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MJA

    Reducing the burden of group A streptococcal disease in the Northern Territory: the role of chemoprophylaxis for those at greatest risk

    Katherine Gibney and Andrew Steer
    Med J Aust 2022; 217 (10): . || doi: 10.5694/mja2.51766
    Published online: 21 November 2022

    The unacceptably high prevalence among Indigenous people and people who need dialysis warrants a clinical trial of prophylactic antibiotics

    Relatively little is known about the epidemiology of invasive group A streptococcal (iGAS) disease in Australia. In this issue of the MJA, Birrell and colleagues report that the iGAS disease burden in the Northern Territory continues to fall largely on Indigenous Australians and people undergoing haemodialysis.1 This raises the question of whether antibiotic prophylaxis should be provided to those at greatest risk. Their report is timely, as national public health guidelines are being developed following the listing of iGAS disease as nationally notifiable in July 2021.2

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      Where should we offer mass drug administration for trachoma?

      Jaki Adams, Sung Hye Kim and Anthony W Solomon
      Med J Aust 2022; 217 (10): . || doi: 10.5694/mja2.51752
      Published online: 21 November 2022

      Elimination programs should be guided by the prevalence of markers of infection, not of disease

      Trachomatous trichiasis can be devastating: it deforms the eyelid, scars the cornea, and blinds the eye.1 It disables the individual and impoverishes their family; quality of life is severely impaired.2 As restoring sight to a dry eye with a vascularised cornea using keratoplasty is difficult, these effects are generally irreversible. Most people blinded by trachomatous trichiasis live in poor, remote communities without the visual rehabilitation and support services available in major cities.

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      • 1 The Fred Hollows Foundation, Darwin, NT
      • 2 World Health Organization Regional Office for the Western Pacific, Manila, Philippines
      • 3 Hanyang University, Seoul, Republic of Korea
      • 4 World Health Organization, Geneva, Switzerland


      Correspondence: solomona@who.int
      Competing interests:

      Sung Hye Kim and Anthony W Solomon are staff members of the World Health Organization. The authors alone are responsible for the views expressed in this article and they do not necessarily represent the views, decisions, or policies of the institutions with which they are affiliated.

      • 1. Palmer SL, Winskell K, Patterson AE, et al. “A living death”: a qualitative assessment of quality of life among women with trichiasis in rural Niger. Int Health 2014; 6: 291‐297.
      • 2. Habtamu E, Wondie T, Aweke S, et al. The impact of trachomatous trichiasis on quality of life: a case control study. PLoS Negl Trop Dis 2015; 9: e0004254.
      • 3. Solomon AW, Burton MJ, Gower EW, et al. Trachoma. Nat Rev Dis Primers 2022; 8: 32.
      • 4. Gambhir M, Basáñez MG, Burton MJ, et al. The development of an age‐structured model for trachoma transmission dynamics, pathogenesis and control. PLoS Negl Trop Dis 2009; 3: e462.
      • 5. Solomon AW, Holland MJ, Burton MJ, et al. Strategies for control of trachoma: observational study with quantitative PCR. Lancet 2003; 362: 198‐204.
      • 6. Solomon AW, Peeling RW, Foster A, Mabey DC. Diagnosis and assessment of trachoma. Clin Microbiol Rev 2004; 17: 982‐1011.
      • 7. World Health Organization. WHO Alliance for the Global Elimination of Trachoma: progress report on elimination of trachoma, 2021. Wkly Epidemiol Rec 2022; 97: 353‐364. https://www.who.int/publications/i/item/who‐wer9731‐353‐364 (viewed Sept 2022).
      • 8. Kirby Institute. Australian trachoma surveillance report 2019. Sydney: UNSW, 2020. https://kirby.unsw.edu.au/report/australian‐trachoma‐surveillance‐report‐2019 (viewed Sept 2022).
      • 9. Ramadhani AM, Derrick T, Macleod D, et al. The relationship between active trachoma and ocular Chlamydia trachomatis infection before and after mass antibiotic treatment. PLoS Negl Trop Dis 2016; 10: e0005080.
      • 10. World Health Organization Regional Office for the Western Pacific. Expert consultation on the elimination of trachoma in the Pacific: Melbourne, Australia, 17–19 January 2018 [meeting report]. https://apps.who.int/iris/handle/10665/325940 (viewed Sept 2022).
      • 11. O'Brien KS, Emerson P, Hooper PJ, et al. Antimicrobial resistance following mass azithromycin distribution for trachoma: a systematic review. Lancet Infect Dis 2019; 19: e14‐e25.
      • 12. Lynch K, Morotti W, Brian G, et al. Clinical signs of trachoma and laboratory evidence of ocular Chlamydia trachomatis infection in a remote Queensland community: a serial cross‐sectional study. Med J Aust 2022; 217: 538‐543.
      • 13. World Health Organization. Validation of elimination of trachoma as a public health problem (WHO/HTM/NTD/2016.8). Geneva: World Health Organization, 2016. https://apps.who.int/iris/handle/10665/208901 (viewed Sept 2022).
      • 14. World Health Organization. Vanuatu leads the way for Pacific elimination of trachoma: the world's biggest infectious cause of blindness. Manila: World Health Organization, 2022. https://www.who.int/westernpacific/about/how‐we‐work/pacific‐support/news/detail/12‐08‐2022‐vanuatu‐leads‐the‐way‐for‐pacific‐elimination‐of‐trachoma‐‐‐the‐world‐s‐biggest‐infectious‐cause‐of‐blindness (viewed Aug 2022).
      • 15. Butcher R, Handley B, Garae M, et al. Ocular Chlamydia trachomatis infection, anti‐Pgp3 antibodies and conjunctival scarring in Vanuatu and Tarawa, Kiribati before antibiotic treatment for trachoma. J Infect 2020; 80: 454‐461.
      • 16. Butcher R, Tagabasoe J, Manemaka J, et al. Conjunctival scarring, corneal pannus and Herbert's pits in adolescent children in trachoma‐endemic populations of the Solomon Islands and Vanuatu. Clin Infect Dis 2021; 73: e2773–e2780.
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        The long term implications of fertility therapy for the health of women

