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To the Editor: More Australians die of prescription medication overdose than of illicit drug use or motor vehicle accidents.1 Real time prescription monitoring systems have been recommended to track patients’ supply history for potentially high risk medicines, including strong opioids and benzodiazepines. These programs aim to assist in the early identification of high risk medicine use to inform clinical care, and have received broad support from pharmacy and medical professional groups.
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To the Editor: The coronavirus disease 2019 (COVID‐19) pandemic is placing increasing pressure on the health care resources of nations. Particular concern is held for supplies of N95 (or P2) masks and surgical masks — personal protective equipment designed to achieve close facial fit and protection from more than 95% of 0.3 μm test particles. These masks are recommended for routine care of patients on airborne precautions, with current guidelines indicating that N95 masks are single use.1 Further highlighting the importance of N95 masks in protecting health care workers during the COVID‐19 pandemic, a recent study of severe acute respiratory syndrome coronavirus 2 (SARS‐CoV2) infection rates among medical staff in Zhongnan Hospital of Wuhan University showed that none of the staff (0/278) who wore N95 masks and followed frequent disinfection and handwashing became infected during the period of 2–22 January 2020 compared with 4.7% (10/231) of staff who did not wear masks, despite the fact that the latter group worked in lower risk areas.2
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Introduction: The global pandemic of coronavirus disease 2019 (COVID‐19) has caused significant worldwide disruption. Although Australia and New Zealand have not been affected as much as some other countries, resuscitation may still pose a risk to health care workers and necessitates a change to our traditional approach. This consensus statement for adult cardiac arrest in the setting of COVID‐19 has been produced by the Australasian College for Emergency Medicine (ACEM) and aligns with national and international recommendations.
Main recommendations:
Changes in management: The changes outlined in this document require a significant adaptation for many doctors, nurses and paramedics. It is critically important that all health care workers have regular PPE and advanced life support training, are able to access in situ simulation sessions, and receive extensive debriefing after actual resuscitations. This will ensure safe, timely and effective management of the patients with cardiac arrest in the COVID‐19 era.
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The authors would like to acknowledge the assistance of the following ACEM staff in the production of this consensus statement: Robert Lee, Nicola Ballenden, Andrea Johnston and Belinda Rule.
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Objectives: To prepare more accurate population‐based Australian birthweight centile charts by using the most recent population data available and by excluding pre‐term deliveries by obstetric intervention of small for gestational age babies.
Design: Population‐based retrospective observational study.
Setting: Australian Institute of Health and Welfare National Perinatal Data Collection.
Participants: All singleton births in Australia of 23–42 completed weeks’ gestation and with spontaneous onset of labour, 2004–2013. Births initiated by obstetric intervention were excluded to minimise the influence of decisions to deliver small for gestational age babies before term.
Main outcome measures: Birthweight centile curves, by gestational age and sex.
Results: Gestational age, birthweight, sex, and labour onset data were available for 2 807 051 singleton live births; onset of labour was spontaneous for 1 582 137 births (56.4%). At pre‐term gestational ages, the 10th centile was higher than the corresponding centile in previous Australian birthweight charts based upon all births.
Conclusion: Current birthweight centile charts probably underestimate the incidence of intra‐uterine growth restriction because obstetric interventions for delivering pre‐term small for gestational age babies depress the curves at earlier gestational ages. Our curves circumvent this problem by excluding intervention‐initiated births; they also incorporate more recent population data. These updated centile curves could facilitate more accurate diagnosis of small for gestational age babies in Australia.
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We acknowledge the Ministries of Health of all Australian states and territories for providing data to the National Perinatal Data Collection. We also acknowledge the Australian Institute of Health and Welfare (AIHW) for preparing and providing the National Perinatal Data Collection data for this study. We are grateful to the Victorian Consultative Council on Obstetric and Paediatric Mortality and Morbidity (CCOPMM) for providing access to the de‐identified data from the Victorian Perinatal Data Collection that contributes to the AIHW National Perinatal Data Collection and for the assistance of the staff at the Consultative Councils Unit, Safer Care Victoria, for facilitating the Victorian approval process for this project. The views expressed in this article do not necessarily reflect those of CCOPMM. Finally, we thank Kevin McGeechan for his advice on statistical analysis.
