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    The Medical Journal of Australia endorses the Uluru Statement

    Nicholas J Talley AC
    Med J Aust 2018; 209 (1): . || doi: 10.5694/mja18.e0207
    Published online: 2 July 2018

    The Medical Journal of Australia endorses the Uluru Statement from the Heart (https://www.referendumcouncil.org.au/sites/default/files/2017-05/Uluru_Statement_From_The_Heart_0.PDF). The Statement, a consensus from the First Nations National Constitutional Convention held in May 2017, calls for “establishment of a First Nations Voice enshrined in the Constitution” and seeks “a Makarrata Commission to supervise a process of agreement-making between governments and First Nations and truth-telling about our history”. It affirms the connection of Aboriginal and Torres Strait Islander peoples with the land, and highlights the social difficulties and ongoing suffering faced by Aboriginal and Torres Strait Islander peoples. The MJA accepts the invitation of the Aboriginal and Torres Strait Islander peoples to join with them “in a movement of the Australian people for a better future”.

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    • Editor-in-Chief, Medical Journal of Australia, Sydney, NSW


    Correspondence: 

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      Priorities for preventing a concentrated HIV epidemic among Aboriginal and Torres Strait Islander Australians

      James S Ward, Karen Hawke and Rebecca J Guy
      Med J Aust 2018; 209 (1): . || doi: 10.5694/mja17.01071
      Published online: 2 July 2018

      An accelerated HIV prevention and control strategy is necessary to ensure that Aboriginal and Torres Strait Islander people meet local and global suppression targets

      Greater efforts are required to prevent human immunodeficiency virus infection (HIV) escalating among Aboriginal and Torres Strait Islander Australians. Recently released national data highlight a 33% increase in new HIV diagnosis rates among Aboriginal and Torres Strait Islander people, from 4.8 per 100 000 population in 2012 to 6.4 per 100 000 population in 2016.1 In the same period, newly diagnosed HIV rates among Australian-born non-Indigenous people decreased by 22% (from 3.7 per 100 000 population in 2012 to 2.9 per 100 000 population in 2016).1

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      • 1 South Australian Health and Medical Research Institute, Adelaide, SA
      • 2 Flinders University, Adelaide, SA
      • 3 The Kirby Institute, UNSW Sydney, Sydney, NSW


      Correspondence: james.ward@sahmri.com
      Competing interests:

      No relevant disclosures.

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        Closing the vaccination coverage gap in New South Wales: the Aboriginal Immunisation Healthcare Worker Program

        Alexandra J Hendry, Frank H Beard, Aditi Dey, Dennis Meijer, Sue Campbell-Lloyd, Katrina K Clark, Brynley P Hull and Vicky Sheppeard
        Med J Aust 2018; 209 (1): . || doi: 10.5694/mja18.00063
        Published online: 25 June 2018

        Abstract

        Objectives: To assess vaccination coverage and timeliness among Indigenous and non-Indigenous children in New South Wales and the rest of Australia, with a particular focus on changes in the vaccination coverage gaps after the introduction of the Aboriginal Immunisation Healthcare Worker (AIHCW) Program in NSW in 2012.

        Design: Cross-sectional analysis of Australian Immunisation Register data (2008–2016).

        Main outcome measures: Annual estimates of full vaccination coverage at 9, 15 and 51 months of age for Indigenous and non-Indigenous children in NSW and the rest of Australia; differences in coverage between Indigenous and non-Indigenous children at each milestone.