        Robert J Norman
        Med J Aust 2022; 217 (10): . || doi: 10.5694/mja2.51760
        Published online: 21 November 2022

        Cardiovascular disease mortality is not increased in women undergoing IVF, but vigilant surveillance is nonetheless required

        Since the first birth facilitated by in vitro fertilisation (IVF) in 1978, the use of IVF has spread across the world and more than eight million babies have been born.1 The use of medically assisted reproduction, including IVF, currently accounts for about 7% of all births in Australia, and the annual number of births involving assisted reproductive technology has increased by 55% over the past ten years.2 IVF is a recognised medical technology with a reasonable success rate in younger women, partially funded by Medicare, widely available across Australia, and well accepted by the Australian community.


        • The Robinson Research Institute, the University of Adelaide, Adelaide, SA


        Competing interests:

        No relevant disclosures.

        • 1. European Society of Human Reproduction and Embryology. Eight million IVF babies since the birth of the world’s first in 1978 [media release]. 4 July 2018. https://www.focusonreproduction.eu/article/ESHRE‐News‐GlobalIVF18 (viewed Oct 2022).
        • 2. Choi SKY, Venetis C, Ledger W, et al. Population‐wide contribution of medically assisted reproductive technologies to overall births in Australia: temporal trends and parental characteristics. Hum Reprod 2022; 37: 1047‐1058.
        • 3. Venn A, Hemminki E, Watson L, et al. Mortality in a cohort of IVF patients. Hum Reprod 2001; 16: 2691‐2696.
        • 4. Venn A, Watson L, Lumley J, et al. Breast and ovarian cancer incidence after infertility and in vitro fertilisation. Lancet 1995; 346: 995‐1000.
        • 5. Yiallourou S, Magliano D, Haregu TN, et al. Long term all‐cause and cardiovascular disease mortality among women who undergo fertility treatment. Med J Aust 2022; 217: 532‐537.
        • 6. Sergentanis TN, Diamantaras AA, Perlepe C, et al. IVF and breast cancer: a systematic review and meta‐analysis. Hum Reprod Update 2014; 20: 106‐123.
        • 7. Spaan M, van den Belt‐Dusebout AW, Lambalk CB, et al. Long‐term risk of ovarian cancer and borderline tumors after assisted reproductive technology. J Natl Cancer Inst 2021; 113: 699‐709.
        • 8. Joham AE, Norman RJ, Stener‐Victorin E, et al. Polycystic ovary syndrome. Lancet Diabetes Endocrinol 2022; 10: 668‐680.
        • 9. Moran LJ, Norman RJ, Teede HJ. Metabolic risk in PCOS: phenotype and adiposity impact. Trends Endocrinol Metab 2015; 26: 136‐143.
        • 10. Wang R, Li W, Bordewijk EM, et al. Reproductive Medicine Network; International Ovulation Induction IPDMA Collaboration. First‐line ovulation induction for polycystic ovary syndrome: an individual participant data meta‐analysis. Hum Reprod Update 2019; 25: 717‐732.
        • 11. Gomes JMD, VanHise K, Stachenfeld N, et al. Subclinical cardiovascular disease and polycystic ovary syndrome. Fert Steril 2022; 117: 912‐923.
        • 12. Saito K, Kuwahara A, Ishikawa T, et al. Endometrial preparation methods for frozen‐thawed embryo transfer are associated with altered risks of hypertensive disorders of pregnancy, placenta accrete and gestational diabetes. Hum Reprod 2019; 34: 1567‐1575.
        • 13. Luke B, Brown MB, Eisenberg M, et al. In vitro fertilization and risk for hypertensive disorders of pregnancy: associations with treatment parameters. Am J Obstet Gynecol 2020; 222: 350.e1‐350. e13.
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          Reducing the burden of anaemia for people undergoing major surgery

