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Bulletin for 1 October 2021


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Carotid stenting versus endarterectomy for asymptomatic carotid stenosis
Earlier trials comparing transfemoral carotid artery stenting (TF-CAS) with carotid endarterectomy (CEA) for asymptomatic carotid stenosis reported that the periprocedural (30-day) stroke or death rate is higher for TF-CAS, while long-term outcomes are similar. In the recent ACST-2 trial, the periprocedural rate of death or any stroke was slightly higher with TF-CAS compared with CEA, but the difference was not statistically significant [11]. (See "Management of asymptomatic extracranial carotid atherosclerotic disease", section on 'Stenting versus endarterectomy trials'.)

Choice of anticoagulant for atrial fibrillation post-transcatheter aortic valve implantation 
 In a recent open-label trial that randomly assigned over 1400 post-TAVI patients with AF to the direct oral anticoagulant (DOAC) edoxaban or a vitamin K antagonist (VKA), rates of mortality and ischemic stroke at a median of 1.5 years were similar between the two treatment groups [12]. Although the overall rate of major bleeding was higher in the edoxaban group, rates of intracranial hemorrhage were comparable between the groups. For patients with AF requiring anticoagulation (including those post-TAVI), we generally prefer a DOAC to VKA. (See "Transcatheter aortic valve implantation: Antithrombotic therapy", section on 'Anticoagulation with or without antiplatelet therapy'.)

Fluid resuscitation with saline or a buffered crystalloid in adults 
The choice between normal saline and a buffered crystalloid for initial fluid resuscitation in adults is debated. A recent two-by-two-factorial randomized trial of >11,000 critically ill patients (mostly surgical) treated with normal saline or a buffered crystalloid found that neither the fluid type nor the rate of administration had an impact on 90-day mortality or the incidence of acute kidney injury (AKI) [1,2]. However, the trial may have been underpowered, only small volumes of fluids were administered, and fluid was administered prior to randomization, all of which preclude firm conclusions. We suggest that the choice between fluids be individualized and re-evaluated following initial resuscitation. (See "Treatment of severe hypovolemia or hypovolemic shock in adults".)

Awake proning in hospitalized patients with COVID-19 
Self-pronation has been a widespread practice for awake patients hospitalized with hypoxemic respiratory failure due to COVID-19 based on limited data indicating temporary improvements in oxygenation. In a recent meta-analysis of six randomized trials, awake pronation also reduced the rate of intubation in such patients (33 versus 40 percent), although a mortality benefit was not identified [30]. Given the minimal harms of self-proning, these data further support our recommendation for routine proning in awake patients with COVD-19-related respiratory failure. (See "COVID-19: Respiratory care of the nonintubated critically ill adult (high-flow oxygen, noninvasive ventilation, and intubation)", section on 'Awake pronation'.)

COVID-19 vaccination does not increase risk for miscarriage 
Evidence of the safety of COVID-19 vaccination in pregnancy continues to accrue. Results were consistent with either mRNA-1273 or BNT162b2 vaccine exposure; risks specific to Ad26.COV.2.S vaccine could not be assessed due to a small number of exposures. We recommend COVID-19 vaccination regardless of pregnancy status. (See "COVID-19: Pregnancy issues and antenatal care", section on 'Vaccines'.)

Statins not effective for preventing preeclampsia 
Statins are generally discontinued in pregnancy; however, data from animal studies and a small pilot trial in humans suggested statins may reduce the risk for preeclampsia. A multicenter randomized trial including over 1100 singleton pregnancies at high risk for term preeclampsia now reports that pravastatin 20 mg daily beginning at 35+0/7ths to 36+6/7ths weeks and continuing until birth did not reduce the incidence of preeclampsia or other adverse pregnancy outcomes compared with placebo [1]. (See "Preeclampsia: Prevention", section on 'Statins'.)

Prenatal antipsychotics and psychopathology in the offspring 
Maternal use of antipsychotics during pregnancy does not appear to increase the risk of psychopathology in offspring. These results are reassuring for pregnant patients with bipolar disorder who require antipsychotics. (See "Teratogenicity, pregnancy complications, and postnatal risks of antipsychotics, benzodiazepines, lithium, and electroconvulsive therapy", section on 'Developmental effects'.)

Electroconvulsive therapy and risk of serious medical events
Electroconvulsive therapy (ECT) is often beneficial for patients with severe, treatment-resistant depression and may reduce the risk of suicide. We suggest offering ECT to patients with treatment-resistant depression and suicidal behavior. (See "Unipolar major depression in adults: Indications for and efficacy of electroconvulsive therapy (ECT)", section on 'Suicidality'.)

Preexisting psychiatric disorders and COVID-19-related outcomes
Patients with preexisting psychiatric disorders who develop SARS-CoV-2 infection may be at increased risk for severe COVID-19. In a meta-analysis of observational studies including nearly 1.5 million COVID-19 patients, preexisting psychiatric disorders (>40,000 patients) were associated with increased risks of COVID-19-related hospitalization and death, which remained after adjustment for confounding factors [11]. Patients with psychotic or mood disorders were at highest risk. These findings underscore the importance of SARS-CoV-2 vaccination in this vulnerable population, which may be less informed or have reduced access to care. (See "COVID-19: Psychiatric illness", section on 'Patients with pre-existing psychiatric illness'.)

Updated guidance for COVID-19 vaccine use in patients with rheumatic disease
The American College of Rheumatology (ACR) COVID-19 Vaccine Clinical Guidance Task Force has updated their recommendations regarding use of COVID-19 vaccines in patients with rheumatic disease [16]. The guidance addresses the timing of the vaccination, administration of immunosuppressive agents, and the use of postexposure prophylaxis with monoclonal antibodies in certain patients. (See "COVID-19: Care of adult patients with systemic rheumatic disease", section on 'Timing of vaccine'.)


Cochrane library

Effects of consumers and health providers working in partnership on health services planning, delivery and evaluation
The effects of consumers and providers working in partnership as an intervention, or as part of a multi‐component intervention, are uncertain, due to a lack of high‐quality evidence and/or due to a lack of studies. Cochrane Database of Systematic Reviews – Intervention 15 September 2021

Continuing education meetings and workshops: effects on professional practice and healthcare outcomes
Compared with no intervention, educational meetings as the main component of an intervention probably slightly improve professional practice and, to a lesser extent, patient outcomes. Educational meetings may improve compliance with desired practice to a greater extent than other kinds of behaviour change interventions, such as text messages, fees, or office systems. Cochrane Database of Systematic Reviews – Intervention 15 September 2021

Instruments for assisted vaginal birth
This review provides low‐certainty evidence that forceps may be more likely to achieve vaginal birth and have lower rates of fetal trauma, but at a greater risk of perineal trauma and higher pain relief requirements compared with vacuum cups. Cochrane Database of Systematic Reviews – Intervention 24 September 2021


Cochrane clinical answers

What are the benefits and harms of interventions to increase patient and family involvement in the escalation of care for community health and hospital settings?
For adults and children with acute life‐threatening illnesses in community health and hospital settings, low‐certainty evidence suggests that interventions to increase patient and family involvement in the escalation of care may moderately improve patient and family involvement and knowledge about symptoms, appropriate responses, and preparedness capacity. Cochrane clinical answers 23 September 2021



The value of clinical breast examination in a breast cancer surveillance program for women with germline BRCA1 or BRCA2 mutations
Clinical breast examination did not increase the number of breast cancers detected in MRI‐screened women with BRCA1/2 mutations. Removing breast examination from surveillance programs that include MRI may be reasonable for these women. MJA 13 September 2021

Sex differences in the management and outcomes of non‐STelevation acute coronary syndromes
In Australia, adherence to guideline‐based therapy for people with NSTEACS could be improved, especially for women in hospital and for both sexes at discharge. MJA 20 September 2021

Gun violence in Australia, 2002–2016: a cohort study
Rates of self‐harm with firearms are higher for older people, men, and residents in outer regional and rural/remote areas, while those for assault‐related injuries are higher for younger people, men, and residents of major cities. Strategies for reducing injuries caused by self‐harm and assault with firearms should focus on people at particular risk. MJA 27 September 2021


Team debriefings in healthcare: aligning intention and impact 
The covid-19 pandemic has renewed focus on debriefings to improve performance among healthcare providers: debriefings help teams learn quickly and manage patients more safely.  BMJ 13 September 2021

Biliary colic 
This article outlines how to assess and manage a patient with suspected biliary colic in primary care. Areas covered include criteria for referral, investigations, and discussion of management options. BMJ13 September 2021

Use of metformin to prolong gestation in preterm pre-eclampsia: randomised, double blind, placebo controlled trial
This trial suggests that extended release metformin can prolong gestation in women with preterm pre-eclampsia. BMJ 23 September 2021

Early computed tomography coronary angiography in patients with suspected acute coronary syndrome: randomised controlled trial
In intermediate risk patients with acute chest pain and suspected acute coronary syndrome, early CT coronary angiography did not alter overall coronary therapeutic interventions or one year clinical outcomes, but reduced rates of invasive angiography while modestly increasing length of hospital stay. These findings do not support the routine use of early CT coronary angiography in intermediate risk patients with acute chest pain and suspected acute coronary syndrome. BMJ 29 September 2021

Post-discharge after surgery Virtual Care with Remote Automated Monitoring-1 (PVC-RAM-1) technology versus standard care: randomised controlled trial
Virtual care with RAM shows promise in improving outcomes important to patients and to optimal health system function. BMJ 30 September 2021



Association between Transcatheter Aortic Valve Replacement for Bicuspid vs Tricuspid Aortic Stenosis and mortality or stroke among patients at low surgical risk
Patients at low surgical risk who underwent TAVR for bicuspid aortic stenosis compared with tricuspid aortic stenosis had no significant difference in mortality or stroke at 30 days or 1 year. JAMA 21 September 2021

Effect of Methylphenidate on apathy in patients with Alzheimer disease: The ADMET 2 randomized clinical trial
Methylphenidate may be useful for the treatment of apathy in individuals with Alzheimer disease, which can reduce symptoms and caregiver burden. JAMA 27 September 2021

