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Bruce Campbell has received research support from the National Health and Medical Research Council (GNT1043242, GNT1035688), the Royal Australasian College of Physicians, the Royal Melbourne Hospital Foundation, the National Heart Foundation and the Stroke Foundation. He has received unrestricted grant funding for the EXTEND‐IA trial to the Florey Institute of Neuroscience and Mental Health from Medtronic. He co‐chaired the 2017 Australian Stroke Guidelines content working party.
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A 26‐year‐old refugee from Myanmar was referred to the infectious diseases unit of an Australian teaching hospital for assessment of suspected recurrent pulmonary tuberculosis (TB). He had arrived in Australia 3 months earlier, after spending the preceding 5 years in Malaysia. He was diagnosed with presumed pulmonary TB in Malaysia in 2013, in the context of a productive cough and suspicious chest x‐ray findings, without microbiological confirmation. He completed treatment with 6 months of first line anti‐TB therapy (2 months of rifampicin, isoniazid, pyrazinamide and ethambutol, followed by 4 months of rifampicin and isoniazid).
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David Griffin and Khai Huang contributed equally to the authorship of this manuscript. We would like to thank the staff in the Department of Microbiology at Melbourne Health.
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Objective: To describe the frequencies of acute kidney injury (AKI) and of associated diagnoses in Indigenous people in a remote Western Australian region.
Design: Retrospective population‐based study of AKI events confirmed by changes in serum creatinine levels.
Setting, participants: Aboriginal and Torres Strait Islander residents of the Kimberley region of Western Australia, aged 15 years or more and without end‐stage kidney disease, for whom AKI between 1 June 2009 and 30 May 2016 was confirmed by an acute rise in serum creatinine levels.
Main outcome measures: Age‐specific AKI rates; principal and other diagnoses.
Results: 324 AKI events in 260 individuals were recorded; the median age of patients was 51.8 years (IQR, 43.9–61.0 years), and 176 events (54%) were in men. The overall AKI rate was 323 events (95% CI, 281–367) per 100 000 population; 92 events (28%) were in people aged 15–44 years. 52% of principal diagnoses were infectious in nature, including pneumonia (12% of events), infections of the skin and subcutaneous tissue (10%), and urinary tract infections (7.7%). 80 events (34%) were detected on or before the date of admission; fewer than one‐third of discharge summaries (61 events, 28%) listed AKI as a primary or other diagnosis.
Conclusion: The age distribution of AKI events among Indigenous Australians in the Kimberley was skewed to younger groups than in the national data on AKI. Infectious conditions were common in patients, underscoring the significance of environmental determinants of health. Primary care services can play an important role in preventing community‐acquired AKI; applying pathology‐based criteria could improve the detection of AKI.
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We thank Julia Marley (Kimberley Research, University of Western Australia) for critically reviewing our manuscript.
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Objective: To investigate trends in the incidence and causes of traumatic spinal cord injury (TSCI) in Victoria over a 10‐year period.
Design, setting, participants: Retrospective cohort study: analysis of Victorian State Trauma Registry (VSTR) data for people who sustained TSCIs during 2007–2016.
Main outcomes and measures: Temporal trends in population‐based incidence rates of TSCI (injury to the spinal cord with an Abbreviated Injury Scale [AIS] score of 4 or more).
Results: There were 706 cases of TSCI, most the result of transport events (269 cases, 38%) or low falls (197 cases, 28%). The overall crude incidence of TSCI was 1.26 cases per 100 000 population (95% CI, 1.17–1.36 per 100 000 population), and did not change over the study period (incidence rate ratio [IRR], 1.01; 95% CI, 0.99–1.04). However, the incidence of TSCI resulting from low falls increased by 9% per year (95% CI, 4–15%). The proportion of TSCI cases classified as incomplete tetraplegia increased from 41% in 2007 to 55% in 2016 (P < 0.001). Overall in‐hospital mortality was 15% (104 deaths), and was highest among people aged 65 years or more (31%, 70 deaths).
