Volume 217 Issue 10

When chlamydia is detected, retesting and thorough contact tracing and management can help to interrupt transmission and reduce the risk of reinfection and reproductive complications

Stephanie C Munari · Jane L Goller · Margaret E Hellard · Jane S Hocking

Better reporting of harms is needed in clinical trials to support better decision making

Christina Abdel Shaheed · Christopher G Maher · Ann‐Mason Furmage · Tammy Hoffmann · Andrew J McLachlan

An understanding of the landscape of clinical trials in pancreatic cancer available to the Australian population may assist in informing gaps and opportunities for future trial interventions and increased participation

Nadia N Khan · Harleen Basrai · Sue M Evans · Liane J Ioannou · Charles HC Pilgrim · John R Zalcberg · Gayle M Jones · Susan Hanson

Australia should develop a sustainable evidence-based pharmacogenomic screening program, with DPYD genotyping at the forefront

Cassandra White · Rodney Scott · Christine L Paul · Stephen P Ackland

The largest health workforce has the greatest research potential; investing in nursing and midwifery researchers is an investment in better care and cost outcomes

Marion Eckert · Claire M Rickard · Deborah Forsythe · Kathleen Baird · Judith Finn · Andrea Gilkison · Richard Gray · Caroline SE Homer · Sandy Middleton · Stephen Neville · Lisa Whitehead · Greg R Sharplin · Samantha Keogh

A 71-year-old man with a history of 6 weeks of generalised decline presented for outpatient clinic assessment

Karen Bromley · Jessica Phillips · Ashley Irish

Full disclosure of research plans and their subsequent modifications facilitates transparency in medical research

Sabine Braat · Katherine J Lee

Cardiovascular disease mortality is not increased in women undergoing IVF, but vigilant surveillance is nonetheless required

Robert J Norman

Elimination programs should be guided by the prevalence of markers of infection, not of disease

Jaki Adams · Sung Hye Kim · Anthony W Solomon

The unacceptably high prevalence among Indigenous people and people who need dialysis warrants a clinical trial of prophylactic antibiotics

Katherine Gibney · Andrew Steer

Chung E, Lowy M, Gillman M, et al. Urological Society of Australia and New Zealand (USANZ) and Australasian Chapter of Sexual Health Medicine (AChSHM) for the Royal Australasian College of Physicians (RACP) clinical guidelines on the management of erectile dysfunction. Med J Aust 2022; 217: 318‐324. https://doi.org/10.5694/mja2.51694 In these Guidelines, the affiliations for Darren Katz should be: “Men’s Health Melbourne, Melbourne, VIC; University of Melbourne, Melbourne, VIC; and Western Health, Melbourne, VIC”.

Harris MG, Hobbs MJ, Burgess PM, et al. Frequency and quality of mental health treatment for affective and anxiety disorders among Australian adults. Med J Aust 2015; 202: 185‐189. https://doi.org/10.5694/mja14.00297. On page 187, “This equates to 26% and 16%, respectively, of all consultees with a past‐year affective or anxiety disorder” should read: “This equates to 26% and 16%, respectively, of all adults with a past‐year affective or anxiety disorder.” On page 189, “…we might speculate that 19% of consultees with affective and/or anxiety disorders received adequate treatment in 2009–10” should read: “…we might speculate that 19% of adults with affective and/or anxiety disorders received adequate treatment in 2009–10”.

The documentation of changes made to research protocols should be formalised to improve transparency

Xanthi Coskinas · R John Simes · Andrew J Martin

Reassuringly, fertility treatment does not increase long term all-cause or CVD mortality risk

Stephanie R Yiallourou · Dianna Magliano · Tilahun N Haregu · Melinda J Carrington · Daniel L Rolnik · Luk Rombauts · Andre Rodrigues · Jocasta Ball · Fiona J Bruinsma · Fabricio Da Silva Costa

Assessing progress to trachoma elimination in Australia and elsewhere should therefore incorporate laboratory testing

Kathleen D Lynch · Wendy Morotti · Garry Brian · Lenore Ketchup · Kozue Kingston · Mitchell Starr · Robert S Ware · Beth Everill · Nazihah Asgar · Anne O'Keefe · Lisa J Whop · John M Kaldor · Stephen B Lambert

An intersectoral response to improving the social determinants of skin health is needed, particularly in remote communities

Johanna M Birrell · Rowena Boyd · Bart J Currie · Nicholas M Anstey · Asanga Abeyaratne · Sandawana William Majoni · Vicki L Krause

