Topics

Information science

The MJA has a unique responsibility and opportunity to report, reflect, and be an advocate for health priorities across Australia and our region

As 2023 begins, no‐one would argue that we are short of medical information. Sifting and assessing the daily tide of information — and misinformation — to obtain actionable and reliable evidence that can influence and inform health care has become one of the key problems for both medical professionals and the general public. Health care faces many challenges, and the need for high quality evidence has never been greater. These challenges include the increasing burden of chronic disease on an already strained health system, even as we continue to navigate the COVID‐19 pandemic, and prepare for whatever epidemics lie ahead. And, as evidenced by the recent devastation in our region, the increasing significance of climate change as a major risk to human health is ever more apparent. What should be the priorities of the MJA now?

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Editor‐in‐Chief, the Medical Journal of Australia

Correspondence: vbarbour@mja.com.au

Competing interests:

I am the director of Open Access Australasia, a paid position. I am a member of the National Health and Medical research Council Research Quality Steering Committee. I am an unpaid advisor to a number of national and international open access and research quality and integrity organisations, including cOAlition S (https://www.coalition‐s.org), the San Francisco Declaration on Research Assessment (DORA; https://sfdora.org), the Confederation of Open Access Repositories (COAR; https://www.coar‐repositories.org), and Cochrane (https://www.cochrane.org).

1. United Nations. United Nations Declaration on the Rights of Indigenous Peoples. 13 Sept 2007. https://www.un.org/development/desa/indigenouspeoples/wp‐content/uploads/sites/19/2018/11/UNDRIP_E_web.pdf (viewed Dec 2022).
2. National Agreement on Closing the Gap. July 2020. https://www.closingthegap.gov.au/national‐agreement (viewed 2022).

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Research letter

Diagnosis of cystic fibrosis in adults: Australian Cystic Fibrosis Data Registry data, 2000–2019

Amelia Lin, Keith Wong, Simone K Visser, Helen Jo, Yasmeen Al‐Hindawi, Katrin Kosbab‐Jackson, Molly Cocks, Anastasia Volovets, Paul Haber, Kirsten Hammond, Nicole Taylor, Veronica Yozghatlian, Edmund MT Lau, Nathaniel S Marshall, Tara Aquino‐Salomon and Sheila Sivam

Med J Aust 2023; 218 (3): . || doi: 10.5694/mja2.51797
Published online: 16 January 2023

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Topics

Respiratory tract diseases

Statistics, epidemiology and research design

General medicine

Cystic fibrosis (CF) is a multisystem disorder characterised by productive cough and recurrent chest infections linked with bronchiectasis; extrapulmonary symptoms may include gastrointestinal reflux, malnutrition associated with pancreatic insufficiency, and chronic sinus disease.1 With multidisciplinary care and improving therapeutic options, the median life expectancy for people with CF is now almost 50 years of age.1 In 2022, highly effective modulator therapy (elexacaftor–tezacaftor–ivacaftor) was made available to all Australians with CF aged 12 years or more with at least one F508del‐CFTR mutation (present in 90% of people with CF),1 with dramatic clinical benefits.2,3

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1 Royal Prince Alfred Hospital, Sydney, NSW
2 Sydney School of Health Sciences, the University of Sydney, Sydney, NSW
3 Woolcock Institute of Medical Research, Sydney, NSW

Correspondence: amelia.lin@health.nsw.gov.au

Acknowledgements:

We thank the Australian Cystic Fibrosis Data Registry for supporting this study. We also thank people with cystic fibrosis and their families who participate in the data registry.

Competing interests:

No relevant disclosures.

1. Bell SC, Mall MA, Gutierrez H, et al. The future of cystic fibrosis care: a global perspective. Lancet Respir Med 2020; 8: 65‐124.
2. Australian Department of Health. Pharmaceutical Benefits Advisory Committee (PBAC) meeting outcomes: December 2021 PBAC meeting. https://www.pbs.gov.au/industry/listing/elements/pbac‐meetings/pbac‐outcomes/2021‐12/December%202021%20PBAC%20Web%20Outcomes.pdf (viewed Feb 2022).
3. Middleton PG, Mall MA, Drevinek P, et al; VX17‐445‐102 Study Group. Elexacaftor–tezacaftor–ivacaftor for cystic fibrosis with a single Phe508del allele. N Engl J Med 2019; 381: 1809‐1819.
4. Massie RJ, Curnow L, Glazner, et al. Lessons learned from 20 years of newborn screening for cystic fibrosis. Med J Aust 2012; 196: 67‐70. https://www.mja.com.au/journal/2012/196/1/lessons‐learned‐20‐years‐newborn‐screening‐cystic‐fibrosis
5. Ahern S, Salimi F, Caruso M, et al. The Australian Cystic Fibrosis Data Registry: annual report 2020; version 1.1. Updated July 2021. https://research.monash.edu/en/publications/the‐australian‐cystic‐fibrosis‐data‐registry‐annual‐report‐2020 (viewed Feb 2022).
6. Australian Bureau of Statistics. Life tables; reference period 2017–2019. Updated 4 Nov 2020. https://www.abs.gov.au/statistics/people/population/life‐tables/2017‐2019 (viewed Jan 2022).

