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A sustainable future in health: ensuring as health professionals our own house is in order and leading by example

Nicholas J Talley
Med J Aust 2020; 212 (8): . || doi: 10.5694/mja2.50574
Published online: 4 May 2020

It is time for health professionals to step up and lead to ensure a sustainable environment and health

The year 2020 is fast becoming the year of planetary crises, from global warming and the unprecedented bushfire season in Australia over the summer to the severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) pandemic striking around the globe, with its health and financial implications.1,2,3 Social media is littered with often uninformed opinions about both issues, from those unconcerned and arguing the problems are exaggerated or worse to those who are deeply concerned and searching for better solutions. The facts about the climate crisis and health are more stark, as pointed out by Madden and Capon4 in this issue of the Journal and by the most recent LancetMJA countdown report5 — overwhelming evidence points to a warming planet because of human activity and to the potential for very severe adverse health consequences, including other infectious disease outbreaks, if prompt action is not taken now. The recent unprecedented bushfire season may have shifted views about the potential for severe impacts of global warming on health, just as the unfolding health crisis with COVID‐19 has highlighted how vulnerable our health systems are to new pathogens. There has not been political inertia in the United Kingdom, where all sides of politics recognise the global emergency we all face because of climate change.6 However, more effective political action is needed here and around the world in terms of ensuring a sustainable future.

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  • University of Newcastle, Newcastle, NSW



Competing interests:

Nicholas Talley is Editor‐in‐Chief of the Medical Journal of Australia. A complete list of disclosures is available at https://www.mja.com.au/journal/staff/editor-chief-professor-nick-talley.

  • 1. Yu P, Xu R, Abramson MJ, et al. Bushfires in Australia: a serious health emergency under climate change. Lancet Planet Health 2020; 4: e7–e8.
  • 2. Vardoulakis S, Jalaludin BB, Morgan GG, et al. Bushfire smoke: urgent need for a national health protection strategy. Med J Aust 2020; 212: 349–353.
  • 3. Cheng A, Williamson D. An outbreak of COVID‐19 caused by a new coronavirus: what we know so far. Med J Aust 2020; https://doi.org/10.5694/mja2.50530 [Epub ahead of print]. https://www.mja.com.au/journal/2020/212/10/outbreak-covid-19-caused-new-coronavirus-what-we-know-so-far
  • 4. Madden DL, Capon A, Truskett PG. Environmentally sustainable health care: now is the time for action. Med J Aust 2020; 212: 361–362.
  • 5. Beggs PJ, Zhang Y, Bambrick H, et al. The 2019 report of the MJALancet Countdown on health and climate change: a turbulent year with mixed progress. Med J Aust 211: 490–491. https://www.mja.com.au/journal/2019/211/11/2019-report-mja-lancet-countdown-health-and-climate-change-turbulent-year-mixed
  • 6. BBC News. UK Parliament declares climate emergency. BBC News 2019, 1 May. https://www.bbc.com/news/uk-politics-48126677 (viewed Mar 2020).
  • 7. Malik A, Lenzen M, McAlister S, McGain F. The carbon footprint of Australian health care. Lancet Planet Health 2018; 2: e27–35.
  • 8. Sainsbury P, Charlesworth K, Madden D, et al. Climate change is a health issue: what can doctors do? Intern Med J 2019; 49: 1044–1048.
  • 9. Sutton B, Mulvenna V, Voronoff D, Humphrys T. Acting on climate change and health in Victoria. Med J Aust 2020; 212: 345–346.
  • 10. Weeramanthri TS, Joyce S, Bangor‐Jones R. Climate health inquiry: where sustainability, public health law and climate action intersect. Med J Aust 2020; 212: 347–349.
  • 11. NHS England, Public Health England. Sustainable Development Unit: what is sustainable health? [website] https://www.sduhealth.org.uk/policy-strategy/what-is-sustainable-health.aspx (viewed Mar 2020).
  • 12. Ripple WJ, Wolf C, Newsome TM, et al. World scientists’ warning of a climate emergency. BioScience 2020; 70: 8–12.

