Health news


The first year of COVID-19 in Australia: direct and indirect health effects

This new report from the Australian Institute of Health and Welfare looks at the direct and indirect health effects of COVID-19 in Australia using data from the first year of the pandemic (up to April/May 2021). It includes information on case numbers, deaths, and burden of disease as well as the impact on other diseases, health services, changes in health behaviours and social determinants. It draws on data from a range of sources including disease surveillance systems, death registrations, hospitalisations, MBS and PBS, and surveys.

Australian guidelines for the clinical care of people with COVID-19

Clinical guidelines from the Australian National COVID-19 Clinical Evidence Taskforce. The guidelines are designed to provide information to assist decision making and have been informed by the highest quality evidence available at the time of compilation. This version was updated on the 20th August 2021.

Effectiveness of COVID-19 vaccines against the delta variant

This recent study in the UK – funded by Public Health England – and published in the NEJM – investigated the effectiveness of the BNT162b2 (Pfizer) and ChAdOx1 nCoV-19 (AstraZeneca) vaccines against the B.1.617.2 (delta) variant. While effectiveness after one dose of either vaccine was lower among people with the delta variant, they found high levels of vaccine effectiveness against symptomatic disease with the delta variant after the receipt of two doses. Only modest differences in vaccine effectiveness were noted with the delta variant as compared with the alpha variant after the receipt of two vaccine doses. The authors nevertheless advise caution and note that the findings are observational.
Read more in the NEJM...

BMJ Practice Pointer: Mask related acne (“maskne”) and other facial dermatoses

What you need to know:
  • Not all facial dermatoses related to personal protective equipment are “maskne”
  • Irritant contact dermatitis is the most common cause
  • Maintenance of the skin barrier and regular “mask breaks” are important aspects of management, in addition to standard medical treatment of the skin condition
Read BMJ Practice Pointer...
Further content in BMJ...

Whole of population-based cohort study of recovery time from COVID-19 in NSW

COVID-19 results in persisting symptoms but there is little systematically collected data estimating recovery time following infection. The authors followed 94% of all COVID-19 cases (n=2904) diagnosed in NSW between January and May 2020 using 3-4 weekly telephone interviews and linkage to hospitalisation and death data to determine if they had recovered from COVID-19 based on symptom resolution. 80% of those with COVID-19 recovered within a month, and 5% continued to experience symptoms 3 months later.

Practice Changing Update: Triple therapy for children ≥6 years with cystic fibrosis

Elexacaftor-tezacaftor-ivacaftor is an important therapy for most patients with cystic fibrosis, but its use has been limited to adolescents and adults. This new Practice Changing Update from UpToDate recommends triple therapy (elexacaftor-tezacaftor-ivacaftor) rather than dual therapy (tezacaftor-ivacaftor or lumacaftor-ivacaftor) for patients ≥6 years old with cystic fibrosis who are homozygous for the F508del variant. (Grade 1B recommendation)

UpToDate Cystic fibrosis: treatment with CFTR modulators...
Read original article...

NEW REVIEW: Neurology and neuropsychiatry of COVID-19

This systematic review and meta-analysis aims to describe the characteristics of the early literature and estimate point prevalence for neurological and neuropsychiatric manifestations of infection with SARS-CoV-2. 13,292 records were screened to identify 215 included studies from 30 countries. Neurological and neuropsychiatric symptoms of COVID-19 in the pandemic’s early phase are varied and common. Symptoms with the highest prevalence were anosmia, weakness, fatigue, dysgeusia, myalgia, depression, headache, anxiety and altered mental status. Heterogeneity for most clinical manifestations was high.
Read article...

The CANBACK trial - CBD for acute low back pain in the Emergency department

Low back pain is common among patients presenting to hospital emergency departments. The efficacy of standard pharmaceutical interventions is poor. Researchers from Austin Hospital in Melbourne investigated the effects of cannabidiol (CBD), which has known anti-inflammatory and analgesic properties. 100 patients who presented with acute, non-traumatic low back pain from May 2018—Jun 2019 were randomised to receive either 400 mg CBD or placebo, in addition to standard ED analgesic medication. The results indicated that CBD does not reduce pain or hospital length of stay.
Read article in the MJA...
Read editorial from local authors: Lack of efficacy of cannabidiol for relieving back pain: time to re-set expectations?

