Topics

Abstract

Objectives: To assess the efficacy of corticosteroid treatment of patients with coronavirus disease 2019 (COVID‐19).

Design, setting: Observational study in the two COVID‐19‐designated hospitals in Wuhu, Anhui province, China, 24 January – 24 February 2020.

Participants: Thirty‐one patients infected with the severe acute respiratory coronavirus 2 (SARS‐CoV‐2) treated at the two designated hospitals.

Main outcome measures: Virus clearance time, length of hospital stay, and duration of symptoms, by treatment type (including or not including corticosteroid therapy).

Results: Eleven of 31 patients with COVID‐19 received corticosteroid treatment. Cox proportional hazards regression analysis indicated no association between corticosteroid treatment and virus clearance time (hazard ratio [HR], 1.26; 95% CI, 0.58–2.74), hospital length of stay (HR, 0.77; 95% CI, 0.33–1.78), or duration of symptoms (HR, 0.86; 95% CI, 0.40–1.83). Univariate analysis indicated that virus clearance was slower in two patients with chronic hepatitis B infections (mean difference, 10.6 days; 95% CI, 6.2–15.1 days).

Conclusions: Corticosteroids are widely used when treating patients with COVID‐19, but we found no association between therapy and outcomes in patients without acute respiratory distress syndrome. An existing HBV infection may delay SARS‐CoV‐2 clearance, and this association should be further investigated.

Please login with your free MJA account to view this article in full

CREATE AN ACCOUNT

Please note: institutional and Research4Life access to the MJA is now provided through Wiley Online Library.

View on Wiley Online Library

1 Xi'an Jiaotong–Liverpool University, Suzhou, Jiangsu, China
2 The Second People's Hospital of Wuhu, Wuhu, Anhui, China
3 Yijishan Hospital of Wannan Medical College, Wuhu, Anhui, China
4 Institute of Infection and Global Health, University of Liverpool, Liverpool, United Kingdom
5 The Third People's Hospital of Wuhu, Wuhu, Anhui, China

Correspondence: Villanueva@xjtlu.edu.cn

Acknowledgements:

We thank everyone fighting the epidemic of COVID‐19 around the world.

Competing interests:

No relevant disclosures.

1. Zhu N, Zhang D, Wang W, et al. A novel coronavirus from patients with pneumonia in China, 2019. N Engl J Med 2020; 382: 727–733.
2. Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 2020; 395: 497–506.
3. Holshue ML, DeBolt C, Lindquist S, et al. First case of 2019 novel coronavirus in the United States. N Engl J Med 2020; 382: 929–936.
4. Zhou P, Yang XL, Wang XG, et al. A pneumonia outbreak associated with a new coronavirus of probable bat origin. Nature 2020; 579: 270–273.
5. Yang X, Yu Y, Xu J, et al. Clinical course and outcomes of critically ill patients with SARS‐CoV‐2 pneumonia in Wuhan, China: a single‐centered, retrospective, observational study. Lancet Respir Med 2020; https://doi.org/10.1016/s2213-2600(20)30079-5 [Epub ahead of print].
6. Wang D, Hu B, Hu C, et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus‐infected pneumonia in Wuhan, China. JAMA 2020; 323: 1061–1069.
7. Chen N, Zhou M, Dong X, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet 2020; 395: 507–513.
8. World Health Organization. Coronavirus disease 2019 (COVID‐19). Situation report 63. 23 Mar 2020. https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200323-sitrep-63-covid-19.pdf?sfvrsn=d97cb6dd_2 (viewed 24 Mar 2020).
9. Arabi YM, Mandourah Y, Al‐Hameed F, et al. Corticosteroid therapy for critically ill patients with Middle East respiratory syndrome. Am J Respir Crit Care Med 2018; 197: 757–767.
10. Jin YH, Cai L, Cheng ZS, et al. A rapid advice guideline for the diagnosis and treatment of 2019 novel coronavirus (2019‐nCoV) infected pneumonia (standard version). Mil Med Res 2020; 7: 4.
11. Channappanavar R, Perlman S. Pathogenic human coronavirus infections: causes and consequences of cytokine storm and immunopathology. Semin Immunopathol 2017; 39: 529–539.
12. Zhou J, Chu H, Li C, et al. Active MERS‐CoV replication and aberrant induction of inflammatory cytokines and chemokines in human macrophages: implications for pathogenesis. J Infect Dis 2014; 209: 1331–1342.
13. Chan JF, Yao Y, Yeung ML, et al. Treatment with lopinavir/ritonavir or interferon‐β1b improves outcome of MERS‐CoV infection in a nonhuman primate model of common marmoset. J Infect Dis 2015; 212: 1904–1913.
14. DeDiego ML, Nieto‐Torres JL, Regla‐Nava JA, et al. Inhibition of NF‐κB‐mediated inflammation in severe acute respiratory syndrome coronavirus‐infected mice increases survival. J Virol 2014; 88: 913–924.
15. Sibila O, Agusti C, Torres A. Corticosteroids in severe pneumonia. Eur Respir J 2008; 32: 259–264.
16. Hui DS. Systemic corticosteroid therapy may delay viral clearance in patients with Middle East respiratory syndrome coronavirus infection. Am J Respir Crit Care Med 2018; 197: 700–701.
17. Auyeung TW, Lee JS, Lai WK, et al. The use of corticosteroid as treatment in SARS was associated with adverse outcomes: a retrospective cohort study. J Infect 2005; 51: 98–102.
18. World Health Organization. Clinical management of severe acute respiratory infection when novel coronavirus (nCoV) infection is suspected (WHO/2019‐nCoV/clinical/2020.4). Updated 13 Mar 2020. https://www.who.int/publications-detail/clinical-management-of-severe-acute-respiratory-infection-when-novel-coronavirus-(ncov)-infection-is-suspected (viewed Mar 2020).
19. Zhao JP, Hu Y, Du RJ, et al. Expert consensus on the use of corticosteroid in patients with 2019‐nCoV pneumonia] [Chinese]. Zhonghua Jie He He Hu Xi Za Zhi [Chinese Journal of Tuberculosis and Respiratory Medicine] 2020; 43: E007.
20. Mo Y, Fisher D. A review of treatment modalities for Middle East respiratory syndrome. J Antimicrob Chemother 2016; 71: 3340–3350.
21. Haviernik J, Štefánik M, Fojtíková M, et al. Arbidol (Umifenovir): a broad‐spectrum antiviral drug that inhibits medically important arthropod‐borne flaviviruses. Viruses 2018; 10: E184.
22. Xu XW, Wu XX, Jiang XG, et al. Clinical findings in a group of patients infected with the 2019 novel coronavirus (SARS‐Cov‐2) outside of Wuhan, China: retrospective case series. BMJ 2020 Feb 19; 19(368): m606.
23. Xu Z, Shi L, Wang Y, et al. Pathological findings of COVID‐19 associated with acute respiratory distress syndrome. Lancet Respir Med 2020; https://doi.org/10.1016/s2213-2600(20)30076-x [Epub ahead of print].
24. Quispe‐Laime AM, Bracco JD, Barberio PA, et al. H1N1 influenza A virus‐associated acute lung injury: response to combination oseltamivir and prolonged corticosteroid treatment. Intensive Care Med 2010; 36: 33–41.
25. Peiris JSM, Chu CM, Cheng VC, et al. Clinical progression and viral load in a community outbreak of coronavirus‐associated SARS pneumonia: a prospective study. Lancet 2003; 361: 1767–1772.
26. Park JJ, Wong DK, Wahed AS, et al. Hepatitis B virus‐specific and global T‐cell dysfunction in chronic hepatitis B. Gastroenterology 2016; 150: 684–695.
27. Lu H. Drug treatment options for the 2019‐new coronavirus (2019‐nCoV). Biosci Trends 2020; 14: 69–71.
28. Chen J, Xi XH, Liu P, et al. [Efficacies of lopinavir/ritonavir and abidol in the treatment of novel coronavirus pneumonia] [Chinese]. Zhōnghuá chuánrǎn bìng zázhì [Chinese Journal of Infectious Diseases] 2020; https://doi.org/10.3760/cma.j.cn311365-20200210-00050 [Epub ahead of print].