Association between hearing loss and impaired physical function, frailty, and disability in older adults: A cross-sectional study
In this cross-sectional analysis of data from the Seniors-ENRICA-2 cohort study, hearing loss was associated with impaired lower extremity function, frailty syndrome, and instrumental activities of daily living (IADL) disability. It may be useful to examine this association with the mechanisms elucidated in further studies. JAMA 23 September 2021

Effect of preemptive intervention on developmental outcomes among infants showing early signs of autism: A randomized clinical trial of outcomes to diagnosis
This study found that a preemptive intervention reduced autism spectrum disorder (ASD) diagnostic behaviors when used at the time atypical development first emerges during infancy. JAMA 20 September 2021

Evaluating the cost-effectiveness of prehospital plasma transfusion in unstable trauma patients: A secondary analysis of the PAMPer Trial
In this study, prehospital thawed plasma transfusion during air medical transport for trauma patients in hemorrhagic shock was lifesaving and cost-effective compared with standard care and should become commonplace. JAMA 22 September 2021

Aspirin use to prevent preeclampsia and related morbidity and mortality : Updated evidence report and systematic review for the US preventive services task force
Daily low-dose aspirin during pregnancy was associated with lower risks of serious perinatal outcomes for individuals at increased risk for preeclampsia, without evident harms. JAMA 28 September 2021


Agency for healthcare research and quality

Interventions to decrease hospital length of stay
The goals of this Technical Brief are to 1) categorize and evaluate current knowledge regarding strategies to reduce length of stay (LOS) for medically complex, high-risk, or vulnerable patients at increased risk of extended LOS; 2) examine contextual factors (e.g., resources, costs, staffing, technology) that affect implementation of LOS-focused interventions; 3) identify emerging concepts or initiatives that may merit future research; and 4) develop a series of evidence maps to inform health systems’ strategic efforts for LOS reduction in these populations. AHRQ 20 September 2021


Other journals

Association between anion gap and mortality of aortic aneurysm in intensive care unit after open surgery
The level of serum anion gap was an important prognosis factor for aortic aneurysm mortality in intensive care unit after open surgery. BMC cardiovascular disorders 23 September 2021

Antibiotic prescription consistent with guidelines in emergency department is associated with 30-day survival in severe community-acquired pneumonia
The prevalence of antibiotic prescription consistent with guidelines for severe community-acquired pneumonia (CAP) seemed to be low in the ED, and this variable was independently associated with 30-day survival. BMC emergency medicine 27 September 2021

Treatment of humeral shaft fractures: a new minimally-invasive plate osteosynthesis versus open reduction and internal fixation: a case control study
The anteromedial approach minimally-invasive plate osteosynthesis (MIPO) technique has the advantages of less trauma, less bleeding, low risk of nerve injury and high rate of fracture healing. BMC surgery 23 September 2021

Does higher health literacy lead to higher trust in public hospitals?
It is important that health care professionals understand that some patient groups have a higher chance of cooperation (e.g., agreeing on the choice of treatment) or defection (e.g. passing a complaint) than others. In perspective, future research should undertake further qualitative examinations of possible patient types and their demands in relation to different health care sectors, focusing specifically on the opportunities to improve the handling of different patient types. International journal for equity in health 16 September 2021

Impact of a binary triage system and structural reorganization of emergency department on health care workers exposed to suspected COVID-19 patients—a single-centre analysis
A binary triage system based on severity and infectivity and supported with structural reorganization can be effective in reducing HCWs COVID-19 exposure. International journal of emergency medicine 23 September 2021

Enhanced recovery after surgery for hip fractures: a systematic review and meta-analysis
Enhanced recovery after surgery (ERAS) significantly decreases the time to surgery (TTS), length of stay (LOS), and complication rate without increasing readmission rate and mortality, which adds to the evidence that the implementation of ERAS is beneficial to patients undergoing hip fracture repair surgeries. Perioperative medicine 13 September 2021



Dementia in Australia
This online report provides a comprehensive picture of dementia in Australia, including the latest statistics on dementia prevalence, burden of disease, deaths, expenditure, as well as the use of health and aged care services among people with dementia and information on carers of people with dementia. AIHW 20 September 2021

Aboriginal and Torres Strait Islander specific primary health care: results from the nKPI and OSR collections
Information on organisations funded by the Australian Government under its Indigenous Australians’ Health Programme (IAHP) to deliver culturally appropriate primary health care services to Aboriginal and Torres Strait Islander people is available through two data collections—the Online Services Report (OSR); and the national Key Performance Indicators (nKPI). This report presents the latest results from these collections. AIHW 27 September 2021

Heart, stroke and vascular disease—Australian facts
Heart, stroke and vascular disease: Australian facts provides key information for monitoring cardiovascular disease (CVD) in the Australian population, focussing on cardiovascular risk factors, major subtypes, treatment and impact. Incidence, prevalence, hospitalisation and mortality are described for each disease, with additional analysis of priority population groups. An interactive data tool allows for further exploration of CVD hospitalisation and mortality data. AIHW 29 September 2021


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Mental Health - What’s new? I Bulletin for September 2021

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The mediating role of perceived social support in the relationship between perceived stigma and depression among individuals diagnosed with substance use disorders Journal of psychiatric and mental health nursing 28 August 2021 
Based on the present study's results, psychosocial interventions to increase perceived support from family and friends would be helpful in addressing negative effects of perceived stigma on mental health among individuals diagnosed with substance use disorders.

Early recognition method - amplifying relapse management in community mental health care: A comprehensive study of the effects on relapse and readmission Archives of psychiatric nursing December 2021
This naturalistic multicenter study explored the relationship between participating in the Early Recognition Method (ERM) intervention and relapse, defined as spending at least one night at a psychiatric ward. The intervention was tailored to adult patients with schizophrenia or bipolar disorder in an outpatient mental health care setting. Before the intervention, the staff received training in application of the strategy. The ERM strategy is protocolized and includes identification and monitoring of individual early warning signs and development of a personal plan of action. The study showed a reduction in mean number and duration of readmissions during the period the patients participated in the intervention, compared to an equal pre-intervention period. For patients with bipolar disorder the reduction was statistical significant. The difference in outcome between the two diagnostic groups suggests that further tailoring of the application of the ERM strategy might improve the relapse prevention outcome.


New insights into the relationship between drought and mental health emerging from the Australian rural mental health study Frontiers in psychiatry 1 September 2021
It is well-established that the relationship between drought and mental health is complex. However, little is known about (i) how drought duration affects (associates with) mental health (especially when the drought lasts for years) and (ii) how long poor mental health persists after a drought. In this paper, we took a novel approach that allowed us to explore these questions. We found that the association between drought exposure and psychological distress is non-linear (inverted U-shape). More specifically, people experienced an increase in psychological distress for the first 2.5–3 years of drought, after which time distress dissipates. To our knowledge, this is the first paper that exhibits an inverted U-shape for the drought-psychological distress relationship with both theoretical and empirical explanation. This finding suggests the existence of factors that help to moderate the negative effects of drought on mental health or to promote psychological resilience to drought. Further research is required to identify and understand such factors.

Promoting helpful attention and interpretation patterns to reduce anxiety and depression in young people: weaving scientific data with young peoples’ lived experiences BMC psychiatry 25 August 2021 
Anxiety and depression are common, disabling and frequently start in youth, underscoring the need for effective, accessible early interventions. Empirical data and consultations with lived experience youth representatives suggest that maladaptive cognitive patterns contribute to and maintain anxiety and depression in daily life. Promoting adaptive cognitive patterns could therefore reflect “active ingredients” in the treatment and/or prevention of youth anxiety and depression. Here, we described and compared different therapeutic techniques that equipped young people with a more flexible capacity to use attention and/or promoted a tendency to positive/benign (over threatening/negative) interpretations of uncertain situations. CBM techniques target clear hypothesised mechanisms but require further co-design with young people to make them more engaging and augment their clinical effects. Guided instructions benefit from being embedded in clinical interventions, but lack empirical data to support their intervention mechanism, underscoring the need for more experimental work. Feedback from young people suggest that combining complimentary techniques within multi-pronged “toolboxes” to develop resilient thinking patterns in youth is empowering.

Evaluation of coercive measures in different psychiatric hospitals: the impact of institutional characteristics BMC psychiatry 21 August 2021  
Epidemiological studies have demonstrated considerable differences in the use of coercive measures among psychiatric hospitals; however, the underlying reasons for these differences are largely unclear. We investigated to what extent these differences could be explained by institutional factors. The findings are compatible with the hypothesis that more open settings are associated with a more extensive use of coercion. However, due to numerous influencing factors, these results should be interpreted with caution. In view of the relevance of this issue, further research is needed for a deeper understanding of the reasons underlying the differences among hospitals.

Somatic health care professionals’ stigmatization of patients with mental disorder: a scoping review BMC psychiatry 7 September 2021 
The large number of studies identified in this review suggests that stigmatizing attitudes and behaviors toward patients with mental disorders is a worldwide challenge within a somatic health care setting. For more targeted interventions, there is a need for further research on underexposed mental diagnoses and knowledge on whether specific health professionals have a more stigmatizing attitude or behaviour toward specific mental disorders.

Benefits and harms of risperidone and paliperidone for treatment of patients with schizophrenia or bipolar disorder: a meta-analysis involving individual participant data and clinical study reports BMC medicine 25 August 2021 
IPD meta-analysis conclude that Risperidone and Paliperidone antipsychotics had a small beneficial effect on reducing PANSS score over 9 weeks, which is more conservative than estimates from reviews based on journal publications. CSRs also contained significantly more data on harms that were unavailable in journal publications or trial registries. Sharing of IPD and CSRs are necessary when performing meta-analysis on the efficacy and safety of antipsychotics.