Differences in comorbidities and associated severity and mortality among individuals with COVID-19

This systematic review and meta-analysis aimed to determine geographical, age, and gender related differences in the prevalence of comorbidities and associated severity and mortality rates among COVID-19 patients. Of 120 studies with 125,446 patients, the most prevalent comorbidities were hypertension (32%), obesity (25%), diabetes (18%) and cardiovascular disease (16%). Chronic kidney or other renal diseases (51%), cerebrovascular accident (43%), and cardiovascular disease (44%) patients had more COVID-19 severity and mortality respectively. Considerable variation in the prevalence of comorbidities and associated disease severity and mortality in different geographic regions was observed.

New guideline (UK): SARS-CoV-2 routes of transmission and recommendations for preventing acquisition

This guidance document was co-produced by a multi-professional group including clinicians, nurses, academics, and a member of the public. It provides current evidence regarding routes of SARS-CoV-2 transmission and offers recommendations to assist frontline health professionals and managers.

The efficacy and safety of paracetamol for pain relief

An analysis of 36 systematic reviews of randomised controlled trials recently published in the MJA, identified just four conditions for which there was high or moderate quality evidence that paracetamol relieved pain – knee or hip osteoarthritis, craniotomy, tension-type headaches, and perineal pain after childbirth. However even then, the size of pain reduction is small. The study found high quality evidence that paracetamol is not effective for relieving acute low back pain. Frequency of adverse events was generally similar for people receiving placebo or paracetamol.
Read more in MJA Insightplus...
Read full article in the MJA...

Patients’ experience of severe asthma add-on therapies

This study from the Department of Respiratory & Sleep Medicine at JHH, provides insight into the patient’s experience of add-on therapies for severe asthma. Understanding these experiences will aid communication of the potential benefits and limitations of these add-on medications. They can also guide discussion around alternative treatment in cases of reduced treatment efficacy or non-response.

End-of-life decisions in neonatal care

Faced with the decision of whether to limit life support for their critically ill baby, parents fare better when doctors present them with options, rather than making recommendations. Parents given options were more involved in the discussion, and conflict with doctors was reduced. This research provides fresh insight into how to support parents with end-of-life decision-making. It may also inform approaches to other patient-doctor counselling conversations.
Read NIHR evidence review...

Psychosocial impact of pediatric burns on Aboriginal and Torres Strait Islander families

Aboriginal and Torres Strait Islander children are disproportionately affected by burn injuries, yet often omitted from burns literature or inadequately portrayed under Western frameworks. The authors applied a novel combination of participant observations, retrospective thinking aloud, and yarning methods to explore the psychosocial impact of pediatric burn injuries and care on Aboriginal and Torres Strait Islander families.

NEW GUIDE: Immunodeficiency, autoimmunity and COVID-19 vaccination

This guide has been developed by ASCIA (Australasian Society of Clinical Immunology and Allergy), based on current knowledge regarding COVID-19 vaccines, allergic reactions and people with allergic conditions. Current at 18th March 2021, it will be updated when new information is available.

Paediatric genomic testing: navigating Medicare rebatable genomic testing

This paper aims to guide paediatricians through the process of genomic testing, and represents the combined expertise of educators, clinical geneticists, paediatricians and genomic pathologists around Australia. Its purpose is to help paediatricians navigate choosing the right genomic test, consenting patients and understanding the possible outcomes of testing.

Best available evidence on the risk factors of hypertensive crisis in adult patients with hypertension

The risk of hypertensive crisis was higher in patients with a history of comorbid cardiovascular conditions, such as chronic kidney disease, coronary artery disease, and stroke. Hypertensive emergency was more common in men, older patients, and those with diabetes and hyperlipidemia. Non-adherence to antihypertensive medications and hypertensive diagnosis unawareness did not increase the risk of hypertensive emergency.

COVID-19 patients admitted to Australian ICUs – outcome data from the first months of the pandemic

During the first four months of the pandemic in Australia, mortality among invasively ventilated COVID-19 patients was lower than in some overseas reports, and the median duration of intensive care longer. Median peak intensive care unit bed occupancy by patients with COVID-19 was 14%.

Plaster cast as good as surgery for a broken scaphoid bone

The Scaphoid Waist Internal Fixation for Fractures Trial (SWIFFT) attempted to determine which method has the best outcome for patients and is most cost-effective. It included 439 mostly male patients aged 32-39 years. Half had surgery, and half had a plaster cast put on their wrist. The procedures were carried out by experienced surgeons and consultants across 31 NHS hospitals in England and Wales between July 2013 and July 2016. The study found that healing was similar with either approach but the surgical option was significantly more expensive.
Read NIHR review...

