Sickle cell disease (SCD) is an inherited condition that impairs red blood cell function, posing a substantial health burden on patients. As the prevalence of SCD in Australia rises due to migration, discussions surrounding treatment and management strategies are becoming more prominent. Australia lacks a dedicated study on the prevalence and economic implications of SCD. In this study, we estimate the economic burden of SCD in Australia from the perspective of the Australian healthcare system. We performed a cost-of-illness study by using a bottom-up approach to estimate resource use per patient from a national registry with unit costs from national sources, and a top-down estimate of the prevalence of SCD in Australia using stratification by ancestry. We estimated the prevalence of SCD in Australia in 2021 to be 8485 patients, the cost per patient per year to be AU$13 975 and the total cost to the Australian healthcare system to be approximately AU$119 million per year. Factors influencing costs were age, interventions and frequency of hospital visits for vaso-occlusive crises. Prevalence had the greatest influence on results in the sensitivity analysis. While the estimated prevalence of SCD in Australia resulted in a relatively small total cost, the per patient annual cost of SCD remains high. This cost of SCD is anticipated to increase alongside migration and improved treatment. There are policies that could enhance patients' quality of life, thereby mitigating both economic and health burdens.

SummaryBackgroundThere is limited evidence describing the changing natural history of DMD in Australia.MethodsThis retrospective cohort study collated information on clinical management and disease milestones from medical records of males with DMD attending a paediatric hospital between 1973 and 2019 and linked this to information from two adult tertiary hospitals. Data were stratified by decade of birth and Kaplan Meier analyses were conducted to describe median time to key disease milestones.FindingsThe cohort included 356 individuals with DMD with year of birth ranging from 1958 to 2014 and median (interquartile range, IQR) follow up time from diagnosis of 10.5 (4.1, 15.7) years. Use of corticosteroids, angiotensin-converting enzyme inhibitors (ACE-I), echocardiography and respiratory support increased over time. Mean age of diagnosis decreased from 6.4 years in those born before 1970 to 3.4 years in those born 2010–2019. Median (IQR) survival increased over time from 18.2 (15.2, 20.4) years in those born before 1970 to 24.0 (20.3, 27.5) years in those born between 1990 and 1999. Increased life expectancy was observed in individuals using corticosteroids, ACE-I and respiratory support.InterpretationSurvival in individuals with DMD has increased over the last five decades, likely due to changes in clinical management. Given the increased population surviving to adulthood, there is a need to enhance clinical services and surveillance to support neuromuscular disease in Australia, especially in transitional care and adult populations.FundingIndependent Research Grant, 10.13039/501100000948Pfizer Australia.

Cardiovascular disease (CVD) is a major cause of death globally. In advanced stages, patients with CVD often require palliative care due to reduced health-related quality of life from physical, psychological and spiritual symptoms, along with physical disability. To investigate (1) the symptom and function burden of patients with CVD on their first admission to specialist palliative care services and (2) how these care burdens, and other clinical characteristics, affected patients' utilisation of community-based versus inpatient services. A national population-based observational study using point-of-care outcomes sourced from the Australian palliative care outcomes and collaboration (PCOC). Community-based and inpatient Specialist palliative care services across Australia registered in the PCOC. Patients who required specialist palliative care principally for CVD, and whose death occurred between 1 January 2013 and 31 December 2022. Five validated clinical instruments were used to collect point-of-care outcomes on each individual's function (Resource Utilisation Groups - Activities of Daily Living (RUG) & Australia-modified Karnofsky Performance Status (AKPS)), symptom distress (Symptoms Assessment Scale & Palliative Care Problem Severity Score) and other clinical characteristics (Palliative Care Phases). Multivariable logistic regression was applied to evaluate how patients' functional and symptom burden influenced their use of inpatient versus community-based palliative care services. Our analysis included 17 002 patients with CVD, with 7539 (44.3%) receiving community palliative care services and 9463 (55.7%) accessing inpatient palliative care services. On admission to palliative care services, patients often exhibit significant physical functional impairments and substantial symptom burdens, particularly related to fatigue and breathing difficulties. In comparison, patients accessing inpatient services tended to have greater functional impairment (p<0.001) but commonly reported lower symptom burdens (p<0.001). Our analysis indicated that greater functional impairment (ORs ranged from 2.53 to 6.02, p<0.001 for RUG; ORs ranged from 1.72 to 5.02, p<0.008 for AKPS), poorer overall health condition (OR ranged from 1.28 to 17.60, p<0.001) and referrals by a community service (OR=0.16, 95% CI: 0.14 to 0.18, p<0.001) were a negative predictor of inpatient services use. Surprisingly, higher levels of symptom distress and challenges in symptom management were associated with a decreased likelihood of using inpatient services compared with community-based services. Patients with CVD frequently require support to manage decreased functional abilities, as well as symptoms like fatigue and breathing difficulties. With greater investment in community-based supportive services and a skilled palliative care workforce, more individuals with advanced CVD could potentially receive palliative care in community settings.