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General practice research: an investment to improve the health of all Australians

Jo‐Anne E Manski‐Nankervis, Elizabeth A Sturgiss, Siaw‐Teng Liaw, Geoffrey K Spurling and Danielle Mazza
Med J Aust 2020; 212 (9): . || doi: 10.5694/mja2.50589
Published online: 27 April 2020

Opportunities to recognise and invest in general practice research need to be realised

General practice research is essential to quality general practice, building an evidence base for over 27 000 general practitioners working within the specialty who provide medical care to the majority of Australians.1 Over eight in ten Australians consult with their GP at least once per year, and two million people are seen each week in general practice.2,3 General practice, a medical specialty, is the first point of access to the health system, providing longitudinal care for all. It is essential for the delivery of efficient, equitable and effective health care services.4 General practice is unique, complex and continuing to evolve. A GP must have a good working knowledge of 167 problems to cover 85% of the conditions that they see most frequently,5 and management of multimorbidity has become the norm. The number of general practices appears to be declining, practices are becoming larger, and the proportion of GPs who are practice owners is decreasing.6 General practice research is key to optimising health care in this evolving context, but needs to be supported by the profession, funders and our professional colleges.


  • 1 University of Melbourne, Melbourne, VIC
  • 2 Monash University, Melbourne, VIC
  • 3 UNSW Sydney, Sydney, NSW
  • 4 Ingham Institute of Applied Medical Research, Sydney, NSW
  • 5 University of Queensland, Brisbane, QLD


Correspondence: jomn@unimelb.edu.au

Competing interests:

All authors are members of the Australasian Association for Academic Primary Care (AAAPC) and the RACGP Expert Committee – Research, for which they receive sitting fees. Jo‐Anne Manski‐Nankervis is supported by an MRFF Next Generation Clinical Researcher TRIP Fellowship and receives research funding from the RACGP Foundation. Elizabeth Sturgiss is supported by a National Health and Medical Research Council (NHMRC) Investigator Grant (EL1) and is Conference Subcommittee Chair for the AAAPC. Siaw‐Teng Liaw receives sitting fees as Chair of the RACGP National Research and Evaluation Ethics Committee and has received research funding from the Australian Research Council (ARC), the NHMRC, the Ramaciotti Foundations and the HCF Research Foundation. Geoffrey Spurling is supported by an NHMRC Investigator Grant (EL1) and has received funding from the ARC and RACGP Foundation. Danielle Mazza has received research funding, speaker fees and travel support to attend conferences from Bayer and MSD.

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Providing take home naloxone needs to be improved to prevent opioid overdose deaths

Nicholas Lintzeris
Med J Aust 2020; 212 (7): . || doi: 10.5694/mja2.50561
Published online: 20 April 2020

An effective approach can only be achieved by a national strategy for averting opioid‐related deaths

Opioid overdose‐related deaths in Australia have steadily increased over the past 15 years to more than 1000 each year, more deaths than from motor vehicle accidents.1,2 Twenty years ago, most overdoses were in people who injected heroin, but now 70% of deaths involve opioids prescribed by doctors and dispensed by pharmacists.1,2 Our health system must respond to this growing community and public health problem. A number of strategies have been recommended,3 including better education of health professionals and opioid users; hospital opioid stewardship programs; improving access to multidisciplinary services for patients with complex pain or substance use disorders; better coordination of health care with systems such as My Health Record and prescription monitoring programs; and the expansion of take home naloxone (THN) programs.4


  • 1 The University of Sydney, Sydney, NSW
  • 2 Drug and Alcohol Services, South Eastern Sydney Local Health District, Sydney, NSW



Competing interests:

I have sat on advisory boards for Mundipharma, Camurus, and Indivior, have received research funding from Camurus, and provided consultancy services for Mundipharma.

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From over‐the‐counter to prescription only: early results of the rescheduling of codeine combination analgesics

Malcolm D Dobbin
Med J Aust 2020; 212 (7): . || doi: 10.5694/mja2.50560
Published online: 20 April 2020

Upscheduling has not led to substitution with higher strength analgesics, and has reduced the misuse of codeine‐containing preparations

As rates of problematic opioid use and overdose grow in high income countries,1 epidemiologic signals of exposure and harm have increased year by year. It is therefore encouraging to read evidence of a downward trend for one category of this complex crisis described in two papers in this issue of the Journal.2,3


  • Monash University, Melbourne, VIC



Competing interests:

No relevant disclosures.

