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Medical practices
Reducing Nitrous Oxide Emissions Across the Melbourne Biomedical Precinct
Nitrous oxide (N2O) accounts for the majority of Australian healthcare's direct anaesthetic gas-related greenhouse gas emissions due to reticulated system leaks. Updated Australasian guidelines no longer mandate a reticulated N2O supply. We present the efforts of four Melbourne hospitals to reduce N2O emissions across diverse clinical contexts. Two have decommissioned reticulated N2O and adopted cylinder supplies as required through clinical consultation and interdisciplinary collaboration. Two face ongoing high clinical demand for N2O, with multiple locations sharing infrastructure, and are pursuing audits and trials to guide change. These case studies illustrate the diverse strategies and challenges involved in reducing N2O emissions.
Ross Robertson, Andrew Downey, Daryl Williams, Bjorn Makein, Ben Dunne, Tugce Ozturk, Ying Gu, Rebecca McIntyre
Multimorbidity Clusters Among People Aged 65 Years and Over in Australia: A Nationwide Cross-Sectional Data Linkage Study
Objectives To identify sex-specific multimorbidity patterns in Australia, using the Rx-Risk index (a medication-based measure), to: (i) estimate the prevalence of chronic treated conditions; (ii) map network-based multimorbidity clusters; and (iii) examine how these clusters vary by age, socio-economic status and geographic remoteness.DesignAustralian nationwide cross-sectional study using linked Pharmaceutical Benefits Scheme (PBS) and Medicare Benefits Schedule (MBS) data.SettingAustralian residents aged ≥ 65 years with at least one PBS and/or MBS claim between 1 July 2022 and 30 June 2023.Main Outcome MeasuresSex-specific network-based multimorbidity clusters and cluster profiles by age, socio-economic status and geographic remoteness.ResultsA total of 4,435,784 individuals (mean age, 74.8 years; 53.2% female) were included. Multimorbidity (≥ 2 conditions) was present in 76.1% of the cohort. Three consistent multimorbidity clusters were identified in both sexes: cardiovascular–metabolic, neuropsychiatric–functional decline and inflammatory–musculoskeletal–cancer. The prevalence of these clusters and their component conditions varied across sociodemographic groups, with higher prevalence observed in individuals aged ≥ 85 years and those living in socio-economically disadvantaged areas. Minimal differences were observed between metropolitan and non-metropolitan regions.ConclusionsMultimorbidity was highly prevalent among older Australians with at least one PBS and/or MBS claim during the study year, with multimorbidity clusters showing marked sociodemographic variation in prevalence. These findings highlight the heterogeneity in treated conditions captured in administrative claims and provide insights to inform future research and policy planning for prevention and management of multimorbidity in an ageing population.
Weisi Chen, Christine Y. Lu, Sarah N. Hilmer, Alice A. Gibson, Edwin C. K. Tan
When ‘Liver Enzymes’ Are Not Hepatic: Late-Onset Pompe Disease
Elevated liver function tests are commonly attributed to hepatic disease but may reflect extrahepatic pathology. We describe the case of an 18-year-old athletic woman with a 2-year history of elevated aspartate aminotransferase (AST), alanine aminotransferase (ALT) and creatine kinase (CK) levels, initially investigated extensively for hepatic causes. Despite normal liver imaging and biopsy, ongoing abnormalities prompted metabolic evaluation, leading to the diagnosis of late-onset Pompe disease. This case highlights the diagnostic challenges of rare metabolic myopathies, the importance of recognising muscle-derived aminotransferase elevation and the need for broad diagnostic consideration when standard investigations are unrevealing.
Shauna Madigan, Georgina England, Wayne Rankin
West Nile virus Kunjin subtype in rural NSW
The patient experienced headache, anorexia, body aches, and confusion during a camping holiday through central Queensland
Emily Gibson · Megan Whitley · Peter Murray · Linda Hueston · Jane Bennett · Raguharan Kathiresu · David N Durrheim
The impact of the Breast Screen NSW transition from film to digital mammography, 2002–2016: a linked population health data analysis
Rachel Farber · Nehmat Houssami · Katy J L Bell
Evidence from Australian cohort studies about asthma trajectories and transitions across the life course: a narrative review
Using novel statistical and artificial intelligence techniques to interrogate combined cohort datasets will open the door to drug discovery
Caroline Lodge · Xin Dai · Ingrid A. Laing · Michael P Menden · Anthony Flynn · Gary P Anderson · Sarath Ranganathan · Shyamali C Dharmage
Technological advances in the search for a CURE for asthma
Combining new technologies with artificial intelligence will enable more accurate disease prediction, precision diagnoses, and personalised treatments
Sara Quon · Timothy M Johanson · Ridhima Wadhwa · Alen Faiz · Anthony Flynn · Gary P Anderson · Amanda J Cox · Nicholas P West · Michael P Menden · Rhys S Allan
Changes in patient management after preoperative MRI for newly diagnosed breast cancer: a multicentre prospective observational study
MRI for selected women where conventional imaging is suboptimal may improve surgical planning and thus afford better outcomes
Michael L Marinovich · Nehmat Houssami · Andrew Spillane · Gregory B Mann · Donna Taylor · Michelle Reintals · Nadine Phillips · Max K Bulsara · Patsy Siok Hwa Soon · Tracey Dickens · Christobel M Saunders
The detection of avian influenza virus in human pathology laboratories in Australia, New Zealand, and South Pacific nations
