Australian And New Zealand Research Articles

Survey comparing the treatment of central retinal artery occlusion with hyperbaric oxygen in Australia and New Zealand with the recommended guidelines as outlined by the Undersea and Hyperbaric Medical Society.

Central retinal artery occlusion (CRAO) presents suddenly causing painless loss of vision that is often significant. Meaningful improvement in vision occurs in only 8% of patients with spontaneous reperfusion. Hyperbaric oxygen treatment (HBOT) is considered to be of benefit if commenced before retinal infarction occurs. The Undersea and Hyperbaric Medical Society (UHMS) guidelines on the management of CRAO were last amended in 2019. This survey questioned Australian and New Zealand (ANZ) hyperbaric medicine units (HMUs) about the incidence of CRAO cases referred and compared their subsequent management against the UHMS guidelines. An anonymous survey via SurveyMonkey® was sent to all 12 ANZ HMUs that treat emergency indications, allowing for multiple choice and free text answers regarding their management of CRAO. One-hundred and forty-six cases of CRAO were treated in ANZ HMUs over the last five years. Most (101/146) cases (69%) were initially treated at a pressure of 284 kPa. This was the area of greatest difference noted in CRAO management between the UHMS guidelines and ANZ practice. Few ANZ HMUs strictly followed the UHMS guidelines. We suggest a more simplified management protocol as used by the majority of ANZ HMUs.

Framing retail crime through an environmental criminological lens: insights from Australia and New Zealand

This article aims to provide insights regarding crime problems affecting the Australian and New Zealand (ANZ) retail sector, focusing primarily on the size and range of criminal behaviours. The research incorporated an online survey of retailers and police statistics. The study finds that the cost of retail crime increased by 28% over the last 4 years, against 25% growth in revenue. It also reveals that shoplifting remains the most significant and costly economic problem facing retailers, followed by employee theft. Additionally, fraud, notably in online channels, will remain a concern for the foreseeable future. We examine potential explanations and interpretations for retail crime through an environmental criminological lens. Increased research and involvement of researchers hold tremendous potential for reducing retail crime and preventing its growth in the future.

Appraisal of Australian and New Zealand paediatric sepsis guidelines.

Clinical practice guidelines (CPGs) are an important tool for the management of children with sepsis. The quality, consistency and concordance of Australian and New Zealand (ANZ) childhood sepsis CPGs with the Australian Commission on Safety and Quality in Healthcare (ACSQHC) sepsis clinical care standards and international sepsis guidelines is unclear. We accessed childhood sepsis CPGs for all ANZ states and territories through Paediatric Research in Emergency Departments International Collaborative members. The guidelines were assessed for quality using the AGREE-II instrument. Consistency between CPG treatment recommendations was assessed, as was concordance with the ACSQHC sepsis clinical care standards and international sepsis guidelines. Overall, eight CPGs were identified and assessed. CPGs used a narrative and pathway format, with those using both having the highest quality overall. CPG quality was highest for description of scope and clarity of presentation, and lowest for editorial independence. Consistency between guidelines for initial treatment recommendations was poor, with substantial variation in the choice and urgency of empiric antimicrobial administration; the choice, volume and urgency of fluid resuscitation; and the choice of first-line vasoactive agent. Most CPGs were concordant with time-critical components of the ACSQHC sepsis clinical care standard, although few addressed post-acute care. Concordance with international sepsis guidelines was poor. Childhood sepsis CPGs in current use in ANZ are of variable quality and lack consistency with key treatment recommendations. CPGs are concordant with the ACSQHC care standard, but not with international sepsis guidelines. A bi-national sepsis CPG may reduce unnecessary variation in care.

Improving hip fracture care: A five-year review of the early contributors to the Australian and New Zealand Hip Fracture Registry.

