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Is artificial intelligence (AI) a help or hazard? While the industry continues to be divided on the matter, ECRI — a non-profit organisation aimed at improving the safety, quality and cost-effectiveness of care — has named it as the top health technology hazard for 2025 in its annual report.
“The promise of artificial intelligence’s capabilities must not distract us from its risks or its ability to harm patients and providers,” said Marcus Schabacker, MD, PhD, president and chief executive officer of ECRI, when launching the report.
Schabacker emphasised how balancing innovation in AI with privacy and safety will be one of the most difficult, and most defining, endeavours of modern medicine.
The organisation’s nine other health technology hazards for 2025, in ranked order, are: unmet technology support needs for home care patients; vulnerable technology vendors and cybersecurity threats; substandard or fraudulent medical devices and supplies; fire risk from supplemental oxygen; dangerously low default alarm limits on anaesthesia units; mishandled temporary holds on medication orders; poorly managed infusion lines; harmful medical adhesive
products; and incomplete investigations of infusion system incidents.
Healthcare organisations need to strengthen and improve their processes and systems to reduce potential risks and improve patient care and safety.
In this issue’s lead article, Annette Schmiede, CEO of Digital CRC, acknowledges some of the challenges that come with growing penetration of new technologies, but also emphasises the need to address issues such as access and interoperability while deploying solutions responsibly. This Technology Special edition of Hospital + Healthcare features content on a range of topics, including evolving models of care and virtual hospitals, cybersecurity in the age of AI, facility demands and innovation, midwifery care models, demand management in paediatrics and more.
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AI — an untapped opportunity, data access holds the key
Amy Sarcevic
An AI-enabled healthcare sector is a potentially idyllic place, where healthy habits are supported, early disease is detected, and, ultimately, deaths are prevented.
But while 85% of healthcare leaders have an AI strategy, much of this multibillion-dollar industry remains untapped, with clinical AI virtually non-existent in Australian hospitals.
Of those who are dabbling in other AI uses, penetration is limited, with only half of healthcare providers currently using the technology in other forms.
This contrasts with sectors like financial services, where global AI spend is projected to reach $97 billion by 2027.
So what is impeding the healthcare industry’s uptake of this readily available technology?
Access to data
The quality of AI decision-making from large language models largely rests on the quality of data used to train it — a realisation that has helped earn data kudos as the ‘new oil’.
Analysing data from electronic health records, an award-winning AI tool by Telstra Health, RMIT and the Digital Health CRC, for example, can detect early signs of deterioration in frail aged care residents.
“It monitors structured and free-text EHRs for 36 evidence-based signs of deterioration. In turn, it provides staff with a frailty index for each resident, and alerts them to falls, depression and mortality risk,” said Annette Schmiede, CEO of Digital CRC, the organisation that facilitated the research initiative.
However, as Schmiede points out, accessing healthcare data continues to be challenging, with organisations still facing delays when requesting it.
“We are still experiencing significant delays in access to data, despite it being constantly identified as an important element in driving innovation,” she told Hospital + Healthcare
“An example of this is a project we recently ran, which can only commence after two years of waiting for the data to be made available by the state authority.
“We have excellent relationships with the data custodians, we’re well respected, but the whole process is still taking too much time — and that needs some urgent attention.”
While Schmiede is encouraged by the government’s work with health information exchanges — in which health data is being uploaded onto common platforms — she says more work is needed to improve access in the interim.
“There’s widespread acknowledgement of the issue, but we’re still not seeing that being translated into faster access.”
Interoperability
The seamless exchange of data between disparate parts of the healthcare system is also important for end-users — and an ongoing source of frustration for those using new technologies to track health metrics.
“It’s great if you have an AI-powered health app that monitors your vitals over time. But if that information is not automatically added to your health records, then you need to repeatedly explain it to your GP, then to a specialist, and to an allied health professional.
“It affects the user experience for staff and patients, and opens the door for errors and
omissions, which takes away a lot of the benefit,” Schmiede said.
According to Dr Stephanie Allen from Kearney, part of the interoperability puzzle is ensuring that the data and insights collected by personal health devices or apps, are “clinical grade”, and don’t produce false positives.
“False positives can create unnecessary anxiety for users but also swamp the already stretched primary health system, with the expectation to ‘test’ again before a formal diagnosis is given,” she said.
In addition, data from different apps and devices should be brought together to paint a full picture of a person’s health.
“We know that our health is interconnected with many aspects of our lifestyle. For example, the relationship between mental wellbeing, nutrition and sleep is only beginning to be understood.
“Combining this data to form a more holistic picture of an individual’s health is fundamental to making the right behavioural adaptations, to protect and/or enhance our overall wellbeing.
“If we have variable levels of quality and reliability of data capture this becomes an impossibility,” Allen said.
Upskilling the workforce
Even a well-oiled healthcare system, with seamless connectivity, will not support the use and uptake of AI if end-users cannot easily navigate it.
For this reason, Digital CRC is taking steps to improve digital literacy and upskill the healthcare workforce, through its Education and Capacity building and Emerging Leaders programs.
“These were set up with the aim of producing the next generation of digital health professionals. Through this program, they will learn first-hand how to use digital health and data analytics to improve patient outcomes and clinician experiences,” Schmiede said.
“We are empowering this group to revolutionise health care and become change agents.”
Optimistic outlook
With projects like these, Schmiede is confident that Australia’s AI future is bright and that more people will feel empowered to use the technology.
“By introducing it responsibly, we can gradually build industry confidence. And as AI becomes more widespread, we’ll be forced to address issues like data access and interoperability head-on,” she concluded.
Rising healthcare facility demands
pave way for innovation
Lisa Whitehead, Vice President and General Manager, Pacific, Honeywell Building Automation
The pandemic and the years since have highlighted Australia’s severe nursing shortages, with research indicating we could face a shortfall of 100,000 nurses by 2025, creating a need for more — and more modern — facilities to house them and support Australian communities.
Meeting this challenge requires a multipronged approach centred on policy, people and property. In addition, there are a range of promising initiatives and developments across the sector and state and federal governments.
For example, the federal and Victorian governments have partnered and engaged with all states and territories and the nursing profession to develop the nation’s first National Nursing Workforce Strategy, which aims to equip, enable and support the delivery of care and aged care that the Australian population needs.
As part of its historic aged care reforms, the federal government recently reaffirmed its commitment from its Aged Care Taskforce Response to support a range of investments and changes to ensure residential aged care providers have the funds they need to invest in residents’ comfort, keeping facilities open and building new facilities in areas of need.
Meanwhile, in Victoria, the government’s Regional and Metropolitan Health Infrastructure Funds are delivering more than $1 billion combined to improve the safety and quality of services, enhance service capacity and efficiency, and provide other benefits across Melbourne and regional Victoria.
With modern design, construction, engineering and healthcare technology built in from the start, new facilities will stand out from facilities of the past, with a range of state-of-theart features, some of which will be directly observed by patients and clinical staff, while others operate in the background but improve experiences for all in the environment.
However, while new facilities can have a monumental impact on Australia’s health care, the demands we face mean we cannot neglect the extensive existing network of facilities we have in place. Many likely need significant upgrades to meet modern standards and broader strategic objectives.
Fortunately, modern innovation isn’t exclusive to future sites — there are examples of facilities improvements and safely building new state-of-the-art facilities within live hospital environments.
One such example is the cell and gene therapy Good Manufacturing Practice (GMP) manufacturing facility operated by Cell Therapies, co-located with the Peter MacCallum Cancer Centre in Melbourne. Cell Therapies manufactures ‘living’ cell-based therapies for clinical trials enabling access to innovative therapies for Australian patients with cancer, rare diseases and other serious medical conditions.
The facility’s building management technologies are purpose-built to address the ecosystem’s unique needs. Innovations include: a new building management system to assist in controlling energy and capturing data to remain compliant with stringent healthcare and pharmaceutical requirements;
operational technology to assist in the protection of scientists’ critical work; environmental management and monitoring systems to help keep air temperature and humidity at optimal levels; and redundancy of critical mechanical services for each of the facility’s cleanrooms.
The benefits of these technologies also go far beyond improving health care and the experience of workers, patients and visitors within healthcare facilities.
They can help support vital sustainability initiatives by reducing the carbon footprint of healthcare facilities. Buildings account for a staggering 37% of carbon emissions, and the healthcare industry is believed to be responsible for between 4.4 and 5.2%.
