Topics

To the Editor: More Australians die of prescription medication overdose than of illicit drug use or motor vehicle accidents.1 Real time prescription monitoring systems have been recommended to track patients’ supply history for potentially high risk medicines, including strong opioids and benzodiazepines. These programs aim to assist in the early identification of high risk medicine use to inform clinical care, and have received broad support from pharmacy and medical professional groups.

1 Turner Institute for Brain and Mental Health, Monash University, Melbourne, VIC
2 Turning Point, Eastern Health and Monash University, Melbourne, VIC
3 Monash Addiction Research Centre, Monash University, Melbourne, VIC

Correspondence: Sarah.Haines@monash.edu

Competing interests:

No relevant disclosures.

1. Department of Health and Human Services. Regulatory impact statement — proposed drugs, poisons and controlled substances amendment (real‐time prescription monitoring). Melbourne: Victoria State Government, 2018. https://www2.health.vic.gov.au/about/publications/ResearchAndReports/rtpm-regulatory-impact-statement (viewed Apr 2020).
2. Fink DS, Schleimer JP, Sarvet A, et al. Association between prescription drug monitoring programs and nonfatal and fatal drug overdoses: a systematic review. Ann Intern Med 2018; 168: 783–790.
3. James JR, Scott JM, Klein JW, et al. Mortality after discontinuation of primary care‐based chronic opioid therapy for pain: a retrospective cohort study. J Gen Intern Med 2019; 34: 2749–2755.
4. Tsai AC, Kiang MV, Barnett ML, et al. Stigma as a fundamental hindrance to the United States opioid overdose crisis response. PLoS Med 2019; 16: e1002969.
5. Bauer M, Monteith S, Geddes J, et al. Automation to optimise physician treatment of individual patients: examples in psychiatry. Lancet Psychiatry 2019; 6: 338–349.

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

Letters

Reusing N95 (or P2) masks: current evidence and urgent research questions

James M Branley, Adam Polkinghorne and Gwendolyn L Gilbert

Med J Aust 2020; 213 (3): . || doi: 10.5694/mja2.50694
Published online: 3 August 2020

ARTICLE
AUTHORS
REFERENCES

Topics

Infectious diseases

To the Editor: The coronavirus disease 2019 (COVID‐19) pandemic is placing increasing pressure on the health care resources of nations. Particular concern is held for supplies of N95 (or P2) masks and surgical masks — personal protective equipment designed to achieve close facial fit and protection from more than 95% of 0.3 μm test particles. These masks are recommended for routine care of patients on airborne precautions, with current guidelines indicating that N95 masks are single use.1 Further highlighting the importance of N95 masks in protecting health care workers during the COVID‐19 pandemic, a recent study of severe acute respiratory syndrome coronavirus 2 (SARS‐CoV2) infection rates among medical staff in Zhongnan Hospital of Wuhan University showed that none of the staff (0/278) who wore N95 masks and followed frequent disinfection and handwashing became infected during the period of 2–22 January 2020 compared with 4.7% (10/231) of staff who did not wear masks, despite the fact that the latter group worked in lower risk areas.2

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

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 Nepean Hospital, Sydney, NSW
2 University of Sydney, Sydney, NSW
3 Marie Bashir Institute for Infectious Diseases and Biosecurity, University of Sydney, Sydney, NSW

Correspondence: james.branley@health.nsw.gov.au

Competing interests:

No relevant disclosures.

1. National Health and Medical Research Council. Australian guidelines for the prevention and control of infection in healthcare (2019). Canberra: NHMRC, 2019. https://nhmrc.govcms.gov.au/about-us/publications/australian-guidelines-prevention-and-control-infection-healthcare-2019 (viewed June 2020).
2. Wang X, Pan Z, Cheng Z. Association between 2019‐nCoV transmission and N95 respirator use. J Hosp Infect 2020; 105: 104–105.
3. Fisher EM, Shaffer RE. Considerations for recommending extended use and limited reuse of filtering facepiece respirators in health care settings. J Occup Environ Hyg 2014; 11: D115–D128.
4. Beckman S, Materna B, Goldmacher S, et al. Evaluation of respiratory protection programs and practices in California hospitals during the 2009–2010 H1N1 influenza pandemic. Am J Infect Control 2013; 41: 1024–1031.
5. Mills D, Harnish DA, Lawrence C, et al. Ultraviolet germicidal irradiation of influenza‐contaminated N95 filtering facepiece respirators. Am J Infect Control 2018; 46: e49–e55.
6. Lindsley WG, Martin SB, Thewlis RE, et al. Effects of ultraviolet germicidal irradiation (UVGI) on N95 respirator filtration performance and structural integrity. J Occup Environ Hyg 2015; 12: 509–517.
7. Lin TH, Chen CC, Huang SH, et al. Filter quality of electret masks in filtering 14.6–594 nm aerosol particles: effects of five decontamination methods. PLoS One 2017; 12: e0186217.
8. Viscusi DJ, Bergman MS, Eimer BC, Shaffer RE. Evaluation of five decontamination methods for filtering facepiece respirators. Ann Occup Hyg 2009; 53: 815–827.
9. Viscusi DJ, Bergman MS, Novak DA, et al. Impact of three biological decontamination methods on filtering facepiece respirator fit, odor, comfort, and donning ease. J Occup Environ Hyg 2011; 8: 426–436.
10. Lore MB, Heimbuch BK, Brown TL, et al. Effectiveness of three decontamination treatments against influenza virus applied to filtering facepiece respirators. Ann Occup Hyg 2012; 56: 92–101.
11. Carratalà A, Dionisio Calado A, Mattle MJ, et al. Solar disinfection of viruses in polyethylene terephthalate bottles. Appl Environ Microbiol 2016; 82: 279–288.
12. Lin TH, Tang FC, Hung PC, et al. Relative survival of Bacillus subtilis spores loaded on filtering facepiece respirators after five decontamination methods. Indoor Air 2018; 28: 754–762.
13. Coulliette AD, Perry KA, Fisher EM, et al. MS2 coliphage as a surrogate for 2009 pandemic influenza A (H1N1) virus (pH1N1) in surface survival studies on N95 filtering facepiece respirators. J Int Soc Respir Prot 2014; 21: 14–22.

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

Consensus statement

Management of adult cardiac arrest in the COVID‐19 era: consensus statement from the Australasian College for Emergency Medicine

Simon Craig, Mya Cubitt, Ashish Jaison, Steven Troupakis, Natalie Hood, Christina Fong, Adnan Bilgrami, Peter Leman, Juan Carlos Ascencio‐Lane, Guruprasad Nagaraj, John Bonning, Gabriel Blecher, Rob Mitchell, Ellen Burkett, Sally M McCarthy, Amanda M Rojek, Kim Hansen, Helen Psihogios, Peter Allely, Simon Judkins, Lai Heng Foong, Stephen Bernard and Peter A Cameron

Med J Aust 2020; 213 (3): . || doi: 10.5694/mja2.50699
Published online: 3 August 2020

ARTICLE
AUTHORS
REFERENCES

Topics

Emergency medicine

Infectious diseases

Abstract

Introduction: The global pandemic of coronavirus disease 2019 (COVID‐19) has caused significant worldwide disruption. Although Australia and New Zealand have not been affected as much as some other countries, resuscitation may still pose a risk to health care workers and necessitates a change to our traditional approach. This consensus statement for adult cardiac arrest in the setting of COVID‐19 has been produced by the Australasian College for Emergency Medicine (ACEM) and aligns with national and international recommendations.