The aim of this study was to examine temporal trends (2016-2020) in hip fracture care in Australian and New Zealand (ANZ) hospitals that started providing patient-level data to the ANZ Hip Fracture Registry (ANZHFR) on/before 1 January 2016 (early contributors). Retrospective cohort study of early contributor hospitals (n = 24) to the ANZHFR. The study cohort included patients aged ≥50 years admitted with a low trauma hip fracture between 1 January 2016 and 31 December 2020 (n = 26,937). Annual performance against 11 quality indicators and 30- and 365-day mortality were examined. Compared to 2016/2017, year-on-year improvements were demonstrated for preoperative cognitive assessment (2020: OR 3.57, 95% confidence interval [95% CI] 3.29-3.87) and nerve block use prior to surgery (2020: OR 4.62, 95% CI 4.17-5.11). Less consistent improvements over time from 2016/2017 were demonstrated for emergency department (ED) stay of <4 h (2017; 2020), pain assessment ≤30 min of ED presentation (2020), surgery ≤48 h (2020) and bone protection medication prescribed on discharge (2017-2020; 2020 OR 2.22, 95% CI 2.03-2.42). The odds of sustaining a hospital-acquired pressure injury increased in 2019-2020 compared to 2016. The odds of receiving an orthogeriatric model of care and being offered the opportunity to mobilise on Day 1 following surgery fluctuated. There was a reduction in 365-day mortality in 2020 compared to 2016 (OR 0.86, 95% CI 0.74-0.98), whereas 30-day mortality did not change. Several quality indicators improved over time in early contributor hospitals. Indicators that did not improve may be targets for future care improvement activities, including considering incentivised hip fracture care, which has previously been shown to improve care/outcomes. COVID-19 and reporting practices may have impacted the study findings.

Clinician Understanding, Acceptance and utilization of Ketogenic diet therapy for epilepsy in Australia and New Zealand: An online survey

Ketogenic diet therapy (KDT) is an established treatment for people with epilepsy. As increasing evidence demonstrates effectiveness and safety of KDT on seizure reduction, cognition and behaviour, it is essential to evaluate factors hindering and supporting neurologists in prescribing KDT to strengthen quality, evidence-based, appropriate and equitable care. A study of Australian and New Zealand (ANZ) neurologists was undertaken via an online survey. Demographics, clinical role characteristics, perceptions of knowledge, use and experiences of KDT for epilepsy treatment were assessed. Responses were analysed using the Capability, Opportunity, Motivation and Behaviour (COM-B) model. 114 neurologists participated (18 % response rate). All were aware of KDT for epilepsy treatment, most (90 %) perceived it as acceptable and 85 % identified suitable patients in their practice. Poor knowledge of the KDT referral processes was a barrier for 64 %. Clinical role characteristics were significantly associated with perceived level of knowledge and use of KDT in practice, being more likely among paediatric neurologists), epileptologists and those in urban practices (p < 0.00001). Most neurologists (90 %) endorsed adoption of a KDT guideline to facilitate use of KDT in epilepsy management. This study established that KDT is accepted as a suitable treatment for epilepsy in ANZ. There is high variability in perceived knowledge and skills related to KDT, which impacts on utilization in clinical practice. Further education and resources for clinicians, allied health and community support agencies are needed to optimise the use of this valuable therapy. Additionally, a clear referral pathway would improve patient access.

The Schweitzer effect: The fundamental relationship between experience and medical students’ opinions on professional behaviours

Purpose We examined whether medical students’ opinions on the acceptability of a behaviour were influenced by previously encountering a similar professionally challenging situation, assessed the magnitude of effect of ‘experience’ compared to other demographic factors which influence medical students’ opinions, and evaluated whether opinions regarding some situations/behaviours were more susceptible to ‘experience’ bias? Methods Confidential, on-line survey for medical students distributed to Australian and New Zealand (AUS/NZ) medical schools. Students submitted de-identified demographic information, provided opinions on the acceptability of a wide range of student behaviours in professionally challenging situations, and whether they had encountered similar situations. Results 3171 students participated from all 21 Aus/NZ medical schools (16% of registered students). Medical students reported encountering many of the professionally challenging situations, with varying opinions on what was acceptable behaviour. The most significant factor influencing acceptability towards a behaviour was whether the student reported encountering a similar situation. The professional dilemmas most significantly influenced by previous experience typically related to behaviours that students could witness in clinical environments, and often involved breaches of trust. Conclusions Our results demonstrate the relationship between experience and medical students’ opinions on professional behaviour- the ‘Schweitzer effect’. When students encounter poor examples of professional behaviour, especially concerning trust breaches, it significantly influences their perception of the behaviour. These results highlight the importance of placing students in healthcare settings with positive professional role modelling/work cultures.