Online responses are no longer available. Please refer to our instructions for authors page for more information.

Perspectives

One disease, two vaccines: challenges in prevention of meningococcal disease

Cyra Patel, Clayton K Chiu, Frank H Beard, Nigel W Crawford and Kristine Macartney

Med J Aust 2020; 212 (10): . || doi: 10.5694/mja2.50567
Published online: 13 April 2020

Correction(s) for this article:

Erratum | Published online: 13 December 2025

ARTICLE
AUTHORS
REFERENCES

Topics

Infectious diseases

Environment and public health

Gaps in availability of both meningococcal ACWY and B vaccines exist for high risk groups

1 National Centre for Immunisation Research and Surveillance, Sydney Children's Hospital Network, Sydney, NSW
2 University of Sydney, Sydney, NSW
3 Murdoch Children's Research Institute, Melbourne, VIC
4 University of Melbourne, Melbourne, VIC

Correspondence: frank.beard@health.nsw.gov.au

Acknowledgements:

We thank Katrina Clark for her review and input into the article. The authors received no financial support specifically for the authorship and/or publication of this article. The views expressed in this article are those of the individual authors, and are not necessarily the views of the Australian Technical Advisory Group on Immunisation (ATAGI), the Department of Health, or the National Immunisation Program. For information from the ATAGI, please see the meningococcal chapter in the Australian immunisation handbook.

Competing interests:

Cyra Patel, Clayton Chiu, Frank Beard and Kristine Macartney are employed at the National Centre for Immunisation Research and Surveillance, which receives funding from the Australian Government Department of Health for contracted work to support ATAGI. No specific funding was provided for the drafting or publication of this manuscript.

1. Martin NV, Ong KS, Howden BP, et al. Rise in invasive serogroup W meningococcal disease in Australia 2013–2015. Commun Dis Intell Q Rep 2016; 40: E454–E459.
2. Lawrence GL, Wang H, Lahra M, et al. Meningococcal disease epidemiology in Australia 10 years after implementation of a national conjugate meningococcal C immunization programme. Epidemiol Infect 2016; 144: 2382–2391.
3. Archer BN, Chiu CK, Jayasinghe SH, et al. Epidemiology of invasive meningococcal B disease in Australia, 1999–2015: priority populations for vaccination. Med J Aust 2017; 207: 382–387. https://www.mja.com.au/journal/2017/207/9/epidemiology-invasive-meningococcal-b-disease-australia-1999-2015-priority
4. Australian Government, Department of Health. Invasive meningococcal disease national surveillance quarterly report; quarter 4, 2018. https://www.health.gov.au/internet/main/publishing.nsf/Content/5FEABC4B495BDEC1CA25807D001327FA/$File/1Oct-31Dec19-qrt3-IMD.pdf (viewed June 2019).
5. Wang B, Clarke M, Thomas N, et al. The clinical burden and predictors of sequelae following invasive meningococcal disease in Australian children. Pediatr Infect Dis J 2014; 33: 316–318.
6. Australian Technical Advisory Group on Immunisation. The Australian immunisation handbook: meningococcal disease. Canberra: Australian Government, Department of Health, 2018. https://immunisationhandbook.health.gov.au/vaccine-preventable-diseases/meningococcal-disease (viewed Jan 2020).
7. Figueroa J, Densen P. Infectious diseases associated with complement deficiencies. Clin Microbiol Rev 1991; 4: 359–395.
8. National Centre for Immunisation Research and Surveillance. Significant events in meningococcal vaccination practice in Australia, 2019. http://ncirs.org.au/sites/default/files/2019-12/Meningococcal-history-Dec%202019.pdf (viewed Jan 2020).
9. Marshall H, McMillan M, Koehler A, et al. Meningococcal B vaccine and meningococcal carriage in adolescents in Australia. N Engl J Med 2020; 382: 318–327.
10. Christensen H, May M, Bowen L, et al. Meningococcal carriage by age: a systematic review and meta‐analysis. Lancet Infect Dis 2010; 10: 853–861.
11. Northern Territory Government, Department of Health. Update — meningococcal outbreak in Central Australia, 2017. http://mediareleases.nt.gov.au/mediaRelease/23779 (viewed July 2019).
12. Wang B, Santoreneos R, Giles L, et al. Case fatality rates of invasive meningococcal disease by serogroup and age: A systematic review and meta‐analysis. Vaccine 2019; 37: 2768–2782.
13. Nolan T, Santolaya ME, de Looze F, et al. Antibody persistence and booster response in adolescents and young adults 4 and 7.5 years after immunization with 4CMenB vaccine. Vaccine 2019; 37: 1209–1218.
14. Ladhani S, Andrews N, Parikh S, et al. Vaccination of infants with meningococcal group B vaccine (4CMenB) in England. N Engl J Med 2020; 382: 309–317.
15. Medini D, Stella M, Wassil J. MATS: global coverage estimates for 4CMenB, a novel multicomponent meningococcal B vaccine. Vaccine 2015; 33: 2629–2636.
16. Nolan TM. The Australian model of immunization advice and vaccine funding. Vaccine 2010; 28: A76–A83.
17. Trotter C, Maiden MC. Meningococcal vaccines and herd immunity: lessons learned from serogroup C conjugate vaccination programs. Expert Rev Vaccines 2009; 8: 851–861.
18. Pharmaceutical Benefits Advisory Committee. May 2019 PBAC meeting — positive recommendations. http://www.pbs.gov.au/industry/listing/elements/pbac-meetings/pbac-outcomes/2019-05/positive-recommendations-05-2019.pdf (viewed June 2019).
19. Pharmaceutical Benefits Advisory Committee. Public summary document — 5.06 meningococcal polysaccharide conjugate vaccine serogroups A, C, W‐135 and Y, pre‐filled syringe, 0.5 mL, Nimenrix, Pfizer Australia Pty Ltd. 2018. http://www.pbs.gov.au/industry/listing/elements/pbac-meetings/psd/2018-03/files/men-acwy-vaccine-infants-psd-march-2018.pdf (viewed July 2019).
20. Pharmaceutical Benefits Advisory Committee. November 2019 PBAC meeting — positive recommendations. http://www.pbs.gov.au/industry/listing/elements/pbac-meetings/pbac-outcomes/2019-11/positive-recommendations-11-2019.docx.pdf (viewed Jan 2020).
21. Beard FH, Clark KK. High rates of vaccination of Aboriginal and Torres Strait Islander Australians: an underappreciated success? Med J Aust 2019; 211: 17–18. https://www.mja.com.au/journal/2019/211/1/high-rates-vaccination-aboriginal-and-torres-strait-islander-australians

Online responses are no longer available. Please refer to our instructions for authors page for more information.

Research letter

Decline in new medical graduates registered as general practitioners

Denese Playford, Jennifer A May, Hanh Ngo and Ian B Puddey

Med J Aust 2020; 212 (9): . || doi: 10.5694/mja2.50563
Published online: 13 April 2020

ARTICLE
AUTHORS
REFERENCES

Topics

General medicine

Health occupations

Health services administration

Primary care is the single most significant contributor to positive health outcomes,1,2 but the number of general practitioners in Australia has been falling, a situation previously described for nations with poorer health outcomes.2 The reasons for the decline are many,3 but this phenomenon has not been described in detail in the peer‐reviewed literature. We have therefore examined the registration categories, as recorded by the Australian Health Practitioner Regulation Agency (AHPRA), of people who graduated from the University of Western Australia (UWA) medical school during 1985–2007. Our study was approved by the UWA Human Research Ethics Committee (reference, RA 4/1/1627).

