General medicine

It is important to provide options for obtaining both oral fluid- and blood-based HIV self-tests

Dana YL Lee · Jason J Ong · Kirsty Smith · Muhammad S Jamil · Ruthy McIver · Rebecca Wigan · Kate Maddaford · Anna McNulty · John M Kaldor · Christopher K Fairley · Benjamin Bavinton · Marcus Chen · Eric PF Chow · Andrew E Grulich · Martin Holt · Damian P Conway · Mark Stoove · Handan Wand · Rebecca J Guy

First Nations Yol?u women are speaking up to reclaim control and return of childbirth services

Sarah Ireland · Yvette Roe · Suzanne Moore · Elaine Ḻäwurrpa Maypilama · Dorothy Yuŋgirrŋa Bukulatjpi · Evelyn Djota Bukulatjpi · Sue Kildea

mRNA vaccine development will continue to accelerate, and further improvements to the technology may mitigate some of the current limitations

Isabella Overmars · George Au‐Yeung · Terence M Nolan · Andrew C Steer

A 42-year-old man presented with elevated alanine aminotransferase and aspartate aminotransferase on a blood test screening for viral hepatitis

William Luu · Joanne Sy · Queenie Luu

Longer ambulance offload times are associated with greater 30-day risks of death and ambulance re-attendance

Luke P Dawson · Emily Andrew · Michael Stephenson · Ziad Nehme · Jason Bloom · Shelley Cox · David Anderson · Jeffrey Lefkovits · Andrew J Taylor · David Kaye · Karen Smith · Dion Stub

Progress has been sluggish, and social factors and access to major health service schemes need much more attention

Ian T Ring · Kalinda Griffiths

Higher in-hospital mortality during the third wave may reflect the virulence of Delta or the higher number of ICU admissions

Husna Begum · Ary S Neto · Patricia Alliegro · Tessa Broadley · Tony Trapani · Lewis T Campbell · Allen C Cheng · Winston Cheung · D James Cooper · Simon J Erickson · Craig J French · Edward Litton · Richard McAllister · Alistair Nichol · Annamaria Palermo · Mark P Plummer · Hannah Rotherham · Mahesh Ramanan · Benjamin Reddi · Claire Reynolds · Steven AR Webb · Andrew A Udy · Aidan Burrell

A 32-year-old man with 15 years of intermittent bloody diarrhoea was diagnosed with ulcerative proctosigmoiditis

Kenneth K Cho · Yanna Ko · Kelly Nilsen · Christine Verdon · Giuseppe Femia

Cradle-to-grave regional programs featuring immersive community engaged education are needed to ensure a sustainable rural medical workforce

Roger P Strasser

General practitioners view health and medical research positively, but their participation in postal surveys is typically low

Alison C Zucca · Mariko Carey · Rob W Sanson‐Fisher · Joel Rhee · Balakrishnan (Kichu) R Nair · Christopher Oldmeadow · Tiffany‐Jane Evans · Simon Chiu

Value co-creation supports the delivery of optimal person-centred care in an efficient way

Tina Janamian · Paresh Dawda · Walid Jammal

Selective personality-targeted interventions offer an efficacious approach to targeting suicidal ideation in Australian school students

Lucinda R Grummitt · Jennifer Debenham · Erin Kelly · Emma L Barrett · Katrina Champion · Patricia Conrod · Maree Teesson · Nicola Newton

As the number of requests for raw genomic data increases, policies and protocols reflecting the perspectives of clinicians, patients, researchers and research participants are required

Jane L Nielsen · Carolyn Johnston · Tracey O'Brien · Vanessa J Tyrrell

Supporting improved general practice is urgent, and quality improvement collaboratives are an effective Australian strategy

Andrew W Knight · John Fraser · C Dimity Pond

The continuation of chronic disease management in primary care remains essential during the COVID-19 pandemic

Anne Parkinson · Sethunya Matenge · Jane Desborough · Sally Hall Dykgraaf · Lauren Ball · Michael Wright · Elizabeth A Sturgiss · Michael Kidd