Abstract RATIONALE: Occupational respiratory risks/threats in Australia present significant challenges due to difficulties quantifying their impact, frequent underreporting, and ineffective responses. This has resulted in limited data on the national exposure risks/threats and the incidence and prevalence of occupational lung diseases. The lack of information is an impediment to timely identification of new or re-emerging hazardous exposures, as well as the development of targeted interventions and treatment. To address gaps, there is an urgent need for robust surveillance and targeted response measures to safeguard the health of Australian workers. The aim of the rapid response protocol is to minimise the burden of disease of occupational lung diseases in Australia through coordinated identification, response, and evaluation mechanisms and long-term contribution to eliminating these preventable diseases. METHODS: A pioneering national protocol was developed utilising public health decision support frameworks in emergency health management and modification of the environmental health incident management framework. An expert steering committee comprising multidisciplinary professionals across respiratory medicine, occupational and environmental medicine, epidemiology, and workplace health safety was convened to guide the development and testing of the rapid response protocol. The protocol has undergone consultations with the Australian Government Department of Health and Aged Care and other government agencies and regulatory state departments. RESULTS: A robust stakeholder-tested national rapid response protocol was developed for application to novel and re-emerging occupational respiratory risks. The rapid response protocol has four stages, stage 1: intelligence network; stage 2: assessment; stage 3: response and communication and; stage 4: protocol evaluation. The intelligence network stage identifies occupational respiratory risks more broadly from relevant data collection to deliver information to the governing agent. The assessment stage assesses risk to determine if escalation to the response and communication stage is required. The response and communication stage decides the proportionate response activities for the agent and informs the communication strategies for all stakeholders to address concerns. The protocol evaluation stage implements processes and procedures to support recovery operations. CONCLUSIONS: The protocol is fundamental to advise the Australian federal government and governing agencies on the early identification and rapid responses required to address emerging occupational respiratory risks reducing the disease burden for occupational respiratory diseases.

This study examines trends in admissions for alcohol-related liver disease (ALD) for Australian men and women between 1993 and 2020 and disaggregates these trends into age, period and cohort components. Retrospective age-period-cohort analysis of hospital admissions with a primary diagnosis of ALD. Australia. 133,705 hospital admissions - 97,755 men (73%); 35,950 women (27%). Hospital admissions for ALD were grouped into five-year age groups (15-19, 20-24 up to 85 and over) for each financial year between 1992/93 and 2020/21. ALD admission rates were substantially higher for men than women. Rates for men increased up to 2005 and subsequently declined before an uptick in 2020. For women, rates increased steadily over the period. In age-period-cohort models, male admission rates were relatively stable over both period and cohort. For women, period effects increased steadily - compared to the period reference year of 2006, the RR for women's admission rates was 0.69 (0.65, 0.74) in 1993, increasing to 1.23 (1.18, 1.29) in 2020. Recent cohorts had significantly higher rates of hospital admission for ALD than those born earlier (e.g., women born in the 1996 cohort had an RR of 2.2 (1.8, 2.7) relative to those born in the reference year 1956). Increases in hospital admissions for ALD, especially since the COVID-19 pandemic, point to the need for effective identification and interventions for people with alcohol-use disorders at risk of chronic disease outcomes.