Please login with your free MJA account to view this article in full

CREATE AN ACCOUNT

Please note: institutional and Research4Life access to the MJA is now provided through Wiley Online Library.

View on Wiley Online Library

1 The Rural Clinical School of WA, University of Western Australia, Perth, WA
2 University of Newcastle, Tamworth, NSW
3 The University of Western Australia, Perth, WA

Correspondence: denese.playford@uwa.edu.au

Competing interests:

No relevant disclosures.

1. Starfield B, Horder J. Interpersonal continuity: old and new perspectives. Br J Gen Pract 2007; 57: 527–529.
2. Basu S, Berkowitz SA, Phillips RL, et al. Association of primary care physician supply with population mortality in the United States, 2005–2015. JAMA Intern Med 2018; 179: 506–514.
3. Ianuzzi A. General practice: where the problems lie. MJA Insight [online], 25 June 2018. https://insightplus.mja.com.au/2018/2024/general-practice-where-the-problems-lie (viewed Mar 2020).
4. Medical Board of Australia. General registration. Updated Aug 2018. https://www.medicalboard.gov.au/Registration/Types/General-Registration.aspx (viewed Jan 2020).
5. Medical Deans Australia and New Zealand. Medical Schools Outcomes Database: national data report 2019. Data from final year students at Australian medical schools. Sept 2019. https://medicaldeans.org.au/md/2019/09/2019-MSOD-National-Data-Report-2014-2018-Full-report.pdf (viewed Jan 2020).
6. McNamara S. Does it take too long to become a doctor? Part 1: Medical school and prevocational training. Med J Aust 2012; 196: 528–530. https://www.mja.com.au/journal/2012/196/8/does-it-take-too-long-become-doctor.

Online responses are no longer available. Please refer to our instructions for authors page for more information.

Research

A new model of care and in‐house general practitioners for residential aged care facilities: a stepped wedge, cluster randomised trial

Terry P Haines, Andrew J Palmer, Petra Tierney, Lei Si and Andrew L Robinson

Med J Aust 2020; 212 (9): . || doi: 10.5694/mja2.50565
Published online: 6 April 2020

ARTICLE
AUTHORS
REFERENCES

Topics

Gerontology

Abstract

Objectives: To evaluate whether an alternative model of care in aged care facilities, including in‐house general practitioners, influenced health outcomes for residents.

Design: Stepped wedge, cluster randomised controlled trial over 90 weeks (31 December 2012 – 21 September 2014), with a 54‐week pre‐trial retrospective data period (start: 19 December 2011) and a 54‐week post‐trial prospective data collection period (to 4 October 2015).

Participants, setting: Fifteen residential aged care facilities operated by Bupa Aged Care in metropolitan and regional cities in four Australian states.

Intervention: Residential aged care facilities sought to recruit general practitioners as staff members; care staff roles were redefined to allow registered nurses greater involvement in care plan development.

Main (primary) outcome measures: Numbers of falls; numbers of unplanned transfers to hospital; polypharmacy.

Results: The new model of care could be implemented in all facilities, but four could not recruit in‐house GPs at any time during the trial period. Intention‐to‐treat analyses found no statistically significant effect of the intervention on the primary outcome measures. Contamination‐adjusted intention‐to‐treat analyses identified that the presence of an in‐house GP was associated with reductions in the numbers of unplanned hospital transfers (incidence rate ratio [IRR], 0.53; 95% CI, 0.43–0.66) and admissions (IRR, 0.52; 95% CI, 0.41–0.64) and of out‐of‐hours GP call‐outs (IRR, 0.54; 95% CI, 0.36–0.80), but also with an increase in the number of reported falls (IRR, 1.37; 95% CI, 1.20–1.58).

Conclusions: Recruiting GPs to work directly in residential aged care facilities is difficult, but may reduce the burden of unplanned presentations to hospitals and increase the reporting of adverse events.

Trial registration: Australia New Zealand Clinical Trial Registry, ACTRN12613000218796 (25 February 2013).

Please login with your free MJA account to view this article in full

CREATE AN ACCOUNT

Please note: institutional and Research4Life access to the MJA is now provided through Wiley Online Library.

View on Wiley Online Library

1 Monash University, Melbourne, VIC
2 Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS
3 Wicking Dementia Research and Education Centre, University of Tasmania, Hobart, TAS
4 Bupa Aged Care Australia, Sydney, NSW

Correspondence: terrence.haines@monash.edu

Acknowledgements:

Terry Haines was supported by a National Health and Medical Research Council Career Development Fellowship.

Competing interests:

This study was funded by the Bupa Health Foundation, and the trial was conducted at Bupa Aged Care facilities. The Bupa Health Foundation had no role in the study design, data collection, analysis or interpretation, reporting or publication. There were no financial relationships with any organisations with an interest in the research question during the preceding three years. Petra Tierney was employed by Bupa Aged Care during the trial but not during manuscript preparation. A copy of the project report was submitted to the Bupa Health Foundation before submitting the manuscript to the MJA.

1. Appleby J. Spending on health and social care over the next 50 years: why think long term? London: The King's Fund, 2013. https://www.kingsfund.org.uk/publications/spending-health-and-social-care-over-next-50-years (viewed Jan 2020).
2. de la Maisonneuve C, Martins JO. Public spending on health and long‐term care: a new set of projections (OECD Policy Papers, no. 6). Paris: OECD Publishing, 2013. https://www.oecd.org/eco/growth/Health%20FINAL.pdf (viewed Jan 2020).
3. Reed RL. Models of general practitioner services in residential aged care facilities. Aust Fam Physician 2015; 44: 176–179.
4. Shield R, Rosenthal M, Wetle T, et al. Medical staff involvement in nursing homes: development of a conceptual model and research agenda. J Appl Gerontol 2014; 33: 75–96.
5. Swannell C. Aged care “broken”. MJA Insight [online], 7 Apr 2014. https://insightplus.mja.com.au/2014/12/aged-care-broken (viewed Jan 2020).
6. Fussell B, McInerney F, Patterson E. Experiences of graduate registered nurses in aged care: a case study. Contemp Nurse 2009; 33: 210–223.
7. Hemming K, Haines TP, Chilton PJ, et al. The stepped wedge cluster randomised trial: rationale, design, analysis, and reporting. BMJ 2015; 350: h391.
8. Haines TP, Hemming K. Stepped‐wedge cluster‐randomised trials: level of evidence, feasibility and reporting. J Physiother 2018; 64: 63–66.
9. Australian Government. CHCSS00035. Medication Assistance Skill Set (CHC Community Services Training Package) [now superseded by CHC Community Services Training Package CHCSS00070]. www.training.gov.au/Training/Details/CHCSS00070 (viewed Mar 2020).
10. Craig P, Dieppe P, Macintyre S, et al; Medical Research Council Guidance. Developing and evaluating complex interventions: the new Medical Research Council guidance. BMJ 2008; 337: a1655.
11. Rapp K, Becker C, Cameron ID, et al. Epidemiology of falls in residential aged care: analysis of more than 70 000 falls from residents of Bavarian nursing homes. J Am Med Dir Assoc 2012; 13: 187.e1–6.
12. Arendts G, Reibel T, Codde J, Frankel J. Can transfers from residential aged care facilities to the Emergency Department be avoided through improved primary care services? Data from qualitative interviews. Aust J Ageing 2010; 29: 61–65.
13. Nguyen JK, Fouts MM, Kotabe SE, Lo E. Polypharmacy as a risk factor for adverse drug reactions in geriatric nursing home residents. Am J Geriatr Pharmacother 2006; 4: 36–41.
14. Baranzini F, Diurni M, Ceccon F, et al. Fall‐related injuries in a nursing home setting: is polypharmacy a risk factor? BMC Health Serv Res 2009; 9: 228.
15. Onder G, Liperoti R, Fialova D, et al; SHELTER Project. Polypharmacy in nursing home in Europe: results from the SHELTER study. J Gerontol A Biol Sci Med Sci 2012; 67: 698–704.
16. Sussman JB, Hayward RA. An IV for the RCT: using instrumental variables to adjust for treatment contamination in randomised controlled trials. BMJ 2010; 340: c2073.
17. Sarkies MN, Bowles KA, Skinner EH, et al. Do daily ward interviews improve measurement of hospital quality and safety indicators? A prospective observational study. J Eval Clin Pract 2016; 22: 792–798.
18. Snyder LA, Chen PY, Vacha‐Haase T. The underreporting gap in aggressive incidents from geriatric patients against certified nursing assistants. Violence Vict 2007; 22: 367–379.
19. McMillan JH. Randomized field trials and internal validity: not so fast my friend. Practical Assess Res Eval 2007; 12: 15.
20. Kotz D, Spigt M, Arts IC, et al. Use of the stepped wedge design cannot be recommended: a critical appraisal and comparison with the classic cluster randomized controlled trial design. J Clin Epidemiol 2012; 65: 1249–1252.

