Topics

Australian dementia research needs increased representation of people from culturally and linguistically diverse backgrounds

Evidence‐based practice and policy must be based on the best available evidence, which should be representative of the population.1 However, the current body of dementia research does not reflect the ethnic and cultural diversity of the Australian population. Hence, people from culturally and linguistically diverse (CALD) backgrounds may receive inequitable dementia care as there is less evidence to help optimise clinical and service decisions.

1 University of Sydney, Sydney, NSW
2 National Ageing Research Institute, Melbourne, VIC
3 Monash University, Melbourne, VIC

Correspondence: annica.barcenilla@sydney.edu.au

Acknowledgements:

The data presented in this article were funded by the NNIDR as part of the development of the CALD Dementia Research Roadmap. Lee‐Fay Low is funded through an NHMRC Boosting Dementia Research Leadership Development Fellowship. The NNIDR were involved in conceptualising the article, but not in analysis or interpretation.

Competing interests:

Bianca Brijnath has financial relationships with government and private foundations for research and policy development specific to CALD communities and dementia.

1. Djulbegovic B, Guyatt GH. Progress in evidence‐based medicine: a quarter century on. Lancet 2017; 390: 415–423.
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8. Alzheimer's Australia Vic. Perceptions of dementia in ethnic communities. Melbourne: Alzheimer's Australia Vic, 2008. https://www.dementia.org.au/files/20101201-Nat-CALD-Perceptions-of-dementia-in-ethnic-communities-Oct08.pdf (viewed Sept 2019).
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12. Regan B, Wells Y, Farrow M, et al. MAXCOG‐Maximizing Cognition: a randomized controlled trial of the efficacy of goal‐oriented cognitive rehabilitation for people with mild cognitive impairment and early Alzheimer disease. Am J Geriatr Psychiatry 2017; 25: 258–269.
13. Henwood T, Neville C, Baguley C, Beattie E. Aquatic exercise for residential aged care adults with dementia: benefits and barriers to participation. Int Psychogeriatr 2017; 29: 1439–1449.
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16. Australian Institute of Health and Welfare. Dementia in Australia (Cat. No. AGE 70). Canberra: AIHW, 2012. https://www.aihw.gov.au/getmedia/199796bc-34bf-4c49-a046-7e83c24968f1/13995.pdf.aspx?inline=true (viewed Sept 2019).
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19. NHMRC National Institute for Dementia Research (NNIDR). Australia's Boosting Dementia Research Initiative: report on early outcomes. Canberra: Commonwealth of Australia, 2018. https://www.nnidr.gov.au/sites/default/files/files/Boosting%20Dementia%20Research%20Initiative%20Early%20Outcomes%20Report.PDF (viewed Sept 2019).
20. Ellis KA, Ai Bush, Darby D, et al. The Australian Imaging, Biomarkers and Lifestyle (AIBL) study of aging: methodology and baseline characteristics of 1112 individuals recruited for a longitudinal study of Alzheimer's disease. Int Psychogeriatr 2009; 21: 672–687.
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30. Brewster P, Barnes L, Haan M, et al. Progress and future challenges in aging and diversity research in the United States. Alzheimers Dement 2019; 15: 995–1003.

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Perspectives

Responding to mandatory immigration detention: lessons for the health care community

Ryan Essex and David Isaacs

Med J Aust 2019; 211 (9): . || doi: 10.5694/mja2.50366
Published online: 14 October 2019

ARTICLE
AUTHORS
REFERENCES

Topics

Global health

Social determinants of health

Ethics and law

After 25 years of advocacy, what can the health care community learn from recent reforms of Australian immigration detention?

In February 2019, the Australian Government announced that it had removed all refugee and asylum seeker children from offshore detention in Nauru.1 Soon after, the Australian Parliament passed the Migration Amendment (Urgent Medical Treatment) Bill 2018.2 This legislation strengthens the position of doctors to recommend a transfer of an ill person to Australia for treatment from offshore detention centres in Manus Island (Papua New Guinea) and Nauru. While this has been welcome news, these developments are tempered by the fact that the government is seeking to repeal this legislation and has maintained an increasingly combative stance on these issues.

1 University of Sydney, Sydney, NSW
2 University of Greenwich, London, UK
3 Barts Health NHS Trust, London, UK
4 Children's Hospital at Westmead, Sydney, NSW

Correspondence: r.w.essex@gre.ac.uk

Competing interests:

No relevant disclosures.