        Results: The proportion of Indigenous and non-Indigenous children classified as fully vaccinated at 9, 15, and 51 months increased significantly in both NSW and the rest of Australia after the introduction of the AIHCW Program. The mean annual difference in full vaccination coverage between Indigenous and non-Indigenous children in NSW aged 9 months declined from 6.6 (95% CI, 5.2–8.0) during 2008–2011 to 3.7 percentage points (95% CI, 2.5–4.8) during 2012–2016; for those aged 15 months it declined from 4.6 (95% CI, 3.1–6.0) to 2.2 percentage points (95% CI, 1.0–3.4), and for those aged 51 months it declined from 8.5 (95% CI, 7.2–9.8) to 0.6 percentage points (95% CI, –0.6 to 1.8). Reductions in the differences in coverage were not as marked in the rest of Australia. In 2016, there was no statistically significant difference in coverage at any of the three milestones in NSW: at 9 months the difference was 1.6 percentage points (95% CI, –1.0 to 4.1); at 15 months, 0.4 percentage points (95% CI, –2.2 to 2.9); and at 51 months, –1.8 percentage points (95% CI, –4.4 to 0.8).

        Conclusion: Our findings suggest that a dedicated program can help overcome barriers to timely vaccination and significantly improve timely vaccination rates in Indigenous Australian children.

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        • 1 National Centre for Immunisation Research and Surveillance, The Children's Hospital at Westmead, Sydney, NSW
        • 2 University of Sydney, Sydney, NSW
        • 3 Health Protection, New South Wales Ministry of Health, Sydney, NSW


        Acknowledgements: 

        We acknowledge the work and commitment of all past and present Aboriginal health care workers employed under the New South Wales Aboriginal Immunisation Healthcare Worker Program, without whom the progress toward closing the vaccination gap between Indigenous and non-Indigenous children in NSW, as documented in our article, would not have been possible.

        Competing interests:

        No relevant disclosures.

        • 1. Naidu L, Chiu C, Habig A, et al. Vaccine preventable diseases and vaccination coverage in Aboriginal and Torres Strait Islander people, Australia 2006–2010. Commun Dis Intell Q Rep 2013; 37: S1-S95.
        • 2. Hull BP, McIntyre PB. Timeliness of childhood immunisation in Australia. Vaccine 2006; 24: 4403-4408.
        • 3. O’Grady KA, Krause V, Andrews R. Immunisation coverage in Australian Indigenous children: time to move the goal posts. Vaccine 2009; 27: 307-312.
        • 4. Harris MF, Webster V, Jalaludin B, et al. Immunisation coverage among a birth cohort of Aboriginal infants in an urban community. J Paediatr Child Health 2014; 50: 306-313.
        • 5. Aboriginal and Torres Strait Islander Social Justice Commissioner; Steering Committee for Indigenous Health Equality. Closing the Gap: National Indigenous health equality targets. Canberra: Human Rights and Equal Opportunity Commission, 2008. https://www.humanrights.gov.au/publications/closing-gap-national-indigenous-health-equality-targets-2008 (viewed Dec 2016).
        • 6. Australian Bureau of Statistics. 3101.0. Australian demographic statistics: June quarter 2017. 14 Dec 2017. http://www.ausstats.abs.gov.au/ausstats/subscriber.nsf/0/0DEC5B368C5C2D72CA2581F5001011EB/$File/31010_jun%202017.pdf (viewed Dec 2017).
        • 7. Menzies R, Knox S, Kelaher B, et al. Process evaluation of the New South Wales Aboriginal Immunisation Healthcare Worker Program. Sydney: National Centre for Immunisation Research and Surveillance, 2015. http://www.health.nsw.gov.au/immunisation/Documents/process-evaluation-aihcw-program.pdf (viewed Dec 2016).
        • 8. Tashani M, Dey A, Clark K, Beard F. Stage 2. Evaluation of the NSW Aboriginal Immunisation Healthcare Worker Program. Process evaluation. Sydney: National Centre for Immunisation Research and Surveillance, 2017. http://www.health.nsw.gov.au/immunisation/Documents/stage-2-evaluation-aihcw-program.pdf (viewed Sept 2017).
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        • 12. Hull B, Hendry A, Dey A, et al. Immunisation coverage annual report, 2014. Commun Dis Intell Q Rep 2017; 41: E68-E90.
        • 13. Hull BP, McIntyre PB. Immunisation coverage reporting through the Australian Childhood Immunisation Register — an evaluation of the third-dose assumption. Aust N Z J Public Health 2000; 24: 17-21.
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        • 18. Menzies R, Andrews R. Immunisation issues for Indigenous Australian children. J Paediatr Child Health 2014; 50: E21-E25.
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        • 20. Cashman PM, Allan NA, Clark KK, et al. Closing the gap in Australian Aboriginal infant immunisation rates — the development and review of a pre-call strategy. BMC Public Health 2016; 16: 514-520.
        • 21. Hull BP, Dey A, Beard FH, et al. Immunisation coverage annual report, 2013. Commun Dis Intell Q Rep 2016; 40: E146-E169.
        • 22. New South Wales Ministry of Health. Save the date to vaccinate. Feb 2014. http://www.health.nsw.gov.au/immunisation/Pages/brochure-immunisation.aspx (viewed Mar 2018).
        • 23. New South Wales Ministry of Health. Questions and answers about vaccination requirements for child care. 2018. http://www.health.nsw.gov.au/immunisation/Pages/childcare_qa.aspx (viewed Mar 2018).
        • 24. Australian Government Department of Health. No Jab, No Pay — New Immunisation requirements for Family Assistance Payments. Fact sheet for providers. Dec 2017. https://beta.health.gov.au/resources/publications/no-jab-no-pay-new-requirements-fact-sheet (viewed Apr 2018).
        • 25. Beard FH, Hull BP, Leask J, et al. Trends and patterns in vaccination objection, Australia, 2002–2013. Med J Aust 2016; 204: 275. <MJA full text>