Further, integrating building management, life safety and security systems in one place can provide greater data and insights, enhanced physical and cyber security, and increased operational efficiency as Australia builds and retrofits the healthcare facilities we need for our future.
The unprecedented healthcare challenges we’ve experienced in the last five years, coupled with the clear and present challenges that lie ahead in terms of healthcare demand, should make the accelerated deployment of these technologies a national priority.
If successful, we can maintain Australia’s proud position as a global leader in health care and remain an attractive location for healthcare clinicians and researchers to work, live, and develop new treatments and therapies to save and improve lives.
The Rounds Updates in health care
Tool to predict risk of sudden cardiac arrest
A new gene mutation-specific test will help predict the severity of heart arrhythmia that could cause sudden cardiac arrest.
Scientists at the Victor Chang Cardiac Research Institute made the discovery in conjunction with colleagues at the Vanderbilt University Medical Centre.
Lead author Professor Jamie Vandenberg, Deputy Director of the Victor Chang Cardiac Research Institute, said the findings published in Circulation would enable patients with one of the most common inherited heart diseases — Long QT syndrome — to discover how severe their condition was.
“Genetic testing for inherited heart diseases has been transformative, but there have been limitations in what it can tell you. It might reveal you have the disease, but there has been no way of using this genetic information to determine how high your risk is for suffering a sudden cardiac arrest,” Vandenberg said.
“This will provide patients and their families with answers and better enable clinicians to tailor treatment appropriately.”
Long QT Syndrome affects people who are otherwise fit and healthy. Around one in 2000 Australians will have this condition. The researchers investigated 533 genetic variants or mutations associated with Long QT syndrome from 1458 patients. The mutations affect the function of ion channel gene variants.
They analysed every mutation and its function using a highspeed electrical test, a high-throughput automated patch clamp assay. They revealed which genetic mutations were the most dangerous by comparing these findings against traditional testing methods and using patient records. The researchers discovered that some genetic mutations reduced the function of the ion channel by up to 90%, resulting in a 13.3-fold greater risk of major cardiac events (arrhythmia, sudden death). A 75% reduction in function was associated with an 8.6-fold greater risk of major cardiac events.
How meal timing impacts chronic disease risk in night shift workers
Overnight eating may be increasing the risk of chronic health conditions for night shift workers, suggests a new study by the University of South Australia, University of Adelaide and SAHMRI.
Researchers undertook a six-day trial, involving 55 adults in the healthy BMI range, who don’t usually work night shifts, for the NHMRC-funded study, published in Diabetologia
Participants stayed at the University of South Australia’s Behaviour-BrainBody Sleep Research Centre and were divided into three groups: those who fasted at night, those who had snacks, and those who ate full meals. All participants stayed awake for four nights and slept during the day, with a recovery day on day five to re-establish normal sleeping and eating cycles, and blood glucose testing on day six.
Results showed participants who ate meals or snacks during the night shift had significantly worse glucose tolerance compared to those who fasted, said Professor Leonie Heilbronn, from SAHMRI and the University of Adelaide.
“We found that blood glucose skyrocketed for those who ate full meals at night and those who snacked, while the people who fasted at night showed an increase in insulin secretion which kept blood sugar levels balanced.”
“We know shift workers are more likely to have diabetes, they’re more likely to have heart disease, and they’re more likely to be overweight. Our research suggests that meal timing could be a major contributor to those issues,” Heilbronn said.
Insulin sensitivity was disrupted among all participants, regardless of their eating habits, adding to the body of evidence that night shifts cause circadian misalignment and impair glucose metabolism.
“When you eat a meal, your body secretes insulin, and that insulin helps your muscles and other tissues to take up glucose. If you become resistant to insulin, then you can’t take up that glucose as effectively into your muscles and if it continues, that potentially puts you at risk of diabetes.”
Lead investigator UniSA Professor Siobhan Banks said not eating large meals while working night shift and instead eating primarily during the day could be a straightforward intervention to manage health outcomes for many workers.
Researchers said future trials will investigate whether eating only protein snacks on night shift is a potential solution to satiating hunger without predisposing workers to negative health consequences.
Improving COPD diagnosis, care outcomes
Each year, more than 7600 Australians lose their lives to chronic obstructive pulmonary disease (COPD) and 53,000 people aged 45 and over are hospitalised. The hospital admissions are a staggering 1.7 times higher than the OECD average.
While one in 13 Australians over the age of 40 have COPD, only half of them know they have it. Awareness of this incurable lung disease — which makes it difficult to breathe — lags considerably behind other serious chronic health conditions, despite COPD being a leading cause of avoidable hospitalisations.
In a bid to accurately diagnose COPD patients, and keep them well and out of hospital, the Australian Commission on Safety and Quality in Health Care has developed the first national standard of care.
The new Chronic Obstructive Pulmonary Disease Clinical Care Standard is endorsed by 20 peak bodies, including leading lung health organisations, the Thoracic Society of Australia and New Zealand and Lung Foundation Australia.
Importantly, if a person consistently feels short of breath, has wheezing and a persistent ‘wet’ cough, they should talk to their doctor and get tested for COPD. While the inflamed airways and damaged air sacs in the lungs cannot be cured, treatment can reduce symptoms that make it hard to breathe, and help people avoid serious flareups that can lead to an emergency hospital admission.
High-quality care — a partnership between primary and secondary care
Respiratory physician Associate Professor Natasha Smallwood from The Alfred Hospital Melbourne, who is also President-Elect of the Thoracic Society of Australia and New Zealand, said the standard describes the care COPD patients should receive to improve their health longer-term.
“The new standard recognises the immense impact of COPD as a significant illness in Australia and as one of the leading causes of preventable hospital admissions,” she said.
Smallwood said a flare-up or exacerbation could unfold over days and was not always an instant change, so it was important for patients to know the signs and what management strategies to put in place.
“The Standard also emphasises the value of providing high-quality clinical care, for all patients living with COPD, wherever they’re being treated.
“High-quality care for COPD is a partnership between primary care including GPs, and secondary care including hospitals, because it is a condition that impacts people’s lives over many years. For all patients, it is vital they receive good care in their community close to home and that they understand how to stay well. We want to prevent people from becoming so unwell that they need a hospital admission.
“As healthcare practitioners, we need to communicate in a timely and effective way, particularly at transitions of care — whether someone is referred for specialist care or discharged from hospital and returning home after an exacerbation,” Smallwood said.
“The good news is that this clinical care standard also empowers COPD patients to self-manage their condition, to take control and give them the best chance of living well.
“There are many strategies people with COPD can use to live their best life; our job is to help them achieve that.”
Early identification
Medical Advisor for the Commission and general practitioner Dr Lee Fong said it was
important to identify COPD early, so that people could manage the condition and slow its progression.
“A breathing test called spirometry is the only way to know if you have COPD. Getting an accurate diagnosis is essential because treatment for COPD is different to other lung conditions with similar symptoms, like asthma.
“Feeling unable to breathe is an awful and scary thing. While there is no magic cure, if you’re living with COPD there are many things we can do that will make a big difference to how you live your life,” he said.
“If you smoke, quitting will certainly improve your health. Talk with your GP or healthcare provider who can help you find a way to quit.”
Best practice care
Once a person is diagnosed, Fong said it was important to get a COPD action plan and to know the right treatment, which may involve inhaler medicines and pulmonary (lung) rehabilitation.
“Most COPD medicines are given through an inhaler, but with multiple inhaler types, it’s really important to know how to use them properly to get the full dose. You may be surprised what a difference it makes,” he said.
The new guidance explains best practice care throughout a patient’s journey with COPD — starting with correct diagnosis, through to using medicines and pulmonary rehabilitation to stay well, managing flare-ups, and palliative
care techniques to ease symptoms throughout the person’s illness.
The standard aligns with current evidencebased Australian guidelines for COPD management, including the COPD-X Guidelines and Therapeutic Guidelines.
Dr Lee Fong, ACSQHC Medical Advisor and GP. Image courtesy of the Australian Commission on Safety and Quality in Health Care.
Providing 'gold standard' midwifery care
A new report reveals that women in rural Australia highly vale the Midwifery Group Practice (MGP) model, highlighting the importance of supporting rural services in providing quality maternity care.
Mothers at a small rural hospital in Victoria’s Goldfields that adopted this continuity of carer model, called MGP, said they felt “empowered” and “respected” during their labour and birth.
Over the past two decades, rural and remote locations in Australia have seen a decline of more than 200 birthing suites, with only 19% of the country’s population having access to the MGP model.