  • 1. Organisation for Economic Co‐operation and Development. Addressing problematic opioid use in OECD countries (OECD Health Policy Studies). Paris: OECD Publishing, 2019. https://www.oecd.org/health/addressing-problematic-opioid-use-in-oecd-countries-a18286f0-en.htm (viewed Feb 2020).
  • 2. Schaffer AL, Cairns R, Brown J, et al. Changes in pharmaceutical sales to pharmacies after codeine was rescheduled a prescription only medicine. Med J Aust 2020; 212: 321–327.
  • 3. Harris K, Jiang A, Knoeckel R, Isoardi KZ. Rescheduling codeine‐containing analgesics reduced codeine‐related hospital presentations. Med J Aust 2020; 212: 328.
  • 4. Degenhardt L, Gisev N, Cama M, et al. The extent and correlates of community‐based pharmaceutical opioid utilisation in Australia. Pharmacoepidemiol Drug Saf 2016; 25: 521–538.
  • 5. Annabel B, Scrymgeour M. Fork handles. Australas J Pharm 2017; 98: 74–75.
  • 6. McAllister WB. The global political economy of scheduling: the international–historical context of the Controlled Substances Act. Drug Alcohol Depend 2014; 76: 3–8.
  • 7. Derry S, Karlin SM, Moore RA. Single dose oral ibuprofen plus codeine for acute postoperative pain in adults. Cochrane Database Syst Rev 2015; CD010107.
  • 8. Daniels SE, Goulder MA, Aspley S, Reader S. A randomised, five‐parallel‐group, placebo‐controlled trial comparing the efficacy and tolerability of analgesic combinations including a novel single‐tablet combination of ibuprofen/paracetamol for postoperative dental pain. Pain 2011; 152: 632–642.
  • 9. Cock V, Edmonds C, Cock C. Complications related to chronic supratherapeutic use of codeine containing compound analgesics in a cohort of patients presenting for codeine withdrawal. Drug Alcohol Rev 2018; 37: 731–737.
  • 10. Frei MY, Nielsen S, Dobbin MDH, Tobin CL. Serious morbidity associated with misuse of over‐the‐counter codeine‐ibuprofen analgesics: a series of 27 cases. Med J Aust 2010; 193: 294–296. https://www.mja.com.au/journal/2010/193/5/serious-morbidity-associated-misuse-over-counter-codeine-ibuprofen-analgesics
  • 11. Mill D, Johnson JL, Cock V, et al. Counting the cost of over‐the‐counter codeine containing analgesic misuse: a retrospective review of hospital admissions over a 5 year period. Drug Alcohol Rev 2018; 37: 247–256.
  • 12. Australian Institute of Health and Welfare. Opioid harm in Australia and comparisons between Australia and Canada (Cat. no. HSE 210): data tables (here: table S2.14). Canberra: AIHW, 2018. https://www.aihw.gov.au/getmedia/a7c50ae7-5150-452d-8fcc-d24dcf862e48/aihw-hse-210-data-tables.xlsx.aspx (viewed Jan 2020).
  • 13. Australian Department of Health, Therapeutic Goods Administration. Codeine re‐scheduling: regulation impact statement, version 1.1 (Office of Best Practice Regulation no. 19826). Dec 2016. https://www.tga.gov.au/sites/default/files/regulation-impact-statement-codeine-re-scheduling.pdf (viewed Feb 2020).
  • 14. Sarantitis I, Gerrard AD, Teasdale R, Pettit S. Small bowel diaphragm disease mimicking malignancy. BMJ Case Rep 2015; bcr2015210174.
  • 15. Dang MH, Wu S, Sia C. Ibuprofen‐induced renal tubular acidosis: a rare cause of rhabdomyolysis: a case report. Oxf Med Case Reports 2016; 8: 212–214.
  • 16. Robertson CG, Kumar B, Bright T, Watson DI. Beware NSAID abuse: think twice before operating! Aust N Z J Surg 2014; 84: 495–496.
  • 17. Cairns R, Scheffer AL, Brown JA, et al. Codeine use and harms in Australia: evaluating the effects of re‐scheduling. Addiction 2020; 115: 451–459.

