Volume 215 Issue 6

VITT is a potential complication of ChAdOx1-nCov-19 vaccination — early recognition is key to improved outcomes

Vivien M Chen · Jennifer L Curnow · Huyen A Tran · Philip Y‐I Choi

Medical students with disabilities bring lived experience as patients, with a positive impact on school culture and learning

Liz Fitzmaurice · Kenneth Donald · Carl Wet · Dinesh Palipana

The recent enthusiasm for the clinical use of placebos seems driven by myths and misunderstandings

Christopher G Maher · Adrian C Traeger · Christina Abdel Shaheed · Mary O'Keeffe

A 27-year-old man presented with right upper quadrant abdominal pain which had gradually worsened in the previous week

Muhajir Mohamed · Jeanette Koay

A public health unit in Sydney was notified of two unrelated patients who presented on the previous day with methaemoglobinaemia

Caitlin O’Neill · Zeina Najjar · Andrew Ingleton · Alan Edwards · Andrew Dawson · Leena Gupta

A previously healthy 45-year-old woman presented with a history of sudden-onset right hemiparesis and dysarthria while walking

Mário LM Silva Júnior · Tereza EFC Albuquerque · Eduardo S Melo

Allard NL, MacLachlan JH, Tran L, et al. Time for universal hepatitis B screening for Australian adults. Med J Aust 2021; 215: 103‐105.e1. https://doi.org/10.5694/mja2.51114. In this Perspective article, in the Box on page 104, the colour blue in the legend should read, “Number of people with chronic hepatitis B diagnosed (modelled)”, and the red colour should read, “Number of people with chronic hepatitis B undiagnosed (modelled).”

Collaboration and education are critical to understanding and managing this mounting public health problem

Elliot Freeman · Stuart K Roberts

Objective: To compare the characteristics and outcomes of drug‐induced liver injury (DILI) caused by paracetamol and non‐paracetamol medications, particularly herbal and dietary supplements. Design: Retrospective electronic medical record data analysis. Setting, participants: Adults admitted with DILI to the Gastroenterology and Liver Centre at the Royal Prince Alfred Hospital, Sydney (a quaternary referral liver transplantation centre), 2009–2020. Main outcome measures: 90‐day transplant‐free survival; drugs implicated as causal agents in DILI. Results: A total of 115 patients with paracetamol‐related DILI and 69 with non‐paracetamol DILI were admitted to our centre. The most frequently implicated non‐paracetamol medications were antibiotics (19, 28%), herbal and dietary supplements (15, 22%), anti‐tuberculosis medications (six, 9%), and anti‐cancer medications (five, 7%). The number of non‐paracetamol DILI admissions was similar across the study period, but the proportion linked with herbal and dietary supplements increased from 2 of 13 (15%) during 2009–11 to 9 of 19 (47%) during 2018–20 (linear trend: P = 0.011). Despite higher median baseline model for end‐stage liver disease (MELD) scores, 90‐day transplant‐free survival for patients with paracetamol‐related DILI was higher than for patients with non‐paracetamol DILI (86%; 95% CI, 79–93% v 71%; 95% CI, 60–82%) and herbal and dietary supplement‐related cases (59%; 95% CI, 34–85%). MELD score was an independent predictor of poorer 90‐day transplant‐free survival in both paracetamol‐related (per point increase: adjusted hazard ratio [aHR], 1.19; 95% CI, 1.09–3.74) and non‐paracetamol DILI (aHR, 1.24; 95% CI, 1.14–1.36). Conclusion: In our single centre study, the proportion of cases of people hospitalised with DILI linked with herbal and dietary supplements has increased since 2009. Ninety‐day transplant‐free survival for patients with non‐paracetamol DILI, especially those with supplement‐related DILI, is poorer than for those with paracetamol‐related DILI.

Emily Nash · Abdul‐Hamid Sabih · John Chetwood · Georgette Wood · Keval Pandya · Terry Yip · Avik Majumdar · Geoffrey W McCaughan · Simone I Strasser · Ken Liu

The substantial mortality and financial cost means that effective policies are needed to reduce wood heater pollution

Dorothy L Robinson · Joshua A Horsley · Fay H. Johnston · Geoffrey G Morgan

Saliva may be suitable as a stand-alone test specimen for people aged 10 years or more

