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Our approach to estimating risk in some patients should be updated and the role of coronary artery calcium scoring evaluated
While about one in five Australians aged 45–74 years are at high absolute cardiovascular risk, fewer than half of these people are taking lipid‐ and blood pressure‐lowering medications.1,2 New Medicare Benefits Schedule items for heart health checks (items 699 and 177) were introduced to reduce this gap,3 but the problem remains that recommended risk calculators are inaccurate and misclassification rates are high.4
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Harry Klimis is supported by a Royal Australian College of Physicians Fellows Research Entry Scholarship and a Research Training Program Scholarship. Clara Chow is supported by a National Health and Medical Research Council Career Development Award (APP1105447) co‐funded by a Future Leader Fellowship from the National Heart Foundation.
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Engaging First Nations peoples in public health emergencies is critical to reducing health inequities
Aboriginal and Torres Strait Islander (respectfully hereafter First Nations) peoples of Australia have experienced poorer health outcomes than the rest of the Australian population during recent pandemics.1,2 In 2009, during the H1N1 influenza pandemic, diagnosis rates, hospitalisations and intensive care unit admissions occurred at five, eight and three times, respectively, the rates recorded among non‐Indigenous people.1,2,3
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We acknowledge the traditional custodians of the land and waters on which we live and work as the First Peoples of Australia. We are members of the Aboriginal and Torres Strait Islander Advisory Group on COVID‐19 and we acknowledge and thank all members of the Advisory Group for their continued work and commitment in advocating for cultural inclusion and providing space for First Nations peoples to have a voice in pandemic planning, response and management.
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COVID‐19‐related unemployment may significantly increase suicide rates; implementation of appropriate preventive measures is critical
In response to the coronavirus disease 2019 (COVID‐19) pandemic, the imposition of social distancing policies and related labour market impacts have resulted in extensive job losses. Globally, the International Monetary Fund has predicted the steepest economic downturn since the Great Depression.1 In May 2020, 2.3 million Australians (one in five employed people) were either unemployed or had work hours reduced for economic reasons, resulting in the steepest rise in rates of unemployment on record — a change from 5.2% in March to 7.1%2 — with Treasury predicting a rate of 8% by September 2020.
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Mark Deady, Leona Tan and Samuel Harvey are funded by an icare Foundation grant. Samuel Harvey is also supported by a National Health and Medical Research Council (NHMRC) investigator grant (No. 1178666). The authors are additionally supported by the NHMRC Centre for Research Excellence in Suicide Prevention. The funding institutions had no role in the planning, writing or publication of this work.
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Objective: To synthesise quantitative data on the effects of rural background and experience in rural areas during medical training on the likelihood of general practitioners practising and remaining in rural areas.
Study design: Systematic review and meta‐analysis of the effects of rural pipeline factors (rural background; rural clinical and education experience during undergraduate and postgraduate/vocational training) on likelihood of later general practice in rural areas.
Data sources: MEDLINE (Ovid), EMBASE, Informit Health Collection, and ERIC electronic database records published to September 2018; bibliographies of retrieved articles; grey literature.
Data synthesis: Of 6709 publications identified by our search, 27 observational studies were eligible for inclusion in our systematic review; when appropriate, data were pooled in random effects models for meta‐analysis. Study quality, assessed with the Newcastle–Ottawa scale, was very good or good for 24 studies, satisfactory for two, and unsatisfactory for one. Meta‐analysis indicated that GPs practising in rural communities was significantly associated with having a rural background (odds ratio [OR], 2.71; 95% CI, 2.12–3.46; ten studies) and with rural clinical experience during undergraduate (OR, 1.75; 95% CI, 1.48–2.08; five studies) and postgraduate training (OR, 4.57; 95% CI, 2.80–7.46; eight studies).
Conclusion: GPs with rural backgrounds or rural experience during undergraduate or postgraduate medical training are more likely to practise in rural areas. The effects of multiple rural pipeline factors may be cumulative, and the duration of an experience influences the likelihood of a GP commencing and remaining in rural general practice. These findings could inform government‐led initiatives to support an adequate rural GP workforce.
Protocol registration: PROSPERO, CRD42017074943 (updated 1 February 2018).
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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.
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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
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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:
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.
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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.
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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.
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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.
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Abstract
Introduction: The coronavirus 2019 disease (COVID‐19) pandemic is caused by severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2). Pre‐existing cardiovascular disease (CVD) increases the morbidity and mortality of COVID‐19, and COVID‐19 itself causes serious cardiac sequelae. Strategies to minimise the risk of viral transmission to health care workers and uninfected cardiac patients while prioritising high quality cardiac care are urgently needed. We conducted a rapid literature appraisal and review of key documents identified by the Cardiac Society of Australia and New Zealand Board and Council members, the Australian and New Zealand Society of Cardiac and Thoracic Surgeons, and key cardiology, surgical and public health opinion leaders.
Main recommendations: Common acute cardiac manifestations of COVID‐19 include left ventricular dysfunction, heart failure, arrhythmias and acute coronary syndromes. The presence of underlying CVD confers a five‐ to tenfold higher case fatality rate with COVID‐19 disease. Special precautions are needed to avoid viral transmission to this population at risk. Adaptive health care delivery models and resource allocation are required throughout the health care system to address this need.
Changes in management as a result of this statement: Cardiovascular health services and cardiovascular health care providers need to recognise the increased risk of COVID‐19 among CVD patients, upskill in the management of COVID‐19 cardiac manifestations, and reorganise and innovate in service delivery models to meet demands. This consensus statement, endorsed by the Cardiac Society of Australia and New Zealand, the Australian and New Zealand Society of Cardiac and Thoracic Surgeons, the National Heart Foundation of Australia and the High Blood Pressure Research Council of Australia summarises important issues and proposes practical approaches to cardiovascular health care delivery to patients with and without SARS‐CoV‐2 infection.