Using the Australian Census survey 2021 as base population, a microsimulation model, PreconMOD was developed to evaluate the cost-effectiveness of population-based expanded reproductive carrier screening (RCS) for 569 recessive conditions from the health service and societal perspectives. The model simulated the effect of expanded RCS including the downstream interventions for at-risk couples on cost and outcomes. The comparators were (i) no population screening (ii) limited screening for cystic fibrosis, spinal muscular atrophy, and fragile X syndrome and (iii) a 300 conditions screening panel. Averted affected births and health service cost with expanded RCS were projected to year 2061. At a 50% uptake, our model predicts that expanded RCS is cost saving (i.e., higher quality-adjusted life-years and lower costs) compared with other screening strategies in the model from the health service and societal perspectives. The number of affected births averted in a single cohort would increase from 84 [95% confidence interval (CI) 60–116] with limited screening to 2067 (95%CI 1808–2376) with expanded RCS. Expanded RCS was cost-saving compared to the 300-conditions screening panel. Indirect cost accounted for about one-third of the total costs associated with recessive disorders. Our model predicts that the direct treatment cost associated with current limited 3 genes screening would increase by 20% each year to A$73.4 billion to the health system by 2061. Our findings contribute insights on the cost burden of genetic diseases and the economic benefits of expanded RCS to better informed resource allocation decisions.

Current clinical guidelines for people at risk of heart disease in Australia recommend nutrition intervention in conjunction with pharmacotherapy(1). However, Australians living in rural and remote regions have less access to medical nutritional therapy (MNT) provided by Accredited Practising Dietitians (APDs) than their urban counterparts(2). The aim of the HealthyRHearts study was to trial the delivery of MNT by APDs using telehealth to eligible patients of General Practitioners (GPs) located in small to large rural towns in the Hunter New England region(3) of New South Wales, Australia. The study design was a 12-month pragmatic randomised controlled trial. The key outcome was reduced total cholesterol. The study was place-based, meaning many of the research team and APDs were based rurally, to ensure the context of the GPs and patients was already known. Eligible participants were those assessed as moderate-to-high risk of CVD by their GP. People in the intervention group received five MNT consults (totalling two hours) delivered via telehealth by APDs, and also answered a personalised nutrition questionnaire to guide their priorities and to support personalised dietary behaviour change during the counselling. Both intervention and control groups received usual care from their GP and were provided access to the Australian Eating Survey (Heart version), a 242-item online food frequency questionnaire with technology-supported personalised nutrition reports that evaluated intake relative to heart healthy eating principles. Of the 192 people who consented to participate, 132 were eligible due to their moderate-to-high risk. Pre-post participant medication use with a registered indication(4) for hypercholesterolemia, hypertension and glycemic control were documented according to class and strength (defined daily dose: DDD)(5). Nine GP practices (with 91 participants recruited) were randomised to the intervention group and seven practices (41 participants) were randomised to control. Intervention participants attended 4.3 ± 1.4 out of 5 dietetic consultations offered. Of the132 people with baseline clinical chemistry, 103 also provided a 12-month sample. Mean total cholesterol at baseline was 4.97 ± 1.13 mmol/L for both groups, with 12-m reduction of 0.26 ± 0.77 for intervention and 0.28 ± 0.79 for control (p = 0.90, unadjusted value). Median (IQR) number of medications for the intervention group was 2 (1–3) at both baseline and 12 months (p = 0.78) with 2 (1–3) and 3 (2–3) for the control group respectively. Combined DDD of all medications was 2.1 (0.5–3.8) and 2.5 (0.75–4.4) at baseline and 12 months (p = 0.77) for the intervention group and 2.7 (1.5–4.0) and 3.0 (2.0–4.5) for the control group (p = 0.30). Results suggest that medications were a significant contributor to the management of total cholesterol. Further analysis is required to evaluate changes in total cholesterol attributable to medication prescription relative to the MNT counselling received by the intervention group.