Nutrition provision in Australian and New Zealand PICUs: A prospective observational cohort study (ePICUre)

ObjectivesThe main aim of this study was to describe nutrition provision in Australian and New Zealand (ANZ) pediatric intensive care units (PICUs), including mode of nutrition and adequacy of enteral nutrition (EN) to PICU day 28. Secondary aims were to determine the proportion of children undergoing dietetics assessment, the average time to this intervention, and the methods for estimation of energy and protein requirements. MethodsThis observational study was conducted in all ANZ tertiary-affiliated specialist PICUs. All children ≤18 y of age admitted to the PICU over a 2-wk period and remaining for ≥48 h were included. Data were collected on days 1 to 7, 14, 21, and 28 (unless discharged prior). Data points included oral intake, EN and parenteral nutrition support, estimated energy and protein adequacy, and dietetics assessment details. ResultsWe enrolled 141 children, of which 79 were boys (56%) and 84 were <2 y of age (60%). Thirty children (73%) received solely EN on day 7 with documented energy and protein targets for 22 (73%). Of these children, 14 (64%) received <75% of their estimated requirements. A dietetics assessment was provided to 80 children (57%), and was significantly higher in those remaining in the PICU beyond the median length of stay (41% in patients staying ≤4.6 d versus 72% in those staying >4.6 d; P < 0.001). ConclusionsThis prospective study of nutrition provision across ANZ PICUs identified important areas for improvement, particularly in EN adequacy and nutrition assessment. Further research to optimize nutrition provision in this setting is urgently needed.

A Prospective, Multinational Study of Clinical and Biological Factors Associated with Short Overall Survival in Multiple Myeloma

Introduction: Multiple myeloma (MM) is an incurable cancer, but a subset of patients can achieve long-term remission and overall survival (OS). We aimed to study the clinical and biological factors associated with short OS defined as less than 3 years. Methods: A prospective, observational, multinational study was conducted by Australian and New Zealand (ANZ) and Asia-Pacific (APAC) Myeloma and Related Disease Registry (MRDR) from January 2013 to January 2023, across 5 countries (Australia, New Zealand, Korea, Singapore, Malaysia). Eligible patients were ≥18 years old, diagnosed with MM per International Myeloma Working Group (IMWG) criteria, received a bortezomib-containing triplet, and had at least 3 years of follow-up or had deceased within 3 years. Descriptive analysis was completed using chi-squared test for categorical variables and Wilcoxon rank-sum test for continuous variables. The Kaplan-Meier method was used for analysing OS and follow-up data. The ‘stepwise’ function in Stata was used for the forward stepwise logistic regression, with the p-value set to 0.1. All analyses were completed using Stata 16. Results: Of the 1539 patients enrolled, majority were from ANZ (1071 and 359, respectively), with male preponderance (61.0%). Half were above 65 years old. High risk cytogenetic abnormalities, a criterion of the Revised International Staging System (R-ISS), was unknown for half of the patients (49.4%). 45.3% patients presented as ISS stage 1, 21.9% stage II, and 32.8% stage III, respectively at study entry . The most frequent front-line agent used in combination with bortezomib-based triplet was cyclophosphamide [VCd, 1380 (89.7%)], followed by thalidomide [VTd, 92(6.0%)], lenalidomide [VRd, 63 (4.1%)] and daratumumab [DVd, 4 (0.3%)]. The median follow-up was 29.9 months (95%CI: 28.3-31.8) and the median OS was 87.7 months (95%CI: 80.9-93.2). Thirty percent patients had OS&amp;lt;3 years. Clinical and biological factors associated with long OS (≥3 years) were compared with those &amp;lt;3 years (Table 1). Baseline factors associated with higher odds of short OS included age≥65, Eastern Cooperative Oncology Group performance status (ECOG PS)≥2, ISS III, lower creatinine clearance and platelet count, high LDH and poor cytogenetic abnormalities (Table 1). In a multivariate analysis, age≥65 (OR:2.50; p&amp;lt;0.001), ECOG≥2 (OR:2.08; p&amp;lt;0.001), ISS III (OR:2.48; p&amp;lt;0.001), t(4;14)[OR:2.04; p=0.004], t(14;16)[OR:6.33; p=0.004] and 17p deletion (OR:2.77; p =0.001) were associated with a significantly shorter OS. Conclusion: From clinician perspective, identifying patients with an increased likelihood of shorter OS through the determination of patient- and disease-specific risk factors might be clinically relevant to facilitate better treatment decisions.