          Philip Crispin
          Med J Aust 2022; 217 (9): . || doi: 10.5694/mja2.51748
          Published online: 7 November 2022

          Pathways and a culture that view blood as disposable must yield to approaches that value patients’ own blood

          The often predictable haemostatic challenge of surgery includes the possibility of anaemia increasing procedure‐induced stress and consequently the burden on the patient during the operation and their recuperation. Peri‐operative anaemia has often been managed by transfusion. Blood was regarded as disposable, and the ready supply of donor blood has enabled higher risk invasive procedures in the knowledge that blood can be replaced even in the event of excessive loss. Despite considerable advances in the safety of transfusion, blood remains a biological product with residual risks, including infection and immunological effects. Further, each unnecessarily transfused unit of blood increases the burden on donations.


          • 1 Canberra Hospital, Canberra, ACT
          • 2 Australian National University, Canberra, ACT


          Correspondence: philip.crispin@act.gov.au
          Competing interests:

          I have received funding for my institution from the Australian Commission for Safety and Quality in Healthcare for the National Patient Blood Management Collaborative.

          • 1. Spence RK, Erhard J. History of patient blood management. Best Pract Res Clin Anaesthesiol 2013; 27: 11‐15.
          • 2. Australian National Blood Authority. Patient blood management guidelines, module 2: perioperative. 2012. https://www.blood.gov.au/pbm‐module‐2 (viewed Sept 2022).
          • 3. Muñoz M, Acheson AG, Auerbach M, et al. International consensus statement on the peri‐operative management of anaemia and iron deficiency. Anaesthesia 2017; 72: 233‐247.
          • 4. POSTVenTT Study Collaborative. The management of peri‐operative anaemia in patients undergoing major abdominal surgery in Australia and New Zealand: a prospective cohort study. Med J Aust 2022; 217: 487‐493.
          • 5. Anker SD, Comin Colet J, Filippatos G, et al; FAIR‐HF Trial Investigators. Ferric carboxymaltose in patients with heart failure and iron deficiency. N Engl J Med 2009; 361: 2436‐2448.
          • 6. Richards T, Baikady RR, Clevenger B, et al. Preoperative intravenous iron to treat anaemia before major abdominal surgery (PREVENTT): a randomised, double‐blind, controlled trial. Lancet 2020; 396: 1353‐1361.
          • 7. Australian Commission on Safety and Quality in Health Care. Resources for improved patient blood management. Nov 2017. https://www.safetyandquality.gov.au/sites/default/files/migrated/National‐Patient‐Blood‐Management‐Collaborative‐NPBMC‐Resource‐Booklet‐November‐2017.pdf (viewed Sept 2022).
          • 8. Cancer Council Victoria; Department of Heath Victoria. Optimal care pathway for people with colorectal cancer. Second edition. https://www.cancer.org.au/assets/pdf/colorectal‐cancer‐optimal‐cancer‐care‐pathway (viewed Sept 2022).
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            The Future Healthy Countdown 2030: holding Australia to account for the health and wellbeing of future generations

            Sandro Demaio, Sharon R Goldfeld, Anne Hollonds, George C Patton, Fiona J Stanley, Rosemary Calder, Kate Lycett and Zuleika Arashiro
            Med J Aust 2022; 217 (9): . || doi: 10.5694/mja2.51746
            Published online: 7 November 2022

            It is time to reimagine wellbeing and place the future of our children and young people at the centre of public action

            As we approach World Children’s Day and the 2022 United Nations Climate Change Conference (COP27), we are once again reminded of how lack of leadership and coordinated action is threatening the future of humankind and, particularly, that of our children, young people and generations to come.1 Although climate change had already affected how younger generations and their parents imagine a healthy future, the onset of the global coronavirus disease 2019 (COVID‐19) pandemic has only served to heighten their concerns.2 Research from around the world indicates that children and young people have been disproportionately burdened by the changes and challenges of the past 3 years. The sudden disruptions and high uncertainty at critical points of their development, along with the mental health and financial impacts on their parents, have placed a heavy toll on their wellbeing.3 However, even before the pandemic, there were growing concerns that, for the first time, the current generation of children would be less healthy than their parents.4

