Issues
Volume 222 Issue 5
Cover image credit: Bussarin/stock.adobe.com
Editor’s choice
A national perspective
Since 1914, when a Melbourne and a Sydney publication joined forces, Australia has had a national medical journal. The three perspective articles in today's issue of the MJA exemplify the unique frame of reference that a national journal brings to the Australian medical community. Perspectives are short pieces that discuss current questions in health care practice and policy. Sometimes commissioned by the Journal, but usually welcomed as submissions, they always present an expert, individual analysis of a topic of interest to our readers. In this issue of the MJA, Clifford and colleagues (https://doi.org/10.5694/mja2.52605) discuss the looming threat posed by synthetic opioids such as nitazenes, and call for greater national preparedness. Nitazenes are a class of drugs that, since 2021, have become well established in the illicit drug market in Australia, and have been implicated in 17 deaths since 2021. The authors assess the national situation with regards to these drugs and conclude that “there are sufficient signals to consider preparedness for an increase in opioid‐related harms”. Building on Australia's world‐leading experience in harm reduction, they note that people with lived and living experience of drug use must be central to preparedness planning and responses. Wyber and colleagues (https://doi.org/10.5694/mja2.52590) review the fragility of our country's access to the essential drug benzathine benzylpenicillin G, and the threat this poses to the management of syphilis and the prevention of rheumatic heart disease. These diseases, as the authors note, disproportionately affect Aboriginal and Torres Strait Islander people, who in turn are affected by a lack of reliable supply of high quality benzathine benzylpenicillin G. There are global issues with supply because of fragmented manufacturing. In 2023–24, we saw how Australia was able to respond to a supply disruption. Although many organisations were involved in the response, the authors note the important action of the National Aboriginal Community Controlled Health Organisations in disseminating key information that mitigated the effect of this disruption. They call for national strategic investment in domestically important products, including developing a sovereign manufacturing capability. Abdi and colleagues (https://doi.org/10.5694/mja2.52608) guide the reader through a thoughtful consideration of the term “CALD” (culturally and linguistically diverse), the history of its use in our national discourse, and the hidden, potentially negative effects of language. They note that as Australia moves towards greater inclusivity, our language must evolve to encapsulate the richness and complexity of the experiences of multicultural communities. These perspectives each present a scholarly consideration of an issue of national importance, and through this Journal reach a national readership. Having lived and worked in countries where a national medical journal was absent, or ineffective, I am reminded of the unique value of this part of our health system. In this time, as boundaries blur and as trust in traditional sources of information is questioned, that value only increases. The MJA has a history of engaging strongly in issues of national importance, alerting and giving voice to the Australian medical community. The Journal had an important role in sharing the dangers of thalidomide (https://doi.org/10.5694/j.1326‐5377.1961.tb70244.x and https://doi.org/10.5694/j.1326‐5377.1962.tb20203.x), providing a forum for the lively debate (https://doi.org/10.5694/j.1326‐5377.2000.tb139219.x) for Universal Healthcare (Medibank, the precursor to Medicare), and promoting an evidence‐based approach to prevention during the terrible early years of the HIV/AIDS epidemic (https://doi.org/10.5694/j.1326‐5377.1984.tb113138.x). As climate change and new pandemic agents present changing threats to health, having a continued national perspective on these issues is essential.
Robert Oelrichs
Perspective
Responding to reports of nitazene toxicity in Australia
To reduce opioid-related harms, we must support evidence-informed and timely detection and monitoring of nitazenes and emerging drugs; and harm reduction and clinical interventions
Brendan Clifford · Amy Peacock · Krista J Siefried · John Gobeil · Jennifer L Smith · Nadine Ezard
Is it time to retire the label “CALD” in public health research and practice?
The term “culturally and linguistically diverse” (CALD) is widely used in Australian public health. We discuss the limitations of the term and how it masks distinct needs and experiences of various cultural groups
Ikram Abdi · Adeline Tinessia · Abela Mahimbo · Meru Sheel · Julie Leask
Shortages of benzathine benzylpenicillin G in Australia highlight the need for new sovereign manufacturing capability
A proactive national response to ongoing benzathine benzylpenicillin G shortages is required, and this includes exploring sovereign manufacturing capacity
Rosemary Wyber · Glenn Pearson · Laurens Manning
Medical education
Management challenges and prognostic uncertainties in heat‐induced acute liver failure
A 26-year-old man with central obesity (body mass index, 32.7 kg/m2) and a history of drinking up to 22 standard drinks over weekends, collapsed 5 minutes following a 5 km run in hot and humid conditions in Brisbane, Australia
Nicholas Smith · Richard Skoien · Melita Andelkovic
Erratum
Erratum
Ramson JA, Williams MJ, Afolabi BB, et al. Pregnancy, childbirth and the postpartum period: opportunities to improve lifetime outcomes for women with non-communicable diseases. Med J Aust 2024; https://doi.org/10.5694/mja2.52452 In this perspective article, the first two authors should have been recognised as equal first authors (Jenny A Ramson and Myfanwy J Williams). ■ doi: 10.5694/mja2.52614
Editorial
Mandatory research projects by medical specialist trainees: suboptimal today, world‐leading tomorrow?
