Restrictions on social media access for users under 16 years raise a critical question about how adolescents in Australia will access sexual and reproductive health (SRH) information, especially where traditional systems...Restrictions on social media access for users under 16 years raise a critical question about how adolescents in Australia will access sexual and reproductive health (SRH) information, especially where traditional systems often fall short. Social media has become an important source of SRH education, offering timely and relatable content that bridges gaps left by formal education and healthcare. As access to these platforms is restricted, other pathways must be strengthened. This includes investing in comprehensive in- and out-of-school sexuality education, youth-friendly primary care services and safe digital platforms designed with and for adolescents.
OBJECTIVES: To determine how many people who die of cancer in Victoria receive palliative care and early palliative care (more than 3 months before death); to assess the impact of early palliative care on the quality of...OBJECTIVES: To determine how many people who die of cancer in Victoria receive palliative care and early palliative care (more than 3 months before death); to assess the impact of early palliative care on the quality of end-of-life care. STUDY DESIGN: Retrospective, population-based cohort study; analysis of linked Victorian Cancer Registry data and routinely collected data for inpatient, non-admitted health service and emergency department care during the 12 months prior to death. SETTING, PARTICIPANTS: Victorian adults who died of cancer during 1 January 2018-31 January 2023. MAIN OUTCOME MEASURES: Proportions of people who received palliative care (any time) or early palliative care (more than 3 months prior to death); likelihood of quality of end-of-life care measures: dying outside an acute hospital; chemotherapy, two or more emergency department visits, two or more hospital admissions during final 30 days of life; advance care plan at death. RESULTS: Of 53,305 people who died of cancer (mean age, 74.8 years [standard deviation, 13.0 years]; 29,527 men [55.4%]), palliative care was provided for 38,697 (72.6%); 17,409 people (32.7%) received early palliative care. The most frequent palliative care type was palliative approach to care (Z51.5 code; 33,974 people, 63.7%). The overall proportion of people who received palliative care did not change markedly during 2018-2022; the proportion who received early palliative care declined slightly, from 34.8% (95% confidence interval [CI], 33.6-35.9) to 33.0% (95% CI, 31.7-33.8). People who received early palliative care were more likely than people who received late palliative care to have an advance care plan (adjusted odds ratio [aOR], 1.46; 95% CI, 1.38-1.55) and to die outside hospital (aOR, 2.50; 95% CI, 2.37-2.64); they were less likely to have two or more of emergency department presentations (aOR, 0.75; 95% CI, 0.70-0.81), two or more hospital admissions (aOR, 0.58; 95% CI, 0.55-0.61) or chemotherapy (aOR, 0.51; 95% CI, 0.47-0.55) during their final 30 days of life. CONCLUSION: 72.6% of people who died of cancer in Victoria during 2018-2023 had received palliative care, but only 33% had received it early. End-of-life care may be improved by providing palliative care early. The low early palliative care rate, despite the potential for improved outcomes for people who receive it, indicates that action is needed.
Genomic newborn screening (gNBS) can screen for a broad range of genetic conditions, potentially enabling early treatment and improving health outcomes. However, it remains outside publicly funded programmes due to limit...Genomic newborn screening (gNBS) can screen for a broad range of genetic conditions, potentially enabling early treatment and improving health outcomes. However, it remains outside publicly funded programmes due to limited evidence and substantial implementation challenges. Offering gNBS in the interim as a fee-for-service option in Australia risks creating inequitable healthcare access, fragmenting care and limiting control over genomic data. Conversely, prohibiting private access may unfairly deny potential benefits to individual infants and families. This article discusses the ethical and practical implications of offering gNBS on a fee-for-service basis prior to a decision being made regarding public funding. Although fee-for-service gNBS undermines equitable access, regulated private offerings by public genomics services could mitigate some of the risks. We emphasise the need for large-scale, well-designed research studies to inform the development and equitable implementation of robust gNBS programmes within public healthcare frameworks.