Clinical predictors of rectal cancer response after neo-adjuvant (Chemo)Radiotherapy in Australia and New Zealand: Analysis of the Bi-National Colorectal Cancer Audit (BCCA)

Pathological complete response (pCR) is observed in 11–26% of locally advanced rectal cancers undergoing neoadjuvant chemoradiotherapy (nCRT). This study aims to determine pCR rates and clinicopathological predictors in the Australian and New Zealand (ANZ) cohort. The Bi-National Colorectal Cancer Audit (BCCA) was interrogated for all rectal cancer patients who underwent nCRT prior to surgical resection between 2007 and 2020. Patients were divided in two groups: pCR (AJCC tumour regression grade 0) and partial/no response (pPR, regression grade 1,2 or 3). In total, 3230 patients were included. Rates of pCR and pPR were 704 (21.8%) and 2526 (78.2%), respectively. Long-course nCRT (p < 0.0001), lower clinical tumour stage (cT; p < 0.0001), and nodal stage (cN; p = 0.003) were associated with pCR on univariate analysis. On multivariable analysis, cN0 stage and long-course nCRT remained independent factors for a pCR. Awareness of these predictors provides valuable information when counseling patients regarding prognosis and treatment options.

How much do we throw away in the intensive care unit? An observational point prevalence study of Australian and New Zealand ICUs

ObjectiveDuring the current COVID pandemic, waste generation has been more evident with increased use of single use masks, gowns and other personal protective equipment. We aimed to understand the scale of waste generation, recycling rates and participation in Australian and New Zealand (ANZ) ICUs. DesignThis is a prospective cross-sectional point prevalence study, as part of the 2021 ANZICS Point Prevalence Program. Specific questions related to waste and sustainability practices were asked at the site and patient level. Setting and participantsANZ adult ICUs and their patients on the day of the study. Main outcome measuresAmount of single use items disposed of per shift, as well as the engagement of the site with sustainability and recycling practices. ResultsIn total, 712 patients (median number of patients per ICU = 17, IQR 11–30) from 51 ICUs across ANZ were included in our study; 55% of hospitals had a sustainability officer, and recycling paper (86%) and plastics (65%) were frequent, but metal recycling was limited (27%). Per patient bed space per 12-h shift there was recycling of less than 40% paper, glass, intravenous fluid bags, medication cups and metal instruments. A median of 10 gowns (IQR 3–19.5), 10 syringes (4.5–18) and gloves 30 (18–49) were disposed of per bed space, per 12-h shift. These numbers increased significantly when comparing patients with and without infection control precautions in place. ConclusionsIn ANZ ICUs, we found utilisation of common ICU consumables to be high and associated with low recycling rates. Interventions to abate resource utilisation and augment recycling are required to improve environmental sustainability in intensive care units.

Dietitian and nutrition-related practices and resources in Australian and New Zealand PICUs: A clinician survey