Personalised support
Labelled as ‘gold standard’ by La Trobe University researchers, the MGP model provides personalised support and enables a woman to be cared for by the same (or a backup) midwife throughout their entire pregnancy, labour and birth, and postnatal journey.
In May 2020, Dhelkaya Health (previously called Castlemaine Health) suspended its maternity service following an extensive review and concerns midwives were not utilising their full scope of practice under the hospital’s GP obstetric-led model at the time.
The one-year closure had an immense impact on the small community, located about 40 kilometres from the regional centre of Bendigo. A review recommended the development of the MGP model of midwifery care and in May 2021 the ward reopened, with the first birth occurring in early June.
“[For] the birth of my first child … the care was very impersonal. At Castlemaine, it was the opposite; I felt as though my midwife took the time to get to know me and my family, took the time to discuss any concerns and respected my decisions and preferences," said a study participant.
Continuity of care
Researchers from La Trobe’s Judith Lumley Centre evaluated the first 12 months of the MGP operation at Dhelkaya Health.
“Women’s experiences were overwhelmingly positive in demonstrating the impact it had on them, on their birthing experience, the transition to motherhood and their whole family,” Dr Laura Whitburn said.
“We know this type of care can lead to reduced rates of caesarean section and have better outcomes for the baby and the mother.
“The success is a testament to this service and how important continuity of care is for women and their birth experiences.”
The evaluation shared the experiences of 44 women, including 22 women who birthed at Dhelkaya Health, 18 women who were transferred to birth at Bendigo Health and two
women who birthed before arrival, from its reopening until May 2022.
Women particularly valued the continuity of care by a known midwife, the care tailored to their individual needs and circumstances, and the ability to access the service locally. They reported low levels of anxiety during labour and birth and felt that they coped physically and emotionally better than they anticipated.
Meeting community needs
April Jardine, Dhelkaya Health’s Maternity Unit Manager, works with a team of MGP midwives, core midwives and nurses from their Maternity Unit in Castlemaine. She said the key to the service’s success is its ability to leverage consumer insight to ensure the focus stays firmly on what’s most important to women and families.
“Dhelkaya Health continues to place a high value on the feedback and experiences of the women who experienced our continuity of carer model,” Jardine said.
“We collect ongoing data through a maternity consumer survey, with the results used to guide and shape the service to meet evolving community needs.”
The importance of continuity of carer was also highlighted by mothers who felt their experience was negatively affected when continuity was lost during transfer to another service.
The overall success of the MGP model at Dhelkaya Health has informed other rural maternity services across Victoria to introduce similar models, including Maryborough and Cohuna, which developed a model based on Castlemaine.
Supporting rural services
“I feel deeply, deeply honoured to have had the experience I had. I would give so much for every woman to have the sort of care and experience I had. I am beyond grateful Castlemaine opened up again,” a study participant said.
Whitburn said the findings support and expand on existing research regarding the value of midwifery continuity of carer models.
“Castlemaine’s success has become a catalyst and blueprint for how other rural services can create positive impacts on women and families,” Whitburn said.
“We hope this is another piece of evidence that points to more resourcing into supporting rural services to provide maternity care.”
Sustainable by design
The Victorian Health and Building Authority (VHBA) recently unveiled designs for the new Melton Hospital.
The designs reveal key spaces in the new hospital, including the main entrance, façade, main foyer, a patient room and waiting areas.
The design draws inspiration from the local landscape and ecosystems to provide patients, staff and visitors with strong connections to nature and Country. Like the local natural ecosystems, the design for the
all-electric hospital aims to be interconnected, life-sustaining and healing at all scales.
More than 1000 ideas and priorities from locals helped shape the designs — with the new hospital to include green spaces, artwork, intuitive and simple wayfinding, natural light, access to the outdoors, and the incorporation of local Indigenous culture and storytelling.
The Exemplar Health consortium was awarded the contract to deliver the new hospital and critical site preparation works are now underway.
The project will be delivered as a public–private partnership (PPP) under the Partnerships Victoria Framework. Melton Hospital will be a public hospital, with all clinical health services operated and provided by Western Health.
Victoria’s Minister for Health Infrastructure Mary-Anne Thomas said, “Melbourne’s west is one of the fastest-growing regions in the country and it is critical that families moving to the area can rely on 24-hour world-class health care right on their doorstep.”
The new $900 million hospital will have the capacity to treat 130,000 patients each year and almost 60,000 patients in its emergency department, supporting the growing communities of Melton, Caroline Springs, Rockbank, Bacchus Marsh and Gisborne.
Located close to Cobblebank Station, the hospital will include a 24-hour ED, at least 274 beds, an intensive care unit, maternity and neonatal services, mental health services, radiology services, outpatient care and teaching, training and research spaces.
The design phase of the project involves clinicians and user group meetings on key functional and operational details — including the location of beds, lights, doors and equipment required.
The new Melton Hospital hopes to reduce waiting times at other busy Melbourne hospitals and provide an essential link with services at Sunshine Hospital and the new $1.5 billion Footscray Hospital.
Images courtesy of VHBA
Featured Products
Keep up with the latest industry innovations
Flexible endoscope sterilisation
Olympus Australia’s Sapphire facility in Melbourne offers an on-demand solution to reduce the risks, costs and complexities associated with managing an endoscopy service.
It provides access to high-quality flexible endoscopes, delivered directly to hospitals in a sterile barrier with a microbiological test result, ready for immediate clinical use.
When device usage has been completed, Olympus collects and transports the endoscope from the hospital to the Sapphire reprocessing facility, where it undergoes a cleaning and sterilisation process in preparation for future clinical use.
This option for endoscope reprocessing will be particularly useful for regional and remote endoscopy units with limited endoscopes and reprocessing capabilities. These units will now have access to the latest endoscope technology for every procedure and for every patient.
Sapphire is a purpose-built facility where certified staff oversee the cleaning, disinfection and sterilisation process of endoscopes. The facility and its quality management system comply with Australian AS5369 Reprocessing of Reusable Medical Devices and ISO 13485 Medical Devices - Quality Management Systems.
Olympus Australia Pty Ltd www.olympusaustralia.com.au
Mammography platform
The Hologic 3D Envision mammography platform is built to tilt — a feature engineered to unlock a new perspective on patient positioning and yield consistent, high-quality imaging.
This platform has been designed to adapt to every patient contour, relaxing the pectoral muscle to improve tissue capture. In addition, tilt may help improve positioning of patients with limited mobility for more inclusive, accessible care.
Without increasing patient dose, the proprietary acquisition pathway is designed to offer a 2.5-second 3D scan time, generating fast, sharp high-resolution (70 µm) images. The Envision platform is engineered to streamline the mammography exam with the technologist in mind.
It features: advanced touchscreens that display prior to scans and activate procedure views to modify workflow; auto-MLO with angle memory that intuitively rotates to the appropriate location for repeatable and optimal positioning with few clicks; a streamlined surface for expanded positioning access, with a slimmer detector compared to the Hologic 3Dimensions system; and interactive displays which highlight essential positioning metrics for smarter, more connected care.
The Acquisition Workstation also includes personalised ergonomics, a biometric login and height adjustment, a modernised user interface, and integrated storage solutions. Hologic Inc www.hologic.com.au
Fabric mask
The ResMed AirTouch N30i tube-up nasal mask for CPAP features a nasal cradle design that contours to the shape of the wearer’s nose and face, while being gentle on the face and hair. The mask is breathable, and features a moisture-wicking design for comfort.
Other key features of the AirTouch N30i include: the ComfiSoft cushion and fabric-wrapped frame incorporate a fabric seal design with fabric coated over silicone; incorporating advanced technology into a compact, visually appealing design, with an aim to deliver performance, durability, and comfort; a customised fit using thousands of digital biomarkers; available in three cushion sizes — small, medium, and large — and two frame sizes: small and standard.
Resmed LTD www.resmed.com.au
Personal mobile alarm
The LiveLife Personal Mobile Alarm is an SOS pendant with automatic fall detection technology. As it uses the Telstra network, the alarm is mobile, making it suitable for people who want to feel safe out in the community, not just at home. It will work anywhere in Australia where there is network coverage.
In the event of an emergency or fall, the alarm will send an SMS to the elected contacts, alerting them of the event and providing the wearer’s location via Google Maps. The alarm then starts the call sequence and when the emergency contact answers, the wearer can talk hands-free through the pendant. Anyone who knows the number of the pendant can call it and it will answer in speakerphone mode.