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Prescribing psychotropic medications in residential aged care facilities

Gerard J Byrne
Med J Aust 2020; 212 (7): . || doi: 10.5694/mja2.50562
Published online: 20 April 2020

Individualised care plans that take greater account of the behavioural and psychological needs of residents are needed

The prescribing of psychotropic medication for people living in residential aged care facilities (RACFs) is of concern to the community, as reflected in evidence presented to the Royal Commission into Aged Care Quality and Safety.1 Although there is a tendency to blame the prescribers, it is increasingly recognised that many RACFs are poorly equipped for managing cognitively impaired older people with challenging behaviours, particularly ambulant residents with dementia. Not all RACFs have adequate circulation space for reducing the likelihood of aggressive incidents, or accessible outside areas for regular physical exercise. Some RACFs have insufficient natural light for maintaining normal sleep/wake cycles, and many do not have enough staff trained in managing the behavioural and psychological symptoms of their residents. In some locations, public sector mental health services can assist with the assessment and management of RACF residents with mental illness or challenging behaviour, but these services are often under‐resourced and unable to respond quickly. In addition, Dementia Support Australia (https://demen​tia.com.au) offers multidisciplinary assessment and management advice.


  • The University of Queensland, Brisbane, QLD


Correspondence: gerard.byrne@uq.edu.au

Competing interests:

No relevant disclosures.

  • 1. Royal Commission into Aged Care Quality and Safety. Restrictive practices. In: Interim report: Neglect, volume 1. Canberra: Commonwealth of Australia, 2019; pp. 193–216. https://agedc​are.royal​commi​ssion.gov.au/publi​catio​ns/Docum​ents/inter​im-repor​t/inter​im-report-volume-1.pdf (viewed Feb 2020).
  • 2. Ballard CG, Waite J. The effectiveness of atypical antipsychotics for the treatment of aggression and psychosis in Alzheimer's disease. Cochrane Database Syst Rev 2006; CD003476.
  • 3. Harrison SL, Sluggett JK, Lang C, et al. The dispensing of psychotropic medicines to older people before and after they enter residential aged care. Med J Aust 2020; 212: 309–313.
  • 4. Banerjee S, Hellier J, Romeo R, et al. Study of the use of antidepressants for depression in dementia: the HTA‐SADD trial: a multicentre randomised, double‐blind, placebo‐controlled trial of the clinical effectiveness and cost‐effectiveness of sertraline and mirtazapine. Health Technol Assess 2013; 17: 1–166.
  • 5. Morton R. Outsourcing to hit “dysfunctional” aged‐care system. The Saturday Paper (Melbourne), 2–8 Nov 2019. https://www.thesa​turda​ypaper.com.au/news/polit​ics/2019/11/02/outso​urcing-hit-dysfu​nctio​nal-aged-care-syste​m/15726​13200​9026 (viewed Mar 2020).
  • 6. Ballard C, Margallo LM, Theodoulou M, et al; Investigators DART AD. A randomised, blinded, placebo‐controlled trial in dementia patients continuing to take or stopping neuroleptics (the DART‐AD trial). PLoS Med 2008; 5: e76.
  • 7. Devanand DP, Mintzer J, Schultz SK, et al. Relapse risk after discontinuation of risperidone in Alzheimer's disease. N Engl J Med 2012; 367: 1497–1507.
  • 8. Patel AN, Lee S, Andrews HF, et al. Prediction of relapse after discontinuation of antipsychotic treatment in Alzheimer's disease: the role of hallucinations. Am J Psychiatry 2017; 174: 362–369.

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A case of drug reaction with eosinophilia and systemic symptoms (DRESS) without a typical precipitant

David WJ Griffin, Genevieve E Martin, Catriona McLean, Allen C Cheng and Michelle L Giles
Med J Aust 2020; 212 (7): . || doi: 10.5694/mja2.50519
Published online: 20 April 2020

An 80‐year‐old man presented with 2 days of fever and a widespread, itchy, non‐blanching, erythematous rash involving more than 50% of body surface area over arms, legs, abdomen, back and palms, with sparing of the face and soles of feet (Box 1). He had a history of type 2 diabetes mellitus (treated with sitaglipin 100 mg and metformin 1000 mg modified release daily), hypertension (perindopril arginine 2.5 mg daily), vitamin D deficiency (weekly colecalciferol 125 μg oral) and pernicious anaemia.