Online responses are no longer available. Please refer to our instructions for authors page for more information.

Narrative review

Chronic fatigue syndrome: progress and possibilities

Carolina X Sandler and Andrew R Lloyd

Med J Aust 2020; 212 (9): . || doi: 10.5694/mja2.50553
Published online: 6 April 2020

ARTICLE
AUTHORS
REFERENCES

Topics

Infectious diseases

General medicine

Information science

Summary

Chronic fatigue syndrome (CFS) is a prevalent condition affecting about one in 100 patients attending primary care.
There is no diagnostic test, validated biomarker, clear pathophysiology or curative treatment.
The core symptom of fatigue affects both physical and cognitive activities, and features a prolonged post‐activity exacerbation triggered by tasks previously achieved without difficulty.
Although several different diagnostic criteria are proposed, for clinical purposes only three elements are required: recognition of the typical fatigue; history and physical examination to exclude other medical or psychiatric conditions which may explain the symptoms; and a restricted set of laboratory investigations.
Studies of the underlying pathophysiology clearly implicate a range of different acute infections as a trigger for onset in a significant minority of cases, but no other medical or psychological factor has been reproducibly implicated.
There have been numerous small case–control studies seeking to identify the biological basis of the condition. These studies have largely resolved what the condition is not: ongoing infection, immunological disorder, endocrine disorder, primary sleep disorder, or simply attributable to a psychiatric condition.
A growing body of evidence suggests CFS arises from functional (non‐structural) changes in the brain, but of uncertain character and location. Further functional neuroimaging studies are needed.
There is clear evidence for a genetic contribution to CFS from family and twin studies, suggesting that a large scale genome‐wide association study is warranted.
Despite the many unknowns in relation to CFS, there is significant room for improvement in provision of the diagnosis and supportive care. This may be facilitated via clinician education.

1 UNSW Fatigue Clinic, UNSW, Sydney, NSW
2 Queensland University of Technology, Brisbane, QLD
3 Kirby Institute for Infection and Immunity in Society, UNSW, Sydney, NSW
4 UNSW Medicine, Sydney, NSW

Correspondence: a.lloyd@unsw.edu.au

Acknowledgements:

Andrew Lloyd is supported by a National Health and Medical Research Council Practitioner Fellowship (1041897). We are grateful for the review of the manuscript by Phillip Peterson MD.

Competing interests:

No relevant disclosures.