The alarm can be programmed to contact either family and friends or the LiveLife A1 graded 24/7 monitoring centre. There are no lock-in contracts, allowing customers to switch between service models as their situation changes.
Available in black or white, the pendant is showerproof and comes with three complimentary accessories: a lanyard, wristband and clothing clip. The alarm comes fully programmed and the company offers free lifetime support. Additional optional features include geofencing, medication alerts, whitelisting, voice prompts in multiple languages and activity reminders.
The LiveLife Alarm is designed to provide safety and peace of mind to wearers and their family members, with help that is a button press away, at home or out in the community.
Live Life Alarms www.livelifealarms.com.au
Healthcare organizations can improve the nursing experience by tackling the most time-consuming part of their shift: charting and documentation. Ergotron’s medical carts and healthcare workstations are designed to support those who care for patients, offering customizable features that enhance nurse comfort and well-being.
The unintended impacts of antibiotic use
New research challenges the long-held belief that rifaximin — an antibiotic commonly prescribed for patients with liver disease — poses a ‘low risk’ for causing antibiotic resistance.
Published in Nature, the study found that the drug could, in fact, expose patients to a greater risk of a dangerous superbug: vancomycinresistant Enterococcus faecium (VRE).
The project, led by researchers from the University of Melbourne at the Peter Doherty Institute for Infection and Immunity (Doherty Institute) and Austin Health — highlights the critical need for a deeper understanding of the negative impacts of antibiotic use, according to the researchers.
Responsible use in clinical practice
Rifaximin has led to the global emergence of an almost untreatable form of VRE, which frequently causes serious infections in hospitalised patients — reinforcing the importance of responsible antibiotic use in clinical practice, according to the researchers. Their findings reinforce the recent political declaration of the UN General Assembly High-Level Meeting on Antimicrobial Resistance, where world leaders committed to decisive action on antimicrobial resistance, including reducing the estimated 4.95 million AMR-associated human deaths annually by 10% by 2030.
The eight-year study drew on several disciplines, including molecular microbiology, bioinformatics and clinical science. Using large-scale genomics — the study of an organism’s DNA makeup — the scientists were able to identify changes in the DNA of daptomycin-resistant VRE that were absent in susceptible strains. Subsequent laboratory experimentation and clinical studies showed that rifaximin use caused these changes and resulted in the emergence of daptomycinresistant VRE.
The University of Melbourne’s Dr Glen Carter, a Senior Research Fellow at the Doherty Institute and senior author of the study, said, “We’ve shown that rifaximin makes VRE resistant to daptomycin in a way that has not been seen before.
“It is also of concern that these daptomycinresistant VRE might be transmitted to other patients in the hospital; a hypothesis that we are presently investigating.”
The University of Melbourne’s Dr Adrianna Turner, a Research Officer at the Doherty Institute and first author of the study, said rifaximin triggers specific changes in an enzyme called RNA Polymerase within the bacteria. These changes “upregulate” a previously unknown gene cluster (prdRAB) leading to alterations in the VRE cell membrane and causing cross resistance to daptomycin.
“When bacteria become resistant to an antibiotic, it’s a bit like gaining a new ability in a video game, like super-speed. But when exposed to rifaximin, the VRE bacteria don’t just get one boost — they gain multiple abilities, like super-speed and super-strength, allowing them to easily defeat even the final boss, which in this case is the antibiotic daptomycin,” Turner said.
“In other words, rifaximin doesn’t just make bacteria resistant to one antibiotic; it can make them resistant to others, including critical last-resort antibiotics like daptomycin.”
Caution when treating infections
Associate Professor Jason Kwong, Infectious Diseases Physician at Austin Health and lead investigator of the clinical studies, emphasised two critical implications of the findings.
“Firstly, clinicians must exercise caution when treating VRE infections in patients who have been taking rifaximin, since daptomycin’s efficacy may be compromised, necessitating laboratory verification before use,” Kwong said.
“Secondly, the findings underscore the importance of regulatory bodies considering ‘off-target and cross class’ effects when approving new drugs. For antibiotics, this means understanding whether exposure to one agent, like rifaximin, could induce resistance against other antibiotics — even those that work differently.
“Rifaximin is still a very effective medication when used appropriately and patients with advanced liver disease who are currently taking it should continue to do so. But we need to understand the implications going forward both when treating individual patients and from a public health perspective.”
The University of Melbourne’s Dr Claire Gorrie, a senior bioinformatician from the Doherty Institute and co-senior author, said the research highlights how cutting-edge technologies, combined with interdisciplinary collaboration, can uncover exactly how and
why bacteria develop resistance to antibiotics — even those they’ve never encountered.
“These insights are crucial for developing smarter, more sustainable strategies for antibiotic use, especially as these life-saving drugs become an increasingly precious resource,” Gorrie said.
Genomics-based surveillance
Professor Benjamin Howden, the Director of the Microbiological Diagnostic Unit Public Health Laboratory at the Doherty Institute and an Infectious Diseases Physician at Austin Health, whose laboratory led the project, said the research will help ensure daptomycin remains an effective antibiotic for treating severe VRE infections in hospitals in Australia and around the world, particularly in the most vulnerable patients.
“Our findings highlight the critical need for effective genomics-based surveillance to detect emerging antimicrobial resistance. They also underscore the importance of judicious antibiotic use to safeguard vital last-resort treatments like daptomycin,” Howden concluded.
The team’s main collaborators were Bio21 Molecular Science and Biotechnology Institute; University Medical Center, Regensburg, Germany; The University of Queensland; and Flinders University, Adelaide.
VRE bacteria on a petri dish and Rifaximin antibiotics.
Dr Adrianna Turner.
How genes impact
susceptibility to infections
Researchers have uncovered a unique genetic variation that may influence how the immune system responds to infections.
As a part of an eight-year project, co-led by the Peter Doherty Institute for Infection and Immunity (Doherty Institute) and Monash University, researchers comprehensively mapped a component of natural killer cells in First Nations people.
First Nations people globally, including Aboriginal and Torres Strait Islander people, are at high risk of severe respiratory viral diseases, including COVID-19, pandemic influenza and seasonal influenza. In addition to social determinants of health, genetic variations within immune cells may contribute to the increased risk.
Natural killer cells are part of the body’s first line of defence against viral intruders, which can restrict viruses from replicating in the earliest stages of infection. This is crucial because they can either eliminate low level infection completely or buy time for the generation of virus-specific immunity. Consequently, these immune cells play a key role in an individual’s ability to both prevent infection and recover from a virus.
Findings from this study, done in partnership with Menzies School of Health Research (Northern Territory), the University of Colorado and Stanford University, could guide the development of new vaccines and immunotherapies to ensure they work effectively across diverse populations.
A highly variable natural killer cell receptor
The University of Melbourne’s Professor Katherine Kedzierska, Head of the Human T
Cell Laboratory at the Doherty Institute and co-senior author of the paper, has been coleading the research since 2016.
“We focused our research on the origin, distribution and functions of killer cell immunoglobulin-like receptors in First Nations people, as these receptors are crucial components that direct immune responses following viral infections,” Kedzierska said.
Specifically, the study examined a highly variable natural killer cell receptor, called KIR3DL1, of which there are over 200 forms in humans, capable of binding to subsets of a person’s human leukocyte antigens (HLA) molecules, which present viral peptides for recognition by immune cells, and are themselves highly variable.
Dr Camilla Faoro, co-first author of the study from Monash University, used the Australian Synchrotron to provide detailed structural insights into the impact of killer cell immunoglobulin-like receptors found in First Nations Peoples at the molecular level.
“We have shown how the Indigenous and Māori forms of KIR3DL1 interact with the most common HLA molecules in Oceania, which explains why they bind more tightly than the KIR3DL1 forms predominant in other parts of the world,” Faoro said.
“This tighter binding changes the capacity of natural killer cells to sense and respond to infection.”
Reducing disparities in outcomes
Critically, the team identified an ancient variant of the natural killer receptor that appears to be exclusive to the people of
Oceania, binding more strongly to the HLA variants that are common to Oceanic peoples, Kedzierska said.
“Our analyses of over 1300 individuals revealed that the frequency of this Oceanic variant was as high as 28% among highland Papuans and around 6% in First Nations people from Northern Australia, which could influence susceptibility to infection,” she said.
She noted that genetic and immunological studies often do not involve First Nations and other minority populations around the world.
