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Objectives: To assess whether specific factors predict the development of ManuScript Rejection sYndrome (MiSeRY) in academic physicians.
Design: Prospective pilot study; participants self‐administered a questionnaire about full manuscript submissions (as first or senior author) rejected at least once during the past 5 years.
Setting: Single centre (tertiary institution).
Participants: Eight academic physician‐authors.
Main outcome measures: Duration of grief. MiSeRY was pre‐specified as prolonged grief (grief duration longer than the population median).
Results: Eight participants provided data on 32 manuscripts with a total of 93 rejections (median, two rejections per manuscript; interquartile range [IQR], 1–3 rejections per manuscript). Median age at rejection was 37 years (IQR, 33–45 years); 86% of 80 rejections involved male authors (86%), 56 of the authors providing data about these rejections were first authors (60%). The median journal impact factor was 5.9 (IQR, 5.2–17). In 48 cases of rejection (52%), pre‐submission expectations of success had been high, and in 54 cases (58%) the manuscripts had been sent for external review. Median grief duration was 3 hours (IQR, 1–24 h). Multivariate analysis indicated that higher pre‐submission expectation (adjusted odds ratio [aOR], 5.0; 95% CI, 1.5–18), first author status (aOR, 9.5; 95% CI, 1.1–77), and external review (aOR, 19.0; 95% CI 2.9–126) were independent predictors of MiSeRY.
Conclusions: To help put authors out of their MiSeRY, journal editors could be more selective in the manuscripts they send for external review. Tempering pre‐submission expectations and mastering the Coping and reLaxing Mechanisms (CaLM) of senior colleagues are important considerations for junior researchers.
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We acknowledge the various medical journals that have rejected our manuscripts and provided inspiration for this study. To quote a contemporary poet: “thank u, next”.
All but one of the rejected authors in this study are co‐authors of this article. We are uncertain whether referencing Tinder or quoting Ariana Grande infringes any copyright laws. We have no other relevant disclosures.
We celebrate another exciting year and wish our readers a restful break and a prosperous 2020
Welcome to our 2019 Christmas issue, in which we celebrate the MJA year in review together with the traditional holiday season Down Under. As many of our readers and authors across Australia commence their well deserved breaks, we hope this more light‐hearted issue of the MJA will still inform, inspire — and amuse.
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I would like to thank the tireless efforts of the Editorial team throughout 2019, without which the quality and timely publication of our Journal in print and online would not be possible: our Head of Publishing Content, Lilia Kanna; Senior Deputy Medical Editor, Christine Gee; Deputy Medical Editors, Francis Geronimo, Robyn Godding, Tania Janusic, Selina Lo, Wendy Morgan, and Zoë Silverstone; our Structural and Scientific Editors, Graeme Prince, Paul Foley, and Laura Teruel; our Consultant Biostatistician, Elmer Villanueva; our News and Online Editor, Cate Swannell; our Graphic Designer, Leilani Widya; and our Senior Publishing Coordinator, Kerrie Harding.
No relevant disclosures for this article. A complete list of my conflict of interest disclosures is found at https://www.mja.com.au/journal/staff/
Introduction: Paracetamol is a common agent taken in deliberate self‐poisoning and in accidental overdose in adults and children. Paracetamol poisoning is the commonest cause of severe acute liver injury. Since the publication of the previous guidelines in 2015, several studies have changed practice. A working group of experts in the area, with representation from all Poisons Information Centres of Australia and New Zealand, were brought together to produce an updated evidence‐based guidance.
Main recommendations (unchanged from previous guidelines):
Major changes in management in the guidelines:
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Angela Chiew receives funding from a National Health and Medical Research Council Early Career Fellowship (ID 1159907).
Angela Chiew, Katherine Isoardi, Jessamine Soderstrom and Nicholas Buckley were involved in the 2019 Australian Therapeutic Guidelines — Toxicology and Toxinology Guidelines Writing Group and received travel and meeting expenses. Jessamine Soderstrom receives royalties from the Toxicology handbook from Elselvier. David Reith chairs the Medicines Adverse Reactions Committee for Medsafe.
Until recently, analgesic medications containing less than 30 mg codeine per dosage unit were available over the counter in Australia.1 Codeine‐related hospital presentations placed an increasing economic burden on the Australian health care system;2 in response, the Therapeutic Goods Administration re‐scheduled all codeine‐containing products as prescription‐only medicines from 1 February 2018.3
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No relevant disclosures.