1. Australian Broadcasting Corporation News. Last remaining asylum seeker children on Nauru to leave the island for the US, Scott Morrison confirms. ABC 2019; 2 Feb. https://www.abc.net.au/news/2019-02-03/nauru-last-asylum-seeker-children-to-leave-detention-pm-says/10774910 (viewed Sept 2019).
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5. Morrison S. Six months without a successful people smuggling venture but the job goes on [media release]. 20 June 2014. http://pandora.nla.gov.au/pan/143035/20141002-0006/www.minister.immi.gov.au/media/sm/2014/sm215587.htm (viewed Sept 2019).
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10. Essex R. Health, social movements, and Australian immigration detention. Am J Public Health 2018; 108: 614–615.
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20. Essex R. Healthcare and clinical ethics in Australian offshore processing centres: a review of the literature. Int J Hum Right 2016; 20: 1039–1053.
21. Jackson S. Politicizing the white coat: physician activism and asylum seeker healthcare in Canada, Germany and England [doctoral dissertation]. Hamilton, Canada: McMaster University, 2018. https://macsphere.mcmaster.ca/handle/11375/23448 (viewed Sept 2019).
22. Doherty B. “Begging to die”: succession of critically ill children moved off Nauru. The Guardian 2018; 24 Aug. https://www.theguardian.com/australia-news/2018/aug/25/begging-to-die-succession-of-critically-ill-children-moved-off-nauru (viewed Sept 2019).
23. Zwi KJ, Herzberg B, Dossetor D, Field J. A child in detention: dilemmas faced by health professionals. Med J Aust 2003; 179: 319–322. https://www.mja.com.au/journal/2003/179/6/child-detention-dilemmas-faced-health-professionals
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26. della Porta D. Solidarity mobilizations in the “refugee crisis”: contentious moves. London/New York: Palgrave Macmillan, 2018.

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Research

Frailty in very old critically ill patients in Australia and New Zealand: a population‐based cohort study

Jai N Darvall, Rinaldo Bellomo, Eldho Paul, Ashwin Subramaniam, John D Santamaria, Sean M Bagshaw, Sumeet Rai, Ruth E Hubbard and David Pilcher

Med J Aust 2019; 211 (7): . || doi: 10.5694/mja2.50329
Published online: 7 October 2019

ARTICLE
AUTHORS
REFERENCES

Topics

Anesthesia, analgesia and pain

Gerontology

Health services administration

Abstract

Objective: To explore associations between frailty (Clinical Frailty Scale score of 5 or more) in very old patients in intensive care units (ICUs) and their clinical outcomes (mortality, discharge destination).

Design, setting and participants: Retrospective population cohort analysis of Australian and New Zealand Intensive Care Society (ANZICS) Adult Patient Database data for all patients aged 80 years or more admitted to participating ICUs between 1 January 2017 and 31 December 2018.

Main outcome measures: Primary outcome: in‐hospital mortality; secondary outcomes: length of stay (hospital, ICU), re‐admission to ICU during the same hospital admission, discharge destination (including new chronic care or nursing home admission).

Results: Frailty status data were available for 15 613 of 45 773 patients aged 80 years or more admitted to 178 ICUs (34%); 6203 of these patients (39.7%) were deemed frail. A smaller proportion of frail than non‐frail patients were men (47% v 57%), the mean illness severity scores of frail patients were slightly higher than those of non‐frail patients, and they were more frequently admitted from the emergency department (28% v 21%) or with sepsis (12% v 7%) or respiratory complications (16% v 12%). In‐hospital mortality was higher for frail patients (17.6% v 8.2%; adjusted odds ratio [OR], 1.87 [95% CI, 1.65–2.11]). Median lengths of ICU and hospital stay were slightly longer for frail patients, and they were more frequently discharged to new nursing home or chronic care (4.9% v 2.8%; adjusted OR, 1.61 [95% CI, 1.34–1.95]).

Conclusions: Many very old critically ill patients in Australia and New Zealand are frail, and frailty is associated with considerably poorer health outcomes. Routine screening of older ICU patients for frailty could improve outcome prediction and inform intensive care and community health care planning.