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            • 1 Victorian Health Promotion Foundation, VicHealth, Melbourne, VIC
            • 2 Centre for Community Child Health, Royal Children’s Hospital, Melbourne, VIC
            • 3 Australian Human Rights Commission, Sydney, NSW
            • 4 University of Melbourne, Melbourne, VIC
            • 5 Centre for Adolescent Health, Murdoch Children’s Research Institute, Melbourne, VIC
            • 6 Telethon Kids Institute, Perth, WA
            • 7 University of Western Australia, Perth, WA
            • 8 Mitchell Institute, Victoria University, Melbourne, VIC
            • 9 Centre for Social and Early Emotional Development, Deakin University, Geelong, VIC
            • 10 Murdoch Children’s Research Institute, Melbourne, VIC


            Competing interests:

            No relevant disclosures.

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              A planetary health–organ system map to integrate climate change and health content into medical curricula

              Hayden Burch, Laura J Beaton, Grace Simpson, Ben Watson, Janie Maxwell and Kenneth D Winkel
              Med J Aust 2022; 217 (9): . || doi: 10.5694/mja2.51737
              Published online: 7 November 2022

              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.

              • 1. Romanello M, McGushin A, Di Napoli C, et al. The 2021 report of the Lancet Countdown on health and climate change: code red for a healthy future. Lancet 2021; 398: 1619‐1662.
              • 2. Brand G, Collins J, Bedi G, et al. “I teach it because it is the biggest threat to health”: integrating sustainable healthcare into health professions education. Med Teach 2021; 43: 325‐333.
              • 3. Gomez J, Goshua A, Pokrajac N, et al. Teaching medical students about the impacts of climate change on human health. J Clim Chang Health 2021; 3: 100020.
              • 4. Guzmán CAF, Aguirre AA, Astle B, et al. A framework to guide planetary health education. Lancet Planet Health 2021; 5: e253‐e255.
              • 5. Hackett F, Got T, Kitching GT, et al. Training Canadian doctors for the health challenges of climate change. Lancet Planet Health 2020; 4: e2‐e3.
              • 6. Hansen M, Rohn S, Moglan E, et al. Promoting climate change issues in medical education: Lessons from a student‐driven advocacy project in a Canadian Medical school. J Clim Chang Health 2021; 3: 100026.
              • 7. Maxwell J, Blashki G. Teaching about climate change in medical education: an opportunity. J Public Health Res 2016; 5: 673.
              • 8. Medical students and faculty from 74 medical schools in the US, UK, Ireland, Canada, Germany, Malaysia, and Japan. 2021–2022 Summary report and international health student initiative. https://phreportcard.org/wp‐content/uploads/2022/04/2022‐PHRC‐Summary‐Report_FINAL.pdf (viewed Sept 2022).
              • 9. Shaw E, Walpole S, McLean M, et al. AMEE Consensus Statement: Planetary health and education for sustainable healthcare. Med Teach 2021; 43: 272‐286.
              • 10. Walpole SC, Mortimer F. Evaluation of a collaborative project to develop sustainable healthcare education in eight UK medical schools. Public Health 2017; 150: 134‐148.
              • 11. Tun S. Fulfilling a new obligation: teaching and learning of sustainable healthcare in the medical education curriculum. Med Teach 2019; 41: 1168‐1177.
              • 12. Lal A, Walsh EI, Wetherell A, Slimings C. Climate change in public health and medical curricula in Australia and New Zealand: a mixed methods study of educator perceptions of barriers and areas for further action. Environ Educ Res 2022; 7: 1070‐1087.
              • 13. Bell EJ. Climate change: what competencies and which medical education and training approaches? BMC Med Educ 2010; 10: 31.
              • 14. Sharma M, Pinto AD, Kumagai AK. Teaching the social determinants of health: a path to equity or a road to nowhere? Acad Med 2018; 93: 25‐30.
              • 15. Schwerdtle N, Horton G, Kent F, et al. Education for sustainable healthcare: a transdisciplinary approach to transversal environmental threats. Med Teach 2020; 42: 1102‐1106.
              • 16. Salas RN, Solomon CG. The climate crisis — health and care delivery. N Engl J Med 2019; 381: e13.
              • 17. Rabin BM, Laney EB, Philipsborn RP. The unique role of medical students in catalyzing climate change education. J Med Educ Curric Dev 2020; 7: 2382120520957653.
              • 18. Madden DL, Horton GL, McLean M. Preparing Australasian medical students for environmentally sustainable health care. Med J Aust 2022; 216: 225‐229. https://www.mja.com.au/journal/2022/216/5/preparing‐australasian‐medical‐students‐environmentally‐sustainable‐health‐care
              • 19. Madden DL, McLean M, Horton GL. Preparing medical graduates for the health effects of climate change: an Australasian collaboration. Med J Aust 2018; 208: 291‐292. https://www.mja.com.au/journal/2018/208/7/preparing‐medical‐graduates‐health‐effects‐climate‐change‐australasian
              • 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).
              • 21. Australian Medical Association, Doctors for the Environment Australia. Joint statement — medical professionals call for emissions reduction in healthcare 2021 [media release]. 17 March 2021 https://www.dea.org.au/wp‐content/uploads/2021/03/170321‐Joint‐statement‐Medical‐Professionals‐call‐for‐emissions‐reduction‐in‐health‐care.pdf (viewed Apr 2021).
              • 22. Council of Presidents of Medical Colleges. Managing and responding to climate risks in healthcare. Canberra: CPMC, 2018. https://cpmc.edu.au/communique/managing‐and‐responding‐to‐climate‐risks‐in‐healthcare (viewed Apr 2021).
              • 23. Yeung C, Friesen F, Farr S, et al. Development and implementation of a longitudinal students as teachers program: participant satisfaction and implications for medical student teaching and learning. BMC Med Educ 2017; 17: 28.
              • 24. Anderson LW, Krathwohl DR. A taxonomy for learning, teaching, and assessing: a revision of Bloom’s taxonomy of educational objectives. New York: Addison Wesley Longman, 2001.
              • 25. Remedios L, Winkel KD. Education for sustainable healthcare: setting the educational agenda for our future. Focus on Health Professional Education: A Multi‐disciplinary Journal 2022; 23: i‐v.
              • 26. Ferris HA, O’Flynn D, Flynn O. Assessment in medical education; what are we trying to achieve? Int J High Educ 2015; 4.
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                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