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Ian Reid and Mark Bolland are supported by grants from the Health Research Council of New Zealand. The Health Research Council of New Zealand had no role in the study design, data collection, analysis or interpretation, reporting or publication.
No relevant disclosures.
Objectives: To assess the clinical effectiveness of faecal calprotectin (FC) testing for distinguishing between organic gastrointestinal diseases (organic GID), such as inflammatory bowel disease (IBD), and functional gastrointestinal disorders (functional GIDs).
Study design: Studies that assessed the accuracy of FC testing for differentiating between IBD or organic GID and functional GIDs were reviewed. Articles published in English during January 1998 – June 2018 that compared diagnostic FC testing in primary care and outpatient hospital settings with a reference test and employed the standard enzyme‐linked immunosorbent FC assay method with a cut‐off of 50 or 100 μg/g faeces were included. Study quality was assessed with QUADAS‐2, an evidence‐based quality assessment tool for diagnostic accuracy studies.
Data sources: MEDLINE and EMBASE; reference lists of screened articles.
Data synthesis: Eighteen relevant studies were identified. For distinguishing patients with organic GID (including IBD) from those with functional GIDs (16 studies), the estimated sensitivity of FC testing was 81% (95% CI, 74–86%), the specificity 81% (95% CI, 71–88%); area under the curve (AUC) was 0.87. For distinguishing IBD from functional GIDs (ten studies), sensitivity was 88% (95% CI, 80–93%), specificity 72% (95% CI, 59–82%), and AUC 0.89. Assuming a population prevalence of organic GID of 1%, the positive predictive value was 4.2%, the negative predictive value 100%. The difference in sensitivity and specificity between FC testing cut‐offs of 50 μg/g and 100 μg/g faeces was not statistically significant (P = 0.77).
Conclusions: FC testing is clinically useful for distinguishing organic GID (including IBD) from functional GIDs, and its incorporation into clinical practice for evaluating patients with lower gastrointestinal symptoms could lead to fewer patients with functional GIDs undergoing colonoscopy, reducing costs for both patients and the health system.
PROSPERO registration: CRD4201810507.
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Objective: To determine whether routine blood glucose assessment of patients admitted to hospital from emergency departments (EDs) results in higher rates of new diagnoses of diabetes and documentation of follow‐up plans.
Design, setting: Cluster randomised trial in 18 New South Wales public district and tertiary hospitals, 31 May 2011 – 31 December 2012; outcomes follow‐up to 31 March 2016.
Participants: Patients aged 18 years or more admitted to hospital from EDs.
Intervention: Routine blood glucose assessment at control and intervention hospitals; automatic requests for glycated haemoglobin (HbA1c) assessment and notification of diabetes services about patients at intervention hospitals with blood glucose levels of 14 mmol/L or more.
Main outcome measure: New diagnoses of diabetes and documented follow‐up plans for patients with admission blood glucose levels of 14 mmol/L or more.
Results: Blood glucose was measured in 133 837 patients admitted to hospital from an ED. The numbers of new diabetes diagnoses with documented follow‐up plans for patients with blood glucose levels of 14 mmol/L or more were similar in intervention (83/506 patients, 16%) and control hospitals (73/278, 26%; adjusted odds ratio [aOR], 0.83; 95% CI 0.42–1.7; P = 0.61), as were new diabetes diagnoses with or without plans (intervention, 157/506, 31%; control, 86/278, 31%; aOR, 1.51; 95% CI, 0.83–2.80; P = 0.18). 30‐day re‐admission (31% v 22%; aOR, 1.34; 95% CI, 0.86–2.09; P = 0.21) and post‐hospital mortality rates (24% v 22%; aOR, 1.07; 95% CI, 0.74–1.55; P = 0.72) were also similar for patients in intervention and control hospitals.
Conclusion: Glucose and HbA1c screening of patients admitted to hospital from EDs does not alone increase detection of previously unidentified diabetes. Adequate resourcing and effective management pathways for patients with newly detected hyperglycaemia and diabetes are needed.
Trial registration: Australian New Zealand Clinical Trials Registry, ACTRN12611001007921.