Examination of dosing of antipsychotic drugs for relapse prevention in patients with stable schizophrenia: A meta-analysis JAMA psychiatry 18 August 2021
The results of our meta-analysis may provide some guidance based on average patients with chronic disease. The dose-response associations in specific populations are likely to be different. For example, doses might be lower for patients with a first episode of schizophrenia and higher for treatment-resistant patients. Moreover, the substantial interindividual variability in all these outcomes is important to consider. Individual dosing decisions should be guided by patient wishes. For many patients, adverse events may be a priority, and for many others, avoidance of relapse may be more important. Several factors should be considered in dosing of antipsychotic drugs to prevent relapse. These include patient characteristics, such as degree of residual symptoms; physical and psychiatric comorbidities, such as kidney damage or substance abuse; slow or ultrarapid metabolism due to polymorphisms of cytochrome enzymes; doses that were effective in the acute phase and/or for relapse prevention in the past; the severity of previous relapses (higher doses may be recommendable if relapses could be disastrous); the properties of each drug (eg, pharmacodynamic and pharmacokinetic properties, adverse event profile), and concomitant treatment with psychiatric and nonpsychiatric drugs which, by interaction, can affect drug plasma levels.

Antipsychotic use and risk of breast cancer in women with schizophrenia: a nationwide nested case-control study in Finland Lancet psychiatry 30 August 2021
Long-term exposure to prolactin-increasing, but not to prolactin-sparing, antipsychotics is significantly associated with increased odds of breast cancer. Monitoring prolactinemia and addressing hyperprolactinemia is paramount in women with schizophrenia being treated with prolactin-increasing antipsychotics.

Suicide mortality after a nonfatal suicide attempt: A systematic review and meta-analysis Australian and New Zealand journal of psychiatry 1 September 2021 
Deliberate self-harm and suicide attempts share common risk factors but are associated with different epidemiological features. While the rate of suicide after deliberate self-harm has been evaluated in meta-analyses, the specific rate of death by suicide after a previous suicide attempt has never been assessed. The aim of our study was to estimate the incidence of death by suicide after a nonfatal suicide attempt. The evidence of a high rate of suicide deaths in the year following nonfatal suicide attempts should prompt prevention systems to be particularly vigilant during this period.

Prevalence of dental disorders among people with mental illness: An umbrella review Australian and New Zealand journal of psychiatry 30 August 2021 
Mental health clinicians should screen for oral diseases when treating those with mental illness and facilitate referral to affordable dental clinics when indicated. Prevention should be a priority, including the promotion of dental care, as well as the management of xerostomia when psychopharmacologic agents are prescribed.

Appraisal of patient-level health economic models of severe mental illness: systematic review British journal of psychiatry 19 August 2021 
Existing patient-level economic models of interventions for severe mental illness have considerable limitations. New modelling efforts must be supplemented by the generation of good-quality, contemporary evidence suitable for model building. Combined effort across the research community is required to build and validate economic extrapolation models suitable for accurately assessing the long-term value of new interventions from short-term clinical trial data.

A systematic review of instruments for the assessment of eating disorders among adults Current opinion in psychiatry 1 September 2021 
The availability of psychometrically sound assessment instruments for assessing eating disorder symptomatology is crucial for both clinical practice and research. The purpose of the current review is to provide the reader with a list of psychometrically validated assessments for adults that are available within the field of eating disorders. Eating disorder interviews and self-report questionnaires were identified using online literature searches, reviewing previous review articles, and via research and/or clinical experience of the authors. The focus of the review was on (1) standard assessments that were frequently used in eating disorder research (such as the Eating Disorder Examination and Eating Attitudes Test), and (2) newer assessments that were developed over the past 5 years. Information compiled on each instrument included the purpose of the assessment, scores that can be derived, psychometric information, translations in other languages, and availability for use in research and clinical settings.

Eating disorders, pregnancy and the postnatal period: a review of the recent literature Current opinion in psychiatry 30 August 2021  
Eating disorders (ED) are severe psychiatric disorders that affect women in reproductive age. The purpose of this review is to provide an up-to-date overview of the impact of maternal ED on pregnancy and the postnatal period. The clinical implications for identification and management of maternal ED are also discussed. These findings continue to emphasise the clinical importance of early identification and response to maternal ED to mitigate potentially adverse maternal and infant outcomes.

Neurocognitive effects of ketamine and esketamine for treatment-resistant major depressive disorder: A systematic review Harvard review of psychiatry October 2021 
Ketamine and esketamine do not seem to exert significant deleterious neurocognitive effects in the short or long term in individuals with treatment-resistant depression. Results suggest neuropsychological functions and brain areas commonly impaired in treatment-resistant depression may especially benefit from subanesthetic ketamine infusions. Key questions that remain unanswered are discussed.

How shared is shared decision making? Reaching the full potential of patient-clinician collaboration in mental health Harvard review of psychiatry October 2021 
Shared decision making in mental health is a priority for stakeholders, but faces significant implementation barriers, particularly in settings intended to serve people with serious mental illnesses (SMI). As a result, current levels of shared decision making are low. We highlight these barriers and propose that a novel paradigm, collaborative decision making, will offer conceptual and practical solutions at the systemic and patient/clinician level. Collaborative decision making is tailored for populations like people with SMI and other groups who experience chronic and complex symptoms, along with power imbalances within health systems. Advancing from shared decision making to collaborative decision making clarifies the mission of the model: to facilitate an empowering and recovery-oriented decision-making process that assigns equal power and responsibility to patients and clinicians; to improve alignment of treatment decisions with patient values and priorities; to increase patient trust and confidence in clinicians and the treatment process; and, in the end, to improve treatment engagement, satisfaction, and outcomes. The primary purpose of collaborative decision making is to increase values-aligned care, therefore prioritizing inclusion of patient values, including cultural values and quality of life–related outcomes. Given the broad and constantly changing context of treatment and care for many people with SMI (and also other groups), this model is dynamic and continuously evolving, ready for use across diverse contexts. Implementation of collaborative decision making includes increasing patient knowledge but also patient power, comfort, and confidence. It is one tool to reshape patient-clinician and patient-system relationships and to increase access to value-aligned care for people with SMI and other groups.


Metacognitive change during exposure and metacognitive therapy in obsessive- compulsive disorder Frontiers in psychiatry 13 September 2021 
Metacognitive therapy (MCT) has been shown to be a promising treatment approach for obsessive-compulsive disorder (OCD). The changeability of metacognitions by (metacognitive) treatment and its relevance to treatment outcome is, however, still unclear. The current study investigates, (1) if treatment with MCT or exposure and response prevention (ERP) in a randomized-controlled pilot trial (n = 24 patients with OCD) changes OCD-specific metacognitions of thought fusion beliefs, beliefs about rituals and stop signals, and (2) if these changes are relevant for the treatment outcome in terms of patient- and therapist-rated OCD symptoms. ANOVA with pretest, posttest and follow-up scores could show that all three metacognitions significantly decreased during both treatments. Regarding thought fusion beliefs, a significant interaction effect indicated a higher decrease after MCT than ERP treatment. In hierarchical regression analyses, changes in stop signals from pre- to post-treatment significantly predicted patient-rating OCD symptoms at post-treatment and follow-up at 3 months after treatment. These changes were even predictive of post-treatment outcome after controlling for general metacognitions and dysfunctional cognitive beliefs. These findings support the assumption that metacognitions can change during both treatments and that changes in stop signals might be relevant for the treatment outcome on the symptom level in OCD.

Tackling the ‘digital pandemic’: The effectiveness of psychological intervention strategies in problematic internet and smartphone use—a meta-analysis Australian and New Zealand journal of psychiatry 3 September 2021 
Current evidence indicates that psychological interventions can be effective in reducing problematic Internet use/problematic smartphone use. However, the results must be considered preliminary due to the limited number of studies available in the respective fields.

New developments in cognitive-behavioural therapy for eating disorders (CBT-ED) Current opinion in psychiatry 26 August 2021 
CBT-ED has developed substantially in the past 5 years, with consolidation of its existing evidence base, further support for real-life implementation, extension of methods used, and the development of new approaches for working with younger people – particularly in the form of treatments for ARFID. Over the past 18 months, even more promising changes in delivery occurred in response to the COVID19 pandemic, showing that we can adapt our methods in order to work effectively via remote means. Challenges remain regarding poor outcomes for anorexia nervosa.

The role of mindfulness and life satisfaction in psychological distress during the COVID-19 lockdown in New Zealand: a quasi-experimental study Mindfulness 26 August 2021  
Individuals who have higher levels of mindfulness and those with greater life satisfaction experience significantly less depression, anxiety, and stress over time, during both uncertain and emergency conditions such as during the threat of COVID-19. The finding of anxiety and stress reduction during lockdown may be specific to New Zealand, as conditions differ in many ways from those in other countries. Preventative measures which increase mindfulness and satisfaction with life could help alleviate depression, anxiety, and stress during uncertain and emergency conditions.

Effects of mindfulness-based parallel-group interventions on family functioning and child and parent mental health: a systematic review and meta-analysis Mindfulness 24 August 2021 
MBPG interventions show promising effects in improving mental health of both parents and children as well as in improving overall family functioning. However, significant variations exist in characteristics of participants, interventions, and study designs. Given the limited evidence currently available, more studies are needed to assess the determinants of effectiveness in MBPG interventions.

Mindfulness and parenting: A meta-analysis and an exploratory meta-mediation Mindfulness 21 August 2021 
There has been increasing interest in recent years on the links between parents’ mindfulness and their parenting. The present meta-analysis systematically synthesized the research on the associations between mindfulness and mindful, positive, and negative parenting. The mediating role of mindful parenting in the indirect link between mindfulness and child outcomes was also explored using meta-structural equation modeling (meta-SEM). Given the increasing attention on mindfulness in family settings, we discuss the results in relation to existing models of mindful parenting. Directions for future research are presented, including the use of observational or child-reported parenting measures and father samples.

Bouldering psychotherapy is effective in enhancing perceived self-efficacy in people with depression: results from a multicenter randomized controlled trial BMC psychology 26 August 2021  
Participation in the manualized BPT in a group setting leads to a clinically relevant enhancement of perceived self-efficacy in people with depression. This effect is superior to that of physical exercise alone. The results provide also initial indications that BPT is comparable to CBT in enhancing perceived self-efficacy, suggesting a strong case for a broader use of BPT as a supplement to existing health services. Future studies should focus on the modes of action of BPT and its effect on perceived self-efficacy in people with other mental or physical disorders.