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          Absolute cardiovascular disease risk and lipid-lowering therapy among Aboriginal and Torres Strait Islander Australians

          Bianca Calabria, Rosemary J Korda, Raymond W Lovett, Peter Fernando, Tanya Martin, Leone Malamoo, Jennifer Welsh and Emily Banks
          Med J Aust 2018; 209 (1): . || doi: 10.5694/mja17.00897
          Published online: 25 June 2018

          Abstract

          Objective: To quantify absolute cardiovascular disease (CVD) risk in Aboriginal and Torres Strait Islander people and their use of lipid-lowering therapies.

          Design, participants: Cross-sectional analysis of nationally representative data from 2820 participants aged 18–74 years who provided biomedical data for the National Aboriginal and Torres Strait Islander Health Measures Survey component of the 2012–13 Australian Aboriginal and Torres Strait Islander Health Survey.

          Main outcome measures: Prior CVD and use of lipid-lowering medications were ascertained at interview. 5-year absolute risk of a primary CVD event was calculated with the Australian National Vascular Disease Prevention Alliance algorithm, with categories low (< 10%), moderate (10–15%) and high risk (> 15%).

          Results: Among participants aged 35–74 years, 9.6% (95% CI, 7.2–12.0%) had prior CVD; 15.7% (95% CI, 13.0–18.3%) were at high, 4.9% (95% CI, 3.3–6.6%) at moderate, and 69.8% (95% CI, 66.8–72.8%) at low absolute primary CVD risk. 82.6% of those at high primary risk were identified on the basis of clinical criteria. High primary absolute risk affected 1.1% (95% CI, 0.0–2.5%) of 18–24-year-olds, 4.7% (95% CI, 2.0–7.5%) of 25–34-year-olds, and 44.2% (95% CI, 33.1–55.3%) of 65–74-year-olds. Lipid-lowering therapy was being used by 52.9% (95% CI, 38.2–67.6%) of people aged 35–74 years with prior CVD and by 42.2% (95% CI, 30.5–53.8%) of those at high primary CVD risk.

          Conclusion: Absolute CVD risk is high among Aboriginal and Torres Strait Islander people, and most of those at high risk are undertreated. Substantial proportions of people under 35 years of age are at high risk, but are not targeted by current guidelines for absolute CVD risk assessment, compromising CVD prevention in this population.