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This study was funded by a National Health and Medical Research grant (1013443) and the NSW Agency for Clinical Innovation, which also funded the project officer for the project, who was involved in data collection. We acknowledge the contributions of the following colleagues who supported the study as research assistants, site investigators, or pathology department employees: Nancy Cinnadaio, Ivan Kuo, Paul Tridgell, Tony Morrow, Graham Jones, Rita Horvath, Michael Earl, and Mark Bishop. NSW Health provided access to the linked datasets. Cause of Death Unit Record Files were provided by the Australian Coordinating Registry for the Cause of Death Unit Record File on behalf of the NSW Registry of Births, Deaths and Marriages, the NSW Coroner, and the National Coronial Information System.
No relevant disclosures.
An 88‐year‐old woman presented with 2 months of right upper quadrant pain, weight loss, and 3 days of fevers. Computed tomography scan of her abdomen demonstrated a 5.8 × 5.4 cm peripherally enhancing lesion (Figure, blue arrow) with a linear radiodensity suggestive of a fish bone traversing the gastric antrum and migrating into the liver (Figure, red arrow). Removal of the fish bone laparoscopically, drainage of the abscess, and 8 weeks of antibiotic therapy for Streptococcus constellatus cultured intraoperatively resulted in cure. Prompt recognition and surgical excision of the foreign body, with drainage of the abscess and appropriate antibiotic therapy are crucial for cure.1
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Australian Genomics is calling for a change in research ethics and governance frameworks
Australian Genomics is a national initiative building evidence to ensure the effective implementation of genomic medicine into Australian health care (www.australiangenomics.org.au). The research program is embedded in clinical practice, with 5000 patients with rare diseases and cancers being prospectively recruited for genomic testing into clinical flagship projects through 31 hospitals across Australia (Box 1). Achieving national recruitment will ensure that the clinical, diagnostic and research pathways are developed through the infrastructure and workforce in each jurisdiction. We initiated the research ethics and governance approval process for our multisite human research project, which was eligible for single ethical review by one Human Research Ethics Committee under the Australian National Mutual Acceptance (NMA) framework (Box 2), and recorded details relating to our experience in navigating the research ethics and governance system. This included any site‐specific assessment (SSA) requirements, review time, personnel costs, and causes of delay.
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The Australian Genomics Health Alliance is funded by a National Health and Medical Research Council grant (Grant Reference No. 1113531) and the Australian Government's Medical Research Future Fund. Members of the Australian Genomics Health Alliance who also supported and contributed to the publication of this work: Andrea M Belcher, Peta Phillips, Zornitza Stark, Adam Jaffe, Christopher Barnett, Julie McGaughran, Christopher Semsarian, Richard J Leventer, Katherine Howell, Andrew J Mallett, Aron Chakera, Chirag Patel, Cathy Quinlan, Amali Mallawaarachchi, Tony Roscioli, Kristi Jones, Matthew Cook, David R Thorburn, Paul J Lockhart, Cas Simons, Sebastian Lunke, Denise Howting, Clara Gaff, Deborah White, Marcel Dinger, Stephen Fox, Nigel Laing, Jozef Gecz, Ingrid E Scheffer, John Christodoulou, Andrew Sinclair and Kathryn N North. We thank Nikolajs Zeps and Craig Willers for their insightful comments on the manuscript.
No relevant disclosures.
Abstract
Objectives: To determine whether gendered symbols on patient call bells are restricted to our hospital or are examples of an international practice that perpetuates gender stereotypes and occupational segregation.
Setting: Multicentre, international study of hospital equipment, 2018.
Main outcome measure: Types of symbols on patient call bells.
Results: We received 56 responses from 43 hospitals in eight countries across five continents: 37 devices included female‐specific images, nine included gender‐neutral images, and ten did not use imagery (for example, button‐only devices). No call bells included male‐specific images.
Conclusion: Female symbols on patient call bells are an international phenomenon. Only female or gender‐neutral images are used, indicating bias in their design, manufacture, and selection. Female symbols may reinforce gender stereotypes and contribute to occupational segregation and reduced equity of opportunity. We suggest alternative symbols. Individual action with coloured marker pens may provide a pragmatic short term, albeit provocative, solution. While call bell design has only a minor impact on patients, everyday bias affects all staff and society in general.