Topics

Digestive system diseases

Australia has one of the highest rates of inflammatory bowel disease (IBD) in the world; its prevalence has increased significantly over the past 20 years and is projected to increase by > 250% from 2010 to 2030, to then affect 1% of the population.1 Although advances in clinical practice have led to increased identification, this increase is thought to be due to urbanisation of communities, with changes in sanitation and dietary practices. Such changes seen in Asia over the past 20 years have mirrored the rapidly increasing rates of IBD in the Western society, lending support to the “hygiene hypothesis”, and explaining, in part, the increasing burden of IBD on Australian health care due to our high rates of immigration.1,2

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1 Alfred Health, Melbourne, VIC
2 Monash University, Melbourne, VIC

Correspondence: mark.ward@monash.edu

Open access:

Open access publishing facilitated by Monash University, as part of the Wiley ‐ Monash University agreement via the Council of Australian University Librarians.

Competing interests:

Mark Ward has received educational grants and speaker fees from AbbVie, Takeda and Ferring; travel grants from Pfizer; and has served on advisory boards for AbbVie.

1. Kaplan GG, Windsor JW. The four epidemiological stages in the global evolution of inflammatory bowel disease. Nat Rev Gastroenterol Hepatol 2021; 18: 56‐66.
2. Mak W, Zhao M, Ng S, Burisch J. The epidemiology of inflammatory bowel disease: east meets west. J Gastroenterol Hepatol 2020; 35: 380‐389.
3. Phavichitr N, Cameron D, Catto‐Smith A. Increasing incidence of Crohn's disease in Victorian children. J Gastroenterol Hepatol 2003; 18: 329‐332.
4. Schildkraut V, Alex G, Cameron D, et al. Sixty‐year study of incidence of childhood ulcerative colitis finds eleven‐fold increase beginning in 1990s. Inflamm Bowel Dis 2013; 19: 1‐6.
5. Grover Z. Predicting and preventing complications in children with inflammatory bowel disease. Transl Pediatr 2019; 8: 70‐76.
6. Perler BK, Ungaro R, Baird G, et al. Presenting symptoms in inflammatory bowel disease: descriptive analysis of a community‐based inception cohort. BMC Gastroenterol 2019; 19: 1‐8.
7. Ozer M, Bengi G, Colak R, et al. Prevalence of irritable bowel syndrome‐like symptoms using Rome IV criteria in patients with inactive inflammatory bowel disease and relation with quality of life. Medicine (Baltimore) 2020; 99: e20067.
8. Menees S, Powell C, Kurlander J, et al. A meta‐analysis of the utility of C‐reactive protein, erythrocyte sedimentation rate, fecal calprotectin, and fecal lactoferrin to exclude inflammatory bowel disease in adults with IBS. Am J Gastroenterol 2015; 110: 444‐454.
9. Item 66522. Medicare Benefits Schedule 2023 [website]. https://www9.health.gov.au/mbs/fullDisplay.cfm?type=item&q=66522&qt=ItemID (viewed June 2024).
10. Maaser C, Sturm A, Vavricka SR, et al. ECCO‐ESGAR guideline for diagnostic assessment in IBD part 1: initial diagnosis, monitoring of known IBD, detection of complications. J Crohns Colitis 2019; 13: 144‐164.
11. Ward M, Kariyawasam V, Mogan S, et al. Prevalence and risk factors for functional vitamin B12 deficiency in patients with Crohn's disease. Inflamm Bowel Dis 2015; 21: 2839‐2847.
12. Akbulut S. An assessment of serum vitamin B12 and folate in patients with Crohn's disease. Medicine (Baltimore) 2022; 101: e31892.
13. Caviezel D, Maissen S, Niess J, et al. High prevalence of vitamin D deficiency among patients with inflammatory bowel disease. Inflamm Intest Dis 2018; 2: 200‐210.
14. Alper A, Zhang L, Pashankar D. Correlation of erythrocyte sedimentation rate and C‐reactive protein with pediatric inflammatory bowel disease activity. J Pediatr Gastroenterol Nutr 2017; 65: e25‐27.
15. Srinivasan A, Cruz PD. Review article: a practical approach to the clinical management of NSAID enteropathy. Scand J Gastroenterol 2017; 52: 941‐947.
16. Surawicz C. What's the best way to differentiate infectious colitis (acute self‐limited colitis) from IBD? Inflamm Bowel Dis 2008; 14 Suppl 2: S157‐158.
17. Gazelakis K, Chu I, Martin C, et al. P320 thrombocytosis in acute inflammatory bowel disease: a useful biomarker? J Crohns Colitis 2020; 14 Suppl 1: S313‐314.
18. Fernandes S, Vasconcelos‐Castro S, Teixeira C, Soares‐Oliveira M. Yersinia enterocolitis may mimic appendicitis: 12 years of experience in a single tertiary center. GE Port J Gastroenterol 2020; 28: 26‐31.
19. Mellander MR, Ekbom A, Hultcrantz R, et al. Microscopic colitis: a descriptive clinical cohort study of 795 patients with collagenous and lymphocytic colitis. Scand J Gastroenterol 2016; 51: 556‐562.
20. Hung A, Calderbank T, Samaan M, et al. Ischaemic colitis: practical challenges and evidence‐based recommendations for management. Frontline Gastroenterol 2019; 12: 44‐52.
21. Cassieri C, Brandimarte G, Elisei W, et al. How to differentiate segmental colitis associated with diverticulosis and inflammatory bowel diseases. J Clin Gastroenterol 2016; 50 Suppl 1: S36‐38.
22. Hatemi I, Hatemi G, Çelik A. Systemic vasculitis and the gut. Curr Opin Rheumatol 2017; 29: 33‐38.
23. Skef W, Hamilton M, Arayssi T. Gastrointestinal Behçet's disease: a review. World J Gastroenterol 2015; 21: 3802‐3812.
24. Australian Bureau of Statistics. Permanent migrants in Australia. Mar 2023. https://www.abs.gov.au/statistics/people/people‐and‐communities/permanent‐migrants‐australia/latest‐release (viewed July 2023).
25. Choudhury A, Dhillon J, Sekar A, et al. Differentiating gastrointestinal tuberculosis and Crohn's disease – a comprehensive review. BMC Gastroenterol 2023; 23: 246.
26. King J, McManus H, Kwon J, et al. HIV, viral hepatitis and sexually transmissible infections in Australia: annual surveillance report 2022. Sydney: The Kirby Institute, UNSW, 2022. Chrome‐extension://efaidnbmnnnibpcajpcglclefindmkaj/ https://www.kirby.unsw.edu.au/sites/default/files/documents/Annual‐Surveillance‐Report‐2022_HIV.pdf (viewed July 2023).
27. Di Altobrando A, Tartari F, Filippini A, et al. Lymphogranuloma venereum proctitis mimicking inflammatory bowel diseases in 11 patients: a 4‐year single‐center experience. Crohns Colitis 360 2019; 1:otz004.
28. Sheibani S, Gerson L. Chemical colitis. J Clin Gastroenterol 2008; 42: 115‐121.

