Connect
MJA
MJA

    The challenges of establishing adequate capacity for SARS‐CoV‐2 testing

    David W Smith
    Med J Aust 2020; 212 (10): . || doi: 10.5694/mja2.50610
    Published online: 1 June 2020

    The response to COVID‐19 in Australia has been impressive, but our laboratory capacity must be used wisely

    Severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2), the virus that causes coronavirus disease 2019 (COVID‐19), has spread rapidly throughout the world from its origins in China in late 2019; the COVID‐19 outbreak was declared a pandemic by the World Health Organization on 11 March 2020.1 It is the seventh coronavirus known to have crossed from animals to humans, and may become the fifth to persist as an endemic human coronavirus.2

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

    LOGIN
    CREATE AN ACCOUNT

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

    View on Wiley Online Library

    • 1 University of Western Australia, Perth, WA
    • 2 PathWest Laboratory Medicine WA, Perth, WA


    Competing interests:

    No relevant disclosures.

    Author
    remove_circle_outline Delete Author
    add_circle_outline Add Author
    Comment
    Do you have any competing interests to declare? *
    I/we agree to assign copyright to the Medical Journal of Australia and agree to the Conditions of publication *
    I/we agree to the Terms of use of the Medical Journal of Australia *
    Email me when people comment on this article
    Online responses are no longer available. Please refer to our instructions for authors page for more information.

      Transfusion support in mass casualty events: lessons for hospital and pathology preparedness from the Bourke Street Mall incident

      Linda Saravanan and Amanda Ormerod
      Med J Aust 2020; 212 (11): . || doi: 10.5694/mja2.50611
      Published online: 25 May 2020

      An integrated approach that includes a central role for pathology laboratories is necessary

      Mass casualty events (MCEs) are defined as events or other circumstances “where the normal major incident response of one or several health organisations must be augmented by extraordinary measures to maintain an efficient, suitable and sustainable response”.1 Haemorrhage is a leading cause of mortality in MCEs, accounting for almost 50% of deaths in the first 24 hours,2,3 and transfusion emergency preparedness is increasingly recognised as a critical element of an integrated approach to MCEs,4 with timely availability and appropriate delivery of blood components being an essential part of management.


      • 1 Melbourne Pathology, Melbourne, VIC
      • 2 Latrobe Regional Hospital, Traralgon, VIC
      • 3 Dorevitch Pathology, Traralgon, VIC


      Correspondence: linda.saravanan@mps.com.au
      Competing interests:

      No relevant disclosures.

      • 1. Ryan J, Doll D. Mass casualties and triage. In: Velmahos GC, Degiannis E, Doll D editors. Penetrating trauma. Berlin, Heidelberg: Springer, 2012: 151–159.
      • 2. Glasgow S, Davenport R, Perkins Z, et al. A comprehensive review of blood product use in civilian mass casualty events. J Trauma Acute Care Surg 2013; 75: 468–474.
      • 3. Holcomb JB, Jenkins D, Rhee P, Johannigman J. Damage control resuscitation: directly addressing the early coagulopathy of trauma. J Trauma 2007; 62: 307–310.
      • 4. Doughty H, Rackham R. Transfusion emergency preparedness for mass casualty events. ISBT Sci Ser 2018; 14: 77–83.
      • 5. Victorian Department of Health and Human Services. Code Brown planning – guidance note for health services and facilities, February 2017. Melbourne: State Government of Victoria, 2017. https://www2.health.vic.gov.au/about/publications/policiesandguidelines/code-brown-planning-guidance-note-for-health-services-and-facilities (viewed Dec 2019).
      • 6. Mckeown D, Chowdhury F, Regan F. London 2017: a year to remember for all the wrong reasons! Vox Sang 2018; 113 (Suppl 1): 22.
      • 7. Bala M, Kaufman T, Keidar A, et al. Defining the need for blood and blood products transfusion following suicide bombing attacks on a civilian population: a level I single‐centre experience. Injury 2014; 45: 50–55.
      • 8. Noël S, Francois A, Le Failler F, et al. Lessons learned from Paris and Nice. ISBT Sci Ser 2018; 13: 35–46.

      Author
      remove_circle_outline Delete Author
      add_circle_outline Add Author
      Comment
      Do you have any competing interests to declare? *
      I/we agree to assign copyright to the Medical Journal of Australia and agree to the Conditions of publication *
      I/we agree to the Terms of use of the Medical Journal of Australia *
      Email me when people comment on this article
      Online responses are no longer available. Please refer to our instructions for authors page for more information.

        Presentations to emergency departments by children and young people with food allergy are increasing

        Rachel O'Loughlin and Harriet Hiscock
        Med J Aust 2020; 213 (1): . || doi: 10.5694/mja2.50604
        Published online: 25 May 2020

        The prevalence of food allergy among Victorian children is rising.1 In Victoria, children with suspected food allergies can be on hospital outpatient clinic waiting lists for months before being assessed.2 This may lead families to consider alternative avenues, which can lead to poor allergy management and the need for emergency care. Increasing numbers of Victorian children are presenting to emergency departments,3 but we do not know whether the number visiting with food allergy is also rising.

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

        LOGIN
        CREATE AN ACCOUNT

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

        View on Wiley Online Library

        • 1 Royal Children's Hospital Melbourne, Melbourne, VIC
        • 2 Murdoch Children's Research Institute, Melbourne, VIC


        Correspondence: harriet.hiscock@rch.org.au
        Acknowledgements: 

        Harriet Hiscock is supported by a National Health and Medical Research Council Practitioner Fellowship (1136222). The Health Services Research Unit is funded by the Royal Children's Hospital Foundation. The Murdoch Children's Research Institute is supported by the Victorian Government Operational Infrastructure Support Program.