Are people with social anxiety disorder happier alone? Journal of anxiety disorders 1 September 2021  
Quality contact with other people serves as a reliable mood enhancement strategy. We wondered if the emotional benefits of socializing are present even for those with a psychological disorder defined by social distress and avoidance: social anxiety disorder (SAD). We conducted two ecological momentary assessment (EMA) studies and analyzed 7243 total surveys. In both studies, community adults diagnosed with SAD and healthy controls received five surveys each day for 2 weeks. Consistent with research on positivity deficits in SAD, between-person analyses in both studies suggest that, on average, participants with SAD reported lower positive and higher negative affect in social and non-social situations than healthy controls. Within-person analyses, however, revealed that in both studies participants with SAD and healthy controls reported higher positive affect when with others than when alone; no differences were found for negative affect for those with SAD. The difference in positive affect between social and nonsocial situations was smaller for participants with SAD in Study 1, suggesting that people with SAD may experience diminished reward responding when socializing. Our results suggest that even those with a mental illness defined by interpersonal distress can and do derive positive emotions from social interactions.

EffECTively treating depression: A pilot study examining manualized group CBT as follow-up treatment after ECT Frontiers in psychology September 2021  
There is an urgent need for effective follow-up treatments after acute electroconvulsive therapy (ECT) in depressed patients. Preliminary evidence suggests psychotherapeutic interventions to be a feasible and efficacious follow-up treatment. However, there is a need for research on the long-term usefulness of such psychotherapeutic offers in a naturalistic setting that is more representative of routine clinical practice. Therefore, the aim of the current pilot study was to investigate the effects of a half-open continuous group cognitive behavioral therapy (CBT) with cognitive behavioral analysis system of psychotherapy elements as a follow-up treatment for all ECT patients, regardless of response status after ECT, on reducing depressive symptoms and promoting psychosocial functioning. Even though the interpretability of the results is limited by the small sample and the non-controlled design, they indicate that manualized group CBT with cognitive behavioral analysis system of psychotherapy elements might pose a recommendable follow-up treatment option after acute ECT for depressed patients, regardless of response status after ECT. This approach might not only help to further reduce depressive symptoms and prevent relapse, but also promote long-term psychosocial functioning by improving emotion regulation strategies and psychological quality of life and thus could be considered as a valuable addition to clinical routine after future validation.

Social work

Recovery from severe mental health problems: A systematic review of service user and informal caregiver perspectives Frontiers in psychiatry 1 September 2021 
The recovery model provided by this review offers a template for further research in the field and a guide for policy and practice. Predominant definitions of recovery currently reflect understandings of mental health which focus on an individual perspective, while this review found an important emphasis on socio-political aspects. At the same time, only a small number of studies took place in low-income countries, focused on minoritized populations, or included caregivers' perspectives. These are important gaps in the literature that require further attention.


OCTOBER | Shared decision making in mental health treatment: what clinicians need to know 
Presenter: Dr Alana Fisher (Research Fellow, eCentre Clinic, Macquarie University) 
When: Thursday 21 October, 12PM - 1PM (AEST)


Bulletin for October 2021


Prediabetes and pregnancy: Early pregnancy HbA 1c identifies Australian Aboriginal women with high-risk of gestational diabetes mellitus and adverse perinatal outcomes Diabetes research and clinical practice vol 176 2021 
Early pregnancy HbA1c 5.6% (38 mmol/mol) identifies Aboriginal women with apparent prediabetes and elevated risk of having an LGA newborn. Universal HbA1c at first antenatal presentation could facilitate earlier management of hyperglycemia and improved perinatal outcome in this high-risk population.

Prediction accuracy of commonly used pneumonia severity scores in Aboriginal patients with severe community-acquired pneumonia : a retrospective study Internal medicine journal 15 September 2021  
None of the pneumonia severity scores accurately predicted mortality. The authors recommend SMARTACOP to predict IRVS requirement in Aboriginal patients with severe community-acquired pneumonia (SCAP). Given Aboriginal patients are over-represented in Australian ICUs, a new score is warranted for this understudied population.

Peritoneal dialysis in Indigenous Australians: a critical review and personal opinions Bulletin de la Dialyse à Domicile 3 September 2021  
Indigenous people in wealthy countries have out-comes of chronic disease that are comparable to those of patients in low socio-economic developing countries. This is not different for renal disease and outcomes of renal replacement therapy. This chapter addresses the dilemmas of using Peritoneal Dialysis in aboriginal patients in Australia. The focus is on aboriginal people in very remote areas and some personal views are presented as to the causes of the gap between outcomes for aboriginal and non-aboriginal patients and how the many failed attempts to close the gap could be addressed.

We’re not being treated like mothers”: listening to the stories of First Nations mothers in prison Laws 13 September 2021 
This article is based on research with over 160 First Nations women in prisons in New South Wales, Australia. The research identified the lived experience of prison sentences for First Nations women in prison. Our research methodology was guided by an Aboriginal women’s advisory body called sista2sista. It was based on the principles of Dadirri in which we listened to the stories of First Nations women in prison on their terms. Consequently, many stories heard were not about the criminal sentencing process itself, but about the impacts of imprisonment on their capacity to be caregivers in the community, including as mothers, grandmothers, aunts, sisters, teachers and role models. The findings from this research are dual. First, the importance of listening to and empowering First Nations women in prison in policy making that concerns First Nations women. Second, the need to decarcerate First Nations mothers and listen and respond to their needs, expectations, priorities and aspirations, to ensure they are supported in fulfilling their role and responsibility to care, nurture, strengthen and lead their families and communities.

A discourse analysis of the Aboriginal and Torres Strait Islander COVID-19 policy response ANZ journal of public health 16 September 2021
The policy response perpetuates an ongoing paternalistic discourse where Aboriginal and Torres Strait Islander people must be controlled for the sake of their health, informed by notions of Indigeneity as deficient. This stands in contrast with the work of community-controlled health organisations, advocacy by Aboriginal and Torres Strait Islander people for and against restrictions, and examples of communities protecting themselves. Implications for public health: Unilateral government intervention creates limiting discourses of Aboriginal and Torres Strait Islander people. In contrast, ongoing COVID-19 responses can build on the strengths of and work done by Aboriginal and Torres Strait Islander families, leaders, and communities

Risk of severe illness from COVID-19 among Aboriginal and Torres Strait Islander adults: the construct of ‘vulnerable populations’ obscures the root causes of health inequities ANZ journal of public health 22 September 2021
Aboriginal and Torres Strait Islander peoples must continue to be recognised as a priority population in all stages of pandemic preparedness and response as they have disproportionate exposure to social factors associated with risk of severe COVID-19 illness. Indigeneity itself is not a ‘risk’ factor and must be viewed in the wider context of inequities that impact health. Implications for public health: Multi-sectoral responses are required to improve health during and after the COVID-19 pandemic that: enable self-determination; improve incomes, safety, food security and culturally-safe healthcare; and address discrimination and trauma.

Prioritizing built environmental factors to tackle chronic and infectious diseases in remote Northern Territory (NT) communities of Australia: A concept mapping study Int. J. Environ. Res. Public Health 2021, 18(10), 2021  
High prevalence of chronic and infectious diseases in Indigenous populations is a major public health concern both in global and Australian contexts. Limited research has examined the role of built environments in relation to Indigenous health in remote Australia. This study engaged stakeholders to understand their perceptions of the influence of built environmental factors on chronic and infectious diseases in remote Northern Territory (NT) communities.

Improving interagency service integration of the Australian Nurse Family Partnership Program for First Nations women and babies: a qualitative study International journal for equity in health 25 September 2021
Effective service integration is essential to maximise access and acceptability of the ANFPP; we provide practical recommendations to improve service integration in this context.

The adaptation of a youth diabetes prevention program for Aboriginal children in Central Australia: Community perspectives International journal of environmental research and public health 31 August 2021
This study reports on integrating community perspectives to adapt a family-focused, culturally appropriate behavioural intervention program to prevent diabetes among Aboriginal children (6–11 years) in Central Australia.

Mental health and well-being of Aboriginal and Torres Strait Islander peoples in Australia during COVID-19 Australian journal of social issues 20 September 2021
In May 2020, an independent working party was convened to determine the mental health and well-being needs of Aboriginal and Torres Strait Islander peoples in Australia, in response to COVID-19. Thirty Aboriginal and Torres Strait Islander leaders and allies worked together in a two-month virtual collaboration process. Here, we provide the working party's five key recommendations and highlight the evidence supporting these proposals. Aboriginal and Torres Strait Islander self-determination and governance must be prioritised to manage the COVID-19 recovery in Aboriginal and Torres Strait Islander communities. To mitigate long-term social and economic impacts of COVID-19 to Australian society, the historical underinvestment in Aboriginal and Torres Strait Islander peoples must be reconciled. Equitable, needs-based funding is required to support strengths-based, place-based initiatives that address the determinants of health. This includes workforce and infrastructure development and effective evaluation. There is a clear, informed pathway to health and healing for Aboriginal and Torres Strait Islander peoples being enacted by Aboriginal and Torres Strait Islander leadership and community organisations; it remains to be seen how these recommendations will be implemented.


Australian reconciliation convention (Virtual) 
When 15-17 November 2021 
Synopsis: The Convention program will include rigorous discussions and panel presentations with local, national and international perspectives to reflect on the past, and explore the future of a just, equitable, and reconciled Australia.

Poche Indigenous Health Network 10th Annual Aboriginal Health Research Showcase (Virtual)
When 17 – 18 November 2021
The online event, chaired by Professor Tom Calma AO, will bring together an array of researchers, scholars and community collaborators to share our experiences and findings from some of the great initiatives happening in Aboriginal and Torres Strait Islander Health research. Join us to hear about all the great work being done within Aboriginal and Torres Strait Islander health research

Cultural awareness training
30 October 2021  

Where Living Kaurna Cultural Centre
Synopsis  For general practitioners, practice staff, pharmacists, allied health professionals & service providers

Online resources

Covid 19 – call the Aboriginal Infoline - 1800 312 911

Information for Aboriginal and Torres Strait Islander peoples about COVID-19 vaccines
This electronic resource aims to promote the vaccination rate and provide information about the COVID-19 vaccination in Aboriginal and Torres Strait Islander communities.