“Recent studies including this one, underscore the importance of inclusively working with First Nations peoples. Our learnings may inform the design of new vaccines or vaccine regimens and immunotherapies, helping to ensure these agents are effective for the broad sweep of human populations,” she said.
The University of Melbourne’s Professor Andrew Brooks, Head of the Natural Killer Cell Laboratory at the Doherty Institute and a cosenior author of the paper, said the extent to which natural killer cells can respond to viral infections and cancer is dictated by these genes, which are among the most variable in the human genome.
“At a global level, genetic differences contribute to population-specific immune variation, so gaining insights into these differences is important for both addressing and reducing disparities in health outcomes,” Brooks said.
“An understanding of this diversity is key not only to explain why responses to viral infections differ from person to person, but it may also allow us to identify individuals and/or populations at higher risk of severe disease.”
Elevate your healthcare career with postgraduate study
Whether you’re a nurse or a CEO, the University of Tasmania can help you to develop the leadership, clinical, and critical thinking skills you need to make a real impact, no matter your role in the healthcare sector.
Our postgraduate health courses are designed with busy health professionals in mind, with flexible, online study options, and partner scholarships available, so you can advance your career, fulfil your professional development requirements, and lead change in your sector.
Confidence to climb the career ladder
grow my skills and capabilities. This in turn provided me with more confidence and tools to become a more effective leader.”
Learn to transform healthcare from within
importance of lifelong learning and shares her experiences to inspire others.
Finding flexibility and friendship
As a Nurse Manager of Professional Practice at Gold Coast Health, Catherine was driven by a desire to formalise and deepen her understanding of healthcare redesign.
“I had been considering postgraduate studies for a while but hadn’t found a program that truly resonated with me until I discovered the University of Tasmania’s Master of Healthcare Redesign,” she said.
Adelaide nurse and clinical educator Claire Webber studied her Master of Clinical Nursing entirely online through the University of Tasmania. And she forged such close bonds with her fellow students that she flew to Tasmania for her graduation, so she could share the day with them in person.
Moira Finch was able to take on her dream job as a hospital CEO thanks to her postgraduate degree at the University of Tasmania and a Ramsay Health Care Scholarship.
Moira has worked at the Port Macquarie Private Hospital for over a decade and had reached the level of Allied Health Manager when she started her degree in Health and Human Services, during what turned out to be a challenging time in her industry.
“I really required the extra boost to move to a new level of corporate management,” she said. After graduating, Moira made the leap to become CEO of Port Macquarie Private Hospital.
“Completing the postgraduate degree at the University of Tasmania allowed me to
Despite the demands of balancing university, work, and personal life, she found the intellectual stimulation incredibly rewarding.
And a 50% fee waiver — thanks to a partnership between Gold Coast Health and the University — also made a big difference.
“The opportunity to explore new topics and perspectives has been a highlight,” she said.
The emphasis on redesign strategies was one of the most valuable aspects of Catherine’s studies, and her understanding of global health systems, policy, and political influences was also invaluable.
“This broader perspective has allowed me to see healthcare in a more holistic way.”
Now, as a lecturer to emerging nurse leaders, Catherine emphasises the
Working in the paediatric and neonatal wards at the Women’s and Children’s Hospital in Adelaide, she was looking for a master’s degree to further boost her expertise when a colleague suggested the University of Tasmania.
As a mum to a young family, as well as a full-time nurse and educator, the flexible, online options were a huge benefit for Claire.
“And for my Master of Clinical Nursing, the University of Tasmania had exactly the specialisation I needed — neonatal intensive and special care — so it was a perfect match to my needs.”
As a clinical educator, Claire continues to share her expertise with new generations of undergraduate nursing students.
Enhance your skills and improve patient care with postgraduate courses at the University of Tasmania and study online, at your own pace.
» For more information about University of Tasmania, visit www.utas.edu.au
Featured Products
Watch alarm
The LiveLife 4G Watch Alarm is designed to fit into the wearer’s daily life, offering discreet support and peace of mind with a modern look.
With all the features of the company’s popular pendant, the watch keeps the wearer connected when they are out in the community, not just at home.
In the event of an emergency or fall, the watch will send an SMS to the elected contacts, alerting them of the event, showing their location on Google Maps. The alarm then starts the call sequence and when an emergency contact answers, the wearer can talk hands-free through the watch.
The alarm can be programmed to contact family and friends or the LiveLife A1 graded 24/7 monitoring centre. With no lock-in contracts, the monitoring options are flexible, allowing customers to switch between service models as their situation changes, for a month or as long as required.
Features include fall detection, GPS location technology and showerproof design. The device is equipped with geofencing technology, allowing the creation of a geographical ‘safe zone’. When enabled, the alarm sends an alert to the first emergency contact if the wearer leaves the predefined area.
Daily reminders can be programmed into the watch for medication and activities. The voice prompts talk the wearers through the activation process and are available in seven languages. Like a smartwatch, it includes a step counter that tracks daily steps, distance and calories burned, and a heart rate monitor for real-time measurements.
LiveLife Alarms livelifealarms.com.au
AI-powered clinical assistant
The Zetaris AI Clinical Assistant automates the use of patient data for faster detection, diagnosis and treatment.
The tool uses data-driven agentic RAG technology (advanced technology for mature AI) to automate routine tasks and help healthcare providers deliver a more accurate and faster service to help save lives and improve healthcare patient outcomes.
Secure historical patient healthcare records and healthcare systems data are combined in Zetaris to power the brain for the AI Clinical Assistant, so medical teams do not have to search, retrieve and analyse data manually. For example, a patient presenting to an emergency department who has a history of cardiac issues can have heart rate, blood oxygen, blood pressure and other measures taken. Clinicians may also collect unstructured information such as a patient’s recent travel history. The AI Clinical Assistant will retrieve the patient’s medical history and bring all this information together to support clinicians as they conduct triage and determine a course of action.
Zetaris www.zetaris.com
Vaccine refrigerator with UPS battery backup
PSS Distributors has partnered with medical coldstorage manufacturer Vacc-Safe to introduce Vacc-Safe PowerGuard, a vaccine refrigerator with an integrated UPS battery backup. This helps keep vaccines stored under optimal conditions — even during power outages — meeting stringent government regulations.
The integration of a backup battery into a vaccinesafe refrigerator provides peace of mind to healthcare providers, keeping vaccines effective and safe for use even in the event of a power failure. It also reduces the hassle of having to buy and install a separate backup battery. In accordance with government regulations, all vaccines must be stored in a purpose-built vaccine refrigerator that is data-logged and reviewed at least weekly.
The vaccine refrigerator includes continuous data logging and weekly datareporting capabilities, as well as a streamlined high-precision temperature control and all-in-one design that eliminates the need to have a separate refrigerator and bulky UPS battery backup system.
PSS Distributors www.pssdistributors.com.au
Single-use scopes
The Ambu aScope 5 Uretero, the newest addition to the company’s single-use scopes portfolio, is designed to offer sharp vision and precise control, making it suitable for both routine and complex urological procedures.
The company offers a range of single-use medical devices within endoscopy, anaesthesia and patient monitoring. The products are designed to optimise workflows, save lives and improve patient care through intelligent, functional solutions.
aScope 5 Uretero has high-resolution imaging with adaptive light control for optimised clarity, which makes it easy to detect stone fragments. Ambu’s Advanced Red Contrast (ARC) enhances the visibility of red tones without distorting the natural appearance of the image, helping clinicians better detect stone fragments or other abnormalities.
Designed to access difficult-to-reach areas, aScope 5 Uretero has direct 1:1 torque transmission, offering control of the endoscope tip during navigation through challenging anatomy. Its 7.9 FR tip is tapered to ease insertion, and the 3.6 Fr working channel is compatible with stone removal devices, lasers, guidewires and biopsy forceps. Its bending capabilities make it suitable for accessing difficult areas like the lower pole calyces. These features allow clinicians to perform a wide range of procedures with confidence and accuracy.
With the company’s commitment to sustainability, aScope 5 Uretero handles are made from bioplastics — a plastic made from 50% second-generation bio-based feedstock, blended with 50% fossil-based raw materials. This material offers the possibility of repurposing organic waste associated with food and agriculture production.
For more information, visit www.ambuaustralia.com.au or call 1300 233 118.
Ambu Australia Pty. Ltd www.ambuaustralia.com.au
Featured Products
Digital microscope
The ZEISS ARTEVO 800 is an integrated digital microscope that allows for complete heads-up surgery, eliminating the need to look through the oculars of an analog microscope.