Main recommendations:

In a setting of low community transmission, most cardiac arrests are not due to COVID‐19.
Early defibrillation saves lives and is not considered an aerosol generating procedure.
Compression‐only cardiopulmonary resuscitation is thought to be a low risk procedure and can be safely initiated with the patient's mouth and nose covered.
All other resuscitative procedures are considered aerosol generating and require the use of airborne personal protective equipment (PPE).
It is important to balance the appropriateness of resuscitation against the risk of infection.
Methods to reduce nosocomial transmission of COVID‐19 include a physical barrier such as a towel or mask over the patient's mouth and nose, appropriate use of PPE, minimising the staff involved in resuscitation, and use of mechanical chest compression devices when available.
If COVID‐19 significantly affects hospital resource availability, the ethics of resource allocation must be considered.

Changes in management: The changes outlined in this document require a significant adaptation for many doctors, nurses and paramedics. It is critically important that all health care workers have regular PPE and advanced life support training, are able to access in situ simulation sessions, and receive extensive debriefing after actual resuscitations. This will ensure safe, timely and effective management of the patients with cardiac arrest in the COVID‐19 era.

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

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 Monash Health, Melbourne, VIC
2 Monash University, Melbourne, VIC
3 Royal Melbourne Hospital, Melbourne, VIC
4 Centre for Integrated Critical Care, University of Melbourne, Melbourne, VIC
5 Emergency and Trauma Centre, Alfred Health, Melbourne, VIC
6 Epworth HealthCare, Melbourne, VIC
7 Surf Life Saving Australia, Sydney, NSW
8 Fiona Stanley Hospital, Perth, WA
9 University of Western Australia, Perth, WA
10 Royal Hobart Hospital, Hobart, TAS
11 University of Tasmania, Hobart, TAS
12 South Western Emergency Research Institute, Liverpool Hospital, Sydney, NSW
13 University of New South Wales, Sydney, NSW
14 Australasian College for Emergency Medicine, Melbourne, VIC
15 Council of Medical Colleges of Aotearoa New Zealand, Wellington, New Zealand
16 Monash Medical Centre, Melbourne, VIC
17 Princess Alexandra Hospital, Brisbane, QLD
18 Clinical Excellence Queensland, Brisbane, QLD
19 Prince of Wales Hospital and Community Health Services, Sydney, NSW
20 Centre for Integrated Critical Care, University of Melbourne, Melbourne, VIC
21 St Andrew's War Memorial Hospital, Brisbane, QLD
22 Prince Charles Hospital, Brisbane, QLD
23 Sir Charles Gairdner Hospital, Perth, WA
24 Austin Hospital, Melbourne, VIC
25 Bankstown–Lidcombe Hospital, Sydney, NSW
26 University of Western Sydney, Sydney, NSW
27 Centre for Research and Evaluation, Ambulance Victoria, Melbourne, VIC

Correspondence: simon.craig@monashhealth.org

Acknowledgements:

The authors would like to acknowledge the assistance of the following ACEM staff in the production of this consensus statement: Robert Lee, Nicola Ballenden, Andrea Johnston and Belinda Rule.

Competing interests:

No relevant disclosures.

1. Falconer R. Australia and New Zealand reopen after coronavirus cases plummet. Axios News 2020; 14 May. https://www.axios.com/coronavirus-australia-new-zealand-reopen-lockdown-3da28be5-1526-4790-a44a-a25c63dc0895.html (viewed May 2020).
2. Chan‐Yeung M. Severe acute respiratory syndrome (SARS) and healthcare workers. Int J Occup Environ Health 2004; 10: 421–427.
3. Christian MD, Loutfy M, McDonald LC, et al. Possible SARS coronavirus transmission during cardiopulmonary resuscitation. Emerg Infect Dis 2004; 10: 287–293.
4. Loeb M, McGeer A, Henry B, et al. SARS among critical care nurses, Toronto. Emerg Infect Dis 2004; 10: 251–255.
5. Wang J, Zhou M, Liu F. Reasons for healthcare workers infected with novel coronavirus disease 2019 (COVID‐19) in China. J Hosp Infect 2020; 105: 100–101.
6. Fritz Z, Perkins GD. Cardiopulmonary resuscitation after hospital admission with COVID‐19. BMJ 2020; 369: m1387.
7. Mahase E, Kmietowicz Z. covid‐19: doctors are told not to perform CPR on patients in cardiac arrest. BMJ 2020; 368: m1282.
8. Markwell A, Mitchell R, Wright A, Brown AF. Clinical and ethical challenges for emergency departments during communicable disease outbreaks: can lessons from Ebola virus disease be applied to the COVID‐19 pandemic? Emerg Med Australas 2020; 32: 520–524.
9. Australasian College for Emergency Medicine. Clinical guidelines for the management of COVID‐19 in Australasian emergency departments, version 4.0. Updated June 2020. https://acem.org.au/Content-Sources/Advancing-Emergency-Medicine/COVID-19/Resources/Clinical-Guidelines (viewed July 2020).
10. Australian and New Zealand Committee on Resuscitation. Resuscitation during the COVID‐19 pandemic (updated Apr 2020). Australian Resuscitation Council, 2020. https://resus.org.au/ (viewed Apr 2020).
11. New Zealand Resuscitation Council. COVID‐19 modifications to essential life support (updated Mar 2020). https://www.nzrc.org.nz/assets/Guidelines/COVID-19/2020-03-27-Temporary-Guideline-in-State-of-EmergencyFINAL.pdf (viewed Apr 2020).
12. Resuscitation Council UK. Resuscitation Council UK statement on COVID‐19 in relation to CPR and resuscitation in acute hospital settings (updated Apr 2020). https://www.resus.org.uk/media/statements/resuscitation-council-uk-statements-on-covid-19-coronavirus-cpr-and-resuscitation/covid-healthcare/ (viewed Apr 2020).
13. Resuscitation Council UK. Guidance for the resuscitation of adult COVID‐19 patients in acute hospital settings, version 4 (updated Apr 2020). https://www.resus.org.uk/media/statements/resuscitation-council-uk-statements-on-covid-19-coronavirus-cpr-and-resuscitation/covid-healthcare/ (viewed Apr 2020).
14. Couper K, Taylor‐Phillips S, Grove A, et al; International Liaison Committee on Resuscitation. Consensus on Science with Treatment Recommendations (CoSTR). COVID‐19 infection risk to rescuers from patients in cardiac arrest (updated Apr 2020.). Brussels: International Liaison Committee on Resuscitation, 2020. https://costr.ilcor.org/document/covid-19-infection-risk-to-rescuers-from-patients-in-cardiac-arrest (viewed Apr 2020).
15. Edelson DP, Sasson C, Chan PS, et al. Interim guidance for basic and advanced life support in adults, children, and neonates with suspected or confirmed COVID‐19: from the Emergency Cardiovascular Care Committee and Get with the Guidelines‐Resuscitation Adult and Pediatric Task Forces of the American Heart Association. Circulation. 2020; 141: e933–e943.
16. Brewster DJ, Chrimes N, Do TB, et al. Consensus statement: Safe Airway Society principles of airway management and tracheal intubation specific to the COVID‐19 adult patient group. Med J Aust 2020; 212: 472–481. https://www.mja.com.au/journal/2020/212/10/consensus-statement-safe-airway-society-principles-airway-management-and-0
17. Australian and New Zealand Intensive Care Society. ANZICS COVID‐19 guidelines. Melbourne: ANZICS, 2020. https://www.anzics.com.au/coronavirus-guidelines/ (viewed Apr 2020).
18. Siegel JD, Rhinehart E, Jackson M, Chiarello L; Healthcare Infection Control Practices Advisory Committee. 2007 Guideline for isolation precautions: preventing transmission of infectious agents in healthcare settings (updated July 2019). https://www.cdc.gov/infectioncontrol/pdf/guidelines/isolation-guidelines-H.pdf (viewed June 2020).
19. World Health Organization. Rational use of personal protective equipment for coronavirus disease (COVID‐19): interim guidance; 27 Feb 2020. https://apps.who.int/iris/handle/10665/331215 (viewed Apr 2020).
20. Davies A, Thomson G, Walker J, et al. A review of the risks and disease transmission associated with aerosol generating medical procedures. J Infect Prev 2009; 10: 122–126.
21. International Liaison Committee on Resuscitation. COVID‐19: practical guidance for implementation (updated Apr 2020). https://www.ilcor.org/covid-19 (viewed Apr 2020).
22. Public Health England. PHE statement regarding NERVTAG review and consensus on cardiopulmonary resuscitation as an aerosol generating procedure (AGP); 2020. https://www.gov.uk/government/publications/wuhan-novel-coronavirus-infection-prevention-and-control/phe-statement-regarding-nervtag-review-and-consensus-on-cardiopulmonary-resuscitation-as-an-aerosol-generating-procedure-agp (viewed May 2020).
23. Australian Government, Department of Health. Guidance on the use of personal protective equipment (PPE) in hospitals during the COVID‐19 outbreak. https://www.health.gov.au/resources/publications/guidance-on-the-use-of-personal-protective-equipment-ppe-in-hospitals-during-the-covid-19-outbreak (viewed May 2020).
24. Australian Government, Department of Health. Coronavirus Disease (COVID‐19): information for paramedics and ambulance first responders. https://www.health.gov.au/resources/publications/coronavirus-covid-19-information-for-paramedics-and-ambulance-first-responders (viewed May2020).
25. World Federation of Societies of Anaesthesiologists. Coronavirus — guidance for anaesthesia and perioperative care providers. WFSA, 2020. https://www.wfsahq.org/resources/coronavirus (viewed Apr 2020).
26. Shao F, Xu S, Ma X, et al. In‐hospital cardiac arrest outcomes among patients with COVID‐19 pneumonia in Wuhan, China. Resuscitation 2020; 151: 18–23.
27. Department of Health and Human Services. Handling the body of a deceased person with suspected or confirmed COVID‐19. https://www.dhhs.vic.gov.au/guidance-handling-body-deceased-person-suspected-or-confirmed-covid-19 (viewed Apr 2020).