To the Editor: Molecular diagnostics with whole genome sequencing (WGS) of severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) has been well described as a method to monitor the evolving epidemiology of the coronavirus disease 2019 (COVID‐19) pandemic and coordinate public health responses.1,2 WGS allows for the accurate identification of COVID‐19 variants, which, when combined with accessible diagnostic testing with polymerase chain reaction (PCR) and rapid antigen tests, supports contact tracing and public health action.1,2 Since January 2022, by agreement with the Forensic and Scientific Services reference laboratory, it has been our practice at the Prince Charles Hospital — a tertiary cardiothoracic transplant centre in Brisbane — to sequence all SARS‐CoV‐2 samples of patients requiring hospital admission for COVID‐19. The rapid turnaround times, averaging 36 hours, supported decisions on variant‐specific therapeutics and optimised bed management. The first case of the Omicron BA.2 subvariant detected at our centre was from a sample collected on 4 March 2022 (Box). This was 17days before public announcements of the dominance of the BA.2 strain by the Queensland Chief Health Officer on 21 March 2022.3 With the anticipated increase in local BA.2 cases, we were able to tailor our hospital level response in real time.4 Initially, even though case numbers were low, from an infection prevention and control perspective, we cohorted BA.1 and BA.2 patients separately to mitigate the risk of nosocomial co‐infection. We maintained the workforce and resourcing surge capacity with a second COVID‐19 ward that opened within days of the initial BA.2 case being identified. Furthermore, genome sequencing for COVID‐19 therapeutics resistance mutations led to alterations in clinical management as BA.2 became the dominant local strain, given its lack of susceptibility to sotrovimab. At the hospital and health service level, access to rapid WGS for identification of emerging variants provides the basis for greater infection prevention and control practices, resource and workforce management, and epidemiological monitoring, and carries implications for clinical management and therapeutics. WGS allows for rapid detection and contact tracing of nosocomial outbreaks, supporting identification of chains of transmission within hospitals. This information augments infection prevention and control by identifying gaps in current practice as well as supporting safer health care environmental design that minimises nosocomial transmission. Furthermore, detection of novel variants at the hospital level can help to predict new waves that require allocation of additional staffing and resources. The Australian Government has recognised the evolving role of microbial genomics in public health surveillance but has not yet committed to further development to optimise personalised medicine, hospital care, and therapeutic decision making.5 We strongly advocate for the inclusion of funding for sustainable rapid WGS that provides real‐time results under the Medicare Benefits Schedule. This will expedite Australia's transition to living with COVID‐19 and will allow us to better prepare our health system to manage new and emerging pathogens into the future. Box – Number of patients admitted and sequenced with coronavirus disease 2019 (COVID‐19) at the Prince Charles Hospital from 1 January to 3 April 2022 by genotype* *Bubble size range, 1–9; total number of patients, 256.

Matthew B Eustace · Ambika Sud · Craig Thompson · Sanmarie Schlebusch · Robert L Horvath

To the Editor: As nicotine prescribers, we welcome much needed advice for doctors on prescribing nicotine. However, we disagree with several recommendations and concerns raised in the article by Ween and colleagues.1 First, in our experience, the recommended starting nicotine concentration of 18mg/mL is inappropriate for most new users. The most popular devices for transitioning to vaping (pod vapes) have small batteries and require higher nicotine salt concentrations to effectively relieve cravings and withdrawal symptoms, typically 20–50mg/mL.2 On the other hand, 18mg/mL would be too strong for a smoker with low nicotine dependence using a more powerful vape pen or mod device. The concentration of nicotine required should be personalised for each user based on the level of nicotine dependence, device type and puffing topography.3 Second, the authors’ concerns about the toxicity of nicotine are overstated in our view. Nicotine is a toxic poison in its highly concentrated form, but the low concentrations used for vaping carry minimal risk of serious harm, although the long term impact of inhaled nicotine on lung tissue is not yet known.4 Third, Ween and colleagues raise concerns about the addictiveness of nicotine. However, most smokers who switch to vaping are already nicotine‐dependent. Dependence on vaping is generally less than for smoking5 because, in many cases, peak nicotine levels from vaping are lower and nicotine delivery is slower. In vitro and animal studies suggest other chemicals in smoke may also increase dependence, but human studies are lacking.6,7 Fourth, a blanket “3‐month prescription maximum” and an “agreed abstinence plan” do not recognise the diversity of the needs of smokers. Switching to vaping and then ceasing smoking can take many months or years for some smokers. Many continue to vape long term to avoid relapse to smoking or for perceived benefits. Therefore, a more flexible and personalised approach is needed. Last, Ween and colleagues are correct that unknown harms from flavours may appear over time and these need to be carefully monitored. However, flavours are an integral part of the appeal of vaping. Flavours encourage the uptake of vaping by smokers and are associated with higher quit rates.8,9 A recommendation to avoid flavours risks inadvertently increasing smoking.

Colin P Mendelsohn · Carolyn Beaumont

In reply

Alexander Larcombe · David Chapman · Miranda Ween