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There is a concerning lack of data comparing surgical with non-surgical management of femoroacetabular impingement
Femoroacetabular impingement (FAI) is a common cause of groin pain in physically active young adults, accompanied by limited hip movements. It occurs when bony anatomical abnormalities of the femoral head-neck junction (cam deformity) and acetabular rim (pincer deformity) result in abnormal contact between the two joint surfaces during hip motion. Radiological evidence of FAI is present in about 25% of asymptomatic young adults in the general community.1 FAI increases the risk of end-stage hip osteoarthritis (OA) in later life and is a long term risk factor for joint replacement;2 it may be very disabling. The quality of life of young adults with FAI is comparable to that of older adults who had a total hip replacement for OA.3
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Andrew Teichtahl is the recipient of a National Health and Medical Research Council (NHMRC) Early Career Fellowship (no. 1073284). Yuanyuan Wang is the recipient of an NHMRC Career Development Fellowship (Clinical Level 1, no. 1065464).
No relevant disclosures.
Are our child protection policies causing more harm to our most vulnerable children?
In Australia, there were 43 399 children in out-of-home care (OOHC) on 30 June 2015 (Box).1 Over the past 18 years, the rate at which Indigenous children have been placed in care has more than tripled and more than doubled for non-Indigenous children.1,2,3 This is disturbing, and particularly so for Indigenous children where one in 19 are in OOHC.1 A recent review of child maltreatment across various countries, including Australia, concluded that 40 years after contemporary child protection policies were introduced in the 1970s, there has been “no clear evidence for an overall decrease in child maltreatment”.4 Despite the call by this review for more evidence,4 there have been no studies planned to assess the effectiveness of our current OOHC policy in Australia.
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Objectives: To conduct a descriptive epidemiological analysis of external cause deaths (premature, usually injury-related, and potentially preventable) of nursing home residents in Australia.
Design: Retrospective study of a cohort of nursing home residents, using coronial data routinely recorded by the National Coronial Information System.
Setting and participants: Residents of accredited Australian nursing homes, whose deaths were reported to coroners between 1 July 2000 and 30 June 2013, and determined to have resulted from external causes.
Main outcome measures: Causes of death, analysed by sex and age group, and by location of incidents leading to death and location of death. Rates of death were estimated on the basis of Australian Bureau of Statistics population and Australian Institute of Health and Welfare nursing home data.
Results: Of 21 672 deaths of nursing home residents, 3 289 (15.2%) resulted from external causes. The most frequent mechanisms of death were falls (2 679 cases, 81.5%), choking (261 cases, 7.9%) and suicide (146 cases, 4.4%). The incidents leading to death usually occurred in the nursing home (95.8%), but the deaths more frequently occurred outside the nursing home (67.1%). The annual number of external cause deaths in nursing homes increased during the study period (from 1.2 per 1000 admissions in 2001–02 to 5.3 per 1000 admissions in 2011–12).
Conclusion: The incidence of premature and potentially preventable deaths of nursing home residents has increased over the past decade. A national policy framework is needed to reduce the incidence of premature deaths among Australians living in nursing homes.
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This work was supported by the federal Department of Social Services, the Victorian Department of Health and Human Services (Ageing and Aged Care Branch), and the Department of Forensic Medicine, Monash University. None of the funders influenced the design, methods, subject recruitment, data collection, analysis or preparation of the paper.
We are affiliated with or employed by the Department of Forensic Medicine, Monash University, which was also a funding source.
18 August 2025
18 August 2025
4 August 2025
21 July 2025
7 July 2025
Abstract
Objectives: To describe the management of cardiovascular disease (CVD) risk in Australian patients with diabetes; to compare the effectiveness of a quality improvement initiative for people with and without diabetes.
Research design and methods: Subgroup analyses of patients with and without diabetes participating in a cluster randomised trial.
Setting and participants: Indigenous people (≥ 35 years old) and non-Indigenous people (≥ 45 years old) who had attended one of 60 Australian primary health care services at least three times during the preceding 24 months and at least once during the past 6 months.
Intervention: Quality improvement initiative comprising point-of-care electronic decision support with audit and feedback tools.
Main outcome measures: Adherence to CVD risk screening and prescribing guidelines.
Results: Baseline rates of guideline-recommended screening were higher for 8829 patients with diabetes than for 44 335 without diabetes (62.0% v 39.5%; P < 0.001). Baseline rates of guideline-recommended prescribing were greater for patients with diabetes than for other patients at high risk of CVD (55.5% v 39.6%; P < 0.001). The proportions of patients with diabetes not attaining recommended treatment targets for blood pressure, low-density lipoprotein-cholesterol or HbA1c levels who were not prescribed the corresponding therapy at baseline were 28%, 44% and 24% respectively. The intervention was associated with improved screening rates, but the effect was smaller for patients with diabetes than for those without diabetes (rate ratio [RR], 1.14 v 1.28; P = 0.01). It was associated with improved guideline-recommended prescribing only for undertreated individuals at high risk; the effect size was similar for those with and without diabetes (RR, 1.63 v 1.53; P = 0.28).
Conclusions: Adherence to CVD risk management guidelines was better for people with diabetes, but there is room for improvement. The intervention was modestly effective in people with diabetes, but further strategies are needed to close evidence–practice gaps.
Australian and New Zealand Clinical Trials Registry number: ACTRN12611000478910.