Issues
Volume 217 Issue 6
News
News briefs
Step towards local long COVID diagnostics Researchers from Murdoch University’s Australian National Phenome Centre (ANPC) have developed a new diagnostic tool which may aid the diagnosis of debilitating symptoms of long COVID, which can include severe headaches, extreme exhaustion, heart palpitations and brain fog. Eighteen months ago, the researchers used multimillion dollar nuclear magnetic resonance (NMR) technology to identify new diagnostic molecular biomarkers that tell if someone has the disease, without the need to detect the disease itself. They then used this work to develop an inexpensive clinical NMR that general practitioners can use to detect vital blood markers to predict the long term effects of the conditions. The technology uses a specially designed set of radio pulses to extract signals from highly specific biomarker signals (from inflammatory glycoprotein markers and fats bound to lipoproteins) that gives a rapid diagnosis in approximately one minute. The findings were recently published in The Analyst. “We only discovered these signals about 18 months ago using a more expensive NMR instrument, but with some pulse sequence modifications, we are now able to get identical results on small machines that costs one‐tenth of the price,” Professor Jeremy Nicholson, Director of the ANPC said. “We think this technology (low field NMR spectroscopy) will probably have many other clinical applications in the future and may be of particular value in monitoring some of the residual effects of long COVID in individual patients.” https://pubs.rsc.org/en/content/articlelanding/2022/an/d2an01097f RSV prevention in reach Immunisation providing protection against respiratory syncytial virus (RSV) could be just months away according to research published in The Lancet Infectious Diseases. The study, by researchers from Telethon Kids Institute, UNSW Sydney and the University of Western Australia, has revealed a long‐lasting monoclonal antibody treatment for babies is likely to be accessible on the market within 12 months, followed closely by the approval of a maternal vaccine given in pregnancy to provide newborns with protection against the virus. Professor Peter Richmond, Head of the Vaccine Trials Group at the Wesfarmers Centre of Vaccines and Infectious Diseases and a paediatrician at Perth Children’s Hospital, said researchers were now completing the final stages of development for numerous preventive antibody treatments and RSV vaccines. “There are nine potential candidates in phase 3 clinical trials including two antibody immunisation treatments for prevention in babies and two maternal vaccines designed to be given to pregnant mothers,” said Professor Richmond. “We started our first phase 1 and 2 studies looking at RSV vaccines all the way back in 2000 and it has been a long journey to get to this point. In 2016 we began to see positive results for a phase 2 study looking at a monoclonal antibody treatment called niversimab. We recently completed phase 3 studies on niversimab here in Perth, and there have been positive results reported from the northern hemisphere pre‐COVID‐19, so it is expected to be licensed for use as the very first RSV prevention treatment in the USA/Europe by late 2022 or early 2023. [We have begun] a phase 3 study on the second potential antibody treatment, which hopes to provide long‐lasting protection for babies at highest risk of being hospitalised with RSV, including those born prematurely, or those with congenital heart disease or chronic lung disease,” said Professor Richmond. https://www.thelancet.com/journals/laninf/article/PIIS1473‐3099(22)00291‐2/fulltext#%20
Perspectives
Assessing the value of precision medicine health technologies to detect and manage melanoma
Early detection remains an important strategy to reduce melanoma mortality and improve survival, and novel precision medicine technologies for melanoma diagnosis are rapidly changing this field
Rashidul A Mahumud · Monika Janda · H Peter Soyer · Pablo Fernández‐Peñas · Victoria J Mar · Rachael L Morton
Roadmap to incorporating group A Streptococcus molecular point‐of‐care testing for remote Australia: a key activity to eliminate rheumatic heart disease
Strep A POCT is a critical element in preventing acute rheumatic fever and will contribute to the elimination of rheumatic heart disease in Australia
Dylan D Barth · Gelsa Cinanni · Jonathan R Carapetis · Rosemary Wyber · Louise Causer · Caroline Watts · Belinda Hengel · Susan Matthews · Anna P Ralph · Janessa Pickering · Jeffrey W Cannon · Lorraine Anderson · Vicki Wade · Rebecca J Guy · Asha C Bowen
Establishing the worth of deprescribing inappropriate medications: are we there yet?