Obesity is still recognised as a risk factor rather than a chronic disease in Australia. General practitioners (GPs) have reported a lack of confidence and support in the management of obesity. In this study, we explored GPs' current definitions and treatment of obesity and their attitudes towards proposed clinician educational and billing strategies. In this cross-sectional study, an online survey was distributed to GPs across Australia. Of the 189 GPs who completed the survey, 82% defined obesity, with and/or without comorbidities, as a chronic disease. There is a significant gap between current practice and clinical guidelines, particularly in screening and prevention. The overall attitude towards proposed solutions was very positive. Descriptive analysis was used to present the characteristics of the participants. Chi-squared tests or Fisher's exact test were used to evaluate the relationship between categorical variables. Australia's outdated definition of obesity likely hinders management and contributes to the observed gap between clinical guidelines and current practice. Clinician education on behaviour change and long-term weight management, funding for more enhanced primary care referrals and Pharmaceutical Benefits Scheme listing of pharmacotherapy for weight loss might be possible solutions.

Cardiovascular disease (CVD), the leading cause of death globally and in Australia, is sensitive to heat exposure. This study assesses the burden of CVD attributable to high temperatures across Australia and projects future burden in the context of climate change. Disability-adjusted life years for CVD, including years of life lost and years lived with disability, were sourced from the Australian Burden of Disease database. A meta-regression model was constructed using location-specific predictors and relative risks from prior literature to estimate relative risks of CVD mortality and morbidity due to high temperatures in the Australian context. The baseline CVD burden attributable to high temperatures in Australia for 2003-18 was calculated, and future burdens under two greenhouse gas emissions scenarios [Representative Concentration Pathways (RCP4.5 and RCP8.5)] for the 2030s and 2050s were projected, considering demographic changes and human adaptation. During the baseline period, high temperatures accounted for 7.3% (95% confidence interval: 7.0%-7.6%) of the CVD burden in Australia, equivalent to 223.8 Disability-adjusted life years (95% confidence interval: 221.0-226.6) per 100 000 population. Future projections suggest a steady increase in the CVD burden across all scenarios examined. By the 2050s, under the RCP8.5 scenario that considers population growth and no adaptation, the total attributable burden of CVD is projected to more than double compared with the baseline, with the Northern Territory facing the most significant increase. These impacts could be mitigated with effective human adaptation to the warming climate. Higher temperatures are expected to exacerbate the burden of CVD. This study highlights the need for urgent adaptation and mitigation efforts to minimize the negative health impacts of a warming climate on CVD.

Assessing the impact of non-pharmaceutical interventions against COVID-19 on 64 notifiable infectious diseases in Australia: A Bayesian Structural Time Series model.

Untreated severe heart valve disease (HVD) is associated with premature mortality. Research shows low population awareness of when to seek assessment and low focus on cardiac auscultation by physicians in primary care settings. We studied contemporary public knowledge of HVD and assessment by their general practitioner (GP) in Australia. A total of 1,041 Australians >60 years of age participated in an online survey via the YouGov platform. The results were compared with data collected in 2020 using a similar approach. In addition, in-depth online interviews with 10 GPs were conducted. The top health concerns were cancer (29.7%), heart attack (14.6%), and Alzheimer's disease (14.3%), and only 2.4% rated HVD as a major health concern (in 2020: 1.4%; p<0.001). HVD could be explained by 17.1% of respondents, with 29.3% being aware of aortic stenosis (in 2020: 17.3%; p<0.001). The majority of Australians >60 years of age reported being socially and physically active on a regular basis. A total of 41.6% of respondents had a cardiac auscultation rarely or never performed by their GP (in 2020: 37.1%; p<0.001). Although GPs were confident with detecting the presence of a murmur, they were not confident to diagnose HVD without further investigation by a cardiologist. The knowledge and concern about HVD are low among Australians >60 years of age. Large gaps remain including the need for simple, cost-effective strategies to improve patient education to seek routine medical care, promote regular auscultation within primary care, and request echocardiography if clinical suspicion of HVD is present.