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Research

Increasing screening for atrial fibrillation in general practice: the Atrial Fibrillation Self‐Screening, Management And guideline‐Recommended Therapy (AF Self‐SMART) study

Katrina Giskes, Nicole Lowres, Jessica Orchard, JiaLin Li, Kirsty McKenzie, Charlotte Mary Hespe and Ben Freedman

Med J Aust 2023; 218 (1): . || doi: 10.5694/mja2.51803
Published online: 16 January 2023

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Topics

Cardiovascular diseases

General medicine

Information science

Abstract

Objective: To assess whether atrial fibrillation (AF) self‐screening stations in general practice waiting rooms improve AF screening, diagnosis, and stroke risk management.

Design, setting: Intervention study (planned duration: twelve weeks) in six New South Wales general practices (two in rural locations, four in greater metropolitan Sydney), undertaken during 28 August 2020 – 5 August 2021.

Participants: People aged 65 years or more who had not previously been diagnosed with AF, and had appointments for face‐to‐face GP consultations. People with valvular AF were excluded.

Intervention: AF self‐screening station and software, integrated with practice electronic medical record programs, that identified and invited participation by eligible patients, and exported single‐lead electrocardiograms and automated evaluations to patients’ medical records.

Main outcome measures: Screening rate; incidence of newly diagnosed AF during intervention and pre‐intervention periods; prescribing of guideline‐recommended anticoagulant medications.

Results: Across the six participating practices, 2835 of 7849 eligible patients (36.1%) had face‐to‐face GP appointments during the intervention period, of whom 1127 completed AF self‐screening (39.8%; range by practice: 12–74%). AF was diagnosed in 49 screened patients (4.3%), 44 of whom (90%) had CHA₂DS₂‐VA scores of 2 or more (high stroke risk). The incidence of newly diagnosed AF during the pre‐intervention period was 11 cases per 1000 eligible patients; during the intervention period, it was 22 per 1000 eligible patients (screen‐detected: 17 per 1000 eligible patients; otherwise detected: 4.6 per 1000 eligible patients). Prescribing of oral anticoagulation therapy for people newly diagnosed with AF and high stroke risk was similar during the pre‐intervention (20 of 24, 83%) and intervention periods (46 of 54, 85%).

Conclusions: AF self‐screening in general practice waiting rooms is a feasible approach to increasing AF screening and diagnosis rates by reducing time barriers to screening by GPs. AF self‐screening could reduce the number of AF‐related strokes.

Trial registration: Australian New Zealand Clinical Trials Registry ACTRN12620000233921 (prospective).

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1 Heart Research Institute, the University of Sydney, Sydney, NSW
2 The University of Notre Dame Australia, Sydney, NSW
3 Charles Perkins Centre, the University of Sydney, Sydney, NSW
4 Centenary Institute, the University of Sydney, Sydney, NSW

Correspondence: katrina.giskes@nd.edu.au

Open access

Open access publishing facilitated by The University of Notre Dame Australia, as part of the Wiley ‐ The University of Notre Dame Australia agreement via the Council of Australian University Librarians.

Acknowledgements:

This investigation was supported by an investigator‐initiated research grant to the Heart Research Institute from Bristol‐Myers Squibb/Pfizer Alliance. We gratefully acknowledge the HCF Research Foundation and the Royal Australian College of General Practitioners Foundation for supporting this project. Nicole Lowres was funded by a New South Wales Health Early Career Fellowship (H16/52168). Jessica Orchard is supported by a Postdoctoral Fellowship from the National Heart Foundation of Australia (104809). Publication and open access costs were covered by AFFECT‐EU (http://www.affect‐eu.eu), which received funding from the European Union Horizon 2020 research and innovation program (grant agreement no. 847770).