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

Narrative review

Clinical trials for the prevention and treatment of COVID‐19: current state of play

Joshua S Davis, David Ferreira, Justin T Denholm and Steven YC Tong

Med J Aust 2020; 213 (2): . || doi: 10.5694/mja2.50673
Published online: 20 July 2020

ARTICLE
AUTHORS
REFERENCES

Topics

Infectious diseases

Statistics, epidemiology and research design

Pharmaceutical preparations

Summary

Since coronavirus disease 2019 (COVID‐19) emerged in Wuhan, China in December 2019 and spread around the world, over 1100 clinical studies have been registered globally on clinical trials registries, including over 500 randomised controlled trials.
Such rapid development and launch of clinical trials is impressive but presents challenges, including the potential for duplication and competition.
There is currently no known effective treatment for COVID‐19.
In order to focus on those studies most likely to influence clinical practice, we summarise the 31 currently registered randomised trials with a target sample size of at least 1000 participants.
We have grouped these trials into four categories: prophylaxis; treatment of outpatients with mild COVID‐19; treatment of hospitalised patients with moderate COVID‐19; and treatment of hospitalised patients with moderate or severe disease.
The most common therapeutic agent being trialled currently is hydroxychloroquine (24 trials with potential sample size of over 25 000 participants), followed by lopinavir–ritonavir (seven trials) and remdesevir (five trials)
There are many candidate drugs in pre‐clinical and early phase development, and these form a pipeline for future large clinical trials if current candidate therapies prove ineffective or unsafe.

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

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 Menzies School of Health Research, Darwin, NT
2 John Hunter Hospital, Newcastle, NSW
3 Royal Melbourne Hospital, Melbourne, VIC
4 University of Melbourne, Melbourne, VIC
5 Peter Doherty Institute for Infection and Immunity, Melbourne, VIC

Correspondence: joshua.davis@menzies.edu.au

Competing interests:

No relevant disclosures.

