Worldwide access to treatment for end-stage kidney disease: a systematic review

We thank Dr. Vicendese for his interest in our article investigating the underlying reasons for socioeconomic inequalities in survival from colon cancer using causal mediation analysis (1). We acknowledge that surgical volume is not a perfect measure for quality of a hospital; therefore, we might have missed an (indirect) effect of quality on the observed socioeconomic differences in colon cancer survival due to measurement error. Dichotomizing surgical volume at the median (due to limitations of the current methods) might have also further limited our ability to detect this potential indirect effect. We did not have data on hospital characteristics such as whether they had multidisciplinary teams, specialized or high-volume surgeons, and specialist technology-based services, and the method of analysis Dr. Vicendese has proposed to overcome confounding by hospital characteristics cannot be incorporated into a causal mediation analysis; therefore, it would not address our research question.See the original Letter to the Editor, p. 296N. Afshar reports grants from the Australian National Health and Medical Research (NHMRC) Council during the conduct of the study. R.L. Milne reports grants from NHMRC during the conduct of the study. D.R. English reports grants from Australian National Health and Medical Research Council during the conduct of the study.This work was supported by the Australian National Health and Medical Research Council (grant number 1150012).

Effects of Fluoxetine on Functional Recovery after Acute Stroke (AFFINITY): A Randomised, Double-Blind, Placebo-Controlled Trial

What gets measured does not always get done

The effectiveness and safety of mRNA (BNT162b2) and inactivated (CoronaVac) COVID-19 vaccines among individuals with chronic kidney diseases

Detention, denial, and death: migration hazards for refugee children.

SJC is funded by an Australian Postgraduate Award and a University of Queensland Advantage Scholarship, ACAC is an Australian National Health and Medical Research Council (NHMRC) Career Development Fellow (631619), RJSM is funded by a Post-doctoral Research Fellowship from the University of Queensland (41795457), JSM is an Australian National Health and Medical Research Council Practitioner Fellow, and DJG is an Australian Research Council (DECRA) Fellow. This work is funded by an NHMRC Partnership project in collaboration with WaterAid Australia.

Canagliflozin and Cardiovascular (CV) Outcomes in Patients with Chronic Kidney Disease

Carbon Footprint of Anesthesia: Reply.

Mindfulness-Based Online Intervention to Improve Quality of Life in Late-Stage Bipolar Disorder a Randomised Clinical Trial

Effectiveness of an Integrated Responsive Web Application for Cardiovascular Disease Management in Primary Care: 1 Year Multicenter, Open-Label Randomized Controlled Trial

Correspondence: Kobie Boshoff University of South Australia, School of Health Sciences, GPO Box 2471, Adelaide, SA 5001, Australia Tel +61 8 8302 1089 Fax +61 8 8302 2645 Email kobie.boshoff@unisa.edu.au Background: Sensory processing disorders have an estimated prevalence of 5%–10% in children without disability and 40%–88% in children with disability. A subtype of sensory processing disorder is sensory overresponsivity, which can result in fear, irritability, aggression, or avoidance behaviors in children. The Wilbarger protocol is the most prescriptive program used to treat sensory overresponsivity in children aged 2–12 years. Strong anecdotal evidence suggests that the Wilbarger protocol successfully reduces challenging behavior in children with sensory overresponsivity. The aim of this systematic review was to identify and appraise the existing evidence for the effectiveness of the Wilbarger protocol with children aged 0–18 years. Methods: A systematic review was conducted of the peer-reviewed literature written in English. The electronic databases searched up to April 2012 included CINAHL, Ovid Medline (R), Embase, Scopus, the Cochrane Library, AMED, and the Web of Science. OT Seeker and Google Scholar were searched for missed literature, along with hand-searching of retained articles. Adult studies were excluded. The Critical Review Form for Quantitative Studies by McMaster University and the levels of hierarchy from the Australian National Health and Medical Research Council were used to appraise the literature. Results: A total of 341 studies were found, and 302 were screened for eligibility after duplicates were removed. Four level IV intervention (case series with pretest/posttest) studies were included for indepth review. All four studies had very small sample sizes, exhibited low methodological quality, differed in outcome measures used, and lacked homogeneity of samples and treatment fidelity. Conclusion: A lack of high quality evidence currently exists to support or refute the use of the Wilbarger protocol with children. While the grade of recommendation, as proposed by the Australian National Health and Medical Research Council, suggests that the Wilbarger protocol should be applied with caution, emerging evidence from these studies warrants future robust research on this topic. Clinicians are advised to use clear outcome measures when using the Wilbarger protocol with clients.