OBJECTIVES: To assess the prevalence, characteristics and outcomes of health impairment notifications to the Australian Health Practitioner Regulation Agency (Ahpra) and to assess the influence of doctor age, sex, specia...OBJECTIVES: To assess the prevalence, characteristics and outcomes of health impairment notifications to the Australian Health Practitioner Regulation Agency (Ahpra) and to assess the influence of doctor age, sex, specialty, practice location and country of training on the incidence of health impairment notifications. STUDY DESIGN: Retrospective cohort study; analysis of linked de-identified Ahpra medical register and health impairment notifications data. SETTING, PARTICIPANTS: All doctors registered to practise in Australia (except New South Wales) for whom notifications of concerns about physical or mental illness, cognitive decline, substance use disorder or other impairment to safely practising medicine were received by Ahpra during 1 July 2012-30 June 2022. MAIN OUTCOME MEASURES: Health impairment notifications, overall and by notification type and specialty; influence of doctors' characteristics on the incidence of notifications. RESULTS: During 2012-2022, 112,677 doctors were registered to practise in Australia (other than New South Wales). A total of 1732 health impairment notifications were recorded, including at least one notification for 1258 doctors (1.1%). In multivariable analyses, the incidence of health impairment notifications was higher for male than female doctors (adjusted incidence rate ratio [aIRR], 1.45; 95% confidence interval [CI], 1.26-1.67), for doctors aged 70 years or older than for those aged 30-39 years (aIRR, 2.92; 95% CI, 2.30-3.70) and for doctors in regional (aIRR, 1.33; 95% CI, 1.12-1.58), rural (aIRR, 1.27; 95% CI, 1.03-1.57) and remote areas (aIRR, 1.55; 95% CI, 1.03-2.33) than in metropolitan areas. Among doctors with specialist qualifications, the incidence of notifications was higher for psychiatrists than internal medicine physicians (aIRR, 2.28; 95% CI, 1.62-3.21) and the incidence of substance use notifications was highest for anaesthetists (vs. internal medicine physicians: aIRR, 2.83; 95% CI, 1.66-4.83). Compared with doctors who trained in Australia, doctors who trained in non-comparable jurisdictions were less likely to be subjects of health impairment notifications (aIRR, 0.53; 95% CI, 0.43-0.64). Of 1708 notifications with final Ahpra determinations, 367 (21.5%) resulted in practice restrictions or removal from practice. CONCLUSIONS: Health impairment notifications are infrequent but can have serious consequences for doctors. The incidence of health impairment notifications is influenced by doctor age, sex, specialty and location. Specific measures that take these factors into account could support workplace health and safety for doctors and protect patients from harm.
A 41-year-old woman presented to the emergency department with a widespread pruritic, erythematous eruption following 6 weeks of kava consumption for anxiety and insomnia. The eruption began on the abdomen and progressiv...A 41-year-old woman presented to the emergency department with a widespread pruritic, erythematous eruption following 6 weeks of kava consumption for anxiety and insomnia. The eruption began on the abdomen and progressively involved the chest, upper back and face. Laboratory investigations revealed mild derangement of liver function test results. Skin biopsy results demonstrated folliculocentric inflammation and necrosis of sebaceous glands, consistent with acute kava dermopathy. Kava, a traditional anxiolytic herbal preparation, has been implicated in both chronic and acute cutaneous reactions, including ichthyosiform and sebotropic eruptions. Its active compounds, kavalactones, are hypothesised to provoke a cytotoxic T-cell-mediated response targeting sebaceous glands. This case is notable as it occurred in an Australian woman with no travel history to the Pacific Islands-a region where kava use is prevalent. Moreover, the distinct histopathological findings, rarely documented in the literature, provide valuable diagnostic insight and serve as a visual reference for clinicians encountering this condition.
An older man with Crohn's disease underwent emergency laparotomy for small bowel perforation. A peri-incisional vesiculobullous eruption developed 5 days later. Histopathology demonstrated viral cytopathic changes, immun...An older man with Crohn's disease underwent emergency laparotomy for small bowel perforation. A peri-incisional vesiculobullous eruption developed 5 days later. Histopathology demonstrated viral cytopathic changes, immunohistochemistry was positive for herpes simplex virus and HSV-1 DNA confirmed by polymerase chain reaction test, representing the first reported case of localised herpes simplex following abdominal surgery.
Over recent decades, the medical profession has undergone significant changes due to the influence of managerialism, which is characterised by standardisation, efficiency and cost control. Although these principles aim t...Over recent decades, the medical profession has undergone significant changes due to the influence of managerialism, which is characterised by standardisation, efficiency and cost control. Although these principles aim to improve sustainability and transparency within healthcare systems, they often conflict with fundamental aspects of medical professionalism and patient-centred care. This perspective explores how managerialism may negatively affect the medical profession, focussing on its impact on clinician autonomy, the changing nature of medical work, professional identity and collegial relationships within hospital settings. Key challenges faced by doctors include diminishing control over patient care, growing administrative burden, increasing burn-out, erosion of professional values and identity, and fragmentation of collegiality. To address these issues, this perspective advocates for institutional change such as hybrid governance models that integrate professional and managerial expertise to ensure managerial goals remain aligned with clinical realities. Professional bodies and institutions should empower doctors with managerial and leadership competencies to influence organisational change, reconcile clinical and managerial priorities, and uphold professional values and quality patient care within the evolving healthcare landscape. Effective reform requires the considerate integration of managerial systems into healthcare to strengthen, rather than undermine, the professional foundations and ethical values that give medicine its integrity and meaning.