It provides information on frequently asked questions such as:

  • Why should I get vaccinated for COVID-19?
  • Where and when should I get vaccinated?
  • Are there any known side-effects?
  • What if I already had my first does of the AstraZeneca vaccine?
  • Can I choose not to be vaccinated?
  • Which vaccine will I be getting?
  • I live remotely and move between places, what should I do?

Murradambirra dhangaang (make food secure): a food security planning tool for Aboriginal communities in urban and regional areas [posters] (The Australian Prevention Partnership Centre)

These six posters are designed as planning tools to assist Aboriginal communities in urban and regional areas in developing a clearer picture of the whole food system and how local changes can be made.

22nd Libby Harricks Memorial Oration: Indigenous ear and hearing health – tackling the silent epidemic 
This is a video recording of the 2021 Libby Harricks Memorial Oration, presented by Professor Harvey Coates AO.
The topic of the oration is Indigenous ear and hearing health.
Captioned and Auslan versions of the recording are available.
The Libby Harricks Memorial Oration series is a joint project by Deafness Forum of Australia and Audiology Australia. It honours the memory of the first President of Deafness Forum of Australia. Since 1999, the series has raised awareness of key issues relating to hearing loss and deafness.

Good for kids, good for life [website] 
The Good for Kids, Good for Life website gives guidance about developing healthy lifestyles in children, including physical activity and healthy eating and making sure it contains information for early childhood education and care (ECEC) providers, primary and high schools as well as for parents and carers. There is a dedicated page on the website which provides resources and links to information, especially for Aboriginal and Torres Strait Islander people. It covers topics such as:

  • healthy drinks for kids
  • healthy foods for strong kids
  • handy serve sizes
  • healthy lunch box ideas
  • recipe book
  • quick meals for Kooris.

Falling asleep to First Nations storytelling ABC Radio ‘Life matters’
What sends you to sleep at night? Perhaps reading before bed is your thing or keeping the window open so you can look up at the stars. We take a look at a new First Nations audio series targeting sleep and relaxation while bringing audiences closer to Indigenous knowledge and culture.


Profile of Indigenous Australians (AIHW)  
Aboriginal and Torres Strait Islander people are the Indigenous peoples of Australia. They are not one group, but rather comprise hundreds of groups that have their own distinct set of languages, histories and cultural traditions (AIHW 2015). The health and welfare of Indigenous Australians living in the big cities are different to those living in the Torres Strait, which are different again to those living on the outskirts of Alice Springs or those living in remote communities.

Aboriginal and Torres Strait Islander specific primary health care: results from the nKPI and OSR collections (AIHW)  
Information on organisations funded by the Australian Government under its Indigenous Australians’ Health Programme (IAHP) to deliver culturally appropriate primary health care services to Aboriginal and Torres Strait Islander people is available through two data collections—the Online Services Report (OSR); and the national Key Performance Indicators (nKPI). This report presents the latest results from these collections.

Aged care for Indigenous Australians (AIHW)
This page focuses on Indigenous Australians a
ged 50 and over and their use of aged care services.

Bulletin for 24 September 2021


Clinical management of withdrawal from benzodiazepine anxiolytic and hypnotic medications Addiction 20 September 2021 
Benzodiazepines continue to be prescribed widely in the management of patients with insomnia or anxiety disorders, despite the availability and acceptability of alternative pharmacological and psychological treatments. Many patients will experience adverse effects during treatment and considerable distress when the dosage is reduced and stopped. Management of benzodiazepine withdrawal includes measures to prevent the development of dependence, careful attention to underlying medical conditions, medication consolidation and gradual dosage reduction, accompanying psychological interventions, occasional prescription of concomitant medication, and relapse prevention with on-going support to address psychosocial stressors. There is a need for easier patient access to services with refined expertise and further research to optimise strategies for preventing dependence and facilitating withdrawal.

Reducing craving and consumption in individuals with drug addiction, obesity or overeating through neuromodulation intervention: A systematic review and meta-analysis of its follow-up effects Addiction 13 September 2021
Excitatory neuromodulation targeting the dorsolateral prefrontal cortex appears to lead to a sustained reduction of craving and consumption in individuals with addiction or overeating behavior.

Technology-mediated just-in-time adaptive interventions (JITAIs) to reduce harmful substance use: A systematic review Addiction 13 September 2021
Current implementations of just-in-time adaptive interventions (JITAIs) for reducing harmful substance use rely on active measurement and static decision rules to deliver support tailored to micro-scale changes in mood or urges. Studies on JITAI effectiveness are lacking.

Differential gateways, facilitators, and barriers to substance use disorder treatment for pregnant women and mothers: A scoping systematic review Journal of addiction medicine early view 2021 
There has been progress in implementing different types of interventions and treatments for that were attentive to pregnant women and mothers’ needs. The authors developed a conceptual model that characterized women’s pathways to treatment by deciphering women’s potential engagement in gateway settings.

Effectiveness of and access to medications for opioid use disorder for adolescents and young adults: A scoping review Journal of addiction medicine early view 2021 
Medications for opioid use disorder (MOUD) therapies reduce opioid use among adolescent and young adults but few receive MOUD. MOUD services for adolescents and young adults should be developed and tested. Randomized clinical trials are necessary to develop appropriate clinical guidelines for using MOUD with adolescents and young adults

Effectiveness of an optimized text message and Internet intervention for smoking cessation: a randomized controlled trial Addiction 2 September 2021 
A randomized controlled trial found no evidence that a combined Internet and text message intervention for smoking cessation compared with an Internet intervention alone increased 9-month abstinence rates among adult current smokers in the US, despite evidence of higher levels of intervention engagement and satisfaction at 3 months.

Potential effects of digital inequality on treatment seeking for opioid use disorder International journal of mental health and addiction 27 August 2021
This paper explores the role of digital inequalities in the uptake of treatment for opioid use disorder. Given the shift toward telemedicine and online counseling for substance use treatment as a consequence of the COVID-19 pandemic, more research into the digital inequalities faced by those who misuse opioids may provide insight into ways of engaging and encouraging this population to utilize treatment.

Opioid agonist treatment and patient outcomes during the COVID-19 pandemic in south east Sydney, Australia Drug and alcohol review 14 September 2021
These preliminary findings suggest that the modified model of care continued to provide safe and effective treatment, during the pandemic. Notably, there was no association between more take-away doses (TAD) and significant increases in substance use. Limitations are discussed and further evaluation is needed.

Psychosocial difficulties and treatment retention in inpatient detoxification programmes Nordic studies on alcohol and drugs 38(5) 2021
Special attention should be paid to younger individuals with opioid and/or polysubstance use, as well as those with cognitive difficulties, in order to retain people in treatment.

Exploring the effectiveness of dextroamphetamine for the treatment of stimulant use disorder: a qualitative study with patients receiving injectable opioid agonist treatment Substance abuse treatment, prevention, and policy 16 September 2021
In the context of continued investigation of pharmacological treatments for stimulant use disorder, the present study has highlighted how the study of clinical outcomes could be extended to account for factors that contribute to perceptions of effectiveness from the perspective of patients. In practice, elements of treatment delivery (e.g. dosing and dispensation protocols) can be adjusted to allow for various scenarios (e.g. on site vs. take home dosing) by which dextroamphetamine and other pharmacological stimulants could be implemented to provide “effective” treatment for people with a wide range of treatment goals and needs.

Effectiveness of ENDS, NRT and medication for smoking cessation among cigarette-only users: a longitudinal analysis of PATH Study wave 3 (2015–2016) and 4 (2016–2017), adult data Tobacco control 15 September 2021
No differences were found when cessation rates of ENDS, NRT or non-NRT medication were compared. Given uncertainty about the long-term health effect of ENDS and the likelihood of becoming dual users, people who smoke and need assistance quitting should be encouraged to use current Food and Drug Administration-approved cessation methods until more effective methods are developed.

The need for multidisciplinary hospital teams for injection drug use-related infective endocarditis Journal of addiction medicine early view 2021  
Although universally recognized that Injection drug use-related infective endocarditis (IDU-IE) requires antibiotics and often requires cardiac surgery, most patients do not receive addiction treatment which substantially increases their risk of recurrent IDU-IE from drug use recurrence. Accordingly, a multidisciplinary approach integrating addiction treatment may benefit patients with IDU-IE. The authors describe the format and structure of a team called the Multidisciplinary Endocarditis Evaluation Team (MEET) whose purpose is to optimize, formalize, and standardize the care of patients with IDUIE. Given the complexity of IDU-IE, MEET is comprised of addiction medicine, anesthesia, cardiology, cardiac surgery, infectious disease, case management, nursing, and social work.

Better off alone? Comparing the substance use, mental health and trauma risks of youth alcohol and other drug service users either living in out of home care, living with parents or experiencing homelessness Drug and alcohol review 9 September 2021
The results demonstrate the similar and serious health and wellbeing risks facing both youths in residential out of home care (OoHC) and homeless youths. These results are concerning as one of these groups is ostensibly in the care of the community and government, while the other group is experiencing unstable accommodation and associated physical risks.

Primary care associated with follow up viral load testing in patients cured of Hepatitis C infection with direct acting antivirals at a multidisciplinary addiction treatment program: insights from a real-world setting Journal of addiction medicine early view 2021 
Over half of a cohort of patients with substance use disorder cured of hepatitis C virus infection (HCV) received Follow up viral load testing (FUVL). The relationship between FUVL and engagement in primary medical and substance use treatment highlights the importance of integrated systems in providing longitudinal care for patients cured of HCV. Standardized interventions that facilitate FUVL testing and management of infectious complications of SUD in addiction treatment settings are needed.

Emergency department-initiated buprenorphine and referral to follow-up addiction care: A program description Journal of addiction medicine early view 2021 
Initiating treatment for OUD in the ED was associated with increased engagement in outpatient addiction care.

Participant experiences of a quit smoking attempt through either nicotine replacement therapy (NRT) methods or the use of an e-cigarette Journal of addiction medicine early view 2021 
Participant e-cigarette experience were generally positive; however, concerns over long-term application were noted. There was a noticeable preference for nicotine-containing e-cigarettes, but further research is required to better understand how nicotine is used in conjunction with e-cigarettes long-term as a quit aid alongside other NRT.