We thank Andrew Kay (TOC3 Consulting) for project management advice. We are grateful to Kim Barnett and Bruce Satchwell (Alive Technologies), co‐inventors of Alivecor, for their expertise in developing the software integration. We also thank the general practices, GPs, receptionists, and practice managers involved in the study.

Competing interests:

Katrina Giskes and Charlotte Hespe have received honoraria from Pfizer. Ben Freedman has received grants, personal fees, and non‐financial support from Bayer, BMS–Pfizer, Daiichi Sankyo, AliveCor, and Omron.

1. Freedman B, Camm J, Calkins H, et al; AF‐Screen Collaborators. Screening for atrial fibrillation: a report of the AF‐SCREEN international collaboration. Circulation 2017; 135: 1851‐1867.
2. Freedman SB, Lowres N. Asymptomatic atrial fibrillation: the case for screening to prevent stroke. JAMA 2015; 314: 1911‐1912.
3. NHFA CSANZ Atrial Fibrillation Guideline Working Group. National Heart Foundation of Australia and the Cardiac Society of Australia and New Zealand: Australian Clinical guidelines for the diagnosis and management of atrial fibrillation 2018. Heart Lung Circ 2018; 27: 1209‐1266.
4. Hindricks G, Potpara T, Dagres N, et al; ESC Scientific Document Group. 2020 ESC guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio‐Thoracic Surgery (EACTS). Eur Heart J 2021; 42: 373‐498.
5. Royal Australian College of General Practitioners. General practice: health of the nation 2018. Melbourne: RACGP, 2018. https://www.racgp.org.au/download/Documents/Publications/Health‐of‐the‐Nation‐2018‐Report.pdf (viewed June 2022).
6. The Economist Intelligence Unit. Preventing stroke: uneven progress. A global policy research program. 2017. https://impact.economist.com/perspectives/sites/default/files/Preventing%20Stroke_Uneven%20Progress.pdf (viewed June 2022).
7. Orchard J, Neubeck L, Freedman B, et al. eHealth tools to provide structured assistance for atrial fibrillation screening, management, and guideline‐recommended therapy in metropolitan general practice: The AF‐SMART Study. J Am Heart Assoc 2019; 8: e010959.
8. Orchard J, Li J, Freedman B, et al. Atrial fibrillation screen, management, and guideline‐recommended therapy in the rural primary care setting: a cross‐sectional study and cost‐effectiveness analysis of ehealth tools to support all stages of screening. J Am Heart Assoc 2020; 9: e017080.
9. Orchard J, Li J, Gallagher R, et al. Uptake of a primary care atrial fibrillation screening program (AF‐SMART): a realist evaluation of implementation in metropolitan and rural general practice. BMC Fam Pract 2019; 20: 170.
10. Kaasenbrood F, Hollander M, Rutten FH, et al. Yield of screening for atrial fibrillation in primary care with a hand‐held, single‐lead electrocardiogram device during influenza vaccination. Europace 2016; 18: 1514‐1520.
11. Kaasenbrood F, Hollander M, de Bruijn SHM, et al. Opportunistic screening versus usual care for diagnosing atrial fibrillation in general practice: a cluster randomised controlled trial. Br J Gen Pract 2020; 70: e427‐e433.
12. Giskes K, Lowres N, Li J, et al. Atrial fibrillation self screening, management and guideline recommended therapy (AF SELF SMART): a protocol for atrial fibrillation self‐screening in general practice. Int J Cardiol Heart Vasc 2021; 32: 100683.
13. Orchard J, Lowres N, Freedman SB, et al. Screening for atrial fibrillation during influenza vaccinations by primary care nurses using a smartphone electrocardiograph (iECG): a feasibility study. Eur J Prev Cardiol 2016; 23: 13‐20.
14. Crockford C, Mitchell A, Kaba R, et al. SAFE2SCREEN: can patient initiated kiosk‐based self‐screening provide an opportunity to identify atrial fibrillation within a GP waiting room environment? [abstract: Heart Rhythm Congress, Birmingham, UK, 1–4 October 2017]. Europace 2017; 19 (Suppl 1): i5.
15. Crockford C. When med‐tech is just a few years ahead of its intended audience. 2 Oct 2017. https://www.linkedin.com/pulse/when‐med‐tech‐just‐few‐years‐ahead‐its‐intended‐chris‐crockford (viewed Dec 2021).
16. Sanders C, Rogers A, Bowen R, et al. Exploring barriers to participation and adoption of telehealth and telecare within the Whole System Demonstrator trial: a qualitative study. BMC Health Serv Res 2012; 12: 220.
17. Tompson A, Fleming S, Lee MM, et al. Mixed‐methods feasibility study of blood pressure self‐screening for hypertension detection. BMJ Open 2019; 9: e027986.
18. McKenzie K, Lowres N, Orchard J, et al. Staff acceptability and patient usability of a self‐screening kiosk for atrial fibrillation in general practice waiting rooms. Cardiovasc Digit Health J 2022; 3: 212‐219.
19. Whitton AE, Hardy R, Cope K, et al. Mental health screening in general practices as a means for enhancing uptake of digital mental health interventions: observational cohort study. J Med Internet Res 2021; 23: e28369.
20. Royal Australian College of General Practitioners. Guidelines for preventive activities in general practice. 9th ed. Melbourne: RACGP, 2016. https://www.racgp.org.au/download/Documents/Guidelines/Redbook9/17048‐Red‐Book‐9th‐Edition.pdf (viewed June 2022).
21. Proudfoot J, Gale N, O'Moore K, et al. Implementation of an augmented stepped mental health care service in Australian primary care: a mixed method study. Adv Mental Health 2019; 19: 75‐93.
22. Tompson AC, Grant S, Greenfield SM, et al. Patient use of blood pressure self‐screening facilities in general practice waiting rooms: a qualitative study in the UK. Br J Gen Pract 2017; 67: e467‐e73.
23. AliveCor. FDA clears first of its kind algorithm suite for personal ECG [media release]. 23 Nov 2020. https://www.alivecor.com/press/press_release/fda‐clears‐first‐of‐its‐kind‐algorithm‐suite‐for‐personal‐ecg (viewed Nov 2022).
24. Orchard J, Lowres N, Neubeck L, Freedman B. Atrial fibrillation: is there enough evidence to recommend opportunistic or systematic screening? Int J Epidemiol 2018; 47: 1372‐1378.
25. Orchard JJ, Neubeck L, Orchard JW, et al. ECG‐based cardiac screening programs: legal, ethical, and logistical considerations. Heart Rhythm 2019; 16: 1584‐1591.