BackgroundRecommendations to facilitate evidence-based nutrition provision for critically ill children exist and indicate the importance of nutrition in this population. Despite these recommendations, it is currently unknown how well Australian and New Zealand (ANZ) paediatric intensive care units (PICUs) are equipped to provide nutrition care. ObjectivesThe objectives of this project were to describe the dietitian and nutrition-related practices and resources in ANZ PICUs. MethodsA clinician survey was completed as a component of an observational study across nine ANZ PICUs in June 2021. The online survey comprised 31 questions. Data points included reporting on dietetics resourcing, local feeding-related guidelines and algorithms, nutrition screening and assessment practices, anthropometry practices, and indirect calorimetry (IC) device availability and local technical expertise. Data are presented as frequency (%), mean (standard deviation), or median (interquartile range). ResultsSurvey responses were received from all nine participating sites. Dietetics staffing per available PICU bed ranged from 0.01 to 0.07 full-time equivalent (median: 0.03 [interquartile range: 0.02–0.04]). Nutrition screening was established in three (33%) units, all of which used the Paediatric Nutrition Screening Tool. Dietitians consulted all appropriate patients (or where capacity allowed) in six (66%) units and on a request or referral basis only in three (33%) units. All units possessed a local feeding guideline or algorithm. An IC device was available in two (22%) PICUs and was used in one of these units. ConclusionsThis is the first study to describe the dietitian and nutrition-related practices and resources of ANZ PICUs. Areas for potential improvement include dietetics full-time equivalent, routine nutrition assessment, and access to IC.

How Does Treatment Intolerance Affect Survival in Patients with Multiple Myeloma (MM)?

Background MM is the second most frequent hematological neoplastic disease. Management of MM is moving toward long-term continuous regimens , but this approach is sometimes difficult to implement due to multiple factors including intolerance to treatment. In this study, we aim to identify the factors associated with treatment intolerance and assess it impact on MM patient's outcome . Method We analyzed data from the Australian and New Zealand (ANZ) and Asia-Pacific (APAC) Myeloma and Related Diseases Registry (MRDR). Newly diagnosed MM patients that have stopped their treatment were included. The patients are further classified according to whether they stopped the treatment due to intolerances or other reasons. Categorical variables are compared using a chi-squared test, whilst for continuous variables a rank-sum test was used. Survival analyses we performed using the Kaplan-Meier method and statistical comparisons performed using a log-rank test. Results 4454 patients diagnosed MM in the registry. Of these, 2753 ceased treatment. 313 stopped due to intolerance, 2313 stopped due to other reasons and 127 were not classified and therefore excluded from the analysis. Compared to others, patients who stopped treatment due to intolerance were older (Median age 74.7 years vs 64.3 years, p<0.001), tended to have advanced disease (38.9% ISS3 vs 30.4%, p=0.009), had poorer performance status (33.6% ECOG2-4 vs 17.3% ECOG2-4), and more co-morbidities such as moderate to severe cardiac disease (16.8% vs 8.2%, p=0.001), pulmonary disease (7.7% vs 3.7%. p<0.001) and diabetes requiring treatment (18.8% vs 11.2%, p<0.001). Consistent with the patient profile, a lower proportion of the intolerant patients underwent stem cell transplantation and bortezomib based treatment whereas more patients in the intolerant group had lenamidomide based treatment. Importantly, there was no clinically relevant difference in duration of treatment between the intolerant and tolerant group, although there was a lower proportion patients achieving a partial response or deeper in the intolerant group (74% vs 88.8%, p<0.001) . On multivariate analysis, age was the predominant factor associated with intolerance, with the odds ratio increasing with age, whereas the use of velcade was relatively protective with an odds ratio of 0.33 (p<0.001). Patients who ceased treatment due to intolerance to treatment had shorter PFS (median PFS 36.8 months compared to 47.7 months, p<0.001) and OS (Median OS 47.5 months compared to 80.9 months, p<0.001). On multivariate analysis, intolerance to treatment itself was an independent prognostic factor. To remove the immortal time bias inherent in analyzing the effect of treatment duration on survival, we measured survival from the cessation of treatment. This analysis showed a shorter survival in the intolerant group (35.3 months compared to 68.4 months, p<0.001). When we added duration of treatment and depth of response to the multivariate model of survival, intolerance was no longer a significant prognostic factor, whereas depth of response was. Duration of treatment was also not significant [show table] Conclusion Intolerance to chemotherapy is associated with inferior survival, independent of potential confounding baseline variables associated with intolerance, in particular age and performance as well as chemotherapy regimen (ISS stage is not independently associated with an intolerant response once adjusted for age and performance status). The main reason for this appears to be reduced depth of response achieved. Optimizing treatment to achieve better tolerance and to increase chance of deeper response especially in the elderly, and those with comorbidities and poorer performance status, would be important in improving outcomes of MM patients. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Commentary on the 2020 update of the KDOQI clinical practice guideline for nutrition in chronic kidney disease.