1. Prins JB, van der Meer JW, Bleijenberg G. Chronic fatigue syndrome. Lancet 2006; 367: 346–355.
2. Rowe PC, Underhill RA, Friedman KJ, et al. Myalgic encephalomyelitis / chronic fatigue syndrome diagnosis and management in young people: a primer. Front Pediatr 2017; 5: 121.
3. Committee on the Diagnostic Criteria for Myalgic Encephalomyelitis/Chronic Fatigue Syndrome; Board on the Health of Select Populations; Institute of Medicine. Beyond myalgic encephalomyelitis/chronic fatigue syndrome: redefining an illness. Washington, DC: National Academies Press (US), 2015.
4. Clayton EW. Beyond myalgic encephalomyelitis/chronic fatigue syndrome: an IOM report on redefining an illness. JAMA 2015; 313: 1101–1102.
5. Keech A, Sandler CX, Vollmer‐Conna U, et al. Capturing the post‐exertional exacerbation of fatigue following physical and cognitive challenge in patients with chronic fatigue syndrome. J Psychosom Res 2015; 79: 537–549.
6. Bennett BK, Goldstein D, Chen M, et al. Characterization of fatigue states in medicine and psychiatry by structured interview. Psychosom Med 2014; 76: 379–388.
7. Nijs J, Aelbrecht S, Meeus M, et al. Tired of being inactive: a systematic literature review of physical activity, physiological exercise capacity and muscle strength in patients with chronic fatigue syndrome. Disabil Rehabil 2011; 33: 1493–1500.
8. Michiels V, Cluydts R. Neuropsychological functioning in chronic fatigue syndrome: a review. Acta Psychiatr Scand 2001; 103: 84–93.
9. Cvejic E, Birch RC, Vollmer‐Conna U. Cognitive dysfunction in chronic fatigue syndrome: a review of recent evidence. Curr Rheumatol Rep 2016; 18: 24.
10. Lloyd AR. Chronic fatigue and chronic fatigue syndrome: shifting boundaries and attributions. Am J Med 1998; 105: 7S–10S.
11. Royal Australasian College of Physicians Working Group. Chronic fatigue syndrome: clinical practice guidelines — 2002. Med J Aust 2002; 176 (9 Suppl): S17–S55. https://www.mja.com.au/journal/2002/176/9/chronic-fatigue-syndrome.
12. Griffith JP, Zarrouf FA. A systematic review of chronic fatigue syndrome: don't assume it's depression. Prim Care Companion J Clin Psychiatry 2008; 10: 120–128.
13. Hickie I, Davenport T, Wakefield D, et al. Post‐infective and chronic fatigue syndromes precipitated by viral and non‐viral pathogens: prospective cohort study. BMJ 2006; 333: 575.
14. Petersen I, Thomas JM, Hamilton WT, White PD. Risk and predictors of fatigue after infectious mononucleosis in a large primary‐care cohort. QJM 2006; 99: 49–55.
15. White PD, Thomas JM, Amess J, et al. Incidence, risk and prognosis of acute and chronic fatigue syndromes and psychiatric disorders after glandular fever. Br J Psychiatry 1998; 173: 475–481.
16. White PD, Thomas JM, Kangro HO, et al. Predictions and associations of fatigue syndromes and mood disorders that occur after infectious mononucleosis. Lancet 2001; 358: 1946–1954.
17. Jackson ML, Bruck D. Sleep abnormalities in chronic fatigue syndrome/myalgic encephalomyelitis: a review. J Clin Sleep Med 2012; 8: 719–728.
18. Mariman AN, Vogelaers DP, Tobback E, et al. Sleep in the chronic fatigue syndrome. Sleep Med Rev 2013; 17: 193–199.
19. Jason LA, McManimen S, Sunnquist M, et al. Examining the Institute of Medicine's recommendations regarding chronic fatigue syndrome: clinical versus research criteria. J Neurol Psychol 2015; 2: 25.
20. Fukuda K, Straus SE, Hickie I, et al. The chronic fatigue syndrome: a comprehensive approach to its definition and study. International Chronic Fatigue Syndrome Study Group. Ann Intern Med 1994; 121: 953–959.
21. Reeves WC, Lloyd A, Vernon SD, et al. Identification of ambiguities in the 1994 chronic fatigue syndrome research case definition and recommendations for resolution. BMC Health Serv Res 2003; 3: 25.
22. Jason LA, Helgerson J, Torres‐Harding SR, et al. Variability in diagnostic criteria for chronic fatigue syndrome may result in substantial differences in patterns of symptoms and disability. Eval Health Prof 2003; 26: 3–22.
23. Carruthers BM, Jain AK, De Meirleir KL, et al. Myalgic encephalomyelitis/chronic fatigue syndrome. J Chronic Fatigue Syndrome 2003; 11: 7–115.
24. National Institute for Health and Clinical Excellence. Chronic fatigue syndrome/myalgic encephalomyelitis (or encephalopathy): diagnosis and management of CFS/ME in adults and children. London: NICE, 2007. https://www.ncbi.nlm.nih.gov/books/NBK53577/ (viewed Nov 2019).
25. Carruthers BM, van de Sande MI, De Meirleir KL, et al. Myalgic encephalomyelitis: International Consensus Criteria. J Intern Med 2011; 270: 327–338.
26. Brown A, Molly B, Nicole P, et al. The development of a revised Canadian myalgic encephalomyelitis chronic fatigue syndrome case definition. Am J Biochem Biotechnol 2010; 6: 120–135.
27. Sunnquist M, Jason LA, Nehrke P, Goudsmit EM. A comparison of case definitions for myalgic encephalomyelitis and chronic fatigue syndrome. J Chronic Dis Manag 2017; 2: 21.
28. Johnston S, Brenu EW, Staines D, Marshall‐Gradisnik S. The prevalence of chronic fatigue syndrome/ myalgic encephalomyelitis: a meta‐analysis. Clin Epidemiol 2013; 5: 105–110.
29. Johnston S, Brenu EW, Staines DR, Marshall‐Gradisnik S. The adoption of chronic fatigue syndrome/myalgic encephalomyelitis case definitions to assess prevalence: a systematic review. Ann Epidemiol 2013; 23: 371–376.
30. Brurberg KG, Fonhus MS, Larun L, et al. Case definitions for chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME): a systematic review. BMJ Open 2014; 4: e003973.
31. Haney E, Smith ME, McDonagh M, et al. Diagnostic methods for myalgic encephalomyelitis/chronic fatigue syndrome: a systematic review for a National Institutes of Health Pathways to Prevention Workshop. Ann Intern Med 2015; 162: 834–840.
32. Williams TE, Chalder T, Sharpe M, White PD. Heterogeneity in chronic fatigue syndrome ‐ empirically defined subgroups from the PACE trial. Psychol Med 2017; 47: 1454–1465.
33. Wilson A, Hickie I, Hadzi‐Pavlovic D, et al. What is chronic fatigue syndrome? Heterogeneity within an international multicentre study. Aust N Z J Psychiatry 2001; 35: 520–527.
34. Ross SD, Estok RP, Frame D, Stone LR, Ludensky V, Levine CB. Disability and chronic fatigue syndrome: a focus on function. Arch Intern Med 2004; 164 (10): 1098–107.
35. Vercoulen JH, Hommes OR, Swanink CM, et al. The measurement of fatigue in patients with multiple sclerosis. A multidimensional comparison with patients with chronic fatigue syndrome and healthy subjects. Arch Neurol 1996; 53: 642–649.
36. Wilson J, Morgan S, Magin PJ, van Driel ML. Fatigue–a rational approach to investigation. Aust Fam Physician 2014; 43: 457–461.
37. Knight S, Harvey A, Lubitz L, et al. Paediatric chronic fatigue syndrome: complex presentations and protracted time to diagnosis. J Paediatr Child Health 2013; 49: 919–924.
38. Stadje R, Dornieden K, Baum E, et al. The differential diagnosis of tiredness: a systematic review. BMC Fam Pract 2016; 17: 147.
39. Joyce J, Hotopf M, Wessely S. The prognosis of chronic fatigue and chronic fatigue syndrome: a systematic review. QJM 1997; 90: 223–233.
40. Cairns R, Hotopf M. A systematic review describing the prognosis of chronic fatigue syndrome. Occup Med (Lond) 2005; 55: 20–31.
41. Katz BZ, Collin SM, Murphy G, et al. The International Collaborative on Fatigue Following Infection (COFFI). Fatigue 2018; 6: 106–121.
42. Crawley E. The epidemiology of chronic fatigue syndrome/myalgic encephalitis in children. Arch Dis Child 2014; 99: 171–174.
43. Schag CC, Heinrich RL, Ganz PA. Karnofsky performance status revisited: reliability, validity, and guidelines. J Clin Oncol 1984; 2: 187–193.
44. Lombardi VC, Ruscetti FW, Das Gupta J, et al. Detection of an infectious retrovirus, XMRV, in blood cells of patients with chronic fatigue syndrome. Science 2009; 326: 585–589.
45. Groom HC, Bishop KN. The tale of xenotropic murine leukemia virus‐related virus. J Gen Virol 2012; 93 (Pt 5): 915–924.
46. Wessely S, Chalder T, Hirsch S, et al. Postinfectious fatigue: prospective cohort study in primary care. Lancet 1995; 345: 1333–1338.
47. Hopper B, Cameron B, Li H, et al. The natural history of acute Q fever: a prospective Australian cohort. QJM 2016; 109: 661–668.
48. Weinstein A, Klempner M. Treatment of patients with persistent symptoms and a history of Lyme disease. N Engl J Med 2001; 345: 1424–1425.
49. Cameron B, Bharadwaj M, Burrows J, et al. Prolonged illness after infectious mononucleosis is associated with altered immunity but not with increased viral load. J Infect Dis 2006; 193: 664–671.