        Competing interests:

        No relevant disclosures.

        Author
        remove_circle_outline Delete Author
        add_circle_outline Add Author
        Comment
        Do you have any competing interests to declare? *
        I/we agree to assign copyright to the Medical Journal of Australia and agree to the Conditions of publication *
        I/we agree to the Terms of use of the Medical Journal of Australia *
        Email me when people comment on this article
        Online responses are no longer available. Please refer to our instructions for authors page for more information.

          Beyond skin deep: addressing comorbidities in psoriasis

          Tom Kovitwanichkanont, Alvin H Chong and Peter Foley
          Med J Aust 2020; 212 (11): . || doi: 10.5694/mja2.50591
          Published online: 11 May 2020

          Summary

          • Psoriasis is a chronic inflammatory disease that is commonly encountered in primary care and is associated with significant morbidity that extends beyond the skin manifestations.
          • Psoriasis is associated with an elevated risk of psoriatic arthritis, cardiovascular disease, obesity, insulin resistance, mental health disorders, certain types of malignancy, inflammatory bowel disease and other immune‐related disorders, and hepatic and renal disease.
          • Enhanced recognition of these comorbidities may lead to earlier diagnosis and potentially better overall health outcomes.
          • Psoriatic nail involvement, severe skin disease and obesity are associated with a greater risk of psoriatic arthritis. Individuals with psoriasis should be routinely screened for psoriatic arthritis to allow for early intervention to improve long term prognosis.
          • Life expectancy is reduced in people with psoriasis due to a variety of causes, with cardiovascular disease and malignancy being the most common aetiologies.
          • Psoriasis affects several factors that contribute to worsened quality of life and increased risk of depression and anxiety. Effective therapies are now available that have been shown to concurrently improve skin disease, quality of life and psychiatric symptoms.
          • As the concordance between psychosocial impact and objective disease severity does not always correlate, it is essential to tailor management strategies specifically to the needs of each individual.
          • Cigarette smoking and excess alcohol consumption are among the most important modifiable risk factors that increase the likelihood of psoriasis development and severity of skin disease. This provides a compelling rationale for smoking cessation and limiting alcohol intake in people with psoriasis beyond their traditional harmful health consequences.

          • 1 Skin Health Institute, Melbourne, VIC
          • 2 St Vincent's Hospital, Melbourne, VIC


          Competing interests:

          Peter Foley is a consultant, investigator, speaker and/or advisor for, and/or received travel grants from 3M/iNova/Valeant, Abbott/AbbVie, Amgen, Biogen, Bristol Myers Squibb, Boehringer Ingelheim, Celgene, Celtaxsys, Cutanea, Dermira, Eli Lilly, Galderma, GSK/Stiefel, Janssen, LEO Pharma/Peplin, Novartis, Regeneron Pharmaceuticals, Roche, Sanofi Genzyme, Schering‐Plough/MSD, Sun Pharma, UCB and Wyeth/Pfizer.