Chronic pain is a leading cause of chronic disease in Australia, with a 2020 report indicating that one in five Australians aged over 45 experience chronic pain. The high prevalence of chronic pain accounts for significant healthcare utilization and associated costs, with the economic impact of chronic pain estimated to be AUD$139 billion in 2018. This paper uses two exemplar cases to demonstrate inadequacies within the current systems supporting those with chronic pain and the associated impacts these inadequacies have on patient outcomes and healthcare costs. An analysis of these cases demonstrated a combined healthcare cost of AUD$312,705 throughout their inpatient admissions, with no apparent benefit to either patient's pain experience. These cases highlight a multitude of opportunities to improve current pain management systems and their detrimental effects on patient well-being, healthcare utilization, and associated costs. Despite massive expenditures for the management of chronic pain, patients often continue to experience ongoing pain and reduced quality of life. This indicates that the available funds could be better utilized through reallocation to support a proactive, biopsychosocial model of care for the prevention and management of chronic pain.

Abstract Background Microbial dysbiosis is associated with Crohn’s disease (CD) and ulcerative colitis (UC) onset and disease activity, however, large-scale data pertaining to Australian patients are limited1. This study aimed to describe the differences in gut microbiota composition between patients with IBD and healthy controls within the Australian IBD Microbiome (AIM) study2. Methods Paired faecal and oral samples alongside participant demographics and disease characteristics were collected at baseline from all healthy controls (HC) and IBD patients enrolled in the Australian IBD Microbiome (AIM) study from June 2019 to November 2023. Faecal and oral samples were self-collected in DNA stabilising buffer, aliquoted and stored at -80oC until extraction. Samples underwent 16S rRNA sequencing with annotation of DNA sequences to operational taxonomic units at the genus level. Differences in alpha diversity (Chao1) between groups were assessed using Mann-Whitney U tests. Beta diversity (weighted UniFrac dissimilarity) in bacterial communities were shown using Principal Coordinate Analysis (PCoA), and significance of variance was tested using ADONIS in R. Results 751 participants (305 HC, 232 CD, 214 UC) returned baseline faecal (n = 697) and/or oral samples (n = 737) and were included in the analysis, with patient group characteristics presented in Table 1. Most IBD patients were in clinical remission (Table 1). However, CD and UC patients had comparably lower faecal alpha diversity than the HC group (Figure 1A). Faecal beta diversity differed between CD, UC, and HC groups (Figure 1B). Five phyla were significantly different between the three groups in faecal samples (Figure 1C). No significant inter-group differences were seen with oral microbial analysis. Conclusion Compared to healthy adults, patients with IBD in Australia have distinct gut microbial profiles. Faecal rather than oral microbial sampling demonstrated a difference in community structure between IBD and healthy groups. Incorporating longitudinal microbial sampling and increasing sequencing resolution may elucidate a pathogenic relationship between gut microbiota and IBD.

Background Chronic diseases are a significant health concern in Australia. Understanding community preferences for health screening services is vital for enhancing service delivery. We conducted a study to determine community preferences for health screening services for chronic diseases in Australia using a discrete choice experiment (DCE). This paper aims to present the development of the final DCE design using priors estimated from a survey. Methods A DCE was conducted in Australia. An online survey was administered to a general Australian population over 18. The final attribute list of five attributes with three levels each was designed. A D-efficient design with 30 pair-wise choice tasks was developed using a fractional factorial design. A pre-test was conducted to assess comprehension and understanding of the online DCE survey. The pilot survey aimed to compute priors (i.e. coefficients) associated with attributes. A multinomial logit model was used to analyse the pilot DCE data. Results The survey included 30 choice tasks in three blocks, with 119 participants responding. The best DCE design was selected based on D-error, with a lower D-error indicating the most efficient design. The pilot survey results indicated a strong preference for highly accurate screening tests, with coefficients for 85% and 95% accuracy being positive. Coefficients estimated from the pilot survey were used as priors to design the DCE choice tasks for the main survey. The final DCE design showed a notable improvement in the attribute level overlap compared to the design used for the pilot survey. Conclusions A rigorous approach was taken to develop a DCE survey that could effectively determine the preferences of the community for health screening services. The resulting DCE design consisted of 30 choice tasks presented in pairs and was deemed efficient enough to gather comprehensive information in the final survey.