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1 Royal Melbourne Hospital, Melbourne, VIC
2 Centre for Integrated Critical Care, University of Melbourne, Melbourne, VIC
3 Austin Hospital, Melbourne, VIC
4 Monash University, Melbourne, VIC
5 Peninsula Health, Melbourne, VIC
6 Peninsula Clinical School, Monash University, Melbourne, VIC
7 St Vincent's Hospital Melbourne, Melbourne, VIC
8 University of Alberta, Edmonton, AB, Canada
9 ANU Medical School, Australian National University, Canberra, ACT
10 Canberra Hospital, Canberra, ACT
11 Centre for Health Services Research, University of Queensland, Brisbane, QLD
12 The Alfred Hospital, Melbourne, VIC
13 Centre for Outcome and Resource Evaluation, Australian and New Zealand Intensive Care Society, Melbourne, VIC

Correspondence: jai.darvall@mh.org.au

Acknowledgements:

Sean Bagshaw is supported by a Canada Research Chair in Critical Care Nephrology.

Competing interests:

No relevant disclosures.

1. Australian Bureau of Statistics. 3222.0. Population projections, Australia, 2017 (base) – 2066. Nov 2018. https://www.abs.gov.au/AUSSTATS/abs@.nsf/mf/3222.0 (viewed July 2019).
2. Corke C, Leeuw E, Lo SK, George C. Predicting future intensive care demand in Australia. Crit Care Resusc 2009; 11: 257–260.
3. Bagshaw SM, Stelfox HT, McDermid RC, et al. Association between frailty and short‐ and long‐term outcomes among critically ill patients: a multicentre prospective cohort study. CMAJ 2014; 186: E95–E102.
4. Flaatten H, De Lange DW, Morandi A, et al; VIP1 study group. The impact of frailty on ICU and 30‐day mortality and the level of care in very elderly patients (≥ 80 years). Intensive Care Med 2017; 43: 1820–1828.
5. Bagshaw SM, Stelfox HT, Johnson JA, et al. Long‐term association between frailty and health‐related quality of life among survivors of critical illness: a prospective multicenter cohort study. Crit Care Med 2015; 43: 973–982.
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7. Australian and New Zealand Intensive Care Society Centre for Outcome and Resource Evaluation. Adult Patient Database: activity report 2017/2018. Melbourne: ANZICS, 2019. https://www.anzics.com.au/wp-content/uploads/2019/07/ANZICS-CORE-APD-Activity-Report-2017-18.pdf (viewed July 2019).
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12. Pilcher D, Paul E, Bailey M, Huckson S. The Australian and New Zealand Risk of Death (ANZROD) model: getting mortality prediction right for intensive care units. Crit Care Resusc 2014; 16: 3–4.
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14. Gordon EH, Peel NM, Samanta M, et al. Sex differences in frailty: a systematic review and meta‐analysis. Exp Gerontol 2017; 89: 30–40.
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16. Duke GJ, Barker A, Knott CI, Santamaria JD. Outcomes of older people receiving intensive care in Victoria. Med J Aust 2014; 200: 323–326. https://www.mja.com.au/journal/2014/200/6/outcomes-older-people-receiving-intensive-care-victoria
17. Bagshaw SM, Webb SA, Delaney A, et al. Very old patients admitted to intensive care in Australia and New Zealand: a multi‐centre cohort analysis. Crit Care 2009; 13: R45.
18. Ball IM, Bagshaw SM, Burns KE, et al. Outcomes of elderly critically ill medical and surgical patients: a multicentre cohort study. Can J Anaesth 2017; 64: 260–269.
19. So RKL, Bannard‐Smith J, Subbe CP, et al; METHOD study investigators. The association of clinical frailty with outcomes of patients reviewed by rapid response teams: an international prospective observational cohort study. Crit Care 2018; 22: 227.
20. Faller JW, Pereira DDN, de Souza S, et al. Instruments for the detection of frailty syndrome in older adults: a systematic review. PLoS One 2019; 14: e0216166.
21. Darvall JN, Greentree K, Braat MS, et al. Contributors to frailty in critical illness: multi‐dimensional analysis of the Clinical Frailty Scale. J Crit Care 2019; 52: 193–199.
22. Zampieri FG, Iwashyna TJ, Viglianti EM, et al; ORCHESTRA Study Investigators. Association of frailty with short‐term outcomes, organ support and resource use in critically ill patients. Intensive Care Med 2018; 44: 1512–1520.
23. Darvall JN, Boonstra T, Norman J, et al. Retrospective frailty determination in critical illness from review of the ICU clinical record. Anaesth Intensive Care 2019; 36: 1–6.
24. Shears M, Takaoka A, Rochwerg B, et al; Canadian Critical Care Trials Group. Assessing frailty in the intensive care unit: a reliability and validity study. J Crit Care 2018; 45: 197–203.
25. Davies J, Whitlock J, Gutmanis I, Kane SL. Inter‐rater reliability of the retrospectively assigned clinical frailty scale score in a geriatric outreach population. Can Geriatr J 2018; 21: 1–5.