LOCAL RESEARCH: Innovative personalised management program for older adults with Parkinson’s disease

Parkinson’s disease in older persons presents with a diverse array of clinical manifestations. This article by local authors reviews the literature for strategies to proactively address the care needs of older persons with Parkinson’s disease.

A single preoperative dose of tranexamic acid reduces perioperative blood loss

This is the first meta-analysis to identify the efficacy and safety of a single preoperative dose of intravenous tranexamic acid (TXA). The authors found that preoperative intravenous TXA reduced perioperative blood loss and transfusion requirements in a variety of surgical disciplines without increasing the risk of thromboembolic events.

LANCET REVIEW: Physical distancing, face masks, and eye protection to prevent person-to-person transmission of COVID-19

The authors of this recent review from Lancet investigated the optimum distance for avoiding person-to-person transmission of SARS-CoV-2 (the virus that causes COVID-19) and assessed the use of face masks and eye protection to prevent transmission of viruses in health-care and community settings. The current best available evidence from 172 observational studies across 16 countries and six continents, and 44 relevant comparative studies (n=25,697 patients) suggests that transmission of viruses was lower with physical distancing of 1 m or more (compared with a distance of less than 1 m). Face mask use could result in a large reduction in risk of infection, with stronger associations with N95 or similar respirators compared with disposable surgical masks or similar. Eye protection was also associated with less infection.

Diagnostic error: incidence, impacts, causes and preventive strategies

Diagnosis consists of eliciting information from history and examination, formulating a differential diagnosis, and selecting a final diagnosis based on the predictive value of specific clinical features and laboratory investigations. A timely and accurate diagnosis is every patient’s expectation, yet some form of diagnostic error occurs in up to one in seven clinical encounters, and most are preventable.
Find out more...

LOCAL RESEARCH: High community burden of smoke-related symptoms in the Hunter and New England regions during the 2019–2020 Australian bushfires

During October 2019 – February 2020, when large parts of the country were ravaged by bushfires, there were increases in emergency presentations of respiratory illnesses in NSW. Visible smoke and prolonged periods of elevated particulate air pollution became the norm, and resulted in community concern. In order to reveal the true health impact of the bushfires, local authors investigated the proportion of the community who were affected by smoke but did not present to health services.

What is Post-COVID-19 Neurological Syndrome?

As the global COVID-19 pandemic continues, researchers are beginning to understand the long-term impact of the virus on the human brain. Something they refer to as Post-COVID-19 Neurological Syndrome (PCNS). The symptoms are similar to those experienced post-stroke – but the age group is much younger. Given the scale of global infection, PCNS has the potential to become a major problem. The neurological impacts of various infections have been explored and investigated in the past, but as COVID-19 is a new virus, they are still working to understand the longer term impact of the infection.

ANZAED Eating disorder treatment principles and general clinical practice and training standards

Eating disorders are complex to manage, and there is limited guidance around the depth and breadth of knowledge, skills and experience required by treatment providers. The Australia & New Zealand Academy for Eating Disorders (ANZAED) convened an expert group of eating disorder researchers and clinicians to define the clinical practice and training standards recommended for mental health professionals and dietitians providing treatment for individuals with an eating disorder. Implementing these standards aims to bring treatment closer to best practice, and consequently improve treatment outcomes, reduce financial cost to patients and services and improve patient quality of life.

Evidence-based prevention of Alzheimer's disease

An epic new systematic review and meta-analysis pooled evidence from 44,676 reports on the prevention of Alzheimer's disease. 243 observational prospective studies and 153 randomised controlled trials were eligible for analysis. Twenty-one suggestions are proposed based on the consolidated evidence, with Class I suggestions targeting 19 factors: 10 with Level A strong evidence (education, cognitive activity, high body mass index in late life, hyperhomocysteinaemia, depression, stress, diabetes, head trauma, hypertension in midlife and orthostatic hypotension) and 9 with Level B weaker evidence (obesity in midlife, weight loss in late life, physical exercise, smoking, sleep, cerebrovascular disease, frailty, atrial fibrillation and vitamin C). In contrast, two interventions are not recommended: oestrogen replacement therapy (Level A2) and acetylcholinesterase inhibitors (Level B).