Adolescent, parent, and provider perspectives of a social-media-based support tool for parents of teens in treatment for substance use Journal of addictions nursing 17 September 2021 
Adolescent substance use disorder contributes to negative psychosocial and physical health outcomes. Parents best support their child's treatment and recovery when they are equipped with knowledge and skills; however, barriers hinder parental engagement. Social-media-based groups present an opportunity for parents who may not otherwise seek support. Qualitative data were collected via focus groups to examine the opinions of adolescents, parents, and treatment providers on the potential utility and possible concerns of a Facebook-based parent support group; input constituted the development phase for an online group (PURPOSE). Fifty-eight participants, recruited through adolescent treatment programs, took part in six focus groups: two parent (n = 18), two adolescent (n = 21), and two provider (n = 19) groups. Groups were audio recorded and transcribed, and themes were extracted. Three main themes emerged: (a) traditional support groups and treatment services, (b) PURPOSE intervention content and delivery, and (c) issues related to PURPOSE implementation. Traditional treatment/support groups can be helpful, but participation in them is limited. Emotional support offered by peers is valuable, but parents also need and seek out psychoeducation, parenting skills, and self-care support. PURPOSE could offer easy access to skills and real-time peer support.

Time to rethink tobacco dependence treatment in Australia Australian and New Zealand journal of public health 16 September 2021
Australia leads in many other aspects of Framework Convention on Tobacco Control (FCTC) implementation but is not yet delivering a systematic approach to TDT systems as part of a comprehensive national approach to reducing smoking prevalence. This is not an either/or scenario in which tobacco dependence treatment (TDT) for individuals is prioritised over population level interventions. Article 14 specifically recognises the role population level interventions have in driving motivation to quit. There is no ‘magic bullet’ that can reduce smoking prevalence. It requires a multi-faceted, coordinated and comprehensive approach.

Strategies to improve smoking cessation rates in primary care Cochrane Database of Systematic Reviews – Intervention 6 September 2021 
There is moderatecertainty evidence that providing adjunctive counseling by an allied health professional, costfree smoking cessation medications, and tailored printed materials as part of smoking cessation support in primary care can increase the number of people who achieve smoking cessation.

Electronic cigarettes for smoking cessation Cochrane Database of Systematic Reviews – Intervention 14 September 2021 
There is moderatecertainty evidence that electronic cigarettes (ECs) with nicotine increase quit rates compared to NRT and compared to ECs without nicotine.

Australia could miss the WHO hepatitis C virus elimination targets due to declining treatment uptake and ongoing burden of advanced liver disease complications Plos one 16 September 2021 
Australia was one of the first countries to introduce government-funded unrestricted access to direct-acting antiviral (DAA) therapy, with 88,790 treated since March 2016. However, treatment uptake is declining which could potentially undermine Australia’s progress towards the WHO HCV elimination targets.


2021 NDRI Symposium: (Virtual) - Working Together: Community Collaboration in Drug Policy and Practice Research
6 October 2021 
Synopsis: The NDRI symposium program includes presentations and panel sessions on research into alcohol and illicit drug policy, harm, prevention and trends as well as partnership approaches to addressing AOD harm in Aboriginal communities.

NDARC Annual Research Symposium (Virtual)
When: 20 October – 22 October 2021 

Synopsis The Symposium will showcase the wide variety and depth of research and programs at NDARC, facilitate dynamic discussions, and provide opportunities to create new connections.


Treating patients with traumatic brain injury SAMHSA (US)
There is a well-documented association between TBI and behavioral health comorbidities, including depression, anxiety, suicide, and substance use disorders. . Recognizing that a patient has a potentially problematic history of TBI and adapting both one’s style of interaction and treatment planning can greatly reduce the additional challenges this population faces when addressing a behavioral health problem.

Ketamine for the treatment of addictions and mental health
Wed. 27 Oct 2021 10:00 am – 11:00 am AEST (QLD time) 
Synopsis:  How does ketamine work in the treatment of Substance Use Disorders and Mental Health? How is it used around the world and what the evidence?

Updated 19 October 2021

Asymptomatic SARS-CoV-2 vaccine breakthrough infections in health care workers identified through routine universal surveillance testing
Our results indicate that systematic surveillance of asymptomatic vaccinated HCWs uncovers many times more cases of vaccine breakthrough (VBT) infection than symptom-based testing. Annals of internal medicine 19 October 2021

Association between tumor necrosis factor inhibitors and the risk of hospitalization or death among patients with immune-mediated inflammatory disease and COVID-19
In this cohort study, TNF inhibitor monotherapy was associated with a lower risk of adverse COVID-19 outcomes compared with other commonly prescribed immunomodulatory treatment regimens among individuals with IMIDs. JAMA 18 October 2021

The impact of re‐opening the international border on COVID19 hospitalisations in Australia: a modelling study
If highly transmissible SARS‐CoV‐2 variants are circulating locally or overseas, large and disruptive COVID‐19 outbreaks will still be possible in Australia after 80% of people aged 16 years or more have been vaccinated. Continuing public health measures to restrict the spread of disease are likely to be necessary throughout 2022. MJA 18 October 2021

The readability of official public health information on COVID‐19
Public health information should be easily accessible to the general public. Despite the WHO5 and the National Academy of Medicine6 endorsing plain language, practice has not been aligned with guidelines. The high health literacy demands of vaccination information in Australia has important implications for vaccination uptake. Successfully managing the COVID‐19 pandemic requires a whole‐of‐community response based on effective public communication and a commitment to health literacy. MJA 18 October 2021

What's new at this update

Casirivimab/ imdevimab recommended for treatment of COVID-9

  • The World Health Organization (WHO) has updated its living therapeutics guideline to include new recommendations for the use of casirivimab/imdevimab. The WHO recommends the treatment for patients with non-severe disease who are at highest risk of hospitalisation, and those with severe disease and a seronegative status.
  • The UK National Institute for Health and Care Excellence has also updated its living guideline to recommend casirivimab/imdevimab for hospitalised patients with a seronegative status, provided they meet certain eligibility criteria.
  • US guidelines currently recommend casirivimab/imdevimab for both treatment and post-exposure prophylaxis.
  • See the Emerging section for more information.

Application for authorisation of first oral antiviral for COVID-19 submitted to FDA

  • The manufacturer of molnupiravir, an experimental oral antiviral, has submitted an emergency-use authorisation application to the US Food and Drug Administration for the treatment of mild to moderate disease in at-risk adults. If authorised, it will be the first oral antiviral available for COVID-19.
  • See the Emerging section for more information.

WHO scientific brief summarises current knowledge about infection and transmission in children

  • Infections among children and adolescents typically cause less severe disease and fewer deaths compared with adults. While a less severe disease course is a positive outcome, milder symptoms may have resulted in less testing and fewer identified cases. Therefore, children and adolescents who are asymptomatic or have mild symptoms may transmit the disease and contribute to transmission in the community. This understanding is important for developing, adapting, and improving control measures for COVD-19, especially since vaccination is not currently available or authorised for those under 12 years.
  • See the Epidemiology section for more information.

BMJ 14 October 2021

Effectiveness of therapeutic heparin versus prophylactic heparin on death, mechanical ventilation, or intensive care unit admission in moderately ill patients with covid-19 admitted to hospital: RAPID randomised clinical trial
In moderately ill patients with covid-19 and increased D-dimer levels admitted to hospital wards, therapeutic heparin was not significantly associated with a reduction in the primary outcome but the odds of death at 28 days was decreased. The risk of major bleeding appeared low in this trial. BMJ 14 October 2021

Virologic features of SARS-CoV-2 infection in children
Symptomatic and asymptomatic children can carry high quantities of live, replicating SARS-CoV-2, creating a potential reservoir for transmission and evolution of genetic variants. As guidance around social distancing and masking evolves following vaccine uptake in older populations, a clear understanding of SARS-CoV-2 infection dynamics in children is critical for rational development of public health policies and vaccination strategies to mitigate the impact of COVID-19. Journal of infectious diseases 14 October 2021

Covid-19 breakthrough infections in vaccinated health care workers
Among fully vaccinated health care workers, the occurrence of breakthrough infections with SARS-CoV-2 was correlated with neutralizing antibody titers during the peri-infection period. Most breakthrough infections were mild or asymptomatic, although persistent symptoms did occur. NEJM 14 October 2021

Audio Interview: Reporting on Covid-19
In this audio interview conducted on October 12, 2021, the editors are joined by award-winning science writer Katherine Wu of the Atlantic to discuss dealing with rapid change and uncertainty in Covid news. NEJM 14 October 2021

Sociodemographic, clinical, and immunological factors associated with SARS-CoV-2 diagnosis and severe COVID-19 outcomes in people living with HIV: a retrospective cohort study
People living with HIV with detectable HIV viraemia, chronic comorbidities, and some subpopulations could be at increased risk of severe outcomes from COVID-19. These groups should be prioritised in clinical management and SARS-CoV-2 vaccination programmes. The Lancet HIV 13 October 2021

Short-term and long-term rates of postacute sequelae of SARS-CoV-2 Infection: A systematic review
In this systematic review, more than half of COVID-19 survivors experienced PASC 6 months after recovery. The most common PASC involved functional mobility impairments, pulmonary abnormalities, and mental health disorders. These long-term PASC effects occur on a scale that could overwhelm existing health care capacity, particularly in low- and middle-income countries. JAMA 13 October 2021

Increasing ICU capacity to accommodate higher demand during the COVID-19 pandemic
The number of currently available staffed ICU beds was lower than in 2020. Equipment shortfalls have been remediated, with sufficient ventilators to equip every ICU bed. ICU capacity can be increased in response to demand, but is constrained by the availability of appropriately trained staff. Fewer than half the potentially additional physical ICU beds could be opened with currently available staff levels while maintaining pre-pandemic models of care. MJA 12 October 2021

Anti-SARS-CoV-2 IgA identifies asymptomatic infection in first responders
First responders are at high risk of infection with SARS-CoV-2. IgA testing identified a significant portion of cases missed by IgG testing and its use as part of serologic surveys may improve retrospective identification of asymptomatic infection.  Journal of infectious diseases 12 October 2021