The product, developed in close collaboration with ophthalmic surgeons, allows users to make immediate decisions based on real-time data. With ZEISS ARTEVO 800 with Hybrid Mode, surgeries can be viewed using the 3D image on the screen or through the oculars. The operating team can continue to view the image and data on the 55″ monitor.
AdVision places essential data where it is needed: into the view of the surgeon, without blocking the surgical field. Users can see intraoperative OCT imaging, cataract assistance functions, phaco vitrectomy values and patient identification.
The AutoAdjust feature is designed to follow the surgeon’s workflow and automatically adjusts settings without additional interaction — for example, when switching between anterior and posterior segments. Cloud connectivity allows surgeons to access essential information no matter where they are — and when they want.
ZEISS Group www.zeiss.com.au
Airway clearance device
The LifeVac is an ARTG reviewed and listed medical device for the removal of airway obstructions (both solid and liquid). The device is indicated for use after the failure of first aid measures or primarily where they cannot be applied due to the resident’s frailty and/or position.
A patented one-way valve assembly helps to prevent obstructions from being pushed further down the airway. The non-invasive, hand-operated, single-patient device is supplied with a range of masks to fit all facial sizes.
LifeVac Australia www.lifevac.net.au
Single-use bronchoscopes
The Ambu aScope 5 Broncho combines the manoeuvrability and imaging needed in a bronchoscopy suite with the sterility and efficiency of the single-use concept.
The aScope 5 Broncho HD 5.6/2.8 and 5.0/2.2 endoscopes are designed to offer manoeuvrability, even when working with endotherapy instruments, including highfrequency tools. This, combined with a bright and clear image, makes them suitable for a wide range of diagnostic and therapeutic procedures.
Whether it’s diagnostic or therapeutic procedures, access to peripheral airways or a patient with a smaller anatomy, with aScope 5 Broncho the solution needed is available.
The aScope 5 Broncho 4.2/2.2 offers users an opportunity to take advantage of a regularsized working channel in a thin bronchoscope. The thin size and high bending angles of 210°/210° enable manoeuvrability. Additionally, it is compatible with commonly used endotherapy instruments and active tools.
aScope 5 Broncho includes a variety of sterile bronchoscopes, an integrated sampling solution and an all-in-one displaying and processing unit. The single-use Ambu aScope 5 Broncho Sampler Set is an integrated sampling solution that protects the sample, simplifies workflow and improves safety. It includes a 60 ml sample container to address the need for larger samples in BAL procedures. By the end of 2024, all Ambu endoscopes will have handles made from bioplastics — a plastic made from 50% second-generation bio-based feedstock, blended with 50% fossil-based raw materials. This material offers the possibility of repurposing organic waste associated with food and agriculture production.
The Ambu range of single use endoscope products provides a solution for all bronchoscopy needs: Vivasight 2 DLT for One Lung Ventilation, aScope 4 Broncho for therapeutic procedures and aScope 5 Broncho for advanced therapeutic and diagnostic procedures in the bronchoscopy suite.
For more information, visit www.ambuaustralia.com.au or call 1300 233 118.
Ambu Australia Pty. Ltd www.ambuaustralia.com.au
Vertical integration — a threat to patient care?
Are virtual hospitals the answer to our overwhelmed health system? While they sure have a role in the future of healthcare, the road to delivering on the promise of care at home is not without challenges.
In 2030, around 350,000 patients who would otherwise be admitted to a traditional hospital could receive hospital care in their home, saving up to $1bn in costs. This is according to new KPMG report, commissioned by Medibank.
The report examines the potential economic benefits of expanding hospital care in the home, with up to 30% of conditions potentially able to be treated at home.
Medibank CEO David Koczkar welcomed the report, which responds to calls from patients for more ‘in home’ care and comes as the health company calls for a system-wide shift to support the sustainability of the health system.
“Australia is currently over-reliant on traditional inpatient care settings at the expense of access and choice for patients. There is a health transition underway and we are trailing behind many other countries when it comes to the uptake of more fit-for purpose and economically sustainable models of care,” Koczkar said.
Futureproofing the system
Dr Craig Emerson, consulting economist to KPMG, said the report suggests the impact of home hospitals could be transformative for the health sector.
“Public hospitals are currently grappling with ambulance ramping, bed block and an overstretched health workforce. These challenges will only compound in the future, with health the area of government spending set to increase the most over the next 40 years,” Emerson said.
“By 2030, 350,000 patients could be treated in the home instead of a traditional hospital bed. We need to make changes now to futureproof our healthcare system; hospital beds in the home play an important part.”
The report states that Australia has been slow to adopt these models of care, pointing to limited examples such as The Alfred (Victoria), rpavirtual (NSW) and My Home Hospital (South Australia). The report includes a deep dive analysis of the My Home Hospital service, which is delivered through a joint venture between Medibank’s Amplar Health and Calvary Health Care on behalf of SA Health.
More than 15,000 public patients from Adelaide and surrounding areas have used the My Home Hospital service since it started in 2021, saving more than 69,000 physical hospital beds in the process. The community has embraced the service, with admissions growing and patient satisfaction sitting at around 98%.
A threat to patient care?
The Australian Private Hospitals Association (APHA) has warned that private health insurers’ push for vertical integration is a threat to patient care.
These are almost exclusively services the insurers provide themselves, and they seldom recognise or pay for anyone else providing them, the APHA said in a statement.
“Insurance companies determining clinical needs based on what they’re prepared to pay. Yeah, nah… that’s not why anyone takes out private health insurance,” said APHA CEO Brett Heffernan.
“Australians’ bulldust barometers are welltuned. Care outside of a hospital is something private hospitals are perfectly positioned to provide, complementing the high-quality care patients expect inside the hospital setting.
“The two go hand in hand and can be complementary depending on patient needs. This continuum of care can be critical to patient wellbeing.
“But when insurance companies refuse to pay for the same services other than the ones they run, you’d be excused for being a tad dubious about the standard of care you’re getting.
“When insurance companies seek to justify their forays into clinical service provision based on cost savings, be alarmed. The growth of vertical integration by health insurers is a threat to clinician autonomy. The only people who should be making decisions about what care a patient receives and where that care is delivered is the doctor and their patient.
“Private health insurers have embraced hospital in the home as a model that allows them to monopolise patient care and take the decision-making away from clinicians. Often
they will only fund a hospital in the home or other innovative program if, lo and behold, they are also delivering it.
“APHA is calling for alternative funding options in private psychiatric and private rehabilitation hospitals. A default benefit in those settings would give patients more options for their care and access to innovative programs developed by the hospital for their patients in their own homes.”
Innovation vs funding models
Last year the Australian Medical Association (AMA) released a report warning that Australia could be heading towards a USstyle managed care health system if health insurance companies continue their push for vertical integration.
“It said about 40% of patients are missing out on access to out-of-hospital services, in large part because the funding models don’t support the innovation we know exists in the private hospital sector,” Heffernan said.
“It also highlighted the danger that vertical integration is leading to outcomes that are not in patients’ best interests.
“In the end, this is about large health insurers adding to their ever-expanding coffers by effectively paying themselves to provide cutcost care. Health funds are sitting on billions of dollars of skyrocketing profits. This pitch for even more cash serves only benefit them and stands to fail patients completely.”
Cancer recurrence anxiety: clinical pathway for health professionals
Supporting people with fear of cancer recurrence is a critical yet frequently overlooked aspect of cancer care. A new industry-university partnership is set to change that.
An estimated 60% of people affected by cancer experience moderate to severe anxiety that cancer could return or worsen.
Now, a multidisciplinary team, led by researchers from the Daffodil Centre, a joint venture between the University of Sydney and Cancer Council NSW, has developed the clinical pathway for health professionals to identify and support those experiencing fear of cancer recurrence, which is often a key factor in the wellbeing of people living with and beyond cancer.
The team has developed a three-step plan to support those burdened by the intense fear of cancer returning. This plan offers a consistent, streamlined approach to managing recurrence anxiety, empowering patients to regain confidence and move forward with their lives.
Associate Professor Ben Smith, Cancer Institute NSW Career Development Fellow and Senior Implementation Scientist at the Daffodil Centre, University of Sydney, said that finishing treatment and getting the “all clear” is a major milestone for people with cancer. While many people think that they ‘should’ feel happy or relieved after treatment, they often don’t.