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Editorials

Learning from the past to prepare for the future

Douglas Johnson and Megan Anne Rees

Med J Aust 2023; 218 (1): . || doi: 10.5694/mja2.51800
Published online: 16 January 2023

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Topics

Infectious diseases

Lessons from the COVID‐19 experience can minimise the morbidity, mortality and social disruption of future pandemics

Our society and health care systems have experienced significant challenges and undergone major changes as a consequence of the coronavirus disease 2019 (COVID‐19) pandemic: from the dramatic early days, with high rates of morbidity and mortality overseas,1,2 and the long, difficult lockdowns in several Australian states to incredible advances in medical knowledge in terms of both vaccination and treatment.

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1 The University of Melbourne, Melbourne, VIC
2 The Royal Melbourne Hospital, Melbourne, VIC

Correspondence: douglas.f.johnson@mh.org.au

Competing interests:

No relevant disclosures.

1. Onder G, Rezza G, Brusaferro S. Case‐fatality rate and characteristics of patients dying in relation to COVID‐19 in Italy. JAMA 2020; 323: 1775‐1776.
2. Wang H, Paulson KR, Pease SA, et al. Estimating excess mortality due to the COVID‐19 pandemic: a systematic analysis of COVID‐19‐related mortality, 2020–21. Lancet 2022; 399: 1513‐1536.
3. McCloskey B, Heymann DL. SARS to novel coronavirus: old lessons and new lessons. Epidemiol Infect 2020; 148: e22.
4. Rowe SL, Leder K, Dyson K, et al. Associations between COVID‐19 and hospitalisation with respiratory and non‐respiratory conditions: a record linkage study. Med J Aust 2023; 218: 33‐39.
5. Australian Department of Health and Aged Care. COVID‐19 vaccine rollout update: 31 May 2021. https://www.health.gov.au/resources/publications/covid‐19‐vaccine‐rollout‐update‐31‐may‐2021 (viewed Nov 2022).
6. Feikin DR, Higdon MM, Abu‐Raddad LJ, et al. Duration of effectiveness of vaccines against SARS‐CoV‐2 infection and COVID‐19 disease: results of a systematic review and meta‐regression. Lancet 2022; 399: 924‐944.
7. Kelly P; Australian Department of Health and Aged Care. New COVID‐19 variant leads to increase in cases [media release]. 8 Nov 2022. https://www.health.gov.au/news/new‐covid‐19‐variant‐leads‐to‐increase‐in‐cases (viewed Nov 2022).
8. Andrews D (Premier of Victoria). BioNTech coup: more mRNA manufacturing, research in Melbourne [media release]. 7 Oct 2021. https://www.premier.vic.gov.au/biontech‐coup‐more‐mrna‐manufacturing‐research‐melbourne (viewed Nov 2022).
9. Monash University. Moderna to build manufacturing facility at Monash [media release]. 15 Aug 2022. https://www.monash.edu/news/articles/moderna‐to‐build‐manufacturing‐facility‐at‐monash (viewed Nov 2022).
10. Australian Department of Health and Aged Care. Australian Centre for Disease Control. Sept 2022. https://www.health.gov.au/initiatives‐and‐programs/australian‐cdc (viewed Nov 2022).
11. Summers J, Cheng HY, Lin HH, et al. Potential lessons from the Taiwan and New Zealand health responses to the COVID‐19 pandemic. Lancet Reg Health West Pac 2020; 4: 100044.
12. Chen JI, Yap JC, Hsu LY, Tao YY. COVID‐19 and Singapore: from early response to circuit breaker. Ann Acad Med Singap 2020; 49: 561‐572.
13. Fauci AS, Lane HC, Redfield RR. Covid‐19: navigating the uncharted [editorial]. N Engl J Med 2020; 382: 1268‐1269.

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Editorials

Welcoming the new MJA Editor‐in‐Chief, and the top ten original research articles in the MJA in 2022

Nicholas J Talley

Med J Aust 2023; 218 (1): . || doi: 10.5694/mja2.51801
Published online: 16 January 2023

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General medicine

It has been a privilege to lead the Journal through challenging times, but it is time to pass the baton

From 23 January 2023, I hand over responsibility for the MJA to the new Editor‐in‐Chief, Professor Virginia (Ginny) Barbour. Professor Barbour is eminently qualified to lead the MJA, having been a Senior Editor at The Lancet and one of the founding editors and the first Chief Editor of PLOS Medicine. She completed her undergraduate immunology and medical degrees at Cambridge University, trained in haematology in the United Kingdom (including at University College London and the Royal Free Hospital), and was awarded her DPhil degree by Oxford University for her investigation of human α‐globin gene regulation. Open access for all medical journals is the future, and Professor Barbour is an internationally recognised expert in innovative scholarly communication, open access, and research integrity. In 2021, she was an expert advisor with the Australian delegation to the intergovernmental meeting of experts on the UNESCO Open Science Recommendation, and she has been involved in many international initiatives, including as vice‐chair of the Declaration on Research Assessment (DORA) steering committee and as a Plan S ambassador. Professor Barbour is based at the Queensland University of Technology, where she is co‐lead of the Office for Scholarly Communication and director of Open Access Australasia; she is also a member of the NHMRC Research Quality Steering Committee, and during the COVID‐19 pandemic was an editorial advisor to the medRxiv preprint server. I congratulate Professor Barbour on her appointment and wish her and the entire MJA team every success in the years to come. I know the Journal will be in very good hands!

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Editor‐in‐Chief, the Medical Journal of Australia

Correspondence: nicholas.talley@newcastle.edu.au

Correspondence: ntalley@mja.com.au

Competing interests:

A complete list of disclosures is available at https://www.mja.com.au/journal/staff/editor‐chief‐professor‐nick‐talley.