          • 1. Parisi R, Symmons DP, Griffiths CE, Ashcroft DM. Global epidemiology of psoriasis: a systematic review of incidence and prevalence. J Invest Dermatol 2013; 133: 377–385.
          • 2. Ogdie A, Weiss P. The epidemiology of psoriatic arthritis. Rheum Dis Clin North Am 2015; 41: 545–568.
          • 3. Iragorri N, Hazlewood G, Manns B, et al. Psoriatic arthritis screening: a systematic review and meta‐analysis. Rheumatology (Oxford) 2019; 58: 692–707.
          • 4. Armstrong EJ, Harskamp CT, Armstrong AW. Psoriasis and major adverse cardiovascular events: a systematic review and meta‐analysis of observational studies. J Am Heart Assoc 2013; 2: e000062.
          • 5. Armstrong AW, Harskamp CT, Armstrong EJ. The association between psoriasis and obesity: a systematic review and meta‐analysis of observational studies. Nutr Diabetes 2012; 2: e54.
          • 6. Mamizadeh M, Tardeh Z, Azami M. The association between psoriasis and diabetes mellitus: a systematic review and meta‐analysis. Diabetes Metab Syndr 2019; 13: 1405–1412.
          • 7. Armstrong AW, Harskamp CT, Dhillon JS, Armstrong EJ. Psoriasis and smoking: a systematic review and meta‐analysis. Br J Dermatol 2014; 170: 304–314.
          • 8. Zhu KJ, Zhu CY, Fan YM. Alcohol consumption and psoriatic risk: a meta‐analysis of case‐control studies. J Dermatol 2012; 39: 770–773.
          • 9. Dowlatshahi EA, Wakkee M, Arends LR, Nijsten T. The prevalence and odds of depressive symptoms and clinical depression in psoriasis patients: a systematic review and meta‐analysis. J Invest Dermatol 2014; 134: 1542–1551.
          • 10. Dalgard FJ, Gieler U, Tomas‐Aragones L, et al. The psychological burden of skin diseases: a cross‐sectional multicenter study among dermatological out‐patients in 13 European countries. J Invest Dermatol 2015; 135: 984–991.
          • 11. Chi CC, Chen TH, Wang SH, Tung TH. Risk of suicidality in people with psoriasis: a systematic review and meta‐analysis of cohort studies. Am J Clin Dermatol 2017; 18: 621–627.
          • 12. Singh S, Taylor C, Kornmehl H, Armstrong AW. Psoriasis and suicidality: a systematic review and meta‐analysis. J Am Acad Dermatol 2017; 77(425–440): e2.
          • 13. Chen YJ, Chen CC, Lin MW, et al. Increased risk of sexual dysfunction in male patients with psoriasis: a nationwide population‐based follow‐up study. J Sex Med 2013; 10: 1212–1218.
          • 14. Wu T, Duan X, Chen S, et al. Association between psoriasis and erectile dysfunction: a meta‐analysis. J Sex Med 2018; 15: 839–847.
          • 15. Puig L, Thom H, Mollon P, et al. Clear or almost clear skin improves the quality of life in patients with moderate‐to‐severe psoriasis: a systematic review and meta‐analysis. J Eur Acad Dermatol Venereol 2017; 31: 213–220.
          • 16. Strober B, Gooderham M, de Jong E, et al. Depressive symptoms, depression, and the effect of biologic therapy among patients in Psoriasis Longitudinal Assessment and Registry (PSOLAR). J Am Acad Dermatol 2018; 78: 70–80.
          • 17. Pouplard C, Brenaut E, Horreau C, et al. Risk of cancer in psoriasis: a systematic review and meta‐analysis of epidemiological studies. J Eur Acad Dermatol Venereol 2013; 27(Suppl): 36–46.
          • 18. Gelfand JM, Shin DB, Neimann AL, et al. The risk of lymphoma in patients with psoriasis. J Invest Dermatol 2006; 126: 2194–2201.
          • 19. Fu Y, Lee CH, Chi CC. Association of psoriasis with inflammatory bowel disease: a systematic review and meta‐analysis. JAMA Dermatol 2018; 154: 1417–1423.
          • 20. Wu JJ, Nguyen TU, Poon KY, Herrinton LJ. The association of psoriasis with autoimmune diseases. J Am Acad Dermatol 2012; 67: 924–930.
          • 21. Chi CC, Tung TH, Wang J, et al. Risk of uveitis among people with psoriasis: a nationwide cohort study. JAMA Ophthalmol 2017; 135: 415–422.
          • 22. Candia R, Ruiz A, Torres‐Robles R, et al. Risk of non‐alcoholic fatty liver disease in patients with psoriasis: a systematic review and meta‐analysis. J Eur Acad Dermatol Venereol 2015; 29: 656–662.
          • 23. Ungprasert P, Raksasuk S. Psoriasis and risk of incident chronic kidney disease and end‐stage renal disease: a systematic review and meta‐analysis. Int Urol Nephrol 2018; 50: 1277–1283.
          • 24. Ritchlin CT, Colbert RA, Gladman DD. Psoriatic arthritis. N Engl J Med 2017; 376: 957–970.
          • 25. Wilson FC, Icen M, Crowson CS, et al. Incidence and clinical predictors of psoriatic arthritis in patients with psoriasis: a population‐based study. Arthritis Rheum 2009; 61: 233–239.
          • 26. Ogdie A, Langan S, Love T, et al. Prevalence and treatment patterns of psoriatic arthritis in the UK. Rheumatology (Oxford) 2013; 52: 568–575.
          • 27. Kehl AS, Corr M, Weisman MH. Review: enthesitis: new insights into pathogenesis, diagnostic modalities, and treatment. Arthritis Rheumatol 2016; 68: 312–322.
          • 28. Setty AR, Choi HK. Psoriatic arthritis epidemiology. Curr Rheumatol Rep 2007; 9: 449–454.
          • 29. Højgaard P, Ballegaard C, Cordtz R, et al. Gender differences in biologic treatment outcomes — a study of 1750 patients with psoriatic arthritis using Danish health care registers. Rheumatology (Oxford) 2018; 57: 1651–1660.
          • 30. Coates LC, Moverley AR, McParland L, et al. Effect of tight control of inflammation in early psoriatic arthritis (TICOPA): a UK multicentre, open‐label, randomised controlled trial. Lancet 2015; 386: 2489–2498.
          • 31. Haroon M, Gallagher P, FitzGerald O. Diagnostic delay of more than 6 months contributes to poor radiographic and functional outcome in psoriatic arthritis. Ann Rheum Dis 2015; 74: 1045–1050.
          • 32. Coates LC, Aslam T, Al Balushi F, et al. Comparison of three screening tools to detect psoriatic arthritis in patients with psoriasis (CONTEST study). Br J Dermatol 2013; 168: 802–807.
          • 33. Menter A, Strober BE, Kaplan DH, et al. Joint AAD‐NPF guidelines of care for the management and treatment of psoriasis with biologics. J Am Acad Dermatol 2019; 80: 1029–1072.
          • 34. Langenbruch A, Radtke MA, Krensel M, et al. Nail involvement as a predictor of concomitant psoriatic arthritis in patients with psoriasis. Br J Dermatol 2014; 171: 1123–1128.
          • 35. Reich K. The concept of psoriasis as a systemic inflammation: implications for disease management. J Eur Acad Dermatol Venereol 2012; 26 (Suppl): 3–11.
          • 36. Skiveren J, Philipsen P, Therming G. Patients with psoriasis have insufficient knowledge of their risk of atherothrombotic disease and metabolic syndrome. Clin Exp Dermatol 2015; 40: 600–604.
          • 37. Navarini L, Margiotta DPE, Caso F, et al. Performances of five risk algorithms in predicting cardiovascular events in patients with psoriatic arthritis: an Italian bicentric study. PLoS One 2018; 13: e0205506.
          • 38. Roubille C, Richer V, Starnino T, et al. The effects of tumour necrosis factor inhibitors, methotrexate, non‐steroidal anti‐inflammatory drugs and corticosteroids on cardiovascular events in rheumatoid arthritis, psoriasis and psoriatic arthritis: a systematic review and meta‐analysis. Ann Rheum Dis 2015; 74: 480–489.
          • 39. Ahlehoff O, Skov L, Gislason G, et al. Cardiovascular outcomes and systemic anti‐inflammatory drugs in patients with severe psoriasis: 5‐year follow‐up of a Danish nationwide cohort. J Eur Acad Dermatol Venereol 2015; 29: 1128–1134.
          • 40. Ridker PM, Everett BM, Pradhan A, et al. Low‐dose methotrexate for the prevention of atherosclerotic events. N Engl J Med 2019; 380: 752–762.