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          • 1 National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University, Canberra, ACT
          • 2 National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW
          • 3 Australian Institute of Aboriginal and Torres Strait Islander Studies, Canberra, ACT
          • 4 Sax Institute, Sydney, NSW
          • 5 Poche Centre for Indigenous Health, University of Sydney, Sydney, NSW


          Correspondence: emily.banks@anu.edu.au
          Acknowledgements: 

          We thank the participants of the AATSIHS 2012–13 and NATSIHMS 2012–13, and the Australian Government and the Australian Bureau of Statistics for supporting biomedical data collection and the NATSIHMS. We thank investigators in the National Health and Medical Research Council (NHMRC) Partnership Project and from the National Heart Foundation for their feedback on preliminary findings, and Cate D’Este for statistical advice. This investigation was supported by an NHMRC and Heart Foundation of Australia Partnership Project (1092674). Emily Banks is supported by an NHMRC grant (1042717). The funding sources had no role in the study design, collection, analysis or interpretation of the data, in the writing of the article, or in the decision to submit it for publication.

          Competing interests:

          No relevant disclosures.

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            Colorectal cancer screening reduces incidence, mortality and morbidity

            Bilel Jideh and Michael J Bourke
            Med J Aust 2018; 208 (11): . || doi: 10.5694/mja18.00279
            Published online: 18 June 2018

            Adhering to evidence-based surveillance guidelines will optimise the use of health care resources

            Colorectal cancer (CRC) is the second most commonly diagnosed cancer in Australia in both men and women; there were about 17 000 new cases and more than 4000 deaths during 2017.1 It imposes a tremendous burden of disease, dominated by mortality rather than disability; in the 2011 Australian Burden of Disease Study, almost 86 000 years of life were lost because of CRC.2 The disorder is also a substantial economic burden; it costs more than $100 000 to treat one case of advanced CRC.3


            • 1 Westmead Hospital, Sydney, NSW
            • 2 City West Specialist Day Hospital, Sydney, NSW


            Correspondence: bjid7747@uni.sydney.edu.au
            Competing interests:

            No relevant disclosures.

            • 1. Australian Institute of Health and Welfare. National Bowel Cancer Screening Program: monitoring report 2017 (AIHW Cat. No. CAN 103). Canberra: AIHW, 2017.
            • 2. Australian Institute of Health and Welfare. Australian Burden Of Disease Study: impact and causes of illness and death in Australia 2011 (AIHW Cat. No. BOD 4). Canberra: AIHW, 2016.
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              Outpatient heart failure programs: time for a new standard

              Amera Halabi and Derek P Chew
              Med J Aust 2018; 208 (11): . || doi: 10.5694/mja18.00329
              Published online: 18 June 2018

              Effective ambulatory services and community heart failure care may mitigate its impact on our health care system

              Heart failure imposes a significant burden on the Australian health care system. Driven by the increasing number of patients diagnosed each year, repeated hospitalisations and long inpatient stays result in substantial morbidity and costs to the health care system.1


              • 1 Southern Adelaide Local Health Network, Adelaide, SA
              • 2 Flinders University, Adelaide, SA


              Correspondence: Derek.Chew@flinders.edu.au
              Competing interests:

              No relevant disclosures.

              • 1. Sahle BW, Owen AJ, Mutowo MP, et al. Prevalence of heart failure in Australia: a systematic review. BMC Cardiovasc Disord 2016; 16: 32.
              • 2. McAlister FA, Stewart S, Ferrua S, McMurray JJ. Multidisciplinary strategies for the management of heart failure patients at high risk for admission: a systematic review of randomized trials. J Am Coll Cardiol 2004; 44: 810-819.
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              • 5. Craig P, Dieppe P, Macintyre S, et al. Developing and evaluating complex interventions: the new Medical Research Council guidance. BMJ 2008; 337: a1655.
              • 6. Huynh Q, Negishi K, De Pasquale C, et al. Effects of post-discharge management on rates of early re-admission and death after hospitalisation for heart failure. Med J Aust 2018; 208: 485-491.