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Scientific rigour and pragmatic implementation are both required, combining research findings with other forms of evidence
Primary health networks (PHNs) have been part of the health landscape in Australia since July 2015. Following the Horvath review of Medicare Locals,1 they were established as locally configured organisations that could support primary health care service providers, design and deliver improved primary health care, and work with hospitals to maximise the efficiency, effectiveness and coordination of care. One key role for PHNs is to commission primary health care services that meet local needs and improve outcomes by procuring services from third party providers, applying market‐making and supply‐shaping principles.2 To do this, PHNs undertake population‐level needs analyses to identify service gaps, reduce hospital burden, and promote value for money. They also help general practices and other primary health care providers deliver community care, optimise quality and safety, and make meaningful use of electronic support systems.
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We thank Dianne Kitcher (chief executive officer, COORDINARE) for her insights and comments on the draft manuscript.
Amanda Barnard is a board director and chair of the Southern NSW Clinical Council of COORDINARE (South Eastern NSW primary health network).
Objectives: Using echocardiographic screening, to estimate the prevalence of rheumatic heart disease (RHD) in a remote Northern Territory town.
Design: Prospective, cross‐sectional echocardiographic screening study; results compared with data from the NT rheumatic heart disease register.
Setting, participants: People aged 5–20 years living in Maningrida, West Arnhem Land (population, 2610, including 2366 Indigenous Australians), March 2018 and November 2018.
Intervention: Echocardiographic screening for RHD by an expert cardiologist or cardiac sonographer.
Main outcome measures: Definite or borderline RHD, based on World Heart Federation criteria; history of acute rheumatic fever (ARF), based on Australian guidelines for diagnosing ARF.
Results: The screening participation rate was 72%. The median age of the 613 participants was 11 years (interquartile range, 8–14 years); 298 (49%) were girls or women, and 592 (97%) were Aboriginal Australians. Definite RHD was detected in 32 screened participants (5.2%), including 20 not previously diagnosed with RHD; in five new cases, RHD was classified as severe, and three of the participants involved required cardiac surgery. Borderline RHD was diagnosed in 17 participants (2.8%). According to NT RHD register data at the end of the study period, 88 of 849 people in Maningrida and the surrounding homelands aged 5–20 years (10%) were receiving secondary prophylaxis following diagnoses of definite RHD or definite or probable ARF.
Conclusion: Passive case finding for ARF and RHD is inadequate in some remote Australian communities with a very high burden of RHD, placing children and young people with undetected RHD at great risk of poor health outcomes. Active case finding by regular echocardiographic screening is required in such areas.
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The Pedrino Project (early detection and treatment of rheumatic heart disease in high risk communities using community‐led approaches) is a Menzies School of Health Research project, supported by a Heart Foundation Vanguard Grant and a pilot grant from the National Health and Medical Research Council (1131932: Improving health outcomes in the tropical north: a multidisciplinary collaboration [HOT NORTH]). It was also supported by Rotary Oceania Medical Aid for Children (ROMAC), the Snow Foundation, the Bawinanga Aboriginal Corporation, and the Humpty Dumpty Foundation, and by in‐kind support from NT Cardiac, the Starlight Children's Foundation, Take Heart (Moonshine Agency), the Northern Territory Department of Health, the Maningrida Health Centre, the Northern Territory Rheumatic Heart Disease Control program, the Mala'la Health Board, Maningrida College, the Lurra Language and Culture Unit, and the West Arnhem Regional Council. Anna Ralph is supported by a National Health and Medical Research Council fellowship (1142011).We acknowledge the contributions of Leroy Bading, Lionel Cooper, Madeline Mackey, Lachlan Nicolson, Erin Riddell and Matthew Ryan (West Arnhem Shire Council, logistics); Joyce Bohme, Roderick Brown and Rickisha Redford Bohme (Bawinanga Aboriginal Corporation, logistics); Georgina Byron (Snow Foundation, communications); Abigail Carter, Carolyn Coleman, Joseph Diddo, Laurie Guraylayla, Alistair James, Cindy Jinmarabynana, Nelson Nawilmak, Stanley Rankin, Mason Scholes, Russell Stewart and Karen Wuridjal (Maningrida College, education); Sue Collins and Mike Hill (Moonshine Agency, communications); Laura Francis, Kate Hardie, Lorraine Harry, Kristine McConnell‐King, Karen Shergold, Steven Wilson Dashwood and James Woods (Top End Health Services, logistics); Trudy Francis and Kaya Gardiner (data entry); Debbie Hall (Menzies School of Health, logistics); Kate Johnston, Daniel Milne and Sarah Reuben (Starlight Foundation, participant entertainment); Jo Killmister, Daryll Kinnane and Craig Watkins (Maningrida College, logistics); Chris Lowbridge (Menzies School of Health, graphics); Trephrena Taylor and Lesley Woolf (Mala'la Health Board, logistics); and Corinne Toune and Rhiannon Townsend (NT Cardiac, echocardiography).