Commentary on the 2020 update of the KDOQI clinical practice guideline for nutrition in chronic kidney disease.

Development of an australian and new zealand guideline for the identification and management of malnutrition and frailty in the community setting

Rationale: Malnutrition and frailty are common among community-dwelling older adults, resulting in poor outcomes and increased health care costs; yet most patients living with these conditions go unidentified and untreated in the community1. There is a need for community health professionals from all disciplines to understand, recognise and act on suspected malnutrition and frailty. Our team has developed a guideline, specific to the Australian and New Zealand (ANZ) context, for identifying and managing malnutrition/frailty in the community setting.

Decline Is Not Inevitable: Exercise Capacity Trajectory in an Australian and New Zealand Fontan Cohort

In people with a Fontan circulation, serial cardiopulmonary exercise testing (CPET) to evaluate change in peak exercise capacity has been increasingly recognised as a useful prognostic tool; a decline is associated with adverse clinical outcomes. The aim of this study is to describe the "natural" history of exercise capacity in the Australian and New Zealand (ANZ) Fontan cohort and to identify factors associated with a decline. The ANZ Fontan registry was retrospectively reviewed for adolescent and adult patients (≥16 years) with serial CPET results performed on a cycle ergometer ≥6 months apart. Patients were excluded if they underwent a surgical procedure or fenestration closure in-between tests or if the tests were considered as submaximal effort. Exercise capacity trajectory was defined as the change in percentage of predicted peak oxygen uptake (% pred VO2peak) points per year. Thirty-seven (37) patients (59.5% male, mean age 24±7 years) were eligible. Average duration between CPET was 5.3±3.9 years. At baseline, % pred VO2peak was 61.3±14.5%. Thirteen (13) (35%) had a systemic right ventricle, and 14 (38%) had an atriopulmonary type Fontan circulation. Average change in % pred VO2peak overall was+1.3±6.4 percentage points per year. Sixteen (16) had a negative exercise capacity trajectory, and the average decline in that group was-2.7±3.4 percentage points per year. There was no association between exercise capacity trajectory and clinical characteristics. Of the 18 patients with physical activity levels recorded, 12 (67%) were physically active and % pred VO2peak in that group increased by 2.7±4.0 percentage points per year compared with the physically inactive group who fell by 0.5±0.8 percentage points per year. In this ANZ series of Fontan patients, over half of our cohort had stable, or an increase, in peak exercise capacity. Regular participation in physical activity was common in patients with a positive exercise capacity trajectory. Clinical characteristics were not associated with exercise capacity trajectory.

Is MELD Score the Best Method of Predicting Waiting List Mortality in the Australian and New Zealand Liver Transplant Population?

Introduction: Model for end-stage liver disease (MELD) score is a reproducible, validated and widely accepted method for prioritisation of patients for liver transplantation, although there are some limitations. The aim was to create an Australian and New Zealand (ANZ) population-derived waiting list mortality score, and to compare the discriminative ability of this score to MELD and MELD-Na scores. Method: All transplants from January 1998 to May 2019 were included, using data from the ANZ Liver Transplant Registry. The outcome considered was patient death prior to transplantation. The ANZ-derived waiting list mortality score was created by randomly splitting the data into training and test datasets (70:30). Elastic net regularisation was used to select variables to create the multivariable Cox model. Discrimination of MELD, MELD-Na and the ANZ scores was compared using the c-statistic. Results: 4886 listings were included, with a total of 534 waiting list deaths. 30 of 39 variables were selected for the ANZ score Cox model, with the highest hazard ratios for patients who were ventilated at time of listing (HR 4.4, 95% CI 2.22-8.68) and patients listed from 2006 to 2011 (HR 2.54, CI 1.69-3.82). The c-statistic for MELD and MELD-Na score was 0.76 and 0.77 respectively. The c-statistic for the ANZ score was 0.8. Conclusion: The discriminative ability of all 3 scores was similar, despite a large number of variables included in the ANZ score. Both MELD and MELD-Na are simple to calculate and performed well in predicting waiting list mortality in the ANZ transplant population.