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                Burnout in the medical profession: not a rite of passage

                Michael Baigent and Ruth Baigent
                Med J Aust 2018; 208 (11): . || doi: 10.5694/mja17.00891
                Published online: 18 June 2018

                Establishing mentally healthy workplaces will reduce the risk of burnout

                It is an attention-demanding tragedy when doctors’ deaths are attributed to their work, which, after all, is in the service of others. “Epidemic”, “crisis” and “urgent need” are words accompanying discussions of burnout and doctor suicides. Yet, despite this bombardment, there has been no sustained approach to achieve an effective national response. Recently, responding to calls for action, the Victorian government launched a workplace mental health strategy and the New South Wales government held a junior doctor wellbeing forum. Some colleges and medical organisations have websites, forums, action plans, conferences and seminars on doctors’ mental health. Doctors develop mental illness for the same reasons as any other person. Yet burnout, which is a risk factor,1 is highly prevalent in doctors. Why not address the burnout? Who should address it?


                • 1 Flinders University, Adelaide, SA
                • 2 Norwood General and Family Practice, Adelaide, SA


                Competing interests:

                Michael Baigent serves on the Board of Directors for beyondblue, the national depression initiative, a not-for-profit organisation.

                • 1. Salvagioni DAJ, Melanda FN, Mesas AE, et al. Physical, psychological and occupational consequences of job burnout: a systematic review of prospective studies. PLoS ONE 2017; 12: e0185781.
                • 2. Freudenberger HJ. The staff burnout syndrome in alternative institutions. Psychother Theory Res Pract 1975; 12: 72-83.
                • 3. Maslach C, Schaufeli WB, Leiter MP. Job burnout. Annu Rev Psychol 2001; 52: 397-422.
                • 4. Maslach C. What have we learned about burnout and health? Psychol Health 2001; 16: 607-611.
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                • 8. Imo UO. Burnout and psychiatric morbidity among doctors in the UK: a systematic literature review of prevalence and associated factors. Psychiatrist 2017; 41: 197-204.
                • 9. beyondblue. National mental health survey of doctors and medical students. Oct 2013. https://www.beyondblue.org.au/docs/default-source/research-project-files/bl1132-report–-nmhdmss-full-report_web (viewed Apr 2018).
                • 10. Kwarta P, Pietrzak J, Miśkowiec D, et al. Personality traits and styles of coping with stress in physicians. Pol Merkur Lekarski 2016; 40: 301-307.
                • 11. McManus IC, Keeling A, Paice E. Stress, burnout and doctors’ attitudes to work are determined by personality and learning style: a twelve year longitudinal study of UK medical graduates. BMC Medicine 2004; 2: 29.
                • 12. Shanafelt TD, Oreskovich MR, Dyrbye LN, et al. Avoiding burnout: the personal health habits and wellness practices of US surgeons. Ann Surg 2012; 255: 625-633.
                • 13. Halliday L, Walker A, Vig S, et al. Grit and burnout in UK doctors: a cross-sectional study across specialties and stages of training. Postgrad Med J 2017; 93: 389-394.
                • 14. beyondblue. Developing a workplace mental health strategy: a how-to guide for health services. http://resources.beyondblue.org.au/prism/file?token=BL/1728 (viewed Apr 2018).