Conclusions: Given the devastating consequences of TSCI, improved primary prevention strategies are needed, particularly as the incidence of TSCI did not decline over the study period. The epidemiologic profile of TSCI has shifted, with an increasing number of TSCI events in older adults. This change has implications for prevention, acute and post‐discharge care, and support.
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We thank the Victorian State Trauma Outcome Registry and Monitoring (VSTORM) group for providing Victorian State Trauma Registry data. We also thank Sue McLellan for her assistance with providing the data. The VSTR is funded by the Department of Health and Human Services, Victoria and the Transport Accident Commission. Ben Beck was supported by an Australian Research Council Discovery Early Career Researcher Award Fellowship (DE180100825). Peter Cameron was supported by a National Health and Medical Research Council Practitioner Fellowship (545926). Warwick Teague's role as director of trauma services was supported by a grant from the Royal Children's Hospital Foundation. Belinda Gabbe was supported by an Australian Research Council Future Fellowship (FT170100048).
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Immunisation providers should offer annual influenza vaccination for children aged 6 months to 5 years and report it to the Australian Immunisation Register
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A review of the legislation may be warranted to assess the balance between professional and public interests
Patient health‐related datasets are protected by national and state‐based privacy laws which establish requirements for data security that safeguard identified patient information.1,2,3 Nevertheless, these data may potentially be accessed by third parties in accordance with the law — for example, in connection with freedom of information requests or legal proceedings — by statutory bodies such as the Australian Health Practitioner Regulatory Agency, or by jurisdictional health complaints commissions. Patient information from health service medical records is regularly used in medico‐legal proceedings, a recent significant example of which was the Bawa‐Garba case in the United Kingdom,4 discussed below.
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Introduction: There have been significant advances in the understanding of the management of inherited bleeding disorders in pregnancy since the last Australian Haemophilia Centre Directors’ Organisation (AHCDO) consensus statement was published in 2009. This updated consensus statement provides practical information for clinicians managing pregnant women who have, or carry a gene for, inherited bleeding disorders, and their potentially affected infants. It represents the consensus opinion of all AHCDO members; where evidence was lacking, recommendations have been based on clinical experience and consensus opinion.
Main recommendations: During pregnancy and delivery, women with inherited bleeding disorders may be exposed to haemostatic challenges. Women with inherited bleeding disorders, and their potentially affected infants, need specialised care during pregnancy, delivery, and postpartum, and should be managed by a multidisciplinary team that includes at a minimum an obstetrician, anaesthetist, paediatrician or neonatologist, and haematologist. Recommendations on management of pregnancy, labour, delivery, obstetric anaesthesia and postpartum care, including reducing and treating postpartum haemorrhage, are included. The management of infants known to have or be at risk of an inherited bleeding disorder is also covered.
Changes in management as a result of this statement: Key changes in this update include the addition of a summary of the expected physiological changes in coagulation factors and phenotypic severity of bleeding disorders in pregnancy; a flow chart for the recommended clinical management during pregnancy and delivery; guidance for the use of regional anaesthetic; and prophylactic treatment recommendations including concomitant tranexamic acid.
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We are grateful to Steph P'ng, John Rowell, Tim Brighton, Huyen Tran and Ian Douglas for their helpful feedback and comments. We acknowledge Ruth Hadfield for medical writing and editing assistance.
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A system that integrates all aspects of health care is essential for facing future challenges
After another Australian summer of record‐breaking temperatures, bushfires, floods and widespread drought, it is clear that our health systems should be strengthened to cope with the challenges of climate change. We must also reduce the carbon footprint of health care,1 and continue to advocate that Australia play its part in dealing with the fundamental causes of climate change. In May, the 21st biennial congress of the World Association for Disaster and Emergency Medicine (WADEM) will be hosted by Brisbane. The congress will bring together investigators and practitioners from around the world to discuss disaster health care, future risks, community vulnerabilities, and the strategies required by resilient health systems.
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Summary