50. Vollmer‐Conna U, Lloyd A, Hickie I, Wakefield D. Chronic fatigue syndrome: an immunological perspective. Aust N Z J Psychiatry 1998; 32: 523–527.
51. Cameron B, Hirschberg DL, Rosenberg‐Hassan Y, et al. Serum cytokine levels in postinfective fatigue syndrome. Clin Infect Dis 2010; 50: 278–279.
52. Vollmer‐Conna U, Cameron B, Hadzi‐Pavlovic D, et al. Postinfective fatigue syndrome is not associated with altered cytokine production. Clinical Infectious Diseases 2007; 45 (6): 732–5.
53. Sabath DE, Barcy S, Koelle DM, Zeh J, Ashton S, Buchwald D. Cellular immunity in monozygotic twins discordant for chronic fatigue syndrome. J Infect Dis 2002; 185 (6): 828–32.
54. Lyall M, Peakman M, Wessely S. A systematic review and critical evaluation of the immunology of chronic fatigue syndrome. J Psychosom Res 2003; 55: 79–90.
55. Blundell S, Ray KK, Buckland M, White PD. Chronic fatigue syndrome and circulating cytokines: a systematic review. Brain Behav Immun 2015; 50: 186–195.
56. Teodoro T, Edwards MJ, Isaacs JD. A unifying theory for cognitive abnormalities in functional neurological disorders, fibromyalgia and chronic fatigue syndrome: systematic review. J Neurol Neurosurg Psychiatry 2018; 89: 1308–1319.
57. Harrison NA, Brydon L, Walker C, et al. Neural origins of human sickness in interoceptive responses to inflammation. Biol Psychiatry 2009; 66: 415–422.
58. Kraynak TE, Marsland AL, Wager TD, Gianaros PJ. Functional neuroanatomy of peripheral inflammatory physiology: a meta‐analysis of human neuroimaging studies. Neurosci Biobehav Rev 2018; 94: 76–92.
59. Morris G, Berk M, Puri BK. A comparison of neuroimaging abnormalities in multiple sclerosis, major depression and chronic fatigue syndrome (myalgic encephalomyelitis): is there a common cause? Mol Neurobiol 2018; 55: 3592–3609.
60. VanElzakker MB, Brumfield SA, Lara Mejia PS. Neuroinflammation and cytokines in myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS): a critical review of research methods. Front Neurol 2018; 9: 1033.
61. Lange G, Wang S, DeLuca J, Natelson BH. Neuroimaging in chronic fatigue syndrome. Am J Med 1998; 105: 50S–53S.
62. Tanaka M, Ishii A, Watanabe Y. Neural mechanisms underlying chronic fatigue. Rev Neurosci 2013; 24: 617–628.
63. Walitt B, Ceko M, Gracely JL, Gracely RH. Neuroimaging of central sensitivity syndromes: key insights from the scientific literature. Curr Rheumatol Rev 2016; 12: 55–87.
64. Meeus M, Nijs J, Vanderheiden T, et al. The effect of relaxation therapy on autonomic functioning, symptoms and daily functioning, in patients with chronic fatigue syndrome or fibromyalgia: a systematic review. Clin Rehabil 2015; 29: 221–233.
65. Van Cauwenbergh D, Nijs J, Kos D, et al. Malfunctioning of the autonomic nervous system in patients with chronic fatigue syndrome: a systematic literature review. Eur J Clin Invest 2014; 44: 516–526.
66. Martinez‐Martinez LA, Mora T, Vargas A, et al. Sympathetic nervous system dysfunction in fibromyalgia, chronic fatigue syndrome, irritable bowel syndrome, and interstitial cystitis: a review of case‐control studies. J Clin Rheumatol 2014; 20: 146–150.
67. Smith ME, Haney E, McDonagh M, et al. Treatment of myalgic encephalomyelitis/chronic fatigue syndrome: a systematic review for a National Institutes of Health Pathways to Prevention Workshop. Ann Intern Med 2015; 162: 841–850.
68. Sullivan PF, Evengard B, Jacks A, Pedersen NL. Twin analyses of chronic fatigue in a Swedish national sample. Psychol Med 2005; 35: 1327–1336.
69. Kato K, Sullivan PF, Evengard B, Pedersen NL. A population‐based twin study of functional somatic syndromes. Psychol Med 2009; 39: 497–505.
70. Corfield EC, Martin NG, Nyholt DR. Familiality and heritability of fatigue in an Australian twin sample. Twin Res Hum Genet 2017; 20: 208–215.
71. Landmark‐Hoyvik H, Reinertsen KV, Loge JH, et al. The genetics and epigenetics of fatigue. PM R 2010; 2: 456–465.
72. Cameron B, Galbraith S, Zhang Y, et al. Gene expression correlates of postinfective fatigue syndrome after infectious mononucleosis. J Infect Dis 2007; 196: 56–66.
73. Galbraith S, Cameron B, Li H, et al. Peripheral blood gene expression in postinfective fatigue syndrome following from three different triggering infections. J Infect Dis 2011; 204: 1632–1640.
74. Schutzer SE, Angel TE, Liu T, et al. Distinct cerebrospinal fluid proteomes differentiate post‐treatment Lyme disease from chronic fatigue syndrome. PLoS One 2011; 6: e17287.
75. Baraniuk JN, Casado B, Maibach H, et al. A chronic fatigue syndrome‐related proteome in human cerebrospinal fluid. BMC Neurol 2005; 5: 22.
76. Ciregia F, Kollipara L, Giusti L, et al. Bottom‐up proteomics suggests an association between differential expression of mitochondrial proteins and chronic fatigue syndrome. Transl Psychiatry 2016; 6: e904.
77. Tomas C, Newton J. Metabolic abnormalities in chronic fatigue syndrome/myalgic encephalomyelitis: a mini‐review. Biochem Soc Trans 2018; 46: 547–553.
78. Newberry F, Hsieh SY, Wileman T, Carding SR. Does the microbiome and virome contribute to myalgic encephalomyelitis/chronic fatigue syndrome? Clin Sci (Lond) 2018; 132: 523–542.
79. Castro‐Marrero J, Saez‐Francas N, Santillo D, Alegre J. Treatment and management of chronic fatigue syndrome/myalgic encephalomyelitis: all roads lead to Rome. Br J Pharmacol 2017; 174: 345–369.
80. Collatz A, Johnston SC, Staines DR, Marshall‐Gradisnik SM. A systematic review of drug therapies for chronic fatigue syndrome/myalgic encephalomyelitis. Clin Ther 2016; 38 (1263–1271): e9.
81. Fluge O, Mella O. Clinical impact of B‐cell depletion with the anti‐CD20 antibody rituximab in chronic fatigue syndrome: a preliminary case series. BMC Neurol 2009; 9: 28.
82. Fluge O, Bruland O, Risa K, et al. Benefit from B‐lymphocyte depletion using the anti‐CD20 antibody rituximab in chronic fatigue syndrome. A double‐blind and placebo‐controlled study. PLoS One 2011; 6: e26358.
83. Fluge O, Rekeland IG, Lien K, et al. B‐lymphocyte depletion in patients with myalgic encephalomyelitis/chronic fatigue syndrome: a randomized, double‐blind, placebo‐controlled trial. Ann Intern Med 2019; 170: 585–593.
84. Sandler CX, Hamilton BA, Horsfield SL, et al. Outcomes and predictors of response from an optimised, multidisciplinary intervention for chronic fatigue states. Intern Med J 2016; 46: 1421–1429.
85. McBride RL, Horsfield S, Sandler CX, et al. Cognitive remediation training improves performance in patients with chronic fatigue syndrome. Psychiatry Res 2017; 257: 400–405.
86. White PD, Goldsmith KA, Johnson AL, et al. Comparison of adaptive pacing therapy, cognitive behaviour therapy, graded exercise therapy, and specialist medical care for chronic fatigue syndrome (PACE): a randomised trial. Lancet 2011; 377: 823–836.
87. Sharpe M, Hawton K, Simkin S, et al. Cognitive behaviour therapy for the chronic fatigue syndrome: a randomized controlled trial. BMJ 1996; 312: 22–26.
88. Prins JB, Bleijenberg G, Bazelmans E, et al. Cognitive behaviour therapy for chronic fatigue syndrome: a multicentre randomised controlled trial. Lancet 2001; 357: 841–847.
89. Price JR, Mitchell E, Tidy E, Hunot V. Cognitive behaviour therapy for chronic fatigue syndrome in adults. Cochrane Database Syst Rev 2008; (3): CD001027.
90. Janse A, Worm‐Smeitink M, Bleijenberg G, et al. Efficacy of web‐based cognitive‐behavioural therapy for chronic fatigue syndrome: randomised controlled trial. Br J Psychiatry 2018; 212: 112–118.
91. Larun L, Brurberg KG, Odgaard‐Jensen J, Price JR. Exercise therapy for chronic fatigue syndrome. Cochrane Database Syst Rev 2019; (10): CD003200.
92. Larun L, Brurberg KG, Odgaard‐Jensen J, Price JR. Exercise therapy for chronic fatigue syndrome. Cochrane Database Syst Rev 2017; (4): CD003200.
93. Brimmer DJ, Fridinger F, Lin JM, Reeves WC. US healthcare providers’ knowledge, attitudes, beliefs, and perceptions concerning chronic fatigue syndrome. BMC Fam Pract 2010; 11: 28.
94. Thomas MA, Smith AP. Primary healthcare provision and chronic fatigue syndrome: a survey of patients’ and general practitioners’ beliefs. BMC Fam Pract 2005; 6: 49.
95. Myalgic Encephalomyelitis/Chronic Fatigue Syndrome Advisory Committee. Report to NHMRC Chief Executive Officer. Canberra: NHMRC, 2019. https://www.nhmrc.gov.au/about-us/publications/mecfs-advisory-committee-report-nhmrc-chief-executive-officer (viewed Feb 2020).