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Perspectives

Difficulties in knowing which critical care trial data warrant change in practice

Benjamin Reddi, Mark Finnis and Sandra Peake

Med J Aust 2019; 211 (7): . || doi: 10.5694/mja2.50331
Published online: 7 October 2019

ARTICLE
AUTHORS
REFERENCES

Topics

Statistics, epidemiology and research design

Why is some strong evidence ignored while some weak evidence is rapidly acted upon?

Most clinicians aspire to practise evidence‐based medicine, no longer believing it acceptable to implement novel interventions simply because they “make sense” or remain untested. However, external influences, psychological factors, and misapplied statistical techniques may hinder rational decision making. Using examples from intensive care literature, we discuss why well supported therapies are not always readily adopted, while poorly supported interventions may be unduly welcomed into practice.

1 Royal Adelaide Hospital, Adelaide, SA
2 Queen Elizabeth Hospital, Adelaide, SA

Correspondence: Benjamin.Reddi@sa.gov.au

Competing interests:

No relevant disclosures.

1. Acute Respiratory Distress Syndrome Network; Brower RG, Matthay MA, Morris A, et al. Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. N Engl J Med 2000; 342: 1301–1308.
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3. de Smet AM, Kluytmans JA, Cooper BS, et al. Decontamination of the digestive tract and oropharynx in ICU patients. N Engl J Med 2009; 360: 20–31.
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8. van den Berghe G, Wouters P, Weekers F, et al. Intensive insulin therapy in critically ill patients. N Engl J Med 2001; 345: 1359–1367.
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16. Fisher R. The design of experiments, 9th ed. London: Macmillan; 1971.

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Perspectives

Towards gender balance in the Australian intensive care medicine workforce

Lucy J Modra and Sarah A Yong

Med J Aust 2019; 211 (7): . || doi: 10.5694/mja2.50330
Published online: 7 October 2019

ARTICLE
AUTHORS
REFERENCES

Topics

Emergency medicine

Medical education

Health occupations

Achieving gender equity in intensive care medicine requires specific interventions to attract and retain female trainees and support their progress to leadership roles

For several decades, women have comprised about half of medical graduates in Australia.1 This is yet to translate into a gender‐balanced specialty workforce. In 2016, fewer than one in five practising surgeons, cardiologists and intensivists were women.2 In recognition of this, several Colleges have developed plans to improve gender balance within their specialty.

1 Austin Health, Melbourne, VIC
2 Alfred Health, Melbourne, VIC
3 Monash University, Melbourne, VIC

Correspondence: Lucy.MODRA@austin.org.au

Competing interests:

Lucy Modra and Sarah Yong are founding convenors of the WIN‐ANZICS Committee.