  • 1 Alfred Health, Melbourne, VIC
  • 2 Monash University, Melbourne, VIC


Correspondence: g.martin@alfred.org.au

Acknowledgements: 

We acknowledge the input of Jason Trubiano and Nigel Crawford for valuable discussions in the management of this case.

Competing interests:

No relevant disclosures.

  • 1. Kardaun SH, Sidoroff A, Valeyrie‐Allanore L, et al. Variability in the clinical pattern of cutaneous side‐effects of drugs with systemic symptoms: does a DRESS syndrome really exist? Br J Dermatol 2007; 156: 609–611.
  • 2. O'Hagan DT, Ott GS, De Gregorio E, Seubert A. The mechanism of action of MF59 — an innately attractive adjuvant formulation. Vaccine 2012; 30: 4341–4348.
  • 3. Schaffner W, Chen WH, Hopkins RH, Neuzil K. Effective immunization of older adults against seasonal influenza. Am J Med 2018; 131: 865–873.
  • 4. Solak B, Dikicier BS, Kara RO, Erdem T. DRESS syndrome potentially induced by allopurinol and triggered by influenza vaccine. BMJ Case Rep 2016; 2016: bcr2016214563.
  • 5. Hewitt N, Levinson M, Stephenson G. Drug reaction with eosinophilia and systemic symptoms associated with H1N1 vaccination. Intern Med J 2012; 42: 1365–1366.
  • 6. Naranjo CA, Busto U, Sellers EM, et al. A method for estimating the probability of adverse drug reactions. Clin Pharmacol Ther 1981; 30: 239–245.
  • 7. Shiohara T. The role of viral infection in the development of severe drug eruptions. Dermatologica Sinica 2013; 31: 205–210.
  • 8. Ramírez E, Medrano‐Casique N, Tong HY, et al. Eosinophilic drug reactions detected by a prospective pharmacovigilance programme in a tertiary hospital. Br J Clin Pharmacol 2017; 83: 400–415.
  • 9. Villa M, Black S, Groth N, et al. Safety of MF59‐adjuvanted influenza vaccination in the elderly: results of a comparative study of MF59‐adjuvanted vaccine versus nonadjuvanted influenza vaccine in northern Italy. Am J Epidemiol 2013; 178: 1139–1145.
  • 10. Lindert K, Leav B, Heijnen E, et al. Cumulative clinical experience with MF59‐adjuvanted trivalent seasonal influenza vaccine in young children and adults 65 years of age and older. Int J Infect Dis 2019; 85S: S10–S17.

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Sodium–glucose cotransporter type 2 inhibitors: managing the small but critical risk of diabetic ketoacidosis

Peter S Hamblin, Rosemary Wong and Leon A Bach
Med J Aust 2020; 212 (7): . || doi: 10.5694/mja2.50525
Published online: 20 April 2020

Risk of SGLT2 inhibitor‐associated diabetic ketoacidosis in type 2 diabetes: some answers, but more questions

Prescribers have enthusiastically embraced sodium–glucose cotransporter type 2 (SGLT2) inhibitors for the treatment of type 2 diabetes on the strength of accumulating data reporting improved cardiovascular and renal outcomes. In Australia, in 2016, 757 826 Pharmaceutical Benefits Scheme and Repatriation Pharmaceutical Benefits Scheme prescriptions containing an SGLT2 inhibitor were dispensed. By 2019, that number had risen to 2.3 million.1 Assuming these scripts are dispensed monthly, an estimated 19% of all patients with type 2 diabetes (about 190 000 people) are currently being treated with SGLT2 inhibitors.


  • 1 Western Health, Melbourne, VIC
  • 2 University of Melbourne, Melbourne, VIC
  • 3 Box Hill Hospital, Melbourne, VIC
  • 4 Alfred Health, Melbourne, VIC
  • 5 Monash University, Melbourne, VIC


Correspondence: peter.hamblin@wh.org.au

Competing interests:

Leon Bach was an investigator in the DECLARE study.