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National Hypertension Taskforce of Australia: a roadmap to achieve 70% blood pressure control in Australia by 2030

Aletta E Schutte, Belinda Bennett, Clara K Chow, Geoffrey C Cloud, Kerry Doyle, Zoe Girdis, Jonathan Golledge, Andrew Goodman, Charlotte M Hespe, Meng P Hsu, Sharon James, Garry Jennings, Taskeen Khan, Audrey Lee, Lisa Murphy, Mark R Nelson, Stephen J Nicholls, Natalie Raffoul, Breonny Robson, Anthony Rodgers, Andrea Sanders, Catherine Shang, James E Sharman, Nigel P Stocks, Tim Usherwood, Ruth Webster, Jun Yang and Markus Schlaich

Med J Aust || doi: 10.5694/mja2.52373
Published online: 12 July 2024

ARTICLE
AUTHORS
REFERENCES

Topics

Cardiovascular diseases

Environment and public health

General medicine

Raised blood pressure or hypertension is by far the leading risk factor for preventable deaths in Australia, contributing to over 25 000 deaths annually (Supporting Information, figure 1 and figure 2),1,2,3 mainly due to stroke, heart disease, kidney disease, heart failure, atrial fibrillation and dementia.3,4

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1 University of New South Wales, Sydney, NSW
2 George Institute for Global Health, Sydney, NSW
3 Westmead Applied Research Centre, University of Sydney, Sydney, NSW
4 Alfred Hospital, Melbourne, VIC
5 Australian Cardiovascular Alliance, Sydney, NSW
6 Pharmacy Guild of Australia, Canberra, ACT
7 Queensland Research Centre for Peripheral Vascular Disease, James Cook University, Townsville, QLD
8 Australian e‐Health Research Centre, CSIRO, Brisbane, QLD
9 University of Notre Dame Australia, Sydney, NSW
10 Sexual and Reproductive Health for Women in Primary Care Centre of Research Excellence, Monash University, Melbourne, VIC
11 University of Sydney, Sydney, NSW
12 Geneva, Switzerland
13 Stroke Foundation, Melbourne, VIC
14 Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS
15 Victorian Heart Institute, Monash University, Melbourne, VIC
16 National Heart Foundation of Australia, Melbourne, VIC
17 Kidney Health Australia, Adelaide, SA
18 University of Adelaide, Adelaide, SA
19 Hudson Institute of Medical Research, Melbourne, VIC
20 Dobney Hypertension Centre, University of Western Australia, Perth, WA
21 Royal Perth Hospital, Perth, WA

Correspondence: a.schutte@unsw.edu.au

Open access:

Open access publishing facilitated by University of New South Wales, as part of the Wiley ‐ University of New South Wales agreement via the Council of Australian University Librarians.

Acknowledgements:

Aletta Schutte is supported by a National Health and Medical Research Council (NHMRC) investigator grant (APP2017504). Jun Yang is supported by an NHMRC investigator grant (APP1994576). Clara Chow is supported by an NHMRC investigator grant (APP1195326). The National Hypertension Taskforce would like to thank all members of the International Advisory Panel (Sheldon Tobe, Norm Campbell, Mike Rakotz, Janet Wright, Paul Muntner, Andrew Moran and Pedro Ordunez) for their time and helpful guidance. We acknowledge the input and collaboration of many Australians volunteering to join working groups, workshops and other meetings to inform our decisions. We express sincere gratitude towards the Australian Cardiovascular Alliance for excellent and continued strategic and administrative support.

Competing interests:

Aletta Schutte is past president of the International Society of Hypertension, secretary of the Australian Cardiovascular Alliance, board member of Hypertension Australia. Garry Jennings is the chief medical advisor of the Heart Foundation of Australia and board member of Hypertension Australia. Markus Schlaich is the chair of Hypertension Australia, and treasurer of the World Hypertension League. Sharon James is a board director of the Australian Primary Health Care Nurses Association. Mark Nelson is deputy‐chair of the Research Advisory Committee, Stroke Foundation, co‐chair of the Expert Advisory Committee CVD Guidelines, member of the Board of Hypertension Australia. Lisa Murphy is chief executive officer of the Stroke Foundation, member of the Advisory Group for the CVD Risk Guidelines. James Sharman is a board member of Hypertension Australia. Taskeen Khan works at the World Health Organization, but the views do not represent the views of the organisation. Jun Yang is a member of the Endocrine Society Primary Aldosteronism Guideline Development Panel and lead of the Primary Aldosteronism Foundation Patient Engagement Committee. Breonny Robson is general manager, Clinical & Research at Kidney Health Australia, and member of the Advisory Group for the CVD Risk Guidelines. Aletta Schutte, Markus Schlaich, James Sharman, Garry Jennings, Mark Nelson, Lisa Murphy, Andrew Goodman are members of the National Hypertension Taskforce Steering Committee. Aletta Schutte has received speaker fees from Omron, Medtronic, Aktiia, Servier, Sanofi, Novartis and is advisory board member for Skylabs and Abbott. Mark Nelson has received speaker fees from Medtronic. Stephen Nicholls has received research support from AstraZeneca, Amgen, Anthera, CSL Behring, Cerenis, Eli Lilly, Esperion, Resverlogix, New Amsterdam Pharma, Novartis, InfraReDx and Sanofi‐Regeneron and is a consultant for Amgen, Akcea, AstraZeneca, Boehringer Ingelheim, CSL Behring, Eli Lilly, Esperion, Kowa, Merck, Takeda, Pfizer, Sanofi‐Regeneron, Vaxxinity, CSL Sequiris and Novo Nordisk. Geoffrey Cloud received speaker fees from Astra Zeneca and serves on their Advisory Board. Markus Schlaich has received research support from Medtronic, ReCor (Otsuka), Boehringer‐Ingelheim, Abbott, Idorsia, Janssen, and serves on scientific advisory boards for Medtronic, Abbott, Novartis and Astra Zeneca.