Online responses are no longer available. Please refer to our instructions for authors page for more information.

Letters

Time to recognise gout as a chronic disease

Helen I Keen, Philip C Robinson, Nicola Dalbeth and Catherine Hill

Med J Aust 2020; 212 (6): . || doi: 10.5694/mja2.50512
Published online: 6 April 2020

ARTICLE
AUTHORS
REFERENCES

Topics

Musculoskeletal diseases

To the Editor: In August 2019, the Australian Institute of Health and Welfare (AIHW) released a report on chronic musculoskeletal conditions in Australia.1

1 Fiona Stanley Hospital, Perth, WA
2 Royal Perth Hospital, Perth, WA
3 University of Western Australia, Perth, WA
4 Centre for Neurogenetics and Statistical Genomics, Diamantina Institute, University of Queensland, Brisbane, QLD
5 Royal Brisbane and Women's Hospital, Brisbane, QLD
6 University of Auckland, Auckland, Auckland, New Zealand
7 Queen Elizabeth Hospital, Adelaide, SA
8 Royal Adelaide Hospital, Adelaide, SA

Correspondence: helen.keen@uwa.edu.au

Competing interests:

Nicola Dalbeth reports grants and personal fees from AstraZeneca, grants from Amgen, and personal fees from Dyve, Hengrui, Horizon, Abbvie, Pfizer, and Janssen outside the submitted work. Helen Keen reports personal fees from Abbvie, Cornerstones, Roche, and Pfizer outside of the submitted work.

1. Australian Institute of Health and Welfare. Arthritis [Cat. No. PHE 234]. Canberra: AIHW, 2019. https://www.aihw.gov.au/reports/chronic-musculoskeletal-conditions/arthritis/related-material (viewed Jan 2019).
2. Pisaniello HL, Lester S, Gonzalez‐Chica D, et al. Gout prevalence and predictors of urate‐lowering therapy use: results from a population‐based study. Arthritis Res Ther 2018; 20: 143.
3. Rai SK, Choi HK, Choi SHJ, et al. Key barriers to gout care: a systematic review and thematic synthesis of qualitative studies. Rheumatology (Oxford) 2018; 57: 1282–1292.
4. Bursill D, Taylor WJ, Terkeltaub R, et al. Gout, Hyperuricaemia and Crystal‐Associated Disease Network (G‐CAN) consensus statement regarding labels and definitions of disease states of gout. Ann Rheum Dis 2019; 78: 1592–1600.
5. Dalbeth N, Schumacher HR, Fransen J, et al. Survey definitions of gout for epidemiologic studies: comparison with crystal identification as the gold standard. Arthritis Care Res (Hoboken) 2016; 68: 1894–1898.

Online responses are no longer available. Please refer to our instructions for authors page for more information.

Letters

The hidden slaves of medicine

Sharon Sitters

Med J Aust 2020; 212 (6): . || doi: 10.5694/mja2.50510
Published online: 6 April 2020

ARTICLE
AUTHORS
REFERENCES

Topics

Global health

Ethics and law

Social determinants of health

To the Editor: Nearly all industries profit from today's 25 million slaves and 150 million child labourers.1 The results of their work, including medical disposables, are sold worldwide. Unfortunately, there is not a comprehensive analysis identifying exactly where slaves are involved in the medical products supply chain.

Unitec Institute of Technology, Auckland, New Zealand

Correspondence: ssitters@unitec.ac.nz

Competing interests:

No relevant disclosures.

1. International Labour Organization. Modern slavery and child labour: 40 million in modern slavery and 152 million in child labour around the world. International Labour Organization, 2017. https://www.ilo.org/global/about-the-ilo/newsroom/news/WCMS_574717/lang-en/index.htm (viewed June 2019).
2. Bhutta MF. Time for a global response to labour rights violations in the manufacture of health‐care goods. Bull World Health Organ 2017; 95: 314–314A.
3. Bureau of International Labor Affairs. US Department of Labor's 2018 list of goods produced by child labor or forced labor. US Department of Labor, 2018. https://www.dol.gov/sites/dolgov/files/ILAB/ListofGoods.pdf (viewed June 2019).
4. Khadem N. Ansell says worker rights abuse in its supply chain under investigation. ABC News 2019, 11 Mar. https://www.abc.net.au/news/2019-01-04/ansell-investigating-claims-worker-rights-abuse-in-supply-chain/10685124 (viewed June 2019).
5. Boersma M. Do no harm? Procurement of medical goods by Australian companies and government. Australian Nursing and Midwifery Federation, Australia Institute, 2017. http://www.anmf.org.au/documents/Do_No_Harm_Report.pdf (viewed June 2019).
6. Nestlé. Tackling child labour — 2017 report. Nestlé, 2017. https://www.nestle.com/asset-library/documents/creating-shared-value/responsible-sourcing/nestle-cocoa-plan-child-labour-2017-report.pdf (viewed June 2019).
7. King B, Payne C, Melsom R. The tobacco free portfolios story [website]. Tobacco Free Portfolios, 2019. www.tobaccofreeportfolios.org/who-we-are/ (viewed Oct 2019).

Online responses are no longer available. Please refer to our instructions for authors page for more information.

Research

Optimising epilepsy management with a smartphone application: a randomised controlled trial

Yang Si, Xiaoqiang Xiao, Cai Xia, Jiang Guo, Qiukui Hao, Qianning Mo, Yulong Niu and Hongbin Sun

Med J Aust 2020; 212 (6): . || doi: 10.5694/mja2.50520
Published online: 6 April 2020

ARTICLE
AUTHORS
REFERENCES

Topics

Nervous system diseases

Health services administration

Information science

Abstract

Objective: To assess whether a practical intervention based upon a smartphone application (app) would improve self‐management and seizure control in adults with epilepsy.

Design, setting: Randomised, controlled trial in western China, December 2017 to August 2018.

Participants: 380 eligible people with epilepsy were recruited; 327 completed the 6‐month follow‐up (176 in the app group, 151 in the control group).

Main outcome measures: Self‐management of epilepsy (measured with the validated Chinese Epilepsy Self‐Management Scale, C‐ESMS) and self‐reported seizure frequency.

Results: In the intention‐to‐treat analysis, the mean C‐ESMS score increased significantly in the app group between baseline and the 6‐month evaluation (from 121.7 [SD, 12.1] to 144.4 [SD, 10.0]; P < 0.001); improvements on the information management, medication management, and safety management subscales were also statistically significant. At 6 months, the mean overall C‐ESMS score for the app group was significantly higher than that for the control group (125.4 [SD, 1.5]; P < 0.001). The proportion of patients who were seizure‐free at the 6‐month follow‐up was larger for the app than the control group (54 of 190, 28% v 22 of 190, 12%), as was the proportion with reductions in frequency of between 75 and 100% (22 of 190, 12% v 8 of 190, 4%). Changes in C‐ESMS score were not statistically associated with seizure frequency.