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3. Modra LJ, Yong SA, Austin DE. Women in leadership in intensive care medicine. ICU Manage Pract 2016; 16: 174–176.
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9. Valian V. Why so slow? The advancement of women. Cambridge, MA: MIT Press, 1998.
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15. Wennerås C, Wold A. Nepotism and sexism in peer‐review. Nature 1997; 387: 341–343.
16. Witteman HO, Hendricks M, Straus S, Tannenbaum C. Are gender gaps due to evaluations of the applicant or the science? A natural experiment at a national funding agency. Lancet 2019; 393: 531–540.
17. Royal Australasian College of Surgeons. 2018 progress report: Building respect, improving patient safety. Melbourne: RACS, 2018. https://umbraco.surgeons.org/media/3338/building-respect_progress-report_2018_final_4.pdf (viewed June 2019).
18. Besley T, Folke O, Persson T, Rickne J. Gender quotas and the crisis of the mediocre man: theory and evidence from Sweden. Am Econ Rev 2017; 107: 2204–2242.
19. Whelan J, Wood R. Targets and quotas for women in leadership: a global review of policy, practice, and psychological research. Melbourne: Centre for Ethical Leadership, University of Melbourne, 2012. https://sage-pilot.uq.edu.au/files/121/targets_and_quotas_report_2012.pdf (viewed June 2019).
20. Australian Institute of Company Directors. 30% by 2018: gender diversity progress report. September – December 2018 Quarterly Report, Volume 14. https://aicd.companydirectors.com.au/-/media/cd2/resources/advocacy/board-diversity/pdf/06440-4-pol-gender-diversity-quarterly-report-jan19-a4_final.ashx (viewed June 2019).
21. Weiss B, Task Force and Working Groups for Diversity and Equality of the ESICM. Statement paper on diversity for the European Society of Intensive Care Medicine (ESICM). Intensive Care Med 2019; 45: 1002–1005.
22. Castilla EJ, Benard S. The paradox of meritocracy in organizations. Adm Sci Q 2010; 55: 543–576.
23. Moss‐Racusin CA, Dovidio JF, Brescoll VL, et al. Science faculty's subtle gender biases favour male students. Proc Natl Acad Sci USA 2012; 109: 16474–16479.
24. Juster FR, Baum RC, Zou C, et al. Addressing the diversity‐validity dilemma using situational judgment tests. Acad Med 2019; 94: 1197–1203.
25. Australian Government Workforce Gender Equity Agency. Towards gender‐balanced parental leave: Australian and international trends. Insight paper. Sydney: WGEA, 2017. https://www.wgea.gov.au/sites/default/files/documents/gender%20balanced%20parental%20leave.pdf (viewed June 2019).
26. College of Intensive Care Medicine of Australia and New Zealand. Guidelines on practice re‐entry, re‐training and remediation for intensive care specialists. IC‐15 (2019). https://www.cicm.org.au/CICM_Media/CICMSite/CICM-Website/Resources/Professional%20Documents/IC-15-Recommendations-on-Practice-Re-entry,-Retraining-and-Remediation_2.pdf (viewed June 2019).
27. Venkatesh B, Corke C, Raper R, et al. Prevalence of bullying, discrimination and sexual harassment among trainees and Fellows of the College of Intensive Care Medicine of Australia and New Zealand. Crit Care Resusc 2016; 18: 230–234.

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Perspectives

Equity for Indigenous Australians in intensive care

Paul J Secombe, Alex Brown, Michael J Bailey and David Pilcher

Med J Aust 2019; 211 (7): . || doi: 10.5694/mja2.50339
Published online: 7 October 2019

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AUTHORS
REFERENCES

Topics

Indigenous health

Health services administration

Social determinants of health

The similarity in mortality among Indigenous and non‐Indigenous critically ill patients hides a complex story

Aboriginal and Torres Strait Islander Australians are more likely to be admitted to acute care hospitals than non‐Indigenous Australians.1 While this is widely recognised, the over‐representation of Indigenous patients in Australian intensive care units (ICUs) has been highlighted only recently.2,3 The headline finding that Indigenous Australians have an ICU admission rate that is 1.2 times the expected rate considering population representation is concerning, although not surprising, given higher Indigenous hospitalisation rates.1,2,3 It is reassuring that Indigenous patients appear to have similar in‐ICU and in‐hospital mortality.2,3 Intensivists should be justifiably proud of this mortality equivalence, but deeper analysis conveys some inconvenient truths.

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1 Alice Springs Hospital, Alice Springs, NT
2 Monash University, Melbourne, VIC
3 South Australian Health and Medical Research Institute, Adelaide, SA
4 University of South Australia, Adelaide, SA
5 Alfred Health, Melbourne, VIC
6 Centre for Outcome and Resource Evaluation, Australian and New Zealand Intensive Care Society, Melbourne, VIC

Correspondence: paulsecombe@bigpond.com

Competing interests:

No relevant disclosures.