1. Caly L, Druce J, Roberts J, et al. Isolation and rapid sharing of the 2019 novel coronavirus (SARS‐CoV‐2) from the first patient diagnosed with COVID‐19 in Australia. Med J Aust 2020; 212: 459‐462. https://www.mja.com.au/journal/2020/212/10/isolation‐and‐rapid‐sharing‐2019‐novel‐coronavirus‐sars‐cov‐2‐first‐patient
2. Hill NTM, Witt K, Rajaram G, et al. Suicide by young Australians, 2006–2015: a cross‐sectional analysis of national coronial data. Med J Aust 2021; 214: 133‐139. https://www.mja.com.au/journal/2021/214/3/suicide‐young‐australians‐2006‐2015‐cross‐sectional‐analysis‐national‐coronial
3. Machalek DA, Roberts JM, Garland SM, et al. Routine cervical screening by primary HPV testing: early findings in the renewed National Cervical Screening Program. Med J Aust 2019; 211: 113‐119. https://www.mja.com.au/journal/2019/211/3/routine‐cervical‐screening‐primary‐hpv‐testing‐early‐findings‐renewed‐national
4. Davis K, Remenyi B, Draper ADK, et al. Rheumatic heart disease in Timor‐Leste school students: an echocardiography‐based prevalence study. Med J Aust 2018; 208: 303‐307. https://www.mja.com.au/journal/2018/208/7/rheumatic‐heart‐disease‐timor‐leste‐school‐students‐echocardiography‐based
5. Tong EY, Roman CP, Mitra B, et al. Reducing medication errors in hospital discharge summaries: a randomised controlled trial. Med J Aust 2017; 206: 36‐39. https://www.mja.com.au/journal/2017/206/1/reducing‐medication‐errors‐hospital‐discharge‐summaries‐randomised‐controlled
6. Burrell AR, McLaws ML, Fullick M, et al. SEPSIS KILLS: early intervention saves lives. Med J Aust 2016; 204: 73. https://www.mja.com.au/journal/2016/204/2/sepsis‐kills‐early‐intervention‐saves‐lives
7. Zhao Y, Li SQ, Wilson T, Burgess CP. Improved life expectancy for Indigenous and non‐Indigenous people in the Northern Territory, 1999–2018: overall and by underlying cause of death. Med J Aust 2022; 217: 30‐35. https://www.mja.com.au/journal/2022/217/1/improved‐life‐expectancy‐indigenous‐and‐non‐indigenous‐people‐northern‐territory
8. Lord SJ, Daniels B, Kiely BE, et al. Long term risk of distant metastasis in women with non‐metastatic breast cancer and survival after metastasis detection: a population‐based linked health records study. Med J Aust 2022; 217: 402‐409. https://www.mja.com.au/journal/2022/217/8/long‐term‐risk‐distant‐metastasis‐women‐non‐metastatic‐breast‐cancer‐and
9. Hirani R, Weinert N, Irving DO. The distribution of ABO RhD blood groups in Australia, based on blood donor and blood sample pathology data. Med J Aust 2022; 216: 291‐295. https://www.mja.com.au/journal/2022/216/6/distribution‐abo‐rhd‐blood‐groups‐australia‐based‐blood‐donor‐and‐blood‐sample
10. Roder C, Maggs C, McNamara BJ, et al. Area‐level social and economic factors and the local incidence of SARS‐CoV‐2 infections in Victoria during 2020. Med J Aust 2022; 216: 349‐356. https://www.mja.com.au/journal/2022/216/7/area‐level‐social‐and‐economic‐factors‐and‐local‐incidence‐sars‐cov‐2‐infections
11. Williams P, Koirala A, Saravanos GL, et al. COVID‐19 in New South Wales children during 2021: severity and clinical spectrum. Med J Aust 2022; 217: 303‐310. https://www.mja.com.au/journal/2022/217/6/covid‐19‐new‐south‐wales‐children‐during‐2021‐severity‐and‐clinical‐spectrum
