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Until recently, the management of people with inherited retinal diseases (IRDs) was largely limited to referral for vision aids and registration as being legally blind. This situation is now rapidly changing in the disciplines of ophthalmology and clinical genetics, largely due to the emergence of gene‐based therapies that halt disease progression. IRDs comprise a group of diverse disorders that includes retinitis pigmentosa, Stargardt disease, choroideraemia, Best disease, congenital stationary night blindness, achromatopsia, Leber congenital amaurosis, and similar conditions. Four decades of research have led to the identification of pathogenic variants in more than 300 IRD‐causing genes. While the individual conditions and gene variants are rare, together they affect up to one in 1000 people in Australia, or as many as 25 000 people; IRDs are the leading cause of blindness in working age adults.1,2 The loss of central or peripheral vision, profound nyctalopia, and debilitating photophobia have a significant impact on daily activities and consequently the independence of people with these conditions. For example, IRDs can affect navigation, facial recognition, and driving: all significant for quality of life.3
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Fred Chen receives consultancy fees from Novartis, PYC Therapeutics, and Janssen.
The burden of asthma for patients and doctors can be reduced through simple evidence‐based approaches to care and self‐management
In 2017–18, there were almost 40 000 hospitalisations for asthma, up to 80% of which could have been avoided with better asthma care and resources in the community.11,12,13 In 2020–21, the numbers were reduced, paradoxically thanks to the COVID‐19 pandemic.14 However, children aged under 15 years still constitute the largest proportion of people presenting to emergency departments in Australia with a respiratory condition, and asthma is the leading preventable cause of these presentations.15,16,17 Respiratory conditions generally account for the highest proportion of emergency department presentations in relation to other disease systems, and around one‐third of these people are admitted to hospital.5 These presentations and admissions for asthma comprise a large group of patients with a readily treatable disease.12 Further, there is a tenfold variation in hospitalisation rate between the highest and the lowest socio‐economic regions, and people with asthma in low income settings and in rural Australia are doing worst of all.5,18 This is not inevitable — much of it can be prevented by simple evidence‐based approaches to asthma care, including assessing triggers, performing spirometry, devising a written action plan, and checking device use and adherence.
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Christine Jenkins has received honoraria from AstraZeneca, GSK, Boehringer Ingelheim, Novartis and Chiesi for educational and advisory activities. Philip Bardin has received honoraria from GSK, AstraZeneca and Sanofi for educational activities. John Blakey has received honoraria from AstraZeneca, Boehringer Ingelheim, Chiesi, GSK and Sanofi for educational activities. Kerry Hancock has received honoraria from AstraZeneca, Chiesi, Novartis, BI Arterial Education, Asthma Australia and Spirometry Learning Australia for educational activities. Peter Gibson has received honoraria from AstraZeneca, GSK, Novartis and Chiesi for educational activities. Vanessa McDonald has received honoraria from GSK, AstraZeneca, Novartis, Boehringer Ingelheim and Menarini for educational and advisory activities.
The direct and indirect costs of cancer care are rising and can influence treatment decisions and outcomes for patients.1 Several patient‐level characteristics are risk factors for financial burden, including lower age, chemotherapy, and poorer general health.2 Health professionals have a role in providing information, resources, and support to mitigate financial distress for patients.3
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jefford@unimelb.edu.au, michael.jefford@petermac.org
Open access:
Open access publishing facilitated by The University of Melbourne, as part of the Wiley – The University of Melbourne agreement via the Council of Australian University Librarians.
We acknowledge the Victorian Department of Health as the source of the Victorian Health Experience Survey data. We also thank all participants who completed the survey.
No relevant disclosures.
Introduction: Long term opioids are commonly prescribed to manage pain. Dose reduction or discontinuation (deprescribing) can be challenging, even when the potential harms of continuation outweigh the perceived benefits. The
Main recommendations: Eleven recommendations provide advice about when, how and for whom opioid deprescribing should be considered, while noting the need to consider each person's goals, values and preferences. The recommendations aim to achieve:
Changes in management as a result of these guidelines: To our knowledge, these are the first evidence‐based guidelines for opioid deprescribing. The recommendations intend to facilitate safe and effective deprescribing to improve the quality of care for persons taking opioids for pain.