1. GBD 2019 Risk Factors Collaborators. Global burden of 87 risk factors in 204 countries and territories, 1990‐2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet 2020; 396: 1223‐1249.
2. Institute of Health Metrics and Evaluation. Global burden of disease. Deaths by risk factor in Australia. IHME, 2019. https://ourworldindata.org/grapher/number‐of‐deaths‐by‐risk‐factor?country=~AUS (viewed Apr 2024).
3. Xu X, Islam SMS, Schlaich M, Jennings G, Schutte AE. The contribution of raised blood pressure to all‐cause and cardiovascular deaths and disability – adjusted life‐years (DALYs) in Australia: analysis of global burden of disease study from 1990 to 2019. PLoS One 2024; 19: e0297229.
4. Institute of Health Metrics and Evaluation. Disability adjusted life years attributable to raised systolic blood pressure, Australia. 2019. https://vizhub.healthdata.org/gbd‐results/ (viewed June 2024).
5. Schutte AE, Webster R, Jennings G, Schlaich MP. Uncontrolled blood pressure in Australia: a call to action. Med J Aust 2022; 216: 61‐63. https://www.mja.com.au/journal/2022/216/2/uncontrolled‐blood‐pressure‐australia‐call‐action
6. NCD Risk Factor Collaboration. Worldwide trends in hypertension prevalence and progress in treatment and control from 1990 to 2019: a pooled analysis of 1201 population‐representative studies with 104 million participants. Lancet 2021; 398: 957‐980.
7. World Health Organization. Global report on hypertension: the race against a silent killer. 2023. ISBN 978‐92‐4‐008106‐2. https://www.who.int/publications/i/item/9789240081062 (viewed Apr 2024).
8. Australian Cardiovascular Alliance. The National Hypertension Taskforce is launched by the Honourable Mark Butler MP, Minister for Health and Aged Care [media release]. 8 Dec 2023. ozheart.org/taskforce‐launched‐by‐minister/.
9. National Hypertension Taskforce of Australia [website]. https://www.hypertensiontaskforce.au (viewed July 2024).
10. Australian Institute of Health and Welfare. High blood pressure [website]. Canberra: AIHW, 2019. https://www.aihw.gov.au/reports/risk‐factors/high‐blood‐pressure/contents/summary (viewed June 2024).
11. Carnagarin R, Nolde JM, Yang J, et al. Stagnating rates of blood pressure control in Australia: insights from opportunistic screening of 10046 participants of the May Measurement Month campaigns. J Hypertens 2023; 41: 632‐637.
12. Roseleur J, Gonzalez‐Chica DA, Bernardo CO, et al. Blood pressure control in Australian general practice: analysis using general practice records of 1.2 million patients from the MedicineInsight database. J Hypertens 2021; 39: 1134‐1142.
13. Pickersgill SJ, Msemburi WT, Cobb L, et al. Modeling global 80‐80‐80 blood pressure targets and cardiovascular outcomes. Nat Med 2022; 28: 1693‐1699.
14. Rodgers A, Ezzati M, Vander HS, et al. Distribution of major health risks: findings from the Global Burden of Disease study. PLoS Med 2004; 1: e27.
15. Olsen MH, Angell SY, Asma S, et al. A call to action and a lifecourse strategy to address the global burden of raised blood pressure on current and future generations: the Lancet Commission on hypertension. Lancet 2016; 388: 2665‐2712.
16. Australian Government Department of Health. National preventive health strategy 2021–2030. Canberra: Commonwealth of Australia, 2021. https://www.health.gov.au/sites/default/files/documents/2021/12/national‐preventive‐health‐strategy‐2021‐2030_1.pdf (viewed Apr 2024).
17. Charchar FJ, Prestes PR, Mills C, et al. Lifestyle management of hypertension: International Society of Hypertension position paper endorsed by the World Hypertension League and European Society of Hypertension. J Hypertens 2024; 42: 23‐49.
18. Stroke Foundation. Australia under pressure. Australia's biggest blood pressure check report. 2018. https://strokefoundation.org.au/media/cerfkt0t/abbpc2018_australia_under_pressure_report.pdf (viewed Oct 2023).
19. Si S, Moss JR, Sullivan TR, et al. Effectiveness of general practice‐based health checks: a systematic review and meta‐analysis. Br J Gen Pract 2014; 64: e47‐53.
20. Gordon J, Britt H, Miller GC, et al. General practice statistics in Australia: pushing a round peg into a square hole. Int J Environ Res Public Health 2022; 19: 1912.
21. NPS MedicineWise. General practice insights report July 2018 ‐ June 2019. Sydney: NPS MedicineWise, 2020.
22. Australian Government Department of Health and Aged Care. Australia's primary health care 10 year plan 2022–2032. 2022. https://www.health.gov.au/resources/publications/australias‐primary‐health‐care‐10‐year‐plan‐2022‐2032 (viewed June 2024).
23. Khanam MA, Kitsos A, Stankovich J, et al. Association of continuity of care with blood pressure control in patients with chronic kidney disease and hypertension. Aust J Gen Pract 2019; 48: 300‐306.
24. Australian Government Department of Health and Aged Care. Strengthening Medicare Taskforce Report 2022 https://www.health.gov.au/sites/default/files/2023‐02/strengthening‐medicare‐taskforce‐report_0.pdf (viewed June 2024).
25. Unger T, Borghi C, Charchar F, et al. 2020 International Society of Hypertension Global Hypertension Practice Guidelines. Hypertension 2020; 75: 1334‐1357.
26. Mancia G, Kreutz R, Brunström M, et al. 2023 ESH Guidelines for the management of arterial hypertension The Task Force for the management of arterial hypertension of the European Society of Hypertension: endorsed by the International Society of Hypertension (ISH) and the European Renal Association (ERA). J Hypertens 2023; 41: 1874‐2071.
27. Schutte AE, Kollias A, Stergiou GS. Blood pressure and its variability: classic and novel measurement techniques. Nat Rev Cardiol 2022; 19: 643‐654.
28. National Heart Foundation of Australia. Australian Guideline for assessing and managing cardiovascular disease risk [website]. 2023. https://www.cvdcheck.org.au/overview (viewed Apr 2024).
29. Wright JT Jr, Williamson JD, Whelton PK, et al. A randomized trial of intensive versus standard blood‐pressure control. N Engl J Med 2015; 373: 2103‐2116.
30. Beckett NS, Peters R, Fletcher AE, et al. Treatment of hypertension in patients 80 years of age or older. N Engl J Med 2008; 358: 1887‐1898.
31. Juraschek SP, Hu JR, Cluett JL, et al. Orthostatic hypotension, hypertension treatment, and cardiovascular disease: an individual participant meta‐analysis. JAMA 2023; 330: 1459‐1471.
32. Moran AE, Gupta R, Global Hearts Initiative Collaborators. Implementation of Global Hearts Hypertension Control Programs in 32 low‐ and middle‐income countries: JACC International. J Am Coll Cardiol 2023; 82: 1868‐1884.
33. World Health Organization. HEARTS Technical Package (WHO Ref. No. WHO/NMH/NVI/19.8). 2021. https://www.who.int/publications/i/item/WHO‐NMH‐NVI‐19‐8 (viewed Apr 2024).
34. Jaffe MG, Lee GA, Young JD, et al. Improved blood pressure control associated with a large‐scale hypertension program. JAMA 2013; 310: 699‐705.
35. Nguyen LH, Bruyn E, Webster R, et al. Are we there yet? Exploring the use of single‐pill combination therapy in the management of raised blood pressure in Australia. Heart Lung Circ 2022; 31: 954‐963.
36. Parati G, Kjeldsen S, Coca A, et al. Adherence to single‐pill versus free‐equivalent combination therapy in hypertension: a systematic review and meta‐analysis. Hypertension 2021; 77: 692‐705.
37. Salam A, Kanukula R, Atkins E, et al. Efficacy and safety of dual combination therapy of blood pressure‐lowering drugs as initial treatment for hypertension: a systematic review and meta‐analysis of randomized controlled trials. J Hypertens 2019; 37: 1768‐1774.
38. National Heart Foundation of Australia. Guideline for the diagnosis and management of hypertension in adults. 2016. Melbourne: National Heart Foundation of Australia. https://www.heartfoundation.org.au/getmedia/c83511ab‐835a‐4fcf‐96f5‐88d770582ddc/PRO‐167_Hypertension‐guideline‐2016_WEB.pdf (viewed Apr 2024).
39. Law MR, Wald NJ, Morris JK, Jordan RE. Value of low dose combination treatment with blood pressure lowering drugs: analysis of 354 randomised trials. BMJ 2003; 326: 1427.
40. Atkins E, Nguyen LH, Chatterton ML, et al. The costs of treating hypertension in Australia. Med J Aust 2024; in press.
41. Cheung AK, Whelton PK, Muntner P, et al. International consensus on standardized clinic blood pressure measurement ‐ a call to action. Am J Med 2023; 136: 438‐445.
42. Picone DS, Chapman N, Schultz MG, et al. Availability, cost, and consumer ratings of popular nonvalidated vs validated blood pressure‐measuring devices sold online in 10 countries. JAMA 2023; 329: 1514‐1516.
43. Stergiou GS, Mukkamala R, Avolio A, et al. Cuffless blood pressure measuring devices: review and statement by the European Society of Hypertension Working Group on Blood Pressure Monitoring and Cardiovascular Variability. J Hypertens 2022; 40: 1449‐1460.
44. Carter BL, Bosworth HB, Green BB. The hypertension team: the role of the pharmacist, nurse, and teamwork in hypertension therapy. J Clin Hypertens (Greenwich) 2012; 14: 51‐65.
45. Stephen C, Halcomb E, Fernandez R, et al. Nurse‐led interventions to manage hypertension in general practice: a systematic review and meta‐analysis. J Adv Nurs 2022; 78: 1281‐1293.
46. Carrington MJ, Jennings GL, Harris M, et al. Impact of nurse‐mediated management on achieving blood pressure goal levels in primary care: insights from the Valsartan Intensified Primary carE Reduction of Blood Pressure Study. Eur J Cardiovasc Nurs 2016; 15: 409‐416.
47. Australian Government Department of Health and Aged Care. Unleashing the potential of our health workforce ‐ scope of practice review [website]. 2024. https://www.health.gov.au/our‐work/scope‐of‐practice‐review (viewed June 2024).
48. Australian Primary Heatlh Care Nurses Association. Nurse skills, experience being wasted despite nursing shortage ‐ national survey [media release]. 13 June 2023. https://www.apna.asn.au/about/media/archive‐media‐releases/nurse‐skills‐‐experience‐being‐wasted‐despite‐nursing‐shortage‐‐‐national‐survey (viewed June 2024).
49. Australian Government Department of Health and Aged Care. National medicines policy 2022. 2nd edition. https://www.health.gov.au/sites/default/files/2022‐12/national‐medicines‐policy.pdf (viewed Apr 2024).
50. Gertig D, Lee J. Supporting health care providers in cancer screening: the role of the National Cancer Screening Register. Med J Aust 2023; 219: 94‐98. https://www.mja.com.au/journal/2023/219/3/supporting‐health‐care‐providers‐cancer‐screening‐role‐national‐cancer‐screening
51. Farley TA, Dalal MA, Mostashari F, Frieden TR. Deaths preventable in the US by improvements in use of clinical preventive services. Am J Prev Med 2010; 38: 600‐609.
52. Hird TR, Zomer E, Owen AJ, et al. Productivity burden of hypertension in Australia. Hypertension 2019; 73: 777‐784.

