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The available tools are largely unregulated, and do not reliably guide people to the right care at the right time
In times when health services are under increasing strain, digital health technologies such as online symptom checkers appear convenient and cost‐effective tools for reducing the burden on clinics, telemedicine services, and emergency departments. In practical terms, an online symptom checker is a smartphone app or web‐based form that can provide a diagnosis on the basis of a set of self‐reported symptoms. They can suggest diagnoses for a broad range of conditions with which people may present to a clinic or emergency department. When they work properly, symptom checkers should turn current practice guidelines into tools that can diagnose and triage patients at low cost.
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The number of tests for vitamin D deficiency in Australia rose steeply between 2000 and 2011, from 0.4 to 36.5 tests per 1000 population; the cost to Medicare increased from $1.1 million in 2000 to $95.6 million in 2010,1 and peaked at $151 million in 2012–13.2 Consequently, the Medical Benefits Schedule (MBS) items for testing (66608, 66609) were replaced in November 2014 by new items (66833–66837) with the aim of restricting testing to people at particular risk of vitamin D deficiency, including those with a history of osteomalacia or osteoporosis, elevated alkaline phosphatase levels, hyperparathyroidism, hypo‐ or hypercalcaemia, hypophosphataemia, malabsorption, chronic renal failure, deeply pigmented skin or chronic and severe lack of sun exposure, or a diagnosis of vitamin D deficiency, and people who used medications that reduce 25‐hydroxyvitamin D levels.3
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Elevated serum angiotensin‐converting enzyme (ACE) activity, a biomarker for epithelioid granuloma, has a supportive role in the diagnosis and management of sarcoidosis,1 although in population‐based studies its diagnostic usefulness is modest, with positive and negative predictive values of 25.4% and 89.9% respectively.2 Further, elevated ACE activity is non‐specific; it is also found in people with tuberculous and other infectious granulomata, liver disease, lymphoma, diabetes, or hyperthyroidism, and also as a benign familial condition. However, elevated ACE activity can facilitate some clinical decisions, including the diagnosis of Löfgren syndrome or adults with uveitis.1,3
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The existing system is failing to deliver the care that Australia expects
Australia's aged care has changed considerably in recent decades. In response to consumer demand, old institutional‐style nursing homes have been progressively phased out in favour of better facilities. Home‐like furnishings and decor and single bedrooms personalised with residents’ own belongings have increasingly become the norm. In the process, they have become residential aged care facilities (RACFs), and there is no longer a distinction between low and high care.1
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The research summarised in this article was funded by the Royal Commission into Aged Care Quality and Safety. This funding was paid to the university and not the authors. The Royal Commission into Aged Care Quality and Safety had no role in the research or in the preparation of the manuscript.
None declared.
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
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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.
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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.
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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.
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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.
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
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Our investigation was funded by the Cancer Council of Western Australia and the WA Cancer and Palliative Care Network.
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Abstract
Objectives: To evaluate whether cannabis use during pregnancy is associated with adverse neonatal outcomes that are independent of cigarette smoking.
Design: Prospective cohort study.
Setting: Adelaide (Australia), Auckland (New Zealand), Cork (Ireland), and Leeds, London and Manchester (United Kingdom).
Participants: 5610 pregnant nulliparous women with low risk pregnancies recruited for the Screening for Pregnancy Endpoints (SCOPE) study, November 2004 – February 2011. At 14–16 weeks of pregnancy, women were grouped by self‐reported cannabis use.
Main outcome measures: Infant birthweight, head circumference, birth length, gestational age, and severe neonatal morbidity or mortality.
Results: 314 women (5.6%) reported using cannabis in the 3 months before or during their pregnancy; 97 (31%) stopped using it before and 157 (50%) during the first 15 weeks of pregnancy, while 60 (19%) were still using cannabis at 15 weeks. Compared with babies of mother who had never used cannabis, infants of those who still used it at 15 weeks had lower mean values for birthweight (adjusted mean difference [aMD], –127 g; 95% CI, –238 to –17 g), head circumference (aMD, –0.5 cm; 95% CI, –0.8 to –0.1 cm), birth length (aMD, –0.8 cm; 95% CI, –1.4 to –0.2 cm), and gestational age at birth (aMD, –8.1 days; 95% CI, –12.1 to –4.0 days). The differences for all outcomes except gestational age were greater for women who used cannabis more than once a week than for those who used it less frequently.
Conclusions: Continuing to use cannabis during pregnancy is an independent risk factor for poorer neonatal outcomes.