Abstract Cystic fibrosis (CF) is the most prevalent serious inherited disease in Australia, imposing significant health risks. CF is characterized by chronic lung inflammation and recurrent pulmonary infections that increase morbidity and premature mortality rates. The emergence of antimicrobial resistance (AMR) places further challenges on the treatment and management of CF, necessitating research into alternative strategies for treatment of bacterial infections. Bacteriophage therapy, involving bacterial-specific viruses, is a potential avenue for AMR infections in patients with CF. Existing literature supports the feasibility of phage therapy in CF but there has been a gap in investigating attitudes of the CF community including affected individuals and their caregivers, regarding phage therapy. Understanding perspectives and needs of the CF community is essential for successful implementation and acceptance of novel therapies including phage therapy. We conducted a survey that encompasses responses from 112 consumers from across Australia, comprising people living with CF (38.4%), parents of affected children (49.6%), carers (6.4%), and family members (3%). The findings showed a significant reliance on antibiotics with 51.4% requiring oral, 43.4% nebulized, and 11.4% intravenous antibiotics within the preceding 2 weeks. Respondents highlighted the availability of new treatments, duration of hospitalizations and costs associated with treatment as important priorities to address. Despite an awareness of phage therapy among 62.4% of respondents, 86.4% expressed interest in obtaining more information, primarily from medical staff (66.7%). Notably, 96.0% of respondents expressed willingness to participate in phage therapy trials. The results of this survey highlighted the CF community’s strong interest in advanced therapeutic approaches, specifically phage therapy. The findings reveal a notable recognition and acceptance of phage therapy as a viable treatment option for pulmonary infections associated with CF. This study addresses UN Sustainable Development Goal 3: Good Health and Wellbeing by advancing knowledge on alternative therapeutic strategies for managing AMR in CF. By exploring community attitudes towards bacteriophage therapy, the research promotes informed development and implementation of innovative, targeted treatments for CF-associated infections. These findings support the sustainable management of AMR, fostering better health outcomes and reducing reliance on traditional antibiotics, thereby contributing to long-term health resilience.

PurposeGiven the evolving literature regarding the optimal surgical approach to mitigate post-operative recurrence of Crohn’s disease (CD), this survey study aimed to elucidate the practices and preferences of colorectal surgeons in Australia and New Zealand (ANZ) in their surgical management of CD.MethodsColorectal surgical consultants and fellows (n = 337) registered with the Colorectal Surgical Society of Australia and New Zealand (CSSANZ) were invited by email in April 2022 to participate in a cross-sectional survey consisting of basic demographics and 12 questions relating to their usual surgical practice and preferred operative strategy.ResultsA total of 135 responses were received (39.9%). Regarding anastomotic configuration, 47% (n = 68) preferred the side-to-side anastomosis (STSA), 19% (n = 28) the end-to-end anastomosis (ETEA), and 15% (n = 21) the Kono S anastomosis. Most respondents preferred to resect at the proximal junction of the abnormal mesentery (75%, n = 97), while radical resection of the mesentery was preferred in 10% (n = 13) and close intestinal resection through abnormal mesentery in 15% (n = 20). The preferred surgical approach was by far laparoscopic (93%, n = 125) with extraction from the midline peri-umbilical port (80%, n = 108).ConclusionAmongst participating colorectal surgeons, there was a clear consensus on the approach, where the dominant practice was laparoscopy with a midline peri-umbilical extraction. Similarly, most respondents preferred some degree of mesenteric resection. However, anastomotic configuration and technique were domains of resection in CD lacking unanimity despite clear guidelines, highlighting an area requiring further attention.