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Research letter

Online first

Reduced numbers of elective joint replacement procedures in Australia during the COVID‐19 pandemic, 2020–2022: a registry data analysis study

Christopher J Wall, Christopher J Vertullo, David RJ Gill, Richard S Page, Carl Holder and Paul N Smith

Med J Aust || doi: 10.5694/mja2.52318
Published online: 10 June 2024

ARTICLE
AUTHORS
REFERENCES

Topics

Infectious diseases

Musculoskeletal diseases

The osteoarthritis burden in Australia is growing,1 partly because of population growth, population ageing, and high rates of obesity and sports‐related knee injuries.2 Joint replacement is an effective treatment for people with advanced osteoarthritis; the number of procedures performed in Australia increased markedly during 2003–2019, and is projected to rise further.3

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1 Toowoomba Hospital, Toowoomba, QLD
2 Rural Clinical School, the University of Queensland, Toowoomba, QLD
3 Australian Orthopaedic Association National Joint Replacement Registry, Adelaide, SA
4 Knee Research Australia, Gold Coast, QLD
5 Gold Coast Orthopaedic Research and Education Alliance, Griffith University, Gold Coast, QLD
6 Deakin University, Geelong, VIC
7 Barwon Health, Geelong, VIC
8 South Australian Health and Medical Research Institute, Adelaide, SA
9 Canberra Hospital, Canberra, ACT

Correspondence: chris.wall@health.qld.gov.au

Correspondence: c.wall@uq.edu.au

Open access:

Open access publishing facilitated by the University of Queensland, as part of the Wiley – the University of Queensland agreement via the Council of Australian University Librarians.

Data sharing:

Patient‐level AOANJRR data are not publicly available for sharing.

Acknowledgements:

Open access publishing facilitated by the University of Queensland, as part of the Wiley – the University of Queensland agreement via the Council of Australian University Librarians.

Competing interests:

Christopher Wall, Christopher Vertullo, David Gill, and Paul Smith are clinical directors of the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR). Richard Page is a clinical advisor to the AOANJRR. Christopher Wall has received payments from Stryker for educational presentations. Christopher Vertullo is director of Knee Research Australia. Christopher Vertullo and David Gill are members of Prosthesis List Advisory Committee clinical advisory groups. Paul Smith is chair of the Canberra Orthopaedic Research and Education Foundation, and director of the Trauma and Orthopaedic Research Unit at the Australian National University. Richard Page and Paul Smith have received institutional support from various orthopaedic device companies.

1. Ackerman IN, Bohensky MA, Pratt C, et al. Counting the cost: the current and future burden of arthritis. Part 1: healthcare costs. Arthritis Australia, May 2016. https://arthritisaustralia.com.au/wordpress/wp‐content/uploads/2017/09/Final‐Counting‐the‐Costs_Part1_MAY2016.pdf (viewed July 2023).
2. Hunter DJ, Bierma‐Zeinstra S. Osteoarthritis. Lancet 2019; 393: 1745‐1759.
3. Smith PN, Gill DR, McAuliffe MJ, et al. Hip, knee and shoulder arthroplasty. Australian Orthopaedic Association National Joint Replacement Registry 2023 annual report. Data period 1 September 1999 – 31 December 2022. https://aoanjrr.sahmri.com/documents/10180/1579982/AOA_NJRR_AR23.pdf (viewed Dec 2023).
4. Gill S, Graves S, Lorimer M, et al. COVID‐19 impact on joint replacement surgery in Australia in 2020: a nationwide perspective. ANZ J Surg 2022; 92: 10‐13.
5. Australian Bureau of Statistics. Australia's population to reach 30 million in 11 to 15 years. 22 Nov 2018. https://www.abs.gov.au/articles/australias‐population‐reach‐30‐million‐11‐15‐years (viewed July 2023).
6. Heckmann ND, Bouz GJ, Piple AS, et al. Elective inpatient total joint arthroplasty case volume in the United States in 2020: effects of the COVID‐19 pandemic. J Bone Joint Surg Am 2022; 104: e56.
7. Czubak‐Wrzosek M, Czubak J, Grzelecki D, Tyrakowski M. The effect of the COVID‐19 pandemic on total hip and knee arthroplasty surgical volume in 2020 in Poland. Int J Environ Res Public Health 2021; 18: 8830.
8. Barahona M, Martínez Á, Barahona M, et al. Impact of COVID‐19 outbreak in knee arthroplasty in Chile: a cross‐sectional, national registry‐based analysis. Medwave 2022; 22: e8731.
9. Sayers A, Deere K, Lenguerrand E, et al. The COVID‐19 induced joint replacement deficit in England, Wales and Northern Ireland. In: The National Joint Registry 18th annual report. Surgical data to 31 December 2020. 2021. https://www.ncbi.nlm.nih.gov/books/NBK576854 (viewed Dec 2023).
10. Cobos R, Latorre A, Aizpuru F, et al. Variability of indication criteria in knee and hip replacement: an observational study. BMC Musculoskelet Disord 2010; 11: 249.

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Research

Menstrual pain in Australian adolescent girls and its impact on regular activities: a population‐based cohort analysis based on Longitudinal Study of Australian Children survey data

Lauren Cameron, Antonina Mikocka‐Walus, Emma Sciberras, Marilla Druitt, Katherine Stanley and Subhadra Evans

Med J Aust 2024; 220 (9): . || doi: 10.5694/mja2.52288
Published online: 20 May 2024

ARTICLE
AUTHORS
REFERENCES

Topics

Women's health

Health occupations

Abstract

Objectives: To determine the proportion of Australian adolescent girls who experience menstrual pain (dysmenorrhea); to assess associations of dysmenorrhea and period pain severity with adolescents missing regular activities because of their periods.

Study design: Prospective, population‐based cohort study; analysis of Longitudinal Study of Australian Children (LSAC) survey data.