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Aili Langford was funded by a Research Training Program Scholarship and Supplementary Scholarship from the University of Sydney throughout her PhD candidature. The research team were awarded a 2019 Sydney Pharmacy School, Faculty of Medicine and Health, University of Sydney Research Support Grant. Christine Lin is funded by a National Health and Medical Research Council (NHMRC) Investigator Grant (1193939). Danijela Gnjidic is funded by the NHMRC Dementia Leadership Fellowship (1136849). Emily Reeve is funded by an NHMRC Investigator Grant (1195460). Suzanne Nielsen is funded by an NHMRC Career Development Fellowship (1163961). The funding bodies/sources had no role in the planning, writing or publication of this work.
We acknowledge Jack Collins (Postdoctoral Research Associate, University of Sydney) and Benita Suckling (Master of Philosophy Candidate, University of Sydney, and Pharmacist at Caboolture Hospital, Queensland Health, Brisbane) for their contributions to the synthesis and appraisal of evidence informing this guideline. We also acknowledge Steven Agiasotis (undergraduate pharmacy student, University of Sydney) for his contribution to the development of the guideline algorithm.
Emily Reeve receives royalties from UpToDate (Wolters Kluwer) for writing a chapter on deprescribing. Suzanne Nielsen has received untied educational grants from Seqirus to study prescription opioid poisoning, and was a named investigator on a buprenorphine depot implementation trial funded by Indivior, both unrelated to this work. Simon Holliday was provided an honorarium by Indivior for two presentations unrelated to this work.
Objectives: To assess the effectiveness of a brief alcohol intervention for improving awareness of alcohol as a breast cancer risk factor, improving alcohol literacy, and reducing alcohol consumption by women attending routine breast screening.
Design: Single‐site, double‐blinded randomised controlled trial.
Setting: Maroondah BreastScreen (Eastern Health, Melbourne), part of the national breast cancer screening program.
Participants: Women aged 40 years or more, with or without a history of breast cancer and reporting any alcohol consumption, who attended the clinic for routine mammography during 5 February – 27 August 2021.
Intervention: Active arm: animation including brief alcohol intervention (four minutes) and lifestyle health promotion (three minutes). Control arm: lifestyle health promotion only.
Major outcome measure: Change in proportion of women who identified alcohol use as a clear risk factor for breast cancer (scaled response measure).
Results: The mean age of the 557 participants was 60.3 years (standard deviation, 7.7 years; range, 40–87 years); 455 had recently consumed alcohol (82%). The proportions of participants aware that alcohol use increased the risk of breast cancer were larger at four weeks than at baseline for both the active intervention (65%
Conclusion: A tailored brief alcohol intervention for women attending breast screening was effective for improving awareness of the increased breast cancer risk associated with alcohol use and alcohol literacy more broadly. Such interventions are particularly important given the rising prevalence of risky drinking among middle‐aged and older women and evidence that even very light alcohol consumption increases breast cancer risk.
Registration: ClinicalTrials.gov, NCT04715516 (prospective; 20 January 2021).
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This study was supported by research grants from VicHealth and the Eastern Health Foundation. The funders had no role in any part of this study. We thank BreastScreen Victoria for their support. We thank the staff of Maroondah BreastScreen for supporting this project at their clinic, and we gratefully acknowledge all Maroondah BreastScreen clients who participated in the trial. We thank Erin Flatters (Jumbla Animation Studios) for producing the intervention animations. We thank Alun Pope (Analytical Insight) for his contribution to data preparation and statistical analyses.
Dan Lubman, Victoria Manning, Robin Bell, and Jasmin Grigg have received grants from the National Health and Medical Research Council. Dan Lubman, Victoria Manning and Robin Bell have received grants from the Medical Research Future Fund. Dan Lubman, Victoria Manning, and Jasmin Grigg have received funding from Shades of Pink and the Victorian Department of Health. Dan Lubman and Victoria Manning have received grants from the HCF Research Foundation, the Alcohol and Drug Research Innovation Agenda, the Alcohol and Drug Foundation, the Eastern Health Foundation, the Victorian Responsible Gambling Foundation, and the National Centre for Clinical Research on Emerging Drugs. Dan Lubman has received grants from Google, the Australian Research Council, VicHealth, and the Australian Department of Health and Aged Care. Victoria Manning has received funding from the Transport Accident Commission (Victoria). Jasmin Grigg has received funding from the Victorian Department of Transport and Planning. Dan Lubman is supported by a National Health and Medical Research Council Leadership Fellowship. Isabelle Volpe is supported by an Australian Government Research Training Program stipend.