          • 41. Bissonnette R, Harel F, Krueger JG, et al. TNF‐alpha antagonist and vascular inflammation in patients with psoriasis vulgaris: a randomized placebo‐controlled study. J Invest Dermatol 2017; 137: 1638–1645.
          • 42. Chung ES, Packer M, Lo KH, et al. Randomized, double‐blind, placebo‐controlled, pilot trial of infliximab, a chimeric monoclonal antibody to tumor necrosis factor‐alpha, in patients with moderate‐to‐severe heart failure: results of the anti‐TNF Therapy Against Congestive Heart Failure (ATTACH) trial. Circulation 2003; 107: 3133–3140.
          • 43. Egeberg A, Sørensen JA, Gislason GH, et al. Incidence and prognosis of psoriasis and psoriatic arthritis in patients undergoing bariatric surgery. JAMA Surg 2017; 152: 344–349.
          • 44. Jensen P, Zachariae C, Christensen R, et al. Effect of weight loss on the severity of psoriasis: a randomized clinical study. JAMA Dermatol 2013; 149: 795–801.
          • 45. Wan MT, Shin DB, Hubbard RA, et al. Psoriasis and the risk of diabetes: a prospective population‐based cohort study. J Am Acad Dermatol 2018; 78(315–322): e1.
          • 46. Michaёlsson G, Gustafsson K, Hagforsen E. The psoriasis variant palmoplantar pustulosis can be improved after cessation of smoking. J Am Acad Dermatol 2006; 54: 737–738.
          • 47. Nguyen UDT, Zhang Y, Lu N, Louie‐Gao Q, et al. Smoking paradox in the development of psoriatic arthritis among patients with psoriasis: a population‐based study. Ann Rheum Dis 2018; 77: 119–123.
          • 48. Naldi L, Chatenoud L, Linder D, et al. Cigarette smoking, body mass index, and stressful life events as risk factors for psoriasis: results from an Italian case‐control study. J Invest Dermatol 2005; 125: 61–67.
          • 49. Ko SH, Chi CC, Yeh ML, et al. Lifestyle changes for treating psoriasis. Cochrane Database Syst Rev 2019; (7): CD011972.
          • 50. Kurd SK, Troxel AB, Crits‐Christoph P, Gelfand JM. The risk of depression, anxiety, and suicidality in patients with psoriasis: a population‐based cohort study. Arch Dermatol 2010; 146: 891–895.
          • 51. Kimball AB, Jacobson C, Weiss S, et al. The psychosocial burden of psoriasis. Am J Clin Dermatol 2005; 6: 383–392.
          • 52. Aberra TM, Joshi AA, Lerman JB, et al. Self‐reported depression in psoriasis is associated with subclinical vascular diseases. Atherosclerosis 2016; 251: 219–225.
          • 53. Dauden E, Griffiths CE, Ortonne JP, et al. Improvements in patient‐reported outcomes in moderate‐to‐severe psoriasis patients receiving continuous or paused etanercept treatment over 54 weeks: the CRYSTEL study. J Eur Acad Dermatol Venereol 2009; 23: 1374–1382.
          • 54. Hawro M, Maurer M, Weller K, et al. Lesions on the back of hands and female gender predispose to stigmatization in patients with psoriasis. J Am Acad Dermatol 2017; 76(648–654): e2.
          • 55. Sampogna F, Tabolli S, Abeni D. Living with psoriasis: prevalence of shame, anger, worry, and problems in daily activities and social life. Acta Derm Venereol 2012; 92: 299–303.
          • 56. Armstrong AW, Schupp C, Wu J, Bebo B. Quality of life and work productivity impairment among psoriasis patients: findings from the National Psoriasis Foundation survey data 2003–2011. PLoS One 2012; 7: e52935.
          • 57. Molina‐Leyva A, Jiménez‐Moleón JJ, Naranjo‐Sintes R, Ruiz‐Carrascosa JC. Sexual dysfunction in psoriasis: a systematic review. J Eur Acad Dermatol Venereol 2015; 29: 649–655.
          • 58. Matterne U, Baumeister SE, Apfelbacher CJ. Suicidality and risk of suicidality in psoriasis: a critical appraisal of two systematic reviews and meta‐analyses. Br J Dermatol 2019; 181: 717–721.
          • 59. Chiesa Fuxench ZC, Shin DB, Ogdie Beatty A, Gelfand JM. The risk of cancer in patients with psoriasis: a population‐based cohort study in the Health Improvement Network. JAMA Dermatol 2016; 152: 282–290.
          • 60. Crusz SM, Balkwill FR. Inflammation and cancer: advances and new agents. Nat Rev Clin Oncol 2015; 12: 584–596.
          • 61. Peleva E, Exton LS, Kelley K, et al. Risk of cancer in patients with psoriasis on biological therapies: a systematic review. Br J Dermatol 2018; 178: 103–113.
          • 62. Sokolova A, Lee A, Saxon DS. The safety and efficacy of narrow band ultraviolet B treatment in dermatology: a review. Am J Clin Dermatol 2015; 16: 501–531.
          • 63. Papp KA, Griffiths CE, Gordon K, et al. Long‐term safety of ustekinumab in patients with moderate‐to‐severe psoriasis: final results from 5 years of follow‐up. Br J Dermatol 2013; 168: 844–854.
          • 64. Fiorentino D, Ho V, Lebwohl MG, et al. Risk of malignancy with systemic psoriasis treatment in the Psoriasis Longitudinal Assessment Registry. J Am Acad Dermatol 2017; 77(845–854): e5.
          • 65. Papp K, Gottlieb AB, Naldi L, et al. Safety surveillance for ustekinumab and other psoriasis treatments from the Psoriasis Longitudinal Assessment and Registry (PSOLAR). J Drugs Dermatol 2015; 14: 706–714.
          • 66. Gottlieb AB, Kalb RE, Langley RG, et al. Safety observations in 12095 patients with psoriasis enrolled in an international registry (PSOLAR): experience with infliximab and other systemic and biologic therapies. J Drugs Dermatol 2014; 13: 1441–1448.
          • 67. Rademaker M, Rubel DM, Agnew K, et al. Psoriasis and cancer. an Australian/New Zealand narrative. Australas J Dermatol 2019; 60: 12–18.
          • 68. Ayala‐Fontánez N, Soler DC, McCormick TS. Current knowledge on psoriasis and autoimmune diseases. Psoriasis (Auckl) 2016; 6: 7–32.
          • 69. Alinaghi F, Tekin HG, Burisch J, et al. Global prevalence and bidirectional association between psoriasis and inflammatory bowel disease — a systematic review and meta‐analysis. J Crohns Colitis 2019; 14: 351–360.
          • 70. Egeberg A, Thyssen JP, Burisch J, Colombel JF. Incidence and risk of inflammatory bowel disease in patients with psoriasis — a nationwide 20‐year cohort study. J Invest Dermatol 2019; 139: 316–323.
          • 71. Pugliese D, Guidi L, Ferraro PM, et al. Paradoxical psoriasis in a large cohort of patients with inflammatory bowel disease receiving treatment with anti‐TNF alpha: 5‐year follow‐up study. Aliment Pharmacol Ther 2015; 42: 880–888.
          • 72. Cottone M, Sapienza C, Macaluso FS, Cannizzaro M. Psoriasis and inflammatory bowel disease. Dig Dis 2019; 37: 451–457.
          • 73. Eppinga H, Poortinga S, Thio HB, et al. Prevalence and phenotype of concurrent psoriasis and inflammatory bowel disease. Inflamm Bowel Dis 2017; 23: 1783–1789.
          • 74. Chandran V, Cook RJ, Edwin J, et al. Soluble biomarkers differentiate patients with psoriatic arthritis from those with psoriasis without arthritis. Rheumatology (Oxford) 2010; 49: 1399–1405.
          • 75. Ogdie A, Grewal SK, Noe MH, et al. Risk of incident liver disease in patients with psoriasis, psoriatic arthritis, and rheumatoid arthritis: a population‐based study. J Invest Dermatol 2018; 138: 760–767.
          • 76. Shahwan KT, Kimball AB. Psoriasis and cardiovascular disease. Med Clin North Am 2015; 99: 1227–1242.
          • 77. Grewal SK, Wan J, Denburg MR, et al. The risk of IgA nephropathy and glomerular disease in patients with psoriasis: a population‐based cohort study. Br J Dermatol 2017; 176: 1366–1369.
          • 78. Warren RB, Weatherhead SC, Smith CH, et al. British Association of Dermatologists’ guidelines for the safe and effective prescribing of methotrexate for skin disease 2016. Br J Dermatol 2016; 175: 23–44.