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                  How antibiotic allergy labels may be harming our most vulnerable patients

                  Jason A Trubiano, M Lindsay Grayson, Karin A Thursky, Elizabeth J Phillips and Monica A Slavin
                  Med J Aust 2018; 208 (11): . || doi: 10.5694/mja17.00487
                  Published online: 18 June 2018

                  Antibiotic allergy testing programs will ensure that vulnerable patients receive appropriate antibiotic therapy

                  Antibiotic allergy labels are accumulated by various mechanisms and are often incorrectly self-reported or recorded. Incorrect antibiotic allergy labels frequently persist in community and hospital medical records throughout patients’ health care journeys, either with the phenotype unverified by clinicians or recorded as unknown.1,2 Among a cohort of older Australian general medical inpatients, we identified that 25% had a mismatch between their reported and recorded antibiotic allergy.3 Further, as an additional source of incorrect antibiotic allergy labels, patients with a true immunological basis for antibiotic allergy, such as immediate (IgE-mediated) reactions, may lose reactivity over time.4 Incorrect antibiotic allergy labels often prevent the use of appropriate narrow spectrum penicillin and targeted antibiotic therapies in both community and hospital practice, frequently among the patients most in need.4,5


                  • 1 Austin Health, Melbourne, VIC
                  • 2 Peter MacCallum Cancer Centre and National Centre for Infections in Cancer, Melbourne, VIC
                  • 3 University of Melbourne, Melbourne, VIC
                  • 4 Royal Melbourne Hospital, Melbourne, VIC
                  • 5 Institute for Immunology and Infectious Diseases, Murdoch University, Perth, WA


                  Acknowledgements: 

                  We thank Megan Crane for her significant contribution to the manuscript preparation and Michael Sutherland for establishing the Austin Health multidisciplinary antibiotic allergy testing service.

                  Competing interests:

                  No relevant disclosures.