                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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                  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

                  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


                  Competing interests:

                  No relevant disclosures.

                  • 1. Lord SJ, Daniels B, Kiely BE, et al. Long term risk of distant metastasis in women with non‐metastatic breast cancer and survival after metastasis detection: a population‐based linked health records study. Med J Aust 2022; 217: 402‐409.
                  • 2. Breast Cancer Trialists’ Collaborative Group. Effects of chemotherapy and hormonal therapy for early breast cancer on recurrence and 15‐year survival: an overview of the randomized trials. Lancet 2005; 365: 1687–1717.
                  • 3. Lohrisch C, Francl M, Sun S, et al. Willingness of breast cancer patients to undergo biopsy and breast cancer clinicians’ practices around seeking biopsy at the time of breast cancer relapse. Breast Cancer Res Treat 2018; 168: 221–228.
                  • 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).
                  • 6. Martin HL, Ohara K, Chin W, et al. Cancer services in Western Australia: a comparison of regional outcomes with metropolitan Perth. Aust J Rural Health 2015; 23: 302‐308.
                  • 7. Beith J, Burslem K, Bell R, et al. Hormone receptor positive, HER2 negative metastatic breast cancer: a systematic review of the current treatment landscape. Asia Pac J Clin Oncol 2016; 12: 3‐18.
                  • 8. Hölzel D, Eckel R, Bauerfeind I, et al. Improved systemic treatment for early breast cancer improves cure rates, modifies metastatic pattern and shortens post‐metastatic survival: 35‐year results from the Munich Cancer Registry. J Cancer Res Clin Oncol 2017; 143: 1701‐1712.
                  • 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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                    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

                    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


                    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.
                    • 4. Simon A, Onya O, Mazza‐Stalder J, et al. Added diagnostic value of 16S rRNA gene pan‐mycobacterial PCR for nontuberculous mycobacterial infections: a 10‐year retrospective study. Eur J Clin Microbiol Infect Dis 2019; 38: 1873‐1881.
                    • 5. Calonje JE, Brenn T, Lazar AJ, Billings SD. Granulomatous, necrobiotic and perforating dermatoses. In: McKee’s pathology of the skin. 5th ed. Elsevier, 2018.
                    • 6. Grayson W, Calonje E. Infectious diseases of the skin. In: McKee’s pathology of the skin. 5th ed. Elsevier, 2018.
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                      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

                      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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