Our medical colleges in Australia are on the right track by promoting and, preferably, requiring research during specialty training
Nicholas J Talley
Research
Mandatory research projects during medical specialist training in Australia and New Zealand: a survey of trainees’ experiences and reports
The time commitment and poor quality research associated with mandatory research projects were frequent concerns
Paulina Stehlik · Caitlyn Withers · Rachel C Bourke · Adrian G Barnett · Caitlin Brandenburg · Christy Noble · Alexandra Bannach‐Brown · Gerben B Keijzers · Ian A Scott · Paul P Glasziou · Emma C Veysey · Sharon Mickan · Mark Morgan · Hitesh Joshi · Kirsty Forrest · Thomas G Campbell · David A Henry
Closing the gap in kidney disease: validating the reporting of Aboriginal and/or Torres Strait Islander identification in a clinical quality registry using linked data
Integrating data to improve equity metrics in ANZDATA, including ethnicity and cultural identity, is vital for improving the health of Indigenous people
Heather J Baldwin · Nicole De La Mata · Grant Sara · Faye McMillan · Brett Biles · Jianyun Wu · Paul Lawton · Stephen McDonald · Angela C Webster
The impact of pay‐for‐performance incentives for stroke unit access on public hospital costs and use, Queensland, 2012–17: interrupted time series analysis
Improving quality of care without increasing costs or hospital demand, the pay-for-performance program increased value for health care spending
Rohan Grimley · Joosup Kim · Helen M Dewey · Nadine E Andrew · Taya A Collyer · Eleanor S Horton · Greg Cadigan · Dominique A Cadilhac
Research letter
Methylphenidate and (lis)dexamfetamine toxicity‐related deaths of adults, Australia, 2000–24: analysis of NCIS data
People for whom greater caution is warranted including those with histories of substance misuse or mental health problems
Shane Darke · Amy Peacock · Johan A Duflou · Michael Farrell · Julia Lappin
Consensus statement
National consensus statement on opioid agonist treatment in custodial settings
Introduction: Opioid use and dependence are prevalent among incarcerated people, contributing to elevated rates of overdose and other harms in this population. Opioid agonist treatment (OAT) has been shown to be an effective intervention to mitigate these risks. However, challenges to health care implementation in the custodial sector result in suboptimal and variable access to OAT in prisons nationally. Main recommendations: Among a national multidisciplinary expert panel, we conducted a modified Delphi study that yielded 19 recommendations to government, relevant health authorities and custodial health services. These recommendations cover five core domains: induction or continuation of OAT, OAT options and administration, transition of care to the community, special populations, and organisational support. Key recommendations include prompt recognition and treatment of opioid withdrawal, active linkage to community‐based OAT providers upon release, and ensuring appropriate organisational support through local protocols, adequate funding, and monitoring of key program indicators. Changes in management as a result of this statement: This consensus statement addresses a significant gap in national policy on OAT in Australian prisons. The recommendations, finalised in July 2024, set forth best practice standards grounded in evidence and expert consensus. We expect that implementing these recommendations will enhance the quality, consistency and continuity of OAT both within prison and upon release. Optimising OAT provision is crucial for improving health outcomes and addressing the risk of overdose, which is the leading cause of death among people released from prison.
Jocelyn Chan · Jon Cook · Michael Curtis · Adrian J Dunlop · Ele Morrison · Suzanne Nielsen · Rebecca J Winter · Thileepan Naren
The 2024 report of the MJA–Lancet Countdown on health and climate change: Australia emerging as a hotspot for litigation
Paul J Beggs · Alistair J Woodward · Stefan Trueck · Martina K Linnenluecke · Hilary Bambrick · Anthony G Capon · Zerina Lokmic‐Tomkins · Jacqueline Peel · Kathryn Bowen · Ivan C Hanigan · Nicolas Borchers Arriagada · Troy J Cross · Sharon Friel · Donna Green · Maddie Heenan · Ollie Jay · Harry Kennard · Arunima Malik · Celia McMichael · Mark Stevenson · Sotiris Vardoulakis · Aditya Vyas · Marina B Romanello · Maria Walawender · Ying Zhang
The Fossil Fuel Non‐Proliferation Treaty: what it is, its importance for health, and why Australia should endorse it
Philomena Colagiuri · Jake TW Williams · Paul J Beggs · Ying Zhang
Tick tock: the travelling time bomb
Matthew AK Martin · Maxwell E Olenski
Improving palliative care for people who use alcohol and other drugs
Grace FitzGerald · Jon Cook · Peter Higgs · Charles Henderson · Sione Crawford · Thileepan Naren
Decentralised COVID‐19 molecular point‐of‐care testing: lessons from implementing a primary care‐based network in remote Australian communities
Belinda Hengel · Rebecca J Guy · Dawn Casey · Lorraine Anderson · Kirsty Smith · Kelly Andrewartha · Tanya D Applegate · Amit Saha · Philip Cunningham · Lucas DeToca · William D Rawlinson · Marianne Martinello · Annie Tangey · Prital Patel · Mark DS Shephard · Susan Matthews · Louise Causer