1. Australian Institute of Health and Welfare. Australia's health 2018 [Australia's health series No. 16; Cat. No.: AUS 221]. Canberra: AIHW; 2018. https://www.aihw.gov.au/reports/australias-health/australias-health-2018/contents/table-of-contents (viewed Aug 2019).
2. Magee F, Wilson A, Bailey MJ, et al. Trauma‐related admissions to intensive care units in Australia: the influence of Indigenous status on outcomes. Med J Aust 2018; 210: 493–498. https://www.mja.com.au/journal/2019/210/11/trauma-related-admissions-intensive-care-units-australia-influence-indigenous
3. Secombe P, Brown A, McAnulty G, Pilcher D. Aboriginal and Torres Strait Islander patients requiring critical care: characteristics, resource use and outcomes. Crit Care Resus 2019; 21: 200–211.
4. Needham DM, Davidson J, Cohen H, et al. Improving long‐term outcomes after discharge from intensive care unit: report from a stakeholders' conference. Crit Care Med 2012; 40: 502–509.
5. Einsiedel LJ, Woodman RJ. Two nations: racial disparities in bloodstream infections recorded at Alice Springs Hospital, central Australia, 2001–2005. Med J Aust 2010; 192: 567–571. https://www.mja.com.au/journal/2010/192/10/two-nations-racial-disparities-bloodstream-infections-recorded-alice-springs
6. Tong SY, van Hal SJ, Einsiedel L, et al; Australian New Zealand Cooperative on Outcomes in Staphylococcal Sepsis. Impact of ethnicity and socio‐economic status on Staphylococcus aureus bacteremia incidence and mortality: a heavy burden in Indigenous Australians. BMC Infect Dis 2012; 12: 249.
7. Randall DA, Lujic S, Havard A, et al. Multimorbidity among Aboriginal people in New South Wales contributes significantly to their higher mortality. Med J Aust 2018; 209: 19–23. https://www.mja.com.au/journal/2018/209/1/multimorbidity-among-aboriginal-people-new-south-wales-contributes-significantly
8. National Aboriginal and Torres Strait Islander Health Workers Association. Cultural safety framework. NATSIHWA; 2019. https://www.natsihwa.org.au/sites/default/files/natsihwa-cultural_safety-framework_summary.pdf (viewed July 2019).
9. Laverty M, McDermott DR, Calma T. Embedding cultural safety in Australia's main health care standards. Med J Aust 2017; 207: 15–16. https://www.mja.com.au/journal/2017/207/1/embedding-cultural-safety-australias-main-health-care-standards
10. Li SQ, Gray NJ, Guthridge SL, Pircher SL. Avoidable hospitalisation in Aboriginal and non‐Aboriginal people in the Northern Territory. Med J Aust 2009; 190: 532–536. https://www.mja.com.au/journal/2009/190/10/avoidable-hospitalisation-aboriginal-and-non-aboriginal-people-northern
11. Pond BR, Dalton LG, Disher GJ, Cousins MJ. Helping medical specialists working in rural and remote Australia deal with professional isolation: the Support Scheme for Rural Specialists. Med J Aust 2009; 190: 24–27. https://www.mja.com.au/journal/2009/190/1/helping-medical-specialists-working-rural-and-remote-australia-deal-professional
12. Wakerman J, Humphreys JS. “Better health in the bush”: why we urgently need a national rural and remote health strategy. Med J Aust 2019; 210: 202–203. https://www.mja.com.au/journal/2019/210/5/better-health-bush-why-we-urgently-need-national-rural-and-remote-health
13. Wakerman J, Shannon C. Strengthening primary health care to improve Indigenous health outcomes. Med J Aust 2016; 204: 363–364. https://www.mja.com.au/journal/2016/204/10/strengthening-primary-health-care-improve-indigenous-health-outcomes

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Perspectives

The evolving role of intensive care in health care and society

Stephen Warrillow and Raymond Raper

Med J Aust 2019; 211 (7): . || doi: 10.5694/mja2.50340
Published online: 7 October 2019

Correction(s) for this article:

Erratum | Published online: 13 January 2020

ARTICLE
AUTHORS
REFERENCES

Topics

Anesthesia, analgesia and pain

Despite the evolving needs of patients and changing societal expectations, Australasian intensive care continues to provide a world leading service to patients and the broader society

With Melbourne hosting the 2019 World Congress of Intensive Care, it is timely to reflect on the nature of the speciality and consider its role within health care. The intensive care unit (ICU) can be a daunting place. For patients, families and even non‐intensive care clinicians, the complex and technically advanced environment can feel intimidating. The ICU represents a microcosm of the broader acute health care system, where the challenges of patient‐centred care, treatment, communication and resource management are encountered in a more impactful setting. The reach of intensive care is wide; current estimates from the Australian and New Zealand Intensive Care Society Centre for Outcome and Resource Evaluation suggest that Australians and New Zealanders have a 50% lifetime chance of requiring admission to an ICU.1 Intensive care interacts with every other element of acute care, serving the needs of patients, specialist units, hospitals and broader society. In its more recent history, intensive care has evolved to encompass more than just a single geographic location; it is an organised system of care that ensures delivery of timely and expert treatment to critically ill patients, increasingly extending this capability beyond the walls of the ICU itself and into many other settings.