1. US Centers for Disease Control and Prevention. Outbreak of severe acute respiratory syndrome–worldwide, 2003. MMWR Morb Mortal Wkly Rep 2003; 52: 226–228.
2. Wise J. Patient with new strain of coronavirus is treated in intensive care at London hospital. BMJ 2012; 345: e6455.
3. Dawood FS, Jain S, Finelli L, et al. Emergence of a novel swine‐origin influenza A (H1N1) virus in humans. N Engl J Med 2009; 360: 2605–2615.
4. Momattin H, Al‐Ali AY, Al‐Tawfiq JA. A systematic review of therapeutic agents for the treatment of the Middle East respiratory syndrome coronavirus (MERS‐CoV). Travel Med Infect Dis 2019; 30: 9–18.
5. Yao T‐T, Qian J‐D, Zhu W‐Y, Wang Y, et al. A systematic review of lopinavir therapy for SARS coronavirus and MERS coronavirus – a possible reference for coronavirus disease‐19 treatment option. J Med Virol 2020; 92: 556–563.
6. Yao X, Ye F, Zhang M, et al. In vitro antiviral activity and projection of optimized dosing design of hydroxychloroquine for the treatment of severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2). Clin Infect Dis 2020; https://doi.org/10.1093/cid/ciaa237 [Epub ahead of print].
7. Costanzo M, De Giglio MAR, Roviello GN. SARS CoV‐2: recent reports on antiviral therapies based on lopinavir/ritonavir, darunavir/umifenovir, hydroxychloroquine, remdesivir, favipiravir and other drugs for the treatment of the new coronavirus. Curr Med Chem 2020; https://doi.org/10.2174/0929867327666200416131117 [Epub ahead of print].
8. Liu B, Li M, Zhou Z, Guan X, et al. Can we use interleukin‐6 (IL‐6) blockade for coronavirus disease 2019 (COVID‐19)‐induced cytokine release syndrome (CRS)? J Autoimmun 2020; https://doi.org/10.1016/j.jaut.2020.102452 [Epub ahead of print].
9. Dunning JW, Merson L, Rohde GGU, et al. Open source clinical science for emerging infections. Lancet Infect Dis 2014; 14: 8–9.
10. Bi Q, Wu Y, Mei S, Ye C, et al. Epidemiology and transmission of COVID‐19 in Shenzhen, China: analysis of 391 cases and 1286 of their close contacts. Lancet Infect Dis 2020; https://doi.org/10.1016/s1473-3099(20)30287-5 [Epub ahead of print].
11. Zimmermann P, Finn A, Curtis N. Does BCG vaccination protect against nontuberculous mycobacterial infection? a systematic review and meta‐analysis. J Infect Dis 2018; 218: 679–687.
12. Wu Z, McGoogan JM. Characteristics of and important lessons from the coronavirus disease 2019 (COVID‐19) outbreak in China: summary of a report of 72314 cases from the Chinese Center for Disease Control and Prevention. JAMA 2020; https://doi.org/10.1001/jama.2020.2648 [Epub ahead of print].
13. Woodcock J, LaVange LM. Master protocols to study multiple therapies, multiple diseases, or both. N Engl J Med 2017; 377: 62–70.
14. Angus DC, Berry S, Lewis RJ, et al. The Randomized Embedded Multifactorial Adaptive Platform for Community‐acquired Pneumonia (REMAP‐CAP) study: rationale and design. Ann Am Thorac Soc 2020; https://doi.org/10.1513/annalsats.202003-192sd [Epub ahead of print].
15. Gordon CJ, Tchesnokov EP, Feng JY, et al. The antiviral compound remdesivir potently inhibits RNA‐dependent RNA polymerase from Middle East respiratory syndrome coronavirus. J Biol Chem 2020; 295: 4773–4779.
16. Sheahan TP, Sims AC, Leist SR, et al. Comparative therapeutic efficacy of remdesivir and combination lopinavir, ritonavir, and interferon beta against MERS‐CoV. Nat Commun 2020; 11: 222.
17. Tchesnokov EP, Feng JY, Porter DP, Gotte M. Mechanism of inhibition of Ebola virus RNA‐dependent RNA polymerase by remdesivir. Viruses 2019; 11: 326.
18. Cao B, Wang Y, Wen D, et al. A trial of lopinavir‐ritonavir in adults hospitalized with severe Covid‐19. N Engl J Med 2020; 382: 1787–1799.
19. Gautret P, Lagier JC, Parola P, et al. Hydroxychloroquine and azithromycin as a treatment of COVID‐19: results of an open‐label non‐randomized clinical trial. Int J Antimicrob Agents 2020; https://doi.org/10.1016/j.ijantimicag.2020.105949 [Epub ahead of print].

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

Research

New Australian birthweight centiles

Farmey A Joseph, Jonathan A Hyett, Philip J Schluter, Andrew McLennan, Adrienne Gordon, Georgina M Chambers, Lisa Hilder, Stephanie KY Choi and Bradley Vries

Med J Aust 2020; 213 (2): . || doi: 10.5694/mja2.50676
Published online: 20 July 2020

ARTICLE
AUTHORS
REFERENCES

Topics

Women's health

Pediatric medicine

Abstract

Objectives: To prepare more accurate population‐based Australian birthweight centile charts by using the most recent population data available and by excluding pre‐term deliveries by obstetric intervention of small for gestational age babies.

Design: Population‐based retrospective observational study.

Setting: Australian Institute of Health and Welfare National Perinatal Data Collection.

Participants: All singleton births in Australia of 23–42 completed weeks’ gestation and with spontaneous onset of labour, 2004–2013. Births initiated by obstetric intervention were excluded to minimise the influence of decisions to deliver small for gestational age babies before term.

Main outcome measures: Birthweight centile curves, by gestational age and sex.

Results: Gestational age, birthweight, sex, and labour onset data were available for 2 807 051 singleton live births; onset of labour was spontaneous for 1 582 137 births (56.4%). At pre‐term gestational ages, the 10th centile was higher than the corresponding centile in previous Australian birthweight charts based upon all births.

Conclusion: Current birthweight centile charts probably underestimate the incidence of intra‐uterine growth restriction because obstetric interventions for delivering pre‐term small for gestational age babies depress the curves at earlier gestational ages. Our curves circumvent this problem by excluding intervention‐initiated births; they also incorporate more recent population data. These updated centile curves could facilitate more accurate diagnosis of small for gestational age babies in Australia.

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

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 Institute for Women, Children and their Families, Sydney, NSW
3 Sydney Medical School, University of Sydney, Sydney, NSW
4 University of Canterbury, Christchurch, New Zealand
5 University of Queensland, Brisbane, QLD
6 Charles Perkins Centre, University of Sydney, Sydney, NSW
7 National Perinatal Epidemiology and Statistics Unit, University of New South Wales, Sydney, NSW
8 Centre for Big Data Research in Health, University of New South Wales, Sydney, NSW

Correspondence: farmey@alum.mit.edu

Acknowledgements:

We acknowledge the Ministries of Health of all Australian states and territories for providing data to the National Perinatal Data Collection. We also acknowledge the Australian Institute of Health and Welfare (AIHW) for preparing and providing the National Perinatal Data Collection data for this study. We are grateful to the Victorian Consultative Council on Obstetric and Paediatric Mortality and Morbidity (CCOPMM) for providing access to the de‐identified data from the Victorian Perinatal Data Collection that contributes to the AIHW National Perinatal Data Collection and for the assistance of the staff at the Consultative Councils Unit, Safer Care Victoria, for facilitating the Victorian approval process for this project. The views expressed in this article do not necessarily reflect those of CCOPMM. Finally, we thank Kevin McGeechan for his advice on statistical analysis.

Competing interests:

No relevant disclosures.