Jane Oliver · Shidan Tosif · Lai‐yang Lee · Anna‐Maria Costa · Chelsea Bartel · Katherine Last · Vanessa Clifford · Andrew Daley · Nicole Allard · Catherine Orr · Ashley Nind · Karyn Alexander · Niamh Meagher · Michelle Sait · Susan A Ballard · Eloise Williams · Katherine Bond · Deborah A Williamson · Nigel W Crawford · Katherine B Gibney

Clinical cardiac complications were reassuringly uncommon among more than 600 patients admitted to hospital with COVID-19

on behalf of the AUS‐COVID Investigators

COPD is the fifth greatest contributor to burden of disease and fifth overall cause of death among Australians

Alan M Carew · Jonathan P Williamson · Claude S Farah · Tajalli Saghaie · Martin Phillips · Alvin Ing

To the Editor: We congratulate Buising and colleagues1 on their article published in the MJA and agree that the approach needs to be multidimensional and iterative. To expand upon the multidimensional theme of their article, we would like to emphasise the need for the approach to be multidisciplinary and to include the whole of the health service workforce. The article highlighted the ubiquitous nature of coronavirus disease 2019 (COVID‐19) transmission in health care settings, with 18.3% (or almost one in five) of health care workers infected, and that these workers are traditionally regarded as non‐clinical staff (food services, environmental services, administrative and security staff). The non‐clinician workforce has been overlooked in other research investigating COVID‐19 transmission risk factors.2 At Monash Health, we used multidisciplinary shift briefings to ensure all health service team members were included in the information and safety messages.3 Human factor‐designed briefing cards, based on the airline industry pre‐flight safety cards, were used to ensure consistent messaging (Box and online Supporting Information). The early involvement of a design team, from the Design Health Collab at Monash University, ensured clear and unambiguous messaging to health care workers. The images were designed to represent diversity in gender, race and role to ensure all health care workers would see themselves reflected in the briefing card and that the safety messages were relevant and directed towards them. Providing information that is timely and accessible as well as readable and visually clear is important.4 Commentaries have emphasised the need for clear and concise communication to ensure the safety and wellbeing of health care workers during the COVID‐19 pandemic.5 However, we believe that involving all workers, not just clinicians, in the safety messages and interventions is paramount to the health and safety of non‐clinical health care workers and to the ongoing operation of health care services. COVID‐19 does not recognise the individual worker role in the health care service and the pandemic has offered us a unique and powerful opportunity to bring together the whole health care workforce and break down traditional barriers. We believe that a multidisciplinary approach is just as vital as a multidimensional one. Box – Card used to ensure consistent messaging during shift briefings Permission to reproduce this image was obtained from the American Journal of Infection Control.

Diana Egerton-Warburton · Lisa Kuhn · Daphne Flynn

To the Editor: Low and colleagues1 highlight the long‐standing issue that the provision of residential aged care in Australia remains grossly inadequate. This is particularly egregious given that these deficits and remedial actions have been known for decades from numerous inquiries commissioned by successive federal governments and reiterated by the Royal Commission. This vacuum is being filled by initiatives undertaken by the Victorian Government in public sector residential aged care services to develop better ways to conceptualise aged care. We acknowledge there is no single ideal model2 for the provision of residential aged care, as there is such wide variation in residential aged care services profiles (eg, number and type of residents, geographic location, physical environment, staffing). However, our recently proposed conceptual model for the provision of residential aged care3 includes many of the necessary aspects recommended by the NHMRC National Institute for Dementia Research Special Interest Group in Rehabilitation and Dementia. Our conceptual model takes as its purpose the provision of person‐centred care to older people with complex health issues, especially those living with dementia. It consists of five domains relevant to the experience of older people living in residential aged care: health care, social inclusion, individual rights, personal care and reablement, and dementia management. The model also supports the dignity of risk and quality of life beyond clinical care to enable older people to thrive. The development of our model involved several stages using a similar approach to model development described in 20104 which comprised: initial conceptualisation and development based on a review of the literature to document and map the key domains of residents’ needs in aged care; brainstorming using the expertise and experience of the research team to refine and categorise the domains and subdomains; extensive consultation with key stakeholders (n = 382) to test the model for feasibility and acceptability (field testing) for the sector; and testing against a range of theoretical organisational failure scenarios (validity checks against coroners’ cases). The model has been presented to the Royal Commission into Aged Care Quality and Safety and published in a peer‐reviewed journal.3 Uptake of this model would allow the Commonwealth government, which finances and regulates this sector, and individual service providers to have a common understanding of aged care. This is an important step towards improving aged care services.

Jo‐Anne Rayner · Deirdre Fetherstonhaugh · Joseph E Ibrahim