                  • 1. Trubiano JA, Chen C, Cheng AC, et al. Antimicrobial allergy ‘labels’ drive inappropriate antimicrobial prescribing: lessons for stewardship. J Antimicrob Chemother 2016; 71: 1715-1722.
                  • 2. Knezevic B, Sprigg D, Seet J, et al. The revolving door: antibiotic allergy labelling in a tertiary care centre. Intern Med J 2016; 46: 1276-1283.
                  • 3. Zhou L, Dhopeshwarkar N, Blumenthal KG, et al. Drug allergies documented in electronic health records of a large healthcare system. Allergy 2016; 71: 1305-1313.
                  • 4. Trubiano JA, Leung VK, Chu MY, et al. The impact of antimicrobial allergy labels on antimicrobial usage in cancer patients. Antimicrob Resist Infect Control 2015; 4: 23.
                  • 5. MacFadden DR, LaDelfa A, Leen J, et al. Impact of reported beta-lactam allergy on inpatient outcomes: a multicenter prospective cohort study. Clin Infect Dis 2016; 63: 904-910.
                  • 6. Trubiano JA, Pai Mangalore R, Baey YW, et al. Old but not forgotten: Antibiotic allergies in General Medicine (the AGM Study). Med J Aust 2016; 204: 273. <MJA full text>
                  • 7. Caubet JC, Frossard C, Fellay B, Eigenmann PA. Skin tests and in vitro allergy tests have a poor diagnostic value for benign skin rashes due to beta-lactams in children. Pediatr Allergy Immunol 2015; 26: 80-82.
                  • 8. Vezir E, Dibek Misirlioglu E, Civelek E, et al. Direct oral provocation tests in non-immediate mild cutaneous reactions related to beta-lactam antibiotics. Pediatr Allergy Immunol 2016; 27: 50-54.
                  • 9. Bourke J, Pavlos R, James I, Phillips E. Improving the effectiveness of penicillin allergy de-labeling. J Allergy Clin Immunol Pract 2015; 3: 365-334 e361.
                  • 10. Trubiano JA, Worth LJ, Urbancic K, et al. Return to sender: the need to re-address patient antibiotic allergy labels in Australia and New Zealand. Intern Med J 2016; 46: 1311-1317.
                  • 11. Macy E, Contreras R. Health care use and serious infection prevalence associated with penicillin “allergy” in hospitalized patients: a cohort study. J Allergy Clin Immunol 2014; 133: 790-796.
                  • 12. Campagna JD, Bond MC, Schabelman E, Hayes BD. The use of cephalosporins in penicillin-allergic patients: a literature review. J Emerg Med 2012; 42: 612-620.
                  • 13. Romano A, Gaeta F, Arribas Poves MF, Valluzzi RL. Cross-reactivity among beta-lactams. Curr Allergy Asthma Rep 2016; 16: 24.
                  • 14. Kula B, Djordjevic G, Robinson JL. A systematic review: can one prescribe carbapenems to patients with IgE-mediated allergy to penicillins or cephalosporins? Clin Infect Dis 2014; 59: 1113-1122.
                  • 15. Patriarca G, Schiavino D, Lombardo C, et al. Tolerability of aztreonam in patients with IgE-mediated hypersensitivity to beta-lactams. Int J Immunopathol Pharmacol 2008; 21: 375-379.
                  • 16. Ressner RA, Gada SM, Banks TA. Antimicrobial stewardship and the allergist: reclaiming our antibiotic armamentarium. Clin Infect Dis 2016; 62: 400-401.
                  • 17. Dellit TH, Owens RC, McGowan JE Jr, et al. Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America guidelines for developing an institutional program to enhance antimicrobial stewardship. Clin Infect Dis 2007; 44: 159-177.
                  • 18. Schuts EC, Hulscher M, Mouton JW, et al. Current evidence on hospital antimicrobial stewardship objectives: a systematic review and meta-analysis. Lancet Infect Dis 2016; 16: 847-856.
                  • 19. Barlam TF, Cosgrove SE, Abbo LM, et al. Implementing an antibiotic stewardship program: guidelines by the Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America. Clin Infect Dis 2016; 62: e51-77.
                  • 20. King EA, Challa S, Curtin P, Bielory L. Penicillin skin testing in hospitalized patients with beta-lactam allergies: effect on antibiotic selection and cost. Ann Allergy Asthma Immunol 2016; 117: 67-71.
                  • 21. Trubiano JA, Thursky KA, Stewardson AJ, et al. Impact of an integrated antibiotic allergy testing program on antimicrobial stewardship: a multicenter evaluation. Clin Infect Dis 2017; 65: 166-174.
                  • 22. Marwood J, Aguirrebarrena G, Kerr S, et al. De-labelling self-reported penicillin allergy within the emergency department through the use of skin tests and oral drug provocation testing. Emerg Med Australas 2017; 29: 509-515.
                  • 23. Confino-Cohen R, Rosman Y, Meir-Shafrir K, et al. Oral challenge without skin testing safely excludes clinically significant delayed-onset penicillin hypersensitivity. J Allergy Clin Immunol Pract 2017; 5: 669-675.

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                    Transcranial magnetic stimulation: an item number is justified

                    Saxby Pridmore
                    Med J Aust 2018; 208 (11): . || doi: 10.5694/mja17.00849
                    Published online: 18 June 2018

                    Evidence shows that transcranial magnetic stimulation is a safe and effective treatment for drug-resistant depression

                    Depression is the leading cause of disability globally.1 The condition is painful for the patient (and may end in suicide), distressing for relatives and friends and challenging to clinicians. One-third of patients with depression do not respond to the first antidepressant medication, the likelihood of achieving remission diminishes with each additional medication, and one-third will not respond to any known medication.2


                    • University of Tasmania, Hobart, TAS


                    Correspondence: s.pridmore@utas.edu.au
                    Competing interests:

                    No relevant disclosures.

