Research

Improving control of health risk factors will be required for further substantial life expectancy increases

Alan D Lopez · Tim Adair

Given the devastating consequences of TSCI, improved primary prevention strategies are needed

Ben Beck · Peter A Cameron · Sandra Braaf · Andrew Nunn · Mark C Fitzgerald · Rodney T Judson · Warwick J Teague · Alyse Lennox · James W Middleton · James E Harrison · Belinda J Gabbe

Infectious conditions were common among patients, underscoring the significance of environmental determinants of health

Joseph V Mohan · David N Atkinson · Johan B Rosman · Emma K Griffiths

Novel, multifaceted recruitment methods are needed to obtain adequate participation in Australian randomised controlled trials

Roseanne Peel · Shu Ren · Alexis Hure · Tiffany‐Jane Evans · Catherine A D'Este · Walter P Abhayaratna · Andrew M Tonkin · Ingrid Hopper · Amanda G Thrift · Christopher R Levi · Jonathan Sturm · David Durrheim · Joseph Hung · Tom G Briffa · Derek P Chew · Phil Anderson · Lynelle Moon · Mark McEvoy · Philip M Hansbro · David A Newby · John R Attia

EPAs have a strong theoretical basis, can be used as assessment tools in a real world workplace based training environment

Nyoli Valentine · Jon Wignes · Jill Benson · Stephanie Clota · Lambert WT Schuwirth

Pertussis vaccination of pregnant women in Victoria has increased, but influenza vaccination rates remain moderate and variable

Stacey L Rowe · Kirsten P Perrett · Rosemary Morey · Nicola Stephens · Benjamin C Cowie · Terry M Nolan · Karin Leder · Helen Pitcher · Brett Sutton · Allen C Cheng

Correct swabbing technique and caution when interpreting negative results are needed

Daniel P O'Brien · Maria Globan · Janet M Fyfe · Caroline J Lavender · Adrian Murrie · Damian Flanagan · Peter Meggyesy · Jonathan T Priestley · David Leslie

Rapid PCR testing may have several benefits for patients and for the health care system

Nasir Wabe · Ling Li · Robert Lindeman · Ruth Yimsung · Maria R Dahm · Kate Clezy · Susan McLennan · Johanna Westbrook · Andrew Georgiou

The known Treatment of people infected with human immunodeficiency virus (HIV) soon after diagnosis reduces the risk of transmission and HIV‐related morbidity. The proportion and characteristics of people who receive early treatment are not well described.

Hamish McManus · Denton Callander · Basil Donovan · Darren B Russell · Catherine C O'Connor · Stephen C Davies · David A Lewis · Margaret E Hellard · Marcus Y Chen · Kathy Petoumenos · Rick Varma · Aaron Cogle · Mark Alastair Boyd · Andrew Grulich · James Pollard · Nick Medland · Christopher K Fairley · Rebecca J Guy

The known: The gap in life expectancy between Indigenous and non‐Indigenous Australians remains large. Urban Indigenous Australian‐controlled health services are under‐resourced, and mainstream primary care services are often not culturally sensitive.

Siaw‐Teng Liaw · Vicki Wade · John S Furler · Iqbal Hasan · Phyllis Lau · Margaret Kelaher · Wei Xuan · Mark F Harris

The known: Rapid access chest pain clinics (RACPCs), common in the United Kingdom, could improve the management of patients with chest pain in Australia.

James Andrew Black · Kevin Cheng · Jo‐Anne Flood · Garry Hamilton · Serena Parker · Anees Enayati · Faisal S Khan · Tom Marwick

The known The format, content and conduct of medical handovers by hospital doctors are receiving increasing attention from health care policymakers.

David JR Morgan · Tania Harris · Ron Gidgup · Martin Whitely

The known: Opportunistic Q fever serosurveys in Australia suggest that it is underreported, but exposure histories have not been collected.

Heather F Gidding · Helen M Faddy · David N Durrheim · Stephen R Graves · Chelsea Nguyen · Penny Hutchinson · Peter Massey · Nicholas Wood

The knownThe future pancreatic cancer burden attributable to tobacco smoking has not been estimated in Australia. The newNearly 22% of the future burden of pancreatic cancer is attributable to current and former smoking, 15% (5500 cases over the next 10 years) to current smoking alone. The smoking‐related burden of pancreatic cancer is markedly higher for men and for people under 65. The implicationsReducing smoking rates among men and people under 65 would have the greatest impact on reducing the future burden of pancreatic cancer in Australia.

Maria E Arriaga · Claire M Vajdic · Robert J MacInnis · Karen Canfell · Dianna J Magliano · Jonathan E Shaw · Julie E Byles · Graham G Giles · Anne W Taylor · Tiffany K Gill · Vasant Hirani · Robert G Cumming · R Paul Mitchell · Emily Banks · Julie Marker · Barbara‐Ann Adelstein · Maarit A Laaksonen

The known: Clinicians need accurate and reliable tools to help identify people at increased risk of a cardiovascular event.

