australia


                      Correspondence: ntalley@mja.com.au
                      Acknowledgements: 

                      I thank the tireless efforts of the editorial team throughout 2022, without which the quality and timely publication of our Journal would be impossible: deputy editors Alisha Dorrigan, Francis Geronimo, Robyn Godding, Tania Janusic, Wendy Morgan, Aajuli Shukla, Elizabeth Zuccala, and Maria Inacio; our scientific and structural editors, Paul Foley, Graeme Prince, and Laura Teruel; our consultant biostatistician, Elmer Villanueva; our news and online editor, Cate Swannell; our graphic designer, Leilani Widya; our head of publishing content, Ben Dawe; and our senior publishing coordinator, Kerrie Harding.

                      Competing interests:

                      Guy Eslick, the winner of the Christmas competition, is employed part time by the University of Newcastle, and works with the author. A complete list of disclosures is available at https://www.mja.com.au/journal/staff/editor‐chief‐professor‐nick‐talley

                      Online responses are no longer available. Please refer to our instructions for authors page for more information.
                      Subscribe to