1 Austin Heath, Melbourne, VIC
2 Australian and New Zealand Intensive Care Society, Melbourne, VIC
3 University of Melbourne, Melbourne, VIC
4 College of Intensive Care Medicine of Australia and New Zealand, Melbourne, VIC
5 Royal North Shore Hospital, Sydney, NSW

Correspondence: stephen.warrillow@austin.org.au

Competing interests:

Stephen Warrilow is President of the Australian and New Zealand Intensive Care Society and Convenor of the 2019 World Congress of Intensive Care. Raymond Raper is President of the CICM.

1. Australian and New Zealand Intensive Care Society Centre for Outcome and Resource Evaluation. Adult patient database. https://www.anzics.com.au/adult-patient-database-apd/ (viewed July 2019).
2. Lichtenberg FR. The impact of biomedical innovation on longevity and health. Nordic J Health Econ 2015; 5: 45–57.
3. Montgomery H, Grocott M, Mythen M. Critical care at the end of life: balancing technology with compassion and agreeing when to stop. Br J Anaesth 2017; 119 Suppl 1: i85–i89.
4. Bagshaw SM, Webb SAR, Delaney A, et al. Very old patients admitted to intensive care in Australia and New Zealand: a multi‐centre cohort analysis. Crit Care 2009; 13: R45.
5. Muscedere J, Waters B, Varambally A, et al. The impact of frailty on intensive care unit outcomes: a systematic review and meta‐analysis. Intensive Care Med 2017; 43: 1105–1122.
6. Darvall JN, Bellomo R, Paul E, et al. Frailty in very old critically ill patients in Australia and New Zealand: a population‐based cohort study. Med J Aust 2019; 211: 318–323.
7. Corke C, Leeuw E, Lo SK, George C. Predicting future intensive care demand in Australia. Crit Care Resusc. 2009; 11: 257–260.
8. Melville A, Kolt G, Anderson D, et al. Admission to intensive care for palliative care or potential organ donation: demographics, circumstances, outcomes, and resource use. Crit Care Med 2017; 45: e1050–e1059.
9. Hicks P, Huckson S, Fenny E, et al. The financial cost of intensive care in Australia: a multicentre registry study. Med J Aust 2019; 211: 324–325.
10. Prin M, Wunsch H. International comparisons of intensive care: informing outcomes and improving standards. Curr Opin Crit Care 2012; 18: 700–706.
11. Hillman KM, Chen J, Jones D. Rapid response systems. Med J Aust 2014; 201: 519–521. https://www.mja.com.au/journal/2014/201/9/rapid-response-systems
12. Lasiter S, Oles SK, Mundell J, et al. Critical care follow‐up clinics: a scoping review of interventions and outcomes. Clin Nurse Spec. 2016; 30: 227–237.
13. Hilton AK, Jones D, Bellomo R. Clinical review: the role of the intensivist and the rapid response team in nosocomial end‐of‐life care. Crit Care 2013; 17: 224.
14. Marini JJ. Re‐tooling critical care to become a better intensivist: something old and something new. Crit Care 2015; 19 Suppl 3: S3.
15. Venkatesh B, Mehta S, Angus DC, et al. Women in Intensive Care study: a preliminary assessment of international data on female representation in the ICU physician workforce, leadership and academic positions. Crit Care 2018; 22: 211.
16. Modra LJ, Yong SA. Towards gender balance in the Australian intensive care medicine workforce. Med J Aust 2019; 211: 300–302.
17. Warrillow S, Farley KJ, Jones D. How to improve communication quality with patients and relatives in the ICU. Minerva Anestesiol 2016; 82: 797–803.
18. Anesi GL, Wagner J, Halpern SD. intensive care medicine in 2050: toward an intensive care unit without waste. Intensive Care Med 2017; 43: 554–556.
19. Warrillow S, Farley K, Jones D. Ten practical strategies for effective communication with relatives of ICU patients. Intensive Care Med 2015; 41: 2173–2176.
20. Bellomo R, Stow PJ, Hart GK. Why is there such a difference in outcome between Australian intensive care units and others? Curr Opin Anaesthesiol 2007; 20: 100–105.
21. Peake S, Delaney A, French CJ. Evolution not revolution: the future of the randomised controlled trial in intensive care research. Med J Aust 2019; 211: 303–305.
22. Haines KJ, Berney S, Warrillow S, Denehy L. Long‐term recovery following critical illness in an Australian cohort. J Intensive Care 2018; 6: 8.
23. Secombe PJ, Brown A, Bailey MJ, Picher D. Diversity and equity within critical care: Indigenous Australians in intensive care. Med J Aust 2019; 211: 297–299.