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                    • 3. George MS, Wassermann EM, Williams WA, et al. Daily repetitive transcranial magnetic stimulation (rTMS) improves mood in depression. Neuroreport 1995; 6: 1853-1856.
                    • 4. Lefaucheur J-P, André-Obadia N, Antal A, et al. Evidence-based guidelines on the therapeutic use of repetitive transcranial magnetic stimulation (rTMS). Clin Neurophysiol 2014; 125: 2150-2206.
                    • 5. Loo CK, Mitchell PB, Corker VM, et al. Double-blind controlled investigation of bilateral prefrontal transcranial magnetic stimulation for the treatment of resistant major depression. Psychol Med 2003; 33: 33-40.
                    • 6. Fitzgerald PB, Brown TL, Marston NA, et al. Transcranial magnetic stimulation in the treatment of depression: a double-blind, placebo-controlled trial. Arch Gen Psychiatry 2003; 60: 1002-1008.
                    • 7. Milev R, Giacobbe P, Kennedy SH, et al. Canadian Network for Mood and Anxiety Treatments (CANMAT) 2016 clinical guidelines for the management of adults with major depressive disorder: section 4. Neurostimulation treatments. Can J Psychiatry 2016; 61: 561-575.
                    • 8. Magnezi R, Aminov E, Shmuel D, et al. Comparison between neurostimulation techniques repetitive transcranial magnetic stimulation vs electroconvulsive therapy for the treatment of resistant depression: patient preference and cost-effectiveness. Patient Prefer Adherence 2016; 10: 1481-1487.
                    • 9. Kozel FA, George MS, Simpson KN. Decision analysis of the cost-effectiveness of repetitive transcranial magnetic stimulation versus electroconvulsive therapy for treatment of nonpsychotic severe depression. CNS Spectr 2004; 9: 476-482.
                    • 10. Zhao YJ, Tor PC, Khoo AL, et al. Cost-effectiveness modelling of repetitive transcranial magnetic stimulation compared to electroconvulsive therapy for treatment-resistant depression in Singapore. Neuromodulation 2017. doi:10.1111/ner.12723. [Epub ahead of print].
                    • 11. Galletly CA, Clarke P, Carnell BL, Gill S. A clinical repetitive transcranial magnetic stimulation service: 6 years on. Aust N Z J Psychiatry 2014; 49: 1040-1047.
                    • 12. McClintock SM, Reti IM, Carpenter LL, et al. Consensus recommendations for the clinical application of repetitive transcranial magnetic stimulation (rTMS) in the treatment of depression. J Clin Psychiatry 2018; 79: 16cs10905.

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                      Australian standards of care and treatment guidelines for transgender and gender diverse children and adolescents

                      Michelle M Telfer, Michelle A Tollit, Carmen C Pace and Ken C Pang
                      Med J Aust 2018; 209 (3): . || doi: 10.5694/mja17.01044
                      Published online: 18 June 2018

                      Abstract

                      Introduction: The Australian standards of care and treatment guidelines aim to maximise quality care provision to transgender and gender diverse (TGD) children and adolescents across Australia, while recognising the unique circumstances of providing such care to this population. Recommendations are made based on available empirical evidence and clinician consensus, and have been developed in consultation with Australian professionals from multiple disciplines working with the TGD population, TGD support organisations, as well as TGD children and adolescents and their families.

                      Main recommendations: Recommendations include general principles for supporting TGD children and adolescents using an affirmative approach, separate guidelines for the care of pre-pubertal children and TGD adolescents, as well as discipline-based recommendations for mental health care, medical and surgical interventions, fertility preservation, and speech therapy.

                      Changes in management as a result of this statement: Although published international treatment guidelines currently exist, challenges in accessing and providing TGD health care specific to Australia have not been addressed to date. In response to this, these are the first guidelines to be developed for TGD children and adolescents in Australia. These guidelines also move away from treatment recommendations based on chronological age, with recommended timing of medical transition and surgical interventions dependent on the adolescent’s capacity and competence to make informed decisions, duration of time on puberty suppression, coexisting mental health and medical issues, and existing family support.


                      • 1 Royal Children's Hospital Melbourne, Melbourne, VIC
                      • 2 Murdoch Children's Research Institute, Melbourne, VIC


                      Correspondence: michelle.telfer@rch.org.au
                      Competing interests:

                      No relevant disclosures.

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