  • 1. Australian Government, Department of Human Services. Medicare Australia statistics: Pharmaceutical Benefits Schedule item reports. http://medicarestatistics.humanservices.gov.au/statistics/pbs_item.jsp (viewed Feb 2020).
  • 2. Zinman B, Wanner C, Lachin JM, et al. Empagliflozin, cardiovascular outcomes, and mortality in type 2 diabetes. N Engl J Med 2015; 373: 2117–2128.
  • 3. Wiviott SD, Raz I, Bonaca MP, et al. Dapagliflozin and cardiovascular outcomes in type 2 diabetes. N Engl J Med 2019; 380: 347–357.
  • 4. Neal B, Perkovic V, Mahaffey KW, et al. Canagliflozin and cardiovascular and renal events in type 2 diabetes. N Engl J Med 2017; 377: 644–657.
  • 5. McMurray JJV, Solomon SD, Inzucchi SE, et al. Dapagliflozin in patients with heart failure and reduced ejection fraction. N Engl J Med 2019; 381: 1995–2008.
  • 6. Perkovic V, Jardine MJ, Neal B, et al. Canagliflozin and renal outcomes in type 2 diabetes and nephropathy. N Engl J Med 2019; 380: 2295–2306.
  • 7. Wanner C, Inzucchi SE, Lachin JM, et al. Empagliflozin and progression of kidney disease in type 2 diabetes. N Engl J Med 2016; 375: 323–334.
  • 8. Mosenzon O, Wiviott SD, Cahn A, et al. Effects of dapagliflozin on development and progression of kidney disease in patients with type 2 diabetes: an analysis from the DECLARE–TIMI 58 randomised trial. Lancet Diabetes Endocrinol 2019; 7: 606–617.
  • 9. Hamblin PS, Wong R, Ekinci EI, et al. SGLT2 inhibitors increase the risk of diabetic ketoacidosis developing in the community and during hospital admission. J Clin Endocrinol. Metab 2019; 104: 3077–3087.
  • 10. Cotter DG, Schugar RC, Crawford PA. Ketone body metabolism and cardiovascular disease. Am J Physiol Heart Circ Physiol 2013; 15; 304: H1060–H1076.
  • 11. Australian and New Zealand College of Anaesthetists. Severe euglycaemic ketoacidosis with SGLT2 inhibitor use in the perioperative period [alert]. Melbourne: ANZCA. http://www.anzca.edu.au/documents/alert-dka-and-oral-hypoglycaemics-20180215.pdf (viewed June 2019).
  • 12. Australian Diabetes Society. Alert update January 2020: periprocedural diabetic ketoacidosis (DKA) with SGLT2 inhibitor use. https://diabetessociety.com.au/documents/ADS_DKA_SGLT2i_Alert_update_2020.pdf (viewed Feb 2020).
  • 13. Therapeutic Goods Administration. Adverse Event Management System [accessed 4 June 2019]. Canberra: Australian Government Department of Health, 2019.
  • 14. Daniele G, Xiong J, Solis‐Herrera C, et al. Dapagliflozin enhances fat oxidation and ketone production in patients with type 2 diabetes. Diabetes Care 2016; 39: 2036–2041.
  • 15. Al Jobori H, Daniele G, Adams J, et al. Determinants of the increase in ketone concentrations during SGLT2 inhibition in NGT, IFG and T2DM patients. Diabetes Obes Metab 2017; 19: 809–813.
  • 16. Ferrannini E, Baldi S, Frascerra S, et al. Shift to fatty substrate utilization in response to sodium‐glucose cotransporter 2 inhibition in subjects without diabetes and patients with type 2 diabetes. Diabetes 2016; 65: 1190–1195.
  • 17. Hillier S, Grimmer‐Somers K, Merlin T, et al. FORM: an Australian method for formulating and grading recommendations in evidence‐based clinical guidelines. BMC Med Res Methodol 2011; 11: 23.

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Corticosteroid treatment of patients with coronavirus disease 2019 (COVID‐19)

Lei Zha, Shirong Li, Lingling Pan, Boris Tefsen, Yeshan Li, Neil French, Liyun Chen, Gang Yang and Elmer V Villanueva
Med J Aust 2020; 212 (9): . || doi: 10.5694/mja2.50577
Published online: 13 April 2020

Abstract

Objectives: To assess the efficacy of corticosteroid treatment of patients with coronavirus disease 2019 (COVID‐19).

Design, setting: Observational study in the two COVID‐19‐designated hospitals in Wuhu, Anhui province, China, 24 January – 24 February 2020.