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Tetrahydrocannabinol‐containing (THC) products with vitamin E additives are implicated in the pathogenesis of EVALI
Electronic cigarettes, or e‐cigarettes, are battery‐powered devices that heat liquids containing nicotine and other chemicals in order to produce vapour.1 “Vaping” is the act of inhaling the vapour produced by an e‐cigarette.1 First marketed in 2005, e‐cigarette use is viewed by many as less harmful than traditional cigarette smoking, and championed as a strategy for smoking cessation.1,2,3 A detailed discussion of e‐cigarette use in smoking cessation is available in the United States Surgeon General's 2020 report, and is beyond the scope of this article; however, the report states that “there is presently inadequate evidence to conclude that e‐cigarettes, in general, increase smoking cessation”.2 Thus far, no e‐cigarette product for the therapeutic purpose of smoking cessation has been submitted to Australia's Therapeutic Goods Administration for safety evaluation or approval.
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Australia needs to improve vigilance in the global endeavour to eradicate poliomyelitis
In 1988, there were over 350 000 cases of paralytic poliomyelitis globally.1 In 2018, there were 29 cases and in 2019 there were 112 cases2 — all in the only two remaining countries in the world where wild poliovirus (WPV) is endemic (Afghanistan and Pakistan). We are tantalisingly close to global eradication.
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We thank David Isaacs and Bruce Thorley for their assistance in providing relevant information for this manuscript.
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Abstract
Objective: To synthesise quantitative data on the effects of rural background and experience in rural areas during medical training on the likelihood of general practitioners practising and remaining in rural areas.
Study design: Systematic review and meta‐analysis of the effects of rural pipeline factors (rural background; rural clinical and education experience during undergraduate and postgraduate/vocational training) on likelihood of later general practice in rural areas.
Data sources: MEDLINE (Ovid), EMBASE, Informit Health Collection, and ERIC electronic database records published to September 2018; bibliographies of retrieved articles; grey literature.
Data synthesis: Of 6709 publications identified by our search, 27 observational studies were eligible for inclusion in our systematic review; when appropriate, data were pooled in random effects models for meta‐analysis. Study quality, assessed with the Newcastle–Ottawa scale, was very good or good for 24 studies, satisfactory for two, and unsatisfactory for one. Meta‐analysis indicated that GPs practising in rural communities was significantly associated with having a rural background (odds ratio [OR], 2.71; 95% CI, 2.12–3.46; ten studies) and with rural clinical experience during undergraduate (OR, 1.75; 95% CI, 1.48–2.08; five studies) and postgraduate training (OR, 4.57; 95% CI, 2.80–7.46; eight studies).
Conclusion: GPs with rural backgrounds or rural experience during undergraduate or postgraduate medical training are more likely to practise in rural areas. The effects of multiple rural pipeline factors may be cumulative, and the duration of an experience influences the likelihood of a GP commencing and remaining in rural general practice. These findings could inform government‐led initiatives to support an adequate rural GP workforce.
Protocol registration: PROSPERO, CRD42017074943 (updated 1 February 2018).