MJA RESEARCH SKILLS – De-confounding confounding Part 3: controlling for confounding in statistical analyses

This MJA series – co-edited by HNELHD staff John Attia – aims to make statistics accessible for clinicians. The latest instalment – after a period of limbo – returns to the topic of confounding, offering an alternative method of control.

Part 2: Discusses the emergence of directed acyclic graphs (DAGs) to identify confounding
Part 1: Provides traditional explanations of confounding

Saliva as a candidate for COVID-19 diagnostic testing

The present gold standard for sampling is the nasopharyngeal swab method. However, several recent papers suggested that saliva-based testing is a promising alternative that could simplify and accelerate COVID-19 diagnosis.

Rapid review...
Practical challenges...

Management of post-acute COVID-19 in primary care

Post-acute covid-19 (“long covid”) seems to be a multisystem disease, sometimes occurring after a relatively mild acute illness. Clinical management requires a whole-patient perspective. This article, intended for primary care clinicians, relates to the patient who has a delayed recovery from an episode of covid-19 that was managed in the community or in a standard hospital ward. Broadly, such patients can be divided into those who may have serious sequelae (such as thromboembolic complications) and those with a non-specific clinical picture, often dominated by fatigue and breathlessness.

LISTEN to podcast: ‘What do we know about long covid?’

Living systematic review: comparing effects of drug treatments for COVID-19

A network meta-analysis was performed on data extracted from the US Centers for Disease Control and Prevention COVID-19 Research Articles Downloadable Database. 23 trials were included, in which people with suspected, probable, or confirmed covid-19 were randomised to drug treatment or to standard care or placebo. The certainty of the evidence for most comparisons was very low because of risk of bias and serious imprecision.

Glucocorticoids were the only intervention with evidence for a reduction in death compared with standard care and mechanical ventilation (moderate certainty). Three drugs might reduce symptom duration compared with standard care: hydroxychloroquine (low certainty), remdesivir (moderate certainty), and lopinavir-ritonavir (low certainty). Hydroxychloroquine might increase the risk of adverse events compared with the other interventions, and remdesivir probably does not substantially increase the risk of adverse effects leading to drug discontinuation. No other interventions included enough patients to meaningfully interpret adverse effects leading to drug discontinuation.

The value of this resource is in its ‘living’ status. The review will be updated (for up to two years) to reflect emerging evidence.

READ full article in the BMJ...
VIEW - Infographic (Use Microsoft Edge)...


As of 08:30 this morning Health Districts in NSW have been directed by Elizabeth Koff, NSW Health Secretary to escalate to Amber Risk Status.

Today the JHH Executive, along with Dr John Ferguson gave an update via Broadcast, the link to this broadcast can be found here.

One key requirement is that all health staff are required to wear standard, level 2 surgical masks if they are within 1.5m of patients. Visitors will also be asked to mask.

During our usual weekly JHH ALL Staff Information Broadcast on Wednesday, Dr Ferguson referred to a handwashing technique video which can be accessed via this link.  

Please keep an eye on the CE news, Webinars and COVID site on the Intranet as to how you can help us keep us all safe.


Injections are two-and-a-half times safer when nurses use revamped guidelines

The UK's National Health Service (NHS) is changing the way it writes its guidelines for giving injections in hospitals, following new research from the University of Bath. The study found that hospital nurses make far fewer mistakes when administering medicines intravenously if they follow instructions written with nurses in mind. Current NHS guidelines on intravenous injections are written by pharmacists with little input from their primary audience - nurses. These instructions can be confusing or overly complicated, which contributes to 30-50% of intravenous doses being incorrect in some way. Researchers used a process called 'user testing', which identifies where mistakes are being made and introduces changes so the instructions are easier to use.

READ full article...
WATCH - Lead author Matthew Jones discuss the study...

Mask use provides significant protective effect on the spread of respiratory viruses in healthcare workers

This recent meta-analyses based on 21 studies found that use of masks by healthcare workers (HCWs) and non-healthcare workers (Non-HCWs) can reduce the risk of respiratory virus infection by 80% and 47%. Masks had a protective effect against influenza viruses, SARS, and SARS-CoV-2. The protective effect of wearing masks in Asia appeared to be higher than that of Western countries.

READ full article...

COVID -19: Implementing sustainable low cost physical distancing and enhanced hygiene

SARS-CoV-2 continues to disseminate globally and there are likely to be recurrent waves of infection into the foreseeable future. We would argue that low cost interventions including physical distancing and enhanced hygiene have increasing relevance. They will protect against the emerging concern for pre-symptomatic transmission and their optimisation will better enable the more restrictive and economically damaging constraints to be relaxed.