1. Doctor BA, O'Riordan MA, Kirchner HL, et al. Perinatal correlates and neonatal outcomes of small for gestational age infants born at term gestation. Am J Obstet Gynecol 2001; 185: 652–659.
2. Strauss RS. Adult functional outcome of those born small for gestational age. JAMA 2000; 283: 625–632.
3. Rao SC, Tompkins J; World Health Organization. Growth curves for preterm infants. Early Hum Dev 2007; 83: 643–651.
4. Reeves S, Bernstein IM. Optimal growth modeling. Semin Perinatol 2008; 32: 148–153.
5. Hoftiezer L, Hukkelhoven CWPM, Hogeveen M, et al. Defining small‐for‐gestational‐age: prescriptive versus descriptive birthweight standards. Eur J Pediatr 2016; 175: 1047–1057.
6. Hadlock F, Harrist R, Martinez‐Poyer J. In utero analysis of fetal growth: a sonographic weight standard. Radiology 1991; 181: 129–133.
7. Papageorghiou AT, Ohuma EO, Altman DG, et al; International Fetal and Newborn Growth Consortium for the 21st Century (INTERGROWTH‐21st). International standards for fetal growth based on serial ultrasound measurements: the Fetal Growth Longitudinal Study of the INTERGROWTH‐21st Project. Lancet 2014; 384: 869–879.
8. Dobbins TA, Sullivan EA, Roberts CL, Simpson JM. Australian national birthweight percentiles by sex and gestational age, 1998–2007. Med J Aust 2012; 197: 291–294. https://www.mja.com.au/journal/2012/197/5/australian-national-birthweight-percentiles-sex-and-gestational-age-1998-2007
9. Sarris I, Ioannou C, Ohuma EO, et al; International Fetal and Newborn Growth Consortium for the 21st Century. Standardisation and quality control of ultrasound measurements taken in the INTERGROWTH‐21st Project. BJOG 2013; 120: 33–37.
10. Dudley NJ. A systematic review of the ultrasound estimation of fetal weight. Ultrasound Obstet Gynecol 2005; 25: 80–89.
11. Burkhardt T, Schäffer L, Zimmermann R, Kurmanavicius J. Newborn weight charts underestimate the incidence of low birthweight in preterm infants. Am J Obstet Gynecol 2008; 199: 139.e1–139.e6.
12. Hutcheon JA, Platt RW. The missing data problem in birth weight percentiles and thresholds for ‘“small‐ for‐gestational‐age”. Am J Epidemiol 2008; 167: 786–792.
13. Joseph FA, Hyett JA, McGeechan K, et al. A new approach to developing birth weight reference charts: a retrospective observational study. Fetal Diagn Ther 2018; 43: 148–155.
14. Australian Institute of Health and Welfare. Australia's mothers and babies 2016: in brief (Cat. no. PER 97; Perinatal statistics series no. 34). Canberra: AIHW, 2018.
15. von Elm E, Altman DG, Egger M, et al. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. PLoS Med 2007; 4: e296.
16. Daniel‐Spiegel E, Weiner E, Yarom I, et al. Establishment of fetal biometric charts using quantile regression analysis. J Ultrasound Med 2013; 32: 23–33.
17. Hoaglin DC, John W. Tukey and data analysis. Stat Sci 2003; 18: 311–318.
18. Fenton TR, Kim JH. A systematic review and meta‐analysis to revise the Fenton growth chart for preterm infants. BMC Pediatr 2013; 13: 59.
19. Hoftiezer L, Hof MHP, Dijs‐Elsinga J, et al. From population reference to national standard: new and improved birthweight charts. Am J Obstet Gynecol 2019; 220: 383.e1–383.e17.
20. Villar J, Cheikh Ismail L, Victora CG, et al; International Fetal and Newborn Growth Consortium for the 21st Century (INTERGROWTH‐21st). International standards for newborn weight, length, and head circumference by gestational age and sex: the Newborn Cross‐Sectional Study of the INTERGROWTH‐21st Project. Lancet 2014; 384: 857–868.
21. Wei Y, Pere A, Koenker R, He X. Quantile regression methods for reference growth charts. Stat Med 2006; 25: 1369–1382.
22. Goldenberg RL, Culhane JF, Iams JD, Romero R. Epidemiology and causes of preterm birth. Lancet 2008; 371: 75–84.
23. Bastek JA, Gómez LM, Elovitz MA. The role of inflammation and infection in preterm birth. Clin Perinatol 2011; 38: 385–406.
24. Kim CJ, Romero R, Chaemsaithong P, et al. Acute chorioamnionitis and funisitis: definition, pathologic features, and clinical significance. Am J Obstet Gynecol 2015; 213 (4 Suppl): S29–S52.
25. Zeitlin J, Ancel PY, Saurel‐Cubizollles MJ, Papiernik E. The relationship between intrauterine growth restriction and preterm delivery: an empirical approach using data from a European case–control study. BJOG 2000; 107: 750–758.
26. Park FJ, de Vries B, Hyett JA, Gordon A. Epidemic of large babies highlighted by use of INTERGROWTH21st international standard. Aust New Zeal J Obstet Gynaecol 2018; 58: 506–553.

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

Editorials

The role of cost‐effectiveness analyses in investment decision making by primary health networks

Sally Hall Dykgraaf and Amanda Barnard

Med J Aust 2020; 213 (2): . || doi: 10.5694/mja2.50689
Published online: 20 July 2020

ARTICLE
AUTHORS
REFERENCES

Topics

Health services administration

Scientific rigour and pragmatic implementation are both required, combining research findings with other forms of evidence

Primary health networks (PHNs) have been part of the health landscape in Australia since July 2015. Following the Horvath review of Medicare Locals,1 they were established as locally configured organisations that could support primary health care service providers, design and deliver improved primary health care, and work with hospitals to maximise the efficiency, effectiveness and coordination of care. One key role for PHNs is to commission primary health care services that meet local needs and improve outcomes by procuring services from third party providers, applying market‐making and supply‐shaping principles.2 To do this, PHNs undertake population‐level needs analyses to identify service gaps, reduce hospital burden, and promote value for money. They also help general practices and other primary health care providers deliver community care, optimise quality and safety, and make meaningful use of electronic support systems.

Rural Clinical School, Australian National University, Canberra, ACT

Correspondence: Sally.Hall@anu.edu.au

Acknowledgements:

We thank Dianne Kitcher (chief executive officer, COORDINARE) for her insights and comments on the draft manuscript.

Competing interests:

Amanda Barnard is a board director and chair of the Southern NSW Clinical Council of COORDINARE (South Eastern NSW primary health network).

1. Horvath J. Review of Medicare Locals: report to the Minister for Health and Minster for Sport. 4 Mar 2014. https://www1.health.gov.au/internet/main/Publishing.nsf/Content/A69978FAABB1225ECA257CD3001810B7/$File/Review-of-Medicare-Locals-may2014.pdf (viewed May 2020).
2. Australian Department of Health. Market making and development guidance and toolkit. Updated 21 Sept 2018. https://www1.health.gov.au/internet/main/publishing.nsf/Content/Market+Making+and+Development+Guidance+and+Toolkit (viewed May 2020).
3. Patel B, Peiris DP, Patel A, et al. A computer‐guided quality improvement tool for primary health care: cost‐effectiveness analysis based on TORPEDO trial data. Med J Aust 2020; 213: 73–78.
4. Peiris D, Usherwood T, Panaretto K, et al. Effect of a computer‐guided, quality improvement program for cardiovascular disease risk management in primary health care. Circ Cardiovasc Qual Outcomes 2015; 8: 87–95.
5. The Kings Fund, University of Melbourne, PricewaterhouseCoopers. Challenges and lessons for good practice. Review of the history and development of health service commissioning. Mar 2016. https://www1.health.gov.au/internet/main/publishing.nsf/Content/0DA0E153E02C0501CA2582E900023FD0/$File/Literature%20and%20evidence%20review%20v0.1.pdf (viewed May 2020).
6. Patel B, Usherwood T, Harris M, et al. What drives adoption of a computerised, multifaceted quality improvement intervention for cardiovascular disease management in primary healthcare settings? A mixed methods analysis using normalisation process theory. Implement Sci 2018; 13: 140.
7. Abimbola S, Patel B, Peiris D, et al. The NASSS framework for ex post theorisation of technology‐supported change in healthcare: worked example of the TORPEDO programme. BMC Med 2019; 17: 233.
8. Bodenheimer T, Sinsky C. From triple to quadruple aim: care of the patient requires care of the provider. Ann Fam Med 2014; 12: 573–576.
9. Freebairn L, Atkinson J, Kelly P, et al. Simulation modelling as a tool for knowledge mobilisation in health policy settings: a case study protocol. Health Res Policy Syst 2016; 14: 71.
10. Jimenez Soto E. Other handy tools from health economics. Beacon Strategies [website], 30 Sept 2019. https://www.beaconstrategies.net/beacon-strategies-blog/2019/9/4/other-handy-tools-from-health-economicsnbsp (viewed May 2020).
11. Lo K, Karnon J. inDEPtH framework: evidence informed, co‐creation framework for the Design, Evaluation and Procurement of Health services. BMJ Open 2019; 9: e026482.