Longitudinal respiratory subphenotypes in patients with COVID-19-related acute respiratory distress syndrome: results from three observational cohorts
At baseline, COVID-19-related ARDS has no consistent respiratory subphenotype. Patients diverged from a fairly homogenous to a more heterogeneous population, with trajectories of ventilatory ratio and mechanical power being the most discriminatory. Modelling these parameters alone provided prognostic value for duration of mechanical ventilation and mortality. The Lancet respiratory medicine 12 October 2021

Antibody responses after SARS-CoV-2 mRNA vaccination in adults with inflammatory bowel disease
These findings showing seroconversion across medication groups are consistent with those seen in other IBD studies. In contrast, transplant recipients have lower rates of seroconversion, likely related to B-cell–depleting medications and combined therapies. Whether biologic and small-molecule therapies accelerate waning of titers over time is not yet known, but our results may reassure patients receiving these medications that initial humoral responses to mRNA vaccines are generally robust. Annals of internal medicine 12 October 2021

Association between risk of COVID-19 infection in nonimmune individuals and COVID-19 immunity in their family members
These results suggest that COVID-19 vaccines play a key role in reducing the transmission of the virus within families, which likely has implications for herd immunity and pandemic control. JAMA 11 October 2021

A continuously benchmarked and crowdsourced challenge for rapid development and evaluation of models to predict COVID-19 diagnosis and hospitalization
In this diagnostic and prognostic study, models submitted by citizen scientists achieved high performance for the prediction of COVID-19 testing and hospitalization outcomes. Evaluation of challenge models on demographic subgroups and prospective data revealed performance discrepancies, providing insights into the potential bias and limitations in the models. JAMA 11 October 2021

Effect of antithrombotic therapy on clinical outcomes in outpatients with clinically stable symptomatic COVID-19 : The ACTIV-4B randomized clinical trial
Among symptomatic clinically stable outpatients with COVID-19, treatment with aspirin or apixaban compared with placebo did not reduce the rate of a composite clinical outcome. However, the study was terminated after enrollment of 9% of participants because of an event rate lower than anticipated. JAMA 11 October 2021

The ethics of human challenge trials using emerging SARS-CoV-2 virus variants
The world’s first COVID-19 human challenge trial using the D614G strain of SARS-CoV-2 is underway in the United Kingdom. The Wellcome Trust is funding challenge stock preparation of the Beta and Delta variant for a follow-up human challenge trial, and researchers at hVIVO are considering conducting these trials. However, little has been written thus far about the ethical justifiability of human challenge trials with SARS-CoV-2 variants of concern. The authors explore two specific characteristics of some variants that may initially be thought to make such trials unethical and conclude that SARS-CoV-2 variant challenge trials can remain ethical. Journal of infectious diseases 8 October 2021

Bamlanivimab plus Etesevimab in mild or moderate Covid-19
Among high-risk ambulatory patients, bamlanivimab plus etesevimab led to a lower incidence of Covid-19–related hospitalization and death than did placebo and accelerated the decline in the SARS-CoV-2 viral load. NEJM 7 October 2021

SARS-CoV-2 RNAemia and clinical outcomes in children with COVID-19
The burden of COVID-19 in children represents a fraction of cases worldwide, yet a subset of those infected are at risk for severe disease. The authors measured plasma SARS-CoV-2 RNA in a cohort of 103 children hospitalized with COVID-19 with diverse clinical manifestations. SARS-CoV-2 RNAemia was detected in 27 (26%) of these children, lasted for a median of 6 [2-9] days, and it was associated with higher rates of oxygen administration, admission to the intensive care unit, and longer hospitalization.  Journal of infectious diseases 7 October 2021

Audio Interview: Are Covid-19 vaccine boosters necessary?
In this audio interview conducted on October 5, 2021, the editors discuss four new studies that inform two questions: Are Covid-19 vaccine boosters needed, and are they safe? NEJM 7 October 2021

Efficacy and safety of therapeutic-dose heparin vs standard prophylactic or intermediate-dose heparins for thromboprophylaxis in high-risk hospitalized patients with COVID-19 : The HEP-COVID randomized clinical trial
Thromboprophylaxis with therapeutic-dose low-molecular-weight heparin reduces a composite outcome of major thromboembolism and death in high-risk inpatients with COVID-19. JAMA 7 October 2021

Female authorship of covid-19 research in manuscripts submitted to 11 biomedical journals: cross sectional study
Women have been underrepresented as co-authors and in prominent authorship positions in covid-19 research, and this gender disparity needs to be corrected by those involved in academic promotion and awarding of research grants. Women attained some prominent authorship positions equally or more frequently than before the pandemic on non-covid-19 related manuscripts submitted at some time points during the pandemic. BMJ 6 October 2021

Waning immune humoral response to BNT162b2 Covid-19 vaccine over 6 months
Six months after receipt of the second dose of the BNT162b2 vaccine, humoral response was substantially decreased, especially among men, among persons 65 years of age or older, and among persons with immunosuppression. NEJM 6 October 2021

Waning of BNT162b2 vaccine protection against SARS-CoV-2 Infection in Qatar
BNT162b2-induced protection against SARS-CoV-2 infection appeared to wane rapidly following its peak after the second dose, but protection against hospitalization and death persisted at a robust level for 6 months after the second dose. NEJM 6 October 2021

Deaths involving COVID-19 by self-reported disability status during the first two waves of the COVID-19 pandemic in England: a retrospective, population-based cohort study
Given the association between disability and mortality involving COVID-19, verification of these findings and consideration of recommendations for protective measures are now required. The Lancet public health 6 October 2021

Duration of viral nucleic acid shedding and early reinfection with the severe respiratory syndrome Coronavirus 2 (SARS-CoV-2) in health care workers and first responders
The authors estimated the distributions of duration of SARS-CoV-2 nucleic acid shedding and time to reinfection among 137 persons with at least two positive nucleic acid amplification test (NAAT) results from March to September 2020. They analyzed gaps of varying length between subsequent positive and negative NAAT results and estimated a mean duration of nucleic acid shedding of 30.1 (95% CI 26.3, 34.5) days. The mean time to reinfection was 89.1 (95% CI 75.3, 103.5) days. Together, these indicate that a 90-day period between positive NAAT results can reliably define reinfection in immunocompetent persons although reinfection can occur at shorter intervals. Journal of infectious diseases 5 October 2021

Effect of COVID-19 pandemic lockdowns on planned cancer surgery for 15 tumour types in 61 countries: an international, prospective, cohort study
Cancer surgery systems worldwide were fragile to lockdowns, with one in seven patients who were in regions with full lockdowns not undergoing planned surgery and experiencing longer preoperative delays. The Lancet oncology 5 October 2021

Update Alert 2: Should Remdesivir be used for the treatment of patients with COVID-19? rapid, living practice points from the American College of Physicians (Version 2)

  • Practice Point 1: Consider remdesivir for 5 days to treat hospitalized patients with COVID-19 who do not require invasive ventilation or extracorporeal membrane oxygenation (ECMO).
  • Practice Point 2: Consider extending the use of remdesivir to 10 days to treat hospitalized patients with COVID-19 who require invasive ventilation or ECMO within a 5-day course.
  • Practice Point 3: Avoid initiating remdesivir to treat hospitalized patients with COVID-19 who are already on invasive ventilation or ECMO. Annals of internal medicine 5 October 2021

Association of Serum Ferritin Levels and Methylprednisolone treatment with outcomes in nonintubated patients with severe COVID-19 Pneumonia
These findings suggest that ferritin levels on admission may be used as a marker associated with corticosteroid response among patients with severe COVID-19 pneumonia. JAMA 4 October 2021

Acute Myocarditis following COVID-19 mRNA vaccination in adults aged 18 years or older
In this population-based cohort study of 2 392 924 individuals who received at least 1 dose of COVID-19 mRNA vaccines, acute myocarditis was rare, at an incidence of 5.8 cases per 1 million individuals after the second dose (1 case per 172 414 fully vaccinated individuals). The signal of increased myocarditis in young men warrants further investigation. JAMA 4 October 2021

Effect of convalescent plasma on organ support–free days in critically ill patients with COVID-19 : A randomized clinical trial
Among critically ill adults with confirmed COVID-19, treatment with 2 units of high-titer, ABO-compatible convalescent plasma had a low likelihood of providing improvement in the number of organ support–free days. JAMA 4 October 2021

Effectiveness of mRNA BNT162b2 COVID-19 vaccine up to 6 months in a large integrated health system in the USA: a retrospective cohort study
The results provide support for high effectiveness of BNT162b2 against hospital admissions up until around 6 months after being fully vaccinated, even in the face of widespread dissemination of the delta variant. Reduction in vaccine effectiveness against SARS-CoV-2 infections over time is probably primarily due to waning immunity with time rather than the delta variant escaping vaccine protection. The Lancet 4 October 2021

The durability of immunity against reinfection by SARS-CoV-2: a comparative evolutionary study
The timeframe for reinfection is fundamental to numerous aspects of public health decision making. As the COVID-19 pandemic continues, reinfection is likely to become increasingly common. Maintaining public health measures that curb transmission—including among individuals who were previously infected with SARS-CoV-2—coupled with persistent efforts to accelerate vaccination worldwide is critical to the prevention of COVID-19 morbidity and mortality. The Lancet microbe 1 October 2021

Association of children’s physical activity and screen time with mental health during the COVID-19 Pandemic
In this cross-sectional survey study, more physical activity and less screen time were associated with better mental health for children, accounting for pandemic stressors. Children engaged in suboptimal amounts of physical activity and screen time, making this a potentially important target for intervention. JAMA 1 October 2021

Humoral immune response in hematooncological patients and health care workers who received SARS-CoV-2 vaccinations
The study findings suggest that lower SARS-CoV-2 antibody levels in patients with cancer after vaccination compared with vaccinated health care workers, and particularly weak seroconversion in specific subgroups, highlight the need for dedicated vaccination trials in patients with cancer. JAMA 30 September 2021

Assessment of communication strategies for mitigating COVID-19 vaccine-specific hesitancy in Canada
These findings suggest that communication strategies that focus on the death prevention potential of less-preferred COVID-19 vaccines have the potential to improve their uptake, whereas focusing on such metrics as their comparatively less impressive overall effectiveness at preventing symptomatic COVID-19 could undermine these efforts. JAMA 30 September 2021