Conclusions: Using a smartphone app improved epilepsy self‐management scores in people in western China. It should be further tested in larger populations in other areas. Our preliminary investigation of building digital communities for people with epilepsy should encourage similar approaches to managing other chronic diseases.

Trial registration: Chinese Clinical Trial Registry, ChiCTR1900026864, 24 October 2019.

Please login with your free MJA account to view this article in full

CREATE AN ACCOUNT

Please note: institutional and Research4Life access to the MJA is now provided through Wiley Online Library.

View on Wiley Online Library

1 Sichuan Academy of Medical Sciences and Sichuan People's Hospital, Chengdu, Sichuan, China
2 University of Electronic Science and Technology of China, Chengdu, Sichuan, China
3 Sichuan Provincial Center for Mental Health, Sichuan Academy of Medical Sciences and Sichuan People's Hospital, Chengdu, Sichuan, China
4 National Clinical Research Center for Geriatrics, Sichuan University West China Hospital, Chengdu, Sichuan, China
5 Key Laboratory of Bio‐Resource and Eco‐Environment, College of Life Sciences, Sichuan University, Chengdu, Sichuan, China

Correspondence:

yulong.niu@hotmail.com, sndxgl@163.com

Acknowledgements:

This investigation was supported by the National Natural Science Foundation of China (NSFC, 81701269).

Competing interests:

No relevant disclosures.

1. Murray CJ, Vos T, Lozano R, et al. Disability‐adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 2012; 380: 2197–2223.
2. Wang WZ, Wu JZ, Wang DS, et al. The prevalence and treatment gap in epilepsy in China: an ILAE/IBE/WHO study. Neurology 2003; 60: 1544–1545.
3. Briesacher BA, Andrade SE, Fouayzi H, Chan KA. Comparison of drug adherence rates among patients with seven different medical conditions. Pharmacotherapy 2008; 28: 437–443.
4. Ettinger AB, Baker GA. Best clinical and research practice in epilepsy of older people: focus on antiepileptic drug adherence. Epilepsy Behav 2009; 15 (Suppl 1): S60–S63.
5. Li J, Si Y, Hu J, et al. Enhancing medical compliance of patients with convulsive epilepsy in rural community: a randomized intervention trial. Epilepsia 2013; 54: 1988–1996.
6. Goh G, Tan NC, Malhotra R, et al. Short‐term trajectories of use of a caloric‐monitoring mobile phone app among patients with type 2 diabetes mellitus in a primary care setting. J Med Internet Res 2015; 17: e33.
7. Lorig KR, Holman H. Self‐management education: history, definition, outcomes, and mechanisms. Ann Behav Med 2003; 26: 1–7.
8. Arnhold M, Quade M, Kirch W. Mobile applications for diabetics: a systematic review and expert‐based usability evaluation considering the special requirements of diabetes patients age 50 years or older. J Med Internet Res 2014; 16: e104.
9. Kumar N, Khunger M, Gupta A, Garg N. A content analysis of smartphone‐based applications for hypertension management. J Am Soc Hypertens 2015; 9: 130–136.
10. Liu X, Wang R, Zhou D, Hong Z. Feasibility and acceptability of smartphone applications for seizure self‐management in China: questionnaire study among people with epilepsy. Epilepsy Behav 2016; 55: 57–61.
11. Liu X, Wang R, Zhou D, Hong Z. Smartphone applications for seizure care and management in children and adolescents with epilepsy: feasibility and acceptability assessment among caregivers in China. Epilepsy Res 2016; 127: 1–5.
12. Sun L, Wang Y, Greene B, et al. Facilitators and barriers to using physical activity smartphone apps among Chinese patients with chronic diseases. BMC Med Inform Decis Mak 2017; 17: 44.
13. Xiao X, Si Y, Mo Q, et al. Development and validation of the Chinese version of the Adult Epilepsy Self‐Management Scale (C‐ESMS) in western China. Epilepsy Res 2018; 144: 43–48.
14. Scheffer IE, Berkovic S, Capovilla G, et al. ILAE classification of the epilepsies: position paper of the ILAE Commission for Classification and Terminology. Epilepsia 2017; 58: 512–521.
15. Sajatovic M, Jobst BC, Shegog R, et al. The Managing Epilepsy Well Network: advancing epilepsy self‐management. Am J Prev Med 2017; 52 (3 Suppl 3): S241–S245.
16. Hixson JD, Barnes D, Parko K, et al. Patients optimizing epilepsy management via an online community: the POEM Study. Neurology 2015; 85: 129–136.
17. Brady TJ, Anderson LA, Kobau R. Chronic disease self‐management support: public health perspectives. Front Public Health 2014; 2: 234.
18. Shegog R, Begley CE. Clinic‐based mobile health decision support to enhance adult epilepsy self‐management: an intervention mapping approach. Front Public Health 2017; 5: 256.
19. DiIorio C, Bamps Y, Walker ER, Escoffery C. Results of a research study evaluating WebEase, an online epilepsy self‐management program. Epilepsy Behav 2011; 22: 469–474.
20. DiIorio C, Escoffery C, McCarty F, et al. Evaluation of WebEase: an epilepsy self‐management Web site. Health Educ Res 2009; 24: 185–197.
21. Mittan RJ. Psychosocial treatment programs in epilepsy: a review. Epilepsy Behav 2009; 16: 371–380.
22. Fraser RT, Johnson EK, Lashley S, et al. PACES in epilepsy: results of a self‐management randomized controlled trial. Epilepsia 2015; 56: 1264–1274.

Online responses are no longer available. Please refer to our instructions for authors page for more information.

Corticosteroid treatment of patients with coronavirus disease 2019 (COVID‐19)

Topics

Abstract

Author

One disease, two vaccines: challenges in prevention of meningococcal disease

Topics

Author

Decline in new medical graduates registered as general practitioners

Topics

Author

A new model of care and in‐house general practitioners for residential aged care facilities: a stepped wedge, cluster randomised trial

Topics

Abstract

Author

Chronic fatigue syndrome: progress and possibilities

Topics

Summary

Author

Time to recognise gout as a chronic disease

Topics

Author

The hidden slaves of medicine

Topics

Author

Optimising epilepsy management with a smartphone application: a randomised controlled trial

Topics

Abstract

Author

Monitoring changes in infant feeding practices after changes to guidelines for food allergy prevention

Topics

Author

Testing the effect of discharge destination on outcomes for people with isolated lower limb fractures

Topics

Author

Corticosteroid treatment of patients with coronavirus disease 2019 (COVID‐19)

Topics

Abstract

Author

Comment

Do you have any competing interests to declare? *

One disease, two vaccines: challenges in prevention of meningococcal disease

Topics

Author

Comment

Do you have any competing interests to declare? *

Decline in new medical graduates registered as general practitioners

Topics

Author

Comment

Do you have any competing interests to declare? *

A new model of care and in‐house general practitioners for residential aged care facilities: a stepped wedge, cluster randomised trial

Topics

Abstract

Author

Comment

Do you have any competing interests to declare? *

Chronic fatigue syndrome: progress and possibilities

Topics

Summary

Author

Comment

Do you have any competing interests to declare? *

Time to recognise gout as a chronic disease

Topics

Author

Comment

Do you have any competing interests to declare? *

The hidden slaves of medicine

Topics

Author

Comment

Do you have any competing interests to declare? *

Optimising epilepsy management with a smartphone application: a randomised controlled trial

Topics

Abstract

Author

Comment

Do you have any competing interests to declare? *

Monitoring changes in infant feeding practices after changes to guidelines for food allergy prevention

Topics

Author

Comment

Do you have any competing interests to declare? *

Testing the effect of discharge destination on outcomes for people with isolated lower limb fractures

Topics

Author

Comment

Do you have any competing interests to declare? *

Pagination