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

Research

Hyperendemic rheumatic heart disease in a remote Australian town identified by echocardiographic screening

Joshua R Francis, Helen Fairhurst, Hilary Hardefeldt, Shannon Brown, Chelsea Ryan, Kurt Brown, Greg Smith, Roz Baartz, Ari Horton, Gillian Whalley, James Marangou, Alex Kaethner, Anthony DK Draper, Christian L James, Alice G Mitchell, Jennifer Yan, Anna Ralph and Bo Remenyi

Med J Aust 2020; 213 (3): . || doi: 10.5694/mja2.50682
Published online: 13 July 2020

ARTICLE
AUTHORS
REFERENCES

Topics

Cardiovascular diseases

Infectious diseases

Diagnostic techniques and procedures

Indigenous health

Abstract

Objectives: Using echocardiographic screening, to estimate the prevalence of rheumatic heart disease (RHD) in a remote Northern Territory town.

Design: Prospective, cross‐sectional echocardiographic screening study; results compared with data from the NT rheumatic heart disease register.

Setting, participants: People aged 5–20 years living in Maningrida, West Arnhem Land (population, 2610, including 2366 Indigenous Australians), March 2018 and November 2018.

Intervention: Echocardiographic screening for RHD by an expert cardiologist or cardiac sonographer.

Main outcome measures: Definite or borderline RHD, based on World Heart Federation criteria; history of acute rheumatic fever (ARF), based on Australian guidelines for diagnosing ARF.

Results: The screening participation rate was 72%. The median age of the 613 participants was 11 years (interquartile range, 8–14 years); 298 (49%) were girls or women, and 592 (97%) were Aboriginal Australians. Definite RHD was detected in 32 screened participants (5.2%), including 20 not previously diagnosed with RHD; in five new cases, RHD was classified as severe, and three of the participants involved required cardiac surgery. Borderline RHD was diagnosed in 17 participants (2.8%). According to NT RHD register data at the end of the study period, 88 of 849 people in Maningrida and the surrounding homelands aged 5–20 years (10%) were receiving secondary prophylaxis following diagnoses of definite RHD or definite or probable ARF.

Conclusion: Passive case finding for ARF and RHD is inadequate in some remote Australian communities with a very high burden of RHD, placing children and young people with undetected RHD at great risk of poor health outcomes. Active case finding by regular echocardiographic screening is required in such areas.

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

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 Menzies School of Health Research, Charles Darwin University, Darwin, NT
2 Royal Darwin Hospital, Darwin, NT
3 Top End Health Service, Maningrida Health Centre, Maningrida, NT
4 University of Otago, Dunedin, New Zealand
5 NT Cardiac, Darwin, NT
6 Centre for Disease Control, Northern Territory Department of Health, Darwin, NT

Correspondence: josh.francis@menzies.edu.au

Acknowledgements:

The Pedrino Project (early detection and treatment of rheumatic heart disease in high risk communities using community‐led approaches) is a Menzies School of Health Research project, supported by a Heart Foundation Vanguard Grant and a pilot grant from the National Health and Medical Research Council (1131932: Improving health outcomes in the tropical north: a multidisciplinary collaboration [HOT NORTH]). It was also supported by Rotary Oceania Medical Aid for Children (ROMAC), the Snow Foundation, the Bawinanga Aboriginal Corporation, and the Humpty Dumpty Foundation, and by in‐kind support from NT Cardiac, the Starlight Children's Foundation, Take Heart (Moonshine Agency), the Northern Territory Department of Health, the Maningrida Health Centre, the Northern Territory Rheumatic Heart Disease Control program, the Mala'la Health Board, Maningrida College, the Lurra Language and Culture Unit, and the West Arnhem Regional Council. Anna Ralph is supported by a National Health and Medical Research Council fellowship (1142011).We acknowledge the contributions of Leroy Bading, Lionel Cooper, Madeline Mackey, Lachlan Nicolson, Erin Riddell and Matthew Ryan (West Arnhem Shire Council, logistics); Joyce Bohme, Roderick Brown and Rickisha Redford Bohme (Bawinanga Aboriginal Corporation, logistics); Georgina Byron (Snow Foundation, communications); Abigail Carter, Carolyn Coleman, Joseph Diddo, Laurie Guraylayla, Alistair James, Cindy Jinmarabynana, Nelson Nawilmak, Stanley Rankin, Mason Scholes, Russell Stewart and Karen Wuridjal (Maningrida College, education); Sue Collins and Mike Hill (Moonshine Agency, communications); Laura Francis, Kate Hardie, Lorraine Harry, Kristine McConnell‐King, Karen Shergold, Steven Wilson Dashwood and James Woods (Top End Health Services, logistics); Trudy Francis and Kaya Gardiner (data entry); Debbie Hall (Menzies School of Health, logistics); Kate Johnston, Daniel Milne and Sarah Reuben (Starlight Foundation, participant entertainment); Jo Killmister, Daryll Kinnane and Craig Watkins (Maningrida College, logistics); Chris Lowbridge (Menzies School of Health, graphics); Trephrena Taylor and Lesley Woolf (Mala'la Health Board, logistics); and Corinne Toune and Rhiannon Townsend (NT Cardiac, echocardiography).

Competing interests:

No relevant disclosures.