Asian-born MSM are a priority population as Australia aims to end HIV transmission, but they reported additional barriers to access PrEP and other HIV prevention methods. This study investigates factors associated with PrEP use among Asian MSM in Sydney and Melbourne, Australia, to inform strategies to improve PrEP uptake in this population. This was a sub-analysis of a community-based cross-sectional survey conducted from March to June 2021. We recruited participants online in Sydney and Melbourne, Australia. Univariable and multivariable logistic regression analyses were performed to identify the factors associated with PrEP use in the last six months and lifetime. Latent class analyses were used to identify subgroups of Asian MSM sharing similar characteristics related to their risk practices for HIV. Overall, 870 Asian MSM were included: 288 Oceanian-born Asian MSM and 582 Asian-born MSM. Three latent classes were identified: 1) Asian-born MSM who recently arrived in Australia with limited English, were less likely to use PrEP and at higher risk of HIV infection (e.g., had condomless anal sex with a casual sex partner in the last six months) (4.6%); 2) Asian MSM who were at lower risk of HIV infection and less likely to use PrEP (69.3%) and; 3) Asian MSM who were at substantial risk of HIV infection and more likely to use PrEP (26.1%). Compared to Oceanian-born Asian MSM, those who were born in Southeast Asia (adjusted odds ratio (aOR)=0.5, 95% confidence interval (CI) 0.3-0.7) and South Asia (aOR=0.4, 95% CI 0.2-0.8) were less likely to ever use PrEP. Compared to Oceanian-born Asian MSM, those who were born in Southeast Asia (aOR=0.4, 95% CI 0.3-0.7), Northeast Asia (aOR=0.5, 95% CI 0.3-0.8) and South Asia (aOR=0.4, 95% CI 0.2-0.7) were less likely to use PrEP in the last six months. To end HIV transmission in Australia, it will be necessary to develop strategies to improve PrEP access for the significant minority of Asian-born MSM who are at substantial risk of HIV infection. EPFC and JJO are supported by an Australian National Health and Medical Research Council (NHMRC) Emerging Leadership Investigator Grant (EPFC: GNT1172873 and JJO: GNT1193955). CKF is supported by an Australian National Health and Medical Research Council (NHMRC) Leadership Investigator Grant (GNT1172900).

1216-P: The Effects of Canagliflozin on Uric Acid and Gout in Patients with Type 2 Diabetes in the CANVAS Program

To evaluate the evidence for the effectiveness of sham surgery in orthopedics by conducting a systematic review of literature. Systematic searches were conducted on Biomed Central, BMJ.com, CINAHL, the Cochrane Library, NLM Central Gateway, OVID, ProQuest (Digital Dissertations), PsycInfo, PubMed/Medline, ScienceDirect and Web of Science. Secondary searching (PEARLing) was undertaken, whereby reference lists of the selected articles were reviewed for additional references not identified in the primary search. All randomized controlled trials comparing surgery versus sham surgery in orthopedics were included. Data were extracted and methodological quality was assessed by two reviewers using the Critical Review Form-Quantitative Studies. Levels of scientific evidence, based on the direction of outcomes of the trials, were established following the Australian National Health and Medical Research Council (NHMRC) Hierarchy of Evidence (Australian National Health and Medical Research Council, 1999). This review includes six randomized controlled trials (RCTs) involving 277 subjects. All six studies were rated as very good on methodological quality. Heterogeneity across the studies, with respect to participants, interventions evaluated, and outcome measures used, prevented meta-analyses. Narrative synthesis of results, based on effect size, demonstrated that sham surgery in orthopedics was as effective as actual surgery in reducing pain and improving disability. This review suggests that sham surgery has shown to be just as effective as actual surgery in reducing pain and disability; however, care should be taken to generalize findings because of the limited number of studies.

Background and PurposeThe UK's NIHR and Australia's NHMRC have funded two randomised controlled trials (RCTs) to determine if lumbar fusion surgery (LFS) is more effective than best conservative care (BCC) for adults with persistent, severe low back pain (LBP) attributable to lumbar spine degeneration. We aimed to describe clinicians’ decision-making regarding suitability of patient cases for LFS or BCC and level of equipoise to randomise participants in the RCTs.MethodsTwo online cross-sectional surveys distributed via UK and Australian professional networks to clinicians involved in LBP care, collected data on clinical discipline, practice setting and preferred care of five patient cases (ranging in age, pain duration, BMI, imaging findings, neurological signs/symptoms). Clinicians were also asked about willingness to randomise each patient case.ResultsOf 174 responses (73 UK, 101 Australia), 70 were orthopaedic surgeons, 34 neurosurgeons, 65 allied health professionals (AHPs), 5 others. Most worked in public health services only (92% UK, 45% Australia), or a mix of public/private (36% Australia). Most respondents chose BCC as their first-choice management option for all five cases (81–93% UK, 83–91% Australia). For LFS, UK surgeons preferred TLIF (36.4%), whereas Australian surgeons preferred ALIF (54%). Willingness to randomise cases ranged from 37–60% (UK mean 50.7%), and 47–55% (Australian mean 51.9%); orthopaedic and neuro-surgeons were more willing than AHPs.ConclusionWhilst BCC was preferred for all five patient cases, just over half of survey respondents in both the UK and Australia were willing to randomise cases to either LFS or BCC, indicating clinical equipoise (collective uncertainty) needed for RCT recruitment.Conflicts of interestNoneSources of fundingNo specific funding obtained for the surveys. DB, SA, AG and NEF have funding from the National Institute for Health Research (NIHR) UK (FORENSIC-UK NIHR134859); NEF, DB and SA have funding from the Australian National Health and Medical Research Council (NHMRC FORENSIC-Australia GA268233). AG has funding from Orthopaedic Research UK (combined with British Association of Spine Surgeons and British Scoliosis Society) and Innovate UK. NEF is funded through an Australian National Health and Medical Research Council (NHMRC) Investigator Grant (ID: 2018182).