Audio interview: Covid-19 and the media
In this audio interview conducted on September 28, 2021, the editors are joined by former ProPublica president Dick Tofel to discuss Covid-19 coverage in the lay press, as well as new studies of vaccine and treatment efficacy. NEJM 30 September 2021

REGEN-COV antibody combination and outcomes in outpatients with Covid-19
REGEN-COV reduced the risk of Covid-19–related hospitalization or death from any cause, and it resolved symptoms and reduced the SARS-CoV-2 viral load more rapidly than placebo. NEJM 29 September 2021

Phase 3 safety and efficacy of AZD1222 (ChAdOx1 nCoV-19) Covid-19 vaccine
AZD1222 was safe and efficacious in preventing symptomatic and severe Covid-19 across diverse populations that included older adults. NEJM 29 September 2021

The role of viral genomics in understanding COVID-19 outbreaks in long-term care facilities 
The authors reviewed all genomic epidemiology studies on COVID-19 in long-term care facilities (LTCFs) that had been published to date. The Lancet microbe 29 September 2021

Extracorporeal membrane oxygenation for COVID-19: evolving outcomes from the international Extracorporeal Life Support Organization Registry
Mortality after ECMO for patients with COVID-19 worsened during 2020. These findings inform the role of ECMO in COVID-19 for patients, clinicians, and policy makers. The Lancet 29 September 2021

COVID-19 hospital admissions and deaths after BNT162b2 and ChAdOx1 nCoV-19 vaccinations in 2·57 million people in Scotland (EAVE II): a prospective cohort study
COVID-19 hospitalisations and deaths were uncommon 14 days or more after the first vaccine dose in this national analysis in the context of a high background incidence of SARS-CoV-2 infection and with extensive social distancing measures in place. Sociodemographic and clinical features known to increase the risk of severe disease in unvaccinated populations were also associated with severe outcomes in people receiving their first dose of vaccine and could help inform case management and future vaccine policy formulation. The Lancet respiratory medicine 29 September 2021

Symptoms and health outcomes among survivors of COVID-19 infection 1 year after discharge from hospitals in Wuhan, China
This study reported prolonged symptoms of COVID-19 and found that severe disease during hospitalization was a risk factor for more symptoms and higher chronic obstructive pulmonary disease assessment test scores. JAMA 29 September 2021.

Myocarditis and Pericarditis after vaccination for COVID-19
Two distinct self-limited syndromes, myocarditis and pericarditis, were observed after COVID-19 vaccination. Myocarditis developed rapidly in younger patients, mostly after the second vaccination. Pericarditis affected older patients later, after either the first or second dose. Some vaccines are associated with myocarditis,5 including mRNA vaccines, and the Centers for Disease Control and Prevention recently reported a possible association between COVID-19 mRNA vaccines and myocarditis, primarily in younger male individuals within a few days after the second vaccination, at an incidence of about 4.8 cases per 1 million. JAMA 28 September 2021

COVID-19 vaccine nasal spray
Administering the Oxford/AstraZeneca COVID-19 vaccine through the nose reduced viral shedding in animal models, a recent study led by a National Institute of Allergy and Infectious Diseases (NIAID) scientist found. University of Oxford researchers are now conducting an open-label clinical trial of the intranasal vaccine in healthy human volunteers. JAMA 28 September 2021

Using after-action reviews of outbreaks to enhance public health responses: lessons for COVID-19
After-action reviews (AARs) of Australian outbreaks have led to recommendations for enhancing readiness to respond.

  • Recommendations for improvement from 14 Australian public health outbreak reviews facilitated between 2006 and 2020 were analysed for common themes and implications for the ongoing COVID-19 response.
  • The challenges repeatedly identified in the AARs related to: information management and interagency access; incident command systems (ICS); surge response; clarification of outbreak leadership; communication; rapid risk assessment and decision support
  • A national framework for enhancing outbreak response should embed AARs as standard practice supported by a national register of ARRs’ findings and recommendations.
  • Learnings from past outbreaks and intra-action reviews could further enhance pandemic responses.

MJA 27 September 2021

Trajectory of COVID-19 vaccine hesitancy over time and association of initial vaccine hesitancy with subsequent vaccination
This cohort study found that COVID-19 vaccine hesitancy is not a stable trait precluding vaccination but, instead, is labile. Hesitancy decreased between late 2020 and early 2021, with nearly one-third (32%) of persons who were initially hesitant being vaccinated at follow-up and more than one-third (37%) transitioning from vaccine hesitant into vaccine willing. JAMA 24 September 2021

Update to living WHO guideline on drugs for covid-19
This living guideline by Lamontagne and colleagues (BMJ 2020;370:m3379) has been updated. BMJ 23 September 2021

Antibody and cellular therapies for treatment of covid-19: a living systematic review and network meta-analysis
In patients with non-severe covid-19, casirivimab-imdevimab probably reduces hospitalisation; bamlanivimab-etesevimab, bamlanivimab, and sotrovimab may reduce hospitalisation. Convalescent plasma, IVIg, and other antibody and cellular interventions may not confer any meaningful benefit. BMJ 23 September 2021

Covid-19 vaccination: evidence of waning immunity is overstated
The case for universal boosters is weak, and the benefits are unclear. BMJ 23 September 2021

Humoral and T-Cell response to SARS-CoV-2 vaccination in patients with Multiple Sclerosis treated with Ocrelizumab
In this study, patients with MS who were treated with ocrelizumab generated comparable SARS-CoV-2–specific T-cell responses with healthy controls and had lower antibody response following vaccination. Given the potential role of T cells in protection from severe disease, this is reassuring and will help physicians develop consensus guidelines regarding MS treatment in the era of the COVID-19 pandemic. JAMA 23 September 2021

Association of disease-modifying treatment and Anti-CD20 infusion timing with humoral response to 2 SARS-CoV-2 vaccines in patients with multiple sclerosis
In this study, the humoral response against SARS-CoV-2 at 1 month after vaccination was appropriate under treatment with cladribine and teriflunomide and diminished/absent under treatment with anti-CD20 therapies and S1P modulators. JAMA 23 September 2021

Ways that mental health professionals can encourage COVID-19 Vaccination
This Viewpoint reviews what little is known about mental health and vaccination behavior and addresses 3 areas for intervention by mental health professionals, based on the Increasing Vaccination Model. JAMA 23 September 2021

The impact of real-time whole genome sequencing in controlling healthcare-associated SARS-CoV-2 outbreaks
Nosocomial SARS-CoV-2 infections have severely affected bed capacity and patient flow. The authors utilised whole genome sequencing (WGS) to identify outbreaks and focus infection control resources and intervention during the UK’s second pandemic wave in late 2020. Phylogenetic analysis of WGS and epidemiological data pinpointed an initial transmission event to an admission ward, with immediate prior community infection linkage documented. High incidence of asymptomatic staff infection with genetically identical viral sequences was also observed, which may have contributed to the propagation of the outbreak. WGS allowed timely nosocomial transmission intervention measures, including admissions ward point of care testing and introduction of portable HEPA14 filters. Conversely WGS excluded nosocomial transmission in two instances with temporospatial linkage, conserving time and resources. In summary, WGS significantly enhanced understanding of SARS-CoV-2 clusters in a hospital setting, both identifying high risk areas and conversely validating existing control measures in other units, maintaining clinical service overall. Journal of infectious diseases 23 September 2021

Audio Interview: Vaccine efficacy and boosters in Covid-19
In this audio interview conducted on September 21, 2021, the editors discuss vaccine booster recommendations from an FDA advisory committee, as well as new data on SARS-CoV-2 vaccine effectiveness. NEJM 23 September 2021

Safety and efficacy of NVX-CoV2373 Covid-19 vaccine
A two-dose regimen of the NVX-CoV2373 vaccine administered to adult participants conferred 89.7% protection against SARS-CoV-2 infection and showed high efficacy against the B.1.1.7 variant. NEJM 23 September 2021

Subcutaneous REGEN-COV antibody combination to prevent Covid-19
Subcutaneous REGEN-COV prevented symptomatic Covid-19 and asymptomatic SARS-CoV-2 infection in previously uninfected household contacts of infected persons. Among the participants who became infected, REGEN-COV reduced the duration of symptomatic disease and the duration of a high viral load. NEJM 23 September 2021

Mask Wars
This graphic perspective explores the fraught history of masking as a preventative intervention in public health crises. Masks themselves have evolved, but the existence of mask slackers and questions about balancing individual right with the public good are not new. NEJM 23 September 2021

Infections, hospitalisations, and deaths averted via a nationwide vaccination campaign using the Pfizer–BioNTech BNT162b2 mRNA COVID-19 vaccine in Israel: a retrospective surveillance study
Without the national vaccination campaign, Israel probably would have had triple the number of hospitalisations and deaths compared with what actually occurred during its largest wave of the pandemic to date, and the health-care system might have become overwhelmed. Indirect effects and long-term benefits of the programme, which could be substantial, were not included in these estimates and warrant future research. The Lancet infectious diseases 22 September 2021

Clinical characteristics of multisystem inflammatory syndrome in adults: A systematic review
hese findings suggest that MIS-A is a serious hyperinflammatory condition that presents approximately 4 weeks after onset of acute COVID-19 with extrapulmonary multiorgan dysfunction. JAMA 22 September 2021

Efficacy of the mRNA-1273 SARS-CoV-2 vaccine at completion of blinded phase
The mRNA-1273 vaccine continued to be efficacious in preventing Covid-19 illness and severe disease at more than 5 months, with an acceptable safety profile, and protection against asymptomatic infection was observed. NEJM 22 September 2021

Effectiveness of mRNA Covid-19 vaccine among U.S. health care personnel
The BNT162b2 and mRNA-1273 vaccines were highly effective under real-world conditions in preventing symptomatic Covid-19 in health care personnel, including those at risk for severe Covid-19 and those in racial and ethnic groups that have been disproportionately affected by the pandemic. NEJM 22 September 2021

Assessment of a program for SARS-CoV-2 screening and environmental monitoring in an urban public school district
This study suggests that routine SARS-CoV-2 testing may identify infected staff and students who are not identified through conventional case detection and may provide insight into disease burdens of undertested communities. JAMA 22 September 2021