READ this article in the MJA by local public health physician Craig Dalton
Or this one by the same author in the Conversation

New PubMed has now replaced legacy PubMed

Legacy PubMed has been retired, and New PubMed has become the default PubMed site. If it’s been a while since you ran a search on PubMed – or feel a little anxious about the changes – don’t worry, here’s an article that will walk you through the new features.

They include: mobile-friendly design; a cite button - that lets you toggle between different formats, or download citations as an Endnote-compatible file; social media sharing buttons; and a button to copy a permalink. All collections and saved searches stored in your ‘My NCBI’ account are available in the new site.

Find out how to build a search strategy, manage results, save records and see comparisons to legacy PubMed on the Library webpage – ‘Tutorials and Guides’ - PubMed .

For more search tips – see the National Library of Medicine support page

COVID-19 research has overall low methodological quality thus far: case in point for chloroquine/hydroxychloroquine

This article examines recent hydroxychloroquine-azithromycin research, and finds that it is underpinned by very low-quality methodology. The authors, who include researchers from Health Research Methods, Evidence and Impact and the GUIDE Research Methods Group at McMaster University, consider the overall body of recent COVID-19 research to be unreliable. Flawed methodology and sub-optimal reporting of research findings could lead to biased estimates of effect. This could lead to substandard treatment decisions, and may be detrimental to patients. The article provides specific suggestions for improving on COVID-19 research methods and reporting, with a focus on issues that researchers must consider in their methodology and reporting if we are to have confidence in the estimates of effect.

READ full-text article
Discussion on the Centre for Evidence-Based Medicine website

Surviving Sepsis Campaign: Guidelines on the management of critically ill adults with COVID-19

A panel of 36 experts from 12 countries, proposed 53 questions relevant to the management of COVID-19 in critically ill patients in the ICU. All panel members completed the World Health Organization conflict of interest disclosure form. They identified relevant and recent systematic reviews on most questions relating to supportive care. The certainty of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. The panel then generated recommendations based on the balance between benefit and harm, resource and cost implications, equity, and feasibility. Recommendations were either strong or weak, or in the form of best practice recommendations. No recommendation was provided for the following topics: infection control, laboratory diagnosis and specimens, hemodynamic support, ventilatory support, and COVID-19 therapy. When available, the panel will provide new recommendations in further releases of the guidelines.

READ SSC guidelines
LISTEN to author discussion
VIEW full-size infographic

How safe are library books?

Current research says that in ideal lab conditions, the COVID-19 virus can survive for up to 24 hours on cardboard and up to 2-3 days on plastic and stainless steel. We want to help you stay safe in the library – so we’ve implemented book quarantines, social distancing, and regular cleaning of surfaces such as tables, door handles and computer keyboards and mice.

LISTEN: CDC guidance on mitigating COVID-19 when managing paper-based, circulating, and other types of collections
SOURCE: National Institutes of Health news release
NEJM: Aerosol and surface stability of HCoV-19 (SARS-CoV-2) compared to SARS-CoV-1
13.03.20 (updated)

COVID-19: get the latest research

Coronaviruses are important human and animal pathogens. At the end of 2019, a novel coronavirus was identified as the cause of a cluster of pneumonia cases in Wuhan, a city in the Hubei Province of China. It rapidly spread, resulting in an epidemic throughout China, with sporadic cases reported globally. In February 2020, the World Health Organization (WHO) designated the disease COVID-19, which stands for coronavirus disease 2019. Previously, this virus was referred to as 2019-nCoV.

The COVID-19 update presented to interns on 11 March 2020 is now available via the Library website. Presenters included: Dr Tony Merritt (Public Health Physician, Population Health), Dr Catherine Berry (Staff Specialist, Immunology and Infectious Diseases Unit, JHH), and Assoc Prof Chris Grainge (Staff Specialist, Respiratory and General Medicine, JHH)

This UpToDate topic discusses the epidemiology, clinical features, diagnosis, management, and prevention of COVID-19

Understanding of this novel coronavirus is evolving try this PubMed filter to locate recent literature

Access BMJ Best Practice resources on coronavirus including BMJ topic page, learning modules and patient leaflets

A counter showing in real time the global number of COVID-19 cases, deaths and recoveries from Johns Hopkins University