Smarter measures for general medicine are needed to improve hospital access
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Retraction: Madden DL, Horton GL and McLean M. Preparing Australasian medical students to practise environmentally sustainable health care. Med J Aust 2020; https://doi.org/10.5694/mja2.50585.
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Improved, integrated care for older patients with complex medical needs could avert some modifiable causes of readmission
The incidence of peripheral artery disease (PAD) is rising around the world as populations age and the prevalence of diabetes, obesity, and cardiovascular disease increase.1 The clinical manifestations of lower limb PAD range from asymptomatic atherosclerosis and exertional pain caused by intermittent claudication, to chronic limb‐threatening ischaemia with rest pain, ulceration, and necrosis. Long term survival is poorer for patients with PAD than for people with many common cancers,1 and quality of life and patient‐reported outcomes are impaired.2 A recently published analysis of Global Burden of Disease Study data found that lower limb amputation rates were higher in Australia than in eighteen other high income countries, highlighting the need to improve outcomes for people with PAD.3
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Culling low value care will cut health care carbon emissions
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Alexandra Barratt received funding from the National Health and Medical Research Council (grant no. 1104136).
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Three‐dimensional printing or additive manufacturing has the potential to transform personalised medicine
Personalised medicine aims to move gold‐standard care away from empiric prescribing for a typical patient towards tailored treatment for the patient as an individual.1 It is well known that the effect of a medicine on an individual can vary based on factors including sex, genetics and even hormones. Currently, the personalisation of medicines to adjust for factors such as these is limited by the doses and combinations that are commercially available. This inflexibility makes it difficult for clinicians to tailor the medication for individual needs. One technology that could revolutionise personalised medicine is a process called additive manufacturing. In this process, a three‐dimensional (3D) object is produced by fusing thin layers of materials on top of each other until the complete object is formed. This 3D printing method could be applied to medicines to include several drugs in a single tablet at entirely customisable doses set by the clinician, such as the proof of concept five‐in‐one polypill developed in 2015.2
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Amirali Popat is the recipient of a National Health and Medical Research Council (NHMRC) Career Development Fellowship (GNT1146627) and receives funding from the School of Pharmacy, University of Queensland. Tushar Kumeria pays respect to the Bedegal people who are the traditional owners of the land on which the University of New South Wales Kensington campus is situated. Tushar Kumeria also acknowledges the support from the NHMRC Early Career Fellowship (GNT1143296) and the University of New South Wales for support and Scientia Grant.
No relevant disclosures.
Knowledge about the composition and physiological effects of e‐liquids is essential for assessing their effects on health
The popularity of electronic cigarettes (e‐cigarettes) has surged in the past few years, and it is estimated that 1.2% of Australians now use them.1 While the main premise in support of e‐cigarettes is that they are safer for smokers than conventional tobacco products, a considerable proportion of users are, unfortunately, never‐smokers or young people.2,3 In 2020, about 3.6 million young people in the United States reported current e‐cigarette use,2 and in 2017, 14% of secondary school students in Australia were reported to have ever used e‐cigarettes.3
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Laura Crotty Alexander was supported by VA Merit, National Heart, Lung, and Blood Institute R01, and Tobacco‐Related Disease Research Program pilot awards.
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We need strength and courage to live with COVID‐19, and still more to overcome chronic social and planetary neglect
Welcome to 2022! According to the Chinese zodiac, we are entering the Year of the Tiger, a symbol of strength — and danger. Despite nearly two years of the coronavirus disease 2019 (COVID‐19) pandemic, there is much to celebrate, including the huge uptake of vaccination by Australians that has saved many lives and made the return to a more open lifestyle possible. However, the pandemic has not yet passed, and health and medical professionals will need both strength and resilience during the coming year as we navigate the post‐pandemic recovery phase.1 But as I write this editorial (December 2021), it is clear that Europe and the United States will have tough COVID‐19 winters, and the implications of the new Omicron variant of the virus are unclear. We too need to prepare for the possibility of more difficult months ahead as winter approaches. So please get your booster dose of the vaccine when it is due (I have!), celebrate, rest up, re‐charge, and gear up for the year ahead!
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A complete list of disclosures is available at https://www.mja.com.au/journal/staff/editor‐chief‐professor‐nick‐talley
Dowry abuse is fundamentally driven by gender inequality and is a lesser known form of family violence in Australia
Dowry is a cultural tradition maintained by some migrant and refugee communities living in Australia. It has long been practised in India, but with rising materialism in the post‐colonial era, the size of gifts for marriage increased to multiple times that of the annual income of the bride’s family.1 Dowry is also linked to family prestige.2 Rampant dowry abuse associated with significant interpersonal, family and community harm in the newly independent India gave rise to the antidowry movement and laws prohibiting it in 1961.3 Decades later, countries with large South Asian diasporas, such as Canada, the United Kingdom and Australia, continue to experience cases of dowry‐related abuse, including the husband’s confiscation of dowry wealth followed by abandonment of brides.4
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The national Survey on Dowry Abuse was designed and conducted by the authors on behalf of Harmony Alliance (https://harmonyalliance.org.au) and the Australasian Centre for Human Rights and Health (www.achrh.org). The survey is published on both websites and forms part of the project National Platform for Prevention of Dowry Abuse — an action research project, which obtained ethics approval from the Human Research Ethics Committee from the Melbourne Clinic — and is funded by the Department of Social Services, Australian Government, through the Community‐led Projects to Prevent Violence Against Women and their Children program. We are grateful to the Indian and the broader South Asian communities for their generous support. We thank Harmony Alliance and the Australasian Centre for Human Rights and Health for supporting the project. We also thank the Department of Social Services for funding the project and Our Watch for providing guidance.
No relevant disclosures.
Second infections with the severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) are thought to affect fewer than 1% of people with resolved coronavirus disease 2019 (COVID‐19).1 Reinfections as soon as 26 days after the initial diagnosis have been reported, in some cases with increased disease severity.1,2 No confirmed cases of second SARS‐CoV‐2 infections have been reported in Australia, but public awareness of the possibility is needed to encourage continued testing and vaccination.
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This investigation was funded by the Victorian Government, and by the National Health and Medical Research Council through the Medical Research Future Fund (MRF9200006). We acknowledge and thank Australian SARS‐CoV‐2 diagnostic and sequencing laboratories for their contributions to this research.
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The guidance provided in this article is inspired by the National Institute for Health and Care Excellence (NICE),2 the European Society of Cardiology (ESC),3 and the National Heart Foundation of Australia and Cardiac Society of Australia and New Zealand (NHFA)4 guidelines. Our advice applies only to the management of atrial fibrillation (AF) in Santa Claus, and should not be used in other individuals with AF. Important areas of AF management not covered in our guidance include the prevention of AF, left atrial appendage occlusion for stroke prevention, and the surgical treatment of AF in Santa Claus.
No patients or public were asked for input in the creation of this article, but we did send a copy to Santa Claus along with our Christmas list for 2021.
No relevant disclosures.
I thank my many colleagues clinical and non‐clinical from local, national and international units and boards who have contributed to the ideas discussed in this article: in particular, Richard Coates, Daniel Fineberg, Felice Borghmans, Lara Kimmel and Andrew Way of Alfred Health for creating space for, and leading, conversations that matter.
No relevant disclosures.