Setting, participants: Female adolescents in the nationally representative cross‐sequential sample of Australian children recruited in 2004 for the Kinder cohort (aged 4–5 years at enrolment). Survey data from waves 6 (mean age 14 years), wave 7 (16 years) and wave 8 (18 years) were analysed.

Main outcome measures: Severity of period pain during the preceding three months (very, quite, a little, or not at all painful); number of activity types missed because of periods; relationship between missing activities and period pain severity.

Results: Of the 1835 participating female members of the LSAC Kinder cohort at waves 6 to 8, 1600 (87%) responded to questions about menstruation during at least one of waves 6 to 8 of data collection. At wave 6 (14 years), 227 of 644 respondents (35%) reported dysmenorrhea, 675 of 1341 (50%) at wave 6 (16 years), and 518 of 1115 (46%) at wave 8 (18 years). Of the 366 participants who reported period pain severity at all three waves, 137 reported no dysmenorrhea at all three waves (37%), 66 reported dysmenorrhea at all three waves (18%), 89 reported increasing period pain over time (24%), and 38 reported declining pain (10%). At wave 6, 223 of 647 participants reported missing at least one activity because of their periods (34%), 454 of 1341 at wave 7 (34%), and 344 of 1111 at wave 8 (31%). Of the participants who experienced very painful periods, 72% (wave 6), 63% (wave 7), and 65% (wave 8) missed at least one activity type because of their periods, as did 45% (wave 6), 36% (wave 7), and 40% (wave 8) of those who experienced quite painful periods.

Conclusions: A large proportion of adolescent girls in Australia experience period pain that affects their engagement in regular activities, including school attendance. Recognising adolescent period pain is important not only for enhancing their immediate quality of life with appropriate support and interventions, but also as part of early screening for chronic health conditions such as endometriosis.

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1 Deakin University, Melbourne, VIC
2 Monash University, Melbourne, VIC
3 Deakin University, Geelong, VIC
4 University Hospital Geelong, Geelong, VIC
5 Endo Help Foundation, Point Lonsdale, VIC

Correspondence: lauren.cameron@deakin.edu.au

Open access:

Open access publishing facilitated by Deakin University, as part of the Wiley – Deakin University agreement via the Council of Australian University Librarians.

Acknowledgements:

The study was funded by the Endo Help Foundation (https://endohelp.com.au), a not‐for‐profit advocacy organisation. This article uses unit record data from the Longitudinal Study of Australian Children (LSAC), conducted by the Australian Government Department of Social Services (DSS) (doi: 10.26193/QR4L6Q). The findings and views reported in this article, however, are those of the authors and should not be attributed to the Australian government, DSS, or any of contractors or partners of DSS.

Competing interests:

No relevant disclosures.

1. Armour M, Parry K, Manohar N, et al. The prevalence and academic impact of dysmenorrhea in 21 573 young women: a systematic review and meta‐analysis. J Women's Health 2019; 28: 1161‐1171.
2. Armour M, Ferfolja T, Curry C, et al. The prevalence and educational impact of pelvic and menstrual pain in Australia: a national online survey of 4202 young women aged 13–25 years. J Pediatr Adolesc Gynecol 2020; 33: 511‐518.
3. Hillen TIJ, Grbavac SL, Hohnston PJ, et al. Primary dysmenorrhea in young Western Australian women: prevalence, impact, and knowledge of treatment. J Adolesc Health 1999; 25: 40‐45.
4. Parker MA, Sneddon AE, Arbon P. The menstrual disorder of teenagers (MDOT) study: determining typical menstrual patterns and menstrual disturbance in a large population‐based study of Australian teenagers. BJOG 2010; 117: 185‐192.
5. Subasinghe AK, Happo L, Jayasinghe YL, et al. Prevalence and severity of dysmenorrhea, and management options reported by young Australian women. Aust Fam Physician 2016; 45: 829‐834.
6. Li A, Bellis EK, Girling JE, et al. Unmet needs and experiences of adolescent girls with heavy menstrual bleeding and dysmenorrhea: a qualitative study. J Pediatr Adolesc Gynecol 2020; 33: 278‐284.
7. Chen CX, Draucker CB, Carpenter JS. What women say about their dysmenorrhea: a qualitative thematic analysis. BMC Womens Health 2018; 18: 47.
8. De Sanctis V, Soliman ST, Elsedfy H, et al. Dysmenorrhea in adolescents and young adults: a review in different countries. Acta Biomed 2016; 87: 233–246.
9. Treloar SA, Bell TA, Nagle CM, et al. Early menstrual characteristics associated with subsequent diagnosis of endometriosis. Am J Obstet Gynecol 2010; 202: 534. e1‐e6.
10. Knox B, Ong YC, Bakar MA, Grover SR. A longitudinal study of adolescent dysmenorrhea into adulthood. Eur J Ped 2019; 178: 1325‐1332.
11. Soloff C, Lawrence D, Johnstone R. LSAC technical paper No. 1: sample design. Australian Institute of Family Studies, May 2005. https://growingupinaustralia.gov.au/sites/default/files/tp1.pdf (viewed Aug 2022).
12. Vandenbroucke JP, von Elm E, Altman DG, et al. Strengthening the Reporting of Observational Studies in Epidemiology (STROBE): explanation and elaboration. PLoS Med 2007; 4: e297.
13. Australian Bureau of Statistics. IRSAD. In: Census of Population and Housing: Socio‐Economic Indexes for Areas (SEIFA), Australia, 2016 (2033.0.55.001). 27 Mar 2018. https://www.abs.gov.au/ausstats/abs@.nsf/Lookup/by%20Subject/2033.0.55.001~2016~Main%20Features~IRSAD~20 (viewed Nov 2022).
14. Gutman G, Nunez AT, Fisher M. Dysmenorrhea in adolescents. Curr Probl Pediatr Adolesc Health Care 2022; 52: 101186.
15. Australian Institute of Health and Welfare. Chronic pain in Australia (cat. no. PHE 267). 7 May 2020. https://www.aihw.gov.au/reports/chronic‐disease/chronic‐pain‐in‐australia/summary (viewed Nov 2022).
16. Schindler AE. Non‐contraceptive benefits of oral hormonal contraceptives. Int J Endocrinol Metab 2013; 11: 41‐47.
17. Harel Z. Dysmenorrhea in adolescents and young adults: etiology and management. J Pediatr Adolesc Gynecol 2006; 19: 363‐371.
18. Finning K, Ukoumunne OC, Ford T, et al. The association between child and adolescent depression and poor attendance at school: a systematic review and meta‐analysis. J Affect Disord 2019; 245: 928‐938.
19. Epstein S, Roberts E, Sedgwick R, et al. School absenteeism as a risk factor for self‐harm and suicidal ideation in children and adolescents: a systematic review and meta‐analysis. Eur Child Adolesc Psychiatry 2019; 29: 1175‐1194.
20. Belcher BR, Zink J, Azad A, et al. The roles of physical activity, exercise, and fitness in promoting resilience during adolescence: effects on mental well‐being and brain development. Biol Psychiatry Cogn Neurosci Neuroimaging 2021; 6: 225‐237.

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Lifestyle advice from general practitioners and changes in health‐related behaviour in Australia: secondary analysis of 2020–21 National Health Survey data

Loai Albarqouni, Hannah Greenwood, Caroline Dowsett and Paul P Glasziou

Med J Aust || doi: 10.5694/mja2.52285
Published online: 6 May 2024

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REFERENCES

Topics

General medicine

Health services administration

Statistics, epidemiology and research design

Lifestyle factors — smoking, alcohol consumption, inadequate dietary levels of fruit and vegetables — are major risk factors for chronic medical conditions.1 The importance of clinicians encouraging people to modify their lifestyles is emphasised in many guidelines.2 A study that included 4716 American adults found that patient‐reported lifestyle advice from their doctors was associated with corresponding behavioural changes (weight reduction, increased physical activity).3 How often Australian general practitioners provide their patients with lifestyle advice and whether such advice is effective are unknown.

