Letters

In Reply We thank Hakimi and colleagues [1] for their interest in our article summarising the epidemiological data pertaining to metabolic dysfunction-associated steatotic liver disease (MASLD) and metabolic dysfunction-associated fatty liver disease (MAFLD) in Australia [2]. We agree with their sentiments that the multisystem nature of MASLD/MAFLD necessitates a broader approach to managing metabolic health and that it is imperative for governmental policy initiatives to curb the rising prevalence and associated morbidity and mortality that occur with metabolic-associated or obesity-related diseases, which currently place a strain on resource-limited public health services....

Karl Vaz, Daniel Clayton-Chubb, William W. Kemp, Stuart K. Roberts, Ammar Majeed

To the Editor, We read with interest the review by Vaz and colleagues [1] examining metabolic dysfunction-associated steatotic liver disease (MASLD) in Australia. They should be commended on synthesising epidemiological data and emphasising fibrosis as the principal determinant of liver-related morbidity and mortality. Their focus on fibrosis risk stratification, using the Fibrosis-4 Index followed by vibration-controlled transient elastography or enhanced liver fibrosis testing, reflects international consensus and is pragmatic and scalable given rising disease prevalence [2]....

Yousef Hakimi, Prarthana Thiagarajan, Michael Braude

To the Editor, Thurtle's timely article [1] is one of a sea of examples where the default position of many of our healthcare bodies is captured very aptly by the Lancet article title: ‘Gaza has been failed by silence and impunity’ [2]. Both articles make for challenging reading, demonstrating how even pathways to publication have created their own form of denial and distance....

Ayman Hamdan, Anisa J. N. Jafar

To the Editor, We thank Kazi and colleagues for their recent publication outlining important outcomes concerning sex differences in people from New South Wales with ST-elevation myocardial infarction (STEMI) [1]. We agree with the authors that efforts must be made to address inequities in myocardial infarction treatment and outcomes worldwide with respect to sex [2]....

Adam C. Livori, Jedidiah I. Morton, Dianna J. Magliano, Jonathan E. Shaw

In Reply: We thank Hugh for his comments [1] on our article [2] and the opportunity to reply.The monthly morbidity and mortality meetings have been central to surgical quality since the founding of the American College of Surgeons in 1913. However, as Hugh notes, their quality is highly variable and their conclusions not robustly reported. Further, many are inwardly focused and do not assess care against external evidence-based or peer benchmarks....

Robert J. Aitken, Julian A. Smith, Guy J. Maddern

In Reply: The aim of our article was to examine whether sex differences in care and outcomes for people with ST-elevation myocardial infarction (STEMI) had declined through analysis of the New South Wales Admitted Patient Data Collection from 2011 to 2020 [1]. This found that care and outcomes had improved over time among patients with STEMI and that this improvement was steeper in females compared with males and, thus, the gap by sex had narrowed over time....

Samia Kazi, Simone Marschner, Clara K. Chow

To the Editor, I read with interest the perspective by Aitken and colleagues on the role of medical colleges in ensuring participation in Clinical Quality Registries [1]. The authors should be commended for discussing this issue and for calling for stronger accountability. Although they highlighted the importance of clinical audit, the reality is that, despite long-standing guidelines from the Royal Australasian College of Surgeons (RACS) and state health departments [2, 3], clinical audit is performed inconsistently and often poorly. Morbidity and mortality meetings, although universally endorsed, vary widely in quality and many fail to deliver genuine quality improvement. High-quality, effective clinical audit meetings (surgical mortality and morbidity meetings) are rare, notwithstanding RACS guidelines or the administrative box-ticking exercises often done by clinical governance departments [4]....

Thomas J. Hugh

Liz Sutton, Harsha Ananthram, Rebecca Matthews

Wendy Pollock, Alissa Fleming, Ensieh Fooladi, Joy Kloester, Anne Tremayne, Yasmin Zisin, Bethany Carr, Kym Davey, Suzanne Willey, Jenny Gamble

Bashi Kumar-Hazard, Andrew M. Bisits, Sharon L. Settecasse, Jenny Gamble, Hazel Keedle, Hannah G. Dahlen

Virginia Barbour

Michael J. Stewart, Tom R. Sutherland

Meggan J. Devery, Katie Brooker, Kitty-Rose Foley

Saman Khalatbari-Soltani, Edward Jegasothy, Seye Abimbola, Anita van Zwieten

Lucio Naccarella, Katrina Plamondon, Alison Brown, Alexandra Kent, Sana Shahram, Donya Eghrari, Nicole M. Rankin, Stephanie Best, Marlena Klaic, Zoe Fehlberg, Michelle Lambert, Sue Crengle

Joanna Y. Gong, Emily D. Williams, Agus Salim, Spiros Fourlanos, Jonathan E. Shaw, Dianna J. Magliano

Mark Robinson, Gerry McCartney

Fei Zhang, Zhong Wang

Danielle M. Muscat, Kirsten J. McCaffery, Heather L. Shepherd, Marguerite Tracy

Thomas Bradley

Sav Zwickl, Ada S. Cheung

Jason Chuen

Jesse Ey, Guy J. Maddern

Emma McGonigal, Andrew V. White, Valerie Sung, Karen Liddle, Lilian Downie, Emily Shepard

Matthew Samarin