Participants: Thirty‐one patients infected with the severe acute respiratory coronavirus 2 (SARS‐CoV‐2) treated at the two designated hospitals.

Main outcome measures: Virus clearance time, length of hospital stay, and duration of symptoms, by treatment type (including or not including corticosteroid therapy).

Results: Eleven of 31 patients with COVID‐19 received corticosteroid treatment. Cox proportional hazards regression analysis indicated no association between corticosteroid treatment and virus clearance time (hazard ratio [HR], 1.26; 95% CI, 0.58–2.74), hospital length of stay (HR, 0.77; 95% CI, 0.33–1.78), or duration of symptoms (HR, 0.86; 95% CI, 0.40–1.83). Univariate analysis indicated that virus clearance was slower in two patients with chronic hepatitis B infections (mean difference, 10.6 days; 95% CI, 6.2–15.1 days).

Conclusions: Corticosteroids are widely used when treating patients with COVID‐19, but we found no association between therapy and outcomes in patients without acute respiratory distress syndrome. An existing HBV infection may delay SARS‐CoV‐2 clearance, and this association should be further investigated.

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  • 1 Xi'an Jiaotong–Liverpool University, Suzhou, Jiangsu, China
  • 2 The Second People's Hospital of Wuhu, Wuhu, Anhui, China
  • 3 Yijishan Hospital of Wannan Medical College, Wuhu, Anhui, China
  • 4 Institute of Infection and Global Health, University of Liverpool, Liverpool, United Kingdom
  • 5 The Third People's Hospital of Wuhu, Wuhu, Anhui, China


Correspondence: Villanueva@xjtlu.edu.cn

Acknowledgements: 

We thank everyone fighting the epidemic of COVID‐19 around the world.

Competing interests:

No relevant disclosures.

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One disease, two vaccines: challenges in prevention of meningococcal disease

Cyra Patel, Clayton K Chiu, Frank H Beard, Nigel W Crawford and Kristine Macartney
Med J Aust 2020; 212 (10): . || doi: 10.5694/mja2.50567
Published online: 13 April 2020
Correction(s) for this article: Erratum | Published online: 21 September 2020

Gaps in availability of both meningococcal ACWY and B vaccines exist for high risk groups


  • 1 National Centre for Immunisation Research and Surveillance, Sydney Children's Hospital Network, Sydney, NSW
  • 2 University of Sydney, Sydney, NSW
  • 3 Murdoch Children's Research Institute, Melbourne, VIC
  • 4 University of Melbourne, Melbourne, VIC



Acknowledgements: 

We thank Katrina Clark for her review and input into the article. The authors received no financial support specifically for the authorship and/or publication of this article. The views expressed in this article are those of the individual authors, and are not necessarily the views of the Australian Technical Advisory Group on Immunisation (ATAGI), the Department of Health, or the National Immunisation Program. For information from the ATAGI, please see the meningococcal chapter in the Australian immunisation handbook.

Competing interests:

Cyra Patel, Clayton Chiu, Frank Beard and Kristine Macartney are employed at the National Centre for Immunisation Research and Surveillance, which receives funding from the Australian Government Department of Health for contracted work to support ATAGI. No specific funding was provided for the drafting or publication of this manuscript.

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Decline in new medical graduates registered as general practitioners

Denese Playford, Jennifer A May, Hanh Ngo and Ian B Puddey
Med J Aust 2020; 212 (9): . || doi: 10.5694/mja2.50563
Published online: 13 April 2020

Primary care is the single most significant contributor to positive health outcomes,1,2 but the number of general practitioners in Australia has been falling, a situation previously described for nations with poorer health outcomes.2 The reasons for the decline are many,3 but this phenomenon has not been described in detail in the peer‐reviewed literature. We have therefore examined the registration categories, as recorded by the Australian Health Practitioner Regulation Agency (AHPRA), of people who graduated from the University of Western Australia (UWA) medical school during 1985–2007. Our study was approved by the UWA Human Research Ethics Committee (reference, RA 4/1/1627).

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  • 1 The Rural Clinical School of WA, University of Western Australia, Perth, WA
  • 2 University of Newcastle, Tamworth, NSW
  • 3 The University of Western Australia, Perth, WA


Correspondence: denese.playford@uwa.edu.au

Competing interests:

No relevant disclosures.

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