The Medical journal of Australia
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Emerging infectious diseases (EIDs) are infectious diseases whose incidence has increased in humans in the past 20 years or could increase in the near future. EID agents may represent a threat to blood safety if they infect humans, cause a clinically significant illness, include an asymptomatic blood phase in the course of infection, and are transmissible by transfusion. EID agents are typically not well characterised, but there is a consensus that we can expect ongoing outbreaks. ⋯ In assessing the potential risk of ZIKV to blood safety in Australia, it should be noted that a relatively small number of imported ZIKV infections have been reported in Australia, there have been no reported cases of local ZIKV transmission, and the geographical distribution of the potential ZIKV mosquito vector in Australia (Aedes aegypti) is limited to northern Queensland. Moreover, reported transfusion-transmitted ZIKV cases worldwide are rare. At present, ZIKV represents a low risk to blood safety in Australia.
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Cognitive biases in decision making may make it difficult for clinicians to reconcile evidence of overuse with highly ingrained prior beliefs and intuition. Such biases can predispose clinicians towards low value care and may limit the impact of recently launched campaigns aimed at reducing such care. ⋯ Various strategies may be used to counter such biases, including cognitive huddles, narratives of patient harm, value considerations in clinical assessments, defining acceptable levels of risk of adverse outcomes, substitution, reflective practice and role modelling, normalisation of deviance, nudge techniques and shared decision making. These debiasing strategies have considerable face validity and, for some, effectiveness in reducing low value care has been shown in randomised trials.
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The brain-computer interface (BCI) is an exciting advance in neuroscience and engineering. In a motor BCI, electrical recordings from the motor cortex of paralysed humans are decoded by a computer and used to drive robotic arms or to restore movement in a paralysed hand by stimulating the muscles in the forearm. Simultaneously integrating a BCI with the sensory cortex will further enhance dexterity and fine control. ⋯ Scalp surface recording using electroencephalography is much less precise. BCI technology is still in an early phase of development and awaits further technical improvements and larger multicentre clinical trials before wider clinical application and impact on the care of people with disabilities. There are also many ethical challenges to explore as this technology evolves.
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Major progress has been made over the past decade in the understanding of motor neurone disease (MND), changing the landscape of this complex disease. Through identifying positive prognostic factors, new evidence-based standards of care have been established that improve patient survival, reduce burden of disease for patients and their carers, and enhance quality of life. These factors include early management of respiratory dysfunction with non-invasive ventilation, maintenance of weight and nutritional status, as well as instigation of a multidisciplinary team including neurologists, general practitioners and allied health professionals. ⋯ Successful translation of this clinical research through growth in community funding, awareness and national MND research organisations has laid the foundation for closing the research-practice gap on this debilitating disease. In this review, we highlight these recent developments, which have transformed treatment, augmented novel therapeutic platforms, and established a nexus between research and the MND community. This era of change is of significant relevance to both specialists and general practitioners who remain integral to the care of patients with MND.