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Institute for Evidence‐Based Healthcare, Bond University, Gold Coast, QLD

Correspondence: lalbarqo@bond.edu.au

Open access:

Open access publishing facilitated by Bond University, as part of the Wiley ‐ Bond University agreement via the Council of Australian University Librarians.

Data sharing:

The data we analysed for this report are publicly available.

Acknowledgements:

This study was supported by a National Health and Medical Research Council Investigator Grant (2008379). The funder played no role in the planning, writing, or publication of this study.

Competing interests:

No relevant disclosures.

1. GBD 2019 Risk Factors Collaborators. Global burden of 87 risk factors in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet 2020; 396: 1223‐1249.
2. US Preventive Services Task Force; Mangione CM, Barry MJ, Nicholson WK, et al. Behavioral counseling interventions to promote a healthy diet and physical activity for cardiovascular disease prevention in adults without cardiovascular disease risk factors: US Preventive Services Task Force recommendation statement. JAMA 2022; 328: 367‐374.
3. Williams AR, Wilson‐Genderson M, Thomson MD. A cross‐sectional analysis of associations between lifestyle advice and behavior changes in patients with hypertension or diabetes: NHANES 2015–2018. Prev Med 2021; 145: 106426.
4. Australian Bureau of Statistics. Data items. In: National Health Survey: first results methodology, 2020–21. 21 Mar 2022. https://www.abs.gov.au/methodologies/national‐health‐survey‐methodology/2020‐21 (viewed Oct 2023).
5. Henry JA, Jebb SA, Aveyard P, et al. Lifestyle advice for hypertension or diabetes: trend analysis from 2002 to 2017 in England. Br J Gen Pract 2022; 72: e269‐e275.
6. Albarqouni L, Montori V, Jørgensen KJ, et al. Applying the time needed to treat to NICE guidelines on lifestyle interventions. BMJ Evid Based Med 2023; 28: 354‐355.

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Symptomatic cancer diagnosis in general practice: a critical perspective of current guidelines and risk assessment tools

Brent Venning and Jon D Emery

Med J Aust || doi: 10.5694/mja2.52287
Published online: 6 May 2024

ARTICLE
AUTHORS
REFERENCES

Topics

Neoplasms

General medicine

On 2 November 2023, Cancer Australia unveiled the Australian Cancer Plan, emphasising a strategic commitment to “maximising cancer prevention and early detection”.1,2 This initiative holds particular significance for general practice, as most cancer diagnoses originate from symptomatic presentations to primary care, even when screening programs are available.3 For context, full‐time general practitioners on average diagnose up to 12 non‐cutaneous cancers annually, but they see patients consulting with symptoms associated with cancer almost daily.3,4

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Centre for Cancer Research, University of Melbourne, Melbourne, VIC

Correspondence: brent.venning@unimelb.edu.au

Open access:

Open access publishing facilitated by The University of Melbourne, as part of the Wiley ‐ The University of Melbourne agreement via the Council of Australian University Librarians.

Acknowledgements:

Brent Venning is supported by the Melbourne Academic Centre for Health (MACH) through the MACH‐Track program and by a University of Melbourne Research Training Program Scholarship. Jon Emery is supported by a National Health and Medical Research Council Investigator Grant (APP1195302) and is an Associate Director of the CanTest Collaborative (funded by Cancer Research UK, C8640/A23385).

Competing interests:

No relevant disclosures.

1. Cancer Australia. Australian Cancer Plan [website]. Canberra: Commonwealth of Australia, 2021. https://www.canceraustralia.gov.au/australian‐cancer‐plan (viewed Nov 2023).
2. Chaji D, Boltong A, Der Vartanian C, et al. Setting the policy agenda for cancer control reform: Australia's first national cancer control plan. Med J Aust 2023; 219: 451‐454. https://www.mja.com.au/journal/2023/219/10/setting‐policy‐agenda‐cancer‐control‐reform‐australias‐first‐national‐cancer
3. Emery JD. The challenges of early diagnosis of cancer in general practice. Med J Aust 2015; 203: 391‐393. https://www.mja.com.au/journal/2015/203/10/challenges‐early‐diagnosis‐cancer‐general‐practice
4. Hamilton W. Cancer diagnosis in primary care. Br J Gen Pract 2010; 60: 121‐128.
5. Rubin G, Berendsen A, Crawford SM, et al. The expanding role of primary care in cancer control. Lancet Oncol 2015; 16: 1231‐1272.
6. Koo MM, Hamilton W, Walter FM, et al. Symptom signatures and diagnostic timeliness in cancer patients: a review of current evidence. Neoplasia 2018; 20: 165‐174.
7. Stapley S, Peters TJ, Neal RD, et al. The risk of pancreatic cancer in symptomatic patients in primary care: a large case‐control study using electronic records. Br J Cancer 2012; 106: 1940‐1944.
8. Jensen H, Tørring ML, Olesen F, et al. Cancer suspicion in general practice, urgent referral and time to diagnosis: a population‐based GP survey and registry study. BMC Cancer 2014; 14: 636.
9. McGarvey N, Gitlin M, Fadli E, Chung KC. Increased healthcare costs by later stage cancer diagnosis. BMC Health Serv Res 2022; 22: 1155.
10. Emery JD, Shaw K, Williams B, et al. The role of primary care in early detection and follow‐up of cancer. Nat Rev Clin Oncol 2014; 11: 38‐48.
11. Renzi C, Kaushal A, Emery J, et al. Comorbid chronic diseases and cancer diagnosis: disease‐specific effects and underlying mechanisms. Nat Rev Clin Oncol 2019; 16: 746‐761.
12. Brownlee S, Chalkidou K, Doust J, et al. Evidence for overuse of medical services around the world. Lancet 2017; 390: 156‐168.
13. Lyratzopoulos G, Vedsted P, Singh H. Understanding missed opportunities for more timely diagnosis of cancer in symptomatic patients after presentation. Br J Cancer 2015; 112 (Suppl): S84‐S91.
14. Banks J, Hollinghurst S, Bigwood L, et al. Preferences for cancer investigation: a vignette‐based study of primary‐care attendees. Lancet Oncol 2014; 15: 232‐240.
15. Venning B, Pearce A, Lourenco RDA, et al. Patient preferences for investigating cancer‐related symptoms in australian general practice: a discrete choice experiment. Br J Gen Pract 2024; https://doi.org/10.3399/BJGP.2023.0583 [Epub ahead of print].
16. Cancer Australia. Optimal Care Pathways. Canberra: Commonwealth of Australia, 2024. https://www.canceraustralia.gov.au/optimal‐cancer‐care‐pathways (viewed Apr 2024).
17. Cancer Australia. Optimal Care Pathways: for general practitioners and primary care staff — I‐PACED (Implementing Pathways for Cancer Early Diagnosis). Canberra: Commonwealth of Australia, 2024. https://www.cancervic.org.au/get‐support/for‐health‐professionals/optimal‐care‐pathways (viewed Apr 2024).
18. Cancer Australia. GP guides and resources. https://www.canceraustralia.gov.au/clinical‐best‐practice/gynaecological‐cancers/gp‐guides‐and‐resources. Canberra: Commonwealth of Australia, 2021. (viewed Apr 2024).
19. Chiang PPC, Glance D, Walker J, et al. Implementing a QCancer risk tool into general practice consultations: an exploratory study using simulated consultations with Australian general practitioners. Br J Cancer 2015; 112 (Suppl): S77‐S83.
20. National Institute for Health and Care Excellence. Suspected cancer: recognition and referral [NICE guideline NG12; updated Oct 2023]. Manchester (UK): NICE, 2015. https://www.nice.org.uk/guidance/ng12 (viewed Mar 2024).
21. Conroy T, Pfeiffer P, Vilgrain V, et al. Pancreatic cancer: ESMO clinical practice guideline for diagnosis, treatment and follow‐up. Ann Oncol 2023; 34: 987‐1002.
22. Hamilton W. The CAPER studies: five case‐control studies aimed at identifying and quantifying the risk of cancer in symptomatic primary care patients. Br J Cancer 2009; 101 (Suppl): S80‐S86.
23. Hamilton W, Green T, Martins T, et al. Evaluation of risk assessment tools for suspected cancer in general practice: a cohort study. Br J Gen Pract 2013; 63: e30‐e36.
24. Price S, Spencer A, Medina‐Lara A, Hamilton W. Availability and use of cancer decision‐support tools: a cross‐sectional survey of UK primary care. Br J Gen Pract 2019; 69: e437‐e443.
25. Hamilton W, Mounce L, Abel GA, et al. Protocol for a pragmatic cluster randomised controlled trial assessing the clinical effectiveness and cost‐effectiveness of Electronic RIsk‐assessment for CAncer for patients in general practice (ERICA). BMJ Open 2023; 13: e065232.
26. Royal Australian College of General Practitioners. Electronic clinical decision support in general practice [website]. Melbourne: RACGP, 2024. https://www.racgp.org.au/advocacy/position‐statements/view‐all‐position‐statements/clinical‐and‐practice‐management/electronic‐clinical‐decision‐support (viewed Mar 2024).
27. Chima S, Reece JC, Milley K, et al. Decision support tools to improve cancer diagnostic decision making in primary care: a systematic review. Br J Gen Pract 2019; 69: e809‐e818.
28. Hunter B, Biezen R, Alexander K, et al. Future Health Today: codesign of an electronic chronic disease quality improvement tool for use in general practice using a service design approach. BMJ Open 2020; 10: e040228.
29. Davies D, Morgan M, de Wet C. Supporting quality and safety in general practice: Response rates to computer decision support. Aust J Gen Pract 2022; 51: 884‐892.