12. Begum H, Neto AS, Alliegro P, et al. People in intensive care with COVID‐19: demographic and clinical features during the first, second, and third pandemic waves in Australia. Med J Aust 2022; 217: 352‐360. https://www.mja.com.au/journal/2022/217/7/people‐intensive‐care‐covid‐19‐demographic‐and‐clinical‐features‐during‐first
13. Deng L, Clover C, Dymock M, et al. The short term safety of COVID‐19 vaccines in Australia: AusVaxSafety active surveillance, February – August 2021. Med J Aust 2022; 217: 195‐202. https://www.mja.com.au/journal/2022/217/4/short‐term‐safety‐covid‐19‐vaccines‐australia‐ausvaxsafety‐active‐surveillance
14. Iorfino F, Carpenter JS, Cross SPM, et al. Social and occupational outcomes for young people who attend early intervention mental health services: a longitudinal study. Med J Aust 2022; 216: 87‐93. https://www.mja.com.au/journal/2022/216/2/social‐and‐occupational‐outcomes‐young‐people‐who‐attend‐early‐intervention
15. Wang X, Carcel C, Hsu B, et al. Differences in the pre‐hospital management of women and men with stroke by emergency medical services in New South Wales. Med J Aust 2022; 217: 143‐148. https://www.mja.com.au/journal/2022/217/3/differences‐pre‐hospital‐management‐women‐and‐men‐stroke‐emergency‐medical
16. Banks E, Yazidjoglou A, Brown S, et al. Electronic cigarettes and health outcomes: systematic review of global evidence. Report for the Australian Department of Health. Apr 2022. Canberra: National Centre for Epidemiology and Population Health. https://openresearch‐repository.anu.edu.au/bitstream/1885/262914/1/Electronic%20cigarettes%20health%20outcomes%20review_2022_WCAG.pdf (viewed Nov 2022).
17. Larcombe A, Allard S, Pringle P, et al. Chemical analysis of fresh and aged Australian e‐cigarette liquids. Med J Aust 2022; 216: 27‐32. https://www.mja.com.au/journal/2022/216/1/chemical‐analysis‐fresh‐and‐aged‐australian‐e‐cigarette‐liquids
18. Chlvers E, Janka M, Franklin P, et al. Nicotine and other potentially harmful compounds in “nicotine‐free” e‐cigarette liquids in Australia. Med J Aust 2019; 210: 127‐128. https://www.mja.com.au/journal/2019/210/3/nicotine‐and‐other‐potentially‐harmful‐compounds‐nicotine‐free‐e‐cigarette
19. Talley NJ. The impact of the MJA continues its rise. Med J Aust 2022; 217: 187‐188. https://www.mja.com.au/journal/2022/217/4/impact‐mja‐continues‐its‐rise
20. Atwoli L, Baqui AH, Benfield T, et al. Call for emergency action to limit global temperature increases, restore biodiversity, and protect health. Lancet 2021; 398: 939‐941.
21. Atwoli L, Erhabor GE, Gbakima AA, et al. COP27 Climate Change Conference: urgent action needed for Africa and the world. Med J Aust 2022; 217: 482‐483.
22. Zhang Y, Beggs PJ. The Lancet Countdown down under: tracking progress on health and climate change in Australia. Med J Aust 2018; 208: 285‐286. https://www.mja.com.au/journal/2018/208/7/lancet‐countdown‐down‐under‐tracking‐progress‐health‐and‐climate‐change
23. Churchill W. The end of the beginning: war speeches (ed. C Eade). London: Cassell and Company, 1943; p. 214.
24. Guest C. Welcoming the new Editor‐in‐Chief. Med J Aust 2015; 203: 419. https://www.mja.com.au/journal/2015/203/11/welcoming‐new‐editor‐chief

