Volume 219 Issue 4

Choosing therapies well, with the patient’s preference, requires an understanding of the temporal risk profile of coronary artery disease

Derek P Chew · Sarah Zaman

The availability of evidence-based therapies should be seen as a call to action to urgently streamline and unify the diagnosis of HFpEF at the clinical interface

Sandhir B Prasad · David J Holland · John J Atherton

To survive a sudden cardiac arrest, you need to be in the “right place at the right time”; but should someone’s chance of surviving a sudden cardiac arrest really come down to a roll of the dice?

Elizabeth Paratz · Gregory J Page · Garry LR Jennings

A 19-year-old male student with a history of asthma and nut anaphylaxis was taken by ambulance to hospital when he was found unresponsive with vomitus and faecal soiling after one day of lethargy and sore throat

Gary Louie · Romeo Torres · Anthea L Katelaris · Courtney McGregor · Victor Lai · Robert Stevens · Richard Sullivan · Pamela Konecny

A 76-year-old woman presented to a regional hospital with COVID-19-related symptoms

Gabriela Strey

Improving diagnostic capabilities in rural areas will require a commensurate increase in clinical decision-making and therapeutic capacity

Taylor Strube · Derek P Chew

Local assessment could improve access to cardiac services in rural centres and reduce the costs associated with sending patients to Perth

Mikhail Alexander · Nick S R Lan · Michael J Dallo · Tom G Briffa · Frank M Sanfilippo · Andrew Hooper · Helen Bartholomew · Loletta Hii · Graham S Hillis · Brendan M McQuillan · Girish Dwivedi · James M Rankin · Abdul Rahman Ihdayhid

Maintaining good vaccination coverage effectively reduces the hospital burden associated with COVID-19

Nicolas R Smoll · Mahmudul Hassan Al Imam · Connie Shulz · Robert Booy · Gulam Khandaker

Allard NL, Canevari J, Haslett N, Cowie BC. Access to oral COVID‐19 antivirals in the community: are eligibility criteria and systems ensuring equity? Med J Aust 2023; 218: 438‐441. https://doi.org/10.5694/mja2.51949

Many ED presentations deemed suitable for GP care based on the AIHW defintion of lower urgency care may be unsuitable

Haomin S Wu · James L Mallows

A national framework could be beneficial to provide sites with evidence, possible models, and business cases

Kenneth K Cho · John K French · Gemma A Figtree · Clara K Chow · Rebecca Kozor

Selecting a suitable CVD risk equation for the Australian population

Sinan Brown · Emily Banks · Mark Woodward · Natalie Raffoul · Garry Jennings · Ellie Paige

To the Editor: The incidence of lung cancer and the five‐year survival of patients diagnosed with lung cancer reflect the social gradient within the Australian society. Most notably, Aboriginal and Torres Strait Islander people are twice as likely to develop lung cancer and half as likely to survive lung cancer.1 Reducing inequity in lung cancer outcomes was a key objective of Cancer Australia when it proposed a National Lung Cancer Screening Program (NLCSP) in 2020, following an enquiry that consulted both medical experts and the broader community.1 The Department of Health sought funding for Cancer Australia's proposed NLCSP in the 2021–2022 Budget but was required by the Department of Finance to refer the proposal to the Medical Services Advisory Committee (MSAC) for review.2 So, when MSAC recently announced its support for the creation of the NLCSP, there was great relief within the lung cancer community. However, what few people seemed to realise was that MSAC had in fact designed, then endorsed, their own alternative model for an NLCSP.3 MSAC's model is fundamentally different to Cancer Australia's model in terms of who is eligible to be screened and, therefore, who can benefit from the screening program. Whereas Cancer Australia intended using an individual's risk of lung cancer (as estimated by the PLCOm2012 risk calculator, which combines sociodemographic data and smoking history),4 MSAC recommended using fixed cut‐offs for age and smoking history. This is problematic in terms of both the evidence base that should have guided MSAC's decision and the ethical implications of the decision. MSAC's approach aligns with the design of historical lung cancer screening trials but it ignores an extensive body of evidence, including both a priori and post hoc analyses of trial data that consistently demonstrate that risk calculators are more efficient than fixed criteria.5 Furthermore, it also ignores international trends in the design of lung cancer screening trials and the implementation of lung cancer screening programs.1 But more importantly, the inevitable consequence of applying MSAC's eligibility criteria will be that fewer socially disadvantaged individuals will be eligible to participate in the NLCSP. This has the potential to exacerbate the existing inequity.

Jonathon B Ryan

Joshua M Inglis · Ganessan Kichenadasse · Arduino A Mangoni

Rosalind Walmsley · Priya Sumithran

The Medical Journal of Australia has published an editorial, supporting an Aboriginal and Torres Strait Islander Voice to Parliament. New approaches are needed which place Aboriginal and Torres Strait Islander communities at the heart of discussions and decision making about their futures, the editorial said. Authored by the MJA’s Editor-in-Chief Professor Virginia Barbour, the editorial said the MJA had a fundamental role in promoting and supporting what is best for Australian health and practice. “As you form your own positions, we encourage our readership of health practitioners and researchers, and organisations across Australia, to weigh arguments for and against the Voice in an evidence-led manner that centres core public health principles of equity, justice, and recognition of the upstream determinants of health,” Professor Barbour wrote. The health outcomes in Aboriginal and Torres Strait Islander populations during the coronavirus disease 2019 (COVID-19) pandemic provide an outstanding example of how outcomes are best when Aboriginal people have a voice, the editorial said. "Aboriginal Community Controlled Health Organisations coordinated the response from the National Aboriginal Community Controlled Health Organisation down to remote communities,” Professor Barbour wrote. “As a result, the health gap was reversed in the first year of the pandemic, with Aboriginal and Torres Strait Islander populations experiencing six times fewer cases than the non-Indigenous population, and no recorded deaths [here and here].” Current health care structures and processes do not meet the needs of the Aboriginal and Torres Strait Islander population, the editorial said. “New approaches, which place Aboriginal and Torres Strait Islander communities at the heart of discussions and decision making about their futures, are clearly needed,” Professor Barbour said. Many other health and medical organisations have also announced their support for the Voice to Parliament, Professor Barbour wrote, including the Lowitja Institute, the Australian Indigenous Doctors Association, the Australian Medical Association and the Australian Academy of Health and Medical Sciences. The referendum is expected to occur later this year, on a date to be announced.

Sam Hunt