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Research

How should artificial intelligence be used in Australian health care? Recommendations from a citizens’ jury

Stacy M Carter, Yves Saint James Aquino, Lucy Carolan, Emma Frost, Chris Degeling, Wendy A Rogers, Ian A Scott, Katy JL Bell, Belinda Fabrianesi and Farah Magrabi

Med J Aust 2024; 220 (8): . || doi: 10.5694/mja2.52283
Published online: 6 May 2024

ARTICLE
AUTHORS
REFERENCES

Topics

Information science

Health services administration

Social determinants of health

Abstract

Objective: To support a diverse sample of Australians to make recommendations about the use of artificial intelligence (AI) technology in health care.

Study design: Citizens’ jury, deliberating the question: “Under which circumstances, if any, should artificial intelligence be used in Australian health systems to detect or diagnose disease?”

Setting, participants: Thirty Australian adults recruited by Sortition Foundation using random invitation and stratified selection to reflect population proportions by gender, age, ancestry, highest level of education, and residential location (state/territory; urban, regional, rural). The jury process took 18 days (16 March – 2 April 2023): fifteen days online and three days face‐to‐face in Sydney, where the jurors, both in small groups and together, were informed about and discussed the question, and developed recommendations with reasons. Jurors received extensive information: a printed handbook, online documents, and recorded presentations by four expert speakers. Jurors asked questions and received answers from the experts during the online period of the process, and during the first day of the face‐to‐face meeting.

Main outcome measures: Jury recommendations, with reasons.

Results: The jurors recommended an overarching, independently governed charter and framework for health care AI. The other nine recommendation categories concerned balancing benefits and harms; fairness and bias; patients’ rights and choices; clinical governance and training; technical governance and standards; data governance and use; open source software; AI evaluation and assessment; and education and communication.

Conclusions: The deliberative process supported a nationally representative sample of citizens to construct recommendations about how AI in health care should be developed, used, and governed. Recommendations derived using such methods could guide clinicians, policy makers, AI researchers and developers, and health service users to develop approaches that ensure trustworthy and responsible use of this technology.

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1 University of Wollongong, Wollongong, NSW
2 Australian Centre for Health Engagement, Evidence and Values, University of Wollongong, Wollongong, NSW
3 Macquarie University, Sydney, NSW
4 University of Queensland, Brisbane, QLD
5 Princess Alexandra Hospital, Brisbane, QLD
6 University of Sydney, Sydney, NSW
7 Australian Institute for Health Innovation, Macquarie University, Sydney, NSW

Correspondence: stacyc@uow.edu.au

Open access:

Open access publishing facilitated by University of Wollongong, as part of the Wiley – University of Wollongong agreement via the Council of Australian University Librarians.

Data sharing:

Individual deidentified participant data will be partially shared. The ethics approval for the study stipulated that transcripts of recordings of the jurors’ deliberations would remain confidential because of the risk of individual identification. Our study did not involve data dictionaries. Extensive information about the study protocol, and data generated for and in the study (including descriptions of the process, the expert witness videos, questions generated by the jury, and answers provided by the experts) are available at https://uow.info/TAWSYN_JURY.

Acknowledgements:

This study was supported by the National Health and Medical Research Council (1181960).

Competing interests:

No relevant disclosures.