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Research letters

Clinically important sport‐related traumatic brain injuries in children

Nitaa Eapen, Gavin A Davis, Meredith L Borland, Natalie Phillips, Ed Oakley, Stephen Hearps, Amit Kochar, Sarah Dalton, John Cheek, Jeremy Furyk, Mark D Lyttle, Silvia Bressan, Louise Crowe, Stuart Dalziel, Emma Tavender and Franz E Babl

Med J Aust 2019; 211 (8): . || doi: 10.5694/mja2.50311
Published online: 30 September 2019

ARTICLE
AUTHORS
REFERENCES

Topics

Emergency medicine

Sports medicine

Pediatric medicine

Sports participation by children and adolescents is generally high in Australia and New Zealand,1,2 and many children sustain head injuries of varying severity during such activities. Concussion has received increasing attention, but less is known about the risk of severe acute intracranial injuries in children with sports‐related head injuries.3

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1 Royal Children's Hospital, Melbourne, VIC
2 Murdoch Children's Research Institute, Melbourne, VIC
3 University of Melbourne, Melbourne, VIC
4 Perth Children's Hospital, Perth, WA
5 University of Western Australia, Perth, WA
6 Queensland Children's Hospital, Brisbane, QLD
7 Children's Health Research Centre, University of Queensland, Brisbane, QLD
8 Women's and Children's Hospital, Adelaide, SA
9 Children's Hospital at Westmead, Sydney, NSW
10 The Townsville Hospital, Townsville, QLD
11 Bristol Royal Hospital for Children, Bristol, United Kingdom
12 University of Padova, Padova, Italy
13 Starship Children's Health, Auckland, New Zealand
14 University of Auckland, Auckland, New Zealand

Correspondence: franz.babl@rch.org.au

Acknowledgements:

The study was funded by grants from the National Health and Medical Research Council (NHMRC; project grant GNT1046727, Centre of Research Excellence for Paediatric Emergency Medicine GNT1058560); the Murdoch Children's Research Institute, Melbourne; the Emergency Medicine Foundation, Brisbane (EMPJ‐11162); Perpetual Philanthropic Services (2012/1140); Auckland Medical Research Foundation (3112011) and the A + Trust (Auckland District Health Board); WA Health Targeted Research Funds 2013; and the Townsville Hospital and Health Service Private Practice Research and Education Trust Fund; and was supported by the Victorian Government Infrastructure Support Program. Franz Babl was partly funded by an NHMRC Practitioner Fellowship and a Melbourne Campus Clinician Scientist fellowship. Stuart Dalziel was partly funded by the Health Research Council of New Zealand (HRC13/556).

Competing interests:

No relevant disclosures.

1. Australian Bureau of Statistics. 4156.0. Sports and physical recreation: a statistical overview, 2012. Dec 2012. http://www.abs.gov.au/ausstats/abs@.nsf/Products/76DF25542EE96D12CA257AD9000E2685?opendocument (viewed Sept 2018).
2. Brocklesby J, McCarty G., Active NZ. Main report — the New Zealand Participation Survey 2017. Wellington: Sport New Zealand, 2018. https://sportnz.org.nz/assets/Uploads/Main-Report.pdf (viewed Sept 2018).
3. Davies GA, Anderson V, Babl FE, et al. What is the difference in concussion management in children as compared with adults? A systematic review. Br J Sports Med 2017; 51: 949–957.
4. Babl FE, Borland ML, Phillips N, et al. Paediatric Research in Emergency Departments International Collaborative (PREDICT). Accuracy of PECARN, CATCH and CHALICE head injury decision rules in children: a prospective cohort study. Lancet 2017; 389: 2393–2402.
5. Kuppermann N, Holmes JF, Dayan PS, et al. Pediatric Emergency Care Applied Research Network (PECARN). Identification of children at very low risk of clinically‐important traumatic brain injuries after head trauma: a prospective cohort study. Lancet 2009; 374: 1160–1170.

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Including ethnic and cultural diversity in dementia research

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Responding to mandatory immigration detention: lessons for the health care community

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Frailty in very old critically ill patients in Australia and New Zealand: a population‐based cohort study

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Difficulties in knowing which critical care trial data warrant change in practice

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Towards gender balance in the Australian intensive care medicine workforce

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Equity for Indigenous Australians in intensive care

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The evolving role of intensive care in health care and society

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Clinically important sport‐related traumatic brain injuries in children

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