          Author
          remove_circle_outline Delete Author
          add_circle_outline Add Author
          Comment
          Do you have any competing interests to declare? *
          I/we agree to assign copyright to the Medical Journal of Australia and agree to the Conditions of publication *
          I/we agree to the Terms of use of the Medical Journal of Australia *
          Email me when people comment on this article
          Online responses are no longer available. Please refer to our instructions for authors page for more information.

            Marked variation in out‐of‐pocket costs for cancer care in Western Australia

            Neli S Slavova‐Azmanova, Jade C Newton and Christobel M Saunders
            Med J Aust 2020; 212 (11): . || doi: 10.5694/mja2.50590
            Published online: 4 May 2020

            Out‐of‐pocket expenses for cancer care are of growing concern for patients, clinicians, service providers, non‐governmental organisations, private insurers, and politicians. Contrary to popular belief, there is no direct link between the cost and quality of care. Out‐of‐pocket expenses are a particular problem for patients who live further from treatment centres, are younger, or have later stage disease.1

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

            LOGIN
            CREATE AN ACCOUNT

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

            View on Wiley Online Library

            • The University of Western Australia, Perth, WA


            Acknowledgements: 

            Our investigation was funded by the Cancer Council of Western Australia and the WA Cancer and Palliative Care Network.

            Competing interests:

            No relevant disclosures.

            Author
            remove_circle_outline Delete Author
            add_circle_outline Add Author
            Comment
            Do you have any competing interests to declare? *
            I/we agree to assign copyright to the Medical Journal of Australia and agree to the Conditions of publication *
            I/we agree to the Terms of use of the Medical Journal of Australia *
            Email me when people comment on this article
            Online responses are no longer available. Please refer to our instructions for authors page for more information.