Survey of clinician opinions on the role of proton beam therapy in Australia and New Zealand.

We surveyed the Australian and New Zealand (ANZ) radiation oncology community to assess their perceptions, understanding and experience of the current role of proton beam therapy (PBT) and the existing referral process to access PBT overseas, ahead of the development of the first PBT centre in Australia. The survey was conducted between September and October 2019 using a 17-question instrument, which was distributed by email to all 632 radiation oncology fellows and trainees listed in the Royal Australian and New Zealand College of Radiologists database. One hundred and one respondents completed the survey, with an overall response rate of 16%. Most respondents were based in Australia (93%), with the majority working in public centres only (59%); 51% were >10years post fellowship and 17% were trainees. Most respondents (76%) reported moderate or high levels of confidence in the role of PBT. Only 28% had previously referred a patient for PBT overseas, with the most common referral indication being chordoma. Of those who had not previously referred a patient, 48% were not convinced about the rationale of PBT over current therapies available locally, 33% were not aware of the referral process, and 24% had concerns about the timeliness of a decision for government-funded PBT abroad. This survey has demonstrated that, although there is reasonable confidence in the role of PBT among ANZ radiation oncologists, there are a number of important aspects of PBT awareness, education and access that need to be developed prior to commencement of PBT in Australia.

‘It is a different type of learning’. A survey-based study on how simulation educators see and construct observer roles

BackgroundSimulation is reported as an appropriate replacement for a significant number of clinical hours in pregraduate programmes. To increase access for learners, educators have looked to understanding and improving learning...

Medical ethics education in Australian and New Zealand (ANZ) medical schools: a mixed methods study to review how medical ethics is taught in ANZ medical programs

The objective of this study was to review the design and delivery of medical ethics (ME) education within medical programs across Australia and New Zealand (ANZ), how current teaching has been informed by the proposed core curriculum published in 2001 by the ATEAM (Braunack-Mayer et al. 2001) and how it could look moving forward. We conducted a mixed methods study using an online questionnaire consisting of 51 items. This included both binary and open-ended questions to categorise and explore similarities and differences in medical ethics curricula in medical programs accredited by the Australian Medical Council (AMC) across ANZ. Participants were asked about curriculum design format, duration, goals, assessments, content areas of their own ME curriculum. Convenors from 18 universities responded (78%). The main commonality was that ME curricula were integrated both longitudinally and laterally with other content. There was also commonality in content areas addressed. The goals, format, educators, and assessments of the ME curricula were highly variable. Most respondents described a curriculum which prioritised knowledge and skill development related to ME. Although the core goals of including knowledge, skills, and attitudinal development in ME curricula are still present, there is no uniformity in terms of format, delivery, or assessment across medical programs in ANZ. This is an area for collaborative development.

Global consensus on nutritional rickets: Implications for Australia.

In 2016, a global consensus on the prevention, diagnosis and management of nutritional rickets was published. The bone and mineral working group of the Australasian Paediatric Endocrine Group provides a summary and highlights differences to previous Australian and New Zealand (ANZ) guidelines on vitamin D deficiency and their implications for clinicians. Key points are: (i) The International Consensus document is focused on nutritional rickets, whereas the ANZ guidelines were focused on vitamin D deficiency. (ii) Definitions for the interpretation of 25-hydroxy vitamin D (25OHD) levels do not differ between statements. (iii) The global consensus recommends that routine 25OHD screening should not be performed in healthy children and recommendations for vitamin D supplementation are not based solely on 25OHD levels. The Australasian Paediatric Endocrine Group bone and mineral working group supports that screening for vitamin D deficiency should be restricted to populations at risk. (iv) Recommendations from the global consensus for vitamin D dosages for the therapy of nutritional rickets (diagnosed based on history, physical examination, biochemical testing and a confirmation by X-rays) are higher than in ANZ publications. (v) The global consensus recommends the implementation of public health strategies such as universal supplementation with vitamin D from birth to 1 year of age and food fortification. We conclude that updated global recommendations for therapy of nutritional rickets complement previously published position statements for Australia and New Zealand. Screening, management and the implementation of public health strategies need to be further explored for Australia.