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Christmas competition
Winner

The Paediatric Aussie Chocolate Poo Scale

Guy D Eslick and Eloise G Eslick

Med J Aust 2022; 217 (11): . || doi: 10.5694/mja2.51779
Published online: 12 December 2022

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Topics

Digestive system diseases

The Bristol Stool Scale (BSS) was developed 30 years ago, with the aim of determining the range of bowel habits including stool types in the adult population.1 We conducted a PubMed search (All Fields), which identified more than 600 published papers associated with the BSS. The BSS is currently the gold standard to classify stool consistency in adults. In its present form, it has been useful in assessing intestinal transit time;2 the longer the time, the lower the stool number (eg, type 1 has the slowest transit time [constipation]; type 7 has the fastest transit time [diarrhoea]) (Box 1). The form of the stool strongly influences the act of defecation. The need to strain increases as the type number goes down, and the feeling of urgency increases as the type number rises.1 Feelings of incomplete evacuation occur quite often in normal individuals if their stool is at either end of the scale, but rarely if the stool is type 3 or 4.

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1 Centre for Research Excellence in Digestive Health, Hunter Medical Research Institute, University of Newcastle, Newcastle, NSW
2 Clued (Clinical Links using Evidence‐based Data), Sydney, NSW

Correspondence: guy.eslick@sydney.edu.au

Competing interests:

No relevant disclosures.

1. Heaton KW, Radvan J, Cripps H, et al. Defecation frequency and timing, and stool form in the general population: a prospective study. Gut 1992; 33: 818‐824.
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Reflection

Clinical staging of clinicians

Gordon B Parker

Med J Aust 2022; 217 (11): . || doi: 10.5694/mja2.51780
Published online: 12 December 2022

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Medical education

Medical practice weights clinical staging models, so why not a staging model for medical practitioners themselves?

Clinical staging models are relevant to managing many medical conditions and have the potential to determine prognosis and phase‐specific interventions. Reflecting this age of personalised medicine, a staging model for personalising clinicians (henceforth, personalised to “you”) is now offered.