Avian influenza viruses can be detected by human diagnostic testing platforms routinely used for testing for influenza A viruses
Lisa M Sedger · Vishal Ahuja · Katherine A Lau · Deane L Byers · Torsten Theis · Peter D Kirkland · Catherine Pitman
A case of Lyme carditis in a returned traveller: a rare cause of reversible heart block in Australia
A well 37-year-old male patient presented to a tertiary hospital in New South Wales in July 2024 with presyncope and his smart watch alerts indicating resting bradycardia at 40 beats per minute
Eunice Chuah · Hari Sritharan · Zachariah Seidman · Avedis A Ekmejian · Karin Chia
Assessment of metabolic dysfunction‐associated fatty liver disease in primary care: a consensus statement summary
In recognition of the increasing burden of metabolic dysfunction-associated fatty liver disease (MAFLD) in Australia, and the lack of clear guidelines for general practitioners, this consensus statement summary presents 21 recommendations on the assessment and monitoring of MAFLD in adult patients in primary care
Leon A Adams · William W Kemp · Kate R Muller · Elizabeth E Powell · Stuart K Roberts · Luis Calzadilla Bertot · Stephanie Best · Gary Deed · Jon D Emery · Samantha L Hocking · Graham R Jones · John S Lubel · Sinead Sheils · Stephen M Twigg · Gerald F Watts · Jacob George
Lung cancer biobanking in Australia: challenges and future directions
Overview of lung cancer biobanking globally and in Australia, challenges such as difficulty with tissue acquisition, the usefulness of biospecimens in multi-omic analysis, as well as unique challenges faced in Australia
Sarah Yeo · Stephen Q Wong · Farzaneh Atashrazm · Andreas Behren · Anthony T Papenfuss · Natalia Vukelic · Lisa Briggs · Ashleigh R Poh · Daniel Steinfort · Natasha Smallwood · Kate Sutherland · Vivek Naranbhai · Sagun Parakh · Tracy Leong
Opportunities to improve surveillance of hepatocellular carcinoma in Australia
Introduction of five key actions for Australia to reduce hepatocellular carcinoma mortality through increasing liver cancer surveillance uptake
Jess Howell · Jon D Emery · Stuart Roberts · Alexander J Thompson · Michael Ng · Jacob George · Barbara A Leggett · Edmund Tse · Bella Nguyen · Troy Combo · Alan J Wigg
Severe hypoglycaemia secondary to chronic opioid‐induced hypothalamic–pituitary–adrenal axis suppression: an under‐recognised phenomenon
A 49-year-old woman with type 2 diabetes mellitus was hospitalised with critical hypoglycaemia
Michael Do · Annabelle G Hayes · Malgorzata M Brzozowska
Incidental findings during lung low‐dose computed tomography cancer screening in Australia and Canada, 2016–21: a prospective observational study
Incidental findings during lung cancer screening are frequent, and clinical reporting of these findings is inconsistent
Asha Bonney · Diane M Pascoe · Mark W McCusker · Daniel Steinfort · Henry Marshall · Annette McWilliams · Fraser J Brims · Emily Stone · Paul Fogarty · Jeremy D Silver · Brad Milner · Elizabeth Silverstone · Eugene Hsu · Duy Nguyen · Christopher Rofe · Cameron White · XinXin Hu · John Mayo · Renelle Myers · Kwun M Fong · Renee Manser · Stephen Lam
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
Decentralised COVID‐19 molecular point‐of‐care testing: lessons from implementing a primary care‐based network in remote Australian communities
The First Nations COVID-19 molecular point-of-care (POC) testing program was part of the Australian pandemic response, ensuring equitable testing access and minimising diagnosis delays. To inform future pandemic preparedness, we reviewed the POC framework to provide key recommendations.
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
The impact of the BreastScreen NSW transition from film to digital mammography, 2002–2016: a linked population health data analysis
The transition from film to digital mammography may have increased the detection of indolent cancers
Rachel Farber · Nehmat Houssami · Kevin McGeechan · Alexandra L Barratt · Katy JL Bell
Beware of the rinse: magic mouthwash as a rare cause of iatrogenic Cushing syndrome and secondary adrenal insufficiency
A 76-year-old female patient was urgently referred to the endocrine clinic for suppressed morning serum cortisol levels
Mike Lin · Lisa Horgan · Albert Hsieh
Five decades of debate on burnout
To inform future burnout research, we discuss the aetiology, prevalence, distinctiveness, stigmatising character and basic definition of burnout.
Renzo Bianchi · James F Sowden
The resurgence of congenital syphilis in Australia: novel approaches and sustained, effective public health efforts are required
Coordinated antenatal and sexual health care policies, clear guidelines, and broad education programs could reduce the rate
Stephanie Bond · Marcus Y Chen
Ensuring a fit‐for‐purpose resource for consumers, clinicians and health services: the updated Osteoarthritis of the Knee Clinical Care Standard
The updated Clinical Care Standard is an important tool that can support best practice care for people with knee osteoarthritis
Ilana N Ackerman · Fiona Doukas · Rachelle Buchbinder · Sally Dooley · Wendy Favorito · Phoebe Holdenson Kimura · David J Hunter · James Linklater · John B North · Louise Elvin‐Walsh · Christopher Vertullo · Alice L Bhasale · Samantha Bunzli
Treatment‐resistant tinea caused by Trichophyton indotineae in Australia
An otherwise well 25-year-old man presented with an itchy rash of 15 months duration on his groin and thighs, with no systemic symptoms
Kyra YL Chua · Catriona L Halliday · Sharon C‐A Chen · Sonia Koning · Jedrzej Pawlikowski · Philipp du Cros · Tony M Korman