“People fear that cancer will return,” said Smith, who led the development of the new plan. “This could be an occasional fleeting thought, through to more serious fear and anxiety that happens every day. Every ache, pain or wait for scan results, can trigger concerns about cancer coming back, known as ‘fear of cancer recurrence’. If not addressed, these worries can lead to isolation, anxiety and difficulty planning for the future.”
Ocular Melanoma patient Michelle Taylor said, “I liken my fear of recurrence with waiting for a guillotine to fall. Unless something scientifically changes, I will never be ‘in remission’ because ocular melanoma can reoccur at any time, and 50% of patients will metastasize. My genetic test results revealed that I have a high risk of metastasis, so may the odds be forever in my favour. More than eight years later, and so far, so good.”
To address this fear, the team worked with almost 100 health professionals and researchers to create a pathway comprising three key steps.
The process begins with screening, where individuals are asked about their worries related to cancer recurrence. The next step is assessment, which involves: gauging the severity of the patient’s concerns and exploring treatment options; the final step is a stepped-care approach that provides staged and tailored support — starting with normalising concerns around recurrence and offering key information on recurrence risks and symptoms, then offering support online or from others affected by cancer, or treatment from a mental health specialist to those who need it.
“With Australia’s aging population and estimates of over one million people currently living with or beyond a cancer diagnosis, there is a growing group of people facing fear of recurrence. If left unaddressed, we know these fears can endure for many years and can lead to other mental health issues, such as anxiety and depression. If we don’t address this issue now, it will continue to grow, potentially overwhelming a system that is already struggling to meet the demand for specialist mental health care. By implementing this plan, we will be able to respond to fears early and address them efficiently before reaching crisis point,” Smith said.
Treating unexplained infertility
New evidence-based guidelines hope to enable health professionals to better inform people affected by unexplained infertility and increase the chances of pregnancy.
Up to 30% of infertile heterosexual couples are affected by ‘unexplained’ infertility, which cannot be assigned a direct cause.
The diagnosis is made when no abnormalities of the female or male reproductive systems are clearly identified, mostly by excluding possible causes such as the absence of ovulation or low sperm count.
The Centre for Research Excellence in Women’s Health in Reproductive Life (CRE WHiRL), which is administered by Monash University, partnered with the European Society of Human Reproduction and Embryology (ESHRE) in developing the international guidelines, then engaged Australian experts and consumers to adapt these for use in Australia.
New evidence-based recommendations
Led by experts at the University of Adelaide, UNSW Sydney and Monash University, the Australian guideline has been published in the Medical Journal of Australia alongside the launch of consumer resources including a new Monash Ask Fertility App.
The Australian Evidence-based Guideline for Unexplained Infertility: Adapted from the ESHRE Evidence-based Guideline for Unexplained Infertility was developed in response to a priority from the state and federal governments with growing concern about evidence-based practice in the fertility industry, and an increasing cost to government and consumers.
The adapted guideline is approved by NHMRC and endorsed by the Royal Australian and New Zealand College
of Obstetricians and Gynaecologists (RANZCOG) and the Fertility Society of Australia and New Zealand (FSANZ).
It advances understanding of infertility prognosis and treatment and has new evidence-based recommendations so that women and their partners can make informed decisions and avoid expensive, ineffective or unproven treatments.
Consumers, including Indigenous and women from culturally and linguistically diverse (CALD) backgrounds, have been engaged in guideline development and translation. CRE WHiRL is led by Monash University’s Professor Helena Teede, who joined the University of Adelaide’s Professor Robert Norman and
UNSW Sydney’s Dr Michael Costello as the experts leading the guideline.
Teede said the guideline was developed using the most robust processes, involved all stakeholders including those with lived experience of infertility, and was approved by the NHMRC, so the community could be reassured it was trustworthy.
“Unexplained infertility greatly impacts quality of life, and it is important to ensure those affected receive the best advice and care for optimal outcomes, whilst avoiding rapidly rising use of often unproven treatments, increasing costs and inequity seen in Australia for those with unexplained infertility,” Teede said.
Streamline, simplify treatments
“This new guideline will help to streamline and simplify treatments, potentially reducing cost and increasing equity, by avoiding complex testing and treatments that were not necessarily evidence-based. The guideline’s evidence-based advice will play an important role in improving health outcomes for those with unexplained infertility and is adapted for the Australian health system and context,” Norman said.
Infertility is defined as the inability to achieve pregnancy after 12 months of regular unprotected intercourse and affects around 15% of couples. It is increasing due
to ecosocial factors including advancing maternal age and rising weight, both of which adversely affect fertility.
“This year, IVF is estimated to cost the government $500 million through Medicare, with another $200 million at a cost for consumers in out-of-pocket expenses. If fully implemented, this guideline could potentially save more than $100 million in unnecessary health procedure costs annually, while maintaining current pregnancy chances and widening access to treatment,” Norman said.
Costello said that, until now, this had been compounded by a lack of evidence-based guidelines and limited independent consumer information and empowerment strategies.
“The guideline aims to assist healthcare professionals and couples in appropriate and effective management of the condition, acknowledging that each medical decision must consider individual characteristics, preferences, socioeconomic status, beliefs and values.”
“The ESHRE and Australian guideline uses the best available scientific evidence to guide health professionals in diagnosing and treating those with unexplained infertility,” he said.
Effective management of the condition
The guideline outlines the definition of unexplained infertility, diagnostic tests, treatments and differences between explained and unexplained infertility.
It is aimed at but not limited to general practitioners, gynaecologists, andrologists, infertility specialists, reproductive surgeons and those with unexplained infertility.
“The guideline aims to assist healthcare professionals and couples in appropriate and effective management of the condition, acknowledging that each medical decision must consider individual characteristics, preferences, socioeconomic status, beliefs and values,” Costello said.
“It should also be acknowledged that couples with unexplained infertility may experience considerable impact on their quality of life and they can be offered support and therapeutic counselling.”
New research from Macquarie University could make effective interventions for managing low back pain accessible to more people.
About four million Australians — and 800 million people worldwide — have low back pain, which is a leading cause of disability and reduced quality of life. Around seven in 10 people who recover from an episode go on to have a recurrence within a year.
Now, a new study by Spinal Pain Research Group at Macquarie University has found that adults with a history of low back pain lasted nearly twice as long without a recurrence if they walked regularly.
From treatment to prevention
Professor of Physiotherapy Mark Hancock* and his research team have been investigating ways to shift the emphasis from treatment to prevention to improve the management of back pain, an approach that empowers individuals to manage their own health and reduces the cost to society and the healthcare system.
Far from the bed rest recommended for back pain in the past, current best practice includes the combination of exercise and education, both to treat current pain and to prevent future episodes.
While beneficial, some forms of exercise are not accessible or affordable to many people due to their high cost, complexity and need for supervision.
The WalkBack trial
The WalkBack trial followed 701 adults who had recently recovered from an episode of low back pain, randomly allocating participants to either an individualised walking program facilitated by a physiotherapist and six education sessions across six months, or to a no-intervention control group.
The trial examined whether a program of walking combined with education could be effective in preventing recurrences of low back pain. The participants’ progress was followed for between one and three years to collect information about any new recurrences of low back pain they experienced.
The researchers’ primary aim was to compare the two groups for the number of days before participants experienced a recurrence of back pain that impacted daily activities or required care from a healthcare provider. They also evaluated the cost-effectiveness of the intervention, including costs related to work absenteeism and healthcare services.
The findings have now been published in the latest edition of the international medical journal The Lancet
Longer pain-free periods
What the researchers discovered could have a profound impact on how low back pain is managed, said the paper’s senior author Hancock.
“The intervention group had fewer occurrences of activity-limiting pain compared to the control group, and a longer average period before they had a recurrence, with a median of 208 days compared to 112 days,” Hancock said.
“The risk of having a recurrence that required seeking care was nearly halved in those in the intervention group.
“Walking is a low-cost, widely accessible and simple exercise that almost anyone can engage in, regardless of age, geographic location or socio-economic status.
“We don’t know exactly why walking is so good for preventing back pain, but it is likely to include the combination of gentle oscillatory movements, loading and strengthening the spinal structures and muscles, relaxation and stress relief, and the release of ‘feel-good’ endorphins.
“And of course, we also know that walking comes with many other health benefits, including cardiovascular health, improved bone density, maintenance of a healthy weight and improved mental health.”
The amount of walking each person completed was individualised based on a range of factors including their age, physical capacity, preferences and available time. Participants were given a rough guide to build up to 30 minutes, five times a week over a six-month period, Hancock said. After three months, most of the people who took part were walking three to five days a week for an average of 130 minutes.