IntroductionChronic kidney disease (CKD) is a significant burden on health systems globally, with limited up-to-date information on health system costs, particularly for non-dialysis patients. This study estimates the direct healthcare costs of CKD within Australia.MethodsThe study utilised the CKD.WA dataset, a linked repository for the state of Western Australia, containing public and private pathology, hospital, emergency and mortality data for over 2 million people, along with a secondary dataset of general practice records. Costs were calculated for individuals with CKD in 2019 and compared to controls without CKD to identify costs attributable to CKD. Cost items included hospital, emergency, medication, general practice, pathology, dialysis and outpatient services. Costs were expressed in 2023 AUD.ResultsThere were 114,899 individuals with CKD in 2019. Average yearly costs attributable to CKD were $3,367 for Stage 1, $4,114 for Stage 2, $3,607 for Stage 3a, $6,572 for Stage 3b, $11,456 for Stage 4 and $62,558 for Stage 5. Non-dialysis hospital costs were the biggest contributor, followed by dialysis costs. The estimated total cost of CKD to Australia was $8.3 billion for 2019.ConclusionThese findings highlight the significant cost burden of CKD. While CKD costs per individual are highest in later stages, the greater number of early-stage CKD cases means the majority of the cost burden is located among early-stage cases. Primary and secondary prevention strategies are likely key to reducing costs.

BackgroundInternational consensus exists for neurodevelopmental follow-up care of children with congenital heart disease (CHD) to support timely intervention for developmental delays. Yet, documentation of how this care is implemented in Australia is lacking. This study aimed to identify, categorise, and understand care pathways and services supporting neurodevelopmental follow-up of Australian children with CHD.MethodsA qualitative study, using semi-structured virtual interviews with healthcare professionals across Australia involved in neurodevelopmental care of children with CHD (n = 52) was conducted. Data was analysed using a rapid qualitative approach including structured templates, data reduction, and inductive-deductive analysis of matrices to synthesise data.ResultsMost neurodevelopmental follow-up was delivered as pathways through existing healthcare services rather than centre-based cardiac programmes. Service availability and accessibility varied across the country. Community-based primary care services, paediatric clinics, child development services, neonatal follow-up programmes, and allied health providers were commonly accessed pathway components. However, participants reported a lack of formal structures to coordinate care pathways.ConclusionsThe study identifies how cardiac neurodevelopmental follow-up in Australia can be embedded into existing services and adapted to meet local needs and contexts. Future approaches will benefit from integrating, leveraging, and growing existing services, although adoption of new models may be needed.ImpactThis study found neurodevelopmental follow-up care for children with CHD in Australia to be delivered as pathways through existing services rather than the centre-based cardiac follow-up programmes common in North America.Our study describes alternate options, including providers in community settings, that can be used for follow-up care delivery and how these can adapted to local context.Future approaches will benefit from integrating, leveraging, and growing existing services, although adoption of new models may be needed. Greater systematic coordination of care pathways is still required to optimise service delivery, inform planning, and support implementation of national standards of care.

Otitis externa (OE) is a very common disease in Australia. It is associated with swimming and exposure to water. Typically, treatment consists of aural toileting and the use of topical antimicrobial drops. Antimicrobial treatment is empiric, and most Australian guidelines advise the use of dexamethasone/framycetin/gramicidin as first-line therapy. This study aimed to identify the most prevalent pathogens implicated in OE in Queensland, Australia, and determine if there was any variability with the season, proximity to a coastline, age, gender and First Nations status. The primary pathogen cultured, the specimen type, thedate of collection and the patient demographics were retrieved from microbiology swabs sent from hospitals toPathology Queensland. Multivariate analysis was performed on the swabs. Pseudomonas aeruginosa was the most prevalent pathogen cultured in the external ear in Queensland, at37.9%. In inland regions, Staphylococcus aureus was themost prevalent organism. Children were three-fold less likely to have OE resulting from a fungal pathogen. The use of targeted antimicrobials against Pseudomonas aeruginosa in coastal regions during summer is sensible. Due to the low burden of fungal disease in children, there should be a high threshold for the commencement of antifungal ear drops.

ObjectivesThe objective of this study is to examine the hospitalisation profile for respiratory diseases in Australia between 1998 and 2019.DesignAn ecological study.SettingA population study that involved all private and public...