Lack of clinician knowledge, poor access to services, negative attitudes, and lagging research have led to substandard menopause‐related health care
The menopause is the permanent loss of ovarian reproductive function. Irrespective of symptoms, menopause causes silent biological changes that may increase women's risks of cardiovascular disease, diabetes, osteoporosis, and some cancers.1 Consequently, it should be expected that health care providers, especially general practitioners, are equipped to provide evidence‐based menopause advice to the 3.28 million Australian women aged 40–59 years. Sadly, this is not the case.
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Susan Davis reports honoraria from Besins Healthcare, Mayne Pharma, Pfizer Australia, BioFemme, Lawley Pharmaceuticals, Southern Star Research, and Que Oncology. She has served on advisory boards for Mayne Pharma, Gedeon Richter, Astellas Pharmaceuticals, Roche Diagnostics, Theramex, and Abbott Laboratories; and is an institutional investigator for Que Oncology and Ovoca Bio. Karen Magraith has received honoraria for presentations from Mylan, Jean Hailes for Women's Health, and the Australasian Menopause Society.
There is much to be done to make high quality, accessible medical abortion a reality in Australia
The overturning of Roe v Wade in the United States has renewed impetus in Australia to ensure the availability of high quality, accessible abortion services. But decriminalisation and the availability of medical abortion do not in and of themselves mandate service delivery or ensure access. Numerous barriers continue to exist. These include issues such as inconsistent abortion laws, over‐regulation, lack of regional level planning and accountability for service delivery, sparse and inconsistent services across the country, inadequate numbers of skilled providers, a lack of training opportunities for the current and future workforce, and consumer concerns such as high costs and difficulty navigating services.
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No relevant disclosures.
Objective: To investigate in‐hospital mortality among people admitted to Australian intensive care units (ICUs) with conditions other than coronavirus disease 2019 (COVID‐19) during the COVID‐19 pandemic.
Design: National, multicentre, retrospective cohort study; analysis of data in the Australian and New Zealand Intensive Care Society Centre for Outcome and Resource Evaluation (ANZICS CORE) Adult Patient Database.
Setting, participants: Adults (16 years or older) without COVID‐19 admitted to Australian ICUs, 1 January 2016 – 30 June 2022.
Main outcome measures: All‐cause in‐hospital mortality, unadjusted and relative to the January 2016 value, adjusted for illness severity (Australian and New Zealand Risk of Death [ANZROD] and hospital type), with ICU as a random effect. Points of change in mortality trends (breakpoints) were identified by segmental regression analysis.
Results: Data for 950 489 eligible admissions to 186 ICUs were available. In‐hospital mortality declined steadily from January 2016 to March 2021 by 0.3% per month (
Conclusion: The rise in in‐hospital mortality among people admitted to Australian ICUs with conditions other than COVID‐19 from March 2021 reversed the improvement of the preceding five years. Changes to health service delivery during the pandemic and their consequences should be investigated further.
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We thank the Australia New Zealand Intensive Care Society (ANZICS) Centre for Outcomes and Resource Evaluation (CORE) for providing the data we analysed. The authors and the management committees of ANZICS CORE also thank the clinicians, data collectors, and researchers at the contributing sites.
No relevant disclosures.
Objectives: To examine the clinical characteristics and short term outcomes for children with severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) infections who presented to Australian hospitals during 2020 and 2021.
Design, setting: Retrospective case review study in nineteen hospitals of the Paediatric Research in Emergency Departments International Collaborative (PREDICT) network from all Australian states and territories, including seven major paediatric tertiary centres and eight Victorian hospitals.
Participants: SARS‐CoV‐2‐positive people under 18 years of age who attended emergency departments or were admitted to hospital during 1 February 2020 – 31 December 2021.
Main outcome measures: Epidemiological and clinical characteristics, by hospital care type (emergency department [ED] or inpatient care).