“You don’t need to be walking five or 10 kilometres every day to get these benefits," Hancock said.
A simple, cost-effective option
The paper’s lead author, Postdoctoral Fellow Dr Natasha Pocovi*, said in addition to providing participants with longer pain-free periods, they found the program was also cost effective.
“It not only improved people’s quality of life, but it reduced their need both to seek healthcare support and the amount of time taken off work by approximately half,” Pocovi said.
“The exercise-based interventions to prevent back pain that have been explored previously are typically group-based and need close clinical supervision and expensive equipment, so they are much less accessible to the majority of patients.
“Our study has shown that this effective and accessible means of exercise has the potential to be successfully implemented on a much larger scale than other forms of exercise.”
To build on these findings, the team now hopes to explore how they can integrate the preventive approach into the routine care of patients who experience recurrent low back pain.
*Professor Mark Hancock is a Professor of Physiotherapy in the Department of Health Sciences at Macquarie University. He has more than 20 years of experience as a musculoskeletal physiotherapist in a clinical setting.
*Dr Natasha Pocovi is a registered physiotherapist and Postdoctoral Fellow in the Department of Health Sciences at Macquarie University.
In Conversation
with Gregory Garcia
Amy Sarcevic
Gregory Garcia* is a cybersecurity specialist and the Executive Director of the Health Sector Coordinating Council Cybersecurity Working Group. As the nature of cybersecurity risks continues to evolve, how is the US health sector tackling risks? What could Australia learn from its approach? Read on to find out.
Gregory Garcia was once the most senior cybersecurity professional in all of the United States. Appointed by President George Bush in 2006, Garcia spent two years pre-empting and mitigating threats for the US Department of Homeland Security, where he supported the country’s critical industry sectors.
However, it was his later experience in health care that would humble him the most. Now, in a more sophisticated threat landscape, Garcia finds himself contending, daily, with the possibility of entire hospitals being seized for seven — sometimes eight — figure ransoms.
“The stakes are just so high in healthcare. And malicious actors are of course attracted to this because, when patient safety is at stake, it is more likely their financial demands will be met.
“All they have to do is hack your system, install a ransomware, and they can shut down your electronic health records, your critical software, you name it, until a hefty ransom is coughed up.”
The threat is pertinent to Garcia on a personal level, having watched close friends narrowly miss catastrophe from malicious attacks on hospitals.
Closest to home was a major ransomware attack which took down one third of America’s health care system in February 2024, at the same time his wife was receiving hospital care.
“It turned out the hospital she was attending did not use the affected software — but I didn’t know that at the time, so it was scary.
“It’s frightening when malicious actors attack systems designed to keep people safe — when cyber security crosses into the physical realm.”
With this in mind, Garcia — who is now Executive Director at the Health Sector Coordinating Council Cybersecurity Working Group — has not had time to sleep on his strategy.
“Whether it is nation states, criminal groups, or teenagers in their mum’s basement, adversaries are innovative,” he said.
“They will exploit any weakness you have — so you can’t rest.”
Whole of organisation input
One of his strategic priorities is to mobilise leaders from across the organisation, not just in IT.
“Today’s threats are a shared challenge and responsibility, which permeates into the C-suite. It is simply part of broader enterprise risk management.
“If we confine it to the IT department, we won’t be able to tackle it. It requires a wholeof-organisation input, and a security culture that trickles down from the top.”
While leaders from across the organisation might not understand the technicalities of product security features, Garcia said they can certainly demand them from technology vendors.
“At present, many vendors treat security as an add-on, sometimes charging high prices on top of the initial product cost. Too often, I see healthcare procurers turning down these addons due to resource constraints.
“But my advice is to always demand them, no matter how tight your budget. If you can’t afford product security, then you can’t afford the product.”
Cutting through the literature
A challenge in involving the broader executive team is the noisiness of the cyber security landscape.
Garcia says that, to non-specialists, the sheer volume of advice can be overwhelming, leaving leaders unclear on which direction to take.
“There are a lot of resources out there. We've published 28 guidance documents over the past eight years — and we are not the only ones. In some ways, there is just too much information.
“For health systems, whether you are a small rural clinic, or a large urban integrated system, you need to be clear on best practice.
“So, as IT leaders, we need to find ways to engage the C-suite and senior management teams. Help them understand cyber risk, so they can develop a cybersecurity, sign off on larger purchases, demand security features, and audit them for efficacy.”
A further challenge is the constantly evolving nature of cybersecurity guidance. What was best practice last week, might not hold relevance today, Garcia said.
“You can’t just get your team to do a quick course and move on. Once a cybersecurity loophole becomes known to hospital staff,
attackers know they can no longer use it, so they find and exploit another one. As a hospital leader, I’d be holding weekly meetings with staff to discuss cybersecurity.”
Government input
While measures at the organisation level can make a difference, Garcia said they are not enough. In the US, he — and other advocates — are calling for a public cyber health strategy, and encourage Australia to do the same.
“Even in a government-centric health system like Australia, this is a crucial step forward,” he said.
Additionally, countries will need to build resilience in their international supply chains, whether though market influence or reach.
“In the US, we are still shoring up our operational security at a domestic level, but a coherent, sector-wide approach is something we are working towards. I recommend Australia keeps up with its work in this space too.”
*Gregory Garcia recently presented at The Australia Centre for Value-Based Health Care’s event on cyber safety, organised in collaboration with CyberCX. The Centre is part of the Australian Healthcare and Hospital Association (AHHA).
Paediatric critical care
and future demand management
The Children’s Hospital at Westmead (CHW) has deployed a new tool developed by the Sax Institute to simulate patient flows at the Paediatric Intensive Care Unit (PICU).
The tool is designed to assist in prediction and management of future demand for state-level services requiring paediatric critical care admission in NSW, including for cardiac patients.
“With the high number of patients needing the PICU, we weren’t always able to ensure a bed was available for cardiac patients needing intensive postoperative care. This created challenges for us in ensuring surgery could go ahead as originally planned,” said Dr Marino Festa, senior staff specialist and co-lead for Kids Critical Care Research at The Children’s Hospital at Westmead.
“We started to wonder how we could reconfigure resources to address these challenges and minimise impact on our families, as well as our staff.”
Tackling challenges, minimising impact on families
One of the ideas, Festa said, was to ringfence beds in the PICU for cardiac patients, but the team wondered what effect that would have for cardiac patients as well as all other patients needing admission to the unit.
Festa and team were aware of the use of modelling in adult ICUs, particularly during COVID, so they understood its potential for PICU. “But we needed more granularity, particularly around the staffing needed and the specialist nurses needed to manage care in PICU.”
With funding support from Hearts and Minds Investments charity, the team worked closely with the Sax Institute to develop modelling using six years of data on patients who had come through the PICU — their diagnoses, the therapies and complex support they needed, the chance of surgery being cancelled for particular types of patients, the duration of treatment, staffing needs and more in order to fully map the patient journey through the care process.
This type of modelling, known as discrete event simulation (DES) modelling, provides insights into complex systems and identifies where to best target efforts to improve outcomes.
“We wanted to know whether the modelling could replicate a fictitious year that would reflect what we saw in the previous six years. We got a very accurate model that was immediately helpful,” Festa said.
A strategic health service planning solution
“It was great to see we could create a model that reflected reality, which meant we had a safe way of testing new ideas or system changes without the risks of having to implement them in real life. The model showed us the overall impact of ringfencing beds just for cardiac patients and helped us decide this was probably not the most effective way to use our current resources.”
A new, larger PICU is being built at Westmead, and a new phase of the Sax Institute modelling will be used to study the impact of increasing bed numbers and creating subspecialty care areas for cardiac and other patient groups, Festa said.
“What modelling has given us is the ability to see the whole system more clearly and the overall effect of inflows and outflows of patients, which is not always so easy when you’re working at the coalface. It’s also given us a shared language and objectivity that we can use with clinicians, heads of departments and the Ministry of Health to better understand the benefits of adding resources and getting the best outcomes in the most efficient way.”
This project not only showcases the successful application of simulation in tackling real-world healthcare management problems but also sets a precedent for employing DES as a strategic tool in health service planning.
Building on this success, The Sax Institute plans to use the same process to create models for entire hospital facilities, aiming to develop a hospital ‘digital twin’ which will optimise hospital operations and improve patient care outcomes.