The Australian and New Zealand living stroke management guidelines provide timely, evidence-based updates to recommendations

Coralie English · Kelvin Hill · Dominique A Cadilhac · Maree L Hackett · Natasha A Lannin · Sandy Middleton · Annemarei Ranta · Nigel P Stocks · Julie Davey · Steven G Faux · Erin Godecke · Bruce CV Campbell

The search for a cost-effective Australian model of comprehensive, coordinated patient-centred care that improves outcomes continues

Mark F Harris · Joel Rhee

To the Editor: Fraile Navarro and colleagues1 recently published 20 recommendations for the treatment of coronavirus disease 2019 (COVID‐19) in children and adolescents from the National COVID‐19 Clinical Evidence Taskforce. For the paediatric inflammatory multisystem syndrome (PIMS‐TS) recommendations, the Taskforce convened an expert advisory group.1 In the absence of clinical trials, the panel considered peer‐reviewed guidelines and cohort studies to formulate consensus recommendations.1 However, they deferred providing any guidance to help clinicians prevent thromboembolism. We suggest the Taskforce consider the same approach for paediatric anticoagulation guidance. COVID‐19 is associated with marked coagulation activation and hypercoagulability in children.2,3 Life‐threatening pulmonary embolus requiring thrombolysis has been encountered in Australian adolescents hospitalised with COVID‐19. A retrospective cohort study published in 2021 found that 2.1% of children hospitalised with symptomatic COVID‐19 infection and 6.5% of those with PIMS‐TS developed thrombosis.4 Thrombosis occurred more frequently in children aged 12years and over who had central lines, PIMS‐TS, or an underlying oncological diagnosis. A D‐dimer of more than five times the upper limit of normal was significantly associated with thrombosis.4 The authors refer to “paediatric guidelines published in the US”, which are published on behalf of the Pediatric/Neonatal Hemostasis and Thrombosis Subcommittee of the International Society of Thrombosis and Haemostasis; these adapt current consensus prophylaxis guidelines to include COVID‐19‐specific features.5 In deferring making specific recommendations, the authors suggested using existing local thromboprophylaxis guidelines. The Royal Children’s Hospital, Melbourne and the Sydney Children’s Hospital, Randwick have both independently developed COVID‐19‐specific thromboprophylaxis guidelines (that are very closely aligned),6,7 as have many other centres globally because previous local thromboprophylaxis guidelines are inadequate for COVID‐19‐associated thrombotic coagulopathy. The Melbourne/Sydney guidelines advise baseline coagulation testing in hospitalised children with COVID‐19, incorporating D‐dimer to assist risk assessment, twice‐daily enoxaparin and anti‐Xa monitoring/dose titration.6,7 These could be provided as supplemental material in these living guidelines. The COVID‐19 anticoagulation in Children–Thromboprophylaxis (COVAC‐TP) trial — a phase 2 single‐arm study looking at 40 children who will receive monitored, low dose, twice‐daily enoxaparin (ClinicalTrials.gov Identifier NCT04354155) — will not change the level of evidence, so waiting for completion of this trial does not seem appropriate.

Gemma L Crighton · Anthea Greenway · Susan Russell

COVID-19 has challenged and tested Australian general practice while reinforcing its centrality and potential

Claire L Jackson

A condition considered rare is not sought; a condition not sought is not diagnosed; a condition not diagnosed is considered rare…

Mark R Nelson

Our multicomponent intervention did not improve self-rated health, health service use, or health literacy

Richard L Reed · Leigh Roeger · Yuen H Kwok · Billingsley Kaambwa · Stephen Allison · Richard H Osborne

Understanding drug-related anaphylaxis could improve prescribing practice in Australia

George P Drewett · Jess Encena · Joy Gregory · Lucinda Franklin · Jason A Trubiano

Recruitment to and retention in rural practice were higher among graduates with extended RCS experience

Alexa N Seal · Denese Playford · Matthew R McGrail · Lara Fuller · Penny L Allen · Julie M Burrows · Julian R Wright · Suzanne Bain‐Donohue · David Garne · Laura G Major · Georgina M Luscombe