Healthcare in Australian custodial settings is hampered by fragmented care, a lack of consistent standards and a lack of accountability. Creating national minimum standards for healthcare in custodial settings, with the...Healthcare in Australian custodial settings is hampered by fragmented care, a lack of consistent standards and a lack of accountability. Creating national minimum standards for healthcare in custodial settings, with the aim of equivalence to community standards, will be an important step in reducing health inequalities for some of Australia's most marginalised people.
The burden of disease estimates from the Australian Institute of Health and Welfare are influential in driving priorities for actions across research, policy and practice. Following the latest estimates in 2024, much att...The burden of disease estimates from the Australian Institute of Health and Welfare are influential in driving priorities for actions across research, policy and practice. Following the latest estimates in 2024, much attention focused on top risk factors including obesity, tobacco and diet. Meanwhile, upstream social, economic and political drivers were overlooked. In this perspective, we argue that to effectively move the dial on disease burden, we must shift our focus from downstream action on individual-level risk factors to upstream action on structural causes. Failure to do so represents a missed opportunity to improve population health and tackle health inequity.
There is consistent evidence of who is more likely to practise in a rural location; however, current selection criteria used by most specialty colleges do not reflect this. In fact, our evidence-based perspective article...There is consistent evidence of who is more likely to practise in a rural location; however, current selection criteria used by most specialty colleges do not reflect this. In fact, our evidence-based perspective article shows how specialty selection is likely driving many rural interested graduates away from rural pathways, perhaps never to return post-fellowship. The Australian Government has strongly invested in rural training, with greatly increased opportunities for end-to-end pathways and raised awareness of social accountability of training programs. However, specialty training pathways have been slow to change the selection criteria, which should align with supporting workforce diversity and distribution into rural areas. We highlight potentially untapped opportunities to directly address workforce distribution that require negligible financial costs to change criteria and processes.
OBJECTIVES: To assess the effectiveness of Strengthening Care for Children (SC4C) for reducing the number of referrals by general practitioners of patients under 18 years of age to hospital services. STUDY DESIGN: Steppe...OBJECTIVES: To assess the effectiveness of Strengthening Care for Children (SC4C) for reducing the number of referrals by general practitioners of patients under 18 years of age to hospital services. STUDY DESIGN: Stepped-wedge cluster randomised trial; data collected for up to 16 months after the intervention. SETTING: General practices in North Western Melbourne and Central and Eastern Sydney primary health networks, 1 May 2021-30 September 2023. PARTICIPANTS: General practitioners who worked at least two clinical sessions each week, saw patients under 18 years of age, and for whom at least 1 month of referrals data during the control period were available; families of people under 18 years attending these practices. INTERVENTION: Weekly (6 months) then fortnightly (6 months) general practitioner-paediatrician co-consultations; monthly paediatrician-led case discussions; weekday phone and email support by paediatricians. MAIN OUTCOME MEASURES: Proportion of general practitioner visits in which patients were referred to publicly funded hospital outpatient clinics or emergency departments (patient level), overall and by baseline referral rate. SECONDARY OUTCOMES: Referrals after completion of the intervention; general practitioner confidence regarding child health care; low value care for frequent childhood conditions; family preference for general practitioner or paediatrician care. RESULTS: One hundred and thirty participating general practitioners from 22 general practices conducted 50,101 consultations during the control period; 125 general practitioners from 21 general practices received the intervention and undertook 96,804 consultations. Patients were referred to hospitals in 2.3% of control period consultations and 1.9% of intervention period consultations (risk difference, -0.34 [95% confidence interval {CI}, -0.69 to 0.004] percentage points). Among general practitioners with high referral rates at baseline (5% or higher), patients were referred to hospital outpatient or emergency department in 7.3% of control period consultations and in 3.0% of intervention period consultations (risk difference, -4.28 [95% CI, -6.59 to -1.97] percentage points); the referral rate was also lower after the intervention period (sustainability vs. control periods: 2.9% vs. 5.8%; risk difference, -2.92 [95% CI, -5.36 to -0.48] percentage points). The proportions of general practitioners confident about their knowledge and skills regarding child health care were larger during the intervention than the control period. Quality of care and family preference for general practitioner-led care for their children remained high across the study. No adverse events were recorded. CONCLUSION: Strengthening primary care for children reduces the frequency of hospital referrals of children by general practitioners with high referral rates, increases rates of general practitioner confidence about caring for children and maintains family preference for general practitioner-led care. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry ACTRN12620001299998 (prospective).