              A case of toxigenic, pharyngeal diphtheria in Australia

              Sarah Grigg, David Hogan, F Shaun Hosein, Dean Johns, Amy Jennison and Shradha Subedi
              Med J Aust 2020; 213 (2): . || doi: 10.5694/mja2.50566
              Published online: 4 May 2020

              A 42‐year‐old woman presented to the Sunshine Coast University Hospital, Queensland, with a 5‐day history of odynophagia, orthopnoea and rapid onset of neck swelling over 12 hours. She had returned one week prior from a year‐long trip to Central America, Sri Lanka and Indonesia. Relevant past medical history included nephrotic syndrome due to minimal change disease, use of prednisolone 2.5 mg daily and previous treatment with rituximab. Childhood vaccinations were reported, but she had no booster travel vaccinations.


              • 1 Sunshine Coast Hospital and Health Service, Sunshine Coast, QLD
              • 2 Griffith University, Sunshine Coast, QLD
              • 3 Forensic and Scientific Services, Brisbane, QLD


              Correspondence: sarahgrigg28@gmail.com
              Competing interests:

              No relevant disclosures.

              • 1. Nakao H, Pruckler JM, Mazurova IK, et al. Heterogeneity of diphtheria toxin gene, tox, and its regulatory element, dtxR, in Corynebacterium diphtheriae strains causing epidemic diphtheria in Russia and Ukraine. J Clin Microbiol 1996; 34: 1711–1716.
              • 2. Sing A, Berger A, Schneider‐Brachert W, et al. Rapid detection and molecular differentiation of toxigenic Corynebacterium diphtheriae and Corynebacterium ulcerans strains by LightCycler PCR. J Clin Microbiol 2011; 49: 2485.
              • 3. Queensland Government, Queensland Health. Diphtheria [website]. Queensland Health, 2012. https://www.health.qld.gov.au/cdcg/index/diphtheria (viewed Mar 2020).
              • 4. Hadfield TL, McEvoy P, Polotsky Y, et al. The pathology of diphtheria. J Infect Dis 2000; 181 (Suppl): S116–S120.
              • 5. World Health Organization. Diphtheria [website]. WHO, 2017. http://www.who.int/immunization/monitoring_surveillance/burden/diphtheria/en/ (viewed Mar 2020).
              • 6. NNDSS Annual Report Working Group. Australia's notifiable disease status, 2014: annual report of the National Notifiable Diseases Surveillance System. Commun Dis Intell Q Rep 2016; 40: E48–E145.
              • 7. Lubran MM. Bacterial toxins. Ann Clin Lab Sci 1988; 18: 58–71.
              • 8. Adler NR, Mahony A, Friedman ND. Diphtheria: forgotten, but not gone. Intern Med J 2013; 43: 206–210.
              • 9. Lumio JT, Groundstroem KW, Melnick OB, et al. Electrocardiographic abnormalities in patients with diphtheria: a prospective study. Am J Med 2004; 116: 78–83.
              • 10. Tiwari TSP, Wharton M. Diphtheria toxoid. In: Plotkin SA, Orenstein WA, Offit PA, Edwards KM, editors. Plotkin's vaccines, 7th ed. Elsevier, 2018: 261–275.

              Author
              remove_circle_outline Delete Author
              add_circle_outline Add Author
              Comment
              Do you have any competing interests to declare? *
              I/we agree to assign copyright to the Medical Journal of Australia and agree to the Conditions of publication *
              I/we agree to the Terms of use of the Medical Journal of Australia *
              Email me when people comment on this article
              Online responses are no longer available. Please refer to our instructions for authors page for more information.

                The carbon footprint of pathology testing

                Scott McAlister, Alexandra L Barratt, Katy JL Bell and Forbes McGain
                Med J Aust 2020; 212 (8): . || doi: 10.5694/mja2.50583
                Published online: 4 May 2020

                Abstract

                Objectives: To estimate the carbon footprint of five common hospital pathology tests: full blood examination; urea and electrolyte levels; coagulation profile; C‐reactive protein concentration; and arterial blood gases.

                Design, setting: Prospective life cycle assessment of five pathology tests in two university‐affiliated health services in Melbourne. We included all consumables and associated waste for venepuncture and laboratory analyses, and electricity and water use for laboratory analyses.

                Main outcome measure: Greenhouse gas footprint, measured in carbon dioxide equivalent (CO2e) emissions.

                Results: CO2e emissions for haematology tests were 82 g/test (95% CI, 73–91 g/test) for coagulation profile and 116 g/test (95% CI, 101–135 g/test) for full blood examination. CO2e emissions for biochemical tests were 0.5 g/test CO2e (95% CI, 0.4–0.6 g/test) for C‐reactive protein (low because typically ordered with urea and electrolyte assessment), 49 g/test (95% CI, 45–53 g/test) for arterial blood gas assessment, and 99 g/test (95% CI, 84–113 g/test) for urea and electrolyte assessment. Most CO2e emissions were associated with sample collection (range, 60% for full blood examination to 95% for coagulation profile); emissions attributable to laboratory reagents and power use were much smaller.

                Conclusion: The carbon footprint of common pathology tests was dominated by those of sample collection and phlebotomy. Although the carbon footprints were small, millions of tests are performed each year in Australia, and reducing unnecessary testing will be the most effective approach to reducing the carbon footprint of pathology. Together with the detrimental health and economic effects of unnecessary testing, our environmental findings should further motivate clinicians to test wisely.