1. Australian Department of Industry, Science and Resources. Supporting responsible AI: discussion paper. Government's interim response. 17 Jan 2024. https://consult.industry.gov.au/supporting‐responsible‐ai (viewed Mar 2024).
2. Lyell D, Wang Y, Coiera E, Magrabi F. More than algorithms: an analysis of safety events involving ML‐enabled medical devices reported to the FDA. J Am Med Inform Assoc 2023; 30: 1227‐1226.
3. Wadie J. A roadmap for artificial intelligence in healthcare for Australia news]. Australian Alliance for Artificial Intelligence in Healthcare, 1 Dec 2021. https://aihealthalliance.org/2021/12/01/a‐roadmap‐for‐ai‐in‐healthcare‐for‐australia (viewed Oct 2023).
4. Coiera EW, Verspoor K, Hansen DP. We need to chat about artificial intelligence. Med J Aust 2023; 219: 98‐100. https://www.mja.com.au/journal/2023/219/3/we‐need‐chat‐about‐artificial‐intelligence
5. Pearce C, McLeod A, Rinehart N, et al. Artificial intelligence and the clinical world: a view from the front line. Med J Aust 2019; 210 (6 Suppl): S38‐S40. https://www.mja.com.au/journal/2019/210/6/artificial‐intelligence‐and‐clinical‐world‐view‐front‐line
6. Moodie C. Australian Medical Association calls for national regulations around AI in health care. ABC News (Australia), 28 May 2023. https://www.abc.net.au/news/2023‐05‐28/ama‐calls‐for‐national‐regulations‐for‐ai‐in‐health/102381314 (viewed Oct 2023).
7. Mathews DJH, Balatbat CA, Dzau VJ. Governance of emerging technologies in health and medicine: creating a new framework. N Engl J Med 2022; 386: 2239‐2242.
8. Degeling C, Carter SM, Rychetnik L. Which public and why deliberate? A scoping review of public deliberation in public health and health policy research. Soc Sci Med 2015; 131: 114‐121.
9. Flanigan B, Gölz P, Gupta A, et al. Fair algorithms for selecting citizens’ assemblies. Nature 2021; 596: 548‐552.
10. Australian Centre for Health Engagement Evidence and Values. Artificial intelligence in health: community jury. Undated. https://uow.info/TAWSYN_JURY (viewed Oct 2023).
11. White K, Hunter N, Greaves K. Facilitating deliberation: a practical guide. Melbourne: MosaicLab, 2022.
12. Brown J, Isaacs D. The world café: shaping our futures through conversations that matter. San Francisco: Berrett–Koehler, 2005.
13. Aquino YSJ, Carter SM, Houssami N, et al. Practical, epistemic and normative implications of algorithmic bias in healthcare artificial intelligence: a qualitative study of multidisciplinary expert perspectives. J Med Ethics 2023: jme‐2022‐108850.
14. Thomas R, Sims R, Degeling C, et al. CJCheck Stage 1: development and testing of a checklist for reporting community juries: Delphi process and analysis of studies published in 1996–2015. Health Expect 2016; 20: 626‐637.
15. Australian Bureau of Statistics. Snapshot of Australia, 2021. 28 June 2022. https://www.abs.gov.au/statistics/people/people‐and‐communities/snapshot‐australia/2021 (viewed Oct 2023).
16. Australian Bureau of Statistics. Education and training: census, 2021. 28 June 2022. https://www.abs.gov.au/statistics/people/education/education‐and‐training‐census/latest‐release (viewed Oct 2023).
17. Australian Bureau of Statistics. National state and territory population, December 2023. 28 June 2022. https://www.abs.gov.au/statistics/people/population/national‐state‐and‐territory‐population/dec‐2021 (viewed Oct 2023).
18. Australian Institute of Health and Welfare. Profile of Australia's population. 6 June 2023. https://www.aihw.gov.au/reports/australias‐health/profile‐of‐australias‐population (viewed Oct 2023).
19. van der Veer SN, Riste L, Cheraghi‐Sohi S, et al. Trading off accuracy and explainability in AI decision‐making: findings from 2 citizens’ juries. J Am Med Inform Assoc 2021; 28: 2128‐2138.
20. Forum for Ethical AI. Democratising decisions about technology: a toolkit. 24 Oct 2019. https://www.thersa.org/reports/democratising‐decisions‐technology‐toolkit (viewed Oct 2023).
21. Ada Lovelace Institute. The Citizens’ Biometrics Council London: report with recommendations and findings of a public deliberation on biometrics technology, policy and governance. 30 Mar 2021. https://www.adalovelaceinstitute.org/report/citizens‐biometrics‐council (viewed Oct 2023).
22. European Commission. Proposal for a regulation of the European parliament and the council laying down harmonised rules on artificial intelligence (Artificial Intelligence Act) and amending certain union legislative acts (COM/2021/206 final). 21 Apr 2021. https://eur‐lex.europa.eu/legal‐content/EN/TXT/?uri=CELEX:52021PC0206 (viewed Oct 2023).
23. Therapeutic Goods Administration. Regulation of software based medical devices. 28 Sept 2023. https://www.tga.gov.au/how‐we‐regulate/manufacturing/medical‐devices/manufacturer‐guidance‐specific‐types‐medical‐devices/regulation‐software‐based‐medical‐devices (viewed Oct 2023).
24. Street J, Duszynski K, Krawczyk S, Braunack‐Mayer A. The use of citizens' juries in health policy decision‐making: a systematic review. Soc Sci Med 2014; 109: 1‐9.

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Towards national paediatric clinical practice guidelines

Mike Starr

Med J Aust || doi: 10.5694/mja2.52272
Published online: 15 April 2024

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Topics

General medicine

Pediatric medicine

Clinical practice guidelines (CPGs) are intended to improve the quality of clinical care by promoting evidence‐based care, reducing inappropriate variation, and producing optimal outcomes for patients.

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1 Royal Children's Hospital, Melbourne, VIC
2 University of Melbourne, Melbourne, VIC

Correspondence: mike.starr@rch.org.au

Open access:

Open access publishing facilitated by The University of Melbourne, as part of the Wiley ‐ The University of Melbourne agreement via the Council of Australian University Librarians.

Acknowledgements:

The PIC CPG work is funded in part by Clinical Excellence Queensland, the NSW Agency for Clinical Innovation, Safer Care Victoria, RCH Melbourne, and the RCH Foundation. Kate Harding, Matthew O'Meara and Mike South have had an integral role in the work of the CPG committee and PIC steering committee.

Competing interests:

No relevant disclosures.

1. Cohn SL, Gautam B, Preddy JS, et al. Barriers to the use of paediatric clinical practice guidelines in rural and regional New South Wales Australia. Aust J Rural Health 2016; 24, 23‐28.
2. Braithwaite J, Hibbert PD, Jaffe A, et al. Quality of health care for children in Australia, 2012‐2013. JAMA 2018; 319: 1113‐1124.
3. Duggan A, Koff E, Marshall V. Clinical variation: why it matters. Med J Aust 2016; 205: S3‐S4. https://www.mja.com.au/journal/2016/205/10/clinical‐variation‐why‐it‐matters
4. Royal Children's Hospital Melbourne. Clinical Practice Guidelines: CPG information. https://www.rch.org.au/clinicalguide/about_rch_cpgs/CPG_information/ (viewed July 2023).
5. Rea CJ, Alvarez FJ, Tieder JS. The silent crisis of pediatric clinical practice guidelines. JAMA Pediatr 2021; 175: 1201‐1202.
6. Flores G, Lee M, Bauchner H. Pediatricians’ attitudes, beliefs, and practices regarding clinical practice guidelines: a national survey. Pediatrics 2000; 105: 496‐501.

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Mimics of inflammatory bowel disease: commonly encountered differentials of an uncommon condition

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National Hypertension Taskforce of Australia: a roadmap to achieve 70% blood pressure control in Australia by 2030

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Reduced numbers of elective joint replacement procedures in Australia during the COVID‐19 pandemic, 2020–2022: a registry data analysis study

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Menstrual pain in Australian adolescent girls and its impact on regular activities: a population‐based cohort analysis based on Longitudinal Study of Australian Children survey data

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Lifestyle advice from general practitioners and changes in health‐related behaviour in Australia: secondary analysis of 2020–21 National Health Survey data

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Symptomatic cancer diagnosis in general practice: a critical perspective of current guidelines and risk assessment tools

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How should artificial intelligence be used in Australian health care? Recommendations from a citizens’ jury

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Towards national paediatric clinical practice guidelines

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Mainstreaming genomic testing: pre‐test counselling and informed consent

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Medicare‐funded reproductive genetic carrier screening in Australia has arrived: are we ready?

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Mimics of inflammatory bowel disease: commonly encountered differentials of an uncommon condition

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National Hypertension Taskforce of Australia: a roadmap to achieve 70% blood pressure control in Australia by 2030

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Reduced numbers of elective joint replacement procedures in Australia during the COVID‐19 pandemic, 2020–2022: a registry data analysis study

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Menstrual pain in Australian adolescent girls and its impact on regular activities: a population‐based cohort analysis based on Longitudinal Study of Australian Children survey data

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Lifestyle advice from general practitioners and changes in health‐related behaviour in Australia: secondary analysis of 2020–21 National Health Survey data

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Symptomatic cancer diagnosis in general practice: a critical perspective of current guidelines and risk assessment tools

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How should artificial intelligence be used in Australian health care? Recommendations from a citizens’ jury

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Towards national paediatric clinical practice guidelines

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Mainstreaming genomic testing: pre‐test counselling and informed consent

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Medicare‐funded reproductive genetic carrier screening in Australia has arrived: are we ready?

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