Loai Albarqouni · Jennifer A Doust · Dianna Magliano · Elizabeth LM Barr · Jonathan E Shaw · Paul P Glasziou

The known: Iodine deficiency re‐emerged in Australia in the 1990s, motivating mandatory fortification of bread with iodised salt in 2009.

Gurmeet R Singh · Belinda Davison · Gary Y Ma · Creswell J Eastman · Dorothy EM Mackerras

Colonoscopy should also be considered in cases of infective endocarditis with an unclear source of infection

Eugene Athan · Ivana Cabiltes · Sarah Coghill · Steven J Bowe

The popularity of e‐cigarettes has increased in Australia since they first became available as smoking cessation tools; an estimated 1.3% of the New South Wales population used them in 2015, and as many as 8.4% had experimented with them.1 E‐cigarettes have been recommended by Public Health England and the Royal College of Physicians as safe smoking cessation tools.2,3 In Australia, a prescription is required for legally importing nicotine‐containing e‐cigarettes.4 The safety of these products for users and the risks for members of their households have not been established. Imported products may not conform to Australian standards, including having child‐resistant closures and appropriate labelling, and refill bottles containing highly concentrated nicotine solutions — one millilitre of which can be lethal if ingested by a child — can be purchased online. Podcast with Ms Carol Wylie We undertook a retrospective analysis of calls to Australian Poisons Information Centres (PICs) during 2009–2016. PICs play a valuable role as health care sentinels when new products such as e‐cigarettes are introduced. Our study was exempted from formal ethics approval by the Children's Health Queensland Hospital and Health Service Human Research Ethics Committee. The numbers of calls about e‐cigarette exposures increased considerably across the study period (Box), although the overall PIC call volume was stable at about 164 000 cases per year. Of 202 sequential e‐cigarette‐related cases, 38% were from relatives of children worried about their exposure to the liquid component of an e‐cigarette after children were found with uncapped vials, sucking the mouthpiece, drinking from separated liquid containers, inhaling the liquid, eating the cartridge, or having splashed liquid in their eyes. Adults and adolescents were the subjects of calls in 126 cases (62%), including calls about the potential side effects of routine use or accidental ingestion, or about skin or eye splash exposures. Twelve calls followed deliberate administration for self‐harm, ten by oral ingestion and two by injection. The reported median concentration of the 43 commercial nicotine solutions involved was 20.2 mg/mL, (range, 0.06–200 mg/mL), but confirmatory testing was not performed and actual concentrations may be higher than labelled, as noted recently.5 Most patients had only mild symptoms at the time of the call to the PIC, mainly gastrointestinal disturbances; twelve had moderate symptoms, usually a gastrointestinal disturbance combined with sedation. The potential risks, however, should not be underestimated; we are aware that an infant recently died in Australia after ingesting a concentrated nicotine solution. Almost all exposures of children to nicotine‐containing e‐cigarette liquid require their hospitalisation for monitoring of possible toxic effects. Australian PIC data refer to calls about exposures to e‐cigarette liquid but may not reflect the prevalence of such exposures. These data nevertheless provide insights into patterns of exposure, usage, and the side effects of e‐cigarettes. Our study can assist health care practitioners when advising patients about the use of e‐cigarettes, and our findings indicate that nicotine‐containing products should be stored where children cannot access them. We would welcome any move to improve the safety of electronic cigarettes, including changes to their labelling, storage, and packaging. Box – Numbers of cases related to e‐cigarette exposures reported to Australian Poisons Information Centres, by calendar year and state* No calls were received about cases in the Northern Territory.

Carol Wylie · Aaron Heffernan · Jared A Brown · Rose Cairns · Ann‐Maree Lynch · Jeff Robinson

General practice can be a rich environment for research when barriers to recruitment are overcome

Jessica E Lockery · Taya A Collyer · Walter P Abhayaratna · Sharyn M Fitzgerald · John J McNeil · Mark R Nelson · Suzanne G Orchard · Christopher Reid · Nigel P Stocks · Ruth E Trevaks · Robyn Woods

Characterising the isolates responsible for infection would help identify virulence factors and the relatedness of isolates

Nabeel Imam · Simone Tempone · Paul K Armstrong · Rebecca McCann · Sandra Johnson · Leon J Worth · Michael J Richards

The known: Rehabilitation reduces the patient's risk of death and disability after a stroke.

Elizabeth A Lynch · Shylie Mackintosh · Julie A Luker · Susan L Hillier

The known: Since 2011, Australian clinical guidelines recommend universal antenatal screening of pregnant women with the Edinburgh Postnatal Depression Scale (EPDS).

Macarena A San Martin Porter · Kim Betts · Steve Kisely · Gino Pecoraro · Rosa Alati

Older people face particular barriers obtaining advice or treatment for alcohol-related problems

Ann M Roche · Victoria Kostadinov

Overprescribing of these medications should be reduced, patients at greater risk identified, risk mitigation strategies implemented

Gillian E Caughey · Svetla Gadzhanova · Sepehr Shakib · Elizabeth E Roughead