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

                LOGIN
                CREATE AN ACCOUNT

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

                View on Wiley Online Library

                • 1 The University of Melbourne, Melbourne, VIC
                • 2 Sydney School of Public Health, University of Sydney, Sydney, NSW
                • 3 Western Health, Melbourne, VIC


                Acknowledgements: 

                Funding for this investigation (data collection, life cycle assessment analysis, report writing) was provided by the Victorian Department of Health and Human Services, Choosing Wisely Australia, and by a National Health and Medical Research Council Centre for Research Excellence grant (Alexandra Barratt: 1104136). Scott McAlister is supported by a National Health and Medical Research Council PhD scholarship. Cathy Cockshott provided access to the Sunshine Hospital pathology laboratory, and Nick Crinis to the Austin Hospital pathology laboratory, to allow collection of data about analysers and reagents.

                Competing interests:

                No relevant disclosures.

                Author
                remove_circle_outline Delete Author
                add_circle_outline Add Author
                Comment
                Do you have any competing interests to declare? *
                I/we agree to assign copyright to the Medical Journal of Australia and agree to the Conditions of publication *
                I/we agree to the Terms of use of the Medical Journal of Australia *
                Email me when people comment on this article
                Online responses are no longer available. Please refer to our instructions for authors page for more information.

                  Telemedicine is improving outcomes for patients with stroke

                  Richard I Lindley
                  Med J Aust 2020; 212 (8): . || doi: 10.5694/mja2.50587
                  Published online: 4 May 2020

                  Technology is revolutionising medicine, and telemedicine is having a measurable impact on stroke care

                  Technology is revolutionising medicine, and telemedicine for patients with stroke (telestroke) is now having a measurable impact on outcomes. Acute stroke care is challenging for many reasons: stroke mimics are common (about 30% of all cases initially suspected to be stroke);1 patients with intracerebral haemorrhage and ischaemic stroke can present with identical syndromes, making brain imaging essential for diagnosis; treatments must be initiated without delay, and some require transfer for tertiary intervention (eg, endovascular thrombectomy). The lack of specialist stroke physicians in regional Australia and underinvestment in stroke care results in poor access for many Australians. Unwarranted clinical variation is unacceptable, so why do some regions of Australia, even today, have no access to specialist stroke care? The answers are complex, but some are clear (too few specialists in regional areas), while some are more difficult to understand (health providers declining offers of help).


                  • 1 Westmead Applied Research Centre, University of Sydney, Sydney, NSW
                  • 2 The George Institute for Global Health, Sydney, NSW


                  Acknowledgements: 

                  I am supported by a National Health and Medical Research Council program grant (APP1149987: Clinical, public health and policy interventions to combat cardiovascular diseases).

                  Competing interests:

                  No relevant disclosures.

                  • 1. Bladin C, Kim J, Bagot KL, et al. Improving acute stroke care in regional hospitals: clinical evaluation of the Victorian Stroke Telemedicine program. Med J Aust 2020; 212: 371–376.
                  • 2. National Institute of Neurological Disorders and Stroke rt‐PA Stroke Study Group. Tissue plasminogen activator for acute ischemic stroke. N Engl J Med 1995; 333: 1581–1587.
                  • 3. Stroke Foundation. Stroke symptoms. Undated. https://strok​efoun​dation.org.au/About-Strok​e/Stroke-symptoms (viewed Mar 2020).
                  • 4. Emberson J, Lees KR, Lyden P, et al. Effect of treatment delay, age, and stroke severity on the effects of intravenous thrombolysis with alteplase for acute ischaemic stroke: a meta‐analysis of individual patient data from randomised trials. Lancet 2014; 384: 1929–1935.
                  • 5. Saver JL. Time is brain‐quantified. Stroke 2006; 37: 263–266.
                  • 6. Saver JL, Fonarow GC, Smith EE, et al. Time to treatment with intravenous tissue plasminogen activator and outcome from acute ischemic stroke. JAMA 2013; 309: 2480–2488.
                  • 7. Stroke Unit Trialists’ Collaboration. Organised inpatient (stroke unit) care for stroke. Cochrane Database Syst Rev 2013; CD000197.
                  • 8. Wang Y, Johnston SC, Bath PM, et al. BMJ 2019; 364: l895.
                  • 9. Goyal M, Menon BK, van Zwam WH, et al. Endovascular thrombectomy after large‐vessel ischaemic stroke: a meta‐analysis of individual patient data from five randomised trials. Lancet 2016; 387: 1723–1731.
                  • 10. Parry‐Jones AR, Sammut‐Powell C, Paroutoglou K, et al. An intracerebral hemorrhage care bundle is associated with lower case fatality. Ann Neurol 2019; 86: 495–503.
                  • 11. Anderson CS, Heeley E, Huang Y, et al. Rapid blood‐pressure lowering in patients with acute intracerebral hemorrhage. N Engl J Med 2013; 368: 2355–2365.
                  • 12. Reed SD, Cramer SC, Blough DK, et al. Treatment with tissue plasminogen activator and inpatient mortality rates for patients with ischemic stroke treated in community hospitals. Stroke 2001; 32: 1832–1840.

                  Author
                  remove_circle_outline Delete Author
                  add_circle_outline Add Author
                  Comment
                  Do you have any competing interests to declare? *
                  I/we agree to assign copyright to the Medical Journal of Australia and agree to the Conditions of publication *
                  I/we agree to the Terms of use of the Medical Journal of Australia *
                  Email me when people comment on this article
                  Online responses are no longer available. Please refer to our instructions for authors page for more information.