1. Australian Institute of Health and Welfare. Acute rheumatic fever and rheumatic heart disease in Australia (AIHW Cat. no. CVD 86). Canberra: AIHW, 2019. https://www.aihw.gov.au/reports/cvd/086/acute-rheumatic-fever-rheumatic-heart-disease/contents/introduction/arf-rhd-preventable-diseases (viewed Oct 2019).
2. Lowell A, Maypilama Ḻ, Fasoli L, et al. The “invisible homeless”: challenges faced by families bringing up their children in a remote Australian Aboriginal community. BMC Public Health 2018; 18: 1382.
3. Coffey PM, Ralph AP, Krause VL. The role of social determinants of health in the risk and prevention of group A streptococcal infection, acute rheumatic fever and rheumatic heart disease: a systematic review. PLoS Negl Trop Dis 2018; 12: e0006577.
4. Lawrence JG, Carapetis JR, Griffiths K, et al. Acute rheumatic fever and rheumatic heart disease: incidence and progression in the Northern Territory of Australia, 1997 to 2010. Circulation 2013; 128: 492–501.
5. Zühlke L, Engel ME, Karthikeyan G, et al. Characteristics, complications, and gaps in evidence‐based interventions in rheumatic heart disease: the Global Rheumatic Heart Disease Registry (the REMEDY study). Eur Heart J 2015; 36: 1115–1122.
6. Reményi B, Wilson N, Steer A, et al. World Heart Federation criteria for echocardiographic diagnosis of rheumatic heart disease: an evidence‐based guideline. Nat Rev Cardiol 2012; 9: 297–309.
7. Remenyi B, Carapetis J, Stirling JW, et al. Inter‐rater and intra‐rater reliability and agreement of echocardiographic diagnosis of rheumatic heart disease using the World Heart Federation evidence‐based criteria. Heart Asia 2019; 11: e011233.
8. Roberts KV, Brown ADH, Maguire GP, et al. Utility of auscultatory screening for detecting rheumatic heart disease in high‐risk children in Australia's Northern Territory. Med J Aust 2013; 199: 196–199. https://www.mja.com.au/journal/2013/199/3/utility-auscultatory-screening-detecting-rheumatic-heart-disease-high-risk
9. Rothenbühler M, O'Sullivan CJ, Stortecky S, et al. Active surveillance for rheumatic heart disease in endemic regions: a systematic review and meta‐analysis of prevalence among children and adolescents. Lancet Glob Health 2014; 2: e717–e726.
10. Roberts KV, Maguire GP, Brown A, et al. Rheumatic heart disease in Indigenous children in northern Australia: differences in prevalence and the challenges of screening. Med J Aust 2015; 203: 221. https://www.mja.com.au/journal/2015/203/5/rheumatic-heart-disease-indigenous-children-northern-australia-differences
11. RHD Australia (ARF/RHD writing group), National Heart Foundation of Australia, Cardiac Society of Australia and New Zealand. The Australian guideline for prevention, diagnosis and management of acute rheumatic fever and rheumatic heart disease (2nd edition). Darwin: Menzies School of Health Research, 2012. https://www.rhdaustralia.org.au/arf-rhd-guideline (viewed Oct 2019).
12. Roberts K, Cannon J, Atkinson D, et al. Echocardiographic screening for rheumatic heart disease in Indigenous Australian children: a cost–utility analysis. J Am Heart Assoc 2017; 6: e004515.
13. Beaton A, Okello E, Engelman D, et al. Determining the impact of benzathine penicillin G prophylaxis in children with latent rheumatic heart disease (GOAL trial): study protocol for a randomized controlled trial. Am Heart J 2019; 215: 95–105.
14. Australian Bureau of Statistics. Maningrida (and outstations). 2016 Census QuickStats. Updated Oct 2017. https://quickstats.censusdata.abs.gov.au/census_services/getproduct/census/2016/quickstat/IARE704003; https://quickstats.censusdata.abs.gov.au/census_services/getproduct/census/2016/quickstat/SSC70172?opendocument (viewed Sept 2019).
15. Francis JR, Gargan C, Remenyi B, et al. A cluster of acute rheumatic fever cases among Aboriginal Australians in a remote community with high baseline incidence. Aust N Z J Public Health 2019; 43: 288–293.
16. Culliford‐Semmens N, Nicholson R, Tilton E, et al. The World Heart Federation criteria raise the threshold of diagnosis for mild rheumatic heart disease: three reviewers are better than one. Int J Cardiol 2019; 291: 112–118.
17. Watkins DA, Johnson CO, Colquhoun SM, et al. Global, regional, and national burden of rheumatic heart disease, 1990–2015. N Engl J Med 2017; 377: 713–722.
18. Davis K, Remenyi B, Draper ADK, et al. Rheumatic heart disease in Timor‐Leste school students: An echocardiography‐based prevalence study. Med J Aust 2018; 208: 303–307. https://www.mja.com.au/journal/2018/208/7/rheumatic-heart-disease-timor-leste-school-students-echocardiography-based
19. Cannon J, Roberts K, Milne C, Carapetis JR. Rheumatic heart disease severity, progression and outcomes: a multi‐state model. J Am Heart Assoc 2017; 6: e004515.
20. McGurty D, Remenyi B, Cheung M, et al. Outcomes after rheumatic mitral valve repair in children. Ann Thorac Surg 2019; 108: 792–797.
21. de Dassel JL, de Klerk N, Carapetis JR, Ralph AP. How many doses make a difference? An analysis of secondary prevention of rheumatic fever and rheumatic heart disease. J Am Heart Assoc 2018; 7: e010223.
22. Remenyi B, Webb R, Gentles T, et al. Improved long‐term survival for rheumatic mitral valve repair in compared to replacement in the young. World J Pediatr Congenit Hear Surg 2013; 4: 155–164.
23. Roberts K, Colquhoun S, Steer A, et al. Screening for rheumatic heart disease: current approaches and controversies. Nat Rev Cardiol 2013; 10: 49–58.
24. Walsh WF, Kangaharan N. Cardiac care for indigenous Australians: practical considerations from a clinical perspective. Med J Aust 2017; 207: 40–45. https://www.mja.com.au/journal/2017/207/1/cardiac-care-indigenous-australians-practical-considerations-clinical
25. Amery R. Recognising the communication gap in Indigenous health care. Med J Aust 2017; 207: 13–15. https://www.mja.com.au/journal/2017/207/1/recognising-communication-gap-indigenous-health-care

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

Perspectives

E‐cigarette or vaping product use‐associated lung injury (EVALI): a cautionary tale

Maitri Munsif, Mark Hew and Eli Dabscheck

Med J Aust 2020; 213 (3): . || doi: 10.5694/mja2.50691
Published online: 13 July 2020

ARTICLE
AUTHORS
REFERENCES

Topics

Respiratory tract diseases

Environment and public health

Tetrahydrocannabinol‐containing (THC) products with vitamin E additives are implicated in the pathogenesis of EVALI

Electronic cigarettes, or e‐cigarettes, are battery‐powered devices that heat liquids containing nicotine and other chemicals in order to produce vapour.1 “Vaping” is the act of inhaling the vapour produced by an e‐cigarette.1 First marketed in 2005, e‐cigarette use is viewed by many as less harmful than traditional cigarette smoking, and championed as a strategy for smoking cessation.1,2,3 A detailed discussion of e‐cigarette use in smoking cessation is available in the United States Surgeon General's 2020 report, and is beyond the scope of this article; however, the report states that “there is presently inadequate evidence to conclude that e‐cigarettes, in general, increase smoking cessation”.2 Thus far, no e‐cigarette product for the therapeutic purpose of smoking cessation has been submitted to Australia's Therapeutic Goods Administration for safety evaluation or approval.

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

CREATE AN ACCOUNT

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

View on Wiley Online Library

Alfred Health, Melbourne, VIC

Correspondence: e.dabscheck@alfred.org.au

Competing interests:

No relevant disclosures.