The burden and costs of potentially inappropriate medications and polypharmacy are major public health challenges, but the effectiveness of deprescribing interventions in routine care remains unclear
Ian A Scott · Emily Reeve · Sarah N Hilmer
Health care in police watch‐houses: a challenge and an opportunity
Police watch-house detainees have complex health needs that involve multiple agencies and require coordinated, interagency solutions
Julia L Crilly · Caitlin Brandenburg · Stuart A Kinner · Ed Heffernan · Joshua Byrnes · Cathy Lincoln · Paul Gardiner · Peter Davidson · Annabel Somerville · Daniel Wilson · David Green · Stuart Thomas
Stroke in Australia: long term survivors have fallen into a black hole
People with long term disability after stroke should have access to the services they need, when they require them
Katharine Scrivener · Catherine Dean · Ian D Cameron · Louise Ada
Medical education
A polymorphic rash from across the seas
A 21-year-old man who migrated to Australia from Nepal 4 years previously was referred to a dermatologist
Akshay Flora · Priya Garg · Karen Cheung · Deshan F Sebaratnam · Monisha Gupta
The ambulatory glucose profile and its interpretation
Continuous glucose monitoring (CGM) has transformed diabetes management
Rose Lin · Fran Brown · Elif I Ekinci
Editorials
Balancing the medical and social needs of children during the COVID‐19 pandemic
During the New South Wales Delta outbreak, social factors caused more hospitalisations than medical reasons
Keith Grimwood · Anne B Chang
Measuring the quality of surgical care in Australia
A single robust and widely accepted measure for comparing outcomes between hospitals and systems would be a step forward
David I Watson · Tim Bright
Research
COVID‐19 in New South Wales children during 2021: severity and clinical spectrum
Community support for children with special care needs could reduce the number of COVID-19-related hospitalisations
Phoebe Williams · Archana Koirala · Gemma L Saravanos · Laura K Lopez · Catherine Glover · Ketaki Sharma · Tracey Williams · Emma Carey · Nadine Shaw · Emma Dickens · Neela Sitaram · Joanne Ging · Paula Bray · Nigel W Crawford · Brendan McMullan · Kristine Macartney · Nicholas Wood · Elizabeth L Fulton · Christine Lau · Philip N Britton
Hospital costs and factors associated with days alive and at home after surgery (DAH30)
As a practical proxy measure of quality of care, DAH30 could be used to assess overall improvement in patient outcomes
Jennifer R Reilly · Paul S Myles · Darren Wong · Stephane R Heritier · Wendy A Brown · Toby Richards · Max Bell
Guidelines
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
Modification of lifestyle behaviour, management of reversible risk factors and optimisation of existing medical conditions remain pivotal
Eric Chung · Michael Lowy · Michael Gillman · Chris Love · Darren Katz · Graham Neilsen
Letters
The need for improved Australian data on social determinants of health inequities
To the Editor: We endorse the call of Flavel and colleagues1 for improved data on, and greater attention to inequities in, social determinants of health. People with disability experience poorer health than the general population. Much of this disparity is attributable to entrenched disadvantage in social determinants of health such as employment, housing, and violence.2 Ongoing impacts from the coronavirus disease 2019 (COVID‐19) pandemic may increase disparities in social determinants and health outcomes for people with disability. Yet people with disability remain largely invisible in key data sources.3,4 Disability identifiers are included in several national surveys conducted by the Australian Bureau of Statistics (eg, the Survey of Disability, Ageing and Carers5 and General Social Survey6) and some of the longitudinal datasets mentioned by Flavel and colleagues. However, survey data have limitations: they are based on a population sample, capture data at specific time points, and rely on self‐report information (eg, on income, service use). National surveys typically exclude individuals living in settings such as boarding houses and welfare institutions, where people with disability are over‐represented. Administrative datasets complement survey data. They capture more detailed and often continuous data on individuals, their contact with services and related outcomes. Regrettably, disability status is rarely collected in administrative datasets in Australia. Work is underway on the National Disability Data Asset,7 comprising linked data from multiple state, territory and national administrative sources. This asset will require a robust and consistent basis for identifying individuals with disability, beyond the subset of people identified by their contact with disability‐specific programs or payments. Australia urgently needs a nationally agreed, consistent disability identifier to leverage the opportunity provided by the National Disability Data Asset to identify and monitor disparities in health and social determinants experienced by Australians with disability. Development of such a disability identifier is essential to build a strong evidence base to deliver better outcomes and reduce health inequities. Crucially, people with disability and their representative organisations must be involved as key drivers and decision makers at every stage of development and implementation of the to‐be‐developed national disability identifier.
Nicola Fortune · Jodie Bailie · Gwynnyth Llewellyn
The need for improved Australian data on social determinants of health inequities
In reply
Joanne Flavel · Connie Musolino · Toby Freeman
Quality improvement strategies in trauma care: review and proposal of 31 novel quality indicators
for the Trauma Care Verification and Quality Improvement Writing Group †
Seafarers on the shore: issues raised by Australian doctors treating seafarers
John J Bockxmeer · Nilukshi Ranwala
Australia needs to implement a national health strategy for doctors
Chanaka Wijeratne · Margaret P Kay · Mark H Arnold · Jeffrey CL Looi
Surviving and thriving after breast cancer treatment
Christobel M Saunders · Lesley Stafford · Martha Hickey
Bariatric surgery: a call for greater access to coordinated surgical and specialist care in the public health system
Ahmad Aly · Michael L Talbot · Wendy A Brown
Systemic amyloidosis in a patient presenting with myopathy, peripheral oedema and proteinuria
Laura Bywater · Anthea C Gist · Rahul G Muthalaly · Joanna Loh · Ian Simpson · Anthony J White · Andy KH Lim