Results: A total of 1193 SARS‐CoV‐2‐positive children and adolescents (527 girls, 44%) attended the participating hospitals (107 in 2020, 1086 in 2021). Their median age was 3.8 years (interquartile range [IQR], 0.8–11.4 years); 63 were Aboriginal or Torres Strait Islander people (5%). Other medical conditions were recorded for 293 children (25%), including asthma (86, 7%) and premature birth (68, 6%). Medical interventions were not required during 795 of 1181 ED presentations (67%); children were discharged directly home in 764 cases (65%) and admitted to hospital in 282 (24%; sixteen to intensive care units). The 384 admissions to hospital (including 102 direct admissions) of 341 children (25 infants under one month of age) included 23 to intensive care (6%); the median length of stay was three days (IQR, 1–9 days). Medical interventions were not required during 261 admissions (68%); 44 children received respiratory support (11%) and 21 COVID‐19‐specific treatments, including antiviral and biologic agents (5%). Being under three months of age (
Conclusion: During 2020 and 2021, most SARS‐CoV‐2‐positive children and adolescents who presented to participating hospitals could be managed as outpatients. Outcomes were generally good, including for those admitted to hospital.
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We acknowledge the support of the National Health and Medical Research Council (NHMRC) through a Centre of Research Excellence grant for Paediatric Emergency Medicine (1171228), which also supported Catherine Wilson, who coordinated the study and data collection across the PREDICT network. Franz Babl is supported by an NHMRC Practitioner Fellowship (1124468), which partially supported his role as a senior author and principal investigator for this study.
We also acknowledge the assistance of the hospital staff who assisted with data retrieval: Katrina Pandey and James Gaston (Sunshine Hospital, Western Health); Deepali Thosar (the Children's Hospital at Westmead); Giles Barrington (Royal Hobart Health Service); Amelia Skaczkowski (Royal Darwin Hospital); Jo Miller, Ethan Fernandes, Andrew McGlinchy, Ye Yang Tham, and Olivia Slifirski (Eastern Health: Box Hill, Maroondah, and Angliss hospitals); Gaby Nieva and Lara Caruso (Adelaide Women's and Children's Hospital); Angus Jones and Alyce Callaghan (Queensland Children's Hospital); and Nitaa Eapen, Yilin Liu, Karen Lu, Violet Sattari Bahri, Michael Wojno, Haoyue Zhang, and Zahra Ataie‐Ashtiani (Royal Children's Hospital).
No relevant disclosures.
Abstract
Objectives: To assess Australian hospital utilisation, 1993–2020, with a focus on use by people aged 75 years or more.
Design: Review of Australian Institute of Health and Welfare (AIHW) hospital utilisation data.
Setting, participants: Tertiary data from all Australian public and private hospitals for the financial years 1993–94 to 2019–20.
Main outcome measures: Numbers and population‐based rates of hospital separations and bed utilisation (bed‐days) (all and multiple day admissions) and mean hospital length of day (multiple day admissions), overall and by age group (under 65 years, 65–74 years, 75 years or more).
Results: Between 1993–94 and 2019–20, the Australian population grew by 44%; the number of people aged 75 years or more increased from 4.6% to 6.9% of the population. The annual number of hospital separations increased from 4.61 million to 11.33 million (146% increase); the annual hospital separation rate increased from 261 to 435 per 1000 people (66% increase), most markedly for people aged 75 years or more (from 745 to 1441 per 1000 people; 94% increase). Total bed utilisation increased from 21.0 million to 29.9 million bed‐days (42% increase), but the bed utilisation rate did not change markedly (1993–94, 1192 bed‐days per 1000 people; 2019–20, 1179 bed‐days per 1000 people), primarily because the mean hospital length of stay for multiple day admissions declined from 6.6 days to 5.4 days; for people aged 75 years or more it declined from 12.2 to 7.1 days. However, declines in stay length have slowed markedly since 2017–18. Total bed utilisation was 16.8% lower than projected from 1993–94 rates, and was 37.3% lower for people aged 75 years or more.
Conclusion: Hospital bed utilisation rates declined although admission rates increased during 1993–94 to 2019–20; the proportion of beds occupied by people aged 75 years or more increased slightly during this period. Containing hospital costs by limiting bed availability and reducing length of stay may no longer be a viable strategy.