1. National Academies of Sciences, Engineering, and Medicine. Public health consequences of e‐cigarettes. Washington (DC): National Academies Press, 2018. https://www.nap.edu/read/24952 (viewed Feb 2020).
2. US Department of Health and Human Services. Smoking cessation: a report of the Surgeon General. Atlanta, GA: US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health; 2020. https://www.hhs.gov/sites/default/files/2020-cessation-sgr-full-report.pdf (viewed Feb 2020).
3. Eissenberg T, Bhatnagar A, Chapman S, et al. Invalidity of an oft‐cited estimate of the relative harms of electronic cigarettes. Am J Public Health 2020; 110: 161–162.
4. Pearson JL, Villanti AC. It is past time to consider cannabis in vaping research. Nicotine Tob Res 2020; 22: 597–598.
5. Hartnett KP, Kite‐Powell A, Patel MT, et al. Syndromic surveillance for e‐cigarette, or vaping, product use — associated lung injury. N Engl J Med 2019; 382: 766–772.
6. Lozier M, Wallace B, Anderson K, et al. Update: demographic, product, and substance‐use characteristics of hospitalized patients in a nationwide outbreak of e‐cigarette, or vaping, product use — associated lung injuries — United States, December 2019. MMWR Morb Mortal Wkly Rep 2019; 68: 1142–1148.
7. Cullen KA, Gentzke AS, Sawdey MD, et al. e‐Cigarette use among youth in the United States, 2019. JAMA 2019; 322: 2095–2103.
8. Miech RA, Patrick ME, O'Malley PM, Johnston LD, Bachman JG. Trends in reported marijuana vaping among US adolescents, 2017–2019. JAMA 2020; 323: 475–476.
9. Gentzke AS, Creamer M, Cullen KA, et al. Vital signs: tobacco product use among middle and high school students — United States, 2011–2018. MMWR Morb Mortal Wkly Rep 2019; 68: 157–164.
10. King BA, Jones CM, Baldwin GT, et al. The EVALI and youth vaping epidemics — implications for public health. N Engl J Med 2020; 382: 689–691.
11. Morgan J, Breitbarth AK, Jones AL. Risk versus regulation: an update on the state of e‐cigarette control in Australia. Intern Med J 2019; 49: 110–113.
12. Wolfenden L, Stockings E, Yoong SL. Regulating e‐cigarettes in Australia: implications for tobacco use by young people. Med J Aust 2018; 208: 89. https://www.mja.com.au/journal/2018/208/1/regulating-e-cigarettes-australia-implications-tobacco-use-young-people.
13. Dunlop S, Dessaix A, Currow D. How are tobacco smokers using e‐cigarettes? Patterns of use, reasons for use and places of purchase in New South Wales [letter]. Med J Aust 2016; 205: 336. https://www.mja.com.au/journal/2016/205/7/how-are-tobacco-smokers-using-e-cigarettes-patterns-use-reasons-use-and-places-0.
14. Guerin N, White V. ASSAD 2017 Statistics and Trends: Australian secondary school students’ use of tobacco, alcohol, over‐the‐counter drugs, and illicit substances. Melbourne: Cancer Council Victoria, 2018. https://www.cancervic.org.au/downloads/cbrc/R18_NG_ASSAD_2017_National_Report.pdf (viewed Feb 2020).
15. Layden JE, Ghinai I, Pray I, et al. Pulmonary illness related to e‐cigarette use in Illinois and Wisconsin — final report. N Engl J Med 2020; 382: 903–916.
16. Centers for Disease Control and Prevention. Outbreak of lung injury associated with e‐cigarette use, or vaping products [website]. Atlanta, GA: CDC, 2020. https://www.cdc.gov/tobacco/basic_information/e-cigarettes/severe-lung-disease.html (viewed June 2020).
17. Siegel DA, Jatlaoui TC, Koumans EH, et al. Update: interim guidance for health care providers evaluating and caring for patients with suspected e‐cigarette, or vaping, product use associated lung injury — United States. MMWR Morb Mortal Wkly Rep 2019; 68: 919–927.
18. Schier JG, Meiman JG, Layden J, et al. Severe pulmonary disease associated with electronic‐cigarette‐product use — interim guidance. MMWR Morb Mortal Wkly Rep 2019; 68: 787–790.
19. Blount BC, Karwowski MP, Shields PG, et al. Vitamin E acetate in bronchoalveolar‐lavage fluid associated with EVALI. N Engl J Med 2019; 382: 697–705.
20. Kalininskiy A, Bach CT, Nacca NE, et al. E‐cigarette, or vaping, product use associated lung injury (EVALI): case series and diagnostic approach. Lancet Respir Med 2019; 7: 1017–1026.
21. Butt YM, Smith ML, Tazelaar HD, et al. Pathology of vaping‐associated lung injury. N Engl J Med 2019; 381: 1780–1781.
22. Chivers E, Janka M, Franklin P, et al. Nicotine and other potentially harmful compounds in “nicotine‐free” e‐cigarette liquids in Australia. Med J Aust 2019; 210: 127–128. https://www.mja.com.au/journal/2019/210/3/nicotine-and-other-potentially-harmful-compounds-nicotine-free-e-cigarette.

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

Unintended consequences of using real time prescription monitoring systems

Topics

Author

Reusing N95 (or P2) masks: current evidence and urgent research questions

Topics

Author

Management of adult cardiac arrest in the COVID‐19 era: consensus statement from the Australasian College for Emergency Medicine

Topics

Abstract

Author

Clinical trials for the prevention and treatment of COVID‐19: current state of play

Topics

Summary

Author

New Australian birthweight centiles

Topics

Abstract

Author

The role of cost‐effectiveness analyses in investment decision making by primary health networks

Topics

Author

Hyperendemic rheumatic heart disease in a remote Australian town identified by echocardiographic screening

Topics

Abstract

Author

E‐cigarette or vaping product use‐associated lung injury (EVALI): a cautionary tale

Topics

Author

The risks of medical complacency towards poliomyelitis

Topics

Author

COVID‐19: planning for the aftermath to manage the aftershocks

Topics

Author

Unintended consequences of using real time prescription monitoring systems

Topics

Author

Comment

Do you have any competing interests to declare? *

Reusing N95 (or P2) masks: current evidence and urgent research questions

Topics

Author

Comment

Do you have any competing interests to declare? *

Management of adult cardiac arrest in the COVID‐19 era: consensus statement from the Australasian College for Emergency Medicine

Topics

Abstract

Author

Comment

Do you have any competing interests to declare? *

Clinical trials for the prevention and treatment of COVID‐19: current state of play

Topics

Summary

Author

Comment

Do you have any competing interests to declare? *

New Australian birthweight centiles

Topics

Abstract

Author

Comment

Do you have any competing interests to declare? *

The role of cost‐effectiveness analyses in investment decision making by primary health networks

Topics

Author

Comment

Do you have any competing interests to declare? *

Hyperendemic rheumatic heart disease in a remote Australian town identified by echocardiographic screening

Topics

Abstract

Author

Comment

Do you have any competing interests to declare? *

E‐cigarette or vaping product use‐associated lung injury (EVALI): a cautionary tale

Topics

Author

Comment

Do you have any competing interests to declare? *

The risks of medical complacency towards poliomyelitis

Topics

Author

Comment

Do you have any competing interests to declare? *

COVID‐19: planning for the aftermath to manage the aftershocks

Topics

Author

Comment

Do you have any competing interests to declare? *

Pagination