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University of New South Wales, Sydney, NSW

Correspondence: g.parker@unsw.edu.au

Open access

Open access publishing facilitated by University of New South Wales, as part of the Wiley – University of New South Wales agreement via the Council of Australian University Librarians.

Competing interests:

No relevant disclosures.

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Editorial

From meals, movies and microbes to a new chocolate yuk scale, mortality among wizards, and medical career staging: season's greetings!

Nicholas J Talley

Med J Aust 2022; 217 (11): . || doi: 10.5694/mja2.51783
Published online: 12 December 2022

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Information science

Time to celebrate another successful year in difficult times, but we are mindful of the challenges that remain

Welcome to the final MJA issue of 2022! As most Australians take well earned Christmas–New Year breaks, many health professionals across Australia continue to serve their communities, staff our hospitals and clinics, and provide outstanding health care 24 hours a day. We at the MJA thank everyone working in health and medicine for all you do every day, during the holiday season and throughout the year, and hope that you too will find time for a break.

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Editor‐in‐Chief, the Medical Journal of Australia

Correspondence: ntalley@mja.com.au

Acknowledgements:

I thank the tireless efforts of the editorial team throughout 2022, without which the quality and timely publication of our Journal would be impossible: deputy editors Alisha Dorrigan, Francis Geronimo, Robyn Godding, Tania Janusic, Wendy Morgan, Aajuli Shukla, Elizabeth Zuccala, and Maria Inacio; our scientific and structural editors, Paul Foley, Graeme Prince, and Laura Teruel; our consultant biostatistician, Elmer Villanueva; our news and online editor, Cate Swannell; our graphic designer, Leilani Widya; our head of publishing content, Ben Dawe; and our senior publishing coordinator, Kerrie Harding.

Competing interests:

Guy Eslick, the winner of the Christmas competition, is employed part time by the University of Newcastle, and works with the author. A complete list of disclosures is available at https://www.mja.com.au/journal/staff/editor‐chief‐professor‐nick‐talley

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Centering the Medical Journal of Australia in the landscape of medical information in 2023

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Diagnosis of cystic fibrosis in adults: Australian Cystic Fibrosis Data Registry data, 2000–2019

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Increasing screening for atrial fibrillation in general practice: the Atrial Fibrillation Self‐Screening, Management And guideline‐Recommended Therapy (AF Self‐SMART) study

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Learning from the past to prepare for the future

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Welcoming the new MJA Editor‐in‐Chief, and the top ten original research articles in the MJA in 2022

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The Paediatric Aussie Chocolate Poo Scale

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Clinical staging of clinicians

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Author

From meals, movies and microbes to a new chocolate yuk scale, mortality among wizards, and medical career staging: season's greetings!

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Author

Reducing the burden of group A streptococcal disease in the Northern Territory: the role of chemoprophylaxis for those at greatest risk

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Where should we offer mass drug administration for trachoma?

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Centering the Medical Journal of Australia in the landscape of medical information in 2023

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Comment

Do you have any competing interests to declare? *

Diagnosis of cystic fibrosis in adults: Australian Cystic Fibrosis Data Registry data, 2000–2019

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Author

Comment

Do you have any competing interests to declare? *

Increasing screening for atrial fibrillation in general practice: the Atrial Fibrillation Self‐Screening, Management And guideline‐Recommended Therapy (AF Self‐SMART) study

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Abstract

Author

Comment

Do you have any competing interests to declare? *

Learning from the past to prepare for the future

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Author

Comment

Do you have any competing interests to declare? *

Welcoming the new MJA Editor‐in‐Chief, and the top ten original research articles in the MJA in 2022

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Author

Comment

Do you have any competing interests to declare? *

The Paediatric Aussie Chocolate Poo Scale

Topics

Author

Comment

Do you have any competing interests to declare? *

Clinical staging of clinicians

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Author

Comment

Do you have any competing interests to declare? *

From meals, movies and microbes to a new chocolate yuk scale, mortality among wizards, and medical career staging: season's greetings!

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Author

Comment

Do you have any competing interests to declare? *

Reducing the burden of group A streptococcal disease in the Northern Territory: the role of chemoprophylaxis for those at greatest risk

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Author

Comment

Do you have any competing interests to declare? *

Where should we offer mass drug administration for trachoma?

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Comment

Do you have any competing interests to declare? *

Pagination