                    Hepatitis C elimination in Australia: progress and challenges

                    Marianne Martinello, Behzad Hajarizadeh and Gregory J Dore
                    Med J Aust 2020; 212 (8): . || doi: 10.5694/mja2.50584
                    Published online: 4 May 2020

                    Early empirical evidence provides grounds for optimism about eliminating HCV by 2030

                    Curative direct‐acting antiviral (DAA) therapy for people with chronic hepatitis C virus (HCV) infections1 has transformed clinical management and spurred ambitious World Health Organization elimination targets for 2030.2 WHO service targets encompass marked improvements in prevention, diagnosis, and treatment; impact targets include a 65% reduction in HCV‐related deaths and an 80% reduction in new HCV infections compared with 2015.2


                    • Kirby Institute, UNSW, Sydney, NSW


                    Competing interests:

                    Gregory Dore is an advisory board member and has received honoraria, research grant funding, and travel sponsorship from Merck, Gilead, and Abbvie.

                    • 1. Spearman CW, Dusheiko GM, Hellard M, Sonderup M. Hepatitis C. Lancet 2019; 394: 1451–1466.
                    • 2. Word Health Organization. Global health sector strategy on viral hepatitis, 2016–2021 (WHO/HIV/2016.06). Geneva: WHO, 2016. https://www.who.int/hepatitis/strategy2016-2021/ghss-hep/en/ (viewed Mar 2020).
                    • 3. Hajarizadeh B, Grebely J, Matthews GV, et al. Uptake of direct‐acting antiviral treatment for chronic hepatitis C in Australia. J Viral Hepat 2018; 25: 640–648.
                    • 4. Iversen J, Dore GJ, Catlett B, et al. Association between rapid utilisation of direct hepatitis C antivirals and decline in the prevalence of viremia among people who inject drugs in Australia. J Hepatol 2019; 70: 33–39.
                    • 5. Iranpour N DG, Martinello M, Matthews G, et al. Estimated uptake of hepatitis C direct‐acting antiviral treatment among individuals with HIV co‐infection in Australia: a retrospective cohort study. Sexual Health 2020; https://doi.org/10.1071/sh19101 [Epub ahead of print].
                    • 6. Moon S, Erickson E. Universal medicine access through lump‐sum remuneration: Australia's approach to hepatitis C. N Engl J Med 2019; 380: 607–610.
                    • 7. Alavi M, Law MG, Valerio H, et al. Declining hepatitis C virus‐related liver disease burden in the direct‐acting antiviral therapy era in New South Wales, Australia. J Hepatol 2019; 71: 281–288.
                    • 8. Scott N, Sacks‐Davis R, Wade AJ, et al. Australia needs to increase testing to achieve hepatitis C elimination. Med J Aust 2020; 212: 365–370.
                    • 9. NSW Government. NSW hepatitis B and hepatitis C strategies 2014–2020 data report: 2018 annual data report. 2018. https://www.health.nsw.gov.au/hepatitis/Publications/2018-annual-data-report.pdf (viewed Mar 2020).
                    • 10. Larney S, Peacock A, Leung J, et al. Global, regional, and country‐level coverage of interventions to prevent and manage HIV and hepatitis C among people who inject drugs: a systematic review. Lancet Glob Health 2017; 5: e1208–e1220.
                    • 11. Fraser H, Zibbell J, Hoerger T, et al. Scaling‐up HCV prevention and treatment interventions in rural United States‐ model projections for tackling an increasing epidemic. Addiction 2017; 113: 173–182.
                    • 12. The Kirby Institute. Monitoring hepatitis C treatment uptake in Australia (issue 10). June 2019. https://kirby.unsw.edu.au/report/monitoring-hepatitis-c-treatment-uptake-australia-issue-10-june-2019 (viewed Mar 2020).

                    Author
                    remove_circle_outline Delete Author
                    add_circle_outline Add Author
                    Comment
                    Do you have any competing interests to declare? *
                    I/we agree to assign copyright to the Medical Journal of Australia and agree to the Conditions of publication *
                    I/we agree to the Terms of use of the Medical Journal of Australia *
                    Email me when people comment on this article
                    Online responses are no longer available. Please refer to our instructions for authors page for more information.

                      Environmentally sustainable health care: now is the time for action

                      Diana L Madden, Anthony Capon and Philip G Truskett
                      Med J Aust 2020; 212 (8): . || doi: 10.5694/mja2.50586
                      Published online: 4 May 2020

                      Excellence in environmentally sustainable health care must be the goal of the Australian medical profession

                      The bushfires that recently raged across south‐eastern Australia have again shown that climate change has serious health consequences. Thirty‐four people died, and half the Australian population was exposed to sustained, hazardous levels of air pollution.1 Mental health experts are flagging rising levels of eco‐anxiety about bushfires and climate change in general.2 The intensity and scale of the bushfires, which were amplified by climate change, have highlighted the urgent need for climate action.3 It is timely for clinicians and health care managers to reflect on the environmental footprint — including the carbon footprint — of the health care we provide, and to act to reduce it.


                      • 1 University of Notre Dame Australia, Sydney, NSW
                      • 2 Monash Sustainable Development Institute, Monash University, Melbourne, VIC
                      • 3 University of New South Wales, Sydney, NSW
                      • 4 Royal Australasian College of Surgeons, Melbourne, VIC


                      Correspondence: lynne.madden@nd.edu.au
                      Competing interests:

                      No relevant disclosures.

                      Author
                      remove_circle_outline Delete Author
                      add_circle_outline Add Author
                      Comment
                      Do you have any competing interests to declare? *
                      I/we agree to assign copyright to the Medical Journal of Australia and agree to the Conditions of publication *
                      I/we agree to the Terms of use of the Medical Journal of Australia *
                      Email me when people comment on this article
                      Online responses are no longer available. Please refer to our instructions for authors page for more information.
                      Subscribe to